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Purchasing Department
RFP #082704EMS
Emergency Medical Transport Billing and Collection Services
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City of Oakland Park
REQUEST FOR PROPOSAL -EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION
SERVICES
SECTION 1- INTRODUCTION AND INFORMATION
1.0 - PURPOSE:
1.1
The City of Oakland Park is actively seeking proposals from qualified Emergency Medical Transport
Billing and Collection Services contractors, hereinafter referred to as the "Contractor", to provide
vehicle Emergency Medical Transport Billing and Collection Services in accordance with the terms,
conditions, and specifications contained in this Request For Proposals (RFP).
2.0 - SCOPE:
2.1 The City of Oakland Park Fire Rescue transports individuals from incident scenes to health care
facilities in city -owned emergency medical transport vehicles. Transported individuals are charged a
transport fee, a mileage fee, an oxygen administration fee, and also fees as applicable for 1V solutions,
cardiac monitor, cervical collar and/or backboard, intubation, and medications.
2.2 The contractor shall be responsible for the invoicing, collection, generation of any and all insurance
forms and filings, record maintenance and reports.
3.0 - USE OF BILLING INFORMATION:
3.1 The successful Proposer will use the collected billing information only as the basis for:
3.1.1 Billing the transported individual, Medicare, Medicaid, insurance companies or other
appropriate third party payors for services provided.
3.1.2 Preparing the required management and financial reports including information on delinquent
accounts.
4.0 - SERVICES TO BE PROVIDED BY PROPOSER:
4.1 Mail an invoice to each transported individual at the current prevailing rate for transportation services.
4.2 File all insurance claim forms for all patients based upon information received from the patient or
obtained from the Proposer research done at the health care facility.
4.3 Provide required paperwork to Medicare, Medicaid, insurance companies or third party payers.
4.4 Mail copies of invoices to patients, Medicare, Medicaid, insurance companies or other third party
payers, as necessary.
4.5 Mail a series of follow-up invoices to patients, as necessary.
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4.6 Re -file Medicare, Medicaid or insurance claims, as necessary to obtain payment.
4.7 Record customer payments.
4.8 Prepare monthly management / financial reports.
4.9 Negotiate and agree upon modified pay out schedules within City established guidelines for those
individuals unable to remit the full amount when initially billed.
4.10 When a billed account has become past due (defined as: an account older than the date of transport
plus six (6) months and that has a balance larger than zero), notify the City by providing the City with
a listing and/or computer file of these past due account including all pertinent facts regarding
attempted collection effort.
4.11 The successful Proposer must provide the City with an independent audit report regarding the firms
adequacy of an compliance with their internal controls on an annual basis.
4.12 Any other services as agreed to between the parties, in order to effectively collect all fees.
4.13 It shall be the responsibility of the contractor to provide:
1. All invoices with a remittance advice
2. Return envelopes with the address, to be designated by the City of Oakland Park Fire Rescue
Department.
3. Postage for the mailing of all said invoices.
4.14 The invoices shall contain the following information.
1) Invoice Number
2) Invoice Date
3) Name of patient
4) Name of responsible person, if different from patient
5) Complete address
6) Date of the transport
7) Cost of the transport
8) Incident number
9) Transport from and Transport to (location)
10) Insurance coverage and instruction, if applicable
The invoice will contain a message stating that all checks must be made payable to the 'City of
Oakland Park", with remittance address, as designated by the City of Oakland Park.
5.0 - RESPONSIBILITIES OF THE CITY:
5.1 The City/EMS will provide a copy of the Florida HRS EMS Report, or an acceptable substitute, for
each EMS transport.
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5.2 The City/EMS will provide a copy of all payment documents and any other correspondence that may
be received by City/EMS related to EMS service as defined within this Proposal.
5.3 The City/EMS will provide written definitive procedures regarding any special City policies for
billings, collections, discounts, adjustments, courtesies, refunds, cut-off dates, and so forth. Any
changes to these procedures will be in writing.
6.0 - REQUIRED USE OF ELECTRONIC FILING:
6.1 All Proposers must be currently filing Medicare and Medicaid Claims electronically and must transmit
Medicare claims via the required National Standard Format (NSF). Where appropriate, all private
insurance claims shall be filed electronically.
7.0 - REQUIRED BILLING RESEARCH AT HOSPITALS:
7.1 Based upon past history, those billing and collection firms with the highest collection rates have sent
their personnel to hospitals, as necessary, to obtain billing/insurance information. Therefore, the
successful Proposer will be required to either:
(1) Send their personnel to hospitals or
(2) Have the ability to electronically access a hospital's database to obtain all available
information to collect an account on behalf of the City and have a pre -defined system
approved by City Staff to address patient information errors, such as, but not limited to,
misspelled names, incorrect admission date, no address listed, etc.
8.0 - STAFFING REQUIREMENTS:
8.1 The City of Oakland Park Fire Rescue estimates transport of approximately 4,000 patients annually.
This number should continue to increase in the future. The successful Proposer is required to have an
adequate number of employees necessary to perform activities related to the billing and collection of
medical bills.
8.2 No warranty or guarantee is given or implied as to the total amount of transports as a result of this
contract. The quantities stated in this Request are estimates of annual usage, to be used for proposal
comparison purposes only.
9.0 - PROPOSER'S REQUIRED NUMBER OF YEARS IN BUSINESS/ELIGIBILITY:
9.1 To ensure that the successful Proposer has a proven record of service and experience, the successful
Proposer 's company is required to have been operating the same business entity for a minimum of
three (3) years and been successful in the business of billing and collecting fees for medical related
services or Fire Department Emergency Medical Transportation Services actively and continuously for
a minimum of three (3) years, have satisfactory financial support, required equipment, and
organization sufficient to ensure that they can satisfactorily provide the services if awarded a contract.
9.2 Contractor shall not have any pending criminal charges against the firm, principal owners, partners,
corporate officers, or management employees.
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10.0 - PERCENTAGE FEE FOR SERVICES:
10.1 The Proposer's fee for services to be provided will be a percentage of actual dollars collected during
the previous month. Each Proposer must submit a single PERCENTAGE FEE with their proposal.
This same fee will remain firm and fixed for the term of this agreement, that is the initial twenty-four
(24) month contract period and each of the two (2) two (2) year renewal periods.
Therefore, each Proposer should give consideration to their possible cost increases during a potential
six (6) year contract period and possible increases in transport fees, as no price adjustments will be
allowed during the renewal periods.
11.0 - REQUIRED MANAGEMENT REPORTS:
11.1 The successful Proposer must provide the City with a series of reports to show management and
financial information. The following list of reports is the required minimum:
11.2 Collection Statistics:
Gross billings by date of incident (transport) month and the related collections to date. Gross billings
should not be reduced for returned mail, bad debts or authorized write-offs. The required format
would have a minimum of four columns as follows:
1. Transport month.
2. Gross billed in transport month.
3. Total collected in transport month.
4. Percent collected. (2 & 3)
11.3 Insurance Report:
The portion of actual collections and the accounts receivable, detailed by self, Medicare, Medicaid
and private insurance.
11.4 Monthly Payment Report:
The payments posted to the accounts receivable in batch deposit order during the month. The report
must show the following information, as a minimum:
1. Patient number.
2. Patient name.
3. Patient complete address.
4. Payment amount and type.
5. Batch total on each batch number.
6. Grand total of all monthly payments.
11.5 Monthly Collection Summary:
The monthly payments in 11.4 above by original transport month. The columns will be
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1. Incident month.
2. Collected this month.
11.6 Total Billings by Incident Month:
The cumulative number of gross billings for each incident (transport) month.
11.7 Accounts Receivable:
An aged report of the amount owed by all transported patients at the end of the month. The format
will be:
1. Gross billings since inception.
2. Less: Payments since inception.
3. Less: Fire approved adjustments and write-offs since inception.
4. Ending balance of accounts receivable.
11.8 Adjustments and Write -Offs:
The detail of (3) above. The report must show:
1. Patient number.
2, Patient name.
3. Adjustment or write-off payment.
11,9 Other : Additional Reports as may be required:
1. Transports by City Vehicle Unit #
2. Transports by Hospital.
3. Patient demographic information.
12.0 - INFORMATION/CLARIFICATION:
12.1 For information concerning this RFP contact Maggie Turner at 954-561-6105. Such contact is to be
for clarification purposes only. Material changes, if any, to the technical specifications or proposal
procedures will only be transmitted by written addendum.
12.1.1 ADDENDA, CHANGES OR INTERPRETATIONS DURING PROPOSAL: Any inquiry or
request for interpretation received ten (10) or more days prior to the date fixed for the
opening of the proposals will be given consideration. All such changes or interpretations will
be made in writing in the form of an addendum and, if desired, will be mailed or sent by
available means to all known prospective Offerors not later than seven (7) days prior to the
established proposal opening date. Each prospective Offeror shall acknowledge receipt of
such addenda in the space provided in the proposal form. In case any Offeror fails to
acknowledge receipt of such addenda or addendum, his proposal will nevertheless be
considered as though it had been received and acknowledged and the submission of his
proposal will constitute acknowledgment of the receipt of same. All addenda are a part of the
contract documents and each Offeror will be bound by such addenda, whether or not received
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by him. It is the responsibility of each prospective Offeror to verify that he has received all
addenda issued before proposals are opened.
12.2 Questions should be sent to Maggie Turner, Purchasing Division, City of Oakland Park, 3650 NE 12
Ave., Oakland Park, Fl. 33334. To facilitate prompt receipt of questions they can be sent to the City
via FAX at 954-567-7129 to the attention of: Maggie Turner.
13.0 - REQUEST FOR PROPOSAL SCHEDULE:
Release RFP
Proposals due and opening date
(prior to3:00 PM)
Proposal Evaluation Committee
review of proposals and references
(estimated date)
8/06/04
8/27/04
9/2/04
Award by City Commission 9/15/04
(estimated date)
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CITY OF OAKLAND PARK
REQUEST FOR PROPOSAL - EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION
SERVICES
SECTION 2 - SPECIAL CONDITIONS
14.0 - EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION RIGHTS:
14.1 Contractor shall have exclusive right in the collection of Emergency Medical Transport Billing and
collection and during the designated period, except as otherwise noted herein.
15.0 - INITIAL CONTRACT PERIOD AND CONTRACT RENEWAL:
15.1 The initial contract shall be for a period of twenty-four (24) months, starting upon execution of the
agreement, and terminating twenty-four (24) months from that date. In addition, the City reserves the
right to renew the contract for two (2) additional two (2) year periods, providing that both parties
agree that all terms, conditions and specifications remain the same, contingent upon approval by the
City Manager and the City Commission of the City of Oakland Park provided that the contract can be
terminated by the City without cause on thirty (30) days notice and the contractor shall receive
payment only to the date of termination.
15.2 CONTRACT CONTINUITY: In the event services are scheduled to end either by contract
expiration or by termination by the City of Oakland Park (at the City's discretion), it shall be
incumbent upon the Contractor to continue the service, if requested by the City, until new services can
be completely operational. At no time shall this transition period extend more than ninety (90) days
beyond the expiration date of the existing contract.
16.0 - ASSIGNMENT:
16.1 The Contractor agrees that he will not assign any portion of this agreement without written permission
of the City of Oakland Park.
17.0 - SUSPENSION:
17.1 Should at any time during the term of this contract, including any option terms, the Contractor is in
violation of any of the terms and conditions of this contract, the City shall have the right to suspend the
Contractor until the violation is resolved to the satisfaction of the City. If the violation is not promptly
resolved or is of such serious nature that the City determines that suspension is not adequate, the City
reserves the right to terminate for cause.
17.2 In the event a Contractor is terminated, the City may assign the contract to another Contractor, or
seek a new Contractor, until the contract is re -bid, or until the end of the contract term then in effect, at its sole
option.
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18.0 - BENEFITS FROM CONTRACT:
18.1 The Contractor shall not engage directly, or indirectly without prior written City approval, in the
provision of health care insurance business. If the Contractor has any interest in health care insurance
businesses, he shall so state in his proposal, and list the specifics. If during the term of the contract, including
any option terms, Contractor acquires an interest in health care insurance, he shall immediately notify the City
in writing. Failure to do so could result in termination for cause. Further, contractor shall not release the
names of persons receiving services to third parties without the City's written permission.
19.0 - COMPLAINTS AND DISPUTES:
19.1 All complaints concerning misconduct on the part of the Contractor or disputes between City staff and
the Contractor will be referred to the City Manager or his designee, who shall conduct investigations
and inquiries, including discussions with the Contractor and involved staff. The determinations of the
City Manager or designee shall be binding upon the parties, and failure of the Contractor to follow any
such determination could be considered a material breach and subject the Contractor to termination for
cause. The Contractor agrees that any complaints received by the City concerning misconduct on the
part of the Contractor, such as excessive charges, poor business practices etc., will be referred to the
Office of the City Manager for appropriate action. The Contractor agrees to make any complaints
concerning the City of Oakland Park available to the Office of the City Manager for action as
required.
20.0 - REQUIRED LICENSING:
20.1 The Contractor shall at all times have all necessary State, County, City, and local licenses and permits
as may be required to operate this type of business.
21.0 - VARIANCES:
21.1 While the City allows Contractors to make variances to the RFP terms, conditions, and specifications,
the number and extent of variances taken will be considered in determining proposal responsiveness
and in allocating proposal evaluation points.
21.2 No proposal containing material variances to the following RFP Sections will be considered
responsive.
22.0 - COMPLIANCE WITH ALL LAWS:
22.1 Contractor shall comply with all federal, state & local laws in undertaking responsibilities pursuant to
this contract.
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CITY OF OAKLAND PARK
REQUEST FOR PROPOSAL - EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION
SERVICES
SECTION 3 - CONSIDERATION OF A WARD
23.0 - CONSIDERATION FOR AWARD/AWARD PROCEDURES:
23.1 Evaluation of the proposals will be conducted by an evaluation committee of qualified City Staff, or
other persons selected by the City. The committee will evaluate all responsive proposals received
from Offerors who meet or exceed the eligibility requirements contained in the RFP based upon the
information and references contained in the proposals as submitted and an inspection of the Offeror's
facilities, equipment, record keeping procedures, and staff.
23.2 The committee will conduct discussions, for clarification purposes only, with the responsive and
responsible Offerors and rank the proposals in accordance with the criteria contained below. A firm
and final contract, with the first ranked proposal resulting from this process, will be negotiated, and
that Contractor will be recommended to the Oakland Park City Commission for award.
23.3 The City reserves the right to award the contract to that Offeror who will best serve the interest of the
City. The City reserves the right, based upon its deliberations and in its sole opinion, to accept or
reject any or all proposals. The City also reserves the right to waive minor irregularities or variations
to the specifications and in the bidding process.
23.4 The following evaluation criteria will be used:
1. Fee, as proposed.
Maximum points available are 0 - 30.
2. Ability of the Offeror to provide the required services in regards to the extent and condition
of equipment and facilities, record keeping procedures, competency of staff, financial
support, and variances taken to RFP terms, conditions, and specifications.
Maximum points -available are 0 - 20.
3. Experience, references, qualifications, and past performance of the Offeror, owners and
officers, and persons who will be directly involved managing the service on a daily basis.
Maximum points available are 0 - 50.
Total Points Available are one hundred (100) points.
Some proposals may be selected for an interview prior to a recommendation being presented to the City
Commission. As the best interest of the City may require, the right is reserved to reject any and all proposals
or waive any minor irregularity or technicality in proposals received. Proposers are cautioned to make no
assumptions unless their proposal has been evaluated as being responsive.
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CITY OF OAKLAND PARK
REQUEST FOR PROPOSAL - EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION
SERVICES
SECTION 4 - STANDARD TERMS AND CONDITIONS
24.0 - SUBMISSION OF PROPOSALS:
24.1 Proposals must be typed or printed in ink. Use of erasable ink is not permitted. All corrections to
prices made by the offeror must be initialed.
24.2 Proposals must contain a manual signature of the authorized representative of the Offeror. Proposals
shall contain an acknowledgment of receipt of all Addenda. The address and telephone number for
communications regarding the Proposal must be shown.
24.3 Proposals by corporations must be executed in the corporate name by the President or other corporate
officer accompanied by evidence of authority to sign. The corporate address and state of
incorporation must be shown below the signature.
24.4 Proposals by partnerships must be executed in the partnership name and signed by a partner, whose
title must appear under the signature and the official address of the partnership must be shown below
the signature.
24.5 Proposals shall be submitted at or before the time and at the place indicated in the Request for
Proposals and shall be submitted in a sealed envelope (faxed proposals will not be accepted under any
circumstances). The envelope shall be clearly marked on the exterior "PROPOSAL FOR
EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION SERVICES FOR
THE CITY OF OAKLAND PARK, FLORIDA," and shall state the name and address of the
Offeror and shall be accompanied by any other required documents. No responsibility will attached to
the Purchasing Office for the premature opening of a Proposal not properly addressed and identified.
24.6 All Proposals received from Offerors in response to the Request for Proposal will become the property
of the City of Oakland Park and will not be returned to the Offerors. In the event of Contract award,
all documentation produced as part of the Contract shall become the exclusive property of the City.
25.0 - QUALIFICATIONS OF OFFERORS:
25.1 Each Offeror shall complete the Qualifications Statement and submit the same with his Proposal.
Failure to submit the Qualifications Statement and the documents required thereunder with the
Proposal may constitute grounds for rejection of the Proposal.
25.2 As a part of the Proposal evaluation process, the City of Oakland Park may conduct a background
investigation, including a record check by the Broward Sheriff's Office of the Offeror. Offeror's
submission of a Proposal constitutes acknowledgment of the process and consent to such
investigation.
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25.3 The City of Oakland Park reserves the right to make a pre -award inspection of the Offeror's facilities
and equipment prior to award of the Contract.
26.0 - MISTAKES:
26.1 Offerors are cautioned to examine all terms, conditions, specifications, drawings, exhibits, addenda,
delivery instructions, and special conditions pertaining to the RFP. Failure of the Offeror to examine
all pertinent documents shall not entitle him to any relief from the conditions imposed in the contract.
27.0 - RESERVATIONS FOR AWARD AND REJECTION OF PROPOSALS:
27.1 The City reserves the right to accept or reject any or all proposals, part of proposals, and to waive
minor irregularities or variations to specifications contained in proposals, and minor irregularities in
the proposal process.
27.2 The City reserves the right, in the event the selected Contractor does not perform satisfactorily, to
award a trial period to the next ranked Offeror or to award a contract to the next ranked Offeror. This
procedure to continue until an Offeror is selected or the contract is re -bid, at the sole option of the
City.
28.0 - LEGAL REQUIREMENTS:
28.1 Applicable provisions of all federal, state, and county laws, and local ordinances, rules and
regulations, shall govern development, submittal and evaluation of all proposals received in response
hereto and shall govern any and all claims and disputes which may arise between person(s) attaching a
bid response hereto and the City by and through its officers, employees and authorized
representatives, or any other person, natural or otherwise; and lack of knowledge by any Offeror shall
not constitute a cognizable defense against the legal effect thereof.
28.2 The Legal Advertisement, Notice of Invitation To Bid, General Conditions, Special Conditions,
Specifications, Instructions to Bidders, Exhibits, Addenda and any other pertinent document form a
part of this RFP and by reference are made a part of any response to this RFP.
29.0 - TERMINATION FOR CAUSE:
29.1 If, through any cause, the Contractor shall fail to fulfill in a timely and proper manner its obligations
under this Agreement, or if the Contractor shall violate any of the provisions of this Agreement, the
City may upon written notice to the Contractor, terminate the right of the Contractor to proceed under
this Agreement or with such part or parts of the Agreement as to which there has been a default, and
may hold the Contractor liable for any damages caused to the City by reason of such default and
termination. In the event of such termination, any completed services performed by the Contractor
under this Agreement shall, at the option of the City, become the City's property and the Contractor
shall be entitled to receive equitable compensation for any work completed to the satisfaction of the
City. The Contractor, however, shall not be relieved of liability to the City for damages sustained by
the City by reason of any breach of the Agreement by the Contractor, and the City may withhold any
payments to the Contractor for the purpose of setoff until such time as the amount of damages due to
the City from the Contractor can be determined.
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30.0 - TERMINATION FOR CONVENIENCE OF CITY:
30.1 Upon thirty (30) calendar days written notice delivered by certified mail, return receipt requested, to
the successful bidder, the City may without cause and without prejudice to any other right or remedy,
terminate the agreement for the City's convenience whenever the City determines that such
termination is in the best interest of the City. Where the agreement is terminated for the convenience
of the City, the notice of termination to the successful bidder will state that the contract is being
terminated for the convenience of the city under the termination clause and the extent of the
termination.
31.0 - SUBMISSION AND RECEIPT OF PROPOSALS:
31.1 To receive consideration, proposals must be received prior to the RFP opening date and time. Unless
otherwise specified, Offerors should use the proposal forms provided by the City. These forms may
be duplicated, but failure to use the forms may cause the proposal to be rejected. Any erasures or
corrections on the proposal must be made in ink and initialed by Offeror in ink. All information
submitted by the Offeror shall be printed, typewritten or filled in with pen and ink. Proposals shall be
signed in ink. Separate proposals must be submitted
for each RFP issued by the City in separate sealed envelopes properly marked. When a particular RFP
requires multiple copies they may be included in a single envelope or package, properly sealed and
identified.
31.2 Proposals will be publicly opened in the Commission Chambers, City of Oakland Park, FL 33441, in
the presence of Offerors, the public, and City staff. Offerors and the public are invited and
encouraged to attend RFP openings. Proposals will be tabulated and made available for review by
Offerors and the public in accordance with applicable regulations
32.0 - SPECIAL CONDITIONS:
32.1 Any and all Special Conditions contained in this RFP that may be in variance or conflict with the
General Conditions shall have precedence over the General Conditions. If no changes or deletions to
General Conditions are made in the Special Conditions, then the General Conditions shall prevail in
their entirety.
33.0 - NO BIDS:
33.1 If you do not intend to bid please indicate the reason such as, insufficient time to respond, do not offer
product or service, unable to meet specifications, schedule would not permit, or any other reason in
the space provided in this RFP. Failure to bid or return no bid comments prior to the RFP due and
opening date and time indicated in this RFP, may result in your firm being deleted from our Bidder's
Registration List for the Commodity Class Item requested in this RFP.
34.0 - BIDS FIRM FOR ACCEPTANCE:
34.1 Offeror warrants by virtue of bidding, that his Proposal and the prices quoted in his Proposal will be
firm for acceptance by the City for a period of ninety (90) days from the date of RFP opening unless
otherwise stated in the RFP.
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35.0 - RETENTION OF RECORDS AND RIGHT TO ACCESS CLAUSE:
35.1 The Contractor shall maintain and preserve during the term of the contract, all books of account,
reports and records, in accordance with generally accepted accounting practices and standards for
records directly related to this contract. The Contractor agrees to make available to the City's
designated representative, during normal business hours and in Broward, or Palm Beach County, all
books of account, reports and records relating to this contract for the duration of the contract and
retain them for a minimum period of three (3) years beyond the last day of the contract term, or if an
audit has been initiated and audit findings have not been resolved at the end of these three (3) years,
the records shall be retained until resolution of audit findings.
36.0 - PUBLIC RECORDS:
36.1 Florida law (Section 119.01, F.S., The Public Records Law) provides that municipal records shall at
all times be open for personal inspection by any person. Information and materials received by the
City in connection with a Request for Proposal response shall be deemed to be public records subject
to public inspection upon award, rejection for award, or ten (10) days after proposal opening,
whichever occurs first. However, certain exemptions to the public records law are statutorily provided
for in Section 119.07, F.S. If the Offeror believes any of the information contained in his or her
response is exempt from the Public Records Law, then the Offeror, must in his or her response,
specifically identify the material which is deemed to be exempt and cite the legal authority for the
exemption, otherwise, the City will treat all materials received as public records.
36.2 In accordance with Chapter 119 of the Florida Statutes (Public Records Law), and except as may be
provided by other applicable state and federal law, the Request for Proposal and the responses thereto
are in the public domain. However, the Offerors are requested to identify specifically any information
contained in their Proposals which they consider confidential and/or proprietary and which they
believe to be exempt from disclosure, citing specifically the applicable exempting law.
37.0 - PROHIBITION OF INTEREST:
37.1 No contract will be awarded to an Offeror who has City elected officials, officers or employees
affiliated with it, unless the Offeror has fully complied with current Florida State Statutes and City
Ordinances relating to this issue. Offerors must disclose any such affiliation. Failure to disclose any
such affiliation will result in disqualification of the Offeror and removal of the Offeror from the City's
Bidder's List and prohibition from engaging in any business with the City.
38.0 - INDEMNIFICATION AND HOLD HARMLESS:
38.1 Contractor shall, in addition to any other obligation to indemnify the City of Oakland Park and to the
fullest extent permitted by law, protect, defend, indemnify and hold harmless the City of Oakland
Park, their agents, elected officials and employees from and against all claims, actions, liabilities,
losses (including economic losses), or costs arising out of any actual or alleged;
A) bodily injury, sickness, disease or death, or injury to or destruction of tangible property
including the loss of use resulting therefrom, or any other damage or loss arising out of or
resulting or claims to have resulted in whole or in part from any actual or alleged act or
omission of the Contractor, any subcontractor, anyone directly or indirectly employed by any
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of them, of anyone for whose acts any of them may be liable in the performance of the work;
or
B) violation of law, statute, ordinance, governmental administration order, rule, regulation, or
infringement of patent rights by Contractor in the performance of the work; or
C) liens, claims or actions made by the Contractor or any subcontractor or other party performing
the work.
D) Any claims of whatsoever nature related to collection practices or any actions of contradictory
pursuant to this contract or in the attempt to collect monies due or claimed to be due to the
City.
39.0 - DISCRIMINATION:
39.1 Contractor agrees that in the performance of any provisions of this agreement, not to discriminate or
permit discrimination in the hiring practices of Contractor or in the performance of the Contractor on
the basis of race, sex, religion, political affiliation or national origin. The Contractor will strictly
adhere to the equal employment opportunity requirements and any applicable requirements established
by the State of Florida or the Federal Government.
40.0 - AGREEMENTS OUTSIDE THIS AGREEMENT:
40.1 This Agreement contains the complete Agreement concerning the Contractor arrangement between
the parties and shall as of the effective date of this Agreement supersede all other Agreements
between the parties. The parties stipulate that neither of them has made any representation with
respect to the subject matter of this Agreement or its execution and duly accept such representations as
are specifically set forth in this Agreement. Each of the parties to this Agreement acknowledge that it
has relied on its own judgment in entering into this Agreement.
41.0 - MODIFICATION OF THIS AGREEMENT:
41.1 No waiver or modification of this Agreement or any covenant, condition, or limitation, contained in
this Agreement shall be valid unless in writing and duly executed by all parties. No evidence of any
waiver or modification shall be offered or received in evidence in any proceeding, arbitration, or
litigation between the parties arising out of or affecting this Agreement or the rights and obligations of
the parties unless such waiver or modification is in writing and duly executed. The parties hereto do
acknowledge and agree that time is of the essence relative to the performance of any term, condition,
or covenant herein. In the event any litigation or other action shall arise from this Agreement, the
prevailing party shall be entitled to reasonable attorney's fees and all costs and expenses, including
attorney's fees and all costs and expenses for any court proceedings relative to the disposition of any
issues arising under this Agreement.
42.0 - NO CONTINGENT FEE:
42.1 Contractor warrants that it has not employed or retained any company or person, other than a bona
fide employee working solely for the Contractor to solicit or secure the agreement and that it has not
paid or agreed to pay any person, company, corporation, individual or firm, other than a bona fide
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employee working solely for the Contractor, any fee, commission, percentage, gift, or other
consideration contingent upon or resulting from the award or making the Agreement. For the breach
or violation of this provision, the City shall have the right to terminate the Agreement without liability
at its discretion.
43.0 - VENUE/SEVERABILITY:
43.1 Venue shall be in Broward County, Florida, with respect to any and all actions which may be brought
now or hereafter in connection with this Agreement. In the event that any portion, provision, term, or
condition of this Agreement shall be found to be unconstitutional or illegal in any way, it shall be
deemed severed and the remainder of the Agreement shall remain in full force and effect.
44.0 - VARIANCES:
44.1 For purposes of Proposal evaluation, Offerors must indicate any variances, no matter how slight, from
RFP General Conditions, Special Conditions, Specifications or Addenda in the space provided in the
RFP. No 'variations or exceptions by an Offeror will be considered or deemed a part of the Proposal
submitted unless such variances or exceptions are listed in the RFP and referenced in the space
provided on the proposal pages. If variances are not stated, or referenced as required, it will be
assumed that the product or service fully complies with the City's terms, conditions, and
specifications.
44.2 By receiving a proposal, the City does not necessarily accept any variances contained in the RFP. All
variances submitted are subject to review and approval by the City. If any Proposal contains material
variances that, in the City's sole opinion, makes that Proposal conditional in nature, the City reserves
the right to reject the Proposal or part of the Proposal that is declared, by the City as conditional.
45.0 - CONTRACTOR'S RELATION TO THE CITY:
45.1 It is expressly agreed and understood that the Contractor is in all respects an independent contractor as
to work, and that the Contractor is in no respect an agent, servant or employee of the City of Oakland
Park. This contract specifies the work to be done by the Contractor, but the method to be employed to
accomplish this work shall be the responsibility of the Contractor, unless otherwise provided in the
contract, subject to approval by the City.
45.2 Contractor and the employees of the Contractor are not entitled to any of the benefits that the City
provides for City's employees.
46.0 - COMPLIANCE WITH LAWS:
46.1 This Agreement shall be governed by all Federal, State, and local laws, regulations, ordinances, or
other standards as amended from time to time and as set by any other regulatory agency. This is
including, but not limited to, any and all municipal regulations or any other regulations which may
govern the City as a municipality of the State of Florida.
47.0 - PUBLIC ENTITY CRIMES INFORMATION STATEMENT:
47.1 A person or affiliate who has been placed on the convicted vendor list following a conviction for
public entity crime may not submit a bid on a contract to provide any goods or services to a public
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entity, may not submit a bid on a contract with a public entity for the construction or repair of a public
building or public work, may not submit bids on leases of real property to public entity, may not be
awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with
any public entity, and may not transact business with any public entity in excess of the threshold
amount provided in Section 287.017, for CATEGORY TWO for a period of thirty-six (36) months
from the date of being placed on the convicted vendor list.
48.0 - NON -COLLUSIVE AFFIDAVIT:
48.1 Each Offeror shall complete the Non -Collusive Affidavit Form and shall submit the form with the
Proposal. The City considers the failure of the Offeror to submit this document to be a major
irregularity and may be cause for rejection of the Proposal.
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CITY OF OAKLAND PARK
REQUEST FOR PROPOSAL - EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION SERVICES
SECTION 5 - REQUIREMENTS OF THE PROPOSAL
Proposal Identification: Indicated on the face of your sealed proposal envelope is the following:
EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION
SERVICES
OPENS 08/27/04, 3:00 p.m.
RFP #082704EMS
All proposals trust be submitted as specified on the proposal pages which follow. Any attachments must be
clearly identified. To be considered, the proposal must respond to all parts of the RFP. Any other information
thought to be relevant, but not applicable to the enumerated categories, should be provided as an appendix to
the proposal. If publications are supplied by an Offeror to respond to a requirement, the response should
include reference to the document number and page number. This will provide a quick reference for the
evaluators. Proposals not providing this reference will be considered to have no reference material included in
the additional documents.
Sealed proposals will be received by the City Clerk's Office, City of Oakland Park, 3650 NE 12 Ave., Oakland
Park FL. 33334 until 3:00 PM, Friday, August 27, 2004 proposals will be opened shortly thereafter.
The proposal shall be signed by a representative who is authorized to contractually bind the Contractor.
OFFERORS MUST SUBMIT AN ORIGINAL COPY
PLUS FOUR (4) COPIES OF THE PROPOSAL PAGES
INCLUDING ANY ATTACHMENTS IN A SEALED ENVELOPE AND
IDENTIFIED WITH THE FOLLOWING INFORMATION: "RFP #082704
EMERGENCY MEDICAL TRANSPORT BILLING AND COLLECTION"
Proposal Pages are as Follows:
Required Forms:
Proposal Submission Statement
Proposal Price/Fee Schedule
Sworn Statement Regarding Public Entities Crime
Non -collusion Affidavit
References/Qualifications
Attachments to your Proposal
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PROPOSAL SUBMISSION STATEMENT
City of Oakland Park
3650 NE 12th Ave.
Oakland Park, FL 33334
Date:
The undersigned, as Proposer, here declares that the only person(s) interested in this proposal, as principal, are
named herein and that no person other than herein mentioned has any interest in Proposer, this proposal or in the
contract to be reached; that this proposal is made without connection with any other person, company or parties
making a proposal; and that it is in all respects fair and in good faith without collusion or fraud.
The Proposer further declares that it has examined the site of the work and informed himself fully of all conditions
concerning the place where the work is to be done; and, if applicable, that it has examined the plans for the work and
other contract documents relative thereto and has read all of the addenda furnished as acknowledged below; and that
it has satisfied himself about the work to be performed.
The Proposer also agrees to furnish the prescribed Performance and Payment Bonds as specified, and to furnish the
required evidence of the specified insurance. The Proposer will acknowledge this Proposal by signing and
completing the spaces provided below.
Authorized Signature of Proposer
Printed name
Company name and address
Phone and fax numbers
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Proposal Percentage Fee
The Proposer's fee for services to be provided will be a percentage of actual dollars collected during the
previous month. Proposer must submit a single PERCENTAGE FEE with their proposal.
PERCENTAGE FEE FOR SERVICES:
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SWORN STATEMENT UNDER SECTION 287.133(3)(A),FLORIDA STATUTES, ON THE PUBLIC ENTITY
CRIMES
(To be signed in the presence Of a notary public or other officer authorized to administer oaths.)
STATE OF
COUNTY
Before me, the undersigned authority, personally appeared, who, being by me first duly sworn, made the following
statement:
Name of Proposer:
The business address
I understand that a public entity crime as defined in Section 287.133 of the Florida Statutes includes a violation of
any state or federal law by a person with respect to and directly related to the transaction of business with any public
entity in Florida or with an agency or political subdivision of any other state or with the agency or political
subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or any such agency or political subdivision and involving antitrust, fraud,
theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
I understand that "convicted" or "conviction" is defined by the statue to mean a finding of guilt or a conviction of a
public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to
charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of
a plea of guilty or nolo contendere.
I understand that "affiliate" is defined by the statute to mean (1) a predecessor or successor of a person or a
corporation convicted of a public entity crime, or (2) and entity under the control of any natural person who is active
in the management of the entity and who has been convicted of a public entity crime, or (3) those officers, directors,
executives, partners, shareholders, employees, members and agents who are active in the management of an affiliate,
or (4) a person or corporation who knowingly entered into a joint venture with a person who has been convicted of a
public entity crime in Florida during the preceding 36 months.
Neither the Proposer or contractor nor any officer, director, executive, partner, shareholder, employee member or
agent who is active in the management of the Proposer or contractor nor any affiliate of the Proposer or contractor
has been convicted of a public entity crime subsequent to July 1, 1989, YES NO
(Please check the box that applied to paragraph 6. If answer is NO, go on and complete paragraph
There has been a conviction of a public entity crime by the Proposer or contractor, or an officer, director, executive,
partner, shareholder, employee, member or agent of the Proposer or contractor who is active in the management of
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the Proposer or contractor or an affiliate of the Proposer or contractor. A determination has been made pursuant to
Section 287.133(3) by order of the Division of Administrative Hearings that it is not in the public interest for the
name of the convicted person or affiliate to appear on the convicted vendor list. The name of the convicted person or
affiliate is
A copy of the order of the Division of Administrative Hearings is attached to this statement.
Sworn to and subscribed before me in the state and county first mentioned above on this day of
2fl
(affix seal)
Notary Public
My commission expires
22
NON -COLLUSION AFFIDAVIT
By submission of this affidavit, the Proposer certifies that this price is made independently and free from collusion.
Proposer shall disclose below, to the best of its knowledge, any City of Oakland Park officer or employee, or any
spouse, son, daughter, stepson, stepdaughter, or parent of any such officer or employee, who is an officer or director
of, or has a material interest in, the Proposer's business who is in a position to influence this procurement. Any City
of Oakland Park officer or employee who has any input into the writing of specifications or requirements, solicitation
of offers, decision to award, evaluation of offers, or any other activity pertinent to this procurement is presumed, for
purposes hereof, to be in a position to influence this procurement. For purposes hereof, a person has a material
interest if he or she directly or indirectly owns more than five percent (5%) of the total assets or capital stock of any
business entity, or if he or she otherwise stands to personally gain if the contract is awarded to this vendor.
Failure of a vendor to disclose any relationship described herein shall be reason for debarment in accordance with
the provisions of the City of Oakland Park Code of Ordinances.
NAME RELATIONSHIPS
Signature
Sworn to and subscribed before me in the state and county first mentioned above on this day of
20
(affix seal)
Notary Public
My commission expires
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REFERENCES
The following is a list of at least five (5) references that Bidder has provided similar product or service in the past
two (2) years.
Name of Firm, City, County or Agency:
Address:
Contact Name and Current Phone Number:
Name of Firm, City, County or Agency:
Address:
Contact Name and Current Phone Number:
Name of Firm, City, County or Agency:
Address:
Contact Name and Current Phone Number:
Name of Firm, City, County or Agency:
Address:
Contact Name and Current Phone Number:
Name of Firm, City, County or Agency:
Address:
Contact Name and Current Phone Number:
Name of Firm, City, County or Agency:
Address:
Contact Name and Current Phone Number:
References and qualifications may be attached on separate pages.
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