Request for Proposals. RFP Insurance Broker Services for Employee Benefits Program

Transcription

1 Page 1 of Request for Proposals RFP Insurance Broker Services for Employee Benefits Program Children s Services Council of Palm Beach County 2300 High Ridge Road Boynton Beach, Florida

2 Page 2 of 25 Table of Contents SECTION 1: INTRODUCTION WHAT WE ARE SEEKING THE COUNCIL OVERVIEW OF THE CHILDREN S SERVICES COUNCIL... 3 SECTION 2: INSURANCE BROKER SERVICES FOR EMPLOYEE BENEFITS INSURANCE BACKGROUND SCOPE OF SERVICES MARKETING AND PLACEMENT REQUIREMENTS TIMING OF SOLICITATIONS COST OF SERVICES MINIMUM REQUIREMENTS... 9 SECTION 3: RFP PROCESS LIMITATIONS ON CONTACTING CSC PERSONNEL BROKER DISQUALIFICATION RFP TIMETABLE INQUIRIES ACCEPTANCE OF APPLICATIONS NOTICE OF INTERVIEWS PROCEDURE FOR CONDUCTING INTERVIEWS NOTICE OF QUALIFIED BROKERS FOR CONTRACT DISCUSSIONS SECTION 4: RFP RESPONSE INSTRUCTIONS FOR SUBMITTING RESPONSE TO RFP INCOMPLETE RESPONSES RESPONSE FORMAT RESPONSE REVIEW AND SELECTION CRITERIA INSURANCE REQUIREMENTS COMPLIANCE WITH SECTION , FLORIDA STATUTES SECTION 5: SUBMITTAL DOCUMENTS... 15

3 Page 3 of 25 SECTION 1: INTRODUCTION 1.1 WHAT WE ARE SEEKING The Children s Services Council of Palm Beach County (CSC) is seeking to solicit formal written proposals from experienced and qualified individuals, corporations, partnerships and other legal entities (BROKER) to provide Insurance Broker Services for a comprehensive Employee Benefits Insurance Program for the CSC. 1.2 THE COUNCIL Children s Services Council of Palm Beach County (CSC), an independent special district created by Palm Beach County voters in 1986, and reauthorized in 2014, provides leadership, funding, services and research on behalf of the county s children so they grow up healthy, safe and strong. 1.3 OVERVIEW OF THE CHILDREN S SERVICES COUNCIL The Council invests resources in programs and services that support the physical, social-emotional and psychological development of children. In order to have an impact in those areas, the Council has four goals: children are born healthy, are safe from neglect and abuse, are ready for kindergarten, and have access to quality afterschool and summer programs. Supported by a blend of federal, state and local funding, our programs and systems are designed to achieve our goals by providing seamless, efficient, and accountable prevention and early intervention services to Palm Beach County s children and families. For additional information regarding CSC, please visit

4 Page 4 of 25 SECTION 2: INSURANCE BROKER SERVICES FOR EMPLOYEE BENEFITS INSURANCE 2.1 BACKGROUND The CSC S Human Resources Department is responsible for providing for the insurance needs of employees and retirees. A major portion of this responsibility involves the acquisition of competitively priced insurance coverage from qualified sources and also includes certain consultation/advisory services as related to CSC S insurance needs. The purpose of this RFP is to select a qualified Insurance Broker for Employee Benefits Insurance (BROKER) who will assist the Human Resources Department in representing CSC in the marketing of employee benefit insurance and provide services and consultation for each of CSC S benefit options/plans. This invitation to submit proposals is not an authorization to approach the insurance marketplace on behalf of CSC. The selected BROKER shall be responsible for marketing, placement, and servicing of coverages for an Employee Benefits Program, for approximately 100 employees as deemed necessary or beneficial by CSC. CSC currently offers a fully-insured medical program with a high deductible, open-access plan. CSC S employee benefits for 2015 include: A. Life Insurance 1. Basic Life Insurance 2. Basic Accidental Death and Dismemberment Insurance B. Medical Insurance 1. High Deductible Health Plan (HDHP) Choice Fund Open Access 2. Prescription Drug Coverage 3. Health Savings Account (HSA) with OptumHealth Bank C. Dental Insurance 1. Dental PPO Plan Open Access D. Disability Insurance 1. Short Term Disability Insurance 2. Long Term Disability Insurance E. Voluntary Wellness Bonus Program 1. Personal betterment and well-being (Administered by third party)

5 Page 5 of 25 F. CSC Funded Supplemental Programs 1. Employee Life Assistance Program G. Employee Funded Voluntary Supplemental Programs 1. Vision Insurance 2. Supplemental Life Insurance 3. Personal Cancer Care, Hospital Advantage, Critical Care and Recovery, Accident Advantage, Life Insurance 4. Dependent Care Flexible Spending Account (FSA) (Administered by third party) Note: Additional supplemental coverages may be requested at the direction of the CSC. 2.2 SCOPE OF SERVICES Selected BROKER shall analyze the employee benefit needs of CSC and provide written recommendations for changes where appropriate or dictated by changing market conditions or laws. Selected BROKER shall suggest alternative funding methods and plan changes to affect cost savings, while maintaining appropriate coverages, as well as a comprehensive in-network provider network. Selected BROKER shall advise CSC on insurance trends, insurance market conditions, financial stability of any insurance companies writing policies for CSC, or any other items having the potential to materially impact any insurance coverage carried by or claims processing services provided to CSC. Selected BROKER shall keep CSC informed of statutory and regulatory changes and advise CSC on any federal or state mandated benefits, compliance or testing requirements relevant to CSC S plans. Selected BROKER shall provide regular updates, shall ensure plans are in compliance with the Patient Protection and Affordable Care Act (PPACA), and guidance on requirements or mandates of health care reform and assist CSC with implementation of changes as required or requested. Selected BROKER shall provide guidance and a rationale for calculations in developing imputed income factors for each coverage for both domestic partner and over age dependent coverage. Selected BROKER shall provide guidance, when required or requested, in developing plan changes to comply with regulations. Selected BROKER shall review and be current with pending legislation and report to CSC any that may impact or have future impact on benefits. Selected BROKER shall negotiate initial and/or renewal rates with current carriers and/or market group coverage to competing carriers as directed and authorized by CSC. Selected BROKER shall provide enrollment analysis, utilization and/or claims analysis and comparisons.

6 Page 6 of 25 Selected BROKER shall provide budgetary projections for renewal premium costs in September of each year or as requested by CSC and conduct review sessions with Human Resources and renewal negotiations with carriers. Selected BROKER shall provide support to Human Resources by resolving important enrollment, claims and/or billing problems. Selected BROKER shall conduct periodic on-site meetings with employees and/or dependents on a voluntary basis for individual claim resolution and benefits counseling. Selected BROKER shall attend and/or conduct group insurance committee meetings with employees and management. Selected BROKER shall conduct on-site annual employee open enrollment sessions in collaboration with Human Resource staff. Selected BROKER shall provide customized benefit booklet for all staff for open enrollment sessions outlining CSC s annual benefits, as well as for new staff that join the organization throughout the year. Selected BROKER shall be available for questions, explanations, and discussions, and shall respond to requests from Human Resources within the time frame requested. Selected BROKER shall provide guidance and assistance with COBRA and retiree compliance and administration. Selected BROKER shall provide guidance and assistance with selected carriers for on-site employee wellness fair, biometric screening, and flu shot clinic. Selected BROKER shall provide employees with all Summary of Benefits and Coverages and all other required documents in compliance with the PPACA. Selected BROKER shall attend Council meetings for insurance related presentations as requested by Human Resources. 2.3 MARKETING AND PLACEMENT REQUIREMENTS Selected BROKER shall acquire every policy on a competitive basis, through sealed bid/rfp/quotation from carriers qualified to provide the services specified. Prior to solicitation, CSC may review the solicitation document prepared by the BROKER. A comparative spreadsheet/tabulation analysis of all bids/quotes received and carrier responses shall be provided by selected BROKER to CSC. The BROKER shall make a presentation to CSC of responses received, along with a recommendation and supporting rationale. Subsequent to the presentation/recommendation, a decision will be made and communicated to the BROKER for placement of the coverage(s). CSC will, in consultation with the selected BROKER, determine which carriers shall be approached for solicitation of bids/quotes. It is expected that carrier s policies will be a minimum of one-year duration with the option to extend, on an annual basis, for additional years, if available.

7 Page 7 of 25 Should additional marketing/placement efforts be necessary during the BROKER S contract, the appropriate marketing/placement fee will be paid. 2.4 TIMING OF SOLICITATIONS BROKER shall commence marketing (bid/quote) efforts four months in advance of the expiration of the existing coverages, allowing CSC sufficient time for a comprehensive review of the BROKER'S submission and recommendations, referenced in Section Scope of Services. 2.5 COST OF SERVICES Fee Schedule CSC prefers to pay for the services on a flat fee basis, but will consider proposals based on a commission basis. BROKERS must provide a flat fee price. Failure to provide a flat fee price will result in the proposal being deemed non-responsive. Providing a commission percentage is optional. Fees shall be stated in whole numbers. All costs identified below must be submitted on Fee Schedule form; download RFP : Forms at: and include with proposal. DESCRIPTION ANNUAL FLAT FEE ANNUAL MARKETING/ PLACEMENT FEE COMMISSION 1. Life Insurance $ $ % 2. Medical Insurance $ $ % 3. Dental Insurance $ $ % 4. Disability Insurance $ $ % 5. Voluntary Wellness Plan $ $ % 6. CSC Funded Supplemental Life Assistance Program 7. Supplemental Programs (as described in Section 2.1.G.1-4) $ $ % $ $ % Total: $ $

8 Page 8 of 25 Maximum Annual Increase Percentage The maximum annual increase percentage shall only apply to the flat fee rate. Should an agreement be awarded based on a commission no annual increase will be permitted. Annual Increase Percentage % Additional Fees (if any) Proposer may list additional fees in the table below for services/materials that are identified under Section 2.2 Scope of Services. Services/Materials (specify) $ $ $ $ $ Annual Flat Rate Upon invoicing, Annual Flat Fees will be paid as follows: BROKER will receive one-twelfth of the Annual Flat Fee each month. Marketing/Placement Fees will be paid to BROKER upon review and acceptance of recommended coverage and carriers. Total cost of BROKER services are to be covered by proposed fees. CSC prefers to pay carriers and BROKER(s) services directly. The proposed fees will be incorporated into the agreement. Should the BROKER S contract resulting from this RFP be terminated, CSC will only owe the Annual Flat Fee prorated to the date of termination.

9 Page 9 of MINIMUM REQUIREMENTS The BROKER must possess the minimum qualifications and/or experience needed to support CSC s needs: BROKER shall be fully licensed and certified in the State of Florida, for the type of work to be performed, for a minimum of five (5) years prior to the submission of this RFP BROKER shall have a minimum of ten (10) years experience with at least two accounts each with annual premiums of $1,000,000 or more BROKER shall have a minimum of four qualified principals and/or management staff, each with a minimum of five (5) years experience in employee benefits with experience in governmental/ public sector processes and marketing strategies BROKER shall submit a current resume or curriculum vitae for each individual who will be working with CSC BROKER shall complete all required submission documents, sign, scan and submit, as required BROKER shall participate in an interview process, upon request BROKER shall provide three references from current (within 2 years) governmental/public sector accounts o o o o o Name of governmental/public sector entity Number of employees Contact person (address, telephone number, ) Type of employee benefit plan services provided Term of the contract (effective date and end date) BROKER must note experience and compliance with the PPACA BROKER must note compliance with Health Insurance Portability and Accountability Act (HIPAA) regarding Protected Health Information (PHI) to include copies of privacy notices and internal policy & procedures for the protection of PHI

10 Page 10 of 25 SECTION 3: RFP PROCESS 3.1 LIMITATIONS ON CONTACTING CSC PERSONNEL This Request for Proposals is issued by the Children s Services Council of Palm Beach County. The contact person listed below is the sole point of contact for this RFP: Paulina Rudzinska, Human Resources Assistant Paulina.Rudzinska@cscpbc.org All contact regarding this RFP shall be by only BROKERs are prohibited from contacting CSC personnel or board members regarding this solicitation other than the person identified above. Any occurrence of a violation may result in the disqualification of the BROKER. 3.2 BROKER DISQUALIFICATION Failure to have performed any contractual obligations with CSC in a manner satisfactory to CSC will be sufficient cause for disqualification. To be disqualified as a BROKER under this provision, the BROKER must have: 1. Previously failed to satisfactorily perform in a contract with CSC, been notified by CSC of unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of CSC; or 2. Had a contract terminated by CSC, by any other county or state agency, or by any Children s Services Council for cause.

11 Page 11 of RFP TIMETABLE 04/27/2015 RFP packets are available on CSC website ( 05/13/2015 Deadline for submission of questions regarding clarification of RFP by 5PM 05/15/2015 Final posting of questions and answers and/or clarification or addenda to RFP (if any) on CSC website ( 05/28/2015 RESPONSE DEADLINE - All RFP responses are due by 2 PM at: BIDS@cscpbc.org Subject: RFP # Responses will be opened publicly at 2:01 PM Note: CSC server date and time stamps all 06/01-05/2015 Evaluation of responses by RFP Selection Team 06/05/2015 Notification by to BROKERS selected for interviews, if needed; list of those selected for interviews, if needed, posted on CSC website ( 06/09/2015 Interviews at CSC offices, if needed 06/10/2015 Discuss and finalize contract, subject to Council approval 06/25/2015 Recommendation submitted to the Council for approval 06/26/2015 Notice of Award posted on CSC website at: Notification by of BROKERs not selected for further contract discussions; notification by to BROKERs selected for contract discussions 09/01/2015 Contract begins The CSC may require a BROKER to provide additional information for clarification purposes at any time prior to the award of the contract. NOTE: CSC reserves the right to adjust the timetable and any adjustments will be made available on the CSC website.

12 Page 12 of INQUIRIES All inquiries requesting clarification regarding this RFP must be made in writing and ed to the identified contact person by 5/13/2015. During the RFP period, BROKERS must not submit any forms of marketing or promotional materials that would raise the BROKER s profile or give the BROKER an advantage or benefit not enjoyed by other perspective BROKERS. Copies of responses to all inquiries that require clarifications and/or addenda to the RFP will be made available no later than 5 PM 5/18/2015 on CSC s website. 3.5 ACCEPTANCE OF APPLICATIONS All responses must be received by CSC no later than 05/28/2015 by 2 PM. Sign, scan and attach document in PDF format to and send to: BIDS@cscpbc.org Subject: RFP # No changes, modifications or additions to the responses submitted will be accepted by, or binding on, CSC after the deadline for submissions has passed. ALL COMMUNICATIONS ARE DATE AND TIME STAMPED BY CSC S SERVER. BIDS RECEIVED AFTER THE DEADLINE WILL NOT BE CONSIDERED. CSC reserves the right to reject any and all responses or to waive minor irregularities when doing so would be in the best interest of CSC. A minor irregularity is defined as a variation from the RFP terms and conditions that do not affect the price of the application, or do not give the BROKER an advantage or benefit not enjoyed by other prospective BROKERs, or do not adversely impact the interest of CSC. 3.6 NOTICE OF INTERVIEWS CSC will post a list of qualified BROKERs for interviews, if needed, on 06/05/2015 by 5 PM on the CSC website. 3.7 PROCEDURE FOR CONDUCTING INTERVIEWS After completion of the scoring process based on the review criteria, CSC will determine which, if any, BROKERs meet the minimum requirements deemed necessary by CSC for interviews. Assuming that such minimum requirements have been met, CSC may require face-to-face interviews with one or more BROKERs.

13 Page 13 of NOTICE OF QUALIFIED BROKER FOR CONTRACT DISCUSSIONS CSC will post a list of qualified BROKER for contract discussions after 06/09/2015 on CSC s website: SECTION 4: RFP RESPONSE 4.1 INSTRUCTIONS FOR SUBMITTING RESPONSE TO RFP All responses must be submitted on the forms included in this package (forms available on CSC website ( All responses are to be signed by an official who is legally authorized to bind the BROKER to the proposed activity. IMPORTANT: All responses must be received via no later than 05/28/2015 at 2 PM per the deadline in the RFP. BROKERs will receive an auto-generated confirmation acknowledging receipt of the proposal. Do not respond to this . This receipt does not verify that CSC has received a complete proposal that will be determined after opening all proposals at the time set forth in this RFP. CSC is not responsible for the reputation of the BROKER s account which may cause delays or undeliverable messages if your server has been blacklisted. To check your sender score, please utilize an reputation service or use a service such as to confirm that you have a good reputation. CSC s server has the capacity to accept large files but, in some cases, the BROKER s server may delay sending based on the size of attachments. Please ensure you allow ample time for transmission of files. CSC will not be responsible for s received after the deadline. Proposals received after the deadline will not be considered. 4.2 INCOMPLETE RESPONSES Failure to respond to any item, including providing any requested information, or failure to follow these instructions shall be considered submission of an incomplete response and may result in disqualification from further consideration. 4.3 RESPONSE FORMAT The typewritten portion of your response is to be submitted on the RFP forms included in Section 5. The forms are available for download on CSC s website:

14 Page 14 of RESPONSE REVIEW AND SELECTION CRITERIA BROKER selection will be based upon the following criteria: EVALUATION CRITERIA POINTS Experience and Qualifications 40 Technical & Scope of Services 30 Compensation 15 Accessibility 10 Other (see Forms section) 5 TOTAL: INSURANCE REQUIREMENTS BROKER must provide, upon award of contract, proof of insurance meeting or exceeding the following requirements: Worker s Compensation Insurance as required by law. This policy must include Employer s Liability with the following limits - $300,000 for accident. CSC will accept filed certificates of exemption forms for Worker s Compensation Insurance. General Liability Insurance - $500,000 general aggregate, $500,000 per person, $500,000 each occurrence, and $500,000 per accident for bodily injury. Automobile Liability Insurance for owned vehicles, non-owned vehicles and hired vehicles, coverage shall provide minimum limits of liability of $300,000 per accident Combined Single Limit for Bodily Injury and Property Damage. Professional Liability Coverage of at least $1,000,000 per occurrence A certificate of insurance naming Children s Services Council of Palm Beach County as additional insured for General Liability must be submitted no later than ten (10) days after award and prior to execution of Statement of Work. 4.6 COMPLIANCE WITH SECTION , FLORIDA STATUTES In accordance with Section , Florida Statutes, persons and affiliates who have been placed on the convicted vendor list may not submit responses, contract with, or perform work (as a contractor, supplier, subcontractor or BROKER) with CSC in excess of the threshold amount provided in Section , Florida Statutes, for Category Two for a period of thirty-six (36) months from the date of being placed on the convicted vendor list. Any response received from a person, entity or affiliate who has been placed on the convicted vendor list shall be rejected by CSC as unresponsive and shall not be further evaluated.

15 Page 15 of 25 Forms: SECTION 5: SUBMITTAL DOCUMENTS The following documents can be downloaded from CSC s website at: Reference file name: RFP # Forms Cover Page Complete this entire document, sign, and scan and include with response. This form must be signed. BROKER Qualifications This section must contain all pertinent data related to the BROKER (including BROKER s organization, if applicable) and experience that would substantiate BROKER s qualifications and capabilities to perform the services requested. Technical Complete this section in detail and provide required samples of work. Statement of Accessibility Provide statement of accessibility of Account Representative(s) and other documentation, as required; scan and include with response. Other Complete this section and provide all required documents; scan and include with response. Professional References - Provide three references from current (within 2 years) governmental/public sector accounts: a. Name of governmental/public sector entity b. Number of employees c. Contact person (address, telephone number, ) d. Type of employee benefit plan services provided e. Term of the contract (effective date and end date) Fee Schedule Provide a schedule of fees/commissions; complete this document, scan and include with response. Conflict of Interest Disclosure Form Complete this document, sign, scan and include with response. This document must include a signature. Additional Documentation: All other documentation supporting requirements outlined in Section 2.2. Scope of Services Resume or Curriculum Vitae as described in Section 2.6 All other documentation as described in Section 2.6 Minimum requirements, as outlined

16 Page 16 of 25 REMINDER DEADLINE FOR SUBMISSION IS 05/28/2015 Subject: RFP # REPLIES ARRIVING AFTER 2 PM ON 05/28/2015 WILL NOT BE OPENED

17 Page 17 of 25 Submit this RFP response to: COVER PAGE Subject: RFP # RFP Title: Insurance Broker Services for Employee Benefits Program RFP #: NAME OF FIRM, ENTITY, ORGANIZATION: NAME OF CONTACT PERSON: TITLE: PHONE NUMBER: FAX NUMBER: MAILING ADDRESS: CITY: STATE: ZIP CODE: HEADQUARTERS ADDRESS (If different than mailing address): FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN): STATE OF FLORIDA BUSINESS LICENSE NUMBER (If Applicable): DO NOT include Social Security number with this application; CSC will obtain if/when contracted. ORGANIZATION STRUCTURE (Please check one): Corporation Partnership Proprietorship Joint Venture Other If Corporation, please provide the following: (A) Date of incorporation (B) State or Country of incorporation: If BROKER is a corporation, provide certification from the Florida Secretary of State verifying BROKER S corporate status and good standing, and in the case of out-of-state corporations, evidence of BROKER to do business in the State of Florida. Additionally, indicate the Parent Organization(s) that the BROKER is a subsidiary of and the identification of any subsidiaries of the BROKER, if any. 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 materials, supplies, or equipment, and is in all respects fair and without collusion or fraud. I agree to abide by all terms and conditions of this RFP and certify that I am authorized to sign this Proposal and that this Proposal is in compliance with all requirements of the Request for Proposals, including but not limited to, certification requirements. Authorized Signature (Manual) (Authorized Signature (Print or Type) Title (Print or Type) COMPLETE & PRINT FORMS; SIGN THE COVER PAGE; SCAN INTO PDF FORMAT AND TO CSC BY 2 PM ON DUE DATE

18 Page 18 of 25 BROKER QUALIFICATIONS The following shall be completed and submitted with the Request for Proposals. BROKER guarantees the truth and accuracy of all statements and answers herein contained. 1. Provide details on the qualifications of the individual(s) who will be assigned to work on CSC s account, including curriculum vitae, relevant college, graduate and/or professional courses and experience in similar work. 2. Provide details on the qualifications of the firm, including documentation of the firm s experience in similar work, and number of years in business under the current name. Qualifications for all subconsultant(s) should also be included in this section. 3. Describe in detail the team, project management structure, number of employees, current and anticipated workloads. Specifically, detail hours of operations and availability of BROKER S key personnel. Identify office location that will have primary responsibility for CSC s account. Include proximity or frequency to CSC s Administration building for service calls. Identify the extent and nature of any anticipated outside support. Identify primary Account Representative. Identify back-up Account Representative if primary is temporarily unavailable.

19 Page 19 of 25 TECHNICAL In this section BROKER must explain the Scope of Work as understood by the BROKER and detail the approach, activities and work products. BROKER shall also provide the following: 1. Provide descriptions, samples, and/or examples of evaluations of carrier quotes outlining criteria used for final recommendations. 2. Provide samples of employee communications that BROKER has developed for clients. 3. Provide samples of at least three (3) client newsletters or other method of communication to notify clients of benefits updates and/or legislative developments/changes. 4. Provide sample of utilization, claims analysis and comparison report. 5. Provide sample of Employee Benefits booklet for open enrollment. 6. Provide sample of marketing materials used for open enrollment and wellness fairs. 7. Describe in detail what concepts BROKER has proposed to clients to help contain/reduce health care costs (maximum three pages, double-spaced, 11-point type). 8. Provide any special experience, services, resources or programs which might make one BROKER superior to another BROKER or of unique value-add to the CSC. 9. What measures and analysis would be used to evaluate the CSC s current employee benefit plans? 10. What factors does BROKER take into consideration when marketing a benefit plan? BROKER may answer in general or separate answer into specific plans? 11. Describe BROKER policy regarding turnaround time to respond to CSC s voic , and/or other communications. 12. How would BROKER assist CSC in the use of technology in the communication, enrollment and administration of all employee benefit plans? 13. Detail BROKER S ability to monitor regulatory and legislative developments at both the State and Federal level and how this will be communicated to CSC.

20 Page 20 of List any assistance CSC may be requested to provide to the selected BROKER. 15. Provide any other information the BROKER may deem advantageous to demonstrate understanding and approach to the work (maximum three pages, double-spaced, 11-point type).

21 Page 21 of 25 STATEMENT OF ACCESSIBILITY Tech Location and Accessibility The name and office location of the Account Representative directly responsible for handling CSC s account. Description of the present composition of the Account Representative s personal volume of business including the following: 1. Number of accounts for which the Account Representative is responsible 2. How the CSC account will compare in size and scope to the other clients of the BROKER 3. Steps the Account Representative or the BROKER will take to assure that proper attention will be given to CSC s account as the Account Representative s or BROKER S volume of business grows. 4. Describe what access will be made available to CSC administrators and/or CSC employees. Outline the response process and timeframe for addressing needs and/or concerns of CSC s administration and/or CSC employees.

22 Page 22 of 25 OTHER 1. Provide evidence of current levels of insurance in areas of General Liability, Automobile Liability, Workers' Compensation, and Professional Liability. 2. Provide a statement of BROKER S financial security, strength, resources and capabilities to include financial reports and current or prior bankruptcy proceedings, if applicable (bankruptcy only). 3. Provide a summary of any litigation filed against the BROKER in the past three years which is related to the services that BROKER provides in the regular course of business. The summary shall state the nature of the litigation, a brief description of the case, the outcome or current status, and the monetary amounts involved. 4. Additional Data - Any additional information, which the BROKER considers pertinent for consideration, should be included in a separate section of the proposal (maximum three pages, double-spaced, 11-point type).

23 Page 23 of 25 REFERENCES Provide three references from current (within 2 years) governmental/public sector accounts. For each reference, please specify: a. Name of governmental/public sector entity b. Number of employees c. Contact person (address, telephone number, ) d. Type of employee benefit plan services provided e. Term of the contract (effective date and end date) Reference #1: Reference #2: Reference #3:

24 Page 24 of 25 FEE SCHEDULE PURPOSE: The purpose and intent of this RFP is to secure an annual fee schedule and establish a termcontract for BROKER professional services for a period of two (2) years with three (3) additional one (1) year renewals. CSC intends to award contract(s) to the most responsible and qualified BROKER in response to this RFP, taking into consideration experience, staffing, references, products, and past performance. In the case of disputes in the award of contract(s), the decision by CSC shall be final and binding on both parties. Include all relevant fees associated with provision of BROKER services as fully defined on page 7 & 8 of the RFP. DESCRIPTION ANNUAL FLAT FEE ANNUAL MARKETING/ PLACEMENT FEE COMMISSION 1. Life Insurance $ $ % 2. Medical Insurance $ $ % 3. Dental Insurance $ $ % 4. Disability Insurance $ $ % 5. Voluntary Wellness Plan $ $ % 6. CSC Funded Supplemental Life Assistance Program 7. Supplemental Programs (as described in Section 2.1.G.1-4) $ $ % $ $ % Total: $ $ Annual Increase Percentage % Services/Materials (specify) $ $ $ $ $ Annual Flat Rate

25 Page 25 of 25 CONFLICT OF INTEREST DISCLOSURE The BROKER certifies that proposal is made independently and free from collusion. BROKER shall disclose below, to the best of its knowledge, any CSC Council member, employee, or any spouse, son, daughter, stepson, stepdaughter, or parent of any such officer or employee, who is an officer or director of, or has a material interest in, the BROKER s business. For purposes hereof, a person has a material interest if he or she directly or indirectly owns more than five percent (5%) of the total assets or capital stock of any business entity, or if he or she otherwise stands to personally gain if the contract is awarded to this vendor. Failure of a vendor to disclose any relationship described herein shall be reason for debarment. Check this Box if BROKER has No Relationship(s) to Disclose - or - LIST NAME(S) AND RELATIONSHIP(S), IF APPLICABLE NAME RELATIONSHIPS (Print Name) (Print Name) REQUIRED SIGNATURE (BROKER s Signature) (Date)