CSP906718_LDC032_Contract_Rev.pdf

Index No.: LDC032

Eff. Date: 07/01/25 Page No. 1

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

MANDATORY USE CONTRACT FOR: STATEWIDE COMPREHENSIVE DENTAL SERVICES

CONTRACT NUMBER: CSP906718 EFFECTIVE DATES: 07/01/18 TO 06/30/21

* Renewal through 07/31/25

The Department of Administrative Services has accepted Proposals submitted in response to Request for Proposal (RFP) No.

CSP906718 that opened on 03/21/18. The evaluation of the Proposal responses has been completed. The Offeror listed herein has been determined to be the highest ranking Offeror and has been awarded a Contract for the services listed. The respective Proposal response including, Contract Terms & Conditions, any Proposal amendment, special Contract Terms & Conditions, specifications, pricing schedules and any attachments incorporated by reference and accepted by DAS become a part of this Services Contract.

This Requirements Contract is effective beginning and ending on the dates noted above unless, prior to the expiration date, the Contract is renewed, terminated, or cancelled in accordance with the Contract Terms and Conditions.

This Requirements Contract is available to the Ohio Department of Rehabilitation and Correction (DRC) and the Ohio Department of Youth Services (DYS) as applicable.

The agency is eligible to make purchases of the contracted services in any amount and at any time as determined by the agency. The State makes no representation or guarantee that department will purchase the volume of services as advertised in the Request for Proposal.

This Requirements Contract and any Amendments thereto are available from the DAS Web site at the following address:

www.ohio.gov/procure

*Denotes a one month renewal, per amendment 4.

Eff. Date: 04/12/24 Page No. 2

MUTUALLY AGREED UPON CLARIFICATIONS / MODIFICATIONS TO THE RFP

Revised Renewal Staffing Levels and Understandings Email – 05/28/21

The Professional Liability insurance requirement is waived.

PROHIBITION OF THE EXPENDITURE OF PUBLIC FUND FOR OFFSHORE SERVICES

No State Cabinet Agency, Board or Commission will enter into any contract to purchase services provided outside of the United States or that allows State data to be sent, taken, accessed, tested, maintained, backed-up, stored, or made available remotely outside (located) of the United States, unless a duly signed waiver from the State has been attained.

Notwithstanding any other terms of this Contract, the State reserves the right to recover any funds paid for services the Contractor performs outside of the United States for which it did not receive a waiver. The State does not waive any other rights and remedies provided to the State in the Contract.

Further, no State agency, board, commission, State educational institution, or pension fund will make any purchase from or investment in any Russian institution or company. Notwithstanding any other terms of this Contract, the State reserves the right to recover any funds paid to Contractor for purchases or investments in a Russian institution or company in violation of this paragraph. The provisions of this paragraph will expire when the applicable Executive Order is no longer effective.

The Contractor must complete the Contractor/Subcontractor Affirmation and Disclosure Form (https://procure.ohio.gov/pdf/EO2022-02D/04-Affirmation%20and%20Disclosure%20Form_3-4-22.pdf) affirming the Contractor understands and will meet the requirements of the above prohibition. During the performance of this Contract, if the Contractor changes the location(s) disclosed on the Affirmation and Disclosure Form, Contractor must complete and submit a revised Affirmation and Disclosure Form reflecting such changes.

*EFFECTIVE 04/01/24:

The monthly invoice amount carries the understanding that invoice adjustments may be made for vacancies in the Staffing Plan reflected on the actual hours worked that fall below 95% per quarterly reconciliation.

CSP906718 LDC032 - OH FTE for 2024

*Denotes the modification of contract terms as a result of mutual agreement to be effective 04/01/24, per amendment 3.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fprocure.ohio.gov%2Fpdf%2FEO2022-02D%2F04-Affirmation%2520and%2520Disclosure%2520Form_3-4-22.pdf&data=04%7C01%7CShaun.Roderer%40das.ohio.gov%7C1dc3d7c864c2466d072908da219079ff%7C50f8fcc494d84f0784eb36ed57c7c8a2%7C0%7C0%7C637859202055735466%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=WVwDL78CFoKzT8s%2BHisFGV%2FO1NADHzGDP4W1m%2BvWXlw%3D&reserved=0

Eff. Date: 04/12/24 Page No. 3

COST SUMMARY FORM

RFP Title: STATEWIDE COMPREHENSIVE DENTAL SERVICES RFP Number: CSP906718

UNSPSC CATEGORY CODE: 85122000

OAKS ITEM

ID

DESCRIPTION

07/01/18-07/05/20

COST

EFFECTIVE

07/06/20-06/30/21

COST

EFFECTIVE

07/01/21 COST

EFFECTIVE

07/01/23-

03/31/24 COST

*EFFECTIVE

04/01/24-06/30/24

COST

* EFFECTIVE

07/01/24-06/30/25

COST

34295 Professional Services (Staffing) Cost per Month $930,004.00 $790,503.00 $870,000.00 $964,877.00 *$1,070,361.00 *$1,113,175.00

34296 Supplies Cost Per Month $52,873.00 $52,873.00 $52,873.00 $58,639.00 $58,639.00 * $60,985.00

34297

Equipment Management Pass Through Total Cost Per Month TBD/AMT TBD/AMT TBD/AMT TBD/AMT TBD/AMT TBD/AMT

All costs are in U.S. Dollars.

The State is not responsible for any costs not identified.

There is no additional reimbursement for travel or other related expenses.

All equipment related costs will be passed through to the Agency on a monthly basis. If the Contractor determines that equipment needs to be repaired or replaced it shall consult with the Agency Dental Director. Any equipment expenditures in excess of $1,000.00 must be approved by the Dental Director prior to purchase to receive reimbursement. Email communication is acceptable. Contractor will receive compensation through pass-through invoicing, invoice copies must be submitted with monthly invoice to be reimbursed.

*Indicates an update to the pricelist with an increase of price effective on all orders placed on or after 04/01/24 and 07/01/24 respectively, per amendment 3.

Eff. Date: 07/01/21 *Page No. 4

CONTRACTOR INDEX

CONTRACTOR AND TERMS: BID CONTRACT NO.: CSP906718

0000254246 TERMS: Net 30 Days Mid America Health of Ohio, Inc.

470 Olde Worthington Road Suite 200 Westerville, OH 43082

CONTRACTOR'S CONTACT: Jose Lopez Telephone: 1-888-309-8239 ext. 2056

FAX: 317-972-7969

E-Mail: Jlopez@mahweb.com

*Denotes repagination, per amendment 1.

Jlopez@mahweb.com

Eff. Date: 07/01/25 Page No. 5

SUMMARY OF AMENDMENTS

Amendment Number

Effective Date

Description

4 07/01/25

The State of Ohio elects to exercise its option to renew the subject contract for an additional one month effective 07/01/25 through 07/31/25.

All other prices, terms and conditions remain unchanged.

3 04/12/24

This amendment is issued to denote an update to the pricelist with an increase of price effective on all orders placed on or after 04/01/24 and 07/01/24 respectively and the mutually agreed upon clarification of terms.

All other prices, terms and conditions remain unchanged.

2 07/01/23

This amendment is issued to notify that as a result of mutual agreement between the State of Ohio and the Contractor, this contract is renewed for an additional twenty-four

(24) months, effective 07/01/23 through 06/30/25 and to update the pricelist, effective with all orders placed on or after 07/01/23.

Additionally, this amendment is also issued to include updated language regarding the Prohibition of the Expenditure of Public Funds for Offshore Services, effective with all orders on or after 07/01/23.

All other prices, terms and conditions remain unchanged.

1 07/01/21

As a result of mutual agreement between the Contractor and the State of Ohio, this amendment is issued to renew the subject contract for twenty-four (24) months, effective 07/01/21-06/30/23. Additionally, this amendment is issued to indicate an update to the pricelist, effective on all orders placed on or after 07/01/21, the creation of the Summary of Amendments page, the mutually agreed upon clarification of terms, effective 07/01/21, and repagination.

All other prices, terms and conditions remain unchanged.