Proposal Instructions - Confidential Treatment - Vendor Questions Worksheet.docx

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Attached to
MPSERS Dental Benefit Plan Administration
Solicitation number
RFP 171 200000001290 3
Issued by
Michigan

About this file

This document comprises the Proposal Instructions and Vendor Questions Worksheet for Request for Proposal No. 200000001290 issued by the State of Michigan Department of Technology, Management and Budget for the Administration of MPSERS Dental Benefit Plan. The RFP was issued on March 5, 2020, with a proposal deadline of April 6, 2020, at 3:00 p.m. Eastern. The deadline for bidders to submit questions was March 13, 2020, with answers posted by March 19, 2020. Bidders had until March 27, 2020, to request Claims Repricing Data Files (Schedule C1 and C2), which total approximately 110 MB and are provided via private site links due to file size constraints. The anticipated contract begin date is July 8, 2020. The Solicitation Manager is Mary Ostrowski, reachable at (517) 249-0438 or ostrowskim@michigan.gov. Bidders must submit complete proposals electronically through www.michigan.gov/SIGMAVSS in modifiable format with file size limits of 6 MB per document. The proposal is irrevocable and binding for 180 calendar days from submission.

The evaluation process awards the contract to the responsive and responsible bidder offering the best value, with technical evaluation weighted at 200 points covering Schedule A requirements (staffing, project management, transition), vendor background and experience, and proposal quality. Proposals must achieve at least 160 points to have pricing evaluated. Mandatory minimum requirements include duplicating the current Plan Design and possessing a Michigan TPA license or equivalent statutory authorization. The State reserves the right to conduct site visits, oral presentations, reference checks, and request price concessions. Contracts valued at $500,000 or greater require State Administrative Board approval. Bidders must submit a completed Confidential Treatment Form regardless of whether confidential information is included, provide responses to the Vendor Questions Worksheet addressing company background, relevant experience, qualified disabled veteran status, prior litigation, Michigan economic impact, and various certifications regarding tax compliance, labor practices, and corporate citizenship. The State will not be liable for bidder costs and may incorporate proposal elements into the final contract.

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Other files

File Type Posted
Schedule B Pricing.xlsx XLSX spreadsheet
Schedule M Service Availability Report.docx DOCX document
Schedule A Statement of WorkREVISED.docx DOCX document
Schedule F1 834 Example.docx DOCX document
Standard Contract Terms.docx DOCX document
Schedule H Service Level Agreements.xlsx XLSX spreadsheet
Schedule O Contractors Disaster Recovery Plan.docx DOCX document
Schedule L Coordination of Benefits.docx DOCX document
Schedule D Contractor Hosted Software and Terms.docx DOCX document
Schedule J Plan Design with Procedure Codes.xlsx XLSX spreadsheet
Schedule I Account Management Satisfaction Survey.doc DOC document
Schedule G Generic Medical Claim Layout.xlsx XLSX spreadsheet
Schedule S Enrollment Data.xlsx XLSX spreadsheet
Schedule K Policy Appeals Processes.docx DOCX document
Schedule N Definitions.docx DOCX document
Schedule Q GeoAccess.xlsx XLSX spreadsheet
Schedule E Data Security Requirements REVISED2.docx DOCX document
Schedule F2 834 Use Case.docx DOCX document
Schedule P - HIPAA Business Associate Agreement.docx DOCX document
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STATE OF MICHIGAN

Department of Technology, Management and Budget—Procurement

Administration of MPSERS Dental Benefit Plan Request for Proposal No. 200000001290

Solicitation Manager Name: Mary Ostrowski Direct Phone: (517)249-0438 Email: ostrowskim@michigan.gov Main Phone: 1-855-MI-PURCH 1-855-647-8724

This is a Request for Proposal (RFP) for:

Administration of MPSERS Dental Benefit Plan

RFP Timeline

Event
Time
Date
RFP issue date
N/A
3/5/20
Deadline for Bidders to submit questions about this RFP
3:00 p.m. Eastern
3/13/20

Anticipated date State will post answers to bidder questions on www.michigan.gov/SIGMAVSS

3/19/20

Deadline for Bidders to request Schedule C1 and C2 Claims Repricing Data Files from Solicitation Manager
3:00 p.m. Eastern
3/27/20
Proposal Deadline*
3:00 p.m. Eastern
4/6/20
Anticipated contract begin date
N/A
7/8/20

*A Bidder’s proposal received at 3:00:01 p.m. Eastern is late and subject to disqualification.

This RFP is subject to change. Check www.michigan.gov/SIGMAVSS for current information.

PROPOSAL INSTRUCTIONS

1. PROPOSAL PREPARATION. The State recommends reading all RFP materials prior to preparing a proposal, particularly these Proposal Instructions and the Vendor Questions Worksheet. Bidders must follow these Proposal Instructions and provide a complete response to the items indicated in the table below. References and links to websites or external sources may not be used in lieu of providing the information requested in the RFP within the proposal. Include the bidder’s company name in the header of all documents submitted with your proposal.

RFP Structure and Documentation

Document
Description
Bidder Response Instructions
Cover Page
Provides RFP title and number, important dates, and contact information for Solicitation Manager
Informational
Proposal Instructions
Provides RFP instructions to bidders
Informational
Confidential Treatment Form
Required verification on whether bidder’s proposal contains confidential information
Bidder to complete and submit by proposal deadline
Vendor Questions Worksheet
Questions to bidders on background and experience
Bidder to complete and submit by proposal deadline
Schedule A – Statement of Work
Statement of work
Bidder to complete and submit by proposal deadline
Schedule B – Pricing
Pricing for goods and services sought by the State through this RFP
Bidder to complete and submit by proposal deadline
Schedule C1 and C2 – Claims Repricing Part 1 and 2
Claims data for FY2018 and 2019
Bidder to complete and submit by proposal deadline. See also Proposal Instructions Section 5 Claims Repricing Files.
Schedule D - Contractor Hosted Software and Terms
Contractor Hosted Software and Terms
Bidder must acknowledge acceptance in Schedule A, Section 1.1.E.5
Schedule E – Data Security Requirements
Data Security Requirements
Bidder must acknowledge acceptance in Schedule A, Section 1.1.E.9
Schedule F1 – 834 Example
834 Example
Bidder must acknowledge acceptance in Schedule A, Section 1.1.D.8
Schedule F2 – 834 Use Case
834 Use Case
Bidder must acknowledge acceptance in Schedule A, Section 1.1.D.8
Schedule G – Generic Medical Claim Layout
Generic Medical Claim Layout
Bidder must acknowledge acceptance in Schedule A, Section 1.1.I.1.a
Schedule H – Service Level Agreements
Service Level Agreements
Bidder must acknowledge acceptance in Schedule A, Section 1.1.J.1
Schedule I – Account Management Satisfaction Survey
Account Management Satisfaction Survey
Bidder must acknowledge acceptance in Schedule A, Section 4.4
Schedule J – Plan Design with Procedure Codes
Plan Design with Procedure Codes
Bidder must acknowledge acceptance as part of Mandatory Minimums and in Schedule A, Section 1.1.A.2
Schedule K – Policy Appeals Processes
Policy Appeals Processes
Bidder must acknowledge acceptance in Schedule A, Section 1.1.L.11
Schedule L – Coordination of Benefits
Coordination of Benefits
Bidder must acknowledge acceptance in Schedule A, Section 1.1.L.13
Schedule M – Service Availability Report
Service Availability Report
Bidder to complete and submit by proposal deadline
Schedule N - Definitions
Definitions
Bidder must acknowledge acceptance in Schedule A, Section 1.G
Schedule O – Contractor’s Disaster Recovery Plan
This Schedule is a placeholder for the Bidder to provide their Disaster Recovery Plan.
Bidder to complete and submit by proposal deadline
Schedule P – HIPAA Business Associate Agreement
HIPAA Business Associate Agreement
Bidder must acknowledge acceptance in Schedule A, Section 1.1.D.4
Schedule Q - GeoAccess
GeoAccess Data
Bidder to complete and submit by proposal deadline
Schedule R – Disruption Analysis
Provider Location Data for Disruption Analysis
Bidder to complete and submit by proposal deadline
Schedule S – Enrollment Data
Enrollment Data
Informational
Contract Terms
Provides legal terms for a contract awarded through this RFP
Deemed accepted by bidder unless information required in Section 8, Evaluation Process is submitted by proposal deadline

2. CONTACT INFORMATION FOR THE STATE. The sole point of contact for the State concerning this RFP is listed on the Cover Page. Contacting any other State personnel, agent, consultant, or representative about this RFP may result in bidder disqualification.

3. MODIFICATIONS. The State may modify this RFP at any time. Modifications will be posted on www.michigan.gov/SIGMAVSS . This is the only method by which the RFP may be modified.

4. QUESTIONS. Bidder questions about this RFP must be emailed to the Solicitation Manager (ostrowskim@michigan.gov) no later than the time and date specified on the Cover Page. In the interest of transparency, only written questions are accepted. Answers to questions will be posted on www.michigan.gov/SIGMAVSS. Submit questions using the format below; a Microsoft Excel format or similar is suggested.

Q #
Document and Section
Page #
Bidder Question

5. CLAIMS REPRICING FILES. (Schedule C1 Claims Repricing Part 1 of 2 and Schedule C2 Claims Repricing Part 2 of 2) Due to the large file size (approximately 110MB each), these files cannot be provided to Bidders on SIGMA VSS, nor uploaded to the SIGMA VSS once the Bidders have added their repricing data. Bidders planning to submit a proposal must request the files by emailing the Solicitation Manager no later than the deadline noted on the RFP timeline above. The Solicitation Manager will then send the Bidder contact a private site link to access and download the files. Bidders must upload their completed repricing file back to this same site prior to the Proposal deadline noted in the RFP timeline above. Do not wait until the last minute to submit this portion of your proposal. Bidders will not have access to this private site after the proposal deadline.

6. DELIVERY OF PROPOSAL.

Electronic – The bidder must submit its proposal, all attachments, and any modifications or withdrawals electronically through www.michigan.gov/SIGMAVSS. The price proposal should be saved separately from all other proposal documents. The bidder should submit all documents in a modifiable (native) format (examples include, but are not limited to: Microsoft Word or Excel and Google Docs or Sheets). In addition to submitting documents in a modifiable format, the bidder may also submit copies of documents in PDF. Attachment file size is limited to 6 MB per document. Bidder’s failure to submit a proposal as required may result in disqualification. The proposal and attachments must be fully uploaded and submitted prior to the proposal deadline. Do not wait until the last minute to submit a proposal, as the SIGMA VSS system requires the creation of an account and entry of certain information, in addition to uploading and submitting the materials. The SIGMA VSS system will not allow a proposal to be submitted after the proposal deadline identified in the solicitation Closing On/Closing Date fields (Summary view/Detail view), even if a portion of the proposal has been uploaded.

Questions on how to submit information or how to navigate in the SIGMA VSS system can be answered by calling (517) 373-4111 or (888) 734-9749. The Solicitation Manager will not provide assistance related to the submittal of the proposal and all attachments on the day of the proposal deadline. Responsibility for a complete submission lies with the bidder.

7. MANDATORY MINIMUM REQUIREMENTS. To avoid disqualification, the bidder must:

1. The Contractor must duplicate the current Plan Design for the Plan Sponsor. See Schedule A Section 1.1.A.2.

2. The Contractor must be a licensed Third-Party Administrator (TPA) in the State of Michigan or insurance company licensed to do business in Michigan, or must qualify in any other capacity as an entity that is properly licensed by statute to provide administrative services only and cost-plus arrangements, or to act as a TPA. The Contractor must attach details regarding any statutory cites that permit the Contractor to meet this requirement. See Schedule A Section 1.H.

Only proposals meeting the mandatory minimum requirements will be considered for evaluation.

8. EVALUATION PROCESS. If all mandatory minimum requirements are met the State will evaluate each proposal based on the following factors:

Technical Evaluation Criteria
Weight
1.
Schedule A, excluding Sections: 3. Staffing, 4. Project Management, 7. Invoice and Payment, and Section 8 Transition.
120
2.
Schedule A, Section 3. Staffing
20
3.
Schedule A, Section 4. Project Management and

Schedule A, Section 7. Invoice and Payment, Section 8 Transition

4.
Vendor Questions, Section 2 Company Background and

Vendor Questions, Section 5 Experience

Total
200

Proposals receiving 160 or more technical evaluation points will have pricing evaluated and considered for award.

The State may utilize all bidder information, without regard to a proposal’s technical score, to determine fair market value for goods or services sought. The State is not obligated to accept the lowest price proposal. If applicable, the State’s evaluation will include consideration of a bidder’s qualified disabled veterans/service -disabled veteran owned business(QVD/SDVOB) status under MCL 18.1261(8). Additional information on the SDVOB preference is available at: https://www.michigan.gov/dtmb/0,5552,7-358-82550_85746_48677-412612--,00.html.

The State strongly encourages strict adherence to the Contract Terms. The State reserves the right to deem a bid non-responsive for failure to accept the Contract Terms. Nevertheless, the bidder may submit proposed changes to the Contract Terms in track changes (i.e., visible edits) with an explanation of the bidder’s need for each proposed change. Failure to include track changes with an explanation of the bidder’s need for the proposed change constitutes the bidder’s acceptance of the Contract Terms. General statements, such as that the bidder reserves the right to negotiate the terms and conditions, may be considered non-responsive.

The State may but is not required to conduct an on-site visit to tour and inspect the bidder’s facilities; require an oral presentation of the bidder's proposal; conduct interviews, research, reference checks, and background checks; and request additional price concessions at any point during the evaluation process.

9. NOTICE OF DEFICIENCY. The State reserves the right to issue a Notice of Deficiency to bidders if the State determines after the proposal deadline that a portion of the RFP was deficient, unclear, or ambiguous. Failure to respond to a Notice of Deficiency timely may be cause for disqualification.

10. CLARIFICATION REQUEST. The State reserves the right to issue a Clarification Request to a bidder to clarify its proposal if the State determines the proposal is not clear. Failure to respond to a Clarification Request timely may be cause for disqualification.

11. RESERVATIONS. The State reserves the right to:

a. Disqualify a bidder for failure to follow these instructions.

b. Discontinue the RFP process at any time for any or no reason. The issuance of an RFP, your preparation and submission of a proposal, and the State’s subsequent receipt and evaluation of your proposal does not commit the State to award a contract to you or anyone, even if all the requirements in the RFP are met.

c. Consider late proposals if: (i) no other proposals are received; (ii) no complete proposals are received; (iii) the State received complete proposals, but the proposals did not meet mandatory minimum requirements or technical criteria; or (iv) the award process fails to result in an award.

d. Consider an otherwise disqualified proposal, if no other proposals are received.

e. Disqualify a proposal based on: (i) information provided by the bidder in response to this RFP; (2) the bidder’s failure to complete registration on www.michigan.gov/SIGMAVSS ; or (3) if it is determined that a bidder purposely or willfully submitted false or misleading information in response to the RFP.

f. Consider prior performance with the State in making its award decision.

g. Consider overall economic impact to the State when evaluating proposal pricing and in the final award recommendation. This includes but is not limited to: considering principal place of performance, number of Michigan citizens employed or potentially employed, dollars paid to Michigan residents, Michigan capital investments, job creation, tax revenue implications, and economically disadvantaged businesses.

h. Consider total-cost-of-ownership factors (e.g., transition and training costs) when evaluating proposal pricing and in the final award recommendation.

i. Refuse to award a contract to any bidder that has failed to pay State taxes or has outstanding debt with the State.

j. Enter into negotiations with one or more bidders on price, terms, technical requirements, or other deliverables.

k. Award multiple, optional-use contracts, or award by Contract Activity.

l. Evaluate the proposal outside the scope identified in Section 8, Evaluation Process, if the State receives only one proposal.

12. AWARD RECOMMENDATION. The contract will be awarded to the responsive and responsible bidder who offers the best value to the State, as determined by the State. Best value will be determined by the bidder meeting the minimum point threshold and offering the best combination of the factors stated in Section 8, Evaluation Process, and price, as demonstrated by the proposal. The State will post a Notice of Recommendation for Award on www.michigan.gov/SIGMAVSS .

13. DEBRIEF MEETING AND BID PROTEST. The State will post a Notice of Recommendation for Award, which will provide instructions on how to request a debrief meeting

If you wish to initiate a protest of the award, you must submit your written protest electronically at BidProtest-DTMB@michigan.gov no later than 3:00 p.m., 5 calendar days after posting the Notice of Recommendation for Award on SIGMA VSS, or by 3:00 p.m. the next business day if that date falls on a state holiday or weekend. The State reserves the right to adjust this timing and will publish any change on the SIGMA VSS.

Additional information about the protest process is available at www.michigan.gov/micontractconnect under the “Programs and Policies” link.

14. STATE ADMINISTRATIVE BOARD. Contracts equal to $500,000 or greater than require approval by the State Administrative Board. The State Administrative Board’s decision is final; however, its approval does not constitute a contract. The award process is not complete until the awarded contractor receives a contract fully executed by all parties.

15. GENERAL CONDITIONS. The State will not be liable for any costs, expenses, or damages incurred by a bidder participating in this solicitation. The bidder agrees that its proposal will be considered an offer to do business with the State in accordance with its proposal, including the Contract Terms, and that its proposal will be irrevocable and binding for a period of 180 calendar days from date of submission. If a contract is awarded to the bidder, the State may, at its option, incorporate any part of the bidder’s proposal into a contract. This RFP is not an offer to enter into a contract. This RFP may not provide a complete statement of the State’s environment, or contain all matters upon which agreement must be reached. Other than verified trade secrets, proposals submitted via www.michigan.gov/SIGMAVSS are the State’s property.

16. CONFIDENTIAL TREATMENT FORM AND THE FREEDOM OF INFORMATION ACT. All portions of the bidder’s proposal and resulting contract are subject to disclosure as required under Michigan’s Freedom of Information Act (FOIA), MCL 15.231, et seq. However, some information may be exempt from disclosure. Under MCL 18.1261(13)(b), records containing “a trade secret as defined under section 2 of the uniform trade secrets act, 1998 PA 448, MCL 445.1902,” are exempt from disclosure under FOIA. In addition, “financial or proprietary information” submitted with a bidder’s proposal is exempt from disclosure under FOIA. A bidder’s failure to comply with this Section is grounds for rejecting a bidder’s proposal as non-responsive. As a part of its proposal, each bidder must follow the procedure below.

a. SUBMIT A COMPLETED “CONFIDENTIAL TREATMENT FORM” (CT FORM) WITH YOUR BID. Completion and submission of the CT Form is required regardless of whether the bidder seeks confidential treatment of information. Failure to submit a completed CT Form may be cause for disqualification from the solicitation process.

i. Complete and sign Section 1 of the CT Form if the bidder does NOT request confidential treatment of information contained in its proposal; or

ii. Complete and sign Section 2 of the CT Form if the bidder requests confidential treatment of certain information. Bidder must also submit a “Public Copy” of the proposal with the trade secret, financial, and proprietary information redacted and clearly labeled as the “Public Copy.”

b. FOIA REQUESTS. If a FOIA request is made for a bidder’s proposal, the Public Copy may be distributed to the public along with the bidder’s CT Form. The CT Form is a public document and serves as an explanation for the redactions to the Public Copy. Do not put any trade secret, financial, or proprietary information in the CT Form. Do not redact the CT Form itself.

c. NO ADVICE. The State will not advise a bidder as to the nature or content of documents entitled to protection from disclosure under FOIA or other laws, as to the interpretation of such laws, or as to the definition of trade secret or financial or proprietary information. Nothing contained in this provision will modify or amend requirements and obligations imposed on the State by FOIA or other applicable law.

d. FAILURE TO REQUEST CONFIDENTIAL TREATMENT. Failure to request material be treated as confidential as specified herein relieves the State, its agencies, and personnel from any responsibility for maintaining material in confidence.

e. Bids containing a request to maintain an entire proposal as confidential may be rejected as non-responsive. Bidders may not request confidential treatment with respect to resumes, pricing, and marketing materials. The State reserves the right to determine whether material designated as exempt by a bidder falls under MCL 18.1261 or other applicable FOIA exemptions. If a FOIA request is made for materials that the bidder has identified as trade secret, financial, or proprietary information, the State has the final authority to determine whether the materials are exempt from disclosure under FOIA.

f. Bidder forever releases the State, its departments, subdivisions, officers, and employees from all claims, rights, actions, demands, damages, liabilities, expenses and fees, which arise out of or relate to the disclosure of all or a portion of bidder’s proposal submitted under this RFP. Bidder must defend, indemnify and hold the State, its departments, subdivisions, officers, and employees harmless, without limitation, from and against all actions, claims, losses, liabilities, damages, costs, attorney fees, and expenses (including those required to establish the right to indemnification), arising out of or relating to any FOIA request, including potential litigation and appeals, related to the portion of bidder’s proposal submitted under this RFP that bidder has identified as a trade secret, or financial or proprietary information. The State will notify bidder in writing if indemnification is sought. The State is entitled to: (i) regular updates on proceeding status; (ii) participate in the defense of the proceeding; (iii) employ its own counsel; and to (iv) retain control of the defense, or any portion thereof, if the State deems necessary. Bidder will not, without the State’s written consent (not to be unreasonably withheld), settle, compromise, or consent to the entry of any judgment in or otherwise seek to terminate any claim, action, or proceeding. If a State employee, official, or law is involved or challenged, the State may control the defense of that portion of the claim. Any litigation activity on behalf of the State, or any of its subdivisions under this Section, must be coordinated with the Department of Attorney General. An attorney designated to represent the State may not do so until approved by the Michigan Attorney General and appointed as a Special Assistant Attorney General.

CONFIDENTIAL TREATMENT FORM (CT FORM)

INSTRUCTIONS. Complete either Section 1 or Section 2 of this CT Form and sign where indicated. This CT Form must be signed by the individual who signed the bidder’s proposal. A completed CT Form must be submitted with your proposal, regardless of whether your proposal contains confidential information. Failure to submit a completed CT Form with your bid is grounds for rejecting the proposal as non-responsive. See Section 16 of the Proposal Instructions for additional information.

Section 1. Confidential Treatment Is Not Requested

This section must be completed, signed, and submitted with the proposal if bidder does not request confidential treatment of any material contained in the proposal.

By signing below, the bidder affirms that confidential treatment of material contained in the proposal is not requested.

________________________________________________________________
RFP NumberRFP Title
_________________________________________________________
SignatureDate

[Printed Name] [Title] [Company]

Section 2. Confidential Treatment Is Requested

The section must be completed, signed, and submitted with the proposal if bidder requests confidential treatment of any material contained in the proposal. Submission of a completed CT Form is required to request confidential treatment.

Provide the information in the table below. Bidder may add rows or additional pages using the same format shown in the table. Bidder must specifically identify the information to be protected as confidential and state the reasons why protection is necessary. The CT Form will not be considered fully complete unless, for each confidentiality request, the bidder: (1) identifies whether the material is a trade secret (TS), financial information (FI), or proprietary information (PI); (2) explains the specific legal grounds that support treatment of the material as TS, FI, or PI; and (3) provides the contact information for the person at bidder’s organization authorized to respond to inquiries by the State concerning the material. Bidders must not simply cite to an applicable act or case name; rather, bidders must provide a complete justification as to how the material falls within the scope of an applicable act or relevant case law.

CONFIDENTIAL TREATMENT FORM (CT FORM)

RFP page #, paragraph #, and section #
State whether the material is a trade secret (TS), financial information (FI), or proprietary information (PI)
Explain the specific grounds in State or other applicable law which supports treatment of the material as TS, FI, or PI. Do not simply cite to the applicable act. Provide a complete justification as to how the material falls within the scope of the applicable act or relevant case law.
Provide the bidder contact information

By signing below, the bidder affirms that confidential treatment of material contained in its proposal is requested and has attached to this form a redacted “Public Copy” of the bidder’s proposal.

________________________________________________________________
RFP NumberRFP Title
_________________________________________________________
SignatureDate

[Printed Name] [Title] [Company]

VENDOR QUESTIONS WORKSHEET

Provide a detailed response to each question. “You” and “company” refers to the bidder.

Information Sought
Bidder Response

1. Contact Information

Bidder’s sole contact person during the RFP process. Include name, title, address, email, and phone number.

Person authorized to receive and sign a resulting contract. Include name, title, address, email, phone number and vendor customer code in SIGMA VSS.

2. Company Background Information

Legal business name and address. Include business entity designation, e.g., sole proprietor, Inc., LLC, or LLP.

What state was the company formed in?

Phone number

Website address

Number of years in business and number of employees

Legal business name and address of parent company, if any

Has there been a recent change in organizational structure (e.g., management team) or control (e.g., merger or acquisition) of your company? If the answer is yes: (a) explain why the change occurred and (b) how this change has affected your company.

Discuss your company’s history. Has growth been organic, through mergers and acquisitions, or both?

Has bidder ever been debarred, suspended, or disqualified from bidding or contracting with any entity, including the State of Michigan? If yes, provide the date, the entity, and details about the situation.

Has your company been a party to litigation against the State of Michigan? If the answer is yes, then state the date of initial filing, case name and court number, and jurisdiction.

Within the last 5 years, has your company or any of its related business entities defaulted on a contract or had a contract terminated for cause? If yes, provide the date, contracting entity, type of contract, and details about the termination or default.

State your gross annual sales each of the last 5 years. If receiving a contract under this RFP will increase your gross revenue by more than 25% from last year’s sales, explain how the company will scale-up to manage this increase.

Does your company have experience working with the State of Michigan? If so, please provide a list (including the contract number) of the contracts you hold or have held with the State for the last 10 years.

Describe partnerships and strategic relationships you think will bring significant value to the State.

State the physical address of the place of business that would have primary responsibility for this account if bidder is awarded a contract under this RFP.

3. Qualified Disabled Veteran/Service Disabled Veteran-Owned Business Program

Under MCL 18.1261, a “qualified disabled veteran” means a business entity that is 51% or more owned by 1 or more veterans with a service-connected disability. A “service-connected disability” means a disability incurred or aggravated in the line of duty in the active military, naval, or air service as described in 38 USC 101(16). Are you a qualified disabled veteran?
Enter YES or NO.

To demonstrate qualification as a qualified disabled veteran, you must provide:

(a) Proof of service and conditions of discharge (DD214 or equivalent);

(b) Proof of service-connected disability (DD214 if the disability was documented at discharge or Veterans Administration Rating Decision Letter or equivalent if the disability was documented after discharge); and

(c) Legal documents setting forth the ownership of the business entity.

In lieu of the documentation identified above, you may provide proof of certification by the National Veterans Business Development Council.

Enter the names of documents submitted with your proposal to demonstrate status as a qualified disabled veteran.

4. Participation in RFP Development or Evaluation

Did your company, an employee, agent, or representative of your company, or any affiliated entity participate in developing any component of this solicitation? For purposes of this question, business concerns, organizations, or individuals are affiliates of each other if, directly or indirectly: (1) either one controls or has power to control the other or (2) a third party controls or has the power to control both. Indicia of control include, but are not limited to, interlocking management or ownership, identity of interests among family members, shared facilities or equipment, and common use of employees.

If you entered “YES”, you are not eligible for contract award or to work as a subcontractor for the awarded vendor.

If you are awarded a contract under this solicitation, in order to provide the goods or services required under a resulting contract, do you intend to partner or subcontract with a person or entity that assisted in the development of this solicitation?
If you entered “YES,” you are not eligible for contract award. An awarded vendor may not partner or subcontract with anyone to provide goods and services required under a resulting contract if that subcontractor or partner assisted in the development of this solicitation.
Will your company, or an employee, agent, or representative of your company, participate in the evaluation of the proposals received in response to this RFP?
If you entered “YES”, you are not eligible for contract award or to work as a subcontractor for the awarded vendor.

5. Prior Experience

Describe at least 3 relevant experiences from the last 5 years supporting your ability to successfully manage a contract of similar size and scope for the work described in this RFP.

Experience 1

Company name Contact name Contact role at time of project Contact phone Contact email

City State Zip

1. Project name and description of the scope of the project

2. What role did your company play?

3. How is this project experience relevant to the subject of this RFP?

4. Approximate number of covered lives (total membership) at the end of the last plan year?

Dollar value

Start and end date (mm/yy – mm/yy)

Status (completed, live, other – specify phase)

Results obtained

Experience 2

Company name

Contact role at time of project

City

1. Project name and description of the scope of the project

Dollar value

Start and end date (mm/yy – mm/yy)

Status (completed, live, other – specify phase)

Results obtained

Experience 3

Company name

Contact role at time of project

City

1. Project name and description of the scope of the project

Dollar value

Start and end date (mm/yy – mm/yy)

Status (completed, live, other – specify phase)

Results obtained

6. Standard Contract Terms

Bidder must affirm agreement with the attached Contract Terms. If not in agreement, written exceptions in accordance with Section 8 Evaluation Process must be provided with Bidder’s proposal.

7. Michigan Economic Impact

Number of employees currently employed at locations within the State of Michigan

Number of additional employees to be employed at locations within the State of Michigan if awarded this Contract (if any)

Minimum wage paid to employees employed at locations within the State of Michigan

Average wage paid to employees employed at locations within the State of Michigan

Percentage of employees employed at locations within the State of Michigan that are covered by employer-provided health insurance

8. Other

Abusive Labor Practices. The Contractor certifies that it will not furnish any Deliverable that was produced fully or partially by forced labor, forced or indentured child labor, or indentured servitude.
Enter YES or NO.
Certification of Michigan Business- Public Act 431 of 1984, Sec. 268. I certify that the company has, pursuant to the provisions of Sec 268 of Public Act 431 of 1984, filed a Michigan Business Tax Corporate Income Tax Return. I certify that the company has, pursuant to the provisions of Sec 268 of Public Act 431 of 1984, filed a Michigan Income Tax return showing income generated in, or attributed to the State of Michigan. I certify that the company has, pursuant to the provisions of Sec 268 of Public Act 431 of 1984, withheld Michigan Income Tax from compensation paid to the company’s owners and remitted the tax to the Michigan Department of Treasury.
Enter YES or NO.
Iran Linked Business- Public Act 517 of 2012. I certify that the Company is not an Iran-Linked business as defined by Public Act 517 of 2012.
Enter YES or NO.
Clean Corporate Citizen. I certify that the Company is a Clean Corporate Citizen as defined by the Environmental Protection Act, 1994 PA 451.
Enter YES or NO.
Convict Labor. The Contractor certifies that if using convict labor, it is complying with all applicable state and federal laws and policies.
Enter YES or NO.
SOM Debt/Tax Payment. All SOM tax/debts. I certify that all applicable State of Michigan taxes are paid, and that no outstanding debt is owed to the State of Michigan.
Enter YES or NO.
Authorization to Verify Information provided by Vendor. I authorize the State to verify that all information provided in this registration, in bidding and contracting documents, and any attachments or supplement documents and processes are accurate.
Enter YES or NO.

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File details come from the government source that posted it. Updated .