Table of Contents

(files on this site are in PDF and Excel format)
(PDF files are controlling)

Dependent Eligibility Audit Services

A. Request For Proposals (RFP)

Section I: Introduction
Section II: Procurement Protocol and Process
Section III: Administrative Proposal Requirements
Section IV: Technical Proposal Requirements (amended 7/14/08)
Section V: Cost Proposal Requirements
Section VI: Evaluation and Selection Criteria
Section VII: Contract Provisions (amended 7/14/08)
Appendix A: Standard Clauses for All New York State Contracts
Appendix B: Standard Clauses for All DCS Contracts
Appendix C: Third Party Data Connection and Data Exchange Agreement

B. Exhibit I - Offeror Form Submissions

Exhibit I.A: Proposal Submission Requirement Checklist
Exhibit I.B: Biographical Sketch Form
Exhibit I.C: Freedom of Information Law – Request for Redaction Chart
Exhibit I.D: MacBride Statement and Non-Collusive Bidding Certification
Exhibit I.E: ST-220-CA - Registration for Sales & Compensating Use Tax Form
Exhibit I.F: ST-220-TD - Section 5-a Tax Certification Form
Exhibit I.G: EEO Obligations – Offeror Certification of Compliance (ADM-988
Exhibit I.H: Workforce Employment Utilization Report (ADM-989)
Exhibit I.I: Vendor Responsibility Questionnaire (For-Profit)
Exhibit I.J: Notice of Bidding Intention Form
Exhibit I.K: Offeror’s Affirmation of Understanding & Agreement (ADM-982)
Exhibit I.L: Policy on Restrictions on Contacts During the Procurement Process (ADM-982.1)
Exhibit I.M: Compliance with Public Officers Law Requirements (ADM-992)
Exhibit I.N: Compliance with Americans with Disabilities Act (ADM-987)
Exhibit I.O: Omnibus Procurement Act Statement of Acceptance (ADM-991)
Exhibit I.P: Certification of Compliance Pursuant to State Finance Law §139-k (ADM-983)
Exhibit I.Q:

Article 15-A of the Executive Law

Exhibit I.R:

Questions Template

Exhibit I.S:

Formal Offer Letter

Exhibit I.T:

Offeror Attestations Form

Exhibit I.U:

Key Subcontractors

Exhibit I.V:

Project References


C. Exhibit II - Eligibility Information

Exhibit II.A: Dependent Eligibility Guidelines
Exhibit II.B: Survivor Eligibility Guidelines
Exhibit II.C: Required Proofs for Dependent Eligibility
Exhibit II.D: Policy Memos on Dependent Eligibility
Exhibit II.E: Intentionally Left Blank
Exhibit II.F: Form PS 425.1 – Domestic Partners
Exhibit II.G: Form PS 425  – Domestic Partners
Exhibit II.H: Form PS 425.3 – Domestic Partners
Exhibit II.I: Form PS 457 – Other Dependent Children
Exhibit II.J: Sample Enrollee Benefit Statement
Exhibit II.K: Glossary of Terms

D. Exhibit III - Informational

Exhibit III.A: Collective Bargaining Units and Other Non-Represented Groups
Exhibit III.B: Enrollment by Age
Exhibit III.C: Empire Plan Family Enrollment
Exhibit III.D: NYSHIP Plan Family Enrollment
Exhibit III.E: Empire Plan Enrollment by Region
Exhibit III.F: Empire Plan Dependent Claims Cost
Exhibit III.G: Eligibility Status Determination File Layouts
Exhibit III.H: Sample Return on Investment Calculation

E. Exhibit IV - Offeror Cost Submission


Supplemental Documents

Exhibit V.A Pre-Proposal Conference Attendees (exhibit added 7/11/08)
Exhibit V.B Pre-Proposal Conference Transcript (exhibit added 7/11/08)

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