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Home My WebLink AboutR-93-0385J-U3---42, G / 9 / 9 3 13 t".5 RESOL.UTSON NO, a A RESOLUTION, WITH ATTACHMENTS, ACCEPTING THE PROPOSALS OF CONSOLIDATED MEDICAL SERVICES AND ADVANCED DATA PROCESSING TO FURNISH MEDICAL TRANSPORTATION BILLING AND COLLECTION SERVICES TO THE DEPARTMENT OF FIRE, RESCUE AND INSPECTION SERVICES FOR A PERIOD OF ONE (1) YEAR WITH THE OPTION TO EXTEND FOR TWO (2) ADDITIONAL ONE (1) YEAR PERIODS; ALLOCATING FUNDS THEREFOR FROM ACCOUNT CODE NO. 280501-340; AUTHORIZING THE CITY MANAGER TO ENTER INTO AGREEMENTS, IN SUBSTANTIALLY THE ATTACHED FORMS, FOR THIS SERVICE AND THEREAFTER TO EXTEND SAID AGREEMENTS FOR TWO (2) ADDITIONAL ONE (1) YEAR PERIODS. WHEREAS, pursuant to public notice, proposals were received November 2, 1992 for the furnishing of medical transportation billing and collection services on a contract basis to the Department of Fire, Rescue and Inspection Services; and WHEREAS, invitations were mailed to eleven (11) proposers and two (2) proposals were received; and WHEREAS, funds for this service are available from Account Code No. 280501-340; and WHEREAS, this service will be used to provide medical transportation billing and collection services to the City of Miami Fire, Rescue and Inspection Services Department; and 'ATTACH MENT (S) C04TAINEQ t=y COMMISSION MEETING OF JUN291993 Resolution No. 93- 385 WtTFP,EAS , the City Manager and the Chief of the Fire , Fescv,a.. and Inspection Services Department recommend that the proposal. received from Consolidated Medical Services and Advanced Data Processing be accepted as the most advantageous to the City; NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: Section 1. The recitals and findings contained in the Preamble to this Resolution are hereby adopted by reference thereto and incorporated herein as if fully set forth in this Section. Section 2. The November 2, 1992 proposals of Consolidated Medical Services and Advanced Data Processing to furnish medical transportation billing and collection services to the Department of Fire, Rescue and Inspection Services for a period of one (1) year with the option to extend for two (2) additional one (1) year periods, at an estimated first year cost of $120,000.00 is hereby accepted, with funds therefor hereby allocated from Account Code No. 280501-340. Section 3. The City Manager is hereby authorized to enter into agreements, in substantially the attached forms, for this service and thereafter to extend said agreements for two (12) additional one (1) year periods. Section 4. This Resolution shall become effective immediately upon its adoption. -2- 93- 385 El PASSED AND ADOPTED #-hir, 2yttZ ATTEST: / 'd MATT' HIRAI CITY CLERK PREPARED AND APPROVED BY: CARMEN L. LEON ASSISTANT CITY ATTORNEY APPROVED AS TO FORM AND CORRECTNESS: 0 / A. QUf NN 0 ES. III CITY ATT R EY CLL : csk :4i3664 13 s� .AVIER L. UARE MAYOR —3— 93-- 385 AGREEMENT 13FTKFFN CONSOLIDATED MEDICAL SERVICES, INC. ANI3 THE CITY OF MIAMI THIS AGREEMENT is made and entered into this ____ day of 19 9_, by and between The City of Miami, a municipal corporation of the State of Florida, hereinafter referred to as the "CITY", and CONSOLIDATED MEDICAL SERVICES, INC., a Florida corporation, hereinafter referred to as the "SERVICE PROVIDER". WITNESS WHEREAS, the CITY routinely provides ground transportation of private individuals to local hospitals in CITY rescue vehicles; and WHEREAS Dade County Ordinance #_ provides for the charging of a fee for such transportation service; WHEREAS, the SERVICE PROVIDER has demonstrated its capability and its willingness to provide the requested services; NOW THEREFORE, for and in consideration of the premises and mutual covenants herein contained, the parties] hereto agree as follows: I. TERM: The term of this Agreement shall be for a period of one (1) year from the date of execution. The Agreement may be renewed for two (2) additional one-year periods by mutual agreement of the parties indicated in writing sixty (60) days prior to the expiration date. The rate of compensation to be paid and the 43 93- 385 p4'7;c Pasta P of total ground trnnsport.ilk,- i.on hill a ng to by pflrfCtrrngd by SERVTCE PROVIDER for each of the two ( 2 ) optional one-year periods is described in Exhibit A, attached and made a part hereto. ZI. SCOPE OF SERVICES: 1. The CITY will provide the SERVICE PROVIDER with the information necessary for billing on a magnetic computer tape for each individual transported by a ground rescue vehicle. These documents will be forwarded to the SERVICE PROVIDER by the CITY Fire Department, Rescue Division ("Rescue") on a weekly basis. 2. Within five (5) business days after receipt of any particular Rescue Report, the SERVICE PROVIDER shall initiate and mail to the transported individual an appropriate invoice. 3. The SERVICE PROVIDER agrees to generate and mail follow-up invoices on a set billing cycle. Milling cycles and the number of invoices will be determined by the financial clase (self -pay, commercial insurance, Medicare, Medicaid, or Worker's Compensation) of the individual transported. 4. The form and content of appropriate invoices and the specific billing cycles are described in Exhibit H, attached and made a part hereto. A final step in the collection process may be a letter from an attorney - 2 - 93- 385 5. 6. 7. rPg1)est:_i.nq immediate payment:. The C TTY may Pyer_c ise this option nt its discretion. The SERVICE PROVIDER will provide to the CITY monthly reports in the format described in Exhibit C, attached and made a part hereto. The SERVICE PROVIDER agrees to generate and mail necessary forms to third party payers when appropriate. The SERVICE PROVIDER understands that it may be necessary to solicit additional data beyond the information provided on the CITY Rescue Report in order to complete the third party invoices and forms. In such situations, the SERVICE PROVIDER agrees to solicit such information from the transported individual and/or the appropriate hospital. The SERVICE PROVIDER agrees to abide by the terms of any remittance agreement or lockbox agreement entered into by the CITY and its chosen bank. It is agreed that all payments originated by reason of billings made on behalf of the CITY by the SERVICE PROVIDER shall be deposited into the account of the CITY in said depository. The SERVICE PROVIDER shall provide for direct remittance on its bills and/or statements rendered to transported individuals (or third parties, as the case may be) on behalf of the CITY. Said Agreement shall provide for the third party depository to provide the SERVICE PROVIDER with a statement setting for the name and amount of each account making - 3 - 93-- 385 C-M M paynant, and stic:h rztatenPTAt shAl.l. h Vrnvi.d;?d to the SERVICE PROVIDER within three (3) husiness days after receipt. All transport payments collected by the City Fire Department Records Custodian are to be deposited in the lockbox account and a copy of remittance will be forwarded to the SERVICE PROVIDER. In addition, said Agreement shall include a standard procedure to be followed by the third party depository when checks have been returned for insufficient funds. Said procedure shall require the third party depository to forward such checks to the SERVICE PROVIDER and to list such checks on the statement as debits. In the event that a payment is mistakenly transmitted by the payer to either the SERVICE PROVIDER or the City Fire Department, both parties agree to deposit said payments into the third depository account. The SERVICE PROVIDER agrees to provide the CITY with a listing, or a computer tape which is compatible with CITY equipment, of all accounts past due 180 days or more (except where a modified pay -out schedule has been arranged), including all pertinent facts regarding attempted collection efforts. (At the CITY's option, accounts due 180 days or more may be withdrawn from the SERVICE PROVIDER and returned to the CITY for further collection efforts). The SERVICE PROVIDER agrees to prepare responses to all inquires concerning invoices received by transported - 4 - 93- 385 i_ndi_vi.d+aal.s, commercial .insurance f or ns , hAal-th pl nn Claims forms, all govern.menf.al agency claim .f.orr+s, Worker's Compensation claim forms, and .such other forms and reports as may be required from time to time to be prepared, submitted, filed or otherwise provided by the CITY to any entity in connection with the operation of its ground transport billing and collection business. 10. The SERVICE PROVIDER agrees to provide and furnish all material and personnel required for the performance of the Agreement. 11. The CITY reserves the right to withdraw any individual account from the SERVICE PROVIDER, if it determines that a Casualty Form was miscoded by rescue personnel, and therefore, mistakenly forwarded to the 5NKviut PROVIDER for billing. In such cases, the CITY will notify the SERVICE PROVIDER in writing, specifying name of transported individual, incident number, and reason for withdrawal. For such withdrawn accounts, there is no charge to the CITY. COMPENSATION: 1. The CITY shall pay the SERVICE PROVIDER, as compensation for the services required pursuant to Section II hereof, the fees described in Exhibit A. 2. The SERVICE PROVIDER will submit monthly invoices to the CITY. Such invoices will be produced on the 15th day of each month for services rendered during the 5 - 93- 385 precedinq mcntrh. The mon.t fjy invoices wi1i. i.ncl.tade t.yt SERVICE PROVIDER's flat fea far initial billings originated by the SERVICE PROVIDER during the preceding month, as well as the SERVICE PROVIDER's computation of payments owed by the CITY for the preceding month. Within one week of receipt of monthly invoices for the SERVICE PROVIDER, the CITY Fire Department will review requested amounts If the Department review concurs with the SERVICE PROVIDER's calculations, the invoice will be forwarded to the CITY's Finance Department for payment. 3. The monthly invoice will also include a list of account which require refunds due to overpayment of account. Said .list will include the transported individual's name, the incident number, the amount of refund required, the address to which the refund should be mailed, and the reason for overpayment. 4. The CITY shall have the right to review and audit the records of the SERVICE PROVIDER pertaining to any such billings. 5. CITY shall have the right to review and audit the records of SERVICE PROVIDER pertaining to any payment by the CITY. IV. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: Both parties shall comply with all applicable laws, ordinances, and codes of. Federal, State, and Local Government. - 6 - 93- 385 F"i.trf:h�?t rac7t ?, >FRV Tcr PR0 VTDFR .Igr";?P < to 1hi de by the Fprier.,al ncj)t Collection Practices laws and regulations and all similar State of Florida .Laws and regulations. V. GENERAL CONDITIONS % ]. All notices or other communications Which shall or may be given pursuant to this Agreement shall be in writing and shall be delivered by personal service, or by registered mail, addressed to the other party at the address indicated herein or as the s-me may be changed for time to time. Such notice shall be deemed given on the fifth day after being posted or the date of actual receipt, whichever is earliert CITY OF MIAMI Rescue Administration Fire, Rescue & Inspection Services Department 1131 N.W. 7th Street Miami, Florida 33136 SERVICE PROVIDER: Consolidated Medical Service, Inc. 10685 S.W. 88th Street Miami, Florida 33176 2. Title and Paragraph headings are for convenience reference and are not part of this Agreement. 3. In the event of conflict between terms of this Agreement and any terms or conditions contained in any attached documents, the terms in this Agreement shall rule. 4. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the same or any other provision hereof, and no waiver shall be effective unless made in writing. - 7 - 93- 385 Shnt).ld any proviainn, paricirnplic, sentancRg, wr np phrcisPs cont-ainer 3,n this Agreement bc? determi.nac3 by a court of competent jurisdiction to be invalid, illegal, or otherwise unenforceable under the laws of the State of Florida or the City of Miami, such provisions, paragraphs, sentences, words or phrases shall be deemed modified to the extent necessary in order to conform with such laws or, if not modifiable to conform with such laws, them same shall be deemed severable and, in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect. VI. OWNERSHIP OF DOCUMENTS: All documents developed by SERVICE PROVIDER under this Agreement shall be delivered to CITY by said SERVICE PROVIDER upon completion of the services required pursuant to Section II hereof and shall become the property of CITY, without restriction or limitation on its use. SERVICE PROVIDER agrees that all documents maintained and generated pursuant to this contractual relationship between CITY and SERVICE PROVIDER shall be subject to all provisions of the Public Records Law, Chapter 119, Florida Statutes. It is further understood by and between the parties that any information, writings, maps, contract documents, reports or any other matter whatsoever which is given by CITY to SERVICE PROVIDER pursuant to this Agreement shall at all times remain the 8 93- 385 property (.-,f CTTY ind sshnll not hc, xised try SRRVICr PRnVT )FF for. any other purposes whatsoever without the wxJtten consent of CITY. VII. NONDELEGABIDITY: The obligations undertaken by SERVICE PROVIDER pursuant to this Agreement shall not be delegated or assigned to any other person or firm unless CITY shall first consent in writing to the performance or assignment of such service or any part thereof by another person or firm. lih0-tv AUDIT RIGHTS: CITY reserves the right to audit the records related to this Agreement of SERVICE PROVIDER at any time during the performance of this Agreement and for a period of one (1) year after final payment is made under this Agreement. I8. AWARD OF AGREEMENT: SERVICE PROVIDER warrants that it has not employed or retained any person employed by the CITY to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person employed by the CITY any fee, commission percentage, brokerage fee, or gift of any kind contingent upon or resulting from the award of this Agreement. _ 9 _ 93 385 X. CONSTRUCTION OF AGREEMENT* 0 This Agreement shall be construed and enforced according to the laws of the State of Florida and venue shall be .in Dade County, Florida. k10.6 SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties herein, their heirs, executors, legal representatives, successors, and assigns. XI I. INDEMNIFICATION: SERVICE PROVIDER shall indemnify and save CITY harmless from and against any and all claims, liabilities, losses, and causes of action which may arise out of SERVICE PROVIDER's activities under this Agreement, including all other acts or omissions to act on the part of SERVICE PROVIDER, including any person acting for or on its behalf, and, from and against any orders, judgments, or decrees which may be entered and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claims, or in the investigation thereof. CONFLICT OF INTEREST: 1. SERVICE PROVIDER covenants that no person under its employ who presently exercises any functions or responsibilities in connection with this Agreement has any personal financial interests, direct or indirect, - 10 - 93-- 385 wd.t:h CTTY. STRVTCF PPOVTrjFR ftirthor covensnt-,s thit:, in the performs.nce of this Agreement, no person having such conflicting .interest shall be employed. Any such interests on the pant of SERVICE PROVIDER or its employees, must be disclosed in writing to CITY. 2. SERVICE PROVIDER is aware of the conflict of interest laws of the City of Miami (City of Miami Code Chapter 2, Article V), Dade County Florida (Dade County Code Section 2--11.1) and the State of Florida, and agrees that it shall fully comply in all respects with the terms of said laws. XIV. INDEPENDENT CONTRACTOR: SERVICE PROVIDER and its employees and agents shall be deemed to be independent contractors, and not agents or employees of CITY, and shall not attain any rights or benefits under the Civil Service or Pension Ordinances of CITY, or any rights generally afforded classified or unclassified employees; further he/she shall not be deemed entitled to the Florida Workers' Compensation benefits as an employee of CITY. ACV. TERMINATION OF CONTRACT: 1. The CITY may, at its sole discretion, terminate this Agreement at any time by giving ninety (90) days prior written notice to the SERVICE PROVIDER. Upon termination, the SERVICE PROVIDER will continue to perform all duties except original billing, for 180 days or until requested to - 11 - 93- 385 cesae, whi r h-ve r first: 0r`"X Pro-urld (I thy , t rd t:'TTx continixesa to convey necessary cioctlMentS of SERVICE PPOVTDER as provided herein. 2. It is hereby understood by and between CITY and SERVICE PROVIDER that any payment made to SERVICE PROVIDER shall be made only if said SERVICE PROVIDER is not in default under the terms of this Agreement. If SERVICE PROVIDER is in default, the CITY shall in no way be obligated and shall not pay to SERVICE PROVIDER any sum whatsoever. In no case, however, will City pay SERVICE PROVIDER an amount in excess of the sum provided by this Agreement. 3. Upon expiration or termination of this Agreement for any cause, SERVICE PROVIDER shall provide all reasonable assistance to the CITY and shall use its best efforts to return to the CITY in an orderly and expeditious manner, but in no event later than thirty (30) days after the date of such termination, all data, records, documents, reports, information, equipment and other property belonging to the CITY. ZVI. NONDISCRIMINATION: SERVICE PROVIDER agrees that it shall not discriminate as to race, sex, color, creed, national origin, or handicap in connection with its performance under this Agreement. Furthermore that no otherwise qualified individual shall, solely by reason of his/her race, sex, color, creed, national origin, or handicap, be excluded from the participation in, be - 12 - 93- 385 deny, {d hpnef its of, 0,77 h"? Gt1 :7 e{ eCj to di,scB: ],mi nnt:..1..!�n 1?i1C� T ilj' program or Activity receiving f_edera_l, financial. assisJnnce. XVII. MINORITY PROCUREMENT COMPLIANCE: SERVICE PROVIDER acknowledges that it has been furnished a copy of Ordinance No. 10062, the Minority Procurement Ordinance of the City of Miami, and agrees to comply with all applicable substantive and procedural provisions therein, including any amendments thereto. XVIII. DEFAULT PROVISION: In the event that SERVICE PROVIDER shall fail to comply with each and every term and condition of this Agreement or fails to perform any of the terms and conditions contained herein, then CITY, at its sole option, upon written notice to SERVICE PROVIDER may cancel and terminate this Agreement, and all payments, advances, or other compensation paid to SERVICE PROVIDER by CITY while SERVICE PROVIDER was in default of the provisions herein contained, shall be forthwith returned to CITY. EIa. T i1B •1'[f f 1tf7ti . SERVICE PROVIDER agrees to maintain all insurance coverage required by the CITY. Within seven (7) days of notification, the SERVICE PROVIDER shall furnish Evidence of Insurance to the CITY's Risk Management Department. The CITY shall be shown as an additional insured. 13 - 93- 385 xx C0NF IDE1g1Aj' TY s The SERVICE PROVIDER agrees to maintain as confidential all medical and other patient information and to otherwise conform with federal, state and local laws or rules related to the confidentiality of patient information. In the event of a demand for such information by a person or entity other than the parties of this Agreement, the patient or any person or entity authorized by the patient or ty law to obtain such information, the SERVICE PROVIDER agrees to notify the CITY of the demand and to withhold release of the requested information until such time as release is authorized by the CITY. XXI. ENTIRE AGREEMENT: This instrument and its attachments constitutes the sole and only Agreement of the parties hereto and correctly sets forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. ZXII. AMENDMENTS t No amendments to this Agreement shall be binding on either party unless in writing and signed by both parties. IN WITNESS WHEREOF► the parties hereto have caused this instrument to be executed by the respective officials thereunto duly authorized, this the day and year first above written- - 14 - 93-r 385 LA ATTEST: MATTY HIRAI City Clerk ATTEST: Corporate Secretary :2 CTT3' OF NTAMT, e mllni_ctva.i CorporAt:..ion of t,hP St at:e of Fl(.)ri_da By: CESAR H. ODIO City Manager SERVICE PROVIDER: CONSOLIDATED MEDICAL SERVICES, INC. By: Title: APPROVED AS TO INSURANCE APPROVED AS TO FORM AND REQUIREMENTS: CORRECTNESS: SWAN S. CHHABRA, DIRECTOR A. QUINN JONES, III Risk Management Department City Attorney CLL:ra:M421 4/27/93 - 15 - 93- 385 F?XTITRTT "A" CONSOLIDATED MEDICAL SERVICES, INC. ("CMS") FEES FOR SERVICES AND PERCENTAGE OF BILLING A. First Year of Agreement: 1. CMS is awarded the collection rights to approximately fifty percent (50%) of the total ground transportation and services billed. City shall pay CMS the following for said collections: 1. For monthly collections up to $20,000, the CITY shall pay 7 3/4% of net collections (collections after refunds). 2. For monthly collections in excess of $20,000, but not more than $25,000, the CITY shall pay 9 3/4% of net collections. 3. For monthly collections in excess of $25,000, but not more than $30,000, the CITY shall pay 11% of net collections. 4. For monthly collections in excess of $30,000, the CITY shall pay 12% of net collections. B. Second Year.. of Agreement (first option year): 1. if at the end of the First Year of the Agreement, CMS's collection ratel/ exceeds by five percent (5%) the collection rate of Advanced Data Processing, Inc. ("ADP"), CMS will be awarded the collection rights to approximately seventy-five percent (75%) of the total ground transportation and services billed. CITY shall pay CMS the following for said collections: l/ "Collection rate" is defined as "the ratio of billing versus =_ actual collection with no adjustments except for adjustment for distribution of patient accounts and City -mandated adjustments". The "collection rate" will be determined solely by the CITY. 93- 385 1. , For monthly col iectinns UP t.n S30, 000, the CITY shail per ? 3/4of collections, 2. For monthly collections in excess of $30,000, but not more than $37, 500, the CITY shall pay 9 3/4% of net collections. 3. For monthly collections in excess of $37,500, but not more than $45,000, the CITY shall pay 11% of net collections. 4. For monthly collections in excess of $45,000, the CITY shall pay 12% of net collections. 2. If at the end of the First Year of the Agreement, A.PP's collection rate exceeds by five percent (5%) the collection rate of CMS, CMS will be awarded the collection rights to approximately twenty-five percent (25%) of the total ground transportation and services billed. CITY shall pay CMS the following for said collections: 1. For monthly collections up to $10,000, the CITY shall pay 7 3/4 of net collections. 2. For monthly collections in excess of $10,000, but not more than $12,500, the CITY shall pay 9 3/4% of net collections. 3. For monthly collections in excess of $12,000, but not more than $15,000, the CITY shall pay 11% of net collections. 4. For monthly collections in excess of $15,000, the CITY shall pay 12% of net collections. 3. If at the end of the First Year of the Agreement, CMS's collection rate does not exceed or is not less than five percent (5%) the collection rate of ADP, CMS will be awarded approximately fifty percent (50%) of the total ground transportation and services billed. CITY shall pay CMS for said collection the same fees as for the First Year of the Agreement as further described in Section A herein. - 2 - J3-- 385 W ON C. Thjrl Tof Aq'rec!Mpnj_ (Spc,(-)nd opt ion yen-ir)., , I. I f at the end of the Second Yen-- of the Agreement, CMS's collection rate exceeds by five percent (5%) the collection rate of ADP, CMS will be awarded the collection rights to either (a) ninety percent (90%) of the total ground transportation and services billed if CMS was awarded seventy-five percent (75%) of the amount billed during the Second Year of Agreement; or (b) approximately fifty percent . (50%) of the total ground transportation and services billed if CMS was awarded twenty-five percent (25%) of the amount billed during the Second Year of the Agreement. If CMS is awarded ninety percent (90%) of the amount billed, CITY shall pay CMS the following for said collections: I For monthly collections up to $36,000, the CITY shall pay 7 3/4% of net collections. 2. For monthly co llections in excess of $36,00or but not more than $45,000, the CITY shall pay 9 3/4 of net collections. 3. Fr monthly collections in excesof $45,000, but noot more than $54rOOO? the CITY shall pay 11% Of net collections, 4. For monthly collections in excess Of $54,000, the CITY shall pay 12% of net collections. If CMS is awarded approximately fifty percent (50%) of the amount billed, CITY shall pay CMS for said collections the same fees as for the First Year of the Agreement as further described in Section A herein. 2. If at the end of the Second Year of the Agreement, ADp,s co . ilection rate exceeds by five percent (5%) the collection rate of CMS, CMS will be awarded the collection rights to either (a) ten percent (10%) of the total ground transportation and - 3 - 93- 385 cc�rvi_c p_ 1?.i l l.aci i.f cp-il -ci q nwnt,: iad twenty-f .`e pp--cont ( 25* ) of the amount tilll.ed during the Second Year of .Agreement; or (h) approximately fifty percent (50%) of the total ground transportation and services billed if CMS was awarded seventy- five percent (75%) of the amount billed during the Second Year of the Agreement. If CMS is awarded ten percent (10%) of the amount billed, CITY shall pay CMS the following for said collections: 1. For monthly collections up to $4,000, the CITY shall pay 7 3/4% of net collections. 2. For monthly collections in excess of $4,000, but not more than $5,000, the CITY shall pay 9 3/4 of net collections. 3. For monthly collections in excess of $5,000, but not more than $6,000, the CITY shall pay 11% of net collections. 4. For monthly collections in excess of $6,000, the CITY shall pay 12% of net collections. If CMS is awarded approximately fifty percent (50%) of the amount billed CITY, shall pay CMS for said collections the same fees as for the First Year of the Agreement as further described in Section A herein. CLL:ra:M421(A) - 4 -. 93- 385 AGREEMENT BETWEEN ADVANCED DATA FR0C*FSSTN(7,, TNC. AND THE CITY OF MIAMI THIS AGREEMENT is made and entered into this day of 199_, by and between The City of Miami, a municipal corporation of the State of Florida, hereinafter referred to as the "CITY", and ADVANCED DATA PROCESSING, INC., a Florida corporation, hereinafter referred to as the "SERVICE PROVIDER". WITNESS: WHEREAS, the CITY routinely provides ground transportation of private individuals to local hospitals in CITY rescue vehicles; and WHEREAS Dade County Ordinance # provides for the charging of a fee for such transportation service; WHEREAS, the SERVICE PROVIDER has demonstrated its capability and its willingness to provide the requested services; NOW THEREFORE, for and in consideration of the premises and mutual covenants herein contained, the parties hereto agree as follows: I. TERM: The term of this Agreement shall be for a period of one (1) year from the date of execution. The Agreement may be renewed for two (2) additional one-year periods by mutual agreement of the parties indicated in writing sixty (60) days prior to the expiration date. The rate of compensation to be paid and the Ctb z4�g3 5, 93- 385 3 n T)oTC;eT1f.: �Qs? n Ir ttal. 3-nUTIf) r.ransperta.t_iori hi.l ling t.0 he perfn m.o�f by SFRVTCE PROVIDER for each of the two (2) optional one-year periods is described in Exhibit A, attached and made a part hereto. II. SCOPE OF SERVICES: 1. The CITY will provide the SERVICE PROVIDER with the information necessary for billing on a magnetic computer tape for each individual. transported by a ground rescue vehicle. These documents will be forwarded to the SERVICE PROVIDER by the CITY Fire Department, Rescue Division ("Rescue") on a weekly basis. 2. Within five (5) business days after receipt of any particular Rescue Report, the SERVICE PROVIDER shall initiate and mail to the transported individual an appropriate invoice. 3. The SERVICE PROVIDER agrees to generate and mail follow-up invoices on a set billing cycle. Billing cycles and the number of invoices will be determined by the financial class (self -pay, commercial insurance, Medicare, Medicaid, or Worker's Compensation) of the individual transported. 4. The form and content of appropriate invoices and the specific billing cycles are described in Exhibit B, attached and made a part hereto. A final step in the collection process may be a letter from an attorney - 2 - 93- 385 5. C. 7. re-rpl;Qst .ng immedifito payrnent . The C,TTY may ek:Pt-c i F,7Q this option at its (Jiscr@tion. The SERVICE PROVIDER will provide to the CITY monthly reports in the format described in Exhibit C, attached and made a part hereto. The SERVICE PROVIDER agrees to generate and mail necessary forms to third party payers when appropriate. The SERVICE PROVIDER understands that it may be necessary to solicit additional data beyond the information provided on the CITY Rescue Report in order to complete the third party invoices and forms. In such situations, the SERVICE PROVIDER agrees to solicit such information from the transported individual and/or the appropriate hospital. The SERVICE PROVIDER agrees to abide by the terms of any remittance agreement or lockbox agreement entered into by the CITY and its chosen bank. It is agreed that all payments originated by reason of billings made on behalf of the CITY by the SERVICE PROVIDER shall be deposited into the account of the CITY in said depository. The SERVICE PROVIDER shall provide for direct remittance on its bills and/or statements rendered to transported individuals (or third parties, as the case may be) on behalf of the CITY. Said Agreement shall provide for the third party depository to provide the SERVICE PROVIDER with a statement setting for the name and amount of each account making - 3 - 93- 385 9. p,)yment., anal ruc.h st:a.tement shall be provided to the SERVICE PROVIDER within three ( 3 ) business days after receipt. All transport payments collected by the City Fire Department Records Custodian are to be deposited in the lockbox account and a copy of remittance will be forwarded to the SERVICE PROVIDER. In addition, said Agreement shall include a standard procedure to be followed by the third party depository when checks have been returned for insufficient funds. Said procedure shall require the third party depository to forward such checks to the SERVICE PROVIDER and to list such checks on the statement as debits. In the event that a payment is mistakenly transmitted by the payer to either the SERVICE PROVIDER or the City Fire Department, both parties agree to deposit said payments into the third depository account. The SERVICE PROVIDER agrees to provide the CITY with a listing, or a computer tape which is compatible with CITY equipment, of all accounts past due 180 days or more (except where a modified pay -out schedule has been arranged), including all pertinent facts regarding attempted collection efforts. (At the CITY's option, accounts due 180 days or more may be withdrawn from the SERVICE PROVIDER and returned to the CITY for further collection efforts). The SERVICE PROVIDER agrees to prepare responses to all inquires concerning invoices received by transported - 4 - 93- 385 IndIvi,dun1,s, f--cmmerc I a I i.nqurnnc:p formq health plan claims forms, a I I governmental_ agency claim forms, Worker's Compensation claim forms, and such other forms and reports as may be required from time to time to be prepared, submitted, filed or otherwise provided by the CITY to any entity in connection with the operation of its ground transport billing and collection business. 10. The SERVICE PROVIDER agrees to provide and furnish all material and personnel required for the performance of the Agreement. 11. The CITY reserves the right to withdraw any individual account from the SERVICE PROVIDER, if it determines that a Casualty Form was miscoded by rescue personnel, and therefore, mistakenly forwarded to the SERVICE PROVIDER for billing. In such cases, the CITY will notify the SERVICE PROVIDER in writing, specifying name of transported individual, incident number, and reason for withdrawal. For such withdrawn accounts, there is no charge to the CITY. COMPENSATION: 1. The CITY shall pay the SERVICE PROVIDER, as compensation for the services required pursuant to Section II hereof, the fees described in Exhibit A. 2. The SERVICE PROVIDER will submit monthly invoices to the CITY. Such invoices will be produced on the 15th day of each month for services rendered during the 5 A rr,-Pr-qd i.nq month. The mr)nt_hl.y i nvoi_r;As wi l l nr. l.urjp tho SERVICE PROVIDER's f-1at foe for initial. billings originated by the SERVICE PROVIDER during the preceding month, as well as the SERVICE PROVIDER's computation of payments owed by the CITY for the preceding month. Within one week of receipt of monthly invoices for the SERVICE PROVIDER, the CITY Fire Department will review requested amounts If the Department review concurs with the SERVICE PROVIDER's calculations, the invoice will be forwarded to the CITY's Finance Department for payment. 3. The monthly invoice will also include a list of account which require refunds due to overpayment of account. Said list will include the transported individual's name, the incident number, the amount of refund required, the address to which the refund should be mailed, and the reason for overpayment. 4. The CITY shall have the right to review and audit the records of the SERVICE PROVIDER pertaining to any such billings. 5. CITY shall have the right to review and audit the records of SERVICE PROVIDER pertaining to any payment by the CITY. IV. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS Both parties shall comply with all applicable laws, ordinances, and codes of Federal, State, and Local Government. 6 - 93- Uzi LA U rj)rthcry-m.orQ,-FRVTCF PPOVTDFR, agress t.o allide by -11- Federal. Debt-. Collection Practices laws and regulations and all similar State of Florida laws and regulations. U GENERAL, CONDITIONS: 1. All notices or other communications which shall or may be given pursuant to this Agreement shall be in writing and shall be delivered by personal service, or by registered mail, addressed to the other party at the address indicated herein or as the same may be changed for time to time. Such notice shall be deemed given on the fifth day after being posted or the date of actual receipt, whichever is earlier: CITY OF MIAMI Rescue Administration Fire, Rescue & Inspection Services Department 1131 N.W. 7th Street Miami, Florida 33136 SERVICE PROVIDER: Advanced Data Processing, Inc. 520 N.W. 165th Street Road Suite 201 Miami, Florida 33169 2. Title and Paragraph headings are for convenience reference and are not part of this Agreement. 3. In the event of conflict between terms of this Agreement and any terms or conditions contained in any attached documents, the terms in this Agreement shall rule. 4. No waiver or breach of any provision of this Agreement shall constitute a waiver of any subsequent breach of the same or any other provision hereof, and no waiver shall be effective unless made in writing. - 7 - J3�-161 000 7 , ,hr)'1 1(i anY SST-Ov_ts l_-`)n , pr3r aQra�: ilfi , sent:�?r?�-�?fi , 'wordG or phrases contained in this Agreement be determined. by a court of competent jurisdiction to be invalid, illegal, or otherwise unenforceable under the laws of the State of Florida or the City of Miami, such provisions, paragraphs, sentences, words or phrases shall be deemed modified to the extent necessary in order to conform with such laws or, if not modifiable to conform with such laws, them same shall be deemed severable and, in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect. VI. OWNERSHIP OF DOCUMENTS: All documents developed by SERVICE PROVIDER under this Agreement shall be delivered to CITY by said SERVICE PROVIDER upon completion of the services required pursuant to Section II hereof and shall become the property of CITY, without restriction or limitation on its use. SERVICE PROVIDER agrees that all documents maintained and generated pursuant to this contractual relationship between CITY and SERVICE PROVIDER shall be subject to all provisions of the Public Records Law, Chapter 119, Florida Statutes. It is further understood by and between the parties that any information, writings, maps, contract documents, reports or any other matter whatsoever which is given by CITY to SERVICE PROVIDER pursuant to this Agreement shall at all times remain the 8 - 93- 385 T)r.e,tPr"ty of (7J TY And G,1,11.1_ T)Ot lac? iised by >FPVTCF: MP0VTPFR for any ether pr�x:Fosea wh�itsoever_ without the gar_ i_ttpr� consent of CITY. VT. I. NONDELEGAB I L Z TY : The obligations undertaken by SERVICE PROVIDER pursuant to this Agreement shall not be delegated or assigned to any other person or firm unless CITY shall first consent in writing to the performance or assignment of such service or any part thereof by another person or firm. VIII. AUDIT RIGHTS: CITY reserves the right to audit the records related to this Agreement of SERVICE PROVIDER at any time during the performance of this Agreement and for a period of one (1) year after final payment is made under this Agreement. I%. AWARD OF AGREEMENT: SERVICE PROVIDER warrants that it has not employed or retained any person employed by the CITY to solicit or secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person employed by the CITY any fee, commission percentage, brokerage fee, or gift of any kind contingent upon or resulting from the award of this Agreement. - 9 - 93- 385 X , CONSTRUCTI:0" OF AGREEMENT! This Agreement- shall_ be construed and enforced according to the laws of the State of Florida and venue shall be in Dade County, Florida. XI. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties herein, their heirs, executors, legal representatives, successors, and assigns. XII. INDEMNIFICATION: SERVICE PROVIDER shall indemnify and save CITY harmless from and against any and all claims, liabilities, louses, and causes of action which may arise out of SERVICE PROVIDER's activities under this Agreement, including all other acts or omissions to act on the part of SERVICE PROVIDER, including any person acting for or on its behalf, and, from and against any orders, judgments, or decrees which may be entered and from and against all costs, attorneys' fees, expenses and liabilities incurred in the defense of any such claims, or in the investigation thereof. XIII. CONFLICT OF INTEREST: 1. SERVICE PROVIDER covenants that no person under its employ who presently exercises any functions or responsibilities in connection with this Agreement has any personal financial interests, direct or indirect, - 10 - 9 3085 With f:TTY. SRRI111CF i'ROT;IT)FR ft�rt:tte.r_LL covenant: t.h�t, zn the performance of this Agreement, no person having such conflicting interest shall be employed. Any such interests on the part of SERVICE PROVIDER or its employees, must be disclosed in writing to CITY. 2. SERVICE PROVIDER is aware of the conflict of interest laws of the City of Miami (City of Miami Code Chapter 2, Article V), Dade County Florida (Dade County Code Section 2-11.1) and the State of Florida, and agrees that it shall fully comply in all respects with the terms of said laws. %IV. INDEPENDENT CONTRACTOR: SERVICE PROVIDER and its employees and agents shall be deemed to be independent contractors, and not agents or employees Of CITY, and shall not attain any rights or benefits under the Civil Service or Pension Ordinances of CITY, or any rights generally afforded classified or unclassified employees; further he/she shall not be deemed entitled to the Florida Workers' Compensation benefits as an employee of CITY. %V. TERMINATION OF CONTRACT: 1. The CITY may, at its sole discretion, terminate this Agreement at any time by giving ninety (90) days prior written notice to the SERVICE PROVIDER. Upon termination, the SERVICE PROVIDER will continue to perform all duties except original billing, for 180 days or until requested to 93- 385 f7e;119ci_chetror f i rRt urnvi.ded than. the CITY continues to convey necessary documents of SEPVICE PROV It?ER. as provided herein. 2. it is hereby understood by and between CITY and SERVICE PROVIDER that any payment made to SERVICE PROVIDER shall be made only if said SERVICE PROVIDER is not in default under the terms of this Agreement. If SERVICE PROVIDER is in default, the CITY shall in no way be obligated and shall not pay to SERVICE PROVIDER any sum whatsoever. In no case, however, will City pay SERVICE PROVIDED an amount in excess of the sum provided by this Agreement. 3. Upon expiration or termination of this Agreement for any cause, SERVICE PROVIDER shall provide all reasonable assistance to the CITY and shall use its best efforts to return to the CITY in an orderly and expeditious manner, but in no event later than thirty (30) days after the date of such termination, all data, records, documents, reports, information, equipment and other property belonging to the CITY. %VI. NONDISCRIMINATION: SERVICE PROVIDER agrees that it shall not discriminate as to race, sex, color, creed, national origin, or handicap in connection with its performance under this Agreement. -i J Furthermore that no otherwise qualified individual shall, solely by reason of his/her race, sex, color, creed, national - origin, or handicap, be excluded from the participation in, be i - 12 - 93- 385 dAnied hp.nQfi.t:s of., or tie t:.o d _scri_m .nit_i_on cinder any program or activity receiving federal financial assistance. XVI1. MINORITY PROCUREMENT COMPLIANCE: SERVICE PROVIDER acknowledges that it has been furnished a copy of Ordinance No. 10062, the Minority Procurement Ordinance of the City of Miami, and agrees to comply with all applicable substantive and procedural provisions therein, including any amendments thereto. XVIII. DEFAULT PROVISION: In the event that SERVICE PROVIDER shall fail to comply with each and every term and condition of this Agreement or fails to perform any of the terms and conditions contained herein, then CITY, at its sole option, upon written notice to SERVICE PROVIDER may cancel and terminate this Agreement, and all payments, advances, or other compensation paid to SERVICE PROVIDER by CITY while SERVICE PROVIDER was in default of the provisions herein contained, shall be forthwith returned to CITY. XIX. INSURANCE: SERVICE PROVIDER agrees to maintain all insurance coverage required by the CITY. Within seven (7) days of notification, the SERVICE PROVIDER shall furnish Evidence of Insurance to the CITY's Risk Management Department. The CITY shall be shown as an additional insured. - 13 - 93- 385 XK. CONFIDENTIALITY: The SERVICE PROVIDER. agrees to maintain as confidential all medical and other patient information and to otherwise conform with federal, state and local laws or rules related to the confidentiality of patient information. In the event of a demand for such information by a person or entity other than the parties of this Agreement, the patient or any person or entity authorized by the patient or by law to obtain such information, the SERVICE PROVIDER agrees to notify the CITY of the demand and to withhold release of the requested information until such time as release is authorized by the CITY. XX I . ENTIRE AGREEMENT: This instrument and its attachments constitutes the sole and only Agreement of the parties hereto and correctly sets forth the rights, duties, and obligations of each to the other as of its date. Any prior agreements, promises, negotiations, or representations not expressly set forth in this Agreement are of no force or effect. XXII. AMENDMENTS: No amendments to this Agreement shall be binding on either party unless in writing and signed by both parties. IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by the respective officials thereunto duly authorized, this the day and year first above written. - 14 - 33- 385 CITY OF ?I!AMT, a mt.ani..r'ipal C;nr.�xi�_t.on of the. t.at: of ATTEST: Fl0ri.da By: MATTY HIRAI CESAR H. ODIO City Clerk City Manager ATTEST: Corporate Secretary APPROVED AS TO INSURANCE REQUIREMENTS: SUJAN S. CHHABRA, DIRECTOR Risk Management Department CLL:ra:M422 4/27/93 SERVICE PROVIDER: ADVANCED DATA PROCESSING, INC. By:_--� Title: APPROVED AS TO FORM AND CORRECTNESS: A. QUINN JONES, III City Attorney - 15 - 93- 385 EXHIBIT "A" ADVANCED DATA PROCESSING, INC. ("ADP") FEES FOR SERVICES AND PERCENTAGE OF BILLINGS I. FEES: During the term of this Agreement, including any option year., ADP shall be paid by the CITY seven percent (7%) of all net collections (collections after refund). II. PERCENTAGE OF BILLINGS: A. First Year of Agreement: 1. ADP is awarded the co1lectionrights to approximately fifty percent (50%) of the total ground transportation and services billed. B. Second Year of Agreement (first option year): 1. If at the end of the First Year of the Agreement ADP's collection rater exceeds by five percent (5%) the collection rate of Consolidated Medical Services, Inc. ("CMS"), ADP will be awarded the collection rights to approximately seventy-five percent (75%) of the total ground transportation and services billed. 2. If at the end of the First Year of the Agreement CMS's collection rate exceeds by five percent (5%) the collection rate of ADP, ADP will be awarded the collection rights to 1/ "Collection rate" is defined as "the ratio of billing versus actual collection with no adjustments except for adjustment for distribution of patient accounts and City -mandated adjustments". The "collection rate" will be determined solely by the CITY.. 93- 385 approximately twenty-five percent ( 25� ) of the t.ota.l ground transportation and serviced billed. 3. If at, the end of the First Year of the Agreement ADP's collection rate does not exceed or is not less than five percent (5%) the collection rate of CMS, ADP will be awarded approximately fifty percent (50%) of the total ground transportation and services billed. C. Third Year of Agreement second option year): 1. If at the end of the Second Year of the Agreement ADP's collection rate exceeds by five percent 4-5$) the collection rate of CMS, ADP will be awarded the collection rights to either (a) ninety percent (90%) of the total ground transportation and services billed if ADP was awarded approximately seventy five percent (75%) of the amount billed during the Second Year of the Agreement; or (b) approximately fifty percent (50%) of the total ground transportation and services billed if ADP was awarded twenty-five percent (25%) of the amount billed during the Second Year of the Agreement. 2. If at the end of the Second Year of the agreement CMS's collection rate exceeds five percent (5%) the collection rate of ADP, ADP will be awarded the collection rights to either: (a) ten percent (10%) of the total ground transportation and services billed if ADP was awarded approximately twenty-five percent (25%) of the amount billed during the Second Year of Agreement; or (b) approximately fifty percent (50%) of the total ground transportation and services billed if ADP was awarded approximately seventy five percent (75%) of the amount billed during the Second year of the Agreement. r i CLL:ra:M422A 93_ 385 2 - ('IT'! ()f?,11.n �.;±V f i (-)n:f 11, Tr Honorable Mayor ands+' Members of the City Commission Approval for Rescue Billing Fees Contract r rjo�,! R'cFEAEWCES Ces dio, Cit ager Eru:LOSUPEs It is respectfully recommended that the City Commission adopt a resolution authorizing the City Manager to enter into contract in accordance with RFP 92-93-105 with Advanced Data Processing and Consolidated Medical Services for the billing of Rescue services. Accounts will be split 50/50 for the first year between the two vendors, split 75/25 during the second year, and either 50/50, or 90/10 during the third year with the higher percentage going to the most efficient vendor. Advanced Data Processing is a minority/Dade County vendor located at 520 N.W. 165th St. Rd., Suite 201 Miami, Florida 33169 and Consolidated Medical Services is a non minority/Dade County vendor located at 10685 SW 88th Street, Miami, Florida 33176. We estimate that the cost of these collections services for the period of January 29, 1993 to December 31, 1993 will be $130,000 froin a projected revenue of $1,200,000 from the Rescue Transport fees, and the non -City resident car fire fees. These fees are to be taken from Account Code #280501-340. BACKGROUND: RFP 92--93-105 was put out to solicit vendors for the collection of Rescue transport fees. Advanced Data Processing and Consolidated Medical Services were the only responders to the RFP. A committee was formed to choose the best vendor and the results were close enough that an even 50/50 split of the contract was decided upon. This split will change yearly awarding a higher percentage of the contract to the vendor that brings in most revenue for the City. This new contract is for the first year of a three year contract. This contract eliminates a previous $2.00 per account fee, significantly lowering the costs to the City by a projected $32,000. 36-I 93— 385 T',' Or INTER -OFF IC.,E MEMMIAND1,11M, Judy S. Carter T, April 27, 1993 TO Chief Procurement officer General Serviqp-s Administration Approval. for and "o e Department Rescue Billing Fees Contract *Solid irec nEFF 41C Depart 'ts� o Fire Rescue and 0 s t3_0 ry 1C e I T nspnection ervices This department has verified that funds are available with the Department of Budget to cover the cost of the subject contract in the amount of $97,000 for the current PY 1992/1993, Account Code # 280501-340 and $33,000 for the 1993/1994 FY, which is pending approval. BUDGETARY REVIEW AND APPROVED BY: Mabohae Surana, Director Department of Budget 93- 385 ��litr 1. FI..{1n:{)� Judy Carter riATP April ?,7, 1.993 Chief Procurement Officer. Department of General Services ��FrT Approval for. and Soll ste Department Rescue Billina /l.l Fees Contract -f3irector RFFFHFtWF', tmeI of Fire Rescue and Inspect' Services ENCLOSIMFF; rnF In order to choose the best proposal from two bidders, a selection committee was formed to rate each bidder by using a predetermined set of criteria provided to the bidders in RFP 92- 93-015. The committee was composed of Procurement Supervisor Sara Gonzalez, Rescue Division Chief J.R. Mestas, Department of Computers liaison Gary Lehnhard and myself. It was the group's consensus after rating the bidder proposals on their qualifications, their experience, the completeness of the proposal and price, that Consolidated Medical Services (CMS) would be. the most responsive to our needs. However, Advanced Data Processing was significantly close enough in the running, that a 50/50 split of the contract was decided upon. We request that Consolidated Medical Services and Advanced Data Processing be designated as the most qualified responsible and responsive bidders in reference to RFP No. 92-93-015 for the billing of Rescue services. This department has verified that funds are available with the Department of Budget to cover the cost of the attached contract in the amount of $130,000 for the current FY 1992/1993, Account Code # 280501--340. O 93- 385 ('IT�•' f'16 �a�n�� FI,(it�('li INTF��-c?f=F�C:f' P��n�O��AT�nt�Ph April 27, 1993 Judy S. Carter Chief Procurement officer ==--- roval for ®_ General Services Adminisatiotl "�'"- Rescue Billing and Soli ste DepartmentFees Contract - RE�ERE�JCES Director — — . .��.mene Depart t of Fire Rescue and ENCLOSURES - Inspectio Services This de artment has verified T P that funds he are sub lec blcontracttin t 7 Department of Budget to cover the cost of FY 1992/199:�, Account Code = the amount of $130,000 for the current # 280501-340. BUDGETARY REVIEW AND APPROVED BY: Manohar Surana, Director Department of Budget =- 93- 385 Ali BIDDER 1 DTD TAF2ULATTO" Advanced Data Processing (ADP) 520 NW 1.65 Street Road #201 Miami., F1 33169 Minority Status (51% woman owned) See attachment (A) for bid prices. BIDDER 2 Consolidated Medical Services (CMS) 10685 SDI 88 Street Miami, Fl 33176 Non Minority Status See attachment (B) for bid prices. 13 S3- 385 . .......... ------ T C) Juan Mestas, Division Chief D r, T L April 28, 1993 Fire, Rescue and inspection Services Department Advanced Data Processing, ��--{�zr-Cf) Inc. ("ADP") and Consolidated Medical Services, Inc. ROM Leon WIPER7'WES "CMS") Assistant City 2ttorney ENCLOSURFS Enclosed please find the drafts of the agreements to be entered with ADP and CMS. Please review them carefully, specially Exhibits A of each Agreement, and provide comments to each. If you have any questions, please do not hesitate to contact me. CLL:ra:P187 enclosures 93- 385 7p_f!SUF,ITi'__-LIfT 14EDICAL TRANSPORTA'T'TON T!TT.,L114(; COI.LF CTIOI ST=TVICLS flipRFP 92-93-015 3MAT-S IAZD(S) OPINIDt rMBER 2., 1992 0:30 a.m. IOTAL �I��►eia�B®�� BIDDER TD ®R01J�fr C®SHIBR_E_CHICK _ ------ anrel®pes on Dabsli of (Zarsoa recalvindDids) GSA/Solid waste -Procurement Division Oa ? ____._,,__ (City Depart®sat)� dI Gity ()f Nmiqrni REOUISITION FOR ADVERTISEMENT arrni.r in ff,41 P(J,F,I!ic¢rrmnt 12. Division: 1. Department: j 3. Account Code number: A. is this, a confirmation: 5. Prepared by. J i (T Yes---- 6. Size of advertisement: 7. Starling date: 8. Telephone number- 9. Number of times this advertisement is to be 110. Type of advertisement: I -LDisplay nhIiQhPtI- cane. 1.1 ) d al L Claified- - 11. Remarks: o 12. Publication Dales) of invoice No. Amount ement Advertisement Miand TiMCIE icas ----------- 13. 0 Approved 0 Disapproved - " Department Director/ Designea Date Approved for Payment Date f, 1, A ID,-,.mant MAnsknernentl and retain Pink copy. C JGS/PC 503 Rev. 12/89 1 Kouun& rutwalu -- --6-- -- , DISTR UTION: White - GS.A.; Canary epartment