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					State of Wisconsin             Wis. Statutes s.16.75                                                                            DOA-3070
(R08/2003)
BIDS TO BE SEALED AND ADDRESSED TO:                Remove from bidder list for this commodity/service. (Return this page only.)
 AGENCY ADDRESS:                                            Bid envelope to be sealed and plainly marked in lower corner
 Department of Health Services                              with due date and Request for Bid 1718 DPH-BC Late bids
 1 West Wilson Street                                       will be rejected. Bids to be date and time stamped by the
 PO Box 7850                                                soliciting purchasing office on or before the date and time that
 Madison, WI 53707-7850                                     the bid is due. Bids dated and time stamped in another office
                                                            will be rejected. Receipt of a bid by the mail system does not
                                                            constitute receipt of a bid by the purchasing office. Any bid
 REQUEST FOR BID                                            which is inadvertently opened as a result of not being properly
                                                            and clearly marked is subject to rejection. Bids to be
                                                            submitted separately, i.e., not included with sample packages
                                                            or other bids. Bid openings are public unless otherwise
                                                            specified. Records will be available for public inspection after
                                                            issuance of the notice of intent to award or the award of the
                                                            contract. Bidder should contact person named below for an
                                                            appointment to view the bid record. Bids shall be firm for
                                                            acceptance for sixty (60) days from date of bid opening, unless
                                                            otherwise noted. The attached terms and conditions apply to
                                                            any subsequent award.
 THIS IS NOT AN ORDER                                       Bids to be in this office no later than
 BIDDER (Name and Address)                                  April 18, 2011 11:00am CST
                                                            Name (Contact for further information)
                                                            Bernadette Connolly
                                                            eMail Bernadette.Connolly@wi.gov Date Revised

                                                            Quote Price and Delivery FOB Wisconsin
                                                               Fax bids are accepted      Fax bids are not accepted
                                                               Email bids are accepted      Email bids are not accepted
 Item      Quantity                                                                      Price
                              Description
 No.       and Unit                                                                      Per Unit            Total
 1                            Wisconsin Emergency Assistance Volunteer Registration

 Payment Terms                                                         Delivery Time
           We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be
 granted to CERTIFIED Minority Business Enterprises. Bidder to be certified by the Wisconsin Department of Commerce. If you
 have questions concerning the certification process, contact the Wisconsin Department of Commerce, 5th Floor, 201 W.
 Washington Ave., Madison, Wisconsin 53702, (608) 267-9550. Does Not Apply to Printing Bids.
           We are a work center certified under Wis. Stats. s. 16.752 employing persons with severe disabilities. Questions
 concerning the certification process should be addressed to the Work Center Program, State Bureau of Procurement, 6th Floor, 101
 E. Wilson St., Madison, Wisconsin 53702, (608) 266-2605.
 Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when
 all other factors are substantially equal. Materials covered in our bid were manufactured in whole or in substantial part within the
 United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States.
              Yes        No        Unknown
 In signing this bid we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any
 collusion or otherwise taken any action in restraint of free competition; that no attempt has been made to induce any other person or
 firm to submit or not to submit a bid; that this bid has been independently arrived at without collusion with any other bidder,
 competitor or potential competitor; that this bid has not been knowingly disclosed prior to the opening of bids to any other bidder or
 competitor; that the above statement is accurate under penalty of perjury. We will comply with all terms, conditions and
 specifications required by the state in this Request for Bid and all terms of our bid.
 Name of Authorized Company Representative                 Title                                        Phone (        )
 (Type or Print)                                                                                        Fax     (      )
 Signature of Above                                        Date                    Federal Employer             Social Security No. if
                                                                                   Identification No.           Sole
                                                                                                                Proprietor (Voluntary)

This form can be made available in accessible formats upon request to qualified individuals with disabilities
                   REQUEST FOR BIDS (RFB)

                                For:

             Wisconsin Emergency Assistance Volunteer Registry

                       RFB# 1718-DPH-BC




                             Issued by:

                   STATE OF WISCONSIN
             DEPARTMENT OF HEALTH SERVICES
                DIVISION OF PUBLIC HEALTH


                          March 24, 2011




                         Bids to be submitted
              No later than April 18, 2011 11:00am CST


                For further information regarding this
RFB contact Procurement Manager Bernadette Connolly at 608 266-1138


                 LATE BIDS WILL BE REJECTED
      Wisconsin Emergency Assistance Volunteer Registry System RFB
1     INTRODUCTION AND PURPOSE .............................................................................................................................................. 5
    1.1     PURPOSE OF THE REQUEST FOR BID ............................................................................................................................................ 5
    1.2     REASONABLE ACCOMMODATIONS .............................................................................................................................................. 5
    1.3     SCOPE ......................................................................................................................................................................................... 5
    1.4     OVERVIEW OF PROCURING AGENCY ........................................................................................................................................... 6
    1.5     CONTRACT LENGTH .................................................................................................................................................................... 6
    1.6     METHOD OF AWARD ................................................................................................................................................................... 6
    1.7     CANCELLATION AND TERMINATION: .......................................................................................................................................... 6
    1.8     VENDORNET ............................................................................................................................................................................... 7
2     BID PROCEDURE AND INSTRUCTIONS ................................................................................................................................. 8
    2.1     METHOD OF BID ..................................................................................................................................................................... 8
    2.2     CALENDAR OF EVENTS ............................................................................................................................................................... 8
    2.3     FORMAT OF BID: .................................................................................................................................................................... 9
    2.4     MULTIPLE BIDS ........................................................................................................................................................................ 10
    2.5     INCURRING COSTS .................................................................................................................................................................... 10
    2.6     QUESTIONS ............................................................................................................................................................................... 10
    2.7     NEWS RELEASES: ................................................................................................................................................................. 11
3     BID ACCEPTANCE, EVALUATION AND AWARD ............................................................................................................... 12
    3.1     BID ACCEPTANCE ..................................................................................................................................................................... 12
    3.2     BID EVALUATION ..................................................................................................................................................................... 12
    3.3     NOTIFICATION OF INTENT TO AWARD ....................................................................................................................................... 12
    3.4     APPEALS PROCESS .................................................................................................................................................................... 12
4     TECHNICAL REQUIREMENTS ................................................................................................................................................ 14
    4.1     SYSTEM REQUIREMENTS........................................................................................................................................................... 14
    4.2     SECURITY & SYSTEM ADMINISTRATION .................................................................................................................................. 14
    4.3     SYSTEM HOSTING REQUIREMENTS ........................................................................................................................................... 15
    4.4     SYSTEM CUSTOMIZATION/MAINTENANCE ................................................................................................................................ 15
    4.5     INSTALLATION, SUPPORT, TRAINING, USABILITY ..................................................................................................................... 15
    4.6     REPORTING ............................................................................................................................................................................... 16
5     PERFORMANCE REQUIREMENTS ........................................................................................................................................ 17
    5.1     CREDENTIALING AND BACKGROUND CHECK REQUIREMENTS .................................................................................................. 17
    5.2     USE CASE ONE: REGISTRATION AND CREDENTIALING ............................................................................................................. 17
    5.3     USE CASE TWO: RESPOND TO AN EMERGENCY ......................................................................................................................... 18
    5.4     USE CASE THREE: MANAGEMENT OF AN EMERGENCY.............................................................................................................. 19
6     SUPPORT REQUIREMENTS ..................................................................................................................................................... 21

7     COST INFORMATION ................................................................................................................................................................ 22
    7.1     SYSTEM TOTAL COST SHEET .................................................................................................................................................... 22
    7.2     CREDENTIALING CHECK DETAILED COST SHEET...................................................................................................................... 22
    7.3     BACKGROUND CHECK IMPLEMENTATION COST SHEET............................................................................................................ 23
8     REQUIRED FORMS..................................................................................................................................................................... 24

9     TERMS AND CONDITIONS ....................................................................................................................................................... 25
    9.1     PRIME CONTRACTOR AND MINORITY BUSINESS SUBCONTRACTORS........................................................................................... 25
APPENDIX A – VENDOR AGREEMENT DOA 3333 ...................................................................................................................... 31

APPENDIX B - VENDOR INFORMATION DOA 3477 ................................................................................................................... 32

APPENDIX C - VENDOR REFERENCES DOA 3478 ...................................................................................................................... 33

APPENDIX D - STATE OF WISCONSIN DATA PROCESSING AGREEMENT ........................................................................ 34
APPENDIX E – DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION DOA 3027.......................... 35
   1 INTRODUCTION AND PURPOSE

   1.1    PURPOSE OF THE REQUEST FOR BID
   The State, as represented by its Department of Health Services, intends to use the results of this process to
   purchase a software solution to support registration and credentialing of volunteer health professionals.
   The purpose of this document is to provide interested parties with the opportunity to describe how their
   product(s) would meet the Wisconsin Division of Public Health’s (DPH) need for an off the shelf, vendor
   hosted, web-based, ESAR-VHP compliant software solution to support registration and credentialing of
   volunteer health professionals.
   The ESAR-VHP requirements are provided in Attachment 1: Emergency System for Advance Registration of
   Volunteer Health Professionals (ESAR-VHP) Interim Technical and Policy Guidelines, Standards and
   Definitions issued March 2010, and Attachment 2: Interim Technical and Policy Guidelines, Standards and
   Definitions issues June 2005. Attachment 1 updates material in Chapters 4 and 12 of Attachment 2.
   Hereafter, references to Emergency System for Advance Registration of Volunteer Health Professionals
   (ESAR-VHP) Interim Technical and Policy Guidelines, Standards and Definitions issued March 2010 will
   call that document “Attachment 1”.
   Hereafter, references to Interim Technical and Policy Guidelines, Standards and Definitions issues June 2005
   will call that document “Attachment 2”.
    Vendor systems being promoted through this RFB are expected to meet all guidelines as specified in
                                    the ESAR-VHP requirements.
   Proposed solutions must be able to meet all RFB requirements as of April 18, 2011, the submission deadline.
   The State needs to begin implementation in Quarter 2 or early Quarter 3 of 2011 and have the system running
   in production during 2011 calendar year Q4; therefore the State is not interested in receiving bids on systems
   that are in development or not yet in true production use in other jurisdictions.
   The State expects the system to be hosted and supported by the vendor, and will also look to the vendor to
   provide ongoing support through the life of the contract including standard maintenance, new releases, and
   (optionally) the addition of new functionality as deemed needed by the State.
   Attachment 3: Informational Requests contains descriptions of potential enhancements that could be
   requested during the contract period. Responses supplied on these items will not be reviewed until after the
   bid award has been completed.

   1.2    REASONABLE ACCOMMODATIONS
   The Department will provide reasonable accommodations, including the provision of informational material
   in an alternative format, for qualified individuals with disabilities upon request. If you think you need
   accommodations at a bid opening/vendor conference, contact the Procurement Manager, Bernadette
   Connolly (§ 2.1).

   1.3    SCOPE
   The volunteer registry and credentialing system will provide an easy-to-use, statewide, web-based set of
   functions to support both registration and credentialing of health care professionals who wish to volunteer for
   possible deployment in public health emergencies. The system must:
         Provide secure web-based registration, deployment and administration functionality;
         Maintain data in a secure format and environment;
         Be vendor-hosted in a secure environment;


WISCONSIN                                 Page 5 of 35
Department of Health Services RFB-1718-DPH-BC
             Be of a modular design that allows for flexibility in implementation and extension for additional
              functionality;
             Provide 24x7x365 online access;
             Allow administration by users with appropriate access privileges and training;
             Provide analysis, visualization and reporting capabilities;
             Provide document and file management capabilities.

   1.4       OVERVIEW OF PROCURING AGENCY
   DHS is an umbrella health services agency headed by a cabinet-level Secretary. The Department has
   responsibility for a wide range of health related program areas. The Public Health Preparedness Program is
   located in the Bureau of Communicable Diseases and Emergency Response (BCDER) within the Division of
   Public Health, with more information at http://www.dhs.wisconsin.gov/aboutdhs/dph/bcder.htm .
   Department information, services, and organizational charts are on the DHS web site at:
   http://www.dhs.wisconsin.gov/aboutdhs/
   The Wisconsin Department of Health Services issued this RFB, which is the sole point of contact for the
   State of Wisconsin during the selection process.
   The procurement manager for this RFB is Bernadette Connolly, Division of Enterprise Services, who is the
   sole point of contact for the State of Wisconsin during the procurement process. The Department of Health
   Services, Division of Public Health, will administer any resulting contract(s).

   1.5       CONTRACT LENGTH
   The contract will be for a 5 year period with five one-year extensions possible by mutual consent of the
   Department and the selected vendor.

   1.6       METHOD OF AWARD
   Award(s) shall be made on the basis of the lowest price from a responsive, responsible bidder meeting
   bid specifications and requirements, which is judged to be in the best interest of the DHS. The DHS
   reserves the right to accept or reject any and all bids in whole or in part. Bids that state the DHS shall
   guarantee a specific quantity or dollar amount will be disqualified.
   In the event of bidder error in calculation, price shall prevail in award.

   1.7       CANCELLATION AND TERMINATION:
   The State reserves the right to cancel the resulting contract/agreement, for any reason, by giving written
   notice to Contractor of such cancellation and specifying the effective date thereof, at least ten (10) days
   before the effective date of such cancellation. Contractor shall, in the event of such cancellation, be entitled
   to receive compensation for any work accepted hereunder in accordance with the State's order(s). Contractor
   may also be compensated for partially completed work in the event of such cancellation. The compensation
   for such partially completed work shall be no more than the percentage of completion of each work effort, as
   determined in the sole discretion of the State, times the corresponding payment for completion of such work
   as set forth in the State's order(s).
   In addition, the State reserves the right to terminate the resulting contract/agreement, for reasons of breach of
   contract, by giving written notice to Contractor of such termination and specifying the effective date thereof,
   at least ten (10) days before the effective date of such termination. Contractor shall, in the event of such
   termination, be entitled to receive compensation for any work accepted hereunder in accordance with the
   State's order(s). Contractor shall also be compensated for partially completed work in the event of such
   termination. The compensation for such partially completed work shall be no more than the percentage of


WISCONSIN                                 Page 6 of 35
Department of Health Services RFB-1718-DPH-BC
   completion of each work effort, as determined in the sole discretion of the State, times the corresponding
   payment for completion of such work as set forth in the State's order(s).
   Upon cancellation, termination or other expiration of the resulting contract/agreement, each party shall
   forthwith return to the other all papers, materials, and other properties of the other held by each for purposes
   of execution of the contract/agreement. In addition, each party will assist the other party in the orderly
   termination of this contract/agreement and the transfer of all aspects hereof, tangible or intangible, as may be
   necessary for the orderly, nondisruptive business continuation of each party.

   1.8    VENDORNET
   Only vendors registered with the State of Wisconsin’s VendorNet will receive future official notice for this
   service/commodity. The State of Wisconsin’s purchasing information and vendor notification service is
   available to all businesses and organizations that want to sell to the state. Anyone may access VendorNet on
   the Internet at http://vendornet.state.wi.us to get information on state purchasing practices and policies, goods
   and services that the state buys, and tips on selling to the state. Vendors may use the same Web site address
   for inclusion on the bidders list for goods and services that the organization wants to sell to the state. A
   subscription with notification guarantees the organization will receive an e-mail message each time a state
   agency, including any campus of the University of Wisconsin System, posts a request for bid or a request for
   proposal in their designated commodity/service area(s) with an estimated value over $25,000. Organizations
   without Internet access receive paper copies in the mail. Increasingly, state agencies also are using
   VendorNet to post simplified bids valued at $25,000 or less. Vendors also may receive e-mail notices of
   these simplified bid opportunities.




WISCONSIN                                 Page 7 of 35
Department of Health Services RFB-1718-DPH-BC
   2 BID PROCEDURE AND INSTRUCTIONS

   2.1    METHOD OF BID
   All response information should be typewritten or, if that is not possible, printed clearly. Vendors must
   submit two CD copies; one disc containing an original, CD copy, marked as such, and one disc
   excluding the proprietary information reported on the Designation of Confidential and Proprietary
   Information form (DOA-3027). Vendors must submit three printed copies of all materials required for
   acceptance of their bid by the deadline shown on the Request for Bid form to:


         USPS ADDRESS                                    COMMON CARRIER ADDRESS
         Bernadette Connolly                             Bernadette Connolly
         WI Department of Health Services                WI Department of Health Services
         Division of Enterprise Services                 Division of Enterprise Services
         PO Box 7850                                     1 W. Wilson Street 7th Floor, Room 750
         Madison, WI 53707-7850                          Madison, WI 53703

   Bids must be received by Bernadette Connolly at the above office by the due date and time noted in Section
   2.2. All bids must be time-stamped by the Division of Enterprise Services at the address and room noted
   above prior to the stated opening time. Bids not so stamped will be considered late. Receipt of a bid by the
   State mail system does not constitute receipt of a bid by the Division of Enterprise Services, for purposes of
   this request for bids. Emailed bids will not be accepted. Faxed bids will not be accepted.
   All bids must be packaged, sealed, and show the following information on the outside of the package:
   Do not place any information below the address area of a USPS mailed envelope.
                  Vendor's Name and Address
                  Request for Bids Title:
                  Request for Bids Number:
                  Bid Due Date: Day, Month Date, 2011

   2.2    CALENDAR OF EVENTS
   Listed below are important dates and times by which actions related to this RFB are to be completed. In the
   event that the State finds it necessary to change any of these dates and times it will do so by issuing a
   supplement to this RFB.

                       EVENT                                          DATE/TIME
   Date of issue of the RFB                        03/24/2011
   Deadline for written questions                  04/04/2011
   Deadline for written questions and              04/08/2011
   answers to be posted
   Bids due from vendors                           04/18/2011 11:00 AM CST
   Vendor Demonstrations (see note below)          04/21/2011 (tentative)
   Notification of intent to award                 04/28/2011 (tentative)
   Contract start date                             05/09/2011 (tentative)



WISCONSIN                                 Page 8 of 35
Department of Health Services RFB-1718-DPH-BC
   Note: Select vendors may be asked to demonstrate the functionality of their proposed solution as described in
   their RFB response. Vendors should be prepared to provide a web-based two-hour presentation during the
   tentative demonstration window defined above.

   2.3    FORMAT OF BID:
   Vendors responding to this RFB must comply with the following format requirements:
   TAB 1 – VENDOR CERTIFICATION:
   Signed Request for Bid Sheet: Include here the signed Request for Bid sheet included with the bid and those
   certifications required for submittal of a bid. Bids submitted in response to this RFB must be signed by the
   person in the vendor's organization who is responsible for the decision as to the prices being offered in the
   bid or by a person who has been authorized in writing to act as agent for the person responsible for the
   decision on prices.
   By submitting a signed bid, the vendor's signatories certify that in connection with this procurement: (a) the
   vendor's organization or an agent of the vendor's organization has arrived at the prices in its bid without
   consultation, communication or agreement with any other respondent or with any competitor for the purpose
   of restricting competition, (b) the prices quoted in the bid have not been knowingly disclosed by the vendor's
   organization or by any agent of the vendor's organization and will not be knowingly disclosed by same,
   directly or indirectly, to any other respondent or to any competitor, and (c) no attempt has been made or will
   be made by the vendor's organization or by any agent of the vendor's organization to induce any other person
   or firm to submit or not to submit a bid for the purpose of restricting competition.
   State of Wisconsin Terms and Conditions: These standard and supplemental terms and conditions shall
   govern this proposal and subsequent award. Vendors must accept these terms and conditions or submit
   point-by-point exceptions along with proposed alternative or additional language for each point,
   including any vendor contracts. Submission of any standard vendor contracts as a substitute for
   language in the terms and conditions is not a sufficient response to this requirement and may result in
   rejection of the vendor's proposal. The State reserves the right to negotiate contractual terms and
   conditions other than those in the State of Wisconsin Contract when it is in the best interest of the State to do
   so.
   TAB 2 – REQUIRED FORMS:
   Include here all required forms as specified in § 8 Required Forms.
   The State reserves the right to contact and/or visit any party listed as a reference that has previously utilized
   or is presently utilizing product(s) or service(s) identical or similar to those being proposed by the vendor. It
   may also utilize other sources of information about the product(s) and/or service(s) proposed by the vendor
   where these sources are publicly available and are equally available for competing vendors. The vendor
   should not be present during site visits.
   Include all additional information that will be essential to an understanding of the bid. This might include
   diagrams, excerpts from manuals, or other explanatory documentation that would clarify and/or substantiate
   the bid document.
   TAB 3 - MANAGEMENT SUMMARY:
   Provide a narrative summary of the bid being submitted. This summary should identify all product(s) and/or
   service(s) that are being offered in the bid. A brief description of the vendor's organization and its history
   may also be included. Vendors responding to this RFB must be able to substantiate their financial stability.
   The State may request reports on financial stability from independent financial rating services in order to
   further substantiate stability.
   TAB 4 - RESPONSE TO REQUIREMENTS:


WISCONSIN                                 Page 9 of 35
Department of Health Services RFB-1718-DPH-BC
   Provide a point-by-point response to each and every requirement in this RFB. Responses to requirements to
   be in the same sequence as they appear in this RFB. Responses to indicate that either vendor's bid does
   comply with specifications “YES” or that it does not comply “NO” with specifications. A succinct narrative
   explanation of how each requirement can be met or cannot be met to be included and associated with the
   question.
   For example:
             These requirements are mandatory. In addition to your written              YES   NO
             response, please indicate Yes or No
    9.9.9    Vendor to provide a User Acceptance Test (UAT) environment for use          X
             by State.

                Respondent Clarification:
                A UAT environment is included in the standard implementation
                package. Changes to the production application will not be made until
                and unless the customer has tested the changes in UAT and provided
                written authorization to proceed.
   TAB 5 - COST INFORMATION:
   Provide cost information on the Request for Bid sheet or the cost sheets included in this RFB. All costs for
   furnishing the product(s) and/or service(s) included in the bid in accordance with the terms and conditions in
   this RFB must be included.
   Final payment will not be made to any vendor receiving an award until the Department of Health Services
   determines that the software is operating satisfactorily and according to specifications. Payment will be 25%
   on Wisconsin acceptance of a detailed plan for implementation of the system, 25% on Wisconsin acceptance
   of completion of pilot testing, 25% on production implementation and usability in Wisconsin, and the final
   25% on Wisconsin acceptance of the full system as defined in the RFB, vendor response to the RFB and
   associated contract(s). Wisconsin acceptance of the full system as defined in the RFB to be no later than
   December 30, 2011.
   TAB 6 – ATTACHMENT 3 SPECIFICATIONS (OPTIONAL)
   Tab 6 is optional. If submitted, responses are submitted in a sealed envelope and identified as Attachment 3.
   Provide a point-by-point response to the specifications as listed in Attachment 3. Responses to indicate that
   either vendor's bid can meet the specification “YES” or that it cannot “NO” with specifications. A succinct
   narrative explanation of how each specification can be met or cannot be met to be included and associated
   with the question.

   2.4    MULTIPLE BIDS
   Multiple bids from a vendor will be permissible; however, each bid to conform fully to the requirements for
   bid submission. Each such bid to be separately submitted and labeled as Bid #1, Bid #2, etc. on each page
   included in the response. Alternate acquisition plans do not constitute multiple bids.

   2.5    INCURRING COSTS
   The State of Wisconsin is not liable for any cost incurred by a vendor in the process of responding to this
   RFB.

   2.6    QUESTIONS
   Any questions concerning this RFB must be submitted via email on or before the date listed in 2.2 Calendar
   of Events to the Procurement Manager (see § 2.1).

WISCONSIN                                 Page 10 of 35
Department of Health Services RFB-1718-DPH-BC
   Vendors are expected to raise any questions, exceptions, or additions they have concerning the RFB
   document or the attached State of Wisconsin Contract at this point in the RFB process. If a vendor discovers
   any significant ambiguity, error, conflict, discrepancy, omission, or other deficiency in this RFB, the vendor
   should immediately notify the above named individual of such error and request modification or clarification
   of the RFB document.
   In the event that it becomes necessary to provide additional clarifying data or information, or to revise any
   part of this RFB, supplements or revisions will be posted on VendorNet.
   From the date of release of this RFP, until a Letter of Intent is issued, all contacts with Department of
   Administration Personnel regarding this RFP shall be made through this purchasing section in the Division of
   Administrative Services. Violation of this condition may be considered sufficient cause for rejection of a
   proposal, irrespective of any other considerations.
   Each bid shall stipulate that it is predicated upon the terms and conditions of this RFB and any supplements
   or revisions thereof.

   2.7    NEWS RELEASES:
   News releases pertaining to the RFB or to the acceptance, rejection, or evaluation of bids shall not be made
   without the prior written approval of the State.




WISCONSIN                                 Page 11 of 35
Department of Health Services RFB-1718-DPH-BC
   3 BID ACCEPTANCE, EVALUATION AND AWARD

   3.1    BID ACCEPTANCE
   Bids that do not comply with instructions or are unable to comply with specifications contained in this RFB
   may be rejected by the State. The State may request reports on a vendor's financial stability and if financial
   stability is not substantiated, may reject a vendor's bid. The State retains the right to accept or reject any or
   all bids, or accept or reject any part of a bid deemed to be in the best interest of the State. The State shall be
   the sole judge as to compliance with the instructions contained in this RFB.

   3.2    BID EVALUATION
   Bids will be evaluated by the Department's purchasing agent and program manager to verify that they will
   meet all mandatory requirements in this RFB. This verification may include requesting reports on the
   vendor's financial stability, conducting demonstrations of the vendor's proposed products(s) and/or service(s),
   and reviewing results of past awards to the vendor by the State of Wisconsin.
   Bids from certified Minority Business Enterprises may be provided up to a five percent (5%) bid preference
   in accordance with Wis. Stats. s. 16.75(3m).
   Vendors may be required to demonstrate their solutions through a webinar and teleconferencing. DPH will
   notify vendors of the need to demonstrate during the demonstration period described in section 2.2 Calendar.
   Failure of a vendor to demonstrate the system proposed within the time constraints of section 2.2 Calendar
   may result in rejection of that bid. Failure of the system to meet the State’s specified requirements during the
   demonstration may result in rejection of the vendor’s bid. The successful demonstration of the vendor’s
   system does not constitute acceptance by the State as specified under the terms of the State of Wisconsin
   Data Processing Agreement.
   The system used by the vendor for the purposes of this demonstration is to be identical in every respect to
   that which will be furnished for initial configuration testing under the terms of the State of Wisconsin Data
   Processing Agreement for the period of 2011-2015. See Appendix D

   3.3    NOTIFICATION OF INTENT TO AWARD
   Any vendors who respond to this RFB, with a bid, will be notified in writing of the State's intent to award the
   contract(s) as a result of this RFB.
   After notification of the intent to award is made, and under the supervision of agency staff, copies of bids
   will be available for public inspection 8:30 a.m. to 4:30 p.m. at 101 E. Wilson St., 6th floor, Madison WI.
   Vendors should schedule reviews with the procurement manager.

   3.4    APPEALS PROCESS
   The appeals procedure applies to only those requests for bids that are greater than $25,000. Notices of intent
   to protest and protests must be made in writing. Protestors should make their protests as specific as possible
   and should identify statutes and Wisconsin Administrative Code provisions that are alleged to have been
   violated.
   The written notice of intent to protest the intent to award a contract must be filed with the Department’s
   Secretary:


                   USPS ADDRESS                             COMMON CARRIER ADDRESS
                   Dennis Smith, Secretary                  Dennis Smith, Secretary
                   WI Department of Health Services         WI Department of Health Services

WISCONSIN                                 Page 12 of 35
Department of Health Services RFB-1718-DPH-BC
                   Division of Enterprise Services         Division of Enterprise Services
                   PO Box 7850                             1 W. Wilson Street 6th Floor, Room 650
                   Madison, WI 53707-7850                  Madison, WI 53703


   and received in his/her office no later than five (5) working days after the notices of intent to award are
   issued.
   The written protest must be received in his/her office no later than ten (10) working days after the notices of
   intent to award are issued.
   The decision of the head of the procuring agency may be appealed to the Secretary of the Department of
   Administration within five (5) working days of issuance, with a copy of such appeal filed with the procuring
   agency, provided the appeal alleges a violation of a statute or a provision of the Wisconsin Administrative
   Code.




WISCONSIN                                 Page 13 of 35
Department of Health Services RFB-1718-DPH-BC
        4 Technical Requirements
    While the format specifies only a “yes” or “no” answer, vendors are expected to provide supporting
    information to document their answer to each requirement.

        4.1    SYSTEM REQUIREMENTS
              These requirements are mandatory. In addition to your written                    YES   NO
              response, please indicate Yes or No
 4.1.1        System to be Web-based with no client component installation required.
              System to be compatible with all popular browsers such as Internet Explorer
 4.1.2        7 or higher, Firefox, and Safari, etc.
              System to have a centralized ODBC compliant database from a vendor with
              a proven market place presence such as Microsoft, Oracle, or IBM. Vendors
 4.1.3        to indicate which DBMS and version number in bid response.
              System must allow for real-time updates and access to the central data
 4.1.4        repository via secure Web-based screens and/or electronic transmission.
              The system must allow for records to be added, updated, or deleted through
              on-line and batch processes. Posting of data must occur in real-time --
              information must be available to all authorized users as soon as it is entered
              into the system. e.g. When a user clicks the submit button on a page, the
              database must be updated regardless of whether the application is submitted
              – the entered information must be available for review by users with
 4.1.5        administrative rights.
              System must support a user community of at least 50,000 registered users
              and at least 1500 administrator-users with up to 1000 users signed on one
 4.1.6        time.
              The system must be capable of interfacing to email systems, especially MS
              Outlook. Reports as to the success of transmission must be available (e.g.
 4.1.7        returned for bad address).
              System to generate electronic data files (CSV, XML) in a secure format for
              download, and be capable of using incoming electronic data files for
 4.1.8        capturing information.

        4.2    SECURITY & SYSTEM ADMINISTRATION
               These requirements are mandatory. In addition to your written                   YES   NO
              response, please indicate Yes or No.
4.2.1         System to implement unique ID and password sign-in for user
              authentication.
4.2.2         System to implement hierarchical role-based security, providing appropriate
              user access to system functions and data.
4.2.3         System to utilize encryption for all data transmissions. Please describe how
              your system meets this requirement.
4.2.4         System must provide a Systems Administration module or functionality that
              allows differing levels of access, e.g., “Super Administrator” for overall
              State authority, midlevel administration for local organization administrators
              such as Medical Reserve Corps Units, Disaster Medical Assistance Team,
              hospitals, local public health departments, etc.
4.2.5         System must have lockout capability to allow quick response when needed
              at individual user level.
4.2.6         The system must provide routine auditing (who updated what when) and an

 WISCONSIN                                  Page 14 of 35
 Department of Health Services RFB-1718-DPH-BC
         audit information retrieval function, including onscreen reviews and/or
         reporting.

   4.3    SYSTEM HOSTING REQUIREMENTS
         These requirements are mandatory. In addition to your written Yes                   No
         response, please indicate Yes or No.
4.3.1    The Wisconsin system must be a separate instance not shared by other states,
         organizations or jurisdictions. However, the Wisconsin instance can be
         installed on shared servers with other jurisdictions for purposes of
         redundancy, availability, load-balancing, etc. Please describe how you would
         establish and maintain the Wisconsin instance.
4.3.2    Vendor to provide a User Acceptance Test (UAT) environment for use by
         State.
4.3.3    The vendor’s data center should have industry standard physical and
         environmental controls , including but not limited to:,
         • Intrusion prevention
         • Patch management
         • Firewall Security
         • Event monitoring
         • Logging
         • Encryption
         • Virus protection
         The vendor will provide documentation to show compliance with this
         requirement.
4.3.4    The Vendor must agree to provide a complete Disaster Recovery/Business
         Continuity plan and demonstrate its actual implementation
4.3.5    The vendor must provide a separate fail-over/backup site that is
         geographically separate (at least 90 miles) from the primary hosting location.
4.3.6    All backup files must be encrypted and stored in secure locations for a
         period acceptable to the State.
4.3.7    The server operating system is to be kept up-to-date with necessary patches
         tested and applied regularly.

   4.4    SYSTEM CUSTOMIZATION/MAINTENANCE
          These requirements are mandatory. In addition to your written                YES   NO
         response, please indicate Yes or No.
4.4.1    System should allow for minor changes to be handled via configuration
         options usable by DHS Program Area staffs rather than requiring vendor
         action. Example of this are changing labels on forms and other screen and
         updating selectable values for entry fields.
4.4.2    Contractor must be committed to (1) maintaining and improving application
         functionality through release of updated versions of application system and
         (2) maintaining compliance with changing federal regulations for the ESAR-
         VHP program. Please describe any schedule of application releases and
         plans for maintaining program compliance.
4.4.3    Contractor to have some means in place whereby supported customers can
         provide requests for new/improved functionality during the life of this
         contract.

   4.5    INSTALLATION, SUPPORT, TRAINING, USABILITY

WISCONSIN                                 Page 15 of 35
Department of Health Services RFB-1718-DPH-BC
          These requirements are mandatory. In addition to your written                    YES   NO
         response, please indicate Yes or No.
4.5.1    Contractor must provide support for initial system configuration and start-
         up.
4.5.2    Contractor must conduct training sufficient to ensure key users of the system
         are familiar with application functionality (“Train the Trainer”).
4.5.3    Contractor to provide ongoing, 24 x 7 technical support to be used as a 3rd
         level help-desk as well as technical support for system administrators.
         Please describe technical support levels of service available.
4.5.4    System to be available 7 x 24 x 365 with allowance for periodic, announced
         maintenance and enhancement windows

   4.6    REPORTING
         These requirements are mandatory. In addition to your written
         response, please indicate Yes or No
4.6.1    A robust query and reporting function to be available which includes the
         ability to define and publish “canned” reports subject to role and jurisdiction
         based access.
4.6.2    System to allow users with appropriate security to create/save/modify
         “custom” reports with filtering capability to ensure that the scope of the
         report is accurate for the users’ needs
4.6.3    System to allow select users to download reports and/or data in an easy to
         use format such as .xls, .csv




WISCONSIN                                 Page 16 of 35
Department of Health Services RFB-1718-DPH-BC
   5       Performance Requirements

   5.1    CREDENTIALING AND BACKGROUND CHECK REQUIREMENTS
   The full list of Federal ESAR-VHP requirements are provided in Attachment 1 & Attachment 2.
   These interfaces should be accessible with a send of an individual record, as will occur during registration,
   and with a send of a group of records, as will be done to update information or verify selection of group.

         These requirements are mandatory. In addition to your written                  YES   NO
         response, please indicate Yes or No
5.1.1    System must meet all ESAR-VHP requirements, standards, and guidelines as
         defined in Attachment 1 and Attachment 2. Respondent to provide a full
         description of any guidelines that are not met by the application being
         proposed.
5.1.2    System must provide an interface with American Board of Medical
         Specialties –ABMS – for use in verifying medical specialties -
         http://www.abms.org/
5.1.3    System must provide an interface with American Osteopathic Association –
         AOA - http://www.abms.org/
5.1.4     System must provide an interface with Federation of State Medical Boards –
         FSMB - http://www.fsmb.org/
5.15     System must provide an interface with Office of Inspector General – OIG -
         http://oig.hhs.gov/
5.1.6    System must provide an interface with Drug Enforcement Agency – DEA -
         http://www.justice.gov/dea/index.htm
5.1.7    System must provide an interface with Wisconsin Department of Regulation
         & Licensing (internal State interface for State-issued license verification) -
         http://www.drl.state.wi.us/
5.1.8    System must provide an interface with Wisconsin Department of Health
         Services ImageTrend (internal DHS interface used for EMT and paramedics
         license verifications) - http://www.dhs.wisconsin.gov/
5.1.9    System must provide an interface with the Wisconsin Department of Justice
         for a State-based criminal background check - http://www.doj.state.wi.us/
5.1.10   System must provide an interface with Intellicorp for a national criminal
         background check - http://www.intellicorp.net/marketing/Home.aspx
   The Business Requirements listed below are grouped with Use Case descriptions to provide contextual
   examples of application use and to illustrate how Wisconsin plans on implementing the ESAR-VHP
   requirements.
   Vendors are expected to review the Use Case descriptions and the ESAR-VHP requirements to use as a guide
   in understanding the State’s needs. While the format specifies only a “yes” or “no” answer, vendors are
   expected to provide supporting information to document their answer to each requirement.

   5.2    USE CASE ONE: REGISTRATION AND CREDENTIALING
   A presentation on WEAVR is given at a health-care symposium. The audience is a mixed group comprised
   of State DHS staff, local public health department staffs, health care professionals of all kinds, and even
   some members of the general public.
   A number of attendees are enthused about WEAVR after the presentation and decide to register as volunteers
   using the system. Some specific registrants, and the results of their registration, are detailed below:

WISCONSIN                                 Page 17 of 35
Department of Health Services RFB-1718-DPH-BC
             An orthopedic surgeon who works for a local HMO and is authorized to perform surgery at several
              local hospitals in the area is successfully credentialed by the State’s professional licensing authority
              and the board certification credentialing authority for the surgeon’s specialty.
             A licensed EMT who works in Minnesota but lives in Wisconsin is successfully credentialed due to
              the WEAVR system’s ability to access border state credentialing authority data. While registering
              for WEAVR, the EMT is able to select the MRC Unit to which he currently belongs.
             A nurse who had registered for WEAVR a few years ago and wants to review and update
              information on the system. She has moved and switched jobs since last using WEAVR.
             An employee of DHS successfully registers as a non-medical volunteer
             A doctor registers and passed professional credentialing, but is found to have a criminal record
              during the background check.
             A dentist begins registering but is unable to complete the process. He contacts the State Office for
              help the next day.
   The orthopedic surgeon, EMT, nurse and DHS employee will all receive an email message back notifying
   them they have successfully registered in the WEAVR system.
   The WEAVR administrator is able to see a screen showing registrations in exception situations, which show
   both the doctor and dentist records. She looks at the information on the doctor’s record and is able to flag
   his record as being rejected for WEAVR registration or any future use in WEAVR. The data will remain
   available to show the doctor attempted to register, the credentialing result, and the administrative decision.
   The WEAVR Administrator must be able to see the details of the dentist’s attempt to register.

         These requirements are mandatory. In addition to your written                   YES        NO
         response, please indicate Yes or No
5.2.1    System to offer secure registration for volunteers. Volunteers self-register
         and manage their own information, including password resets and changes to
         profile information (e.g., contact information, training updates).
5.2.2    The system must capture the volunteer’s consent in the form of an electronic
         agreement that states specific terms and conditions.
5.2.3    The system must be usable by both health professionals and non-health
         professionals with different tracks being taken through the registration
         process based on volunteer supplied answers to key questions.
5.2.4    The system must provide feedback to the volunteer regarding his/her
         registration status and provide a means to contact program administrators
         when the registration is rejected or a problem is encountered.
5.2.5    The system must deny registration if a credential is questionable. Once
         accepted, the system must provide administrators a means of nullifying the
         registration as the result of a program management decision. When denied
         on initial application or after initial acceptance, the system must generate an
         email notification as described in 4.1.1.4.
5.2.6    System to support automated re-collection of personal information and re-
         verifying credential information.
5.2.8    System must be able to save incomplete registrations and allow
         Administrator to review data that was entered. Applicants must be able to
         suspend registration and complete at another time.
5.2.9    System must be able to integrate Medical Reserve Corps Units and other
         specialty teams as part of routine registration (volunteer must be able to
         indicate a specific MRC Unit they are interested in joining as part of the
         overall WEAVR registration process.

   5.3       USE CASE TWO: RESPOND TO AN EMERGENCY
WISCONSIN                                 Page 18 of 35
Department of Health Services RFB-1718-DPH-BC
   Major flooding is occurring across most of Badger County, Wisconsin. Thousands of residents have been
   displaced from their homes, and there are concerns about the spread of disease and caring for displaced
   persons with pre-existing medical issues.
   After a planning meeting, the decision is made to request a volunteer group to assist in responding to the
   event. Ten to 20 nurses are needed to manage medication and basic first aid and 5 doctors (ideally with
   experience in gerontology, family practice or pediatrics) are needed to work for an estimated 2 week time
   frame starting immediately.
   The Wisconsin WEAVR Administrator (Becky Badger) queries the system and comes up with a list of over
   100 potential volunteers based on the specific requirements for the volunteers. Becky sends this group for
   immediate credentialing authorities as specified in ESAR-VHP guidelines. Two of the group fails
   credentialing due to lapsed licenses and will show up on the Administrator’s exception screen, as described
   in Use Case 1. She creates an alert to the potential volunteers.
   Over a dozen people respond to the alert. Ms Badger is able to update her information in WEAVR to note
   that these people will be assigned to work on the flooding. While still working within WEAVR, she can send
   the group information on how to respond to the flooding.
   A few weeks later, when the flood waters have receded, Ms. Badger runs post-event reporting against
   WEAVR to analyze the effectiveness of volunteer response.

         These requirements are mandatory. In addition to your written                    YES   NO
         response, please indicate Yes or No
5.3.1    The system must allow for identification of potential volunteers via queries
         of critical variables, e.g. querying for doctors who specialize in geriatrics,
         pediatrics or family practice.
5.3.2    The system must generate a list of volunteers to be used during emergencies.
5.3.3    The system must allow program staff to define/initiate an emergency event.


   5.4    USE CASE THREE: MANAGEMENT OF AN EMERGENCY
   Cheesehead Hospital in Badger County contacts the State WEAVR administrator to let her know they have a
   contingent of 20 health workers ready to be assigned to help as needed. None of these people are currently
   registered in WEAVR. The required registration information for each of them is submitted as a .csv file and
   immediately uploaded into WEAVR. WEAVR has the capability to create a Cheesehead Team for the group
   and run the credential check for each person in the Team.
   The flooding emergency is being managed onsite by the Badger County Department of Public Safety. Bernie
   Brewer, the Badger County emergency coordinator, has local administrator security for WEAVR. He
   performs a lookup in WEAVR for each volunteer as they arrive at the volunteer reception center.

         These requirements are mandatory. In addition to your written                 YES      NO
         response, please indicate Yes or No
5.4.1    The system must provide the ability to track volunteers during deployment
         and track deployment history of volunteers.
5.4.2    The system must provide ways to identify the volunteers during an
         emergency. This includes being able to print a copy from a photo that was
         downloaded into the registry by an administrator, the volunteers registration
         data and credential information.
5.4.3    The system must allow emergency operations to update the deployment
         information for the volunteers deployed (or not available) in their area
5.4.4    The system must allow management staff to monitor and manage

WISCONSIN                                 Page 19 of 35
Department of Health Services RFB-1718-DPH-BC
        deployment.
5.4.5   System to allow for grouping volunteers into work teams or units, such as
        MRC units or DMAT coordinator, or hospital groups
5.4.6   System to provide a printable screen view or report that contains a summary
        of data on an individual and a picture of that individual (provided one was
        uploaded into the system).




WISCONSIN                                 Page 20 of 35
Department of Health Services RFB-1718-DPH-BC
      6 Support Requirements
        These requirements are mandatory. In addition to your written response, YES    NO
        please indicate Yes or No
6.1     The Vendor/Bidder must be currently providing complete services (software
        and hosting services) for an operational ESAR-VHP solution in at least one
        jurisdiction similar in size and composition to Wisconsin.
6.2     The Vendor/Bidder must have two or more years of experience in operating
        and hosting web-based software and providing training and assistance in
        software use.
6.3     The specific system and version being bid by the vendor must be a system
        currently in production use by at least one site.
6.4     The Vendor/Bidder must have experience and expertise in credentialing health
        care providers and working with credentialing organizations.




WISCONSIN                                 Page 21 of 35
Department of Health Services RFB-1718-DPH-BC
   7 COST INFORMATION
   Vendors must fully complete the following cost sheets. The cost sheets must be submitted using the form in
   section 7.1-7.3. The forms must be completed in their entirety. If something is “not applicable” please mark
   NA. Do not provide a narrative in any of the cells on the cost bid sheet.

WEAVR SYSTEM
Vendor Name                                                    Date
Vendor Signature


   7.1    SYSTEM TOTAL COST SHEET
    Prices below are mandatory

         Wisconsin Emergency Assistance Volunteer Registry   QUANTITY   UNIT COST      TOTAL COST
          Software,
          Product
         name(s):______________________________

         Credentialing Databases Online Submission
         Setup Total Cost
         Enter the amount in cell 8.A. from cost sheet 7.2
         Credentialing Databases Batch Submission
         Implementation Total Cost
         Enter the amount in cell 8.B. from cost sheet 7.2
         Background Check Databases Online
         Implementation Total Cost
         Enter the amount in cell 3.A. from cost sheet 7.3
         Background Check Databases Batch
         Submission Implementation Total Cost
         Enter the amount in cell 3.B. from cost sheet 7.3
         Installation and Configuration Assistance for
         Software Product
         Training

         Maintenance and Support

         Year 1 – Maintenance & Support
         Year 2 – Maintenance & Support
         Year 3 – Maintenance & Support
         Hosting

         Year 1 – Hosting
         Year 2 – Hosting
         Year 3 – Hosting
          OTHER COSTS:
         (SPECIFY)

          TOTAL PRICE:

   7.2    CREDENTIALING CHECK DETAILED COST SHEET

WISCONSIN                                   Page 22 of 35
Department of Health Services RFB-1718-DPH-BC
   This table contains a detailed list of every credentialing check that will be required. Total Cost amounts
   entered to cells A-8 and B-8 will be entered to Cost Sheet 7.1.
    Prices below are mandatory

                    Credentialing Database                        Cost to setup     Cost to setup
                                                                  system for online system for
                                                                  submissions       sending batch
                                                                                    file submissions
                                                                          A.                B.
                  American Board of Medical Specialties -
               1. ABMS
               2. American Osteopathic Association - AOA
               3. Federation of State Medical Boards - FSMB
               4. Office of Inspector General - OIG
               5. Drug Enforcement Agency - DEA
                  Wisconsin Department of Regulation &
                  Licensing (internal State interface for State
               6. license verification)
                  Wisconsin Department of Health Services
                  ImageTrend (internal DHS interface for
               7. EMT and paramedics)
               8. TOTAL COST


   7.3    BACKGROUND CHECK IMPLEMENTATION COST SHEET
   This table contains a detailed list of every background check that will be required and the type of check
   (batch, online, or both) that is required by Wisconsin. Total Cost amounts entered to cells A-3 and B-3 will
   be entered to Cost Sheet 7.1.
    Prices below are mandatory

                    Background Database                           Cost to setup     Cost to setup
                                                                  system for online system for
                                                                  submissions       sending batch
                                                                                    file submissions
                                                                          A.                B.
               1. Wisconsin Department of Justice
               2. Intellicorp
               3. TOTAL COST




WISCONSIN                                 Page 23 of 35
Department of Health Services RFB-1718-DPH-BC
   8 REQUIRED FORMS
   The following forms must be completed and submitted with the bid in accordance with the instructions given
   in Section 2.3. Blank forms are attached.
                Appendix A: Vendor Information (DOA-3477)
                Appendix B: Vendor Reference (DOA-3478)
                Appendix C: Vendor Agreement (DOA-3333)
                Appendix D: State of Wisconsin Data Processing Agreement\
                Appendix E: Designation of Confidential and Proprietary Information (DOA 3027)




WISCONSIN                                 Page 24 of 35
Department of Health Services RFB-1718-DPH-BC
   9 TERMS AND CONDITIONS
   The State of Wisconsin reserves the right to incorporate standard State contract provisions into any contract
   negotiated with any proposal submitted responding to this RFB (Standard Terms and Conditions (DOA-
   3054) and Supplemental Standard Terms and Conditions for Procurements for Services (DOA-3681)).
   Failure of the successful proposer to accept these obligations in a contractual agreement may result in
   cancellation of the award.

   SPECIAL TERMS AND CONDITIONS

   9.1    PRIME CONTRACTOR AND MINORITY BUSINESS SUBCONTRACTORS.
   The prime contractor will be responsible for contract performance when subcontractors are used. However,
   when subcontractors are used, they must abide by all terms and conditions of the contract. If subcontractors
   are to be used, the proposer must clearly explain their participation.
   The State of Wisconsin is committed to the promotion of minority business in the state’s purchasing program
   and a goal of placing five (5) percent of its total purchasing dollars with certified minority businesses.
   Authority for this program is found in Wisconsin Statutes 15.107(2), 16.75(4), and 16.75(5) and 560.036(2).
   The Department of Administration is committed to the promotion of minority business in the department’s
   purchasing program.
   The State of Wisconsin’s policy provides that minority owned business enterprises certified by the Wisconsin
   Department of Commerce, Bureau of Minority Development should have the maximum opportunity to
   participate in the performance of its contracts. The awarded vendor is strongly urged to use due diligence to
   further this policy by awarding subcontracts to minority owned business enterprises, or by using such
   enterprises to provide goods and services incidental to this requested service or contract, with a goal of
   awarding at least 5% of the award amount of this request for bid/proposal to such enterprises.
   Upon request the awarded vendor shall furnish a subcontracting plan of action indicating appropriate
   information about its effort to achieve this goal, including identities of such enterprises certified by the
   Wisconsin Department of Commerce and their subcontract amount. The Department of Administration will
   require from the successful contractor a quarterly report of amounts spent with certified minority business
   enterprises.
   A listing of certified minority businesses, as well as the services and commodities they provide, is available
   from the Department of Administration, Office of Minority Business Program, (608) 267-7806. The list is
   published on the Internet at: http://www.doa.state.wi.us/deo/mbe/minority_search.asp




WISCONSIN                                 Page 25 of 35
Department of Health Services RFB-1718-DPH-BC
Wisconsin Department of Administration
DOA-3054 (R10/2005)
Ch. 16, 19, 51, Wis. Stats.
                       Standard Terms And Conditions (Request For Bids / Proposals)
1.0    SPECIFICATIONS: The specifications in this request are                       6.3    In determination of award, discounts for early
       the minimum acceptable. When specific manufacturer and                              payment will only be considered when all other con-
       model numbers are used, they are to establish a design,                             ditions are equal and when payment terms allow at
       type of construction, quality, functional capability and/or                         least fifteen (15) days, providing the discount terms
       performance level desired.           When alternates are                            are deemed favorable. All payment terms must allow
       bid/proposed, they must be identified by manufacturer, stock                        the option of net thirty (30).
       number, and such other information necessary to establish
       equivalency. The State of Wisconsin shall be the sole judge           7.0    UNFAIR SALES ACT: Prices quoted to the State of
       of equivalency. Bidders/proposers are cautioned to avoid                     Wisconsin are not governed by the Unfair Sales Act.
       bidding alternates to the specifications which may result in
       rejection of their bid/proposal.                                      8.0    ACCEPTANCE-REJECTION: The State of Wisconsin
                                                                                    reserves the right to accept or reject any or all
2.0    DEVIATIONS AND EXCEPTIONS: Deviations and excep-                             bids/proposals, to waive any technicality in any bid/proposal
       tions from original text, terms, conditions, or specifications               submitted, and to accept any part of a bid/proposal as
       shall be described fully, on the bidder's/proposer's letter-                 deemed to be in the best interests of the State of
       head, signed, and attached to the request. In the absence                    Wisconsin.
       of such statement, the bid/proposal shall be accepted as in
       strict compliance with all terms, conditions, and specifica-                 Bids/proposals MUST be date and time stamped by the
       tions and the bidders/proposers shall be held liable.                        soliciting purchasing office on or before the date and time
                                                                                    that the bid/proposal is due. Bids/proposals date and time
3.0    QUALITY: Unless otherwise indicated in the request, all                      stamped in another office will be rejected. Receipt of a
       material shall be first quality. Items which are used,                       bid/proposal by the mail system does not constitute receipt
       demonstrators, obsolete, seconds, or which have been                         of a bid/proposal by the purchasing office.
       discontinued are unacceptable without prior written approval
       by the State of Wisconsin.                                            9.0    METHOD OF AWARD: Award shall be made to the lowest
                                                                                    responsible, responsive bidder unless otherwise specified.
4.0    QUANTITIES: The quantities shown on this request are
       based on estimated needs. The state reserves the right to             10.0   ORDERING: Purchase orders or releases via purchasing
       increase or decrease quantities to meet actual needs.                        cards shall be placed directly to the contractor by an
                                                                                    authorized agency.    No other purchase orders are
5.0    DELIVERY: Deliveries shall be F.O.B. destination freight                     authorized.
       prepaid and included unless otherwise specified.
                                                                             11.0   PAYMENT TERMS AND INVOICING:                  The State of
6.0    PRICING AND DISCOUNT: The State of Wisconsin quali-                          Wisconsin normally will pay properly submitted vendor
       fies for governmental discounts and its educational institu-                 invoices within thirty (30) days of receipt providing goods
       tions also qualify for educational discounts. Unit prices shall              and/or services have been delivered, installed (if required),
       reflect these discounts.                                                     and accepted as specified.

       6.1     Unit prices shown on the bid/proposal or contract                    Invoices presented for payment must be submitted in
               shall be the price per unit of sale (e.g., gal., cs., doz.,          accordance with instructions contained on the purchase
               ea.) as stated on the request or contract. For any                   order including reference to purchase order number and
               given item, the quantity multiplied by the unit price                submittal to the correct address for processing.
               shall establish the extended price, the unit price shall
               govern in the bid/proposal evaluation and contract                   A good faith dispute creates an exception to prompt
               administration.                                                      payment.

       6.2     Prices established in continuing agreements and               12.0   TAXES: The State of Wisconsin and its agencies are
               term contracts may be lowered due to general market                  exempt from payment of all federal tax and Wisconsin state
               conditions, but prices shall not be subject to increase              and local taxes on its purchases except Wisconsin excise
               for ninety (90) calendar days from the date of award.                taxes as described below.
               Any increase proposed shall be submitted to the
               contracting agency thirty (30) calendar days before                  The State of Wisconsin, including all its agencies, is
               the proposed effective date of the price increase, and               required to pay the Wisconsin excise or occupation tax on
               shall be limited to fully documented cost increases to               its purchase of beer, liquor, wine, cigarettes, tobacco
               the contractor which are demonstrated to be indus-                   products, motor vehicle fuel and general aviation fuel.
               trywide. The conditions under which price increases                  However, it is exempt from payment of Wisconsin sales or
               may be granted shall be expressed in bid/proposal                    use tax on its purchases. The State of Wisconsin may be
               documents and contracts or agreements.                               subject to other states' taxes on its purchases in that state
                                                                                    depending on the laws of that state. Contractors perform
Wisconsin Department of Administration
DOA-3054 (R10/2005)


WISCONSIN                                          Page 26 of 35
Department of Health Services RFB-1718-DPH-BC
Ch. 16, 19, 51, Wis. Stats.
                       Standard Terms And Conditions (Request For Bids / Proposals)
                                                                              contract, the contractor agrees not to discriminate against
       ng construction activities are required to pay state use tax           any employee or applicant for employment because of age,
       on the cost of materials.                                              race, religion, color, handicap, sex, physical condition,
                                                                              developmental disability as defined in s. 51.01(5), Wis.
13.0   GUARANTEED DELIVERY: Failure of the contractor to                      Stats., sexual orientation as defined in s. 111.32(13m), Wis.
       adhere to delivery schedules as specified or to promptly               Stats., or national origin. This provision shall include, but
       replace rejected materials shall render the contractor liable          not be limited to, the following: employment, upgrading,
       for all costs in excess of the contract price when alternate           demotion or transfer; recruitment or recruitment advertising;
       procurement is necessary. Excess costs shall include the               layoff or termination; rates of pay or other forms of
       administrativecosts14.0         ENTIRE        AGREEMENT:               compensation; and selection for training, including appren-
       These Standard Terms and Conditions shall apply to any                 ticeship. Except with respect to sexual orientation, the
       contract or order awarded as a result of this request except           contractor further agrees to take affirmative action to
       where special requirements are stated elsewhere in the                 ensure equal employment opportunities.
       request; in such cases, the special requirements shall
       apply. Further, the written contract and/or order with                 19.1   Contracts estimated to be over twenty-five thousand
       referenced parts and attachments shall constitute the entire                  dollars ($25,000) require the submission of a written
       agreement and no other terms and conditions in any                            affirmative action plan by the contractor. An exemp-
       document, acceptance, or acknowledgment shall be                              tion occurs from this requirement if the contractor has
       effective or binding unless expressly agreed to in writing by                 a workforce of less than twenty-five (25) employees.
       the contracting authority.                                                    Within fifteen (15) working days after the contract is
                                                                                     awarded, the contractor must submit the plan to the
15.0   APPLICABLE LAW: This contract shall be governed under                         contracting state agency for approval. Instructions
       the laws of the State of Wisconsin. The contractor shall at                   on preparing the plan and technical assistance
       all times comply with and observe all federal and state                       regarding this clause are available from the
       laws, local laws, ordinances, and regulations which are in                    contracting state agency.
       effect during the period of this contract and which in any
       manner affect the work or its conduct. The State of                    19.2   The contractor agrees to post in conspicuous places,
       Wisconsin reserves the right to cancel this contract if the                   available for employees and applicants for employ-
       contractor fails to follow the requirements of s. 77.66, Wis.                 ment, a notice to be provided by the contracting state
       Stats., and related statutes regarding certification for                      agency that sets forth the provisions of the State of
       collection of sales and use tax. The State of Wisconsin                       Wisconsin's nondiscrimination law.
       also reserves the right to cancel this contract with any
       federally debarred contractor or a contractor that is                  19.3   Failure to comply with the conditions of this clause
       presently identified on the list of parties excluded from                     may result in the contractor's becoming declared an
       federal procurement and non-procurement contracts.                            "ineligible" contractor, termination of the contract, or
                                                                                     withholding of payment.
16.0   ANTITRUST ASSIGNMENT: The contractor and the State
       of Wisconsin recognize that in actual economic practice,        20.0   PATENT INFRINGEMENT: The contractor selling to the
       overcharges resulting from antitrust violations are in fact            State of Wisconsin the articles described herein guarantees
       usually borne by the State of Wisconsin (purchaser).                   the articles were manufactured or produced in accordance
       Therefore, the contractor hereby assigns to the State of               with applicable federal labor laws. Further, that the sale or
       Wisconsin any and all claims for such overcharges as to                use of the articles described herein will not infringe any
       goods, materials or services purchased in connection with              United States patent. The contractor covenants that it will
       this contract.                                                         at its own expense defend every suit which shall be brought
                                                                              against the State of Wisconsin (provided that such
17.0   ASSIGNMENT: No right or duty in whole or in part of the                contractor is promptly notified of such suit, and all papers
       contractor under this contract may be assigned or dele-                therein are delivered to it) for any alleged infringement of
       gated without the prior written consent of the State of                any patent by reason of the sale or use of such articles, and
       Wisconsin.                                                             agrees that it will pay all costs, damages, and profits recov-
                                                                              erable in any such suit.
18.0   WORK CENTER CRITERIA: A work center must be certi-
       fied under s. 16.752, Wis. Stats., and must ensure that         21.0   SAFETY REQUIREMENTS: All materials, equipment, and
       when engaged in the production of materials, supplies or               supplies provided to the State of Wisconsin must comply
       equipment or the performance of contractual services, not              fully with all safety requirements as set forth by the
       less than seventy-five percent (75%) of the total hours of             Wisconsin Administrative Code and all applicable OSHA
       direct labor are performed by severely handicapped                     Standards.
       individuals.
                                                                       22.0   WARRANTY: Unless otherwise specifically stated by the
19.0   NONDISCRIMINATION / AFFIRMATIVE ACTION: In                             bidder/proposer, equipment purchased as a result of this
       connection with the performance of work under this                     request shall be warranted against defects by the


Wisconsin Department of Administration
DOA-3054 (R10/2005)

WISCONSIN                                       Page 27 of 35
Department of Health Services RFB-1718-DPH-BC
Ch. 16, 19, 51, Wis. Stats.
                       Standard Terms And Conditions (Request For Bids / Proposals
       bidder/proposer for one (1) year from date of receipt. The                      result of the contracted commodities or services
       equipment manufacturer's standard warranty shall apply as                       cannot be copyrighted or patented. All data, docu-
       a minimum and must be honored by the contractor.                                mentation, and innovations become the property of
                                                                                       the State of Wisconsin.
23.0   INSURANCE RESPONSIBILITY: The contractor perform-
       ing services for the State of Wisconsin shall:                           27.2   Any material submitted by the vendor in response to
                                                                                       this request that the vendor considers confidential
       23.1    Maintain worker's compensation insurance as                             and proprietary information and which qualifies as a
               required by Wisconsin Statutes, for all employees                       trade secret, as provided in s. 19.36(5), Wis. Stats.,
               engaged in the work.                                                    or material which can be kept confidential under the
                                                                                       Wisconsin public records law, must be identified on a
       23.2    Maintain commercial liability, bodily injury and prop-                  Designation of Confidential and Proprietary Informa-
               erty damage insurance against any claim(s) which                        tion form (DOA-3027).         Bidders/proposers may
               might occur in carrying out this agreement/contract.                    request the form if it is not part of the Request for
               Minimum coverage shall be one million dollars                           Bid/Request for Proposal package. Bid/proposal
               ($1,000,000) liability for bodily injury and property                   prices cannot be held confidential.
               damage including products liability and completed
               operations. Provide motor vehicle insurance for all       28.0   DISCLOSURE: If a state public official (s. 19.42, Wis.
               owned, non-owned and hired vehicles that are used                Stats.), a member of a state public official's immediate
               in carrying out this contract. Minimum coverage shall            family, or any organization in which a state public official or
               be one million dollars ($1,000,000) per occurrence               a member of the official's immediate family owns or controls
               combined single limit for automobile liability and               a ten percent (10%) interest, is a party to this agreement,
               property damage.                                                 and if this agreement involves payment of more than three
                                                                                thousand dollars ($3,000) within a twelve (12) month
       23.3    The state reserves the right to require higher or lower          period, this contract is voidable by the state unless appro-
               limits where warranted. 24.0       CANCELLATION:                 priate disclosure is made according to s. 19.45(6), Wis.
               The State of Wisconsin reserves the right to cancel              Stats., before signing the contract. Disclosure must be
               any contract in whole or in part without penalty due to          made to the State of Wisconsin Ethics Board, 44 East
               nonappropriation of funds or for failure of the                  Mifflin Street, Suite 601, Madison, Wisconsin 53703
               contractor to comply with terms, conditions, and                 (Telephone 608-266-8123).
               specifications of this contract.
                                                                                State classified and former employees and certain
25.0   VENDOR TAX DELINQUENCY: Vendors who have a                               University of Wisconsin faculty/staff are subject to separate
       delinquent Wisconsin tax liability may have their payments               disclosure requirements, s. 16.417, Wis. Stats.
       offset by the State of Wisconsin.
                                                                         29.0   RECYCLED MATERIALS: The State of Wisconsin is
26.0   PUBLIC RECORDS ACCESS: It is the intention of the                        required to purchase products incorporating recycled mate-
       state to maintain an open and public process in the solicita-            rials whenever technically and economically feasible.
       tion, submission, review, and approval of procurement                    Bidders are encouraged to bid products with recycled
       activities.                                                              content which meet specifications.

       Bid/proposal openings are public unless otherwise speci-          30.0   MATERIAL SAFETY DATA SHEET: If any item(s) on an
       fied. Records may not be available for public inspection                 order(s) resulting from this award(s) is a hazardous chemi-
       prior to issuance of the notice of intent to award or the                cal, as defined under 29CFR 1910.1200, provide one (1)
       award of the contract.                                                   copy of a Material Safety Data Sheet for each item with the
                                                                                shipped container(s) and one (1) copy with the invoice(s).
27.0   PROPRIETARY INFORMATION: Any restrictions on the
       use of data contained within a request, must be clearly           31.0   PROMOTIONAL ADVERTISING / NEWS RELEASES:
       stated in the bid/proposal itself. Proprietary information               Reference to or use of the State of Wisconsin, any of its
       submitted in response to a request will be handled in                    departments, agencies or other sub-units, or any state offi-
       accordance with applicable State of Wisconsin procurement                cial or employee for commercial promotion is prohibited.
       regulations and the Wisconsin public records law. Proprie-               News releases pertaining to this procurement shall not be
       tary restrictions normally are not accepted. However, when               made without prior approval of the State of Wisconsin.
       accepted, it is the vendor's responsibility to defend the                Release of broadcast e-mails pertaining to this procurement
       determination in the event of an appeal or litigation.                   shall not be made without prior written authorization of the
                                                                                contracting agency.
       27.1    Data contained in a bid/proposal, all documentation
               provided therein, and innovations developed as a          32.0   HOLD HARMLESS: The contractor will indemnify and
                                                                                save harmless the State of Wisconsin and all of its officers,
                                                                                agents and employees from all suits, actions, or claims of
                                                                                any character brought for or on account of any injuries or
Wisconsin Department of Administration
DOA-3054 (R10/2005)
Ch. 16, 19, 51, Wis. Stats.

WISCONSIN                                        Page 28 of 35
Department of Health Services RFB-1718-DPH-BC
                      Standard Terms And Conditions (Request For Bids / Proposals
damages received by any persons or property resulting from the
     operations of the contractor, or of any of its contractors, in
     prosecuting work under this agreement.

33.0   FOREIGN CORPORATION: A foreign corporation (any
       corporation other than a Wisconsin corporation) which
       becomes a party to this Agreement is required to conform
       to all the requirements of Chapter 180, Wis. Stats., relating
       to a foreign corporation and must possess a certificate of
       authority from the Wisconsin Department of Financial
       Institutions, unless the corporation is transacting business
       in interstate commerce or is otherwise exempt from the
       requirement of obtaining a certificate of authority. Any
       foreign corporation which desires to apply for a certificate of
       authority should contact the Department of Financial
       Institutions, Division of Corporation, P. O. Box 7846,
       Madison, WI 53707-7846; telephone (608) 267-7577.

34.0   WORK CENTER PROGRAM:                       The successful
       bidder/proposer shall agree to implement processes that
       allow the State agencies, including the University of
       Wisconsin System, to satisfy the State's obligation to
       purchase goods and services produced by work centers
       certified under the State Use Law, s.16.752, Wis. Stat.
       This shall result in requiring the successful bidder/proposer
       to include products provided by work centers in its catalog
       for State agencies and campuses or to block the sale of
       comparable items to State agencies and campuses.

35.0   FORCE MAJEURE: Neither party shall be in default by
       reason of any failure in performance of this Agreement in
       accordance with reasonable control and without fault or
       negligence on their part. Such causes may include, but are
       not restricted to, acts of nature or the public enemy, acts of
       the government in either its sovereign or contractual
       capacity, fires, floods, epidemics, quarantine restrictions,
       strikes, freight embargoes and unusually severe weather,
       but in every case the failure to perform such must be
       beyond the reasonable control and without the fault or
       negligence of the party.




WISCONSIN                                        Page 29 of 35
Department of Health Services RFB-1718-DPH-BC
State of Wisconsin                                                                                                 Division of Agency Services
Department of Administration                                                                                            Bureau of Procurement
DOA-3681 (01/2001)
ss. 16, 19 and 51, Wis. Stats.




             Supplemental Standard Terms And Conditions for Procurements for Services
1.0    ACCEPTANCE OF BID/PROPOSAL CONTENT: The con-                                      sion, in writing, if those activities of the potential con-
       tents of the bid/proposal of the successful contractor will                       tractor will not be adverse to the interests of the state.
       become contractual obligations if procurement action ensues.               3.2    Contractors shall agree as part of the contract for
                                                                                         services that during performance of the contract, the
2.0    CERTIFICATION            OF        INDEPENDENT           PRICE                    contractor will neither provide contractual services nor
       DETERMINATION:           By signing this bid/proposal, the                        enter into any agreement to provide services to a
       bidder/proposer certifies, and in the case of a joint                             person or organization that is regulated or funded by
       bid/proposal, each party thereto certifies as to its own organi-                  the contracting agency or has interests that are
       zation, that in connection with this procurement:                                 adverse to the contracting agency. The Department
                                                                                         of Administration may waive this provision, in writing, if
       2.1     The prices in this bid/proposal have been arrived at                      those activities of the contractor will not be adverse to
               independently, without consultation, communication,                       the interests of the state.
               or agreement, for the purpose of restricting competi-
               tion, as to any matter relating to such prices with any      4.0   DUAL EMPLOYMENT:                Section 16.417, Wis. Stats.,
               other bidder/proposer or with any competitor;                      prohibits an individual who is a State of Wisconsin employee
                                                                                  or who is retained as a contractor full-time by a State of
       2.2     Unless otherwise required by law, the prices which                 Wisconsin agency from being retained as a contractor by the
               have been quoted in this bid/proposal have not been                same or another State of Wisconsin agency where the
               knowingly disclosed by the bidder/proposer and will                individual receives more than $12,000 as compensation for
               not knowingly be disclosed by the bidder/proposer                  the individual’s services during the same year.            This
               prior to opening in the case of an advertised procure-             prohibition does not apply to individuals who have full-time
               ment or prior to award in the case of a negotiated                 appointments for less than twelve (12) months during any
               procurement, directly or indirectly to any other                   period of time that is not included in the appointment. It does
               bidder/proposer or to any competitor; and                          not include corporations or partnerships.

       2.3     No attempt has been made or will be made by the              5.0   EMPLOYMENT: The contractor will not engage the services
               bidder/proposer to induce any other person or firm to              of any person or persons now employed by the State of
               submit or not to submit a bid/proposal for the purpose             Wisconsin, including any department, commission or board
               of restricting competition.                                        thereof, to provide services relating to this agreement without
                                                                                  the written consent of the employing agency of such person
       2.4     Each person signing this bid/proposal certifies that:              or persons and of the contracting agency.
               He/she is the person in the bidder's/proposer's organi-
               zation responsible within that organization for the          6.0   CONFLICT OF INTEREST: Private and non-profit corpora-
               decision as to the prices being offered herein and that            tions are bound by ss. 180.0831, 180.1911(1), and 181.0831
               he/she has not participated, and will not participate, in          Wis. Stats., regarding conflicts of interests by directors in the
               any action contrary to 2.1 through 2.3 above; (or)                 conduct of state contracts.

               He/she is not the person in the bidder's/proposer's          7.0   RECORDKEEPING AND RECORD RETENTION:                        The
               organization responsible within that organization for              contractor shall establish and maintain adequate records of
               the decision as to the prices being offered herein, but            all expenditures incurred under the contract. All records must
               that he/she has been authorized in writing to act as               be kept in accordance with generally accepted accounting
               agent for the persons responsible for such decisions               procedures. All procedures must be in accordance with
               in certifying that such persons have not participated,             federal, state and local ordinances.
               and will not participate in any action contrary to 2.1
               through 2.3 above, and as their agent does hereby so               The contracting agency shall have the right to audit, review,
               certify; and he/she has not participated, and will not             examine, copy, and transcribe any pertinent records or
               participate, in any action contrary to 2.1 through 2.3             documents relating to any contract resulting from this
               above.                                                             bid/proposal held by the contractor. The contractor will retain
                                                                                  all documents applicable to the contract for a period of not
3.0    DISCLOSURE OF INDEPENDENCE AND RELATIONSHIP:                               less than three (3) years after final payment is made.

       3.1     Prior to award of any contract, a potential contractor       8.0   INDEPENDENT CAPACITY OF CONTRACTOR:                         The
               shall certify in writing to the procuring agency that no           parties hereto agree that the contractor, its officers, agents,
               relationship exists between the potential contractor               and employees, in the performance of this agreement shall
               and the procuring or contracting agency that interferes            act in the capacity of an independent contractor and not as
               with fair competition or is a conflict of interest, and no         an officer, employee, or agent of the state. The contractor
               relationship exists between the contractor and another             agrees to take such steps as may be necessary to ensure
               person or organization that constitutes a conflict of              that each subcontractor of the contractor will be deemed to
               interest with respect to a state contract.             The         be an independent contractor and will not be considered or
               Department of Administration may waive this provi-                 permitted to be an agent, servant, joint venturer, or partner of
                                                                                  the state.

WISCONSIN                                         Page 30 of 35
Department of Health Services RFB-1718-DPH-BC
        Appendix A – Vendor Agreement DOA 3333
State of Wisconsin                                                                                  Division of State Agency Services
Department of Administration                                                                        State Bureau of Procurement
DOA-3333 (R03/2004)


Wisconsin’s Cooperative Purchasing Service
Wisconsin statutes (s. 16.73, Wis. Stats.) establish authority to allow Wisconsin municipalities to purchase from state contracts.
Participating in the service gives vendors opportunities for additional sales without additional bidding. Municipalities use the
service to expedite purchases. A "municipality" is defined as any county, city, village, town, school district, board of school
directors, sewer district, drainage district, vocational, technical and adult education district, or any other public body having the
authority to award public contracts (s. 16.70(8), Wis. Stats.). Federally recognized Indian tribes and bands in this state may
participate in cooperative purchasing with the state or any municipality under ss. 66.0301(1) and (2), Wis.Stats.

Interested municipalities:
will contact the contractor directly to place orders referencing the state agency contract number; and
are responsible for receipt, acceptance, inspection of commodities directly from the contractor, and making payment directly to the
contractor.
The State of Wisconsin is not a party to these purchases or any dispute arising from these purchases and is not liable for delivery
or payment of any of these purchases.
The State of Wisconsin will determine the contractor’s participation by checking a box below.
     MANDATORY: Bidders/Proposers to agree to furnish the commodities or services of this bid/proposal to Wisconsin
municipalities. Vendors should note any special conditions below.
     OPTIONAL: Bidders/Proposers may or may not agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. A vendor’s decision on participating in this service has no effect on awarding this contract.
A vendor in the service may specify minimum order sizes by volume or dollar amount, additional charges beyond normal delivery
areas, or other minimal changes for municipalities.
Vendor: please check one of the following boxes in response.
          I Agree to furnish the commodities or services of this bid/proposal to Wisconsin municipalities with any special
conditions noted below.
          I Do Not Agree to furnish the commodities or services to Wisconsin municipalities.

Special Conditions (if applicable):




Signature                                                                                       Date (mm/dd/ccyy)


Name (Type or Print)                                                                            Title


Company                                                                                         Telephone
                                                                                                (     )

Address (Street)                                      City                                      State           ZIP + 4


Commodity/Service                                                                               Request for Bid/Proposal Number

        This document can be made available in accessible formats to qualified individuals with disabilities.




        WISCONSIN                                         Page 31 of 35
        Department of Health Services RFB-1718-DPH-BC
     Appendix B - Vendor Information DOA 3477
STATE OF WISCONSIN                                                              Bid / Proposal #
DOA-3477 (R05/98)
                                                                            Commodity / Service


1.    BIDDING / PROPOSING COMPANY NAME
      FEIN
      Phone         (     )                                           Toll Free Phone       (       )
      FAX           (     )                                           E-Mail Address
      Address
      City                                                            State               Zip + 4


2.    Name the person to contact for questions concerning this bid / proposal.
      Name                                                              Title
      Phone         (     )                                             Toll Free Phone         (       )
      FAX           (     )                                             E-Mail Address
      Address
      City                                                            State               Zip + 4


3.    Any vendor awarded over $25,000 on this contract must submit affirmative action information to the department.
      Please name the Personnel / Human Resource and Development or other person responsible for affirmative
      action in the company to contact about this plan.
      Name                                                    Title
      Phone         (     )                                             Toll Free Phone         (       )
      FAX           (     )                                             E-Mail Address
      Address
      City                                                            State               Zip + 4


4.    Mailing address to which state purchase orders are mailed and person the department may contact concerning
      orders and billings.
      Name                                                              Title
      Phone         (     )                                             Toll Free Phone         (       )
      FAX           (     )                                             E-Mail Address
      Address
      City                                                            State               Zip + 4


5.    CEO / President Name
              This document can be made available in accessible formats to qualified individuals with disabilities.


     WISCONSIN                                    Page 32 of 35
     Department of Health Services RFB-1718-DPH-BC
    Appendix C - Vendor References DOA 3478
STATE OF WISCONSIN                                                             Bid / Proposal #
DOA-3478 (R12/96)


FOR VENDOR:

Provide company name, address, contact person, telephone number, and appropriate information on the product(s)
and/or service(s) used for four (4) or more installations with requirements similar to those included in this solicitation
document. If vendor is proposing any arrangement involving a third party, the named references should also be
involved in a similar arrangement.

Company Name

Address (include Zip + 4)

Contact Person                                                                    Phone No.

Product(s) and/or Service(s) Used




Company Name

Address (include Zip + 4)

Contact Person                                                                    Phone No.

Product(s) and/or Service(s) Used




Company Name

Address (include Zip + 4)

Contact Person                                                                    Phone No

Product(s) and/or Service(s) Used




Company Name

Address (include Zip + 4)

Contact Person                                                                    Phone No.

Product(s) and/or Service(s) Used




    This document can be made available in accessible formats to qualified individuals with disabilities.


    WISCONSIN                                     Page 33 of 35
    Department of Health Services RFB-1718-DPH-BC
Appendix D - State of Wisconsin Data Processing Agreement
This Agreement is made between the State of Wisconsin (the State) as represented by the (Contracting Agency) and
__________________________ (Contractor) commencing on the date this Agreement is signed by the Contracting
Agency.
This Agreement shall become effective commencing on the date this Agreement is signed by the Contracting
Agency and shall remain in effect for five (5) years from that date. This Agreement may be renewed for five (5)
additional periods of one (1) year upon mutual agreement by the State and Contractor.
The State agrees to acquire from Contractor and Contractor agrees to furnish the services specifically identified in
the Contractor’s response to the State solicitation document in accordance with the terms and conditions specified
herein.
The following are by reference attached hereto and made part of this Agreement and in the event of conflicts are
listed in the order of precedence with this Agreement having primary precedence.
                      Official Purchase Orders
                      Contractor’s Proposal
                      State’s Request for Proposal
                      Standard & Supplemental Terms and Conditions
                      Special Contract Terms and Conditions
This Agreement with attachments and purchase orders issued hereunder constitutes the entire agreement of the
parties in relation to the subject matter hereof, and no other agreements or understandings, verbal or otherwise, exist
between the parties except as herein expressly set forth.

For:                                                                        For       State of Wisconsin:

By:                                                                         By:

Name:                                                                       Name:

Title:                                                                     Title:

Date:                                                                       Date:

Witness:    Witness:



For the Contractor: Insert the name and address where all notices under this Agreement are to be sent. The name of
the person signing this Agreement for the vendor, their title, and the date of the signing must be inserted above.
Witnesses to the signing must sign in the area provided.



This document can be made available in accessible formats to qualified individuals with disabilities.




WISCONSIN                                         Page 34 of 35
Department of Health Services RFB-1718-DPH-BC
Appendix E – Designation of Confidential and Proprietary Information DOA
3027
STATE OF WISCONSIN
DOA-3027 N(R01/98)


The     attached    material     submitted     in response       to    Bid/Proposal  #   1718-DPH-BC
includes proprietary and confidential information which qualifies as a trade secret, as provided in s.
19.36(5), Wis. Stats., or is otherwise material that can be kept confidential under the Wisconsin Open
Records Law. As such, we ask that certain pages, as indicated below, of this bid/proposal response be
treated as confidential material and not be released without our written approval.
Prices always become public information when bids/proposals are opened, and therefore
cannot be kept confidential.
Other information cannot be kept confidential unless it is a trade secret. Trade secret is defined in s.
134.90(1)(c), Wis. Stats. as follows: "Trade secret" means information, including a formula, pattern,
compilation, program, device, method, technique or process to which all of the following apply:
 1. The information derives independent economic value, actual or potential, from not being generally
  known to, and         not being readily ascertainable by proper means by, other persons who can obtain
  economic value from its        disclosure or use.
 2. The information is the subject of efforts to maintain its secrecy that are reasonable under the
 circumstances.
We request that the following pages not be released

Section                                                Page #                 Topic

 _______________________________________________________________________________________________________

 _______________________________________________________________________________________________________

 _______________________________________________________________________________________________________

 _______________________________________________________________________________________________________
IN THE EVENT THE DESIGNATION OF CONFIDENTIALITY OF THIS INFORMATION IS CHALLENGED,
THE UNDERSIGNED HEREBY AGREES TO PROVIDE LEGAL COUNSEL OR OTHER NECESSARY
ASSISTANCE TO DEFEND THE DESIGNATION OF CONFIDENTIALITY AND AGREES TO HOLD THE
STATE HARMLESS FOR ANY COSTS OR DAMAGES ARISING OUT OF THE STATE'S AGREEING TO
WITHHOLD THE MATERIALS.
Failure to include this form in the bid/proposal response may mean that all information provided as part of the
bid/proposal response will be open to examination and copying. The state considers other markings of confidential
in the bid/proposal document to be insufficient. The undersigned agrees to hold the state harmless for any damages
arising out of the release of any materials unless they are specifically identified above.


Company Name___________________________________________


Authorized Representative___________________________________________
                                                                                                 Signature


Authorized Representative___________________________________________
                                                                                                Type or Print


Date___________________________________________

This document can be made available in accessible formats to qualified individuals with disabilities.


WISCONSIN                                         Page 35 of 35
Department of Health Services RFB-1718-DPH-BC

				
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