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HomeMy WebLinkAboutRFP - 7512 ON-SITE EMPLOYEE WELLNESS CLINIC (2)RFP 7512 On-Site Employee Wellness Clinic Page 1 of 44 REQUEST FOR PROPOSAL 7512 ON-SITE EMPLOYEE WELLNESS CLINIC The City of Fort Collins is requesting proposals from qualified firms to provide an on-site employee wellness clinic. Proposals submission via email is preferred. Proposals shall be submitted n Microsoft Word or PDF format and e-mailed to: purchasing@fcgov.com. If electing to submit hard copy proposals instead, five (5) copies, will be received at the City of Fort Collins' Purchasing Division, 215 North Mason St., 2nd floor, Fort Collins, Colorado 80524. Proposals will be received before 3:00 p.m. (our clock), June 7, 2013 and referenced as Proposal No. 7512. If delivered, they are to be sent to 215 North Mason Street, 2nd Floor, Fort Collins, Colorado 80524. If mailed, the address is P.O. Box 580, Fort Collins, 80522-0580. The City encourages all disadvantaged business enterprises to submit proposals in response to all requests for proposals and will not be discriminated against on the grounds of race, color, national origin for all proposals for negotiated agreements. Questions concerning the scope of the project should be directed to Project Manager, Amy Sharkey, Compensation, Benefits and HRIS Manager at (970) 416-2721 or asharkey@fcgov.com. Questions regarding bid submittal or process should be directed to David Carey, CPPB, Buyer at (970) 416-2191 or dcarey@fcgov.com. The deadline for submitting questions is 5:00 PM (our clock) on Tuesday, May 29, 2013. Please submit your questions via email to Project Manager, Amy Sharkey, with a copy to David Carey. A copy of the Proposal may be obtained as follows: 1. Download the Proposal/Bid from the BuySpeed Webpage, www.fcgov.com/eprocurement The City of Fort Collins is subject to public information laws, which permit access to most records and documents. Proprietary information in your response must be clearly identified and will be protected to the extent legally permissible. Proposals may not be marked ‘Proprietary’ in their entirety. Information considered proprietary is limited to material treated as confidential in the normal conduct of business, trade secrets, discount information, and individual product or service pricing. Summary price information may not be designated as proprietary as such information may be carried Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707 fcgov.com/purchasing RFP 7512 On-Site Employee Wellness Clinic Page 2 of 44 forward into other public documents. All provisions of any contract resulting from this request for proposal will be public information. Sales Prohibited/Conflict of Interest: No officer, employee, or member of City Council, shall have a financial interest in the sale to the City of any real or personal property, equipment, material, supplies or services where such officer or employee exercises directly or indirectly any decision-making authority concerning such sale or any supervisory authority over the services to be rendered. This rule also applies to subcontracts with the City. Soliciting or accepting any gift, gratuity favor, entertainment, kickback or any items of monetary value from any person who has or is seeking to do business with the City of Fort Collins is prohibited. Collusive or sham proposals: Any proposal deemed to be collusive or a sham proposal will be rejected and reported to authorities as such. Your authorized signature of this proposal assures that such proposal is genuine and is not a collusive or sham proposal. The City of Fort Collins reserves the right to reject any and all proposals and to waive any irregularities or informalities. Sincerely, Gerry S. Paul Director of Purchasing & Risk Management RFP 7512 On-Site Employee Wellness Clinic Page 3 of 44 TABLE OF CONTENTS I. REQUEST FOR PROPOSAL SCOPE OF SERVICES II. REQUEST FOR PROPOSAL VENDOR QUESTIONNAIRE (Form to be completed and submitted with Proposal) III. INSTRUCTIONS AND PROPOSAL REQUIREMENTS VI. REVIEW AND ASSESSMENT V. REFERENCE EVALUATION (TOP RANKED FIRM) VI. TIMETABLE EXHIBITS Exhibit A Sample City of Fort Collins Services Agreement Exhibit B Proposer’s Certification Page (Form must be completed and submitted with Proposal) Exhibit C* Current medical plan designs (UMR Core PPO and UMR Advantage PPO) Exhibit D* Current City Enrollment, Cost and Utilization Information Exhibit E* Rate Response Sheets (Form must be completed and submitted with Proposal) *Attached Business Associate Agreement (BAA) must be signed and returned prior to the City of Fort Collins providing RFP Exhibits C through E. RFP 7512 On-Site Employee Wellness Clinic Page 4 of 44 To participate in the RFP process, vendors need to sign and return this Business Associate Agreement (BAA). This BAA must be signed and returned prior to the City of Fort Collins providing Exhibits C through E to this Request for Proposal. BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("Agreement") is entered into on this ___ day of (the "Effective Date"), by and between City of Fort Collins ("Covered Entity") and ______________________ ("Business Associate"). RECITALS: WHEREAS, Covered Entity and Business Associate mutually desire to outline their individual responsibilities with respect to the use and/or disclosure of Protected Health Information ("PHI") as mandated by the Privacy Rule promulgated under the Administrative Simplifications subtitle of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") including all pertinent regulations issued by the U.S. Department of Health and Human Services as outlined in 45 C.F.R. Parts 160, 162 and 164; (“HIPAA Privacy Rules and/or Security Standards”)and WHEREAS, Covered Entity and Business Associate understand and agree that the HIPAA Privacy Rules and Security Standards requires the Covered Entity and Business Associate enter into a Business Associate Agreement which shall govern the use and/or disclosure of PHI and the security of PHI and ePHI. NOW, THEREFORE, the parties hereto agree as follows: Article I Definitions. When used in this Agreement and capitalized, the following terms have the following meanings: Section 1.01 "Breach" shall mean the unauthorized acquisition, access, use, or disclosure of PHI which comprises the security or privacy of such information. However, the term 'breach' shall not include (1) any unintentional acquisition, access, or use of PHI by an employee or individual acting under the authority of a covered entity or business associate if such acquisition, access, or use was made in good faith and within the course and scope of the employment or other professional relationship of such employee or individual, respectively, with the covered entity or business associate; and such information is not further acquired, accessed, used, or disclosed by any person; or (2) any inadvertent disclosure from an individual who is otherwise authorized to access protected health information at a facility operated by a covered entity or business associate to another similarly situated individual at same facility; and (3) any such information received as a result of such disclosure is not further acquired, accessed, used, or disclosed without authorization by any person. Section 1.02 "Electronic Protected Health Information" or “ePHI” shall mean Protected Health Information transmitted by electronic media or maintained in electronic media. RFP 7512 On-Site Employee Wellness Clinic Page 5 of 44 Section 1.03 "Individual" shall have the same meaning as the term "Individual" in 45 C.F.R. §164.501 and shall include a person who qualifies as a personal representative in accordance with 45 C.F.R. §164.502(g). Section 1.04 "Privacy Rule" shall mean the Standards for Privacy of Individual Identifiable Health Information as set forth at 45 C.F.R. Parts 160 and 164 Subparts A and E. Section 1.05 "Protected Health Information" or "PHI" shall have the same meaning as the term "protected health information" in 45 C.F.R. § 164.501, limited to the information created or received by Business Associate from or on behalf of Covered Entity. Section 1.06 "Required by Law" shall have the same meaning as the term "required by law" in 45 C.F.R. § 164.501. Section 1.07 "Secretary" shall mean the Secretary of the Department of Health and Human Services or his or her designee. Section 1.08 “Security Incident” shall mean any attempted or successful unauthorized access, use, disclosure, modification or destruction of information or systems operations in an electronic information system. Section 1.09 “Security Rule” shall mean the Standards for Security of PHI, including ePHI, as set forth at 45 C.F.R. Parts 160 and 164 Subpart C. Section 1.10 “Unsecured Protected Health Information” shall mean protected health information that is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of a technology or methodology specified by the Secretary. Terms used but not defined in this Agreement shall have the same meaning as those terms in the HIPAA regulations. Article II. Obligations and Activities of Business Associate Regarding PHI. Section 2.01 Business Associate agrees to not use or further disclose PHI other than as permitted or required by this Agreement or as Required by Law. Section 2.02 Business Associate agrees to use appropriate safeguards to prevent use or disclosure of the PHI other than as provided for by this Agreement. Section 2.03 Business Associate agrees to ensure that any agents, including sub-contractors (excluding entities that are merely conduits), to whom it provides PHI agree to the same restrictions and conditions that apply to Business Associate with respect to such information. RFP 7512 On-Site Employee Wellness Clinic Page 6 of 44 Section 2.04 Business Associate agrees to provide access, at the request of Covered Entity, and in a reasonable time and manner designated by Covered Entity, to PHI in a Designated Record Set that is not also in Covered Entity's possession, to Covered Entity in order for Covered Entity to meet the requirements under 45 C.F.R. § 164.524. Section 2.05 Business Associate agrees to make any amendment to PHI in a Designated Record Set that the Covered Entity directs or agrees to pursuant to 45 C.F.R. § 164.526 in a reasonable time and manner designated by Covered Entity. Section 2.06 Business Associate agrees to make internal practices books and records relating to the use and disclosure of PHI available to the Secretary, in a reasonable time and manner as designated by the Covered Entity or Secretary, for purposes of the Secretary determining Covered Entity's compliance with the Privacy Rule. Business Associate shall immediately notify Covered Entity upon receipt or notice of any request by the Secretary to conduct an investigation with respect to PHI received from the Covered Entity. Section 2.07 Business Associate agrees to document any disclosures of PHI that are not excepted under 45 C.F.R. § 164.528(a)(1) as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 C.F.R. § 164.528. Section 2.08 Business Associate agrees to provide to Covered Entity or an Individual, in a time and manner designated by Covered Entity, information collected in accordance with paragraph (g) above, to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 C.F.R. § 164.528. Section 2.09 Business Associate agrees to use or disclose PHI pursuant to the request of Covered Entity; provided, however, that Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rule if done by Covered Entity. Article III. Permitted Uses and Disclosures of PHI by Business Associate. Section 3.01 Business Associate may use or disclose PHI to perform functions, activities or services for, or on behalf of, Covered Entity provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity. Section 3.02 Business Associate may use PHI for the proper management and administration of Business Associate and to carry out the legal responsibilities of Business Associate. RFP 7512 On-Site Employee Wellness Clinic Page 7 of 44 Section 3.03 Business Associate may disclose PHI for the proper management and administration of Business Associate and to carry out the legal responsibilities of Business Associate if: (i) such disclosure is Required by Law, or (ii) Business Associate obtains reasonable assurances from the person to whom the information is disclosed that such information will remain confidential and used or further disclosed only as Required by Law or for the purposes for which it was disclosed to the person, and the person agrees to notify Business Associate of any instances of which it is aware that the confidentiality of the information has been breached. Section 3.04 Business Associate shall limit the PHI to the extent practicable, to the limited data set or if needed by the Business Associate, to the minimum necessary to accomplish the intended purpose of such use, disclosure or request subject to exceptions set forth in the Privacy Rule. Section 3.05 Business Associate may use PHI to provide Data Aggregation services to Covered Entity as permitted by 42 C.F.R. § 164.504(e)(2)(i)(B). Article IV. Obligations of Covered Entity Regarding PHI. Section 4.01 Covered Entity shall provide Business Associate with the notice of privacy practices that Covered Entity produces in accordance with 45 C.F.R. § 164.520, as well as any changes to such notice. Section 4.02 Covered Entity shall provide Business Associate with any changes in, or revocation of, authorization by an Individual to use or disclose PHI, if such changes affect Business Associate's permitted or required uses and disclosures. Section 4.03 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 C.F.R. § 164.522, if such restrictions affect Business Associate's permitted or required uses and disclosures. Section 4.04 Covered Entity shall require all of its employees, agents and representatives to be appropriately informed of its legal obligations pursuant to this Agreement and the Privacy Rule and Security Standards required by HIPAA and will reasonably cooperate with Business Associate in the performance of the mutual obligations under this Agreement. RFP 7512 On-Site Employee Wellness Clinic Page 8 of 44 Article V. Security of Protected Health Information. Section 5.01 Business Associate has implemented policies and procedures to ensure that its receipt, maintenance, or transmission of all protected health information (“PHI”), either electronic or otherwise, on behalf of Covered Entity complies with the applicable administrative, physical, and technical safeguards required protecting the confidentiality, availability and integrity of PHI as required by the HIPAA Privacy Rules and Security Standards. Section 5.02 Business Associate agrees that it will ensure that agents or subcontractors agree to implement the applicable administrative, physical, and technical safeguards required to protect the confidentiality, availability and integrity of PHI as required by HIPAA Privacy Rules and Security Standards. Section 5.03 Business Associate agrees to report to Covered Entity any Security Incident (as defined 45 C.F.R. Part 164.304) of which it becomes aware. Business Associate agrees to report the Security Incident to the Covered Entity as soon as reasonably practicable, but not later than 10 business days from the date the Business Associate becomes aware of the incident. Section 5.04 Business Associate agrees to establish procedures to mitigate, to the extent possible, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of this Agreement. Section 5.05 Business Associate agrees to immediately notify Covered Entity upon discovery of any Breach of Unsecured Protected Health Information (as defined in 45 C.F.R. §§ 164.402 and 164.410) and provide to Covered Entity, to the extent available to Business Associate, all information required to permit Covered Entity to comply with the requirements of 45 C.F.R. Part 164 Subpart D. Section 5.06 Covered Entity agrees and understands that the Covered Entity is independently responsible for the security of all PHI in its possession (electronic or otherwise), including all PHI that it receives from outside sources including the Business Associate. Article VI. Term and Termination. Section 6.01 Term. This Agreement shall be effective as of the Effective Date and shall remain in effect until the Business Associate relationship with the Covered Entity is terminated and all PHI is returned, destroyed or is otherwise protected as set forth in Section 7(d). Section 6.02 Termination by Covered Entity. Covered entity shall have the right to terminate this Agreement at any time by providing thirty (30) days’ written notice of such termination to Business Associate. RFP 7512 On-Site Employee Wellness Clinic Page 9 of 44 Section 6.03 Termination for Cause by Covered Entity. Covered Entity may terminate its contract(s) or business association with Business Associate if Covered Entity determines that Business Associate has violated a material term of the contract, to include this Agreement. Section 6.04 Termination by Business Associate. This Agreement may be terminated by Business Associate upon 30 days prior written notice to Covered Entity in the event that Business Associate, acting in good faith, believes that the requirements of any law, legislation, consent decree, judicial action, governmental regulation or agency opinion, enacted, issued, or otherwise effective after the date of this Agreement and applicable to PHI or to this Agreement, cannot be met by Business Associate in a commercially reasonable manner and without significant additional expense. Section 6.05 Effect of Termination. Upon termination of this Agreement for any reason, at the request of Covered Entity, Business Associate shall return or destroy all PHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. Business Associate shall not retain any copies of the PHI unless necessary for proper document retention/archival purposes only or if such PHI is stored as a result of backup email systems that store emails for emergency backup purposes. If the return or destruction of PHI is infeasible, Business Associate shall extend the protections of this Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such PHI. Article VII. Amendment. The parties may agree to amend this Agreement from time to time in any other respect that they deem appropriate. This Agreement shall not be amended except by written instrument executed by the parties. Article VIII. Severability. The parties intend this Agreement to be enforced as written. However, (i) if any portion or provision of this Agreement will to any extent be declared illegal or unenforceable by a duly authorized court having jurisdiction, then the remainder of this Agreement, or the application of such portion or provision in circumstances other than those as to which it is so declared illegal or unenforceable, will not be affected thereby, and each portion and provision of this Agreement will be valid and enforceable to the fullest extent permitted by law; and (ii) if any provision, or part thereof, is held to be unenforceable because of the duration of such provision, the Covered Entity and the Business Associate agree that the court making such determination will have the power to modify such provision, and such modified provision will then be enforceable to the fullest extent permitted by law. RFP 7512 On-Site Employee Wellness Clinic Page 10 of 44 Article IX. Notices. All notices, requests, consents and other communications hereunder will be in writing, will be addressed to the receiving party's address set forth below or to such other address as a party may designate by notice hereunder, and will be either (i) delivered by hand, (ii) made facsimile transmission, (iii) sent by overnight courier, or (iv) sent by registered mail or certified mail, return receipt requested, postage prepaid. If to the Covered Entity: City of Fort Collins If to the Business Associate: Article X. Regulatory References. A reference in this Agreement to a section in the Privacy Rule means the referenced section or its successor, and for which compliance is required. Article XI. Headings and Captions. The headings and captions of the various subdivisions of the Agreement are for convenience of reference only and will in no way modify or affect the meaning or construction of any of the terms or provisions hereof. Article XII. Entire Agreement. This Agreement sets forth the entire understanding of the parties with respect to the subject matter set forth herein and supersedes all prior agreements, arrangements and communications, whether oral or written, pertaining to the subject matter hereof. Article XIII. Binding Effect. The provisions of this Agreement shall be binding upon and shall inure to the benefit of both Parties and their respective successors and assigns. Article XIV. No Waiver of Rights, Powers and Remedies. No failure or delay by a party hereto in exercising any right, power or remedy under this Agreement, and no course of dealing between the parties hereto, will operate as a RFP 7512 On-Site Employee Wellness Clinic Page 11 of 44 waiver of any such right, power or remedy of the party. No single or partial exercise of any right, power or remedy under this Agreement by a party hereto, nor any abandonment or discontinuance of steps to enforce any such right, power or remedy, will preclude such party from any other or further exercise thereof or the exercise of any other right, power or remedy hereunder. The election of any remedy by a party hereto will not constitute a waiver of the right of such party to pursue other available remedies. No notice to or demand on a party not expressly required under this Agreement will entitle the party receiving such notice or demand to any other or further notice or demand in similar or other circumstances or constitute a waiver of the right of the party giving such notice or demand to any other or further action in any circumstances without such notice or demand. The terms and provisions of this Agreement may be waived, or consent for the departure therefrom granted, only by written document executed by the party entitled to the benefits of such terms or provisions. No such waiver or consent will be deemed to be or will constitute a waiver or consent with respect to any other terms or provisions of this Agreement, whether or not similar. Each such waiver or consent will be effective only in the specific instance and for the purpose for which it was given, and will not constitute a continuing waiver or consent. Article XV. Governing Law. This Agreement will be governed by and construed in accordance with the laws of the State of Colorado. Article XVI. Interpretation. It is the Parties' intent to comply strictly with all applicable laws, including without limitation, HIPAA, state statutes, or regulations (collectively, the "Regulatory Laws"), in connection with this Agreement. In the event there shall be a change in the Regulatory Laws, or in the reasoned interpretation of any of the Regulatory Laws or the adoption of new federal or state legislation, any of which are reasonably likely to materially and adversely affect the manner in which either Party may perform or be compensated under this Agreement or which shall make this Agreement unlawful, the Parties shall immediately enter into good faith negotiations regarding a new arrangement or basis for compensation pursuant to this Agreement that complies with the law, regulation or policy and that approximates as closely as possible the economic position of the Parties prior to the change. In addition, the Parties hereto have negotiated and prepared the terms of this Agreement in good faith with the intent that each and every one or the terms, covenants and conditions herein be binding upon and inure to the benefit of the respective Parties. To the extent this Agreement is in violation of applicable law, then the Parties agree to negotiate in good faith to amend this Agreement, to the extent possible consistent with its purposes, to conform to law. RFP 7512 On-Site Employee Wellness Clinic Page 12 of 44 IN WITNESS WHEREOF, the parties have executed this Business Associate Agreement as of the Effective Date. BUSINESS ASSOCIATE: _________________________________ By: Print Name: Title: COVERED ENTITY: CITY OF FORT COLLINS By: Print Name: Title: RFP 7512 On-Site Employee Wellness Clinic Page 13 of 44 REQUEST FOR PROPOSAL 7512 ON-SITE EMPLOYEE WELLNESS CLINIC I. SCOPE OF SERVICES BACKGROUND The City of Fort Collins, the City, currently offers two medical plan options to their members; a UMR Core PPO and a UMR Advantage PPO (please refer to Exhibit C for plan designs). In addition, the City has a comprehensive Wellness Program described below. The City would like to open an on-site clinic in the Summer/Fall of 2014 for all employees and dependents (children over age 2 or Vendor’s recommended age). The City would like Vendors to provide two quotes using the Rate Response Sheets attached to this RFP as Exhibit E:  One assuming all employees have access to the clinic  One assuming all employees/dependents have access to the clinic. The City’s Current Wellness Program It is an important requirement of the City that the on-site vendor selected be able and willing to integrate their efforts with those of the City’s Wellness Program. Wellness Program Vision To have the healthiest workplace in America. Wellness Program Mission To provide City of Fort Collins employees, and their families, with exceptional wellness programming which motivates them towards healthy lifestyle choices, and ultimately healthier, more productive lives. 2013 Well Day Incentive Program Philosophy The goal of the 2013 Well day Incentive Program is to empower employees through education and opportunities to make lifestyle choices that reduce the risk of illness and injury, and to provide support and encouragement throughout the process. We recognize the need to be accessible to individuals at different stages of change. General Information Employees who are in a benefit-eligible position will be eligible to earn up to three Well Days. Non-benefit eligible employees and employees Police Services employees may participate and will be eligible for prize drawings each trimester. Program Basics For 2013, there will be three trimesters as well as three chances to earn a well day, one per trimester. Dates for the trimesters are below, and are important because to earn a well day you must have accumulated 300 total points by the end of each trimester. RFP 7512 On-Site Employee Wellness Clinic Page 14 of 44 The 3 trimesters: February 1 - May 16 May 17 - August 29 August 30 - December 12 Of the 300 points, you must earn at least 100 in each of the following categories:  Awareness  Behaviorcation  Activities Each category has specific tasks you can choose from in order to earn points in that specific category. Also your points will transfer from one trimester to the next, so if you accumulate extra points in the first trimester, you will start out with more in the second! Mandatory Points:  1st trimester: o Registration & Pre Survey – 25 points o Mayo Clinic Health Risk Assessment (HRA) – 100 points (available after April 1st)  2nd trimester: o Blood Pressure (BP) check – 25 points  3rd trimester: o Post-Program Survey – 25 points  Disease Management: o If you are eligible for UMR’s Disease Management Program, they will contact you by phone o If you are eligible for this program, you must participate to receive your well day o You will receive 200 points in the behaviorcation category for participating in this program Clinic Scope The vendor selected by the City must be able to offer the following services and work within the scope described below:  One of the primary goals of the clinic is to work hand in hand with the current Wellness Program offered by the City. The on-site clinic staff will be expected to:  Coordinate wellness efforts with the City’s benefits staff, including the Wellness Coordinator.  Be knowledgeable about the City’s Wellness offerings/classes and refer employees to those resources accordingly. RFP 7512 On-Site Employee Wellness Clinic Page 15 of 44  Be willing to obtain employee waiver in order to share information with the City’s Wellness Coordinator.  The vendor selected must be able to categorize employees based on their health risk and set up individual health plans for each employee (such as high risk individuals must visit the clinic X times during the year). The vendor must work with the City’s Wellness Coordinator to help employees meet their established clinic goals. The vendor must then be able to report back to the City’s benefits staff on which employees have met the established “clinic” goals. It will be a requirement that employees meet the “clinic” goal to receive the premium reduction mentioned in the section above. If the City decides to have goals set for spouses, the vendor must also be willing and able to set “clinic” goals for spouses as well.  The vendor selected must have exceptional reporting and data gathering capabilities. It is the goal of the City that the vendor selected maintain an individual health record for all employees visiting the clinic including but not limited to:  biometric results,  any additional lab work results,  HRA information,  PA/NP notes and recommendations,  goals set for employee and  claim information provided by UMR  The vendor selected must also work hand in hand with the employee’s primary care provider or specialist by providing the above mentioned information to such providers as needed and collaborating on treatment plans and goals. The vendor must also provide necessary referrals to in-network physicians as needed.  The City will provide and pay for the location (lease) and build-out of the proposed site (including equipment). It is expected that the on-site vendor provide the staffing and medical and prescription drug supplies needed to open and maintain the clinic.  The clinic will be staffed by one PA/NP and a Medical Office Assistant for 32-36 hours per week, based on need and projected use of the clinic. The clinic staff will be employees of the on-site clinic vendor.  The clinic will house a waiting area, exam room(s), restroom(s), a blood workup lab, office and secure area for medical records and prescription medications, training and conference space as well as possible expansion for physical therapy or exercise. RFP 7512 On-Site Employee Wellness Clinic Page 16 of 44  Employees and dependents enrolled in one of the City medical plans would be eligible to access services at the clinic at no cost.  Clinic services would include but not be limited to:  Routine exams, screenings, vaccinations and immunizations  Acute care (ear infections, cold, flu, muscle strain, respiratory infections, strep, laceration repair, etc.)  Dispensing free prescriptions (limited scope)  Managing medication compliance by members  Chronic care maintenance follow-up  Individualized plans to reduce risk factors  School/sports/camp physicals  Well-being educational classes (nutrition, exercise, etc)  Smoking cessation and weight management support  Diabetic and blood pressure management  Disease Management  Mental health screening and referrals  Musculoskeletal consultation  No occupational health will be provided at the clinic.  The on-site vendor must be able to provide performance guarantees on:  Return on investment  Employee satisfaction  Wait times  City satisfaction  Reporting capabilities  Patient confidentiality Vendor Qualifications The vendor must demonstrate at least three (3) years of successfully administering similar medical clinics. The vendor must show a financial model for the proposed services to include a return on investment (ROI) analysis of the proposed services. RFP 7512 On-Site Employee Wellness Clinic Page 17 of 44 II. REQUEST FOR PROPOSAL VENDOR QUESTIONNAIRE Please complete questionnaire and return with Proposal. Incomplete Proposals may not be considered. Attach additional pages as necessary. General Information 1. Name of your organization and date established. 2. Please provide a brief history of your organization. Explain medical services/clinical experience for the last three years. 3. Provide the contact information of the individual(s) authorized to answer any questions related to the proposal. Name: Title: Address: Phone Number: Fax Number: Email Address: On-site Medical Clinic General Information 1. Please identify any aspects of the “Clinic Scope” described on pages 13-14 that you are not able to provide or that do not fit your clinic model. 2. How many other clinics are currently being serviced by your firm, from where and how many eligible participants do they have? 3. Describe your company’s performance standards with respect to: (attach samples from current clients) a. employee inquiries (both written and telephonic); b. wait times; c. monthly invoice accuracy (statistical, payment, financial, technical); d. patient satisfaction surveys; and e. documented face-to-face time with person providing the care. 4. For our information, please describe the nature of the contract you would propose, indicating: a. length of time of the contract; b. length of time your fees are guaranteed; c. proposed service renewal guarantees or terms; and d. termination notices required. 5. If your company is selected, describe in detail the steps and schedule/timeline necessary to implement the clinic. RFP 7512 On-Site Employee Wellness Clinic Page 18 of 44 6. Describe your company’s quality assurance and/or internal audit procedures and programs. To whom does your in-house audit/quality assurance persons report? 7. Describe your clinic appointment scheduling system, proposed clinic wait times, the method in which employees will be notified of an appointment, and the amount of face-to-face contact with a medical care provider. 8. Describe your policy relative to sharing, selling, or otherwise utilizing member usage and other member data. 9. How is confidentiality assured? How is it communicated to participants? 10. What practices do you have in place to protect the confidentiality of individual information when electronically transferring or storing information? Financial Plan 1. How do you measure ROI? What are the measures you use? 2. What kind of ROI can a client expect? 3. Please provide two (2) actual client annual reports detailing ROI. 4. Will you provide a guaranteed ROI? 5. Please provide in detail your financial administration plan, including your administration, staffing, and other elements. 6. What financial reporting of materials can we expect to receive and when? 7. Please complete Exhibit E (Rate Response Sheets). Make sure to complete both tabs within the excel spreadsheet (one tab is the rate response assuming only employees have access to the clinic and the other tab is the rate response sheet assuming that both employees and dependents have access to the clinic). In completing the rate response sheets, please make sure that you have clearly communicated the cost of each of the services listed and explained in detail any additional costs projected to be incurred. 8. Based on the current enrollment outlined in Exhibit D (number of eligible employees, spouses and children), what participation by tier would you expect if the clinic were only offered to employees? If the clinic were offered to both employees and dependents? 9. Based on your enrollment assumptions in question 8, how many clinic hours would you recommend in both scenarios? On-site Medical Clinic Technical Information 1. Describe in detail your hardware and software systems, and in particular your scheduling and invoicing editing capabilities. Describe methods/procedures/services used to prevent unexpected computer downtime (e.g., disaster recovery procedures, physical security of computer facilities, and internal controls relative to computer system access.) RFP 7512 On-Site Employee Wellness Clinic Page 19 of 44 2. Describe the proposed medical system software you will use to interface with City of Fort Collins employees’ primary care physicians. Describe in detail who will own this system and how this system will work to ensure consistency in the delivery of information to primary care physicians. 3. In addition to the above, please provide your proposed electronic file layout (Electronic Health Record, (EHR)/specifications for a weekly eligibility file submission for the City. Does your preferred electronic file layout include:  Personal Health Record Component  EHR interface with any existing proprietary Personal Health Records  Other standard interfaces your EHR has to offer (describe)  Does your EHR have an employee portal  Disease registry features your EHR offers (describe) 4. Please state what records belong to the client upon contract termination. How will these records be transferred to the City at termination? 5. Please submit a sample of your monthly invoicing. Would you be willing to customize the information contained in these forms? If so, what customization is available and would there be an additional cost for this service? 6. Explain your ability/willingness to customize or adjust your education program to meet the unique needs of City of Fort Collins employees. Please provide current examples of this customization with your current programs. 7. Please attach samples of standard reports or any special cost containment reports available. Please explain how often the reports are provided and if there is a charge. 8. Please include a sample copy of a clinic compliance report (eg. the clinic will set clinic goals for employees and the City will require reports outlining who did and did not meet their set goals). 9. Please provide a list of all data elements that will be captured. Do you capture Current Procedural Terminology (CPT) classifications? If yes please provide; if no, why not? On-site Medical Clinic Communication and Education Plan 1. Describe in detail your educational outreach program elements for the City of Fort Collins. Please provide examples of outreach educational components you have implemented in other programs you are currently involved with. 2. Describe how you would communicate the programs to an audience spread out over multiple locations. What media are used? How do you continue to promote the program after the initial rollout and at what frequency? Do you send direct mailings and at what cost? Provide copies (both English and Spanish). 3. How would you suggest outreach to spouses and dependents? RFP 7512 On-Site Employee Wellness Clinic Page 20 of 44 4. Specific to employee communication, what is your typical time frame for implementation? Please provide an implementation time line with activities and responsible parties. 5. Do you provide drafts of all necessary communications? What is your process of approval for communication? Can these be customized by location? 6. Please describe your account management team. Who will be responsible for the account and who will be the employer’s day-to-day contact? Where are these individuals located? Please provide a brief description of their experience and years with your organization. 7. How are you going to communicate with local community healthcare providers? On-site Medical Staffing Plan 1. Do you employ a Medical Doctor (MD) as a medical director? What are his/her credentials? 2. Provide and describe in detail your staffing model based on information provided in regards to plan utilization. 3. Based upon the information submitted herein, please develop a plan demonstrating how services will be provided to City of Fort Collins employees and by whom. Wellness and Prevention Plan 1. Please describe your proposed Wellness approach delivered through the clinic. Will you require Health Risk Assessments, how often and how will you interface with the City of Fort Collins Wellness Program and activities? 2. How often and how will you interface with the City of Fort Collins Wellness Program and activities as they relate to blood/lipid profile? 3. Would you be willing to use the City’s current HRA? Risks Assessed: Alcohol Use Blood Pressure Blood Sugar Cholesterol Emotional Health Exercise Nutrition Safety Tobacco Use Triglycerides Weight 4. Would you be willing to incorporate in the City’s current blood/lipid profile, which includes a CHEM-SCREEN/TSH/LIPID and a CBC (INC. DIFF/PLT)? RFP 7512 On-Site Employee Wellness Clinic Page 21 of 44 5. Provide an executive summary of the wellness services you provide. Provide information regarding the measurable effectiveness of these services. 6. Confirm that you provide the following services:  Flu shots  Immunizations If so, please list _________________________  Booster shots If so, please list _________________________ 7. Are wellness and prevention medical services your main line of business? If not, please explain in detail where and how wellness fits into your business plan. 8. Describe qualifications, services, or other information unique to your company in the wellness and prevention area. 9. Please give a list of the different Partners/Vendors you already have an interface built with to exchange data (e.g., Pharmacy Benefit Managers, Third Party Administrators, and Mental Health/Employee Assistance Program providers.) 10. Describe how you will work with the on-site wellness coordinator and employee wellness program. 11. Please list each educational service available to wellness participants. Are self- care books available and at what cost? 12. Please provide a URL and password for a web site demo, if available. Disease Management Plan 1. Describe how you will function/coordinate with the Disease Management program currently in place with our medical provider. How will the clinic enhance services to our users? 2. Do you offer your own Disease Management program? If so, please describe in detail. 3. Which diseases are included in your Disease Management program?  Depression  Asthma  Low Back Problems  Obesity  Osteoporosis  High Cholesterol  Pain  Other ____________________ RFP 7512 On-Site Employee Wellness Clinic Page 22 of 44 4. How will you identify which members to enroll in the Disease Management program? 5. What kinds of health coaching does the Disease Management program include?  Phone  Online  Face-to-face 6. Do you have a system for reminding members when their yearly and age appropriate screenings are due? If so, explain the system. 7. Does your generic medicine benefit include prescriptions and/or over the counter medications to treat these diseases or conditions?  Mental Health Conditions (i.e. Common Mental Health Conditions and/or Depression)  Asthma  Cancer  Heart Disease  Chronic lung disease (Chronic Obstructive Pulmonary Disease)  Diabetes  High Risk Pregnancy  Hypertension  Low Back Problems  Obesity  Osteoporosis  High Cholesterol  Pain  Tobacco Use  Allergies  Gastro-esophageal reflux disease (GERD) 8. Do you have a system in place to identify generic medications for members enrolled in a Disease Management program? If so, please describe the system. Biometric Health Risk Assessment (HRA) 1. Describe the biometric HRA tool your organization offers. Please attach a sample. 2. What tests are included in the biometrics done? RFP 7512 On-Site Employee Wellness Clinic Page 23 of 44 3. What is the average participation rate for your current clients? 4. How often would you expect/require participants to complete the HRA? The biometrics? 5. Explain your experience designing incentive systems to drive participation, including your most successfully-designed incentive program. 6. When can we anticipate receiving the aggregate (HRA & biometric) report to the employer? Please provide samples of both. 7. Please complete the grid below with a checkmark or specific answer (yes or no) if your HRA plan includes the feature described. Please include a copy of your HRA. HRA PRODUCT FEATURE Included? Web-based HRA Paper-based HRA Biometric clinic based Provides information on confidentiality Provides information on how data will be used DATA COLLECTED Health status Chronic conditions Family health history Medications Lifestyle risks Safety Preventive exams (If so, please specify which exams.) Immunizations Biometrics (If so, please specify which biometrics.) Readiness to change INDIVIDUAL RESULTS High-risk clinical situations are identified and appropriate steps can be taken for immediate intervention. Score communicated Focus/priority of individual’s health/lifestyle areas are communicated Health improvement recommendations are made Action steps provided Can go to specific topics within web site Summary report is available online Summary report can be printed Links to additional health information are available Provides information or links to risk reduction programs Employer can customize messages on their Uniform Resource Locator (URL) to include references and links to internal programs or other vendors EMPLOYER REPORTS RFP 7512 On-Site Employee Wellness Clinic Page 24 of 44 Web-based/electronic reports available Reports can be printed Lifestyle risks are reported Health status are reported Chronic conditions are reported Risk Stratification Report Other Questions: 1. If you use the City’s current HRA and/or other employee clinical information, how will that be uploaded in to the Vendor’s Electronic Medical Records? Is there a cost? 2. Will you assist in on-site employee education as requested? If yes, how and what is the cost? 3. Can you provide educational or other materials in electronic format for posting? 4. Do you have a web site for participants? For health information, education, scheduling? 5. How do you handle referrals to specialists? 6. Will your providers be willing to complete dependent sport physicals? 7. Who is legally at risk for all liability issues? 8. Who manages the staff and assures proper credentialing? 9. How do you staff a full time clinic? What are the degrees and credentials of each person providing care to the employee? 10. Describe how you manage and deliver a program for multiple clients to a single location. 11. Are you a franchise? If so, who is the parent company and where is it located? 12. How is HIPAA compliance maintained and implemented through the clinic? 13. What type of dependent and spouse identification is used at the clinic to ensure appropriate validation of this group? 14. Would you entertain the idea of working with your other clients in the Fort Collins area and surrounding counties to allow the City members to use their clinics and vice versa? 15. Please provide information on your other Colorado clients/clinics. 16. Is the PA and/or MOA willing to meet monthly and/or quarterly with City benefits staff? 17. What is the vacation/leave policy for the PA and MOA? 18. Is there an Account Manager, and what is their role? RFP 7512 On-Site Employee Wellness Clinic Page 25 of 44 PROPOSAL REQUIREMENTS: Using the Rate Response Sheets attached as Exhibit E to this RFP, please include two (2) price quotes with proposals: a) One (1) assuming all employees have access to the clinic; b) One (1) assuming all employees/dependents have access to the clinic III. INSTRUCTIONS AND PROPOSAL REQUIREMENTS PART 1 - INSURANCE REQUIREMENTS The Successful Vendor shall carry the insurance specified in the Employee Wellness Clinic Agreement included as Exhibit A with this request for proposal. PART 2 - DEFINED TERMS When used in this RFP, the following terms shall have the following meaning: 2.01 “Addenda” or “Addendum” means a clarification or modification to this RFP issued by the City according to Section 6.01 of these instructions. 2.02 “Agreement” means the form of agreement included as Exhibit A to this request for proposal. 2.02 “Vendor” or “Vendors” means entities responding to this RFP. 2.03 “Project” means the Employee Wellness Clinic as more specifically described in this RFP. 2.03 “Project Manager” means City staff responsible for overall project. 2.04 “RFP” means this Request for Proposal, dated May 10, 2012, for the Employee Wellness Clinic 2.05 “Successful Vendor” means the best qualified, responsible Vendor to whom the City makes an award on the basis of the City's evaluations as hereinafter provided. PART 3 - CONTRACT DOCUMENTS 3.01 The Agreement is included as Exhibit B of this RFP. The Vendor will be expected to sign the Agreement in substantially the same form as presented in Exhibit “A” of this RFP packet, except that the Agreement will be modified to reflect the actual scope of services being provided. Requests for changes or modifications to the Agreement must be noted in the Vendor’s proposal. The failure to note constitutes Vendor’s acceptance of all of the terms and conditions of the City’s form of Agreement that is included with this RFP. The City reserves the right to negotiate optional scope of work items with the Successful Vendor. RFP 7512 On-Site Employee Wellness Clinic Page 26 of 44 3.02 Payment under the Agreement shall be negotiated prior to award. The City will not reimburse the Successful Vendor or other Vendors for any expenses incurred in preparing proposals in response to this RFP. 3.03 The City, in making the Agreement available on the above terms, does so only for the purpose of obtaining proposals on the work and does not confer a license or grant for any other use. PART 4 - QUALIFICATIONS OF VENDOR 4.01 All Vendors must be prepared to submit, within five days of the City's request, written evidence of their qualifications to perform the work. Vendors may be required to submit evidence that they have a practical knowledge of the particular work required by the Project and that they have the financial resources to complete the Project. In determining the Vendor's qualifications, the following factors will be considered: (a) work previously completed by the Vendor, (b) staff and resources available for this Project, (c) recent financial statement relative to resources, including cash and bank credits available, (d) statement of material on hand and available for this Project, (e) whether the Vendor maintains a permanent place of business, and (f) whether the Vendor has appropriate technical experience. Each Vendor may be required to show that it has handled former work so that no just claims are pending against such work. No proposal will be accepted from a Vendor who is engaged on any work that would impair his ability to perform or finance this Project. No proposal shall be accepted from and no agreement will be awarded to any person, firm, or corporation that is in arrears to the City, upon debt or contract that is a defaulter, as surety or otherwise, upon any obligation to the City or that is deemed irresponsible or unreliable by the City. If requested, any Vendor shall be required to submit satisfactory evidence that they have a practical knowledge of the particular service proposed upon and that they have the necessary financial resources to provide the proposed service called for as described in the Contract Documents. 4.02 Evidence of Vendor's qualification to do business in the State of Colorado may be required. 4.03 Vendors will be required to establish to the satisfaction of the City the reliability and responsibility of all proposed subcontractors and suppliers pursuant to the criteria set forth in these Instructions and Proposal Requirements. Prior to the award of the Contract, the City will notify Vendors in writing if the City has reasonable objection to any such proposed subcontractor. In this event, Vendor may, at his option, (1) withdraw his proposal, or (2) submit a substitute acceptable to the City with an adjustment in the proposal to cover any difference in cost. The City may, at its discretion, accept the adjusted proposal or may disqualify the Vendor. RFP 7512 On-Site Employee Wellness Clinic Page 27 of 44 PART 5 - EXAMINATION OF CONTRACT DOCUMENTS AND SITE 5.01 Before submitting a proposal, each Vendor should perform the following as applicable: (a) examine the RFP and project requirements thoroughly; (b) familiarize himself with federal, state, and local laws, ordinances, rules and regulations that may in any manner affect cost, progress or performance of the Project; and (c) study the RFP requirements. 5.02 The submission of a proposal will constitute an incontrovertible representation by the Vendor that he has complied with every requirement of this RFP and that the RFP requirements are sufficient in scope and detail to indicate and convey understanding of all terms and conditions for performance of the Project. 5.03 If a meeting with City Staff or Vendor is desired, the prospective Vendor must contact the Project Manager at least twenty-four (24) hours prior to the time they would like an appointment to review the project, Monday through Friday. City Staff will comply with such requests on a time-available basis only. PART 6 - INTERPRETATIONS AND GOVERNING LAW 6.01 All questions regarding the meaning or intent of this RFP are to be submitted to the City’s Project Manager using the contact information set forth in page 1 of this RFP. Only questions answered by formal written Addenda will be binding. Oral and other interpretations or clarifications will be without legal effect and will NOT be considered in awarding of project. Addenda will be mailed or delivered to all parties recorded by the City as having received the RFP. No addenda will be issued later than three (3) days prior to the proposal due date. It shall be each Vendor's responsibility to make inquiry as to Addenda that have been issued. All Addenda shall become part of this RFP, and all Vendors shall be bound by such Addenda, whether or not received by the Vendor. 6.02 All applicable State of Colorado and Federal laws, City and County ordinances, licenses and regulations of all agencies having jurisdiction shall apply to the Vendor and project throughout and incorporated here by reference. The Agreement with the selected Vendor, and all questions concerning the execution, validity or invalidity, capacity of the parties, and the performance of the Agreement, shall be interpreted in all respects in accordance with the Charter and Code of the City of Fort Collins and the laws of the State of Colorado. PART 7 - CONTRACT TIME 7.01 Contract term will be negotiated prior to execution of the Agreement and made part thereof. The City’s anticipates the Agreement to have an initial term of two (2) years with an option to renew for one additional three (3) year term. PART 8 - PROPOSAL CONTENTS AND FORMAT 8.01 Proposals must specifically include the following, at a minimum: 1. Complete responses to the Vendor Questionnaire (Part III of this RFP) RFP 7512 On-Site Employee Wellness Clinic Page 28 of 44 2. Completed Exhibit B 8.02 In addition, each Vendor must submit the proposal with a complete Certification Page (see Exhibit B to this RFP) in its usual signature by an authorized representative. 1. For corporations, the Certification Page must be executed in the corporate name by the president or a vice-president (or other corporate officer accompanied by evidence of authority to sign) and the corporate seal must be affixed and attested by the secretary or an assistant secretary. The corporate address and state of incorporation shall be shown below the signature. 2. For partnerships, the Certification Page must be executed in the partnership name and signed by a partner, whose title must appear under the signature. The official address of the partnership must be shown below the signature. 3. For joint ventures, the Certification Page shall be signed by each participant in the joint venture or by an authorized agent of each participant, and accompanied by evidence of authority to sign. 4. The names of all persons signing must also be legibly printed or typed below the signature. A proposal by a person who affixes to his signature the word "president", "secretary", "agent", or other designation without disclosing his principal may be held to be the proposal of the individual signing. When requested by the City, evidence of the authority of the person signing shall be furnished. 5. The full name of each person or company interested in the proposal shall be listed on the Certification Page. 8.03 The proposal shall contain an acknowledgment of receipt of all Addenda (the numbers of which shall be filled in on the proposal). 8.04 No alterations in proposals, or in the printed forms therefore, by erasures, interpolations, or otherwise will be acceptable unless each such alteration is signed or initialed by the Vendor. If initialed, the City may require the Vendor to identify an alteration so initialed. No alteration in any proposal shall be made after the proposal has been submitted. 8.05 The address and phone number to which communications regarding the proposal are to be directed must be shown. 8.06 All prices must be written in words and expressed in figures. The unit price items in the proposal must cover all items of work to be done and material to be furnished to fully complete the work in accordance with the RFP’s Minimum Scope of Services, included in Section II of this RFP. The cost of appurtenant items of work, material, and equipment not listed separately, not shown on the drawings or not specified as necessary to complete the work in accordance with the RFP shall be considered as included in the unit price. 8.07 The Vendor may be provided confidential information. Complete confidentiality must be maintained regarding City information and data. Signing of a confidentiality agreement will be required by the Successful Vendor. RFP 7512 On-Site Employee Wellness Clinic Page 29 of 44 8.08 The City is exempt from City, State, and Federal sales/excise taxes. Certificates will be issued upon request. Any appropriate taxes shall be shown as a separate item in the proposal. PART 10 AWARD OF PROJECT 10.01 The City reserves the right and discretion to reject any and all proposals, to waive any and all informalities and to negotiate Agreement terms with the Successful Vendor, and the right to disregard all nonconforming, non-responsive or conditional proposals. Discrepancies between words and figures will be resolved in favor of the words. Discrepancies between the indicated sum of any column of figures and the correct sum thereof shall be resolved in favor of the correct sum. Your attention is called to the fact that proposals that are not completed as directed in this RFP are subject to rejection in the discretion of the City. 10.02 In evaluating proposals, the City shall consider the qualifications of the Vendors, and whether or not the proposals comply with the prescribed requirements. The City reserves the right to reject the proposal of any Vendor who does not pass any such evaluation to the City's satisfaction. 10.03 The proposal of any Vendor that is in arrears to the City upon debt of contract or that is a defaulter, as surety or otherwise, upon any obligation to the City may be rejected. 10.04 If the Agreement is to be awarded, it will be awarded to the most qualified responsible Vendor, the evaluation of whom by the City indicates that the award will be in the best interest of the City. 10.05 If the Agreement is to be awarded, the City will notify the successful Vendor within the time specified in this Section III of the RFP. RFP 7512 On-Site Employee Wellness Clinic Page 30 of 44 VI. REVIEW AND ASSESSMENT Professional firms will be evaluated on the following criteria. These criteria will be the basis for review of the written proposals and interview session. Based on results of the initial evaluation, the City will select finalists for consideration. Any or all proposals may be rejected by The City. The City reserves the right to award based only on written proposal rating results. The finalists may be asked to make formal presentations of their proposals, as well as to demonstrate their systems and procedures for providing employee benefits consulting services. The rating scale shall be from 1 to 5, with 1 being a poor rating, 3 being an average rating, and 5 being an outstanding rating. WEIGHTING FACTOR QUALIFICATION STANDARD 2.0 Scope of Proposal Does the proposal show an understanding of the project objective, methodology to be used and results that are desired from the project? 2.0 Assigned Personnel Do the persons who will be working on the project have the necessary skills? Are sufficient people of the requisite skills assigned to the project? 1.0 Availability Can the work be completed in the necessary time? Can the target start and completion dates be met? Are other qualified personnel available to assist in meeting the project schedule if required? Is the project team available to attend meetings as required by the Scope of Work? 1.0 Motivation Is the firm interested and are they capable of doing the work in the required time frame? 2.0 Cost and Work Hours Do the proposed cost and work hours compare favorably with the project Manager's estimate? Are the work hours presented reasonable for the effort required in each project task or phase? 2.0 Firm Capability Does the firm have the support capabilities the assigned personnel require? Has the firm done previous projects of this type and scope? RFP 7512 On-Site Employee Wellness Clinic Page 31 of 44 V. REFERENCE EVALUATION (TOP RANKED FIRM) The Project Manager will check references using the following criteria. The evaluation rankings will be labeled Satisfactory/Unsatisfactory. QUALIFICATION STANDARD Overall Performance Would you hire this Professional again? Did they show the skills required by this project? Timetable Was the original Scope of Work completed within the specified time? Were interim deadlines met in a timely manner? Completeness Was the Professional responsive to client needs; did the Professional anticipate problems? Were problems solved quickly and effectively? Budget Was the original Scope of Work completed within the project budget? Job Knowledge a) If a study, did it meet the Scope of Work? b) If Professional administered a construction contract, was the project functional upon completion and did it operate properly? Were problems corrected quickly and effectively? RFP 7512 On-Site Employee Wellness Clinic Page 32 of 44 VI. TIMETABLE The following is a proposed timetable developed for this project. You will be notified of any significant change: ITEM DATE Written follow up questions due to the City May 29, 2013 Proposals due to the City June 7, 2013 Finalist vendors notified September 4, 2013 Finalist interviews Week of September 16, 2013 Selection of vendor Week of September 23, 2013 Selected Vendor Presentation to City Management/City Council October 1, 2013 Potential Implementation Date April 1, 2014 RFP 7512 On-Site Employee Wellness Clinic Page 33 of 44 EXHIBIT “A” TO REQUEST FOR PROPOSAL SERVICES AGREEMENT THIS AGREEMENT made and entered into the day and year set forth below by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and , hereinafter referred to as "Service Provider". WITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Scope of Services. The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit "A", consisting of ( ) page and incorporated herein by this reference. 2. The Work Schedule. [Optional] The services to be performed pursuant to this Agreement shall be performed in accordance with the Work Schedule attached hereto as Exhibit " ", consisting of ( ) page , and incorporated herein by this reference. 3. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated within ( ) days following execution of this Agreement. Services shall be completed no later than . Time is of the essence. Any extensions of the time limit set forth above must be agreed upon in a writing signed by the parties. 4. Contract Period. [Option 1] This Agreement shall commence upon the date of execution shown on the signature page of this Agreement and shall continue in full force and effect for one (1) year, unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for an additional period of one (1) year at the rates provided with written notice to the Professional mailed no later than ninety (90) days prior to contract end. RFP 7512 On-Site Employee Wellness Clinic Page 34 of 44 4. Contract Period. [Option 2] This Agreement shall commence , 200 , and shall continue in full force and effect until , 200 , unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed ( ) additional one year periods. Renewals and pricing changes shall be negotiated by and agreed to by both parties. The Denver Boulder Greeley CPIU published by the Colorado State Planning and Budget Office will be used as a guide. Written notice of renewal shall be provided to the Service Provider and mailed no later than ninety (90) days prior to contract end. 5. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within fifteen (15) days from the onset of such condition. [Early Termination clause here as an option 6. Early Termination by City/Notice. Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Service Provider. Such notice shall be delivered at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses: City: City of Fort Collins Attn: Purchasing PO Box 580 Fort Collins, CO 80522 Copy to: City of Fort Collins Attn: PO Box 580 Fort Collins, CO 80522 Service Provider: In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, subject only to the satisfactory performance of the Service RFP 7512 On-Site Employee Wellness Clinic Page 35 of 44 Provider's obligations under this Agreement. Such payment shall be the Service Provider's sole right and remedy for such termination. 7. Contract Sum. The City shall pay the Service provider for the performance of this Contract, subject to additions and deletions provided herein, per the attached Exhibit " ", consisting of ( ) page , and incorporated herein by this reference. 8. City Representative. The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the services provided under this agreement. All requests concerning this agreement shall be directed to the City Representative. 9. Independent Service provider. The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins. The City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose. 10. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the City. 11. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights or benefits provided to the City under this Agreement or cause of action arising out of performance of this Agreement. RFP 7512 On-Site Employee Wellness Clinic Page 36 of 44 12. Warranty. a. Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. b. Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. c. Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City-furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired or replaced by Service Provider in a manner and at a time acceptable to City. 13. Default. Each and every term and condition hereof shall be deemed to be a material element of this Agreement. In the event either party should fail or refuse to perform according to the terms of this agreement, such party may be declared in default thereof. 14. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non-defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be RFP 7512 On-Site Employee Wellness Clinic Page 37 of 44 liable to the non-defaulting party for the non-defaulting party's reasonable attorney fees and costs incurred because of the default. 15. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire agreement between the parties and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representatives, successors and assigns of said parties. 16. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit “B”, consisting of one (1) page, attached hereto and incorporated herein by this reference. The Service Provider before commencing services hereunder, shall deliver to the City's Director of Purchasing and Risk Management, P. O. Box 580 Fort Collins, Colorado 80522 one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City. 17. Entire Agreement. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. RFP 7512 On-Site Employee Wellness Clinic Page 38 of 44 18. Law/Severability. The laws of the State of Colorado shall govern the construction interpretation, execution and enforcement of this Agreement. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such holding shall not invalidate or render unenforceable any other provision of this Agreement. 19. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et. seq., Service Provider represents and agrees that: a. As of the date of this Agreement: 1. Service Provider does not knowingly employ or contract with an illegal alien who will perform work under this Agreement; and 2. Service Provider will participate in either the e-Verify program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the “e-Verify Program”) or the Department Program (the “Department Program”), an employment verification program established pursuant to Section 8-17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired employees to perform work under this Agreement. b. Service Provider shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement. c. Service Provider is prohibited from using the e-Verify Program or Department Program procedures to undertake pre-employment screening of job applicants while this Agreement is being performed. d. If Service Provider obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employs or contracts with an illegal alien, Service Provider shall: RFP 7512 On-Site Employee Wellness Clinic Page 39 of 44 1. Notify such subcontractor and the City within three days that Service Provider has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and 2. Terminate the subcontract with the subcontractor if within three days ofreceiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Service Provider shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. Service Provider shall comply with any reasonable request by the Colorado Department of Labor and Employment (the “Department”) made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17.5-102 (5), C.R.S. f. If Service Provider violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17.5-102, C.R.S. the City may terminate this Agreement. If this Agreement is so terminated, Service Provider shall be liable for actual and consequential damages to the City arising out of Service Provider’s violation of Subsection 8-17.5-102, C.R.S. g. The City will notify the Office of the Secretary of State if Service Provider violates this provision of this Agreement and the City terminates the Agreement for such breach. 20. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit “C“ - Confidentiality, consisting of one (1) page, attached hereto and incorporated herein by this reference. RFP 7512 On-Site Employee Wellness Clinic Page 40 of 44 CITY OF FORT COLLINS, COLORADO a municipal corporation By:_______________________________ Gerry S. Paul Director of Purchasing and Risk Management Date: _____________________________ ATTEST: _________________________________ City Clerk APPROVED AS TO FORM: ________________________________ Assistant City Attorney By: _______________________________ __________________________________ PRINT NAME __________________________________ CORPORATE PRESIDENT OR VICE PRESIDENT Date: _____________________________ ATTEST: (Corporate Seal) _____________________________ CORPORATE SECRETARY RFP 7512 On-Site Employee Wellness Clinic Page 41 of 44 EXHIBIT “B” (To Services Agreement) INSURANCE REQUIREMENTS 1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: "The insurance evidenced by this Certificate will not be cancelled or materially altered, except after ten (10) days written notice has been received by the City of Fort Collins." In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Service Provider's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. RFP 7512 On-Site Employee Wellness Clinic Page 42 of 44 EXHIBIT “C” (To Services Agreement) CONFIDENTIALITY IN CONNECTION WITH SERVICES provided to the City of Fort Collins (the “City”) pursuant to this Agreement (the “Agreement”), the Service Provider hereby acknowledges that it has been informed that the City has established policies and procedures with regard to the handling of confidential information and other sensitive materials. In consideration of access to certain information, data and material (hereinafter individually and collectively, regardless of nature, referred to as “information”) that are the property of and/or relate to the City or its employees, customers or suppliers, which access is related to the performance of services that the Service Provider has agreed to perform, the Service Provider hereby acknowledges and agrees as follows: That information that has or will come into its possession or knowledge in connection with the performance of services for the City may be confidential and/or proprietary. The Service Provider agrees to treat as confidential (a) all information that is owned by the City, or that relates to the business of the City, or that is used by the City in carrying on business, and (b) all information that is proprietary to a third party (including but not limited to customers and suppliers of the City). The Service Provider shall not disclose any such information to any person not having a legitimate need-to-know for purposes authorized by the City. Further, the Service Provider shall not use such information to obtain any economic or other benefit for itself, or any third party, except as specifically authorized by the City. The foregoing to the contrary notwithstanding, the Service Provider understands that it shall have no obligation under this Agreement with respect to information and material that (a) becomes generally known to the public by publication or some means other than a breach of duty of this Agreement, or (b) is required by law, regulation or court order to be disclosed, provided that the request for such disclosure is proper and the disclosure does not exceed that which is required. In the event of any disclosure under (b) above, the Service Provider shall furnish a copy of this Agreement to anyone to whom it is required to make such disclosure and shall promptly advise the City in writing of each such disclosure. In the event that the Service Provider ceases to perform services for the City, or the City so requests for any reason, the Service Provider shall promptly return to the City any and all information described hereinabove, including all copies, notes and/or summaries (handwritten or mechanically produced) thereof, in its possession or control or as to which it otherwise has access. The Service Provider understands and agrees that the City’s remedies at law for a breach of the Service Provider’s obligations under this Confidentiality Agreement may be inadequate and that the City shall, in the event of any such breach, be entitled to seek equitable relief (including without limitation preliminary and permanent injunctive relief and specific performance) in addition to all other remedies provided hereunder or available at law. RFP 7512 On-Site Employee Wellness Clinic Page 43 of 44 APPENDICES A – F TO CLINIC OPERATOR AGREEMENT (TO BE FINALIZED UPON AWARD) A) Scope of Work B) Guidelines / Standards of Work C) List of Permitted Materials for Storage D) Equipment that Clinic Operator Will Provide E) Equipment that the City Will Provide F) Business Associate Agreement RFP 7512 On-Site Employee Wellness Clinic Page 44 of 44 EXHIBIT ”B” TO REQUEST FOR PROPOSAL PROPOSER’S CERTIFICATION NOTE: Please ensure that this document is completed and submitted with your proposal. Failure to do so may result in your proposal not being considered for award. I have carefully examined the Request for Proposal and any other documents accompanying or made a part of this Request for Proposal, including the form of agreement provided as Exhibit A to the RFP (the “Agreement”) and the Business Associate Agreement (the “BAA”) provided. I hereby certify that, if selected, I can meet all insurance and other requirements contained within the Agreement and the BAA and that I will sign the Agreement and the BAA in substantially the form presented in this RFP. I hereby propose to furnish the services specified in the Request for Proposal at the prices or rates quoted in my proposal. I agree to abide by all conditions of this proposal and understand that a background investigation may be conducted on Vendor and individuals employed by Vendor by the Westminster Police Department prior to award. I certify that all information contained in this proposal is true to the best of my knowledge and belief, that I am duly authorized to submit this proposal on behalf of the Vendor, and that the Vendor is ready, willing and able to perform if awarded the contract. I acknowledge that this proposal is a public record and may be subject, upon request, to disclosure to the public. I further certify, under oath, that this proposal is made without prior understanding, agreement, connection, discussion, or collusion with any other person, firm or corporation submitting a proposal for the same product or service; no officer, employee or agent of the City of Fort Collins or of any other Proposer interested in said proposal; and that the undersigned executed this Proposer’s Certification with full knowledge and understanding of the matters therein contained. _________________________ NAME OF BUSINESS BY: _________________________ _________________________ SIGNATURE PRINTED NAME & TITLE ______________________ _________________________________ MAILING ADDRESS _______________________________________________________ CITY, STATE, ZIP CODE ( )___________________ ____________________________ TELEPHONE NUMBER EMAIL