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2016-29351 Reso RESOLUTION NO. 2016-29351 A RESOLUTION OF THE MAYOR AND THE CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE ISSUANCE OF INVITATION TO NEGOTIATE (ITN) 2016-084-WG FOR THE ADMINISTRATION OF THE CITY'S FOLLOWING ANCILLARY HEALTH AND DISABILITY BENEFITS FOR EMPLOYEES, RETIREES AND THEIR DEPENDENTS: FAMILY AND MEDICAL LEAVE ACT (FMLA) ADMINISTRATION; LONG-TERM DISABILITY COVERAGE FOR DEFINED CONTRIBUTION RETIREMENT PLAN (401A) PARTICIPANTS AND VOLUNTARY SHORT-TERM AND LONG-TERM DISABILITY; GROUP DENTAL COVERAGE; AND GROUP TERM LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT COVERAGE; AND FURTHER' AUTHORIZING THE RETROACTIVE EXTENSION OF THE AGREEMENT' WITH UNUM AND MONTH-TO-MONTH EXTENSIONS OF THE EXISTING AGREEMENTS WITH METROPOLITAN LIFE INSURANCE COMPANY AND HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY FOR THE ABOVE-STATED SERVICES AND BENEFITS, UNTIL SUCH TIME AS THE ITN CAN BE AWARDED. WHEREAS, on July 25, 2009, the Mayor and City Commission approved Resolution No. 2009- 27141 authorizing the City to enter into an agreement with UNUM for the administration of the City's Family Medical Leave Act ("FMLA") program, long-term disability coverage for defined contribution retirement plan (401A) participants, and voluntary short-term and long-term disability coverage fully funded by employees; and WHEREAS, the agreement with UNUM for administration of the City's FMLA program, long-term disability coverage for defined contribution retirement plan (401A) participants, and voluntary short-term and long-term disability coverage fully funded by employees expired December 31, 2015; and WHEREAS, the City Manager is requesting authorization to retroactively extend the agreement with UNUM, on a month-to-month basis, until such time as the successor contract pursuant to an ITN is awarded; and WHEREAS, on July 15, 2009, the Mayor and City Commission approved Resolution No. 2009- 27137 authorizing the City to enter into an agreement with Metropolitan Life Insurance Company ("MetLife")for administration of the City's group dental plan; and WHEREAS, the original three (3) year contract term for the administration of the City's group dental plan expired December 31,2013, but was renewed thereafter on an annual basis through a confirmation letter from the MetLife to the City and is presently scheduled to expire September 30, 2016; and WHEREAS, the City Manager is requesting authorization to extend the existing agreement with MetLife, on a month-to-month basis, until such time as the successor contract pursuant to an ITN is awarded; and WHEREAS, on July 151, 2009, the Mayor and City Commission approved Resolution No. 2009- 27140 authorizing the City to enter into an agreement with Hartford Life and Accident Insurance Company ("Hartford") for group life insurance and accidental death and dismemberment coverage with Hartford; and WHEREAS, the original three (3) year contract term for the administration of the City's group life insurance and accidental death and dismemberment coverage expired December 31, 2013; but was renewed thereafter on an annual basis through a confirmation letter from Hartford to the City and is presently scheduled to expire September 30, 2016; and WHEREAS, the City Manager is requesting authorization to extend the existing Agreement with Hartford, on a month-to-month basis, until such time as the successor contract pursuant to an ITN is awarded; and WHEREAS, the City Manager is also requesting authorization to issue Invitation to Negotiate (ITN) 2016-084-WG for the administration of the City's following ancillary health and disability benefits for employees, retirees and their dependents: Family and Medical Leave Act (FMLA) administration; long- term disability coverage for defined contribution retirement plan (401a) participants and voluntary short- term and long-term disability; group dental coverage; and group term life and accidental death and dismemberment coverage. NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission hereby authorize the issuance of Invitation to Negotiate (ITN) 2016-084-WG for the administration of the City's following ancillary health and disability benefits for employees, retirees and their dependents: Family and Medical Leave Act (FMLA) administration; long-term disability coverage for defined contribution retirement plan (401a) participants and voluntary short-term and long-term disability; group dental coverage; and group term life and accidental death and dismemberment coverage; and further authorizing the retroactive extension of the agreement with UNUM and month-to-month extensions of the existing agreements with Metropolitan Life Insurance Company and Hartford Life and Accidental Insurance Company for the aforementioned services until such time as the ITN can be awarded. PASSED AND ADOPTED this 13 day of p 2016. ATTE Rafael E. Granado, City �;=�'�' Phili .�, p /ayor lob I • .�" '+•: � APPROVED AS TO 0 INCORP ORATEC FORM & LANGUAGE y &FOR XE UTION N=7%. P kr, ±(2C ip Z�? City Attorney, Dote T:W GENDA\2016\April\Procurement\2016-084-WG ADMINISTRATION OF THE CITYS ANCILLARY HEALTH BENEFITS-Issuance Month to Month Ext\ITN 2016-084-WG ADMINISTRATION OF THE CITYS ANCILLARY HEALTH BENEFITS-ISSUANCE RESO- 3.29.16.doc COMMISSION ITEM SUMMARY Condensed Title: A RESOLUTION OF THE MAYOR AND THE CITY COMMISSION OF THE CITY OF MIAMI BEACH,FLORIDA, AUTHORIZING THE ISSUANCE OF INVITATION TO NEGOTIATE (ITN) 2016-084-WG FOR THE ADMINISTRATION OF THE CITY'S ANCILLARY HEALTH BENEFITS FOR EMPLOYEES, RETIREES AND THEIR DEPENDENTS - FAMILY AND MEDICAL LEAVE ACT (FMLA) ADMINISTRATION; LONG-TERM DISABILITY COVERAGE FOR DEFINED CONTRIBUTION RETIREMENT PLAN(401A)PARTICIPANTS,AND VOLUNTARY SHORT-TERM AND LONG-TERM DISABILITY; GROUP DENTAL COVERAGE; AND GROUP TERM LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT COVERAGE; FURTHER AUTHORIZING THE MONTH TO MONTH EXTENSION OF THE EXISTING AGREEMENTS FOR THE AFOREMENTIONED SERVICES UNTIL SUCH TIME AS THE ITN CAN BE AWARDED. Key Intended Outcome Supported: Ensure Expenditure Trends Are Sustainable Over The Long Term Supporting Data (Surveys, Environmental Scan, etc: N/A Item Summary/Recommendation: In advance of a successor contract, the City Manager is requesting authorization to issue Invitation to Negotiate (ITN) 2016-084-WG for the administration of the City's ancillary health benefits for employees, retirees and their dependents, Family and Medical Leave Act (FMLA) administration; long-term disability coverage for defined contribution retirement plan (401a) participants, and voluntary short-term and long-term disability; group dental coverage; and group term life and accidental death &dismemberment coverage; further authorizing the month to month extension of the existing agreements with UNUM, Metropolitan Life Insurance Company and Hartford Life and Accidental Insurance Company, for the aforementioned services until such time as the ITN can be awarded. FMLA ADMINISTRATION, SHORT and LONG TERM DISABILITY On July 25,2009,the Mayor and City Commission approved Resolution#2009-27141,authorizing the City to enter into an agreement with UNUM, for the administration of the City's FML program, long-term disability policy for defined contribution retirement plan(401A)participants,and voluntary short-term and long-term disability policy fully funded by employees. DENTAL INSURANCE On July 15,2009,the Mayor and City Commission approved Resolution#2009-27137, authorizing the City to enter into an agreement with Metropolitan Life Insurance Company("MetLife"),for administration of the City's group dental plan, commencing on January 1, 2010, and ending on December 31, 2013. The insurance policy was renewed thereafter on an annual basis through a confirmation letter from the Hartford to our previous Employee Benefits Manager. LIFE INSURANCE On July 15,2009,the Mayor and City Commission approved Resolution#2009-27140,authorizing the City to enter into an agreement with Hartford Life and Accident Insurance Company("Hartford"), for a group life insurance and dismemberment policy,commencing on January 1,2010,and ending on December 31,2013. The insurance policy was renewed thereafter on an annual basis through a confirmation letter from the Hartford to our previous Employee Benefits Manager. ADMINISTRATION RECOMMENDATION Adopt the Resolution. Advisory Board Recommendation: N/A Financial Information:The annual cost associated with the administration of the City's ancillary health plans are subject to the funds availability approved through the City's budgeting process. Source of _ Amount 'Account Funds: 1 2 Total Financial Impact Summary: City Clerk's Office Legislative Tracking: Alex Denis, Extension 6641 Sign-Offs: Alta■ Depa ent Di Assists,.: ager City Ma - er SCT • AD tf M' A JLM■I'A F:\T Drive\AGENDA\2016\April\Pro, - �-nt\2016-084-WG ADMINISTRATION OF'..L!rte ANCILLARY HEALTH BENEFITS-Issuance Month . .a h Ext\ITN 2016-084- WG ADMINISTRATION OF THE CI: :ANCILLARY HEALTH BENEFITS-ISSUANCE SUMMARY.doc MIAMIBEACH AGENDA ITEM C 7 M -/3—IL DATA �l MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139,www.miamibeachfl.gov CO MISSION MEMORANDUM TO: Mayor Philip Levine and Members o the City C. mission FROM: Jimmy L. Morales, City Manager Aik . DATE: April 13, 2016 SUBJECT: A RESOLUTION OF THE MAYOR AND THE CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE ISSUANCE OF INVITATION TO NEGOTIATE (ITN) 2016-084-WG FOR THE ADMINISTRATION OF THE CITY'S ANCILLARY HEALTH BENEFITS FOR EMPLOYEES, RETIREES AND THEIR DEPENDENTS - FAMILY AND MEDICAL LEAVE ACT (FMLA) ADMINISTRATION; LONG-TERM DISABILITY COVERAGE FOR DEFINED CONTRIBUTION . RETIREMENT PLAN (401A) PARTICIPANTS, AND VOLUNTARY SHORT-TERM AND LONG-TERM DISABILITY; GROUP DENTAL COVERAGE; AND GROUP TERM LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT COVERAGE; FURTHER AUTHORIZING THE MONTH TO MONTH EXTENSION OF THE EXISTING AGREEMENTS FOR THE AFOREMENTIONED SERVICES UNTIL SUCH TIME AS THE ITN CAN BE AWARDED. ADMINISTRATION RECOMMENDATION Authorize the issuance of the ITN and the month to month extension of existing agreements for the aforementioned services until such time as the ITN can be awarded. BACKGROUND DISABILITY COVERAGE AND FMLA ADMINISTRATION On July 25, 2009, the Mayor and City Commission approved Resolution #2009-27141, authorizing the City to enter into an agreement with UNUM, for the administration of the City's FML administration ; long-term disability policy for defined contribution retirement plan (401A) participants; and voluntary short-term and long-term disability policy fully funded by covered employees. This agreement expired on December 31,2015. Currently, employees who are not vested in the Miami Beach Employees' Retirement Plan (MBERP) are not provided salary protection should they be unable to work. For an employee to receive a disability benefit from the MBERP, the employee must be fully vested in the plan. With the plan's current five (5) year vesting provision, a number of City employees would not be eligible for a disability benefit from the pension plan. In addition, the disability benefit provided by Social Security is not available to an individual who has not contributed to Social Security in the twenty-four (24) months prior to the date of their disability. As City employees do not contribute to Social Security, an individual who has been employed by the City for a period of twenty-four (24) months or more may not be eligible for Social Security disability benefits. Offering employees the opportunity to purchase voluntary short-term and long-term disability coverage provides an opportunity for protection should they be unable to work for an extended period of time due to illness or accidental injury not related to their employment. Short-term disability provides an employee a percentage of their earnings for a maximum period of twenty-six (26) weeks for the reasons included above. . The cost of the coverage is based on the employee's earnings prior to their disability and the percentage of coverage purchased. Long-term City Commissioner Memorandum —Authorizing The Issuance Of ITN 2016-084-WG For The Administration Of the City's Ancillary Health Benefits; Further Authorizing the Month to Month Extension of the existing Agreements for the Aforementioned Services Until Such Time as the ITN can be Awarded. April 13,2016 Page 2 of 5 disability provides the employee a percentage of their earnings after their first twenty-six (26) weeks of disability due to a non-work related illness or injury. Coverage under the plan continues until the employee is able to return to work, is approved by Social Security for Disability Benefits (if eligible), or dies. In addition, the long-term disability plan provides training and job placement opportunities should the individuals be unable to perform the duties of the job held prior to their illness or injury. The cost of the coverage for either is fully borne by the employee. Additionally, UNUM provides a long-term disability policy for approximately thirty (29) participants in the City's Defined Contribution Retirement Plan 401(a). There are employees who were hired prior to the March 18, 2006, change in the City's pension benefits which terminated the defined contribution plan 401(a) and elected to continue their pension benefit through the plan the 401 (a) plan. This long- term disability benefit is provided to these plan participants to mirror the long-term disability benefit provided by MBERP to vested employees. This long-term disability plan for employees in the 401(a) will end when all participants voluntarily or involuntarily separate for City employment. UNUM also provides management services for the City's FMLA federal mandate for all employees who qualify. The cost to administer this service is $1.49/per employee/per month ("PEPM"). Management services include acquiring required medical certification from the employee and the day- to-day administration of the City's FML policy, providing protections from misinterpretation of the FMLA and its current and future changes, and convenience to the employee with one (1) point of contact for their FMLA application, questions, and certifications. UNUM also works closely with the employees and their physicians to monitor the employee's expedited return to work. As required by the U.S. Federal Government, Department of Labor, the City's policy follows the FMLA mandate that eligible employees be guaranteed employment continuity up to twelve (12) weeks of unpaid leave for their own care or the care of a family member due to a medical need. The leave can be taken all at once, or intermittently. The City has enhanced the FMLA to include an additional twelve (12) week period of FMLA leave, if deemed medically necessary. The FMLA also provides leave for family members in the military called to active duty or to care for a covered service member recovering from a serious injury or illness in the line of duty. DENTAL INSURANCE On July 15, 2009, the Mayor and City Commission approved Resolution #2009-27137, authorizing the City to enter into an agreement with Metropolitan Life Insurance Company ("MetLife"), for administration of the City's group dental plan, commencing on January 1, 2010, and ending on December 31, 2013. The insurance policy was renewed thereafter on an annual basis through a confirmation letter from the Hartford to our previous Employee Benefits Manager and is presently scheduled to expire September 30, 2016. Chapter 78, Article II, Sections 78 through 8 of the City Code of Ordinances provide for employee group health coverage, including group dental coverage, with the cost of such coverage shared between the employee and the City. In addition, the collective bargaining agreements of the American Federation of State, County and Municipal Employees ("AFSCME"), Communication Workers of America ("CWA"), Government Supervisors Association ("GSA") and Fraternal Order of Police ("FOP") require the City to provide group dental coverage to their members. The City's group dental plans exclude coverage for members of the International Association of Fire Fighters ("IAFF"), as they are provided group dental coverage through their own dental trust. Providing group dental coverage to employees is just one of the benefits that enable the City to attract and maintain a quality workforce. City Commissioner Memorandum —Authorizing The Issuance Of ITN 2016-084-WG For The Administration Of the City's Ancillary Health Benefits; Further Authorizing the Month to Month Extension of the existing Agreements for the Aforementioned Services Until Such Time as the ITN can be Awarded. April 13,2016 Page 3 of 5 Currently, the City provides its active full-time employees and retirees the opportunity to purchase group dental coverage from a self-insured Preferred Dentist Plan ("PDP") or a dental health maintenance organization ("DHMO") plan. The Administrative Services Only (ASO) Fee for the PDP self-insured group dental plan is $3.86 PEPM. This fee represents the charges for paying claims and performing other standard administrative services. LIFE INSURANCE On July 15, 2009, the Mayor and City Commission approved Resolution #2009-27140, authorizing the City to enter into an agreement with Hartford Life and Accident Insurance Company ("Hartford"), for a group life insurance and dismemberment policy, commencing on January 1, 2010, and ending on December 31, 2013. The insurance policy was renewed thereafter on an annual basis through a confirmation letter from the Hartford to our previous Employee Benefits Manager and is presently scheduled to expire September 30, 2016. The Hartford group life coverage includes basic life coverage for all employees (except police staff covered by the FOP); supplemental life, spouse life, and dependent life; and Accidental Death & Dismemberment ("AD&D") coverage for all employees and retirees. As is standard with most term life insurance, this insurance coverage includes certain limitations and exclusions. SCOPE OF SERVICES The City is seeking proposals from qualified firms to provide and administer ancillary benefits plans for eligible employees, retirees, Consolidated Omnibus Budget Reconciliation Act (COBRA) participants and their dependents, including domestic partners. The intent of this ITN is to provide plans that are equal to or better than the City's current ancillary benefits, which are described below. Bidders have the option to submit proposals on all plans or may submit a proposal for only one plan. The City reserves the right to award the plans separately or in the aggregate, in the best interests of the City. PLAN A GROUP DENTAL PLAN The City provides its employees and retiree's two dental plans—a self-insured PDP and a fully-insured DHMO plan. Both the City and the employee/retiree contribute to the cost of dental coverage, at different rates, based on the plan elected by the participant. PLAN B: FMLA ADMINISTRATION Administration of the City's FMLA policy for all employees is requested. Management of this program includes medical certification and day-to-day administration of the City's FMLA policy, providing protections from misinterpretation of the FMLA and its current and future changes, and convenience to the employee with one (1) point of contact for all their FMLA application, questions, and certifications. The provider is expected to work closely with the employees and their physicians to monitor the employee's expedited return to work. SHORT-TERM AND LONG-TERM DISABILITY Short-term disability provides an employee a percentage of their earnings for a maximum period of twenty-six (26) weeks due a non-work related illness or injury. Long-term disability provides the employee a percentage of their earnings after their first twenty-six (26) weeks of disability due to a non-work related illness or injury. The cost of the coverage is fully borne by the employee. City Commissioner Memorandum —Authorizing The Issuance Of ITN 2016-084-WG For The Administration Of the City's Ancillary Health Benefits; Further Authorizing the Month to Month Extension of the existing Agreements for the Aforementioned Services Until Such Time as the ITN can be Awarded. April 13,2016 Page 4 of 5 LONG-TERM DISABILITY FOR 401(A) PENSION PLAN PARTICIPANTS The City provides a long-term disability policy for approximately thirty (29) participants in the City's Defined Contribution Retirement Plan 401(a). These employees were hired prior to the March 18, 2006 change in the City's pension benefits terminating the defined contribution plan 401(a) and elected to continue their pension benefit through the plan. This long-term disability benefit is provided to these plan participants to mirror the long-term disability benefit provided by the MBERP. This long- term disability plan will end when all participants terminate or retire. PLAN C: GROUP TERM LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT PLAN Basic Life and AD&D —The City of Miami Beach requires that employees purchase this coverage in an amount equal to 1 times their salary, rounded to the next highest $1,000, to a maximum of $250,000. This coverage is available to all full-time classified and unclassified employees, excluding police, who work at least 30 hours per week on a regularly scheduled basis. Supplemental dependent life insurance is also available to employees. Supplemental Life coverage is 100% paid by the employee. • MINIMUM QUALIFICATIONS. Please Reference, Appendix C, Page 27, ITN 2016-084-WG Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short- Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage. • SUBMITTAL REQUIREMENTS. Please Reference Section 0300, Page 14, ITN 2016-084-WG Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401 a) Participants, and Voluntary Short- Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage. • CRITERIA FOR EVALUATION. Please Reference Section 0400, Page 16, ITN 2016-084-WG Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short- Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage. CONCLUSION The Administration recommends that the Mayor and Commission authorize the issuance of ITN 2016- 084-WG for the administration of the City's The Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage and further authorizing the Administration to extend the existing agreements on a month to month basis, until such time as the ITN is awarded and an agreement executed. • City Commissioner.Memorandum •Authorizing The Issuance Of-ITNf2016 INVITATION TO NEGOTIATE ( ITN Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long- Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage 2016-084-WG ITN ISSUANCE DATE: APRIL 14, 2016 PROPOSALS DUE: MAY 16, 2016 @ 3:00 PM ISSUED BY: MIAMIBEACH William Garviso, Procurement Contracting Officer II PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor, Miami Beach, FL 33139 305.673.7000 x 6650 I www.miamibeachfl.gov iIM BEACH TABLE OF CONTENTS . SOLICITATION SECTIONS: PAGE 0100 NOT UTILIZED N/A 0200 INSTRUCTIONS TO PROPOSERS & GENERAL CONDITIONS 4 0300 SUBMITTAL INSTRUCTIONS & FORMAT 13 0400 PROPOSAL EVALUATION 15 APPENDICES: PAGE APPENDIX A PROPOSAL CERTIFICATON, QUESTIONNAIRE AND AFFIDAVITS 19 APPENDIX B "NO PROPOSAL" FORM 26 APPENDIX C MINIMUM REQUIREMENTS & SPECIFICATIONS 28 APPENDIX D SPECIAL CONDITIONS 45 APPENDIX E COST PROPOSAL FORM 47 APPENDIX F INSURANCE REQUIREMENTS 51 ATTACHMENTS ATTACHMENT A CENSUS ATTACHMENT B1 DENTAL COST PROPOSAL ATTACHMENT B2 DENTAL QUESTIONNAIRE ATTACHMENT B3 DENTAL PLAN DESIGNS ATTACHMENT B4 DPPO PLAN SUMMARY ATTACHMENT B5 DHMO COPAY SCHEDULE ATTACHMENT B6 DPPO ASO AGREEMENT ATTACHMENT B7 DHMO CERTIFICATE ATTACHMENT B8 DPPO TOP PROVIDERS ATTACHMENT B9 DHMO TOP PROVIDERS ATTACHMENT B10 DENTAL GEOACCESS REPORTS ATTACHMENT B11 DENTAL ENROLLMENT ATTACHMENT B12 DPPO CLAIMS FILE ATTACHMENT B13 DHMO CLAIMS EXPERIENCE ATTACHMENT B14 DPPO DENTAL UTILIZATION ATTACHMENT C1 DISABILITY-FML COST PROPOSAL ATTACHMENT C2 DISABILITY-FML QUESTIONNAIRE ATTACHMENT C3 DISABILITY-FML PLAN DESIGN ATTACHMENT C4 VOLUNTARY STD CONTRACT ATTACHMENT C5 VOLUNTARY LTD CONTRACT ATTACHMENT C6 ER PAID LTD CONTRACT ATTACHMENT C7 STD CLAIMS EXPERIENCE ATTACHMENT C8 VOLUNTARY LTD CLAIMS EXPERIENCE ATTACHMENT C9 VOLUNTARY LTD RESERVES ITN 2016-084-WG 2 t ' TD CLAIMS EXPERIENCEf .-: _ - ATTACHMENT C10::.. �, ER PAID L„ A_ r� , ,, ATTACHMENT C11.:........ .................. .... LT E -_. .. tERuPAID° D_RESERV S a ATTACHMENT C12'...... .. ...........:.. .. .. . TOTAL ABSENCE;REPORT s } a r :,, ATTACHMENT C13•... ........ E %16) S E:S ON LEAVE 3 21 ATTACHMENT,`C14 FMLAjCU•RRENT AGRE -} ... ... .. EMENT „ k ATTACHMENT D1 . i.... ..... GROUP LIFE COST:PRO`POSAL` ATTACHMENT:D2 .....:.:.:..:f.'.:-.._ . . ...... ...... GROUP LIFE QUESTIONNAIRE ATTACHMENT{D3 GROUP LIFE PLAN;DESIGN • • h ATTACHMENT D4 `; .' _ t ' 3"`° EMPLOYEE LIFE BOOKLET j 1 { ATTACHMENT�D5` ` r1 "RETIREE LIFE BOOKLET ;: — ATTACHMENT_D6 s ....... k '° 3 LIFE CLAIMS EXPERIENCE f �ATTACHMENT`D7} ••. ,. •.. _ LIFE:DETAILED CLAIMS .'. ATTACHMENT D8 ... .. i t °LIFE.,P.REMIUM WAIVER ATTACHMENT.D9 .. ... .. .1 � "LIFE ANNUAL PREMIUM - 1 ' Y�� X7, - - - J - ' .. . '„ s • + - f 1 fir., _ l�,• � - _ ( ' _ . .1 f •l 1. L ,1 ` 1 r � - -. r. „ ,..t _ _,. . i.• -.. . _r .,. r.' - :f._ITN 20- 670847WG 0, MIAMI BEACH SECTION 0200 INSTRUCTIONS TO PROPOSERS&GENERAL CONDITIONS 1. GENERAL.This Invitation to.Negotiate (ITN) is issued by the City of Miami Beach, Florida (the "City"), as the means for prospective Proposers to submit their qualifications, proposed scopes of work and cost proposals (the - "proposal") to the City for the City's consideration as an option in achieving the required scope of services and • requirements as noted herein. All documents released in connection with this solicitation, including all appendixes and addenda, whether included herein or released under separate cover, comprise the solicitation, and are complementary to one another and together establish the complete terms, conditions and obligations of the Proposers and, subsequently, the successful Proposer(s) (the"contractor[s]") ifthis ITN results in an award. • The City utilizes PublicPurchase (www.publicpurchase.com) for automatic notification of competitive solicitation opportunities and document fulfillment, including the issuance of any addendum to this ITN. Any prospective Proposer who has received this ITN by any means other than through PublicPurchase must register immediately with PublicPurchase to assure it receives any addendum issued to this ITN. Failure to receive an addendum may result in disqualification of proposal submitted. 2. PURPOSE. The City is seeking proposals from qualified firms for the administration of the City's ancillary health benefits for employees, retirees and their dependents which include the Family Medical Leave Act (FMLA), long-term disability coverage for Defined Contribution Retirement Plan (401a) participants, and voluntary short-term and long-term disability; group dental coverage; and group term life and accidental death & dismemberment coverage. It is the intent of this ITN to evaluate, score and rank, plans separately, as grouped within. Firm's proposal shall clearly indicate if proposal(s) are being submitted under Plan A— Dental Health Plan or Plan B — Disability Plan and FMLA Administration or Plan C - Group Life & Accidental Death and Dismemberment. Furthermore, firms are required to submit separate proposals for each Plan for which they seek to be;evaluated. Example: a firm which provides Group Dental, shall respond under Plan A— Group Dental Health Plan and shall submit proposal in accord with Section 0300 Proposal Submittal Instructions and Format; a firm which provides Group Dental and Disability Plan:& FMLA Administration, shall submit two (2) separate proposals; one for Plan A-.Group Dental Health Plan and another for Plan B.- Disability and FMLA Administration. 3.ANTICIPATED ITN TIMETABLE. The tentative schedule for this solicitation is as follows: - ITN Issued April 14, 2016 • - • Pre-Proposal Meeting April 22, 2016 Deadline for Receipt of Questions May 6, 2016 @ 3:00PM • Responses Due May 16, 2016 @ 3:00PM • Evaluation Committee Review TBD Proposer Presentations TBD Tentative:Commission Approval Authorizing TBD • . Negotiations • Contract Negotiations Following Commission Approval • ITN 2016-084-WG 4 mMIAMIBEACH 4. PROCUREMENT CONTACT. Any questions or clarifications concerning this solicitation shall be submitted to the Procurement Contact noted below: Procurement Contact: Telephone: Email: William Garviso, CPPB 305 673-7000#6650 WilliamGarviso• miamibeachfl.gov dditionally, the City Clerk is to be copied on all communications via e-mail at: RafaelGranadomiamibeachfl.gov; or via facsimile: 786-394-4188. The Bid title/number shall be referenced on all correspondence. All questions or requests for clarification must be received no later than ten (10) calendar days prior to the date proposals are due as scheduled in Section 0200-3. All responses to questions/clarifications will be sent to all prospective Proposers in the form of an addendum. 5. PRE-PROPOSAL MEETING OR SITE VISIT(S). Only if deemed necessary by the City, a pre-proposal meeting or site visit(s) may be scheduled. A Pre-PROPOSAL conference will be held as scheduled in Anticipated ITN Timetable section above at the following address: City of Miami Beach Procurement Department • Conference Room C 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 Attendance (in person or via telephone) is encouraged and recommended as a source of information, but is not mandatory. Proposers interested in participating in the Pre-Proposal Submission Meeting via telephone must follow these steps: (1) Dial the TELEPHONE NUMBER: 1-888-270-9936 (Toll-free North America) (2) Enter the MEETING NUMBER: 9415468 Proposers who are interested in participating via telephone should send an e-mail to the contact person listed in this ITN expressing their intent to participate via telephone. 6. PRE-PROPOSAL INTERPRETATIONS. Oral information or responses to questions received by prospective Proposers are not binding on the City and will be without legal effect, including any information received at pre- submittal meeting or site visit(s). The City by means of Addenda will issue interpretations or written addenda clarifications considered necessary by the City in response to questions. Only questions answered by written addenda will be binding and may supersede terms noted in this solicitation. Addendum will be released through PublicPurchase. Any prospective proposer who has received this ITN by any means other than through PublicPurchace must register immediately with PublicPurchase to assure it receives any addendum issued to this ITN. Failure to receive an addendum may result in disqualification of proposal. Written questions should be received no later than the date outlined in the Anticipated ITN Timetable section. 7. CONE OF SILENCE. This ITN is subject to, and all proposers are expected to be or become familiar with, the City's Cone of Silence Requirements, as codified in Section 2-486 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Cone of Silence are complied with, and shall be subject to any and all sanctions, as prescribed therein, including rendering their response voidable, in the event of such non-compliance. Communications regarding this solicitation are to be submitted in writing to the Procurement Contact named herein with a copy to the City Clerk at rafaelgranado @miamibeachfl.gov ITN 2016-084-WG 5 0.—_ BEACH 8. SPECIAL NOTICES. You are hereby advised that this solicitation is subject to the following ordinances/resolutions, which may be found on the City Of Miami Beach website: http://web.miamibeachfl.gov/procurement/scroll.aspx?id=23510 • CONE OF SILENCE CITY CODE SECTION 2-486 • PROTEST PROCEDURES CITY CODE SECTION 2-371 • DEBARMENT PROCEEDINGS................................. CITY CODE SECTIONS 2-397 THROUGH 2-485.3 • LOBBYIST REGISTRATION AND DISCLOSURE OF FEES CITY CODE SECTIONS 2-481 THROUGH 2-406 • CAMPAIGN CONTRIBUTIONS BY VENDORS CITY CODE SECTION 2-487 • CAMPAIGN CONTRIBUTIONS BY LOBBYISTS ON PROCUREMENT ISSUES... CITY CODE SECTION 2-488 • REQUIREMENT FOR CITY CONTRACTORS TO PROVIDE EQUAL BENEFITS FOR DOMESTIC PARTNERS CITY CODE SECTION 2-373 • LIVING WAGE REQUIREMENT CITY CODE SECTIONS 2'107 THROUGH 2 410 • LOCAL PREFERENCE FOR MIAMI BEACH BASED VENDORS CITY CODE SECTION 2 372 • PREFERENCE FOR FLORIDA SMALL BUSINESSES OWNED AND CONTROLLED BY VETERANS AND TO STATE-CERTIFIED SERVICE- DISABLED VETERAN BUSINESS ENTERPRISES.. .. ...... CITY CODE SECTION 2-374 • FALSE CLAIMS ORDINANCE CITY CODE SECTION 70-300 • ACCEPTANCE OF GIFTS,FAVORS&SERVICES...... CITY CODE SECTION 2-449 9. PUBLIC ENTITY CRIME. A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crimes may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid 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, sub-contractor, or consultant under a contract with a public entity, and may not transact business with any public entity in excess of the threshold amount provided in Sec. 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list. 10. COMPLIANCE WITH THE CITY'S LOBBYIST LAWS. This ITN is subject to, and all Proposers are expected to be or become familiar with, all City lobbyist laws. Proposers shall be solely responsible for ensuring that all City lobbyist laws are complied with, and shall be subject to any and all sanctions, as prescribed therein, including, without limitation, disqualification of their responses, in the event of such non-compliance. 11. DEBARMENT ORDINANCE: This ITN is subject to, and all proposers are expected to be or become familiar with, the City's Debarment Ordinance as codified in Sections 2-397 through 2-406 of the City Code. 12. WITH THE CITY'S CAMPAIGN FINANCE REFORM LAWS. This ITN is subject to, and all Proposers are expected to be or become familiar with, the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribed therein, including disqualification of their responses, in the event of such non-compliance. 13. CODE OF BUSINESS ETHICS. Pursuant to City Resolution No.2000-23879, the Proposer shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Division with its response or within five (5) days upon receipt of request. The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. ITN 2016-084-WG 6 m► MAMI BEACH 14. AMERICAN WITH DISABILITIES ACT (ADA). Call 305-673-7490 to request material in accessible format; sign language interpreters (five (5) days in advance when possible), or information on access for persons with disabilities. For more information on ADA compliance, please call the Public Works Department, at 305-673- 7000, Extension 2984. 15. POSTPONEMENT OF DUE DATE FOR RECEIPT OF PROPOSALS. The City reserves the right to postpone the deadline for submittal of proposals and will make a reasonable effort to give at least three (3) calendar days written notice of any such postponement to all prospective Proposers through PublicPurchase. 16. PROTESTS. Proposers that are not selected may protest any recommendation for selection of award in accordance with eh proceedings established pursuant to the City's bid protest procedures, as codified in Sections 2- 370 and 2-371 of the City Code (the City's Bid Protest Ordinance). Protest not timely made pursuant to the requirements of the City's Bid Protest Ordinance shall be barred. . . ..•• : • - -• - -• . . ..• .•. ..• - 11 .•• ! . • .. . ... 18. VETERAN BUSINESS ENTERPRISES PREFERENCE. Pursuant to City Code Section 2-374, the City shall give a preference to a responsive and responsible Proposer which is a small business concern owned and controlled by a veteran(s) or which is a service-disabled veteran business enterprise, and which is within five percent (5%) of the lowest responsive, responsible proposer, by providing such proposer an opportunity of providing said goods or contractual services for the lowest responsive proposal amount (or in this ITN, the highest proposal amount). Whenever, as a result of the foregoing preference, the adjusted prices of two (2) or more proposers which are a small business concern owned and controlled by a veteran(s) or a service-disabled veteran business enterprise constitute the lowest proposal pursuant to an ITN or oral or written request for quotation, and such proposals are responsive, responsible and otherwise equal with respect to quality and service, then the award shall be made to the service-disabled veteran business enterprise. 19. DETERMINATION OF AWARD. The final ranking results of Step 1 & 2 outlined in Section 0400, Evaluation of Proposals, will be considered by the City Manager who may recommend to the City Commission the Proposer(s) s/he deems to be in the best interest of the City or may recommend rejection of all proposals. The City Manager's recommendation need not be consistent with the scoring results identified herein and takes into consideration Miami Beach City Code Section 2-369, including the following considerations: (1)The ability, capacity and skill of the Proposer to perform the contract. (2) Whether the Proposer can perform the contract within the time specified, without delay or interference. (3) The character, integrity, reputation,judgment, experience and efficiency of the Proposer. (4) The quality of performance of previous contracts. (5) The previous and existing compliance by the Proposer with laws and ordinances relating to the contract. The City Commission shall consider the City Manager's recommendation and may approve such recommendation. The City Commission may also, at its option, reject the City Manager's recommendation and select another Proposal or Proposals which it deems to be in the best interest of the City, or it may also reject all Proposals. ITN 2016-084-WG 7 m iI MI BEACH 20. NEGOTIATIONS. Following selection, the City reserves the right to enter into further negotiations with the selected Proposer(s). Notwithstanding the preceding, the City is in no way obligated to enter into a contract with any selected Proposer in the event the parties are unable to negotiate a contract. It is also understood and acknowledged by Proposers that no property, contract or legal rights of any kind shall be created at any time until and unless an Agreement has been agreed to; approved by the City; and executed by the parties. 21. POSTPONEMENT/CANCELLATION/ACCEPTANCE/REJECTION. The City may, at its sole and absolute discretion, reject any and all, or parts of any and all, responses; re-advertise this ITN; postpone or cancel, at any time, this ITN process; or waive any irregularities in this ITN, or in any responses received as a result of this ITN. Reasonable efforts will be made to either award the proposer the contract or reject all proposals within one-hundred twenty (120) calendar days after proposal opening date. A proposer may withdraw its proposal after expiration of one hundred twenty (120) calendar days from the date of proposal opening by delivering written notice of withdrawal to the Department of Procurement Management prior to award of the contract by the City Commission. 22. PROPOSER'S RESPONSIBILITY. Before submitting a response, each Proposer shall be solely responsible for making any and all investigations, evaluations, and examinations, as it deems necessary, to ascertain all conditions and requirements affecting the full performance of the contract. Ignorance of such conditions and requirements, and/or failure to make such evaluations, investigations, and examinations, will not relieve the Proposer from any obligation to comply with every detail and with all provisions and requirements of the contract, and will not be accepted as a basis for any subsequent claim whatsoever for any monetary consideration on the part of the Proposer. 23. COSTS INCURRED BY PROPOSERS.All expenses involved with the preparation and submission of Proposals, or any work performed in connection therewith, shall be the sole responsibility (and shall be at the sole cost and expense) of the Proposer, and shall not be reimbursed by the City. 24. RELATIONSHIP TO THE CITY. It is the intent of the City, and Proposers hereby acknowledge and agree, that the successful Proposer is considered to be an independent contractor, and that neither the Proposer, nor the Proposer's employees, agents, and/or contractors, shall, under any circumstances, be considered employees or agents of the City. 25. OCCUPATIONAL HEALTH AND SAFETY. In compliance with Chapter 442, Florida Statutes, any toxic substance listed in Section 38F-41.03 of the Florida Administrative Code delivered as a result of this proposal must be accompanied by a Material Safety Data Sheet(MSDS)which may be obtained from the manufacturer. 26. ENVIRONMENTAL REGULATIONS. The City reserves the right to consider a proposer's history of citations and/or violations of environmental regulations in investigating a proposer's responsibility, and further reserves the right to declare a proposer not responsible if the history of violations warrant such determination in the opinion of the City. Proposer shall submit with its proposal, a complete history of all citations and/or violations, notices and dispositions thereof. The non-submission of any such documentation shall be deemed to be an affirmation by the Proposer that there are no citations or violations. Proposer shall notify the City immediately of notice of any citation or violation which proposer may receive after the proposal opening date and during the time of performance of any contract awarded to it. 27. TAXES. The City of Miami Beach is exempt from all Federal Excise and State taxes. 28. MISTAKES. Proposers are expected to examine the terms, conditions, specifications, delivery schedules, proposed pricing, and all instructions pertaining to the goods and services relative to this ITN. Failure to do so will ITN 2016-084-WG 8 P__ ov\IAA BEACH be at the Proposer's risk and may result in the Proposal being non-responsive. 29. PAYMENT. Payment will be made by the City after the goods or services have been received, inspected, and found to comply with contract, specifications, free of damage or defect, and are properly invoiced. Invoices must be consistent with Purchase Order format. 30. COPYRIGHT, PATENTS & ROYALTIES. Proposer shall indemnify and save harmless the City of Miami Beach, Florida, and its officers, employees, contractors, and/or agents, 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 the City of Miami Beach, Florida. 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 proposal prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. 31. DEFAULT: Failure or refusal of the selected Proposer to execute a contract following approval of such contract by the City Commission, or untimely withdrawal of a response before such award is made and approved, may result in a claim for damages by the City and may be grounds for removing the Proposer from the City's vendor list. 32. MANNER OF PERFORMANCE. Proposer agrees to perform its duties and obligations in a professional manner and in accordance with all applicable Local, State, County, and Federal laws, rules, regulations and codes. Lack of knowledge or ignorance by the Proposer with/of applicable laws will in no way be a cause for relief from responsibility. Proposer agrees that the services provided shall be provided by employees that are educated, trained, experienced, certified, and licensed in all areas encompassed within their designated duties. Proposer agrees to furnish to the City any and all documentation, certification, authorization, license, permit, or registration currently required by applicable laws, rules, and regulations. Proposer further certifies that it and its employees will keep all licenses, permits, registrations, authorizations, or certifications required by applicable laws or regulations in full force and effect during the term of this contract. Failure of Proposer to comply with this paragraph shall constitute a material breach of this contract. Where contractor is required to enter or go on to City of Miami Beach property to deliver materials or perform work or services as a result of any contract resulting from this solicitation, the contractor will assume the full duty, obligation and expense of obtaining all necessary licenses, permits, and insurance, and assure all work complies with all applicable laws. The contractor shall be liable for any damages or loss to the City occasioned by negligence of the Proposer, or its officers, employees, contractors, and/or agents, for failure to comply with applicable laws. 33. SPECIAL CONDITIONS. Any and all Special Conditions that may vary from these General Terms and Conditions shall have precedence. 34. NON-DISCRIMINATION. The Proposer certifies that it 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. In accordance with the City's Human Rights Ordinance, codified in Chapter 62 of the City Code, Proposer shall prohibit (and cause hotel operator to prohibit) discrimination by reason of race, color, national origin, religion, sex, intersexuality, gender identity, sexual orientation, marital and familial status, and age or disability in the sale, lease, use or occupancy of the Hotel Project or any portion thereof. ITN 2016-084-WG 9 M.ANA BEACH 35. DEMONSTRATION OF COMPETENCY. The city may consider any evidence available regarding the financial, technical, and other qualifications and abilities of a Proposer, including past performance (experience) in making an award that is in the best interest of the City, including: A. Pre-award inspection of the Proposer's facility may be made prior to the award of contract. B. Proposals will only be considered from firms which are regularly engaged in the business of providing the goods and/or services as described in this solicitation. C. Proposers must be able to demonstrate a good record of performance for a reasonable period of time, and have sufficient financial capacity, equipment, and organization to ensure that they can satisfactorily perform the services if awarded a contract under the terms and conditions of this solicitation. D. The terms "equipment and organization", as used herein shall, be construed to mean a fully equipped and well established company in line with the best business practices in the industry, and as determined by the City of Miami Beach. E. The City may consider any evidence available regarding the financial, technical, and other qualifications and abilities of a Proposer, including past performance (experience), in making an award that is in the best interest of the City. F. The City may require Proposer s to show proof that they have been designated as authorized representatives of a manufacturer or supplier, which is the actual source of supply. In these instances, the City may also require material information from the source of supply regarding the quality, packaging, and characteristics of the products to be supply to the City. 36. ASSIGNMENT. The successful Proposer shall not assign, transfer, convey, sublet or otherwise dispose of the contract, including any or all of its right, title or interest therein, or his/her or its power to execute such contract, to any person, company or corporation, without the prior written consent of the City. 37. LAWS, PERMITS AND REGULATIONS. The Proposer shall obtain and pay for all licenses, permits, and inspection fees required to complete the work and shall comply with all applicable laws. 38. OPTIONAL CONTRACT USAGE. When the successful Proposer (s) is in agreement, other units of government or non-profit agencies may participate in purchases pursuant to the award of this contract at the option of the unit of government or non-profit agency. 39. VOLUME OF WORK TO BE RECEIVED BY CONTRACTOR. It is the intent of the City to purchase the goods and services 'specifically listed in this solicitation from the contractor. However, the City reserves the right to purchase any goods or services awarded from state or other governmental contract, or on an as-needed basis through the City's spot market purchase provisions. 40. DISPUTES. In the event of a conflict between the documents, the order of priority of the documents shall be as follows: A. Any contract or agreement resulting from the award of this solicitation; then B. Addendum issued for this solicitation, with the latest Addendum taking precedence; then C. The solicitation; then D. The Proposer's proposal in response to the solicitation. ITN 2016-084-WG 10 P__ MI AAA I BEAC 41. INDEMNIFICATION. The Proposer shall indemnify and hold harmless the City and its officers, employees, agents and instrumentalities from any and all liability, losses or damages, including attorney's fees and costs of defense, which the City or its officers, employees, agents or instrumentalities may incur as a result of claims, demands, suits, causes of actions or proceedings of any kind or nature arising out of, relating to or resulting from the performance of the agreement by the contractor or its employees, agents, servants, partners, principals or subcontractors. The contractor shall pay all claims and losses in connection therewith, and shall investigate and defend all claims, suits or actions of any kind or nature in the name of the City, where applicable, including appellate proceedings, and shall pay all costs, judgments, and attorney's fees which may be incurred thereon. The Proposer expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the contractor shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The above indemnification provisions shall survive the expiration or termination of this Agreement. 42. CONTRACT EXTENSION. The City reserves the right to require the Contractor to extend contract past the stated termination date for a period of up to 120 days in the event that a subsequent contract has not yet been awarded. Additional extensions past the 120 days may occur as needed by the City and as mutually agreed upon by the City and the contractor. 43. FLORIDA PUBLIC RECORDS LAW. Proposers are hereby notified that all Bid including, without limitation, any and all information and documentation submitted therewith, are exempt from public records requirements under Section 119.07(1), Florida Statutes, and s. 24(a), Art. 1 of the State Constitution until such time as the City provides notice of an intended decision or until thirty (30) days after opening of the proposals, whichever is earlier. Additionally, Contractor agrees to be in full compliance with Florida Statute 119.0701 including, but not limited to, agreement to (a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the services; (b) provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; (c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; (d) Meet all requirements for retaining public records and transfer, at no cost, to the public agency all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the public agency in a format that is compatible with the information technology systems of the public agency. 44. NEGOTIATIONS. The City reserves the right to enter into further negotiations with the selected Proposer. Notwithstanding the preceding, the City is in no way obligated to enter into a contract with the selected Proposer in the event the parties are unable to negotiate a contract. It is also understood and acknowledged by Proposers that no property, contract or legal rights of any kind shall be created at any time until and unless a Development and Ground Lease Agreement has been agreed to; approved by the City; executed by the parties, and approved pursuant to the Referendum. 45. OBSERVANCE OF LAWS. Proposers are expected to be familiar with, and comply with, all Federal, State, County, and City laws, ordinances, codes, rules and regulations, and all orders and decrees of bodies or tribunals having jurisdiction or authority which, in any manner, may affect the scope of services and/or project contemplated by this ITN (including, without limitation, the Americans with Disabilities Act, Title VII of the Civil Rights Act, the EEOC Uniform Guidelines, and all EEO regulations and guidelines). Ignorance of the law(s) on the part of the Proposer will in no way relieve it from responsibility for compliance. ITN 2016-084-WG 11 MINV\IBEACI-1 46. CONFLICT OF INTEREST. All Proposers must disclose, in their Proposal, the name(s) of any officer, director, agent, or immediate family member(spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. 47. MODIFICATION/WITHDRAWALS OF PROPOSALS. A Proposer may submit a modified Proposal to replace all or any portion of a previously submitted Proposal up until the Proposal due date and time. Modifications received after the Proposal due date and time will not be considered. Proposals shall be irrevocable until contract award unless withdrawn in writing prior to the Proposal due date, or after expiration of 120 calendar days from the opening of Proposals without a contract award. Letters of withdrawal received after the Proposal due date and before said expiration date, and letters of withdrawal received after contract award will not be considered. 48. EXCEPTIONS TO ITN. Proposers must clearly indicate any exceptions they wish to take to any of the terms in this ITN, and outline what, if any, alternative is being offered. All exceptions and alternatives shall be included and clearly delineated, in writing, in the Proposal. The City, at its sole and absolute discretion, may accept or reject any or all exceptions and alternatives. In cases in which exceptions and alternatives are rejected, the City shall require the Proposer to comply with the particular term and/or condition of the ITN to which Proposer took exception to (as said term and/or condition was originally set forth on the ITN). 49. ACCEPTANCE OF GIFTS, FAVORS, SERVICES. Proposers shall not offer any gratuities, favors, or anything of monetary value to any official, employee, or agent of the City, for the purpose of influencing consideration of this Proposal. Pursuant to Sec. 2-449 of the City Code, no officer or employee of the City shall accept any gift, favor or service that might reasonably tend improperly to influence him in the discharge of his official duties. 50. SUPPLEMENTAL INFORMATION. City reserves the right to request supplemental information from Proposers at any time during the ITN solicitation process. 51. ADDITIONAL SERVICES. Although this solicitation and resultant contract identifies specific goods, services or facilities ("items"), it is hereby agreed and understood that the City, through the approval of the Department and Procurement Directors (for additional items up to $50,000) or the City Manager (for additional items greater than $50,000), may require additional items to be added to the Contract which are required to complete the work. When additional items are required to be added to the Contract, awarded vendor(s), as_applicable to the item being requested, under this contract may be invited to submit price quote(s) for these additional requirements. If these quote(s) are determined to be fair and reasonable, then the additional work will be awarded to the current contract vendor(s) that offers the lowest acceptable pricing. The additional items shall be added to this contract by through a Purchase Order(or Change Order if Purchase Order already exists). In some cases, the City may deem it necessary to add additional items through a formal amendment to the Contract, to be approved by the City Manager. The City may determine to obtain price quotes for the additional items from other vendors in the event that fair and reasonable pricing is not obtained from the current contract vendors, or for other reasons at the City's discretion. ITN 2016-084-WG 12 MIAMIBEACH SECTION 0300 PROPOSAL SUBMITTAL INSTRUCTIONS AND FORMAT 1. SEALED PROPOSALS. One original Proposal (preferably in 3-ring binder) must be submitted in an opaque, sealed envelope or container on or before the due date established for the receipt of proposals. Additionally, ten (10) bound copies and one (1) electronic format (CD or USB format) are to be submitted. The following information should be clearly marked on the face of the envelope or container in which the proposal is submitted: solicitation number, solicitation title, Proposer name, Proposer return address. Proposals received electronically, either through email or facsimile, are not acceptable and will be rejected. If you require a non-disclosure agreement to complete the dental re-pricing exercise, please send to the City for consideration and execution prior to proposal submittal for City review 2When submitting this re-pricing data to the City, please indicate whether it is private,confidential, and/or containing trade secrets as any non-disclosure agreement with the City's Consultant does not prevent a possible public records requests made to the City by a third-party.The City will make the final determination regarding any public records request In case of any discrepancy between the original hardcopy proposal and the electronic copies, the original hard copy proposal will be the governing document. 2. LATE PROPOSALS. Proposals are to be received on or before the due date established herein. Any Proposal received after the deadline established for receipt of Proposals will be considered late and not be accepted or will be returned to Proposer unopened. The City does not accept responsibility for any delays, natural or otherwise. 3. PROPOSAL FORMAT. In order to maintain comparability, facilitate the review process and assist the Evaluation Committee in review of Proposals, it is strongly recommended that Proposals be organized and tabbed in accordance with the sections and manner specified below. Hard copy submittal should be tabbed as enumerated below and contain a table of contents with page references. Electronic copies should also be tabbed and contain a table of contents with page references. Proposals that do not include the required information will be deemed non- responsive and will not be considered. It is the intent of this ITN to evaluate, score and rank, plans separately, as grouped within. Firm's proposal shall clearly indicate if proposal(s) are being submitted under Plan A— Dental Health Plan or Plan B — Disability Plan and FMLA Administration or Plan C — Group Life & Accidental Death and Dismemberment. Furthermore, firms are required to submit separate proposals for each Plan for which they seek to be evaluated. The following requirements must be submitted independently for each Plan. TAB 1 Cover Letter& Minimum Qualifications Requirements 1.1 Cover Letter and Table of Contents.The cover letter must indicate Proposer and Proposer Primary Contact for the purposes of this solicitation. 1.2 Proposal Certification, Questionnaire & Requirements Affidavit (Appendix A). Attach Appendix A fully completed and executed. 1.3 Minimum Qualifications Requirements. Submit verifiable information documenting compliance with the minimum qualifications requirements established in Appendix C, Minimum Requirements and Specifications. TAB 2 , Experience&Qualifications 2.1 Qualifications of Proposing Firm. Submit detailed information regarding the firm's history and relevant experience and proven track record of providing the scope of services similar as identified in this solicitation, including experience in providing similar scope of services to public sector agencies. For each project that the Proposer submits as evidence of ITN 2016-084-WG 13 ®_ MIAMIBEACH similar experience, the following is required: project description, agency name, agency contact, contact telephone & email, and year(s) and term of engagement. 2.2 Qualifications of Proposer Team. Provide an organizational chart of all personnel and consultants to be used for this project if awarded, the role that each team member will play in providing the services detailed herein and each team members' qualifications. A resume of each individual, including education, experience, and any other pertinent information, shall be included for each Proposal team member to be assigned to this contract. 2.3 Financial Capacity. Each Proposer shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the Procurement Contact named herein. No Proposal will be considered without receipt, by the City, of the SQR directly from Dun & Bradstreet. The cost of the preparation of the SQR shall be the responsibility of the Proposer. The Proposer shall request the SQR report from D&B at: https://supplierportal.dnb.com/webapp/wcs/stores/servlet/SupplierPortal?storeld=11696 Proposers are responsible for the accuracy of the information contained in its SQR. It is highly recommended that each Proposer review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun &Bradstreet at 800-424-2495. TAB 3 Scope of Services Proposed Submit detailed information addressing how Proposer will achieve each portion of the scope of services and technical requirements outlined in Appendix C, Minimum Requirements and Specifications. Responses shall be in sufficient detail and include supporting documentation, as applicable, which will allow the Evaluation Committee to complete a fully review and score the proposed scope of services. TAB 4 Approach and Methodology Submit detailed information on how Proposer plans to accomplish the required scope of services, including detailed information, as applicable, which addresses, but need not be limited to: implementation plan, project timeline, phasing options, testing and risk mitigation options for assuring project is implemented on time and within budget. TAB 5 1 Cost Proposal Submit a completed Cost Proposal Form (Appendix E), completed mechanically or, if manually, in ink, and submitted in both hard copy and electronic PDF format. Attachments, B1 for Dental, Attachment C1 for Disability, and/or Attachment D1 for Life Insurance and all other applicable Attachments are to be completed and submitted in electronic PDF format as well as, electronically in either the Excel or Word format in which it was received. Note: After Proposal submittal, the City reserves the right to require additional information from Proposers (or Proposer team members or sub-consultants) to determine: qualifications (including, but not limited to, litigation history, regulatory action, or additional references); and financial capability (including, but not limited to, annual reviewed/audited financial statements with the auditors notes for each of their last two complete fiscal years). ITN 2016-084-WG 14 MIAMI BEACH SECTION 0400 PROPOSAL EVALUATION 1. Evaluation Committee. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the requirements set forth in the solicitation. If further information is desired, Proposers may be requested to make additional written submissions of a clarifying nature or oral presentations to the Evaluation Committee. The evaluation of Proposals will proceed in a two-step process as noted below. It is important to note that the Evaluation Committee will score the qualitative portions of the Proposals only. The Evaluation Committee does not make an award recommendation to the City Manager. The results of Step 1 & Step 2 Evaluations-will be forwarded to the City Manager who will utilize the results to make a recommendation to the City Commission. In the event that only one responsive proposal is received, the City Manager, after determination that the sole responsive proposal materially meets the requirements of the ITN, may, without an evaluation committee, recommend to the City Commission that the Administration enter into negotiations. Award may be made by plan, which are grouped, as follows; Plan A - Dental Health Plan; Plan B - Group Disability and FMLA Plan; and Plan C - Group Life & Accidental Death and Dismemberment. Scoring and ranking will be made individually by plan in accordance with Maximum Points Schedule as stated in Section 0400 Proposal Evaluation. Proposers may attain a maximum of 105 points per plan. PLAN A DENTAL HEALTH PLAN Step 1 Evaluation. The first step will consist of the qualitative criteria listed below to be considered by the Evaluation Committee. The second step will consist of quantitative criteria established below to be added to the Evaluation Committee results by the Department of Procurement Management. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the qualifications criteria established below for Step 1, Qualitative Criteria. In doing so, the Evaluation Committee may: • review and score all Proposals received, with or without conducting interview sessions; or • review all Proposals received and short-list one or more Proposers to be further considered during subsequent interview session(s) (using the same criteria). Step 1 -Qualitative Criteria Maximum Points Proposer Experience and Qualifications,including Financial Capability 35 Scope of Services Proposed 30 Approach and Methodology 15 TOTAL AVAILABLE STEP 1 POINTS Step 2 Evaluation. Following the results of Step 1 Evaluation of qualitative criteria, the Proposers may receive additional quantitative criteria points to be added by the Department of Procurement Management to those points earned in Step 1, as follows. Step 2 Quantitative.Criteria Cost Proposal 20 Veterans Preference 5 TOTAL AVAILABLE STEP 2 POINTS ITN 2016-084-WG 15 ® MIAMI PROPOSAL EVALUATION 1. Evaluation Committee. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the requirements set forth in the solicitation. If further information is desired, Proposers may be requested to make additional written submissions of a clarifying nature or oral presentations to the Evaluation Committee. The evaluation of Proposals will proceed in a two-step process as noted below. It is important to note that the Evaluation Committee will score the qualitative portions of the Proposals only. The Evaluation Committee does not make an award recommendation to the City Manager. The results of Step 1 & Step 2 Evaluations will be forwarded to the City Manager who will utilize the results to make a recommendation to the City Commission. In the event that only one responsive proposal is received, the City Manager, after determination that the sole responsive proposal materially meets the requirements of the ITN, may, without an evaluation committee, recommend to the City Commission that the Administration enter into negotiations. Award may be made by plan, which are grouped, as follows; Plan A - Dental Health Plan; Plan B - Group Disability and FMLA Plan; and Plan C - Group Life & Accidental Death and Dismemberment. Scoring and ranking will be made individually by plan in accordance with Maximum Points Schedule as stated in Section 0400 Proposal Evaluation. Proposers may attain a maximum of 105 points per plan. PLAN B GROUP DISABILITY and FMLA PLAN Step 1 Evaluation. The first step will consist of the qualitative criteria listed below to be considered by the Evaluation Committee. The second step will consist of quantitative criteria established below to be added to the Evaluation Committee results by the Department of Procurement Management. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the qualifications criteria established below for Step 1, Qualitative Criteria. In doing so, the Evaluation Committee may: • review and score all Proposals received, with or without conducting interview sessions; or • review all Proposals received and short-list one or more Proposers to be further considered during subsequent interview session(s) (using the same criteria). • Step 1 Qualitative Criteria Maximum Points Proposer Experience and Qualifications, including Financial Capability 35 Scope of Services Proposed 30 Approach and Methodology 15 TOTAL AVAILABLE STEP 1 POINTS Step 2 Evaluation. Following the results of Step 1 Evaluation of qualitative criteria, the Proposers may receive additional quantitative criteria points to be added by the Department of Procurement Management to those points earned in Step 1, as follows. Step 2-Quantitative Criteria Cost Proposal 20 Veterans Preference 5 TOTAL AVAILABLE STEP 2 POINTS ITN 2016-084-WG 16 MINV\IBEACH PROPOSAL EVALUATION 1. Evaluation Committee. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the requirements set forth in the solicitation. If further information is desired, Proposers may be requested to make additional written submissions of a clarifying nature or oral presentations to the Evaluation Committee. The evaluation of Proposals will proceed in a two-step process as noted below. It is important to note that the Evaluation Committee will score the qualitative portions of the Proposals only. The Evaluation Committee does not make an award recommendation to the City Manager. The results of Step 1 & Step 2 Evaluations will be forwarded to the City Manager who will utilize the results to make a recommendation to the City Commission. In the event that only one responsive proposal is received, the City Manager, after determination that the sole responsive proposal materially meets the requirements of the ITN, may, without an evaluation committee, recommend to the City Commission that the Administration enter into negotiations. Award may be made by plan, which are grouped, as follows; Plan A - Dental Health Plan; Plan B - Group Disability and FMLA Plan; and Plan C - Group Life & Accidental Death and Dismemberment. Scoring and ranking will be made individually by plan in accordance with Maximum Points Schedule as stated in Section 0400 Proposal Evaluation. Proposers may attain a maximum of 105 points per plan. PLAN C GROUP TERM LIFE &ACCIDENTAL DEATH AND DISMEMBERMENT Step 1 Evaluation. The first step will consist of the qualitative criteria listed below to be considered by the Evaluation Committee. The second step will consist of quantitative criteria established below to be added to the Evaluation Committee results by the Department of Procurement Management. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each Proposal in accordance with the qualifications criteria established below for Step 1, Qualitative Criteria. In doing so, the Evaluation Committee may: • review and score all Proposals received, with or without conducting interview sessions; or • review all Proposals received and short-list one or more Proposers to be further considered during subsequent interview session(s) (using the same criteria). Step 1 -Qualitative Criteria Maximum Points Proposer Experience and Qualifications, including Financial Capability 35 Scope of Services Proposed 30 Approach and Methodology 15 TOTAL AVAILABLE STEP 1 POINTS • Step 2 Evaluation. Following the results of Step 1 Evaluation of qualitative criteria, the Proposers may receive additional quantitative criteria points to be added by the Department of Procurement Management to those points earned in Step 1, as follows. Step 2-Quantitative Criteria Cost Proposal 20 Veterans Preference 5 TOTAL AVAILABLE STEP 2 POINTS ITN 2016-084-WG 1 7 MIAMIBEACH Cost Proposal Evaluation.The cost Proposal points shall be developed in accordance with the following formula: Sample Objective Formula for Cost Vendor Vendor Example Maximum Formula for Calculating Points Total Cost Allowable Points (lowest cost I cost of Proposal Points Proposal (Points noted are for being evaluated X maximum Awarded illustrative purposes only. allowable points=awarded Actual points are noted above.) points) Round to Vendor A $100.00 20 $1001$100 X 20=20 20 Vendor B $150.00 20 $1001$150 X20=13 13 Vendor C $200.00 20 $1001$200 X20=10 10 5. Determination of Final Ranking. At the conclusion of the Evaluation Committee Step 1 scoring, Step 2 Points will be added to each evaluation committee member's scores by the Department of Procurement Management for each Plan. Step 1 and 2 scores will be converted to rankings by Plan in accordance with the example below: Proposer A Proposer B Proposer C Ste.1 Points 82 76 80 Ste.2 Points 22 15 12 Committee Total 104 91 92 Member 1 Rank 1 3 2 Step 1 Points 79 85 72 Step 2 Points 22 15 12 Committee Total 101 100 84 Member 2 Rank 1 2 3 Step 1 Points 80 74 66 Step 2 Points 22 15 12 Committee Total 102 89 78 Member 2 Rank 1 2 3 Low Aggregate Score j 3 7 8 Final Ranking* I 1 2 3 * Final Ranking is presented to the City Manager for further due diligence and recommendation to the City Commission. Final Ranking does not constitute an award recommendation until such time as the City Manager has made his recommendation to the City Commission, which may be different than final ranking results. ITN 2016-084-WG 18 APPENDIX A AA I AM BEACH Proposal Certification , Questionnaire & Requirements Affidavit Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage 2016-084-WG PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 ITN 2016-084-WG 19 Solicitation No: Solicitation Title: 2016-084-WG Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long- Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death &Dismemberment Coverage Procurement Contact: Tel: Email: William Garviso, CPPB (305) 673-7000#6650 WilliamGarviso @miamibeachfl.gov PROPOSAL CERTIFICATION, QUESTIONNAIRE & REQUIREMENTS AFFIDAVIT Purpose: The purpose of this Proposal Certification, Questionnaire and Requirements Affidavit Form is to inform prospective Proposers of certain solicitation and contractual requirements, and to collect necessary information from Proposers in order that certain portions of responsiveness, responsibility and other determining factors and compliance with requirements may be evaluated. This Proposal Certification, Questionnaire and Requirements Affidavit Form is a REQUIRED FORM that must be submitted fully completed and executed. 1. General Proposer Information. FIRM NAME: No of Years in Business: No of Years in Business Locally: No of Employees: OTHER NAME(S)PROPOSER HAS OPERATED UNDER IN THE LAST 10 YEARS: FIRM PRIMARY ADDRESS(HEADQUARTERS): CITY: STATE: ZIP CODE: TELEPHONE NO.: TOLL FREE NO.: FAX NO.: FIRM LOCAL ADDRESS: CITY: STATE: ZIP CODE: PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT: ACCOUNT REP TELEPHONE NO.: ACCOUNT REP TOLL FREE NO.: ACCOUNT REP EMAIL: FEDERAL TAX IDENTIFICATION NO.: The City reserves the right to seek additional information from Proposer or other source(s), including but not limited to: any firm or principal information, applicable licensure, resumes of relevant individuals, client information, financial information, or any information the City deems necessary to evaluate the capacity of the Proposer to perform in accordance with contract requirements. ITN 2016-084-WG 20 1. Veteran Owned Business. Is Proposer claiming a veteran owned business status? YES NO SUBMITTAL REQUIREMENT: Proposers claiming veteran owned business status shall submit a documentation proving that firm is certified as a veteran-owned business or a service-disabled veteran owned business by the State of Florida or United States federal government,as required pursuant to ordinance 2011-3748. 2. Conflict Of Interest.All Proposers must disclose, in their Proposal,the name(s)of any officer,director,agent,or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Proposers must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates. SUBMITTAL REQUIREMENT: Proposers must disclose the name(s) of any officer, director, agent, or immediate family member (spouse, parent,sibling, and child)who is also an employee of the City of Miami Beach. Proposers must also disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the Proposer entity or any of its affiliates 3. References&Past Performance. Proposer shall submit at least three(3) references for whom the Proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: For each reference submitted, the following information is required: 1) Firm Name, 2) Contact Individual Name&Title,3)Address,4)Telephone,5)Contact's Email and 6)Narrative on Scope of Services Provided. 4. Suspension,Debarment or Contract Cancellation.Has Proposer ever been debarred,suspended or other legal violation,or had a contract cancelled due to non- erformance by an ublic sector agency? YES NO SUBMITTAL REQUIREMENT: If answer to above is "YES," Proposer shall submit a statement detailing the reasons that led to action(s). 5. Vendor Campaign Contributions. Proposers are expected to be or become familiar with, the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code. Proposers shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with, and shall be subject to any and all sanctions, as prescribed therein,including disqualification of their Proposals, in the event of such non-compliance. SUBMITTAL REQUIREMENT: Submit the names of all individuals or entities (including your sub-consultants) with a controlling financial interest as defined in solicitation. For each individual or entity with a controlling financial interest indicate whether or not each individual or entity has contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. 6. Code of Business Ethics. Pursuant to City Resolution No.2000-23879, each person or entity that seeks to do business with the City shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Management Department with its response or within five (5) days upon receipt of request. The Code shall, at a minimum, require the Proposer, to comply with all applicable governmental rules and regulations including, among others, the conflict of interest, lobbying and ethics provision of the City of Miami Beach and Miami Dade County. SUBMITTAL REQUIREMENT: Proposer shall submit firm's Code of Business Ethics. In lieu of submitting Code of Business Ethics, Proposer may submit a statement indicating that it will adopt, as required in the ordinance,the City of Miami Beach Code of Ethics,available at www.miamibeachfl.gov/procurement/. ITN 2016-084-WG 21 • •7. - .e-. _ •.• - _ - -• I _ •- 1 1 _•• !.-..• _ _. e , - .••- ••. .• _ e•• •••- _ , •• • --- The City Commission approved Ordinance 2014-3897 on September 30, 2014 increasing the living wage rate to same(in a particular year). Proposers'failure to comply with this provision shall be deemed a material breach under this proposal, under which the City may, available at www.miamibeachfl.gov/procurement/. to the living wage requirement. 8. Equal Benefits for Employees with Spouses and Employees with Domestic Partners. When awarding competitively solicited contracts valued at over$100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive proposals, to provide "Equal Benefits"to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida;and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? YES NO B. Does your company provide or offer access to any benefits to employees with(same or opposite sex)domestic partners*or to domestic partners of employees? YES NO C. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave;other benefits are provided directly to the spouse or domestic partner,such as medical insurance. BENEFIT Firm Provides for Firm Provides for Firm does not Employees with Employees with Provide Benefit Spouses Domestic Partners Health Sick Leave Family Medical Leave Bereavement Leave If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached)with all necessary documentation.Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at www.miamibeachfl.gov/procurement/. ITN 2016-084-WG 22 9. Public Entity Crimes.Section 287.133(2)(a), Florida Statutes,as currently enacted or as amended from time to time,states that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal, Proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a proposal, 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 proposals, Proposals, or replies on leases of real property to a 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 s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees with the requirements of Section 287.133, Florida Statutes,and certifies it has not been placed on convicted vendor list. 10. Acknowledgement of Addendum. After issuance of solicitation, the City may release one or more addendum to the solicitation which may provide additional information to Proposers or alter solicitation requirements. The City will strive to reach every Proposer having received solicitation through the City's e-procurement system, PublicPurchase.com. However, Proposers are solely responsible for assuring they have received any and all addendum issued pursuant to solicitation.This Acknowledgement of Addendum section certifies that the Proposer has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addendum may result in Proposal disqualification. Initial to Confirm Initial to Confirm Initial to Confirm Receipt Receipt Receipt Addendum 1 Addendum 6 Addendum 11 Addendum 2 Addendum 7 Addendum 12 Addendum 3 Addendum 8 Addendum 13 Addendum 4 Addendum 9 Addendum 14 Addendum 5 Addendum 10 Addendum 15 If additional confirmation of addendum is required,submit under separate cover. ITN 2016-084-WG 23 DISCLOSURE AND DISCLAIMER SECTION The solicitation referenced herein is being furnished to the recipient by the City of Miami Beach (the"City")for the recipient's convenience. Any action taken by the City in response to Proposals made pursuant to this solicitation, or in making any award, or in failing or refusing to make any award pursuant to such Proposals, or in cancelling awards, or in withdrawing or cancelling this solicitation, either before or after issuance of an award,shall be without any liability or obligation on the part of the City. In its sole discretion, the City may withdraw the solicitation either before or after receiving Proposals, may accept or reject Proposals, and may accept Proposals which deviate from the solicitation, as it deems appropriate and in its best interest. In its sole discretion, the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this solicitation. Following submission of a Bid or Proposal, the applicant agrees to deliver such further details, information and assurances, including financial and disclosure data, relating to the Proposal and the applicant including, without limitation, the applicant's affiliates, officers, directors,shareholders,partners and employees,as requested by the City in its discretion. The information contained herein is provided solely for the convenience of prospective Proposers. It is the responsibility of the recipient to assure itself that information contained herein is accurate and complete.The City does not provide any assurances as to the accuracy of any information in this solicitation. Any reliance on these contents,or on any permitted communications with City officials, shall be at the recipient's own risk. Proposers should rely exclusively on their own investigations, interpretations, and analyses.The solicitation is being provided by the City without any warranty or representation, express or implied, as to its content, its accuracy, or its completeness. No warranty or representation is made by the City or its agents that any Proposal conforming to these requirements will be selected for consideration, negotiation,or approval. The City shall have no obligation or liability with respect to this solicitation,the selection and the award process,or whether any award will be made.Any recipient of this solicitation who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer, is totally relying on this Disclosure and Disclaimer,and agrees to be bound by the terms hereof.Any Proposals submitted to the City pursuant to this solicitation are submitted at the sole risk and responsibility of the party submitting such Proposal. This solicitation is made subject to correction of errors, omissions, or withdrawal from the market without notice. Information is for guidance only,and does not constitute all or any part of an agreement. The City and all Proposers will be bound only as, if and when a Proposal (or Proposals), as same may be modified, and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties.Any response to this solicitation may be accepted or rejected by the City for any reason, or for no reason,without any resultant liability to the City. The City is governed by the Government-in-the-Sunshine Law,and all Proposals and supporting documents shall be subject to disclosure as required by such law. All Proposals shall be submitted in sealed proposal form and shall remain confidential to the extent permitted by Florida Statutes, until the date and time selected for opening the responses. At that time, all documents received by the City shall become public records. Proposers are expected to make all disclosures and declarations as requested in this solicitation. By submission of a Proposal,the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information contained in the Proposal, and authorizes the release to the City of any and all information sought in such inquiry or investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete, to the best of its knowledge, information, and belief. Notwithstanding the foregoing or anything contained in the solicitation,all Proposers agree that in the event of a final unappealable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this solicitation, or any response thereto, or any action or inaction by the City with respect thereto, such liability shall be limited to$10,000.00 as agreed-upon and liquidated damages. The previous sentence, however, shall not be construed to circumvent any of the other provisions of this Disclosure and Disclaimer which imposes no liability on the City. In the event of any differences in language between this Disclosure and Disclaimer and the balance of the solicitation, it is understood that the provisions of this Disclosure and Disclaimer shall always govern. The solicitation and any disputes arising from the solicitation shall be governed by and construed in accordance with the laws of the State of Florida. ITN 2016-084-WG 24 PROPOSER CERTIFICATION I hereby certify that: I, as an authorized agent of the Proposer, am submitting the following information as my firm's Proposal; Proposer agrees to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation, all attachments, exhibits and appendices and the contents of any Addenda released hereto, and the Disclosure and Disclaimer Statement; Proposer agrees to be bound to any and all specifications, terms and conditions contained in the solicitation, and any released Addenda and understand that the following are requirements of this solicitation and failure to comply will result in disqualification of Proposal submitted; Proposer has not divulged, discussed, or compared the Proposal with other Proposers and has not colluded with any other Proposer or party to any other Proposal; Proposer acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; all responses, data and information contained in this Proposal, inclusive of the Proposal Certification, Questionnaire and Requirements Affidavit are true and accurate. Name of Proposer's Authorized Representative: Title of Proposer's Authorized Representative: Signature of Proposer's Authorized Representative: Date: State of ) On this day of , 20_,personally appeared before me who County of ) stated that (s)he is the of , a corporation, and that the instrument was signed in behalf of the said corporation by authority of its board of directors and acknowledged said instrument to be its voluntary act and deed. Before me: Notary Public for the State of My Commission Expires: ITN 2016-084-WG 25 APPENDIX B ,s„ k ---1 -',, ‘..,:i . r , r .1k, '‘, 1 �I\ Jdh: /\ I'? ms=s , h ® Bid " Form Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage 2016-084-WG PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 h e. t is important�sfa Those vendors who�G •au re r �e:4d �c tt�frcation ofG fh sc�l,citd Fars bu have de tde3 o to res �u d t. co•• ,I:ete�:and�sub it r :.� .t.•a 41 , L:" z _3 x i. �: e_� =tat ent� of N.®�B d w roue es t Z eatache�d S cat et�o �o ei t� � 1 I P tF 1Ps. c9 with•}• ifarmation Onah i � E pro r . f e so c:.ife trop-pro es�s. �Fatleu.e t. s bmtt a,` tat\e e t f N �;id" nia i esu1t in _n bee:in ' no rf►ecl �S f ..a �a\ �3� tta• �ap... .. '•�R• •�a�2c. �� a•�. �•`r�'z.,.•• �.�•:; �`�•• N ISI e V;S• � �E t,#.E•{ �� \re�it . u:• N 1 5 ..9— vet^ asYx ;sa. rsa,ir..,.., �m „�.:» ` ITN 2016084 WG 26 Statement of No Bid WE HAVE ELECTED NOT TO SUBMIT A PROPOSAL AT THIS TIME FOR REASON(S) CHECKED AND/OR INDICATED BELOW: Workload does not allow us to proposal Insufficient time to respond Specifications unclear or too restrictive Unable to meet specifications Unable to meet service requirements Unable to meet insurance requirements Do not offer this product/service OTHER. (Please specify) We do_ do not_want to be retained on your mailing list for future proposals of this type product and/or service. Signature: Title: Legal Company Name: Note: Failure to respond, either by submitting a proposal or this completed form, may result in your company being removed from our vendors list. PLEASE RETURN TO: CITY OF MIAMI BEACH PROCUREMENT DEPARTMENT ATTN: William Garviso PROPOSAL#2016-084-WG 1755 Meridian Avenue, 3rd Floor MIAMI BEACH, FL 33139 ITN 2016-084-WG 27 APPENDIX C AAA1 '111 Minimum Requirements Specifications Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage 2016-084-WG PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 ITN 2016-084-WG 28 C1. Minimum Eligibility Requirements.The Minimum Eligibility Requirements for this solicitation are listed below. Proposer shall submit,with its proposal,the required submittal(s)documenting compliance with each minimum requirement. Proposers that fail to include the required submittals with its proposal or fail to comply with minimum requirements shall be deemed non-responsive and shall not have its proposal considered. Plan A-Dental Health Plan Bidder shall have a minimum of five years'experience providing Group Dental Health Plan services to city,county,or other local governmental organizations or public entities. Required Submittals: Three (3) client references including name, contact information including address/telephone/email, length of services provided, and the actual services provided to the client. Plan B-Disability&FMLA Plan Bidder shall have a minimum of five years'experience providing Disability&FMLA Plan services to city,county,or other local governmental organizations or public entities. Required Submittals: Three (3) client references including name, contact information including address/telephone/email, length of services provided, and the actual services provided to the client. PLAN C-Group Term Life&Accidental Death and Dismemberment Bidder shall have a minimum of five years' experience providing Group Term Life & Accidental Death and Dismemberment health benefits services to city, county, or other local governmental organizations or public entities. Required Submittals: Three (3) client references including name, contact information including address/telephone/email, length of services provided, and the actual services provided to the client. If doing business as an insurance company in the State of Florida and you are responding to any aspect of this ITN that requires an insurance company service, please provide proof that your application to do business as an insurance company was submitted to the Florida Office of Insurance Regulation and approval was granted. Please include the types of insurance you have the authority to underwrite and that your authority is current(has not expired). Required Submittals: Current insurance business license, proof of approval and that underwriting authority is current from the FLOIR ITN 2016-084-WG 29 C2. Statement of Work Required and ITN Submittal Instructions The City is seeking proposals from qualified firms to provide and administer ancillary benefits plans for eligible employees, retirees, Consolidated Omnibus Budget Reconciliation Act (COBRA) participants and their dependents, including domestic partners. The intent of this ITN is to provide plans that are very similar to or better than the City's current ancillary benefits, which are described below and in more detail in the Attachments. Plan Year/ The City's benefits plan has traditionally been administered on a calendar year basis. Effective Date This changed effective October 1, 2014 when the City's benefits plan converted to History: coincide with the fiscal year. This was done on a passive basis with a following short plan year from January 1, 2015—September 30, 2015. An active open enrollment process took place effective October 1, 2015 and future subsequent renewal effective dates will be on October 1. Dental Plan The City's Dental Plan is administered by MetLife. The City offers employees and retirees the option of a fully-insured DHMO or a self-funded DPPO. For active employees,the City pays 50%for each tier of the fully-insured DHMO rates or 50%of the self-funded DPPO rates. The City currently has three(3)tiers—Employee Only, Employee+ 1,and Family—and requests that this continue for the DHMO rates quoted. The City's Consultant will incorporate the DPPO ASO fee quoted in your proposal with the Dental Repricing Data and develop three(3)tier rates for the City. The City's DHMO tier ratios are currently 1, 1.75, and 2.75. The City would prefer for DHMO quotes to closely resemble the current tier ratios. Disability Plan The City's Disability Plan and FMLA Administration is administered by Unum. The STD and FMLA and LTD disability benefits are fully-insured and 100%voluntary with the exception of Administration approximately 29 participants in the Defined Contribution Retirement Plan 401(a)for which the City pays the LTD rate. Group Life Plan The City's Group Life Plan is administered by the Hartford on a fully-insured basis. Basic Life and AD&D, Supplemental Life and AD&D, and Dependent Life are offered to the City's active employees. Retirees may elect$1,000 of Basic Life at retirement and $4,000 of Supplemental Life at retirement if they previously participated in the Supplemental Life program as an active employee. Consultant The City completed a Consultant selection process and has appointed Gallagher Information Benefit Services, Inc. as the exclusive City Consultant. Gallagher has been retained by the City under a fixed fee arrangement. No quote should contain any commissions payable to Gallagher. If an individual agent or agency chooses to respond to any portion of this ITN,the City prefers not to incur any additional,compensatory expense. ITN 2016-084-WG 30 PLAN A: GROUP DENTAL PLAN The City provides its employees and retirees two dental plans — a self-insured Preferred Provider Organization (PPO) group dental plan and a fully-insured Dental Health Maintenance Organization (DHMO) plan. Both the City and the employee/retiree contribute to the cost of dental coverage, at different rates, based on the plan elected by the participant. Please note—the Dental Plan is also offered to the City's Police Department(Fraternal Order of Police). The Administrative Services Only (ASO) Fee for the DPPO self-insured group dental plan is $3.86 PEPM. This fee represents the charges for paying claims and performing other standard administrative services. Claims data is used by the City's Consultant to set the DPPO rates in combination with the ASO fee. The rates for the PPO self-insured plan are as follows: • Employee Only—$41.80 • Employee+ 1 —$80.52 • Employee+ Family-$123.48 The rates for the DHMO plan are as follows: • Employee Only-$17.15 • Employee+ 1 -$30.06 • Employee+ Family-$47.23 COST PROPOSAL Please complete the Dental Cost Proposal in Attachment B1 and submit back in Excel format and hardcopy. Please note that Appendix E: Cost Proposal Forms within this document must also be completed, signed and submitted in hardcopy. Appendix E will include the same information as submitted in Attachment B1. Attachment B1 should include your DHMO rates, DPPO administrative fee, and the total value of repriced claims. See the DPPO Claims Data for Repricing Section of this ITN for instructions. Please answer questions 1 —7 in this Attachment. Current enrollment has been provided in this Attachment and historical enrollment can be found in Attachment B11 — Dental Enrollment. In order to price the DHMO option, Attachment B13 includes DHMO Claims Experience. In order to price the DPPO ASO fee, Attachment B14 includes DPPO utilization. QUESTIONNAIRE Please complete the Dental Questionnaire in Attachment B2 and submit back in Excel format and hardcopy. Please do not copy/paste lengthy, generalized answers to the questions but create responses that are specific to this ITN. If you would like to submit additional information that is not easily submitted in Attachment B2, please include in your hardcopy ITN response. If you are unsure how to answer a specific question, please submit a clarification question to the City or ask the clarification question during the pre- proposal meeting. ITN 2016-084-WG 31 PLAN DESIGN The City requests that the current dental plan designs be replicated to the greatest extent possible in your response. Please complete Attachment B3— Dental Plan Designs and submit back in Excel format and hardcopy. If improvements can be made to the DHMO copays without significant additional expense, the City will review liberalized DHMO quotes/copays but still requests a plan design to most closely resemble the current DHMO offering. As the DPPO is self-funded, enhancements to the plan for an effective date of October 1, 2016 will be discussed with the successful Proposer and the City's Consultant. Additional information regarding plan design and contractual requirements can be found in the following Attachments: • Attachment B4—DPPO Plan Summary • Attachment B5—DHMO Copay Schedule • Attachment B6—PPO ASO Agreement • Attachment B7—DHMO Certificate These Attachments should be reviewed carefully in order to provide a response that most closely matches the City's current dental program arrangement, plan design,eligibility requirements, and contract. Failure to identify any area in which your proposal deviates from Attachments B3 to B7 may result in unfavorable consideration during the Evaluation Phase. Please note —Attachment B4 includes an example of a claim being priced out-of-network at the 80th percentile of Reasonable and Customary(R&C)charges. The City's self-funded DPPO plan reimburses at the 90th percentile of R&C charges for out-of-network claims. The City requests that your proposal assumes reimbursing for DPPO out-of-network claims at this same level. TOP PROVIDERS Please complete Attachment B8— DPPO Top Providers and Attachment B9— DHMO Top Providers and submit back in Excel format and hardcopy. Attachment B8 (DPPO) requests that you review and list whether each provider is in-network or out-of- network for your DPPO and DHMO networks. Attachment B9 (DHMO) has two (2) worksheets — DHMO Capitation and DHMO Procedures. Please indicate in each sheet whether the DHMO provider is in-network or out-of-network for your DHMO network. Failure to complete these Attachments may result in the City being unable to assess what type of network disruption would occur for its dental plan members if your proposal is accepted. ITN 2016-084-WG 32 GEOACESS REPORTS A census has been provided in Attachment A for purposes of running GeoAccess reports. Please note— the census has the"County, State" already populated and includes zip codes. The zip codes should be used to produce the GeoAccess report. However,the report must aggregate this data by County. Attachment B10, GeoAccess Reports, has been provided with the census data per County already populated. There are separate tabs for DHMO and DPPO summaries - please make sure that the GeoAccess reports are run both on your DHMO and DPPO networks. Please return the file in Excel format and hardcopy populating Column C (with the correct network data — DHMO or DPPO) for the number of eligible employees that have access to: • 2 General Dentists within 10 Miles • 2 Orthodontists within 10 Miles • 2 Periodontists within 10 Miles • , 2 Oral Surgeons within 10 Miles • 2 Pediatric General Dentists within 15 Miles After populating Column C with employees/retirees that have access, please enter into Column E what the average distance (miles) would be to five (5) providers for employees/retirees that have access. Do not enter average distance(miles)for all eligible employees. Only those with access. Please see the example below. Columns C and E are in yellow. The County, Eligible Employees and the Percentage with Access are pre-populated and/or formula driven. Please pay careful attention to the instructions below and in the Attachment B10, GeoAccess reports. Also, please submit the actual GeoAccess Reports used to populate the results in Attachment B10 as part of your ITN response both in hardcopy and electronically. Geo Access Report Please populate with Employees WITH Access using your DPPO Network Enter the number of employees with the requested access in Column C and the Average#of Miles to 5 Providers for those employees with the requested access in Column E Please use the 25th County as a catch-all for the Remainder of the Group as listed below Full GeoAccess reports by County should also be submitted as part of your proposal General Dentists County-HMO Eligible 2 Providers within 10 Miles Average#Miles Employees Employees with Access to 5 Providers Miami-Dade County, FL 1,780 0 0.0% 0.0 Broward County, FL 510 0 0.0% 0.0 Palm Beach County, FL 37 0 0.0% 0.0 Brevard County, FL 15 0 0.0% 0.0 Highlands County, FL 13 0 0.0% 0.0 ITN 2016-084-WG 33 DPPO CLAIMS DATA FOR REPRICING As part of the ITN process, Attachment B12 — DPPO Claims File, has been provided for interested proposers to reprice DPPO claims under their current network arrangements. All interested proposers must reprice DPPO claims to provide an accurate comparison of data for analysis. For each claim, please indicate whether the provider is an in-network (par) or out-of-network (non-par) DPPO provider and list the allowed amount per claim for your DPPO network without consideration of member cost share /copays. If the provider is out-of-network, please list the amount you would pay at the 90th percentile of Reasonable & Customary(R&C)charges. The R&C charge should be the lowest of 1)the dentist's actual charge or 2)the charge of most dentists in the same geographic area for the same or similar services at the 90th percentile. Claims should be repriced based on your network agreements in place effective January 1, 2016. Claims repriced to a zero dollar ($0) amount with a submitted amount greater than zero ($0) will be scrutinized. Please verify that any zero dollar ($0) repriced claims are correctly priced in your submittal. Failure to submit all repriced claims accurately may result in your proposal being deemed non-responsive. Please indicate in your proposal whether you consider this information to be confidential and/or proprietary, to be used only in an aggregate analysis, and/or whether you consider any Florida State Statutes applicable to this confidentiality (e.g. F.S. §812.081, F.S. §815.045). Attachment B12 must be submitted back in Excel format as part of your proposal. Failure to do so will limit the analysis that can take place during the Evaluation phase. PLAN B: GROUP DISABILITY AND FMLA ADMINISTRATION The City provides a short-term (STD) and long-term disability (LTD) plan for employees to select on a voluntary basis. STD provides an employee 60%of their earnings up to a maximum of$1,500 weekly for a maximum period of twenty-six (26) weeks due to a non-work related illness or injury. The cost of STD coverage is based on the employee's age and annual earnings prior to their disability. The cost of the coverage is fully borne by the employee. LTD provides an employee 60% of their earnings up to a maximum of $10,000 monthly after their first twenty-six (26) weeks of disability due to a non-work related illness or injury. Coverage continues under the plan until the employee is able to return to work, is approved by Social Security for Disability Benefits (if eligible), or dies. In addition, the long-term disability plan provides training and job placement opportunities should the individual be unable to perform the duties of the job held prior to their illness or injury. The cost of the coverage is based on the employee's age and - annual earnings prior to their disability. The cost of LTD coverage is fully borne by the employee. The City provides and pays for a long-term (LTD) disability policy for currently twenty nine (29) participants in the City's Defined Contribution Retirement Plan 401(a). These employees were hired prior to the March 18, 2006 change in the City's pension benefits terminating the defined contribution plan 401(a) and elected to continue their pension benefit through the plan. This long-term disability benefit is provided to these plan participants to mirror the long-term disability benefit provided by the Miami Beach Employees' Retirement Plan (MBERP). This long-term disability plan will end when all participants terminate or retire. Please note — this LTD benefit is slightly different than the voluntary LTD plan offered to all other employees. LTD provides these employees 66.67% of their earnings up to a maximum of $8,000 monthly after their first twenty-six(26)weeks of disability due to a non-work related illness or injury. Please note—the Disability Plan is also offered to the City's Police Department(Fraternal Order of Police)and the City's Fire Department(IAFF). Administration of the City's FMLA policy for all employees is requested. Management of this program includes medical certification and day-to-day administration of the City's FMLA policy, providing protection from misinterpretation of the FMLA and its current and future changes, and to provide convenience to employees with one (1) point of contact for their FMLA application, questions, and certifications. The ITN 2016-084-WG 34 current provider works closely with the employees and their physicians to monitor the employee's expedited return to work. As required by the U.S. Federal Government, Department of Labor, the City's FMLA policy provides employees the opportunity for up to twelve (12) weeks of unpaid leave for their own care or the care of a family member due to a medical need. The leave can be taken all at once, or intermittently. The City has enhanced the FMLA program to include an additional twelve (12) week period of FML if deemed medically necessary. The FMLA program also provides leave for family members in the military called to active duty or to care for a covered service member recovering from a serious injury or illness in the line of duty. The current administrative fee for managing the FMLA program is$1.49 per employee per month(PEPM). COST PROPOSAL Please complete the Disability-FML Cost Proposal in Attachment Cl and submit back in Excel format and hardcopy. Please note that Appendix E: Cost Proposal Forms within this document must also be completed, signed and submitted in hardcopy. Appendix E will include the same information as submitted in Attachment C1. Attachment C1 should include your Voluntary STD rates, Voluntary LTD rates, ER paid LTD rates, and the PEPM charge to administer the FMLA program. Please answer any questions in each worksheet of this Attachment and follow the instructions carefully. Current enrollment and volumes have been provided in this Attachment and in Attachment A—Census. Please note that while volumes have been pre-populated in the Cost Proposal, please verify these amounts independently by analyzing Attachment A—Census. If you find any discrepancies between the Census and the Volume amounts listed in Attachment C1, please submit a clarification question to the City. The City has the following rate structure for the current disability-FML program and would prefer to continue this rate structure moving forward: • Voluntary STD Rate—Age Banded, Monthly Rate per$10 of weekly covered benefit • Voluntary LTD Rate—Age Banded, Monthly Rate per$100 of monthly covered payroll • ER Paid LTD Rate—Composite Monthly Rate per$100 of monthly covered payroll o The City pays this rate for the 29 employees currently enrolled and for ease of administration a Composite rate is preferred. • FMLA Administration—Per Employee Per Month (PEPM)fee If you are unable to provide a financial quote in the requested format above, please submit as a clarification question to the City and/or discuss this limitation at the pre-proposal meeting. The following Attachments have been provided in order to price your disability-FML response: • Attachment C7—STD Claims Experience • Attachment C8—Voluntary LTD Claims Experience • Attachment C9—Voluntary LTD Reserves • Attachment C10—ER Paid LTD Claims Experience • Attachment C11 —ER Paid LTD Reserves • Attachment C12—Total Absence Report • Attachment C13—EE's on Leave(as of March 21, 2016) ITN 2016-084-WG 35 QUESTIONNAIRES Please complete the Disability=FML Questionnaire in Attachment C2 and submit back in Excel format and hardcopy. Please be aware that there are two worksheets to complete—the LTD-STD Questionnaire and the FMLA Questionnaire. Please do not copy/paste lengthy, generalized answers to the questions but create responses that are specific to this ITN. If you would like to submit additional information that is not easily submitted in Attachment C2, please include in your hardcopy ITN response. If you are unsure how to answer a specific question, please submit a clarification question to the City or ask the clarification question during the pre-proposal meeting. PLAN DESIGN The City requests that the current disability plan designs and FMLA administration services be duplicated exactly in your ITN response. Please complete Attachment C3 — Disability-FML Plan Design and submit back in Excel format and hardcopy. If improvements can be made to the disability plan without significant additional expense, the City will review any proposed enhances. But, at a minimum, the City requires an identical plan design and commensurate quote. Additional information regarding plan design and contractual requirements can be found in the following Attachments: • Attachment C4—Voluntary STD Contract • Attachment C5—Voluntary LTD Contract • Attachment C6—ER Paid LTD Contract • Attachment C14—FMLA Current Agreement These Attachments should be reviewed carefully in order to provide a response that most closely matches the City's current Group Disability and FMLA program arrangement, plan design, eligibility requirements, and contract. Failure to identify any area in which your proposal deviates from Attachments C3 — C6 and C14 may result in unfavorable consideration during the Evaluation Phase. ITN 2016-084-WG 36 GROUP DISABILITY ENROLLMENT, MONTHLY VOLUMES,AND RATE QUOTE VOLUMES Age Bands STD Participants......................................._....................................._LTD...Participants..........- LTD 401 Participants................................ 0-24 20 20 25-29 96 92 30-34 112 120 4 35-39 96 104 5 40-44 98 103 5 45-49 96 104 3 50-54 112 108 7 55-59 39 39 60-64 19 18 65-69 8 2 1 70-74 1 1 1 75+ 2 3 Grand Total 699 711 29 Age Bands STD Volume LTD Volume LTD 401 Volume 0-24 $10,926.92 $77,666.67 $0.00 25-29 $58,800.00 $420,250.00 $0.00 30-34 $73,384.62 $596,833.33 $16,583.33 35-39 $69,576.92 $578,166.67 $23,666.67 40-44 $72,103.85 $601,000.00 $26,416.67 45-49 $82,373.08 $697,916.67 $17,583.33 50-54 $81,415.38 $638,666.67 $37,500.00 55-59 $26,007.69 $190,333.33 $0.00 60-64 $12,311.54 $107,833.33 $0.00 65-69 $4,719.23 $14,250.00 $4,833.33 70-74 $357.69 $2,583.33 $4,166.67 75+ $1,200.00 $0.00 $13,083.33 Totals $493,176.92 $3,925,500.00 $143,833.33 STD Volume($10 Weekly LTD Volume($100 Monthly LTD 401 Volume($100 Monthly Covered Benefit) Covered Payroll) Covered Payroll) 0-24 $1,092.69 $776.67 $0.00 25-29 $5,880.00 $4,202.50 $0.00 30-34 $7,338.46 $5,968.33 $165.83 35-39 $6,957.69 $5,781.67 $236.67 40-44 $7,210.38 $6,010.00 $264.17 45-49 $8,237.31 $6,979.17 $175.83 50-54 $8,141.54 $6,386.67 $375.00 55-59 $2,600.77 $1,903.33 $0.00 60-64 $1,231.15 $1,078.33 $0.00 65-69 $471.92 $142.50 $48.33 70-74 $35.77 $25.83 $41.67 75+ $120.00 $0.00 $130.83 Totals $49,317.69 $39,255.00 $1,438.33 ITN 2016-084-WG 37 PLAN C: GROUP TERM LIFE AND ACCIDENTAL DEATH &DISMEMBERMENT PLAN The City provides employees and retirees a Group Term Life and AD&D program. Active Employees Active employees receive Basic Life and AD&D. The Basic benefit is 1x salary up to $250,000. Basic AD&D provides lx salary up to$20,000. Employees may choose to purchase Supplemental Life insurance in increments of 1, 2, 3, 4, or 5 times salary with a guaranteed issuance amount of $250,000. If an employee's salary at a multiple of 1 — 5 exceeds $250,000, the employee may elect a flat $250,000. The maximum Supplemental Life benefit amount is $500,000 with amounts above$250,000 subject to evidence of insurability. Supplemental AD&D is included when employees elect Supplemental Life. Supplemental AD&D mirrors the Supplemental Life insurance amount. Basic and Supplemental Life, combined, cannot exceed $500,000. If the amount elected in combination exceeds$500,000, the Supplemental Life insurance amount elected will be reduced followed by a reduction in the Basic Life insurance amount if necessary. Employees may choose to purchase Dependent Life insurance in the following amounts: • $20,000 Spouse/$10,000 per Child, live birth but under age 19 • $30,000 Spouse/$10,000 per Child, live birth but under age 19 • $40,000 Spouse/$10,000 per Child, live birth but under age 19 • $50,000 Spouse/$10,000 per Child, live birth but under age 19 The amount of Spousal coverage may never exceed 50% of the Combined Basic and Supplemental Life insurance in-force for the Employee. Retired Employees At retirement, Retirees may choose to elect to continue Basic Life with a flat benefit of$1,000. Retirees do not receive a Basic AD&D benefit. If the Retiree participated in the Supplemental Life plan during employment, the Retiree can elect a flat$4,000 in Supplemental Life benefit at retirement. Retirees do not receive a Supplemental AD&D benefit. Please note — the Group Term Life and AD&D Plan is also offered to the City's Fire Department (IAFF). The Police Department(FOP)may purchase Supplemental Life(they are ineligible for Basic). ITN 2016-084-WG 38 COST PROPOSAL Please complete the Group Life Cost Proposal in Attachment D1 and submit back in Excel format and hardcopy. Please note that Appendix E: Cost Proposal Forms within this document must also be completed, signed and submitted in hardcopy. Appendix E will include the same information as submitted in Attachment Dl. Attachment D1 should include a Basic Life and Basic AD&D rate, a Supplemental Life and Supplemental AD&D rate, Dependent Life Unit rates, and a Retiree Basic Life and Supplemental Life rate. Please answer any questions in each worksheet of this Attachment and follow the instructions carefully. Current enrollment and volumes have been provided in this Attachment and in Attachment A—Census. Please note that while volumes have been pre-populated in the Cost Proposal, please verify these amounts independently by analyzing Attachment A—Census. If you find any discrepancies between the Census and the Volume amounts listed in Attachment D1, please submit a clarification question to the City. The City has the following rate structure for the current Group Term Life and AD&D program and would prefer to continue this rate structure moving forward: • Active Employees ➢ Basic Life Rate—Composite Monthly Rate per$1,000 of Volume ➢ Basic AD&D Rate—Composite Monthly Rate per$1,000 of Volume ➢ Supplemental Life Rate—Age Banded, Monthly Rate per$1,000 of Volume ➢ Supplemental AD&D Rate—Composite Monthly Rate per$1,000 of Volume added to the Age Banded Supplemental Life Rate • For example, if an employee age 52 has an age-banded rate of$0.42 per$1,000 of Volume, the total age banded rate would be $0.42 + $0.015 (illustrative) to take into account Supplemental AD&D • Similarly, if an employee age 45 has an age-banded rate of$0.26 per$1,000 of Volume, the total rate would be $0.26 + $0.015 (illustrative) to take into account Supplemental AD&D ➢ Dependent Life Rate — Monthly Unit Rate for each $10,000 in Spousal amount elected taking into consideration the four(4)options • For example, if an employee elects $40,000 and your rate is $0.75 per$10,000, the premium would be$40.000/$10,000 x$0.75=$3.00 per month. • Please note that the lowest option that an employee can choose is $20,000. So, if your rate is $0.75 per$10,000, the rate you would enter in the Cost Proposal would be 2 x$0.75=$1.50 per month for this option. • Retirees ➢ Basic Life Rate—Composite Monthly Rate per each retiree's$1,000 of Volume • This rate currently matches the Active Employee Basic Life Rate and the City would prefer that this continues ➢ Supplemental Life Rate—Composite Monthly Rate per$1,000 of Volume • For example, if a Retiree elects Supplemental Life at retirement and your rate is $2.00,the monthly premium would be$4,000/$1,000 x$2=$8. If you are unable to provide a financial quote in the requested format above, please submit as a clarification question to the City and/or discuss this limitation at the pre-proposal meeting. The following Attachments have been provided in order to price your Group Term Life and AD&D response: • Attachment D6—Life Claims Experience ITN 2016-084-WG 39 • Attachment D7—Life Detailed Claims • Attachment D8—Life Premium Waiver • Attachment D9—Life Annual Premium(also includes enrollment and elections) QUESTIONNAIRES Please complete the Group Life Questionnaire in Attachment D2 and submit back in Excel format and hardcopy. Please do not copy/paste lengthy, generalized answers to the questions but create responses that are specific to this ITN. If you would like to submit additional information that is not easily submitted in Attachment D2, please include in your hardcopy ITN response. If you are unsure how to answer a specific question, please submit a clarification question to the City or ask the clarification question during the pre-proposal meeting. PLAN DESIGN The City requests that the current Group Term Life and AD&D plan designs be duplicated exactly in your ITN response. Please complete Attachment D3—Group Life Plan Design and submit back in Excel format and hardcopy. If improvements can be made to the Group Life plan without significant additional expense,the City will review any proposed enhances. But, at a minimum,the City requires an identical plan design and commensurate quote. Additional information regarding plan design and contractual requirements can be found in the following Attachments: • Attachment D4—Employee Life Booklet • Attachment D5—Retiree Life Booklet These Attachments should be reviewed carefully in order to provide a response that most closely matches the City's current Group Term Life and AD&D program arrangement, plan design, eligibility requirements, and contract. Failure to identify any area in which your proposal deviates from Attachments D3— D5 may result in unfavorable consideration during the Evaluation Phase. ITN 2016-084-WG 40 GROUP TERM LIFE PREMIUM AMOUNTS BY YEAR EXPERIENCE GROUP BENEFIT LEVEL 2013 2014 2015 ACTIVE EES LIFE $155,375 $156,180 $170,074 AD/D $4,633 $6,151 $6,848 SUPPLEMENTAL LIFE<25 $542 $500 $477 SUPPLEMENTAL LIFE 25-29 $4,134 $3,028 $4,100 SUPPLEMENTAL LIFE 30-34 $12,059 $9,376 $12,469 SUPPLEMENTAL LIFE 35-39 $18,049 $19,989 $21,852 SUPPLEMENTAL LIFE 40-44 $42,477 $42,192 $41,667 SUPPLEMENTAL LIFE 45-49 $72,986 $65,949 $68,811 SUPPLEMENTAL LIFE 50-54 $68,385 $109,123 $122,598 SUPPLEMENTAL LIFE 55-59 $30,369 $42,063 $55,112 SUPPLEMENTAL LIFE 60-64 $19,646 $27,508 $32,733 SUPPLEMENTAL LIFE 65-69 $19,718 $17,278 $11,116 SUPPLEMENTAL LIFE 70-74 $5,443 $13,078 SUPPLEMENTAL AD/D $22,442 $23,465 $26,139 CL 1 -$20 000 SPOUSE/$10 000 CHILD-ALL FTA EES $3,382 $3,870 $4,620 CL 1 -$20 000 SPOUSE/$10 000 CHILD-ALL OTHER FTA EES $0 CL 2-$30 000 SPOUSE/$10 000 CHILD-ALL FTA EES $1,215 $1,230 $1,488 CL 2-$30 000 SPOUSE/$10 000 CHILD-ALL OTHER FTA EES $0 CL 3-$40 000 SPOUSE/$10 000 CHILD-ALL FTA EES $1,024 $944 $1,008 CL 3-$40 000 SPOUSE/$10 000 CHILD-ALL OTHER FTA EES $0 CL 4-$50 000 SPOUSE/$10 000 CHILD-ALL FTA EES $8,930 $9,005 $9,970 CL 4-$50 000 SPOUSE/$10 000 CHILD-ALL OTHER FTA EES $0 ACTIVE EES Total $485,365 $543,294 $604,160 RETIREES LIFE $1,011 $1,004 $1,020 SUPPLEMENTAL LIFE $36,881 $35,100 $34,112 RETIREES Total $37,892 $36,104 $35,132 Grand Total $523,257 $579,398 $639,292 ITN 2016-084-WG 41 C3. Scope of Services and Implementation UNDERWRITING INFORMATION The City is seeking high quality, accessible provider networks that are sufficient to meet the multiple needs and geographic diversity of a group of approximately one thousand seven hundred thirty-nine (1,739) participating employees, retirees, COBRA participants, and their eligible dependents, including domestic partners. EFFECTIVE DATE The Plans proposed shall have an effective date of October 1, 2016,the start of the City's fiscal year. EMPLOYEE WAITING PERIOD FOR BENEFITS Ancillary Health Benefits are available to active employees after a 90-day waiting period of eligible employment. RATE GUARANTEES Any changes that would affect the rates, such as drastic enrollment changes, are to be included in the Price Proposal. PLAN YEAR The Plan Year shall be on a fiscal-year basis from October through September. Open Enrollment is held each year in August for an October 1st effective date. ELIGIBILITY For Plans A, B, C -All existing and enrolled full-time employees shall be eligible immediately for coverage. The City requires that all new hires be eligible on the 91St day of eligible employment. Activity-at-work clause must be waived for the initial enrollment period. For 401(a) participants in the disability program, ER Paid LTD, all existing and enrolled employees shall be eligible immediately for coverage. (This plan will not be enrolling any new members.) VERIFICATION OF COVERAGE The City's eligibility system will be the primary eligibility source. Coverage shall begin on the 91St day following eligible employment,and end on the last day of the month in which termination occurs. ITN 2016-084-WG 42 C3. Scope of Services and Implementation Continued SUMMARY REQUIREMENTS OF PLAN AND PLAN PROVIDERS a. The City prefers that the Bidder provide the pricing, rates and fees net of commissions and overrides. However, all pricing information provided should be offered in compliance with Florida Statutes requirements regarding broker fees and commissions. b. All COBRA recipients and their eligible dependents must be provided coverage in the new Plans, as of the effective date, and network availability shall include out-of-state providers if COBRA recipients reside out of Florida. c. All retirees and their eligible dependents must be provided coverage in the new Plans, as of the effective date, and network availability shall include out of state providers if retirees reside out of Florida. d. All out-of-area students of eligible Employees must be provided coverage in the new Plans, as of the effective date, and network availability must include out-of-state providers. e. Bidders must have in place at the time of Proposal submission an "employer" website for processing of enrollments, terminations, and changes throughout the term of the agreement. The website must be accessible by City employees to provide network provider listing, with search and filter capability, and be able to provide printed directories, as appropriate. f. Bidders shall have the ability to accept EDI transmission from the City's current online enrollment providers. g. The successful Bidder(s) shall provide Health Care Reform compliance updates to the City, including any impacts to cost,as they become available and apply to the Plan offerings. h. The successful Bidder shall agree to the Center for Medicare Services requirement of obtaining Social Security numbers on all dependents if applicable to the Plan offerings. i. The successful Bidder shall assume full fiduciary responsibilities for all claim decisions and for Level 1 and 2 appeals,and be responsible for coordinating any required external review. j. Bidders shall be capable of administering all HIPAA requirements, including employee and dependent notices and certificates. k. The successful Bidder shall develop and provide the standard reports to the City, without additional charges. Reports shall be broken out by active employees, retiree participants, COBRA participants and all covered dependents. I. The City and/or its Consultant, at their discretion, shall have the right to audit claims through either electronic methods or on-site inspection at least annually. It is understood that the Bidder shall make every effort to recover any over-payments in excess of $50 discovered during the audit process. ITN 2016-084-WG 43 C3. Scope of Services and Implementation Continued ENROLLMENT PROCESS, CUSTOMER SERVICE AND BILLING a. The successful Bidder shall assist in all plan communications during Open Enrollment for all products they have proposed. b. The successful Bidder shall provide sufficient, licensed, and properly trained staff for Open Enrollment meetings and other events. c. The successful Bidder shall make available representatives to coordinate with City staff during the initial and any future Open Enrolment periods and participation in multiple group information and planning meetings. d. The successful Bidder shall provide enrollment forms and perform verification on all dependent eligibility data prior to coverage taking effect,throughout the contract period. e. The City requires that all collateral materials be reviewed prior to distribution to employees. f. The successful Bidder shall provide approximately one thousand eight hundred (1,800) brochures for the Open Enrollment period, which is August of each year and an adequate supply throughout the year. No materials shall be distributed to employees without the prior approval of the City. g. The City requires that each employee enrolled receive an identification (ID) card, information on the plan they have chosen, and/or a certificate, within fifteen (15) days of their effective date. This information must be provided to each employee at no additional charge to the City. h. For Plans A, B, &C, the successful Bidder shall offer a toll-free services or claims office telephone number that covered members can access Customer Service during regular work days. i. The successful Bidder shall assist, if deemed necessary by the City, with the submission of paper claims, the payment of claims, written inquiries and complaints, or any other problems with the plans. j. For each Plan the successful Bidder shall assign a designated Account Representative to the City's account as a liaison between the City and Bidder, in the event of claim processing discrepancies. k. The designated Account Representative for each Plan (except for 401(a) LTD participants) shall visit the City on an agreed schedule, to meet with participating employees who have claim and or benefit questions. City employees shall have the opportunity to meet one-on-one with questions or concerns. I. The designated Account Representative shall have a back-up representative. m. The successful Bidder shall provide quality enrollment and informative materials that fully explain the benefits, limitations and exclusion of each plan to participants. Materials shall meet all requirements of the Affordable Care Act, and must be updated as needed. n. All uncontested claims shall be accurately processed within seventy-two(72)hours. C3. Scope of Services and Implementation Continued IMPLEMENTATION AND TRANSITION The successful Bidder(s) shall provide the City with a transition and implementation schedule, inclusive of written weekly project status updates. The transition and implementation must be completed at the agreed timeline based on the estimated schedule herein, and as finalized in the agreement. Any changes in the project timeline or implementation must be approved by the City. Any surcharges or additional costs involved in transition and implementation must be accounted for in the price Proposal. The City will not pay any additional charges for travel or other related expenses. ITN 2016-084-WG 44 APPENDIX D � M Special Conditions Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage 2016-084-WG PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 ITN 2016-084-WG 45 1. TERM OF CONTRACT. The term of the agreement(s) shall commence upon final execution of the agreement(s),and shall be effective for three(3)years. 2. OPTION TO RENEW. The City, through its City Manager, will have the option to extend for two (2) additional one-year periods subject to the availability of funds for succeeding fiscal years. Continuation of the contract beyond the initial period is a City prerogative; not a right of the bidder. This prerogative will be exercised only when such continuation is clearly in the best interest of the City. ITN 2016-084-WG 46 APPENDIX E AlA AA lit I t—Ati \st "fr. r Cost Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage 2016-084-WG PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 ITN 2016-084-WG 47 APPENDIX E PLAN A - DENTAL COST PROPOSAL FORM Failure to submit Appendix E,Cost Proposal Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in Proposal being deemed non-responsive and being rejected. Bidder affirms that the prices stated on the cost proposal form below represents the entire cost of the items in full accordance with the requirements of this ITN, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Cost Proposal Form (Tab 5)shall be completed mechanically or, if manually, in ink. Cost Proposal Form (Tab 5) completed in pencil shall be deemed non-responsive. All corrections on the Cost Proposal Form(Tab 5)shall be initialed. Vendor Name DHMO Plan Design Name DHMO Enrollment Fully-Insured Rates Employee Only 487 $0.00 Employee+1 157 $0.00 Employee FAM 241 $0.00 Total DHMO Enrollment I Expense 885 $0 DPPO-ASO Fee Enrollment DPPO ASO Fee Administrative Services Only Fee(PEPM) 1447 $0.00 Total DPPO Administrative Expense 1447 $0 DPPO- Paid Claims Repricing Enrollment Repriced Claims in Totals Repricing from DPPO Claims File 1447 $0.00 Total Expected Dental Program Expense 2332 $0 1Please enter the total value of repriced allowed claims without member copay I cost share from the PPO claims file provided. Repricing files will be scrutinized so make sure they have been verified for accuracy. Bidder's Affirmation Company: Authorized Representative: Address: Telephone: Email: Authorized Representative's Signature: ITN 2016-084-WG 48 APPENDIX E PLAN B - DISABILITY AND FMLA COST PROPOSAL FORM Failure to submit Appendix E,Cost Proposal Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in Proposal being deemed non-responsive and being rejected. Bidder affirms that the prices stated on the cost proposal form below represents the entire cost of the items in full accordance with the requirements of this ITN, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance.The Cost Proposal Form(Tab 5)shall be completed mechanically or, if manually, in ink. Cost Proposal Form (Tab 5) completed in pencil shall be deemed non-responsive. All corrections on the Cost Proposal Form(Tab 5)shall be initialed. Carrier Name Premium Voluntary Short-Term Disability Annual Cost .$0.00 Voluntary Long-Term Disability Annual Cost $0.00 Employer Paid Long-Term Disability Annual Cost $0.00 Family and Medical Leave Act Administration Annual Cost $0.00 TOTAL ANNUAL PREMIUM AND/OR EXPENSE $0.00 Confirm or Explain Deviations Please confirm that the premium amounts above represent and replicate or expand current benefits. If they do not, please explain the deviations. Please confirm that the premium amounts above represent and replicate current eligibility criteria. If they do not, please explain the deviations. Please confirm that your quote includes pricing for a "true open enrollment" meaning that all actively-at-work employees may elect short- term disability or long-term disability without evidence of insurability and without participating group disability program in the previous plan year. If your quote does not, please explain what type of open enrollment it contemplates. Please confirm that the premium amounts above represent a quote that has actively-at-work provisions waived for existing enrollees. If they do not, please explain your quote's actively-at-work limitations. Please confirm that the premium amounts above are inclusive of all costs required to administer, communicate, manage, and pay benefits from the group disability and FMLA administration program. If they do not, please explain the additional costs not contemplated in premium or fixed expenses. Bidder's Affirmation Company: Authorized Representative: Address: Telephone: Email: Authorized Representative's Signature: ITN 2016-084-WG 49 APPENDIX E PLAN C - TERM LIFE AND AD&D COST PROPOSAL FORM Failure to submit Appendix E,Cost Proposal Form, in its entirety and fully executed by the deadline established for the receipt of proposals will result in Proposal being deemed non-responsive and being rejected. Bidder affirms that the prices stated on the cost proposal form below represents the entire cost of the items in full accordance with the requirements of this ITN, inclusive of its terms, conditions, specifications and other requirements stated herein, and that no claim will be made on account of any increase in wage scales, material prices, delivery delays, taxes, insurance, cost indexes or any other unless a cost escalation provision is allowed herein and has been exercised by the City Manager in advance. The Cost Proposal Form (Tab 5) shall be completed mechanically or, if manually, in ink. Cost Proposal Form (Tab 5) completed in pencil shall be deemed non-responsive.All corrections on the Cost Proposal Form (Tab 5) shall be initialed. Carrier Name Premium Active Employee Basic Life Premium $0.00 Active Employee AD&D Premium $0.00 Active Employee Supplemental Life+Supplemental AD&D Premium $0.00 Active Employee Dependent Life Premium $0.00 Retiree Basic Life Premium $0.00 Retiree Supplemental Life Premium $0.00 TOTAL ANNUAL PREMIUM $0.00 Confirm or Explain Deviations Please confirm that the premium amounts above represent and replicate or expand current benefits. If they do not, please explain the deviations. Please confirm that the premium amounts above represent and replicate current eligibility criteria. If they do not, please explain the deviations. Please confirm that the premium amounts above represent and replicate current guaranteed issuance amounts. If they do not, please explain the deviations. Please confirm that your quote includes pricing for a"true open enrollment" meaning that all actively-at-work employees may elect life insurance amounts at the guaranteed issuance amount or lower without evidence of insurability and without participating in the Supplemental or Dependent Life programs in the previous plan year. If your quote does not, please explain what type of open enrollment it contemplates. Please confirm that the premium amounts above represent a quote that has actively- at-work provisions waived for existing enrollees. If they do not, please explain your quote's actively-at-work limitations. Please confirm that the premium amounts above are inclusive of all costs required to administer, communicate, manage, and pay benefits from the group life program. If they do not, please explain the additional costs not contemplated in premium. Bidder's Affirmation Company: Authorized Representative: Address: Telephone: Email: Authorized Representative's Signature: ITN 2016-084-WG 50 APPENDIX F m Al , MEBEACH Insurance Requirements Administration of the City's Ancillary Health Benefits for Employees, Retirees and Their Dependents - Family and Medical Leave Act (FMLA) Administration; Long-Term Disability Coverage for Defined Contribution Retirement Plan (401a) Participants, and Voluntary Short-Term and Long-Term Disability; Group Dental Coverage; and Group Term Life and Accidental Death & Dismemberment Coverage 2016-084-WG PROCUREMENT DEPARTMENT 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 ITN 201 6-084-WG 51 161 NA I A AA I B EAC H PROFESSIONAL SERVICES Before beginning any work, and throughout the term of the contract(including renewal periods), the Provider shall indicate that insurance coverage has been obtained which meets the requirements as outlined below: A. Worker's Compensation for all employees of the provider as required by Florida Statute 440, and Employer's Liability Insurance in an amount not less than$1,000,000. B. Commercial General Liability on a comprehensive basis in an amount not less than $1,000,000 combined single limit per occurrence, for bodily injury and property damage. City of Miami Beach must be shown as an additional insured with respect to this coverage. C. Automobile Liability Insurance covering all owned, non-owned and hired vehicles used in connection with the work, in an amount not less than $1,000,000 combined single limit per occurrence for bodily injury and property damage. D. Professional Liability Insurance in an amount not less than$1,000,000. The insurance coverage required above must include a waiver of subrogation in favor of the City. The insurance coverage required shall include those classifications, as listed in standard liability insurance manuals,which most nearly reflect the operations of the provider. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida,with the following qualifications: The company must be rated no less than "B+" as to management, and no less than "Class VI" as to financial strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey,or its equivalent,subject to the approval of the City Risk Management Division. CERTIFICATE HOLDER MUST READ: CITY OF MIAMI BEACH 1700 CONVENTION CENTER DRIVE 3rd FLOOR MIAMI BEACH, FL 33139 Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. ITN 2016-084-WG 52