F2053049230_11AttachmentDEvaluatorScoreSheet.pdf

2122-01 ITN RM Statewide Claims and Investigation Services

DEPARTMENT OF FINANCIAL SERVICES

Attachment D

Evaluator Score Sheet

2122-01 ITN RM

INSTRUCTIONS

Each evaluator should read all Responses before attempting to assign scores to any one Response.

Evaluators must score each Respondent being evaluated on a separate score sheet.

Throughout the evaluation process, the confidentiality and security of the Responses and the scoring process must be maintained.

Response Evaluation – The evaluation team will independently score Volume Two: Technical Response.

The evaluation team will not review or evaluate any other volumes of the Response.

RESPONSE EVALUATION CRITERIA

The evaluation of the Responses will involve scoring the following 2 categories:

Category 1 – Experience and Ability Category 2 – Proposed Approach

Criteria have been developed for each category and are presented on the score sheet. A score should be assigned to each criterion as follows:

Assessment Maximum Points - 20

Maximum Points - 15

Excellent 18-20 13-15 Good 14-17 10-12

Adequate 10-13 7-9 Poor 6-9 4-6

Unacceptable 0-5 0-3

Scoring should reflect the evaluator’s independent evaluation of the Respondent’s overall response based on each criterion and should consider the Respondent’s ability to meet each function, characteristic, performance level, or specification described in the solicitation. A Respondent who exceeds the function, characteristic, performance level, or specification described in the solicitation should receive a higher score than a Respondent who merely meets the function, characteristic, performance level, or specification.

Once the evaluator has completed a score sheet for each Response, the evaluator will submit the completed score sheets to the Procurement Officer.

EVALUATOR SCORE SHEET

Respondent’s Name:

CATEGORY 1 - Experience and Ability

Criteria for Evaluation Maximum Points

ITN/Statement of Work Section

Points Received

1. How well did the Response demonstrate that the Respondent has adequate experience to provide the statewide claims and investigation services sought in this ITN?

ITN

Section 3.3.2, A., 1.

through 3.

2. How well did the Respondent demonstrate its proven ability to effectively administer, manage, and support the services sought in this

ITN?

ITN

Section 3.3.2, A.,

1. through 3.

3. To what extent do the Respondent’s current and/or past contracts demonstrate experience in providing the services sought in this ITN?

Section 3.3.2, A., 1.

through 3.

CATEGORY 2 - Proposed Approach

4. How well did the Respondent’s

Continuity of Operations Plan (COOP) demonstrate the Respondent’s ability to provide the services during an emergency or other non-typical event?

15 ITN

Section 3.3.2, B., 1.

5. How well does the Response demonstrate the Respondent’s ability to perform the services required for Administrative Set-Up, as described in the Statement of Work (SOW)? 20

ITN

Section 3.3.2, B., 4.

and Attachment 2, Statement of Work,

5.1 (See also related portion of Section 5.2.14, Table 2)

6. How well does the Response demonstrate the Respondent’s ability to perform the services for Type I:

Special Investigation/Field Contact - Workers’ Compensation Claims?

Section 3.3.2, B., 5.

and Attachment 2, Statement of Work, 5.2.1., A. (See also related portion of Section 5.2.14, Table 2)

7. How well does the Response to perform the services for Type I:

Special Investigation/Field Contact - State Liability and Property Claims?

Section 3.3.2, B., 6.and Attachment 2, Statement of Work, 5.2.1., B.

(See also related

8. How well does the Response demonstrate the Respondent’s ability to perform the services for Type II:

External Full Handling and Processing of a Claim - Workers’ Compensation? 15

ITN

Section 3.3.2, B., 7.

and Attachment 2, Statement of Work 5.2.2, A.

(See also related

9. How well does the Response demonstrate the Respondent’s ability to perform the services for Type II:

External Full Handling and Processing of a Claim - State Liability and Property Claims?

ITN

Section 3.3.2, B., 8.

and Attachment 2, Statement of Work, 5.2.2, B. (See also related portion of

10. How well does the Response to perform the services for Type III:

Investigation of Possible Insurance Fraud for Workers’ Compensation and State Liability and Property Claims?

Section 3.3.2., B., 9.

and Attachment 2, Statement of Work,

5.2.3 (See also related portion of

11. How well does the Response to perform the services for Type IV:

Surveillance?

ITN

Section 3.3.2, B., 10.and Attachment 2, Statement of Work,

5.2.4 (See also related portion of

12. How well does the Response to perform the services for Type V:

Appraisals?

ITN

Section 3.3.2, B.,

11. and Attachment 2, Statement of Work,

5.2.5 (See also related portion of

13. How well does the Response to perform the services for Type VI:

Temporary Catastrophe Adjusters?

ITN

Section 3.3.2, B., 12.

and

Attachment 2, Statement of Work

5.2.6 (See also related portion of

14. How well does the Response to comply with the Reporting requirements specified in the SOW?

ITN

Section 3.3.2, B.,

13. and Attachment 2, Statement of Work

5.2.7 (See also related portion of

15. How well does the Response demonstrate the Respondent’s proposed approach for developing, finalizing, and maintaining an Internal Quality Assurance Plan?

Section 3.3.2, B.,

14. and Attachment 2, Statement of Work

5.2.8 (See also related portion of

16. How well does the Response demonstrate the Respondent’s proposed approach to complying with the Information Technology (IT) Requirements specified in the SOW? 20

ITN

Section 3.3.2, B.,

15. and Attachment 2, Statement of Work

5.2.9 (See also related portion of

17. How well does the Response to provide and adhere to the staffing requirements specified in the SOW?

ITN

Section 3.3.2, B.,

16. and Attachment 2, Statement of Work

5.2.10 (See also related portion of

18. How well does the Response to adhere to the SSAE 18 (SOC 1 &

2) Type II Audit and Contractor’s Self-Assessment Tool requirements specified in the SOW?

ITN

Section 3.3.2, B.,

17. and Attachment 2, Statement of Work

5.2.11 (See also related portion of

TOTAL POINTS RECEIVED FOR TECHNICAL

RESPONSE - CATEGORY 1 & CATEGORY 2

(300 Points Possible)

Evaluator Name: ___________________________________ Date: __________________________

Evaluator Signature: ________________________________