HomeMy WebLinkAboutMINUTES - 12162014 - D.8RECOMMENDATION(S):
1. CONSIDER reviewing and approving the Draft Emergency Ambulance Request for Proposal (RFP) for emergency
ambulance services for Emergency Response Areas (ERA) I, II and V from Emergency Medical Services (EMS)
Agency staff and RFP consultants, Fitch and Associates LLC.
2. DIRECT the Emergency Medical Services (EMS) Agency, with the assistance of Fitch and Associates to finalize
the RFP for submission to the California State EMS Authority.
FISCAL IMPACT:
No fiscal impact. This item is requesting review and approval of the draft RFP only.
BACKGROUND:
On October 21, 2014 the Board of Supervisors gave direction to the EMS Agency and Fitch consultants to prepare a
RFP that included plan A and plan B for prospective bidders. This approach was designed to create flexibility in
ambulance service terms to enable the County to assure the fiscal sustainability of countywide
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 12/16/2014 APPROVED AS RECOMMENDED OTHER
Clerks Notes:See Addendum
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: Patricia Frost,
925-646-4690
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board
of Supervisors on the date shown.
ATTESTED: December 16, 2014
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc: T Scott, C Rucker, Leticia Andres
D.8
To:Board of Supervisors
From:William Walker, M.D., Health Services Director
Date:December 16, 2014
Contra
Costa
County
Subject:Draft Emergency Ambulance Request for Proposal (RFP) for Exclusive Response Areas (ERA) I, II and V
BACKGROUND: (CONT'D)
emergency ambulance services in the event insurance reimbursement of services was no longer able to fully fund
the contracted provider. Emergency ambulance services in ERA Zone I, II and V are currently provided at no cost
to the county and are sustained through patient medical insurance reimbursement to the private contractor.
Presently the EMS system is facing a number of uncertainties associated with the funding of fire first responder
services, changes in ambulance transport destinations in west county, and reductions in health care reimbursement
patterns affecting both governmental and private insurance programs. In this uncertain environment, designing an
ambulance service RFP with options that would largely retain existing response standards as well as options that
would incorporate changes as recommended in the Fitch report as needed to support sustainable emergency
ambulance services without subsidy is prudent.
The draft RFP and the resulting emergency ambulance contract language is intended to facilitate potential changes
to the EMS system as may be approved by the Board of Supervisors. The RFP will also identify ambulance
contract administration costs which the Board may choose to recover from the ambulance provider. The existing
ambulance contract includes provision to allow for changes in patient charges to cover changes in governmental
reimbursements (e.g., MediCal, Medicare) and increased operational costs that could not have been reasonably
anticipated. These provisions would be expanded to include Board-approved increased charges to cover significant
changes in private payer reimbursements.
The draft RFP incorporates the specific recommendations from the Emergency Medical Care Committee, Hospital
Council, Contra Costa Executive Fire Chiefs, Alameda and Contra Costa Medical Care Association, Health Plans,
Law enforcement and numerous other EMS System and community partners presented to the Board on October
21, 2014.
Public and Stakeholder Feedback: The draft RFP is available on the Contra Costa EMS website at
http://cchealth.org/ems/system-review.php#simpleContained8. The draft document was discussed at the
Emergency Medical Care Committee on 12/3/2014. There is an ongoing public comment process in place to
collect feedback from stakeholders and the community.
Status of RFP Timeline (subject to change)
Date Action Item
8/5/2014 EMS Agency recommendations for RFP direction associated with EMS Modernization report to BOS
(completed)
9/17/2014 RFP Stakeholder Development Workshop (completed)
9/23/2014 Fire BOS RFP Workshop (completed)
9/25/2014 BOS submission deadline for 10/7 (completed)
10/21/2014 Draft RFP Workshop to BOS including stakeholder input (completed)
Nov 2014 Draft RFP to Supervisors, Fire Chiefs and posted on EMS Website
12/3/2014 RFP Status Update to EMCC
12/10/2014 Draft RFP Posted to EMS and Board website
12/16/2014 Draft RFP to BOS for discussion and direction to finalize
1/13/2015 Draft RFP to BOS approval (if final direction not given on 12/16/2014)
Dec/Jan TBD RFP to California EMS Authority (EMSA) for approval
All Dates below are TBD pending timing of EMSA approval
Jan/Feb TBD EMSA RFP amendment period (if required)
Feb/April 2015 Final RFP to BOS for Approval if EMSA amendment required
Feb/April 2015 Final RFP Released to Bidders
April/May 2015 Proposer's Conference
May/June 2015 Proposals Due
June 2015 Review Panel Evaluation Period
July 2015 Recommendation of Review Panel to Health Officer
July 2015 Health Officer recommendation to BOS Intent to Award
July/Aug 2015 Final Contract Preparation Period
Aug/Sep 2015 Final Contract Approved by BOS
Sept 2015 Ambulance Provider Transition Planning Period
1/1/2016 New Contract Start
CONSEQUENCE OF NEGATIVE ACTION:
Approval and opening of the ambulance RFP may be delayed.
CHILDREN'S IMPACT STATEMENT:
Approximately 8-10% of EMS system services are provided to children.
CLERK'S ADDENDUM
Speakers: Lance Maples, City of El Cerrito Fire Department; Stephan Healy, County Fire Chiefs; Paige
Meyer, Executive Fire Chiefs; Brian Johnson, Falcon Ambulance; Traci Reilly, Vice Mayor, City of Lafayette;
Brandt Andersson, City of Lafayette. DIRECTED the EMS Agency and Fitch consultants to return to the
Board with information specifically addressing all the concerns raised by stakeholders and the public today,
and to change attendance at the Proposers Conference from recommended to mandatory.
ATTACHMENTS
DRAFT Request for Proposals - Exclusive Operator for Emergency Ambulance Service - Contra Costa County,
California
Map of EMS Response Areas
Page i
Request for Proposals
Exclusive Operator for Emergency Ambulance Service
Contra Costa County, California
Release Date:
Proposal Due Date:
Time: 4:00 PST
Return Location:
Contra Costa County EMS Agency
1340 Arnold Drive, Suite 126
Martinez, CA 94553
Attention: Patricia Frost
i
Table of Contents
SECTION I. EMS SYSTEM SUMMARY________________________________________________________ 1
A. OVERVIEW _______________________________________________________________________________1
B. EXCLUSIVE OPERATING AREAS (EOAS)_____________________________________________________________2
C. PROPOSALS MUST INCLUDE RESPONSE TO TWO SERVICE PLANS _____________________________________________2
D. BACKGROUND ____________________________________________________________________________3
E. OVERVIEWOF EMSSYSTEM ____________________________________________________________________4
F. LOCAL EMSAGENCY RESPONSIBILITIES ____________________________________________________________7
G. CONTRA COSTA EMSSYSTEM IMPROVEMENTS ________________________________________________________7
1._______________________________________________________________________________7
2.-
Established ________________________________________________________________________________________________8
3.__________________________________________________________________8
4.__________________________________________________________________________________________8
5.________________________________________________________________________________________8
H. RELEVANT INFORMATION REGARDING SERVICE AREAS ____________________________________________________9
1.________________________________________________________________________________9
2._______________________________________________________________________9
3.-1-1 _______________________________________9
4.__________________________________________________________________________________________________9
SECTION II. PROCUREMENT INFORMATION _________________________________________________ 11
A. PERFORMANCE-BASED CONTRACT _______________________________________________________________11
B. NOTICE TO PROPOSERS ______________________________________________________________________11
C. USE OF OWN EXPERTISE AND JUDGMENT ___________________________________________________________12
D. PROCUREMENT TIME LINE ____________________________________________________________________12
E. PROCUREMENT PROCESS ____________________________________________________________________12
1. Pre-____________________________________________________________________________________12
2.___________________________________________________________________________________12
3._____________________________________________________________________________________13
4.________________________________________________________________________________13
5.esponsibilities ___________________________________________________________________13
6._______________________________________________________________________________14
F. PROPOSAL INSTRUCTIONS ____________________________________________________________________14
1._________________________________________________________________________________________14
2.______________________________________________________________________________14
G. PROPOSAL EVALUATION PROCESS _______________________________________________________________15
1.__________________________________________________________________________________15
2.________________________________________________________________________________16
3.____________________________________________________18
4._________________________________________________________________________18
5. Post-___________________________________________________________________________19
6. Investigation _____________________________________________________________________________________________19
7. Notification ______________________________________________________________________________________________19
8. Debriefing ________________________________________________________________________________________________19
9. Protest____________________________________________________________________________________________________20
10.________________________________________________________________________________21
11.____________________________________________________22
12. Award ____________________________________________________________________________________________________22
ii
13.__________________________________________________________________________________________22
14.______________________________________________________________________________23
H. SCORING MATRIX _________________________________________________________________________23
SECTION III. MINIMUMQUALIFICATIONS ___________________________________________________ 24
A. ORGANIZATIONAL DISCLOSURES ________________________________________________________________24
1._________________________________________________________24
2. C ___________________________________________________________________________________24
3.____________________________________________________________________________________24
4.______________________________________________________________________________24
5. Litigation_________________________________________________________________________________________________24
B. EXPERIENCE AS SOLE PROVIDER ________________________________________________________________25
1._________________________________________________________25
2._________________________________________________________________________________25
3.___________________________________________________________________________________25
4.____________________________________________________________________________________25
C. DEMONSTRATED RESPONSE TIME PERFORMANCE______________________________________________________26
D. DEMONSTRATED HIGH LEVEL CLINICAL CARE ________________________________________________________26
SECTION IV. CORE REQUIREMENTS _______________________________________________________ 27
A. TWO SERVICE PLANS ARE TO BE ADDRESSED _________________________________________________________27
B. CONTRACTOR’S FUNCTIONAL RESPONSIBILITIES_______________________________________________________27
1.____________________________________________________________________________________________27
2._____________________________________________________________________________________28
C. CLINICAL ______________________________________________________________________________28
1.________________________________________________________________________________________28
2.__________________________________________________________________________29
3.__________________________________________________30
D. OPERATIONS ____________________________________________________________________________33
1.____________________________________________________________________________________33
2._______________________________________________________________34
3. Respons ____________________________________________________________35
4.__________________________________________________________37
5.____________________________________________________________38
6.____________________________________________________40
7. Response-_________________________42
8._______________________________________________________________________________________46
9.__________________________________________46
E. PERSONNEL _____________________________________________________________________________46
1.___________________________________________________________________46
2.____________________________________________47
3.__________________________________________________________________47
4._____________________________________________________48
5._____________________________________________________________________________48
F. MANAGEMENT ___________________________________________________________________________48
1._____________________________________________________________________48
G. EMSSYSTEM AND COMMUNITY ________________________________________________________________52
1._____________________________________________________________52
2. Accreditation ____________________________________________________________________________________________52
3. Multi-______________________________________________________________________52
4. Mutual--______________________________________________________________________54
5._______________________________________________________________________________54
6.________________________________________________54
iii
7.___________________________________________________________________________55
8.____________________________________________________________55
H. ADMINISTRATIVE PROVISIONS __________________________________________________________________55
1.
________________________________________________________________55
2._______________________________________________________________________________________55
3.___________________________________________________________________________56
4.__________________________________________________56
5.____________________________________________________________________________57
6.______________________________________________________________________________57
7.____________________________________________________________________________________________58
8.__________________________________________________________________________________59
9.____________________________________________________________________________________________59
10.____________________________________________________________________________________60
11._________________________________60
12._____________________________________________________________________________60
13.______________________________________________________________________________________61
14.________________________________________________________________________61
15._____________________________________________________________________________61
16.________________________________________________________________________61
17.____________________________________________62
18. Termination______________________________________________________________________________________________63
19.____________________________________________________________________________________63
20._____________________________________________________________________________________65
21._______________________________________________________________________________________65
22.____________________________________65
23. "Lame-_________________________________________________________________________________66
24._______________________________________________________________________________________67
SECTION V. COMPETITIVE CRITERIA _______________________________________________________ 70
A. CLINICAL ______________________________________________________________________________70
1.___________________________________________________________70
2. Com ______________________________________73
3._______________________________________75
4._______________________________________________________________76
5.________________________________________77
6._______________________________78
B. OPERATIONS ____________________________________________________________________________78
1.________________________________________________78
2._________________________________________________________________________80
3.______________________________________________________________________81
4._________________________________________82
5.__________________________________________________________83
C. PERSONNEL _____________________________________________________________________________84
1._______________________________________________________________84
2._________________________________________________________________84
3.___________________________85
4.________________________________________________________86
D. MANAGEMENT ___________________________________________________________________________87
1.__________________________________________________________________87
E. EMSSYSTEM AND COMMUNITY ________________________________________________________________88
1._____________________88
2._____________________89
F. INTEGRATION WITH HEALTHCARE PROVIDERS_________________________________________________________91
iv
1.____________________________________91
SECTION VI. FINANCIAL CRITERIA ________________________________________________________ 92
A. FINANCIAL STRENGTH AND STABILITY _____________________________________________________________92
B. FINANCIAL SITUATION DOCUMENTS ______________________________________________________________92
1.ts ____________________________________________________________________________________92
2.______________________________________________________________________________________92
3._________________________________________________________________________________92
4._________________________________________________________________________________________92
5.___________________________________________________________________________________93
6._______________________________________________________________________________________93
C. FINANCIAL PROJECTIONS _____________________________________________________________________93
1._____________________________________________________________________________________93
2._______________________________________________________________________________93
3._____________________________________________________________________________________93
4. One-___________________________________________________________________94
5.Summary ____________________________________________________________________________________94
D. PRICING _______________________________________________________________________________94
T 1.C C C P CENTERS______________________________________________________________4
T 2.E P MIX_____________________________________________________________________________________9
T 3.S ALLOCATION______________________________________________________________________________________22
T 4.P R S ALLOCATIONS_________________________________________________________________23
T 5.R T C R P A A C C C E R
ZONES_________________________________________________________________________________________________________37
T 6.R T C R P B_________________________________________________37
T 7.C R T PENALTIES _______________________________________________________________________43
T 8.OUTL R T PENALTIES_______________________________________________________________________44
T 9.B E PENALTIES___________________________________________________________________________45
APPENDICES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16. BudgetTemplates
17. One-Ti
Template
18.
19.
1
SECTION I. EMS SYSTEM SUMMARY
A. Overview
Request for Proposals:
countyth
a
Ea
.
aProposerCounty
-
“”
-ambulanceCounty.
9-1-1
PSAPs
sources,
ambulanceEOA.
Policy Goals of the Procurement:
:((
(;
T
-structions
2
-
Rec
-
-
-to--
stability.
B. Exclusive Operating Areas(EOAs)
EOA)
-
EOA
C. Proposals Must Include Response to Two Service Plans
with
minor
measures
http://www.cchealth.org/ems/system-
review.php#simpleContained4 )
both
3
D. Background
five
ma
(83-
equipment, -
that4.
LEMSA County
athttp://www.cche alth.org/ems/policies.php.
Tacounty
communities
4
1 1
Community 2013
Census
Richmond 107,571 A
29,685 B
24,086 B
12,669 B
Kensington 5,077 B
Pinole 18,902 B
Hercules 24,848 B
Rodeo 8,679 B
Crockett 3,094 B
190
Concord 125,880 C
Martinez 37,165 C
34,127 C
Pacheco 3,685 C
Clayton 11,505 C
Clyde 678 C
66,900 C
Lafayette 25,053 C
Orinda 18,681 MOFD
Moraga 16,771 MOFD
Canyon 842 MOFD
Alamo 14,570 SRFD
Danville 43,341 SRFD
Diablo 1,158 SRFD
72,313 SRFD
Blackhawk 9,354 SRFD
Antioch 107,100 D
Pittsburg 66,695 D
21,349 D
Oakley 38,194 E
2,137
Knightsen 1,568
Brentwood 55,000 E
13,352
Byron 1,277
Unincorporated 70,509 NA
Total 1,094,205
www.emsa.ca.gov.
E. Overview of EMS System
Day-to-
1Ibid
5
n-
EOA
Eight
-desi
-elevat
County.
-1-
-
communications
-
Crockett--Orin
-
mic
http://www.cchealth.org/ems/pdf/mtnspec_v1.5.pdf).
paramedic-
-
Emerge
-
6
center.
five (5
5
ERZA—
–-
Hercules -
.
ERZC—
.
ERZ D— Antioch
sser
ERZE—
b
(trauNon-
-of-
s
-
3
http://cchealth.org/ems/documents.php.
7
F. Local EMSAgencyResponsibilities
:
service-
-and
.
G. Contra CostaEMS System Improvements
the and
EMS s
and
areview
systemstakeholders.
LEMSA’s -
perf,EMSA
through
Contractor.
1. Call Transfer and Dispatch
6 centers
Contractorp rioritized
W-
instruLEMSA.
8
2. Call Density Response Zones, Response Time Requirements and Non-performance
Penalties Established
EOA
IV.C.3.
r’s
Contractor’s
calls
IV.C.7.
6includesEOA.
3. Surplus or Reserve Fleet Requirements
125’s30
38302537.5
38)25is
ambulance.
4. Provider Fatigue
Crewmembers
Costa
5. No Subsidy System
years.I
desire
9
H. Relevant Information Regarding Service Areas
promises,
-
1. HistoricalService Volume
http://cchealth.org/ems/pdf/annual-report-2013.pdfThreeyears
##############.
information LEMSA
2. Current Ambulance Service Rates
7.
3. ALS Ground AmbulanceTransports Not Originating from 9-1-1
ambulance
-1-––are
theseservice
conducting
.
4. Payer Mix
s able2.
2
Payer
Medicare 42.9%
Medi-- 26.3%
Insurance 14.4%
16.4%
Total 100.0%
10
LEMSA 3
3
identifiedIV.G.3.b.
- 29.3
adjustment.
11
SECTION II. PROCUREMENT INFORMATION
A. Performance-based Contract
-
- ,
requirements
Agreement.
;
;
certification/licensure;
;
On-
;
.
The-of-.
improvement,
Specifications.
B. Notice to Proposers
LEM SA
contract,
LEMSA
or LEMSA
determines.
Proposer
-
opening.
LEMSA
.
12
C. Use of Own Expertise and Judgment
Agreement
plans,
D. Procurement Time Line
8(the
LEMSA
LEMSA.
E. Procurement Process
Health
HSD).
1. Pre-proposal Process
-4379
Patricia.Frost@hsd.cccounty.us
(Appendix8).
2. Proposers’ Conference
theProposers’
8)
Proposer
opportuniProposer four(4
13
RFPthey
Proposers’Conferenceworki
Proposers’C
wconference.LEMSA.
an
3. Proposal Submission
ten(10
-ROM
electronic
Proposalsshall(120
“Proposal
”name.
five(5
.”
6
4. Public Proposal Opening
--
6,,at
opening.
5. Additional Proposer Responsibilities
will
14
and
6. Noticeof Intent to Award
NoticeAward.Notice
-
upe
Notice
ng I
.
F. Proposal Instructions
1. Proposal Format
2--
III.A..
;
es;
;
;
dividers
2. Required Proposal Format
a) Mandatory Table of Contents
15
may
.
b) Required Proposal Sections
Narrative
.
9of
.
evaluated,rprocess.
P
G. Proposal Evaluation Process
1. Proposal Review Panel
SA Consultant -
four(4 Consultant
.
information.
16
Dir ector,
Panel
Proposer’
2. Proposal Review Process
.
a)
Qualifications
Director
Director
qualifications,
disqualified.
b)
s
(the
Director Director
Director
Director
exception.
c) evaluatecomp are,
d)
the
17
panel.
ualifications
pfail.
.
poProposal.
Consultant
R
Director.
Directorwill,
to
(Board)Directoridentify
Director:
LEMSAor Proposer
Director
t LEMSA
.
Directordecision.
18
Director.
The
3. Method for Competitive Scoring of Price Proposals
9-1-
10.
--1-1)
-emergency $____X
-
____
$____Y____
$____Z___
$_X+Y+Z _
m.
50
charges50poin
45 25.
4. Independent Financial Analysis
-
-
19
5. Post-submission Presentation
6. Investigation
inquiry,
suppli
LEMSA
pr
7. Notification
selection,
addresslistedProposal.
Director’s
DirectorNotice
Award.
8. Debriefing
Proposer
Proposersubmission Propos
legaPropos
6,within
issuanceNoticeAward
the
requireme
20
9. Protest
Within Notice of Award -
Notwithstanding
RFP-ersProtests
Director
a) Filing a Protest
NoticeAward
6
-4379
Patricia.Frost@hsd.cccounty.us
LEMSAstaff.
b) Contents of Protest
Prote
Protest
initialP
Protest
c) Grounds for Protest
followedd
.
d) Protest Resolution Process
(1)
Director.
PDir ectorschedule
conve county
Director
Informal Meeting with Health Services Director
21
(2)
Director
Director Director
Director
CountyAppeals
Director
.
Formal Review byIndependent Hearing Officer
Appeal
Appeal
Protestshall
theAppeal
Appeal15)
e) Remedies
applicablelaws
.
LEMSA
fety.
f) Stay of Procurement Action during a Protest
RFP;
O
Protest Protest
Protest
LEMSA ,
10. Withdrawal of Proposals
LEMSA.
22
11. Canceling the Procurement Process after Opening
LEMSA
theLEMSA
12. Award
recommendatBoard.
may
13. Scoring Criteria
three cat egories
higher
effectivenessSecond
Proposerts.
on
offerings
below.
3
Rating Poor Adequate Good Excellent
0% 25% 50% 75% 100%
23
14. RFP Governed by Its Terms
,,
Ordinances
.S
H. Scoring Matrix
ompetitiv
4
1 Pass/Fail
2 Agree/Exception
3 -uirements Agree/Exception
4 -300
5 - 300
6 - 250
7 -175
8 Compet -
Community
275
9 - 275
10 75
11 Pass/Fail
12 350
2,000
24
SECTION III. MINIMUM QUALIFICATIONS
A. Organizational Disclosures
Proposer
organizations
RFP,
investigations,
items:
1. Organizational ownership and legal structure
date,
formation.
2. Continuity of business
3. Licenses and permits
4. Government investigations
state,
I.F.2.
5. Litigation
25
I.F.2.
B. Experience as Sole Provider
a
300
1. Demonstrate Capability in Lieu of Experience
obli
-
2. Comparable experience
3. Government contracts
4. Contract Compliance
26
may
C. Demonstrated Response Time Performance
T
ambulance
D. Demonstrated High Level Clinical Care
Th high-level
care.
-
performance .
Agency 2 3 4.
2http://cchealth.org/ems/quality.php
3http://www.emsa.ca.gov/CEMSIS
4http://www.nasemso.org/
27
SECTION IV. CORE REQUIREMENTS
A. Two Service Plans are to be Addressed
–
elements this
il
B. Contractor’s Functional Responsibilities
EOA
-1-
.
Costa -28,
LEMSA
EMS
designate.
1. Basic Services
LEMSA
EOA,LEMSA:
a) -the-
b)
:
c)
28
d)
County
LEMSA
2. Services Description
EOASuch
paramediclevel.
groundLEMSA
Einterfacility
Countyand
apprr.
C. Clinical
1. Clinical Overview
LEMSA
Future
Servi 5 6.
,,
minimized,,
-78
5
I
6 http://www.emscultureofsafety.org/wp-content/uploads/2013/10/Strategy-for-a-National-EMS-Culture-of-Safety-10-03-
13.pdf
7
29
2. EMS System Medical Oversight
LEMSAs
(
physicians).LEMSA
LEMSArequirements.
a) Medical Protocols
LEMSAandstandardsestablishe
Director.
protocols
LEMSA
LEMSA
website.
b) Direct Interaction with Medical Control
LEMSA
c) Medical Review/Audits
program
8
http://www.ihi.org/education/IHIOpenSchool/Courses/Pages/OSInTheCurriculum.aspx#California
30
3. Minimum Clinical Levels and Staffing Requirements
a) Ambulance Staffing Requirements
CaliforniaEMT
s
ilitypatients.
AEA
EMT
b) Personnel Licensure and Certification and Training Requirements
val
LEMSA
from LEMSA website
per LEMSApolicies,
(1)
PreHospit
Required Trauma Training
(2)
Contr
Required Pediatric Trainingand Performance
31
-
gram.
(3)
in
hire.
.
Required Institute of Healthcare Improvement (IHI) Certificate of Patient Safety, Quality and
Leadership
(4)
Co
radios
process.
Company and EMS System Orientation and On-Going Preparedness
(5)
-
LEMSA
Preparation for Multi-casualty Incident
(6)
-
Required Assaultive Behavior Management Training
32
(7)
-driver-training
hours,
LEMSA
confirmation.
Driver Training
(8)
Contrac
practices; competency-based
Infection Control
,
a
(9)Critical Incident Stress Management
(10)Homeland Security
(11)
.S. Departmen
Services.
HIPAA Compliance
(12)Compliance
33
9
requirements
LEMSA
D. Operations
1. Operations Overview
County The
accountability
a) Emergency Response Zones
The ERZ) sep
density/urban-
6.
.
3
–
—
-
Crockett-
—
—
9
34
3
—
--
—
—
b) All Emergency and Non-emergency ALS Ambulance Calls
contract
9-1-1
9-1-1
County.
c) Primary Response to Isolated Peripheral Areas of the EOA
emergencyEOA
-
am
LEMSA
d) Substantial Penalty Provisions for Failure to Respond
2. Transport Requirement and Limitations
t
a) Destinations
County
LEMSAProtocolsLEMSA’spolicymanual.
35
b) Prohibition againstInfluencing Destination Decisions
3. Response Time Performance Requirements
“ below
Methodology), oper ations,
LEMSA
amb
centertransfer
LEMSA
CADs.
a) Description of Call Classification
four (4
-
LEMSA
non-t
EOA.
b) Response Time Performance Requirements
twoareas--de(B)--
reporting,purposesRespo
(1)Potentially Life Threatening Emergency Response (Priority 1)
E-
Contractor’sdi
.
Tables
36
-
(2)
2
Non-Life Threatening Emergency Response (Priority 2)
E non-life
threatening
di
2
-
(3)
3
Non Emergency Response (Priority 3)
non-
3-
s
(4)
-
.
Interfacility ALSNon-emergency Transports (Priority 4)
three
Contractor’sD.
requests.
37
-three-
c) Summary of Response Time Requirements
summarize –
-
priority.
5
P
Level
ERZ Compliance
Urban/Suburban Rural
A 90% N/A
90% 20:00
1 90% 16:45 20:00
90%
Prior 90%
90%+/-N/A
Table 6. R
Prior
Level ERZ Compliance Urban/Suburban Rural
BC 90%
90%
90%
90%+/-N/A
4. Modifications During the Term of Agreement
e
Contract
38
5. Response Time Measurement Methodology
ResponseTimes
above.month,
-
a) Call Receipt
communications center
,
s.
b) AtScene
“AtScene”
.
-
-
c) Response Time
ReceiptaA.
d) Failure to Report atScene Time
“”
-
e) Calculating Upgrades, Downgrades, Reassignmentsand CanceledResponses
-
39
(1)
calc
Upgrades
a)
;or
b)
-
non-
Time.
(2)Downgrades
a)
b)
cases,
LEMSA
(3)Reassignment enroute
(4)
l
Canceled Calls
f) Response Times outsideEOA areExcluded
EOA EOA
40
g) Each Incident a Separate Response
h) Response Time Compliance for Individual Emergency Response Zones
utilizedfor
.
i) Equity in Response Times throughout the County
LEMSA
LEMSAtwo(2 designationshigh-density.
LEMSA
density
compliance
.
TheEOA
Respo
6. Response Time Exceptions and Exception Requests
deter
Services
a) Multi-casualty Disaster
may
-
.
b) Good Cause
RT
justification
Time,
:
;
41
-
()
off-
nearesthigh-densityarea.
ption s.
crews,
c) Exception Request Procedure
LEMSAf
.
reasonable
LEMSALEMSA
Administrator1calendar
after
Administratoror
decision
final.
42
7. Response-time Performance Reporting Procedures and Penalty Provisions
a) Response Time Performance Reporting Requirements
(1)
RT,,
- ,
hospital,a
c
LEMSA
hanges
acceptable.
Documentation of Incident Time Intervals
(2)
1
LEMSA
LEMSAIV.D.
Response Time Performance Report
a) -goin
b)
-
c)
b) Penalty Provisions
compliance
, non-
compliance
below.
(1)
LEMSA 250
-
-
Penalty for Failure to Report On-sceneTime
43
on-
-
Response
compliance.
(2)
LEMSA
all
responses7below.
Penalty for Failure to Comply with Response Time Requirements
requests
7
-Responses each
Penalty
$15,000
%$25,000
8% $50,000
E -2 Responses each
Penalty
$5,000
$10,000
$15,000
-3 Responses each
Penalty
$2,500
$5,000
$7,500
Non--Responses
Penalty
$4,000
$6,000
$7,500
44
(3)
Pare
and
(non-emer
Repetitive Non-Compliance
T
non-compliance
-cotwelve-
monthperiod-
LEMSA
- LEMSA -
compliance
compliance
(4)
O R T
8.shall
ERZ
Penalties for Outlier Responses
is
Time
8
Level OutlierH
>18:59 >29:59 $1,500
>22:59 >44:59 $1,000
>29:59 >59:59 $750
>
>89:59-scheduled $500
(5)
LEMSA
Additional Penalty Provisions
45
LEMSA
LEMSA
Table 9
:
9
Criteria Penalty
reports
O
end
100percentofLEMSA
percent
is
-1-$1,000
.
reports
s
LEMSA
Ambulance .
LEMSA
Ambulan
for
LEMSA
cident
AMA
46
(6)
LEMSA1
LEMSA
Penalty Disputes
8. Fleet Requirement
2
twenty-seven(27)33
(27232.433
2
33).
9. Coverage and Dedicated Ambulances, Use of Stations/Posts
LEMSA
LEMSA
E. Personnel
1. Treatment of Incumbent Work Force
cobyanyA
non-
-
c
Whin
which
47
LEMSAI
-
an essful,
proposal.
LEMSA
-
a
describe
provider
2. Character, Competence and Professionalism of Personnel
LEMSA
managers,
ts
seriousoffenses.
3. Internal Health and Safety Programs
driver-training
48
#and
4. Evolving OSHA & Other Regulatory Requirements
,,-
, LEMSA
f
-
5. Discrimination Not Allowed
state,
promulga
orientation,
orientation,,,-
upgraddemotion,-
F. Management
1. Data and Reporting Requirements
-
LEMSAclinical,
a) Dispatch Computer
LEMSA
LEMSA
-
.
49
.
-
b) Essential Patient Care Record and Assignment Data
compatible,,
isLEMSA
-
0171
patientLEMSApolicy.
ilable.
ecords
priorities.
non-transports.
c) Records
maintain,LEMSA
LEMSA
system.
d) Monthly Reports Required
1
operational,
50
LEMSA
(1)
;
Clinical
;
,and and
-
(2)
area;
Operational
;
ma
-;
-
-
(3)
Respon
;
Response Time Compliance
calls;and
.
(4)
1
LEMSA
County
Response Time Statistical Data
–
–unincorporatedCounty
51
-longitude
-latitude
–
-scene
(5)
LEMSA annually ,
monthly,
necessary.
Personnel Reports
100208.1.
Californi
(6)
i.e.
engagement)
Community/Governmental Affairs Report
52
PRelat
(7)
forLEMSA
PCRs LEMSA
review.-
ElectronicAccess
(8)
LEMSA
Other Reports
G. EMSSystem and Community
1. Participation in EMS System Development
LEMSA
-LEMSA
activi
.
2. Accreditation
24
3. Multi-casualty/Disaster Response
LEMSA
-LEMSA plans.
53
.
may
non-e .
- LEMSA multi-
LEMS A-by-
-
multi-
a) Internal Disaster Response Notification
Cont-
-
personnel.
b) Disaster Response Vehicle/Equipment
unty-
,the
-to-
c) Incident Notification
LEMSA -
incidents,
d) Ambulance Strike Team
54
shall
e) Interagency Training for Exercises/Drills
LEMSA
4. Mutual-aid and Stand-by Services
a) Mutual Aid Requirements
EOA
EOA
b) Stand-by Service
LEMSA-
-
-
inistrator.
5. Permitted Subcontracting
Theproviders
EOA
s LEMSA-
entitiesLEMSA
services
-performance
subcontractor.
LEMSA.
6. Communities May Contract Directly for Level of Effort
County.
communities
wit
LEMSACounty’s
expense.
55
LEMSA
standards
7. Supply Exchange and Restock
-for-
8. Handling Service Inquiries and Complaints
Contrac
non-
follow-
LEMSA
appropri
-
H. Administrative Provisions
1. Contractor Payments for Procurement Costs, County ComplianceMonitoring,Contract
Management, and Regulatory Activities(Plan B only)
t LEMSAits
Agreement
A
750,000).
2. No SystemSubsidy
t LEMSA
sp
iders.
-
56
11.
3. Contractor Revenue Recovery
-for-
charges.
a) Patient Charges
LEMSA 7
10.
b) Fee Adjustments
Services
LEMSA.
ces
services
contr
twelve(12
anniversary
Director
4. Federal Healthcare Program Compliance Provisions
enterservices,
a) Medicare and MedicaidCompliance Program Requirements
57
on
LEMSA
b) HIPAA, CAL HIPAA and HITECHCompliance Program Requirements
,
1.
2.
3.
Standards
,
LEMSA
5. State Compliance Provisions
LEMSAprocedures,
6. Billing/Collection Services
1. claims;
2.
3.
complaints.
58
man
describe
discounting
:
,,
.
7. Market Rights
LEMSA
S
LEM SA
Contractor’sALS
LEMSA
LEMSA
-
-
59
8. Accounting Procedures
a) Invoicing and Payment for Services
LEMSA
LEMSA
LEMSA
LEMSA
-
LEMSA
b) Financial Reporting
net
c) Audits and Inspections
LEMSA
LEMSA
Costa LEMSA
,,
LEMSA
LEMSALEMSA
9. County Permit
-
.
http://cchealth.org/ems/ambulance-providers.php#simpleContained3
60
10. Insurance Provisions
as12.-
11. Hold Harmless / Defense / Indemnification / Taxes / Contributions
a) Hold Harmelss
Contractor
award
Contractor.
Contractor’sliabili
Contractor
Contractor,
b) Employee Character and Fitness.
acc
agents,
crim ic
County
LEMSAtheir
12. Performance Security Bond
twomillion2,000,000)
a)
LEMSA
61
b)
LEMSAtheLEMSA.
13. Term of Agreement
[,2015][
2020].
14. Earned Extensionto Agreement
LEMSAC
Services
LEMSA
--
-
LEMSA
15. Continuous Service Delivery
LEMSA
LEMSA
16. Annual Performance Evaluation
LEMSA Contractor
sta
a)
;
b)
;
62
c) ;
d) ;
e)
Agreement
f)
g)
17. Default and Provisions for Termination of the Agreement
LEMSA
LEMSA
a) Definitions of Breach
include,,
1.
LEMSA
fsc
,
2. LEMSA
3.
4.
H.23;
5.
6.
7.
associations;
8.
63
9.
procedures;
10. e
-
11. ;
12.
13.
14.
15.
16. Failure
17.
18. Termination
a) Written Notice
b) Failure to Perform
LEMSA
LEMSA
LEMSA
LEMSA.
19. Emergency Takeover
LEMSA
Director.
Director
LEMSALEMSA
Director’sdecision
.
64
LEMSA
LEMSA
s
LEMSALEMSA
LEMSALEMSA
disburse
LEMSA
LEMSA
ch
Director
LEMSA F
LEMSA
Director
LEMSA entity
LEMSA
LEMSA
LEMSA
LEMSA
LEMSA
longer LEMSA
LEMSAchooses.
LEMSA
LEMSA
65
ambulanceLEMSA
transfer,
5)
20. Transition Planning
a) Competitive Bid Required
LEMSA
E Amb ulanc S LEMSA
LEMSA
EA S
,,
b) Future BidCycles
-
21. LEMSA's Remedies
exist,LEMSA
e-.AllLEMSA
non-LEMSA.
22. Provisions for Curing Material Breachand Emergency Take Over
LEMSA
d
,LEMSA
breach.
66
why
.
LEMSA
r
i
LEMSA
LEMSA, LEMSA take-
LEMSA
LEMSA.
d
channelsdispute
LEMSA
e-
e-
d
LEMSA
-
dLEMSA
error.
dd
thLEMSA
23. "Lame-duck" Provisions
LEMSA
essary
a)
67
,,
b)
c) LEMSA
LEMSA
d) ShouldLEMSA
24. General Provisions
a) Assignment
LEMSA
p
LEMSA
b) Permits and Licenses
state,or
p
p a
state,p
c) Compliance with Laws and Regulations
state, rules,
d) Private Work
68
e) Retention of Records
Agreement(7
Agreement
LEMSA
County
f) Product Endorsement/Advertising
Administrator.
g) Observation and Inspections
LEMSA
LEMSA
LEMSA
cou
LEMSALEMSA
LEMSAmLEMSA
h) Omnibus Provision
i) Relationship of the Parties
LEMSA
69
LEMSA,
j) Rights and Remedies Not Waived
LEMSA
County .
LEMSA
k) Consent to Jurisdiction
California.
l) End-term Provisions
.
m) Notice of litigation
LEMSA
n) Cost of Enforcement
o) General Contract Provisions
,
LEMSA
herein.
13
successf
response.
70
SECTION V. COMPETITIVE CRITERIA
criteria
Criteria).
,,
LEMSA
II.G.
systems
.
A. Clinical
1. Competitive Criterion: Quality Improvement
a) Minimum Requirements—Demonstrable Progressive Clinical Quality Improvement
LEMSA
egulations.
71
process improvement
process
LEMSA
scienceLEMSA
LEMSA
http://cchealth.org/ems/quality.php.
LEMSA th-
afetyand
implemented.
error-
(Failu--
proc
maintaining
72
illustrate
com
b) Higher Levels of Commitment—Quality Management
,“
LEMSA
,to,
3-2014
www.nist.gov/baldrige/
framework
include:
Leadership;
;
;
;
;
Results.
ion
exper
(http://www.ihi.org
73
2. Competitive Criterion: Clinical and Operational Benchmarking
operations
component.
a) Minimum Requirements—Clinical and Operational Benchmarking
s),KPIs
LEMSA
The
KPIs
1. -wide;
2. ;
3. -
;
4. ;
5. ;
6. -
;
7.
lure;
8.
seizures;
9.
arrest;
10. s
;
11. ;
12. ,
are.
13.
;
14. S ;
15. ;
16. ;
17. aid
18. Safety.
challenges.
74
KPI
b) Higher Levels of Commitment—Clinical and Operational Benchmarking
KPIs
org
benchmarking,
Non-
advancement
-s
;
;
;
ion;
;and
.
-
-of-
;
;
;
75
3. Competitive Criterion: Dedicated Clinical Oversight Personnel
LEMSA
a
activities.
a) Minimum Requirements—Clinical Leadership Personnel
-
- full-
-
ind
provid
-
-go
-
http://www.ihi.org/education/IHIOpenSchool/Courses/Pages/OSInTheCurriculum.aspx.
months,-
,,
LEMSA
.
relationships.
b) Higher Levels ofCommitment—Clinical Leadership Personnel
,
1.
;
76
2.
;
3.
;
4.
monitored;
5.
;
6. ;
7.
;
8.
;
9.
10.
4. Competitive Criterion: Medical Direction
a) Minimum Requirements—Medical Direction
fications.
oversight.
b) Higher Levels of Commitment—Medical Direction
,
1.
individual’s
NAEMSPM
2.
LEMSA
3. liaising
C
77
5. Competitive Criteria: Focus on Patients and Other Customers
’sutcometo
in
a) Minimum Requirements—Focus on Patients and Other Customers
stations,
day.
b) Higher Levels of Commitment—Focus onPatients and Other Customers
,
1. needs,
patients.
2.
cu
3.
ethnicity,
gender,
ethnicity.
4.
5.
F ewer
78
hea
6. Competitive Criterion: Continuing Education Program Requirements
a) Minimum Requirements—Continuing Education
---
LEMSAlicensure/c
in-
s
requirements,LEMSA
b) Higher Levels of Commitment—Continuing Education
,to:
1. T;
2. E;
3. I;and
4. M.
B. Operations
1. Competitive Criterion: Dispatch and Communications
sometimes-complex
9-1-1
County.
Count
a) Minimum Requirements—Dispatch and Communications
-
79
from.
seconds,
,
response.
.
,Transmission
.
C ontractor’s Dispatch
1.
agenc
ambulance-to-
-s
2.
Contractor’sDispatc hCenter S
(CALCORD) -
System.
80
compliant
http://www.ebrcsa.org).
3. -
(FCC)
LEMSA
4.
5.
devices.
real--
County.
b) Higher Levels of Commitment—Dispatch and Communications
,e
1. -
2.
3.
which
.
4.
-
-
2. Competitive Criterion: Vehicles
a) Minimum Requirements—Vehicles
minimum,
1.
2.
"
81
9-1-1
,”
3.
9-1-1
4. color,
Administrator.
5.
6.
7. equipped
b) Higher Levels of Commitment—Vehicles
include,
1.
superviso
2.
specialized
3. Competitive Criterion: Equipment
parts,
a) Minimum Requirements—Equipment
-
LEMSA
on- ,
equipment,LEMSA
.
LEMSA
-
theLEMSALEMSAmay:
1.
;
2. d
3.
82
dispat LEMSA
-
.
b) Higher Levels of Commitment—Equipment
1. those required
effective.
2.
dat
4. Competitive Criterion: Vehicle and Equipment Maintenance
a) Minimum Requirements—Vehicle and Equipment Maintenance
vehicles,-
LEMSA
mannvehicle,
s
LEMSA
83
services,
nse.
b) Higher Levels of Commitment—Vehicle and Equipment Maintenance
,
1. s—
2. s
maintaining, -
standard.
5. Competitive Criterion: Deployment Planning
a) Minimum Requirements—Deployment Planning
Times
Costa
---of-
b) Higher Levels of Commitment—Deployment Planning
,
1.
performance
2.
performance.
3.
displays.
84
C. Personnel
LEMSA
compensation.
1. Competitive Criterion: Field Supervision
LEMSA
-to-LEMSA
a) Minimum Requirements—Field Supervision
- -
County-
-
b) Higher Levels of Commitment—Field Supervision
,
1. (s)(s)
coverage;
2.
interaction.
3.
leadership);
4.
5. .
2. Competitive Criterion: Work Schedules
-
conditions.
85
a) Minimum Requirements—Work Schedules
LEMSA
LEMSA
-
E A
escribe
impairment.
b) Higher Levels of Commitment—Work Schedules
,to:
riately.
3. Competitive Criterion: Internal Risk Management/Loss Control Program
a) Minimum Requirements—Risk Management
LEMSA safety,
1. Pre-;
2. -;
3. raining;
4.
and
5.
issues.
6.
1. ;
2.
-;
86
3. ;
4.
law;and
5. .
s
b) Higher Levels of Commitment—Risk Management
,
activities,
and
.
4. Competitive Criterion: Workforce Engagement
rested,
wit
and
a) Minimum Requirements—Workforce Engagement
minimum,
1.
2.
3.
supervisors
4.
5.
6.
7. partners,
s.
8.
b) Higher Levels of Commitment—Workforce Engagement
,:
87
1.
2. -
3.
ions.
4.
positions.
5.
D. Management
1. Competitive Criterion: Key Personnel
a) Minimum Requirements—Key Personnel
Costa
-of-ContraCosta
responsibilities.
b) Higher Levels of Commitment—Key Personnel
ude,
1. on-
program
2.
Proposermay
3.
88
E. EMS System and Community
1. Competitive Criterion: Supporting Improvement in the First Response System
collaboration
LEMSA
and
responders.
-
,manycommunities,
m
LEMSA
ctivities
negotiate
.
a) Minimum Requirements—First Response System
Proposer
1.
EOA;
2.
EOA;
3. Contractor-for-
;
4.
County
5.
.
89
b) Higher Level of Commitment—First Response System
,
emergencyservices :
1. Share
2.
-
3.
4.
5.
programming
6.
7. ramming
8.
9. Collaborat
10.
economically.
2. Competitive Criterion: Health Status Improvement and Community Education
LEMSA
LEMSA
90
a) Minimum Requirements—Community Education
s
B.
b) Higher Level of Commitment—Health Status Improvement and Community Education
,
LEMSA
professionals.
Proposs
-
, program
9-1-1
h
sshould
91
thesmayinclude:
,
F. Integration with Healthcare Providers
1. Competitive Criterion: Collaboration with Healthcare Providers
dur
Contra
a) Minimum Requirements—Collaboration with Healthcare Providers
provid
b) Higher Level of Commitment—Collaboration with Healthcare Providers
1. out-of-
2.
RFP.
3.
92
SECTION VI. FINANCIAL CRITERIA
A. Financial Strength and Stability
x
orde
B. Financial Situation Documents
1. Financial Statements
- -to-
2. Audited Statements
3. Financial Commitments
4. Working Capital
-
-
93
--
5. Performance Security
6. Financial Interests
businesses.
C. Financial Projections
1. Revenue projections
collection
10
14
2. Revenue Flow Projections
.
-incumbentp
3. Expense Projections
A B-
94
4. One-Time Start Up and Capital Items
--
.
5. Pro Forma Summary
D. Pricing
Page 97
Appendix 1
MANDATORY TABLE OF
CONTENTS
Appendix 1 Mandatory Table of Contents Page 1
Appendix 1
Mandatory Table of Contents
FACE SHEET (FORM IN APPENDIX 9-EXHIBIT A)
SECTION I. EXECUTIVE SUMMARY
SECTION II.
A. Insurance Certificates (Requirements in Appendix 12)
SUBMISSION OF REQUIRED FORMS
B. Debarment and Suspension Certification (Form in Appendix 9-Exhibit B)
C. References (Form in Appendix 9-Exhibit C)
D. Investigative Authorization-Individual (Form in Appendix 9-Exhibit D)
E. Investigative Authorization-Entity (Form in Appendix 9-Exhibit E)
SECTION III. QUALIFICATION REQUIREMENTS
A. Organizational Disclosures
1. Organizational ownership and legal structure
2. Continuity of business
Supporting documentation required.
3. Licenses and permits
Supporting documentation required.
4. Government investigations
Supporting documentation required.
5. Litigation
Supporting documentation required (May be in electronic format).
Supporting documentation required. (May be in electronic format)
Appendix 1 Mandatory Table of Contents Page 2
B. EXPERIENCE AS SOLE PROVIDER
1.Demonstrate Capability in Lieu of Experience
2.Comparable experience
Supporting documentation required for applicable qualifications in this section.
3. Government contracts
Supporting documentation required.
4. Contract Compliance
Supporting documentation required.
C. Demonstrated Response Time Performance
Supporting documentation required.
D. Demonstrated High Level Clinical Care
Supporting documentation required.
Supporting documentation required.
Appendix 1 Mandatory Table of Contents Page 3
SECTION IV. CORE REQUIREMENTS
A. Two Service Plans are to be Addressed
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.A.
_________ Proposer takes exception to provisions contained in Section IV.A. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
B. Contractor’s Functional Responsibilities
1. Basic Services
2. Services Description
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.B. (1.-2.)
_________ Proposer takes exception to provisions contained in Section IV.B. (1.-2.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 4
C. Clinical
1. Clinical Overview
2. Medical Oversight
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.C. (1.-2.)
_________ Proposer takes exception to provisions contained in Section IV.C. (1.-2.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
3. Minimum Clinical Levels and Staffing Requirements
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.C.3.
_________ Proposer takes exception to provisions contained in Section IV.C.3 as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 5
D. Operations
1. Operations Overview
a) Emergency Response Zones
Attestation for Plan A
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.1.a.
_________ Proposer takes exception to provisions contained in Section IV.D.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
Attestation for Plan B
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.1.a.
_________ Proposer takes exception to provisions contained in Section IV.D.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
b) All Emergency and Non-emergency ALS Ambulance Calls
c) Primary Response to Isolated Peripheral Areas of the EOA
d) Substantial Penalty Provisions for Failure to Respond
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.1. (b.-d.)
_________ Proposer takes exception to provisions contained in Section IV.D.1. (b.-d.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 6
2. Transport Requirement and Limitations
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.2. (a.-b.)
_________ Proposer takes exception to provisions contained in Section IV.D.2. (a-b.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
3. Response time Performance Requirements
a) Description of Call Classification
b) Response Time Performance Requirements
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.3. (a.-b.)
_________ Proposer takes exception to provisions contained in Section IV.D3. (a-b.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
c) Summary of Response Time Requirements
Attestation for Plan A
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.3.c.
_________ Proposer takes exception to provisions contained in Section IV.D.3.c. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 7
Attestation for Plan B
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.3.c.
_________ Proposer takes exception to provisions contained in Section IV.D.3.c. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
4. Modifications During the Term of Agreement
5. Response Time Measurement Methodology
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.4 and IV.D.5. (a.-i.)
_________ Proposer takes exception to provisions contained in Section IV.D.4 and IV.D.5. (a.-i.)
as delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
6. Response Time Exceptions and Exception Requests
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.6. (a.-c.)
_________ Proposer takes exception to provisions contained in Section IV.D.6. (a.-c.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 8
7. Response Time Performance Reporting Procedures and Penalty Provisions
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D.7. (a.-b.)
_________ Proposer takes exception to provisions contained in Section IV.D.7. (a.-b.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
8. Fleet Requirement
9. Coverage and Dedicated Ambulances, Use of Stations/Posts
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.D. (8.-9.)
_________ Proposer takes exception to provisions contained in Section IV. D. (8.-9.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
E. Personnel
1. Treatment of Incumbent Work Force
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.E.1.
_________ Proposer takes exception to provisions contained in Section IV. E.1. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 9
2. Character, Competence and Professionalism of Personnel
3. Internal Health and Safety Programs
4. Evolving OSHA & Other Regulatory Requirements
5. Discrimination Not Allowed
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.E.(2.-5.)
_________ Proposer takes exception to provisions contained in Section IV. E.(2.-5.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
F. Management
1. Data and Reporting Requirements
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.F.1. (a.-d.)
_________ Proposer takes exception to provisions contained in Section IV. F.1. (a.-d.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 10
G. EMS System and Community
1. Participation in EMS System Development
2. Accreditation
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.G. (1.-2.)
_________ Proposer takes exception to provisions contained in Section IV.G. (1.-2.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
3. Multi-casualty/Disaster Response
4. Mutual Aid and Stand-by Services
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.G. (3.-4.)
_________ Proposer takes exception to provisions contained in Section IV.G. (3.-4.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
5. Permitted Subcontracting
6. Communities May Contract Directly for Level of Effort
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.G. (5.-6.)
_________ Proposer takes exception to provisions contained in Section IV.G. (5.-6.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 11
7. Supply Exchange and Restock
8. Handling Service Inquiries and Complaints
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.G. (7.-8.)
_________ Proposer takes exception to provisions contained in Section IV.G. (7.-8.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
H. Administrative Provisions
1. Contractor Payments for Procurement Costs, County Compliance Monitoring, Contract
Management, and Regulatory Activities (Plan B only)
Attestation for Plan B
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H.1.
_________ Proposer takes exception to provisions contained in Section IV.H.1.. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
2. No Subsidy System
Attestation for Plan B
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H.2.
_________ Proposer takes exception to provisions contained in Section IV.H.2.. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 12
Supporting narrative and/or documentation required.
Attestation for Plan A
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H.2.
_________ Proposer takes exception to provisions contained in Section IV.H.2.. as delineated
below. Proposer recognizes that taking exception with any provision of the Core Requirements
may result in finding that the Proposal is unresponsive and result in disqualification.
Exceptions:
3. Contractor Revenue Recovery
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H. 3. (a.-b.)
_________ Proposer takes exception to provisions contained in Section IV.H. 3. (a.-b.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 13
4. Federal Healthcare Program Compliance Provisions
5. State Compliance Provisions
6. Billing/Collection Services
7. Market Rights
8. Accounting Procedures
99.County Permit..
10. Insurance Provisions
Insurance documentation required
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H. (4.-10.)
_________ Proposer takes exception to provisions contained in Section IV.G. (4.-10.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 14
11. Hold Harmless / Defense / Indemnification / Taxes / Contributions
12. Performance Security Bond
13. Term of Agreement
14. Earned Extension to Agreement
15. Continuous Service Delivery
16. Annual Performance Evaluation
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H. (10.-16.)
_________ Proposer takes exception to provisions contained in Section IV.H. (10.-16.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
17. Default and Provisions for Termination of the Agreement
18. Termination
19. Emergency Takeover
20. Transition Planning
21. LEMSA's Remedies
22. Provisions for Curing Material Breach and Emergency Take Over
23. "Lame duck" Provisions
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H. (17.-23.)
_________ Proposer takes exception to provisions contained in Section IV.H. (17.-23.). as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
Appendix 1 Mandatory Table of Contents Page 15
24. General Provisions
Exceptions to General Provisions of Contract Requires Documentation
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section IV.H.24 (a.-o.)
_________ Proposer takes exception to provisions contained in Section IV.H.24. (a.-o.) as
delineated below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
SECTION V. COMPETITIVE CRITERIA
A. Clinical
1. Competitive Criterion: Quality Improvement
a) Minimum Requirements—Demonstrable Progressive Clinical Quality Improvement
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.A.1.a.
_________ Proposer takes exception to provisions contained in Section V.A.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment—Quality Management
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 16
2. Competitive Criterion: Clinical and Operational Benchmarking
a) Minimum Requirements—Clinical and Operational Benchmarking
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.A.2.a.
_________ Proposer takes exception to provisions contained in Section V.A.2.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment—Clinical and Operational Benchmarking
3. Competitive Criterion: Dedicated Clinical Oversight Personnel
Supporting narrative and/or documentation required.
a) Minimum Requirements—Clinical Leadership Personnel
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.A.3.a.
_________ Proposer takes exception to provisions contained in Section V.A.3.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment—Clinical Leadership Personnel
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 17
4. Competitive Criterion: Medical Direction
a) Minimum Requirements—Medical Direction
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.A.4.a.
_________ Proposer takes exception to provisions contained in Section V.A.4.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment—Medical Direction
5. Competitive Criteria: Focus on Patients and Other Customers
Supporting narrative and/or documentation required.
a) Minimum Requirements— Focus on Patients and Other Customers
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.A.5.a.
_________ Proposer takes exception to provisions contained in Section V.A.5.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Focus on Patients and Other Customers
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 18
6. Competitive Criterion: Continuing Education Program Requirements
a) Minimum Requirements—Continuing Education
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.A.6.a.
_________ Proposer takes exception to provisions contained in Section V.A.6.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Continuing Education
Supporting narrative and/or documentation required.
B. Operations
1. Competitive Criterion: Dispatch and Communications
a) Minimum Requirements— Dispatch and Communications
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.B.1.a.
_________ Proposer takes exception to provisions contained in Section V.B.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Dispatch and Communications
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 19
2. Competitive Criterion: Vehicles
a) Minimum Requirements—Vehicles
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.B.2.a.
_________ Proposer takes exception to provisions contained in Section V.B.2.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Vehicles
3. Competitive Criterion: Equipment
Supporting narrative and/or documentation required.
a) Minimum Requirements—Equipment
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.B.3.a.
_________ Proposer takes exception to provisions contained in Section V.B.3.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Equipment
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 20
4. Competitive Criterion: Vehicle and Equipment Maintenance
a) Minimum Requirements— Vehicle and Equipment Maintenance
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.B.4.a.
_________ Proposer takes exception to provisions contained in Section V.B.4.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Vehicle and Equipment Maintenance
5. Competitive Criterion: Deployment Planning
Supporting narrative and/or documentation required.
a) Minimum Requirements— Deployment Planning
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.B.5.a.
_________ Proposer takes exception to provisions contained in Section V.B.5.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Deployment Planning
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 21
C. Personnel
1. Competitive Criterion: Field Supervision
a) Minimum Requirements— Field Supervision
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.C.1.a.
_________ Proposer takes exception to provisions contained in Section V.C.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Field Supervision
2. Competitive Criterion: Work Schedules
Supporting narrative and/or documentation required.
a) Minimum Requirements— Work Schedules
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.C.2.a.
_________ Proposer takes exception to provisions contained in Section V.C.2.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Work Schedules
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 22
3. Competitive Criterion: Internal Risk Management/Loss Control Program
a) Minimum Requirements—Risk Management
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.C.3.a.
_________ Proposer takes exception to provisions contained in Section V.C.3.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Risk Management
4. Competitive Criterion: Workforce Engagement
Supporting narrative and/or documentation required.
a) Minimum Requirements— Workforce Engagement
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.C.4.a.
_________ Proposer takes exception to provisions contained in Section V.C.4.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Workforce Engagement
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 23
D. Management
1. Key Personnel
a) Minimum Requirements—Key Personnel
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.D.1 .a.
_________ Proposer takes exception to provisions contained in Section V.D.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment—Key Personnel
E. EMS System and Community
Supporting narrative and/or documentation required.
1. Supporting Improvement in the First Response System
a) Minimum Requirements—First Response System
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.E.1.a.
_________ Proposer takes exception to provisions contained in Section V.E.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment—First Response System
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 24
2. Health Status Improvement and Community Education
a) Minimum Requirements—Community Education
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.E.2.a.
_________ Proposer takes exception to provisions contained in Section V.E.2.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment—Health Status Improvement and Community Education
F. Integration with Healthcare Providers
Supporting narrative and/or documentation required.
1. West Side Healthcare District Area
a) Minimum Requirements—Collaboration with Healthcare Providers
Supporting narrative and/or documentation required.
Attestation:
_________ Proposer understands and agrees to comply without qualification to provisions,
requirements, and commitments contained in Section V.F.1.a.
_________ Proposer takes exception to provisions contained in Section V.F.1.a. as delineated
below. Proposer recognizes that taking exception with any provision of the Core
Requirements may result in finding that the Proposal is unresponsive and result in
disqualification.
Exceptions:
b) Higher Levels of Commitment— Collaboration with Healthcare Providers
Supporting narrative and/or documentation required.
Appendix 1 Mandatory Table of Contents Page 25
SEPARATE SUBMISSION: FINANCIAL DOCUMENTS
A. Financial Documents
The Proposer shall submit all of the requested financial documents in a separately sealed containt
labeled “Financial Documents.” There shall be one (1) original and five (5) copies plus one (1)
electronic version on a disk or USB memory stick.
B. Financial Situation Documents
The Proposer shall submit the following documents and information supporting the following:
1. Financial Statements
2. Audited Statements
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
3. Financial Commitments
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
4. Working Capital
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
5. Performance Security
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
6. Financial Interests
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
C. Financial Projections
Proposers shall submit the following financial projections and assumptions consistent with the
specified templates contained in the Appendices.
1. Revenue projections
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
Appendix 1 Mandatory Table of Contents Page 26
2. Revenue Flow Projections
3. Expense Projections
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
4. One-Time Start Up and Capital Items
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
5. Pro Forma Summary
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
D. ALS Interfacility Pricing
Proposer shall complete and submit the ALS Interfacility Price Sheet in Appendix 20.
Supporting documentation required. (Separate sealed envelope labeled “Financial Documents”)
Page 98
Appendix 2
MAP OF EXCLUSIVE
OPERATING AREA
Appendix 2 Exclusive Operating Areas Page 1
Page 99
Appendix 3
EMERGENCY RESPONSE
ZONE MAPS
Page 100
Appendix 4
COUNTY AMBULANCE
ORDINANCE
Page 101
Appendix 5
CURRENT AMBULANCE
ZONES MAP
Page 102
Appendix 6
CALL DENSITY
RESPONSE AREAS IN
EOA
Page 103
Appendix 7
CURRENT AMBULANCE
RATES
Appendix 7
Contra Costa County
Current Approved Ambulance Rates
Emergency Base Rate ------------------------------------------------------------------------------- $1,957.19
Mileage Rate (per loaded mile) ------------------------------------------------------------------------ $45.00
Oxygen ----------------------------------------------------------------------------------------------------$175.00
Page 104
Appendix 8
PROCUREMENT
TIMELINE
APPENDIX 8
PROCUREMENT TIME LINE
Date Activity
Month Day, Year Board Approval of RFP
RFP Released
RFP Questions/Clarifications Due
Proposer’s Conference
Proposals due at 4 p.m. and Public Proposal Opening
Proposer presentations
Protest period Begins
Presentation to Board; negotiation of contract
authorized
Contract negotiations completed
Board approval of contract
Startup of new contract
Page 105
Appendix 9
REQUIRED FORMS
EXHIBIT A
FACE SHEET
Page | 1
***THIS FORM MUST APPEAR AS THE FIRST PAGE OF THE PROPOSAL***
This is a proposal to contract with Contra Costa County to provide emergency medical and ALS interfacility
ambulance services.
Name of Proposer:
Dba:
Type Of Organization: Corporation LLC Partnership Other _______
Date Founded Or Incorporated: __/__/____
Legal Address:
Phone: (___)____-_____ ext.:_____ Fax: (___)___-_____ (Required For Notification)
Federal Tax Identification Number:
Contact person:
Title:
Phone: (___)____-_____ E-Mail:
Address For Mailings: (If different from above):
Authorized Signature: _________________________________________
Date Submitted: __/___/_____
Print Name:
Title:
EXHIBIT B
DEBARMENT AND SUSPENSION CERTIFICATION
Page | 1
The Proposer, under penalty of perjury, certifies that, except as noted below, Proposer, its
principal, and any named subcontractor:
1. Is not currently under suspension, debarment, voluntary exclusion, or determination of
ineligibility by any federal agency;
2. Has not been suspended, debarred, voluntarily excluded or determined ineligible by any
federal agency within the past three years;
3. Does not have a proposed debarment pending; and,
4. Has not been indicted, convicted, or had a civil judgment rendered against it by a court
of competent jurisdiction in any matter involving fraud or official misconduct within the
past three years.
If there are any exceptions to this certification, insert the exceptions in the following space.
Exceptions will not necessary result in denial of award, but will be considered in determining
Proposer responsibility. For any exception noted above, indicate below to whom it applies,
initiating agency, and dates of action.
Notes: Providing false information may result in criminal prosecution or administrative
sanctions. The above certification is part of the Proposal. Signing this Proposal on the
signature portion thereof shall also constitute signature of this Certification.
Proposer Name: ______________________________________________________________
Proposer Signature: ____________________________________________________________
Title: ________________________________________________
Date: ___/__/____
EXHIBIT C REFERENCES Page | 1 CURRENT REFERENCES Proposer name:______________________________________________ Company Name: Address: City, State, Zip Code: Contact Person: Telephone Number: (____) _______ - _________ Service Provided: Dates/Type of Service: ___/____/_____, Company Name: Address: City, State, Zip Code: Contact Person: Telephone Number: (____) _______ - _________ Service Provided: Dates/Type of Service: ___/____/_____,
EXHIBIT C REFERENCES Page | 2 Company Name: Address: City, State, Zip Code: Contact Person: Telephone Number: (____) _______ - _________ Service Provided: Dates/Type of Service: ___/____/_____,
EXHIBIT C REFERENCES Page | 3 FORMER REFERENCES Proposer name: ______________________________________________ Company Name: Address: City, State, Zip Code: Contact Person: Telephone Number: (____) _______ - _________ Service Provided: Dates/Type of Service: ___/____/_____, Company Name: Address: City, State, Zip Code: Contact Person: Telephone Number: (____) _______ - _________ Service Provided: Dates/Type of Service: ___/____/_____,
EXHIBIT C REFERENCES Page | 4 Company Name: Address: City, State, Zip Code: Contact Person: Telephone Number: (____) _______ - _________ Service Provided: Dates/Type of Service: ___/____/_____,
EXHIBIT D
INVESTIGATIVE AUTHORIZATION – INDIVIDUAL
Page | 1
The undersigned, being ___________ (title) for __________ (entity), which is a prospective
Contractor to provide Emergency Ambulance Services to Contra Costa County recognizes that
public health and safety requires assurance of safe, reliable and cost efficient ambulance
service. That assurance will require an inquiry into matters which are determined relevant by
the Contra Costa County EMS Agency or its agents, such as, but not limited to, the character,
reputation, competence of the entity’s owners and key employees.
The undersigned specifically acknowledges that such inquiry may involve an investigation of his
or her personal work experience, educational qualifications, moral character, financial stability
and general background, and specifically agrees that the EMS Agency, or its agents, may
undertake a personal investigation of the undersigned for the purpose stated. This
authorization shall expire six (6) months from the signature date.
AUTHORIZATION FOR SUCH PERSONAL INVESTIGATION IS HEREBY EXPRESSLY GIVEN:
______________________________________________________________________
Date: _____/____/_______
Individual Name
ACKNOWLEDGEMENT
STATE OF ______________________________________________
COUNTY OF ____________________________________________
On this _______ day of _______, 20____, before me, the undersigned, a Notary Public in and
for said County and State, personally appears ________________ to me known to be the
person described herein and who executed the foregoing Affirmation Statement, and
acknowledged that he/she executed the same as his/her free act and deed.
Witness my hand and Notarial Seal subscribed and affixed in said County and State, the day and
year above written.
Notary Public;__________________________________________________
Notary Public Seal Commission Expiration Date: ___/___/____
EXHIBIT E
INVESTIGATIVE AUTHORIZATION – ENTITY
Page | 1
The undersigned entity, a prospective Contractor to provide Emergency Ambulance Services for
Contra Costa County recognizes that public health and safety requires assurance of safe,
reliable and cost-efficient ambulance service. That assurance will require inquiry into aspects of
entity’s operations determined relevant by the Contra Costa County EMS Agency, or its agents.
The entity specifically agrees that the Contra Costa County EMS Agency or its agents may
conduct an investigation for the purpose into, but not limited to the following matters;
1. The financial stability of the entity, including its owners and officers, any information
regarding potential conflict of interests, past problems in dealing with other clients or
cities where the entity has rendered service, or any other aspect of the entity
operations or its structure, ownership or key personnel which might reasonably be
expected to influence the Contra Costa County EMS Agency’s selection decision.
2. The entity’s current business practices, including employee compensation and benefits
arrangements, pricing practices, billings and collections practices, equipment
replacement and maintenance practices, in-service training programs, means of
competing with other companies, employee discipline practices, public relations efforts,
current and potential obligations to other buyers, and genera internal personnel
relations.
3. The attitude of current and previous customers of the entity toward the entity’s services
and general business practices, including patients or families of patients served by the
entity, physicians or other health care professionals knowledgeable of the entity’s past
work, as well as other units of local government with which the entity has dealt in the
past.
4. Other business in which entity owners and/or other key personnel in the entity
currently have a business interest.
5. The accuracy and truthfulness of any information submitted by the entity in connection
with such evaluation.
EXHIBIT E
INVESTIGATIVE AUTHORIZATION – ENTITY
Page | 2
This authorization shall expire six (6) months from the date of the signature.
AUTHORIZATION FOR SUCH INVESTIGATION IS HEREBY EXPRESSLY GIVEN BY THE ENTITY:
Entity Name: _________________________________________________
Authorized Representative (Signature): ___________________________________________
Authorized Representative (Printed):___________________________________
Title: ______________________________
Date: __/___/___
ACKNOWLEDGEMENT
STATE OF ______________________________________________________
COUNTY OF ____________________________________________________
On this _________ day of _______, 20____, before me appeared __________ to me personally
known, who being by me duly sworn, did say that he/she is the _________ of ___________ and
that said instrument was signed in behalf of said entity by authority delegated to him/her, and
said affiant acknowledges said instrument to be the free act and deed of said entity. In
WITNESS WHEREOF, I have hereunto set by hand and affixed my official seal the day and year
last above written.
___________________________________________________________
Notary Public
Notary Public Seal Commission Expiration Date: ___/___/_____
Page 106
Appendix 10
STIPULATED
AMBULANCE CHARGES
Appendix 10
Contra Costa County
Stipulated Ambulance Rates for Year 1 of Contract
Emergency Base Rate ------------------------------------------------------------------------------- $2,100.00
Mileage Rate (per loaded mile) ------------------------------------------------------------------------ $50.00
Oxygen ----------------------------------------------------------------------------------------------------$175.00
Treat and Refused Transport -------------------------------------------------------------------------$450.00
Page 107
Appendix 11
SUBSIDY REQUEST
FORM
Appendix 11
Plan A
Subsidy Requirements
Proposer shall identify any subsidies required to support the level of service and performance
requirements for Plan A. An annual subsidy for each of the first five years of the term of the
Agreement shall be identified in this submission, if a subsidy is required.
Year One Subsidy: -------------------------------------------------------------------- $_________________________
Year Two Subsidy: ------------------------------------------------------------------- $_________________________
Year Three Subsidy: ----------------------------------------------------------------- $_________________________
Year Four Subsidy: ------------------------------------------------------------------- $_________________________
Year Five Subsidy: ------------------------------------------------------------------- $_________________________
FIRM: __________________________________________________________________________
SIGNATURE:___________________________________________________________________
DATE: ___/____/_____
PRINTED NAME: _____________________________________________________________
TITLE: _________________________________________________________________________
Page 108
Appendix 12
INSURANCE
REQUIRMENTS
APPENDIX 12
INSURANCE REQUIREMENTS
Page | 1
1. EVIDENCE OF INSURANCE: Certificates of insurance are required from a reputable
insurer evidencing all overages required for the term of any contract that may be
awarded pursuant to this RFP.
2. COUNTY NAMED AS ADDITIONAL INSURED: The County’s insurance requirements for
Additional Insured reads, “All insurance required above with the exception shall be
endorsed to name as additional insured.” An endorsement is an amendment to a
contract, such as an insurance policy, by which the original terms are changed. The
insurance certificate (also known as the “Accord”) carries a disclaimer, “This certificate
is issued as a matter of information only and confers no rights upon the certificate
holder. This certificate does not amend, extend or alter the coverage afforded by the
policy below.” Additional insured listed in the description box are not a proper risk
transfer. Any amendment or extension of the coverage such as an additional insured
should be provided by a separate endorsement page or copy of the policy.
3. INSURANCE PROVISIONS
3.1 CONTRACTOR shall obtain and maintain in full force and effect throughout the
term of this Agreement, and thereafter as to matters occurring during the term
of this Agreement, the following insurance coverage:
(a) Workers' Compensation insurance. If and to the extent required by law
during the term of this Agreement, CONTRACTOR shall provide
workers' compensation insurance for the performance of any of
CONTRACTOR's duties under this Agreement; including but not
limited to, coverage for workers' compensation and employer's
liability and a waiver of subrogation, and shall provide COUNTY
with certification of all such coverages upon request by COUNTY’s
Risk Manager.
(b) Liability insurance.CONTRACTOR shall obtain and maintain in full force
and effect during the term of this Agreement the following liability
insurance coverages, issued by a company with an A.M. Best rating
of A: VII or better:
1. General Liability. Commercial general liability [CGL] insurance coverage
(personal injury and property damage) of not less than FIVE
MILLION DOLLARS ($5,000,000) combined single limit per
occurrence, covering liability or claims for any personal injury,
including death, to any person and/or damage to the property of
any person arising from the acts or omissions of CONTRACTOR or
any officer, agent, or employee of CONTRACTOR under this
Agreement. If the coverage includes an aggregate limit, the
APPENDIX 12
INSURANCE REQUIREMENTS
Page | 2
aggregate limit shall be no less than twice the per occurrence
limit.
2.Professional Liability/Errors and Omissions. Professional liability [or
errors and omissions] insurance for all activities of CONTRACTOR
arising out of or in connection with this Agreement in an amount
not less than THREE MILLION DOLLARS ($3,000,000) per claim.
3.Comprehensive Automobile Liability Insurance. Comprehensive
automobile liability insurance (Bodily Injury and Property
Damage) on owned, hired, leased and non-owned vehicles used in
conjunction with CONTRACTOR's business of not less than THREE
MILLION DOLLARS ($3,000,000) combined single limit per
occurrence.
(c) Certificates. All insurance coverages referenced in 7(b), above, shall
be evidenced by one or more certificates of coverage or, with the
approval of COUNTY's Risk Manager, demonstrated by other
evidence of coverage acceptable to COUNTY's Risk Manager, which
shall be filed by CONTRACTOR with the County Fire Department
prior to commencement of performance of any of CONTRACTOR's
duties; shall reference this Agreement by its COUNTY number or
title and department; shall be kept current during the term of this
Agreement; shall provide that COUNTY be given no less than thirty
(30) days prior written notice of any non-renewal, cancellation,
other termination, or material change, except that only ten (10)
days prior written notice shall be required where the cause of non-
renewal or cancellation is non-payment of premium; and shall
provide that the inclusion of more than one insured shall not
operate to impair the rights of one insured against another insured,
the coverage afforded applying as though separate policies had
been issued to each insured, but the inclusion of more than one
insured shall not operate to increase the limits of the company's
liability. For the insurance coverages referenced in 7(b)(1) and (3),
CONTRACTOR shall also file with the evidence of coverage an
endorsement from the insurance provider naming COUNTY, its
officers, employees, agents and volunteers as additional insureds
and waiving subrogation, and the certificate or other evidence of
coverage shall provide that if the same policy applies to activities
of CONTRACTOR not covered by this Agreement then the limits in
the applicable certificate relating to the additional insured coverage
of COUNTY shall pertain only to liability for activities of
CONTRACTOR under this Agreement, and that the insurance
APPENDIX 12
INSURANCE REQUIREMENTS
Page | 3
provided is primary coverage to COUNTY with respect to any
insurance or self-insurance programs maintained by COUNTY. The
additional insured endorsements for the general liability coverage
shall use Insurance Services Office (ISO) Form No. CG 20 09 11 85
or CG 20 10 11 85, or equivalent, including (if used together) CG
2010 10 01 and CG 2037 10 01; but shall not use the following
forms: CG 20 10 10 93 or 03 94. Upon request of COUNTY’s Risk
Manager, CONTRACTOR shall provide or arrange for the insurer to
provide within thirty (30) days of the request, certified copies of
the actual insurance policies or relevant portions thereof.
(d) Deductibles/Retentions. Any deductibles or self-insured retentions
shall be declared to, and be subject to approval by, COUNTY’s Risk
Manager, which approval shall not be denied unless the COUNTY's
Risk Manager determines that the deductibles or self-insured
retentions are unreasonably large in relation to compensation
payable under this Agreement and the risks of liability associated
with the activities required of CONTRACTOR by this Agreement. At
the option of and upon request by COUNTY’s Risk Manager if the
Risk Manager determines that such deductibles or retentions are
unreasonably high, either the insurer shall reduce or eliminate such
deductibles or self-insurance retentions as respects COUNTY, its
officers, employees, agents and volunteers or CONTRACTOR shall
procure a bond guaranteeing payment of losses and related
investigations, claims administration and defense expenses.
Page 109
Appendix 13
SAMPLE STANDARD
COUNTY CONTRACT
Initials:___________ _____________
Contractor County Dept.
1.Compliance with Law. Contractor is subject to and must comply with all applicable federal, state, and local laws
and regulations with respect to its performance under this Contract, including but not limited to, licensing,
employment, and purchasing practices; and wages, hours, and conditions of employment, including
nondiscrimination.
2.Inspection. Contractor's performance, place of business, and records pertaining to this Contract are subject to
monitoring, inspection, review and audit by authorized representatives of the County, the State of California, and the
United States Government.
3.Records. Contractor must keep and make available for inspection and copying by authorized representatives of the
County, the State of California, and the United States Government, the Contractor's regular business records and such
additional records pertaining to this Contract as may be required by the County.
a.Retention of Records. Contractor must retain all documents pertaining to this Contract for five years from the
date of submission of Contractor's final payment demand or final Cost Report; for any further period that is
required by law; and until all federal/state audits are complete and exceptions resolved for this Contract's funding
period. Upon request, Contractor must make these records available to authorized representatives of the County,
the State of California, and the United States Government.
b.Access to Books and Records of Contractor, Subcontractor. Pursuant to Section 1861(v)(1) of the Social
Security Act, and any regulations promulgated thereunder, Contractor must, upon written request and until the
expiration of five years after the furnishing of services pursuant to this Contract, make available to the County,
the Secretary of Health and Human Services, or the Comptroller General, or any of their duly authorized
representatives, this Contract and books, documents, and records of Contractor necessary to certify the nature and
extent of all costs and charges hereunder.
Further, if Contractor carries out any of the duties of this Contract through a subcontract with a value or cost of
$10,000 or more over a twelve-month period, such subcontract must contain a clause to the effect that upon
written request and until the expiration of five years after the furnishing of services pursuant to such subcontract,
the subcontractor must make available to the County, the Secretary, the Comptroller General, or any of their duly
authorized representatives, the subcontract and books, documents, and records of the subcontractor necessary to
verify the nature and extent of all costs and charges thereunder.
This provision is in addition to any and all other terms regarding the maintenance or retention of records under
this Contract and is binding on the heirs, successors, assigns and representatives of Contractor.
4.Reporting Requirements. Pursuant to Government Code Section 7550, Contractor must include in all documents
and written reports completed and submitted to County in accordance with this Contract, a separate section listing the
numbers and dollar amounts of all contracts and subcontracts relating to the preparation of each such document or
written report. This section applies only if the Payment Limit of this Contract exceeds $5,000.
Initials:___________ _____________
Contractor County Dept.
5.Termination and Cancellation.
a.Written Notice. This Contract may be terminated by either party, in its sole discretion, upon thirty-day advance
written notice thereof to the other, and may be cancelled immediately by written mutual consent.
b.Failure to Perform. County, upon written notice to Contractor, may immediately terminate this Contract should
Contractor fail to perform properly any of its obligations hereunder. In the event of such termination, County
may proceed with the work in any reasonable manner it chooses. The cost to County of completing Contractor's
performance will be deducted from any sum due Contractor under this Contract, without prejudice to County's
rights to recover damages.
c.Cessation of Funding. Notwithstanding any contrary language in Paragraphs 5 and 11, in the event that federal,
state, or other non-County funding for this Contract ceases, this Contract is terminated without notice.
6.Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties. Except as
expressly provided herein, no other understanding, oral or otherwise, regarding the subject matter of this Contract will
be deemed to exist or to bind any of the parties hereto.
7.Further Specifications for Operating Procedures. Detailed specifications of operating procedures and budgets
required by this Contract, including but not limited to, monitoring, evaluating, auditing, billing, or regulatory changes,
may be clarified in a written letter signed by Contractor and the department head, or designee, of the county
department on whose behalf this Contract is made. No written clarification prepared pursuant to this Section will
operate as an amendment to, or be considered to be a part of, this Contract.
8.Modifications and Amendments.
a.General Amendments. In the event that the total Payment Limit of this Contract is less than $100,000 and this
Contract was executed by the County’s Purchasing Agent, this Contract may be modified or amended by a written
document executed by Contractor and the County’s Purchasing Agent or the Contra Costa County Board of
Supervisors, subject to any required state or federal approval. In the event that the total Payment Limit of this
Contract exceeds $100,000 or this Contract was initially approved by the Board of Supervisors, this Contract may
be modified or amended only by a written document executed by Contractor and the Contra Costa County Board
of Supervisors or, after Board approval, by its designee, subject to any required state or federal approval.
b.Minor Amendments. The Payment Provisions and the Service Plan may be amended by a written administrative
amendment executed by Contractor and the County Administrator (or designee), subject to any required state or
federal approval, provided that such administrative amendment may not increase the Payment Limit of this
Contract or reduce the services Contractor is obligated to provide pursuant to this Contract.
9.Disputes. Disagreements between County and Contractor concerning the meaning, requirements, or performance of
this Contract shall be subject to final written determination by the head of the county department for which this
Contract is made, or his designee, or in accordance with the applicable procedures (if any) required by the state or
federal government.
10.Choice of Law and Personal Jurisdiction.
Initials:___________ _____________
Contractor County Dept.
a. This Contract is made in Contra Costa County and is governed by, and must be construed in accordance with, the
laws of the State of California.
b. Any action relating to this Contract must be instituted and prosecuted in the courts of Contra Costa County, State
of California.
11.Conformance with Federal and State Regulations and Laws. Should federal or state regulations or laws touching
upon the subject of this Contract be adopted or revised during the term hereof, this Contract will be deemed amended
to assure conformance with such federal or state requirements.
12.No Waiver by County. Subject to Paragraph 9. (Disputes) of these General Conditions, inspections or approvals, or
statements by any officer, agent or employee of County indicating Contractor's performance or any part thereof
complies with the requirements of this Contract, or acceptance of the whole or any part of said performance, or
payments therefor, or any combination of these acts, do not relieve Contractor's obligation to fulfill this Contract as
prescribed; nor is the County thereby prevented from bringing any action for damages or enforcement arising from
any failure to comply with any of the terms and conditions of this Contract.
13.Subcontract and Assignment. This Contract binds the heirs, successors, assigns and representatives of Contractor.
Prior written consent of the County Administrator or his designee, subject to any required state or federal approval, is
required before the Contractor may enter into subcontracts for any work contemplated under this Contract, or before
the Contractor may assign this Contract or monies due or to become due, by operation of law or otherwise.
14.Independent Contractor Status. The parties intend that Contractor, in performing the services specified herein, is
acting as an independent contractor and that Contractor will control the work and the manner in which it is performed.
This Contract is not to be construed to create the relationship between the parties of agent, servant, employee,
partnership, joint venture, or association. Contractor is not a County employee. This Contract does not give
Contractor any right to participate in any pension plan, workers’ compensation plan, insurance, bonus, or similar
benefits County provides to its employees. In the event that County exercises its right to terminate this Contract,
Contractor expressly agrees that it will have no recourse or right of appeal under any rules, regulations, ordinances, or
laws applicable to employees.
15.Conflicts of Interest. Contractor covenants that it presently has no interest and that it will not acquire any interest,
direct or indirect, that represents a financial conflict of interest under state law or that would otherwise conflict in any
manner or degree with the performance of its services hereunder. Contractor further covenants that in the
performance of this Contract, no person having any such interests will be employed by Contractor. If requested to do
so by County, Contractor will complete a “Statement of Economic Interest” form and file it with County and will
require any other person doing work under this Contract to complete a “Statement of Economic Interest” form and file
it with County. Contractor covenants that Contractor, its employees and officials, are not now employed by County
and have not been so employed by County within twelve months immediately preceding this Contract; or, if so
employed, did not then and do not now occupy a position that would create a conflict of interest under Government
Code section 1090. In addition to any indemnity provided by Contractor in this Contract, Contractor will indemnify,
defend, and hold the County harmless from any and all claims, investigations, liabilities, or damages resulting from or
related to any and all alleged conflicts of interest. Contractor warrants that it has not provided, attempted to provide,
or offered to provide any money, gift, gratuity, thing of value, or compensation of any kind to obtain this Contract.
16.Confidentiality. To the extent allowed under the California Public Records Act, Contractor agrees to comply and to
require its officers, partners, associates, agents and employees to comply with all applicable state or federal statutes or
regulations respecting confidentiality, including but not limited to, the identity of persons served under this Contract,
Initials:___________ _____________
Contractor County Dept.
their records, or services provided them, and assures that no person will publish or disclose or permit or cause to be
published or disclosed, any list of persons receiving services, except as may be required in the administration of such
service. Contractor agrees to inform all employees, agents and partners of the above provisions, and that any person
knowingly and intentionally disclosing such information other than as authorized by law may be guilty of a
misdemeanor.
17.Nondiscriminatory Services. Contractor agrees that all goods and services under this Contract will be available to
all qualified persons regardless of age, gender, race, religion, color, national origin, ethnic background, disability, or
sexual orientation, and that none will be used, in whole or in part, for religious worship.
18.Indemnification. Contractor will defend, indemnify, save, and hold harmless County and its officers and employees
from any and all claims, demands, losses, costs, expenses, and liabilities for any damages, fines, sickness, death, or
injury to person(s) or property, including any and all administrative fines, penalties or costs imposed as a result of an
administrative or quasi-judicial proceeding, arising directly or indirectly from or connected with the services provided
hereunder that are caused, or claimed or alleged to be caused, in whole or in part, by the negligence or willful
misconduct of Contractor, its officers, employees, agents, contractors, subcontractors, or any persons under its
direction or control. If requested by County, Contractor will defend any such suits at its sole cost and expense. If
County elects to provide its own defense, Contractor will reimburse County for any expenditures, including
reasonable attorney’s fees and costs. Contractor’s obligations under this section exist regardless of concurrent
negligence or willful misconduct on the part of the County or any other person; provided, however, that Contractor is
not required to indemnify County for the proportion of liability a court determines is attributable to the sole
negligence or willful misconduct of the County, its officers and employees. This provision will survive the expiration
or termination of this Contract.
19.Insurance. During the entire term of this Contract and any extension or modification thereof, Contractor shall keep
in effect insurance policies meeting the following insurance requirements unless otherwise expressed in the Special
Conditions:
a.Commercial General Liability Insurance.For all contracts where the total payment limit of the contract is
$500,000 or less, Contractor will provide commercial general liability insurance, including coverage for business
losses and for owned and non-owned automobiles, with a minimum combined single limit coverage of $500,000
for all damages, including consequential damages, due to bodily injury, sickness or disease, or death to any person
or damage to or destruction of property, including the loss of use thereof, arising from each occurrence. Such
insurance must be endorsed to include County and its officers and employees as additional insureds as to all
services performed by Contractor under this Contract. Said policies must constitute primary insurance as to
County, the state and federal governments, and their officers, agents, and employees, so that other insurance
policies held by them or their self-insurance program(s) will not be required to contribute to any loss covered
under Contractor’s insurance policy or policies. Contractor must provide County with a copy of the endorsement
making the County an additional insured on all commercial general liability policies as required herein no later
than the effective date of this Contract. For all contracts where the total payment limit is greater than $500,000,
the aforementioned insurance coverage to be provided by Contractor must have a minimum combined single limit
coverage of $1,000,000.
b.Workers' Compensation. Contractor must provide workers' compensation insurance coverage for its employees.
c.Certificate of Insurance. The Contractor must provide County with (a) certificate(s) of insurance evidencing
liability and worker's compensation insurance as required herein no later than the effective date of this Contract.
If Contractor should renew the insurance policy(ies) or acquire either a new insurance policy(ies) or amend the
Initials:___________ _____________
Contractor County Dept.
coverage afforded through an endorsement to the policy at any time during the term of this Contract, then
Contractor must provide (a) current certificate(s) of insurance.
d.Additional Insurance Provisions.No later than five days after Contractor’s receipt of: (i) a notice of
cancellation, a notice of an intention to cancel, or a notice of a lapse in any of Contractor’s insurance coverage
required by this Contract; or (ii) a notice of a material change to Contractor’s insurance coverage required by this
Contract, Contractor will provide Department a copy of such notice of cancellation, notice of intention to cancel,
notice of lapse of coverage, or notice of material change. Contractor’s failure to provide Department the notice as
required by the preceding sentence is a default under this Contract
20.Notices. All notices provided for by this Contract must be in writing and may be delivered by deposit in the United
States mail, postage prepaid. Notices to County must be addressed to the head of the county department for which
this Contract is made. Notices to Contractor must be addressed to the Contractor's address designated herein. The
effective date of notice is the date of deposit in the mails or of other delivery, except that the effective date of notice to
County is the date of receipt by the head of the county department for which this Contract is made.
21.Primacy of General Conditions. In the event of a conflict between the General Conditions and the Special
Conditions, the General Conditions govern unless the Special Conditions or Service Plan expressly provide otherwise.
22.Nonrenewal. Contractor understands and agrees that there is no representation, implication, or understanding that the
services provided by Contractor under this Contract will be purchased by County under a new contract following
expiration or termination of this Contract, and Contractor waives all rights or claims to notice or hearing respecting
any failure to continue purchasing all or any such services from Contractor.
23.Possessory Interest. If this Contract results in Contractor having possession of, claim or right to the possession of
land or improvements, but does not vest ownership of the land or improvements in the same person, or if this Contract
results in the placement of taxable improvements on tax exempt land (Revenue & Taxation Code Section 107), such
interest or improvements may represent a possessory interest subject to property tax, and Contractor may be subject to
the payment of property taxes levied on such interest. Contractor agrees that this provision complies with the notice
requirements of Revenue & Taxation Code Section 107.6, and waives all rights to further notice or to damages under
that or any comparable statute.
24.No Third-Party Beneficiaries. Nothing in this Contract may be construed to create, and the parties do not intend to
create, any rights in third parties.
25.Copyrights, Rights in Data, and Works Made for Hire. Contractor will not publish or transfer any materials
produced or resulting from activities supported by this Contract without the express written consent of the County
Administrator. All reports, original drawings, graphics, plans, studies and other data and documents, in whatever
form or format, assembled or prepared by Contactor or Contractor’s subcontractors, consultants, and other agents in
connection with this Contract are “works made for hire” (as defined in the Copyright Act, 17 U.S.C. Section 101 et
seq., as amended) for County, and Contractor unconditionally and irrevocably transfers and assigns to Agency all
right, title, and interest, including all copyrights and other intellectual property rights, in or to the works made for hire.
Unless required by law, Contractor shall not publish, transfer, discuss, or disclose any of the above-described works
made for hire or any information gathered, discovered, or generated in any way through this Agreement, without
County’s prior express written consent. If any of the works made for hire is subject to copyright protection, County
reserves the right to copyright such works and Contractor agrees not to copyright such works. If any works made for
hire are copyrighted, County reserves a royalty-free, irrevocable license to reproduce, publish, and use the works
made for hire, in whole or in part, without restriction or limitation, and to authorize others to do so.
Initials:___________ _____________
Contractor County Dept.
26.Endorsements. In its capacity as a contractor with Contra Costa County, Contractor will not publicly endorse or
oppose the use of any particular brand name or commercial product without the prior written approval of the Board of
Supervisors. In its County-contractor capacity, Contractor will not publicly attribute qualities or lack of qualities to a
particular brand name or commercial product in the absence of a well-established and widely accepted scientific basis
for such claims or without the prior written approval of the Board of Supervisors. In its County-contractor capacity,
Contractor will not participate or appear in any commercially produced advertisements designed to promote a
particular brand name or commercial product, even if Contractor is not publicly endorsing a product, as long as the
Contractor's presence in the advertisement can reasonably be interpreted as an endorsement of the product by or on
behalf of Contra Costa County. Notwithstanding the foregoing, Contractor may express its views on products to other
contractors, the Board of Supervisors, County officers, or others who may be authorized by the Board of Supervisors
or by law to receive such views.
27.Required Audit. (A) If Contractor is funded by $500,000 or more in federal grant funds in any fiscal year from any
source, Contractor must provide to County, at Contractor's expense, an audit conforming to the requirements set forth
in the most current version of Office of Management and Budget Circular A-133. (B) If Contractor is funded by less
than $500,000 in federal grant funds in any fiscal year from any source, but such grant imposes specific audit
requirements, Contractor must provide County with an audit conforming to those requirements. (C) If Contractor is
funded by less than $500,000 in federal grant funds in any fiscal year from any source, Contractor is exempt from
federal audit requirements for that year; however, Contractor's records must be available for and an audit may be
required by, appropriate officials of the federal awarding agency, the General Accounting Office (GAO), the pass-
through entity and/or the County. If any such audit is required, Contractor must provide County with such audit.
With respect to the audits specified in (A), (B) and (C) above, Contractor is solely responsible for arranging for the
conduct of the audit, and for its cost. County may withhold the estimated cost of the audit or 10 percent of the
contract amount, whichever is greater, or the final payment, from Contractor until County receives the audit from
Contractor.
28.Authorization. Contractor, or the representative(s) signing this Contract on behalf of Contractor, represents and
warrants that it has full power and authority to enter into this Contract and to perform the obligations set forth herein.
29.No Implied Waiver. The waiver by County of any breach of any term or provision of this Contract will not be
deemed to be a waiver of such term or provision or of any subsequent breach of the same or any other term or
provision contained herein.
Initials:___________ _____________
Contractor County Dept.
Number:
HIPAA BUSINESS ASSOCIATE ATTACHMENT
__________
To the extent, and as long as required by the Health Insurance Portability and Accountability Act of 1996 and the
Health Information Technology for Economic and Clinical Health Act, this HIPAA Business Associate Attachment
(“Attachment”) supplements and is made a part of the Contract identified as Number _________ (hereinafter referred
to as “Agreement”) by and between a Covered Entity (Contra Costa County for its Health Services Department,
hereinafter referred to as “County”) and Business Associate (the Contractor identified in the Agreement, hereinafter
referred to as “Associate”).
A. County wishes to disclose certain information to Associate pursuant to the terms of the Agreement, some of
which may constitute Protected Health Information (“PHI”), defined below.
B. County and Associate intend to protect the privacy and provide for the security of PHI disclosed to Associate
pursuant to the Agreement as required by the Health Insurance Portability and Accountability Act of 1996
(“HIPAA”), the Health Information Technology for Economic and Clinical Health Act (“HITECH Act”), and
the regulations promulgated thereunder (collectively, the “HIPAA Regulations”), and other applicable laws.
C. As part of the HIPAA Regulations, the Privacy Rule and the Security Rule, defined below, require County to
enter into a contract containing specific requirements with Associate prior to the disclosure of PHI, as set forth
in, but not limited to, Title 45, Sections 164.314(a), 164.502(e), and 164.504(e) of the Code of Federal
Regulations and contained in this Attachment.
In consideration of the mutual promises below and the exchange of information pursuant to this Attachment, the
parties agree as follows:
1. DDefinitions. As used in this Attachment, the following terms have the following meanings:
a. BBreach has the meaning given to such term under the HITECH Act set forth at 42 U.S.C. Section 17921.
b. BBusiness Associate (“Associate”) means an individual or entity that provides services, arranges, performs or
assists in the performance of activities on behalf of the County and who uses or discloses PHI, pursuant to
the HIPAA Regulations including, but not limited to, 42 U.S.C. Section 17938 and 45 C.F.R. Section
160.103.
c. CCovered Entity (“County”) means Contra Costa County for its Health Services Department.
d. DData Aggregation has the meaning given to such term under the Privacy Rule, including, but not limited to,
45 C.F.R. Section 164.501, as in effect or as amended.
e. DDesignated Record Set has the meaning given to such term under the Privacy Rule, including, but not limited
to, 45 C.F.R. Section 164.501, as in effect or as amended.
f. EElectronic Media is:
(1) Electronic storage media including memory devices in computers (hard drives) and any
removable/transportable digital memory medium, such as magnetic tape or disk, optical disk, or digital
memory card; or
(2) Transmission media used to exchange information already in electronic storage media. Transmission
media include, for example, the Internet (wide-open), extranet (using internet technology to link a
business with information accessible only to collaborating parties), leased lines, dial-up lines, private
networks, and the physical movement of removable/transportable electronic storage media.
g. EElectronic Protected Health Information (ePHI) is any Protected Health Information that is stored in or
transmitted by electronic media.
h. EElectronic Health Record has the meaning given to such term under the HITECH Act, including, but not
limited to, 42 U.S.C. Section 17921.
Initials:___________ _____________
Contractor County Dept.
i. HHealth Care Operations has the meaning given to such term under the Privacy Rule, including, but not
limited to, 45 C.F.R. Section 164.501, as in effect or as amended.
j. PPrivacy Rule means the Standards for Privacy of Individually Identifiable Health Information set forth in 45
C.F.R. Parts 160 and 164, as in effect or as amended.
k. PProtected Health Information (“PHI”) means any information in any form or medium, including oral,
paper, or electronic: (i) that relates to the past, present or future physical or mental condition of an
individual; the provision of health care to an individual; or the past, present or future payment for the
provision of health care to an individual; and (ii) that identifies the individual or with respect to which there is
a reasonable basis to believe the information can be used to identify the individual, and shall have the
meaning given to such term under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.501.
Protected Health Information includes electronic Protected Health Information (45 C.F.R. Sections
160.103, 164.501).
l. PProtected Information means PHI provided by County to Associate or created or received by Associate on
behalf of the County in connection with the Agreement.
m. RRequired by Law has the same meaning given to such term under the Privacy Rule, including, but not limited
to, 45 C.F.R. Section 164.103.
n. SSecurity Incident means the attempted or successful unauthorized access, use, disclosure, modification, or
destruction of information or interference with system operations in an information system.
o. SSecurity Rule means the standards for protecting the security of electronic Protected Health Information in
45 C.F.R. Parts 160 and 164, as in effect or as amended.
p. UUnsecured PHI shall have the meaning given to such term under the HITECH Act and any guidance issued
pursuant to said Act including, but not limited to, 42 U.S.C. Section 17932(h).
Terms used, but not defined, in this Attachment will have the same meanings as those terms are given in the
HIPAA Privacy Rule.
2. OObligations of Associate.
a. PPermitted Uses. Associate shall not use Protected Information except for the purpose of performing
Associate’s obligations under the Agreement and as permitted under the Agreement and this Attachment, or
as Required by Law. Further, Associate shall not use Protected Information in any manner that would
constitute a violation of the Privacy Rule or the HITECH Act.
b. PPermitted Disclosures. Associate shall not disclose Protected Information in any manner that would
constitute a violation of the Privacy Rule or the HITECH Act if so disclosed by County. However, Associate
may disclose Protected Information (i) in a manner permitted pursuant to the Agreement and this
Attachment, (ii) for the proper management and administration of Associate, (iii) as Required by Law, or (iv)
for Data Aggregation purposes for the Health Care Operations of County. To the extent that Associate
discloses Protected Information to a third party, Associate must obtain, prior to making any such disclosure
(i) reasonable written assurances from such third party that such Protected Information will be held
confidential as provided pursuant to this Attachment and only disclosed as Required By Law or for the
purposes for which it was disclosed to such third party, and (ii) a written agreement from such third party to
immediately notify Associate or any breaches of confidentiality of the Protected Information, to the extent it
has obtained knowledge of such breach.
c. PProhibited Uses and Disclosures. Associate shall not use or disclose Protected Information for fundraising
or marketing purposes. Associate shall not disclose Protected Information to a health plan for payment or
health care operations purposes if the patient has requested this special restriction, and has paid out-of-
pocket in full for the health care item or services to which the PHI solely relates (42 U.S.C. Section
17935(a)). Associate shall not directly or indirectly receive remuneration in exchange for Protected
Information, except with the prior written consent of County and as permitted by the HITECH Act, 42
Initials:___________ _____________
Contractor County Dept.
U.S.C. Section 17935(d)(2); however, this prohibition shall not affect payment by County to Associate for
services provided pursuant to the Agreement.
d. AAppropriate Safeguards. Associate agrees to implement administrative, physical, and technical safeguards
that reasonably and appropriately protect the confidentiality, integrity, and availability of Protected
Information that it creates, receives, maintains, or transmits on behalf of County as required by the
Agreement or this Attachment and in accordance with 42 C.F.R. Sections 164.308, 164.310, and 164.312.
Associate shall comply with the policies and procedures and documentation requirements of the Security
Rule, including, but not limited to, 45 C.F.R. Section 164.316.
e. RReporting of Improper Use or Disclosure. Associate will notify County in writing within twenty-four (24)
hours of its discovery of any security incident or any other use or disclosure of Protected Information not
permitted by the Agreement or this Attachment of which Associate or its officers, employees or agents
become aware, without unreasonable delay, and in no case later than ten (10) calendar days after discovery.
Associate will take (i) prompt corrective action to cure any deficiencies and (ii) any action pertaining to such
unauthorized disclosure required by applicable federal and state laws and regulations.
f. Associate’s Agents. Associate agrees to ensure that any agents, including subcontractors, to whom it provides
Protected Information, agree in writing to the same restrictions and conditions that apply to Associate with
respect to such Protected Information and implement the safeguards required by paragraph c, above, with
respect to ePHI. Associate agrees to implement and maintain sanctions against agents and subcontractors
who violate such restrictions and will mitigate the effects of any such violation.
g. AAccess to Protected Information. Associate agrees to make Protected Information maintained by Associate
or its agents or subcontractors in Designated Record Sets available to County for inspection and copying
within ten (10) days of request by County to enable County to fulfill its obligations under the Privacy Rule set
forth at 45 C.F.R. Section 164.524. If Associate maintains an Electronic Health Records, Associate shall
provide such information in electronic format to enable County to fulfill its obligations under the HITECH
Act, including, but not limited to, 42 U.S.C. Section 17935(e).
h. AAmendment of Protected Information. Within ten (10) days of receipt of a request from County for an
amendment of Protected Information or a record about an individual contained in a Designated Record Set,
Associate or its agents or subcontractors will make such Protected Information available to County for
amendment and incorporate any such amendment to enable County to fulfill its obligations under the
Privacy Rule set forth at 45 C.F.R. Section 164.526. If any individual requests an amendment of Protected
Information directly from Associate or its agents or subcontractors, Associate must notify County within five
(5) calendar days of the request, without unreasonable delay. County, and not Associate, will determine if
and when to deny a request for an amendment of Protected Information maintained by Associate.
i. AAvailability and Accounting of Information. Within ten (10) calendar days of notice by County of a request
for an accounting of disclosure of Protected Information, Associate and its agents or subcontractors shall
make available to County the information required to provide an accounting of disclosures to enable County
to fulfill its obligations under the Privacy Rule set forth at 45 C.F.R. Section 164.528, and the HITECH Act,
including, but not limited to, 42 U.S.C. Section 17935(c), as determined by County. As set forth in, and as
limited by, 45 C. F. R. Section 164.528, Associate need not provide an accounting to County of disclosures:
(i) to carry out treatment, payment or health care operations, as set forth in 45 C.F.R. Section 164.502; (ii) to
individuals of PHI about them as set forth in 45 C. F. R. 164.502; (iii) to persons involved in the individual’s
care or other notification purposes as set forth in 45 C. F. R. Section 164.510; (iv) for national security or
intelligence purposes as set forth in 45 C.F.R. Section 164.512(k)(2); or (v) to correctional institutions or law
enforcement officials as set forth in 45 C.F.R. Section 164.512(k)(5). Associate agrees to implement a
process that allows for an accounting to be collected and maintained by Associate and its agents or
subcontractors for at least six (6) years prior to the request, but not before the compliance date of the Privacy
Rule. However, accounting of disclosures from an Electronic Health Record for treatment, payment or
health care operations purposes are required to be collected and maintained for only three (3) years prior to
the request, and only to the extent that Associate maintains an electronic health record and is subject to this
requirement. At a minimum, such information must include: (i) the date of disclosure; (ii) the name of the
Initials:___________ _____________
Contractor County Dept.
entity or person who received Protected Information and , if known, the address of the entity or person; (iii)
a brief description of Protected Information disclosed; and (iv) a brief statement of the purpose of the
disclosure that reasonably informs the individual of the basis for the disclosure, or a copy of the individual’s
authorization, or a copy of the written request for disclosure. In the event that the request for an accounting
is delivered directly to Associate or its agents or subcontractors, Associate will send the request, in writing, to
County within five (5) calendar days of receipt. It will then be County’s responsibility to prepare and deliver
or otherwise respond to the accounting request. Associate will not disclose any Protected Information except
as set forth in Section 2.b. of this Attachment.
j. GGovernmental Access to Records. Associate agrees to make its internal practices, books, and records relating
to the use and disclosure of Protected Information available to the Secretary of the U.S. Department of
Health and Human Services (the “Secretary”) for purposes of determining Associate’s compliance with the
HIPAA Privacy Rule. Associate agrees to provide County with copies of any Protected Information that
Associate provides to the Secretary of the U.S. Department of Health and Human Services at the same time
Associate provides such Protected Information to the Secretary of the U.S. Department of Health and
Human Services.
k. MMinimum Necessary. Associate and its agents and subcontractors will only request, use, and disclose the
minimum amount of Protected Information necessary to accomplish the purpose of the request, use, or
disclosure. Associate understands and agrees that the definition of “minimum necessary” is in flux and shall
keep itself informed of guidance issued by the Secretary with respect to what constitutes “minimum
necessary.”
l. DData Ownership. Associate acknowledges that Associate has no ownership rights with respect to Protected
Information.
m. RRetention of Protected Information. Except as provided in Section 3.c. of this Attachment, Associate and its
subcontractors and agents must retain all Protected Information throughout the term of the Agreement and
must continue to maintain the information required by Section 2.h. of this Attachment for a period of six (6)
years after termination or expiration of the Agreement. However, accounting of disclosures from an
Electronic Health Record for treatment, payment or health care operations purposes are required to be
collected and maintained for only three (3) years prior to the request, and only to the extent that Associate
maintains an electronic health record and is subject to this requirement.
n. AAssociate’s Insurance. In addition to any other insurance requirements specified in the Agreement,
Associate will, at its sole cost and expense, insure its activities in connection with this Attachment. Associate
will obtain, keep in force and maintain insurance or equivalent program(s) of self-insurance with appropriate
limits, as determined by County, at its sole discretion, that will cover losses that may arise from any breach of
this Attachment, breach of security, or any unauthorized use or disclosure of Protected Information. It is
expressly understood and agreed that the insurance required herein does not in any way limit the liability of
Associate with respect to its activities in connection with this Attachment.
o. NNotification of Breach. During the term of the Agreement, Associate shall notify County within twenty-four
(24) hours of any suspected or actual breach of security, intrusion, or unauthorized use or disclosure of PHI
of which Associate becomes aware and/or any actual or suspected use or disclosure of data in violation of any
applicable federal or state laws or regulations. Associate shall take (i) prompt corrective action to cure any
such deficiencies; and (ii) any action pertaining to such unauthorized disclosure required by applicable
federal and state laws and regulations. In the event the breach was caused, directly or indirectly, by negligent
misconduct on the part of Associate, Associate’s agents or subcontractors, Associate will be solely responsible
for all damages resulting from the breach.
p. BBreach Pattern or Practice by County. Pursuant to 42 U.S.C. Section 17934(b), if the Associate knows of a
pattern of activity or practice of County that constitutes a material breach of violation of the County’s
obligations under the Agreement or Attachment, the Associate must take reasonable steps to cure the breach
or end the violation. If the steps are unsuccessful, the Associate must terminate the Agreement, if feasible, or
if termination is not feasible, report the problem to the Secretary of the U.S. Department of Health and
Initials:___________ _____________
Contractor County Dept.
Human Services. Associate shall provide written notice to County of any pattern of activity or practice of
County that Associate believes constitutes a material breach or violation of the County’s obligations under the
Agreement or Attachment within five (5) days of discovery and shall meet with County to discuss and attempt
to resolve the problem as one of the reasonable steps to cure the breach or end the violation.
q. CCertification and Enforcement. At any time during the term of the Agreement, and without advance notice,
County and its authorized agents or contractors may examine Associate’s facilities, systems, procedures and
records as may be necessary to determine the extent to which Associate’s security safeguards comply with
HIPAA, HITECH Act, other HIPAA Regulations, and this Attachment.
3. TTermination.
a. MMaterial Breach. A breach by Associate of any material provision of this Attachment, as determined by
County, constitutes grounds for termination of the Agreement pursuant to General Conditions Paragraph 5.
(Termination and Cancellation), Subsection b. (Failure to Perform), of the Agreement.
b. RReasonable Steps to Cure Breach. If County knows of an activity or practice of Associate that constitutes a
material breach or violation of Associate’s obligations under the provisions of this Attachment, County may,
in its sole discretion, terminate the Agreement pursuant to Section 3.a., above, or provide Associate an
opportunity to cure such breach or end such violation. If Associate’s efforts to cure such breach or end such
violation are unsuccessful, County will either (i) terminate the Agreement, if feasible or (ii) if termination of
the Agreement is not feasible, County will report Associate’s breach or violation to the Secretary of the U.S.
Department of Health and Human Services.
c. EEffect of Termination. Upon termination of the Agreement for any reason, Associate must return or
destroy, at the exclusive option of County, all Protected Information that Associate, its agents and
subcontractors, still maintain in any form, and Associate may not retain any copies of such Protected
Information. If return or destruction is not feasible, Associate may retain the Protected Information and
must continue to extend the protections of Sections 2.a., 2.b., 2.c., and 2.d. of this Attachment to such
information and limit further use of such Protected Information to those purposes that make the return or
destruction of such Protected Information infeasible. If Associate destroys the Protected Information,
Associate must verify in writing to County that such Protected Information has been destroyed.
4. DDisclaimer. County makes no warranty or representation that compliance by Associate with this Attachment,
HIPAA, HITECH Act, or the HIPAA Regulations, will be adequate or satisfactory for Associate’s own
purposes. Associate is solely responsible for all decisions made by Associate regarding the safeguarding of PHI.
5. CChanges to HIPAA and its regulations.
a. CCompliance with Law. The parties acknowledge that state and federal laws relating to electronic data security
and privacy are evolving and that changes to this Attachment may be required to ensure compliance with
such developments. The parties agree to take such action(s) as may be necessary to implement the standards
and requirements of HIPAA, HITECH Act, the HIPAA Regulations, and other applicable state and federal
laws relating to the security and/or confidentiality of PHI.
b. NNegotiations. In the event that a state or federal law, statute, or regulation materially affects the Agreement or
this Attachment, the parties agree to negotiate immediately and in good faith any necessary or appropriate
revisions to the Agreement or this Attachment. If the parties are unable to reach an agreement concerning
such revisions within the earlier of thirty (30) calendar days after the date of notice seeking negotiations or the
effective date of a change in law or regulations, or if the change is effective immediately, then County may, in
its sole discretion, immediately terminate the Agreement upon written notice to Associate.
Initials:___________ _____________
Contractor County Dept.
6. MMiscellaneous Provisions.
a. AAssistance in Litigation or Administrative Proceedings. Associate will make itself, and any subcontractors,
employees or agent assisting Associate in the performance of its obligations under the Agreement, available
to County, at no cost to County, to testify as witnesses or otherwise, in the event of litigation or administrative
proceedings against County, its officers or employees, based upon a claimed violation of HIPAA, HITECH
Act, the HIPAA Regulations, or other laws relating to security and privacy and arising out of the Agreement
or this Attachment.
b. NNo Third Party Beneficiaries. Nothing express or implied in this Attachment is intended to confer, nor shall
anything herein confer, upon any person other than County, Associate, and their respective successors or
assigns, any rights, remedies, obligations, or liabilities whatsoever.
c. IInterpretation. The provisions of this Attachment prevail over any provisions in the Agreement that may
conflict, or appear to be inconsistent with, any provision of this Attachment. This Attachment and the
Agreement will be interpreted as broadly as necessary to implement and comply with HIPAA and the
Privacy Rule. The parties agree that any ambiguity in this Attachment will be resolved in favor of a meaning
that complies, and is consistent, with HIPAA and the Privacy Rule.
d. NNotice to Secretary. Associate understands and agrees that if County knows of a pattern of activity or
practice of Associate that constitutes a material breach or violation of Associate’s obligations under this
Attachment and the breach or violation continues and termination of the Agreement is not feasible, County
will report the problem to the Secretary of the U.S. Department of Health and Human Services, as required
by HIPAA, HITECH Act, and the HIPAA regulations.
e. SSurvival. The obligations of Associate pursuant to Sections 2.l. and 3.c. of this Attachment survive the
termination or expiration of the Agreement.
Form approved by County Counsel [12/2009]
Page 110
Appendix 14
BASIS FOR REVENUE
PROJECTIONS
TEMPLATE
# TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash CollectionsALS 1-Emergency ALS 1-Emergency ALS 1-EmergencyALS 2ALS 2ALS 2BLS-Emergency BLS-Emergency BLS-EmergencyALS 1-Non-emergency ALS 1-Non-emergency ALS 1-Non-emergencyBLS Non-emergency BLS Non-emergency BLS Non-emergencyTOTAL TOTAL TOTAL# TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash CollectionsALS 1-Emergency ALS 1-Emergency ALS 1-EmergencyALS 2ALS 2ALS 2BLS-Emergency BLS-Emergency BLS-EmergencyALS 1-Non-emergency ALS 1-Non-emergency ALS 1-Non-emergencyBLS Non-emergency BLS Non-emergency BLS Non-emergencyTOTAL TOTAL TOTAL# TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash CollectionsALS 1-Emergency ALS 1-Emergency ALS 1-EmergencyALS 2ALS 2ALS 2BLS-Emergency BLS-Emergency BLS-EmergencyALS 1-Non-emergency ALS 1-Non-emergency ALS 1-Non-emergencyBLS Non-emergency BLS Non-emergency BLS Non-emergencyTOTAL TOTAL TOTALInsurance (Year One) Insurance (Year Two) Insurance (Year Three)Medicare (Year One) Medicare (Year Two) Medicare (Year Three)Medi-Cal (Year One) Medi-Cal (Year Two) Medi-Cal (Year Three)
# TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash CollectionsALS 1-Emergency ALS 1-Emergency ALS 1-EmergencyALS 2ALS 2ALS 2BLS-Emergency BLS-Emergency BLS-EmergencyALS 1-Non-emergency ALS 1-Non-emergency ALS 1-Non-emergencyBLS Non-emergency BLS Non-emergency BLS Non-emergencyTOTAL TOTAL TOTAL# TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash Collections # TransportsTotal ChargesCash CollectionsALS 1-Emergency ALS 1-Emergency ALS 1-EmergencyALS 2ALS 2ALS 2BLS-Emergency BLS-Emergency BLS-EmergencyALS 1-Non-emergency ALS 1-Non-emergency ALS 1-Non-emergencyBLS Non-emergency BLS Non-emergency BLS Non-emergencyTOTAL TOTAL TOTALTotals (Year One) Totals (Year Two) Totals (Year Three)Self Pay (Year One) Self Pay (Year Two) Self Pay (Year Three)
Page 111
Appendix 15
REVENUE FLOW
PROJECTION TEMPLATE
Total ChargesNet Revenue Expected Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12Month 1Month 2Month 3Month 4Month 5Month 6Month 7Month 8Month 9Month 10Month 11Month 12TOTALPortion of Monthly Net Revenue Expected in Month ReceivedTotal and Net Revenue Projected by Month
Page 112
Appendix 16
EXPENSE BUDGET
TEMPLATES
ANNUAL EXPENSES
Personnel
Wages
Paramedics -$
EMTs -$
QI/Training -$
Management/Supervisors -$
Other Personnel -$
Overtime Expense -$
Benefits -$
Other Personnel -$
TOTAL PERSONNEL -$
General and Administration
Professional Services -$
Medical Director Fees -$
Consulting Fees -$
Billing & Collection Fees/Expenses -$
Contract Administration Fees
Office Supplies & Equipment -$
Leased equipment -$
Occupancy leases, rents -$
Utilities and Telephone -$
Insurance -$
Overhead Expenses -$
Taxes and Licenses -$
Travel Expenses -$
Office Capital Equp Depreciation -$
Misc Expenses -$
Operations
Dispatch and communication expense -$
Information technology expenses -$
Training/ QI expenses -$
Community Education Expenses -$
Vehicles
Fuel, oil, tires, disposable supplies -$
Repair and maintenance -$
Vehicle lease expense -$
Depreciation -$
Medical
Medical Equipment -$
Pharmaceuticals, oxygen -$
Medical Supplies -$
Depreciation -$
Other Expenses -$
TOTAL NON-PERSONNEL -$
TOTAL EXPENSES -$
YEAR 1 (Plan A)
ANNUAL EXPENSES
Personnel
Wages
Paramedics -$
EMTs -$
QI/Training -$
Management/Supervisors -$
Other Personnel -$
Overtime Expense -$
Benefits -$
Other Personnel -$
TOTAL PERSONNEL -$
General and Administration
Professional Services -$
Medical Director Fees -$
Consulting Fees -$
Billing & Collection Fees/Expenses -$
Contract Administration Fees
Office Supplies & Equipment -$
Leased equipment -$
Occupancy leases, rents -$
Utilities and Telephone -$
Insurance -$
Overhead Expenses -$
Taxes and Licenses -$
Travel Expenses -$
Office Capital Equp Depreciation -$
Misc Expenses -$
Operations
Dispatch and communication expense -$
Information technology expenses -$
Training/ QI expenses -$
Community Education Expenses -$
Vehicles
Fuel, oil, tires, disposable supplies -$
Repair and maintenance -$
Vehicle lease expense -$
Depreciation -$
Medical
Medical Equipment -$
Pharmaceuticals, oxygen -$
Medical Supplies -$
Depreciation -$
Other Expenses -$
TOTAL NON-PERSONNEL -$
TOTAL EXPENSES -$
YEAR 2 (Plan A)
ANNUAL EXPENSES
Personnel
Wages
Paramedics -$
EMTs -$
QI/Training -$
Management/Supervisors -$
Other Personnel -$
Overtime Expense -$
Benefits -$
Other Personnel -$
TOTAL PERSONNEL -$
General and Administration
Professional Services -$
Medical Director Fees -$
Consulting Fees -$
Billing & Collection Fees/Expenses -$
Contract Administration Fees
Office Supplies & Equipment -$
Leased equipment -$
Occupancy leases, rents -$
Utilities and Telephone -$
Insurance -$
Overhead Expenses -$
Taxes and Licenses -$
Travel Expenses -$
Office Capital Equp Depreciation -$
Misc Expenses -$
Operations
Dispatch and communication expense -$
Information technology expenses -$
Training/ QI expenses -$
Community Education Expenses -$
Vehicles
Fuel, oil, tires, disposable supplies -$
Repair and maintenance -$
Vehicle lease expense -$
Depreciation -$
Medical
Medical Equipment -$
Pharmaceuticals, oxygen -$
Medical Supplies -$
Depreciation -$
Other Expenses -$
TOTAL NON-PERSONNEL -$
TOTAL EXPENSES -$
YEAR 3 (Plan A)
ANNUAL EXPENSES
Personnel
Wages
Paramedics -$
EMTs -$
QI/Training -$
Management/Supervisors -$
Other Personnel -$
Overtime Expense -$
Benefits -$
Other Personnel -$
TOTAL PERSONNEL -$
General and Administration
Professional Services -$
Medical Director Fees -$
Consulting Fees -$
Billing & Collection Fees/Expenses -$
Contract Administration Fees
Office Supplies & Equipment -$
Leased equipment -$
Occupancy leases, rents -$
Utilities and Telephone -$
Insurance -$
Overhead Expenses -$
Taxes and Licenses -$
Travel Expenses -$
Office Capital Equp Depreciation -$
Misc Expenses -$
Operations
Dispatch and communication expense -$
Information technology expenses -$
Training/ QI expenses -$
Community Education Expenses -$
Vehicles
Fuel, oil, tires, disposable supplies -$
Repair and maintenance -$
Vehicle lease expense -$
Depreciation -$
Medical
Medical Equipment -$
Pharmaceuticals, oxygen -$
Medical Supplies -$
Depreciation -$
Other Expenses -$
TOTAL NON-PERSONNEL -$
TOTAL EXPENSES -$
YEAR 1 (Plan B)
ANNUAL EXPENSES
Personnel
Wages
Paramedics -$
EMTs -$
QI/Training -$
Management/Supervisors -$
Other Personnel -$
Overtime Expense -$
Benefits -$
Other Personnel -$
TOTAL PERSONNEL -$
General and Administration
Professional Services -$
Medical Director Fees -$
Consulting Fees -$
Billing & Collection Fees/Expenses -$
Contract Administration Fees
Office Supplies & Equipment -$
Leased equipment -$
Occupancy leases, rents -$
Utilities and Telephone -$
Insurance -$
Overhead Expenses -$
Taxes and Licenses -$
Travel Expenses -$
Office Capital Equp Depreciation -$
Misc Expenses -$
Operations
Dispatch and communication expense -$
Information technology expenses -$
Training/ QI expenses -$
Community Education Expenses -$
Vehicles
Fuel, oil, tires, disposable supplies -$
Repair and maintenance -$
Vehicle lease expense -$
Depreciation -$
Medical
Medical Equipment -$
Pharmaceuticals, oxygen -$
Medical Supplies -$
Depreciation -$
Other Expenses -$
TOTAL NON-PERSONNEL -$
TOTAL EXPENSES -$
YEAR 2 (Plan B)
ANNUAL EXPENSES
Personnel
Wages
Paramedics -$
EMTs -$
QI/Training -$
Management/Supervisors -$
Other Personnel -$
Overtime Expense -$
Benefits -$
Other Personnel -$
TOTAL PERSONNEL -$
General and Administration
Professional Services -$
Medical Director Fees -$
Consulting Fees -$
Billing & Collection Fees/Expenses -$
Contract Administration Fees
Office Supplies & Equipment -$
Leased equipment -$
Occupancy leases, rents -$
Utilities and Telephone -$
Insurance -$
Overhead Expenses -$
Taxes and Licenses -$
Travel Expenses -$
Office Capital Equp Depreciation -$
Misc Expenses -$
Operations
Dispatch and communication expense -$
Information technology expenses -$
Training/ QI expenses -$
Community Education Expenses -$
Vehicles
Fuel, oil, tires, disposable supplies -$
Repair and maintenance -$
Vehicle lease expense -$
Depreciation -$
Medical
Medical Equipment -$
Pharmaceuticals, oxygen -$
Medical Supplies -$
Depreciation -$
Other Expenses -$
TOTAL NON-PERSONNEL -$
TOTAL EXPENSES -$
YEAR 3 (Plan B)
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Appendix 17
ONE TIME EXPENSE AND
CAPITAL BUDGET
TEMPLATE
AssumptionsPlan APlan BNumber of Staffed Ambulance at Peak Total Number of Ambulance in FleetNumber of Leased AmbulancesNumber of Purchased AmbulancesNumber of Existing Ambulances for CCCQty. Cost/ValueQty. Cost/ValueNumber of New AmbulancesMedical EquipmentSupply InventoryLeasehold ImprovementsIT Equipment (including mobile)Communications EquipmentOffice Furnishing/EquipmentShop EquipmentShop Supply/Parts InventoryWages & BenefitsEmployment CostsLeases/RentsLegal/Professional ServicesOther > $10,000 TOTAL ONE TIME COSTSPlan APlan BOne-Time Costs
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Appendix 18
PRO FORMA BUDGET
SUMMARY TEMPLATE
Start-Up CostsYear 1 Year 2 Year 3Start-Up CostsYear 1 Year 2 Year 3RevenueExpensesGain (Loss)Plan APlan B
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Appendix 19
ALS INTERFACILITY
PRICE SHEET
APPENDIX 19
ALS Interfacility Charges
Page | 1
1. Patient Charges shall be submitted on this exhibit in Table A as is. Proposed patient
charges should take into consideration the cost of providing care to indigent patients.
No alterations or changes of any kind are permitted.
2. The County has adopted a “bundled” rate for ambulance services with a single base
rate, whereby most fees for service are included in the base rate, with the exception of
oxygen and mileage.
3. The patient charges quoted in Table A shall include all taxes and all fees charged to
patients or third party payers. Proposals should reflect a bundled rate structure and no
other charges for supplies, equipment, or procedures, or other services will be accepted.
Contractor shall comply with fee schedule and rates proposed in response to this RFP
and approved by the County.
Table A - Proposed Charges
Complete the proposed charge for each item listed below.
No other patient charges will be considered.
Ambulance ALS Interfacility Base Rate
Mileage/mile
Oxygen
Treat, Non-transport rate*
$______.___
$______.___
$___175.00_
$______.___
Proposer agrees that the prices quoted are the maximum that will be charged during the
term of any contract awarded, with the exception of increases or fee adjustments described
in the RFP.
FIRM: ___________________________________________________________________
SIGNATURE:___________________________________________________________________
DATE: ___/____/_____
PRINTED NAME:
___________________________________________________________________________
TITLE: ________________________________________________________________________
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