REQUEST FOR PROPOSALS #161(PH) FOR THIRD-PARTY MEDICAID (SHARS/MAC) BILLING SERVICES PROVIDER

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1 The Manor Independent School District ( Manor ISD MISD or the District ) is soliciting for Request For Proposals from qualified offerors for the products/services to provide Third-Party Medicaid (SHARS/MAC) Billing Services for the Manor ISD Special Education Department. Request for Proposals must be addressed to the Administration at the address listed below and marked as follows: RFP #161(PH) FOR THIRD-PARTY MEDICAID (SHARS/MAC) BILLING due no later than Wednesday, May 31, 2017, not later than 2:00 PM CST Manor ISD Attn: Carla Stevens, Director of Purchasing US Hwy 290E Manor, Texas ANY PROPOSAL RECEIVED AFTER THE TIME AND DATE STATED ABOVE WILL NOT BE CONSIDERED. UNSIGNED PROPOSALS AND/OR PROPOSALS RECEIVED VIA FACSIMILE OR WILL NOT BE CONSIDERED. ALL RESPONSES MUST BE RECEIVED AT THE ADDRESS SHOWN ABOVE. RESPONSES SENT/ DELIVERED TO ANY OTHER DISTRICT ADDRESS WILL NOT BE CONSIDERED. FAILURE TO COMPLY WITH SPECIFICATIONS MAY RESULT IN THE DISQUALIFICATION OF YOUR PROPOSAL. Offerors must provide all requested information; failure to comply with any portion of this solicitation will be reflected in the evaluation process. The MISD reserves the right to accept or reject any Submission or any part thereof or any combination of Submissions and to waive any or all formalities. All responses in the Submission may be used by the MISD in the selection process. The MISD reserves the right to verify the accuracy and completeness of all responses by utilizing any information available to the MISD without regard to whether such information appears in the Submission. 1

2 I. OVERVIEW The School Health and Related Services (SHARS) program allows Texas school districts to request Medicaid reimbursement for certain health-related services. Services must be medically necessary and reasonable to ensure that children with disabilities are able to participate in educational programs. The Manor Independent School District is seeking proposals from qualified Offerors to provide third party Medicaid billing services beginning with the school year effective July 1, The District s estimated annual Medicaid Claims total is approximately $300,000 - $500,000. Summary of Key Dates: (Subject to Change) May 15, 2017: RFP Issued May 19, 2017: Pre-Proposal Conference, if necessary May 22, 2017: Written questions must be submitted by vendors by 12:00 p.m. May 23, 2017: Responses to Written Questions posted to not later than 5 p.m. May 31, 2017: Proposals Due by 2:00 p.m. at Manor ISD - Purchasing. June 1-7, 2017: Evaluation Period June 19, 2017: Board of Trustees meeting to review and approve. Pursuant to the provisions of Texas Education Code Chapter 44, Subchapter B, as amended, it is the intention of the Manor Independent School District ( MISD or the District ) to select via the Request for Proposal process, an individual consultant or firm to provide Medicaid SHARS/MAC billing services to the Special Education Department. Responses to this Request for Proposals ( RFP ) are referred to herein as proposals or submissions. Entities submitting proposals are referred to as Offerors or Proposers. The RFP, Plans and Specifications (collectively referred to herein as the RFP ) and addenda may be obtained at: >Inside MISD>Departments>Purchasing >Current RFPs-Purchasing. PROPOSALS MUST BE RECEIVED NO LATER THAN 2:00 P.M. (CST) ON WEDNESDAY, MAY 31, 2017 Any Proposal received after such time will not be considered and will be returned unopened. Proposals will be received by: Mrs. Carla Stevens Manor ISD, Director of Purchasing US Hwy 290E Manor, Texas One (1) original and (4) copies of the proposal must be submitted. Proposal envelopes must be plainly marked on the outside as follows: 2

3 RFP #161(PH) FOR THIRD PARTY MEDICAID (SHARS/MAC) BILLING SERVICES PRODIVER PROPOSALS MUST BE SUBMITTED ON THE PROPOSAL FORM ATTACHED AS EXHIBIT A. THIS REQUEST FOR RFP CONTAINS REQUIRED TERMS AND DESCRIPTIVE INFORMATION ABOUT THE SERVICES. RESPONSES NOT MADE AS SET FORTH IN THE REQUEST FOR RFP MAY BE DEEMED NON- RESPONSIVE AND MAY NOT BE CONSIDERED. 3

4 For questions regarding this Request for RFP, please contact Ms. Carla Stevens, Director of Purchasing, by at All questions and answers will be posted on the District website at: > Inside MISD >Departments >Purchasing >Current RFPs-Purchasing not later than 5:00 P.M. on Tuesday, May 23, All questions shall be submitted by 4:00 P.M., Monday, May 22, Proposals are to include the information requested in Section V of this Request for RFP in the sequence and format prescribed. In addition to and separate from the requested information, Offerors submitting proposals may provide supplementary materials further describing their capabilities and experience. Following the deadline for receipt, the MISD s staff will open the Proposals. Within forty-five (45) days after the opening of the Proposals, the MISD shall evaluate each Proposal submitted in relation to the selected criteria set forth below. The MISD shall either select a consultant from the respondents to this Request for Proposals or reject all proposals. The recommended ranking shall be based on the data furnished by the Offerors in response to the Request for RFP. The following is a list of criteria and weight for each criterion. This criteria and weight of criteria shall be utilized by the MISD pursuant to Texas Education Code Chapter 44, Subchapter B: Purchase Price: Percentage of Medicaid Payments received from the TMHP. 15% Reputation of the vendor and the vendor's goods or services 15% Reputation of the vendor and the vendor's goods or services 20% The extent to which the goods or services meet the district's 20% Vendor's past relationship with the District or Other Districts of like Size 0% Long-term cost to the District to acquire the vendor's goods and services. - Do Percentages Change each year? 10% Whether the vendor or the vendor's ultimate parent company or majority owner has its place of business in this State; or employs at least 500 persons in this State 5% Any other relevant factor specifically listed in the Request for Proposal 5% Extent to Which the Vendor Offers Training and Support 10% All responses in the Proposal may be used to help the MISD select a provider based on these criteria. The MISD reserves the right to verify the accuracy and completeness of all responses by utilizing any information available to the MISD without regard to whether such information appears in the proposal. 4

5 II. COMMITMENTS OF THE MISD 1. The MISD reserves the right to withdraw this Request for RFP at any time and for any reason. 2. Receipt of response by the MISD or submission of a response to the MISD or selection of an Offeror for the purposes of negotiating a contract; confers no rights to the Offeror, nor obligates the MISD in any manner. 3. The MISD reserves the right to award or not award a contract. The MISD also will award the Contract to the party or parties that the Board of Trustees of the MISD determines to be most qualified and most responsive to this Request for RFP. 4. The MISD is under no obligation regarding this Request for RFP until a written contract is approved and executed by all parties and funding of the Project occurs. 5. The cost of developing a response is the sole responsibility of the Offeror. The MISD shall not provide reimbursement of such cost, and shall not be liable for any response preparation cost for any reason whatsoever. III. INSTRUCTIONS TO OFFERORS A. PROPOSAL FORM: The Proposal Form attached as Exhibit A must be filled out and signed by the Offeror. Proposed price should be firm (fixed). a. MISD is exempt from federal excise taxes, state and local sales and use taxes. b. Failure to manually sign the offer will disqualify it. B. TIME: Offeror agrees to hold the proposal open for acceptance for forty-five (45) calendar days from the proposal due date. C. WITHDRAWAL OF PROPOSALS: Offerors may request permission to withdraw a proposal prior to the actual time for proposal opening. Such request must be made in person or in writing at the same location designated to receive the proposal. The MISD will return the proposal documents unopened at that time. D. WAIVER: By submitting a proposal, each Offeror agrees to waive any claim it has or may have against the MISD, its trustees, agents and employees, and any reference sources, arising out of or in connection with the administration, evaluation, or recommendation of any proposal; waiver of any requirements under the proposal documents; acceptance or rejection of any proposal; and award of the proposal. The MISD shall have no contractual obligation to any Offeror, nor will any Offeror have any property interest or other right in the proposal or contract being proposed unless and until the contract is unconditionally executed and delivered by all parties, and all conditions to be fulfilled by the Offeror have been fulfilled by the Offeror. E. OTHER INFORMATION: The MISD believes the information included in this Request for RFP is materially accurate, however, the MISD does not warrant this information to be free from errors or omissions. Offerors are encouraged to inspect the premises prior to submitting a response. 5

6 F. THE OFFEROR MUST SUBMIT THE FOLLOWING ITEMS: 1. PROPOSAL FORM: Exhibit A, signed by Offeror. 2. RESPONSES TO INFORMATION REQUESTED: Section V, signed by Offeror. 3. CONFLICTS OF INTEREST: Offeror acknowledges that it is informed that District Policy and Chapter 176 of the Texas Local Government Code requires that persons, or their agents, who seek to contract for the sale or purchase of property, goods, or services with the District, shall file a completed conflict of interest questionnaire with the appropriate district records administrator not later than the 7 th business day after the date that the person: (1) begins contract discussions or negotiations with the District; or (2) submits to the District an application, response to a request for qualifications, submissions or proposals, correspondence, or another writing related to a potential agreement with the District. The conflict of interest questionnaire form is available from the Texas Ethics Commission at Completed conflict of interest questionnaires must be included with responses to this RFP. Please consult your own legal counsel if you have questions regarding the statute or form. 4. FELONY CONVICTION NOTIFICATION: See Exhibit B Attachment NON-COLLUSION STATEMENT: See Exhibit C Attachment DISCLOSURE OF INTERESTED PARTIES. See Exhibit D Attachment CENTRAL TEXAS PURCHASING ALLIANCE (CTPA) ADOPTION CLAUSE. See Exhibit E - Attachment 4. IV. SCOPE OF WORK A. Services Item Requirement Meets Requirement (Yes or No) Comments Must have proven experience and expertise in developing and implementing a direct service SHARS program with a working knowledge of Medicaid rate structures, timelines, regulations, etc., in a school district of a comparable size to the Manor ISD (MANOR Must be fully ISD) versed within in the legal state requirements of Texas. of Health Care Financing Administration, Texas Education Agency, Texas Health and Human Services Commission, Centers for Medicare and Medicaid services and/or any other state or federal agencies governing SHARS 6

7 Item Requirement Must be able to comply at all times with all requirements (and any revisions of such) set forth by the HHSC, CMS and any other state, local or federal agency governing the SHARS program and services (including documentation requirements). Must have the capacity to fully implement all aspects of the SHARS reimbursement services within the time frame established by MANOR ISD. Meets Requirement (Yes or No) Comments 5. Must have the capacity to accept /process both electronic and paper service tickets for filing claims. 6. Must do all data entry for SHARS claims. Describe your claims process Because of the nature of this work requirements for a quality management system are essential. The Offerors system should; demonstrate its ability to consistently provide product that meets customer and applicable statutory and regulatory requirements, and Aim to enhance customer satisfaction through the effective application of the system, including processes for continual improvement of the system and the assurance of conformity to customer and applicable statutory and regulatory requirements. Therefore the Offeror should have an internal quality system such as that validated by ISO 9001 certification (or is in the process of certification by similar industry standards) Must have the internal capacity to assess and ensure that all SHARS claims are at least 99% correct within +/- 3% error with a confidence level of 95%. Briefly describe how you do this. Must have an internal systemic capacity of validating all SHARS requirements for billing to include but not limited to: a) Parental consent to bill b) Existence of a current Individualized Educational Plan c) (IEP) that authorizes the frequency and duration of school health and related services d) Verification of licensure and certifications for all service providers e) Verification of prescription for services provided to students f) Medicaid eligibility at different times of the year g) Proper documentation on SHARS 10. Must provide relevant training to District personnel as needed to ensure legal compliance and efficient claim processing. 11. Provide a description of training methods provided, target audience, and costs if any. Must provide, and agree to furnish all MANOR ISD billing and related data at the end of each contract year, or at any time within 10 business days 12. of receipt of a written request. Such data should be given to MANOR ISD in a standard Comma-Separated-Values (CSV) format, or any other information systems standard acceptable to the District. 7

8 Item Requirement Meets Requirement (Yes or No) Comments 13. Must submit claims on a timely basis to be determined by MANOR ISD, notify MANOR ISD when claims have been submitted, and resubmit rejected claims repeatedly to obtain alignment with floating Medicaid eligibility periods Must be able to meet with MANOR ISD program director/coordinator or other representative, as appointed, in person in Manor, TX at least once a month, or other determined frequency based on need, for the duration of the entire contract period and via teleconference at least once a week to review implementation plan and coordinate Provide a Gantt project. type chart showing proposed activities (tasks or events) necessary for District implementation displayed against time When each activity begins and ends How long each activity is scheduled to last Where activities overlap with other activities, and by how much The start and end date of the whole project Must furnish all communication letters from/to any state or federal 16. inspection or law-enforcement agency for the last two (2) years with formal bid. 17. Disclose all civil litigation in any state or federal courts involving the proposer, active or closed within the last 2 years: 18. Must give MANOR ISD program director/coordinator access to all reports used to submit 19. claims. Describe how your system keeps data secure and your disaster recovery plan in case of fire, flood or system failure. 20. Must represent MANOR ISD before state and federal officials relating to SHARS matters, upon request. 8

9 Must be able to provide billing data reports in a standard "commaseparated-values" (CSV) format, or any other information systems standard acceptable to the District to be able to reconcile for each billed session to include but not limited to the following fields: 21. a. Student ID b. Student SSN c. Student Medicaid Number d. Medicaid Eligibility as of Date of Service e. Beginning Date of Service f. Ending Date of Service g. Date Claim Submitted h. Date Claim was Paid i. RNS Report Reference j. Service Provider ID k. Service Provider Name I. Transaction ID m. Claim Amount n. Reimbursed Amount o. Type of Service p. Amount q. Billing Code r. Modifier 1 s. Modifier2 9

10 Item QUALIFICATIONS: Only contractors who can clearly demonstrate the necessary experience, skills and capacity to meet the scope of work as defined by this RFP will be considered. The Offeror s account management team has a minimum of five(5) years of experience in K-12 education and SHARS services prior to the RFP due 1. date with experience in building and maintaining successful relationships servicing independent school districts in Texas comparable to the size of the MANOR ISD. (Please attach list of school districts served by Offeror with dates of services). 2. The Offeror has corporate personnel dedicated solely to SHARS claim processing, management and support for MANOR ISD. 3. The Offeror has been in business for more than five (5) years in succession. The Offeror has been the service provider for at least three (3) independent 4. school districts with successful reviews by HHSC during the last 2 years, (please attach ISD audit findings). 5. Offeror must provide assistance during audit of Districts SHARS program. Describe your assistance and fees if applicable. 6. The Offeror must offer needs analysis for proper implementation or continuation of all aspects of the SHARS program. 7. The Offeror will establish and dedicate a local Account Manager as the point of contact for MANOR ISD throughout the term of the contract. 8. The Offeror will be capable of maintaining consistent service levels throughout the term of the contract. 9. The Offeror will train MANOR ISD program director/coordinator to seek reimbursement from TMHP The Offeror will be capable of providing clear documentation designed for 10. the appropriate audience - end user, manager, administrator, etc., with complete for each target in an organized and easy to reference format. The Offeror has a standard quality control system (e.g. ISO 9001, Six 11. Sigma or other industry accepted certification). Name your quality control system and how long it has been in place at your organization. 12. The Offeror must provide a price, if any, for the use of an electronic documentation system to be used for claim submissions. Web based documentation systems shall support the latest versions of the following browsers for desktop and mobile devices: 13. Firefox: 30 + Chrome: 30 plus Internet Explorer: Newest plus two back versions Safari: Newest 14. Provide a list of software systems your solution has successfully integrated with. 15. The Offeror must provide separate pricing for the preparation and submission of a SHARS Cost Report, if any. 16. The Offeror must provide hard copies sample of documentation forms to be used to seek reimbursement. Offer must provide support on a day to day basis Monday-Friday during normal business hours: 17. Describe your support system for District staff and service providers when difficulties arise. Provide your response time in hours to help calls. 10 Meets Requirement (Yes or No) Comments

11 B. Duration of Services 1. The contract for the Third-Party Billing Services with the selected vendor would be effective from July 1, 2017 (pending Board Approval) to June 30, 2018, with 3 optional 1- year renewal periods. C. Methodology 1. The successful candidate or firm will provide, as a result of this process, a timeline to transition to record-keeping system in addition to training all personnel requiring understanding of related software/program to manage day-to-day activities at the Central, campus, and department levels.. D. Timeline and Budget 1. Proposals shall provide a schedule of costs, to include an itemized listing of budget items, which will total the complete cost of services required under this Request for Proposal. (This space left blank intentionally) 11

12 E. Evaluation and Award Process 1. Proposals received as a result of this solicitation will be evaluated and scored according to the following scoring matrix: Evaluation Criteria Max Points Vendor Score Purchase Price: Percentage of Medicaid Payments received from the TMHP. Reputation of the vendor and the vendor's goods or services -15 Points total as distributed in 2 a. and 2 b. below; 15 a. Experience with Other School Districts of Like Size 5 b. Experience: Proven Success Rate with Other School Districts Quality of vendor's goods and services -20 Points total as distributed in 3a. and 3b. below; a..ease of Use for the End-Users 10 b. Proven Increased Revenue with use of Proposed Services The extent to which the goods or services meet the district's needs -20 Points total as distributed in 4a. 4b. below; a. Provided Information on How System Increased SHARS for the District 10 b. Provided Information on Proposed Electronic Documentation Increasing 10 Efficiency of Service Submissions to TMHP. 5. Vendor's past relationship with the District or Other Districts of Like Size Long-term cost to the District to acquire the vendor's goods and services. - Do Percentages Change each year? 7. Whether the vendor or the vendor's ultimate parent company or majority owner has its place of business in this State; or employs at least 500 persons in this State Any other relevant factor specifically listed in the Request for Proposal Extent to Which the Vendor Offers Training and Support 10 Maximum Total Points 100 Company Name: 12

13 Evaluator: *Note: The Evaluation Criteria Scoring can be adjusted to fit each Request for Bid, Request for Proposal, Request for Qualification, or any procurement process determined by the Purchasing Department. a. Criteria: Each proposal submitted in response to this RFP shall focus on the above criteria. The District reserves the right to make additional inquiries and may request the submission of additional information for further clarification when/if necessary to make a final selection. b. Process: After the initial evaluation of submittals, the District may conduct a formal interview with selected firm(s) or the District may award based solely on the proposals received. If necessary, the selected firm(s) will be contacted to schedule such an interview. c. Contract Fee: Your proposed price shall include necessary labor, supervision, travel, equipment, materials, supplies, employer payments, overhead and profit, and applicable fees. V. INFORMATION TO BE PROVIDED BY OFFERORS Please provide the following information concerning your firm. Section 1: General Information 1-1. Please provide a cover letter that includes the name, business address, telephone number, fax number, type of organization (individual, partnership, corporation, and/or association), number of employees in the home and any field offices, a brief statement of interest and information regarding your organizational structure, availability, and intent to perform services. The letter shall also include general qualifications for selection and signature of an authorized officer of the Offeror who has legal authority in such matters Describe any substantial changes in ownership of your firm during the past five (5) years. How many years has your firm operated in its current form of business operation? Section 2: Applicant Management Services 2-1. Provide a statement on the availability and commitment for all team members and how the management services will assist the District with executing strategic plans. 13

14 Section 3: Applicant Experience 3-1. Provide a comprehensive list of all services for which the applicant firm has provided comparable services for Texas Public School District in the past three (3) years. Include total cost and Client/Owner contact information What do you bring to the project team that is unique? Please answer in essay form Describe all instances in which your firm was unable to complete the work under a contract. 14

15 VI. EXECUTION The foregoing is true and correct. The MISD, or any authorized representative of the MISD, is authorized by the undersigned to contact any firm, institution, or person listed above to obtain information about our firm's services and any other information which the MISD might determine as being desirable. Offeror: By: (Signature) (Printed Name) (Title) 15

16 #161(PH) FOR EXHIBIT A PROPOSAL FORM IDENTIFICATION OF OFFEROR AND ACCEPTANCE OF TERMS IMPORTANT: A proposal, to be valid, must be manually signed in ink by an authorized person in the space provided. By such signature, offeror agrees to strictly abide by the terms, conditions, and specifications set out in the Request for Proposal. 1.1 TO: Manor Independent School District US Hwy 290 E Manor, Texas SUBMITTED BY: Address: Phone No.: Fax: Date Signature: 1.3 PROPOSAL BREAKDOWN Facilitate the Third-Party Medicaid (MAC/SHARS) Billing Services for Manor ISD: Undersigned agrees to complete the Work, for the amount of: (Amount written in words governs) Dollars $ (Amount in Figures) 16

17 #161(PH) FOR SERVICESPROVIDER 1.4 ADDENDA: Undersigned acknowledges receipt of Addenda: (No. & Date) (No. & Date) (No. & Date) 17

18 #161(PH) FOR EXHIBIT B, ATTACHMENT 1 FELONY CONVICTION NOTIFICATION State of Texas Legislative Senate Bill No.1, Section , Notification of Criminal History, Subsection (a) states a person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony. Subsection (b) states a school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for services performed before the termination of the contract. This notice is not required of a Publicly-held Corporation. I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me and the following information furnished is true to the best of my knowledge. Vendor s Name: Authorized Company Official s Name (Printed): a. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable: Signature of Company Official b. My firm is not owned nor operated by anyone who has been convicted of a felony. Signature of Company Official c. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony: Name of Felon(s) Details of Conviction(s) Signature of Company Official 12

19 #161(PH) FOR EXHIBIT C, ATTACHMENT 2 ACKNOWLEDGMENT FORM - NON-COLLUSION STATEMENT The undersigned affirms that they are duly authorized to execute this contract, that this company, corporation, firm, partnership or individual has not prepared this submission in collusion with any other proposer, and that the contents of this submission as to prices, terms or conditions of said submission have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this submission. Vendor: Address: Phone: FAX: Respondent (Signature): Respondent (Print Name): Position with Company: Signature of Company Official Authorizing Submission: Company Official (Print Name): Official Position: 13

20 #161(PH) FOR EXHIBIT D, ATTACHMENT 3 DISCLOSURE OF INTERESTED PARTIES Effective January 1, 2016, Manor Independent School District must comply with the Disclosure of Interested Parties, mandated by Texas HB 1295, as implemented by the Texas Ethics Commission. Briefly stated, all contracts requiring an action or vote by the governing body of the entity or agency before the contract may be signed (regardless of the dollar amount) or has a value of at least $1 million will require the on-line completion of Form 1295 Certificate of Interested Parties, per Texas Government Code Statute Form 1295 is also required for any and all contract amendments, extensions or renewals. All entities are required to complete and file electronically with the Texas Ethics Commission using the online filing application. Step 1. Business Entity completes Form 1295 in electronic format on the Texas Ethics Commission website - Form 1295 Filing Application Step 2. Upon receipt of a completed Interested Parties Disclosure Form, Texas Ethics Commission issues a Certification of Filing to the business Entity and the business Entity download(s), print, sign(s) and notarize(s) Form An authorized agent of the business entity will need to sign the printed copy of the form and have the form notarized. Step 3. At the time of submission of the solicitation to Manor ISD the Business Entity must submit the completed notarized Form 1295 with the Certification of Filing with their contract (i.e. CSP, RFP, RFQ) Upon receipt, Manor ISD may proceed with the award and/or execution of the contract. Step 4. Not later than the 30 th day after the date the contract has been signed by all parties, Manor ISD must notify the Texas Ethics Commission (in electronic format) of the receipt of (1) Form 1295, and (2) the Certification of Filing. Step 5. Not later than the 7 th business day after receipt of the above notice, Texas Ethics Commission makes the disclosure available to the public by posting the disclosure on its website. 14

21 #161(PH) FOR Definitions: a. Contract includes amended, extended, or renewed contract. b. Business entity includes an entity through which business is conducted with a governmental entity or state agency, regardless of whether the entity is a for-profit or nonprofit entity. The term does not include a governmental entity or state agency. c. Controlling interest means: (1) an ownership interest or participating interest in a business entity by virtue of units, percentage, shares, stock, or otherwise that exceeds 10 percent; (2) membership on the board of directors or other governing body of a business entity of which the board or other governing body is composed of not more than 10 members; or (3) service as an officer of a business entity that has four or fewer officers, or service as one of the four officers most highly compensated by a business entity that has more than four d. Interested party means: (1) a person who has a controlling interest in a business entity with whom a governmental entity or state agency contracts; or (2) a person who actively participates in facilitating a contract or negotiating the terms of a contract with a governmental entity or state agency, including a broker, intermediary, adviser, or attorney for the business entity. e. Intermediary, for purposes of this rule, means, a person who actively participates in the facilitation of the contract or negotiating the contract, including a broker, adviser, attorney, or representative of or agent for the business entity who: (1) Receives compensation from the business entity for the person s participation; (2) Communicates directly with the governmental entity or state agency on behalf of the business entity regarding the contract; and (3) Is not an employee of the business entity. To obtain additional information on HB 1295, and to complete the online Form 1295, and to learn more about Texas Ethics Commission process to create a new account or to complete an electronic version of Form 1295 for submission with a signed contract, please go to the following website: Instructional Videos for Business Entities on how to file online can be found at: 15

22 #161(PH) FOR EXHIBIT E, ATTACHMENT 4 CENTRAL TEXAS PURCHASING ALLIANCE (CTPA) Adoption Clause USE OF CONTRACT(S) BY MEMBERS COMPRISING THE CENTRAL TEXAS PURCHASING ALLIANCE A. If authorized by the Vendor(s), resultant contract(s) may be adopted by the member districts of the CTPA as indicated below. Authorized members may purchase goods and/or services in accordance with contract pricing and purchasing terms established by the Contract Lead District. B. A list of members that may utilize the Vendor s contract is listed on the CTPA website, C. Any district member wishing to utilize such contract(s), will contact the Vendor to verify that the contract is available to them and will place its own order(s) directly with the successful Vendor. The Successful Vendor may contact the member districts to inform them about the contract award. There shall be no obligation on the part of any participating district to utilize the contract(s). D. A negative reply by the Vendor will not adversely affect consideration of the Vendor s Solicitation response. E. Each participating district has the option of executing a separate contract with the successful Vendor, which may contain general terms and conditions unique to that contracting district. If, when preparing such contract, the general terms and conditions of a district are unacceptable to the successful Vendor, the successful Vendor may withdraw its extension of their Bid to that district. F. The Contract Lead District shall not be held liable for any costs or damages incurred by another district as a result of any award extended to that district by the Successful Vendor. BY SIGNATURE BELOW, THE VENDOR HEREBY AUTHORIZES THE MEMBER DISTRICTS AS INDICATED BELOW TO ADOPT ANY CONTRACT RESULTING FROM THE VENDOR S RESPONSE TO THIS SOLICITATION: YES NO YES, with the exception of the following districts: Company Name: Printed Name of Authorized Company Official: Signature of Company Official: Date: 16