PROPOSAL FOR RISK MANAGEMENT CONSULTANT

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1 PROPOSAL FOR RISK MANAGEMENT CONSULTANT Wantage Township is seeking proposals through the fair and open process as set forth in the State of New Jersey s Pay to Play legislation for the position of Risk Management Consultant serving the needs of Wantage Township within the Statewide Insurance Fund and the North Jersey Municipal Employee Benefit Fund for the period of January 1 to December 31, A request for proposal packet is on file with the Municipal Clerk. The forms can be obtained by visiting the Clerk s Office at: Wantage Township Municipal Building, 888 Route 23, Wantage, New Jersey OR By sending a self addressed, stamped envelope to the Clerk s Office to the attention of Jim Doherty, Municipal Administrator Clerk and requesting said packet be sent via the United States Postal Service OR By downloading the forms from the Wantage Township Website, The forms in the packet must be fully completed and returned in a sealed envelope to: Mr. Jim Doherty, Administrator Clerk, Wantage Township Municipal Building, 888 Route 23, Wantage, New Jersey 07461, no later than December 29, 2010 at 11:00 a.m. Any questions regarding the forms should be directed to Mr. Doherty, at telephone number No facsimile transmission shall be accepted. The proposals shall be evaluated pursuant to the following criteria: 1. Experience in the Insurance Field 50% 2. Prior Experience Within Wantage Township 25% 3. Availability 25% TOTAL 100% The proposals shall be opened at 11:00 a.m. on December 29, 2010 and the award of a professional services contract may occur anytime thereafter. Late proposals SHALL NOT BE ACCEPTED. Wantage Township reserves the right to award a professional services contract to any candidate as determined by officials of the Township of Wantage. The Township of Wantage recognizes and complies with the requirements of the Americans With Disabilities Act of As such, the Township of Wantage endorses nondiscrimination on the basis of disability in every public service provided through municipal departments, programs and contractors. It is a requirement and an expectation that all vendors who do business with the Township shall likewise endorse the philosophy of this act, and shall strive to meet the requirements of it in conducting its business affairs.

2 FAIR AND OPEN PROCESS PROPOSAL FOR RISK MANAGEMENT CONSULTANT The Proposal must be submitted no later than 11:00 a.m. on WEDNESDAY, DECEMBER 29, 2010 to: Mr. James Doherty, Administrator Clerk, Wantage Township Municipal Building, 888 Route 23, Wantage, New Jersey By submitting this Proposal, the applicant consents to allowing municipal officials to contact any and all references and municipalities as contained herein and to verify any information contained herein. Wantage Township reserves the right to award a professional service contract as Township officials deem appropriate. Wantage Township reserves the right to reject any application which is incomplete and further reserves the right to reject any applicant, even after award of contract, if any of the information contained on this proposal form is false. All those submitting proposals should review the enclosed Request for Proposals and submit all documentation requested in order to aid the Township of Wantage in making an informed decision. All proposals must address ALL of the Sections contained in this Request for Proposals by providing documentation and/or a response to that Section. An authorized individual must sign all proposals. Failure to follow the instructions as set forth herein will render the submission unresponsive and will result in rejection. The Township will not accept responsibility for mislabeled submissions. Submissions shall be hand delivered, mailed by way of First Class Mail, or overnight delivery service. Fax submissions shall not be considered. Late submissions shall be deemed unresponsive and will not be considered. No rights are conferred upon any party with regard to Wantage township by virtue of a response to this Request for Proposals unless there is a contract awarded, approved, and executed by the Township. The Mayor and Committee of the Township of Wantage will award the Contract for Services using the criteria that form the framework of the applicant s response as set forth in this proposal. Experience, prior experience as a client of Wantage Township, and availability represent the basis for review of applications. In the event that two or more applicants score equally, the Mayor and Committee of the Township of Wantage shall give additional consideration to the factor of reputation, to form the basis for the award of contract. All submissions become the property of the Township of Wantage and there shall be no obligation to return any submission. James R. Doherty, MMC/CPM Township of Wantage Administrator Clerk 888 Route 23, Wantage, New Jersey

3 RESPONSE TO REOUEST FOR RISK MANAGEMENT CONSULTANT TABLE OF CONTENTS Section A Identification Page Section B Experience; Qualifications Section C Prior Experience Within Wantage Township Section D Availability Section E Reputation

4 SECTION A: IDENTIFICATION PAGE A. Name of Proposer (Individual to be appointed): B. Street Address of Proposer: C. Name of Firm: D. Primary Location of Firm: E. Mailing Address of Firm: F. Contact Information: Work Telephone: Fax Number: address: G. BUSINESS REGISTRATION CERTIFICATE Proposers and their subcontractors, if any, must comply with the provisions of P.L c.57 (N.J.S.A. 52:32-44) and submit proof that the Proposer is registered with the New Jersey Department of the Treasury, Division of Revenue, by including a copy of the Business Registration Certificate issued to the Proposer and any subcontractor by the Division of Revenue in the Package returned to the Township. The only acceptable proof is the Business Registration Certificate provided by the New Jersey Division of Revenue.

5 SECTION B: EXPERIENCE; QUALIFICATIONS Years of experience as a Risk Management Consultant: Wantage Township believes experience as a Risk Management Consultant is an important factor when awarding this professional service contract. Wantage Township further believes that a person who has served as a municipal Risk Management Consultant better appreciates the functioning and needs of Wantage Township. Points in this category shall be awarded as follows: Please place a check mark in front of the applicable response: Applicant has 10 years or more experience as a Municipal Risk Management Consultant within the State of New Jersey Applicant has 5 years or more experience serving as a Municipal Risk Management Consultant within the Statewide Insurance Fund Applicant has 5 years or more experience serving as a Municipal Risk Management Consultant within the North Jersey Municipal Employee Benefit Fund Applicant has 3 years or more experience as a Public Entity Risk Management Consultant within one or more other Insurance Funds 25 points 10 points 10 points 5 points TOTAL POSSIBLE POINTS: 50 # POINTS SCORED: Explanation of Details: Please attach a narrative to address this Section, providing details regarding the applicant s experience and qualifications

6 SECTION C: PRIOR EXPERIENCE WITHIN WANTAGE TOWNSHIP Wantage Township believes prior experience as a Risk Management Consultant for Wantage Township represents an important factor when awarding this professional service contract. Wantage Township further believes that a person who has served as a Municipal Risk Management Consultant for Wantage Township better appreciates the functioning and needs of Wantage Township. Points in this category shall be awarded as follows: Applicant has 5 years or more experience as a Municipal Risk Management Consultant serving Wantage Township within Statewide Insurance Fund Applicant has 5 years or more experience as a Municipal Risk Management Consultant serving Wantage Township within North Jersey Municipal Employee Insurance Fund 10 points 10 points Applicant has prior experience as a Municipal Risk Management Consultant serving Wantage Township under a municipal insurance Fund other than Statewide Insurance Fund and/or North Jersey Municipal Insurance Fund 5 points TOTAL POSSIBLE POINTS: 25 # POINTS SCORED:

7 SECTION D: AVAILABILITY Wantage Township believes availability and prompt response represent important factors when awarding this professional service contract. Points in this category shall be awarded as follows: Applicant has professional support staff available To accept claims, address questions and respond To problems Monday through Friday, from 9:00 am To 4:00 pm (Holidays excluded) Applicant is available to meet with employee union groups, The governing body, and/or the Township Administrator Within 4 business days of receiving a request for such Meeting from the Township Administrator Applicant shall respond to questions and concerns posed by the Township Administrator and/or his duly designated representative, via electronic mail And/or cellular telephone contact, within 2 business days 15 points 5 points 5 points TOTAL POSSIBLE POINTS: 25 # POINTS SCORED:

8 SECTION E: REPUTATION List All Municipalities (identify county as well) for whom you have served as Municipal Risk Management Consultant operating within the Statewide Insurance Fund and/or the North Jersey Municipal Employee Benefit Fund (ATTACH ADDITIONAL SHEET IF NEEDED): List All Other Public Bodies (identify county as well) for whom you have served as Risk Management Consultant operating within the Statewide Insurance Fund and/or the North Jersey Municipal Employee Benefit Fund, and/or any other insurance funds (ATTACH ADDITIONAL SHEET IF NEEDED): References I authorize officials of Wantage Township to contact any of the municipalities listed hereon or any other source to verify the truthfulness of the information contained in this proposal form. I also authorize officials to contact the two professional references below: Name Position/Title Telephone Number Explanation of Details: Please attach a narrative to address this Section, providing details regarding the applicant s reputation

9 SIGNATURE PAGE The information contained in this proposal form is true. I realize that if any information is false, Wantage Township reserves the right to reject my application or terminate my services and the professional service contract even after same has been awarded. Signature of Proposer: Print name: Date:

10 EXHIBIT A MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will take affirmative action to ensure that such applicants are recruited and employed, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. The contractor or subcontractor, where applicable, will send to each labor union or representative or workers with which it has a collective bargaining agreement or other contract or understanding, a notice, to be provided by the agency contracting officer advising the labor union or workers' representative of the contractor's commitments under this act and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to employ minority and women workers consistent with the applicable county employment goals established in accordance with N.J.A.C. l7:27-5.2, or a binding determination of the applicable county employment goals determined by the Division, pursuant to N.J.A.C. 17: The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, labor unions, that it does not discriminate on the basis of age, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices.

11 The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions. In conforming with the applicable employment goals, the contractor or subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal Affirmative Action Plan Approval Certificate of Employee Information Report Employee Information Report Form AA302 The contractor and its subcontractors shall furnish such reports or other documents to the Div. of Contract Compliance & EEO as may be requested by the office from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Div. of Contract Compliance & EEO for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.

12 AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:5-31 and N.J.A.C. 17:27 GOODS AND SERVICES CONTRACTS (INCLUDING PROFESSIONAL SERVICES) This form is a summary of the successful bidder s requirement to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27-1 et seq. The successful bidder shall submit to the public agency, after notification of award but prior to execution of this contract, one of the following three documents as forms of evidence: (a) A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned affirmative action program (good for one year from the date of the letter); OR (b) A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4; OR (c) A photocopy of an Employee Information Report (Form AA302) provided by the Division and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 17:27-4. The successful vendor may obtain the Affirmative Action Employee Information Report (AA302) from the contracting unit during normal business hours. The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract Compliance and Equal Employment Opportunity in Public Contracts (Division). The Public Agency copy is submitted to the public agency, and the vendor copy is retained by the vendor. The undersigned vendor certifies that he/she is aware of the commitment to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27.1 et seq. and agrees to furnish the required forms of evidence. The undersigned vendor further understands that his/her bid shall be rejected as non-responsive if said contractor fails to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27-1 et seq. COMPANY: PRINT NAME: SIGNATURE: TITLE: DATE:

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