18-Volume of Previous Payments Attestation - RFP-RFQ-RLI.docx

DOCX document 47 KB Posted

Attached to
Group Long Term Disability Insurance
Solicitation number
GEN2129113P1
Issued by
Broward County, Florida

About this file

This document is a Volume of Previous Payments Attestation form for Broward County, Florida, related to a solicitation for Group Long Term Disability Insurance. The form requires vendors to report their payment history with Broward County over the past five years, including prime contract payments and payments to Certified County Business Enterprise (CBE) firms. Vendors must disclose all contracts awarded by the Broward County Board of County Commissioners, with specific attention to joint venture arrangements and equity percentages.

The solicitation emphasizes the importance of CBE participation and uses the volume of previous payments as a potential tie-breaker mechanism. Vendors must electronically submit their responses through BPRO (Broward County's procurement system) and may be required to provide supporting documentation within three business days of request. The form includes provisions for both individual vendors and joint venture firms, with points assigned based on payment volumes and CBE goal commitments. The procurement process involves the Broward County Human Resources Division and the Office of Economic and Small Business Development, with a focus on providing long-term disability insurance and related administrative services for benefit-eligible employees.

View the file

Other files

File Type Posted
22-Pricing Worksheet, GEN2129113P1, Group Long Term Disability Insurance.xlsx XLSX spreadsheet
12-Vendor Reference Verification, GEN2129113P1, Group Long Term Disability Insurance.docx DOCX document
25-Instructions to Vendors, GEN2129113P1, Group Long Term Disability Insurance.pdf PDF
14-Performance Measures Questionnaire GEN2129113P1 Group Long Term Disability Insurance.docx DOCX document
26-Vendor Questionnaire and Standard Certifications - RFP-RFQ-RLI.docx DOCX document
24-Addenda No. 1, GEN2129113P1, Group Long Term Disability Insurance.pdf PDF
32-Submissions, GEN2129113P1, Group Long Term Disability Insurance.pdf PDF
10-Plan Design Questionnaire, GEN2129113P1 Group Long Term Disability Insurance.docx DOCX document
23-Scope of Services, GEN2129113P1, Group Long Term Disability Insurance.pdf PDF
6-Litigation History —
11-Attachment 3 - Census Report.pdf PDF
1-OESBD - Procurement Preferences SBE-CBE —
5-OESBD Ownership Disclosure —
15-Agreement Exceptions - RFP-RFQ-RLI.docx DOCX document
16-Domestic Partnership Act Certification - RFP-RFQ-RLI.docx DOCX document
7-Subcontractors-Subconsultants-Suppliers Requirement.docx DOCX document
21-ETS Vendor Security Questionnaire, GEN2129113P1, Group Long Term Disability Insurance.xlsx XLSX spreadsheet
27-Addenda No. 2.pdf PDF
29-Attachment 2 - Group Claim Experience Report January 1, 2021 - June 30, 2025 Updated.pdf PDF
19-Foreign Country of Concern Attestation (PII).docx DOCX document
3-Lobbyist Registration Requirement Certification —
4-OESBD Affiliated Entities of the Principals Certification —
30-Group LTD Premium Rate History July 1, 2020 - June 30, 2024.pdf PDF
13-Insurance Requirement, GEN2129113P1, Group Long Term Disability Insurance.pdf PDF
17-Location Certification - RFP-RFQ-RLI.docx DOCX document
20-Criminal History Screening Practices Certification.docx DOCX document
8-Attachment 1 - Claims to Premium Report January 1, 2021 - December 31, 2024.pdf PDF
2-Summary of Vendor Rights for Broward County Competitive Solicitations —
28-Addenda No. 3.pdf PDF
9-Evaluation Criteria, GEN2129113P1 Group Long Term Disability Insurance.pdf PDF
31-619352 Incurred Paid Report January 1, 2021 - June 30, 2025.pdf PDF
Show all 31

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

The completed form(s) should be returned with the Vendor’s submittal. If not provided with the submittal, Vendor must submit the form(s) within three business days after County’s request. Failure to timely submit this form and supporting documentation may affect the Vendor’s evaluation.

Points assigned for Volume of Previous Payments will be based on the amount paid-to-date by the Broward County Board of County Commissioners (County) to a prime Vendor MINUS the Vendor’s confirmed payments paid-to-date to approved certified County Business Enterprise (CBE) firms performing services as Vendor’s subcontractor/subconsultant to obtain the CBE goal commitment as confirmed by County’s Office of Economic and Small Business Development. Reporting must be within five (5) years of the current solicitation’s closing date.

Vendor must list all received payments paid-to-date by contract as a prime vendor from Broward County Board of County Commissioners. Reporting must be within five (5) years of the current solicitation’s closing date.

Vendor must also list all total confirmed payments paid-to-date by contract, to approved certified CBE firms utilized to obtain the contract’s CBE goal commitment. Reporting must be within five (5) years of the current solicitation’s closing date.

In accordance with Section 21.41(h)(4) and 21.42(d)(3) of the Broward County Procurement Code, the Vendor with the lowest dollar volume of payments previously paid by the County over a five-year period from the current solicitation’s closing date will receive the Tie Breaker.

The Vendor attests to the following:

Project Title
Contract No.
Department/Division
Date Awarded
Prime: Paid to Date
CBE: Paid to Date
Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

Has the Vendor been a member/partner of a Joint Venture firm that was awarded a contract by the County?

☐ Yes (if Yes, Vendor must submit a Joint Venture Volume of Previous Payments Attestation.)

☐ No Vendor Name: Click or tap here to enter text.

Form Date 9/9/24

VOLUME OF PREVIOUS PAYMENTS ATTESTATION

REQUEST FOR PROPOSALS, REQUEST FOR QUALIFICATIONS, OR REQUEST FOR LETTERS OF INTEREST

VOLUME OF PREVIOUS PAYMENTS ATTESTATION FORM FOR JOINT VENTURE

The completed form(s) should be returned with the Vendor’s submittal. If not provided with the submittal, Vendor must submit the form(s) within three business days after County’s request. Failure to timely submit this form and supporting documentation may affect the Vendor’s evaluation.

If a Joint Venture, the payments paid-to-date by contract provided must encompass the Joint Venture and each of the entities forming the Joint Venture. Points assigned for Volume of Previous Payments will be based on the amount paid-to-date by contract to the Joint Venture firm MINUS all confirmed payments paid-to-date to approved certified CBE firms utilized to obtain the CBE goal commitment. Reporting must be within five (5) years of the current solicitation’s closing date. Amount will then be multiplied by the member firm’s equity percentage.

In accordance with Section 21.41(h)(4) and 21.42(d)(3) of the Broward County Procurement Code, the Vendor with the lowest dollar volume of payments previously paid by the County over a five-year period from current solicitation’s closing date will receive the Tie Breaker.

The Vendor attests to the following:

Project Title
Contract No.
Department/ Division
Date Awarded
JV Equity Percent
Prime: Paid to Date
CBE: Paid to Date
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.
Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.Click or tap here to enter text.

Vendor is required to submit an executed Joint Venture agreement(s) and any amendments for each project listed above. Each agreement must be executed prior to the opening date of this solicitation.

Vendor Name: Click or tap here to enter text.

Form Date 9/9/24

File details come from the government source that posted it. Updated .