DOH22-021 Addendum 6_Final.pdf

Mission:

To protect, promote and improve the health of all people in Florida through integrated state, county and community efforts.

Ron DeSantis Governor

Joseph A. Ladapo, MD, PhD

State Surgeon General

Vision: To be the Healthiest State in the Nation

Addendum #6

ITN DOH22-021

Operations and Maintenance of the Florida Women, Infant and Children (WIC)

Information System and EBT Data System

DATE: February 2, 2024

TO: Prospective Vendors

FROM: Niki Sparks, Procurement Officer

Florida Department of Health Central Purchasing Office

SUBJECT: Addendum #6

The purpose of this addendum is to modify Section 3.3.2.2.12 and Attachment I, Evaluation Criteria, of the ITN. This addendum serves as notice of the following change(s):

Deletions are indicated by “strikethrough” or reference. Additions, updates or replacements are indicated by highlighting.

A. Modifications: The following modification is made to the ITN:

1. Section 3.3.2.2.12 Describe in the Reply the Respondent’s ability to perform system maintenance and technical support as specified in Specifications B.2.a.1)-6).

2. Attachment I, Evaluation Criteria, has been modified and is replaced in its entirety with Revised Attachment I, Evaluation Criteria, attached hereto.

Failure to file a protest within the time prescribed in section 120.57(3), Florida Statutes, or failure to post the bond or other security required by law within the time allowed for filing a bond shall constitute a waiver of proceedings under Chapter 120, Florida Statutes.

REVISED ATTACHMENT I

EVALUATION CRITERIA

Respondent Name: ____________________________________________________________

The information below will be used by each evaluator to independently evaluate the technical reply for each responsive, responsible reply received. Each evaluation criteria listed below applies to Section 3.3.1.1, Section 3.3.2.1 and the Deliverables outlined in Attachment A, Specifications. Points will be awarded only for the evaluation criteria listed in this attachment.

EVALUATION CRITERIA –Section 3.3.1.1 (20 points available)

CRITERIA #1: How comprehensive is the Respondent's overall experience and qualifications as specified in the ITN?

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.1 (5 points available)

CRITERIA #2: How comprehensive is the Respondent's Executive Overview as specified in the

ITN?

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

4 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.1 (20 points available)

CRITERIA #3: Ability to maintain scheduling tools as specified in Specification B.1.a.1).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.2 (10 points available)

CRITERIA #4: Ability to provide automated monitoring processes as specified in Specification B.1.a.2).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.3 (10 points available)

CRITERIA #5: Ability to provide access to software sources code repository as specified in Specification B.1.a.3)a.-b.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.4 (10 points available)

CRITERIA #6: Ability to manage FL-WiSE peripheral device solutions as specified in Specification B.1.a.4).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.5 (10 points available)

CRITERIA #7: Ability to assist the Department and Data Center in testing the disaster recovery environment annually as specified in Specification B.1.a.5).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.6 (10 points available)

CRITERIA #8: Ability to advise and assist the Department in proposed changes to Data Center software as specified in Specification B.1.a.6).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.7 (10 points available)

CRITERIA #9: Ability to assist the Department in implementing changes from the Data Center evaluation as specified in Specification B.1.a.7).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.8 (10 points available)

CRITERIA #10: Ability to provide remote diagnostic capabilities as specified in Specification B.1.a.8).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.9 (10 points available)

CRITERIA #11: Ability to ensure infrastructure environment operation and accessibility as specified in Specification B.1.b.1).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.10 (10 points available)

CRITERIA #12: Ability to complete nightly processing tasks as specified in Specification B.1.b.2).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.11 (10 points available)

CRITERIA #13: Ability to provide a complete WIC FL-WiSE state agency package as specified in Specification B.1.b.3)a).-c) .

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.12 (10 points available)

CRITERIA #14: Ability to perform system maintenance as specified in Specification B.2.a.1)-6).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.1213 (10 points available)

CRITERIA #15: Ability to maintain technical support as specified in Specification B.2.a.1)-6) B.2.b.1)-6).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.1314 (10 points available)

CRITERIA #16: Ability to perform application enhancements as specified in Specification B.3.a.1)-9).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.1415 (10 points available)

CRITERIA #17: Ability to perform modifications to existing functionalities as specified in Specification B.3.b.1)-2).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.1516 (10 points available)

CRITERIA #18: Ability to provide new functionalities for the system as specified in Specification B.3.c.1)-3).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.1617 (10 points available)

CRITERIA #19: Ability to develop an annual plan as specified in Task B.4.a.1)a)-o).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.1718 (10 points available)

CRITERIA #20: Ability to provide an annual schedule as specified in Specification B.4.a.2)a)-q).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.1819 (20 points available)

CRITERIA #21: Ability to meet and provide the software release requirements as specified in Specification B.4.a.3)a)-i).

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.1920 (10 points available)

CRITERIA #22: Ability to provide an updated report monthly as specified in Specification B.4.b.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.2021 (10 points available)

CRITERIA #23: Ability to conduct bi-weekly planning and operational status meetings as specified in Specification B.4.c.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.2122 (10 points available)

CRITERIA #24: Ability to prepare and submit a Disaster Recovery Plan as specified in Specification B.4.d.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

6 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.2223 (20 points available)

CRITERIA #25: Ability to develop and maintain User Guides, help files, and any technical documentation as specified in Tasks B.4.e.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.2324 (20 points available)

CRITERIA #26: Ability to report results of application and database findings and any tuning activities as specified in Specification B.4.f.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.2425 (20 points available)

CRITERIA #27:

Ability to assist the Department in maintaining an up-to-date list of software, equipment, licensure, and any other configurable items used in the FL-WiSE system as specified in Specification B.4.g.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.2526 (20 points available)

CRITERIA #28: Ability to meet the training requirements as specified in Specification C.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.2627 (20 points available)

CRITERIA #29: Ability to provide literature as specified in Specification D.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

EVALUATION CRITERIA – Section 3.3.2.2.2728 (20 points available)

CRITERIA #30: Ability to provide manuals as specified in Specification E.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

EVALUATION CRITERIA – Section 3.3.2.2.2829 (20 points available)

CRITERIA #31: Ability to provide services remotely or locally as specified as specified in Specification F.

Allocation of Points Evaluation Scoring - Response Guide

Respondent’s Reply provides a detailed response; exceeds minimum requirements; demonstrates superior understanding of the project, its capability, and understanding approach.

10 Respondent’s Reply provides a brief descriptive response; meets minimum requirements; demonstrates general understanding of project.

Respondent’s Reply provides a vague response and is not clearly presented;

below minimum requirements; demonstrates insufficient understanding of the project; demonstrates poor programmatic capability.

0 Respondent’s Reply provides little to no information; fails to address or include the required information in Reply.

_________ Total Points Awarded

Notes:

_________ GRAND TOTAL POINTS AWARDED

EVALUATION CERTIFICATION: I certify that the evaluation of this application was completed independently and consistent with the instructions provided.

Evaluator Name _______________________

Evaluator Signature _______________________

Date _______________