Attachment A - Information Requested.docx

ATTACHMENT A

INFORMATION REQUESTED FROM VENDORS

Please respond to each of the following requests for information. Responses will help DOC decide whether to pursue a contract with a Vendor. Vendors may provide answers on a different sheet, but please try to provide responses in an order that corresponds with the requests below.

1. Business Profile. Please provide the following information:

0. Vendor’s name and dba, if applicable.

0. Vendor’s address and principal place of business.

0. Vendor’s contact information.

0. Name(s) of business owners.

0. Legal status of the Vendor (e.g. partnership, LLC, corporation, etc.).

0. Vendor’s Tax ID and UBI number.

0. Whether Vendor is a small, diverse, or veteran owned business as defined here: Tips for Small, Diverse and Veteran-Owned Businesses | Department of Enterprise Services (DES) (wa.gov).

0. Please state whether Vendor is involved in an lawsuits related to the quality of services.

1. Background and Experience: Please describe Vendor’s background and experience providing electrolysis services. In Vendor’s response, please be sure to include any staff that Vendor consider using when performing work for DOC:

1. Vendor’s general background and experience providing electrolysis to transgender individuals.

1. Vendor/Staff’s experience providing pre-operative electrolysis of the genital area for male-to-female patients.

1. Professional licenses held by Vendor/Staff, if any.

1. Is Vendor/Staff a member of the American Electrology Association?

1. Does Vendor/Staff hold a Certified Professional Electrologist (CPE) credential?

1. Is Vendor/Staff a member of the Society for Clinical and Medical Hair Removal?

1. Is Vendor/Staff eligible for membership with the Washington State Electrologist Association?

1. Does Vendor have any TGD client testimonials that Vendor can provide?

1. Electrolysis Treatment Plans: Please describe Vendor’s general treatment plan and timeline for pre-operative electrolysis services. Please be sure to include:

2. Description of program, treatment plan, and treatments.

2. Description of clearances and the number of clearances involved in treatment.

2. Length of treatments.

2. Expected number of treatments.

2. Expected time between treatments.

2. Is Vendor licensed and insured to provide local anesthetic injections? If not, is Vendor willing to use topical anesthesia if performing services at DOC facilities?

2. What infection prevention procedures does Vendor follow?

2. Does Vendor offer needle electrolysis treatments?

1. Service Locations: DOC prefers that services be conducted at DOC facilities (“on-site”) but may consider transporting Individuals to Vendor facilities (“off-site”) under certain circumstances. Vendors providing off-site services should be located within approximately fifty (50) miles of the facility location. Please describe whether Vendor is willing and able to provide electrolysis services to Individuals on-site and/or off-site. Please be sure to address the following in the response:

3. Whether Vendor is willing to provide services on-site and, if so, to which of the DOC facilities listed in Section 2.2 of the RFI.

3. Whether Vendor is willing to provide services off-site and, if so, the address of Vendor’s facility and the distance from Vendor’s facility to the nearest DOC facility listed in Section 2.2 of the RFI.

1. Equipment: The Department is committed to ensuring that necessary supplies and equipment are available at DOC facilities for effective on-site electrolysis treatments. The Department will provide Vendor with supplies and equipment for on-site electrolysis treatments as well as a space for performing the treatments. Please describe any atypical or non-standard equipment that Vendor needs to provide services. Also describe any common equipment or supplies that Vendor refuses to use in the provision of services.

1. Availability and Capacity: The Department anticipates that 10-25 Individuals will need electrolysis treatment each year. Please describe Vendor’s availability and capacity to provide services to Individuals. In the response, please address the following:

5. The approximate number of Individuals Vendor could accommodate for on-site services, if any.

5. The approximate number of Individuals Vendor could accommodate for off-site services, if any.

5. When would Vendor be available to begin providing services to Individuals and the number of Individuals Vendor is able to provide services to at that time?

1. Pricing: Please describe any and all charges for services. Please include:

6. Whether prices are on an hourly basis, per treatment basis, or a hybrid pricing structure.

6. If payment is on an hourly rate, indicate the number of providers and/or assistants that will be involved in treatments and their respective hourly rates.

6. Any and all charges Vendor would bill to the Department related to the provision of services.