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General Insurance Broker
BID #: N/A
ISSUED: 10/16/2025
DUE: 11/5/2025
VALUE: TBD
70
Rating
Risk Rank
Red Risk
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Executive Summary
The Borough of Fanwood is soliciting proposals from qualified brokers to provide dental and life insurance brokerage services for its employees. Key responsibilities include plan design and strategic consulting, market analysis and carrier negotiation, renewal management, employee support and education, claims and utilization review, regulatory compliance, and account management and reporting. Proposals are due by November 5, 2025, at 12:00 PM. Submissions must include one unbound original and one electronic copy on a flash drive, submitted in a sealed envelope clearly marked with the RFP title.
Web Content
General Insurance Broker - Source: https://fanwoodnj.org/government/bidsrfprfq/
Document Text
--- Document: General Insurance Broker Document ---
2026
Request for Proposals: Dental
& Life Insurance Broker
Municipality
BOROUGH OF FANWOOD, NJ
NOTICE DATE : OCTOBER 16, 2025
Contents
Notice to Bidders ......................................................................................................................................... 3
RFP Documents Checklist .......................................................................................................................... 5
Mandatory Equal Employment Opportunity Language ......................................................................... 7
Americans with Disabilities Act Mandatory Language ........................................................................... 9
Instructions to Bidders ............................................................................................................................. 10
Scope of Work ........................................................................................................................................... 16
1. Plan Design & Strategic Consulting ............................................................................................... 16
2. Market Analysis & Carrier Negotiation .......................................................................................... 16
3. Renewal Management ..................................................................................................................... 16
4. Employee Support & Education ..................................................................................................... 16
5. Claims & Utilization Review .......................................................................................................... 16
6. Regulatory Compliance................................................................................................................... 16
7. Account Management & Reporting ................................................................................................ 17
Evaluation Criteria ................................................................................................................................... 18
RFP Proposal Form ................................................................................................................................... 19
Affirmative Action Regulations Public Law 1975, C. 127 (N.J.A.C. 17:27) ......................................... 20
Mandatory Affirmative Action Language P.L. 1975, C. 127 (N.J.A.C. 17:27)..................................... 21
Statement of Ownership (Ownership Disclosure Certification) ........................................................... 24
NON-COLLUSION AFFADAVIT ........................................................................................................... 29
ADDENDA ACKNOWLEDGEMENT ................................................................................................... 30
Prohibited Russia-Belarus Activities & Iran Investment Activities ..................................................... 31
Notice to Bidders
Invitations are extended to bidders to bid for the following service: Dental & Life Insurance
Broker.
The Borough of Fanwood (Borough) will accept RFPs by mail, recognized overnight carrier or
in person by November 5, 2025 at 12:00pm. The Borough shall not be responsible for any bid
mailed which is lost in transit or delivered late by the postal service or recognized overnight
carrier. Bids should be submitted in SEALED ENVELOPES, addressed to the Borough Clerk,
Borough of Fanwood, 75 N. Martine Avenue, Fanwood, New Jersey 07023, and clearly marked
on the outside “Fanwood – RFP for Dental & Life Insurance Broker ENCLOSED – DO NOT
OPEN.” One (1) unbound original for further copying (if necessary) and 1 electronic copy
(flash-drive/thumb drive) of the proposal shall be submitted.
Specification documents may be examined Monday through Friday, except legal holidays, from
8:00 A.M. to 4:00 P.M. prevailing time, at the Borough's administrative office at the address
listed above.
A digital version may be requested at no charge by sending an email request to
cagnello@fanwoodnj.org. Paper copies of the RFP documents will not be provided. Include the
following information in your request: company name, address, phone, fax, contact person and
their email address. Bidders electing to receive specifications from a third party, or any other
service or entity assume the responsibility of ensuring they receive any issued revisions or
addenda.
After receipt of RFPs, no proposals may be withdrawn within sixty (60) days after the date of the
bid opening except as provided for in the contract documents. The RFP of any bidder who
consents to an extension may be held for consideration for a longer period as may be agreed
upon between bidder and the Borough. Bidders must use and fully complete proposal forms
within the specifications and comply with all requirements included therein and in the contract
documents.
The Borough reserves the right to reject any or all bids, to waive immaterial informalities, or to
accept any bid which, in the opinion of the Borough, will be in the public interest, all in
accordance with the New Jersey Local Public Contracts Law, N.J.S.A. 40A:11—l, et seq. In the
event of an equal or tie bid, the Borough shall award the bid to the bidder which, in the
Borough’s sole discretion, best serves the public interest.
Bidders are required to comply with the Contract Compliance and Equal Employment
Opportunities in Public Contracts N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27 and have a current
New Jersey Business Registration Certificate P.L. 2004, N.J.S.A. 52:25-24.2 and all New Jersey,
Federal, local, and Borough laws, regulations and policies.
BY ORDER OF BOROUGH OF FANWOOD OF THE COUNTY OF UNION, STATE OF
NEW JERSEY.
Courtney Agnello, Borough Clerk
RFP Documents Checklist
For The Contract Entitled:
Dental & Life Insurance Broker
CONTENTS AND CHECK LIST FOR BIDDERS
DESCRIPTION
INCLUDED IN
RFP DOCUMENT
BIDDER MUST
INCLUDE
IN RFP
PUBLISHED NOTICE TO BIDDERS
X
MANDATORY EQUAL EMPLOYMENT
OPPORTUNITY LANGUAGE
X
MANDATORY AMERICANS WITH
DISABILITIES ACT LANGUATE
X
INSTRUCTIONS TO BIDDERS
X
PROJECT SPECIFICATIONS
X
BID PROPOSAL FORM
X
X
AFFIRMATIVE ACTION FORM
X
X
MANDATORY AFFIRMATIVE ACTION
LANGUAGE
X
CHAPTER 33 DISCLOSURE
STATEMENT
X
STATEMENT OF OWNERSHIP FORM
X
X
NON-COLLUSION AFFIDAVIT
X
X
ACKNOWLEDGEMENT OF RECEIPT
OF ADDENDA
X
X
PROHIBITED RUSSIA-BELARUS
ACTIVITIES & IRAN INVESTMENT
ACTIVITIES
X
X
NEW JERSEY BUSINESS
REGISTRATION CERTIFICATE
X
W-9 TAX ID FORM
X
BID GUARANTEE
Mandatory Equal Employment Opportunity Language
N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127)
N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE
CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any
employee or applicant for employment because of age, race, creed, color, national origin,
ancestry, marital status, affectional or sexual orientation, gender identity or expression,
disability, nationality or sex. Except with respect to affectional or sexual orientation and
gender identity or expression, the contractor will take affirmative action to ensure that such
applicants are recruited and employed, and that employees are treated during employment,
without regard to their age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or
sex. Such action 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. The contractor agrees to post in conspicuous places, available to
employees and applicants for employment, notices to be provided by the Public Agency
Compliance Officer setting forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or
advertisements for employees placed by or on behalf of the contractor, state that all
qualified applicants will receive consideration for employment without regard to age, race,
creed, color, national origin, ancestry, marital status, affectional or sexual orientation,
gender identity or expression, disability, nationality or sex.
The contractor or subcontractor, where applicable, will send to each labor
organization or representative or workers with which it has a collective bargaining
agreement or other contract or understanding, a notice, to be provided by the agency
contracting officer advising the labor organization or workers' representative of the
contractor's commitments under this act and shall post copies of the notice in conspicuous
places available to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations
promulgated by the Treasurer pursuant to N.J.S.A. 10:5-31 et seq., as amended and
supplemented from time to time and the Americans with Disabilities Act. The contractor
or subcontractor agrees to make good faith efforts to employ minority and women workers
consistent with the applicable county employment goals established in accordance with
N.J.A.C. l7:27-5.2, or a binding determination of the applicable county employment goals
determined by the Division, pursuant to N.J.A.C. 17:27- 5.2.
The contractor or subcontractor agrees to inform in writing its appropriate
recruitment agencies including, but not limited to, employment agencies, placement
bureaus, colleges, universities, and labor organizations, that it does not discriminate on the
basis of age, creed, color, national origin, ancestry, marital status, affectional or sexual
orientation, gender identity or expression, disability, nationality or sex, and that it will
discontinue the use of any recruitment agency which engages in direct or indirect
discriminatory practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if
necessary, to assure that all personnel testing conforms with the principles of job-related
testing, as established by the statutes and court decisions of the State of New Jersey and
as established by applicable Federal law and applicable Federal court decisions.
In conforming with the applicable employment goals, the contractor or
subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading
and layoff to ensure that all such actions are taken without regard to age, creed, color,
national origin, ancestry, marital status, affectional or sexual orientation, gender identity
or expression, disability, nationality or sex, consistent with the statutes and court decisions
of the State of New Jersey, and applicable Federal law and applicable Federal court
decisions.
The contractor shall submit to the public agency, after notification of award but prior
to execution of a goods and services contract, one of the following three documents:
Letter of Federal Affirmative Action Plan
Approval Certificate of Employee
Information Report Employee Information
Report Form AA302
The contractor and its subcontractors shall furnish such reports or other
documents to the Div. of Contract Compliance & EEO as may be requested by the
office from time to time in order to carry out the purposes of these regulations, and
public agencies shall furnish such information as may be requested by the Div. of
Contract Compliance & EEO for conducting a compliance investigation pursuant to
Subchapter 10 of the Administrative Code at N.J.A.C. 17:27.
Bidder’s Signature
Americans with Disabilities Act Mandatory Language
Equal Opportunity for Individuals with Disabilities
The contractor and Fanwood Borough (hereinafter the “Borough”) do hereby agree that the
provisions of Title II of the Americans with Disabilities Act of 1990 (the “Act” or “ADA”), 42
U.S.C. §12101 et seq., which prohibits discrimination on the basis of disability by public entities
in all services, programs, and activities provided or made available by public entities and the
rules and regulations promulgated pursuant thereunto, are made a part of this contract. In
providing any aid, benefit, or service on behalf of the Borough pursuant to this contract, the
contractor agrees that the performance shall be in strict compliance with the Act. In the event that
the contractor, its agents, servants, employees or subcontractors violate or are alleged to have
violated the Act during the performance of this contract, the contractor shall defend the Borough
in any action or administrative proceeding commenced pursuant to this Act. The contractor shall
indemnify, protect, and save harmless the Borough, its agents, servants, and employees from and
against any and all suits, claims, losses, demands or damages of whatever kind or nature arising
out of or claimed to arise out of the alleged violation. The contractor shall, at its own expense,
appear, defend and pay any and all charges for legal services and any and all costs and other
expenses arising from such action or administrative proceeding or incurred in connection
therewith. In any and all complaints brought pursuant to the Borough’s grievance procedure, the
contractor agrees to abide by any decision of the Borough which is rendered pursuant to said
grievance procedure. If any action or administrative proceeding results in an award of damages
against the Borough or if the Borough incurs any expense to cure a violation of the ADA which
has been brought pursuant to its grievance procedure, the contractor shall satisfy and discharge
the same at its own expense.
The Borough shall, as soon as practicable after a claim has been made against it, give written
notice thereof to the contractor along with full and complete particulars of the claim. If any
action or administrative proceeding is brought against the Borough or any of its agents, servants
and employees, the Borough shall expeditiously forward or have forwarded to the contractor
every demand, complaint, notice, summons, pleading, or other process received by the Borough
or its representatives.
It is expressly agreed and understood that any approval by the Borough of the services provided
by the contractor pursuant to this contract will not relieve the contractor of the obligation to
comply with the Act and to defend, indemnify, protect, and save harmless the Borough pursuant
to this paragraph.
It is further agreed and understood that the Borough assumes no obligation to indemnify or save
harmless the contractor, its agents, servants, employees and subcontractors for any claim which
may arise out of their performance of this Agreement. Furthermore, the contractor expressly
understands and agrees that the provisions of this indemnification clause shall in no way limit the
contractor’s obligations assumed in this agreement, nor shall they be construed to relieve the
contractor from any liability, nor preclude the Borough from taking any other actions available to
it under any other provisions of this agreement or otherwise at law.
Instructions to Bidders
1.
Submission of Bids
Borough of Fanwood, Union County, New Jersey, invites sealed bids pursuant to the Notice to
Bidders.
A.
Sealed bids will be received by the designated representative at the time and
place stated in the Notice to Bidders, and at such time and place will be publicly
opened and read aloud.
B.
The bid proposal form and required documentation shall be submitted in a
sealed envelope; addressed to Borough of Fanwood, Attn: Administration, 75 N.
Martine Ave., Fanwood, New Jersey, 07023; bearing the name and address of the
bidder written on the face of the envelope, and clearly marked “RFP for 2026
Dental & Life Insurance Broker Services ENCLOSED -- DO NOT OPEN". One
(1) unbound original for further copying (if necessary) and 1 electronic copy
(flash-drive/thumb drive) of the proposal shall be submitted. All proposals
must be returned on or before November 5, 2025 at 12:00 pm, prevailing time.
C.
It is the bidder's responsibility to see that bids are presented to the Borough on
the hour and at the place designated. Bids may be hand delivered or mailed;
however, the Borough disclaims any responsibility for bids forwarded by regular
or overnight mail. Bids received after the designated time and date will be
returned unopened.
D.
Sealed bids forwarded to the Borough before the time of opening of bids may be
withdrawn upon written application of the bidder, who shall be required to
produce evidence showing that the individual is or represents the principal or
principals who submitted the bid.
E.
All prices and amounts must be written in ink or preferably typewritten. Bids
containing any conditions, omissions, unexplained erasures or alterations, items
not called for in the bid proposal form, attachment of additive information not
required by the specifications, or irregularities of any kind, may be rejected by
the Borough. Any changes, white-outs, strikeouts, etc. on the proposal page must
be initialed in ink by the person responsible for signing the bid.
F.
Each bid proposal form must give the full business address of the bidder and be
signed by an authorized representative. Bids by partnerships must be signed in
the partnership name by one of the members of the partnership or by an
authorized representative, followed by the signature and designation of the
person signing. Bids by corporations must be signed in the legal name of the
corporation, followed by the name of the State in which incorporated and must
contain the signature and designation of the president, secretary or other person
authorized to bind the corporation in the matter. When requested, satisfactory
evidence of the authority of the officer signing shall be furnished. Additionally,
certain bid proposal forms must be notarized.
2.
RFP Documents
The bid must be returned in its entirety in order to be considered for an award. Each bid must be
accompanied by the items requested below in the form(s) attached.
Failure to provide these items and the entire bid package may cause for rejecting this proposal.
For bidders’ convenience, a Bid Documents Check List is also included with the Bid Documents.
1.
Proposal Form
2.
Affirmative Action Form
3.
List of names and addresses of all stockholders in the corporation or
partnership who own 10% or more of its stock - "Ownership Disclosure".
4.
Non-collusion Affidavit
5.
Addenda Acknowledgment
6.
New Jersey State Business Registration Certificate.
7.
Prohibited Russia-Belarus Activates & Iran Investment Activities
8.
Political Contribution Statement
3.
Interpretation and Addenda
1.
No oral interpretation shall be made to any bidder as to the meaning of any of the
contract documents or be effective to modify any of the provisions of the
specifications and contract documents.
2.
Any supplemental instructions or requirements will be in the form of a written
Addendum which will be forwarded to all prospective bidders on record by Fax
and/or email not later than five (5) working days prior to the date fixed for the
opening of bids. Failure of any bidder to receive addenda shall not relieve the
bidder from any obligation under its bid.
3.
All Addenda issued prior to bid receipt date must also be signed and returned
with the bid.
4.
All Addenda issued prior to date of receipt of bids shall become part of the
contract documents and included in bid prices.
4.
Failure to Execute a Contract
Should the successful bidder fail to execute and deliver the Contract, as defined in Section 7,
within one hundred eighty (180) days after bid award, the bidder forfeits to the Borough, as
liquidated damages, the bid security deposited with its bid. An extension of the 180-day window
may be granted by the Borough if the Borough determines, in its reasonable discretion, to do so.
5.
Right to Reject RFPs
The Borough reserves the right to reject any and all bids or parts thereof and to waive any
informality if deemed in the best interests of the Borough.
6.
Award of Contract
Award of the contract will be made at a regularly scheduled meeting of the Mayor and Council of
the Borough of Fanwood following the receipt of RFPs and the evaluation of the responses
received.
7.
Termination
1.
If through any cause the successful bidder shall fail to fulfill in a timely and
proper manner obligations under this contract or if the successful bidder shall
violate any of the requirements of the Lease Agreement, the Borough shall
thereupon have the right to terminate this contract by giving written notice to the
successful bidder should the successful bidder fail to rectify the situation after
reasonable notice.
2.
In the event that (i) any of Successful bidder’s applications for Governmental
Approvals should be finally rejected; (ii) any Governmental Approval issued to
Successful bidder is canceled, expires, lapses, or is otherwise withdrawn or
terminated by governmental authority; (iii) Successful Bidder determines that
such Governmental Approvals may not be obtained in a timely manner; (iv)
Successful bidder determines that any soil boring tests or structural analysis is
unsatisfactory; (v) Successful bidder determines that the Premises is no longer
technically or structurally compatible for its use, or (vi) Successful bidder, in its
sole discretion, determines that the use the Premises is obsolete or unnecessary,
Successful bidder or Borough shall have the right to terminate this Agreement.
Notice of successful bidder’s or Borough’s exercise of its right to terminate shall
be sent to either party, at the address indicated in the contract documents for
receipt of Notices, in writing, by certified mail, return receipt requested, and
shall be effective one-hundred and eighty
(180) days upon receipt of the Notice by the non-terminating party, or upon such later date as
designated by the terminating party.
3.
The successful bidder agrees to indemnify and hold the Borough harmless from
any liability to subcontractors/suppliers for payment for work performed or
goods supplied arising out of the lawful termination of the contract by the
Borough or the successful bidder under this provision.
8.
Hold Harmless
Any bidder awarded a Lease under these specifications shall indemnify and hold harmless the
Borough, its officers, employees, agents and servants from and against any and all claims,
demands, suits, actions, recoveries, judgments, costs and expenses including attorney’s fees
incurred or suffered on account of property damage or loss and/or personal injury, including loss
of life, of any person, agency, corporation or governmental entity which shall arise out of the
course of or in consequence to any acts or omissions of the bidder, its employees, agents,
servants or subcontractors in the performance of the work pursuant to these specifications or the
failure of the bidder, its employees, agents, servants or subcontractors to comply with any term
or condition of these specifications. These Hold Harmless obligations of the bidder shall not
apply to any claims arising from the acts or omissions of the Borough. The bidder further agrees
that this indemnification by the bidder shall continue after completion, expiration or termination
of the Lease for all claims, demands, suits, actions, recoveries, judgments, costs and expenses,
including attorney’s fees resulting from acts or omissions of the bidder, its employees, agents,
servants or subcontractors which occur prior to the completion, expiration or termination of the
Lease.
9.
Non-Collusion Affidavit
The Non-Collusion Affidavit, which is part of these specifications, shall be properly executed
and submitted intact with the proposal.
10.
Statement of Corporate Ownership
Chapter 33 of the Public Laws of 1977 provides that no corporation or partnership shall be
awarded any contract for the performance of any work or the furnishing of any materials or
supplies, unless, prior to the receipt of the bid or accompanying the bid said corporation or
partnership, there is submitted a statement setting forth the names and addresses or all
stockholders in the corporation or partnership who own a ten (10%) percent or greater interest
therein. Said Statement shall be completed and attached to the bid proposal. If any stockholder or
partner has been previously convicted of a crime of bribery (or other financial crime), then such
bidder shall not be a responsible bidder.
11.
Non-Discrimination
There shall be no discrimination against any employee engaged in the work pursuant to any
contract resulting from this bid, or against any applicant to such employment because of race,
creed, color, national origin or ancestry, sexual or affectional preference or handicap. This
provision shall include, but not be limited to the following: employment upgrading, demotion,
transfer, recruitment or recruitment advertising, layoff or termination, rate of pay or other forms
of compensation and selection for training, including apprenticeship. The contractor shall insert a
similar provision in all subcontracts for services to be covered by any contract resulting from this
bid.
12.
STATUTORY AND OTHER REQUIREMENTS.
1.
Required Affirmative Action Evidence
2.
No firm may be awarded a contract unless they comply with the Affirmative
Action regulations of P.L. 1975, C. 127 (N.J.A.C. 12:27 et seq).
3.
Procurement, Professional and Service Contracts
All successful vendors must submit prior to the date of award one of the following:
i.
a letter from the U.S. Department of Labor that the contractor has an
existing federally approved or sanctioned Affirmative Action Program;
or
ii.
a Certificate of Employee Information Report approval;
if vendor does not have either of the above, the public agency is required to provide the vendor
with an initial Affirmative Action Employee Information Report form (Form AA-302).
4.
Americans with Disabilities Act of 1990
All vendors must comply with Title II of the Americans with Disabilities Act of 1990 (42 U.S.C.
12101).
5.
Worker and Community Right to Know:
The manufacturer or supplier of a substance or mixture shall supply the Chemical Abstracts
Service number of all the components of the mixture or substance and the chemical name to the
Borough to assure that every container bears a proper label 315 “Worker and Community Right
to Know Act”, subsection b, Section 14. Further all applicable Material Safety Data Sheets
(M.S.D.S.), a/k/a, hazardous substance fact sheet, must be furnished to the Borough.
6.
Acquisition, Merge, Sale and/or Transfer of Business, etc.
It is understood by all parties that if, during the life of the Lease, the successful bidder disposes
of his/her business concern by acquisition, merger, sale and/or transfer or by any means convey
his/her interest(s) to another party, all obligations are transferred to that new party. In this event,
the successful bidder shall in a timely manner notify the Borough of the identity of the new
owner(s), and the new owners may be required to submit a performance bond in the amount of
one year of then current Lease payments.
7.
Governing Law, State and Funding:
This contract shall be governed by and construed in accordance with the laws of the State of
New Jersey, including the New Jersey Prevailing Wage Act, N.J.S.A. 34:56-27 and the New
Jersey Local Lands and Buildings Law, N.J.S.A. 40A:12-1 et seq.
13.
Prohibited Russia-Belarus Activates & Iran Investment Activities
Prohibited Russia-Belarus Activates & Iran Investment Activities, which is part of these
specifications, shall be properly executed and submitted prior to award of contract.
14.
Pay to Play Requirements
Contractors are advised of the responsibility to file an annual disclosure statement on political
contributions with the New Jersey Election Enforcement Commission, pursuant to N.J.S.A.
19:44- 20.13(P.L. 2005, c, 271, s.3), if the contractor receives contracts in excess of $50,000 in
the aggregate from public entities during the calendar year. It is the contractor’s responsibility to
determine if filing is necessary. Additional information on this requirement is available from
ELEC at 888-313-3532 or at www.elec.state.nj.us. In addition, pursuant to Section 2-68.1 of the
Revised General Ordinances of the Borough of Fanwood respondents shall disclose all political
contributions of two hundred dollars ($200) or more made within the preceding five (5) years to
any elected officials of the Borough of Fanwood currently in office or any political organization
affiliated with an elected official of the Borough currently in office.
Scope of Work
DENTAL & LIFE INSURANCE BROKER SERVICES
The selected Broker shall provide professional insurance brokerage services to the Borough of
Fanwood for its employee dental and life insurance programs. The Broker must be a licensed
insurance producer in the State of New Jersey and demonstrate experience in managing public
sector benefit plans.
1. Plan Design & Strategic Consulting
•
Evaluate current dental and life insurance plans and recommend cost-effective
alternatives.
•
Advise on plan structure, funding options, and benefit enhancements.
•
Ensure plans comply with applicable federal and state regulations.
2. Market Analysis & Carrier Negotiation
•
Solicit quotes and proposals from qualified insurance carriers.
•
Negotiate rates, terms, and coverage levels to secure the most advantageous plans.
•
Provide comparative analysis of carrier proposals.
3. Renewal Management
•
Review renewal proposals and negotiate favorable terms.
•
Provide renewal estimates in advance of the municipal budget cycle.
4. Employee Support & Education
•
Assist with open enrollment and employee education sessions.
•
Provide guidance on coverage options and claims processes.
•
Serve as a liaison between employees and carriers for issue resolution.
5. Claims & Utilization Review
•
Monitor claims activity and provide periodic utilization reports.
•
Recommend adjustments to plan design based on usage trends.
6. Regulatory Compliance
•
Ensure compliance with applicable laws including ERISA, HIPAA, and COBRA.
•
Provide updates on legislative changes affecting dental and life insurance benefits.
7. Account Management & Reporting
•
Assign a dedicated account manager and support team.
•
Maintain regular communication with the Borough Administrator and HR department.
•
Provide quarterly and annual reports on plan performance and cost trends.
Evaluation Criteria
EVALUATION CRITERIA
POSSIBLE
POINTS
ACTUAL
SCORE
Technical Criteria
----
----
Response demonstrates a clear understanding of the scope of work and
related objectives;
10
Response is complete and responsive to the technical specifications/RFP
requirements;
10
History and past performance of like projects;
10
Management Criteria
----
----
Meets/exceeds criteria of Eligible Applicants;
10
Qualifications required for applicant staff;
10
Demonstration of sufficient capacity to undertake the proposal.;
10
Ability to implement the proposal in an effective and timely manner
consistent with the intent and spirit of this program;
10
Favorable recommendations from similar clients;
10
Cost Criteria
----
----
Budget proposal;
20
POINT TOTALS
100
RFP Proposal Form
DENTAL & LIFE INSURANCE BROKER SERVICES PROPOSAL
Firm Name: _________________________________________________
Address: ___________________________________________________
City, State, Zip: ________________________________________
Phone: ______________________ Fax: ____________________
Email: ____________________________________________________
Contact Person: ____________________________________________
License #: ___________________________
Years in Business: ________________________________________
Federal Tax ID #: _________________________________________
Annual Flat Fee Proposed: $ ____________________________
I/We hereby propose to provide Dental & Life Insurance Broker Services for the Borough of
Fanwood in accordance with the specifications and requirements set forth in this RFP.
Signature: ________________________________________________
Print Name: ______________________________________________
Title: __________________________________________________
Date: ___________________________________________________
Affirmative Action Regulations Public Law 1975, C. 127 (N.J.A.C. 17:27)
If awarded a contract, all procurement and service contractors will be required to comply with
the requirements of P.L. 1975, C 127, (N.J.A.C. 17:27). Prior to the date of the award, the
successful bidder shall present one of the following:
1.
A letter from the U.S. Department of Labor that the successful bidder has an existing
federally approved or sanctioned Affirmative Action Program.
OR
2.
A Certificate of Employee Information Report Approval.
OR
3.
If you do not have either of the above, check below:
Please send our company an Affirmative Action form for our completion (A.A.302 -
Affirmative Action Employee Information Report).
The following questions must be answered by all successful bidders:
1.
Do you have federally approved or sanctioned Affirmative Action Program?
Yes
No
2.
Do you have a State Certificate of Employee Information Report Approval?
Yes
No
You shall submit a photostatic copy of such certificate.
The undersigned successful bidder certifies that he is aware of the commitment to comply with
the requirements of P.L. 1975, C 127 (N.J.A.C. 17:27) and agrees to furnish the required
documentation pursuant to the law. The successful bidder must be rejected as non-responsible if
the successful bidder fails to comply with the requirements of P.L. 1975, C 127 (N.J.A.C. 17:27)
within the time frame. The Affirmative Action Affidavit for vendors having less then fifty (50)
employees is no longer acceptable, a New Jersey Certificate of approval or A.A.302 is required.
Company
Signature
Title
Mandatory Affirmative Action Language P.L. 1975, C. 127 (N.J.A.C. 17:27)
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or
applicant for employment because of age, race, creed, color, national origin, ancestry, marital
status, sex, affectional or sexual orientation. The contractor will take affirmative action to ensure
that such applicants are recruited and employed and that employees are treated during
employment, without regard to their age, race, creed, color, national origin, ancestry, marital
status, sex, affectional or sexual orientation. Such action 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. The contractor agrees to post in conspicuous places, available to
employees and applicants for employment, notices to be provided by the Public Agency
Compliance Officer setting forth provisions of this nondiscrimination clause;
The contractor or subcontractor, where applicable, will, in all solicitations or advertisements for
employees placed by or on behalf of the contractor, state that all qualified applicants will receive
consideration for employment without regard to age, race, creed, color, national origin, ancestry,
marital status, sex, affectional or sexual orientation;
The contractor or subcontractor, where applicable, will send to each labor organization or
representative or workers with which it has a collective bargaining agreement or other contract or
understanding, a notice to be provided by the agency contracting officer advising the labor
organization or workers’ representative of the contractor’s commitments under this act and shall
post copies of the notice in conspicuous places available to employees and applicants for
employment.
The contractor or subcontractor, where applicable, agrees to comply with the regulations
promulgated by the Treasurer pursuant to PL 1975, C127, as amended and supplemented from
time to time and the Americans with Disabilities Act.
The contractor or subcontractor agrees to inform in writing appropriate recruitment agencies in
the area, including employment agencies, placement bureaus, colleges, universities, and labor
organizations, that it does not discriminate on the basis of age, creed, color, national origin,
ancestry, marital status, sex, affectional or sexual orientation, and that it will discontinue the use
of any recruitment agency which engages in direct or indirect discriminatory practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to
assure that all personnel testing conforms with the principles of job-related testing, as established
by the statutes and court decisions of the State of New Jersey and as established by applicable
Federal Law and applicable Federal Court decisions.
The contractor or subcontractor agrees to review all procedures relating to transfer, upgrading,
downgrading, and layoff to ensure that all such actions are taken without regard to age, creed,
color, national origin, ancestry, marital status, sex, affectional or sexual orientation, and conform
with the applicable employment goals, consistent with the statues and court decisions of the State
of New Jersey, and applicable Federal Law and applicable Federal Court decisions.
The contractor and its subcontractors shall furnish such reports or other documents to the
Affirmative Action
Office as may be requested by the office from time to time in order to carry out the purposes of
these regulations and public agencies shall furnish such information as may be requested by the
Affirmative Action Office for conducting a compliance investigation pursuant to Subchapter 10
of the Administrative Code (N.J.A.C. 17:27).
State Of New Jersey – Laws Of 1977 – Chapter 33
(Disclosure Statement)
No corporation or partnership shall be awarded any contract, nor shall any agreement be entered
into for the performance of any work or the furnishing of any materials or supplies, the cost of
which is to be paid with or out of public funds, by the State, or agency of the State, or of any
county, municipality or Borough, or any authority, board of commission which exercises
governmental functions, unless prior to the receipt of the bid, or accompanying the bid, of said
corporation or partnership, there is submitted a statement setting forth the names and addresses
of all stockholders in the corporation or partnership who own 10% or more of that corporation’s
stock, or the individual partners owning 10% or greater interest in that partnership, as the case
may be, shall also be listed. The disclosure shall be continued until names and addresses of every
non-corporate stockholder and individual partner, exceeding the 10% ownership criteria
established in this act, has been listed.
Statement of Ownership (Ownership Disclosure Certification)
N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016,
c.43)
This Statement Shall Be Included with All Bid and Proposal Submissions
Name of Business:
Address of Business:
Name of person completing this form:
N.J.S.A. 52:25-24.2:
"No corporation, partnership, or limited liability company shall be
awarded any contract nor shall any agreement be entered into for the
performance of any work or the furnishing of any materials or supplies,
unless prior to the receipt of the bid or proposal, or accompanying the bid
or proposal of said corporation, said partnership, or said limited liability
company there is submitted a statement setting forth the names and
addresses of all stockholders in the corporation who own 10 percent or
more of its stock, of any class, or of all individual partners in the
partnership who own a 10 percent or greater interest therein, or of all
members in the limited liability company who own a 10 percent or greater
interest therein, as the case may be.
If one or more such stockholder or partner or member is itself a
corporation or partnership or limited liability company, the stockholders
holding 10 percent or more of that corporation’s stock, or the individual
partners owning 10 percent or greater interest in that partnership, or the
members owning 10 percent or greater interest in that limited liability
company, as the case may be, shall also be listed. The disclosure shall
be continued until names and addresses of every noncorporate
stockholder, and individual partner, and member, exceeding the 10
percent ownership criteria established in this act, has been listed.
To comply with this section, a bidder with any direct or indirect parent
entity which is publicly traded may submit the name and address of each
publicly traded entity and the name and address of each person that
holds a 10 percent or greater beneficial interest in the publicly traded
entity as of the last annual filing with the federal Securities and Exchange
Commission or the foreign equivalent, and, if there is any person that
holds a 10 percent or greater beneficial interest, also shall submit links to
the websites containing the last annual filings with the federal Securities
and Exchange Commission or the foreign equivalent and the relevant
page numbers of the filings that contain the information on each person
that holds a 10 percent or greater beneficial interest."
The Attorney General has advised that the provisions of N.J.S.A. 52:25-24.2,
which refer to corporations and partnerships apply to limited partnerships,
limited liability partnerships, and Subchapter S corporations.
This Ownership Disclosure Certification form shall be completed, signed and
notarized.
Failure of the bidder/proposer to submit the required information is cause for automatic
rejection of the bid or proposal
Part I
Check the box that represents the type of business organization:
□Sole Proprietorship (skip Parts II and III, sign and notarize at the end)
□Non-Profit Corporation (skip Parts II and III, sign and notarize at the end)
□Partnership □Limited Partnership
□Limited Liability Partnership
□Limited Liability Company
□For-profit Corporation (including Subchapters C and S or Professional Corporation)
□Other (be specific):
Part II
□
I certify that the list below contains the names and addresses of all stockholders in the
corporation who own 10 percent or more of its stock, of any class, or of all individual partners
in the partnership who own a 10 percent or greater interest therein, or of all members in the
limited liability company who own a 10 percent or greater interest therein, as the case may be.
OR
□
I certify that no one stockholder in the corporation owns 10 percent or more of its stock, of any
class, or no individual partner in the partnership owns a 10 percent or greater interest therein,
or that no member in the limited liability company owns a 10 percent or greater interest therein,
as the case may be.
Sign and notarize the form below, and, if necessary, complete the list below. (Please attach
additional sheets if more space is needed):
Name:
Name:
Address:
Address:
Name:
Name:
Address:
Address:
Name:
Name:
Address:
Address:
Name:
Name:
Address:
Address:
Name:
Name:
Address:
Address:
28
Part III -
Any Direct or Indirect Parent Entity Which is Publicly Traded:
“To comply with this section, a bidder with any direct or indirect parent entity
which is publicly traded may submit the name and address of each publicly
traded entity and the name and address of each person that holds a 10 percent
or greater beneficial interest in the publicly traded entity as of the last annual
filing with the federal Securities and Exchange Commission or the foreign
equivalent, and, if there is any person that holds a 10 percent or greater
beneficial interest, also shall submit links to the websites containing the last
annual filings with the federal Securities and Exchange Commission or the
foreign equivalent and the relevant page numbers of the filings that contain the
information on each person that holds a 10 percent or greater beneficial
interest.”
□
Pages attached with name and address of each publicly traded entity as
well
as the
name and address of each person that holds a 10 percent or greater
beneficial interest.
OR
□
Submit here the links to the Websites (URLs) containing the
last annual filings with the federal Securities and Exchange
Commission or the foreign equivalent.
AND
□
Submit here the relevant page numbers of the filings
containing the information on each person holding a 10
percent or greater beneficial interest.
29
NON-COLLUSION AFFADAVIT
Bid for the right to lease ground space for the installation of communications
equipment at 75 N. Martine Ave., Fanwood, NJ 07023, with simultaneous leasing of
additional carriers at the site.
STATE OF
COUNTY OF
I,
as
of
(Name of Partner or Officer
Title
Name of the Firm)
Located at
(Business Address)
in the County of
and State of
being of full
age, and duly sworn according to law on my oath depose and say that I am
of the firm of
the bidder making the Proposal for the
above named project, and that I executed said Proposal with full authority to do so;
that said bidder has not, directly or indirectly, entered into any agreement,
participated in collusion, or otherwise taken any action in restraint of free,
competitive bidding in connection with the above named project; and that statements
contained in said Proposal and in this affidavit are true and correct, and made with
full knowledge that Borough of Fanwood relies upon the truth of the statements
contained in said Proposal and in the statements contained in this affidavit in
awarding the contract for said project.
I further warrant that no person or selling agency has been employed or retained to
solicit or secure such contract upon an agreement of understanding for a commission,
percentage, brokerage or contingent fee, except bona fide employees of bona fide
established commercial or selling agencies maintained by
(Name of bidder)
in accordance with NJSA 52:34-15.
Subscribed and sworn to before me
this
date of
, 2025
Signature
NOTARY PUBLIC
NAME OF AFFIANT
30
ADDENDA ACKNOWLEDGEMENT
THIS MUST BE SUBMITTED WITH YOUR BID
• Please sign this sheet to indicate that you have received all the addenda that have been
prepared for this project.
• List on this sheet all the addenda that you have received.
• In the event that no addenda were issued, were necessary please initial below to indicate
that you have not received any addenda.
31
Acknowledgement by Bidder:
NO ADDENDA HAVE BEEN NECESSARY
Signature:
Print Name:
Name of Company:
Prohibited Russia-Belarus Activities & Iran Investment Activities
32
Prohibited Russia-Belarus Activities & Iran Investment Activities
Person or Entity
Part 1: Certification
COMPLETE PART 1 BY CHECKING ONE OF THE THREE BOXES BELOW
Pursuant to law, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter
into or renew a contract, for goods or services must complete the certification below prior to contract award
to attest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or
affiliate, is identified on the Department of Treasury's Russia-Belarus list or Chapter 25 list as a person or
entity engaging in prohibited activities in Russia, Belarus or Iran. Before a contract for goods or services
can be amended or extended, a person or entity must certify that neither the person or entity, nor any parent
entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list. Both lists are
found on Treasury’s website at the following web addresses:
https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf
www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf.
As applicable to the type of contract, the above-referenced lists must be reviewed prior to completing the
below certification.
A person or entity unable to make the certification must provide a detailed, accurate, and precise description
of the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging in prohibited
activities in Russia or Belarus and/or investment activities in Iran. The person or entity must cease engaging
in any prohibited activities and provide an updated certification before the contract can be entered into.
If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may be
provided by law, rule, or contract, including but not limited to imposing sanctions, seeking compliance,
recovering damages, declaring the party in default, and seeking debarment or suspension of the party.
CONTRACT AWARDS AND RENEWALS
I certify, pursuant to law, that neither the person or entity listed above, nor any parent
entity, subsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of
entities engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022,
c. 3 or in investment activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25 List").
I further certify that I am the person listed above, or I am an officer or representative
of the entity listed above and am authorized to make this certification on its behalf.
(Skip Part 2 and sign and complete the Certification below.)
33
CONTRACT AMENDMENTS AND EXTENSIONS
I certify, pursuant to law, that neither the person or entity listed above, nor any parent
entity, subsidiary, or affiliate is listed on the N.J. Department of the Treasury’s lists
of entities determined to be engaged in prohibited activities in Russia or Belarus
pursuant to P.L. 2022, c. 3. I further certify that I am the person listed above, or I
am an officer or representative of the entity listed above and am authorized to make
this certification on its behalf. (Skip Part 2 and sign and complete the Certification
below.)
IF UNABLE TO CERTIFY
I am unable to certify as above because the person or entity and/or a parent entity,
subsidiary, or affiliate is listed on the Department's Russia-Belarus list and/or
Chapter 25 Iran list. I will provide a detailed, accurate, and precise description of the
activities as directed in Part 2 below, and sign and complete the Certification below.
Failure to provide such will prevent the award of the contract to the person or entity,
and appropriate penalties, fines, and/or sanctions will be assessed as provided by
law.
Part 2: Additional Information
PLEASE PROVIDE FURTHER INFORMATION RELATED TO PROHIBITED ACTIVITIES IN RUSSIA
OR BELARUS AND/OR INVESTMENT ACTIVITIES IN IRAN.
You must provide a detailed, accurate, and precise description of the activities of the person or entity, or of a
parent entity, subsidiary, or affiliate, engaging in prohibited activities in Russia or Belarus and/or investment
activities in Iran in the space below and, if needed, on additional sheets provided by you.
34
Part 3: Certification of True and Complete Information
I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any
attachments there, to the best of my knowledge, are true and complete. I attest that I am authorized to
execute this certification on behalf of the above-referenced person or entity.
I acknowledge that the Borough of Fanwood is relying on the information contained herein and
hereby acknowledge that I am under a continuing obligation from the date of this certification through
the completion of any contracts with the Borough of Fanwood to notify the Borough of Fanwood in
writing of any changes to the answers of information contained herein.
I acknowledge that I am aware that it is a criminal offense to make a false statement or
misrepresentation in this certification. If I do so, I recognize that I am subject to criminal prosecution
under the law and that it will also constitute a material breach of my agreement(s) with the Borough of
Fanwood and that the Borough of Fanwood at its option may declare any contract(s) resulting from this
certification void and unenforceable.
Full Name
(Print)
Title
Signature
Date
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performance bond
Evidence Detected
"...he successful bidder shall in a timely manner notify the Borough of the identity of the new owner(s), and the new owners may be required to submit a performance bond in the amount of one year of then current Lease payments. 7. Governing Law, State and Funding: This contract shall be governed by and construed i..."
liquidated damages
Evidence Detected
"...Should the successful bidder fail to execute and deliver the Contract, as defined in Section 7, within one hundred eighty (180) days after bid award, the bidder forfeits to the Borough, as liquidated damages, the bid security deposited with its bid...."
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Contacts
Courtney Agnello
Borough Clerk
hidden@email.com
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Timeline
First Discovered
Mar 19, 2026
Last Info Update
Apr 30, 2026
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