RICHARDSON INDEPENDENT SCHOOL DISTRICT

400 S. GREENVILLE AVENUE

RICHARDSON, TEXAS 75081

REQUEST FOR PROPOSAL

FOR

Flexible Spending Account (FSA) Administration

RFP #1389

The Richardson Independent School District (RISD) is soliciting proposals for Flexible Spending Account (FSA)

Administration as per specifications stated in this solicitation document. Sealed proposals shall be submitted in an

envelope marked on the outside with the proposer’s name, address and proposal number (RFP #1389) to:

McGriff, Seibels and Williams of Texas, Inc.

5080 Spectrum Dr., Suite 900E

Addison, TX 75001

Attention: Scott Gibbs and Brant Brinlee

Proposals will be received at the above address until 2:00 PM, Thursday, February 4, 2016. Proposals will be

publicly opened at 2:30 PM the same day.

Proposals must be submitted in sufficient time to be received and time-stamped at the above location on or before

the published date and time shown on the RFP. Richardson Independent school District will not be responsible for

delivering mail from the post office. Proposals received after the published time and date may not be considered.

FAX proposals will not be accepted.

Note: The Proposal Form MUST be filled out, signed, and returned with your proposal.

The proposal name and number must be identified on the outside envelope being delivered (i.e. Federal Express,

UPS, US Postal Service, and Hand Delivery.)

The proposer shall quote prices F.O.B. delivered to the Richardson I.S.D. location to be determined by project.

Proposers must submit sealed proposals and (2) copies with any material required by any addendum to this RFP by

the time and date specified. This is a compliance proposal to establish vendors and cost which will allow for the

legal acquisition of Flexible Spending Account (FSA) Administration. Proposal prices must remain firm for one-

year from date of award for proposal to be considered. This proposal is also renewable for a second and third year

in one-year increments provided all prices remain firm and both parties agree.

RISD’s current broker of record will be the contact for this proposal: McGriff, Seibels and Williams – Scott

Gibbs, 469-232-2188, sgibbs@mcgriff.com or Brant Brinlee, 469-232-2167, bbrinlee@mcgriff.com. Contact

between solicited vendors and user departments during the request for sealed proposal process or evaluation process

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

All questions regarding proposals must be submitted in writing no later than January 28, 2016 to Brant

Brinlee at bbrinlee@mcgriff.com.

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TABLE OF CONTENTS

General Stipulations and Conditions of Proposal ___________________________________3

Signature Sheet _______________________________________________________________6

Statement of Equal Opportunity and Non-Discrimination ____________________________7

Conflict of Interest Questionaire _________________________________________________8

Proposal Information _________________________________________________________11

Disqualification and Rejection of Proposals _______________________________________11

Selection Criteria ____________________________________________________________11

Contract Period ______________________________________________________________12

Authorized Signature _________________________________________________________12

Continuity of Coverage________________________________________________________12

Enrollment __________________________________________________________________12

Commissions ________________________________________________________________12

General Information __________________________________________________________13

Quoting Instructions __________________________________________________________13

Resolution __________________________________________________________________14

Minority Statement ___________________________________________________________15

Assumptions_________________________________________________________________16

Requirements of Companies Submitting Proposals ________________________________17

Certification Regarding Debarment, Suspension, and other Responsibility Matters _____18

Information _________________________________________________________________20

References __________________________________________________________________21

Confidentiality and other Conditions ____________________________________________23

Proposal Requirements _______________________________________________________23

Current Rate ________________________________________________________________24

List of Attachments ___________________________________________________________24

Benefit Grid _________________________________________________________________25

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RICHARDSON INDEPENDENT SCHOOL DISTRICT Richardson, Texas 75081

GENERAL STIPULATIONS AND CONDITIONS OF PROPOSAL

PROFESSIONAL SERVICES

IF THERE ARE CONTRADICTIONS BETWEEN THE GENERAL STIPULATIONS AND CONDITIONS OF

PROPOSAL AND THE SPECIFICATIONS, WRITTEN OR VERBAL, THE GENERAL STIPULATIONS AND

CONDITIONS OF PROPOSAL SHALL CONTROL.

I. INVITATION TO SUBMIT STATEMENT OF QUALIFICTIONS:

A. Richardson Independent School District invites all interested and qualified firms to submit

proposals for RFP #1389 – Request for Proposal for Flexible Spending Account (FSA)

Administration in accordance with directions available with McGriff, Seibels & Williams of

Texas, Inc. 5080 Spectrum Dr., Suite 900E, Addison, TX 75001, contact Mr. Scott Gibbs, Sr. Vice

President, phone 469-232-2188 or email at sgibbs@mcgriff.com or Mr. Brant Brinlee, Sr. Vice

President, phone 469-232-2167, Fax 972-386-3144 or email BBrinlee@McGriff.com .

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

the Richardson Independent School District and/or the Board of Trustees of Richardson, Dallas

County, Texas. As used herein, the term “Proposer” means any reliable person, entity, broker,

vendor, and/or contractor who wants to submit a proposal in response to Request for Proposal.

The term “Proposal” refers to all responses or proposals submitted hereunder.

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

Proposals must be delivered to McGriff, Seibels, and Williams of Texas, Inc. 5080 Spectrum Dr.,

Suite 900E, Addison, TX 75001, attention: Scott Gibbs and Brant Brinlee.

D. Please submit one original and two copies.

E. Time Frame

1. The tentative timeline for specifications is noted below and followed by the detailed

requirements.

Proposal Issue: January 13, 2016

First Publication: January 13, 2016

Due Date: February 4, 2016

Notification of Finalist: February 16-19, 2016

If Chosen, Potential Finalist Meetings (or Calls) February 29-March 4, 2016

Tentative Council Approval: May 2, 2016

If Chosen, Open Enrollment Materials Delivered June 15, 2016

Contract/Services Effective: September 1, 2016

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

A. An authorized representative of the firm must sign all Proposals. It is the intent of this RFP that

should a given Proposal be accepted, it will automatically become a part of a binding contract.

B. At the time RISD opens the Proposals, the Director of Financial Services, or his designee, shall

open and record all Proposals received. Sufficient time will be allotted to analyze all Proposals

received and the final recommendations shall be prepared for District review and approval. The

District will follow the review process described in the RFP.

III. BILLING AND PAYMENT/DISCOUNTING:

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

on purchase order (unless otherwise noted).

All invoices shall be forwarded to:

RICHARDSON INDEPENDENT SCHOOL DISTRICT ATTENTION: INSURANCE SERVICES DEPARTMENT

400 S. GREENVILLE AVE. RICHARDSON, TEXAS 75081

B. Invoices will be returned for correction unless they contain a detailed description of the invoiced

services that is sufficient to allow the District to ascertain the specific services provided and the

dates of services. Any expenses that the District has agreed to reimburse shall be itemized. RISD

will not be responsible for normal overhead or overtime costs unless the District has specifically

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

to the office listed above.

C. The standard terms for payment: Net 30 days from receipt of complete/correct invoice. All

discounts, including prompt payment, shall be included in any proposal price(s) submitted.

IV. COLLUSION:

A. All Proposers shall sign the appropriate certification as provided on the signature sheet. The

District may reject any Proposal that does not include the required certification.

V. COMPLIANCE WITH SPECIFICATIONS:

A. The Proposer shall abide and comply with the true intent of the specifications and not take

advantage of any unintentional error or omission.

B. The District reserves the right to reject any or all Proposals that comply with these specifications,

or to accept a higher Proposal price that complies, when, in the judgment of the District, such

Proposal offers additional value or function, which justifies the difference in price.

VI. DEVIATIONS FROM SPECIFICATIONS:

All requested deviations from the specifications and requirements stated in the RFP must be specified in

writing by the Proposer at the time the Proposal is submitted. The absence of a written list of requested

deviations or exceptions when the Proposal is submitted will hold the firm strictly accountable to the

District to the specification or requirement as written. The District reserves the right to reject or modify

any requested exception or deviation. Excessive exceptions may result in disqualification of a Proposal.

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IX. ERRORS IN PROPOSALS:

Proposers and their authorized representatives shall fully inform themselves as to the conditions,

requirements, and specifications before submitting a Proposal. Failure to do so will be at the firm’s risk.

X. QUALITY OF PROFESSIONAL SERVICE:

RISD expects that each vendor will perform all contracted services in a good, thorough and professional

manner consistent with industry and professional standards for similar services.

XI. SIGNATURE TO PROPOSALS:

Each Proposal must show the full business address and telephone number of the firm and be signed by the

person or persons legally authorized to sign contacts. All correspondence concerning the Proposal and

contract, including Notice of Award, and Purchase Order, will be mailed or delivered to the address shown

on the Proposal in the absence of written instructions from the Proposer to the contrary. The vendor is

responsible for notifying RISD in writing of any change of company name, address or contact person.

XII. TAXES:

A. The District is exempt from the payment of the Texas Sales Tax. Exemption Certificates for the

Federal Excise Tax may be furnished upon request.

B. Prices quoted shall not include federal excise or state sales and use taxes. Exemption certificates

will be furnished upon request.

C. The District’s Tax Identification Number is 1-75-6002311-5.

XIII. DISPUTE RESOLUTION:

Any disputes arising out of Proposal or subsequent contract shall be resolved informally, where possible,

through conference with the District official responsible for the professional service area in question. Any

dispute that cannot be promptly resolved through informal conference shall be presented to the District in

writing pursuant to Board Policy (GF) Public Complaints. The timelines set out in that policy shall be

followed. A copy of the policy is available at www.tasb.org/policy/pol/private/057916 or from the Director

of Purchasing.

XIV. GOVERNING LAW/VENUE:

Any contract resulting from the Proposal and all matters related thereto shall be construed according to the

laws of the State of Texas. Venue for any disputes between the parties shall lie in Dallas County, Texas.

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SIGNATURE SHEET

My/our signature below confirms that I/we:

1. propose to provide professional services to the Richardson Independent School District, as

described in the accompanying proposal;

2. certify that this Proposal is made without any previous understanding, agreement, or connection

with any person, firm, or corporation making a Proposal for the same services and is in all respects

fair and without collusion or fraud; and

3. certify that this firm is an equal opportunity employer and that all employment decisions are made

without regard to the color, race, sex, national origin, religion, age, or disability status of otherwise

qualified individuals.

COMPANY NAME:

SIGNATURE:

By: __________________________________________

(Print Name)

Title: ________________________________________

DATE SIGNED: ________________________________________________________________

ADDRESS:

TELEPHONE:

FAX :

TERMS:

RETURN TO: Scott Gibbs and Brant Brinlee

McGriff, Seibels, and Williams of Texas, Inc.

5080 Spectrum Dr., Suite 900 E.

Addison, TX 75001

Return completed sheet with proposal

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RICHARDSON INDEPENDENT SCHOOL DISTRICT

STATEMENT OF EQUAL OPPORTUNITY AND NON-DISCRIMINATION

The Richardson Independent School District is committed to fair and equal competition among

all vendors. It is the policy of Richardson ISD to encourage participation in the competitive

proposal process by all interested parties. Richardson ISD does not discriminate against any

otherwise qualified vendor because of the vendor’s race, color, national origin, age, religion, sex,

or disability.

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RICHARDSON INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT

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PROPOSAL INFORMATION

1. RFP Responses must be clearly explained and identified. All costs, including any optional

programs provided by the proposer, must be clearly stated and summarized. Exceptions to or

deviations from the specifications must be explicitly identified.

2. The District currently recognizes McGriff, Seibels and Williams of Texas, Inc. as the benefits

consultant/Agent of Record for all benefit plans and related issues.

3. This RFP does not commit the District to award a contract or to pay any costs incurred in the

preparation of a proposal in response to this request. 4. At all times during the term of this contract, the vendor shall maintain the minimum insurance

requirements set by the District, and shall require all subcontractors and sub-subcontractors

performing work for which the same liabilities may apply under this contract to do likewise.

a. Commercial General Liability:

$2,000,000 Combined Single Limit

b. Policy Aggregate:

$1,000,000 Combined Single Limit each occurrence

DISQUALIFICATION AND REJECTION OF PROPOSALS

Failure to comply with the requirements or the procedures set forth herein, or to satisfy the coverage and

servicing criteria as set forth in the specifications, may result in disqualification. It is not intended that

exceptions to the specifications will, in and of themselves, result in disqualification.

SELECTION CRITERIA

1. The District may award a contract on the basis of proposals received, without discussions.

Therefore, each proposal should contain the proposer’s best terms from a financial and technical

standpoint. The District may negotiate with one or more proposer; and no proposer shall have any

rights against the District arising from such negotiations or any invitation to negotiate.

2. The District reserves the right to reject any or all of the RFPs, in whole or in part, to waive any

informality in any proposal response, and to accept the proposal, which, in its discretion, is in the

best interest of the District. RFP responses will be carefully evaluated for cost effectiveness,

coverage provisions, and compliance with the coverage and servicing criteria contained in the

specifications. The following selection criteria will be applied when considering the proposals:

a. Professional Competence

b. Service & Coverage

c. Fees, Renewal and Guarantees

3. The District recognizes the fact that there are very important considerations involved other than

the fees, and therefore will not be bound to accept the lowest cost proposal. The following

criteria will be considered as part of the weighting factors noted above in considering which

proposal serves in the best interest of the District:

a. Competitiveness of fees; ability to offer multi-year rate guarantees or multi-year renewal

options with capped liability.

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b. Commitment and ability to proactively serve the District’s account and respond to

questions or problems that arise during the course of the agreement.

c. Ability of the proposer to assume the work in a timely manner and coordinate well with

the District’s Insurance Services Department to implement the benefits.

d. Financial stability, service reputation, references, and experience with other clients of

similar size and/or government entities.

CONTRACT PERIOD

Richardson ISD is seeking a three-year contract period: 09/01/2016 – 08/31/2019. The

contract is to contain a sixty-day cancellation notification provision by the District for any

reason and a sixty-day cancellation notification provision by the provider for any reason

other than non-payment.

NOTE: In addition, Richardson ISD is seeking three, one-year renewal options subsequent to

the original contract period. PLEASE NOTE YOUR ACCEPTANCE OF THIS REQUEST.

AUTHORIZED SIGNATURE

All proposal forms must be signed by persons having legal authority to bind the proposer to the services

that are quoted in the RFP response. Failure to provide the proper signatures will make the proposal non-

responsive.

CONTINUITY OF COVERAGE

All participants covered by the current employee benefit plans are to receive immediate coverage under the

new employee benefit plans. Continuity of coverage for current participants is to be on a “no loss-no gain”

basis for all employee benefit plans.

ENROLLMENT

The basis for “take-over” of all employee benefit plans for each of the selected providers is to be the

District’s current enrollment records.

COMMISSIONS

No Commissions should be included in your rates.

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GENERAL INFORMATION

The Richardson Independent School District is located in northern Dallas County and covers 38.5 square miles.

This area encompasses most of the city of Richardson, as well as portions of the cities of Dallas and Garland.

Richardson ISD provides Flexible Benefits Plan in the form of Medical Flexible Spending Account (FSA) and

Dependent Care Reimbursement Account (DCRA) to its eligible employees as part of its overall compensation and

benefits program. Eligible employees are full-time regular employees. Payflex has been RISD’s FSA administrator

since September 1, 2010. Before the beginning of the plan year (September 1, 2010) participants will determine pay

period allocations pursuant to Section 125 of the Internal Revenue Code. The Medical FSA current annual

maximum is $2,500. The current DCRA annual maximum is $5,000.

The current cost for these services is $3.25 pppm (there is no current debit card, although RISD does want to

see proposals that include a debit card option).

As a result, Richardson ISD is soliciting proposals from firms who may be interested in providing Third-Party

Administrative Services (Plan Administrator) for the Flexible Benefits Plan.

Current plan specifics can be found in Attachment 1.

Total Active Full-time Employees 5,268 Health Care Account Participants 593 Dependent Care Account Participants 94

QUOTING INSTRUCTIONS

The information contained in these specifications is confidential and is to be used only in connection with preparing

an RFP response for the following:

The District is requesting quotes for the following:

Flex Plan Administration

IF YOU ARE CHOSEN AS RICHARDSON ISD’S FLEX PLAN ADMINISTRATOR, YOU WILL BE

REQUIRED TO PROVIDE HARD-COPY OPEN ENROLLMENT MATERIALS TO THE INSURANCE

SERVICES DEPARTMENT NO LATER THAN – JUNE 15, 2016!

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RESOLUTION

Whereas, Article 601 (f), Texas Revised Civil Statutes, providing for the payment of goods and services

contracted for, by state or political subdivisions, as amended, is effective July 1, 1986.

Whereas, the Richardson Independent School District desires to implement the Legislative intent and the

exceptions of Article 601 (f), Texas Revised Civil Statutes;

NOW, THEREFORE, BE IT RESOLVED by the Richardson Independent School District:

That unless otherwise authorized by the Board of Trustees of the Richardson Independent School District,

at the request of the Superintendent, no contractor of the Richardson Independent School District shall be entitled to

interest on any delayed, disputed, or delinquent payment, or attorney’s fees in any dispute to collect such payments.

The restrictions of this resolution shall constitute the sole, controlling, contract terms with respect to interest owed

on delayed, disputed, or delinquent payments, in lieu of Article 601 (f), Texas Revised Civil Statutes.

The provisions of this resolution apply to payments made under Contracts executed on or after the effective

date of this resolution. Payments made under contracts executed before the effective date are governed by the laws

of the State of Texas in effect at the time that the contracts were executed, and the former law is continued in effect

for this purpose.

RETURN RESPONSE TO THE RFP NO LATER THAN: February 4, 2016, 2:30 PM, C.S.T.

PROPOSAL WILL BE OPENED AT: McGriff, Seibels, and Williams of Texas, Inc.

5080 Spectrum Dr., Suite 900 E.

Addison, TX 75001

SIGNED PROPOSAL MUST BE RETURNED IN A SEALED ENVELOPE. DO NOT ENCLOSE PROPOSAL

WITH SAMPLES. PROPOSERS SHALL RETAIN DUPLICATE COPY AND RETURN ONLY THOSE PAGES

PERTAINING TO THE ITEMS BEING PROPOSED.

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RICHARDSON INDEPENDENT SCHOOL DISTRICT MINORITY STATEMENT

The Richardson Independent School District is committed to fair and equal competition among all vendors. It is the

policy of Richardson ISD to encourage participation in the competitive proposal process by all interested parties.

Richardson ISD does not discriminate against any vendor because of race, color, national origin, age, Religion,

gender or disability.

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ASSUMPTIONS

1. Medical benefits for new hires are effective on their actively-at-work date or the first of the month

following their actively-at-work date. All other benefits (including the flex plan) are effective the 1st of the

month following sixty (60) days of employment.

2. The District is seeking proposal responses for Flex Plan Administration, (including FSA and DCRA) for a

three-year (3) contract period. In addition, Richardson ISD is seeking three, one-year renewal options

subsequent to the original contract. Please confirm your acceptance of this request.

3. Renewal rates must be received by Richardson ISD no later than six (6) months prior to anniversary date.

4. Performance Guarantees will be approved and agreed upon by Richardson ISD before the effective date of

the coverage.

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REQUIREMENTS OF COMPANIES SUBMITTING PROPOSALS

1. Provide all necessary plan documents including, but not limited to supplying information and enrollment

booklets for the FSA and DCRA and prepare all required enrollment materials.

2. Provide all descriptive literature/enrollment materials, in both hard copy and electronic copy forms.

3. Participate in meetings with eligible employees to orient and enroll employees.

4. Prepare Summary Plan Description for distribution to employees.

5. Process all enrollment materials and establish disbursement procedures as directed by Richardson ISD.

6. Provide and compile all data necessary for Richardson ISD to make payroll deductions and operate the

plan, including, but not limited to:

a. Medical Spending Account Transaction Report.

b. Dependent Care Spending Account Transaction Report.

c. Pre-tax Payroll Deduction Report.

d. Bank Account Report (for prospective deposits).

e. Plan Qualification Report (pursuant to IRS discrimination testing requirements).

g. Employee Transaction Report.

h. Employee Account Statement (provided to each employee participant with each reimbursement

and also upon request).

i. Employee Year End Account Statement (provided to each employee participating four to eight weeks

prior to the end of the plan year).

7. Provide Richardson ISD with all data at each reimbursement period. Reimbursements are processed each

week on Thursdays and Richardson ISD wants that to continue.

Administration of the Plan, including, but not limited to:

a. Reviewing, tracking deposits and tracking reimbursement requests.

b. Processing reimbursements.

c. Conducting annual information meeting for employees.

d. Preparation of disbursements, reports specified above and all other necessary reports.

e Employee communication services.

All employee and employer record keeping services, e.g. enrollments, deposits, distributions, elections and

changes, employee activity summaries, and processing bi-weekly payroll deposits.

Ensure compliance with Internal Revenue Code.

11. Preparation of all IRS tax reporting, withholding, and distribution documents.

12. Consultation as required.

13. Accept a weekly electronic file that you can use to download to your eligibility system for changes to new

hires/terms/changes of deductions. Please include a sample of your required data request as a result.

Note: Richardson ISD currently uses the PGP Encryption Process. Please confirm this is acceptable.

14. Richardson ISD does not currently have a debit card option but please include this as an alternative.

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CERTIFICATION

REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY

MATTERS

I. DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY

EXCLUSION

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

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

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

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

department or agency;

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

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

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

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

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

making false statements, or receiving stolen property;

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

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

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

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

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

explanation to this offer.

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

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

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

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

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

or agency.

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

an explanation shall be attached to the offer.

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

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

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

request.

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II. FELONY CONVICTION NOTIFICATION AND

CRIMINAL BACKGROUND CHECK

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

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

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

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

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

corporation. :

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

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

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

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

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

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

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

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

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

violation of this section shall constitute a substantial failure.

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

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

acceptable to the District with this Agreement showing compliance.

Signature below acknowledges compliance with Section I. DEBARMENT,

SUSPENSION, INELIGILITY AND VOLUNTARY EXCLUSION and Section II.

FELONY CONVICTION NOTIFICATION AND CRIMINAL BACKGROUND

CHECK.

SIGNATURE OF OFFEROR: DATE: __________________

PRINTED/TYPED NAME OF OFFEROR:____________________________________

COMPANY NAME: ______________________________________ TEL#: ______________________

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INFORMATION

1. Organization

Please provide an organizational chart for the proposed account manager and service team assigned to

Richardson ISD. Be sure to also attach the following information for each team member:

a. Biography

b. Primary responsibility on this account

c. Years of experience in managed care/insurance

d. Years with the company

e. Proposed percent of time dedicated to this account (based on a 40 hour week)

f. Contact information (title, phone, fax, address, e-mail)

2. Financial

a. Copy of your most recent annual report and the annual reports of your parent company.

b. Insurance Companies quoting on a Fully Insured basis must provide most recent A.M. Best,

Standard & Poor’s, Weiss, and Moody’s rating (if applicable). If no rating, please explain.

3. Contracts

a. Vendors should list specific services included in the pricing.

4. Implementation Timetable and Materials

a. Detailed implementation timetable, including an outline of the activities you expect to be

performed prior to the stated effective date, completion dates, and the individuals or groups

who will have major responsibility for each activity, including:

Contracts completed

Customer service toll-free phone line operational

ID cards mailed to employees

Electronic access established with Richardson ISD

Program operational and ready to deliver benefits to members

Summary Plan Documents

Welcome packets

Sample claim forms

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REFERENCES

Using the format outlined below, please provide three current client references and three former client

references for which you provided the same services. References should be based on the office that will be

providing services to Richardson ISD. Please include at least one School District in current and former

client reference (if possible).

Current Client Reference 1 Organization name:

Contact and title:

Address:

Phone number:

Effective date of contract:

Number of enrolled employees:

Description of services provided:

Current Client Reference 2 Organization name:

Contact and title:

Address:

Phone number:

Effective date of contract:

Number of enrolled employees:

Description of services provided:

Current Client Reference 3 Organization name:

Contact and title:

Address:

Phone number:

Effective date of contract:

Number of enrolled employees:

Description of services provided:

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Former Client Reference 1 Organization name:

Contact and title:

Address:

Phone number:

Effective date of contract:

Number of enrolled employees:

Number of enrolled employees at date of termination: Description of services provided:

Reason for termination:

Former Client Reference 2 Organization name:

Contact and title:

Address:

Phone number:

Effective date of contract:

Number of enrolled employees:

Number of enrolled employees at date of termination: Description of services provided:

Reason for termination:

Former Client Reference 3 Organization name:

Contact and title:

Address:

Phone number:

Effective date of contract:

Number of enrolled employees:

Number of enrolled employees at date of termination: Description of services provided:

Reason for termination:

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CONFIDENTIALITY AND OTHER CONDITIONS

Medical Claims processing must be confidential and no information shall be transmitted to Richardson ISD

or any other party, except the employee, that indicates the nature or any claim without written authorization

of the employee. Notwithstanding the foregoing, Richardson ISD or its designee shall have access to all

records for the purpose of auditing reimbursements in the detection and prevention of fraud.

All data, documents, discussion or other information developed or received by the Plan Administrator in

performance of above services are confidential and are not to be disclosed to any person except as

authorized by Richardson ISD or as required by law.

PROPOSAL REQUIREMENTS

If your firm is interested in providing these services to Richardson ISD, please provide one (1) original and

two (2) hard copies of your detailed proposal which includes the following information:

1. Name, address and telephone number, fax number, email address, website (if applicable) of the

firm.

2. Name of principal contact person and contact information.

3. A brief history of the firm.

4. Length of time the firm has provided Third Party Administrative Services. Please provide a copy

of you Third Party Administrator license with Texas Department of Insurance.

5. Description of all services that would be provided by the firm under this proposal. Do you have

insurance of bonding of your staff to guarantee the safety of deposited fund? If so, what is the

extent of your insurance/bonding?

6. Copies of sample reports regularly made to employers and employee and copies of reimbursement

forms to be used by employees.

7. Please list the number of Flex Plans that your firm services and the average number of employees per

plan.

8. Licenses and certifications that the firm has obtained through regulatory or industry organizations as

required.

9. List of business partners or subsidiaries that might be utilized to provide the full scope of services, if

through a third party.

10. List of staff likely to service this account and their licenses, certifications, and educational

background.

11. A reference list of three accounts (preferably other school districts) to whom you are providing

similar services; include contact names, titles, and telephone numbers and length of services at these

locations.

12. Provide a list of applicable usual and customary fees, including an annual administration fee,

participant/enrollee fees, new participant fee, re-enrollment fees and any additional service fees

that may apply.

13. Explain your standard plan funding process including: banking setup, contributions and

disbursements.

24

RATE HISTORY

9/1/2013-9/1/2016

Payflex – $3.25 PPPM

9/1/2010-9/1/2013

Payflex – $3.65 PPPM

LIST OF ATTACHMENTS

The list of electronic attachments includes:

1) Current Flex Plan Fees and Services

2) Current Flex Plan SPD

25

In addition to including your own rates page, please fill in the following grid.

FSA ADMINISTRATION Pay Flex Your Company

Debit Card Available Yes, but RISD did not choose this

option

Direct Deposit Available Yes

Installation

Set-up Fee Waived

Communication Materials Included

Administration

Monthly Administration for FSA Participants

$3.25 PPPM (without debit card) $3.50 (w/ debit card) – Was not

chosen as an option $250 monthly minimum

Annual Maintenance / Renewal Fee

Waived

Grace Period Services Included

Debit Card Fee $.25 PPPM (was not chosen as an

option)

Annual Reports - (Standard) Included

Plan Doc/SPD Included

Rate Guarantee 3 years

Notes

- Enrollment Meetings Support: $250/day + Expenses - Mobile App available - Electronic statements already sent - Optional quarterly paper statement +$.25 pppm