COG_Sub_W9_.pdf

This is a Substitute Form W-9 tax identification form issued by the County of Greenville, South Carolina, for use in connection with the County's Request for Proposals (RFP #26101) for third-party administration services of the County's self-funded workers' compensation claims program. The form requests comprehensive claims administration services including claims processing, benefit determination, medical provider management, investigative services, legal representation at hearings, safety management programs, and OSHA compliance. Qualified vendors must possess a minimum of ten years' experience in workers' compensation third-party administration for groups of 1,000 or more employees and maintain professional certifications such as CPCU, ARM, or AIC. The RFP was released on April 10, 2026, with a question submission deadline of April 24, 2026 at 2:00 p.m. and a proposal submission deadline of May 8, 2026 at 3:00 p.m. via the County's online procurement portal. The review period extends from May 11-22, 2026, with a tentative award date of May 25, 2026, contract negotiations scheduled for June 1-12, 2026, and a notice to proceed expected on June 15, 2026. The contract is anticipated to span multiple years with renewal options up to five years total.

The pricing proposal must include separate fees structured on a quarterly retainer and fee-for-service model, encompassing administrative services, conversion fees, per-claim fees for lost time claims (estimated at 50), medical-only claims (estimated at 130), and record-only claims (estimated at 90), as well as bill review fees and hourly rates for ad hoc services. Vendors must confirm willingness to provide either a three-year fee guarantee or a maximum fee increase for years two and three. Contractors must obtain comprehensive general liability insurance ($1,000,000 per occurrence/$2,000,000 aggregate), automobile liability insurance ($1,000,000 per occurrence), and statutory workers' compensation coverage with employer liability limits of $1,000,000 per accident and disease, with the County named as an additional insured on all applicable policies. Vendors must complete the County's Substitute Form W-9 to provide required taxpayer identification information, and failure to submit this form timely may prevent or delay payment. Proposals will be evaluated based on responsiveness to solicitation (20%), experience and past performance with similar public entities (20%), references with preference for governmental entities (20%), pricing and fee transparency (20%), and technology platform and reporting capabilities (20%). The RFP documentation does not specify an explicit award value or budget range.