RFQ Broker Services Final.pdf

WHITE COUNTY GOVERNMENT

REQUEST FOR QUALIFICATIONS (RFQ)

FOR

EMPLOYEE BENEFITS BROKER SERVICES

SUBMISSIONS ARE DUE AT THE ADDRESS SHOWN BELOW NO LATER THAN

FRIDAY, DECEMBER 11, 2026, AT 2:00 PM, LOCAL TIME

WHITE COUNTY GOVERNMENT

ATTENTION: HUMAN RESOURCES

1235 HELEN HWY

CLEVELAND, GA 30528

THE RESPONSIBILITY FOR SUBMITTING A RESPONSE TO THIS RFQ ON OR BEFORE THE

STATED DATE AND TIME WILL BE SOLELY AND STRICTLY THE RESPONSIBILITY OF THE

RESPONDER.

ISSUE DATE: MONDAY, OCTOBER 12, 2026

WHITE COUNTY, GEORGIA

REQUEST FOR QUALIFICATIONS

FOR EMPLOYEE BENEFITS BROKER SERVICES

SECTION I – GENERAL OVERVIEW

A. PURPOSE

White County Board of Commissioners is issuing this Request for Qualifications (RFQ) to seek qualified brokers to assist with strategically planning, designing and negotiating the best coverage and cost for our comprehensive employee benefit program. The County has approximately 272 benefit eligible employees. Our leadership is looking to ensure we have financially competitive, effectual and affordable benefit programs to offer county employees.

The County does not guarantee a minimum value for this contract.

This RFQ is not an authorization to approach insurers or other underwriting sources on behalf of the County. We specifically request that no insurance market contact or solicitation be made on behalf of White County at this time and that no insurance market reservations or commitments be made for any purpose in respect to any insurance or reinsurance to be provided for the County.

B. INFORMATION TO VENDORS

1. RFQ TIMETABLE

The anticipated schedule for the RFQ is as follows:

RFQ Released Monday, October 12, 2026 Pre-Proposal Conference Meeting None Deadline for questions to White County to smurphy@whitecountyga.gov

Friday, November 20, 2026 at 2:00 PM

Deadline for Addenda posted on www.whitecountyga.gov under Bid Opportunities

Monday, November 30, 2026 2:00 PM

Submittal deadline Friday, December 11, 2026 at 2:00 PM

2. PROPOSAL SUBMISSION

One (1) original and four (4) copies of the complete signed submittal must be received FRIDAY, DECEMBER 11, 2026 AT 2:00 PM, LOCAL TIME. Proposals must be submitted in a sealed envelope stating on the outside, the vendor's name, address, title of RFQ BROKER SERVICES to:

White County Government Attention: Human Resources

1235 Helen Hwy Cleveland, GA 30528

Hand delivered copies may be delivered to the above address ONLY between the hours of 8:00 AM and 5:00 PM, Monday through Friday.

Vendors are responsible for informing any commercial delivery service, if used, of all delivery requirements and for ensuring that the required address information appears on the outer wrapper or envelope used by such service. NOTE: Many express mail and delivery services do not guarantee overnight by noon to White County.

Submission by US Mail must be sent to the address below:

White County

Attention: Human Resources 1235 Helen Hwy

Cleveland, GA 30528

The Submittal must be signed by a company officer who is legally authorized to enter into a contractual relationship in the name of the vendor.

3. CONTACT PERSON

All questions that arise (prior to the deadline for questions due date) must be directed to the contact person by email. The designated contact is Shanda Murphy, smurphy@whitecountyga.gov .Any unauthorized contact shall not be used as a basis for responding to this RFQ and also may result in the disqualification of the vendor's submittal.

Vendors may not contact any elected official or other county employee to discuss the proposal process or proposal opportunities except 1.) through the contact person designated herein, or 2.) as provided by existing work agreement(s). This policy shall be strictly enforced, and the County reserves the right to reject the submittal of any vendor violating this provision.

4. ADDITIONAL INFORMATION/ADDENDA

White County will issue responses to questions and any other corrections or amendments it deems necessary in written addenda issued prior to the due date posted on the county’s website under bid opportunities. Vendors should not rely on any representations, statements or explanations other than those made in this RFQ or in any addendum to this RFQ. Where there appears to be a conflict between the RFQ and any addenda issued, the last addendum issued will prevail. Vendors are advised to check the website for addenda before submitting their response.

Vendors must acknowledge any issued addenda by including Attachment B- Addenda Acknowledgement with the submittal. Proposals which fail to acknowledge the vendor’s receipt of any addendum will result in the rejection of the response if the addendum contains information which substantively changes the county’s requirements

5. LATE SUBMITTAL AND LATE MODIFICATIONS

Submittals received after the due date and time will not be considered. Modifications received after the due date will not be considered. White County Government assumes no responsibility for the premature opening of a proposal not properly addressed and identified, and/or delivered to the proper designation.

6. REJECTION OF PROPOSALS/CANCELLATION

White County Government reserves the right to reject any and all submittals and reserves the right to waive irregularities or informalities in any submittal or in the submittal procedure, when to do so would be to the advantage of White County. White County reserves the right to cancel this RFQ at any time.

7. MINIMUM RFQ ACCEPTANCE PERIOD

Submittals shall be valid and may not be withdrawn for a period of 180 days from the date specified for receipt of submittals.

8. NON-COLLUSION AFFIDAVIT

By submitting a response to this RFQ, the vendor represents and warrants that such proposal is genuine and not a sham or collusive or made in the interest or in behalf of any person not therein named and that the vendor has not directly or indirectly induced or solicited any other vendor to put in a sham proposal, or any other person, firm or corporation to refrain from submitting and that the vendor has not in any manner sought by collusion to secure to that vendor any advantage over any other vendor.

By submitting a proposal, the vendor represents and warrants that no official or employee of White County Government has, in any manner, an interest, directly or indirectly in the proposal or in the contract which may be made under it, or in any expected profits to rise there from.

9. COST INCURRED BY VENDORS

All expenses involved with the preparation and submission of the RFQ to the White County Board of Commissioners, or any work performed in connection therewith is the responsibility of the vendor(s).

10. RFQ OPENING

Only the names of the firms responding to this RFQ will be read aloud publicly due to the fact that the proposals will be subject to an evaluation review for accurate qualifications. A list of names of firms responding to the RFQ may be obtained from the county’s website www.whitecountyga.gov, after the RFQ due date and time stated herein.

11. OPEN RECORDS

All materials submitted in connection with this RFQ will be public documents and subject to the Open Records Act and all other laws of the State of Georgia, the United States of America and the open records policies of White County Board of

Commissioners. All such materials shall remain the property of White County and will not be returned to the respondent.

12. TAXES

White County Government is tax exempt. No sales tax will be charged on any products or services. White County cannot exempt any other person/vendor from applicable sales taxes that may be required of them in relation to this project. Selected vendor will be provided with White County’s Sales and Use Tax Certificate of Exemption upon request.

13. VENDOR INFORMATION

All submissions shall include a completed vendor information form and copy of c u r r e n t business license. Failure to provide this information could result in the disqualification of the vendor from submitting a proposal.

14. INSURANCE

Selected vendor will be required to provide White County with a Certificate of Insurance for liability and worker’s compensation insurance before work can begin on this County project and be effective for the duration of the work as described in the contract documents, including authorized change orders, plus any period of guarantee as required in the general warranty.

Workers Compensation Insurance In the amounts of the statutory limits established by the General Assembly of the

State of Georgia (A self-insurer must submit a certificate from the Georgia Board of Workers compensation stating that the Contractor qualifies to pay its own workers compensation claims.) In addition, the Contractor shall require that all subcontractors occupying the premises or performing the work under the contract to obtain an insurance certificate showing proof of Worker Compensation Coverage with the following minimum coverage:

Georgia Statutory including Employers Liability Bodily injury by Accident – each employee $100,000 Bodily injury by Disease - each Employee $100,000 Bodily injury by Disease – policy limit $500,000

Commercial General Liability Each Occurrence Limit $1,000,000 Personal and Advertising Injury Limit $1,000,000 General Aggregate Limit $2,000,000 Products/Completed Operations Aggregate Limit $2,000,000

Automobile Liability Combined Single Limit $1,000,000

Professional Liability Limit (w/ errors & omissions) $1,000,000

15. ANTI-DISCRIMINATION

White County, in accordance with Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d to 2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in federally assisted programs of the Department of Transportation issued pursuant to such Act hereby notifies all respondents that it will affirmatively ensure that in any contract entered into pursuant to this advertisement, disadvantaged business enterprises as defined at 49 CFR Part 23 will be afforded full opportunity to submit proposals in response to this Request for Qualifications and will not be discriminated against on the grounds of race, color, national origin, sex, handicap/disability in consideration of an award.

By submitting their response, all respondents certify to White County that they will conform to the provisions of the Federal Civil Rights Act of 1964.

In every contract of over $10,000 the provisions in 1. and 2. below apply:

1. During the performance of this contract, the contractor agrees as follows:

a. The contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex or national origin, except where religion, sex or national origin is a bona fide occupational qualification reasonably necessary to the normal operation of the contractor. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause.

b. The contractor, in all solicitations or advertisements for employees placed by or on behalf of the contractor, will state that such contractor is an equal opportunity employer.

c. Notices, advertisements and solicitations placed in accordance with federal law, rule or regulation shall be deemed sufficient for the purpose of meeting the requirements of this section.

2. The contractor will include the provisions of 1. above in every subcontract or purchase order of over $10,000 so that the provisions will be binding upon each subcontractor or vendor.

16. GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT

Pursuant to the Georgia Security and Immigration Compliance Act of 2006, the successful Contractor understands and agrees that compliance with the requirements of O.C.G.A.13-10-91 and Georgia Department of Labor Rule 300-10- 02 are conditions of this proposal and contract document. The Contractor further agrees that such compliance shall be attested by the Contractor and any of his Subcontractors by execution of the appropriate Affidavit and Agreement which will be included and become a part of the Agreement between White County and the successful Contractor.

SECTION II – GENERAL CONDITIONS

A. PURPOSE

White County Board of Commissioners is issuing this Request for Qualifications (RFQ) to seek qualified brokers to assist with strategically planning, designing and negotiating the best coverage and cost for our comprehensive employee benefit programs. The County has approximately 272 benefit eligible employees. Our leadership is looking to ensure we have financially competitive, effectual and affordable benefit programs to offer our employees.

The County does not guarantee a minimum value for this contract.

This RFQ is not an authorization to approach insurers or other underwriting sources on behalf of the County. We specifically request that no insurance market contact or solicitation be made on behalf of White County at this time and that no insurance market reservations or commitments be made for any purpose in respect to any insurance or reinsurance to be provided for the County.

B. CONTRACT PERIOD

The initial term of a contract awarded as a result of this RFQ shall be from July 1, 2027 through June 30, 2028. The contract may be renewed according to the terms stated herein.

The contract shall terminate absolutely and without further obligation at such time as appropriated and otherwise unobligated funds are no longer available to satisfy the obligations of the County under this contract. The County does not guarantee a minimum value for this contract.

If, at any time, the County determines it is in its best interest to discontinue use of these services the County reserves the right to cancel this Agreement by giving thirty (30) days advance written notice.

C. SCOPE OF WORK

White County views broker services as a direct extension of our Human Resources Department. Provisions of brokerage services to White County under any agreement ensuing from this proposal will entail the following, at a minimum:

1. Auditing resulting contracts and monthly invoices for accuracy of coverage, terms and conditions;

2. Coordinating annual benefits renewals, including negotiation of changes in contracts;

3. Assisting the County in determining specifications for future insurance coverage;

4. Marketing the County’s desired insurance package through identification of appropriate markets, analysis of proposals, provisions of recommendations, and assistance in contract negotiation;

5. Preparing, disseminating, and analyzing bid packages in accordance with County specifications, should a formal bidding package for quality of benefits be deemed necessary;

6. Reviewing the employee benefit package for quality of benefits provided, cost effectiveness, competitiveness and plan administration on an annual basis;

7. Monitoring all associated, ongoing contracts, to ensure contract compliance;

8. Analyzing claims history and insurance utilization at least quarterly;

9. Providing information on employee benefit issues, trends and proposed or new legislation;

10. Meeting with the County administrative staff on a regular basis;

11. Conducting new-hire enrollments on a monthly basis through coordination with County Human Resources;

12. Designing and supplying employee benefit communication materials including an annual high-quality Employee Benefits Handbook;

13. Participating in the annual employee wellness fair;

14. Providing a key contact person to be available to answer questions and resolve issues that arise during the year regarding employee benefits, contract administration and service provisions;

15. Providing a key contact person that specializes in Benefits Services assisting employees and families with claims and questions. This stipulation is required in order to remain in compliance with HIPAA regulations.

16. Providing weekly reporting of necessary benefit deduction changes in order to assist with processing accurate deductions for employees;

17. Coordinating and processing COBRA Benefits;

18. Providing ongoing support and resources in order to submit mandated annual reporting;

19. Providing an electronic, web-based platform for annual open-enrollment, new hire benefit selections and routine benefit / information changes throughout the year;

20. Evaluating various insurance products submitted by carriers, agents and brokers;

and;

21. Perform other related consultation services as needed or requested.

** A brief summary of services provided by our current broker is attached – this summary will be considered a minimum level of service for the purpose of this RFQ**

D. STATEMENT OF QUALIFICATIONS

Broker Proposal Questionnaire:

The Broker Proposal Response Questionnaire must clearly demonstrate the required qualifications, expertise, competence, and capability of the vendor. Please provide a concise description of your firm’s ability to provide the services required in the Scope of

Work of this document. Additionally, please include the answers to the following questions (Address each by number):

1. Describe your organizational structure (i.e. publicly held corporation, partnership, etc.). Review each area of your organization and describe their function.

Describe the process for handling concerns/questions/calls from client staff and employees.

2. Confirm that you are a licensed broker in the State of Georgia and provide documentation. Confirm that you serve as a broker, independently, and are not employed by any insurance company, third party administrative agency or provider network.

3. Briefly describe your company’s organization, philosophy and management.

Also, please provide a brief company history.

4. Describe your contractual relationship, if any, with organizations or entities necessary to your proposal’s implementation (i.e. actuarial services, data information services, third party providers for Open Enrollment, etc.).

5. How long has your organization been providing brokerage services? Has your organization ever operated under a different name? Why was the name changed?

6. Provide a list of known complaints filed with the Insurance Commissioner’s Office, against your firm, over the past ten (10) years. Include the nature of the complaint and disposition.

7. How many public sector clients does your firm currently provide brokerage services to?

8. Indicate the method of service provision your organization would utilize in implementing your proposal (i.e. individual broker, individual broker with supporting back up, team of brokers). Please provide resumes of individual brokerage staff that would provide services to the County. Include a brief professional history for each individual and how they are qualified to provide services to White County.

9. Briefly describe the level of service and support provided to White County by your broker(s) on a day-to-day basis. Describe the level of service and support by your staff on a day-to-day basis. Are your customer service employees licensed insurance agents and are they certified under COBRA and HIPAA?

10. How does your firm provide continuing education to ensure that each broker is educated on current market trends and legislative developments? How is this information communicated to your clients?

11. Describe how you build an understanding of the direction and priorities of the County employee benefit program and how you would utilize this information to recommend changes and project future trends.

12. Detail how your organization assists clients in developing a strategic benefit plan.

13. Describe your organization’s anticipated involvement in the annual renewal process. Include information regarding process timeframes, negotiation of rates and vendor selection. NOTE: White County’s current benefits plan year is July 1 to June 30.

14. Discuss any innovative mechanisms you have used to minimize insurance and service costs to your clients.

15. How do you keep your clients aware of trends and new developments in employee benefits?

16. How would your firm assist White County in developing plan specifications?

Explain your process for providing plan recommendation to your clients.

17. Explain the process your organization would utilize to assist White County in selecting an insurance vendor. How would your company’s experience and expertise benefit the County in this process?

18. Please provide a list of the vendors you have relationships with in regard to medical, pharmacy, disability, life, supplemental health and dental insurance plans.

19. Describe your preferred carrier relationships and the benefits of these relationships to your clients. Describe any blocks or pools of business that your firm has access to and what benefits are to your clients.

20. Include notice of any interest in any TPA, PBM, network, reinsurer, insurance company or affiliate or any contractual agreements you have with carriers to meet a quota for business with that carrier.

21. Describe how your organization strives to streamline benefit administration for your clients. Include any services you provide for automation of the benefit process (i.e. electronic capabilities, outsourcing options). How many of your clients are enrolled online? How many employees does this represent? Does your staff build these enrollment websites? Attach any associated cost for these services on a separate fee schedule.

22. Describe process for Open Enrollment for client staff and its employees.

23. Detail how you develop a benefit communication strategy with your clients.

Include what tools or resources you have available to assist your clients in effective communication not only the specific plan details but also the value of the benefits offered? Please provide a sample of an Employee Benefits Handbook you have produced and provided for client employees.

24. What training resources does your organization provide to assist your clients in education and training their employees?

25. Describe your compliance services. What resources does your organization utilize to answer compliance questions from your clients? List three recent compliance questions and show the format and content of your response.

26. Please provide a case study on a recent client that has begun working with your firm in the past three years and show the financial impact on claims that your firm has made through benefit consulting. Describe your recommendation and how these related to the financial impact on their plan.

27. What makes your organization unique from the other organizations that may submit proposals for the County’s consideration?

28. Provide any additional information regarding your organization or services that you feel would be beneficial in helping the County to select a benefits broker.

29. Please provide a list of three verifiable public sector references, all of whom are able to comment on your organization’s relevant experience. Please furnish:

Group Name; Contact name and telephone number;

Services you provided; Time period covered;

Benefit programs addressed; and number of covered employees.

30. List any and all accounts held by local governments (city, county, authority) in Georgia within the last five (5) years. If any, do you still hold that account? If no, why not? If no Georgia local governments, indicate so.

31. Will any of the representatives which you will assign to work with White County and meet with county employees on an individual basis – be compensated on a commission basis determined by the elections made by the county employees?

If yes, please explain.

32. List any limitations your firm would have in providing the Scope of Work outlined in Section II (c) and broker services outlined on page 15.

Pricing:

It is White County’s expectation that brokerage fees and commissions will be borne by the selected insurance provider. If additional brokerage fees are expected of White County, or if your firm offers additional fee-supported services which are supplemental to your proposal, please clearly outline such costs and services on a separate fee addendum at the end of the proposal in a separate, sealed envelope clearly identified as “Financial Proposal.”

Oral Presentations:

During the evaluation process, White County may at its discretion, request oral presentations from any or all respondents for the purpose of clarification or amplifying the materials presented. However, respondents are cautioned that the County is not required to request clarification; therefore, all proposals should be complete and reflect the most favorable terms available from the broker.

Criteria for Evaluation:

All proposals will be evaluated according to, but not necessarily limited to, the following:

Your firm’s indicated ability to provide a level of service sufficient to meet the County’s needs, as stated in your response to Scope of Work and Broker Proposal Questionnaire.

Extent and success of previous work your firm has provided to organizations similar in nature and size to White County, as determined by White County’s contact with references provided.

The proposal itself as an example of your firm’s work product.

Qualifications/experience of key personnel to be assigned to the project as stated in question

8 of Broker Proposal Questionnaire.

Adherence to RFQ requirements, including: completion of all required forms;

Provision of all requested information; adequacy of responses, and return of the RFQ by the stated deadline.

The following point system will be utilized to help evaluate the proposals:

Criteria Points Allowed Responsiveness of understanding scope 15 points

Technical Experience of firm A. Insurance work of the type under consideration 15 points

B. Work with similar public entities 20 points

C. Qualifications of Staff 20 points

D. Size and structure of the firm 15 points

E. References 15 points

TOTAL POSSIBLE POINTS

(carried forward if selected for presentation / interview)

100 points

Oral Presentation/Interview (if applicable) 20 points TOTAL POSSIBLE POINTS: 120 points

E. ADMINISTRATION

The project will be administered by the White County Board of Commissioners with the White County Human Resources Director being the main point of contact for all questions during the term of the contract.

F. RESPONDENT’S CHECKLIST – REQUIRED FORMS

Each proposal should be prepared simply and economically, avoiding the use of elaborate promotional materials beyond those sufficient to provide a complete presentation. The cost for developing the submittal is the sole responsibility of the respondent. The following documents are also required to be included in your proposal packet:

REQUIRED FORMS – See page 25 for your reference Documentation that is required for a complete proposal includes:

1. Numbered responses and documentation listed under Section II D: Statement of Qualifications / Broker Proposal Questionnaire

2. Vendor Information Form

3. Execution of Proposal Form

4. Addenda Acknowledgment Form (if applicable)

5. Proposer’s Certification and Non-Collusion Affidavit

6. Georgia Security and Immigration Compliance Act Affidavit

i. Contractor Affidavit

ii. Subcontractor Affidavit (if applicable)

7. Copy of current business license

8. Copy of current Georgia Insurance Brokerage license

9. Reference Form

10. Financial Proposal – labeled & sealed (if applicable as referenced page 12)

G. PROCEDURES AND MISCELLANEOUS ITEMS

1. All questions shall be submitted via email and shall be communicated in the form of an addenda if the scope specifications are to be affected and posted on the County’s website under the bid opportunities section, all firms responding to this RFQ should check the website before responding to this RFQ.

2. All respondents to this RFQ shall indemnify and hold harmless the White County Board of Commissioners, and any of their officers and employees from all suits and claims alleged to be a result of this RFQ. The issuance of this RFQ constitutes only an invitation to present a proposal. It does not constitute an Invitation to Bid nor does it commit the County to issuing an Invitation to Bid. The White County Board of Commissioners reserves the right to determine, at its sole discretion, whether any aspect of a respondent's submittal meets the criteria in this RFQ. The White County Board of Commissioners also reserves the right to seek clarifications, to negotiate with any vendor submitting a response, to reject any or all responses with or without cause, and to modify the procurement process and schedule. In the event that this RFQ is withdrawn or the project canceled for any reason, the White County Board of Commissioners shall have no liability to any respondent for any costs or expenses incurred in connection with this RFQ or otherwise.

3. The RFQ is subject to the provisions of the White County Purchasing Policy and any revisions thereto, which are hereby incorporated into this RFQ in their entirety except as amended or superseded herein.

4. Failure to submit all the mandatory forms from this RFQ package shall be just cause for the rejection of the qualification package. However, White County reserves the right to decide, on a case-by-case basis, in its sole discretion, whether or not to reject such a proposal as non-responsive.

5. In case of failure to deliver goods in accordance with the contract terms and conditions, White County, after due oral or written notice, may procure substitute goods or services from other sources and hold the contractor responsible for any resulting additional purchasing and administrative costs. This remedy shall be in addition to any other remedies which White County may have.

6. By submitting a qualification package, the vendor is certifying that they are not currently debarred from bidding on contracts by any agency of the State of Georgia, nor are they an agent of any person or entity that is currently debarred from submitting bids on contracts by any agency of the State of Georgia.

7. Any contract resulting from this RFQ shall be governed in all respects by the laws of the State of Georgia and any litigation with respect thereto shall be brought in the courts of the State of Georgia. The contractor shall comply with applicable federal, state, and local laws and regulations.

8. It is understood and agreed between the parties herein that White County shall be bound hereunder only to the extent of the funds available or which may hereafter become available for the purpose of this agreement.

H. BONDS

Bid Bond – not required Payment Bond – not required Performance Bond – not required

I. FINAL SELECTION

Following review of all qualified proposals, selection of a suitable vendor, and preliminary contract negotiations, a recommendation will be made to the White County Board of Commissioners. Following Commission approval, the County will complete contract negotiations. The selected vendor should be prepared to commence working on the employee benefit program no later than March 2027.

The White County Board of Commissioners reserves the right to accept the response that is determined to be in the best interest of the County. The County reserves the right to reject any and / or all proposals.

Overview of Current Broker Services (As Referenced on Page 8)

Evaluates & competitively bids comprehensive employee benefits program annually – evaluating both fully-insured and self-funded options

Provides annual open enrollment materials

Conducts group benefit information meetings

Provides a custom employee benefit booklet annually

Coordinates annual open enrollment - individual meetings (1 location) & online

Processes annual open enrollment via electronic portal

Provides annual employee benefit statements detailing elections made with county cost, employee cost, and total compensation calculations

Provides electronic portal for routine benefit changes throughout the plan year

Meets (at county office – 1 location) with and processes new hires monthly

Provides weekly activity reports / payroll deduction reports for all changes made

Receives and reviews all benefit related monthly invoices – and makes any corrections necessary with vendors and sends to Human Resources once accuracy is confirmed

Manages all annual legal notifications required including COBRA notification & enrollment

Provides Human Resources staff with any necessary legal updates related to benefits administration

Processes annual ACA required reporting – 1094 / 1095 requirements

Provides access to dedicated eligibility & claims assistance for HR Department

Provides dedicated staff for Human Resources staff and employees to contact to assist in resolving claims & eligibility issues

Participates in annual employee wellness fair

Quarterly claims evaluation

RFQ BROKER SERVICES

EXECUTION OF PROPOSAL

DATE: __________

The potential Contractor certifies the following by placing an "X" in all blank spaces:

___ That this proposal was signed by an authorized representative of the firm.

___ That the potential Contractor has determined the cost and availability of all materials and supplies associated with performing the services outlined herein.

___ That all labor costs associated with this project have been determined, including all direct and indirect costs.

___ That the potential Contractor agrees to the conditions as set forth in this Request for Qualifications with no exceptions.

Therefore, in compliance with the foregoing Request for Qualifications, and subject to all terms and conditions thereof, the undersigned offers and agrees, if this proposal is accepted within 180 days from the date of the opening, to furnish the services for the prices and / terms quoted within the timeframe required.

Business Name

Authorized Signature Date

Typed Name & Title

THIS PAGE MUST BE COMPLETED AND SUBMITTED AS A PART OF YOUR PROPOSAL

REFERENCE FORM

All references must be from customers for whom your company has completed work similar to the specifications of this proposal. Attach additional page if necessary.

References for: ______________________________________________________________ (Company Name)

1. Company

Street Address

City, State & Zip

Contact Person Name Title

Phone Email

Describe Scope of Work and dates of project/service:

2. Company

Street Address

City, State & Zip

Contact Person Name Title

Phone Email

Describe Scope of Work and dates of project/service:

3. Company

Street Address

City, State & Zip

Contact Person Name Title

Phone Email

Describe Scope of Work and dates of project/service:

ADDENDA ACKNOWLEDGEMENT

The vendor has examined and carefully studied the Request for Qualifications and the following Addenda, receipt of all of which is hereby acknowledged:

Addendum No.

Addendum No

Addendum No.

Addendum No.

Authorized Representative (Signature) Date

Authorized Representative/Title (Print or Type)

Vendors must acknowledge any issued addenda. Proposals which fail to acknowledge the vendor’s receipt of any addendum will result in the rejection of the offer if the addendum contained information which substantively changes the Owner’s requirements.

PROPOSER’S CERTIFICATION AND STATEMENT OF NON-COLLUSION

I ____________________________ certify that this proposal is made without prior understanding, agreement or connection with any corporation, firm or person submitting a proposal for the same services and is in all respects fair and without collusion or fraud. I understand that collusive bidding is a violation of state and Federal law and can result in fines, prison sentences and civil damages awards.

I certify that this proposal has been prepared independently and the price submitted will not be disclosed to another person.

I certify that there has been no contact or communication by the proposer or the proposer’s associates with any County staff, or elected officials since the date this RFQ FOR BROKER SERVICES was issued except: 1) through the Human Resources Department 2) at the Pre- Proposal Conference (if applicable) or 3) as provided by existing work agreement(s). The County reserves the right to reject the proposal submitted by any proposer violating this provision.

I agree to abide by all conditions of this proposal and certify that I am authorized to sign this proposal.

COMPANY NAME:

Authorized Representative (Signature) Date

Authorized Representative/Title (Print or Type)

VENDOR’S INFORMATION FORM

1. Legal Business Name

2. Street Address

3. City, State & Zip

4. Type of Business: State of Registration: ____________________

(Association, Corporation, Partnership, Limited Liability Company, etc)

5. Name & Title of Authorized Signer:

6. Primary Contact

7. Phone Fax

8. E-mail

9. Company Website

10. Has your company ever been debarred from doing business with any federal, state or local agency?

Yes ____ No ____ If Yes, please state the agency name, dates and reason for debarment.

ATTACH COPY OF BUSINESS LICENSE

THIS PAGE MUST BE COMPLETED AND SUBMITTED WITH PROPOSAL

Georgia Security & Immigration Compliance (GSIC) Act Affidavit

As per the Georgia Senate Bill 529 and Senate Bill 447, the Georgia Department of Labor has promulgated new rules for the implementation of Section 2. O.C.G.A. §13-10-91 and GDOL Rule 300-10-01-.02 state that no Georgia Public Employer shall enter into a contract for the physical performance of services within the State of Georgia unless the Contractor registers and participates in a federal work authorization program to verify the work eligibility information of all of its new employees.

The Employment Eligibility Verification “E-Verify” site operated by the U.S. Citizenship and Immigration Services Bureau of the U.S. Department of Homeland Security is the electronic federal work authorization program to be utilized for these purposes.

The website is https://e-verify.uscis.gov/enroll/

By executing the attached Contractor Affidavit, Contractor verifies its compliance with O.C.G.A.

§13-10-91 stating affirmatively that the individual, firm or corporation which is contracting with the White County Board of Commissioners has registered and is participating in this federal work authorization program in accordance with the applicability provisions and deadlines established in this Statute.

Contractor further agrees that should it employ or contract with any Sub-Contractor(s) for the physical performance of services pursuant to the contract with the White County Board of Commissioners, Contractor will secure from the Sub-Contractor(s) verification of compliance with O.C.G.A. §13-10-91 on a Sub-Contractor Affidavit and shall provide a copy of each such verification to the White County Board of Commissioners at the time the Sub-Contractor(s) is retained to perform such services.

PLEASE COMPLETE THE ATTACHED AFFIDAVIT AND RETURN IT TO:

Shanda Murphy

White County Human Resources Director 1235 Helen Hwy

Cleveland, GA 30528

Fax: (706) 865-1324 Email: smurphy@whitecountyga.gov

IMMIGRATION AND SECURITY FORM

(GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT)

Contractor’s Name:

County Solicitation/ Contract No.:

RFQ Broker Services

CONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned Contractor verifies its compliance with

O.C.G.A. §13-10-91, stating affirmatively that the Contractor identified above has registered with and is participating in a federal work authorization program*, in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-10-91.

The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the County, Contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the attached Subcontractor Affidavit. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the County at the time the subcontractor(s) is retained to perform such service.

EEV / E-Verify Company Identification Number

BY: Authorized Officer or Agent Date (Contractor Name)

Title of Authorized Officer or Agent of Contractor

Printed Name of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS

THE DAY OF 20___

[NOTARY SEAL]

Notary Public

My Commission Expires:

*any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-

THIS PAGE MUST BE SUBMITTED WITH PROPOSAL

(GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT)

Contractor’s Name:

County Solicitation/

Contract

RFQ Broker Services

ADDITIONAL INSTRUCTIONS TO CONTRACTOR: Identify all subcontractors used to perform under the county contract. In addition, you must attach a signed and notarized affidavit (next page of this form) from each of the subcontractors listed below. The contractor is responsible for providing a signed and notarized affidavit to the County within five (5) days of the addition of any new subcontractor used to perform under the identified County contract.

Contractor’s

Subcontractors:

(GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT)

Contractor’s Name:

Subcontractor’s (Your) Name:

County Solicitation/ Contract No.:

RFQ Broker Services

SUBCONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned Subcontractor verifies its compliance with O.C.G.A. §13-10-91, stating affirmatively that the Subcontractor which is engaged in the physical performance of services under a contract with the Contractor identified above on behalf of the County identified above has registered with and is participating in a federal work authorization program*, in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-10-91.

EEV / E-VerifyTM Company Identification Number

BY: Authorized Officer or Agent Date (Subcontractor Name)

Title of Authorized Officer or Agent of Contractor

Printed Name of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS

THE DAY OF 20___

[NOTARY SEAL]

Notary Public

My Commission Expires:

*any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603

White County Government

RFQ Broker Services

Checklist for RFQ Documents

Failure to include all required documents will result in the proposal being removed from consideration

Broker Proposal Response Questionnaire (# responses and with referenced documentation)

Vendor Information Form

Copy of Business License

Copy of Georgia Insurance Brokerage License

Execution of Proposal Form

Reference Form

Addenda Acknowledgement

Non-Collusion Certification

E-Verify Affidavit

E-Verify Subcontractor Affidavit (if applicable)

Financial Proposal – labeled & sealed (if applicable as referenced page 12)

Thank you for your interest in doing business with White County

Medical | Dental | Vision | HRA | Basic Life | Voluntary Life | Disability

Employee Benefits Guide Plan Year July 1, 2026 – June 30, 2027

EXHIBIT A

Table of Contents

2 Message from the Chairman

3 Benefits Eligibility

4 Medical Benefit Summary

6 Anthem LiveHealth Online

7 Dental and Vision Benefit Summaries

8 Life and AD&D Insurance

9 Disability Insurance

10 Employee Assistance Program

11 Critical Illness Insurance

12 COBRA Notice

Important contact information is located on the back cover of this guide.

This guide is a summary only. Please refer to each plan’s certificate of coverage / plan document for a complete description of all benefits and exclusions. If there is any difference between the information provided in this guide and any certificate of coverage / plan document, the certificate of coverage / plan document will govern. Copies of all certificates of coverage / plan documents are available at the Human Resources department. In the event that some information changes, you will receive notice about the changes prior to the annual Open Enrollment. If you are a new employee, this information will help you to understand the benefit options available to you. If you’re already covered by any of the benefit plans, you may refer to this guide throughout the year as you use your benefits. This guide also provides information regarding your COBRA rights and responsibilities.

Message from the Chairman White County Employee Benefits Guide

To: All Full Time Employees From: Chairman Travis Turner Subject: Employee Benefit Plans

White County very much appreciates the hard work and dedication of all our employees, and we recognize that a quality, comprehensive benefits package is a critical component in retaining skilled and seasoned employees as well as recruiting new talent when needed. The following pages contain detailed information about your available benefits.

Travis Turner Chairman White County Board of Commissioners

Board of Commissioners

Shan Ash District 1

Lyn Holcomb District 2

Edwin Nix District 3

Craig Bryant District 4

White County Board of Commissioners Staff:

Derick Canupp County Manager Shanda Murphy Assistant County Manager / Human Resources Director Krystal Talley Human Resources Coordinator

Commissioners serve staggered terms of four years and are by district with the chairman elected at-large.

Benefits Eligibility White County Employee Benefits Guide

Group Insurance Eligibility The County’s group insurance plan year is

July 1 through June 30.

Eligibility

Employees are eligible to participate in the County’s insurance plans if they are full-time employees working a minimum of 30 hours per week. Coverage will be effective the first of the month following 30 days of employment. For example, if employee is hired on April 11, then effective date of coverage will be June 1.

Dependents are defined as the legal spouse and/or dependent child(ren) of the participant or the spouse. The term “child” includes any of the following; A natural child, a stepchild, a legally adopted child, a child for whom legal guardianship has been awarded to the participant or the participant’s spouse.

Dependent Age Requirements

Medical/Dental/Vision Coverage:

A dependent child may be covered through the end of the month in which they turn 26.

Supplemental Term Life Coverage:

A dependent child 15 days to age 26 may be covered for $10,000.

Important Notes!

If you have a qualifying event during the year, you must notify Human Resources within 30 days and provide valid documentation supporting a change in status or “Qualifying Event”. Any request to make changes after 30 days will not be allowed until the next annual open enrollment. Please contact Human Resources (706) 865-2235 if you have any questions regarding the open enrollment period or changes.

Medical Benefit Summary White County Employee Benefits Guide

Medical Summary White County offers medical insurance through Anthem to benefit eligible employees. The costs per pay period for coverage are listed in the table below and a brief side by side summary of benefits is provided on the following pages. For more detailed information about the medical plans, please refer to the carrier’s Summary of Benefits and Coverage (SBC) document and/or the plan document, policy, or certificate of coverage.

Summary of Benefit and Coverage A Summary of Benefits & Coverage (SBC) for the medical plan is provided as a supplement to this booklet being distributed to new hires and existing employees during Open Enrollment. The summary is an important item in understanding the employee’s benefit options. The SBC is only a summary of the plan’s coverage. A copy of the SBC and/or group certificate of coverage may be requested from Human Resources or is available as follows:

Go to: www.msibg.com Username: whiteEE

Password: Benefits123

Employee Medical Deductions Bi-Weekly (26 / year)

Wellness Participant

Tier of Coverage Employee Cost

Employee Only $40.51

Employee + Spouse $141.03

Employee + Child(ren) $123.64

Employee + Family $174.46

Non-Wellness Participant

Tier of Coverage Employee Cost

Employee Only $109.51

Employee + Spouse $210.03

Employee + Child(ren) $192.64

Employee + Family $243.46

Locate a Provider To search for a participating provider, visit www.anthem.com/fine-care or contact Anthem’s customer service. When completing search criteria (as a guest), select Blue Open Access POS network.

Medical Benefit Summary White County Employee Benefits Guide

Medical Plan at a Glance In-Network Individual Annual Deductible $4,500 Health Reimbursement Arrangement (HRA)* -$3,000 Net Annual Deductible $1,500 Family Annual Deductible 3X Individual Co-Insurance (Member Pays) 10% Co-Insurance (Plan Pays) 90% Individual Out-of-Pocket Maximum (Includes deductible and co-pays) $8,300 Health Reimbursement Arrangement (HRA)* -$3,000 Net Individual Out-of-Pocket Maximum $5,350 Family Out-of-Pocket Maximum (Includes deductible and co-pays) 2X Individual

Lifetime Maximum Unlimited Physician Copay $30 Specialist Physician Copay $60 Preventive Care Services $0 Urgent Care Copay $75 Emergency Room Copay $250 Out-of-Network Individual Annual Deductible $10,000 Family Annual Deductible $20,000 Co-Insurance (Member Pays) 40% Co-Insurance (Plan Pays) 60% Individual Out-of-Pocket Maximum (Includes deductible) $20,000 Family Out-of-Pocket Maximum (Includes deductible) $60,000 Prescription Drug Copayments Retail Prescription Drugs and Oral Contraceptives (31-day supply) Tier 1: Generic $10 Tier 2: Preferred Brand $35 Tier 3: Non-Preferred Brand $75 Mail Order Prescription Drugs and Oral Contraceptives (90-day supply) Tier 1: Generic $30 Tier 2: Preferred Brand $105 Tier 3: Non-Preferred Brand $225

Health Reimbursement Arrangement (HRA) Deductible: This is the amount you pay before the plan begins to pay for covered services

Annual Deductible Your Share County HRA will cover your:

$4,500 Plan First $1,500 Next $3,000

Our HRA is administered by Anthem which eliminates the need for members to manually file for reimbursement.

Additionally, you will only be required to pay providers (physicians, hospital, etc.) your share of the deducible.