Exhibit_3_-_Navigator_Business_Assessment.pdf

PDF 201 KB Posted Aug 14, 2026

Attached to: RFP for SBE Navigator
Solicitation number: EV00000966
Issued by: Oklahoma

About this file

Written by GovTribe AI · Aug 20, 2026

This is a Business Assessment and Mandatory Disclosure form for the Oklahoma Health Insurance Marketplace, administered by the Office of Management and Enterprise Services (OMES) Central Purchasing division on behalf of the Oklahoma Insurance Department (OID). The form is designed to evaluate potential SBE Navigator Entity service providers who oversee individual Navigators and conduct education and outreach to help Oklahomans access health insurance through the State Based Exchange on the Federal Platform. Navigators assist consumers with health insurance applications, provide education on health care basics, plan options, and available financial assistance. The RFP allows for either a single award or multiple awards as determined in the State's best interest, though no specific response dates, site visits, bidder meetings, contract term length, or renewal options are detailed in this assessment document.

The Business Assessment form requires applicants to provide comprehensive information across multiple compliance and operational areas, including organizational legal name and EIN, annual revenue and percentage from government funding, oversight history, grant management experience, conflict of interest disclosures, debt and bankruptcy status, fidelity bond coverage, accounting policies and procedures, budgetary controls, personnel qualifications, payroll segregation of duties, consultant policies, property management systems, travel policies, internal controls, audit history, and mandatory federal disclosures regarding criminal violations. No specific pricing terms, set-asides, incumbent information, or funding amounts are specified in this assessment document itself, as it serves solely as a pre-award evaluation tool to ensure applicant organizational capacity and compliance with federal and state requirements under 2 CFR Part 200 and 45 CFR regulations.

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Exhibit_6_-_SBE_Navigator_Entity_SOW.pdf	PDF	Aug 14, 2026
Attachment_B_-_General_Terms.docx	DOCX document	Aug 14, 2026
Exhibit_4_-_Navigator_Program_Application_Form.pdf	PDF	Aug 14, 2026
Exhibit_1_-ExecutiveSummaryWorksheet.xlsx	XLSX spreadsheet	Aug 14, 2026
Attachment_A.pdf	PDF	Aug 14, 2026
Exhibit_2_-_Navigator_Program_Detailed_Budget.xlsx	XLSX spreadsheet	Aug 14, 2026
Agency_Bidder_Instructions.pdf	PDF	Aug 14, 2026
OMESformCP076.pdf	PDF	Aug 14, 2026
Exhibit_5_-ThirdPartySupplierInfo_.xlsx	XLSX spreadsheet	Aug 14, 2026
omes-form-cp004.docx	DOCX document	Aug 14, 2026

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Oklahoma Health Insurance Marketplace: Business Assessment & Mandatory Disclosure Instructions: Complete the information below. For each question, provide an answer and attach supporting documents if relevant. If a question does not apply, write “Not applicable” and explain why. Incomplete or unclear responses may delay processing of application.

A. Organization Information

1. Organization’s Legal Name

2. Organization’s Employer

Identification Number (EIN)

B. General Information

3. What is the organization’s annual revenue, and what percentage of annual revenue is from government funding (percentage = total government funding received in previous fiscal year / organization’s total gross revenue in previous fiscal year)?

4. Has the organization received additional oversight (e.g., Corrective Action Plan, Federal Awardee Performance and Integrity Information System finding, or reimbursement payments for enforcement actions for state or federal funds) from a federal or state agency within the past 3 years due to performance, programmatic, or financial concerns with the organization (Yes/No)?

If yes, provide the name of the government agency and the reason for the additional oversight as explained by the government agency.

If resolved, indicate how the issue was resolved with the agency.

5. Does the organization currently manage grants with state or federal agencies (Yes/No)?

If yes, list the current grants managed by the organization.

6. Does the organization or any of its employees have any real or perceived personal or organizational conflicts of interest related to 45 CFR § 155.215(a)(1) (Yes/No)?

If yes, explain and provide a mitigation plan.

7. Indicate whether there are any existing or potential conflicts of interest involving the organization. If so, describe your plan to mitigate conflicts of interest. If this question does not apply, state “Not applicable.”

8. Does the organization currently have, or has it ever had, delinquent state, federal, or other lender debt in the last 3 years (Yes/No)?

If yes, explain.

9. Have you filed bankruptcy or entered into proceedings for bankruptcy, whether voluntarily or involuntarily (Yes/No)?

If yes, explain.

10. Has the organization obtained fidelity bond insurance coverage for responsible officials and employees of the organization in amounts required by statute or organization policy (Yes/No)?

If yes, what is that amount?

11. Does the organization have policies and procedures in place to meet the requirements below (Yes/No)? (Please answer only if your organization has subrecipients).

a. Make determinations between subrecipient versus contractors in accordance with 2 CFR § 200.331?

b. Compliance with 2 CFR § 200.332?

c. Manage, assess risk, review audits, and monitor subrecipient as necessary to ensure that subawards are used for authorized purposes in compliance with laws, regulations, and terms and conditions of award and that established performance goals are achieved in compliance with 2 CFR §§ 200.331-200.333?

If yes, provide a summary of the policies and procedures. If no, explain your plan and estimated timeline for establishing these policies and procedures.

C. Accounting System

12. Does the organization have updated (within last two years) written accounting policies and procedures to manage state and/or federal awards (Yes/No)?

If no, explain.

Describe the management of navigator program funds including how these funds are separated (not co-mingled) from other organizational funds.

13. Briefly describe budgetary controls in effect to preclude incurring obligations in excess of:

a. Total funds available for an award.

b. Total funds available for a budget cost category.

14. Has any government agency rendered an official written opinion within the last 3 years concerning the adequacy of the organization’s accounting system for the collection, identification, and allocation of costs under government awards (Yes/No)?

If yes, provide the name and address of the agency that performed the review, a summary of the opinion, and an explanation of how the organization resolved any concern.

15. How does the accounting system provide for recording the non-state share and in-kind contributions (if applicable)?

16. Does the organization’s accounting system provide identification for funding by state/Federal agency, pass-through entity, Assistance Listing (CFDA) number, and period of funding (Yes/No)?

If yes, how does the organization identify awards? If no, explain.

D. Budgetary Controls

17. What controls does the organization use to ensure that the Authorized

Organizational Representative (AOR) approves all budget changes for the state award?

E. Personnel

18. Does the organization have a current organizational chart or similar document establishing clear lines of responsibility and authority (Yes/No)?

19. Does your organization have updated (last two years) written Personnel and/or Human Resource policies and procedures?

20. Does the organization pay compensation to Board Members

If yes, provide details.

21. Does the organization’s staff with fiscal and administrative oversight have prior experience managing navigator program funds and have familiarity with applicable rules and regulations (Yes/No)?

If yes, provide details of experience. If no, explain.

22. Describe how the payroll distribution system accounts for, tracks, and verifies employee compensation.

F. Payroll

23. Describe the segregation of duties for staff who prepare the payroll and those who sign the checks, have custody of cash funds, and maintain accounting records.

G. Consultants

24. Are there written policies or consistently followed procedures regarding the use of consultants? (Answer each question below) Briefly describe the organization’s method or policy for ensuring consultant costs and fees are allowable, allocable, necessary, and reasonable.

Briefly describe the organization’s method or policy to ensure that only consultants who are permitted to receive state or federal funds are selected.

H. Property Management

25. Briefly describe the system for property (tangible and intangible) management used for maintaining property records consistent with 2 CFR § 200.313.

26. Does the organization have adequate insurance to protect the state interest in equipment and real property (2 CFR § 200.310, “Insurance coverage.”) (Yes/No)?

27. How does the organization calculate the amount of property insurance?

I. Property Standards

28. Describe the organization’s property standards in accordance with 2 CFR §§

200.310-327 (“Procurement Standards”). If there are no procurement procedures, briefly describe how your organization handles purchasing activities.

a. Include individuals responsible and their roles.

b. Describe the competitive bid process for procurement purchases of equipment, rentals, or service agreements that are over certain dollar amounts.

J. Transportation Costs

29. Describe the organization’s written travel policy. Ensure, at minimum, that:

• Travel charges are reimbursed based on actual costs incurred or by use of per diem and/or mileage rates in accordance with State policy.

• Receipts for lodging and meals are required when reimbursement is based on actual cost incurred.

• Subsistence and lodging rates are equal to or less than current State per diem and mileage rates.

• Commercial transportation costs incurred at coach fares unless adequately justified. Lodging costs do not exceed GSA rate unless adequately justified (e.g., conference hotel).

• Travel expense reports show purpose and date of trip.

• Travel costs are approved by organizational official(s) and funding agency prior to travel.

K. Internal Controls

30. Provide a brief description of the organization’s internal controls that will provide reasonable assurance that the organization will manage award funds properly (2 CFR § 200.303).

31. What is the organization’s policy on separation of duties as they relate to receipt, payment, and recording of cash transactions?

32. Does your organization have internal audit or legal staff? If not, how do you ensure compliance with the award? Please describe.

33. If the organization has a petty cash fund, how is it monitored?

34. Who in the organization reconciles bank accounts?

Is this person familiar with the organization’s financial activities (Yes/No)?

Does the organization authorize this person to sign checks or handle cash

35. Are all employees who handle funds required to be bonded against loss by reason of fraud or dishonesty (Yes/No)?

If no, what control mechanisms are in place?

L. Audit

36. When is the organization’s fiscal year?

37. Did the organization expend $1,000,000 or more in federal or state awards from all sources during its most recent fiscal year (Yes/No)?

38. Has the organization previously submitted federal or state grant audits in the last 2 years (Yes/No)?

If no, briefly explain. If yes, address the following:

• The date of the most recently submitted audit report.

• The auditor's opinion on the financial statement.

• If applicable, indicate if the organization has findings in the following areas: 1) internal controls, 2) questioned or unallowable costs, 3) procurement/suspension and debarment, 4) cash management of award funds, and 5) subrecipient monitoring.

• Include (if applicable):

o A description of each finding classified as Material Weakness.

o A description of each finding classified as Significant Deficiency.

39. Does the organization have any Corrective Action Plans in the past 2 years for the findings identified in a previously submitted audit as outlined above (Yes/No)?

If yes, describe the status (closed or open) and progress made on those corrective actions.

M. Mandatory Disclosures

40. Disclose all information related to violations by the organization of state or federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the state award.

41. Explain the organization’s process to comply with (a) 45 CFR § 75.113 Mandatory Disclosures and (b) Federal Funding Accountability and Transparency Act (FFATA) requirements.

N. Authorized Organizational Representative (AOR) Signature AOR Name AOR Signature

Date https://www.ecfr.gov/cgi-bin/text-idx?SID=06a0b0411d1520fae5e2799030e64ebf&node=pt45.1.75&rgn=div5

Oklahoma Health Insurance Marketplace: Business Assessment & Mandatory Disclosure

1 Organizations Legal Name:

2 Organizations Employer Identification Number EIN:

3 What is the organizations annual revenue and what percentage of annual revenue is from government funding percentage total government funding received in previous fiscal year organizations total gross revenue in previous fiscal yearRow1:

4 Has the organization received additional oversight eg Corrective Action Plan Federal Awardee Performance and Integrity Information System finding or reimbursement payments for enforcement actions for state or federal funds from a federal or state agency within the past 3 years due to performance programmatic or financial concerns with the organization YesNo:

If yes provide the name of the government agency and the reason for the additional oversight as explained by the government agencyRow1:

If resolved indicate how the issue was resolved with the agencyRow1:

5 Does the organization currently manage grants with state or federal agencies YesNo:

If yes list the current grants managed by the organizationRow1:

6 Does the organization or any of its employees have any real or perceived personal or organizational conflicts of interest related to 45 CFR 155215a1 YesNo:

If yes explain and provide a mitigation planRow1:

7 Indicate whether there are any existing or potential conflicts of interest involving the organization If so describe your plan to mitigate conflicts of interest If this question does not apply state Not applicableRow1:

8 Does the organization currently have or has it ever had delinquent state federal or other lender debt in the last 3 years YesNo:

If yes explainRow1:

9 Have you filed bankruptcy or entered into proceedings for bankruptcy whether voluntarily or involuntarily YesNo:

If yes explainRow1_2:

10 Has the organization obtained fidelity bond insurance coverage for responsible officials and employees of the organization in amounts required by statute or organization policy YesNo:

If yes what is that amount:

11 Does the organization have policies and procedures in place to meet the requirements below YesNo Please answer only if your organization has subrecipients a Make determinations between subrecipient versus contractors in accordance with 2 CFR 200331 b Compliance with 2 CFR 200332 c Manage assess risk review audits and monitor subrecipient as necessary to ensure that subawards are used for authorized purposes in compliance with laws regulations and terms and conditions of award and that established performance goals are achieved in compliance with 2 CFR 200331200333:

If yes provide a summary of the policies and procedures If no explain your plan and estimated timeline for establishing these policies and proceduresRow1:

12 Does the organization have updated within last two years written accounting policies and procedures to manage state andor federal awards YesNo:

If no explainRow1:

Describe the management of navigator program funds including how these funds are separated not comingled from other organizational fundsRow1:

13 Briefly describe budgetary controls in effect to preclude incurring obligations in excess of a Total funds available for an award b Total funds available for a budget cost categoryRow1:

14 Has any government agency rendered an official written opinion within the last 3 years concerning the adequacy of the organizations accounting system for the collection identification and allocation of costs under government awards YesNo:

If yes provide the name and address of the agency that performed the review a summary of the opinion and an explanation of how the organization resolved any concernRow1:

15 How does the accounting system provide for recording the nonstate share and inkind contributions if applicableRow1:

16 Does the organizations accounting system provide identification for funding by stateFederal agency passthrough entity Assistance Listing CFDA number and period of funding YesNo:

If yes how does the organization identify awards If no explainRow1:

17 What controls does the organization use to ensure that the Authorized Organizational Representative AOR approves all budget changes for the state awardRow1:

18 Does the organization have a current organizational chart or similar document establishing clear lines of responsibility and authority YesNo:

If no explainRow1_2:

19 Does your organization have updated last two years written Personnel andor Human Resource policies and procedures:

If no explainRow1_3:

20 Does the organization pay compensation to Board Members YesNo:

If yes provide detailsRow1:

21 Does the organizations staff with fiscal and administrative oversight have prior experience managing navigator program funds and have familiarity with applicable rules and regulations YesNo:

If yes provide details of experience If no explainRow1:

22 Describe how the payroll distribution system accounts for tracks and verifies employee compensationRow1:

23 Describe the segregation of duties for staff who prepare the payroll and those who sign the checks have custody of cash funds and maintain accounting recordsRow1:

Briefly describe the organizations method or policy for ensuring consultant costs and fees are allowable allocable necessary and reasonableRow1:

Briefly describe the organizations method or policy to ensure that only consultants who are permitted to receive state or federal funds are selectedRow1:

25 Briefly describe the system for property tangible and intangible management used for maintaining property records consistent with 2 CFR 200313Row1:

26 Does the organization have adequate insurance to protect the state interest in equipment and real property 2 CFR 200310 Insurance coverage YesNo:

If no explainRow1_4:

27 How does the organization calculate the amount of property insuranceRow1:

28 Describe the organizations property standards in accordance with 2 CFR 200310327 Procurement Standards If there are no procurement procedures briefly describe how your organization handles purchasing activities a Include individuals responsible and their roles b Describe the competitive bid process for procurement purchases of equipment rentals or service agreements that are over certain dollar amountsRow1:

29 Describe the organizations written travel policy Ensure at minimum that Travel charges are reimbursed based on actual costs incurred or by use of per diem andor mileage rates in accordance with State policy Receipts for lodging and meals are required when reimbursement is based on actual cost incurred Subsistence and lodging rates are equal to or less than current State per diem and mileage rates Commercial transportation costs incurred at coach fares unless adequately justified Lodging costs do not exceed GSA rate unless adequately justified eg conference hotel Travel expense reports show purpose and date of trip Travel costs are approved by organizational officials and funding agency prior to travelRow1:

30 Provide a brief description of the organizations internal controls that will provide reasonable assurance that the organization will manage award funds properly 2 CFR 200303Row1:

31 What is the organizations policy on separation of duties as they relate to receipt payment and recording of cash transactionsRow1:

32 Does your organization have internal audit or legal staff If not how do you ensure compliance with the award Please describeRow1:

33 If the organization has a petty cash fund how is it monitoredRow1:

34 Who in the organization reconciles bank accountsRow1:

Is this person familiar with the organizations financial activities YesNo:

Does the organization authorize this person to sign checks or handle cash YesNo:

35 Are all employees who handle funds required to be bonded against loss by reason of fraud or dishonesty YesNo:

If no what control mechanisms are in placeRow1:

36 When is the organizations fiscal yearRow1:

37 Did the organization expend 1000000 or more in federal or state awards from all sources during its most recent fiscal year YesNo:

38 Has the organization previously submitted federal or state grant audits in the last 2 years YesNo:

If no briefly explain If yes address the following The date of the most recently submitted audit report The auditors opinion on the financial statement If applicable indicate if the organization has findings in the following areas 1 internal controls 2 questioned or unallowable costs 3 procurementsuspension and debarment 4 cash management of award funds and 5 subrecipient monitoring Include if applicable o A description of each finding classified as Material Weakness o A description of each finding classified as Significant DeficiencyRow1:

39 Does the organization have any Corrective Action Plans in the past 2 years for the findings identified in a previously submitted audit as outlined above YesNo:

If yes describe the status closed or open and progress made on those corrective actionsRow1:

40 Disclose all information related to violations by the organization of state or federal criminal law involving fraud bribery or gratuity violations potentially affecting the state awardRow1:

41 Explain the organizations process to comply with a 45 CFR 75113 Mandatory Disclosures and b Federal Funding Accountability and Transparency Act FFATA requirementsRow1:

AOR Name:

Today's Date:

File details come from the government source that posted it. Updated Aug 20, 2026.