Financial Services
January 16, 2014 To: Board of Education
Cindy Stevenson, Superintendent From: Lorie Gillis, Chief Financial Officer Betty Standley, Director of Purchasing Subject: Superintendent Search Services RFP ___________________________________________________________ As requested at the January 9 Board of Education Study Session, we are providing additional information regarding the Executive Search Services Request for Proposals (RFP) process. The following documents are being provided for your review:
Attachment 1 – Final Request for Proposal Executive Search Services o Final copy of the RFP document which was posted on Rocky Mountain
e-Purchasing on January 13, 2014. o Board directed changes from the January 9 Study Session were incorporated
in the RFP. o Because schedules were still being coordinated when the RFP document was
issued, any changes to dates will be communicated in the RFP Addendum which will be issued on January 22.
Attachment 2 – Draft Proposal Evaluation Form o This form will be used by the RFP evaluation committee to evaluate proposals. o Evaluation criteria requested by the Board has been incorporated. o Overall the proposals are worth 100 points. Please review the total weighted
points assigned to each evaluation criteria. o This form must be finalized prior to review of proposals. o Revisions will be compiled and a final evaluation form submitted for Board
review at the January 30 Study Session.
Attachment 3 – Guidelines for Proposal Review o The attached guidelines will provide guidance on the use of the qualitative
ratings of excellent, above average, average and below average.
Attachment 4 – Evaluation Committee Responsibilities Form o This form outlines the responsibilities of RFP evaluation committee members. o A signed form is required from each evaluation committee member, prior to
receiving proposals for review. o Please submit this signed form to the Board office by January 28.
Superintendent Search Services RFP January 16, 2014 Page 2 The next steps for the evaluation committee in the RFP process for the executive search services are:
Event Date
RFP advertised January 13, 2014
Questions from vendors will be collected.
No questions will be accepted following
this deadline. An addendum containing all
questions and responses will posted on
http://www.govbids.com/scripts/co1/public/
home1.asp
January 17, 2014, no later than 2:00 p.m.
(our clock)
Board of Education and staff provide
responses to vendor questions.
(Per Board direction any questions
requiring answers from the Board will be
sent to Mr. Newkirk.)
January 22, 2014, noon
Addendum posted (A final copy of the
Addendum will also be provided to the
Board.)
January 22, 2014, close of business
Proposals due January 29, 2014, no later than 2:00 p.m.
(our clock)
Board to individually review Draft
Proposal Evaluation Form and provide
feedback to Helen Neal.
January 23, 2014
Evaluation Committee Responsibilities
form to be reviewed, signed by Board
members and returned to Helen Neal.
January 28, 2014
Board Members will receive copies of
vendor proposals as well as final
Evaluation Proposal forms.
January 30, 2014
Board Members and staff on evaluation
committee individually review and evaluate
proposals.
January 30 – February 4, 2014
Individual ratings from Board Members
and staff on evaluation committee
due to Betty Standley, Purchasing Director.
February 4, 2014, 3:00 p.m.
Evaluation committee meets to review
ratings, select finalists to interview, and to
develop agenda and questions for finalists.
February 5, 2014, 5:30–7:30 p.m.
Seminar Room
Finalists notified. February 6, 2014
Finalist interviews (if required).
Vendor selection made.
February 18, 2014, 5:30–9:30 p.m.
Seminar Room
Agreement effective date. February 26, 2014
If there are any questions regarding this process, please direct them to Helen Neal, and she will coordinate getting responses to you.
EXECUTIVE SEARCH SERVICES
Request for Proposal (RFP) # 23431
Date of Issue: January 13, 2014
Question cut off: January 17, 2014 at 2:00 p.m. (our clock)
RFP Close Date: January 29, 2014 at 2:00 p.m. (our clock)
Proposal to be returned PRIOR to time and date above.
RESPONDENT’S CERTIFICATION
The undersigned, having carefully examined all of the documents pertaining to the subject project,
including the project specifications, agreement, and Terms & Conditions, hereby proposes to furnish all
required labor, materials equipment, tools and insurance to complete the work described in their proposal
document in strict accordance with the project documents for the price set forth herein.
The Respondent’s Certification must be signed by an authorized agent and returned with Firm’s proposal.
RETURN TO:
Betty Standley, Purchasing Director
Jefferson County School District No. R-1
Education Center, Purchasing Dept.
1829 Denver West Drive, Bldg #27, 3rd
floor
P.O. Box 4001
Golden, Colorado 80401-0001
(303) 982-6750
Company Name _____________________________________
Address _______________________________________________________
City ________________________ State _____ Zip___________
Telephone No. ________________________________
Fax No. _____________________________
Contact Name ____________________________________, Title __________________________
By __________________________________________
(Authorized Signature)
Email ______________________________________
CONTINUATION SHEET
REQUEST FOR PROPOSAL NO. 23431
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TABLE OF CONTENTS
OVERVIEW OF THE DISTRICT………………………………………..….2
PURPOSE………………………………………………………………….....2
GENERAL CONDITIONS……………………………………………….….3
SPECIAL CONDITIONS…………………………………………………....5
SCOPE OF WORK……………………………………………………...…...5
PROPOSAL SUBMISSION REQUIREMENTS…………………………....6
EVALUATION CRITERIA………………………………………………....7
SCHEDULE……………………………………………………………..…...8
TERMS AND CONDITIONS…………………………………………….…8
SAMPLE AGREEMENT………………………………………..………….14
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OVERVIEW OF THE DISTRICT
Jefferson County School District No. R-1 (District or Jeffco), a large school district in Colorado,
serves a geographic area of approximately 800 square miles and has a current enrollment of over
86,000 students. We have a diverse student population, 67% white, 24% Hispanic, 4% multiple race,
3% Asian/Pacific Islander, 1% Black and 1% American Indian/Alaska Native. 34.4 percent of our
students qualified for free and reduced lunch in 2012-2013. As Jefferson County’s largest employer,
the District employs over 12,000 full and part time professional and support personnel located in over
155 schools and office facilities. For more information visit the website at
http://www.jeffcopublicschools.org/
The District has a tradition of excellence. Jeffco students continue to outperform the state in all grade
levels and content areas on CSAP tests. U.S. News & World Report ranks six Jeffco high schools in
the top 40 on their 2013 Best High Schools list. In 2013, The Washington Post released its list of
most challenging high schools in the High School Challenge 2012 and five Jeffco schools are on the
national and state rankings. Jeffco ties for the second best graduation rate of the nation’s 50 largest
school districts, according to Education Week’s Diplomas Count report. The 2011-2012 graduation
rate was 81.4%. In 2013, Jeffco High School graduates received approximately $54.7 million in
scholarships.
The District is overseen by a Board of Education that is composed of five members elected to
alternating four-year terms. Elections are held every two years. Board members are elected at large,
but represent a specific area of the county. Three new board members were elected in the November
2013 election. Two board member’s terms expire in November 2015. Board members are not paid;
they give freely of their time to serve the community.
The Board of Education has drafted the following student achievement goals, which are anticipated to
be approved at the January 16, 2014 Board Meeting.
Ends 1: Every student will master the Colorado Content Standards at grade level.
The percentage of proficient/advanced third grade students in reading on
TCAP will increase from 80% to 85% by August of 2015. (The second
year of this goal will have to be determined based on the changes in
testing.)
The percentage of proficient/advanced fourth grade students in math on
TCAP will increase from 77% to 80% by August of 2015. (The second
year of this goal will have to be determined based on the changes in
testing.)
The percentage of proficient/advanced students in writing on TCAP will
increase to:
o Elementary – 64%
o Middle level – 66%
o High school – 59%
By August of 2014.
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Ends 2: Every student will achieve at least one year's growth, or more as needed
to catch up, in every year of school and be ready for the next level.
The percentage of third graders scoring in the unsatisfactory category on
third grade reading TCAP will decrease by 1 percentage point each year
in 2014 and 2015. (Current percentage is 6%). (The second year of this
goal will have to be determined based on the changes in testing.)
The percentage of ALP students who have growth measures over 50 will
increase:
In writing from (54) to (56)
In math from (60) to (62)
In reading from (57) to (59)
By August of 2014. (The second year of this goal will have to be determined
based on the changes in testing.)
Ends 3: Every student will graduate career and workforce and/or post-secondary
ready.
The college remediation rate for Jeffco graduates will decrease from
29.8% (2011-2012 data) to 27.8% by Spring 2015.
The Superintendent serves at the pleasure of the Board and carries out the policies established by the
Board. Dr. Cindy Stevenson, the current superintendent of Jefferson County School District No. R-1,
will retire on June 30, 2014 after being with the district for forty-one years, 12 of which were as
superintendent.
PURPOSE
Through this request for proposal process, the Board desires to enter into a contract with a qualified
executive search firm to assist the Board of Education in a comprehensive nationwide superintendent
search for Jefferson County School District No. R-1 in accordance with the terms and conditions of
the Request for Proposal.
GENERAL CONDITIONS
1. All prices shall be quoted FOB destination.
2. The respondent(s) shall be in agreement with all provisions of the Request for Proposal. Any
request for deviations/exceptions to the technical requirements, data requirements, and/or terms
and conditions of the Request for Proposal must be explained in detail on respondent’s letterhead
and included in the proposal response.
3. Proposals may be held by the District for a period not to exceed ninety (90) days from the date of
the closing of the RFP process for the purpose of reviewing the proposals and investigating the
qualifications of Respondent prior to awarding the contract.
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4. Proposal responses must include all of the information requested. Proposals may be rejected by
the District if the respondent(s) fail to completely provide all information necessary for a complete
understanding of the proposal or fails to answer all questions adequately.
5. District reserves the right to waive any technical or formal errors or omissions, and to accept or
reject in part or in whole any or all proposals submitted.
6. Any award made will be to the respondent(s) whose technically acceptable offer will be the most
advantageous to the District considering the evaluation criteria listed in EVALUATION
CRITERIA, page 7.
7. Any written statement made as part of the proposal, including the RFP may become part of the
final contract. Any addenda to the respondent's original proposal, such as letters, facsimile, and
any other written clarifications and commitments may also become part of the final contract.
8. The effective period of contracts resulting from this proposal shall be for a period of one year from
the date of award, or upon satisfactory completion of services.
9. The respondent(s) guarantees prices for the services will not increase during the initial term of the
agreement. If prices decrease during the term of this contract, the successful respondent must
notify the District of the lower prices.
10. The District reserves the right to cancel at any time any awards occurring as a result of this
proposal without cause. If it is determined by the Director of Purchasing that quality of product
or vendor service/performance is unacceptable, the District reserves the right to cancel any
awards.
11. All information shall be submitted at the dates and times indicated herein to:
Betty Standley, Purchasing Director
Jefferson County School District No. R-1
1829 Denver West Drive, Building #27
Golden, CO 80401-0001
All contacts regarding this Request for Proposal during the submittal preparation and evaluation
period must be done in writing through the Jefferson County School District Purchasing
Department.
This restriction does not apply to:
District initiated communications to satisfy clarification questions as part of the stage one
evaluation process.
Scheduled product demonstrations and vendor interviews during the second stage evaluation.
In the event that a firm has contact with any official, employee or representative of the
District in any manner contrary to the above requirements, said firm may be disqualified
from further consideration.
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SPECIAL CONDITIONS
1. Each respondent shall submit all information requested, in the order specified in the Proposal
Submission Requirements. Failure to do so may result in the proposal being rejected. Proposals
shall be straightforward and concise and shall demonstrate the proposer’s ability to satisfy
the requirements of the RFP.
2. This process is a Request for Proposal/Competitive Negotiation process. As such, only the names
of the respondents shall be read at the closing of proposals. The District reserves the right to
negotiate on any or all components of each proposal submitted. From the time the proposals are
submitted until the formal award of a contract, each proposal is considered a working document
and as such will be kept confidential. The negotiation discussions will be held as confidential as
well until such time as the award is completed.
The District, at its discretion, may utilize a Best and Final Offer (BAFO) process. If this process is
utilized, the purchasing agent shall submit to the respondents most likely to receive the award,
requests for specific clarification and allow vendors to enhance their pricing. Respondents are
encouraged to provide their best pricing and to not rely on the opportunity to submit a BAFO. The
purchasing agent shall coordinate the respondents’ responses for review by the evaluation
committee. The purchasing agent shall be the SOLE point of contact throughout the process for all
respondents.
3. The proposing firm shall submit one (1) original and seven (7) copies of their response and one
CD-ROM or thumb drive in write protected PDF format of their response. Each hard copy shall
be provided in a 3-ring, loose-leaf binder with the firm name, proposal name and number on it.
Although an electronic version of the attachments is available to assist respondents in preparing
proposals, the proposal must be submitted in hard copy.
4. Proposals submitted in response to this Request for Proposal shall become the property of the
District and be considered public documents under applicable Colorado state law. Financial
records marked as “Confidential” and submitted in a separate sealed envelope shall be returned to
the Respondent upon completion of the process. Entire proposals may not be marked as
“Confidential”. Proposals may be considered non-responsive and may not be accepted.
5. Respondents are responsible for downloading all addendum issued for this Request for Proposal.
It is not the District’s responsibility to ensure that a respondent is notified of issuance of
addendum. Addendums will be posted at http://www.govbids.com/scripts/co1/public/home1.asp
SCOPE OF WORK
Proposals must include, but not be limited to, the following activities:
a. Engage school system stakeholders, including board of education, employees, parents,
community leaders and business leaders in developing the criteria for superintendent
selection.
b. Develop job description and recruitment information for review by Board of Education
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and current superintendent.
c. Work with Board of Education and staff to develop a detailed timeline and work
schedule for the search. All activities of the recruitment process shall be included.
d. Prepare and distribute materials to advertise and recruit and maximize the number of
qualified candidates.
e. Receive and screen applications, coordinate the interview process, arrange any site
visits and make recommendations on candidates to the Board.
f. Background verification on candidates.
g. Negotiate agreement with successful candidate.
h. Maintain strict confidentiality throughout the process as directed by the Board of
Education.
i. Prepare and provide reports and recommendations to the Board as requested.
j. Provide any other assistance as necessary to facilitate the Board’s final selection of a
superintendent for a term to begin on July 1, 2014.
PROPOSAL SUBMISSION REQUIREMENTS
Proposals shall contain all sections described below in the order specified. Failure to adhere to this
outline and submittal information may eliminate the proposal from further consideration.
Proposals shall be straightforward and concise and shall demonstrate the proposer’s ability to satisfy
the requirements of the RFP.
1. Respondent’s Certification sheet signed by an authorized representative of your company in
unaltered fashion.
2. All addenda issued for this RFP should be included and signed by an authorized representative
of your Company.
3. Statement of Qualifications
a. Overview of firm submitting proposal
i. Main Office address.
ii. When organized and type of organization.
iii. Describe qualifications and experience of organization and assigned staff
performing the work described in the RFP document.
iv. Provide a description of successful superintendent of school searches conducted
by your firm for other K-12 school districts of similar or larger size to Jeffco.
v. Provide information demonstrating a track record of successful placement of
superintendents. How does your firm define successful? Provide the shortest
and longest tenure of superintendents appointed in other searches.
vi. Please provide any performance guarantees your firm offers.
b. Personnel to be directly assigned to this project. This shall include full-time, part-time
staff, consultants and subcontractors. The work groups qualifications and recent
relevant experience shall be demonstrated. Resumes of staff, consultants and
subcontractors shall be included which show education, background and relevant
experience.
c. Provide a statement as to whether the firm is currently engaged in any other projects
that might impact the timeline of this search or that would be a conflict of interest.
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d. References for similar clients to whom you have provided superintendent search
services. Please provide organization name, client contact name, e-mail and phone
number.
4. Technical Proposal and proposed definitive Scope of Work (SOW) to include as a minimum
those tasks outlined under the Scope of Work Section beginning on page 5.
a. Provide a detailed plan for the completion of the SOW to include tasks, recommended
process for completion of each task, timeline for completion of tasks and staffing plan
showing who will be responsible for each task. Include any support required by the
Board and District staff. This section should also contain a discussion of any changes
or additional tasks recommended by the respondent.
b. Provide information on any special services or value added services that your company
will provide under this project that differentiate you from your competition.
c. Provide samples of any reports for the Board that are available and would be used in
this project.
d. Address how your firm would meet the Board’s desire to hire an innovative and
creative leader.
e. Discuss how your firm can be nimble and flexible in meeting Board’s needs throughout
the executive search process.
5. Cost Proposal shall include the following:
a. A total firm fixed price for the project.
b. A cost breakdown for each task showing the estimated number of man-hours, and
applicable hourly rates.
c. Any applicable travel or per diem costs or other expenses not accounted for in the
above cost breakdown. These are to be included in the total firm fixed price and will
not be in addition to.
d. Provide milestones and payment schedule related to these milestones, if progress
payments are required throughout the work rather than one payment being made at
completion.
6. Most recent audited financial statement of the responding company.
7. The proposing firm shall submit one (1) original, seven (7) paper copies, and one (1) electronic
copy on CD-ROM or flash drive with write protected PDF format of response. Each copy
shall be provided with the firm name and RFP name and number clearly marked.
EVALUATION CRITERIA
The information listed below is in a random order. Proposals will be evaluated based on the following
criteria:
1. Qualifications and experience of the firm
2. Qualifications and experience of the proposed staff.
3. Demonstrated experience in hiring innovative and creative leaders.
4. Demonstrated flexibility in meeting Board of Education’s needs throughout the executive
search process.
5. Technical proposal.
6. Staffing plan.
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7. Cost.
8. Client References.
SCHEDULE
The following is the schedule of events for the RFP submittal and selection. The District reserves
the right to change the schedule.
Event Date
RFP
RFP advertised January 13, 2014
Questions from vendors will be collected.
No questions will be accepted following
this deadline. An addendum containing all
questions and responses will posted on
http://www.govbids.com/scripts/co1/public/
home1.asp
January 17, 2014 no later than 2:00pm
(our clock)
Addendum posted January 22, 2014 close of business
Proposals due January 29, 2014 no later than 2:00 p.m.
(our clock)
Finalist Interviews (if required) February 14, 2014 (date may be revised)
Agreement negotiated February 21, 2014
Contract effective date February 24, 2014
TERMS AND CONDITIONS
SUBMISSION: All bids/proposals must be sealed at submission. Late bids will not be accepted. No
oral, telephonic, telegraphic email or facsimile responses will be considered. A duly authorized
official must sign this bid. Signature indicates agreement to comply with all terms, conditions,
requirements and instructions of this bid as stated or implied herein. Signature indicates agreement to
furnish the proposed materials, supplies, products, equipment and/or services in strict accordance with
the conditions, requirements, and specifications herein. Should anything be omitted which is
necessary to clearly understand or should it appear that various instructions are in conflict, the
Respondent shall secure instructions at least 72 hours prior to the closing date and time.
AWARD: No award shall be made to any person, firm or corporation that is in arrears upon any
obligations to the District, or that otherwise may be deemed irresponsible or unreliable by the Director
of Purchasing or designee. The Director of Purchasing or designee reserves the right to waive any
technical or formal errors or omissions and reject any and all bids or to make an award, either in
whole or in part, by item, category, or total, whichever is deemed to be most advantageous to and in
the best interest of the District. In compliance with the provisions of Colorado Revised Statutes,
Sections 8-17-101 and 102, 8-18-101, and 8-19-101 and 102, preference shall be given to Colorado
labor and to resident Respondents against nonresident Respondents to the extent required by those
sections. It is understood and agreed that the District reserves the right to modify conditions,
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specifications, and prices by mutual agreement with the selected Respondent.
MODIFICATION: Any alteration, erasure or interlineation by the Respondent in this bid may
constitute cause for rejection by the Director of Purchasing or designee. Exceptions or deviations
should not be added to the individual pages, but should be submitted on Respondent’s letterhead.
COMPLETION: Respondent shall complete all of the information requested for each item. Failure to
do so shall constitute sufficient cause to reject any or all items offered if deemed to be in the best
interest of the District. The District requests that this bid be completed using either black ink or black
type.
ACCURACY: Accuracy of the quotation is the responsibility of the Respondent. Quotations may not
be changed after the bid opening time and date. No dollar amount change will be allowed, only
clarification as to the unit represented. The Director of Purchasing or designee must do this in writing
24 hours after notification.
PRICING: The unit price for each item shall be for the unit of measurement specified. All trade
discounts and terms of payment must be reflected within the unit price. All prices must be quoted at a
firm price, F.O.B. Destination. Prices shall remain firm for the term of the contract. If prices decrease
during the term of this contract, the successful Respondent must notify the District of the lower prices
so that all subsequent orders will reflect accurate pricing.
PAYMENT: The District payment terms are Net 30 days, unless otherwise negotiated. Payment shall
be processed upon receipt by the District of an itemized invoice. Each purchase order shall be
invoiced separately. All invoices shall be submitted to Jefferson County School District No. R-1,
Attn: Accounts Payable, 1829 Denver West Dr. Bldg #27, Golden Colorado 80401.
QUALITY: All services furnished must strictly conform to the RFP and must be of the quality
specified. No deviation or substitution is permitted without the prior written consent of the Director
of Purchasing or designee. In the event no quality is specified, the services must be at least equal to
the standards of the industry. The Director of Purchasing or designee shall have the right at all times
during the performance of this Agreement to conduct such tests and inspections as is deemed
necessary to assure Respondent’s compliance with this Agreement. The District will be supplied, as
needed, data, drawings, specifications, test results, quality documentation, schedules, and other
documents and information.
SHIPPING: Unless an order specifies a different delivery point, all deliveries under this Agreement
shall be F.O.B. destination. Title and risk of loss of all goods shall pass to the District upon final
acceptance.
DELIVERY: Delivery dates must be specified on this bid. Time is of the essence. Delivery is part of
the consideration and the advised delivery date given on this bid must be complied with unless
otherwise instructed by the Director of Purchasing or designee. The District will not be responsible
for any goods delivered or services performed without a purchase order signed by an authorized
representative of The District.
SAMPLES: Samples of items, when requested/required, must be furnished free of expense and if not
destroyed, will be returned upon request at the Respondents’ expense.
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NON-COLLUSION: By submission of the bid, the Respondent certifies that the bid has been arrived
at independently and submitted without collusion with any other Respondent and that the contents of
the bid have not been communicated, nor to the best of its knowledge and belief, by any one of its
employees or agents, to any person not an employee or agent of the Respondent or its surety on any
bond furnished herewith, and will not be communicated to any person prior to the official opening of
the bid.
GRATUITIES: Respondents are expressly advised that gratuities are not allowed. District employees
and Board of Education members may not accept any gift, service, honorarium, stipend or fee, or use
their position for private advantage or personal, financial or material gain. The District will
investigate reported violations. Respondents, whom the Director of Purchasing or designee finds to
have violated these provisions, may be barred from doing business with the District; employees may
be disciplined according to District Policy.
CANCELLATION: The District reserves the right to cancel without penalty, at any time, any awards
occurring as a result of this bid. Time is of the essence. When a date is set for the delivery of
merchandise or the performance of work, the merchandise must be delivered, or work performed, in
accordance with the bid specifications or description on or before that date, or the order to the
delinquent Respondent may be canceled and re-awarded. In such case, the District will have the right
to buy merchandise or services at market price for immediate delivery. Any excess in cost shall be
paid by the delinquent Respondent or deducted from any money due the delinquent Respondent.
TERMINATION: The District, by written notice, may terminate this contract, in whole or in part,
when it is in the District’s interest. If this contract is terminated, the District shall be liable only for
payment of this contract for services rendered or goods provided before the effective date of
termination.
COMPLIANCE: The Respondent agrees to comply with all applicable federal, state, and local laws,
regulations, administrative rulings, and codes and secure all necessary licenses and permits in
connection with this bid and any services to be provided hereunder.
GOVERNING LAW: Venue for any and all legal action regarding or arising out of transactions
covered herein shall be solely in the District Court in and for Jefferson County, State of Colorado.
The transaction shall be governed by the laws of the State of Colorado.
TAX: The District is a political subdivision of the State of Colorado and as such is generally exempt
and not liable for any sales, use, excise, property, or other taxes imposed by any federal, state or local
government tax authority. The District is also not liable for any franchise taxes or taxes related to the
income of a contractor. No taxes of any kind shall be charged to the District. Quotations shall not
include the cost of any such taxes, including those on any materials, supplies or equipment used or
installed in the work. The Respondent is hereby notified that when materials are purchased for the
benefit of the District, some political subdivisions require the Respondent to pay sales or use taxes
even though the ultimate product or service is provided to the District. These sales or use taxes will
not be reimbursed by the District, nor will any prices be adjusted on account of such taxes. The
Respondent shall file an “Application for Exemption Certificate” with the Colorado Department of
Revenue and submit copies of such certificate to the District upon award of the contract and prior to
commencement of any work.
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HOLD HARMLESS: The Respondent agrees to protect, defend and hold the District harmless from
and against any claim or demand for payment or other claim based upon or related to the use of any
patented material, process, article or device that may enter into the manufacture, construction or form
a part of any work covered or materials and equipment furnished under this bid.
INDEMNIFICATION: The Respondent agrees to indemnify and hold the District harmless from
claims, suits or actions of every nature and description brought against it for or on account of any
injuries or damages received or sustained by any party or parties, caused in whole or in part by or
from the acts of the Respondent, its servants or agents. To this extent, the Respondent agrees to
furnish adequate Public Liability and Property Damage Insurance, the amount of which will be
determined by the District whenever such insurance, in the opinion of the District, is deemed
necessary.
APPROPRIATIONS & APPROVAL: Any and all obligations of the District under this Agreement
may be subject to annual approval and/or budgeting and appropriation by the District.
EQUAL OPPORTUNITY: In connection with the performance of any work under the bid, the
Respondent shall agree not to refuse to hire, discharge, promote or demote, or to discriminate in
matters of compensation against any person otherwise qualified, solely because of race, creed, color,
national origin, ancestry, age, sex, or disability, and further agrees to insert the foregoing provisions in
all subcontracts hereunder.
INSURANCE: Consultant shall maintain in effect at all times during the term of this Agreement the
following policies of insurance:
Commercial General Liability with limits of $2,000,000 per occurrence/$2,000,000 aggregate;
Auto Liability, including hired and non-owned auto, with limits of $2,000,000, per occurrence
combined single limit;
Professional liability insurance with limits of $2,000,000 per claim and aggregate, if “Claims Made”,
coverage is to be maintained for a period of two years beyond the expiration of this contract or a two
year extended reporting period must be purchased.
Statutory workers’ compensation coverage and employer’s liability insurance with limits of not less
than $100,000
All insurance carriers (other than with respect to Professional Liability) must have an AM Best rating
of A-VIII or better. The District is to be included as an Additional Insured on the commercial general
liability and auto insurance policies with respect to its vicarious liability arising out of Consultant’s
performance hereunder. The District must be notified in writing at least thirty (30) days prior to
cancellation of any insurance policy.
Notwithstanding the preceding, the District may waive or modify these requirements. Such waiver or
modification shall not be effective unless made in writing executed by an appropriate officer or employee
of the District.
ILLEGAL ALIENS: Pursuant to Colo. Rev. Stat. § 8-17.5-101 et. seq., the District cannot enter into
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or renew a public contract for services with a vendor/contractor who knowingly employs or contracts
with an illegal alien to perform work under the contract or who knowingly contracts with a
subcontractor who knowingly employs or contracts with an illegal alien to perform work under the
contract.
In accordance with the mandatory provisions of Colo. Rev. Stat. § 8-17.5-101 et. seq.,
Vendor/Contractor certifies that it has not knowingly employed or contracted with an illegal alien to
perform work under this Agreement, and that the Vendor/Contractor will participate in the E-Verify
Program or the Department Program [as defined in Colo. Rev. Stat. § 8-17.5-101(3.3)] in order to
confirm the employment eligibility of all employees who are newly hired to perform work under this
Agreement. Vendor/Contractor further certifies that it will not enter into a contract with a
subcontractor who fails to certify to Vendor/Contractor that the subcontractor shall not knowingly
employ or contract with an illegal alien to perform work under this Agreement.
Vendor/Contractor has confirmed the employment eligibility of all employees who are newly hired to
perform work under this Agreement through participation in either the E-Verify Program or the
Department Program. Vendor/Contractor shall not use the E-Verify Program or the Department
Program to undertake pre-employment screening of job applicants while the Agreement is being
performed.
If Vendor/Contractor obtains actual knowledge that a subcontractor performing work under this
Agreement knowingly employs or contracts with an illegal alien, Vendor/Contractor shall:
a. Notify the subcontractor and the District within three days that Contractor has actual
knowledge that the subcontractor is employing or contracting with an illegal alien; and
b. Terminate the subcontract if within three days of receiving actual notice the subcontractor does
not stop employing or contracting with the illegal alien, except that Vendor/Contractor shall not
terminate the subcontractor if during such three days the subcontractor provides information to
establish that the subcontractor has not knowingly employed or contracted with an illegal alien.
Vendor/Contractor shall comply with any reasonable request by the Department of Labor and
Employment (hereinafter referred to as the “Department”) made in the course of an investigation that
the Department is undertaking pursuant to C.R.S. § 8-17.5-102(5).
If Vendor/Contractor violates the provisions of this paragraph, the District may terminate the contract
for breach and Vendor/Contractor shall be liable for actual and consequential damages.
If Vendor/Contractor is a natural person eighteen years of age or older, Vendor/Contractor hereby
swears or affirms under penalty of perjury that the Vendor/Contractor (i) is a citizen of the United
states or otherwise lawfully present in the United States pursuant to federal law, (ii) shall comply with
the provisions of CRS 24-76.5-101 et seq, and (iii) shall produce one of the forms of identification
required by CRS 24-76.5-103 prior to the effective date of this Agreement.
CRIMINAL RECORD VERIFICATION: Successful Respondent will be required to complete
Criminal record check on any person providing services under the contract, employees, subcontractors
or other agents of Vendor who work on district property for this contract. Employees, subcontractors
or other agents of Vendor who have been convicted of, pled nolo contendere to, or received a deferred
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sentence or deferred prosecution for a felony, or a misdemeanor crime involving unlawful sexual
behavior or unlawful behavior involving children, will not be allowed to work on District property for
this contract. The Respondent must complete the district’s Criminal Records Check Certification.
Each individual Respondent will be responsible to adhere to any Federal, State, and Local privacy and
confidentiality requirements.
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SAMPLE AGREEMENT
MASTER SERVICES CONSULTING AGREEMENT
THIS AGREEMENT (“Agreement”) is entered into and made effective this ________ day of
_________, 2014, (“Effective Date”) by and between Jefferson County School District No. R-1
(“District”) and _______________ with offices at _________________________(“Consultant”).
RECITALS
WHEREAS, the District seeks to purchase awarded items/services quoted on Bid/Request for
Proposal (RFP) No.23431 issued by the District.
WHEREAS, the District issued Bid/RFP No. 23431 and awarded the Bid/RFP as specified in
the Bid/RFP document.
WHEREAS, the District and the Vendor desire to enter into an agreement in accordance with
the terms and conditions contained herein.
AGREEMENT
NOW, THEREFORE, in consideration of the mutual promises and covenants contained
herein, the parties agree as follows:
The Contract Documents shall be this Agreement, the RFP No.23431 together with the District’s
Bid/Proposal document in its entirety, Bid/Proposal Terms and Conditions, any Addenda, the
bid/Proposal of the Consultant, the Best and Final Offer and any and all signed Statements of Work
(SOW) during the term of this agreement, together with any Change Orders all incorporated herein by
reference.
The District accepts the SOW of the Consultant for the costs as set forth in the SOW of the
Consultant, and the Consultant at its sole risk, cost and expense agrees to furnish, supply and deliver
the said item(s)/services as ordered and to perform all necessary labor, and to undertake and complete
this Agreement in accordance with the standards of the industry and the terms of this Agreement and
the other contract documents.
WITNESSETH
In consideration of the mutual promises and covenants herein set forth, District and Consultant agree as
follows:
Services. Consultant shall perform the Professional Services described and attached hereto and
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incorporated herein by this reference (the "Services"). In the event of any inconsistency in the terms of
the incorporated documents, this Agreement shall control.
Term. Consultant shall commence the Services _____________ and complete the Services by
________________. Deliverables are to be completed in accordance with the schedule outlined in the
project’s SOW. This contract may be extended after the initial term upon the mutual consent of both parties. A
new SOW will be established and mutually agreed upon for each service provided by the Consultant
during the initial term of the agreement and any one year extensions thereafter.
Standards. All Services shall be performed by Consultant in a diligent, safe, and workmanlike manner
and Consultant shall use its best skill and judgment pursuant to the prevailing standards of the profession
for such Services in furthering the District's best interests. In the event of a breach by Consultant of the
terms of this Agreement, the District may terminate this Agreement, and may pursue any remedies
available in law or in equity.
Contract Price. Consultant shall perform the Services for a total fee, as outlined in the SOW, payment
to be paid in monthly installments in arrears based upon completion and acceptance by the District for
work being billed. The District reserves the right to modify the payment schedule in the event the Project
and deliverables are not proceeding to completion in the manner proposed such that the payments
coincide with the percentage of total Project Services performed during any payment period. Consultant
will assume the information supplied by the District (or which is supplied on its behalf) is accurate
and complete.
Independent Contractor. Consultant shall perform all services using independent judgment and
expertise as an independent contractor and not as an employee of the District. Neither party shall be
construed, in any way, as a partner or joint venture with the other party. Neither the Consultant nor any
agent or employees of the Consultant shall be an agent or employee of the District nor shall any of them
have any authority, express or implied, to bind the District to any agreement or incur any liability
attributable to the District. Consultant acknowledges that it is not entitled to Unemployment
Compensation or Workers' Compensation benefits and that Consultant is obligated to pay federal
and state income tax on any moneys earned from the District pursuant to this Agreement.
Materials. All necessary labor, licenses, materials, supplies, equipment, and all other items necessary to
complete the Services required to be furnished by Consultant (the "Materials") shall be part of and not in
addition to the Contract Price. Consultant shall be responsible and liable for any damage or destruction to
any Materials resulting from the negligence or willful misconduct of Consultant and not resulting from
the deliberate or negligent acts of the District for which it could be held liable under the Colorado
Governmental Immunity Act.
Government Regulations. Consultant shall comply with all laws, statutes, ordinances, standards, rules,
and regulations of all federal, state, municipal, and special district governmental authorities which are or
may become applicable to any of the Services or Materials covered under this Agreement. Compliance
shall also include, without limitation, applicable District policies and records requirements, which have
been made known to Consultant in writing.
Consultant's Representations.
The Consultant shall perform all of the Services set forth herein.
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The Consultant represents that it understands the nature, location, and scope of the Services, the character
of the equipment and facilities needed preliminary to and during the performance of the Services, and the
general and local conditions and all other matters which can in any way affect the Services and is not
relying on any representations or promises by the District except as set forth in this Agreement.
The Consultant shall reasonably cooperate with other consultants, if any and employees of the District in
performing the Services.
Consultant's Warranties.
The Consultant warrants that the Services shall be conducted in a good and workmanlike manner in
accordance with mutually agreed specifications.
The Consultant warrants and represents that it has full authority under applicable law to execute and
deliver this Agreement and to perform all of the obligations under this Agreement.
The Consultant represents that it shall perform the Services in a safe and diligent manner.
The Consultant warrants that any Materials utilized shall be adequate and appropriate for the use
contemplated by the required Services.
Notice. Any notice required under this Agreement shall be in writing and shall be effective upon
personal delivery or three days after mailing when deposited in the United States first-class mail, postage
prepaid, or upon confirmed transmission by electronic mail or a facsimile:
DISTRICT:
Director of Purchasing
Jefferson County School District No. R-1
1829 Denver West Drive, Building No.27
P.O. Box 4001
Golden, Colorado 80401-0001
CONSULTANT:
Expenses. The Contract Price is inclusive of all expenses for this project
Infringement Claims. The Consultant shall defend all suits or claims for infringement of any alleged
patent rights, copyright, or trade secrets arising from the products or services delivered by Consultant
under this Agreement and shall indemnify the District from loss on account thereof and shall pay any
judgments or fees resulting there from, including, but not limited to, royalties, license fees, and
reasonable attorneys' fees, provided that the Consultant is notified promptly of any such suit or claim.
The indemnification obligation set forth above shall not be applicable to the extent the infringement is
attributable to the acts or omissions of the District including, without limitation, materials,
specifications or products provided by the District, modifications made by the District to any of the
products or services delivered by the Consultant or if the District uses the products or the services in a
manner not intended by the Consultant.
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Indemnity. Consultant shall indemnify, defend, and hold the District harmless from any and all claims
and causes of action, including reasonable attorneys' fees, or any damage to or destruction of property or
injury to any person as a result of negligent or wrongful acts or omissions of Consultant or any of its
agents in the performance of the Services required herein.
Use of Work Product. Consultant's work product produced or created by Consultant specifically and
exclusively for the District (“work product”) shall be delivered to the District in the time frame
contemplated by this Agreement, shall become the property of the District, and may be used by the
District for any purpose connected with the Project or as otherwise contemplated hereunder. Consultant
shall not be responsible, and shall have no liability whatsoever, if the work product is used for a
purpose or in a manner other than the parties contemplated hereunder. The District further
understands that Consultant retains exclusive rights to the intellectual capital (such as methodologies,
know how, models, tools, and any graphic or digitized representation of any of these) now possessed,
or subsequently developed, by Consultant.
No Interest. Consultant hereby acknowledges that it (i) has no personal or financial interest in the
project requiring the performance of the Services other than the fee it is to receive under this
Agreement; (ii) shall not acquire any such interest, direct or indirect, which would conflict in any
manner with the performance of the Services hereunder; and (iii) does not and will not employ or
engage any person with a personal or financial interest in the project requiring the Services under this
Agreement.
Non-disclosure. By performance of this Agreement, the Consultant may have access to information that
is confidential third party information such as specifications, software code, ideas, documents or other
material (collectively, “Third Party Information”). The Consultant agrees not to disclose the Third Party
Information to any person or entity except as necessary to perform Services under this Agreement.
Further, the Consultant agrees to maintain the confidential nature of all Third Party Information and to
use the Third Party Information solely for the purposes of performing Services hereunder. The
Consultant shall require its employees; agents and subcontractors performing work hereunder to do
likewise. The Consultant agrees to indemnify and hold harmless the District from and against any claim,
demand, loss, or cause of action that arises as a result of the Consultant’s breach of this non-disclosure
requirement or misuse by Consultant, its employees, agents, or subcontractors of the Third Party
Information. The obligations of this section will survive any termination of this Agreement.
Termination. This Agreement may be terminated by the District upon not less than five days' written
notice should the Consultant fail substantially to perform in accordance with the terms of this Agreement
through no fault of the District and such failure is not cured within such five day period. This Agreement
may also be terminated by the District upon ten days' written notice without cause. Consultant shall not
terminate this Agreement, without the written consent of the District, other than for nonpayment as
provided below. In the event of termination of this Agreement, the Consultant shall be paid for Services
performed to the date of termination, including reimbursable expenses then due, provided such services
have been performed in accordance with the terms and conditions hereof. In the event of termination, the
Consultant shall deliver to the District or its designee, within 10 days of notification, at no additional cost,
all drawings, plans, reports, data, and similar Materials relating to the Project prepared by or in the
possession of the Consultant to which the District is entitled.
If the Project is suspended or abandoned in whole or in part for more than two months, the Consultant
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shall be compensated for all Services performed prior to receipt of written notice from the District of such
suspension or abandonment, together with all reimbursable expenses then due. At its sole discretion, the
District may terminate this Agreement by giving written notice to the Consultant if the Project is
abandoned or suspended for more than two months.
Nonassignment. Consultant shall not assign or subcontract any of its rights or obligations hereunder
without the express written consent of the District.
Governing Law. This Agreement is made in and will be governed by the laws of the State of Colorado.
Any legal action by either party to enforce any rights hereunder shall be brought in the Jefferson County,
Colorado District Court.
Entire Agreement. This Agreement, together with the Statement of Work incorporated herein by
reference, contains all of the terms, conditions, and provisions hereof and the entire understanding and all
representations of understandings and discussions of the parties relating thereto, and all such prior
representations, understandings, and discussions are merged herein and superseded and canceled by this
Agreement. This Agreement may only be modified or amended by further agreement executed by the
parties hereto.
Confidentiality. The Consultant agrees to maintain all of the District’s personnel and student data as
confidential information and to use such District confidential information solely for the purposes of
performing services here under. The Consultant shall require its employees; agents and subcontractors
performing work here under to do likewise. The obligations of this section will survive any
termination of this Agreement.
Appropriations & Approval. Any and all obligations of the District under this Agreement may be
subject to annual approval and/or budgeting and appropriation by the District.
Illegal Aliens. Pursuant to Colo. Rev. Stat. § 8-17.5-101 et. seq., the District cannot enter into or
renew a public contract for services with a Consultant who knowingly employs or contracts with an
illegal alien to perform work under the contract or who knowingly contracts with a subcontractor who
knowingly employs or contracts with an illegal alien to perform work under the contract.
In accordance with the mandatory provisions of Colo. Rev. Stat. § 8-17.5-101 et. seq., Consultant
certifies that it has not knowingly employed or contracted with an illegal alien to perform work under
this Agreement, and that the Consultant will participate in the E-Verify Program or the Department
Program [as defined in Colo. Rev. Stat. § 8-17.5-101(3.3)] in order to confirm the employment
eligibility of all employees who are newly hired to perform work under this Agreement. Consultant
further certifies that it will not enter into a contract with a subcontractor who fails to certify to
Consultant that the subcontractor shall not knowingly employ or contract with an illegal alien to
perform work under this Agreement.
Consultant has confirmed the employment eligibility of all employees who are newly hired to perform
work under this Agreement through participation in either the E-Verify Program or the Department
Program. Consultant shall not use the E-Verify Program or the Department Program to undertake pre-
employment screening of job applicants while the Agreement is being performed.
If Consultant obtains actual knowledge that a subcontractor performing work under this Agreement
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knowingly employs or contracts with an illegal alien, Consultant shall:
a. Notify the subcontractor and the District within three days that Contractor has actual
knowledge that the subcontractor is employing or contracting with an illegal alien; and
b. Terminate the subcontract if within three days of receiving actual notice the subcontractor does
not stop employing or contracting with the illegal alien, except that Consultant shall not terminate the
subcontractor if during such three days the subcontractor provides information to establish that the
subcontractor has not knowingly employed or contracted with an illegal alien.
Consultant shall comply with any reasonable request by the Department of Labor and Employment
(hereinafter referred to as the “Department”) made in the course of an investigation that the
Department is undertaking pursuant to C.R.S. § 8-17.5-102(5).
If Consultant violates the provisions of this paragraph, the District may terminate the contract for
breach and Consultant shall be liable for actual and consequential damages.
If Consultant is a natural person eighteen years of age or older, Consultant hereby swears or affirms
under penalty of perjury that the Consultant (i) is a citizen of the United states or otherwise lawfully
present in the United States pursuant to federal law, (ii) shall comply with the provisions of CRS 24-
76.5-101 et seq, and (iii) shall produce one of the forms of identification required by CRS 24-76.5-103
prior to the effective date of this Agreement.
Criminal Record Certification. Consultant will be required to complete a criminal record check on
any person providing services under the agreement, including but not limited to employees,
subcontractors or other agents of Consultant who work on district property for this agreement.
Employees, subcontractors or other agents of Consultant who have been convicted of, pled nolo
contendere to, or received a deferred sentence or deferred prosecution for a felony, or a misdemeanor
crime involving unlawful sexual behavior or unlawful behavior involving children, will not be
allowed to work on District property for this agreement. Consultant must complete the District’s
Criminal Records Check Certification. Consultant will be responsible to adhere to any Federal, State,
and Local privacy and confidentiality requirements.
Insurance of Consultant. Consultant shall maintain in effect at all times during the term of this
Agreement the following policies of insurance:
Commercial General Liability with limits of $2,000,000 per occurrence/$2,000,000 aggregate;
Auto Liability, including hired and non-owned auto, with limits of $2,000,000, per occurrence
combined single limit;
Professional liability insurance with limits of $2,000,000 per claim and aggregate, if “Claims Made”,
coverage is to be maintained for a period of two years beyond the expiration of this contract or a two
year extended reporting period must be purchased.
Statutory workers’ compensation coverage and employer’s liability insurance with limits of not less
than $100,000
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All insurance carriers (other than with respect to Professional Liability) must have an AM Best rating
of A-VIII or better. The District is to be included as an Additional Insured on the commercial general
liability and auto insurance policies with respect to its vicarious liability arising out of Consultant’s
performance hereunder. The District must be notified in writing at least thirty (30) days prior to
cancellation of any insurance policy. Notwithstanding the preceding, the District may waive or modify
these requirements. Such waiver or modification shall not be effective unless made in writing executed
by an appropriate officer or employee of the District.
IN WITNESS WHEREOF, the parties have executed this Agreement on the date first above written.
CONSULTANT: JEFFERSON COUNTY SCHOOL DISTRICT NO. R-1
By: By:
Signature Signature
Name Name
Title Title
Vendor:
A B
(Row A*B=C)
C
Ratings* Weights
Total Weighted
Points
Qualifications and experience of the firm 4 3 12
Qualifications and experience of the proposed
staff 4 3 12
Demonstrated experience in hiring innovative
and creative leaders 4 3.5 14
Demonstrated flexibility in meeting BOE needs
through the executive search process 4 3.5 14
Technical Proposal 4 4.5 18
Staffing Plan 4 3 12
Cost 4 4.5 18
Proposal worth 100 pts Total Points 100
*Ratings
Excellent = 4
Above Average = 3
Average = 2
Below Average = 1
Please note strengths and weaknesses below:
The proposals of the vendors will be evaluated by each committee member, then an
average score assigned based upon the results of the evaluations.
Note: Client references will be used to confirm final selection
Draft Proposal Evaluation Form
RFP 23431 - Executive Search Services
Strengths:
Questions and Clarification:
Weaknesses
Guidelines for Proposal Review
RFP 23431 – Executive Search Services
Review the proposals received using the evaluation factors on the Evaluation Sheet.
Assign a rating Excellent, Above Average, Average, Below Average. Take the points
associated with the rating in Column A times the Weight in Column B and put that total
in Column C. (If you fill out the evaluation form electronically, the ratings will
automatically calculate.) The sum of Column C will be the total score used to determine
the average rating of the vendor. The average of all ratings will be calculated and will be
the final rating awarded by the evaluation committee. Use the following guidelines in
rating proposals.
1. Evaluate each area of the proposal as a whole based on the evaluation criteria.
The evaluation criteria are:
Qualifications and experience of the firm.
Qualifications and experience of the proposed staff.
Demonstrated experience in hiring innovative and creative leaders.
Demonstrated flexibility in meeting Board of Education’s needs throughout
the executive search process.
Technical proposal.
Staffing plan.
Cost.
Client References.
2. If an area of the proposal exceeds requirements, and offers a qualitative benefit
that is exceptional, the area should be rated Excellent.
3. If an area of the proposal meets requirements, with an acceptable solution, no
major deficiencies and has a qualitative benefit beyond the minimal requirements,
a rating Above Average should be assigned.
4. If the majority of factors meet standards and any deficiencies are minor or
correctible the item should rate Average.
5. If the majority of factors are acceptable, but more than one factor is deficient and
correction or risk is involved, the rating should be Below Average.
Adapted from information posted on NIGP website
https://www.nigp.org/common/restrict/formsdocsnew/casrfpevalresp.pdf
RESPONSIBILITIES OF PROPOSAL EVALUATION COMMITTEE MEMBERS
RFP 23431 – Executive Search Services
Thank you for participating on the evaluation committee for this Request for Proposal
(RFP). To protect the integrity of this formal solicitation and the evaluation process, it is
essential that each participant understand and abide by the following responsibilities.
Adherence to these requirements will help assure the effectiveness of the evaluation team
as a whole, and protect the overall interests of Jefferson County Schools in the award of
this RFP.
1. Fairness and Integrity. It is the responsibility of every member on the
evaluation panel to collectively ensure that the evaluation is conducted in an
impartial, objective and professional manner, and that the same level of effort is
extended to the evaluation of all vendors’ proposals/presentations.
2. Understanding of the Project. Your success as an effective member of the team
depends on your comprehensive understanding of the project, and your familiarity
with the requirements and specifications contained in the RFP. A copy of the
RFP has been provided to all committee members. Familiarize yourself with this
document.
3. Attendance. Attendance of all committee members at all scheduled evaluation
meetings is crucial to the quality of the evaluation process. Without all
representatives present, meetings are not effective, as not all opinions can be
shared in a group setting. Therefore, committee members must attend all
meetings of the committee, including interviews with the proposers, if conducted.
4. Confidentiality. To preserve the integrity of the evaluation process, the
following rules of confidentiality must be observed:
a. Committee members must conduct themselves with complete confidentiality.
Confidentiality is both a legal and ethical requirement and is vital to fair,
equitable evaluation of the proposals. You must not discuss the contents of
the proposals with anyone outside of the committee.
b. Committee members must not communicate with proposers about this project
outside of any scheduled and sanctioned evaluation activity, without the
knowledge and approval of Purchasing. If any member of this evaluation
committee has any reason to contact one or more proposers participating in
this RFP, even if the matter is not directly or indirectly related to this project,
they must divulge the nature and reason of the contact with the firm to
Purchasing, who will determine if that activity poses a conflict with the
person’s participation on this evaluation committee.
5. Conflicts of Interest. Per Board Policy GBEA-E, you may not participate as a
member of this committee if you hold an interest in any business or undertaking
which may be directly and substantially affected to its economic benefit by an
official action to be taken by this committee.
________________________________________ ______________________
Signature Date