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1509 Seminole Behavioral Healthcare EAPI N I-1877-1 PURCHASING DEPARTMENT TRANSMITTAL MEMORANDUM To: City Clerk /Mayor RE Seminole Behavioral Healthcare EAP Piggy Back Contract RFP 601327 -11BJC /City Contract for execution The item(s) noted below is /are attached and forwarded to your office for the following action(s): Once completed, please: '� ® Return originals to Purchasing ❑ Return copies Special Instructions: r s sign ing ng ping (Vault) pager ❑ Payment Bond ❑ City Manager Signature ❑ City Clerk Attest/Signature Please execute contract and City Clerk to attest it r - Marisol Ordonez c/ n UV From Development Order Final Plat (original mylars) Letter of Credit Maintenance Bond Ordinance Performance Bond Resolution sfa aol 4- 17 - a-o(a Date TADept_ forms \City Clerk Transmittal Memo - 2009.doc pi-n % f% DOCUMENT APPROVAL, Contract Agreement Name: Seminole Behavioral Healthcare EAP Piggy Back Contract RFP 601327 -11 BJC /City Contract for execution Approval: Finance birector a A ey —,4z , r il Zd Date +.(IIglI - .% L Date -- 2 Date W S RM Item No. CITY COMMISSION MEMORANDUM 12 -049.E APRIL 9, 2012 AGENDA To: Honorable Mayor and Members of the City Commission PREPARED BY: Fred W. Fosson, Director of Human Resources Management SUBMITTED BY: Norton N. Bonaparte, Jr., City Manager r..t SUBJECT: Employee Assistance Program Services with minole Behavioral Healthcare - 47 SYNOPSIS: ;sue. Approval of the Employee Assistance Program (EAP) with Seminole County Menta Wealth Center, Inc. d/b /a Seminole Behavioral Healthcare, Fern Park (Seminole Behavioral Heghcare) via a piggyback of the agreement with Seminole County (the County) is requested. FISCAL/STAFFING STATEMENT: By using a piggyback rate from the County's agreement with Seminole Behavioral Healthcare the rate for the City's EAP services, effective the date of its execution by the City will be $12.60 annually per General employee household, and $14.52 annually per Public Safety employee household. BACKGROUND: The City currently is contracted with Horizon Health (Horizon) through a piggyback of the agreement between Horizon and the County. The agreement between Horizon and the County was extended until April 20, 2012 to allow the County time to proceed with a competitive bid process for EAP services. That bid process has been completed and County staff is recommending to the Board of County Commissioners (BCC) that the County award the EAP services to Seminole Behavioral Healthcare. The EAP is a valuable benefit the City provides to its employees. For most services there is no charge to the employee. A few of the counseling services offered in the EAP to employees are: alcohol and drug abuse, child and elder care issues, depression, grief issues, emotional well- being, life improvement issues, credit counseling and legal concerns. Additionally, after the initial allotted legal counseling for the same matter, if additional counseling is needed the employee can receive that through an attorney at a discounted rate. Quarterly reports reveal that City employees are taking advantage of the EAP. Additionally, the EAP will provide Citywide training on issues such as wellness and supervisory skills. The EAP is also the City source of counseling if an employee should be found to have a positive drug screen due to random, reasonable suspicion or post accident screenings, as well as other work related issues. LEGAL REVIEW: The City Attorney has reviewed this agenda items and will ensure that the piggyback agreement between the City and Seminole Behavioral Healthcare is drafted in accordance with City standards. RECOMMENDATION: It is staff's recommendation that the City Commission adopt the proposed piggyback agreement with Seminole Behavioral Healthcare as the City's EAP provider conditioned upon the BCC approving Seminole Behavioral Healthcare as the County's provider at their April 10, 2012 BCC meeting. SUGGESTED MOTION: "I move that the City approve a piggyback agreement with Seminole Behavioral Healthcare to provide the City's EAP services." Seminole Community Mental Health Center, Inc. d /b /a Seminole Behavioral Healthcare EAP Piggyback Contract The City of Sanford ( "City ") enters this "Piggyback" Contract with Seminole Community Mental Health Center, Inc. d /b /a Seminole Behavioral Healthcare (hereinafter referred to as the "Vendor "), under the terms and conditions hereinafter provided. The City and the Vendor agree as follows: 1. The Purchasing Policy for the City of Sanford allows for "piggybacking" contracts. Pursuant to this procedure, the City is allowed to piggyback an existing government contract, and there is no need to obtain formal or informal quotations, proposals or bids. The parties agree that the Vendor has entered a contract with Seminole County, said contract being identified as "Employee Assistance Program Services Agreement RFP 601327- 11 /BJC ", (said original contract being referred to as the "original government contract "). 2. The original government contract is incorporated herein by reference and is attached as Exhibit "A" to this contract. All of the terms and conditions set out in the original government contract are fully binding on the parties and said terms and conditions are incorporated herein. 3. Notwithstanding the requirement that the original government contract is fully binding on the parties, the parties have agreed to modify certain technical provisions of the original government contract as applied to this Contract between the Vendor and the City, as follows: a) Time Period ( "Term ") of this Contract: (state N/A if this is not applicable). N /A. b) Insurance Requirements of this Contract: (state N/A if this is not applicable). N /A. c) Any other provisions of the original government contract that will be modified: (state N/A if this is not applicable). N /A. 1 Seminole Community Mental Health Center, Inc., Seminole Behavioral Healthcare City of Sanford EAP Program Annual Budget General Fire Police TOTAL Personnel Salaries General EAP Clinicians: approximately X 77.56 hours at an average of $18 per hour Fire: EAP Clinicians: approximately X 28.06 hours at an average of $18 per hour Police: EAP Clinicians: approximately x 66.19 hours at an average of $18 per hour Fringe @ 25% Includes FICA @ (7.65 %), Unemployment Insurance @ (2.00 %), Worker's Compensation Insurance @ (1.00 %), Health Insurance @ (7.00 %), 403b TSA @ (4.0 %), Paid Time Off (PTO) @ (3.35 %). TOTAL Personnel Other Expense Build Occ Travel (44.5 cents a mile) Insurance Interest Oper Supplies /Exp Sub -Total SUBTOTAL Personnel and Other Expense Indirect/Administration (10 %) TOTAL Estimated number of employees Cost Per Year Per Member Cost Per Month Per Member $1,396 $1,396 $505 $505 $1,191 $1,191 $349 $126 $298 $773 $1,745 $631 $1,489 $3,866 $333 $60 $130 $523 $201 $36 $78 $315 $540 $97 $210 $848 $268 $48 $104 $421 $432 $78 $168 $678 $1,774 $319 $691 $2,784 $3,519 $950 $2,180 $6,649 352 95 218 $665 $3,871 $1,046 $2,398 $7,314 308 72 120 $12.57 $14.52 $19.99 $1.05 $1.21 $1.67 EXHIBIT A SCOPE OF WORK Cunerit number of a nployees: Option I — Board of County Commissioners Employees - 783 Property Appraiser Employees - 53 Supervisor of Elections Employees -16 Option II -- Public Safety Employees - 487 SCOPE OF SERVICES FOR OPTION is Employee Assistance Program (EAP) Scope of Services.— Board of County Commissioners Employees . (excluding Public Safety Department personnel), Property Appraiser and Supervisor of Elections employees. 1. The EAP Provider will provide services to 783 employees of the Board of County Commissioners; 53 employees for the Property Appraiser's Office; and 16 for Supervisor of Elections (852 total). For Option 1, said employees consist of all Board of County Commissioner's employees, excluding the employees of the Fire Rescue Division and the Communications Division. The EAP provider agrees to a provision for minor increases or decreases (5% or less) in client population without change to the contract or quoted fee amount. 2. The EAP Provider will accept employees and their immediate families who are self - referred or referred to the EAP by their supervisors. 3. The EAP Provider will have day and evening hours scheduled services and will also have a 24 -hour, 7 -day emergency hotline available to deal with emergency situations. 4. The EAP Provider will advise employees of the next available appointment, and assist employees with obtaining appointments in the office of their choice. 5. The EAP Provider will evaluate and diagnose the employee's problem within three (3) visits. If necessary, referrals will be made to other agencies or to a more intensive program offered by the EAP Provider. Every effort will be made by the EAP Provider to coordinate referrals for extended counseling with the County's insurance provider. The EAP Provider will provide the County with a listing and rate charge of other services provided through their agency. Employees will have unlimited visits per contract period covered under this program. The EAP Provider must be willing to provide some flexibility, at no additional charge, to this program restriction based upon the situation. For those employees who have been referred to other EAP Provider services or an outside agency, the EAP Provider will stay in contact with the employee and referred provider to ensure that the employee receives the proper and appropriate care. 6. To maximize program effectiveness, the EAP Provider will provide a comprehensive on- site orientation program for all employees as an introduction to the services provided through the Employees Assistance Program. Due to the many locations of the County Offices, the dates, times and locations of the orientation program will be determined by the County. The EAP Provider must agree to be available to provide at least twenty (20) 15. The EAP provider will be available to provide periodic training in the format of a "lunch and learn" to the employees in conjunction with the County Wellness on various wellness subjects. '.These -trainings will be on a mutually agreed upon: subject, date, time and - location. These training will not exceed twelve (12) per year. SCOPE OF SERVICES FOR OPTION II: Employee Assistance Program (EAP) Scope of Services — Public Safety Department. The EAP Provider will provide services to 487 employees of the Seminole County Public Safety Department. 2. The EAP Provider will accept employees and their immediate families who are self - referred or referred to EAP by their supervisors. 3. The EAP Program will have day and evening hours scheduled for services and will also have a 24 -hour, 7-day emergency hotline available to deal with emergency situations. 4. The EAP Provider will evaluate and diagnose the employee's problem within three (3) visits. If necessary, referrals will be made to other agencies or to a more intensive program offered by the EAP Providers. Every effort will be made by the EAP Provider to coordinate referrals for extended counseling with the County's insurance provider. The EAP Provider will provide the County with a listing and rate charge of other services provided through their agency. The EAP Provider must be willing to provide some flexibility, at no additional charge, to this program restriction based upon the situation: For those employees who have been referred to other EAP Provider services or an outside agency, the EAP Provider will stay in contact with the employee and referred provider to ensure that the employee receives the proper and appropriate care. 5. To maximize program effectiveness, the EAR Provider will provide a comprehensive on- site orientation program for all employees as an introduction to. the services provided through the Employees Assistance Program. Due to the many locations of County Offices, the dates, times, and locations of the orientation program will be determined by the County. The EAP ,Provider must agree to be available to provide at least twenty orientation sessions during the initial start-up. of the program. Each employee attending this program will receive a brochure outlining the EAP Provider's services. The brochure content will be mutually agreed upon by the County and the EAP Provider. The EAP Provider also agrees to provide 500 brochures for distribution by the County. The cost of said brochures will be borne solely by the EAP Provider. 6. To maximize program effectiveness, the EAP Provider will provide a comprehensive on- site program for management and supervisory personnel, with dates, times, and locations to be determined by the County. This program will not only acquaint management and supervisory personnel to the purposes of the EAR Program but also to help utilize EAP as a supervisory tool and to encourage a high level of enthusiasm for the program. The EAP Provider agrees to provide a supervisory training manual /handbook mutually agreed upon by the County. The EAP Provider agrees to provide the County with 100 said manuals /handbooks for distribution by the County. 1 1 1 I I p rr: ; fl SUBMIT PROPOSALS TO: REQU EST FOR Seminole County PROPOSALS 1301 East Second Street Sanford, Florida 32771 and Attn.: PURCHASING DIVISION Proposer Acknowledgment RFP- 601327- 11 /BJC Contact: Betsy J Cohen, C.P.M. Purchasing Supervisor 407- 665 -7112 Employee Assistance Program bcohen(&_seminolecoun l.aov Proposal Due Date: January 11, 2012 Location of Public Opening: Proposal Due Time: 2:00 P.M. 1301 East Second Street Sanford, Florida 32771 Proposer Name: Seminole Community Mental Health Center, Inc., DBA Seminole Behavioral Healthcare Federal Employer ID Number or SS Number: 59- 1304471 Mailing Address: 237 Femwood Blvd. If retuming as a "No Submittal', state reason (if so, return only this page): City, State, Zip: Fern Park, FL 32730 Type of Entity: (Circle one) orporadon Partnership AdNaROW Signature (Manuao Propdetorsillp Joint Venture Incorporated in the State of: Florida , E -Mail Address: Jberko @seminolecares.org Telephone Number: 407 -831 -2411 ext. 1245 Typed Name: James P. Berko Toll Free Telephone Number: N/A Title: Chief Executive Officer Fax Number: 407 -831 -0195 Date: January 10, 2012 THIS FORM MUSS' BE COMPLETED AND RETURNED WITH YOUR PROPOSAL The Applicant is expected to completely analyze the information contained in this Request for Proposals as guidance for the preparation of the submittal. The Applicant's submittal shall be sufficiently specific, detailed, and complete to clearly and fully demonstrate the Applicant's understanding of the proposed work requirements. RFP- 601327- 111BJC . Employee Assistance Program 6 Q a EXHIBIT B Seminole Community Mental Health Center, Inc., Seminole Behavioral Healthcare Seminole County Government EAP Program Annual Budget OPTION 1 OPTION 2 Personnel Salaries Option 1: EAP Clinicians: approximately X 215.44 hours at an average of $ 1 a per hour Option 2: P.{1P Clinicians: approximately X 214.67 hours at an average of $18 per hour Fringe @ 25% Includes FICA @ (7.65%), Unemployment insurance @ (2.0036), Worker's Compensation Insurance @ (1.00 Health Insurance @ (7.00 %), 403b TSA @ (4.0 %), Paid Time Off (PTO) C (3.35 %). TOTAL Personnel Other Expense Build Occ Travel (44.5 cents a mile x 1,750 total miles) Insurance Interest Oper Supplies/Exp Sub -Total SUBTOTAL Personnel and Other Expense Indirect/Administration (10 %) TOTAL TOTAL $3,878 $3,878 $3,864 $3,864 $970 $966 $1,936 $4,848 $4,830 $9,678 $926 $287 $1,213 $538 $242 $780 $1,500 $465 $1,965 $747 $232 $979 _ - � $1 $372 __ $1,572 $4,911 _ $1,597 $6,609 $9,759 $6,427 $_16,186 �M 643 $1,619 $10,735 $7,070 $17,805 Estimated number of employees 852 487 Cost Per Year Per Member $12.60 $14.52 Cost Per Month Per Member $1.05 $1.21 EXHIBIT A SCOPE OF WORK Current number of employees: Option I — Board of County Commissioners Employees - 783 Property Appraiser Employees - 53 Supervisor of Elections Employees - 16 Option II — Public Safety Employees - 487 SCOPE OF SERVICES FOR OPTION I: Employee Assistance Program (EAP) Scope of Services — Board of County Commissioners Employees (excluding Public Safety Department personnel), Property Appraiser and Supervisor of Elections employees. The EAP Provider will provide services to 783 employees of the Board of County Commissioners; 53 employees for the Property Appraiser's Office; and 16 for Supervisor of Elections (852 total). For Option 1, said employees consist of all Board of County Commissioner's employees, excluding the employees of the Fire Rescue Division and the Communications Division. The EAP provider agrees to a provision for minor increases or decreases (5% or less) in client population without change to the contract or quoted fee amount. 2. The EAP Provider will accept employees and their immediate families who are self - referred or referred to the EAP by their supervisors. 3. The EAP Provider will have day and evening hours scheduled for services and will also have a 24 -hour, 7 -day emergency hotline available to deal with emergency situations. 4. The EAP Provider will advise employees of the next available appointment, and assist employees with obtaining appointments in the office of their choice. 5. The EAP Provider will evaluate and diagnose the employee's problem within three (3) visits. If necessary, referrals will be made to other agencies or to a more intensive program offered by the EAP Provider. Every effort will be made by the EAP Provider to coordinate referrals for extended counseling with the County's insurance provider. The EAP Provider will provide the County with a listing and rate charge of other services provided through their agency. Employees will have unlimited visits per contract period covered under this program. The EAP Provider must be willing to provide some flexibility, at no additional charge, to this program restriction based upon the situation. For those employees who have been referred to other EAP Provider services or an outside agency, the EAP Provider will stay in contact with the employee and referred provider to ensure that the employee receives the proper and appropriate care. 6. To maximize program effectiveness, the EAP Provider will provide a comprehensive on- site orientation program for all employees as an introduction to the services provided through the Employees Assistance Program. Due to the many locations of the County Offices, the dates, times and locations of the orientation program will be determined by the County. The EAP Provider must agree to be available to provide at least twenty (20) orientation sessions during the initial start-up of the program. Each employee attending this program will receive a brochure outlining the EAP Provider's services. The brochure content will be mutually agreed upon by the County and the EAP Provider. The EAP Provider also agrees to provide 2,000 brochures for distribution by the County. The cost of said brochures will be borne solely by the EAP Provider. 7. To maximize program effectiveness, the EAP Provider will provide a comprehensive on- site program for management and supervisory personnel, with dates, times and locations to be determined by the County. This program will not only acquaint management and supervisory personnel to the purpose of the EAP Program, but also to help utilize EAP as a supervisory tool and encourage a high level of enthusiasm for the program. The EAP Provider agrees to provide a supervisory training manual /handbook for use by supervisory personnel. The content of the manual /handbook will be mutually agreed upon by the County and the EAP Provider. The EAP Provider agrees to provide the County with 500 said manuals /handbooks for distribution by the County. The EAP Provider agrees to bear the cost for production and printing of these manuals /handbooks. 8. The EAP Provider agrees to provide periodic training sessions throughout the term of the agreement as a refresher to both employees and supervisory personnel. The EAP Provider also agrees to provide training for stress management and other mental health issues as requested by the County. 9. The EAP Provider will provide, via telephone, assistance and consultation to supervisors on an as- needed basis for guidance on handling EAP issues including supervisory referrals. 10. The EAP Provider agrees to provide promotional materials to the County for posting at the various County work - sites. The type and amount of materials shall be mutually agreed upon by the County and the EAP Provider. Suggested promotional materials include, but not limited to, home mailings of program brochures, bulletin board displays, visits by the EAP Provider and their staff to County work - sites, and articles /announcements for inclusion in the County's employee newsletter. 11. Quarterly meetings with the EAR Provider and the designated County representative to review a written statistical report on client services will be conducted and coordinated by the County. 12. The EAP Provider must provide assurances to the County on the confidentially of meeting sessions. This should include scheduling so that employees from the County are not given "adjacent" appointments. 13. All EAP participants will have an opportunity to anonymously evaluate the services received through the EAP Provider. The format of said evaluation will be mutually agreed upon by the County and the EAP Provider. 14. The EAP provider will provide periodic training for supervisors on the effective use of the program to assist in the improvement of performance and to address job related issues of employees. These trainings will be made available on a mutually agreed upon date, time and location as needed by the County. These trainings will not exceed six (6) per year. 15. The EAP provider will be available to provide periodic training in the format of a "lunch and learn" to the employees in conjunction with the County Wellness on various wellness subjects. These trainings will be on a mutually agreed upon subject, date, time and location. These training will not exceed twelve (12) per year. SCOPE OF SERVICES FOR OPTION II: Employee Assistance Program (EAP) Scope of Services — Public Safety Department. The EAP Provider will provide services to 487 employees of the Seminole County Public Safety Department. 2. The EAP Provider will accept employees and their immediate families who are self - referred or referred to EAP by their supervisors. 3. The EAP Program will have day and evening hours scheduled for services and will also have a 24 -hour, 7 -day emergency hotline available to deal with emergency situations. 4. The EAP Provider will evaluate and diagnose the employee's problem within three (3) visits. If necessary, referrals will be made to other agencies or to a more intensive program offered by the EAP Providers. Every effort will be made by the EAP Provider to coordinate referrals for extended counseling with the County's insurance provider. The EAP Provider will provide the County with a listing and rate charge of other services provided through their agency. The EAP Provider must be willing to provide some flexibility, at no additional charge, to this program restriction based upon the situation. For those employees who have been referred to other EAP Provider services or an outside agency, the EAP Provider will stay in contact with the employee and referred provider to ensure that the employee receives the proper and appropriate care. 5. To maximize program effectiveness, the EAR Provider will provide a comprehensive on- site orientation program for all employees as an introduction to the services provided through the Employees Assistance Program. Due to the many locations of County Offices, the dates, times, and locations of the orientation program will be determined by the County. The EAP Provider must agree to be available to provide at least twenty orientation sessions during the initial start-up of the program. Each employee attending this program will receive a brochure outlining the EAP Provider's services. The brochure content will be mutually agreed upon by the County and the EAP Provider. The EAP Provider also agrees to provide 500 brochures for distribution by the County. The cost of said brochures will be borne solely by the EAP Provider. 6. To maximize program effectiveness, the EAP Provider will provide a comprehensive on- site program for management and supervisory personnel, with dates, times, and locations to be determined by the County. This program will not only acquaint management and supervisory personnel to the purposes of the EAR Program but also to help utilize EAP as a supervisory tool and to encourage a high level of enthusiasm for the program. The EAP Provider agrees to provide a supervisory training manual /handbook mutually agreed upon by the County. The EAP Provider agrees to provide the County with 100 said manuals /handbooks for distribution by the County. The EAP Provider agrees to bear the cost of production /printing of the manual /handbook. 7. The EAP Provider agrees to provide periodic training sessions throughout the term of the agreement as a refresher to both employees and supervisory personnel. 8. The EAP Provider will provide, via telephone, assistance and consultation to supervisors on an as- needed basis for guidance on handling EAP issues including referrals. 9. The EAP Provider agrees to provide promotional materials to the County for posting at the various County worksites. Type and amount of material shall be mutually agreed upon by the County and EAP Provider. Suggested promotional materials include, but are not limited to, home mailings of program brochures, bulletin board displays, visits by the EAP Provider and their staff to County worksites, and articles /announcements for inclusion in the County's employee newsletter. 10. Quarterly meetings with the EAP Provider and the designated County representative to review a written statistical report on client services. 11. The EAP Provider must provide assurances to the County on the confidentiality of meeting sessions. This should include scheduling so that employees from the County are not given "adjacent" appointments. 12. All EAP participants will have an opportunity to anonymously evaluate the services received through the EAP Provider. The format of said evaluation will be mutually agreed upon by the County and the EAP Provider. 13. Due to the high stress level involved in the work of Option II personnel, "crisis" counseling, including the ability to be familiar with the types of problems encountered by said personnel is required. To accomplish this task, on -site visits to Public Safety Operations is required. 14. The EAP Provider must be able to provide "critical incident stress debriefing" services to personnel on an as- needed basis. 4 : SUBMIT PROPOSALS TO: REQUEST FOR Seminole County PROPOSALS 1301 East Second Street Sanford, Florida 32771 and Attn.: PURCHASING DIVISION Proposer Acknowledgment RFP- 601327 -11 /BJC Contact: Betsy J Cohen, C.P.M. Purchasing Supervisor 407 -665 -7112 Employee Assistance Program bcohen(a)-seminolecountyfl.gov Proposal Due Date: January/ 11, 2012 Location of Public Opening: Proposal Due Time: 2:00 P.M. 1301 East Second Street Sanford, Florida 32771 Proposer Name: Seminole Community Mental Health Center, Inc., DBA Seminole Behavioral Healthcare Federal Employer ID Number or SS Number: 59- 1304471 Mailing Address: 237 Fernwood Blvd. If returning as a "No Submittal ", state reason (if so, return only this page): City, State, Zip: Fern Park, FL 32730 Type of Entity: (Circle one) Corporation Partnership Au on ed Signature (Manual) Proprietorship Joint Venture Incorporated in the State of Florida E -Mail Address: jberko @seminolecares.org Telephone Number: 407 - 831 -2411 ext. 1245 Typed Name: James P. Berko Toll Free Telephone Number: N/A Title: Chief Executive Officer Fax Number: 407 - 831 -0195 Date: January 10, 2012 THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR PROPOSAL The Applicant is expected to completely analyze the information contained in this Request for Proposals as guidance for the preparation of the submittal. The Applicant's submittal shall be sufficiently specific, detailed, and complete to clearly and fully demonstrate the Applicant's understanding of the proposed work requirements. RFP- 601327 -11 /BJC - Employee Assistance Program EXHIBIT B 15 Section 5 Price Proposal Employee Assistance Program - RFP- 601327 -11 /BJC Name of Proposer: Seminole Community Mental Health Center, Inc. DBA Seminole Behavioral Healthcare Mailing Address: 237 Fernwood Blvd City /State /Zip: Fern Park, FL 32730_ Phone Number: ( 407 ) 831 -2411 FAX Number: ( 407) 831 -0195 F E -mail Address: jberko @seminolecares.org Pursuant to and in compliance with the Request for Proposals, the undersigned Proposer agrees to perform the Work in strict conformity with Contract Documents, including Addenda Nos. _2_ through , on file for the rates hereinafter set forth. The undersigned Proposer, declares that the only persons /parties interested in this proposal as i principals are those named herein; that this proposal is made without collusion with any person, firm or corporation; and he proposes and agrees, if the proposal is accepted, that he /she will execute an Agreement with the COUNTY and will furnish Insurance Certificates. Proposer shall ► include all costs including, but not limited to general administrative overhead; fringe and benefits; profit and related items; and all incidental necessary for the performance of the work. I FEE STRUCTURE: OPTION I- Board of County Commissioners Employees - 783 I Property Appraiser Employees - 53 I Supervisor of Elections Employees _ 16 I Rate per Employee Household: $1.05 PMPM Annual Rate: $ 12.60 I I OPTION II _ Public Safety Employees - 487 I Rate per Employee Household: $1.21 PMPM Annual Rate: $ 14.52 I Number of training hours the Provider will provide as part of the contract for Brown Bag Lunch P Training: 12 per year Provide a schedule of fees for training programs outside of the scope of services outlined in the I RFP documents, example: workplace violence, etc.) ` All training described in the RFP is included in the prices above. Customized trainings would be r provided based on actual preparation, presentation, and evaluation time at $75 per hour. E r I RFP- 601327 -11 /BJC _ Employee Assistance Program 1 EXHIBIT B Seminole Community Mental Health Center, Inc., Seminole Behavioral Healthcare Seminole County Government EAP Program Annual Budget OPTION 1 OPTION 2 TOTAL Personnel Salaries Option 1 : EAP Clinicians: approximately X 215.44 hours at an average of $18 per hour Option 2: EAP Clinicians: approximately X 214.67 hours at an average of $18 per hour Fringe @ 25% Includes FICA @ (7.65 %), Unemployment Insurance @ (2.00 %), Worker's Compensation Insurance @ (1.00 %), Health Insurance @ (7.00 %), 403b TSA @ (4.0 %), Paid Time Off (PTO) @ (3.35 %). TOTAL Personnel Other Expense Build Occ Travel (44.5 cents a mile x 1,750 total miles) Insurance Interest Oper Supplies /Exp Sub -Total SUBTOTAL Personnel and Other Expense Indirect/Administration (10 %) TOTAL Estimated number of employees Cost Per Year Per Member Cost Per Month Per Member $3,878 $3,878 $3,864 $3,864 $970 $966 $1,936 $4,848 $4,830 $9,678 $926 $287 $1,213 $538 $242 $780 $1,500 $465 $1,965 $747 $232 $979 ____ $1200 $372 $1,572 $4,911 $1,597 $6,509 $9,759 $6,427 $16,186 976 643 $1,619 $10,735 $7,070 $17,805 852 487 $12.60 $14.52 $1.05 $1.21 OP ID: LE ' r R° CERTIFICATE OF LIABILITY INSURANCE °A ' 06130 ° ""'" ) 06!30111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED R EPRESENTATIVE O R PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Neu of such endorsemen s . PRODUCER 386- 252 -9601 Brown & Brown of Florida, Inc. 386 -239 -5729 Daytona Beach Office P.O Box 2412 Daytona Beach, FL 32115 -2412 Julie Young T CT NAY P q N AI No ADDRES PRUDLIGER BENIN -1 INSURE R($) AFFORDING COVERAGE NAIC !< INSURED SEMINOLE BEHAVIORAL HEALTHCARE SEMINOLE COMMUINITY MENTAL HEALTH CENTER 237 FERNWOOD BLVD FERN PARK, FL 32730 INSURER A: PHILADELPHIA INDEMNITY INS CO 18058 INSURERB :FHM 10699 INsunEptc;The Phoenix Insurance Co 25623 INSURERD;RSUI Indemnity Company 22314 INSURER P; S 1,00o,00 INSURER F: $ 100,00 COVFRAMPS CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t TYPE OF INSURANCE SCHOOL BOARD OF SEMINOLE CNTY ACCORDANCE WITH THE POLICY PROVISIONS. POLICY Nukmk YY D1YYYY1 LIMITS 400E LAKE MARY BLVD SANFORD, FL 32773 -7127 /4_ �- �ul GENERAL LIABILITY U Q EACH OCCURRENCE S 1,00o,00 PREMISES occurrenc $ 100,00 A X COMMERCIAL GENERAL. LIABILITY CLAIMS-MADE � OCCUR X PHPK741777 06/30/11 06130112 MED EXP (Any one son) $ 5,00 PERSONAL & ADV INJURY S 1,000,00 X PROFESSIONAL LIAB LIMIT $1,000,000 GENERAL AGGREGATE $ 3,000,00 GGR $3 ,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG S 1,000,00 r $ POLICY PRO LOC C AUTOI*O0ILEUABILITY X ANY AUTO BA8126X125 06/30111 06/30/12 CO BINED $ 1,000, BODILY INJURY (Per person) $ ALL OWNED AUTO$ BODILY INJURY (Pat axident) $ - X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ X NON -OWNED AUTOS $ X PHY DAM DED OMP $500 /COLE 1 000 U"Pt -LA LIAO X OCCUR EACH OCCURRENCE $ 1 ,0 00 ,0 0 AGGREGATE $ 1,000,00 A EXCESS UAB CLAIMS - MADE PHUB351140 06130/11 06130112 DEDUCTIBLE $ $ X RErENT N 10 000 B VfORKERB COMPENSATION AND EMPLOYERS' UAWLITY ANY PROPRLETORIPARTNERIE)CECUTNEY OFFICERIMEMBER EXCLUDED? (MsnddM In NH) NIA 30620444 04/01/11 04/01/12 X WC STATU- OTH- rR E.L. EACH ACCIDENT S 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1 0 y� 1P 7 T 3a under DEiG O OP RA NS bebw E.L. DISEASE- POLICY LEfr41T $ 1,000,00 A PHPK741777 08!$0111 06/30/12 EMPL SH 50,00 D ;FUME RECTORS & OFFICE I NHP54201111 08130111 06130/12 D &O 3,000,D0 DESCRIPTION OF OPERATION$ I LOCATIONS I VEHICLES (Atbrch ACORD 101, Addltlond Rsmuks Scf»dub, IN mon Wwo Is nqulred) CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL INSURED IN REPSECTS TO THE G ENERAL LIABILITY COVERAGE. rFRTIFIrATR unl Mr-0 CANCELLATION - - - - -- ----- - - - - -- SCHOS01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SCHOOL BOARD OF SEMINOLE CNTY ACCORDANCE WITH THE POLICY PROVISIONS. SEMINOLE COUNTY PUBLIC SCHOOLS AUTHORIZED REPRESENTATIVE EDUCATION SUPPORT CENTER 400E LAKE MARY BLVD SANFORD, FL 32773 -7127 /4_ �- �ul U Q ©1988 -2009 ACORD CORPORATION. All rights reserved. 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