RFP, Technical Proposal Packet Template

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TECHNICAL PROPOSAL PACKET710-21-0046

Technical Proposal PacketBid No. 710-21-0046PROPOSAL SIGNATURE PAGEType or Print the following information.PROSPECTIVE CONTRACTOR’S n:Minority andWomenOwnedDesignation*:State: Individual PartnershipZip Code: Sole Proprietorship Corporation Not Applicable African American American Indian Hispanic AmericanAR Certification #: Public Service Corp Nonprofit Asian American Pacific Islander American Service-Disabled Veteran Women-Owned* See Minority and Women-Owned Business PolicyPROSPECTIVE CONTRACTOR CONTACT INFORMATIONProvide contact information to be used for bid solicitation related matters.Contact Person:Title:Phone:Alternate Phone:Email:CONFIRMATION OF REDACTED COPY YES, a redacted copy of submission documents is enclosed. NO, a redacted copy of submission documents is not enclosed. I understand a full copy of non-redacted submissiondocuments will be released if requested.Note: If a redacted copy of the submission documents is not provided with Prospective Contractor’s response packet,and neither box is checked, a copy of the non-redacted documents, with the exception of financial data (other thanpricing), will be released in response to any request made under the Arkansas Freedom of Information Act (FOIA).See Bid Solicitation for additional information.ILLEGAL IMMIGRANT CONFIRMATIONBy signing and submitting a response to this Bid Solicitation, a Prospective Contractor agrees and certifies that they donot employ or contract with illegal immigrants. If selected, the Prospective Contractor certifies that they will not employor contract with illegal immigrants during the aggregate term of a contract.ISRAEL BOYCOTT RESTRICTION CONFIRMATIONBy checking the box below, a Prospective Contractor agrees and certifies that they do not boycott Israel, and if selected,will not boycott Israel during the aggregate term of the contract. Prospective Contractor does not and will not boycott Israel.An official authorized to bind the Prospective Contractor to a resultant contract shall sign below.The signature below signifies agreement that any exception that conflicts with a Requirement of this Bid Solicitation willcause the Prospective Contractor’s proposal to be disqualified.Authorized Signature:Printed/Typed Name:Use Ink Only.Title:Date:

Technical Proposal PacketBid No. 710-21-0046SECTION 1 - VENDOR AGREEMENT AND COMPLIANCE Any requested exceptions to items in this section which are NON-mandatory must be declared below or as an attachment to thispage. Vendor must clearly explain the requested exception, and should label the request to reference the specific solicitation itemnumber to which the exception applies. Exceptions to Requirements shall cause the vendor’s proposal to be disqualified.By signature below, vendor agrees to and shall fully comply with all Requirements as shown in this section of the bidsolicitation.Authorized Signature:Printed/Typed Name:Use Ink Only.Date:

Technical Proposal PacketBid No. 710-21-0046SECTION 2 - VENDOR AGREEMENT AND COMPLIANCE Any requested exceptions to items in this section which are NON-mandatory must be declared below or as an attachment to thispage. Vendor must clearly explain the requested exception, and should label the request to reference the specific solicitation itemnumber to which the exception applies. Exceptions to Requirements shall cause the vendor’s proposal to be disqualified.By signature below, vendor agrees to and shall fully comply with all Requirements as shown in this section of the bidsolicitation.Authorized Signature:Printed/Typed Name:Use Ink Only.Date:

Technical Proposal PacketBid No. 710-21-0046SECTIONS 3, 4, 5 - VENDOR AGREEMENT AND COMPLIANCE Exceptions to Requirements shall cause the vendor’s proposal to be disqualified.By signature below, vendor agrees to and shall fully comply with all Requirements as shown in this section(s) of the bidsolicitation.Authorized Signature:Printed/Typed Name:Use Ink Only.Date:

Technical Proposal PacketBid No. 710-21-0046PROPOSED SUBCONTRACTORS FORM Do not include additional information relating to subcontractors on this form or as an attachment to this form.PROSPECTIVE CONTRACTOR PROPOSES TO USE THE FOLLOWINGSUBCONTRACTOR(S) TO PROVIDE SERVICES.Type or Print the following informationSubcontractor’s Company NameStreet AddressCity, State, ZIP PROSPECTIVE CONTRACTOR DOES NOT PROPOSE TO USE SUBCONTRACTORS TOPERFORM SERVICES.

Technical Proposal PacketBid No. 710-21-0046INFORMATION FOR EVALUATION Provide a response to each item/question in this section. Prospective Contractor may expand the space under eachitem/question to provide a complete response. Do not include additional information if not pertinent to the itemized request.TECHNICAL SOLUTIONS AND SCOPE OF WORKE.1 Background and QualificationsProvide a narrative of Contractor’s experience reflecting the requirement(s) at RFP Section2.3.B, as well as Letter of Recommendations from contract managers who can verify experience atbid submission. Letter of Recommendation for contract managers must include the following:current phone number, mailing address, email address, title, and printed name.E.2 Examination Development and ValidationProvide Contractor’s proposed approach to providing the services specified in RFP Section 2.4.A.E.3 Examination AdministrationProvide Contractor’s proposed application process and procedures for screening test candidateeligibility, test scheduling, and processing test fees based on established criteria and timeframesas required at 2.4.B.1.Provide Contractor’s approach to ensuring a sufficient number of registered nurses at each trainingsite as required at RFP Section 2.4.B.2-3.Test Accommodations Provide Contractor’s approach to providing the testing accommodationrequired in RFP Section 2.4.B.4-6.Test Integrity Provide Contractor’s approach to ensuring testing integrity as required at RFPSection 2.4.B.7-8.Contingency Provide Contractor’s proposed contingency plan meeting the requirements at RFPSection 2.4.B.9.B.10. 11. 12. 13 Test Sites Provide Contractor’s proposed approach to meeting the testing siterequirements specified at RFP Section 2.4.10-13.B.14 Scheduling Provide Contractor’s approach to meeting the scheduling requirements specifiedat RFP Section 2.4.B.14.B.15 16. 17. Test Scoring Provide Contractor’s approach to meeting the test scoring requirementsat RFP Section 2.4.B.15-17.E.4 Renewal ProcessProvide Contractor’s proposed approach to providing the renewal processes and procedures asrequired at RFP Section 2.4.C.E.5 Reciprocity ProcessProvide Contractor’s proposed approach to providing the interstate transfer and reciprocityprocesses and procedures as required at RFP Section 2.4.D.E.6 Military LicensureProvide Contractor’s approach to providing automatic licensure for active duty service members asrequired at RFP Section 2.4.E.E.7 Customer ServiceProvide Contractor’s approach to meeting the customer service requirements at RFP Section 2.4.J.E.8 ReportsProvide Contractor’s approach to meeting the reporting requirements specified at RFP Section2.4.G.E.9 Web-based PortalProvide Contractor’s approach to providing the web-based portal as required at RFP Section 2.4.H.E.10 Electronic Clearinghouse RegistryProvide Contractor’s approach to providing the electronic clearinghouse registry as required atRFP Section 2.4.I.Information for Evaluation SectionMaximumAvailableRAW Score5 points5 points5 points5 points5 points5 points5 points5 points5 points5 points5 points5 points5 points5 points5 points5 points5 pointsPage 1 of 3

Technical Proposal PacketBid No. 710-21-0046E.11 TrainingProvide Contractor’s approach to providing training as required at RFP Section 2.4.K.E.12 Work Plan RequirementsProvide Contractor’s proposed work plan meeting the requirements at RFP Section 2.4.M.E.13 Data RequirementsProvide Contractor’s approach to meeting the data requirements specified in RFP Section 2.5.E.14 Future ProgramsPlease provide contractor’s approach to providing nursing home administrator examinations in thef uture as required in RFP Section 2.7.Information for Evaluation Section5 points5 points5 points5 pointsPage 2 of 3

Technical Proposal PacketBid No. 710-21-0046OFFICIAL BID PRICE SHEETTotal cost: All bid pricing must be in United States dollars and cents.Please provide a detailed budget as a separate attachmentBy signature of this form and submission of a cost in response to this request, the respondent acknowledges that this submissionis all-inclusive, true, and accurate. Also, by signature below, vendor agrees to and shall fully comply with all terms andcompliances agreed to in responses submitted for the original solicitation 710-17-1000.Vendor Name:Date:Signature:Title:Printed Name:Information for Evaluation SectionPage 3 of 3

Technical Proposal Packet Bid No. 710-21-0046 Information for Evaluation Section Page 2 of 3 E.11 Training Provide Contractor’s approach to providing training as required at RFP Section 2.4.K .

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