3242_5.DOCX
DOCX document 38 KB Posted
- Contract number
- S-0190
- Issued by
- Wisconsin
About this file
This document is a project-based work request form for the Wisconsin eHealth Program, administered by the Wisconsin Department of Health Services Division of Health Care Access and Accountability. The form is used under Contract Number 435400-P15-eHealth to procure Health Information Technology (HIT) services from two authorized suppliers: Deloitte Consulting and Public Consulting Group (PCG). Authorized users must submit requests via email to both contractors simultaneously, with a courtesy copy to ehealth@wi.gov, and the contractors compete by proposing candidates and rates for project-based engagements.
The contract covers Health IT services personnel across various job titles and levels as defined in Appendix I of RFP S-0190 DHCAA-14. Contractors must bid hourly rates at or below ceiling rates specified in the contract's Rate Card (Exhibit A) and propose specific candidates with estimated project hours for each deliverable. The authorized user selects the project team based on best qualifications and total project cost, with the authority to conduct interviews and reference checks. The state does not reimburse travel expenses for contractor personnel, and contractors must certify no conflicts of interest exist. Total project costs are calculated by multiplying each candidate's hourly rate by their estimated project hours.
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| 3242_4.DOCX | DOCX document | |
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Text version
DEPARTMENT OF HEALTH SERVICES
Division of Health Care Access and Accountability F-01446 (02/15)
STATE OF WISCONSIN
WISCONSIN EHEALTH PROGRAM PROJECT-BASED WORK 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 a project-based engagement. An Authorized User can acquire one or more individuals with the various job titles and levels needed to establish a project team from Deloitte Consulting or PCG.
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
The contractors shall propose the job titles and levels needed using the job descriptions in Appendix I of RFP S-0190 DHCAA-14 as a guide, and bid a rate and a specified number of hours for each proposed candidate based on the services and deliverables needed for the project. The hourly rates bid shall be at or below the ceiling rates in the Rate Card at Exhibit A in the contract.
When the Authorized User receives the contractors’ responses, the Authorized User shall review the candidates and rates proposed by each contractor and select the project team with the candidates that best meet the skill and experience required at the best total cost for the project. 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 selection and inform Deloitte Consulting and PCG of the results in writing.
Date of Request Response Due Date / Time Authorized User / Agency
Estimated Engagement Start Date Estimated Engagement End Date Location of Engagement
Contact Name Telephone Number E-mail Address
| Fax Number | |
| Preferred Response Format | |_| E-mail |_| Postal |_| Fax |
Engagement Request Information
Project 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 for the project team. 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 PROJECT-BASED WORK REQUEST FOR SERVICES | Page 2 of 3 F-01446 (02/15) | |
| Engagement Request Information - Continued |
| EHEALTH PROGRAM REQUEST FOR SERVICES FOR PROJECT-BASED WORK REQUEST FOR SERVICES | Page 3 of 3 F-01446 (02/15) |
| 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 |
| Project Hours |
| Total Cost |
| 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
| Project total cost to complete deliverables. The total cost shall be based on the number of project hours the vendor estimates for each proposed candidate multiplied by the candidate’s hourly rate. |
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
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