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Res 16-40 Awarding the bid for Health Dental Vision Insurance to United Healthcare 2017TOWN OF WESTLAKE RESOLUTION 16-40 A RESOLUTION QF THE TC?WN COUNCIL OF THE TOWN OF WESTLAKE, TEXAS, APPROVING UNITED HEALTH CARE AS THE TtJWN'S HEALTH AND VISION INSURANCE CARRIER AND APPROVING RENEWAL OF METLIFE AS THE TOWN'S DENTAL INSURANCE CARRIER FOR T�IE 2017 CALENDAR YEAR. WHEREAS, Town of Westlake desires to maintain a camprehensive health and dental insurance benefits for its employees that is competitive to surrounding cities; and WHEREAS, the leaders of the Town of Westlake desire to exercise exceptional levels of stewardship with all financial resources; and, WHEREAS, the Town Council finds that the passage of this Resolution is in the best interest of the emplayees and citizens of the Town of Westlake. NOW, THEREFORE, BE IT RESOLVED �Y THE TOWN COUNCIL OF THE TC?WN 4F WESTLAKE, TEXAS: SECTION 1: That, all matters stated in the recitals hereinabove are faund to be true and correct and are incorporated herein by reference as if copied in their entirety. SECTION 2: That, the Westlake Town Council hereby approves United Health Care as the Tawn's health and vision insurance carrier for a twelve (12) month period, beginning January 1, 2017, with an estimated annual employer cost of $472,393. SECTION 3: That, the Westlake Town Council hereby approves the renewal of MetLife as the Town's dental insurance carrier for a twelve (12) month period, beginning January l, 2017, with an estimated annual employer cost of $28,333. SECTION 4: If any portion of this resolution shall, for any reason, be declared invalid by any court of competent jurisdiction, such invalidity shall not affect the remaining provisions hereof and the Council hereby determines that it would have adopted this Resolution without the invalid provisian. Resolution 16-40 Page 1 of 2 SECTION 5: That this Resolution shall became effective from and after its date of passage. PASSED AND APPROVED ON THIS 14���; DAY NtJVEMBER, 2016. ATTEST: ;�� /� � d(„fi���+'� � Fe°' ���''n"��.�` Laura`Wheat, Mayor ..► .i, � _ � � '��I'�"��� .t��._� � i� _ .r ~ — - • . �. � - - - ;, :���i �. ,•: �x•;+,�• ., . ll�f �!."'r.,� �,. APPROVE,,H AS TO ORM: 4�`� �p L. anton Lo y, n Attorney \� ... � �` . ;: . � �.�' �k: � ' ��� • . � . �� � � ' � �W�- � � r�`��� Resolution 1b-40 Page 2 of 2 CERTIFICATE OF INTERESTED PARTIES FORM 1295 101`1 Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2016-135624 Lifetime Benefits Insurance, LLP Grapevine,TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 11/10/2016 being filed. Town Of Westlake Date Acknowledged: 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a description of the services,goods,or other property to be provided under the contract. Health Insurance RFP Insurance Broker Nature of interest 4 Name of Interested Party City,State,Country(place of business) (check applicable) Controlling Intermediary Mundlin, Robert S Grapevine,TX United States X Kidd,Connie N Grapevine,TX United States X Clark,John W Grapevine,TX United States X 5 Check only if there is NO Interested Party. Q z, 6 AFFIDAVIT I swear,or affn,under alty aff/pe jury,that the above di ure is true and correct. 'aY'Av'.k KELLY EDWARDS <. Notary Public a P ox �r *� *� STATE OF TEXAS r' Notary ID 8 12408268-8 .� Baa of `r My Comte.Exp.Febmary 3.2018 Atigoat e of auth&fZed,agent of contracting business entity AFFIX NOTARY STAMP/SEAL ABOVE r Sworn to and subscribed before me,by the said this the day of Alcr 20-- ,to certify which,witness my hand and seal of office. CA -n l ay3aL )6 Sic atur ' m cer administering oath Printed naof officer administering oath Title of officer administering tly 11 1 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING 1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number: of business. 2016-135624 Lifetime Benefits Insurance, LLP Grapevine,TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 11/10/2016 being filed. Town Of Westlake Date Acknowledged: 11/17/2016 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a description of the services,goods,or other property to be provided under the contract. Health Insurance RFP Insurance Broker 4 Nature of interest Name of Interested Party City,State,Country(place of business) (check applicable) Controlling I intermediary Mundlin, Robert S Grapevine,TX United States X Kidd,Connie N Grapevine,TX United States X Clark,John W Grapevine,TX United States X 5 Check only if there is NO Interested Party. ❑ 6 AFFIDAVIT I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP/SEAL ABOVE Sworn to and subscribed before me,by the said this the day of 20 ,to certify which,witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277 rw` Town of Westlake Westlake Academy Human Resources Department FELONY CONVICTION NOTICE State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History, Subsection (a), states "a person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony. Subsection (b) states "a school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for the services performed before the termination of contract." THIS NOTICE IS NOT REQUIRED OF A PUBLICLY-HELD CORPORATION I, the undersigned agent for the firm named below, certify that the information concerning notification of felony has been reviewed by me and the following information furnished is true to the best of my knowledge. VENDOR'S NAME: Lifetime Benefits Insurance LLP AUTHORIZED COMPANY OFFICIAL'S NAME (PRINTED) Robert S. Mundlin Please check all that apply: ❑ My firm is publicly-held corporation, therefore, this reporting requirement is not applicable. FR-My firm is neither owned nor operated by anyone who has been convicted of a felony: My firm is owned or operated by the following individual(s)who has/have been convicted of a felony: Name: Details of Conviction(s): /11 Tli 10/31/2016 Contractor/I ` . pany icial Signature Date 3 Village Circle, Suite #202 • Westlake,Texas 76262 Metro: 817-490-5711 •Fax: 817-430-1812 •www.westlakeacademy.org CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B.23,84th Leg.,Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1),Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.An offense under this section is a misdemeanor. 1 Name of vendor who has a business relationship with local governmental entity. a a Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) Name of local government officer about whom the information is being disclosed. Name of Officer escn a each employment or other business relationship with the local government officer, ora tamily me-m-TiZe-r-07 the officer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income,from the vendor? Yes F-\7-1 No B. Is the vendor receiving or likely to receive taxable income,other than investment income,from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes No 1 1_41 beannibeedch employinentai business telationship that the vendoi Mulled in Section 1 maintains with a cul Puldfivil 0i other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent ormore. 006: 6 Check this box if the vendor has given the local government officer or a farrpily member of the officer one or more gifts as described in Section 176.003(a)(2)(B),excluding gifts describgd in Section 176.003(a-1). Irv_= � c.�, Signature of vendor doing business with the governmental;e�#ir' {�, 10!3112016 -I � Town of Westlake Westlake Academy Human Resources Department NON-COLLUSION STATEMENT The undersigned Proposer, by signing and executing this proposal, certifies and represents to the Town of Westlake and Westlake Academy that Proposer has not offered, conferred or agreed to confer any pecuniary benefit, as defined by Section 1.07 (a)(6) of the Texas Penal Code, or any other thing of value, as consideration for the receipt of information or any special treatment or advantage relating to this proposal; the Proposer also certifies and represents that Proposer has not offered, conferred or agreed to confer any pecuniary benefit or other things of value as consideration for the recipient's decision, opinion, recommendation, vote or other exercise of discretion concerning this proposal; the Proposer certifies and represents that Proposer has neither coerced nor attempted to influence the exercise of discretion by any officer, trustee, agent or employee of the Town of Westlake and Westlake Academy concerning this proposal on the basis of any consideration not authorized by law; the Proposer also certifies and represents that Proposer has not received any information not available to other proposers so as to give the undersigned a preferential advantage with respect to this proposal; the Proposer further certifies and represents that Proposer has not violated any state, federal or local law, regulation or ordinance relating to bribery, improper influence, collusion or the like and that Proposer will not in the future, offer, confer, or agree to confer any pecuniary benefit or other thing of value of any officer, trustee, agent or employee of the Town of Westlake and Westlake Academy in return for the person having exercised the person's official discretion, power or duty with respect to this proposal; the Proposer certifies and represents that it has not now and will not in the future offer, confer, or agree to confer a pecuniary benefit or other thing of value to any office, trustee, agent or employee of the Town of Westlake and Westlake Academy in connection with information regarding this proposal, the submission of this proposal, the award of this proposal or the performance, delivery or sale pursuant to this proposal. Firm Name: Lifetime Benefits Insurance LLP Address: 400 N. Main St., Suite 103 City/State/Zip: Grapevine, TX 76051 Phone: 817-481-7133 Fax: 817-481-27-61 Name of Representative(s): Robert S. Mundlin F Signature of Representative(s): (wl�_7 Date: 10/31/2016 3 Village Circle, Suite #202 ♦ Westlake,Texas 76262 Metro: 817-490-5711 ♦Fax: 817-430-1812 ♦www.westiakeacademy.org