1-RFP 704-26 Pharmacy Benefit Manager - City of Richardson Final.pdf

REQUEST FOR PROPOSALS

City of Richardson, Texas

RFP Data Proposal Number: RFP #704-26

Title: Pharmacy Benefit Manager

Request for Proposals to Market Issue Date: May 5, 2026

Distributed By: HUB International Texas, Inc.

10000 N. Central Expwy.

Suite 1200 Dallas, Texas 75231

Proposals Due Prior To Date: June 4, 2026 Time: Prior to 2:00 p.m. Central Time

Location: City of Richardson Attn: Purchasing Manager Richardson City Hall 2360 Campbell Creek Blvd., #525 Richardson, TX 75082

Submission Instructions: It is preferred that the proposals be submitted on Bonfire

(https://cor.bonfirehub.com/). If you are not able to utilize Bonfire (https://cor.bonfirehub.com/), please submit one original paper copy and 1 electronic thumb drive to the mailing address noted above by the due date and time.

http://https/cor.bonfirehub.com/

Title Page

Specifications, Requirements & Instructions

Contractual Provisions for Consideration

Submission Forms Instructions

Deviations from Specifications

RFP Overview

Coverage Funding Matrix/ Vendor Selection Criteria

Plan Summaries

Submission Forms (5 noted below)

Conflict of Interest Questionnaire

Bidder Acknowledgement, Certifications and Supplemental Forms, Lower Tier Debarment and Prohibition Documents – All must be Returned Completed and Signed

Summary, Conditions & Specification – Signature Page – Required

Attachments:

Census Plan SPD COR_RxResponse_HSLLC_T&Cs - Word COR_RxResponse_QA_Template - Excel COR_RXRFP_Response_Clinical - Excel COR_RFP_Financial – Excel COR_RxRFP_Response_SurveyQuestions - Excel

SPECIFICATIONS, REQUIREMENTS AND INSTRUCTIONS

I. Important Dates:

RFP Issue Date: May 5, 2026 Deadline for Questions: May 14, 2026 2:00 p.m. Central Time Addenda Sent: May 21, 2026 Proposal Due Date: June 4, 2026 prior to 2:00 p.m. CST

Coverage Effective Date: January 1, 2027

II. Submission Information: Sealed proposals will be accepted until June 4, 2026, prior to 2:00 p.m. Central Time. It is preferred that Proposals be submitted on Bonfire (https://cor.bonfirehub.com/). If delivery must be made, the address for deliveries is City of Richardson, Attention: Purchasing Manager, 2360 Campbell Creek Blvd., #525, Richardson, TX 75082. Deliveries must contain: one original paper copy and 1 electronic thumb drive to the mailing address noted above by the due date and time.

You must label the submission – RFP #704-26 Pharmacy Benefit Manager

No mobile text, email or faxed proposals will be accepted. Proposals will be accepted only if delivered in person, by the U.S. Postal Service, or by delivery service such as UPS or Federal Express. The City will not be responsible for or consider missing, lost, or late deliveries.

III. Vendors requesting additional information: Requests for additional information must be made no later than 2:00 p.m. on May 14, 2026, and directed to Purchasing Manager, City of Richardson via email to ally.dobbins@cor.gov . All requests must be made in writing.

IV. Confidentiality: Information contained in the RFP is confidential and should be used only for the purpose of preparing legitimate proposals for all of the benefits plans specified in this RFP.

V. Proposal Review: The City reserves the right to accept or reject, in part or entirely, any portion of the proposals, waive minor technicalities, and select the proposal which best serves the interest of the City.

The City also reserves the right to waive or dispense with any of the formalities contained herein.

VI. Premium Costs: All premium costs related to the RFP must be clearly defined, and all deviations from the specifications must be clearly identified and explained.

The information contained in the RFP is believed to be accurate and current, but is not intended to be an expressed or implied warranty.

As noted in Section III, requests for interpretation of the specifications should be directed to Ally

Dobbins, Purchasing Manager, City of Richardson.

mailto:ally.dobbins@cor.gov

VII. Legal Consideration: All parties submitting proposals are expected to comply with all federal, state, and local laws and regulations pertaining to the preparation of proposals and the services to be provided.

Specifically, the services to be provided are expected to be in compliance with the Americans with Disabilities Act (ADA), insurance laws and insurance regulations. All proposals that are submitted will be presumed to be in compliance with applicable laws.

VIII. Carrier Information: It is expected that those submitting RFPs will provide full disclosure of the insurance carriers who will be used for each line of coverage requested. Failure to provide this information may result in disqualification or rejection of the RFP.

IX. RFP Notification: Parties who are selected based on the proposal(s) submitted will be notified as soon as possible following thorough review by City management.

X. Proposal Format:

A. Proposals must be clearly explained and identified. All costs, including optional programs, must be clearly stated and summarized. Alternative proposals will also be considered, provided the alternatives are clearly explained. Exceptions to or deviations from the specifications must be explicitly identified.

B. Those submitting proposals are responsible for the full costs associated with the preparation of the proposal.

C. Proposals may be withdrawn prior to the closing time for RFPs. Thereafter, all proposals shall remain open and valid for a period of 180 days or the effective date of the new plan, whichever is latest.

D. Accuracy in the proposals submitted is essential. All parties are asked to validate proposals for compliance with all stipulations of the RFP and accurate numbers submitted.

XI. Disqualification and Rejection of Proposals: Failure to comply with the requirements or the procedures set forth herein, or to satisfy the insurance and servicing criteria as set forth in the specification, may result in disqualification. It is not intended that exceptions to the specifications will, in and of itself, result in disqualification.

XII. Basis for Consideration: The City will review all proposals for completeness based on the requirements in this RFP. Those found to be incomplete or fail to address the needs of the City may not be evaluated.

Only those proposals that are complete, with all required documentation, may be evaluated.

Respondents should initially submit their best offer. If an award is made, primary consideration will be given to the respondent’s proposal deemed to the best interest of the City.

XIII. Service Considerations: The City will evaluate the proposals on factors other than cost, including level of benefits and coverage area. After a preliminary evaluation of the technical criteria, the cost proposal will be included in the evaluation process.

XIV. Right to Reject: Merely submitting a proposal does not warrant an expressed or implied contract for the insurance program for the City of Richardson.

XV. Authorized Signature: All proposal forms must be signed by individuals who have the legal authority to bind the respondent to the proposed lines of coverage.

CONTRACTUAL PROVISIONS FOR CONSIDERATION

The firm, who enters into a contract with the City of Richardson to provide services to the City, shall be required to abide by the contract provisions outlined here. Potential contractors should consider the following carefully, and it is assumed by submitting a proposal that these conditions shall be acceptable and included in the final signed document.

I. Handling of Claims & Customer Service:

A. The contractor must agree to deliver quality customer service to the City and its employees and follow all applicable regulations and industry standards. Any problems related to servicing the contract, the employees, or the City with regard to billing procedures must be rectified immediately.

B. The contractor shall submit separate invoices, in duplicate, for payment due on the 15th of each month. Invoices should include the contract number and will be itemized in accordance with the components of the contract. Payment will not be due until thirty (30) days after the date the above instruments are submitted, or the work is actually performed, whichever is later. It is required that the winning proposer be able to accept payment via Electronic Fund Transfer (EFT).

C. If invoices have not been paid by the due date, the contractor shall submit an overdue reminder notice. The City reserves the right to review all the contractor’s invoices after payment and recover any overpayments discovered in such review.

II. Continuity of Coverage: All employees and dependents covered by the current plan are to receive immediate coverage under the new plan.

III. Claims Experience Monitoring: The contractor shall provide monthly reports allowing the city to monitor claims experience on a monthly basis.

IV. Contractor Insurance Coverage: During the duration of any agreed contract, the contractor shall maintain, at its sole cost and expense, coverage outlined in the sample attachment. The insurance policy must name the City of Richardson as an additional insured and include a waiver of subrogation where applicable. (as shown on attachment). A certificate of insurance evidencing such coverage shall be furnished to the City prior to the commencement of any work for the City.

Cyber Coverage. Pharmacy Benefit Administrator shall maintain at its expense cyber liability insurance coverage with a minimum limit of not less than $25 million ($25,000,000) that includes coverage for loss, disclosure and theft of data, network security failure, and denial of service attacks and transmission of malicious code. Coverage shall include data breach regulatory fines and penalties, the cost of notifying individuals of security or data breach and the cost of credit monitoring services. If this coverage is provided on a claims-made basis then it must be maintained for a period of two (2) years after termination of the agreement.

If there are any subcontractors that work for the Pharmacy Benefit Administrator, they should also have the same cyber coverage limits required of the Pharmacy Benefit Administrator.

Claim Administrator Will Maintain at its Expense:

a. Commercial General Liability with a minimum limit of $1,000,000 per occurrence with a $2,000,000 aggregate. Policy shall include Employer as additional insured; be primary and non-contributing to any insurance carried by City of Richardson and shall waive subrogation and any other recovery rights against Employer.

b. Automobile liability coverage for all owned, non-owned, hired vehicles with a combined single limit of $1,000,000 and include Employer as additional insured and shall waive subrogation and any other recovery rights against Employer.

c. Worker’s Compensation/Employer’s liability insurance shall be in full compliance with all applicable state and federal laws and regulations which cover all employees of Pharmacy Benefit Manager and shall include Employer’s liability in an amount of not less than $1,000,000; bodily injury, occupational illness or disease coverage with minimum limits of not less than $1,000,000/$1,000,000/$1,000,000. Policy shall waive subrogation and any other recovery rights against Employer.

d. Professional Liability (Errors & Omissions coverage) with a minimum of no less than five million ($5,000,000). If there are any subcontractors that work for the Pharmacy Benefit Administrator, they should also have the same professional liability limits required of the Pharmacy Benefit Administrator.

Pharmacy Benefit Administrator will provide Employer with at least ninety (90) days written notice for cancellation or non-renewal that are not replaced and/or material changes in policy. All insurance companies providing the required insurance shall be authorized to transact business in Texas and rated at least A-VII by AM Best or other equivalent rating service.

A certificate of insurance evidencing the required insurance shall be submitted prior to commencement of services. On every date of renewal of the required insurance policies, Pharmacy Benefit Administrator shall cause a certificate of insurance to be issued evidencing the required insurance herein and delivered to Employer. In addition, Pharmacy Benefit Administrator shall within ten (10) business days after written request provide Employer with certificates of the insurance required herein.

V. Contractor Provision Requirement: The contract shall provide any necessary tools, equipment, supplies, materials, employees, management, and other items or services necessary to provide full service to the contract.

VI. INDEMNITY CLAUSE: BY SUBMITTING A PROPOSAL AND/OR ACCEPTING AN AGREEMENT FOR SERVICES, THE CONTRACTOR WILL AGREE TO HOLD HARMLESS THE CITY OF RICHARDSON, ITS OFFICERS, AGENTS, AND EMPLOYEES, FROM AND AGAINST ANY AND ALL CLAIMS, LOSSES, DAMAGES, CAUSES OF ACTION, SUITS AND LIABILITY OF EVERY KIND, INCLUDING ALL EXPENSES OF LITIGATION, COURT COSTS, AND ATTORNEY’S FEES, FOR INJURY TO, OR DEATH OF, ANY PERSON, OR FOR DAMAGE TO PROPERTY ARISING OUT OF, OR IN CONJUNCTION WITH, THE WORK DONE BY THE CONTRACTOR, REGARDLESS OF WHETHER SUCH INJURIES, DEATH OR DAMAGES ARE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE

CITY.

VII. Expectations of the Contractor: It is understood upon submission of a proposal that:

A. The Contractor shall not assign or subcontract any of its rights, duties, or obligations under the contract without prior written consent from the City. The contractor shall be entitled to assign, pledge or encumber its right to receive payments under this contract pursuant to security interests based upon the Uniform Commercial Code, so long as the City shall never be obligated to negotiate with any such third party in respect to compliance with the terms and conditions of the agreed contract. Any such assignment, pledge or encumbrance shall be limited by any rights of offset by the City for damages or claims arising under this Contract or any other obligation owed by the Contractor to the City.

B. At all times during the term of the contract, the company awarded the contract shall operate as an independent contractor to the City, and the contractor shall not in any event be deemed an employee or other representative of the City, nor shall he/she hold themselves up as such.

VIII. Contractor Employee Arrangements: All employees of the contractor shall at all times be considered an employee of the contractor, and the contractor will be solely liable for the payment of all wages and benefits made available to such employees in connection with their employment. In addition, it is expected and understood that the contractor will be responsible at all times for the supervision and performance of their employees. All employees of the contractor should warrant that all employees are fully covered by workers compensation insurance and that each employee has been carefully screened as to character and fitness for the performance of his/her job.

IX. Equal Opportunity: It is expected during the performance of the contract, all contractor employees will be treated under the requirements of an Equal Employment Opportunity employer and honor all protected rights afforded to employees under the law.

The contractor will be advised of any complaints filed with the City alleging that the contractor is not operating in good faith as an equal employment opportunity employer. The City reserves the right to consider such complaints, along with other considerations, in determining whether to terminate any portion of this contract for which the services have not yet been performed.

X. Advertising: The contractor awarded the contract agrees not to advertise or publish, without the City’s prior consent, the information related to the entry into a contract, except as required to comply with requests for information from an authorized representative of the federal, state or local authority.

XI. Contract Amendments & Enforceability: No amendments, modifications, or changes to the provisions outlined here may be made absent from the written agreement of both parties. Further, the contract awarded to the firm will be interpreted, construed, and governed by the laws of the United States and the State of Texas and shall be enforceable in any court of competition jurisdiction in Dallas and Collin Counties, Texas.

XII. Termination: The City retains the right to terminate for default on all or any part of its contract if the contractor breaches any for the terms hereof or if the contractor becomes insolvent or files for bankruptcy. Such right of termination, in addition to, and not in lieu of, any other remedies, which the City may have in law or equity, specifically including, but not limited to, the right to sue for damages or demand specific performance. The City additionally has the right to terminate this contract without cause by delivery to the contractor a “Notice of Termination” specifying the extent to which performance hereunder is terminated and the date upon which such termination becomes effective.

XIII. Other Terms and Conditions: CONFLICT OF INTEREST: No public official shall have interest in this contract except in accordance with Vernon’s Texas Codes Annotated, Local Government Code Title 5, Subtitle C, Chapter 171.

ETHICS: The respondent shall not offer or accept gifts or anything of value or enter into any business arrangement with any employee, official or agent of City of Richardson. More than one proposal on any one contract from a respondent or individual under different names shall be grounds for rejection of all proposals in which the respondent or individual has an interest. One or all proposals will be rejected if there is any reason to believe that collusion exists between respondents.

Respondents must make every effort to comply with Chapter 176 of the Texas Local Government Code.

Chapter 176 mandates the public disclosure of certain information concerning persons doing business or seeking to do business with the City of Richardson, including affiliations and business and financial relationships such persons may have with City of Richardson officers.

By doing business or seeking to do business with the City of Richardson, including submitting a response to this Request for Proposals, you acknowledge that you have been notified of the requirements of Chapter 176 of the Texas Local Government Code, and you are representing that you are in compliance with them.

Conflict of Interest questionnaire found on the last page of this document must be filled out and turned in with each proposal.

DISCLOSURE OF INTERESTED PERSONS FOR COUNCIL – APPROVED CONTRACTS: Under Section 2252.908 of the Texas Gov’t Code - The Commission has approved a Certificate of Interested Persons form, which must be filled out, signed, notarized and submitted to the City at the time of execution of the contract/agreement, along with the certification of filing generated from the Commission’s website. The Certificate of Interested Persons form is available on the Commission’s website at https://www.ethics.state.tx.us/filinginfo/1295/ and the successful bidder/proposer must follow the commission’s filing process adopted pursuant to the statute. The successful contractor’s notarized Certificate of Interested Persons and certification of filing will be attached to the Contract/ Agreement.

TRADE SECRETS, CONFIDENTIAL INFORMATION AND THE TEXAS PUBLIC INFORMATION ACT.

If you consider any portion of your proposal to be privileged or confidential by statute or judicial decision, including trade secrets and commercial or financial information, clearly identify those portions.

Proposals will be opened in a manner that avoids disclosure of the contents of competing Offerors and keeps the proposals secret during negotiations. All proposals are open for public inspection after the contract is awarded, but trade secrets and confidential information in the proposals are not open for inspection.

The City will honor your notations of trade secrets and confidential information and decline to release such information initially, but please note that the final determination of whether a particular portion of your proposal is in fact a trade secret or commercial or financial information that may be withheld from public inspection will be made by the Texas Attorney General or a court of competent jurisdiction. In the event a public information request is received for a portion of your proposal that you have marked as being confidential information, you will be notified of such request, and you will be required to justify your legal position in writing to the Texas Attorney General pursuant to Section 552.305 of the Government Code. In the event that it is determined by opinion or order of the Texas Attorney General or a court of competent jurisdiction that such information is in fact not privileged and confidential under Section 552.110 of the Government Code and Section 252.049 of the Local Government Code, then such information will be made available to the requester.

Marking your entire proposal CONFIDENTIAL/PROPRIETARY is not in conformance with the Texas Open Records Act.

https://www.ethics.state.tx.us/filinginfo/1295/

ASSUMPTIONS AND EXPECTATIONS

Assumptions are as follows:

1. The proposal is to be based on the proposed plan for benefits.

2. The quote is to be based upon the census provided in the RFP.

3. All participants enrolled in the Employee Benefits Plan as of December 31, 2026, are to receive immediate coverage under the new plan. All claims incurred on or after January 1, 2027, for currently enrolled participants are to be eligible expenses. The City’s enrollment records are to be the basis for “take-over.”

4. Coverage for employees (full time) becomes effective 31 days following the employee’s date of hire.

Benefit termination date is determined by the last check date the employee received with premiums deducted. Termination date is then rounded to the next 14th or end of month, whichever is closest.

5. This RFP is for a five (5) year contract. A 3-year rate guarantee with two (2) 1-year renewal options.

If it is the respondent’s intent to increase rates at the renewal date, the City must be notified of the maximum increase for each renewal period and the basis for calculating the increase. The City must be notified of renewal rates at least one hundred and twenty (120) days prior to the effective date of the rate change.

INSTRUCTIONS TO PROPOSERS

Cover Letter – Please Include

Pharmacy Benefit Manager

INSTRUCTIONS

1. Refer to “Requirements and Instructions” before submitting your proposal.

2. Quote your best price.

3. Please see the Requirements and Instructions section of this RFP for submission guidelines (copies, deadlines, etc.)

4. You must label the submission – RFP #704-26 Pharmacy Benefit Manager

5. RxResponse_Financial

a. Fill out all tabs to the best of your ability using the provided claims extract

6. RxResponse_Clinical

a. Fill out all tabs to the best of your ability using the provided claims extract

7. RxResponse_QA_Template

a. Use the template to submit questions to the Bonfire Portal (https://cor.bonfirehub.com/)

8. HSLLC_T&Cs

a. These are the preferred HSLLC terms and conditions for use within your proposal. Please follow instructions contained within this attached document in terms of agreement or disagreement with redlines. Any redlines submitted with your proposal response will be considered and further questions may be addressed to you during proposal analysis. Failure to submit a completed HSLLC_T&Cs document per the instructions will remove your proposal from consideration.

9. Intro Page

a. This page contains basic information about the client and the RFP and the current Network

Composition of the client.

10. Survey Questions

a. Fill out the answer column to the best of your ability.

i. Some answers can be checked off when the corresponding tab of either the clinical or financial spreadsheet is completed.

ii. Some answers will be filled out in the Survey Questions spreadsheet directly.

iii. Some answers will require the upload of supplemental files. In this case, please list the file names in the answer to the survey question.

https://cor.bonfirehub.com/

DEVIATIONS FROM SPECIFICATIONS

1. Describe, in detail, any deviations from the specifications.

• Does your organization agree to the Specifications as outlined in the RFP?

• Will your organization administer and/or underwrite the benefits as outlined in the "Proposed Benefit Plans" section?

Signature of Officer

OVERVIEW

Client: City of Richardson

Industry: Municipality

Group to be Covered: All Active Employees working 30+ hours per week

Number of Employees: 978 Active Employees

Location: Richardson, TX 75080

Coverage to Bid: Pharmacy Benefit Manager

Commission: NET OF COMMISSION

Timetable:

Release of Request for Proposals 5/5/2026 Deadline for Questions 5/14/2026 2:00 p.m.

Addenda Sent 5/21/2026 Terms & Conditions 6/4/2026 Uploaded on Bonfire prior to 2:00 p.m.

Proposal Deadline 6/4/2026 Uploaded on Bonfire prior to 2:00 p.m.

Finalist Notifications End of June Best and Final Offers Early July New Coverage Effective 1/1/2027

Direct All Questions To: Ally Dobbins City of Richardson Purchasing Manager Ally.dobbins@cor.gov mailto:Ally.dobbins@cor.gov

COVERAGE / FUNDING MATRIX

VENDOR SELECTION CRITERIA

COVERAGE / FUNDING MATRIX

REQUEST FOR PROPOSALS FOR CITY OF RICHARDSON

Coverage Contributory Non-Contributory Funding *Retiree Cov.

Pharmacy Benefit Manager Current X Self-Funded Pre-65

VENDOR SELECTION CRITERIA OVERVIEW

Selection Criteria: In addition to cost, the City of Richardson is looking for carriers or vendors who can provide a high level of service and whose products hold with long term cost containment goals.

Maximum Contract Length: 5 Years

3-Year rate guarantee with two 1-year renewal options

Opportunity for Presentation: Not required

VENDOR SELECTION CRITERIA

Pharmacy Benefit Manager

The objective of the evaluation of proposals will be to select the provider whose proposal is most responsive to the City's needs, based on the vendor selection criteria below:

1. Cost (60%)

a) Fixed Costs: include insurance costs and administrative costs

b) Variable Costs: costs stated as a percentage of paid claims, cost management

(i.e., shifting of more/less workload to City staff)

c) Ability to reduce claims expenses

d) Cost of PBM integration with current third-party administrator

e) Rebate Transparency

f) Data integrity of AWP vs. MAC

2. Financial Stability (Pass/Fail)

a) Financial Stability (AM Best or Equivalent Agency Rating)

3. Claims Processing (20%)

a) Turnaround time excluding medical review of claims

b) Pended claims procedures

c) Statistical accuracy

d) General service procedures

e) Dedicated service team

f) Willingness to contractually establish performance criteria

g) Turnaround time of prescription resolution issues

h) Claims transparency capabilities

i) Claims adjudication process

4. Past Performance (10%)

a) Active and terminated references

b) Past relationship with client

c) Recognitions / reputation of proposer

d) Claims processing accuracy

5. Network & Service Area (10%)

a. Current pharmacy network/disruption analysis

CITY OF RICHARDSON

MEDICAL RX PLAN OF BENEFITS

CERTIFICATE OF INTERESTED PARTIES

Texas Government Code section 2252.908 provides that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties form to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency. The form discloses any interested parties who have a controlling interest (10% or more ownership) in the business entity and those who actively participate in facilitating the contract or negotiate the terms of the contract (broker, intermediary, advisor, and/or attorney), if any.

The Texas Ethics Commission was required to adopt rules necessary to implement that law, prescribe the disclosure of interested parties form, and post a copy of the form on the commission’s website. The commission adopted the Certificate of Interested Parties form (Form 1295) on October 5, 2015 and new rules (Chapter 46) on November 30, 2015.

The successful proposer will be required to submit a signed 1295 form to the City prior to signing a contract with the City. The successful proposer will be required to download the form via the Texas Ethics Commission’s website at:

The “identification number” to be used on the 1295 form for this procurement is:

RFP No. 704-26

All prospective proposers shall familiarize themselves with this requirement and agree to provide the completed Form 1295 if selected as the successful proposer for this procurement.

CONFLICT OF INTEREST QUESTIONNAIRE

Chapter 176 Texas Local Government Code requires the public disclosure of certain information concerning persons doing business or seeking to do business with the City of Richardson, including family, business, and financial relationships such persons may have with City of Richardson officers or employees involved in the planning, recommending, selecting, and contracting of a vendor for this procurement.

For a copy of Form CIQ and CIS:

https://www.ethics.state.tx.us/forms/conflict/

The Bidder/Proposer acknowledges by doing business or seeking to do business with the City of Richardson that he/she has been notified of the requirements under Chapter 176 of the Texas Local Government Code and that he/she is solely responsible for complying with the terms and conditions therein. Furthermore, any individual or business entity seeking to do business with the City of Richardson who does not comply with this practice may risk award consideration of any City contract.

For a listing of current City of Richardson Officers:

www.cor.net/modules/showdocument.aspx?documentid=9001 https://www.ethics.state.tx.us/forms/conflict/ http://www.cor.net/modules/showdocument.aspx?documentid=9001

PROHIBITION ON CONTRACTS WITH COMPANIES BOYCOTTING ISRAEL

Texas Government Code Chapter 2270, Prohibits on Contracts with Companies Boycotting Israel. A state agency and a political subdivision (which includes a city) may not enter a contract with a company for goods or services unless the contract contains a written verification from the company that; (i) it does not Boycott Israel; and (ii) will not Boycott Israel during the term of the contract. This section does not apply if the Company is a sole proprietor, a non-profit entity or a governmental entity; and only applies if: (i) the Company has ten (10) or more fulltime employees and (ii) this Contract has a value of $100,000.00 or more to be paid under the terms of this Contract.

“Boycott Israel” is defined to mean refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli- controlled territory, but does not include an action made for ordinary business purposes. “Company” is defined to mean a for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit.

I, , the ___________________________

(Name of Certifying Official) (Title or Position of Certifying Official) of , does hereby verify on behalf of said company to the (Name of Company) City of Richardson that said company does not Boycott Israel and will not Boycott Israel (as that term is defined in Texas Government Code Section 808.001, as amended) during the term of this contract.

Signature of Certifying Official

Title

Date of Certification

PROHIBITION OF BOYCOTT OF

ENERGY COMPANIES

Prohibition of Boycott Energy Companies. In accordance with Texas Government Code Chapter 2274, Professional (Contractor) verifies that it does not Boycott Energy Companies and agrees that during the term of this Agreement will not Boycott Energy Companies as that term is defined in Texas Government Code Section 809.001, as amended. This section does not apply if Professional (or Contractor) is a sole proprietor, a non-profit entity, or a governmental entity; and only applies if: (i) Professional (or Contractor) has ten (10) or more fulltime employees and (ii) this Agreement has a value of $100,000.00 or more to be paid under the terms of this Agreement.

I, , the

(Name of Certifying Official) (Title or Position of Certifying Official) of , does hereby verify on behalf of said company to the

(Name of Company)

City of Richardson that said company does not Boycott Energy Companies and agrees that during the term of this Agreement will not Boycott Energy Companies as that term is defined in Texas Government Code Section 809.001, as amended.

PROHIBITION OF DISCRIMINATION AGAINST

FIREARM ENTITIES AND FIREARM TRADE ASSOCIATIONS

In accordance with Texas Government Code Chapter 2274, Professional (Contractor) verifies that it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and (ii) will not discriminate during the term of the contract against a firearm entity or firearm trade association. This section only applies if: (i) Professional (or Contractor) has ten (10) or more fulltime employees and (ii) this Agreement has a value of $100,000.00 or more to be paid under the terms of this Agreement; and does not apply: (i) if Professional (or Contractor) is a sole proprietor, a non-profit entity, or a governmental entity; (ii) to a contract with a sole-source provider; or (iii) to a contract for which none of the bids from a company were able to provide the required certification.

I, , the

(Name of Certifying Official) (Title or Position of Certifying Official) of , does hereby verify on behalf of said company to the

(Name of Company)

City of Richardson that said company does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and will not discriminate during the term of the contract against a firearm entity or firearm trade association.

CERTIFICATIONS AND

REPRESENTATIONS M/WBE STATUS

IS CERTIFIED AS A:

(CHECK ONE, IF APPLICABLE)

DISADVANTAGED BUSINESS ENTERPRISE

MINORITY-OWNED BUSINESS ENTERPRISE

WOMEN-OWNED BUSINESS ENTERPRISE

PLEASE ATTACH OFFICIAL DOCUMENTATION FROM THE STATE OF TEXAS OR

OTHER QUALIFIED CERTIFICATION AGENCY OF M/WBE STATUS OF YOUR COMPANY

WITH YOUR RESPONSE TO THIS ITB/RFQ/RFP.

* * * * * NOTE * * * * *

THIS DATA IS REQUESTED FOR INFORMATIONAL PURPOSES ONLY AND WILL NOT

AFFECT THE ITB/RFQ/RFP AWARD.

(SUBMISSION OF THIS INFORMATION IS NOT A REQUIREMENT.)

CERTIFICATION OF NON-DISCRIMINATION

A. The Contractor (successful Bidder) and/or any subcontractor(s), if permitted, certifies complete compliance with the Federal Civil Rights Law and the Americans with Disabilities Act, agreeing to non-discrimination based on race, age, color, religion, disability, gender, ancestry, national origin, or place of birth in employment practices, programs and services. These practices, programs, and services shall include, but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other compensation; and selection for training, including apprenticeship.

B. The Contractor shall in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, age, color, religion, disability, gender, ancestry, national origin, or place of birth.

C. Upon request by the City, the Contractor shall furnish all information or reports required to investigate his/her payrolls and personnel records, which pertain to current contract(s) with the City for purposes of ascertaining compliance with this non-discrimination certification.

CERTIFICATION OF INDEPENDENT PRICE DETERMINATION

By submission of a response to this ITB, the Bidder certifies, and in the case of a joint offer, each party thereto certifies as to its own organization, that in connection with this procurement:

A. The prices in this response to this ITB 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 Bidder or with any competitor;

B. Unless otherwise required by law, the prices which have been bid herein have not knowingly been disclosed by the Bidder and will not knowingly be disclosed by the Bidder prior to opening of ITB responses, directly or indirectly to any other Bidder or competitor; and

C. No attempt has been made by the Bidder to induce any other person or firm to submit or not to submit an ITB response for the purpose of restricting competition.

BID CERTIFICATION

The undersigned hereby certifies that he/she has read, understands and agrees that acceptance by the City of the Bidder's offer by issuance of a purchase order will create a binding contract. Furthermore, he/she agrees to fully comply with documentary forms herewith made a part of this specific procurement.

NAME OF COMPANY

AUTHORIZED SIGNATURE

ADDRESS

CITY AND STATE ZIP

PHONE NUMBER

DATE

OUT OF STATE CERTIFICATION

As defined by Section 2252.001 of the Texas Government Code, a “nonresident Bidder/Proposer” means a Bidder/Proposer whose principal place of business is not in Texas but excludes a contractor whose ultimate parent company or majority owner has its principal place of business in Texas.

( ) I certify that my company is a “Resident Bidder/Proposer”:

Company Name

( ) I certify that my company qualifies as a “Non-Resident

Bidder/Proposer”

(Note: You must furnish the following information)

Indicate the following information for your “Resident State” (the state in which your principal place of business is located):

Company Name Address

City State Zip

A. Does your “resident state” require Bidders whose principal place of business is in Texas to underprice Bidders whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?

( ) Yes

( ) No

B. What is the prescribed amount or percentage?

$ or %

By signature below, I certify that the above is true and correct and that I am authorized by my company to make such certifications.

Company Name

Signature of Authorized Company Official Date

BIDDER SUPPLEMENTAL INFORMATION

Name of Company:

Indicate the state by which your business is governed:

Is the company a:

Sole Proprietorship Yes No

General Partnership Yes No

Limited Partnership Yes No

Corporation Yes No

Other:

Year the company was established and former names of the company, if applicable.

If the company is a sole proprietorship, please list the owner’s full legal name, the name under which business is conducted (i.e. d/b/a), the address for the company, including the state and county in which your business is located:

If the company is a general partnership, please list the exact name of the partnership, whether it is a partnership formed under the laws of the State of Texas or another state, the business address for the partnership, including the state and county, and list of the names of all of the partners for the partnership:

If the company is a limited partnership, please list the exact name of the limited partnership, whether it is a limited partnership formed under the laws of the State of Texas or another state, the business address for the limited partnership, including the state and county, and list the names of all the general partners for the partnership:

Bidder Supplemental Information continued

In the case of a limited partnership (foreign or domestic), is it registered with the Secretary of the State of the State of Texas and authorized to do business in this State?

Yes No

In the case of a limited partnership (foreign or domestic), is its general partner(s) registered with the Secretary of State of the State of Texas and authorized to do business in this State?

Yes No

If the company is a corporation, please list the exact name of the corporation, whether it is a corporation formed under the laws of the State of Texas or another state, the business address for the corporation, including the state and county, and list the names of all of the officers of the corporation:

In the case of a corporation (foreign or domestic), is it registered with the Secretary of State of the State of Texas and authorized to do business in this State?

Yes No

If the company is a limited liability company, please list the exact name of the limited liability company, whether it is a limited liability company formed under the laws of the State of Texas or another state, the business address for the limited liability company, including the state and county, and list the names of all the members/managers for the limited liability company:

In the case of a limited liability company (foreign or domestic), is it registered with the Secretary of State of the State of Texas and authorized to do business in this State?

Yes No

In the case of a limited liability company (foreign or domestic), is its member(s)/manager(s) (if not an individual) registered with the Secretary of State of the State of Texas and authorized to do business in this State?

Yes No

If the company is another entity not listed above, please lists the exact name and type of company, the state under which it is formed, the business address for the company, including the state and county, and lists the names of all of the persons authorized to act on the company’s behalf:

CITY OF RICHARDSON TERMS AND CONDITIONS OF BIDDING

FOR COOPERATIVE PURCHASING

As permitted under Government Code, Title 7, Chapter 791.025, other governmental entities may wish to cooperatively purchase under the same terms and conditions contained in this contract (piggyback). Each entity wishing to piggyback must have prior authorization from the City and Contractor. If such participation is authorized, all purchase orders will be issued directly from and shipped directly to the entity requiring supplies/services. The City shall not be held responsible for any orders placed, deliveries made, or payment for supplies/services ordered by these entities. Each entity reserves the right to determine their participation in this contract.

IS YOUR FIRM WILLING TO ALLOW OTHER GOVERNMENTAL ENTITIES TO PIGGYBACK OFF

THIS CONTRACT, IF AWARDED, UNDER THE SAME TERMS AND CONDITIONS?

YES NO

HOW DID YOU HEAR ABOUT US?

The City of Richardson would like to know how you heard about this invitation to bid. Please select from the following options:

NEWSPAPER

BONFIRE

PLAN ROOM

CITY REPRESENTATIVE

OTHER (PLEASE SPECIFY BELOW)

REFERENCES

Provide three client references, preferably of same size and industry:

NAME OF

CLIENT

CONTACT

PERSON

TELEPHONE

NUMBER

NUMBER OF

EMPLOYEES

1.

2.

3.

Provide two terminated client references:

NAME OF

CLIENT

CONTACT

PERSON

TELEPHONE

NUMBER

NUMBER OF

EMPLOYEES

1.

2.

SUMMARY, CONDITIONS & SPECIFICATIONS

The undersigned hereby acknowledges that they have reviewed these specifications, have had the opportunity to clarify any question or information in these specifications in the manner provided and that the responses are true and accurate.

The undersigned hereby agrees to furnish all services in complete accordance with the requirements of these specifications, the answers provided in responding to these specifications.

The undersigned affirms that this proposal has been arrived at independently and is submitted without collusion to obtain information or gain any favoritism that would in any way limit competition or give unfair advantage to the proposer.

The undersigned hereby declares that they have the authority to represent the proposer and to bind this proposal at the rates contained herein and that the resultant contract will reflect the answers provided in response to these specifications and questionnaire.

Name of Proposer:

Proposer Phone:

Proposer E-mail:

Signature:

Printed Name:

Title:

Date:

ATTACHMENTS

Census

Plan SPD COR_RxResponse_HSLLC_T&Cs - Word COR_RxResponse_QA_Template - Excel COR_RXRFP_Response_Clinical - Excel

COR_RFP_Financial – Excel COR_RxRFP_Response_SurveyQuestions – Excel

Contact: Charlotte.starks@hubinternational.com for the attachments not on Bonfire mailto:Charlotte.starks@hubinternational.com