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SECTION C - H-GAC FORMS
(Rev 12/02/09)
For Use In Responding To Competitive Bid And Proposal Invitations
Invitation No.: TS06-11
Title: Direct-Hire, Teporary Staffing and Other Employer Services
This Section contains the following H-GAC FORMS .
FORM DESCRIPTION
Form A: Offeror Identification and Authorized Signatory
Form B: Historically Underutilized Business Enterprises
Form C: Response Checklist
Form D: Pricing - Page #1
Form D: Pricing - Page #2
Form E: Published Options
These FORMS are hereby made available in electronic format. They should be copied to Offeror's
computer for completion and/or printout as required. The FORMS may not be changed or altered in any
way, except as may be specified on the FORM .
ALL completed FORMS must also be submitted electronically on electronic media (DVD, CDRom,
flash/thumb drive), excepting of course for signatures. The printed "Original" of the response will be
considered as the official copy in case of any discrepancy between the electronic version and the printed
Original.
FORM A - OFFEROR IDENTIFICATION & AUTHORIZED SIGNATORY
Invitation No.: TS06-11
(DO NOT handwrite this Form. Information must be typed in.)
Invitation Title: Direct-Hire, Temporary Staffing and Other Employer Services
Offeror Company:
(Legal name of business which will appear on contract, if awarded)
Offeror Status: Manufacturer Dealer/Distributor Other
Response Type(1): Single Offeror Acting Multiple Offerors
Alone Or As Lead Acting Jointly
Contract Signatory(2): Title:
Mailing Address(3):
Street/PO Box City State & Zip
Physical Address:
Street City State & Zip
Phone: Fax:
Email Address:
Federal Tax ID No.: Web Page URL:
(1) If Joint Offering, all parties must submit a signed Form A. A contract will be offered to each.
(2) Person who will sign final contract documents if an award is made.
(3) Address to which final contract documents would be sent for signature.
Member Contact Information
Contact Person(4): Title:
Mailing Address:
Street/PO Box City State & Zip
Physical Address:
Street City State & Zip
Toll Free Phone: Fax:
Email Address:
(4) Person who End Users will contact for product information and to get pricing quotes.
The Signatory below, on behalf of Offeror:
- Acknowledges having thoroughly reviewed the Invitation;
- Attests to having the authority to sign this response and commit Offeror to honor all requirements;
- Makes, under penalty of perjury, all required Offeror Certifications as detailed in General Terms;
- Certifies that all information provided in this Response is true and correct.
Signature: Title:
Printed Name: Date:
FORM B - HISTORICALLY UNDERUTILIZED BUSINESS ENTERPRISES Procurement No.: TS06-11
Title: Direct-Hire, Temporary Staffing and Other Employer Services
Offeror:
Most, if not all, of the Members of HGACBuy are subject to various requirements relative to purchasing goods and services from
Historically Underutilized Business Enterprises (HUBs)(See Note 1). These requirements are promulgated by federal and state
governmental authorities, and include measureable criteria such as 'percentage of total dollars spent directed to HUBs', 'number of
HUB contractors used', 'HUB subcontractors employed by primary contractors', etc. These requirements are generally formalized
in goal oriented programs.
HGACBuy is comitted to promoting full and equal business opportunities for HUB contractors, and to assisting Cooperative
Purchasing Program (COOP) Members in meeting mandated HUB goals. In that regard, Contractor shall make a good faith effort
to use the services of Certified/Listed (See Note 2) HUBs whenever possible.
As part of a good faith effort, Contractor agrees to work with and assist HGACBuy Members in meeting HUB targets and goals, as
may be required by any rules, processes or programs they might have in place. Such assistance may include such things as
compliance with reporting requirements, provision of documentation, consideration of 'Certified/Listed' subcontractors, provision of
documented evidence that an active participatory role for a HUB entity was considered in a procurement transaction, etc.
Note 1: There are many designations other than "HUB" used across the country within various jurisdictions. Examples include
terms such as Disadvantaged Business Enterprise (DBE), Minority Owned Business Enterprise (MBE), Woman Owned Business
Enterprise (WBE), Small Disadvantaged Business (SDB), Small, Woman or Minority-owned Business (SWAM), etc. Regardless
of the formal designation, the overall objective of the relavant programs is basically the same, i.e. to insure that disadvantaged and
underutilized members of the business community receive a fair share of public spending. The term HUB as used herein shall be
understood to encompass all such programs/business enterprises, no matter what terminology is used by the Member.
Note 2: The terms "Certified" and "Listed" as used in conjunction with HUB programs relate to the process of HUB qualification
review. Jurisdictions usually require that companies claiming HUB status be reviewed and confirmed as meeting certain minimum
requirements to claim that status, and that the review and confirmation process be carried out by certain designated entities. They
are then "Certified" or "Listed" by having their name included on an official listing published by the Certifying or Listing Authority.
Accepted and Agreed By:
Title: Date:
HUB Status Of Offeror
Offeror is a HUB, as detailed below. Offeror is not a HUB.
Designation(s):
HUB DBE MBE WBE Other
Certifying/Listing Authority(s):
Subcontracts
On a separate sheet, list any subcontractors that would be employed in providing products or services related to this procurement.
Include subcontractor name, designation (HUB, DBE, etc.) and certifying/listing authority.
Subcontractor List attached. No Subcontractors will be used.
FORM C - RESPONSE CHECKLIST Procurement No.: TS06-11
Title: Direct-Hire, Temporary Staffing Services and Other Employer Services
Offeror:
This FORM is provided to help insure that all required Response elements have been completed and included, or
certified as being available upon request. Responses that do not comply with all requirements may be considered
non-compliant. Offeror's signatory must review each item below, and certify by initialing in the space to the right.
This Response Includes: Init.
1 An "Original" hard copy of the COMPLETE submission, including all required FORMS, plus one
copy, each in a separate hard-sided 3-ring binder.
2 A copy of the COMPLETE submission, including all required FORMS , in electronic format (CD,
DVD, flash drive).
3 An originally signed Form A from all entities who are party to this submission and who should be
offered a contract if this submission is successful.
4 The required list of (10) References.
5 Details of "Service Organization", including locations, hours, personnel and parts/service availability.
(Applies to hard goods only.) N/A
6 Complete Warranty Documentation for all Products offered.
N/A
7 The manufacturer’s latest Specification Documents detailing standard features, operating
characteristics, etc., for all products offered. N/A
8 Form CIQ, if required by law, completed and signed. (The Form, and instructions for its use, can be
found at: http://www.ethics.state.tx.us/whatsnew/conflict_forms.htm) If Form CIQ does not apply, put
"N/A" in the box to the right.
9 If the Non-Resident Reciprocal Bid Act applies, a copy of your state statute and a determination of the
status of Texas bidders/proposers in your home state. If not applicable, indicate "N/A"
10 Detailed Geographic capability listing, including a list of various office locations and number of
employees at each location. Use a map if necessary.
11 Have you submitted a marketing plan and an Executive Summary?
12 If applicable, have you submitted any Value Added Services or added any additional comments on the
Form E.
13 Filled out Both Form D, Pricing Sheets
14 If offer includes motor vehicles to be sold in Texas, copies of all current licenses as required by the
Texas Motor Vehicle Commission. N/A
Form D Pricing - Page #1
Proposer shall provide cost of services, Mark-up (MU) percentage pricing on the worksheet as noted:
When using the DOL website guidelines, as the Base pricing rate for Temporary Hire:
1.) What is the percentage of Mark-Up added to the Base rate for an Administrative
position?
2.) What is the percentage of Mark-Up added to the Base rate for an Light Industrial
position?
3.) What is the percentage of Mark-Up added to the Base rate for an Heavy Industrial
position?
4.) What is the percentage of Mark-Up added to the Base rate for an IT position?
5.) What is the coversion time in (hours) for a temporary position to a direct-hire?
6.) Are there any liquidation fees for the above transaction? yes/no > >
7. ) If there are liquidation fees or charges for the above transaction, what is the percentage
or hours charged?
hours: > > >
percentage > >
8.) Direct-Hire annual salary percentage of Mark-up.
** The annual salary must be equal to or less than hourly rate provided by the DOL
(times 2080 hours) or within hourly rate found in the additional job descriptions
listed on Form D, Page 2, using the multiplier of 2080 hours.
9.) Direct-Hire guarantee period in hours.
10.) Payrolling percentage of Mark-Up.
Page 5 of 9
Form D Pricing - Page #2
Code Occupation Despription Pricing Range Mark-Up % Total Total
Please Use a
Whole Number as
Low High the % (MU). Low High
Example 25% =
1.25
Accounting:
A01 Accountant I (Entry Level) $0.00 $0.00
A02 Accountant II $0.00 $0.00
A03 Financial Analyst I $0.00 $0.00
A04 Financial Analyst II $0.00 $0.00
A05 Payroll Clerk $0.00 $0.00
A06 Cost Accounting Specialist $0.00 $0.00
A07 CPA $0.00 $0.00
A08 Financial / Business Analyst $0.00 $0.00
A09 Controller $0.00 $0.00
A10 Auditor I $0.00 $0.00
A11 Auditor II $0.00 $0.00
Administrative Clerical:
B01 Office Manager $0.00 $0.00
B02 PBX / Information Specialist (Entry Level) $0.00 $0.00
B03 PBX Operator I $0.00 $0.00
B04 PBX Operator II $0.00 $0.00
B05 Call Center Representative $0.00 $0.00
B06 Customer Service Representative $0.00 $0.00
Craft and Trade:
C01 Groundman $0.00 $0.00
C02 Park Maintenance Worker $0.00 $0.00
C03 Park Naturalist $0.00 $0.00
C04 Recreation Specialist $0.00 $0.00
C05 Instrument & Control Tech. $0.00 $0.00
C06 Control Room Operator $0.00 $0.00
C07 Sr. Metering Technician $0.00 $0.00
Education:
D01 Teacher I $0.00 $0.00
D02 Teacher II $0.00 $0.00
D03 Teacher III $0.00 $0.00
D04 At Risk Counselor I $0.00 $0.00
Engineering:
E01 Power Plant Engineer $0.00 $0.00
E02 Planner / Scheduler $0.00 $0.00
E03 Project Engineer $0.00 $0.00
E04 Sr. Engineer with a PE License $0.00 $0.00
Health:
F01 Credentialing Assistant $0.00 $0.00
F02 Claims Processor $0.00 $0.00
F03 Claims Processor (Senior) $0.00 $0.00
F04 Dietary Aide $0.00 $0.00
F05 Eligibility / Insurance Verifier $0.00 $0.00
F06 Eligibility Referral Coordinator $0.00 $0.00
F07 Insurance Coordinator $0.00 $0.00
F08 Patient Access Representative $0.00 $0.00
F09 Patient Account Representative $0.00 $0.00
F10 Secretary (Medical) $0.00 $0.00
F11 Social Worker $0.00 $0.00
F12 Home Health Aids $0.00 $0.00
Information Technology:
G01 GIS (Geographic Info. Systems) Tech. I $0.00 $0.00
G02 GIS (Geographic Info. Systems) Tech. II $0.00 $0.00
G03 Network / Communications Support Clerk $0.00 $0.00
G04 Project Staff Coordinator $0.00 $0.00
G05 Computer Programer I $0.00 $0.00
G06 Computer Programer II $0.00 $0.00
G07 Computer Programer III $0.00 $0.00
G08 Computer Programer IV $0.00 $0.00
G09 Computer Analyst I $0.00 $0.00
G10 Computer Analyst II $0.00 $0.00
G11 Computer Analyst III $0.00 $0.00
G12 Database Administrator $0.00 $0.00
G13 Senior Technical Hardware Analyst $0.00 $0.00
G14 Senior Communications Technician $0.00 $0.00
G15 LAN Specialist $0.00 $0.00
G16 Senior Sys. Support Analyst - Data Center $0.00 $0.00
G17 Senior Sys. Support Analyst - LAN/WAN $0.00 $0.00
G18 Sen. Sys. Sup. Analyst - Application Devel. $0.00 $0.00
G19 Senior Microcomputer Analyst $0.00 $0.00
G20 Systems Consultant-Applications Develop. $0.00 $0.00
G21 Systems Consultant-Nework & Communic. $0.00 $0.00
G22 Information Systems Project Manager $0.00 $0.00
Procurement:
H01 Buyer I $0.00 $0.00
H02 Buyer II $0.00 $0.00
H03 Buyer III $0.00 $0.00
H04 Purchasing Manager $0.00 $0.00
Professional:
I01 Park Ranger $0.00 $0.00
I02 Community Relations Representative II $0.00 $0.00
I03 Community Relations Representative III $0.00 $0.00
I04 Facility Manager $0.00 $0.00
I05 Human Resources Manager $0.00 $0.00
I06 Safety Manager $0.00 $0.00
I07 Transportation Manager $0.00 $0.00
I08 Business Development Manager $0.00 $0.00
I09 Business Development Sales Rep. $0.00 $0.00
I10 Debris Specialist I $0.00 $0.00
I11 Debris Specialist II $0.00 $0.00
I12 Debris Specialist III $0.00 $0.00
I13 Disposal Site Monitor $0.00 $0.00
I14 Mitigation Specialists $0.00 $0.00
I15 Insurance Specialist I $0.00 $0.00
I16 Insurance Specialist II $0.00 $0.00
I17 Insurance Specialist III $0.00 $0.00
I18 Grant Administrator $0.00 $0.00
I19 Collection Monitor $0.00 $0.00
I20 Security - unarmed $0.00 $0.00
I21 Security - armed $0.00 $0.00
I22 Logistics Specialists $0.00 $0.00
I23 Logistics Manager $0.00 $0.00
I24 Inspection Manager $0.00 $0.00
I25 Inspection Specialists $0.00 $0.00
I26 Principle Consultant $0.00 $0.00
I27 Executive Consultant $0.00 $0.00
I28 Public Assistance Specialist $0.00 $0.00
I29 Fire / HAZMAT Specialist $0.00 $0.00
I30 Law Enforcement Specialist $0.00 $0.00
Scientific:
J01 Wildlife Biologist $0.00 $0.00
J02 Environmental Coordinator I $0.00 $0.00
J03 Geologist $0.00 $0.00
Miscellaneous:
K01 Legal Secretary I $0.00 $0.00
K02 Legal Secretary II $0.00 $0.00
K03 Contracts Administrator $0.00 $0.00
K04 Citizen Drop Off Monitor $0.00 $0.00
K05 Load Ticket Data Entry Clerk $0.00 $0.00
FORM E -- ADDITIONAL VALUE ADDED SERVICES THAT CAN BE OFFERED TS06-11
Offeror
Name:
1) Quote each Value Added Service (VAS) on a single separate line. Pricing must be included in order for the
Notes: VAS to become accepted and approved.
(Important)
2) Use a single Form E for ALL Items. Add/Insert additional lines as necessary.
Code Offered Rate,
(if any)
Description of Additional Services Price or Range
Page 9 of 9
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