Exhibit I, Work Order Request-Response Form.pdf
PDF 322 KB Posted
- Attached to
- WIC Multi-media Program
- Solicitation number
- HHS0016182
- Issued by
- Texas
About this file
This is a Work Order Request-Response Form template (Exhibit I) for RFP No. HHS0016182 issued by the Texas Health and Human Services Commission for the WIC Multi-media Program. The form establishes the framework for issuing individual work orders to eligible contractors under a master contract, with sections addressing work order scope, deliverables, compensation structure, and contractor response requirements. The solicitation timeline includes a contractor questions deadline, response distribution date, work order response due date, optional negotiation period, and estimated work order award date, with all dates subject to change at the agency's discretion. Contractors must submit work order responses via email, USB drive, or paper submission with USB drive according to specified deadlines. The form requires contractors to identify all deliverables with associated deadlines, propose a detailed project timeline, assign qualified staff to each deliverable, and describe how they will fulfill the work order requirements.
Compensation under resulting work orders will utilize either a lump sum/fixed fee or time and materials structure with a not-to-exceed amount, with pricing tied to specific deliverables as identified in the master contract. The form requires contractors to detail projected expenditures by deliverable, including hourly rates, number of hours per staff member, and total costs per deliverable, with proposed pricing limited to established rates in the master contract. Travel reimbursement is permitted only if authorized by the master contract and must comply with agency-specified requirements. Work order evaluation criteria are weighted at 25% for contractor experience, 20% for key personnel qualifications, 25% for project plan, and 30% for pricing. Contractors must submit a Historically Underutilized Business (HUB) Subcontracting Plan upon work order authorization to HHSCHUB@hhs.texas.gov and cannot proceed with work until obtaining HUB Program Office approval. No work or invoicing is authorized until the work order is signed by both parties and a purchase order is issued.
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RFP No. HHS0016182 Exhibit I
EXHIBIT I – RFP HHS0016182
WORK ORDER REQUEST-RESPONSE FORM
This form has two sections. SECTION I, WORK ORDER REQUEST REQUIREMENTS, is to be completed by the System Agency Contract Manager and comprises the requirements associated with the specified individual Work Order. SECTION II, WORK ORDER RESPONSE, is to be completed by the Contractor.
SECTION I. WORK ORDER REQUEST REQUIREMENTS
A. GENERAL INFORMATION AND TIMELINE
1. Work Order Request Information
Solicitation #: [Enter Number] Solicitation Title: [Enter Title]
Work Order #: [Enter Number] Work Order Request Project Title:
[Enter Title]
2. Work Order Request Timeline
This Work Order Request solicits Work Order Responses from eligible Contractors according to the timeline below.
Work Order Request Release Date: [Enter date]
Contractor Questions Deadline: [Enter date] at [Enter time a.m./p.m.] Central Time
Responses to Questions Distributed to Contractors: [Enter date]
Work Order Response *DUE DATE*: [Enter date] at [Enter time a.m./p.m.] Central Time
Response Evaluation Period [optional] ☐ Yes [Enter month and year] ☐ Not applicable
Work Order Negotiation Meeting [optional]: ☐ Yes [Enter month and year] ☐ Not applicable
Estimated Work Order Award Date [optional] ☐ Yes [Enter date] ☐ Not applicable
Work Order Start Date: [Enter date]
Work Order End Date: [Enter date]
All dates are subject to change at the System Agency’s discretion and Contractors will be notified in writing if there are changes to this timeline.
B. WORK ORDER POINT OF CONTACT
1. System Agency Point of Contact
All communications and submission of documents required under this Work Order Request will be conducted by email. All communications for this Work Order Request must be directed to the Work Order Request Point of Contact at the following email address:
Agency Contact: [Enter Name] Agency Contact Title: [Enter Title]
Agency Contact Email: [Enter Email Address]
Agency Contact Phone: [Enter Phone #]
Failure to comply with this requirement may result in disqualification of Contractor from being selected for this Work Order.
2. Questions
Any questions by Contractors regarding the Work Order Request must be submitted to the System Agency Work Order Request Point of Contact by the “Contractor Questions Deadline” provided in this Work Order Request. Responses to questions will be emailed to all Contractors receiving this Work Order Request. The Work Order Request Point of Contact may combine duplicative or similar questions and provide one response. Also, the System Agency reserves the right not to respond to submitted questions that it determines are not relevant to the Work Order Request.
C. WORK ORDER SCOPE OF WORK
1. Description of Services and Contractor Requirements
Under this Work Order, Contractor must provide the following Services to the System Agency:
[Describe all services that Contractor must provide under this specific resulting Work Order. Ensure that the detailed services are consistent with the Master Contract.]
2. Work Order Deliverables
The Contractor will be responsible for submitting the following Deliverables under the resulting Work Order (additional rows can be added as required):
No. Deliverable Description Deadline
1. [Description of Deliverable 1] [Deadline for Deliverable 1]
2. [Description of Deliverable 2] [Deadline for Deliverable 2]
3. [Description of Deliverable 3] [Deadline for Deliverable 3]
4. [Description of Deliverable 4] [Deadline for Deliverable 4]
5. [Description of Deliverable 5] [Deadline for Deliverable 5]
6. [Description of Deliverable 6] [Deadline for Deliverable 6]
7. [Description of Deliverable 7] [Deadline for Deliverable 7]
8. [Description of Deliverable 8] [Deadline for Deliverable 8]
9. [Description of Deliverable 9] [Deadline for Deliverable 9]
10. [Description of Deliverable 10] [Deadline for Deliverable 10]
3. Liquidated Damages Associated with Deliverables (if applicable):
If applicable, will this Work Order require complementary liquidated damages in addition to those of the Master Contract? ☐ Yes ☐ No ☐ Not Applicable
If “No” or “Not Applicable” move to next section of this form.
If “Yes” insert liquidated damages specific to this project below.
[Insert liquidated damages specific to this project.]
4. Compensation Method
The resulting Work Order will utilize the following compensation structure set forth in the Master Contract (check one option only):
☐ Lump Sum / Fixed Fee for this project is: [$0.00]
☐ Time & Materials with a not-to-exceed amount of: [$0.00]
5. Payment and Invoicing
a. All payments under a resulting Work Order shall comply with the Master Contract including, but not limited to, travel expenses.
b. Payment for Services related to this Work Order Request will be tied to specific Deliverables.
Contractor must identify the invoice for each Deliverable. See SECTION II, WORK ORDER
RESPONSE.
c. Contractor is not authorized to perform Work or invoice for Work performed until a Work Order is signed by both parties and the purchase order is issued for this Work Order.
D. RESPONSE SUBMISSION REQUIREMENTS
Failure to adhere to the requirements of this section may result in disqualification of Contractor’s Work Order Response.
1. Work Order Response Contents and Format
Contractor must fully complete SECTION II, WORK ORDER RESPONSE, and the submission must adhere to the requirements of this Work Order Request. Contractor must not modify the form in any way, including, but not limited to, changing font, font size, margins, section order, or headers. Contractor’s Work Order Response must be clearly legible.
a. The Narrative, Response identified at SECTION II, WORK ORDER RESPONSE is limited to [# (Number)] pages in length and excludes any HUB Subcontracting Plan (HSP) updates, supporting documentation, resumes, and budget information.
b. Contractor shall submit any updates to its HUB Subcontracting Plan in a separate document. For assistance updating HSP forms, call (512) 406-2570 or send an email to HHSCHUB@hhs.texas.gov.
2. Work Order Response Submission Method
Contractor shall submit its Work Order Response using any of the checked options below: (Select all that apply) ☐ Email
Contractor will attach this Work Order Request, and its completed Work Order Response to an email and submit to the Point of Contact identified in SECTION I(B)(1). The subject line in Contractor’s email should include the Work Order Request number.
☐ USB Drive Contractor will submit an electronic copy of this document including its completed Work Order Response on one USB drive in a sealed package. Delivery address is as follows:
Click or tap here to enter text.
☐ Paper Submission with USB Drive Contractor will submit one original and four copies of this document including its completed Work Order Response. Contractor must also submit an electronic copy of its submission on one USB drive. Contractor must ensure that all information is in both the hard and electronic copies.
Delivery address is as follows:
Click or tap here to enter text.
Note: Telephone or facsimile responses will not be accepted.
3. Work Order Response Deadline
The completed Work Order Response must be received no later than the Work Order Response DUE DATE specified in SECTION I(A)(2) of this Work Order Request.
E. WORK ORDER EVALUATION
1. Evaluation Criteria
The System Agency will evaluate and select the Work Order Response offering best value using the following criteria:
Contractor experience with work order requirements - 25% Key personnel’s relevant qualifications and experience – 20% Proposed project plan – 25% Proposed pricing – 30%
2. Negotiations, if required
The selected Contractor(s) must be prepared for a contract negotiation meeting(s), if required, in Section A (2), Work Order Request Timeline, of this Work Order Request-Response.
F. GENERAL REQUIREMENTS
This Work Order Request and the resulting Work Order are subject to the terms and conditions of the Contract.
The terms of the Contract may not be amended by a Work Order.
G. APPENDICES
As applicable, the following Appendix/Appendices is/are attached hereto, incorporated herein, and made part of the Contract for all purposes.
1. Appendix A - [Insert Name, as applicable]
2. Appendix B - [Insert Name, as applicable]
3. Appendix C - [Insert Name, as applicable]
SECTION II. WORK ORDER RESPONSE
A. NARRATIVE RESPONSE
1. Contractor’s General Information
Contractor Name: [Enter Name] Contact: [Enter Contractor’s Contact Name]
Address: [Enter Contractor Address] Contact Title: [Enter Contact’s Phone #]
Phone: [Enter Contractor’s General Phone #]
Contact Phone: [Enter Contact’s Phone #]
Email: [Enter Contractor’s General Email
Contact Email: [Enter Contact’s Email]
2. Contractor’s Fulfillment of Work Order Request Requirements
[Contractor must describe how it will fulfill the requirements identified in the Work Order Request.]
3. Contractor’s Proposed Timeline/Project Schedule
Contractor must propose a timeline/project schedule to meet the “Estimated Work Order End Date” identified at Section I(A)(2) of the Work Order Request. Contractor may use the table, below, to submit this information. (Rows can be added as required.)
Deliverable Assigned Contractor Staff
Submission Deadline
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
[Description of Deliverable] [Staff] [Deadline]
B. CONTRACTOR’S PROPOSED PRICING
1. Contractor’s Projected Expenditures under Work Order by Deliverable
a. Contractor’s Work Order Response must provide the projected expenditures for each Deliverable identified in the Work Order Request using the table, below.
b. Contractor must use the table, below, and must not modify it in any way including, but not limited to, changing font, font size, margins, section order, or headers.
c. The System Agency will evaluate the Contractor’s projected expenditures provided in this Work
Order Response and, if approved, will request that Contractor execute the Work Order.
d. Submission of projected expenditure information on a Work Order Response does not guarantee funding, unless, and until, the Work Order is signed by the Contractor and System Agency.
e. Contractor must identify its proposed staff by Deliverable. For each member of its proposed staff, Contractor must identify the staff member’s hourly rate, the number of hours the staff member is expected to work on the identified Deliverable, and the total cost associated with that staff member for the identified Deliverable.
f. Contractor’s proposed pricing may not exceed established rates identified in its Master Contract.
Staff by Deliverable Hourly Rate
Number of Hours
Cost per Staff Total Cost of Deliverable
Deliverable [#] $ [#]
Staff 1: [Staff] [Rate] [#] [#]
Staff 2: [Staff] [Rate] [#] [#]
Staff 3: [Staff] [Rate] [#] [#]
Staff 4: [Staff] [Rate] [#] [#]
Deliverable [#] $ [#]
Staff 1: [Staff] [Rate] [#] [#]
Staff 2: [Staff] [Rate] [#] [#]
Staff 3: [Staff] [Rate] [#] [#]
Staff 4: [Staff] [Rate] [#] [#]
Deliverable [#] $ [#]
Staff 1: [Staff] [Rate] [#] [#]
Staff 2: [Staff] [Rate] [#] [#]
Staff 3: [Staff] [Rate] [#] [#]
Staff 4: [Staff] [Rate] [#] [#]
Deliverable [#] $ [#]
Staff 1: [Staff] [Rate] [#] [#]
Staff 2: [Staff] [Rate] [#] [#]
Staff 3: [Staff] [Rate] [#] [#]
Staff 4: [Staff] [Rate] [#] [#]
Deliverable [#] $ [#]
Staff by Deliverable Hourly Rate
Number of Hours
Cost per Staff Total Cost of Deliverable
Staff 1: [Staff] [Rate] [#] [#]
Staff 2: [Staff] [Rate] [#] [#]
Staff 3: [Staff] [Rate] [#] [#]
Staff 4: [Staff] [Rate] [#] [#]
Total Costs for Deliverables $ [#]
2. Contractor’s Projected Expenditures under Work Order for Travel
If travel reimbursement is allowed by the Master Contract, the Contractor must list projected travel expenditures by staff member’s title and type of travel, to include length of stay, identification of hotel, location, flight costs, mileage, etc. Contractor acknowledges that System Agency is not authorized to remit payment for travel expenses that do not comply with the Master Contract.
Staff Travel (Contractor must list projected travel costs expenditures by staff title and type of travel).
Projected Travel Expenditures
Staff 1 - [Insert Staff (Member Title]1) [Staff Name] $ [#]
Flight/Bus/Train Trips [Description] [#]
Hotel [Description]
Mileage [Description] [#]
Car Rental [Description] [#]
Per Diems [Description] [#]
Total Staff 1 $ [#] Staff (2 - [Insert Staff Member Title]) [Staff Name] $ [#]
Flight/Bus/Train Trips [Description] [#]
Hotel [Description]
Mileage [Description] [#]
Car Rental [Description] [#]
Per Diems [Description] [#]
Total Staff 2 $ [#] Staff (3 - [Insert Staff Member Title]) [Staff Name] $ [#]
Flight/Bus/Train Trips [Description] [#]
Hotel [Description] [#]
Mileage [Description] [#]
Staff Travel (Contractor must list projected travel costs expenditures by staff title and type of travel).
Projected Travel Expenditures
Car Rental [Description] [#]
Per Diems [Description] [#]
Total Staff 3 $ [#]
Staff (4) [Staff Name] $ [#]
Flight/Bus/Train Trips [Description] [#]
Hotel [Description] [#]
Mileage [Description] [#]
Car Rental [Description] [#]
Per Diems [Description] [#]
Total Staff 4 [#] Total Projected Travel Expenditures $ [#]
C. HISTORICALLY UNDERUTILIZED BUSINESS REQUIREMENTS
Upon Work Order Authorization, the Contractor will the submit its HUB Subcontracting Plan to the following email address: HHSCHUB@hhs.texas.gov. Note: Contractor will not be able to proceed with any Work under the resulting Work Order without obtaining approval from the HHS HUB Program Office.
D. WORK ORDER RESPONSE CERTIFICATION
By signing this Work Order Response Form, Contractor certifies that the information provided in its Work Order Response is complete and accurate. Contractor further certifies that it meets the requirements and is capable of providing the Services identified in the Work Order Request. The individual whose name and signature appears below, acts with authority to bind Contractor.
[Contractor’s Name]
[Signature]
[Date]
Authorized Signature Date [Enter Name]
Printed Name [Enter Signatory’s Title]
Title mailto:HHSCHUB@hhs.texas.gov
SECTION III. WORK ORDER AUTHORIZATIONS
A. NEGOTIATIONS
Did negotiations result in modifications to the original Work Order Request? (Select one) ☐ Yes ☐ No ☐ Not Applicable (negotiations were not conducted)
If “No” or “Not Applicable” move to the signature section of this form.
If “Yes” provide the details of the negotiated modifications below.
DOCUMENTED NEGOTIATED WORK ORDER REQUEST CHANGES
Item WO Section & Language
Clarification Required
Response Notes
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
[#] [Enter Language]
[Clarification] [Response] [Notes]
B. AUTHORITY TO EXECUTE WORK ORDER:
This Work Order is subject to the terms and conditions of the specified Master Contract. By signing below, each Party represents and warrants that the person executing this Work Order on its behalf has full power and authority to enter into this Work Order. The Work Order is effective on the date of last signature.
[Contractor’s Name]
[Signature] [Date]
Authorized Signature Date
[Enter Name]
Printed Name
[System Agency]
[Signature] [Date]
Authorized Signature Date [Enter Name]
Printed Name
| Exhibit I – RFP HHS0016182 |
| Work Order Request-Response Form |
| Section I. Work Order Request Requirements |
| A. General Information and Timeline |
| 1. Work Order Request Information |
| 2. Work Order Request Timeline |
| B. Work Order Point of Contact |
| 1. System Agency Point of Contact |
| 2. Questions |
| C. Work Order Scope of Work |
| 1. Description of Services and Contractor Requirements |
| 2. Work Order Deliverables |
| 3. Liquidated Damages Associated with Deliverables (if applicable): |
| 4. Compensation Method |
| 5. Payment and Invoicing |
| D. Response Submission Requirements |
| 1. Work Order Response Contents and Format |
| 2. Work Order Response Submission Method |
| 3. Work Order Response Deadline |
| E. Work Order Evaluation |
| 1. Evaluation Criteria |
| 2. Negotiations, if required |
F. General Requirements
| G. Appendices |
| Section II. Work Order Response |
| A. Narrative Response |
| 1. Contractor’s General Information |
| 2. Contractor’s Fulfillment of Work Order Request Requirements |
| 3. Contractor’s Proposed Timeline/Project Schedule |
| B. Contractor’s Proposed Pricing |
| 1. Contractor’s Projected Expenditures under Work Order by Deliverable |
| 2. Contractor’s Projected Expenditures under Work Order for Travel |
| C. Historically Underutilized Business Requirements |
| D. Work Order Response Certification |
| Section III. Work Order Authorizations |
| A. Negotiations |
| B. Authority to execute Work Order: |
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