request for proposal bid no. 397 self insured prescription

REQUEST FOR PROPOSAL

BID NO. 397

SELF INSURED PRESCRIPTION PROGRAM

Monroe County School District

Steve Pribramsky, District 1

Andy Griffiths, District 2, Chair

R. Duncan Mathewson, District 3

John Dick, District 4

Debra Walker, District 5, Vice-Chair

Mike Henriquez, Acting Superintendent

July 1, 2009

TABLE OF CONTENTS

Page

1.0 Required Notice .......................................................................................................... 3

2.0 Introduction ................................................................................................................. 4

Compensation .............................................................................................................. 5

3.0 Calendar ...................................................................................................................... 6

4.0 Interpretations ............................................................................................................. 6

5.0 Minimum Eligibility Criteria ....................................................................................... 6

6.0 Information to be Included in the Submitted Proposals............................................... 7

7.0 Evaluation of Proposals ............................................................................................... 8

8.0 Special Conditions ...................................................................................................... 9

EXHIBITS

Exhibit A – Monroe County School Board Standard Contract 15 – 24

Exhibit B – Statement of No Bid 25

Exhibit C – Debarment Certification 26

Exhibit D – Drug Free Work Place Form 27

Exhibit E – Public Entity Crime Statement 28

Exhibit F – Refusal of Standard Contract 29

Exhibit G – Business/Personal Relationship Disclosure Affidavit 30

Exhibit H – Non-Collision Affidavit 31

FILE ATTACHMENTS

Attachment A – Formulary

Attachment B – Claim Pricing Data

Attachment C – Questionnaire

Attachment D – Financial Quotation Form

Attachment E – Performance Guarantees

Addendum 1 (See attached)

REQUEST FOR PROPOSAL

BID NO. 397

NOTICE IS HEREBY GIVEN TO PROSPECTIVE PROPOSERS that on Wednesday, August 5, 2009 at 2:00 P.M.

the School Board of Monroe County (the “School District” or “School Board”) will open sealed bids for the

following:

BID NO. 397

SELF INSURED PRESCRIPTION PROGRAM

EMPLOYEE BENEFITS & RISK MANAGEMENT

Specifications and bid documents may be requested from DemandStar by Onvia by calling 1-800-711-1712

or by going to the website www.demandstar.com. The public record document is available at the

Purchasing Department, 241 Trumbo Road, 2nd

Floor, Key West, FL 33040.

Questions regarding the bid should be directed to Wanda Menendez, Risk Management Specialist, 241

Trumbo Road, Key West, Fl 33040, and Telephone: 305-293-1400 Ext. 53342.

All bids must be received by the Purchasing Department on or before August 5, 2009 at 2:00 P.M. No

waivers shall be allowed for Bids which have not been submitted to the Purchasing Department by the

deadline date.

Bidders must submit two (2) signed originals and four (4) typed and bound copies and one (1) copy of the

completed questionnaire and Financial Quotation Form on diskette in a format compatible with Microsoft

Excel in a sealed envelope clearly marked on the outside: Bid No. 397 Self Insured Prescription Program

addressed and delivered to:

Purchasing Department

241 Trumbo Road

Key West, FL 33040

All Bids must remain valid for a period of ninety (90) days. The School Board will automatically reject the

response of any person or affiliate who appears on the convicted vendor list prepared by the Department of

General Services, State of Florida, under Section 287.133(3) (d), F.S. (1997).

The Monroe County School District reserves the right, at its discretion to accept or reject any and all bids

and to waive informalities for irregularities when it is in the best interest of the Board to do so.

Award will be by the District School Board of Monroe County to the bids(s) whose bid is deemed by the

board to be in the best interest of Monroe County.

Dated at Key West, Florida, this 1st Day of July, 2009.

http://www.demandstar.com/

2.0 INTRODUCTION

Monroe County School Board (hereinafter referred to as “MCSB”) desires to receive proposals for Third

Party Administration Services for their Prescription Drug benefit only. MCSB will consider proposals

offered by Pharmacy Benefit Administrators who operate with a fully transparent financial model.

Proposers will be bidding on Pharmacy Benefits Administration at this time, to include pharmacy network

management, claims administration for both retail and mail order prescriptions, Drug Utilization Review,

reporting, formulary development, rebate processing, etc. MCSB may also consider carving out the

Specialty Drug program from the Medical plan and placing it under the Pharmacy Benefit.

It is critical to MCSB that a pharmacy network be accessible in the Keys.

MCSB is a governmental entity including the public schools in the Florida Keys, elementary grades through

high school. MCSB is located in Key West, Florida 33041. There are approximately 549 employees and

558 families covered by the plan, as well as approximately 100 Retirees. The SIC code is 8211.

MCSB presently offers their employees a self-insured medical plan that is administered by Blue Cross

Blue Shield of Florida. The Pharmacy benefit is administered by PBM Plus. Stop Loss Coverage is

provided by Symetra Financial.

MCSB pays for the full year over a 10 month period from September through June.

Current Pharmacy Benefit: You will be required to match the current benefit design.

Prescription Drugs –

Calendar Year Deductible - $100.00 individual, $200.00 per family (cumulative).

Copayments: Retail $ 10.00 Generic (Mandatory)*

$ 25.00 Brand

$ 25.00 Brand w/generic available.

$ 40.00 Non-Formulary.

Mail Order $ 14.00 Generic (Mandatory)*

$ 40.00 Brand

$ 40.00 Brand w/generic available

$ 70.00 Non-Formulary

The patient currently pays the lower of the contracted charge or the listed Copayment.

*Retail/Mail Order Mandatory Generic benefit – If you request the Brand medication, when the

Generic is available, you will pay the Brand co-pay PLUS the difference between the Brand and

Generic price.

Compensation: Gallagher Benefit Services is acting as a consultant for MCSB and currently receives fees

directly from the School Board.

Beginning with the new contract period, compensation for Gallagher Benefit Services should be included in

all pricing as follows at the rate of $ .50 PCPM.

Florida Licensed Insurance Agent Involvement

Due to the nature of group health benefits programs the School Board is publicly advertising for the

benefit of other agents who may wish to propose.

The School Board does not wish to pay any more than the minimum remuneration required by Florida

Statute 624.428 or any other Florida Statute.

Administrators are required to disclose the amounts of commission/remuneration to be paid to Florida

licensed agents, whether they are inside employee agents of the insurer or outside agents and proposers

are requested to explain the full extent of services to be provided to the School Board for the

commission/remuneration paid.

Insurance agents should recognize that the School Board will be scrutinizing the amount of remuneration

in relation to the expected level of service to be received. The School Board is desirous of avoiding

payment of remuneration that may appear to be excessive. It may be interested in negotiation such

remuneration, especially when two or more agents have similar or identical lowest cost proposals.

Proposing agents should state if they are willing to negotiate such remuneration.

Background information should be furnished on proposing agents and/or other key agency personnel that

will serve the School Board. Such information should include size of agency, experience to providing

insurance for public entities, personnel and qualifications (particularly of the agent who will serve the

School Board), references, frequency and type of contact with the county, etc.

Insurers and agents should state the amount of their errors and omissions insurance, and their insurer’s

name. $1,000,000 of coverage is the minimum acceptable.

3.0 CALENDAR

July 8, 2009 Release of RFP

July 14, 2009 Final questions due in writing

July 21, 2009 Release of Addendum # 1 (if necessary)

August 5, 2009 Proposals due/opening

4.0 INTERPRETATIONS

If necessary, Addenda will be issued. Any verbal or written information that is obtained other than by

information in this RFP document or by Addenda shall not be binding on the Monroe County School Board.

It is the proposer’s sole responsibility to check on the Demandstar website (www.demandstar.com) to

determine if there has been a release of Addenda.

5.0 MINIMUM ELIGIBILITY CRITERIA

In order to be considered eligible for this assignment, proposer must meet or exceed the following criteria:

5.1 Awardee must obtain and maintain the insurance with coverage limits as stated in Section 8.0 -

SPECIAL CONDITIONS, Subsection 8.25 - Insurance Requirements, for the term of the contract. Proposer

must submit a current Certificate of Insurance showing that proposer has the required level of insurance with

their proposal or within three days of request. If proposer does not have the required level of insurance,

include a letter from the proposer’s insurance company or agent stating that proposer is eligible to provide

this level of insurance and include a statement that proposer agrees to provide this level of insurance, if

awarded this RFP.

5.2 Proposer must provide evidence that they are appropriately licensed or certified to do business in

the State of Florida.

5.3 Proposer for Pharmacy Benefit Administration must have access to a network of participating

pharmacies in Monroe County, Florida.

5.4 The proposer must confirm that they operate in compliance with HIPAA requirements.

5.4.1 Proposer must confirm and be able to provide evidence that they operate with full

transparency.

Failure to submit a statement (in the format required under Section 6.0: INFORMATION TO BE

INCLUDED IN THE SUBMITTED PROPOSAL) indicating full compliance with each of the

requirements of this section will disqualify proposal submitted.

6.0 INFORMATION TO BE INCLUDED IN THE SUBMITTED PROPOSAL

In order to maintain comparability and facilitate the review process, it is required that proposals be

organized in the manner specified below. Include all information in your proposal.

6.1 Title Page: Show the subject, the name of the proposer, address, telephone number and the date.

6.2 Table of Contents: Include a clear identification of the material by section and by page number.

http://www.demandstar.com/

6.3 Letter of Transmittal: Give the names of the persons who will be authorized to make

representations for the proposer, their titles, addresses and telephone numbers.

6.4 Notice Provision: When any of the parties desire to give notice to the other, such notice must be

in writing, sent by US Mail, postage prepaid, addressed to the party for whom it is intended at the

place last specified; the place for giving notice shall remain such until it is changed by written notice

in compliance with the provisions of the paragraph. This information must be submitted with the

proposal or within three days of request. For the present, the parties designate the following as the

respective places for giving notice:

Monroe County School Board

District Office

Attention: Wanda Menendez

Employee Benefits and Risk Management Specialist

241 Trumbo Road

Key West, FL 33040

With a Copy to: ______________________________________

______________________________________

______________________________________

______________________________________

Name of Proposer: ________________________________________

(Name of Proposer, Corporation and Agency)

________________________________________

________________________________________

(Address)

With a Copy to: ________________________________________

(Name and Position of Designee of Proposer,

Corporation and Agency)

________________________________________

________________________________________

(Address)

6.0 INFORMATION TO BE INCLUDED IN THE SUBMITTED PROPOSAL (Continued)

6.5 Addenda: Proposer has determined that their firm has received all Addenda released prior to

their RFP submittal.

6.6 Questionnaire (Attachment C): The Questionnaire contains required information concerning

the following:

6.6.1 Minimum Eligibility: Proposer must provide a detailed response for each criterion

stated in Section 5.0 describing how they are in compliance.

6.6.2 Experience and Qualifications of the Proposer

6.6.3 Scope of Services Provided: The services requested by MCSB in providing the

benefits requested by this RFP are listed in the Questionnaire. The proposer must

address each item in the questionnaire and fully describe any deviations.

6.7 Purchasing Forms: The following forms must all be executed as directed and included

with each proposal:

Exhibit C (Debarment Certification)

Exhibit D (Drug Free Work Place Form)

Exhibit E (Public Entity Crime Statement)

Attachment B (Claim Pricing Data Form)

Attachment C (Questionnaire)

Attachment D (Financial Quotation Form)

Attachment E (Performance Guarantees

The following forms are to be included and executed only if applicable:

Exhibit B (Statement of no Bid)

Exhibit F (Refusal of Standard Contract)

Any modifications or alterations to these forms shall not be accepted and proposal will be rejected.

6.8 Special Conditions: Proposer must acknowledge understanding and acceptance of the items

outlined in Section 8.0 – SPECIAL CONDITIONS, as outlined or explain any deviations from

these conditions.

6.9 Other Information: Please include any sample reports, documents or exhibits under this

section.

7.0 EVALUATION OF PROPOSALS

MCSB shall rank all proposals received that meet the Minimum Eligibility Requirements and the Submittal

Requirements.

MCSB reserves the right to interview proposers that respond to this RFP or to make their recommendation

based solely upon the information included in the proposals submitted. MCSB may ask questions of a

clarifying nature and may request a hearing or hearings with any or all proposers as part of the evaluation

process.

It is important to MCSB that proposers demonstrate that they will be viable partners going forward. To that

end, MCSB is requesting that they demonstrate financial stability by providing financial ratings from

recognized sources, with a minimum rating of A. Companies that are not rated may submit audited financial

statements for a minimum of three years. Please see the Questionnaire for additional details.

After initial ranking on the basis of the following selection criteria, Minimum Eligibility Criteria, Experience

and Qualifications, Scope of Services Provided, Cost of Services Provided and, References. MCSB reserves

the right to negotiate further terms and conditions including price with the selected proposer for

recommendation. If MCSB cannot reach a mutually beneficial agreement with the highest ranked proposer,

MCSB reserves the right to enter into negotiations with the next highest ranked proposer. The contract will

not be awarded solely on the basis of lowest cost.

MCSB reserves the right to waive irregularities in proposals received. MCSB also reserves the right to award

the contract on such material MCSB deems will best serve its interests.

AWARD OF IDENTICAL TIE BIDS – Whenever identical bids are received, that are tied in all respects,

preference shall be given to the bid certifying a drug free workplace has been implemented in accordance

with Section 287.087, F.S. In order to receive preference, a signed certification of compliance must be

submitted with a bid response. Preference will be given to a Florida resident vendor over an out of state

vendor if both have certified a drug-free workplace. If all vendors are Florida residents, a Monroe county

vendor with a drug-free workplace will receive preference. If all bids or no bids include certificate of

compliance, the tie will be broken by a flip of a coin in the presence of witnesses

8.0 SPECIAL CONDITIONS

8.1 CONTRACT TERM: The purpose of this RFP is to establish a three year contract

beginning January 1, 2010 and continuing through December 31, 2012. The term of the contract

may, by mutual agreement between MCSB and the awardee, upon final approval of MCSB, be

extended for two additional one-year periods and, if needed, 90 days beyond the expiration date of

the final renewal period. MCSB, will, if considering to renew, request a letter of intent to renew

from each awardee, prior to the end of the current contract period. The awardee will be notified

when the recommendation has been acted upon by MCSB. All prices shall be firm for the term of

the contract. The successful awardee(s) agrees to this condition by signing its proposal.

8.2 IRREVOCABILITY OF PROPOSAL: A proposer may withdraw a bid at any time

before the deadline for proposal submission/opening. A proposal may not be withdrawn before the

expiration of (90) days from the date of proposal opening. Bidder warrants by virtue of bidding, that

prices, terms and conditions quoted in the bid will remain firm for acceptance by MCSB for a period

of (90) days from the date of bid opening, unless otherwise stated by MCSB.

8.3 INFORMATION NOT IN RFP: No verbal or written information that is obtained other

than by information in this document or Addenda to this Request for Proposal shall be binding on

MCSB.

8.4 PROPOSAL PUBLIC RECORD: Proposer acknowledges that all information contained

within their proposal is part of the public domain as defined by the State of Florida Sunshine and

Public Record Laws.

8.5 CONTACT AFTER PROPOSER’S SUBMITTAL: Any proposer or a lobbyist for a

proposer is prohibited from having any communication concerning this RFP or any response with

any representative of the MCSB, after the submittal of their proposal and prior to the contract being

awarded with the exception of communications with the office of the Director of Purchasing, unless

so notified by the Purchasing Department. A proposal from any firm will be disqualified when the

proposer or a lobbyist for the proposer violates this condition of the RFP.

8.6 GRATUITIES: Proposers shall not offer any gratuities, favors, or anything of monetary

value to any official, employee, or agent of MCSB for the purpose of influencing consideration of

this proposal.

8.7 PREPARATION COST OF PROPOSAL: Proposer is solely responsible for any and all

costs associated with responding to this RFP. MCSB will not reimburse any proposer for any costs

associated with the preparation and submittal of any proposal, or for any travel and per diem costs

that are incurred by any proposer.

8.8 JOINT VENTURES: In the event multiple proposers submit a joint proposal in response

to the RFP, a single proposer shall be identified as the Prime Proposer. If offering a

joint proposal, Prime Proposer must include the name and address of all parties of the joint proposal.

Prime Proposer shall provide all bonding and insurance requirements, execute any Contract, have

overall and complete accountability to resolve any dispute arising within this contract. Only a single

contract with one proposer shall be acceptable. Prime Proposer responsibilities shall include, but not

be limited to, performing of overall contract administration, preside over other proposers

participating or present at meetings, oversee preparation of reports and presentations, and file any

notice of protest and final protest as described herein. Prime Proposer shall also prepare and present

a consolidated invoice(s) for services performed. MCSB shall issue only one check for each

consolidated invoice to the Prime Proposer for services performed. Prime Proposer shall remain

responsible for performing services associated with response to this RFP.

8.9.1 APPLICABLE LAW: This RFP and any agreement resulting from it shall be interpreted

and construed according to the laws of the State of Florida and Monroe County.

8.9.2 GOVERNING LAW: This RFP, and any award(s) resulting from this RFP, shall be

governed by and construed under the laws of the State of Florida and Monroe County.

8.9.3 LEGAL REQUIREMENTS: Federal, state, county and local laws, ordinances, rules and

regulations that in any manner affect the goods or services covered herein apply. Lack of

knowledge by the proposer will in no way be a cause for relief from responsibility.

8.9.4 ADVERTISING: In submitting an RFP, proposer agrees not to use the results there from

as a part of any commercial advertising without prior written approval of MCSB.

8.9.5 PAYMENT: Payment will be provided only after receipt and acceptance of services.

8.9.6 EXPENDITURE: No guarantee is given or implied as to the total dollar value or work as a

result of this RFP. MCSB is not obligated to place any order for services performed with any

awardee(s) as a result of this award. Order placement will be based upon the needs and in the

best interest of MCSB.

8.9.7 CONFLICT OF INTEREST: The award of this RFP is subject to the provisions of

Chapter 112, Florida Statutes, as currently enacted or as amended from time to time. All

proposers must disclose with their proposal the name of any officer, director or agent who is also

an employee of MCSB. Gallagher Benefit Services, Inc. will be providing consultant services to

MCSB in relation to the employee benefit program. All proposers must disclose with their

proposal the name of any officer, director or agent who is also an employee of Gallagher Benefit

Services.

8.9.7.1 DISPUTES: In the event of a conflict between the documents, the order of priority of the

documents shall be as follows:

Any agreement resulting from the award of this RFP (if applicable); then

Addenda released for this RFP, with the latest Addendum taking precedence; then

the RFP; then

awardee’s proposal.

In case of any other doubt or difference of opinion, the decision of MCSB shall be final and binding

on both parties.

8.9.8 HOLD HARMLESS AGREEMENT: During the term of this award, the awardee(s) shall

indemnify, hold harmless, and defend MCSB, its agents, servants and employees from any and

all costs and expenses, including but not limited to, attorney’s fees, reasonable investigative and

discovery costs, court costs and all other sums which MCSB, its agents, servants and employees

may pay or become obligated to pay on account of any, all and every claim or demand, or

assertion of liability, or any claim or actions found, thereon, arising or alleged to have arisen out

of the products, goods or services furnished by the awardee(s), his agents, servants or employees,

or any of awardee’s equipment when such persons or equipment are on premises owned or

controlled by MCSB for the purpose of performing services, delivering products or goods,

installing equipment, or otherwise transacting business, whether such claim or claims be for

damages, injury to person or property, including MCSB’s property, or death of any person, group

or organization, whether employed by the awardee(s) or MCSB or otherwise.

8.9.9 PATENTS AND ROYALTIES: The proposer, without exception, shall indemnify and

save harmless MCSB and its employees from liability of any nature or kind, including cost and

expenses for or on account of any copyrighted, patented, or unpatented invention, process, or

article manufactured or used in the performance of the contract, including its use by MCSB. If

the proposer uses any design, device, or materials covered by letters, patent, or copyright, it is

mutually understood and agreed without exception that the RFP prices shall include all royalties

or cost arising from the use of such design, device or materials in any way involved in the work.

8.9.10 ANTI-DISCRIMINATION: The Vendor certifies that he or she is in compliance with the

non-discrimination clause contained in Section 202, Executive Order 11246, as amended by

Executive Order 11375, relative to equal employment opportunity for all persons without regard

to race, color, religion, sex or national origin.

8.9.11 LIABILITY, INSURANCE, LICENSES AND PERMITS: Where proposers are

required to enter or go onto MCSB property to deliver materials or perform work or services as a

result of award, the proposer agrees to The Hold Harmless Agreement stated herein and will

assume the full duty obligation and expense of obtaining all necessary licenses, permits and

insurance. The proposer shall be liable for any damages or loss to MCSB occasioned by

negligence of the proposer (or agent) or any person the proposer has designated in the completion

of the contract.

8.9.12 SELLING, TRANSFERRING OR ASSIGNING CONTRACT: No contract awarded

under these terms, conditions and specifications shall be sold, transferred or assigned without

prior written approval of MCSB.

8.9.13 CANCELLATION: MCSB reserves the right to terminate any contract resulting from this

RFP at any time and for no reason, upon giving 60 days prior written notice to the other party.

Purchaser reserves the right to cancel such orders, or any part thereof, without obligation, if

delivery is not made at the time specified on the bid proposal form.

8.9.14 INDEMNIFICATION PROVISION: Each party agrees to be fully responsible for its acts

of negligence or its agent’s acts of negligence when acting within the scope of their employment

and agrees to be liable for any damages resulting from said negligence. Nothing herein is

intended to serve as a waiver of sovereign immunity by any agency to which sovereign immunity

may be applicable.

Nothing herein shall be construed as consent by an agency or political subdivision of the State of

Florida to be sued by third parties in any matter arising out of any contract.

8.10 ACCEPTANCE AND REJECTION OF PROPOSALS:

8.10.1 Acceptance: All proposals properly completed and submitted will be considered

by MCSB. However, MCSB reserves the right to request additional information, reject any or all

proposals that do not meet all mandatory requirements, or reject all proposals received.

8.10.2 MCSB also reserves the right to waive irregularities in any proposal received if

such action is in the best interest of MCSB. However, such a waiver shall in no way modify the

RFP requirements or excuse the proposer from full compliance with the RFP specifications and

other contract requirements if the proposer is awarded the contract.

8.25 INSURANCE REQUIREMENTS:

Proof of the following insurance will be furnished by any awardee to MCSB by Certificate of

Insurance or a Certified copy of the actual insurance policy within three days of notification by

MCSB. Such certificate must contain a provision for notification to MCSB 45 days in advance

of any material change in coverage, non-renewal or cancellation. The notification must be by

return-receipt, certified mail and no other form of notification will otherwise relieve the

insurance company, its agents, or its representatives of responsibility. “The Monroe County

School Board, its employees and officials shall be named as “Additional Insured” as outlined.

Any deviations from these General Insurance Requirements must be requested in writing.

The insurance information must be submitted on a Certificate of Insurance or a Certified copy of

the actual insurance policy and submitted with the proposal.

8.25.1 Contractor’s public liability shall include comprehensive general liability, contractual liability,

and products and completed operations liability. Bodily injury limits of liability shall be at least

$100,000 per claimant, $200,000 per occurrence. Property damage limits of liability shall be at

least $100,000 per claimant, $200,000 per occurrence. Personal injury liability (a separate

coverage from bodily injury) shall be required. Personal injury liability limits shall be specified

in amounts of at least $100,000 per claimant, $200,000 per occurrence. MCSB shall be named as

additional insured on Contractor’s public liability policy.

8.25.2 Professional Liability insurance with limits of not less than $500,000 per

occurrence/$1,000,000 Aggregate.

8.25.3 Motor vehicle liability shall be required with limits of at least $100,000 per claimant,

$200,000 per occurrence for both bodily injury and property damage (this coverage

should include all owned, non-owned and hired vehicles used in connection with this

RFP).

8.25.4 Worker's Compensation shall be in compliance with chapter 440 Florida Statutes.

Workers compensation shall include employer’s liability in the amount of at least

$100,000 per accident, $500,000 policy limit for disease, $100,000 per bodily injury by

disease for each employee.

8.25.5 Employee Dishonesty Insurance in the amount of $100,000 per Occurrence.

Prior to the commencement of any work the awardee must provide MCSB with evidence of the

required insurance.

8.26 WITHDRAWAL OR REJECTION OF RFP: In the best interest of MCSB, MCSB

reserves the right to withdraw this RFP at any time prior to the time and date specified for the

proposal opening; to reject any and all proposals and to waive any irregularity in proposals

received.

8.27 DEFAULT PROVISION: In case of default by the successful bidder or contractor, MCSB

may procure the items or services from other sources and hold the bidder or contractor

responsible for any excess cost occasioned or incurred thereby.

8.28 SIGNED BID CONSIDERED AN OFFER: The signed bid shall be considered an offer

on the part of the bidder or contractor, which offer shall be deemed accepted upon approval by

MCSB and in case of default on the part of the successful bidder or contractor, after such

acceptance, MCSB may take such action as it deems appropriate, including legal action, for

damages or specific performance.

8.29 SPECIFICATIONS: Any omissions of detailed specifications stated herein, that would

render the materials/services from use, as specified, will not relieve the bidder from

responsibility.

8.30 CONTRACTS: Sample contracts must be provided.

EXHIBITS

EXHIBIT A CONTRACT FORM 2-S

(REV. 9/07)

THE SCHOOL DISTRICT OF MONROE COUNTY

Contract for Services:

Threshold Two (Equal to or in Excess of $25,000.00)

W I T N E S E T H:

WHEREAS, the School Board of Monroe County, Florida (“School Board” or “MCSB”), as the

contracting agent for the School District of Monroe County, Florida (“School District”), has

requested bids for

____________________________________________________________________________________

_______________________________________________________________________.

WHEREAS, (“Contractor”) has submitted a

bid, dated to provide the services sought by the School Board.

WHEREAS, is duly qualified

to provide the services sought by the School Board.

WHEREAS, School Board, on behalf of the School District, desires to engage

to provide such services for the School District and

________________________________ _____________________________ desires to provide such

services for the School District.

NOW, THEREFORE, in consideration of the mutual covenants and benefits hereinafter set forth,

the parties herein covenant and agree as follows:

1. REQUEST FOR BIDS AND BID INCORPORATED HEREIN

The terms and specifications of the Request for Bids issued by the Monroe County School

District on {Date of Request for Bids and Identifying Number}

, and the terms of that bid submitted by

are herein incorporated by reference as if fully set forth

herein, made part of this Contract and are attached hereto as Exhibits “_A_” and “__”

respectively. In the event of a conflict between the terms of this Contract and any exhibit, the

terms of this Contract shall control, unless otherwise agreed in writing as an amendment pursuant

to the terms for such as provided herein.

2. TERM

The term of this Contract shall be from January 1, 2010, to December 31, 2012.

This Contract may be renewed for a period that may not exceed two (2) years or the term set forth

above, whichever period is longer. The compensation for the renewal term shall be determined

prior to renewal of this contract and is subject to approval by the MCSB. Further, renewal of this

contract is contingent upon a determination by the MCSB that the services have been satisfactorily

performed, that the services are needed and upon availability of funds.

3. CONTRACTOR'S SERVICES

Contractor agrees to provide the following services:

______________________________________________________________________________

______________________________________________________________________________

____________________________________________________________

If documentation of the specific goods/services is attached, said documentation is labeled as

Exhibit “___” to this Contract and is incorporated herewith by reference.

4. COMPENSATION

School Board shall pay Contractor the sum of ________________________________ for

services rendered pursuant to this Contract. Payment to be made as follows:

______________________________________________________________________________

__________________________________________________________________

No payment shall be due until the School Board verifies that all services for which payment

has been requested have been fully and satisfactorily performed. The School Board will

make diligent efforts to verify and pay invoices within one (1) payment cycle after receipt.

5. COMPLIANCE WITH LAWS AND POLICIES

Contractor agrees to comply with all current Monroe County School Board policies and all

applicable local, state and federal laws, including laws pertaining to the confidentiality of

student records and public records requests. Specifically, Contractor has executed a

Relationship Disclosure Affidavit, attached hereto as Exhibit “_G__”. Contractor agrees

that MCSB has the right to unilaterally and immediately cancel this Contract upon refusal

by Contractor to allow public access to all documents, papers, letters, or other material

made or received by the Contractor in conjunction with the contract, unless the records are

exempt from s.24(a) of Art. I of the State Constitution and s.119.07 (1). Should cancellation

be necessary under this clause, MSCB is required only to provide written notice to

Contractor, effective upon receipt of notice, which shall be documented.

6. INDEPENDENT CONTRACTOR STATUS

Contractor is, for all purposes arising under this Contract, an independent contractor.

Contractor and its officers, agents or employees shall not, under any circumstances, hold

themselves out to anyone as being officers, agents or employees of the School Board, Scholl

District of Monroe County, Florida, nor any department thereof. No officer, agent or

employee of the Contractor or School/Department shall be deemed an officer, agent or

employee of the other party. Neither Contractor or School Board, nor any officer, agent or

employee thereof, shall be entitled to any benefits to which employees of the other party are

entitled, including, but not limited to, overtime, retirement benefits, workers compensation

benefits, injury leave, or other leave benefits.

7. BACKGROUND CHECKS/FINGERPRINTING

In accordance with the legislative mandate set out in sections 1012.32, 1012.465 and 435.04,

Florida Statutes (2005) as well as with the requirements of HB 1877, The Jessica Lunsford

Act (2005), effective September 1, 2005, Contractor agrees that all of its employees and sub-

contractors, including employees of sub-contractors, who provide or may provide services

under this Contract have completed all background screening requirements through a

Monroe County School Board designee pursuant to the above-referenced statutes. It is

recognized and agreed that the provisions and exceptions relating to the dictates of The

Jessica Lunsford Act, and codified at sections 1012.321, 1012.465, 1012.467 and 1012.468 of

the Florida Statutes, shall apply to the requirements of this paragraph where so applicable.

Contractor agrees to bear any and all costs associated with acquiring the required

background screenings. Contractor agrees to require all affected employees and sub-

contractors to sign a statement, as a condition of employment with Contractor in relation to

performance under this Contract, that the employee and/or sub-contractor will abide by

the terms and notify Contractor/Employer of any arrest or conviction of any offense

enumerated in section 435.04, Florida Statutes within forty-eight (48) hours of their

occurrence. Contractor agrees to provide MCSB with a list of all employees and/or sub-

contractors who have completed background screenings as required by the above-

referenced statutes and that meet the statutory requirements contained therein.

Contractor agrees that it has an ongoing duty to maintain and update these lists as new

employees and/or sub-contractors are hired and in the event that any previously screened

employee fails to meet the statutory standards. Contractor further agrees to notify MCSB

immediately upon becoming aware that one of its employees or its sub-contractor’s

employees, who was previously certified as completing the background check, and meeting

the statutory standards, is subsequently arrested or convicted of any disqualifying offense.

Failure by Contractor to notify MCSB of such arrest or conviction within forty-eight (48)

hours of being put on notice by the employee/sub-contractor and within 5 days of its

occurrence shall constitute grounds for immediate termination of this contract by MCSB.

The parties further agree that failure by Contractor to perform any of the duties described

in their paragraph shall constitute a material breach of the contract entitling MCSB to

terminate this Contract immediately with no further responsibility to make payment or

perform any other duties under this Contract.

8. TERMINATION

A. WITHOUT CAUSE

This Contract may be terminated for any reason by either party upon sixty (60) days

written notice to the other party at the addresses set forth below. If said Contract should

be terminated as provided in this paragraph of the Contract, the MCSB will be relieved of

all obligations under said contract and the MCSB will only be required to pay that amount

of the contract actually performed to the date of termination with no payment due for

unperformed work or lost profits.

B. TERMINATION FOR BREACH

Either party may terminate this Contract upon breach by the other party of any material

provision of this Contract, provided such breach continues for fifteen (15) days after

receipt by the breaching party of written notice of such breach from the non-breaching

party.

C. IMMEDIATE TERMINATION BY MCSB

School Board may terminate this Contract immediately upon written notice to Contractor

(such termination to be effective upon Contractor’s/Individual’s receipt of such notice)

upon occurrence of any of the following events:

a. the denial, suspension, revocation, termination, restricting, relinquishment or

lapse of any license or certification required to be held by the Contractor, or

of any Company/Individual staff’s professional license or certification in the

State of Florida;

b. conduct by Contractor or any Company/Individual staff which affects the

quality of services provided to the School Board or the performance of duties

required hereunder and which would, in the School Board’s sole judgment,

be prejudicial to the best interests and welfare of the School Board and/or its

students;

c. breach by Contractor or any Company/Individual staff of the confidentiality

provisions of this Contract;

d. failure by Contractor to maintain the insurance required by the terms of this

Contract.

9. ASSIGNMENT

Neither Consultant nor the Monroe County School Board may assign or transfer any

interest in this Contract without the prior written consent of both parties. Should an

assignment occur upon mutual written consent, this Contract shall inure to the benefit of

and be binding upon the parties hereto and their respective heirs, representatives,

successors and assigns.

10. AMENDMENT

This Contract may be amended only with the mutual consent of the parties. All

amendments must be in writing and must be approved by the Monroe County School

Board.

11. INDEMNIFICATION, GOVERNING LAW & VENUE

Contractor shall indemnify and hold harmless the Monroe County School Board from and

against any and all claims, liabilities, damages, and expenses, including, without limitation,

reasonable attorneys' fees, incurred by the MCSB in defending or compromising actions

brought against it arising out of or related to the acts or omissions of Contractor, its agents,

employees or officers in the provision of services or performance of duties by Contractor

pursuant to this Contract.

This Contract shall be construed in accordance with the laws of the State of Florida. Any

dispute arising hereunder is subject to the laws of Florida, venue in Monroe County,

Florida. The prevailing party shall be entitled to reasonable attorney's fees and costs

incurred as a result of any action or proceeding under this Contract.

12. REPRESENTATIONS & WARRANTIES

Contractor represents and warrants to the Monroe County School Board, upon execution

and throughout the term of this Contract that:

1) Contractor is not bound by any Contract or arrangement which would

preclude it from entering into, or from fully performing the services required

under the Contract;

2) None of the Contractor’s agents, employees or officers has ever had his or

her professional license or certification in the State of Florida, or of any other

jurisdiction, denied, suspended, revoked, terminated and/or voluntarily

relinquished under threat of disciplinary action, or restricted in any way;

3) Contractor has not been convicted of a public entity crime as provided in

F.S. §287.133, to wit: A person or affiliate who has been placed on the

convicted vendor list following a conviction for public entity crime may not

submit a bid, proposal, or rely on a contract to provide any goods or services

to a public entity, may not submit a bid, proposal, or reply on a contract with

a public entity for the construction or repair of a public building or public

work, may not submit bids on leases of real property to public entity, may

not be awarded or perform work as a contractor, supplier, subcontractor, or

consultant under a contract with any public entity, and may not transact

business with any public entity in excess of the threshold amount provided in

Section 287.017, for CATEGORY TWO for a period of 36 months from the

date of being placed on the convicted vendor list; and

4) Contractor and Contractor’s agents, employees and officers have, and shall

maintain throughout the term of this Contract, all appropriate federal and

state licenses and certifications which are required in order for Contractor to

perform the functions, assigned to him or her in connection with the

provisions of the Contract.

13. CONFIDENTIALITY

Contractor recognizes and acknowledges that by virtue of entering into this Contract and

providing services hereunder, Contractor, its agents, employees and officers may have

access to certain confidential information, including confidential student information and

personal health information. Contractor agrees that neither it nor any Contractor agent,

employee or officer will at any time, either during or subsequent to the term of this

Contract, disclose to any third party, except where permitted or required by law or where

such disclosure is expressly approved by the MCSB in writing, any confidential student

information, personal health information or other confidential information, and MCSB, its

agents, employees and officers shall comply with all Federal and State laws and regulation

and all MCSB policies regarding the confidentiality of such information.

14. INSURANCE

Contractor agrees to secure and maintain at all times during the term of this Contract, at

Contractor’s expense, insurance coverage, as laid out below, covering Contractor for all

acts or omissions which may give rise to liability for services under this Contract. All

Contractor staff is to be insured in minimum amounts acceptable to the Monroe County

School Board and with a reputable and financially viable insurance carrier, naming the

Monroe County School Board as an additional insured. Such insurance shall not be

cancelled except upon thirty (30) days written notice to the MCSB. Contractor shall

provide MCSB with a certificate evidencing such insurance coverage within five (5) days

after obtaining such coverage. Contractor agrees to notify MCSB immediately of any

material change in any insurance policy required to be maintained by Contractor.

Contractor is required to obtain the following coverage, with documentation of having

obtained such coverage being attached hereto as Exhibit “ I “:

_X__ General Liability Insurance As specified on 8.25.1 of the RFP.

Amount: _______________

Details/Comments: (Naming the Monroe County School District as additional

insured.)

_____________________________________________________________

_________________________________________________

_X__ Professional Liability Insurance As specified on 8.25.2 of the RFP

Amount: _______________

Details/Comments:

_____________________________________________________________

_________________________________________________

_X__ Vehicle Liability Insurance As specified on 8.25.3 on the RFP.

Amount: _______________

Details/Comments:

_____________________________________________________________

_________________________________________________

_X__ Workers Compensation Insurance As specified on 8.25.4 on the RFP.

Amount: _______________

Details/Comments:

_____________________________________________________________

________________________________________________

15. BILLING

Bills for fees or compensation under this contract shall be submitted in detail sufficient for

a proper pre-audit and post-audit thereof. Further, bills for any travel expenses shall be

submitted in accordance with s. 112.061 where applicable.

16. THIRD-PARTY BILLING AND PAYMENT

To the extent applicable with regard to the services provided in this Contract, the

Contractor shall cooperate with School Board representatives to determine the eligibility of

a referred student for third-party benefits and to bill cooperatively the third-party for

services provided to the referred student. Should the third-party decline to pay for billed

services, or should the third-party only make partial payment for billed services,

Contractor shall provide appropriate documentation to School Board and will assist the

School Board in any administrative or appeals process regarding eligibility or payment as

may be requested by the School Board. Contractor shall not be entitled to bill nor accept

third-party payment without authorization of the School Board and Contractor agrees that

School Board shall not be obligated to make any payment that exceeds the rate referred to

in the paragraph governing Compensation. The Contractor shall provide service

documentation in accordance with professional standards and School Board criteria as

requested.

17. CONTRACT RECORDS RETENTION

Contactor agrees to comply with all state and federal regulations governing contracts with

public entities, including but not limited to cooperation with public records requests as

provided by law, cooperation with comptrollers and auditors as provided by law,

and adherence to Title 34, section 80.36, which requires the retention of all

records concerning a public entity contract for three (3) years after the School

Board makes final payment and all other pending matters concerning the contract are

closed.

18. ETHICS CLAUSE

Contractor warrants that he/it has not employed, retained or otherwise had act on his/its

behalf any former Monroe County School District officer or employee. For breach or

violation of this provision the Monroe County School District may, in its discretion,

terminate this contract without liability and may also, in its discretion, deduct from the

contract or purchase price, or otherwise recover the full amount of any fee, commission,

percentage, gift, or consideration paid to the former Monroe County School District officer

or employee.

19. CONFLICT OF INTEREST

The following provisions shall apply for conflict of interest. Any violation of these

provisions by a School District employee may be grounds for dismissal. No contract for

goods or services may be made with any business organization in which the Superintendent

or a School Board member has any material financial interest unless it is a single source or

clear documentation exists to show that, no other supplier can provide the

identical/comparable goods/service, at a lower cost to the School Board. No School Board

member or officer, or School District officer or employee, may directly or indirectly

purchase or recommend the purchase of goods or services from any business organization

which they or their near relative have a material interest as defined by §112.313, Florida

Statutes, except as allowed by DOE Interpretative Memorandum No. A-20. No School

Board member, School District employee or official may receive gifts or any preferential

treatment from vendors. Such members, officers, officials or employees shall not be

prohibited from participating in any activity or purchasing program that is offered to all

School District employees or in School District surplus sales, provided there is no

preferential treatment.

20. DEBARMENT CERTIFICATION

A Debarment Certification Form, attached hereto as Exhibit “_C__”, shall be executed by

Contractor and is incorporated herein as part of this Contract. Contractor certifies that

neither the firm, nor any person associated therewith in the capacity of owner, partner,

director, officer, principal, investigator, project director, manager, auditor, and/or position

is involved in the administration of federal funds.

21. SEVERABILITY

The parties recognize and agree that should any clause(s) herein be held invalid by a Court

of competent jurisdiction, the remaining clauses shall not be affected and shall remain of

full force and effect.

22. COUNTERPARTS

This Contract may be executed in one or more counterparts, all of which together

shall constitute only one Contract.

23. WAIVER

A waiver by either party of a breach or failure to perform hereunder shall not constitute a

waiver of any subsequent breach or failure to perform. Any waiver of insurance

requirements as provided by this Contract and/or the policies of the School Board does not

relieve the Contractor of the indemnification provisions contained within this Contractor.

24. CAPTIONS

The captions contained herein are used solely for convenience and shall not be deemed to

define or limit the provisions of this Contract.

25. ENTIRE CONTRACT

The parties hereto agree that this is the final Contract between the parties and supercedes

any and all prior Contracts and/or assurances, be it oral or in writing.

26. NOTICES

All notices required by this Contract, unless otherwise provided herein, by either party to

the other shall be in writing, delivered personally, by certified or registered mail, return

receipt requested, or by Federal Express or Express Mail, and shall be deemed to have

been duly given when delivered personally or when deposited in the United States mail,

postage prepaid, addressed as follows:

Monroe County School Board:

Superintendent

Monroe County School District

241 Trumbo Road

Key West, FL 33040

With a copy to:

Monroe County School District Counsel

Vernis & Bowling of the Florida Keys, P.A.

81990 Overseas Hwy, 3rd

Floor

Islamorada, FL 33036

(“CONTRACTOR”):

APPROVED:

_____________________________________ __________ LEGAL DEPARTMENT (Initial Review) DATE

_____________________________________ __________ RISK MANAGEMENT DATE

_____________________________________ __________ PURCHASING DEPARTMENT DATE

_____________________________________ __________

PERSONNEL DEPARTMENT DATE

_____________________________________ __________

LEGAL DEPARTMENT (Final Review) DATE

IN WITNESS WHEREOF, the parties have executed this Contract on this _____ day of

_____________________ , ___________ .

__________________________________ __________ SIGNATURE OF CHAIRPERSON OF THE BOARD DATE

__________________________________ __________

SIGNATURE OF SUPERINTENDENT DATE

________________________________________ ____________

SIGNATURE OF CONTRACTOR/REPRESENTATIVE DATE

________________________________________

PRINT NAME AND TITLE

EXHIBIT B Statement of No Bid

NOTE: If you do not intend to bid on this requirement/project, please return this form

immediately. Thank you.

School Board of Monroe County, Florida

We, the undersigned have declined to submit a bid for No. _______

Specifications too “tight”, i.e. geared toward one brand/manufacturer/service only (explain

below)

Unable to meet time period for responding to ITB/RFP.

We do not offer this product or service.

Our schedule would not permit us to perform.

Unable to meet specifications.

Unable to meet Bond/Insurance requirement(s).

Specifications unclear (explain below).

Unable to Meet Insurance Requirements.

Please Remove Us from Your “Bidders List”.

Other (specify below).

REMARKS: ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

We understand that if the “No Bid” letter is not executed and returned our name may be deleted

from the Bidders List of the School Board of Monroe County.

Company Name: _________________________ Email: ________________________

Bidder Number: _________________________ Date: ________________________

Signature ______________________________ Fax: _________________________

Telephone: _________________________

EXHIBIT C

Debarment Certification “The Bidder certifies that, neither the firm nor any person associated therewith in the capacity of

owner, partner, director, officer, principal, investigator, project director, manager, auditor,

and/or position involving the administration of federal funds:

(a) Is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily

excluded from covered transactions, as defined in 49 CFR s29.110(a), by any federal department

or agency;

(b) Has within a three-year period preceding this certification been convicted of or had a civil

judgment rendered against it for: commission of fraud or a criminal offense in connection with

obtaining, attempting to obtain, or performing a federal, state, or local government transaction or

public contract; violation of federal or state antitrust statutes; or commission of embezzlement,

theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving

stolen property;

(c) Is presently indicted for or otherwise criminally or civilly charged by a federal, state, or local

Governmental entity with commission of any of the offenses enumerated in paragraph 9(b) of this

certification; and

(d) Has within a three-year period preceding this certification had one or more federal, state, or

local government public transactions terminated for cause or default.

The Bidder certifies that it shall not knowingly enter into any transaction with any subcontractor,

material supplier, or vendor who is debarred, suspended, declared ineligible, or voluntarily

excluded from participation in this project by any federal agency.

Dated this day of , 20 . By_______________________________________________________________

Authorized Signature/Contractor _____

_______________________________________________________________ Typed Name/Title _______________________________________________________________ Contractor's Firm Name _______________________________________________________________ Street Address _______________________________________________________________ City/State/Zip Code _______________________________________________________________ Area Code/Telephone Number Fax Number

EXHIBIT D

DRUG FREE WORKPLACE FORM

The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:

________________________________________________________________

(Name of Business)

1. Publish a statement notifying employees that the unlawful manufacture, distribution,

dispensing, possession, or use of a controlled substance is prohibited in the workplace

and specifying the actions that will be taken against employees for violations of such

prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business’s

policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation,

and employee assistance programs, and the penalties that may be imposed upon

employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services

that are under bid a copy of the statement specified in subsection (1).

4. In the statement specified in subsection (1), notify the employees that, as a condition

of working on the commodities or contractual services that are under bid, the employee

will abide by the terms of the statement and will notify the employer of any conviction of, or

plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any

controlled substance law of the United States or any state, for a violation occurring in the

workplace no later than five (5) days after such conviction.

5. Impose a sanction on, or require the satisfactory participation in a drug abuse

assistance or rehabilitation program if such is available in the employee’s community, or

any employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through

implementation of this section.

As the person authorized to sign the statement, I certify that this firm complies fully with

the above requirements.

Date: ______ _________________________________________

Applicant’s Signature

EXHIBIT E

PUBLIC ENTITY CRIME STATEMENT

Public Entity Crime Statement. All invitations to bid, request for proposals and any contract

document shall contain a statement which reads as follows (Section 287.133 FS): “A person or

affiliate who has been placed on the convicted vendor list following a conviction for public entity

crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a

public entity, may not submit a bid, proposal, or reply on a contract with a public entity for the

construction or repair of a public building or public work, may not submit bids on leases of real

property to public entity, may not be awarded or perform work as a contractor, supplier,

subcontractor, or consultant under a contract with any public entity, and may not transact

business with any public entity in excess of the threshold amount provided in Section 287.017, for

CATEGORY TWO for a period of 36 months from the date of being placed on the convicted

vendor list.”

PROPOSER’S SIGNATURE

DATE

As the person authorized to sign the statement, I certify that this firm complies fully with the

above requirements.

EXHIBIT F


_______________, _____ (Date)

_____________________________ (Name of Company/Contractor)

_____________________________ (Address)

_____________________________

_____________________________

Dear ________________________:

Please be advised that pursuant to the policies and procedures of The Monroe County

School Board (“MCSB”), all contracts between companies and/or contractors and the School

District are to be documented using standard form contracts drafted by the Monroe County

School Board. It is our understanding, however, that (you have/your company has) refused

and/or otherwise neglected to utilize a standard form contract for goods or services.

Kindly acknowledge (your or your company’s) refusal to utilize a Monroe County School

Board standard form contract by signing below. Please return a signed copy of this letter to the

Monroe County School Board at your earliest convenience.

Should you have any questions or concerns, please do not hesitate to contact me.

I am refusing or have otherwise neglected to use a Monroe County School Board standard

form contract.

__________________________________

Contractor or authorized designee

Very truly yours,

Lisa Ernst Cherry

Director of Purchasing

Cc: Randy Acevedo, Superintendent

Legal Department

Legal Department

EXHIBIT G


BUSINESS/PERSONAL RELATIONSHIP DISCLOSURE AFFIDAVIT (Exhibit to Standard Form Contract)

I, ___________________________________, of the City/Township/Parrish of

__________________________________, State of ______________________, and according to law

on my oath, and under penalty of perjury, depose and say that;

1) I am the authorized representative of the company or entity making a proposal for a

project described as follows:

Name of company (or vendor if no company): __________________________________; and

Nature of services presently being offered to School District: __________________________

2) I have ____ have not ____, at any time, and excluding the instant proposal, had a business

or personal relationship with any member of the School Board of Monroe County,

Florida, and/or with any employee of the School District of Monroe County, Florida.

a.) The details of my or my company’s present and/or former relationship, excluding the instant

proposal, are:

{include particular Board member or employee’s name(s), position held by such

member or employee and relevant date(s); use reverse for space if needed}

____________________________________________________________________________________

________________________________________________________________________

3) The statements contained in this affidavit are true and correct, and made with full

knowledge that The School Board of Monroe County, Florida, relies upon the truth of the

statements contained in this affidavit in awarding contracts for the subject project.

_____________________________________ Dated:_____________

(Signature of Authorized Representative)

Print: ______________________________

STATE OF ____________________,

COUNTY OF ___________________

PERSONALLY APPEARED BEFORE ME, the undersigned authority,

_____________________________________________________, who, after first being sworn by me,

affirmed that the statements made herein are true, and has affixed his/her signature in the space

provided above on this ______ day of ___________________________, 2009

NOTARY PUBLIC My commission expires:

_____________________________

EXHITIB H

NON-COLLUSION AFFIDAVIT

I,____________________________________________________of the city

ing to law on my oath, and under

penalty of perjury, depose and say that;

1) I am_____________________________________________, the bidder making the Proposal for

the project described as follows:

_______________________________________________________________

2) The prices in this bid have been arrived at independently without collusion, consultation,

communication or agreement for the purpose of restricting competition, as to any matter relating to such

prices with any other bidder or with any competitor;

3) Unless otherwise required by law, the prices which have been quoted in this bid have not been

knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening,

directly or indirectly, to any other bidder or to any competitor; and

4) No attempt has been made or will be made by the bidder to induce any other person, partnership

or corporation to submit, or not to submit, a bid for the purpose of restricting competition;

5) The statements contained in this affidavit are true and correct, and made with full knowledge

that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts

for said project.

STATE OF ____________________ _________________________________

(Signature of Bidder)

COUNTY OF ___________________ _________________________________

DATE

PERSONALLY APPEARED BEFORE ME, the undersigned authority,

__________________________________ who, after first being sworn by me, (name of individual signing)

affixed his/her signature in the space provided above on this

___________ day of _______________________, 20___.

_________________________________ My commission expires:

NOTARY PUBLIC

Exhibit A

Monroe County School Board (See Attached – Addendum 1) RFP Number; 397 Instructions for Claim Re-Pricing

This file contains claims data from 1/1/2007 through 8/19/2008. It has been sorted in date order and contains sufficient data for you to provide pricing according to your contracts at the time of the prescription fill.

The data provided should not be changed in any way and includes: Fill Date Service Provider ID (NCPDP) Product ID (NDC) Quantity Day's Supply Brand/Generic Indicator Mail/Retail Indicator Formulary Flag Compounding Code

You are requested to complete the fields shaded in blue, using your standard claims processing practices based on the plan as described below and based on the fees you are proposing to MCSB.

Please provide what your actual charge to the patient would be, outline any per prescription dispensing fee and any per prescription administration fee. In the column labeled Client Cost, please show the total cost to the client for each prescription.

If you have recently negotiated more favorable discounts for the providers utilized and wish to demonstrate greater savings than shown with the original fill dates, you may add a supplemental Claim Pricing form with your Proposal. You must clearly identify the Supplemental form and identify the revised "fill dates" clearly.

MCSB requests that you return the completed form along with your proposal in Excel format - it is not necessary to print the form. As the proposals are evaluated, MCSB will provide approximately 20 drug codes for which we will need full pricing detail.

Copayments:$ $10.00 Generic (Mandatory)* $ 25.00 Brand $ 25.00 Brand w/generic available. $ 40.00 Non-Formulary. Mail Order $ 14.00 Generic (Mandatory)*

$ 40.00 Brand $ 40.00 Brand w/generic available $ 70.00 Non-Formulary Patients currently pay the lower of the charge or the Copayment. Retail/Mail Order Mandatory Generic benefit-if you Request the Brand medication, when the Generic is Available, you will pay the Brand co-pay PLUS the Difference between the Brand and Generic price. Exhibit B

MONROE COUNTY SCHOOL BOARD

QUESTIONNAIRE

May-09

Please note there are 2 tabs in this workbook. You must complete both the Requirements Tab and the General Questions Tab in order to present a complete proposal.

The Requirements Tab contains items that comprise the Minimum Eligibility, Scope of Services requested, and Experience and Qualifications.

The General Questions Tab contains questions about your operational abilities, pricing and discounts, reporting, and other capabilities that are of importance.

Please note that space is limited in these forms and keep your answers succinct. If additional space is required, please insert a new row for the remaining response to ensure that your response will be complete.

Where an item requests documentation, please provide that documentation at the end of your proposal under the tab entitled: Other Information.

Please do not modify the format of these forms except to add a row for additional space.

Exhibit C

ATTACHMENT D - FINANCIAL QUOTATION FORM

1. PRICING - RETAIL Brand Drugs

AWP minus %

or

MAC

Estimated MAC Discount: AWP minus %

Dispensing Fee $ Per Script

Administrative Fee $ Per Script

Generic Drugs

AWP minus %

or

MAC




2. PRICING - MAIL ORDER Brand Drugs

AWP minus %

or

MAC




Generic Drugs

AWP minus %

or

MAC




3. PRICING - SPECIALTY PHARMACY Brand Drugs

AWP minus %

or

MAC




Generic Drugs

AWP minus %

or

MAC




3. OTHER FEES

One Time Set-Up Fee: $ Electronic Data Feeds to Medical / UR Vendor $ Per Feed Initial ID Card Packets (2 Cards) Mailed to

Home: $ Per Packet Replacement ID Cards:

$ Per Packet

Prior Authorizations $ Per Authorization

4. REBATES Percentage of Rebates to be Paid to Plan: %

Guaranteed Rebate per Retail Brand Script: $ Guaranteed Rebate per Mail Order Brand

Script: $ 5. ADMINISTRATION FEE GUARANTEE Months

Please list any additional fees or pricing concerns no mentioned above, including any fees for Medicare Part D related services.

Monroe County School Board requires the successful bidder to have sufficient confidence in its performance to warrant certain performance levels. Claims processing standards are important as well as discounts and the effective implementation of the program. Please indicate below which components of your performance you are willing to guarantee and the amount you will place at risk.

Component Measure and Amount at Risk

Accurate and effective implementation within X days of notification of award.

Claim payment accuracy

Claim payment turnaround

Delivery of timely reports

Transparency in operations

Effective data sharing and integration across all program components

Account Management

Please indicate any additional program components for which you are willing to guarantee performance. Exhibit E

request for proposal bid no. 397 self insured prescription

Education

high school

exhibit h

exhibit b statement

purchasing department

prescription drug benefit

bid documents

sealed bids

mcsb desires