RFP_04-26_Agent_of_Record_Final.pdf

/40404/5#61487610 v2

NEW SMYRNA BEACH UTILITIES

200 CANAL STREET

P.O. BOX 100

NEW SMYRNA BEACH, FL 32170-010

REQUEST FOR PROPOSAL #04-26

RFP #04-26

REQUEST FOR PROPOSAL

New Smyrna Beach Utilities is seeking proposals from qualified firms, licensed in the State of Florida to enter into a contractual agreement to provide Agent of Record services. The awarded firm shall furnish all services in accordance with, but not limited to, the guidelines in the Scope of Work.

Notice is hereby given that sealed proposals will be ACCEPTED ELECTRONICALLY VIA VENDOR LINK, until JANUARY 27, 2026 AT 2:30PM https://www.myvendorlink.com/external/bids?a=358

Submit Proposals To:

Maureen Lynch, CPPB Procurement Manager New Smyrna Beach Utilities mlynch@nsbufl.com

(386) 424.3046 Voice

(386) 424.3147 Fax

TABLE OF CONTENTS

Proposal Schedule General Terms & Conditions w. Insurance Requirements Certification of Drug-Free Workplace Form Non-Collusion Affidavit of Prime Bidder Form…………………………………………………13 Request for Taxpayer Identification Number and Certification W-9 Form Vendor Application Questionnaire Foreign Country of Concern Attestation…………...…………………………………………… 17 Required Disclosure Scope of Work Proposal Submittal Requirements and Evaluation Factors Proposal Form Sample Agreement

PROPOSAL SCHEDULE

• DISTRIBUTION OF THE REQUEST FOR PROPOSAL: December 15, 2025

• DEADLINE FOR FINAL QUESTIONS BY 2:30 P.M.: December 31, 2025

E-MAIL TO MLYNCH@NSBUFL.COM

• ADDENDUM PUBLISHED BY 5:00 P.M.: January 14, 2025

• PROPOSAL RETURN DEADLINE BY 2:30 P.M.: January 27, 2026

ELECTRONIC SUBMITTALS THROUGH VENDOR LINK

• BID OPENING 3:00 P.M. January 27, 2026

WE ARE ALSO OFFERING A REMOTE CALL-IN FOR LISTENING TO THE BID

OPENING.

YOU CAN ATTEND BY DIALING (872) 216-5903

CONFERENCE ID: 978 663 782#

OR BY CLICKING ON THE LINK BELOW

https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZGJjYjU0YTctNGU5ZS00OGVjLTkzNzctMTQwODM5ZWYxMzA5 %40thread.v2/0?context=%7b%22Tid%22%3a%2219e89539-5749-45c7-8e15-c666411ecab8%22%2c%22Oid%22%3a%22a50d38e8-dc21-4945-8930- 118cfc76150d%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZGJjYjU0YTctNGU5ZS00OGVjLTkzNzctMTQwODM5ZWYxMzA5%40thread.v2/0?context=%7b%22Tid%22%3a%2219e89539-5749-45c7-8e15-c666411ecab8%22%2c%22Oid%22%3a%22a50d38e8-dc21-4945-8930-118cfc76150d%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZGJjYjU0YTctNGU5ZS00OGVjLTkzNzctMTQwODM5ZWYxMzA5%40thread.v2/0?context=%7b%22Tid%22%3a%2219e89539-5749-45c7-8e15-c666411ecab8%22%2c%22Oid%22%3a%22a50d38e8-dc21-4945-8930-118cfc76150d%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZGJjYjU0YTctNGU5ZS00OGVjLTkzNzctMTQwODM5ZWYxMzA5%40thread.v2/0?context=%7b%22Tid%22%3a%2219e89539-5749-45c7-8e15-c666411ecab8%22%2c%22Oid%22%3a%22a50d38e8-dc21-4945-8930-118cfc76150d%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZGJjYjU0YTctNGU5ZS00OGVjLTkzNzctMTQwODM5ZWYxMzA5%40thread.v2/0?context=%7b%22Tid%22%3a%2219e89539-5749-45c7-8e15-c666411ecab8%22%2c%22Oid%22%3a%22a50d38e8-dc21-4945-8930-118cfc76150d%22%7d https://teams.microsoft.com/l/meetup-join/19%3ameeting_ZGJjYjU0YTctNGU5ZS00OGVjLTkzNzctMTQwODM5ZWYxMzA5%40thread.v2/0?context=%7b%22Tid%22%3a%2219e89539-5749-45c7-8e15-c666411ecab8%22%2c%22Oid%22%3a%22a50d38e8-dc21-4945-8930-118cfc76150d%22%7d

GENERAL TERMS AND CONDITIONS

1. INSTRUCTIONS TO PROPOSERS: To ensure consideration of your proposal, please follow these instructions. Proposals not in compliance with conditions specified herein are subject to rejection.

2. SEALED PROPOSALS: An Electronic Proposal must be submitted through Vendor Link by the date and time specified.

3. NEW SMYRNA BEACH UTILITIES: The term Commission used herein refers to the New

Smyrna Beach Utilities, or its duly authorized representative.

4. PROPOSER: The term PROPOSER used herein refers to the dealer/manufacturer/vendor or business organization submitting a proposal to the Commission in response to this solicitation.

5. COLLUSION: The Proposer hereby attests that the prices in this offer have been arrived at independently without consultation, communication, or agreement with any competitor for the purpose of restricting competition.

6. PRICE WARRANTY: The Proposer warrants that the prices of the items set forth herein do not exceed the prices charged by the Proposer under a contract with the State of Florida.

7. QUESTIONS REGARDING PROPOSAL: Commission has made every effort to provide prospective vendors with the information needed to appropriately respond to this RFP. Commission realizes that some clarification, interpretation, or additional information may be required.

Questions regarding any portion of this RFP shall be directed, in writing, to:

New Smyrna Beach Utilities Maureen Lynch, CPPB Procurement Manager mlynch@nsbufl.com

All such requests must be received no later than 2:30 PM, Eastern Standard Time, December 31, 2025 Responses to all requests for more information will be included in any addenda and will be made available to all Proposers via Vendor Link on January 14, 2026 by 5:00PM.

Requests for additional information received after the December 31, 2025 deadline will not receive a response. Responses will not be made orally.

Any additional information pertaining to this RFP or to the services being sought hereunder obtained in a manner other than as described in the preceding paragraph should be regarded as unofficial.

mailto:mlynch@nsbufl.com

Commission will not be bound in any way by information so obtained, or by a Proposer’s reliance thereon.

8. COMMUNICATIONS: Any communication between any potential vendor, service provider, bidder, lobbyist or consultant and any commission, staff member or consultant of the Commission regarding this procurement is strictly prohibited from the date on which the solicitation advertisement appears on the Commission website, VendorLink, or newspaper through the date of contract award.

Also, from the date of the filing of any notice of protest of award through resolution for the parties involved in the protest or contract award, whichever is longer. The only exceptions to this are communications with the Commission Material Manager or the Commission designated point of contact. Any violation shall constitute grounds for immediate and permanent disqualification of the offending firm and possible debarment or suspension. At the Commission General Manager/CEO and Director of Finance (CFO)’s sole discretion, it may also serve as grounds for the voiding of any Contract with the violator and/or to temporarily or permanently debarring the violator from future work with the Commission. This process will safeguard the integrity of the Commission procurement and protest process and also provide an ethical, equitable and transparent procurement process.

9. TRADE SECRETS AND CONFIDENTIAL INFORMATION: Trade secrets and information confidential and exempt from Subsection 119.07(1) of the Florida Statutes and Subsection 24(a) of Article I of the Florida Constitution is not solicited nor desired as information to be submitted with proposals. The Florida Statutes and the State Constitution govern whether information in a proposal is confidential or exempt from the Florida Public Records Act. If information is submitted in a proposal which a consultant deems to be a trade secret or confidential and exempt from the Public Records Act, the information shall be submitted with the proposal in a separate, clearly identifiable email referencing the specific statutory citation for such exemption. Submitted proposals which are marked “confidential” (or other similar language) in their entirety or those in which a significant portion of the submitted proposal is marked “confidential” may be deemed non-responsive by NSBU. The NSBU is not obligated to agree with the consultant’s claim of an exemption and, by submitting a proposal, the consultant agrees to be responsible for defending its claim that each and every portion of the separately marked information is exempt from inspection and copying under the Public Records Act. The consultant agrees that it shall protect, defend, and indemnify, including attorney’s fees and costs, the NSBU for any and all claims and litigation (including litigation initiated by the NSBU) arising from or relating to the consultant’s claim that the separately marked portions of its proposal are not subject to disclosure. If the consultant fails to separately mark portions of its proposal or marks its proposal “confidential” (or other similar language) in its entirety, the NSBU is authorized to produce the entire proposal submitted by the consultant in responding to a public records request.

10. E-VERIFY: By [registering as a vendor, submitting a response to this solicitation, entering into a

Contract], you are obligated to comply with the provisions of Section 448.095, Florida Statutes, “Employment Eligibility.” Further, by your [registration as a vendor/response to this solicitation/entering into a contract] you affirm and represent that you are registered with the E- Verify system are using same, and will continue to use same as required by Section 448.095, Florida Statutes. Compliance with Section 448.095, Florida Statutes, 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. Failure to comply will lead to termination [as a vendor, disqualifying you for award of this solicitation, entering into a contract and/or, cancellation of an active contract], or if your 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 terminated for a violation of the statute by the Proposer, the Proposer may not be allowed to do business with Commission or be awarded a solicitation or contract for a period of 1 year after the date of termination. All costs incurred to initiate and sustain the aforementioned programs shall be the responsibility of the Proposer.

11. PROHIBITION AGAINST CONSIDERATION OF SOCIAL, POLITICAL OR

IDEOLOGICAL INTERESTS

Proposers are hereby notified of the provisions of section 287.05701, Florida Statutes, as amended, that the Commission will not request documentation of or consider a Proposer’s social, political, or ideological interests when determining if the Proposer is a responsible Proposer. Proposers are further notified that the Commission’s governing body may not give preference to a Bidder based on the Proposer’s social, political, or ideological interests.

12. COMPLIANCE WITH FOREIGN ENTITY LAWS

Pursuant to Section 287.138, Florida Statutes, Proposer hereby attests under penalty of perjury the following:

A. Entity is not owned by the government of a foreign country of concern as defined in Section

287.138, Florida Statutes.

B. The government of a foreign country of concern does not have a controlling interest in Entity.

C. Entity is not owned or controlled by the government of a foreign country of concern, as defined in Section 692.201, Florida Statutes.

D. Entity is not a partnership, association, corporation, organization, or other combination of persons organized under the laws of or having its principal place of business in a foreign country of concern, as defined in Section 692.201, Florida Statutes, or a subsidiary of such entity.

E. Entity is not a foreign principal, as defined in Section 692.201, Florida Statutes.

F. Entity is in compliance with all applicable requirements of Sections 692.202, 692.203, and

692.204, Florida Statutes.

G. (Only applicable if purchasing real property) Entity is not a foreign principal prohibited from purchasing the subject real property. Entity is either (a) not a person or entity described in Section 692.204(1)(a), Florida Statutes, or (b) authorized under Section 692.204(2), Florida Statutes, to purchase the subject property. Entity is in compliance with the requirements of Section 692.204, Florida Statutes.

13. INVOICES: All invoices resulting from the award of this bid will be paid within 30 days of receipt of invoice or receipt of goods or acceptance of work performed.

14. BID FORM: A Bid Form is provided, and shall be returned via Vendor Link https://www.myvendorlink.com/external/bids?a=358 marked with Bid number and acknowledgment of receipt of addenda where applicable. It is incumbent upon each Proposer to ensure that they have received all addenda before submitting their Proposals.

15. PREPARATION OF PROPOSAL: All information shall be entered in ink, typewritten or produced by computer. It is your responsibility to make certain that unit prices and extended prices are correct. The Commission will not be responsible for errors or omissions made by proposer in determining proposal price(s). The proposal must contain a manual signature of an authorized representative of the agency proposing. In order to ensure uniformity, proposals must be submitted on this Proposal Form and the attached pages.

16. OBLIGATION OF PROPOSER: By submitting a proposal, the Proposer covenants and agrees that they have satisfied themselves from their own investigation of the conditions to be met, that they fully understand their obligation and that they will not make any claim for or have right to cancellation or relief from the contract because of any misunderstanding or lack of information.

17. AMENDED OR WITHDRAWN PROPOSALS: Proposals may be amended or withdrawn only by written notice prior to the Proposal opening. Amendments will only be accepted in the form of a new Proposal package. The Proposer must pick up the original RFP package and submit an amended sealed proposal prior to the RFP’s closing date and time. Amendments or withdrawals received after the RFP opening will not be effective, and the original RFP submitted will be considered.

18. PUBLIC ENTITY CRIMES: Under Section 287.133(2)(a), Florida Statutes, a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.0l7, Florida Statutes, for Category Two for a period of 36 months from the date of being placed on the convicted vendor list.

19. CONSIDERATION OF PROPOSALS: The Commission reserves the right to award the contract to the Proposer(s) that the Commission deems to offer the best overall proposal. The Commission is therefore not bound to accept a proposal on the basis of lowest price. In addition, the Commission at its sole discretion, reserves the right to cancel this Proposal, to reject any and all proposals, to waive any and all informalities and/or irregularities, to re-advertise with either the identical or revised specifications, or not award a contract at all if it is deemed to be in the best interest of the Commission to do so. The Commission also reserves the right to make multiple or split awards if it is deemed to be in the Commission’s best interest. The Commission shall not be responsible for any cost or expense incurred by the Proposer in preparing or submitting a proposal or any cost prior to the execution of a contract agreement.

20. TIE PROPOSAL: In the event of a tie proposal where quality and service are equal; a preference is given to vendors submitting, with the proposal, a certification of a drug free workplace in accordance with Section 287.087, Florida Statutes. Where tie proposals are between proposers, one of which is located in Volusia County and the other proposer is not, the recommended award shall be to the local proposer. Past Performance-Consideration will be given to a vendor based on previous history and performance on similar Commission projects or requirements. Delivery availability or completion period. Capacity to perform in terms of service availability, facilities, personnel or financial availability. Closeness to delivery point. If all conditions are equal, a flip of a coin, with two witnesses present, shall be the deciding factor.

21. SUBMITTING PROPOSALS: Proposals shall be submitted through the Vendor Link.

22. NO PROPOSAL: In the event a Request for Proposal is returned as a no bid, “NO PROPOSAL” shall be properly marked on the outside of the envelope with the RFP number.

23. REJECTED PROPOSAL: The Commission reserves the right to reject proposals containing any additional OR EXCLUDED terms or conditions not specifically requested in the original conditions and specifications.

24. AWARDS: Awards shall be made as required for the best interest of the Commission. The right is reserved to make award(s) by individual items, group of items, all or none, or any combination thereof, with one or more suppliers.

25. PURCHASING AGREEMENTS WITH OTHER GOVERNMENT AGENCIES

At the option of the awarded Proposer, the submission of any bid in response to this proposal request constitutes a bid made under the same terms and conditions, for the same contract price, to other governmental agencies including the State of Florida and its agencies, political subdivisions, counties and cities.

Each governmental agency desiring to accept these bids, and make an award thereof, shall do so independently of any other governmental agency. Each agency shall be responsible for its own purchases, and each shall be liable only for materials ordered and received by it and no agency assumes any liability by virtue of this bid.

26. CHANGES: Commission may, at any time, direct in writing additions, deletions or changes to all or any part of the work. If any such changes cause an increase or decrease in the cost of or in the time required to perform such work, Proposer shall submit detail information substantiating such claims and an equitable adjustment shall be made to the price or time of performance.

27. CONFLICT OF INTEREST OF OFFICERS OR EMPLOYEES OF THE CONTRACTING

ENTITY/LOCAL JURISDICTION, MEMBERS OF THE LOCAL GOVERNING BODY, OR

OTHER ELECTED OFFICIALS: No member or employee of the contracting entity/local jurisdiction or its designees or agents; no member of the governing body; and no other public official of the Commission who exercises any function or responsibility with respect to this contract, during his/her tenure or for one year thereafter, shall have any interest, direct or indirect, in any contract or subcontract, or the proceeds thereof, for work to be performed. Further, the Proposer shall cause to be incorporated in all subcontracts, the language set forth in this paragraph prohibiting conflict of interest.

28. EMPLOYEE CONFLICT OF INTEREST: It shall be unethical for any Commission employee to participate directly or indirectly in a procurement contract when the Commission employee knows that:

(1) The Commission employee or any member of the Commission employee’s immediate family has a financial interest in the procurement contract; or

(2) Any other person, business, or organization with whom the Commission employee or any member of a Commission employee’s immediate family is negotiating or has an arrangement concerning prospective employment is involved in the procurement contract.

A Commission employee or any member of a Commission employee’s immediate family who holds a financial interest in a disclosed blind trust shall not be deemed to have a conflict of interest with regard to matters pertaining to that financial interest.

29. GRATUITIES AND KICKBACKS:

(1) Gratuities. It shall be unethical for any person to offer, give, or agree to give any Commission employee or former Commission employee, or for any Commission employee or former Commission employee to solicit, demand, accept, or agree to accept from another person, a gratuity or an offer of employment in connection with any decision, approval, disapproval, recommendation, or preparation of any part of a program requirement or a purchase request, influencing the content of any specification or procurement standard, rendering of advice, investigation, auditing, or in any other advisory capacity Commission in any proceeding or application, request for ruling, determina-tion, claim or controversy, or other particular matter, pertaining to any program requirement or a contract or subcontract, or to any solicitation or proposal therefore.

(2) Kickbacks. It shall be unethical for any payment, gratuity, or offer of employment to be made by or on behalf of a subcontractor under a contract to the prime contractor or higher tier sub-contractor or any person associated therewith, as an inducement for the award of a subcontract or order.

(3) Contract Clause. The prohibition against gratuities and kickbacks prescribed in this Section shall be conspicuously set forth in every contract and solicitation, therefore.

30. Indemnification for Tort Actions/Limitation of Liability- The provisions of Section 768.28, Florida Statutes, apply in full to this contract. Any legal actions to recover monetary damages in tort for injury or loss of property, personal injury, or death caused by the negligent or wrongful act or omission of any employee of the Commission acting within the scope of his/her office or employment are subject to the limitations specified in this statute.

No officer, employee or agent of the Commission acting within the scope of his/her employment or function shall be held personally liable in tort or named as a defendant in any action for injury or damage suffered as a result of any act, event or failure to act.

The Commission shall not be liable in tort for the acts or omissions of an officer, employee or agent committed while acting outside the course and scope of his/her employment. This exclusion includes actions committed in bad faith or with malicious purpose, or in a manner exhibiting wanton and willful disregard of human rights, safety, or property.

To the fullest extent permitted by law, the Proposer shall defend, indemnify, and hold harmless the Commission, its officials, agents, and employees from and against any and all claims, suits, judgments, demands, liabilities, damages, cost and expenses (including attorney’s fees) of any kind or nature whatsoever arising directly or indirectly out of or caused in whole or in part by any act or omission of the Proposer or its subcontractors (if any), anyone directly or indirectly employed by them, or anyone for whose acts any of them may be liable; excepting those acts or omissions arising out of the sole negligence of the Commission.

Provided, however, if the contract between the Commission and the Proposer is deemed by a court of competent jurisdiction to be a construction contract for purposes of Section 725.06, Florida Statutes, any obligation of the Proposer to defend, indemnify or hold harmless the Commission, shall be limited to an obligation to indemnify or hold harmless the Commission, its officers and employees from liability damages, losses, and costs, including but not limited to reasonable attorney’s fees, to the extent caused by the negligence, recklessness or intentionally wrongful conduct of the contractor and persons employed or utilized by the Proposer in the performance of the contract.

CERTIFICATION OF DRUG-FREE WORKPLACE FORM

IDENTICAL TIE BIDS - 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 proposers have a drug-free workplace program. In order to have a drug-free workplace program, a business shall:

1. 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.

2. 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.

3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1).

4. 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 contendere to, any violation of chapter 893 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.

5. 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.

6. 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 certify that this firm complies fully with the above requirements.

PROPOSER SIGNATURE

NON-COLLUSION AFFIDAVIT OF PRIME BIDDER FORM

State of______________

County of____________

_____________________________, being first duly sworn, deposes and says that:

He/she is ______________of__________________, Proposer that has submitted the attached Proposal.

He/she is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid.

Neither the said Proposer nor any of its officers, partners, owners, agent representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, sought by agreement or collusion or communication or conference with any other Proposer, firm or person, to fix the price or prices in the attached Bid or of any other Proposer, or to fix any overhead, profit or cost element of the Bid price or the Bid price of any other Proposer, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the Commission.

The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Proposer or any of its agents, representatives, owners, employees, or parties in interest, including this affiant.

Signed

Title

Subscribed and sworn to before me this _____day of________, 20___.

Title

My Notary Commission Expires: ___________

Form W-9 (Rev. March 2024)

Request for Taxpayer Identification Number and Certification

Department of the Treasury Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information.

Give form to the requester. Do not send to the IRS.

Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.

P ri nt o r ty p e.

S ee S p ec if ic

In st ru ct io n s on p ag e 3.

1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded entity’s name on line 2.)

2 Business name/disregarded entity name, if different from above.

3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor C corporation S corporation Partnership Trust/estate

LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.

Other (see instructions)

3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions

4 Exemptions (codes apply only to certain entities, not individuals;

see instructions on page 3):

Exempt payee code (if any)

Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any)

(Applies to accounts maintained outside the United States.)

5 Address (number, street, and apt. or suite no.). See instructions.

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.

Social security number or Employer identification number

Part II Certification Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign Here

Signature of U.S. person Date

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

What’s New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the “LLC” box and enter its appropriate tax classification.

New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow-through entity in which it has an ownership interest. This change is intended to provide a flow-through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065).

Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they

Cat. No. 10231X Form W-9 (Rev. 3-2024)

VENDOR APPLICATION

In addition to General conditions, your Proposal may be disqualified if the following vendor information is not returned with your Proposal.

Proposer is:

( ) Corporation ( ) Partnership ( ) Sole Proprietorship ( ) Other ________________________________________________ (Explain)

Federal Employer Identification Number or Social Security Number: _________________________________

Do you collect Florida State Sales Tax? ( ) Yes ( ) No

Firm Name: ______________________________________________________

Mailing Address: __________________________________________________

Telephone No. _______________________ Fax No. ____________________

Email Address: ____________________Web Address:____________________

Commodity or Service Supply: ________________________________________

If Proposer is quoting, as a manufacturer’s representative and the purchase order should be addressed to the manufacturer in care of the Proposer, so indicate.

If remittance address is different from the mailing address so indicate below.

Firm Name: ________________________________________________________

Mailing Address: ____________________________________________________

Submitted by: _______________________________________________________

Name & Title Printed: _________________________________________________

QUESTIONNAIRE

Additional space may be required. Please answer questions in the order presented. All questions must be answered, or Proposer may be disqualified.

1. Has your company ever been denied insurance or had insurance canceled?

2. Is your company bondable? Has your company ever been denied bond?

If yes, explain.

3. Can your insurance company produce a certificate of insurance stating your limits and naming Commission as an Additional Insured?

4. Has your company been a defendant in any lawsuits?

5. Is your company a subsidiary or otherwise legally affiliated with any other company?

6. Is your company rated by Dunn & Bradstreet or any other rating agency?

If yes, what is the name of the agency and rating?

7. Is your company in any stage of bankruptcy, including initial filing?

8. Has your company been disbarred by the Federal Government or any State Government?

9. How many employees does your company have?

Staff Employees: Full Time______________ Part Time______________

Contract Employees: Full Time_______________ Part Time_______________

FOREIGN COUNTRY OF CONCERN ATTESTATION

This form must be completed by an officer or representative of the entity submitting a bid, proposal, or reply to, or entering into, renewing, or extending, a contract with Commission (the Governmental Entity), which would grant the entity access to an individual’s Personal Identifying Information. Capitalized Terms used herein have the definitions ascribed in Rule 60A-1.020, F.A.C.

Proposer is not owned by the government of a Foreign County of Concern, is not organized under the laws of nor has its Principal Place of Business in a Foreign Country of Concern, and the government of a Foreign Country of Concern does not have a Controlling Interest in Proposer.

Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.

Date: ____________________, 20___ Signed: _________________________

Entity: _______________________ Name:___________________________

Title: ___________________________

REQUIRED DISCLOSURE

At its sole discretion, the Commission may reject any proposer the Commission finds to lack, or whose present or former executive employees, officers, directors, stockholders, partners or owners are found by the Commission to lack honesty, integrity, or moral responsibility. The discretion of the Commission may be exercised based on the Commission own investigation, public records, or any other reliable sources of information. By submitting a proposal, Proposer recognizes and accepts that the Commission may reject the proposal based upon the exercise of its sole discretion and proposer waives any claim it might have for damages or other relief resulting from the rejection of its proposal based on these grounds.

Proposer:_____________________________________

SCOPE OF WORK

The Utilities Commission, City of New Smyrna Beach, Florida dba New Smyrna Beach Utilities (NSBU) is currently fully insured and seeks the services of an Insurance Agent of Record (Agent) to provide innovative benefit plan design and effective health care choices for approximately 180 full-time employees. Insurance Brokers/Agents licensed to do business in the State of Florida are invited to submit proposals to provide service for the following: (a) Group Health Insurance; (b) Group Dental Insurance; (c) Group Basic Life and Accidental Death & Dismemberment Insurance; (d) Group Vision Insurance; (e) Long Term Disability Insurance; and (f) Supplemental Insurance (e.g., short-term disability, cancer, accident, hospital confinement, etc.).

This RFP is not an authorization to approach insurers or other underwriting sources on behalf of NSBU.

We specifically request that no insurance market contact or solicitation be made on behalf of NSBU at this time and that no insurance market reservations or commitments be made for any purpose as respects any insurance or reinsurance to be provided for NSBU.

NSBU is not looking for an electronic benefits enrollment platform. UKG is the Human Resources Information System (HRIS) and payroll system for NSBU that employees use to electronically enroll in benefits which is fed to payroll automatically.

Qualifications

1. The offeror must have a staffed office in Central Florida.

2. The offeror must provide a copy of their State of Florida insurance license with their response.

3. The offeror must have acted as a full-service Broker/Agent for a Florida local government for at least four (4) years and have expertise and training in the fields of group life, health and related insurance programs. Professional designations in the benefit field (e.g., CEBS- Certified Employee Benefit Specialist, GBDS-Group Benefits Disability Specialist, VBS-Voluntary Benefits Solutions/Specialist) are a plus.

4. The offeror must be fully HIPAA compliant and their employees must be trained in the requirements of the HIPAA Laws.

Requirements

The selected offeror will provide a full range of services including but not limited to innovative plan design, funding alternatives, risk identification, risk exposures, insurance placement, written analysis and recommendations. Specific responsibilities include but are not limited to the following:

• Negotiate annual renewal of coverage from carriers for Major Medical, Prescription Drug, Dental, Basic Life, AD&D, Supplemental, Vision and Long-Term Disability coverage. Seek competitive quotes from other health benefit carriers and provide advice and recommendations for consideration.

• Review policies and endorsements for accuracy and conformance with negotiated coverage.

Ensure the timely issuance of policies and endorsements to NSBU.

• Analyze and review all health benefit carrier proposed settlements, claims history, group utilization, claims processing, and other plan costs and expenses to provide information and recommendations to NSBU.

• Assist the HR Division in claims adjudication or grievances/appeals relating to insurance benefits issues. Assist NSBU with health benefit plan administration, wellness and preventive insurance management and provide information on new laws, regulations and procedures in the area of health benefit administration.

• Provide the Support Services Senior Manager with reasonable preliminary renewal figures during the budget process.

• Attend on request, NSBU meetings, budget meetings, and other negotiation meetings, whenever necessary.

• Assist the HR Division with required employee presentations, education sessions, and organizing annual open enrollments or health fairs if requested.

• The offeror ultimately selected through this RFP will be responsible for assisting NSBU with all aspects of its health insurance consulting/agent services and for the management of all aspects of NSBU’s health and benefits insurance programs listed above.

• Identifying issues and exposures and negotiating on NSBU’s behalf with insurance carriers;

keeping NSBU informed of significant developments affecting its insurance coverage. The Offeror selected as NSBU’s Agent shall be authorized to represent and assist NSBU in discussions and transactions with all insurance carriers, provided that the Agent shall not place any insurance on behalf of NSBU unless so authorized in writing by NSBU.

• Following up with insurance carriers for timely issuance of policies and endorsements.

• Reviewing policies and endorsements for accuracy and conformity to specifications and negotiated coverage.

• All annual rate renewal reports shall include the following:

Executive Summary – include key findings and recommendations; (recommendations can include, in addition to rate actions, the removal of plans or corrective actions, new benefit recommendations or deletions of old benefits, and revised programs, and historical highlights (overall historical trends in membership)

Enrollment history and claims trends.

Analysis of Health Care trends: methodology for prediction of trend.

Financial Projections – determination of past period to project need for renewal.

Development of Rate Renewal –analysis will include identification of plan costs and utilization trends and how those trends parallel or vary from known general experience for other carriers Statewide.

Presentation of Premium Rates.

• NSBU claims experience will be provided to the Support Services Senior Manager on a quarterly basis.

• During the second quarter of each year, the Agent will provide the Support Services Senior

Manager with a written projection of costs and proposed rate renewal for the following fiscal year.

• Assist in preparation of educational materials.

• Design of New Programs or Benefits. Upon the written request of NSBU, the Agent shall provide expert assistance, and advice in the design of new benefits, and will independently recommend new programs.

• Evaluation of Proposed or Enacted Legislation. The Agent is expected to immediately advise

NSBU of pending or enacted Federal and State legislation affecting NSBU. Upon the written request of NSBU, the Agent shall advise of the financial/administrative impact of State or Federal legislation on NSBU and assist in the implementation of changes made necessary by such legislation.

SPECIFIC ITEMS TO BE ADDRESSED IN YOUR PROPOSAL RESPONSE

The following items must be clearly addressed in the proposal response agent services for the benefit program:

1. A narrative statement that the Offeror understands NSBU’s needs and goals.

2. What percentage of your firm’s current clients are public employers?

3. Describe the proposed management of the account as detailed as possible, (use bullet listing) including the identification of the account executive directly responsible for the overall management of the account. The industry-specific experience and functions of the account executive are to be clearly outlined along with the roles and identification of support personnel for the account.

4. Identify the other employees who will be assigned to service the account of NSBU. Highlight their experience in the service area they will provide, along with resumes.

5. Outline the program the account team will implement in working with New Smyrna Beach

Utilities administration and staff to provide transition in new and/or existing programs, to communicate the scope of benefits program with employees. Outline the administrative support and organization included by the agent services team for carrier changes

6. Describe your experience and relationship with NSBU’s current insurance carriers. These vendors include: Florida Health Care (Health Insurance), MetLife (Dental, Vision, Group Life and AD&D, Voluntary Life, and Long-Term Disability), Colonial Life (Supplemental), and MedCom (FSA and COBRA).

7. Provide a sample of the information which would be provided to NSBU detailing the outcome of your renewal negotiation efforts, and analysis of competitive markets.

8. How will the firm routinely serve NSBU in the annual enrollment process, written communications, employee meetings, employee information updates, employer responsibilities updates and benefits usage and limitations.

9. Does your firm provide a toll-free number and/or internet access and support? What access will be made available to administrators? Outline the response process and timeframe for addressing needs and/or concerns of NSBU’s administration.

10. Describe the firm’s methods for development of specifications to obtain competitive health insurance policy quotes and the means of communicating with NSBU administration the results.

Outline the calendar for the process to be followed.

11. Describe how your firm will review plan documents for compliance with applicable laws and contracted agreements.

FEE

Describe your method of compensation for your services. Discuss how your method of compensation will be transparent and reported to our team. Does your company accept any carrier overrides? If on a commission basis, would your company be taking any form of compensation beyond the commission built into the premium rates? If selected, what are your methods of disclosing compensation to NSBU and the frequency of that disclosure?

PROPOSAL SUBMITTAL REQUIREMENTS AND EVALUATION FACTORS

PROPOSER NAME:

Proposals shall include all of the information as listed below, and any additional information that the PROPOSER deems pertinent to the understanding and evaluating of the proposal. Proposals shall be organized for evaluation in tabbed sections. One tab FOR EACH EVALUATION FACTOR BELOW Submittals must be clear, concise, typed on letter size paper and individually bound. Submittals should contain no more than (30), double sided, single spaced pages, at least #10 fonts. Longer submittals may be discarded. The PROPOSER should not withhold any information from the written response in anticipation of presenting the information orally or in a demonstration, since oral presentations or demonstrations may not be solicited. Failure to supply all of the information requested shall result in the proposal being excluded from consideration. The COMMISSION reserves the right to request information or clarification from PROPOSERs following the bid opening if omissions are deemed curable.

COMMISSION WILL CONSIDER THE FOLLOWING WEIGHTED FACTORS IN THE

EVALUATION OF THE PROPOSALS RECEIVED. The total possible points earned in this RFP by the Evaluation Committee is 100. See table below.

EVALUATION CRITERIA MAXIMUM POSSIBLE POINTS

Experience 40 Project Schedule 10 Capability & Past Performance (References) 15 Pricing 30 Completed Forms 5

TOTAL 100

PROPOSAL SUBMITTAL REQUIREMENTS AND EVALUATION FACTORS

PROPOSER NAME:

EVALUATION FACTOR # 1: EXPERIENCE

MAXIMUM POINTS OF 40

Qualifications and experience of the firm. This will be evaluated on the Firm’s experience as a whole as it pertains to the Statement of Work and proof of reliable financial backing. Qualifications and experience of those who will perform and oversee the work. Extensive background working with statutes and regulations, which govern the provision of service by local government. Statement of his/her understanding of work to be performed and NSBU’s approach to coverage. Services provided to enhance the service to employees.

EVALUATION FACTOR # 2: PROJECT SCHEDULE

-MAXIMUM POINTS 10

Work plan and time schedule.

EVALUATION FACTOR # 3: REFERENCES-

MAXIMUM POINTS 15

Past experience of at least three references within the past five years with similar local government entities in the State of Florida and of similar size as NSBU and with a similar scope.

EVALUATION FACTOR # 4: PRICING-

MAXIMUM POINTS 30

Describe your method of compensation for your services. Discuss how your method of compensation will be transparent and reported to our team. Does your company accept any carrier overrides? If on a commission basis, would your company be taking any form of compensation beyond the commission built into the premium rates? If selected, what are your methods of disclosing compensation to NSBU and the frequency of that disclosure?

EVALUATION FACTOR # 5: COMPLETED FORMS-

MAXIMUM POINTS 5

Forms must be complete and attached within the proposal under Tab 5 o Certification of Drug-Free Workplace o Non-collusion Affidavit o Request for Taxpayer Identification Number and Certification W-9 Form o Vendor Application o Questionnaire o Foreign Country of Concern Attestation o Required Disclosure o Copy of your Business License

PROPOSAL FORM

PROPOSER’S NAME:

The undersigned hereby declares that the following list states any and all variations from, and exceptions to, the requirements of the scope of work.

Submitted By:

Company

Name and Title Signature

Telephone No. e-mail

Commission reserves the right to…