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RICHARDSON INDEPENDENT SCHOOL DISTRICT 400 SOUTH GREENVILLE AVENUE

RICHARDSON, TEXAS 75081

REQUEST FOR PROPOSAL FOR

WORKERS’ COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES

RFP# 1319

The Richardson Independent School District (RISD) is soliciting proposals for WORKERS’ COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES as per specification stated in this solicitation document. Sealed proposals shall be submitted in an envelope marked on the outside with the proposer’s name, address and proposal number RFP# 1319. Please submit proposals to: Richardson Independent School District Purchasing Department 970 Security Row Richardson, Texas 75081 Attn: Rose Kohut Proposals will be received at the above address until 1:00 PM CDT MONDAY APRIL 14, 2014. Proposals will be publicly opened at 2:00 PM CDT the same day. Proposals must be submitted in sufficient time to be received and time-stamped at the above location on or before the published proposal date and time show on the RFP. Richardson Independent School District will not be responsible for delivering mail from the post office. Proposals received after the published time and date cannot be considered. FAX bids will not be accepted. When downloading from the web page it is necessary to open and download any “Addendum” to ensure all required information is provided. The proposal name and number must be identified on the outside envelope being delivered (i.e. Federal Express, UPS, US Postal Service or Hand Delivery.) Proposers must submit sealed proposals and FOUR (4) TYPED and BOUND COPIES in the form of the executed Proposal Form together with any material required by an addendum to this RFP by the time and date specified. RISD’s contact for this bid/proposal is Rose Kohut (469) 593-0560. Rose.Kohut@risd.org Contact between solicited vendors and user departments during the request for sealed proposal process or evaluation

process is prohibited. Any attempt by a solicited vendor to contact the departments will result in disqualification.

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RICHARDSON INDEPENDENT SCHOOL DISTRICT REQUEST FOR PROPOSALS # 1319

FOR WORKERS’ COMPENSATION THIRD PARTY CLAIMS

ADMINISTRATION SERVICES

I. INTRODUCTION

Richardson Independent School District, Richardson, Texas (hereinafter referred to as "DISTRICT") is soliciting proposals from organizations (hereinafter referred to as "PROPOSER') qualified to perform professional claims administration and risk management services for the DISTRICT's self-funded Workers' Compensation Program. The scope of the work will encompass all aspects of DISTRICT operations and requires extensive knowledge and experience across all lines of coverage. The information provided in the Request for Proposals (hereinafter referred to as "RFP") is only to be used for the purpose of preparing a proposal in the areas of claims administration and/or risk management services.

II. GENERAL BACKGROUND

DISTRICT is seeking a new contract for its self-funded workers' compensation program. DISTRICT is comprised of 61 campuses and has a work force of approximately 4800. Currently, DISTRICT averages approximately 200 workers' compensation claims per year, including approximately 40 indemnity claims. Currently, all benefits payments, payments to medical providers, and vendors are accomplished through the process of having the Contractor issue checks from a zero fund balance account funded by the DISTRICT. DISTRICT’S current contractor provides a monthly check register and loss runs to DISTRICT’S Risk Management Department on or around the 5th day of the following month. Additionally, the Contractor provides a daily invoice to the DISTRICT’S Finance Department for maintenance of the zero balance account. The Contractor also annually produces IRS forms 1099-Misc for all vendors and mails the forms to the appropriate vendors. These computer and data processing services shall be included in all proposals. DISTRICT will also consider alternate proposals to its existing self-insured workers’ compensation program. Any and all alternate proposals for options other than our traditional self-insurance program will be considered. DISTRICT's designated representative during the RFP process shall be DISTRICT's Insurance Broker, McGriff, Seibels and Williams of Texas, Inc.

III. CONTRACT TERM

The Contract term shall be for a period of three (3) years, beginning on July 1, 2014 and ending June 30, 2017. It is renewable for two successive one (1) year terms upon the same terms and conditions unless terminated. Contract shall be reviewed prior to renewal and changes made by agreeing parties.

IV. SCOPE OF SERVICES

A. CLAIMS ADMINISTRATION AND SUPPORT SERVICES A. Each PROPOSER must be experienced in Public Entity workers’ compensation claims handling.

B. The PROPOSER must have an office within 60 miles of the DISTRICT”S main offices with the

Account Manager and staff available to handle the account 24 hours a day, 365 days per year.

C. Each PROPOSER must supply a list of all potential servicing personnel with a current resume of each adjuster who handle or is in any way involved in the handling of DISTRICT claims. Any additional personnel to be involved in DISTRICT claims handling at a later date should have a resume’ submitted for prior consultation with the DISTRICT. Resumes should include a summary of education, experience, licenses, and languages spoken/written.

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D. Minimum qualifications for personnel handling DISTRICT claims:

Position Qualifications 1. Account Manager Minimum of five years experience in workers’

compensation claims, including public entity claims. 2. Adjuster | Workers’ Compensation Minimum of four years experience handling workers’

compensation claims, preferably for Texas public entities.

E. Each Proposal shall include samples of the types of statistical data and loss reports they will provide

monthly.

F. The claim load of each adjuster may not exceed the following limits:

Claim Type Limit Workers’ Compensation, Indemnity 100 Workers’ Compensation, Medical Only 200

G. PROPOSER will ensure personal delivery of any documentation needed in order for any RME to be

completed, at no additional cost to DISTRICT.

H. PROPOSER will prepare and submit IRS form 1099 for all vendors and mail the forms to vendors. PROPOSER will prepare and submit IRS 1099 data electronically no later than January 15th of each year to DISTRICT.

I. PROPOSER will be available for claims reporting on a 24-hour basis.

J. Any duplicate payments or overpayments made due to PROPOSER's oversight or negligence shall be

the responsibility of the PROPOSER; PROPOSER will reimburse DISTRICT for same, within 30 days. In addition, PROPOSER will provide DISTRICT an overpayment report by type, reason, payee and by fiscal year on a quarterly and annual basis.

K. Any workers' compensation claim to be controverted by PROPOSER must be submitted in a caption

report form to DISTRICT Risk Management for review prior to submission to the Texas Department of Insurance Workers’ Compensation Division.

L. PROPOSER will cooperate with any medical cost containment, case management, risk management,

investigations, law firm or any other organization designated by DISTRICT.

M. DISTRICT will require the following services from the selected PROPOSER:

1. A monthly summary of the workers' compensation checking account, listing all checks, vouchers, voided checks, in numerical sequence, stating date issued, claim number, claimant name, payee, amount, type of benefit paid, and benefit period.

2. Computer Loss Runs: A monthly computer produced claims report and management summary will

be required by Risk Management no later than the 10th of the following month with a suggested format as follows:

a. A management summary (loss analysis) of all pending claims; reports of all claims by fiscal year (July 1 - June 30) by department, division; current month new claims; closed claims; all claims by date of injury by fiscal year; all claims by payment type; all claims with total incurred greater than $20,000; all active claims, alpha order; all claims with payment in current month with payment detail in alpha order. Each department incurred, paid, and number of claims must be total by claim type. An average cost per claim by department must be included by claim type. Lost Work Day Index and Injury Incident Rate, calculated by department will need to be provided. Formats other than described above will be considered in negotiation of the Contract.

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b. A loss control report which breaks down injuries by fiscal year by department, division, cause

and type (nature), employee age, years of experience, body part affected, time of day, repeat offenders, etc., and shows the monthly trend for each category is also to be provided on a monthly basis.

3. Provide details on types of reports PROPSER offers with samples. The DISTRICT wants the

ability to run reports on-line. Training should be included in costs. 4. Notification to all employees and providers of services of the change in workers' compensation

administration shall be completed by PROPOSER on behalf of the DISTRICT. This notification shall include a statement indicating that all billing of DISTRICT claims for all injuries subsequent to the Contract date should be submitted to the new administrator for processing.

5. PROPOSER will meet with the DISTRICT'S Risk Management Department as follows:

• Quarterly to review the status and or handling of up to 25 claims selected by the DISTRICT

• Annually to review all open claims and any other matters at the discretion of the DISTRICT

6. PROPROSER will respond to any request by the DISTRICT within 24-hours from time a request is made.

7. The agreement will include an indemnify provision to protect the DISTRICT against errors or

omissions committed by the TPA. The provision should also specify that the PROPOSER agrees to hold the DISTRICT harmless and to indemnify the DISTRICT for all loss arising out of any claims alleging an error or omission with respect to the services performed by the PROPOSER.

8. PROPOSER must include a description of the policies and procedures of PROPOSER to ensure

and measure internal quality control.

9. The selected PROPOSER will be subject to periodic claims audits by internal DISTRICT staff and/or an independent firm at the discretion of the DISTRICT.

10. Provide description of the on-line computer claims service and attach a sample copy of an on-line

illustration or exhibit.

V. PROPOSALS

The PROPOSER's completed Proposal pages in Attachment "A" of this RFP are the main source of evaluation for the Proposal. Along with the Proposal pages, Proposals should include a description of additional claims and support services and/or risk management services that PROPOSER offers and wants to propose in a written presentation form. All PROPOSERS are encouraged to include any other information that they feel will enhance their opportunities to be awarded a Contract. A Proposal from a PROPOSER for Claims Administration should include the following:

A. The location of your offices and hours staffed, number of professional staff members, attorneys, claim adjusters, etc. Provide the names of principal owners, partners or officers.

B. DISTRICT would like Proposals to indicate who is primarily responsible for the management and

supervision of DISTRICT account. This individual should be at least an account manager level (whose duties are primarily the supervision of claim files). The account manager and the names of any adjusters and/or examiners assigned to the handling of DISTRICT files should also be included with an indication of length of service and area of expertise.

C. Advise as to the average and maximum number of files claims adjusters and/or examining personnel

must handle at the office assigned to handle DISTRICT's claims.

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D. Advise as to whether or not the designated claims personnel on DISTRICT's account will also be involved in on-site investigation and other outside claims adjusting functions. If so, provide some detail as to when and who would perform these outside functions and the time frame expected.

E. Advise how frequently your diary system allows claims supervisory personnel to review open claims. F. Describe if you have a formal program for managing lawsuits and litigation expense. G. Do you use a formal claims procedure and performance manual and, if so, provide a sample. H. Do you use standard forms other than state forms used in PROPOSER claim process? (If so, you may

be asked to provide copies.) I. Provide a fixed cost per claim as well as a flat rate cost for:

• Workers' Compensation (identify separate rates for report only, medical only and indemnity)

• Provide a not-to-exceed maximum annual fee for any and all workers' compensation J. Specify whether or not fees include your firm performing all of the necessary and required State

filings.

K. Indicate the types of allocated claims expenses which are not included in your per claim cost. L. Include a list of local and Texas public entity references. Along with your references, include a list that

is representative of your clients. References will be contacted as part of the evaluation process. M. Quote a flat fee for handling of pending workers' compensation claims from the current Contractor. N. Advise specifically as to how and at what cost you would handle DISTRICT's claim "runoff" in the

event of a discontinuance of your services.

VI. PREPARATION OF PROPOSAL

A. PROPOSER is expected to examine this Request for Proposal (RFP) carefully, understand the terms and conditions for providing the pertinent services, and respond completely. Failure to respond completely may result in disqualification. Questions about this RFP shall be directed, in writing only, to the address provided below, on company letterhead.

B. Verbal questions and explanations are not permitted, other than during any interviews. It is suggested that

any and all questions be sent via email or by Certified Mail, return receipt requested. No inquiries or questions will be answered after 2:00 PM CDT, March 31, 2014 to allow ample time for distribution of answers and/or any changes. Any questions regarding this RFP may be directed to:

McGriff, Seibels and Williams of Texas, Inc. Attention: Robert Waggoner, ARM, CGBA 5080 Spectrum Drive, Suite 900E Addison, TX 75001 Telephone: 469-232-2140 Email: RWaggoner@McGriff.com

C. Failure to respond to all portions of this RFP may result in the PROPOSER's response being deemed

non-responsive. If DISTRICT deems a Proposal non-responsive, it will be disqualified. An officer or principal of the PROPOSER must sign proposals, however, an agent if accompanied by written evidence of authority may sign them.

D. The Proposal response should indicate whether the PROPOSER would be able to include all items

identified in Section IV of this Request for Proposal. If a Proposal does not identify whether the PROPOSER will include these items, the PROPOSER may be disqualified.

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E. All Proposals should include the PROPOSER's federal tax identification number.

VII. SELECTION PROCESS

DISTRICT will conduct a comprehensive evaluation of all Proposals received in response to this RFP. DISTRICT will establish a Selection Committee comprised of staff members to perform such evaluation. Each Proposal received will be analyzed to determine overall responsiveness and qualifications under the RFP; further, the Selection Committee may select proposing organizations for "in person" presentation. Criteria to be evaluated, not necessarily in order of priority, may include the items listed below. Final approval of a selected PROPOSER is subject to the action of DISTRICT's Administrative Board. A. Economic evaluation of the Proposed Fee Schedule (20%)

1. The purchase price 2. Long-term cost to DISTRICT

B. Responsiveness to the Request for Proposal (20%)

1. Requested information included and thoroughness of response. 2. Understanding and acceptance of the scope of services. 3. Acceptance of the RFP and Contract requirements. 4. Clarity and conciseness of the response.

C. PROPOSER's capability to provide the services requested and information contained in Attachment "A". (60%)

1. Background of PROPOSER and support personnel, including professional qualifications. 2. Relevant experience of the PROPOSER. 3. Specific experience with public entity clients, especially school districts. 4. Other resources, including the total number of employees, number and location of offices. 5. References and experience in the Texas public sector. 6. PROPOSER’s past relationship with DISTRICT. 7. The impact on the ability of the DISTRICT to comply with laws and rules relating to historically

underutilized businesses. DISTRICT may accept, within the time specified herein, any Proposal in whole or in part, whether or not there are negotiations subsequent to its receipt. If subsequent negotiations are conducted, they shall not constitute a rejection or alternate RFP on the part of DISTRICT. The Contract will be awarded to the respondent whose Proposal will be most advantageous to DISTRICT, as determined by the evaluation factor's listed herein and by the recommendation of the Selection Committee with approval of the Board of Trustees.

VIII. TERMS AND CONDITIONS

Execution of Contract: The services outlined are anticipated to commence July 1, 2014, and DISTRICT and the selected PROPOSER must execute all contracts and agreements by no more than 14 days after DISTRICT notifies the PROPOSER that it has been selected to perform the services. DISTRICT's notice will be made in writing. DISTRICT will require the successful PROPOSER to enter into Contract with the DISTRICT. Contract documents are not binding on the DISTRICT until approved as to form by the DISTRICT Legal Counsel. Submission of Proposals: Four (4) typed and bound copies of the Proposal shall be enclosed in a sealed envelope with the notation "Workers’ Compensation Third Party Claims Administration Services” clearly marked on the envelope. All Proposals are due in the Purchasing Department at the District no later than 1:00 PM CDT, April 14, 2014. Any Proposal received at the location below after that time shall not be considered. Proposals will be opened at 2:00 PM CDT April 14, 2014 in the Purchasing Department.

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Please mail or deliver your Proposal to:

Richardson ISD Purchasing Department 970 Security Row Richardson, Texas 75081 ATTN: Rose Kohut

All provisions in PROPOSER’s Proposal, including any estimated or projected costs, shall remain valid for ninety (90) days following the deadline date for submissions or if a Proposal is selected, throughout the entire term of the Contract. All Proposals become property of DISTRICT upon receipt and will not be returned. Proposals submitted will clearly identify trade secrets or information deemed confidential by the PROPOSER by typing the word "CONFIDENTIAL" in bold fourteen (14) point font on the bottom margin and indicate what information is protected. However, all PROPOSERs are hereby notified that any Proposals submitted to DISTRICT may be subject to disclosure, either in whole or part, under the Texas Public Information Act. Withdrawal of Proposal

Submitted proposals may be withdrawn prior to the proposal due date. Restrictions on Communication

After the RFP has been issued, PROPOSER is prohibited from communicating with DISTRICT staff regarding the RFP or Proposals, with the following exceptions:

• The selection committee during any finalist interviews. DISTRICT shall not schedule meetings with representatives of any PROPOSER to discuss Proposals, and PROPOSER should not contact DISTRICT employees to explain, clarify or discuss their Proposals before an award has been made except as set out in this section. Violation of this provision may lead to disqualification from this process. DISTRICT reserves the right to contact any PROPOSER for clarification after responses are opened and/or to further negotiate with any PROPOSER if DISTRICT so desires. Independent Contractor

It is expressly understood and agreed that PROPOSER and all persons designated by it to provide services in connection with this RFP, is and shall be deemed to be an independent contractor, responsible for its respective acts or omissions, and that DISTRICT shall in no way be responsible for any acts or omissions by the PROPOSER. Neither party hereto has authority neither to bind the other nor to hold out to third party that it has the authority to bind the other.

IX. INSURANCE & INDEMNITY PROVISIONS

A. Prior to the commencement of any work under this CONTRACT, CONTRACTOR shall furnish an original completed certificate(s) of insurance to the DISTRICT's risk manager, which shall be completed by an agent authorized to bind the named underwriter(s) and their company to the coverage, limits, and termination provisions shown thereon, and which shall furnish and contain all required information referenced or indicated thereon. The original certificate(s) must have the agent's original signature, include the signer's company affiliation, title and phone number, and be mailed directly from the agent to the DISTRICT. The DISTRICT shall have no duty to pay or perform under this CONTRACT until such certificate shall have been delivered to the DISTRICT's risk manager, and no officer or employee, other than the DISTRICT's risk manager shall have authority to waive this requirement.

B. The DISTRICT reserves the right to review the insurance requirements of this section during the effective

period of this CONTRACT and any extension or renewal hereof and to modify insurance coverage and their limits when deemed necessary and prudent by the DISTRICT's risk manager based upon changes in

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statutory law, court decisions, or circumstances surrounding this Contract, but in no instance will the DISTRICT allow modification whereupon the DISTRICT may incur increased risk.

C. CONTRACTOR's financial integrity is of interest to the DISTRICT, therefore, subject to CONTRACTOR's

right to maintain reasonable deductibles in such amounts as are approved by the DISTRICT, CONTRACTOR shall obtain and maintain in full force and effect for the duration of this CONTRACT, and any extension hereof, at CONTRACTOR's sole expense, insurance coverage written by companies authorized and admitted to do business in the State of Texas. Requirements are addressed in Attachment C and a Payment/Performance Bond in the amount of the contract.

D. The DISTRICT shall be entitled, upon request and without expense, to receive copies of the policies and all

endorsements thereto as they apply to the limits required by the DISTRICT, and may make a reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations or exclusions (except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any such policies). Upon such request by the DISTRICT, the CONTRACTOR shall exercise reasonable efforts to accomplish such changes in policy coverage, and shall pay the cost thereof.

E. CONTRACTOR agrees that with respect to the above required insurance, all insurance contracts and

certificate(s) of insurance will contain the following required provisions.

A. Name the DISTRICT and its directors, officers, employees, agents and elected officials as additional insureds with respects to the operations and activities of, or on behalf of, the named insured performed under contract with the DISTRICT, with the exception of the workers' compensation/employers' liability and the professional liability policies.

B. The CONTRACTOR's insurance shall be deemed primary with respect to any insurance or self-insurance carried by the DISTRICT for liability arising out of operations under the contract with the DISTRICT.

• Provide for an endorsement that the "other insurance" clause shall not apply to the DISTRICT where

the DISTRICT is an additional insured on the policy.

• Workers' Compensation/Employers' liability policy will provide a waiver of Subrogation in favor of the DISTRICT.

F. CONTRACTOR shall notify the DISTRICT in the event of any notice of cancellation, non renewal or

material change in coverage and shall give such notices not less than ten (10) days prior to the change, or ten (10) days for nonpayment of premium, which notice must be accompanied by a replacement Certificate of Insurance. All notices shall be given to the DISTRICT, by Certified mail, at the following address:

Richardson Independent School District 970 Security Row Richardson, Texas 75081 Attn: Rose Kohut

G. If CONTRACTOR fails to maintain the aforementioned insurance, or fails to secure and maintain the

aforementioned endorsements, the DISTRICT may obtain such insurance and deduct and retain the amount of the premiums for such insurance from any sums due under the agreement, however, procuring of said insurance by the DISTRICT is an alternative to other remedies the DISTRICT may have, and is not the exclusive remedy for failure of CONTRACTOR to maintain said insurance or secure such endorsement. In addition to any other remedies the DISTRICT may have upon CONTRACTOR's failure to provide and maintain any insurance or policy endorsements to the extent and within the time required, the DISTRICT shall have the right to order CONTRACTOR to stop work hereunder, and/or withhold any payments(s) which become due to CONTRACTOR hereunder until CONTRACTOR demonstrates compliance with the requirements hereof.

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H. Nothing herein contained shall be construed as limiting in any way the extent to which CONTRACTOR may be held responsible for payments of damages to persons or property resulting from CONTRACTOR's or its subcontractors performance of the work covered by this CONTRACT.

I. CONTRACTOR covenants and agrees to FULLY INDEMNIFY and HOLD HARMLESS, the

DISTRICT and its elected officials, employees, officers, directors, and representatives, individually or collectively, from and against any and all costs, claims, liens, damages, losses, expenses, fees, fines, penalties, proceedings, actions, demands, causes of action, liability and suits of any kind and nature, including but not limited to, personal or bodily injury, death and property damage, made upon the DISTRICT directly or indirectly arising out of, resulting from or related to CONTRACTOR's activities under this CONTRACT, including any acts or omissions of CONTRACTOR, any agent, officer, director, representative, employee, consultant or subcontractor of CONTRACTOR, and their respective officers, agents, employees, directors and representatives while in the exercise of performance of the rights or duties under this CONTRACT. The indemnity provided for in this paragraph shall not apply to any liability resulting from the negligence of DISTRICT, its officers or employees, in instances where such negligence causes personal injury, death, or property damage. IN THE EVENT CONTRACTOR AND DISTRICT ARE FOUND JOINTLY LIABLE BY A COURT OF COMPETENT JURISDICTION, LIABILITY SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE STATE OF TEXAS, WITHOUT, HOWEVER, WAIVING ANY GOVERNMENTAL IMMUNITY AVAILABLE TO THE DISTRICT UNDER TEXAS LAW AND WITHOUT WAIVING ANY DEFENSES OF THE PARTIES UNDER TEXAS LAW.

J. The provisions of this INDEMNIFICATION are solely for the benefit of the parties hereto and not

intended to create or grant any rights, contractual or otherwise, to any other person or entity.

K. CONTRACTOR shall promptly advise the DISTRICT, in writing of any claim or demand against the DISTRICT or CONTRACTOR known to CONTRACTOR related to or arising out of CONTRACTOR'S activities under this CONTRACT.

X. SCHEDULE OF EVENTS

RFP Release Last Day for Questions

March 10, 2014 March 31, 2014 at 2:00 PM CDT

Proposals Due April 14, 2014 at 1:00 PM CDT Contract Award June 2, 2014 Board of Trustees Start Date July 01, 2014

XI. RESERVATION OF RIGHTS

DISTRICT reserves the right to:

• Reject any and all Proposals received. • Issue a subsequent RFP • Cancel the entire RFP • Remedy technical errors in the RFP process • Negotiate with any, all or none of the respondents to the RFP • Accept the written Proposal as an offer • Waive informalities and irregularities • Accept one or more Proposals This RFP does not commit DISTRICT to enter into a Contract, nor does it obligate it to pay any costs incurred in preparation and submission of Proposals or in anticipation of a Contract.

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ATTACHMENT A

PROPOSAL FORM WORKERS’ COMPENSATION THIRD PARTY CLAIMS

ADMINISTRATION SERVICES

Firm Name Address of Service Office

(City) (State) (Zip) (County) Telephone No. Fax No. Office Hours Date Established Principal Contact for This Proposal PRICING

DISTRICT is requesting proposals with the cost distributed on a "per file" set up with a maximum annual not to exceed fee for any and all workers' compensation. A file is to be defined as per occurrence, regardless of the number of claimants involved in the same occurrence. In the case of indemnity claims under the workers' compensation system, an indemnity file will be defined as an occurrence in which an employee has lost eight (8) calendar days or when medical exceeds $10,000. Each PROPOSER is also requested to submit a flat annual fee for any and all claims. Each PROPOSER will provide pricing that reflects the total bottom line fee for all lines of claims. All claims costs and related expenses will be projected by the PROPOSER and included in the fee quoted. PROPOSER must complete Attachment B. Failure to complete could result in rejection of proposal.

Do fees included in your proposed fee schedule include handling of the claim after suit is filed? Yes No. CLAIMS ADMINISTRATION

Please answer the following questions regarding your ability to administer workers' compensation for the DISTRICT. Answers to all questions, except Item 8, should apply to the specific claims adjusting location that would actually process DISTRICT claims should you be selected. COMPANY QUALIFICATIONS

(Note: If a national or regional company, respond only for the local branch/office that would handle DISTRICT's account.)

1. Principal Owner/Owners/Partners and Officers

2. Date Founded/Opened

3. Total number of full time employees

a. Total number of employees who have left the company within the past 12 months

% of total workers.

b. Total number of adjusters who have left the company within the past 12 months

% of total adjusters employed.

c. Total number of managers/executives who have left the company within the past 12 months

% of managers/executives employed.

4. Number of public entity clients % of total clientele.

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5. Total number of clients

6. List of four (4) similar-size or larger Texas public entity clients, including address, telephone number and contact person. Please indicate length of relationship.

Texas Public Entity Address Telephone No. Contact Person Length of Relationship

a.

b.

c.

d.

7. List the three (3) most recent Texas public entity clients that did not renew their contracts for your services,

including address, telephone number and contact person. Please indicate length of relationship.

Texas Public Entity Address Telephone No. Contact Person Length of Relationship

a.

b.

c.

8. How many claims processing locations does your firm operate in Texas?

9. Which claims processing location will be associated with DISTRICT account?

10. Please indicate the size of the claims processing location in the following terms:

(Note: If location handles claims other than workers’ compensation, respond only for workers’ compensation)

a. Number of accounts served

b. Average number of claims opened each month

c. Average number of claims handled by an adjuster per month

d. Average number of claims processed each month

e. Number of public entities this office handles

11. Please furnish the following information regarding the number of personnel at this location only, and their experience. Please classify each employee in only one of the job categories listed below so that the total will be the total number of employees assigned to the location that will provide services to DISTRICT. Please choose the job category that best describes the function of the employees involved. If all categories are inadequate to describe the function of an employee or a group of employees, please create and describe your own category.

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Claims Experience (in years) JOB CATEGORY

Number of Employees

Most Experienced Employee

Least Experienced Employee

Average Experienced Employee

Texas Experience

Clerical Support

Billing & Premium Collection and Accounting Claims Adjusters | Workers Compensation (No supervisory duties)

Supervisors

Workers’ Compensation Hearing Representative Claims Technical Referral and/or Support (Not assigned directly to processing claims, i.e. cost containment, quality control, audit, etc.)

Computer Professionals Other (Describe)

TOTALS

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12. Please furnish the following information regarding the workers' compensation claims manager of the claim

adjusting location from which DISTRICT claims will be paid.

Name

Years of employment with your firm

Years of experience in insurance industry

Years of experience in workers' compensation claims administration

Professional designations and/or degrees earned

13. Please furnish the following information regarding the Texas Department of Insurance hearing professional that would handle this account.

Name

Years of employment with your firm

Years of experience in insurance industry

Years of Texas Workers' Compensation experience

Years of hearing experience

Professional designations and/or degrees earned

14. Attach an Organizational Chart for the specified claims processing location. Please include a block for each separate function included in the operation, including, any special units that exist.Label each unit with its function, number of employees, and unit name, if it has one. If there are several claims processing units, please indicate the unit that would be involved in the DISTRICT account.

15. Indicate your standards for claims assignment/workload for each adjuster.

16. Compare your actual performance for the 12 months ending December 31, 2013 to standard. (if you are selected, we may ask for support for these figures.)

17. Provide the following statistics regarding your operation as of December 31, 2013:

a. Claims on hand b. Claims requiring medical only payments c. Total claims requiring compensation payments d. Open/active claims e. Number of claims opened each month f. Number of claims closed each month g. Number of TDI hearings each month.

18. Provide information regarding any ongoing training that your employees servicing this account will be required to satisfactorily complete. Indicate if DISTRICT personnel may attend this training and at what cost, if any.

19. Describe the workflow of claims presented by DISTRICT for handling.

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20. If the caseload for an adjuster is greater than the total required by DISTRICT, as defined in Section IV (Scope of Services), would your firm reduce the number to no more than the total active files per adjuster as defined in Section IV? Yes No.

21. If yes, how would this be accomplished?

22. Describe your screening and follow-up system for the following:

a. Review of usual, customary and reasonable medical charges

b. Duplicate billings and duplicate payments

c. Duplicate claims filed against employer's major medical plan or other insurance carriers

d. Selection of physician for independent medical exam

e. Peer review or other means of reporting suspected medical malpractice

f. Overpayment of benefits

23. Describe your quality control program and attach your written internal control procedures. DISTRICT minimum required standards are indicated in Attachments C & D. Can you comply with DISTRICT's minimum standards?

24. Has anyone filed any complaint with Texas Department of Insurance concerning your organization? Yes No.

If "yes", please explain.

25. Describe your documentation procedure for handling customer complaints.

26. Describe your system for managing telephone calls.

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27. Describe your internal audit procedures for the claims office. Include the frequency of the audits, who performs them, and what percentage of claims are audited.

28. How frequently does your diary system allow claims supervisory personnel to review open claims?

29. How are reserves established and monitored?

30. How are allocated expenses monitored and adjusted?

31. Describe contractual options for the years following culmination of the initial contractual agreement.

32. Will you subcontract any portion of the services you propose to furnish? Yes No. If "yes", please provide three vendor options with proposals per service.

Vendor Contracted Service Type Attached Proposal Title

1.

2.

3.

4.

5.

6.

33. Describe your compliance audit procedures for the subcontracted services. Include the frequency of the

audits, who performs them, and what percentage of services are audited.

34. Are you aware of any complaints filed with State Insurance Board or other agencies regarding claims that you have paid or denied? Yes No. If "yes", give full details.

35. Do we have your permission to request an investigation of your firm's financial condition, reputation, etc.? Yes No.

36. Does your firm or do persons within your firm currently have claims or litigation against the DISTRICT? Yes No. If "yes", please explain.

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37. Is your firm, or are persons within your firm currently involved in outstanding claims or litigation which would have bearing on your bid? Yes No. If "yes", please explain.

38. Please attach a copy of all licenses and permits you are required to obtain in order to administer claims in Texas.

39. Is your firm audited by an outside independent auditor?

Yes, as an independent entity.

Yes, as a part of parent corporation.

No (if not, explain below).

40. Has Fidelity Bond or Errors & Omissions coverage ever been refused, non-renewed, or canceled? Yes No. If "yes", please explain.

41. Is your firm currently approved as a Third Party Administrator for any insurance carrier? Yes No. If "yes", please explain.

Name of Insurer Lines of Insurance Administered Amount of Authority

42. Has any insurance company ever withdrawn its authority? Yes No. If "yes", please explain.

43. Has any principal or employee of your firm ever been accused or convicted of mishandling or

misappropriating funds? Yes No. If "yes", please explain.

ADJUSTER QUALIFICATIONS

Complete for each adjuster and supervisor who will service DISTRICT's account

1. Adjuster's Name

Address

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(City) (State) (Zip) (County)

2. Years of adjusting experience

3. Years of public entity adjusting experience

4. Length of adjusting service with your firm

5. Type of adjusting (i.e. inside/outside/public)

6. Current number of claims handled per month by type.

Claim Type Number of Claims Claim Type Number of Claims

Medical Only PHC, BRC and CCH

Lost Time Subrogation

Denials Liability

7. List adjuster's license, include categories and expiration date

8. Languages spoken

9. Languages written

10. Attach adjuster's Resume.

INSURANCE

Please answer the following questions regarding your firm:

1. Employee Fidelity Bond

Underwriter

Bond Amount

Term From To

Policy Number

2. Professional Liability Coverage

Insurer

Liability Limit

Term From To

Policy Number

*List any claims pending against you

3. Commercial General Liability Insurance

Liability Limit

Term From To

Policy Number

4. Business Automobile Liability

Liability Limit

Term From To

Policy Number

5. Workers’ Compensation

Liability Limit

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Term From To

Policy Number

MISCELLANEOUS

A. Have you completed and attached all requested Attachments? Yes No.

B. Have the requested support documentation in Sections IV and V. been attached to this Proposal Form? Yes No.

C. Federal tax ID number

I affirm that the information provided herein is correct and that pricing information contained in this document shall remain a valid offer for 90 days following the deadline date for submission or if a Proposal is selected, throughout the entire term of the Contract. By (Authorized Officer)

Type Name and Title

Date

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Attachment B Fee Schedule

Must be completed and returned. Failure to complete could result in rejection of proposal.

Claims Administration Workers Compensation Fee per Claim Annual Fee Annual

Maximum Report Only N/A

Medical Only N/A

Indemnity N/A

RMIS System and Services – Annual Administration Fee N/A

On-Line Claim Reporting N/A

On-Line Computer Services – Provide list of features N/A

Annual Fixed Rate Option Year 1 Year 2 Year 3

Life of File Pricing

Life of Contract Pricing

Allocated Expenses Fee per Claim Flat Fee Fee per Hour

Field Services/Investigation

Section 111 Reporting

Subrogation (Adjuster /Supervisor)

TDI Hearing Attendance (Adjuster/Supervisor)

Medical Cost Containment

Telephonic Case Management

Field Case Management

Vocational Case Management

Preauthorization

Peer Review

RME Coordination

Impairment Rating Review

Designated Doctor Analysis

Medical Bill Review (All)

Medical

Pharmacy

Hospital

Negotiated Savings (Hospital)

Medical Bill Reconsideration

Medical Cost Projection

Legal

Austin Board Representative

Benefit Review Conference

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Contested Case Hearing

Expedited Contested Case Hearing

Appeals Panel

Judicial Review

Litigation

Medical Hearings

Subrogation Handling

Program Implementation Costs Fee per Claim Fixed Fee Implementation

Timeline

Take Over Claims

Medical Only

Indemnity

Run-Off Claims

Medical Only

Indemnity

Please state additional fees not included in the above

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ATTACHMENT C Workers’ Compensation

Minimum Claims Standards

I. PROCESSING

A. Files will be created and assigned within one working day from receipt of the initial report.

B. Contact with claimant will be within one working day from receipt of initial report, either by telephone call or by sending a contact letter.

C. Diaries will be established so that each case is reviewed at least every 30 days, or as needed. Confirmation

of review will be documented.

D. Payments will be made promptly and in accordance with the Workers' Compensation Statute.

E. TPA or an outside agency approved by DISTRICT will audit medical bills for causal relationship and reasonableness of charges.

F. All indemnity cases will be reported to the Index Bureau upon file creation, and a copy will be retained with

the file, at no cost to DISTRICT.

G. Medical only claims will be reviewed for possible closure no less frequently than every 30 days.

H. Copies of all written correspondence from the TPA to/from other parties will be provided to DISTRICT’s Risk Manager, or designee, upon request.

I. On all indemnity claims and/or those claims reserved in excess of $20,000, periodic written reports, at least

bi-monthly, will be provided to DISTRICT accompanied by any pertinent file materials. As an alternative, TPA shall have the ability to submit reports electronically through the MIS System.

II. RESERVING

A. Reserving will be estimated and maintained on the basis of most probable final cost and documented by

dated and initialed reserved worksheets. Reserves will be established and reviewed every 30 days.

B. With the exception of medical only claims, reserve worksheets will be completed for all initial and revised incurred loss estimates.

C. Reserve worksheets will take into consideration the categories of indemnity, medical, rehabilitation, and

allocated expenses, and all major sub categories of each.

D. Changes in reserves must be accompanied by a supervisor's approval.

III. EXCESS REPORTING The excess insurer will be reported to, on a specific excess basis only, on the status of all files that meet the criteria of the policy providers. Such reporting will be conditioned upon DISTRICT providing all necessary coverage and reporting criteria.

IV. FILE DOCUMENTATION

A. Thoroughly completed reserve worksheets will be contained within all indemnity files.

B. All file activity, including telephone conversations or personal meetings and diary reviews will be clearly documented to reflect the date, individuals involved, content of discussion and plan of action.

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C. Specific direction on the investigation and handling of all indemnity and bodily injury cases will be established within one working day from receipt of the initial report and clearly evidenced within the file. All claims will have a recorded statement from claimant as part of the file documentation.

D. TPA's basis for acceptance or denial of compensability will be clearly documented.

E. Copies of all correspondence, including reports to the DISTRICT's Risk Manager, or designee, and reports

to excess carriers, will be documented in the file.

F. All files should utilize a checklist.

V. INVESTIGATION AND CASE MANAGEMENT

A. Initial contact with the claimant will be accomplished or attempted prior to the initial compensation unless the claimant has returned to work. All contacts and attempts to make contact will be fully documented. Claim profiles will be prepared on all claimants with two (2) or more prior workers' compensation indemnity claims. Adjuster will actively work with Medical Professionals, employee and District to enhance DISTRICT's return to work and limited duty programs.

B. Prior to all initial payments of temporary income benefits, and unless a medical report has been received,

the medical provider facility will be contacted to establish extent of injury, causal relationship to the alleged incident, and estimated return to work date.

C. On all questionable cases, informative statements will be secured from the claimant, supervisor, witnesses,

and any other pertinent parties, and DISTRICT's Risk Management Division within three (3) working days of receipt of initial report, wherever possible.

D. Medical reports will be obtained, or the medical provider contacted for same, as frequently as needed for

verification of continuing indemnity payments.

E. Initialed fax by DISTRICT will be obtained prior to each indemnity payment to confirm continued disability, provide status information, and discuss availability of modified duty and part time work.

F. Telephone or personal contact will be maintained with temporarily disabled employees and their

supervisor or other designated persons no less frequently than weekly, to maintain rapport and to monitor medical progress, return to work status and modified duties.

G. Surveillance should be considered, following authorization by DISTRICT, where length or extent of

temporary disability is questioned. Outside investigation services, such as a private investigator, will be employed only where necessary and approved by DISTRICT. Documentation of assignment will include specific reasons for referral. Direction and control will be exercised over the investigator's activities.

H. Independent medical examinations will be scheduled with qualified DISTRICT approved physicians in

cases where treatment, length of disability or extent of permanent impairment assigned is in question. Appointment letters will attach copies of all medical reports, relevant information concerning the case, job information, and detailed description of opinions being sought. This will include coordination with the case manager.

I. Pertinent past medical records will be secured and apportionment addressed in all cases, prior to final

resolution of permanent partial disability, Impairment Income Benefits (IIBS) or Supplemental Income Benefits (SIBS).

J.

Vocational rehabilitation will be administered where approved by DISTRICT.

K. DISTRICT will select appropriate Cost Containment vendor and their services will be paid as an allocated loss adjustment expense by TPA. DISTRICT prefers Cost Containment Services provider not be a wholly owned subsidiary of TPA.

23 RFP 1319

L. Benefit payments will comply with maximum medical improvement and impairment/supplemental income

benefits of the Texas Department of Insurance Statutes. The TPA's workers' compensation manager will approve these payments and this information will be submitted to the Risk Manager, or designee, for review/comment in a timely manner.

M. Where not already reported verbally, in writing, or via electronic means, as time permits for authorization, a

written analysis of all proposed settlements by stipulation or compromise will be provided to DISTRICT's Risk Manager, or designee, for review and authorization.

N. Case Management will be assigned according to criteria established by the DISTRICT and PROPOSER, the

cost will be charged to file.

. Case Management costs will be tracked. On a quarterly basis a report will be provided to DISTRICT by PROPOSER.

O. Adjuster will attend all Workers' Compensation hearings. Fee Schedule costs include all preparation time

and attendance at the hearings.

VI. LITIGATION MANAGEMENT

A. There may be selected cases not handled by DISTRICT’s legal staff. In these instances, Legal Counsel will be selected on the basis of legal expertise and experience in handling workers' compensation cases. DISTRICT's Risk Manager will be contacted for agreement and authorization to utilize selected counsel.

B. Upon referral, a letter will be directed to defense counsel outlining case history, status and work to be

performed; TPA will provide file copies to defense counsel.

C. Legal payments will be applied to the files. On a quarterly basis PROPOSER will provide a report of Legal expenses to DISTRICT.

24 RFP 1319

ATTACHMENT D

INSURANCE REQUIREMENTS Third Party Administrator shall procure and maintain for the duration of the contract, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the contractor, his agents, representatives, employees or subcontractors. The cost of such insurance shall be included in the Contractor's bid.

A. Minimum Scope of Insurance

Coverage shall be at least as broad as:

1. ISO Form Number GL 0002 (Ed 1/72) covering Comprehensive General Liability and ISO Form Number GL 0404 covering Broad Form Comprehensive General Liability; or ISO Commercial General Liability coverage ("occurrence" Form CG 0001). "Claims made" form is unacceptable except for professional liability.

2. Workers' Compensation insurance as required by the Labor Code of the State of Texas, including

Employers' Liability Insurance.

3. Professional Liability.

B. Minimum Limits of Insurance

Contractor shall maintain limits not less than:

1. Commercial General Liability: $500,000 per occurrence for bodily injury, personal injury and property damage. $1,000,000 Aggregate Policy will include coverage for a) Premises - Operations; b) Broad Form Contractual Liability; c) Products and Completed Operations; d) Use of Contractors and Subcontractors; e) Personal Injury; f) Broad Form Property Damage.

2. Workers' Compensation and Employer's Liability: Workers’ Compensation limits as required by the Labor

Code of the State of Texas and Statutory Employer's Liability Limits.

3. Professional Liability $500,000.

C. Deductibles and Self-Insured Retentions

Any deductible or self-insured retentions must be declared to and approved by the District.

D. Other Insurance Provisions

The policies are to contain, or be endorsed to contain the following provisions:

1. General Liability.

a. The District, its officers, officials, employees, Boards and Commissions and volunteers are to be added as "Additional Insureds" as respects liability arising out of activities performed by or on behalf of the vendor, products and completed operations of the vendor, premises owned, occupied or used by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the District, its officers, officials, employees or volunteers. It is understood that the business auto policy under 'Who is an Insured" automatically provides liability coverage in favor of the District.

b. The contractor's insurance coverage shall be primary insurance as respects the District, its officers,

officials, employees and volunteers. Any insurance or self-insurance maintained by the District, its officials, employees or volunteers shall be excess of the contractor's insurance and shall not contribute with it.

25 RFP 1319

c. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the

District, its officers, officials, employees, Boards and Commissions or volunteers.

d. The contractor's insurance shall apply separately to each insured against who claim is made or suit is brought, except with respect to the limits of the insured's liability.

2. Workers' Compensation and Employer's Liability Coverage

a. The insurer shall agree to waive all rights of subrogation against the District, its officers, officials, employees and volunteers for losses arising from work performed by the contractor for the District.

3. All Coverages

a. Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled or non-renewed by either party, reduced in coverage or in limits except after ten (10) days prior written notice by certified mail return receipt requested, has been given to the District.

E. Acceptability of Insurers

The District prefers that Insurance be placed with insurers with an A.M. Best's rating of no less than B+:VI, or, A or better by Standard & Poors. This requirement will be waived for workers' compensation coverage only for those consultants whose workers' compensation coverage is placed with companies who participate in the State of Texas Workers' Compensation Assigned Risk Pool. Professional Liability carriers will need to be approved by the Risk Manager.

F. Verification of Coverage

Contractor shall furnish the District with certificates of insurance effecting coverage required. The certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificates are to be on forms approved by the District and are to be received and approved by the District before work commences. The District reserves the right to require complete, certified copies of all required insurance policies, at any time.

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RICHARDSON INDEPENDENT SCHOOL DISTRICT Richardson, Texas 75081

GENERAL STIPULATIONS AND CONDITIONS OF PROPOSAL

PROFESSIONAL SERVICES

IF THERE ARE CONTRADICTIONS BETWEEN THE GENERAL STIPULATIONS AND CONDITIONS OF BID/ PROPOSAL AND THE SPECIFICATIONS, WRITTEN OR VERBAL, THE GENERAL STIPULATIONS AND CONDITIONS OF PROPOSAL SHALL CONTROL.

I. INVITATION TO SUBMIT STATEMENT OF QUALIFICATIONS:

A. Richardson Independent School District invites all interested and qualified firms to submit proposals in accordance with directions available in the Purchasing Department, 970 Security Row, Richardson, Texas, 75081.

B. For the purpose and clarity of this document only, the terms “RISD” or “District” will herein mean

the Richardson Independent School District and/or the Board of Trustees of Richardson, Dallas County, Texas. As used herein, the term “Proposer” means any reliable person, entity, broker, vendor, and/or contractor who wants to submit a proposal in response to a Request for Statement of Qualifications (RFQ). The term “Proposal” refers to all responses or proposals submitted hereunder.

C. The District will receive sealed Proposals until date and time indicated on the solicitation cover.

Proposals must be delivered to the RISD Purchasing office, 970 Security Row, Richardson, Texas, where they will be opened.

II. PROPOSAL PREPARATION, SPECIFICATIONS SHEET, AND PROPOSAL OPENING:

A. An authorized representative of the firm must sign all Proposals. It is the intent of this solicitation that should a given Proposal be accepted, it will automatically become a part of a binding contract.

B. At the time RISD opens the Proposals, the responsible Buyer, or his/her designate, shall open and

record all Proposals received. Sufficient time will be allotted to analyze all Proposals received and the final recommendations shall be prepared for District review and approval. The District will follow the review process described in the RFQ.

III. BILLING AND PAYMENT/DISCOUNTING:

A. All invoices shall be submitted in duplicate and mailed in accordance with instructions as shown

on the purchase order (unless otherwise noted). All invoices shall be forwarded to: RICHARDSON INDEPENDENT SCHOOL DISTRICT

ATTENTION: ACCOUNTS PAYABLE DEPARTMENT 970 SECURITY ROW RICHARDSON, TEXAS 75081

B. Invoices will be returned for correction unless they contain a detailed description of the invoiced services that is sufficient to allow the District to ascertain the specific services provided and the dates of services. Any expenses that the District has agreed to reimburse shall be itemized. RISD will not be responsible for normal overhead or overtime costs unless the District has specifically

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agreed to such expenses in advance. The original and one copy of the invoice shall be forwarded to the office listed above.

C. Terms for payment: Net 30 days from receipt of complete/correct invoice. All discounts, including

prompt payment, shall be included in bid price. IV. COLLUSION:

A. All Proposers shall sign the appropriate certification as provided on the signature sheet. The District may reject any Proposal that does not include the required certification.

V. COMPLIANCE WITH SPECIFICATIONS:

A. The Proposer shall abide and comply with the true intent of the specifications and not take advantage of any unintentional error or omission.

B. PROPRIETARY INFORMATION – Any information in your proposal that is of a proprietary

nature should be clearly and specifically identified. Such identification shall not limit the District’s right to use such information if it is obtained from another source, or if it comes into the public domain.

C. The District reserves the right to reject any or all Proposals that comply with these specifications, or to accept a higher Proposal price that complies, when, in the judgment of the District, such Proposal offers additional value or function, which justifies the difference in price.

VI. DEVIATIONS FROM SPECIFICATIONS:

All requested deviations from the specifications and requirements stated in the solicitation must be specified in writing by the Proposer at the time the Proposal is submitted. The absence of a written list of requested deviations or exceptions when the Proposal is submitted will hold the firm strictly accountable to the District to the specification or requirement as written. The District reserves the right to reject or modify any requested exception or deviation. Excessive exceptions may result in disqualification of a Proposal.

VII. ERRORS IN PROPOSALS:

Proposers and their authorized representatives shall fully inform themselves as to the conditions, requirements, and specifications before submitting a Proposal. Failure to do so will be at the firm’s risk.

VIII. QUALITY OF PROFESSIONAL SERVICE:

RISD expects that each vendor will perform all contracted services in a good, thorough and professional manner consistent with industry and professional standards for similar services.

IX. SIGNATURE TO BIDS:

Each Proposal must show the full business address and telephone number of the firm and be signed by the person or persons legally authorized to sign contacts. All correspondence concerning the Proposal and contract, including Notice of Award, and Purchase Order, will be mailed or delivered to the address shown on the Proposal in the absence of written instructions from the Proposer to the contrary. The vendor is responsible for notifying RISD in writing of any change of address or contact person.

X. TAXES:

A. The District is exempt from the payment of the Texas Sales Tax. Exemption Certificates for the Federal Excise Tax may be furnished, if such should apply to any item purchased.

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B. Prices quoted shall not include federal excise or state sales and use taxes. Exemption certificates will be furnished upon request.

C. The District’s Tax Identification Number is -75-6002311.

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XI. DISPUTE RESOLUTION:

Any disputes arising out of Proposal or subsequent contract shall be resolved informally, where possible, through conference with the District official responsible for the professional service area in question. Any dispute that cannot be promptly resolved through informal conference shall be presented to the District in writing pursuant to Board Policy GF-- Public Complaints. The timelines set out in that policy shall be followed. A copy of the policy is available at http://pol.tasb.org/Home/Index/370 or from the Director of Purchasing.

XII. GOVERNING LAW/VENUE:

Any contract resulting from the Proposal and all matters related thereto shall be construed according to the laws of the State of Texas. Venue for any disputes between the parties shall lie in Dallas County, Texas.

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SIGNATURE SHEET AND ANTITRUST CERTIFICATION STATEMENT

(Texas Gov’t Code § 2155.005) My signature below confirms that I: 1. propose to furnish, package, mark, and deliver to the Richardson Independent School

District, the supplies, materials or equipment as required in the accompanying specifications, and at the unit price indicated;

2. certify that this firm is an equal opportunity employer and that all employment decisions

are made without regard to the color, race, sex, national origin, religion, age, or disability status of otherwise qualified individuals; and

3. certify that all material and equipment bid by this firm and to be supplied to the

Richardson Independent School District meets all safety and health standards as prescribed by the rules and regulations of the Occupational Safety and Health Act (OSHA).

My signature below affirms under penalty of perjury of the laws of the State of Texas that:

1. I am duly authorized to execute this contract on my own behalf or on behalf of the company, corporation, firm, partnership, or individual (Company) listed below;

2. In connection with this bid, neither I nor any representative of the Company has violated

any provision of the Texas Free Enterprise and Antitrust Act, Tex. Bus. & Comm. Code Chapter 15;

3. In connection with this bid, neither I nor any representative of the Company have

violated any federal antitrust law; and

4. Neither I nor any representative of the Company has directly or indirectly communicated any of the contents of this bid to a competitor of the Company or any other company, corporation, firm, partnership, or individual engaged in the same line of business as the Company.

COMPANY NAME: BIDDER’S SIGNATURE:

Title: _______________________________________ COMPANY OFFICIAL AUTHORIZING BID: _______________________________________ Title: _______________________________________

DATE SIGNED: __________________________________________________________

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ADDRESS: CITY, STATE, ZIP: __________________________________________________________ TELEPHONE: FAX: E-MAIL: __________________________________________________________ TERMS:

Complete and return with proposal

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CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY

MATTERS

I. DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION

(a) In accordance with the provisions of Appendix A to 49 CFR (Code of Federal Regulations), Part 29, the

offeror certifies to the best of the offeror’s knowledge and belief, that it and its principals:

(1) are not presently debarred, suspended, proposed for debarment, declared ineligible, or

voluntarily excluded from covered transactions by any Federal, State or Local Government

department or agency;

(2) have not within a three (3) year period preceding this offer been convicted of or had a civil

judgment rendered against them for the commission of fraud or a criminal offense in connection

with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction

or contract under a public transaction; violation of Federal or State antitrust statutes, or

commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,

making false statements, or receiving stolen property;

(3) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity

(Federal, State, or local with commission of any of the offenses enumerated in (a)(2) above; and

(4) have not within a three (3) year period preceding this offer had one or more public transactions

(Federal, State, or local) terminated for cause or default.

(b) Where the offeror is unable to certify to any of the statements above, the offeror shall attach a full

explanation to this offer.

(c) For any subcontract at any tier expected to equal or exceed $25,000:

(1) In accordance with the provisions of Appendix B to 49 CFR, Part 29, the prospective

lower tier subcontractor certifies, by submission of this offer, that neither it nor its

principals is presently debarred, suspended, proposed for debarment, declared ineligible,

or voluntarily excluded from participation in this transaction by any Federal department

or agency.

(2) Where the prospective lower tier participant is unable to certify to the statement, above,

an explanation shall be attached to the offer.

(3) This certification (specified in paragraphs (c)(1) and (c) (2), above, shall be included in

all applicable subcontracts and a copy kept on file by the prime contractor. The prime

contractor shall be required to furnish copies of the certifications to the Authority upon

request.

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II. FELONY CONVICTION NOTIFICATION AND CRIMINAL BACKGROUND

CHECK

(a) Offeror must give advance notice to the Owner if the person or an owner or operator of the business entity

has been convicted of a felony. The notice must include a general description of the conduct resulting in

the conviction of a felony. The District may terminate any Agreement or if the Owner determines that the

person or business entity failed to give notice as required by this paragraph or misrepresented the conduct

resulting in the conviction. This paragraph requiring advance notice does not apply to a publicly held

corporation. :

(b) Offeror will obtain criminal history record information that relates to an employee, applicant for

employment, or agent of the Offeror if the employee, applicant, or agent has or will have continuing duties

related to the contracted services; and the duties are or will be performed on school property or at another

location where students are regularly present. The Offeror certifies to the Owner before beginning work

and at no less than an annual basis thereafter that criminal history record information has been obtained.

Offeror shall assume all expenses associated with the background checks, and shall immediately remove

any employee or agent who was convicted of a felony, or misdemeanor involving moral turpitude, as

defined by Texas law, from Owner property or other location where students are regularly present. District

shall be the final decider of what constitutes a “location where students are regularly present.” Offeror’s

violation of this section shall constitute a substantial failure.

(c) If the Offeror is the person or owner or operator of the business entity, that individual may not self-certify

regarding the criminal history record information and its review, and must submit original evidence

acceptable to the District with this Agreement showing compliance.

Signature below acknowledges compliance with Section I. DEBARMENT,

SUSPENSION, INELIGILITY AND VOLUNTARY EXCLUSION and

Section II. FELONY CONVICTION NOTIFICATION AND CRIMINAL

BACKGROUND CHECK. SIGNATURE OF OFFEROR: DATE: __________________ PRINTED/TYPED NAME OF OFFEROR:____________________________________ COMPANY NAME: ______________________________________ TEL#: ______________________

Complete and return with proposal

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RICHARDSON INDEPENDENT SCHOOL DISTRICT

STATEMENT OF EQUAL OPPORTUNITY AND NON-DISCRIMINATION

The Richardson Independent School District is committed to fair and equal competition among all vendors. It is the policy of the Richardson ISD to encourage participation in the competitive bid process by all interested parties. The Richardson ISD does not discriminate against any otherwise qualified vendor because of the vendor’s race, color, national origin, age, religion, sex, or disability.

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RICHARDSON INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT

Notice to Vendors: Conflict of Interest Questionnaire Required by Chapter 176 of

the Texas Local Government Code Effective January 1, 2006, any person or entity who contracts or seeks to contract with RISD for the sale or purchase of property, goods, or services (as well as agents of such persons) (hereafter referred to as Vendors) are required to file a Conflict of Interest Questionnaire with the District. Each covered person or entity who seeks to or who contracts with RISD is responsible for complying with any applicable disclosure requirements. RISD will post the completed questionnaires on its website. The Conflict of Interest Questionnaire must be filed:

• No later than the seventh business day after the date that the Vendor begins contract discussions or negotiations with the government entity, or submits to the entity an application, response to a request for proposal or bid, correspondence, or other writing related to a potential agreement with the entity.

• The Vendor also shall file an updated questionnaire not later than September 1 of each

year in which a covered transaction is pending, and the seventh business day after the date of an event that would make a statement in the questionnaire incomplete or inaccurate.

Note: A Vendor is not required to file an updated questionnaire if the person had filed an updated statement on or after June 1, but before September 1 of the year. The Conflict of Interest Questionnaire may be downloaded from the Texas Ethics Commission’s website at http://www.ethics.state.tx.us/whatsnew/conflict_forms.htm. Completed forms should be sent to: Richardson Independent School District Attn: Purchasing Department 970 Security Row Richardson, Texas 75081 The Local Government Officers of the Richardson Independent School District are: Board of Trustees: Kim Quirk

Karen Ellis Kim Caston Lanet Greenhaw Karen Holburn Kris Oliver Adam Meierhofer

Superintendent: Kay Waggoner, Ph.D.

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