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25O - AGMT AMBULANCE SVCS
REQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: DECEMBER 18, 2018 TITLE: APPROVE OF FIRE/EMERGENCY MEDICAL SERVICES, EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES AGREEMENT WITH CARE AMBULANCE SERVICE, INC. {STRATEGIC PLAN NO. 1, 5} CITY M NAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED ❑ As Recommended ❑ As Amended ❑ Ordinance on 1s' Reading ❑ Ordinance on 2ntl Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER Authorize the City Manager and Clerk of the Council to execute and agreement with CARE Ambulance Services, Inc. to provide emergency ambulance transportation and related services for an initial 5 -year term ending December 31, 2023, in an amount not to exceed $22,967,616 with provisions for two optional extensions: a 3 -year extension beginning January 1, 2024 and ending December 31, 2026, in an amount not to exceed $17,028,204, followed by a final 2 -year extension beginning January 1, 2027 and ending December 30, 2028 in an amount not to exceed $12,521,712 for a total agreement amount not to exceed $52,517,532, including renewal options, subject to non -substantive changes approved by the City Manager and City Attorney. DISCUSSION Competitive Process for Exclusive Operating Area #20 for Ambulance Service Pursuant to the California Emergency Medical Services (EMS) act, only the County may create Exclusive Operating Areas (EOA) for the provision of ambulance services. The City of Santa Ana was established as EOA No. 20 and, until the April 20, 2012 transition to the Orange County Fire Authority (OCFA), was not required to conduct the competitive process for selection of an ambulance service provider as the City's 9-1-1 transportation service was provided by City firefighter personnel prior to 1980 and therefore the City was exempt from the EMS statute that requires the competitive process. City of Santa Ana Public Safety — Fire and Emergency Services The City's fire and emergency services structure is comprised of three separate entities, each with its own distinct set of responsibilities and services which are provided to the City. Since April 20, 2012, the City has contracted with OCFA for emergency fire services while the transportation services are handled by Care Ambulance Service, Inc. ("CARE") personnel and vehicles. The billing and collections of said services are handled by the Wittman Enterprises, LLC ('Wittman"). 250-1 Approval of Fire/EMS Emergency Ambulance Transportation & Related Services Agreement with CARE Ambulance Service, Inc. December 18, 2018 Page 2 CARE Ambulance Service, Inc. (2012 - 2018 Agreement) The current agreement with CARE, entered into pursuant to a competitive Request for Proposals (RFP) selection process, commenced on September 20, 2012 and covered an initial three (3) year period ending September 20, 2015. The City in concurrence with OCFA, exercised its option to extend the original agreement twice for additional one (1) year terms, respectively on September 3, 2015 (A-2012-196-01) and again on August 11, 2016 (A-2012-196-02). The agreement was further extended in concurrence with OCFA on September 5, 2017 for an additional period commencing September 20, 2017 and ending June 30, 2018 (A-2012-196-03) with the option for a final additional six (6) month term ending December 31, 2018. To accommodate a thorough and deliberate RFP process in association with OCFA, this final extension option was exercised in concurrence with OCFA on May 29, 2018. Subsequently, on August 21, 2018, Mayor and City Council authorized staff to issue Requests for Proposals (No. #18-059) for Emergency Ambulance Transportation and Related Services. Since its founding in 1969, CARE has become the oldest and largest provider of emergency ambulance transportation services in Orange County. Currently, CARE operates five 24 hour units and two peak hour units on a daily basis in the City of Santa Ana. Throughout the term of its contract CARE has continued to meet or exceed key performance measures such as: . • Maintained 97% response time compliance standard • All -back up calls for service handled by CARE vehicle's • Have never used Mutual Aid providers • Vehicles maintain computer aided dispatch (CAD) to CAD connection with OCFA Request for Proposals # 18-059: Fire/EMS Emergency Ambulance Transportation and Related Services (RFP). Given the significance of emergency ambulance transportation services, in order to ensure that the City receives proposals from qualified and experienced 9-1-1 providers, RFP No. #18-059 set high standards with respect to provider experience, operational systems, vehicle maintenance/records, personnel training/records, and patient care/transport system design but also allowed providers the opportunity to submit complimentary proposals with additional innovative services and potential cost -savings. The following descriptions are the key components of the RFP: 1. Scope: Provide sufficient number of ambulances to respond to 100% of the 9-1-1 call volume within response time requirements. 2. Experience Requirements: Must have recent and comparable 9-1-1 transport experience to 80% of 2017 call volume. 3. Response Requirements: Bidder must strictly adhere to the following minimum requirement response times at a quarterly compliance rate of ninety percent (90%) in each Code 2 and Code 3 Categories, which are reported separately: a. Code 2 — Response times must not exceed fourteen (14) minutes, fifty-nine (59) seconds. Code 3 — Response times mwZ-51pq)_Zceed nine (9) minutes, fifty-nine (59) seconds. v L Approval of Fire/EMS Emergency Ambulance Transportation & Related Services Agreement with CARE Ambulance Service, Inc. December 18, 2018 Page 3 4. Vehicles: Selected provider will be required to provide and incur all costs (including fuel, storage repair maintenance costs) for Type III ambulances for Tier I and Tier II service. 5. Billing: City will retain billing authority/responsibility for all calls and transports within the City of Santa Ana. 6. Bid Submittal Cost: Proposal must be all inclusive for all First, Second, and Mutual Aid Emergency Transportation Services within the City of Santa Ana. 7. Housina: Bid submittal should assume ambulances will not be housed within City owned facilities or property. Release of RFP #18-059 & Pre -submission Conferences On August 28, 2018, the Finance and Management Services Agency (FMSA) released the RFP on the City's online bid portal (PlanetBids) seeking emergency ambulance transportation and related services. According to PlanetBids, the following actions occurred: Vendors notified 147 Santa Ana vendors notified 0 Vendors Downloaded RFP 10 As part of the RFP, an optional Pre -Submission Conference took place on October 3, 2018 and was attended by two bidders: CARE and Doctor's Ambulance Service ("Doctor's"). During the optional Pre -Submission Conference (attended by both bidders), City and OCFA staff answered pre - submitted questions. A bidder request for enhanced 2017 call volume data, beyond that preliminarily provided by OCFA, resulted in the need to call a second pre -bidders conference to disseminate this data which was provided by the Orange County Emergency Medical Services (OCEMS) Agency, a comprehensive and un -biased source. As a result, a mandatory Pre - Submission conference was held on October 25, 2018 to disclose said call volume data to all bidders. The mandatory second Pre -Submission Conference was attended by both bidders, CARE and Doctor's. Bid Proposal Submission & Public Openin4 On October 31, 2018, proposals were received from two providers: CARE and Doctors. During the bid opening, the following information was released and made public with both bidders present: • RFP number • Submission date • General description of services to be provided • Name of bidders • Amounts proposed: o Annual contract price o Not to exceed amount per month o Complimentary billing (optional) Proposal Grading Panel & Criteria 250-3 Approval of Fire/EMS Emergency Ambulance Transportation & Related Services Agreement with CARE Ambulance Service, Inc. December 18, 2018 Page 4 The subsequent proposals were evaluated by a Proposal Grading Panel comprised of five staff members from the following agencies: FMSA (3), Santa Ana Police Department (1) and OCFA (1). The Proposal Grading Panel members reviewed and ranked each proposal separately from one other based on the criteria and grading scale established in the RFP. The following evaluation criteria with a maximum 500 point scale was utilized by the Proposal Grading Panel to rate each proposal: Criteria A. Experience of the Proposer B. Operational Systems C. Patient Care/Transport System Design D. Personnel Training and Records E. Financial Analysis (Cost to the City) F. Vehicle Maintenance and Records Points 0-100 0-100 0-100 0- 75 0- 75 0- 50 500 maximum points The listed criteria requirements were assigned a point scale based on the item's relative importance. The final score was derived by averaging the individual members' ranking for each category and then reaching a cumulative score. Using this methodology, the highest average cumulative score would reflect the best proposal. Proposal Grading Panel Evaluations & Bidders Presentations The proposals from the two bidders were evaluated by the Proposal Grading Panel members for assessment and scoring. The Proposal Grading Panel members each submitted their own preliminary scoring to the Supervising Buyer of the Purchasing Department prior to the oral in- person presentations. Presentations from bidders occurred on November 8, 2018, and served as an opportunity to highlight key points of their proposal and to respond to clarification requests from the grading panel based on information contained within the RFP submittals. As such, bidders were instructed not to present new content or information not contained in their respective RFP submittals. Proposal Grading Panel Rankings & Recommendation The Proposal Grading Panel final rankings of the submitted RFP responses to Request for Proposals # 18-059: Fire/EMS Emergency Ambulance Transportation and Related Services are as follows: 250-4 Approval of Fire/EMS Emergency Ambulance Transportation & Related Services Agreement with CARE Ambulance Service, Inc. December 18, 2018 Page 5 RFP # 18-059: Fire/EMS Emeraencv Ambulance Transportation and Related Services The RFP submittal by CARE met all the criteria and required services contained within the RFP. Additionally, based on the highest points total in the above table, CARE is the bidder with the highest ranking. In addition to maintaining a fleet of dedicated emergency vehicle units and maintaining a greater than 97% response compliance standard, CARE is committed to the following service enhancements: • On -board language translation services (200 languages) • First provider in Orange County to carry automated external cardiac compression devices • Electronic patient care records with document scanning • Road safety and video recording • Transport of injured SAPD K -9's Therefore, staff recommends that CARE be retained to continue providing emergency transportation services. STRATEGIC PLAN ALIGNMENT Approval of this item assists the City in meeting Goal #1 Community Safety, Objective #5 (Provide high quality Police and Fire/Emergency Medical Services response within the City of Santa Ana). 250-5 Average Score Evaluation Criteria / Possible Points Care Ambulance Service Doctor's Ambulance Experience / 0 - 100 98 92 Operational Systems / 0 - 100 98 93 Patient Care/Transport System Design 10 - 100 97 93 Personnel Training and Records / 0 - 75 70 69 Financial Analysis (cost to the City) / 0 - 75 75 67 Vehicle Maintenance and Records / 0 - 50 34 34 Total 471 448 Final Ranking 1 2 The RFP submittal by CARE met all the criteria and required services contained within the RFP. Additionally, based on the highest points total in the above table, CARE is the bidder with the highest ranking. In addition to maintaining a fleet of dedicated emergency vehicle units and maintaining a greater than 97% response compliance standard, CARE is committed to the following service enhancements: • On -board language translation services (200 languages) • First provider in Orange County to carry automated external cardiac compression devices • Electronic patient care records with document scanning • Road safety and video recording • Transport of injured SAPD K -9's Therefore, staff recommends that CARE be retained to continue providing emergency transportation services. STRATEGIC PLAN ALIGNMENT Approval of this item assists the City in meeting Goal #1 Community Safety, Objective #5 (Provide high quality Police and Fire/Emergency Medical Services response within the City of Santa Ana). 250-5 250-6 Approval of Fire/EMS Emergency Ambulance Transportation & Related Services Agreement with CARE Ambulance Service, Inc. December 18, 2018 Page 6 FISCAL IMPACT Funds are budgeted and available in fiscal year 2018-19 and will be budgeted in subsequent fiscal years in the Fire Suppression/EMS account (01115330-62300) as follows: Account No. Fiscal Year Total 01115330-62300 FY 2018-19(January 1, 2019 - June 30, 2019 6 months * $ 1,818,372 FY 2019-20 (July 1, 2019 - June 30, 2020 12 months $ 4,412,016 FY 2020-21 (July 1, 2020 - June 30, 2021 12 months $ 4,578,936 FY 2021-22 (July 1, 2021 - June 30, 2022 12 months $ 4,745,256 FY 2022-23 (July 1, 2022 - June 30, 2023 12 months $ 4,914,000 FY 2023-24 (July 1, 2023 - December 31, 2023 6 months $ 2,499,036 Initial 5 -Year Term - Subtotal $ 22,967,616 FY 2023-24(January 1, 2024 - June 30, 2024 6 months $ 2,728,494 FY 2024-25 (July 1, 2024 - June 30, 2025 12 months $ 5,564,736 FY 2025-26 (July 1, 2025 - June 30, 2026 12 months $ 5,785,608 FY 2026-27 (July 1, 2026 - December 31, 2026 6 months $ 2,949,366 1st 3 -Year Optional Extension Term - Subtotal $ 17,028,204 FY 2026-27(January 1, 2027 - June 30, 2027 6 months $ 3,068,088 FY 2027-28 (July 1, 2027 - June 30, 2028 12 months $ 6,260,856 FY 2028-29 (July 1, 2028 - December 31, 2028 6 months $ 3,192,768 Final 2 -Year Optional Extension Term - Subtotal $ 12,521,712 Total $ 52,517,532 *NOTE. FY 2018-19 expenses reflect negotiated pricing discount of $345,000 for the initial 6 months of agreement. APPROVED AS TO FUNDS AND ACCOUNT:. Kathryn Downs, CPA _4vw Executive Director Finance and Management Services Agency Exhibit: 1. Agreement AR: WH 250-7 250-8 EXHIBIT 1 AGREEMENT FOR FIRE / EMS EMERGENCY TRANSPORTATION SERVICES This Agreement ("Agreement" / "Contract") is made and entered into this 18th day of December, 2018, by and between the CITY OF SANTA ANA of Santa Ana, a municipal corporation located in the County of Orange ("CITY OF SANTA ANA") and CARE Ambulance Service, Inc. Inc., a California corporation, with principal offices at 1517 W. Braden Court, Orange, California ("CONTRACTOR"). City of Santa Ana and CONTRACTOR may each be referred to as "Party' or collectively as the "Parties". RECITALS WHEREAS, CITY OF SANTA ANA issued a Request for Proposals (No. # 18- 059) on August 28, 2018, related to the provision of emergency transportation services in the CITY OF SANTA ANA (the "RFP"). A copy of the RFP is attached hereto and incorporated herein by this reference as Exhibit "A"; and WHEREAS, in response to the RFP, CONTRACTOR submitted a Proposal dated October 31, 2018 (the "Proposal"), a copy of which is attached hereto and incorporated herein by this reference as Exhibit "B"; and WHEREAS, CITY OF SANTA ANA desires to utilize the services of CONTRACTOR to provide primary ambulance transportation services and other related services in accordance with the terms of the RFP and applicable federal, state and local laws; and WHEREAS, CONTRACTOR is an ambulance provider fully licensed and otherwise qualified to perform the work required by this Agreement, and was selected by CITY OF SANTA ANA following evaluation of proposals submitted in response to the RFP. NOW, THEREFORE, in consideration of the mutual promises, covenants and conditions herein contained, the Parties hereby agree as follows: 1. Contract Documents and Order of Precedence A. This Agreement shall consist of the following documents: (a) this Agreement; (b) the CITY OF SANTA ANA's RFP, (c) and the CONTRACTOR's Proposal. This Agreement, the RFP, and the Proposal, shall be hereinafter collectively referred to as the "Contract Documents". The Contract Documents constitute the entire agreement between the Parties. This Agreement contemplates that CONTRACTOR will do whatever is required to perform the work in accordance with the terms of the Contract Documents and in accordance with any applicable governmental laws and regulations, whether specifically identified in the Contract Documents or not. Should any inconsistency be found to exist 250-9 between the aforesaid Contract Documents and this written Agreement, the provisions of this Agreement shall control. B. All provisions of the Contract Documents shall be binding on CONTRACTOR. In the event there is any discrepancy between the terms and conditions of one or more of the aforementioned Contract Documents, the Order of Precedence shall be used to resolve the discrepancy unless both parties mutually agree in writing to an alternative decision. The Order of Precedence for these documents shall be as follows: 1) First, this Agreement (together with any Amendments thereto). 2) Second, the RFP. 3) Third, the Proposal. C. The Parties acknowledge and agree that in the event of a material conflict or inconsistency between the terms and conditions of CITY OF SANTA ANA's RFP incorporated herein as Exhibit A and/or CONTRACTOR's Proposal incorporated herein as Exhibit B, the terms specified in the Recitals of this Agreement shall control. 2. Scope of Work A. In exchange for the compensation to be provided by CITY OF SANTA ANA to CONTRACTOR, CONTRACTOR will perform all of the services described in this Section for CITY OF SANTA ANA. The details of the services to be provided by CONTRACTOR are described in detail in the Contract Documents. Those services shall include the provision of all 9-1-1 Emergency Transportation Services, including but not limited to the First Tier Service and the Mutual Aid Service (as defined below), together with the provision of any labor, material, supplies and equipment related to the provision of those services, and any other duties, obligation or services required of CONTRACTOR in the Contract Documents. (All of the services to be provided by CONTRACTOR under this Agreement shall be hereinafter collectively referred to as the "9-1-1 Emergency Transportation Services"). CONTRACTOR shall perform the 9-1-1 Emergency Transportation Services in accordance with the terms and conditions contained in this Agreement, and as described in Contract Documents. B. All emergency transportation personnel assigned by CONTRACTOR or by the Mutual Aid Provider to perform 9-1-1 Emergency Transportation Services under this Agreement shall be hereinafter referred to as the "Transportation Personnel". C. Without limiting CONTRACTOR's obligation to comply with all of its duties and obligations under the Contract Documents, the 9-1-1 Emergency Transportation Services to be provided by CONTRACTOR shall include, but shall not be limited to, each of the following: 1. First Tier Service. CONTRACTOR will provide with its own forces a sufficient number of fully equipped ambulances and Transportation Personnel, so 2 250-10 as to provide, in accordance with industry standards and this RFP, all of the CITY OF SANTA ANA's needs for 9-1-1 Emergency Transportation Service, being able to respond 24 hours a day 7 days a week to all 911 and other emergencies as required (the "First Tier Service" or "First Tier"). The First Tier Service will be designed by CONTRACTOR so as to ensure that there are enough of CONTRACTOR's own ambulances and Transportation Personnel available to meet 100% of the anticipated number of calls for 9-1-1 Emergency Transportation Service in the CITY OF SANTA ANA. The First Tier Service shall meet the response times and all other requirements of this RFP for the 9-1-1 Emergency Transportation Service. Each year thereafter, for the duration of the Term of the proposed Contract, CONTRACTOR will be required to re-evaluate the level of coverage being provided, so as to ensure it is providing the required level of coverage. 2. Mutual Aid Service. CONTRACTOR will also enter into one or more mutual aid agreement(s) with a separate qualified ambulance service provider(s) doing business in Orange County, to provide backup services in the event the First Tier Service is unable to respond to a call for Emergency Services (hereinafter "Mutual Aid Contract," "Mutual Aid Service," or "Mutual Aid"). The company/companies providing the Mutual Aid Service will be hereinafter referred to as the "Mutual Aid Provider." In providing 9-1-1 Emergency Transportation Services the Mutual Aid Provider must meet the same RFP requirements, response times, and otherwise provide the same level of service, as CONTRACTOR is required to provide under the Contract. The Mutual Aid Contract and the Mutual Aid Provider must be approved by the CITY OF SANTA ANA and the Orange County Fire Authority ("OCFA") _prior to provision of any service by CONTRACTOR, such approval not to be unreasonably withheld. The intent of this RFP is that CONTRACTOR will provide a sufficient level of coverage under the First Tier Service, such that services under the Mutual Aid Service will only be needed in rare circumstances, if at all. CONTRACTOR will be solely responsible for paying the Mutual Aid Provider for any services rendered under the Mutual Aid, which amount will be the Mutual Aid Provider's sole compensation for services rendered under the Mutual Aid. D. Basic Life Support and Advanced Life Support. All Transportation Personnel assigned to perform 9-1-1 Emergency Transportation Services under this Contract, whether under the First Tier Service or Mutual Aid Service, will provide Basic Life Support ("BLS") services and transport patients to medical facilities when required. OCFA, in cooperation with the Transportation Personnel, will provide on -scene Advanced Life Support ("ALS") services. E. All Transportation Personnel assigned to perform 9-1-1 Emergency Transportation Service under this Contract, whether under the First Tier Service or Mutual Aid Service, must at all times meet the minimum qualifications as listed in Section 5 of the RFP. 3 250-11 F. This Agreement is subject to annual review based on the criteria specified in the Contract and as outlined herein. The CITY OF SANTA ANA's intent is to contract with and hold accountable those parties working with and on behalf of the CITY OF SANTA ANA of Santa Ana and OCFA in providing 9-1-1 Emergency Transportation Service to the citizens and visitors of Santa Ana. G. CONTRACTOR and the Mutual Aid Provider will provide type III emergency transport (ambulance) vehicles (including all costs related to maintenance, fuel, insurance, repair costs and communication equipment) for all 9-1-1 Emergency Transportation Services provided under the First Tier Service and the Mutual Aid Service. 3. Contract Price and Payment A. CITY OF SANTA ANA shall pay CONTRACTOR on a monthly basis the "Not to Exceed" monthly prorata of the annual fiscal year contract price set forth in subsection 3 below (Contract Price Table) for furnishing the material and doing the prescribed work as set forth in CONTRACTOR's Proposal. 1. CONTRACTOR's sole compensation for providing all 9-1-1 Emergency Transportation Services, specifically including but not limited to the First Tier Service and Mutual Aid Service will be the Contract Price. CONTRACTOR will not be entitled to bill CITY OF SANTA ANA or any of its customers any additional amount for any services provided under this Contract, unless it is first approved in writing by CITY OF SANTA ANA. 2. The payment of the Contract Price includes the provision of the Mutual Aid Service. CONTRACTOR will be solely responsible for compensating the Mutual Aid Provider for any 9-1-1 Emergency Transportation Services it may provide in the CITY OF SANTA ANA under this Contract, which compensation will be at the rate set forth in the Mutual Aid Contract or as otherwise required by law. CONTRACTOR and the Mutual Aid Provider will not have any recourse against the CITY OF SANTA ANA to recover for any 9-1-1 Emergency Transportation Services provided under either the First Tier Service or the Mutual Aid Service, except as specifically authorized in the Contract. CONTRACTOR's sole compensation will be the Contract Price it receives from CITY OF SANTA ANA. In the event of a dispute between the Mutual Aid Provider and CONTRACTOR, the Mutual Aid Provider's sole remedy will be against CONTRACTOR. This fact will be clearly stated in the Mutual Aid Contract, and CONTRACTOR must agree to indemnify and defend CITY OF SANTA ANA against any claims or demands arising out of, or which are in any way related to, any services provided under the Mutual Aid Service. The Mutual Aid Contract will include similar provisions requiring the Mutual Aid Provider to indemnify CITY OF SANTA ANA for any claims or demands made by CONTRACTOR or other parties related to the 9-1-1 Emergency Transportation Services it may provide. 4 250-12 3. Contract Price Table A. CITY OF SANTA ANA will be solely responsible for the billing and collection of all amounts owed by customers/patients provided 9-1-1 Emergency Transportation Services in the CITY OF SANTA ANA, whether for services provided by CONTRACTOR, the Mutual Aid Provider, OCFA, CITY OF SANTA ANA, or their respective employees, agents, volunteers, or subcontractors. CITY OF SANTA ANA, in its discretion, will be free to bill for these services in whatever manner it may deem appropriate, and may combine billings for various services provided. CONTRACTOR and the Mutual Aid Provider will actively cooperate with CITY OF SANTA ANA to provide whatever information or assistance CITY OF SANTA ANA may reasonably require so that it can process customer/patient billings in a timely manner. This will include, but is not limited to, CONTRACTOR providing CITY OF SANTA ANA with a detailed list of all the 9-1-1 Emergency Transportation Services provided by both the CONTRACTOR and the Mutual Aid Provider during the preceding month. The specific information to be provided by CONTRACTOR in the monthly reports will be determined by CITY OF SANTA ANA, and may be modified by CITY OF SANTA ANA from time to time to meet its reasonable needs. Failure to provide accurate information in a timely manner will constitute a material breach of this Agreement. 5 250-13 Fiscal Year Fiscal Year Total Not to Exceed Monthly Price FY 2018-19(January 1, 2019 - June 30, 2019 6 months $ 1,818,372 $ 303,062 FY 2019-20 (July 1, 2019 - June 30, 2020 12 months $ 4,412,016 $ 367,668 FY 2020-21 (July 1, 2020 - June 30, 2021 12 months $ 4,578,936 $ 381,578 FY 2021-22 (July 11 2021 - June 30, 2022 12 months $ 4,745,256 $ 395,438 FY 2022-23 (July 1, 2022 - June 30, 2023 12 months $ 4,914,000 $ 409,500 FY 2023-24 (July 1, 2023 - December 31, 2023 6 months $ 2,499,036 $ 416,506 Initial 5 -Year Term - Subtotal $ 22,967,616 FY 2023-24(January 1, 2024 - June 30, 2024 6 months $ 2,728,494 $ 454,749 FY 2024-25 (July 1, 2024 - June 30, 2025 12 months $ 5,564,736 $ 463,728 FY 2025-26 (July 1, 2025 - June 30, 2026 12 months $ 5,785,608 $ 482,134 FY 2026-27 (July 1, 2026 - December 31, 2026 6 months $ 2,949,366 $ 491,561 1st 3 -Year Optional Extension Term - Subtotal $ 17,028,204 FY 2026-27(January 1, 2027 - June 30, 2027 6 months $ 3,068,088 $ 511,348 FY 2027-28 (July 1, 2027 - June 30, 2028 12 months $ 6,260,856 $ 521,738 FY 2028-29 (July 1, 2028 - December 31, 2028 6 months $ 3,192,768 $ 532,128 Final 2 -Year Optional Extension Term - Subtotal $ 12,521,712 Total $ 52,5171532 A. CITY OF SANTA ANA will be solely responsible for the billing and collection of all amounts owed by customers/patients provided 9-1-1 Emergency Transportation Services in the CITY OF SANTA ANA, whether for services provided by CONTRACTOR, the Mutual Aid Provider, OCFA, CITY OF SANTA ANA, or their respective employees, agents, volunteers, or subcontractors. CITY OF SANTA ANA, in its discretion, will be free to bill for these services in whatever manner it may deem appropriate, and may combine billings for various services provided. CONTRACTOR and the Mutual Aid Provider will actively cooperate with CITY OF SANTA ANA to provide whatever information or assistance CITY OF SANTA ANA may reasonably require so that it can process customer/patient billings in a timely manner. This will include, but is not limited to, CONTRACTOR providing CITY OF SANTA ANA with a detailed list of all the 9-1-1 Emergency Transportation Services provided by both the CONTRACTOR and the Mutual Aid Provider during the preceding month. The specific information to be provided by CONTRACTOR in the monthly reports will be determined by CITY OF SANTA ANA, and may be modified by CITY OF SANTA ANA from time to time to meet its reasonable needs. Failure to provide accurate information in a timely manner will constitute a material breach of this Agreement. 5 250-13 B. The entire proceeds of all such billings and collection efforts will be the sole property of CITY OF SANTA ANA. Neither CONTRACTOR nor the Mutual Aid Provider will have any right to the proceeds of any billings or collections for services provided under the First Tier Service, the Mutual Aid Service or for any other services provided under this Agreement, unless specifically authorized in writing by CITY OF SANTA ANA. 4. Term A. Effective Date. The effective date of this Agreement shall be 12:00 A.M. on January 1, 2019 ("Effective Date"), at which time CONTRACTOR will assume full responsibility for the provision of 9-1-1 Emergency Transportation Services within the CITY OF SANTA ANA. At the sole discretion of the OCFA on behalf of the CITY OF SANTA ANA, the Effective Date may be postponed in order to protect public health and safety, or in the event CONTRACTOR is for any reason unable to commence performance at that time. B. Initial Term. This Agreement is for a basic term of five (5) years, beginning on the Effective Date and ending on 11:59:59 P.M. hours on December 31, 2023 (the `Initial Term"). This Agreement shall automatically expire at the end of the Initial Term unless extended as provided below. C. Extension. Upon a writing to the CONTRACTOR by the CITY OF SANTA ANA City Manager and City Attorney made prior to the expiration of the Initial Term of this Agreement, the Contract may be extended for up to one additional three (3) year term (first extension) and thereafter for one further additional two (2) year term (final extension). Successful past performance during the Initial Term period will be a critical factor in the decision to grant an extension. The decision to grant an extension shall be made solely at the discretion of the CITY OF SANTA ANA in consultation with OCFA. At the end of the Initial Term, or at the end of Contract extension term(s) if granted, this Agreement shall automatically terminate (the Initial Term together with any Contract extension(s), if any, shall hereinafter be collectively referred to as the "Term"). 5. Termination This Agreement may be terminated by the parties as hereinafter provided: A. This Agreement may be terminated by either party, with or without cause, upon ninety (90) days prior written notice to the other party. B. OCFA on behalf of the CITY OF SANTA ANA may terminate this Agreement for cause by providing CONTRACTOR seven (7) days prior written notice of termination for cause and the factors constituting cause. 6 250-14 C. OCFA on behalf of the CITY OF SANTA ANA may terminate this Agreement immediately if the OCFA Fire Chief or designee (in their reasonable discretion) determine that continued operations by CONTRACTOR following the breach would constitute a danger to the public health, safety or general welfare. 6. Breach of Agreement A. Factors Constituting Breach and Cause. Factors constituting a breach of this Agreement and also warranting cause for termination include but are not limited to each of the following: 1. A failure by CONTRACTOR's to perform the covenants and requirements set forth in the Contract Documents in the time and manner specified, and as required by this Agreement. 2. Failure of CONTRACTOR to perform the 9-1-1 Emergency Transportation Services in a manner which enables the CITY OF SANTA ANA/OCFA or CONTRACTOR to remain in compliance with the requirements of the County of Orange Emergency Medical Services ("OCEMS") ambulance ordinance and related rules and regulations. 3. Supplying the CITY OF SANTA ANA/OCFA with materially false or misleading information during the RFP process or during the course of producing any required reports to the CITY OF SANTA ANA or OCFA. 4. Willful falsification or unreasonable withholding of data supplied to the CITY OF SANTA ANA or OCFA or to OCEMS during the Term of this Agreement, including but not limited to: dispatch data, patient report data, response time data, financial data, or omission of other data required under this Agreement. 5. Failure to meet the minimum vehicle deployment plan for ambulance service as described in the RFP. 6. Failure of CONTRACTOR's employees to conduct themselves in a professional and courteous manner, and to present a professional appearance. 7. Failure of CONTRACTOR to maintain all required vehicle maintenance schedules and records as set forth as described in the RFP or as reasonably required by CITY OF SANTA ANA or OCFA. 8. Failure of CONTRACTOR to maintain all training and continuing education as required in the RFP, and as required by OCFA and OCEMS policies and procedures and State regulations. 250-15 9. CONTRACTOR's failure or refusal to respond to any request by CITY OF SANTA ANA or OCFA concerning the manner or means by which CONTRACTOR is providing the operation of 9-1-1 Emergency Transportation Services in the CITY OF SANTA ANA under this Agreement and pursuant to the Contract Documents. 10. Transfer or assignment of ownership or other interest in CONTRACTOR contrary to the terms of this Agreement, including but not limited to Section 10 of this Agreement ["Assignment"]. 11. Disruption of service due to failure to maintain ambulance maintenance schedule. 12. The lapse of any license, permit or approval issued CONTRACTOR by a federal, state or local government, which license, permit or approval is/are reasonably necessary for the provision of the 9-1-1 Emergency Transportation Services contemplated by the Contract Documents. 13. CONTRACTOR becomes insolvent or unable to pay its debts as they mature, or makes an assignment for the benefit of creditors, or suffers or fails to pay and discharge within ninety (90) days of entry any final judgment (after exhaustion of any period of appeals) by any court in an amount of fifty thousand dollars ($50,000.00) or more. 14. CONTRACTOR files, or there is filed against CONTRACTOR, a petition to have CONTRACTOR adjudicated in a bankruptcy, or a petition for a reorganization or arrangement under any law relating to bankruptcy or insolvency. 15. CONTRACTOR is enjoined or prohibited by any court of competent jurisdiction from performing services under this Agreement. 16. The assets of CONTRACTOR are assumed by a trustee or other person pursuant to a judicial proceeding. 17. CONTRACTOR breaches or defaults in the performance of any of CONTRACTOR's material duties or obligations arising under this Agreement involving the payment of money, and after receiving written notice thereof from CITY OF SANTA ANA fails within seven (7) days from receipt of such notice or have fully cured and corrected such breach or default. 18. Lapse of insurance required under this Agreement. 8 250-16 19. Failure to manage and resolve citizen complaints to the satisfaction of the CITY OF SANTA ANA or OCFA. 20. Failure to meet the on-time performance criteria as required in the RFP. 21. The breach or default of, or a failure to comply with, any material provision of this Agreement, any material provision of the RFP, or of any covenant specifically contained herein or incorporated by reference. B. Right to Cure. In the event of any dispute arising under this Agreement, the injured Party shall notify the injuring Party in writing of its contentions by submitting a claim therefore. The injured Party shall continue performing its obligations hereunder so long as the injuring Party cures any default within thirty (30) days after service of the notice; provided, however, if a breach of this Agreement creates an immediate danger to the health and safety or general welfare to the CITY OF SANTA ANA, in the reasonable discretion of the Fire Chief or designee, may take immediate action to remedy the breach itself and/or terminate this Agreement. Notwithstanding the preceding, if the Fire Chief or designee finds that CONTRACTOR is diligently proceeding with all steps necessary to cure such default, the Fire Chief or designee in conjunction with the CITY OF SANTA ANA may, in his sole discretion, extend the time period by which CONTRACTOR must cure such deficiencies, including the effective date of such termination. C. Waiver. No waiver of any Event of Breach or Default shall be valid or effective unless in writing and signed by CITY OF SANTA ANA. Any waiver of any one Event of Default or Breach shall not constitute, or be construed as creating, a waiver of any other Event of Default or Breach. D. Action Following Termination. Should this Agreement be terminated for breach, CONTRACTOR agrees that CITY OF SANTA ANA and/or OCFA, in their discretion, may take immediate possession of any CITY OF SANTA ANA or OCFA materials, equipment, and supplies CONTRACTOR may have used in the performance of the 9-1-1 Emergency Transportation Services. Notwithstanding the above, should this Agreement be terminated for breach, CITY OF SANTA ANA or OCFA shall have the option to take over the delivery of the 9-1-1 Emergency Transportation Services itself, using CITY OF SANTA ANA personnel or contractors; contracted on a temporary emergency basis with other providers of emergency transport ambulance services; seek new proposals for service; or such other option as may be deemed necessary and legally available to CITY OF SANTA ANA. 9 250-17 E. No Limitation on CITY OF SANTA ANA's Rights. Nothing herein shall act as any limitation upon the remedies available to CITY OF SANTA ANA whether at law, or otherwise, in the event of a breach or default of this Agreement. 7. Insurance A. Prior to beginning the provision of 9-1-1 Emergency Transportation Services under this Agreement, CONTRACTOR must provide to the satisfaction of the CITY OF SANTA ANA and OCFA, certificates of insurance and endorsements evidencing the policy or policies of insurance in the types and amounts set forth below and shall name CITY OF SANTA ANA and OCFA as certificate holders. CONTRACTOR shall at all times during the term of this Agreement carry, maintain, and keep in full force and effect, the following minimum scope of insurance coverage: 1) Commercial General Liability Insurance in an amount not less than $10,000,000 per occurrence, written on an occurrence form. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $10,000,000 per occurrence. 2) Ambulance Medical Malpractice Insurance in an amount not less than $3,000,000 per occurrence. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. Such insurance coverage may be combined with either the general or automobile liability coverage required above; provided, however, if the insurance coverage is so structured, the combined coverage shall be in an amount not less than $5,000,000 per occurrence, with an annual aggregate of not less than $10,000,000. 3) Comprehensive Business Automobile Liability Insurance in an amount not less than $3,000,000 per occurrence, covering owned, non -owned and hired vehicles, written on an occurrence form. If policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. CONTRACTOR understands that it must provide Business Automobile Liability coverage for all vehicles under both the First Tier Service and the Mutual Aid Service. This specifically includes, but is not limited to, CONTRACTOR's obligation to provide Business Automobile Liability coverage for any vehicles provided by CITY OF SANTA ANA/OCFA for use by CONTRACTOR under the First Tier, as well as for any vehicles provided by CONTRACTOR directly. 4) Workers' Compensation and Employers' Liability Insurance in a statutory amount for workers' compensation and in an amount not less than $1,000,000 for employers' liability. Such insurance shall contain a waiver -of - subrogation clause in favor of the CITY OF SANTA ANA and OCFA, and their respective officers, officials, employees and agents. 10 250-18 B. CONTRACTOR shall also comply with the following requirements: 1) If the above -required insurance coverage does not provide for an annual aggregate which is twice the per -occurrence limit, in the alternative the insurance policy (policies) shall be amended (by appropriate ISO endorsements) so that the policy limits apply solely to this Agreement. 2) The above -required liability insurance shall be in a form which supports coverage for the provisions of the indemnification clause required under this Agreement, including a claim brought against the CITY OF SANTA ANA and/or OCFA for the injury to, or death of an employee or agent of CONTRACTOR. 3) In the event of a claim or claims against the above -referenced liability policies which reasonably may deplete one-half or more of the aggregate limits, CONTRACTOR shall immediately notify OCFA. In the event a claim or claims against the above -referenced liability policies which are reasonably expected to deplete 90% of the aggregate limits, CONTRACTOR shall, at CONTRACTOR's expense, reinstate the aggregate limits at least to an amount equal to one-half of the face amount of the aggregate limits on the policies. 4) All insurance required pursuant to this section shall be issued by a company authorized by the Insurance Department of the State of California and rated A -VII or better by the latest edition of Best's Key Rating Guide. 5) No insurance required herein shall provide for a deductible in excess of $5,000 or a self-insured retention in any amount, without prior written consent of the CITY OF SANTA ANA and OCFA; and, the granting or denying of such consent shall be at the sole and absolute discretion of the CITY OF SANTA ANA and OCFA. C. Endorsements. 1) All insurance required herein shall be endorsed to state that "Coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior to written notice by certified mail, return receipt requested, has been given to the CITY OF SANTA ANA and OCFA." 2) The liability policies required herein, except for professional liability (if a stand -above coverage), workers compensation and employers' liability, shall, by endorsement, contain the following provisions: (a) "The CITY OF SANTA ANA and OCFA, and their respective officers officials, employees, representatives, and volunteers, are hereby declared to be additional insureds as respects the operations, activities, work, errors, or omissions of the named insured arising out of or in 250-19 connection with any contract or agreement with the CITY OF SANTA ANA." (b) "This insurance is primary to, and shall not contribute with, any insurance or self-insurance maintained by the CITY OF SANTA ANA, by OCFA, or by any of the designated additional insureds." (c) "This insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability." 3) Worker's Compensation and Professional Liability policies shall be endorsed to state that the insurer waives all rights of subrogation against the CITY OF SANTA ANA and OCFA, and their respective officers, officials, agents, employees, and volunteers for losses arising from work performed by the CONTRACTOR under this Agreement. D. All insurance coverages shall be confirmed by execution of endorsements and certificates of insurance. CONTRACTOR is required to file the completed policy endorsements and certificates with CITY OF SANTA ANA and OCFA on or before the Effective Date of this Agreement, and to thereafter maintain current endorsements on file with CITY OF SANTA ANA and OCFA. The completed endorsements and certificates of insurance are subject to the approval of CITY OF SANTA ANA and OCFA. E. Nothing in this section shall be construed as limiting in any way; the Indemnification and Hold Harmless clause contained herein in this Agreement, or the extent to which CONTRACTOR may be held responsible for payments of damages to persons or property. F. CITY OF SANTA ANA or OCFA shall have the right at any time to review the coverage, form, and limits of insurance required herein. If, in the sole and absolute discretion of the CITY OF SANTA ANA and/or OCFA, the insurance provisions in this Agreement do not provide adequate protection for the CITY OF SANTA ANA and/or OCFA, the CITY OF SANTA ANA and/or OCFA shall have the right to require CONTRACTOR to obtain insurance sufficient in coverage, form, and limits to provide adequate protection and CONTRACTOR shall promptly comply with such requirement. The CITY OF SANTA ANA's and OCFA's requirements shall not be unreasonable, but shall be adequate in the sole opinion of the CITY OF SANTA ANA and OCFA to protect against the kind and nature of risks which exists at the time a change of insurance is required, or thereafter. G. Alternate forms of insurance, that meet the above requirements, must be approved by the CITY OF SANTA ANA's and OCFA's Risk Manager prior to awarding a contract and beginning any work under this Agreement. 12 250-20 8. Indemnification CONTRACTOR agrees to defend, indemnify, hold free and harmless the CITY OF SANTA ANA and OCFA, and their respective officers, officials, agents, employees and volunteers, at CONTRACTOR's sole expense, from and against any and all claims, actions, suits or other legal proceedings brought against the CITY OF SANTA ANA or OCFA, or their respective officers, officials, agents, employees or volunteers, arising out of the performance of the CONTRACTOR, its employees, agents and/or authorized subcontractors, of the work undertaken pursuant to this Agreement, specifically including but not limited to the 9-1-1 Emergency Transportation Services. The defense obligation provided for hereunder shall apply without any advance showing of negligence or wrongdoing by the CONTRACTOR, its employees, agents and/or authorized subcontractors, but shall be required whenever any claim, action, complaint, or suit asserts as its basis the negligence, errors, omissions or misconduct of the CONTRACTOR, its employees, agents and/or authorized subcontractors, and/or whenever any claim, action, complaint or suit asserts liability against the CITY OF SANTA ANA or OCFA, or their respective officers, officials, agents, employees or volunteers, based upon the work performed by the CONTRACTOR, its employees, agents and/or authorized subcontractors under this Agreement, whether or not the CONTRACTOR, its employees, agents and/or authorized subcontractors are specifically named or otherwise asserted to be liable. Notwithstanding the foregoing, the CONTRACTOR shall not be liable for the defense or indemnification of the CITY OF SANTA ANA or OCFA for claims, actions, complaints or suits arising out of the sole negligence or willful misconduct of the CITY OF SANTA ANA or OCFA. 9. Compliance with RFP Requirements for Operations, Personnel and Safety. Without limiting CONTRACTOR's duty to comply with other requirements of the RFP, CONTRACTOR understands that throughout the Term of this Agreement CONTRACTOR must remain in full compliance with the terms, conditions and requirements in each of the following sections of the RFP: A. Section 4 of the RFP, entitled "Operational Standards, Procedures and Performance Requirements." B. Section 5 of the RFP, entitled "Personnel" C. Section 6 of the RFP, entitled "Supplies, Equipment and Vehicles." The failure of CONTRACTOR to abide by any of the requirements set forth in Sections listed above will be considered a breach of this Agreement, and will be grounds for termination. 13 250-21 10. Assignment. A. Except as provided herein, CONTRACTOR may not delegate, transfer or assign its rights or otherwise transfer its obligations, in whole or in part, under this Contract to any other person or entity without first obtaining the prior written consent of the OCFA and not for 180 days after the formal Contract award. Any such assignment or transfer without the prior written consent of the OCFA shall be void; the attempted assignment shall constitute a breach of the Contract. B. For purposes of this section, the following will be considered to be a "transfer" or "assignment": 1. Any change in the business structure, including but not limited to, changes from or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; 2. Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 3. A transfer by any of the owners, shareholders or members (whichever is applicable) of CONTRACTOR of greater than ten percent (10%) of the ownership interest, stock or membership interest (whichever is applicable) in CONTRACTOR's business, issued as of the Effective Date by the CONTRACTOR, or the sale or transfer of over twenty-five percent (25%) of the assets of the CONTRACTOR. In the event a CONTRACTOR experiences regular stock exchanges in excess of the fifteen percent (15%) threshold, a separate agreement may be negotiated to set a threshold that still provides the OCFA with the protections intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. 11. Audits and Inspections. At any time during normal business hours, and as often as may reasonably be deemed necessary by the OCFA, the CITY OF SANTA ANA may observe and inspect CONTRACTOR's business office, and CONTRACTOR must make promptly available to the CITY OF SANTA ANA or OCFA for its examination all of CONTRACTOR's records that pertain to performance of this Agreement. The CITY OF SANTA ANA or OCFA may audit, examine, and copy any and all CONTRACTOR records pertaining to their performance of this Agreement, including but not limited to, personnel records, daily logs, conditions of employment, and all other data. The CITY OF SANTA ANA's or OCFA's right to inspect CONTRACTOR's business office and any and all records pertaining to their performance of this Agreement will be restricted to normal business 14 250-22 hours and reasonable notice shall be given to CONTRACTOR in advance of such inspection. 12. Independent Contractor. A. In the performance of'this Agreement, CONTRACTOR shall be acting in an independent capacity from the CITY OF SANTA ANA and OCFA, and not as an agent, employee, partner, or pursuant to any kind of joint venture or partnership with the CITY OF SANTA ANA or OCFA. The Parties understand and agree that CONTRACTOR, its officers, agents and employees (which term specifically includes, but is not limited to, the Transportation Personnel) are not employees of the CITY OF SANTA ANA, the County, or OCFA, and are not entitled to any of the rights, benefits, or privileges of CITY OF SANTA ANA, County, or OCFA employees including, but not limited to, medical, unemployment, or workers' compensation insurance. B. Neither the County, the CITY OF SANTA ANA or OCFA, or any of their respective officers, elected officials, agents, representatives, or employees, shall have any control over the conduct of CONTRACTOR's agent's and employees except as specifically set forth in the Contract Documents. Under no circumstances shall CONTRACTOR or any of its agents or employees represent that they are in any manner agents or employees of the CITY OF SANTA ANA, County or OCFA, it being understood that CONTRACTOR its agents and employees are as to the CITY OF SANTA ANA, County and OCFA, wholly independent contractors and that CONTRACTOR's obligations to the CITY OF SANTA ANA and OCFA are solely those prescribed by the Contract Documents. C. CITY OF SANTA ANA, the County, and OCFA have no responsibility whatsoever for the payment of any wages, salary, health benefits, retirement benefits, taxes, or any other benefits that may be due to CONTRACTOR's employees and agents performing 9-1-1 Emergency Transportation Services under this Agreement, specifically including but not limited to the Transportation Personnel. CONTRACTOR further acknowledges and agrees that the CITY OF SANTA ANA, the County, and OCFA have no responsibility whatsoever for the filing of any employer related documentation (tax forms, payroll, or otherwise) with the federal, state or local governmental authorities, concerning those persons CONTRACTOR assigns to perform 9-1-1 Emergency Transportation Services under this Agreement. The preparation and filing of all employee related documentation shall be the sole responsibility of CONTRACTOR. 13. Compliance with Laws All services provided by CONTRACTOR pursuant to the Contract Documents must be rendered in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It will be CONTRACTOR's sole responsibility to determine which federal, state, and local laws, rules, statutes, and regulations apply to 15 250-23 the services to be performed pursuant to the Contract Documents, and to maintain compliance at all times throughout the Term of this Agreement. 14. Responsibility Except as may be specifically stated herein to the contrary, it shall be the responsibility of CONTRACTOR to provide all Transportation Personnel with whatever resources and equipment are necessary to perform the 9-1-1 Emergency Transportation Services, and to otherwise satisfy all of the terms and conditions set forth in the Contract Documents at all times during the Term of this Agreement. Except where it may be specifically permitted in this Agreement, CONTRACTOR may not use any outside ambulance service providers or other resources to satisfy its obligations to provide 9-1-1 Emergency Transportation Services to the CITY OF SANTA ANA, without first obtaining the prior written consent of the CITY OF SANTA ANA. Notwithstanding the granting of any such approval by the CITY OF SANTA ANA, nothing stated herein shall relieve CONTRACTOR of its duties and responsibilities under this Agreement, and any additional cost incurred shall not be charged to the County, CITY OF SANTA ANA or OCFA. 15. Acts or Omissions of Representatives The acts and/or omissions of the owner(s), officers, operators, officials, employees, agents, and representatives of the CONTRACTOR in the performance of the services and obligations under the Contract Documents shall constitute the acts and/or omissions of the CONTRACTOR. 16. Insolvency CONTRACTOR shall not, without the prior written consent of the OCFA Fire Chief or designee, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of CONTRACTOR, or make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by CONTRACTOR under any insolvency or bankruptcy proceeding constitutes a material breach of this Agreement by CONTRACTOR, and all property, equipment or materials assigned by OCFA, the CITY OF SANTA ANA and/or the County to CONTRACTOR related to the provision of services under this Contract shall be automatically "released" by CONTRACTOR and returned back to the possession and control of the CITY OF SANTA ANA and OCFA. Following the occurrence of any such event, the OCFA Fire Chief or designee may assign such property, equipment or materials to another 9-1-1 Emergency Transportation Services provider, in the CITY OF SANTA ANA's sole discretion. 16 250-24 17. Familiarity with Work By execution of this Agreement, CONTRACTOR warrants that A. It has thoroughly investigated and considered the 9-1-1 Emergency Transportation Services to be performed; B. It possesses any and all licenses which are required under relevant local, State, or Federal law to perform the 9-1-1 Emergency Transportation Services contemplated by this Agreement, and shall maintain all appropriate licenses during the performance of this Agreement. C. It has expertise in the provision of 9-1-1 Emergency Transportation Services as that term is defined in this Agreement; D. It carefully considered how the 9-1-1 Emergency Transportation Services should be performed; and E. It fully understands the difficulties and restrictions attending the performance of the 9-1-1 Emergency Transportation Services under this Agreement. 18. Validity The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any of the other provisions of this Agreement. 19. Governing Law This Agreement shall be governed by and construed in accordance with the laws of the State of California. Any legal action relating to or arising out of this Agreement shall be subject to the jurisdiction of the County of Orange, California. 20. Entire Agreement This Agreement supersedes any and all other agreements whether oral or written, between the parties hereto with respect to the subject matter hereof, and contains all of the covenants and agreements between the parties with respect to said matter, and each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that any other agreement or modification of this Agreement shall be effective only if executed in writing and signed by both CITY OF SANTA ANA and CONTRACTOR. 17 250-25 21. Attorney's Fees In the event any legal proceeding is instituted to enforce any term or provision of this Agreement, the prevailing party in said legal proceeding shall be entitled to recover attorneys' fees and costs from the opposing party in an amount determined by the court to be reasonable. 22. Representatives and Notices The City Manager or his designee shall be the representative of the CITY. The OCFA Fire Chief or his designee shall be the representative of OCFA. For the purposes of this Agreement the City Manager may issue all administrative consents, approvals, directives and agreement on behalf of the CITY OF SANTA ANA. The OCFA Fire Chief on behalf the CITY OF SANTA, may issue operational directives required by this Agreement, except as otherwise expressly provided in this Agreement. Troy M. Hagen, Chief Executive Officer (CEO), CARE Ambulance Service, Inc. shall be the representative of CONTRACTOR for purposes of this Agreement and may issue all consents, approvals, directives and agreements on behalf of CONTRACTOR, called for by this Agreement, except as otherwise expressly provided in this Agreement. All notices and written communications sent by one party to the other shall be personally delivered or sent by registered or certified U.S. Mail, postage prepaid, return receipt requested, to the following addresses indicated below: To CITY: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92701 Fax (714) 647-6956 With courtesy copy to: Treasury and Customer Services Manager Finance and Management Services Agency Treasury & Customer Division (M-15) 20 Civic Center Plaza Santa Ana, CA 92701 Fax (714) 647-5304 To VENDOR: Attn: Troy M. Hagen, CEO CARE Ambulance Service, Inc. 1517 W. Braden Ct. Orange, CA 92868 Fax (714) 288-3899 The effective date of any notice or written communications sent by one party to the other shall be the date received if by personal service, or forty-eight (48) hours after deposit in the U.S. Mail as reflected by the official U.S. postmark. Either party may change its address by giving notice in writing to the other party. 18 250-26 f*Aylr= No waiver of any provision of this Agreement shall be effective unless in writing and signed by a duly authorized representative of the party against whom enforcement of a waiver is sought, referring expressly to this paragraph. The waiver of any right or remedy in respect to any occurrence or event shall not be deemed a waiver of any right or remedy in respect to any other occurrence or event, nor shall any waiver constitute a continuing waiver. 24. Rights and Remedies are Cumulative Except with respect to rights and remedies expressly declared to be exclusive in this Agreement, the rights and remedies of the Parties are cumulative and the exercise by either Party of one or more of such rights or remedies shall not preclude the exercise by it, at the same or different times, of any other rights or remedies for the same default or any other default by the other Party. 25. Cooperation CONTRACTOR must cooperate with the CITY OF SANTA ANA and take all actions necessary to ensure that all terms and conditions, and required performance levels, set forth in the Contract Documents are satisfied at all times throughout the Term of this Agreement. 26. Legal Action In addition to any other rights or remedies, either Party may take legal action, in law or in equity, to cure, correct, or remedy and default, to recover damages for any default, to compel specific performance of this Agreement, to obtain injunctive relief, or to obtain any other remedy consistent with the purposes of this Agreement. 27. Amendment This Agreement may be amended only by the written mutual consent of CITY OF SANTA ANA and CONTRACTOR. 28. Additional Services CONTRACTOR shall not receive compensation for any services provided outside the scope of the Contract Documents unless such additional services are approved in writing by CITY OF SANTA ANA prior to CONTRACTOR performing the additional services. It is specifically understood that oral requests or approvals of such additional services, change orders, or additional compensation, and any approvals from the CITY OF SANTA ANA, shall be barred and are unenforceable. 19 250-27 29. Counterparts This Agreement may be executed in one or more counterparts by the parties hereto, including by facsimile copy. All counterparts shall be construed together and shall constitute one Agreement. Each counterpart (including facsimile copies) is deemed an original and all counterparts are deemed one and the same instrument and legally binding on the parties. Extensions and amendments to this Agreement may likewise be executed by facsimile copy. 30. Corporate Authority The persons executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by doing so the Parties hereto are formally bound to the provisions of this Agreement. (SIGNATURES TO FOLLOW ON NEXT PAGE) 20 250-28 IN WITNESS WHEREOF, Parties hereto have executed this AGREEMENT on the date and year first written above. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: r -- Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: Kathryn Downs Executive Director Finance & Management Services Agency 21 CITY OF SANTA ANA RAUL GODINEZ II City Manager "CONTRACTOR" Name: Troy Hagen Title: CEO CARE Ambulance Service, Inc. Tax ID# 250-29 250-30 EXHIBIT A City of Santa Ana Finance & Management Services Agency Treasury & Customer Services Division REQUEST FOR PROPOSALS RFP # 18-059 Fire/EMS Emergency Ambulance Transportation and Related Services Issued: August 28, 2018 Due Date: October 22, 20181 3:00 PM (PST) deadline Submit to: City of Santa Ana Purchasing Division RFP# 18-059 20 Civic Center Plaza, Room 429 Santa Ana, CA 92701 Attn: Sandy Perez, Supervising Buyer Project Coordinators: Willard V. Holt, Treasury & Customer Services Manager Arturo Rodriguez, Management Analyst 250-31 City of Santa Ana City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services 250-32 RFP No. 18-059 Table of Contents 1. GENERAL INFORMATION 1.1 BACKGROUND..................................................................................................................1 1.2 SCOPE OF SERVICES.........................................................................................................2 1.2.1 FIRST TIER SERVICE..................................................................................................2 1.2.2 MUTUAL AID SERVICES.............................................................................................3 1.2.3 BLS AND ALS SERVICES............................................................................................4 1.2.4 MINIMUM QUALIFICATIONS OF TRANSPORTATION PERSONNEL.....................................4 1.2.5 COMPENSATION........................................................................................................4 1.2.6 BILLING....................................................................................................................5 1.2.6 COMPLIMENTARY PROPOSALS...................................................................................6 1.2.7 TERM.......................................................................................................................7 1.2.8 ANNUAL REVIEW.......................................................................................................7 1.3 REJECTION OF BIDS...........................................................................................................8 1.4 COST OF PREPARATION.....................................................................................................8 1.5 UNDERSTANDING PROPOSAL..............................................................................................8 1.6 CONTRACTOR SELECTION AND AWARD...............................................................................9 2. ADMINISTRATION................................................................................................................10 2.1 BID PROPOSAL SUBMISSION PROCESS............................................................................. 10 2.2 BID PROPOSAL PRE -SUBMISSION CONFERENCE................................................................ 10 2.3 BID PROPOSAL SUBMISSION REQUIREMENTS.................................................................... 10 2.3.1 BID PROPOSAL SUBMISSION DATE......................................................................... 10 2.3.2 BID PROPOSAL SUBMISSION INSTRUCTIONS............................................................ 11 2.4 PUBLIC OPENING OF BID PROPOSALS............................................................................... 15 2.4.1 BID PROPOSAL OPENING........................................................................................ 15 2.4.2 LATE SUBMISSION.................................................................................................. 15 2.5 BID PROPOSAL EVALUATIONS......................................................................................... 16 2.5.1 COMPETITIVE PROCESS.......................................................................................... 16 2.5.2 PROPOSAL GRADING PANEL................................................................................... 16 2.6 ADMINISTRATIVE............................................................................................................ 17 2.6.1 ORAL PRESENTATIONS........................................................................................... 17 2.6.2 PROPRIETARY INFORMATION.................................................................................. 17 2.6.3 VOLUNTARY WITHDRAWAL OF BID PROPOSAL......................................................... 18 2.6.4 CANCELLATION OF RFP PROCESS........................................................................... 18 2.7 BID PROPOSAL REJECTION.............................................................................................. 18 2.7.1 RIGHT TO REJECT.................................................................................................. 18 2.7.2 FAILURE TO COMPLY.............................................................................................. 18 2.7.3 WAIVER; CORRECTION & RESUBMITTAL.................................................................. 19 2.7.4 INCOMPLETE, IRREGULAR, MATERIAL MISREPRESENTATION - REJECTION ................. 19 2.7.5 CORRUPT, FRAUDULENT OR ILLEGAL PRACTICES .................................................... 19 2.7.6 EXCEPTION TO RFP SPECIFICATION; DELIVERY CRITERIA, TERMS & CONDITIONS ....... 19 2.7.7 FAILURE TO PROVIDE ALL INFORMATION REQUESTED - INCOMPLETE ........................ 19 2.7.8 NOTIFICATION OF REJECTION................................................................................. 19 2.8 AWARD PROTEST............................................................................................................ 20 2.9 PROPOSED SCHEDULE OF EVENTS................................................................................... 20 3. GENERAL TERMS AND CONDITIONS............................................................................... 22 3.1 PROPOSED CONTRACT.................................................................................................... 22 250-32 r City of Santa Ana TABLE OF CONTENTS (CONTINUED) 3.2 CONTRACT DOCUMENTS................................................................................................. 22 4. OPERATIONAL STANDARDS PROCEDURES & PERFORMANCE REQUIREMENTS... 35 4.1 3.2.1 EXECUTED CONTRACT........................................................................................... zz 3.2.2 RFP....................................................................................... ............................... 22 35 3.2.3 ORIGINAL BID PROPOSAL....................................................................................... 22 3.3 CONTRACT MODIFICATIONS AND AMENDMENTS................................................................ 23 3.4 CONTRACT ADMINISTRATION........................................................................................... 23 3.5 CONTRACT EFFECTIVE DATE........................................................................................... 23 3.6 CONTRACTTERM............................................................................................................ 24 38 3.6.1 TERM...................................................................................................................24 4.2.1 SERVICE........................................................................................................... 3.6.2 CONTRACT EXTENSION.......................................................................................... 24 4.2.2 3.6.3 TERMINATION....................................................................................................... 24 3.7 INSURANCE.................................................................................................................... 25 3.7.1 CERTIFICATES OF INSURANCE............................................................................... 25 39 3.7.2 CONTRACTOR COMPLIANCE.................................................................................. 26 RESPONSE TIME MEASUREMENT......................................................................... 3.7.3 ENDORSEMENTS................................................................................................... 27 4.3.3 3.7.4 CERTIFICATES OF INSURANCE............................................................................... 28 3.7.5 INDEMNIFICATION AND HOLD HARMLESS CLAUSE .................................................... 28 40 3.7.6 RIGHT TO REVIEW................................................................................................. 29 CALL CANCELLATION......................................................................................... 3.7.7 ALTERNATE FORMS OF INSURANCE........................................................................ 29 3.7.8 MUTUAL AID......................................................................................................... 29 3.8 ASSIGNMENT.................................................................................................................. 30 3.8.1 CHANGE IN BUSINESS STRUCTURE......................................................................... 30 3.8.2 BANKRUPTCY....................................................................................................... 30 3.8.3 TRANSFER ................................................. :.......................................................... 30 3.9 AUDITS AND INSPECTIONS............................................................................................... 31 3.9.1 BUSINESS OFFICE................................................................................................. 31 3.10 COOPERATION................................................................................................................ 31 3.11 NON -COLLUSION CERTIFICATE........................................................................................ 31 3.12 INDEPENDENT CONTRACTOR........................................................................................... 32 3.13 INDEMNIFICATION........................................................................................................... 32 3.14 COMPLIANCE WITH LAWS................................................................................................ 33 3.15 RESPONSIBILITY............................................................................................................. 33 3.16 ACTS OR OMISSIONS OF REPRESENTATIVES..................................................................... 34 3.17 INSOLVENCY.................................................................................................................. 34 4. OPERATIONAL STANDARDS PROCEDURES & PERFORMANCE REQUIREMENTS... 35 4.1 EMERGENCY RESPONSE COMMUNICATION SYSTEM........................................................... 35 4.1.1 COMMUNICATIONS REQUIREMENTS..................................................................... 35 4.1.2 VEHICLE COMMUNICATIONS............................................................................... 36 A. 800MHz MOBILE RADIO............................................................................... 36 B. MOBILE DATA COMPUTER SYSTEM................................................................ 37 4.2 SERVICE HOURS............................................................................................................. 38 4.2.1 SERVICE........................................................................................................... 38 4.2.2 FIELD SUPERVISOR............................................................................................ 39 4.3 RESPONSE TIMES........................................................................................................... 39 4.3.1 GENERAL REQUIREMENTS.................................................................................. 39 4.3.2 RESPONSE TIME MEASUREMENT......................................................................... 39 4.3.3 RESPONSE TIMES REQUIRED.............................................................................. 40 4.3.4 RESPONSE TIME REPORTING.............................................................................. 40 4.3.5 CALL CANCELLATION......................................................................................... 40 250-33 City of Santa Ana 5. PERSONNEL.............................................................................. 5.1 PERSONNEL REQUIREMENTS..................................................... 5.2 CONTROL................................................................................. 57 57 61 6. SUPPLIES, EQUIPMENT AND VEHICLES......................................................................... 62 6.1STANDARDS......................................................................................................... 62 6.1.1 STANDARD INVENTORY......................................................................................... 62 6.1.2 REQUIRED EQUIPMENT.......................................................................................... 62 6.1.3 PERSONAL SAFETY EQUIPMENT............................................................................. 63 7. A. SUBMISSION OUTLINE BID PROPOSAL SUBMISSION FORMS & CHECKLIST................................................................. 65 TITLE PAGE/COVER SHEET................................................................................................... 66 TABLEOF CONTENTS........................................................................................................... 67 B. DESCRIPTION OF REQUIRED ITEMS 1 COVER LETTER............................................................................................................. 68 2 GENERAL OVERALL DESCRIPTION OF PLAN TO PROVIDE 9-1-1 EMERGENCY TRANSPORTATION SERVICE IN CITY............................................................................... 70 3 OVERALL OPERATIONAL SYSTEM................................................................................... 71 4 DRIVERTRAINING.......................................................................................................... 72 250-34 TABLE OF CONTENTS (CONTINUED) 4.3.6 QUARTERLY RESPONSE TIME REPORT- FORMAT ................................................. 41 4.3.7 EXEMPTIONS TO RESPONSE TIME REQUIREMENTS ............................................... 41 A.HIGH CALL VOLUME........................................................................................ 41 B.DISASTERS.................................................................................................... 41 C.MULTIPLE AMBULANCE RESPONSE.................................................................. 41 D.RESPONSE UP/DOWNGRADE........................................................................... 41 E.RETURN OF OCFA PERSONNEL........................................................................ 42 4.3.8 PROCEDURES TO REQUEST RESPONSE TIME EXEMPTION ..................................... 42 4.3.9 USE OF ALTERNATIVE METHODS TO MEET RESPONSE TIME REQUIREMENTS .......... 43 4.3.10 DISCIPLINARY ACTIONS FOR FAILURE TO MEET RESPONSE TIME REQUIREMENTS AND PERFORMANCE DEFICIENCY........................................................................ 44 A.MEET AND CONFER......................................................................................... 44 B. PENALTIES..........................................................................I.......................... 44 C.CORRECTIVE ACTION PLAN............................................................................. 46 D.TIMELY PERFORMANCE REQUIRED................................................................... 47 E. WAIVER......................................................................................................... 48 4.3.11 EMERGENCY ON -SCENE PROCEDURES................................................................ 48 4.3.12 DISASTER ASSISTANCE...................................................................................... 49 4.3.13 STANDARD OF PERFORMANCE........................................................................... 50 4.3.14 GENERAL PROVISIONS....................................................................................... 51 A. RETURN OF OCFA PERSONNEL...................................................................... 51 B. 9-1-1 CALLS FOR SERVICE/REFERRAL........................................................... 51 C. PERFORMANCE............................................................................................ 52 D. CONFLICT OF INTEREST................................................................................. 52 E. COMPLAINTS................................................................................................ 52 F. HIPAA BUSINESS ASSOCIATE ASSURANCES.................................................... 53 G. MEDICARE/MEDT-CAL PARTICIPATION............................................................. 55 4.3.15 EXTERNAL MEDICAL QUALITY CONTROL.............................................................. 55 4.3.16 INTERNAL MEDICAL QUALITY CONTROL............................................................... 56 5. PERSONNEL.............................................................................. 5.1 PERSONNEL REQUIREMENTS..................................................... 5.2 CONTROL................................................................................. 57 57 61 6. SUPPLIES, EQUIPMENT AND VEHICLES......................................................................... 62 6.1STANDARDS......................................................................................................... 62 6.1.1 STANDARD INVENTORY......................................................................................... 62 6.1.2 REQUIRED EQUIPMENT.......................................................................................... 62 6.1.3 PERSONAL SAFETY EQUIPMENT............................................................................. 63 7. A. SUBMISSION OUTLINE BID PROPOSAL SUBMISSION FORMS & CHECKLIST................................................................. 65 TITLE PAGE/COVER SHEET................................................................................................... 66 TABLEOF CONTENTS........................................................................................................... 67 B. DESCRIPTION OF REQUIRED ITEMS 1 COVER LETTER............................................................................................................. 68 2 GENERAL OVERALL DESCRIPTION OF PLAN TO PROVIDE 9-1-1 EMERGENCY TRANSPORTATION SERVICE IN CITY............................................................................... 70 3 OVERALL OPERATIONAL SYSTEM................................................................................... 71 4 DRIVERTRAINING.......................................................................................................... 72 250-34 0 City of Santa Ana TABLE OF CONTENTS (CONTINUED) 5 INTERNAL MEDICAL QUALITY CONTROL.......................................................................... 73 6 MUTUAL AID PROVIDER................................................................................................. 74 7 PERSONNEL AND TRAINING....................................................................................... 75-76 A. ASSIGNED PERSONNEL PROFILE B. FIELD TRAINING OFFICERS C. PRIMARY PERSONNEL D. EMPLOYEE RECRUITMENT, SCREENING & ORIENTATION E. CONTINUING EDUCATION PROGRAMS F. HIPAA TRAINING PROGRAMS 8 HIPAA COMPLIANCE PLAN............................................................................................. 77 9 CORPORATE COMPLIANCE PLAN.................................................................................... 78 10 PLAN FOR TAKEOVER OF SERVICE/START UP.................................................................. 79 11 EMS RESUME........................................................................................................... 80-81 12 AGREEMENT TO CONDITIONS.................................................................................... 82-83 13 PRICE WORKSHEET.................................................................................................. 84-86 14 CONFLICT OF INTEREST CERTIFICATION.......................................................................... 87 15 STATEMENT OF TRUTH............................................................................................. 88-89 16 NON -COLLUSION CERTIFICATION.................................................................................... 90 17 PHOTOGRAPHS (OPTIONAL)........................................................................................... 91 TABLE OF CONTENTS (END) 250-35 City of Santa Ana ATTACHMENTS ATTACHMENT 1 -SAMPLE CONTRACT WITH CITY 250-36 92 0 City of Santa Ana SECTION 1 GENERAL INFORMATION 1.1 BACKGROUND The City of Santa Ana is initiating a Request for Proposal (RFP) for Fire/EMS Emergency Ambulance Transportation and Related services for up to a five-year (5) contract period with an option for one (1) three (3) year extension and one (1) two (2) year extension commencing on or after the contract effective date. In the City, the OCFA operates out of ten city -owned fire stations located at 2301 Old Grande Street North (Station No.70), 1029 West 17th Street, (Station No.71), 1668 East 4th Street (Station No. 72), 419 South Franklin Street (Station No.73), 1427 South Broadway (Station No.74), 120 West Walnut (Station No.75), 950 West MacArthur (Station No.76), 2317 South Greenville (Station No.77), 501 North Newhope (Station No.78), and 1320 East Warner (Station No.79). 2017 Response Volume: Calendar Year 2017 Total Incidents 26,521 EMS Incidents 21,239 The City of Santa Ana ("City") has a long and proud history of providing emergency medical care for the citizens of Santa Ana and its visitors. For many years the City of Santa Ana has provided its own transportation services. Effective April 20, 2012 the City of Santa Ana contracted with the Orange County Fire Authority ("OCFA") for fire and emergency medical services. The Orange County Fire Authority is a regional fire service agency that serves 23 cities in Orange County and all unincorporated areas. The OCFA currently protects over 1,800,000 residents from its 71 fire stations located throughout Orange County. City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-37 Page 11 City of Santa Ana 1.2 SCOPE OF SERVICES The City of Santa Ana is soliciting proposals from qualified ambulance service operators (hereinafter referred to as either "Proposer' or "Contractor") to contract with the City of Santa Ana to provide 9-1-1 Emergency Transportation Service within the territorial jurisdiction of the City of Santa Ana related to operation of the City's ambulance service (the "Contract"). All personnel assigned to perform services under the Contract, whether under the First Tier Service or under the Mutual Aid Contract (each of which is defined below), shall be hereinafter referred to as the "Transportation Personnel." The provision of the First Tier Service and the Mutual Aid Service, together with all of the other services, duties and obligations Contractor may provide under the proposed Contract, shall be hereinafter jointly referred to as the "9-1-1 Emergency Transportation Service" or "9-1-1 Emergency Transportation Services." The details of the 9-1-1 Emergency Transportation Services which must be provided by Contractor under the proposed Contract are as follows: 1.2.1 First Tier Service The proposed Contractor will be required to provide, with its own forces, a sufficient number of fully equipped ambulances and Transportation Personnel, so as to provide, in accordance with the County of Orange Emergency Medical Services ("OCEMS') standards and this RFP, all of the City's needs for 9-1-1 Emergency Transportation Service, being able to respond 24 hours a day 7 days a week to all 9-1-1 and other emergencies as required (referred to as the "First Tier Service" or "First Tier'). The First Tier Service will be designed so as to ensure that there are enough of Contractor's ambulances and Transportation Personnel available to meet 100% of all calls for 9-1-1 Emergency Transportation Service in the City of Santa Ana within the response time criteria. The First Tier Service shall meet the OCFA response times and all other requirements of this RFP for the 9-1-1 Emergency Transportation Service. A. The provision of the First Tier Service shall include an adequate number of fully equipped committed ambulances and associated staffing/Transportation City of Santa Ana Page 12 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7p*fe e, City of Santa Ana Personnel, to provide 9-1-1 Emergency Transportation Services exclusively for the City of Santa Ana. The Ambulances must be able to respond 24 hours a day 7 days a week to all 9-1-1 and other emergencies as required within the City of Santa Ana. B. In addition to the First Tier Service Contractor must also provide whatever additional number of fully equipped ambulances and Transportation Personnel which may be required to meet the response times in this RFP, and to otherwise meet 100% of all 9-1-1 calls for Emergency Transportation Service within the City of Santa Ana 9-1-1 Emergency Transportation Services. C. OCFA, in cooperation with the Transportation Personnel, will provide on -scene Advanced Life Support ("ALS') services. The Transportation Personnel will provide Basic Life Support ("BLS') services and transport patients to medical facilities when required and under the direction of OCFA on behalf of the City of Santa Ana. 1.2.2 Mutual Aid Service (Second Tier Service) Contractor shall also be required to enter into a mutual aid agreement with a separate qualified 9-1-1 ambulance service provider doing business in Orange County, to provide backup services in the event the Contractor is unable to respond to a call for Emergency Services (hereinafter "Mutual Aid Contract' or "Mutual Aid Service"). The company providing the Mutual Aid Service will be hereinafter referred to as the "Mutual Aid Provider." In providing 9-1-1 Emergency Transportation Services the Mutual Aid Provider must meet the same RFP requirements, response times, and otherwise provide the same level of service, as Contractor is required to provide under the Contract. The Mutual Aid Contract must be approved by the OCFA prior to provision of any service by Contractor, such approval not to be unreasonably withheld. The intent of this RFP is that Contractor will provide a sufficient level of coverage under the First Tier and Mutual Aid Services, such that services under the Mutual Aid Service will only be needed in rare circumstances, if at all. Bids submitted in response to this RFP should be designed to provide a sufficient level of First and Mutual Aid coverage as to meet all City of Santa Ana Page 13 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-39 0 City of Santa Ana of the demands for 9-1-1 Emergency Transportation Service calls within the City of Santa Ana. 1.2.3 BLS and ALS Services All Transportation Personnel assigned to perform 9-1-1 Emergency Transportation Services under this Contract, whether under the First Tier Service and Mutual Aid Service, will provide Basic Life Support ("BLS") services and transport patients to medical facilities when required. OCFA, in cooperation with the Transportation Personnel, will provide on -scene Advanced Life Support ("ALS") services. 1.2.4 Minimum Qualifications of Transportation Personnel All Transportation Personnel assigned to perform 9-1-1 Emergency Transportation Service under this Contract, whether under the First Tier Service and Mutual Aid Service, must at all times meet the minimum qualifications as listed in Section 5 of this RFP. 1.2.5 Compensation. A. The winning Contractor's bid shall include the cost to provide both the First Tier and Mutual Aid Service. Contractor's sole compensation for providing all of the 9-1-1 Emergency Transportation Services under both the First Tier and Mutual Aid Service will be the amount bid. Contractor will not be entitled to bill City, or OCFA, or any of its customers any additional amount for any services provided under this Contract, unless it is first approved in writing by City of Santa Ana and the OCFA. B. Contractor's bid will include the provision of the Mutual Aid Service to the degree those services are required. Contractor will be solely responsible for compensating the Mutual Aid Provider for any 9-1-1 Emergency Transportation Services it may provide in the City of Santa Ana under this Contract, which City of Santa Ana Page 14 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-40 r City of Santa Ana compensation will be at the rate set forth in the Mutual Aid Contract or as otherwise required by law. Contractor and the Mutual Aid Provider will not have any recourse against the City of Santa Ana or OCFA to recover for any 9-1-1 Emergency Transportation Services provided under either the First Tier Service or Mutual Aid Service, except as specifically authorized in the Contract. Contractor's sole compensation will be the amount of its winning bid. In the event of a dispute between the Mutual Aid Provider and Contractor, the Mutual Aid Provider's sole remedy will be against Contractor. This fact will be clearly stated in the Mutual Aid Contract, and Contractor must agree to indemnify and defend City of Santa Ana and OCFA against any claims or demands arising out of, or which are in any way related to, any services provided under the Mutual Aid Service. 1.2.6 Billinq A. City of Santa Ana will be solely responsible for the billing and collection of amounts owed by customers/patients provided 9-1-1 Emergency Transportation Services in the City, whether for services provided by Contractor, the Mutual Aid Provider, OCFA, City, or their respective employees, agents, volunteers, or subcontractors. As part of its billing process, City, in its discretion, will also bill for services provided by City of Santa Ana or OCFA personnel. Contractor and the Mutual Aid Provider will actively cooperate with City of Santa Ana to provide whatever information or assistance the City of Santa Ana may reasonably require so that it can process customer/patient billings in a timely manner. This will include, but is not limited to, Contractor providing City of Santa Ana with a detailed list of all the 9-1-1 Emergency Transportation Services provided by both the Contractor and the Mutual Aid Provider during the preceding month. The specific information to be provided by Contractor in the monthly reports will be determined by City, and may be modified by City of Santa Ana from time to time to meet its reasonable needs. City of Santa Ana Page 15 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-41 o City of Santa Ana B. The entire proceeds of all such billings or collection efforts will be the sole property of the City of Santa Ana. Neither Contractor nor the Mutual Aid Provider will have any right to the proceeds of any billings or collections for services provided under the First Tier Service or Mutual Aid Service, or for any other services provided under the Contract, unless specifically authorized in writing by City of Santa Ana. Contractor must design its bid so that the amount bid will be sufficient to provide the required level of services under both the First Tier Service and the Mutual Aid Service, without expecting any additional amounts. 1.2.7 Complimentary Proposals. Given the significance of emergency ambulance transportation and related services and in order to ensure that the City receives proposals from qualified and experienced 9-1-1 providers, this RFP (No. #18-059) sets high standards with respect to provider experience, operational systems, vehicle maintenance/ records, personnel training/records, patient care/transport system design but also allows providers the opportunity to submit complimentary proposals with additional innovative services and potential cost -savings. Any such complimentary proposals shall not constitute an alternative RFP response, but are instead wholly optional and shall be in addition to the required responses set forth in this RFP. All instructions contained in this RFP shall be fully complied with or the proposal may be rejected as nonresponsive. This RFP is not a formal bidding process. Such additional complimentary information that a qualified 9-1- 1 provider may wish to include in their RFP response may be presented as an appendix to their RFP. Please note: the City's contract for paramedic/medical billing and collection services expires June 30, 2019. The City intends to develop and release an RFP for the performance of paramedic/medical billing and collection services on behalf of the City prior to April 2019. Qualified experienced 9-1-1 providers with competent experience in providing paramedic/medical billing and collection services shall be eligible to submit proposals to this RFP. City of Santa Ana Page 16 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-42 0City of Santa Ana 1.2.8 Term The Contract awarded under this RFP is for an initial five (5) year term, with 9-1- 1 Emergency Transportation Service beginning at "TBD" hours on the contract effective date and ending five years thereafter at "TBD" hours, with an optional three (3) year extension, with a final optional two (2) year extension, exercisable at the sole discretion of the City. In the event the Contract is awarded to a new contractor, to allow sufficient time for the transition of services between contractors, the incumbent contractor may at the sole discretion of the City, be granted a six (6) month Contract extension upon the approval of the City Manager and City Attorney. Exercise of the City's option to extend the incumbent Contractor's agreement for said period shall be made via a separate and distinct writing to the incumbent Contractor by the City Manager and City Attorney and shall be issued fifteen (15) days prior to January 1, 2019. 1.2.9 Annual Review The Contract is subject to annual review based on the criteria specified in the Contract and as outlined herein. The City's intent is to contract with and hold accountable those parties working with and on behalf of the City of Santa Ana and OCFA in providing 9-1-1 Emergency Transportation Service to the citizens and visitors of Santa Ana. The contractor is required to keep their Type III emergency transport vehicles (ambulance) up to date on all current regulatory requirements (including all costs related to storage, housing, maintenance, fuel, insurance, repair costs and communication equipment) for all 9-1-1 Emergency Transportation Services provided under the First Tier and Mutual Aid Service. The Mutual Aid Service shall also be required to meet the same personnel and vehicle requirements as are required for the First Tier and Mutual Aid Service. The storage of such Type III ambulances must be within the City limits and cannot be housed within City owned facilities or property. City of Santa Ana Page 17 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-43 0 City of Santa Ana The City has a total of 26,542 incident responses. Over 22,000 of them are medical aids which require an ambulance response. The City has experienced an average of 11% annual increase in incident responses and the bidder should maintain ambulance coverage to meet the response time minimums for the duration of the contract. 1.3 REJECTION OF BIDS At the sole discretion of City, the City of Santa Ana reserves the right to reject any or all prequalification applications and RFP bids, in whole or in part, and is not bound to accept any. The RFP bid may be rejected by the City of Santa Ana if it is in any way incomplete, irregular or if it contains material misrepresentations of fact or omits material information required. 1.4 COST OF PREPARATION Proposers assume all costs associated with the preparation of their bid proposals and any oral presentations that may be necessary or required throughout the procurement process. 1.5 UNDERSTANDING PROPOSAL It is the responsibility of each Proposer to inquire about any criteria, condition, term, provision, or requirement of the RFP that the Proposer does not understand. Responses to inquiries, if they significantly change or clarify the RFP requirements or any aspect of the procurement process, will be forwarded by addenda to all Proposers. The City of Santa Ana will not be bound by any oral responses to inquiries. By submitting bid proposals, Proposers assert that they have fully read the RFP and any addenda issued by City, the proposed Contract and any other Contract Documents, and affirm that the terms and conditions stated therein are fully understood and are acceptable to the Proposer. Each Proposer accepts the terms and conditions of the Contract Documents and indicates their ability and willingness to perform the requested services under such terms and conditions. Any exceptions to the terms and conditions City of Santa Ana Page 18 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-44 d City of Santa Ana set forth in the Contract Documents should be clearly noted in each Proposer's proposal. Please direct all questions regarding the procurement process to: City of Santa Ana Finance & Management Services -Purchasing Sandy Perez, Supervising Buyer Email: sperez(a.santa-ana.orq Phone: 714-647-5329 1.6 CONTRACTOR SELECTION AND AWARD The award of contract under this RFP will be made by the City of Santa Ana. All Proposers will be notified in writing at the conclusion of the procurement process as to the results of the bid proposal evaluation process and the final award recommendation. Proposers will receive mailed award/non-award notification, which will include the name of the Proposer awarded a contract. City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-45 Page 19 0 City of Santa Ana SECTION 2 ADMINISTRATION 2.1 BID PROPOSAL SUBMISSION PROCESS The City of Santa Ana is committed to providing and maintaining the highest levels of emergency response service possible to the public. In conjunction with OCFA, the provision of the 9-1-1 Emergency Transportation Service pursuant to this RFP process is a critical part of the City's continuing efforts to achieve this objective. 2.2 BID PROPOSAL PRE -SUBMISSION CONFERENCE A bid proposal pre -submission conference will be held at Santa Ana City Hall, First Floor, Ross Annex, Room #1200 on Wednesday. October 3. 2018 at 2:00 P.M. The purpose of the conference is for City of Santa Ana staff to respond to any questions, concerns, comments and/or suggestions concerning the procurement process, which have been submitted in advance and in writing to the City of Santa Ana, Purchasing Division. All questions must be submitted by Wednesday, September 26, 2018 to Sandy Perez, Supervising Buyer. The conference is also an opportunity for City of Santa Ana staff to clarify bid specifications and requirements before submission. 2.3 BID PROPOSAL SUBMISSION REQUIREMENTS 2.3.1 Bid Proposal Submission Due Date In order to compete in the RFP process, all bid proposals must be completed and received by the City of Santa Ana, Purchasing Division no later than 3:00 P.M., on Monday, October 22, 2018 ("Submission Due Date"). Bid proposals must be hand -delivered or sent via courier/messenger to the City of Santa Ana, Purchasing City of Santa Ana Page 110 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7p*fe �, 0City of Santa Ana Division. Do not send bid proposals via U.S. Mail. All proposals must be sealed and submitted to the City of Santa Ana, Purchasing Division in accordance with the required format and in the manner prescribed herein by the Submission Due Date. A signed original bid proposal plus seven (7) copies and one electronic copy on a flash drive of the proposal must be received by the City of Santa Ana, Purchasing Division no later than 3:OOP.M. on Monday, October 22. 2018 for public opening. Proposers are strongly encouraged to submit their bid proposals in advance of the due date to avoid the possibility of missing the 3:00 P.M deadline due to unforeseen circumstances. Proposers assume the risk of the methods of dispatch chosen. City of Santa Ana or OCFA assumes no responsibility for any delays whatsoever caused by any courier, delivery, or messenger service. Bid proposals must be date and time stamped by the City of Santa Ana, Purchasing Division on time by the 3:OOP.M. Submission Due Date in order to be considered. Additional time will not be granted to any single Proposer; however, additional time may be granted to all Proposers when, at its sole discretion, the City of Santa Ana or OCFA determines that circumstances require additional submission time. Bid proposals sent to the City of Santa Ana, Purchasing Division via U.S. Mail, Fax, or E-mail will NOT be accepted. No amendments, additions, deletions, or alterations to submitted bid proposals will be accepted by the City of Santa Ana, Purchasing Division after the Submission Due Date. Bid proposals received after 3:00 P.M. on the Submission Due Date will be returned unopened. 2.3.2 Bid Proposal Submission Instructions: Required Format All bid proposals must be submitted in accordance with the following requirements: A. Proposal Binders: All bid proposals must be submitted in three-ring binders, which are not larger than twelve inches by twelve inches (12"x12"); B. Original + Copies: The original signed bid proposal shall be clearly marked "ORIGINAL" and seven (7) copies and one electronic of the bid proposal, City of Santa Ana Page 111 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-47 0 City of Santa Ana including any attachments, must be sent under seal to the City of Santa Ana, Purchasing Division by the Submission Due Date and time; C. Early Bids: Bid proposals received by the City of Santa Ana, Purchasing Division prior to the Submission Due Date will be date and time stamped and secured by the City of Santa Ana, Purchasing Division; D. Title Page: All bid proposals must be clearly marked on the outside binder cover with a title page containing the following information: i. Name of ambulance transportation service operator (i.e., the Proposer); ii. Name of RFP and RFP #18-059; ill. Proposer address and telephone number; iv. Proposer authorized contact person; v. Proposer authorized contact person's signature; vi. Bid proposal submission date; and vii. Marked as original submitted copy E. Bid Format To facilitate the bid proposal review process, all bid proposals must strictly adhere to the format, table of contents, titles, page limits, and numbering for requested information items as set forth in Section 7, Bid Proposal Submission Forms. Any deviation from the Section 7 format and the required Bid Proposal Submission Forms may result in disqualification, at the City's discretion. All Proposers must strictly adhere to the following rules in preparing their bid proposals, and any deviation may result in disqualification: L Use only standard one inch (1") margins; fl. Use only size 12 font; iii. Use only single -sided pages; iv. Observe all page limit requirements, as specified; v. Use proposal binders no larger than 12"x12"; City of Santa Ana Page 112 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 P74*6 i S 0 City of Santa Ana vi. Use tabs or dividers to separate bid response sections. F. Complete Answers & Responses All bid proposals must provide answers to all questions and provide complete responses to each and every requested item and category as specified in Section 7. Specific submission data have been provided for your convenience for each submission item. Proposers are required to supply, at a minimum, the items listed for specific submission. Proposers are permitted, within the prescribed page limits, to submit additional information that they deem helpful in the evaluation and grading process. Failure to provide answers to all questions and complete responses to all requested item categories may result in disqualification, at the City's discretion; G. Table of Contents Bid proposals must include a table of contents listing the individual information as requested by section and set forth in Section 7, Bid Proposal Submission Forms, and their corresponding page numbers. Tabs or dividers must be used to clearly separate each of the individual sections; H. Cover Letter Bid proposals must include a cover letter on official letterhead describing the Proposer, and must include the following information: i. The official name of the Proposer, and stating the Proposer's interest in participating in the RFP; ii. The Proposer's organizational structure (e.g. corporation, partnership, limited liability corporation, or otherwise); The jurisdiction in which the Proposer is organized and the date of such organization; City of Santa Ana Page 113 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 40MV, R City of Santa Ana iv. The address and telephone number of the Proposer's headquarters and of any local office involved in the bid proposal; v. The Proposer's Federal Tax Identification Number; vi. The name, address, telephone, fax numbers, and e-mail address of the person(s) who will serve as the authorized contact(s) to the City/OCFA with regards to the bid proposal, the RFP process, the Contract Documents, and the administration of the contract, if awarded, with authorization to make representations on behalf of and to bind the Proposer; vii. Provide applicable authorized signature documentation, pursuant to Proposer's organizational structure/bylaws, verifying the authority of the person signing the original bid proposal to commit to the proposal on behalf of the Proposer; viii. A representation that the Proposer is in good standing in the State of California and has obtained all necessary licenses, permits, certifications, approvals, and governmental authorizations necessary in order to perform all of the required performance obligations specified herein; ix. A representation that the Proposer is in good standing in the Medicare and Medi -Cal programs and is not the subject of any pending actions, investigations, or prosecutions, whether civil, criminal, or administrative, relating to their billing or reimbursement practices, and that Proposer has not been excluded from any state or federal healthcare program or employs any individual who has been excluded from any state or federal healthcare program. City of Santa Ana Page 114 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-50 W'I City of Santa Ana x. Statement of acceptance of all terms, conditions, requirements, and performance criteria contained in the Contract Documents; and A. Any additional information Proposer deems relevant for consideration during the selection process. I. Photographs Proposers may submit, as part of their bid proposal, a maximum of three (3) pages of color photographs or other renderings depicting their ambulance service facilities, operation, and/or personnel. Such photographs are to be inserted at the end of the bid proposal; J. Non -Collusion Certificate Each Proposer must execute and submit with each bid proposal the Non - Collusion Certificate in Section 7; and K. Compliance Bid proposals that do not strictly adhere to the format requirements and rules set forth herein may be disqualified at the sole discretion of the City of Santa Ana and OCFA. 2.4 PUBLIC OPENING OF BID PROPOSALS 2.4.1 Bid Proposal Opening. All bid proposals received on time by the Submission Due Date will be publicly opened. The public opening will be held at the City of Santa Ana, Purchasing Division site time on Monday, October 22, 2018 at 3:15P.M. 2.4.2 Late Submission. Bid proposals received after 3:00 P.M. on Monday, October 22, 2018 on the Submission Due Date will be returned unopened and will not be considered. City of Santa Ana Page 115 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-51 j City of Santa Ana 2.5 BID PROPOSAL EVALUATIONS 2.5.1 Competitive Process The Proposal Grading Panel will evaluate and rate each bid proposal according to established criteria. The following evaluation criteria, with a maximum of 500 points, will be utilized by the Proposal Grading Panel to rate each proposal: At the conclusion of the evaluation process, the Proposal Grading Panel will make a final contract award recommendation(s), which will be presented to the Santa Ana City of Santa Ana Council. The City of Santa Ana Council may accept the professional Grading Panel's award recommendation and award the contract pursuant to that recommendation. Alternatively, the City of Santa Ana Council may award the contract to another qualified Proposer upon conducting its own review and evaluation of the grading criteria, scoring materials, final scores, bid proposals submission materials, and other pertinent information. 2.5.2 Pr000sal Grading Panel. Bid proposals will be reviewed and evaluated by a Proposal Grading Panel. City/OCFA staff will participate and appoint the members of the Proposal Grading Panel. City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-52 Page 116 Criteria Points A. Experience of the Proposer 0-100 B. Operational Systems 0-100 C. Patient Care/Transport System Design 0-100 D. Personnel Training and Records 0-75 E. Financial Analysis (Cost to the City) 0-75 F. Vehicle Maintenance and Records 0-50 At the conclusion of the evaluation process, the Proposal Grading Panel will make a final contract award recommendation(s), which will be presented to the Santa Ana City of Santa Ana Council. The City of Santa Ana Council may accept the professional Grading Panel's award recommendation and award the contract pursuant to that recommendation. Alternatively, the City of Santa Ana Council may award the contract to another qualified Proposer upon conducting its own review and evaluation of the grading criteria, scoring materials, final scores, bid proposals submission materials, and other pertinent information. 2.5.2 Pr000sal Grading Panel. Bid proposals will be reviewed and evaluated by a Proposal Grading Panel. City/OCFA staff will participate and appoint the members of the Proposal Grading Panel. City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-52 Page 116 0 City of Santa Ana Following an initial bid proposal evaluation process, the grading panel will select finalists for possible onsite visits and oral presentations. Oral presentation concerning the Proposer's proposal, all of which may be videotape recorded, will be limited to 30 minutes per presentation. During the oral presentations the Proposal Grading Panel will listen to the Proposer's presentation and may ask questions of the Proposers and/or request amplification, explanation, or further information regarding their proposal. Additional presentation time may be allotted at the sole discretion of the panel. 2.6 ADMINISTRATIVE 2.6.1 Oral Presentations Oral presentations may be requested of all Proposers at any time throughout the procurement process. 2.6.2 Proprietary Information All bid proposals and documents submitted in response to this RFP shall become the property of the City. It is the responsibility of each Proposer to clearly identify any and all information contained in their bid proposal that it considers to be confidential and/or proprietary. To the extent that City of Santa Ana agrees with that designation, and it is consistent with the Public Record Act requirements, the City of Santa Ana will seek to protect that information from disclosure. All other information will be considered public. However, all information regarding the procurement process will not be disclosed to the public or be subject to disclosure pursuant to the California Public Records Act (Government Code §6250 et seq.) during the deliberative process, until such time as evaluations have been completed and final award recommendations have been made to the Council. In the event that a demand is made for disclosure of information designated by a Proposer as being "confidential and/or proprietary," City of Santa Ana will notify the Proposer in writing of such demand and shall furnish a copy of City's written response to the requestor. If the City of Santa Ana intends to disclose documents which Proposers believe to be confidential, Proposers may then pursue, at City of Santa Ana Page 117 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-53 0 City of Santa Ana their sole cost and expense, all appropriate legal action necessary to maintain the confidentiality of those documents. 2.6.3 Voluntary Withdrawal of Bid Proposal A Proposer may, upon written notice to City of Santa Ana and OCFA, voluntarily withdraw their bid proposal at any time prior to the Public Opening. Withdrawal of a bid proposal will be subject to verification of the identity of the requestor and confirmed with the Proposer's authorized representative. A receipt for the return of any unopened bid proposal will be prepared by the City of Santa Ana, Purchasing Division and signed by the Proposer's authorized representative. 2.6.4 Cancellation of RFP Process The City, in its sole and absolute discretion, may cancel this RFP at any time if it determines cancellation is in the best interest of the City of Santa Ana and OCFA... 2.7 BID PROPOSAL REJECTION 2.7.1 Right to Refect At the sole discretion of the City of Santa Ana and OCFA reserves the right to reject any and all bid proposals, in whole or in part, and is not bound to accept the lowest proposal (or the proposal prices for services). In such event the City of Santa Ana Council, in its discretion, may direct the issuance of a new RFP. 2.7.2 Failure to Comply: Provision of Inaccurate or False Information: Hindrance A bid proposal may be rejected by the City of Santa Ana and OCFA, in its sole discretion, for failure to comply with the requirements set forth in this RFP, for providing inaccurate or false information, or for other reasons that the City of Santa Ana determines create or may create a hindrance or impairment to the objective evaluation of such proposal. City of Santa Ana Page 118 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-54 0 City of Santa Ana 2.7.3 Waiver: Correction & Resubmittal The City of Santa Ana and OCFA reserves the right, in its sole discretion, to waive any and all bid proposal irregularities or informalities that the City of Santa Ana deems correctible or otherwise not relevant. In the event of a bid proposal irregularity or informality, the Proposer may be required to immediately correct and/or resubmit, in whole or in part, its bid proposal. 2.7.4 Incomplete: Irregular: Material Misrepresentations - Reiection A bid proposal may be rejected by the City of Santa Ana and OCFA, in its sole discretion, if it is in any way incomplete, irregular, or if it contains material misrepresentations of fact or omits material information required. Bid proposals that do not strictly adhere to the format requirements set forth in this RFP may be rejected. 2.7.5 Corrupt, Fraudulent, Illegal Practices - Disqualification A bid proposal may be rejected or disqualified by the City of Santa Ana and OCFA upon evidence that the Proposer may have engaged in corrupt, fraudulent, and/or illegal practices involving the performance, administration, or award of a similar contract in another jurisdiction. 2.7.6 Exceptions to RFP Specifications: Delivery Criteria: Terms & Conditions Bid proposals that take exception to the RFP specifications and/or delivery criteria, or terms and conditions of the Contract Documents may be rejected. 2.7.7 Failure to Provide All Information Requested - Incomplete Bid proposals that do not provide all information requested in this RFP may be rejected as incomplete. 2.7.8 Notification of Reiection In the event a bid proposal is rejected, the City of Santa Ana will notify the Proposer in writing and shall explain the specific reason(s) for the rejection. City of Santa Ana Page 119 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-55 ~ City of Santa Ana 2.8 AWARD PROTEST The award of contracts under this RFP will be made by the City of Santa Ana. All protests shall be made in writing, signed and addressed to: City of Santa Ana Finance & Management Services -Purchasing Division Sandy Perez, Supervising Buyer 20 Civic Center Plaza (M-16) Santa Ana, California 92702 Email: sperez(ftanta-ana.org Phone: 714-647-5329 Protests shall state the reason(s) for the protest, citing the law, rule, regulation or procedure on which the protest is based. If a protest is based on what appears to be an erroneous assessment of the ability of a Proposer to meet the RFP specifications and requirements, the protester must provide facts and evidence to support the claim. If the protest is sent via U.S. mail, it must be sent certified or registered. All protests shall be submitted no later than ten (10) working days from notification. 2.9 PROPOSED SCHEDULE OF EVENTS City of Santa Ana Page 120 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-56 Action Date A Final RFP Issued Tuesday, August 28, 2018 B Deadline for Written Questions Regarding the RFP Wednesday, September 26, 2018 C Bid Proposal Pre -Submission Conference (RSVP Required) Wednesday, October 3, 2018 at 2:00 P.M. in City Hall, Ross Annex, Conf. Room #1200 D RFP Addenda to Address Questions Thursday, October 4, 2018 to Friday, October 12, 2018 City of Santa Ana Page 120 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-56 0 City of Santa Ana * Start date assumes a January 1, 2019 contract effective date. In the event the Contract is awarded to a new contractor, the incumbent contractor may be granted a six month extension, with City Council approval, beginning January 1, 2019 to June 30, 2019, to allow sufficient time for the transition of services between service providers. City of Santa Ana Page 121 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-57 E Proposal Submission Due Date Monday, October 22, 2018 at 3:00 P.M. F Proposal Submission Public Opening Monday, October 22, 2018 at 3:15 P.M. City Hall, 4th Floor, Purchasing Division, Room 429 G Proposal Grading Panel Evaluation Process Start Tuesday, October 30, 2018 to Thursday, November 1, 2018 H Proposal Grading Panel - Recommendations Wednesday, November 7, 2018 I Final Recommendation, Selection and Contract Award Submitted to City Council Tuesday, December 4, 2018 J Final Date for Submission of Award Protests Tuesday, December 18, 2018 K Execution of Contract Wednesday, December 19, 2018 L Contract Performance Start Date Tuesday, January 1, 2019' * Start date assumes a January 1, 2019 contract effective date. In the event the Contract is awarded to a new contractor, the incumbent contractor may be granted a six month extension, with City Council approval, beginning January 1, 2019 to June 30, 2019, to allow sufficient time for the transition of services between service providers. City of Santa Ana Page 121 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-57 City of Santa Ana SECTION 3 GENERAL TERMS AND CONDITIONS 3.1 PROPOSED CONTRACT The proposed Contract is attached to this RFP as Attachment No. 1. Please review the terms of the proposed Contract carefully (the "Contract" or the "Agreement'). Where there is a discrepancy in the terms of this RFP and the terms of the Contract, the terms of the Contract shall prevail. 3.2 CONTRACT DOCUMENTS The Contract entered into by the successful Proposer shall consist of the: 3.2.1 Executed Contract Executed Contract between the City of Santa Ana and Contractor attached as Attachment No. 1 to this RFP. 3.2.2 RFP Request for Proposal(s) 3.2.3 Original Bid Proposal(s) Signed, original bid proposal(s) submitted by the successful Proposer ('Bid Proposal') The Executed Contract, the RFP, and the Bid Proposal(s), submitted by the successful Proposer will be incorporated and made a part of the Contract and shall be hereinafter collectively referred to as the "Contract Documents." All provisions of the RFP, the Bid Proposal(s), and the contract shall be binding on the parties. Should any inconsistency or ambiguity occur or exist in the Contract Documents, the provisions of the Contract, then the provisions of the Proposal, then the provisions of the RFP shall control. City of Santa Ana Page 122 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 0 City of Santa Ana For purposes of this section the successful Proposer shall be referred to as the "Contractor." 3.3 CONTRACT MODIFICATION AND AMENDMENTS Once a Contract has been awarded and executed, the parties may adjust the specific terms of the Contract Documents from time to time where circumstances beyond the control of either party require modification or amendment. Any modification or amendment proposed by the Contractor must be submitted in writing to the City of Santa Ana, OCFA, and OCEMS for consideration. The decision to modify or amend any term or condition of the Contract Documents shall be at the sole discretion of the City of Santa Ana, with feedback from OCFA and may require concurrence from OCEMS. Any agreed upon modification or amendment must be in writing, approved by all parties. 3.4 CONTRACT ADMINISTRATION The Executive Director of Finance & Management Services of the City of Santa Ana, or his designee, shall be the authorized representative in all matters pertaining to the RFP process. The contract awarded pursuant to this RFP for the provision of 9-1-1 Emergency Transportation Service to the City of Santa Ana shall be administered by the Executive Director of Finance & Management Services of the City of Santa Ana, or his designee. 3.5 CONTRACT EFFECTIVE DATE The effective date of the contract awarded pursuant this RFP shall be TBD, ("Effective Date") at which time Contractor will assume full responsibility for the provision of 9-1-1 Emergency Transportation Service within the City of Santa Ana, as outlined in this RFP. The Effective Date may be postponed at the sole discretion of the Executive Director of Finance & Management Services of the City of Santa Ana or designee in order to protect public health and safety or in the event a successful Proposer/Contractor is for any reason unable to commence performance at that time. City of Santa Ana Page 123 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-59 0 City of Santa Ana 3.6 CONTRACT TERM 3.6.1 Term The exclusive contract awarded pursuant to this RFP are for an initial five (5) year term, ending at TBD. The contract shall automatically expire at the end of the initial five year term, unless extended as provided below. 3.6.2 Contract Extension Upon the mutual written agreement of the parties, the contract may be extended with an optional three (3) year extension, plus a final optional two (2) year extension (for a possible total term of 10 years). Successful past performance during the initial contract period will be a critical factor in the decision to grant an extension. The decision to either grant or deny a contract extension(s) shall be final. The decision to grant an extension shall be made solely by the City of Santa Ana. At the end of the initial contract term, or if extended at the end of the extended term, the Contract awarded pursuant to this RFP shall automatically terminate. 3.6.3 Termination. Once the Agreement is executed, it may be terminated as follows: A. The Agreement may be terminated by either party, with or without cause, upon ninety (90) days prior written notice to the other party. B. CITY OF SANTA ANA may terminate the Agreement for Cause by providing CONTRACTOR thirty (30) days prior written notice of termination for Cause and the factors constituting Cause. CONTRACTOR will have thirty (30) days to cure any alleged breach, prior to termination for cause under this section. City of Santa Ana Page 124 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7pMe .0, 0 City of Santa Ana C. CITY OF SANTA ANA may terminate the Agreement immediately if the OCFA Fire Chief or designee (in their reasonable discretion) determines that continued operations by CONTRACTOR following the breach would constitute a danger to the public health, safety or general welfare. K �1016Yl1:?-,I [M=1 Contractor must provide, to the satisfaction of the City of Santa Ana and OCFA, insurance in accordance with the following requirements: 3.7.1 Certificates of Insurance Prior to beginning the provision of 9-1-1 Emergency Transportation Service under this Agreement, CONTRACTOR must provide to the satisfaction of the CITY OF SANTA ANA and OCFA, certificates of insurance and endorsements evidencing the policy or policies of insurance in the types and amounts set forth below. CONTRACTOR shall at all times during the term of this Agreement carry, maintain, and keep in full force and effect, the following minimum scope of insurance coverage: A. Commercial General Liability Insurance in an amount not less than $10,000,000 per occurrence, written on an occurrence form. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $10,000,000 per occurrence. B. Ambulance Medical Malpractice Insurance in an amount not less than $3,000,000 per occurrence. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. Such insurance coverage may be combined with either the general or automobile liability coverage; provided, however, if the insurance coverage is so structured, the combined coverage shall be City of Santa Ana Page 125 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-61 I City of Santa Ana in an amount not less than $5,000,000 per occurrence, with an annual aggregate of not less than $10,000,000. C. Comprehensive Business Automobile Liability Insurance in an amount not less than $3,000,000 per occurrence, covering owned, non -owned and hired vehicles, written on an occurrence form. If policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. Contractor understands that it must provide Business Automobile Liability coverage for all vehicles. D. Workers' Compensation and Employers' Liability Insurance in a statutory amount for workers' compensation and in an amount not less than $1,000,000 for employers' liability. Such insurance shall contain a waiver -of -subrogation clause in favor of the CITY OF SANTA ANA and OCFA, and their respective officers, officials, employees and agents. 3.7.2 CONTRACTOR shall also comply with the following requirements: A. If the above -required insurance coverage does not provide for an annual aggregate which is twice the per -occurrence limit, in the alternative the insurance policy (policies) shall be amended (by appropriate ISO endorsements) so that the policy limits apply solely to this Agreement. B. The above -required liability insurance shall be in a form which supports coverage for the provisions of the indemnification clause required under this Agreement, including a claim brought against the CITY OF SANTA ANA and/or OCFA for the injury to, or death of an employee or agent of CONTRACTOR. C. In the event of a claim (claims) against the above -referenced liability policies which reasonably may deplete one-half or more of the City of Santa Ana Page 126 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-62 0 City of Santa Ana aggregate limits, CONTRACTOR shall immediately notify CITY OF SANTA ANA and/or OCFA. In the event a claim (claims) against the above -referenced liability policies which are reasonably expected to deplete 90% of the aggregate limits, CONTRACTOR shall, at CONTRACTOR's expense, reinstate the aggregate limits at least to an amount equal to one-half of the face amount of the aggregate limits on the policies. D. All insurance required pursuant to this section shall be issued by a company authorized by the Insurance Department of the State of California and rated A -VII or better by the latest edition of Best's Key Rating Guide. E. No insurance required herein shall provide for a deductible in excess of $5,000 or a self-insured retention in any amount, without prior written consent of the CITY OF SANTA ANA and OCFA; and, the granting or denying of such consent shall be at the sole and absolute discretion of the CITY OF SANTA ANA and OCFA. 3.7.3 Endorsements A. All insurance required herein shall be endorsed to state that "Coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior to written notice by certified mail, return receipt requested, has been given to the CITY OF SANTA ANA and OCFA." B. The liability policies required herein, except for professional liability (if a stand -above coverage), workers compensation and employers' liability, shall, by endorsement, contain the following provisions: City of Santa Ana Page 127 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-63 a City of Santa Ana I. 'The CITY OF SANTA ANA and OCFA, and their respective officers, officials, employees, representatives, and volunteers are hereby declared to be additional insureds as respects the operations, activities, work, errors, or omissions of the named insured arising out of or in connection with any contract or agreement with the CITY OF SANTA ANA and OCFA." ii. 'This insurance is primary to, and shall not contribute with, any insurance or self-insurance maintained by the City of Santa Ana or OCFA, or by any of the designated additional insureds." iii. 'This insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability." C. Worker's Compensation and Professional Liability policies shall be endorsed state that the insurer waives all rights of subrogation against the CITY OF SANTA ANA and OCFA, and their respective officers, officials, agents, employees, and volunteers for losses arising from work performed by the CONTRACTOR under this Agreement. 3.7.4 Certificates of Insurance All insurance coverages shall be confirmed by execution of endorsements and certificates of insurance. CONTRACTOR is required to file the completed policy endorsements and certificates with CITY OF SANTA ANA and OCFA on or before the Effective Date of this Agreement, and to thereafter maintain current endorsements on file with CITY OF SANTA ANA and OCFA. The completed endorsements and certificates of insurance are subject to the approval of CITY OF SANTA ANA and OCFA and shall show the CITY OF SANTA ANA as an insurance CERTIFICATE HOLDER. City of Santa Ana Page 128 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-64 r" City of Santa Ana 3.7.5 Indemnification and Hold Harmless Clause Nothing in this section shall be construed as limiting in any way; the Indemnification and Hold Harmless Clause contained in this Contract, or the extent to which CONTRACTOR may be held responsible for payments of damages to persons or property. 3.7.6 Right to Review CITY OF SANTA ANA or OCFA shall have the right at any time to review the coverage, form, and limits of insurance required herein. If, in the sole and absolute discretion of the CITY OF SANTA ANA and/or OCFA, the insurance provisions in this Agreement do not provide adequate protection for the CITY OF SANTA ANA and/or OCFA, shall have the right to require CONTRACTOR to obtain insurance sufficient in coverage, form, and limits to provide adequate protection, and CONTRACTOR shall promptly comply with such requirement. The CITY's and OCFA's requirements shall not be unreasonable, but shall be adequate in the sole opinion of the CITY OF SANTA ANA and OCFA to protect against the kind and nature of risks which exists at the time a change of insurance is required, or thereafter. 3.7.7 Alternate Forms of Insurance Alternate forms of insurance that meet the above requirements, must be approved by the CITY's and OCFA's Risk Manager prior to submitting a proposal for any work under this Agreement. 3.7.8 Mutual Aid The Mutual Aid provider shall be required to meet all of the insurance requirements in this Section to the same degree as Contractor, and those requirements will be included in the Mutual Aid Contract. City of Santa Ana Page 129 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-65 0 City of Santa Ana 3.8 ASSIGNMENT Except as provided herein, Contractor may not delegate, transfer or assign its rights or otherwise transfer its obligations, in whole or in part, under the proposed contract to any other person or entity without first obtaining the prior written consent of the City of Santa Ana and OCFA and not for 180 days after the formal contract award. Any such assignment or transfer without the prior written consent of the City of Santa Ana and OCFA shall be void, the attempted assignment shall constitute a breach of the Contract, and if discovered during the bidding process will be grounds for rejection of the bid. For purposes of this section, the following will be considered to be a "transfer" or "assignment": 3.8.1 Change in Business Structure Any change in the business structure, including but not limited to, changes from or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; 3.8.2 Bankruptcy Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 3.8.3 Transfer A transfer by any of the owners, shareholders or members (whichever is applicable) of Contractor of greater than ten percent (10%) of the ownership interest, stock or membership interest (whichever is applicable) in Contractor's business, issued as of the Effective Date by the Contractor, or the sale or transfer of over twenty-five percent (25%) of the assets of the Contractor. In the event a Contractor experiences regular stock exchanges in excess of the ten percent (10%) threshold, a separate agreement may be negotiated to set a threshold that still provides the City of Santa Ana and OCFA with the protections City of Santa Ana Page 130 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7pWO • ,, 0 City of Santa Ana intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. 3.9 AUDITS AND INSPECTIONS 3.9.1 Business Office At any time during normal business hours, and as often as may reasonably be deemed necessary by the City of Santa Ana or OCFA, the City of Santa Ana or OCFA may observe and inspect Contractor's business office, and Contractor must make promptly available to the City of Santa Ana or OCFA for its examination all of Contractor's records that pertain to performance of the Contract. The City of Santa Ana or OCFA may audit, examine, and copy any and all Contractor records pertaining to their performance of the contract, including but not limited to, personnel records, daily logs, conditions of employment, and all other data. The City of Santa Ana or OCFA's right to inspect Contractor's business office and any and all records pertaining to their performance of the Contract will be restricted to normal business hours and reasonable notice shall be given to Contractor in advance of such inspection. 3.10 COOPERATION Contractor must cooperate with the City of Santa Ana and OCFA and take all actions necessary to ensure that all terms and conditions, and required performance levels, set forth in the Contract Documents are satisfied at all times throughout the contract term. 3.11 NON -COLLUSION CERTIFICATE Each Proposer must execute and submit with each bid proposal the Non - Collusion Certificate in Section 7. If there is reason to believe that collusion exists City of Santa Ana Page 131 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-67 City of Santa Ana among Proposers, all bid proposals submitted will be rejected and none of the participants in such collusion will be considered in any future RFP. 3.12 INDEPENDENT CONTRACTOR Both parties in the performance of the Contract shall be acting in an independent capacity of Santa Ana one from the other, and not as agents, employees, partners, or pursuant to a joint venture with one another. The parties understand and agree that Contractor and its employees (which term specifically includes, but is not limited to, the Transportation Personnel) are not employees of the City, the County or OCFA, and are not entitled to any of the rights, benefits, or privileges of City, County or OCFA, employees including, but not limited to, medical, unemployment, or workers' compensation insurance. 3.13 INDEMNIFICATION CONTRACTOR agrees to defend, indemnify, hold free and harmless the CITY OF SANTA ANA and OCFA, and their respective officers, officials agents, employees and volunteers, at CONTRACTOR's sole expense, from and against any and all claims, actions, suits or other legal proceedings brought against the CITY OF SANTA ANA or OCFA, or their respective officers, officials, agents, employees or volunteers, arising out of the performance of the CONTRACTOR, its employees, agents and/or authorized subcontractors, of the work undertaken pursuant to the Agreement, specifically including but not limited to the 9-1-1 Emergency Transportation Service. The defense obligation provided for hereunder shall apply without any advance showing of negligence or wrongdoing by the CONTRACTOR, its employees, agents and/or authorized subcontractors, but shall be required whenever any claim, action, complaint, or suit asserts as its basis the negligence, errors, omissions or misconduct of the CONTRACTOR, its employees, agents and/or authorized subcontractors, and/or whenever any claim, action, complaint or suit asserts liability against the CITY OF SANTA ANA or OCFA, or their respective officers, officials, agents, employees or City of Santa Ana Page 132 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 0 City of Santa Ana volunteers, based upon the work performed by the CONTRACTOR, its employees, agents and/or authorized subcontractors under this Agreement, whether or not the CONTRACTOR, its employees, agents and/or authorized subcontractors are specifically named or otherwise asserted to be liable. Notwithstanding the foregoing, the CONTRACTOR shall not be liable for the defense or indemnification of the CITY OF SANTA ANA or OCFA for claims, actions, complaints or suits arising out of the sole negligence or willful misconduct of the CITY OF SANTA ANA or OCFA. The Mutual Aid Provider shall be required to include the same language in the Mutual Aid Contract, indemnifying the City of Santa Ana and OCFA to the same degree as Contractor. 3.14 COMPLIANCE WITH LAW All services provided by Contractor pursuant to the Contract Documents must be rendered in full. All compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It will be Contractor's sole responsibility to determine which federal, state, and local laws, rules, statutes, and regulations apply to the services to be performed pursuant to the Contract Documents, and to maintain compliance at all times throughout the Contract term. 3.15 RESPONSIBILITY Except as may be specifically stated herein to the contrary, it shall be the responsibility of Contractor to provide all Transportation Personnel with whatever resources and equipment are necessary to perform the 9-1-1 Emergency Transportation Service, and to otherwise satisfy all of the terms and conditions set forth in the Contract Documents at all times during the Contract term. Except where it may be specifically permitted in the Contract, Contractor may not use any outside ambulance service providers or other resources to satisfy its obligations to provide 9-1-1 Emergency Transportation Service to the City of Santa Ana and OCFA, without first obtaining the prior written consent of the City of Santa Ana. Notwithstanding the City of Santa Ana Page 133 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7pMe • o �1 City of Santa Ana granting of any such approval by the City of Santa Ana and OCFA, nothing stated herein shall relieve Contractor of its duties and responsibilities under the Contract, and any additional cost incurred shall not be charged to the County, City of Santa Ana or OCFA. 3.16 ACTS OR OMISSIONS OF REPRESENTATIVES The acts and/or omissions of the owner(s), officers, operators, officials, employees, agents, and representatives of the Contractor in the performance of the services and obligations under the Contract Documents shall constitute the acts and/or omissions of the Contractor. 3.17 INSOLVENCY ACTS OR OMISSIONS OF REPRESENTATIVES Contractors shall not, without the prior written consent of the City of Santa Ana or OCFA, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of Contractor, or make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by Contractor under any insolvency or bankruptcy proceeding constitutes a breach of contract by Contractor, and all property, equipment or materials assigned by OCFA, the City of Santa Ana and/or the County to Contractor related to the provision of services under this contract shall be automatically "released" by Contractor and returned back to the possession and control of the City of Santa Ana and OCFA. Following the occurrence of any such event, the City of Santa Ana or OCFA may assign such property, equipment or materials to another assigned service provider, in the City of Santa Ana's or OCFA's sole discretion. City of Santa Ana Page 134 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-70 0 City of Santa Ana SECTION 4 OPERATIONAL STANDARDS, PROCEDURES AND PERFORMANCE REQUIREMENTS 4.1 EMERGENCY RESPONSE COMMUNICATIONS SYSTEM 4.1.1 Communications Requirements Contractors must comply with the following requirements concerning the installation, use, operation, and maintenance of their Emergency Response Communications System: A. Emergency Response Communications System must be operated and maintained by Contractor twenty-four (24) hours per day, seven (7) days per week; B. Contractor dispatch centers must be equipped with a secondary, emergency back-up electrical system to insure uninterrupted twenty- four (24) service; and, C. Complete integration of Contractor's dispatch center with OCFA (CAD to CAD) at the Contractor's sole expense is desirable. D. All 9-1-1 Emergency Transport units assigned to the City of Santa Ana must at a minimum be equipped with an 800 MHz communication device that allows communication between OCFA personnel, OCFA dispatch center, and contractor dispatch center. Tier II (Mutual Aid) units must meet same requirements. E. Automatic Vehicle Locator System (AVL) will be required on all 9-1-1 Emergency Transport units at contractor's expense. F. GPS/Route navigation will be required on all 9-1-1 Emergency Transport units at contractor's expense. City of Santa Ana Page 135 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-71 - City of Santa Ana 4.1.2 Vehicle Communications A. 800 MHz Mobile Radio Contractors must install and maintain at their sole cost and expense, an OCFA approved 800MHz mobile radio in the front passenger area (with a remote head in the rear patient area) of each ambulance that will be used for patient transport in the performance of the contract. The 800MHz mobile radios with a pre -identified radio identifier and at the discretion of the OCFA, configured to send status and message data, are to be used by Contractors' EMTs and ambulance personnel to communicate response status with OCFA dispatch and by OCFA paramedics to communicate with base and receiving hospitals during patient transport. Contractors must comply with the following 800 MHz mobile radio requirements: i. Contractors must obtain all necessary licenses, permits, and/or approvals from OCC (and any other applicable licensing or permitting agency) to operate and maintain their 800 MHz mobile. radios as required herein in conjunction with the 800 MHz C.C.C.S.; ii. Contractors must comply with all federal, state, and local laws, rules, statutes, and regulations governing the operation of 800 MHz mobile radios, including compliance with 800 MHz C.C.C.S. Standard Operating Procedures; iii. Contractors must ensure that their 800 MHz mobile radios are pre -assigned to a vehicle with a pre -identified radio identifier and are configured to send status and message data compatible with OCFA SmartNet Information Management System (SIMS), and must include an OCFA approved and issued Motorola DEKbox with 8 status/message keys to transmit unit status (e.g., en route, on scene, and available status functions); OCFA will City of Santa Ana Page 136 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-72 0 City of Santa Ana configure the SIMS system to enable this feature on all Contractor radios enabled on the 800 MHz C.C.C.S.; and iv. All Contractor 800MHz mobile radios must meet OCFA, OCC, ECC, 800 MHz C.C.C.S., and OCEMS specifications and requirements. B. Mobile Data Computer System Contractors must install and maintain, at their sole cost and expense, an OCFA approved and issued mobile data radio at Contractors' dispatch center for purposes of sending and receiving electronic emergency dispatch information, instructions, and call status. Contractors must comply with the following mobile data radio system requirements: I. MDC Radio Upon the award of a contract and prior to the Effective Date, Contractors must pay OCFA a onetime, non-refundable communications start-up fee of $3,500, which shall cover the following: (a) OCFA-issued and owned mobile data radio; (b) OCFA-issued mobile data application software; (c) mobile data installation; (d) mobile data programming; and (e) Mobile Data Radio and antenna to be installed at the Contractor's expense, as specified by OCFA. All communications equipment issued to Contractors by OCFA pursuant to this Section shall remain the property of OCFA. The communications systems described in this Section must be installed and fully operational prior to the Effective Date. Upon contract termination, all OCFA-issued communications equipment must be returned to OCFA within City of Santa Ana Page 137 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-73 16MTR% r City of Santa Ana thirty (30) days. This fee may be waived by OCFA if Contractor currently meets the specified requirements of this paragraph. ii. Annual MDC Fee Contractors must pay OCFA a $250 annual fee for MDC system operation and maintenance, which shall be due and payable upon contract award and annually thereafter. iii. Personal Computer Contractors must provide, at their sole cost and expense, and as part of their Emergency Response Communications System, a personal computer having the following minimum specifications: Intel Pentium 500 MHz or greater; 10.0 GB Hard Drive; 256 Mb SDRAM; 2000XP OS; Color display VGA; Com Ports — 1 serial, 1 USB, 1 Parallel; CD ROM; and, Keyboard — Standard Qwerty 104. iv. Mobile Application Software Motorola Tx Messenger v3.0 software or greater as specified by OCFA. 4.2 SERVICE HOURS 4.2.1 Service Contractor must provide, at a minimum: A. Transportation Personnel to fully staff the First Tier Service ambulances as provided by the Contractor as part of this contract, such that those vehicles are able to provide twenty-four (24) hour emergency ambulance transportation within the City, seven (7) days a week, for the duration of the term of the contract. B. A sufficient number of fully equipped Mutual Aid units, such that Contractor is able to respond to all 911 and other emergencies calls in City of Santa Ana Page 138 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-74 City of Santa Ana the City of Santa Ana and meet the response time requirements set forth in Section IV(C) below. C. Except to the degree that the RFP specifically provides for an exemption, during the term of the Contract, Contractor shall provide sufficient resources such that Contractor is able to respond to 100% of all 911 and other emergency calls in the City of Santa Ana by means of the combined efforts of the First Tier Service and Mutual Aid Service within the response time requirement. 4.2.2 Field Supervisor Contractor must have an authorized field supervisor available to the City of Santa Ana and OCFA personnel, either by radio or in person, on a twenty-four (24) hour, seven (7) day per week basis during the term of the contract. The Field Supervisor must be assigned and staffed in a separate non -transport unit. 4.3 RESPONSE TIMES 4.3.1 General Requirements Contractors must respond to OCFA's requests for emergency ambulance transportation service within the response times set forth in this Section. Response times will be calculated as the actual elapsed time in minutes from the moment the request is received by the Contractor's dispatch center to the time that the Contractor's first ambulance arrives on scene. Where multiple ambulances are dispatched to the same emergency scene, only the response time of the ambulance arriving first will be counted for purposes of calculating the response time. 4.3.2 Response Time Measurement Response times are measured in full minutes, rounded upward. For purposes of measuring compliance and for the imposition of any penalties, any City of Santa Ana Page 139 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-75 0 City of Santa Ana partial minute will be rounded to the next full minute. For example, a response time of 10:01 or 11:00 is counted as eleven minutes. 4.3.3 Response Times Required Contractor must strictly adhere to the following required response times at a quarterly compliance rate of ninety percent (90%) in each Code 2 and Code 3 categories, which shall be reported separately: Metro/Urban Requirements: a. Code 3 - Response time must not exceed nine (9) minutes, fifty-nine (59) seconds. b. Code 2 - Response time must not exceed fourteen (14) minutes, fifty- nine (59) seconds. 4.3.4 Response Time Reporting Contractor must provide quarterly response time reports to the City and OCFA ("Quarterly Response Time Reports"). If the Quarterly Response Time Reports are not submitted to the OCFA as prescribed herein two (2) or more times in a single 12 -month period, such omissions may constitute breach of contract. 4.3.5 Call Cancellation In the event a call for service is cancelled prior to arrival, the response will be considered to be within the response time requirement so long as the elapsed time between the call for service and the cancellation does not exceed the applicable response time requirement. In the event the elapsed time between the call for service and the cancellation is in excess of the applicable response time requirement, the call will be considered late. City of Santa Ana Page 140 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-76 City of Santa Ana 4.3.6 Quarterly Response Time Report - Format The Quarterly Response Time Reports must be submitted by Contractor using an electronic spreadsheet format. Whenever response times in either Code 2 or Code 3 categories fall below the 90% compliance rate in any given quarter, Contractor shall include a narrative assessment as to the cause of any response delay, and, if requested, shall meet and confer with the OCFA Fire Chief or designee for purposes of establishing a plan for avoiding such delay in the future. 4.3.7 Exemptions to Response Time Requirements The response time requirements set forth in this Section may be suspended and not enforced, at the sole discretion of the OCFA, in unusual circumstances. There shall be no exemption for response delays due to vehicle mechanical problems, driver error, traffic, weather, or mistake. The response time requirements set forth in this Section will be suspended and not enforced under the following limited circumstances: A. High Call Volume: Responses to calls for service during periods of unusual system overload or high call volume, which shall be determined at the sole discretion of the OCFA; B. Disasters: Responses to calls for service during an OCFA or city -declared disaster occurring during a declared disaster in a neighboring jurisdiction, which has requested emergency ambulance transportation or other mutual aid assistance from OCFA or the City of Santa Ana. For purposes of this Section, a "declared disaster' means any condition of disaster as declared or affirmed by the OCFA Fire Chief or his designee; C. Multiple Ambulance Response: For responses to calls for service where more than one ambulance is dispatched to the same incident, only the response time of the ambulance first to respond will be required to meet the required response time requirements; City of Santa Ana Page 141 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 1 B-059 August 28, 2018 250-77 City of Santa Ana D. Response UP/Downgrade: For Code 3 calls where the response priority code is downgraded to Code 2 by OCFA while the ambulance is en route to the scene, the response time standard for that call shall be recorded as a Code 2 call. If the response priority code is upgraded from Code 2 to Code 3 by OCFA while the ambulance is en route to the scene, the response time standard for that call shall be recorded as the number of minutes for a Code 3 call plus the number of minutes already elapsed, not to exceed the original total minutes for a Code 2 call;. E. Return of OCFA Personnel: In the event that an ambulance is delayed in responding to a call for service, or is hindered from providing a timely response, due to the need to comply with the requirement that it return all OCFA personnel to their respective fire stations, as described herein, the response time requirement for that call will be suspended. This exemption will only apply for a call for service dispatch that occurs while the ambulance is waiting for or actually returning OCFA personnel. It shall be the Contractor's responsibility to document such circumstances, including the length of time and the affected call(s) for service. Contractor must apply for a specific exemption as provided below. Calls for service dispatches that occur after the ambulance has returned OCFA personnel and while returning to any ambulance post location are not eligible for this exemption. 4.3.8 Procedures to Request Response Time Exemption Applications for receiving an exemption to the response time requirements must be submitted by Contractor to the OCFA for approval. Such requests must accompany the Quarterly Response Time Report for the period in which the exemption is requested. Requests for exemptions outside of the current quarterly reporting period will not be considered. Each request for exemption must include the following information: A. The incident date; City of Santa Ana Page 142 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 City of Santa Ana B. The OCFA Incident Number(s); C. A narrative summary of the incident; D. Explanation for the cause of the response time delay; and E. The specific exemption requested. The decision to either grant or deny a response time exemption request will be made by the OCFA within thirty (30) days; the decision to deny may be appealed to the Santa Ana OCFA Fire Chief or his designee, whose decision shall be final. 4.3.9 Use of Alternative Methods to Meet Response Time Requirements For purposes of maintaining compliance with the response time requirements established herein, Contractor must negotiate and enter into a Mutual Aid Contract with an ambulance service operator for the provision of 9-1-1 Emergency Transportation Service ("Mutual Aid Provider'). Any ambulance provider selected to provide such services, and any agreement to provide such services pursuant to this Section, must satisfy the following requirements: A. The Mutual Aid Contract must be reviewed and approved by the City of Santa Ana and OCFA prior to execution of the Contract awarded pursuant to this RFP and a copy of the Mutual Aid Contract must be sent to the OCFA EMS Section Battalion Chief; B. Mutual Aid Providers will be expected to perform 9-1-1 Emergency Transportation Service in the City of Santa Ana in accordance with all of the operational standards, procedures, and performance requirements set forth in the Contract Documents. Prior to Contractor providing any 9-1-1 Emergency Transportation Service under the Contract, the Mutual Aid Provider must acknowledge this obligation in writing to the City of Santa Ana and OCFA. City of Santa Ana Page 143 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-79 UR City of Santa Ana C. Mutual Aid Providers and their employees must cooperate with the City of Santa Ana and OCFA and must participate in any audit requested by the City of Santa Ana or OCFA concerning their performance; and D. Notwithstanding the above, Contractor, and not the Mutual Aid Provider will be primarily responsible for ensuring compliance with all terms, conditions, standards, and performance requirements set forth in the Contract Documents, including but not limited to, the primary obligation to pay any penalties which may be imposed by the OCFA and the payment of all fees and reimbursements. 4.3.10 Disciplinary Actions for Failure to Meet Response Time Requirements/ Performance Deficiency A. Meet and Confer Should a Contractor fail to meet the response time requirements set forth in this section in any quarterly period, either for any single Code category or for the cumulative total of Code 2 and Code 3 calls as outlined in section 4.3.3 -Response Times Required of this RFP, the OCFA representative shall notify the Contractor and meet and confer with said Contractor regarding performance and response time deficiencies. The purpose of this meeting is to notify the Contractor of its deficiencies and to work with the Contractor to ensure proper response time performance in the immediate future. B. Penalties At the discretion of the OCFA, monetary penalties may be assessed against a non-compliant Contractor for failure to meet the response time requirements set forth in this Section. Quarterly aggregate response times (i.e., in any quarterly period for any single Code category) that are City of Santa Ana Page 144 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 P74*6 : 1, 0 City of Santa Ana not in compliance with the response time requirements set forth in this Section may result in the OCFA assessing the non-compliant Contractor with a monetary penalty according to the following compliance and fine schedule: Quarterly Responses That Are In Compliance with Response Time Requirements: Penalty Imposed*: 90% or Better None 85%-89.9% $5,000 80%-84.9% $7,000 Less than 79.9% $10,000 * Note: Penalties are for Code 2 / Code 3 reported separately and calculated separately. In addition to the above response time penalties, the OCFA may assess monetary penalties against Contractor for the following: i. Turned Call Penalties Any calls for service that are not handled by the Contractor through the First Tier or Mutual Aid Service, that require OCFA to request service from another ambulance service operator, will result in the assessment of a 'Turned Call' penalty in the amount of $1,000 per occurrence. Contractor is to immediately notify the OCFA EMS Chief of said occurrence within 24 hours. Failure to report within 24 hours will result in an additional penalty of $500. ii.Late Report/Late Payment Penalties Any reports, fees, or reimbursements that are required to be submitted to the OCFA Contractor pursuant to the Contract City of Santa Ana Page 145 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-81 City of Santa Ana Documents (e.g., Quarterly Response Time Reports, CQI, etc.) and that are not submitted on time may result in the imposition of a $500 penalty per occurrence. C. Corrective Action Plan Situations which come to the attention of, or are reported to, the OCFA EMS Section Battalion Chief and which appear to constitute a Contractor service or performance deficiency or substantial inadequacy, as determined by the OCFA, shall be immediately investigated by the OCFA. An example of such situation might be the Contractor's failure to achieve at least a 90% response time performance in any single Code category for a quarterly reporting period. At the discretion of the OCFA, a Corrective Action Plan may be imposed on the Contractor to correct identified and verified performance deficiencies and inadequacies. The OCFA authorized representative shall meet to develop a written Corrective Action Plan (CAP) within fifteen (15) working days of the identification and verification of the service or performance deficiency, or substantial inadequacy, in accordance with the following CAP requirements: L CAP Format The CAP shall describe the following: (1) The service or performance deficiency, or substantial inadequacy shall be identified; and (2) The method by which Contractor is to correct the service or performance deficiency, or substantial inadequacy, shall be outlined. Contractor shall sign the CAP, thereby agreeing to the corrective action set forth in the CAP, with any areas of disagreement noted in writing. A copy of the signed CAP shall be furnished to Contractor at the conclusion of the CAP meeting. ii. Correction Period City of Santa Ana Page 146 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 P7F*1O O A City of Santa Ana Correction of the service or performance deficiency, or substantial inadequacy, shall occur within a period of not to exceed sixty (60) days from the development of the CAP, unless the OCFA representative determines that correction cannot be accomplished within the specified time frame. When correction will take longer than sixty (60) days from the development of the CAP, the CAP shall specify interim dates by which specific steps toward correction of the service or performance deficiency, or substantial inadequacy, will take place with the total time period not to exceed three (3) months. iii. CAP Inspection/Compliance The Fire Chief or his designee, shall visit and inspect Contractor's business office, facilities, vehicles, personnel, and/or records to review and document actions taken by Contractor to implement the CAP and shall document any continuing service or performance deficiency, or substantial inadequacy, which is not corrected within the specified time frame. In the event Contractor fails to correct the service or performance deficiency, or substantial inadequacy identified in the CAP within the time frame provided, OCFA may find Contractor to be in material breach of the Agreement. D.Timely Performance Required Assessment of penalties or the imposition of a CAP, pursuant to this Section will not relieve Contractor of the responsibility to meet all performance expectations as set forth in the Contract Documents. Substandard cumulative response time performance (i.e., below the 90% compliance rate for combined Code 2 and Code 3 calls) in any two (2) quarters in a single twelve (12) month period will constitute breach of contract, resulting in the imposition of a Remedial Action Plan (RAP). City of Santa Ana Page 147 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7pWO O City of Santa Ana Failure to timely correct and cure any response time deficiency, after having been given notice and a reasonable opportunity to cure such violation in accordance with an established Corrective Action Plan (CAP) or failure to cure a breach of contract after the imposition of a Remedial Action Plan (RAP), may constitute a material breach of the Agreement. Additionally, consistent problems in meeting and/or maintaining the response time requirements will be a key factor in determining whether to grant contract extensions. This RFP requires the highest levels of performance, reliability, and compliance with the established performance criteria and service delivery criteria, and the mere demonstration of effort, even diligent and well-intentioned effort, will not substitute for proper compliance. E. Waiver Any monetary penalty that may be imposed pursuant to this Section may be waived, upon a showing of good cause, at the sole discretion of the OCFA whose decision shall be final. 4.3.11 Emergency On -Scene Procedures A. Contractors must perform as a part of the patient care team and must be able to perform all BLS treatment modalities within their scope of practice, as required by OCEMS. B. All ambulance Transportation Personnel assigned by Contractor to perform 9-1-1 Emergency Transportation Service under the contract must: i. Be trained in Orange County EMS protocol and procedure; Work under the direction of the OCFA Incident Commander and/or the OCFA EMT -Paramedic in charge of the patient(s) and/or incident; City of Santa Ana Page 148 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 wj.V , City of Santa Ana iii. Fully cooperate with and abide by the instructions of the OCFA Incident Commander and/or the OCFA EMT -Paramedic in charge of the patient(s) and/or incident; iv. Place their apparatus and equipment at the scene in a safe location or as deemed appropriate by the OCFA Incident Commander and must be mindful of the need for safe operations, including the avoidance of exhaust fumes; v. Not interfere with or assist OCFA personnel in any firefighting or emergency rescue operation; vi. Request a secondary ambulance and/or field supervisor immediately upon determining that their unit has suffered a mechanical failure or is or may become disabled, or upon the request of an OCFA Incident Commander, and must likewise immediately inform the OCFA Incident Commander of any mechanical failures; and, vii. Be aware that safety is the responsibility of all personnel on scene; ambulance personnel shall not enter or operate in unsafe environments. 4.3.12 Disaster Assistance During a disaster, declared locally or in a neighboring jurisdiction, strict application of the performance standards set forth in the Contract Documents may be temporarily suspended by the OCFA in order to provide an appropriate response. While disaster coordination shall be provided by OCFA, Contractor is expected to be actively involved in the planning and response to any declared disaster. Upon notification of a disaster by OCFA, Contractor must immediately City of Santa Ana Page 149 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 0 City of Santa Ana commit any and all available resources and assist OCFA and the City of Santa Ana in accordance with disaster plans and protocols applicable in the locality where the disaster has occurred. In the event of a disaster, the following shall apply: A. During such periods, Contractor will be released from the response time requirements until notified by the OCFA Duty Officer that disaster assistance is no longer needed; B. When disaster assistance is no longer needed, Contractor must resume performance pursuant to the Contract Documents as quickly as is practical considering personnel exhaustion, medical supply restocking needs, and other relevant considerations; C. While performing disaster assistance, Contractor shall provide supervisory assistance at the command post or emergency operations center as requested and are to use best efforts to provide local emergency coverage; Contractor must also suspend non -emergency transport services as necessary, informing persons requesting non -emergency transport of the reason for the temporary suspension; D. During the course of a disaster, OCFA will work with Contractor to utilize mutual aid providers who are authorized to perform such services within the County to meet the service demands of the disaster. 4.3.13 Standard of Performance Contractors must perform all work and services pursuant to the Contract Documents in a skillful and workmanlike manner, and consistent with the standards generally recognized as being employed by professionals in the private, emergency ambulance transportation field in the State of California. City of Santa Ana Page 150 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-86 ,sill`(; �'° City of Santa Ana Contractor must warrant that they are skilled in the professional calling necessary to perform all work and services under the Contract Documents. Contractor must warrant, and from time to time may be required by the OCFA to demonstrate, that all employees and authorized subcontractors shall have sufficient skill and experience to perform the work and services assigned to them under the Contract. Finally, Contractor must further represent that they, their employees, and authorized subcontractors have all licenses, permits, qualifications and approvals of whatever nature that are legally required to perform the work and services under the contract, and that such licenses and approvals shall be maintained at all times during the term of the contract. 4.3.14 General Provisions A. Return of OCFA Personnel OCFA provides Advanced Life Support ("ALS") services from a variety of delivery platforms, including engine and truck companies. In cases where OCFA personnel accompany patients in the ambulance en route to hospitals or to other receiving facilities, and the OCFA ALS unit does not follow-up to the hospital/receiving facility, the Contractor/ or Mutual Aid Provider shall return those personnel to their assigned fire station(s) within 30 minutes from the conclusion of the run. The conclusion of the run is defined as the moment when the patient has been transferred into the care of hospital/medical staff, the ambulance crew has completed all required documentation, and the ambulance has been restocked and is ready to be placed back in service. At the conclusion of the run, the ambulance crew is to advise the accompanying OCFA personnel that they are ready to return them to their station. If while returning OCFA personnel to their station, the ambulance receives another 9- 1-1 emergency call, the ambulance may accept that call for service and take those returning OCFA personnel to the new call at the discretion of the OCFA personnel on board. City of Santa Ana Page 151 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-87 yrr,,.. City of Santa Ana B. 9-1-1 Calls for Service/Referral The 9-1-1 Emergency Transport Ambulances must be able to respond 24 hours a day 7 days a week to all 911 and other emergencies as required. C. Performance Contractor must demonstrate a continuous effort to detect and correct service level performance deficiencies, as determined by the OCFA, and to continuously upgrade the performance and reliability of the EMS system. Clinical and response time performance must be extremely reliable, with equipment failure and human error held to an absolute minimum through constant attention to performance, protocol, procedure, performance auditing, proper management oversight, employee training, continuing education, and prompt and definitive service level corrective actions plans. D. Conflict of Interest Proposers must certify that they are not, and will not be, violating either directly or indirectly any conflict of interest statute, rule, or regulation by their performance of the services described herein. E. Comolaints Contractor must immediately notify the OCFA in writing of any complaints, inquiries, or investigations initiated by OCEMS, the California Emergency Medical Services Authority, and/or any other federal, state, or local regulatory agency regarding Contractor's services performed pursuant to the Contract Documents, including but not limited to: level of service; service delivery; service quality; billing practices; medical training; and personnel. Nothing in the Contract Documents shall be construed as superseding the authority of OCEMS or any other duly empowered regulatory agency from separately and/or concurrently exercising its authority to provide regulatory oversight and to take action to ensure that emergency ambulance response services are administered according to law. City of Santa Ana Page 152 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 W2" City of Santa Ana F. HIPAA Business Associate Assurances Effective April 14, 2003, or such other implementation date established by law, to the extent that the parties have a "business associate" relationship, the parties shall carry out their obligations under the Contract Documents in compliance with the privacy regulations published at 65 Federal Register 82462 (December 28, 2000) (the "Privacy Regulations") pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"), to protect the privacy of any personally identifiable, protected health information ("PHI") that is collected, processed or learned as a result of the services provided pursuant to the Contract. In conformity therewith, both parties must agree that they will: L Not use or further disclose PHI except: (a) As permitted under the Contract (that is, for the purpose of maintaining accurate records of the services provided pursuant to the Contract and for the billing of such services to patients, guarantors, insurers, carriers or other responsible parties; the issuance of reports to the other party pertaining to same; and related administrative functions pertaining to these activities); (b) As required for the proper management and administration of ALS and BLS in their capacity of Santa Ana as HIPAA "Business Associates" of each other; or (c) As required by law; ii. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by the Contract; City of Santa Ana Page 153 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 City of Santa Ana iii. Report to each other any use or disclosure of PHI not provided for by the Contract of which a party becomes aware; iv. Ensure that any agents or subcontractors to whom either party provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to both parties with respect to such PHI; v. Make PHI available to the individual who has a right of access as required under HIPAA; vi. Make available for amendment and incorporate any amendments to PHI when notified to do so by either party; vii. Make available to either party the information required to provide an accounting of the disclosures of PHI made by the one party on the other party's behalf, provided such disclosures are of the type for which an accounting must be made under the Privacy Regulations; viii.Make their internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining either party's compliance with HIPAA and the Privacy Regulations; and ix. At the termination of the Contract, return or destroy all PHI received from, or created or received by one party on behalf of the other party. In the event the return or destruction of such PHI is infeasible, both parties' obligations under this Section shall continue in full force and effect so long as either party possesses any PHI, notwithstanding the termination of the Contract for any reason. City of Santa Ana Page 154 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 0 City of Santa Ana G. Medicare/Medi-Cal Participation Contractor must warrant and represent that they are enrolled providers in good standing in the Medicare and Medi -Cal programs and are not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to their billing or reimbursement practices, and that Contractor shall not employ or utilize individuals for the performance of services hereunder who have been excluded from any state or federal health care program. Contractor must agree to notify the OCFA of any imposed exclusions or sanctions covered by this warranty and the OCFA in consultation with the City of Santa Ana reserves the right to immediately terminate the Contract upon receipt of such notice. 4.3.15 External Medical Quality Control Contractor must fully comply with all federal, state, and local medical standards, protocols, and rules and regulations applicable to the provision of private, emergency BLS ambulance transportation, including those established by OCEMS. Contractor must at all times during the contract term cooperate with the OCEMS program managers and the OCEMS Medical Director in the monitoring, regulation, management, oversight, and administration of the County EMS system. The OCEMS Medical Director, or his designee, has both the authority and responsibility to routinely establish and monitor private, emergency ambulance system performance, including but not limited to: ambulance equipment standards; medical protocols; personnel standards; training standards; medical dispatch procedures; first responder practices and training; medical control; and to effect corrective and disciplinary action as necessary. City of Santa Ana Page 155 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-91 City of Santa Ana 4.3.16 Internal Medical Quality Control Contractors must establish a Continuous Quality Improvement ("CQI") program directed at, but not limited to, effective administration and management of clinical performance, response time performance, driver performance, dispatch performance, and for all other BLS service levels. City of Santa Ana Page 156 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-92 4- City of Santa Ana SECTION 5 PERSONNEL 5.1 PERSONNEL REQUIREMENTS 5.1.1 Employee Performance Contractor must employ only competent and trained personnel, and shall provide a sufficient number of employees to perform the services provided under the Contract Documents. Contractor must comply with all the following personnel requirements: A. All of Contractor's Transportation Personnel and employees shall be sufficiently trained and capable to ensure the safe and proper discharge of their service responsibilities; B. All Contractor ambulance personnel must possess valid California Driver's Licenses in the proper class, including any required certifications, and must be compliant with all relevant provisions of the California Vehicle Code, Health and Safety Code, and all other laws applicable to private, emergency ambulance response personnel; C. Contractor must have an employee alcohol and drug program that includes at a minimum, an alcohol and drug free workplace policy, and an employee alcohol/drug-testing program that complies with the U.S. Department of Transportation requirements to the extent allowed by law, including random alcohol and drug testing. Any Contractor employee found working under the influence of alcohol or drugs must be immediately removed from performing any further duties under the Contract Documents. The alcohol and drug program must meet the following requirements: A contract with a program administrator and authorized lab certified by the U.S. Department of Transportation; City of Santa Ana Page 157 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-93 0 City of Santa Ana ii. Procedures and components substantially as in Part 40 of Title 49 of the Code of Federal Regulations for pre-employment; iii. Procedures and components substantially as in Part 382 of Title 49 of the Code of Federal Regulations for rehabilitation, return -to -duty and follow up testing; iv. Procedures and components for random testing following U.S. Department of Transportation guidelines, and additional tests as required following accidents, rehabilitation, return -to -service, and other circumstances providing reasonable suspicion to test; v. Upon request by the OCFA, yearly reports of the random testing component must be filed by the program administrator, in redacted form concealing employee identifiable information, with OCFA; vi. Contractors and program administrator's alcohol and drug program records shall be made available, in redacted form concealing individual employee identities, to OCFA upon request; vii. Contractor employees must show a valid California driver's license at the time and place of testing; and viii. All test results are kept confidential except that OCFA is authorized to receive copies, in redacted form concealing individual employee identities, for its administrative purposes, and except as otherwise authorized or required by law. City of Santa Ana Page 158 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-94 i City of Santa Ana E. Contractor must participate in the California Department of Motor Vehicles (DMV) Employer Pull Notice Program; F. Contractor must not employ in the performance of services pursuant to the Contract Documents any ambulance operator or attendant or employee convicted of or having pled nolo contendere to a crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fraud, or misdemeanor or felony driving while under the influence of alcohol or drugs. If any Contractor employee is charged with any of the above listed crimes, Contractor must immediately suspend that employee from performing any further duties under the Contract Documents pending the outcome of the criminal case; G. Contractor's employees must maintain acceptable standards of dress, including uniforms, and cleanliness while on duty in the community and must at all times conduct themselves in a professional manner; H. Contractor's employees must fully cooperate with and abide by the instructions of OCFA personnel while on scene; I. If any employee becomes ineligible to provide services under the Contract Documents, Contractor must immediately notify the OCFA EMS Section Battalion Chief in writing of such ineligibility and the reason(s) therefore; J. Contractors must ensure that all of its employees and ambulances are, at all times during the term of the contract, in full compliance with all federal, state, and local laws, rules, statutes, and regulations, including but not limited to: the California Vehicle Code; the California Health & Safety Code; Orange County Ambulance Ordinance; applicable City of Santa Ana ambulance ordinances; and any and all OCEMS or State EMS Authority policies, standards, procedures, regulations, and/or protocols. All Contractor City of Santa Ana Page 159 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-95 City of Santa Ana employees must have in their possession, at all times while on duty, applicable licenses, certifications, and/or permits, as may be required by the agencies and authorities listed above; K. Contractor's emergency response personnel must carry and furnish to OCFA personnel upon request any required licenses, certifications, and/or permits, including proper identification, for purposes of verifying validity, ensuring compliance with licensing, certification, and permitting requirements, and for the proper reporting of employee performance -related issues to Contractor; L. The OCFA EMS Section Battalion Chief may request Contractor to participate in emergency response joint training exercises to improve the capability and coordination of both OCFA and Contractor's response to a given emergency or disaster. Such training will be scheduled and mutually coordinated by the OCFA EMS Section Battalion Chief and the Contractor. Such training shall not exceed twenty (20) hours per year/per shift and not billable to the City of Santa Ana; M. Any additional training that may be deemed necessary by OCFA shall be attended by Contractor's personnel upon reasonable notice and at the sole cost and expense of Contractor. Such additional training may include, but is not limited to, mass casualty, weapons of mass destruction, and/or other emergency response training; N. Contractors must make available to the OCFA EMS Battalion Chief upon request any and all Contractor personnel training records for those employees who perform services pursuant to the Contract Documents; O. Contractor employees shall perform the duties required under the Contract Documents in an ethical, professional, and orderly manner and shall endeavor at all times to obtain and keep the confidence of the public. City of Santa Ana Page 160 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7p*[O T I, City of Santa Ana P. Contractor must utilize management practices that ensure that its Transportation Personnel, working extended shifts, part-time jobs, voluntary overtime or mandatory overtime, are not exhausted, overworked, or exhibiting impaired judgment or motor skills. 5.1.2 Employee Removal At the request of the OCFA (in the sole discretion of either) and based on a demonstrated pattern of either poor performance, misconduct, or service complaints, Contractor shall remove any Transportation Personnel designated by the OCFA from performing further duties under the Contract. 5.2 CONTROL Neither the County, the City of Santa Ana or OCFA, or any of their respective officers, elected officials, agents, representatives, or employees, shall have any control over the conduct of Contractor's employees except as specifically set forth in the Contract Documents. Under no circumstances shall Contractor or any of its employees represent that they are in any manner agents or employees of the City of Santa Ana, County or OCFA, it being understood that Contractor its agents and employees are as to the City of Santa Ana, County and OCFA, wholly independent contractors and that Contractor's obligations to the City of Santa Ana and OCFA are solely those prescribed by the Contract Documents. Contractor further acknowledges and agrees that the City of Santa Ana, the County, and OCFA have no responsibility whatsoever for the payment of any wages, salary, health benefits, retirement benefits, taxes, or any other benefits that may be due to Contractor employees. City of Santa Ana Page 161 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-97 .;d R City of Santa Ana SECTION 6 SUPPLIES, EQUIPMENT AND VEHICLES 6.1 Standards All equipment and supplies furnished by Contractors to perform BLS services under the Contract Documents must comply with all federal, state, and local laws, rules, statutes, and regulations applicable to the provision of emergency ambulance transportation, including but not limited to, those BLS equipment and supply standards and protocols established by the OCEMS Medical Director. Such equipment and supplies must be stocked at all times on each ambulance performing services under the Contract Documents. The amount, type and specifications of vehicles included in the proposal must be maintained throughout the life or term of the Agreement. All ambulances must be Type III modular ambulances, to be used exclusively for emergency ambulance transports originating within the City, will be considered a minimum acceptable level for service in the City. The Type III ambulances must be equipped with 800 MHZ radios with encryption capability (on board and/or portable), navigation system, Automatic Vehicle Locator System (AVL) hardware and software (GPS system) that interfaces with OCFA. All Type III ambulances shall meet or exceed requirements of the California Highway Patrol, the Department of Transportation, OCEMSA, and NFPA 1917. 6.1.1 Standard InventoN In addition to the above equipment and supply standards, Contractors must carry and stock at all times throughout the contract term on each ambulance performing services within an assigned EOA the following emergency medical equipment, which shall all be readily available and accessible from the interior portions of the patient transportation compartment: City of Santa Ana Page 162 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 p7p*fe w S City of Santa Ana A. Bag valve mask resuscitator, adult with variable mask sizes; B. Bag valve mask resuscitator, pediatric with variable mask sizes; C. Heavy gloves to be used for blood or body fluid protection; D. Disposable Latex gloves, medium, large and x -large, two (2) boxes; E. Suction unit that complies with OCEMS policies and procedures; F. Non-invasive blood pressure device (various cuff sizes, including thigh cuff); G. Child safety seats (when approved by federal agencies). 6.1.2 Required Equipment Automated External Defibrillator (in conjunction with trained and qualified employees). Favorable consideration will be given if Contractor can supply an External Cardiac Compression Device for each Type III ambulance. 6.1.3 Personal Safety Equipment Contractors shall_ provide personal safety equipment for all employees in accordance with applicable federal and state laws or standards. It shall be the sole responsibility and expense of the Contractor to maintain or replace, or cause to be maintained or replaced, any personal safety equipment required. Contractors are solely responsible for ensuring that all of its personnel abide by all federal, state and local safety standards. To ensure that each ambulance responder has emergency scene personal protective equipment they may need to keep them safe in a potentially hazardous environment, Contractors shall comply with State OCEMS Guideline 216 regarding recommended PPE for Ambulance Personnel (OSHA's General Description and Discussion of the levels of Personal Protective Gear, 29CFR 1926.65, App. 8, Part IV, Level D) for each ambulance dedicated to 911 emergency transportation, including: City of Santa Ana Page 163 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 0 City of Santa Ana Full-length blue (EMS) jacket with reflective stripes. (NFPA 1999, EMS Standards) ii. Hard hat, Work Helmet Blue iii. Leather gloves City of Santa Ana Page 164 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-100 yi' City of Santa Ana SECTION 7 BID PROPOSAL SUBMISSION FORMS PROPOSER CHECKLIST ❑ BINDER (ORIGINAL + 7 COPIES + 1 ELECTRONIC FILE OF THE PROPOSAL PACKAGE SAVED ON FLASH DRIVE) ❑ ONE BID PROPOSAL ❑ PAGE SIZE, FONT SIZE, PAGE LIMITS ❑ TITLE PAGE ❑ TABLE OF CONTENTS ❑ ITEM 1 - COVER LETTER ❑ ITEM 2: GENERAL OVERALL DESCRIPTION OF PLAN TO PROVIDE 9-1-1 EMERGENCY TRANSPORTATION SERVICE IN CITY OF SANTA ANA ❑ ITEM 3 - OVERALL OPERATIONAL SYSTEM ❑ ITEM 4 - DRIVER TRAINING ❑ ITEM 5 - INTERNAL MEDICAL QUALITY CONTROL ❑ ITEM 6 - MUTUAL AID PROVIDER ❑ ITEM 7 - PERSONNEL AND TRAINING ❑ ITEM 8 - HIPAA COMPLIANCE PLAN ❑ ITEM 9 - CORPORATE COMPLIANCE PLAN ❑ ITEM 10 - PLAN FOR TAKEOVER OF SERVICE/START-UP ❑ ITEM 11 - EMS RESUME ❑ ITEM 12 — AGREEMENT TO CONDITIONS ❑ ITEM 13 - PRICE WORKSHEET ❑ ITEM 14 - CONFLICT OF INTEREST CERTIFICATION ❑ ITEM 15 - STATEMENT OF TRUTH ❑ ITEM 16 - NON -COLLUSION CERTIFICATION ❑ ITEM 17 - PHOTOGRAPHS (OPTIONAL) City of Santa Ana Page 165 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-101 r City of Santa Ana TITLE PAGE/COVER SHEET (1 PAGE LIMIT) City of Santa Ana Request for Proposals for Fire/EMS Emergency Ambulance Transportation and Related Services RFP # 18-059 Insert Proposer Name Insert Proposer Address Insert Proposer Authorized Contact/Representative Signature of Authorized Contact/Representative Insert Proposer Telephone Number Insert Date of Bid Proposal Submission Designate as "Original' or Copy City of Santa Ana Page 166 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-102 ; City of Santa Ana TABLE OF CONTENTS Please include in the Bid Proposal a Table of Contents listing the following requested items and submission forms in the order provided: ITEM 1: COVER LETTER ITEM 2: GENERAL OVERALL DESCRIPTION OF PLAN TO PROVIDE 9-1-1 EMERGENCY TRANSPORTATION SERVICE IN CITY OF SANTA ANA ITEM 3: OVERALL OPERATIONAL SYSTEM ITEM 4: DRIVER TRAINING ITEM 5: INTERNAL MEDICAL QUALITY CONTROL ITEM 6: MUTUAL AID PROVIDER ITEM 7: PERSONNEL AND TRAINING ITEM 8: HIPAA COMPLIANCE PLAN ITEM 9: CORPORATE COMPLIANCE PLAN ITEM 10: PLAN FOR TAKEOVER OF SERVICE/START-UP ITEM 11: EMS RESUME ITEM 12: AGREEMENT TO CONDITIONS ITEM 13: PRICE WORKSHEET ITEM 14: CONFLICT OF INTEREST CERTIFICATION ITEM 15: STATEMENT OF TRUTH ITEM 16: NON -COLLUSION CERTIFICATION ITEM 17: PHOTOGRAPHS (OPTIONAL) City of Santa Ana Page 167 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-103 0 City of Santa Ana ITEM 1: COVER LETTER (4 PAGE LIMIT) Please include a cover letter, on official Proposer letterhead, that describes the Proposer and its qualifications. A. The official name of the Proposer; B. The Proposer's organizational structure (e.g. corporation, partnership, limited liability corporation, or otherwise); C. The jurisdiction in which the Proposer is organized and the date of such organization; D. The address and telephone number of the Proposer's headquarters and of any local office involved in the bid proposal; E. The Proposer's Federal Tax Identification Number; F. The name, address, telephone, fax numbers and e-mail address of the person(s) who will serve as the authorized contact(s) to the City of Santa Ana and OCFA with regards to the bid proposal, the RFP process, the Contract Documents, and the administration of the contract, if awarded, with authorization to make representations on behalf of and to bind the Proposer; G. Provide applicable authorized signature documentation, pursuant to Proposer's organizational structure/bylaws, verifying the authority of the person signing the original bid proposal to commit to the proposal on behalf of the Proposer (attach to cover letter); H. A representation that the Proposer is in good standing in the State of California and has obtained all necessary licenses, permits, certifications, approvals and governmental authorizations necessary in order to perform all of the required performance obligations specified in the RFP; I. A representation that the Proposer is in good standing in the Medicare and Medi -Cal programs and is not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to their billing or reimbursement practices, and that Proposer has not been excluded from any state or federal healthcare program or employs any individual who has been excluded from any state or federal healthcare program; City of Santa Ana Page 168 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-104 City of Santa Ana Statement of acceptance of all terms, conditions, requirements, and performance criteria contained in the Contract Documents; and, K. Any additional information Proposer deems relevant for consideration during the selection process. City of Santa Ana Page 169 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-105 0 City of Santa Ana Q PAGE LIMIT) 1. Provide a general description of how Proposer proposes to provide the 9-1-1 Emergency Transportation Service contemplated by this Request for Proposals. This specifically includes, but is not necessarily limited to, the provision of the First Tier Service, and Mutual Aid Service. This section is intended to provide Proposer with an opportunity to provide a general overview of how their company will be able to provide the various levels of 9-1-1 Emergency Transportation Service, and to provide any other information that Proposer believes will be helpful to City of Santa Ana in making its decision. City of Santa Ana Page 170 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-106 City of Santa Ana ITEM 3: OVERALL OPERATIONAL SYSTEM (3 PAGE LIMIT) 1. Provide description of supervisory plan of crews, including number and location of supervisory personnel. 2. Provide an overall summary of Proposer's Southern California system operations including: a. Total number of ambulances in fleet; b. Total number of employees including line staff, supervisors, managers, administrative, billing, etc.; and C. Contact information for medical director; contact information for continuing education program, driver training, etc. City of Santa Ana Page 171 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-107 City of Santa Ana ITEM 4: DRIVER TRAINING (2 PAGE LIMIT) Please provide a description of the Driver Training Program Proposer proposes for its provision of the 9-1-1 Emergency Transportation Service and describe in detail how the proposed Driver Training Program will either meet or exceed the performance expectations and requirements. Additional Specific Submission Data: 1. Provide a detailed course syllabus or curriculum for driver training program offered to employees; 2. Provide the total number of course hours per course offered; 3. Describe the internal training plan, including timeframe for completion and retraining; and 4. Provide the name of the institution providing the training, if applicable. City of Santa Ana Page 172 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 P74*6I:, 0 City of Santa Ana ITEM 5: INTERNAL MEDICAL QUALITY CONTROL (3 PAGE LIMIT) Please provide a description of Proposer's Internal Medical Quality Control and Continuous Quality Improvement ("CQI") Programs. Additional Specific Submission Data: Provide a description of Proposer's quality assurance/improvement process, including time frames for process completion; and 2. If your proposed Internal Medical Quality Control and Continuous Quality Improvement ("CQI") Programs will exceed the standards and requirements set forth in this RFP, please clearly explain in a description how such requirements will be exceeded City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-109 Page 173 City of Santa Ana ITEM 6: MUTUAL AID PROVIDER (2 PAGE LIMIT) Please provide a description of the Proposer's Mutual Aid Service Provider Agreement. Additional Specific Submission Data: Provide a copy of all current or proposed Mutual Aid Contracts that would include: a. Name of mutual aid provider(s) (if known); b. Location of mutual aid provider(s); c. Staffing capabilities of mutual aid provider, if known. d. Expiration date of the mutual aid provider contracts. City of Santa Ana Page 174 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-110 0 City of Santa Ana ITEM 7: PERSONNEL AND TRAINING (A).ASSIGNED PERSONNEL PROFILE (3 PAGE LIMIT) Please provide a detailed spreadsheet of the individual personnel, including proposed management team, employee names, current certification/license level of service, certificate/license number, and number of years as an employee of Proposer, proposed by Proposer for the performance of services under the Contract Documents. (B). FIELD TRAINING OFFICERS 1 PAGE Please provide the ratio of field training officers to EMTs or other ambulance personnel that Proposer proposes to commit, and provide a detailed explanation of Proposer's proposed Field Supervisor and Training Programs and management/field supervisor oversight plan. (C). PRIMARY PERSONNEL (5 PAGE LIMIT) Please provide the resumes of no more than five (5) proposed key personnel (maximum one page each) whose job duties for Proposer's Orange County operations will relate solely and exclusively to the fulfillment of the terms, conditions, performance expectations, and obligations relative to Proposers performance under the Contract Documents. (D).EMPLOYEE RECRUITMENT. SCREENING AND ORIENTATION (2 PAGE LIMIT) Please provide description of the current personnel Recruitment, Screening, and Orientation Program Proposer currently employs and modifications Proposer proposes to utilize in connection with its provision of 9-1-1 Emergency Transportation Service and describe in detail how the proposed Recruitment, Screening, and Orientation Program will enable Proposer to consistently and continuously meet or exceed the training standards, personnel requirements, and performance expectations set forth in Section 5. City of Santa Ana Page 175 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-111 City of Santa Ana ITEM 7: PERSONNEL AND TRAINING (CONTINUED) (E).CONTINUING EDUCATION PROGRAMS (2 PAGE LIMIT) Please provide a description of any and all continuing education programs, including continuing medical education programs, that will be provided to all employees who perform services under the Contract Documents, as well as a discussion of Proposer's commitment to providing such programs at all times throughout the contract term. (F). HIPAA TRAINING PROGRAMS (2 PAGE LIMIT) Please provide a description of Proposer's HIPAA training program that has been provided to all employees and will be provided to all new employees who perform services under the Contract Documents. City of Santa Ana Page 176 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-112 ms`=s. City of Santa Ana ITEM 8: HIPAA COMPLIANCE PLAN (1 PAGE LIMIT) Please provide a description and explanation of Proposer's HIPAA Compliance Plan, including Proposer's certification that all personnel have signed a confidentiality agreement and have undergone HIPAA Privacy Training. City of Santa Ana Page 177 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-113 0 City of Santa Ana ITEM 9: CORPORATE COMPLIANCE PLAN (2 PAGE LIMIT) Please provide a summary and explanation of Proposer's Corporate Compliance Plan, if applicable. A Corporate Compliance Plan should include those elements identified in the Office of Inspector General's Compliance Program Guidance for Ambulance Suppliers [Federal Register: March 24, 2003 (Volume 68, Number 56)]. City of Santa Ana Page 178 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-114 = N, A City of Santa Ana ITEM 10: PLAN FOR TAKEOVER OF SERVICE/START-UP (4 PAGE LIMIT) Please describe in detail Proposer's proposed implementation plan for the takeover of services/start-up, or resumption of services under the new Contract, as applicable, within the City of Santa Ana by the Effective Date; including but not limited to: (a) Proposer's transition or implementation management team; (b) proposed start-up schedule for ensuring timely commencement of services on TBD, at TBD hours; and (c) proposed initial service response and coverage plan, including deployment plans, post locations, housing, and staffing plans. City of Santa Ana Page 179 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-115 City of Santa Ana ITEM 11 EMS RESUME (5 PAGE LIMIT) Please provide a detailed resume of Proposer's 9-1-1 Emergency Transportation Service experience. Minimum Qualifications: Proposer meets the experience required outlined in RFP. 1. Complete the 911/Fire/EMS Contracts chart found in the following page and include the following information: • List the city(ies) or Fire Department(s) Agencies for which provider has provided emergency ambulance transportation services during the past ten (10) years that can be used to meet one of the "experience" requirement in the RFP. Provide contact information including contact person, telephone number and address. • Provide 911 emergency ambulance transportation annual call volume by operating area or equivalent. • Indicate whether the provider was the primary or back-up 911 provider. • Indicate the contractual or agreed upon response time requirements for each of the listed contracts. • List the duration, in years, that the provider held a contract as a primary or back- up provider. City of Santa Ana Page 180 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-116 City of Santa Ana ITEM 11 EMS RESUME (continued) (5 PAGE LIMIT) Ten (10) Years 911/Fire/EMS Experience The experience requirements this applies to: At least five (5) consecutive years experience providing 9-1-1/Fire/EMS services as a prima 9-1-1 provider in a system comparable to the City of Santa Ana system (which meets a minimum qualification based on 80% of the 2017 Santa Ana Response Data, page 1.) within the last 10 years; or 2. Provide a description of the EMS system as it relates to ambulance deployment for those areas where contracts are/were held. (2 pages.) City of Santa Ana Page 181 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-117 Primary Response Time Cities/Fire Depts. For Contact Name Monthly 8 or 911 Requirement which bidder has provided And Calendar years Back-up status Call Volume 911 ambulance services in Phone Number that provider M=Metro/Urban past five years held contract. P=Primary S=Suburbanlmral B=Back-up W=Wilderness M= S= W= M= S= W= M= S= W= M= S= W= M= S= W= The experience requirements this applies to: At least five (5) consecutive years experience providing 9-1-1/Fire/EMS services as a prima 9-1-1 provider in a system comparable to the City of Santa Ana system (which meets a minimum qualification based on 80% of the 2017 Santa Ana Response Data, page 1.) within the last 10 years; or 2. Provide a description of the EMS system as it relates to ambulance deployment for those areas where contracts are/were held. (2 pages.) City of Santa Ana Page 181 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-117 City of Santa Ana ITEM 12 AGREEMENT TO CONDITIONS Agreement to Conditions Additional Information The Proposer agrees to promptly supply the CITY OF SANTA ANA and OCFA with any further information requested for the accurate determination of the prospective Proposer's qualifications to perform the proposed services. Right to Audit The Proposer agrees to give the City, County, and/or the CITY OF SANTA ANA and OCFA the right to audit those documents or records (including financial records) requested in the Submission Form, provided by the Proposer, or referred to in the Proposer's submission prior to and after award of the contract. Agreement to Pay Expenses Required THE CITY OF SANTA ANA or OCFA may require Proposers submitting proposals to participate in an onsite visit by the CITY OF SANTA ANA and OCFA staff to inspect and/or verify records. If based outside of Orange County, the Proposer submitting the proposal agrees to pay related travel expenses, including food and lodging, for up to three the CITY OF SANTA ANA staff members and three OCFA staff members for up to two days to conduct the inspection. Agreement to Expand Resources as Needed The Proposer agrees to expand its resources, at the sole discretion of the CITY OF SANTA ANA or OCFA, and at no additional cost to the City, including number of ambulances, if response times are not met or if call volume increases. In addition, the Proposer agrees to maintain, at a minimum, the number and type of vehicles as proposed throughout the term of the contract. The CITY OF SANTA ANA is in the process of annexing parcels of land owned by the COUNTY OF ORANGE that would be incorporated by the CITY OF SANTA ANA. The area is commonly referred to as the "Seventeenth Street and Tustin Avenue Island". The area consists of the following: 29 single family homes: 13942-13971 Deodar Street 20 single family homes: 13822-13831 Medford Street; 17152, 17162, 17182 Medford Street 8 business locations: 2301, 2305, 2307, 2309, 2311, 2313, 2315, 2401 Seventeenth Street 3 business locations: 2301 Seventeenth Street 7 business locations: 13912 Ponderosa Street City of Santa Ana Page 182 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-118 City of Santa Ana 18 apartment units: 13892 Ponderosa Street 15 apartment units: 13862 Ponderosa Street 8 vacant lots: 13862, 13872, 13892, 13902, 13922, 13946, 13952, 13972 Ponderosa Street _Agreement to Reduce Resources as Needed The Proposer agrees to reduce the number of resources at the sole discretion of the CITY OF SANTA ANA or OCFA, and renegotiate costs in the event response times are met and the actual call volume after one year from contract award date does not require the number and hours/days of coverage. Proprietary Information It is the responsibility of each Proposer to clearly identify information in their prequalification application and RFP bid response that it considers to be confidential or proprietary under the California Public Records Act. To the extent that the CITY OF SANTA ANA agrees with that designation, such information will be held in confidence whenever possible. All other information will be considered public. However, all information regarding the prequalification and RFP bid responses will not be released to the public or be subject to the Public Records Act during the deliberative process until such time as the evaluation has been completed and, or if, an award has been made. AUTHORIZED NAME (print) AUTHORIZED SIGNATURE DATE City of Santa Ana Page 183 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-119 0 City of Santa Ana ITEM 13: PRICE WORKSHEET CITY OF SANTA ANA RFP # 18-059 FOR FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES Initial Term: Year 1 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2019- 12/31/2019* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) Initial Term: Year 2 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2020- 12/31/2020* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) Initial Term: Year 3 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2021- 12/31/2021* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) City of Santa Ana Page 184 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-120 0 City of Santa Ana Initial Term: Year 4 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2022- 12/31/2022* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) Initial Term: Year 5 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2023- 12/31/2023* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) First Renewal Option: Year 1 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2024- 12/31 /2024* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) First Renewal Option: Year 2 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/112025- 12/31/2025* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) City of Santa Ana Page 185 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-121 0 City of Santa Ana First Renewal (Final) Option: Year 3 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/11/2026- 12/31/2026* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) Second (Final) Renewal Option: Year 1 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2027- 12/31/2027* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) Second Renewal (Final) Option: Year 2 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/11/2028- 12/31/2028* Annual Contract Price $ Not to exceed $ per month Complimentary Billing: (Price Per Transport) *Dates assume a January 1, 2019 contract effective date. In the event the Contract is awarded to a new contractor, the incumbent contractor may be granted a six month extension, with City Council approval, beginning January 1, 2019 to June 30, 2019, to allow sufficient time for the transition of services between service providers. City of Santa Ana Page 186 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-122 .4 . City of Santa Ana ITEM 14: CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of ("Proposer"), and hereby declares under penalty of perjury under the laws of the State of California, that Proposer is not, and will not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a contract and if authorized to perform the services described in this RFP. Signed, this day of 2018 in California. IF SOLE OWNER: Signature of Owner Print Name IF PARTNERSHIP (JPA or mercer): Signature of Partner (General Partner) Print Name IF CORPORATION: Signature of President Print Name Signature of Secretary Print City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-123 Date Date Date Date Page 187 0City of Santa Ana ITEM 15: STATEMENT OF TRUTH The undersigned hereby certifies on behalf of ('Proposer"), and hereby declares under penalty of perjury under the laws of the State of California, that the information provided by Proposer and contained in this bid to the (TBD) EMS 9-1-1 Emergency Transportation Service RFP is accurate, complete, true and correct to the best of our knowledge. We are aware that should any of the information contained herein be found to be false, incorrect, or otherwise untruthful, or if the information contained herein contains material misrepresentations and/or material omissions of fact, the City of Santa Ana of Santa Ana may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option of the City, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and/or to declare any contract awarded as the result thereof void. Signed, this day of , 2018 in . California. In the event that one of the above events occurs during the bid submittal date and contract award, the new corporation/stockholder must provide a notarized statement stating their agreement to the terms and conditions of the contract and prior to bid submittal without exceptions. This must be received within 5 business days of the change IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date City of Santa Ana Page 188 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-124 0 City of Santa Ana Print Name Signature of Secretary Print Name Date City of Santa Ana Page 189 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-125 0City of Santa Ana ITEM 16: NON -COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of ("Proposer'), and hereby declares under penalty of perjury under the laws of the State of California, that this (TBD) EMS 9-1-1 Emergency Transportation Service RFP is genuine and not sham or collusive, nor made in the interest of or on behalf of any person not herein named; the Proposer has not directly or indirectly induced or solicited any other Proposer to put in a sham proposal nor solicited any other person, firm or corporation to refrain from submitting a proposal; the Proposer has not communicated, directly or indirectly, with any other Proposer regarding the amount, price, and/or service rates proposed herein; and Proposer has not in any manner sought by collusion to secure for himself/herself/itself any advantage over any other Proposer. We declare the foregoing is true and correct under penalty of perjury under the laws of the State of California. Signed, this day of 2018 in , California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name City of Santa Ana Page 190 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-126 0 City of Santa Ana ITEM 17: PHOTOGRAPHS (OPTIONAL) (3 PAGE LIMIT) Proposers may provide, at their option, any color photographs or other renderings depicting Proposer's emergency ambulance service facilities, operations, vehicles, equipment, performance and/or personnel. City of Santa Ana Page 191 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-127 City of Santa Ana ATTACHMENT NO. 1 SAMPLE CONTRACT WITH CITY AGREEMENT FOR FIRE / EMS EMERGENCY TRANSPORTATION SERVICES This agreement ("Agreement") is made and entered into this day of , 2018, by and between the CITY OF SANTA ANA of Santa Ana, a municipal corporation located in the County of Orange ("CITY OF SANTA ANA") and with principal offices at ("CONTRACTOR"). RECITALS WHEREAS, CITY OF SANTA ANA issued a Request for Proposals on August 28, 2018 related to the provision of emergency transportation services in the CITY OF SANTA ANA (the "RFP"). A copy of the RFP is attached hereto and incorporated herein by this reference as Exhibit "A"; and WHEREAS, in response to the RFP, CONTRACTOR submitted a Proposal dated 2018 (the "Proposal"), a copy of which is attached hereto and incorporated herein by this reference as Exhibit "B"; and WHEREAS, CONTRACTOR is an ambulance provider fully licensed and otherwise qualified to perform the work required by this Agreement, and was selected by CITY OF SANTA ANA following evaluation of proposals submitted in response to the RFP; and WHEREAS, CITY OF SANTA ANA desires to utilize the services of CONTRACTOR to provide primary ambulance transportation services and other related services in accordance with the terms of the RFP and applicable federal, state and local laws; and WHEREAS, at its meeting of 2018, the Santa Ana Council accepted CONTRACTOR's Proposal and authorized CITY OF SANTA ANA staff to negotiate an Agreement with CONTRACTOR to provide emergency transportation services described in the RFP and in the Proposal. NOW, THEREFORE, in consideration of the mutual promises, covenants and conditions herein contained, the parties hereby agree as follows: City of Santa Ana Page 192 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-128 r City of Santa Ana SAMPLE AGREEMENT (For Illustrative Purposes Only) 1. Contract Documents and Order of Precedence A. This Agreement shall consist of the following documents: (a) this Agreement; (b) the CITY OF SANTA ANA's RFP, (c) and the CONTRACTOR's Proposal. This Agreement, the RFP, and the Proposal, shall be hereinafter collectively referred to as the "Contract Documents". The Contract Documents constitute the entire agreement between the parties. This Agreement contemplates that CONTRACTOR will do whatever is required to perform the work in accordance with the terms of the Contract Documents and in accordance with any applicable governmental laws and regulations, whether specifically identified in the Contract Documents or not. Should any inconsistency be found to exist between the aforesaid Contract Documents and this written Agreement, the provisions of this Agreement shall control. B. All provisions of the Contract Documents shall be binding on CONTRACTOR. In the event there is any discrepancy between the terms and conditions of one or more of the aforementioned Contract Documents, the Order of Precedence shall be used to resolve the discrepancy unless both parties mutually agree in writing to an alternative decision. The Order of Precedence for these documents shall be as follows: 1) First, this Agreement (together with any Amendments thereto). 2) Second, the RFP 3) Third, the Proposal. 2. Scope of Work A. In exchange for the compensation to be provided by CITY OF SANTA ANA to Contractor, Contractor will perform all of the services described in this Section for CITY OF SANTA ANA. The details of the services to be provided by CONTRACTOR are described in detail in the Contract Documents. Those services shall include the provision of all 9-1-1 Emergency Transportation Services, including but not limited to the First Tier Service and the Mutual Aid Service (as defined below), together with the provision of any labor, material, supplies and equipment related to the provision of those services, and any other duties, obligation or services required of Contractor in the Contract Documents. (All of the services to be provided by CONTRACTOR under this Agreement shall be hereinafter collectively referred to as the "9-1-1 Emergency Transportation Services"). CONTRACTOR shall perform the 9-1-1 Emergency City of Santa Ana Page 193 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-129 0City of Santa Ana Transportation Services in accordance with the terms and conditions contained in this Agreement, and as described in Contract Documents. B. All emergency transportation personnel assigned by CONTRACTOR or by the Mutual Aid Provider to perform 9-1-1 Emergency Transportation Services under this Agreement shall be hereinafter referred to as the "Transportation Personnel". C. Without limiting CONTRACTOR's obligation to comply with all of its duties and obligations under the Contract Documents, the 9-1-1 Emergency Transportation Services to be provided by CONTRACTOR shall include, but shall not be limited to, each of the following: 1. First Tier Service. Contractor will provide with its own forces a sufficient number of fully equipped ambulances and Transportation Personnel, so as to provide, in accordance with industry standards and this RFP, all of the CITY OF SANTA ANA's needs for 9-1-1 Emergency Transportation Service, being able to respond 24 hours a day 7 days a week to all 911 and other emergencies as required (the "First Tier Service" or "First Tier"). The First Tier Service will be designed by Contractor so as to ensure that there are enough of Contractor's own ambulances and Transportation Personnel available to meet 100% of the anticipated number of calls for 9-1-1 Emergency Transportation Service in the CITY OF SANTA ANA. The First Tier Service shall meet the response times and all other requirements of this RFP for the 9-1-1 Emergency Transportation Service. Each year thereafter, for the duration of the Term of the proposed Contract, Contractor will be required to re-evaluate the level of coverage being provided, so as to ensure it is providing the required level of coverage. 2. Mutual Aid Service. Contractor will also enter into a mutual aid agreement with a separate qualified ambulance service provider doing business in Orange County, to provide backup services in the event the First Tier Service is unable to respond to a call for Emergency Services (hereinafter "Mutual Aid Contract," "Mutual Aid Service," "Mutual Aid Service" or "Mutual Aid"). The company providing the ST Mutual Aid Service will be hereinafter referred to as the "Mutual Aid Provider." In providing 9-1-1 Emergency Transportation Services the Mutual Aid Provider must meet the same RFP requirements, response times, and otherwise provide the same level of service, as Contractor is required to provide under the Contract. The Mutual Aid Contract and the Mutual Aid Provider must be approved by the CITY OF SANTA ANA and the OCFA prior to provision of any service by Contractor, such approval not to be unreasonably withheld. The intent of this RFP is that Contractor will provide a sufficient level of coverage under the First Tier Service, such that services under the Mutual Aid Service will only be needed in rare circumstances, if at all. Contractor will be solely City of Santa Ana Page 194 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-130 VA W119 City of Santa Ana responsible for paying the Mutual Aid Provider for any services rendered under the Mutual Aid, which amount will be the Mutual Aid Provider's sole compensation for services rendered under the Mutual Aid. D. BLS and ALS Services. All Transportation Personnel assigned to perform 9-1- 1 Emergency Transportation Services under this Contract, whether under the First Tier Service or Mutual Aid Service, will provide Basic Life Support ("BLS") services and transport patients to medical facilities when required. OCFA, in cooperation with the Transportation Personnel, will provide on -scene Advanced Life Support ("ALS") services. E. All Transportation Personnel assigned to perform 9-1-1 Emergency Transportation Service under this Contract, whether under the First Tier Service or Mutual Aid Service, must at all times meet the minimum qualifications as listed in Section V of the RFP. F. The Agreement is subject to annual review based on the criteria specified in the Contract and as outlined herein. The CITY OF SANTA ANA's intent is to contract with and hold accountable those parties working with and on behalf of the CITY OF SANTA ANA of Santa Ana and OCFA in providing 9-1-1 Emergency Transportation Service to the citizens and visitors of Santa Ana. G. Contractor and the Mutual Aid Provider will provide type III emergency transport (ambulance) vehicles (including all costs related to maintenance, fuel, insurance, repair costs and communication equipment) for all 9-1-1 Emergency Transportation Services provided under the First Tier Service and the Mutual Aid Service. 3. Contract Price and Payment A. CITY OF SANTA ANA shall pay CONTRACTOR for furnishing the material and doing the prescribed work at the unit prices or lump sum prices set forth in CONTRACTOR's Proposal ("Contract Price"). 1. Contractor's sole compensation for providing all 9-1-1 Emergency Transportation Services, specifically including but not limited to the First Tier Service and Mutual Aid Service will'be the Contract Price. Contractor will not be entitled to bill CITY OF SANTA ANA or any of its customers any additional amount for any services provided under this Contract, unless it is first approved in writing by CITY OF SANTA ANA. 2. The payment of the Contract Price includes the provision of the Mutual Aid Service. Contractor will be solely responsible for compensating the Mutual City of Santa Ana Page 195 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-131 City of Santa Ana Aid Provider for any 9-1-1 Emergency Transportation Services it may provide in the CITY OF SANTA ANA under this Contract, which compensation will be at the rate set forth in the Mutual Aid Contract or as otherwise required by law. Contractor and the Mutual Aid Provider will not have any recourse against the CITY OF SANTA ANA to recover for any 9-1-1 Emergency Transportation Services provided under either the First Tier Service or the Mutual Aid Service, except as specifically authorized in the Contract. Contractor's sole compensation will be the Contract Price it receives from CITY OF SANTA ANA. In the event of a dispute between the Mutual Aid Provider and Contractor, the Mutual Aid Provider's sole remedy will be against Contractor. This fact will be clearly stated in the Mutual Aid Contract, and Contractor must agree to indemnify and defend CITY OF SANTA ANA against any claims or demands arising out of, or which are in any way related to, any services provided under the Mutual Aid Service. The Mutual Aid Contract will include similar provisions requiring the Mutual Aid Provider to indemnify CITY OF SANTA ANA for any claims or demands made by Contractor or other parties related to the 9-1-1 Emergency Transportation Services it may provide. 4. Billing A. CITY OF SANTA ANA will be solely responsible for the billing and collection of all amounts owed by customers/patients provided 9-1-1 Emergency Transportation Services in the CITY OF SANTA ANA, whether for services provided by Contractor, the Mutual Aid Provider, OCFA, CITY OF SANTA ANA, or their respective employees, agents, volunteers, or subcontractors. CITY OF SANTA ANA, in its discretion, will be free to bill for these services in whatever manner it may deem appropriate, and may combine billings for various services provided. Contractor and the Mutual Aid Provider will actively cooperate with CITY OF SANTA ANA to provide whatever information or assistance CITY OF SANTA ANA may reasonably require so that it can process customer/patient billings in a timely manner. This will include, but is not limited to, Contractor providing CITY OF SANTA ANA with a detailed list of all the 9-1-1 Emergency Transportation Services provided by both the Contractor and the Mutual Aid Provider during the preceding month. The specific information to be provided by Contractor in the monthly reports will be determined by CITY OF SANTA ANA, and may be modified by CITY OF SANTA ANA from time to time to meet its reasonable needs. Failure to provide accurate information in a timely manner will constitute a material breach of this Agreement. B. The entire proceeds of all such billings and collection efforts will be the sole property of CITY OF SANTA ANA. Neither Contractor nor the Mutual Aid Provider will have any right to the proceeds of any billings or collections for services provided under the First Tier Service, the Mutual Aid Service or for any other services provided under this Agreement, unless specifically authorized in writing by CITY OF SANTA ANA. City of Santa Ana Page 196 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-132 0 City of Santa Ana Contractor must design its bid so that the amount bid as the Contract Price will be sufficient to provide the required level of services under both the First Tier Service and the Mutual Aid Service, without expecting any additional amounts in compensation. C. CITY OF SANTA ANA may amend this contract in the event the City of Santa Ana elects an alternate bid proposal submitted by a contractor as part of the RFP process. 5. Term A. Effective Date. The effective date of this Agreement shall be TBD hours on TBD, ("Effective Date"), at which time CONTRACTOR will assume full responsibility for the provision of 9-1-1 Emergency Transportation Services within the CITY OF SANTA ANA. At the sole discretion of the OCFA on behalf of the City of Santa Ana, the Effective Date may be postponed in order to protect public health and safety, or in the event CONTRACTOR is for any reason unable to commence performance at that time. B. Initial Term. This Agreement is for a basic five (5) year term, beginning on the Effective Date and ending on TBD hours on TBD (the `Initial Term"). The contract shall automatically expire at the end of the Initial Term unless extended as provided below. C. Extension. Upon a writing to the CONTRACTOR by the CITY OF SANTA ANA City Manager and City Attorney made prior to the expiration of the Initial Term of this Agreement, the contract may be extended for up to one additional three (3) year term (first extension) and thereafter for one additional (2) year term (final extension) [for a possible total of 10 years]. Successful past performance during the Initial Term period will be a critical factor in the decision to grant an extension. The decision to grant an extension shall be made solely at the discretion of the CITY OF SANTA ANA in consultation with OCFA. At the end of the Initial Term, or at the end of contract extension term(s) if granted, this Agreement shall automatically terminate (the Initial Term together with any contract extension(s), if any, shall hereinafter be collectively referred to as the "Term"). 6. Termination This Agreement may be terminated by the parties as hereinafter provided: A. This Agreement may be terminated by either party, with or without cause, upon ninety (90) days prior written notice to the other party. B. OCFA on behalf of the CITY OF SANTA ANA may terminate this Agreement for Cause by providing CONTRACTOR seven (7) days prior written notice of termination for Cause and the factors constituting Cause. City of Santa Ana Page 197 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-133 City of Santa Ana C. OCFA on behalf of the CITY OF SANTA ANA may terminate this Agreement immediately if the OCFA Fire Chief or designee (in their reasonable discretion) determine that continued operations by CONTRACTOR following the breach would constitute a danger to the public health, safety or general welfare. 7. Breach of Agreement A. Factors Constituting Breach and Cause. Factors constituting a breach of this Agreement and also warranting Cause for termination include but are not limited to each of the following: 1. A failure by CONTRACTOR's to perform the covenants and requirements set forth in the Contract Documents in the time and manner specified, and as required by this Agreement. 2. Failure of CONTRACTOR to perform the 9-1-1 Emergency Transportation Services in a manner which enables the CITY OF SANTA ANA/OCFA or CONTRACTOR to remain in compliance with the requirements of the County of Orange Emergency Medical Services ("OCEMS") ambulance ordinance and related rules and regulations. 3. Supplying the CITY OF SANTA ANA/OCFA with materially false or misleading information during the RFP process or during the course of producing any required reports to the CITY OF SANTA ANA or OCFA. 4. Willful falsification or unreasonable withholding of data supplied to the CITY OF SANTA ANA or OCFA or to OCEMS during the Term of this Agreement, including but not limited to: dispatch data, patient report data, response time data, financial data, or omission of other data required under this Agreement. 5. Failure to meet the minimum vehicle deployment plan for ambulance service as described in the RFP. 6. Failure of CONTRACTOR's employees to conduct themselves in a professional and courteous manner, and to present a professional appearance. 7. Failure of CONTRACTOR to maintain all required vehicle maintenance schedules and records as set forth as described in the RFP or as reasonably required by CITY OF SANTA ANA or OCFA. City of Santa Ana Page 198 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-134 City of Santa Ana 8. Failure of CONTRACTOR to maintain all training and continuing education as required in the RFP, and as required by OCFA and OCEMS policies and procedures and State regulations. 9. CONTRACTOR's failure or refusal to respond to any request by CITY OF SANTA ANA or OCFA concerning the manner or means by which CONTRACTOR is providing the operation of 9-1-1 Emergency Transportation Services in the CITY OF SANTA ANA under this Agreement and pursuant to the Contract Documents. 10. Transfer or assignment of ownership or other interest in CONTRACTOR contrary to the terms of this Agreement, including but not limited to Section 11 of this Agreement ["Assignment"]. 11. Disruption of service due to failure to maintain ambulance maintenance schedule. 12. The lapse of any license, permit or approval issued CONTRACTOR by a federal, state or local government, which license, permit or approval islare reasonably necessary for the provision of the 9-1-1 Emergency Transportation Services contemplated by the Contract Documents. 13. CONTRACTOR becomes insolvent or unable to pay its debts as they mature, or makes an assignment for the benefit of creditors, or suffers or fails to pay and discharge within ninety (90) days of entry any final judgment (after exhaustion of any period of appeals) by any court in an amount of fifty thousand dollars ($50,000.00) or more. 14. CONTRACTOR files, or there is filed against CONTRACTOR, a petition to have CONTRACTOR adjudicated in a bankruptcy, or a petition for a reorganization or arrangement under any law relating to bankruptcy or insolvency. 15. CONTRACTOR is enjoined or prohibited by any court of competent jurisdiction from performing services under this Agreement. 16. The assets of CONTRACTOR are assumed by a trustee or other person pursuant to a judicial proceeding. 17. CONTRACTOR breaches or defaults in the performance of any of CONTRACTOR's material duties or obligations arising under this Agreement involving the payment of money, and after receiving written notice thereof from CITY OF SANTA ANA fails within seven (7) days from City of Santa Ana Page 199 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-135 City of Santa Ana receipt of such notice or have fully cured and corrected such breach or default. 18. Lapse of insurance required under this Agreement. 19. Failure to manage and resolve citizen complaints to the satisfaction of the CITY OF SANTA ANA or OCFA. 20. Failure to meet the on-time performance criteria as required in the RFP. 21. The breach or default of, or a failure to comply with, any material provision of this Agreement, any material provision of the RFP, or of any covenant specifically contained herein or incorporated by reference. B. Right to Cure. In the event of any dispute arising under this Agreement, the injured Party shall notify the injuring Party in writing of its contentions by submitting a claim therefore. The injured Party shall continue performing its obligations hereunder so long as the injuring Party cures any default within thirty (30) days after service of the notice; provided, however, if a breach of this Agreement creates an immediate danger to the health and safety or general welfare to the CITY OF SANTA ANA, in the reasonable discretion of the Fire Chief or designee, may take immediate action to remedy the breach itself and/or terminate this Agreement. Notwithstanding the preceding, if the Fire Chief or designee finds that CONTRACTOR is diligently proceeding with all steps necessary to cure such default, the Fire Chief or designee in conjunction with the CITY OF SANTA ANA may, in his sole discretion, extend the time period by which CONTRACTOR must cure such deficiencies, including the effective date of such termination. C. Waiver. No waiver of any Event of Breach or Default shall be valid or effective unless in writing and signed by CITY OF SANTA ANA. Any waiver of any one Event of Default or Breach shall not constitute, or be construed as creating, a waiver of any other Event of Default or Breach. D. Action Following Termination. Should this Agreement be terminated for breach, CONTRACTOR agrees that CITY OF SANTA ANA and/or OCFA, in their discretion, may take immediate possession of any CITY OF SANTA ANA or OCFA materials, equipment, and supplies CONTRACTOR may have used in the performance of the 9-1-1 Emergency Transportation Services. Notwithstanding the above, should this Agreement be terminated for breach, CITY OF SANTA ANA or OCFA shall have the option to take over the delivery of the 9-1-1 Emergency Transportation Services itself, City of Santa Ana Page 1 100 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-136 �= Vim. City of Santa Ana using CITY OF SANTA ANA personnel or contractors; contract on a temporary emergency basis with other providers of emergency transport ambulance services; seek new proposals for service; or such other option as may be deemed necessary and legally available to CITY OF SANTA ANA. E. No Limitation on CITY OF SANTA ANA's Rights. Nothing herein shall act as any limitation upon the remedies available to CITY OF SANTA ANA whether at law, or otherwise, in the event of a breach or default of this Agreement. 8. Insurance A. Prior to beginning the provision of 9-1-1 Emergency Transportation Services under this Agreement, CONTRACTOR must provide to the satisfaction of the CITY OF SANTA ANA and OCFA, certificates of insurance and endorsements evidencing the policy or policies of insurance in the types and amounts set forth below. CONTRACTOR shall at all times during the term of this Agreement carry, maintain, and keep in full force and effect, the following minimum scope of insurance coverage: 1) Commercial General Liability Insurance in an amount not less than $10,000,000 per occurrence, written on an occurrence form. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $10,000,000 per occurrence. 2) Ambulance Medical Malpractice Insurance in an amount not less than $3,000,000 per occurrence. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. Such insurance coverage may be combined with either the general or automobile liability coverage required above; provided, however, if the insurance coverage is so structured, the combined coverage shall be in an amount not less than $5,000,000 per occurrence, with an annual aggregate of not less than $10,000,000. 3) Comprehensive Business Automobile Liability Insurance in an amount not less than $3,000,000 per occurrence, covering owned, non -owned and hired vehicles, written on an occurrence form. If policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. Contractor understands that it must provide Business Automobile Liability coverage for all vehicles under both the First Tier Service and the Mutual Aid Service. This specifically includes, but is not limited to, Contractor's obligation to provide Business Automobile Liability coverage for any vehicles provided by CITY OF SANTA ANA/OCFA for use by Contractor under the First Tier, as well as for any vehicles provided by Contractor directly. City of Santa Ana Page 1 101 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-137 .iilvr'q}S City of Santa Ana 4) Workers' Compensation and Employers' Liability Insurance in a statutory amount for workers' compensation and in an amount not less than $1,000,000 for employers' liability. Such insurance shall contain a waiver -of - subrogation clause in favor of the CITY OF SANTA ANA and OCFA, and their respective officers, officials, employees and agents. B. CONTRACTOR shall also comply with the following requirements: 1) If the above -required insurance coverage does not provide for an annual aggregate which is twice the per -occurrence limit, in the alternative the insurance policy (policies) shall be amended (by appropriate ISO endorsements) so that the policy limits apply solely to this Agreement. 2) The above -required liability insurance shall be in a form which supports coverage for the provisions of the indemnification clause required under this Agreement, including a claim brought against the CITY OF SANTA ANA and/or OCFA for the injury to, or death of an employee or agent of CONTRACTOR. 3) In the event of a claim (claims) against the above -referenced liability policies which reasonably may deplete one-half or more of the aggregate limits, CONTRACTOR shall immediately notify OCFA. In the event a claim (claims) against the above -referenced liability policies which are reasonably expected to deplete 90% of the aggregate limits, CONTRACTOR shall, at CONTRACTOR's expense, reinstate the aggregate limits at least to an amount equal to one-half of the face amount of the aggregate limits on the policies. 4) All insurance required pursuant to this section shall be issued by a company authorized by the Insurance Department of the State of California and rated A -VII or better by the latest edition of Best's Key Rating Guide. 5) No insurance required herein shall provide for a deductible in excess of $5,000 or a self-insured retention in any amount, without prior written consent of the CITY OF SANTA ANA and OCFA; and, the granting or denying of such consent shall be at the sole and absolute discretion of the CITY OF SANTA ANA and OCFA. C. Endorsements 1) All insurance required herein shall be endorsed to state that "Coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior to written notice by certified mail, return receipt requested, has been given to the CITY OF SANTA ANA and OCFA." City of Santa Ana Page 1 102 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-138 0 City of Santa Ana 2) The liability policies required herein, except for professional liability (if a stand -above coverage), workers compensation and employers' liability, shall, by endorsement, contain the following provisions: (a) "The CITY OF SANTA ANA and OCFA, and their respective officers officials, employees, representatives, and volunteers, are hereby declared to be additional insureds as respects the operations, activities, work, errors, or omissions of the named insured arising out of or in connection with any contract or agreement with the CITY OF SANTA ANA." (b) "This insurance is primary to, and shall not contribute with, any insurance or self-insurance maintained by the CITY OF SANTA ANA, by OCFA, or by any of the designated additional insureds." (c) "This insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability." 3) Worker's Compensation and Professional Liability policies shall be endorsed to state that the insurer waives all rights of subrogation against the CITY OF SANTA ANA and OCFA, and their respective officers, officials, agents, employees, and volunteers for losses arising from work performed by the CONTRACTOR under this Agreement. D. All insurance coverages shall be confirmed by execution of endorsements and certificates of insurance. CONTRACTOR is required to file the completed policy endorsements and certificates with CITY OF SANTA ANA and OCFA on or before the Effective Date of this Agreement, and to thereafter maintain current endorsements on file with CITY OF SANTA ANA and OCFA. The completed endorsements and certificates of insurance are subject to the approval of CITY OF SANTA ANA and OCFA. E. Nothing in this section shall be construed as limiting in any way; the Indemnification and Hold Harmless clause contained herein in this Agreement, or the extent to which CONSULTANT may be held responsible for payments of damages to persons or property. F. CITY OF SANTA ANA or OCFA shall have the right at any time to review the coverage, form, and limits of insurance required herein. If, in the sole and absolute discretion of the CITY OF SANTA ANA and/or OCFA, the insurance provisions in this Agreement do not provide adequate protection for the CITY OF SANTA ANA and/or OCFA, the CITY OF SANTA ANA and/or OCFA shall have the right to require CONTRACTOR to obtain insurance sufficient in coverage, form, and limits to provide City of Santa Ana Page 1 103 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-139 City of Santa Ana adequate protection and CONTRACTOR shall promptly comply with such requirement. The CITY OF SANTA ANA's and OCFA's requirements shall not be unreasonable, but shall be adequate in the sole opinion of the CITY OF SANTA ANA and OCFA to protect against the kind and nature of risks which exists at the time a change of insurance is required, or thereafter. G. Alternate forms of insurance, that meet the above requirements, must be approved by the CITY OF SANTA ANA's and OCFA's Risk Manager prior to awarding a contract and beginning any work under this Agreement. 9. Indemnification CONTRACTOR agrees to defend, indemnify, hold free and harmless the CITY OF SANTA ANA and OCFA, and their respective officers, officials, agents, employees and volunteers, at CONTRACTOR's sole expense, from and against any and all claims, actions, suits or other legal proceedings brought against the CITY OF SANTA ANA or OCFA, or their respective officers, officials, agents, employees or volunteers, arising out of the performance of the CONTRACTOR, its employees, agents and/or authorized subcontractors, of the work undertaken pursuant to the Agreement, specifically including but not limited to the 9-1-1 Emergency Transportation Services. The defense obligation provided for hereunder shall apply without any advance showing of negligence or wrongdoing by the CONTRACTOR, its employees, agents and/or authorized subcontractors, but shall be required whenever any claim, action, complaint, or suit asserts as its basis the negligence, errors, omissions or misconduct of the CONTRACTOR, its employees, agents and/or authorized subcontractors, and/or whenever any claim, action, complaint or suit asserts liability against the CITY OF SANTA ANA or OCFA, or their respective officers, officials, agents, employees or volunteers, based upon the work performed by the CONTRACTOR, its employees, agents and/or authorized subcontractors under this Agreement, whether or not the CONTRACTOR, its employees, agents and/or authorized subcontractors are specifically named or otherwise asserted to be liable. Notwithstanding the foregoing, the CONTRACTOR shall not be liable for the defense or indemnification of the CITY OF SANTA ANA or OCFA for claims, actions, complaints or suits arising out of the sole negligence or willful misconduct of the CITY OF SANTA ANA or OCFA. 10. Compliance with RFP Requirements for Operations, Personnel and Safety. Without limiting Contractor's duty to comply with other requirements of the RFP, Contractor understands that throughout the Term of this Agreement Contractor must remain in full compliance with the terms, conditions and requirements in each of the following sections of the RFP: City of Santa Ana Page 1 104 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-140 0 City of Santa Ana A. Section IV of the RFP, entitled "Operational Standards, Procedures and Performance Requirements." B. Section V of the RFP, entitled "Personnel Rules and Requirements." C. Section VI of the RFP, entitled "Personal Safety Equipment." The failure of Contractor to abide by any of the requirements set forth in Sections listed above will be considered a breach of this Agreement, and will be grounds for termination. 11. Assignment. A. Except as provided herein, Contractor may not delegate, transfer or assign its rights or otherwise transfer its obligations, in whole or in part, under the proposed contract to any other person or entity without first obtaining the prior written consent of the OCFA and not for 180 days after the formal contract award. Any such assignment or transfer without the prior written consent of the OCFA shall be void; the attempted assignment shall constitute a breach of the Contract. B. For purposes of this section, the following will be considered to be a "transfer' or "assignment": 1. Any change in the business structure, including but not limited to, changes from or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; 2. Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 3. A transfer by any of the owners, shareholders or members (whichever is applicable) of Contractor of greater than ten percent (10%) of the ownership interest, stock or membership interest (whichever is applicable) in Contractor's business, issued as of the Effective Date by the Contractor, or the sale or transfer of over twenty-five percent (25%) of the assets of the Contractor. In the event a Contractor experiences regular stock exchanges in excess of the ten percent (10%) threshold, a separate agreement may be negotiated to set a threshold that still provides the OCFA with the protections intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. City of Santa Ana Page 1 105 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-141 ri City of Santa Ana 12. Audits and Inspections. At any time during normal business hours, and as often as may reasonably be deemed necessary by the OCFA, the CITY OF SANTA ANA may observe and inspect CONTRACTOR's business office, and CONTRACTOR must make promptly available to the CITY OF SANTA ANA or OCFA for its examination all of CONTRACTOR's records that pertain to performance of the Agreement. The CITY OF SANTA ANA or OCFA may audit, examine, and copy any and all CONTRACTOR records pertaining to their performance of the Agreement, including but not limited to, personnel records, daily logs, conditions of employment, and all other data. The CITY OF SANTA ANA's or OCFA's right to inspect CONTRACTOR's business office and any and all records pertaining to their performance of the Agreement will be restricted to normal business hours and reasonable notice shall be given to CONTRACTOR in advance of such inspection. 13. Independent Contractor. A. In the performance of this Agreement, CONTRACTOR shall be acting in an independent capacity from the CITY OF SANTA ANA and OCFA, and not as an agent, employee, partner, or pursuant to any kind of joint venture or partnership with the CITY OF SANTA ANA or OCFA. The parties understand and agree that CONTRACTOR, its officers, agents and employees (which term specifically includes, but is not limited to, the Transportation Personnel) are not employees of the CITY OF SANTA ANA, the County, or OCFA, and are not entitled to any of the rights, benefits, or privileges of CITY OF SANTA ANA, County, or OCFA employees including, but not limited to, medical, unemployment, or workers' compensation insurance. B. Neither the County, the CITY OF SANTA ANA or OCFA, or any of their respective officers, elected officials, agents, representatives, or employees, shall have any control over the conduct of CONTRACTOR's agent's and employees except as specifically set forth in the Contract Documents. Under no circumstances shall CONTRACTOR or any of its agents or employees represent that they are in any manner agents or employees of the CITY OF SANTA ANA, County or OCFA, it being understood that CONTRACTOR its agents and employees are as to the CITY OF SANTA ANA, County and OCFA, wholly independent contractors and that CONTRACTOR's obligations to the CITY OF SANTA ANA and OCFA are solely those prescribed by the Contract Documents. C. CITY OF SANTA ANA, the County, and OCFA have no responsibility whatsoever for the payment of any wages, salary, health benefits, retirement benefits, taxes, or any other benefits that may be due to CONTRACTOR's employees and agents performing 9-1-1 Emergency Transportation Services under this Agreement, specifically including but not limited to the Transportation Personnel. City of Santa Ana Page 1 106 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-142 0 City of Santa Ana CONTRACTOR further acknowledges and agrees that the CITY OF SANTA ANA, the County, and OCFA have no responsibility whatsoever for the filing of any employer related documentation (tax forms, payroll, or otherwise) with the federal, state or local governmental authorities, concerning those persons CONTRACTOR assigns to perform 9-1-1 Emergency Transportation Services under this Agreement. The preparation and filing of all employee related documentation shall be the sole responsibility of CONTRACTOR. 14. Compliance with Laws All services provided by CONTRACTOR pursuant to the Contract Documents must be rendered in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It will be CONTRACTOR's sole responsibility to determine which federal, state, and local laws, rules, statutes, and regulations apply to the services to be performed pursuant to the Contract Documents, and to maintain compliance at all times throughout the Term of this Agreement. 15. Responsibility Except as may be specifically stated herein to the contrary, it shall be the responsibility of CONTRACTOR to provide all Transportation Personnel with whatever resources and equipment are necessary to perform the 9-1-1 Emergency Transportation Services, and to otherwise satisfy all of the terms and conditions set forth in the Contract Documents at all times during the Term of this Agreement. Except where it may be specifically permitted in the Agreement, CONTRACTOR may not use any outside ambulance service providers or other resources to satisfy its obligations to provide 9-1-1 Emergency Transportation Services to the CITY OF SANTA ANA, without first obtaining the prior written consent of the CITY OF SANTA ANA. Notwithstanding the granting of any such approval by the CITY OF SANTA ANA, nothing stated herein shall relieve CONTRACTOR of its duties and responsibilities under the Agreement, and any additional cost incurred shall not be charged to the County, CITY OF SANTA ANA or OCFA. 16. Acts or Omissions of Representatives The acts and/or omissions of the owner(s), officers, operators, officials, employees, agents, and representatives of the CONTRACTOR in the performance of the services and obligations under the Contract Documents shall constitute the acts and/or omissions of the CONTRACTOR. 17. Insolvency CONTRACTOR shall not, without the prior written consent of the OCFA Fire City of Santa Ana Page 1 107 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-143 City of Santa Ana Chief or designee, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of CONTRACTOR, or make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by CONTRACTOR under any insolvency or bankruptcy proceeding constitutes a material breach of this Agreement by CONTRACTOR, and all property, equipment or materials assigned by OCFA, the CITY OF SANTA ANA and/or the County to CONTRACTOR related to the provision of services under this contract shall be automatically "released" by CONTRACTOR and returned back to the possession and control of the CITY OF SANTA ANA and OCFA. Following the occurrence of any such event, the OCFA Fire Chief or designee may assign such property, equipment or materials to another 9-1-1 Emergency Transportation Services provider, in the CITY OF SANTA ANA's sole discretion. 18. Familiarity with Work By execution of this Agreement, CONTRACTOR warrants that: A. It has thoroughly investigated and considered the 9-1-1 Emergency Transportation Services to be performed; B. It possesses any and all licenses which are required under relevant local, State, or Federal law to perform the 9-1-1 Emergency Transportation Services contemplated by this Agreement, and shall maintain all appropriate licenses during the performance of this Agreement. C. It has expertise in the provision of 9-1-1 Emergency Transportation Services as that term is defined in this Agreement; D. It carefully considered how the 9-1-1 Emergency Transportation Services should be performed; and E. It fully understands the difficulties and restrictions attending the performance of the 9-1-1 Emergency Transportation Services under this Agreement. 19. Validity The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any of the other provisions of this Agreement. City of Santa Ana Page 1 108 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-144 City of Santa Ana 20. Governing Law This Agreement shall be governed by and construed in accordance with the laws of the State of California. Any legal action relating to or arising out of this Agreement shall be subject to the jurisdiction of the County of Orange, California. 21. Entire Agreement This Agreement supersedes any and all other agreements whether oral or written, between the parties hereto with respect to the subject matter hereof, and contains all of the covenants and agreements between the parties with respect to said matter, and each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that any other agreement or modification of this Agreement shall be effective only if executed in writing and signed by both CITY OF SANTA ANA and CONTRACTOR. 22. Attorney's Fees In the event any legal proceeding is instituted to enforce any term or provision of this Agreement, the prevailing party in said legal proceeding shall be entitled to recover attorneys' fees and costs from the opposing party in an amount determined by the Court to be reasonable. 23. Representatives and Notices The City Manager or his designee shall be the representative of the CITY. The OCFA Fire Chief or his designee shall be the representative of OCFA. For the purposes of this Agreement the City Manager may issue all administrative consents, approvals, directives and agreement on behalf of the CITY OF SANTA ANA. The OCFA Fire Chief on behalf the CITY OF SANTA, may issue operational directives required by this Agreement, except as otherwise expressly provided in this Agreement. shall be the representative of CONTRACTOR for purposes of this Agreement and may issue all consents, approvals, directives and agreements on behalf of CONTRACTOR, called for by this Agreement, except as otherwise expressly provided in this Agreement. All notices and written communications sent by one party to the other shall be personally delivered or sent by registered or certified U.S. Mail, postage prepaid, return receipt requested, to the following addresses indicated below: City of Santa Ana Page 1 109 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-145 4;1 City of Santa Ana To CITY: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92701 Fax(714)647-6956 With courtesy copy to: Treasury and Customer Services Manager Finance and Management Services Agency Treasury & Customer Division (M-15) 20 Civic Center Plaza Santa Ana, CA 92701 Fax(714)647-5304 To VENDOR: Attn: Fax (XXX) XXX-XXXX The effective date of any notice or written communications sent by one party to the other shall be the date received if by personal service, or forty-eight (48) hours after deposit in the U.S. Mail as reflected by the official U.S. postmark. Either party may change its address by giving notice in writing to the other party. 24. Waiver No waiver of any provision of this Agreement shall be effective unless in writing and signed by a duly authorized representative of the party against whom enforcement of a waiver is sought, referring expressly to this Paragraph. The waiver of any right or remedy in respect to any occurrence or event shall not be deemed a waiver of any right or remedy in respect to any other occurrence or event, nor shall any waiver constitute a continuing waiver. 25. Rights and Remedies are Cumulative Except with respect to rights and remedies expressly declared to be exclusive in this Agreement, the rights and remedies of the Parties are cumulative and the exercise by either Party of one or more of such rights or remedies shall not preclude the exercise by it, at the same or different times, of any other rights or remedies for the same default or any other default by the other Party. City of Santa Ana Page 1 110 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-146 ;z� ..�rr�-rra City of Santa Ana 26. Cooperation CONTRACTOR must cooperate with the CITY OF SANTA ANA and take all actions necessary to ensure that all terms and conditions, and required performance levels, set forth in the Contract Documents are satisfied at all times throughout the Term of the Agreement. 27. Legal Action In addition to any other rights or remedies, either Party may take legal action, in law or in equity, to cure, correct, or remedy and default, to recover damages for any default, to compel specific performance of this Agreement, to obtain injunctive relief, or to obtain any other remedy consistent with the purposes of this Agreement. 28. Amendment This Agreement may be amended only by the written mutual consent of CITY OF SANTA ANA and CONTRACTOR. 29. Additional Services CONTRACTOR shall not receive compensation for any services provided outside the scope of the Contract Documents unless such additional services are approved in writing by CITY OF SANTA ANA prior to CONTRACTOR performing the additional services. It is specifically understood that oral requests or approvals of such additional services, change orders, or additional compensation, and any approvals from the CITY OF SANTA ANA, shall be barred and are unenforceable. 30. Counterparts This Agreement may be executed in one or more counterparts by the parties hereto. All counterparts shall be construed together and shall constitute one Agreement. 31. Corporate Authority The persons executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by doing so the Parties hereto are formally bound to the provisions of this Agreement. {SIGNATURES TO FOLLOW ON NEXT PAGE} City of Santa Ana Page 1111 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-147 0 City of Santa Ana IN WITNESS WHEREOF, Parties hereto have executed this AGREEMENT on the date and year first written above. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney CITY OF SANTA ANA RAUL GODINEZ II City Manager RECOMMENDED FOR APPROVAL: "CONTRACTOR" Executive Director Name: Finance & Management Services Agency Tax ID# City of Santa Ana Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals: # 18-059 August 28, 2018 250-148 Page 1112 EXHIBIT B City of Santa Ana Request for Proposals for Fire / EMS Emergency Ambulance Transportation and Related Services RFP # 18-059 Care Ambulance Service, Inc. Proposer Name 1517 W. Braden Q., Orange, CA 92868 Proposer Address Troy M. Hagen, CEO Proposer Authorized Contact/Representative Signature of Authorized Contact/Representative (714)288-3800 Proposer Telephone Number October 31, 2018 Date of Proposal Submission Original Copy 250-149 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Table of Contents ITEM1: COVER LETTER...........................................................................................................1 ITEM 2: GENERAL OVERALL DESCRIPTION OF PLAN TO PROVIDE 9-1-1 EMERGENCY TRANSPORTATION SERVICE IN CITY OF SANTA ANA............................................................... 5 ITEM 3: OVERALL OPERATIONAL SYSTEM............................................................................... 8 ITEM 4: DRIVER TRAINING................................................................................................... it ITEM 5: INTERNAL MEDICAL QUALITY CONTROL..................................................................13 ITEM 6: MUTUAL AID PROVIDER..........................................................................................16 ITEM 7: PERSONNEL AND TRAINING.................................................................................... 18 ITEM 8: HIPAA COMPLIANCE PLAN....................................................................................... 31 ITEM 9: CORPORATE COMPLIANCE PLAN............................................................................. 32 ITEM 30: PLAN FOR TAKEOVER OF SERVICE/START-UP......................................................... 34 ITEM 11: EMS RESUME........................................................................................................ 38 ITEM 12: AGREEMENT TO CONDITIONS................................................................................43 ITEM 13: PRICE WORKSHEET................................................................................................45 ITEM 14: CONFLICT OF INTEREST CERTIFICATION................................................................. 48 ITEM 15: STATEMENT OF TRUTH.......................................................................................... 49 ITEM 16: NON -COLLUSION CERTIFICATION........................................................................... 50 ITEM17: PHOTOGRAPHS..................................................................................................... 51 APPENDIX............................................................................................................................ 52 RFP # 18-059—CARE AMBULANCE SERVICE250-150 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATIONS, RELATED SERVICES CITY OF SANTA ANA ITEM 1: COVER LETTER October 31, 2018 Sandy Perez, Supervising Buyer Finance and Management Services — Purchasing City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92702 Dear Ms. Perez and Evaluation Committee Members: Care Ambulance Service is pleased to present our response to your Request for Proposal (RFP) for the provision of Fire / EMS Emergency Ambulance Transportation and Related Services to the City of Santa Ana. Care Ambulance has been serving Orange County with professional ambulance services since 1969 and is the largest provider of 9-1-1 emergency ambulance services in Orange County. We are proud to be the incumbent provider of services, serving the City of Santa Ana since the transition of the Santa Ana Fire Department to the Orange County Fire Authority. This year we celebrate our 49th year of providing quality, cost-effective ambulance services to the residents and visitors of Orange County. Our on-site leadership team has deep Orange County community ties and extensive experience working with local city and fire officials. Listed below is the specific information requested for this section: A. Care Ambulance Service, Inc. is the official name of the Bidder. B. Care Ambulance Service, Inc. is a California corporation. C. Care Ambulance Service was incorporated in California on March 28, 1988. D. Care's corporate headquarters are located at 1517 W. Braden Ct., Orange, CA 92868. Our business telephone number is (714) 288-3800. E. Our Federal Tax Identification Number is 33-0285453. F. The authorized contact for the City of Santa Ana regarding the bid proposal, the RFP Process, the Contract Documents and the administration of the contract, if awarded, with authorization to make representations on behalf of and to bind Care Ambulance is: Troy M. Hagen, CEO Care Ambulance Service 1517 W. Braden Ct. Orange, CA 92868 RFP # 18-059 — CARE AMBULANCE SERVICE 250-151 1 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES ,11/ a4 CITY OF SANTA ANA Telephone (714) 288-3800 Fax (714) 288-3899 Email — troyh@careambulance.net G. Authorized signature documentation, pursuant to Care's organizational structure / bylaws, verifying the authority of Troy M. Hagen to sign Care's original bid proposal and to commit to the proposal on behalf of Care Ambulance Service is provided as an Attachment to this section of the proposal. H. Care Ambulance Service is in good standing in the State of California and has all necessary licenses, permits, certifications, approvals and authorizations necessary to perform all required obligations specified in the RFP. Care Ambulance is licensed by the California Highway Patrol and the County of Orange — EMS Agency to provide ambulance services in Orange County. I. Care Ambulance Service is in good standing with the Medicare and Medi -Cal programs and is not the subject of any pending actions, investigation or prosecutions, whether civil, criminal or administrative related to billing or reimbursement practices. Care Ambulance has never been excluded from any state or federal healthcare program and does not employ any persons who have been excluded from any state or federal healthcare program. J. Care Ambulance Service agrees and accepts all terms, conditions, requirements and performance criteria contained in the Contract Documents. K. Care Ambulance is known for the following unique strengths, which we commit to provide the City of Santa Ana through this proposal: Existing Emergency Ambulance Transport Provider Care Ambulance has served with distinction as the contracted 9-1-1 emergency ambulance provider for the City of Santa Ana since April 20, 2012. Working with City and OCFA Officials, Care Ambulance has exceeded all contract requirements and provided the City of Santa Ana with outstanding ambulance transport services. Commitment to the Community Care Ambulance is based in Orange County and maintains a state-of-the-art dispatch center within the county. Many members of Care's leadership team were raised in Orange County and continue to raise their families here. Many of the men and women who make up Care Ambulance were also raised or live in Orange County. This is our community, and Care Ambulance takes great pride in being part of Orange County. National Accreditation and California Council for Excellence Award In February 1993, Care Ambulance applied for and was the first ambulance service in California to receive a national accreditation from the Commission on Accreditation of Ambulance Services (CARS). This accreditation for meeting the "Gold Standard of Excellence" was awarded RFP # 18-059— CARE AMBULANCE SERVICE250-152 2 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA c4+c ; 4" u after an exhaustive application process, on-site review by nationally recognized experts in emergency medical services and a perfectly scored evaluation. In addition to CAAS, Care Ambulance recently received the "Prospector Award for Performance Excellence" from the California Council for Excellence. Care Ambulance is one of only four (4) private ambulance providers in the Nation to receive this award, which is based on the criteria from the Malcolm Baldrige National Quality Award. Experience Care Ambulance possesses significant experience in the field of 9-1-1 emergency ambulance operations. Care Ambulance is the current contracted provider to the City of Santa Ana and also operates all similar ambulance transport programs in Orange County for the Cities of San Clemente, Westminster, Costa Mesa, Fullerton and La Habra. In addition, we are also the contracted emergency ambulance provider for 21 of the 23 member Cities of the Orange County Fire Authority and the Cities of Anaheim, Fountain Valley and Garden Grove. Care Ambulance Service does not come to the City of Santa Ana looking for emergency ambulance experience; we bring experience. Management Expertise Care Ambulance Service has demonstrated depth of management experience in all areas of ambulance operations, fiscal management and prehospital medical care. We have an on-site management team with proven leadership capabilities and cumulative EMS management experience of over two hundred (200) years. Qualifications and Training of Personnel Care Ambulance is a people -oriented company providing a people -oriented service. We are acutely aware that the ambulance industry is a service industry, and as such, our most important resource is our people. To that end, Care Ambulance recruits and screens employees to ensure we hire only the most qualified applicants. Employees are provided with substantial initial and ongoing training to maintain and improve their expertise. Operational Standards Care Ambulance has already implemented an operational system that meets or exceeds the performance standards established in this RFP. We currently operate, at no cost to the City of Santa Ana or OCFA, Operational System Enhancements that include Patient Care Record (PCR) scanning with timely data transmission to the City of Santa Ana's billing service. We also offer Automatic External Defibrillators (AEDs) on every ambulance in Care's fleet, a Road Safety On - Board Computer, a Video System on each dedicated City ambulance, and a language translation service. RFP N18-059—CARE AMBULANCE SERVICE 250-153 3 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Capabilities to Respond to Terrorist Threats or Disasters Care Ambulance Service is recognized as an ambulance service leader in disaster preparedness. On a county -wide level, Care Ambulance has taken a leadership position in developing standardized training for an operational response to acts of terrorism or natural disasters. We have created a master mutual -aid agreement with other Orange County ambulance providers and serve as an Emergency Regional Transportation Coordination Center. Vehicles and Vehicle Maintenance Care's established preventative and regular maintenance program exceeds manufacturer and CAAS standards. Our maintenance program ensures the highest quality equipment is available twenty-four (24) hours a day, seven (7) days a week. Mutual -Aid Providers Care Ambulance has an established and extensive network of mutual -aid partners. Care and our mutual -aid providers have worked together for years to deliver effective emergency ambulance services. These are not new relationships but long-term commitments from well-established ambulance service providers. Interagency Partnership Care believes the provision of high-quality emergency and non -emergency transportation services begins with a strong agency partnership. We are committed to working with the City of Santa Ana and OCFA to partner on issues related to EMS and health care services. What is important to you is important to us. We believe that our Proposal meets or exceeds all the standards specified in the Request for Proposal. Care Ambulance has the equipment, personnel, management talent and, most of all, the desire to continue providing the highest quality emergency ambulance services to the City of Santa Ana. Please don't hesitate to reach out to me for any clarifications or additional information. Sincerely, Troy M. Hagen, CEO RFP # 18-059— CARE AMBULANCE SERVICL2 50 _ 154 4 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES 7 J T �x CITY OF SANTA ANA ITEM 2: GENERAL OVERALL DESCRIPTION OF PLAN TO PROVIDE 9-1-1 EMERGENCY TRANSPORTATION SERVICE IN CITY OF SANTA ANA Care Ambulance Service has already implemented an operational system plan that exceeds the requirements of the Request for Proposal and provides quality ambulance services to the residents and visitors of Santa Ana. With Care Ambulance Service, the City of Santa Ana is not dealing with an unknown entity. Our management team and implementation techniques have been tested and proven. Our capabilities have been clearly demonstrated. In the description that follows, we demonstrate a sustained commitment to the City of Santa Ana with our plan to provide continuing emergency services. First -Tier Service Care's First -Tier Service plan ensures that there are enough of Care's own ambulances and transportation personnel available to meet 100% of the anticipated number of calls for Emergency Transportation in the City of Santa Ana. Currently, Care Ambulance Service provides EMT staffing and emergency ambulance transportation personnel for seven (7) dedicated and fully equipped ambulances in accordance with all industry standards and requirements of the City of Santa Ana and OCFA. Care Ambulance operates these seven (7) dedicated City of Santa Ana emergency ambulances from the following five (5) Santa Ana ambulance station locations: • Santa Ana Station One — 4718 W. 1s` Street, Santa Ana • Santa Ana Station Two —1209 N. Broadway Street, Santa Ana • Santa Ana Station Three — 2701 Hotel Terrace Drive, Santa Ana • Santa Ana Station Four — 2913 Warner Avenue, Santa Ana •' Santa Ana Station Five — 2125 N. Grand Avenue, Santa Ana Care's EMT personnel are able to respond twenty-four (24) hours a day, seven (7) days a week to all 9-1-1 and other emergencies, as directed by the City of Santa Ana and the OCFA. Care's dedicated Santa Ana EMT Personnel are assigned a similar three (3) platoon shift schedule as OCFA firefighters; however, because of shift demands, 48-hour shifts are minimized. This staffing pattern allows for a coordinated team effort and provides necessary familiarity with OCFA staff. Care Ambulance provides a minimum of 14 EMTs per shift, for a minimum of 38 EMTs assigned to this program. Each EMT assigned to the City of Santa Ana is licensed and qualified as an emergency ambulance driver. All of Care's EMT personnel are sufficiently trained and capable of ensuring the safe and proper discharge of their service responsibilities. To ensure this, Care Ambulance will work directly with the City of Santa Ana and OCFA officials to determine a proper training program. Care RFP ##18-059—CARE AMBULANCE SERVICE 250-155 5 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA proposes that all EMTs assigned to the dedicated transport program have completed, at a minimum, the following additional training classes: • Incident Command System 100 & 200 • First Responder Awareness • FEMAIS-800NIMS In addition to the seven (7) fully dedicated transport ambulances and EMT crews, Care Ambulance provides full and complete backup services for the City of Santa Ana, twenty-four (24) hours a day, seven (7) days a week to all 9-1-1 and other emergencies in the City of Santa Ana, as may be required. Care Ambulance provides fully equipped and staffed vehicles from our regular fleet of 143 emergency ambulances, which stand ready to provide backup emergency transportation services to the City of Santa Ana in the event the dedicated ambulances are unavailable or unable to respond to a call for service. As the City of Santa Ana's current provider, Care Ambulance has responded to 100% of the request for service and exceeded all response time requirements. Notably, this has been achieved without the use of mutual -aid assistance. One of the challenges faced today by the City of Santa Ana EMS Transport Program is that there are only two (2) acute care hospitals located in the city. In addition, there can often be delays at the receiving hospital due to emergency room overload. Care Ambulance recognized this challenge and devised a secondary system that exceeds the requirements of the RFP. Currently as a contracted ambulance provider for the City of Santa Ana and the OCFA, Care Ambulance maintains a data link from our Computer Aided Dispatch (CAD) to the OCFA CAD. This allows for a seamless electronic handshake and exchange of information. By electronically sharing this information, Care has knowledge when dedicated Santa Ana ambulances are unavailable for a response and we deploy additional ambulance(s) into the city in advance of a request for service rather than waiting for a response to occur and not having an ambulance properly deployed for that response. In addition to a program of "advance warning" of a call for service, Care Ambulance maintains a significant ambulance presence in cities and hospitals that surround the City of Santa Ana. We are the contracted emergency ambulance service for most of the Cities that surround Santa Ana, including Tustin, Irvine, Costa Mesa, Fountain Valley and Garden Grove. In addition, Care Ambulance is the contracted non -emergency ambulance service to area hospitals in and near the City of Santa Ana. As the largest provider of emergency and non -emergency ambulance services in Orange County, Care can deliver back-up services to the City of Santa Ana unmatched by any other provider. In the event that dedicated ambulances are unavailable or assigned to calls, we will immediately deploy ambulance resources from our fleet to Santa Ana to ensure there is always an ambulance available for an emergency response in the City. RFP # 18 -059 -CARE AMBULANCE SERVICE 250-156 6 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES ! CITY OF SANTA ANA ' Second Tier Service In the unlikely event that Care's dedicated ambulances and Care's fleet of 143 other ambulances were unavailable for an emergency response in the City of Santa Ana, Care Ambulance has entered into several "Mutual Aid" agreements with separate qualified ambulance service providers doing business in Orange County to provide backup ambulance services. In addition, we maintain a "Master Mutual Aid" agreement with five (5) other licensed Orange County ambulance services, each capable of responding to a request for Second Tier Services. For further details about Care's mutual -aid capabilities, please refer to Item 6: Mutual Aid Providers. Since the beginning of this contract in 2012, Care Ambulance has never used the services of any back-up provider in Santa Ana. We have covered over 130,000 requests for service, without using any services from any other ambulance provider. Response Time Commitment The most critical measure of an emergency ambulance service's performance is its response times. While clinical performance is essential, it is not commonly understood by the public or as easily measured as response times. The key question for most patients and the public is: How long does it take to get an ambulance after making the call for help? It is for that reason that Care agrees to be held to a higher standard. Care Ambulance Service commits to the following response time standards, which exceed the requirements of the RFP: • Code 3 — Care Ambulance agrees that all Code 3, red lights and siren, responses shall not exceed nine (9) minutes and fifty-nine (59) seconds, ninety-three (93%) of the time, reported on a quarterly basis. • Code 2— Care Ambulance agrees that all Code 2, expeditious response without red lights and siren, responses shall not exceed fourteen (14) minutes and fifty-nine (59) seconds, ninety-three (93%) of the time, reported on a quarterly basis. These response -time standards are extremely stringent and concrete. These are not promises that cannot be fulfilled. Unlike, other bidders, these are response -time standards that Care Ambulance achieves today. We provide this level of exceptional service today in Santa Ana, and we will continue do it in the future for the City of Santa Ana. To date in the City of Santa Ana, Care Ambulance Service maintains greater than a 97% response -time compliance standard and has never failed to meet our 9-1-1 emergency contracted response -time obligations, nor been penalized for any sub -standard system performance. Care Ambulance is very confident in our abilities to deliver timely ambulance services and readily agrees to the response time requirements and penalties specified. RFP # 18-059— CARE AMBULANCE SERVICE 250-157 % PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES aCITY OF SANTA ANA ITEM 3: OVERALL OPERATIONAL SYSTEM The following pages provide a review of Care's overall operational system, including a summary of our operations system and supervisory plans. In addition, we have outlined our proposed operational system enhancements. Supervisory Plan Currently, Care Ambulance Service provides five (5) on -duty Operations Manager on a twenty- four (24) hour basis, seven (7) days a week. In addition, Care Ambulance has a dedicated full- time Operations Manager specifically assigned to the City of Santa Ana, Monday through Friday, from 0800 to 1600 hours. Care's Operations Managers function in a manner similar to a fire department Battalion Chief and are only assigned to field supervision and administrative duties. Our Operations Managers are located in the City of Orange, Garden Grove, Villa Park, Laguna Niguel and Rancho Santa Margarita. Care's on -duty Operations Managers are available at all times and may be contacted immediately via radio through Care's communications center or directly through their cellular telephone. The following individuals currently work as Operations and Administrative Managers in Care's Orange County Division: • Rob Viera - OC Division Manager, Employed with Care for 23 years • Marc Jessner— Division Manager Logistics, Employed with Care for 28 years • Jeff Talmage —SA Operations Manager, Employed with Care for 6 years • Klatann Thomas— Operations Manager, Employed with Care for 11 years • Sean Cox—OC Operations Manager, Employed with Care for 13 years All Operations Managers employed by Care Ambulance have successfully completed training at the ICS 200 level and California Ambulance Strike Team Leader training. All Operations Managers have completed the required FEMA training, including IS 700 NIMS and IS 800 National Response Plan. In addition, all Operations Managers have completed First Responder Awareness (FRA) and First Responder Operations (FRO) training. On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 capable vehicle equipped with all necessary fire department radios and extra medical equipment, including backboards, medical supplies and oxygen. Each Operations Manager vehicle is also equipped with a Mobile Data Computer (MDC) allowing our supervisory personnel to continually monitor the location and activities of all Care ambulances within Santa Ana and Orange County. RFP # 18-059—CARE AMBULANCE SERVICE250_158 8 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Summary of Care's Southern California System Operations Total Number of Ambulances in Fleet Care Ambulance provides a response ready fleet of 143 ambulances licensed to provide ambulance services in Orange County. We are the largest provider of emergency and non- emergency ambulance services in Orange County. Each emergency ambulance in Care's dedicated fleet is complete with the latest technology, including 800 MHz mobile radios and satellite -based Automatic Vehicle Locator (AVL) tracking systems. All of Care's ambulances meet and exceed the safety and equipment requirements listed in the RFP. Total Number of Employees By continuing to contract with Care Ambulance as the EMS Emergency Transportation Services provider for the City of Santa Ana, the City will maintain an experienced and dedicated workforce trained to the highest clinical standards. The following is a breakdown of employees according to job category: •' CATEGORY Orange County Accredited EMT Staff NUMBER OF • 910 Communications 48 Field Training Officers 87 Registered Nurses 16 Managers and Directors 54 Administrative / Billing 105 Fleet Maintenance 11 Clinical Contacts Care Ambulance provides clinical support and training for all employees through our in-house Training Department. With our full-time clinical education staff, including our participatory Medical Director, Care offers the City of Santa Ana the highest possible clinical standards. Contacts for the Medical Director and Training Department are: • Medical Director, Dr. Freddy Sotelo, Telephone Number (714) 288-3800 RFP # 18-059 — CARE AMBULANCE SERVICE 250-159 9 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Employee (CE) Training Manager, Jerry Melendrez, Telephone (714) 288-3930 Driver Training Manager, Sergio Montoya, Telephone (714) 713-3521 Resumes for the above individuals are provided as an Attachment to this section. Implemented Operational System Enhancements 1. EMT -D Immediate defibrillation is the most effective treatment for out-of-hospital cardiac arrest (ventricular fibrillation). Care Ambulance is proud to be the first ambulance service in Orange County to provide Automatic External Defibrillators (AEDs) on all ambulance vehicles. Care Ambulance equips all ambulances with an AED and ensures all EMT personnel are properly trained. We provide this service in Santa Ana at no additional cost to the City or OCFA. 2. Electronic PCR and Document Scanning Each ambulance in Care's fleet is equipped with Electronic PCR capabilities and portable document scanning. While other companies in the nation have implemented an EPCR solution, Care Ambulance is the first to go completely paperless, allowing our EMTs to instantly scan the report and electronically transmit that report to the City of Santa Ana billing agency. This scanning service is not available with any other Orange County ambulance provider. 3.. Road Safety. On -Board Computer System Over twenty (20) years ago, Road Safety brought the "Black Box" from the airplane cockpit to the highway. Today, every Care Ambulance vehicle is equipped with this state-of-the-art technology. The Road Safety On -Board Computer System records each second and each mile of operation of every vehicle in the Care Ambulance fleet. Active driver identification enables the system to evaluate driver performance based on the number of miles they drive and how safely they operate their ambulance. Each ambulance operated by Care Ambulance in the City of Santa Ana is equipped with this technology. 4. Changing Demographics of Orange County UCLA researchers estimate that 224 different languages are spoken in the region. We recognize that communication with patients is essential. Because it's impossible to teach all our EMTs to speak in multiple languages, we equip each ambulance with a mobile phone and contract with a language translation service. If our EMTs arrive on -scene at a medical emergency and cannot communicate with a patient or family members, they contact the language translation service using the mobile phone. The translation service then connects an approved translator to the EMT and patient to facilitate complete and accurate communications. RFP # 18-059— CARE AMBULANCE SERVICE250-160 10 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES :¢v CITY OF SANTA ANA ITEM 4: DRIVER TRAINING Care Ambulance uses the National Safety Council, Coaching the Emergency Vehicle Operator (CEVO) course for all drivers' training. The highly interactive, six (6) hour program adapts defensive driving techniques to the unique nature of ambulance work. The course promotes critical thinking during high-pressure driving situations and offers defensive driving strategies to avoid collisions. The course features lecture and videos with real-life driver simulations. Care's training program exceeds the standards established for the ambulance industry by the National Highway Traffic Safety Administration (NHTSA), the Department of Transportation (NHTSA DOT); the National Commission on the Accreditation of Ambulance Services (CAAS); the California State Department of Motor Vehicles; and the California Highway Patrol. Pre -Employment Screening Care's risk management approach to driving safety begins with the insistence on high-caliber personnel. Care Ambulance requires all ambulance personnel to possess a valid California Driver's License, with all required certifications, and to remain compliant with all provisions of the California Vehicle Code. Care Ambulance performs an extensive background check of all ambulance applicants and ensures that no Care Ambulance drivers have been convicted of or have pled nolo contender to any crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fraud or misdemeanor, or felony driving under the influence of alcohol or drugs. Driver Training Program The Care Ambulance driver training program is a three -phased comprehensive instructional based program incorporating: classroom instruction (Phase 1); with a closed cone -course practice (Phase 2); and supervised on -the -road practical experience (Phase 3). Students are required to complete a minimum of fifty-four (54) hours of driving instruction. This time may be extended if our trainer decides more experience or training is necessary before the trainee can operate an emergency ambulance on their own. Phase 1— Classroom Instruction: Phase 1 consists of six (6) hours of classroom instruction and covers the basic components of driving and emergency vehicle operations. The driver trainee is taught low force driving techniques, vehicle dynamics, vehicle code law, due regard and Care's policies and procedures relative to ambulance operations. Specific topics covered in Phase 1 include: backing, lane changes, intersection and skid control, special awareness, following distances, fatigue recognition, on -scene vehicle placement, daily crew responsibilities and operator liabilities. The classroom session includes case -study reviews of actual emergency vehicle collisions and actions that could have been taken to avoid those collisions. The final component of the classroom experience is a fifty (50) -question written final. RFP # 18-059— CARE AM BU LANCE SERVICE 250-161 11 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Phase 2— Closed Cone Course: Upon successful completion of Phase 1, the driver trainee moves to Phase 2; the Closed Cone Course. The Closed Cone Course is conducted at Anaheim Stadium, under the watchful eyes of Care's certified driving instructors. The course consists of eight (8) hours of practice, where trainees hone their driving skills in a controlled environment. During the cone course, trainees are required to safely drive their ambulance through a series of obstacles, such as diminishing lanes, backing, evasive maneuvers, forward and reverse serpentines, controlled braking and turning movements. Trainees are scored on their control of the vehicle and must score one hundred percent (100%) before proceeding to the next phase. Phase 3— Supervised Practical Road Experience: Driver trainees must successfully complete both Phase 1 and Phase 2 of Care's driver training program, before being assigned to work with a Field Training Officer (FTO), in our behind -the -wheel driving experience. Phase 3 is forty (40) hours of supervised practical road experience in which the trainee is paired with an FTO who continues to coach the trainee on an as -needed basis. This behind -the -wheel experience allows trainees to practice their driving skills in Southern California's unique driving environment, enhancing their ability to understand local traffic patterns, road and weather conditions and the reaction of other drivers to emergency vehicles. Road Safety Computer Systems: All Care ambulances and supervisor vehicles are equipped with a computerized driver monitoring system and video recording system. The same technologies that monitor commercial airline performance dynamics are used to monitor our drivers' performance. The system works as a full-time, unbiased driving coach, providing an audible warning as our drivers approach an unsafe condition, allowing sufficient time for the driver to take corrective action before an incident occurs. In addition to monitoring driving habits, the system monitors incidents such as unsafe backings and emergency light and siren activation. All data generated from the driving monitoring system become a key component of Care's QA/QI process, allowing Care to monitor and provide important feedback to our drivers regarding their vehicle operations. Additional Specific Submission Data: 1. A detailed course syllabus and curriculum for Care's driver training program has been provided as an Attachment to this section of the proposal. 2. Care's driver training program consists of a minimum of fifty-four (54) hours of instructor -led education. The program may be extended for trainees that have difficulty mastering a section of the program. 3. Care's three (3) phased training program is described above. If a driver trainee is unsuccessful in completing the program, remedial training is provided. If still unsuccessful, the trainee is removed from driver trainee status and returned to Ambulance Operations as an Ambulance Attendant. 4. N/A. Care Ambulance conducts all drivers' training in-house. RFP # 18 -059 -CARE AMBULANCE SERVICE 250-162 12 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA ITEM 5: INTERNAL MEDICAL QUALITY CONTROL Excellence in customer service requires a commitment and systems in place to allow continuous evaluation and improvement. Care's Continuous Quality Improvement (CQI) Program meets this need. Our CQI processes are pervasive throughout our organization, from the traditional clinical application, to our communications center and fleet maintenance facility, to our billing office and our relationships with external providers and oversight agencies. Care's Quality Assurance/Quality Improvement Manager, Chris Wilson, is responsible for the overall management of Care's CQI Program. Quality is just a word until the people in an organization give it meaning. At Care Ambulance, quality is the responsibility and commitment of every employee. Description of Care's "CQI" Process An effective CQI program must provide the education, resources and support staff needed to provide quality service and outstanding patient care. This is best accomplished through observation, review, discussion and exchange of ideas when areas for improvement are identified. These components are found in Care's CQI process in the following distinct but connected phases: Prospective—This phase includes employee recruitment, employee screening and selection, written protocols, operational policies and employee orientation. Care Ambulance has a comprehensive set of policies that address clinical, safety and operational issues, as well as performance expectations for all personnel. Policies are updated and distributed to all employees as needed to stay current with new laws, industry standards and EMS Agency guidelines. Employee screening and selection is the first step of prospective quality assurance. It is critically important to be able to recognize and choose the right personnel when they apply. EMT candidates are required to pass several rigorous tests before employment is offered to them. These tests include a written EMT knowledge test, EMT skills testing, oral interview, strength and flexibility testing, medical examination and drug screening test and a complete background check conducted by a licensed private investigator. As part of the prospective phase new employees are assigned to New Employee Orientation. All employees receive extensive education and training to create their personal foundation for delivering exceptional service. Each orientation class has a presentation on Customer Service and Quality Improvement. These presentations ensure that all Care employees understand the importance, concepts, and the expectations in both of these areas. Concurrent—The concurrent phase of the quality process encompasses the delivery of service and patient care. It focuses on performance monitoring and application of procedures. The Operations Managers are the primary resource for this evaluation. The Care Ambulance RFP # 18-059 — CARE AMBULANCE SERVICE 250-163 13 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES 1qg CITY OF SANTA ANA Operations Managers actively engage field employees, public safety personnel, and facility staff. During this interaction, the Operations Managers are observing patient care and crew interpersonal skills with other members of the patient care team. The concurrent evaluation provides the environment for almost immediate feedback on job performance. The concurrent evaluation is where many exceptional performances are recognized. The real-time aspect of concurrent evaluation allows issues or concerns to be identified and addressed immediately. Quality improvement is ongoing and does not need to wait for the end of month report. Operational changes to improve system performance can be implemented quickly when organizations are committed to quality. Care Ambulance through a variety of mechanisms, has the ability to notify employees of changes that are put into practice. These changes are approved by appropriate company officials prior to implementation. Retrospective — All phases of the quality process are important. The retrospective phase is the after -event evaluation of system performance. To ensure positive findings retrospectively, it is important to invest heavily in quality control that is prospective (hiring, training etc.) and concurrent (evaluation of the service / care at the time of delivery). Retrospective quality control is looking back on service or care that has already been delivered. Examples of areas of retrospective review are: • Patient Care Reports • Emergency Vehicle Operations reports • Use of an Automated External Defibrillator • Unexpected clinical events • Documentation of the need for patient restraints The results of the retrospective review provide data to facilitate changes in operating procedures to improve performance. This data also allows the organization to identify trends. Data is wonderful, but improvement only occurs when the data is acted on. The QA/QI Manager works closely with the Training Department to identify areas for additional training or the need for a change in training curriculum. There may be times when the quality process identifies an individual or individual(s); who require refresher training. These situations are referred to the Training Department where the necessary training is provided. Upon completion of the training, the Training Manager will advise the QA/QI Manager that the required training has been completed. The individual(s) will be monitored to ensure compliance. This action of "closing the loop" is one of the fundamental concepts of continuous quality improvement. Many organizations say that they are driven by the CQI process, yet only invest in the retrospective component of the process. Care Ambulance truly embraces CQI and has the systems in place to facilitate continual improvement: Prospective, Concurrent, and Retrospective. It is with great pride that Care Ambulance employees provide exceptional service to each and every customer because of our commitment to quality. RFP # 18-059— CARE AMBULANCE SERVICE250-164 14 PROPOSALTO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Data Management and Time Frames The Care Ambulance Quality Improvement Program is designed to be dynamic and change, as the company and customer needs change. Our ability to collect and manage data is a key to the success of our CQI program. Information that is collected is evaluated and maintained in a database for future reference. The QA/QI Manager generates monthly reports on identified quality indicators. These reports are shared with the Company Executives, Company Medical Director, Department Directors, and other appropriate managers. Quality indicators specific to patient care are shared with field employees. Field employees have open communication in the quality process. They can direct questions, comments, or suggestions directly to the QA/QI Manager. The employees performing the job many times have the best perspective. Meeting and Exceeding RFP CQI Standards Care Ambulance fully complies with all federal, state and local medical standards, protocols, rules and regulations applicable to the provision of emergency BLS ambulance transportation, including those established by the Orange County EMS Agency. In addition, Care's internal CQI process is directed at, but not limited to, effective administration and management of clinical performance, response time performance, driver performance, dispatch performance, and other BLS service levels. We believe that our CQI process exceeds the standards and requirements set forth in the RFP. Our CQI process clearly covers all topics related to BLS ambulance transportation. It not only exceeds the specified requirements of effective administration and management of clinical performance, response time performance, driver performance, and dispatch performance but also includes records, reports and documentation, radio and telephone communications, compliance with preventative maintenance, and repair of ambulances and on -board equipment, infection control and employee safe practices, medical supply management, human resource practices, and employee education, and training. We propose to further expand our existing CQI process to include a commitment to meet monthly or quarterly with City of Santa Ana officials and representatives of OCFA to discuss areas of mutual concern or opportunities for improvement. We propose to work collaboratively with Santa Ana and OCFA to develop CQI processes that are essential to the safe, efficient operations of their emergency ambulance service. By understanding what is important to the City of Santa Ana and OCFA, Care Ambulance can fine tune our CQI process to ensure that Santa Ana EMS Transportation Services are fiscally and clinically accountable to the patients served. Copies of Care's CQI Program and sample monthly CQI reports are provided as an Attachment to this section of the RFP. RFP # 18-059 — CARE AMBULANCE SERVICE 250-165 15 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES toCITY OF SANTA ANA ITEM 6: MUTUAL AID PROVIDER Care Ambulance is the largest provider of emergency and non -emergency ambulance services in Orange County. At any given time, Care Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance rarely needs mutual aid assistance, but in fact, frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not routinely rely on the services of another provider as an alternative method to meet contracted response time requirements, Care does recognize that the mutual aid process is important to ensure structured responses to mass casualty incidents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural disasters. Care Ambulance understands and agrees that all Second Tier or mutual aid agreements must be approved by the City of Santa Ana and that all mutual aid providers must meet the operational requirements of OCFA. Care further understands and agrees that should a Second Tier or mutual aid provider provide back-up services in the City of Santa Ana, Care Ambulance and not the Second -Tier provider will be responsible for ensuring compliance with all terms, conditions, standards and performance requirements set forth in the contract documents, including payment of all transport services. As a current OCFA emergency ambulance contractor, Care Ambulance is party to the existing Master Mutual Aid Agreements between OCFA contracted ambulance providers and members of the Ambulance Association of Orange County (AAOC). In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each Second Tier or mutual aid provider used by Care Ambulance in Orange County that meet the operational requirements of the City of Santa Ana and OCFA: Doctor's Ambulance Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services in Laguna Beach and non- emergency ambulance services for hospitals in the Santa Ana area. Doctor's uses a crew staffing of two (2) EMTs and has seventeen (17) Orange County licensed ambulances. Doctor's Ambulance began service in 1974 and is CAAS Accredited. RFP # 18-059— CARE AMBULANCE SERVICE250-166 16 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Nva Doctor's Ambulance headquarters are located at 23091 Terra Drive, Laguna Hills, California 92653. Contact person is Aaron Sundstrom — Operations Manager. Telephone number is (949) 951-6600. There is no defined expiration date to the agreement. Emergency Ambulance Emergency is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the communities of Brea, Placentia and Yorba Linda. Emergency Ambulance uses a crew staffing of two (2) EMTs and has fifteen (15) Orange County licensed ambulances. Emergency Ambulance began service in 1977 and is CAAS Accredited. Emergency Ambulance headquarters are located at 3200 E. Birch Street, Suite A, Brea, California 92821. Contact person is Chad Drutten — Chief Operating Officer. Telephone number is (714) 990-1331. There is no defined expiration date to the agreement. Shoreline Ambulance Emergency is a licensed Orange County EMS provider and former OCFA contractor to the City of Westminster. Currently, Shoreline Ambulance maintains a non -emergency ambulance station and crew in the City of Santa Ana. Shoreline Ambulance uses a crew staffing of two (2) EMTs and has seven (7) Orange County licensed ambulances. Shoreline Ambulance headquarters are located at 3400 W. Warner Avenue, Suite H, Santa Ana, CA 92704. Contact person is Jim Karras— Chief Operating Officer. Telephone number is (855) 474-6735. There is no defined expiration date to the agreement. Regional Disaster Transportation Coordination Center In addition to being one of the largest providers of emergency ambulance services in Southern California, Care Ambulance also serves as the Regional Disaster Transportation Coordination Center for our Southern California Region. From localized disasters to state wide disasters, Care Ambulance provides the required emergency ambulance coordination for these events. Care's Regional Disaster Transportation Coordination plan and copies of our mutual aid agreements are provided as an Attachment to this section of the proposal. RFP # 18-059—CARE AMBULANCE SERVICE 250-167 17 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION 8, RELATED SERVICES CITY OF SANTA ANA ITEM 7: PERSONNEL AND TRAINING (A) ASSIGNED PERSONNEL PROFILE Key to Care Ambulance Service's successful provision of emergency ambulance services is our experienced on-site management team. By selecting Care Ambulance as the contracted EMS provider, the city will maintain an experienced and dedicated workforce. Management Team During Care's 49 years of providing ambulance services, we have developed an outstanding management team, which will oversee and manage our contract with the City of Santa Ana. The following table outlines the individuals responsible for the City of Santa Ana operations. Title Name it Troy Hagen CEO PositionManager Years in 29 Years Care 5 Years Dr. Freddy Sotelo Medical Director 10 Years 3 Years Bill Weston Director of Operations 32 Years 22 Years Ben Baker Director of Communications 22 Years 20 Years Robert Barry Director of Government Relations 28 Years 15 Years Mitch Felde Director of HR 37 Years 10 Years Ali Mian Director of Finance 17 Years 7 Years Rob Viera O.C. Division Manager 22 Years 22 Years Jeffry Talmage S.A. Administrative Manager 40 Years 6 Years Kathryn Lopez Scheduling Manager 25 Years 12 Years Marc Jessner Logistics Manager 28 Years 28 Years Jerry Melendrez Training Manager 22 Years 12 Years Klatann Thomas Operations Manager 11 Years 11 Years Sean Cox Operations Manager 20 Years 13 Years Chris Wilson CIA / QI Manager 29 Years 12 Years Sergio Montoya Safety Manager 25 years 12 Years Field EMT Personnel Care Ambulance will continue to offer the highest clinical and staffing levels. These professional standards comply with all applicable State laws and regulations, as well as Orange County EMS Agency statutes, rules and regulations. Minimum requirements for field personnel include: California recognized EMT Certification CPR / AED Certification RFP q 18-059 — CARE AMBULANCE SERVICE 250-168 18 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA California Driver's License 0 Orange County EMT Accreditation Ambulance Driver's License Endorsement • Medical Examiner's Certification Care Ambulance has 910 Orange County -certified Emergency Medical Technicians (EMTs) and 92 Field Training Officers (FTOs). The following table shows the name, years of experience as a Care employee, languages spoken in addition to English and certification level of EMT personnel who are currently assigned to the City of Santa Ana EMS Program. Name SpokenEMT Language Yrs License # Jose Gutierrez Eng,Span 16 E065982 Jeremy Hill Eng 6 E089892 Zach Mitchell Eng 6 E099936 Christopher Daller Eng 5 E096716 Manuel Guzman Eng,Span 4 E104823 Santiago Isidro Eng,Span 4 E109197 Timothy Quintero English 4 E112171 Juan Castandeda Eng,Span 4 E106984 Logan Oliver Eng, Viet 3.5 E112200 Collin Geary Eng 3.5 E109089 Randall Horn Eng 3.5 JE113366 Roger Henry Eng 3.5 E092764 Don Nguyen Eng,Span, Viet 3 E113666 Max Taylor Eng 3 E118085 Jared Melendez Eng 3 E119761 Zachary Herrin Eng 3 E108785 Robert Lees Eng,Span, French 2.5 E117470 SpokenEMT Language Name Yrs . License Travis Luckeybaker Eng 2.5 E121510 Andy Cortez Eng, Span 2.5 E121667 Caitlyn Ward Eng,Span Mand, Viet 2.5 E121706 Gerardo Rodarte Eng,Span 2 E127301 Angel Munoz Eng,Span 2 E122057 Michael Wielert Eng 2 E126173 Alejandro Chavez Eng,Span 2 E128596 Craig Matthews Eng 2 E128743 Fermin Ramos Eng,Span Germ, Ilocano, Numu 2 E123877 Daniel Reilly Eng 2 E132853 Brandon Gachuzo Eng,Span 1.5 E122991 Fabiola Guzman Eng,Span 1.5 E128452 Adrian Vazquez Eng,Span 1 E129674 Robert Juarez Eng,Span 1 E129674 Andrew Huang Eng,Span Mandarin 1 E124483 Mychael Nyberg lEng 1 E130278 Communications Personnel Minimum requirements for our communications personnel include National Emergency Telecommunicator Certification, from the National Academies of Emergency Dispatch and CPR / RFP # 18-059—CARE AMBULANCE SERVICE 250-169 19 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA AED Certification. The 40 -hour, Emergency Telecommunicator Course is a joint effort between the National Academy, The National Emergency Number Association (NENA). The following table shows the name, years of EMS experience and position of communication center personnel who are responsible for dispatching Care's emergency ambulance units: Sam Crowder YEARSNAME EXP 31 POSITION Manager Erick Aguilar 12 Manager Dan Bennett 10 Manager Katie Stark 10 Supervisor Pete Morales 27 Supervisor Ryan Horowitz 13 Supervisor Eileen Cegarra 12 Supervisor Ivan Gonzalez 12 Supervisor Paul Lopez 12 Supervisor Keri Kiss 3 Training Officer Riley White 3 Training Officer Aaron Infiesto 6 Lead Call Taker Ben Agatep 11 Lead Call Taker Jamie Hendricks 6 Lead Call Taker Anothy Beck 34 Dispatcher Blake Cadogan 1 Dispatcher Braulio Arling 5 Dispatcher Bruke Lakew 1 Dispatcher Chad Starr 3 Dispatcher Chris Landgraf 6 Dispatcher Danny Grimshaw 1 Dispatcher Dennis Soto 1 Dispatcher Jeric Hizon 5 Dispatcher Ryan Miller 3 Dispatcher Shaun McClure YEARSNAME EXP 2 POSITION Dispatcher Taylor Ogden 1 Dispatcher Travis Fader 3 Dispatcher Brian Freeman 7 Dispatcher Bryan Reuf 1 Dispatcher Colby Jackson 1 Dispatcher Tim Landgraf 4 Dispatcher Adreanna Moreno 1 Dispatcher Alex Nunez 2 Dispatcher Ashley Cortez 2 Dispatcher Bayron Sanchez 2 Dispatcher Jonathan Carcamo 1 Dispatcher Kelly Moscoso 1 Dispatcher Matthew Viscaino 1 Dispatcher Michelle Doyle 1 Dispatcher Nicole Laygo 2 Dispatcher Raul Flores 1 Dispatcher Richard Ca 1 Dispatcher Vernonica Pallan 1 Dispatcher Xochilt Guiterrez 1 Dispatcher Caridad Soto 2 Call Taker David Freeman 3 Call Taker Esperanza Espinoza 1 CaIlTaker Haydee Wilson 3 Call Taker RFP k 18-059— CARE AMBULANCE SERVICE 250-170 20 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES J n� CITY OF SANTA ANA (B) Field Training Officers Care's Field Training Officers (FTOs) are responsible for all aspects of EMT training, including ongoing observation in the field. The ratio of FTOs to EMTs committed to the City of Santa Ana EMS Transportation Program is 1 to 7. FTO Training and Job Functions The FTO job training program is an extensive familiarization with preceptor training objectives, including but not limited to evaluation forms, rating factors, EMT standards, inter -personal communications, patient care documentation, FTO ethics and standards, teaching and support services. FTOs must have at least one (1) year of EMT/field experience and undergo an extensive selection process before being promoted. The Field Training Officers perform many functions, including: • New employee selection process and field orientation of new employees; • Driver training; • Classroom, refresher training and EMT -B skills testing; • Provide outside training (CPR, First Aid etc.); and • Career days and ambulance demonstrations. Supervisory Training and Job Functions Operations Managers are responsible for overseeing all EMT personnel in the field. All Operations Managers employed by Care Ambulance have successfully completed Incident Command training at the ICS 100 and 200 levels and Ambulance Strike Team Leader training. All Operations Managers have completed required FEMA training, including IS 700 and IS 800. In addition, all Operations Mangers have completed courses in Bio -Terrorism (CBRNE) and First Responder Awareness (FRA) and First Responder Operations (FRO). Management / Field Supervisor Oversight Plan Currently, Care provides an on -duty Operations Manager on a twenty-four (24) hour basis, seven (7) days a week. The Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Manager is located at our corporate offices in Orange. The on -duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center, or directly through their cellular telephone. On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 -capable vehicle that's equipped with all necessary fire department radios and extra medical equipment, including back -boards, medical supplies and oxygen. RFP # 18-059—CARE AMBULANCE SERVICE 250-171 21 PROPOSALTO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA (C) Primary Personnel Care Ambulance currently assigns the following individuals to the City of Santa Ana EMS Emergency Transportation Services program. A summary of each person's current position, job duties and responsibilities, and years of employment is provided below, with detailed resumes provided as an Attachment to this section of our proposal. Chief Executive Officer: Troy Hagen, 5 years at Care With more than 29 years of EMS and medical service management experience, Troy Hagen, Chief Executive Officer, leads the on-site management team. Troy's background includes serving as an EMT, paramedic, volunteer firefighter, reserve deputy sheriff, flight medic, tactical medic, technical rescue commander, community paramedicine program coordinator and field supervisor. Prior to joining Care Ambulance, Troy helped create the incident command coursework for the State of Idaho and taught many classes across the state before FEMA developed a nationwide program. He also beta -tested the ICS training program for FEMA. He is a Type 3 Incident Commander and served on Idaho's Incident Management and Support Team. Troy's extensive experience and leadership in this arena helps ensure his team has the resources at their disposal to appropriately respond to MCIs and disaster events. Troy Hagen, CEO Troy holds a Bachelor of Science degree in Biology and a Master's degree in Business Administration. He is a frequent lecturer and writer on EMS leadership and management topics, EMS finance, emergency preparedness and special event planning. He served as Medical Commissioner and Incident commander for the 2009 Special Olympic World Winter Games. Troy was the 2010 Pinnacle Leadership Award winner, recognized for outstanding dedication to improving EMS and for his lead role in developing a whitepaper entitled "EMS Makes a Difference," published by the U.S. Department of Transportation. Troy is the Past -President of the National EMS Management Association (NEMSMA) and has served as the Finance Committee Chair for the National EMS Advisory Council (NEMSAC). He is truly a hands-on manager who provides our on-site leadership team and employees with an open-door policy that encourages frequent interaction. Troy never expects anything from employees that he would not expect from himself, raising the quality bar at Care Ambulance. RFP # 18-059— CARE AMBULANCE SERVICE250-1 72 22 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES! CITY OF SANTA ANA Director of Operations: Bill Weston, 21 years at Care Bill is responsible for Care Ambulance's emergency daily operations and has worked for Care for 21 years. He began his EMS career as an EMT and has current responsibilities for all emergency field operations, training, EMT hiring, risk management and fleet Bill Weston Director of Operations maintenance. Bill directs and coordinates all emergency ambulance operations activities to optimize use of equipment, facilities and personnel. He frequently acts as Care's representative before government commissions or regulatory bodies with regards to ambulance operations and is the current Vice President of the Ambulance Association of Orange County. Bill also serves as the Region One Disaster Transportation Coordinator and serves on the Regional Disaster Training Committee. At the State level, Bill serves on the California EMS Authority Ambulance Strike Team (AST) Task Force and other local disaster working groups. Bill holds both a Bachelor of Science and a Master's in Business Administration (MBA). Orange County Division Manager: Robert Viera, 21 years at Care Robert joined Care Ambulance Service in 1996 and in 2007 was promoted to position of Orange County Division Manager. He supervises all Orange County ambulance operations and oversees his division's Operations Managers (Field Supervisors). Passionate about ensuring all personnel, vehicles and equipment are operated in a professional and efficient manner, Rob maintains strong agency relationships within the EMS system. He has completed industry - specific courses established by the AAA and extensive ICS training. He is a trained and experienced Ambulance Strike Team (AST) Leader. Ben Baker, Director of Communications & I.T. Director of Communications & I.T.: Ben Baker, 19 years at Care Robert Viera, OC Division Manager Ben Baker, Director of Communications, provides ambulance deployment management and Communication Center supervision. With 19 years of experience at Care, Ben is responsible for deployment planning and optimal crew staffing. He also monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben has implemented multiple improvements to enhance operational efficiency, producing outstanding results in both ambulance response time and quality of service. Ben is a "Black Belt" in RFP g18-059—CARE AMBULANCE SERVICE 250-173 23 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES �s CITY OF SANTA ANA Six Sigma Quality Improvement. He is an industry leader in maximizing the capabilities of our EMS computer-aided dispatching system. Medical Director: Freddy Sotelo, MD, MPH, 3 years at Care Freddy Sotelo, MD, MPH, serves as Care's Medical Director. Our newest and a welcome addition to the team following the retirement of Care's former Medical Director, Dr. Sotelo ensures Care's staff operate within their scope of practice and in accordance with all company, County, and State of California requirements. Dr. Sotelo is also a key member of Care's QA/QI team, ensuring individual and system -wide education addresses specific areas of concern. Dr. Sotelo serves in the Department of Emergency Medicine at Long Beach Memorial Hospital and is a member of the UCLA Emergency Department and Surgical Department Quality Improvement, Risk Management and Patient Safety Task Force. He completed his residency and MPH at UCLA. Jeff Talmage — Santa Ana Administrative Manager Freddy Sotelo, MD, MPH Medical Director Daily supervision and oversight of Care's specific operations in the City of Santa Ana is provided by Jeff Talmage. Prior to accepting employment with Care, Jeff was a paramedic with the Santa Ana Fire Department and for the last 16 years served as the City's Paramedic Coordinator. Jeff has more than 33 years of experience in the City of Santa Ana and within the Orange County EMS system. Jeff is a seasoned, system veteran that truly understands the EMS needs for the City of Santa Ana. Jeff Talmage, Paramedic Operations Manager RFP # 18-059—CARE AMBULANCE SERVICE50-174 24 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA (D) Employee Recruitment, Screening and Orientation Recruitment If there was only one function a manager could control to provide high-quality ambulance service, it would be recruitment. By starting with only qualified and motivated candidates, the remainder of the management process is simplified, allowing management to focus on quality improvement. The majority of ourjob applicants are experienced EMT personnel, drawn to Care Ambulance Service because of our core values, working conditions and comprehensive wage and benefits package. It is the policy of Care Ambulance Service to be fair and impartial to all employees and applicants for employment, without regard to race, religion, age, gender, color, ethnic or national origin, marital status, genetic information, sexual orientation or ancestry. Care Ambulance Service conforms to all applicable federal, state, and local regulations and guidelines guaranteeing equal employment opportunity for all qualified disabled individuals, disabled veterans, and veterans of the Vietnam Era. In any service industry, people shape the personality of the product. At Care Ambulance Service we recognize and respect the power that can be hidden behind each new face. Care Ambulance Service realizes that having the best equipment is only 50% of providing the best service. The other 50% of the impact on the patient's emergency is made by the people who care for them. Consequently, we are painstakingly careful about recruiting the right people to provide outstanding clinical and customer service to our patients. Screening Just as it is critically important to attract top quality personnel, it is also essential to be able to recognize and select them for employment. Care Ambulance Service EMT candidates are required to complete the following candidate screening process. This process is very stringent and modeled after the same selection criteria used by local fire departments and law enforcement agencies. • Credential Verification: EMT candidates are required to submit proof of a valid EMT certification, Orange County EMT Accreditation, CPR Card, California Driver's License and a California Ambulance Driver's Certificate with a Medical Examiner's Certificate. • Driving History: All EMT candidates must provide a current DMV Report of their Driving Record. If the EMT candidate is a non -California licensed driver, the candidate must RFP # 18-059 — CARE AMBULANCE SERVICE 250-175 25 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES R.a CITY OF SANTA ANA submit a driving record from the state in which the applicant is currently licensed. Any candidate with a poor driving history is not considered for employment. • Criminal History & Background Investigation: Care Ambulance uses the services of a retired police officer and currently licensed private investigator to conduct a thorough background investigation for prospective EMT employees. This includes a complete criminal history check, DMV search, reference check with former employers, social security check and credit history check. • Oral Interview: Qualified candidates are invited to an oral interview conducted by our Operations Managers and Field Training Officers. The candidate's prior work history, goals and EMT knowledge are reviewed. Strength & Flexibility Testing: Strength and flexibility testing is conducted by a licensed physical therapist. The test is done to simulate the physical strength necessary for the position, flexibility, and use of proper lifting techniques. • Physical Exam & Drug Testing: The final step in the process is a pre -placement medical examination, including a personal health history, vision testing, hearing tests, musculoskeletal evaluation, spinal x-ray and urinalysis drug screening. Orientation New employees' most crucial learning takes place during the formal training process, including development of good work habits. As such, Care Ambulance provides a minimum of 124 training hours in a structured and rigid training format. Orientation begins on the first day of employment, and ends when scheduled, without interruption. The orientation program is taught by our Field Training Officers who maintain written documentation throughout the process. The program begins with a 80 -hour classroom and didactic program, including a general overview, OSHA requirements and Policy Manual Review. During the next phase, the new employee is assigned to a Field Training Officer and rides as a third person ride -along in an ambulance. Basic skills are reviewed and tested. Training is continued until the EMT is able to function as a primary partner. The final phase of Care's orientation program is our in-house comprehensive emergency vehicle driver training program. We present the "Emergency Vehicle Operators Course National Standard Curriculum" and "Coaching the Emergency Vehicle Operators" courses. These programs provide the necessary classroom instruction, competency field training, and testing for new and existing drivers. Our program verifies proficiency in the understanding of emergency vehicle driving, as well as the practical application of that knowledge. RFP q 18-059—CARE AMBULANCE SERVICE250_176 26 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA (E) Continuing Education Programs Care Ambulance Service has always had a commitment to and a reputation for service excellence. This well-deserved reputation can be attributed to the Care Ambulance philosophy that employees are our most important asset. We treat employees as valuable customers and give them the tools to be successful. These tools include training and education and equip the employee to provide exceptional service to external customers. The applicants that make it through the rigorous selection process are assigned to New Employee Orientation. New Employee Orientation provides a combination of education and training that begins in the classroom and finishes in the field with a Field Training Officer. This New Employee Orientation is the foundation for ongoing continuing education. Care Ambulance provides continuing education through a variety of venues, described in detail below. Care commits to provide these programs at all times throughout the contract term. • Annual Mandatory Training • On -Line Education • In -House Training • Tailboard Training Annual Mandatory Training • Classes on Various Topics • Field Training Officer Meetings • Conference Attendance • Management Development Annual Mandatory Training is a requirement for all field employees. Topics such as Blood and Airborne Pathogens, Emergency Vehicle Operations, Customer Service, Incident Command System, Hazardous Materials, and Patient Care Documentation are covered. Continuing Education credit is given for those subjects that meet the criteria for CE approval. On -Line Education Care Ambulance pays for every field employee to be enrolled in the Virtual Solutions Manager (Med CE) on-line education program. The program is explained to employees in the New Employee Orientation. Each employee is given their personal password to access the program. In -House Training There are times when training and education is facilitated in-house by outside providers. Examples of this are Incident Command System 200 and 300, EMS Basic Supervisory Workshop (Texas A&M), Sexual Harassment Prevention and Investigation, Terrorism Awareness, and Emergency Medical Dispatch. RFP # 18-059 — CARE AMBULANCE SERVICE 250-177 27 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Tailboard Training This is a written informative training update that is distributed to field personnel on a regular basis. It is designed to be a quick and easy read. The Tailboard Training is very effective to address current issues of interest. Classes on Various Topics Continuing education classes are offered on a variety of subjects, such as Basic EKG Rhythm Recognition, Pharmacology and Terrorism Awareness and Response. These classes are often facilitated by Registered Nurses from Care's Specialty Care Transport Program. Field Training Officer Meetings Field Training Officer Meetings are held on a bi-monthly basis. This is an opportunity to meet with all Training Officers at the same time. Each meeting has an agenda and an educational component where Field Training Officers can then share information with other F -I -Os. Conference Attendance Operations and Training personnel frequently attend EMS conferences. Any personnel that attend conferences are required to share information that was learned with other employees. Information can be shared in Annual Mandatory Training, CE Classes, Employee Company Meetings, Tailboard Training, or in small informal settings with employees. Management Development Care Ambulance's management team must effectively direct, guide and lead field personnel. To prepare for this critical role in the organization, managers participate in ongoing training and continuing education. Managers and supervisors routinely attend professional conferences and local training sessions. Local training often includes programs facilitated by partner public provider agencies or hospitals. Managers from the Operations and Training departments also participate in Article Review. Article Review involves the selection of a business or management article from a relevant source. The article is then distributed to all managers for review and preparation for discussion. Two weeks after distribution of the article, the managers meet to share perspectives and insights on the article. These sessions provide a valuable learning environment, providing an opportunity for team members to learn from one another and to appreciate different perspectives. Ongoing training and education are important in every job. The dynamics of healthcare requires the healthcare professional to stay current on changes in the delivery of care to patients. RFP # 18-059— CARE AMBULANCE SERVICE2 i, O — 1 78 28 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA (F) HIPAA Training Programs In the spring of 2003, Care Ambulance Service developed a training program to meet the requirements of HIPAA and Medicare Compliance. It is the position of Care Ambulance Service that compliance with patient privacy issues is an extremely important standard. Care Ambulance Service also decided that it would be feasible and cost effective to conduct training on Corporate (Medicare) Compliance and HIPAA policies at the same training sessions. To meet this combined goal a course outline and objectives were created to include: • Ensure regulatory compliance with federal, state and local laws regarding patient privacy and Medicare compliance. • Provide staff with a basic knowledge of patient privacy and Care's policies regarding patient privacy. • Provide staff with skills, knowledge and ability to complete Patient Care Records (PCRs) and provide patients with required privacy notices. • Ensure staff is aware of Care Ambulance Service's Compliance and Privacy Officer. • Provide staff with a basic knowledge of Medicare Compliance. • Ensure staff is aware of Federal Fraud and Abuse Statutes. In summary, HIPAA Compliance and Medicare Compliance training is mandated for every employee and will be provided to all new employees. This training was structured to provide Care employees with the necessary information to adequately protect Patient Health Information (PHI) and understand the issues of fraud and abuse. HIPAA Training Program — Implementation of Privacy Act The following represents the key points of HIPAA training that are included in the company wide training: • History of Privacy Act • Basic Primary Rule • Impact of HIPAA— How each of us are affected by the new regulations • HIPAA Training Requirements — Who must be trained — Why? • What Must Training Include — workforce training on privacy policies and procedures • Required Employee Certification • Enforcement and Penalties — What agency of government is responsible for enforcement and mandatory practices • Criminal Sanctions — It is extremely important to share this point in training so that staff members will understand and appreciate the need to follow the procedures RFP # 18-059— CARE AMBULANCE SERVICE 250-179 29 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Salient Points of HIPAA legislation • Overview of privacy rule • What is Protected Health Information (PHI) • Permitted uses of PHI • Other permitted Disclosures of PHI such as to Law Enforcement, Family, etc. • Review of "The Minimum Necessary Rule" • Notice of Privacy Procedures • Emergency Treatment Situations • Minors and PHI • Workforce Training Obligation Medicare Compliance Training • Elements of Compliance • Compliance Policies and Procedures • Education and Training • Monitoring & Review (QA/QI) • Open Lines of Communication • Response to Detected Misconduct • Identification of Compliance Officer • Fraud and Abuse Risks • Keys to,Coverage • Medical Necessity • Destination / Origin issues • Non -Emergency Transports • What is bed confined • Kickbacks and inducements The above is representative of the HIPAA and Medicare Compliance training programs at Care Ambulance Service. These are dynamic programs. Attendee participation is required and at the conclusion of training, each participant signs Care's Policy on Confidentiality and Dissemination of Patient Information and Staff Member Verification Certifying Attendance at the Training Session. By signing the certification, a number of goals are achieved. First, it certifies that the employee attended the training. Secondly, the employee acknowledges that compliance with patient privacy issues and Medicare Compliance issues are taken very seriously at Care Ambulance Service. Finally, the employee acknowledges he or she will comply with these important policies and regulations. RFP # 18-059—CARE AMBULANCE SERVICE250-1 8U 30 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Y r a u E:9 : WIT_«•1►Ti N 4 r_1 I.11114 M A W-11 Care Ambulance Service is fully committed to complying with all requirements set forth by the Health Insurance Portability and Accountability Act (HIPAA) as stated in 45 CFR Parts 160 and 164. As a health care provider that transmits Protected Health Information (PHI) electronically to Medicare and other entities, Care Ambulance meets the definition of "covered entity" under HIPAA regulations and therefore must legally comply with all segments of HIPAA. Effective April 1, 2003, Care Ambulance implemented our comprehensive program to comply with the HIPAA requirements, including those requirements specific to patient privacy. Copies of our HIPAA policies are available online at www.careambulance.net. Care Ambulance certifies that all personnel employed by our organization have been appropriately trained regarding HIPAA and signed an approved HIPAA confidentiality agreement. As part of Care's HIPAA program, Care Ambulance provides over two (2) hours of interactive HIPAA and Medicare Compliance training to all employees during an employee's first day of orientation and requires all new employees to sign a non -disclosure agreement. Annually, Care Ambulance conducts mandatory compliance refresher training for all EMTs and Field Personnel. With Care's HIPAA Compliance Plan, we ensure that PHI is only released as permitted under the HIPAA regulations. Examples of permitted releases include: • Treatment —We may use PHI to treat a patient and disclose PHI to doctors, nurses or technicians directly involved in patient care. • Payment— We may use and disclose PHI so that we or others may bill an insurance company or other third -party payer for services provided. • Health Care Operations —We may use and disclose PHI to ensure that our patients receive the highest quality care and to audit the care provided by our care givers in our official QA/QI processes. • By Law —We will disclose PHI when required to do so by federal, state or local law. Care Ambulance does not consider HIPAA compliance and the protection of patient's private information to be a static process. The protection of a patient's privacy remains an ongoing agenda item for Care's senior management and all corporate decisions are rooted in the basis of patient privacy. Care Ambulance performs routine privacy audits to ensure adherence with our HIPAA Compliance Program so that all reasonable steps are taken to guard a patient's protected health information. RFP # 18-059—CARE AMBULANCE SERVICE 250-181 31 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES oil CITY OF SANTA ANA ITEM 9: CORPORATE COMPLIANCE PLAN Care Ambulance has adopted a Corporate Compliance Plan to reflect our commitment to highest ethical standards and compliance with all applicable laws and regulations. Care's plan meets and exceeds all recommendations established by the Office of Inspector General's Compliance Program Guidance for Ambulance Suppliers, as published in the Federal Register. The plan has been adopted by Care's Board of Directors by Board Resolution and provides standards by which all employees and managers of Care Ambulance will conduct themselves in order to protect and promote integrity throughout the company and to enhance Care's ability to achieve organizational goals. The Compliance Plan is structured to achieve specific objectives, which are outlined below along with key components of each section of the Plan: Legal Compliance Objective: Ensure all activity by or on behalf of the organization is in compliance with all applicable laws. This standard is intended to provide guidance to employees and management, to assist them in their obligation to comply with applicable laws. These standards are neither exclusive nor complete. If questions regarding the existence, interpretation or application of any law arise, they are directed to Care Ambulance Service's legal counsel. This section covers: • Fraud and Abuse • Environmental • Antitrust • Discrimination Business Ethics Objective: Employees accurately and honestly represent Care Ambulance Service and do not engage in any activity or scheme intended to defraud anyone of money, property or honest services. The Standards set forth below are designed to provide guidance to employees to ensure that Care's business activities reflect the highest standards of business ethics and integrity. This section covers: • Honest Communication • Misappropriation of Proprietary Information • Fraud and Abuse Confidentiality Objective: Maintain the confidentiality of patient and other confidential information in accordance with applicable legal and ethical standards. Every Care Ambulance employee has an obligation to actively protect and safeguard confidential, sensitive and proprietary information in a manner designed to prevent the unauthorized disclosure of such information. This section covers: • Patient Information • Proprietary Information • Personnel Actions and Decisions RFP # 18-059—CARE AMBULANCE SERVICE250-1 82 32 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES 11f CITY OF SANTA ANA Conflicts of Interest Objective: Directors, officers, and employees owe a duty of undivided and unqualified loyalty to the organization. Persons holding such positions may not use their positions to profit personally or to assist others in profiting in any way at the expense of the organization. This section covers: • Outside Financial Interests • Participation on Boards of Directors / • Services for Competitors and Trustees Vendors • Honoraria Business Relationships Objective: Business transactions with vendors, contractors and other third parties shall be transacted free from offers or solicitation of gifts and favors or other improper inducements in exchange for influence or assistance in a transaction. The standards are intended to guide employees in determining the appropriateness of the listed activities or behaviors within the context of Care Ambulance business relationships, including relationships with vendors, providers, contractors, third -party payers and government entities. This section covers: • Gifts and Gratuities • Gifts from Patients or Family Members • Gifts Influencing Decisions Protection of Assets Objective: All employees will strive to preserve and protect the corporation assets by making prudent and effective use of Care Ambulance resources and properly and accurately reporting its financial condition. The standards are intended to guide employees by articulating Care Ambulance Service's expectations as they relate to the activities or behaviors which may impact Care's financial health. This section covers: • Internal Control • Travel and Entertainment • Financial Reporting • Personal Use of Corporate Assets Administration and Application of this Code of Conduct Objective: Each person to whom our Code of Conduct applies will abide by the Principles and Standards established and will conduct the business and affairs of Care Ambulance Service in a manner consistent with our commitment to highest ethical standards and compliance with all applicable laws and regulations. Mitch Felde, Director of Human Resources serves as Care's Corporate Compliance Officer. Mr. Felde reports directly to the Board of Directors as Compliance Officer and is charged with the responsibility for operating and monitoring the compliance program. A copy of Care's Code of Conduct is provided as an Attachment to this section of our proposal. RFP # 18-059— CARE AMBULANCE SERVICE 250-183 33 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES to CITY OF SANTA ANA ITEM 10: PLAN FOR TAKEOVER OF SERVICE / START-UP Care Ambulance Service is the incumbent emergency provider for the City of Santa Ana, currently providing fully compliant and nationally accredited emergency ambulance services to the residents and visitors of Santa Ana. In selecting Care Ambulance as the continuing provider for the City of Santa Ana, the community will experience no interruption of the excellent ambulance services they already enjoy. Santa Ana city officials can count on our seamless continuation of stable, consistent and accountable services without fear of service halts or concern for performance decline while a new provider learns on the job. One of the true advantages Care Ambulance brings to the City of Santa Ana is seasoned management, experienced with this type of dedicated ambulance operation. This experience is critical to ensure uninterrupted quality ambulance service. With Care Ambulance, the City of Santa Ana can be certain it is working with an experienced, reputable, well-known firm that has a management team with emergency ambulance service implementation experience that has been tested and proven. Care's plan for continuation of service includes the following: • An experienced and knowledgeable local management team that is already in place with EMTs, Dispatchers and Managers who are familiar with the City of Santa Ana Emergency Ambulance program. • A proven and effective emergency ambulance deployment strategy that has exceeded all requirements of the RFP for the last six (6) years. In the following section, we detail our plan for takeover and implementation of the Santa Ana contract with a January 1, 2019 start date. (a) Care's Transition and Implementation Management Team Care Ambulance provides a very comprehensive management team with over 200 years' experience in the management and supervision of emergency ambulance operations. A key to the successful growth of Care Ambulance has been the strength of our on-site management team, which includes: Bill Weston — Director of Operations Bill is responsible for the daily operations of Care Ambulance. Bill has worked for Care Ambulance for over 22 years. Bill began his EMS career as an EMT and has responsibilities for field operations, EMT hiring, and risk management. Bill serves as Care Ambulance liaison with the City of Santa Ana and OCFA. RFP # 18-059—CARE AMBULANCE SERVICE250-184 34 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Bill directs and coordinates all activities of Care's ambulance operations to optimize use of equipment, facilities and personnel. Bill frequently acts as Care's representative before government commissions or regulatory bodies as it relates to ambulance operations and is the current Vice President of the Ambulance Association of Orange County. Working with other Care Managers, Bill has participated in the development of Care's ambulance transport programs for the Cities of Santa Ana, Westminster, San Clemente, La Habra, Anaheim, Buena Park, Costa Mesa, Fullerton, Garden Grove, County of Los Angeles and the Orange County Fire Authority. Ben Baker— Director of Communications and Deployment Ambulance Deployment Management and Communication Center supervision is provided by Ben Baker. Ben is responsible for Care Ambulance's Deployment Planning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is a currently credentialed EMT and a retired Police Officer. Ben plays a pivotal role in Care's day-to-day performance. Ben is an industry leader in maximizing the capabilities of our EMS computer-aided dispatching system and Electronic Patient Care Record (ePCR) systems. Rob.Viera - Orange County Operations Division Manager Rob Viera was promoted to the Orange County Division Manager position in 2005. He supervises all Orange County ambulance operations and is directly responsible for the oversight of EMS supplies and his Division's Daily Operations Managers. Rob is tasked with the establishment of agency relationships in the EMS system and acts as a liaison for Care Ambulance to area fire department partners. As part of his duties Rob also coordinates and documents the local operating area and the Region 1 ambulance response for emergency incidents. Jeff Talmage— Santa Ana Administrative Manager Daily supervision and oversight of Care's specific operations in the City of Santa Ana is provided by Jeff Talmage. Prior to accepting employment with Care, Jeff was a paramedic with the Santa Ana Fire Department and for the last 16 years served as the City's Paramedic Coordinator. Jeff has more than 33 years of experience in the City of Santa Ana and within the Orange County EMS system. Jeff is a seasoned, system veteran that truly understands the EMS needs for the City of Santa Ana. RFP # 18-059 — CARE AMBULANCE SERVICE 250-185 35 PROPOSALTO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES R CITY OF SANTA ANA One of the strongest advantages Care Ambulance brings to the City of Santa Ana is experienced management. Care Ambulance does not anticipate the use of an implementation management team that is different from the permanent management team. (b) Care's Proposed Start -Up Schedule Care Ambulance has already implemented all RFP requirements as outlined in the following Gantt chart. The chart outlines our proposed implementation timelines associated with the services and enhancements described in our proposal. Cam Ambulance Stant Up Schedule I¢•l'Na�! WA Irp:N u�vlrrry� •n. .v. . rr IV.V Y !3r t [ 5Y�1 1 IJflaxJ b':2/Ip:! V:Ur.U10 1J 1'�iiI:PPP _ :A/.Old 4�1R^le l!J mnn•m: wl•rae 1Mv.+ns m6/:pni Id 1 9 J.ni�Pl:•�,�N!]e• Ip/)YRnB Ip/.}/MIB 1.1 1 5 1•cmo+w c...:.:1 :}narpva r�n:rnls M1q 1 F•rt...i-1.M lbnxf•sanrre 12M1+pn1} V1Y.al9 :W i LnWueeZCJimtrt RencenG t`J1"llJli 1P/S:J.'D10 '.1 g : nv Yrrtle ♦rlll Enennntlen 1`AP.^IM19 1?PS/g12 W R PutOMl:n Sr..n amomIP L 10C ..xUml4rrcr.!aim d{IN. 1? 1`JtIQp:S IiW (c) Care's Proposed Initial Service Response Plan Care's First Tier Service is designed to ensure that there are enough of Care's own ambulances and transportation personnel available to meet 100% of the anticipated number of calls for Emergency Transportation in the City of Santa Ana. To date, Care's deployment strategy has handled over 130,000 requests for service, in the City of Santa Ana, while maintaining a 98% response time compliance rate, without a single failure or request for service turned to another ambulance provider. Care's First Tier strategy isn't theoretical, its six (6) years actual proven successful performance. Currently, Care Ambulance Service provides EMT staffing and emergency ambulance transportation personnel for seven (7) dedicated and fully equipped ambulances in accordance with all industry standards and requirements of the City of Santa Ana and OCFA. Care Ambulance operates our seven (7) dedicated City of Santa Ana emergency ambulances from the following Santa Ana ambulance station locations: • Santa Ana Station One —4718 W. 1St Street, Santa Ana • Santa Ana Station Two —1209 N. Broadway Street, Santa Ana • Santa Ana Station Three — 2701 Hotel Terrace Drive, Santa Ana RFP # 18-059— CARE AMBULANCE SERVICE 250-186 36 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES a CITY OF SANTA ANA • Santa Ana Station Four -2913 Warner Avenue, Santa Ana • Santa Ana Station Five — 2125 N. Grand Avenue, Santa Ana In addition to the seven (7) fully dedicated transport ambulances and EMT crews, Care Ambulance provides full and complete backup services for the City of Santa Ana, twenty-four (24) hours a day, seven (7) days a week to all 9-1-1 and other emergencies in the City of Santa Ana as may be required. Care Ambulance provides fully equipped and staffed vehicles from our regular fleet of emergency ambulances, ready to provide backup emergency transportation services to the City of Santa Ana in the event the dedicated ambulances are unavailable or unable to respond to a call for service. To accomplish this task, Care Ambulance currently maintains an additional fleet of 143 emergency ambulances at our various ambulance station locations, including multiple ambulances located at Care's Corporate Offices, just outside of Santa Ana, at 1517 W. Braden Ct., Orange. Dedicated Ambulance Fleet For the provision of service to the City of Santa Ana, Care commits to continue to furnish seven (7) Modular Type III emergency ambulance, built on a specialized Ford gasoline chassis, and then configured locally by Leader Ambulance in South EI Monte. Each ambulance meets and exceeds all requirements of the California Highway Patrol, the Department of Transportation, Orange County EMS, OCFA and the City of Santa Ana. Each ambulance is already equipped with an OC fire 800 MHZ radio system, navigation systems, automatic vehicle (AVL) locator systems and Care's dispatch center already interfaces with the Communications Center for OCFA. To assure that these vehicles are entirely available to the City of Santa Ana, Care Ambulance has lettered the front line/dedicated ambulance with a city -approved distinctive lettering scheme that designates the ambulance as "Proudly Serving the City of Santa Ana". Automated External Cardiac Compression Devices Recent studies have demonstrated that the use of a mechanical automated chest compression device may lead to superior coronary perfusion pressures by addressing the shortcomings of conventional manual CPR, thus improving survival rates from out-of-hospital cardiac arrest. For that reason, Care Ambulance proposes to provide an Automated External Cardiac Compression Device on each of our seven (7) dedicated Santa Ana ambulances. RFP # 18-059— CARE AMBULANCE SERVICE 250-187 37 PROPOSALTO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA ITEM 11: EMS RESUME 1. Detailed Resume of Care's Emergency Transportation Experience Care Ambulance Service has provided ambulance service to the residents and visitors of Orange County for over 49 years. Care Ambulance provides the following services: • 9-1-1 Emergency Ambulance Transport • Nurse Staffed Critical Care Transport Services, and • Non -Emergency Ambulance Transport • Neonatal / Pediatric Intensive Care Transport • Basic Life Support Stand-by Services Services In the year 2017, Care Ambulance Service responded and provided ambulance transport service to 254,697 patients, with 3761,716 total ambulance responses. Emergency Ambulance Transport Experience Care Ambulance Service has 111 years of combined experience in providing emergency ambulance services (ground transportation, ALS, BLS and billing services). All of Care's emergency ambulance service experience is local, with service in Orange or Los Angeles County, and includes six (6) years of experience providing emergency ambulance services in the City of Santa Ana in partnership with the Orange County Fire Authority. Care works very hard to maintain excellent relationships with our EMS Agency and fire department first responder agencies. We embrace the philosophies of interagency cooperation, tailoring our services to meet the needs of each partner, whether in the area of emergency ambulance response, communications, record-keeping, billing or community outreach. Regardless of the request, we strive to ensure our partners' needs are met. Our successful program of integrating our services with fire agencies in both Orange County and Los Angeles County exemplifies Care's proven experience. For example, through a recent competitive bid to provide services to the Los Angeles County Fire Department, Care Ambulance prevailed against two incumbent providers. Using our solid and proven formula for dedicating 24-hour ambulances and crews to specific cities and fire agencies, Care Ambulance has exceeded all contract requirements for all contract areas. By teaming local area firefighters / paramedics with our dedicated EMT staff, the County has strengthened the patient care "response -chain." This public-private partnership, with all agencies' professionals working together on a regularly scheduled basis, has reduced ambulance response times, increased scene communications between responders and resulted in better patient care. This serves as only one example of our commitment to developing customized solutions that suit each City or fire agency's specific needs. We are committed to continuing to do the same here in Santa Ana. RFP # 18-059— CARE AMBULANCE SERVI 250—A Q Q 38 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION 8, RELATED SERVICES CITY OF SANTA ANA Details of emergency services provided by Care Ambulance in calendar year 2011, including a summary of the call volume by operating area, response time requirements and contract durations, are detailed below. RFP # 18-059— CARE AMBULANCE SERVICE 250-189 39 Contract•ry— Previous 10 Years Cities/Fire Contact Name Contract Primary 911 Response Time Red Dept Served and Phone No. Dates or Call Volume M=Metro/Urban Back-up 2017 S=Suburban/rural Status Transports W=Wilderness City of Santa City Treasury, 6 Years Contracted 15,983 M= 10 Min, Code 3 Ana Willard Holt and 1 Primary (714) 647 5456 Month City of San Assistant City 2 Years Contracted 1,734 M=10 Min, Code 3 Clemente Manager, Erik and 11 Primary Sund Months (949) 3618341 City of Police 2 Years Contracted 5,059 M= 10 Min, Code 3 Westminster Commander, and 6 Primary Mark Lauderback Months (714) 898 3315 City of La Assistant to the 8 Years, Contracted 6,078 M=10 Min, Code 3 Habra City Manager, and 9 Primary Robert Ferrier Months (562) 383 4012 County of EMS Admin, 3 Years, Contracted 46,620 M=10 Min, Code 3 Orange EMS Tammi and 5 Primary Agency, EOAs McConnell Months B, C, D and E (714) 834 3500 County of Los Director, Cathy 1 Year Contracted 95,885 M= 8 Min, Code 3 Angeles EMS Chidester and 3 Primary Agency, EOAs (562) 347 1604 Months 3,4and 5 City of Fire Chief, Randy 20 Years Contracted 18,026 M= 10 Min, Code 3 Anaheim Bruegman and 1 Primary (714) 765 4001 Months RFP # 18-059— CARE AMBULANCE SERVICE 250-189 39 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA 2. Description of Care's EMS System for Ambulance Deployment Listed below is a brief description of each EMS system and ambulance deployment strategy for Care's contracted areas: City of Santa Ana Seven (7) dedicated EMT Basic Life Support (BLS) ambulances. Care Ambulance provides BLS ambulance transport services, with ALS services provided by the Orange County Fire Authority. All EMT personnel are assigned similar shifts as OCFA Firefighters. Back-up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. EMT services are leased to the City of Santa Ana for a flat daily fee. Transport revenue is retained by the City of Santa Ana. Care Ambulance has never used back-up or mutual aid services in the City of Santa Ana. City of San Clemente Two (2) dedicated EMT BLS ambulances. Care Ambulance provides BLS ambulance transport services, with ALS services provided by the Orange County Fire Authority. Back up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. EMT services are leased RFP # 18-059 — CARE AMBULANCE SERVICE2 5 0 -190 40 Contract•ry — Previous 10 Years Cities/Fire Contact Name Contract Primary 911 Response Time Red Dept Served and Phone No. Dates or Call Volume M=Metro/Urban Back-up 2017 S=Suburban/rural Status Transports W=Wilderness City of Buena City Manager, 16 Years Contracted 4,450 M= 10 Min, Code 3 Park Jim Vanderpool and 4 Primary (714) 562-3552 Months City of Costa Fire Chief, Dan 8 Years Contracted 7,684 M= 10 Min, Code 3 Mesa Stefano and 4 Primary (714)754-5106 Months City of Fire Chief, Tony 20 Years Contracted 3,648 M= 8 Min, Code 3 Fountain Coppolino and 8 Primary Valley (714) 593-4436 Months City of Fire Chief 14 Years Contracted 6,940 M=10 Min, Code 3 Fullerton Wolfgang Knabe and 11 Primary (714)738-6506 Months City of Fire Chief, Tom 17 Years Contracted 8,343 M=10 Min, Code 3 Garden Grove Schultz, and 5 Primary (714)741-5618 Months 2. Description of Care's EMS System for Ambulance Deployment Listed below is a brief description of each EMS system and ambulance deployment strategy for Care's contracted areas: City of Santa Ana Seven (7) dedicated EMT Basic Life Support (BLS) ambulances. Care Ambulance provides BLS ambulance transport services, with ALS services provided by the Orange County Fire Authority. All EMT personnel are assigned similar shifts as OCFA Firefighters. Back-up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. EMT services are leased to the City of Santa Ana for a flat daily fee. Transport revenue is retained by the City of Santa Ana. Care Ambulance has never used back-up or mutual aid services in the City of Santa Ana. City of San Clemente Two (2) dedicated EMT BLS ambulances. Care Ambulance provides BLS ambulance transport services, with ALS services provided by the Orange County Fire Authority. Back up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. EMT services are leased RFP # 18-059 — CARE AMBULANCE SERVICE2 5 0 -190 40 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES WFITESTSITITHETTIMPT, QO2\ E ego - to the City of Santa Ana for a flat daily fee. Transport revenue is retained by the City. Care Ambulance has never used a back-up or mutual -aid company for any services in San Clemente. City of Westminster Two (2) dedicated EMT BLS ambulances. Care Ambulance provides BLS ambulance transport services, with ALS services provided by the Orange County Fire Authority. Back up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. EMT services are leased to the City of Westminster for a flat daily fee. Transport revenue is retained by the City of Westminster. Care Ambulance has never used a back-up or mutual -aid company for any services in the City of Westminster. City of La Habra Two (2) dedicated EMT BLS ambulances, each staffed twenty-four (24) hours daily, seven (7) days per week Care Ambulance provides BLS services, with ALS services provided by the LA County Fire Department. All EMTs are assigned the same shift as LA County Firefighters. Back- up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. Care Ambulance provides all of La Habra's first responder and paramedic billings. EMT labor is leased to the City for a flat monthly fee. Transport revenue is retained by the City of La Habra. County of Orange EMS — EOAs, B, C, D and E Thirty (30) dedicated EMT BLS ambulances. Care Ambulance provides BLS ambulance transport services, with ALS services provided by the Orange County Fire Authority. Back up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. Los Angeles County EMS Agency — EOAs 3, 4 and 5 Ninety (90) dedicated EMT BLS ambulances. Thirty-seven (37) staffed twenty-four (24) hours daily, seven (7) days per week and additional fifty-three (53) peak demand ambulances staffed daily. Care Ambulance provides BLS services, with ALS services provided by the Los Angeles County or other area fire agencies. Back up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. City of Anaheim Six (6) dedicated EMT BLS ambulances, staffed twenty-four (24) hours daily, seven (7) days per week. Care Ambulance provides BLS services, with ALS services provided by the Anaheim Fire Department. Each ambulance is stationed within a city fire station with all EMT personnel assigned the same shift as Anaheim Firefighters. Back-up services are provided from Care's non- dedicated fleet of staffed EMT ambulances. City of Buena Park One (1) dedicated EMT BLS ambulance, staffed twenty-four (24) hours daily, seven (7) days per week. Care Ambulance provides BLS services, with ALS services provided by the Orange County RFP # 18-059 — CARE AMBULANCE SERVICE 250-191 41 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA T Fire Authority. All six (6) EMT personnel are assigned the same shift as OCFA Firefighters. Back- up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. City of Costa Mesa Three (3) dedicated EMT BLS ambulances and One (1) back up EMT BLS ambulance. All our staffed twenty-four (24) hours daily, seven (7) days per week. Care Ambulance provides BLS services, with ALS services provided by the Costa Mesa Fire Department. All dedicated EMT personnel are assigned the same shift as Costa Mesa Firefighters. Back-up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. City of Fountain Valley One (1) dedicated EMT BLS ambulance and One (1) back-up EMT BLS staffed ambulance. Both are staffed twenty-four (24) hours daily, seven (7) days per week. Care Ambulance provides BLS services, with ALS services provided by the Fountain Valley Fire Department. All six (6) dedicated EMT personnel are assigned the same shift as Fountain Valley Firefighters. Back-up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. City of Fullerton Three (3) dedicated EMT BLS ambulances, staffed twenty-four (24) hours daily, seven (7) days per week. Care Ambulance provides BLS services, with ALS services provided by the Fullerton Fire Department. Each ambulance is stationed within a city fire station with all 18 EMT personnel assigned the same shift as Fullerton Firefighters. Back-up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. City of Garden Grove Three (3) dedicated EMT BLS ambulances, each staffed twenty-four (24) hours daily, seven (7) days per week. Care Ambulance provides BLS services, with ALS services provided by the Garden Grove Fire Department. All 18 EMT personnel are assigned the same shift as Garden Grove Firefighters. Back up services are provided from Care's non -dedicated fleet of staffed EMT ambulances. Totals for All Communities Served Population Served: 4,199,644 Calendar Years of Contracts: 117 Years Total Square Miles Covered: 1,117 Contract Failures: None Number of 2017 Transports: 221,296 RFP # 18-059— CARE AMBULANCE SERVICE 250-192 42 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA ITEM 12: AGREEMENT TO CONDITIONS Additional Information Care Ambulance Service agrees to promptly supply the CITY OF SANTA ANA and OCFA with any further information requested for the accurate determination of Care's qualifications to perform the proposed services. Right to Audit Care Ambulance Service agrees to give the City, County, and/or the CITY OF SANTA ANA and OCFA the right to audit those documents or records (including financial records) requested in the Submission Form, provided by Care Ambulance, or referred to in Care's submission prior to and after award of the contract. Agreement to Pay Expenses Required The CITY OF SANTA ANA or OCFA may require Proposers submitting proposals to participate in an onsite visit by the CITY OF SANTA ANA and OCFA staff to inspect and/or verify records. If based outside of Orange County, Care Ambulance agrees to pay related travel expenses, including food and lodging, for up to three CITY OF SANTA ANA staff members and three OCFA staff members for up to two days to conduct the inspection. Agreement to expand Resources as Needed Care Ambulance agrees to expand its resources, at the sole discretion of the CITY OF SANTA ANA or OCFA, and at no additional cost to the CITY, including number of ambulances, if required response times are not met or if call volume increases. In addition, Care Ambulance agrees to maintain, at a minimum, the number and type of vehicles as proposed throughout the term of the contract. The CITY OF SANTA ANA is in the process of annexing parcels of land owned by the COUNTY OF ORANGE that would be incorporated by the CITY OF SANTA ANA. The area is commonly referred to as the "Seventeenth Street and Tustin Avenue Island". The area consists of the following: 29 single family homes: 13942 —13971 Deodar Street RFP # 18-059— CARE AMBULANCE SERVICE 250-193 43 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA 20 single family homes: 13822 —13831 Medford Street; 17152, 17162, and 17182 Medford Street 8 business locations: 2301, 2305, 2307, 2309, 2311, 2313, 2315, 2401 Seventeenth Street 3 business locations: 2301 Seventeenth Street 7 business locations: 13912 Ponderosa Street 16 apartment units: 13982 Ponderosa Street 15 apartment units: 1382 Ponderosa Street 8 vacant lots: 13862, 13872, 13892, 13902, 13922, 13946, 13952, 13972 Ponderosa Street Agreement to Reduce Resources as Needed Care Ambulance agrees to reduce the number of resources at the sole discretion of the CITY OF SANTA ANA or OCFA and renegotiate costs in the event response times are met and the actual call volume after one year from contract award date does not require the number of hours/days of coverage. Proprietary Information It is the responsibility of Care Ambulance Service to clearly identify information in our prequalification application and RFP bid response that it considers to be confidential or proprietary under the California Public Records Act. To the extent that the CITY OF SANTA ANA agrees with that designation, such information will be held in confidence whenever possible. All other information will be considered public. However, all information regarding the prequalification and RFP bid responses will not be released to the public or subject to the Public Records Act during the deliberative process until such time as the evaluation has been completed and, or if, an award has been made. AUTHORIZED NAME AUTHORIZED SIGNATURE DATE Troy M. Hagen October 31, 2018 RFP q 18-059—CARE AMBULANCE SERVICE250_194 44 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA ITEM 13: PRICE WORKSHEET CITY OF SANTA ANA RFP # 18-059 FOR EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES Initial Term: Year 1 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2019 —12/31/2019 Annual Contract Price $ $4,326,744 Not to exceed $ per month $360,562 Optional Billing: (Price Per Transport) N/A Initial Term: Year 2 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2020 - 12/31/2020 Annual Contract Price $ $4,497,288 Not to exceed $ per month $374,774 Optional Billing: (Price Per Transport) N/A Initial Term: Year 3 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2021-12/31/2021 Annual Contract Price $ $4,660,584 Not to exceed $ per month $388,382 Optional Billing: (Price Per Transport) N/A Initial Term: Year 4 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2022 —12/31/2022 Annual Contract Price $ $4,829,928 Not to exceed $ per month $402,494 Optional Billing: (Price Per Transport) N/A RFP # 18-059— CARE AMBULANCE SERVICE 250-195 45 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Initial Term: Year 5 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2023 —12/31/2023 Annual Contract Price $ $4,998,072 Not to exceed $ per month $416,506 Optional Billing: (Price Per Transport) N/A First Renewal Option: Year 1 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2024-12/31/2024 Annual Contract Price $ $5,456,988 Not to exceed $ per month $454,749 Optional Billing: (Price Per Transport) N/A First Renewal Option: Year 2 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2025 —12/31/2025 Annual Contract Price $ $5,672,484 Not to exceed $ per month $472,707 Optional Billing: (Price Per Transport) N/A First Renewal Option: Year 3 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2026-12/31/2026 Annual Contract Price $ $5,898,732 Not to exceed $ per month $491,561 Optional Billing: (Price Per Transport) N/A Second (Final) Renewal Option: Year 1 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2027 —12/31/2027 Annual Contract Price $ $6,136,176 Not to exceed $ per month $511,348 Optional Billing: (Price Per Transport) N/A RFP # 18-059—CARE AMBULANCE SERVICE 250-196 46 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES 11 L Second (Final) Renewal Option: Year 2 9-1-1 EMERGENCY TRANSPORTATION SERVICE FOR PERIOD OF: 1/1/2028 —12/31/2028 Annual Contract Price $ $6,385,536 Not to exceed $ per month $532,128 Optional Billing: (Price Per Transport) N/A RFP # 18-059 — CARE AMBULANCE SERVICE 250-197 47 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA ITEM 14: CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of Care Ambulance Service, Inc. ("Proposer"), and hereby declares under penalty of perjury under the laws of the State of California, that Proposer is not, and will not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a contract and if authorized to perform the services described in this RFP. Signed, this 22nd day of October, 2018 in Orange, California. IF CORPORATION: October 31, 2018 Signature of CEO Troy M. Hagen October 31, 2018 Signature of Secretary Brian M. Richmond RFP # 18-059—CARE AMBULANCE SERVICE 250-198 48 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA ITEM 15: STATEMENT OF TRUTH The undersigned hereby certifies on behalf of Care Ambulance Service, Inc. ("Proposer"), and hereby declares under penalty of perjury under the laws of the State of California, that the information provided by Proposer and contained in this bid to the (TBD) EMS 9-1-1 Emergency Transportation Service RFP is accurate, complete, true and correct to the best of our knowledge. We are aware that should any of the information contained herein be found to be false, incorrect, or otherwise untruthful, or if the information contained herein contains material misrepresentations and/or material omissions of fact, the City of Santa Ana of Santa Ana may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option of the City, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and/or to declare any contract awarded as the result thereof void. Signed, this 22nd day of October. 2018 in Orange, California. In the event that one of the above events occurs during the bid submittal date and contract award, the new corporation/stockholder must provide a notarized statement stating their agreement to the terms and conditions of the contract and prior to bid submittal without exceptions. This must be received within 5 business days of the change IF CORPORATION: October 31, 2018 Signature of CEO Troy M. Hagen October 31, 2018 Signature of Secretary Brian M. Richmond RFP # 18-059— CARE AMBULANCE SERVICE 250-199 49 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA ITEM 16: NON -COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of Care Ambulance Service, Inc. ("Proposer"), and hereby declares under penalty of perjury under the laws of the State of California, that this (TBD) EMS 9-1-1 Emergency Transportation Service RFP is genuine and not sham or collusive, nor made in the interest of or on behalf of any person not herein named; the Proposer has not directly or indirectly induced or solicited any other Proposer to put in a sham proposal nor solicited any other person, firm or corporation to refrain from submitting a proposal; the Proposer has not communicated, directly or indirectly, with any other Proposer regarding the amount, price, and/or service rates proposed herein; and Proposer has not in any manner sought by collusion to secure for himself/herself/itself any advantage over any other Proposer. We declare the foregoing is true and correct under penalty of perjury under the laws of the State of California. Signed, this 22nd day of October, 2018 in Orange, California. IF CORPORATION: October 31, 2018 Signature of CEO Troy M. Hagen October 31, 2018 Signature of Secretary Brian M. Richmond RFP # 18-059—CARE AMBULANCE SERVICE 250-200 50 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES Il • _► _ _►_ ITEM 17: PHOTOGRAPHS Care Ambulance staff proudly give back to their communities every day in partnership with first responder agencies throughout Orange and Los Angeles Counties. Care Ambulance Service's 'Pillars of Care' RFP # 18-059 — CARE AMBULANCE SERVICE 250-201 51 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Care provides a wide complement of pediatric Care employee Priscilla Rodriguez with Elijah, who was so equipment to maximize safety. taken with Priscilla and the business of EMS, he's now considering a career as a paramedic. Road Safety real-time safe driver monitoring provides instant feedback to Care's drivers and informs our quality improvement and training activities. RFP # 18-059—CARE AMBULANCE SERVICE Care Ambulance employs several cutting-edge strategies and data systems to continually improve our response times. 250-202 52 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CITY OF SANTA ANA Care Ambulance Billing staff show their EMS Week spirit. Care's on-site fleet maintenance facility includes a touchless carwash. Care Ambulance uses both static and dynamic vehicle deployment strategies to ensure crews are best positioned to respond quickly to the next call for help. Picture here, EMTs Ashlynn Martinez and John Dormer respond to a two -car crash during a rain storm. RFP # 18-059 — CARE AMBULANCE SERVICE Care Ambulance employees enjoy a diverse workplace reflective of the communities we serve. 250-203 53 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES CIN OF SANTA ANA APPENDIX With the U.S. healthcare system rapidly transforming, ambulance service executives are increasingly focused on how existing service lines can be adapted to provide better patient outcomes at a lower cost. Municipal ambulance services are facing the same level of scrutiny. Today in the City of Santa Ana, the City accepts all financial responsibility for the provision of ambulance services, both Basic Life Support (BLS) and Advanced Life Support (ALS). The City, through its third -party contracted billing agency, bills for the provided services, and hopes those recovered fees are sufficient to pay for the contracted ambulance services. The entire risk of ambulance revenue rests with the City of Santa Ana. An ambulance organization, public or private, must weigh a number of factors when deciding whether to provide ambulance services themselves or contract ambulance services. On the Municipal side that decision to provide ambulance services or contract for services also must include a review of California legislation covering ambulance contracting. In California, the relevant legislation governing City and County ambulance contracting is found in California Health and Safety Code Sections 1797.201 and 1797.224. These sections provide a "grandfathering" of service rights to those cities or fire districts that contracted for or provided prehospital EMS on June 1, 1980; in these cases, the administration of those services shall be retained by those cities or fire districts. The City of Santa Ana has contracted or provided EMS services prior to June 1, 1980, and so retains the right to continue to contract for EMS services. Having established a legal authority to contract or provide for EMS services presents the City of Santa Ana with the flexibility to contract services in a manner most beneficial to the City. In this "Appendix" to our proposal, Care Ambulance offers the following general overview of an optional alternative contracting opportunity with our organization. Care Ambulance currently serves the Orange County Fire Authority (OCFA) and other local cities/fire agencies, with a number of similar "Public/Private" partnerships. These models include an assumption by Care Ambulance of the risk for payment of services and revenue recovery methodology to reimburse the City for cost of ALS services. Specifically, for the City of Santa Ana, Care Ambulance is offering the option to provide all emergency ambulance services in the City of Santa Ana at no cost to the City. Care Ambulance would bill for services using rates already established by the Orange County Board of Supervisors. Care Ambulance would then retain the revenue collected to pay for these services and completely relieve the City of Santa Ana of the risk for non-payment. In addition, Care Ambulance offers to bill for the City's ALS transport services, currently provided in concert with OCFA, and pay that collected ALS revenue directly to the City of Santa :11Iii4:��b II�l_llW1162I111I_n[yWIW.VRM 250-204 54 PROPOSAL TO PROVIDE FIRE/EMS EMERGENCY TRANSPORTATION & RELATED SERVICES 0 CITY OF SANTA ANA Ana. Using current transport data, Care Ambulance estimates that this ALS recovery model would generate4approximately $840,000 in annual revenue to the City of Santa Ana. The estimated annual revenue of $840,000 would be without the risk of billing and collecting for ambulance services, as that risk would be borne entirely by Care Ambulance. Care Ambulance understands the City of Santa Ana has a current contractor for billing of ambulance services. Care Ambulance further understands that this contract does not expire until July 2019. As such, Care Ambulance would agree to use the City's current contracted billing services for all Santa Ana ambulance transports until this existing billing service contract with the City of Santa Ana expires. After that contract expiration, Care Ambulance would then provide all required ambulance billing services. Care Ambulance welcomes the opportunity to meet with designated City Officials to further discuss this proposed strategy and to share service contracts and the contracting results achieved with other area cities and fire agencies utilizing a similar model. RFP # 18-059— CARE AM 8U LANCE SERVICE 250-205 55 Secretary of State SI -550 Statement of Information (California Stock, Agricultural Cooperative and Foreign Corporations) IMPORTANT — Read instructions before completing this form. Fees (Filing plus Disclosure)– $25.00; - Copy Fees – First page $1.00; each attachment page $0.50; • Certification Fee - $5.00 plus copy fees •1:8='650101 FILE® Secretary of.Stat® State of Calwomle AUG 2 3 2018 1. Corporetlon NamB (EMerthe ermctnema of Sha corporation es Bis recerded with the Caft aP2. p �.•7 t� '1� t�I'KT a . o I a1 SevetaryofState. Note: Ifyou registered In Califomia using an assumed name, see trsWCUMs.) This Pace For Office Use O ly CARE AMBULANCE SERVICE, INC. 7 -Digit Secretary of state File Number. C1432655 C,. -I..-- Aww.A«-A a. street Address of PdndPal Executive OBke-Dor HIM a P.O. Box City (An eebrenfalions) stem 'tip Code 1517 West Braden Court Orange CA 92868 IS. Melling Address of Corporation lftif/arent than Item so City (no abbreviations) Stele Zip Code e Street Address of Pdndpal California Office, if any and B different than item tie- Do not list a P.O. Box Ciy(w abbreviations) Slate Mp Code 1517 West Braden Court Orange CA 92868 .4. Officers The Corporation Is required to list all three of the dRcers sol forth below. An additional title for the Chief Executive Officer and unlet Financial ORder may be added; however. Ne preprinted tides on this form must not be altered, Chief Executive Omeed First Name Middle Name lest Name Suffixe. Troy city (w chbreuietlens) Hagen Zip fade Address Cily(noebbroviatlons) State tip Code 1517 West Braden Colirt Orange CA I 92868 IS. Secretary FIrsl Noma Middle Name Last Name suffix Brian M, Richmond Address _ City (no ebbravlatlons) state tip Code 1517 West Braden Court Orange CA 92868 . M Chief Financial Omeed Fust Name• MWdie theme - last Name Sax All Mian Address City (no abbreviations) state Zip Code ' 1517 West Braden CDurt Orange CA 92.868 5. Director(s) Celltdmle Smoa and A96dultuM Goopannin corporations ONLY. Rem da: vw reasr uta name vnv uavna oma' uo u. -A. n A,o , r.rn.reA.............I wra .- nmol Oto.nmafal And addrn... on Form 56550A fees iMWdanal. a First Name . mdde Name last Name Stax Rick city (w chbreuietlens) Richardson Zip fade Address CIN Ino abbreviation) am Zip Code 1517 West Braden Court Orange CA 1 92868 b. Number orvaean des MUM Board of Diretlars, gam L -1 . S. Service of Process (Must provide either Individual OR Corporation.) tunnnni tet _ rn-Neta Itnmc an Anti Rh,mr¢ Must inv ude aeenra nel name end Caffiamla street address. a. Cathode Agents Fist Name(Ifegentis not a corporation) Middle Name Last Name six b. Street Address of agent is not a corporation)- Do not entero P.O. Box city (w chbreuietlens) Stata CA Zip fade CORPORATION-ComptateItemsconly. OteyIlltlde the name or IDs regsmrea agent Oorport on. Fo. colgoMa Re&lorad Corporate Assets Name gfagent is a wMand on)-Dn not remptete Siem 6a dr So C T Corporation System 7. Type of Business Desdba the type of business or services of the Corpmagon MEDICAL TRANSPORTATION S. The Information contained herein, Including In any attachments, Is true and correct. � p' 08-23-2018 Brian M. Richmond Secretary Date Type or Print Nome of Person Completing cue Farm • 'nue Signature 56550 (REV 0112017) II � 2017 California Se6vtary of State www.sta.ta.gwfousiflass(ba 250-206 Attachment to Statement of Information 8I -550A (California Stock and Agricultural Attachment Cooperative Corporations) A. Corporation Name CARE AMBULANCE SERVICE, INC. B. 7 -Digit Secretary of State File Number, .C1432655 ;18-650101 This Space For Office Use Ont C. List of Additional Direetor(s)— If the corporation has more than one director, enter the additional tlirectors' names and addresses. so. First Name Dan !Addle Name Last Name I Richardson SurtIY Address 1517 West Braden Court Ciy(wabbreviadons) Orange Stare CA Zip Code 92868 5e Flrst Nemo Troy . Middle Nemo Last Name Hagen sulfa ' Address 1517 West Braden Court City (w abbreulaaonte Orange Slate CA • ZlpCude- 92868 5d. Flnd Name Matt Middle Name last Name - Gallagher Sulfa Address 1517 West Braden Court City (no ebbreNedons) Orange State CA 7Jp Code 92868 Se. Flist Name All Mlddie Ndma Lest Name Mian Suffix Acidness 1517 West Braden Court City (no abbmdeaom) Orange State. CA Zip Code 92868 Sf. First Name Mille Name Les! Nema Suabt Address City (no abbrevledons)' State Zip Code _ aa. First Name Mole Name Lest Name• surix Address City (no abbreNadons) State Zip Code SL First Name Middle Naive last Name Suffix Address City (no abbreviations) state Zip Code Si. First Name l:. 'Ole... '. p: •i Middle NamLast Name Sulfa Addresa City (no abbnevla0uns) 'State LD Coda — 51. Flint Nam Middle Name Lest Nema Slllflx Address Ciry(no abbWaV03) Sate Zip code Sl.SsaA- Attachment (EST 112016) 2� , 250-207 2076 Caftnis SetrabryofShata wlawsos.agovlhusinesslhe m ym'c�rorepouq�y �• befutl,WeondoareaWplof odginel redord In Mo W7tody ORM Calttamb Seomtery of Sbteb office, AUG 2 4 2018 ALEX Pof State 250-208 Self Appraisal . . . . . . . M ... . . . . . . . . . . Vehicle Inspection and Characteristics . . . . . . . . . . . Critical Elements .: . . . . . . . . . . . . . . . . . . Situational Driving (Emergency and Non -Emergency) . Situational Driving Continued (Emergency & Non -Emergency) Special Considerations . . . _ . . . . . . You Be The Coach (Emergency Driving Scenarios) . . . . . Final Test: . . . , . . . . . . . . . . . . . . . . . . , . Page 3 . . . Page 6 . . , Page 7 ... Page Page 10 . . . Page 11 . Page 13 Page 14 FEI Welcome to Coaching the Emergency Vehicle Operator'" 4: Ambulance. This is an all-new course in the successful CEVOO series of driver training programs. Since its introduction over 25 years ago, tens of thousands of ambulance operators have completed these CEVO° courses. This latest course integrates feedback from past participants as well as current training experts. It also teaches safe operating principles, concepts, and the ever -evolving demands of the emergency response profession. However, as you know, not all hazards and collisions happen in response to an emergency. That's why this comprehensive course offers safe driving skills and techniques that can be applied during both emergency and non -emergency situations. You will rind the structure of this course to be different from many other safe driving courses. Instead of listening to a series of lectures, you will take an active part in the training. You will watch video, presentations on various driving situations common to operating an ambulance. Then, combined with your experience as an operator, you will respond to various scenarios in this Response Book and discuss them with your fellow participants. Doing so will help you to incorporate new safe operating_ principles into your driving and reduce your chances of having a collision or near miss. Name: The Information and recommendations contained In this publication have been compiled from sources believed to be reliable and to represent the best current opinion on the subject. No warranty, guarantee, or representation is made by the National Safety Council, Coaching Systems LLC or other distributors as to the absolute correctness or sufficiency of any representation contained in this publication, and the National Safety Council, Coaching Systems LLC and other distributors assume no responsibility in connection therewith; nor can it be assumed that all acceptable safety.measures are contained In this publication, or that other or additional measures,_ may not be required under particular or exceptional conditions or circumstances. Copyright 0 2017 Coaching Systems LLC MAY NOr BE REPRODUCED. 250-210 -1. When driving an ambulance at 60 miles per hour in ideal conditions, what is the recommended following distance? Z. What advice would you give to a new operator regarding controlling one's emotions while driving in a true emergency? 3. Where are the blind spots located on the ambulance that you normally drive? 4. What is your organization's policy for inspecting your ambulance? Include in your answer "when" it should be inspected as well as "how often." S. Describe your organization's policy for reporting a defect on your ambulance. Be specific. 6. What do you consider to be the most hazardous part of operating your ambulance on an emergency run? On a non -emergency run? Check Your Mirrors Copydgh1®2017CwCh1ngbVe =LLC MAY NOT BE REPRODUCED. 3 250-211 Self Appraisal — continued 7. You have been called to an. "active shooter" situation. Describe your protocol for responding to this type of'situation. 8. When driving an ambulance at 35 miles per hour,in ideal conditions, what is the recommended following distance? 9. Are there any exceptions to the rule that states "everybody must be buckled up"? Be specific. 10. What specific actions and precautions would you take when approaching a red light while on an emergency run? 11. Describe in your own words what the following terms mean to you regarding operating your ambulance. Be specific. Scanning Cushion of Safety Communicating Try to Maintain a Cushion of Safety 4 Copyright®2017 Coaching Systema LLC MAY NOT BE REPRODUCED. 250-212 1 Self Appraisal -- corrtirrr{ed 12. What are some of the factors that influence your total stopping distance? 13. In addition to adjusting your mirrors, what else can you do to reduce your blind spots? 14. How often should you glance in your mirrors? 15. Describe how each of the following differs between your personal vehicle and the ambulance you drive: Braking Distance Blind Spots Vehicle Characteristics 16. How many feet per second does your ambulance travel when traveling 60 mph? 17. Traffic specialists say that average reaction time is three quarters of a second. What is your reaction time? Communicate With Others Copyright 07017 C=h1ng Systeme LLC IdAY NOT SE REPRODUCED. 5 250-213 Vehicle Inspection & CharacterlsOcs 1. Complete the following statement: As an ambulance operator you must, at all times, operate the vehicle in a and manner without 2. When conducting an inspection, it is recommended that you use a checklist. Why is this important? 3. What is your organization's procedure for reporting a defect found on your ambulance? 4. List the items that you should check during an inspection in the following areas: Outside the ambulance: Engine area: Patient area: Operator area: S. Because of your lights and sirens, you do not have to be concerned with your blind spots. ❑TRUE ❑FALSE 6 Copyright ® 2017 Coaching Systeme LLC MAY NOT 8E REPRODUCEQ 250-214 r r y 6. How far ahead should you scan in city -like environments? And on open roadways? 7. What are some ways you can communicate with other drivers and pedestrians? Be specific. 8. How can your actions miscommunicate your intentions to others? Please give a exam 9. Your reaction time is always the same. ❑TRUE ❑FALSE Explain your answer: 10. What are the components of your total stopping distance? 11. What is the recommended following distance in ideal conditions when traveling at 40 mph or slower?. Scan all around your vehicle - notjust to the front CoWght 92017 Coaching Systems LLC MAY 250-215 7 SESSION TWO - Critcal Elements — continued 12. What is the recommended following distance in ideal conditions when traveling over 40 mph? 13. In what conditions would you increase your following distance? Be specific. 14. In this rural situation the ambulance "A" is approaching a stop sign at a controlled intersection. Describe how "A" should handle this situation. When on a non -emergency run: When on an emergency run: 8 Copyright 02017 Coaching Systema LLC MAY NOi BE REPRODUCED. 250-216 ©9)Qoc 0c:�c-�0(�) 9) �n�f))CC-) Q Se0= c»c'(D- ucE)aZ)0— e & (B CD C. OO QL;O(;z)(zD©OCO) ):JuOO (Di )iJ_r�(DCJt.,..r)000('9)r� 0 Q Q C-) (D CG UOQ Cl) 0m00u 00©00004) O O O G O Q3 a) G Q O 00 C)L7Q(EDPi Q rt L) L a lg, 0 CO i_) C5;0@' U Q OO Oc-011--DBQCJ C-) C50 (7OCl) :-)OQ ©C'OO G),w) 0 C., Q 000 i) n' O©Go00- 00 O ii)C) Q pQ O 0 a) O E) Q E, (E) IT, c-T)(D@I Q r U 00 e000 Q;J(J C,u0 C-) 0 0, (a) OO C>pl_,OO ii)OOO Q©n- C7G© dO Cw)OG'O0- OO G(=)UL Q©CE) 0)DUO(€, 00'QCE) 0(]Q G Q Q S CLuu If CIE) C)(6" )O CID CY)l )Ui)C')@i=`U (1r)JOOn ,S)(Z,(F) ((D r)` QD C- C- �'E" ;D C)OC)©Q 0� C7)Y) SO C")OO (9)OO ifj OOQW)00- Q >O(D(- Cl) Cl) Q OQQOQQ OQ ( �ng)Ce)Q(WDa. _`r-+ r=) nC�) C51 Ci GI©'C. )70C,C-', DCx.-��DEr, C-, `7 C.(�L C'C.(H) O LD Q) OOOOCl) C ) O CD('>>) v O C)(10(?)( nQ@O L<1Q(:':)a)GD1 Q C,)C)t=)OO CIDFj co�C:0- )v C: G;7 (D (OD G CC, I '-Y) CD- limm) O O Cj O O U C) O G O r CDQD('lG CU On (t`OO QQ00000GQO©Q)C7CFD JOO Cl(DQDC. rJSQOOOOQQ(DI Q UC-Q(D,.wj0- 60,Der )`)G(*)(_)(o_)©QQUCDvO(EC. ''D—' ( C, )im rrD,`•p%C)Q.- 00Cd) Q®(L'J = 0- (E) O C-) Q OCO) CU CD W) CED QO C>DC C-, O ID t -R) (D 0- 0- 0 0'000 CID (✓QOuD, ,a`(?>0- C)QQ(�,(0C40(;)r�)(>`lOO E)C-Q—C—) :�0i70C--:19Q C, C°, Cu) (o) (9) Q, -Z2) O O O( GOCRD QC)uG O0 (=)C(:)CI O0- QOl^J C7 00000 ®CP C) O Q n Q O C, r✓,•ui L)(C)I DZ (oJ -),70:. «,) C-) (5) '1r < l,u L w CII) 000Cl) <:J (010OO 'D Co) �¢�,. OO >O OO JG7000OOta©GGOO Oil C)O� )QO �)©C=,) id C)OJ C=.) C-5 (ID Q J© 0-(D(J(7 i w TI .a r ar roiru ru�rg r� �r1� Y, Ori,• o1 V'�OO ,JOI �,'. ., C. p00co —OOo I ;-._ ,o io!t✓-rai�s,�!OG. Gx: L.i uJ-:, Lo)rn �)�cJ t"t��C?i (3 J 5 C1 L1 lJ :j C4).-D(J r 'l_ 3• Cz I Cai 0(ot(]C') S Ora,00r)C,fJ(�"C--�1�JCO•_`.i:coo.(Dcc'C)O:?3>JQ) Z')(a' O©Oa 0a OC.(DGC-)0000 L"- Cj®©(5)o0- ':"�=?C90C'Gs- c (D '- Oo got .©OC�nO©C,(�000)OCJO�OOCC�00 >irt70 C I ra C>(m Jt�rulI < a ia. to i (Emergency and non -Emergency) 15. Why is covering the brake a recommended technique? Be specific. 16. When stopping behind another vehicle, how far back should you stop? Why? 17. In this situation, the light has just turned green. "A", with the green light, started through the intersection. Unfortunately, "B" continued through the intersection from the cross street and collided with "A". How could "A" have prevented this collision? When on a non -emergency run: When on an emergency run: Copyright O 9017 Coaching Systems LLC NAV NOT BE REPRODUCED. 9 250-219 ■ i tj ,B•z .W When on a non -emergency run: When on an emergency run: Copyright O 9017 Coaching Systems LLC NAV NOT BE REPRODUCED. 9 250-219 (Emergency and lion -Emergency) 18. How far ahead should you scan on an open roadway? 19. How can you determine if you are in another driver's blind spot? 20. If you are In another driver's blind spot, what should you do, if anything? 21. What is a "pinch point" situation? How would you avoid being caught in this situation? 22. In this situation, describe the potential hazards and safety considerations that "A" is facing. How would you handle them? If "A" is exiting the highway: If "A" is not exiting the highway: 10 Copyright O 2017 CwchlnB systems LLC MAY NOT BE REPRODUCED. 250-220 Special Considerations 23. Please listen carefully to the ten questions on the video presentation. Following each, you will have five seconds to answer either True or False. 1. ❑TRUE LI FALSE 6. LITRUE ❑FALSE 2. L) TRUE LI FALSE 7. ❑TRUE ❑ FALSE 3. ❑TRUE LI FALSE 8. ❑TRUE LI FALSE 4. ❑TRUE LI FALSE 9. ❑TRUE LI FALSE S. ❑ TRUE ❑ FALSE 10. ❑ TRUE ❑ FALSE 24. For each of the following driving situations, what safety precautions would you take? Please answer as completely as possible. Backi Driving at Night Hydroplaning Roundabouts/Traffic Circles Ccpyrl8ht®7D17CWddng Byetems LLC MAY NOT BE REPRODUCED. 250-221 11 SESSION FIVE - Special Considerations -- continued Move Over Toll Areas 25. 1(A) was stopped behind vehicle "C" at an intersection. "C" must've had a problem because the driver got out and lifted the hood. When I backed up to get around "C", I struck the vehicle "B" right behind me that pulled up too close. What, if anything, could the driver of the ambulance "A' have done differently to avoid this collision? Avold Backing When Possible 12 Copyrlght02017 CoaeNag Systema LLC MAY NOT BE REPRODUCED. 250-222 7jr _ ,,wwrr% �S�iS f fai a 1,�� i�t 4_ ri„f♦'' _Ji. In the appropriate spaces below, record your responses to the eight emergency driving scenarios presented. 1. 2. 3. 4. S. r-11 7. 8. Cover the Brake WhenApproaching Potential Hazards Copyright ®2017 Coaching Systema LLC MAYNOT 250-223 13 -CEVQ 4 AM8ULANCE FINAL TEST TO ID ;218 1. When inspecting your ambulance: a, try to perform the Inspection the same way each kine. b. use a cheddist d possible, c. review the previous inspection report. d. All of the above. 2. Check that the ambulance's tires are property Inflated by: o. using an appropriate gauge. b. kicklog the fives and listening fora hollow sound c. striking the lines with a solid object. d. visually inspecting the fires., 3.properly adjusted mirrors will: e. eliminate Wind spots b. allow you to safely exceed the speed Emit c. reduce your Wind spots. d. allow you to reduce your following distance while on emergency rums. 4. All of the following are true of blind spots €=: a, they can be created by the structure o1 the ambulance. b. they can be eliminated by property adjusting the minots. c. they are different from the blind spots around your personal vehicle. d. properly adjusted minors will reduce their size. 5. Before moving the ambulance, be sure that everyone Is buckled In and secured aft: a, on an emergency run. b, on a non -emergency con. e, when patient care would be adversely impacted. d. when traveling at slow speed. 6. What do the fetters "SCC" stand tor? a. Safety, Care, Concent b. Scanning; Cushion of Safely, Communicating c. Speed, Control, Care d. Scan, Care, Control '7. When driving an open roads such as highways, try to scan down the road: a.12-15 seconds. e. 3 vehicle lengths. b. 3-5 sec onds. d. to the next vehicle. B. When driving in congested, city -like environments, try to scan: a. to next vehlda. Is. 3.5 seconds ahead e. a block to a bock and one had ahead. A. four vehicle lengths ahead. 9. How often should you glance In your mirrors? a. every 12-15 seconds. b. �Mry. 3-5 seconds. c. only when. preparing to change lanes.. d. once each nue. 10. What does "Cushion of Safety" refer to? a. the patient care area b. the area protected with safety ah bags. c. the area around ycur ambulance. d. the area within your ambulance. 11.Which area of your Cushion of Safety Is the most critleal? a. to the IronL b. to both skin e. dnectly behind. d. the area within the ambulance. 12. The front tires of the ambulance should have a minimum tread depth of: a. 2142 of adlirch. c. 2M of an Inch. - b.4132 of an inch.. d. 4116 of an inch. 13, Maintaining a cushion of safety Is Important: a. only in adverse weather. b, only on the highway. c. only in the city. d. In all driving environments 14. A key concept In establishing a cushlon of safety In front of the ambulance Is: a. using your emergency lights and siren. b. maintaining a safe following distance. c. traveling slightly faster than the speed limit d. changing lanes frequently to avoid . traveling behind other vehicles. 15. A safe following distance Is _your ambulance's total stopping distance. a. the same as c. less than b. greater than d. not related to '16. Leaning in your seat while glancing in your mbrots: a. is not recommended. b. is only recommended when driving on the highway. c. is only recommended when backing. d can help you monitor your bund spots. 17, Which of the following Is not a component of your total stopping distance? e. Following Distance b. Braking Distance c. Reaction Distance d. perception Distance 18. As you approach the ambulance to perform an Inspection, do all of the following MM:, a. look for obvious damage or leakg fluid. b. check compartment doors c. Mc k each tits to check for proper inflaffan. d. use a cheddisl if one is avalabfe: 19. Trying to maintain a safe following distance is Important: a. only when being taggated. b. only at highway speeds. c. only in adverse weather. d. under an driving circumstances. '20. The average reaction time for all drivers Is: a. 314 of a second. b. 2 seconds. c. 3-5 seconds. U..1 second. '21.' Covering your broke will: a. allow you to reduce your fallowing distance. b. allow you to safely exceed the speed limit e, help reduce your reaction ffme. d. eliminate non -emergency colrisiora., 22. Total slopping distance is: a. difficult to predict accurately. b. is the same for all vehicles. c. is always the same regardless of conditions. d. Is the same regardless of speed. 23. In Ideal condlllorte and when traveling under 40 mph, the recommended minimum following distance Is: a. two vehicle lengths. b. 3 seconds. e.4 seconds. d. 5 seconds. 24. In Ideal conditions and when traveling over 40 mph, the recommended minimum following distance is: a. duee vehicle lengths 6.3 seconds., c. 4 seconds d. 5 seconds, 25. When approaching a jaywalker attempting to cross the street, which of the fallorAng is not recommended: e, cover the brake as you approach. b. stop and wave the jaywalkar across the street, c. be certain the jaywalker remains on the side of the read before proceeding. d. be prepared to stop. 26. When approaching a `stale green light, It is recommended that you: a. aoceler5te slightly to make it through the inter. section. b. cover the brake as you approach. e. stop before the IntersmWit. d. put your emergency rights on to warn others. 27. When stopping behind another vehicle, do so dose enough to prevent pedestrians from passing between the two vehicles: a. True b. False 14 Copyrraht03017 Coaching Systema LLC MAY Nor aE REPRCOUCEn: 250-224 28. If you must stop at an Interseellon before making a left turn, you should: a. wait with your wheels turned to the left. Jr. wait with your wheals pointed straight ahead e. wait with your wheels turned to the right d. turn on your hazard lights. 29. When you have the choice of two designat- ed left turn lanes, from which lane should_ you make the tum if possible? a. The lane to the fight b. The lane to the left. c. Either lane: it makes no difference. d. Straddle both lanes to prevent others from turning at the same time. 30. If you are stopped at an Intersection, controlled by a traffic light and the Ilghl turns green, It Is recommended that you: a. proceed immedwtety to avoid being struck from behind. b. tum on your emergency lights briefly to clear the Intersection. c. use your siren to make sure others see your ambulance before proceeding. d. delay your start to be certain the intersection dears. 31. When on a ramp and preparing to enter a highway, you should'do each of the follow. Ing exceor: a. stay close to the vehicle ahead to make entering and merging easier. b. scan for opening In traffic across all lanei c. maintain a safe following distance. d. use your turn signal to communicate your Intention to enter the highway. 32. On the open roadway and traveling at typical highway speeds, scanning ahead 12 —15 seconds Is: a. ineffective. b. about 114 mile ahead. d fecommended only when on an emergency run. d. abobt 112 mile. 33.You should assume that you are in another driver's blind spot: a. if you cannot see the other vehicle's inside rear view minor through the rear window. b. at all limes. c. it you cannot see that other vehkle's rear bumper. d if you cannot see the other vehicle's license plate. 1. It you notice that you are being tallgeted, you should: a. tap the brakes to yarn the other driver. b. briefly turn an your emergency lights. e. Increase your following distance. d Increaseyour speed. 35. When you approach a red light on an emergency run: a. it is not necessary to slop. b. you should slop before entering the intersee- Vonand proceed only when sale. c. you should stop and wail for the light to tum green: d. your lights and sirens will prevent other vehicles from entering the inlerseclion. 35.When preparing to back, you should do all of the following except: a. ask a pedestrian to watch your backing path. b, scan your backing path as you approach the site. c. back only when you are certain that it Is safe. d. open your window slightly so you can hear exterior warnings. 37. When backing with a helper or spotter, agree on hand signals before beginning: s. True - b. False 38.When driving at night: a. flash your high beams t another driver neglects to lower their headlights. b. use your high beams at all times for better visibility. c. use your low beams at an times. d. use your high beams whensafeand legal to do so. 39. On an emergency run, which of the follow - Ing is a concent? a. Tailgalers. .b. Maintaining a cushion of safety. c, Passing other vehicles. d. All of the above. 40.When driving at night and another vehicle approaches with high beams: a. flash your high beams. b. briefly flash your emergency lights. c. shift your eyes to the right edge'of the lane. d. pull onto the shoulder to avoid being blinded. 41. Which of the following is true of hydroplaning: a. it can occur at speeds as low as 30 mph. b. it is not a concern for ambulance drivers. c. it occurs'only during very heavy rain. d. once If occurs, hard braking will reduce its effects. 42. When driving In wet, Icy or other slippery conditions, you should: a. keep your speed low. b. increase your following distance. c. avoid sudden braking and steering. d. All of the above. 43. When approaching traffic elreles, you should try to do the following e3{ N: a. know your exit ahead of time and ff you miss it, continue around the &Ce. b. scan ahead for clues about the traffic patem. c, cover the brake as you new in case you must slop (of other vehicles. d, if you miss your exit point, slop and back up. 44. Ali of the following are true of the "Move Over Lad' except that t: a states Ihat other vehicles must move over to an adacent lane when approaching an emergency vehicle displaying its lights. 6. states that if another vehicle cannot move over to an adjacent lane, it must slow before passing the emergency vehicle. c. does not apply to "ambulances.' d. applies to all police, fire and ambulance vehicles. 45. A vehicle's stopping distance can be affected by: a. the road con?tions, b. the type of tires. e. the reaction time of the driver. d. All of the above. 46. Effective scanning allows you to: e, monitor the area In front as well as the traffic around your ambulance. b. exceed the speed Emil. c. monitor and asslat with patient care. d. Ali of the above. 47. Checking your mirrors: e. allows you to spot following vehicles before they move into a Iallgating posa'on. b. will distract you from driving safely. c. Is recommended only when backing. d is recommended only when chanifing lanes. 48. When driving on lural roads: a. following distance beromes less Important, b. visibility and maneuverability are restricted; c. mirror chicks are unimportant d. scanting becomes fess important.. 49. On an emergency run: e. you can disregard all train control laws. b. your main concern is gaging to the site as fast as possible. c. you can disregard some traffic control laws, but must still drive responsibly and with regard for the safety of others. d. your responsbtlity'is both driving and monitoring patient care. 50. When you are running with your lights and sirens on: a, assume drivers ahead can see and hear you, then scan further doom the road b. expect other drivers to yield to, you. c. don't assume others can see and hear you and will ad correctly. d. it is safe to disregard all traffic control laws. Copyright ®aat7 Cnnching Bystemc LLC MAY NOT BE REPRODUCED. 250-225 is H:w I ft Mission and Values Statement Above all else,, CARE is committed to the care and.1mprovement of human life. In recognition of this commitment, we will strive to deliver high quality, cost-effective healthcare in the communities we serve.. In pursuit of our mission,' we believe the following value.statements are�es sential and timeless: • We recognize and affirm the unique and Intrinsic worth of each Individ- ual • We treat all those we serve with compassion and kindness. • We act with absolute honesty, integrity and fairness inthe way we con- duct our business and the way we live our lives. • We trust our colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty, respect, and dignity. Purpose of Our Code of Conduct Our Code of Conduct provides guidance to all CARE colleagues and assists us in carrying out our daily activities within appropriate ethical and legal stand- ards. These obligations apply to our relationships with patients, affiliated phy- sicians; nurses, third -party payers, subcontractors, Independent contractors, vendors, consultants, and one another. TheCode is a critical component of our overall Compliance Program. We have developed the Code to ensure we meet our ethical standards and com- ply with applicable laws and regulations. The Code is intended to be comprehensive and easily understood. In some instances, the Code deals fully with the subject covered. In many cases, how- ever, the subject discussed has so much complexity that additional guidance is necessary for those directly involved with the particular area to have suffi- cient direction. To provide additional guidance, we have developed a compre- hensive set of compliance policies and procedures which maybe accessed by contacting the Compliance Officer or reviewing the Reference Binder'of Policies and Procedures available from your Manager. Those policies expand 250-228 upon or supplement many of the principles articulated in this Code of Con- duct. Every employee, administrator, and member of management should' use the Code of Conduct to understand the specific Intent behind each policy and procedure. The standards set forth in the Code and in the Policies and Procedures are mandatory and must be followed. Leadership Responsibilities While all CARE colleagues are ob- ilgated to follow our Code, we ex- pect our leaders to set the exam- ple, to be In every respect a mod- el. We expect everyone in the or- ganization with supervisory re- sponsibility to exercise that re- sponsibility in a manner that is kind, sensitive, thoughtful, and respectful. We expect each super- visor to create an environment where all team members feel free to raise concerns and propose ideas. We also expect that they will ensure those on their team have sufficient infor- mation to comply with laws, regulations, and policies, as well as the re- sources to resolve ethical dilemmas. They must help to create a culture with- in CARE which promotes the highest standards of ethics and compliance. This culture must encourage everyone in the organization to share concerns when they arise. We must never sacrifice ethical and compliant behavior In the pursuit of business objectives. Our Compliance Program encourages what we refer to as "principled leader- ship." Such leadership assumes that those in our organization will lead by ex- ample, xample, confront problems directly and candidly, be inclusive in making deci- sions as to who should participate In the decision=making process, try to give the maximum responsibility to those who work with them, and emphasize effective team -building. In addition to these fundamental approaches to prin- cipled leadership, we expect those in our organization to understand and care -about their colleagues at work. CARE's work is accomplished each day, for the most part, in small team settings. This encourages all leaders to try to 250-229 ensure that the talents Of•each member of the organization are utilized to the rriazimum extent possible -'and that we give careful attention to the pro- fessional development of all of those within CARE. _Leaders and managers must also understand that certain laws hold those in positions of'authority responsible and accountable If a healthcare provider violates the law. For this reason, it Is very important for managers to contact the Compliance Officer or CARE's legal counsel If there is any doubt as to the. legality of actions.taken by anyone associated with or employed by CARE. Our Fundamental Commitments We affirm the.following fundamental commitments: To our patients: We are committed to providing quality care that is sensitive, compassionate, promptly delivered, and cost-effective. To our CARE colleagues: We are committed to a work setting which treats all colleagues. with fairness, dignity, and respect, and affords them an opportunity to grow, to develop profession- ally, and to work in a team environment in which all ideas are considered. To our paramedics, emergency medical technicians, nurses, and other medical providers: We are committed to providing a work environment which has excellent facilities, modern equipment and vehicles, and outstanding professional support. To our third party payers: We are committed to dealing with our third - party payers in a way that demonstrates our commitment to contractual obli- gations and reflects our shared concern for quality healthcare and bringing efficiency and cost effectiveness to healthcare. We encourage our private third -party payers to.adopt their own set of comparable ethical principles to explicitly recognize their obligations to patients as well as the need for fair- ness in dealing with providers. To our regulators: We are committed to complying with all applicable laws, regulations, statutes, and guidance issued 'by the state of California 250-230 and the federal government. Weare committed to an environment in which compliance with rules, regulations, and sound business practices Is woven Into the corporate culture. We accept the responsibility to aggressively self - govern and monitor adherence to the requirements of law and to our Code of Conduct. To the communities we serve: We are committed to honest and respon- sible actions and corporate conduct. We are committed to understanding the particular needs of the communities we serve and providing these communi- ties quality, cost-effective healthcare. We realize as an.organization that we have a responsibility to help those in need. We proudly support charitable contributions and events In the communities we serve in an effort to promote good will and further good causes. 7*0MIt, 4S iN�m�g 94raF��� i ",iNQ C4gOlN�� "OK7tnL��t',' i enmsscu k� .RPOClS� To our suppliers: We are committed to fair competition among prospec- tive suppliers. We encourage our suppliers to adopt their own set of compa- rable ethical principles. 250-231 Quality of Care and Patient Safety Our mission'is to provide high quality, cost-effective healthcare to all of our patients.'We treat all patients with warmth, respect, and dignity and provide care that is both necessary and appropriate: As a general principle, CARE aspires to a standard of excellence for all em- ployem and contractors in the areas of quality of care and patient safety.. This commitment is an obligation of every CARE colleague, which includes .employees; contractors, vendors, managers, directors, owners, and anyone who acts or performs services on behalf of CARE. Accordingly, it is a fundamental principle of being part of CARE that each per- son dedicate himself or herself to achieving the goals described here. In addi- tion, in any circumstance where a CARE colleague has a question about whether the quality or patient safety commitments set forth herein are being fully met, that individual is obligated to raise this concern through appropri- ate channels until it is'satisfactodly addressed and resolved. Such channels include the CARE colleague's supervisor, and If necessary, the CARE Ethics Line or Compliance Officer. Patient Rights We make no distinction in the availability of services or In the care we,provide based on age, gender, disability; race, color, religion, financial classification, or national origin.We recognize and respect the diverse back= grounds and cultures of our pa- tients and make every effort to equip our caregivers with the knowledge and resources to re- spect each patient's cultural heritage and needs. Each patient Is provided with a written statement of patient rights and a no- tice of privacy practices. These statements Include the rights.of a patient*to make decisions regarding medical care, the right to refuse or accept treat- Ment, reatMent, the right to informed decision-making, and. a patient's rights related to 250-232 his or her health Information main- tained by CARE. Such statements con- form to all applicable state and Federal laws, including but not limited to the Health Insurance Portability. and Ac- countability Act of 1996 (hereinafter re- ferred to as HIPAA). We seek to involve patients in all as- pects of their care, including giving con- sent for treatment or transfer and mak- Empathy is patiently and Sincerely seeing the world through the other, person's eyes. Itis not learned in school; it.i�. cultivated' over a lifetime -Allier, Einstein, _ -_ Ing healthcare decisions. As applicable, each patient or patient representa- tive is provided with a clear explanation of care. In the promotion and protec- tion roteation of each patient's rights, each patient and his or her representatives are accorded appropriate confidentiality, privacy, security, advocacy and protec- tive services, opportunity for resolution of complaints, and pastoral care or spiritual care. Patients and, when appropriate, their families are informed about the out- comes of care, treatment and services that have been provided, including un- anticipated outcomes. Patients are also involved as clinically appropriate In resolving dilemmas about care decisions. Patients have the right to refuse care,. treatment, and services in accordance with the law and regulations. . CARE also maintains processes for prompt resolution of patient grievances which include informing patients who to contact regarding grievances and Informing patients regard - Ing the grievance resolu- tion. ILa Patient Information C. 250-233 To the extent possible, we collect information about the patient's medical con- dition, history, medication, and, family Illnesses to Provide quality care. We are also committed to keeping comprehensive medical records that adequately explain and support the need for the services provided. We realize the sensitive nature of this information and are committed to maintaining its confidenti- ality. Consistent with HIPAA and with the California Confidentiality of Medical Infor- mation Act (CMIA), we do not use, disclose or discuss patient -specific information with others unless it is necessary to serve the patient or required by law. CARE colleagues must never use or disclose confidential information that vi- olates the privacy rights of our patients. In accordance with our appropriate access and privacy policies and procedures, which reflect HIPAA and CIVIIA requirements, no CARE colleague, affiliated healthcare providers, or other healthcare partner has a right to any patient information other than that nec- essary to perform his or her job. Subject only to emergency exceptions, pa- tients can expect their privacy will be protected and patient specific infor- mation Will be released only to persons authorized by law or by the patient's written authorization. Healthcare Providers Working for CARE As set forth in our Fundamental Commitments, CARE is committed to provid- Ing a work environment for paramedics, emergency medical technicians, nurses, and other licensed or credentialed providers who provide medical care on behalf of CARE that is excellent In all respects. We encourage mem- bers of our medical staff to be familiar with this Code of Conduct. There are many portions of this Code of Con- duct that pertain to ethical or legal obligations of medi- cal providers, and this docu- ment is likely to be a helpful summary of those obliga- tions for our medical staff members. 9 250-234 Interactions with Hospitals, Physicians, and Other'Potential Referral Sources Federal and state laws and regulations govern CARE's relationship with hospitals, physicians, and any other individuals or entities who may refer patients to CARE. The applicable Federal laws'lnclude the Anti:Kickback Law and the Stark Law (applicable to physiclans refer- rals). Any payment that can be considered a kickback is prohibited. Additional information about these laws Is set forth in the CARE Compliance Policies and Proce- dures. It Is Important that those CARE colleagues who interact with hospitals, physicians, and other potential referral sources are aware of the requirements of the laws, regulations, and policies that address relation- ships between CARE and potential referral sources. If relationships with hospitals, physicians, and other potential'referral sources are properly structured, but not diligently administered, failure to ad- minister the arrangements as agreed may result in violations of the law. Any arrangement with a hospital, physician, or other potential referral source must be structured to ensure compliance with legal requirements, our poli- cies and procedures, and with any operational guidance that has been Is- sued..Most arrangements must be in writing and approved by CARE's CEO. Fallure to meet all requirements of these laws and regulations can result in serious consequences for CARE. For more information, see the CARE Com_- pilance'Policles and Procedures. Keeping in mind that it is essential to be familiar with the laws, regulations, and policies that govern CARE's Interactions with physicians and other poten- tial. referral sources, two overarching principles govern our interactions with all potential referral sources: • CARE does not pay for referrals. We accept patient referrals and ad- missions based solely on the patient's medical needs and our ability to render the needed services. We do not pay or offer to pay anyone— colleagues, physicians, or other persons or entities — for referral of pa- tients: • CARE does not accept payments for any referrals we make. No CARE ao 250-235 colleague, or any other person acting on behalf of the organization is permitted to solicit or receive anything of value, directly or indirectly, 'including loans, rebates, or services, in exchange for the referral of pa- tients. Similarly, when making patient referrals to another healthcare provider, we do not take into account the volume or value of referrals that the provider has made (or may make) to us. For additional information, consult the CARE Compliance Policies and Proce- dures. Any referral or pattern of referrals that is questionable should be brought to the attention of the Compliance Of- ficer immediately. �•-- - Legal and Regulatory Compliance CARE provides healthcare services pursuant to ,i� „i �,vyvtbil appropriate Federal, California, and local laws i and regulations, and the conditions of participa- tion for Federal healthcare programs. Such laws, regulations, and conditions of participation may include, but are not limited to, subjects such as licenses, permits, accreditation, access to treatment, consent to treatment, medical record-keeping, access to medical records and confidentiality, patients' rights, research, corporate practice of medicine restrictions, and Medicare and Medicaid program requirements. The organization Is subject to numer- ous other laws in addition to these healthcare laws, regulations, and the con- ditions of participation. We have developed policies and procedures to address many legal and regu- latory requirements. However, it is impractical to develop policies and;proce- dures that encompass the full body ' of applicable law and regulation. Ob- viously, those laws and regulations not covered in organization policies and procedures must be followed. �o Anyone aware of violations or sus pected violations of laws, regula- r tions, the conditions of participation, or CARE policies and procedures must report them immediately to.a ,- supervisor, or to CARE's Human Re= 250-236 sources Director, Compliance ,Officer, or the _Ethics Line Surveys and Accredltatlons From timeAo-time, government agencies, accreditation agencies, and other entities conduct surveys in our facility. We respond with openness and accu- rate information. In preparation for or during a survey or inspection, CARE colleagues must never conceal, destroy, or alter any documents; tie; or make misleading statements to the agency representative. Colleagues also must never attempt to cause another colleague to'fail to provide accurate infor- mation or obstruct, mislead, or delay the communication of :information or records relating to a possible violation of law. Business and Financial Information Accuracy, Retention, and Disposal of Documents and Records. Each CARE colleague is responsible for the integrity and accuracy of our or- ganization's documents and records, not only to comply with regulatory and legal requirements but also to ensurexecords are available to support our business practices and ac- tions. No one may alter or falsify information on any record or document. Records must never be de- stroyed in an effort to deny. governmental authorities that which may be relevant to a government Investi- gation. Medical and business documents and records are retained in accordance with the law and our record retention policy, which Includes comprehensive retention schedules. For retention schedules, seethe CARE Compliance Poli- cles and Procedures. Medical and business documents. include paper documents such.asaetters and memos, computer-based information such as e-mail or computer files on disk or tape, and any other medium that contains information aboutthe organization or Its business activities. It is important to retain and destroy records only according to our polices and procedures. CARE colleagues must not tamper with records. No one may remove or de- stroy records prior to the specified date without first obtaining permission as outlined in the CARE records management policy. Finally, under no circum - 12 250-237 stances may a CARE colleague use patient, colleague or any other individu- al's or entity's information for his or her personal benefit (e.g., to perpetrate identity theft). Coding and Billing for Services — CARE bears a great responsibility to the.public to accu- rately bill for services. Only those services that are. medically necessary and properly authorized, ordered, and performed will be billed. We have implemented i policies, procedures and systems to facilitate accurate billing to government payers, commercial Insurance : payers, and patients. These policies, procedures, and " systems conform to pertinent Federal and state laws and regulations. We prohibit any colleague or agent of CARE from knowingly presenting or causing to be presented claims for pay- ment or approval which are false, fictitious, or fraudulent, or from retaining any funds to which the person or CARE Is not entitled beyond the refund deadline. For additional information, see the CARE Compliance Policies and Procedures. In support of accurate billing, medical records must provide reliable, accu- rate, and timely documentation of the services we render. It is important that all individuals who contribute to medical records provide accurate infor- mation and do not destroy any information considered part of the official medical record. Any subcontractors engaged to perform billing or coding services are ex- pected to have the necessary skills, quality control processes, systems, and appropriate procedures to ensure all billings for government and.commercial insurance programs are accurate and complete. CARE requires such entitles to have their own ethics and compliance programs and code of conduct or to adopt CARE's�� code as their own. In addition, third -party billing entities, con- _NEW tractors, and preferred vendors !!!T� under contract consideration must be approved consistent with CARE's cor- porate policy on this subject. 13 250-238 For coding and billing questions; please contact the. CARE Billing DepaFtment or'refer to the Compliance Policies and Procedures. if at any time you suspect that services are not being billed accurately, please'no- tify a supervisor or the Compliance Officer Immediate- ly. Confidential Information The term "confidential information" refers to proprietary information about CARE's strategies and operations as well as patient information and third party Information. Improper use or disclosure of confidential Information could violate legal and ethical obligations. CARE colleagues may use confi- dential information only to perform their job responsibilities and.shall not share such Information with others unless the Individuals and/or entities have a legitimate need to know the information in order to perform their. spe- cific job duties or carry out a contractual business relationship;• provided dis- closure is not prohibited by law or regulation. Confidential information covers virtually anything'related to CARE's opera - .tions that is not publicly known, such as personnel data maintained by CARE; patient lists and clinical information; patient financial information; pass- words;.pricing and cost data;.financial data; details regarding.Fedeial,'state, and local tax examinations of CARE; research data; strategic plans; market- ing strategies and techniques; supplier and subcontractor Information; and proprietary computer software. In order to maintain the confidentiality and integrity of patient and confidential information, such information should be sent through the Internet only in accordance with information security poli- cies and standards, which require, among other things, that the individual and/or entity be validated and the information be encrypted. Use of d_ ue care and due diligence is required to maintain'the confidentiality, availability and integrity of information assets that CARE owns or of which It is.the custodian. Because so much of our clinical and business information is. generated and contained within our computer systems; itis essential that each CARE colleague protect our computer systems and the information contained in them by not sharing passwords and by reviewing and adhering to our infor- mation security policies and guidance. 14 250-239 If an Individual's employment or.contractual relationship with CARE ends for any reason, the individual is still.bound to maintain the confidentiality of in- formation viewed, received or used during the employment or contractual business relationship with CARE. This provision does not restrict the right of a colleague to disclose, if he or she wishes, Information about his or her own compensation, benefits, or terms and conditions of employment. Copies of confidential information in an employee's or contractor's possession shall be left with CARE at the end of the employment or contractual relationship. Electronic Media and Security Requirements All communications systems, Including but not limited to computers, elec- tronic mail, Internet access, telephones, personal data assistants, communi- cation devices, and voice mail, are the property of CARE and are to be used primarily for business purposes in accordance with electronic communica- tions policies and standards. Limited reasonable personal use of CARE com- munications systems is permitted; however, users should assume these com- munications are not private. Users of computer and telephonic systems should presume no expectation of privacy in anything they create, store, send, or receive on the computer and telephonic systems, and CARE reserves the right to monitor and/or access communications usage and content con- sistent with CARE policies and procedures. Colleagues may not use internal communication channels or access to the Internet at work to post, store, transmit, download, or distribute any threaten- ing materials; knowingly, recklessly, or maliciously false materials; obscene materials; or anything constituting or encouraging a criminal offense, giving rise to civil liability, or otherwise violating any laws. Also, these channels of communication may not be used to send chain letters, personal broadcast messages, or copyrighted documents that are not authorized for reproduc- tion. CARE colleagues who abuse our communications systems or use them excessively for non -business purposes may lose these privileges and be suti- ject to disciplinary action as set forth in the CARE Compliance Policies and Procedures. IE 250-240 CARE colleagues shall comply with CARE's security policies governing use of Information systems. Only assigned user IN and passwords shall be used.. 'Passwords shall never be shared or disclosed. Colleagues shall never use tools or techniques to break or exploit CARE information.security measures, or those used by other companies or Individuals. CARE information systems shall not be used to access inappropriate or prohibited websites. Financial.Reporting and Records. CARE has established and maintains a high standard of accuracy and com- pleteness in documenting, maintaining and reporting financial information. This information serves as a basis for managing -our business and is im- portant in meeting our obligations to patlents, colleagues, suppliers, and oth- ers. It is also necessary for compliance with tax and finan- cial reporting requirements. To lmowl ' All financial information must reflect actual transactions what igs and conform to generally -accepted accounting principles. n , t ahi l All funds or assets must be properly recorded in the books . 'I?Qt'tU?40it and records of CARE. The organization maintains a system of Internal controls to provide reasonable assurances that *Sale"WOIst all.transactions are executed in accordance with manage-,- COWardiCr;. ment's authorization and are recorded in a proper manner so as to maintain accountability of the organization's as- sets. 0011 , �C111S Anyone having concerns regarding questionable account- ing or auditing matters should report such matters to by calling the CARE Ethics Line (714288-3958) or calling the CARE Compliance Officer. Workplace Conduct and Employment Practices Conflict of Interest A conflict of interest may occur if a CARE colleague's outside activities; per- sonal financial interests, or other personal interests influence or appear to Influence his or her ability to make objective decisions in the course of the colleague's job responsibilities. A conflict of interest may also exist if the de- mands of any outside activities hinder or distract a colleague from the perfor- mance of his or her job or cause the Individual to use CARE resources for oth- I6 250-241 er than CARE purposes. CARE colleagues are obligated to ensure they remain free of conflicts of interest in the performance CARE. of 1heir responsibilities at In particular, clinical decisions will be made without regard to compensation or financial risk to CARE leaders, managers, clini cal staff, or licensed, independent practitioners. If any CARE colleague has any question about Whether an outside activity or personal interest Aq might constitute a conflict of interest, he or she must obtain the written approval of his or her su- pervisor before pursuing the activity or obtaining or retaining the Interest. Storing and Dispensing Controlled Substances Some CARE colleagues routinely have access to prescription drugs, con- trolled substances, and other medical supplies. Many of these substances are governed and monitored by specific regulatory organizations and must be administered by physician order only. Prescription and controlled medica= tions and supplies must be handled properly and only by authorized individu- als to minimize risks to .us and to patients. If an individual becomes aware of inadequate security of drugs or controlled substances or the diversion of drugs from the organization, the incident must be reported immediately. Copyrights CARE colleagues may only copy and/or use copyrighted materials pursuant to the organization's policy on such matters. Diversity and Equal Employment'Opportunity e- CARE actively promotes diversity In its Work- force at all levels of the organization. We are committed to providing an inclusive work en- vironment where everyone is treated With fairness, dignity, and respect. We will make ourselves accountable to one another for the manner in which we treat one another and 17 250-242 for the manner In Which people around us are treated. We are committed,to recruit and retain a diverse staff reflective of the;patients and communities' We serve. We regard laws, regulations and policies relating to diversity as a minimum standard. We strive to create and maintain a setting In which we celebrate cultural and other differences and consider them strengths of the organization. CARE is an equal opportunity workforce and no one shall discriminate against any indi- vidual with regard to race, color, religion, sex, ethnic origin, religion, age, disability, sexual orientation, or veteran status with respect to anyoffer, or -term or con- dition, of employment. We make reasonable accommodations to the known physical and mental limitations of qualified individuals with disabilities. Harassment and Workplace Violence Each CARE colleague has the right to work in an environment free of harass- ment and disruptive behavior. We do not tolerate harassment'by anyone based on the diverse characteristics or cultural backgrounds of those who work with us: Degrading or hurrilliating jokes, slurs, intimidation; or other har- assing conduct is not acceptable in our workplace. Sexual harassment is prohibited. This prohibition includes unwelcome sexual advances or requests for sexual favors in conjunction with employment deci- sions. Moreover, verbal or physical conduct of a sexual nature that'interferes 'with an Individual's work performance or creates an intimidating; hostile, or offensive work environment has no place at CARE. Harassment also includes Incidents of workplace vlolerlce. Workplace vio- lence includes robbery and other commercial crimes, threats, stalking, vio- lence directed at CARE or its employees or patients, � t SAFETY IS EVERYBODY'S ' JOB terrorism, and hate crimes committed by current_ or former colleagues. CARE colleagues Who observe or experience any form of discrimination, harassment or violence should report the incident to their supervisor, the Hut 18 250-243 man Resources Director, a member of management, the Compliance Officer, or the Ethics line (714-288-3958) Health and Safety All CARE facilities and vehicles comply with all government regulations and rules, CARE policies, and required fa- cility practices that promote the pro- tection of workplace health and safe- ty. Our policies have been developed to protect our colleagues from poten- tial workplace'hazards. CARE col- leagues must become familiar with and understand how these policies apply to their specific job responsibil- ities and seek advice from their su- pervisor or other member of man- agement whenever they have a ques- tion or concern. It is important that each colleague immediately advise his or her supervisor or other member of management of any serious workplace injury or any situation presenting a danger of injury so timely corrective ac- tion may be taken to resolve the issue. Ineligible Persons CARE does not contract with, employ, or bill for services rendered by an indi- vidual or entity that is excluded or ineligible to participate in Federal healthcare programs; suspended or debarred from Federal government con- tracts; or has been convicted of a criminal offense related to the provision of healthcare Items or services and has not been reinstated in a Federal healthcare program after a period of exclusion, suspension, debarment, or ineligibility, provided that we are aware of such criminal offense. We routinely search the Department of Health and Human Services' Office of Inspector General and General Services Administration's lists of such exclud- ed and ineligible persons. The CARE Compliance Policies and Procedures ad- dress the procedures for timely and thorough review of such lists and appro- priate enforcement actions. CARE colleagues, vendors, independent contractors, and health care practi- 19 250-244 tioners who provide services on behalf of CARE are required to report to.us. if they become excluded, debarred, or ineligible to participate in Federal healthcare programs; or have been convicted of a criminal offense related to the provision of healthcare Items or services. .License and Certification Renewals CARE colleagues, individuals retained as Independent contractors, and health care practitioners in.positions which require professional licenses, cer- tifications, or other credentials are responsible for maintaining the current status of their credentials and shall comply at all times with Federal and state requirements applicable to their respective disciplines. To assure com- pliance, CARE requires evidence .of the individual having a current dicense,or credential status. For additional information, see the CARE Compliance Poli- cies and Procedures. CARE does not allow any colleague, independent contractor or privileged practitioner to work without valid, current licenses or credentials. 1. Personal Use of CARE Resources It is the responsibility of each CARE colleague to preserve our organization's assets including time, materials, supplies, equipment, and information. Or- ganization assets are to be maintained for business-related. purposes. As a general rule, the.personal use of any CARE asset without prior supervisory approval Is prohibited. The occasional use of items, such as copying equip- ment or telephones, where the cost to CARE is insignificant, Is permissible. Any community or charitable use of organization resources must be ap- proved in advance by one's supervisor. Any use of organization resources for za 250-245 personal financial gain, unrelated to. the organization's business is pro-, hibited. The assets of individuals and companles'with which we do busi- ness shall be treated with the some respect as the property owned by CARE. For additional information, see the CARE Compliance Policies and Procedures. Relationships Among CARE Colleagues Loyalty means that. I share; k In the normal day-to-day functions of an organi-• COMMA ldG'ah. zation like CARE, there are Issues that arise .. which relate to how people in the organization with YOU'.4W deal with one another. It is Impossible to foresee _ - t11t, regardless' all of these, and many do not. require explicit treatment In a document like this. A few routine= Of, OqV ly arise, however. One involves gift giving among colleagues for cer- differences,, o5e'. tain occasions.'While we wish to avoid any strict - rules, no one should ever feel compelled to give a der,,, ©r' gift to anyone, and any gifts offered or received ; should be appropriate to the circumstances. Shedder,; con�fi�en 3n A lavish gift to anyone in a supervisory role would clearly violate organization policy. Another situa- " One Met1ieris! 'tion, which routinely arises, Is a fund-raising orgpOd' ;dal ,similar effort undertaken by individual col- leagues, in which no one should ever be com- . M -�Y tt1YS=,'Ct)21St2t1C;", pelted to participate. Similarly, if CARE deter-ai d l ' . - , . E ", a ectiWit, mines to support charitable organizations, no col- league should be compelled to contribute to the charitable organization, nor should there be any Me i iriger workplace consequences of such non - participation: Finally, no CARE colleague may give.gifts or rewards for performance by other colleagues or employees based on patient or services volume, e.g., pizza parties, gifts, or other -rewards for performing a specific number of transports or ordering a specific number of services or supplies. Relationships with Subcontractors and Suppliers zi 250-246 CARE,manages its consulting, subcontractor, and supplier relationships in a fair and reasonable manner, free from conflicts of interest and consistent with all applicable laws and good business practices. We promote competi- tive procurement to the maximum extent practicable. Our selection of con- sultants, subcontractors, suppliers, and vendors will be made on the basis of objective criteria including quality, technical excellence, price, delivery, adher- ence to schedules, service, and maintenance of adequate sources of supply. Our purchasing decisions will be made on the -supplier's ability to meet our needs, and not on personal relationships and friendships. We employ the highest ethical standards in business practices In source selection, negotia- tion, determination of contract awards, and the administration of all purchas- ing activities. We comply with contractual obligations not to disclose vendor confidential information unless permitted under the contract or otherwise au- thorized by the vendor. (The subject of Business Courtesies and subcoritrac- tors or suppliers is discussed on pages 23 through 26 of this Code.) Truthful Marketing and Advertising Materials Consistent with laws and regulations that may govern such activities, CARE may use marketing and advertising activities to educate the public, provide information to the community, increase awareness of our services, and to re- cruit colleagues. We present only truthful, fully Informative, and non - deceptive information in these materials and announcements. Substance Abuse and Mental Acuity To protect the interests of our CARE colleagues and pa- tients, we are committed to an alcohol and drug-free work environment. All colleagues must report for work free of the influence of alcohol and illegal drugs. Re- porting to work under the Influence of any illegal drug or alcohol; having,an illegal drug in a colleague's sys- tem; or using, possessing, or selling Illegal drugs while on CARE work time or property may result in immedi- ate termination. We may use drug testing as a means of enforcing this policy. It..is also recognized that individuals may be taking pre- scriptlon or over-the-counter drugs, which could impair'judghient or other skills required in job performance. For this reason, it is requested that em - 22 250-247 ployees report the use of prescription drugs to their supervisors if they are working directly with patients or in a potentially hazardous situation (i.e. op- erating heavy machinery). CARE colleagues with questions about the effect of such medication on their performance or who observe an individual who appears to be impaired In the performance of his or her job must immediate- ly consult with their supervisor. CARE may conduct post -accident and reasonable suspicion drug testing of employees to the extent allowable by law. If CARE chooses to do so, drugs tests will be carefully monitored, conducted in an approved and certified la- boratory, and kept confidential. For additional information, see CARE's Ethics_ and Compliance Policies and Procedures. Firearms, Weapons, and Explosive Devices The use or possession of firearms, weapons, and explosive devices on CARE property violates state law, federal law, and CARE's Policies and Procedures. The only exception to this policy is for law enforcement authorities, who may carry otherwise prohibited devices while on regular duty and In the conduct of their responsibilities. For more information, see CARE's Ethics and Compli- ance Policles and Procedures. Environmental Compliance -- It is CARE's policy to comply with all,environmental laws and regulations as they relate to our, organiza= tion's operations. We act to preserve our natural l_ re- ' _ sources to the full extent reasonably possible. We com- ply with all environmental laws and operate each of our facilities and vehicles with the necessary permits, approvals, and con- trols. We diligently employ the proper procedures to provide a good environ- ment of care and to prevent. pollution. In helping CARE comply with these laws and regulations, all CARE colleagues must understand how job duties may impact the environment, adhere to all requirements for the proper handling of hazardous materials, and Imme& ately alert supervisors to any situation regarding the discharge of a hazard- ous substance, Improper disposal of hazardous and medical waste, or any situation which maybe potentially damaging to the environment. 23 250-248 Business Courtesies This part of the Code of Conduct should not be considered in any way as an encouragement to ' P,p make, solicit, or receive any type of entertain- ment or gift. For clarity purposes, please note that these limitations govern activities with those outside of CARE. This section does not pertain to actions between CARE and its colleagues or actions among CARE colleagues themselves. (See "Relationships Among CARE Colleagues" on pages 20 through 21 of this Code.) Extending Business Courtesies and Tokens of Appreciation to Potential Re- ferrel Sources Any entertainment, gift or token of apprecia- tion involving hospital employees, physicians or other persons and entities who are in a position to refer patients to CARE must com- ply with CARE's policies, which have been developed consistent with -Federal laws; reg- ulations, eg ulations, and rules regarding these practie- es. CARE colleagues must consult such CARE Compliance Policies and Procedures prior to extending any business courtesy or token of appreciation to a poten- tial referral source. In general, a CARE employee. may extend business cour- tesies to a potential referral source and his or her immediate family provided that the total value of such business courtesies does not exceed $355 per calendar year. Receiving Business Courtesies: We recognize there will be times when a current or,potential business associ- ate, Including a potential referral source, may extend an Invitation to attend a ;social event in order to further develop a business relationship. A CARE colleague may accept such invitations, provided: (1) the cost assocl- ated with such an event is _reasonable and appropriate, which, as a general 24 250-249 rule; means the cost will not:exceed $100 per per= son; (2) no expense Is Incurred for any travel costs (other than in a vehicle owned privately or by the 'host entity) or overnight lodging; and (3) such events are infrequent. The limitations of this sec- tion do not apply to business meetings at which food (Including meals) may be provided. Prior to ac- cepting invitations'to training and educational op- portunities that include travel and overnight ac- commodations at reduced or no cost to a colleague or CARE, consult our•policies and seek appropriate approvals. CARE colleagues may accept unsolicited gifts with a total value of $25 or less in any one year from any individual or organization.who'has:a business relationship with CARE. For purposes of this paragraph, physicians who make_ referrals to CARE are considered to have such a relationship. 'Perishable or consumable gifts given to a CARE department or group are not subject to ariy specific limitation: CARE colleagues may never accept cash or financial inr struments (e.g., checks, stocks). Finally, under no,ciicurrrstances may a CARE colleague solicit a gift. Extending Business Courtesies to Non -referral Sources No portion of this section, "Extending Business Courtesies to Non:referral Sources;" applies to any Individual who makes, or is Ina position.to make, referrals to CARE. Such business courtesies are addressed in the Extending Business Courtesies and Tokens of Appreclation'to Potential Referral Sources section on page 24 of this Code,,and in the CARE Compliance Policies and Procedures. Meals and Entertainment. There may times when a CARE colleague;wish•- es to extend to a current.or•potential business associate (otherthan some- one who maybe in a position to make a patient referral) an invitation to at- tend a social :event'(e g., reception, meal, sporting event, ortheatriical event) to further or develop a business relationship. The purpose of the entertain- ment must never be to induce any favorable business action. During these events, topics of.a business nature must be discussed and the host must be present. These events must not include expenses paid, for any travel casts .(other than in a vehicle owned, privately or by the host entity) or overnight 2s 250-250 lodging, The cost associated with such -an event� We can t'SO1V6"" : must be reasonable and appropriateAs a general rule, this means the cost will not exceed $100 per "problems by"usm person. Moreover, such business entertainment the same kind of"" with respect to any particular individual must be. tll?g. weused; Infrequent, which, as a general rule, means not more than four times per year.. When We CrelteCh Consult CARE policies,for events that are ex- them, pected to exceed $100 or were not expected to but inadvertently do exceed $100. The policies re- EIIIStelYl 'quire establishing the business necessity and ap. propriateness of the proposed entertainment. Un- der no circumstances will CARE'sanction any business entertainment that 'might be.considered lavish or in questionable taste. Departures from the $100 guideline are highly discouraged. Sponsoring Business Events. Also, CARE may sponsor events with a WOO - mate business purpose. If such events are for business purposes, reasona- ble and appropriate meals and entertainment may, be offered. In addition, transportation and lodging can be paid for. However, all elements of such events, including these courtesy elements, must be consistent with the CARE Compliance Policies and Procedures.. Gifts. It is critical to avoid the appearance.of impropriety when giving gifts to Individuals who do business or are seeking to do business with CARE .We will ,never use gifts or other incentives to improperly influence relationships or business outcomes. In order to avoid embarrassment, an effort should be Made to ensure that any gift we extend meets the business conduct stando ards of the recipient's organization. Gifts to non -referral sources who are not government employees must not exceed $50 per year,per recipient. A CARE colleague or facility may give gift certificates,,but may never give cash -or fi- nancial instruments (e.g , checks, stocks). CARE's policy on business courte- sles.permits, occasional exceptions to the $50 limit to recognize the efforts of those who have spent meaningful amounts of volunteer time on behalf of CARE. Federal and state governments have strict rules and laws regarding gifts,. meals, and other business courtesies for their employees: CARE does not provide any gifts, entertainment, meals, or anything else of value to any,em- 26 250-251 ployee of the Executive Branch of the Federal government, except for minor refreshments in connection with business discussions or promotional Items with the CARE or facility logo valued at no more than $10. With regard to gifts, meals, and other business courtesies involving any other category of government official or employee, colleagues must determine the particular rules applying to any such person and carefully follow them. For additional infor- mation, see the CARE Compliance Policies and Proce- dures. Government Relations and Political Activities The organization and its representatives comply with all Federal, state, and local laws governing participation in government relations and political activities. Further, CARE funds or resources are not contributed directly to individual political campaigns, po- litical parties, or other organizations which Intend to use the funds primarily for political campaign objectives. Organization re- sources include financial and non-financial donations such as using work time and telephones to solicit for a political cause or candidate or the loaning of CARE property for use in the political campaign. The conduct of any political action committee is to be consistent with relevant laws and regulations. In addition, political action committees associated with the organization select candidates to support based on the overall ability of the candidate to render meaningful public service. The organization does not select can- didates to support as a reflection of expected sup- port of the candidate on any specific.issue. CARE engages in public policy debate only In a lim- ited number of instances where it has special exper- tise that can inform the public policy formulation process. When CARE is directly impacted by public policy decisions, it may provide relevant, factual in- formation about the impact of such decisions on the private sector. In articulating positions, CARE only 27 250-252 The. fine, is'always right_ to: do;,what'is right. Martin_ Lutfier King, Jr. takes positions that it believes cab be shown to be In the larger public interest. CARE encourages We are -what we trade and tribal associations with which It Is as- repeatedly d0: sooiated to do the same. Excellence,, then, It Is importantto separate personal and corpo- iS 110.t all+aC,,blit :a' rate political activities'in order to comply with the appropriate rules and regulations relating to lob- habit. bying or attempting to influence government oM cials. No use of CARE resources, including a -mail, Axi§i tlO Is appropriate for personally engaging In political activity. A CARE colleague may, of course, particl- pate in the political process on his or her own time and at his or her own expense. While doing so, ft is important CARE coL leagues not give the impression they are speaking on'behalf of or represent- ing CARE in these activities. Colleagues cannot seek to be reimbursed by CARE for any personal contributions for such purposes.. At times, CARE may ask colleagues to make personal contact with govern- ment officials or to write letters to present our position on specific issues. In addition, it is apart of the role of some CARE management to interface on a regular basis with government officials. If a colleague Is making these com- munications. on behalf of the -organization, he or she must, be certain to be familiar with any regulatory constraints and observe them. The Company's Compliance Program .Program Stricture CARE's Compliance Program islntended.to demonstrate in the clearest pos- sible terms the absolute commitment of the organization to the highest' standards of ethics and compliance. The elemerits.of the program include. setting standards (this Code of Conduct and the CARE Compliance Policies and Procedures), communicating the standards, providing a mechanism .for reporting potential exceptions, monitoring and auditing_ , and maintaining an organizational structure. that supports the furtherance of the program.jEach of these elements is detailed below and in the CARE Compliance Policies and Procedures. These elements are supported at all levels of CARE's organ- ization. Providing direction, guidance and oversight is'the CARE Compliance Officer, 26 250-253 who is responsible for the day-to-day direction and implementation of the Compliance Program. This includes developing resources (including policies and procedures, training programs, and communication tools) for:and provid- ingsupport (including operatingthe Ethics Line, conducting program assess- ment, -and providing advice) to CARE colleagues. Another Important resource who can address is- sues arising out of this'Code. of Conduct is'the.Hu- man Resources Director„ who'Is highlyknowledgea- bie about many of the compliance risk areas de- scribed in this Code of. Conduct that pertain* to em- ployment and the workplace and is responsible.for ensuring compliance with various employment laws. If a concern relates to specific details of an Individ- ual's work situation, rather than larger issues of or- ganizational compliance, the Human Resources Di- rector Is the most appropriate person to contact. in that we promote the concept of management au- tonomy, every effort should be made to resolve workplace conduct and em- ployment practice Issues through the, Individual'ssupervisor or other man- agement personnel. Experience has shown that,this'is an effective and pro- ductive way to deal promptly with these.matters: Setting Standards With respect to our Compliance Program, CARE sets standards.through this Code of Conduct, ethics and compliance policies and procedures and, occa- sionally, through other guidance mechanisms_, such as compliance alerts and advisory memoranda: It is the responsibility of each CARE colleague -to be aware of those policies and.procedures that.pertain to his or.her.work and to follow those policies and procedures. Training and-Communicatlon Comprehensive training and education has been developed by CARE to en- sure that colleagues throughout the•organization are aware of the standards that apply to them. Code of Conduct and Policies and Procedures trainings areconducted at the time an individual.joins1he organization and annually 39 250-254 'for all colleagues. New colleagues must receive compliance training within 30 days of employment. Compliance training in specific areas of compliance risk (e.g., billing, coding) is required of certain individuals. CARE policies out- line the training requirements. Adherence to and support of CARE's Code of Conduct and participation in re- lated activities and training is considered in CARE's decisions regarding hir- ing, promotion, and compensation for all candidates and colleagues_. Compli- ance will be part of each employee's annual performance review. Resources for Guidance and Reporting Concerns To obtain guidance on an ethics or compliance issue or to report a concern, individuals may choose from several options. We encourage the resolution of issues, including human resources -related issues (e.g., payroll, fair treatment and disciplinary Issues) as directly as possible. Colleagues should use the hu- man resources -related problemsoly- ing procedure to resolve such issues. It is an expected good practice, when one is comfortable with it and think it appropriate under the circumstances, to raise concerns first with one's su- pervisor. If.this is uncomfortable or in- appropriate, the individual may dis- cuss the situation with the Human Re- sources Director or another member of management in the organization. Individuals are always free to contact the Ethics Line at (71428&3958) or the HHS OIG Hotline at (800) OIG TIPS. CARE makes every effortto maintain, within the limits of the.law, the confi- dentiality of the identity of any Individual who reports concerns or possible misconduct. There is no retribution or discipline for anyone who reports a concern in good faith. Any colleague who deliberately makes a false accusa- tion with the purpose of harming or retaliating against another colleague is subject to discipline. Personal Obligation to Report CARE is committed to ethical and legal conduct that is compliant with all rel- evant laws and regulations and to correcting wrongdoing wherever it may oc- 30 250-255 cur in the organization. Each CARE colleague has an Individual responsibility for reporting any activityby any colleague, physician, subcontractor, or ven- dor that appears to violate applicable laws, rules; regulations, accreditation standards, standards of medical.practice, Federal healthcare conditions of participation, or this Code. If a matter that poses serious compliance risk to the organization or that Involves a serious Issue of medical necessity, clinical outcomes or patient safety is reported locally, and 'if the reporting individual doubts that the issue, has been given sufficient or appropriate attention, the .individual should report the matter to. higher levels of management or the Ethics Lane until satisfied that the. full importance of the matter has been reo- ognized. There will be no retaliatory disciplinary action taken against an em- ployee who reports any of these concerns to.CARE. Internal Investigations of Reports CARE is committed tolnvestigating all reported concerns promptly and confi- dentially to the extent_ possible. CARE's Compliance Officer coordinates any findings from CARE -led Investigatlons and Immediately recommends correc- tive action or changes that need to be made. We expect all colleagues to co-. operate with Investigation efforts. For additional information, please see CARE's Ethics and Compliance Policies and Procedures regarding the Inter- nal handling of ethics complaints. Corrective Action Hones si,the. Where an internal CARE investigation substantiates a f. . t cba:pOr-"ga reported violation, it Is CARE's policy to initiate correc- ,the, book of tive action, including, as appropriate, making prompt W1SC�t)M restitution of any overpayment amounts, notifying the appropriate governmental agency, instituting whatev- er disciplinary action is necessary, and implementing Thoma& systemic changes to prevent a similar. violation from recurring in the future. For additional information, Jefferson. see CARE's Ethics•and Compliance Policie_ s and Pro- cedures. Disclpline All violators of the Code will be subject to disciplinary action. The precise dis= cipline utilized will depend on the nature, severity; and frequency of the viola- tion and may result in any or all of the following disciplinary actions,in-any '31 250-256 order: • Oral warning; • .Written warning; • Loss of certain privileges and duties; • Suspension, • Termination; and/or • Restitution For more information, see CARE's Ethics and Compliance Policies and Procedures regarding disciplinary action. Cooperation with Government Investigations It is CARE's policy to promptly and completely comply with any governmental investigation or request for information. CARE employees will not destroy, alter, or conceal any records or in- formation that has been requested by the gov- ernment. All requests for information shall be in writing and shall be forwarded to CARE's counsel for review before any information is given to the government investigators. if you receive a sub- poena directed at'CARE for documents, com- puters, or records of any kind, please notify your supervisor and :forward the subpoena'to the Compliance officer. It's not what we! -eat but what we `'gest that makes us', strong" not W. 'at vc�e .gain.{ but: what we; save'thatm 'aes*0 rich;; 40f.what;we react' biif what „wee rewemb-errthati- makes� and n°ot What= WE'. p o&ssl but wlwt we practice. ��iat: gLUi svg ntEgeftj!:_ Sir Fraic's: Bacon, Staff will refrain from making public statements about any potential, pend- ing, active, or past government investigation. Failure to comply.with this may violate CARE's responsibility to protect resident confidentiality orprivacy. Measuring Program Effectiveness We are committed to assessing the effectiveness,of our Compliance Pro- gram through various efforts. Much of this effort is provided by CARE's regu- lar internal audits of issues that•have regulatory or compliance implications. 32 250-257 - t` � � 1 �t�'Gsgr oS �� IfII/BULMNCE:SEA1/lGrE.; CARE AMBULANCE SERVICE QUALITY ASSURANCE WED QUALITY IMPROVEMENT PROGRAM Medical Director CEO QA/QI Manager Original: July 1997 Revised: J61y.2007 Revised: January 2008 Revised: October 2009 Revised: September 2010 Revised: October 2012 Revised: March 2014 Revised: May 2017 TABLE OF CONTENTS PAGE Mission Statement 3 Section I Structure and Organization Description 4 Philosophy of Care Ambulance 4 Responsibilities for Oversight 4 Performance Improvement Organizational Chart 4 Integration of the Technical Advisory Group (TAG) 6 Quality Sub -Committee 6 Patients Privacy 7 Scooe of Practice 7 Section II Data Collection and Reporting 7 Selection QI Indicators 7 Current State EMSA Indicators Categodes 7 Manager, Director, Corporate Board or Strategic Planning 8 Incident's and Non -Indicator Trackinq/Fallout Log 8 Current Indicators "Appendix A` 11 Section III Evaluation of System Indicators 11 Analysis 11 Presentation 11 Section IV Action to Improve 12 Notify the Departments and Employees 12 Periodic Review of Discontinued Indicators 13 Section V Training and Education 13 New Employee Training and Orientation 13 _Continuing Education Programs 16 Performance Improvement Action Plans for Field Employees 18 Exceptional Performance 18 _Training Managers Responsibility to the QI Committee 19 Section VI Annual Update 19 Program Review 19 Quality Improvement Program Goals and Objectives 20 LEMSA Specified Requirements 21 250-259 MISSION STATEMENT The continual process of assessing and monitoring individual and system performance, as well as documenting that performance, is the responsibility of quality assurance and quality Improvement. Care Ambulance's Quality Assurance and Quality Improvement Program is predicated on the belief that field personnel are highly skilled medical professionals empowered to make judgments that if not properly executed could have far reaching and serious consequences for patients. It is the goal of Care Ambulance to adopt the standards of patient care and protocols established by the State of California and local EMS agencies as the minimum standard by which we measure our performance. The Care Ambulance Quality Assurance and Quality Improvement Program provides a system which gathers patient care data, analyzes and reviews the data, provides educational and operational feedback to medical personnel and continually audits our performance to assure quality patient care. 250-260 Section l: Structure and Organizational Description PHILOSOPHY OF CARE AMBULANCE Care Ambulance commits itself to quality. patient care and that commitment is evident in the quality of care provided to each and every patient: RESPONSIBILITIES FOR OVERSIGHT The Medical Director will have, significant input and control of the QA/QI -program. The QA/QI Manager shall be the management representative responsible for the day -today monitoring.of the QA/QI process.'The Specialty Care Nurse Managerwill be primary person responsible'for oversight of the Specialty Care Quality Program: Performance Improvement Organizational Chart The QI program/process demonstrates the dissemination of QI information to all participants, (Le.., administration, EMTs, dispatchers, EMS Agencies, base hospitals, training and other,provideragencies.) rsp Med: l We r SpacbFLane7'f� 07emg= I _ R Oka Marap" _ I � I 'P medics 'T(eiNn9Men¢,w gP/01 Specalit rVbs I I vw'_ 250-261 I LEMSA j Si We EMSA j . _.J i I QA/QI INTERFACE WITH LOCAL EMS AGENCY AND STATE EMS AUTHORITY The QA/QI Manager will be responsible for the direct interaction with the local EMS Agency (Orange,l_os Angeles and Riverside County EMS agencies), and will bean active participant in any county.EMS/QI process. Orange, Los Angeles and Riverside County EMS agencies will be known or referred to as EMS agencies (LEMSA) through this document. By cooperating with the local EMS agencies (LEMSA), Care Ambulance Service will make available mutually agreed upon relevant records for program monitoring and :evaluation. QA/QI Manager or his/her designee will be responsible for the following: • Cooperate with the LEMSA in carrying out the responsibilities of the LEMSA's EMS QI Program and participate in the LEMSA Technical Advisory Group. • Cooperate with the LEMSA in the implementation of state required EMS system indicators. • Cooperate with the LEMSA in the implementation of state optional EMS system indicators. • Cooperate -with the local EMS agency in monitoring, collecting data on, and evaluating state required and optional EMS system indicators. • Cooperate with the local EMS agency in monitoring, collecting data on, and evaluating local/regional EMS system indicators. • Cooperate in the re-evaluation and improvement of state and local EMS system indicators. • Develop, monitor, collect data on, and evaluate indicators specific to the EMS provider as needed. • Conduct meetings for internal review of EMS provider information and development of performance improvement plans related to the findings. • Establish a mechanism to receive input from the local EMS agency, other service providers and other EMS system participants for the development of f performance improvement plans. • Assure reasonable availability of EMS QI Program training and in-service education for EMS provider,personnel. • Prepare plans for expanding_ or improving the EMS Provider EMSQI Program. • Participate in meetings and presentations of state and local EMS system information for peer review to local designated advisory groups and other authorized constituents. QUALITY REVIEW COMMITTEE The Quality Review Committee (QI Committee) is a multi -disciplinary group thatvtilizes collective insight to evaluate system issues. The committee will meet a minimum of two times (or more as needed) a year and review audit findings /results regarding ,field care issues, develop indicators, acknowledge performance improvement, and develop action plans for deficiencies. The committee does not determine disciplinary action. The.focus' is to look at "global" system -wide issues. If field care is to be reviewed the employees Who participated in the call are to remain anonymous. The committee will look at issues 250-262 such as policies, procedures, protocols, equipment, skills performance and "clinical indicators. The group can evaluate any issue at the request,of,appropriate individuals. To effective there should be representation from management; the field and dispatch. This is the opportunity for employees to participate in the quality improvement process and truly make a difference. The committee acts as a. resource to the Nursing Manager, Training Manager, QA/QI Manager, Director of Operations; Medical Director; and Corporate Officers. QA/QI Manager will manage"meeting minutes and a sign in sheet for every meeting. The committee meeting may be composed of as few as two members of the committee or as many as the following: Dr. Freddy Sotelo Medical Director Gerardo Melendrez Gerardo Melendrez Training Manager I Nurse Manager Dannie Wurtz Paramedic Coordinator Chris Wilson Dannie Wurtz Nurse Manager I Director of Operations Chris Wilson Manager of QI/QA I Mitch Felde Bill Weston Director -of O erations I Wand RT's Ben Baker Director of Communications Alina Candal, RN, BHS, MICN Mitch Feld_e Director of Human Resources Receiving.Hospital(s) Care Ambulance Division Managers Nicole Norman Care Ambulance EMT's Integration of the Technical Advisory Group (TAG) The TAG assists in the implementation of the quality improvement plan/process and will meet on an ad hoc basis. A committee meeting may be composed_ of as few two_ members of the committee or as many as the following: Dr. Freddy Sotelo I Medical Director Gerardo Melendrez I Training Manager Dannie Wurtz I Nurse Manager Dannie Wurtz Paramedic Coordinator Chris Wilson Manager of QI/QA Bill Weston Director of Operations Ben Baker Director of Communications Mitch Felde Director of. Human Resources I- Care Ambulance I Wand RT's Care Ambulance I EMT's Alina Candal, RN, BHS, MICN I PIH Health Base Hospital Designated Rep Receiving.Hospital(s) Vicki Sweet, MSN, EN, MICN, Local EMS Agency Nicole Norman LA County Fire Department Quality Sub -Committee QI Sub -Committee 'is an ad-hoc developed by the by. Quality Committee :or by the TAG for the purpose of finding a solution to a specific improvement need: The Sub - 250 -263 Committee may be comprised of personnel from previously stated bodies, company departments or may include consultants or experts from, other agencies as needed. Each Sub -Committee will be assigned only one specified project and be disbanded on completion. The Sub -Committee will be chaired by a member of the Quality Committee., Patients Privac All QI Committee, Sub_Committee and TAG Meetings will follow strict patient privacy guidelines under Care Ambulance Service:HIPAA'Polic.y ralck USA'Corpora_ to Ethics & Compliance Programarid Falck ;USA Employee Handbook.: scbPE OF PRACTICE .All Care Ambulance employees asslgned.to a specific county will follow.thetocal scope• of practice. Care Ambulance Service only provides Basic Life Support'(BLS), Advanced' Life Support (Paramedic) and'Critical Care Nurse?ransport (SCT) Services. As part of the scope, of practice every field 'care provider fully understands the standard of care for every patient they contact. Standard =and and scope of practice are both areas that are reviewed during continuing education classes. Section ll: Data Collection and Reooitin4 SELECTION QI INDICATORS The selection of QI Indicators is a key component to the entire,process.• The system:is only as good as each of its components. There are eight (8) required indicators . categories determihed.by the state. Current State EMSA Indicators Categories Care Ambulance Service current indicators -will be attached_ to,Append_ ix A of the QI Plan using the indicator detail sheets. (t) Personnel (2) Equipment and Supplies (3) Documentation (4) Clinical Care and Patient Outcome (5) Skills Maintenance/Competency, (6) Transportation/Facilities (7) Public Education and Prevention (8) Risk Management (9) A County required indicator or special study. 250-264 To determine or to assist in developing an indicator using the eight (8) categories above, the Manager of QA/QI will present to Quality Review Committee the information from the following: Manager, Director, Corporate Board or Strategic Planning Information or issues during a meeting of Company Managers, Directors or Corporate Board members that are forward to the Quality Review Committee for consideration of tracking as an indictor. Incidents and Non=indicator Tracking/Fallout Log .Incident reports may be used for a variety of circumstances, and not only #or negative situations. An incident report may be initiated to simply identify a situation that warrants attention. The report creates a "paper trail" that can allow'a situation to be monitored and tracked. Below are some examples of when an incident report might,be Initiated: • Unexpected Clinical Event • Equipment Failure • Delayed Response • Protocol Variance • Extenuating Circumstances Vehicle Accidents • Customer Dissatisfaction • Deviation of Destination Guidelines_ • Exceptional Performance Incident reports are normally routed through the Division Manager or Operations Manager. The Operations' Manager will forward to Quality Improvement any situations With patient care implications. These may be positive or negative. The Quality` Improvement Department will document the incident In the non -indictor tracking log and present the findings to Quality Review Committee. Quality Review Committee Development of Standardized EMS Indicators The.Process The primary QI tool is the standardized EMS quality indicator. Methods for developing and using the indicators to measure EMS system performance are described in the following steps: STEP 1. Asking the Questions ■ Gather all committee.members together and have. the Manager of QA/QI present feedback from the management meetings and the incident tracking logs. Use a brainstorming session with the group find out what questions they have regarding the issues. Clearly state the purpose of the brainstorming a 250-265 session. Take a tum, in sequence, around.the entire group. Do not. criticize or discuss any ideas. Record each question carefully. Distributing a survey ca also facilitate this step. Clarify the brainstorming questions antl make sure everyone understands all the items. Categorize the questions based upon related subject matEer and/or discipline 'Prioritize or rank the questions based upon the level of 1mportance to Committee members. .If possible, _narrow the list of questions by eliminating any duplication or questions which may be too complex or off limits i.e:; finances, working conditions, etc. STEP 2. Defining the Quality.lndicator Begin by clearly stating the question to be answered. Stratify the question (break down) into steps identifying the structures (who, what, ;Where) and the`actiVities (how), which lead to, the outcome, that will be measured. 'STEP 3. Develop the Quality Indicator Standardize how the information will be gathered, !and define the'following • Population (inclusion.criteria) • Data numerator • Data denominator • Reporting formula • 'Reported item STEP 4: Collecting the indicatorinformation • Work with technical personnel to design systems which can. capture the data • Develop the easiest and most efficient technology design • Educate all personnel who will be collecting data on the technology and the indicator. This could be QA/QI Specialist, Nurse Manager.or the Manager of QA/QI. • Issue the "step by step - how.to memo" information in writing and explain the indicator process • Provide resource & contact point for FAQ's and troubleshooting STEP 5: Organizing the Data into Indicator Format • Assure all data submissions have been received and checked • Identify and segregate data, by indicator or sub -indicators • Reference the indicator to identify details such as denominators and numerators • Perform tests as defined previously by the indicator • Summarize and organize,all results • Prepare data for presentation • Perform appropriate tests and measurements of central tendencies • If appropriate -aggregate and blind the data • Select and prepare appropriate presentation format (Charts, graphs, check sheet, diagram) • Select appropriate, presentation, medium (slide, overhead; document) 250-266 STEP 6: Present and Evaluate the'Indicator This step also gives participants the opportunity to evaluate the credibility of the data; and. the meaning of the results. It is very important that all participants do their. homework by reviewing the preliminary results. prior to. the presentation. Participants. should receive preliminary" reports well ahead of the scheduled evaluation meeting date. It is at this step in the process where participants will have to make a collective decision; the•decision whether to acfor not to act on the answer. Present data • The data will be presented to. QI Committee . 'Directors • Medical Director • Corporate`Board • Employee's • Schedule presentation date and time • Assure all participants can attend presentation • Issue report, date, time and location of report presentation • Present report to consortium with project Question Answer statement from Steps 1 &2 • Present report to consortium with project 'indicators/measurements • Present relevant list of benchmarks from past, projects & published studies_ • Identify any data collection or analysis problems • Provide consultation regarding data indicators during meeting • Assure that all participants have had an opportunity to "review the results prior to presentation. Assure that all pertinent information has been presented • Evaluate Data 1. Assure that all participants understand the presented information 2. Does the data suffice to answer the proposed questions? 3. Is the.data presented in a( format that is understood? 4. Is the data and results reasonably believable? 5. Is the answer (data) within, an acceptable performance range? 6. Does the answer (data) demonstrate that action to improve performance is wartanted? STEP 7: Acting to Improve the Indicator ■ Assure all participants have opportunity for input • Review results and evaluation process • Identify reasons forimprovement • Identify and verify,root causes.or need for improvement • Brainstorm potential performance improvement -action plans ■ Reduce & select performance improvement -action plan • Decide whether performance improvement -action plan is short term • (60 days -rapid cycle model) or longer (over 60 days -traditional model) • Create a performance improvement - action plan with specific steps identifying who, what,.how:and-When they will occur. • Elect a performance improvement project leader Schedule,performance improvement plan Implement performance improvement plan with appropriate schedule STEP 8: -Checking foe Improvement !10 250-267 • Set'a target date for re-evaluation Repeat steps 1 -8 . • Obtain'consensus from participants,(QI Committee, CEO and Directors) for sharing results Identify Authors.and associated participants Draft final. publication document • Resubmit"to group for final approval 'e. IPuhlish document. Current Indicators:. Detailed explanation of indicators will be found in the back:of this plan in Appendix A Section III: Evaluation of System, Indicators Analysis Care Ambulance Service uses a monthly trending ahalysis tool that uses percentages. Each quarter there is an m area for sumarizing findings,,tiends identified; effectiveness Of previous actions and corrective actions. The data is gathered by the Managerof. QA/QI or QA/QI Specialist. The Nurse, Manage_ r may also be asked to, gather data for the trending tool. Presentation This information will be presented to the QI Committee with the trending analysis tools and any raw data twice a_year. Trending Tool Flow Chart Line Chart Pie. Graph Utilizing the processes outlined in Appendix F. of the EMS System'Quality Improvement Program Model Guidelines, the QI Committee will meet at'least twice a year -to evaluate and discuss the data provided by the Manager of QAlQI according to the following agenda: 1. Review of prior meeting action items. 2. Presentation of indicators and results/trends. a. For each h indicator that the committee reviews, the following process will be failowed: I. Identify the objectives of the evaluation. II. Present indicators and related EMS information III. Compare,performance with goal&or benchmarks IV. Discuss performarice with peers/colleagues V. Determine whether improvement or.further e_ valuation'is required.. VI. Establish plan based upon decision VII. Assign responsibility for,post-decision action plan 3..Examine'correlations between/among trends. 4. Acknowledgement of,positive trends; discussion of _unsatisfactory trends. - 250 -268 5. Receive report's from Quality Sub -Committee, if any. 6. Discuss changes needed to indicators. 7: Recommend the chartering of Quality Sub -Committee, if any. 8. Provide input to the QI Cornmittee,from the Strategic Plan, 9. Summarize action items identified at'this meeting. 10. Recommend training/educational ,needs. 11. Evaluabon'of the meeting. Section IV: Action to'Improve A. Once a need for improvement in performance has been identified by the TAG, Care Ambulance Service will be utilizing the FOCUS-PDSA model for performance improvement.'FOCUS-PDSA iinvolves the following steps: 1.. Find a process to improve _ the TAG will identify improvement needs: 2. Organize a team that knows the process — the QI Committee will form QI Sub-Committee(s) as needed and.review process documents.. 3. Clarify currentknowledge of the process - review indicator trends relevantto the process, collect, other information 4. Understand causes of process variation utilizing tools such as fishbone diagrams, .Pareto.analyses, etc. 5. Select process improvement to reduce or eliminate cause(s). 6. Plan — State objective of the test, make predictions, Develop plan to carry out the test (who, what where, when) 7. Do - Carry out the test, document problems and unexpected observations, begin analysis of the data 13. Study - Complete the analysis of the data, compare the test'data to predictions, and summarize what was learned 9. Act - What changes are to be institutionalized? :What will be the objective of the next cycle? What, if any, re-education or training is needed to effect the changes? Once a Performance Improvement Plan has been implemented, the fesults:of the improvement plan will be measured.. Changes to the system willbe standardized and/or integrated.'A plan for monitoring future activities will be established. B. During its Bi -Annual or other meetings, the QI Committee will identify` indicators that signal a need for improvement and make recommendations for chartering a QI �Sub- Committee, if needed. The QI Committee will select members and charter the Task_ Force with a specific objective for1mprovement. Each Task Force will use the; FOCUS-PDSA model to conduct improvement planning and prepare recommendations or a report for review by the QI Committee. The QLCommittee will modify or accept and implement recommendations of the QI Sub -Committee and prepare the report for distribution to the TAG. The QI Committee will -also disband the Quality Task Force at the appropriate time. Notify the Departments and Employees Manager of QAlQI .will put. together a department task force to plan and. implement the indicator under review. If the indicator is_ a clinician documentation improvement issue, 12 250-269 then the Operations and Training Department will implement a plan. This plan may be a. simple memo to the ambulance crews or a CE class. Manager of QA/QI ,will report back to. the QI.Committee with the plan being. implemented. All indicators will be shared with the employees affected by using the.electronic bulletin board system used by Care Ambulance Service. Periodic Review of Discontinued Indicators Manager of QA/QI will review periodically discontinued ;indicators to make sure they meet the standards of the previous study. if they'fail to meet the standards then the discontinued indicator will be brought back to the QI Committee for further evaluation. Section V: Training and Education QI Committee with the direction of the Medical Director'will recommend the appropriate training topics and'in what forum. This will be completed on a bi-annual basses unless' the topic is critical to improve the deficiency, then the QI Committee'will meet as soon_ as possible. If the QI Committee determines that atopic needs to be addressed in a mandatory or annual training class, continuing education or individual training, then the Manager of QA/QI will inform the Training Department. The Training Manager and Manager of QA/Q1 will report back to the QI Committee and the Medical Director with a report on the topic covered and how many employees were trained. This will usually take place at the next scheduled Q1. Committee Meeting. It a policy needs to be changed or corrected because of a recommendation from the QI Committee, then Policy 103 Policy Formulation and Review Approval will be implemented. The Manager of QA/QI will take the recommendations to the Senior Management and the CEO for approval. The policy then will be communicated to the staff using the electronic bulletin board (ePRO), New Hire Training and Annual Mandatory Training. New Employee Training and Orientation Because a new employee's most important learning takes place, and good work habits develop, during the formal training process, Care Ambulance uses a 190=hour organized structure and rigid training format. The Field Training and Evaluation Program (FTEP) is the process in which new hires are trained and evaluated to ensure their maximum potential and opportunity for success as they begin their career with Care Ambulance. The program consists of multiple phases and decision points that will be used to determine how the neiv trainee will proceed. Success is defined when,the'trainee has progressed through the program to a point in which he or she is working independently and is satisfactorily performing according to the Care standard evaluation guidelines.and other performance metrics. The FTEP program begins once the employee has successfully completed the hiring process and has accepted employment with Care Ambulance Service. Phase 0 13 250-270 Phase 0 (zero) is the time between. the conditional job offer and the employee starting the new hire orientation academy. Certain pre -requisites are necessaryfor the trainee to begin prior to their first day in the academy. These are requirements of federal,.state, or local govemrrient and must be completed before the trainee is eligible to work;in the field. Care expects these requirements to be completed prior to starting the academy and is considered part of the conditions for employment. Phase 0 includes ICS'100, ICS 200, IS 700 and IS 800. These courses can be found at FEMA.gov. In addition to the FEMA courses, employees will be required to complete their LA County accreditation class. The employee must also have an Ambulance Driver's License issued by the State of CA; It is expected the Ambulance'Dri-ver's License will be obtained prior to, Day 1 of the academy. If. the employee experiences delays. in processing by the DMV, the employee can complete Phase,1 and Phase_ 2 of the FTEP, but cannot complete Phase 3 until the Ambulance Driver's License is submitted to Care Ambulance. The trainee will complete all courses and submit proof.of" the completed classes on day 1 of,the academy: Phase 7 Phase 1 (one) is the new hire orientation/academy. The goal of the academy into, cover the didactic materiae and physical skills necessary to be successful in the field as an EMS provider for Care Ambulance. The academy will include classroom, ePCR computer skills lab, clinical operational skills labs, and driver training. Trainees will complete Phase 1 when they successfully pass the academy exit exam. The exam will test familiarity with the content of the academy. If the trainee fails the.exam, remedial training may be offered at the discretion of the Training" Manager and the opportunity to retest. The orientation/academy program is taught by our Training Managers with the assistance of the Training Supervisors who maintain's written documentation throughout the process. The Training Supervisors report to the Training Manager who oversees the Training Department. The following is an overview of the areas that are covered in Phase 1 (one)'is the new 'hire orientation/academy: • Company Overview and Introductions • Care Ambulance Service HIP,AA Policy, Falck USA Corporate Ethics & Compllance.Program and Falck'USA Employee�Handbook • Personnel Files (sign required forms and review job description) • Customer Service • Patient Lifting and Movement • Gumey Operations • Equipment Familiarization • Radio Procedures • Assisting the Paramedic • Patient Restraints • CPR /AED • Mapping (Thomas Bro"s. &'District Maps) Orange, Los Angeles and Riverside :Counties ei Quality Improvement ra 250-271 Blood Bomb and Air Bomb- Pathogens • Los Angeles'Cou*...Expanded Scope of Practice 'Orange County Accreditation • 'Orange, Los Angeles and Riverside Counties policies and procedures. • 'Patient Care Documentation Hazardous Materials • Incident Command_ Syste_ m • Drivers Training o Class'Room: Emergency Vehicle.Operators Course National Standard, Curriculum o Closed, Cone Course where, trainees hone their driving ski lls'in a coritrolled environment. Phase Phase 2 (two) is the first experience in the field at Care Ambulance. The trainee is a.3rd person along with a two person EMS team, one of which. is a Field Training Officer. (FTO). This initial two=week phase is'intended to. both train and evaluate the trainee to be a good Care employee. While'this phase is predominantly about training the individual, the trainee will be evaluated each shift according to_the company,approved Standard Evaluation Guidelines (SEGOand documented on the Daily Observation Report. Phase 2 will last two weeks and the trainee will'be trained and evaluated bya minimum of 2 FTO's. Attempts will be made to limit the FTO's to 2, but no more than 4 during this period to provide,some level of consistency for the trainee. The final FTO involved during this phase will either move the trainee on'to Phase 3 or call for a meeting With the Training Manager and Training Supervisor to recommend, an extension of Phase 2, remedial training or termination from the FTEP program. The Training Manager can approve remedial training or one extension of Phase 2, either in whole or impart, not to exceed 2 weeks. If termination is recommended, an HR representative and a Department Director will be involved in making the determination. Phase 3 Once the trainee successfully completes Phase 2, the trainee will move on to Phase 3. Phase' 3 involves,working side_ by side with an FTO as their partner. There is no 3r'd,' person on the vehicle. While Phase 2 focuses on training with some evaluation, Phase 3 focuses on evaluation while continued training. The Phase 3 FTO will.be a different. FTO than Phase 2,and will evaluate the trainee for one week according,to the SEGs..if the trainee achieves a score of 4 or higher on the DOR.and successfully completes the required tasks, the FTO will sign off on trainee to be approved to work with regular. EMT partners without an FTO partner. The trainee will complete an FTEP evaluation and will be eligible to be,placed on thb,regular,schedule. Phase 4 After 90 days working in the _field independently, the trainee will undergo a quality review using the EMT report card. The trainee will meet with the Training Supervisor and Training Manager and review their progress. During the review, administration will determine.if the trainee is.released from the FTEP,Program without restriction or Whether the trainee needs.a performance improvement plan With, remediabtraining and 15 250-272 additional evaluation. If itis determined the trainee is riot responsive to:training, the trainee will be terminated from the program after consultation and approval from HR and a Care Ambulance Director., if the trainee has successfully completed all, -aspects of the program, he or she will be released from the FTEP program and able to work without restriction. The employee will complete a'full F_ TEP evaluation used for.quality improvement. Continuing Education Programs Care Ambulance is approved by the Orange County LEMSA to provide continuing .education for medical professionals in California. and award state -recognized continuing education hours. Care Ambulance Service' has always had a commitrrient to and a reputation for service excellence. This'well deserved reputation can be attributed to the Care Ambulance philosophy that employees are our most important asset. We treat employees as valuable customers and give them the tools to be successful. These tools include training and education, and equip the employee_ toprovide_ exceptional service to external customers. Care Ambulance provides continuing education through a variety of venues, described in detail below., • 'Annual Mandatory Training • On -Line Education • In -House Training • Tailboard_ Training • Classes on Various Topics Field Training Officer Meetings • Conference Attendance • Management. Development • Annual Mandatory Training Annual Mandatory Training is a requirement for all .field employees. Topics such as Blood and Airborne Pathogens,.Emergency Vehicle'Operations, Customer Service, Incident Command System, Hazardous Materials, and Patient Care Documentation are covered. Topics that are discussed in the QI Committee, or the TAG are also instructed during this time. Continuing Education credit is given for those subjects that meet the criteria for CE approval. • On -Line Education Care Ambulance pays for every field employee to be enrolled in the Virtual Solutions Manager (CE Medic) on-line education program. The,prograni is explained to employees in the New Employee Orientation. Each. employee is given their personal password to access the program. • In -House Training There are times when training and education is facilitated in-house by outside providers. Examples of this.are Incident Command System 200.and 300,.EMS Basic Supervisory. 16 250-273 Workshop.(Texas A&M), Sexual Harassment Prevention and Investigation, Terrorism Awareness, and Emergency Medical Dispatch. • Tailboard Training This is a written informative training update that is distributed to field personnel on a regular basis. It Is designed to be a quick, easy read. The Tailboard Training is very effective to address current issues of interest. • Classes on' Various Topics Continuing education classes are offered on a variety of subjects.' Subjects such as Basic EKG Rhythm Recognition,'Pharmacology, and Terrorism Awareness and Response are popular. Many times these classes are facilitated by Registered Nurses from the Care Ambulance Specialty Care Transport Program. • Field Training Officer Meetings Field Training Officer Meetings are held on a bi-monthly basis. This is an opportunity to meet with all Training Officers At the same time. Each meeting has an agenda and,an educational component.,Field Training Officers can then share information.with field employees. Conference Attendance Operations and Training personnel frequently attend EMS conferences. Any personnel that attend conferences are required to share information that was learned with other employees. Information can be shared In Annual Mandatory Training, Continuing Education Classes, Employee Company Meetings, Tallboard Training; or small informal settings with employees.. • Management Development The Care Ambulance Management Team must provide direction, guidance and leadership to field personnel. To accomplish this It is Important that the' Management. Team Is participating in ongoing training.' Managers and Supervisors attend professional conferences and local training sessions. Some of the local training is facilitated by public providers or hospitals. Managers from the Operations and Training departments also participate in Article Review. Article Review involves the.selection of, a business or management article from a relevant source. The article is then distribufed'to all managers for review and preparation for discussion. Two (2) weeks after distribution of .the article the managers share perspectives and insights on the article. These sessions are valuable learning environments allowing individuals to learn from each other and appreciate different perspectives. Ongoing training and education are important in every job. The dynamics of healthcare requires the healthcare_ professional to stay current on changes in the delivery of care.to patients. Remedial Training There are times when performance deficiencies are'identified. Employees who request or are require refresher training are referred to the training department. The training department develops an Action Plan for Improvement and provides the required training..After completion of the refresher training employees are monitored to ensure compliance. Skills Testing and Skills Competency Verification - 17 250-274 Care Ambulance Service offers EMT -Basic Skills'Days twice a month. Field Training Officers facilitate the Skills Days, which allow employees to have one-on-one assistance with skills. Care Ambulance EMTs' are required to participate in at least one Skills Day annually. All of the Care Ambulance Service Skills Days are open to employees from other provider agencies. Performance Improvement Action Plans for Field Employees The management team of Care Ambulance has always taken immediate action to correct deficiencies in employee.performance. Through this program,'the level of correction is greatly enhanced. In the event that QI Committee or Care Management Is made aware of a clinical issue from the. EMS agency, or the employee, or a customer an investigation will be conducted. If the employee has an area that needs to be improved then the Director of Operations., Division Managers, Specialty Care Nurse Manager, Training Manager,and Medical Director will be h ade aware. The employee will be provided the Initial educational opportunity for improving his or her performance by using an Improvement Action Plan. The Improvement.A.ction Plan will .contain the following: • Employee Name • Incident'Date Run Number • Statement of Problem/lssue • .Relation of Problem or issue to Required Performance Standards • Cognitive, Psychomotor, and/or Affective Education/Training Objectives • Expected Results of the Action Plan • Employee Comments • Employee and Supervisor Signature. If that fails to produce the desired behavior changes, supervision and management will take whatever actions are necessary to assure the quality of patient care provided by the organization. Records kept on in employees will allow a more objective measure of patient Pare performance, thus enhancing the employee appraisal system. Exceptional Performance Care Ambulance has exceptional performances on a regular basis, it is important that these exceptional performances be recognized and shared with others. To emphasize the. significance of this requires that the_performances be truly exceptional and not just good or above average. The recognition of these performances may come from a variety of sources such as patients, coworkers, other agency staff, hospitals, and citizens.. Once a performance is recognized as ekceptional any of the following may take place: • Wratten Commendation Company Award • Local media notification rs 250-275 Notification to thetocal EMS Agency A copy of the perrormance commendation will be placed in the employee's personnel file, and a copy given to the recipient. These exceptional performances are inspirational to everyone. They are proof that with a true commitmentto quality.and excellence, employees_ will be an example to each other of the high levels of service excellence we aspire to; Training Managers Responsibility to the QI Committee Training Manager will report to the QI Committee the topics and attendance of each class. Continuing education is crucial to ensuring ongoing quality. An Increase in knowledge and confidence leads -to an'increase in'the quality and level of care provided. Sectlon VI: Annual Update PROGRAW REVIEW The Quality Improvement Program will be reviewed on an'annual basis.. The Manager of QA)QI will obtain feedback and provide a written account of the indicators monitored to the members of the Quality Review Committee, Directors, and the Corporate Board Officers. The Manager of OA/01 will summarize the input from, aq participants and submit a report to the Corporate Officers and Medical Director. After review of this information, the Corporate Officers and Medical Director will make recommendations: The Manager of QA/QI will be responsible for the implementation of any changes. The annual review ensures program effectiveness with the dynamic component to ,change as needed: This review will also provide direction for the coming year. The following Trending Analysis sheet will be the template used for the presentation of the indicator progress to the QI Committee. 19 250-276 r Trending Analysis for (Put In Indicator) �v+st-ravt� Quality Improvement MI MI MMou,IM6I M M090 1a+slffi�s me 1 M 1 ,•1 A1WyW uTRn0a0Oalaf iMiermrDdiNtime- m Ron �LYnOArtr " +mm d op Pt+ilb Ca�ttf la M.a�(U Mim � . ZW AdW4)nyurt!b Ynpme(e blwllea.} �N �mRer umE W Wpn N memaemoyfs�I [I1a4•tb weutlOeYlrh+b GorteaaPmx(sl. was WYKtlr- Orn �ainfq rt¢fm0 m bpoMrev 44aY beb.} to riN FOKWw o-U�OC.m U t1GOm1011titSt'"Cspw 11 9udlidwat la Wo boo on Wkfn Bull ,U Reo Fliandbmpmontiq' is 030== at W MM -9 Quality Improvement Program Goals and Obiectives • Recognize, reward, and reinforce positive behavior. • Define standards, evaluate methodologies and utilize the evaluation results for continued system improvement. • Identify important aspects of care that affect patient outcomes and customer 'satisfaction. • Establish performance standards and indicators related to these aspects of care. • Establish thresholds for evaluation related_ to the indicators_. • Identify methods for data collection.. • Organize and collect data. • Recognize, develop and enhance opportunities for improvement"based on performance standards and thresholds. • Take action to improve care. • Assess the effectiveness of remedial actions and document improvement. ao 250-277 LEMSA Specified Requirements Los Angeles County Emergency Medical Services Care Ambulance Service will submit the updated QI plan that reflects the current processes being used if any changes occurred. This plan will include all requirements specified in reference No. 620 EMS Quality Improvement Program Guidelines. Care Ambulance Service will submit each year to Los Angeles County EMS the following: • Care Ambulance Service will conduct a review of the CQI plan and submit any changes once a year. • Provide a list of QI Committee Meetings • Provide copies of meeting rosters and minutes for the last three meetings. • From the QI Plan submit the current BLS Program, ALS Program and SCT Program indicators • Submit copies of the fallout tracking tool • As an approved Advanced Life Support Provider in Los Angeles County it is a requirement to participate in the TEMIS Data Entry Program. • The QA/QI Manager will provide direct oversight of the TEMIS Data entry process. The QA/QI Manager and all personnel who will be performing data entry on the TEMIS system will be required to attend a minimum of 16 hours of TEMIS basic software training and 24 hours of advanced / refresher training per year. • The QA/QI Manager and or Paramedic Coordinator and or SCT Nurse Manager will attend all Los Angeles County EMS Quality Improvement Committee as out lined on page 5 (QA/QI Interface with local EMS Agency and State EMS Authority). Riverside County Emergency Medical Service (REMSA) Care Ambulance Service will abide by REMSA CQI System Policy 7101 Care Ambulance Service will conduct a review of the CQI plan and submit any changes once a year. Care Ambulance Service will submit the CQI Plan and Indicators for review every five (5) years to REMSA. Orange County Emergency Medical Service (OCEMS) • The QA/QI Manager and or SCT Nurse Manager will attend the Orange County EMS Private Provider CQI Work Group as out lined on page 5 (QA/QI Interface with local EMS Agency and State EMS Authority). 21 250-278 Appendices 22 250-279 EMERGENCY AMBULANCE MUTUAL AID AND AUTOMATIC_ AID TRANSPORTATION AGREEMENT This Agreement is made and entered into this 30th day.of May, 2015 by and between. Care Ambulance Service (hereinafter "CARE"), Herren Enterprises, Inc., d/lVa Doctor's Ambulance service,(hereinafter "DOCTOR'$°) with reference to the following recitals: WHEREAS, the parties' hereto wish to confirm the terms of mutual aid and. automatic aid agreements in conjunction with emergency services within exclusive: operating and service areas in the County of Orange; and WHEREAS,. each party hereto wishes to utilize the services of the other from time to time for backup emergency ambulance transportation within the specifications of the Orange County EMS Emergency Ambulance Transportation Services Agreement . effective June 1, 2015 and NOW THEREFORE, IT IS ACCORDINGLY AGREED AS FOLLOWS: I.: 'TERM_ A. This Agreerhent shall become effective upon execution by the parties hereto and shall continue in full force and effect for a period of twelve months, unless terminated or extended pursuant to the terms hereinafter set forth. This Agreement shall automatically renew for successive twelve month periods, unless terminated. by either party hereto as provided for herein. B. Notwithstanding any other:provision of this Agreement, either party may terminate this Agreement, without cause, by providing the other party hereto thirty (30) days prior written notice of their intent to terminate this Agreement. 2. MUTUAL AID SERVICE RESPONSIBILITIES A. Each party agrees to provide_ and respond with, subject to availability, mutual aid emergency ambulance transportation when requested by the other party. Backup services include, but are not limited to, locating an ambulance at a specified standby location if requested. B. Each party agrees to maintain all necessary licenses and permits required to operate an ambulance service in the State of California and the County of Orange and to be in compliance with all statutes, regulations, and ordinances as may now be in effect or as may hereafter be implemented or amended. C. Each party, upon receiving a request for emergency ambulance service from the other party, will provide the requesting party's dispatcher its estimated time of arrival to the requested transport location. The backup provider shall immediately notify the other if for any reason it determines that a delay may occur which would prevent the requested party's ambulance from arriving at the location within the quoted estimated time of arrival. 'Page 1 of 3. 250-280 D. Each party agrees'to use best efforts respond on, all emergency, ambulance requests within the contractual response time frames as specked in Care Ambulance'Service's Emergency Ambulance Transportation Services Agreement with the County of Orange as is in force at the time of the request. E. Each party agrees -to maintain general and professional liability insurance in an amount which meets or exceeds all statutory requirements of the state of California and as specified in Care Ambulance Service's Emergency Ambulance Transportation Services_ Agreement with the County of Orange as it in force at the time of the request: F. Each party agrees to maintain Workers Compensation insurance_ . coverage as required by the state of California and the County of Orange pursuant to the terms of the Emergency Ambulance'Transportatio6 Services Agreement with the party's hereto. 3. AUTOMATIC AID SERVICE RESPONSIBILITIES A. Doctor's Ambulance agrees to provide, automatic aid for emergency ambulance services in the Newport Coast, Emerald Bay and Crystal Cove areas of Care's EOA #D. During the times that Doctor's Ambulance is providing these services, Care Ambulance agrees, upon request from Doctors Ambulance,. to pre -deploy an ambulance crew at either of the following locations within the City of _Laguna Beach.- Pacific each:Pacific Coast Highway and Wesley Drive • Laguna Canyon Road and Acres Drive B. All response times for calls for service in the Newport Coast, Emerald Bay and Crystal Coves areas of,Care's EOA #D, shall be'reported to the Orange County EMS Agency. 4. COMPENSATION A. Each party'agrees to bill for services rendered under this Agreement, to the patient or approodate'third party Insurance provider in accordance with and as specified in the requesting.party's Emergency Ambulance Transportation Services Agreement With the County of Orange, if applicable, as Is in force at the time of the request or the prevailing County of Orange Ambulance Rate Ordinance; whichever rate is applicable. Each party shall be responsible for any medical supplies or ALS pass-through reimbursement for calls which the party transports under this Agreement. B. The requesting party and the County of Orange shall not be financially responsible for backup service provided by the other,party. Page 2 of 3 250-281 5: INDEMNIFICATION Each 'party shall indemnify,' defend and hold the othenhannless and its officers, employees, and agents from and against any liability, claim or cause of action or expense, including defense costs and Legal fees arising from or - connected .with claims and lawsuits:for damages or workers' compensation benefits relating to their operations or services, which result from bodily injury, death; ;personal injury or property damage. 6. NOTICES Written notice required under this Agreement shall be delivered personally or sent by United States Re'gistered.or Certified Mail,, postage prepaid, addressed pr delivered to the. parties at the following addresses: Care Ambulance Service, Ind. ATTENTION: Bill ,Weston, Director of Operations_ 1517 W: Braden Court Orange, CA `92868 Doctor's Ambulance Service ATTENTION: Mike_ Herren, Vice President 23091 Terra Drive Laguna Hills, CA 92653 7. ENTIRE AGREEMENT This Agreement contains the full and complete expressions of the rights and obligations of the parties and shall supersede all other agreements, written oe oral, heretofore made by the parties. This Agreement may only be modified by an agreement in writing, signed by the parties hereto.. IN WITNESS WHEREOF, the parties'hereto have set their hands to this:Agreement on the date first above written. Care Ambulance Service, Inc. Troy V. Hagen O Herren Enterprises, Inc. d/b/a Doctors Anibul�6i`- Service Page 3 of 3. 250-282 'EMERGENCY AMBULANCE BACKUP TRANSPORTATION AGREEMENT ThisAgreement ismade and entered into tli-is'lstdiydfMay,-29M by and l'i6tweeh Card Anibulawe Service, a California corporation, (hereinifter "CARE"), Emergency Ambulance Service, Inc.-, a California corporation; (hercin0ker MEMERGENCY1 with reference'tothe following recitals: WHEREAS, the parties hereto wish to confirm the terms. of mutual aid and backup agreements in conjunction with emerge&y.servic6s within ex6hisiVe operating and service azeas in the County of Los Angeles; and WHEREAS, each party here -to wishes to utilize'the services of the other from time to time for backup, emergency ambulance transportation within the specifications;.. f the Emergency Ambulance Transportation Services Aerechient and as effective May 1, 2004 and NOW THEREFORE, IT IS ACCORDINGLY AGREED AS. FOLLOWS: 1. TERM A. This Agreement shall become effec6eupon ekecuti6ii by the parties hereto and shall continue in full force and effect . for a period of twelve months, -unless terminated -or extended pursuant to the terms hereinafter set forth. This -Agreement shall automatically renew new for successive twelve month, periods, unless terminated by either party hereto as provided for herein. B. Notwithstanding anyother provision of this Agreement, dither party may terminate this Agreement, without cause, by providing the other party,hereto. thirty (30) days prior written notice of their intent to terminate this Agreement, 2. SERVICE RESPONSIBILITIES A. Each party - , agrees to provide. and respond with wl subject to, availability, backup enlergency.ambulartce transportation when requested by the other party, s' Backup serviceinclude, but are re not limited to, locaiing an arnbulan6e at aspecified standby location ifreooed. B. Each party agreestb maintain all necessary licenses and permits required to operate an ambulance service in the State of CaliforniaC- and the County of Los Angeles and to,be in compliance with all statutes regulations, and ordinances as may now be in effect or as may he-reafter be.implerridnted or amended. C. Each party, upon receiving a request for emergency ambulance service from the other patty, Will provide the requested "party's dispatcher its estimated time of arrival to the requested transport location. The backup provider shall immediately notif es that a delay may occur which y the other party if for any reason it detcrmin would prevent the requested party's ambulance from arriving at the location within the quoted estimated time of arrival. 250-283 A Each party agrees to,raspond on all emergency ambulanee requests within the contractual response time, frames as specified in Care Ambulance Service's Emergency Ambularice Transportation Services Agreement with the County of Los Angeles as is iit force at the time of tike request: E. 'Each party agrees to maintain general and professional liability insurance in an amount -which meets or exceeds all statutory.requiretnents of the :State of California and as specified in Care Ambulance Sen -ice's Emergency Ambulance Transportation Services Agreement with the County of Los Angeles as is in force at ,the time ofthe request. F. Each party agrees'to maintain'Workers ;Compensation insurance coverage as required by the State of California and the County of Los Angeles pursuant to the terms of the Emergency Ambulance Transportation Services Agreement with the party's hereto. 3. COMPENSATION A. Each party agrees to bill, for services rendered under this Agreement, to the patient or appropriate third pary insurance provider in accordance with and as specified in'the requesting party's Emergency Ambulance Transportation'Services Agreement with the County of Los Angeles, if Applicable, as is in force at the time of the request or the prevailing County_ of Los Angeles Ambulance Rate Ordinance, whichever'rate is applicable. B. The requesting party and the County of Los Angeles shall not be financially responsible for backup service provided by the otherparry. 4. INDEMNIFICATION Each party shall indemnify, defend and hold the other harmless and its officers, employees, and agents from, and against any liability, claim or cause of action or expense, including defense costs and legal fees arising from or coanecied with claims and lawsuits for damages or workers' compensation bene ,fits relating to their operations or services, which result from bodily injury, death, personal injury or property' damage. 5. NOTICES Written notice required under this Agreement shall be delivered personally or sent by United States Registered or Certified Mail, postage prepaid, addressed or delivered to the parties at the following'addresses: 250-284 Care Ambulance Service, Inc. ATTENTION: Bill Weston, Director of Operations 1517 W. Braden Court Orange, CA 92868 Emergency Ambulance Service, -Inc. ATTENTION:, Philip Davis — President.and CEO 3200 E. Biroh Street, Suite. A Brea; CA 92821 6. ENTIRE ACRE E MENT This Agreement contains the full and complete expressions of the rights and. obligations of the parties and shall supersede all other agreements, written or oral, heretofore made by the parties. This Agreement may only be modified by an agreement in writing, signed by the parties hereto. 1N WITNESS WHEREOF, tire parties hereto have set their hands to this Agreement on the date first above written. Care Ambulance Service, Tne. Bill Weston, Director of Operations Emergency Ambulance Service, Inc. Phillip Davis, President and CEO 250-285 FIRST AMENDMENT TO EMERGENCY MEDICAL SERVICES TRANSPORTATION MUTUAL AID AG EMENT FOR ORANGE COUNTY FIRE UTHORITY EXCLUSIVE OPERAT G AREAS THIS FIRST AMENDMENT TO EMERGENCY MEDICAL SERVICES TRANSPORTATION MUTUAL AID AGREEMENT FOR ORANGE COIUNTY FIRE AUTHORITY EXCLUSIVE OPERATING AREA (this "Amendment") is entered into as of March 3, 2014, between SHORELINE AMBULANCE COMPANY, LLC, a California limited iability company ("Shoreline"), and CARE AMBULANCE SERVICE, INC., a California corporatio ("Care"), with reference to the following: A. Shoreline and Care made and entered into that certain Emergency Medical Services Transportation Mutual Aid Agreement For Orange County Fire Authority Exclusive Operating Area (the "Aureement") dated as of September 1, 2013 (the " kureement Effective Date"), with respect to certain backup or secondary emergency ambulance services, as more particularly described in the Agreement. B. The Agreement was made and entered into, among other reasons, in connection with that certain Agreement for EMS Emergency Transportation Services dated as of February 13, 2013 (the "Cin• Contract"), between Shoreline and the City of Westminster, a California municipal law corporation i C. To obtain City approval of the Agreement and of Care as a "Second Tier Provider" (as defined in the City Contract), the Agreement must proide, among other terms, that Care has no remedies against City, and for each of Shoreline and Car to indemnify City for claims related to the Agreement. By notice dated February 26, 2014, City declared that such.requirements. have not been satisfied, and requested such be so satisfied by means of t iis Amendment. D. The parties now desire to amend the Agreem nt as provided in this Amendment. Initially capitalized terms that are not otherwise defined in this Amendment shall have the meaning given to such terms in the Agreement. I NOW, THEREFORE, in consideration of die foregoing'and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowle4ged, the parties agree as follows: 1. No Recovery From City. Care acknowledg6I' and agrees as follows: (i) Care shall not seek compensation from City for any emergency tmnspo�tation services Care may provide under the rse Agreement; (ii) Care shall ]lave no recouagainst City to recover for any emergency transportation services Care may provide under the Agreement, and (iii) in the event of a dispute with Shoreline under the Agreement, Care shall not be entitled to any remedy against or recovery from City. 2. City Indemnity, 2.1 By Shoreline. Shoreline shall indemnify and defend City against any claims or demands arising out of, or which are in any way related to, Shoreline's acts or omissions in providing services under the Agreement, excepting acts or omissions specifically directed by City, OCFA or their respective officers, agents or employees acting within the scope of their duties, agency or employment (individually 4000.55tt8),e I and collectively, "Agents ). Further, and without waiving or,limiling Section 10.1 of the Agreement or any other rights or remedies as to Care, Shoreline shall indemnify and defend City against any claims or demands arising out of, or which are in any way related to, re's acts or omissions in providing services under the.Agreement, excepting acts or omissions directed b City, OCFA, or their Agents. 2.2 By Care. Care shall indemnify and defe Id City against any claims or demands arising out of, or which are in any way related to. Care's acts r omissions in providing services under the Agreement, excepting acts or omissions directed by City,OCFA or their Agents. Further, and without waiving or limiting Section 10.1 of the Agreement or any 1ther rights or remedies as to Shoreline, Care shall indemnify and defend City against any claims or demands arising out of, or which are in any way related to, Shoreline's acts or omissions in providing services under the Agreement, excepting acts or omissions directed by City, OCFA or their Agents. 3. Effective Date. The provisions of Sections land 2 above shall be retroactively effective as of the Agreement Effective Date. 4. Nonimpairment. Shoreline and Care hereby acknowledge and agree that except as provided in this Amendment, the Agreement is unchanged, shall remain in full force and effect and shall be binding upon the parties in accordance with its teams. 5. Counterparts; Electronic Execution. This Amendment may be executed in counterparts, each of which shall be deemed a part of an original and Il of which together shall constitute one (1) agreement. Delivery of an executed counterpart of this Amendment by email or facsimile shall be equally as effective as delivery of an original. Signature I ages may be detached from the counterparts and attached to a single copy of this Amendment to fora one (1) document. The recitals above are hereby incorporated into this Amendment by this referenc . (Signature Page Follows INAVITNESS WHEREOF, the parties Lace executed this First Amendment To Emergency Medical Services Transportation Mutual 'Aid Agreement For Orange: County Fire Authority Exclusive Operating Area as of the'date first "set forth' above. SHORELINE AMBULANCE COMPANY, LLC, a Califomia limited liability company By:� Samuel I'lauptinan Chairman CARE AMBULANCE SERVICE, INC., a California corporation By-�/-- TroyLthgen CEO' S-1 �09033(blac: 250-289 Professional Resume of Pen Baker DIRLCTOR OF COMMUNICATIONS Key Qualifications ` Ben Baker has 10 years of experience in the EMS field. He is skilled at managing both systems and staff, with a focus on team building and quality performance. During his tenure with Care Ambulance, Ben Baker has implemented multiple improvements to enhance operational efficiency, producing outstanding results in both ambulance response time and quality of service. He is skilled at identifying and tracking performance indicators, as well as designing and implementing processes to continuously improve performance. While with the Riverside Police Department, he honed his communication and problem -solving skills which he brings to his position of leadership at Care. Professional Experience Care Ambulance Service 2002 to Present • Director of Communications job responsibilities include system status management and communication center supervision • Director of Information Technology (IT) overseeing network management and all technological components of the business • Responsible for recruiting; interviewing, hiring, scheduling and overseeing 30 dispatchers and continually allocating resources for 130 ambulances and over 550 EMTs; consistently matching the change in demand to the available resources to provide appropriate resources for exceptional customerservice while maintaining productivity • Responsible for contractual compliance and reporting Riverside Police Department 1999-2002 • As a sworn police officer, responsible for supervision of every scene on a daily basis • Extensive experience in emergency and non -emergency radio communication • Documentation of incidents, • Citizen contact and problem solving Care Ambulance Service 1996-1999 • Field Training Officer responsible for overseeing and scheduling EMTs • Conducted EMT training in multiple subjects including basic orientation, fail-safe driving, chest tubes, Pediatric Airway • Prior to becoming a Field Training Officer, served as Emergency Medical Technician Educational Achievements Bachelor of Science. Degree/Business Administration, University of Phoenix (2009) POST Certified Police Officer; Riverside Community College (2000) Certified Emergency Medical' Technician, Riverside Community College (1996) Associate of Science Degree; Riverside Community College (1996) Certified Lifeguard; American Heart Association (1993) Certified in CPR, American Heart Association (1992) ComputerSkills: IBM PC, Windows, Microsoft Word, Excel 250-290 Professional Resume of Robert E .Parry BUSIA'Ess'DE4'GLOPMENTy PUBLIC RELATIONSMANAGER Key Qualifications Robert Barry, is responsible for all of Care Ambulance's business development activities including contracting, marketing and sales, strategic planning and government relations. With over 30 years in the ambulance transportation industry, he has extensive experience in designing transport programs that help customers select the best provider to meet their needs and manage: their risks. Barry serves as Chairman of the Board of Directors of the California Ambulance, Association, helping to assure the delivery of excellent pre -hospital care to the people of California, by promoting recognized industry best practices. Professional Experience Care Ambulance Service 2003 to Present Responsible for the development, growth and retention of emergency and non -emergency ambulance service market area and sales volume • Develops and implements marketing strategies • Oversees the company's support of community programs and charities • Acts as Community Liaison with community officials and elected leaders • Negotiates, service contracts with hospitals, PPOs, HMOs and public entities Health0ne[1Tedical'Transport 1993-2003 • As President and CEO; guided business from initial startup to sales of $350,000 per year • Specialized in Hospital Courtesy Van services • Responsible for- the day-to-day operations including marketing, accounting, human resources; and contracting Education, Licenses, and Certifications Bachelor of Science/Business Administration, California State University, Fullerton (1987) Awards and Professional Affiliations Chairman of the Board of Directors, California Ambulance Association (2010 — Present) Board Member, St. Joseph Hospital, TOCO's Foundation Committee (2007 — Present) Board Member, Garden Grove Chamber of Commerce (2004 — 2006) Board Member, Acacia Adult Day Services, Garden Grove, CA (2004— 2006) 250-291 Professional Resume of Sean Cox OPERATIONS MANAGER7 FIELD .SUPERVISOR /DISASTER SPECIALIST Professional Experience Care Ambulance Service 2005 to Present Positions Operations Manager Responsible for all aspects of emergency preparedness and disaster management. The responsibilities are all encompassing from pre -planning through emergency operations and disaster recovery. Peterson Pipeline 2004-2005 Position: Safety Officer Insure Safety and OSHA compliance during excavations and other projects. Responsible for the set up and' tear down of job sites. American Medical Response 1998-2004 Position:, Operations Supervisor • Provided courteous and efficient medical care to individuals in need of such during emergency medical'transports. • Provided smooth transition for new -hires from the classroom to the field setting. • Utilized leadership skills to enforce the policies and procedures of the company and served as an example to fellow employees. Affiliations • Orange County Private' Sector Terrorism Response Group • Orange County Medical Reserve Corps. Education and Training April -2011' ICS 400, Santa Ana College, Santa Ana, Ca. March -2011 Medical Unit Leader, Orange, Ca. April- 2010 S404 Safety Officer, Santa Ana College Oct- 2007 Ambulance Service Management training, Kansas City Aug -2007 WMD' Planning and Operations. June -2007 EMS Leadership, Academy for Supervisors Mar -2007 CERT' Instructor Course Mar -2007 IS 139, IS 230, IS 235, IS 240, IS 241, IS 242, IS 244, IS 271, IS 703 and IS 800. Oct 2006' National Association of EMS Educators (NAEMSE) Instructor Course Oct-2006IncidentResponse to Terrorist Bombings (IRTB) Instructor Course. continued 250-292 Pr ofess'ional Resaante of Sean Cox - page 2 of 2 Education and Training - cont. Sept- 2006 WMD Technical Emergency Response Course (TERT) Sept -2006 ICS 300 Aug -2006 ICS 200 Aug -2006 Ambulance Strike Team Leader/Medical Task Force Leader Training course Aug -2006 HAZ MAT First Responder Awareness/Operations 2006 --Care Ambulance 1517 W. Braden Ct., Orange, Ca. Cal State University, Fullerton, Extended Education Program: "Communication Skills For Leaders." "The Art of Motivating Employees." "Building Teamwork in Organizations." Advanced Speaking and Listening skills." 2006—Advanced HazMat Life Support. University of Arizona, Az. 2006—Care Ambulance 1517 W. Braden Ct., Orange, Ca. Basic Life Support, First Aid, CPR and AED Instructor. 2005—IS100 and 700. 2005—International Critical Incident Stress Foundation. CISM: Group Interventions. 2005—International Critical Incident Stress Foundation. Terrorism: Psychological impact and Interventions. 250-293 Professional Resume ofMitch F'elde DIRECTOR OF I uNIAN RESOURCES AND COMPLIANCE OFFICER Ifey Qualifications' Mitch Felde possesses a wealth of experience in employee relations, with 25+ years in Human Resource management at organizations ranging from emergency management services to banking institutions, a non-profit firm, a software development company, and a real estate and mortgage company. With this background, Mitch Felde brings to Care Ambulance a powerful focus on the importance of customer service and the development of employee -management collaboration. He also has extensive knowledge of employee -related California laws and compliance requirements. He is a steady and calm team player, with strong communications skills. Professional Experience Care Ambulance Service 2008 to Present Human Resources Director and Compliance Officer responsible for day-to-day functions of Human Resources department including employee relations, recruitment, compensation and benefits, training, policy development and implementation, vendor management Responsible for Medicare, Medi -Cal and HIPAA compliance; ensuring Care's Code of Conduct is followed; and all mandatory training Pacific Park Financial Associates 2002-2008 • Human Resources Manager for this real estate firm, in charge of leadership development, staffing,compensation, benefits, and performance management Also, responsible for company financials, budgeting and tracking 8e6 Technologies 2000 - 2002, 1998 • Human Resources Manager in charge of all Human Resources functions similar to those listed above Regional Center of Orange County 1998-2000 • Human Resources Director in charge of all Human Resources functions similar to those listedabove Southern California Bank (Currently U.S.Bank) 1993-1998 • Human Resources Manager in charge of all Human Resources functions similar to those listed above First Interstate Bank of California 1981-1993 Held progressively responsible positions including Securities Settlement Supervisor, Senior Trainer/Program Designer, and Employee Relations Officer continuer) 250-294 1' Professional Resume of Mitch Felde, page 2 of 2 Education, Licenses, and Certifications Bachelor of Arts/Communications, Loyola Marymount University (1979) Awards and Professional Affiliations Certified in Health Care Compliance Member of Health Care Compliance Association Member of Society of Human Resources Management 250-295 -d Curriculum Vitae of Troy Hagen, MBA, Paramedic PRESIDENT AND CEO, CARE AMBULANCE .SERVICES Curriculum Vitae Overview Troy Hagen is the President and CEO of Care Ambulance Service, based in Orange County, CA. Troy has been involved in Emergency Medical Services since 1989. His background includes: paramedic, volunteer fire fighter, reserve deputy sheriff, flight medic, tactical medic, technical rescue team commander, community paramedicine, field supervisor, management, and executive positions. Troy holds a Bachelor of Science degree in Biology and a Master's degree in Business Administration. He is a frequent lecturer and writer on EMS leadership and management topics, EMS' finance, emergency preparedness, and special events planning. Troy served as Medical Commissioner and Incident Commander for the 2009 Special Olympic World Winter Games. Troy was the 2010 Pinnacle Leadership Award Winner and was recognized for outstanding dedication to improving EMS, and for his lead role in developing a white paper entitled "EMS Makes a. Difference' published by the US Department of Transportation. Troy is President of the National EMS Management Association (NEMSMA) and served as the Finance Committee Chair' for the National EMS Advisory Council (NEMSAC) from 2010 to 2012. Educational Achievements Ada County Strategic Leadership Program 5/09 George Fox University, Meridian, ID Master in Business Administration 10/05 University of Phoenix, Meridian, ID Level One ReserveP.O.S.T Academy 7/94 Ada County Sheriff's Office, Boise, ID P -a amedicProgram 6/93 Mckennan Hospital, Sioux Falls, SD Bachelor' of Science Degree, Biology with Minor in Chemistry 5/92 South' Dakota State University, Brookings, SD Emergency Medical Technician - Special Skills 6/91 Mitchell, SD Emergency Medical Technician - Basic 4/89 Brookings, SD continueel 250-296 Curriculum Vitae of Troy Hagen,: page 2 of 4' Professional Experience Care Ambulance Service CEO Ada County Paramedics,. Boise, ID Director 5/04 -1/13 Assistant Director 7/02-5/04 Emergency Medical Dispatch QI Coordinator 3/00-5/04 Field Supervisor 5/99 -7/02 EMT - Paramedic 9/93 - Present Special Operation Team (SOT) Commander 12/96-5/03 SOT Training Officer 12/45 - 12/96 Unied Emergency Response Consulting, Boise, ID Partner, Consultant, Instructor Life Flight - St. Alphonsus Regional Medical Center, Boise, ID Flight Paramedic Ada County Sheriffs Department, Boise, ID Reserve. Deputy 1113 to Present 2104-12109 7198-1100 2194-11,97 West Idaho Critical Incident Stress Management Team, Boise, ID 9194 - 9196 EMS Consultant Brookings Ambulance, Brookings, SD EMT - Paramedic Education Coordinator EMT - Special Skills QI Assistant Coordinator EMT - Basic Canistota Fire Department, Canistota, SD Rescue Squad, Firefighter Canistota Municipal Pool, Canistota, SD Lifeguard/Safety Instructor/Manager continued 6/93-9/93 8/92-9/93 7/91 -6/93 1/91 -9/93 8/89-6/91 250-297 8189-9193 6189-9193 Summers 1986 - 89 Professional Resume of Troy Dagen, page 3 of 4 Professional Affiliations/Experien cc Adaptive Business Leaders (ABL) Orange County (CA) Healthcare CEO Roundtable - Member National EMS Management Association - President Center for Leadership, Innovation and Research (CLLR) - Board Member National EMSAdvisory Council -Member 2010-2012 DHS First Responder Working Group - Member Idaho Incident Management and Support Team - Incident Commander Idaho EMS Chiefs Association - Member Idaho Emergency Communications Commission - Commissioner Idaho State UniversityParalnedicDegree Program -Adjunct FaculyandAdvisoryBoardMember 2009 Special Olympics World' Winter Games - Medical Commissioner and Area Commander Burning Man - Medical Incident Commander (2012-13) Awards/Recognition 20010 Pinnacle EMS Leadership Award of Excellence 2009 Idaho Health Care Hero Publications. Hagen, T. (2041, December). Five Steps to Becoming a Learning Organization. EMS World, pp. 91-92 Hagen, T. (2012, February). Learning from History. EMS World, pp. 24-25. Hagen, T. (2012, April). Moving Toward Regionalization. EMS World, pp. 55. Hagen, T. (2012, August)'. The Value of EMS. Best Practices in Emergency Services. Hagen, T. (2012, June)_ What's Your EMS Story. EMS World, p. 47. Hagen, T. M. (2010, September). Crystal Clear Vision. NAEMSPNEWS, 19(2), p.5. Hagen, T. M. (2011, October). The Executive EMS Officer. EMS World 40(10), p.26. Hagen, T. M. (2011, March). The Making of a Leader. EMS World, 40(3). Hagen, T. M. (2011, September). The Managing EMS Officer. EMS World, 40(9), p.34. Hagen. T. M. (2011, September). The Managing EMS Officer. EMS World, 40(9), p.20. Ilagen, T. M. (2011, August). The Supervising EMS Officer. EMS World, 40(8), p.35. Hagen, T. M. (2011, May). What's a Leader to Do? EMS World, 40(5), p.34. Hagen, T. M. (2013). It's A Dangerous World. 38(12), 65. Hagen, T. M. (2013). Laundry Bins -Basic needs, pay raises & other morale issues. JEMS, 38(11), 84, Hagen, T. M. (2013, February). Stepping Up. EMS World, 42(2), 20. Hagen, T. M. (2014). The Circle of Life. JEMS, 39(1), 2. National EMS Advisory Council. (2009, December). Retrieved July 11, 2011, from EMS-.GOV:www.ems.gov/nemsac National EMS Advisory Council. (2012). EMS System Performance-based Funding and Reimbursement Model. Washington; DC: NHTSA. continued 250-298 Curriculum Vitae of Troy Hagen, page 4 of 4 Conference/Panel Discussion Speaking Engagements 2013 EMS Today (� Iashmgton, D.C.), Pinnacle (Amelia Island, FL), EMS World Expo (Las Vegas) -- = -- - _ - --- 2012 EMS Today (Baltimore)-Pinnacle-(C-olorado Springs), EMS World EXPO (New Orleans) Idaho Hospital Association (Sun Valley, ID), Community Paramedic Policy Summit (Atlanta), NASEMSO (Boise) 2011- NAEMSE (Reno), EMS World EXPO (Las Vegas), Pinnacle (Miami), EMS Today (Baltimore) Association for Healthcare Documentation Integrity (AHDI) National Conference (Phoenix), ESO Northwest User Working Group (Seattle) 2010 - Pinnacle (San Diego), ESO WAVE Conference (Austin) 2009 - EMS EXPO (Atlanta), AHDI (Orlando), AHDI West (Lincoln City, OR) 2007 - EMLRC 28th Annual International Disaster Management Conference (Orlando) Certifications and Training • NationalRegistered Paramedic • Advanced' Cardiac Life Support Provider • Pediatric Advanced Life Support Provider • Neonatal Resuscitation Provider • Incident Command System (ICS) 100-400 Instructor • NIMS 700' and 800 • Integrated'Emergency Management Course • All Hazards Incident Management Team - Incident Commander • ICS to Emergency Operations Center (EOC) Interface • Exercise' Design • Basic Public Information Officer • Multi -Agency Coordination • Six Sigma Black Belt • Project Management • Strategic Planning and Leadership • The Speed of Trust (Steven MR Covey) - Instructor • State of Idaho ELVIS Instructor- EMT through Paramedic • State of Idaho Emergency Services Training Instructor • Idaho. State' University Institute of Emergency Management Adjunct Faculty • Rope Rescue Technician • Haz Mat Operations • Confined Space Rescue Operations • Structure Collapse Awareness Instructor • CIVIC Level I and 2 Rope Rescue/Rappelling • AMSAR Level 1 and 2 Rope Rescue • C.O.N'.T.'O'..M.S'. Tactical Paramedic • Emergency Medical Dispatcher (EMD) and EMD-QI • Basic Critical Incident Stress' Management • P 0 S T. Peace Officer and Marine Duty • Emergency Vehicle' Operations Course Referrnc&s,available upon 1"21543 —2 9 9 "215 3-299 Professional Resume of Marc Jessner OPERATIONS MANAGER / SUPERVISOR / PURCHASING SPECIALIST Professional Experience Care Ainbulance Service - Operations Manager 1990 to Present • Responsible for the smooth operations of field operations, ensuring that all personnel, vehicles, and equipment operate in a professional and efficient manner. • Utilized leadership skills to enforce the policies and procedures of the company and served as an example to fellow employees. • Responsible for purchasing medical equipment and station supplies for 2 warehouses and 40 stations. • Responsible for annual licensing and inspections with CHP and OCEMS for over 165 Ambulances lknotts Berry Farm 2006 – Present • Respond to all medical aid callswithin the theme park and hotel. • During summer months respond to medical calls at Soak City Water Park. • Maintain employee medical records. • Staff first aid station for employees industrial, med and guest needs. Education, Licenses, and Certifications 2012 Associates Degree University of Phoenix April -2011 ICS 400, Santa Ana College, Santa Ana, Ca. March -2011 Medical Unit Leader, Orange, Ca. OCT 2007 WMD Technical Emergency Response Training course Anniston Alabama June -2007 EMS Leadership Academy for Supervisors Mar -2007 IS 139, IS 230, IS 235, IS 240, IS 241, IS 242, IS 244, IS 27I, IS 703 and IS 800. Oct -2006 National Association of EMS Educators (NAEMSE) Instructor Course. Oct -2006 Incident Response to Terrorist Bombings (IRTB) Instructor Course. Sept- 2006 WMD Technical Emergency Response Course (TERT) Sept -2006 ICS 300 ALIa 2006ICS 200 Aug -2006 Ambulance Strike Team Leader/Medical Task Force Leader Training course Aug-2006IIAZ MAT First Responder Awareness/Operations 2006-- Care Ambulance -Cal State University, Fullerton, Extended Education Program: "Communication Skills For Leaders." "The Art of Motivating Employees." "Building Teamwork in Organizations.. "Advanced Speaking and Listening Skills." 2006—Care Ambulance. Basic Life Support, First Aid, CPR and AED Instructor. 2005—IS 100 and 700. 2005-1'nternational Critical Incident Stress Foundation. CISM: Group Interventions. 2905—International Critical lncidentStressFoundation. Terrorism: Psychological impactand Interventions. Oct- 2004 Ambulance Service Management training, Kansas City 250-300 '4 M Professional Resume ofKathryn'Lorle Lopez ik film ' OPERATIONS MANAGLI2 FIELD SUPERVISORI r ,: r Key Qualifications For 20 years Lorie Lopez has been involved in every aspect of emergency medical services, from hospice transports to mass casualty incidents. She is passionate about providing the highest quality of care for the sick and injured, and has served in a wide range of roles from providing direct care as an Emergency Medical Technician, to employee supervision and management, to liaison with executive leadership. Professional Experience Care Ambulance Service 2006 to Present • OperationsManager, supervising over 200 employees on the policies and protocols of ambulance service • Responds to major incidents; responsible for complaints and commendations for EMS personnel • Assists with hospital relationship development American Medical Response 1993— 2006 • Held progressively responsible roles including EMT Training Officer, Supervisor, and Operations Manager, ultimately overseeing the Cerritos division of 500 employees and the related budget • Provided direct care for sick and injured patients Hoag Hospital' Cancer Center 1998— 2000 • Provided transport and care for patients undergoing cancer treatment • Assisted with administrative functions including patient care reports, treatment scheduling and insurance verification Education, Licenses, and Certifications CPR Instructor; American Heart Association (2010) Basic Supervisor Certification, Texas A&M (2008) Ambulance Service Manager Certification (2006) Ambulance Strike Team Leader; State of California (2004) Emergency Medical Technician la (1993) Emergency Medical Technician, Rio Hondo College (1993) Animal Science Coursework, Cal State Polytechnic Pomona University (2008) Awards and Professional Affiliations Star of Life Award, State of California (2006) 250-301 Professional Resurne ofJerry Melendrez TRAINING MANAGLR Key Qualifications Jerry Melendrez has over 16 years of Emergency Medical Service experience. Schooled as a teacher, he brings that teaching expertise to the EMS field. Because of his excellent communication skills, Melendrez is able to engage, support and challenge EMT students, building their skills in the EMS profession. He currently conducts Care Ambulance's orientation and CPR classes. He is fluent in Spanish. Professional Experience Care Ambulance Service 2006 to Present • Holds progressively responsible positions including Emergency Medical Technician, Field Training Officer and Operations Supervisor • Trains new and current EMTs in the field • Facilitates new hire orientation classes, CPR classes and County skills testing :eve, American Medical Response 1996-2006 • Held progressively responsible positions including. Emergency Medical Technician, Field Training Officer and Operations Supervisor Education, Licenses and Certifications - Emergency Medical Technician, Los Angeles County (1996 — Present) CPR Instructor; American Heart Association NEMSA EMITInstructor American Service Management Program Trained Bachelor of'Arts/History, St. Mary's College of California (1993) 250-302 Professional Resume ofAll Man, DIRECTOR of FINANCE Summary _. ; , €1 More than 12 years of experience in Accounting and Finance with focus on Health Care Industries. Providing financial oversight, business and financial planning. Leading the preparation and analysis of financial reports. Expertise in driving efficiency and productivity through evaluation of financial management systems and implementation of process improvements. Directing skilled teams to support achievement of overall goals and objectives. Creating challenges and proactively preparing and planning for priorities. Proficient knowledge of current accounting standards, US GAAP and International Financial reporting standards IFRS. Key Strengths • Financial and Strategic Planning • Budgeting and Forecasting • Corporate, Accounting and Reporting • Internal Control and Business Process Analysis • System design and Implementation • Efficiency improvement and Cost analysis • Management and Administration • Policies, and Procedures Professional Background Experience at Care Ambulance Service (May 2011 - present) • Leading, finance and accounting department. • Optimizing business resultsthrough process improvement and financial analysis. • Providing strategic alignment between Finance & Accounting, Business Development, Operations and Communications with a focus on accounting, financial reporting, budgeting, operational metrics and analysis to support attainment of current and future goals. • Meeting objectives in a highly customer focused and ever-changing environment. • Ensuring the month end close, reporting, P&L and Balance sheet analysis and Cash Flow management processes are completed in a seamless manner. • Designing and Implementing internal control process. • Maintaining active communication to manage expectations, ensuring deadlines are met and leading change efforts effectively Experience in Public Accounting (December 2001 -May 2011) • Leading and managing all phases of financial audit, review, and consulting engagements. • Drafting financial statements with footnote disclosures and opinion. • Monitoring. multiple engagements at a given time. • Establishing engagement expectations, planning objectives for the engagement and determining -an audit strategy that appropriately addressed the engagement risk. continued 250-303 Professional Resume ofAli Man, pg. 2 of 2 Experience in Public Accounting - continued • Identification' of critical audit areas, risk assessment and development of audit approach thereto. • Evaluating internal controls based on COSO requirements. • Documenting the system, procedures and accounting processes. • Improvements to client internal controls and business procedures. • Formulating: and tailoring appropriate audit programs. • Researching complex and specialized accounting and auditing issues. • Working with audit team to identify and resolve client issues discovered during audit process. • Supervising, mentoring and training staff on engagements. • Reviewing and evaluating assigned audit areas, and work papers to document work performed. • Reviewing financial statements for completeness, accuracy and compliance, when performing technical review. • Performing consolidated financial statement audits and preparing consolidated financial reports when required. • Interacting with key client management to gather information, resolve audit -related problems, and make recommendations for business and process improvement. • Effectively communicating financial statement disclosure requirements to clients and applying new pronouncements to client situations. • Experience in developing, restructuring and evaluating internal control design and operating effectiveness. • Analyzed data obtained for evidence of deficiencies in controls and developed action plans to remediate control weaknesses. Education MBA (Finance and Accountancy) Premier College, Chartered Certified Accountant (ACCA), London, UK, Completed CPA in California. Professional Resume of Sergio Montoya DRIVER TRAINING / SAFETY MANAGER Frey Qualifications Sergio Montoya has 20 years of practicing emergency medical service. Throughout his career, :he has integrated his skill of maximizing efficiency across multiple areas including customer service, marketing, business/community relations, and leadership. He is adept at conducting timely follow up with customers to ensure safe and efficient transportation, as well as working closely with crew instructors to promote and maintain optimal crew performance. Sergio Montoya is dedicated to education and training so that team members understand and implement the highest standards in vehicle operation and safety. Professional Experience Care Ambulance Service 2006 to Present • Driver Training/Safety Manager in charge of Driver Training Program including emergency vehicle operations training and curriculum • Trains Field Training Officers on proper methods of trainee evaluation • Implements policies and procedures to continuously maintain the highest standards in vehicle operation American Medical Response 1993— 2006 • Held several positions including CES Specialist/CQI Specialist, Driver Training Specialist/FTO Coordinator, LeadField Training Officer, and Emergency Medical Technician • As CES Specialist/CQI Specialist, responsibilities included developing comprehensive education programs for working professionals to maintain licenses and certifications • Collaborated in the development and training for the State of California ambulance strike team concept • Responsible for recruitment and staff development of qualified instructors for educational programs United States Navy 1990-1992 • Seaman Apprentice, USS' Missouri Education, Licenses and Certifications CPR, AED and First Aid Instructor, American Heart Association Certified Instructor, National Safety Council Emergency Medical Technician (current) Management, Leadership Training, Program, Leadership University EVOC Instructor/Instructor Trainer, US DOT/NHTSA ICS 100 and 200 NICI Basic Field Operations, California Emergency Medical Service Agency 250-305 Curriculum Vitae Freddy Sotelo, 31'.D., MPH MEDICAL DIRECTOR Summary of Qualifications • Physician leader with a focus on maximizing strengths of my staff and organization; encourage creative problem -solving • Motivated in achieving positive results. • Exceptional verbal and written communication on an individual and group level • Have the required knowledge of medical management, evidence -based practice, and physician engagement to create a successful hospital -physician collaboration Professional E xperience Chair, Credentials Committee, Medical Executive Committee July 2015 —present Co -Chair Health Information Management Committee Sept 2014 -present Crimson Clinical Advantage, Clinical Documentation Improvement Program and Emergency Department Best Practices Committee, MemorialCare Health Systems June 2014 -present Physician liaison and program champion MenrorialCare Health, Medical Director•, Senior Physician Advisor, Departmentofllealth Information Management, Clinical Documentation Improvement Project April 2014 - present Provide medical direction, coordination and oversight for the program and the medical centers. Challenged with a lowest quartile hospital case mix index for our large multi - specialty teaching hospital in Los Angeles I have currently led a diverse medical staff in capturing true patient severity of illness and risk or mortality. Part of the success is educating physicians and coding staff to ensure adequate and data capture practices are compliant, consistent, efficient and accurate. I developed sound and efficient clinical queries for physicians'. Currently our case mix index has increased from 1.6 to 1.91 and has led to increase revenue of about 1.6M in FY 2016. In addition the improved documentation has ledto a mortality ratio of over 1 to 0.5 over the last two years work. The proved required collaboration with HIM, hospital Medical Directors, the Chief of Staff, and hospital administrative staff. continued 250-306 Freddy Sotelo M.D., MPI1 - pg 2 of Professional Experience, continued Department of Emergency Medicine, Long Beach Memorial Medical Center July 2011 -present Leader, MC -21 Lean Process, Emergency Department continuous quality improvement and process improvement 1) Sub -treatment -Pause Improvement Project (process owner) 1112012-112013 - Challenged by poor patient waiting room experience in the emergency department I led improvement by streamlining and increasing efficiency of patient check-in, registration and time to treatment by a physician Results: improved ED arrival to ED bed times by 20% over 3 months and anticipate improvement in AVATAR scores. i 2) Early discharge A3 Rapid Process Improvement (process owner) 12/2013 present -With and increasing census our wait times were increasing leading to find an innovative way to decrease our length of stay for discharge patient. Allotted a new, previously underutilized, room in the ED to create and new pathway for early discharges and improvement in patient experience in the emergency department. The process required significant cultural change by nursing and physician practice and key frequent communication with ED staff Results: increased efficiency by increasing capacity without changes or additions to staffing. Demonstratedreduction in AMA rates, decreased length of stay for early discharge patients and anticipating improved AVATAR scorers. AMA has decreased 50% since start of process and length of stay for early discharge has decreased below target of 210 minutes Emergency Department and Surgical Department, Trauara service, Harbor -UCLA Medical Center Judy 2015 —present Member; Quality Improvement, Risk Management and Patient Safety Task force Harbor UCLA Medical Center, Department of Emergency Medicine August 2008 MSE Triage Pilot Study, Leader Obtained data to assess change in left -without -being -seen rate before and after initiation of the newly implemented Medical Screening Exam (MSE) in the emergency room triage area Freddy Sotelo M.D., MPH - pA, 3 of Education J Harbor -UCLA Medical Center, Department of Emergency Medicine Resident Physician, graduated June 2010 June 2007 - June 2010 UCLA School of Public Health, Department of Health Services M.P.H. Public Policy and Health administration September 2005 - June 2007 David Geffen School of Medicine at UCLA M.D. August 2002 - June 2007 University of California, Los Angeles September 2000 - June 2002 B.S. Biology Irvine Valley College September 1997 - June 2000 License and Certification American Board of Emergency Medicine, Board Certified June 2009 -present California License and DEA certified January 2008 - present ACLS, BLS, PALS certified June 2012 -present The Advisory Board Crimson Analytics Fellow October - November 2014 Academic Appointments Clinical Instructor of Medicine, Volunteer Clinical Instructor University of Southern California, Keck School of Medicine July 2011 -present Clinical Instructor of Medicine, Volunteer Clinical Instructor University of California, Irvine, School of Medicine July 2011 -present Speaking Engagements IfealthCare Partners Regional Hospitalist Meeting. "Clinical documentation integrity through capture of comorbid conditions and HCC capture" July 2014 MemorialCare Physician Society Annual Meeting "How clinical documentation integrity can impact national quality metrics" September 2014 Organizations American Association of Physician Leadership June 2015 - present American College of Emergency Physicians June 2009 -present MemorialCare Physician Society -June 2010 -pesent 250-308 JProfessional Resume of Jeffry G Talfnage, MICP L d OPERATIONS MANAGER r Professional Experience Care Ambulance Service / Orange, CA 2012 - Present Santa Ana Fire Department /Santa Ana, CA Paramedic Coordinator 1996-2012 Paramedic Training Coordinator 1992-1996 Paramedic 1982-1992 Paramedic (Western Medical Center for SAFD) 1978-1982 Santa Ana College Associate Instructor of Fire Technology Mi. San Antonio College Associate Instructor of Fire Technology Acereditations and Licenses Paramedic License - State of California LimitedServices Credential - State of California ACLS - Advanced Cardiac Life Support Provider BLS' Instructor BCLS Provider PALS - Pediatric Advanced Life Support Provider EMT'- Emergency Medical Dispatch Paramedic Preceptor California State Fire Marshall Instructor lA California State Fire Marshall Instructor 1B 250-309 i >S Professional Resume ofKlatann Thomas OPERATIC\S MANAGER/ FIELD SUPERVISOR Professional Experience Operations Manager - Care Ambulance Service 2012— Present - Field Training Officer/Emergency Medical Technician, Care Ambulance 2007 — 2012 Trained new hire attendants and drivers in all aspects of the company's performance expectations. This includes but is not limited to: ambulance checkout, documentation/ PCR/Invoicing, gurney handling, mapping/navigation, radio procedures/communication, scene management, patient care/disposition/safety, return to service, and emergency vehicle operations. FTO's at CARE also participate in career fairs, recertification for EMT -B's, skills training and testing for local ROP classes, and safety reviews. EMT Clinical Instructor; Center for Pre -Hospital Care, UCLA 2008-2011 Presented short skills presentations and instruction in the UCLA EMT Program. Provides mini -demonstrations and instructing students in practical skills, acting as a student advocate in the learning process, and creating an active learning environment. Netx,ork Implementation Specialist, L foNet Services Corporation 2000— 2003 Determined the required tasks and distribute work required to implement services requested. Developed project plans to ensure services ordered will be implemented correctly and on time. Performed quality reviews, provide ideas and input for process improvements and provide documentation to support necessary changes required to improve quality and efficiency. Troubleshot customer impacting issues through resolution phase. Resolution is defined as identifying, correcting, performing root cause analysis and documenting procedures required (if nonexistent) for future troubleshooting. Trained junior staff members to raise expertise levels within the group. Review team metrics relative to performance goals. Senior Non-CommissionedOf%icer US Army, United States Army 1988-2000 Senior/Lead Special Operations Intelligence Advisor with proven ability to solve problems, sustained high productivity in critical deadline environments. Managed more than 60 multi -discipline intelligence professionals at one time. Trained; supervised, and evaluated personnel in performance. Assisted in the development and implementation of operational procedures for US Army Special forces, Psychological Operations and Civil Affairs groups. Consistent demonstrated oral and written communications skills as the point of contact for briefings to various officers as well as foreign senior officials. Details are restricted based on Qovernment classification. y, fi continued 250-310 Professional Resume ofl(latann Thomas, pg 2' of 2 11 y Education Penn State University Bachelor of Science In progress (projected Winter 2015 Grad.) LA City College Associate of Arts Training • Completednational standard curriculum EMT -13 course at UCLA -CPC. • Certified/State Licensed Phlebotomist • Completed ACLS, PALS, Paramedic Preparation and Pre -hospital Trauma Life Support programs at UCLA -CPC. • Completed the Six Sigma for EMS course to the Black Belt level • Regularly attends workshops provided by various Hospitals throughout Los Angeles and Orange County focused on both ALSBLS continuing education programs. Certifi'cat'ions • Received CPR, NREMT-B and California EMT -13 credentials. • Certified AHA BCLS Instructor • Clinical' Skills instructor at UCLA, Center for Pre -Hospital Care • Current CA driver's license with a solid Ambulance and Private vehicle driving record. • Currently serving as a full-time Operations Manager with CARE Ambulance Service; 20,000+ hours field experience to date. 250-311 Professional Resume of Robert Wera Wig' i ORANGECOUNTY OPERATIONS DIVISION MANAGER T Key Qualifications ---- — -- ---- - „,A" Robert Viera began his career in emergency medical services with Care Ambulance and the J Orange County Fire Authority. He then advanced from Emergency Medical Technician to Operations Manager to his current position of Operations Division Manager at Care Ambulance. He is passionate about ensuring that all personnel, vehicles and equipment are operated in a professional and efficient manner. Robert Viera is proficient at optimizing resources while inspiring high quality performance, which makes him an outstanding operational leader. Professional Experience Care Ambulance Service 1996 - 1997, 1999 - Present • As Operations Division Manager (2007 - present) responsible for managing day-to-day operations within Orange County to meet strategic direction and goals • Coordinates Operational Area strike teams in cooperation with the Orange County EMS Agency; documented such activity for successful reimbursement from the State of California during the 2007 Firestorms • From 2004 = 2007, served as: Operations Manager in charge of Orange County field operations • Deployed as an ambulance Strike Team Leader to Hurricanes Katrina and Rita in 2005 • As Emergency Medical Technician (1996-97 and 1999 - 2004) responsible for providing emergency and non -emergency medical care and transport to patients Orange County Fire Authority 1997-1999 • Paid Call' Firefighter; Station 10, responding to structure fires, medical emergencies, traffic collisions,, floods;rescues and other emergencies Education, Licenses and Certifications Business Administration coursework, Vanguard' University (2007-2008) (2013) Emergency Medical Technician, North Orange County ROP (1995) ICS 100, 200, 300, 400, Management 1, Instructor I & 1B, California State Fire Marshal IS 200, 230, 235, 240, 241, 242, 244, 700, 703 and 800, FEMA WMD Technical Emergency Response Training, COBRA, Department of Homeland Security Ambulance Service Manager Program, Jay Fitch and Associates Ambulance Strike Team Leader; California Emergency Medical Services Agency Hazardous Materials' First Responder Operations Certified Car Seat Technician; National Highway Traffic Safety Administration Medical Unit Leader Trainee, National Wildfire Coordinating Group Awards and Professional Affiliations Recognized by the County of Orange EMS Agency for Outstanding Performance (2003, 2006 & 2007) Recognized by University, of Irvine' Medical Center for successfully delivery of a baby without paramedic assistance (1997) 250-312 Pr ofessional Resume of William T. Weston DIRECTOR Or OPER MONS Key Qualifications Bill Weston has been involved in the provision of emergency medical service since 1986. He is Highly skilled at tracking crucial operational and financial data to maximize operational efficiency and quality. He also possesses strong interpersonal and communication skills that make him a natural leader, able to educate, and challenge employees to the highest quality performance. Professional Experience Care Ambulance, Service 1996 - Present • Director -of Operations in charge of daily operations of this full-service ambulance company; include all aspects of safety, risk management, and human resources • Develops and implements operational and financial reporting procedures • Conducts weekly operational meetings Adams Ambulance Service 1994-1996 Director responsible for business development activities including marketing and promotional strategies Spearheaded management training program Implemented operational success indicator reporting process to effectively track crucial operational and financial data American Medical Response 1986-1994 • Director responsible to establish a medical transportation program between American Medical Response and Sutter Health Systems (the largest health care system in Northern California) • This required working with a multi -disciplinary team of company personnel, hospital executives and administrators, and social workers Education, Licenses and Certifications Designated Subjects Teaching Credential, California State University, Long Beach (2003) Master of Business Administration, University of Phoenix (2000) Bachelor'of Science/Business Administration, University of Phoenix (1997) Awards and Professional Affiliations Leadership in EMS Award, Orange County Emergency Medical Services Orange County Private Sector Terrorism Group Hospital Preparedness Program group President, Ambulance Association of Orange County California Ambulance Strike Team Task Force, Statewide Patient Movement Taskforce Region 1 Patient Transportatio5oQrd' tQ r 250-314