Appendix D - Statement of Qualifications - Conflicts - Technical Questionnaire.docx

APPENDIX D

STATEMENT OF QUALIFICATIONS/CONFLICTS/TECHNICAL QUESTIONNAIRE

Name of Law Firm (i.e. the Offeror):

Address of the Law Firm:

Telephone Number of Law Firm:

Name of Key Contact for the Engagement:

Telephone Number of Key Contact:

The Law Firm’s Statement of Qualification must demonstrate the firm’s ability to meet all of the minimum qualifications and provide the requested information as set forth below.

**Law Firms are expected to use this Statement of Qualifications and Technical Questionnaire in conjunction with the Statement of Work contained in Part IV of this RFP.**

1. The Law Firm shall designate a senior member to serve as the contract manager for all issues relating to services provided under the resulting Contract. This contract manager must have a minimum of seven (7) years’ experience in workers’ compensation. All other attorneys assigned to this contract must have a minimum of three (3) years of workers’ compensation practice experience

2. Describe the Law Firm and its capabilities, including the size of the firm, its practice group areas, its workers’ compensation practice group, its specific workers’ compensation expertise and the types of expertise within the firm on matters related to Pennsylvania workers’ compensation law. State the availability of specific labor counsel and other relevant individuals for the Engagement.

3. List each member of the Law Firm who will be providing services to the Commonwealth as part of the Engagement, and identify the percentage of time that will be dedicated to the Commonwealth.

a. Confirm each member is admitted to practice law before the Supreme Court of Pennsylvania and is a member in good standing.

b. Provide resumes or complete Appendix E – Personnel Experience by Position, outlining each member’s background, years of experience and expertise in Pennsylvania workers’ compensation law.

4. Confirm Law Firm’s experience in the following:

a. State the number of years of practice in Longshore Harbor Workers Compensation, Federal Black Lung, Medicare Set Aside, Special Fee Review (including pharmaceutical regimen reviews), and pension offset issues, both for the Firm as well as all the attorneys within the Firm, who are expected to provide services under the resulting Contract. Complete Appendix F – Project Reference for at least one (1) identified client.

b. Identify whether or not the Law Firm has experience with workers’ compensation subrogation. State the number of years of practice in workers’ compensation subrogation, both for the Firm as well as all the attorneys within the Law Firm, who are expected to provide services under the resulting Contract. Complete Appendix F – Project Reference for at least one (1) identified client.

c. Confirm that the Law Firm has experience in workers’ compensation appellate practice. State the number of years of workers’ compensation appellate practice, both for the Law Firm as well as all the attorneys within the Law Firm, who are expected to provide services for the Engagement. Complete Appendix F – Project Reference for at least one (1) identified client.

(i) Workers’ Compensation Appeal Board.

(ii) Commonwealth Court.

(iii) Pennsylvania Supreme Court.

d. Confirm that the law firm has experience in coverage issues to provide analysis/comment on certain workers compensation policies, endorsements and/or amendments, draft denial letters and reservation of rights letters.

5. Confirm that the Firm only handles workers’ compensation defense work, and not claimant work.

6. Describe the anticipated division of duties among Senior Attorney, Junior Attorney(s), and paralegals.

7. List the address for each of the Law Firm’s offices in Pennsylvania that will be performing workers’ compensation services for the Engagement and coverage by county for each office.

8. Provide detailed descriptions of:

a. Any litigation or administrative proceeding in which the Law Firm was a party in any matter related to the professional activities of the Law Firm during the five (5) years prior to the date of this RFP;

b. Any pending litigation, investigation, or proceeding in which a court or administrative agency is addressing any question relating to the professional activities of the Law Firm; and

c. Any indictments, convictions or civil offenses during the past 10 years arising directly or indirectly from the conduct of business of the firm or any of its partners, associates, employees or agents.

9. The Law Firm has and will maintain in full force and effect, during the duration of the engagement, professional liability insurance through an insurance carrier in an aggregate amount usual and customary for firms of its size and practice areas, subject to normal deductibles. State the amount of professional liability insurance the Law Firm currently carries.

10. Provide written acknowledgment that the Law Firm will comply with OGC’s Conflict Waiver Policy, a copy of which is attached to the Standard Contract for Legal Services.

a. Describe any existing or potential conflict of interest arising from the Law Firm’s relationships with or representation of other parties. A conflict shall include, but not be limited to, the representation of any party in a matter adverse to the Commonwealth or to any Commonwealth agency for which OGC has not previously granted a conflict waiver. This includes potential conflicts for any proposed subcontractor. As set forth in Part IV-2 of this RFP, failure to disclose a conflict is grounds for rejection of a proposal, or removal or suspension from an engagement.

b. Provide sufficient facts, legal implications, and possible effects so that OGC may evaluate the significance of each potential conflict.

c. Represent and warrant, in writing, that the Law Firm has no conflicting representations that have not been fully disclosed to and waived by the General Counsel.

d. Represent and warrant that the Law Firm shall not undertake any representation that conflicts with the performance of the services or obligations unless such conflicting representation has been fully disclosed to and waived by the General Counsel. All conflicting representation shall be promptly disclosed to the General Counsel.

11. Describe the Law Firm’s ability to provide paper and electronic documents to the Commonwealth in a format compatible with the Commonwealth’s technology.

12. Confirm that the Law Firm will perform legal services in accordance with the terms and conditions of the Standard Contract for Legal Services, a copy of which is attached to the RFP as Part V.

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