Government W2 Forms Printable

Document Sample
Government W2 Forms Printable Powered By Docstoc
					   HARRIS COUNTY
REQUEST FOR PROPOSAL                                                                JOB #01/0138
                                                                           Date Due: Tuesday, May 22, 2001
      Cover Sheet                                                         DUE NO LATER THAN 1:00 P.M.

                                                                        Proposals received later than the date
                                                                        and time above will not be considered.


 PROPOSAL FOR:
                                      LASER PRINTING SYSTEM
                                   for Harris County Hospital District’s
                                  Accounts Payable and Payroll Functions

                                             OFFERORS NOTE!!
Carefully read all instructions, requirements and                 Please return proposal in the envelope provided or in a
specifications.  Fill out all forms properly and                  comparable size envelope. Be sure that return envelope
completely. Submit your proposal with all appropriate             shows the Job Number, Description and is marked
supplements and/or samples.                                       "SEALED PROPOSAL."

                                           RETURN PROPOSAL TO:
                                   HARRIS COUNTY PURCHASING AGENT
                                     1001 PRESTON AVENUE, SUITE 670
                                           HOUSTON, TEXAS 77002

   For additional information, contact Dan Thweatt at 713.755.5982.

   You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or
   written in ink.
                      Total Amount of Proposal: $____________________________


   Company Name:          _________________________________________________________
   Company Address:       _________________________________________________________
                          _________________________________________________________
   Taxpayer Identification Number (T.I.N.): _____________________________________

   Telephone No. __________________________                   FAX No. __________________

   Print Name: ____________________________________________________________________

   Signature: ______________________________________________________________________

   [Your signature attests to your offer to provide the goods and/or services in this proposal according to the published
   provisions of this Job. When an award letter is issued, it becomes a part of this contract. Contract is not valid until
   Purchase Order is issued.]




                                               TABLE OF CONTENTS
                                                                                                                  Page 1 of 41
Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT
APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If
any portion of the package is missing, notify the Purchasing Department immediately.

It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the
following before you return your bid packet.
__X__ 1.             Cover Sheet
                     Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear
                     on this page.

__X__ 2.          Table of Contents
                  This page is the Table of Contents.

__X__ 3.          General Requirements
                  You should be familiar with all of the General Requirements.

__X__ 4.          Special Requirements/Instructions
                  This section provides information you must know in order to make an offer properly.

__X__ 5.          Specifications
                  This section contains the detailed description of the product/service sought by the County.

__X__ 6.          Pricing/Delivery Information
                  This form is used to solicit exact pricing of goods/services and delivery costs.

__X__ 7.          Attachments
                  __X__ a.           Residence Certification
                                     Be sure to complete this form and return with packet.

                  _____    b.        Bid Guaranty & Performance Bond Information & Requirements
                                     This form applies only to certain bids/proposals. Please read carefully and fill out
                                     completely.

                  _____    c.        Bid Check Return Authorization Form
                                     This form applies only to certain forms. Please read carefully and fill out completely.

                  _____    d.        Vehicle Delivery Instructions
                                     Included only when purchasing vehicles.

                  __X__ e.           Minimum Insurance Requirements
                                     Included when applicable (does not supersede "Hold Harmless" section of General
                                     Requirements).

                  __X__ f.           Workers' Compensation Insurance Coverage Rule 110.110
                                     This requirement is applicable for a building or construction contract.

                  _____    g.        Financial Statement
                                     When this information is required, you must use this form.

                  _____    h.        Reference Sheet

                  _____    i.        Other (from time to time other attachments may be included.)
Revised 09/00




                                                                                                                      Page 2 of 41
                                      GENERAL REQUIREMENTS
                                          FOR PROPOSALS

READ THIS ENTIRE DOCUMENT CAREFULLY. FOLLOW ALL INSTRUCTIONS. YOU ARE
RESPONSIBLE FOR FULFILLING ALL REQUIREMENTS AND SPECIFICATIONS. BE SURE YOU
UNDERSTAND THEM.

General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in
part, by the SPECIAL REQUIREMENTS/INSTRUCTIONS OR OTHER DATA CONTAINED HEREIN. Review the
Table of Contents. Be sure your proposal package is complete.

GOVERNING LAW
This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas
Local Government Code, §262.021 et seq., as amended. Offerors shall comply with all applicable federal, state and
local laws and regulations. Offeror is further advised that these requirements shall be fully governed by the laws of the
State of Texas and that Harris County may request and rely on advice, decisions and opinions of the Attorney General of
Texas and the County Attorney concerning any portion of these requirements.

PROPOSAL COMPLETION
Fill out and return to Purchasing, ONE (1) complete proposal form, using the envelope provided. An authorized
company representative should sign the Cover Sheet. Completion of these forms is intended to verify that the offeror
has submitted the proposal, is familiar with its contents and has submitted the material in accordance with all
requirements.

PROPOSAL RETURNS
Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001
Preston Avenue, Suite 670, Houston, Texas before 1:00 P.M. on the date specified. Late proposals will not be
accepted.

GOVERNING FORMS
In the event of any conflict between the terms and provisions of these requirements and the specifications, the
specifications shall govern. In the event of any conflict of interpretation of any part of this overall document, Harris
County's interpretation shall govern.

ADDENDA
When specifications are revised, the Harris County Purchasing Agent will issue an addendum addressing the nature of
the change. Offerors must sign it and include it in the returned proposal package.

HOLD HARMLESS AGREEMENT
Contractor, the successful offeror, shall indemnify and hold Harris County harmless from all claims for personal injury,
death and/or property damage resulting directly or indirectly from contractor's performance. Contractor shall procure
and maintain, with respect to the subject matter of this proposal, appropriate insurance coverage including, as a
minimum, public liability and property damage with adequate limits to cover contractor's liability as may arise directly
or indirectly from work performed under terms of this proposal. Certification of such coverage must be provided to the
County upon request.

WAIVER OF SUBROGATION
Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris
County as an indirect party to any suit arising out of personal or property damages resulting from offeror's performance
under this agreement.




SEVERABILITY
If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall
be held invalid, such holding shall not affect the remaining portions of these requirements and the specifications and it is




                                                                                                              Page 3 of 41
hereby declared that such remaining portions would have been included in these requirements and the specifications as
though the invalid portion had been omitted.

BONDS
If this proposal requires submission of proposal guarantee and performance bond, there will be a separate page
explaining those requirements. Offers submitted without the required proposal bond or Cashier's Check are not
acceptable.

TAXES
Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris
County claims exemption from all sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited
Sales Tax Exemption Certificates will be furnished upon written request to the Harris County Purchasing Agent.

FISCAL FUNDING
A multi-year lease or lease/purchase arrangement (if requested by the specifications), or any contract continuing as a
result of an extension option, must include fiscal funding out. If, for any reason, funds are not appropriated to continue
the lease or contract, said lease or contract shall become null and void on the last day of the current appropriation of
funds. After expiration of the lease, leased equipment shall be removed by the contractor from the using department
without penalty of any kind or form to Harris County. All charges and physical activity related to delivery, installation,
removal and redelivery shall be the responsibility of the offeror.

PRICING
Prices for all goods and/or services shall be negotiated to a firm amount for the duration of this contract or as agreed to
in terms of time frame. All prices must be written in ink or typewritten. Where unit pricing and extended pricing differ,
unit pricing prevails.

SILENCE OF SPECIFICATIONS
The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description
concerning any point, shall be regarded as meaning that only the best commercial practice is to prevail and that only
material and workmanship of the finest quality are to be used. All interpretations of specifications shall be made on the
basis of this statement. The items furnished under this contract shall be new, unused of the latest product in production
to commercial trade and shall be of the highest quality as to materials used and workmanship. Manufacturer furnishing
these items shall be experienced in design and construction of such items and shall be an established supplier of the item
proposed.

SUPPLEMENTAL MATERIALS
Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures,
data sheets, specification information, completed forms requested as part of the proposal package and any other facts
which may affect the evaluation and subsequent contract award should be included. Materials such as legal documents
and contractual agreements, which the offeror wishes to include as a condition of the proposal, must also be in the
returned proposal package. Failure to include all necessary and proper supplemental materials may be cause to reject
the entire proposal.

MATERIAL SAFETY DATA SHEETS
Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must
provide to the County with each delivery, material safety data sheets which are applicable to hazardous substances
defined in the Act. Failure of the offeror to furnish this documentation will be cause to reject any bid applying thereto.




EVALUATION
Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most
economical for the County. It shall be based on all factors which have a bearing on price and performance of the items
in the user environment. All proposals are subject to negotiations by the Purchasing Agent and other appropriate
departments, with recommendation to Commissioners Court. Compliance with all requirements, delivery and needs of
the using department are considerations in evaluating proposals. Pricing is NOT the only criteria for making a


                                                                                                             Page 4 of 41
recommendation. A preliminary evaluation by Harris County will be held and appropriate proposals will be subjected
to the negotiating process. Upon completion of the negotiations, Harris County will make an award. All proposals that
have been submitted shall be available and open for public inspection after the contract is awarded except for trade
secrets or confidential information contained in the proposals and identified as such.

INSPECTIONS
Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and
requirements and needs of the using department. If an offeror cannot furnish a sample of a proposed item, where
applicable, for review, or fails to satisfactorily show an ability to perform, the County can reject the offer as inadequate.

TESTING
Harris County reserves the right to test equipment, supplies, material and goods proposed for quality, compliance with
specifications and ability to meet the needs of the user. Demonstration units must be available for review. Should the
goods or services fail to meet requirements and/or be unavailable for evaluation, the offer is subject to rejection.

DISQUALIFICATION OF OFFEROR
Upon signing this proposal document, an offeror offering to sell supplies, materials, services, or equipment to Harris
County certifies that the offeror has not violated the antitrust laws of this state codified in §15.01, et seq., Business &
Commerce Code, or the federal antitrust laws, and has not communicated directly or indirectly the offer made to any
competitor or any other person engaged in such line of business. Any or all proposals may be rejected if the County
believes that collusion exists among the offerors. Proposals in which the prices are obviously unbalanced may be
rejected. If multiple proposals are submitted by an offeror and after the proposals are opened, one of the proposals is
withdrawn, the result will be that all of the proposals submitted by that offeror will be withdrawn; however, nothing
herein prohibits a vendor from submitting multiple offers for different products or services.

AWARD
Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance
with the laws of the State of Texas, to waive any formality or irregularity, to make awards to more than one offeror, to
reject any or all proposals. In the event the lowest dollar offeror meeting specifications is not awarded a contract, the
offeror may appear before the Commissioners Court and present evidence concerning his responsibility after officially
notifying the Office of the Purchasing Agent of his intent to appear.

ASSIGNMENT
The successful offeror may not assign, sell or otherwise transfer this contract without written permission of Harris
County Commissioners Court.

TERM CONTRACTS
If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE.




MAINTENANCE
Maintenance required for equipment proposed should be available in Harris County by a manufacturer-authorized
maintenance facility. Costs for this service shall be shown on the Pricing/Delivery Information. If Harris County opts to
include maintenance, it shall be so stated in the purchase order and said cost will be included. Service will commence
only upon expiration of applicable warranties and should be priced accordingly.

CONTRACT OBLIGATION
Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the
Harris County Commissioners Court must sign the contract before it becomes binding on Harris County or the offeror.
Department heads are NOT authorized to sign agreements for Harris County. Binding agreements shall remain in effect
until all products and/or services covered by this purchase have been satisfactorily delivered and accepted.

TITLE TRANSFER
Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes
possession of the goods at the point or points of delivery. Receiving times may vary with the using department.
Generally, deliveries may be made between 8:30 a.m. and 4:00 p.m., Monday through Friday. Offerors are advised to


                                                                                                               Page 5 of 41
consult the using department for instructions. The place of delivery shall be shown under the "Special
Requirements/Instructions" section of this proposal and/or on the Purchase Order as a "Deliver To:" address.

WARRANTIES
Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors
may not limit or exclude any implied warranties. Offeror warrants that product sold to the County shall conform to the
standards established by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the
event product does not conform to OSHA Standards, where applicable, Harris County may return the product for
correction or replacement at the offeror's expense. If offeror fails to make the appropriate correction within a reasonable
time, Harris County may correct at the offeror's expense.

PURCHASE ORDER AND DELIVERY
The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by
an authorized agent of the Harris County Purchasing Agent. The fastest, most reasonable delivery time shall be
indicated by the offeror in the proper place on the proposal document. Any special information concerning delivery
should also be included, on a separate sheet, if necessary. All items shall be shipped F.O.B. INSIDE DELIVERY
unless otherwise stated in the specifications. This shall be understood to include bringing merchandise to the
appropriate room or place designated by the using department. Every tender or delivery of goods must fully comply
with all provisions of these requirements and the specifications including time, delivery and quality. Nonconformance
shall constitute a breach which must be rectified prior to expiration of the time for performance. Failure to rectify within
the performance period will be considered cause to reject future deliveries and cancellation of the contract by Harris
County without prejudice to other remedies provided by law. Where delivery times are critical, Harris County
reserves the right to award accordingly.

CONTRACT RENEWALS
Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are
limited to those stated by the offeror in the original proposal.

INVOICES AND PAYMENTS
Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the purchase
order number. Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is otherwise
incorrect, will be returned to the offeror for correction. Under term contracts, when multiple deliveries and/or services are
required, the offeror may invoice following each delivery and the County will pay on invoice. Contracts providing for a monthly
charge will be billed and paid on a monthly basis only. Prior to any and all payments made for good and/or services provided
under this contract, the offeror should provide his Taxpayer Identification Number or social security number as applicable. This
information must be on file with the Harris County Auditor‟s office. Failure to provide this information may result in a delay in
payment and/or back-up withholding as required by the Internal Revenue Service.

TERMINATION
Harris County reserves the right to terminate the contract for default if Seller breaches any of the terms therein, including
warranties of offeror or if the offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in
addition to and not in lieu of any other remedies which Harris County may have in law or equity. Default may be
construed as, but not limited to, failure to deliver the proper goods and/or services within the proper amount of time,
and/or to properly perform any and all services required to Harris County's satisfaction and/or to meet all other
obligations and requirements. Harris County may terminate the contract without cause upon thirty (30) days written
notice.

RECYCLED MATERIALS
Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to
products made of recycled materials if the products meet applicable specifications as to quantity and quality. Harris
County will be the sole judge in determining product preference application.

SCANNED OR RE-TYPED RESPONSE
If in its response, offeror either electronically scans, re-types, or in some way reproduces the County's published
proposal package, then in the event of any conflict between the terms and provisions of the County's published proposal
package, or any portion thereof, and the terms and provisions of the response made by offeror, the County's proposal
package as published shall control. Furthermore, if an alteration of any kind to the County's published proposal package
is only discovered after the contract is executed and is or is not being performed, the contract is subject to immediate
cancellation.


                                                                                                                   Page 6 of 41
FLOPPY DISK
If offeror obtained the specifications on a floppy disk in order to prepare a response, the proposal must be submitted in
hard copy according to the instructions contained in this Request-for-Proposals package. If, in its response, offeror
makes any changes whatsoever to the County's published specifications, the County's specifications as published shall
control. Furthermore, if an alteration of any kind to the County's published specifications is only discovered after the
contract is executed and is or is not being performed, the contract is subject to immediate cancellation.

YEAR 2000 COMPLIANCE
All products and/or services furnished as part of this contract must be year 2000 compliant. This applies to all
computers including hardware and software as well as all other commodities with date sensitive embedded chips.

Revised 01/00




                                                                                                           Page 7 of 41
                    SPECIAL REQUIREMENTS/INSTRUCTIONS

  The following requirements and instructions supersede General Requirements where
  applicable. the term “Harris County” is understood to include the Harris County
  Hospital District (HCHD or District).

PROPOSAL FOR:
                                 LASER PRINTING SYSTEM
                              for Harris County Hospital District’s
                             Accounts Payable and Payroll Functions

  1.0 SPECIAL REQUIREMENTS - Vendor Instructions
  Proposals shall be formatted as follows:
  All proposals must be typed and printed single sided on standard 8 1/2 x 11 paper,
  indexed, and each placed in a separate three-ring binder. One original, clearly marked
  “original”, and three (3) copies, clearly marked “copy”, must be submitted. Each
  binder must also be label on the front cover with the Offeror‟s Company Name, the Job
  number, and the RFP Title. The complete proposal should be sealed in an envelope or
  box for delivery to the Office of the Harris County Purchasing Agent per instructions in
  the general requirements (see returning the proposal and proposal completion). All
  documents included in the proposal and the outside of the package must be labeled with
  the vendor's name and the job number that corresponds to this RFP.

  Each proposal shall be organized as follows:
    Section I:     Table of Contents
    Section II:    Preface – consisting of:
                           II.A - Proposal Cover Sheet (completed)
                           II B - Residence Certification (completed)
    Section III:   Response to Requirements – consisting of:
                           III A - Corporate Summary
                                    III A.1 - Corporate Profile (completed)
                                    III A.2 - Financial Reports (completed)
                                    III A.3 - Sample Standard Contract
                                    III A.4 - Organizational Chart
                           III B - Questionnaire Sections
                                    III B.1 - Product Overview
                                    III B.2 - Technical Requirements
                                    III B.3 - Functional Requirements
    Section IV:    Pricing and Delivery
    Section V:     Client References
    Appendix:      Marketing Literature (optional)

  Each section of the response should begin on a new page. A “Tab/Index” page
  indicating the section number and title of the section should separate each section. In
  addition, each page within the section should be “marked” with the section title and the
  Offeror‟s Company Name.



                                                                                    Page 8 of 41
See the “Specifications” Section of this RFP for a more detailed explanation of the
response requirements.

The proposal response may be incorporated into any contract which results from this
RFP. Vendors are cautioned not to make claims or statements to which they are not
prepared to commit contractually. Failure by the vendor to meet such claims will result
in a requirement that the vendor provide resources necessary to meet submitted claims.

The vendor is expected to examine all documents, forms, specifications and instructions.
Failure to do so will be at vendor‟s risk.

Harris County will not be liable for any costs incurred by the vendor in preparing a
response to this RFP. Vendors submit proposals at their own risk and expense. Harris
County makes no guarantee that any product or service will be purchased as a result of
this request for proposal, and reserves the right to reject any and all proposals. All
proposals and their accompanying documents will become the property of Harris
County. All proposals are open to negotiation.

All documents will be held by the County and are NOT subject to public review until an
award is made. Under the Request for Proposal process, sealed offers will be received
and opened in the Office of the Purchasing Agent. At and after opening, proposals will
NOT be part of the public record and subject to disclosure, but will be kept confidential
until time of award. When such award is completed, proposals will be available for
public inspection, including those portions marked confidential and/or proprietary.

2.0 EVALUATION PROCESS
All proposals will be examined by an evaluation committee consisting of representatives
from various departments and clinics within Harris County Hospital District as well as
members from Harris County Purchasing. Members may be added as needed.

Proposals which do not conform to the instructions given or which do not address all the
questions and/or services specified may be eliminated from consideration. Harris
County, however, reserves the right to accept such a proposal if it is determined to be in
the County‟s best interest to do so.

Harris County may initiate discussions with vendors. Proposals will be accepted during
this period but only from vendors who responded to the original request. Discussions
may not be initiated by vendors. Harris County expects to conduct discussions with
vendor personnel authorized to contractually obligate the vendor with an offer.

Proposals, vendor interviews and/or evaluations will develop into negotiating sessions
with the successful vendor as selected by the evaluation committee. If Harris County is
unable to agree to contract terms, Harris County reserves the right to terminate contact
negotiations with that vendor and initiate negotiations with another vendor.

All correspondence relating to this RFP, from advertisement to award, shall be sent
to the Office of the Harris County Purchasing Agent. All presentations and/or
meetings between Harris County and the vendor relating to this RFP shall be


                                                                                    Page 9 of 41
     coordinated by the Office of the Harris County Purchasing Agent. All
     correspondence, written and/or verbal, shall be through the Office of the Harris
     County Purchasing Agent.

     Before, during or after award, Harris County will not be obligated to the vendor for
     products and/or services until the completion of a signed purchase order from Harris
     County Hospital District. Progress toward this end is solely at the discretion of Harris
     County and may be terminated at any time prior to the issuance of a purchase order.

     Submission of a proposal implies the vendor‟s acceptance of the evaluation criteria and
     vendor recognition that subjective judgements must be made by the evaluating
     committee.

     3.0 EVALUATION CRITERIA
     Award of the proposal shall be made to the responsible vendor whose proposal is
     determined to be the best evaluated offer resulting from negotiations, taking into
     consideration compliance with instructions, specifications and quality of the services
     proposed which best meet the needs of the using department. Harris County may use
     references to make judgements directly affecting the award of this proposal.



Harris County Hospital District Overview

District Background

The mission of the Harris County Hospital District is to provide access to cost-effective, quality
health care and deliver it in a compassionate manner to all residents of Harris County. By
hospital admissions, number of births, clinic visits, and emergency center visits, the Hospital
District is the largest health care provider in the Texas Gulf Coast area. It is the sixth largest
hospital system in the United States.

In 1994 and 1995, the Harris County Hospital District was named one of the "Top 100 hospitals”
in the United States by Modern Healthcare Magazine. This honor was given in recognition of the
District's patient care outcomes and financial management. The medical staff is affiliated with
two of the finest medical schools in the country - Baylor College of Medicine and the University
of Texas Houston Health Science Center. The dental staff is from the University of Texas Dental
Branch and a private contract service.

AWARD:
It is anticipated that the award will be all or nothing; however, if it is deemed in the best interest
for Harris County Hospital District, multiple awards could be possible.




                                                                                         Page 10 of 41
                                       SPECIFICATIONS

 PROPOSAL FOR:
                                    LASER PRINTING SYSTEM
                                 for Harris County Hospital District’s
                                Accounts Payable and Payroll Functions

SCOPE:
Harris County Hospital District (HCHD) invites qualified vendors to respond to this proposal for a
LASER PRINTING SYSTEM for its Accounts Payable and Payroll Departments. The awarded
system will integrate with the Payroll and Accounts Payable systems to capture payment
information and automate paper-based payments. Printing media will include, but may not be
limited to, paper checks, direct deposit “stubs”, and year-end forms/reports. The printing is
anticipated to be from a laser printer utilizing blank stock. Questions concerning the RFP process
may be directed to Dan Thweatt in the Office of the Harris County Purchasing Agent at
713.755.5982. Questions concerning the content, clarification, or additional information associated
with the RFP must be E-mailed to dan_thweatt@co.harris.tx.us. The last date that questions will be
entertained for this RFP is Tuesday, May 15, 2001, 12:00 noon. Any and all questions associated
with content, clarification, or additional RFP information will be returned to all vendors of record
prior to the opening date.

SPECIFICATIONS:

BACKGROUND INFORMATION AND STATISTICS:
By hospital admissions, number of births, clinic visits, and emergency center visits, the Harris
County Hospital District is the largest health care provider in the Texas Gulf Coast area. It is the
sixth largest hospital system in the United States.

The Harris County Hospital District consists of three (3) hospitals, a number of outlying
Community Health Centers, a specialty HIV/AIDS clinic, and a central Dental Center with
satellites located in several of the clinics.

The medical staffs associated with the facilities are from Baylor College of Medicine and the
University of Texas Houston Health Science Center while portions of certain services (e.g.
podiatry and dental) are outsourced.

CURRENT ACCOUNTS PAYABLE, PAYROLL AND CASH MANAGEMENT SYSTEM
USERS PROFILE:
HCHD Accounts Payable, Payroll and Patient Business Services perform functions involving
payment and disbursement processing while the Cash Management Department performs
functions involving printing and handling of checks, process control, and exceptions. The current
volume of disbursement transactions is approximately 13,750 per month consisting of 4,000
payroll checks, 7,500 direct deposit payroll disbursements, 2,250 accounts payable checks, and
patient refund checks.




                                                                                        Page 11 of 41
FUTURE SYSTEM CONFIGURATION:
Harris County Hospital District is in the process of acquiring systems that will replace the current
ones utilized by Accounts Payable and Payroll. The new systems will be used to process all
checks and disbursements for HCHD. A new Patient Accounting system has been purchased and
will be used to process patient refund checks.

SYSTEM GOAL:
It is the ambition of the District to obtain an application that will allow HCHD to generate
payments more efficiently, obtain and disseminate accurate and concise payment transaction
information, provide state of the art cash management tools, and provide the highest degree of
security and fraud protection available as well as provide a greater flexibility in the reporting of
Tax Forms (e.g. 1099‟s and W2‟s).

SYSTEM CHARACTERISTICS:
   Relational/object oriented design
   Consistent and easy to use graphical user interfaces
   Easy to use database reporting tools and utilities
   Tools that permit the user to extend the functionality of the system
   Standard EDI compliant
   Bi directional interfaces with other applications on various platforms
   Flexibility of the system allowing quick and easy adaptation to changing business needs
   Flexibility of integration and design features allowing customization of certain
     functions/reports by the user




                                                                                        Page 12 of 41
VENDOR RESPONSE REQUIREMENTS:

The following table summarizes the sections of the Offeror‟s response to this Request for
Proposal. Detailed instructions for responding follow.

                       Section of Contents
                       Response
                       I          Table of Contents
                       II         Preface
                                  II A - Proposal Cover Sheet
                                  II B - Residence Certification
                       III        Response to Requirements
                                  III A - Corporate Summary:
                                      III A.1 - Corporate Profile
                                      III A.2 - Financial Reports
                                      III A.3 - Sample Standard
                                      Contract
                                      III A.4 - Organizational Chart
                                  III B – Questionnaire Sections:
                                      III B.1 - Product Overview
                                      III B.2 - Technical
                                      Requirements
                                      III B.3 - Functional
                                      Requirements
                       IV         Pricing and Delivery
                       V          Client References
                       Appendi Offeror Marketing Literature
                       x          (optional)




                                                                              Page 13 of 41
Instructions for Response:
The following provides instructions for preparing the sections of the Offeror‟s response to this
Request for Proposal.
Section I: Table of Contents
               Offeror should prepare a Table of Contents for the Offeror‟s response document
               indicating the content of each section with the response.
Section II:Preface
               Insert the completed Proposal Cover Sheet (first page of this RFP) and the
               completed Residence Certification (RFP Attachment).
Section III:   Response to Requirements
               This section should contain responses to the information requested within the
               “Component” sections contained within the “Specifications” section of this RFP.
               Responses to these Specifications will be evaluated to determine the operational
               feasibility and desirability of implementing the Vendor's system in the HCHD
               environment.
               This section of the Offeror‟s response should be organized as follows:
               III A - Corporate Summary:
               Should contain your responses to the following sections of the Specifications:
                      III A.1 - Corporate Profile
                      This section provides general information regarding the Offeror‟s
                      company, and an overview of the methodology that the Offeror proposes
                      to utilize to implement the system if awarded.
                      III A.2 – Financial Statement
                      III A.3 – Organizational Chart


               III B - Questionnaire Sections
                      III B.1 - Product Overview
                      This section provides an overview of the solution that is being proposed
                      and an overview of the methodology that the Vendor proposes to utilize to
                      implement the solution, if awarded.
                      III B.2 - Technical Requirements
                      This section provides information about the operating system, database,
                      system utilities, data and systems communications, system administration,
                      and other characteristics of the hardware and software configuration
                      proposed.




                                                                                        Page 14 of 41
                     III B.3 - Functional Requirements
                     This section describes the features and functionality of the solution.
                            All responses to Functional Requirements statements must be
                             answered in the „Keyed Vendor Response‟ column using one of the
                             following codes:
                        P – The functionality is in production at (minimally) five client sites.
                        B – The functionality is in Beta release at (minimally) one client site.
                        D – The functionality is currently in design.
                        U – The functionality is unavailable.
                            Responses that do not correspond to one of the above codes will
                             not be evaluated.
               Comments – Where it is desirable or necessary to clarify your responses with
                additional information, documentation, or a reference to a response elsewhere
                in your proposal, provide a cross-reference to the additional details in the
                Comment Reference column or on a separate sheet. All comments, cross-
                referenced to the appropriate requirement statement, should be inserted in the
                hard-copy response following the Functional Requirements Questionnaire.
Section IV:   Pricing and Delivery
              This section of the proposal should contain the Pricing/Delivery Information
              forms provided in that Section of this Request for Proposal.
                    You must complete the Component Pricing/Delivery Information form for
                     the HCHD LASER PRINTING SYSTEM proposed. No other pricing
                     format will be accepted.


Section V: Client References
              As part of the evaluation process, one or more members of the evaluation team
              will contact current users of the Offeror‟s system(s). Offerors should include a list
              of reference clients available to the team for such discussions.
              Responses to this section should include: organization name, system installation
              date, user name(s), and user(s) phone number(s). Client references should be
              someone with direct experience and responsibility for the system being proposed
              to Harris County.
               Offeror should provide those client references that most represent Harris
                County Hospital District‟s technical and operational environment for the
                HCHD LASER SYSTEM PRINTING that the Offeror is proposing.
Appendix:     Offeror Marketing Literature (optional)
              This Section is optional. Offeror literature may be included in an Appendix to the
              proposal.




                                                                                         Page 15 of 41
                                  HCHD -Corporate Profile
                           (return in Section III A.1 of your response)

    REQUIREMENT                                     RESPONSE
Name and Address of Company
1 Contact Person
2 Phone Number
3 FAX Number
4 E-Mail Address
Company Profile - Need only be answered once for the entire proposal
5 How many years has your company been in
   business?
6 Have you acquired, been acquired or merged
   with another company within the last four
   years? Is so, provide description.
7 Provide organizational financial reports for Include as attachment to this section of your
   the last two years.                            response. (section III A.2 of your response)
8 Provide a brief financial overview of the
   organization for the past two years: include
   gross revenue, profit/loss, and expenses by
   major category (e.g. development, support).
9 Provide a copy of your standard contract.       Include as attachment to this section of your
                                                  response. (section III A.3 of your response)
10 Describe the ownership of your organization
   and identify significant owners, investors, or
   stockholders.
11 Provide an organizational chart of your Include as attachment to this section of your
   company.                                       response. (section III A.4 of your response)
12 Provide a total number of employees.
   Provide the number of employees
   responsible for:
13    Software development
14    Installation/support
15 Does your company have affiliations or
   business dealings with any of the following:
   Harris County, Harris County Hospital
   District, University of Texas Medical
   Branch, Baylor College of Medicine?
16 Does your company enter into development
   partnership agreements which could be
   considered with HCHD in return for: a live
   laboratory to test new functions; access to
   teams including physicians and other
   providers with expert knowledge? If so
   include a description of a typical agreement.



                                                                                    Page 16 of 41
17 Is your company willing to sell the
     application software and maintenance for
     the application software only (excluding
     hardware, operating systems, third party
     software and any other specific needs)?
18 Describe the direction that you intend to
     take for this product offering and technology
     changes over the next 3 years
Implementation/Training Methodology
19 Do you contract with a third party for
     implementation services/resources? If so,
     describe these services
20 What implementation resources do you
     provide for this application and what
     activities would they perform?
21 What implementation resources/staffing
     would HCHD need to provide? What
     activities would they perform?
22 What is your approach to training?
23 Would classes be conducted at HCHD
     facilities?
24 Do you perform custom programming? If
     so, how does the use of custom
     programming affect HCHD‟s ability to
     receive software updates?
Post Implementation Support/Maintenance
25 Is 24 hour by 7 day implementation support
     coverage provided immediately after the
     Go-Live? If so, for how long?
26 Do you maintain a 24-hour by 7-day support
     center? If not, how is off-hours support
     handled?
27 How are support calls prioritized?
28 What call turnaround/escalation policies are
     in place?
29 What warranties are provided?
30 How often are upgrades released?
31 What method or media is used to distribute
     upgrades?
32 What is the process for submission and
     scheduling of user requested enhancements?




                                                     Page 17 of 41
                          QUESTIONNAIRE - Product Overview
                           (return in section III B.1 of your response)

    REQUIREMENT                                     RESPONSE
Company Information
1 How many years has your company been in
    the business of providing the product on
    which you are proposing to bid on?
2 What percentage of your revenue comes
    from the product on which you are
    proposing to bid on?
3 What is the total number of employees in
    the areas of the product on which you are
    proposing to bid on broken down by the
    following categories: software research and
    development, installation support
Product Overview
4 What is the name of the product on which
    you are proposing to bid on?
5 Provide a brief description of the product on
    which you are proposing to bid on.
6 Provide the total number of clients using the
    proposed product.
7 Provide total number of new clients for this
    product in 2000
8 Provide the number of live sites on this
    version of the proposed product and how
    long they have been live.
9 Provide         the    number    of    current
    implementations underway.
10 What        release    are   you    currently
    implementing?
Implementation/Training Methodology
11 What is the average timeframe to implement
    your system?
12 How long do you estimate HCHD will take
    to install your system?
13 How much time will your installers spend
    on site?
14 What implementation documentation is
    provided?
15 Please provide a syllabus of the classes that
    you offer.




                                                                          Page 18 of 41
16 What is the average length of time for user,
   trainer, and operator training?
17 What training documentation is provided?




                                                  Page 19 of 41
                       QUESTIONNAIRE - Technical Requirements
                           (return in section III B.2 of your response)

     REQUIREMENT                                     RESPONSE
Database System
1    What database management systems does
     your system support?
2    What is the most recent version of each
     database management system that you
     currently support?
3    What      is    your     preferred  database
     management system?
4    Can your implementation link physical
     databases from multiple facilities into a
     single consolidated database?
5    Is your database implementation based on
     relational database technology?
6    How can the database monitoring tools be
     used to manage impending maintenance
     needs and potential problems and
     performance impacts (e.g., tool will monitor
     and detect prior to real problem occurring) ?
7    Does your application use logical units of
     work and good transaction processing
     practices to prevent partially committed
     records from being written?
8    How quickly will the application software
     be certified against a new major version
     release of the database subsystem?
9    Can the database accept binary-large-objects
     (BLOBs) and can they be referenced via the
     relational engine?
Reporting Tools
10 What reporting tool do you standardly
     deploy with your system?
11 Are industry standard ad-hoc reporting tools
     available?
12 Is a dedicated, application-specific ad hoc
     report writer provided?
13 Are standard data dictionaries provided for
     use with industry standard reporting tools?
14 Are standard pre-defined SQL queries and
     related calculations provided for use with
     industry standard reporting tools?


                                                                          Page 20 of 41
      REQUIREMENT                                    RESPONSE
 15 Does your implementation provide an
      integrated security system that can apply
      user-level security to any report writing tool
      to restrict or prevent access?
Interfaces
 16 Provide an inventory of the systems for
      which you have developed standard
      interfaces:
 17       Vendor Name
 18       Product Name
 19       Hardware Platform
 20       Communication Protocol and Method
 21       Date of Completion (In Production)
 22 Name of Healthcare Institution (Facility)
 23 Provide a list of interface engines for which
      you have developed standard interfaces.
 24 Can a backlog in an application interface
      queue trigger a system alarm?
 25 Can the system alarm trigger a page, FAX,
      email, etc.?
 26 What is the most recent version of ANSI
      HL7 standards with which your interfaces
      are compliant?
 27 Do all interfaces support HL7 custom or "Z"
      segments?
Security
 28 Describe in detail the access control and
      security features of the system including:
 29       techniques employed
 30       levels of security
 31       terminal and user level security
 32       restriction at the menu level
 33       ability to selectively restrict access to
          patients and/or individual orders/results
 34 Describe the use of audit trails in terms of
      the following:
 35       data collected
 36       retention duration
 37       accessibility
 38 Does your implementation integrate with the
      operating system and network security to
      allow a single logon for a user?
 39 Can security be specified by physical
      operational location of a workstation and by
      user profile?


                                                                Page 21 of 41
     REQUIREMENT                                     RESPONSE
 40 Can security be applied to database content
     at row level granularity?
 41 Can security access to tables be limited to
     view, update, insert, delete, etc.?
 42 How complex of a data encryption
     algorithm do you support (128 bit key, 64
     bit key, etc.)?
 43 Can any security violation alert, alarm, or
     event trigger real-time notification of staff
     (via pager, FAX, email, etc.) and be logged?
 44 Do you offer a single sign-on security tool
     and/or support an integration strategy using
     a third-party single sign-on security tool??
System Administrations/Operations
 45 Provide a summary of the tasks routinely
     performed by computer operators after the
     system is operational.           Indicate the
     approximate amount of time per day
     required for each of these tasks.
 46 Describe any system downtime or
     degradation of performance incurred for
     backups or maintenance.
 47 Identify whether the following redundancy
     or fail-safe capabilities are available with
     the system:
 48      Disk mirroring, shadowing or RAID 5
 49      CPU mirroring or CPU cluster
         technology
 50      Transaction roll-back and roll-forward
 51      Restoration of selected transactions to
         database (e.g., select specific date and/or
         time ranges for restore)
 52 What is the typical time to perform system
     backup?
 53 Describe the features that allow user-defined
     criteria for archiving records.
 54 Does the system support large-scale
     industry-standard tape backup?
 55 Describe how selected archival records
     could be "re-loaded" into the active
     database, if necessary.
 56 Are separate training, testing, and
     production environments supported?
 57 Are there additional fees for support for
     multiple environments?


                                                                Page 22 of 41
    REQUIREMENT                                    RESPONSE
58 Does the software application suite include
    tools      for     monitoring      application
    performance in a distributed environment?
59 Can the system resource utilization by
    normal periodic processing jobs be limited
    to user-specified maximum percentages of
    available resources?
60 Can a job run-time error or the omission of
    a job in a jobstream trigger an alarm?
61 What guarantee will you provide that your
    transaction processing will prevent partially
    committed records from being written?
    What are the client's contractual obligations
    required to maintain your guarantee?
Network

62   Which       is   the    preferred  network
     environment for your system?
63 Has your application been deployed with
     Compaq servers running MS NT Enterprise
     Release 4 with Service Pack 5?
64 Has your application been deployed
     without using any fixed IP addresses
     (taking advantage of DHCP address
     resolution)?
65 What other additional protocols were
     required for a successful implementation?
66 Has your application been successfully
     deployed, running in native mode, in a
     wide-area network environment?
Operating System
67 Describe the operating systems supported in
    terms of the following:
68      workstations
69      application servers
70      database servers
71 Which are the preferred operating systems?
72 How quickly will the application software
    be certified against a new major release of
    the client operating system?
73 How quickly will the application software
    be certified against a new major release of
    the server operating system?




                                                              Page 23 of 41
Hardware
 74     What types of workstations are supported
        on the system?
 75     What types of peripheral devices (e.g.,
        printers, scanner, etc.) are supported on
        the system?
 76     What brands of application servers are
        supported on the system?
 77     What brands of database servers are
        supported on the system?
 78     What       is     the   minimum/optimum
        workstation       hardware    configuration
        required to run the application?
 79     Do you provide a performance guarantee?
        If so, what are the client's contractual
        obligations required to maintain your
        performance guarantee?
 80     Specify the response time level for which
        a performance guarantee would be
        provided.
 81     Does the application support distributed
        processing?
 82     Has the application been successfully
        deployed using Dell workstations running
        MS NT Workstation Release 4 with
        Service Pack 5?
General
83        How does the system accept and
                manage data from multiple
                facilities?
84        Specify user interfaces supported.
85        Will you place your source code in
                escrow?
86        Is all documentation for the application
                available on-line?
87        Is training material available on-line?
88          Is full and complete "help"
            documentation available on-line?
89          Is context-sensitive and user-defined
            help available on-line?
90          Is character-based ASCII output
            available as an optional output for any
            screen display?
91          Is your GUI interface MS Windows
            standards compliant?




                                                      Page 24 of 41
92          Do you require any specific terminal
            emulation software to allow your
            application to run on a Windows NT
            desktop? Is the emulator industry
            standard and available off-the-shelf?
93          What is the percentage distribution
            within your current client base of your
            different         user         interface
            implementation options (e.g., MS
            Windows, other GUI (X-Windows,
            Motif, etc), character-based)?
Application Language
94     What application language(s) are utilized
       by your system?
95     If more than one language is used, in
       general terms, indicate which modules
       utilize which language.
96     Which is the preferred application
       development language?
97     What percentage of the application
       modules were written more than:
98         5 years ago
99         2 years ago
100        1 year ago
101    Has the application been migrated from
       another language in which it was
       originally written?




                                                       Page 25 of 41
                     QUESTIONNAIRE – Functional Requirements
                           (return in section III B.3 of your response)

   1. Payment generation and consolidation. Does your system:

REF #   REQUIREMENT                               KEYED            COMMENT
                                                  VENDOR
                                                  RESPONSE
LP 1    Provide for the consolidations of
        check printing and disbursement
        processing for multiple systems?
LP 2    Provide the ability to print checks in
        remote locations in a controlled and
        secure environment?
LP 3    Allow for a smooth transaction
        between printing of checks and
        creating electronic disbursement
        transactions        without        user
        intervention?
LP 4    Provide the capability of printing
        address bar codes that are compliant
        with US postal codes?
LP 5    Provide the capability for sorting of
        printed checks in various ways that
        will facilitate special processing and
        handling needs such as a second
        signature for checks over a specified
        dollar amount?
LP 6    Provide easy interface mapping
        capabilities to facilitate the flow of
        data to and fro from other
        application?
LP 7    Provide the ability to print overflow
        remittance information on plain
        paper and not check stock without
        user intervention?
LP 8    Provide the ability to process credit
        card refunds as a part of the normal
        disbursement process?
LP 9    Provide the ability to process
        disbursement from multiple banks
        and      accounts      with     limited
        intervention from users?
LP 10   Provide the ability to easily add new
        and inactive unused banks and
        accounts easily and quickly?




                                                                             Page 26 of 41
LP 11      Provide the ability to restart check
           printing at the point where a problem
           was encountered, such as paper jams
           or network problems?
LP 12      Provide the ability to reprint spoiled
           checks with appropriate security and
           reporting?
LP 13      Provide the ability to process manual
           checks easily? What security does
           your system provide for this process
           if the manual check printing is
           available?
LP 14      Provide the ability to accept multiple
           input files in multiple file formats
           and layouts?

“Keyed Vendor Response” Codes
P-Functionality is in production at (minimally) five client sites
B-Functionality is in Beta release at (minimally) one client site
D-Functionality is currently in design
U-Functionality is unavailable




                                                                    Page 27 of 41
   2. Security and Fraud Prevention. Does your system:


REF #   REQUIREMENT                               KEYED    COMMENT
                                                  VENDOR
                                                  RESPONSE
LP 15   Provide the ability to utilize positive
        pay processing offered by major
        banking institutions?
LP 16   Provide encryption capabilities for
        the data and print images?
LP 17   Provide a secure process for clearing
        out print queues and printer buffers
        when the printing process has been
        interrupted? For example, how does
        your system handle a check image
        left in the print queue when a printer
        has lost power to make sure that the
        print image does not automatically
        start printing when the power is
        returned and the responsible check
        processing person is not there?
LP 18   Provide multiple levels of security
        that can be tailored to the specific
        needs and responsibilities of the
        individual users?
LP 19   Provide password-protected security
        requiring a valid user id and
        password combination to access the
        system?
LP 20   Provide automatic log-off of users
        when there has been no activity from
        the users workstation after a specified
        period of time?
LP 21   Provide an audit log of user specific
        activity?
LP 22   Provide protection of check specific
        printable features, such as signatures
        and MICR characters?
LP 23   Provide security and protection of the
        print image as it goes through the
        network to the printer?
LP 24   Provide batch totals for reconciliation
        of disbursement sent from feeder
        systems to the disbursement system?

LP 25   Provide protection against backdating



                                                                     Page 28 of 41
           and/or rerunning a previous file in
           error?
LP 26      Provide protection against issuing
           duplicate checks or issuing duplicate
           check numbers for a particular
           institution and account?

“Keyed Vendor Response” Codes
P-Functionality is in production at (minimally) five client sites
B-Functionality is in Beta release at (minimally) one client site
D-Functionality is currently in design
U-Functionality is unavailable




                                                                    Page 29 of 41
3. Financial EDI. Does your system:
REF # REQUIREMENT                                           KEYED    COMMENT
                                                            VENDOR
                                                            RESPONSE
LP 27      Provide the ability to process
           electronic payments, such as ACH as
           well as EDI standard payments?
LP 28      Provide the ability to transmit EDI
           remittance information?
LP 29      Provide the ability to process
           electronic payment of taxes that are
           compliant with the specifications set
           forth by the Federal Government?
LP 30      Provide a pre-noting capability for
           electronic payment processing?
LP 31      Provide the ability to specify the
           effective    dates    for  electronic
           processing?
LP 32      Provide the ability to specify bank
           holidays and the limit the ability of
           processing an electronic payment
           with an effective date being a bank
           holiday?

“Keyed Vendor Response” Codes
P-Functionality is in production at (minimally) five client sites
B-Functionality is in Beta release at (minimally) one client site
D-Functionality is currently in design
U-Functionality is unavailable




                                                                               Page 30 of 41
4. Cash Management and Reconciliation Tools. Does your system:
REF # REQUIREMENT                              KEYED      COMMENT
                                               VENDOR
                                               RESPONSE
LP 33    Provide a quick and accurate way of
         performing check reconciliation
         functions with the bank?
LP 34    Provide the ability to transfer funds
         between accounts and/or banking
         institutions?
LP 35    Provide the ability to clear
         outstanding checks?
LP 36    Provide the ability to forecast cash
         requirements?

“Keyed Vendor Response” Codes
P-Functionality is in production at (minimally) five client sites
B-Functionality is in Beta release at (minimally) one client site
D-Functionality is currently in design
U-Functionality is unavailable




                                                                    Page 31 of 41
5. Reporting and Information Management. Does your system:
REF # REQUIREMENT                                KEYED    COMMENT
                                                 VENDOR
                                                 RESPONSE
LP 37    Provide the ability to maintain history
         of transactions for auditing purposes?
LP 38    Provide control reports that show
         pertinent      information       about
         processing batches?
LP 39    Provide reporting tools that allow
         users to create custom report with
         limited assistance from information
         technology personnel?
LP 40    Issue checks on plain paper with self-
         mailer capability.
LP 41    Supports design of 1099 and W2
         forms with ability to change forms for
         regulatory changes.

“Keyed Vendor Response” Codes
P-Functionality is in production at (minimally) five client sites
B-Functionality is in Beta release at (minimally) one client site
D-Functionality is currently in design
U-Functionality is unavailable




                                                                    Page 32 of 41
6. General. Is your system:
REF # REQUIREMENT                                          KEYED      COMMENT
                                                           VENDOR
                                                           RESPONSE
LP 42      Capable of providing a Form Design
           Tool.
LP 43      Supported by your company
           including ongoing updates with new
           functionality and new requirements?
LP 44      Allow system configuration for
           additional applications to be added
           in future.
LP 45      Flexible data mapping allowing
           custom-presented      checks    and
           documentation.
LP 46      Single system to do all the micr
           printing including AP and Payroll
           Checks

“Keyed Vendor Response” Codes
P-Functionality is in production at (minimally) five client sites
B-Functionality is in Beta release at (minimally) one client site
D-Functionality is currently in design
U-Functionality is unavailable




                                                                                Page 33 of 41
                                         REFERENCES
                                (return in section V of your response)

1.     Company Name:     ____________________________________
       Address:          ____________________________________
                         ____________________________________
Contact Name:____________________________________________
Contact Telephone: ______________________________________

Version and Release of Software:      _____________
Number of years utilized by client:   _____________

2.     Company Name:     ____________________________________
       Address:          ____________________________________
                         ____________________________________
Contact Name:____________________________________________
Contact Telephone: ______________________________________

Version and Release of Software:      _____________
Number of years utilized by client:   _____________

3.     Company Name:     ____________________________________
       Address:          ____________________________________
                         ____________________________________
Contact Name:____________________________________________
Contact Telephone: ______________________________________

Version and Release of Software:      _____________
Number of years utilized by client:   _____________

4.     Company Name:     ____________________________________
       Address:          ____________________________________
                         ____________________________________
Contact Name:____________________________________________
Contact Telephone: ______________________________________

Version and Release of Software:      _____________
Number of years utilized by client:   _____________

5.     Company Name:     ____________________________________
       Address:          ____________________________________
                         ____________________________________
Contact Name:____________________________________________
Contact Telephone: ______________________________________

Version and Release of Software:      _____________
Number of years utilized by client:   _____________



                                                                         Page 34 of 41
   SOFTWARE DELIVERY, MAINTENANCE, AND IMPLEMENTATION PRICING
                                  (return in section IV of your response)


                    REQUIREMENT                                               RESPONSE
                                                             (add additional pages if necessary and reference the
                                                                           corresponding number)

1. Application Software License Costs
     Provide detailed application software license
     costs (by module, if applicable). Show for 5
     years. Do not include third party software costs.

2. Third-Party Software License Costs
     Provide detailed third party software license
     costs, including database and operating system
     software, plus any other required third-party
     software.

3. Hardware (see Note #1)
     Provide detailed hardware costs (exclude
     workstation costs). Please refer to the
     statistical overview section under Special
     Requirements/Instructions

4. Conversions
     Provide detailed costs of data conversions
     (include type of data conversions required) by
     technical requirements response.

5. Interface Development
      Provide detailed interface licensing costs (by
      interface as noted in response to technical
      requirements)
      Provide detailed interface
      implementation/professional services costs (by
      interface)

6. Custom Programming Costs
     Provide hourly rate for custom programming

7. Implementation/Professional Service Costs
     Provide detailed costs for implementation
     services by:
        Training (classes, materials and
        documentation)
        Vendor implementation resources (hourly
        rates/travel expenses, etc.)



                                                                                                       Page 35 of 41
                      REQUIREMENT                                           RESPONSE
                                                           (add additional pages if necessary and reference the
                                                                         corresponding number)

8. Annual Maintenance and Support
     Provide detailed annual maintenance and
     support for:
        Application Software
        Interfaces
        Hardware (if purchased as part of this RFP)
        Database
        Operating System
        Any other Third-Party Software

9. Additional Expenses
     Provide detail cost for any other expenses
     required not detailed above

System will be delivered and installed within __________ days after receipt of "Executed Contract" and
purchase order

Related to Item #3, Note #1: HCHD reserves the right to purchase additional required hardware from
other sources if found to be in its best interest.




                                                                                                     Page 36 of 41
                                       RESIDENCE CERTIFICATION
                                          (return in section I of your response)

Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests Residence
Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of
governmental contracts; pertinent provisions of §2252.001 are stated below:

   (3)   "Nonresident bidder" refers to a person who is not a resident.

   (4)   "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor
         whose ultimate parent company or majority owner has its principal place of business in this state.



        I certify that ______________________________ is a Resident Bidder of Texas as defined in
                                 [Company Name]
   Government Code §2252.001.




 I certify that ___________________________________ is a Nonresident Bidder as defined in
                            [Company Name]
   Government Code §2252.001 and our principal place of business is _________________________.
                                                                              [City and State]




                                                                                                             Page 37 of 41
                                Minimum Insurance Requirements

•        The contractor shall, at all times during the term of this contract, maintain insurance coverage with
         not less than the type and requirements shown below. Such insurance is to be provided at the sole
         cost of the contractor. These requirements do not establish limits of the contractor's liability.

•        All policies of insurance shall waive all rights of subrogation against the County, its officers,
         employees and agents.

•        Upon request, certified copies of original insurance policies shall be furnished to Harris County.

•        The County reserves the right to require additional insurance should it be deemed necessary.

A.       Workers' Compensation (with Waiver of subrogation to Harris County) Employer's Liability,
         including all states, U.S. Longshoremen, Harbor Workers and other endorsements, if applicable to
         the Project.

         Statutory, and Bodily Injury by Accident: $100,000 each employee. Bodily Injury by Disease:
         $500,000 policy limit $100,000 each employee.


B.       Commercial General Liability Occurrence Form including, but not limited to, Premises and
         Operations, Products Liability Broad Form Property Damage, Contractual Liability, Personal and
         Advertising Injury Liability and where the exposure exists, coverage for watercraft, blasting
         collapse, and explosions, blowout, cratering and underground damage.

         $300,000 each occurrence Limit Bodily Injury and Property Damage Combined $300,000 Products-
         Completed Operations Aggregate Limit $500,000 Per Job Aggregate $300,000 Personal and
         Advertising Injury Limit. Harris County shall be named as "additional insured" on commercial
         general liability policy.


C.       Automobile Liability Coverage:

         $300,000 Combined Liability Limits. Bodily Injury and Property Damage Combined. Harris
         County shall be named as "additional insured" on automobile policy.

Revised 12/00




                                                                                                   Page 38 of 41
       TWCC RULE 110.110 WORKERS' COMPENSATION INSURANCE COVERAGE

If this bid/proposal package is for a building or construction contract, all of the provisions of this
rule as shown below apply. Since this is a mandatory requirement, cost increases should not be
experienced because of the need to comply with the Texas Workers' Compensation Law. For
additional information contact the Texas Workers' Compensation Commission, Southfield Building,
400 S. IH-35, Austin, Texas 78704-7491, (512) 440-3618.

A.     Definitions:

              Certificate of coverage ("Certificate") - A copy of a certificate of insurance, a certificate of
              authority to self-insure issued by the commission, or a coverage agreement, TWCC-81,
              TWCC-82, TWCC-83, or TWCC-84 showing statutory workers' compensation insurance
              coverage for the person's or entity's employees providing services on a project, for the
              duration of the project.

              Duration of the project - Includes the time from the beginning of the work on the project
              until the contractor's/person's work on the project has been completed and accepted by the
              governmental entity.

              Persons providing services on the project ("subcontractor" in §406.096) - Includes all
              persons or entities performing all or part of the services the contractor has undertaken to
              perform on the project, regardless of whether that person contracted directly with the
              contractor and regardless of whether that person has employees. This includes, without
              limitation, independent contractors, subcontractors, leasing companies, motor carriers,
              owner-operators, employees of any such entity, or employees of any entity, which furnishes
              persons to provide services on the project. "Services" include, without limitation,
              providing, hauling or delivering equipment or materials, or providing labor, transportation,
              or other service related to a project. "Services" does not include activities unrelated to the
              project, such as food/beverage vendors, office supply deliveries, and delivery of portable
              toilets.

B.     The Contractor shall provide coverage, based on proper reporting of classification codes and payroll
       amounts and filing of any coverage agreements, which meets the statutory requirements of Texas
       Labor Code, Section 401.011(44) for all employees of the contractor providing services on the
       project, for the duration of the project.

C.     The Contractor must provide a certificate of coverage to the governmental entity prior to being
       awarded the contract.

D.     If the coverage period shown on the Contractor's current certificate of coverage ends during the
       duration of the project, the Contractor must, prior to the end of the coverage period, file a new
       certificate of coverage with the governmental entity showing that coverage has been extended.

E.     The Contractor shall obtain from each person providing services on a project, and provide to the
       governmental entity:



                                                                                                 Page 39 of 41
     (1)    A certificate of coverage, prior to that person beginning work on the project, so the
            governmental entity will have on file certificates of coverage showing coverage for all
            persons providing services on the project; and

     (2)    No later than seven (7) days after receipt by the Contractor, a new certificate of coverage
            showing extension of coverage, if the coverage period shown on the current certificate of
            coverage ends during the duration of the project.

F.   The Contractor shall retain all required certificates of coverage for the duration of the project and
     for one (1) year thereafter.

G.   The Contractor shall notify the governmental entity in writing by certified mail or personal delivery,
     within ten (10) days after the contractor knew or should have known, of any change that materially
     affects the provision of coverage of any person providing services on the project.

H.   The Contractor shall post on each project site a notice, in the text, form and manner prescribed by
     the Texas Workers' Compensation Commission, informing all persons providing services on the
     project that they are required to be covered, and stating how a person may verify coverage and
     report lack of coverage.

I.   The Contractor shall contractually require each person with whom it contracts to provide services
     on a project to:

     (1)    Provide coverage, based on reporting of classification codes and payroll amounts and filing
            of any coverage agreements, which meets the statutory requirements of Texas Labor Code,
            Section 401.011(44) for all its employees providing services on the project, for the duration
            of the project.

     (2)    Provide to the Contractor, prior to that person beginning work on the project a certificate of
            coverage showing that coverage is being provided for all employees of the person providing
            services on the project, for the duration of the project.

     (3)    Provide the Contractor, prior to the end of coverage period, a new certificate of coverage
            showing extension of coverage, if the coverage period shown on the current certificate of
            coverage ends during the duration of the project.

     (4)    Obtain from each other person with whom it contracts, and provide to the Contractor:

            (a)     A certificate of coverage, prior to the other person beginning work on the project,
                    and

            (b)     a new certificate of coverage showing extension of coverage, prior to the end of the
                    coverage period, if the coverage period shown on the current certificate of coverage
                    ends during the duration of the project;

     (5)    Retain all required certificates of coverage on file for the duration of the project and for one
            (1) year thereafter.
                                                                                               Page 40 of 41
   (6)     Notify the government entity in writing by certified mail or personal delivery, within ten
           (10) days after the person knew or should have known, of any change that materially affects
           the provision of coverage of any person providing services on the project; and

   (7)     Contractually require each person with whom it contracts, to perform as required by
           paragraphs (1) - (7), with the certificates of coverage to be provided to the person for whom
           they are providing services.

J. By signing this contract or providing or causing to be provided a certificate of coverage, the
   Contractor is representing to the governmental entity that all employees of the contractor who will
   provide services on the project will be covered by workers' compensation coverage for the duration
   of the project, that the coverage will be based on proper reporting of classification codes and payroll
   amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, in
   the case of a self-insured, with the commission's Division of Self-Insurance Regulation. Providing
   false or misleading information may subject the contractor to administrative penalties, criminal
   penalties, civil penalties, or other civil actions.

K. The Contractor's failure to comply with any of these provisions is a breach of contract by the
   contractor which entitles the governmental entity to declare the contract void if the Contractor does
   not remedy the breach within ten (10) days after receipt of notice of breach from the governmental
   entity.




                                                                                             Page 41 of 41

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:1463
posted:9/15/2010
language:English
pages:41
Description: Government W2 Forms Printable document sample