Loading...
HomeMy WebLinkAbout25B - AMBULANCE & PARAMEDIC COLLECTIONS SERVICESREQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: DECEMBER 17, 2019 TITLE: APPROVE AMBULANCE & PARAMEDIC BILLING AND COLLECTION SERVICES RENEWAL AGREEMENT WITH WITTMAN ENTERPRISES, LLC FOR A CONTINGENT RECOVERY RATE NOT TO EXCEED 3.99% {STRATEGIC PLAN NO. 7, 5F} /s/Kristine Ridge CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED ❑ As Recommended ❑ As Amended ❑ Ordinance on 1" Reading ❑ Ordinance on 2ntl Reading ❑ Implementing Resolution ❑ Set Public Hearing For ,K•�►nl►tr».ic•� FILE NUMBER Authorize the City Manager to execute a renewal agreement with Wittman Enterprises, LLC for a three-year (3) period for ambulance and paramedic/medical billing and collection recovery services including an option exercisable by the City Manager to transfer the administration of the City's Paramedic Subscription Program to the consultant. The agreement would be effective from January 1, 2020 through December 31, 2022 (based on a contingent collection fee rate of 3.99%) with two optional (1) one-year extensions exercisable by the City Manager and City Attorney, subject to non - substantive changes approved by the City Manager and City Attorney. DISCUSSION Background The Treasury & Customer Service Division of the Finance and Management Services Agency ("FMSA") is responsible for the administration of the City's ambulance/paramedic billing and cost recovery services. The primary tasks include: • Assure the City is reimbursed in a timely manner for emergency medical services ("EMS") and transport provided through the City's contracts with the Orange County Fire Authority ("OCFA") and Care Ambulance Services, Inc. ("CARE"). • Maximize the legal cost recovery to the City from all resources, including but not limited to, Medicare, Medi-Cal, Private Insurance, and Private Pay for the EMS and transport provided. • Manage provider compliance with Medicare and Medi-Cal to insure the City has a record of clean claims and a history of proper billing. • Supply comprehensive revenue recovery involving appeal of Medicare, Medi-Cal, and private insurance denials, researching of all private pays to find viable insurance, and working with patients to arrange alternate methods of repayment; and 25B-1 Award Agreement to Wittman Enterprises, LLC for Ambulance and Paramedic Billing & Collection Services December 17, 2019 Page 2 To help coordinate patient participation in the City's Paramedic Subscription Program with other insurance coverage payments. The tasks listed above are accomplished through the use of a third -party billing and collection recovery service provider. In April 2014, the City released a Request for Proposals (RFP) for ambulance and paramedic/medical billing and collection services. Wittman Enterprises, LLC ("Wittman") was the sole qualifying responding agent/provider and was awarded an original three-year contract from July 1, 2014 through June 30, 2017 (No. A-2014-145), followed by an additional two-year amendment that expired on June 30, 2019 (No. A-2017-120) and a six-month extension to the second amended agreement expiring December 31, 2019 (No. A-2019-118). The original agreement, as well as the two subsequent amendments to each agreement contained an option, exercisable by the City Manager, to transfer the administration of the City's Paramedic Subscription Program to a consultant. RFP No. 19-083: Ambulance & Paramedic Billing and Cost Recovery Services On September 13, 2019, a notice inviting bids was advertised on the City's online bid management and publication system for ambulance/ paramedic billing and cost recovery services. The following descriptions were the key components of the RFP: 1. Scope: Proposer needed to possess and demonstrate expertise to correctly invoice paramedic, medical, and ambulance billing and collection services to Medicare, Medi-Cal, commercial insurance companies, and private pay individuals, based on the City's fee schedule and the City's Paramedic Subscription Program. 2. Experience Requirements: Proposer needed to have the ability to work closely with the City's contracted service providers for emergency and medical services, OCFA and CARE. a. Proposers needed to work with OCFA and their electronic Prehospital Care Report (ePCR) vendor to capture all necessary data. b. Proposer needed to demonstrate relative experience in working with other similar cities in Orange County. c. Proposer needed to have the ability to independently administer the City's Annual Paramedic Subscription Membership Program 3. Method of Approach: Proposer needed to provide a detailed description of the approach and methodology to be used to accomplish the Scope of Services. A summary of the Request for Proposal (RFP) solicitations and the proposals received is as follows: 89 Vendors were electronically notified 19 Vendors downloaded the bid packet 0 Bids received from Santa Ana vendors 5 Bids received Proposal Grading Panel Evaluations & Rating 25B-2 Award Agreement to Wittman Enterprises, LLC for Ambulance and Paramedic Billing & Collection Services December 17, 2019 Page 3 A committee composed of four (4) City FMSA Staff members reviewed and evaluated all five (5) bids received. The Proposal Grading Panel members reviewed and ranked each proposal separately based on the evaluation and rating scale established in the RFP. The following evaluation criterion, with a maximum 100 point scale, was utilized by the Proposal Grading Panel to rate each proposal: Evaluation & Rating Scale Understanding Scope of Services Method of Approach Relevant Project Experience Financial Stability Compliance with RFP Requirements References Reasonableness of Cost Points 20 20 20 10 10 10 10 100 Maximum Points The listed evaluation and rating scale requirements were assigned a pointscale based on the item's relative importance. The final score was derived by averaging the individual staffs' rating for each category and then reaching a cumulative score. Using this methodology, the highest average cumulative score would reflect the best proposal. RFP No. 19-083: Ambulance/Paramedic Billing and Collection Services Rank Firm Average Score 1 Wittman Enterprises, LLC 97.67 2 R1 EMS 94.00 3 LifeQuest Services 88.33 4 Digitech 86.00 5 Change Healthcare 82.00 The RFP submittal by Wittman met all the evaluation and rating criteria required in RFP No. 19- 083. Moreover, based on the highest points total in the table above, Wittman was the proposer with the highest rating. Wittman - Billina. Collection. and Paramedic Subscription Proaram Services Staff recommends the selection of Wittman due to its extensive experience and its specialty with invoicing, categorizing, recording, monitoring, supervising, and managing of ambulance billing and EMS cost recovery systems and services. Since 1991, Wittman has had EMS billing experience with the City's neighboring communities and provides services to more than 100 public departments in California from their Sacramento -area headquarters location. Furthermore, because of this RFP, Wittman has proposed a reduction in their cost -recovery fee. Specifically, Wittman's fees are contingent upon successful billing and collection of EMS services provided through the City's contracts with the OCFA and CARE. Wittman's current fee rate is 6.3% 25B-3 Award Agreement to Wittman Enterprises, LLC for Ambulance and Paramedic Billing & Collection Services December 17, 2019 Page 4 of revenues collected. Wittman's proposed fee rate over a term of three (3) contract years, including two optional (1) one-year extensions is 3.99% (a 57.89% reduction): • Agreement Year 1 (Basic Term) — equal to 3.99% of net collections obtained by Consultant (with and without Treat -No -Transport Call Fees). • Agreement Year 2 (Basic Term) — equal to 3.99% of net collections obtained by Consultant (with and without Treat -No -Transport Call Fees). • Agreement Year 3 (Basic Term) — equal to 3.99% of net collections obtained by Consultant (with and without Treat -No -Transport Call Fees). • Agreement Year 1 (Optional Term) — equal to 3.99% of net collections obtained by Consultant (with and without Treat -No -Transport Call Fees). • Agreement Year 2 (Optional Term) — equal to 3.99% of net collections obtained by Consultant (with and without Treat -No -Transport Call Fees). During the most recently completed fiscal year (FY 2018-19), the City received approximately $5.1 million in Paramedic Service charges. Due to the proposed reduction in the cost recovery by Wittman, Staff anticipates an increase in Paramedic Services during the contract period. In addition to administering the City's paramedic/medical billing and collection services agreement, the Treasury & Customer Service Division is responsible for managing the City's Paramedic Subscription Program. Approximately 2,900 Santa Ana households have participated (paid) in the program at an annual membership fee of $60.08, generating approximately $173,000 in revenue for FY 2018-19. As an optional add -on, the agreement proposes that Wittman promote, administer, and collect the City's Paramedic Subscription Program. Optional services to be performed by Wittman and related costs are as follows: • An initial mass mailing to promote participation in the City's Paramedic Subscription Program. The initial mass mailing list will total approximately 36,000 accounts. • An annual renewal mailer to all registered Paramedic Subscription Program members. • Generate and send a Paramedic Subscription Program membership mailer to all non - subscription paramedic/medical service recipients on an ongoing basis. • Collect all Paramedic Subscription Program applications and membership fees. o The proposed cost for Wittman's Paramedic Subscription Program service will be applied as follows: • Agreement Year 1 through 3 (Basic Term) — fixed rate of $12.50 per membership. • Agreement Year 1 (Optional Term) — fixed rate of $12.75 per membership. • Agreement Year 2 (Optional Term) — fixed rate of $13.00 per membership. 25B-4 Award Agreement to Wittman Enterprises, LLC for Ambulance and Paramedic Billing & Collection Services December 17, 2019 Page 5 In order to implement the optional Paramedic Subscription Program through Wittman, the Centers for Medicare & Medicaid Services (CMS) require that a client jurisdiction such as Santa Ana maintain a certain paramedic subscription fee threshold to meet Medicare Part B cost -sharing guidelines. This would require the City to increase its proposed 2019-20 fiscal year subscription fee from $60.08 to $87.50 ($75.00 CMS threshold fee, plus $12.50 per membership handling charge). Participation in the optional City Paramedic Subscription proposal is elective on the part of the City and can be exercised by the City Manager or his/her designee for the first agreement year, one - hundred -twenty (120) days prior to July 1, 2020, and thereafter one -hundred -twenty (120) days prior to January 1 st for any subsequent agreement year. Any increases to the Subscription Program Fee will be brought to the City Council for consideration during the FY 2020-21 budget process. Based on the evaluations and ratings of RFP No. 19-083 for ambulance and paramedic/medical billing and collection services, staff recommends executing an agreement with Wittman for three (3) years, effective January 1, 2020 through December 31, 2022 including two optional one-year (1) extension periods. Additionally, staff recommends retaining the option, at the election of the City, to transfer the administration of the City's Paramedic Subscription Program to the consultant. STRATEGIC PLAN ALIGNMENT Approval of this item assists the City in meeting Goal #7 — Team Santa Ana, Objective #5 (Create a culture of innovation and efficiency within the organization, Strategy F (Explore opportunities to engage with outside agencies, both private and public, to share information and increase efficiencies). FISCAL IMPACT Payment for services is contingent upon successful collection; Wittman will share in the total revenue recovered from their billing/collection efforts and paid from the Fire Suppression/EMS Contract Services Professional account (no. 01115330-62300). Revenues generated as a result of this agreement will be as follows: • Paramedic Subscription Fee (Ambulance Transport) — 01115002 — 53509 • Paramedic Services Charge (Paramedic Subscription Program) — 01115002 — 53510 APPROVED AS TO FUNDS AND ACCOUNTS: Kathryn Downs, CPA Executive Director Finance and Management Services Agency Exhibits: 1. Agreement 2. RFP No. 19-083 AG:WH 25B-5 W1:I1:1hs AGREEMENT WITH WITTMAN ENTERPRISES FOR PROFESSIONAL AMBULANCE AND PARAMEDIC BILLING & COLLECTION SERVICES THIS AGREEMENT, made and entered into this 17a' day of December, 2019 by and between Wittman Enterprises, LLC, a California Limited Liability company (hereinafter "Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City"). RECITALS A. The City desires to retain a consultant having special skill in providing ambulance and paramedic billing and collection services for the City's Emergency Medical Services (EMS) and Emergency Medical Transport Services (EMTS) Programs. B. Consultant represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the Parties agree as follows: SCOPE OF SERVICES a. CONSULTANT shall perform during the Term of this Agreement, including any extensions thereto exercised by CITY (upon a writing to CONSULTANT by City Manager), the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services - EXHIBIT A, attached hereto and fully incorporated by reference. b. At the sole discretion of the CITY (upon a writing to CONSULTANT by City Manager) CONSULTANT shall perform the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Optional Services - EXHIBIT B, attached hereto and fully incorporated by reference. 2. COMPENSATION a. CITY agrees to pay, and CONSULTANT agrees to accept as total payment for its services as set forth in EXHIBIT A, a percentage fee of 3.99% of net collections obtained by CONSULTANT for each contract year, including any extensions granted by the City. #15078v4 r b. CITY agrees to pay, and CONSULTANT agrees to accept as total payment for its optional services the rates and charges as set forth in EXHIBIT B. c. CONSULTANT shall bill for emergency Medical Services at the rates established by City Council Resolution. d. Payment by CITY shall be made within 45 days (forty-five) days following receipt of proper invoice evidencing work performed, subject to CITY accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by the CITY. k"IIEW:%I This Agreement shall commence on January 1, 2020 and continue until December 30, 2022 with the option for the CITY to grant up to two (2) one (1) year renewals, exercisable in writing by the City Manager and the City Attorney, unless terminated earlier in accordance with Section 12, below. 4. INDEPENDENT CONTRACTOR CONSULTANT shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the CITY. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the CITY to exercise discretion or control over the professional manner in which CONSULTANT performs the services which are the subject matter of this Agreement; however, the services to be provided by CONSULTANT shall be provided in a manner consistent with all applicable standards and regulations governing such services. CONSULTANT shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement, CONSULTANT shall maintain and shall require its Subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. CONSULTANT shall maintain commercial general liability insurance naming the CITY, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of CONSULTANT's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $2,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the #15078v4 25B-7 CITY, its officers, employees, agents, and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the CITY; and (c) contain standard separation of insureds provisions. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. Due to the nature of the services contemplated under this agreement. C. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 of the Labor Code, CONSULTANT, if CONSULTANT has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, CONSULTANT agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. Errors and omissions insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. C. Cyber/Technology liability insurance, together with Crime, and Fiduciary liability insurance with a limit of not less than $1,000,000.00 per claim with $2,000,000 in the aggregate. #15078v4 The following requirements apply to the insurance to be provided by CONSULTANT pursuant to this section: i. CONSULTANT shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. ii. Certificates of insurance shall be furnished to the CITY upon execution of this Agreement and shall be approved by the CITY. iii. City of Santa Ana, its officers, employees, agents and representatives shall be Additional Insureds with respect to General Liability and Auto Liability Insurance is Primary and Non -Contributory. iv. Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the CITY of cancellation with ten (10) days prior notice for non-payment of premium in accordance with policy provisions. V. CONSULTANT shall supply CITY with a fully executed additional insured endorsement. vi. Certificates of insurance endorsements shall show the CITY as a certificate holder as follows: r City of Santa Ana Risk Management Division, 4th Floor 20 Civic Center Plaza Santa Ana, CA 92702 vii. Where the amounts or coverage provided by the certificates of insurance provides coverage greater than those listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. viii. CONSULTANT shall supply CITY with a fully executed additional insured endorsement. g. If CONSULTANT fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the CITY with required proof that insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to forthwith terminate this Agreement. Such termination shall not affect CONSULTANT's right to be paid for its time and materials expended prior to notification of termination. CONSULTANT waives the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. 6. INDEMNIFICATION CONSULTANT agrees to defend, and shall indemnify and hold harmless the CITY, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. CITY agrees to defend, and shall indemnify and hold harmless the CONSULTANT, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claim for person injury, including death, and claims for property damage, which may arise from the negligent operations of the City, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. CITY and CONSULTANT may make all reasonable decisions with respect to their representation in any legal proceeding. 4 #15078v4 25B-9 7. INTELLECTUAL PROPERTY INDEMNIFICATION CONSULTANT shall defend and indemnify the CITY, its officers, agents, representatives, and employees against any all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by CONSULTANT to the CITY pursuant to this Agreement. 8. RECORDS CONSULTANT shall defend and indemnify the CITY, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by CONSULTANT to the CITY pursuant to this Agreement. 9. CONFIDENTIALITY If CONSULTANT receives from the CITY information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, CONSULTANT agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the CONSULTANT disclosed in a publicly available source; (c) is in rightful possession of the CONSULTANT without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the CONSULTANT without reference to information disclosed by the CITY. 10. CONFLICT OF INTEREST CLAUSE CONSULTANT covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 11. DISCRIMINATION CONSULTANT shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. CONSULTANT affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 5 #15078v4 25B-10 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the CITY and CONSULTANT, and supersedes any and all other agreements, oral or written, between the Parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the CITY and by an authorized representative of CONSULTANT. The Parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate CONSULTANT or the CITY. 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 is not embodied herein. 13. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of CONSULTANT, CONSULTANT may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the CITY and any such assignment, transfer, delegation or subcontract without the CITY's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the CITY's ability to have any of the services which are the subject to this Agreement performed by CITY personnel or by other Consultants retained by CITY. 14. TERMINATION This Agreement may be terminated by the CITY upon ninety (90) days written notice of termination. In such event, CONSULTANT shall be entitled to receive and the CITY shall pay CONSULTANT compensation for all services performed by CONSULTANT prior to effective date of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require CONSULTANT to deliver to the CITY all work product(s) completed as of such date, and in such case such work product shall be the property of the CITY unless prohibited by law, and CONSULTANT consents to the CITY's use thereof for such purposes as the CITY deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 15. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. #15078v4 25B-11 16. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both Parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 16. COORDINATION OF WORK OR SERVICES A. No extra work may be undertaken unless a written "Change Order" is first given by the Contract Officer or his/her designee, to CONSULTANT, incorporating therein any material adjustment in the contract and/or the time to perform this Master Renewal Agreement, which said adjustments are subject to the written approval of CONSULTANT. B. Contract Officer CITY will appoint a Contract Officer who will be in charge of the contract maintenance and administration of this Master Renewal Agreement for CITY and have authority to enter into Change Orders with CONSULTANT pursuant to this Master Renewal Agreement. It shall be CONSULTANT's responsibility to assure that CITY's Contract Officer is kept informed of the progress of the performance of the consulting services set forth in this Master Renewal Agreement and CONSULTANT shall refer any decisions which must be made by CITY to the Contract Officer. The Contract Officer shall have authority to sign all documents on behalf of CITY required hereunder to carry out the terms of this Master Renewal Agreement. Unless otherwise specified herein, any approval of CITY required hereunder shall mean the approval of the Contract Officer. All notices regarding consulting services or requested changes in said Master Renewal Agreement shall be sent to the Contract Officer who shall be the City Manager or her/his designee. 20. ADDITIONAL WORK OR SERVICES (a) Extra Work or Services CITY shall have the right at any time during the performance of the work or services set forth in this Master Renewal Agreement, without invalidating said Master Renewal Agreement or any amendments thereto, to elect to exercise any existing option specified in the Scope of Services for extra work or services or to order extra work or services pursuant to a duly executed Change Order or to expend previously authorized contingent funds to cover expenses for work or services agreed to by the PARTIES but exceeding the amounts initially specified under the Compensation provisions of this Master Renewal Agreement or thereby make changes by altering, adding to or deducting from said work or services. (b) Change Order No extra work or services as set forth in subsection (a) above may be undertaken unless a #15078v4 25B-12 written "Change Order" is first given by the Contract Officer to the CONSULTANT, incorporating therein any material adjustment in the contract, which said adjustments are subject to the written approval of the CONSULTANT. 21. PROFESSIONAL LICENSES CONSULTANT shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. CONSULTANT shall notify the CITY immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 22. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. C. Whenever the terms of these Recitals conflict with terms of any Exhibit incorporated herein by reference, then the terms and intent of these Recitals shall prevail and be controlling. d. The said Agreement must be signed below and may be signed in counterpart and delivered by fax, emailed as a PDF (Portable Document Format) file attachment, or by other means that displays the original or a copy of the signatures. Any subsequent amendments may be signed and delivered in the same manner. 23. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To CITY: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714-647-6956 #15078v4 25B-13 To CONSULTANT: Corinne Wittman -Wong, CEO Wittman Enterprises, LLC 11093 Sun Center Dr. Rancho Cordova, CA 95670 Fax: (916) 471-5108 COURTESY COPIES to: Kathryn Downs, CPA Finance & Management Services Agency City of Santa Ana 20 Civic Center Plaza (M-17) P.O. Box 1988 Santa Ana, California 92702 Fax: (714) 647-5304 Sonia R. Carvalho City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 Fax: 714- 647-6515 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. H H #15078v4 25B-14 #15078v4 (Signature Page Follows) 10 25B-15 IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date and year first above written. ATTEST: Daisy Gomez Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho City Attorney Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: Kathryn Downs, CPA Executive Director Finance and Management Service Agency #15078v4 CITY OF SANTA ANA Kristine Ridge City Manager CONSULTANT Wittman Enterprises, LLC Corinne Wittman Wong, CEO Title: CEO Tax ID# 68-0456021 11 25B-16 EXHIBIT A SCOPE OF SERVICES The City of Santa Ana is seeking proposals from qualified firms to provide paramedic, medical, and ambulance billing and collection services. The Proposer should have the expertise needed to correctly invoice for these services to Medicare/Medicaid HMO, commercial insurance companies, and private pay individuals, based on the City's fee schedule and the City's Paramedic Subscription Program. The City currently transports approximately 16,000+ patients per year through its third party ambulance provider. The current payer mix consists of the following: Medicare/Medicare HMO 31% Medi-Cal/HMO 39% Commercial Insurance 12% Private Pay 18% GENERAL PERFORMANCE REQUIREMENTS: Proposers shall be responsible for modifying their billing systems to capture all necessary data generated from the ambulance & paramedic billing and collection services program as an electronic file and provide a description of the electronic file needed to receive data transmitted from OCFA. Proposers shall work with OCFA and their electronic Prehospital Care Report (ePCR) vendor to identify data input gaps, errors and other data needs, and describe a means of obtaining solutions to these problems. Proposers shall provide information regarding their organization's experience with ePCR software, specifically Image Trend, including a complete list of their customers utilizing ePCRs and the name and contact information of the software companies utilized. Proposals shall include a complete package describing billing and collections, follow-up, account posting, and accounts receivable reconciliation and reporting services. 1. Contractor must be able to accurately transfer all necessary information from the OCFA Image Trend database, based on the information provided by the electronic OCFA's 12 #15078v4 25B-17 ePCR, and obtain any additional information needed that is not included in the ePCR for proper and correct invoicing. 2. Contractor must have the capability to fully integrate and support OCFA's selected ePCR application. 3. Contractor shall maintain updated and current technology that will continuously provide the highest level of reimbursement and customer service possible. 4. Contractor shall designate a single manager for the City's account, who will be the City's primary contact with their agency. 5. Contractor shall provide all supplies, equipment, personnel, computer software and hardware, billing forms, insurance forms, lien forms, envelopes, postage and supplies necessary to administer, on a day-to-day basis, the City's EMS billing and accounts receivable functions. 6. Contractor shall maintain complete records of each bill, including all correspondence, documents, account records, transactions and a detailed log of all payments. These records shall be retained for a minimum of three (3) years. 7. Contractor shall maintain records that are in accordance with the Generally Accepted Accounting Principles (GAAP). The Proposer agrees that all account files are the property of the City and will relinquish them to the City at the termination of the contract. 8. Contractor shall provide monthly finance, billing, account receivable aging reports, billing summaries, details for current month invoicing, current write-off, refund reports (including pending refunds), detail of monthly receipts account reconciliation, and any additional reports that the City may need or request, in the specific format requested. 9. Contractor shall process all customer payments in accordance with the applicable Payment Card Industry (PCI) security requirements. #15078v4 13 25B-18 10. Contractor shall have the ability to handle third party payer submission inquiries regarding insurance claims. 11. Contractor shall have demonstrated experience and ability to act as the City's authorized agent for liaising on the City's behalf with the Centers for Medicare Services and/or their designated agents as well as associated state agencies. 12. Contractor shall have demonstrated experience and ability to act as the City's authorized agent for liaising with the City's contract EMS provider (OCFA). 13. Contractor shall have demonstrated experience and ability to independently administer the City's paramedic subscription program. 14. Contractor shall have the ability to cross reference patient files in various methods (i.e. Last Name, Social Security Number, Service or Residence Address, Date of Birth, Date of Service, etc.). 15. Contractor shall have the ability to receive patient care documentation on paper and electronically. 16. Contractor shall research and follow-up on all accounts with inadequate billing information to include: #15078v4 a. Contact OCFA for missing and/ or incomplete information, which may be found in their records. b. Contact receiving hospital for missing and/ or incomplete billing information needed from the admitting/ registration records. c. Contact patient family members or emergency contacts for information. d. Refer to zip code/ street directories for incomplete/ missing address information. e. Mail inquiries to the patient. 14 25B-19 17. Contractor must work with County of Orange and perform screening of all medically indigent patients. 18. Contractor must comply with all applicable provisions and specifications of the Health Insurance Portability and Accountability Act (HIPAA), as well as other federal, state, and local statues and regulations addressing patient privacy issues throughout the term of the contract. 19. Contractor shall maintain proficiency and comply with all statutory, regulatory, and other legal requirements, including amendments to such requirements, which impact billing, reimbursement and/or collections for EMS and release of private medical information. 20. Contractor agrees to cooperate with the City regarding the handling of accounts. These accounts may be included, but are not limited to accounts of the specific age classifications, handicapped, and certain dependent situations. 21. Contractor must meet or exceed mutually agreed upon collection targets. 22. Contractor agrees to provide nationwide toll -free telephone number(s) for billing inquiries. 23. Contractor agrees to meet with the City routinely and on request to discuss problems, special needs, future changes, and updates in software, technology, statistical data requests, or other relevant issues. 24. Contractor shall provide regular and continuous education and training for Contractor's staff, updating them immediately on all changes in the industry or government regulations that may have an impact on services being provided to the City. 25. Contractor shall provide to the City, listings of accounts, which the company feels are uncollectable, through normal collection processes, for further action by the City. 26. Upon request, Contractor shall make all books and records available to both internal and external auditors. #15078v4 15 25B-20 27. Contractor shall not assign or subcontract any portion of this agreement or transfer or assign any claim, pursuant to the contract, without written consent of the City. 28. Contractor must instruct customers to submit all payments to the Proposer, and not the City of Santa Ana. 29. Contractor shall collect and deposit payments on no less than a weekly basis, within three (3) days following receipt of payment. 30. Contract must meet with City staff upon execution of contract to discuss goals of the relationship, the services to be provided, and other topics relevant to the ambulance & paramedic billing and collection services program. 31. Contractor agrees to coordinate with existing service provider to transition current accounts with minimal disruption to service, and deliver to the City a computerized file of active accounts in an agreeable format. 32. Upon implementation of contract, Contractor must be able to process any backlog of billing within thirty (30) days of the implementation date. 16 #15078v4 25B-21 EXHIBIT B SCOPE OF OPTIONAL SERVICES CITY PARAMEDIC SUBSCRIPTION MEMBERSHIP PROGRAM CITY at the sole discretion of the City Manager and City Attorney shall have the option to transfer the promotion and administration of the City's Paramedic Subscription Membership Program to CONSULTANT under the following terms: 1. As a condition to participation in CONSULTANT's optional City Paramedic Subscription Membership Program and to ensure that CITY is compliant with Medicare guidelines on subscription membership fees, CITY shall impose a minimum paramedic services subscription fee of not less than $87.50. 2. CITY shall thereafter inform CONSULTANT in writing of CITY's decision to participate in CONSULTANT's optional City Paramedic Subscription Membership Program within the time -frame parameters set forth in Section 9, below. 3. Upon receipt of CITY's written decision to participate in Optional City Paramedic Subscription Membership Program, CONSULTANT shall assist CITY in generating and formatting an initial mass mailer to solicit participation by residents of the City of Santa Ana in the paramedic services subscription membership program, to be mailed by the CITY. CONSULTANT shall assist in generating and formatting a renewal paramedic services subscription membership program mailer and will assist in formatting that mailer for mass mailing. Basic mailer and renewal mailer shall include a multi -color, double -sided City Paramedic Subscription Membership Program solicitation letter/application, and prepaid return envelope. Use of additional colors, inserts or enclosures may be added at the direction of CITY. CONSULTANT's cost shall reflect increased service costs, materials, and postage. CONSULTANT shall prepare a statement of additional costs per mailing piece for approval by CITY prior to incurring additional costs. 4. CITY shall generate the initial mass mailing list from residential billing accounts listed in CITY's Municipal Utility Billing System database for the most current billing period applicable. The Mailing list shall be comprised of all residential paramedic billing accounts in CITY's Municipal Utility Billing system. CONSULTANT warrants that initial mass mailing list shall total 36,000 accounts, plus or minus 10%, which will be mailed by CITY. CONSULTANT shall annually, not less than sixty (60) days prior to the expiration of each registered City Paramedic Subscription Membership Program member, send a renewal mailer/renewal application to such subscriber; and collect all Paramedic Subscription Membership Program applications and membership fees remitted. CONSULTANT agrees to pay the cost of mailing materials and the postage charges associated to mailing said renewal mailers/applications including prepaid return envelope. 17 #15078v4 25B-22 5. CONSULTANT shall thereafter, on an on -going basis (bi-monthly or oftener in the discretion of CONSULTANT), generate and send an initial paramedic services subscription membership program mailer to all non -subscription paramedic service recipients upon payment or write-off of service recipient's paramedic services billing. CONSULTANT agrees to pay for the cost of mailing materials and the postage charges associated to mailing said paramedic services subscription membership program mailers including prepaid return envelope. 6. CONSULTANT will receive and process each subscription application by adding the member to CONSULTANT's system and posting the payment. This database will be used to identify any subscription member that may be transported upon the input to CONSULTANT's billing system. CITY will receive separate monthly reports for the subscription program. 7. Fees. The annual fee for CONSULTANT's subscription membership program service is as follows: a. The fee for CONSULTANT's Paramedic Subscription Program service will be applied as follows: I. Agreement Year 1 through 3 (Basic Term) — fixed rate of $12.50 per membership. II. Agreement Year 1 (Optional Term) — fixed rate of $12.75 per membership. III. Agreement Year 2 (Optional Term) — fixed rate of $13.00 per membership. 8. Change Order Contingency - from time -to -time, at CITY's option, CITY may request revised or optional Paramedic Subscription Membership Program services of CONSULTANT at mutually agreed upon scope and fee (to be applied as an offset to CONSULTANT's Paramedic Subscription Program billing collection remittances to CITY). 9. Participation in the optional City Paramedic Subscription Membership Program proposal shall be elective on the part of CITY, exercisable by the City Manager and City Attorney, and can be exercised each Renewal Agreement year upon one -hundred -twenty (120) days written notice given prior July 1, 2020, and thereafter one -hundred -twenty (120) days prior to January 1 st for any subsequent agreement year. #15078v4 W. 25B-23 EXHIBIT 2 City of Santa Ana Finance & Management Services Agency Treasury & Customer Services Division Request for Proposals RFP # 19-083 Ambulance & Paramedic Billing and Collection Services Issued: September 13, 2019 Due Date: October 11, 2019 3:00 PM (PST) Deadline Submit to: City of Santa Ana Purchasing Division RFP# 19-093 20 Civic Center Plaza, Room 429 Santa Ana, CA 92701 Attn: Karla Lopez, Buyer Project Coordinators: Willard V. Holt, Treasury & Customer Services Manager Alex Gutierrez, Business Tax Collector/Inspector 25B-24 City of Santa Ana CITY OF SANTA ANA REQUEST FOR PROPOSAL NO. 19-083 TABLE OF CONTENTS TITLE PAGE 1.1 Request for Proposal - Introduction 3 12 Due Date 3 1.3 Background 4 1.4 Overview 4-5 1.5 Schedule of Events 5 1.6 Term of Contract 5 1.7 Scope of Services 6 2.0 Proposal Instructions 6-7 2.1 Communication with Staff 7-8 22 Request for Information 8 2.3 Addenda 8 3.0 Understanding Proposal 8-9 3.1 Proposal Contents 9 32 Proposal Evaluation & Rating 9-10 3.3 Conditions for Proposal Acceptance 10 4.0 Contract Administration 10 4.1 Contract Modification Amendments 10-11 42 Contract Selection & Award 11 4.3Award Protests 11-12 5.0 Proposal Format Guidelines 12-18 6.0 General Terms & Conditions 19-23 Appendix 2447 Attachment A: Scope of Services Attachment B: Costs Proposal Statement Attachment C: Sample of Service Agreement Attachment D: Non -Collusion Affidavit Attachment E: Non -Lobbying Certification Attachment F: Non -Discrimination Certification Attachment G: Proposer's Statement City of Santa Ana Page 12 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-25 City of Santa Ana 1.1 REQUEST FOR PROPOSAL — INTRODUCTION: The City of Santa Ana (hereinafter referred to as "City") is requesting Proposals from qualified firms and organizations (hereinafter referred to as "Proposer") to provide ambulance & paramedic billing and collection services for Emergency Medical Services (EMS). The awarded Proposer (hereinafter referred to as "Proposer/ Contractor" depending on context) shall provide the requested services in accordance with the Scope of Services (SOS) and Sample Professional Service Agreement (Attachment B). The City desires to enter into an agreement for professional services with a qualified firm who can demonstrate competency and relevant experience in providing ambulance & paramedic billing and collection services. The City seeks an experienced and effective Contractor that minimizes City costs, maximizes the use of available technology, provides excellent client and customer service, and performs thorough and complete paramedic billing and cost recovery. Prior to submitting a proposal, Proposers are advised to carefully read the instructions herein, including the Sample Professional Service Agreement, any solicitation attachments/exhibits, and subsequent addenda (if applicable). The City intends to award an agreement for a term of three (3) years, with a two (2) year extension if both parties agree. 1.2 DUE DATE: Parties interested in responding are required to submit a complete proposal electronically to PlanetBids, submit a signed original proposal, plus (5) additional printed copies (all bound), and one electronic copy on a flash drive delivered to the City of Santa Ana, Purchasing Division no later than 3:00 p.m. (PST) on OCTOBER 11, 2019. Proposals will not be accepted after this deadline. Faxed or e-mailed Proposals will not be accepted. NO EXCEPTIONS. Proposal submissions shall constitute acknowledgement and acceptance of all terms and conditions contained in this RFP and all exhibits and attachments hereto. City of Santa Ana Page 13 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-26 City of Santa Ana 1.3 BACKGROUND: The City of Santa Ana is a Charter City, which operates under a City Council -Manager form of government. The City has an annual General Fund budget of over $316 million and a total budget of over $646 million for fiscal year 2019-2020. The City of Santa Ana is a "full service city" providing a wide range of services. These services include: police and fire protection; animal control; emergency medical aid; building safety regulation and inspection; street lighting; land use planning and zoning; housing and community development; maintenance and improvement of streets and related structures; traffic safety maintenance and improvement; and diverse range of recreational and cultural programs. The City of Santa Ana contracts with the Orange County Fire Authority (OCFA) to provide primary response for fire suppression and EMS; they operate ten (10) fire stations strategically located throughout the City of Santa Ana. The City also contracts with a private ambulance provider to respond to all 9-1-1 calls and provide emergency medical transport; the current contractor for ambulance service is CARE Ambulance Service, Inc. The City's current EMS billing and collection service provider is Wittman Enterprises, LLC. In addition, the City maintains a paramedic subscription program that is available to residents to help offset the cost of ambulance transport. 1.4 OVERVIEW: The selected company will bill for emergency medical services in a timely manner, including the billing of Medicare, Medical/Medicaid, private insurances, supplemental insurances, secondary insurances and workers' compensation carriers according to specific requirements. The company shall provide all billing statements in English and Spanish, and maintain a necessary staff of bilingual account representatives. The company shall provide excellent customer service to citizens of Santa Ana who have billing questions or problems, by providing a toll -free phone number and an email address so individuals with questions or requiring assistance with invoices, may contact City of Santa Ana Page 14 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-27 City of Santa Ana the company directly at no additional cost to the City. The company shall provide the City with electronic access to the billing records. The successful Proposer/Contractor shall possess and demonstrate they have the necessary expertise, experience and qualifications to provide these types of services. The City wishes to create efficiencies and make improvements wherever possible, and take advantage of new technologies. It is the City's intent to maintain all emergency medical and ambulance transportation billing with one institution to maximize systems and minimize administrative costs. 1.5 SCHEDULE OF EVENTS: The schedule below is tentative and subject to change at the discretion of City, with appropriate notice to prospective Proposers. • Release of RFP........................................................................ September 13, 2019 • Deadline for Written Questions ................................................. September 19, 2019 • Responses to Questions/Pre-proposal Conference (if held)..... October 1, 2019 • Due Date for Proposal Submission ........................................... October 11, 2019 • Proposal Interviews (if held) ..................................................... on or about October 21, 2019 • Present Recommended Proposal to City Council ..................... December 3, 2019 • Begin Transition to New Contract ............................................. TBD 1.6 TERM OF CONTRACT: The intended length of contract period will be three (3) years beginning July 1, 2020 (base period). The contract may be extended two (2) more years upon agreement of both parties (optional period), with a mutual right to terminate upon ninety (90) days written notice. Transition Period: The successful Proposer/Contractor shall facilitate a transition for the City from the current ambulance & paramedic billing and collection service company to the new company within a 6 month period from January 1, 2020 to June 30, 2020. In the event the incumbent provider is the successful Proposer/Contractor the term of contract will commence January 1, 2020. City of Santa Ana Page 15 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-28 City of Santa Ana 1.7 SCOPE OF SERVICES: Proposal shall include an outline which demonstrates the firm's understanding of the SOS as specified herein and further detailed in Attachment A: Scope of Services. The proposed SOS should detail the work phases to be completed, deliverables to be provided, method of approach, tasks necessary for successful completion, and suggestions or special concerns that the City should be made aware of and how the Proposer can improve or add value to the project. Please provide suggestions and examples of where Proposer has executed their strategy successfully or how it proposes to address said concerns. 2.0 PROPOSAL INSTRUCTIONS: It is the responsibility of the Proposer to ensure that any proposals submitted have been uploaded to PlanetBids prior to this proposal due date and time. Proposals, including all required sections and forms, shall be submitted electronically via the City's Bid Management System, PlanetBids. It is the responsibility of the Proposer to ensure that any proposals submitted has been uploaded to PlanetBids prior to this proposal due date and time. PlanetBids will not accept late bids and no exceptions shall be made. Proposers will receive an a -bid confirmation number with a time stamp from PlanetBids indicating that their proposal was submitted successfully. The City will only receive and consider those proposals that were transmitted successfully. Submit proposal online at: http://www.planetbids.com/portal/portal.cfm?CompanvlD=20137. Proposer shall be solely responsible for informing itself with respect to the proper utilization of the bid management system, for ensuring the capability of their computer system to upload the required documents, and for the stability of their internet service. Failure of the Proposer to successfully submit an electronic proposal shall be at the Proposer's sole risk and no relief will be given for late and/or improperly submitted proposals. Proposers experiencing any technical difficulties with the bid submission City of Santa Ana Page 16 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-29 City of Santa Ana process may contact PlanetBids at (818) 992-1771. Questions of an operational nature may be directed to the City's assigned Project Manager. Neither the City, nor PlanetBids, makes any guarantee as to the timely availability of assistance, or assurance that any given problem will be resolved by the bid submission deadline. A signed original proposal, plus (5) hard copies (bound), and one electronic copy on a flash drive must be received by the City of Santa Ana, Purchasing Division no later than the due date and time. Proposals must be date and time stamped by the City of Santa Ana Purchasing Division on time by the 3:00 P.M. (PST) Submission Due Date in order to be considered. Proposals shall NOT be mailed or sent via telegraphic, electronic or facsimile means. All notifications, updates and addenda will be posted online on PlanetBids at https://www.planetbids.com/portal/portal.cfm?CompanvlD=20137. Proposers shall be responsible for monitoring the site to obtain information regarding this solicitation. Failure to respond to required updates may result in a determination of a nonresponsive proposal. 2.1 COMMUNICATION / CONTACT WITH CITY STAFF: Unless otherwise authorized herein, Proposers who are considering submitting a proposal in response to this RFP, or who submit a proposal in response to this RFP, are only to communicate with the assigned City Buyer, and no other City staff about this RFP from the date this RFP is issued until a proposal is submitted. The assigned City Buyer will provide all official communication concerning this RFP in writing via the City's Bid Management System, PlanetBids. General questions regarding this RFP may be directed to the following designated City personnel via the City's assigned Buyer utilizing the City's PlanetBids system: City of Santa Ana Page 17 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-30 City of Santa Ana 2.2 REQUEST FOR INFORMATION (OR CLARIFICATION / QUESTIONS): Questions regarding this RFP shall be submitted via PlanetBids, by 5:00 P.M. (PST) on September 19, 2019. Responses to all questions will be posted on PlanetBids, no later than the date and time shown at the schedule of key RFP dates above. All prospective Proposers are advised to visit PlanetBids on a regular basis as the responses may be posted earlier than the date above. No verbal requests or responses will be accepted. Significant interpretations or clarifications will be addressed via addenda to this RFP. 2.3 ADDENDA: Any changes in RFP from the date of release to date of submittal will result in an addendum or amendment. Proposers shall be responsible for monitoring the site to obtain information regarding this solicitation. Notification of such addendum or amendment shall be posted on City's PlanetBids system: https://www.planetbids.com/portal.cfm?CompanylD=20137 3.0 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 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 the City, the proposed Contract and any other Contract Documents, and affirm that City of Santa Ana Page 18 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-31 City of Santa Ana the terms and conditions stated therein are full 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 set forth in the Contract Document should be clearly noticed in each Proposer's proposal. Please direct all questions regarding the procurement process to: City of Santa Ana Finance & Management Services — Purchasing Karla Lopez, Buyer Email: klopezlOosanta-ana.org Phone: (714) 647-5466 3.1 PROPOSAL CONTENTS: Proposals are to be prepared in such a way as to provide straightforward, concise capabilities to satisfy the requirements of this RFP. Colored displays, promotional materials, etc., are not necessary or desired. Emphasis should be concentrated on conformance to the RFP instructions, responsiveness to the RFP requirements, and on completeness and clarity of content. Dividers and clear organization of content and material are encouraged. 3.2 PROPOSAL EVALUATION AND RATING: The criteria for evaluating the proposals submitted will take the following items into consideration: • Understanding Scope of Services 20% • Method of Approach 20% • Relevant Project Experience 20% • Financial Stability 10% • Compliance with RFP Requirements 10% • References 10% • Reasonableness of Cost 10% City of Santa Ana Page 19 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-32 City of Santa Ana The City will establish a proposal review committee to evaluate proposals based on the response to the RFP, which includes adherence to outlined directions and format, and the City evaluation criteria set forth above. A final score will be calculated for each submitted proposal and used to rank the Proposers. The City shall not be obligated to accept the lowest priced proposal, but will make an award in the best interests of the City of Santa Ana after all factors have been evaluated. 3.3 CONDITIONS FOR PROPOSAL ACCEPTANCE: This RFP does not commit the City to award a contract or to pay any costs incurred for any services. The City, at its sole discretion, reserves the right to accept or reject any or all Proposals received as a result of this RFP, to negotiate with any qualified source(s), or to cancel this RFP in part or in its entirety. The City may waive any irregularity in any Proposal. All Proposals will become the property of the City of Santa Ana. If any proprietary information is contained in the Proposal, it should be clearly identified. 4.0 CONTRACT ADMINISTRATION: The Executive Director of Finance & Management Services of the City of Santa Ana, or his or her 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 ambulance & paramedic billing and collection services shall be administered by the Executive Director of Finance & Management Services of the City, or his or her designee. 4.1 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 City of Santa Ana Page 110 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-33 City of Santa Ana control of either party require modification or amendment. Any modification or amendment proposed by the Contractor must be submitted in writing to the City, and may require feedback and concurrence from OCFA. Any agreed modifications and/ or amendments must be in writing, approved by all parties. 4.2 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 notifications, which will include the name of the Proposer awarded the contract. A. Request for Council Action: Following evaluation and rating by the proposal review committee, the Executive Director will recommend award of an agreement to the Proposer providing the best quality and value to the City. Any contract resulting from this RFP shall not be effective unless and until approved by the City Council/City Manager, as applicable. B. Execution of Agreement: A sample standard agreement is included as Attachment B: Professional Service Agreement in this RFP. "Proposer" will hereinafter be referred to as "Consultant" or "Contractor" in the standard agreement. The term of the agreement will begin after the agreement is fully executed, and all required bonds, insurance documents and contents of the payment information packet have been received and approved. 4.3 AWARD PROTESTS: Proposers may file a protest to a RFP with the City's Purchasing Division. In order for a protest to be considered valid, it must: City of Santa Ana Page 111 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-34 City of Santa Ana A. Be filed in writing within five (5) business days after the RFP issue date or before 5:00 p.m. of the 5th business day following the posting of RFP Results/Notice of Intent to Award Contract on the City's website. B. Clearly identify the specific irregularity or accusation. C. Clearly identify the specific City staff determination or recommendation being protested. D. Specify, in detail, describing the grounds of the protest and the facts supporting the protest, and E. Include all relevant, supporting documentation with the protest at time of filing. If the protest does not comply with each of these requirements, it will be rejected as invalid. If the protest is valid, the City's Purchasing Manager, or other designated City staff member, shall review the basis of the protest and all relevant information. The Purchasing Manager will provide a written decision to the protestor within ten (10) business days from receipt of the protest. The decision from the Purchasing Manager, or designee, is final and no further appeals will be considered. 5.0 PROPOSAL FORMAT GUIDELINES: Interested entities or contractors are to provide the City a thorough Proposal using the following guidelines: Proposal should be typed using a 12-point font size, and should contain no more than 100 typed pages (including cover letter, required Attachments `A" through "F", and resumes of key personnel, Index/Table of Contents, dividers, tables, charts, graphic exhibits, and costs proposal). Each Proposal will adhere to the following order and content of sections: proposal should be straightforward, concise and provide "layman" explanations of technical terms that are used; emphasis should be concentrated on conforming to requirements, and on providing City of Santa Ana Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 the RFP instructions, responding to the RFP a complete and clear description of the offer. 25B-35 Page 112 City of Santa Ana Proposals, which appear unrealistic in terms of technical commitments, lack of technical competence or are indicative of failure to comprehend the complexity and risk of this contract may be rejected. The following Proposal sections are to be included in the Proposer's response: A. Cover Letter: Proposals shall include a letter signed by a principal or authorized representative who can make legally binding commitments to the entity. Include form/type of business entity. Cover letter shall not exceed one page. B. Background and Project Summary Section: The Background and Project Summary Section should describe the Proposer's understanding of the City, the work to be done, and the objectives to be accomplished. Refer to Attachment A, Scope of Services, of this RFP. C. Proposal Submittal Requirements: Complete proposals must be submitted electronically to PlanetBids, a signed original proposal, plus (5) hard copies (bound), and one electronic copy on a flash drive must be submitted to the City of Santa Ana, Purchasing Division no later than 3:00 p.m. (PST) on OCTOBER 11, 2019. Proposals will not be accepted after this deadline. Faxed or e-mailed Proposals will not be accepted. NO EXCEPTIONS. The Proposal must provide sufficient detail to allow for thorough evaluation and comparative analysis. Proposals shall NOT be mailed or sent via telegraphic, electronic mail or facsimile means. City of Santa Ana Page 113 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-36 City of Santa Ana D. Method of Approach: Provide a detailed description of the approach and methodology to be used to accomplish the SOS of this RFP. The Method of Approach shall include: 1. Description, in detail, of company's method of approach to the SOS as defined in Attachment A. Address the manner in which the firm proposes to meet the specific requirements of the SOS including, but not limited to, business office and hours and reporting requirements. 2. List of names, titles, responsibilities and telephone numbers of the persons to be contacted, at any hour, in the event of an emergency. 3. Information on whether any of the services proposed will be subcontracted out to another company and if so, then describe the portion of work and who will be providing the service. 4. Company's policies and procedures for receiving and resolving complaints from the public. Including the name, qualifications, and contact information for the person(s) responsible for receiving and resolving complaints. Report to the City response to complaint and resolution time. 5. Description of manner in which the company will inform the City and public of changes to policies and procedures. Include samples of any informational materials the company would use. Describe the procedures for monitoring employee adherence to procedures, whether new or established. 6. Detailed description of manner in which the company intends to meet the reporting requirements of Attachment A. Include a detailed description of the company's record keeping tools and methods. City of Santa Ana Page 114 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-37 City of Santa Ana Describe any additional information the company is capable of recording that may be of use to the City. 7. Propose a method of receiving completed forms electronically from the City by the firm, if one is available. 8. Electronically provide monthly reports of ambulance & paramedic billing and collection services. 9. Propose any informational or reporting enhancements the company is capable of providing. Example: secure web -based access to reports and records under this contract by the City. 10. Proposers are encouraged to provide additional innovative, value - adding features and/ or services, and/ or creative approaches for providing the service that will maximize efficient, cost-effective operations or increased performance capabilities. E. Statement of Qualifications: The information requested in this section shall describe the qualifications of Proposer, key staff, and sub -contractors performing projects within the past five (5) years that are similar in size and scope to demonstrate competence to perform these services. The Proposal must be submitted using the format as indicated in the Proposal Format Guidelines. Each Proposal shall be prepared simply and economically, avoiding the use of elaborate promotional material beyond those sufficient to provide a complete, accurate and reliable presentation. City reserves the right to reject, replace and approve any and all subcontractors and key staff. All subcontractor(s) shall be identified in the response to the RFP. Subcontractors shall be the responsibility of the prime contractor and the City shall assume no liability of such subcontractors. City of Santa Ana Page 115 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-38 City of Santa Ana Information shall include: 1. If Proposer is a corporation, please provide the following at minimum: • Name of corporation • Corporate office street address • City, state, and zip code • State where incorporated • Date of incorporation • First and last name of officers • Local office Address, City, State & Zip • Date local office opened its doors for business 2. If Proposer is a partnership or joint venture, please provide the following at minimum: • Name of partnership or joint venture • Principal office Address, City, State, and Zip • State of organization • Date of organization commencement • First and last name of general partner(s) • Local office Address, City, State, and Zip • Date local office opened its doors for business 3. List all businesses owned or controlled by Proposer or business manager doing similar business in California under another name. List business name and address, and specify who owns or controls the business (e.g., self, business manager, etc.). 4. List all businesses for which Proposer or business manager is or was an officer, director, or partner doing similar business in California under another name City of Santa Ana Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 List business name and address, title, date(s) in 25B-39 Page 116 City of Santa Ana position; specify who was in position (e.g., self, business manager, etc.). 5. Number of years Proposer has been in business under present business name? 6. List all business names to which Proposer provides ambulance & paramedic billing and collection services for EMS Services in the County of Orange. 7. List all businesses for which Proposer or Proposer's business managers have filed for bankruptcy protection while operating under a towing service contract. 8. Provide a list of current and previous contracts awarded to Proposer for the provision of similar services to the requirements for the City of Santa Ana. Include all public agencies served. For each, provide a brief description of the SOS, length of time Proposer has been providing services, and name, title and telephone number of the person who may be contacted regarding the firm's service record. 9. Describe firm's qualifications, experience and abilities that make it uniquely capable to provide services as specified herein. 10. Provide a detailed list of subcontractors proposed to be used, if any. For each, submit a description of the services the subcontractor will perform and specific qualifications and experience. 11. Provide copies of Proposer's ethical standards, confidentiality policies, managerial philosophy, customer service standards and standards of service quality. State manner in which Proposer ensures these City of Santa Ana Page 117 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-40 City of Santa Ana standards will be evaluated and maintained. The materials may include, but are not limited to: a. Membership in and/or good standing with an organization that is devoted to ensuring high standards of customer service and consumer protection, such as the Better Business Bureau. b. Membership in and/or good standing with a professional organization devoted to encouraging and maintaining ethical or service standards. c. Evidence of training and education in customer service, maintaining quality standards and/or maintaining quality standards received by the firm, its employees and its subcontractors. d. Letters of recommendation from customers and contracting agencies. e. Copies of instructional material used to ensure employee adherence to ethical, quality and customer service standards. f. A list of references that will attest to the firm's ethical, quality and service standards. The list should include the name, address and telephone number of the person who may be contacted and a description of the relationship between the firm and the reference. 12.The City is interested in knowing how Proposers support communities they serve. Please provide information on Proposer's company participation in local community, charitable and civic organizations and events, including membership in civic organizations, charitable contributions made by Proposer's company, etc., for consideration in the RFP evaluation. City of Santa Ana Page 118 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-41 City of Santa Ana 6.0 GENERAL TERMS AND CONDITIONS: By submitting a Proposal, the Proposer acknowledges that it has thoroughly examined and accepts the Terms and Conditions of this RFP as described below: A. Conflict of Interest: Contractor shall exercise reasonable care and diligence to prevent any actions or conditions that could result in a conflict with the best interests of the City. This obligation shall apply to the Contractor; the Contractor's employees, agents, and Subcontractors associated with accomplishing work and services hereunder. The Contractor's efforts shall include, but not be limited to, establishing precautions to prevent its employees, agents, and Subcontractors from providing or offering gifts, entertainment, payments, loans or other considerations which could be deemed to influence or appear to influence City staff or elected officers from acting in the best interests of the City. Each Proposer must disclose any existing or potential conflict of interest relative to the performance of the contractual services resulting from this RFP. Any such relationship that might be perceived or represented as a conflict should be disclosed. The City reserves the right to disqualify any Proposer on the grounds of actual or apparent conflict of interest. No person, firm, or subsidiary thereof who has been awarded this Contract may be awarded a Contract for the provision of services, the delivery of supplies, or the provision of any other related action which is required, suggested, or otherwise deemed appropriate as an end product of this Contract. Therefore, Contractor is precluded from contracting for any work recommended as a result of this Contract. City of Santa Ana Page 119 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-42 City of Santa Ana B. Cost Proposal: All Proposers are required to submit a cost breakdown with their Proposal. Pricing instructions should be clearly defined to ensure fees proposed can be compared and evaluated. Cost Proposals must be submitted with and without EMS treat -no -transport call fees. Proposals shall be valid for a minimum of one hundred eighty (180) days following submission. The cost for developing the Proposal is the sole responsibility of the Proposer. All Proposals submitted become the property of the City. C. Contractor's Project Expense: Pre -Contractual Expenses: The City is not liable for any costs incurred by Proposers prior to entering into a formal contract. Costs for developing a response to this RFP are entirely the responsibility of the Proposer, and shall not be reimbursed in any manner by the City. Pre -contractual expenses are not to be included in the cost proposal. Pre -contractual expenses include, but are not limited to, preparation of the proposal, submission of the proposal and additional information, attendance at pre -proposal conference, negotiating any matter related to this RFP with City, and/or any other expenses incurred by the Proposer prior to the date of award and execution, if any, of the contract. Other Expenses: The Contractor will be responsible for all costs related to photo copying, telephone communications, fax communications, and parking while on City sites during the performance of work and services under this Contract. D. Staffing: It is essential that the Proposer provide adequate experienced personnel, capable of and devoted to the successful accomplishment of work to be performed under this contract. The Contractor must agree to assign specific City of Santa Ana Page 120 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-43 City of Santa Ana individuals to the key positions. Provide a list of staff who will be assigned under this contract. 1. The Contractor agrees that, once assigned to work under this contract, key personnel shall not be removed or replaced without written notice to the City. 2. If key personnel are not available for work under this contract for a continuous period exceeding thirty (30) calendar days, or are expected to devote substantially less effort to the work than initially anticipated, the Contractor shall immediately notify the City, and shall, subject to the concurrence of the City, replace such personnel with personnel of substantially equal ability and qualifications. E. Independent Contractor: Contractor is considered an independent Contractor and neither Contractor or its employees, nor anyone working under Contractor will be considered an agent or an employee of the City. Neither Contractor, its employees, nor anyone working under Contractor, will qualify for Workers' Compensation or other fringe benefits of any kind through the City. F. Litigation Status: Each Proposer must include in its proposal a complete disclosure of any alleged significant prior or ongoing contract failures, any civil or criminal litigation or investigations pending which involve the Proposer or in which the Proposer has been judged guilty or liable. Failure to comply with the terms of this provision will disqualify any proposal. The City reserves the right to reject any proposal based upon the Proposer's prior history with the City or with any other party, which documents, without limitation, unsatisfactory City of Santa Ana Page 121 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-44 City of Santa Ana performance, adversarial or contentious demeanor, significant failure(s) to meet contract milestones or other contractual failures. G. Negotiations: The City reserves the right to negotiate final contract terms with any Proposer selected. The contract between the parties will consist of the RFP together with any modifications thereto, and the awarded Contractor's proposal, together with any modifications and clarifications thereto that are submitted at the request of the City during the evaluation and negotiation process. In the event of any conflict or contradiction between or among these documents, the documents shall control in the following order of precedence: the final executed contract, the RFP, any modifications and clarifications to the awarded Contractor's proposal, and the awarded Contractor's proposal. Specific exceptions to this general rule may be noted in the final executed contract. Negotiations shall be confidential and not subject to disclosure to competing Contractors unless and until an agreement is reached. If contract negotiations cannot be concluded successfully, the City reserves the right to negotiate a contract with another Contractor or withdraw the RFP. H. Sample Professional Service Agreement: The organization selected by the City will be required to execute a Professional Service Agreement with the City. A sample of the Agreement is enclosed as Attachment B, but may be modified to suit the specific services and needs of the City. If a Proposer has any exceptions or conditions to the Agreement, these must be submitted for consideration with the Proposal. Otherwise, the Proposer will be deemed to have accepted the form of Agreement. City of Santa Ana Page 122 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-45 City of Santa Ana I. Checklist of Forms to Accompany Proposal: As a convenience to Proposers, the following is a list of the forms, included as appendices to this RFP, which should be included with Proposals (aside from the Statement of Qualifications requirement): 1. Non -Collusion Affidavit 2. Non -Lobbying Certification 3. Non -Discrimination Certification 4. Proposer's Statement 5. Staffing Plan J. Insurance & W-9 Requirements: Upon recommendation of contract award, Contractor will be required to submit the following documents with ten (10) days of City notification, unless otherwise specified in the solicitation: Insurance - City requires that licensees, lessees, and vendors have an approved Certificate of Insurance (not a declaration or policy) or proof of legal self-insurance on file with the City for the issuance of a permit or contract. W-9 — Current signed form W-9 (Taxpayer Identification Number & Certification) which includes Contractor's legal business name(s). K. Licenses & Permits: The selected Proposer shall be required to obtain a City of Santa Ana Business license within ten (10) business days of selection and must provide a copy to the City Project Manager or designee prior to commencing any work in Santa Ana. Additionally, Contractor shall be responsible for obtaining any licenses/permits required by the SOS. City of Santa Ana Page 123 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-46 City of Santa Ana ATTACHMENT A: SCOPE OF SERVICES The City of Santa Ana is seeking proposals from qualified firms to provide paramedic, medical, and ambulance billing and collection services. The Proposer should have the expertise needed to correctly invoice for these services to Medicare/Medicaid HMO, commercial insurance companies, and private pay individuals, based on the City's fee schedule and the City's Paramedic Subscription Program. The City currently transports approximately 16,000+ patients per year through its third party ambulance provider. The current payer mix consists of the following: Medicare/Medicare HMO 31% Medi-Cal/HMO 39% Commercial Insurance 12% Private Pay 18% GENERAL PERFORMANCE REQUIREMENTS: Proposers shall be responsible for modifying their billing systems to capture all necessary data generated from the ambulance & paramedic billing and collection services program as an electronic file and provide a description of the electronic file needed to receive data transmitted from OCFA. Proposers shall work with OCFA and their electronic Prehospital Care Report (ePCR) vendor to identify data input gaps, errors and other data needs, and describe a means of obtaining solutions to these problems. Proposers shall provide information regarding their organization's experience with ePCR software, specifically Image Trend, including a complete list of their customers utilizing ePCRs and the name and contact information of the software companies utilized. Proposals shall include a complete package describing billing and collections, follow-up, account posting, and accounts receivable reconciliation and reporting services. City of Santa Ana Page 124 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-47 City of Santa Ana 1. Contractor must be able to accurately transfer all necessary information from the OCFA Image Trend database, based on the information provided by the electronic OCFA's ePCR, and obtain any additional information needed that is not included in the ePCR for proper and correct invoicing. 2. Contractor must have the capability to fully integrate and support OCFA's selected ePCR application. 3. Contractor shall maintain updated and current technology that will continuously provide the highest level of reimbursement and customer service possible. 4. Contractor shall designate a single manager for the City's account, who will be the City's primary contact with their agency. 5. Contractor shall provide all supplies, equipment, personnel, computer software and hardware, billing forms, insurance forms, lien forms, envelopes, postage and supplies necessary to administer, on a day-to-day basis, the City's EMS billing and accounts receivable functions. 6. Contractor shall maintain complete records of each bill, including all correspondence, documents, account records, transactions and a detailed log of all payments. These records shall be retained for a minimum of three (3) years. 7. Contractor shall maintain records that are in accordance with the Generally Accepted Accounting Principles (GAAP). The Proposer agrees that all account files are the property of the City and will relinquish them to the City at the termination of the contract. 8. Contractor shall provide monthly finance, billing, account receivable aging reports, billing summaries, details for current month invoicing, current write-off, refund reports (including pending refunds), detail of monthly receipts account City of Santa Ana Page 125 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-48 City of Santa Ana reconciliation, and any additional reports that the City may need or request, in the specific format requested. 9. Contractor shall process all customer payments in accordance with the applicable Payment Card Industry (PCI) security requirements. 10. Contractor shall have the ability to handle third party payer submission inquiries regarding insurance claims. 11. Contractor shall have demonstrated experience and ability to act as the City's authorized agent for liaising on the City's behalf with the Centers for Medicare Services and/or their designated agents as well as associated state agencies. 12. Contractor shall have demonstrated experience and ability to act as the City's authorized agent for liaising with the City's contract EMS provider (OCFA). 13. Contractor shall have demonstrated experience and ability to independently administer the City's paramedic subscription program. 14. Contractor shall have the ability to cross reference patient files in various methods (i.e. Last Name, Social Security Number, Service or Residence Address, Date of Birth, Date of Service, etc.). 15. Contractor shall have the ability to receive patient care documentation on paper and electronically. 16. Contractor shall research and follow-up on all accounts with inadequate billing information to include: a. Contact OCFA for missing and/ or incomplete information, which may be found in their records. City of Santa Ana Page 126 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-49 City of Santa Ana b. Contact receiving hospital for missing and/ or incomplete billing information needed from the admitting/ registration records. c. Contact patient family members or emergency contacts for information. d. Refer to zip code/ street directories for incomplete/ missing address information. e. Mail inquiries to the patient. 17. Contractor must work with County of Orange and perform screening of all medically indigent patients. 18. Contractor must comply with all applicable provisions and specifications of the Health Insurance Portability and Accountability Act (HIPAA), as well as other federal, state, and local statues and regulations addressing patient privacy issues throughout the term of the contract. 19. Contractor shall maintain proficiency and comply with all statutory, regulatory, and other legal requirements, including amendments to such requirements, which impact billing, reimbursement and/or collections for EMS and release of private medical information. 20. Contractor agrees to cooperate with the City regarding the handling of accounts. These accounts may be included, but are not limited to accounts of the specific age classifications, handicapped, and certain dependent situations. 21. Contractor must meet or exceed mutually agreed upon collection targets. 22. Contractor agrees to provide nationwide toll -free telephone number(s) for billing inquiries. City of Santa Ana Page 127 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-50 City of Santa Ana 23. Contractor agrees to meet with the City routinely and on request to discuss problems, special needs, future changes, and updates in software, technology, statistical data requests, or other relevant issues. 24. Contractor shall provide regular and continuous education and training for Contractor's staff, updating them immediately on all changes in the industry or government regulations that may have an impact on services being provided to the City. 25. Contractor shall provide to the City, listings of accounts, which the company feels are uncollectable, through normal collection processes, for further action by the City. 26. Upon request, Contractor shall make all books and records available to both internal and external auditors. 27. Contractor shall not assign or subcontract any portion of this agreement or transfer or assign any claim, pursuant to the contract, without written consent of the City. 28. Contractor must instruct customers to submit all payments to the Proposer, and not the City of Santa Ana. 29. Contractor shall collect and deposit payments on no less than a weekly basis, within three (3) days following receipt of payment. 30. Contract must meet with City staff upon execution of contract to discuss goals of the relationship, the services to be provided, and other topics relevant to the ambulance & paramedic billing and collection services program. City of Santa Ana Page 128 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-51 City of Santa Ana 31. Contractor agrees to coordinate with existing service provider to transition current accounts with minimal disruption to service, and deliver to the City a computerized file of active accounts in an agreeable format. 32. Upon implementation of contract, Contractor must be able to process any backlog of billing within thirty (30) days of the implementation date. City of Santa Ana Page 129 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-52 City of Santa Ana ATTACHMENT B: COSTS PROPOSAL STATEMENT Proposer's Costs Proposal (COMPENSATION): COMPENSATION Proposer agrees to accept as total payment for its services a percentage fee of net collections obtained by Proposer/Consultant per contract year as follows: Agreement Year 1 (Basic Term) — equal to % of net collections obtained by Consultant (with Treat -No -Transport Call Fees). Agreement Year 2 (Basic Term) — equal to % of net collections obtained by Consultant (with Treat -No -Transport Call Fees). Agreement Year 3 (Basic Term) — equal to % of net collections obtained by Consultant (with Treat -No -Transport Call Fees). Agreement Year 4 (Optional Term) — equal to % of net collections obtained by Consultant (with Treat -No -Transport Call Fees). Agreement Year 5 (Optional Term) — equal to % of net collections obtained by Consultant (with Treat -No -Transport Call Fees). Agreement Year 1 (Basic Term) — equal to % of net collections obtained by Consultant (without Treat -No -Transport Call Fees). Agreement Year 2 (Basic Term) — equal to % of net collections obtained by Consultant (without Treat -No -Transport Call Fees). Agreement Year 3 (Basic Term) — equal to % of net collections obtained by Consultant (with Treat -No -Transport Call Fees). Agreement Year 4 (Optional Term) — equal to % of net collections obtained by Consultant (without Treat -No -Transport Call Fees). Agreement Year 5 (Optional Term) — equal to % of net collections obtained by Consultant (without Treat -No -Transport Call Fees). City of Santa Ana Page 130 Ambulance S, Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-53 City of Santa Ana The above Cost Proposals shall be valid for a minimum of one hundred eighty (180) days following submission. Firm/Entity: Signed and Printed Name: Title: Date: THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana Page 131 Ambulance S, Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-54 City of Santa Ana ATTACHMENT C: SAMPLE PROFESSIONAL SERVICE AGREEMENT THIS AGREEMENT is made and entered into this day of , 2019 by and between ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a Consultant having special skill in providing ambulance & paramedic billing and collection services for the City's Emergency Medical Services (EMS) and Emergency Medical Transport Services (EMTS), Program. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services - Attachment A, attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services a percentage fee of net collections obtained by Consultant per contract year as follows: Agreement Year 1 (Basic Term) — equal to X.XX% of net collections obtained by Consultant. City of Santa Ana Page 132 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-55 City of Santa Ana ii. Agreement Year 2 (Basic Term) — equal to X.XX% of net collections obtained by Consultant. iii. Agreement Year 3 (Basic Term) — equal to X.XX% of net collections obtained by Consultant. iv. Agreement Year 4 (Optional Term) — equal to X.XX% of net collections obtained by Consultant. V. Agreement Year 5 (Optional Term) — equal to X.XX% of net collections obtained by Consultant. b. Consultant shall bill for emergency Medical Services at the rates established by City Council Resolution. c. Payment by City shall be made within 45 days (forty-five) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by the City. 3. TERM This Agreement shall be for three (3) years commencing July 1, 2020 and terminating June 30, 2023 with the option solely exercisable by the City to grant to extend the Agreement for an additional (2) year period, exercisable in writing by the City Manager and the City Attorney, unless terminated earlier in accordance with Section 16, below. 4. PREVAILING WAGES Consultant is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. If the services being performed are part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total compensation is $1,000 or more, Consultant agrees to fully comply with such Prevailing Wage Laws. Consultant shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. City of Santa Ana Page 133 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-56 City of Santa Ana I•�I.UI=I»,I•l=I,r9d•],rr:L[$ice] N Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 6. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data, which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 7. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its Subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage City of Santa Ana Page 134 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-57 City of Santa Ana applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $2,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. Due to the nature of the services contemplated under this agreement. C. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. Errors and omissions insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. Cyber/Technology liability insurance, together with Crime, and Fiduciary liability insurance with a limit of not less than $1,000,000.00 per claim with $2,000,000 in the aggregate. f. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: i. Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. ii. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved by the City. iii. City of Santa Ana, its officers, employees, agents and representatives shall be Additional Insureds with respect to General Liability and Auto Liability Insurance is Primary and Non - Contributory. iv. Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City of cancellation with ten (10) days prior notice for non-payment of premium in accordance with policy provisions. City of Santa Ana Page 135 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-58 City of Santa Ana V. Consultant shall supply City with a fully executed additional insured endorsement. vi. Certificates of insurance endorsements shall show the City as a certificate holder as follows: City of Santa Ana Risk Management Division, 4th Floor 20 Civic Center Plaza Santa Ana, CA 92702 vii. Where the amounts or coverage provided by the certificates of insurance provides coverage greater than those listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. viii. Consultant shall supply City with a fully executed additional insured endorsement. g. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 8. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, City of Santa Ana Page 136 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-59 City of Santa Ana just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 9. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 10. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respects to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 11. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful City of Santa Ana Page 137 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-60 City of Santa Ana possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 12. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 13. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. I ILIP9P/1111Wail .UYA17A14.U]Jil4.111111 This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. 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 is not embodied herein. 15. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Consultants retained by City. City of Santa Ana Page 138 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-61 City of Santa Ana I[d�I=11CL7tlIaeNIMlk This Agreement may be terminated by the City upon ninety (90) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to effective date of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 17. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. IF�11111111:7E QlotIMkiM1r/=I.DJ4 This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. City of Santa Ana Page 139 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-62 City of Santa Ana fF1!JdFYd=11Iwet.Ix911)10111111:21Y9P/MM.K! a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. C. Whenever the terms of these Recitals conflict with terms of any Exhibit incorporated herein by reference, then the terms and intent of these Recitals shall prevail and be controlling. d. The said Agreement must be signed below and may be signed in counterpart and delivered by fax, emailed as a PDF (Portable Document Format) file attachment, or by other means that displays the original or a copy of the signatures. Any subsequent amendments may be signed and delivered in the same manner. 20. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 City of Santa Ana Page 140 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-63 City of Santa Ana With courtesy copies to Kathryn Downs, CPA Sonia R. Carvalho Finance & Management Services Agency City Attorney City of Santa Ana City of Santa Ana 20 Civic Center Plaza (M-17) 20 Civic Center Plaza (M-29) P.O. Box 1988 P.O. Box 1988 Santa Ana, California 92702 Santa Ana, California 92702 Fax: (714) 647-5304 Fax: 714- 647-6515 To Consultant: First & Last Name Title Consultant Firm Name Address City, State, Zip Fax: A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. f Signatures on following page} City of Santa Ana Page 141 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-64 City of Santa Ana IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Daisy Gomez Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney Bv: Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: Kathryn Downs, Executive Director Finance and Management Service Agency City of Santa Ana Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 CITY OF SANTA ANA Kristine Ridge City Manager XQU-11101f_l,rIA (Name) (Title) Tax I D# 25B-65 Page 142 City of Santa Ana ATTACHMENT D: NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the BIDDER declares that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any BIDDER or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the BIDDER has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the BIDDER or any other BIDDER, or to fix any overhead, profit, or cost element of the bid price, or of that of any other BIDDER, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the BIDDER has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Non -Collusion Affidavit is part of the Proposal. BIDDERS are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed State of California County of Subscribed and sworn to (or affirmed) before me on this day of , 20_, by , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me Notary Public Signature Notary Public Seal THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-66 Page 143 City of Santa Ana ATTACHMENT E: NON -LOBBYING CERTIFICATION The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. Signed: Title: Firm: Date: THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana Page 144 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-67 City of Santa Ana ATTACHMENT F: NON-DISCRIMINATION CERTIFICATION The undersigned consultant or corporate officer, during the performance of this contract, certifies as follows: 1. The Consultant shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The Consultant shall take affirmative action to ensure that applicants are employed, and that employees are treated during employment without, regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Consultant agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. 2. The Consultant shall, in all solicitations or advertisements for employees placed by or on behalf of the Consultant, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. 3. The Consultant shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Consultant's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Consultant shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Consultant shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. 6. In the event of the Consultant's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Consultant may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. City of Santa Ana Page 145 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-68 City of Santa Ana The Consultant shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontract or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Consultant becomes involved in, or is threatened with, litigation with a subconsultant or vendor as a result of such direction by the administering agency, the Consultant may request that the United States enter into such litigation to protect the interests of the United States. 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any consultant of public works violating this Section is subject to all the penalties imposed for a violation of the Chapter. Signed: Title: Firm: Date: THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana Page 146 Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-69 City of Santa Ana ATTACHMENT G: PROPOSER'S STATEMENT Proposer understands and agrees that this written RFP (or any part thereof specifically designated and accepted by the City of Santa Ana, (hereinafter City) shall constitute the entire agreement between Proposer and the City only after it has been accepted by the City Council, endorsed by the Clerk of the Council with her signature and official seal noting hereon the action of approval of the Council, signed by the Executive Director or his duly authorized agent, and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and when it or an exact copy of it has been either delivered to Proposer or deposited with the United States Postal Service properly addressed to the Proposer with the correct postage affixed thereto. Proposer further agrees that upon delivery (as defined above) of the accepted agreement he/she will furnish City all required bonds and certificate of liability insurance within ten (10) days (excluding Saturdays, Sundays and City's legal holidays), or the funds, check, draft, or Proposer's bond substituted in lieu thereof accompanying this proposal shall become the property of the City and shall be considered as payment of damages due to the delay and other causes suffered by City because of the failure to furnish the necessary bonds and because it is distinctly agreed that the proof of damages actually suffered by City is difficult to ascertain; otherwise said funds, check drafts, or Proposer's bond substituted in lieu thereof shall be returned to the undersigned. Proposer understands that a proposal is required set forth in the RFP schedule are solely for the compensation under the contract will be based completed. for the entire work, that the estimated quantities purpose of comparing proposals, and that final upon the actual quantities of work satisfactorily All terms contained in the specifications, the certification of nondiscrimination by contractors, and the required insurance certificates are to be incorporated by reference into this agreement and are made specifically as part of this RFP. Firm/Entity: Signed and Printed Name: Title: Date: THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana Ambulance & Paramedic and Collection Services Request for Proposals: # 19-083 September 13, 2019 25B-70 Page 147