S000000413 Technical Proposal Packet.docx

TECHNICAL PROPOSAL PACKET

S000000413 Third Party Administrator

PROPOSAL SIGNATURE PAGE

PROSPECTIVE CONTRACTOR’S INFORMATION

Company:

Address:

City:

State:

Zip Code:

Minority or Women-Owned Designation See the Minority and Women-Owned Business section of the Solicitation.

PROSPECTIVE CONTRACTOR CONTACT INFORMATION

Provide contact information to be used for Solicitation related matters.

Contact Person:

Title:

Phone:

Alternate Phone:

Email:

CONFIRMATION OF REDACTED COPY

☐ YES, a redacted copy of submission documents is enclosed.

☐ NO, a redacted copy of submission documents is not enclosed. I understand a full copy of non-redacted submission documents will be released if requested.

If a redacted copy of the submission documents is not provided with Prospective Contractor’s response packet, and neither box is checked, a copy of the non-redacted documents, except for financial data (other than pricing), will be released in response to any request made under the Arkansas Freedom of Information Act (FOIA). See the Proprietary Information section of the Solicitation.

REQUIRED CERTIFICATIONS

By signing and submitting a response to this Solicitation, Prospective Contractor represents, warrants, and certifies that they are not a Scrutinized Company and they do not currently and shall not for the aggregate term of a resultant contract:

· Boycott Israel.

· Knowingly employ or contract with illegal immigrants.

· Boycott Energy, Fossil Fuel, Firearms, or Ammunition Industries.

· Employ a Scrutinized Company as a contractor.

Prospective Contractor further represents, warrants, and certifies that it shall not become a Scrutinized Company during the aggregate term of a contract resulting from this Solicitation.

An official authorized to bind the Prospective Contractor to a resultant contract shall sign below. The signature below signifies agreement that any exception that conflicts with a Requirement of this Solicitation may cause the Prospective Contractor’s proposal to be rejected.

Authorized Signature: Title:

Printed/Typed Name: Date:

submission requirements checklist The following items must be submitted with the Prospective Contractor’s proposal:

· Proposal Signature Page

· Proposed Subcontractors Form

· Recommended Options Form

· Information for Evaluation

· Experience (ten (10) pages or less)

· Solution (thirty (30) pages or less)

· Risk (five (5) pages or less)

· Copy of Prospective Contractor’s Equal Opportunity Policy

· Completed Official Solicitation Price Sheet

The following items, which must be submitted prior to a contract award to the Prospective Contractor, may also be included with the Prospective Contractor’s proposal:

· EO 98-04: Contract and Grant Disclosure Form

· Business Associate Agreement (Attachment B)

· Evidence of SOC-2 Level II and SSAE-18 compliance

· Evidence of URAC accreditation

· Evidence of Utilization Management Services registration

The following items should be submitted with the Prospective Contractor’s proposal, if applicable:

· Voluntary Product Accessibility Template (VPAT)

· Redacted copy of the submission documents

RECOMMENDED OPTIONS FORM

Prospective Contractors should identify optional recommended services available to the State, along with the schedule impact and cost details of each item. If the Prospective Contractor does not offer optional recommended services, Prospective Contractor should indicate so by checking the appropriate box. Responses to this form will not be scored for evaluation purposes.

Costs associated with the optional recommended services must be included on this form and must not be included in the completed pricing response.

Prospective Contractor proposes the following optional recommended services under a resulting contract:

Item Description:

How Will This Add Value?

Schedule Impact:

Cost Details:

Item Description:

How Will This Add Value?

Schedule Impact:

Cost Details:

Item Description:

How Will This Add Value?

Schedule Impact:

Cost Details:

Item Description:

How Will This Add Value?

Schedule Impact:

Cost Details:

Item Description:

How Will This Add Value?

Schedule Impact:

Cost Details:

Item Description:

How Will This Add Value?

Schedule Impact:

Cost Details:

☐ Prospective Contractor does not offer optional recommended services.

PROPOSED SUBCONTRACTORS FORM

Prospective Contractors shall complete the form for all subcontractors the Prospective Contractor proposes to use under a resulting contract (Services Contract (SRV-1) Fillable Form, section 14). If the Prospective Contractor does not intend to use subcontractor(s), Prospective Contractor should indicate so by checking the appropriate box.

Prospective Contractors should not include additional information relating to subcontractors on this form or as an attachment to this form.

Prospective Contractor proposes to use the following subcontractor(s) under a resulting contract:

☐ Prospective Contractor does not propose to use subcontractors under a resulting contract.

INFORMATION FOR EVALUATION – EXPERIENCE

Using this template, Prospective Contractors should provide the Prospective Contractor’s experience and capabilities to meet the Solicitation requirements. The information provided should be prioritized beginning with the most important and/or relevant experience listed first.

Prospective Contractors may expand the space in each table, add a table, or delete a table as needed, but Prospective Contractors shall not exceed the ten (10) page limit for this subsection. See RFP Section 3.5 for more information about this subsection.

Prospective Contractors may delete the instructions above and example shown below.

Example:

Claim of Expertise:

Documented Performance:

Claim of Expertise:

Documented Performance:

Claim of Expertise:

Documented Performance:

Claim of Expertise:

Documented Performance:

Claim of Expertise:

Documented Performance:

Claim of Expertise:

Documented Performance:

Claim of Expertise:

Documented Performance:

Claim of Expertise:

Documented Performance:

INFORMATION FOR EVALUATION – SOLUTION

Using this template, Prospective Contractors should include a narrative to address and provide a high-level overview of the solution and/or approach proposed using the requirements outlined in the Solicitation.

Prospective Contractors shall not exceed the thirty (30) page limit for this subsection. See RFP Section 3.5 for more information about this subsection.

The Prospective Contractor may address guarantees not specifically requested in the RFP such as trend and utilization guarantees.

Prospective Contractors may delete the instructions above.

INFORMATION FOR EVALUATION – RISK

Using this template, Prospective Contractors should identify and prioritize major risks that they reasonably foresee could potentially prevent or impair the Prospective Contractor’s delivery of the solution as offered in the proposal or to otherwise fail to meet the State’s desired outcome, specifications, and performance standards, and how they will mitigate, manage, and/or minimize each risk listed.

Prospective Contractors may expand the space in each table, add a table, or delete a table as needed, but Prospective Contractors shall not exceed the five (5) page limit for this subsection. See RFP Section 3.5 for more information about this subsection.

Prospective Contractors may delete the instructions above and the example shown below.

Example:

Risk Description:

Solution:

Documented Performance:

Risk Description:

Solution:

Documented Performance:

Risk Description:

Solution:

Documented Performance:

Risk Description:

Solution:

Documented Performance: