Onsite_Clinic_Management_Services_for_Employee_Health_Center_(Addendum_#3_Revision).pdf

REQUEST FOR PROPOSAL

2024-007

ONSITE CLINIC MANAGEMENT SERVICES FOR EMPLOYEE

HEALTH CENTER

City of St. Cloud

1300 9th Street

St. Cloud, FL 34769

RELEASE DATE: January 14, 2024

DEADLINE FOR QUESTIONS: February 2, 2024

RESPONSE DEADLINE: February 15, 2024, 2:00 pm

RESPONSES MUST BE SUBMITTED ELECTRONICALLY TO:

https://secure.procurenow.com/portal/stcloud https://secure.procurenow.com/portal/%7bproject.government.code%7d

City of St. Cloud

REQUEST FOR PROPOSAL

Onsite Clinic Management Services for Employee Health Center

I. INTRODUCTION

II. DETAILED SCOPE OF SERVICES AND REQUIREMENTS

III. PROPOSAL CONTENT / FORMAT

IV. INSTRUCTIONS TO BIDDERS

V. EVALUATION CRITERIA

VI. Federal Requirements

VII. INSURANCE REQUIREMENTS

VIII. General Terms and Conditions

Attachments:

A - Sample Agreement

B - C-2 Acord Certificate of Insurance Sample

C - No Response Form

D - Exhbit A - Current Census

E - Exhibit B - 2020-2021 Premise AnnualReport City ofSt. Cloud

F - Exhibit C - 2019-2020 CareHere - Annual Report City of St. Cloud V2.1

G - Exhibit D - St. Cloud Clinic CAD

H - Exhibit E St Cloud BCBS MUE 1019 to 0920

I - Exhibit E St Cloud BCBS MUE 1020 to 0921

J - Exhibit E St Cloud BCBS Runout 1021 to 0922

K - Exhibit F St Cloud Cigna MUE 1021 to 0922

L - Exhibit F St Cloud Cigna HCC 1022 to 1222

M - Exhibit F St Cloud Cigna HCC 1021 to 0922

Request For Proposal #2024-007 Title: Onsite Clinic Management Services for Employee Health Center

N - Exhibit G 2022-2023 COSC Incentive Brochure - wellness

O - Exhibit H Police Officer Physical -CJSTC-075-effective 6-9-08

P - Exhibit H Police Officer Physical-CJSTC-075A

Q - Exhibit H Pre Employment Physical - Healthy4Life new logo_updated_7.22

1. INTRODUCTION

1.1. Summary

A. SCOPE OF SERVICES SUMMARY

The City of St. Cloud is requesting proposals from qualified and experienced firms for Onsite

Clinic Management Services for Employee Health Center, as specified in the Detailed Scope of

Services and Requirements Section of this RFP document. The successful proposer shall prove by their qualifications, experience, and plan for the work, that they will best serve the overall needs of the City. The selection of the successful proposer shall be at the City’s discretion and shall be made in a prompt manner after receipt and evaluation of all responses. If you are interested in preparing a response to this RFP, please complete all the requirements set forth in this RFP document. Under the proposal process, the stipulations set forth herein are fully binding on the proposer to the extent that you confirm acceptance by your electronic signature on the

Respondent’s Certification.

B. PRE-RESPONSE CONFERENCE

A non-mandatory pre-response conference is scheduled for this RFP. Please refer to Section 1.4 for the date, time, and location.

C. CONTRACT FOR SERVICES

After selection of the firm by the City, the firm will be required to negotiate and execute a

Medical Services Agreement with the City.

D. MINIMUM BIDDER QUALIFICATIONS

In order for a Proposal to be considered by the City, Proposers shall demonstrate, in their proposals, compliance with the following minimum requirements:

o Firm must demonstrate qualifications and experience in providing onsite clinic management services for employee health center services services.

o Minimum of three (3) years experience providing specified services to public sector entities.

o Firm licensed to do business in the State of Florida.

E. FUND AVAILABILITY

Any Contract resulting from this solicitation is deemed effective only to the extent that funds are available. The City of St. Cloud abides by the provisions set forth in Florida Statutes relative to appropriations of funds. The ability of the successful Proposer to maintain a sense of fiscal responsibility and budgetary awareness shall be favorably considered in the ranking and award of a contract. This disclosure is being made to assist all Proposers in the gauging of their desire to participate in this Proposal and in the planning and preparation of their written response. The

City reserves the right to negotiate all Proposer fees, costs, charges, for any proposed services or appurtenant requirement.

F. PERSONNEL

The work shall be performed and directed by the key personnel identified in the submittal from the awarded firm or individual in response to this RFP. The awarded firm or individual shall not subcontract, assign or transfer any work under the agreement without the prior written consent of the City. Subconsultants must be identified in the submittal and shall be subject to the approval of the City. Any changes in the identified personnel shall be subject to the prior review and approval of the City. When directed by the City, subconsultants personnel whose performance or behavior is determined to be unsatisfactory shall be immediately removed. The awarded firm or individual shall provide a sufficient number of qualified personnel as necessary to effectively carry out its responsibilities under the agreement.

1.2. Background

The City of St. Cloud is a community of approximately 64,000 residents, covering approximately 20 square miles in Osceola County, located in Central Florida. To obtain general information about the City of St. Cloud, access www.stcloud.org.

1.3. Contact Information

Procurement Services

Procurement Services

1300 9th Street

Building A, 2nd Floor

St. Cloud, FL 34769

Email: purchasing@stcloudfl.gov

Phone: (407) 957-7212

Department:

Human Resources

Department Head:

Justin Kluesner

Human Resources Director

1.4. Timeline

Release Project Date January 14, 2024

Pre-Proposal Meeting (Non-Mandatory) January 24, 2024, 8:00am

Employee Clinic

2950 Lakeshore Blvd.

St. Cloud, Florida 34769

Question Submission Deadline February 2, 2024, 5:00pm http://www.stcloud.org/ mailto:purchasing@stcloudfl.gov tel:(407)957-7212

Proposal Submission Deadline February 15, 2024, 2:00pm

2. DETAILED SCOPE OF SERVICES AND REQUIREMENTS

2.1. Overview

The City of St. Cloud is requesting proposals from qualified and experienced firms to operate and manage its onsite health center. The City's health center, Healthy 4 Life Employee Health & Wellness

Center is currently managed and operated by Premise Health, formerly CareHere, and is located at 2950

Lakeshore Blvd., St. Cloud, Florida 34769. The City self-insures its health plan, including prescription drugs, through Cigna. The City also contracts with Brown & Brown as its insurance broker and consultant.

2.2. Background

Employees, retirees, and dependents age 2 and over that are covered under the City’s health plan are eligible to use the health center. The health center provides the following services: primary care, preventive care, acute care, chronic condition management, biometric screenings, wellness coaching, referral management, flu shots, generic medication dispensing, labs, and occupational health services excluding worker’s compensation (pre-employment physicals, pre-employment drug testing, DOT physicals, random drug screens). The health center also provides 24/7 virtual primary care.

There are approximately 350 employees, 460 dependents, and 21 retirees on the health plan. A current census is included in Exhibit A.

The health center is open 40 hours per week and has one full-time physician’s assistant and one full-time medical assistant. The hours of operation are as follows:

• Monday: 7am to 3:30pm

• Tuesday: 7am to 3:30pm

• Wednesday: 10:30am to 7pm

• Thursday: 7am to 3:30pm

• Friday: 7am to 3:30pm

The City has a strong commitment to health and wellness and continues to adopt plans to encourage healthy behaviors. They also use the health center in partnership with Cigna to off wellness incentives to employees, retirees, and spouses.

The City prefers to have a holistic view of employee health and wellness data and will require the clinic to share data via claims files to both Cigna and Brown & Brown. This will ensure reporting will capture all services.

2.3. Scope of Services

Services to include, but are not limited to:

• Primary care

• Acute and urgent care

• Health risk assessments

• Health coaching

• Chronic condition management

• Disease management

• Immunizations

• Injections

• New hire physicals

• Exams and screenings (including random and required drug testing)

• Lab services

• Prescriptions

• Pharmaceutical dispensing

In addition to onsite healthcare, the City has the onsite medical services provider administer health risk assessments to identify high risk individuals. The awarded provider will work with the City’s existing wellness program to provide educational, intervention, and incentive programs. The firm must comply with all guidelines and regulations set forth in the Health Insurance Portability and Accountability Act

(HIPAA).

The City would like staffing to include a minimum of one full-time nurse practitioner (preferably with at least 5 years in child and adult medicine) and one full-time medical assistant, with oversight by a physician. The City will need a guarantee that there will be no gaps in primary staffing and that the City

Human Resources Department is involved in the hiring process for clinicians and staff with the opportunity to meet and greet prior to hire. Monthly meetings with the implementation contact at the

City’s location are required.

The City has the following goal and objectives:

The City’s goal is to reduce medical claims costs through offering the following services in house:

• Primary care and preventive care

• Chronic condition management

• Disease management

• Health coaching

• Lab work

• Occupational health services

• Pre-employment screening to include DOT

• Prescription dispensary

The City's objectives include:

• Increased participation in primary and preventive care

• Measurement and stratification of health risks

• Outreach to those who are determined to have moderate or high health risks to result in the reduction of risk across the employee population

• Promote wellness and population health

• Improve health outcomes through engagement with health plan members

• Provide primary care to those without an existing primary care relationship

• Manage those with chronic conditions

• Collaborate with the City’s HR team, the City’s insurance carrier, and the City’s broker to develop a multi-year strategy for population health

• Provide monthly and annual reporting to measure utilization, cost avoidance, population health metrics and employee engagement

• Ensure the clinic provides reporting to Cigna and Brown & Brown so that this data will be included in all plan reviews. Data feeds will be required.

3. PROPOSAL CONTENT / FORMAT

In order to achieve a more consistent evaluation of all proposals, proposals shall be submitted in the following format and include the following information:

3.1. DBA*

*Response required

3.2. Authorized Representative Name/Title*

*Response required

3.3. Federal Employer Identification Number (FEIN)*

Verfied in SunBiz

*Response required

3.4. PROPOSAL*

A. TITLE PAGE

1. The title page shall list the subject “RFP NO.2024-007 Onsite Clinic Management Services for

Employee Health Center” It shall also contain the proposing firm’s full legal name, physical address, mailing address (if different than physical address), telephone number and e-mail address, as well as the name, address, telephone and/or cell phone number, and e-mail address of a contact person.

B. TABLE OF CONTENTS

1. The table of contents shall list all major topics with their corresponding section title or heading and beginning page number.

C. INTRODUCTORY LETTER

1. Describe information about your Firm and explain why your Firm is best suited to meet the services for this RFP.

D. QUALIFICATIONS AND EXPERIENCE

1. All firms that submit a proposal shall meet, but not be limited to, the following minimum qualifications:

a. Familiarity and years of service to public agencies.

b. Provide a list of all public agencies for which your firm has provided similar services over the last five (5) years. Include contact person name, title, full address, telephone number, fax number, and email address of a reference within each agency, period of contract, dollar value of contract and services provided. Provide information on contracts providing similar services that have been terminated for any reason.

c. Qualifications and experience of the proposer, including type of business entity, organizational size, structure and history of the organization, experience in the provision of services and location of the office that would contract for services to the City.

d. Indicate specifically the personnel who will have primary responsibility for this contract.

e. Organizational chart with team member resumes. The Respondent shall provide an organizational chart depicting the proposed project team and each team member’s role on the project. The Respondent shall identify all subconsultants.

f. Professional staff (name, project role, business address, phone number and email address) including job skills, education (degree and specification), professional training, total years of experience, years of experience with the current firm, professional registration, and other professional qualifications.

g. Identify any subconsultants who are to participate in providing services. This must include their respective tasks or disciplines they are to perform and evidence of their qualifications (name, project role, business address, phone number and email address) including job skills, education (degree and specification), professional training, total years of experience, years of experience with the current firm, years of experience working with the respondent, percent of subconsultants business to be performed for prime and also include past relationships, professional registration, and other professional qualifications.

h. Current and projected workload. Provide a list of your current and projected workload addressing the addition of the City as a client.

i. Claims and Complaint History – List any claims filed against the proposer (or its agents or employees) with the proposer’s liability insurance carrier for professional error and omissions, including the nature and resolution of such claims; list all written complaints filed with local, state or federal regulatory agencies, business organizations, or other outside agencies against the proposer or any of its agents or employee within the past ten (10) years, together with an explanation of their resolution.

j. Provide performance results, if available, from current clients, including Return on

Investment.

k. Provide insurance in accordance with City's requirements.

l. Provide a statement as to whether the proposer has, in the last five years, been a party to a lawsuit of any kind related to, in any manner, the type of services requested in this

RFP. If any such litigation exists, provide a statement as to legal style of the matter, the jurisdiction in which it was filed and the status.

m. State that the business is licensed, permitted, and/or certified to do business in the

State of Florida. All required federal, state, and local licenses and permits shall be kept in force during the term(s) of the contract. Copies of all required licenses are to be provided with Consultant’s submittal.

E. PROPOSED PROGRAM COSTS

1. Please provide pricing below utilizing the staffing and service hours the proposer sees fit for the City.

a. Please include the following in your detailed pricing response. Fixed fee pricing is preferred.

b. Variable expenses would be the cost of biometric screening and the cost of medications.

The City will not pay additional buyout or fees for hiring staff or for lack of staffing.

c.

d. Please include items below in your detailed pricing response, utilizing the following assumptions:

i. The clinic is open 40 hours per week as chosen by the City.

ii. The facility is City owned, stocked by the proposer.

e.

f.

g.

2. Number of years for guaranteed baseline fees.

3. Identify any charges (if any) that would be run through the medical plan.

4. Explain the procedure for adding future clinic/medical staff hours.

5. Will the administration cost increase by adding future hours?

6. Please detail your contract opt-out period and specify if it is with or without cause, or both.

7. Please provide a sample copy of your contract.

8. Please provide a breakdown of potential savings, including medical and prescription drug claims, to the medical plan by offering services through your firm.

9. Address your willingness to enter a performance guarantee and how the performance criteria and penalties might be defined.

10. Provide a sample of any performance guarantees you have offered to current or prospective clients addressing claims savings, ROI, service metrics, and reporting.

11. Provide fee schedule for ancillary providers/services, such as a Behavioral Health clinician, wellness coach, physical therapist, or any other types of services you offer.

12. Can you accommodate invoicing and receiving payment of the clinic from multiple sources, including portions paid by the City and the health insurance carrier, Cigna?

F. SERVICES PROPOSAL

1. This form shall be an estimate of proposed services and fees and the City reserves the right to determine if the proposed schedule of fees is within Reasonable and Customary Limits for this geographic location.

a.

G. TECHNICAL APPROACH

1. Primary Care

a. How are appointments scheduled? Is there an app to download?

b. Will walk-ins be accepted as time allows?

c. Is the appointment scheduling process available online?

d. Describe the types of problems that can be addressed on-site.

e. Will medications be dispensed on-site? If so, please elaborate in the selection process, scope and type to be administered, as well as the cost and/or claims filing process for dispensed medications.

f. What if a disease process escalates?

g. How will the clinic providers coordinate and communicate care with existing providers, including primary care physicians and specialists? Are there specific health care systems you coordinate with? Or can you coordinate with any in-network health care systems/providers as defined by the City’s health insurance carrier, Cigna?

h. The health center must stay open and provide temporary staffing if necessary when the current staff has time off or has called in sick. Describe your process to ensure this item is met.

i. Describe the primary care case management process and how this process integrates with the carriers case management program.

j. Describe the primary care disease management process.

k. Describe how behavioral health needs are assessed and managed.

l. Does your primary care case and disease management work along with the City’s health insurance carrier, Cigna?

m. Are medical staff rates guaranteed for the length of the contract? If not, please provide details on increases during the term of the contract.

n. Does the City have any right to request the removal of a provider?

o. Does the clinic offer zero dollar claims billing to the City’s health insurance carrier, Cigna?

2. Communication Plan and Member Services

a. Please provide a proposed communication plan for introducing your managing company to our employees and retirees, as well as communications on the City’s wellness program to the employee population and reference the ongoing communication process. Outline your company’s responsibilities in these processes. Please include copies of your educational materials and timelines for distribution.

b. Proposer must provide an integrated and fully operational Electronic Medical Record

(EMR) for clinicians and Personal Health Record (PHR) for members. The EMR/PHR must be automatically populated by your organization with HRA data and biometric screening data validated by your clinician(s) to eliminate any self-reported data discrepancies on the part of the members. Proposer must deliver online and offline Health Risk assessments (HRS) as well as biometric screenings.

i. How can employees communicate with the medical team?

ii. Can your website be linked with the City’s respective website?

iii. Describe your ability to communicate and service an employee/retiree population that is geographically dispersed.

iv. Describe your ability to communicate with a bilingual population (Spanish).

Provide examples if appropriate.

v. Discuss the frequency and type of communications that eligible persons will receive throughout the program period. Discuss capability of sending direct emails to members.

vi. How can an employee access your company for member services after hours?

vii. Provide your web address and any access codes needed to explore your services.

viii. Are you willing to allow the City to use its own branding in communication and program materials?

ix. Are appointment reminders sent via email or text?

x. Are members required to call a Call Center or does the clinic accept calls directly?

xi. What is your Electronic Medical Record (EMR) system and describe any related opportunities pertaining to EMR data for coordination of care from other health care systems beyond the clinic.

3. Identification of High-Risk Individuals

a. Understanding there is a variety of methodologies for implementing an HRA/targeted intervention process, please explain in detail the HRA/targeted intervention model that your organization would recommend be implemented. Explain the rationale behind your recommendation. Please keep in mind that this needs to be a confidential process following all HIPAA guidelines.

i. How would your company identify high-risk members (i.e., health risk assessment, member services calls, medical claims data, pharmacy claims data, etc.)?

ii. Please describe your methodology for tracking and intervening with high-risk members on an on-going basis.

iii. Do you stratify members by severity of risk for complication? Please elaborate.

What Health Risk Assessment (HRA) do you use and how long have you used it? List all risk factors you identify in your profile. Please provide a sample HRA in your response.

iv. How often do you recommend distributing the HRA? Is your health risk assessment available both on-line and off-line?

v. Is your HRA available in Spanish (both on-line and off-line)?

vi. Describe your organization’s ability to export HRA results to an insurance carrier.

Describe your ability to import data from an outside HRA vendor.

vii. Please describe turnaround time for each of the following areas:

I. Providing the HRA results to individuals.

II. Contacting individuals for possible interventions.

III. Providing each entity with a summary report of the initial HRA results.

viii. Please describe how your organization would provide a system to assist

HRA participants in completion of their questionnaires and in the interpretation of their personal profile.

ix. What level of participation can we expect in years one, two and three of this program?

x. Describe how your organization will set and reach participation goals.

xi. Do you recommend using incentives? If so, please describe the incentives your organization recommends.

xii. Please describe your plan to involve new employees in the HRA process.

xiii. Please describe your capabilities to update an individual’s HRA record while conducting follow-up calls.

xiv. How does your HRA monitor and report individual change from year to year? Do you provide an Aggregate report for overall population from year to year?

xv. Describe the process for engaging an individual with a targeted health condition.

xvi. Describe the process for persons you are unable to reach.

xvii. What is your process for the completion of an annual Health Risk Assessment for members?

xviii. Are you considered a pharmacy or dispensary, and what protocols do you follow? Are dispensed pharmaceuticals shared with PBM to ensure data accuracy.

4. Measurement Tools and Results

a. Address how you would propose to review the on-site clinic operation and its effectiveness. This should include standards and measurement criteria for onsite healthcare activities, costs, outcomes, HRA, disease management, member services, member intervention, and educational materials.

i. How would you propose measuring outcomes and success of the overall program?

ii. Describe your standard management reports. Describe your custom reporting capabilities and the associated costs. Please provide a recommendation and examples of reports that you would provide to the City on an ongoing basis.

iii. How will the clinic provide reporting to Cigna and Brown & Brown so that this data will be included in all plan reviews. Describe data feed requirements and costs, if applicable.

iv. Provide examples of the following, if applicable:

I. On-site healthcare activity report

II. Member participation

III. Member intervention

IV. Financial summary/savings report

V. Management reports online

VI. Monthly billing invoice

v. Describe how your Plan specifically evaluates the effectiveness of primary care case management. Include any results of the evaluation as an attachment.

vi. Provide all clinical indicators used to track the success of an onsite health clinic. Please include the following, if applicable:

I. Outcomes

II. Utilization Measures (list measures)

III. Member Satisfaction

IV. Changes in the Cost of Care

V. Productivity/Absenteeism (list indicators)

vii. Describe specifically how personal health records for individuals will be managed.

viii. What are your turnover rates for primary physicians, nurses and ancillary staff? What is the total number employed?

ix. Provide recruiting measures to obtain and retain doctors, nurses and staff.

x. Provide a sample member satisfaction survey, how it’s reviewed and responses.

5. Wellness and Health Coaching

a. Proposer must demonstrate a strong focus on behavior-based coaching and capabilities and supporting toolset to drive measurable population risk reduction across our population in terms of modifiable conditions.

i. Describe any wellness/coaching offered at no cost to members.

ii. Describe integration of data from City’s medical provider Cigna and the health center.

iii. Describe how the clinician works with those with chronic conditions. Are there any treatment plans given to the member? How does the clinician build a relationship with the member?

iv. The City’s current wellness incentive program is Cigna’s Motivate Me. Describe your ability to integrate with that platform or if no integration exists, do you provide an incentive tracking program for members? If so, please provide sample/screenshots.

6. HIPAA Compliance

a. Describe the measures your company takes to assure compliance with HIPPA.

b. Describe your system for the assurance of personal health data security.

c. Have your network security systems ever been breached? Describe.

d. Describe your process in the event of a data breach?

7. Implementation

a. Please include projected implementation schedule and information supporting the ability to meet the City’s needs in providing the services outlined in the requested

“Scope of Services”.

8. Additional Data to Support Proposal

a. Provide a copy of your current certificate of insurance. During the entire period of performance of any contract resulting from this solicitation, the successful Proposer shall procure and maintain the minimum insurance coverage required by the City of St.

Cloud as stipulated in the insurance attachment (Refer to Attachment ‘C’). Policies other than Workers’ Compensation shall be issued only by companies authorized by subsisting certificates of authority issued to the company by the Department of

Insurance of the State of Florida to conduct business in the State of Florida, with a minimum A.M. Best rating of VII/A-. Proof of such insurance must be provided to the

City prior to beginning contract performance.

H. PROJECT UNDERSTANDING AND PROPOSED APPROACH

1. Proposer shall include a proposed approach for providing the services outlined in the requested “Scope of Services” as understood by the Firm and the ability of the Firm to provide such resources.

I. SIMILAR PROJECTS

1. To demonstrate experience and success in conducting similar work, the proposer shall provide a minimum of five (5) similar contracts that best illustrates the proposed team’s qualification for the scope of services indicated in this RFP. This shall include project name, project start and completion date, client name and contact information, project staff involved from the proposed project team as listed on the organization chart (to be included with submittal); and a detailed description of the project and its applicability to evaluation of this RFP. Do not include the City of St. Cloud as a reference.

*Response required

3.5. PRICE PROPOSAL*

*Response required

3.6. ADDITIONAL DATA TO SUPPORT PROPOSAL*

Provide a copy of your current certificate of insurance. During the entire period of performance of any contract resulting from this solicitation, the successful Proposer shall procure and maintain the minimum insurance coverage required by the City of St. Cloud as stipulated in the Insurance

Requirements Section. Policies other than Workers’ Compensation shall be issued only by companies authorized by subsisting certificates of authority issued to the company by the Department of Insurance of the State of Florida to conduct business in the State of Florida, with a minimum A.M. Best rating of

VII/A-. Proof of such insurance must be provided to the City prior to beginning contract performance.

*Response required

3.7. COMPLIANCE FORMS

3.7.1. Respondent's Certification*

I have carefully examined the Invitation to Bid.

I hereby propose to furnish the services specified in the Solicitation. I agree that my submittal will remain firm for a period of at least 90 days in order to allow the City adequate time to award bid.

I certify that all information contained in this submittal is truthful. I further certify that I am duly authorized to provide this submittal on behalf of the firm as its act and deed and that the firm is ready, willing and able to perform if awarded the contract.

I further certify, under oath, that this submittal is made without prior understanding, agreement, connection, discussion, or collusion with any other person, firm or corporation tendering a submittal for the same service, that no officer, employee or agent of the City of St. Cloud or any other respondent is interested in said submittal; and that the undersigned executed this Respondent’s Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so.

☐ Please confirm

*Response required

3.7.2. Sworn Statement Pursuant to Section 287.133(3)(a), Florida Statutes, on Public Entity Crimes*

I understand that a “”public entity crime” as defined in Paragraph 287.133 (1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United

States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentations.

I understand that “convicted” or “conviction” as defined in Paragraph 287.133 (1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or non contendere.

I understand that an “affiliate” as defined in Paragraph 287.133(1)(a), Florida Statutes, means:

A. A predecessor or successor of a person convicted of a public entity crime; or

B. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term “affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm’s length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

I understand that a “person” as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term “person” includes those officers, directors, executives, and partners. Shareholders, employees, members, and agents who are active in management of an entity.

Based on information and belief, the statement, which I have marked below, is true in relations to the entity submitting this sworn statement. (Indicate which statement applies).

□ Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.

□ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.

□ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the final Order entered by the

Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list (attach a copy of the final order).

I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE

PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND THAT THIS

FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO

UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A

CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA

STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.

☐ Please confirm

*Response required

3.7.3. Americans with Disabilities Act (ADA) Disability Nondiscrimination Statement* I, being duly first sworn state: That the named firm, corporation or organization is in compliance with and agreed to continue to comply with, and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed below including, but not limited to, those provision pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction. The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat327,42USC1210112213 and 47 USC Sections

225 and 661 including Title I, Employment; Title II, Public Services: Title III, Public Accommodations and

Services Operated by Private entities; Title IV, Telecommunications; and Title V, Miscellaneous

Provisions. The Florida Americans with Disabilities Accessibility Implementation Act of 1993, Section

553.501-553.513, Florida Statutes: The Rehabilitation Act of 1973, 229 USC Section 794; The Federal

Transit Act, as amended 49 USC Section 1612; The Fair Housing Act as amended 42USC Section 3601-

☐ Please confirm

3.7.4. Business Entity Affidavit (Vendor/Bidder Disclosure)*

OWNERSHIP DISCLOSURE AFFIDAVIT

A. If the contact or business transaction is with a corporation, the full legal name and business address shall be provided for each officer and director and each stockholder who holds directly or indirectly five percent (5%) or more of the corporation’s stock. If the contract or business transaction is with a trust, the full legal name and address shall be provided for each trustee and each beneficiary. All such names and addresses are (Post Office addresses are not acceptable), as follows:

Full Legal Name:

Address:

Ownership %:

The full legal names and business address of any other individual (other than subcontractors, materialmen, suppliers, laborers, or lenders) who have, or will have, any interest (legal equitable, beneficial or otherwise) in the contract or business transaction with the City are (Post Office addresses are not acceptable), as follows

3.7.5. City of St. Cloud Drug Free Workplace Compliance Form* Preference shall be given to businesses with drug-free workplace programs. Whenever two or more bids, which are equal with respect to price, quality, and service, are received by the State or by any political subdivision for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie bids will be followed if none of the tied vendors have a drug-free workplace program. In order to have a drug-free workplace program, a business shall: (The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that does): (Name of Business)

A. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

B. Inform employees about the dangers of drug abuse in the workplace, the business’s policy of maintaining a drug-free workplace, any available drug counseling rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

C. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in Subsection 1.

D. In the statement specified in Subsection 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contender to, any violation of Chapter 1893 or of any controlled substance law of the

United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

E. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee’s community, by any employee who is so convicted.

F. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

As the person authorized to sign the statement, I confirm that this form complies fully with the above requirements.

3.7.6. No Lobbying Affidavit*

I confirm that I am an authorized representative, maker of the attached submittal made in response to a request for bid, proposals, qualifications and/or any other solicitation released by the City of St. Cloud, and swear that the bidder and any of its agents agrees to abide by the City of St. Cloud’s no lobbying restrictions in regard to this solicitation

☐ Please confirm

*Response required

3.7.7. Certification for Contracts, Grants, Loans, and Cooperative Agreements* The undersigned certifies, to the best of his or her knowledge, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any

Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of

Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form- LLL, "Disclosure

Form to Report Lobbying," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all sub awards at all tiers (including subcontracts, sub grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352

(as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The undersigned Contractor hereby certifies and attests to the accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any.

3.7.8. Vendor Certification of Scrutinized Companies Lists*

Section 287.135, Florida Statutes, prohibits agencies from contracting with companies for goods or services of $1,000,000 or more, that are on either the Scrutinized Companies with Activities in Sudan

List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which are created pursuant to s. 215.473, F.S., or the Scrutinized Companies that Boycott Israel List, created pursuant to s. 215.4725, F.S., or companies that are engaged in a boycott of Israel. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the section entitled “Respondent Vendor Name” is not listed on either the Scrutinized Companies with

Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector

List, or the Scrutinized Companies that Boycott Israel List. I further certify that the company is not engaged in a boycott of Israel. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney’s fees, and/or costs.

I confirm that I am authorized to sign on behalf of the referenced company and certify acknowledgement and acceptance that the above statement is true.

3.7.9. Certification Regarding Debarment, Suspension, and Other Responsibility Matters*

This certification is required by the Federal Regulations Implementing Executive Order 12549, Debarment and Suspension, 45 CFR Part 93, Government-wide Debarment and Suspension, for the

Department of Agriculture (7CFR Part 3017), Department of Labor (29 CFR Part 98), Department of

Education (34 CFR Parts 85,668,682), Department of Health and Human Services (45 CFR Part 76).

I, the prospective bidder certify to the best of its knowledge and belief that it and its principals:

A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

B. Have not within a three year period preceding this proposal been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements , or receiving stolen property;

C. Are not presently indicted for or otherwise criminally or civilly charged by a government entity

(Federal, State, or local) with commission of any offenses enumerated in paragraph (B) of this certification; and

D. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, local) terminated for cause or default.

I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award. Any exceptions provided will not necessarily result in denial of award, but will be considered in determining bidder responsibility and whether or not the City will enter into contract with the party. For any exception noted, indicate on an attached sheet to whom it applies, initiating agency, and dates of action. Providing false information may result in criminal prosecution or administrative sanctions.

3.7.10. E-Verify Compliance Form*

Definitions:

“Contractor” means a person or entity that has entered or is attempting to enter into a contract with a public employer to provide labor, supplies, or services to such employer in exchange for salary, wages, or other remuneration.

“Subcontractor” means a person or entity that provides labor, supplies, or services to or for a contractor or another subcontractor in exchange for salary, wages, or other remuneration.

Effective January 1, 2021, public and private employers, contractors and subcontractors will begin required registration with, and use of the E-verify system in order to verify the work authorization status of all newly hired employees. Vendor/Consultant/Contractor acknowledges and agrees to utilize the U.S.

Department of Homeland Security’s E-Verify System to verify the employment eligibility of:

A. All persons employed by Vendor/Consultant/Contractor to perform employment duties within Florida during the term of the contract; and

B. All persons (including subvendors/subconsultants/subcontractors) assigned by

Vendor/Consultant/Contractor to perform work pursuant to the contract with the

Department. The Vendor/Consultant/Contractor acknowledges and agrees that use of the

U.S. Department of Homeland Security’s E-Verify System during the term of the contract is a condition of the contract with the City of St. Cloud, Florida; and

C. Should vendor become successful Contractor awarded for the above-named project, by entering into this Contract, the Contractor becomes obligated to comply with the provisions of Section 448.095, Fla. Stat., "Employment Eligibility," as amended from time to time. This includes but is not limited to utilization of the E-Verify System to verify the work authorization status of all newly hired employees, and requiring all subcontractors to provide an affidavit attesting that the subcontractor does not employ, contract with, or subcontract with, an unauthorized alien. The contractor shall maintain a copy of such affidavit for the duration of the contract. Failure to comply will lead to termination of this Contract, or if a subcontractor knowingly violates the statute, the subcontract must be terminated immediately. Any challenge to termination under this provision must be filed in the Circuit Court no later than 20 calendar days after the date of termination. If this contract is terminated for a violation of the statute by the Contractor, the Contractor may not be awarded a public contract for a period of 1 year after the date of termination.

3.7.11. Federal Requirements (If Applicable)

Please review and confirm the acceptance of the Federal Requirements. #Federal Requirements

☐ Please confirm

3.7.12. General Terms and Conditions

Please review and confirm the acceptance of the General Terms and Conditions.

☐ Please confirm

3.8. Additional Documents

3.8.1. PROPRIETARY INFORMATION

https://procurement.opengov.com/portal/stcloud/projects/74987?section=undefined

4. INSTRUCTIONS TO BIDDERS

4.1. PUBLIC RECORD STATEMENT

By submitting a proposal to the City of St. Cloud, each Bidder acknowledges and understands that the

City of St. Cloud is a public agency subject to Chapter 119 Florida Statutes (“Public Records Law”) and all responses are deemed a public record and open to public scrutiny. Any Proposal document the Bidder submits will be a public record when the City of St. Cloud provides notice of an intended decision or 30 days after opening the bids, proposals, or final replies, whichever is earlier. Trade Secrets, certain background financial information, and other items, may constitute exemptions to disclosure under the

Public Records law. Bidder expressly understands records associated with this project are public records and agrees to comply with Florida’s Public Records Law, to include:

A. Keep and maintain public records that ordinarily and necessarily would be required by the City in order to perform the services contemplated herein.

B. Provide the public with access to public records on the same terms and conditions that the City would provide the records and at a…