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RFP #16-1170-3CS

May 6, 2016

REQUEST FOR PROPOSAL (RFP)

GROUP VOLUNTARY SHORT-TERM DISABILITY PLAN AND

GROUP BASIC LONG-TERM DISABILITY PLAN WITH VOLUNTARY BUY-UP OPTION

COUNTY OF HENRICO GOVERNMENT AND PUBLIC SCHOOLS

Your firm is invited to submit a proposal to provide a fully-insured, group, voluntary short-term disability plan and a fully-insured, long-term disability plan (basic non-contributory portion and a voluntary, buy-up option), in accordance with the enclosed specifications. The submittal consisting of the original proposal and seven (7) additional copies and one (1) electronic version marked, "A Proposal for Group Voluntary Short-term Disability Insurance and Group Long-Term Disability Insurance” will be received no later than 2:30 p.m., June 1, 2016, by:

IN PERSON OR SPECIAL COURIER U.S. POSTAL SERVICE

County of Henrico County of Henrico

Department of Finance Department of Finance

Purchasing Division OR Purchasing Division

8600 Staples Mill Road ( NEW ADDRESS P.O. Box 90775

Henrico, Virginia 23228 Henrico, Virginia 23273-0775

This RFP and any addenda are available on the County of Henrico Purchasing website at To receive an email copy of this document, please send a request to: sto05@henrico.us

Time is of the essence and any proposal received after 2:30 p.m., June 1, 2016, whether by mail or otherwise, will be returned unopened. The time of receipt shall be determined by the time clock stamp in Purchasing Office, Department of General Services. Proposals shall be placed in a sealed, opaque envelope, marked in the lower left-hand corner with the RFP number, title, and date and hour proposals are scheduled to be received. Offeror is responsible for insuring that its proposal is stamped by Purchasing Office personnel by the deadline indicated.

Nothing herein is intended to exclude any responsible firm or in any way restrain or restrict competition. On the contrary, all responsible firms are encouraged to submit proposals. The County of Henrico reserves the right to accept or reject any or all proposals submitted.

The awarding authority for this contract is the Henrico County Board of Supervisors.

Questions concerning the procurement process should be directed to Cecelia Stowe, Purchasing Director for the County of Henrico, at sto05@co.henrico.va.us. Questions of a substantive nature concerning the RFP should be put in writing and emailed to Debbie Foster at Wells Fargo Insurance Services (Deborah.Foster1@). Material questions will be answered in writing and will be distributed to all firms that receive the RFP. However, all questions must be submitted no later than 5:00 p.m., May 18, 2016. To request an electronic copy of the RFP and Attachments I-O, please contact Debbie Foster at Deborah.Foster1@.

If it becomes necessary to revise any part of this request or if additional data are necessary to enable an exact interpretation of provisions of this request, an addendum will be issued. Offerors will be required to acknowledge receipt of all addenda, but it is the responsibility of each offeror to ensure that it has received all addenda prior to submitting a proposal.

Sincerely,

Cecelia H. Stowe, CPPO, C.P.M.

Purchasing Director

Sto05@henrico.us

804-501-5685

TABLE OF CONTENTS

SECTIONS:

I. PURPOSE 1

II. BACKGROUND 1

III. OBJECTIVES 3

IV. SCOPE OF SERVICES 3

V. ANTICIPATED SCHEDULE 8

VI. COUNTY RESPONSIBILITIES 8

VII. GENERAL CONTRACT TERMS AND CONDITIONS 8

VIII. PROPOSAL SUBMISSION REQUIREMENTS 18

IX. PROPOSAL RESPONSE FORMAT 20

X. PROPOSAL EVALUATION/SELECTION PROCESS 22

ATTACHMENTS:

ATTACHMENT A: PROPOSAL SIGNATURE SHEET 24

ATTACHMENT B: INSURANCE SPECIFICATIONS 26

ATTACHMENT C: QUESTIONNAIRE 27

ATTACHMENT D: NOTICE OF PROPRIETARY INFORMATION 34

ATTACHMENT E: PERFORMANCE GUARANTEES 35

ATTACHMENT F: CURRENT LEAVE POLICIES 38

ATTACHMENT G: RATE HISTORY 41

ATTACHMENT H: VA STATE CORPORATION COMMISSION IDENTIFICATION 42

ATTACHMENT I: CLAIMS EXPERIENCE Separate Excel File and PDF

ATTACHMENT J: STD PROGRAM BROCHURE Separate PDF

ATTACHMENT K: CURRENT STD PROGRAM BENEFITS SUMMARY Separate PDF

ATTACHMENT L: LTD PROGRAM BROCHURE Separate PDF

ATTACHMENT M: LTD PLAN DOCUMENT Separate PDF

ATTACHMENT N: INCOME PROTECTION PROGRAM FACTS SHEET Separate PDF

ATTACHMENT O: CENSUS Separate Excel File

I. PURPOSE

It is the intent of this Request for Proposal (RFP) to solicit proposals from qualified offerors to provide a group, fully-insured, voluntary short-term disability plan and a group, fully-insured, non-contributory, long-term disability plan for eligible employees of the County of Henrico and Henrico County Public Schools. It is the County’s intent to award to a single offeror that can provide both short and long term fully insured plans. As used in this RFP, the terms “County of Henrico” and “County” refer to both Henrico County General Government and Henrico County Public Schools.

Please note that proposals are to be net of broker commissions (no broker commissions included in rates).

Nothing herein is intended to exclude any reasonable firm or in any way restrain or restrict competition. On the contrary, all responsible firms are encouraged to submit proposals. The County reserves the right to accept or reject any or all proposals submitted.

BACKGROUND

Henrico’s Income Protection Program (STD and LTD Benefits)

Since 1985, the County has provided an income protection program to eligible employees. The program has consisted of (1) a self-administered paid leave plan; (2) a fully-insured voluntary, short-term disability (STD) plan; and (3) a self-administered, self-insured, long-term disability (LTD) plan. These plans are not subject to ERISA.

Until January 1, 2014, the County offered the same STD and LTD plans to all County employees. However, on that date, state law created the Hybrid Retirement Plan (Hybrid Plan) of the Virginia Retirement System (VRS) to cover (1) employees hired on or after January 1, 2014, and (2) employees who were rehired by the County on or after January 1, 2014, and who had prior service in VRS that was refunded after the employee left employment with the County or other VRS employer. Sworn public safety officers (police, fire and sheriff) are not eligible to participate in the VRS Hybrid Plan or the County Hybrid Disability Program.

In addition to the new retirement plan, state law also created a state disability income program for Hybrid Plan employees beginning January 1, 2014. However, it permitted localities to provide their own local disability programs, and the County elected to provide a County Hybrid Disability Program for Hybrid Plan employees who have been employed for at least one year. The County’s program began January 1, 2014.

This RFP seeks proposals for STD and LTD plans for full time County employees who are not covered by the VRS Hybrid Plan and the County’s Hybrid Disability Program. The proposal for STD plan coverage should include VRS Hybrid Plan members during their first year of employment who are not eligible for coverage under the County’s Hybrid Disability Program and permanent part-time employees who work 20 hours or more per week. The RFP does not seek proposals for employees covered by the County’s Hybrid Disability Program.

Current Voluntary STD Plan – The voluntary STD plan is offered to all permanent County employees who work 20 hours or more per week and who (1) are not covered by the Hybrid Plan or (2) have been covered by the Hybrid Plan for less than one year. The STD plan is fully-insured through Aetna and details are included in Attachments J and K. Approximately 5,400 full-time and permanent part-time employees currently purchase voluntary, STD coverage. The current STD plan design (with three waiting period options) has been in place since January 1, 2001.

Current Self-Insured LTD Plan - The County also provides a self-insured and self-administered LTD program. The program consists of: (1) a Basic LTD plan that is automatically provided without cost to all full-time County employees after six months of full-time employment and (2) a Supplemental LTD plan for full-time employees who earn $50,000 or more per year who wish to purchase LTD coverage for the portion of their earnings which exceeds $50,000. Employees covered by the Hybrid Plan are not eligible for coverage under either the Basic or the Supplemental LTD plan. Details about the current LTD program are included in Attachments L and M. Approximately 10,500 full-time employees receive Basic LTD plan coverage. Only 123 (less than 1%) employees with earnings over $50,000/year currently purchase Supplemental LTD plan coverage.

A summary of the County’s sick and annual leave programs is included in Attachment F.

The following table, provided for informational purposes, shows the number of employees hired for the three-year period since the VRS Hybrid Plan was implemented, broken down by participation in each plan by year. This shows the number of employees hired each year, how many have been eligible to participate in the County’s STD plan for the first year of service, and how many have been eligible to participate in the Basic LTD plan.

|Breakdown of New Hires by Year |

|VRS Plan |2014 |2015 |2016 |Total |

|VRS Hybrid Plan |401 |485 |104 |990 |

|VRS Plans 1 & 2 (Hazardous Duty) |72 |160 |8 |240 |

|VRS Plans 1 & 2 (Non-Hazardous Duty) |274 |275 |72 |621 |

| Total |747 |920 |184 |1851 |

II. OBJECTIVES

The primary objectives of the County’s disability plans are to:

1. provide eligible employees with adequate income protection when they experience covered disabilities;

2. ensure disability claims are managed effectively and efficiently;

3. provide a STD program that allows employees to choose among various benefit waiting period options;

5. provide a LTD program that provides basic disability coverage and include the option to purchase additional LTD coverage;

6. provide benefit incentives to encourage employees to return to work at the most appropriate time;

7. responsibly manage taxpayer dollars.

Offerors are encouraged to provide additional options to achieve these objectives.

SCOPE OF SERVICES

A. Minimum Services to Be Performed by the Offeror

This section establishes minimum services and specific conditions the Offeror must meet to fulfill the objectives of this RFP. The Offeror must outline in writing how it will meet these minimum services and specific conditions in Tab 2 of its proposal as instructed in Section IX of this RFP.

Offerors are encouraged to provide additional services which will enhance their ability to meet the County’s objectives.

The following items are the required minimum services to be performed by the Offeror:

1. Provide or make available appropriate, high quality disability coverage to each eligible employee.

2. Provide high quality, efficient program administration and services, including:

a) Maintaining payment records,

b) Providing state-of-the-art data tracking and claims payment services,

c) Providing plan utilization/claims/premium data to the County for General Government and Schools on a quarterly basis,

d) Maintaining separate accounts or sub-groups as required by the County for General Government and Schools.

3. Provide administrative support services that simplify the work input and administrative time of County benefit personnel.

4. Maintain a local or toll-free customer service number for covered employees and benefits staff. The County’s STD plan has telephonic claim submission and its LTD plan has paper claim forms.

5. Meet with County staff within 15 days of contract award date to review the STD and LTD plans, to present proposed employee communication materials, and to jointly establish a preliminary implementation plan, open enrollment program, and schedule.

6. Provide the County with PDFs of employee communications and benefit booklets/plan documents for employees. The initial drafts of these documents must be provided to the County not later than September 1, 2016. The County must review and approve the PDFs prior to finalization.

7. For the Open Enrollment period, provide PDFs of communication materials for the STD and LTD plans. Furnish these materials in hard copy for open enrollment meetings and for new hires.

8. Provide with the proposal any contractual documents for consideration by the County. The County requires a fully executed contract prior to the effective date of coverage.

9. Provide a detailed renewal underwriting analysis, including renewal rates, each July 1 (or earlier if requested by the County) for the upcoming January 1 renewal.

10. Designate a single point of contact responsible for resolving problems, answering claims questions and administrative or billing issues, and expediting services related to the overall performance of the contract.

11. Provide a dedicated customer service unit to the County.

12. Provide an organizational chart and list of contacts in relevant functional areas (with phone numbers, email addresses, department, and titles) and provide updates as they occur.

13. The Offeror shall be an insurance carrier licensed to do business in the Commonwealth of Virginia.

14. Agree to a contract for the entire term of the contract which can only be terminated by the Successful Offeror for the County’s non-payment of premiums after 60 days written notice.

B. Additional Specific Conditions

No loss no gain provision: No employee currently covered by the County’s disability program may suffer a loss of coverage solely as a result of changing insurance carriers. Employees currently covered by the County’s disability plans who will be eligible for coverage effective January 1, 2017, must receive credit under the new contract for any pre-existing condition limits which have been met under the current plans.

C. Plan Specifications

1. Current Plan Design

a. Short-term Disability Plan: The plan pays 60% of gross average weekly salary up to a weekly maximum benefit of $2,500. The minimum weekly benefit is $25. The pre-existing conditions limit is 3/6/12. The plan includes three elimination period options for employees to choose from:

Option 1: 14-day Elimination Period - Benefits begin the 15th calendar day of an illness or injury

Option 2: 28-day Elimination Period - Benefits begin the 29th calendar day of an illness or injury

Option 3: 42-day Elimination Period – Benefits begin the 43rd calendar day of an illness or injury

Based on the Elimination Period option chosen, the Benefit Periods are: Option 1: Benefits are payable for 11 weeks

Option 2: Benefits are payable for 9 weeks

Option 3: Benefits are payable for 7 weeks

A history of the STD fully-insured premium rates has been provided as Attachment G. Commissions are not included in these rates.

b. Long-term Disability Plan: There is a 90-day elimination period. The pre-existing condition limit is defined with the LTD Plan Document (Attachment M). The Basic plan pays 60% of monthly earnings up to $4,166.67 (i.e., a maximum benefit of $2,500 per month). There is no cost to employees for the Basic plan. If the employee wishes to purchase supplemental LTD coverage (a buy-up plan), the Supplemental LTD benefit covers 60% of monthly earnings above $50,000/year. The County charges employees enrolled in the Supplemental plan $.50 per $100 of their salary over $50,000/year.

Please refer to Attachments J through N for details of current STD and LTD plans.

2. Current Plan Eligibility:

a. STD: Employees classified as permanent full-time who are members of VRS Plan 1 and Plan 2 or as permanent part-time who work a minimum of 20 hours per week are eligible to enroll in the STD plan. In addition, VRS Hybrid Plan employees are eligible to participate in the STD plan for the first year of employment. For new hires electing coverage, coverage will begin the first of the month following hire. Refer to evidence of insurability rules below to see the rules for application after initial eligibility. Eligible employees of Schools include those scheduled to work 10 months, 11 months, and 12 months during the year.

b. LTD: Employees classified as permanent full-time and who are members of VRS Plan 1 and Plan 2 are automatically enrolled in the Basic LTD plan. VRS Hybrid Plan employees are not eligible to participate in the LTD plan. Eligible full-time employees who earn more than $50,000 annually may enroll in the Supplemental LTD plan at any time. Refer to evidence of insurability rules below to see the rules for application after initial eligibility. Eligible employees of Schools include those scheduled to work 10 months, 11 months, and 12 months during the year.

3. Evidence of Insurability Requirements:

a. STD Plan: Employees who enroll as new hires do not have to provide medical evidence of insurability and can choose any of the three benefit waiting period options—14-day, 28-day, or 42-day. VRS Hybrid Plan employees may enroll for coverage during their first year of employment and may not change their initial election. VRS Plan 1 and Plan 2 employees and part-time employees who do not enroll when initially eligible are only allowed to enroll during the annual Open Enrollment period and can only select the 42-day waiting period option without providing evidence of insurability —all other options require evidence of insurability. Enrolled employees may decrease their benefit waiting periods by one level (e.g., 42 days to 28 days or 28 days to 14 days) during future annual Open Enrollment periods without providing evidence of insurability. Changes to benefit waiting periods are only allowed during Open Enrollment.

b. LTD Plan: Employees may elect the Supplemental LTD coverage at any time. Employees who elect to purchase Supplemental LTD coverage within 31 days of completing six months of full-time service do not have to provide medical evidence of insurability. Employees who choose to purchase Supplemental LTD coverage more than 31 days following initial eligibility have to provide evidence of insurability.

4. Use of Sick Leave and Annual Leave with STD Plan: Employees must be placed on Leave Without Pay (LWOP) in order to receive a STD benefit. They do not accrue sick or annual leave while on LWOP. Employees cannot receive paid leave and STD benefits at the same time. The STD plan is designed for employees to use accrued leave during their benefit waiting periods; however, employees are not required to exhaust their sick and annual leave balances to receive STD benefits. Employees may choose how they want to use their paid leave balances beyond the benefit waiting period. They may “freeze” some (or all) of their leave balances or use them completely while out of work.

5. Offset for Benefits from VRS:

Employees in “VRS-covered positions” may receive disability retirement benefits from VRS Plans 1 and 2, if they qualify. Any retirement benefits that employees receive from VRS are deducted from both STD and LTD disability benefits as an offset. All permanent full-time County employees are in VRS-covered positions. Permanent part-time employees are not in VRS-covered positions. Permanent full-time and part-time employees have been identified in Attachment O of this RFP.

6. Requested Plans:

a. STD Plan: Offerors are requested to submit proposals to provide the equivalent of the current, 100% employee-paid STD plan on a fully-insured basis.

b. LTD Plan: Offerors are requested to submit proposals to provide a group LTD program on a fully-insured basis. The base, employer-paid plan should pay 60% of base monthly earnings up to $4,166.67 (i.e., a maximum benefit of $2,500 per month).

The base plan should have a 90-day elimination period and a 3/12 pre-existing conditions limitation. In addition, the Offeror should provide an employee-paid, fully-insured supplemental plan to pay 60% of earnings above the monthly limit in the base plan of $4,166.67 (annual salary of $50,000).

c. The offeror that is selected to underwrite the proposed LTD plans will not be expected to assume the risk for any LTD claims incurred prior to January 1, 2017 (the effective date of the new LTD contract). This includes all LTD claims which are open as of January 1, 2017, or claims for employees who are in process of fulfilling the current LTD plan elimination period who do not return to work prior to or on January 1, 2017. The County will continue to self-fund all LTD claims incurred prior to January 1, 2017. Employees who are out of work due to sickness, injury, or disability will be required to return to work for one full day before they may be covered under the new LTD plan effective January 1, 2017.

A description of the plans quoted must be provided in Tab 2 of your proposal as instructed in Section IX of this RFP. A summary of deviations from the RFP specifications must be provided in the appropriate tab of your proposal as instructed in Section IX of this RFP.

ANTICIPATED SCHEDULE

The following represents a tentative outline of the process currently anticipated by the County:

← Request for Proposal Distributed May 6, 2016

← Deadline for Questions May 18, 2016, 5:00 p.m.

← Receive Written Proposals June 1, 2016, 2:30 p.m.

← Conduct Oral Interviews with Finalists June 23, 2016

← Negotiations July, 2016

← Contract Award by Board of Supervisors Aug./Sept. 2016

← Implementation August – October, 2016

← Effective Date of Contract January 1, 2017

COUNTY RESPONSIBILITIES

Henrico County will designate an individual to act as the primary point of contact for all work performed under this contract. The primary point of contact shall coordinate the work, and shall have the authority to make decisions in writing on matters within the scope of the contract.

VII. GENERAL CONTRACT TERMS AND CONDITIONS:

A. Annual Appropriations

It is understood and agreed that the contract resulting from this procurement (“Contract”) shall be subject to annual appropriations by the County of Henrico, Board of Supervisors. Should the Board fail to appropriate funds for this Contract, the Contract shall be terminated when existing funds are exhausted. The Successful Offeror (“Successful Offeror” or “contractor”) shall not be entitled to seek redress from the County or its elected officials, officers, agents, employees, or volunteers should the Board of Supervisors fail to make annual appropriations for the Contract.

B. Award of the Contract

1. The County reserves the right to reject any or all proposals and to waive any informalities.

2. The Successful Offeror shall, within fifteen (15) calendar days after Contract documents are presented for signature, execute and deliver to the Purchasing office the Contract documents and any other forms or bonds required by the RFP.

2. The Contract resulting from this RFP is not assignable.

3. Notice of award or intent to award may also appear on the Purchasing Office website:

C. Collusion

By submitting a proposal in response to this Request for Proposal, the Offeror represents that in the preparation and submission of this proposal, said Offeror did not, either directly or indirectly, enter into any combination or arrangement with any person, Offeror or corporation or enter into any agreement, participate in any collusion, or otherwise take any action in the restraint of free, competitive bidding in violation of the Sherman Act (15 U.S.C. § 1 et seq.) or Section 59.1-9.1 through 59.1-9.17 or Sections 59.1-68.6 through 59.1-68.8 of the Code of Virginia.

D. Compensation

The Successful Offeror shall submit a complete itemized invoice on each delivery or service that is performed under the Contract. Payment shall be rendered to the Successful Offeror for satisfactory compliance with the Contract within forty-five (45) days after receipt of a proper invoice.

E. Controlling Law and Venue

The Contract will be made, entered into, and shall be performed in the County of Henrico, Virginia, and shall be governed by the applicable laws of the Commonwealth of Virginia without regard to its conflicts of law principles. Any dispute arising out of the Contract, its interpretations, or its performance shall be litigated only in the Henrico County General District Court or the Circuit Court of the County of Henrico, Virginia.

F. Default

1. If the Successful Offeror is wholly responsible for a failure to perform the Contract (including, but not limited to, failure to make delivery of goods, failure to complete implementation and installation, and/or if the goods and/or services fail in any way to perform as specified herein), the County may consider the Successful Offeror to be in default. In the event of default, the County will provide the Successful Offeror with written notice of default, and the Successful Offeror shall provide a plan to correct said default within 20 calendar days of the County’s notice of default.

2. If the Successful Offeror fails to cure said default within 20 days, the County, among other actions, may complete the Contract work through a third party, and the Successful Offeror shall be responsible for any amount in excess of the Contract price incurred by the County in completing the work to a capability equal to that specified in the Contract.

G. Discussion of Exceptions to the RFP

This RFP, including but not limited to its venue, termination, and payment schedule provisions, shall be incorporated by reference into the Contract documents as if its provisions were stated verbatim therein. Therefore, Offerors shall explicitly identify any exception to any provisions of the RFP in a separate “Exceptions to RFP” section of the proposal so that such exceptions may be resolved before execution of the Contract. In case of any conflict between the RFP and any other Contract documents, the RFP shall control unless the Contract documents explicitly provide otherwise.

H. Drug-Free Workplace to be Maintained by the Contractor (Va. Code § 2.2-4312)

1. During the performance of this Contract, the contractor agrees to (i) provide a drug-free workplace for the contractor’s employees; (ii) post in conspicuous places, available to employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the contractor’s workplace and specifying the actions that will be taken against employees for violations of such prohibition; (iii) state in all solicitations or advertisements for employees placed by or on behalf of the contractor that the contractor maintains a drug-free workplace; and (iv) include the provisions of the foregoing clauses in every subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor.

2. For the purposes of this section, “drug-free workplace” means a site for the performance of work done in connection with a specific contract awarded to a contractor in accordance with the Virginia Public Procurement Act, the employees of whom are prohibited from engaging in the unlawful manufacture, sale, distribution, dispensation, possession or use of any controlled substance or marijuana during the performance of the contract.

I. Employment Discrimination by Contractor Prohibited

1. During the performance of this Contract, the contractor agrees as follows (Va. Code § 2.2-4311):

(a) The contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, disability, or other basis prohibited by state law relating to discrimination in employment, except where there 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 the foregoing subparagraphs (a), (b), and (c) in every subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor.

J. Employment of Unauthorized Aliens Prohibited

Any contract that results from this Request for Proposal shall include the following language: "As required by Virginia Code §2.2-4311.1, the contactor does not, and shall not during the performance of this agreement, in the Commonwealth of Virginia knowingly employ an unauthorized alien as defined in the Federal Immigration Reform and Control Act of 1986."

K. Indemnification

The Successful Offeror agrees to indemnify, defend and hold harmless the County of Henrico (including Henrico County Public Schools), the County’s officers, agents and employees, from any claims, damages, suits, actions, liabilities and costs of any kind or nature, including attorneys’ fees, arising from or caused by the provision of any services, the failure to provide any services or the use of any services or materials furnished (or made available) by the Successful Offeror, provided that such liability is not attributable to the County’s sole negligence.

L. Insurance Requirements

The Successful Offeror shall maintain insurance to protect itself and Henrico and Henrico’s elected officials, officers, agents, volunteers and employees from claims under the Workers' Compensation Act, and from any other claim for damages for personal injury, including death, and for damages to property which may arise from the provision of goods and/or services under the Contract, whether such goods and/or services are provided by the Successful Offeror or by any subcontractor or anyone directly employed by either of them. Such insurance shall conform to the Insurance Specifications. (Attachment B).

M. No Discrimination against Faith-Based Organizations

The County does not discriminate against faith-based organizations as that term is defined in Va. Code § 2.2-4343.1.

N. Offeror's Performance

1. The Successful Offeror agrees and covenants that its agents and employees shall comply with all County, State and Federal laws, rules and regulations applicable to the business to be conducted under the Contract.

2. The Successful Offeror shall ensure that its employees shall observe and exercise all necessary caution and discretion so as to avoid injury to person or damage to property of any and all kinds.

3. The Successful Offeror shall cooperate with Henrico officials in performing the Contract work so that interference with normal operations will be held to a minimum.

4. The Successful Offeror shall be an independent contractor and shall not be an employee of the County.

O. Ownership of Deliverable and Related Products

1. The County shall have all rights, title, and interest in or to all specified or unspecified interim and final products, work plans, project reports and/or presentations, data, documentation, computer programs and/or applications, and documentation developed or generated during the completion of this project, including, without limitation, unlimited rights to use, duplicate, modify, or disclose any part thereof, in any manner and for any purpose, and the right to permit or prohibit any other person, including the Successful Offeror, from doing so. To the extent that the Successful Offeror may be deemed at any time to have any of the foregoing rights, the Successful Offeror agrees to irrevocably assign and does hereby irrevocably assign such rights to the County.

2. The Successful Offeror is expressly prohibited from receiving additional payments or profit from the items referred to in this paragraph, other than that which is provided for in the general terms and conditions of the Contract.

3. This shall not preclude Offerors from submitting proposals, which may include innovative ownership approaches, in the best interest of the County.

P. Record Retention and Audits

1. The Successful Offeror shall retain, during the performance of the Contract and for a period of five years from the completion of the Contract, all records pertaining to the Successful Offeror’s proposal and any Contract awarded pursuant to this Request for Proposal. Such records shall include but not be limited to all paid vouchers including those for out-of-pocket expenses; other reimbursement supported by invoices, including the Successful Offeror’s copies of periodic estimates for partial payment; ledgers, cancelled checks; deposit slips; bank statements; journals; Contract amendments and change orders; insurance documents; payroll documents; timesheets; memoranda; and correspondence. Such records shall be available to the County on demand and without advance notice during the Successful Offeror’s normal working hours.

2. County personnel may perform in-progress and post-audits of the Successful Offeror’s records as a result of a Contract awarded pursuant to this Request for Proposals. Files would be available on demand and without notice during normal working hours.

Q. Severability

Each paragraph and provision of the Contract is severable from the entire agreement and if any provision is declared invalid the remaining provisions shall nevertheless remain in effect.

R. Small, Women-Owned and Minority-Owned (SWAM) Businesses

The County welcomes and encourages the participation of small businesses and businesses owned by women and minorities in procurement transactions made by the County. The County actively solicits both small business, women-owned and minority (SWAM) businesses to respond to all Invitations for Bids and Requests for Proposals.

All solicitations are posted on the County’s Internet site.



S. Subcontracts

1. No portion of the work shall be subcontracted without prior written consent of the County.  In the event that the Successful Offeror desires to subcontract some part of the work specified in the Contract, the Successful Offeror shall furnish the County the names, qualifications, and experience of the proposed subcontractors.  The Successful Offeror shall, however, remain fully liable and responsible for the work to be done by his/her subcontractor(s) and shall assure compliance with all the requirements of the Contract.

2.  The County encourages the contractor to utilize small, women-owned, and minority-owned business enterprises.  For assistance in finding subcontractors, contact the Supplier Relations Manager (804-501-5689) or the Virginia Department of Small Business & Supplier Diversity (SBSD)  sbsd..

T. Taxes

1. The Successful Offeror shall pay all county, city, state and federal taxes required by law and resulting from the work or traceable thereto, under whatever name levied. Said taxes shall not be in addition to the Contract price between Henrico and the Successful Offeror, as the taxes shall be solely an obligation of the Successful Offeror and not of Henrico, and Henrico shall be held harmless for same by the Successful Offeror.

2. Henrico is exempt from the payment of federal excise taxes and the payment of State Sales and Use Tax on all tangible, personal property for its use or consumption. Tax exemption certificates will be furnished upon request.

U. Termination of Contract

1. The County reserves the right to terminate the Contract immediately in the event that the Successful Offeror discontinues or abandons operations; is adjudged bankrupt, or is reorganized under any bankruptcy law; or fails to keep in force any required insurance policies or bonds.

2. Failure of the Successful Offeror to comply with any section or part of the Contract will be considered grounds for immediate termination of the Contract by the County.

3. Notwithstanding anything to the contrary contained in the Contract between the County and the Successful Offeror, the County may, without prejudice to any other rights it may have, terminate the Contract for convenience and without cause, by giving 30 days’ written notice to the Successful Offeror.

4. If the County terminates the Contract, the Successful Offeror will be paid by the County for all scheduled work completed satisfactorily by the Successful Offeror up to the termination date.

V. County License Requirement

If a business is located in Henrico County, it is unlawful to conduct or engage in that business without obtaining a business license. If your business is located in the County, include a copy of your current business license with your proposal submission. If your business is not located in the County, include a copy of your current business license with your proposal submission. If you have any questions, contact the Business Section, Department of Finance, County of Henrico, telephone (804) 501-4310.

W. Environmental Management

The Successful Offeror shall comply with all applicable federal, state, and local environmental regulations.  The Successful Offeror is required to abide by the County’s Environmental Policy Statement:

which emphasizes environmental compliance, pollution prevention, continual improvement, and conservation.  The Successful Offeror shall be properly trained and have any necessary certifications to carry out environmental responsibilities. The Successful Offeror shall immediately communicate any environmental concerns or incidents to the appropriate County staff.

X. Safety

1. The Successful Offeror shall comply with and ensure that the Successful Offeror’s personnel comply with all current applicable local, state and federal policies, regulations and standards relating to safety and health, including, by way of illustration and not limitation, the standards of the Virginia Occupational Safety and Health Administration for the industry. The provisions of all rules and regulations governing safety as adopted by the Safety and Health Codes Board of the Commonwealth of Virginia and issued by the Department of Labor and Industry under Title 40.1 of the Code of Virginia shall apply to all work under the Contract.

The Successful Offeror shall provide or cause to be provided all technical expertise, qualified personnel, equipment, tools and material to safely accomplish the work specified and performed by the Successful Offeror.

2. Each job site shall have a supervisor who is competent, qualified, or authorized on the worksite, who is familiar with policies, regulations and standards applicable to the work being performed. The supervisor must be capable of identifying existing and predictable hazards in the surroundings or working conditions which are hazardous or dangerous to employees or the public, and is capable of ensuring that applicable safety regulations are complied with, and shall have the authority and responsibility to take prompt corrective measures, which may include removal of the Successful Offeror’s personnel from the work site.

3. In the event the County determines any operations of the Successful Offeror to be hazardous, the Successful Offeror shall immediately discontinue such operations upon receipt of either written or oral notice by the County to discontinue such practice.

Y. Authorization to Transact Business in the Commonwealth

1. A contractor organized as a stock or nonstock corporation, limited liability company, business trust, or limited partnership or registered as a registered limited liability partnership or other business form shall be authorized to transact business in the Commonwealth as a domestic or foreign business entity if so required by Title 13.1 or Title 50 of the Code of Virginia or as otherwise required by law.

2. An Offeror organized or authorized to transact business in the Commonwealth pursuant to Title 13.1 or Title 50 of the Code of Virginia must include in its proposal the identification number issued to it by the State Corporation Commission. (Attachment H). Any Offeror that is not required to be authorized to transact business in the Commonwealth as a foreign business entity under Title 13.1 or Title 50 of the Code of Virginia or as otherwise required by law shall include in its proposal a statement describing why the Offeror is not required to be so authorized.

3. An Offeror described in subsection 2 that fails to provide the required information shall not receive an award unless a waiver is granted by the Purchasing Director, his designee, or the County Manager.

4. Any falsification or misrepresentation contained in the statement submitted by the Offeror pursuant to Title 13.1 or Title 50 of the Code of Virginia may be cause for debarment.

5. Any business entity described in subsection 1 that enters into a contract with a public body shall not allow its existence to lapse or allow its certificate of authority or registration to transact business in the Commonwealth if so required by Title 13.1 or Title 50 of the Code of Virginia to be revoked or cancelled at any time during the term of the contract.

Z. Payment Clauses Required by Va. Code § 2.2-4354

Pursuant to Virginia Code § 2.2-4354:

1. The Successful Offeror shall take one of the two following actions within seven days after receipt of amounts paid to the Successful Offeror by the County for all or portions of the goods and/or services provided by a subcontractor: (a) pay the subcontractor for the proportionate share of the total payment received from the County attributable to the work performed by the subcontractor under that contract; or (b) notify the County and subcontractor, in writing, of the Successful Offeror’s intention to withhold all or a part of the subcontractor's payment with the reason for nonpayment.

2. Pursuant to Virginia Code § 2.2-4354, the Successful Offeror that is a proprietor, partnership, or corporation shall provide its federal employer identification number to the County. Pursuant to Virginia Code § 2.2-4354, the Successful Offeror who is an individual contractor shall provide his/her social security numbers to the County.

3. The Successful Offeror shall pay interest to its subcontractors on all amounts owed by the Successful Offeror that remain unpaid after seven days following receipt by the Successful Offeror of payment from the County for all or portions of goods and/or services performed by the subcontractors, except for amounts withheld as allowed in Subparagraph 1. above.

4. Pursuant to Virginia Code § 2.2-4354, unless otherwise provided under the terms of the Contract interest shall accrue at the rate of one percent per month.

5. The Successful Offeror shall include in each of its subcontracts a provision requiring each subcontractor to include or otherwise be subject to the same payment and interest requirements with respect to each lower-tier subcontractor.

6. The Successful Offeror's obligation to pay an interest charge to a subcontractor pursuant to the payment clause in Virginia Code § 2.2-4354 shall not be construed to be an obligation of the County. A Contract modification shall not be made for the purpose of providing reimbursement for the interest charge. A cost reimbursement claim shall not include any amount for reimbursement for the interest charge.

AA. Contract period:

1. The contract period shall be from January 1, 2017 through December 31, 2018. Contract prices shall remain firm for the contract period.

2. The contract may be renewed for 3 additional one-year periods upon the sole discretion of the County at a price not to exceed 3% above the previous year's prices.

3. The resulting contract should require the Successful Offeror to give at least a ninety (90) day written notice if they do not intend to renew the contract at any annual renewal.

4. The contract shall not exceed a maximum of five (5) years.

VIII. PROPOSAL SUBMISSION REQUIREMENTS:

A. The Purchasing Division will not accept oral proposals, nor proposals received by telephone, FAX machine, or other electronic means.

B. All erasures, interpolations, and other changes in the proposal shall be signed or initialed by the Offeror.

C. The Proposal Signature Sheet (Attachment A) must accompany any proposal(s) submitted and be signed by an authorized representative of the Offeror. If the Offeror is a firm or corporation, the Offeror must print the name and title of the individual executing the proposal. All information requested should be submitted. Failure to submit all information requested may result in the Purchasing Division requiring prompt submission of missing information and/or giving a lowered evaluation of the proposal.

D. The proposal, the proposal security, if any, and any other documents required, shall be enclosed in a sealed opaque envelope. The envelope containing the proposal shall be sealed and marked in the lower left-hand corner with the number, title, hour, and due date of the proposal.

F. The time proposals are received shall be determined by the time clock stamp in the Purchasing Division. Offerors are responsible for insuring that their proposals are stamped by Purchasing Division personnel by the deadline indicated.

G. By submitting a proposal in response to this Request for Proposal, the Offeror represents it has read and understand the Scope of Services and has familiarized itself with all federal, state, and local laws, ordinances, and rules and regulations that in any manner may affect the cost, progress, or performance of the Contract work.

H. The failure or omission of any Offeror to receive or examine any form, instrument, addendum, or other documents or to acquaint itself with conditions existing at the site, shall in no way relieve any Offeror from any obligations with respect to its proposal or to the Contract.

I. Trade secrets or proprietary information submitted by an Offeror in response to this Request for Proposal shall not be subject to public disclosure under the Virginia Freedom of Information Act; however, the Offeror must invoke the protection of this section prior to or upon submission of data or materials, and must identify the data or other materials to be protected and state the reasons why protection is necessary (Va. Code § 2.2-4342.F). (Attachment D)

J. A proposal may be modified or withdrawn by the Offeror any time prior to the time and date set for the receipt of proposals. The Offeror shall notify the Purchasing Division in writing of its intentions.

1. If a change in the proposal is requested, the modification must be so worded by the Offeror as to not reveal the original amount of the proposal.

2. Modified and withdrawn proposals may be resubmitted to the Purchasing Division up to the time and date set for the receipt of proposals.

3. No proposal can be withdrawn after the time set for the receipt of proposals and for one-hundred twenty (120) days thereafter.

K. The County welcomes comments regarding how the proposal documents, scope of services, or drawings may be improved.  Offerors requesting clarification, interpretation of, or improvements to the proposal general terms, conditions, scope of services or drawings shall submit technical questions concerning the Request for Proposal no later than May 18, 2016 in writing.  Any changes to the proposal shall be in the form of a written addendum issued by the Purchasing Division and it shall be signed by the Purchasing Director or a duly authorized representative.  Each Offeror is responsible for determining that it has received all addenda issued by the Purchasing Division before submitting a proposal.

L. All proposals received in the Purchasing Division on time shall be accepted. All late proposals received by the Purchasing Division shall be returned to the Offeror unopened. Proposals shall be open to public inspection only after award of the Contract.

IX. PROPOSAL RESPONSE FORMAT

A. Specific Requirements

1. Offerors shall submit a written proposal that presents their qualifications and their understanding of the work to be performed. Offerors are asked to address each evaluation criterion and to be specific in presenting their qualifications.

2. Offerors should submit the following information in their proposal in order for it to be considered a complete proposal:

a) The completed Proposal Signature Sheet (Attachment A).

b) Cover Letter.

c) Table of Contents – All pages are to be numbered.

d) Executive Summary outlining pertinent aspects of the Offeror’s proposal.

e) Response to Scope of Services – The Offeror should address each item listed in the Minimum Services and the Additional Specific Conditions as outlined in Section IV of this RFP.

f) Exceptions - The Offeror shall identify any exceptions, referenced to the paragraph number of the RFP, in a separate section titled “Exceptions”.

g) Identification of proposal sections to be protected under Section 2.2-4342F of the Code of Virginia. Also include reasons why protection is necessary for each section (Attachment D).

h) Description of proposed short-term disability and long-term disability benefit plans, including limitations and exclusions.

i) A summary of deviations to the requested short-term disability plan and/or long-term disability plan, if any.

j) Performance Guarantees – Complete Attachment E to detail any performance guarantees that are being offered for the proposed short-term disability and long-term disability plans.

k) Questionnaire Responses – Each response must immediately follow the respective question in the Questionnaire (Attachment C).

l) Implementation Plan – A time schedule including proposed time frame and phases if applicable.

m) Training – A brief description and time schedule for proposed Henrico County and Henrico Public Schools staffs to be trained on the claims and/or reporting systems inherent in the voluntary short-term disability plan and group long-term disability plan.

n) Copies of most recent annual report and financial statements.

o) Copies of sample certificates of coverage, employee communications materials, and claims denial notices.

p) Copies of sample reporting for claims, premium, enrollment.

q) Copies of sample claims/administrative forms.

r) Copy of a sample renewal report.

s) Copy of a sample utilization report.

t) Copy of a sample group contract for short-term disability plan and for the long-term disability plan.

u) Pricing for fully-insured STD plan to include:

• 12-month rates (a composite rate for each waiting period option, based on $10 of weekly benefit); Please structure the benefit design to include no minimum benefit for members in the case where the member is receiving other income that will exceed the minimum benefit.

• Rate guarantees (if applicable)

• Participation requirements (if applicable)

v) Pricing for the fully-insured group LTD base plan and buy-up LTD plan to include:

• 12-month rates

• Rate guarantees (if applicable)

• Participation requirements in buy-up plan (if applicable)

w) Virginia State Corporation Commission Identification

(Attachment H).

B. Proposal Format

1. Proposals must be submitted on 8 ½ x 11 paper. Proposals are to be prepared simply. Elaborate artwork, expensive paper, visual and other presentation aids are not required. All pages of the proposal must be numbered, and a table of contents should be included.

2. Each copy of the proposal must be bound or contained in binders organized in the sequence and format outlined below with Tabs as indicated in the table below.

|Tab I |Proposal Signature Sheet (Attachment A) |

| |Cover Letter |

| |Table of Contents |

| |Executive Summary |

| |Response to Scope of Services (Minimum Services and Additional Specific Conditions) |

| |Exceptions |

| |Notice of Proprietary Information (Attachment D) |

| |State Corp. Commission Form (Attachment H) |

|Tab II |Description of Proposed Plan Design |

| |Deviations From Requested Plan |

| |Performance Guarantees (Attachment E) |

|Tab III |Questionnaire Response (Attachment C) |

|Tab IV |Implementation Timeline |

| |Training Plan |

|Tab V |Annual Report and Financial Statements |

|Tab VI |Certificates of Coverage, Employee Communication Materials, Notice of Claim Denial |

|Tab VII |Sample Claims/Premium and Utilization Report, Sample Renewal Report |

| |Sample Claims and Administrative Forms |

|Tab VIII |Sample Group Contract for Fully-Insured, Voluntary STD Plan |

| |Sample Group Contract for the Fully-Insured Group LTD Plan (base plan and buy-up plan) |

|Tab IX |Pricing for Fully-Insured, Voluntary STD Plan (Including Rates, Rate Guarantees, |

| |Participation Requirements) |

| |Pricing for Fully-Insured, Group LTD Plans, Base and Buy-up Plans (Including Rates, Rate |

| |Guarantees, Participation Requirements) |

X. PROPOSAL EVALUATION/SELECTION PROCESS

A. Offerors are to make written proposals which present the Offeror's qualifications and understanding of the work to be performed. Offerors are asked to address each evaluation criteria and to be specific in presenting their qualifications. Proposals should be as thorough and detailed as possible so that the County may properly evaluate the Offeror’s capabilities to provide the required services.

B. Selection of the Successful Offeror will be based upon submission of proposals meeting the selection criteria. The selection criteria will include:

|CRITERIA |WEIGHT |

|Functional Requirements |30% |

|Extent to which the proposed solution satisfies the RFP functional requirements | |

|Clearly demonstrated understanding of the work to be performed | |

|Technical capabilities | |

|Reporting capabilities | |

|Ability to match requested plan design | |

|Experience and Qualifications | |

|Experience (number and size) in local government environment |20% |

|Financial Stability of Firm | |

|Knowledge and experience of staff | |

|References | |

|Implementation of Services/Project Management: |20% |

|Implementation timeline demonstrating Offeror’s ability to complete implementation tasks | |

|prior to Open Enrollment to ensure plan is fully operational by January 1, 2017 | |

|Project Approach | |

|Project Plan and Schedule | |

|Project Management | |

|Project Team | |

|Training | |

|Current Workload and ability to perform required work within County schedule | |

|Performance guarantees |5% |

|Price |20% |

|Quality of written proposal and oral presentation |5% |

|TOTAL |100% |

C. Selection will be made of two or more Offerors deemed to be fully qualified and best suited among those submitting proposals. Negotiations shall then be conducted with each of the Offerors so selected. Price shall be considered, but need not be the sole determining factor. After negotiations have been conducted with each Offeror so selected, the County shall select the Offeror, which, in its opinion, has made the best proposal, and shall award the contract to that Offeror. Should the County determine in writing and in its sole discretion that only one Offeror is fully qualified or that one Offeror is clearly more highly qualified than the others under consideration, a contract may be negotiated and awarded to that Offeror. The award document will be a contract incorporating by reference all the requirements, terms and conditions of the solicitation and the Offeror’s proposal as negotiated.

ATTACHMENT A

SUBMIT THIS FORM WITH PROPOSAL

PROPOSAL SIGNATURE SHEET

Page 1 of 2

My signature certifies that the proposal as submitted complies with all requirements specified in this Request for Proposal (“RFP”).

My signature also certifies that by submitting a proposal in response to this RFP, the Offeror represents that in the preparation and submission of this proposal, the Offeror did not, either directly or indirectly, enter into any combination or arrangement with any person or business entity, or enter into any agreement, participate in any collusion, or otherwise take any action in the restraining of free, competitive bidding in violation of the Sherman Act (15 U.S.C. Section 1) or Sections 59.1-9.1 through 59.1-9.17 or Sections 59.1-68.6 through 59.1-68.8 of the Code of Virginia.

I hereby certify that I am authorized to sign as a legal representative for the business entity submitting this proposal.

|LEGAL NAME OF OFFEROR (DO NOT USE TRADE NAME): |

| |

|ADDRESS: |

| |

| |

|SIGNATURE: |

|NAME OF PERSON SIGNING (print): |

|TITLE: |

|TELEPHONE: |

|FAX: |

|E-MAIL ADDRESS: |

|DATE: |

ATTACHMENT A

Page 2 of 2

Company Legal Name: __________________________________________________________

Business Classification Form – Rev. 02/16

PLEASE SPECIFY YOUR BUSINESS CATEGORY BY

CHECKING THE APPROPRIATE BOX(ES) BELOW.

(Check all that apply.)

□ SMALL BUSINESS

□ WOMEN-OWNED BUSINESS

□ MINORITY-OWNED BUSINESS

□ SERVICE DISABLED VETERAN

□ NON-SWAM *National Minority Supplier Development Council or Affiliate

**Women’s Business Enterprise National Council

ATTACHMENT B

INSURANCE SPECIFICATIONS

The contractor shall carry Public Liability Insurance in the amount specified below, including contractual liability assumed by the Contractor, and shall deliver a Certificate of Insurance from carriers licensed to do business in the Commonwealth of Virginia. The Certificate shall show the County of Henrico and Henrico County Public Schools named as an additional insured for the Commercial General Liability coverage. The coverage shall be provided by a carrier(s) rated not less than “A-” with a financial rating of at least VII by A.M. Best or a rating acceptable to the County. In addition, the insurer shall agree to give the County 30 days notice of its decision to cancel coverage.

1. Workers’ Compensation Statutory Virginia Limits

2. Employers’ Liability Insurance $100,000 for each Accident by employee

$100,000 for each Disease by employee

$500,000 policy limit by Disease

3. Commercial General Liability Combined Single Limit

$1,000,000 each occurrence including

contractual liability for specified agreement

$2,000,000 General Aggregate (other than Products/Completed operations)

$2,000,000 General Liability-Products/ Completed Operations

$1,000,000 Personal and Advertising Injury

$100,000 Fire Damage Legal Liability

Coverage must include Broad Form property damage and (XCU) Explosion, Collapse and Underground Coverage

4. Business Automobile Liability Combined Single Limit $1,000,000 each accident (includes owned, non-owned, and hired car coverage)

5. Umbrella/Excess Liability $4,000,000 per occurrence

6. Professional Liability $10,000,000 per occurrence

Note 1: The commercial general liability insurance shall include contractual liability. The contract includes the following indemnification agreement: “The Successful Offeror agrees to indemnify, defend and hold harmless the County of Henrico including Henrico County Public Schools, its officers, agents and employees from any claims, damages, suits, actions, liabilities and costs of any kind or nature, including attorneys’ fees, arising from or caused by the provision of any services, the failure to provide any services or the use of any services or materials furnished (or made available) by the successful Offeror, provided that such liability is not attributable to the County’s sole negligence.” The County makes no representation or warranty as to how the Offeror’s insurance coverage responds or does not respond. Insurance coverages that are unresponsive to the above indemnification provisions do not limit the Vendor’s responsibilities outlined in the contract.

Note 2: The intent of this insurance specification is to provide the coverage required and the limits expected for each type of coverage. With regard to the Commercial General Liability, the total amount of coverage can be accomplished through any combination of primary and excess/umbrella insurance. However, the total insurance protection provided for Commercial General Liability, either individually or in combination with Excess/Umbrella Liability, must total $5,000,000 per occurrence. This insurance shall apply as primary insurance with respect to any other insurance or self-insurance programs afforded the County of Henrico and Henrico County Public Schools. This policy shall be endorsed to be primary with respect to the additional insured.

ATTACHMENT C

QUESTIONANAIRE

The following questionnaire MUST BE COMPLETED and submitted with your proposal. It will assist the County and Schools in evaluating each Offeror’s proposal.

A. INSTRUCTIONS

1. Answer each question fully, clearly, and concisely. It is only necessary to complete those sections that apply to your proposal.

2. Each response must immediately follow the respective question. The question as well as the answer shall be typed. All questions and responses shall be numbered/labeled exactly as in this Questionnaire.

3. Only answer those questions that apply to the coverages/services quoted.

4. Responses to the Questionnaire should be submitted in written hard copy per the instructions in Section VIII.

5. Samples of documents requested in the Questionnaire should be labeled with the corresponding question number and submitted in Tabs as specified in Section VIII.

6. Type in the following information:

|Point of Contact CoContact: | |

|Title: | |

|Company: | |

|Address: | |

|Telephone: | |

|Fax No.: | | |E-mail: | |

7. Have the proposal requirements been fully met as requested in this RFP?

Yes No

If not, please summarize all deviations and include the summary in the appropriate section of proposal as instructed in Section VIII of this RFP.

B. GENERAL INFORMATION

1. Provide background information and a brief description of your firm. Include any pertinent information relative to the size and organizational structure of your firm.

2. Please provide pertinent financial data which demonstrates your firm’s ability to successfully perform required services. Include a copy of the most recent annual report and financial statements for each quarter since the last annual report to date. Please provide your most recent financial ratings (include the date of the rating) by each of the following:

|Rating Service | Rating | Date of Rating |

|b. Fitch | | |

|c. Standard & Poors | | |

|d. Moody’s | | |

|e. A.M. Best | | |

3. Report any restraining or disciplinary action taken against you by any regulatory body within the last (3) years.

4. Please identify all subcontractors (including consultants, advisors, and suppliers) to be used and describe specific responsibilities, qualifications, and background experience of all key personnel. Include financial stability information for each major subcontractor.

5. Provide references for groups of similar size, industry and location. Specifically, three active and three terminated accounts (other than mergers), within the last five years. Please provide: group name, contact person, telephone number, address, effective date, termination date (if applicable), type of plan offered through your organization, and number of covered members.

C. ADMINISTRATION

6. Describe your ongoing enrollment procedures. Indicate the services you will provide, such as on-site assistance with enrollment meetings. What administration services are offered on an on-going basis for enrollment purposes? Please provide samples of the communication materials you have available for open enrollment.

7. Describe any enrollment services offered at no additional cost. County and Schools employees make annual open enrollment elections directly into the County’s HRMS Oracle System. Please outline any on-line enrollment, laptop enrollment, or other technological enrollment features for benefits administrators that your organization can provide.

8. Is an eligibility interface file required? If so, please describe how it is used. Provide file specification requirements and confirm that your firm can accept an interface from an Oracle human resource management system.

9. What is the location(s) of the office(s) that will be servicing this account (i.e. handling member services and handling general administration)? If administration is separate for any portion of the program, please explain.

10. Please identify all locations where the claims will be processed.

11. Describe how your company will interface on an ongoing basis with the County’s and Schools’ benefits staff on administrative issues (including billing, payment arrangements, etc.) and describe your process for resolving administrative issues/problems.

12. Please explain any on-line capabilities, such as enrollment, eligibility transfer, reporting, etc., that would be available to the County’s and Schools’ plan administrators (benefits staff).

13. What will be the days and hours of operation for the customer service unit? Would you be willing to offer extended hours if necessary? Is there a toll-free number? Do the customer service representatives have the authority to resolve problems immediately? What percentage of problems are typically resolved during the initial call?

14. Provide sample administrative/claim forms applicable to this plan in Tab VII of your proposal.

15. What “tax-related services” will be provided to the County of Henrico and Schools for the voluntary, STD and LTD plans (e.g., preparation and/or distribution of W-2s, withholding and remittance of Employees’ FICA, reporting and remittance of Employer portion of FICA, etc.)? Is there an additional charge associated with any of these services? Currently, Aetna is producing the W-2s for STD enrollees and mailing them to employees, withholding and remitting the employees’ FICA, and reporting and remitting the employer portion of FICA. LTD tax reporting is handled by the County as benefits are paid through payroll. In answering this question, please bear in mind that the STD plan being requested is a voluntary (employee-paid plan) and the LTD plan is comprised of an employer-paid portion and an employee-paid buy-up option.

D. BILLING/FINANCIAL

16. Please describe billing options available. The County currently self bills monthly and wire transfers the total premium due. Explain your billing process. Include time frames for payment and penalties for late payment. Outline any on-line billing options your company offers.

17. How long will you guarantee your quoted rates/fees and for what time period are they guaranteed?

18. Describe your renewal process and include a sample renewal package for the short-term and long term disability plans that you have proposed.

19. Are you willing to offer performance guarantees? If so, please explain/outline.

20. Please outline any minimum participation levels for the STD program.

21. Please outline any minimum participation levels that apply to the fully-insured, LTD program.

E. STD PLAN

22. Are there maximum guaranteed issue amounts for the plan options quoted?

23. Can coverage be automatically increased based on salary increases without medical underwriting? Please provide details, if applicable.

24. Under what circumstances would you require evidence of insurability?

25. What is the turnaround time for approval of evidence of insurability?

26. Please describe the reports that are included in your rates that will be routinely provided to General Government and Schools for the STD plan and the frequency of these reports.

27. Provide a description of the disability management process that will be included for Henrico’s fully-insured LTD plan.

28. Please describe the process that you anticipate for transitioning a STD claim to the proposed group LTD plan.

29. Please explain your contractual provisions and claims administration procedures specific to STD coordination of benefits with workers’ compensation. For example, what are the procedures that are followed when an employee submits a claim for STD benefits that appears to be work-related? What procedures are followed while that claimant is pending approval of workers’ compensation benefits – are STD benefits paid and later recovered or is the claimant’s STD claim pended until the workers’ compensation claim is either approved or denied?

30. Do you have a contractual provision or administrative guideline allowing for breaks in the accumulation of the elimination period? If so, include a description. What are your specific contract provisions that allow a disabled individual to return to work and then go out for the same disability without having to complete a new elimination period?

31. Specifically summarize your “partial” and/or “residual” benefit provision(s) that provide for a return-to-work on a part-time basis. Provide examples to illustrate your description.

32. Are any return-to-work incentive benefits provisions included in the plan that you propose? If so, please describe the provision(s).

33. Does your company offer the capability of reporting STD claims telephonically? If so, please describe the process. Is this an optional service or will the County be required to provide telephonic claim reporting? Is there an additional charge for telephonic claim reporting?

34. Do you have a formal rehabilitation program? If so, provide a brief description. Is the rehabilitation program mandatory?

35. Please identify any tax-related services which are included in your STD proposal rates (e.g., preparation of W-2s, delivery of W-2s, withholding of FICA, withholding of state and/or federal income taxes, reporting of FICA match, etc.). Please identify which of these services is optional for the County.

36. Provide a sample fully-insured STD contract in Tab VIII of your proposal.

37. Do you provide waiver of premium while an employee is on STD?

38. For a Schools employee who is paid monthly, STD benefits are only paid during the employee’s contract period. For example, a teacher who chooses to be paid over 12 months, but only works 10 months can receive STD benefits only for working days (contract days) that the employee misses due to disability. If the disability occurs during the summer (or other non-contract days), the employee would not receive any STD benefits for those days, but the employee’s paycheck from Henrico would continue. If the employee’s disability continued into the next contract period, the employee could be paid benefits for any days remaining of the maximum STD benefit period. Does your company have experience administering this type of arrangement and in calculating the proper benefits due?

LONG-TERM DISABILITY

39. How are disabled lives reserve and IBNR calculated?

40. What is your tolerable loss ratio?

41. Describe your credibility formula? How does the size of the group and the amount of available experience affect the group’s credibility?

42. Can you provide W-2 statements directly to claimants? Is there an additional cost for this service? Explain how this process works.

43. Do you have a contractual provision or administrative guideline allowing for breaks in the accumulation of the elimination period? If so, include a description. What are your specific provisions that allow a disabled individual to return to work and then go out for the same disability without having a new accumulation period? Specifically summarize your “partial” and/or “residual” benefit provision(s) that provide for a return to work on a part-time basis. Provide examples to illustrate your description.

44. What is your contractual provision or administrative guideline relative to integrating with VRS Disability and/or Social Security benefits when the notice of award is pending? What assistance will be rendered in the appeal process?

45. How many appeals did you conduct in the most recent fiscal year and what percentage was successful?

46. Do you have a formal, active rehabilitation program? If so, provide a brief description.

47. Provide sample administrative/claim forms applicable to this plan and include a specimen contract.

48. Clearly outline any industrial, occupational or other considerations that might influence final case acceptance or rates for this plan.

49. Include a sample of your standard long-term disability claim reports, including frequency.

50. What percentage of your book of business gets approved initially for social security disability? After 24 months of disability, what percentage has been approved?

51. What percentage of your book of business are candidates for rehabilitation analysis? Of that percentage, what percentage is approved for rehabilitation benefits?

52. Are there maximum guaranteed issue amounts for the plan options quoted?

53. Can coverage be automatically increased based on salary increase without medical underwriting? Please provide details, if applicable.

54. Under what circumstances would you require evidence of insurability?

55. What is the turnaround time for approval of evidence of insurability?

56. Will you provide reports that include type of disability, reserves and rehabilitation activities for each open claim? How often will these reports be provided? What will be the cost, if any?

57. Please include a return-to-work incentive benefit provision in your proposal and information describing this provision.

58. Identify all participation requirements for the proposed LTD buy-up plan.

59. How would you handle the recovery of an overpayment that results when a claimant has been receiving LTD benefits for a period of time (6 months or longer) and they receive a retroactive Social Security award that is more than the LTD benefits that the claimant has received?

60. Identify delays in moving from STD to LTD.

61. Do you pay the employer’s portion of FICA for LTD? Is there a time limit to file an LTD claim?

62. Please outline or list in your proposal the following for the proposed LTD plan.

• List the plan offsets (other income benefits)

• The process for handling the transition from own occupation to any occupation (validation, use of functional capacity exams, etc.)

• Provisions included in your proposed plan for mandatory rehabilitation or for requirements that members be under the care of a physician

• Plan limitations for mental health and substance abuse

ATTACHMENT D

PROPRIETARY INFORMATION

Ownership of all data, materials, and documentation originated and prepared for Henrico County pursuant to the REQUEST FOR PROPOSAL shall belong exclusively to Henrico County and be subject to public inspection in accordance with the Virginia Freedom of Information Act. Trade secrets or proprietary information submitted by an Offerer shall not be subject to public disclosure under the Virginia Freedom of Information Act, however, the Offerer must invoke the protections of Section 2.2-4342F of the Code of Virginia, in writing, either before or at the time the data or other material is submitted. The written notice must specifically identify the data or materials to be protected and state the reasons why protection is necessary. The proprietary or trade secret material submitted must be identified by some distinct method such as highlighting or underlining and must indicate only the specific words, figures, or paragraphs that constitute trade secret or proprietary information.

NOTICE OF PROPRIETARY INFORMATION

Confidentiality References Protection in Accordance with the

Code of Virginia, Section 2.2-4342F

|Section Title |Page Number |Reason(s) for Withholding from Disclosure |

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INSTRUCTIONS: Identify the data or other materials to be protected and state the reasons by using the codes listed below. Indicate die specific words, figures, or paragraphs that constitute trade secrets or proprietary materials.

A- This page contains information relating to "trade secrets', and "proprietary information" including processes. Operations, style of work, or apparatus, identify confidential statistical data, amount or source of any income... of any person (or) partnership. "See Virginia Public Procurement Act. Section 2.2-4342F. Unauthorized disclosure of such information would violate the Trade Secrets Act 18 U.S.C. 1905.

B- This page contains proprietary information including confidential, commercial or financial information which was provided to the Government on a voluntary basis and is of the type that would not customarily be released to the public. See Virginia Public Procurement Act, Section 2.2-4342F; 5 U.S.C. 552 (b)(4); 12 C.F.R. 309.5(c)(4).

C- This page contains proprietary information including confidential, commercial or financial information. This disclosure of such information would cause substantial harm to competitive position and impair the Government's ability to obtain necessary information from contractors in die future. 5 U.S.C. See Virginia Public Procurement Act. Section 2.2-4342F; 552 (b)(4); 12 C. F. R 309.5(c)(4).

ATTACHMENT E

PERFORMANCE GUARANTEES

|COUNTY OF HENRICO RFP #16-1170-3CS | | | | | |

| | | | | | | |

|PERFORMANCE GUARANTEES EXHIBIT – Effective Date: January 1, 2017 | | | |

| | | | | | | |

|Name of Offeror: ____________________ Performance Guarantees Apply to the Following Plan: _____________ |

| |

|(Provide separate Exhibits if guarantees vary by plan option) |

For each performance category, please insert a financial penalty in the “Financial Penalty” column or insert “N/A” in that column if you cannot guarantee performance in that area. Insert the measure(s) that you intend to use to determine if the minimum standard has been met (Performance Measure column), provide information about how performance in each category will be reported and the frequency of the reports (Performance Reporting column), and indicate whether each of the performance categories will be measured based upon your book of business or if they will be measured for Henrico (Book of Business or Henrico Specific column). Offerors are free to modify any of the minimum standards shown below, but should clearly highlight any modification so that it may be easily identified.

|Performance Category |Minimum Standard |Performance Measure |Performance Reporting |Frequency of Reports |Book of Business or |Financial |

| | | | |(Reporting Period) |Henrico Specific |Penalty |

|Claims Processing Accuracy |98% of all STD and LTD claims | | | | | |

| |processed correctly. | | | | | |

|Claim Turnaround Time |98% of all STD and LTD claims | | | | | |

| |processed within 5 business | | | | | |

| |days. | | | | | |

ATTACHMENT E

PERFORMANCE GUARANTEES

|COUNTY OF HENRICO RFP #16-1170-3CS | | | | | |

| | | | | | | |

|PERFORMANCE GUARANTEES EXHIBIT – Effective Date: January 1, 2017 | | | |

| | | | | | | |

|Name of Offeror: ___________________________ Performance Guarantees Apply to the Following Plan: __________________ |

| |

|(Provide separate Exhibits if guarantees vary by plan option) |

For each performance category, please insert a financial penalty in the “Financial Penalty” column or insert “N/A” in that column if you cannot guarantee performance in that area. Insert the measure(s) that you intend to use to determine if the minimum standard has been met (Performance Measure column), provide information about how performance in each category will be reported and the frequency of the reports (Performance Reporting column), and indicate whether each of the performance categories will be measured based upon your book of business or if they will be measured for Henrico (Book of Business or Henrico Specific column). Offerors are free to modify any of the minimum standards shown below, but should clearly highlight any modification so that it may be easily identified.

|Performance Category |Minimum Standard |Performance Measure |Performance Reporting |Frequency of Reports |Book of Business or |Financial |

| | | | |(Reporting Period) |Henrico Specific |Penalty |

|Customer Services Telephone Response Time |2% or fewer callers to customer| | | | | |

|Average Abandonment Rate |service representative or | | | | | |

| |center abandon the call | | | | | |

|Account Management Satisfaction (to be |To be proposed by Offeror | | | | | |

|rate/d by Benefits Managers) | | | | | | |

ATTACHMENT E

PERFORMANCE GUARANTEES

|COUNTY OF HENRICO RFP #16-1170-3CS | | | | | |

| | | | | | | |

|PERFORMANCE GUARANTEES EXHIBIT – Effective Date: January 1, 2017 | | | |

| | | | | | | |

|Name of Offeror: ___________________________ Performance Guarantees Apply to the Following Plan: __________________ |

|(Provide separate Exhibits if guarantees vary by plan option). |

For each performance category, please insert a financial penalty in the “Financial Penalty” column or insert “N/A” in that column if you cannot guarantee performance in that area. Insert the measure(s) that you intend to use to determine if the minimum standard has been met (Performance Measure column), provide information about how performance in each category will be reported and the frequency of the reports (Performance Reporting column), and indicate whether each of the performance categories will be measured based upon your book of business or if they will be measured for Henrico (Book of Business or Henrico Specific column). Offerors are free to modify any of the minimum standards shown below, but should clearly highlight any modification so that it maybe easily identified.

|Performance Category |Minimum Standards |Performance Measure |Performance Reporting |Frequency of Reports |Book of Business or |Financial |

| | | | |(Reporting Period) |Henrico Specific |Penalty |

|Implementation of Plan |To be proposed by Offeror | | | | | |

|Total $ at Risk | | |

|Sick Leave |Fulltime (VRS Plan 1 & Plan 2 employees) 4 hours per pay period (26 pay periods),|Monthly Personnel: |

| |or 104 hours per year |Fulltime, 10-month personnel: 10 days/year |

| | |Fulltime, 11-month personnel: 11 days/year |

| |Fulltime (VRS Hybrid Plan employees) – 3 hours Per Pay Period (78 hours – 9.75 |Fulltime, 12-month personnel: 13 days/year |

| |days) |Permanent Part-time (50% FTE): 4 hours per month (prorated) |

| | | |

| |Permanent Part-time (Prorated): |Bi-Weekly Personnel: |

| |40-59 hrs per pay period: 2 hrs per pay period |Fulltime (VRS Plan 1 & Plan 2 employees) – 4 hours Per Pay Period (104 hours – 13 days) |

| |60-79 hrs per pay period: 3 hrs per pay period |Fulltime (VRS Hybrid Plan employees) – 3 hours Per Pay Period (78 hours – 9.75 days) |

| | |Permanent Part-time (50% FTE) – Prorated; 2 hours PPD (52 hours – 6.5 days) |

| |Firefighters: 5.6 hours per pay period (26 pay periods), or 145.6 hours per year| |

| |(1.4% higher than regular fulltime employee) | |

| | |Unlimited accumulation – for Monthly employees and VRS Plan 1 and Plan 2 Biweekly employees |

| |Unlimited accumulation – for VRS Plan 1 & Plan 2 employees |Maximum accumulation – 78 hours for VRS Hybrid Plan Biweekly employees |

| |Maximum accumulation– 78 hours at any time for VRS Hybrid Plan employees | |

| | |May be used for: |

| |May be used for: |Personal illness/Appointments |

| |Personal Illness/Appointments |Family illness |

| |Family Illness/Appointments (48 hrs/year; 67.2 firefighters) | |

| | |Flexible Sick Leave: Available to all employees other than 12-month contract personnel and |

| |If sick accumulations are insufficient in the event of extended |employees paid bi-weekly. 2 days of Flexible Sick Leave is available to these employees each |

| |illness/disability, may use annual/compensatory leaveor, if necessary, leave |fiscal year once Personal Leave has been exhausted and Sick Leave is still available. |

| |without pay. | |

| | |Long-term Family Illness: Up to 65 personal sick leave days. |

| |No payout at termination, except retirement or death for VRS Plan 1 and Plan 2 | |

| |employees. $4.00 per hour up to $8,000 maximum. (2,000 hours, 250 days) |No payout at termination, except retirement or death for Monthly employees or VRS Plan 1 and Plan|

| | |2 Biweekly employees. $4.00 per hour up to $8,000 maximum. (2,000 hours, 250 days) |

| |No sick leave payout at termination or retirement for VRS Hybrid Plan employees. | |

| | |No payout at termination or retirement for VRS Hybrid Plan Biweekly employees. |

COUNTY OF HENRICO RFP #16-1170-3CS

ATTACHMENT F

CURRENT LEAVE POLICIES (Continued)

|Leave Type |General Government |Henrico County Public Schools |

|Annual Leave | | | | |

| | | | |Monthly and Bi-Weekly Accrual (12-month employees): |

|Fulltime Ees |0-4 yrs. |104 hrs per year |208 hr max |0-4 yrs. |104 hrs per year |208 hr max |

| |5-9 yrs. |130 hrs per year |260 hr max |5-9 yrs. |130 hrs per year |260 hr max |

| |10-14 yrs. |156 hrs per year |312 hr max |10-14 yrs. |156 hrs per year |312 hr max |

| |15-19 yrs. |182 hrs per year |364 hr max |15-19 yrs. |182 hrs per year |364 hr max |

| |20-24 yrs. |208 hrs per year |416 hr max |20-24 yrs. |208 hrs per year |416 hr max |

| |>25 yrs. |234 hrs per year |468 hr max |>25 yrs. |234 hrs per year |468 hr max |

|Firefighters |0-4 yrs. |263.12 hrs per year |291.20 hr max | | | |

|(Combined with holiday hours);|5-9 yrs. |299.52 hrs per year |364.00 hr max | | | |

|(10.5 holidays = additional 84|10-14 yrs. |335.92 hrs per year |436.80 hr max | | | |

|hrs) |15-19 yrs. |372.32 hrs per year |509.60 hr max | | | |

| |20-24 yrs |408.72 hrs per year |582.40 hr max | | | |

| |>25 yrs. |445.12 hrs per year |655.20 hr max | | | |

|Permanent Part-time |0-4 yrs. |52 hrs per year |104 hr max | | | |

|40-59 hrs/ppd |5-9 yrs. |65 hrs per year |130 hr max | | | |

| |10-14 yrs. |78 hrs per year |156 hr max | | | |

| |15-19 yrs. |91 hrs per year |182 hr max | | | |

| |20-24 yrs |104 hrs per year |208 hr max | | | |

| |>25 yrs. |117 hrs per year |234 hr max | | | |

|Permanent Part-time | | | | | | |

|60-79 hrs/ppd |0-4 yrs. |78 hrs per year |156 hr max | | | |

| |5-9 yrs. |97.50 hrs per year |195 hr max | | | |

| |10-14 yrs. |117 hrs per year |234 hr max | | | |

| |15-19 yrs. |136.50 hrs per year |273 hr max | | | |

| |20-24 yrs. |156 hrs per year |312 hr max | | | |

| |>25 yrs. |175.50 hrs per year |351 hr max | | | |

COUNTY OF HENRICO RFP #16-1170-3CS

ATTACHMENT F

CURRENT LEAVE POLICIES (Continued)

|Leave Type |General Government |Henrico County Public Schools |

|Extended Leave Pool |For VRS Plan 1 and Plan 2 employees: In the event of employee’s injury/illness |Extended Sick Leave: Granted for employee illness only, when Sick Leave is exhausted; |

| |and/or catastrophic employee/family medical situation. |Eligibility: 3 years of service; minimum of 20-day absence |

| | |Duration: End of contractual period or 90 days, whichever occurs first. Runs concurrent with |

| |May borrow 2 hours per pay period of service. Those with < 2 year of service: may|FMLA. |

| |borrow up to 13 days of sick leave. |Remuneration is determined by deducting from the employee’s rate of pay the amount equivalent to |

| | |step 1 of the employee’s pay grade. |

| |All applicable leave must be exhausted. | |

| |15 calendar-day elimination period |Catastrophic Sick Leave: A catastrophic leave pool is available to assist participating employees |

| | |who suffer from a potentially terminal and/or catastrophic health condition. Employees who enroll|

| |Repayment: |in this program must donate 1 day of sick leave and are eligible to receive up to 30 days of paid |

| |2 hours per pay period; from sick leave, or |leave after they have exhausted all other available leave. |

| |final paycheck or employee’s estate | |

| | | |

| |Hybrid Plan employees are not eligible for the extended leave pool. | |

|Personal/ Emergency Leave|Not applicable |Monthly and Bi-Weekly Personnel: |

| | |For instances not covered by any other Leave program. |

| | |Those employed < 260 days: 2 days per year, up to 5-day max; any unused excess converts to Sick |

| | |Leave |

| | |Those employed 260 days+: One day per year; no accumulation. Unused time converts to Sick Leave |

| | |For bi-weekly employees, 8 hours is automatically posted to annual leave the 1st pay period in |

| | |July. |

|Compensatory Leave |Exempt employees: Hour-for-hour credit for time worked in excess of standard |Only non-exempt employees are eligible. Awarded on time and one-half basis when 40-hour work week|

| |hours (subject to approval). |is exceeded. Must be taken within pay period earned, and is not cumulative. |

| | | |

| |Must be used within 26 pay periods, or forfeited. | |

|Bereavement Leave |Up to 24 hours (3 days) granted subsequent to the death of a close family member. |Up to 24 hours (3 days) for death of immediate family member; |

| | |2 sick days may be used in addition to bereavement leave. |

|Adoption Leave |Paid for a maximum of 20 consecutive work days or 160 consecutive work hours |Up to 20 days of sick leave may be used to remain at home after adoption of a child. |

| |(whichever comes first), to care for new, legally adopted child. | |

COUNTY OF HENRICO RFP #16-1170-3CS

ATTACHMENT G

RATE HISTORY

(5-Year Aetna Contract)

| |Monthly Rate Per $10 of Weekly Benefit |

|Period |Option 1 |Option 2 |Option 3 |

| |14-Day Elimination Period |28-Day Elimination Period |42-Day Elimination Period |

|January 1, 2012 – December 31, 2012 |$0.288 |$0.133 |$0.070 |

|January 1, 2013 – December 31, 2013 |$0.288 |$0.133 |$0.070 |

|January 1, 2014 – December 31, 2014 |$0.288 |$0.133 |$0.070 |

|January 1, 2015 – December 31, 2015 |$0.382 |$0.133 |$0.070 |

|January 1, 2016 – December 31, 2016 |$0.382 |$0.133 |$0.070 |

COUNTY OF HENRICO RFP #16-1170-3CS

ATTACHMENT H

VIRGINIA STATE CORPORATION COMMISSION (SCC)

REGISTRATION INFORMATION

The Bidder or Offeror:

□ is a corporation or other business entity with the following SCC identification number: ________________________________ -OR-

□ is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust -OR-

□ is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the Bidder/Offeror in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from Offeror’s out-of-state location) -OR-

□ is an out-of-state business entity that is including with this bid/proposal an opinion of legal counsel which accurately and completely discloses the undersigned Bidder’s/Offeror’s current contacts with Virginia and describes why whose contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.

Please check the following box if you have not checked any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for bids/proposals: □

SUBMIT THIS FORM WITH PROPOSAL

-----------------------

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COMMONWEALTH OF VIRGINIA

COUNTY OF HENRICO

DEPARTMENT OF FINANCE

CECELIA H. STOWE, CPPO, C.P.M.

PURCHASING DIRECTOR

SUPPLIER REGISTRATION – The County of Henrico encourages all suppliers interested in doing business with the County to register with eVA, the Commonwealth of Virginia’s electronic procurement portal, .

eVA Registered? □ Yes □ No

Certifications:

eVA □ Yes □ No

NMSDC* □ Yes □ No

WBENC** □ Yes □ No

definitions

For the purpose of determining the appropriate business category, the following definitions apply:

"Small business" means a business, independently owned and controlled by o敮漠⁲潭敲椠摮癩摩慵獬眠潨愠敲唠匮‮楣楴敺獮漠⁲敬慧敲楳敤瑮愠楬湥ⱳ愠摮琠杯瑥敨⁲楷桴愠晦汩慩整ⱳ栠獡㈠〵漠⁲敦敷⁲浥汰祯敥ⱳ漠⁲湡畮污朠潲獳爠捥楥瑰⁳景␠〱洠汩楬湯漠⁲敬獳愠敶ne or more individuals who are U.S. citizens or legal resident aliens, and together with affiliates, has 250 or fewer employees, or annual gross receipts of $10 million or less averaged over the previous three years. One or more of the individual owners shall control both the management and daily business operations of the small business.

"Women-owned business" means a business that is at least 51 percent owned by one or more women who are U.S. citizens or legal resident aliens, or in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity ownership interest is owned by one or more women who are U.S. citizens or legal resident aliens, and both the management and daily business operations are controlled by one or more women.

"Minority-owned business" means a business that is at least 51 percent owned by one or more minority individuals who are U.S. citizens or legal resident aliens, or in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or more minority individuals who are U.S. citizens or legal resident aliens, and both the management and daily business operations are controlled by one or more minority individuals, or historically black college or university as defined in § 2.2-1604, regardless of the percentage ownership by minority individuals or, in the case of a corporation, partnership, or limited liability company or other entity, the equity ownership interest in the corporation, partnership, or limited liability company or other entity.

"Minority individual" means an individual who is a citizen of the United States or a legal resident alien and who satisfies one or more of the following definitions:

1. "African American" means a person having origins in any of the original peoples of Africa and who is regarded as such by the community of which this person claims to be a part.

2. "Asian American" means a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands, including but not limited to Japan, China, Vietnam, Samoa, Laos, Cambodia, Taiwan, Northern Mariana Islands, the Philippines, a U.S. territory of the Pacific, India, Pakistan, Bangladesh, or Sri Lanka and who is regarded as such by the community of which this person claims to be a part.

3. "Hispanic American" means a person having origins in any of the Spanish-speaking peoples of Mexico, South or Central America, or the Caribbean Islands or other Spanish or Portuguese cultures and who is regarded as such by the community of which this person claims to be a part.

4. "Native American" means a person having origins in any of the original peoples of North America and who is regarded as such by the community of which this person claims to be a part or who is recognized by a tribal organization.

"Service disabled veteran business" means a business that is at least 51 percent owned by one or more service disabled veterans or, in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or more individuals who are service disabled veterans and both the management and daily business operations are controlled by one or more individuals who are service disabled veterans.

"Service disabled veteran" means a veteran who (i) served on active duty in the United States military ground, naval, or air service, (ii) was discharged or released under conditions other than dishonorable, and (iii) has a service-connected disability rating fixed by the United States Department of Veterans Affairs.

“Non-SWAM” means any category other than small, women-owned or minority-owned (i.e., large, non-or not-for-profit, governmental entity).

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