_Att C_Quote Submission Form_RFQ S-44000-00006643.docx

RFQ S-44000-00006643 Att C

ATTACHMENT C

QUOTE SUBMISSION FORM

Company Name: ___________________________________________________________________________________ Contact Person: ___________________________________________Title: ____________________________________ Address: ____________________________________________________________________________________________ Telephone: ____________________________Email: ___________________________________________________ Federal ID #: _________________________ Oregon Secretary of State Registry #_____________________ COBID CERT# (if applicable) __________________________________________________________________

Each Offeror must submit this quote Form. The quote Form must be signed and submitted to the SPC prior to Closing. Quotes must be received no later than May 10, 2023, 3:00 pm (PT)

Award will be made to the lowest responsive and responsible Offeror for the combined hourly rate. Agency intends to award one (1) Contract, but reserves the right to award more or less at Agency’s discretion. The estimated value of the contract is $80,000.

Offerors must meet or exceed all the following minimum qualifications, RFQ Section 5:

Yes / No

1. Offeror shall have documented a minimum of two years’ experience supporting Prescription Drug Affordability Boards, or comparable Agencies, on the prescription drug supply chain, the role of entities in the supply chain, and familiarity with pharmaceutical costs and financial incentives.

2. Offeror shall have documented a minimum of two years’ experience in research and data analytical skills that allow for complex health policy topics to be presented in clear and concise ways. This includes experience analyzing data related to pharmacy benefits and prescription drug reimbursement.

3. Offeror shall have comprehensive knowledge of federal and state-level health insurance market reforms enacted under the Affordable Care Act (ACA).

4. Offeror shall have excellent written and verbal communication skills with specific experience writing and presenting health policy options to diverse stakeholder groups in non-partisan and engaging ways.

5. Offeror shall have experience working under tight timelines to deliver a quality product.

6. Offeror shall have no conflict of interest that may create biases in the work of Agency. (“Yes” response indicates there is no conflict of interest. “No” response indicates there is a conflict of interest.)

Provide a brief narrative of the Offeror’s experience and qualifications. A separate document can be attached if preferred. Attach separately the resumes of any qualified staff that may perform the work.

For evaluation purposes, the Offeror’s estimated cost will be the sum of the two following hourly rates:

Hourly rates will be inclusive for any and all fees, and for all qualified employees who contributed to the work task.

Hourly Rate

Provide the hourly rate for attendance of the weekly and monthly meetings required by Agency. This may include providing advice, technical assistance, presentations, and other tasks as described in Section 4 of the RFQ.

(For clarity, If more than one qualified employee attended a one-hour meeting, then Agency would be invoiced for one work hour at the hourly rate provided.)

Hourly Rate

Provide the hourly rate for all work completed outside of the required meetings. This includes, peer review and technical assistance of data files and calculations, delivery of progress reports, development of meeting materials, and other work tasks as described in Section 4 of the RFQ.

(For clarity, If more than one qualified employee contributed to a data file review that totaled three work hours, then Agency would be invoiced for three works hours at the hourly rate.)

Agency will not reimburse Offeror for any expenses, including travel expenses.

SIGNATURE OF OFFEROR’S DULY AUTHORIZED REPRESENTATIVE

I, the undersigned, agree to be bound by the form of Agreement and all remaining contract documents, including instructions to Offeror’s; Standard Terms and Conditions; Special Conditions; Federal Provisions, if applicable; and Specifications.

I, the undersigned, certify compliance with State of Oregon statutory requirements governing registration of corporations and assumed business names.

I, the undersigned, certify that this Quote has been arrived at independently and has been submitted without any collusion designed to limit independent bidding or competition. I, the undersigned duly authorized representative of the Offeror, understand that the quote must be signed in ink by the Offeror and that any alterations or erasures must be initialed in ink by the person signing the quote. Further, I acknowledge that I have read and understand all quote instructions, specifications, terms and conditions, (including the attachments indicated above) and agree, on behalf of myself and the Offeror to be bound by them.

I the undersigned, duly authorized representative of the Offeror, certify that the information provided in this quote is true and accurate. Further, I understand and acknowledge that providing incorrect information may cause for quote rejections or contract termination.

Company Name: __________________________________________________________________________________

Name of Authorized Representative: ___________________________________________________________

Title: _______________________________________________________________________________________________

Signature: _____________________________________________ Date: ____________________________________