3242_4.DOCX
DOCX document 40 KB Posted
- Contract number
- S-0190
- Issued by
- Wisconsin
About this file
This is a Request for Services form (F-01445) for hourly engagements under the Wisconsin eHealth Program, administered by the Wisconsin Department of Health Services Division of Health Care Access and Accountability. The contract (Number 435400-P15-eHealth) involves two authorized contractors: Deloitte Consulting and Public Consulting Group (PCG), with specific contact persons designated for each company to receive service requests and bid responses.
The contract covers Health Information Technology (HIT) services where authorized users can request contracted personnel for individual hourly engagements across various job titles and experience levels as defined in RFP S-0190 DHCAA-14. Contractors must submit candidates with hourly rates at or below established ceiling rates specified in the contract's Rate Card (Exhibit A), with preference given to proposals offering rates below these ceilings. The engagement process requires authorized users to solicit bids from both contractors, evaluate candidates based on skills, experience, and rates, and select the best value option. The state does not cover travel expenses for personnel, and contractors must certify no conflicts of interest exist with the procuring agency or authorized users.
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| 3242_6.PDF |
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Text version
DEPARTMENT OF HEALTH SERVICES
Division of Health Care Access and Accountability F-01445 (02/15)
STATE OF WISCONSIN
WISCONSIN EHEALTH PROGRAM HOURLY ENGAGEMENTS REQUEST FOR SERVICES
Health Information Technology (HIT) Services Suppliers (Contract Number 435400-P15-eHealth)
Authorized Users should use this form to acquire Health IT Services Supplier contracted personnel for individual hourly engagements. An Authorized User can acquire one or more individuals with the same or different job titles and levels for an engagement. If an Authorized User needs several contracted personnel for a single project, i.e., a project team, the Authorized User should use form F-01446 to request candidates and rates for a project team.
Authorized User: Select the job title and level needed based on the job descriptions in Appendix I of RFP S-0190 DHCAA-14.
After completing the form, the Authorized User shall send a single email requesting services and a bid response with a due date/time for the response and attach the RFS form to the email. The email should be addressed to the contractors eligible to bid personnel under Contract 435400-P15-eHealth, i.e., Deloitte Consulting and Public Consulting Group (PCG), using the following addresses with courtesy copy to ehealth@wi.gov:
| Deloitte Consulting: Russell Pederson, rpederson@deloitte.com and Heidi Pedder, hpedder@deloitte.com |
| PCG: Janice Paterson, jpaterson@pgus.com and Stuart Kaufman, skaufman@pcgus.com |
When the Authorized User receives the responses from the contractors, the Authorized User shall review the candidates and rates proposed by each contractor and select the candidates that best meet the skill and experience required with the best rate for the individual hourly engagement. The Authorized User may conduct interviews and check references before making a final decision. The Authorized User should document and retain the rationale for the final selection and inform Deloitte Consulting and PCG of the results in writing. For an individual hourly engagement requesting more than one contracted personnel, the Authorized User can choose candidates proposed by either contractor or just one contractor, based on best value.
Date of Request Response Due Date / Time Authorized User / Agency
Estimated Engagement Start Date Estimated Engagement End Date Estimated Total Work Days
Location of Engagement Contact Name Telephone Number
E-mail address Fax Number Preferred Response Format |_| E-mail |_| Postal |_| Fax
Engagement Request Information
| Number of staff needed |
| Job Title(s)/Level(s) (listed in Appendix I, Job Descriptions by Title / Level of RFP S-0190 DHCAA-14) |
| Experience |
| Minimum Number of Years |
| Preferred Number of Years |
Hourly rates quoted below the ceiling rates for specified job titles / levels or a total cost less than $ (assuming 8 hours per work day for each candidate for the engagement duration) will be given first consideration.
EHEALTH PROGRAM REQUEST FOR SERVICES FOR HOURLY ENGAGEMENTS Page 2 of 3
Engagement Description / Specifications (include Deliverables (products / services) and a timetable). In the space below, outline any special terms and conditions of the engagement, identify any special skills, knowledge, or certifications required; give enough background information so the vendors can give meaningful estimates and provide the right candidates. All terms and conditions of the Contract apply to each engagement. Authorized User may add and negotiate additional terms and conditions not addressed under this Contract in the Authorized User’s Engagement Letter.
EHEALTH PROGRAM REQUEST FOR SERVICES FOR HOURLY ENGAGEMENTS Page 3 of 3
VENDOR CONTACT - Complete the information below, and attach this form to each resume submitted. The candidates resumes should address the specific experience that relates to the specifications listed above. Incomplete responses may be rejected or set aside in favor of completed responses.
Vendor Name
Contact Person
Email Address Telephone Number Fax Number
CANDIDATES - Each candidate submitted must be listed below and information requested must be provided even if the same information is provided on the resume. Attach a resume for each candidate. References must be from customers for whom the candidate has done work. The job titles, levels, and descriptions for this contract are in Appendix I of RFP S-0190 DHCAA-14. Proposed hourly rates shall be at or below the ceiling rates in the Rate Card at Exhibit A in the contract.
| Candidate |
| Reference |
| Hourly Rate |
Full Name
Company Name
| Job Title / Level |
| Contact Name |
Telephone Number
Full Name
Company Name
| Job Title / Level |
| Contact Name |
Telephone Number
Full Name
Company Name
| Job Title / Level |
| Contact Name |
Telephone Number
Full Name
Company Name
| Job Title / Level |
| Contact Name |
Telephone Number
Total engagement cost assuming 8 hours per work day for the engagement duration specified on Page 1 for each candidate.
The Contractor shall certify in writing to the Authorized User that no relationship exists between the Contractor and the procuring or Authorized User that interferes with fair competition or is a conflict of interest, and no relationship exists between the Contractor and another person or organization that constitutes a conflict of interest with respect to any State Contract.
The State does not pay for any expenses for the personnel to travel to and from the work site.
SIGNATURE – Authorized User
Date Signed
Printed Name of Signer
File details come from the government source that posted it. Updated .