3-PD 1.1 Attachment A- Proposal Submittal Form TR.docx
DOCX document 31 KB Posted
- Attached to
- Employee Benefits Consultant
- Solicitation number
- RFP 25-008
- Issued by
- Williamson County, San Antonio City, Texas
About this file
This is a Proposal Submittal Form and Execution document issued by the City of Round Rock, Texas, for use in response to a Request for Proposals (RFP) seeking an Employee Benefits Consultant. The City of Round Rock requires qualified firms to provide comprehensive employee health benefits consulting services as a full-service advisor covering strategic, financial, actuarial, compliance, communication, wellness, and administrative support. The City currently serves approximately 1,150 benefits-eligible employees across a self-funded health benefits program covering approximately 2,400 individuals, including two co-pay plan options (PPO and EPO types), an on-site health clinic providing personal and occupational health services, and ancillary benefits including dental, vision, EAP, disability, life insurance, accident, critical illness, hospital indemnity, and pre-paid legal/identity theft prevention. The FY 2026 self-funded health insurance budget is $24,785,000, with additional funding dedicated to dental, vision, and wellness programs. Retirement benefits are administered through the Texas Municipal Retirement System and Nationwide Retirement for 457(b) Deferred Compensation benefits. The submittal form requires respondents to complete all sections, provide accurate and current information, certify authorized representation, and submit documentation through the City's Bonfire portal.
Respondents must certify that all statements, pricing, and information are complete and accurate, and confirm they have not offered any economic opportunities, employment, gifts, loans, gratuities, discounts, or favors to City employees or evaluators. The document specifies that the City's Definitions and Standard Terms and Conditions, in effect at the time of solicitation release, shall govern the contract unless otherwise specified, and that Supplemental Terms and Conditions listed in Section III shall also be enforced. Additional terms and conditions are available on the City's website at https://www.roundrocktexas.gov/city-businesses/solicitations/. The form requires the respondent company name, authorized signatory signature and printed name, title, date, complete address, telephone and fax numbers, email address, and Federal Tax Identification Number. Failure to complete, sign, and upload this attachment with the submittal may result in disqualification.
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Text version
ATTACHMENT A
SOLCITATION SUBMITTAL FORM AND EXECUTION
City of Round Rock Name of Solicitation RFP No. XX-XXX Class/Item: ###-## / ###-##
MONTH & YEAR
NOTE: RESPONDENTS SHALL COMPLETE, SIGN, AND UPLOAD THIS ATTACHMENT WITH THEIR SUBMITTAL IN BONFIRE. FAILURE TO DO SO MAY RESULT IN DISQUALIFICATION OF THE SUBMITTAL.
By signature hereon, the Respondent certifies that:
All statements, pricing and information prepared and submitted to the City’s Bonfire portal in response to this solicitation are current, complete, and accurate.
He/she 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 City employee, evaluator, or evaluating entity in connection with the submitted response. Signing the Execution of Solicitation Submittal Form with a false statement shall void the submitted offer or any resulting contracts.
Respondent represents and warrants that the individual signing this Execution of Solicitation Submittal Form is authorized to sign this document, represent the Respondent and to bind the Respondent under any contract resulting from this submittal.
RESPONDENT (COMPANY):
SIGNATURE (INK/DIGITAL):
NAME (TYPED/PRINTED):
TITLE:
DATE:
STREET:
CITY/STATE/ZIP:
TELEPHONE & FAX NO.:
E-MAIL ADDRESS:
FEDERAL TAX IDENTIFICATION NUMBER (FIN):
By submitting a response to this solicitation, the Respondent agrees that the City’s Definitions and Standard Terms and Conditions, in effect at the time of release of the solicitation, shall govern unless specifically provided otherwise in a separate agreement or on the face of a purchase order. In addition, the Supplemental Terms and Conditions listed in Section III, shall also be enforced as part of the contract, and can be obtained from the City’s website at: https://www.roundrocktexas.gov/city-businesses/solicitations/
File details come from the government source that posted it. Updated .