RFP 25-1371 Health and Wellness Medical_Rx Dental Ins Svcs.pdf

Request for Proposals

August 8, 2025 RFP No. 25-1371

Dear Prospective Respondent:

Competitive Sealed Proposals will be received by the be received by the Purchasing Agent or other designee of the Brazos River Authority no later than 10:00 AM, September 3, 2025 for Health and Wellness Medical/Rx and Dental Insurance Services. All qualified firms including Small, Minority, Women Owned Businesses and Historically Underutilized Businesses are encouraged to submit proposals in response to this request.

Proposals must be submitted and received no later than the due date and time specified. Any Proposal received later than the specified time, shall not be considered. The BRA is NOT responsible for ensuring the delivery of Proposals.

Refer to Section 13. Delivery of Proposal Submittals for instructions on submitting a response to this solicitation.

Proposal must be clearly identified as follows on the outside of the sealed physical submission. The BRA shall not be responsible for submissions that are not properly identified. Proper identification of Respondent’s proposal is the sole responsibility of the Respondent and failure to do so may result in the submission not being included in the proposal opening:

PROPOSAL: Health and Wellness Medical/Rx and Dental Insurance Services

RFP NO: 25-1371

RFP DUE DATE: 10:00 AM, September 3, 2025

The BRA shall have the right to accept or reject any or all Proposals, or any part thereof, and to waive any technicalities in the interest of the BRA.

BRA will evaluate all relevant COVID-19, health, safety and business factors on all solicitations to determine when to initiate a notice to proceed on all projects, delivery of goods and/or services or procurement of construction related services to best attempt to balance BRA needs and to protect the health and safety of BRA employees, the employees of respondents and the public at large.

Sincerely, Allison Sheeler, CTCD, CTCM Purchasing Agent

4600 Cobbs Drive • Waco, Texas 76710 254.761.3153

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 2 of 20

SUPPLIER DIVERSITY PURCHASING POLICY

The Brazos River Authority (BRA) will ensure that purchases of equipment, materials, supplies, and/or services conform with Texas Procurement law as applicable to the BRA, are cost effective, and contribute to the competitiveness of the BRA and its customers.

Procurement activities will be conducted in an open and fair manner with equal opportunity provided to all qualified parties. The BRA will provide equal contracting opportunities as provided by all applicable State and Federal laws to small business enterprises, Historically Underutilized Businesses and Disadvantaged Business enterprises.

GENERAL INSTRUCTIONS TO RESPONDENTS

The Work consists of the furnishing of all labor, materials, services, equipment, and appliances required for the delivery and the supplying of products and/or services as described herein and in the contract documents.

1. PROPOSAL SUBMISSION: Proposals must be received no later than the Proposal opening date and time specified above. All Proposals received after closing time will not be considered.

A. To be considered as eligible, a Respondent shall have complied with all legal requirements to permit them to operate in the State of Texas.

B. Proposals must be submitted electronically, mailed or hand delivered to be considered.

2. WITHDRAWAL OF PROPOSALS: No Proposal may be withdrawn for a period of ninety (90) days after Proposal opening, except by: 1) mutual consent of the BRA and Respondent; or 2) a previously submitted Proposals may be withdrawn upon written request received from Respondent prior to time established for receipt of Proposals.

3. SIGNATURE ON PROPOSALS: To be valid, Proposals must be signed by an authorized person. By such signature, Respondent agrees to strictly abide by the terms, conditions, and Scope of Services embodied in this Request for Proposal.

4. EXAMINATION OF PROPOSAL DOCUMENTS: Before submitting a Proposal, all Respondents shall examine the complete Proposal documents, including Proposal Notice, Instruction to Respondent, and Scope of Services, all of which are part of the Proposal documents.

5. ADDENDA: Unless otherwise stated in the Proposal, answers to all questions, inquiries, and request for additional information will be issued in the form of Addenda. During the Proposal period, prospective Respondent may be advised by Addenda of additions, deletions from, or changes in the requirements of the Proposal documents. The BRA will not be responsible for the authenticity or correctness of oral interpretations of the Proposal documents or for information obtained in any other manner than through the media of Addenda. Receipt of each Addendum shall be acknowledged by the Respondent.

Any questions concerning this Proposal should be submitted on https://www.bidnetdirect.com/texas/brazosriverauthority no later than five (5) days prior to the opening of the Proposal. This is to allow the BRA sufficient time to respond to inquiries and provide information to all interested Respondents by Addendum. Unless otherwise stated in the Proposal, Addenda will be posted on https://www.bidnetdirect.com/texas/brazosriverauthority.

Respondent is responsible for checking https://www.bidnetdirect.com/texas/brazosriverauthority for updates and Addenda until the time at which the submission is due. Failure to respond to all requirements, including those Addenda, shall be grounds for rejection of your Proposal.

6. TAXATION: The BRA is exempt under the Texas Sales Tax and Use Tax Laws, and the Respondent shall not include such taxes in the Proposal.

7. QUALIFICATION OF RESPONDENTS: The BRA reserves the right to reject any Proposal if the evidence submitted by, or investigation of, such Respondent fails to satisfy the BRA that such Respondent is properly qualified to carry out the obligations of the contract and to complete the Services contemplated herein.

Conditional Proposals will not be accepted.

8. CONSIDERATION OF PROPOSALS: Unless stated otherwise in the Advertisement or Request for Proposal, the properly identified Proposals received on time will be opened publicly and only the names of the Respondent will be read aloud. Respondents are invited to be present.

9. COMPLIANCE WITH SCOPE OF SERVICES AND RIGHT OF

SELECTION: The Respondent shall abide by and comply with the true intent of the scope of services and not take advantage of any unintentional error or omission.

10. DEVIATION FROM SCOPE OF SERVICES: All deviations from the scope of services must be noted in detail by the Respondent, in writing, at the time of submittal of the formal Proposal. The absence of a written list of deviations at the time of submittal of the Proposal will be considered acceptance of the Scope of Services as written.

Any deviations from the Scope of Services as written not previously submitted, as required by the above, will be grounds for rejection of the material and/or item when delivered.

In case of ambiguity or lack of clarity, the BRA reserves the right to consider the most advantageous Proposal or reject the Proposal.

11. REPRESENTATIONS: By execution and submission of this Proposal, the Respondent hereby represents and warrants to the BRA that Respondent has read and understands the Proposal Documents and this Proposal is made in accordance with the Proposal Documents.

12. INDEMNIFICATION: THE RESPONDENT SHALL COMPLY

WITH THE REQUIREMENTS OF ALL APPLICABLE LAWS, RULES,

AND REGULATIONS AND SHALL EXONERATE, INDEMNIFY AND

HOLD HARMLESS THE BRA FROM ANY AND ALL LIABILITY OR

DAMAGES RESULTING FROM FAILURE TO DO SO.

IN ADDITION, THE RESPONDENT AGREES TO INDEMNIFY,

KEEP, SAVE AND HOLD THE BRA HARMLESS FROM ANY AND

ALL ACTIONS, LIABILITIES, DAMAGES, JUDGMENTS, COSTS

AND EXPENSES INCLUDING REASONABLE ATTORNEY’S FEES,

IN CASE AN ACTION IS FILED OR DOES IN ANY WAY ACCRUE

AGAINST THE BRA, ITS OFFICIALS, OFFICERS, AND

EMPLOYEES IN CONSEQUENCE OF THE AWARDED CONTRACT

FOR ANY NEGLIGENT ACT OR OMISSION OF THE RESPONDENT

IN THE PROVISION OF SERVICES UNDER THE AWARDED

CONTRACT, OR THAT MAY RESULT FROM THE CARELESSNESS

OR LACK OF SKILL OF THE RESPONDENT OR THE

RESPONDENT’S OFFICERS, AGENT, CONTRACTORS, ASSIGNS

OR EMPLOYEES. IN THE EVENT A JUDGMENT IS RECOVERED

AGAINST THE BRA FOR ANY SUCH LIABILITY, COSTS OR

EXPENSES, SUCH JUDGMENT SHALL BE CONCLUSIVE

AGAINST THE RESPONDENT.

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 3 of 20

IT IS SPECIFICALLY UNDERSTOOD AND AGREED BY THE

RESPONDENT THAT SUCH INDEMNITY IS INDEMNITY BY THE

RESPONDENT TO INDEMNIFY AND PROTECT THE BRA FROM

LIABILITY, CLAIMS, SUITS, LOSSES, DAMAGES OR CAUSES OF

ACTION DUE TO THE RESPONDENT’S NEGLIGENCE, ERROR OR

OMISSION.

13. CRITERIA FOR AWARD: The BRA will select the most highly qualified Respondent on the basis of demonstrated competence and qualifications and then attempt to negotiate with that Respondent a contract at a fair and reasonable price. If a satisfactory contract cannot be negotiated with the most highly qualified Respondent, the BRA will select the next most highly qualified Respondent and attempt to negotiate a contract with that Respondent at a fair and reasonable price. REFER TO SECTION 5, SELECTION PROCESS.

14. TERMINATION: The awarded contract may be terminated at any time by the BRA, in BRA’s sole discretion, for any cause or for convenience without penalty or liability. Upon receipt of such notice, the supplier shall immediately discontinue all services and actions.

The BRA shall pay the Respondent promptly the accrued and unpaid amounts due for services to the date of termination, to the extent the services are approved by the BRA.

15. CHANGE OF CONTRACT PRICE: The agreed upon contract price shall not be exceeded without the prior written consent of the BRA and may only be modified by a written amendment to the contract executed by both BRA and Respondent.

16. PAYMENT: Unless otherwise specified, payment for services and/or product will be processed within thirty (30) days from invoice date and acceptance of Services and/or product. Invoices presented for payment must be submitted in accordance with instructions contained on the purchase order including reference to purchase order number and submittal to the correct address for processing. Unit price on invoice shall be in two (2) decimal places only, i.e., $ .XX.

The BRA has set a goal to have as much paperwork submitted electronically. Respondents are asked to submit invoices electronically to the following Accounts Payable email address:

accounts. payable@brazos.org. Respondents who use the electronic service should not mail the original invoice.

17. CONFIDENTIALITY OF DOCUMENTS: The BRA is subject to the Texas Public Information Act (PIA). Any information submitted to the BRA by a Respondent shall be considered non-confidential and available to the public, except as follows:

In the event a Respondent considers a specific portion of their Proposal to be confidential and subject to an exception to disclosure under the PIA, such portion must be clearly identified and marked "CONFIDENTIAL". Do not mark an entire Proposal confidential, as this is not in conformance with the PIA and is not acceptable. Only the specific portion or portions of the Proposal that the Respondent considers to be confidential pursuant to the PIA should be marked. IF

AN ENTIRE PROPOSAL IS MARKED CONFIDENTIAL, THE BRA

WILL NOT TREAT ANY PORTION OF THE PROPOSAL AS

CONFIDENTIAL AND THE PROPOSAL MAY BE REJECTED AS

NON-CONFORMING. The BRA will honor notations of confidentiality made in accordance with this paragraph and decline to release such information initially. However, final determination of whether a particular portion of a Proposal may in fact be withheld pursuant to the PIA will be made by the Texas Attorney General or a court of competent jurisdiction.

In the event a public information request is received for a portion of a Proposal that has been marked confidential, the BRA shall ask the affected Respondent if the information may be released. If the release is agreed to, the BRA shall release the information.

If the release is denied, the matter shall be referred to the Texas Attorney General's Office in accordance with the process set forth in the PIA. The Respondent shall be fully and solely responsible for submitting arguments and evidence within the statutory timeframes to the Texas Attorney General’s Office regarding its claim of confidentiality. The BRA will NOT submit arguments on behalf of the Respondent.

The Texas Attorney General's office shall rule on the matter. In the event that it is determined by opinion or order of the Texas Attorney General or a court of competent jurisdiction that such information may not be withheld, then such information will be made available to the requester. If it is determined that the information may be withheld, BRA will withhold the information from the requestor.

Pricing information contained in Proposals or contracts is not considered confidential under the PIA and will be disclosed without making a request to the Texas Attorney General.

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 4 of 20

REQUEST FOR PROPOSALS

HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES

RFP NO. 25-1371

SUBMITTAL SCHEDULE

Requests for Proposals are posted on the BidNet Direct website at https://www.bidnetdirect.com/texas/brazosriverauthority and prospective Respondents should visit the site for potential updates to Proposal requirements.

Friday, August 8, 2025 RFP is available to download at https://www.bidnetdirect.com/texas/brazosriverauthority

4:00 PM, Monday, August 18, 2025

Last date and time to ask questions or request additional information. Please submit your questions at

4:00 PM, Tuesday, August 20, 2025

Post response to questions received as of the deadline or as soon thereafter, as an Addendum on https://www.bidnetdirect.com/texas/brazosriverauthority

10:00 AM, Wednesday, September 3, Proposals are due.

11:00 AM, Wednesday, September 3, Proposals will be opened virtually at the link below……………………………..

https://youtube.com/live/eS8ttAnuB2k?feature=share

Local Time Prevailing.

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 5 of 20

1. General The BRA requests responses to Proposal for services to provide fully-insured Medical/Rx and Dental insurance coverage. BRA’s current Medical and Rx provider is Blue Cross Blue Shield of Texas (BCBSTX) with a December 31, 2025 contract end date. BRA’s current Dental provider is BCBSTX.

Number of Active Full-Time Employees: 263 Number of COBRA: 0 Eligibility of New Hires: 1st of month following 60 days from date of hire.

Medical Geo Access

General: 2 in 10 mile radius Specialist: 2 in 10 mile radius Hospital: 1 in 10 mile radius

Dental Geo Access General: 2 in 10 mile radius Specialist: 2 in 10 mile radius

The BRA is requesting that Proposers submit pricing based on the current deductible and aggregate limits. All coverages are to be quoted NET of Commissions. New coverage effective date will be January 1, 2026.

Refer to APPENDIX A for Current Plan Summaries.

Refer to APPENDIX B for Requested Plan Options.

Refer to APPENDIX C for BRA Facility Address Locations and Map.

2. Scope of Services Proposals shall be based on the requested plan(s) of benefits.

A. Proposals shall be based upon the census provided in the RFP.

B. The BRA is exempt from paying applicable State premium taxes per Chapter 222 of the Texas Insurance Code. All applicable state premium taxes must be excluded from the BRA’s rates.

C. All participants enrolled in the Employee Benefits Plan as of 12/31/2025 are to receive immediate coverage under the new plan. All health services incurred on or after January 1, 2025 for currently enrolled participants are to be eligible expenses. The BRA's enrollment records are to be the basis for "take-over."

D. Credit is to be given for accumulated deductible, and coinsurance.

3. Base Proposal Proposal price to include all labor, materials, tools, equipment and incidentals necessary to satisfactorily design, fabricate, manufacture, furnish, deliver components and complete assemblies.

4. Information Required in the RFP Submittal - Tab Format The BRA specifically requests succinct submittals tailored to the general and discipline-specific scope of services summarized above. All submittals become the property of the BRA. Each Bid submittal shall include the information requested below.

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 6 of 20

FAILURE TO SUBMIT ANY OF THE REQUESTED INFORMATION MAY BE GROUNDS

FOR REJECTION OF PROPOSAL OR DELAY ISSUANCE OF A PURCHASE

ORDER/CONTRACT.

Tab A: Include the following:

(1) Date your company was established and a brief history; number of employees; provide number and location of offices.

(2) Provide name, title and office location of person who will be the principal contact for the BRA and the billing location if different.

(3) Describe the types of organizations that your company typically serves and general nature of the work. Include your firm’s experience as it relates to this RFP.

(4) A list and description of similar services completed within the last five years under your current company name or any other company name similar in nature to this solicitation.

PROVIDE FIVE (5) TEXAS GOVERNMENTAL CLIENT REFERENCES. Include the name, the location, a brief description of Scope of Services (including number of employees), and a contact name and telephone number of a reference for each client.

(5) List litigation that your company has been a party to in the last five (5) years, under your current company name or any other company name. Include only litigation that involves business units in your company that are proposed for performing services under this RFP. To be fully responsive, provide the level of detail in the attached example, as well as a name and phone number to contact an authorized representative of your company in the event that the BRA needs to clarify your response. Failure to be fully responsive will be sufficient grounds for the BRA to disqualify your company.

(6) Have you ever defaulted, failed to complete a contract or had a contract terminated by the other party? If so, where and why? Provide name and telephone number of the other party.

Tab B: Include the following:

(1) Complete and submit ALL forms listed in APPENDIX B.

(2) Complete and submit Acknowledgement of RFP and Receipt of Addenda Form.

(3) Complete and submit the attached W-9 form, or if foreign entity submit the appropriate tax document information.

(4) Complete and submit the attached Conflicts of Interest Questionnaire [CIQ] form.

(5) Complete and submit the Non-Collusion Affidavit form.

(6) Medical/Rx Certificate(s)

(7) Medical/Rx Provider Disruption

(8) Dental Certificate(s)

(9) Dental Provider Disruption

(10) Rx Disruption

5. Selection Process Proposals will be evaluated and scored based upon the factors listed below. Criteria is listed in general order of importance, from generally more important to generally less important, and the BRA shall select the provider whose services will provide the best value for the BRA while maintaining a comparable level of service to the BRA’s current plan at a reasonable price:

1. Cost

a. Fixed Costs: includes insurance costs and administrative costs

b. Ability to reduce claims expense

2. Network Statistics

3. Financial Stability

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 7 of 20

a. Insurance Company, AM Best Rating

4. Communication

a. Educational material for employees

b. Summary Plan Description capabilities

c. Administrative kits for locations

d. Bilingual capability

5. Claims Processing

a. Turnaround time excluding medical review of claims

b. Pended claims procedures

c. Statistical accuracy

d. General service procedures

e. Willingness to contractually establish performance criteria

6. Claims Management Reports

a. Frequency and format of claims reports are the utmost importance.

7. Integrated Systems / Technology Initiative Integrated systems linked to database are integral to the provider selection. The following components make up the whole of an integrated system:

a. Eligibility

b. Utilization review / Disease Management Programs

c. Claims function

d. Claims payments

e. Internet based enrollment/eligibility

8. References

All proposals will be evaluated by HUB International, a contracted insurance broker for the BRA.

Respondents to this RFP may be required to submit additional information, which HUB International may deem necessary to further evaluate the proposer’s qualifications. HUB International will evaluate each proposal in accordance with the evaluation criteria included in the Request for Proposal. HUB International will arrive at a short list of the top respondents and these short-listed respondents may be scheduled for a structured oral presentation and interview. Such presentations will be at no cost to the BRA or HUB International. At the end of the oral presentation and interview, the evaluation of the short-listed respondents will be completed.

6. RFP Inquiries All inquiries, including clarifying questions, related to this RFP shall only be directed to the Purchasing Agent via https://www.bidnetdirect.com/texas/brazosriverauthority The Purchasing Agent will direct any inquiries to the appropriate BRA staff, a response will be issued and if warranted, an Addendum will be posted on the BidNet Direct site. Failure to adhere to this restriction during the advertising, evaluation, and selection phases will result in the rejection of a Respondent’s Proposal.

EXCEPTION: RFP attachments containing Protected Health Information (PHI): Respondents are to submit written requests via email to BRA’s broker, HUB International, to obtain the following attachments which are a part of this RFP:

1. Medical/Rx and Dental Experience

2. Medical/Rx and Dental Census

3. Medical/Rx and Dental Top Providers for Disruption

Email requests to Caysi Mitchell at caysi.mitchell@hubinternational.com Document access will be provided through a secured online system. State and federal statutes

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 8 of 20 pertaining to PHI and HIPPA apply to Respondents.

7. Respondent’s Past Performance BRA will consider Respondent’s past performance and may conduct reference checks with other entities regarding past performance. BRA may examine Respondent’s performance including, but not limited to:

the Vendor Performance Tracking System, notices of termination, cure notices, assessments of liquidated damages, litigation, audit reports, repeated negative performance, records of repeated non-responsiveness to performance issues, and non-renewals of contracts. Such sources of Respondent performance may include any governmental entity, whether an agency or political subdivision of the State of Texas, another state, or the Federal government. Further, BRA may initiate such examinations of Respondent performance based upon media reports. Any such investigations shall be at the sole discretion of BRA, and any negative findings, as determined by BRA, may result in non-award to Respondent.

8. Conflict of Interest Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local government entity (i.e., Brazos River Authority) must disclose in the Conflicts of Interest Questionnaire Form ("CIQ") the person's affiliation or business relationship that might cause a conflict of interest with the local government entity. By law, the CIQ must be filed with the BRA Records Management Officer no later than seven (7) days after the date the person begins contract discussions or negotiations with the BRA, or submits an application or response to a Request for Proposals, correspondence, or another writing related to a potential agreement with the BRA. Updated Questionnaires must be filed in conformance with Chapter 176.

A copy of the CIQ is attached. If you have any questions about compliance, please consult your own legal counsel. Compliance is the individual responsibility of each person or agent of a person who is subject to the filing requirement. An offense under Chapter 176 carries a penalty up to a Class A misdemeanor.

9. Disclosure of Interested Parties Pursuant to Section 2252.908 of the Government Code, the selected Firm in contracts for the sale or purchase of property, goods, or services with a local government entity (i.e., BRA) anticipated to have a value of at least $250,000/$500,000 must submit a Disclosure of Interested Parties Form to the local government entity that discloses all persons at the Selected Firm who have a controlling interest in the selected Firm or who actively participated in facilitating the contract or negotiating the terms of the contract.

The requirements of Section 2252.908 of the Government Code are subject to change, and if you have any questions about compliance, please consult your own legal counsel.

https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

10. Term of Agreement The term of this Contract shall be for a period of one (1) year, commencing on the Effective Date, and may be renewed by subsequent agreement of the parties annually.

If it is the respondent's intent to increase rates at the renewal date, the BRA must be notified of the maximum increase for each renewal period and the basis for calculating the increase. The BRA must be notified of renewal rates 120 days prior to the effective date of the rate change.

11. Contract The executed contract between BRA and the selected Respondent shall be a BRA standard form contract. Contract terms are not subject to modification and Respondent will be expected to execute the

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 9 of 20 contract in substantially the form provided. Respondent should not base a proposal on an expectation that BRA will modify its contract terms.

The BRA reserves the right to award contract(s) without any negotiations and reserves the right to not make awards. The BRA reserves the right to conduct studies and other investigations as necessary to evaluate any submittal. Submission of a proposal confers no legal right upon any Respondent.

The decision of BRA, or its designee with regard to the above, shall be administratively final. BRA, in its sole discretion, may waive administrative deficiencies and/or minor technicalities in submittals received.

12. Recycled and Recyclable Products The BRA encourages the use of recycled products and products that may be recycled or reused.

13. Delivery of Proposal Submittals Proposals may be submitted in one of the following manners:

Electronic Transmission. Electronic Transmission. Electronic submittals will be received on the following platform. BidNet Direct requires you to register at no charge.

Drop Box Submission Prior to Proposal Submission Deadline: Hand delivery of one sealed, clearly identified original signed paper copy submission may be received up to the proposal submission deadline contained in the solicitation at the Brazos River Authority Waco Central Office, 4600 Cobbs Dr. Waco, Texas 76710, utilizing the secure drop box located at the entrance of the office building. The BRA shall not be responsible for submissions that are not properly identified. Proper identification of Respondent’s proposal is the sole responsibility of the Respondent and failure to do so may result in the submission not being included in the proposal opening.

Mail-In Delivery: Mailed by commercial carrier, overnight or express mail, one sealed clearly identified original signed paper copy submission may be accepted by the Purchasing Agent or other designee up to the proposal submission deadline contained in the solicitation at the Brazos River Authority Waco Central Office, 4600 Cobbs Drive, Waco, Tx. 76710. The BRA shall not be responsible for submissions that are not properly identified. Proper identification of Respondent’s proposal is the sole responsibility of the Respondent and failure to do so may result in the submission not being included in the proposal opening.

RFP No. 25-1371 HEALTH AND WELLNESS MEDICAL/RX AND DENTAL INSURANCE SERVICES Page 10 of 20

REQUEST FOR PROPOSALS – PROPOSAL FORM

ACKNOWLEDGMENT OF REQUEST FOR PROPOSALS AND

RECEIPT OF ADDENDA

RESPONDENT MUST ACKNOWLEDGE RECEIPT OF THIS REQUEST FOR PROPOSALS AND

ADDENDA BY SIGNING BELOW AND SUBMITTING THIS ACKNOWLEDGEMENT WITH YOUR

PROPOSAL. FAILURE TO SIGN THIS ACKNOWLEDGEMENT WILL DISQUALIFY THE PROPOSAL

AS NON-RESPONSIVE. SIGNATURE MAY BE DIGITAL, ELECTRONIC OR HANDWRITTEN.

This acknowledgement shall become part of your response and the subsequent contract documents if applicable.

ACKNOWLEDGMENT OF REQUEST FOR PROPOSALS:

Respondent hereby acknowledges that it has received and read the Request for Proposals and all Addenda, and that this Proposal is made in accordance with the provisions thereof. Respondent acknowledges that this Proposal meets or exceeds all terms, requirements, conditions, and/or specifications set forth in the Request for Proposal and Addenda, and exceptions or deviations from such terms, requirements, conditions, and/or specifications, if any, have been clearly and conspicuously identified as such in the Proposal.

Does your company have ten (10) or more full-time employees? Check one box only.

YES NO

Name of Firm (Respondent)

Signature – Authorized Representative

Printed Name

Date

E-mail Address

Telephone Number

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 n t o r ty p e

S e e S p ec if ic

In st ru ct io n s o n p a g e

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)

Form W-9 (Rev. 3-2024) Page 2 must obtain your correct taxpayer identification number (TIN), which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.

• Form 1099-INT (interest earned or paid).

• Form 1099-DIV (dividends, including those from stocks or mutual funds).

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds).

• Form 1099-NEC (nonemployee compensation).

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers).

• Form 1099-S (proceeds from real estate transactions).

• Form 1099-K (merchant card and third-party network transactions).

• Form 1098 (home mortgage interest), 1098-E (student loan interest), and 1098-T (tuition).

• Form 1099-C (canceled debt).

• Form 1099-A (acquisition or abandonment of secured property).

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

Caution: If you don’t return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued);

2. Certify that you are not subject to backup withholding; or

3. Claim exemption from backup withholding if you are a U.S. exempt payee; and

4. Certify to your non-foreign status for purposes of withholding under chapter 3 or 4 of the Code (if applicable); and

5. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting is correct. See What Is FATCA Reporting, later, for further information.

Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien;

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;

• An estate (other than a foreign estate); or

• A domestic trust (as defined in Regulations section 301.7701-7).

Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding. Payments made to foreign persons, including certain distributions, allocations of income, or transfers of sales proceeds, may be subject to withholding under chapter 3 or chapter 4 of the Code (sections 1441–1474). Under those rules, if a Form W-9 or other certification of non-foreign status has not been received, a withholding agent, transferee, or partnership (payor) generally applies presumption rules that may require the payor to withhold applicable tax from the recipient, owner, transferor, or partner (payee). See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities.

The following persons must provide Form W-9 to the payor for purposes of establishing its non-foreign status.

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the disregarded entity.

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the grantor trust.

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust and not the beneficiaries of the trust.

See Pub. 515 for more information on providing a Form W-9 or a certification of non-foreign status to avoid withholding.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person (under Regulations section 1.1441-1(b)(2)(iv) or other applicable section for chapter 3 or 4 purposes), do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a qualified foreign pension fund under Regulations section 1.897(l)-1(d), or a partnership that is wholly owned by qualified foreign pension funds, that is treated as a non-foreign person for purposes of section 1445 withholding, do not use Form W-9. Instead, use Form W-8EXP (or other certification of non-foreign status).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if their stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first Protocol) and is relying on this exception to claim an exemption from tax on their scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include, but are not limited to, interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third-party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester;

2. You do not certify your TIN when required (see the instructions for Part II for details);

3. The IRS tells the requester that you furnished an incorrect TIN;

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only); or

5. You do not certify to the requester that you are not subject to backup withholding, as described in item 4 under “By signing the filled-out form” above (for reportable interest and dividend accounts opened after 1983 only).

Form W-9 (Rev. 3-2024) Page 3

Certain payees and payments are exempt from backup withholding.

See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.

See also Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding, earlier.

What Is FATCA Reporting?

The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all U.S. account holders that are specified U.S. persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information.

Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you are no longer tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies.

Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific Instructions

Line 1

You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.

If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.

• Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.

Note for ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040 you filed with your application.

• Sole proprietor. Enter your individual name as shown on your Form 1040 on line 1. Enter your business, trade, or “doing business as” (DBA) name on line 2.

• Partnership, C corporation, S corporation, or LLC, other than a disregarded entity. Enter the entity’s name as shown on the entity’s tax return on line 1 and any business, trade, or DBA name on line 2.

• Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. Enter any business, trade, or DBA name on line 2.

• Disregarded entity. In general, a business entity that has a single owner, including an LLC, and is not a corporation, is disregarded as an entity separate from its owner (a disregarded entity). See Regulations section 301.7701-2(c)(2). A disregarded entity should check the appropriate box for the tax classification of its owner. Enter the owner’s name on line 1. The name of the owner entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S.

federal tax purposes has a single owner that is a U.S. person, the U.S.

owner’s name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity’s name on line 2. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

Line 2

If you have a business name, trade name, DBA name, or disregarded entity name, enter it on line 2.

Line 3a

Check the appropriate box on line 3a for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3a.

IF the entity/individual on line 1 is a(n) . . .

THEN check the box for . . .

• Corporation Corporation.

• Individual or

• Sole proprietorship

Individual/sole proprietor.

• LLC classified as a partnership for U.S. federal tax purposes or

• LLC that has filed Form 8832 or 2553 electing to be taxed as a corporation

Limited liability company and enter the appropriate tax classification:

P = Partnership, C = C corporation, or S = S corporation.

• Partnership Partnership.

• Trust/estate Trust/estate.

Line 3b

Check this box if you are a partnership (including an LLC classified as a partnership for U.S. federal tax purposes), trust, or estate that has any foreign partners, owners, or beneficiaries, and you are providing this form to a partnership, trust, or estate, in which you have an ownership interest. You must check the box on line 3b if you receive a Form W-8 (or documentary evidence) from any partner, owner, or beneficiary establishing foreign status or if you receive a Form W-9 from any partner, owner, or beneficiary that has checked the box on line 3b.

Note: A partnership that provides a Form W-9 and checks box 3b may be required to complete Schedules K-2 and K-3 (Form 1065). For more information, see the Partnership Instructions for Schedules K-2 and K-3 (Form 1065).

If you are required to complete line 3b but fail to do so, you may not receive the information necessary to file a correct information return with the IRS or furnish a correct payee statement to your partners or beneficiaries. See, for example, sections 6698, 6722, and 6724 for penalties that may apply.

Line 4 Exemptions

If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you.

Exempt…