11-Required Forms (26-002V).doc

RFP Required Forms

FOR

Stop Loss Insurance Solicitation # 25-002V Issued By:

Schertz-Cibolo-Universal City Independent School District Closing Date:

2:00 PM

October 23, 2025 SCUCISD is accepting proposals to provide in accordance with the instructions, specifications, terms, and conditions, contained in this Solicitation.

ADDENDA TO RFP. SCUCISD reserves the right to revise and amend the specifications prior to the date set for the receipt of proposals. Respondents are requested to clarify any ambiguity, conflict, discrepancy, omission, or other error(s) in the RFP in writing. Revisions or amendments, if any, will be made by issuing an addendum. Every effort will be made to send addenda issued to the parties known to have been furnished a complete copy of the RFP. It is the responsibility of each Contractor, prior to submitting the Proposal, to contact the Purchasing Department to determine if addenda were issued and, if so, to obtain such addenda for attachment to the Proposal. Register online at https://scucisd.bonfirehub.com/ to receive any addenda and submit questions or comments concerning this solicitation.

For Further Information Contact:

SCUCISD Purchasing & Supply Department

Attn: Terri Canal, CPPB, CTSBO 1056 Elbel Road, Schertz, TX 78154

PH: 210-945-6223

Email: tcanal@scucisd.org

REQUIRED FORMS

FORMS INCLUDED IN THIS SOLICITATION DOCUMENT

(1) Proposal Form - Attachment A

(2) Vendor Questionnaire and References – Attachment B

(3) Vendor Workbook Response - Attachment C – posted as separate document

(4) Exceptions to this Solicitation - Attachment D

(5) Felony Conviction Notice - Attachment E

(6) Conflict of Interest Form CIQ – Attachment F Proposal Checklist – to be utilized as a guide only.

*Download solicitations, addenda, and other forms at: https://scucisd.bonfirehub.com/

ATTACHMENT A

PROPOSAL FORM

NOTE:

Failure to complete this form shall result in your Proposal being deemed non-responsive and rejected without further evaluation.

We, , (Company Name) of, , (Business Address)

(Zip Code) The undersigned, having fully and carefully read and examined the Request for Proposal (RFP) Documents, Enclosures and Addenda, hereby offers to Schertz-Cibolo-Universal City Independent School District a Proposal for Stop Loss Insurance in accordance with the solicitation documents, and addenda at the place, price and in a manner set out therein and certifies the following;

a. Represents that to the best of its knowledge it is not indebted to the Schertz Cibolo Universal City Independent School District. Indebtedness to the District shall be basis for the non-award and/or cancellation of any award.

b. Certifies that no suspension or debarment is in place that would preclude receiving a federally funded contract.

c. The undersigned affirms that they are duly authorized to execute this contract, to fully comply with the terms and conditions of this Request for Proposal, including all forms and attachments included herein, that this company, corporation, firm, partnership or individual has not prepared this Proposal in collusion with any other Bidder, and that the contents of this Proposal as to prices, terms or conditions of said Proposal have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this solicitation.

ADDENDA ACKNOWLEDGEMENT

Acknowledgement is hereby made of receipt of the following addenda to this PROPOSAL document:

Addendum No. ______ dated _________________, ______ pages

Addendum No. ______ dated _________________, ______ pages

Addendum No. ______ dated _________________, ______ pages

Signatures: Signed and submitted by:

(Signature of person authorized to sign)

(Print name of person authorized to sign) Name of person to contact regarding this Proposal:

Title:

Telephone #:

FAX:

E-Mail:

ATTACHMENT B

VENDOR QUESTIONNAIRE

In submitting a proposal, each Prospective Bidder shall also provide the following information: (Use additional sheets, if necessary.) A qualifying Proposal must address all items. Incomplete Proposals may be rejected.

PART I - GENERAL INFORMATION

1. Prospective Bidder Information: Provide the following information regarding the Prospective Bidder.

Prospective Bidder Name:

(NOTE: Give exact legal name as it will appear on the contract, if awarded.)

Principal Address:

City:

State:

Zip Code:

Telephone No.

Fax No:

Website address:

Year established:

Provide the number of years in business under the present name:

2. Account Representative: List the account representative information that would service the District’s account, if awarded.

Name:

Title:

Address:

City:

State:

Zip Code:

Office Phone:

Cell Phone:

Fax:

Email Address:

3. Remittance Information:

Please specify the correct legal business name, contact person, address, phone and fax numbers that should be used as the remittance address by SCUCISD, if different from vendor information above.

Legal Business Name:

Address:

City, State, Zip:

Phone:

4. Ordering Information: Please specify the correct legal business name, contact person, address, phone and fax numbers that should be used for all purchase order submittals by the District.

Vendor Contact:

Phone:

Hours of Operation:

Indicate email for receiving purchase orders:

FORMCHECKBOX

Email: _____________________________________________

5. Debarment/Suspension Information: Has the Prospective Bidder or any of its principals been debarred or suspended from contracting with any public entity?

Yes No

If “Yes”, identify the public entity and the name and current phone number of a representative of the public entity familiar with the debarment or suspension, and state the reason for or circumstances surrounding the debarment or suspension, including but not limited to the period of time for such debarment or suspension.

PART II - References:

Provide a minimum of three (3) references that Respondent has provided like services to within the past three (3) years, preferably with K-12 School Districts within the state of Texas. The contact person named should be familiar with the day-to-day management of the contract and be willing to respond to questions regarding the type, level, and quality of service provided.

Reference 1:

Company/District Name:

Contact Name/Title:

Business Address

Contact Phone #:

Contact Email Address:

Date(s) of Contract:

Reference 2:

Company/District Name:

Contact Name/Title:

Business Address

Contact Phone #:

Contact Email Address:

Date(s) of Contract:

Reference 3:

Company/District Name:

Contact Name/Title:

Business Address

Contact Phone #:

Contact Email Address:

Date(s) of Contract:

ATTACHMENT C

VENDOR WORKBOOK RESPONSE

Attachment C – Vendor Workbook Response posted as separate document in Bonfire under the Supporting Documentation section. To access, go to: https://scucisd.bonfirehub.com/.

Workbook tabs include:

1. Cover Sheet

2. General Information

3. Scope of Work

4. Proposal Specifications

5. Deviations Tab

6. Option 1 - Stop Loss Pricing $200K

7. Option 2 - Stop Loss Pricing $250K

8. Option 3 - Stop Loss Pricing $300K

9. Stop Loss Request for Information (RFI)

10. Medical Administration Questionnaire

ATTACHMENT D

EXCEPTIONS TO THIS SOLICITATION

Does the Prospective Bidder have any deviations to any conditions and/or specifications/scope of services listed in this document?

FORMCHECKBOX

No

FORMCHECKBOX

Yes

If yes, noted in writing herein.

(Attach additional Pages if necessary)

Note: Each exception must be clearly defined and referenced to the proper section and paragraph in this Solicitation.

ATTACHMENT E

FELONY CONVICTION NOTICE

State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History, Subsection (a), states “a person or business entity that enters into a contract with a school District must give advance notice to the District if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony”.

Subsection (b) states “a school District may terminate a contract with a person or business entity if the District determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The District must compensate the person or business entity for services performed before the termination of the contract”.

THIS NOTICE IS NOT REQUIRED OF A PUBLICLY-HELD CORPORATION (Sign under ITEM A) I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me and the following information furnished is true to the best of my knowledge.

VENDOR’S NAME: ______________________________________________________

AUTHORIZED COMPANY OFFICIAL’S NAME: __________________________________

A.

My firm is a publicly-held corporation; therefore, this reporting requirement is not applicable.

Signature of Company Official: _____________________________ B.

My firm is not owned nor operated by anyone who has been convicted of a felony.

C.

My firm is owned or operated by the following individual(s) who has/have been convicted of a felony.

Name of Felon(s): _________________________________________

(Attach additional sheet if necessary.)

Details of Conviction(s): ____________________________________

(Attach additional sheet if necessary.)

ATTACHMENT F

PROPOSAL CHECKLIST

Use this checklist to ensure that all required documents have been included in the proposal and that they appear in the correct order.

Electronic Submissions: Upload Document(s) through Euna Bonfire (https://scucisd.bonfirehub.com/)

Documents marked with an asterisk (*) on this checklist require a signature. Be sure they are signed prior to submitting proposal.

REV 09.25

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Schertz-Cibolo-Universal City ISD Solicitation No. 26-002V, Stop Loss Insurance