RFP_BPM003308_Solicitation_Requirements_Part_2.docx

Request for Proposal

ARIZONA DEPT. OF VETERANS’ SERVICES

3839 N. 3rd Street Phoenix, AZ 85012

Solicitation No. BPM003308 Pharmacy Consultant Services for ASVH-Phoenix, ASVH-Tucson, ASVH-Flagstaff and ASVH-Yuma Exhibit 1: Certificate of Insurance

Participation in Boycott of Israel Declaration – Attachment F e

Request for Proposal

Solicitation No. BPM003308 Pharmacy Consultant Services for ASVH-Phoenix, ASVH-Tucson, ASVH-Flagstaff and ASVH-Yuma Part 2

OFFER

TO THE STATE OF ARIZONA:

The Undersigned hereby offers and agrees to furnish the material, service or construction in compliance with all terms, conditions, specifications and amendments in the Solicitation and any written exceptions in the offer. Signature also certifies Small Business status.

Arizona Transaction (Sales) Privilege Tax License No.:

Federal Employer Identification No.:

E-mail: -_____________________________________________ ________________________________________

Phone:

Fax:

Company Name

Signature of Person Authorized to Sign Offer

Address

Printed Name

Title

By signature in the Offer section above, the Offeror certifies:

1. The submission of the Offer did not involve collusion or other anticompetitive practices.

2. The Offeror shall not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, State Executive Order 2009-09 or A.R.S. §§ 41−1461 through 1465.

3. The Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause shall result in rejection of the offer. Signing the offer with a false statement shall void the offer, any resulting contract and may be subject to legal remedies provided by law.

4. The Offeror certifies that the above referenced organization ___ IS/ ___ IS NOT a small business with less than 100 employees or has gross revenues of $4 million or less.

ACCEPTANCE OF OFFER

The Offer is hereby accepted.

The Contractor is now bound to sell the materials or services listed by the attached contract and based upon the solicitation, including all terms, conditions, specifications, amendments, etc., and the Contractor’s Offer as accepted by the State.

This Contract shall henceforth be referred to as Contract No. __________________________________________.

The effective date of the Contract is ________________________.

The Contractor has been cautioned not to commence any billable work or to provide any material or service under this contract until Contractor receives purchase order, contact release document or written notice to proceed.

State of Arizona Awarded this day of

Procurement Officer

Request for Proposal

Solicitation No. BPM003308

Attachment A: Offer and Acceptance Form

Experience and Capacity Questionnaire

OFFER MAY BE DETERMINED AS NON-RESPONSIVE IF ALL QUESTIONS ARE NOT ANSWERED FULLY.

Offeror shall provide the information requested in this Attachment in the order listed below using the Questionnaire Item number as a reference.

1. Experience

A. The following bulleted information shall be provided in this section of your proposal:

· Full legal company name.

· Year business started

· State of incorporation or headquarters

· Are you a United States corporation?

· Tax identification number

· Does another company own you? If so, provide the corporate structure

· How many employees does your company have?

· Do you own other companies? If so, provide the corporate structure

· Location of company headquarters

· Identify the individual who has overall responsibility for the firm’s operations in regards to this account, if awarded.

· Provide a list of current number of people employed for entire organization and the roles of those employees that would specifically be supporting this contract.

· Is your company currently involved in any litigation in which an adverse decision might result in a material change in the company’s financial position or future viability?

· What is your company’s current capacity and current workload and how will your company bridge the gap, if any, to provide the critical services under this contract?

· Provide a brief company history.

· Provide your companies mission statement.

B. Current Customer Base and User Groups

· What is your company’s total number of customers using the services being proposed for this RFP?

· What is your company’s primary business focus?

· Do you provide services in Long Term Care Homes or State Veteran Home Facilities? What type?

C. Complete Attachment B: Offeror’s References.

· Offeror shall provide three (3) customer references as similar in size and scope to this contract that you are providing service for.

· If you are providing service for other government agencies or Long-Term Care Facilities, please include these as one of your three references.

METHOD OF APPROACH

Offerors shall provide a narrative response that describes your organization’s overall method of approach for providing the required services and products as stated in this solicitation. The narrative shall contain a response to all elements and information requested below and clearly demonstrates an understanding of the Scope of Work.

Tasks:

1. The narrative shall describe how the Offeror shall provide the services as stated in section 1 of the Scope of work, including but not limited to: reviewing pharmaceutical services, develop intravenous therapy procedures, review medication regimen, monitor outcomes from drug therapy etc.

Requirements:

2. The narrative shall describe how the Offeror shall provide the requirements as stated in section 3 of the Scope of Work, including but not limited to:

A. How the Offeror shall participate in the drug therapy decision-making process (3.5) B. How the Offeror shall assist physicians and Veterans/Members in selecting appropriate medication (3.6) C. How the Offeror shall design, implement and monitor the pharmaceutical care plan (3.8) D. How the Offeror shall report the recommendations (3.10) E. How the Offeror shall review drug orders to prevent food/drug interactions and process (3.12 - 3.15) F. How the Offeror shall communicate recommendations regarding Veterans/Members medication therapy and establish procedures (4.17) G. How the Offeror shall assist in establishing policies and procedures (4.26) H. How the Offeror shall assist with medication guidelines for new admits (4.31) I. How the Offeror shall follow Reporting policies and procedures (4.41) J. How the Offeror shall follow the Credentialing and Privileging process (4.49) Licensing and Education:

3. The narrative shall provide the appropriate licenses and certificates and describe your knowledge and understanding of the Pharmacy Consultant as stated in section 5 of the Scope of Work.

Request for Proposal

Solicitation No. BPM003308

Attachment B: Questionnaire

REFERENCES:

Materials/goods/equipment provided similar to those described in Solicitation

Services performed similar to those described in Solicitation

Materials/goods/equipment provided similar to those described in Solicitation x

Services performed similar to those described in Solicitation

Materials/goods/equipment provided similar to those described in Solicitation

Services performed similar to those described in Solicitation

Request for Proposal

Solicitation No. BPM003308

Attachment C: References

Check “NO” if you WILL NOT subcontract any portion of the Work and will therefore be carrying out all of the Work with your own personnel.

NO, the Offeror will not subcontract any portion of the Work.

If you WILL subcontract any portion of the Work, check “YES” below and list name of persons or companies you propose to use as subcontractors.

1. Fill in the information for every significant subcontractor – indicate the type of work the subcontractor will perform under the Contract, and their approximate percentage of the total Contract work.

2. Provide copies of relevant certifications each one possesses in the Attachment Supplements section.

3. Provide description of quality assurance methods and quality control measures that you will use to ensure that Subcontractor work meets the Contract requirements.

4. State may demand additional information about proposed subcontractors as a precondition of award.

YES, the Offeror will use the Subcontractors listed below:

Name and contact information Small Business

Work to be performed

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Request for Proposal

Solicitation No. BPM003308

Attachment D: Proposed Subcontractors

Submit Pricing for the Offer directly in the Arizona Procurement Portal Pricing tab in the Solicitation. Each Offer must include a price for every Item in order to be determined Responsive.

Offeror must enter a $1.00 in the Items Tab in the Arizona Procurement Portal. (https://app.az.gov/)

1.1. Pharmacy Consultant Service:

Request for Proposal

Solicitation No. BPM003308

Attachment E: Price Sheet

Unless and until the District Court's injunction in Jordahl v. Brnovich et al., Case No. 3:17-cv-08263 (D. Ariz.) is stayed or lifted, the Anti-Israel Boycott Provision (A.R.S. 35-393.01 (A)) is unenforceable and the State will take no action to enforce it. This attachment (Participation in Boycott of Israel) is not a mandatory part of the offer as long as the injunction remains in place. Offers will not be evaluated based on whether this certification has been completed.

All Materials submitted as part of a response to a solicitation are subject to Arizona public records law and will be disclosed if there is an appropriate public records request at the time of or after the award of or after the award of the contract. Recognizing legislation has been enacted to prohibit the state from contracting with companies currently engaged in a boycott of Israel. To ensure compliance with A.R.S. 35-393.01 This form must be completed and returned with the response to the contract and any supporting information to assist the State in making its determination of compliance.

As defined by A.R.S. §35-393.01:

All Contractors must select one of the following:

_____ My company does not participate in, and agrees not to participate in during the term of the contract a boycott of Israel in accordance with A.R.S. §35-393.01. I understand that my entire response will become public record in accordance with A.A.C. R2-C317.

_____ My company does participate in a boycott of Israel as defined by A.R.S. §35-393.01.

By submitting this response, Contractor agrees to indemnify and hold the State, its agents and employees, harmless from any claims or causes of action relating to the State’s action based upon reliance on the above representations, including the payment of all costs and attorney fees incurred by the State in defending such an action.

Company Name Signature of Person Authorized to Sign

Request for Proposal

Solicitation No. BPM003308

Attachment F: Boycott of Israel Disclosure

City State Zip Title All materials submitted as part of a response to a solicitation are subject to Arizona public records law and will be disclosed if there is an appropriate public records request at the time of or after the award of the contract. Recognizing there may be materials included in a solicitation response that are proprietary or a trade secret, a process is set out in A.A.C. R2-7-103 (copy attached) that will allow qualifying materials to be designated as confidential and excluded from disclosure. For purposes of this process the definition of “trade secret” will be the same as that set out in A.A.C. R2-7-101(52).

Complete this form return it with your Offer along with the appropriate supporting information to assist State in making its determination as to whether any of the materials submitted as part of your Offer should be designated confidential because the material is proprietary or a trade secret and therefore not subject to disclosure.

STATE WILL NOT CONSIDER ANY MATERIAL IN YOUR OFFER “CONFIDENTIAL” UNLESS DESIGNATED ON THIS FORM.

Check one of the following – if neither is checked, State will assume that as equivalent to “DOES NOT”:

This response DOES NOT contain proprietary or trade secret information. I understand that my entire response will become public record in accordance with A.A.C. R2-7-C317.

This response DOES contain trade secret information because it contains information that:

1. Is a formula, pattern, compilation, program, device, method, technique or process, AND Derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; AND Is the subject of efforts by myself or my organization that are reasonable under the circumstances to maintain its secrecy.

NOTE: Failure to attach an explanation may result in a determination that the information does not meet the statutory trade secret definition. All information that does not meet the definition of trade secret as defined by A.A.C. R2-7-101(52) will become public in accordance with A.A.C. R2-7-C317. State may make its own determination on materials in accordance with A.A.C. R2-7-103.

If State agrees with Offeror’s designation of trade secret or confidentiality and the determination is challenged, the undersigned hereby agrees to cooperate and support the defense of the determination with all interested parties, including legal counsel or other necessary assistance.

By submitting this response, Offeror agrees that the entire Offer, including confidential, trade secret and proprietary information may be shared with an evaluation committee and technical advisors during the evaluation process. Offeror agrees to indemnify and hold State, its agents and employees, harmless from any claims or causes of action relating to State’s withholding of information based upon reliance on the above representations, including the payment of all costs and attorney fees incurred by State in defending such an action.

x

Offeror Company Name

Signature of Authorized Person

Printed Name

Title

Request for Proposal

Solicitation No. BPM003308

Attachment G: Confidential Information Designation

Copy of A.A.C. R2-7-103 [Confidential Information] as was current at time of Solicitation issuance Provided for reference only

Request for Proposal

Solicitation No. BPM003308

Attachment G: Confidential Information

Provide a letter from each Insurance company from which you intend to obtain coverage stating that you can obtain the proof of insurance required in Exhibit 2 of the Special Terms and Conditions. The additional letter(s) should be clearly marked as Attachment X Supplement Insurance NOTE: If you are awarded a Contract, you must submit proof of insurance (e.g. ACORD forms and copies of required insurance policy endorsements) prior to providing services under the Contract.

Request for Proposal

Solicitation No. BPM003308

Attachment H: Insurance

STATE MAY DETERMINE YOUR PROPOSAL IS NON-RESPONSIVE IF YOU DO NOT submit all Attachments.

Request for Proposal

Solicitation No. BPM003308

Attachment I Offer Checklist image2.emf image1.png