important notice to participating … number: 17-020 risk management incident reporting system . ......
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IMPORTANT NOTICE TO PARTICIPATING VENDORS
RFP Number: 17-020 Risk Management Incident Reporting System
For your solicitation response to be considered you must return a complete and signed
hardcopy original solicitation along with any other documentation requested in the solicitation
Standard Terms/Conditions, Special Terms/Conditions and all Amendments/Addendums, must
be completely filled out, signed, and returned with the solicitation by the published due date.
Your solicitation response must be received in the MHMR Purchasing Department prior to the
published due date and time shown on page 1 of the solicitation. Solicitation responses received
after that date and time will be returned, unopened to the sender.
Thank you for your participation in this process.
Jamie Brockway, M.B.A., CPPO, A.P.P.
Purchasing Manager
MHMR of Tarrant
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 1 OF 34
MHMR OF TARRANT PURCHASING DEPARTMENT
RFP 17-020
REQUEST FOR PROPOSAL
RISK MANAGEMENT INCIDENT REPORTING SYSTEM
BIDS DUE MARCH 23, 2017 AT 2:00 PM
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 2 OF 34
PRE-PROPOSAL CONFERENCE DATE AND TIME
All vendors must attend the scheduled Pre-Proposal Conference in order to get a clear
understanding of the requirements of this RFP:
DATE: March 8, 2017
TIME: 2:00 P. M.
LOCATION: MHMR Tarrant
Purchasing Department
3840 Hulen ST Suite 200
FORT WORTH, TX 76107
RSVP: Vendors planning to attend the pre-proposal conference should RSVP, in writing, no later
than 12:00 P.M. (Noon), March 7, 2017.
Send RSVP to Purchasing Department fax at (817) 810-3100 or email
[email protected] for schedule.
RSVP:
Company Name: _________________________________________________
Contact Name____________________________________________________
Planning to attend Pre-Bid Meeting: __________YES __________NO
If yes, number of representatives from your company:_______________________________
Tel. No.: _____________________________Fax No.: ______________________________
E-Mail Address:_____________________________________________________________
Interested vendors will be required to sign in at each site. Questions from vendors will be
addressed at the pre-proposal conference. Such applicant who submits a bid and does not attend
the scheduled pre-bid conference waives any right to assert claims due to undiscovered
conditions.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 3 OF 34
REQUEST FOR PROPOSAL
INSTRUCTIONS/TERMS AND CONDITIONS
RFP 17-020 Risk Management Incident Reporting System
MHMR of Tarrant (MHMR) is accepting Proposals for furnishing the merchandise, supplies,
services and/or equipment set forth in this Request for Proposal.
THE ORIGINAL AND AN ELECTRONIC (DISC OR FLASH DRVE) COPY
OF
COMPLETED PROPOSAL
MUST BE RECEIVED IN THE
PURCHASING DEPARTMENT
AT 3840 HULEN STREET, SUITE 200
FORT WORTH, TEXAS 76107
ON OR BEFORE 2:00 P.M., MARCH 23, 2017
MHMR of Tarrant invites your firm to submit a Proposal. If you are interest in submitting a
proposal, please adhere to the General Instructions and Requirements as outlined in the enclosed
Request for Proposal.
Vendors shall pay particular attention to all INSTRUCTIONS, REQUIREMENTS AND
DEADLINES indicated in the attached documents and should govern themselves accordingly.
In accepting Proposals, MHMR of Tarrant reserves the right to reject any and all Proposals, to
waive formalities and reasonable irregularities in submitted documents, and to waive any
requirements in order to take the actions, which it deems to be in the best interest of MHMR of
Tarrant, and is not obligated to accept the lowest proposal.
At any time and place established for receipt of the Proposal, MHMR of Tarrant will only release
the names of the Provider(s) and/or Provider Firm(s). No other information will be released until
after MHMR of Tarrant’s Evaluation Team has evaluated the Proposals, and an award has been
made and approved by Executive staff and MHMR’s Board of Trustees.
We greatly appreciate your efforts and look forward to reviewing your submission.
Jamie Brockway
Purchasing Manager
MHMR of Tarrant
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 4 OF 34
SECTION 1 – OVERVIEW
BACKGROUND AND OBJECTIVES
MHMR of Tarrant invites interested and qualified companies herein after referred to as
“Contractors”, “Providers” or “Vendors” to submit Proposals for Risk Management Incident
Reporting System in response to this solicitation.
MHMR has been a provider of quality mental health and intellectual and developmental disability
services in Tarrant since its inception in 1969. It is the second largest community center in Texas,
offering services in the following areas:
Mental health
Intellectual & developmental disabilities
Addiction
Early Childhood intervention
Criminal justice system support
Homelessness
Veterans
Originally a small center offering only mental health services, MHMR now provides services at
more than 100 sites throughout Tarrant and surrounding counties. The staff of more than 2,000
includes psychiatrists, nurses, social workers, therapists, teachers, case managers, dieticians,
volunteers and many others. All committed to providing services in a way that respects the dignity
and basic human rights of the people we serve.
SECTION II – PROPOSAL SCHEDULE (RFP)
Solicitation Packet issue date: Friday, March 3, 2017
Pre-proposal Conference date: Wednesday, March 8, 2017 at 2:00 P.M.
Receive Questions from Prospective Vendors: Friday, March 10, 2017 by 2:00 P.M.
Deadline to Respond to Questions: Wednesday, March 15, 2017 by 4:00 P.M.
Deadline for Submission of RFP: THURSDAY, March 23, 2017 at 2:00 P.M.
Anticipated Award Date: Contingent upon Committee and/or Board Approval
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 5 OF 34
SECTION III – GENERAL INSTRUCTIONS
A. Questions
Deadline for Questions from Vendors: Friday, March 10, 2017 by 2:00 P.M.
Deadline for Response to Questions: Wednesday, March 15, 2017 by 4:00 P.M.
All questions concerning the Proposal specifications must be submitted in writing and emailed to
Jamie Brockway at [email protected]. It is the bidders’ sole responsibility to
review the MHMR Tarrant website and retrieve all related documents prior to the RFP
due date.
B. Submittal Procedure
The Proposal, subject to all conditions and specifications attached hereto, must be signed in INK
by a person or office or the company submitting the Proposal that is authorized to enter into
contractual agreements on behalf of the company. Proposals received unsigned will be deemed
non responsive and therefore; will not be accepted.
Deadline to submit proposal is Thursday, March 23, 2017 at 2:00 P.M. The original Proposal,
signed in ink, and an electronic copy (Disc or Flash Drive) shall be submitted in a SEALED
ENVELOPE and delivered to the attention of:
MHMR TARRANT
PURCHASING DEPARTMENT
ATTN: JAMIE BROCKWAY, PURCHASING MANAGER
3840 HULEN STREET, SUITE 200
FORT WORTH, TEXAS 76107
RFP 17-020 Risk Management Incident Reporting System
DO NOT OPEN UNTIL THURSDAY, MARCH 23, 2017 AT 2:00 P.M.
No proposal will be accepted after the stated deadline. Respondents may mail or personally
deliver their Proposals to the Purchasing Office of MHMR at the above address. MHMR will
not be responsible from any Proposal(s) that is (are) lost in the mail or not delivered to the
Purchasing Department by the stated deadline for any reason.
C. Proposal Opening
Submitted proposals will be opened at a Public Proposal Opening at 2:00 P.M., on Thursday,
March 23, 2017 at 3840 Hulen Street, Suite 200, Fort Worth, Texas 76107.
D. Proposal Format
Submittals shall be on 8 ½ inch by 11 inch, bound, stapled, or in a binder, with a Table of
Contents and all pages numbered. Each section shall be clearly identified and tabbed. For
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proper comparison and evaluation, MHMR requests that proposals follow the format outlined
below.
Tab 1 - Cover Letter - A brief introductory letter of representation.
Tab 2 - Executive Summary – A brief summary highlighting the most important points
of the Proposal. The Summary should not exceed five (5) pages.
Tab 3 - Contractor Background Information - This section should include a
description of the proposer experience with other services similar to the one described
herein.
a. Submit company background information including principal place of business,
length of existence, breadth of experience and expertise, management structure,
and any other information that demonstrates relative qualifications and
experience.
b. Project Manager – Identify the proposed Project Manager and include a resume.
Include an organization chart of the proposed Management Team including key
personnel and their specific roles.
c. Address any performance related litigation that your firm may be, or has been,
involved in over the last five (5) years. Identify if your firm has had any contracts
terminated due to non-performance over the last five (5) years. Identify adverse
actions sanctioned by any regulatory authorities over the last five (5) years.
Tab 4 - Financial Consideration - Include a copy of your latest annual report or other
comparable documentation. As evidenced by the financial information requested of
each vendor, indication that the vendor, or vendors, are financially stable and able to
provide related services in its entirety. W-9 and Certificate of Insurance as required
herein.
Tab 5 - References – Proposer shall submit with this proposal a list of at least three (3)
references that pertain to this type of service or similar project performed by the firm,
preferably for government agencies. Include name of firm, name of representative,
address, telephone number, email address.
Tab 6 - Scope
a. Include a statement that all products and services quoted in proposal are in full
accord with the specifications or a brief listing of all those specification sections
to which the proposer takes exception. All comments shall be listed and numbered
in order of the respective article of the specification. This statement is required
even if no exceptions are noted.
b. Proposer’s participation and responsibility must be clearly defined. Your firm’s
methodology and project management for implementing a successful project
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should be itemized for all phases. Clearly define the planning, design and
implementation process.
c. MHMR’s participation and responsibility must be clearly defined.
d. Include a proposed project schedule identifying tasks, responsibilities and
estimated time commitments from the Agency. Identify all critical milestones.
e. Include Schedule 1, Technical Questionnaire
Tab 7 – Descriptive Literature – Illustrative or descriptive literature, brochures,
specification, drawings, diagrams etc., that provide additional Proposer/product
information with regard to issues addressed in other areas of Proposer’s proposal.
Tab 8 - Proposal Pricing/Delivery - Pricing shall be itemized for all items requested in
this proposal. Brief notes referencing specific line items may be included, if necessary,
for explanation. MHMR will select and award the products and services that best meets
its needs. Vendor Acknowledgement and Proposal Form as required herein.
E. Non-Discrimination Policy Statement
MHMR of Tarrant does not discriminate against any individual or Vendor/Provider with respect
to his/her compensation, terms, conditions, or award of contract because of race, color, religion,
sex, national origin, age, disability, political affiliation, or limit, segregate, or classify candidates
for award of contract, in any way which would deprive or tend to deprive any individual or
company of business opportunities or otherwise adversely affect status as a Vendor/Provider
because of race, color, religion, sex, national origin, age, disability, or political affiliation.
F. Immigration Reform and Control Act of 1986
By submitting their proposals, Offerors certify that they do not and will not during the
performance of this contract employ illegal alien workers or otherwise violate the provisions of
the federal immigration reform and control act.
G. References and Experience
All interest parties are required to submit with their Proposal a comprehensive list of references.
Interested parties are required to provide a minimum of three (3) references where interested
party has provided services (within the last twelve (12) months) that pertain to this type of
services preferably for a government agency. References shall include company names,
address, telephone number, fax number, contact person and an email address. The interested
parties must agree to authorize client to furnish any information required by MHMR to verify
references provided, and for determining the quality and timeliness of previous work performed.
H. Proposal Guarantee/Award Procedure
It is anticipated that a recommendation for award for this Proposal will be made no more than
thirty (30) days after the PROPOSAL DUE DATE. All interested parties are required to
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guarantee their Proposals as an irrevocable offer valid for one hundred twenty (120) days after
the Proposal due date. MHMR of Tarrant in its sole and absolute discretion shall have the right
to award Proposal for any or all items/services listed in each Proposal, shall have the right to
reject any and all Proposals as it deems to be in its best interest, to waive formalities and
reasonable irregularities in submitted documents, shall not be bound to accept the lowest
Proposal and shall be allowed to accept the total Proposal of any one vendor.
I. Permits
Any and all permits as required by authorities having jurisdiction, local, state, county, and/or
federal, are the total responsibility of the interested parties/Vendor/Provider.
J. Financial Information
Vendor/Provider must submit a copy of their last AUDITED financial statement. A letter from
your CPA is an acceptable alternative for Non Public companies, but must include a statement
that financial solvency is adequate to meet expenditures for a least a year.
K. Invoicing/Payments
The bidder shall be paid upon the completion of all of the following: 1) submission of an
original properly itemized invoice showing the proposal and/or purchase order number, 2)
delivery and acceptance of the commodities/services and 3) proper and legal processing of the
invoice. Proposals with payment terms of less than thirty (30) days will not be accepted.
Discounts will be considered and taken if earned. Invoices must be submitted to MHMR, P.O.
Box 2603, Fort Worth, Texas 76113. L. Price Adjustments
Vendor/Provider will be required to honor their proposed prices for the term of the contract
period.
M. Historically Under-Utilized Business (HUB)
This Agency shall make a good faith effort to utilize Historically Underutilized Business
(HUB’S) in contracts for construction, services, (including professional and consulting
services), and commodities. Please submit proof of Historically Underutilized Business “HUB”
state certificate.
If your firm is not certified, please submit Attachment A, if you intend to subcontract services. If
not, write “None” on Attachment A and submit it. N. Minority/Women and/or Disadvantaged Business The Agency shall make a good faith effort to utilize Minority/Women and/or Disadvantage
Businesses (M/W/DBE’s) in contracts for construction, services (including professional and
consulting Services), and commodities. Please submit proof of M/W/DBE certificate.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 9 OF 34
O. Direct or Indirect Assignment
The successful Vendor/Provider will not be permitted to directly or indirectly assign rights or
duties under the contract without express approval from MHMR. P. Form W-9 Vendors are to complete For W-9 and Submit with Proposal Documents.
http://www.irs.gov/pub/irs-pdf/fw9.pdf
SECTION IV – PROPOSAL STIPULATIONS AND REQUIREMENTS
A. Modification or Withdrawal of Proposals Any Proposal may be modified or withdrawn prior to the deadline, provided such modification
or withdrawal is submitted prior to the deadline. Any modification received after the deadline
shall be deemed late and will not be considered.
B. Errors or Omissions:
The bidders will not be allowed to take advantage of any errors or omissions in the
specification. Where errors or omissions appear in the specifications, the bidder shall promptly
notify MHMR in writing of such error or omission it discovers. Any significant errors,
omissions or inconsistencies in the specifications are to be reported no later than five (5) days
before time for the proposal response is to be submitted. C. Offer and Acceptance Period
All Proposals must be an irrevocable offer valid for 120 days after the Proposal opening. D. Late Proposals
Proposal received after the stated deadline shall be deemed late and will not be considered.
E. Irregularities in Proposals Except as otherwise stated in this Request for Proposal, evaluation of all Proposals will be based
solely upon information contained in the Vendor/Provider’s response to this Proposal. MHMR
shall not be held responsible for errors, omissions or oversights of a material nature may
constitute grounds for rejection of any Proposal.
MHMR shall have the right to reject Proposals containing a statement, representations, warranty
or certification which is determined by MHMR and its council to be materially false, incorrect,
misleading or incomplete. Additionally, any errors, omissions, or oversights of a material nature
may constitute grounds for rejection of any Proposal.
The inability of a Vendor to provide one or more of the required components or specified
features or capabilities required by this Proposal may constitute grounds for rejection.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 10 OF 34
F. Oral Presentations
Any Vendor/Provider that submits a Proposal in response to this request may be required to
make an oral presentation for further clarification upon MHMR’s request.
G. Amendments to the Proposal
If it becomes necessary to revise any part of this Proposal package or if additional information is
necessary to clarify any provision, the revision and/or additional information will be provided to
each Vendor/Provider via faxed amendment or email. H. Availability of the Proposal
After opening, each Proposal, except those portions for which a Vendor/Provider has included a
written request for confidentially (e.g. proprietary information), shall be open to public
inspection.
I. Retention of Proposals
All Proposals considered by MHMR shall become the property of MHMR and shall not be
returned.
J. Notice “No Bid” Form
Vendors must respond to the Proposal request whether they can or cannot provide the products,
supplies, and/or services listed in the Proposal request (See Attachment B Notice “No Bid”
Form). K. Incurred Expenses
MHMR shall not be responsible for expenses incurred by a Vendor/Provider in the
preparation and submission of a Proposal. This provision also includes any costs involved
in providing an oral presentation of the Proposal.
L. Deviation Form
Each response to this Solicitation shall contain a Deviation Form, which states the
prospective contractor’s commitment to the provisions of this Solicitation and Sample
Contract. An individual authorized to execute contracts must sign the Deviation Form.
Any exceptions taken to the terms and conditions identified in this Solicitation Package
must be expressly stated in the Deviation Form. (See Attachment C)
M. Subcontractors All provisions and/or stipulations within this Request for Proposal also apply to any
authorized subcontractors.
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N. Term of Contract
The intent of the RFP is to award this contract to the qualified vendor(s) who can
provide and meet all specified requirements of this request for proposal.
The contract period shall commence upon award date and issuance of Purchase Order until
completion and acceptance of the project by authorized MHMR personnel. Project is not
complete until authorized MHMR personnel has inspected and accepted in writing all
services related to this proposal.
O. Licensure
The vendor shall submit, with their Proposal, a copy of any other license(s), certification(s),
registration(s), permit(s), etc. as required by authorities having jurisdiction: local, state,
county, and/or federal.
P. Pricing
Each vendor shall provide responses to “Acknowledgement and Proposal” page with total
pricing.
SECTION V – INSURANCE REQUIREMENTS
Proof of insurance MUST be submitted with the bid response, failure to do so will disqualify the bid.
Upon award of the contract, the successful contractor’s insurance agent will provide a Certificate of
Insurance naming MHMR as an also insured, and will expressly provide for thirty (30) days prior
written notice of cancellation to all insured parties. The Contractor shall take out, pay for and maintain at all times during the prosecution of the work
under the contract, the following forms of insurance, in carriers acceptable to and approved by
MHMR.
1. Workers’ Compensation/Employer’s Liability
a. Workers' Compensation - statutory
b. Employer's liability - $500,000
2. Comprehensive Commercial General Liability:
a. Bodily Injury/Personal Injury- $1,000,000 per occurrence
$2,000,000 aggregate
b. Property Damage - $1,000,000 aggregate
3. Automobile liability:
a. Bodily injury - $500,000 minimum combined single limit
4. Contractual liability — same limits as above. The MHMR reserves the right to review the insurance requirements of this section during the
effective period of the contract and to require adjustment of insurance coverage and their limits
when deemed necessary and prudent by the Agency based upon changes in statutory law, court
decisions, or the claims history of the industry as well as the Contractor.
Required Provisions:
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 12 OF 34
1. Proof of Carriage of Insurance - All certificates of insurance will be required in duplicate and
filed with the Purchasing Manager at 3840 Hulen St, Suite 200, Fort Worth, Texas 76107.
2. All certificates shall provide MHMR with an unconditional thirty days written notice in case
of cancellation or any major change.
3. As to all applicable coverage, certificates shall name MHMR and its officers, employees, and
elected representatives as an additional insured.
4. All copies of the certificates of insurance shall reference the project name and bid number for
which the insurance is being supplied.
5. The Contractor agrees to waive subrogation against MHMR, its officers, employees, and
elected representatives for injuries, including death, property damage, or any other loss to the
extent the loss, if any, is covered by the proceeds of insurance.
The Contractor/Vendor is responsible for making sure any sub-contractor(s) performing work under
this agreement has the required insurance coverage(s) and supplies MHMR with the proper
documents verifying the coverage.
A CURRENT “CERTIFICATE OF INSURANCE”
MUST ACCOMPANY ALL PROPOSALS
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SECTION VI – PROPOSAL EVALUATION PROCESS
Not all evaluation factors are equal in importance and each factor is weighted in accordance with its
importance to MHMR. Each item has been assessed a percentage upon which the final score will
determined. A total of one hundred percentage (100%) points for the following items will be considered a
perfect score.
The following will be significant factors in evaluating proposals, but the evaluation will not be
limited to these items when making a final recommendation.
A. Overall Program
Capabilities 30%
Incident reporting system capabilities that meet MHMR
requirements. The vendor has a well-defined concept and program
structure for all components of service desired by MHMR.
(Including equipment, availability and start-up time)
B. Project Management
Methodology 25%
Indications of Project Management capabilities for large scale data
center; focus on solution and timeline, and achieve desired result.
Detail of tasks, schedule, dependencies, duration, etc.
C. Understanding 5%
Indication that the vendor understands the nature a n d s c o p e
of MHMR services and guidance as a Local Mental Health
Authority and that the vendor has thoroughly analyzed MHMR’s
needs and requirements.
D. Financial Condition 10%
Include a copy of your latest annual report or other comparable
documentation. As evidenced by the financial information
requested of each vendor, indication that the vendor, or vendors,
are financially stable and able to provide related services in its
entirety.
E.
History/Description
of Firm
Credentials of Staff
5%
Provide a brief history and description of your firm. The
description should include the size (number of employees) and
areas of specialization. Describe any special expertise your firm has
working with the products and/or services required for this
projects’ scope. Employment duration and Certifications of firm’s
staff who will be assigned to this project.
F. References 10%
Provide the names, telephone numbers, emails and addresses of
at least three business references; preferably, from similar not-for-
profit entities located in Texas. Issues that will be addressed
include contract performance, quality of the personnel,
responsiveness, etc.
G. Cost 15%
Final cost may be negotiated with the successful Vendor. Cost
may only become a determining factor when all other conditions are
equal.
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SECTION VII – SPECIALIZED SERVICES TO BE PERFORMED OVERVIEW
MHMR Tarrant is soliciting proposals for Risk Management Incident Reporting System
Services. The purposes of a comprehensive Risk Management Incident Reporting (IR)
framework are to:
Establish risk identification which aligns with other healthcare organizational standards,
procedures, and guidance,
Identify key risks to MHMR performance and solvency,
Utilize trending, tracking, and data analysis to implement controls of manageable risks,
and
Build an agency framework and culture with increased resilience and resistance,
manageable risk, hazards, and untoward events.
CURRENT PROCESSES
Current risk elements are being tracked through three (3) separate repositories. Two of the
repositories utilize an internal Share Point site while the third system uses Excel.
PROJECT SCOPE
1. Vendor shall assess MHMR’s existing Incident Reporting systems a. Identify current Reportable Occurrences in accordance with processes and guidance,
b. Report gaps for Industry Reportable Occurrences and manageable risks; and
recommendations for corrective action;
c. Incorporate agreed upon steps to address gaps.
d. Conduct an audit for compliance to guidance and precertification for credentialing in
accordance with CARF: 1.C.1-3, 1.A.8 , 1.G.1-2,1.H.9-10, CMS Guidance to
Surveyors ICF IDD – App. J, Federal Register Vol. 81 No. 180 Friday September 16,
2016: §441.184(b), §483.475(a)(1), §485.920(b), FEMA – Comprehensive
Preparedness Guide 101 (2010), NFPA-1600, TAC Title 40 Part 1 Chapter 9
Subchapter E Division 4, HSPD 5,8,21 or other IR standards.
2. Vendor shall develop a Statement of Work (SOW) to include:
a. Collaboration with MHMR Department of Emergency Management Environmental -
Safety to develop a project plan that will include both the agreed upon benchmarks
and a schedule from project initiation to project close.
b. Indicate what work will be done on site vs remotely.
c. Travel and expenses will not be paid by MHMR.
d. Indication of the various phases, duration, assumptions, responsibilities, and payment
criteria.
3. Vendor shall categorize Incidents with granular detail and cross routing elements:
EXAMPLE(S):
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911 Calls: Police, Fire, and EMS
Abuse/Neglect
Department of Family Protective Services (DFPS)
Beneficial Elements (Acts of Kindness, Suggestions)
Emergency Preparedness Functions
Human Element
Suicide Ideation / Threat / Completion
Homicide Ideation / Threat / Completion
Health and Medical
Immanent Threat(s)
Life Safety Code
Natural Hazards
Occupational Safety Elements
Technological Hazards Elements
Vehicle Incidents (injuries, staff, non-staff)
Violation of Contractual Requirements or Policy
4. Vendor shall construct Technical Platform
a. Cloud-based (preferred). Please complete Schedule 1: Technical Questionnaire.
b. Offline and mobile reporting accessibility.
c. Accessible and operational using various device types such as desktops, laptops,
tablets, and cell phones.
d. Configurable reporting elements for data analysis forms, tables, and dashboard(s).
e. Able to interface with software applications as needed (MS Outlook, Excel, etc.).
f. Multi-platform incident notification such as text message, and email.
g. Link to Active Directory Sync to automatically setup and manage users.
h. Training/Testing module in separate environment (preferred).
5. The System shall have reporting capabilities:
a. Centralized reporting system to document incidents in real time.
b. Documentation of original report, details of incident, including witnesses, and contact
information (phone number, email address);
c. Creation of an incident report on behalf of another user, contractor, or other external
entity;
d. Assigns a unique identification number to each incident report;
e. Tracks original entry of incident, subsequent entries, edits, and or updates to incident
by user, date, and time;
f. Display and report history of incident report from original report to resolution,
including updates and edits;
g. Require information based on incident type(s) selected. (Example: A property
damage incident vs. a medication error incident);
h. Enter and track status of incident. (Examples include open, investigation pending,
resolved);
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i. Search, select, and display incident(s) in system. (Examples include incident number
(s), incident type(s), individual(s) involved (client, staff), entity, date range, and
program); and
j. Scan and attach or link documents to incident report. Access to view scanned
documents is based on security settings.
6. System shall have alert channel of responsibility and authority to resolve situation
capabilities:
a. Routing with line of succession to appropriate authority for intervention,
investigation, and resolution.
b. Electronic notification of incident occurs in real time by system dashboard, email,
text, and/or Instant Messenger (IM).
c. System shall allow staff supervisor to be notified by email when incident is opened.
d. System tracks confirmation of notifications.
e. System shall allow users to decline a task with documented reason(s).
7. System shall have investigating compatibilities:
a. Immediate email notification with specialized alert for critical incidents or life safety
concerns (Examples include: Critical events requiring sheltering, evacuation,
lockdown; Death – Suicide/Homicide; Homicide threat or attempt; Homicide –
Perpetrator; Litigation threats; Missing person (police report filed); News coverage
media likely;
b. Active task management dashboards;
c. System shall allow user to document task completion with notification to originator of
task;
d. Ability to document investigative actions and discovery by the incident for both
internal and external entities. Investigative details are limited to users based on
security settings. Include relevant details such as date, time, staff, entity, etc.;
e. Ability to classify notes pertaining to assigned groups to ensure ease of reference.
Examples include Risk Management, Client Rights, Medical, Property Management,
Human Resources; and,
f. Ability to store outside entity identifying information relevant to a Tarrant incident.
(Examples include: DFPS#, Police Report#, Hospital ID#; and
outside reporting Authority.
8. System shall have Analyses Data Tracking, Trending, and Resolution functions:
a. Ability to set status of incident as closed or resolved, based on security settings;
b. Configurable data analysis. (Examples may include date range, incident type(s), staff,
program, assigned staff, status of incident);
c. Ability to tap historic reports in the system for annual reporting or longitudinal
comparisons;
d. Real time trends and reports;
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e. Ability to alert of potential risk based on multiple reports or continued escalation of
incidents for program, staff, client, incident type; and,
f. Ability to generate reports from system to view, print, and/or download to external
applications (such as Excel) for analysis.
9. System shall have security capabilities:
a. Security settings of system to allow or limit access to entry of, search, view, edit/add
capabilities based on security settings and or user roles;
b. System allows local maintenance of assigning user licenses and maintaining user
accounts and security settings;
c. System has ability to create and maintain user accounts electronically and manually;
and,
d. System tracks when users are activated, deactivated, and/or security changes occur.
EXERCISE AND TRAINING
1. Exercise
a. Vendor will work with MHMR project leaders to complete configuration of system.
b. Vendor will work with MHMR project leaders to complete functional testing.
c. MHMR and Vendor shall perform Technical Exercise and Testing of Full System to
include Agents, Analyzers, and selected End Users
d. Deliver an after-exercise report highlighting all successes and identified gaps and
inconsistencies with the System. Develop a corrective course of action based on the
results of the exercise.
e. Give a presentation to executive management on the system capabilities.
2. Training
Vendor shall provide training as follows:
a. Administrative (including configuration, security, maintenance);
b. Tracking Trending Agents;
c. Agents and Analyzers / End Users;
d. Support and learning portal; and,
e. Training Manuals (paper or electronic).
DELIVERABLES
1. Final Project Deliverables will include, but are not limited to:
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 18 OF 34
a. Routing Map of MHMR key personnel to be notified in life safety and critical
incidents;
b. Single agency wide repository for reporting incidents;
c. Tracking and trending reports for analysis;
d. Immediate and automatic routing notification for the responsible person(s) to take
investigative action or intervention action(s) in a life safety hazard and or critical
events;
e. A “close the loop” element to report resolution of the incident;
f. Security level/layered accessibility for restricted access to sensitive data;
g. Time-phased implementation procedures to activate various components of the IR;
h. Training and exercise materials package; and,
i. Provide a project plan in electronic format that can be maintained by MHMR.
PROPOSED TIMELINE
IR system is expected to be completed and accepted based on agreed upon project schedule.
It is preferred that once contract is awarded the IR system will be completed in a six (6) month
period.
At present the recommendation for service agreement is expected to be completed in time for
funding to be incorporated into the FY 18 Budget.
MHMR PROJECT MANAGEMENT TEAM
MHMR will be responsible for operational decisions. MHMR will provide staff in the following
roles:
MHMR Project Lead
MHMR Director of Emergency Management Environmental Safety
OUT OF SCOPE
MHMR will not require vendor to convert past incident report history into the new system.
BACKGROUND CLEARANCE CHECK
Certain contracts may require vendors to enter sensitive secure areas. These may include, but are
not limited to, the locations listed above.
If a particular contract requires vendor personnel to enter such a location the following may
apply.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 19 OF 34
1. The successful bidder shall provide information, including, but not limited to, name, date
of birth, and driver’s license number for each individual who will be performing work on
MHMR Tarrant property.
2. Vendor personnel who perform work on MHMR Tarrant property must submit to and
pass a background clearance check. That status must be maintained by all vendor
personnel entering MHMR Tarrant buildings for the duration of the contract.
3. Background clearance checks conducted by vendor’s firm may or may not be accepted by
MHMR Tarrant. MHMR Tarrant reserves the right to conduct additional background
checks as it deems necessary.
4. Award of a contract could be affected by a vendors’ refusal to agree to these terms.
Award could also be affected if vendor is unable to supply personnel who can pass a
background clearance check.
NOTE: The background clearance check applies to the individual and not the
company.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 20 OF 34
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM
ACKNOWLEDGEMENT AND PROPOSAL
Having read and understood the instructions to bidders, terms and conditions, the specifications
and special provisions, we submit the following proposal:
1. Contractor shall include a breakdown and itemized description of products and services to be
performed.
2. Contractor shall include total cost.
3. Contractor shall include ongoing annual support cost.
4. Contractor shall include a breakdown of MHMR Tarrant and Contractor responsibilities.
5. Contractor should include a sample copy of Master Service Agreement or Statement of Work,
as applicable.
6. Contractors are requested to include a tentative schedule with milestone as applicable.
MHMR TARRANT IN ITS SOLE AND ABSOLUTE DISCRETION SHALL HAVE THE
RIGHT TO AWARD CONTRACTS FOR ANY OR ALL MATERIALS LISTED IN EACH
PROPOSAL, SHALL HAVE THE RIGHT TO REJECT ANY AND ALL PROPOSALS, AND
SHALL NOT BE BOUND TO ACCEPT THE LOWEST PROPOSAL AND SHALL BE
ALLOWED TO ACCEPT THE TOTAL PROPOSAL OF ANY ONE VENDOR, OR AS
OTHERWISE STATED IN THIS PROPOSAL. THIS SUBMISSION IS GUARANTEED AS AN IRREVOCABLE OFFER VALID FOR 120
DAYS AFTER THE PROPOSAL OPENING DATE.
BY RETURNING THIS BID PROPOSAL COMPLETED, THE BIDDER CERTIFIES THAT
THE PROPOSAL SPECIFICATIONS ARE UNDERSTOOD AND COMPLIED WITH.
PROPOSAL MAY BE CONSIDERED INVALID IF NOT RETURNED.
Name and Address of Company: Authorized Representative:
___________________________________ ______________________________________
Company Name Authorized Signature
___________________________________ ______________________________________
Number/Street Address Typed or Printed Name
___________________________________ ______________________________________
City, State, Zip Code Title
___________________________________ _______________________________________
Telephone Number Fax Number
E-mail address
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 21 OF 34
SCHEDULE 1
Technical Questionnaire
Note: This series of questions are optional for the initial
submission of the RFP. However, vendors will be required to
complete this list if selected to move to the next round for
consideration.
Vendor Response
("N/A" if Not Applicable)
Upgrades and Maintenance
1
Does your service have regular maintenance windows, and if so,
what are they? What services are impacted or unavailable
during these times?
2
Do you have a regular update and patching cycle? If so please
outline the general cycle and schedule and describe the types of
changes typically released in major and minor revisions.
3 Can clients opt in or out of service pack upgrades? Are some
upgrades mandatory and others optional?
4
What measures are in place to prevent upgrades from breaking
client integrations? Do you issue release notes and
recommendations in advance of each upgrade (for example:
guidelines on where, when, and how to perform regression
testing)?
Logging and System Management
5
Explain what configuration options your solution provides for
logging end-user and administrator actions. Please address the
general types of events that can be logged (or not logged),
options for setting formatting and logging levels, options for
setting retention policies, purging, and so on.
6 How could MHMR get direct access to logs if desired or
required?
7
Can all logged events be trapped and sent as notifications to
MHMR managed systems, dashboards or other correlation
systems?
8
Is there a standard set of usage statistics that you provide to
your customers, accessible via a dashboard? If yes, please
describe the general characteristics of the statistic set and/or
provide example dashboard screenshots in the Exhibits section
of the RFP.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 22 OF 34
9
Can MHMR administrators create their own system
management dashboards and/or populate them with their own
composed metrics?
10
Are there any types of standard limitations on log sizes and log
retention windows that pertain to your customers? Are there
any special charges for modifying such standard limitations? If
so, can log files be sent to MHMR for retention by MHMR
itself?
Hosting Infrastructure, Backup and Disaster Recovery
11
Please describe the types of data center facilities in which your
solution is located. Are your data center facilities rated using
Uptime Institute tier ratings? If so: 1) describe the ratings they
have achieved, and 2) identify the party who conducted the
rating and provide a website or other contact information for
that party in your response.
12
Are third parties involved in your provisioning of data center
services? If yes, please identify those third parties and provide
websites and/or other contact information.
13 Are clients permitted to visit and tour your data center facilities
with advance notice?
14
What documented plans do you have for recovering data center
operations and network connectivity in the event of a local or
regional disaster? How often are your DR plans refreshed and
updated? Can you provide any third-party corroboration or
certification of your DR plan quality?
15
What are the Recovery Time Objectives (RTOs) and Recovery
Point Objectives (RPOs) for your SaaS solution customers’
hosted instances?
16 What is the schedule and the format for backups from your
solution?
17 Are restorations from backup regularly tested? With what
frequency and with what validation?
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 23 OF 34
Integration, Data Import, Export and Location
18
Does your solution support web services (JSON, SOAP, REST,
XML) for exchanging structured information both into and out
of your system? Explain the general mechanism and standards
supported. What data elements can be manipulated via web
services?
19
What approach do you most recommend for sending inbound
data to your service from MHMR systems and/or 3rd party
providers?
20
Does your solution support one or more secure varieties of file
transfer? Explain the general mechanism and standards
supported.
21 What types of Application Programming Interfaces (APIs) does
your solution expose for data extraction?
22 Please identify other general functional areas exposed via your
solution’s APIs.
23 What technical documentation can you provide clients for your
solution’s APIs?
24
Can your clients export data from your solution to their own
cloud solutions and if so how (e.g., do you use a docker based
approach, or something else)?
25
Please indicate if data in your solution is ever stored or moved
outside the US, and if so what type of data is stored outside the
US (e.g. images, cached data, data in transit).
26 Do you supply a certification of data destruction upon contract
termination?
27
Does your solution support bulk load for initial data population
or bulk extraction for return to MHMR upon request or
termination of contract? Is there a fee for such services? What
formats and secure protocols are supported to enable this
functionality?
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 24 OF 34
Performance and Benchmarking
28
What published performance benchmarks does your solution
have for any or all of the following?
• Application response times (separate by module if
appropriate)
• Speed of individual transactions
• Speed of mass transactions
• Speed of mass data imports and data exports
• Data storage limits
• Other
If benchmarks are available, for each benchmark please cite the
benchmarking organization, the date and other relevant details
and assumptions.
Architecture and Supported Platforms
29
What client PC/laptop operating systems (Windows, Macintosh,
etc.) does your solution support? Differentiate by OS version
if/where appropriate.
30
What client PC/laptop browsers (Internet Explorer, Firefox,
Safari, etc.) does your solution support? Differentiate by
browser version if/where appropriate.
31
What client smartphone and tablet operating systems (iPhone,
iPad, Droid, Android, etc.) does your solution support?
Differentiate by smartphone and tablet OS version if/where
appropriate.
32
What server operating system(s) (Windows, Linux, other
flavors of UNIX, other) does your SaaS solution run on?
Differentiate by OS version if/where appropriate. Are certain
application functions limited to certain platforms?
33
What application server environment(s) (WebLogic,
WebSphere, other) does your solution run in? Differentiate by
application server version if/where appropriate.
34 What web server(s) (Apache, IIS, other) does your solution run
on? Differentiate by web server version if/where appropriate.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 25 OF 34
35
What database management system(s) (Oracle, SQL Server,
DB2, other) does your solution run on? Differentiate by DBMS
version if/where appropriate.
Security
36
In your SaaS implementations, do you typically support
clients’ own internal Single Sign-On (SSO) infrastructures?
What types of SSO mechanisms can you support? Can you
support (ADFS/SAML/LDAP)? Are there any SSO variations
you cannot support?
37 Does your system provide tokens as secondary authentication
for read-and-signs or electronic signatures for certificates?
38
What is the recommended user account management process
for this solution? (Adding, Terminating, access level, passwords
etc.)
39
For client-side implementations of your solution (including
browser version, offline-access version if applicable, tablet and
smartphone versions if applicable), what data is cached client-
side? How is such data deleted or otherwise managed at session
termination? If answer differs for each solution, please provide
all relevant responses.
40
Please describe your general approach to stored data for hosted
solutions. Where is data hosted, on what type of media and
equipment? What strategies do you employ for redundancy,
high availability, business continuity, and disaster recovery of
data? For the latter, please make reference to plans and
procedures, regular testing, routine data backups and offsite
storage.
41
If data is clustered, mirrored, duplicated or otherwise
distributed, can the physical location of data be changed
without MHMR’s knowledge or consent? If so, in the event that
MHMR needs to recall, delete, or otherwise modify distributed
data, can you furnish all the location(s) of all such distributed
data to MHMR for those purposes?
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 26 OF 34
42
What mechanisms, policies and procedures are used to
safeguard stored data? Be sure to cite your use or non-use of
intrusion detection, anti-virus, firewalls, vulnerability scanning,
penetration testing, encryption, data at rest encryption,
authentication and authorization protections and policies,
including those involving passwords, removal of unnecessary
network services, limiting of administrative access, code review,
logging, employee training and other relevant safeguards.
43
What mechanisms are used to transport data? What methods
are used to safeguard data during transport? Be sure to cite
your use or non-use of encryption during transmission,
encrypting wireless traffic, physically securing devices in
transit, network traffic segregation, and other relevant
safeguards. Where relevant, include descriptions of the
encryption protocols and algorithms used.
44
In your approach to storage and transport of data, as described
in questions 37, 39 and 40, do you rank any data in terms of
sensitivity and do you employ any special measures when
handling more sensitive data? If so, in implementing such
measures can you respond and act upon the client’s own
rankings for data sensitivity?
45
Please identify any subcontracted parties who are involved in
your handling of stored data as described in questions 37, 39
and 40. Please provide a website address and/or other contact
information for each.
46
Are your information security controls certified through a
certification body (ISACA, SANS, etc.) audit or similar
methodology? If so, please provide a copy of the latest audit
findings in the Exhibits section of your RFP response.
47
Please identify any compliance frameworks for which your
product has been certified, such as HIPAA, FISMA, FERPA,
PCI, and so on. For each, provide the date of the last
certification.
48 Do you have existing Healthcare or government tenants? What
regulatory compliance frameworks are they governed by?
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 27 OF 34
49
Please describe any controls you use to address the threat of
information being mistakenly disclosed to unauthorized
persons. Your response should refer where applicable to issues
of awareness and training, removal of unnecessary data
(electronic and paper), use of screen savers and lockouts,
limiting storage of confidential data on remote devices,
verification of identity of individuals requesting access, and
other relevant safeguards that enforce the principle of “need to
know.”
50
Please describe any controls you use to address the threat of
information knowingly being misused by your workforce and
contractors. Your responses should refer where applicable to
issues of strong sanctions policy and practice, background
checks, role-based access to information, oversight of data
authorization by supervisor, terminating access to data for
terminated employees and employees changing job functions,
prohibition on sharing passwords, and other relevant
safeguards.
51
Please describe controls you use to address the threat of
physical theft or loss of data. Your responses should refer
where applicable to policies on the storage of confidential data
on laptops, PDAs, USB drives and other portable devices,
encryption of data on portable devices, two factor
authentications, removal of unnecessary information, physical
protection of desktops and servers, and other relevant
safeguards.
52
Please describe controls you use to address community
concerns regarding privacy practices. Your responses should
refer where applicable to privacy statements, opt-in or opt-out
consents, compliance with applicable privacy rules, and other
relevant safeguards.
53
Please describe controls you use to address the use, handling,
protection and sharing of confidential data shared with
subcontractors. Your responses should state any relevant
relationships that may induce additional risk to the safe storage
of sensitive data (such as outsourcing of key services, use of sub-
contractors or cloud services for hosting, etc.) and refer where
applicable to contractual safeguards and reviews of security
programs / practices.
53
Do you require the use of two-factor authentication for the
administrative control of servers, routers, switches and
firewalls?
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 28 OF 34
54
Does your SaaS solution support Secure Sockets Layer (or
other industry-standard transport security) with 128-bit or
stronger encryption and two-factor authentication for
connecting to the application?
55
Do your hosting environments provide redundancy and load
balancing for firewalls, intrusion prevention and other critical
security elements?
56
Do you (or an experienced third-party partner) perform
external penetration tests at least quarterly and internal
network security audits at least annually? Are these audits
structured per the International Organization for
Standardization (ISO) 17799 (transitioning to ISO 27001)
standard?
57
Do you provide protection (or receive protection from a third
party) for denial-of-service attacks against your hosted
solutions?
58
Can you provide documented requirements (and audit
procedures) for network access standards to ensure that other
customers will not accidentally compromise the security of your
environments?
59
Can you provide documented policies for OS hardening for
your web, application, database and other hosting-related
servers?
60
Can you provide validated procedures for configuration
management, patch installation, and malware prevention on all
servers and PCs involved in SaaS delivery?
61
If you have a multi-tenant architecture that extends to the
database level, can you provide a documented set of controls for
ensuring the separation of data and the security of information
between different customers’ SaaS instances?
62
How do you review the security of applications (and any
supporting code, such as Ajax, ActiveX controls and Java
applets) that you develop and use?
63
Do you use content monitoring and filtering or data leak
prevention processes and controls to detect inappropriate data
flows?
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 29 OF 34
64
Can you provide documented procedures for configuration
management (including installation of security patches) for all
applications?
65
Do you perform background checks on personnel with
administrative access to servers, applications and customer
data?
66
Can you provide documented processes for evaluating security
alerts from operating system and application vendors, shielding
systems from attack until patched, and installing security
patches and service packs?
67 Do you use write-once technology to assure the validity of audit
trails and security logs?
68
Can you provide documented procedures for vulnerability
management, intrusion prevention, incident response, and
incident escalation and investigation?
69
How many staff do you have dedicated to application and
infrastructure security? How many average years’ experience
do these personnel have and what security certifications do they
possess?
70
Can you provide documented identity management and help-
desk procedures for authenticating callers and resetting access
controls, as well as establishing and deleting accounts when
help-desk service is provided?
Secondary (Non-Production) Environments
71
Do you provide SaaS customers with a standard set of
secondary non-production environments (staging, test, and so
on)? If so, which types of environments? Are there any
limitations on access to and usage of these environments?
72
If you answered yes to question 69, above, can data in these
secondary environments be synched with production data? If
so, is there a fee for this synchronization? If not, what type of
data is provided in these supporting environments?
73
If you answered yes to question 69, above, can changes made in
secondary environments be migrated to production
automatically?
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 30 OF 34
Attachment A MHMR of Tarrant County
Historically Underutilized Business (HUB)/Disadvantaged Business Enterprise (DBE)
HUB Utilization Assessment
Please indicate below any changes to the information provided
Principal Owner Name:_________________________________ Title:__________________________________
Principal Owner Phone:_________________________ Other Phone:______________________________
1. If none of the below applies to your business please initial here____________________, in doing so you
acknowledge that your business will NOT be considered a Historically Underutilized Business or a
Disadvantaged Business Enterprise vendor (you may skip questions 2 and 3).
2. Is your business primarily owned (51% or more) by an individual or individuals that can be classified in
one or more of the following groups? (Please check all that apply from the list below)
4. Please sign and date the form below.
______________________________________________ ______________________________________
Signature Date Print Name
Legal Name of your
Business: ________________________________________________________________
Address: ________________________________________________________________
City: __________________________State:___________Zip:___________________
Women (Check here if you are a self-
employed woman)
African Americans
Hispanic Americans
Native Americans
Asian Americans
Service Disabled Veterans
3. Is your business already certified as disadvantaged or historically underutilized?
[ ] Yes [ ] No
If “Yes”, please indicate the name of the certifying agency:__________________________
Certificate #:_________________________Expiration Date:__________________
If not certified, is your business eligible for certification based on question 2 above? [ ] Yes [ ] No
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 31 OF 34
ATTACHMENT B
NOTICE “NO BID” FORM
Dear Vendor,
Please check the appropriate box below, complete the remainder of this form and return it PRIOR to the scheduled Date and Time:
I/Our Company cannot provide the products, supplies and/or services listed in this request. Please MOVE my/our name and address to the following commodities so that we may submit bids/proposal at a later date:
Commodities: ____________________________________________________________________
I/We have chosen NOT to submit a Proposal at this time, but would like to remain on your list for this Proposal category. We did not submit a Proposal because:
Reason(s): ______________________________________________________________________
________________________________________________________________________________
Please REMOVE my/our name from all MHMR of Tarrant County lists until further notice.
Reason(s): ______________________________________________________________________
________________________________________________________________________________
Company Name: _________________________________________________________________
Representative (Print Name): __________________________________________________________
Address: _______________________________________________________________________
Email: _________________________________________________________________________
Phone Number: ( ______ ) ___________________ Fax Number: ( ______ ) ___________________
PLEASE RETURN THIS FORM ONLY TO:
MHMR Tarrant Purchasing Department
Notice “No Bid” – RFP 17-020 Risk Management Incident Reporting System 3840 Hulen Street, Suite 200
Fort Worth, Texas 76107
Authorized Signature: _____________________________________________________________
Title: ____________________________________ Date: _______________________________
VENDORS WHO RESPOND TO THIS INVITATION WITH A COMPLETED PROPOSAL FORM WILL
REMAIN ON OUR MAILING LIST. VENDORS MAKING NO RESPONSE MAY BE REMOVED FROM THE
MAILING LIST.
Thank you for your time and assistance.
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 32 OF 34
ATTACHMENT C
DEVIATION FORM
All deviations to this Solicitation must be noted on this sheet. In the absence of any entry on this Deviation Form, the prospective contractor assures MHMRTC of their full agreement and compliance with the Specifications, Terms and Conditions.
An individual authorized to execute contracts must sign the Deviation Form. Any exceptions taken to the terms and conditions identified in this Solicitation Package must be expressly stated below.
THIS DEVIATION FORM MUST BE SIGNED BY EACH PROSPECTIVE CONTRACTOR WHETHER THERE ARE DEVIATIONS LISTED OR NOT, AND
SUBMITTED WITH THIS SOLICITATION
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
COMPANY NAME: __________________________________________________________
AUTHORIZED SIGNATURE: ___________________________________________________
PRINTED NAME/TITLE: _______________________________________________________
DATE: ______________________________________________________________________
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 33 OF 34
ATTACHMENT D
NON-COLLUSION AFFIDAVIT OF BIDDER
State of _________________________ County of __________________
_____________________________________________ verifies that:
(Name)
(1) He/She is owner, partner, officer, representative, or agent of
__________________________________, has submitted the attached bid.
(Company Name)
(2) He/She is fully informed in respect to the preparation, contents and
circumstances in regard to attached bid;
(3) Neither said bidder nor any of its officers, partners, agents or employees
has in any way colluded, conspired or agreed, directly or indirectly with
any other bidder, firm or person to submit a collusive or sham bid in
connection with attached bid and the price or prices quoted herein are
fair and proper.
______________________________________
SIGNATURE
______________________________________
PRINTED NAME
Subscribed and sworn to before me this
_________ day of _________________ 2017
______________________________________
NOTARY PUBLIC in and for
___________________________County, Texas.
My commission expires ___________________
THIS FORM MUST BE COMPLETED, NOTARIZED AND SUBMITTED WITH BID
RFP 17-020 RISK MANAGEMENT INCIDENT REPORTING SYSTEM 34 OF 34
ATTACHMENT E
REFERENCE FORM
All references must be from customers for whom your company has provided similar serves as the
specifications of this bid (Invalid contact information will result in default of references and may cause
the bid to be disqualified.)
Company Name: _______________________________________________________________
Street Address: ________________________________________________________________
City, State & Zip: ______________________________________________________________
Contact Name: ________________________________ Phone: __________________________
E-mail: _______________________________________________________________________
List date and describe work performed: ______________________________________________
______________________________________________________________________________
Company Name: _______________________________________________________________
Street Address: ________________________________________________________________
City, State & Zip: ______________________________________________________________
Contact Name: ________________________________ Phone: __________________________
E-mail: _______________________________________________________________________
List date and describe work performed: ______________________________________________
______________________________________________________________________________
Company Name: _______________________________________________________________
Street Address: ________________________________________________________________
City, State & Zip: ______________________________________________________________
Contact Name: ________________________________ Phone: __________________________
E-mail: _______________________________________________________________________
List date and describe work performed: ______________________________________________
______________________________________________________________________________
Company Name: _______________________________________________________________
Street Address: ________________________________________________________________
City, State & Zip: ______________________________________________________________
Contact Name: ________________________________ Phone: __________________________
E-mail: _______________________________________________________________________
List date and describe work performed: ______________________________________________
______________________________________________________________________________
THIS PAGE MUST BE COMPLETED AND SUBMITTED WITH BID