Table Of Content(cid:2)
ORIGINAL
PROPOSAL
Managed Care for Workers’ Compensation
RFP NO.: 10034532-14-L
City of San Diego
Presented by:
John Casey, National Account Manager
October 9, 2013
1
GGENEX Services, Inc.
440 East Swedesford Road
Suite 1000
Wayne, PA 19087
610-964-5100(cid:2) Fax: 610-964-1919
www.genexservices.com
These documents contain proprietary, copyrighted, and other confidential information pertaining to GENEX. No distribution or duplication is
permitted without the express written consent of GENEX, or as defined in any agreement between GENEX and the receiving party.
TTable of Contents
Tab A – Representations and Certifications
1. Contractor’s Cover Sheet ................................................................................................................................................................................. 1
2. Pre-Award Survey Documents ........................................................................................................................................................................ 3
3. Certification Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters .................................... 7
4. Declaration Regarding Information Requested Under The California Public Records Act ................................................................... 9
5. Proof of Insurance .......................................................................................................................................................................................... 11
6. Criminal Background Certification ............................................................................................................................................................... 13
7. Affidavit For Contractor/Vendor .................................................................................................................................................................. 15
8. Conflict of Interest Disclosure Statement ................................................................................................................................................... 17
9. Drug-Free Workplace ...................................................................................................................................................................................... 19
10. Equal Benefits Ordinance .............................................................................................................................................................................. 23
11. Contractor Standards Pledge of Compliance ............................................................................................................................................. 25
12. American with Disabilities Act (ADA) Compliance Certification .............................................................................................................. 31
Tab B – Executive Summary and Response to Scope of Services
Executive Summary .................................................................................................................................................................................................. 1
Exceptions to RFP ..................................................................................................................................................................................................... 3
Section C – Scope of Services ................................................................................................................................................................................. 5
C.01 Background........................................................................................................................................................................................................... 5
C.02 Objective ............................................................................................................................................................................................................... 6
C.03 Scope Of Work and Response ........................................................................................................................................................................... 6
C.04 Implementation/Fully Operational ................................................................................................................................................................... 7
C.05 City’s Claims Management System .................................................................................................................................................................. 7
C.06 Proposer’s System(S) Requirements ................................................................................................................................................................ 7
C.07 Core Requirements And Deliverable ..............................................................................................................................................................1 0
C.08 Audit For Overpayments And Unpaid Bills .....................................................................................................................................................4 1
C.09 Training ................................................................................................................................................................................................................4 1
C.10 Cooperative Work Environment.......................................................................................................................................................................4 2
C.11 Ongoing Coordination/Status Meetings.........................................................................................................................................................4 2
C.12 Transportation ....................................................................................................................................................................................................4 2
C.13 Customer Service ...............................................................................................................................................................................................4 2
C.14 Cooperation And Transition..............................................................................................................................................................................4 3
C.15 Qualifications And Experience .........................................................................................................................................................................4 3
Attachments ................................................................................................................................................................................................... 51 - 394
Tab C – Cost/Price Proposal .................................................................................................................................................................................................... 1
Tab D – Equal Employment Opportunity (EEO) Policy and Forms and Subcontracting Plan ...................................................... 1
Work Force Report .................................................................................................................................................................................................. 11
Tab E – Signed Contract
Section A – Signature Page ..................................................................................................................................................................................... 1
Section B – Price Schedule ...................................................................................................................................................................................... 3
Section C – Scope Of Services, with Proposal Response ................................................................................................................................... 9
Section D – Packaging and Marking ..................................................................................................................................................................403
Section E – Inspection and Acceptance ............................................................................................................................................................405
Section F – Deliveries or Performance ..............................................................................................................................................................407
Section G – Contract Administration .................................................................................................................................................................409
Section H – Special Contract Requirements ....................................................................................................................................................411
Section I – General Contract Clauses ................................................................................................................................................................413
Section J – List of Attachments, Exhibits, or Appendices ...............................................................................................................................433
These documents contain proprietary, copyrighted, and other confidential information pertaining to GENEX. No distribution or duplication is
permitted without the express written consent of GENEX, or as defined in any agreement between GENEX and the receiving party.
(cid:3)(cid:4)(cid:5)(cid:2)(cid:6)(cid:7)(cid:8)(cid:2)(cid:9)(cid:10)(cid:10)(cid:11)(cid:12)(cid:13)(cid:11)(cid:14)(cid:15)(cid:9)(cid:12)(cid:15)(cid:16)(cid:2)
TT A
AB
R C
EPRESENTATIONS AND ERTIFICATIONS
These documents contain proprietary, copyrighted, and other confidential information pertaining to GENEX. No distribution or duplication is
permitted without the express written consent of GENEX, or as defined in any agreement between GENEX and the receiving party.
(cid:3)(cid:4)(cid:5)(cid:2)(cid:6)(cid:7)(cid:8)(cid:2)(cid:9)(cid:10)(cid:10)(cid:11)(cid:12)(cid:13)(cid:11)(cid:14)(cid:15)(cid:9)(cid:12)(cid:15)(cid:16)(cid:2)
(cid:2)(cid:3) (cid:4)(cid:5)(cid:6)(cid:7)(cid:8)(cid:9)(cid:10)(cid:7)(cid:5)(cid:8)(cid:11)(cid:12)(cid:13)(cid:4)(cid:5)(cid:14)(cid:15)(cid:8)(cid:13)(cid:16)(cid:17)(cid:15)(cid:15)(cid:7)(cid:13)
Legal Status of Contractor:
1. Name of Firm: GENEX Services, Inc.
2. Type of Business: The Bidder represents as part of its offer that it operates as (Mark
one with an ‘X’) An Individual ; A Corporation X ; Partnership or Joint
Venture . (If a Joint Venture, provide information for each party to the joint
venture when answering items 3-7 below.)
a. If incorporated, existing under the laws of the State of: Pennsylvania .
b. Date of incorporation: _ October 23, 1978 .
c. The ID Number/Registration Number assigned to your Corporation or Limited
Partnership by the State named above: 95-3327434 . Data Universal
Numbering System (DUN & BRADSTREET) Number: 09-684-3842 .
d. Office which will be responsible for providing the City of San Diego the specified
services:
Address: 888 S. Disneyland Drive
Anaheim, CA 92802
Contact Person/Telephone Number: 925-947-1371 Fax Number: 610-964-1919
Email: [email protected]
5. Name, title, and signature of individual duly authorized as representative to execute
contracts:
Name: John Casey
Title: National Account Executive
Signature:
6. The undersigned understands that the City of San Diego reserves the right to reject any
and all solicitation and to waive informalities and irregularities if there’s a mistake in the
offer.
7a. The undersigned further understands that the contents within this solicitation will become
a part of the Contract when awarded to the above named Propose Firm.
7b. My signature below certifies that the proposal as submitted complies with all terms and
conditions as set forth within the Request for Proposal.
These documents contain proprietary, copyrighted, and other confidential information pertaining to GENEX. No distribution or duplication is
permitted without the express written consent of GENEX, or as defined in any agreement between GENEX and the receiving party.
1
(cid:3)(cid:4)(cid:5)(cid:2)(cid:6)(cid:7)(cid:8)(cid:2)(cid:9)(cid:10)(cid:10)(cid:11)(cid:12)(cid:13)(cid:11)(cid:14)(cid:15)(cid:9)(cid:12)(cid:15)(cid:16)(cid:2)
7c. My signature also certifies that the accompanying solicitation is not the result of, or
affected by, any unlawful act of collusion with another person or company engaged in
the same line of business, or any act of fraud. Furthermore, I understand that fraud and
unlawful collusion are crimes under Federal Law, and can result in fines and/or civil
damage awards.
I, hereby certify that I am a duly authorized representative of the forenamed Firm and
have the authority to enter an agreement if so awarded by the City of San Diego:
Authorized Representative Signature:
Printed Name: Stan Jakubowski
Position: Sr. Vice President, Sales and Marketing
Dated this 10th day of September , 20 13 .
These documents contain proprietary, copyrighted, and other confidential information pertaining to GENEX. No distribution or duplication is
permitted without the express written consent of GENEX, or as defined in any agreement between GENEX and the receiving party.
2
Description:run at a later date may c ontain updated re s u lts bas ed on re considerations and appeals. P. A. % on In itial R e v iew s. % of In itial Denials. A ppealed. % of A ppeals Upheld. % of A ppeals Ov ertu rned. N e t S a Preventive Medicine, Pulmonary. Medicine. Ackroyd, Archie M., OD. 7307A Claire
