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HomeMy WebLinkAbout2009 10 07 Regular 600 Boomershine Consulting Group, LLC ItemCity of Winter Springs RFP 021/09/JD PROPOSAL FOR ACTUARIAL SERVICES Boomershine Consulting Group Executive Center 1 3300 North Ridge Road, Suite 300 Ellicott City, MD 21043 September, 2009 Phone: 410 -418 -5525 Fax: 410 -418 -5644 BOOMERSHINE CONSULTING GROUP, ur. Table of Contents City of Winter Springs Proposal for Actuarial Services September, 2009 Page Responses to RFP Section I Submittal Cover Sheet 1 Section II Letter of Interest 2 Section III Profile of Proposer 4 Section IV Summary of Qualifications 11 Section V Forms 15 j RONERSIIINE CONSULTING CROW%uz Submit proposal to: SUBMITTAL COVER SHEET 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) #0211091J D 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: Boomershine Consulting Group, LLC MAILING ADDRESS: Executive Center 1, 3300 North Ridge Road, Suite 300 City: Ellicott City State: Maryland Zi 21043 Name/Title: David S Boomershine, President and Senior Actuary Authorized Signature /Date: /Iva ORDie. We /c) 9 c/ t Email Address: dboomershine @boomershineconsulting.com Phone (410) 418 -5525 Fax (410) 418 -5644 This Form Must Be Completed and Returned With Your Submittal. 1 Section II Letter of Interest We are pleased that the City of Winter Springs "City is considering this proposal for on -going annual actuarial services for its Defined Benefit Plan "Plan We believe that the City is seeking an actuarial consulting firm that will: Review and advise on the entire retirement program; Provide on -going actuarial valuations and accounting determinations; and Deliver consistent consulting services More important, the consultant must: Provide the highest quality, reliable service; Be responsive to your needs on an appropriate service level and in a timely manner; and Become an extension of your management team and advise you accordingly, assuring that the retirement program meets the objectives for delivering meaningful benefits to employees at reasonable costs, and complies with all federal laws and regulations; Provide independent, objective and proactive input to the decision making process. We understand that the City is seeking the following Scope of Services: 2 City of Winter Springs Proposal for Actuarial Services September, 2009 Benefits Administration Functions Determine eligibility, benefits, and vesting for Plan participants. Perform contribution analysis and review for Plan participants. Prepare benefit calculations for Plan participants as requested. Prepare pension service time buy -back calculations, as needed. Process all documents for payments to terminated or retiring employees within one week of request. Prepare and deliver annual employee benefit statements for Plan participants within 60 days of Plan fiscal year end. Actuarial Valuation and SPD Preparation Produce an annual actuarial valuation report in accordance with State laws and regulations so as to establish required municipal contribution levels, set forth Fund assets and liabilities, provide historical data, and render observations and opinions as to the funding of the Plan. Meet, as necessary, with the Board of Trustees of the Fund, the Pension Board, or Commission to explain changes to the Fund and actuarial assumptions utilized. Prepare a Summary Plan Description (SPD) every two (2) years or as required (as requested). Review of Plan mortality tables used to calculate actuarially- equivalent benefit options. HOOHERSH NE CONSULTING GROCP. We address these services in the following sections, as requested. 3 City of Winter Springs Proposal for Actuarial Services September, 2009 Ad hoc Calculations and Analysis Calculate and report the cost of changes in benefit structure as a result of change of direction in City policy or changes in Federal or State laws impacting upon the Plan. Provide general advice and counsel on the Plan and benefit structures. Respond to any inquiries by the State of Florida regarding issues derived from their review of the Actuarial Valuation Report and obtaining State acceptance. Review current plan design to ensure the retirement program is meeting the goals of the City in benefits provided and cost control. Consult with City's financial advisors and/or legal counsel in the implementation and administration of the plan. ADDITIONAL SERVICES Additional work above and beyond stated scope of services may, from time to time, be requested by the City. All such additional work must be authorized by the City in writing. 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. HOOHERSH NE CONSULTING GROUP, us. Section III Profile of Proposer a. State whether your firm is national, regional, or local. Boomershine Consulting Group is a regional actuarial consulting firm b. State the location of the office from which your work is to be performed Our office is located at: Executive Center 1 3300 North Ridge Road, Suite 300 Ellicott City, MD 21043 c. Describe the firm, including the size, range of activities, etc. Brief History of Firm City of Winter Springs Proposal for Actuarial Services September, 2009 Boomershine Consulting Group (BCG) is a Maryland Limited Liability Company founded in April 2007, by David S. Boomershine. The first priority of the new firm was the acquisition of Yaffe Company's Actuarial Division, which has been providing actuarial consulting services in the mid Atlantic region for over 25 years. Yaffe Company has been an innovator in retirement plan design in the area. Depth in expertise and experience in alternative retirement plan designs has been a hallmark of the firms. David S. Boomershine, Senior Consulting Actuary and President, adds another 32 years of experience with major national employee benefit consulting firms in the field. His experience and clients cover all areas of actuarial consulting expertise, especially plan design, and all types of plan sponsors, including: private sector, public sector and non profit organizations. BCG currently has a staff of 12, and is currently growing. BCG not only understands the trends and issues, we take seriously the crucial challenge of rising costs to an employer's bottom line. As a client you benefit from our many years of major consulting firm expertise and experience, but with the cost efficiency that large firms can't deliver. We have no salesmen, no layers of management and therefore no inflated cost structure. We believe long -term solutions can be found by in -depth actuarial analysis and good communications. Our team model is simple we are all client consultants, here only to help clients with their actuarial and retirement plan needs. This cost effectiveness is passed on to our clients. The message is also simple our focus is our clients. 4 HOOHERSH NE CONSULTING GROUP, us. We strive to provide independent, innovative and professional actuarial and retirement plan services of the highest standards. Our clients are our focus. We pledge to listen and respond in a timely manner and cost effective basis. City of Winter Springs Proposal for Actuarial Services September, 2009 BCG has established a set of principles as the foundation for the services that we provide to our clients. This is summarized in our Mission Statement: The translation of these principles is that we simply take great pride in our: Independence We provide objective solutions, based on sound actuarial principles and impartial advice that always places the client's best interest first. Expertise We possess a depth of professional actuarial and plan administration knowledge that is acquired only through years of experience in the field. Experience In addition to our wealth in years with the many facets of actuarial consulting and retirement plan administration, we also provide comprehensive services to all types of employers in the private, public and non profit sectors, small, medium and large. Examples include corporations, healthcare organizations, government entities and associations. Quality We consistently deliver precise, timely accurate reports and consulting services in accordance with the high standards and requirements of the American Academy of Actuaries (AAA) and the American Society of Pension Professionals and Actuaries (ASPA) and the Society of Actuaries (SOA). Commitment We know how to listen, what the current issues are and what questions to ask. We are determined to develop individually tailored solutions that meet clients' goals. In summary, BCG has a wealth of actuarial expertise and experience, including major consulting firm experience. An added advantage is that as a new actuary taking over the valuation responsibilities, we can provide a "fresh look" at your plans. As noted above, BCG takes great pride in the quality of our services. We accomplish this by complying first with the high standards and requirements of the professional actuarial associations as noted above. We also achieve these standards by assigning a dedicated actuarial team to your account that has the skills and experience to meet your needs. Finally, in the completion of our consulting and analysis, all actuarial calculations are: completed by an analyst checked by a senior consultant reviewed by a credentialed actuary Finally, we are extremely proud of the fact that we can provide the same quality services of the major firms but in a more intimate working relationship and in a more cost efficient manner. 5 Ij HOOHERSHINE C©SSU LTI'iG GROUP, us. d. Provide a list and description of similar municipal engagements satisfactorily performed within the past two (2) years. For each engagement listed, include the name and telephone number of a representative for whom the engagement was undertaken who can verify satisfactory performance. Boomershine Consulting Group, LLC "BCG provides actuarial consulting services to over 30 plans, typically ranging in size from 300 to 4,000 participants. Our clients include public sector, private sector and non profit organization. Our firm has been providing actuarial services for over 27 years. Following are several references for our services: Name of Firm New Castle, Delaware Address of Firm Contact Name, Title Contact Email Contact Phone Contact Fax Number of years served Scope of Services Name of Firm Town of Easton, Maryland Address of Firm Contact Name, Title Contact Email Contact Phone Contact Fax Number of years served Scope of Services City of Winter Springs Proposal for Actuarial Services September, 2009 87 Reads Way New Castle, DE 19720 Gayle Logan, Pension and Benefits Manager gmlogan anccde.org (302) 395 -5182 (302) 395 -5190 10 years Pension and Other Post Employment Benefit "OPEB /GASB #45 actuarial consulting services 201 N. Washington Street Easton, MD 21601 Paul Moeller, Senior Vice President and CFO pmoeller@ eucmail. coin (410) 763-9472 (410) 822 -0743 4 years Pension and Other Post Employment Benefit "OPEB /GASB #45 actuarial consulting services 6 HOOMERSHIM1E CONSULTING CROUP. us. Name of Firm Town of Bel Air, Maryland Phase I: Phase II: Phase III: Phase IV: Phase V: Phase VI: Address of Firm Contact Name, Title Contact Email Contact Phone Contact Fax Number of years served Scope of Services Address of firm Contact Name, Title Contact Email Contact Phone Contact Fax Number of years served Scope of Services City of Winter Springs Proposal for Actuarial Services September, 2009 39 Hickory Avenue Bel Air, MD 21014 Christopher G Schlehr, Town Administrator cschlehr abelairmd.org (410) 638 -4550 (410) 879 -9225 6 years Other Post Employment Benefit "OPEB /GASB #45 actuarial consulting services Name of Firm City of Lynchburg Virginia City Ha11,900 Church Street Lynchburg, VA 24505 Donna Witt, Director donna.witt crlynchburgva.gov (434) 455 -3968 (434) 845 -2711 1 year Other Post Employment Benefit "OPEB /GASB #45 actuarial consulting services Our valuation process for the Defined Benefit Plan has six phases: Valuation Planning Data Collection and Reconciliation Reviewing and Setting the Actuarial Basis for the Valuation Determination of Actuarial Costs Review of Valuation Results Annual Report Presentation Briefly, these are: Phase I: Valuation Planning We meet with the City in a planning session to discuss the needs of all parties for the coming year, including dates when specific information is needed and any anticipated special projects. After this meeting, we summarize the information needed for the upcoming valuations and develop a detailed action plan to identify the specific steps in the valuation process for each plan, the responsible parties and appropriate timing. 7 HOOMERSHIM1E CONSULTING CROUP. us. Before the beginning of each valuation cycle, we review the plan documents and amendments, as well as prior valuations. We verify the benefit structures of the plans to ensure any recent changes are properly reflected. Phase II: Data Collection and Reconciliation After the valuation planning meeting, we verify the specific data needed for the upcoming valuations and work with you to determine any changes needed to the data delivery process. When we receive participant data, we test it against the data from the prior year. Our first step is to reconcile participant counts with those from the prior year to ensure the correct participants are being valued. We look for unexpected participant movements, unusual shifts among classes of participants, unanticipated increases or decreases in numbers of participants, changes in the amount of benefits paid to retirees, and where applicable, unusual compensation changes. Any discrepancies discovered in this process are discussed and, if necessary corrected. In addition to updating the participant census, we gather plan asset information. After we receive the asset information; we reconcile the current balances with the ending balances from the prior year. Contribution amounts are compared to those we calculated for the year. Reported benefit payments are compared to those expected, based on participant data and investment returns are compared to market conditions for the year. Any discrepancies are reviewed with the City. Phase III: Reviewing and Setting the Actuarial Basis for the Valuation Just as important as accurately applying calculation routines is the development of appropriate actuarial assumptions and methods to properly measure plan costs in a manner consistent with your long -term goals and objectives. We strongly believe the selection of appropriate actuarial assumptions and methods is one of the most important and most difficult parts of an actuary's craft. Before starting the valuation, we review and update the experience history to determine whether any new patterns of gains or losses are emerging. This updated experience analysis is a regular part of our valuation processes and reports. Phase IV: Determination of Actuarial Costs 8 City of Winter Springs Proposal for Actuarial Services September, 2009 After the data has been collected and reconciled and the actuarial basis has been set, we project pension plan benefits to the end of each participant's life and then value these benefits to produce the various actuarial costs needed to complete the valuations. These actuarial costs are then used to determine the cash contribution range for the pension plan and the GAS reporting for both plans. HOOHERSH NE CONSULTING GROL ur. City of Winter Springs Proposal for Actuarial Services September, 2009 Phase V: Review of Valuation Results All actuarial calculations are checked and reviewed, passing through our quality control process. In addition, at the end of the valuation process, a qualified actuary not involved in the production of the results performs a fully independent peer review. In this way, an objective third party evaluation of technical matters and adherence to our policy and standards is assured. This review includes an independent detailed verification of all the actuarial results, including the component liabilities, average benefits, and the relationship of the benefits to the various ancillary benefits. We check for reasonableness between the current year's results and those of prior years. We check not only the overall numbers, but also the relationships between the individual benefits and the individual wage, service and age levels. The purpose of this detailed verification and independent checking is to ensure a product of the highest possible quality. We never proceed to completion until we are certain that the results are accurate, reasonable and appropriate. It is our policy that no valuation result or other financial data can be released to a client until the detailed checking and peer review steps are fully completed. Phase VI: Annual Report Presentation The end product of the actuarial process is the annual actuarial valuation report. When the valuation results are completed, we will request a meeting with the City to review the summary results. At this meeting, we point out any factors that influenced valuation results, such as changes in number of participants, plan changes or changes in assumptions as well as any recommended changes in design, actuarial assumptions or cost methods and the effects of these changes. In addition, we discuss any legislative or regulatory developments that might affect future plan operations. We will also present the final valuation results to the Board of Trustees, as requested. As you can see through the steps and the actuarial valuation process described above, we view our role to assist the City and staff in the following areas: Guidance through the valuation process Assistance with plan administration Guidance with any regulatory updates and requirements Review and meaning of key, pertinent results of the actuarial valuation Coordination with investment manager, consultant and future actuarial projections Actuarial method and assumptions reviews Evaluation of current trends and competitive benefit practices Completion of any requested special studies Any other consulting, assistance as requested; such as actuarial studies of plan design issues 9 BOOHERSII I\L CONSULTING GROL LL, City of Winter Springs Proposal for Actuarial Services September, 2009 Following is a timeline covering annual services that generally follows the actuarial valuation process steps for the October 1 valuation: Step Valuation planning Data request September BCG Census data, assets to BCG October City Data questions /answers /reconciliation November 15 BCG /City Review /Set Actuarial Valuation basis October BCG Determination of preliminary Actuarial Costs December 15 BCG Valuation report January 15 BCG Attendance at Board Meetings As needed BCG /City 10 Target Date Responsibility September BCG, City Ij HOOHERSHINE C©SSU LTI'iG GROUP, us. Section IV Summary of Qualifications Identify the key personnel who will work as part of the team. Include resumes for each person to be assigned The resumes may be included as an appendix. The following diagram shows how the BCG actuarial team will work with the City. It shows that depending on the issue, any member of the team could interact with appropriate City personnel such as: Team Member David Boomershine Sunita Bhatia Kelly Carver Darlene Morgan Tahir Islahi Mary Johnson Robert Levine Tricia Fojtik Role Senior Lead Actuary, project development and confirmation, presentations, peer review; Account Manager /Contract Representative Project management, actuary, and delivery of services; Valuation and analysis 11 David Boomershine Lead Actuary Sunita Bhatia Kelly Carver Actuary /Senior Consultants Darlene Morgan Tahir Islahi Mary Johnson Senior Analysts City of Winter Springs Proposal for Actuarial Services September, 2009 Robert Levine Tricia Fojtik Analysts The purpose of assigning a full team to the City, is so that there is always a team member available to address any questions. We also guarantee that any phone calls or messages will be addressed within 24 hours (most calls will be returned immediately). BOGSIERSHItiE CUNSULTI.'iG GROUP. us Resumes David S. Boomershine, EA, MAAA, MSPA Senior Actuary and President As Senior Actuary and President of Boomershine Consulting Group, Dave has primary responsibilities for delivering consulting services and providing strategic retirement and health and welfare consulting solutions to clients. His business background includes more than 32 years of experience with major national employee benefit consulting firms in senior positions. He specializes in helping clients design, administer, fund and communicate employee benefit plans and has worked with all sizes of employers in the public and private sector, as well as non profit organizations. He has extensive experience in analyzing, re- designing and developing solutions for retirement and other benefit programs. Dave has spoken on a broad range of retirement topics in numerous forums including regional and national conferences and seminars, the International Foundation of Employee Benefit Plans (IFEBP), the Government Finance Officers Association (GFOA) and the Worldwide Employee Benefits (WEB) Network. He is an Enrolled Actuary (EA), a member of the American Academy of Actuaries (MAAA), a member of the American Society of Pension Professionals and Actuaries (MSPA), a Fellow in the Conference of Consulting Actuaries (FCA) and a member of the National Retirement and Savings Committee of the American Benefits Council. Mr. Boomershine earned a BA in Mathematics, with concentrations in Business Administration, Economics and Computer Science from Shippensburg University. Sunita Bhatia, EA, ASA, MAAA Senior Consultant /Actuary 12 City of Winter Springs Proposal for Actuarial Services September, 2009 Sunita has over 15 years of experience working with retirement plans, with a concentration on defined benefit plans. This experience includes assisting clients with the various aspects of their plans and interacting with the clients' boards and committees, as well as their employees. She has been involved in performing funding and FAS 87 valuations, FAS 158 and PPA 2006 calculations, regulatory compliance and discrimination testing. She has also been involved in Plan design and implementation of new retirement programs, and has assisted clients in analyzing and modifying their total benefit programs. Ms. Bhatia earned a MS in Mathematics from the University of Maryland, Baltimore County and is an Enrolled Actuary, an Associate of the Society of Actuaries, a Member of the American Academy of Actuaries, and a member of the Conference of Consulting Actuaries. HOOHERSH NE CONSULTING GROL ur. Kelly Carver Senior Consultant Kelly has been a consultant in the retirement plans field for 14 years. She is responsible for providing all aspects of defined benefit and defined contribution plan services including: plan design, implementation, administration, consultation, regulation compliance and plan termination. Ms. Carver earned a BS in Mathematical Sciences from The Johns Hopkins University. Darlene A. Morgan, CEBS Senior Analyst City of Winter Springs Proposal for Actuarial Services September, 2009 Darlene has over 30 years experience in various aspects of defined benefit retirement services, including data maintenance, reconciliation, and update, benefit calculations, benefit statements, actuarial valuations, and government filings. Darlene has earned the Certified Employee Benefit Specialist (CEBS) designation and is a member of the International Society of Certified Employee Benefit Specialists. Tahir Islahi Senior Analyst Tahir has over seven years experience in retirement practices within global consulting firms. His experience is with both public and private sector clients in pension as well as OPEB, and his responsibilities range from reconciling client data and producing pension liabilities, to producing final valuation reports and specialized consulting solutions. His client experience ranges from cities and counties to large state -wide retirement systems in the public arena, and from local firms to multinational corporations in the private arena. Mr. Islahi has an MS in Economics from Texas A &M University and a BS in Applied Mathematics from Southern Methodist University. He is actively pursuing his Fellowship with the Society of Actuaries. Mary C. Johnson Senior Analyst Mary has 9 years of experience in the retirement plans field. She has designed and programmed benefit calculation software. Mary's responsibilities include client data reconciliation, preparation of benefit statements, benefit calculations and government forms filings. She also has experience in preparing annual FAS and Valuation reports. Ms. Johnson has a BS in Mathematical Sciences from Towson University. 13 HOOHERSH NE CONSULTING GROL ur. Robert Levine Analyst City of Winter Springs Proposal for Actuarial Services September, 2009 Robert supports the entire team at Boomershine Consulting Group as we provide the utmost in quality retirement services. He has five years of experience in the retirement plan field, with knowledge of two types of defined benefit plans final average pay and cash balance. He regularly completes post employment benefit calculations and manages client databases. Annually, he produces benefit statements and prepares forms for government filings, all with the focus on personal service to each client. Mr. Levine has dual degree in Mathematics and Economics from Towson University. Tricia Fojtik Analyst Tricia has more than two years of experience in the retirement plan field, with knowledge of two types of defined benefit plans final average pay and cash balance. She regularly completes post employment benefit calculations and manages data and also annually produces benefit statements and prepares forms for government filings, all with the focus on personal service to each client. Tricia is currently preparing for both the P and the FM actuarial exams. She graduated with a Bachelor of Science in mathematics from Towson University. 14 HOOHERSH NE CONSULTING GROL ur. Section V Forms a. Vendor Rate/Fee Schedule (provided herein) b. Disputes Disclosure Form (provided herein) c. Insurance Requirements Form (provided herein) d. Florida Statutes on Public Entity Crimes Form (provided herein) e. Drug -Free Work Place Form (provided herein) f Conflict of Interest Statement (provided herein) g. Certification of Non Segregated Facilities Form (provided herein) h. Public Records Form (provided herein) The forms are provided on the following pages 15 City of Winter Springs Proposal for Actuarial Services September, 2009 I' BOW ER.%!NE C©NSU LTI'iG GROUP, us. 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): Benefits Administration Functions Benefit Calculation 250 /benefit calculation as needed Annual Employee Benefit Statements $1,200 Annual Valuation and SPD Preparation Annual Valuation $12,500 SPD, every 2 years $2,400 Ad hoc Calculations and General Analysis as needed; hourly basis Total proposed annual fee for base services as per scope of work $13,700* *Note includes Annual Valuation and Benefit Statements only; other noted services are provided on an as- needed basis. Fee /Rate Schedule for any additional services (above and beyond that stated in the base scope of services) that may be requested: Category of Employee Lead Actuary Actuary /Senior Consultant Senior Analysts Analyst 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. This Form Must Be Completed and Returned With Your Submittal. 16 Hourly Rate $295 230 190 165 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: Boomershine Consulting Group, LLC Name 1 Title: David S. Boomershine, President and Senior Actuary Authorized Signature Date: DISPUTES DISCLOSURE FORM 4 0 40 S l 4/649 9 This Form Must Be Completed and Returned with your Submittal 17 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 I MINIMUM POLICY LIMITS Workers' Compensation Statutory Commercial General Liability including Contractual Liability, Products and 1,000,000 Occurrence Completed Operations, XCU and Owners and Contractors Protective Comprehensive Auto Liability, CSL, shall include "any auto" 1,000,000 CSL Professional $1,000,000 Occurrence (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: Boomershine Consulting Group, LLC Name Title: David S. Boomershine President and Senior Actuary Authorized Signature 1 Date: INSURANCE REQUIREMENTS FORM di This Form Must Be Completed and Returned with your Submittal 18 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: David S. Boomershine on behalf of: Boomershine Consulting Grout, LLC whose business address is: Executive Center 1, 3300 North Ridge Road, Suite 300 Ellicott City, Maryland 21043 Federal Employer Identification Number (FEIN) 20 8714603 or Social Security of the person signing this statement: 2. I 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. I 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. I 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. 19 5. I 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. I 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. Signati e 0-ippa.5 20 9/o// Date 01/Al State of Heri 4a, County of Howard On this 10 day of eptern befi, 204t, before me, the undersigned Notary Public of the State of- Flerie}a, personally appeared: im A fi .y c�Uu D MA L S. io orn Gits itrri (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. Sworn to and subscribed before me this l 0 day of JtQmh -&L 200? Personally Known Produced Identification: (Type) Did take an Oath Did Not take an Oath 21 ll/a Leg ,-.12141---) Notary Public My Commission expires: //I This Form Must Be Completed and Returned with your Submittal 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: Boomershine Consulting Group, LLC Name Title: David S. Boomershine President and Senior Actuary Authorized Signature Date: DRUG -FREE WORK PLACE FORM This Form Must Be Completed and Returned with your Submittal 22 1. CONFLICT OF INTEREST STATEMENT David S. Boomershine Boomershine Consulting Group of deposes and states that Boomershine Consulting Group 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. I 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. I 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 named entity, will immediately notify the City of Winter Springs in writing. APhe4 f/ /O/ c Signature of Affiant Date President and Senior Actuary, David S. Boomershine Title Typed or Printed Name of Affiant MAXIM ND. State offer -a, County of (-low 1-2i On this ID day of SeP' 72m 20.00°, before me, the undersigned Notary Public of the State of Hls, personally appeared 1Y1F�f.:yu��l� jf1 t rh S, 0.'3h'� EfI S ��WL and 23 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. NOTARY PUBLIC, STATE OF- PbaRteA NOTARY PUBLIC (1 AQSi( -A-N b SEAL OF OFFICE: (Name(s) of individuals who appeared before notary) (Name of Notaryh Publ' Stamr' yp= :s Commissioned.) "227 .-iiig4&„ This Form Must Be Completed and Returned with your Submittal 24 By: 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.C. 1001. David S. Boomershine Print Name Title Date: q /c.)/. President and Senior Actuary Official Address: Executive Center 1, 3300 North Ridge Rd, Ste 300, Ellicott City, MD 21043 This Form Must Be Completed and Returned with your Submittal 25 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) (0), 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. ®We are claiming no exemptions 26 Vendor Signature /Date 4A7)/0 This Form Must Be Completed and Returned with your Submittal