Okaloosa County BOCC — August 19, 2014 — RFP #44-14 - Dental Insurance - MetLife Proposal - Exhibit A — reading text

until the following calendar year. As such, the supplemental compensation percentage may vary from year to year, but will not exceed 8% under the current supplemental compensation plan. The cost of supplemental compensation is not directly charged to the price of our Products except as an allocation of overhead expense, which is applied to all eligible group insurance products, whether or not supplemental compensation is paid in relation to a particular sale or renewal. As a result, your rates will not differ by whether or not your Intermediary receives supplemental compensation. If your Intermediary collects the premium from you in relation to your Products, your Intermediary may earn a return on such amounts. Additionally, MetLife may have a variety of other relationships with your Intermediary or its affiliates that involve the payment of compensation and benefits that may or may not be related to your relationship with MetLife (e.g., consulting or reinsurance arrangements). More information about the eligibility criteria, limitations, payment calculations and other terms and conditions under MetLife’s base compensation and supplemental compensation plans can be found on MetLife’s Web site at www. metlife.com/brokercompensation. Questions regarding Intermediary compensation can be directed to ask4met@metlifeservice.com, or if you would like to speak to someone about Intermediary compensation, please call (800) ASK 4MET. In addition to the compensation paid to an Intermediary, MetLife may also pay compensation to your MetLife sales representative. Compensation paid to your MetLife sales representative is for participating in the sale, servicing, and/or renewal of Products, and the compensation paid may vary based on a number of factors including the type of Product(s) and volume of business sold. If you are the person or entity to be charged under an insurance policy or annuity contract, you may request additional information about the compensation your MetLife sales representative expects to receive as a result of the sale or concerning compensation for any alternative quotes presented, by contacting your MetLife sales representative or Calling (866) 796-1800. 0813337599 [exp0914][All States] L0613330608[exp1214][All Territories] MetLife Cost & Benefits Summary 5/28/2014 1:26 PM Page 20 of 20 P1909291.646688. 1. “NO CONTACT CLAUSE” The Okaloosa County Board of County Commissioners have established a solicitation silence policy (No Contact Clause) that prohibits oral and written communication regarding ail formal solicitations for goods and services (formal bids, Request for Proposals, Requests for Qualifications) issued by the Board through the County Purchasing Department The period commences when the procurement document is advertised and terminates when the Board of County Commissioners approves an award. When the solicitation silence period is in effect, no oral or written communication is allowed regarding the solicitation between prospective bidders/proposers and members of the Board of County Commissioners, the County Administrator or members of the Board Approved Review Committee. All questions or requests for information regarding the solicitation must be directed to the designated Purchasing Representative listed in the solicitation Any information thought to affect the committee or staff recommendation submitted after bids are due, should be directed to the Purchasing Director or his appointed representative. It shall be the Purchasing Director's decision whether to consider this information in the decision process. Any attempt by a vendor/proposer to influence a member or members of the aforementioned shall be grounds to disqualify the proposer from consideration during the selection process. including it wi t i av, i \ wa are Qe f / / lL J 1 \ / \V \ [ / A Vo representing Metropolitan Life Insurance Company “Signatip | a a) Company Name Hereby agree to abide by the County's “No Contact Clause” and understand violation of this policy shall result in disqualification of my proposal/submittal All proposers Watts: to comply with this policy by signing the following statement and h COMPANY DATA Physical Address & Phone #: Proposer’s Company Name: Physical Address: Contact Person (Typed-Printed): Phone #: Cell #: Federal ID or SS #: Proposer’s License #: Fax #: Emergency #'s After Hours, Weekends & Holidays: 4010 W Boy Scout Blvd. Suite 950 Tampa, FL 33607 Metropolitan Life Insurance Company same Larry Guarcello, Account Executive 813-673-3513 813-841-1361 13-5581829 (866) 277-3913 (813) 841-1361 LIST OF REFERENCES Refer to Bid Specification MetLife carefully protects our customers’ confidentiality and has agreed to limit sharing their policy as agreed to with our customers is to provide references only in instances where MetLife is selected as a finalist for the business being bid. If we are notified that we are selected as a finalist we will furnish the appropriate references. NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT NAME OF CUSTOMER ADDRESS PHONE NUMBER PERSON TO CONTACT ADDENDUM ACKNOWLEDGEMENT The bidder acknowledges that he/she has received the following addendum: ADDENDUM NO. DATED_ 4/25/14 ADDENDUM NO. DATED_ 4/29/14 ADDENDUM NO. DATED_ 5/14/44 ADDENDUM NO. DATED. ADDENDUM NO. DATED Bidder Firm Name: Address: Title: Phone #: FAX No.: Metropolitan Life Insurance Company 4010 W Boy Scout Blvd., Suite 950 Tampa, FL 33607 Account Executive 813-673-3513 (866) 277-3913 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest. all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected Officials(s). or if any of its agencies is also an owner corporate officer, agency employee. etc. of their business Indicate either “yes” (a county employee. elected official. or agency is also associated with your business). or “no” If yes, give person(s) name(s) and position(s) with your business. YES NO_X NAME(S) POSITION(S) FIRM NAME Metropolitan Life Insurance Company BY (PRINTED) Cynthia Coversgn f a { VA VY VY wen BY (SIGNATURE): \ XA LOS J STF AN TITLE: Vice President” \. | ~ ADDRESS 4010 W Boy Scout Blvd... Suite 950 Tampa. FL 33607 PHONE NO 813-673-3513 E-MAIL Iguarcello@metlife.com DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED BIDDER CERTIFIES that if has implemented a drug-free workplace program. In order lo have a drug-free workplace program, a business shall: Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession. or use of a controlled substance is prohibited in the warkplace and specifying the actions that will be taken against employees for violations of such prohibition. Inform employees about the dangers of drug abuse in the workplace. the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. Give each employee engaged in providing the commodities or contractual services that are under quote a copy of the statement specified in subsection 1. In the statement specified in subsection 1, notify the employees that, as a condition of working on the commodities or contractual services that are under quote, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contender to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign this statement, | certify that this firm complies fully with the above requirements. ; . DATE: Slig Jit SIGNATURE: | : L) company: Methlife NAME: Cynthia’ Coverson . Vv ADDRESS: 4010 Boy Scout Blvd iipediorrnues) Tite: Vice President Suite 950 E-MAIL? Iguarcello@metlife.com Tampa, FL 33607 PHONENO,: 813-673-3513 LIST OF REPRESENTATIVES CONTRACT ADMINISTRATOR: Gary R. Real, Okaloosa County Risk Management Okaloosa County Risk Management Dept. 601-A North Pearl St. Crestview FL 32536 850-689-5977 / 850-689-5973 (F) CONTRACTOR’S REPRESENTATIVE: Larry Guarcello Account Executive MetLife-Group Benefit Sales Direct-813-673-3513 Fax (866) 277-3913 INDEMNIFICATION AND HOLD HARMLESS To the fullest extent permitted by law, CONTRACTOR shall indemnify and hold harmless COUNTY, its officers and employees from liabilities, damages, losses. and costs including but not limited to reasonable attorney fees, to the extent caused by the negligence, recklessness, or intentional wrongful conduct of the CONTRACTOR and other persons employed or utilized by the CONTRACTOR in the performance of this Agreement. omer concer miract and we will : \ Metropolitan Life Insurance Company L ) / \ Bidders Company Name Authored Bihathie f Manual 4010 W Boy Scout BLVD, Suite 950 Cynthia Coverson Physical Address Authorized Signature — Typed Same Vice President Mailing Address Title 813-673-3513 (866) 277-3913 Phone Number FAX Number 813-841-1361 813-841-1631 Cellular Number After-Hours Number(s) giigtrt DATE ANTI-COLLUSION STATEMENT The below signed bidder has not divulged to. discussed or compared his bid with other bidders and has not colluded with any other bidder or parties to bid whatever. (Note: No premiums. rebates. or gratuities permitted either with. prior to, or after any delivery of materials. Any such violation will result in the cancellation and/or return of material (as applicable) and the removal from bid list(s) i | ane YF Metropolitan Life Insurance Company , <i : \ R ALN, \ ¥ \ K Bidders Company Name Authorized Signature — Manual 4010 W Boy Scout Blvd, Suite 950 Cynthia Coverson Authorized Signature - Typed Tampa, FL_33607 Vice President Address Title 813-673-3513 866-277-3913 Phone # Fax # 13-5581829 Iguarcello@metlife.com Federal ID# or SS# E-mail address OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSAL TERM LIFE, AD & D, LTD AND PDP DENTAL Metropolitan Life Insurance Company (“MetLife”) lists below the deviations it is submitting with respect to its response to the Request for Proposal by Okaloosa County Board of County Commissioners (“Customer”) IL. GENERAL COMMENT If desirable, upon award of the business, the appropriate company in the MetLife family of companies will enter into a contract that addresses your specific requirements. Please also note that as appropriate, insurance policies or other contracts, as required by state law, (referred to throughout our response as the “Group Contract”) will be issued by one or more MetLife companies. The Group Contract governs the terms and conditions of the coverage being provided. In the event of any conflict between the Group Contract and any other documents, the Group Contract will govern. In light of the foregoing, please note the following provisions will be governed by the Group Contract: RFP Document Section 8 ‘Hierarchy of Contract Documents’ (page 8) Il. INDEMNIFICATION With respect to Section 3 ‘Indemnification & Hold Harmless’ (page 7) and ‘Indemnification and Hold Harmless’ certification (page 22) of the RFP document, please note that we are happy to discuss this issue further to address any customer concerns. We can assure you that we will provide coverage in accordance with the terms of the Group Contract and we will defend, at our expense, lawsuits seeking coverage under the Group Contract. Il. DRUG-FREE WORKPLACE