STATEMENT OF WORK/SPECIFICATION REQUIREMENTS WORKERS COMPENSATION JUDGES CONFERENCE May 2016

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Check the box which represents Overnight 5/15, 5/16 5/17 the date(s) your facility can & Conference 5/18 & 5/19 accommodate this conference Cannot accommodate STATEMENT OF WORK/SPECIFICATION REQUIREMENTS CONTRACT SCOPE/OVERVIEW: This Contract will cover the requirements needed for the Workers Compensation Judges to fulfill their yearly 20 hours of Professional Development Requirement. The guest rooms listed shall be paid separately by the attendees using either a corporate credit card or each attendee s personal credit card. This conference is being held in conjunction with the Workers Compensation Conference, already scheduled May 16 th and May 17 th. A majority of the Judges will attend this conference in Hershey and the Workers Compensation Judges Conference will be held May 18 th and May 19 th, immediately following the Workers Compensation Conference. The Judges Conference will take place at the same venue as the Workers Compensation Conference or at a venue that can facilitate the specifications outlined below, within one mile in all directions of the Hershey Lodge, located at 325 University Drive, Hershey, PA. OBJECTIVE: Provide overnight lodging, training facilities and amenities for Workers Compensation Judges and Conference staff on the dates, and as provided below: PARKING: Ample parking shall be available to accommodate the attendees; fees for parking will be submitted as a line item in addition to the individual room fees. Parking will be available for overnight attendees as well as daytime-only attendees from 5/15 through 5/19. Any overflow parking will be accessible by attendees 24 hours; main garage and/or overflow lot are not locked during overnight hours. Garages or lots (main and overflow) shall be staffed 24 hours and connected through an interior entrance to the hotel. Valet parking will not be a requirement. GUEST ROOMS: The facility will not require more than 24 hours notice of a cancellation of a room reservation. The Commonwealth of PA is exempt from all cancellation fees, penalties, and attrition. Facility must be non-smoking inside its premises and guest rooms. Lodging rooms shall be accessed by inside hallways and shall be in the same building as meeting rooms, break-out rooms and meals. Sunday May 15 10 rooms will be blocked, must have at least two handicappedaccessible rooms Monday May 16, 2016: 25 rooms will be blocked, must have at least two handicappedaccessible rooms. Tuesday May 17, 2016: 95 rooms will be blocked, must have at least two handicappedaccessible rooms. Wednesday May 18, 2016: 95 rooms will be blocked, must have at least two handicappedaccessible rooms. - 1 -

Business Center: Use of a business center on 5/17, 18 & 19 for printing and copying. Quoted price for copies can be quantified. (*Outlined more specifically below) TUESDAY, May 17, 2016 QTY UNIT TOTAL ~2 registration tables and 4 chairs, easel and message board next to registration tables 5:00 p.m. to 8:00 p.m. 2 registration tables/ $ $ 4 chairs, easel, Message board with dry erase markers next to tables. Use of a business center on the evening of 5/17 for printing and copying. Quoted price for copies can be quantified. Use of business ctr. $ $ TUESDAY-WEDNESDAY May 17 &18 QTY UNIT TOTAL A designated suite will be provided for presenters to meet during non-conference hours for the purpose of discussing conference materials, prepare for panel discussions and finalize presentation material. The suite shall fit approximately 30 people comfortably Tuesday and Wednesday after main conference hours. 2 $ $ - 2 -

WEDNESDAY, May 18, 2016 QTY UNIT TOTAL Private Meeting Room Rental Set up in classroom style for 110 people from 7:30 am to 7:00 pm to include: ~meeting room itself should be at least 50x50 feet and each attendee will have a clear view of speakers and screen. No viewing obstruction of any kind (such as pillars) between attendees and speakers. ~head table on riser with seating for 6 ~3 table-top microphones spaced across table ~1 stand-alone podium with microphone off to the side of head table ~2 wireless microphones for audience ~1 lapel microphone ~Audio hook-up with above microphone needs* *based on final agenda ~1 screen at front of room, positioned so audience can see and elevated, if determined by conference coordinator to be necessary ~small table, chair and outlet extension cord placed on a raised platform at a key vantage point for Videotaping the event ~10 chairs at rear of room without tables ~2 registration tables and 8 chairs outside of meeting room, easel and message board next to registration tables ~Digital overhead projector with remote ~water and drinking glasses for head table and audience The following shall be provided, based upon final agenda and seminar needs: ~1 TV and VCR/DVD ~1 slide carousel projector 1 meeting room $ $ W/tables, podium, risers, chairs, as outlined in description. 1 screen $ $ All Microphones & Audio$ $ Needs (based on final agenda) Registration table/easel/chairs (Outside room) $ $ Digital overhead projector with remote $ $ 1 TV VCR/DVD $ $ 1 slide carousel projector $ $ 4 breakout rooms $ $ Digital overhead projector with remote for each breakout room $ $ Screen for each breakout room $ $ ~4 breakout rooms each with seating for 50, table needs will be noted based on final agenda. ~Use of a business center for printing and copying. Quoted price for copies can be quantified. Bus. Center $ $ - 3 -

WEDNESDAY, May 18, 2016, cont. QTY UNIT TOTAL Continuous Morning Food & Beverage Station (7:45 am to 12:00 pm): ~Coffee, decaf, tea, orange juice and bottled water ~Fresh pastries and bagels, cream cheese, variety of ~cold cereal and 2% or 1% milk cartons ~Low fat and whole grain muffins ~Fresh fruit and yogurt ~include gratuity ~Kosher section for 4 (included in the 110) Refreshments to be refreshed as needed between these hours. 110 $ $ Continuous Afternoon Food and Beverage Station (1:30 pm to 4:30 pm): ~coffee, decaf, tea ~assorted sodas (including diet) & bottled water ~iced tea, unsweetened, with fresh lemon ~assortment of snacks, to include cookies or brownies, cheese & crackers, vegetable tray & dip, fresh fruit, nuts. All items will be freshly prepared. ~Kosher section for 4 (included in the 110) Refreshments to be refreshed as needed between these hours. ~include gratuity 110 $ $ Hot lunch served conducive for working lunch. Lunch will include a meat (chicken or beef), salad, potato (and/or pasta), vegetable and bread; individuals will have a choice of Vegetarian, Meat (chicken and/or beef), Kosher or Gluten Free, menu items will be agreed upon in advance with conference coordinator and pre-ordered selections will be returned to the hotel within enough notice to hotel for preparation purposes. Time of lunch will be provided to the hotel and is based on final agenda. Food items will be freshly prepared and will not be canned, greens and salad items will be fresh, and choice of assorted salad dressings. Buffet will be an option and decided prior to conference. ~Iced tea and soda will be offered during lunch, as well as water & fresh lemon ~coffee, decaf, tea will be served with desert ~desert selection ~include gratuity 110 $ $ *The need for this lunch will based on final agenda - 4 -

THURSDAY, May 19, 2016 Private Meeting Room Rental Set up in classroom style for 110 people from 7:30 am to 12:30 pm to include: ~meeting room itself should be at least 50x50 feet and each attendee will have a clear view of speakers and screen. No viewing obstruction of any kind (such as pillars)between attendees and speakers. ~head table on riser with seating for 6 ~3 table-top microphones spaced across table ~1 stand-alone podium with microphone off to the side of head table ~2 wireless microphones for audience ~1 lapel microphone ~Audio hook-up with above microphone needs* *based on final agenda ~1 screen at front of room, positioned so audience can see and elevated, if determined by conference coordinator to be necessary ~small table, chair and outlet extension cord placed on a raised platform at a key vantage point for videotaping the event ~10 chairs at rear of room without tables ~2 registration tables and 8 chairs outside of meeting room, easel and message board next to registration tables ~Digital overhead projector with remote ~water and drinking glasses for head table and audience The following shall be provided, based upon final agenda and seminar needs: ~1 TV and VCR/DVD ~1 slide carousel projector ~3 breakout rooms each with seating for 50, table needs will be noted based on final agenda. QTY UNIT TOTAL 1 meeting room $ $ W/tables, podium, risers, chairs, as outlined in description. 1 screen $ $ All Microphones & Audio $ $ Needs (based on final agenda) Registration table/easel/chairs (Outside room) $ $ Digital overhead projector with remote $ $ 1 TV VCR/DVD $ $ 1 slide carousel projector $ $ 3 breakout rooms $ $ Digital overhead projector with remote for each breakout room $ $ Screen for each breakout room $ $ ~Use of a business center for printing and copying. Quoted price for copies can be quantified. Bus. Center $ $ - 5 -

THURSDAY, May 19, 2016 QTY UNIT TOTAL Continuous Morning Food & Beverage Station (7:45 am to 12:00 pm): ~Coffee, decaf, tea, orange juice and bottled water ~Fresh pastries and bagels, cream cheese, variety of cold cereal and 2% or 1% milk cartons ~Low fat and whole grain muffins ~Fresh fruit and yogurt ~Kosher section for 4 (included in the 110) ~include gratuity 110 $ $ Refreshments to be refreshed as needed between these hours. Private meeting room from 11:45-3:00 to accommodate up to 20 people. One large table with seating around the table. Lunch included, to include a limited menu with sandwich options, salads and vegetarian option. Choice of soda, bottled water or iced-tea. 20 $ $ (Exact count will be given to hotel on Thursday morning) GRAND TOTAL: $ Please check the box that represents the May 15, 2016 through May 19, 2016 dates your facility can accommodate this conference: Cannot accommodate (This information requested on the first page as well). - 6 -

Hotel Company Name Contact E-mail Address Telephone Number Fax Number FID Number Signature Name Printed LODGING/PARKING List sleeping room rates for overnight guest rooms (Sunday: 10 rooms, Monday: 25 rooms, 95 rooms Tuesday and Wednesday nights) which will be blocked for attendees prior to the Conference. - 7 -

Employees are responsible for making their own reservations, using a corporate or personal credit card. Hotel will provide weekly rosters on reservations made by our staff to begin approximately 8 weeks before meeting date to coincide with any registration requirements established by the hotel. Provide ample parking for attendees. Parking will be available for all conference attendees, including May 17 and 18, not only for overnight guests. Any overflow parking will be accessible by attendees 24 hours; garage or lot is not locked during overnight hours. Garage or lot shall be staffed 24 hours and connected through an interior entrance to the hotel. Valet parking will not be a requirement. Venue must adhere to DGS Standards terms and conditions. The Commonwealth of PA is exempt from all cancellation fees, penalties, and attrition. The Commonwealth of PA is exempt from local occupancy tax and is subject to the state occupancy tax of 6%. Individual Room Rate: Overnight Guest room: Parking: Overnight guests: Day Rate: $ $ $ /time from :00AM to :00PM BREAKS The final menu for break time drinks and snacks (and lunch, if applicable, based on final agenda) will be determined prior to the event. Pastries shall be fresh, but not individually packaged. The morning break will include pastries/bagels and alternatives for those who do not want starch, such as fresh cut fruit, cereal and yogurt. The afternoon break will include beverages, a dessert, cheese, fruit and alternatives for those who want proteins or other healthy alternatives. Bottled water will be provided during all morning and afternoon break/food stations. Soda (a diet soda is required) will be provided in the afternoon and lunch, if applicable) All food and beverage prices will include gratuity. Additional requirement: Kosher section of food stations for 6, as noted above. There will be a lunch option for those who require vegetarian, gluten-free, kosher or any dietary restriction upon request (with advanced notice). MISCELLANEOUS Provide free internet service for all guests. Advise on bid whether there is any anticipated construction during that might affect this meeting. - 8 -

Provide 4 stanchions on registration table. The facilities and equipment requested are all estimated quantities. If any rooms or equipment will be provided at no charge, please indicate such on this quote. Standard Provision for the Donation of Excess Prepared Food: The contractor agrees to make a good faith effort to donate to a nonprofit organization for ultimate free distribution to needy individuals any apparently wholesome food fit for human consumption which is not consumed at the conference for disposal by the contractor. A good faith effort includes, at a minimum, contacting one or more of the entities appearing on the referral listing maintained by the Department of Agriculture. Pursuant to 42 Pa. C.S.A. 8338, the contractor shall not be subject to liability arising from the nature, age, packaging or condition of the apparently wholesome food. If you have questions or concerns please contact: Gloria Gallagher, Administrative Officer WCOA Eastern District 315 W James Street, Suite 206 717.299-7591 office or 717.856-6593 work cell - 9 -