RFP_K6089_Bidder's_Questionnaire.docx

RETROSPECTIVE RATING INSURANCE TABLE IMPLEMENTATION REVIEW

Solicitation No. K6089

BIDDER’S QUESTIONNAIRE

Please respond directly on this form. Please also see the RFP K6089, Preparing and Submitting the Bid.

Provide complete and concise responses. Do not use colored displays, promotional marketing materials, company brochures, links to external web sites, or corporate web pages in any response.

Response provided for each capability shall not exceed three (3) pages (8 1/2” X 11”, one-sided) unless, specifically noted otherwise.

Answers to all questions shall be in font size not smaller than Calibri, Arial or Times New Roman 11 point.

Company Website

Mailing Address

If Other, please explain:

Federal Tax Identification Number (TIN)

Bidding Firm/Organization:

Washington State Certified Minority/Woman Owned Business (MWBE), Veteran Owned

Certification Type(s):

Certification Number(s):

Bidding Firm/Organization:

Is your firm registered in WEBS as a self-certified Washington Small Business?

Tips for Small, Diverse and Veteran-Owned Businesses | Department of Enterprise Services (DES) (wa.gov)

Yes |_| No |_| If yes, select one below:

Subcontractor(s*): Washington State Certified Minority/Woman Owned Business (MWBE), Veteran Owned (*Add rows as needed to align with Subcontractor Inclusion Plan below.)

Certification Type(s):

Certification Number(s):

Subcontractor(s*): Is Subcontractor(s) registered in WEBS as a self-certified Washington Small Business?

Tips for Small, Diverse and Veteran-Owned Businesses | Department of Enterprise Services (DES) (wa.gov)

Yes |_| No |_| If yes, select one below:

Washington State Uniform Business Identification Number (UBI)

Bidder Representative Name & Title

Bidder Representative Phone Number(s)

Bidder Representative Email Address

1.2 PRIOR OR CURRENT- STATE OF WASHINGTON WORKING RELATIONSHIP

As of the date of this response:

1.2.1 BIDDING FIRM’S PROPOSED KEY TEAM RESOURCE(S)

If you answered “Yes” to either of the questions above, it is possible that under RCW 42.52 the person may not be assigned to work on the contract awarded as a result of this RFX. Contact the Coordinator with your questions. Provide the following information for each person with a current or previous State of Washington working relationship:

1.2.2 TEAM MEMBERS WITH A CURRENT/FORMER WASHINGTON STATE WORKING RELATIONSHIP

Name

Title

State Service Separation Date

Agency/Board/Commission Name

Contact Person

Contact Title

Although some points will be awarded for meeting minimum qualifications, Bidders will be awarded more points for exceeding the minimum qualifications. Bidders who do not meet at least the minimum qualifications shall be considered non-responsive and the response will NOT be scored.

2. PROFESSIONAL APPROACH & PROPOSED TEAM

Professional Approach & Proposed Team. The Bidder must provide information which will enable L&I to assess your approach and ability to successfully perform the services requested. L&I is most interested in projects conducted over the most current five-year period. Bidders who provide references from projects older than five years or use examples from projects older than five years will not be scored as highly.

2.1 In no more than two pages, please introduce yourself and explain why your firm is qualified for this project.

2.2 In no more than two pages explain your methodology and approach to this project and how you will manage expectations.

2.3 Include a brief high-level project plan with due dates for deliverables and primary team member(s) responsible for deliverables.

2.4 In no more than two pages, describe specific roles and skills of proposed primary team member(s) who will carry out this project.

2.5 Provide resumes for all primary team member(s) listed in your response to the preceding question, including title(s) to match with specific roles proposed. Each resume should be limited to one page.

2.6 If you plan on using subcontractors, explain in no more than one page how you select and manage subcontractors. How do you ensure the quality of their work? How do you ensure the coordination among different firms?

2.7 Submit two sample work products that demonstrate the quality of your work and your expertise to perform the services required for this project. If you wish to include a sample of your work that is on-line, please include the web site address.

2.8 Please verify availability of key team members and identify any conflicts that may need to be considered.

3. COST

3.1 Deliverable Based, Flat Fee Break Down. Provide the flat fee bid for each deliverable using Question 10, Table: Cost Quote Summary.

Question 3 - Cost

COST QUOTE SUMMARY

1. Initialization, Management & Work Plan

2. Findings and Recommendation in draft Final Report and draft Executive Summary

3. Final Report with Executive Summary

Total

All responsive Bidders’ Total Contract Cost will be totaled and then divided by the number of responsive Bids. The resulting number will be the Average Total Contract Cost that will establish the “Competitive Range.” Each Bidder’s cost score will be calculated by dividing the Average Total Contract Cost (Numerator) by the Bidder’s Total Contract Cost (Denominator) and multiplying the result by the maximum possible points (15). In no event shall any Bidder receive more than the maximum possible points for the cost section.

4. REFERENCES

Provide information for three (3) individuals who are references as outlined in the table below. References should be familiar with work performed in the last three years, and preferably be familiar with projects and people referenced elsewhere in your Bid. References may be contacted by email, so please be sure to include email addresses.

Question 4 - References

1.

2.

3.

4 REFERENCES

Provide recent (within the last 3 years) contact information for three (3) clients who are professional/business references that you have provided similar services to those your firm would provide to L&I. Include the information outlined in the table below for each reference and indicate the Bidding firm’s relationship to the reference. References should be familiar with work performed in the most recent years as possible.

References

Project Description:

Project Description:

Project Description:

5 CERTIFICATIONS & ASSURANCES

The Bidder makes the following disclosures, certifications and assurances as a required element of the Bid to which this is a part, understanding that the truthfulness of the facts affirmed here and the continuing compliance with these requirements are conditions precedent to the award or continuation of related contract/s.

“Termination for Default” means that notice was given to the Contractor to stop performance due to the Contractor’s nonperformance or poor performance, and the performance issue was either (a) not contested by the Bidder or (b) litigated, with an unfavorable finding for the Bidder.

Has the Bidder’s firm had a contract, agreement, second-tier work order, or other contractual obligation terminated for convenience in the last ten years? |_| Yes |_| No If YES to either of the questions above, attach a signed statement fully describing the contract, the circumstances surrounding the termination, reason for termination, nature of the termination (i.e., for breach or default, convenience, or otherwise), date of the termination and the name, address and telephone number of the other party to the contract. L&I will evaluate the information and may, at its sole discretion, reject the Bidder’s proposal if the information indicates that completion of a Contract resulting from this RFX may be jeopardized by selection of the Bidder.

If YES, attach a signed statement fully describing the contract, the reason for mediation or arbitration, date the mediation or arbitration was initiated and completed (if applicable) and the name, address and telephone number of the other party to the contract. L&I will evaluate the information and may, at its sole discretion, reject the Bidder’s proposal if the information indicates that completion of a Contract resulting from this RFX may be jeopardized by selection of the Bidder.

If any such litigation exists or existed, attach a signed statement fully describing the contract, the reason for the litigation, date the litigation was initiated and completed (if applicable) and the name, address and telephone number of the other party to the contract. L&I will evaluate the information and may, at its sole discretion, reject the Bidder’s proposal if the information indicates that completion of a Contract resulting from this RFX may be jeopardized by selection of the Bidder.

5.4 Additional Certifications and Assurances

Representing the Bidder, I make the following certifications and assurances as a required element of this Bid to which it is attached, understanding the truthfulness of the facts affirmed here, and the continuing compliance with the requirements are conditions precedent to the award or continuation of the related contract. Representing the Bidder, I declare:

5.4.4 In preparing this Bid, the Bidder has not been assisted by any current or former employee of the state of Washington whose duties relate or did relate to this Bid or prospective Contract, and who was assisting in other than his or her official, public capacity. If there are exceptions to these assurances, I have described them in full detail on a separate page attached to this document.

5.4.5 The Bidder understands that L&I will not reimburse the Bidder for any costs incurred in the preparation of this Bid, as submitted initially in writing, and in all subsequent efforts. All Bids become the property of L&I, and the Bidder claims no proprietary right to the ideas, writings, items or samples unless so stated in the Bid.

5.4.6 The Bidder certifies that the costs Bid to perform this Contract do not exceed those charged any other client for the same services performed by the same individuals. The prices and/or cost data were determined independently, without consultation or communication for the purpose of restricting competition.

5.4.7 Submitting this Bid constitutes Bidder’s acceptance of all of the solicitation contents, including but not limited to, procedures, evaluation criteria, requirements, administrative instructions, and other terms and conditions, including those within the Sample Contract.

If there are any exceptions to these assurances that Bidder would like L&I to consider, Bidder has described those exceptions in detail on a separate page titled Exceptions to Assurances.

Bidder agrees that providing detail to exceptions must conform as required and described herein. L&I is not required to make the requested changes. L&I reserves the right, at any time to clarify the Bidder’s intent of any one or more exception, and may establish a deadline for reaching meeting of the minds related to the exceptions submitted. Bidder further understands if agreement cannot be reached, L&I may terminate discussions and remove my organization from further consideration.

Details to exceptions must include the following:

· Content of each requested change, including edits showing changes and deletions;

· Bidder’s specific need for which the change is meant to address; and,

· Bidder’s reasoning and justification for each requested change, including the potential impact if not accepted.

Bidders may not propose exceptions after the Bid Due Date.

5.4.8 No attempt has been made or will be made by the Bidder to induce any other person or firm to submit or not to submit a Bid for the purpose of restricting competition.

5.4.9 Bidder authorizes L&I to contact references and others who may have pertinent information regarding the Bidder’s prior experience and ability to perform the services contemplated by this procurement.

5.4.10 If any employee or personnel of Bidder or of a subcontractor who will perform services contemplated in this procurement has retired from the state of Washington under the provisions of the 2008 Early Retirement Factors legislation, his/her name(s) is noted on a separate page attached to this Bid.

5.4.11 Bidder certifies that each submission, response and information provided by Bidder to L&I pursuant to this solicitation is true, accurate and correct, and that Bidder has not omitted any material facts that would make the response, submission and/or information incomplete or misleading.

1. Executive Order EO-18-03, Supporting Workers’ Rights Pursuant to the Washington State Governor’s Executive Order 18-03 (dated June 12, 2018) L&I seeks to contract with qualified entities and business owners who certify that their employees are not, as a condition of employment, subject to mandatory individual arbitration clauses and class or collective action waivers.

I/we hereby certify, on behalf of the firm identified below, as follows (check one):

|_| NO MANDATORY INDIVIDUAL ARBITRATION CLAUSES AND CLASS OR COLLECTIVE ACTION WAIVERS FOR EMPLOYEES. This firm does NOT require its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waivers.

OR

|_| MANDATORY INDIVIDUAL ARBITRATION CLAUSES AND CLASS OR COLLECTIVE ACTION WAIVERS FOR EMPLOYEES. This firm requires its employees, as a condition of employment, to sign or agree to mandatory individual arbitration clauses or class or collective action waivers.

2. CIVIL RIGHTS. Bidder certifies as follows (must check one):

|_| COMPLIANCE WITH CIVIL RIGHTS REQUIREMENTS. Bidder complies with all applicable requirements regarding civil rights. Such requirements prohibit discrimination against individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

OR

|_| NON-COMPLIANCE WITH CIVIL RIGHTS REQUIREMENTS. Bidder does not comply with all applicable requirements regarding civil rights.

3. STATUTORY NONDISCRIMINATION CLAUSES FOR STATE CONTRACTS. Bidder certifies as follows (must check one):

|_| COMPLIANCE WITH STATUTORY NONDISCRIMINATION CLAUSES FOR STATE CONTRACTS. During the term of an awarded Contract, Bidder, including any subcontractor, shall not discriminate on the bases enumerated at RCW 49.60.530(3). Bidder, including any subcontractor, also shall give written notice of this nondiscrimination requirement to any labor organizations with which Bidder, or subcontractor, has a collective bargaining or other agreement. In addition, Bidder, including any subcontractor, shall cooperate with any Washington state agency investigation regarding any allegation that Bidder, including any subcontractor, engaged in prohibited discrimination set forth in RCW 49.60.530(3).

OR

|_| NON-COMPLIANCE WITH STATUTORY NONDISCRIMINATION CLAUSES FOR STATE CONTRACTS. Bidder does not comply with RCW 49.60.530.

4. Wage Theft Prevention Prior to awarding a contract, agencies are required to determine that a bidder is a ‘responsible bidder.’ See RCW 39.26.160(2) & (4). Pursuant to legislative enactment in 2017, the responsible bidder criteria include a contractor certification that the contractor has not willfully violated Washington’s wage laws. See Chap. 258, 2017 Laws (enacting SSB 5301).

I/we hereby certify, on behalf of the firm identified below, as follows (check one):

|_| NO WAGE VIOLATIONS. This firm has NOT been determined by a final and binding citation and notice of assessment issued by the Washington Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of RCW chapters 49.46, 49.48, or 49.52 within three (3) years prior to the date of the above-referenced procurement solicitation date.

OR

|_| VIOLATIONS OF WAGE LAWS. This firm has been determined by a final and binding citation and notice of assessment issued by the Washington Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, a provision of RCW chapters 49.46, 49.48, or 49.52 within three (3) years prior to the date of the above-referenced procurement solicitation date.

Except with respect to completing (filling in blanks) and executing this Certification and Assurances, Bidder may not modify or alter this Bidder’s Questionnaire, nor may Bidder reserve any rights to change or modify the certifications and/or assurances as provided herein. If Bidder modifies or qualifies the certifications and/or assurances, or fails to submit a scanned copy of this signed Certification and Assurances, Bidder will be considered non-responsive and the Bid will not be scored.

On behalf of the Bidder submitting this Bid, my name below attests to the accuracy of the above statements and herewith submits a scanned copy of my original signature with our Bid.

Under the penalties of perjury of the State of Washington, the undersigned affirms the truthfulness of the statements made herein. The undersigned certifies that the Bidder is now, and shall remain, in compliance with the certifications and assurances contained herein, and agrees that such compliance is a condition precedent to the award and continuation of any related Contract.

The undersigned attests to the accuracy of information submitted with this Bid.

I hereby certify, under penalty of perjury under the laws of the State of Washington, that the disclosures, certifications and assurances provided herein are true and correct and that I am authorized to make these certifications on behalf of the firm listed herein.

Print Name of authorized person

File Name: RFP K6089 Bidder's Questionnaire Page 1 of 11 September 22, 2026 Bidder’s Name: