KNOWLTON TOWNSHIP SCHOOL DISTRICT 80 Route 46, P.O. Box 227, Delaware, N.J. 07833 Phone: (908) 475-5118Fax: 908-475-1141 REQUEST FOR QUALIFICATIONS FOR SCHOOL DISTRICT RISK MANAGEMENT CONSULTANT Notice is hereby given that the Knowlton Township School District, County of Warren, State of New Jersey, is requesting Qualifications for School District Risk Management Consultant. Copies of the Request for Qualifications are available in the Office of the School Business Administrator/Board Secretary, 80 Route 46, Delaware, N.J. 07833 Two (2) copies of the Qualification must be submitted in writing and received at the Board of Education Office in sealed envelope with the name of the RFQ clearly marked on the outside of the envelope by November 18 th, 2013 no later than 2:00 pm, to the attention of: Knowlton Township School District c/o Kevin Mulligan School Business Administrator/Board Secretary 80 Route 46, P.O. Box 227, Delaware, N.J. 07833 Phone: (908) 475-3544 E-mail: mulligank@knowltonschool.com Nothing herein is intended to exclude any responsible firm or in any way restrain or restrict competition. All responsible firms are encouraged to submit Qualifications. The Board of Education reserves the right to accept or reject any and all Qualifications submitted in the best interest of the school district and the Board further reserves the right to waive any defect or informality in any Qualification should it be in the best interest of the school district. Qualifications are required to comply with the requirements of P.L. 1975, c. 127(N.J.A.C. 17:27). This Request For Qualifications does not constitute a bid and is intended solely to obtain information from which the Board of Education may choose contractor(s) that best meet(s) the Board of Education s needs. It is the Board of Education s intent that no statutory, regulatory, or common law bidding requirement apply to this Request for Qualification. The Board of Education intends to award this contract pursuant to N.J.S.A. 18A:18-5.a(1). Page 1 of 4
1. Purpose: The purpose of the Request for Qualification (RFQ) is to obtain information for Risk Management Consultant services. The Board intends to award this contract pursuant to N.J.S.A.18A:18A-37 and N.J.S.A 18A:18A-42. All Brokers shall be currently licensed and authorized by the State of New Jersey, Department of Insurance, to do business in the State of New Jersey and have a favorable record with the State of New Jersey Department of Insurance. 2. Term: The term for the Insurance Broker Services will begin on January 1, 2014, or as soon as practical. The length of the term of the initial contract will be for a period of three years in accordance with New Jersey statute. The Board reserves the right, in accordance with the law, to exercise two additional one-year renewals thereafter. The Board of Education has the right to terminate with a 30-day notice advance notice in writing. Requests for Proposals are on file at the Business Administrator/Board Secretary s office at 80 Route 46, Delaware, N.J. 07833 and may also be downloaded from the Board of Education s website at http://www.knowltonschool.com/board.htm. 3. Submission Proposing firms shall provide evidence that the documentation and minimum qualifications are met. 4. Documentation Required 1. Names of individuals who will perform required tasks as well as the listing of their licenses. a. Identify the person who will be primarily responsible for the services required by the board of education and provide a description of the experience of the primary person with projects and issues similar to those more specifically set forth in the proposal and on behalf of the board of education including resume. b. Identify persons who will serve as back up to the primary person including resumes of all persons. 2. Describe ability to provide services in a timely fashion including a description of the firm staffing and a description of the firms familiarity with the services required by the board of education. Provide a brief description of company background. Page 2 of 4
3. Listing of all current and former public entity and/or board of education clients. 4. References from current public entity and/or board of education clients. 5. Professional Liability Insurance: The professional is to provide, at own expense, a comprehensive general liability insurance policy including professional liability, insuring against any and all claims for bodily injury or death resulting from performance and services by the professional, professionals employees, staff and agents. The insurance shall provide not less than $1,000,000 with respect to injury or aggregate, or may be in such other form as provided by the New Jersey Tort Claims Act, NJSA 59:1-1 et. seq., which shall govern the terms and conditions of any such program. The board of education shall be listed as additional insured on the policy. 6. New Jersey Business Registration Certificate. 7. All responders must comply with Mandatory Equal Employment Opportunity Language N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) and N.J.A.C. 17:27. Evaluation of Proposals The proposals will be evaluated by a committee of administration and board members based upon information supplied in response to the specific Request for Qualification and the following criteria: Ability to meet all minimum qualifications. Overall knowledge and familiarity with the operations of the board of education. Experience of the firm in providing similar services to other public bodies, with special emphasis on experience in New Jersey. Qualifications and experience of the professional. Qualifications and experience of the other members of the professional s firm. Scope of Services: Applicants will be expected to demonstrate knowledge and experience with respect to all aspects of liability/property/worker s compensation insurance coverage by a school board including, but not limited to: negotiating annual renewal of existing coverage prepare all necessary bid specifications, in the event the coverage is marketed, and evaluate all bids that are received provide the central administration with reasonable preliminary renewal figures during the budget process. Page 3 of 4
The firm will also be expected to be available to provide advice to the board of education during non-business hours including the attendance at meetings when requested. Minimum Qualifications: 1. All brokers shall be currently licensed and authorized by the State of New Jersey, Department of Insurance, to do business in the State of New Jersey. 2. The firm shall have one (1) or more licensed professionals on staff whose major focus and work has been and remains providing professional services to and advising public entities. 3. The firm shall have at least ten (10) years experience in representing public entities. 4. The firm shall designate one (1) professional within the firm who will be assigned to represent the interest of the board of education. This individual shall be admitted and/or licensed in his/her profession and be in good standing. 5. The firm and individuals assigned to work with the board of education shall bewell versed in all aspects of the school district s operations. 6. The firm must maintain a current principal office within the State of New Jersey. 7. The firm must show proof of relationship with the district s existing carrier as well as proof of relationship with other insurance carriers. Validity: The Qualification will not be considered a valid Qualification and will not be read unless the following items are included: a. Statement of Ownership; b. Non-collusion Affidavit (Attached); c. Affirmative Action statement (Attached); d. Political Contribution Form (Attached); e. Americans with Disabilities Act Form (Attached); f. Business Registration Certificate; g. Agency and Associate licenses Page 4 of 4
STANDARD BID DOCUMENT REFERENCE Reference: VII-A Name of Form: Statutory Reference: Instructions Reference: Description: AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:5-31 (P.L 1975, c.127) and N.J.A.C 17:27-1 et seq. Statutory and Other Requirements VII-A-1 To assure vendor compliance with State affirmative action requirements. Each 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: 1. 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 2. A photocopy of a Certificate of Employee Information Report approval, issued in accordance with N.J.A.C. 17:27-4; or 3. 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. This form provides the bidder guidance on the requirements. It is advisory in nature only and is a non-mandatory, waiveable form. For information on the requirements of the Affirmative Action Law, contact: Division of Contract Compliance & Equal Employment Opportunity in Public Contracting Department of the Treasury State of New Jersey P.O. Box 209 Trenton, NJ 08625-0209 609-292-5473 E-mail: www.state.nj.us/treasury/contract_compliance/ccmail.shtml Agency website: www.state.nj.us/treasury/contract_compliance
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:
AMERICANS WITH DISABILITIES ACT Equal Opportunity for Individuals with Disabilities The Professional and the (hereafter owner ) do hereby agree that the provision of Title II of the Americans With Disabilities Act of 1990 (the ADA ) (42 U.S.C. Section 12101 et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs and activities provided or made available by public entities, and the rules and regulations promulgated pursuant thereunto, are made a part of this contract. In providing any aid, benefit or service on behalf of the Owner pursuant to this contract, the Professional agrees that the performance shall be in strict compliance with the ADA. In the event that the Professional, its agents, servants, employees or subprofessionals violate or are alleged to have violated the ADA during the performance of this contract, the Professional shall defend the Owner in any action or administrative proceeding commenced pursuant to this ADA. The Professional shall indemnify, protect and save harmless the Owner, its agents, servants and employees from and against any and all suits, claims, losses, demands or damages of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The Professional shall, at its own expense, appear, defend and pay any and all charges for legal services and any and all costs and other expenses arising form such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the Owner grievance procedure, the Professional agrees to abide by any decision of the Owner which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the Owner or if the Owner incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the Professional shall satisfy and discharge the same at its own expense. The Owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the Professional along with full and complete particulars of the claim. If any action or administrative proceeding is brought against the Owner or any of its agents, servants, and employees, the Owner shall expeditiously forward or have forwarded to the Professional every demand, complaint, notice, summons, pleading or other process received by the Owner or its representatives. It is expressly agreed and understood that any approval by the Owner of the services provided by the Professional pursuant to this contract will not relieve the Professional of the obligation to comply with the ADA and to defend, indemnify, protect, and save harmless the Owner pursuant to this paragraph. It is further agreed and understood that the Owner assumes no obligation to indemnify or save harmless the Professional, its agents, servants, employees and subprofessionals for any claim which may arise out of their performance of this agreement. Furthermore, the Professional expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the Professional s obligations assumed in this agreement, nor shall they be construed to relieve the Professional from any liability, nor preclude the Owner from taking any other actions available to it under any other provisions of this agreement or otherwise by law. COMPANY: SIGNATURE: PRINT NAME & TITLE: DATE:
C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A-20.26 This form or its permitted facsimile must be submitted to the local unit no later than 10 days prior to the award of the contract. Part I Vendor Information Vendor Name: Address: City: State: Zip: The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanying this form. Signature Printed Name Title Part II Contribution Disclosure Disclosure requirement: Pursuant to N.J.S.A. 19:44A-20.26 this disclosure must include all reportable political contributions (more than $300 per election cycle) over the 12 months prior to submission to the committees of the government entities listed on the form provided by the local unit. Check here if disclosure is provided in electronic form. Contributor Name Recipient Name Date Dollar Amount Check here if the information is continued on subsequent page(s)
Continuation Page C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM Required Pursuant To N.J.S.A. 19:44A-20.26 Page of Vendor Name: Contributor Name Recipient Name Date Dollar Amount $ Check here if the information is continued on subsequent page(s)
KNOWLTON TOWNSHIP SCHOOL DISTRICT 80 Route 46, P.O. Box 227, Delaware, N.J. 07833 Phone: (908) 475-5118Fax: 908-475-1141 REQUEST FOR QUALIFICATIONS FOR SCHOOL DISTRICT RISK MANAGEMENT CONSULTANT Notice is hereby given that the Knowlton Township School District, County of Warren, State of New Jersey, is requesting Qualifications for School District Risk Management Consultant. Copies of the Request for Qualifications are available in the Office of the School Business Administrator/Board Secretary, 80 Route 46, Delaware, N.J. 07833 Two (2) copies of the Qualification must be submitted in writing and received at the Board of Education Office in sealed envelope with the name of the RFQ clearly marked on the outside of the envelope by November 19 th, 2013 no later than 2:00 pm, to the attention of: Knowlton Township School District c/o Kevin Mulligan School Business Administrator/Board Secretary 80 Route 46, P.O. Box 227, Delaware, N.J. 07833 Phone: (908) 475-3544 E-mail: mulligank@knowltonschool.com Nothing herein is intended to exclude any responsible firm or in any way restrain or restrict competition. All responsible firms are encouraged to submit Qualifications. The Board of Education reserves the right to accept or reject any and all Qualifications submitted in the best interest of the school district and the Board further reserves the right to waive any defect or informality in any Qualification should it be in the best interest of the school district. Qualifications are required to comply with the requirements of P.L. 1975, c. 127(N.J.A.C. 17:27). This Request For Qualifications does not constitute a bid and is intended solely to obtain information from which the Board of Education may choose contractor(s) that best meet(s) the Board of Education s needs. It is the Board of Education s intent that no statutory, regulatory, or common law bidding requirement apply to this Request for Qualification. The Board of Education intends to award this contract pursuant to N.J.S.A. 18A:18-5.a(1). Page 1 of 4
1. Purpose: The purpose of the Request for Qualification (RFQ) is to obtain information for Risk Management Consultant services. The Board intends to award this contract pursuant to N.J.S.A.18A:18A-37 and N.J.S.A 18A:18A-42. All Brokers shall be currently licensed and authorized by the State of New Jersey, Department of Insurance, to do business in the State of New Jersey and have a favorable record with the State of New Jersey Department of Insurance. 2. Term: The term for the Insurance Broker Services will begin on January 1, 2014, or as soon as practical. The length of the term of the initial contract will be for a period of three years in accordance with New Jersey statute. The Board reserves the right, in accordance with the law, to exercise two additional one-year renewals thereafter. The Board of Education has the right to terminate with a 30-day notice advance notice in writing. Requests for Proposals are on file at the Business Administrator/Board Secretary s office at 80 Route 46, Delaware, N.J. 07833 and may also be downloaded from the Board of Education s website at http://www.knowltonschool.com/board.htm. 3. Submission Proposing firms shall provide evidence that the documentation and minimum qualifications are met. 4. Documentation Required 1. Names of individuals who will perform required tasks as well as the listing of their licenses. a. Identify the person who will be primarily responsible for the services required by the board of education and provide a description of the experience of the primary person with projects and issues similar to those more specifically set forth in the proposal and on behalf of the board of education including resume. b. Identify persons who will serve as back up to the primary person including resumes of all persons. 2. Describe ability to provide services in a timely fashion including a description of the firm staffing and a description of the firms familiarity with the services required by the board of education. Provide a brief description of company background. Page 2 of 4
3. Listing of all current and former public entity and/or board of education clients. 4. References from current public entity and/or board of education clients. 5. Professional Liability Insurance: The professional is to provide, at own expense, a comprehensive general liability insurance policy including professional liability, insuring against any and all claims for bodily injury or death resulting from performance and services by the professional, professionals employees, staff and agents. The insurance shall provide not less than $1,000,000 with respect to injury or aggregate, or may be in such other form as provided by the New Jersey Tort Claims Act, NJSA 59:1-1 et. seq., which shall govern the terms and conditions of any such program. The board of education shall be listed as additional insured on the policy. 6. New Jersey Business Registration Certificate. 7. All responders must comply with Mandatory Equal Employment Opportunity Language N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) and N.J.A.C. 17:27. Evaluation of Proposals The proposals will be evaluated by a committee of administration and board members based upon information supplied in response to the specific Request for Qualification and the following criteria: Ability to meet all minimum qualifications. Overall knowledge and familiarity with the operations of the board of education. Experience of the firm in providing similar services to other public bodies, with special emphasis on experience in New Jersey. Qualifications and experience of the professional. Qualifications and experience of the other members of the professional s firm. Scope of Services: Applicants will be expected to demonstrate knowledge and experience with respect to all aspects of liability/property/worker s compensation insurance coverage by a school board including, but not limited to: negotiating annual renewal of existing coverage prepare all necessary bid specifications, in the event the coverage is marketed, and evaluate all bids that are received provide the central administration with reasonable preliminary renewal figures during the budget process. Page 3 of 4
The firm will also be expected to be available to provide advice to the board of education during non-business hours including the attendance at meetings when requested. Minimum Qualifications: 1. All brokers shall be currently licensed and authorized by the State of New Jersey, Department of Insurance, to do business in the State of New Jersey. 2. The firm shall have one (1) or more licensed professionals on staff whose major focus and work has been and remains providing professional services to and advising public entities. 3. The firm shall have at least ten (10) years experience in representing public entities. 4. The firm shall designate one (1) professional within the firm who will be assigned to represent the interest of the board of education. This individual shall be admitted and/or licensed in his/her profession and be in good standing. 5. The firm and individuals assigned to work with the board of education shall bewell versed in all aspects of the school district s operations. 6. The firm must maintain a current principal office within the State of New Jersey. 7. The firm must show proof of relationship with the district s existing carrier as well as proof of relationship with other insurance carriers. Validity: The Qualification will not be considered a valid Qualification and will not be read unless the following items are included: a. Statement of Ownership; b. Non-collusion Affidavit (Attached); c. Affirmative Action statement (Attached); d. Political Contribution Form (Attached); e. Americans with Disabilities Act Form (Attached); f. Business Registration Certificate; g. Agency and Associate licenses Page 4 of 4
STOCKHOLDER DISCLOSURE CERTIFICATION This Statement Shall Be Included with Bid Submission Name of Business: I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned. OR I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned. If a corporation owns all or part of the stock of the corporation or partnership submitting the bid, then the statement shall include a list of the stockholders who own 10% or more of the stock of any class of that owning coporation. If no one owns 10% or more stock, attest to that. Check the box that represents the type of business organization: Partnership Corporation Sole Proprietorship Limited Partnership Limited Liability Corporation Limited Liability Partnership Subchapter S Corporation Sign and notarize the form below, and, if necessary, complete the stockholder list below. Stockholders: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Name: Home Address: Subscribed and sworn before me this day of, 2. (Affiant) (Notary Public) My Commission expires: (Print name & title affiant) (Corporate Seal)