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Directions Exhibit Instructions to Offerors
When completing the exhibits in the Excel workbook, please follow the directions below:
| 1. Do not add or delete rows, columns or alter-pre-labeled text in the exhibits |
| 2. Electronic copies of these exhibits must be returned in Excel. Do not provide in a PDF format. |
| 3. Do not extract individual worksheets (exhibits) and submit as separate Excel workbooks in the electronic copy. |
| 4. Exhibits with light yellow color-coded cells require Offeror responses. Do not leave blank as this may jeopardize a thorough understanding of your proposal. |
5. Do not refer the reader to "see my price proposal" rather than completing the exhibits herein. Your Offer may be rejected for being incomplete.
| Unauthorized replication or use of this financial workbook is prohibited. |
| Copyright © 2025 by Segal. All rights reserved. |
Fee Sheet
| CITY OF CHANDLER |
| RFP #HR5-918-4486 |
| EAP SERVICES FEE QUOTATION FORM |
| Effective January 1, 2026 |
| Please do not alter or delete pre-populated rows. Complete yellow shaded areas only. Refer to the Scope Of Work for services requested. Include comments (expand as needed) to help clarify your proposal pricing so that we are able to have a thorough understanding of your offer. Please do not refer to other RFP materials you provide to understand your pricing. All of your comments to support your pricing must be on this exhibit. Set-up fees or one time implementation fees are highly discouraged but may be listed in an appropriate row. |
| Offerors must complete and submit the Price Proposal in the format requested below. |
| The fee per member per month must be inclusive of all services proposed in response to the Scope of Services. |
| | # of Eligible Employees | 1,248 | 1/1/26 | 1/1/27 | 1/1/28 | 1/1/29 | 1/1/30 |
| | (217 PD, 217 Fire, 814 other eligible employees) | | 12/31/26 | 12/31/27 | 12/31/28 | 12/31/29 | 12/31/30 |
| | EAP Services | | 10 Visit | | | | |
| Model | 10 Visit | | | | | | | |
| Model | 10 Visit | | | | | | | |
| Model | 10 Visit | | | | | | | |
| Model | 10 Visit | | | | | | | |
Model
| Start Up Fees | | | | | |
| Administrative Fee (PEPM) | | | | | |
| Estimated Annual Premium | $0 | $0 | $0 | $0 | $0 |
| Critical Incident Stress Management (CISM) Services | | | | | |
| How Many Hours Are Included without Extra Charge | | | | | |
| Per Hour Rate for Additional Hours | | | | | |
| Are There Any Additional Charges for Services? | | | | | |
| Orientation / Training / Educational Seminars | | | | | |
| How Many Hours Are Included without Extra Charge | | | | | |
| Per Hour Rate for Additional Hours | | | | | |
| Are There Any Additional Charges for Services? | | | | | |
| Indicate How Many Hours Included or Additional Fee for: | | | | | |
| Mediation for HR Referrals | | | | | |
| 24-Hour Telephonic Crisis Counseling | | | | | |
| Internet Services | | | | | |
| In-Person Health/Benefit Fair Representation (1 day per year) | | | | | |
| Educational/Promotional Materials | | | | | |
| Mediation / Management referrals for general counseling, job performance, and other related employment activities | | | | | |
| Referrals to Outside Agencies for: | | | | | |
| Child Care | | | | | |
| Elder Care | | | | | |
| Identity Theft Monitoring/Repair | | | | | |
| Legal Services and Financial Services: | | | | | |
| How Many Hours Included | | | | | |
| Discount or Per Hour Rate for Additional Hours | | | | | |
| Additional Services: | | | | | |
| Unlimited online training modules | | | | | |
| Unlimited online seminars | | | | | |
| Unlimited online wellness resources | | | | | |
| Wellness coaching and HRA | | | | | |
| Nurseline | | | | | |
| Other (Specify) | | | | | |
| Other (Specify) | | | | | |
| Other (Specify) | | | | | |
| Authorized Signature |
| Vendor Name |
| Date |
| Contact Phone Number |
| Comments |
| Unauthorized replication or use of this financial workbook is prohibited. |
| Copyright © 2025 by Segal. All rights reserved. |
Provider Counts
| CITY OF CHANDLER |
| RFP #HR5-918-4486 |
| EAP SERVICES PROVIDER COUNTS |
| Effective January 1, 2026 |
| Provide a list of the number of available EAP counselors matched to the cities of this client’s employees on the grid below: |
| City | # of EAP Counselors |
| Avondale | |
| Chandler | |
| Gilbert | |
| Glendale | |
| Goodyear | |
| Litchfield Park | |
| Mesa | |
| Peoria | |
| Phoenix | |
| Queen Creek | |
| Scottsdale | |
| Tempe | |
| Tolleson | |
| Total | 0 |
| Authorized Signature |
| Vendor Name |
| Date |
| Contact Phone Number |
| Comments |
| Unauthorized replication or use of this financial workbook is prohibited. |
| Copyright © 2025 by Segal. All rights reserved. |
References
| CITY OF CHANDLER |
| RFP #HR5-918-4486 |
| EAP SERVICES REFERENCES |
| Effective January 1, 2026 |
| Provide three client references similar in size and industry. Include contact name, title and phone number. |
| Current Public Sector Client References | | | | |
| Name of Agency | Number of Members | Name, Phone Number, and Email Address of Contact Person | Client Location (City/State) | Contract Start Date |
Provide reference information for any contracts that have been recently terminated.
| Terminated Public Sector Client References | | | | |
| Name of Agency | Number of Members | Name, Phone Number, and Email Address of Contact Person | Client Location (City/State) | Date of Termination |
| Authorized Signature |
| Vendor Name |
| Date |
| Contact Phone Number |
| Comments |
| Unauthorized replication or use of this financial workbook is prohibited. |
| Copyright © 2025 by Segal. All rights reserved. |