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HomeMy WebLinkAbout2009 10 07 Regular 600 SHDR Benefit ConsultantsDUE DATE: Wednesday, September 16, 2009 DUE TIME: 3:00 PM RESPONSE TO REQUEST FOR PROPOSAL For Pension Plan Actuarial Services RFP 021 /09 /JD Presented by: SHDR STANLEY, HUNT, DUPREE RHINE, INC. Benefit Consultants A subsidiary of BB&T Response to RFP Pension Plan Actuarial Services for City of Winter Springs, Florida TABLE OF CONTENTS Submittal Cover Sheet Letter of Interest SHDR Profile 9 Summary of Qualifications Forms Vendor Rate /Fee Schedule Disputes Disclosure Form Insurance Requirements Form Florida Statutes on Public Entity Crimes Form Drug -Free Work Place Form Conflict of Interest Statement Certification of Non Segregated Facilities Form Public Records Form SUBMITTAL COVER SHEET Submit proposal to: Purchasing Department CITY OF WINTER SPRINGS 1126 East State Road 434 Winter Springs, Florida 32708 407- 327 -5959 Proposal Due Date Time: September 16, 2009 3:00 p.m. REQUEST FOR PROPOSAL (RFP) #021 /09 /JD PENSION PLAN ACTUARIAL SERVICES I hereby certify that the information contained herein is true. I agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for disqualification of the submittal, immediate cancellation of any contract with the City that might arise from the representations contained herein, and forfeiture of rights for further consideration for work in the City of Winter Springs. VENDOR NAME: Stanley, Hunt, DuPree Rhine, Inc. (A Subsidiary of BB &T) MAILING ADDRESS: P.O. Box 14967 City: Greensboro Name /Title: Lane B. W Authorized Signature/Date: State: NC Senior Vice President Consulting Actual Zip: 27415 Q /)S /o q Email Address: lbwest@shdr.com Phone (336) 291 -1151 Fax (336) 273 -2712 Zi It' IL STANLEY, HUNT, DUPREE RHINE, INC. Ben a Ji r Cons .11 t.�t, A subsidiary ofBB 7823 National Service Road (27409) P.O. Box 14967 Greensboro, NC 27415 Office (336) 273 -9492 Fax (336) 273 -2712 September 15, 2009 ATTN: Purchasing Coordinator City of Winter Springs, Florida 1126 East State Road 434 Winter Springs, FL 32708 Re: City of Winter Springs Defined Benefit Plan and Trust Dear Coordinator: We appreciate the opportunity to provide a proposal for actuarial services for your pension plan. As requested, we have enclosed (4) originals and (1) electronic copy of our response. Our firm, Stanley, Hunt, DuPree Rhine, Inc. (SHDR), a wholly owned subsidiary of BB &T Corporation, employs professionals with the experience and actuarial designations necessary to perform the proposed services under the standards set by the American Academy of Actuaries as well as fully meeting the requirements established by the Commission for this purpose. The attached proposal identifies our proposed deliverables and provides background information on our capabilities. Thank you for the opportunity to serve the City of Winter Springs. We would be happy to answer any questions with regard to our proposal and if chosen, will consider it an honor to work with you. Sincerely, 6A -gam Lane B. West, FSA, MAAA, EA Consulting Actuary Senior Vice President Actuarial Services Practice (336) 291 -1151 Enclosure Ryan Sladek Profile of SHDR 1. State whether your firm is national, regional, or local. SHDR is a regional actuarial and employee benefit consulting firm. Our firm is a wholly -owned subsidiary of BB &T Corporation and is an employee benefits component of BB &T's strategy to offer a full array of financial services to its client partners. BB &T created SHDR in July 2002 as the result of the merger of two regional employee benefit consulting firms: W.E. Stanley Company, Inc. of Greensboro, NC established 1954 and Hunt, Dupree, Rhine Associates, Inc. of Greenville, SC established 1932. W.E. Stanley Company, Inc. WESCO) was founded in 1954 by William E. Stanley, Sr. and is one of the first firms in North Carolina to provide professional counseling in the field of employee benefits. In 1998, WESCO became a subsidiary of BB &T Corporation, a full- service financial services provider, who has been servicing consumers and business customers since 1872. 2. State the location of the office from which your work is to be performed. 7823 National Service Road (27409) P.O. Box 14967 Greensboro, NC 27415 Phone: General (336) 273 -9492 FAX: (336) 273 -2712 3. Describe the firm, including size, range of activities, etc.. Our firm employs six actuaries, an Actuarial Department of 24, and total employment of 140. Actuaries at SHDR are Enrolled Actuaries under the Internal Revenue Code. These actuaries have significant consulting experience and average in excess of 30 years of benefits experience. Designations include Fellows of the Society of Actuaries and the Conference of Consulting Actuaries, Members of the American Academy of Actuaries, and the American Society of Pension Professionals Actuaries. Our senior Actuaries provide plan design consulting services. Our human capital resources are supported by state -of -the -art technology that allows the performance of actuarial valuations, asset and liability projections, and data management functions to be performed through cost effective and standardized processes. The American Academy of Actuaries Pension Committee is made up of representatives of all large and some regional actuarial firms. The Committee reviews all proposed legislation and regulations and provides commentary to policy makers. The Committee is also responsible for developing Actuarial Practice Notes dealing with such topics as the methods and procedures to be used in the selection of actuarial assumptions. Lane West, a Senior Vice President with SHDR and a FSA, is a nine year member of the Committee and serves as a representative of regional consulting firms. Additionally, Derek Scott has completed the educational requirements of the Florida Public Pension Trustee Association and remains in good standing as a Certified Public Pension Trustee (CPPT). We have a commitment to continuing education for our employees. All of our actuaries and credentialed professionals are in good standing with their professional societies and are current with their continuing education requirements. Staff members are required to meet continuing education requirements and a host of in -house training opportunities are available monthly, including on -site training and web seminars. In addition, employees attend seminars sponsored by national actuarial and benefits consulting organizations. We provide seminars for our clients and other professionals. SHDR has been a qualifying sponsor of continuing education programs for enrolled actuaries since 2004, approved by the Joint Board of the Enrollment of Actuaries. We have provided training on funding policies for governmental plans, along with the detailed needs of accounting for pension and other post employment benefits defined by GASB 27 and 45. We have co- hosted seminars in Maryland, West Virginia and Virginia to discuss GASB 45 Plans. We have been guest speakers at the Enrolled Actuaries Meeting, GFOA Meeting, Florida Public Pension Trustees Association Annual Conference, and the Society for Human Resource Management in Florida on Transfer of Retirement Risk. Our firm has strict compliance guidelines. In addition to receiving the highest possible score on internal audit, we have satisfied FDIC and BSA/AML audit reviews. Our current internal controls insure every step of our work flow is completed and signed by the responsible party, checked and signed by a peer or senior team member, and reviewed by another senior team member. An overview of our services includes: Actuarial Assumptions Review Government Forms Preparation ERISA, FAS 87 and FAS 106 Calculations GASB 25, 27, 43 and 45 calculations Experience studies Plan Design consulting Comprehensive personal benefit statements Web based pension estimator Actuarial forecast valuations Actuarial impact statements 4. References Client name: School Board of Alachua County Contact: Thomas Scott Ward Address: Kirby -Smith Administration Center 620 East University Avenue Gainesville, Florida 32601 -5498 Phone: (352) 955 -7583 Services provided: GASB OPEB Client name: Columbus Regional Health System Contact: Jan Woodham Address: 707 Center Street Columbus, GA 31901 Phone: (706) 660 -6309 Services provided: Defined Benefit, Retiree Medical SERP Client name: Wi1Med Healthcare Contact: Debbie Bradshaw Address: 1705 Tarboro Street, SW Wilson, NC 27893 -3428 Phone: (252) 399 -8018 Services provided: Defined Benefit Client name: Town of Golden Beach, FL Contact: Linda Epperson Address: One Golden Beach Drive Golden Beach, FL 33160 Phone: (305) 932 -0744 x222 Services provided: Defined Benefit Summary of Oualifications The City will have access to a dedicated team of professionals, covering all areas of service for the Plan. Your team works together, guided by a "Client Service Plan" with clear cut goals, responsibilities, and time commitments. We anticipate an annual "Client Service Plan" that includes face to face meetings, consultation, plan valuation and benefits administration. Your project will be led by a consulting actuary who will provide direction and support to valuation project managers and analysts. Our team members process projects by one member completing a task, another checking it, and then a review by the consulting actuary. All work is performed by in -house staff. Your client service team, introduced below, will work with you in operating your plan smoothly. Consulting Actuaries Your Consulting Actuaries will be responsible for managing the entire relationship, leading the team of actuaries and analysts to ensure that your project objectives are met. Consulting Actuaries are responsible for directing the completion of the annual actuarial valuation report, audit report, individual participant statements and related materials. A review by a second SHDR Consulting Actuary of client deliverables is an SHDR quality control standard. Consulting Actuaries attend client presentation meetings, present all SHDR reports, and offer advice as to various actuarial and plan issues. Your relationship will be managed by Consulting Actuaries, Derek Scott and Lane West. Information on their qualifications and experience is provided below. Derek Scott, ASA, EA, FCA, CPPT Vice President/Consulting Actuary Derek joined SHDR in 2003 and has over 14 years experience in providing actuarial and consulting services to sponsors of retirement and other post employment benefit plans. His experience includes valuation, consulting, design and administration for plans ranging in size from 1 to 10,000 participants, specializing with ERISA funding requirements, as well as the accounting standards prescribed by both FASB and GASB. Derek is an Associate in the Society of Actuaries (ASA), a Fellow in the Conference of Consulting Actuaries (FCA) and an Enrolled Actuary (EA) under ERISA. Additionally, he has met the educational requirements by the Florida Public Pension Trustee Association as a Certified Public Pension Trustee (CPPT). Derek has a Bachelor of Science Degree in Mathematics from the University of Massachusetts. Lane B. West, FSA, FCA, MAAA, EA Sr. Vice PresidentlConsulting Actuary Lane is a graduate of Georgia State University where he earned a Bachelors degree in Actuarial Science. Furthermore, Lane obtained a Masters Degree in Business Administration from Virginia Commonwealth University. Lane is a Fellow of the Society of Actuaries, a member of the American Academy of Actuaries (AAA) and an Enrolled Actuary under ERISA. He is a member of the Pension Committee of the AAA which provides input to Congress and the Administration on pension matters. He has extensive experience with governmental pension and OPEB plans. He worked for a major consulting firm for 23 years and was also the Senior Vice President of Product Development Pension and Medical for Life of Virginia. He has been with SHDR since 1999. He recently spoke on the subject of Pension vs. Defined Contribution plans and GASB 43 and 45 at a Florida Public Pension Plan Trustee Association meeting. Actuarial Manager The Actuarial Manager provides the necessary team support for all actuarial projects. He supervises a team of Valuation Analysts who will perform the annual actuarial valuation. The duties of the Analyst include reconciling plan data and trust assets, coding and testing actuarial software, and building valuation reports. The Actuarial Manager will assist in the project management and check the work of the Analyst performing data reconciliation, computer program, and report preparation. Robert A. Grider Assistant Vice President/Actuarial Manager Robert obtained his Bachelor of Science in Actuarial Science from Bowling Green State University, where he was the President and Co- founder of the Actuarial Science Society and a member of the Honors Student Association. He has worked in the employee benefit field since 1998. His experience includes valuation and administration of single and multi- employer defined benefit pension plans, supplemental executive retirement plans and post- retirement medical plans for purposes of funding requirements under ERISA as well as the various accounting standards (i.e. SFAS Nos. 87, 106 and 132, GASB 25,27, 43 and 45). His experience includes plan terminations, forecast and other special studies as well. Robert is the Actuarial Manager for the Greensboro office, where he supervises a team of 5 actuarial analysts, coordinating workflow for over 180 plans. Robert has completed the examinations for the Joint Board of Actuaries and is in the process of applying for his E.A. credentials. Administrative Support Administrative Support Staff members provide support in the preparation of client reports and other communication materials. Other Staff Members Other staff members will provide support, as needed. Whenever necessary, other Actuarial Services staff members will be assigned to help in the completion of any special project that may require additional resources. The individual to be assigned will be determined at the time the project commences, based on the required level of expertise and experience. Also available, if necessary, is our staff of in -house employee benefit attorneys of our Employee Benefit Compliance Group and investment advisory consultants in our affiliate, SHDR IA. Benefit attorneys can assist with compliance and legal issues associated with employee benefit plans. VENDOR RATE /FEE SCHEDULE Please include a breakdown of the dollar amount of and the basis for your fees as appropriate based on the following categories (generally defined in Scope of Services): Item Description Fee Actuarial Valuation Annual valuation to provide contribution requirements in accordance with applicable state and federal laws and regulations SPD Preparation (every 2 years) Benefit Calculations Fees will be charged per calculation based on the rates below: Retirement Pension Service Buy -Back Disability Death Former Vested Employee Options Only QDRO $16,700 750 200 200 265 265 175 125 Billing rate Fee/Rate Schedule for any additional services including ad hoc calculations and general analysis that may be requested: q g g Y �,w"- P`Y'T" Y gym•° ,Y se' dp Consulting/Review Actuary A senior consultant with a substantial amount of experience $350 in all types of retirement plans and consulting. Responsible for reviewing final client deliverable for overall reasonableness. Primary/Plan Actuary The Plan Actuary serves as a technical resource to the lesser $300 experienced team members and ultimately ensures the quality and accuracy of the analysis. Actuarial Manager An experienced associate nearing actuarial credentials that $250 serves a number of different roles on a project. Responsibilities typically include checking analyst work, ensuring product timelines are maintained and being resource for actuarial software and coding. Actuarial Analyst This associate is primarily responsible for the software $175 coding, data maintenance and ultimately the development of results for each project. Benefit Calculation Analyst This person assists your Human Resource staff in the day to $125 -175 day administrative issues with regards to the pension plan. Administrative Assistant This person assists the team in the presentation of the work $100 products. For all additional work, vendor is requested to provide a proposal which shall include a breakdown of the hourly rate which will be applicable, in determining the cost of these services, by major category of employee (actuary, associate, clerical, etc.); for these additional services, billing will be broken down into time per category by major task. These fees will be fixed for the initial period of two years, and negotiated thereafter. Prior to accepting an assignment for additional work, you will be requested to provide a proposed fee for the task on a "not to exceed" basis prior to receiving authority to proceed. DISPUTES DISCLOSURE FORM Answer the following questions by answering "YES" or "NO If you answer "YES please explain in the space provided, please add a page(s) if additional space is needed. 1. Has your firm, or any of its officers, received a reprimand of any nature or been suspended by the Department of Professional Regulation or any other regulatory agency or professional association within the last five (5) years? No 2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years? No 3. Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business? No If yes, the explanation must state the nature of the request for equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or status of suit and the monetary amounts or extended contract time involved. I hereby certify that the statements contained herein are true. I agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for disqualification of the submittal, immediate cancellation of any contract with the City that might arise from the representations contained herein, and forfeiture of rights for further consideration for work in the City of Winter Springs. Firm: Stanley, Hunt, DuPree Rhine, Inc. (A Subsidiary of BB &T) Name/ Title: Lane B. west, Senior vice President /Consulting Actuary Authorized Signature Date: �f 267c7 q This Form Must Be Completed and Returned with your Submittal 8 INSURANCE REQUIREMENTS FORM 1. The vendor shall be required to provide to the Purchasing Coordinator, prior to signing a contract for or commencing any work, a Certificate of Insurance which verifies coverage in compliance with the requirements outlined below. Compliance of said certificate must be acknowledged by the Purchasing Coordinator prior to start of work. Any work initiated without completion of this requirement shall be unauthorized and the City of Winter Springs will not be responsible. 2. The City of Winter Springs reserves the right to require coverage and limits as considered to be in its best interests. Insurance requirements shall be on a case by case basis determined by the project, conditions and exposure. 3. Except for Professional Liability and Workers Compensation Policies, when required, all policies are to be endorsed to include the City of Winter Springs as Additional Insured. In the cancellation clause the number "30" shall be inserted into the blank space provided prior to the words "days prior notice... All vendor policies are to be considered primary to City coverage and shall not contain co- insurance provisions. 4. In the event that the insurance coverage expires prior to the completion of services, a renewal certificate shall be issued 30 days prior to said expiration date. 5. Subvendors or sub contractors retained by the primary vendor are the responsibility of said primary vendor in all respects. 6. Insurance requirements: COVERAGE REQUIRED MINIMUM POLICY LIMITS Workers' Compensation Commercial General Liability including Contractual Liability, Products and Completed Operations, XCU and Owners and Contractors Protective Comprehensive Auto Liability, CSL, shall include "any auto" Professional (NOTE: All limits are per occurrence and must include Bodily Injury and Property Damage. Deductibles and self insured retentions must be approved by the City of Winter Springs, and all insurers must have an A.M. Best rating of at least A: VII.) 7. Bonding Required: None This Submittal 8. Vendor will be required to provide a certificate of insurance in compliance with the above, within four (4) days of notification of award with continuing coverage, without a break. 9. I hereby certify that the insurance and bonding requirements outlined above shall be met as required, if I am awarded a contract for the services specified herein. Firm: Stanley, Hunt, DuPree Rhine, Inc. (A Subsidiary of BB &T) Name Title: Authorized Signature Date: Lane B. West, Senior Vice President /Consulting Actuary 4,t Wfri-, This Form Must Be Completed and Returned with your Submittal 9 Statutory 1,000,000 Occurrence 1,000,000 CSL $1,000,000 Occurrence FLORIDA STATUTES ON PUBLIC ENTITY CRIMES FORM THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to the City of Winter Springs by: Lane B. West, Senior Vice President /Consulting Actuary on behalf of: Stanley, Hunt, Dupree Rhine, Inc. (A Subsidiary of BB &T) whose business address is: 7823 National Service Road Greensboro, NC 27409 Federal Employer Identification Number (FEIN) 56- 2092915 or Social Security of the person signing this statement: 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), F.S., means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services, any lease for real property, or any contract for the construction or repair of a public building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. 1 understand the "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), F.S., means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilt or nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), F.S., means: A predecessor or successor of a person convicted of a public entity crime or an entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 10 5. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), F.S., means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies.) X Neither the entity submitting this sworn statement, nor any of its officers, director, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity were charged with and convicted of a public entity crime after July 1, 1989. The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity was charged with and convicted of a public entity crime after July 1, 1989. The entity submitting this sworn statement, or one of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity was charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) I understand that the submission of this form to the City of Winter Springs is for the City of Winter Springs only, and that this from is valid through December 31, 2007. 1 also understand that I am required to inform the City of Winter Springs prior to entering into a contract in excess of $25,000 of any change in the information contained in this form. Signature W� ��'IS;Lr70 n State of ROFid a, County of ect On this /S day of S 2009, before me, the undersigned Notary Public of the State of Florida, personally appeared: I"CJ 46. Lr/ c3�- (Name(s) of individuals who appeared before notary) 11 whose name(s) is /are Subscribed to the within instrument, and he /she /they acknowledge that he /she /they executed it. Sworn to and subscribed before me this IC day of S ,v&e 20,09 Notary Public My Commission expires: 943-0 /0'0/s Personally Known Produced Identification: (Type) Did take an Oath Did Not take an Oath This Form Must Be Completed and Returned with your Submittal 12 DRUG -FREE WORK PLACE FORM The undersigned, in accordance with Florida Statute 287.087 hereby certifies that the company named below does: 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. 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. 3. Give each employee engaged in providing the commodities or contractual services that are proposed a copy of the statement specified in subsection (1). 4. 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 bid, 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 contendere 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. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. Firm: Stanley, Hunt, DuPree Rhine, Inc. (A Subsidiary of BB &T) Name/ Title: Lane B. West, Senior vice President /Consulting Actuary Authorized Signature Date: /3, A"(2, This Form Must Be Completed and Returned with your Submittal 13 CONFLICT OF INTEREST STATEMENT 1. Lane B. West of SHDR, Inc deposes and states that Lane B. West Stanley, Hunt, DuPree Rhine, Inc. Name of Affiant Name of Company the above named entity is submitting a proposal to the City of Winter Springs for the project identified above. 2. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 3. The Affiant states that only one submittal for the above project is being submitted and that the above named entity has no financial interest in other entities submitting qualifications for the same services. 4. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive pricing in connection with the entity's submittal for the above project. This statement restricts the discussion of pricing data until the completion of negotiations and execution of the Agreement for this project. 5. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from participating in contract lettings by any local, state, or federal agency. 6. Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for these services. 7. 1 certify that no member of the entity's ownership, management, or staff has a vested interest in any aspect of or department of the City of Winter Springs. 8. 1 certify that no member of the entity's ownership or management is presently applying for an employee position or actively seeking an elected position with City of Winter Springs. 9. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above name ntity, will immediately notify the City of Winter Springs in writing. ,rte Signature of Afant Date Senior Vice President /Consulting Actuary Lane B. West Title Typed or Printed Name of Affiant A1161--m State of Ficritta, County of On this day of 20 el, before me, the undersigned Notary Public of the State of Florida, personally appeared "46 16 lflejz� and 14 (Name(s) of individuals who appeared before notary) whose name(s) is /are subscribed to the within instrument, and he /she /they acknowledge that he /she /they executed it. WITNESS my hand and official seal. Alarth C4 el j'0c'J NOTARY PUBLIC, STATE OF 9 NOTARY PUBLIC SEAL OF OFFjCE: (Name of Notary Public: Print, Stamp, or Type as Commissioned.) shay &,WM4/7 This Form Must Be Completed and Returned with your Submittal 15 CERTIFICATION OF NON SEGREGATED FACILITIES FORM By affixing his signature to this form, the consultant certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The consultant certifies further that he will not maintain or provide for his employees any segregated facilities at any location under his control where segregated facilities are maintained. The consultant agrees that a breach of this certification will be a violation of the Equal Opportunity clause in any contract resulting from acceptance of this Bid. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage and dressing areas, parking lots, drinking fountains, recreation or entertainment area, transportation and housing facilities provided for employees which are segregated by explicit directive, or are in fact segregated on the basis of race, color, religious disability or national origin, because of habit, local custom, or otherwise. The consultant agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain such certifications in his files. The nondiscriminatory guidelines as promulgated in Section 202, Executive Order 11246, and as amended by Executive Order 11375 and as amended, relative to Equal Opportunity for all persons and implementations of rules and regulations prescribed by the United States Secretary of Labor are incorporated herein. NOTE; The penalty for making false statements in offers is prescribed in 18 U.S.O. 1001. By: bate: L ev Jv Lane B. West Senior Vice President /Consulting Actuar Print Name Title Official Address: 7823 National Service Rd, Greensboro, NC 27409 This Form Must Be Completed and Returned with your Submittal 16 PUBLIC RECORDS FORM All proposals are subject to the Florida Public Records Act, F.S. 119. The submission of a proposal authorizes release of your firm's credit data to the City of Winter Springs. Responsive proposals are "public records" and shall be subject to public disclosure consistent with Chapter 119.07(3) (o), Florida Statutes. Vendors must invoke any exemptions to disclosure provided by law in the response to the proposal, and must identify the data or other materials to be protected, and must state the applicable statutory exemption for exclusion from public disclosure. Please list below any exemptions to disclosure as provided by law and sign and date the form where indicated.: If you are not claiming any Public Records Exemptions, please check the box below and sign and date the form where indicated. LJWe are claiming no exemptions This Form Must Be Completed and Returned with your Submittal 17 Vendor Signature /Date