General Services Division REQUEST FOR PROPOSALS (RFP ... · Present the vendor’s project...

Finance Department General Services Division

2180 Milvia Street, Berkeley, CA 94704 Tel: 510.981.7320 TDD: 510.981.6903 Fax: 510.981.7390

E-mail: [email protected] Website: http://www.ci.berkeley.ca.us/finance

REQUEST FOR PROPOSALS (RFP)

Specification No. 16-10974-C FOR

TARGETED CASE MANAGEMENT SYSTEM PROPOSALS WILL NOT BE OPENED AND READ PUBLICLY

Dear Proposer:

The City of Berkeley is soliciting written proposals from qualified firms or individuals for a new Targeted Case Management System. As a Request for Proposal (RFP) this is not an invitation to bid and although price is very important, other factors will be taken into consideration. The project scope, content of proposal, and vendor selection process are summarized in the RFP (attached).

Proposals must be received no later than 2:00 pm, on Tuesday, December 1, 2015. All responses must be in a

sealed envelope and have “TARGETED CASE MANAGEMENT SYSTEM” and Specification No. 16-10974-C clearly marked on the outer most mailing envelope. Please submit one (1) unbound original and five (5)

unbound copies of the proposal as follows:

Mail or Hand Deliver To:

City of Berkeley

Finance Department/General Services Division

2180 Milvia Street, 3rd Floor

Berkeley, CA 94704

Proposals will not be accepted after the date and time stated above. Incomplete proposal or proposals that do not

conform to the requirements specified herein will not be considered. Issuance of the RFP does not obligate the City

to award a contract, nor is the City liable for any costs incurred by the proposer in the preparation and submittal of

proposals for the subject work. The City retains the right to award all or parts of this contract to several bidders, to

not select any bidders, and/or to re-solicit proposals. The act of submitting a proposal is a declaration that the

proposer has read the RFP and understands all the requirements and conditions.

For questions concerning the anticipated work, or scope of the project, please contact Rebekah Lowe,

Department of Information Technology Senior Systems Analyst, via email at [email protected] no

later than Friday, November 6, 2015. Answers to questions will not be provided by telephone. Rather, answers to

all questions or any addenda will be posted on the City of Berkeley’s site at

http://www.cityofberkeley.info/ContentDisplay.aspx?id=7128. It is the vendor’s responsibility to check this site.

For general questions concerning the submittal process, contact purchasing at 510-981-7320.

We look forward to receiving and reviewing your proposal.

Sincerely,

Dennis Dang

Acting General Services Manager

mailto:[email protected]

mailto:[email protected]

http://www.cityofberkeley.info/ContentDisplay.aspx?id=7128

City of Berkeley Specification No. 16-10974-C Page 2 of 27

Targeted Case Management System Release Date 10/27/15

Revised December 2014

I. INTRODUCTION

1.1 Information about City of Berkeley

The City of Berkeley is located in Alameda County, California and has a population of approximately 118,000. The

City government's adopted budget for the 2015 fiscal year is approximately $311 million. The City has several large

departments: Police; Fire; Public Works; Health, Housing & Community Services; Planning; Parks and Recreation; plus

several support departments including Information Technology. In addition to these departments the City runs its own

library system, and an independent Rent Control Board. There is currently no significant operational relationship with

the Berkeley Unified School District.

1.2 Existing City Technical Environment

The City of Berkeley has approximately 1400 desktop computers, 200 notebooks, 1500 VoIP phones, 400 printers,

170 servers and 80 mobile computers. The City employs 1Gbit Ethernet for each location’s switching

infrastructure. Five City buildings within the central fiber campus area are linked by 2Gbit fiber (~1000

desktops). Fiber WAN links connect all remote buildings at varying speeds to the datacenters, including off-site

locations used by the Department of Health, Housing and Community Services.

The City’s network database engine is MS SQL Server; and enterprise applications, like the financial system, run on

the AS/400 under DB2. Microsoft Office 2013 is the standard office application suite. Microsoft Exchange and

Outlook provide the messaging environment at the City.

All new desktop machines currently run MS Windows 7 Pro. The servers run Windows 2008 and above, with a

diminishing number of legacy NetWare and MS Server 2003 systems.

1.3 City’s Department of Health, Housing and Community Services (HHCS)

The City’s Department of Health, Housing and Community Services (HHCS) includes five major divisions: Public

Health, Mental Health, Environmental Health, Aging Services, and Community Services.

HHCS provides a variety of important services in the community including the provision of Targeted Case

Management (TCM) program services to Berkeley residents and families. Targeted Case Management work

groups consist of Supervisors and Case Managers in Public Health Nursing and in the Division of Aging Services.

The TCM providers will be located at the West Berkeley Service Center (1900 Sixth Street); although, Case

Managers may also work out of other facilities, e.g., the South Berkeley Senior Center.

The State of California’s Targeted Case Management program provides case management services that assist Medi-

Cal eligible individuals within a target group gain access to needed medical, social, educational and other services.

TCM case management services are comprehensive and must include at least one of the following service

components: Comprehensive Assessment and Periodic Reassessment; Development of a Specific Care Plan;

Referral and Related Activities; and Monitoring and Follow-Up Activities.

The delivery of TCM services to individuals and families occurs at City offices, in homes, and throughout the

community in various settings such as childcare centers, homeless shelters, residential care facilities, social clubs,

churches, and other group settings.

The HHCS Department receives incoming referrals with requests for services from hospitals, medical professionals,

community organizations and clinics, social service agencies, other department and City programs, other health

jurisdictions, public safety officials, and from community members. The TCM case management teams focus on

the provision of Targeted Case Management services as defined in agreements with the State of California;

however, Case Managers may provide program services that fall outside TCM service definitions but such services

must be captured in the new TCM System. For example, Public Health Nurse Case Managers provide specialized




services for pregnant and post-partum women and their children which may include some hands-on assessments of

infants, and the provision of consultation and teaching information on topics like breast feeding and immunizations.

1.4 Project Introduction

The City of Berkeley’s Department of Health, Housing and Community Services (HHCS) requires a new Targeted

Case Management (TCM) System and requests proposals for a comprehensive solution that securely manages client

and service data. The Targeted Case Management System will provide the platform and the architecture to

integrate all information and documentation about the client, as the organization moves away from paper-based

processes and charts. The ideal solution will be configurable and flexible with options for extending the application

to meet future growth.

The City will consider proposals for “best of breed” software products and from vendors who propose to expand

the City’s local NextGen EPM-EHR System to meet Targeted Case Management System requirements.

The new Targeted Case Management System will replace a Public Health legacy system that includes custom Target

Case Management modules, running on Intersystems Cache, currently used by Public Health Nursing and Aging

Services Case Managers. This legacy system will continue to be maintained as an inquiry-only data repository for a

period after implementation of the new TCM System; then it will be decommissioned.

II. SCOPE OF SERVICES

The selected vendor must bring the range of necessary capabilities and experience to implement and maintain the

Targeted Case Management System. Proposals may be submitted by a contractor that proposes to work in

conjunction with subcontractors or partners and/or proposes to utilize third party products to meet one or more of

the components. However, the bidding vendor must assume responsibility for all work and services performed

under the executed contract and demonstrate that the software systems can be seamlessly integrated.

The City plans to begin Targeted Case Management System implementation work in early -2016 and targets July 1,

2016 as the go-live date for the baseline system. There may be some components or functionality implemented as

part of a second phase.

Companies selected as a result of this RFP must be prepared to begin work immediately upon contract signing.

2.1 General Description of Vendor Services

The scope of services will be finalized in the City’s Contract with the vendor; however, vendors should be prepared

to provide the following general scope of services to the City of Berkeley:

Provide information about platform and technical specifications for system hardware and software. (The

system may be hosted by the vendor.)

Present the vendor’s project management plan to the City that describes phases, activities, timelines, and

staffing. Provide regular status information to the City’s project manager and other individuals.

Work with City staff to install and configure any required new vendor software and third party software

components and/or equipment, as necessary. (The system may be hosted by the vendor.)

Work with City staff to establish separate technical environments that accommodate development, testing,

training and production.




Work with the City staff to enhance software product(s) and develop necessary interfaces and data transfer

components as agreed on by contract. (Enhancements that are proposed to meet specifications outlined in this

RFP should be identified in the submitted proposal and included in the cost estimates.)

Work with City staff on the migration of current TCM patient and service data from legacy Public Health

MUMPS-based systems to new database(s). The City will provide the data in an agreed upon format.

Work with City staff on system back-up and disaster recovery plans, as necessary.

Work with City staff on conducting and documenting functional and end-to end testing.

Provide training to City technical and system administrator staff.

Provide onsite training to end users (Program Managers, TCM Supervisors, Case Managers, and support staff).

Provide written and electronic versions of technical documentation and training manuals.

Deliver ongoing software maintenance that provides regular technical support and software upgrades

throughout the contract period as part of annual maintenance fees.

Provide information in advance about requested assistance, expectations, or special arrangements that involve

City and/or other vendors, such as: site preparation requirements; needs for assistance from City technical

staff, etc.

2.2 City of Berkeley Project Management and Technical Services

The City of Berkeley will provide project management and technical assistance to help bring about successful

implementation of the new TCM system:

A City Department of Information Technology (IT) Analyst will provide project management services for the

City and work directly with vendor representatives to: finalize project implementation plans and timelines;

establish work teams; and facilitate project-related communication with HHCS managers, users, and City IT

staff;

The City’s IT Analyst/Project Manager will facilitate and coordinate with the vendor and internal City work

team members to complete the following: acquisition and installation of any required hardware and software,

as needed; provide detailed specifications required to tailor software and interfaces, as needed; set-up system

directory and menu information; configure system, tables, data collection forms; establish user classification

groups and access levels; oversee software testing and tuning; verify completed work components; assist with

documenting business processes; and coordinate technical and user training.

The City’s IT Analyst/Project Manager will work with the City’s project team to: finalize TCM system

configuration; identify gaps, assess options and prepare plan for enhancements; identify TCM work process

automation solutions; and organize end user acceptance testing for the TCM system.

The City will be responsible for working with the vendor on any required legacy data migration, and

downloading TCM data from current legacy applications in the agreed upon format. It is desirable that

information about active clients and recent service summary information can populate the new databases prior

to go-live. There may also be cutover claiming issues that need to be addressed during data migration to the

new system.




2.3 TCM System Components and Functionality

The Health, Housing and Community Services Department (HHCS) seeks a Targeted Case Management (TCM)

System with a fully featured electronic client chart and the architecture to integrate secure data about clients, cases,

families, providers, care plans, assessments, services, billing and payment information, and ancillary documents

and images.

The system solution must collect and manage all the client and service data required of a Local Governmental

Agency (LGA) participating in the California State MAA and/or TCM program(s). It must be capable of ensuring

compliance with State TCM data and recordkeeping requirements.

The desired TCM System will improve case management work processes and recordkeeping. It should automate

workflow using business rules, whenever possible, as the organization moves away from paper-based processes.

The system must provide configurable reports and tools that support case assignment decisions and assist with

caseload and workload management.

The City’s Health, Housing and Community Services Department requests proposals for a comprehensive Targeted

Case Management system that should include or have the capacity to expand its functionality and incorporate these

application components:

Inbound Referral Tracking and Assignment

Client and Family Demographics

Insurance Coverage & Eligibility Verification

Manage Case Tools (Case Activation & Assignment, Case Status Changes)

Appointment Management

TCM Program Eligibility & SPA Designation

Client Consents, Authorizations & Required Enrollment Forms

Assessment Data Collection Instruments

Care Plan Data Collection Instruments

Encounter Data Collection Instruments

Case Progress Notes

Outbound Referrals

TCM Billing/Claiming Functionality

TCM Remittance Functionality (Desired)

Workflow/Process Configuration & Task Management Tools

Robust Report Options & Dashboard

Imaging & Document Management

Schedule & Time Tracking (Desired)

System Administration & Table/File Maintenance

System Interfaces / Data Extraction Utilities

Internal Messaging for Providers

Mobile Applications

The system must be modifiable and include options for extending the application to meet future growth and

changes to program and funding requirements. The City expects to augment the system with new data collection

instruments and must be able to add fields and modify values on out-of-the-box forms. The solution should include

or plan for options that support future system interface development and compliant methods of transferring data to

internal and external entities.




The following information outlines Targeted Case Management System specifications.

Client & Family Management

System maintains a unique master patient record and manages data about clients who may have multiple

episodes of services that span time and include various case/program types.

System provides look up tools that search using various key data and help to prevent the entry of duplicate

client records.

System provides utility for authorized system administrator to merge duplicate client records.

System provides client registration forms for the entry and maintenance of client demographic data with

options for customer-defined fields and values.

System provides functionality necessary to add, update, and remove individuals as members of or support to a

family/household. Captures information about family/household members, such as, type/relationship, family

membership start & end dates, active/inactive case status, indication if member lives part-time in another

household, etc.

Case Status and Management

System manages case status information about inbound referrals and cases and allows authorized supervisors

and case managers to assign, open, transfer, pend, and close cases.

System maintains and displays the history of case status information that includes a minimum dataset of: client

name & id, residence address and geo-code, effective date, case/program type, case status, and assigned case

manager.

System allows a client to be associated simultaneously with more than one active case in different programs

and based on City's business rules.

System provides utilities/reports that allow case managers to produce lists of assigned referrals and active cases

with key data that includes priority/acuity, contact information, upcoming target dates based on business rules,

last contact date, etc.

System provides utilities/reports that allow supervisors to access a case manager's caseload list, selectively

transfer individuals from the caseload, or transfer an entire caseload (including all family members) en masse to

a new case manager.

Inbound Referrals

System captures information about inbound Referrals (service requests) and the related follow-up activities,

including disposition.

System provides tools to manage the workflow associated with review, assignment, follow-up, and disposition

of Referrals.

Eligibility, Claims & Remittance

System is capable of producing real-time Health Care Benefit Eligibility Inquiry transactions (270) and

receiving and storing Responses (271). The system should be configurable for use in verifying client's Medi-

Cal eligibility.

System identifies and flags Targeted Case Management billable services. It creates TCM claims for Medi-Cal

eligible clients and generates claim records in the California State TCM Program required record layout. (TCM

claim and remittance records are non-standard and do not adhere to 837/835 transaction formatting.)




It is desirable that the TCM system is capable of importing information about TCM claim payments, adjustments,

and denials and links the information to appropriate client service records. (TCM claim and remittance records

are non-standard and do not adhere to 837/835 transaction formatting.)

Appointment Scheduling

System provides an appointment scheduling module that supports scheduling and updating appointment times

with clients, providers, and resources.

System allows authorized users to export de-identified appointments to their Outlook system.

Assessments & Plans

System provides data collection instruments that capture all California TCM program-required information

about the initial assessment and re-assessments of individual needs including the need for any medical,

educational, social or other services. Assessment forms also include data like: presenting problem(s);

familial/social support systems; medical/mental health profile/status; housing/physical environment; physical

needs/food/clothing; vocational/educational needs; lifestyle and socio-economic risk factors.

System provides data collection instruments or supports development of other assessment forms that are

required for specific case types, e.g., newborn assessment, postpartum assessment, geriatric assessment,

depression screening, activities of daily living, etc.

System includes or supports development of assessment data collection instruments that are associated with the

family/household, e.g., family acuity assessment.

System provides a Care Plan data collection instrument that captures entry of initial and updated goals, actions,

activities and course of action planned to address the medical, social, educational, and other services needed by

the client as identified in the assessment or re-assessment.

Encounters / Services

System provides an encounter data collection instrument that manages the client service dataset, consisting of a

variety of configurable service types that include case management services categorized as TCM (both billable

and non-billable services) and other services to clients that are not reported as TCM encounters.

The encounter data collection instrument is not limited to but must include all data elements and associated

values that are required to produce TCM claims and to correct and resubmit TCM claims.

The encounter data collection instrument is not limited to but must include data elements and associated values

that produce information for TCM Cost reports and categorize all TCM-related encounters into three groupings:

1) Claimable TCM Medi-Cal Only Encounters; 2) Non-Claimable TCM Medi-Cal Only Encounters; and 3)

TCM Non-Medi-Cal Encounters.

System provides or allows the customer to develop special forms that record the use of Public Health Nursing

teaching instruments (examples: breastfeeding, immunizations, developmental milestones).

System captures information about outbound referrals made by Case Managers on behalf of clients and the

associated follow-up information from the agency or provider. System supports outbound referral forms that

can be generated, printed, and maintained in the electronic chart.

Progress Notes

System supports case/progress notes with entry of dated narrative that can be linked to client encounters,

assessment records, monitoring/follow-up activities, inbound referrals, outbound referrals, or can be associated




with the family/household, etc. System provides an auditable process for amending and modifying

case/progress notes that have been filed.

Time Tracking & State MAA/TCM Time Study

It is desirable that the system provides a time tracking data collection instrument used to record staff time and

activities with the capacity to cross-map time to the State’s MAA/TCM service categories, document review

and approval of time surveys, etc.

Mobile Application

System includes a mobile application that supports secure collection of client data and case management case

records (e.g., assessments) at the point of service which is often the Client’s home.

Data Migration & Extract

It is desirable that the system has the capacity to import legacy client demographic data and Medi-Cal

identifiers for active clients and/or for clients who received TCM services during the prior period, along with

summary encounter data for a designated service period, prior to go-live.

Client and case data can be exported to City data warehouse for reporting and data analytics, etc.

System supports or will be able to support future development of interfaces.

Imaging / Scanning / Document Management

System supports scanning and importing case related documents, pdf files, faxes, letters and images that are

stored and linked to client and case records in the electronic client chart.

System supports customizable letter templates that can be developed to use system-generated information so

users can seamlessly generate and store letters that will be mailed to clients, referral agency representatives,

service providers, etc.

Workflow & Task Management

System supports automated work processes and/or provides workflows that support case management standards

of practice and care, enforce quality case management record keeping, and prevent omission of required case

records.

System provides tools that support workflow notifications at key process steps, e.g., when a case is opened,

transferred, pended, or closed.

System able to use business rules and automatically generate reminders and/or tasks to supervisors, case

managers, other service providers, and support staff.

It is desirable that the system offers or plans to include electronic signature functionality for use on appropriate

forms and to approve case records, where required, including: provider signatures, multiple providers and co-

signatures, client signatures, supervisor/authorization hierarchy.

Flexible Configuration & Extensibility

System is designed to allow the City to configure and modify for local changing needs without requesting the

vendor develop and upgrade the system, when possible.




System provides tools that allow the City to make modifications to out of the box data forms and data field

values.

System provides tools that support the City’s development of data collection instruments.

Output Reports & Data

System supports caseload management and balancing with dashboards and configurable reports that provide

data to assist supervisors with assignment decisions, such as: case acuity information; number of referrals by

type and priority that are assigned to each case manager; number of active cases by type and acuity assigned to

each case manager; information about case managers' schedules; the case managers' specialties (e.g., language

skills).

System provides dashboards and configurable reports that produce up-to-date information for case managers

about their caseload size, case types, case acuity/criticality, priority and other workload markers.

System includes a robust report builder that provides client and service report options with user selection of

multiple parameters to sort and filter the data as needed.

The City is able to create and modify custom output reports. Ad hoc report development/configuration will be

critical in responding to the variety of data needs and studies required to assess program success and outcomes,

to prepare grant and funding reports, and for program planning purposes.

System produces reports with detailed TCM encounter logs for State required encounter categories: Claimable

TCM Medi-Cal Only; Non-Claimable TCM Medi-Cal Only; and TCM Non-Medi-Cal.

System produces encounter logs and monthly encounter statistics by Case Manager and encounter type, as

required for annual MAA/TCM Cost Reports.

System produces reports that identify queued-up TCM claimable encounters and provide information necessary

for quality review prior to generating claims.

System produces detailed information about TCM claim transactions (and payment information).

System report data can be exported to Excel, PDF, etc.

General System & Network

The City will consider both hosted and on-premise solutions. In the proposal, describe any hardware and

software requirements to implement the vendor’s system, including servers, desktops, network equipment,

notebooks, etc. Also include information about how the proposed solution will function in a virtual

environment. Include network architecture diagram that illustrates implementation option(s).

System Access, Security & Compliance

System is compliant with the Health Insurance Portability and Accountability Act (HIPAA) and includes

technology and/or cooperates with City’s technology infrastructure in order to ensure the confidentiality,

integrity, and security of sensitive and protected client information.

System provides audit features that capture information about data access, entry and changes, including audit

logs with user ID, date and time, location, client ID, system form and/or transaction type, user action (e.g., add,

modify, view, delete, etc.), previous value/entry. System provides authorized administrators with reports or

logs of audit information from audit records.

System maintains logs of user logins and access attempts. It is capable of locking out users after a specified

period of account inactivity.




City will be able to authorize system administrators to manage restrictions or privileges associated with users,

groups and processes/operations, including: defining groups; defining levels of access; assigning levels of

access; modifying access; and removing levels of access.

City system administrators will be able to restrict access to confidential and sensitive information by user group

or by user id.

City system administrators will be able to view real-time list of users logged into system; terminate user

sessions; lock users out of application modules; and add user defined messages to log on screen.

System will support complex/strong passwords and require users to change passwords on defined schedule.

System will also be able to require that user changes password at next login.

System will authenticate users and access to the system can be restricted based on Active Directory

authentication.

III. SUBMISSION REQUIREMENTS

All proposals shall include the following information, organized as separate sections of the proposal. The proposal

should be concise and to the point.

3.1 Vendor Proposal Format and Requirements

Vendor proposals must be comprehensive and include all required elements. The City may disqualify a proposal if

it does not contain all requested information. The City also reserves the right to request clarification or ask for

additional information before final decisions are made and contract negotiations begin with the successful company

or companies.

Five (5) unbound complete hard copy proposals must be submitted. The vendor may add an electronic version of

the proposal. A trial version of the software may also be included with the proposal but structured software

demonstrations will be required of all finalists.

Proposals must be submitted in binders with tabs to delineate sections and with material that is organized as

outlined below.

Proposal Packages must include the following:

1. Contractor Identification

Include a Transmittal Letter signed by Authorized Person

The transmittal letter should be on business stationery and accompany all copies of the proposal. An individual

authorized to bind the company to statements in the proposal, including services and prices, must sign the letter.

The letter provides the following:

Legal company name and company’s principal place of business (legal headquarters)

Company’s tax identification number

Name, titles, and telephone numbers of persons to be contacted for clarification of the proposal

Statement that person signing the proposal is authorized to propose and price goods and services for the

company

Name, title and telephone number of the person authorized to negotiate a contract on behalf of the

organization

Acknowledgement that conditions governing the RFP have been read and accepted




Acknowledgement of receipt of any amendments to this RFP (or indicate “none” if no amendments

were received)

Additional information, as appropriate

2. Proposals Describing Software and Services

Proposals should provide information that describes a new comprehensive Targeted Case Management System

solution and outlines the vendor’s proposed services and implementation milestones, including installation,

configuration, integration, testing, training, documentation and maintenance.

Please include the following information that is organized in these sections:

Provide an executive summary that outlines key elements and features of the proposal. Include an overview

of the proposed TCM System solution that is appropriate for managers and non-technical staff. Highlight

business features and how the City can benefit from the products and by partnering with the company.

Provide details about system architecture and the proposed technical solution that are appropriate for

review by Information Technology managers and development staff. Include technical information about

third-party products that are proposed. Attach images, diagrams, and other material, as necessary.

Describe proposed system hardware and software platform. Include recommendations for hand-held devices,

laptops, and equipment that can be used with software at the point of service. Please provide network

architecture diagrams that illustrate implementation options.

The City will consider both hosted and on-premise solutions.

o If on-premise solution, describe and provide specifications for servers, backup system, and related

software and equipment required to operate the vendor’s system. The City will run the software in a

virtual environment so please demonstrate vendor system’s ability to function in a virtual environment.

o If the company is proposing a hosted solution, provide a description of the vendor’s responsibilities.

Include information about where the data will be stored and describe the security standards and methods

used by the vendor to protect the data. Provide information about the vendor’s approach to: ensuring

service levels, availability of the hosted application, server performance monitoring, backup and disaster

recovery, system maintenance, application and environment upgrades, outages and interruptions of

service.

Describe vendor’s responsibility for system’s security features and how the system protects confidential

client information. Provide information about the system’s capacity to maintain audit details about access &

changes to client data, and how information can be provided if an accounting of disclosures is required.

Provide a preliminary implementation plan that identifies proposed milestones and timelines.

Software License and Maintenance Agreements - Include copies of appropriate software license

agreements and support / maintenance agreements that are used by the company and partner company (if

third party product proposed).

Additional Information from Company - Vendors may attach marketing material, white papers, etc., but do

not answer proposal questions by simply referring to company brochures.

3. Completed Response to Attachment I, Features & Functionality

Responses to the Features & Functionality matrix should indicate if the vendor’s system solution can deliver each

feature. Use appropriate columns to designate if the feature is available out of the box, or if it’s already in

development and will be available within six (6) months, or if it can be built by the City (working with the vendor

and using vendors template builder and other tools), or if the feature requires new vendor development that the

vendor will deliver as part of the contract, or if it’s available with recommended third party software. If the

vendor suggests another solution, please describe it. If the desired feature is not addressable, please note that on




the matrix. Provide adequate descriptions and details in the last column. Include information about timelines

and additional costs, as appropriate.

Please provide a response to all of the items listed on Attachment I. Proposals will not be eliminated solely

because the vendor indicates that a desired feature is currently not available in the product or cannot be addressed

at this time. It is important that proposals are complete and include all of the requested information, however.

4. Complete Price Proposal using Attachment J, Technology System RFP Cost Proposal

The City is soliciting a proposal that identifies all year-one (1) costs and includes separate maintenance and

other costs for year two (2) and year three (3). The proposal must include pricing for all services. Pricing shall

be all inclusive unless indicated otherwise on a separate pricing sheet. The Proposal will itemize all services,

including hourly rates for all professional, technical and support personnel, and all other charges related to

completion of the work must be itemized.

Please price goods and services separately. Summarize one-time costs versus recurring costs with a three (3)

year projection of recurring costs. Identify which components are part of the core solution and which are

optional add-ons. Identify whether any of the software components are from a third party vendor and, if so,

does the City have the option of purchasing these products elsewhere.

5. Client References

Provide a minimum of three (3) vendor references. References should include California cities or other public

sector entities, when possible. Provide the designated person's name, title, organization, address, telephone

number, and the system implementation projects that were completed under that client’s direction.

6. Contract Terminations:

If your organization has had a contract terminated in the last five (5) years, describe such incident. Termination for default is defined as notice to stop performance due to the vendor’s non-performance or poor

performance and the issue of performance was either (a) not litigated due to inaction on the part of the vendor,

or (b) litigated and such litigation determined that the vendor was in default.

Submit full details of the terms for default including the other party’s name, address, and phone number. Present

the vendor’s position on the matter. The City will evaluate the facts and may, at its sole discretion, reject the

proposal on the grounds of the past experience.

If the firm has not experienced any such termination for default or early termination in the past five (5) years, so

indicate.

IV. SELECTION CRITERIA

The following criteria will be considered, although not exclusively, in determining which firm is hired.

1. Company References Stability & Viability (15%)

2. Cost of Proposal (30%)

3. System Features, Functionality & Services (40%)

4. Technology & Configurability/Extensibility/Scalability (15%)

A selection panel will be convened of staff from multiple City of Berkeley departments.




V. PAYMENT

Invoices: Invoices must be fully itemized, and provide sufficient information for approving payment and audit.

Invoices must be accompanied by receipt for services in order for payment to be processed. Mail invoices to the

Project Manager and reference the contract number.

City of Berkeley

Accounts Payable

PO Box 700

Berkeley, CA 94701

Attn: Rebekah Lowe, Department of Information Technology

Payments: The City will make payment to the vendor within 30- days of receipt of a correct and complete

invoice.

VI. CITY REQUIREMENTS

A. Non-Discrimination Requirements:

Ordinance No. 5876-N.S. codified in B.M.C. Chapter 13.26 states that, for contracts worth more than $3,000 bids

for supplies or bids or proposals for services shall include a completed Workforce Composition Form. Businesses

with fewer than five employees are exempt from submitting this form. (See B.M.C. 13.26.030)

Under B.M.C. section 13.26.060, the City may require any bidder or vendor it believes may have discriminated

to submit a Non-Discrimination Program. The Contract Compliance Officer will make this determination. This

applies to all contracts and all consultants (contractors). Berkeley Municipal Code section 13.26.070 requires

that all contracts with the City contain a non-discrimination clause, in which the contractor agrees not to

discriminate and allows the City access to records necessary to monitor compliance. This section also applies to

all contracts and all consultants. Bidders must submit the attached Non-Discrimination Disclosure Form

with their proposal

B. Nuclear Free Berkeley Disclosure Form:

Berkeley Municipal Code section 12.90.070 prohibits the City from granting contracts to companies that

knowingly engage in work for nuclear weapons. This contracting prohibition may be waived if the City Council

determines that no reasonable alternative exists to doing business with a company that engages in nuclear

weapons work. If your company engages in work for nuclear weapons, explain on the Disclosure Form the nature

of such work. Bidders must submit the attached Nuclear Free Disclosure Form with their proposal.

C. Oppressive States:

The City of Berkeley prohibits granting of contracts to firms that knowingly provide personal services to specified

Countries. This contracting prohibition may be waived if the City Council determines that no reasonable

alternative exists to doing business with a company that is covered by City Council Resolution No. 59,853-N.S.

If your company or any subsidiary is covered, explain on the Disclosure Form the nature of such work. Bidders

must submit the attached Oppressive States Disclosure Form with their proposal.

D. Conflict of Interest:

In the sole judgment of the City, any and all proposals are subject to disqualification on the basis of a conflict of

interest. The City may not contract with a vendor if the vendor or an employee, officer or director of the

proposer's firm, or any immediate family member of the preceding, has served as an elected official, employee,




board or commission member of the City who influences the making of the contract or has a direct or indirect

interest in the contract.

Furthermore, the City may not contract with any vendor whose income, investment, or real property interest may

be affected by the contract. The City, at its sole option, may disqualify any proposal on the basis of such a conflict

of interest. Please identify any person associated with the firm that has a potential conflict of interest.

E. Berkeley Living Wage Ordinance:

Chapter 13.27 of the Berkeley Municipal Code requires that contractors offer all eligible employees with City

mandated minimum compensation during the term of any contract that may be awarded by the City. If the

Contractor is not currently subject to the Living Wage Ordinance, cumulative contracts with the City within a

one-year period may subject Contractor to the requirements under B.M.C. Chapter 13.27. A certification of

compliance with this ordinance will be required upon execution of a contract. The Living Wage rate is currently

$14.04 (if medical benefits are provided) or $16.37 (if medical benefits are not provided). The Living Wage rate

is adjusted automatically effective June 30th of each year commensurate with the corresponding increase in the

Consumer Price Index published in April of each year. If the Living Wage rate is adjusted during the term of

your agreement, you must pay the new adjusted rate to all eligible employees, regardless of what the rate was

when the contract was executed.

F. Berkeley Equal Benefits Ordinance: Chapter 13.29 of the Berkeley Municipal Code requires that contractors offer domestic partners the same access

to benefits that are available to spouses. A certification of compliance with this ordinance will be required upon

execution of a contract. G. Statement of Economic Interest:

The City’s Conflict of Interest Code designates “consultants” as a category of persons who must complete Form

700, Statement of Economic Interest, at the beginning of the contract period and again at the termination of the

contract. The selected contractor will be required to complete the Form 700 before work may begin.

VII. OTHER REQUIREMENTS

A. Insurance

The selected contractor will be required to maintain general liability insurance in the minimum amount of

$2,000,000, automobile liability insurance in the minimum amount of $1,000,000 and a professional liability

insurance policy in the amount of $2,000,000 to cover any claims arising out of the performance of the contract.

The general liability and automobile insurance must name the City, its officers, agents, volunteers and employees

as additional insureds.

B. Worker’s Compensation Insurance:

A selected contractor who employs any person shall maintain workers' compensation insurance in accordance

with state requirements. Sole proprietors with no employees are not required to carry Worker’s Compensation

Insurance.

C. Business License

Virtually every contractor that does business with the City must obtain a City business license as mandated by

B.M.C. Ch. 9.04. The business license requirement applies whether or not the contractor has an office within the

City limits. However, a "casual" or "isolated" business transaction (B.M.C. section 9.04.010) does not subject




the contractor to the license tax. Warehousing businesses and charitable organizations are the only entities

specifically exempted in the code from the license requirement (see B.M.C. sections, 9.04.295 and 9.04.300).

Non-profit organizations are granted partial exemptions (see B.M.C. section 9.04.305). Persons who, by reason

of physical infirmity, unavoidable misfortune, or unavoidable poverty, may be granted an exemption of one

annual free license at the discretion of the Director of Finance. (see B.M.C. sections 9.04.290).

Vendor must apply for a City business license and show proof of application to Purchasing Manager within

seven days of being selected as intended contractor.

The Customer Service Division of the Finance Department located at 1947 Center Street, Berkeley, CA 94704,

issues business licenses. Contractors should contact this division for questions and/or information on obtaining

a City business license, in person, or by calling 510-981-7200.

D. Recycled Paper

All reports to the City shall be on recycled paper that contains at least 50% recycled product when such paper

is available at a cost of not greater than ten percent more than the cost of virgin paper, and when such paper is

available at the time it is required. If recycled paper is not available the Contractor shall use white paper. Written

reports or studies shall be printed on both sides of the page whenever practical.

E. State Prevailing Wage:

Certain labor categories under this project may be subject to prevailing wages as identified in the State of

California Labor Code commencing in Section 1770 et. seq. These labor categories, when employed for any

“work performed during the design and preconstruction phases of construction including, but not limited to,

inspection and land surveying work,” constitute a “Public Work” within the definition of Section 1720(a)(1) of

the California Labor Code requiring payment of prevailing wages.

Wage information is available through the California Division of Industrial Relations web site at:

http://www.dir.ca.gov/OPRL/statistics_and_databases.html

VIII. SCHEDULE (dates are subject to change)

Issue RFP to potential bidders: Tuesday, October 27, 2015

Questions Due Friday, November 6, 2015

Proposals Due from Potential Bidders Tuesday, December 1, 2015

Complete Selection Process Friday, January 1, 2016

Council Approval of Contract (over $50k) Tuesday, February 9, 2016

Award of Contract Wednesday, February 10, 2016

Sign and Process Contract Thursday, February 11, 2016

Notice to Proceed Friday, February 12, 2016

Thank you for your interest in working with the City of Berkeley for this service. We look forward to receiving

your proposal.

http://www.dir.ca.gov/OPRL/statistics_and_databases.html




Attachments:

Check List of Required items for Submittal Attachment A

Non-Discrimination/Workforce Composition Form Attachment B

Nuclear Free Disclosure Form Attachment C

Oppressive States Form Attachment D

Living Wage Form Attachment E

Equal Benefits Certification of Compliance Attachment F

Right to Audit Form Attachment G

Insurance Endorsement Attachment H

Features and Functionality Matrix Attachment I

Technology System RFP Cost Proposal Attachment J

Business Associates Agreement Attachment K




ATTACHMENT A

CHECKLIST

Proposal includes all requested materials (one (1) unbound original and five (5) unbound copies) and an

electronic file.

Contractor Identification and Company Information – Transmittal Letter

Proposal describing system and services (include all information requested in Item 2 of the Submission

Requirements section)

Completed Response to Attachment I, Features and Functionality Matrix

Completed Response to Attachment J, Technology System RFP Cost Proposal

Review and acknowledgement of Attachment K, Business Associates Agreement

Three (3) Client References

Statement including Contract Terminations or an indication that the firm has not experienced any such

termination for default or early termination in the past five (5) years

The following City forms, completed and signed in blue ink (attached):

o Non-Discrimination/Workforce Composition Form Attachment B

o Nuclear Free Disclosure Form Attachment C

o Oppressive States Form Attachment D

o Living Wage Form (may be optional) Attachment E

o Equal Benefits Ordinance Certification of Compliance (EBO-1) Attachment F

ADDITIONAL SUBMITTALS REQUIRED FROM SELECTED VENDOR AFTER COUNCIL

APPROVAL TO AWARD CONTRACT.

Provide original-signed in blue ink Evidence of Insurance

o Auto

o Liability

o Worker’s Compensation

Right to Audit Form Attachment G

Commercial General & Automobile Liability Endorsement Form Attachment H

Berkeley Business License

For informational purposes only: Sample of Personal Services Contract can be found on the City’s website

on the current bid and proposal page at the top of the page.




NON-DISCRIMINATION/WORKFORCE COMPOSITION FORM FOR NON-CONSTRUCTION CONTRACTS

To assist the City of Berkeley in implementing its Non-Discrimination policy, it is requested that you furnish information

regarding your personnel as requested below and return it to the City Department handling your contract:

Organization: _____________________________________________________________________________________

Address: _______________________________________________________________

Business Lic. #: ___________

Occupational Category:

__________________________

(See reverse side for explanation of

terms)

Total

Employees

White

Employees

Black

Employees

Asian

Employees

Hispanic

Employees

Other

Employees

Female Male Female Male Female Male Female Male Female Male Female Male

Official/Administrators

Professionals

Technicians

Protective Service Workers

Para-Professionals

Office/Clerical

Skilled Craft Workers

Service/Maintenance

Other (specify)

Totals:

Is your business MBE/WBE/DBE certified? Yes _____ No _____ If yes, by what agency? _______________________

If yes, please specify: Male: _____ Female: _____ Indicate ethnic identifications: ___________________________

Do you have a Non-Discrimination policy? Yes: _____ No: _____

Signed: ________________________________________________________________ Date: __________________

Verified by: _____________________________________________________________ Date: __________________

City of Berkeley Contract Compliance Officer

Attachment B




Occupational Categories

Officials and Administrators - Occupations in which employees set broad policies, exercise overall responsibility

for execution of these policies, or provide specialized consultation on a regional, district or area basis. Includes:

department heads, bureau chiefs, division chiefs, directors, deputy superintendents, unit supervisors and kindred

workers.

Professionals - Occupations that require specialized and theoretical knowledge that is usually acquired through

college training or through work experience and other training that provides comparable knowledge. Includes:

personnel and labor relations workers, social workers, doctors, psychologists, registered nurses, economists,

dietitians, lawyers, systems analysts, accountants, engineers, employment and vocational rehabilitation counselors,

teachers or instructors, and kindred workers.

Technicians - Occupations that require a combination of basic scientific or technical knowledge and manual skill

that can be obtained through specialized post-secondary school education or through equivalent on-the-job training.

Includes: computer programmers and operators, technical illustrators, highway technicians, technicians (medical,

dental, electronic, physical sciences) and kindred workers.

Protective Service Workers - Occupations in which workers are entrusted with public safety, security and

protection from destructive forces. Includes: police officers, fire fighters, guards, sheriffs, bailiffs, correctional

officers, detectives, marshals, harbor patrol officers, and kindred workers.

Para-Professionals - Occupations in which workers perform some of the duties of a professional or technician in a

supportive role, which usually requires less formal training and/or experience normally required for professional or

technical status. Such positions may fall within an identified pattern of a staff development and promotion under a

"New Transporters" concept. Includes: library assistants, research assistants, medical aides, child support workers,

police auxiliary, welfare service aides, recreation assistants, homemaker aides, home health aides, and kindred

workers.

Office and Clerical - Occupations in which workers are responsible for internal and external communication,

recording and retrieval of data and/or information and other paperwork required in an office. Includes:

bookkeepers, messengers, office machine operators, clerk-typists, stenographers, court transcribers, hearings

reporters, statistical clerks, dispatchers, license distributors, payroll clerks, and kindred workers.

Skilled Craft Workers - Occupations in which workers perform jobs which require special manual skill and a

thorough and comprehensive knowledge of the processes involved in the work which is acquired through on-the-

job training and experience or through apprenticeship or other formal training programs. Includes: mechanics and

repairpersons, electricians, heavy equipment operators, stationary engineers, skilled machining occupations,

carpenters, compositors and typesetters, and kindred workers.

Service/Maintenance - Occupations in which workers perform duties which result in or contribute to the comfort,

convenience, hygiene or safety of the general public or which contribute to the upkeep and care of buildings,

facilities or grounds of public property. Workers in this group may operate machinery. Includes: chauffeurs,

laundry and dry cleaning operatives, truck drivers, bus drivers, garage laborers, custodial personnel, gardeners and

groundskeepers, refuse collectors, and construction laborers.




CITY OF BERKELEY

Nuclear Free Zone Disclosure Form

I (we) certify that:

1. I am (we are) fully cognizant of any and all contracts held, products made or otherwise handled by

this business entity, and of any such that are anticipated to be entered into, produced or handled for

the duration of its contract(s) with the City of Berkeley. (To this end, more than one individual may

sign this disclosure form, if a description of which type of contracts each individual is cognizant is

attached.)

2. I (we) understand that Section 12.90.070 of the Nuclear Free Berkeley Act (Berkeley Municipal

Code Ch. 12.90; Ordinance No. 5784-N.S.) prohibits the City of Berkeley from contracting with any

person or business that knowingly engages in work for nuclear weapons.

3. I (we) understand the meaning of the following terms as set forth in Berkeley Municipal Code Section

12.90.130:

"Work for nuclear weapons" is any work the purpose of which is the development, testing,

production, maintenance or storage of nuclear weapons or the components of nuclear weapons; or

any secret or classified research or evaluation of nuclear weapons; or any operation, management or

administration of such work.

"Nuclear weapon" is any device, the intended explosion of which results from the energy released

by reactions involving atomic nuclei, either fission or fusion or both. This definition of nuclear

weapons includes the means of transporting, guiding, propelling or triggering the weapon if and only

if such means is destroyed or rendered useless in the normal propelling, triggering, or detonation of

the weapon.

"Component of a nuclear weapon" is any device, radioactive or non-radioactive, the primary intended

function of which is to contribute to the operation of a nuclear weapon (or be a part of a nuclear

weapon).

4. Neither this business entity nor its parent nor any of its subsidiaries engages in work for nuclear

weapons or anticipates entering into such work for the duration of its contract(s) with the City of

Berkeley.

Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California

that the foregoing is true and correct.

Printed Name: ___________________________________Title:______________________________________

Signature: _______________________________________Date:_____________________________________

Business Entity: ___________________________________________________________________________

Contract Description/Specification No.: Targeted Case Management System/16-10974-C

Attachment C




CITY OF BERKELEY

Oppressive States Compliance Statement

The undersigned, an authorized agent of__________________________________________________(hereafter "Vendor"),

has had an opportunity to review the requirements of Berkeley City Council Resolution No. 59,853-N.S. (hereafter

"Resolution"). Vendor understands and agrees that the City may choose with whom it will maintain business relations and may

refrain from contracting with those Business Entities which maintain business relationships with morally repugnant regimes.

Vendor understands the meaning of the following terms used in the Resolution:

"Business Entity" means "any individual, firm, partnership, corporation, association or any other commercial

organization, including parent-entities and wholly-owned subsidiaries" (to the extent that their operations are

related to the purpose of the contract with the City).

"Oppressive State" means: Tibet Autonomous Region and the Provinces of Ado, Kham and U-Tsang

“Personal Services” means “the performance of any work or labor and shall also include acting as an independent contractor or

providing any consulting advice or assistance, or otherwise acting as an agent pursuant to a contractual relationship.”

Contractor understands that it is not eligible to receive or retain a City contract if at the time the contract is executed, or at any

time during the term of the contract it provides Personal Services to:

a. The governing regime in any Oppressive State.

b. Any business or corporation organized under the authority of the governing regime of any Oppressive State.

c. Any person for the express purpose of assisting in business operations or trading with any public or private entity

located in any Oppressive State.

Vendor further understands and agrees that Vendor's failure to comply with the Resolution shall constitute a default of the

contract and the City Manager may terminate the contract and bar Vendor from bidding on future contracts with the City for

five (5) years from the effective date of the contract termination.

The undersigned is familiar with, or has made a reasonable effort to become familiar with, Vendor's business structure and the

geographic extent of its operations. By executing the Statement, Vendor certifies that it complies with the requirements of the

Resolution and that if any time during the term of the contract it ceases to comply, Vendor will promptly notify the City

Manager in writing.

Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the

foregoing is true and correct.

Printed Name: ___________________________________Title:________________________________________

Signature: _______________________________________ Date:_______________________________________

Business Entity: ______________________________________________________________________________


I am unable to execute this Statement; however, Vendor is exempt under Section VII of the Resolution. I have attached a

separate statement explaining the reason(s) Vendor cannot comply and the basis for any requested exemption.

Signature: _______________________________________ Date:_______________________________________

Attachment D




CITY OF BERKELEY

Living Wage Certification for Providers of Services

TO BE COMPLETED BY ALL PERSONS OR ENTITIES ENGAGING IN A CONTRACT FOR PERSONAL

SERVICES WITH THE CITY OF BERKELEY.

The Berkeley Municipal Code Chapter 13.27, Berkeley's Living Wage Ordinance (LWO), provides that contractors who

engage in a specified amount of business with the City (except where specifically exempted) under contracts which furnish

services to or for the City in any twelve (12) month period of time shall comply with all provisions of this Ordinance. The

LWO requires a City contractor to provide City mandated minimum compensation to all eligible employees, as defined in the

Ordinance. In order to determine whether this contract is subject to the terms of the LWO, please respond to the questions

below. Please note that the LWO applies to those contracts where the contractor has achieved a cumulative dollar contracting

amount with the City. Therefore, even if the LWO is inapplicable to this contract, subsequent contracts may be subject to

compliance with the LWO. Furthermore, the contract may become subject to the LWO if the status of the Contractor's

employees change (i.e. additional employees are hired) so that Contractor falls within the scope of the Ordinance.

Section I.

1. IF YOU ARE A FOR-PROFIT BUSINESS, PLEASE ANSWER THE FOLLOWING QUESTIONS

a. During the previous twelve (12) months, have you entered into contracts, including the present contract, bid, or proposal,

with the City of Berkeley for a cumulative amount of $25,000.00 or more?

YES ____ NO ____

If no, this contract is NOT subject to the requirements of the LWO, and you may continue to Section II. If yes, please

continue to question 1(b).

b. Do you have six (6) or more employees, including part-time and stipend workers?

YES ____ NO ____

If you have answered, “YES” to questions 1(a) and 1(b) this contract IS subject to the LWO. If you responded "NO" to

1(b) this contract IS NOT subject to the LWO. Please continue to Section II.

2. IF YOU ARE A NON-PROFIT BUSINESS, AS DEFINED BY SECTION 501(C) OF THE INTERNAL

REVENUE CODE OF 1954, PLEASE ANSWER THE FOLLOWING QUESTIONS.

a. During the previous twelve (12) months, have you entered into contracts, including the present contract, bid or

proposal, with the City of Berkeley for a cumulative amount of $100,000.00 or more?

YES ____ NO ____

If no, this Contract is NOT subject to the requirements of the LWO, and you may continue to Section II. If yes, please

continue to question 2(b).

b. Do you have six (6) or more employees, including part-time and stipend workers?

YES ____ NO ____

If you have answered, “YES” to questions 2(a) and 2(b) this contract IS subject to the LWO. If you responded "NO" to

2(b) this contract IS NOT subject to the LWO. Please continue to Section II.

Section II

Please read, complete, and sign the following:

THIS CONTRACT IS SUBJECT TO THE LIVING WAGE ORDINANCE.

THIS CONTRACT IS NOT SUBJECT TO THE LIVING WAGE ORDINANCE.

Attachment E




The undersigned, on behalf of himself or herself individually and on behalf of his or her business or organization, hereby

certifies that he or she is fully aware of Berkeley's Living Wage Ordinance, and the applicability of the Living Wage

Ordinance, and the applicability of the subject contract, as determined herein. The undersigned further agrees to be bound by

all of the terms of the Living Wage Ordinance, as mandated in the Berkeley Municipal Code, Chapter 13.27. If, at any time

during the term of the contract, the answers to the questions posed herein change so that Contractor would be subject to the

LWO, Contractor will promptly notify the City Manager in writing. Contractor further understands and agrees that the failure

to comply with the LWO, this certification, or the terms of the Contract as it applies to the LWO, shall constitute a default of

the Contract and the City Manager may terminate the contract and bar Contractor from future contracts with the City for five

(5) years from the effective date of the Contract termination. If the contractor is a for-profit business and the LWO is

applicable to this contract, the contractor must pay a living wage to all employees who spend 25% or more or their

compensated time engaged in work directly related to the contract with the City. If the contractor is a non-profit business and

the LWO is applicable to this contract, the contractor must pay a living wage to all employees who spend 50% or more or their

compensated time engaged in work directly related to the contract with the City.

These statements are made under penalty of perjury under the laws of the state of California.

Printed Name: ___________________________________Title:________________________________________

Signature: _______________________________________ Date:_______________________________________

Business Entity: ______________________________________________________________________________

Contract Description/Specification No: Targeted Case Management System /16-10974-C

Section III

_____________________________________________________________________________________________

* * FOR ADMINISTRATIVE USE ONLY -- PLEASE PRINT CLEARLY * * *

I have reviewed this Living Wage Certification form, in addition to verifying Contractor's total dollar amount contract

commitments with the City in the past twelve (12) months, and determined that this Contract IS / IS NOT (circle one)

subject to Berkeley's Living Wage Ordinance.

_________________________________ _________________________________________

Department Name Department Representative

Attachment E Page 2




Form EBO-1 CITY OF BERKELEY

CERTIFICATION OF COMPLIANCE WITH EQUAL BENEFITS ORDINANCE If you are a contractor, return this form to the originating department/project manager. If you are a vendor (supplier of goods), return this form to the Purchasing Division of the Finance Dept.

SECTION 1. CONTRACTOR/VENDOR INFORMATION

Name: Vendor No.:

Address: City: State: ZIP:

Contact Person: Telephone:

E-mail Address: Fax No.:

SECTION 2. COMPLIANCE QUESTIONS

A. The EBO is inapplicable to this contract because the contractor/vendor has no employees. Yes No (If “Yes,” proceed to Section 5; if “No”, continue to the next question.)

B. Does your company provide (or make available at the employees’ expense) any employee benefits? Yes No

If “Yes,” continue to Question C. If “No,” proceed to Section 5. (The EBO is not applicable to you.)

C. Does your company provide (or make available at the employees’ expense) any benefits to

the spouse of an employee? ......................................................................................... Yes No D. Does your company provide (or make available at the employees’ expense) any benefits to

the domestic partner of an employee? .......................................................................... Yes No If you answered “No” to both Questions C and D, proceed to Section 5. (The EBO is not applicable to this contract.) If you answered “Yes” to both Questions C and D, please continue to Question E. If you answered “Yes” to Question C and “No” to Question D, please continue to Section 3.

E. Are the benefits that are available to the spouse of an employee identical to the benefits that

are available to the domestic partner of the employee? ............................................... Yes No If you answered “Yes,” proceed to Section 4. (You are in compliance with the EBO.) If you answered “No,” continue to Section 3.

SECTION 3. PROVISIONAL COMPLIANCE A. Contractor/vendor is not in compliance with the EBO now but will comply by the following date:

By the first effective date after the first open enrollment process following the contract start date, not to

exceed two years, if the Contractor submits evidence of taking reasonable measures to comply with the EBO; or

At such time that administrative steps can be taken to incorporate nondiscrimination in benefits in the

Contractor’s infrastructure, not to exceed three months; or

Upon expiration of the contractor’s current collective bargaining agreement(s).

To be completed by

Contractor/Vendor




B. If you have taken all reasonable measures to comply with the EBO but are unable to do so, do you agree to provide employees with a cash equivalent?* ..................................... Yes No

* The cash equivalent is the amount of money your company pays for spousal benefits that are unavailable for domestic partners.

SECTION 4. REQUIRED DOCUMENTATION

At time of issuance of purchase order or contract award, you may be required by the City to provide documentation (copy of employee handbook, eligibility statement from your plans, insurance provider statements, etc.) to verify that you do not discriminate in the provision of benefits.

SECTION 5. CERTIFICATION

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that I am authorized to bind this entity contractually. By signing this certification, I further agree to comply with all additional obligations of the Equal Benefits Ordinance that are set forth in the Berkeley Municipal Code and in the terms of the contract or purchase order with the City. Executed this _______day of _________________, in the year __________, at __________________, ________ (City) (State) _____________________________________ ______________________________________ Name (please print) Signature _____________________________________ ______________________________________ Title Federal ID or Social Security Number

FOR CITY OF BERKELEY USE ONLY

Non-Compliant (The City may not do business with this contractor/vendor)

One-Person Contractor/Vendor Full Compliance Reasonable Measures

Provisional Compliance Category, Full Compliance by Date: _________________________________________

Staff Name(Sign and Print): _____________________________________Date: ____________ ________________

_____________________

Attachment F




CITY OF BERKELEY

Right to Audit Form

The contractor agrees that pursuant to Section 61 of the Berkeley City Charter, the City Auditor’s office

may conduct an audit of Contractor’s financial, performance and compliance records maintained in

connection with the operations and services performed under this contract.

In the event of such audit, Contractor agrees to provide the Auditor with reasonable access to Contractor’s

employees and make all such financial, performance and compliance records available to the Auditor’s

office. City agrees to provide Contractor an opportunity to discuss and respond to/any findings before a

final audit report is filed.

Signed:______________________________________ Date:__________________

Print Name & Title:_______________________________________________________

Company:_______________________________________________________________


Please direct questions regarding this form to the Auditor's Office, at (510) 981-6750.

Attachment G




CITY OF BERKELEY

Commercial General and Automobile Liability Endorsement

The attached Certificates of Insurance are hereby certified to be a part of the following policies having the

following expiration dates:

Policy No. Company Providing Policy Expir. Date _______________ __________________________ _________

_______________ __________________________ _________

_______________ __________________________ _________

_______________ __________________________ _________

The scope of the insurance afforded by the policies designated in the attached certificates is not less than that

which is afforded by the Insurance Service Organization's or other "Standard Provisions" forms in use by the

insurance company in the territory in which coverage is afforded.

Such Policies provide for or are hereby amended to provide for the following:

1. The named insured is ________________________________________.

2. CITY OF BERKELEY ("City") is hereby included as an additional insured with respect to liability

arising out of the hazards or operations under or in connection with the following agreement:

_______________________________________________________.

The insurance provided applies as though separate policies are in effect for both the named insured

and City, but does not increase the limits of liability set forth in said policies.

3. The limits of liability under the policies are not less than those shown on the certificate to which this

endorsement is attached.

4. Cancellation or material reduction of this coverage will not be effective until thirty (30) days following

written notice to __________________________________, Department of

___________________________, Berkeley, CA.

5. This insurance is primary and insurer is not entitled to any contribution from insurance in effect for

City.

The term "City" includes successors and assigns of City and the officers, employees, agents and

volunteers.

_______________________________________

Insurance Company

Date: _____________ By: ______________________________________

Signature of Underwriter's

Authorized Representative


Attachment H

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