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					     Jeffererson Parish Government SOQ




Jefferson Parish Government




Statement of Qualifications

Benefits Enroller




Submitted By:


Jefferson Parish Government



February, 2012
       Jeffererson Parish Government SOQ




                                           Table of Contents



Introduction                                        Page 2

Due Date for Proposals                              Page 2

Documents Required                                  Pages 3

Timetable                                           Page 4

Enrollment Firm Questionnaire                       Pages 6

Scope of Services, Health Information               Follows Page 7
Privacy Associate Agreement for Benefits
Enroller, Required Contract Terms,
Affidavits
        Jeffererson Parish Government SOQ


Introduction

The Jefferson Parish Government (JPG) wishes to obtain from qualified organizations proposals
to provide both employee electronic benefits open and perpetual, (monthly) enrollment services
offering employee paid voluntary worksite benefits to employees and their dependents for
cancer, short term disability, critical illness, accident insurance, long term disability, hospital
confinement indemnity insurance, voluntary life, accidental death and dismemberment. The
enrollment will occur in mid to late May, 2012 and possible subsequent enrollments in the future.
The individual(s)/firm(s) selected shall provide computer enrollment and verification services, at no
cost to the Parish, to all benefit plan participants. In addition the firm shall be licensed to sell the
following insurance products: cancer, short-term disability, accidental death and dismemberment,
critical illness, accident insurance, long-term disability, hospital confinement indemnity
insurance and voluntary life and be knowledgeable about the voluntary products so that its
enrollment team may assist the participants in selecting products appropriate to them and their
families.
A separate Statement of Qualifications (SOQ) for voluntary worksite insurance products is also
being advertised at this time. A separate request for proposal is being sent to voluntary worksite
carriers for their benefit designs, rate, commissions, etc. (refer to page 7).

Please note that existing worksite benefits products might continue to be payroll deducted. This
does not represent a complete list.

JPG consists of approximately thirty departments providing services for the citizens of Jefferson
Parish. Included in the employee benefit plans are employees of the 24th District Courts, Juvenile
Courts, two Parish Municipal Courts, and the District Attorneys Office. JPG has approximately
3400 active employees. Other agencies may be added at the discretion of JPG.

Proposal Specifications
Due Date For Proposals

All proposals and materials must be submitted at one time.               Proposals missing required
information may be rejected.

Submit one signed original and sixteen (16) proposals, including the signed Professional Services
Questionnaire, Scope of Services, Health Information Privacy Associate Agreement for Benefits
Enroller, Agreement, Questionnaire and notarized Affidavits. Proposals are to be submitted to
the attention of the Council Clerk, Ms. Eula Lopez, at the following address by 4:30 p.m. on
March 15, 2012:

Clerk of Council
Ms. Eula A. Lopez
200 Derbigny St., Room 6700
Gretna, LA 70053
504-364-2626




                                                          2
        Jeffererson Parish Government SOQ

DOCUMENTS REQUIRED

The following are to be included in the proposal package, (the original documents with
signatures must be identified separately required to be signed and included in your
proposal package:

    1. Completed Enrollment Firm Questionnaire.

    2   Signed Scope of Services.

    3. Signed Health Information Privacy Associate Agreement for Benefits Enroller.
    4. Required Contract Terms.

    5. Signed NON-COLLUSION; CAMPAIGN CONTRIBUTION; SUB-CONTRACTOR &
       EMPLOYMENT STATUS VERIFICATION AFFIDAVITS – 1 set of originals,
       notarized. Please provide the original affidavits in a separate identified envelope.

    6. Signed Professional Services Questionnaire

    7. References

    8. Financial Statement

The preferred method of response is by submitting proposals in a spiraled or bound binder
with appropriate tabs. Please include a CD with your proposal.


Any exceptions to the terms, conditions, or other requirements in any part of this Statement of
Qualifications (SOQ) must be clearly identified within your proposal. Otherwise, it will be
considered that all items offered are in strict compliance with the SOQ, and the successful
organization will be responsible for compliance. JPG will consider such exceptions as part of the
evaluation process and variations may constitute grounds for rejection of the proposal.

The proposals submitted in response to this request shall be considered the only submission;
revised proposals shall not be allowed after the proposal return date unless requested by JPG.
Any and all data contained in this SOQ is considered proprietary and confidential.

JPG cannot require employees to attend enrollment/benefit meetings or meet with a benefit
counselor. However, JPG will provide its fullest cooperation in communicating the value of the
benefits being offered and make available time and space to meet with employees.

Effective Date
The effective date of all new policies, service contracts or other insuring agreements will be July
1, 2012




                                                       3
        Jeffererson Parish Government SOQ

Timetable

In order to be considered, each bidder must be capable of meeting the following schedule,
although the schedule may be subject to change:

         Action                                       Target Date

         SOQ Released to Carriers                     February 23, 2012

         Proposal Submitted to JPG                    March 15, 2012

         Selected Organization Notified               April 18, 2012

         Successful Organization Ratified             May 9, 2012

         Effective Date for Benefits                  July 1, 2012



Time for Acceptance

All proposals shall be considered valid for acceptance until such time an award is made, unless
the proposer provides for a different time period within its proposal response. JPG reserves the
right to reject a proposal if the proposer’s response is unacceptable and the proposer is unwilling
to extend the validity of its proposal.

Award of the contract may be made without discussions after proposals are received and
evaluated. Proposals should, therefore, be submitted on the most favorable terms which the
proposer can provide. If the evaluation committee determines that discussions are necessary,
written submissions or oral discussions may be requested.

Additional Information

Any questions regarding this SOQ should be directed to Mr. Aubrey DeVillier, Benefits
Administrator, and JPG no later than March 1, 2012. Any questions regarding these
specifications and/or requests for additional information must be in writing. Email
(adevillier@jeffparish.net) is the preferred method of communication. Substantive questions and
answers will be shared with all respondents.


Evaluation Criteria                                        Total 100 Points

(1) Professional training and experience both generally and in relation to the type and
magnitude of work required for the particular project, with demonstrated strong customer
support, and demonstrated experience electronically enrolling large groups (maximum of 20
points);
(2) Capacity for timely completion of the work, taking into consideration the person's or firm's
current and projected workload and professional and support manpower (maximum of 15 points);
(3) Implementation plan, including proposed schedule, number of enrollers, etc. (maximum 15
points);
(4) Past and current accomplishments, for which references from clients or former clients and
information gathered by inspection of current or recent projects may be considered (maximum of
                                                       4
       Jeffererson Parish Government SOQ

15 points);
(5) Past performance by the person or firm on contracts, including any problems with time
delays, cost overruns, and/or inadequacies in prior projects (maximum of 15 points);
(6) System compatibility with existing JPG software (maximum of 10 points);
(7) Financial strength (maximum 10 points).




                                                 5
       Jeffererson Parish Government SOQ


Enrollment Firm Questionnaire

   1. Name and address of parent company.

   2. Name and address of local office.

   3. Is your company a wholly-owned subsidiary or a division of another company? If so,
      please identify the company name and address.

   4. How many groups are currently being served nationally and in Louisiana? How many
      employers with over 3000 employees if any are currently being served?

   5. How long has your company been in business?

   6. What is the AM best rating for each carrier you are offering?

   7. What is the office 1-800 number?

   8. Where is your customer service office located?

   9. What is the size of your local staff?

   10. Provide a resume for each key employee and enrollment team member in your
       organization who will be handling our account.

   11. List three references of over 3000 employees, including government employees, if any
       who you administer the health plan. Please provide employer, contact, address and phone
       number of references.

   12. Are you able to service various locations throughout the Parish with a person with a
       laptop during the electronic open enrollment process?

   13. List the electronic enrollment platform(s) you plan on using:
Member Services

   14. What are your weekday and weekend hours of telephone member services availability?

   15. For the above-mentioned member services location, what was the 2011 telephone
       average speed of answer?
               Member Line
   16. What is your Website address and what member information can be accessed from the
       Website?




                                                     6
        Jeffererson Parish Government SOQ


Basis of Quotation

Please note that the following completed documents must accompany the proposal: Enrollment
Firm Questionnaire, Professional Service Questionnaire, Scope of Services, Health Information
Privacy Associate Agreement for Benefits Enroller, and four Affidavits which are to be signed by
a duly authorized officer of your company and notarized. All information presented in this SOQ,
as well as information disclosed during the procurement process, is to be considered strictly
confidential, as allowed by law.

JPG reserves the right to choose its vendor relationships based on its own needs and criteria.
Vendors that do not submit information as required by this SOQ may not be evaluated.

Supplemental Benefits will be enrolled mid to late May, 2012 and thereafter an annual
enrollment period for employees will occur in October and November.

List of Carriers: (other carriers are encouraged to respond)
The following is a list of voluntary worksite insurance carriers who will be actively solicited to
respond to an SOQ requesting plan designs, premiums and commissions for JPG. Please identify
any carrier with whom you will not be able work with in this project.
AFLAC                                       HUMANA

AIG                                         ING

ALLSTATE                                    LINCOLN FINANCIAL

ALWAYSCARE                                  METLIFE

AMERICAN GENERAL                            PRINCIPAL

ASSURANT                                    PRUDENTIAL

CIGNA                                       THE STANDARD

COLONIAL                                    SUNLIFE

GUARDIAN                                    TRANSAMERICA

HARTFORD




                                                        7
        Jeffererson Parish Government SOQ


                                        SCOPE OF SERVICES
Upon review and approval of the Insurance Advisory and Coordinating Committee’s
recommendation for award by Jefferson Parish Council, a Notice of Intent to Award letter to the
apparent successful Proposer will be issued. This letter cannot be a guarantee until the Parish
Council has ratified the recommendations.

Provide all annual and perpetual, (monthly) enrollment services to include but not be limited to
the costs for enrollers, enrollment systems, communication materials, submission of enrollment
information to the carries and to JPG, etc. at no cost to JPG. List any services for which you will
not provide:

Provide a minimum number of enrollers sufficient to meet with all eligible employees during
open enrollment time in May 15-31, 2012. There may be a need to do a separate enrollment in
the Fall of 2012 for the Core Benefits.

Perform all work necessary to electronically enroll 3400 employees. This includes but not limited
to: accessing the Parish web site, recording the employee’s benefits selections, and provide a
printed copy of the elections to the employee and to the department benefits coordinator.

Schedule all employees to meet with an assigned enroller during the enrollment period by
coordinating with approximately 60 Department Benefits Coordinators.

Host a training session for enrollers, conducted by JPG, prior to the enrollment period.

Attend planning meetings as necessary with JPG.

Attend several meetings with the Benefits Coordinators, reviewing any necessary topics with
them.

Assign a point of contact and backup for JPG.

Handle all questions, concerns and claim issues from employees regarding the supplemental
plans.

Manage all aspects of all benefit plans provided.

Perform all communication and administrative services necessary to enroll employees in all
supplemental plans offered.

Distribute necessary documents to employees during open enrollment.

With the exception of the CIGNA accidental death and dismemberment plan (there will be no
commissions paid for accidental death and dismemberment), agree to accept the standard
commissions paid by each selected carrier as full compensation for performing all duties as
outlined above.
        Jeffererson Parish Government SOQ



There has been no work performed by any person of this firm which resulted in litigation
between the public entity and the person or firm performing professional services, including but
not limited to ongoing litigation with a public entity or involvement in litigation with a public
entity in which the public entity prevailed.

Terms and conditions, above, agreed to by:




Signature/Title_______________________________          Date _________________
      Jeffererson Parish Government SOQ



HEALTH INFORMATION PRIVACY                Agreement to the Arrangement in
  ASSOCIATE AGREEMENT FOR                 order to enable JEFFERSON
     BENEFITS ENROLLER                    PARISH to satisfy its obligations
This Health Information Privacy           under the Privacy Standards.
Business Associate Agreement (this          NOW, THEREFORE, for and in
“Business Associate Agreement”) is        consideration of the mutual promises
made as of ______________2012,            herein contained and other good and
by and between JEFFERSON                  valuable consideration, the receipt
PARISH and (“BUSINESS                     and sufficiency of which are hereby
ASSOCIATE”).                              acknowledged, the parties hereto
                RECITALS:                 agree as follows:
  A. JEFFERSON PARISH and                 I.    DEFINITIONS.
BUSINESS ASSOCIATE have                     Capitalized terms used in this
entered into an arrangement or            Business Associate Agreement and
arrangements pursuant to which            not otherwise defined herein shall
BUSINESS ASSOCIATE provides               have that meaning given to them in
certain services for and on behalf of     the Privacy Standards.
JEFFERSON PARISH (the
“Arrangement”).                             USE AND DISCLOSURE OF
                                          II.
                                          PROTECTED HEALTH
  B. To enable BUSINESS                   INFORMATION BY BUSINESS
ASSOCIATE to carry out its                ASSOCIATE.
obligations under the Arrangement,
JEFFERSON PARISH discloses to             2.1Confidentiality.       BUSINESS
BUSINESS ASSOCIATE, and/or                ASSOCIATE shall hold Protected
BUSINESS ASSOCIATE creates                Health Information confidentially,
and receives on behalf of                 and shall not Use or Disclose it other
JEFFERSON PARISH, Individually            than as permitted or required by this
Identifiable Health Information, as       Business Associate Agreement or as
such term is defined in 45 C.F.R.         Required by Law.
Parts 160 and 164 (the “Privacy           2.2  Use or Disclosure to Provide
Standards”). Such information is          Services under the Arrangement.
referred to herein as “Protected          BUSINESS ASSOCIATE may Use
Health Information.”                      and Disclose Protected Health
  C. The Privacy Standards obligate       Information as necessary to perform
JEFFERSON PARISH to enter into a          its     obligations    under      the
contract with BUSINESS                    Arrangement; provided however that
ASSOCIATE in order to ensure that         BUSINESS ASSOCIATE shall not,
BUSINESS ASSOCIATE                        and shall ensure that its directors,
appropriately safeguards the              officers, employees, contractors and
Protected Health Information.             agents (the “Representatives”) do
                                          not, Use or Disclose Protected
 D. JEFFERSON PARISH and                  Health Information in any manner
BUSINESS ASSOCIATE desire to              that would violate: (i) the Privacy
make this Business Associate              Standards, as amended from time to
       Jeffererson Parish Government SOQ

time, if done by JEFFERSON                 under this Business Associate
PARISH; (ii) or any other applicable       Agreement and will only be Used or
law, rule, regulation, interpretation or   Disclosed as Required by Law or for
order of any governmental entity.          the purposes for which it was
                                           Disclosed to the third party; and (ii)
2.3 Use or Disclosure for BUSINESS
                                           the third party will immediately notify
ASSOCIATE’ Management and
                                           BUSINESS ASSOCIATE of any
Administration.        Notwithstanding
                                           instances of which it is aware in
Section 2.2 above, BUSINESS
                                           which the confidentiality of the
ASSOCIATE may Use or Disclose
                                           Protected       Health    Information
Protected Health Information for its
                                           Disclosed to it has been breached.
proper          management          and
administration provided that, before       2.4 Use or Disclosure to Provide
Disclosing       Protected        Health   Data      Aggregation      Services.
Information to a third party for           BUSINESS ASSOCIATE may Use or
BUSINESS ASSOCIATE’S proper                Disclose      Protected       Health
management and administration,             Information    to   provide     Data
BUSINESS         ASSOCIATE         must    Aggregation services relating to the
obtain reasonable assurances from          Health     Care    Operations     of
the third party that: (i) the Protected    JEFFERSON PARISH.
Health Information will be held            2.5De-Identification of Protected
confidentially and subject to the          Health Information.    BUSINESS
same restrictions and conditions that      ASSOCIATE may de-identify any
apply to BUSINESS ASSOCIATE
2.6and      all    Protected      Health   forth in this Section, the conditions
Information provided that the de-          and restrictions contained herein on
identification    conforms     to    the   BUSINESS ASSOCIATE’S Use and
requirements       of    the    Privacy    Disclosure of Protected Health
Standards.             The       parties   Information apply to BUSINESS
acknowledge and agree that de-             ASSOCIATE’S Use and Disclosure
identified data does not constitute        of Protected Health Information
Protected Health Information and is        contained in such Limited Data Sets.
not subject to the terms of this           Further, BUSINESS ASSOCIATE
Business Associate Agreement.              agrees that it shall not identify the
                                           information contained in such
2.7  Use and Disclosure of Limited
                                           Limited Data Sets or contact the
Data Sets. BUSINESS ASSOCIATE
                                           Individuals who are the subject of
may      Use    Protected     Health
                                           the Protected Health Information
Information to create Limited Data
                                           contained in such Limited Data Sets,
Sets and may Use or Disclose such
                                           except as otherwise permitted or
Limited Data Sets for only research,
                                           required by this Business Associate
public health or health care
                                           Agreement.
operations purposes. Except as set
III. RESPONSIBILITIES OF                   ASSOCIATE agrees that it will
BUSINESS ASSOCIATE.                        implement appropriate safeguards to
                                           prevent the Use or Disclosure of
3.1 Safeguards Against Misuse of
                                           Protected Health Information other
Information.           BUSINESS
                                           than pursuant to the terms and
       Jeffererson Parish Government SOQ

conditions of this Business Associate      such access within ten (10) days of
Agreement.                                 receiving such request.
3.2 Reporting      Disclosures       of    3.5 Availability of Protected Health
Protected      Health     Information.     Information        for    Amendment.
BUSINESS        ASSOCIATE        shall,    BUSINESS         ASSOCIATE        shall
within three (3) days of becoming          promptly make any amendment to
aware of a Disclosure of Protected         Protected       Health     Information
Health Information in violation of this    maintained in a Designated Record
Business Associate Agreement by            Set by BUSINESS ASSOCIATE that
BUSINESS ASSOCIATE or its                  is requested by JEFFERSON
Representatives,      report     such      PARISH, or as directed by
Disclosure to JEFFERSON PARISH.            JEFFERSON PARISH, that is
BUSINESS ASSOCIATE agrees to               requested       by     an   Individual.
have procedures in place for               BUSINESS ASSOCIATE shall use
mitigating, to the extent practicable,     its best efforts to make such
any harmful effect known to                amendments within twenty (20) days
BUSINESS ASSOCIATE and arising             of receiving such request.
from such Use or Disclosure.               3.6 Accounting     of     Disclosures.
3.3 Agreements by Third Parties.           BUSINESS       ASSOCIATE         shall
BUSINESS ASSOCIATE shall enter             document such Disclosures of
into an agreement with any agent or        Protected Health Information and
subcontractor that will have access        information    related     to    such
to Protected Health Information            Disclosures as would be required for
pursuant to which such agent or            JEFFERSON PARISH to respond to
contractor agrees to be bound by the       a request by an Individual for an
same restrictions, terms, and              accounting    of     Disclosures    of
conditions of this Business Associate      Protected Health Information in
Agreement that apply to BUSINESS           accordance      with     45     C.F.R.
ASSOCIATE with respect to such             § 164.528.
Protected Health Information.                BUSINESS ASSOCIATE shall
3.4 Access        to      Information.     promptly provide to JEFFERSON
BUSINESS        ASSOCIATE        shall     PARISH or, as directed by
promptly provide access, at the            JEFFERSON PARISH, to an
request of JEFFERSON PARISH or             Individual, information collected in
an Individual, to Protected Health         accordance with the preceding
Information        maintained       by     paragraph to permit JEFFERSON
BUSINESS ASSOCIATE in a                    PARISH to respond to a request by
Designated Record Set(s), to               an Individual for an accounting of
JEFFERSON         PARISH,     or    as     Disclosures of Protected Health
directed by JEFFERSON PARISH,              Information in accordance with 45
to an Individual in order to meet the      C.F.R. § 164.528. BUSINESS
requirements       of    45    C.F.R.      ASSOCIATE shall use its best
§ 164.524. BUSINESS ASSOCIATE              efforts to provide such information
shall use its best efforts to provide      within twenty (20) days of receiving
                                           such written request.
       Jeffererson Parish Government SOQ

                                            the cost of supplies for and labor of
                                            copying, the requested Protected
3.7 Uses and Disclosures Required
                                            Health Information; the cost of
by Law.      Except to the extent
                                            postage,         when          BUSINESS
prohibited by law, BUSINESS
                                            ASSOCIATE has been asked to mail
ASSOCIATE shall immediately notify
                                            copies; and the cost of preparing an
JEFFERSON PARISH upon its
                                            explanation or summary of the
receipt of a request for Use or
                                            requested         Protected         Health
Disclosure of Protected Health
                                            Information, if agreed to by the
Information with which BUSINESS
                                            Individual as required under 45
ASSOCIATE believes it is required
                                            C.F.R.         §         164.524(c)(2)(ii).
by Law to comply.           BUSINESS
                                            BUSINESS ASSOCIATE may also
ASSOCIATE           shall      provide
                                            impose at its sole option a fee on
JEFFERSON PARISH with a copy of
                                            JEFFERSON           PARISH        or    an
such request shall consult and
                                            Individual for a request for an
cooperate      with       JEFFERSON
                                            accounting       of      Disclosures     in
PARISH concerning the proper
                                            accordance       with       Section    3.6.
response to such request and shall
                                            BUSINESS          ASSOCIATE           shall
provide JEFFERSON PARISH with a
                                            provide      the      first     accounting
copy of any information Disclosed
                                            concerning an Individual requested
pursuant to such request.
                                            by     either     the      Individual    or
3.8 Availability    of     Books     and    JEFFERSON PARISH in any 12-
Records. BUSINESS ASSOCIATE                 month period without charge.
hereby agrees to make its internal          BUSINESS           ASSOCIATE          may
practices, books, and records               impose a reasonable, cost-based fee
relating to the Use and Disclosure of       for each subsequent request for an
Protected        Health      Information    accounting concerning the same
available to the Secretary of the U.S.      Individual within the 12-month
Department of Health and Human              period, provided that BUSINESS
Services for purposes of determining        ASSOCIATE informs the Individual
JEFFERSON PARISH’s compliance               or JEFFERSON PARISH in advance
with     the     Privacy      Standards.    of the fee and provides the Individual
Notwithstanding        the     foregoing,   or JEFFERSON PARISH with an
nothing herein shall be deemed to           opportunity to withdraw or modify the
require BUSINESS ASSOCIATE to               request for a subsequent accounting
waive any attorney-JEFFERSON                in order to avoid or reduce the fee.
PARISH, accountant-JEFFERSON
PARISH, or other legal privilege.           IV.RESPONSIBILITIES OF
                                            JEFFERSON PARISH.
3.9 Imposition of Fees. BUSINESS
ASSOCIATE may impose at its sole            4.1Requests      for   Uses      or
option a reasonable, cost-based fee         Disclosures. JEFFERSON PARISH
on JEFFERSON PARISH or an                   shall   not  request    BUSINESS
Individual for a request for a copy of      ASSOCIATE to Use or Disclose
Protected Health Information under          Protected Health Information in any
Section 3.4. Such fee shall include         manner that would violate this
only the cost of copying, including
         Jeffererson Parish Government SOQ

Business Associate Agreement.
4.2   Notice of Privacy Practices.
4.3JEFFERSON        PARISH hereby            4.5  Other               Arrangements.
agrees to provide, a notice of privacy       JEFFERSON           PARISH       hereby
practices (the “Notice”) to Individuals      agrees      to    notify    BUSINESS
(or their personal representatives)          ASSOCIATE, in writing and in a
who are the subject of the Protected         timely manner, of any arrangements
Health Information, which Notice             permitted       or      required     of
shall be sufficiently broad so as to         JEFFERSON PARISH under the
permit the Uses and Disclosures of           Privacy Standards that may impact
Protected Health Information by              in any manner the Use or Disclosure
BUSINESS                  ASSOCIATE          of Protected Health Information by
contemplated by this Business                BUSINESS ASSOCIATE under this
Associate Agreement and the                  Business Associate Agreement or
Arrangement.             JEFFERSON           the Arrangement, including without
PARISH shall not amend such                  limitation restrictions on the Use or
Notice unless the amended Notice is          Disclosure of Protected Health
sufficiently broad so as to permit the       Information       agreed      to     by
Uses and Disclosures of Protected            JEFFERSON PARISH, as provided
Health Information contemplated by           for in 45 C.F.R. § 164.522.
this Business Associate Agreement
                                             V.    TERM AND TERMINATION.
and the Arrangement.
                                             5.1 Term. This Business Associate
4.4 Written               Permission.
                                             Agreement shall become effective
JEFFERSON         PARISH        hereby
                                             on the later of the date JEFFERSON
agrees to insure that it obtains
                                             PARISH is required to comply with
Individuals’ permission or the
                                             the Privacy Standards or the date on
permission of Individuals’ personal
                                             which JEFFERSON PARISH and
representatives, to the extent
                                             BUSINESS ASSOCIATE entered
required    under      the     Privacy
                                             into the Arrangement and, unless
Standards and in the form required
                                             otherwise terminated as provided
by the Privacy Standards, for
                                             herein, shall expire upon the
BUSINESS ASSOCIATE’ Uses and
                                             expiration or termination of the
Discloses of Protected Health
                                             Arrangement.
Information contemplated by this
Business Associate Agreement and             5.2 Termination by JEFFERSON
the Arrangement and to inform                PARISH. The Arrangement may be
BUSINESS ASSOCIATE of any                    terminated       by     JEFFERSON
changes in, or withdrawal of, such           PARISH, subject to the delivery of
written permission provided to               the written notice and the expiration
JEFFERSON PARISH by Individuals              of the cure period provided in the
or their personal representatives,           Arrangement, in the event that
including      without       limitation      BUSINESS ASSOCIATE breaches
revocations     of      authorizations       any material term of this Business
pursuant to 45 C.F.R. § 164.508.             Associate Agreement. In the event
                                             that JEFFERSON PARISH is entitled
       Jeffererson Parish Government SOQ

to terminate the Arrangement               the Privacy Standards and the
pursuant to this Section 5.2 but           Transactions and Code Sets
determines, in its sole discretion,        Standards, the parties agree to enter
that termination is not feasible,          into a mutually acceptable
BUSINESS                ASSOCIATE          amendment to this Business
acknowledges that JEFFERSON                Associate Agreement to enable
PARISH shall have the right to report      JEFFERSON PARISH to satisfy its
the breach to the Secretary.               obligations under such additional or
                                           amended standard(s).
5.3 Return     or     Destruction    of
Protected Health Information Upon          VII.   MISCELLANEOUS.
Termination. Upon termination of
                                           7.1 The     parties    agree      and
the     Arrangement,        BUSINESS
                                           acknowledge that, as between
ASSOCIATE shall, at the option of
                                           JEFFERSON           PARISH        and
BUSINESS ASSOCIATE, either
                                           BUSINESS                ASSOCIATE,
return or destroy all Protected Health
                                           JEFFERSON PARISH is the owner
Information      which      BUSINESS
                                           of the Protected Health Information.
ASSOCIATE still maintains in any
form. BUSINESS ASSOCIATE shall             7.2 In the event that a provision of
not retain any copies of such              this Business Associate Agreement
Protected      Health      Information.    conflicts with a provision of the
Notwithstanding the foregoing, to the      Arrangement, the provision of this
extent that it is not feasible, in         Business Associate Agreement shall
BUSINESS                ASSOCIATE’S        control. Otherwise, this Business
reasonable discretion, to return or        Associate Agreement shall be
destroy such Protected Health              construed under, and in accordance
Information,     the     terms     and     with, the terms of the Arrangement.
provisions of this Business Associate      7.3 This     Business     Associate
Agreement       shall    survive    the    Agreement may be amended only by
termination of the Arrangement with        written agreement between the
respect to such Protected Health           parties. The headings of sections in
Information, and such Protected            this Business Associate Agreement
Health Information shall be Used or        are for reference only and shall not
Disclosed solely for such purpose or       affect the meaning of this Business
purposes which prevented its return        Associate Agreement.
or destruction.
                                           7.4 Nothing express or implied in this
VI.MODIFICATIONS TO COMPLY                 Business Associate Agreement is
WITH STANDARDS.                            intended to confer, nor shall anything
  In the event that additional             herein confer, upon any person other
standards are promulgated under            than the parties and the respective
the Administrative Simplification          successors and assigns of the
Section of the Health Insurance            parties    any     rights,    remedies,
Portability and Accountability Act of      obligations, or liabilities whatsoever.
1996, or any existing standards are
amended, including without limitation
         Jeffererson Parish Government SOQ




         IN WITNESS WHEREOF, the parties hereto have executed this Business
         Associate Agreement as of the day and year first written above.




By:


Title:
        Jeffererson Parish Government SOQ




REQUIRED CONTRACT TERMS

RECORDS

Contractor shall keep accurate books, records and documentation using generally accepted
accounting and record-keeping practices in relation to the performance of services pursuant to
this agreement. Contractor shall cooperate with Jefferson Parish to seek release of Jefferson
Parish records and other documentation including but not limited to medical records,
correspondence, instructions, claim forms, receipts, vouchers, and other documentation as is
reasonably necessary for Jefferson Parish to verify the performance of services pursuant to the
agreement. Contractor shall preserve all documentation pertaining to the services required by this
agreement for a period of three years following completion of the services rendered or for any
greater period of time required by law.


INDEMNITY

 To the fullest extent permitted by law, Contractor agrees to protect, defend, indemnify, and save
Jefferson Parish, its agents, officials, employees, and servants including volunteers or any firm,
company, organization, or individual, or their contractors, or subcontractors with whom the Parish
may be contracted, harmless from and against any and all claims, demands, loss or destruction of
property, actions and causes of action of every kind and character including but not limited to
claims based on negligence, strict liability, and absolute liability which may arise in favor of any
person or persons on account of illness, disease, loss of property, services, wages, death or
personal injuries resulting from operations contemplated by this contract, regardless whether
others may be wholly, concurrently, partially or solely negligent, or strictly liable or absolutely
liable or otherwise at fault, and regardless of any defect in the premises, equipment, or materials,
irrespective of whether same pre-existed this agreement, except damages arising out of injuries
or property claims to third parties caused by the sole negligence of Parish, its employees or
agents.

Further, Contractor hereby agrees to indemnify Jefferson Parish for all reasonable expenses
including but not limited to all fees and charges of, attorneys and other professionals and all court
or other dispute resolution costs incurred by or imposed upon Jefferson Parish in connection
therewith for any loss, damage, injury or other casualty. Contractor further agrees to pay all
reasonable expenses and attorney’s fees incurred by Jefferson Parish in establishing the right to
indemnify pursuant to the provisions of this section.

LITIGATION

If there is any dispute concerning this agreement, the laws of Louisiana shall apply. Proper venue
and jurisdiction for all lawsuits, claims, disputes and other matters in question between the parties
                                                            th
to this agreement or any breach thereof shall be the 24 Judicial District Court for the Parish of
Jefferson, State of Louisiana.
        Jeffererson Parish Government SOQ



SAVINGS CLAUSE

In case any one or more of the provisions contained in this agreement shall, for any reason, be
judicially held to be held invalid, illegal or unenforceable in whole or part, such invalidity, illegality
or unenforceability shall not affect any other provision of this agreement and, in such an event,
this agreement shall be construed as if such invalid, illegal or unenforceable provisions had never
been contained herein.

CONFIDENTIAL MEDICAL INFORMATION

To the extent consistent with all applicable federal, state and local laws, rules, regulations and
orders, the parties shall comply with state and federal medical records access and confidentiality
provisions. Contractor and Jefferson Parish records shall be maintained and used with the highest
regard for privacy and in compliance with the provisions of the Health Insurance Portability and
Accountability Act of 1996 as amended.

Jefferson Parish and Contractor agree that each has implemented appropriate safeguards to
protect individually identifiable health information, identified under HIPAA as Protected Health
Information, received from, or created or received on behalf of its employees. Contractor shall
hold Protected Health Information confidential and shall not use or disclose it other than as
permitted or required by this addendum or as required by law. On termination of the agreement
and the addendum Contractor shall return, or on Jefferson Parish’s request, destroy all Protected
Health Information received from, or created or received by Contractor on behalf of Jefferson
Parish that is maintained in any form, and Contractor shall retain no copies of such information.
This section shall apply to Protected Health Information that is in the possession of Contractor or
its representatives and shall survive termination of the agreement and addendum.


INDEPENDENT CONTRACTOR

It is understood and agreed by the Parties hereto that Contractor is entering into this agreement in
the capacity of an independent contractor and that nothing contained in this agreement is intended
to be construed as creating any other relationship between Jefferson Parish and Contractor.

        The Parties hereto acknowledge and agree that Jefferson Parish shall not:
        a)     withhold federal or state income taxes;
        b)     withhold federal social security tax (FICA);
        c)     pay federal or state unemployment taxes for the account of Contractor
        d)     pay worker’s compensation insurance premiums for coverage for Contractor.

Contractor agrees to be responsible for and to pay all applicable federal income taxes, federal
social security tax (or self-employment tax in lieu thereof) and any other applicable federal or state
unemployment taxes.

Contractor agrees to indemnify and hold Jefferson Parish harmless from any and all federal
and/or state income tax liability, including taxes, interest and penalties, resulting from Jefferson
Parish’s treatment of Contractor as an independent contractor. Contractor further agrees to
reimburse Jefferson Parish for any and all costs it incurs, including, but not limited to, accounting
fees and legal fees, in defending itself against such liability.

During the term of this agreement, Jefferson Parish shall not furnish Contractor, or any Contractor
personnel with any ‘benefits’ including health and welfare benefits, since Contractor is not an
employee of Jefferson Parish.
        Jeffererson Parish Government SOQ

Jefferson Parish shall not be obliged to any person, firm, corporation, or governmental entity for
any obligations of Contractor arising from the performance of their services under this agreement.

PARISH RESPONSIBILITIES

 Any reports which are required to be completed by the Contractor and submitted to Jefferson
Parish, Department of Human Resource Management maybe used to review and analyze benefit
claims, prescription benefits, services, and utilization costs. This information may be disclosed in
future requests for proposals, to solicit future employee paid voluntary benefits. No individually
identifiable information will be disclosed and a log will be maintained of the entities to which the
information is disclosed on an annual basis.
PAYMENT

All invoices shall contain an acknowledgement that no subcontractors or persons, excluding full
time employees of the firm, have been added to work on this project without prior council approval
by resolution.

Jefferson Parish will transmit all premium payments due through the Automated Clearing House
(ACH). A Jefferson Parish formatted file will be forwarded at the time of payment detailing each
payment. The file will identify the employee, type of coverage and amount paid and will be
transmitted as an attachment to electronic mail or telephone facsimile mail. Jefferson Parish will
not accept or reconcile billings or statements from the Contractor/Provider. In the event of a
termination of coverage, any dispute between the Parish and the Contractor as to premiums owed
or claims paid will be determined by the Parish’s self-invoice alone.

ASSIGNMENT

Neither the Parish nor the Contractor shall assign, sublet or transfer any interest in this
agreement without the consent of the other.

TERMINATION OR SUSPENSION

The terms of this agreement shall be binding upon the parties hereto until the work has been
completed and accepted by the Parish and all payments required to be made to the contractor
have been made; but this contract may be terminated under any or all of the following conditions:

        1)       By mutual agreement and consent of the parties hereto.
        2)       By the Parish as a consequence of the failure of the contractor
                 to comply with the terms, progress, or quality of work in a
                 satisfactory manner, proper allowance being made for the
                 circumstances beyond the control of contractor.
        3)       By either party upon failure of the other party to fulfill its
                 obligations, as set forth in this contract.
        4)       By satisfactory completion of all services and obligations
                 described herein.
        5)       By Parish with thirty (30) days written notice to contractor.

Upon termination, the contractor shall be paid for actual work performed prior
to notice of termination or a pro rata share of the basic fee on the phase or percentage of work
actually completed. Upon termination under Item 2 above, the contractor shall deliver to the
Parish all original documents, noted drawings, tracings, computer files, and files except the
contractor’s personal and administrative files.

That the council, by resolution, shall terminate a professional service
        Jeffererson Parish Government SOQ



agreement in the event false or misleading information is given to the Parish in the required
professional services questionnaire; in the affidavit identifying all subcontractors and persons,
excluding full time employees of the firm, who would assist in providing professional services for
the project, or in the acknowledgment submitted with each invoice that no subcontractors or
persons, excluding full time employees of the firm, have been added without prior council approval
by resolution; and, further, any and all parties found to be in violation of the provisions of this
resolution or of the provisions of Section 2-928(C) of the Jefferson Parish Code of Ordinances,
including, but not limited to, the person or firm under contract with the parish to provide
professional services and any and all subcontractors improperly added to such a contract, shall be
disqualified from contracting with the Parish to provide professional services for one year after
such violation is discovered and shall be assessed a penalty payable to the Parish in the amount
of five thousand dollars ($5,000.00) in liquidated damages for each such violation.

MODIFICATIONS

This agreement constitutes the entire understanding between the parties hereto, and cancels and
supersedes all prior negotiations, representations, understandings and agreements, either written
or oral, with respect to the subject matter hereof. No changes, alterations, or modifications to this
agreement will be effective unless in writing and signed by all parties hereto.

INSURANCE

The CONSULTANT shall secure and maintain at its expense such insurance that will protect it,
and the PARISH, from claims under the Workmen’s Compensation Acts and from claims for
bodily injury, death or property damage which may arise from the performance of services under
this agreement. All certificates of insurance shall not be canceled without thirty (30) days prior
notice of cancellation given to the PARISH, in writing, on all of the required coverages provided to
PARISH. All notices will name the CONSULTANT, and identify the Council Resolution approving
the terms of the contract. The PARISH may examine the policies.

A.   ALL POLICIES AND CERTIFICATES OF INSURANCE OF THE CONSULTANT SHALL
CONTAIN THE FOLLOWING CLAUSE:

1. The CONSULTANT insurers will have no right of recovery or subrogation against the PARISH,
it being the intention of the parties that the insurance policy so affected shall protect both parties
and be the primary coverage for any and all losses covered by the below described insurance.
2. The PARISH shall be named as additional insured as regards to automobile and general
liability with respect to negligence by the CONSULTANT [ISO Forms CG 20 10 (Form B)].
           3. The insurance companies issuing the policy or policies shall have no recourse
against the PARISH for payment of any premiums or for assessments under any form of policy.
4. Any and all deductible in the below described insurance policies shall be assumed by and be at
the sole risk of the CONSULTANT.

B.       Prior to the execution of this agreement the CONSULTANT, shall provide at its own
expense, proof of the following insurance coverage required by the contract to the PARISH by
insurance companies authorized to do business in the State of Louisiana. Insurance is to be
placed with insurers with an A.M. Best rating of no less than A:VI. This requirement will be waived
for worker’s compensation coverage only for those firms whose worker’s compensation coverage
is placed with companies who participate in the State of Louisiana Worker’s Compensation
Assigned Risk Pool or the Louisiana Worker’s Compensation Corporation.
1.       Worker’s Compensation Insurance:
As required by Louisiana State Statute exception; employer’s liability shall be at least $1,000,000
per occurrence when work is to be over water and involves maritime exposures, otherwise this
limit shall be no less than $500,000 per occurrence.
2.       Commercial General Liability Insurance with a Combined Single Limit of at least
$500,000.00 per Occurrence for bodily injury and property damage. This insurance shall include
        Jeffererson Parish Government SOQ



coverage for bodily injury and property damage, and indicate on the certificate of insurance the
following:
               a)        Premises - operations;
               b)        Broad form contractual liability;
               c)        Products and completed operations;
               d)        Use of contractors and sub-contractors;
               e)        Personal Injury;
               f)        Broad form property damage;
               g)        Explosion, collapse and underground [XCU] coverage.

NOTE: On the certificate of insurance, under the description of operations, the following wording
is required: “The aggregate loss limit applies to each project or a copy of ISO Form CG 25 03 [ed.
11.85 or latest form] shall be submitted.”

3.       An umbrella policy or excess may be used to meet minimum requirements.
4.       Professional Liability Coverage: The CONSULTANT shall take out and maintain a policy
of Professional Liability coverage (errors and omissions) in the amount of five hundred thousand
dollars ($500,000) each claim.

All policies of insurance shall meet the requirements of the PARISH prior to the commencing of
any work. The PARISH has the right but not the duty to approve all insurance policies prior to
commencing of any work. If at any time any of the said policies shall be or becomes
unsatisfactory to the PARISH as to form or substance; or if a company issuing any such policy
shall be or become unsatisfactory to the PARISH, the CONSULTANT shall promptly obtain a new
policy, submit the same to the PARISH for approval and submit a certificate thereof as provided
above.

Upon failure of the CONSULTANT to furnish, to deliver and maintain such insurance as above
provided, this contract, at the election of the PARISH, may be forthwith declared suspended,
discontinued or terminated. Failure of the CONSULTANT to take out and/or to maintain insurance
shall not relieve the CONSULTANT from any liability under the contract, nor shall the insurance
requirements be construed to conflict with the obligation of the CONSULTANT concerning
indemnification.

COMPLIANCE WITH LAWS

CONSULTANT shall comply with all applicable federal, state and local laws, rules, regulations and
orders relative to the professional services required under the provisions of this agreement,
including but not limited to the Louisiana Employment Security Law (LSA-R.S. 23:1471, et seq.)
and the Louisiana Code of Governmental Ethics (LSA-R.S. 42:1101, et seq.).


JURISDICTION

This agreement shall be deemed to be a contract made under the laws of the State of Louisiana
and for all purposes shall be interpreted in its entirety in accordance with the laws of said State.
The parties hereto agree that the sole and exclusive venue for any suit of proceeding brought
                                         th
pursuant to this contract shall be the 24 Judicial District Court for the Parish of Jefferson, State
of Louisiana.

ACKNOWLEDGEMENT OF COMMISSIONS
The firm acknowledges and accepts the commission structures to be paid by carriers.
        Jeffererson Parish Government SOQ



                                  NON-COLLUSION AFFIDAVIT


STATE OF LOUISIANAPARISH OF JEFFERSON


        BEFORE ME, the undersigned authority, personally came and appeared,

__________________________________, who after being duly sworn, deposed and

said that he is the fully authorized _________________ of

__________________________________ (hereinafter referred to as affiant), and said

affiant further said:



        (1)      That affiant has not and will not employ any person either directly or
indirectly, to secure the public contract under which he is to receive payment, other than
persons regularly employed by the affiant whose service in connection with the project
or in securing the public contract are in the regular course of their duties for the affiant;
and

         (2)     That no part of the contract price was paid or will be paid to any person
for soliciting the contract, other than the payment of normal compensation to persons
regularly employed by the affiant whose services with the project are in the regular
course of their duties for the affiant.




                                                      _____________________________
_______
                                                              AFFIANT
SWORN TO AND SUBSCRIBED
BEFORE ME ON THIS _______
DAY OF _______________, 20__.
        Jeffererson Parish Government SOQ



                           CAMPAIGN CONTRIBUTION AFFIDAVIT


STATE OF LOUISIANA
PARISH OF JEFFERSON

Before me, the undersigned authority, personally came and appeared:

________________________________________________, who after being by me duly sworn,
deposed and said that he/she is the fully authorized ________________________ of
__________________________, the party who submitted a bid or proposal
for_______________________________________________, no. _____________, and said
affiant further stated:

Choose one of the following:

_____ Attached hereto is a list of all campaign contributions made to elected officials of the
Parish of Jefferson during the current term, and no contributions have been made in support of
elected officials of the Parish of Jefferson through or in the name of another person or legal
entity, either directly or indirectly.

_____ Affiant has made no campaign contributions made to elected officials of the Parish of
Jefferson during the current term and no contributions have been made in support of elected
officials of the Parish of Jefferson through or in the name of another person or legal entity, either
directly or indirectly


                                                  Affiant

SWORN TO AND SUBSCRIBED
BEFORE ME THIS ______________
DAY OF______________, 20_______.




NOTARY PUBLIC
        Jeffererson Parish Government SOQ



                                 SUB-CONTRACTOR AFFIDAVIT

STATE OF LOUISIANA
PARISH OF JEFFERSON

BEFORE        ME,       the     undersigned     authority,    personally    came   and   appeared,

____________________________________, who after being duly sworn, deposed and said that

he/she/they    are   fully    authorized    ___________________        of   _____________________

(hereinafter referred to as affiant), and said affiant further said:

The following is a complete listing of all subcontractors who may assist in providing
professional services for the project known as
____________________________________________________
________________________________:

Subcontractors, excluding full time employees of firm, who would assist in providing
professional services for the project:




                                                             __________________________
                                                             AFFIANT
SWORN TO AND SUBSCRIBED
BEFORE ME ON THIS _______
DAY OF ______________, 2010.


___________________________
          NOTARY PUBLIC

A copy of this affidavit must be attached to all pay requests.

_____ Check here if no additions or substitutions of subcontractors have been made under this
contract or any amendments to this contract.


_________________________________                            ___________________
   Signature                                                 Date

Any additions or substitutions of subcontractors, excluding full time employees of firm, who
would assist in providing professional services for the project, requires Jefferson Parish Council
approval and requires submission of a new sworn affidavit.
        Jeffererson Parish Government SOQ



                              EMPLOYMENT STATUS AFFIDAVIT

STATE OF LOUISIANA
PARISH OF JEFFERSON

BEFORE         ME,      the        undersigned     authority,      personally    came       and   appeared,

____________________________________, who after being duly sworn, deposed and said that

he/she/they    are   fully    authorized       ___________________         of   _____________________

(hereinafter    referred      to     as     bidder),   the      party   who     submitted     a   bid   for

______________________________________________,

Bid Number ____________________ and said bidder further said:

(1)    That bidder is registered and participates in a status verification system to verify that all
employees in the State of Louisiana are legal citizens of the United States or are legal aliens.

(2)     That bidder shall continue, during the term of the contract, to utilize a status verification
system to verify the legal status of all new employees in the state of Louisiana.

(3)     That bidder shall require all subcontractors to submit to the bidder a sworn affidavit
verifying compliance with statements (1) and (2).


                                                                  __________________________
                                                                  Signature of Affiant
SWORN TO AND SUBSCRIBED
BEFORE ME ON THIS _______
DAY OF ______________, 2012.


___________________________
          NOTARY PUBLIC
         Jeffererson Parish Government SOQ


                                             1. PROJECT NAME / LOCATION FOR WHICH FIRM IS FILLING                2a. Commerce Business               2b. Agency Identification
JEFFERSON PARISH                                                                                                 Daily Announcement Date, if         Number, if any:
PROFESSIONAL ENGINEER                                                                                            any:
AND RELATED SERVICES
QUESTIONAIRE FOR
SPECIFIC PROJECT

REV.10/0906

               3. FIRM (OR JOINT-VENTURE) NAME & ADDRESS                                                     3A. NAME, TITLE & TELEPHONE NUMBER OF PRINCIPAL TO CONTRACT:




                                                                                                            3B. ADDRESS OF OFFICE TO PERFORM WORK, IF DIFFERENT FROM ITEM 3




                                                                                                            3C. NAME OF FULL TIME RESIDENT LA. LICENSED PROFESSIONAL IN CHARGE OF
                                                                                                            3B



              4. PERSONNEL BY DISCIPLINE: (LIST EACH PERSON ONLY ONCE, BY          ALL ARCHITECTS/ENGINEERS IN LISTINGS        4a. Firms domiciled or with branch office in
              PRIMARY FUNCTION)                                                    MUST HAVE CURRENT LA. REGISTRATION          LA. Must list current Occupational License –

    __X__ Administrative                 ____ Electrical Engineers                   ____ Oceanographers                       Occ. Lic. ID No. ________________________
    ____ Architects                      ____ Estimators                             ____ Planners: Urban/Regional             Parish of issue ________________________
    ____ Chemical Engineers              ____ Geologist                              ____ Sanitary Engineers
    ____ Civil Engineers                 ____ Hydrologists                           ____ Soils Engineers
                                         ____ Interior Designers                                                               ____ ___________________________________
    ____ Construction Inspectors                                                     ____ Specification Writers
                                         ____ Landscape Architects                                                             ____ ___________________________________
    ____ Draftsmen                                                                   ____ Structural Engineers
                                         ____ Mechanical Engineers                                                             ____ ___________________________________
    ____ Ecologists                                                                  ____ Surveyors
                                         ____ Mining Engineers                                                                 ____ ___________________________________
    ____Economists                                                                   ____ Transportation Engineers
                                                                                                                               ____ Total Personnel

  5. If submittal is by JOINT-VENTURE list participation firms and outline specific areas of responsibility (including administrative, technical
  and financial) for each firm:




 5a. Has this Joint-Venture previously worked together? Yes          No 
              1
       Jeffererson Parish Government SOQ

 6. If respondent is not a joint-venture, list outside key Consultants/Associates anticipated for this project. All subcontractors must submit a fully
    completed copy of the questionnaire, applicable licenses, and any other information required by the advertisement. See Jefferson Parish Code of
    Ordinance, Sec. 2-928(a)(3).
                                                                                                                                            Work with
                                                                                                                                            Prime before
Name & Address                                                            Specialty                                                         (Yes or No)
1)


2)


3)


4)


5)


6)


7)


8)




           2
       Jeffererson Parish Government SOQ




7) Brief resume of key persons, specialist, and individual consultants anticipated for this project.


   a. Name & Title                                                           b. Name & Title


   c. Project Assignment                                                     d. Project Assignment



   e. Name of Firm with which associated                                     f. Name of Firm with which associated



   g. Years experience: With This Firm _____                                 h. Years experience: With This Firm _____

   i. Education: Degree(s)/Year/Specialization                               j. Education: Degree(s)/Year/Specialization



   k. Active Registration: Year First Registered/Discipline                  l. Active Registration: Year First Registered/Discipline




           3
   Jeffererson Parish Government SOQ

Other Experience and Qualifications relevant to the proposed project   Other Experience and Qualifications relevant to the proposed project




       4
       Jeffererson Parish Government SOQ



8. Work by firm or joint-venture members which best illustrates current qualifications relevant to this project (list not more than 10 projects)
 a. Project Name & Location         b. Nature of Firm’s                 c. Project Owner’s            d. Completion e. Estimated Cost (in thousands)
                                       Responsibility                    Name & Address                 Date (actual
                                                                                                        or estimated
                                                                                                                            Entire      Work for which
                                                                                                                           Project         Firm was/is
                                                                                                                                           responsible

(1)


(2)


(3)


(4)


(5)


(6)


(7)


(8)


(9)


           5
       Jeffererson Parish Government SOQ



(10)

9. All work by firm being performed directly for or selected by Jefferson Parish
 a. Project Name & Location       b. Nature of Firm’s                c. Project Owner’s   d. Completion   e. Estimated Cost (in thousands)
                                     Responsibility                   Name & Address       Date (actual
                                                                                           or estimated
                                                                                                            Entire       Work for which
                                                                                                            Project       Firm was/is
                                                                                                                          responsible




           6
       Jeffererson Parish Government SOQ

9f. Contributions made to elected officials of Jefferson Parish.
                                                                   Contribution Amounts (list singly)   Date Contributed
Name of Councilmen




           7
       Jeffererson Parish Government SOQ


10. Use this space to provide any additional information or description of resources (including any computer design capabilities)
    supporting your firm’s qualifications for the proposed project:




11. The foregoing is a statement of facts.

                                                           Type Name
Signature ______________________________________             & Title ___________________________________________ Date: ____________




           8
        Jeffererson Parish Government SOQ

Sec. 2-928. Required submittals.
              (a)      In order to be considered for selection to perform professional services for the parish or for any of its departments or districts, the
              person or firm submitting must submit:
              (1)      A copy of the questionnaire most recently approved by the council, completely filled out, including professional license and
              occupational license information, if applicable;
              (2)      Any other information required by the advertisement for the project and any additional information related to the technical abilities of
              the person or firm submitting, if specifically requested by the parish prior to the deadline for submittals; and
              (3)      All information as required by (1) and (2) above relative to all subcontractors who would assist in providing professional services for
              the project.
              (4)      For all architectural, engineering and surveying projects for Jefferson Parish or any of its special districts, a statement of the
              maximum fee for the work, including fees for preliminary design, bid, construction and record drawing phases of the work but exclusive of
              supplemental services, expressed as either a dollar amount or a percentage of the estimated construction cost, which dollar amount(s) or
              percentage(s) shall be provided in section 10 of the "Jefferson Parish Professional Engineer and Related Services Questionnaire for
              Specific Project."
              (b)      In addition, the person or firm submitting must submit prior to contract ratification:
              (1)      An affiant attesting:
              a.       That the affiant has not and will not employ any person either directly or indirectly to secure the public contract under which he is to
              receive payment, other than persons regularly employed by the affiant whose service in connection with the project or in securing the public
              contract are in the regular course of their duties for the affiant; and
              b.       That no part of the contract price was paid or will be paid to any person for soliciting the contract other than the payment of normal
              compensation to persons regularly employed by the affiant whose services with the project are in the regular course of their duties for the
              affiant; and
              (2)      An affidavit attesting to:
              a.       Any and all campaign contributions that the affiant has made to elected officials of the parish during the current term; and
              b.       Any and all debts owed by the affiant to any elected or appointed official of the parish, and any and all debts owed by any elected or
              appointed official of the parish to the affiant; and attesting:
              c.       That the affiant has not made any contribution to or in support of elected officials of the parish through or in the name of another
              person or firm either directly or indirectly.
              (c)      The person or firm submitting must identify all subcontractors who would assist in providing professional services for the project in
              the professional services questionnaire. Each subcontractor shall submit all documents and information required by this section.
              Substitutions or subsequent addition of subcontractors to the project must be ratified by council resolution. The person or firm shall provide
              to the council detailed justification of the need for such additional subcontractor.
              (d)      The submission of information or material in excess of that required by this section shall render the entire submission non-
              responsive and may be cause for the disqualification of the person or firm submitting said additional information or material with regard to
              the project under consideration. The technical evaluation committee or the council may request additional information from any person or
              firm submitting.
              (Ord. No. 18993, § 2, 2-23-94; Ord. No. 20060, §§ 2, 3, 6-25-97; Ord. No. 20296, § 2, 3-11-98; Ord. No. 20374, § 1, 6-3-98; Ord. No.
              21593, §§ 5, 6, 6-5-02)




            9

				
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