NEVADA STATE HEALTH DIVISION



Note: For questions regarding completion of this form, please contact your agency’s assigned Purchasing Officer. For a list of assigned Purchasing Officers please visit

|DEPARTMENT/AGENCY INFORMATION |

|Department: | |

|Agency/Division/Bureau: | |

|Budget Account Number: | |Agency Number: | |

|Program (if applicable): | |

|Anticipated Contract Amount: | |

|Anticipated Contract Term: | |

|Contact Person: | |

|Title: | |

|Phone Number: | |Fax Number: | |

|Email Address: | |

|Mailing address: | |

|How many contract originals does your agency require for | |

|signature? | |

|Names and Titles of individuals that will sign the |Name |Title |

|contract: | | |

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|Name of individual to whom the insurance documents should |Name |Email |

|be sent: | | |

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|RFP Title: | |

|Previous RFP Number, if applicable: |RFP #: | |Issued by: | |

|Previous Purchasing Contact, if applicable: | |

|Previous RFP or Contract if done by agency: |Please attach a copy for reference |

|Anticipated BOE Date: | |

|Is the project funded? |Yes: | |No: | |

|Is any portion federal funds? |Yes: | |No: | |

|Does this project require a Technology Investment Request |Yes: | |No: | |

|(TIR)? | | | | |

|If so, has it been approved? Please provide a copy of the|Yes: | |No: | |

|approval. | | | | |

|RFP DEVELOPMENT INFORMATION INSTRUCTIONS |

|Complete all information required in the following tables. If not applicable or required, please put “Not Applicable” in the appropriate section. The information|

|provided below will be included in the appropriate sections within the RFP. Follow the numbering format in the IT RFP Template to identify section headings, |

|subheadings, etc. Attach additional information if applicable. A PDF version of the IT RFP Template is embedded here for your reference in completing this form. |

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|PROJECT OVERVIEW |

|This section should provide a brief synopsis of the project/requirements. |

|The section should include an overview of the project to include such things as anticipated project start and end dates, |

|administering agency, any other pertinent information. |

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|GOALS AND OBJECTIVES |

|If applicable, this section should provide high level goals and objectives of the project. This can be incorporated |

|in the Project Overview Section. More specific goals and objectives should be included in the Scope of Work Section. |

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|BACKGROUND - PROJECT |

|Describe the history and reasons behind the project. |

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|BACKGROUND - AGENCY |

|Describe the agency’s organization and functional units; office locations; |

|staffing, etc., including relationship to current project. |

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|CONCURRENT IMPACTS / PROJECTS |

|Describe any concurrent projects that may have an impact on the project identified in the RFP |

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|CURRENT COMPUTING ENVIRONMENT |

|Describe the agency’s current computing environment |

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|PROJECT SOFTWARE |

|Describe the current desktop tools utilized by the agency |

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|DEVELOPMENT SOFTWARE |

|Review this section and provide modifications as applicable. Development software is defined as a |

|computer system, toolset and methodology used to develop and/or modify and test new software applications. |

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|STATE RESOURCES |

|Review the sections in the IT RFP Template and provide any changes or additions |

|within this section by referencing back to the sections in the IT RFP Template. |

|Will there be a Steering Committee? |Yes: | |No: | |

|Will there be a Project Sponsor? |Yes: | |No: | |

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|________________________________ ______________________ | | | | |

|Name Title | | | | |

|Will there be a Project Manager? |Yes: | |No: | |

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|________________________________ ______________________ | | | | |

|Name Title | | | | |

|State Project Staff – Any limitations on their availability; i.e., specific timeframes they would not be |Yes: | |No: | |

|available? | | | | |

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|If so, identify those timeframes: | | | | |

|Will there be a Quality Assurance Monitor? |Yes: | |No: | |

|SYSTEM REQUIREMENTS – COMPUTING PLATFORM |

|If applicable, this section should include, but not be limited to, the following information regarding the |

|agency’s project platform, LAN/WAN, output requirements, etc. |

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|SYSTEM REQUIREMENTS – TECHNICAL REQUIREMENTS |

|If applicable, this section should include, but not be limited to, the following information regarding the agency’s |

|required presentation requirements, data requirements, processing requirements, reporting, architecture, |

|programming requirements, disaster recovery, development, testing and training environment, error control, |

|on-line help, system interfaces, search tool, etc. |

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|FUNCTIONAL REQUIREMENTS |

|If applicable, this section should include a narrative and illustrative definition of |

|business processes independent of any specific technology or architecture. |

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|SYSTEM REQUIREMENTS – SECURITY STANDARDS |

|If applicable, this section should include the security standards specific to the agency. |

|These are over and above the security standards listed in the IT RFP Template which must be included in all IT RFPs. |

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|REQUIREMENTS MATRIX |

|If applicable, this section should include a system requirements matrix. |

|The matrix can be prepared as an Excel spreadsheet or in a table format. |

|There is a sample in the RFP of the type of conditions/descriptions to be met. |

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|SCOPE OF WORK AND DELIVERABLES |

|The project should be broken down into the following: Tasks (with a defined Objective), |

|Activities (to meet the objective) and Deliverables (tied to each of the activities) |

|The first task should always be Planning and Administration and the balance of tasks in the Scope of Work Section |

|should mirror the format of the Planning and Administration Section. |

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|FINANCIAL STABILITY |

|Please check what information you would like the evaluation committee |

|to use when evaluating each vendor’s financial stability. |

|Profit and Loss Statements and Balance Statements? |Yes: | |No: | |

|Please provide information as to who will be reviewing financial statements on behalf of the |Name: | |

|evaluation committee for the committee’s final determination of financial stability for each | | |

|vendor. | | |

| |Title: | |

| |Phone: | |

| |Email: | |

|Dun and Bradstreet Report on successful vendor only? |Yes: | |No: | |

|BUSINESS REFERENCES |

|Review the questions in the Business Reference Section and modify as applicable. |

|How many business references would you like? Three (3) minimum. | |

|How many years of experience do you want them to reference? | |

|Review the reference questionnaire embedded here and provide any additional information, comments |

|or specific questions that should be included in the questionnaire. |

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|VENDOR STAFF SKILLS AND EXPERIENCE REQUIRED |

|Vendors must include resumes for key personnel to be responsible |

|for performance of any contract resulting from the RFP. |

|Review the qualifications as identified in this section of the IT RFP Template and provide modifications as applicable. |

|Project Manager? |Yes: | |No: | |

|Qualifications for Project Manager: |

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|Technical Lead? |Yes: | |No: | |

|Qualifications for Technical Lead: |

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|Implementation Lead? |Yes: | |No: | |

|Qualifications for Implementation Lead: |

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|Individual Team Members? |Yes: | |No: | |

|Qualifications for Individual Team Members: |

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|Other types of vendor resources? |Yes: | |No: | |

|If yes, identify the resource and qualification requirements: |

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|VENDOR STAFF RESUMES |

|Review the vendor staff resume format and provide any additions and/or deletions as applicable. |

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|IT PROCESS SECTIONS |

|The following sections are part of the Capability Maturity Model (CMM) process for IT projects. |

|Review the sections in the IT RFP Template and determine which sections are applicable for |

|the type of IT project identified in the RFP. |

|Project Management? |Yes: | |No: | |

|Quality Assurance? |Yes: | |No: | |

|Metrics Management? |Yes: | |No: | |

|Design and Development Processes? |Yes: | |No: | |

|Configuration Management? |Yes: | |No: | |

|Peer Review Management? |Yes: | |No: | |

|COST SCHEDULE |

|How do you want the vendor to submit their proposed cost/pricing? |

|There is an Excel spreadsheet embedded below that allows vendors to submit cost/pricing in the |

|same format in order to facilitate a good cost comparison. |

|The schedule should be modified once all of the tasks and deliverables have been determined in the scope of work section. |

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|Review the embedded cost schedule and provide any additional information, comments |

|or specific schedules that should be included. |

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|Do you require the following schedules to be included? |

|Development and Data Conversion Environments? |Yes: | |No: | |

|Integration, System Test and UAT Environments? |Yes: | |No: | |

|Training Environment? |Yes: | |No: | |

|Production Environment? |Yes: | |No: | |

|Other Associated Costs? |Yes: | |No: | |

|Rate Schedule – Change Orders? |Yes: | |No: | |

|Annual Product Licensing and Maintenance Schedule? |Yes: | |No: | |

|FINANCIAL – HOLD BACKS |

|Do you want hold backs? |Yes: | |No: | |

|If so, what percentage? | |

|WRITTEN QUESTIONS AND ANSWERS |

|Do you want to allow for more than one (1) question and answer period? Note: More than one (1) question |Yes: | |No: | |

|and answer period will add additional time to the RFP process. | | | | |

|REFERENCE LIBRARY |

|Will there be a reference library? |Yes: | |No: | |

|If so, identify what will be included in the reference library: |

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|How will vendors access the reference library? | |

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|TERMS AND CONDITIONS - CONTRACT |

|Review the terms and conditions and identify by section number any that may not apply to the project/scope of work. |

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|TERMS AND CONDITIONS - PROJECT |

|Review the terms and conditions and identify by section number any that may not apply to the project/scope of work. |

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|AGENCY SPECIFIC TERMS AND CONDITIONS |

|Are there any agency specific terms and conditions that need to be included in the RFP? If so, please provide them here. |

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|GENERAL INFORMATION/COMMENTS |

|Provide any additional information/comments that should be included in the RFP. |

|Reference applicable RFP section where information should be included. |

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|AGENCY ATTACHMENTS |

|Does your agency have any specific attachments that should be included within the RFP? |

|If so, please identify them below and attach them when submitting the RFP Development Form to Purchasing. |

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|RFP MAILING AND EVALUATION INFORMATION INSTRUCTIONS |

|Complete the following tables for mailing list development, evaluation committee member information and evaluation criteria and weights. |

|PROVIDE THE CODE CLASSIFICATIONS TO BE USED FOR DISTRIBUTION TO VENDORS |

|The Service Code Classifications can be found by opening the following document: |

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|Company Name |Contact Name |Email Address |Fax Number |

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|EVALUATION COMMITTEE |

|Provide name and title, agency name and mailing address, phone number and email address |

|Per NAC 333.162 – Each committee to evaluate proposals must contain members that represent at |

|least two (2) using agencies and the chief will not appoint a member to a committee to evaluate proposals |

|who possesses direct supervisory authority over a majority of the other members of the committee. Additionally, one member of the committee must be a |

|representative from outside of the Department of the using agencies. |

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|Note: Agency must provide a letter from their Administrator or Director approving the evaluation committee |

|Name and Title |Agency Mailing Address |Phone Number |Email Address |

| |(for mailing proposals) | | |

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|EVALUATION CRITERIA |

|Per NRS 333.335(3) - Proposals shall be consistently evaluated and scored based upon the following criteria. |

|If you want additional criteria enter it in the “Other” section. |

|Criteria |Weight |

|Demonstrated Competence | |

|Experience in performance of comparable engagements | |

|Conformance with the terms of this RFP | |

|Expertise and availability of key personnel | |

|Cost | |

|Other: | |

|VENDOR PRESENTATIONS |

|Note: Vendor presentations will add additional time to the RFP process. |

|Do you want vendor presentations? |Yes: | |No: | |

|If so, up to how many vendors? | |

|VENDOR PRESENTATIONS EVALUATION CRITERIA |

|Vendor presentations may be scored based on the original evaluation criteria |

|or new evaluation criteria and weights may be assigned. |

|Criteria |Weight |

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