State of Wisconsin
Wis. Statutes s.16.75
DOA-3070 (R08/2003)
BIDS MUST BE SEALED AND ADDRESSED TO:
AGENCY ADDRESS:
Remove from bidder list for this commodity/service. (Return this page only.)
Bid envelope must be sealed and plainly marked in lower corner with due date and Request for Bid
# SN-1026. Late bids will be rejected. Bids MUST be date and time stamped by the soliciting
purchasing office on or before the date and time that the bid is due. Bids dated and time stamped in
another office will be rejected. Receipt of a bid by the mail system does not constitute receipt of a
bid by the purchasing office. Any bid which is inadvertently opened as a result of not being properly
and clearly marked is subject to rejection. Bids must be submitted separately, i.e., not included with
sample packages or other bids. Bid openings are public unless otherwise specified. Records will
be available for public inspection after issuance of the notice of intent to award or the award of the
contract. Bidder should contact person named below for an appointment to view the bid record.
Bids shall be firm for acceptance for sixty (60) days from date of bid opening, unless otherwise
noted. The attached terms and conditions apply to any subsequent award.
Department of Corrections
Scott Noreuil / Purchasing Services Section
3099 E Washington Avenue
P.O. Box 7991
Madison, WI 53707-7991
REQUEST FOR BID
Bids MUST be in this office no later than
THIS IS NOT AN ORDER
BIDDER (Name and Address)
March 3, 2008 2PM CT
Name (Contact for further information)
PLEASE COMPLETE:
Scott Noreuil
Phone
Date
608-240-5588
February 11, 2008
Quote Price and Delivery FOB
Destination
Item
No.
Quantity
and Unit
Fax bids are not accepted
Price
Per Unit
Total
Description
The Department of Corrections – Bureau of Health Services is
requesting bids for Nursing & Related Healthcare Services at
DOC facilities statewide, per attached terms, conditions and
specifications. Use the Cost Information forms in Section
7.0 to provide bid prices per job classification
.
Prices quoted shall include labor, travel and insurance.
Before submitting this bid be sure to include all requirements
listed in Section 8.
RPA: KHG1026
Payment Terms Net 30
Delivery Time: per specifications
We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Minority Business Enterprises. Bidder must be
certified by the Wisconsin Department of Commerce. If you have questions concerning the certification process, contact the Wisconsin Department of Commerce, 5th Floor, 201 W. Washington
Ave., Madison, Wisconsin 53702, (608) 267-9550. Does Not Apply to Printing Bids.
We are a work center certified under Wis. Stats. s. 16.752 employing persons with severe disabilities. Questions concerning the certification process should be addressed to the Work Center
Program, State Bureau of Procurement, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53702, (608) 266-2605.
Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when all other factors are substantially equal. Materials covered in our
bid were manufactured in whole or in substantial part within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States.
Yes
No
Unknown
In signing this bid we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition;
that no attempt has been made to induce any other person or firm to submit or not to submit a bid; that this bid has been independently arrived at without collusion with any other bidder, competitor or
potential competitor; that this bid has not been knowingly disclosed prior to the opening of bids to any other bidder or competitor; that the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions and specifications required by the state in this Request for Bid and all terms of our bid.
Name of Authorized Company Representative (Type or Print)
Signature of Above
Title
Date
Phone
(
Fax
(
Federal Employer Identification No.
)
)
Social Security No. if Sole
Proprietor (Voluntary)
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
BHS AGENCY STAFFING LOG
STATE OF WISCONSIN
REQUEST FOR BID (RFB) # SN-1026
FOR: Nursing and Related Health Services
TABLE OF CONTENTS
DEFINITIONS
1.0
INTRODUCTION AND PURPOSE
2.0
BID PROCEDURE AND INSTRUCTIONS
3.0
BID ACCEPTANCE, EVALUATION AND AWARD
4.0
TECHNICAL REQUIREMENTS
5.0
PERFORMANCE REQUIREMENTS
6.0
SUPPORT REQUIREMENTS
7.0
COST INFORMATION REQUIREMENTS
8.0
REQUIRED FORMS
9.0
TERMS AND CONDITIONS
ATTACHMENTS
Contract
Attachment “A” Business Associate Agreement
Attachment “B” Wisconsin DOC Institution and Centers Map
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 3 of 49
DEFINITIONS:
The following definitions are used throughout the bid:
Bidder means a firm submitting a bid in response to this Request for Bid
Contractor means successful vendor awarded the contract
DAI means the Division of Adult Institutions, administration of all state correctional incarceration facilities except those
Juvenile facilities operated by Division of Juvenile Corrections – headquartered at DOC Central Offices, 3099 E
Washington Ave., Madison, WI
DCC means the Division of Community Corrections, supervises offenders outside secure facilities
DJC means the Division of Juvenile Corrections, operates the three correctional ‘schools’ – headquartered at DOC
Central Offices, 3099 E Washington Ave., Madison, WI
DOA means the Department of Administration has statutory authority [WI Stats. Chapter 16] to define, regulate and
delegate all aspects of procurement of commodities and services for state agencies.
DOC means the Department of Corrections, also referred to as the “department” or the WDOC – headquartered at
DOC Central Offices, 3099 E Washington Ave., Madison, WI
Facility means the Department of Corrections correctional institutions and centers.
MBE means Minority Business Enterprise
Offender means a person under the custody or supervision of the Wisconsin Department of Corrections
P-Card means Procurement Card (State credit card)
Purchasing means the Department of Corrections Purchasing Section
RFB means Request for Bid
State means State of Wisconsin
Vendor means a firm submitting a bid in response to this Request for Bid
Must means a requirement is mandatory
Shall means a requirement is mandatory
Should means non-mandatory but desirable
CIB means criminal background check
HCFA means Health Care Finance Administration, the federal agency that administers Medicare and Medicaid
programs
CMSD means Correctional Manager Service Director
HSM means Health Service Manager
HSU means Health Service Unit
WCCS means Wisconsin Correctional Center System, used to prepare the offenders for release
RN means Registered Nurse
LPN means Licensed Practical Nurse
CNA means Certified Nursing Assistant
MA means Medical Assistant
MPAA means Medical Program Administrative Assistant
NP means Nurse Practitioner
NPI means National Provider Identification
BHS means Bureau of Health Services
1.0
INTRODUCTION AND PURPOSE
1.1
PURPOSE OF THIS REQUEST FOR BID
The Department of Corrections, hereinafter referred to as the "DOC", through its Purchasing Services
Section, hereinafter referred to as "Purchasing," on behalf of Bureau of Health Services, hereinafter
referred to as "BHS," requests bids for the purchase of Nursing and Related Healthcare Services.
Services will be ‘as needed’ to fill vacancies in a variety of facilities that have Health Services Units staffed
by state employees. The services will be provided as scheduled and will include ‘visiting nurse’ services
for inmates and Employee Health Services for WCCS and DCC in the correctional centers.
Other State agencies may use the resulting contract, if agreeable to both the DOC and the vendor, to obtain
the benefits of volume purchases and/or reduction in administrative expenses
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 4 of 49
The DOC is the sole point of contact during the selection process. The person responsible for managing
the procurement process is Scott Noreuil at 608-240-5588.
The BHS will administer the contract resulting from this RFB. The contract administrator will be Dave Schuller
at 608-240-5134.
Conditions of bid that include the word "must" or "shall" describe a mandatory requirement. All
specifications are defined as mandatory minimum requirements unless otherwise stated. If no bidder is
able to comply with a given specification, condition of bid or provide a specific item, Purchasing reserves
the right to delete that specification, condition of bid or item. FAILURE TO MEET A MANDATORY
REQUIREMENT SHALL DISQUALIFY YOUR BID. This bid document and the awarded bidder’s
(Contractor’s) response information shall become part of the Contract.
1.2
REASONABLE ACCOMMODATIONS
The DOC will provide reasonable accommodations, including the provision of informational material in an
alternative format, for qualified individuals with disabilities upon request. If you think you need
accommodations at a bid opening/vendor conference, contact Scott Noreuil via telephone at 608-2405588 or email at scott.noreuil@wisconsin.gov
1.3
CONTRACT TERM
The resulting contract shall be effective on the date of execution, which shall be the date signed by the
Secretary of the Department of Corrections. The contract period shall be for one year from execution of
the contract by the Department and shall expire on the last day of that month. Two, one-year automatic
extensions are authorized by mutual consent. Extensions will execute automatically unless the Contractor
takes action and notifies the DOC, in writing, of their desire to terminate the contract at least ninety (90)
days prior to the end of the current contract period.
Funding beyond the initial contract term is contingent upon availability of State funds from year to year.
1.4
EXECUTED CONTRACT TO CONSTITUTE ENTIRE AGREEMENT
In the event of contract award, the contents of this RFB (including all attachments), RFB addenda and
revisions, and the bid of the successful bidder, and additional terms agreed to, in writing, by the
Department and the contractor shall become part of the contract. Failure of the successful bidder to
accept these as a contractual agreement may result in a cancellation of award.
The following priority for contract documents will be used if there are conflicts or disputes.
The Final Signed Contract and Official Purchase Orders
Contractor's bid response
DOC Request for Bid and any attachments
Vendors should retain a copy of this DOC Request for Bid document and their own response to the RFB
solicitation. The Vendor Bid Submission becomes part of the awarded contract.
1.5
CANCELLATION AND TERMINATION
This Contract may be terminated for the following conditions:
1.5.1
The DOC may terminate the Contract at any time, with or without cause and without penalty by
delivering thirty (30) days written notice to the Contractor.
1.5.2
The DOC has a Vendor Performance Evaluation process for soliciting feed-back from contract
users about vendor performance and compliance with contract specifications. Vendor
noncompliance with the terms, conditions or specifications that is persistent and/or significantly
impacts the quality and performance provided pursuant to the contract may be considered in
breach of contract. Negative Vendor Performance Evaluation Surveys may result in non-renewal
or termination of contract.
RFB # SN-1026
Nursing and Related Health Services
1.6
Due Date: March 3, 2008
Page 5 of 49
1.5.3
If at any time the Contractor performance threatens the health and/or safety of the DOC, the DOC
has the right to cancel and terminate the Contract without notice.
1.5.4
Failure to maintain the required Certificates of Insurance, Permits and Licenses shall be cause for
Contract termination. If the Contractor fails to maintain and keep in force the insurance as
provided in #23 of the Standard Terms and Conditions, the DOC has the right to cancel and
terminate the Contract without notice.
1.5.5
If at any time a petition in bankruptcy shall be filed against the Contractor and such petition is not
dismissed within 90 calendar days, or if a receiver or trustee of Contractor's property is appointed
and such appointment is not vacated within 90 calendar days, the DOC has the right, in addition to
any other rights of whatsoever nature that it may have at law or inequity, to terminate the Contract
by giving 10 calendar days notice in writing of such termination.
1.5.6
Failure of the DOC to comply with contract terms, conditions or specifications shall provide the sole
cause for which the Contractor is entitled to terminate the contract. The Contractor shall notify the
Department in writing within thirty (30) days after the Contractor becomes aware of the alleged
noncompliance with a complete description of the same. If the DOC does not, within forty-five (45)
days after its receipt of the Contractor’s notice, either (1) effect a cure or (2) if the noncompliance is
not one that can reasonably be cured within forty-five (45) days, develop a plan to cure the
noncompliance and diligently proceed according to that plan unto a cure is effected, then the
Contractor may terminate the Contract for cause by written notice to the DOC. The Contractor may
not terminate the Contract without cause unless express written consent to do so is provided by the
DOC.
VENDORNET REGISTRATION
Department of Administration and State Bureau of Procurement policies no longer require maintenance of
bidder’s lists or individual notification of contractors on bidders’ lists. In addition, there is no requirement to
post solicitations for bids/proposals in the Legal Notices of the Official State Newspaper. Contractors who
fail to register with VendorNet may not receive notification of procurement solicitations.
The State of Wisconsin’s purchasing information and contractor notification service is available to all
businesses and organizations that want to sell to the state. Anyone may access VendorNet on the
Internet at http://vendornet.state.wi.us to get information on state purchasing practices and policies,
commodities and services that the state buys, and tips on selling to the state. Vendors may use the same
Web site address for inclusion on the bidders list for commodities and services that the organization wants
to sell to the state. A subscription with notification guarantees the organization will receive an e-mail
message each time a state agency, including any campus of the University of Wisconsin System, posts a
request for bid or a request for proposal in their designated commodity/service area(s) with an estimated
value over $25,000. Organizations without Internet access receive paper copies in the mail. Increasingly,
state agencies also are using VendorNet to post simplified bids valued at $25,000 or less. Vendors also
may receive e-mail notices of these simplified bid opportunities.
To obtain information on the state’s bidder registration, please visit the VendorNet Web site at
http://vendornet.state.wi.us or call the VendorNet Information Center (1-800-482-7813). In the Madison
area, please call 264-7898.
Make sure you select the appropriate NIGP (Commodity) Codes. If you register without selecting the
codes for the commodities or services you are interested in supplying you will not be notified of bid
solicitations and your name will not be on a potential vendor list. Lists are generated by NIGP codes.
Consider using a generic email address that is accessed or delivered to multiple recipients (example:
bids@xyzcompany.com). This will insure that the bid notice is received.
Annually an email will be sent to renew your registration. If you do not renew the registration your company
may be removed from the VendorNet bidders list.
RFB # SN-1026
Nursing and Related Health Services
2.0
Due Date: March 3, 2008
Page 6 of 49
BID PROCEDURES AND INSTRUCTIONS
2.1
BID SUBMITTAL
Bidder must complete the Cost Information documents in Section 7.0.
Bidders must submit an original, marked as such, and 1 copy of all materials required (see section
8) for acceptance of the bid. Bids must be received in the below office by the specified time stated. All
bids must be time-stamped as accepted by the Purchasing Services Section by the stated time. Bids not
so stamped will not be accepted. Receipt of a bid by the State mail system does not constitute
receipt of a bid by the Purchasing Services Section, for purposes of this RFB. Please use one of the
options below for return of your bid.
The Bid(s) must be received at the Purchasing Services Section, at the office listed below, no later than
March 3, 2007 2pm Central Time. Any bids received after that time and date will be rejected.
USPS ADDRESS
Department of Corrections
Scott Noreuil / Purchasing Services Section
PO Box 7991
Madison, WI 53707-7991
COMMON CARRIER ADDRESS
Department of Corrections
Scott Noreuil / Purchasing Services Section
3099 East Washington Ave.
Madison, WI 53704-4338
FAXING: Faxed bids are NOT accepted.
E-MAILING: Emailed bids are NOT accepted.
All bids must be packaged, sealed, and show the following information on the outside of the package:
Contractor’s Name and Address
Request for Bid Title
Request for Bid Number
Bid Due Date
2.2
CALENDAR OF EVENTS
Listed below are important dates and times by which actions related to this Request for Bid (RFB) must be
completed. In the event that the State finds it necessary to change any of these dates and times it will do
so by issuing a supplement to this RFB, unless the event is listed as estimated.
DATE
February 11, 2008
February 18, 2008
February 19, 2008
March 3, 2008
March 6, 2008
March 17, 2008
2.3
EVENT
RFB posting date
Last day for submitting written questions
Answers to questions posted on VendorNet
Bids due from vendors
Estimated award date
Estimated Contract Start date
FORMAT OF BID
Vendors responding to this RFB must comply with the following format requirements, reference Section 9:
2.3.1.
SIGNED REQUEST FOR BID FORM DOA-3070 – Cover sheet of this RFB
Include here the signed Request for Bid form included with the bid and those certifications required
for submittal of a bid. Bids submitted in response to this RFB must be signed by the person in the
vendor's organization who is responsible for the decision as to the prices being offered in the bid or
by a person who has been authorized in writing to act as agent for the person responsible for the
decision on prices.
By submitting a signed bid, the vendor's signatories certify that in connection with this procurement:
(a) the vendor's organization or an agent of the vendor's organization has arrived at the prices in its
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 7 of 49
bid without consultation, communication or agreement with any other respondent or with any
competitor for the purpose of restricting competition, (b) the prices quoted in the bid have not been
knowingly disclosed by the vendor's organization or by any agent of the vendor's organization and
will not be knowingly disclosed by same, directly or indirectly, to any other respondent or to any
competitor, and (c) no attempt has been made or will be made by the vendor's organization or by
any agent of the vendor's organization to induce any other person or firm to submit or not to submit
a bid for the purpose of restricting competition.
2.4
2.3.2.
COST SUBMITTAL INFORMATION
Provide cost information on the Cost Information Sheets included in this Request for Bid. All costs
to furnish the product(s) included in the bid, in accordance with the terms and conditions of this
RFB, must be included. Reference the Section 7.0, Cost Information Requirements, for additional
instructions.
2.3.3.
VENDOR INFORMATION DOA-3477
Provide Vendor Company contact information as requested on the form.
2.3.4.
MBE/AMERICAN MADE AFFIDAVIT DOA-3476
Indicate on affidavit if Vendor Company is claiming to be certified Minority Enterprise certified by
the State of Wisconsin, Dept of Commerce or a Work Center certified by the State Use Board.
Indicate if product(s) is American- made and sign the non-collusion clause.
2.3.5.
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION DOA-3027
Information submitted as part of the bid document which is proprietary and confidential in nature
and which qualifies as a trade secret may be kept confidential under the Wisconsin Open Records
Law – Section 19.36(5), Wis. Stats. Complete and sign the attached form.
2.3.6.
WISCONSIN COOPERATIVE PURCHASING SERVICES MUNICIPAL DOA-3333
Vendors are encouraged to extend the contract resulting from this RFB to local governments in
Wisconsin. Indicate your willingness to allow Wisconsin municipalities to participate in this
contract by completing Form DOA-3333, Vendor Agreement - Cooperative Purchasing.
2.3.7.
VENDOR REFERENCE DOA-3478 Complete the Vendor Reference form with four vendors that
your company has done business with providing product/ services. Include the company name,
address, contact person and telephone number along with a brief description of the
product/service.
2.3.8.
ADDITIONAL INFORMATION
Include here any other forms required in the bid, see section 8.0. Include all additional information
that will be essential to an understanding of the bid. This might include diagrams, excerpts from
manuals, or other explanatory documentation that would clarify and/or substantiate the bid.
2.3.9.
STATE OF WISCONSIN TERMS AND CONDITIONS
The standard (DOA-3054) and supplemental (DOA-3681, R01/2001) terms and conditions shall govern
this RFB and subsequent award. Vendors must accept these terms and conditions or submit
point-by-point exceptions along with proposed alternative or additional language for each
point, including any vendor contracts. Submission of any standard vendor contracts as a
substitute for language in the terms and conditions is not a sufficient response to this
requirement and may result in rejection of the vendor's bid. The State reserves the right to
negotiate contractual terms and conditions other than those in the State of Wisconsin Contract
when it is in the best interest of the State to do so.
MULTIPLE BIDS
Multiple bids from a bidder will be permissible; however each bid must conform fully to the requirements
for bid submission. Each such bid must be separately submitted and labeled as Bid #1, Bid #2, etc. on
each page included in the response. Alternate acquisition plans do not constitute multiple bids.
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 8 of 49
2.5
INCURRING COSTS
The State of Wisconsin is not liable for any cost incurred by a bidderin the process of responding to this
RFB.
2.6
QUESTIONS, CLARIFICATIONS AND/OR REVISIONS THROUGH DESIGNATED CONTACT
All communications and/or questions regarding this request must be written and submitted via FAX, email, USPS mail or hand delivery to the Purchasing Services Section.
If a Bidder discovers any significant ambiguity, error, conflict, discrepancy, omission, or other deficiency in
this RFB, they have five (5) business days after the bid posting date to notify, in writing, the Purchasing
Agent at the address shown below of such error and request modification or clarification of the RFB
document. All written questions will be responded to in writing and provided to all bidders.
Department of Corrections
Scott Noreuil / Purchasing Services Section
PO Box 7991
Madison, WI 53707-7991
scott.noreuil@wisconsin.gov
Fax: 608-240-3342
From the date of release of this RFB, until a Letter of Intent is issued, all contacts with the DOC regarding
this RFB shall be made through the Purchasing Services Section. Violation of this condition may be
considered sufficient cause for rejection of a bid, irrespective of any other considerations.
In the event that it becomes necessary to provide additional clarifying data or information, or to revise any
part of this RFB, supplements or revisions will be posted on VendorNet.
Each bid shall stipulate that it is predicated upon the terms and conditions of this RFB and any
supplements or revisions thereof.
2.7
3.0
NEWS RELEASES AND PROMOTIONAL MATERIALS
News releases pertaining to the RFB or to the acceptance, rejection, or evaluation of bids shall not be
made without the prior written approval of the State. Contractor agrees to not use promotional or
marketing material which states expressly or by fair implication that the DOC endorses either the
Contractor or any sponsor of such material.
BID ACCEPTANCE, EVALUATION AND AWARD
3.1
BID OPENING
Bids will be opened on Month Day, 2007 at 3099 East Washington Ave. Madison, WI 53704 Purchasing
Services Section. Names of the bidders may be read aloud at that time.
3.2
BID ACCEPTANCE
Bids which do not comply with instructions or are unable to comply with specifications contained in this
RFB may be rejected by the State. The State may request reports on a contractor's financial stability and if
financial stability is not substantiated may reject a contractor's bid. The State retains the right to accept or
reject any or all bids, or accept or reject any part of a bid deemed to be in the best interest of the State.
The State shall be the sole judge as to compliance with the instructions contained in this RFB.
3.3
BID EVALUATION
Bids will be evaluated by the DOC's purchasing agent and program manager to verify that they will meet
all specified requirements in this RFB. This verification may include requesting reports on the contractor's
financial stability, conducting demonstrations of the contractor's proposed service(s), and reviewing results
of past awards to the contractor by the State of Wisconsin.
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 9 of 49
Bids from certified Minority Business Enterprises may be provided up to a five percent (5%) bid preference
in accordance with Wis. Stats. s. 16.75(3m).
3.4
METHOD OF AWARD
Award(s) shall be made on the basis of the lowest total hourly weekday and weekend cost (excluding
Holidays) for each job classification (i.e. RN, LPN, CNA, etc.) and by region from a responsive,
responsible bidder meeting bid specifications and requirements, which is judged to be in the best interest
of the DOC. An award will be provided to the five (5) lowest bidders per classification by region. The
Department reserves the right to accept or reject any and all bids in whole or in part. Bids that state the
DOC shall guarantee a specific quantity or dollar amount will be disqualified. If a responsive, responsible
State qualified work center meets the fair market price and other work center program criteria, the award
will be made to the work center (Wisconsin State Statute 16.752).
If the lowest awarded bidder does not respond to the DOC for service within 48hrs or fill a vacant position
within 10 business days, DOC has the right to contact the next lowest bidder.
In the event of tie, various other criteria may be used to determine the rank. The criteria may include, but
not be limited to individual hourly rates (i.e. lower Mon. – Fri. Days, or lower Holiday days, etc.), location, MBE
(Minority Business) status or any other method authorized by state statute or Administrative Code. Tied bid
decisions will not be arbitrary, but will be made based on the greatest value to the department.
3.5
NOTIFICATION OF INTENT TO AWARD
Any bidder who respond to this RFB, with a bid, will be notified in writing of the State’s intent to award the
contract(s) as a result of this RFB.
After notification of the intent to award is made, and under the supervision of agency staff, copies of bids
will be available for public inspection 8:30 a.m. to 3:30 p.m. at 3099 East Washington Ave., Madison WI.
Vendors should schedule reviews with purchasing agent to ensure that space is available for the review.
3.6
APPEALS PROCESS
The appeals procedure applies to only those Requests For Bids for Services that are $25,000.00 or
greater. Notices of intent to protest and protests must be made in writing. Protesters should make their
protests as specific as possible and shall identify statutes and Wisconsin Administrative Code provisions
that are alleged to have been violated.
The written notice of intent to protest the Intent to Award a Contract must be filed with:
Rick Raemisch, Secretary, Department of Corrections
P.O. Box 7925
Madison, WI 53707-7925
And be received in this office within five (5) working days after the notice of intent to award is issued. The
written protest must be received in this office within ten (10) working days after the notice of intent to
award is issued.
Copies of the notice of intent to protest and the written protest should be sent to the Purchasing
Section Chief.
The decision of the head of the procuring agency may be appealed to the Secretary of the Department of
Administration within five (5) working days of issuance, with a copy of such appeal filed with the procuring
agency, provided the appeal alleges a violation of statute or a provision of a Wisconsin Administrative
Code.
4.0
TECHNICAL REQUIREMENTS
The following specifications are the minimum acceptable specifications of the services desired. Failure by a bidder
to respond to any specific requirement or question may be the basis for elimination from consideration.
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 10 of 49
No revisions to this bid may be made unless in the form of an official addendum issued by the Department of
Corrections, Purchasing Services Section.
4.1
ON SITE SERVICE
In carrying out the scope of this Contract, the Contractor shall be required to perform services on DOC
property. Bidders cost shall include all labor, travel and insurance.
The contractor is required to maintain insurance in compliance with “Standard Terms and Conditions 23.0
Insurance.”
4.2
4.3
4.4
ORDERS
Specific order(s), Contract blanket order(s), may be issued to the Contractor(s).
4.2.1
Purchase Order(s): issued as one-time orders.
4.2.2
Blanket Purchase Order(s): issued for a specified period of time, to allow departmental personnel
to issue releases against the blanket purchase order(s) as needed.
4.2.3
Bidder should identify method by which your company will accept orders against this contract (e.g.
phone, fax, internet, etc.).
SUBCONTRACTING
Any Contract resulting from this bid shall not be, in whole or in part, subcontracted, assigned, or otherwise
transferred to any other Contractor without prior written notification to DOC Central Procurement.
4.3.1
The Contractor shall be directly responsible for any subcontractor’s performance and work quality
when used by the Contractor to carry out the scope of the job
4.3.2
If subcontractors are to be used, the Contractor must clearly explain their participation.
4.3.3
Contractor must make sure subcontractors abide by all terms and conditions under this Contract.
STAFF QUALIFICATIONS, EXPERIENCE AND TRAINING
To be eligible for a contract award, bidder must have the minimum qualifications as listed below or bid will
be disqualified.
4.4.1
The provider’s employees shall be appropriately licensed or certified in the State of Wisconsin.
Registered Nurses, Licensed Practical Nurses, Nurse Practitioners, and/or Physician Assistants shall
have a minimum of one year of documented experience, unless otherwise approved by BHS. Nurse
Practitioners must have a National Provider Identifier (NPI) and Division of Enforcement
Administration (DEA ) number for prescribing medications. Licenses and DEA numbers will need to
be provided to the institutions HSU Mgr on the first day of work.
4.4.2
In the event that duties or services fall under the statutory requirement for, or would reasonably be
expected to require a supervising physician, the provider agency must either have a competent
physician on staff or sub-contracted to fulfill the requirement. WCCS does not have physicians on
staff, and no physician routinely visits the centers. In the event that supervising physician services
are not available at the time of award, a reasonable period of time to secure those services will be
negotiated upon award. Failure to reach agreement on the time period, or failure to secure those
services in the time period agreed upon may result in pursuing the next lowest bidder.
4.4.3
The provider agency must provide a statement of training for each employee. At a minimum, the
training certification must include:
1. CPR/AED certification
2. Blood-Borne Pathogens training
3. Confidentiality (HIPAA) training
The above documents must be made available upon the first day of work to the HSU Manager.
RFB # SN-1026
Nursing and Related Health Services
4.4.4
4.5
Due Date: March 3, 2008
Page 11 of 49
All contractors of service are to have an annual TB test and Hepatitis vaccines or written verification
delivered to the responsible DOC HSU Mgr or CMSD.
SCHEDULING
The contractor will be oriented prior to beginning practice at the facility. Facility will orient the contractor either
during their hours of work or at another time paid for by the facility. Orientation will include at a minimum BHS
policy and procedures pertaining to health care and safety in a correctional environment.
4.5.1 Shifts will be the hours of work of the facility but may be negotiated across shifts if it meets the
institution needs. Unless directed otherwise, the contractual health care contractor will be expected to
work an eight-hour shift (or eight and one half hours, if unpaid lunch period is included), concurrent
with the shift schedule of the HSU. In general, HSU’s operate on a schedule of:
First shift (Days)
Second shift (Eves)
Third shift (Nocs)
8 – 8 ½ hours between the hours of
8 – 8 ½ hours between the hours of
8 – 8 ½ hours between the hours of
6:00 am – 4:00 pm
2:00 pm – 12:00 pm
10:00 pm – 8:00 am
4.5.2 Due to varied scheduling formats at institutions, a half-hour unpaid meal period may be provided per
shift or the contractor may work a straight shift without a meal period if approved by the HSM.
If a contracted RN’s or LPN’s hours exceed 40 hours per week, a premium will be paid in excess of
the base day rate amounting to $15/hr for a RN and $11/hr for LPN. All premium paid hours must be
approved by the HSM or a DOC supervisor.
4.5.3 The DOC will pay holiday pay only for hours worked on days recognized as holidays by DOC. Services
are not provided on these holidays unless otherwise agreed between DOC and contractor.
Recognized DOC holidays:
January 1 (New Year’s Day)
Third Monday in January (Martin Luther King Jr. Day)
Last Monday in May (Memorial Day)
July 4 (Independence Day)
First Monday in September (Labor Day)
Fourth Thursday in November (Thanksgiving Day)
December 24 (Christmas Eve)
December 25 (Christmas Day)
December 31 (New Year’s Eve)
4.5.4 In the event that a scheduled shift is found not to be needed, the department will cancel as soon as
possible, but at least four hours in advance, to avoid being charged.
4.5.5 Contracted agency staff must provide the HSM with a minimum of three (3) hours notice prior to
missing a scheduled work day or that agency staff person may be subject to denial of DOC work for a
period of thirty (30) days. If a contracted agency staff person misses scheduled work hours three times
without notification of the HSM that individual will be subject to removal from DOC work permanently.
4.6
All individuals provided to DOC institutions shall be employees of the contractor or providers subcontractor.
The contractor shall be responsible for all state, federal, and social security taxes, state and federal
unemployment compensation and worker’s compensation.
4.7
All healthcare personnel employed by the contractor and assigned to a DOC facility will have been offered
the option to receive hepatitis B vaccination from the contractor. Those personnel who have not received
immunization by their choice will be required to provide a signed statement of declination and waiver.
RFB # SN-1026
Nursing and Related Health Services
4.8
5.0
Due Date: March 3, 2008
Page 12 of 49
Department Of Correctional Facilities included in this bid are as follows:
CORRECTIONAL INSTITUTIIONS
1. Chippewa Valley Corr Institution, Chippewa Falls, WI
2. Columbia Correctional Institution, Portage, WI
3. Dodge Correctional Institution, Waupun, WI
4. Fox Lake Correctional Institution, Fox Lake, WI
5. Green Bay Correctional Institution, Green Bay, WI
6. Jackson Correctional Institution, Black River Falls, WI
7. Kettle Moraine Correctional Institution, Plymouth, WI
8. Milwaukee Secure Detention Facility, Milwaukee, WI
9. New Lisbon Correctional Institution, New Lisbon, WI
10. Oakhill Correctional Institution, Oregon, WI
11. Oshkosh Correctional Institution, Oshkosh, WI
12. Prairie Du Chien Corr. Facility, Prairie Du Chien, WI
13. Racine Correctional Institution, Sturtevant, WI
14. Racine Youthful Correctional Facility, Racine , WI
CORRECTIONAL CENTERS
21. Ethan Allen School, Wales, WI
22. Lincoln Hills School, Irma, WI
23. Southern Oaks Girls School, Union Grove, WI
24. Black River Correctional Center, Black River Falls, WI
25. John C. Burke Correctional Center, Waupun, WI
26. Drug Abuse Correctional Center, Winnebago, WI
27. Robert Ellsworth Correctional Center, Union Grove, WI
28. Felmers O Chaney Correctional Center, Milwaukee, WI
29. Flambeau Correctional Center, Hawkins, WI
30. Gordon Correctional Center, Gordon, WI
31. Kenosha Correctional Center, Kenosha, WI
32. McNaughton Correctional Center, Lake Tomahawk, WI
33. Milwaukee Womens Corr Center, Milwaukee, WI
34. Oregon Correctional Center, Oregon, WI
15. Redgranite Correctional Institution, Redgranite, WI
16. Stanley Correctional Institution, Stanley, WI
17. Sturtevant Transitional Facility, Sturtevant, WI
18. Taycheedah Correctional Institution, Fond du Lac, WI
19. Waupun Correctional Institution, Waupun, WI
20. Wisconsin Secure Program Facility, Boscobel, WI
35. Sanger Powers Correctional Center, Oneida, WI
36. Marshall Sherrer Correctional Center, Milwaukee, WI
37. St. Croix Correctional Center, New Richmond, WI
38. Thompson Correctional Center, Deerfield, WI
39. Winnebago Correctional Center, Winnebago, WI
4.9
Historical use data for FY07 for each facility included on the table in Section 7. The number of hours is
provided as a guide reference, and is not to be interpreted as a guarantee of minimum or maximum hours.
The nurse will be able to work a flexible schedule that is communicated to and approved in advance by
the Superintendent and contract monitor. The work schedule shall be arranged to consider the needs of
the center and the contractor, the majority of which are usually early morning and late afternoon hours due
to off-grounds work activity.
4.10
The contractor’s employees shall follow the Bureau of Health Services policies and procedures and
therefore, shall be required to read, sign and comply with the Department’s policy.
PERFORMANCE REQUIREMENTS
5.1
FIRM PRICES
Prices must remain firm for the initial contract term. Prices established may be lowered due to general
market conditions.
5.2
PRICE INCREASE REQUESTS
Price increase requests proposed after the initial Contract term must be received by Purchasing in writing
30 calendar days prior to the beginning of the next contract period for acceptance or rejection.
Proposed price increases are limited to fully documented cost increases submitted with the request and
may not increase more than the Consumer Price Index. If Purchasing deems cost increases are not
acceptable, it reserves the right to rebid the contract in whole or part. Acceptance of the price increases
shall be in the form of an amendment to the contract. Price increases must be labeled with the contract
number and be submitted in the same format as the original RFB. Any price increase requested that is
not submitted in the proper format may be rejected.
5.3
The lowest responsive, responsible bidder will be given first opportunity to respond to a need by a facility.
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 13 of 49
The bidder will be given 48hrs to respond after first contact (phone, fax or email) by the requesting facility.
If the bidder does not respond the next lowest bidder will be contracted. The bidder will also be given a
total of 10 business days to have a contracted provider onsite at the requesting facility, unless otherwise
agreed by facility and contractor. If either of these timeliness measures are not fulfilled the facility may go
to the next lowest bidder.
5.4
SITE VISIT
Bidder should visit the job site prior to submitting a bid to assure themselves and the DOC that they fully
understand all requirements of the project. No additional charges shall be allowed for lack of information.
Contact Scott Noreuil at (608) 240-5588 and arrange a visit to the job site.
5.5
NURSING SERVICES PROVIDED TO OFFENDERS
The health care contractors will provide the following services based on their licensure:
training, and experience including but not limited to:











education,
Conduct sick calls for offenders
Facilitate off-site health care by scheduling appointments with local contractors such as dentists,
optometrists, etc., as ordered by the physician or mid-level practitioners
Triage offender requests for services
Provide emergency care to inmates, staff or visitors
Provide specialty care, including hemodialysis with proper training
Order and maintain supplies and equipment
Obtain off-site contractors for care and treatment not provided on-site
Follow and assist with the formation of department policies and procedures
Practice per nursing protocol if a registered nurse or within the parameters of their licensure
Administer medications to inmates as prescribed by the physician or nurse practitioner
Collecting and reporting of utilization data
The contractor will receive direction from the Health Services Manager/designee of the facility.
5.6
EMPLOYEE HEALTH SERVICES PROVIDED TO DOC EMPLOYEES
The contractor will provide Employee Health Services to DOC health care personnel to include the
following:
A. Initial two-step tuberculin testing consisting of administration of the two tests and reading those tests 48
– 72 hours later.
B. Yearly tuberculin testing consisting of a test and reading the test 48 – 72 hours later.
C. Hepatitis B vaccination series (3 injections and follow up for those not shown to be immune).
Testing, results of testing and vaccinations will be recorded on forms provided by the department and
forwarded to the Employee Health Unit for entry into the WDOC Employee Health Database by the
Employee Health Nurses.
The contractor’s employees at each center will have access to the WDOC database for read-only
purposes.
Nursing Protocols for testing and vaccinations will be written by the Medical Director of the Bureau of
Health Services for the department.
Testing and vaccinations will be conducted at regular intervals at the Center, dependent on the employee
population served. Notices will be sent to the designated DCC units to inform them of dates of service,
which they may attend.
Testing materials, vaccines, syringes, etc. will be provided upon order from the DOC Central Pharmacy
Services.
Training in the Employee Health Program will be provided by the DOC Employee Health Unit to the
contractor’s Registered Nurses.
RFB # SN-1026
Nursing and Related Health Services
6.0
Due Date: March 3, 2008
Page 14 of 49
5.7
BHS will evaluate the contractor’s performance quarterly using the standard terms and conditions,
technical and performance specifications of this bid. Agencies that cannot maintain a rate of at least 90%
availability for routine scheduling could be demoted in call preference order, or dropped from the list.
5.8
All health care personnel employed by the contractor and assigned to a DOC facility will have a written
certification from a licensed physician within 30 days of employment that the employee has been screened
for tuberculosis infection and has been found free of communicable disease.
5.9
The contractor’s employees agree to at all times comply with and observe all state laws and regulations
which are in effect during the period of the contract and which in any manner effect the provision of services.
The contractor’s employees shall follow all Department of Corrections, facility, and Bureau of Health Services
Policies and Procedures. These policies and procedures will be available to contractor(s) upon award of
contract. These policies and procedures are available to view, by appointment, by contacting: Dave Schuller
at dave.schuller@wisconsin.gov or (608) 240-5588. The contractor's employees shall be required to
complete a background/conviction record form prior to them working in a correctional facility. That
background check will be conducted by the responsible institution working closely with DOC Human
Resources Department.
5.10
The contractor agrees to maintain all records in accordance with standards acceptable to the practice, and in
compliance with policy as established by the Bureau of Health Services. The contractor further agrees that
all records pertaining to activities under this agreement shall be made available upon request of properly
identified representative of the state for review, audit, and copying. Medical records containing reports of
services, course of treatment, and progress will be maintained at the Health Services Units and will be the
property of the Department of Corrections. Contractors will be responsible for compliance with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) regulations on medical record privacy (45 CFR,
parts 160 & 164).
SUPPORT REQUIREMENTS
6.1
INVOICING / PAYMENT REQUIREMENTS
6.1.1 INVOICES FOR PURCHASE ORDERS
Contractor must agree that all invoices and purchasing card charges shall reflect the prices and
discounts established for the services on this contract for all orders placed by the DOC even
though the contract number and/or correct prices may not be referenced on each order.
The DOC must meet a statutory mandate to pay or reject invoices within 30 days of receipt by
DOC Accounts Payable. Before payment is made, it also must verify that all invoiced charges are
correct as per this Contract. Only properly submitted invoices will be officially processed for
payment. Prompt payment requires that contractor invoices be clear and complete in conformity
with the instructions below. All invoices shall be sent to BHS Central Office for payment
processing. All invoices must be itemized showing:







Contractor name
remit to address
purchase order number if provided
release number if given
date of order/release
BHS Agency Staffing Log on next page (attached to each invoice)
prices per the Contract
The original invoice and two copies must be sent to the DOC address listed on the Purchase
Order.
6.1.2
Final payment may not be made until work has been accepted by the DOC
6.1.3
Billing for the provision of Employee Health Services for WCCS shall be a separate invoice
listing the hours of service and contracted rate. This Invoice shall be sent to BHS Central Offices.
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 15 of 49
BHS AGENCY STAFFING LOG
For the Month of:___________
Hours
Correctional Center A
Classification A
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Classification B
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Classification C
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Correctional Center B
Classification A
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Classification B
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Classification C
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Correctional Institution A
Classification A
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Classification B
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Classification C
Last Name, First Name 1
Last Name, First Name 2
Last Name, First Name 3
Week 1
Hourly
Rate
Total
Dollars
Hours
Week 2
Hourly
Rate
Toal
Dollars
Hours
Week 3
Hourly
Rate
Total
Dollars
Hours
Week 4
Hourly
Rate
Total
Dollars
Hours
Monthly Total
Hourly
Total
Rate
Dollars
RFB # SN-1026
Nursing and Related Health Services
7.0
Due Date: March 3, 2008
Page 17 of 49
COST INFORMATION REQUIREMENTS
Bidder shall complete the Cost Information Sheet(s), including an hourly cost for each weekday (day, eve and noc),
weekend (day, eve and noc), Holiday (day, eve and noc) per classification included in the bid. The bidder does not need
to bid on each job classification. The quoted prices shall include labor, travel and insurance.
7.1
Be sure to include the name of the region for which the costs apply on each Cost Information Sheet based on the
list of Wisconsin service areas listed below. Complete a separate Cost Information Sheet for each region when
the costs will be different between regions. Duplicate Cost Information Sheet as needed. The next page includes
the historical data for some levels of service by the WDOC centers and institutions.
Wisconsin Service Areas
Northwestern Region
North Central Region
North Eastern Region
Central West Region
Central Region
Central East Region
Southwestern Region
South Central Region
Southeastern Region
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 18 of 49
HISTORICAL DATA FOR CENTERS AND INSTITUTION BY JOB CLASSIFICATION FOR FY 07. SEE ATTACHMENT “B” FOR NAMES AND LOCATION
CORRECTIONAL CENTERS
AND INSTITUTIONS
Correctional Centers (No on-site HSU)
BRCC
FCC
FCCC
GCC
KCC
MCC
MSCC
MWCC
OCC
SCCC
SPCC
TCC
WCC
(Correctional Institutions/Centers with
on-site HSU)
CCI
DCI
FLCI
GBCI
JCI
KMCI
MSDF
OCI
OSCI
RCI
RGCI
TCI
WCI
WSPF
DCI DIALYSIS
JBCC
RECC
DACC
Totals
NURSING
(RN,
LPN,CNA)
MA/MPAA
1052
2256
1850
1620
1896
1772
1186
3592
1142
1992
1696
1996
4512
5232
25635
2513
6832
2653
2536
14024
2369
27348
1989
1987
38615
380
656
1351
2530
1796
4952
169960
NP
PHLEBOTOMIST
UNIT CLERK
1052
2256
1850
1620
1896
1867
1186
3592
1142
1992
1696
1996
4548
95
36
1658
1530
305
235
624
1534
924
59
2685
1589
2156
87
126
2139
135
2344
6413
533
104
6267
TOTAL
HOURS FOR
FY 2007
1530
5232
28823
2513
7137
2888
3160
18302
3293
28937
1989
1987
43036
467
565
1351
3063
1796
5191
186423
RFB # SN-1026
Nursing and Related Health Services
Due Date: March 3, 2008
Page 19 of 49
COST INFORMATION SHEET
Nursing and Related Health Services
Weekday and Weekend Cost
(SN-1026)
Complete a separate cost information sheet for each region when the costs will be different between regions.
See Section 7.1 for a listing of the Wisconsin Service Area Regions and Section 4.5.1 for actual scheduled work hours.
Duplicate Cost Information Sheets as needed
Cost for Wisconsin Service Area Region(s): _____________________________________________________________
Bidder shall include an hourly cost for each weekday (day, eve and noc) and weekend (day, eve and noc) for furnishing the service(s)
included in the bid, in accordance with the terms and conditions of this bid. The bidder does not need to bid on each job classification for
their bid to be accepted. The quoted prices shall include labor, travel and insurance.
Mon-Fri
Mon-Fri
Mon-Fri
Weekend
Weekend
Weekend
Total hourly rate
Job
Day
Eve
Noc
Day
Eve
Noc
per job
Classification
classifications
RN
LPN
CNA
Phlebotomist
Unit Clerk/
Receptionist
Physician’s
Assistant/NP
Medical
Assistant
Medical
Records Tech
RN
w/Hemodialysis
Experience
Hemodialysis
Tech
Page 20 of 49
COST INFORMATION SHEET
Nursing and Related Health Services
Holiday Cost
(SN-1026)
Cost for Wisconsin Service Area Region(s): ________________________________________________
Bidder shall include an hourly cost for each holiday (day, evening and noc) for furnishing the service(s) included in the bid, in accordance
with the terms and conditions of their bid. The bidder does not need to bid on each job classification for this bid to be accepted. The
quoted prices shall include labor, travel and insurance.
Holiday costs will be for informational purposes only.
Job Classification
Holiday
Day
Holiday
Eve
Holiday
Noc
RN
LPN
CNA
Phlebotomist
Unit Clerk/
Receptionist
Physician’s Assistant
Medical Assistant
Medical Records Tech
RN w/Hemodialysis
Experience
Hemodialysis Tech
______________________________________________
Name of Authorized Company and Representative (Print)
___________________________________________
Title
______________________________________________
Signature
___________________________________________
Date
Page 21 of 49
8.0
REQUIRED FORMS AND ATTACHMENTS
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION
Information submitted as part of the bid document which is proprietary and confidential in nature and which
qualifies as a trade secret may be kept confidential under the Wisconsin Open Records Law – Section
19.36(5), Wis. Stats. Please complete and sign the attached form.
LOCAL GOVERNMENT PARTICIPATION
Contractors are encouraged to extend the contract resulting from this RFB to local governments in
Wisconsin. Please indicate your company’s willingness to allow Wisconsin municipalities to participate in
this contract by completing Form DOA-3333, Contractor Agreement – WI’s Cooperative Purchasing
Service.
FORMS
The following forms must be completed and submitted with the bid in accordance with the instructions given
in Section 2.3.
Request for Bid Form (DOA-3070) - cover sheet, first page of this RFB
Vendor Information Form (DOA-3477)
MBE/ American Made Affidavit Form (DOA-3476)
W9 Form (DOA-6448)
Designation of Confidential and Proprietary Information Form (DOA-3027)
Vendor Agreement – WI’s Cooperative Purchasing Service Form (DOA-3333)
Vendor Reference Form (DOA-3478)
One (1) Signed State of Wisconsin Department of Corrections Contracts
2 copies of cost information sheet (s)
Copy of License(s) for Nursing and Technical personnel required by State of Wisconsin Law upon
intent to bring a contractor into the DOC system.
Proof of Insurance(The Vendor shall have added the “Department of Corrections” as an additional
insured under the commercial general, automobile and Vendor’s liability policies on any
insurance certificate provided. A minimal comprehensive liability coverage of $1,000,000
per occurrence is required).
Items that will need to be available upon request include:
copy of nurse or health personnel State of Wisconsin licensure or certification
copy of last TB test, hepatitis screening and/or CPR certification
STATE OF WISCONSIN
Bid / Proposal #
SN-1026
Commodity / Service
NURSING
DOA-3477 (R05/98)
VENDOR INFORMATION
1.
BIDDING / PROPOSING COMPANY NAME
FEIN
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
2.
City
State
Zip + 4
Name the person to contact for questions concerning this bid / proposal.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
3.
City
State
Zip + 4
Any vendor awarded over $25,000 on this contract must submit affirmative action information to the
department. Please name the Personnel / Human Resource and Development or other person responsible
for affirmative action in the company to contact about this plan.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
4.
City
State
Zip + 4
Mailing address to which state purchase orders are mailed and person the department may contact
concerning orders and billings.
Name
Title
Phone
(
)
Toll Free Phone
FAX
(
)
E-Mail Address
(
)
Address
City
5.
State
Zip + 4
CEO / President Name
This document can be made available in accessible formats to qualified individuals with disabilities.
State of Wisconsin
Department of Administration
DOA-3476 (R01/2000)
S. 16.75(3m) Wis. Stats.; s. 16.752
Wis. Stats.
Bid / Proposal #
SN-1026
Commodity
Nursing
Affidavit
This completed affidavit must be submitted with the bid/proposal.
Proposer Preference: Please indicate below if claiming a proposer preference.
Minority Business Preference (s. 16.75(3m), Wis. Stats.) - Must be certified by the Wisconsin
Department of Commerce. If you have questions concerning the certification process, contact the
Wisconsin Department of Commerce, 8th Floor, 123 W. Washington Ave., P.O. Box 7970, Madison,
Wisconsin 53707-7970,
(608) 267-9550.
Work Center Preference (s 16.752, Wis Stats.) - Must be certified by the State of Wisconsin Use
Board. If you have questions concerning the certification process, contact the Wisconsin State Use
Board, 101 East Wilson Street, 6th Floor, PO Box 7867, Madison, Wisconsin 53707-7867 or 608/2662553.
American-Made Materials: The materials covered in our proposal were manufactured in whole or in substantial part
within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial
part in the United States.
Yes
No
Unknown
Non-Collusion: In signing this proposal we also certify that we have not, either directly or indirectly, entered into any
agreement or participated in any collusion or otherwise taken any action in restraint of free trade; that no attempt
has been made to induce any other person or firm to submit or not to submit a proposal; that this proposal has been
independently arrived at without collusion with any other proposer competitor or potential competitor; that this
proposal has not been knowingly disclosed prior to opening of proposals to any other proposer or competitor; that
the above statement is accurate under penalty of perjury.
We will comply with all terms, conditions, and specifications required by the State of Wisconsin in this
Announcement of Bid/Proposal and the terms of our bid/proposal.
Authorized
Representative
Authorized
Representative
Company
Name
Title
Type or Print
Date (m/dd/ccyy)
Signature
Telephone
(
)
This document can be made available in accessible formats to qualified individuals with disabilities.
State of Wisconsin
Department of Administration
Division of Executive Budget and Finance
State Controller’s Office
DOA-6448 (R09/2004)
Substitute
W-9
DO NOT send to IRS
Taxpayer Identification Number (TIN) Verification
Print or Type
Please see attachment or reverse for complete instructions.
This form can be made available in alternative formats to qualified individuals upon request.
Legal Name (as entered with IRS)
Entity Designation (check only one) Required
If Sole Proprietorship or LLC Single Owner, enter your Last, First, MI
Individual/Sole Proprietor/LLC Single Owner
Corporation (includes service corporations)
Limited Liability Company - Partnership
Limited Liability Company - Corporation
Government Entity
Hospital Exempt from Tax or Government
Owned
Long Term Care Facility Exempt from Tax or
Government Owned
All Other Entities
Trade Name
Enter Business Name if different from above.
Remit Address (where check should be mailed)
PO Box or Number and Street, City, State, ZIP + 4
Taxpayer Identification Number (TIN)
Order Address
(where order should be mailed; complete only if different from remit)
If you are a sole proprietor and you have an EIN,
you may enter either your SSN or EIN. However,
the IRS prefers that you show the SSN.
PO Box or number and street, City, State, ZIP + 4
___ ___ ___ ___ ___ ___ ___ ___ ___
1099 Address
(for return of 1099 form; complete only if different from remit)
PO Box or number and street, City, State, ZIP + 4
Check Only One Required (see “Instructions”)
Social Security Number (SSN)
Employer Identification Number (EIN)
Individual Taxpayer Identification Number
for U.S. Resident Aliens (ITIN)
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number, AND
2. I am not subject to back up withholding because (a) I am exempt from backup withholding, or (b) I have not been
notified by the Internal Revenue Service (IRS) that I am subject to back up withholding as a result of a failure to report
all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
3. I am a U.S. person (including a US resident alien).
Printed Name
Printed Title
Telephone Number
(
)
Signature
Date (mm/dd/ccyy)
For Agency Use Only
Agency Number
Contact
Phone Number
Change
Name
Address
Other (explain)
Return completed form via facsimile machine or to the address listed below.
For your convenience this form has been designed for return in a standard Window envelope.
DOA-6448 (R06/2004)
Instructions for Completing Taxpayer Identification Number Verification
(Substitute W-9)
Legal Name As entered with IRS
Individuals: Enter Last Name, First Name, MI
Sole Proprietorships: Enter Last Name, First Name, MI
LLC Single Owner: Enter owner's Last Name, First
Name, MI
All Others: Enter Legal Name of Business
Trade Name
Individuals: Leave Blank
Sole Proprietorships: Enter Business Name
LLC Single Owner: Enter LLC Business Name
All Others: Complete only if doing business as a D/B/A
identification purposes and to help verify the accuracy of
your tax return. You must provide your TIN whether or
not you are required to file a tax return. Payers must
generally withhold 29% of taxable interest, dividend, and
certain other payments to a payee who does not furnish
a TIN to a payer. Certain penalties may also apply.
What Name and Number to Give the Requester
For this type of account:
1. Individual
Give name and SSN of:
The individual
2. Two or more individuals (joint
account)
The actual owner of the account or,
if combined funds, the first
individual no the account 1
3. Custodian account of a minor
(Uniform Gift to Minors Act)
The minor 2
Remit Address
Address where payment should be mailed.
The grantor-trustee 1
Order Address
Address where order should be mailed. Complete only if
different from remit address.
1099 Address
Address where 1099 should be mailed. Complete only if
different from remit address.
Entity Designation
Check ONE box which describes the type of business
entity.
Taxpayer Identification Number
LIST ONLY ONE: Social Security Number OR Employer
Identification
Number
OR
Individual
Taxpayer
Identification Number. See “What Name and Number
to Give the Requester” at right.
If you do not have a TIN, apply for one immediately.
Individuals use federal form SS-05 which can be obtained
from the Social Security Administration. Businesses and
all other entities use federal form SS-04 which can be
obtained from the Internal Revenue Service.
Certification
You must cross out item 2 above if you have been
notified by the IRS that you are currently subject to
backup withholding because you have failed to report all
interest and dividends on your tax return. For real estate
transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured
property, cancellation of debt, contributions to an
individual retirement arrangement (IRA), and generally,
payments other than interest and dividends, you are not
required to sign the Certification, but you must provide
your correct TIN.
4. a. The usual revocable savings
trust (grantor is also trustee)
b. So-called trust account that is
not a legal or valid trust under
state law
5. Sole proprietorship or SingleOwner LLC
For this type of account:
6. Sole Proprietorship or SingleOwner LLC
The actual owner 1
The owner 3
Give name and EIN of:
The owner 3
7. A valid trust, estate, or pension
trust
Legal entity 4
8. Corporate or LLC electing
corporate status on Form 8832
The corporation
9. Association, club, religious,
charitable, educational, or other
tax-exempt organization
10. Partnership or multi-member
LLC
The organization
The partnership
11. A broker or registered nominee
The broker or nominee
12. Account with the Department of
Agriculture in the name of a
public entity (such as a state or
local government, school district
or prison) that receives
agricultural program payments
The public entity
1 List first and circle the name of the person whose number you
furnish. If only one person on a joint account has an SSN, that
person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name, but you may also enter your
business or “DBA” name. You may use either your SSN or EIN (if you
have one).
4 List first and circle the name of the legal trust, estate, or pension
trust. (Do not furnish the TIN of the personal representative or trustee
unless the legal entity itself is not designated in the account title.)
Privacy Act Notice
Section 6109 requires you to furnish your correct TIN
to persons who must file information returns with the IRS
to report interest, dividends, and certain other income
paid to you, mortgage interest you paid, the acquisition
or abandonment of secured property, or contributions
you made to an IRA. The IRS uses the numbers for
NOTE: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Taxpayer Identification Request
In order for the State of Wisconsin to comply with the Internal Revenue Service regulations, this letter is to request
that you complete the enclosed Substitute Form W-9. Failure to provide this information may result in delayed
payments or backup withholding. This request is being made at the direction of the Wisconsin State Controller in
order that the State may update its vendor file with the most current information.
Please return or FAX the Substitute Form W-9 even if you are exempt from backup withholding within (10) days of
receipt. Please make sure that the form is complete and correct. Failure to respond in a timely manner may
subject you to a 29% withholding on each payment or require the State to withhold payment of outstanding
invoices until this information is received.
We are required to inform you that failure to provide the correct Taxpayer Identification Number (TIN) / Name
combination may subject you to a $50 penalty assessed by the Internal Revenue Service under section 6723 of the
Internal Revenue Code.
Only the individual’s name to which the Social Security Number was assigned should be entered on the first line.
The name of a partnership, corporation, club, or other entity, must be entered on the first line exactly as it was
registered with the IRS when the Employer Identification Number was assigned.
DO NOT submit your name with a Tax Identification Number that was not assigned to your name. For example, a
doctor MUST NOT submit his or her name with the Tax Identification Number of a clinic he or she is associated
with.
Thank you for your cooperation in providing us with this information.
STATE OF WISCONSIN
DOA-3027 (R01/98)
DESIGNATION OF CONFIDENTIAL AND PROPRIETARY INFORMATION
The attached material submitted in response to Bid/Proposal # SN-1026 Nursing and Related Health
Services includes proprietary and confidential information which qualifies as a trade secret, as provided
in s. 19.36(5), Wis. Stats., or is otherwise material that can be kept confidential under the Wisconsin
Open Records Law. As such, we ask that certain pages, as indicated below, of this bid/proposal
response be treated as confidential material and not be released without our written approval.
Prices always become public information when bids/proposals are opened, and therefore
cannot be kept confidential.
Other information cannot be kept confidential unless it is a trade secret. Trade secret is defined in s.
134.90(1)(c), Wis. Stats. as follows: "Trade secret" means information, including a formula, pattern,
compilation, program, device, method, technique or process to which all of the following apply:
1. The information derives independent economic value, actual or potential, from not being generally
known to, and not being readily ascertainable by proper means by, other persons who can obtain
economic value from its disclosure or use.
2. The information is the subject of efforts to maintain its secrecy that are reasonable under the
circumstances.
We request that the following pages not be released
Section
Page #
Topic
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
IN THE EVENT THE DESIGNATION OF CONFIDENTIALITY OF THIS INFORMATION IS CHALLENGED, THE
UNDERSIGNED HEREBY AGREES TO PROVIDE LEGAL COUNSEL OR OTHER NECESSARY ASSISTANCE
TO DEFEND THE DESIGNATION OF CONFIDENTIALITY AND AGREES TO HOLD THE STATE HARMLESS
FOR ANY COSTS OR DAMAGES ARISING OUT OF THE STATE'S AGREEING TO WITHHOLD THE
MATERIALS.
Failure to include this form in the bid/proposal response may mean that all information provided as part of the
bid/proposal response will be open to examination and copying. The state considers other markings of confidential
in the bid/proposal document to be insufficient. The undersigned agrees to hold the state harmless for any
damages arising out of the release of any materials unless they are specifically identified above.
Company Name
___________________________________________
Authorized Representative
___________________________________________
Signature
Authorized Representative
___________________________________________
Date
___________________________________________
Type or Print
This document can be made available in accessible formats to qualified individuals with disabilities.
Division of State Agency Services
State Bureau of Procurement
State of Wisconsin
Department of Administration
DOA-3333 (R03/2004)
Vendor Agreement
Wisconsin’s Cooperative Purchasing Service
Wisconsin statutes (s. 16.73, Wis. Stats.) establish authority to allow Wisconsin municipalities to purchase from state
contracts. Participating in the service gives vendors opportunities for additional sales without additional bidding.
Municipalities use the service to expedite purchases. A "municipality" is defined as any county, city, village, town, school
district, board of school directors, sewer district, drainage district, vocational, technical and adult education district, or any
other public body having the authority to award public contracts (s. 16.70(8), Wis. Stats.). Federally recognized Indian tribes
and bands in this state may participate in cooperative purchasing with the state or any municipality under ss. 66.0301(1) and
(2), Wis.Stats.
Interested municipalities:

will contact the vendor directly to place orders referencing the state agency contract number; and

are responsible for receipt, acceptance, inspection of commodities directly from the vendor, and making payment
directly to the vendor.
The State of Wisconsin is not a party to these purchases or any dispute arising from these purchases and is not liable for
delivery or payment of any of these purchases.
The State of Wisconsin will determine the vendor’s participation by checking a box below.
MANDATORY: Bidders/Proposers must agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. Vendors should note any special conditions below.
OPTIONAL: Bidders/Proposers may or may not agree to furnish the commodities or services of this bid/proposal to
Wisconsin municipalities. A vendor’s decision on participating in this service has no effect on awarding this
contract.
A vendor in the service may specify minimum order sizes by volume or dollar amount, additional charges beyond
normal delivery areas, or other minimal changes for municipalities.
Vendor: please check one of the following boxes in response.
I Agree to furnish the commodities or services of this bid/proposal to Wisconsin municipalities with any
special conditions noted below.
I Do Not Agree to furnish the commodities or services to Wisconsin municipalities.
Special Conditions (if applicable):
Signature
Date (mm/dd/ccyy)
Name (Type or Print)
Title
Company
Telephone
(
Address (Street)
Commodity/Service
Nursing
City
State
)
ZIP + 4
Request for Bid/Proposal Number
SN-1026
This form can be made available in accessible formats upon request to qualified individuals with disabilities.
STATE OF WISCONSIN
Bid / Proposal #
DOA-3478 (R12/96)
SN-1026
Nursing
VENDOR REFERENCE
FOR VENDOR:
Provide company name, address, contact person, telephone number, and appropriate information on the
product(s) and/or service(s) used for four (4) or more installations with requirements similar to those included in this
solicitation document. If vendor is proposing any arrangement involving a third party, the named references should
also be involved in a similar arrangement.
Company Name
Address (include Zip + 4)
Contact Person
Phone No.
Product(s) and/or Service(s) Used
Company Name
Address (include Zip + 4)
Contact Person
Phone No.
Product(s) and/or Service(s) Used
Company Name
Address (include Zip + 4)
Contact Person
Phone No
Product(s) and/or Service(s) Used
Company Name
Address (include Zip + 4)
Contact Person
Phone No.
Product(s) and/or Service(s) Used
This document can be made available in accessible formats to qualified individuals with disabilities.
9.0
TERMS AND CONDITIONS
The Standard Terms and Conditions (DOA-3054) and Supplemental Standard Terms and Conditions for
Procurements for Services (DOA-3681) are by reference made a part of this RFB. The vendor is directed to the
following paragraphs of DOA-3054 in particular, as they constitute a mandatory part of any resulting contract.
2.0 Deviations and Exceptions
19.0 Nondiscrimination/Affirmative Action
23.0 Insurance Responsibility
24.0 Cancellation
Failure of the successful bidder to accept these terms may result in cancellation of the award.
SPECIAL TERMS AND CONDITIONS
9.1
PRIME CONTRACTOR AND MINORITY BUSINESS SUBCONTRACTORS
The prime contractor will be responsible for contract performance when subcontractors are used.
However, when subcontractors are used, they must abide by all terms and conditions of the contract. If
subcontractors are to be used, the bidder must clearly explain their participation.
The State of Wisconsin is committed to the promotion of minority business in the state's purchasing
program and a goal of placing 5% of its total purchasing dollars with certified minority businesses.
Authority for this program is found in ss. 15.107(2), 16.75(4), 16.75(5) and 560.036(2), Wisconsin
Statutes. The contracting agency is committed to the promotion of minority business in the state's
purchasing program.
The State of Wisconsin policy provides that minority-owned business enterprises certified by the
Wisconsin Department of Commerce, Bureau of Minority Business Development should have the
maximum opportunity to participate in the performance of its contracts. The supplier/contractor is strongly
urged to use due diligence to further this policy by awarding subcontracts to minority-owned business
enterprises or by using such enterprises to provide goods and services incidental to this agreement, with a
goal of awarding at least 5% of the contract price to such enterprises.
The supplier/vendor shall furnish appropriate quarterly information about its effort to achieve this goal,
including the identities of such enterprises certified by the Wisconsin Department of Commerce and their
contract amount.
Quarterly reports shall be due fifteen (15) calendar days after the end of the quarter, 9/31, 12/31, 3/31 and
6/30. The form for submitting this information is available from the VendorNet on the Contract’s Home
Page. http://vendornet.state.wi.us/vendornet/doaforms/doa-3234.doc.
The report shall be submitted even if there is no activity.
Submit to:
e-mail: DOCDMSPurchasing@wisconsin.gov
post:
MBE Purchasing Report
PO BOX 7991
Madison, WI 53707-7991
The State reserves the right to request additional reports from the Vendor at no additional cost. Vendor
shall use every effort to provide such reports in a reasonable timeframe, but no later than thirty (30)
calendar days from the time the request was submitted. These reports shall be in a form approved in
advance in writing by the State.
A listing of certified minority businesses, as well as the services and commodities they provide, is available
from the Department of Administration, Office of the Minority Business Program, 608/267-7806. The listing
is published on the Internet at: http://www.doa.state.wi.us/deo/mbe/minority_search.asp
9.2
AFFIRMATIVE ACTION
All contracts of more than Twenty Five Thousand Dollars ($25,000) require the submission of a written
affirmative action plan. Vendors with an annual workforce of less than twenty-five employees are excluded
from this requirement. Within fifteen (15) days after the award of the contract, the written affirmative action
plan, or statement requesting exception, shall be submitted to the Department’s Contract Compliance
Office. Address plan to:
Ann Hommer
Department of Corrections, Purchasing Section
3099 E. Washington Ave.
PO BOX 7991
Madison, Wisconsin 53707-7991.
Vendors are encouraged to contact this office at, (608) 240-5574, for technical assistance on equal
opportunity.
"Affirmative Action Plan" is a written document that details an affirmative action program. Key parts of an affirmative action plan
are: (1) a policy statement pledging nondiscrimination and affirmative action employment, (2) internal and external dissemination of
the policy, (3) assignment of key employee as the equal opportunity officer, (4) a workforce analysis that identifies job classification
where representation of women, minorities and the disabled is deficient, (5) goals and timetables that are specific and measurable
and that are set to correct deficiencies and to reach a balance of work force, (6) revision of all employment practices to ensure that
they do not have discriminatory effects, (7) establishment of internal monitoring and reporting systems to measure progress
regularly.
Failure to comply appropriately with these requirements can lead to your company being banned from
doing business with any agency of the State of Wisconsin. Additionally, failure to comply can result in
termination of this contract, or withholding of payment. On the Vendor Information Sheet please provide
the requested information. For additional information see Section 19.0 of the Standard Terms and
Conditions.
9.3
WISCONSIN SALES AND USE TAX REGISTRATION
The State of Wisconsin shall not enter into a contract with a vendor, and reserves the right to cancel any
existing contract if the vendor or vendor has not met or complied with the requirements of s. 77.66, Wis.
Stats., and related statutes regarding certification for collection of sales and use tax.
If you have not established a certification for Collection of Sale and Use Tax status with the Wisconsin
Department of Revenue, the DOC and any other state agency can not issue any purchase orders to your
firm. For additional information see http://www.dor.state.wi.us/html/vendlaw.html
9.4
TOBACCO-FREE ENVIRONMENT
All DOC Institutions are Tobacco-Free. Vendors are not to possess or use any tobacco product inside an
institution.
9.5
SECURITY AND CREDENTIAL REVIEW
The department requires that all persons providing services in its facilities submit and pass criminal
background and license/credential checks. History of arrests and/or convictions could disqualify an individual
if deemed relevant to the position, service or site. Background checks will be conducted and paid for by the
institution, and records will be maintained on site, as well as copies of credentials and licenses.
9.6
ACCESS TO DOC INSTITUTIONS
Execution of this contract requires access/entrance into DOC secure facilities. All vendor staff will be
required to submit to a Criminal Background Check, which must be successfully completed prior to arrival.
Although specific policies vary somewhat between facilities, the following will apply:

A contraband item are not allowed in any facility and includes but are not limited to drugs, tobacco
products, cell phones, adult or pornographic materials, explosives and weapons (including pocket
knives and razor knives, unless a part of an inventoried tool box.) Tool boxes should be inventoried
prior to arrival to facilitate security staff accounting. Items may be left with security, however illegal
items may not be returned.

Vendor staff walking in may be required to pass through a metal detector and/or have all carry-in
items x-rayed or searched.

Fraternization with inmates is prohibited. Nothing is to be given to inmates (food, mail, money,
newspapers or magazines, etc.) without authorization and nothing is to be received from inmates for
removal or transport from the institution.
9.7
EMPLOYEE IDENTIFICATION
All vendors’ employees, while working on DOC property, must wear a clearly displayed photo identification
badge (provided by the Vendor at the Vendor’s cost) showing they are employees of the vendor. Badges
must be available but will not be required to be worn when protective clothing and respiratory protection is
required.
9.8
CONFIDENTIALITY
In addition to Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations on medical
record privacy (45 CFR, parts 160 & 164), the department considers all personally identifiable information
relating to offenders to be confidential, and such data is not to be released unless approved by Competent
Authority, designated by the department.
9.9
EMPLOYMENT OF CURRENT OFFENDERS AND EMPLOYMENT AND RETENTION OF
INDIVIDUALS ARRESTED, CHARGED OR CONVICTED OF CRIMINAL OFFENSE
9.9.1 Vendor shall not employ a person who is on probation, parole or an inmate who is supervised by
Intensive Sanctions for any position where the primary duties and responsibilities involve the
supervision or treatment of inmates, probationers or parolees or involve access to offenders' records
or funds.
9.9.2
To make determinations on substantial relationships to the circumstances of the job, Vendor shall
have written policies on how the applicant for employment and the employee will be reviewed. To
guide the development of the policy, the Vendor may obtain a copy of Chapter 301 of the
Department of Corrections Supervisor's Manual from the Contract Administrator.
9.10
FRATERNIZATION
9.10.1 Vendor’s are prohibited from forming of improper relationships between Vendor's employees and
offenders. Vendor shall have a signed employee statement on fraternization and sexual contact
in each employee's personnel file.
9.11
CONTRACTOR AUDIT REQUIREMENT
9.11.1 Governmental entities shall comply with the Single Audit Act of 1984, OMB Circular A-128 and the
State Single Audit Guidelines issued by the Department of Administration. They shall also comply
with the Department of Health and Family Services' Allowable Cost Policy Manual. Single audit
reports are due to the Department within 30 days from issuance of the report, but no later than
one year after the end of the audit period.
9.11.2 If a Vendor agency's audit is based on a calendar rather than state fiscal year (July 1 through June
30), the Vendor and/or auditor shall submit a worksheet which reconciles the expenditures based
on the state fiscal year and the relevant purchase orders within one year of the close of the
contract.
9.11.3 DOC shall notify Vendor within 90 days of receipt of the audit completed by the independent
certified auditor, whether or not the audit meets the requirements of DOC's audit guidelines. DOC
shall initiate resolution of audit findings with Vendor within 180 days following notification of the
audit's acceptance. If the audit is not complete or is acceptable only in part, DOC shall rely upon
the acceptable portion of the audit and any additional audit work shall build upon the work already
done.
9.11.4 DOC reserves the right to conduct an independent audit of Vendor if Vendor fails to secure an
audit covering all funds, or a follow-up review of selected areas is determined to be necessary. In
the event that Vendor fails to secure an audit, DOC's costs for completing an audit will be charged
back to Vendor.
9.11.5 Vendor agrees that it is responsible to assure that all purchase of service contracts of $25,000 or
more meet the requirements of the Office of Management and Budget Circulars A-133 and A-128
that pertain to sub-recipient audits.
Wisconsin Department of Administration
Chs. 16, 19, 51
DOA-3054 (R10/2005)
Page 1 of 3
Standard Terms And Conditions
(Request For Bids / Proposals)
1.0
2.0
3.0
SPECIFICATIONS: The specifications in this request are
the minimum acceptable. When specific manufacturer and
model numbers are used, they are to establish a design,
type of construction, quality, functional capability and/or
performance level desired.
When alternates are
bid/proposed, they must be identified by manufacturer, stock
number, and such other information necessary to establish
equivalency. The State of Wisconsin shall be the sole judge
of equivalency. Bidders/proposers are cautioned to avoid
bidding alternates to the specifications which may result in
rejection of their bid/proposal.
DEVIATIONS AND EXCEPTIONS: Deviations and exceptions from original text, terms, conditions, or specifications
shall be described fully, on the bidder's/proposer's letterhead, signed, and attached to the request. In the absence
of such statement, the bid/proposal shall be accepted as in
strict compliance with all terms, conditions, and specifications and the bidders/proposers shall be held liable.
QUALITY: Unless otherwise indicated in the request, all
material shall be first quality. Items which are used,
demonstrators, obsolete, seconds, or which have been
discontinued are unacceptable without prior written approval
by the State of Wisconsin.
4.0
QUANTITIES: The quantities shown on this request are
based on estimated needs. The state reserves the right to
increase or decrease quantities to meet actual needs.
5.0
DELIVERY: Deliveries shall be F.O.B. destination freight
prepaid and included unless otherwise specified.
6.0
PRICING AND DISCOUNT: The State of Wisconsin qualifies for governmental discounts and its educational institutions also qualify for educational discounts. Unit prices shall
reflect these discounts.
6.1
6.2
6.3
Unit prices shown on the bid/proposal or contract
shall be the price per unit of sale (e.g., gal., cs., doz.,
ea.) as stated on the request or contract. For any
given item, the quantity multiplied by the unit price
shall establish the extended price, the unit price shall
govern in the bid/proposal evaluation and contract
administration.
Prices established in continuing agreements and
term contracts may be lowered due to general market
conditions, but prices shall not be subject to increase
for ninety (90) calendar days from the date of award.
Any increase proposed shall be submitted to the
contracting agency thirty (30) calendar days before
the proposed effective date of the price increase, and
shall be limited to fully documented cost increases to
the contractor which are demonstrated to be industrywide. The conditions under which price increases
may be granted shall be expressed in bid/proposal
documents and contracts or agreements.
In determination of award, discounts for early
payment will only be considered when all other conditions are equal and when payment terms allow at
least fifteen (15) days, providing the discount terms
are deemed favorable. All payment terms must allow
the option of net thirty (30).
7.0
UNFAIR SALES ACT: Prices quoted to the State of
Wisconsin are not governed by the Unfair Sales Act.
8.0
ACCEPTANCE-REJECTION:
The State of Wisconsin
reserves the right to accept or reject any or all
bids/proposals, to waive any technicality in any bid/proposal
submitted, and to accept any part of a bid/proposal as
deemed to be in the best interests of the State of
Wisconsin.
Bids/proposals MUST be date and time stamped by the
soliciting purchasing office on or before the date and time
that the bid/proposal is due. Bids/proposals date and time
stamped in another office will be rejected. Receipt of a
bid/proposal by the mail system does not constitute receipt
of a bid/proposal by the purchasing office.
9.0
METHOD OF AWARD: Award shall be made to the lowest
responsible, responsive bidder unless otherwise specified.
10.0
ORDERING: Purchase orders or releases via purchasing
cards shall be placed directly to the contractor by an
authorized agency.
No other purchase orders are
authorized.
11.0
PAYMENT TERMS AND INVOICING:
The State of
Wisconsin normally will pay properly submitted vendor
invoices within thirty (30) days of receipt providing goods
and/or services have been delivered, installed (if required),
and accepted as specified.
Invoices presented for payment must be submitted in
accordance with instructions contained on the purchase
order including reference to purchase order number and
submittal to the correct address for processing.
A good faith dispute creates an exception to prompt
payment.
12.0
TAXES: The State of Wisconsin and its agencies are
exempt from payment of all federal tax and Wisconsin state
and local taxes on its purchases except Wisconsin excise
taxes as described below.
The State of Wisconsin, including all its agencies, is
required to pay the Wisconsin excise or occupation tax on
its purchase of beer, liquor, wine, cigarettes, tobacco
products, motor vehicle fuel and general aviation fuel.
However, it is exempt from payment of Wisconsin sales or
use tax on its purchases. The State of Wisconsin may be
subject to other states' taxes on its purchases in that state
depending on the laws of that state. Contractors performing construction activities are required to pay state use tax
on the cost of materials.
13.0
GUARANTEED DELIVERY: Failure of the contractor to
adhere to delivery schedules as specified or to promptly
replace rejected materials shall render the contractor liable
for all costs in excess of the contract price when alternate
procurement is necessary. Excess costs shall include the
administrative costs.
14.0
ENTIRE AGREEMENT:
These Standard Terms and
Conditions shall apply to any contract or order awarded as
a result of this request except where special requirements
are stated elsewhere in the request; in such cases, the
special requirements shall apply. Further, the written
contract and/or order with referenced parts and attach-
DOA-3054
Page 2of 3
ments shall constitute the entire agreement and no other
terms and conditions in any document, acceptance, or
acknowledgment shall be effective or binding unless
expressly agreed to in writing by the contracting authority.
15.0
16.0
17.0
18.0
19.0
APPLICABLE LAW AND COMPLIANCE: This contract
shall be governed under the laws of the State of Wisconsin.
The contractor shall at all times comply with and observe all
federal and state laws, local laws, ordinances, and
regulations which are in effect during the period of this
contract and which in any manner affect the work or its
conduct. The State of Wisconsin reserves the right to
cancel this contract if the contractor fails to follow the
requirements of s. 77.66, Wis. Stats., and related statutes
regarding certification for collection of sales and use tax.
The State of Wisconsin also reserves the right to cancel
this contract with any federally debarred contractor or a
contractor that is presently identified on the list of parties
excluded from federal procurement and non-procurement
contracts.
ANTITRUST ASSIGNMENT: The contractor and the State
of Wisconsin recognize that in actual economic practice,
overcharges resulting from antitrust violations are in fact
usually borne by the State of Wisconsin (purchaser).
Therefore, the contractor hereby assigns to the State of
Wisconsin any and all claims for such overcharges as to
goods, materials or services purchased in connection with
this contract.
ASSIGNMENT: No right or duty in whole or in part of the
contractor under this contract may be assigned or delegated without the prior written consent of the State of
Wisconsin.
WORK CENTER CRITERIA: A work center must be certified under s. 16.752, Wis. Stats., and must ensure that
when engaged in the production of materials, supplies or
equipment or the performance of contractual services, not
less than seventy-five percent (75%) of the total hours of
direct labor are performed by severely handicapped
individuals.
Contracts estimated to be over twenty-five thousand
dollars ($25,000) require the submission of a written
affirmative action plan by the contractor. An exemption occurs from this requirement if the contractor has
a workforce of less than twenty-five (25) employees.
Within fifteen (15) working days after the contract is
awarded, the contractor must submit the plan to the
contracting state agency for approval. Instructions
on preparing the plan and technical assistance
regarding this clause are available from the
contracting state agency.
The contractor agrees to post in conspicuous places,
available for employees and applicants for employment, a notice to be provided by the contracting state
agency that sets forth the provisions of the State of
Wisconsin's nondiscrimination law.
19.3
Failure to comply with the conditions of this clause
may result in the contractor's becoming declared an
"ineligible" contractor, termination of the contract, or
withholding of payment.
20.0
PATENT INFRINGEMENT: The contractor selling to the
State of Wisconsin the articles described herein guarantees
the articles were manufactured or produced in accordance
with applicable federal labor laws. Further, that the sale or
use of the articles described herein will not infringe any
United States patent. The contractor covenants that it will
at its own expense defend every suit which shall be brought
against the State of Wisconsin (provided that such
contractor is promptly notified of such suit, and all papers
therein are delivered to it) for any alleged infringement of
any patent by reason of the sale or use of such articles, and
agrees that it will pay all costs, damages, and profits recoverable in any such suit.
21.0
SAFETY REQUIREMENTS: All materials, equipment, and
supplies provided to the State of Wisconsin must comply
fully with all safety requirements as set forth by the
Wisconsin Administrative Code and all applicable OSHA
Standards.
22.0
WARRANTY: Unless otherwise specifically stated by the
bidder/proposer, equipment purchased as a result of this
request shall be warranted against defects by the
bidder/proposer for one (1) year from date of receipt. The
equipment manufacturer's standard warranty shall apply as
a minimum and must be honored by the contractor.
23.0
INSURANCE RESPONSIBILITY: The contractor performing services for the State of Wisconsin shall:
NONDISCRIMINATION / AFFIRMATIVE ACTION: In
connection with the performance of work under this
contract, the contractor agrees not to discriminate against
any employee or applicant for employment because of age,
race, religion, color, handicap, sex, physical condition,
developmental disability as defined in s. 51.01(5), Wis.
Stats., sexual orientation as defined in s. 111.32(13m), Wis.
Stats., or national origin. This provision shall include, but
not be limited to, the following: employment, upgrading,
demotion or transfer; recruitment or recruitment advertising;
layoff or termination; rates of pay or other forms of
compensation; and selection for training, including apprenticeship. Except with respect to sexual orientation, the
contractor further agrees to take affirmative action to
ensure equal employment opportunities.
19.1
19.2
24.0
23.1
Maintain worker's compensation insurance as
required by Wisconsin Statutes, for all employees
engaged in the work.
23.2
Maintain commercial liability, bodily injury and property damage insurance against any claim(s) which
might occur in carrying out this agreement/contract.
Minimum coverage shall be one million dollars
($1,000,000) liability for bodily injury and property
damage including products liability and completed
operations. Provide motor vehicle insurance for all
owned, non-owned and hired vehicles that are used
in carrying out this contract. Minimum coverage shall
be one million dollars ($1,000,000) per occurrence
combined single limit for automobile liability and
property damage.
23.3
The state reserves the right to require higher or lower
limits where warranted.
CANCELLATION: The State of Wisconsin reserves the
right to cancel any contract in whole or in part without
penalty due to nonappropriation of funds or for failure of the
contractor to comply with terms, conditions, and specifications of this contract.
DOA-3054
Page 3of 3
25.0
VENDOR TAX DELINQUENCY: Vendors who have a
delinquent Wisconsin tax liability may have their payments
offset by the State of Wisconsin.
26.0
PUBLIC RECORDS ACCESS: It is the intention of the
state to maintain an open and public process in the solicitation, submission, review, and approval of procurement
activities.
30.0
MATERIAL SAFETY DATA SHEET: If any item(s) on an
order(s) resulting from this award(s) is a hazardous chemical, as defined under 29CFR 1910.1200, provide one (1)
copy of a Material Safety Data Sheet for each item with the
shipped container(s) and one (1) copy with the invoice(s).
31.0
PROMOTIONAL ADVERTISING / NEWS RELEASES:
Reference to or use of the State of Wisconsin, any of its
departments, agencies or other subunits, or any state official or employee for commercial promotion is prohibited.
News releases pertaining to this procurement shall not be
made without prior approval of the State of Wisconsin.
Release of broadcast e-mails pertaining to this procurement
shall not be made without prior written authorization of the
contracting agency.
32.0
HOLD HARMLESS: The contractor will indemnify and
save harmless the State of Wisconsin and all of its officers,
agents and employees from all suits, actions, or claims of
any character brought for or on account of any injuries or
damages received by any persons or property resulting
from the operations of the contractor, or of any of its
contractors, in prosecuting work under this agreement.
33.0
FOREIGN CORPORATION: A foreign corporation (any
corporation other than a Wisconsin corporation) which
becomes a party to this Agreement is required to conform
to all the requirements of Chapter 180, Wis. Stats., relating
to a foreign corporation and must possess a certificate of
authority from the Wisconsin Department of Financial
Institutions, unless the corporation is transacting business
in interstate commerce or is otherwise exempt from the
requirement of obtaining a certificate of authority. Any
foreign corporation which desires to apply for a certificate of
authority should contact the Department of Financial
Institutions, Division of Corporation, P. O. Box 7846,
Madison, WI 53707-7846; telephone (608) 261-7577.
34.0
WORK CENTER PROGRAM:
The successful
bidder/proposer shall agree to implement processes that
allow the State agencies, including the University of
Wisconsin System, to satisfy the State's obligation to
purchase goods and services produced by work centers
certified under the State Use Law, s.16.752, Wis. Stat.
This shall result in requiring the successful bidder/proposer
to include products provided by work centers in its catalog
for State agencies and campuses or to block the sale of
comparable items to State agencies and campuses.
35.0
FORCE MAJEURE: Neither party shall be in default by
reason of any failure in performance of this Agreement in
accordance with reasonable control and without fault or
negligence on their part. Such causes may include, but are
not restricted to, acts of nature or the public enemy, acts of
the government in either its sovereign or contractual
capacity, fires, floods, epidemics, quarantine restrictions,
strikes, freight embargoes and unusually severe weather,
but in every case the failure to perform such must be
beyond the reasonable control and without the fault or
negligence of the party.
Bid/proposal openings are public unless otherwise specified. Records may not be available for public inspection
prior to issuance of the notice of intent to award or the
award of the contract.
27.0
28.0
PROPRIETARY INFORMATION: Any restrictions on the
use of data contained within a request, must be clearly
stated in the bid/proposal itself. Proprietary information
submitted in response to a request will be handled in
accordance with applicable State of Wisconsin
procurement regulations and the Wisconsin public records
law. Proprietary restrictions normally are not accepted.
However, when accepted, it is the vendor's responsibility to
defend the determination in the event of an appeal or
litigation.
27.1
Data contained in a bid/proposal, all documentation
provided therein, and innovations developed as a
result of the contracted commodities or services
cannot be copyrighted or patented. All data, documentation, and innovations become the property of
the State of Wisconsin.
27.2
Any material submitted by the vendor in response to
this request that the vendor considers confidential
and proprietary information and which qualifies as a
trade secret, as provided in s. 19.36(5), Wis. Stats.,
or material which can be kept confidential under the
Wisconsin public records law, must be identified on a
Designation of Confidential and Proprietary Information form (DOA-3027).
Bidders/proposers may
request the form if it is not part of the Request for
Bid/Request for Proposal package. Bid/proposal
prices cannot be held confidential.
DISCLOSURE: If a state public official (s. 19.42, Wis.
Stats.), a member of a state public official's immediate
family, or any organization in which a state public official or
a member of the official's immediate family owns or controls
a ten percent (10%) interest, is a party to this agreement,
and if this agreement involves payment of more than three
thousand dollars ($3,000) within a twelve (12) month
period, this contract is voidable by the state unless appropriate disclosure is made according to s. 19.45(6), Wis.
Stats., before signing the contract. Disclosure must be
made to the State of Wisconsin Ethics Board, 44 East
Mifflin Street, Suite 601, Madison, Wisconsin 53703
(Telephone 608-266-8123).
State classified and former employees and certain
University of Wisconsin faculty/staff are subject to separate
disclosure requirements, s. 16.417, Wis. Stats.
29.0
RECYCLED MATERIALS: The State of Wisconsin is
required to purchase products incorporating recycled materials whenever technically and economically feasible.
Bidders are encouraged to bid products with recycled
content which meet specifications.
State of Wisconsin
Department of Administration
Division of Agency Services
Bureau of Procurement
DOA-3681 (01/2001)
ss. 16, 19 and 51, Wis. Stats.
Supplemental Standard Terms and Conditions
for Procurements for Services
1.0
ACCEPTANCE OF BID/PROPOSAL CONTENT: The contents of the bid/proposal of the successful contractor will
become contractual obligations if procurement action ensues.
2.0
CERTIFICATION
OF
INDEPENDENT
PRICE
DETERMINATION:
By signing this bid/proposal, the
bidder/proposer certifies, and in the case of a joint
bid/proposal, each party thereto certifies as to its own organization, that in connection with this procurement:
2.1
2.2
The prices in this bid/proposal have been arrived at
independently, without consultation, communication,
or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any
other bidder/proposer or with any competitor;
Unless otherwise required by law, the prices which
have been quoted in this bid/proposal have not been
knowingly disclosed by the bidder/proposer and will
not knowingly be disclosed by the bidder/proposer
prior to opening in the case of an advertised procurement or prior to award in the case of a negotiated
procurement, directly or indirectly to any other
bidder/proposer or to any competitor; and
2.3
No attempt has been made or will be made by the
bidder/proposer to induce any other person or firm to
submit or not to submit a bid/proposal for the purpose
of restricting competition.
2.4
Each person signing this bid/proposal certifies that:
He/she is the person in the bidder's/proposer's organization responsible within that organization for the
decision as to the prices being offered herein and that
he/she has not participated, and will not participate, in
any action contrary to 2.1 through 2.3 above; (or)
3.2
4.0
DUAL EMPLOYMENT:
Section 16.417, Wis. Stats.,
prohibits an individual who is a State of Wisconsin employee
or who is retained as a contractor full-time by a State of
Wisconsin agency from being retained as a contractor by the
same or another State of Wisconsin agency where the
individual receives more than $12,000 as compensation for
the individual’s services during the same year.
This
prohibition does not apply to individuals who have full-time
appointments for less than twelve (12) months during any
period of time that is not included in the appointment. It does
not include corporations or partnerships.
5.0
EMPLOYMENT: The contractor will not engage the services
of any person or persons now employed by the State of
Wisconsin, including any department, commission or board
thereof, to provide services relating to this agreement without
the written consent of the employing agency of such person
or persons and of the contracting agency.
6.0
CONFLICT OF INTEREST: Private and non-profit corporations are bound by ss. 180.0831, 180.1911(1), and 181.0831
Wis. Stats., regarding conflicts of interests by directors in the
conduct of state contracts.
7.0
RECORDKEEPING AND RECORD RETENTION:
The
contractor shall establish and maintain adequate records of
all expenditures incurred under the contract. All records must
be kept in accordance with generally accepted accounting
procedures. All procedures must be in accordance with
federal, state and local ordinances.
He/she is not the person in the bidder's/proposer's
organization responsible within that organization for
the decision as to the prices being offered herein, but
that he/she has been authorized in writing to act as
agent for the persons responsible for such decisions
in certifying that such persons have not participated,
and will not participate in any action contrary to 2.1
through 2.3 above, and as their agent does hereby so
certify; and he/she has not participated, and will not
participate, in any action contrary to 2.1 through 2.3
above.
3.0
DISCLOSURE OF INDEPENDENCE AND RELATIONSHIP:
3.1
Prior to award of any contract, a potential contractor
shall certify in writing to the procuring agency that no
relationship exists between the potential contractor
and the procuring or contracting agency that interferes
with fair competition or is a conflict of interest, and no
relationship exists between the contractor and another
person or organization that constitutes a conflict of
interest with respect to a state contract.
The
Department of Administration may waive this provision, in writing, if those activities of the potential contractor will not be adverse to the interests of the state.
Contractors shall agree as part of the contract for
services that during performance of the contract, the
contractor will neither provide contractual services nor
enter into any agreement to provide services to a
person or organization that is regulated or funded by
the contracting agency or has interests that are
adverse to the contracting agency. The Department
of Administration may waive this provision, in writing,
if those activities of the contractor will not be adverse
to the interests of the state.
The contracting agency shall have the right to audit, review,
examine, copy, and transcribe any pertinent records or
documents relating to any contract resulting from this
bid/proposal held by the contractor. The contractor will retain
all documents applicable to the contract for a period of not
less than three (3) years after final payment is made.
8.0
INDEPENDENT CAPACITY OF CONTRACTOR: The parties
hereto agree that the contractor, its officers, agents, and
employees, in the performance of this agreement shall act in
the capacity of an independent contractor and not as an
officer, employee, or agent of the state. The contractor
agrees to take such steps as may be necessary to ensure
that each subcontractor of the contractor will be deemed to
be an independent contractor and will not be considered or
permitted to be an agent, servant, joint venturer, or partner of
the state.
Mailing Address
Jim Doyle
Governor
Matthew J. Frank
Secretary
State of Wisconsin
Department of Corrections
3099 E. Washington Ave.
Post Office Box 7991
Madison, WI 53707-7991
Telephone (608) 240-5583
Fax
(608) 240-3344
CONTRACT
Services:
Nursing and Other Related Health Services for Department of
Corrections Institutions and Correctional Centers
Contract Period:
The Contract shall commence and be effective as of the date when all
parties hereto have affixed their respective signatures below and
shall continue in effect for a period of one year from that date (with
two automatic 1-year renewal contract extensions by mutual
agreement between the contractor and the Department of
Corrections).
Request for Bid Number:
SN-1026
Contract Number:
C1026
1. This agreement (the “Contract”) is entered into for the term set forth above by and between the
State of Wisconsin Department of Corrections (“DOC”) and ______________________
(“Contractor”) an entity doing business in the State of Wisconsin. To exercise the Contract period
extension option set forth above, the parties shall execute a written addendum to the Contract at
least thirty (30) days prior to the Contract expiration date. Any proposed increase in fees pertaining
to said extension period shall be submitted by Contractor in writing to DOC at least ninety (90)
days prior to the Contract expiration date.
2. This Contract formalizes DOC’s agreement to purchase PRN Nursing (“Services”), as more
specifically defined in the “Request For Bid” #SN-1026, from Contractor and Contractor’s
agreement to provide Services, as requested, to each individual requesting Correctional Institution
and/or Correctional Center at prices agreed upon per specifications in the Request for Bid #SN1026 which solicited competition for the Services that are the subject of this Contract, and
Contractor’s written “Bid” in response thereto, both of which are attached hereto and incorporated
into this Contract by reference.
3. Form DOA-3054 (“Standard Terms and Conditions”) and Form DOA-3681 (“Supplemental
Standard Terms and Conditions for Procurement of Services”) are attached hereto and incorporated
into this Contract by reference. To the extent that any term or condition set forth in either Form
DOA-3054 or Form DOA-3681 differs or conflicts with this Contract, the term, condition, or
Contract provision determined by DOC to be the more favorable to DOC in any given situation
shall govern and control.
4. The entire agreement between the parties is composed of this Contract and the documents
incorporated herein and/or applicable hereto as enumerated below in this paragraph. When there
are conflicts or disputes between the terms of this Contract and the terms of the aforementioned
1
documents, the following precedence for all agreement documents, in descending order of priority,
shall be used to resolve said conflict or dispute: (1) Contract (including Forms DOA-3054 and
DOA-3681); (2) written Bid; (3) written Request for Bid; (4) other exhibits/attachments; and (5)
official State of Wisconsin Purchase Order.
5. DOC may terminate this Contract at any time, with or without cause, and without penalty by
delivering thirty (30) days’ written notice to Contractor. Failure of DOC to comply with the
Contract terms, conditions, or specifications shall provide the sole cause for which Contractor is
entitled to terminate this Contract. Contractor shall notify DOC in writing within thirty (30) days
after Contractor becomes aware of the alleged noncompliance with a complete description of the
same. If DOC does not, within forty-five (45) days after its receipt of Contractor’s notice, either (i)
effect a cure or (ii) if the noncompliance is not one that can reasonably be cured within forty-five
(45) days, develop a plan to cure the noncompliance and diligently proceed according to that plan
until a cure is effected, then Contractor may terminate this Contract for cause by written notice to
DOC. Contractor may not terminate this Contract without cause unless express written consent to
do so is provided by DOC.
6. This Contract is contingent upon its authorization under Wisconsin and United States law and any
amendment or repeal of the same determined by DOC to affect its relevant authority or funding
shall permit DOC to immediately terminate this Contract, without penalty, upon written notice to
Contractor.
7. In the event that the Contract is terminated for any reason whatsoever, DOC’s liability shall be
limited to the pro rata cost of the Services approved and satisfactorily provided as of the effective
date of termination and Contractor will refund to DOC, within fourteen (14) days of the effective
date of termination, all payments made hereunder by DOC to Contractor for Services not completed
or not accepted by DOC.
8. Contractor warrants and represents that it is a duly organized and validly existing legal entity
authorized to conduct business in the State of Wisconsin and that the person(s) executing this
Contract on its behalf has the complete and unrestricted power and authority to enter into this
Contract and bind Contractor to the terms herein. All of the terms, covenants, representations,
warranties, and conditions of this Contract will be binding upon, inure to the benefit of, and be
enforceable by the parties hereto and their respective successors, assigns, and other legal
representatives.
9. The parties hereto agree that Contractor, its officers, agents, and employees, in the performance of
this Contract shall act in the capacity of an independent contractor and not as an officer, employee,
or agent of DOC. Contractor agrees to take such steps as may be necessary to ensure that each of
its subcontractors will be deemed to be an independent contractor and will not be considered or
permitted to be an agent, servant, joint venturer, or partner of DOC. Furthermore, neither DOC nor
Contractor will represent itself as the agent or legal representative of the other or as partner or joint
venturers for any purpose whatsoever, and neither shall have any right to create or assume any
obligations of any kind, express or implied, for or on behalf of the other in any way whatsoever.
10. Contractor will indemnify and hold harmless DOC and all of its officials, officers, agents, and
employees from and against any and all liability of any character including, without limitation,
suits, actions, claims, demands, losses, judgments, costs, damages, and expenses, including
attorneys’ fees, arising from or incidental to the act or omission of Contractor, or any of its officers,
agents, employees, or contractors, in performing work under this Contract regardless of whether or
not said liability arises or results in part from the act or omission of a party indemnified hereunder.
11. Revision of this Contract is not effective until agreed to by DOC and Contractor by a written
addendum to this Contract signed by the authorized representatives of both parties.
12. DOC shall be entitled to recover all costs related to obtaining and providing replacement Services
and/or deliverables which could not be provided or completed due to either Contractor’s
termination of the Contract for any reason prior to the expiration of the original or, if applicable,
extended Contract term or DOC’s termination of the Contract due to Contractor’s failure to comply
with the Contract. The rights and remedies of DOC provided herein shall not be exclusive but are
in addition to any other rights and remedies provided by law or elsewhere in the Contract, including
the documents incorporated herein.
13. Upon termination or expiration of this Contract, each party shall forthwith return to the other all
papers, materials, and other properties of the other held by each for purposes relating to this
Contract; provided, however, DOC shall be entitled to retain a copy of any completed or partially
completed deliverables, if any, as well as any other project records DOC is required to retain under
the State of Wisconsin’s records retention requirements. In addition, each party will assist the other
party in the orderly termination of this Contract and the transfer of all aspects hereof, tangible or
intangible, as may be necessary for the orderly, non-disrupted business continuation of each party.
14. This Contract and the performance of the parties’ obligations hereunder will be governed by and
construed and enforced in accordance with the laws of the State of Wisconsin, other than any
conflict-of-laws provisions thereof that would otherwise require the application of the law of any
other jurisdiction. Contractor consents to personal jurisdiction in the State of Wisconsin. The
venue for any action hereunder shall be in Dane County, Wisconsin.
15. The parties agree that this Contract may be signed and transmitted by facsimile and it shall be
considered an original document, and the signature of any party upon a document transmitted by
facsimile shall be considered an original signature having the binding legal effect of an original.
16. All of the terms, covenants, representations, warranties, and conditions of this Contract will be
binding upon, inure to the benefit of, and be enforceable by the parties hereto and their respective
successors, assigns, and other legal representatives.
17. No waiver by either party of any default hereunder shall be deemed as a waiver of any prior or
subsequent default of the same or other provisions of this Contract.
18. If any part of the Contract is held invalid or unenforceable by a court of competent jurisdiction,
such invalidity shall not affect the validity or operation of any other part and said part shall
continue to apply to the extent allowed by said court or, if not so allowed, be deemed severed from
this Contract entirely.
19. Costs, fees, and expenditures incurred by Contractor in relation to its provision of Services
pursuant to the Contract but reported later than ninety (90) days after the end of the Contract term
will not be recognized, allowed, or reimbursed under the terms of the Contract.
20. If for any reason DOC is dissatisfied with the quality or quantity of Services, the Contractor may, at
DOC’s discretion, be given written notice of that dissatisfaction in a timely manner. The notice
will also include a time period in which Contractor may cure the quality or quantity problem. If
Contractor fails to correct the quality or quantity problem, DOC reserves the option to withhold
funds under this Contract.
21. Contractor shall comply with the reporting and auditing requirements of DOC including, without
limitation, the requirement that Contractor retain all documents applicable to the Contract for a
period of not less than three (3) years after the final Contract payment is made. Any required
reports shall be forwarded to the Contract Administrator according to the schedule of DOC. If
Contractor does not submit the forms as required, DOC may cease all payments for Services to
Contractor under this Contract.
22. Contractor agrees to comply with State and Federal constitutions, laws, rules, and regulations
applicable to the Services under this Contract including, without limitation, those set forth in and
pertaining to the Health Insurance Portability and Accountability Act of 1996 (HIPPA) and any
revisions/amendments thereto.
23. Contractor may not subcontract or assign any part or obligations of this Contract without the prior
written consent of DOC. However, even if so permitted to subcontract or assign, Contractor still
retains responsibility for fulfillment of all terms and conditions of this Contract.
24. Contractor guarantees that the sale or use of any software or equipment utilized in the provision of
Services required under this Contract will not infringe any patent or copyright. Contractor
covenants that it will at its own expense defend every suit which shall be brought against DOC
(provided that Provider is promptly notified of such suit, and all papers therein are delivered to it)
for any alleged infringement of any patent or copyright by reason of the sale or use of such software
or equipment, and agrees that it will pay all costs, damages, and profits recoverable in any such
suit.
25. DOC will own all right, title, and interest in all data, documentation, programs, information
systems, innovations, and all other original works of authorship or deliverables developed under or
associated with this Contract. All such materials shall be deemed works made for hire, subject to a
non-exclusive perpetual license of DOC, with the right to sublicense reserved by Contractor, for all
purposes of copyright law, and any copyright shall belong solely to DOC. In the event that any
such work is adjudged not to be a work made for hire, Contractor agrees to assign, and hereby
assigns, all copyright in such work to DOC.
26. DOC may require, at its discretion, that Contractor provide an audit covering all DOC funds paid
pursuant to the Contract. In the event that Contractor fails to comply with a DOC audit request
including all follow-up requests for information pertaining to said audit, DOC reserves the right to
conduct an independent audit and DOC’s costs for completing the same will be charged back to
Contractor. Contractor agrees to retain and make available to DOC all program and fiscal records
until the audit and, if necessary, subsequent audit resolution processes have been completed.
27. Contractor shall maintain such records as are required by State and Federal law and shall comply
with all applicable confidentiality laws and requirements pertaining to said records.
28. Contractor will allow inspection of records and programs, insofar as is permitted by State and
Federal law, by DOC representatives and its authorized agents, and Federal agencies, in order to
confirm Contractor’s compliance with the specifications of this Contract.
29. Contractor agrees to have a policy prohibiting the employment of a person who is on probation,
parole or an inmate who is supervised by Intensive Sanctions for any Service position where the
primary duties and responsibilities involve the supervision or treatment of inmates, probationers or
parolees or involve access to offenders’ records or funds. The policy must be substantially
equivalent to DOC’s policy as expressed in Chapter 301 Attachment A of the DOC Supervisor’s
Manual, October 1990, a copy of which may be obtained from the Contract Administrator.
Furthermore, Contractor’s policy shall provide that records of pending criminal charges and
convictions of employees or job applicants involved or to be involved in providing Services shall
be considered in employment-related decisions when it can be demonstrated that the circumstances
of the pending charge or conviction are substantially related to the Service and would prejudice
DOC’s interests of ensuring that its correctional, rehabilitation, treatment, and administrative
programs are carried out in a legal, effective, safe, and humane manner. The policy must be
substantially equivalent to DOC’s policy as expressed in Executive Directive 42, August 2001, a
copy of which may be obtained from the Contract Administrator.
30. Contractor agrees to have a policy on fraternization which prohibits the forming of improper
relationships between Contractor’s employees and offenders. The policy must be substantially
equivalent to the Department of Corrections' policy as expressed in Executive Directive 16, May
1991 - Revised October 2001 & October 2004, a copy of which may be obtained from the Contract
Administrator.
31. This Contract sets forth the entire agreement and understanding of the parties with respect to the
subject matter hereof, and supersedes all prior agreements, arrangements, and understandings
relating to such subject matter.
32. Prices quoted in bid SN-1026 will remain firm the first year and not increase anymore than the BLS
Midwest CPI% for years two and three.
To be completed by Contractor
For
State of Wisconsin
Department of Corrections
3099 E. Washington Avenue
P.O. Box 7925
Madison, WI 53707-7925
For
By
Rick Raemisch
By
Signature
Date
Title
Signature
Date
Secretary, Department of Corrections
Phone 608-240-5505
Title
Phone
ATTACHMENT “A”
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement (Agreement) supplements and is incorporated into the existing Underlying Contract
(State of Wisconsin Department of Corrections and _______________ known as the _____________ covering the
provision of _________________ entered into by and between ___________________ (Business Associate) and the
Wisconsin Department of Corrections (Department) on ______________. This Agreement is effective beginning on the
date when all parties have affixed their respective signatures to the Underlying Contract and terminates any prior existing
Business Associate Agreements.
This Agreement is specific to those services, activities, or functions performed by the Business Associate on behalf of the
Department when such services, activities, or functions are covered by the Health Insurance Portability and Accountability
Act of 1996 (HIPAA). Services, activities, or functions covered by this Agreement include, but are not limited to:
______________________
The Department and Business Associate agree to modify the Contract to incorporate the terms of this Agreement and to
comply with the requirements of HIPAA addressing confidentiality, security and the transmission of individually
identifiable health information created, used or maintained by the Business Associate during the performance of the
Contract and after Contract termination. The parties agree that any conflict between provisions of the Contract and the
Agreement will by governed by the terms of the Agreement.
1.
DEFINITIONS
Designated Record Set means:
(1) A group of records maintained by or for a covered entity that is:
(i)
The medical records and billing records about individuals maintained by or for a covered health
care provider;
(ii) The enrollment, payment, claims adjudication, and case or medical management record systems
maintained by or for a health plan; or
(iii) Used, in whole or in part, by or for the covered entity to make decisions about individuals.
(2) For purposes of this Agreement, the term record means any item, collection, or grouping of information that
includes protected health information and is maintained, collected, used, or disseminated by or for a covered entity.
Disclosure means the release, transfer, provision of access to, or divulging in any other manner of information
outside the entity holding the information.
Incident means a use or disclosure of PHI by the Business Associate or subcontractor not authorized by this
Agreement or in writing by the Department. This definition includes any attempted, successful or unsuccessful,
unauthorized access, modification, or destruction of PHI, including electronic PHI, or interference with the
operation of any information system that contains PHI.
Individual means the person who is the subject of PHI or the personal representative of the individual, as defined
and provided for under applicable provisions of HIPAA.
Protected Health Information or “PHI” means:
Individually identifiable health information in any form or medium, including demographic information, created,
received, maintained, or transmitted by the Business Associate, on behalf of the Department, where such
information relates to the past, present, or future physical or mental health or condition of an individual, the
provision of health care to an individual, or the payment for the provision of health care to an individual, and
where such information identifies the individual or provides a reasonable basis to believe that it can be used to
identify an individual.
PHI excludes individually identifiable health information in education records covered by the Family Educational
Rights and Privacy Act (FERPA) and employment records held by the Department in its role as employer.
2.
PROHIBITION ON UNAUTHORIZED USE OR DISCLOSURE OF PHI
The Business Associate shall not use or disclose any PHI except as permitted or required by the Contract or this
Agreement, as permitted or required by law, or as otherwise authorized in writing by the Department.
3.
PERMITTED USE AND DISCLOSURE OF PHI
The Business Associate may use or disclose PHI only:
a.
b.
c.
d.
e.
f.
4.
For the delivery of the services, program management, activities, or functions contracted for in the Contract; or
For meeting contractual or legal obligations as established in any agreements between the parties evidencing
their business relationship; or
As permitted by HIPAA if such use or disclosure were made by the Department or otherwise required by
applicable law, rule or regulation; or
For use in the operations of the Business Associate as provided in paragraph 4 of this Agreement; or
As otherwise authorized by the Department in writing; or
For data aggregation for the health care operations of the Department.
USE OF PHI IN BUSINESS ASSOCIATE OPERATIONS
The Business Associate may use or disclose PHI as necessary for the delivery of the services or programs provided for
in the Agreement, including appropriate management and administration of programs or services, or to fulfill the
contractual or legal obligations of the Business Associate provided:
a.
b.
5.
6.
The disclosure is permitted or required by law; or
The Business Associate obtains reasonable assurances, evidenced by a written contract, from any person or
organization to which the Business Associate will disclose PHI that such person or organization shall:
(i)
Hold all PHI in confidence and use or further disclose it only for the purpose for which the Business
Associate disclosed it to the person or organization, or as required by law; and
(ii)
Notify the Business Associate, who will in turn promptly notify the Department, of any instance of
which the person or organization becomes aware that PHI was improperly disclosed.
SAFEGUARDING AND MAINTENANCE OF PHI
a.
The Business Associate will develop, implement, maintain, and use:
(i)
Reasonable and appropriate administrative, technical, and physical safeguards to prevent improper
use or disclosure of PHI, in any form or medium; and,
(ii)
Reasonable and appropriate administrative, technical, and physical security measures that protect the
confidentiality, integrity and availability of electronic PHI that it creates, receives, maintains, or
transmits on behalf of the Department.
b.
The Business Associate will document PHI safeguards and security measures and agrees to provide the
Department with access and review of this documentation if requested by the Department or an agent of the
Department. Security measures employed by the Business Associate must be sufficient to ensure that the
Department is compliant with the HIPAA privacy and security requirements for those covered services,
activities, or functions performed on behalf of the Department on or before the date such requirements become
effective.
c.
The Business Associate agrees to conduct an accurate and thorough assessment of the potential risks and
vulnerabilities to the confidentiality, integrity, and availability of electronic PHI held by the Business
Associate. The Business Associate and the Department agree that all costs associated with performance of
these activities will be the responsibility of the Business Associate unless the Department agrees to be
responsible for some or all of the costs associated with the performance of these activities.
USE OR DISCLOSURE OF PHI BY SUBCONTRACTORS AND AGENTS OF THE BUSINESS ASSOCIATE
The Business Associate agrees to require any agent, including subcontractors, to whom the Business Associate provides
PHI to comply with the same restrictions and conditions applicable to the Business Associate with respect to PHI.
Business Associate further agrees to ensure that any agents or subcontractors, to whom the Business Associate provides
PHI received from, or created or received by the Business Associate on behalf of the Department agrees to the same
restrictions and conditions applicable to the Business Associate with respect to such information. This provision does
not apply to the use or disclosure of PHI by subcontractors that provide health care treatment to individuals or to other
persons or organizations that have entered into an Organized Health Care Arrangement (OHCA) as provided for under
the provisions of HIPAA.
7.
COMPLIANCE WITH ELECTRONIC TRANSACTIONS AND CODE SET REGULATIONS
If the Business Associate conducts any HIPAA-covered standard electronic transactions on behalf of the Department,
the Business Associate will comply with the applicable provisions of HIPAA for such standard transactions. The
Business Associate will likewise require any subcontractor or agent conducting any standard electronic transactions on
behalf of the Business Associate, for services or programs covered by the Contract, to comply with the applicable
provisions of HIPAA relating to standard transactions.
8.
a.
General requirements.
(i)
If any entity requests the Business Associate to conduct any of the standard electronic transactions,
the Business Associate must comply with the request.
(ii)
The Business Associate may not delay or reject a transaction, or otherwise adversely affect or impact
the other entity or the transaction submitted, because the transaction is a standard electronic
transaction.
(iii)
The Business Associate may not reject a standard electronic transaction on the basis that it contains
data elements not needed or used by the Business Associate (e.g., coordination of benefits data
elements).
(iv)
The Business Associate may not offer an incentive to a health care provider to conduct a covered
transaction through direct data entry rather than as a standard electronic transaction.
(v)
The Business Associate, which is operating as a health care clearinghouse, or requiring an entity to
use a health care clearinghouse to receive, process, or transmit standard electronic transactions, may
not charge fees or impose costs in excess of the fees or costs for normal telecommunications that the
entity incurs when it directly transmits, or receives, a standard electronic transaction to, or from, the
Business Associate.
b.
The Business Associate will not enter into, or permit its subcontractors or agents to enter into, any agreement
related to the conducting of standard electronic transactions for or on behalf of the Department that:
(i)
Changes or modifies the definition, data condition, or use of a data element or segment in an
implementation specification; or
(ii)
Adds any data elements or segments to the maximum defined data set; or
(iii)
Uses any code or data elements that are marked “not used” in the implementation specification or are
not contained within the implementation specification; or
(iv)
Changes the meaning or intent of any implementation specification.
c.
If the Business Associate receives a standard electronic transaction and coordinates benefits with another
health plan, it must store the coordination of benefits data it needs to forward the standard electronic
transaction to the other health plan.
ACCESS TO PHI
At the request of the Department, the Business Associate agrees to provide access to PHI held by the Business
Associate that the Department has determined to be part of the Designated Record Sets of the programs covered by the
Agreement. Access to PHI will be provided to the Department or to an individual as directed by the Department to
comply with applicable HIPAA requirements. The Department may delegate to the Business Associate responsibility
for performing any or all obligations related to the Designated Record Set, including those activities required under
HIPAA to permit an individual to exercise his or her HIPAA privacy rights.
9.
AMENDMENT OR CORRECTION TO PHI
At the direction of the Department, the Business Associate agrees to amend or correct PHI that the Department
determines is included in the Designated Record Set held by the Business Associate. The Business Associate agrees to
complete any amendment or correction to PHI in accordance with HIPAA requirements.
10. REPORTING OF INCIDENTS TO THE DEPARTMENT BY BUSINESS ASSOCIATE
The Business Associate agrees to inform the Covered Entity of any incident covered by this Agreement within five (5)
business days of becoming aware of the incident. The Department, at its discretion, may require a written report. If the
Department requests a written report, the Business Associate agrees to forward the report to the Department not more
than five (5) business days after such request is made. Written and verbal reports of incidents will include:
a.
b.
c.
d.
e.
f.
A complete description of the circumstances of the incident;
The name of persons assigned to review and investigate the incident;
A description of all PHI used or disclosed during the incident;
The names of persons and organizations involved in the incident;
The actions the Business Associate has undertaken or will undertake to mitigate any harmful effect of the
incident; and,
A corrective action plan that includes steps the Business Associate has taken or will take to prevent future
similar incidents from occurring.
11. MITIGATING EFFECT OF UNAUTHORIZED DISCLOSURES OR MISUSE OF PHI
The Business Associate agrees to mitigate, to the extent practicable, any harmful effect known to the Business
Associate created by an improper use or disclosure of PHI by the Business Associate in violation of the requirements of
this Agreement.
12. STATUTORY DUTY OF THE DEPARTMENT TO REPORT MATERIAL BREACHES BY BUSINESS ASSOCIATE TO
SECRETARY OF UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Business Associate and the Department agree that if the Business Associate engages in a pattern of activity or practice
that constitutes a material breach or violation of this Agreement, and the Department becomes aware of such pattern or
practice, the Department is required to take reasonable steps to cure the breach or end the violation, as applicable, and,
if such steps are not successful and termination of the Contract is not feasible, the Department is required to report the
problem to the Secretary of HHS.
13. TRACKING AND ACCOUNTING OF DISCLOSURES OF PHI BY THE BUSINESS ASSOCIATE
a.
The Business Associate agrees to track disclosures of PHI as required by the applicable provisions of HIPAA
and applicable Wisconsin laws. Specifically, the Business Associate agrees that it will maintain a record of all
PHI disclosures made to third parties, except as provided for by the subsections to this paragraph below. The
Business Associate agrees that the following information will be recorded:
(i)
The date the PHI was disclosed;
(ii)
The name and address, if known, of the person or entity that the PHI was disclosed to;
(iii)
A brief description of the PHI disclosed; and
(iv)
A brief statement describing the purpose for the disclosure.
b.
For repetitive disclosures that the Business Associate makes to the same person or entity for a single purpose,
the Business Associate will provide:
(i)
The disclosure information as specified in paragraph 13(a)(i-iv) of this Agreement for the first of
such repetitive disclosures;
(ii)
The frequency, periodicity or number of such repetitive disclosures; and
(iii)
The date of the most recent of such repetitive disclosures.
c.
The Business Associate will make the record of disclosures available to the Department within five (5)
business days after receiving a request by the Department.
d.
Exceptions from Disclosure Tracking.
The Business Associate is not required to track or record disclosures of PHI, or to provide an accounting of
disclosures for PHI meeting the following conditions:
(i)
Disclosures of PHI that are permitted under this Agreement, or otherwise expressly authorized by the
Department in writing; and
(ii)
Disclosures of PHI for the following:
(1) For purposes of treatment, payment or health care operations activity of the Department;
(2) In response to a request from an Individual who is the subject of the disclosed PHI, or to that
individual’s personal representative;
(3) Made to persons involved in health care or payment for health care of the individual;
(4) For disaster relief notification purposes;
(5) For national security or intelligence purposes; or,
(6) To law enforcement officials or correctional institutions regarding individuals in custodial
situations.
e.
Agreement to Obtain Valid Authorization or Informed Written Consent Prior to Disclosure of PHI.
Business Associate agrees to obtain a valid authorization or informed written consent from the individual that
is the subject of the PHI disclosure or a personal representative of such individual except for those exceptions
listed in this Agreement or otherwise required by law.
f.
Disclosure Tracking Time Periods.
Business Associate agrees to maintain and make available to the Department upon its request information on
disclosures of PHI made by the Business Associate for the six-year period preceding the request, but not
including disclosures made prior to April 2005, or the date that the Business Associate began performing
covered services, activities, or functions on behalf of the Department, whichever is later.
14. ACCOUNTING TO THE DEPARTMENT AND TO GOVERNMENT AGENCIES
The Business Associate agrees to make its internal practices, books, and records relating to the use and disclosure of
PHI available to the Department, or to the Secretary of HHS in a time and manner determined by the Department or the
Secretary or designee, for purposes of determining compliance by the Department with the requirements of HIPAA.
Further, the Business Associate agrees to promptly notify the Department of communications with HHS regarding PHI
and will provide the Department with copies of any PHI or other information the Business Associate has made available
to HHS under this provision.
15. TERM AND TERMINATION OF AGREEMENT
a.
The Business Associate and the Department agree that this Agreement becomes effective on date all parties
have affixed their respective signatures to the Underlying Contract.
b.
The Business Associate agrees that if in good faith the Department determines that the Business Associate has
materially breached any of its obligations under this Agreement, the Department at its discretion, has the right
to:
(i)
Exercise any of its rights to reports, access and inspection under this Agreement, and, or
(ii)
Require the Business Associate to conduct monitoring and reporting, as the Department determines
reasonably necessary to maintain compliance with this Agreement; and, or
(iii)
Provide the Business Associate with a defined time period to cure the breach; or
(iv)
Terminate the Agreement in accordance with applicable state statutes.
c.
Before exercising any of these options, the Department will provide written notice of preliminary
determination to the Business Associate describing the violation and the action the Department intends to take.
16. RETURN OR DESTRUCTION OF PHI
Upon termination, cancellation, expiration or other conclusion of this Agreement, the Business Associate will:
a.
Return to the Department or, if return is not feasible, destroy all PHI and any compilation of PHI in any
medium or form. The Business Associate agrees to ensure that this provision also applies to PHI in possession
of subcontractors and agents of the Business Associate provided to the agent or subcontractor by the Business
Associate. The Business Associate agrees that any original record or copy of PHI in any medium is included in
and covered by this provision, as are all original or copies of PHI provided to subcontractors or agents of the
Business Associate by the Business Associate. The Business Associate agrees to complete the return or
destruction as promptly as possible, but not more than five (5) business days after the effective date of
termination of this Agreement. The Business Associate will provide written documentation evidencing that
return or destruction of all PHI has been completed. Business Associate agrees to extend the requirements of
this provision to contracts entered into with subcontractors and agents that create, receive, or maintain PHI on
behalf of the Business Associate.
b.
If the Business Associate believes that the return or destruction of PHI is not feasible, the Business Associate
shall provide written notification of the conditions that make return or destruction not feasible. If the Business
Associate and the Department agree that return or destruction of PHI is not feasible, the Business Associate
shall extend the protections of this Agreement to PHI and prohibit further uses or disclosures of the PHI of the
Department without the express written authorization of the Department. Subsequent use or disclosure of any
PHI subject to this provision will be limited to the use or disclosure that makes return or destruction not
feasible.
17. MISCELLANEOUS PROVISIONS
a.
Automatic Amendment: This Agreement shall automatically incorporate any change or modification to
HIPAA as of the effective date of the change or modification. The Business Associate agrees to maintain
compliance with all changes or modifications to HIPAA as required.
b.
Interpretation of Terms or Conditions of Agreement: Any ambiguity in this Agreement shall be construed and
resolved in favor of a meaning that permits the Department and Business Associate to comply with HIPAA.
c.
Submission of Compliance Plan: The Business Associate agrees that the Department may request a HIPAA
compliance plan. If requested by the Department, the Business Associate agrees to provide periodic reports of
the progress of the compliance plan. Further, the Business Associate agrees that the plan and progress reports
will comply with the requirements of the Department.
IN WITNESS WHEREOF, the undersigned have caused this Agreement to be duly executed by their respective
representatives.
DEPARTMENT OF CORRECTIONS
BUSINESS ASSOCIATE
By: _______________________________
By: ________________________________
Title: ______________________________
Title: ______________________________
Date: ______________________________
Date: ______________________________
ATTACHMENT “B”
Wisconsin DOC Institutions, Centers and Schools – by County
30
Northwestern
Region
Northcentral
Region
29
32
Northeastern
Region
22
37
1,16
5
6,24
Central West
Region
Central
Region
35
11,26,39,40
15
Central East
Region
9
18
7
2
3,4,19,25
12
8,28,33,36
Southwestern
Region
10,34,38
Southeastern
21
Region
Southcentral
Region
13,14,17,23,27
20
31
Institutions/Facilities - DAI
1 Chippewa Valley Corr. Treatment Fac.
4 Fox Lake Correctional Institution
7 Kettle Moraine Correctional Institution
10 Oakhill Correctional Institution
13 Racine Correctional Institution
16 Stanley Correctional Institution
19 Waupun Correctional Institution
CVCTF
FLCI
KMCI
OCI
RCI
SCI
WCI
2 Columbia Correctional Institution
5 Green Bay Correctional Institution
8 Milwaukee Secure Detention Facility
11 Oshkosh Correctional Institution
14 Racine Youthful Offender Facility
17 Sturtevant Transitional Facility
20 Wisconsin Secure Program Facility
CCI
GBCI
MSDF
OSCI
RYOCF
STF
WSPF
3 Dodge Correctional Institution
DCI
6 Jackson Correctional Institution
JCI
9 New Lisbon Correctional Institution
NLCI
12 Prairie du Chein Correctional Institution PDCI
15 Redgranite Correctional Institution
RGCI
18 Taycheedah Correctional Institution TCI
Schools - DJC
21 Ethan Allen School
EAS
22 Lincoln Hills School
LHS
23 Southern Oaks Girls School
SOGS
Correctional Centers - WCCS
24 Black River Correctional Center
27 Robt. E Ellsworth Correctional Center
30 Gordon Correctional Center
33 Milw. Women’s Correctional Center
36 Marshall E Sherrer Correctional Ctr
39 Winnebago Correctional Center
BRCC
RECC
GCC
MWCC
MSCC
WCC
25
28
31
34
37
40
JBCC
FCCC
KCC
OCC
SCCC
WRC
26
29
32
35
38
DACC
FCC
MCCC
SPCC
TCC
John C Burke Correctional Center
Felmers O Chaney Correctional Center
Kenosha Correctional Center
Oregon Correctional Center
St. Croix Correctional Center
Wisconsin Resource Center
Drug Abuse Correctional Center
Flambeau Correctional Center
McNaughton Correctional Center
Sanger B Powers Correctional Center
Thompson Correctional Center