Appendix C Subcontractor Information Form.docx
DOCX document 17 KB Posted
- Attached to
- 12 8413 Actuarial Services SWIF
- Solicitation number
- 6100066762
- Issued by
- Dauphin County, Harveys Lake Borough, Pennsylvania
About this file
This document is a Subcontractor Information Form (Appendix C) for Invitation for Bid (IFB) 6100066762 issued by the Commonwealth of Pennsylvania, Department of Labor and Industry, on behalf of the State Workers' Insurance Fund (SWIF), to procure professional Actuarial Services. The form requires bidders to declare whether they propose to use subcontractors and, if so, to identify each proposed subcontractor along with the specific services to be performed and the percentage of total contract services allocated to that subcontractor. The lead actuary assigned to the contract must be a member in good standing of the American Academy of Actuaries (AAA), Society of Actuaries (SOA), or Casualty Actuarial Society (CAS). Actuarial Services encompass independent actuarial analysis and evaluation of SWIF's workers' compensation insurance liabilities, including reserve adequacy assessments, loss projections, actuarial opinions, Actuarial Opinion Summaries (AOS), retrospective analyses, and related consulting services performed in accordance with applicable Actuarial Standards of Practice and statutory accounting principles.
Subcontracting under this contract is capped at forty-nine percent (49%) of the total contract services and is subject to SWIF's prior written approval following award. Bidders must provide complete information for each proposed subcontractor, including legal name, address, primary contact information, description of services, and percentage of contract services to be subcontracted. The bidder's total proposed subcontracting percentage cannot exceed 49 percent and must be certified as accurate and complete. The prime contractor remains fully responsible for all contract performance, including work performed by approved subcontractors, and any approved subcontractor must comply with all applicable contract requirements and the Statement of Work.
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Text version
APPENDIX C
SUBCONTRACTOR INFORMATION FORM
Invitation for Bid (IFB): 6100066762 Project: Actuarial Services Commonwealth Agency: Department of Labor and Industry – State Workers' Insurance Fund (SWIF) Bidder Information Bidder/Vendor Legal Name: _______________________________________________ SAP Vendor Number: _____________________________________________________ Primary Contact Name: _________________________________________________ Telephone Number: _____________________________________________________ Email Address: _________________________________________________________ Authorized Representative Name: ________________________________________ Title: __________________________________________________________________ Signature: ______________________________________________________________ Date: __________________________________________________________________ Subcontractor Status ☐ No Subcontractors: The Bidder does not propose to subcontract any services under this Contract.
☐ Subcontractors Proposed: The Bidder proposes to subcontract services under this Contract.
If the No Subcontractors box is checked, no additional subcontractor information is required.
Subcontracting shall not exceed forty-nine percent (49%) of the services under the Contract, as provided in the Statement of Work, and shall be subject to SWIF's prior written approval following award. The Contractor shall remain fully responsible for the performance of all Contract requirements, including work performed by approved subcontractors.
The Bidder shall identify all subcontractors it proposes to use to perform Contract services and the percentage of Contract services proposed to be subcontracted to each. The total percentage reported below shall equal the aggregate percentage of Contract services proposed to be subcontracted to all proposed subcontractors. The total percentage shall not exceed forty-nine percent (49%) of the services under the Contract.
Subcontractor Information Complete the following information for each proposed subcontractor. If additional space is needed for proposed subcontractors, attach additional copies of the Subcontractor Information section.
Proposed Subcontractor #1 Legal Name: ____________________________________________________________ Address: ______________________________________________________________
Primary Contact: ______________________________________________________ Telephone Number: _____________________________________________________ Email Address: _________________________________________________________ Description of Services to be Performed:
Percentage of Total Contract Services to be Subcontracted: ____________________ % Proposed Subcontractor #2 Legal Name: ____________________________________________________________ Address: ______________________________________________________________
Primary Contact: ______________________________________________________ Telephone Number: _____________________________________________________ Email Address: _________________________________________________________ Description of Services to be Performed:
Percentage of Total Contract Services to be Subcontracted: ____________________ % Subcontracting Certification The Bidder certifies that the information provided on this form is accurate and complete.
The Bidder acknowledges and agrees that:
1. Subcontracting shall not exceed forty-nine percent (49%) of the services under the Contract, as provided in the Statement of Work.
2. Subcontracting is subject to SWIF’s prior written approval following award.
3. The Contractor shall remain fully responsible for the performance of all Contract requirements, including work performed by approved subcontractors.
4. Identification of a proposed subcontractor in the Bidder’s response does not, by itself, constitute approval by SWIF to subcontract.
5. Any approved subcontractor performing services under the Contract shall comply with the applicable requirements of the Contract and SOW.
Total Percentage of Services Proposed to be Subcontracted: ____________ %
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