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TEMPE UNION HIGH SCHOOL DISTRICT NOTICE OF REQUEST FOR PROPOSAL

RFP #17-016

MATERIAL AND/OR SERVICE: Medical Claims Administration, Network, EAP Services

Due Date: December 14, 2016 Time: 2:00 PM

Opening Location: TEMPE UNION HIGH SCHOOL DISTRICT 500 WEST GUADALUPE Road Tempe, AZ, 85283

In accordance with School District Procurement Rules in the Arizona Administrative Code (A.A.C.) promulgated by the State Board of Education pursuant to A.R.S. 15-213, Proposals for the material or services specified will be received by the Tempe Union High School District at the above specified location, until the time and date cited. Proposals received by the correct time and date shall be opened and only the name of the Offerors shall be publicly read and recorded. All other information contained in the Proposal shall remain confidential until award is made. If you need directions to our office, please call 480-839-0292.

Proposals shall be in the actual possession of the District, at the location indicated, on or prior to the exact time and date indicated above. Late Proposals shall not be considered. The official time will be determined by the clock designated by the school district.

Proposals must be submitted in a sealed envelope with the solicitation number and Offeror’s name and address clearly indicated on the envelope. All Proposals must be written legibly in ink or typewritten. Additional instructions for preparing a Proposal are provided herein.

OFFERORS ARE STRONGLY ENCOURAGED TO CAREFULLY READ THE ENTIRE REQUEST FOR PROPOSAL.

____________________________________________Name: Peggy A. Ferrin, CPPBDate: November 21, 2016Phone: 480 345-3725Fax: 480 345-3441Email: [email protected]

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Tempe Union High School Table of Contents

500 West Guadalupe RdTempe, Arizona 85283

Table of Contents

Section Page

Uniform Instruction to Offerors......................................................................................................................................3

Uniform General Terms and Conditions.........................................................................................................................9

Special Instructions, Terms and Conditions.................................................................................................................17

Specifications/Scope of Work ......................................................................................................................................22

Proposal Submittals.......................................................................................................................................................29

Questionnaire................................................................................................................................................................31

Attachments .................................................................................................................................................................58

Proposal and Acceptance Form.....................................................................................................................................60

Statement of Bid/No Bid...............................................................................................................................................61

Confidentiality Agreement............................................................................................................................................62

Confidential/Proprietary Submittals..............................................................................................................................64

Deviations and Exceptions............................................................................................................................................65

Additional Materials Submittal ....................................................................................................................................66

Acknowledgement of Amendment...............................................................................................................................67

Non-Collusion Statement..............................................................................................................................................68

I.R.S. W-9 Form............................................................................................................................................................69

DOCUMENTS REFERENCED:

You may access a copy of the documents referenced within this Proposal at the following web addresses:

Arizona Revised Statutes (A.R.S.) is available at: http://www.azleg.state.az.us/ArizonaRevisedStatutes.asp

The Arizona School District Procurement Rules in the Arizona Administrative Code is available at:http://azsos.gov/public_services/Title_07/7-02.htm#Article_10

I.R.S W-9 Form (Request for Taxpayer I.D. Number) is available at: http://www.irs.gov/pub/irs-pdf/fw9.pdf

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Tempe Union High School Uniform Instructions to Offerors


UNIFORM INSTRUCTIONS TO OFFERORS

1. Definition of Terms

In addition to the definitions specified in Arizona Administrative Code R7-2-1001, the terms listed below are defined as follows:

A. “Attachment” means any item the Solicitation requires an Offeror to submit as part of the Proposal.

B. “Contract Amendment” means a written document signed by the School District/Public Entity that is issued for the purpose of making changes in the Contract.

C. “Exhibit” means any item labeled as an Exhibit in the Solicitation or placed in the Exhibits section of the solicitation.

D. “Gratuity” means a payment, loan, subscription, advance, deposit of money, services, or anything of more than nominal value present or promised, unless consideration of substantially equal or greater value is received.

E. “Procurement Officer” means the person duly authorized to enter into and administer Contracts and make written determinations with respect to this solicitation or his/ her designee.

F. “Solicitation Amendment” means a written document that is authorized by the Procurement Officer and issued for the purpose of making changes to the Solicitation.

G. “Subcontract” means any Contract, express or implied, between the Contractor and another party or between a subcontractor and another party delegating or assigning, in whole or in part, the making or furnishings of any material or any service required for the performance of the Contract.

2. Inquiries

A. Duty to Examine . It is the responsibility of each Offeror to examine the entire Solicitation, seek clarification in writing, and check its Proposal for accuracy before submitting the Proposal. Lack of care in preparing a Proposal shall not be grounds for withdrawing the Proposal after the due date and time nor shall it give rise to any Contract claim.

B. Solicitation Contact Person. Any inquiry related to a Solicitation, including any requests for or inquiries regarding standards referenced in the Solicitation shall be directed solely to the Solicitation contact person. The Offeror shall not contact or direct inquiries concerning this Solicitation to any other employee unless the Solicitation specifically identifies a person other than the Solicitation contact person as a contact.

C. Submission of Inquiries. The Procurement Officer or the person identified in the Solicitation as the contact for inquires may require that an inquiry be submitted in writing. Any inquiry related to a Solicitation shall refer to the appropriate Solicitation number, page, and paragraph. Do not place the Solicitation number on the outside of the envelope containing that inquiry since it may then be identified as an Proposal and not be opened until after the Proposal due date and time.

D. Timeliness. Any inquiry shall be submitted as soon as possible and at least seven (7) days before the Proposal due date and time. Failure to do so may result in the inquiry not being answered.

E. No Right to Rely on Verbal Responses . Any inquiry that results in changes to the Solicitation shall be answered solely through a written Solicitation Amendment. An Offeror may not rely on verbal responses to inquiries.

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F. Solicitation Amendments. The Solicitation shall only be modified by a Solicitation Amendment. Unless otherwise stated in the Solicitation, each Solicitation Amendment shall be acknowledged by the person signing the Offer. Failure to acknowledge a material Solicitation Amendment or to follow the instructions for acknowledgement of the Solicitation Amendment may result in rejection of the Offer.

G. Pre-Proposal Conference. If a Pre-Proposal Conference has been scheduled under this Solicitation, the date, time, and location appear on the Solicitation cover sheet or elsewhere in the Solicitation. An Offeror should raise any questions it may have about the Solicitation or the procurement at that time. An Offeror may not rely on any verbal responses to questions at the conference. Material issues raised at the conference that result in changes to the Solicitation shall be answered solely through a written Solicitation Amendment.

H. Persons with Disabilities. Persons with a disability may request a reasonable accommodation, such as a sign language interpreter, by contacting the appropriate Solicitation contact person. Requests shall be made as early as possible to allow time to arrange the accommodation.

3. Proposal Preparation

A. Forms. A Proposal shall be submitted either on the forms provided in this Solicitation or their substantial equivalent. Any substitute document for the forms provided in this Solicitation will be legible and contain the same information requested on the form.

B. Typed or Ink; Corrections. The Proposal should be typed or in ink. Erasures, interlineations or other modifications in the Proposal should be initialed in ink by the person signing the Proposal. Modifications shall not be permitted after Proposals have been opened except as otherwise provided under R7-2-1030.

C. Evidence of Intent to be Bound. Failure to submit verifiable evidence of intent to be bound, such as an original signature, shall result in rejection of the Proposal.

D. Exceptions to Terms and Conditions. All exceptions included with the Proposal shall be submitted in a clearly identified separate section of the Proposal in which the Offeror clearly identifies the specific paragraphs of the Solicitation where the exceptions occur. Any exceptions not included in such a section shall be without force and effect in any resulting Contract unless such exception is specifically referenced by the Procurement Officer in a written statement. The Offeror’s preprinted or standard terms will not be considered as a part of any resulting Contract. All exceptions that are contained in the Offer may negatively affect the proposal evaluation criteria as stated in the Solicitation or result in rejection of the offer.

E. Subcontracts . Offeror shall clearly list any proposed subcontractors and the subcontractor’s proposed responsibilities in the Proposal.

F. Cost of Proposal Preparation . The District will not reimburse any Offeror the cost of responding to a Solicitation.

G. Solicitation Amendments. Unless otherwise stated in the Solicitation, each Solicitation Amendment shall be acknowledged by the person signing the Proposal. Failure to acknowledge a material Solicitation Amendment or to follow the instructions for acknowledgement of the Solicitation Amendment shall result in rejection of the Proposal.

H. Federal Excise Tax . School Districts/Public Entities are exempt from Federal Excise Tax on manufactured goods. Exemption Certificates will be prepared upon request.

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I. Provision of Tax Identification Numbers . Offerors are required to provide their Arizona Transaction Privilege Tax number and/or Federal Tax Identification number, if applicable, in the space provided on the Offer and Acceptance Form and provide the tax rate and amount, if applicable, on the Proposal Cost Sheet.

J. Identification of Taxes in Proposal. School Districts/Public Entities are subject to all applicable state and local transaction privilege taxes. If Arizona resident Offerors do not indicate taxes on a separate item in the Proposal, the School District/Public Entity will conclude that the price(s) offered includes all applicable taxes. At all times, payment of taxes and the determination of applicable taxes and rates are the sole responsibility of the Offeror.

K. Disclosure. If the Firm, business, or person submitting this Proposal has been debarred, suspended, or otherwise lawfully precluded from participating in any public procurement activity, including being disapproved as a subcontractor with any federal, state, or local government, or if any such preclusion from participation from any public procurement activity is currently pending, the Offeror must fully explain the circumstances relating to the preclusion or proposed preclusion in the Proposal. The Offeror shall include a letter with its Proposal setting forth the name and address of the governmental unit, the effective date of this suspension or debarment, the duration of the suspension or debarment, and the relevant circumstances relating the suspension or debarment. If suspension or debarment is currently pending, a detailed description of all relevant circumstances including the details enumerated above must be provided.

L. Solicitation Order of Precedence. In the event of a conflict in the provisions of this Solicitation and any subsequent contracts, the following shall prevail in the order set forth below:

1. Amendments2. Special Instructions, Terms and Conditions;3. Uniform General Terms and Conditions;4. Scope of Work/Specifications;5. Attachments;6. Exhibits;7. Uniform Instructions to Offerors

M. Delivery. Unless stated otherwise in the Solicitation, all prices shall be F.O.B. Destination and shall include all delivery and unloading at the destination(s).

4. Submission of Proposal

A. Sealed Envelope or Package. Each Proposal shall be submitted to the location identified in this Solicitation, in a sealed envelope or package that identifies its contents as a Proposal and the Solicitation number to which it responds. The appropriate Solicitation Number should be plainly marked on the outside of the envelope or package.

B. Electronic Submission. If determined by the District that electronic submission of proposals is advantageous, the District will include the electronic submission requirements as well as if the electronic submission is mandatory or optional in the Special Instructions, Terms and Conditions section of the RFP. Unless otherwise instructed, a facsimile or electronically submitted Proposal shall be rejected.

C. Proposal Amendment or Withdrawal . An Offeror may modify or withdraw a Proposal in writing at any time before Proposal opening if the modification or withdrawal is received before the Proposal due data and time at the location designed in the RFP. A Proposal may not be amended or withdrawn after the Proposal due date and time except as otherwise provided under R7-2-1044.

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D. Public Record. Under applicable law, all Proposals submitted and opened are public records and must be retained by the School District/Public Entity. Proposals shall be open to public inspection after Contract award, except for such Proposals deemed to be confidential by the School District/Public Entity pursuant to R7-2-1006. If an Offeror believes that information in its Proposal contains confidential trade secrets or other proprietary data not to be disclosed as otherwise required by A.R.S. § 39-121, a statement advising the school district of this fact shall accompany the submission and the information shall be so identified wherever it appears. Contract terms and conditions, pricing, and information generally available to the public are not considered confidential information under this Section.

E. Non-collusion, Employment, and Services. By signing the Offer and Acceptance form or other official contract form, the Offeror certifies that:

1. The prices have been arrived at independently, without consultation, communication or Agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other Offeror or with any competitor; the prices which have been quoted have not been nor will not be disclosed directly or indirectly to any other Offeror or to any competitor; nor attempt has been made or will be made to induce any person or firm to submit or not to submit, an Offer for the purpose of restricting competition. It did not involve collusion or other anti-competitive practices in connection with the preparation or submission of its Proposal; and

2. It does not discriminate against any employee, applicant for employment, or person to whom it provides services because of race, color, religion, sex, national origin, or disability, and that it complies with all applicable federal, state, and local laws and executive orders regarding employment; and

3. By submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible or otherwise lawfully prohibited from participating in any public procurement activity, including, but not limited to, being disapproved as a subcontractor of any public procurement unit or other governmental body; and

4. By submission of this proposal, that no Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a Cooperative Agreement, and the extension, continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.

5. Additional Proposal Information

A. Unit Price Prevails. Where applicable, in the case of discrepancy between the unit price or rate and the extension of that unit price or rate, the unit price or rate shall govern.

B. Taxes. The amount of any applicable transaction privilege or use tax of a political subdivision of this state will not be a factor when determining lowest bidder.

C. Late Proposals, Modifications or Withdrawals. A Proposal, Modification or Withdrawal submitted after the exact Proposal due date and time shall not be considered except under the circumstances set forth in R7-2-1044.

D. Disqualification. A Proposal from an Offeror who is currently debarred, suspended or otherwise lawfully prohibited from any public procurement activity may be rejected.

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E. Proposal Acceptance Period. An Offeror submitting a Proposal under this Solicitation shall hold its Proposal open for the number of days that is stated in the Solicitation. If the Solicitation does not specifically state a number of days for the Proposal acceptance, the number of days shall be ninety (90).

F. Payment. Payments shall comply with the requirements of A.R.S. Titles 35 and 41, Net 30 days. Upon receipt and acceptance of goods or services, the Contractor shall submit a complete and accurate invoice for payment within thirty (30) days.

G. Waiver and Rejection Rights . Notwithstanding any other provision of this solicitation, the School District/Public Entity reserves the right to:

1. Waive any minor informality;2. Reject any and all Proposals or portions thereof; or3. Cancel a solicitation.

6. Award

A. Number or Types of Awards. Where applicable, the School District/Public Entity reserves the right to make multiple awards or to award a Contract by individual line items, by a group of line items, by an incremental award or by Region, as indicated within the Special Instructions, Terms and Conditions. The award will be limited to the least number of Offerors that the School District/Public Entity determines is necessary to meet the needs of the School District/Public Entity.

B. Contract Commencement . A Proposal does not constitute a Contract nor does it confer any rights on the Offeror to the award of a Contract. A Contract is not created until the Proposal is accepted in writing by the District/Public Entity with an authorized signature on the Offer and Acceptance Form. A letter or other notice of award or of the intent to award shall not constitute acceptance of the Proposal.

C. Effective Date. The effective date of this Contract shall be the date that the Procurement Officer signs the Proposal and Acceptance Form or other official contract form, unless another date is specifically stated in the Contract.

D. Final acceptance for each participating School District/Public Entity will be contingent upon the approval of their Governing Board, if applicable.

7. Protests

A protest shall comply with and be resolved according to Arizona Department of Education School District Procurement Code Rule A.A.C. R7-2-1141 through R7-2-1153. Protests shall be in writing and be filed with the District Representative.

A. A protest shall include:

1. The name, addresses, and telephone number of the interested party2. The signature of the interested party or the interested party's representative;3. Identification of the purchasing agency and the Solicitation or Contract number;4. A detailed statement of the legal and factual grounds of the protest including copies of relevant

documents; and 5. The form of relief requested.6. The interested party shall supply promptly any other information requested by the district

representative.

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B. Protests based upon alleged improprieties in a solicitation that are apparent before the due date and time for responses to the solicitation, shall be filed before the due date and time for responses to the solicitation.

C. In cases other than those covered in section B of this section, the interested party shall file the protest within 10 days after the school district makes the procurement file available for public instruction.

D. The interested party may file a written request for an extension of the time limit for protest filing. The written request for an extension shall be filed with the District Representative before the expiration of the time limit and shall set forth good cause as to the specific action or inaction of the school district that resulted in the interested party being unable to file the protest within the 10 days. The district representative shall approve or deny the request in writing, state the reasons for the determination, and, if an extension is granted, set forth a new date for submission of the filing.

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Tempe Union High School Uniform General Terms and Conditions 500 West Guadalupe Rd

Tempe, Arizona 85283

UNIFORM GENERAL TERMS AND CONDITIONS

1. Contract Interpretation

A. Arizona Law . The law of Arizona applies to this Contract including, where applicable, the Uniform Commercial Code as adopted by the State of Arizona and the Arizona School District Procurement Code, Arizona Revised Statutes (A.R.S.) 15-213, and its implementing rules, Arizona Administrative Code (A.A.C.) Title 7, Chapter 2, Articles 10 and 11.

B. Implied Contract Terms. Each Provision of law and any terms required by law to be in this Contract are a part of this Contract as if fully stated in it.

C. Relationship of Parties. The Contractor under this Contract is an independent Contractor. Neither party to this Contract shall be deemed to be the employee agent of the other party to the Contract.

D. Severability. The provisions of this Contract are severable. Any term or condition deemed illegal or invalid shall not affect any other term or condition of the Contract.

E. No Parol Evidence. This Contract is intended by the parties as a final and complete expression of their agreement. No course of prior dealings between the parties and no usage of the trade shall supplement or explain any terms used in this document.

F. No Waiver. Either party’s failure to insist on strict performance of any term or condition of the Contract shall not be deemed waiver of that term or condition even if the party accepting or acquiescing in the nonconforming performance knows of the nature of the performance and fails to object to it.

2. Contract Administration and Operation

A. Records. Under A.R.S. § 35-214 and § 35-215, the Contractor shall retain and shall contractually require each Subcontractor to retain all data and other records (“records”) relating to the acquisition and performance of the Contract for a period of five years after the completion of the Contract. All records shall be subject to inspection and audit at reasonable times. Upon request, the Contractor shall produce a legible copy of any or all such records.

B. Non-Discrimination. The Contractor shall comply with State Executive Order No. 99-4, 2000-4 and all other applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act.

C. Audit. Pursuant to A.R.S. § 35-214 at any time during the term of this Contract and five (5) years thereafter, the Contractor’s or any Subcontractor’s books and records shall be subject to audit by the School District/Public Entity and, where applicable, the Federal Government, the extent that the books and records relate to the performance of the Contract or Subcontract.

D. Inspection and Testing. The Contractor agrees to permit access to its facilities, Subcontractor facilities and the Contractor’s processes for producing the materials, at reasonable time for inspection of the materials and services covered under this Contract. The School District/Public Entity shall also have the right to test at its own cost the materials to be supplied under this Contract. Neither inspection at the Contractor’s facilities nor testing shall constitute final acceptance of the materials. If the School District/Public Entity determines non-compliance of the materials, the Contractor shall be responsible for the payment of all costs incurred by the School District/Public Entity for testing and inspection.

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E. Notices. Notices to the Contractor required by this Contract shall be made by the School District/Public Entity to the person indicated on the Offer and Acceptance Form submitted by the Contractor unless otherwise stated in the Contract. Notices to the School District/Public Entity required by the Contract shall be made by the Contractor to the Solicitation Contact Person indicated on the Solicitation cover sheet, unless otherwise stated in the Contract. An authorized Procurement Officer and an authorized Contractor representative may change their respective person to whom notices shall be given by written notice and an Amendment to the Contract shall not be necessary.

F. Advertising and Promotion of Contract. The Contractor shall not advertise or publish information for commercial benefit concerning this Contract without the prior written approval of the Procurement Officer.

G. Property of the School District/Public Entity. Any materials, including reports, computer programs and other deliverables, created under this Contract are the sole property of the School District/Public Entity. The Contractor is not entitled to a patent or copyright on those materials and may not transfer the patent or copyright to anyone else. The Contractor shall not use or release these materials without the prior written consent of the School District/Public Entity.

3. Costs and Payments

A. Payments. Payments shall comply with the requirements of A.R.S. Titles 35-342 and 41, Net 30 days. Upon receipt and acceptance of goods or services, the Contractor shall submit a complete and accurate invoice for payment from the School District/Public Entity within thirty (30) days. The Purchase Order number must be referenced on the invoice.

B. Applicable Taxes .

1. Payment of Taxes by the School District/Public Entity. The School District/Public Entity will pay only the rate and/or amount of taxes identified in the Proposal and in any resulting Contract.

2. State and Local Transaction Privilege Taxes. The School District/Public Entity is subject to all applicable state and local transaction privilege taxes. Transaction privilege taxes apply to the sale and are the responsibility of the seller to remit. Failure to collect taxes from the buyer does not relieve the seller from its obligation to remit taxes.

3. Tax Indemnification. Contractor and all Subcontractors shall pay all federal, state, and local taxes applicable to its operation and any persons employed by the Contractor. Contractor shall, and require all Subcontractors to hold the School District/Public Entity harmless from any responsibility for taxes, damages and interest, if applicable, contributions required under federal, and/or state and local laws and regulations and any other costs including transaction privilege taxes, unemployment compensation insurance, Social Security and Worker’s Compensation.

4. IRS W-9. In order to receive payment under any resulting Contract, Offeror shall have a current I.R.S. W-9 Form on file with the School District/Public Entity.

C. Availability of Funds for the Next Fiscal Year. Funds may not presently be available for performance under this Contract beyond the current fiscal year. No legal liability on the part of the School District/Public Entity for any payment may arise under this Contract beyond the current fiscal year until funds are made available for performance of the Contract. The School District/Public Entity will make reasonable efforts to secure such funds.

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4. Contract Changes

A. Amendments. This Contract is issued under the authority of the Procurement Officer who signed this Contract. The Contract may be modified only through a Contract Amendment within the scope of the Contract signed by the Procurement Officer. Changes to the Contract, including the addition of work or materials, the revision of payment terms, or the substitution of work or materials, directed by an unauthorized employee or made unilaterally by the Contractor are violations or the Contract and or applicable law. Such changes, including unauthorized written Contract Amendments, shall be void and without effect, and the Contractor shall not be entitled to any claim and this Contract based on those changes.

B. Subcontracts. The Contractor shall not enter into any Subcontract under this Contract without the advance written approval of the Procurement Officer. The Subcontract shall incorporate by reference the terms and conditions of this Contract.

C. Assignment and Delegation. The Contractor shall not assign any right nor delegate any duty under this Contract without the prior written approval of the Procurement Officer. The Procurement Officer shall not unreasonably withhold approval.

5. Risk and Liability

A. Risk of Loss. The Contractor shall bear all loss of conforming material covered under this Contract until received by authorized personnel at the location designated in the purchase order or Contract. Mere receipt does not constitute final acceptance. The risk of loss for nonconforming materials shall remain with the Contractor regardless of receipt.

B. General Indemnification. To the extent permitted by A.R.S. § 41-621 and § 35-154, the School District/Public Entity shall be indemnified and held harmless by the Contractor for its vicarious liability as result of entering into this Contract. Each party to this Contract is responsible for its own negligence.

C. Indemnification - Patent and Copyright. To the extent permitted by A.R.S. § 41-621 and § 35-154, the Contractor shall indemnify and hold harmless the School District/Public Entity against any liability, including costs and expenses, for infringement of any patent, trademark, or copyright arising out of Contract performance or use by the School District/Public Entity of materials furnished or work performed under this Contract. The School District/Public Entity shall reasonably notify the Contractor of any claim for which it may be liable under this paragraph.

D. Force Majeure.

1. Except for payment of sums due, neither party shall be liable to the other nor deemed in default under this Contract if and to the extent that such party’s performance of this Contract is prevented by reason of force majeure. The term “force majeure” means an occurrence that is beyond the control of the party affected and occurs without its fault or negligence. Without limiting the foregoing, force majeure includes acts of God; acts of the public enemy; war; riots; strikes; mobilization; labor disputes; civil disorders; fire; flood; lockouts; injections-intervention-acts; or failures or refusals to act by government authority; and other similar occurrences beyond the control of the party declaring force majeure which such party is unable to prevent by exercising reasonable diligence.

2. Force Majeure shall not include the following occurrences:

a. Late delivery of equipment or materials caused by congestion at a manufacturer’s plant or elsewhere, or an oversold condition of the market; or

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b. Late performance by a Subcontractor unless the delay arises out of a force majeure occurrence in accordance with this force majeure term and condition; or

c. Inability of either the Contractor or any Subcontractor to acquire or maintain any required insurance, bonds, licenses, or permits.

3. If either party is delayed at any time in the progress of the work by force majeure, the delayed party shall notify the other party in writing of such delay, as soon as is practicable and no later than the following working day, of the commencement thereof and shall specify the causes of such delay in such notice. Such notice shall be delivered or mailed certified-return receipt requested, and shall make a specific reference to this article, thereby invoking its provisions. The delayed party shall cause such delay to cease as soon as practicable and shall notify the other party in writing when it has done so. The time of completion shall be extended by Contract Amendment for a period of time equal to the time that results or effects of such delay prevent the delayed party from performing in accordance with this Contract.

4. Any delay or failure in performance by either party hereto shall not constitute default hereunder or give rise to any claim for damages or loss of anticipated profits if, and that such delay or failure is caused by force majeure.

E. Third Party Antitrust Violations. The Contractor assigns to the School District/Public Entity any claim for overcharges resulting from antitrust violation the extent that those violations concern materials of services supplied by third parties to the Contractor toward fulfillment of this Contract.

6. Warranties

A. Liens. The Contractor warrants that the materials supplied under this Contract are free of liens.

B. Quality. Unless otherwise modified elsewhere in these terms and conditions, the Contractor warrants that for one year after acceptance by the School District/Public Entity of the materials or services, they shall be:

1. A quality to pass without objection in the trade under the Contract description;

2. Fit for the intended purposes for which the materials or services are used;

3. Within the variations permitted by the Contract and are of even kind, quality, and quality within each unit and among all units;

4. Adequately contained, packaged and marked as the Contract may require; and

5. Conform to the written promises or affirmations of fact made by the Contractor.

C. Fitness . The Contractor warrants that any material or service supplied to the School District/Public Entity shall fully conform to all requirements of the Solicitation and all representations of the Contractor, and shall be fit for all purposes and uses required by the Contract.

D. Inspection/Testing . The warranties set forth in subparagraphs A through C of this paragraph are not affected by inspection/ testing of or payment for the materials or services by the School District/Public Entity.

E. Exclusions . Except as otherwise set forth in this Contract, there are no express or implied warranties or merchant ability fitness.

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F. Compliance with Applicable Laws. The materials and services supplied under this Contract shall comply with all applicable federal, state and local laws, and the Contract shall maintain all applicable licenses and permits.

G. Survival of Rights and Obligations after Contract Expiration or Termination.

1. Contractor’s Representations and Warranties. All representations and warranties made by the Contractor under this Contract shall survive the expiration of termination hereof. In addition, the parties hereto acknowledge that pursuant to A.R.S. § 12-510, except as provided in A.R.S. § 12-529, the School District/Public Entity is not subject to or barred by any limitations of actions prescribed in A.R.S. Title 12, Chapter 5.

2. Purchase Orders. The Contractor shall, in accordance with all terms and conditions of the Contract, fully perform and shall be obligated to comply with all purchase orders received by the Contractor prior to the expiration or termination hereof, unless otherwise directed in writing by the Procurement Offices, including, without limitation, all purchase orders received prior to but not fully performed and satisfied at the expiration or termination of this Contract.

7. School District/Public Entity’s Contractual Remedies

A. Right to Assurance. If the School District/Public Entity in good faith has reason to believe that the Contractor does not intend to, or is unable to perform or continue performing the Contract, the Procurement Officer may demand in writing that the Contractor give a written assurance of intent or ability to perform. Failure by the Contractor to provide written assurance within the number of days specified in the demand may, at the School District/Public Entity’s option, be the basis for terminating the Contract under the Uniform General Terms and Conditions.

B. Stop Work Order.

1. The School District/Public Entity may, at any time, by written order to the Contractor, require the Contractor to stop all or any part, of the work called for by this Contract for a period of up to ninety (90) days after the order is delivered to the Contractor, and for any further period to which the parties may agree. The order shall be specifically identified as a stop work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage.

2. If a stop work order issued under this clause is canceled or the period of the order or any extension expires, the Contractor shall resume work. The Procurement Officer shall make an equitable adjustment in the delivery schedule or Contract price, or both, and the Contract shall be amended in writing accordingly.

C. Non-exclusive Remedies. The rights and the remedies of the School District/Public Entity under this Contract are not exclusive.

D. Nonconforming Tender. Materials supplied under this Contract shall fully comply with the Contract. The delivery of materials or a portion of the materials in an installment that do not fully comply constitutes a breach of Contract. On delivery of nonconforming materials, the School District/Public Entity may terminate the Contract for default under applicable termination clauses in the Contract, exercise any of its remedies under the Uniform Commercial Code, or pursue any other right or remedy available to it.

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E. Right to Offset. The School District/Public Entity shall be entitled to offset against any sums due the Contractor, any expenses or costs incurred by the School District/Public Entity or damages assessed by the School District/Public Entity concerning the Contractor’s nonconforming performance or failure to perform the Contract, including expenses, costs and damages described in the Uniform General Terms and Conditions.

8. Contract Termination

A. Cancellation for Conflict of Interest. Per A.R.S. 38-511 the School District/Public Entity may cancel this Contract within three (3) years after Contract execution without penalty or further obligation if any person significantly involved in initiating, negotiating, securing, drafting, or creating the Contract on behalf of the School District/Public Entity is, or becomes at any time while the Contract or an extension the Contract is in effect, an employee of or a consultant to any other party to this Contract with respect to the subject matter of the Contract. The cancellation shall be effective when the Contractor receives written notice of the cancellation unless the notice specifies a later time.

B. Gratuities. The School District/Public Entity may, by written notice, terminate this Contract, in whole or in part, if the School District/Public Entity determines that employment or gratuity was offered or made by the Contractor or a representative of the Contractor to any officer or employee of the School District/Public Entity for the purpose of influencing the outcome of the procurement or securing the Contract, an Amendment to the Contract, or favorable treatment concerning the Contract, including the making of any determination or decision about Contract performance. The School District/Public Entity, in addition to any other rights or remedies, shall be entitled to recover exemplary damages in the amount of three (3) times the value of the gratuity offered by the Contractor.

C. Suspension or Debarment. The School District/Public Entity may, by written notice to the Contractor, immediately terminate this Contract if the School District/Public Entity determines that the Contractor has been disbarred, suspended or otherwise lawfully prohibited from participating in any public procurement activity, including but not limited to, being disapproved as a Subcontractor of any public procurement unit or other governmental body.

D. Termination for Convenience. The School District/Public Entity reserves the right to terminate the Contract, in whole or in part at any time, when in the best interests of the School District/Public Entity without penalty recourse. Upon receipt of the written notice, the Contractor shall immediately stop all work, as directed in the notice, notify all Subcontractors of the effective date of the termination and minimize all further costs to the School District/Public Entity. In the event of termination under this paragraph, all documents, data and reports prepared by the Contractor under the Contract shall become the property of and be delivered to the School District/Public Entity. The Contractor shall be entitled to receive just and equitable compensation for work in progress, work completed, and materials accepted before the effective date of the termination. The cost principles and procedures provided in A.A.C. R7-2-1125 shall apply.

E. Termination for Default.

1. In addition to the rights reserved in the Uniform Terms and Conditions, the School District/Public Entity reserves the right to terminate the Contract in whole or in part due to the failure of the Contractor to comply with any term or condition of the Contract, to acquire and maintain all required insurance policies, bonds, licenses and permits, or to make satisfactory progress in performing the Contract. The Procurement Officer shall provide written notice of the termination and the reasons for it to the Contractor.

2. Upon termination under this paragraph, all documents, data and reports prepared by the Contractor under the Contract shall become the property of and be delivered to the School District/Public Entity.

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3. The School District/Public Entity may, upon termination of this Contract, procure, on terms and in the manner that it deems appropriate, materials and services to replace those under this Contract. The Contractor shall be liable to the School District/Public Entity for any excess costs incurred by the School District/Public Entity re-procuring the materials or services.

F. Continuation of Performance through Termination . The Contractor shall continue to perform, in accordance with the requirements of the Contract, up to the date of termination, as directed in the termination notice.

9. Contract Claims

All Contract claims and controversies under this Contract shall be resolved according to A.R.S. Title 15-213 and AAC R7-2-1155 through R7-2-1181and rules adopted there under.

10. Gift Policy

The Tempe Union High School District (TUHSD) will accept no gifts, gratuities or advertising products from Offerors. TUHSD has adopted a zero tolerance policy concerning Offeror gifts. TUHSD may request product samples from Offerors for official evaluation with disposal of those said samples at the discretion of the Procurement Officer.

11. Integrity of Proposal

By signing this Proposal, the Offeror affirms that the Offeror has not given, nor intends to give any time hereafter any economic opportunity, future employment, gift, loan gratuity, special discount, trip favor, or service to any employee of the School District/Pubic Entity in connection with the submitted Proposal. Failure to sign the Proposal, or signing it with a false statement, shall void the submitted proposal or any resulting contract.

12. Offshore Performance

Due to security and identity protection concerns, direct services under any subsequent contract shall be performed within the borders of the United States. Any services that are described in the specifications or scope of work that directly serve the school district(s) or charter school(s) or its clients and may involve access to secure or sensitive data or personal client data or development or modification of software for the State shall be performed within the borders of the United States. Unless specifically stated otherwise in the specifications, this definition does not apply to indirect or “overhead” services, redundant back-up services or services that are incidental to the performance of the contract. This provision applies to work performed by subcontractors at all tiers.

13. Contractor’s Employment Eligibility

By entering the contract, Contractor warrants compliance with A.R.S. 41-4401, A.R.S. 23-214, the Federal Immigration and Nationality Act (FINA), and all other federal immigration laws and regulations.

The District may request verification of compliance from any Contractor or Subcontractor performing work under this contract. The District reserves the right to confirm compliance in accordance with applicable laws.

Should the District suspect or find that the Contractor or any of its Subcontractors are not in compliance, the District may pursue any and all remedies allowed by law, including, but not limited to: suspension of work, termination of the contract for default, and suspension and/or debarment of the Contractor. All costs necessary to verify compliance are the responsibility of the contractor.

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14. Terrorism Country Divestments

Per A.R.S. 35-392, the District/public entity is prohibited from purchasing from a company that is in violation of the Export Administration Act.

15. Fingerprint Clearance Cards

In accordance with A.R.S 15-512(H), a contractor, subcontractor or vendor or any employee of a contractor, subcontractor or vendor who is contracted to provide services on a regular basis at an individual school may be required to obtain a valid fingerprint clearance card pursuant to Title 41, Chapter 12, Article 3.1. An exception to this requirement may be made as authorized in Governing Board policy.

Contractor, subcontractors, vendors and their employees shall not provide services on school district properties until authorized by the District.

Additionally, contractor shall comply with the governing body fingerprinting policies of each individual School District/Public Entity.

16. Clarifications

Clarification means communication with Offeror for the sole purpose of eliminating minor irregularities, informalities, or apparent clerical mistakes in the Proposal. It is achieved by explanation or substantiation, either in a written response to an inquiry from the District or as initiated by Offeror. Clarification does not give Offeror an opportunity to revise or modify its Proposal, except to the extent that correction of apparent clerical mistakes results in a revision.

17. Confidential/Proprietary Information

Confidential information request: If Offeror believes that its Proposal contains trade secrets or proprietary information that should be withheld from public inspection as required by A.R.S. § 39-121, a statement advising the School District/Public Entity of this fact shall accompany the Proposal, and the information shall be so identified wherever it appears. The School District/Public Entity shall review the statement and shall determine in writing whether the information shall be withheld. If the School District/Public Entity determines to disclose the information, the School District/Public Entity shall inform Offeror in writing of such determination.

Contract terms and conditions, pricing and information generally available to the public are not considered confidential information under this section.

Public record: All Proposals submitted in response to this solicitation shall become the property of the School District/Public Entity. They will become a matter of public record available for review, subsequent to award notification, under the supervision of the Purchasing Official, 500 West Guadalupe Road, Tempe, AZ 85283 by appointment.

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Tempe Union High School Special Instructions, Terms and Conditions


SPECIAL INSTRUCTIONS, TERMS AND CONDITIONS

1. District Representative

In accordance with A.A.C. R7-2-1042(A.1.s), and the “Uniform Instructions To Offerors,”, the District Representative is Peggy Ferrin, Director of Purchasing & Warehouse.

2. Purpose

The purpose of this Proposal is to contract for Medical Claims Administration, Network, PBM Services.

3. Sufficient Funds

The District fully anticipates that sufficient funds will be available for this purchase, however funds are not currently available. Any contract awarded under this proposal will be conditioned upon the availability of funds.

4. Insurance

Offeror agrees to maintain such insurance as will fully protect Offeror and the District from any and all claims under any workers’ compensation statute or unemployment compensation laws, and from any and all other claims of any kind or nature for damage to property or personal injury, including death, made by anyone, that may arise from work or other activities carried on, under, or facilitated by this Agreement, either by Offeror, its employees, or by anyone directly or indirectly engaged or employed by Offeror. Offeror agrees to maintain such automobile liability insurance as will fully protect Offeror and the District for bodily injury and property damage claims arising out of the ownership, maintenance or use of owned, hired or non-owned vehicles used by Offeror or its employees, while providing services to the District.

Successful Offeror shall be required to provide proof of and maintain comprehensive general liability insurance with a limit of not less than $1,000,000 per occurrence and $2,000,000 aggregate coverage with a deductible of not more than $5,000 and naming Tempe Union High School District #213 as an additional insured party.

Successful Offeror shall be required to submit proof of and maintain Worker’s Compensation and Employer’s Liability Insurance as required by law.

5. Affordable Care Act

Offeror understands and agrees that is shall be solely responsible for compliance with the Patient Protection and Affordable Care Act, Public Law 111-148 and the Health Care and Education Reconciliation Act, Public Law 111-152 (collectively the Affordable Care Act “ACA”). Offeror shall bear sole responsibility for providing health care benefits for its employees who provide services to the District as required by state or federal law.

6. Licenses

Successful Offeror shall maintain in current status all federal, state, and local licenses and permits required by the operation of the business conducted by the Offeror.

7. Safety

Offeror, at its own expense and at all times, shall take all reasonable precautions to protect persons and the District property from damage, loss or injury resulting from the activities of Offeror, its employees, its subcontractors, and/or other persons present. Offeror will comply with all specific job safety requirements promulgated by any governmental authority, including without limitation, the requirements of the Occupational Safety Health Act of 1970.

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All items supplied on this contract must comply with the current applicable occupational safety and health standards of the State of Arizona Industrial Commission, the National Electric Code, and the National Fire Protection Association Standards.

8. Fingerprint Requirements

Fingerprint clearance cards will not be required for this contract.

9. Evaluation Schedule

The Proposals will be initially evaluated for conforming to the requirements of the RFP. Then a technical score will be given. The Proposals with the highest ranking or scores may be interviewed to determine the best interests of the District.

10. Terms of Award

Per A.A.C. R7-2-1042(A.3.b), it is the intent of the District to award a multi-term contract, beginning July 1, 2017 and continuing through June 30, 2018. If all conditions are met during this period of time, this contract can be extended, if funding is available and services performed by the offeror are satisfactory, for up to an additional four one-year contracts. However, no contract exists unless and until a purchase order is issued each fiscal year.

It is expected that Governing Board approval for this contract will be made in February 2017.

11. Contract Award

It is anticipated that a contract under this RFP will be awarded to a single offer or multiple offerors.

12. Multiple Award

Per A.A.C. R7-2-1042(A)(1)(c), the District reserves the right to make a multiple award to more than one Offeror. Based upon the different services, the District may determine that it is in their best interest to multi-award this solicitation. Contracts will be awarded by types of services. The award will be limited to the least number of Offerors that the District determines is necessary to meet the needs of the District. Offerors are not required to Bid on all items specified in this Solicitation. Offerors who provide an “All or Nothing” Bid will be deemed non-responsive.

13. Award Basis

In accordance with A.A.C. R7-2-1050, the successful Offeror will be determined by evaluation criteria including but not limited to pricing, or other incentives offered. Awards will not be made based on price alone.

14. Evaluation

Representatives of the District will evaluate proposal and score or rank them from the most likely to the one least likely to meet the requirements as outlined in the RFP. Per A.A.C. R7-2-1042(A)(1)(q), if several proposals are very closely ranked, the District may call for interviews to assist in the decision making. In addition to interviews the district reserves the option to call for and enter into discussions with the firms considered most likely to meet the requirements for the purpose of negotiations, on pricing and/or other portions of the proposal, if considered by the District to be in the best interest of the District.

Per A.A.C. R7-2-1042(A)(1)(h) evaluation criteria are listed below in their relative order of importance (Specific weighing may be used, but will not be required):

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Network size and disruption

Ability to meet the services requested under scope of work

Ability to administer the current plan design

Network discounts

Qualifications of the Offeror, including past performance and references

Reporting capabilities

Performance guarantees

Price of services

Multi-year fee guarantees

During the course of the selection process, all prospective companies are cautioned not to contact School Board Members or Selection Committee Members or attempt to persuade or promote through other channels. Committee members will read, review and evaluate the proposals based on the evaluation criteria. A point formula system will be used to evaluate the offers. The District may call for interviews to clarify information received in the proposal. Firms may be asked to host a site visit and/or interview with the Selection Committee, they may also be asked to revise or modify their proposals following the receipt of other information. However, offering firms are cautioned that the District may proceed with an award, on the basis of information received in the original proposal and subsequent interviews (if held) without calling for additional discussions or best and final offers.

All Proposals shall be open for public inspection after award of contract, except to the extent the Offeror designates, and the District concurs, that trade secrets or other proprietary data contained in the Proposal documents remain confidential in accordance with A.A.C. R7-2-1006, R7-2-1016, and R7-2-1042(A.1.u).

15. Evaluation Schedule

The proposals will be initially evaluated for conforming to the requirements of the RFP. Then a technical score will be given. The proposals with the highest ranking may be interviewed to determine the best interests of the District. The following schedule is tentative.

RFP Released November 22, 2016RFP Deadline for Questions December 2, 2016Intent to Propose Notification Due (Bid/No bid form) December 6, 2016RFP Due Date and Time December 14, 2016 @ 2:00 PMRFP Short List Notification January 14, 2017RFP Interviews (if necessary) January 20, 2017RFP Best & Final (if necessary) January 20, 2017Anticipated Board Approval (Tentative) February , 2017Effective Date July 1, 2017

16. Non-Exclusive Contract

Any contract resulting from this solicitation shall be awarded with the understanding and agreement that it is for the sole convenience of the District. The District reserves the rights to obtain like goods or services from other sources.

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17. Acknowledgement of Amendments

In accordance with A.A.C. R7-2-1042(A.1.b), Offeror shall acknowledge receipt of all amendments by signing the amendment acknowledgement form, Attachment 8 of the RFP.

18. Offeror Required Contract/Agreement

If your firm will require the District to sign any form of contract/agreement, a copy of that contract/agreement shall be included with this Proposal. Contents and stipulations contained in the contract/agreement may be part of the evaluation criteria.

19. Local Representative

Offeror shall have a LOCAL field representative available at all times during the contract period.

20. Authority

This solicitation as well as any resulting contract is issued under the authority of the Governing Board or designee. No alteration or any resulting contract may be made without the express written approval of the District in a form of an official contract amendment. Any attempt to alter any contract without such approval is a violation of the contract and the School District Procurement Rules. Any such action is subject to legal and contractual remedies available to the District inclusive of, but not limited to, contract cancellation, suspension and/or debarment of the contractor.

21. Integrity of Offer

By signing this Proposal, the Offeror affirms that the Offeror has not given, nor intends to give any time hereafter any economic opportunity, future employment, gift, loan gratuity, special discount, trip favor, or service to any employee of the District, or per A.A.C. R7-2-1042(A.1.l) Offeror has not engaged in collusion or anti-competitive practices in connection with the submitted Proposal. Failure to sign the Proposal, or signing it with a false statement, shall void the submitted Proposal or any resulting contract.

21. Billing

All billing notices must be sent to each District’s Accounts Payable Department as shown on the purchase orders. All invoices shall identify the specific item(s) being billed. Any purchase order issued by Tempe Union High School District will refer to the RFP number of this solicitation.

22. Price Clause

Prices shall be firm for the term of the contract. Prices as stated must be complete for the services proposed and shall include all associated costs. DO NOT include sales tax on any item in the Proposal.

After initial contract term and prior to any contract renewal, the Tempe Union High School District will review fully documented requests for price increases and may at its sole option accept any changes or cancel from the contract those items concerned. The offeror shall likewise offer any published price reduction, during the contract period, to the District concurrent with its announcement to other customers. All price adjustments will be effective upon acceptance of the Tempe Union High School District.

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23. Deviations to Offer

Any deviation from the general terms and conditions or exceptions taken shall be described fully and appended to the Proposal form on the Offeror’s letterhead. Exceptions must be signed by authorized representative of the company. Such appendages shall be considered part of the Offerors formal Proposal. For the absence of any statements of deviation or exception, the Offer shall be accepted as in strict compliance with all terms and conditions.

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Tempe Union High School Scope of Work/Specifications


Scope of Work/Specifications

1. Background

Tempe Union High School District serves students in grades nine through twelve in Tempe, Arizona. The District is comprised of seven high schools with a student enrollment of approximately 14,000 students in parts of Tempe, Chandler and Phoenix, Arizona. Six of the sites are comprehensive high schools with the seventh site, Compadre High School, being an alternative high school. The Tempe Union High School District is a highly-performing District and is known for excellence in teaching and learning.

The District provides health benefits to approximately 1,389 active employees and 35 retirees (closed class as of July 2008). The employee medical benefits program has been self-insured since July 2012 with the plan administered by UnitedHealthcare (UHC). Prior to 2012, the District was fully insured with UHC.Actives and in-area Retirees are covered under a POS plan utilizing the UHC Choice Plus network while out-of-area Retirees are covered under the Choice PPO network. The benefit plan design is the same for Actives and Retirees and is non-grandfathered under ACA. You should assume that the current benefit plan design will continue to be offered to Actives and Retirees. The plan design can be found in the attachment section of the RFP.

Tempe Union High School District (hereinafter referred to as the Client), is seeking proposals from qualified firms for a July 1, 2017 effective date. The Client is interested only in firms who possess or can subcontract to possess all of the following services for its self-funded medical plan(s) by the start of the contract:

Comprehensive medical network in Arizona with significant provider discounts. Network must include comprehensive transplant centers of excellence, chiropractors and both inpatient and outpatient behavioral health providers.

Medical plan claims administration including administration of all level of claim appeals Utilization Management (as outlined in the Scope of Work) 24-hour telephonic nurse triage line and health information line (toll free phone number) Disease Management (opt in model only) for the chronic conditions outlined in the Scope of Work. Wellness Program (as outlined in the Scope of Work) 3-Visit Employee Assistance Program

Stop loss coverage is not being bid at this time but a separate RFP will be released closer to the effective date.

Pricing should be provided for medical administration/network/EAP and separately for PBM services. Pricing should not be contingent on receiving both services as the Client may consider making separate awards for medical services and PBM services if deemed advantageous. There will be an opportunity to provide “bundled” pricing discounts if awarded both medical services and PBM services.

The Client will not consider any bids from any public entity pools formed pursuant to A.R.S. 11-952.01 or A.R.S. 15-382. Proposals from Third Party Administrators shall include providing all network and EAP financial exhibits from partner organizations and responses to all network questions for the PPO network and EAP being proposed. Failure to provide responses to the network or EAP portion of the RFP shall be deemed an incomplete proposal and may be rejected. Winning proposals that utilize “partners” or subcontractors must allow the Client to have a direct contractual relationship with each respective provider of service. The Client does not desire any indirect contracts where the contract is between your firm and the partner or subcontractor. All contracts will be for one-year with the option for the Client to renew for up to four additional one-year terms.

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The Client offers life, dental, disability and vision benefits and these coverages are out to bid under a separate RFP. Proposals for this RFP must NOT be conditional on receiving an award for one or more of these services under separate RFP.

The Segal Company will be performing a PPO network discount analysis using a proprietary methodology approved by participating medical networks in the Uniform Data Submission (UDS) workgroup. UDS, facilitated by Milliman, is a collaborative effort among participating consulting firms and insurance carriers to reach consensus on the definition of financial terms, claims categories, and general methodology of data files prepared and sent to consulting firms for discount comparison. If your organization is NOT currently part of the UDS workgroup, you must contact Brian King ([email protected]) for data requirements and record layout specifications. Third Party Administrators who propose networks that are not part of UDS or do not comply with the data specification requirements will not be evaluated.

2. Scope of Work

Tempe Union High School District is soliciting proposals from qualified vendors to provide the following services:Medical and vision plan administration

Account Management

Provide a designated Account Management and Account Management Team

Secure Internet Access

Access to Enrollment/eligibility Administration Portal for Employer Access to Claim status and pricing tools for Employees

Customer Service

Provide customer service to answer inquiries on claims, eligibility, provider network, services, coverage, or other inquiries Monday through Friday from 8:00 AM to 6:00 PM (AZ time)

Open Enrollment Support

Prepare and provide Benefit Presentations in collaboration with the District

Attend Open Enrollment Meetings and other Client directed meetings as needed

Communication/Education Materials

Provide bilingual communication/educational materials

Plan Document, Summary Plan Documents, Identification Cards and Certificates

Provide draft of standard plan document and summary plan descriptions which describe the benefits and provide claims filing instructions

Provide data to PBM for Identification Card generation (PBM will generate the cards)

Claims Administration

Provide claims forms Receive claims and process payments of benefits in accordance with the plan designs Correspond with participants and providers if additional information is necessary to complete the processing of

claims Determine, based on the District’s medical necessity guidelines, benefits payable under the Plan, pursuant to the

terms and conditions of the District’s Benefit Plan Coordinate benefits payable under the Plan and with other benefit plans, if applicable

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mailto:[email protected]



Provide notice to the Participants regarding the reason(s) for denial of benefits (which are denied) and provide for the review of such denied claims

Provide an explanation of benefits resulting from claims transactions to plan participants Provide 1099 forms Perform Recovery of Payments of $25 or more Administer a Fraud and Abuse Detection Program Provide Full Claims Fiduciary Services (all levels of appeals)

Eligibility/Enrollment Administration

Administer eligibility based on the District’s eligibility criteria Provide access to an online enrollment maintenance system for the District

Reporting

Provide timely management reports or preferably internet access to monitor financial and service level performance. Such reports much include the following information:

Monthly: Paid (not incurred) claims, number of covered subscribers by rate tier and total number of members. The Client requires this information to be provided by active employees, retirees and COBRA.

Quarterly: A report that includes the results achieved compared to performance metrics for any performance guarantees your firm is proposing

Quarterly: Account level report with utilization statistics by type of service, discounts, and other savings achieved, in-network and out-of-network utilization, and member cost sharing (deductible and coinsurance amounts)

Annual: Lag report

Client and/or Designated Consultant access to Claims Data Reporting Portal

The Client reserves the right to receive a complete claims file extract annually should a third party data warehouse/analytics firm be employed

MEDICAL CASE MANAGEMENT, UTILIZATION REVIEW, DISEASE MANAGEMENT

Utilization Management (UM) including Precertification Services

Inpatient admissions – including elective hospital admission for med/surg and behavioral health, long-term acute care, skilled nursing facility, extended active inpatient rehabilitation facility, residential treatment program, (emergency and maternity admissions do not require precertification)

Inpatient dental services or procedures Medications covered under the “Specialty Self-Injectable Medication” benefit, certain medications covered

under the “Retail and Mail Order Pharmacy” benefit (if these medications are available under the benefit plan), and certain medications covered under the “Home Health/Home Infusion” benefit.

Organ, tissue or bone marrow transplants and stem cell procedures Requests for services by an out-of-network provider for the in-network cost-share Services directly associated with a cancer clinical trial

Concurrent Review

Determine the appropriateness and level of care for ongoing stays in a hospital or health care facility..

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Comprehensive Case Management (CM) Program

Assist participants to learn more about their illness and risk factors and understand treatment options and expected outcomes.

Understand and wisely use their health benefits and case management services Access other resources outside their insurance plan Avoid more expensive care or duplication of services Coordinate services among many different providers

Disease Management Programs

Asthma Diabetes Chronic Obstructive Pulmonary Disease (COPD) Coronary Artery Disease (CAD) Congestive Heart Failure

Claim and UM Appeals

Handle all levels of the Appeal Process for UM and Claims Administration (no litigation)

PREFERRED PROVIDER ORGANIZATION (PPO) NETWORK ACCESS

The current medical program includes access to PPO network providers and discounts. It is the Client’s intent to continue to incorporate these services into the medical plan administration. Your proposal should assume that the following services will be provided:

Provide a comprehensive PPO provider network with competitive discounts for Arizona participants as well as any out-of-state participants. Use of a wrap network outside Arizona is acceptable

Provide a network that includes a sufficient number of providers for acute hospitals, health care professionals, ancillary providers such as durable medical equipment, skilled nursing facility, home health, rehabilitation, hospice, transplant centers of excellence, and behavioral health providers

The Client is interested in exploring a narrow network or ACO as an option. Provide responses for your standard PPO network and then an alternative option (if available) for a narrow network or ACO configuration. Please be sure to identify any additional fees associated with this alternate network and any responses in the questionnaire and financial workbook that may differ from your standard PPO network. You are encouraged to include collateral material so the Client can fully understand your alternate network offer.

PHARMACY BENEFIT MANAGER

Another RFP for PBM services will be posted online and that RFP will be going through Proposal Tech. Once it is posted, the procurement site will contain a link along with instructions to access the PBM RFP.

EMPLOYEE ASSISTANCE PROGRAM (EAP)

These services should be included as part of the Medical plan of benefits. We are not requesting a separate carve-out program.

Provide thorough patient assessment, record-keeping and evaluation, on a short term basis with one-on-one EAP counseling for up to three (3) visits (at no cost to the plan participant), including referral to an appropriate provider for necessary services, considering the plan’s network and benefit design.

Provide 24-hour access to an EAP counselor qualified to assess and triage cases. Maintain this 24-hour service seven days a week, through a toll-free number, including telephonic crisis counseling.

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Provide education material to all enrollees eligible for the EAP (printing only, not mailing). Provide initial training for the Client’s staff and appropriate managers and supervisors regarding the EAP

program, proper referrals, early warning signs, problem employees, etc. Provide orientation meetings, as requested by the Client, for eligible employees and their families. Agree to work with the Client to establish performance guarantees. Provide distribution and feedback from a patient satisfaction survey using a survey format approved for use by

the Client no less frequently than annually. Provide quarterly and annual utilization statistics. Include a copy of your standard reporting package in your

response to this RFP. (Note: Individual names are not to be identified).

WELLNESS BENEFITS ADMINISTRATION

Wellness Programs

Online Health Risk Assessment 24/7 Nurse Call Line Onsite Health Fair Support Wellness Coaching Flu Shots – Onsite Discounted Services

The financial exhibits include a place for your organization to include a wellness allowance

Discount Services

Provide discounted programs for participants that include: Acupuncture Massage Weight Loss Programs Vitamins Gym Memberships Apparel

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INTERFACE AND COORDINATION WITH CLIENT’S VENDORS

Receive data from the PBM on a routine basis Receive data from the PPO network on a routine basis Coordinate data and reporting with stop loss vendor (assume a $200,000 deductible) Coordinate data and reporting with COBRA vendor Coordinate data and reporting

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UNDERWRITING INFORMATION

Your bid should assume the prior TPA will administer all claims incurred prior to the effective date. Your responsibility will be to provide services for claims incurred on or after July 1, 2017 only. Note that proposed fees should include administration of all runout claims upon termination of the contract with your firm.

Censu

Due to HIPAA regulations, a census file and provider disruption exhibit have not been included as an attachment. These documents may be obtained from the Segal Company upon completion of a signed Confidentiality Agreement emailed to Brian King ([email protected]). Firms who have previously completed a Confidentiality Agreement may request a copy of these documents from Brian King ([email protected]). The provider disruption exhibit must be returned on a flash drive in native MS Excel format. You do not need to include hard copies of the disruption analysis in your paper proposal.

Claims Experience

Monthly paid claims experience and enrollment are included in the attached Excel file for the last 36 months. Large claim information for the same experience periods is also included as an attachment.

Eligibility

The following provides a summary of the categories of employees/retirees and dependents eligible for benefits:

Full-time Employees (administrators, teachers and classified) - Benefit eligible employees (as measured by the District in accordance with ACA/IRS) working a minimum of 30 hours per week. Benefit coverage begins on the first day of the month following 30 days of employment. The Employer pays 100 percent of the cost of employee medical coverage. Employees are required to pay 100 percent of the cost of dependent coverage.

Retirees - Former employees who qualify under the Client’s retirement policy (closed class as of July 2008). Dependents - Any lawful spouse and/or dependent children up to age 26.

Plan Design

It is the Client’s intention to continue to offer the current benefit plan. If you are unable to administer any portion of the current plan design, please be very specific in your completion of the Deviations Exhibit contained in the Vendor Forms section of this RFP. Do not merely say you will match benefits using your standard provisions. You must indicate all benefit differences and proposed alternatives or the Client will assume you are matching all benefit provisions.

Enrollment

Below is the current enrollment by rate tier.

RATE TIER CURRENT ENROLLMENTEmployee Only 1,155Employee +Spouse 26Employee+Child(ren) 68Employee + Family 29Retiree 24COBRA Employee 21COBRA Employee +Spouse 0COBRA Employee+Child(ren) 0

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COBRA Employee + Family 1TOTAL ENROLLMENT 1,324

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Additional Instructions

The Client may decide to award multiple contracts if it is deemed to be most advantageous to the Client. Pricing should be standalone for medical administration/network/EAP as one service and standalone for PBM as a separate service (separate RFP to be released by the end of November). Pricing exhibits will include an option for bundling these two services and for providing any additional discounts your firm might propose for a multiple award under this RFP.

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Tempe Union High School Proposal Submittals


Proposal Submittals

One (1) Original, (5) Five copies, and One (1) Digital copy of your Proposal on flash drive must be submitted. All financial exhibits and responses to the questionnaire must be provided in native (unprotected) Microsoft Excel and Word respectively. Your submission should be in a sealed box or envelope(s) clearly marked with your firm’s Name and include the RFP name, RFP number (RFP #17-016) and a list of Services proposed. The Tempe Union High School District will not assume responsibility for any costs related to the preparation or submission of the Proposal.

TUHSD requests that you limit your proposal responses and materials to only the information necessary to understand the services you are proposing. Additional marketing materials beyond those requested in this solicitation are discouraged.

Firms wishing to be considered in the selection process who provide confidential or proprietary information must indicate such information in the exhibit marked Confidential/Proprietary information. Every reasonable effort will be taken to protect confidential or proprietary information and TUHSD will make the final determination. Requests to deem the entire proposal or Fee Exhibits as confidential will not be considered. All provisions of any contract resulting from this RFP will be public information.

In order for your Proposal to be considered, the following should be included and should be referenced with index tabs: Submit a letter of interest to include index tabs with Table of Contents.

Your hard copy proposal should conform to the following format:Section 1 Cover letter

Vendor Information Form

Section 2 Financial Proposal Forms (also include in Excel format on a flash drive)

Section 3 Geo Access Report (also include in Excel format on a flash drive)

Section 4 Questionnaire (also include in Word format on a flash drive)

Section 5 Performance Guarantees

Section 6 Specimen ASO Agreement

RFP Addendums (if necessary)

Section 7 Deviations, Confidential/Proprietary Exhibit, Proposal & Acceptance form, Acknowledgement of Amendments form, Non-Collusion, W-9 form, Certificates of Insurance, & Ancillary Contract (if applicable)

Section 8 Additional Materials form, Miscellaneous (lengthy question responses, underwriting caveats, any brochures, or other materials necessary to understand the services you are proposing).

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Tempe Union High School Proposal Submittals


Your submission must include a flash drive with an electronic copy of your proposal including the requested Excel exhibits and Word questionnaire in their native Microsoft format.

TUHSD also requests an electronic copy of your Maricopa County network provider directory for your PPO network and any alternative narrow network or ACO you might be quoting. The directory should be based on the following file specifications:

Acceptable File Format:

MS Excel (Preferred) MS Access ASCII (Text file)

Required Fields

Provider last name (Please do not put generation indicator i.e. Jr. III…or designation such as MD or DC, etc. in this field)

Provider first name (Please do not combine first and last names in the same field) Provider NPI 5-digit zip code (Some zip codes start with 0. Please do not use number format which deletes the 0) Street address (Only include physical locations not billing addresses such as P.O. Box). Type of provider (primary care, chiropractor, hospital, etc.)

You may also include any other fields that are in your data files, but only the fields listed above are required. Note: be careful not to send duplicate records. Our experience dealing with electronic provider listings is that we very often receive two or more records for the same provider (e.g. “John Smith” & “John A. Smith” with the same address).

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Tempe Union High School Questionnaires


Questionnaire Instructions to Vendors:***DO NOT ALTER THE QUESTIONS OR QUESTION NUMBERING***.

Provide answers to the questionnaires in MS Word format. The questionnaire contains two types of questions: Yes or No and Narrative. For the Yes or No questions,

DO NOT provide narrative in your response, except to refer the reader to an appendix or location where additional information is provided.

Provide an answer to each question even if the answer is “not applicable” or “unknown.” Answer the question as directly as possible.

If the questions asks “How many…” provide a number

If the question asks, “Do you…” indicate Yes or No first, followed by your additional narrative explanation.

Lengthy responses may be truncated when displayed…to avoid this, be concise in your response. Use bullet points as appropriate. Reconsider how to word any response that exceeds 200 words in length so that the response contains the most important points you want displayed. Refer the reader to an appendix/attachment for further information.

Where you desire to provide additional information to assist the reader in more fully understanding a response, refer the reader of your RFP response to your appendix/attachments.

RFP responses will become part of the contract between the winning Vendor and the Client.

NOTE: Answers to the questions must be provided in hard copy and MS Word format on Flash Drive. DO NOT PDF or otherwise protect the Flash Drive.

Complete this form and include it with your response. Indicate “yes” or “no” to your organization’s ability to meet the general requirements. Responses will become part of the contract with the Client.

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GENERAL REQUIREMENTS YES NO

1. Contract has a length of one (1) year with the option to renew four (4) additional one year periods?

2. All fees are guaranteed for a minimum of 36 months?

3. Agree to submit your renewal to the Client or their designated Consulting firm, 6 months prior to the renewal date with full justification for any fee increases.

4. Have you proposed standalone pricing for medical administration/network/EAP and separately for PBM services if the Client chooses to make multiple awards?

5. Agree that your proposal is not contingent on acceptance of other coverage or services (e.g. stop loss, life, dental) outside the scope of this RFP.

6. Your fees are net of commissions.

7. You agree to handle all levels of claims appeals.

If you answered “No” to any of the questions above, please provide an explanation below:

Requirement No. Explanation

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CONTRACTUAL

Indicate Confirmation:

Yes or No Explain any “No” response

1. Termination Provisions: The Client may terminate the contract at any time by giving 30 days written notice. The successful bidder may only terminate the contract by giving notice 120 days in advance. The Client can terminate the contract without cause or financial penalty at any time during the duration of the contract.

2. Upon the termination of the agreement with the Client, you will cooperate fully with the Client and/or its subsequent service provider in order to effect an orderly transition of services from your organization to a subsequent service provider, at no added fee?

3. Size Variance Provision: Any provisions, references, or guidelines relating to reevaluation of proposed fees due to variation in enrollment in the plan must not be less than 15% of the enrollment at the beginning of each plan year.

4. Right to Audit: The Client reserves the right to an independent audit by an auditor of their choice. Bidder agrees to not charge for any expense incurred by the bidder for time necessary to prepare claim files. The cost of the third party to audit will be the responsibility of the client.

5. Subcontracting:

a. List any services related to the Scope of Work of this RFP that you currently subcontract (or plan to subcontract for this contract) and the name of the vendor(s) to whom you subcontract.

b. Do you agree to provide advanced written notice to the Client if you decide to subcontract for any services related to the Scope of Work?

c. Do you understand that if you use subcontractors in the delivery of services under this proposal your firm is responsible for the timeliness, accuracy, privacy, comprehensiveness, and reporting components of the subcontractor’s services?

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CONTRACTUAL

Indicate Confirmation:

Yes or No Explain any “No” response

d. Explain any of your current contractual relationships with a third-party firm in which the third party firm will be paid by the Client either directly or indirectly during the course of the contract with the Client (e.g. % of savings)?

6. Do you agree that you will not assign or transfer the rights or obligations of the contract or any portion thereof, without the prior written approval of the Client?

7. Do you agree to maintain proper licensure as required by any state law where it relates to the services that you will be performing for the Client?

8. Do you agree that the Client will determine eligibility for coverage?

9. Do you agree that your contract includes an indemnification/hold harmless clause to protect the Client?

10. HIPAA Compliance: All bidder systems and services must comply with the HIPAA EDI, Privacy, and Security regulations at all times. Do you agree to maintain adherence to federal HIPAA Privacy and Security regulations as it relates to the personal health information you receive about the Client’s plan participants during the proposal, implementation, contract, and post-contract periods?

11. Are you willing to sign a contract with the Client that indicates your firm will pay fines the Client may be assessed as a result of your firm's noncompliance with HIPAA EDI, Privacy and Security regulations and pay costs associated with remedy of any breach your firm initiates?

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NOTE: This section must be completed in a “yes” or “no” format. You may enter any N/A response in the NO column. If additional details are required, include in a separate attachment to your response labeled “Questionnaire Appendix” in MS Word format.

QUESTIONNAIRE (If the response varies by PPO, ACO, or narrow network, please respond accordingly)

GENERAL INFORMATION YES NO

1. When a participant calls your customer service number, is there an option to:a. Listen to choices in Spanish?

b. Speak with a representative who converses in Spanish?c. How do you accommodate a caller who needs translation in a language other than

Spanish and English?

NETWORK YES NO

2. Does your organization contract directly with providers:a. Inside Arizona?

b. Outside Arizona?

3. Does your organization contract indirectly with providers through another organization:

a. Inside Arizona?b. Outside Arizona?

4. Are any fees associated with contracting with another organization ever billed to the Client?

5. Do you offer reciprocity arrangements for members who travel outside the service area and need:a. Emergency treatment?

b. Non- Emergency treatment?

6. In the State of Arizona, can your network providers deliver services for the following specialized treatment conditions:a. Major burns?

b. Organ transplants?c. Bone marrow transplants?

d. Specialized cancer treatments such as Proton Beam Radiation?e. Neonatal care?

f. Fertility treatments?

7. Are the following providers in your network:

a. Arizona Mayo Clinic?b. Arizona Mayo Hospital?

c. Mayo Clinic’s Outside Arizona?d. Mayo Hospital outside Arizona?

e. Cancer Treatment Centers of America

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8. Do you offer a vision network to accommodate the vision exam benefit in the current medical plan design?

9. Does your network contract with Centers of Excellence for organ transplants?

10. Do you anticipate a change in the size or location of your network in the next year that would affect the Client’s population?

11. Are there any penalties incurred by the Client when claims payments do not occur within a certain number of days (i.e., the discount is not valid if claims are not paid within 30 days of being submitted)?

ADMINISTRATIVE SERVICES YES NO

1. When participants call your customer service number and ask questions about the PPO network, do the representatives:

a. Provide direct answers to all issues?b. Provide a separate number to call for further assistance with network questions?

c. Provide a warm direct transfer, without interruption, to experts who then provide answers to network questions?

2. Are bilingual versions of the following communication materials available:a. Written?

b. Electronic?

3. Do you agree to calculate all provider administrative fees and pay the vendors on behalf of the Client?

4. Can you accept eligibility files in electronic format?

5. Do you have a secure web-based eligibility system the Client’s staff may use to upload eligibility?

6. Does your system support on line real time eligibility inquiries by the Client?

2. Do you require the Client to maintain a minimum checking account balance to pay claims?

7. Do you agree to financially reimburse the Client for the lack of stop-loss reimbursement the client will have incurred if you fail to take appropriate action to pay and send claims to the stop-loss carrier within the required timeframe?

8. Have you noted on the Deviations Form any provisions of the current benefit plan that you are not able to administer?

MEDICAL PLAN CLAIMS PROCESSING AND CAPABILITIES YES NO

1. Do you agree to provide summary and claim level line items detailed accumulator data to the Clients next firm at the termination of your contract:

a. Within 30 days following termination?b. At no cost to the Client?

2. Do you agree to issue 1099’s (and W-2 forms, if applicable), to the appropriate parties?

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3. Does your EOB include:

a. Specific instructions on exactly how to appeal?b. Specific information on the timeframes for appealing?

4. Regarding the use of Independent Review Organizations (IRO):a. Is there a cost?

b. If yes, is it included in your Base Administration Fee?c. Is it billed to the Client?

5. Do you agree to receive claims data from the Client’s PBM at no cost?

6. Do you have an automated method to identify and recover overpayments?

MEDICAL PLAN CLAIMS PROCESSING AND CAPABILITIES YES NO

7. Do you use a subcontracted vendor to identify and recover overpayments?

8. If yes:a. Is the cost borne by the client?

b. Is the cost a part of your administration fee?

9. Do you have the ability to administer claims based on the Client’s current plan design(s) and will not ask the client to alter any of their plan of benefits in order to accommodate your computer system?

10. If no, have you listed any issue on the Deviations Exhibit contained in this RFP?

11. Are you planning to implement a new claim system in the next 24 months?

12. Do you anticipate any major enhancements to your claim system in the next 12 months?

13. Has your claim system been updated to be in compliance with ICD-10?

14. Are you able to administer the vision exam benefit in the current plan design?

15. Do you capture/store the following data in your claim system:

a. Group policy number?

b. Client ID number?

c. Employee ID Number or other unique identifier?

d. Claimant ID number or other unique identifier?

e. Claimant relationship: employee, spouse, child?

f. Claimant gender?

g. Claimant data of birth?

h. Separate claims data for COBRA (self-pay) participants?

i. Provider name?

j. Provider type code?

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k. Provider ID number (TIN and/or NPI)?

l. Provider address, city, state and zip code?

m. Type of service?

n. Billed amount?

o. Allowed amount?

p. Deductible, coinsurance and copay amount?

q. Discount amount?

r. Ineligible amount?

s. Paid amount?

t. Claim processed/date paid?

UTILIZATION MANAGEMENT YES NO

1. Does your precertification program include an analysis and determination of:a. Appropriate level of care?

b. Reasonable length of stay?c. Actual medical necessity?

d. Appropriateness of the surgery of service being requested?e. Necessity for a proposed pre-operative hospital day?

f. Necessity for proposed 23-hour observation stays following outpatient surgery?

2. Do you review the following under pre-service review:

a. Elective inpatient medical/surgical admissions?b. Elective outpatient surgery?

c. Diagnostic services?d. Durable medical equipment?

e. Corrective appliances/prosthetics?f. Skilled nursing facility?

g. Home health/home enteral, infusion therapy?h. Physical therapy?

i. Acute psychiatric and substance use disorder admissions?j. Residential treatment program admissions?

k. Inpatient rehabilitation facility admission?l. Chiropractic care?

3. Do you agree to attempt to redirect pre-service callers to an appropriate in-network provider?

4. If unable to redirect to an appropriate in-network provider, do you agree to document why?

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5. Responsibility for obtaining a pre-service certification lies with the:

a. Member?b. Provider?

c. Client?

6. If the service provider fails to obtain approval, is the member responsible?

7. Do you agree to perform telephonic concurrent review on applicable inpatient admissions, redirect to in-network providers (when possible), and refer to case management for additional follow-up?

8. Do you agree to notify the claims administrator PROMPTLY, of potentially large claims that you identify through your pre-service and case management activity?

9. During case management, do you agree to direct the patient and/or their health care providers to use in-network services?

10. Do you agree to provide the stop loss carrier case manager notes, course of treatment, pre-certification of hospital stays, surgeries or transplants when requested during the contract period?

DISEASE MANAGEMENT YES NO

1. Have you included information in your response regarding all of the Disease Management Programs that you are offering to the Client?

2. Does your Disease Management Program use an:

a. Opt-In Approach?b. Opt-Out Approach?

3. Are you willing to include performance guarantees based on the effectiveness of your Disease Management Program?

WELLNESS SERVICES YES NO

1. Have you included information in your response regarding all of the Wellness Services and Programs that you are offering to the Client?

2. Have you included a wellness allowance?

3. Are you willing to include performance guarantees based on the effectiveness of your Wellness Services Program?

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NOTE: This portion of the Questionnaire is for narrative responses.

GENERAL INFORMATION VENDOR RESPONSE

1. Background information about your organization:

a. Organization’s name

b. Ownership of your firm

c. Address of your corporate headquarters

d. Date your firm became operational for the services requested in this RFP (indicate your years of experience with EACH product you are proposing)

e. Does your firm have any local offices to support the Client’s members (include address)?

f. Will the Client have a dedicated or designated team to help with questions?

g. Who will the Client contact when they have questions?

2. What are the most recent ratings for your company by the following (include date):

Standard and Poors

Duff and Phelps

A.M. Best

Moody’s

3. Implementation:

a. What is the minimum amount of implementation lead-time you need in order to initiate the proposed services for the Client?

b. List any transition issues the Client should consider with respect to moving services from an existing vendor to your services.

c. Are there any specific administrative procedures or information that your firm will need from the Client in order to implement your services?

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NETWORK COMPOSITION - PPO VENDOR RESPONSE

1. What is the name of your network?

2. a. If you indirectly contract with another network inside Arizona, what is the network name and fee you pay?

b. If you indirectly contract with another network outside Arizona, what is the network name and the fee you pay?

c. If there is a fee, is it included in your administration fee or billed to the Client?

d. If billed to the Client, what is the amount of the fee?

3. Provide a list of the Centers of Excellence for organ and tissue transplants included in your network in Arizona?

4. Outline any anticipated network changes for:

i. Physicians

ii. Hospitals

5. Indicate major hospital contracts scheduled for renewal in the next 12 months for:

a. Maricopa County

b. Arizona (other than Maricopa County)

6. List any provider-types in your network that are compensated on a capitation basis.

7. Is your network “Open Access” or “Gatekeeper”? (Open Access is preferred.)

8. Using the number of enrolled employees on the census, please provide a Geo Access report based on the criteria below and further indicate the locations (city, town, state, and zip code) where your network does and does not have coverage.

a. 2 PCPs within 10 miles. Include family practice, general practice, internal medicine, pediatricians and OB/GYN. Provider to be based on MD, DO, or DPM designations only.

b. 2 Specialists within 10 miles

c. 1 Hospital within 20 miles

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NETWORK - ACO VENDOR RESPONSE

1. What is the name of your ACO network?

2. Indicate the name of the ACO(s) that you partner with?

3. What types of providers are part of the ACO?

4. How does a member find an ACO provider?

5. Does a member need to select a PCP?

6. Does a member need a referral from a PCP in order to visit a network specialist?

7. Are there any urgent care facilities in the ACO network?

8. How are emergency services outside the ACO network handled?

9. What happens if services for a certain type of provider are not part of the ACO network?

10. What happens if a child attends college outside the ACO service area?

11. What are the anticipated savings using your ACO?

12. Is the saving from deeper discounts or tighter, integrated medical management?

13. Do you guarantee savings and if so indicate the amount?

14.

15. How are ACO providers compensated?

16. How is the Client billed for the ACO?

17. Indicate all additional fees associated with using your ACO?

18. Is there a true-up or year-end reconciliation if the ACO doesn’t deliver targeted savings or meet established metrics?

19. Are there any loss corridors or limits if the ACO doesn’t meet targets?

20. Is the Client liable to share any savings that may result from using your ACO?

21. How are large claims treated in evaluating ACO performance? What pooling level would be used (if any)?

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NETWORK - ACO VENDOR RESPONSE

22. Is the ACO able to work with a third party PBM?

23. What data/reporting requirements are needed from a third party PBM?

24. Is your ACO an attribution model?

25. How do you determine if the patient falls within the defined population of the ACO?

26. What types of reports and frequency are made available to the Client? Provide samples.

27. How to do you take corrective steps to insure quality metrics are achieved?

28. a. Maricopa County

b. Arizona (other than Maricopa County)

29. List any provider-types in your network that are compensated on a capitation basis.

30. Is your network “Open Access” or “Gatekeeper”? (Open Access is preferred.)

31. Using the number of enrolled employees on the census, please provide a Geo Access report based on the criteria below and further indicate the locations (city, town, state, and zip code) where your network does and does not have coverage.

a. 2 PCPs within 10 miles. Include family practice, general practice, internal medicine, pediatricians and OB/GYN. Provider to be based on MD, DO, or DPM designations only.

b. 2 Specialists within 10 miles

c. 1 Hospital within 20 miles

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NETWORK CLAIMS PAYMENT VENDOR RESPONSE

1. How is continuity of care maintained if the Client were to change to your organization?

2. What penalties should the Client be aware are included in your contracts related to untimely claim payment?

3. List all of the scenarios in which your discounts cannot be applied to bills submitted by network facilities or physicians (e.g., workers comp, third party liability, etc.).

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REPORTING

Report Type Month Quarter Annual

Vendor Response(Y or N)

Online Access (Y or N)

Excel(Y or N)

Enrollment (subscriber/member) by plan option, by coverage tier for each employer

X

Paid Claims

By Plan Option X

By Type (fee for service, capitated) X

By Status (Active, Retiree, COBRA) X

By Member Cost-Sharing by Plan Option

X

Overpayments X

Large Claim Report - $50,000 with diagnosis

By Plan Option X

By Status (Active, Retiree, Terminated, COBRA)

X

Other Claims Reports

Claims Lag X

Network Utilization

In-Network X

Out-of-network X

Out-of-State X

Utilization Management

Precertification X

Case Management X

Large Claims Report including Case Management Status

X

Wellness Programs

Utilization X

ROI Savings X

Disease Management

Utilization Risk Stratification (baseline and YTD)

X

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REPORTING

Report Type Month Quarter Annual

Vendor Response(Y or N)

Online Access (Y or N)

Excel(Y or N)

Clinical Goals Compliance X

ROI Savings X

Stop Loss Reports (for third party Stop Loss Vendor)

Identify when participants have accumulated paid claims greater than or equal to 50% of the specific stop loss, including primary diagnostic code.

X

Provide Case Management Notes for any open cases.

X

Provide pended claims. X

Medical Utilization Benchmarks (Client Industry Specific and Book of Business)

Client Industry Specific X

Book of Business X

Ad Hoc Reporting Capabilities

Ability for the Client to generate Ad Hoc Reports

Determined by the Client

Will the above information be provided in a format to allow the Client or it’s Consultant to drill down on the data?

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ADMINISTRATIVE SERVICES VENDOR RESPONSE

1. Indicate how you manage Coordination of Benefits (COB):

a. Pre-payment or post-payment?

b. What procedures do you perform to determine the presence of other coverage (e.g., use claim detail, open enrollment query, annual query, etc.)?

2. Indicate any minimum checking account balance you require the Client keep to pay claims.

3. Please describe your banking requirements.

4. Indicate which provider networks you are approved to work with.

5. Indicate which reinsurance/stop loss carriers you are approved to work with.

6. Indicate which PBM’s you currently do business with.

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CLAIMS PROCESSING VENDOR RESPONSE

GENERAL INFORMATION

1. Regarding your client base in the office proposed to service the Client:

a. Number of claims administration clients you currently serve at this location.

b. Number of total lives that these clients represent.

c. On average, how long have these clients been under contract with you?

2. Claim Appeals

a. What is your process for coordinating with independent external appeal organizations?

c. Indicate the name and address of the Independent Review Organizations (IRO) used by your firm.

d. What is the amount of the fee for each Independent Review that is billed to the Client, if any?

3. Run-Out Administration

a. Does your proposal include run-out administration in the event your contract is terminated?

b. How long would you continue to process claims past the contract termination date?

SYSTEM CAPABILITIES

4. a. Do you have an automated method to identify and recover overpayments?

b. Do you use a subcontracted vendor to identify and recover overpayments?

c. If you use a subcontracted vendor, is the cost borne by the client or part of your administration fees?

5. For claims that need additional information in order to adjudicate (such as needing an operative report, ER visits notes, ambulance records, student status, etc.):

a. Do you pend those claims, or deny/close the claims?

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CLAIMS PROCESSING VENDOR RESPONSE

b. How long can a claim be listed as pended before you bring resolution to that claim?

PROCESSING TIME

6. Based on the most recent 6 months and including the time the claim is with the clearinghouse), indicate:

a. Average number of calendar days to process a clean claim from date received to date a check is issued to the provider/patient.

b. Average number of calendar days to process a claim from date received to date EOB is sent to patient.

c. What percent of all claims submitted (regardless of information provided on claim) have been processed (from date received to date EOB is issued) within 14 calendar days?

d. What percent of all claims submitted (regardless of information provided on claim) have been processed (from date received to date EOB is issued) within 30 calendar days?

REIMBURSEMENT PROCEDURE

7. If the Client has specific guidelines for multiple surgical procedures that differs from your standard, can your system accommodate?

8. Describe what, if any, hospital bill audit procedures are in place to detect mischarges and inappropriate charges on hospital bills and/or the miscoding of DRGs.

9. Is your interface with UM vendors (for decisions on precertification, length of stay, case management, and UR-negotiated fee discounts) electronic or paper?

10. How do you administer subrogation (pay and pursue or pursue and pay)?

11. Explain what system you use and how you track and document inquiries from claimants.

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For the following categories, provide the performance standard you are willing to offer, the financial penalty (maximum dollar amount or % of administrative fees) you will agree to pay if the standard is not met, and the method of measuring the penalty.

PERFORMANCE GUARANTEES VENDOR RESPONSE

1. Vendor attendance at the Client meetings

Attendance by vendor representatives when requested at meetings scheduled by the Client during the contract period and implementation phase.

2. Vendor call (or e-mail) return timeliness

The Client or designated consultant’s calls (or e-mails) to vendor are returned within 48 business hours.

3. Processing monthly eligibility updates

All updates to eligibility or enrollment records will be made within 3 business days after the information is received by the vendor.

4. Telephone call availability & answering speed

90% of all calls are answered within 30 seconds, and telephone service is available between 8:00 am and 6:00 pm Arizona Time Zone on business days.

5. Telephone call on-hold (in-queue) time

An average of less than 2 minute(s) on hold before a human being answers.

6. Telephone Abandonment Rate

An abandonment rate of less than 3% is maintained during standard business hours.

7. Claims Processing Accuracy

99% of claims dollars submitted for payment will be accurately processed and paid. Regardless of whether or not these standards of performance are satisfied, the vendor must reimburse the Client for all overpayments that are not recovered from the recipient within 60 days after the overpayment is discovered. The Client will assign its right to any recovery of overpayments to the vendor.

8. Turnaround Time on Claims Payments

95% of all claims received will be completely processed (paid, denied, or pended for additional information) within 14 calendar days after they are received. 100% of claims will be processed within 30 calendar days of receipt.

9. Timeliness of Claim Reports

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PERFORMANCE GUARANTEES VENDOR RESPONSE

Each report the vendor will supply the Client will be provided within a mutually agreed upon timeframe.

10. Claims Coding

95% of all claims will be coded with no errors.

11. Implementation

Successful implementation as defined by key milestones. Include measurable milestones in your proposal.

12. Data Exchange

Receive and transmit data with vendors based on a frequency defined by the business needs of the Client.

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UTILIZATION MANAGEMENT (UM)GENERAL ADMINISTRATION VENDOR RESPONSE

1. What is the name of, and who owns, the UM firm you are proposing for the Client?

2. Describe how your firm assures confidentiality of medical information received during the UM process.

3. Is your firm currently URAC accredited for utilization management services?

4. Do you agree to notify the stop loss carrier of potentially large claims as they arise in the course of these services?

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UTILIZATION MANAGEMENT PRE-SERVICE REVIEW VENDOR RESPONSE

1. Indicate the toll-free number and minimum hours of operation of your switchboard:

Weekdays

Weekends

Holidays

2. What type of system is available for receipt of pre-service calls before/after your normal working hours?

a. Answering machine with recorded message given

b. Answering machine will accept receipt of messages

c. Answering service to receive messages

d. Open 24 hours a day

e. No provisions, except during normal business hours

3. Describe the method and frequency of notification from your firm to the claims administrator about the cases that have received your pre-service review and concurrent review services.

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UTILIZATION MANAGEMENT (UM) CASE MANAGEMENT VENDOR RESPONSE

1. Does your firm perform case management?

2. How do you find cases to case manage?

3. What types of cases do you identify for case management?

4. Describe the method and frequency of notification from your firm to the claims administrator about the cases that have received your case management services.

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DISEASE MANAGEMENT PROGRAMS VENDOR RESPONSE

1. What methods and measures will you use to determine the effectiveness of your Disease Management Program with the Client?

2. Do you agree to provide reports of DM activity and gaps in care at least quarterly (within 30 days of the close of the month) and an annual ROI within 3 months of the close of the prior year?

3. Do you agree to manage the Disease Management program for this client under an opt-out model and not as an opt-in model?

4. Answer ONLY as related to your Disease Management program:

a. Is your Disease Management program accredited by URAC?

b. Is your Disease Management program accredited by NCQA?

c. Is your Disease Management program accredited by JCAHO?

d. Is your Disease Management program accredited by any organization other than URAC, JCAHO and/or NCQA?

5. a. Do you plan to use any subcontractors, as opposed to your own employees, in order to perform any portion of your DM services?

b. If yes, indicate the names of all subcontractors and their roles.

c. If yes, indicate the percent of the subcontractor’s staff will be involved in providing services to this client.

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WELLNESS SERVICES VENDOR RESPONSE

1. What methods and measures will you use to determine the effectiveness of your Wellness Services offered to the Client?

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Tempe Union High School Attachments


ATTACHMENTS

Attachment A: Medical/Pharmacy PPO SPD Effective 7/1/2016

Attachment B: Medical/Pharmacy Choice Plus SPD Effective 7/1/2016

Attachment C: Monthly Paid Claims, Monthly Enrollment, Large Claims, Census

Attachment D: Medical Financial Workbook –Pricing Exhibits, Disruption, Discounts

Due to HIPAA regulations, Attachment C & D have not been included. These documents may be obtained from Brian King of the Segal Company upon completion of a signed confidentiality agreement. Email the confidentiality agreement to [email protected]. Firms who have previously completed a confidentiality agreement may request Attachment C & D with an email to [email protected].

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Tempe Union High School DistrictExhibits


EXHIBITS

Exhibit 1 Vendor Information Form (Excel workbook)

Exhibit 2 Medical ASO Fee Form (Excel workbook)

Exhibit 3 Utilization Management Fees (Excel workbook)

Exhibit 4 Disease Management Fees (Excel workbook)

Exhibit 5 EAP Fees (Excel workbook)

Exhibit 6 Medical Inpatient Facility Disruption (Excel workbook)

Exhibit 7 Medical Outpatient Facility Disruption (Excel workbook)

Exhibit 8 Medical Non-Facility (Professional) Disruption (Excel workbook)

Exhibit 9 Provider Counts (Excel workbook)

Exhibit 10 Self-Reported Discounts (Excel workbook)

Exhibit 10a Self-Reported Discounts for Narrow Network (Excel workbook) – if applicable

Exhibit 11 Discount Type (Excel workbook)

Exhibit 11a Discount Type for Narrow Network (Excel workbook) – if applicable

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Tempe Union High School Proposal and Acceptance


PROPOSAL AND ACCEPTANCE

OFFER

The Undersigned hereby submits the Proposal/Proposals and agrees to furnish the material, service or construction in compliance with all terms, conditions, specifications, and amendments in the Solicitation and any written exceptions in the Proposal/Proposals.

Arizona Transaction (Sales) Privilege Tax License No.: For clarification of this Proposal, contact:

___________________________________________________ Name: ___________________________________________

Federal Employer Identification No.______________________ Phone:____________________________________________

___________________________________________________ Fax: _____________________________________________

Tax Rate: _________________________________________% E-Mail: __________________________________________

___________________________________________________ _________________________________________________Company Name Signature of Person Authorized to Sign Proposal

___________________________________________________ _________________________________________________Address Printed Name

___________________________________________________ _________________________________________________City State Zip Title

CERTIFICATIONBy signature in the Offer section above, the Offeror certifies:

1. The submission of the Proposal did not involve collusion or other anti-competitive practices.2. The Offeror shall not discriminate against any employee or applicant for employment in violation of State Executive Order 99-4, 2000-4 or A.R.S. § 41-1461 through 1465.3. The Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip,

favor, or service to a public servant in connection with the submitted Proposal. Failure to provide a valid signature affirming the stipulations required by this clause shall result in rejection of the Proposal. Signing the Proposal with a false statement shall void the Proposal, any resulting contract and may be subject to legal remedies provided by law.

4. The Offeror warrants that it and all proposed subcontractors will maintain compliance with the Federal Immigration and Nationality Act (FINA), A.R.S. § 41-4401 and A.R.S. § 23-214 and all other Federal immigration laws and regulations related to the immigration status of its employees which requires compliance with Federal immigration laws by employers, contractors and subcontractors in accordance with the E-Verify Employee Eligibility Verification Program.

5. In accordance with A.R.S. § 35-392, the Offeror is in compliance and shall remain in compliance with the Export Administration Act.6. In accordance with A.R.S. § 15-512, the Offeror shall comply with fingerprinting requirements unless otherwise exempted.7. By submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from

participation in this transaction by any Federal department or agency.8. By submission of this proposal, that no Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting

to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a Cooperative Agreement, and the extension, continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.

ACCEPTANCE

The Proposal is hereby accepted.

The Contractor is now bound to sell the materials or services listed by the attached contract and based upon the solicitation, including all terms, conditions, specifications, amendments, etc., and the Contractor’s Proposal as accepted by the School District/Public Entity.

This contract shall henceforth be referred to as Contract No. ________________________________.

The Contractor has been cautioned not to commence any billable work or to provide any material or service under this contract until Contractor receives a purchase order, contract release document, or written notice to proceed.

Awarded this_____________________ day of___________________________20________

___________________________________________________________Authorized Signature

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Tempe Union High School DistrictBid/No Bid


STATEMENT OF BID/NO BIDMUST BE RETURNED BY DECEMBER 6, 2016

If you will or will not be responding to this service/commodity, please complete and return only this form to: Tempe Union High School District, by e-mail, [email protected], mail or fax it to the attention of the Purchasing Department (480) 345-3441. (Please print or type, except signature)

Failure to respond may result in deletion of Offeror’s name from the qualified Bidder's list for the Tempe Union High School District.

COMPANY NAME: ____________________________________________________________

ADDRESS: __________________________________________________________________

CITY: ___________________________________STATE: __________ZIP: ________________

CONTACT PERSON: _________________________TELEPHONE: _____________________

We are in receipt of the above referenced RFP and will/will not be quoting the following service:

Services Yes No Reason for Decline

Medical Claims Administration

Preferred Provider (PPO) Network

Utilization Management/Case Management

24-Hour Telephonic Nurse Triage & Health Information Life (Toll-Free)

Disease Management

Wellness Services

EAP

We, the undersigned, have declined to respond to your RFP 17-016 for Medical Claims Administration, Network, EAP Services because of the following reasons:

Service/Commodity__________ We do not offer this product or the equivalent.__________ Insufficient time to respond to this solicitation.__________ Remove our name from this list only.__________ Our product schedule would not permit us to perform.__________ Unable to meet all insurance requirements__________ Other. (Specify below)

REMARKS:

SIGNATURE: ________________________________________ DATE: ________________

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Tempe Union High School DistrictConfidentiality Agreement


CONFIDENTIALITY AGREEMENT

This confidentiality agreement is between The Segal Group, Inc., the parent of The Segal Company, onbehalf of The Segal Company operating subsidiaries, (hereafter “Segal”) and _____________________ on behalf of itself and all of its subsidiaries and affiliates, (hereafter “Bidder”) and is executed in connection with a bid that Bidder intends to submit to Segal in response to an RFP issued by Segal on behalf of Tempe Union High School District [hereafter “TUHSD”].

In order to prepare a responsive bid, Bidder needs to receive certain Client health plan information and data, including individually identifiable health information pertaining to Client health plan participants and beneficiaries, as well as Segal Proprietary Information consisting of the RFP questionnaire/RFI specifications and any associated financial spreadsheets (collectively “Proprietary Information”). Segal and Bidder agree that the term “individually identifiable health information” refers to any health information that is not “de-identified,” as defined in 45 C.F.R. Section 164.514(b)(2). Segal agrees to provide the necessary Proprietary Information in connection with this RFP, and Bidder agrees as follows:

1. Bidder will use this Proprietary Information only for the purpose of preparing Bidder’s response to Segal’s RFP.

2. Bidder agrees that only those individuals employed by Bidder who have a need to know this information to prepare the bid, have been made aware of the terms of this Agreement, and have agreed to abide by its terms will have access to the Proprietary Information provided by Segal (“Bidder’s Representatives”).

3. Neither Bidder nor any of its Representatives will disclose the Proprietary Information to any person or entity outside of Bidder, unless such a disclosure is: (a) necessary to prepare the bid and the recipient first executes a confidentiality agreement with provisions equivalent to this one; or (b) required by law.

4. Bidder agrees to use commercially reasonable efforts to maintain the security of the Proprietary Information.

5. Bidder will return the Proprietary Information to Segal or destroy it upon completion of the bid process if such return or destruction is feasible. If Bidder determines that return or destruction of some or all of the information is not feasible, Bidder agrees to: (a) inform Segal of the specific reason(s) that make return or destruction not feasible; (b) extend the protections of this Agreement to any retained information for as long as Bidder retains it; and (c) limit further uses or disclosures to those that make the return or destruction infeasible.

6. Bidder will report to Segal any use and/or disclosure of Proprietary Information that is not permitted by this Agreement.

7. Bidder shall regard and preserve as confidential all Proprietary Information that has been or may be obtained by Bidder in the course of the bid process, whether Bidder has such information in Bidder’s memory, or in writing or in other physical form. Bidder shall not, without written authority from Segal, use any Proprietary Information for Bidder’s benefit or Bidder’s purposes, either during the term of the bid process or thereafter.

8. The obligations of Bidder assumed in this Agreement shall continue beyond the completion of the bid process.

9. Bidder shall and does hereby indemnify, defend and hold harmless Segal and Segal’s officers, directors, employees and shareholders from and against any and all claims, demands, losses, costs, expenses, obligations, liabilities, damages, recoveries, and deficiencies, including interest, penalties,

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and reasonable attorney fees and costs, that Segal may incur or suffer and that result from, or are related to, any breach or failure of Bidder and Bidder’s Representatives to perform any of the representations, warranties and agreements contained in this Agreement that pertain to individually identifiable health information.

10. Bidder recognizes that any breach of the covenants contained in this Agreement would irreparably injure Segal. Accordingly, Segal may, in addition to pursuing its other remedies, obtain an injunction from any court having jurisdiction of the matter restraining any further violation and no bond or other security shall be required in connection with such injunction.

11. If any of the provisions herein become invalid or are declared invalid, such determination of invalidity as to the clause(s) shall not affect the other provisions of this Agreement. If any provision of this Agreement should be held invalid or unenforceable, the remaining provisions shall be unaffected by such a holding. If any provision is found inapplicable to any person or circumstance, it shall nevertheless remain applicable to all other persons and circumstances.

12. This Agreement shall be binding upon Segal and Bidder and their respective successors, assigns, heirs, executors and administrators.

13. This Agreement contains the entire understanding of the parties hereto and supersedes all previous communications, representations, or agreements, oral or written, with respect to the subject matter hereof. No failure to exercise nor any delays in exercising any right or remedy hereunder shall operate as a waiver thereof; nor shall any single or partial exercise of any right or remedy hereunder preclude any other or further exercise thereof or the exercise of any other right or remedy. Neither this Agreement nor any of its provisions may be amended, supplemented, changed, waived or rescinded except by a written instrument signed by the party against whom enforcement thereof is sought. No waiver of any right or remedy hereunder on any one occasion shall extend to any subsequent or other matter.

14. This Agreement shall be governed by and construed in accordance with the laws of the State of New York applicable to contracts made on and performed within the State of New York. Any action to enforce this Agreement shall be brought in State of New York, County of New York.

Intending to be legally bound, the Parties have executed this Agreement.

The Segal Group, Inc. Bidder

Signed: Signed:Print Name:

Print Name:

Title: Title:

Date: Date:

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CONFIDENTIAL/PROPRIETARY SUBMITTAL FORM

Firm Name

Authorized Signature

Date

Confidential/Proprietary Submittals (mark one):

No confidential/proprietary materials have been included with this offer

Confidential/proprietary materials included. Vendors should identify below any portionof their proposal deemed confidential or proprietary. Identification in this section does not guarantee that disclosure will be prevented but that the items will be subject to review by the Vendor and the Client prior to any public disclosure. Requests to deem the entire proposal or price as confidential will not be considered.

deems the following responses to the Questionnaire as confidential:

Proposal Section Item description/page number

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Tempe Union High School DistrictDeviations and Excetions


DEVIATIONS AND EXCEPTIONSMUST BE RETURNED WITH PROPOSAL

Offerors shall indicate any and all exceptions taken to the provisions or specification in this solicitation document.

Exceptions (mark one):

__________ No exceptions

__________ Exceptions taken (describe –attach additional pages if needed)

The Undersigned hereby acknowledges that there are no deviations/exceptions to this solicitation:

Firm


Date

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Tempe Union High School DistrictAdditional Materials Form


ADDITIONAL MATERIALS SUBMITTED

(Mark One):

__________ No additional materials have been included with this offer

__________ Additional Materials attached (describe—attach additional pages if needed)

Firm


Date

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Tempe Union High School DistrictAmendment Acknowledgment Form


AMENDMENT ACKNOWLEDGMENT

This page is used to acknowledge any and all amendments that might be issued. Any amendments issued within three days of the solicitation due date, will included a new due date to allow for addressing the amendment issues. Your signature indicates that you took the information provided in the amendments into consideration when providing your complete Offer response.

Please sign and date

AMENDMENT NO. 1 Acknowledgement__________________________________________________________________Signature Date



AMENDMENT NO.4 Acknowledgement__________________________________________________________________Signature Date



If no amendments were issued, indicate below, sign the form and return with your response.

Firm


Date

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Tempe Union High School DistrictNon-Collusion Affidavit Form (Attachment 9)


NON-COLLUSION AFFIDAVIT

State of Arizona )) ss.

County of )

________________________________________________________________________________, affiant,

the _______________________________________________________________________________________(Title)

__________________________________________________________________________________________(Contractor/Offeror)

the persons, corporation, or company who makes the accompanying Proposal, having first been duly sworn, deposes and says:

That such Proposal is genuine and not sham or collusive, nor made in the interest of, or behalf of, any persons not herein named, and that the Offeror has not directly or indirectly induced or solicited any other Offeror to put in a sham Proposal, or any other person, firm or corporation to refrain from submitting a Proposal, and that the Offeror has not in any manner sought by collusion to secure for itself an advantage over any other Offeror.

_______________________________________

_______________________________________(Title)

Subscribed and sworn to before me

this ____________ day of_____________________________, 20______________

Signature of Notary Public in and for the

State of ____________________________________________

County of___________________________________________

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Tempe Union High School DistrictW-9 Form (Attachment 10)


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