5-Schedule A Certification of Proposal Form TSD.pdf

This is a Schedule A Certification of Proposal Form for a Request for Statements of Qualifications (RFSQ) issued by Timpanogos School District in Utah for Employee Benefits Insurance Brokerage and Consulting Services. The RFSQ seeks an insurance brokerage firm to provide planning, developing, designing, consulting, negotiating, and monitoring services for employee benefit programs. The procurement is conducted under Utah Procurement Code 63G-6a Part 15 for the purchase of Professional Service Providers and Consultants. The vendor with the highest ranking will be selected to negotiate a contract at compensation determined to be fair and reasonable. If negotiations cannot be successfully completed with the highest-ranked vendor regarding fair and reasonable compensation and contract requirements, the district may proceed with negotiations with the next highest-ranked vendor.

The certification form requires authorized company representatives to confirm adequate personnel and resources to fulfill RFSQ requirements, proper licensure to conduct business in Utah, and compliance with procurement restrictions prohibiting contact, discussion, or negotiations with district contacts regarding the proposal. Vendors are explicitly instructed not to include pricing information in their qualifications submissions. All schedules submitted as part of the RFSQ response are considered part of a legally binding document. The form requests company name, authorized signature, printed name and title, phone, email, and submission date from company representatives.