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Questionnaire Appendix B Questionnaire
Instructions: The electronic version of this document is available for download at www.stpete.org/internal-bids.php. Use tab key to move to each field. After completion, print form out and include in your proposal submission in Section E. If you require additional space, write “additional info attached” in the space provided and include a full response on the separate page included with this Appendix.
Company Name:
Address:
Contact Name:
Contact Title:
Contact E-mail:
Telephone:
Fax:
| 1. |
| Provide a brief narrative of your company’s history in the Employee Assistance Program (EAP) market. |
| 2. |
| How many employers in Florida offer your EAP plan? Provide the number of employees for your largest Florida client. |
| 3. |
| Number of years your company has been administering EAP programs in Florida. |
| 4. |
| Provide a list of at least four (4) current clients and one (1) former client with 2,000+ employees. Florida public sector clients and local governmental agencies are preferred. |
# of Years as Client
| 5. |
| Does your firm currently provide direct accessibility to services of a licensed mental health professional and information 24/7 via telephone? |_| Yes |_| No |
| 6. |
| Will your firm agree to provide direct accessibility to services of a licensed mental health professional and information 24/7 via telephone to city employees and eligible dependents? |_| Yes |_| No |
| 7. |
| Describe standard experience reports available to the City. How often are your standard experience reports produced? Provide samples of each standard experience report in your proposal submission Section G-3. |
| 8. |
| What additional experience reports are available? Detail any cost for each additional report. . Provide samples of each additional experience report in your proposal submission Section G-3. |
| 9. |
| Explain your secondyear, thirdyear, fourth-year and fifth-year rate guarantee, or rate cap basis. |
| 10. |
| Does your firm’s rates include any commission, override, production bonus, or service fees of any kind? |_| Yes |_| No |
If yes, identify amounts and to whom it is to be paid.
| 11. |
| Identify any deviations in your proposal (e.g., services, benefits) from the RFP requirements stated in the Scope of Services. |
| 12. |
| Describe the referral procedures an initial participant call. |
| 13. |
| Give a summary of your firm’s procedures when a request to change mental health professional (counselor) is made by a participant. |
| 14. |
| Describe the after-hours procedures utilized when an employee calls for assistance, including the qualifications of the staff responding to these calls. |
| 15. |
| Are employee assistance programs and services a primary or auxiliary service for your firm? |
|_| Primary |_| Auxiliary
| 16. |
| How are revenues generated? |
| 17. |
| Provide a list of the professional staff who will be assigned to the contract. Include the professional certifications and licenses for each and their tenure with your firm. Include resumes and copies of professional licenses and certifications for each in your Proposal, Section A |
| Name |
| Certifications |
| Licenses |
| Tenure (years) |
| 18. |
| What hours/days are professional counselors available for face-to-face (in office) appointments? |
| 19. |
| What hours/days are professional counselors available for contact via telephone? |
| 20. | |
| Does you firm have a local or toll-free number for after hours contact with professional counselors? |_| Yes | |_| No |
If yes, provide the contact telephone number. - -
| 21. | |
| Does your firm have a general services contract? |_| Yes | |_| No |
If yes, provide a copy with your proposal submission Section G-2.
| 22. |
| Discuss any additional wellness and quality of life benefits available to participants. |
| 23. | |
| Will you provide all printed material needed for enrollment no later than January 21, 2025? |_| Yes | |_| No |
Provide samples of materials for distribution to employees detailing EAP services available and contact information in your proposal submission Section G-3.
| 24. |
| Who will represent your company in negotiations with the City? |
Name: Title:
Office Location:
Telephone: - - Email:
| 25. |
| Who will be the dedicated service account executive for the City? |
Name: Title:
Office Location:
Telephone (including area code): - - Email: