HomeMy WebLinkAbout01 OCFA RFP RES 98-11 02-17-98AGENDA
Inter-Com
NO. 1
2-17-98
DATE:
FEBRUARY 11, 1998
TO:
FROM:
SUBJECT:
WILLIAM A. HUSTON, CITY MANAGEi~
/-
AGENDA ITEM FOR CITY COUNCIL/MEETING ON
Public Hearing, OCFA RFP, Resolution #98-11,
City Ordinance #1195 amending City Code
Sections 3421.5 and 3426.2.
Summary.
The Orange County Fire Authority (OCFA) has prepared the attached Draft
Request for Proposal (RFP) to solicit bidders to provide emergency ambulance
service to the OCFA's Ambulance Service Areas for the next 3 years. Tustin is a
member of the JPA for OCFA.
The Public Hearing is to consider the Draft RFP for Emergency Medical
Transportation and Related Services, and Establishment of an Advanced Life
Support (ALS) Service Charge ceiling (as part of the RFP) to recover actual
costs incurred by OCFA.
Resolution #98-11 addresses one of the options to be considered by Council,
predesignating OCFA to select the most qualified, successful bidder to service
the City of Tustin.
Ordinance #1195 amends Ordinance #955, the City ambulance ordinance,
making minor language changes to reflect Tustin's JPA relationship with OCFA
and require ambulance companies to adhere to the ALS ceiling rates.
This document and all attachments have been reviewed/approved as to content ·
and form by the City Attorney and the Orange County Fire Authority.
Recommendations
That City Council:
1. Adopt the Draft RFP including the ALS Rate ceiling and;
2. Adopt Resolution #98-11, designating the Orange County Fire Authority
as the: 1) Appropriate Governmental body to select a qualified bidder
.
under the RFP for emergency transportation and related services and; 2)
the contracting authority for emergency medical transportation services in
the City of Tustin. and;
Adopt Ordinance Number 1195 to Amend Tustin City Ordinance 955,
Tustin City Code Section 3421.5 'Definitions', to read; ""Fire Chief
means the Fire Chief of the Orange County Fire Authority" and Section
3426.2 to read; "No licensee shall charge more for Advanced Life SuppOrt
than those rates approved by the City or the Board of Supervisors".
Background
The Orange County Fire Authority has provided fire, paramedic, basic and
advanced life support services to the City since 1995 under the JPA. The OCFA
has also contracted for emergency transportation services from private
ambulance companies under an exis[ing RFP.
The contracts originating from that RFP are now expired. Several changes from
the prior RFP are in order and are included in the Draft RFP.
Among those changes are:
1. An Advanced Life Support (ALS) fee ceiling is being established. The
ALS fee is a mechanism for 'direct cost' recovery for OCFA in situations
where the OCFA provides paramedic treatment and accompanies the
patient to the hospital in the contract ambulance, if OCFA provides
treatment but it is not medically necessary for the paramedic(s) to
accompany the patient to the hospital, no ALS fee is charged. This ALS
fee is billed by the ambulance company to the patient and payment is
forwarded to the OCFA.
.
OCFA's methodology for calculating the ALS fee is contained 'in
Attachment 2 of the Draft RFP.
The OCFA has reqUested that each member agency hold a Public
Hearing to approve the new ALS fee ceiling as a component of the RFP.
Anti-Lobbying Provision - The Draft RFP contains an anti-lobbying
provision that prohibits the prospective ambulance bidders from
contacting the City Manager or members of this Council to influence the
outcome of the selection process. Such contact by a bidder will result in a
rejection of their Proposal.
The City does not currently have such a policy for-its selection of
consultants or contractors. It is a City Council policy matter as to whether
such a provision should be included in the RFP. It is an unusual
requirement and one that most'cities do not normally .utilize as general
practice.
3. Special Service Requirements - The Draft RFP contains several core
elements such as the ALS rate, term Of contract, response time
requirements, severability statements and the like. These core elements
must remain consistent for all member cities in order to preserve ..the
efficiencies of regional service delivery.
However, each city may add special service provisions specific to the
community. For example, Tustin may require the contract ambulance
company to provide a standby ambulance at community events such as
Tiller Days Parade. If the council desires special service provisions, it
should be approved as part of this agenda discussion. The current
agreement with the contract ambulance company contains no special
service provisions for the City of Tustin.
4. RFP process - The RFP .was scheduled for distribution on or about
February 1, 1998. Upon receiving proposals from the ambulance
Providers the Fire Authority will establish a list of qualified bidders for the
Ambulance Service Areas (Tustin is ASA #23). The council may.either
elect to a) have the Fire Authority return to council for selection of one of
the qualified bidders to provide ambulance service to Tustin or b) pre-
designate the Fire Authority to select the most highly qualified ambulance
company to service the City (this is the recommendation). Resolution #98-
11 accomplishes this pre-designation.
Also necessary are 'housekeeping' changes' in the existing Tustin City
'Ambulance Ordinance #955, Tustin City Code Sections 3421.5 and 3426.2;
defining Fire Chief as meaning the Chief of OCFA and restricting Ambulance
ALS fees to the'ceiling established in the RFP, respectively. Ordinance #1195
accomplishes those changes.
A management rep~:esentative from OCFA will appear at Council to give a brief
overview of the RFP and be available for any questions from the public or
Council.
Attached to this summary are:
1. The Draft RFP
2. Appendix 1, Ambulance Service Area Descriptions and Special Service
Requirements
3. Appendix 2, Sample Agreement for Provision of Emergency Medical
Transportation and Related Services
4. Attachment 2, RFP Summary of Changes and Paramedic Reimbursement
Cost Analysis
5. Attachment 3, Proposed Amendments to Ambulance Ordinances
6. Resolution #98-11 pre-designating the OCFA to select the most qualified
bidder for the City of Tustin.
.
Ordinance #1195 amending Ordinance #955 to include minor verbiage
changes reflecting both current practice and rate restrictions contained in
the RFP.
CITY OF TUSTIN
OFFICIAL NOTICE OF PUBLIC HEARING
OFFICIAL NOTICE OF PUBLIC HEARING
Notice is hereby given that the City Council of the City of Tustin, Cahfornia, will conduct a
public hearing on February 17, 1998 at 7:00. p.m. in the Council Chambers, 300 Centennial
Way, Tustin, California to consider the following:
.
DRAPF REQUEST FOR PROPOSAL (RFP) FOR EMERGENCY MEDICAL
TRANSPORTATION AND RELATED SERVICES, AND
.
ESTABLISHMENT OF ,Mq ADVANCED LIFE SUPPORT (ALS) SERVICE
CHARGE.
The Orange County Fire Authority provides fire suppression and paramedic services to the City
of Tustin. The Fire Authority also administers agreements with private ambulance companies
for the provision of emergency medical transportation services. The Fire Authority has
prepared a Draft Request for Proposal (RFP) for the purpose of soliciting competitive proposals
and awarding new agreements for the provision of emergency medical transportation services
within defined Ambulance Service Areas, including the City of Tustin.
The Fire Authority has also proposed the establishment of an Advanced Life Support (ALS)
Service Charge, not to exceed $185 per ALS call, to reimburse the Fire Authority for its ALS
Delivery System and associated costs.
The Service Charge would be collected from patients' who require Advanced Life Support
services from Fire Authority paramedics during transportation to a hospital or emergency care
facility by private ambulance.
The Fire Authority has sought the City Council's approval of the Draft RFP and Advanced Life
Support (ALS) Service Charge.
If you challenge the subject item in court, you may be limited to raising only those issues you or
someone else raised at the public hewing described in this notice, or in written correspondence
delivered to the City of Tustin at, or prior to, the public hearing.
If you require special accommodations, please contact the City Clerk at (714) 573-3025.
Information relative to' this item is on file in the City Clerk's Office and is available for public
inspection at City Hall. Anyone interested in the information above may call the City Clerk's
Office at (714) 573-3000.
Pamela Stoker
City Clerk
Publish: Tustin Weekly
January 30, 1998
If you reauire special accommodations, please contact
Tustin City Hall, 300 Centennial Way, Tustin 92680. (714) 573-3000.
ORANGE COUNTY FIRE AUTHORITY
REQUEST FOR PROPOSAL
For
EMERGENCY MEDICAL TRANSPORTATION AND RELATED
SERVICES
RFP # OCFA/EAS-01-98
o 1/o8/98
Draft - RFP for Emergency, _,icai Transport and Related Services, De
Jer 1997
Table Of Contents
Request For Proposal
Emergency Medical Transportation and Related Services
1. Section One - Rules of Competition and Rating Procedure
Page 1
2. Section Two - Format of Proposals
Page 4
3. · Section Three - Overview of Roles and Responsibilities
Page 5
4. Section Four- Response Time Requirements
Page 9
5. SeCtion Five - General Provisions
Page 14
6. Section Six- Special Provisions
page 19
7. Section Seven - Breach, Termination, and Emergency Takeover Page 21
8. Section Eight - Rates For Emergency Ambulance Service
Page 24
9. Section Nine - Submission Requirements and Page 26
Competitive Criteria
Appendices
Appendix I - Ambulance Service Area Description and
Special Service Requirements
Appendix II - Sample Proposed Agreement
Orange County Fire Authority 01/0 $/98
DRAFT RFP for Emergency IV' ! Transportation and Related Serx'ices
'mber1997
SECTION I
RULES OF COMPETITION AND RATING PROCEDURE
The primary competitive bid variables of this bid competition are quality of sexwice and ~ost to residents.
That is, the qualified bidder offering the highest overall quality of service at the lowest cbst to service
recipients, and meeting or exceeding the Fire Authority's mi.nimum requirements as specified herein, shall
be awarded the proposed Agreement.
In preparing proposals, all bidders' revenue assumptions shall be based strictly upon. the compensation
provision set forth in Section 8, hereof, thereby assuring "apples-to-apples" comparison of competing
offers. Proposals based upon compensation ,assumptions other than those set forth in Section 8 hereof,
shall be automatically disqualified.
PROPOSAL REVIEW PROCESS, RANKING METHOD, AND AWARD OF EMERGENCY
MEDICAL TRANSPORTATION AND RELATED SERVICES AGREEMENT ("PROPOSED
AGREEMENT") Proposals failing to meet the Fire AuthOrity's minimum requirements, as set forth in
Section 9, hereof, shall be disqualified. A Proposal Review Board will be assembled to evaluate all
proposals. After presentation and discussion of each section of all qualified proposals, each member of the
Proposal Review Board shall score that section of the individual reviewer's "Proposal Ranking Sheet,"
using the scoring method outlined below. Oral presentations may be required at this step as a part of the
award process.
Each reviewer shall assign the maximum possible.points shown in the table below to the winning entry in
each category, and then assign equal or lower point values to competing entries in the same category,
according to the individual reviewer's judgement as to the relative merit of the competing proposals.
The points awarded each bidder for all categories by all reviewers shall then be totaled. A graded list of
qualified bidders shall be assembled. The credentials of the pre-qualified bidders with the highest score
shall then be investigated by Fire Authority Staff. The graded list will' then be forwarded to the
appropriate governmental body (i.e., County. Board of Supervisors, City Council or Fire Authority .Board
of Directors). Assuming the credentials are verified, the firm with the highest point total shall be
recommended for a proposed Agreement award by the appropriate governmental body. The appropriate
governmental body shall not be bound by the recommendations of staff in the selection of the bidder to
award a proposed Agreement. The decision of the respective governmental body shall be final.
CATEGORY OF PERFORMANCE
MAXIMUM POINTS
A. Commitment to Clinical Performance 50
B. Quality of Equipment and Maintenance Practices 40
C. Commitment to First Responder Program 30
D. Plan for Takeover of Service Responsibilities 20
E. Commitment to Response Time Performance 40
F. Validity of Financial Projections and Strength *
G. Billing and Collection Services 30
H. Ambulance Service Area Description and **
Special Service Requirements
Orange County Fire Authority I 1/9/98
DRAFT RFP for Emergency Med;-' - Transportation and Related Ser~'ices, De'--re?er 1997
* Fiscal strength of the bidder will be rated as acceptable/not acceptable Only. No point value is assigned
to this category. Responses but may be considered as a factor in the award of a proposed Agreement.
.,
** Ambulance Service Area Descriptions/Special Service Requirements and the bidders responses will be
rated as acceptable/not acceptable only. No point value is assigned to these this category. Responses but
may be considered as a factor in the award of a proposed Agreement.
PRE-BID CONFERENCE: A pre-bid conference will be held on date will be filled in later at 10:00 a.m.,
at: To Be Determined
REGARDING EXCEPTIONS: Offers taking exception to the Fire Authority's bid specifications shall
be disqualified. The purpose of the Pre-Bid Conference is to receive suggestions and clarify bid
specifications for bidders before submission of offers. Any bidder that has suggestions or questions
regarding the Fire Authority's bid specifications must submit their suggestions and/or questions in writing
at or before the Pre-Bid Conference to obtain a ruling on the matter prior to submission of proposal.
Suggestions or questions concerning the RFP must be addressed, in writing, to the attention of:
Battalion Chief Ron Blaul
Orange County Fire Authority
180 S. Water Street
Orange, CA 92866
No additional suggestions or questions will be accepted following the bid conference.
Orange County Fire Authority 2 1/9/98
DRAFT RFP for Emergency ~' ':cai Transportation and Related Service '?cember 1997
PUBLIC OPENING OF PROPOSALS: All proposals received in compliance with submission
requirements for deadlines and packaging will be publicly opened. Upon opening, each proposal will be
surveyed and the following information will be publicly stated and recorded:
..
Name of bidder
Ambulance service areas indicated in proposal
Public opening will be on date will be filled in later at:
Orange County Fire Authority Headquarters
180 S. Water Street
Orange, CA 92866
PREPARATION COSTS: Ail costs for preparation of proposals will be borne by the bidder.
PROPERTY DECLARATION: All proposals and documents submitted will become the property of the
Fire Authority. Any item considered to be proprietary should be so designated.
ORAL PRESENTATION: An oral presentation may be requested of all bidders following the proposal
revi. ews.
WITHDRAWAL OF PROPOSALS: Bidders may withdraw their 'proposals, either personally or by
telegraphic or written request, prior to the time set for the opening of proposals, but not during the period
of one hundred twenty (120) days after said time. Withdrawal of proposals will be subject to the
verification of the identity of the requesting bidder and completion of a signed receipt for the proposal
package.
PROPOSAL REJECTION:- Proposals may be rejected for failure to comply with the specifications or
delivery, criteria as outlined in this RFP or for reasons identified by the Fire Authority as creating a
hindrance to the objective evaluation of such proposal.
Contact by bidder with the members of the County Board of Supervisors, City Managers or
Councilpersons, or the Fire Authority to influence the outcome of the selection process will result in a
rejection of the proposal.
The Fire Authority reserves the right to waive, at its discretion, any irregularities or informalities which
the Fire Authority deems correctable or otherwise not warranting rejection of the Proposal.
In the event that a proposal is rejected, for any reason, the bidder will be notified in writing as to the
specifics of the rejection.
AGREEMENT AWARDS NOTIFICATION: All bidders to the RFP shall be notified, in v~q'iting, of
the results of the proposal evaluations and the recommended awards. All bidders will be notified of any
public heatings, if applicable, on the award of the proposed Agreements.
Orange County Fire Authority 3 1/9/98
DRAFT RFP for Emergency Me¥' *'ransportation and Related Services, De' qer 1997
CANCELLATION OF RFP PROCESS' The RFP process for any number of or all Ambulance Service
Areas may be cancelled at any time, prior to the proposed Agreement award, when it is determined by the
Fire Authority that cancellation is in the best interest of the Fire Authority.
SECTION 2
FORMAT OF PROPOSALS
To facilitate the process of review, and to better ensure ~'air comparison of competing proposals, the
format and table of contents of proposals shall' strictly adhere to the table of contents, titles, and
numbering convention employed w/thin Section 9, "Submission Requirements and Competitive Criteria"
of this RFP.
A bidder may desire to submit for consideration a proposal which includes more than one ambulance
service area. While it is not the intent of the process to discourage multiple area submission, the proposal
review panel will recommend awards based on individual service areas and not groupings. To facilitate
tkis consideration, bidders w/shing to bid on multiple service areas must submit a separate proposal for
each area for which they wish to be consiciered.
..
All proPosals must include a cover letter indicating, by ambulance service area number and title, those
areas for which the proposal is submitted.
The deadline for receipt of proposals is date and time w/Il be filled in later. No amendments, additions or
alterations will be accepted after the above date. Any 'proposal received after the deadline for submission
shall be returned to the bidder unopened.
Ten (10) sealed copies of each proposal must be delivered no later than the above time and date; or sent
bY regular mail to the following address:
Orange County Fire Authority
Purchasing Department
145 S. Water Street
Orange, CA 92866-2122
Orange County Fire Authority 4 1/9/98
DRAFT RFP for Emergency M ~"~i Transportation and Related Ser~'ices?. ~
SECTION 3
ember 1997
OVERVIEW OF ROLES AND RESPONSIBILITIES
ALIGNMENT OF INTERESTS: Under this RFP, both the County or City and Fire Authority~ and the
Contractor desire clinical excellence, superb response time performance, cost containment, a professional
and courteous image and that the Contractor should succeed. Under the proposed Agreement, the
relationship between'the County or City and Fire Authority and the Contractor should generally be one of
cooperation not conflict, achieving the best possible marriage of the public interest with private
motivation and expertise.
It is the intent of the proposed Agreement to ensure continuous service, with life-saving response time and
clinical performance, and to furnish safe and effective opportunity for competitive participation by
qualified ambulance service providers. It is the' intent of this RFP to attract and select the most efficient,
qualified ambulance service provider available, and to create a business relationship between the County
or City and Fire Authority and the Contractor in which the Contractor's financial incentives are aligned
with the public interest.
The Contractor shall furnish and manage all ambulance dispatch services and field operation including,
but not limited to, dispatch .personnel, field personnel, equipment and vehicle maintenance, in-service
training, billing and collection of approved fees, and numerous related ~upport services. Vehicles,
on-board equipment, fixed and mobile communication equipment, and all other equipment and software
employed by the Contractor in the delivery of these services shall be furnished by the Contractor.
ORGANIZATIONAL ROLES AND BALANCE OF POWERS: Because the highest level of medical
control over day-to-day operations, is the County of Orafige Emergency Medical Services Agency,
hereinafter referred to as "the EMSA" (a governmental body which has no financial interest in the
system), the organizational structure is mainly patient oriented. However, beneath that level of clinical
authority, a network of contractual incentives and controls works to achieve the standards set by the
EMSA as efficiently as possible, while maintaining the system's long-range financial stability. The
organizational structure deliberately incorporates a separation and balance of interests, expertise, and
authority. In general terms, this division of authority and responsibility can best be described as follows:
As referenced hereinafter, under this RFP, the County, the City or the Fire Authority may be the contracting
authority for the proposed Agreement. As used herein, the phrase "County or City and Fire Authority"
means that the contracting authority and the Fire Authority both have discretionary authority over the
specific obligation or matter addressed. The phrase ,"County or City or Fire Authority" means that the
provision applies to the specified contracting authority under the proposed A~eement.
Orange County Fire Authority. 5 1/9/98
DRAFT RFP for Emergency Me ]'ransportation and Related Services, D'f 'ber 1997
1,
EMERGENCY MEDICAL SERVICES AGENCY (EMSA). Tine EMSA represents the
interests of patients, with a special emphasis upon patients experiencing life-threatening
emergencies. Every decision made by the EMSA should be made in the interest of patient care. All
aspects of the system which may affect patient care are controlled by the EMSA. The EMSA, its
medical director, various subcommittees, and staff have both the authority and resources to
routinely monitor system performance, establish and revise various standards (e.g., equipment
standards, personnel standards, training standards, in-service training standards, medical protocols,
medical dispatch procedures, first responder practices and training, medical control, the processes
whereby physician supervision is provided through direct radio contact with field personnel,
receiving hospital standards, etc.) and to effect corrective or disciplinary action as necessary. The
EMSA is authori2ed to establish and periodically revise the County Ambulance Ordinance and the
ambulance service rate structures.
ge
THE COUNTY OR CITY. In evaluating proposals for prospective ambulance service prOviders,
· the County or City shall consider, among other things:
The quality of services to be provided;.
The level of services to be provided;
The rates charged for services to be provided; and
The cost, if any, to the County or City.
Support of the Fire Authority's Advanced Life Support Program is an integral part of the quality
and level of services to be provided by the Contract6r. Accordingly, the coordination of service
with Advanced Life Support efforts shall be considered When evaluating the foregoing factors.
In cases where the County or City designates the Fire Authority to select and contract with an'
ambulance provider on its behalf, the foregoing responsibilities shall also apply to the Fire
Authority.
Be
THE FIRE AUTHORITY. Among other duties, it is the Fire Authority's responsibility to ensure
that reliable, high quality ambulance services exist on an uninterrupted basis, fully consistent with
the clinical and response time standards established. To accomplish this purpose, the role of the
Fire Authority and its staff will be to:
Employ public safeguards to ensure against poor contractor performance,' service
interruption, or cutbacks for any reason and report such deficiencies to appropriate
authorities;
bo
Provide first responder and paramedic services and ensure compatibility between first
responder operations and ambulance operations;
Orange County Fire Authority. 6 1/9/98
DRAFT RFP for Emergency Medical Transportation and Related Services, December 1997
',
c. Conduct periodic competitive procurements of ambulance service agreements, and to
administer those agreements; e.g., this RFP.
e
AMBULANCE SERVICE CONTRACTOR. It is the responsibility of the Contractor to provide
and manage the actual delivery of all emergency medical transport and related services. Clinical
performance must be consistent with standards established by the EMSA. Response time
performance must meet or exceed the standards set forth in this RFP.
The proposed Agreement is designed to allow the Contractor to focus its management skills and
creativity completely upon the delivery of services to patients. Everything that might affect the
Contractor's ability to perform is under the direct and complete control of the Contractor (e.g.;
personnel hiring, equipment maintenance} in-service training, system status management, coverage
levels, facilities, communications systems, post locations, etc.).
The list provided immediately below identifies the Contractor's primary responsibilities. This list
should be considered illustrative of primary responsibilities, and only partially complete.
Numerous ancillary and support functions are also among the Contractor's responsibilities, such as
maintaining compliance with insurance requirements, personnel recruitment, disaster readiness,
and numerous other functions. Along with other duties and responsibilities, the Contractor shall:
a. Employ and manage all ambulance personnel and dispatch center personnel;
b. Provide all in-service training required of ambulance personnel;
Operate the ambulance dispatch center and ambulance operations system to meet all
applicable staffing, clinical, and response' time gtandards, without refusing to transport any
patient requesting transport to a medical facility, providing the request falls within the
established guidelines;
d. Develop and maintain good hospital relations;
eo
Maintain good working relationships with the Fire Authority first responders and paramedics
to ensure continued field support; and provide prompt return transportation, at Contractor's
own expense, of first responder personnel who assi'st with patient care enroute to the
hospital, as needed;
Secure at its 'own expense all additional, new, or replacement ambulance post locations as
Contractor deems necessary;
g. Maintain good working relationships With all area law enforcement agencies;
ho
Ensure courteous and professional conduct of all office personnel, ambulance dispatch center
personnel, and field personnel at all times;
Orange County Fire Authority. 7 1/9/98
DRAFT RFP for Emergency Me Transportation and Related Serxices, Y .bet 1997
i. Maintain neat, clean, and professional appearance of all personnel, equipment, and facilities;
Negotiate and sign mutually beneficial support agreements with neighboring ambulance
services, subject to approval by the Fire Authority; .
ko
Promote and maintain the good reputation of the EMS system through provision of superior
services, participation in published research and industry affairs, prompt and courteous
response and follow-up to inquiries and complaints, involvement in such community
activities as health fairs, school programs, business and social group meetings, disaster drills,
etc;
Maintain all State, County, and City vehicle permits, licenses, and personnel certifications
and licensure;
m. Maintain compliance with all applicable Federal, State, and local laws, rules, and
regulations;
no
Establish an ongoing "Continuous Quality ImprOvement'' Program directed at, but not
limited to, surveillance of clinical performance, response time performance, driver
performance, and other areas that affect quality of service.
PUBLIC SAFEGUARDS AND EMERGENCY TAKEOVER: The proposed Agreement is Structured
to protect the public from loss of service, service deterioration, and loss of life as a result of performance
deficiencies for any reason on the part of the Contractor. The Fire Authority shall undertake a safe,
orderly, rapid takeover of field operations in the event th~ Contractor should fail to perform. Such
takeover is structured to occur immediately by the Fire Authority upon the finding by the County or City
or Fire Authority after reasonable investigation which may vary with the circumstances, that the
Contractor's performance, or lack thereof, amounts to a material breach of the proposed Agreement. The
EMSA may provide independent, expert, evaluation of questions involving breach of contract in matters
affecting patient care.
If the Contractor is deemed to have materially breached the proposed Agreement, the Contractor retains a
legal fight to contest, in court, the termination of the proposed Agreement, and to receive appropriate
compensation in the event the court should find that the Contractor was not in breach. However, such
possible lengthy court action would take place after takeover and restoration of service, and the
Contractor's full cooperation in effecting such takeover would not imply that the Contractor accepts the
finding that a material breach did occur, or that the breach was the fault of the Contractor.
In summary, this RFP is designed to promote the highest levels of clinical and response time performance,
to allow the public to safely enjoy the economic benefits of private sector participation and effective
competition, and to allow long-term investment in capital equipment and facilities..
Orange County Fire Authority 8 1'/9/98
DRAFT RFP for Emergency
:cai Transportation and Related Sep,'ic~
SECTION 4
cember 1997
RESPONSE TIME REQUIREMENTS
..
General Requirements: Ambulance response time to emereencv requests shall be calculated as the actual
elapsed time in minutes (see Response Time Measurement below) from the moment the information from
the Fire Authority Emergency Communications Center is transferred to and acknowledged as received by
the Contractor's ambulance dispatch center, to the moment the Contractor's first BLS unit arrives at the
scene of the incident. Where multiple ambulances are dispatched to the same emergency incident, only the
response time of the first ambulance to arrive at the scene shall be counted.
For purposes of this RFP, the following definitions of geographical areas shall apply with regard to
response time requirements. These definitions are consistent with those contained in the State of
California Emergency Medical Services Authority EMS Systems Standards and Guidelines #101 June
1993. '
A single ASA may contain one, two or all three types of response areas. These will be listed in Appendix
1- ASA Descriptions/Special Service Provisions.
Metro/Urban: Those areas with a population density greater than 100 persons per square mile.
Suburban/Rural: Those areas with a population density of 7 to 100 persons square mile. These areas
generally include the roads and contiguous canyon areas of the local mountain ranges, specifically
Brea, Tonner, Carbon, Modjeska, Silverado and Trabuco Canyons; Santiago Canyon Road between
the Orange City limits and Live Oak Canyon Road; Ortega Highway between La Plata Avenue and the
Cleveland National Forest. -
Wildemess: Those areas with a population density of less than 7 persons per square mile. These are
generally the areas of the Cleveland National Forest within the County of Orange.
Metro/Urban Requirements:
·
Contractor shall respond to not less than 90 percent of emergency requests (Code 3) in designated
Metro/Urban areas within 10 minutes.
Contractor shall respond to not less than 90 percent of urgent requests (Code 2) in designated
Metro/Urban areas within 15 minutes.
Suburban/Rural Requirements:
Contractor shall respond to not less than 90 percent of emergency requests (Code 3) in designated Rural
areas within 20 minutes.
Contractor shall respond to not less than 90 percent of urgent requests (Code 2) in designated Rural areas
within 25 minutes. '
Wilderness Requirements:
Contractor shall respond to not less than' 90 percent of emergency requests (Code 3) in designated Remote
areas within 30 minutes.
Orange County Fire Authority 9 1/9/98
,
DRAFT RFP for Emergency M( ~Transportation and Related Ser~'ices, ' ~ber 1997
Contractor shall respond to not less than 90 percent of urgent requests (Code 2) in designated Remote
areas within 40 minutes.
Response Time Measurement and Reporting: Response times are measured in full minutes rounded
upward. Thus for the purposes of measuring, reporting compliance, and imposition/accrual of penalties,
any partial minute response time will be rounded up to the next full minute. For example, a response time
of 10:01 and 11:00 would both count as 11 minutes.
Response time compliance will be measured each month and reported in writing quarterly. That is
beginning on 1. 1998 and each quarter thereafter for the life of the proposed Agreement, the
response time co/npliance report for all responses in the previous quarter in each ASA awarded to the
Contractor will be forwarded to the Fire Authority. The report will be considered late 30 calendar days
after the last day of the quarter for which the report is due.
The Response Time Compliance Report shall p.rovide the following statistical report elements for each
awarded ASA:
.
3.
4.
5.
6.
.
.
.
10.
11.
12.
Total number of emergency runs broken out as Code 2 and Code 3, per month.
Total number of hms canceled en route, per month.
Total number of hms canceled at scene, per month.
Total number of runs upgraded from Code 2 to Code 3, per month. ..
Total number of times the contractor could not respond any ambulance, per month.
Total number of times mutual aid providers were utilized to fulfill the Contractor's service
agreement, per month.
Total number and percent of Code 3 calls responded to within 10 minutes in a metro/urban area
per month.
Total number and percent of Code 3 calls responded to within 20 minutes in a suburban/rural area
per month.
Total humber and percent of Code 3 calls responded to within 30 minutes in a wilderness area per
month.
Total number and percent of Code 2 calls responded to within 15 minutes in a metro/urban area
per month.
Total number and percent of Code 2 calls responded to within 25 minutes in a suburban/rural area
per month.
Total number and percent of Code 2 calls responded to within 40 minutes in a wilderness area per
month.
All 12 statistical report elements listed above will be broken out in monthly, current quarter, and
· agreement to date columns.
Note: It is recognized that until the number of runs reaches 'the statistically signifiCant level of 100 runs
the percentage of compliance data element may be misleading. As a result, any penalties will accrue but
will not be assessed until the number of runs in that ASA reaches 100 or per annum beginning the first
day of the proposed Agreement, whichever occurs first.
Orange County Fire Authority 10 1/9/98
DRAFT RFP for Emergency ? al Transportation and Related Service: ember 1997
In addition to the statistical data elements, for each reported response time element out of compliance with
the requirements listed herein, a narrative assessment of cause and plan for bringing the response time into
compliance will be included.
Penalties for Failure to Meet Response Time Requirements: The proposed Agreement established
pursuant to this RFP Mil be subject to penalties for failure to meet response time requirements. These
penalties provide incentives for the Contractor to meet the response time requirements of the proposed
Agreement. The penalties are a Combination of progressive risk of being found in material breach of the
proposed Agreement and financial penalties for continued non-compliance. Upon becoming aware of a
Contractor's failure to meet the response time requirements, whether through the Contractor's quarterly
performance rep6rts or through other means, the Fire Authority will take the following steps:
lo
The Fire Authority. shall advise the Contractor of the imposition of financial penalties as described
· below for further non-compliance and the date those penalties become effective and shall provide
the Contractor a written notice of improvement needed and a reasonable time frame for correcting
the deficiency. This shall require the Contractor to. provide a written response outlining the reason
for the performance deficiency, and the steps the Contractor will tal~e to correct the problem. (In
the case where the deficiency was brought to the Fire Authority's attention by the Contractor's
Quarterly Performance Report, the problem correction narrative required in that report shall suffice
as the Contractor's response.)
o
In the event the Contractor does not correct the performance deficiency within the reasonable time
frame, the Fire Authority may fred the Contractor in material breach of the proposed Agreement
and institute a takeover of services as described in Section 7 of this RFP.
Schedule of Response Time Financial Penalties:
Per Call Penalties - Each individual nm in excess of the stated response time requirements shall be
assessed a financial penalty of $10 per minute or portion thereof for Code 3 runs, and $5 per minute or
portion thereof for Code 2 nms. For example: Code 3 response times in an urban grea of 10 minutes and 1
second, and 11 minutes and 0 seconds would both be assessed a $10 penalty.
In addition to the Per Call Penalty, the following penalties for Code 3 calls in excess of the stated
response time requirements in each ASA shall also apply.
Orange County Fire Authority 11 1/9/98
DRAFT RFP for Emergency Mel ?ransportation and Related Ser¥ices, [ "ber 1997
ASA Penalties - For the entire ASA, monthly aggregate response times in excess of the stated response
time requirements shall be assessed a financial penalty for each month out of compliance according to the
following schedule:
:
Percent of Total Monthly Responses
at or under 10 minutes. Financial Penalty
90% or better $-0-
85% to 89.9% $1,000
80% to 84.9% $ 2,000
Less than 79.9% $ 3,000
Note: Per Call and ASA Penalties are cumulative and assessed individually. Thus it is possible to be
assessed all per call penalties, and also an overall ASA penalty.
Financial Penalties 'Not Related to Response Times: In addition to response time penalties, certain
performance factors are assessed immediate financial penalties.
Turned Call Penalties - Any Fire Authority requests for response, Code 2 or Code 3, that are not handled
by the Contractor either through response of their own equipment or through mutual aid arrangements
with other ambulance companies, and necessitate the Fire Authority ECC to contact another ambulance
company will be assessed a "Turned Call" penalty of $500.
Late Report Penalties - Any reports submitted later than 30 calendar days following the end of the
reporting quarter are considered late and will be assessed a $300 penalty.
All penalties will be calculated by the Contractor and payment submitted together with a detailed invoice,
and requests for exemptions with the compliance report .within 30 calendar days from the last day of the
reporting quarter. The Contractor will be notified in writing of any exemptions denied by the Fire
Authority. Any denial of exemptions that that result in additional penalties above those already submitted
will be due within 30 calendar days of receipt of the notification of exemption denial by the Contractor.
Although there are financial penalties for failure to meet response time requirements and other
performance factors, payment of these penalties shall not relieve the Contractor of the responsibility to
meet all performance expectations as set forth in this RFP.
EXEMPTIONS TO RESPONSE TIME REQUIREMENTS DEFINED: The Contractor shall be
exempt from the response time performance requirements of the proposed Agreement only as follows:
o
Runs shall be exempt which occur during periods of severe xveather conditions which could
reasonably be expected to substantially impair the Contractor's response time performance,
provided it shall be the Contractor's responsibility to document said conditions, the time period
affected, and the affected hms, and to apply for this exemption as provided for below.
Orange County Fire Authority. 12 1;'9/98
DRAFT RFP for Emergency l~' al Transportation and Related Service 'ember 1997
Excess runs shall be exempt which occur during periods of unusual system overload as determined
by the Fire Authority.
o
The response time requirements of the proposed Agreement shall be suspended dun'ng a declared
disaster in the Fire Authority's service area, or during a declared disaster in a neighboring
jurisdiction which has requested assistance from the Fire Authority. For purposes of this
provision, a "declaration of disaster" shall mean any condition of disaster as declared or affirmed
by the Fire Chief or his designee.
.
In cases of multiple ambulance response incidents (i.e., where more than one ambulance is sent to
the same incident), only the response time of the first arriving ambulance shall be counted for
purposes of measuring the Contractor's response time performance.
o
If the' response priority code is downgraded enroute upon the recommendation of an on-scene first
responder, the response time standard for that call shall be recorded as the lower priority code. If
the response priority code is upgraded enroute upon the recommendation of an on-scene first
responder, the response time to that call shall be calculated from the time of the upgrade request,
and the response time standard for that call shall be recorded as that for the higher pi-iority code,
except that under no circumstances shall the total aggregate response time exceed that for the
original lower priority code. 'Additionally, acceptance of a call by the Contractor shall indicate
acceptance of the response time requirement for that call regardless of the location of the
responding ambulance.
o
In the event the Contractor is delayed from responding to a request for transportation and is
hindered from timely response due to complying with the requirement to return Fire Authority
personnel to their station as described in Section 6 of t'he proposed Agreement, an exemption shall
be granted. This exemption shall only apply for a dispatch that occurs while the Contractor's
ambulance is waiting for or actually returning Fire Authority personnel, and provided that it shall
be the Contractor's responsibility to document said conditions, the time period affected, and ~he
affected runs, and to apply for this exemption as provided for below. Dispatches that occur after
the ambulance has returned the personnel and while returning to any ambulance post locations are
specifically not eligible for an exemption.
PROCESS TO REQUEST RESPONSE TIME EXEMPTIONS: The Contractor's applications for
exemptions to the response time requirements required hereunder shall be submitted to the Fire
Authority's EMS Program Manager for approval. The requests for exemptions will accompany the
quarterly compliance report for the quarter in which the exemptions are requested. Exemption requests
from prior quarters will not be considered. Each mn for which an exemption is requested should be listed
by date, and Authority Incident Number and will.include which of the specific exemptions listed above
the Contractor is requesting and supportive information necessary to'assist the Fire Authority in approving
the exemption.
No other causes of poor response time performance, such as traffic congestion, vehicle failure, or other
such causes, shall be allowed as exemptions to these response time requirements. Any exemptions not
falling into one of the categories listed above will not be considered.
Orange County Fire Authority 13 1/9/98
DRAFT RFP for Emergency
'Fransportation and Related Services,
'~ber 1997
The decision of the EMS Program Manager may, at the Contractor's option, be appealed to the Fire Chief
of the Fire Authority, whose decision shall be final.
USE OF ALTERNATIVE METHODS TO MEET RESPONSE TIME REQUIREMENTS: For the
purpose of maintaining response time compliance, the Contractor may negotiate and utilize mutual aid
agreements with neighboring ambulance 'providers or, subcontract any portion of the designated service
area to another qualified ambulance provider. Any providers selected to provide such services pursuant to
this provision must meet the following qualifications and conditions:
The Contractor's mutual aid agreements with the neighboring provider must be reciprocal and fair
to both jurisdictions.
.
Services rendered by the mutual.aid/subcontracted provider must be substantially medically
equivalent to the level of care required of the Contractor under this RFP.
.3.
The mutual aid/subcontracted'provider and its personnel must cooperate with and participate in
any medical audit requested by the Fire Authority regarding ambulance runs responded to by the
mutual aid provider.
.
All such mutual aid/subcontracted'agreements worked out by the Contractor shall be subject to
prior approval by the Fire Authority. The Fire Authority shall approve such agreements if they are
determined to be in the best interest of the general public and the promulgation of quality services.
All mutual aid/subcontract agreements entered into by the Contractor shall be written to expire
concurrently with.the termination of the proposed Agreement.
.
If the Contractor utilizes any of the approved AltErnative Methods to Meet Response Time
Requirements, the Contractor, and not any mutual, aid/subcontractors shall be responsible for and
subject to penalties regarding failure to meet all agreed upon service provisions within the awarded
AmbUlance Service Area.
SECTION 5
GENERAL PROVISIONS
PERFORMANCE AGREEMENT: The most important aspect of this RFP will result in the award of
an Agreement stressing "performance". While the Fire Authority is interested in such things as a bidder's
credentials, key personnel, maintenance program, staffing plan, vehicle coverage plans, and training
capabilities, it is .more interested in the winning bidder's actual performance in delivering the services
which are the subject of the proposed Agreement. That performance may be summarized as follows:
When a request for Contractor's service is received by the ambulance dispatCh center, an ambulance
dispatcher must acknowledge that request promptly, must follow approved dispatch protocols, and
must appropriately manage the ambulance response, given the nature of the request and the competing
demands upon the available resources at that point in time.
Orange County Fire Authority 14 1/9/98
Transportation and Related Services ember 1997
DRAFT RFP for Emergency
Ambulance response times must meet the response time requirements set Ibrth in Section 4 hereof,
and every ambulance unit must at all times be equipped and staffed to operate at the BLS level.
Clinical performance must be consistent Mth approved medical standards and protocols. The conduct
of personnel must be professional and courteous at all times.
There must be an unrelenting effort to detect and correct performance deficiencies and to continuously
upgrade the performance and reliability of the entire EMS system. Clinical and response time
performance must be extremely reliable, with equipment failure and human error held to an absolute
minimum through constant attention to performance, protocol, procedure, performance auditing, and
prompt and definitive corrective action. This RFP requires the highest levels of performance and
reliability, and the mere demonstration of effort, even diligent and well-intentioned effort, shall
not be a substitute for performance results.
NOT A LEVEL-OF-EFFORT AGREEMENT: Still more specifically, this is NOT a level-of-effort
agreement. While proposals may include descriptions of vehicle coverage plans estimated by the bidder to
be sufficient or even in excess of that necessary to meet the performance standards required hereunder,
acceptance by the County or City or Fire Authority of the bidder's offer shall not be construed as
acceptance of the bidder's proposed level-of-effort.
Rather, in accepting a bidder's offer, the County or City or Fire Authority neither accepts nor rejects the
bidder's level-of-effort estimates; rather, the County or City or Fire Authority accepts the bidder's promise
to employ whatever level-of-effort is necessarY to achieve the clinical, response time, and other
performance results required by the terms of the proposed Agreement.
USE OWN EXPERTISE .-~ND JUDGEMENT: Bidders are Specifically advised to use their own best
expertise and professional judgement in deciding upon thg methods 'to be employed to achieve and
maintain the performance required under the proposed Agreement. Methods are meant to include
compensation programs, shift schedules, personnel policies, supervisory structures, vehicle deployment
techniques, and other internal matters which, taken together, comprise each company's own strategies for
getting the job done. The County or City and Fire Authority recognizes that different companies maY
employ different production methods, perhaps with equal success. 'By allowing each bidder to 'select,
employ, and change its production methods, the County or City and Fire Authority hopes to Promote
innovation, efficiency, and superior levels of performance.
REASONABLE WORK SCHEDULES/WORKING CONDITIONS: While the proposed Agreement
is a "performance contract," and while the Contractor is not only allowed but encouraged to employ its
own methods and techniques for producing the required performance reliably and efficiently, the
Contractor is expressly required to utilize reasonable work schedules, shift assignments, and to provide
adequate working conditions. The primary issue is patient care, and the Contractor is expected to utilize
management practices which ensure that .field personnel working extended shifts, part-time jobs,
voluntary overtime, or mandatory overtime are not exhausted to an extent that might impair judgement or
motor s 'kills.
Orange County Fire Authority 15 1/9/98
DRAFT RFP for Emergency Mi'
Transportation and Related Services,
"~ber 1997
PROFESSIONAL CONDUCT/COURTEOUS SERVICE: Ambulance services are often rendered in
the context of stressful situations. Many of the people with whom ambulance personnel come in contact
have little experience dealing with such situations, and do not cope well. In some cases, even flawless
performance by the ambulance system may draw complaints. While patients, their families, and others
are not accustomed to this stress and may not always handle it well, the Contractor and its employees are
paid for their skilled performance in stressful situations.
Thus, the County or City and Fire Authority expects and requires professional and courteous conduct at
all times from Contractor's ambulance personnel, dispatch center personnel, middle management, and top
executives. Management 'of stressful situations is part of the job, and those who do not consistently
perform with professional and courteous demeanor do not meet the required, performance standard. The
Contractor shall address and correct any departure from this standard of conduct.
"BAIT AND SWITCH" BIDDING PROHIBITED: The Contractor understands that the County or
city or Fire Authority shall, in part, award this bid based upon the qualifications of key personnel and the
type/quality of equipment presented in the bidders' proposals. If awarded the proposed Agreement, the
bidder shall furnish those personnel and equipment identified in the bidder's proposal, and throughout the
term of the proposed Agreement, the bidder shall continue to furnish those same personnel and equipment
or replacement personnel and equipment With equal or §uperior qualifications/quality. It is the specific
intent of this provision to prohibit the practice of "bait-and-switch" bidding, intentional or not.
DISASTER ASSISTANCE: During a declared disaster, locally or in a neighboring jurisdiction, the
normal course of business under the proposed Agreement shall be interrupted from the moment the
disaster situation is made known to the Contractor by the Fire Authority. Immediately upon such
notification, the Contractor shall commit such resources as are necessary and appropriate, giVen the nature
of the disaster, and shall assist in accordance with disaster p~ans and protocols applicable in the locality
· where the disaster has occurred. The disaster-related provisions of the proposed Agreement are:
During such periods, the Contractor shall be released from response time performance
requirements until notified by the Fire Authority's authorized representative that
disaster assistance may be terminated. At the scene of such disasters, the Contractor's
personnel shall perform in accordance With local disaster protocols established by that
community.
o
When disaster assistance has been terminated, the Contractor shall resume normal
operations as rapidly as is practical considering exhaustion of personnel, need for
restocking, and other relevant considerations.
.
During the course of the disaster, the Contractor shall use its best efforts to provide
local emergency coverage and shall suspend non-emergency transport work 'as
necessary, informing persons requesting such non-emergency service of the reason for
the temporary suspension.
Orange County Fire Authority 16 1/9/98
DRAFT RFP for Emergency: ~.al Transportation and Related Service. :ember 1997
CONFLICT OF INTEREST: The bidder must certify, that it is not, and will not be, violating either
directly or indirectly any conflict of interest statute, rule, or regulation by its performance of this service.
INSURANCE REQUIREMENTS: Each bidder must submit with its proposal an affidavit from an
insurance company stating that the bidder has, or would be able to obtain, insurance coverages with limits
of liability as stipulated herein. The successful bidder must provide a Certificate of Insurance in
accordance with the following insurance requirements prior to commencement of services under the
proposed Agreement. ,
Minimum Insurance Requirements: Prior to the time the Contractor is entitled to commence any part of
the project, work or services under the proposed Agreement, the Contractsr shall procure, pay for, and
maintain at least the insurance coverages and limits specified below. Said insurance shall be evidenced by
delivery to the Fire Authority of a Certificate of Insurance executed by the insurers listing coverages and
limits, expiration dates and terms of policies and all endorsements, whether or not required by the County
or City or Fire Authority and all carriers issuing said policies; and a certified copy of each policy,
including all endorsements.
a)
The following insurance requirements shall remain in effect throughout the term of the
proposed Agreement. Failure to maintain the insurance requirements as specified herein shall
constitute a breach of contract.
1) Workers' Compensation limits as required by law.
2) Comprehensive automobile liability policy shall be in the sum of not less than
$1 million for combined single limit, bodily injury and property damage.
3) Professional liability insurance .shall be in the sum of not less than $1 million
per occurrence and $2 million annual aggregate.
4)
General liability insurance shall be in the sum of not less than $1 million per
occurrence, bodily injury and property damage and $2 million annual aggregate.
b) All insurance policies except Workers' Compensation and Employer's Liability and
Professional Liability shall contain the following clauses:
1)
"The County.or City and Fire Authority are added as an additional insured as
respects .operations to the named insured performed under contract with the
County or City or Fire Authority."
2) "It is agreed that any insurance maintained by the County or City and Fire
Authority shall apply in excess of and not contribute with, insurance provided
by this policy."
3)
"This insurance shall not be canceled, limited or allowed to lapse until after 30
days written notice has been given the County or City and Fire Authority."
Orange County Fire Authority 17 1/9/98
DRAFT RFP for Emergency Me ,Transportation and Related Services, E ~er 1997
INDEMNIFICATION: The Contractor shall agree to defend, indemnify and hold harmless the County
or City and Fire Authority, its officers, agents, and employees, from all liability, claims, losses and
demands, including defense costs, whether resulting from court action or otherwise, arising out of the acts
or omissions of Contractor. its officers, agents, or employees, or the condition of property .used in the
performance of the proposed Agreement, excepting acts or omissions directed by the County or City and
Fire Authority, its officers, agents, or employees, acting within the scope of their employment for which
County or City and Fire Authority agrees to defend and indemnify the Contractor in a like manner,
PERMITS AND LICENSES: The successful bidder shall be responsible for obtaining all necessary
permits and licenses required for initiation and completion of its work under the proposed Agreement and
will bear their cost.
AUDITS AND INSPECTIONS: At any time during normal business hours, and as often as may
reasonably be deemed necessary, the Fire Authority's representatives may observe the Contractor's
operations and the Contractor shall make available to the Fire.Authority for its examination, its records
With respect to all matters covered by the proposed Agreement. and the Fire Authority may audit,
examine, copy, and make excerpts or transcripts from such records, records of personnel, daily logs,
Conditions of employment, and other data related to all matters covered by the proposed Agreement. Fire
Authority representatives may, at any time and without notification, directly observe the Contractor's
operation of the ambulance dispatch center, maintenance facility, or any ambulance post location, and a
Fire Authority representative may ride as "observer" on any of the Contractor's ambulance units at any
time, provided, however, that in exercising this right to inspection and observation, the Fire Authority
representatives shall conduct themselves in a professional and courteous manner, shall not interfere in any
way with the Contractor's employees in the performance of their duties, and shall at all times be respectful
of the Contractor's employer-employee relationships.
The Fire Authority's right to observe and inspect operations or records in the Contractor's business office
shall be' restricted to normal business hours and reasonable notification shall be given the Contractor in
advance of any such visit.
NON-TRANSFERABLE AGREEMENT: The Contractor may not delegate or assign the fights or
obligations hereunder, either in whole or in part, without prior written consent of the County or City or
Fire Authority. Any attempted assignment or delegation in derogation of this paragraph shall be void. A
transfer by any shareholder of greater than ten percent (10%) of the stock currently issued by the
Contractor, or a sale or transfer of over twenty-five percent (25%) of the assets of the Contractor, will be
deemed an assignment.
NON-DISCRIMINATION: The Contractor shall not discriminate in the provision of services,
employment practices, or in the allocation of benefits on the basis of color, race, religion, national origin,
.sex, age, physical or mental handicap, in accordance with Title VI and VII of the Civil Rights Act 1964,
42 USC Section 200d, rules and regulations promulgated pursuant theretol 'and under the laws of the State
of California as each law, rule, or regulation many now exist or hereafter be amended.
Orange County Fire Autho~/ity 18 1/9/98
DRAFT RFP for Emergency ~al Transportation and Related Service :ember 1997
COMPLIANCE WITH LAWS: All services furnished by the Contractor under the proposed
Agreement shall be rendered in full compliance with all applicable Federal, State, and local laws, rules,
and regulations. It shall be the Contractor's sole responsibility to determine which laws, rules, and
regulations apply to the services rendered under the Proposed Agreement, and to maintain compliance
with these appl. icable standards at all times.
SECTION 6
SPECIAL PROVISIONS
PROPOSED AGREEMENT: The Contractor shall agree to the terms of the proposed Agreement,
incorporated herein, and attached as an exhibit to this RF~
TERM OF CONTRACT AND RENEWAL PROVISIONS: The following provisions shall govem the
term of the proposed Agreement and process of renewal:
.
Agreement Start Date. The proposed Agreement start date shall be 12:01 a.m.
,
at which time the Contractor shall assume full responsibility for the provision of all emergency
medical transportation and related services throughout the designated service area.
.
Term of Contract. The term of the proposed Agreement shall be three (3) years and shall'
automatically terminate at midnight, · unless the proposed Agreement is
. extended pursuant to the conditions described in #3 below.
o
Contract Extension. Prior to the end of the pr6posed Agreement, the Contractor may be
granted a single extension ofl to 3 years upon the following conditions:
The Contractor provides vYzitten notice to the County or City and Fire Authority, no
sooner than 9 months and no later than 6 months prior to the expiration of the proposed
Agreement of its desire to obtain an extension. The notice should include the number of
years extension that the Contractor is requesting.
The Contractor provides written verification that its services rendered to date have been
consistently above the requirements as set forth in this RFP, the Contractor's response
to this RFP, and the proposed Agreement.
Provided these conditions are met, the Fire Authority staff will prepare: 1) a review of performance; 2) an
impact analysis of granting the extension, and 3) a recommendation for action. The County or City or Fire
Authority will review the extension request and staff recommendations and make a determination whether
to grant an extension and what the term of that extension shall be. The decision whether to grant the
extension and for what term shall be at the sole discretion of the County or City or Fire Authority and
shall be final.
Orange County Fire Authority 19 1/9/98
DRAFT RFP for Emergency Me
Yransportation and Related Services,
~ber 1997
TERMINATION OF AGREEMENT:
Either party may terminate the proposed Agreement upon providing the other party with one-hundred
eighty (180) days ,~a-irten notice.
The proposed Agreement shall terminate and the duties of the parties cease immediately, at the option of
County or City or Fire Authority, should Contractor fail to perform the covenants contained in the
proposed Agreement in the time and manner specified. The reasons for termination include, but are not
limited to, the following:
· The provisions set forth in Section 7 of the RFP;
The lapse of any license, permit, or approval issued Contractor necessary to the services provided
within the proposed Agreement by any Federal, State, or local government;
Unethical conduct or malpractice by Contractor as determined either by a court of competent
jurisdiction or by such review processes as are, or may be, established by County or City and Fire
Authority;
· The breach by Contractor of any provision of the proposed Agreement or any covenant contained
herein;
· The loss by Contractor of legal capacity to contract.
Notice of termination shall be given in the manner set out in the Notices paragraph Of the proposed
Agreement. .'
EXTERNAL MEDICAL QUALITY CONTROL: The Contractor shall fully comply with all medical
standards, protocols-and ambulance rUles and regulations established by the EMSA, and shall cooperate
with the program and medical directors in the monitoring, regulation, and oversight of the EMS system,
throughout the term of the proposed Agreement.
The Contractor shall notify the Fire Authority of any complaints or inquiries initiated by the County
Emergency Medical Services Agency, the California Emergency Medical Services Authority, and any
other local, State, or Federal regulatory agency regarding service quality, billing practices, or personnel
matters. The notification shall consist of: The agency making the complaint or inquiry, the general nature
of the complaint or inquiry, and the outcome if any. This notification shall occur within a reasonable
amount of time folloMng the complaint or inquiry, but under no circumstances should the time exceed 14
calendar days.
- Orange County Fire Authority 20 1/9/98
DRAFT RFP for Emergency M,~-':o. ai Transportation and Related Services - 'o. ember 1997
,,!
_
INTERNAL QUALITY CONTROL: The Contractor shall establish an ongoing "Continuous Quality.
Improvement" (CQI) Program directed at but not limited to surveillance of clinical performance, response
time performance, driver performance, and other areas that affect quality of service. The Contractor shall
provide the Fire Authority quarterly summary reports showing the results of those CQI elements related to
clinical performance. CQI reports will begin on 1, 1998 and each quarter thereafter for the life
of the proposed Agreement. The report will be considered late 30 calendar days after the last day of the
quarter for which the report is due.
COMPUTER AIDED DISPATCH (CAD) REQUIREMENTS: Once awarded the proposed
Agreement, the Contractor will take such steps as are necessary to establish and maintain a CAD interface
with the Fire Authority Emergency Communications Center (ECC). This may include but is not limited
to hardware, software, and telecommunications lines and equipment. All equipment will meet Fire
Authority specifications. All costs are to be borne by the Contractor.
Once the Contractor's dispatch center is connected via computer to the Fire Authority's ECC, any abuse
or misuse of the computer equipment for purposes other than the intended use amounts to a breach of the
proposed Agreement.
RETURN OF FIRE AUTHORITY PERSONNEL TO STATIONS: The Fire Authority provides ALS
services from a variety of delivery platforms including engine and truck companies. In cases where Fire
Authority personnel accompany the patient in the ambulance enroute to the hospital o~' other receiving
facility and the ALS unit does not follow up to the hospital/receiving facility, the Contractor agrees to
return those personnel to their assigned fire station within 30 minutes from the conclusion of the run.
SECTION 7
BREACH, TERMINATION AND EMERGENCY TAKEOVER PROVISIONS
If the City or County or Fire Authority determines that a breach of the proposed Agreement has occurred,
the Contractor shall be given written notice and a reasonable opporumity to correct said breach; provided
however, that if the Cit'3,' or County or Fire Authority determines that the breach is material, the proposed
Agreement may be terminated without an opportunity to correct said breach.
MATERIAL BREACH DEFINED: Conditions and circumstances which shall constitute a material
breach of the proposed Agreement by the Contractor shall include, but not be limited to, the following:
Failure of the Contractor to operate the ambulance service system in a manner which enables the
Fire Authority and the Contractor to remain in substantial compliance with the requirements of
applicable Federal, State and local laws, rules and regulations, and xvith the requirements of
Orange County ambulance ordinance and related rules and regulations;
o
Supplying to the Fire Authority false or misleading information during this bid process or omitting
material information so as to effectively mislead;
Orange County Fire Authority 21 1/9/98
DRAFT RFP for Emergency M Transportation and Related Services, 1 ,bet 1997
o
Withholding or falsifying data supplied to the Fire Authority or to the EMSA Medical Director
during the course of operation, including by way of example but not by way of exclusion, dispatch
data, patient report data, response time data, financial data, or falsification or withholding of any
other data required under the proposed Agreement; :
o
Failure to comply with (or exceed) the proposed and accepted plan for ambulance coverage during
the first three months of operation, as referenced in Section 9D of this RFP;
o
Failure to comply with (or exceed) the minimum employee wage/salary and benefit package as
submitted by the bidder and accepted by the Fire Authority;
~ 6. Scaling down of operations to the detriment of performance;
o
Failure to maintain equipment in accordance with good maintenance practices, or to replace
equipment in accordance with the Contractor's submitted and accepted equipment replacement
policy, except when extended use of such equipment is approved by the Fire Authority as provided
for herein;
Attempts by the Contractor to intimidate or otherwise punish' employees who desire to interview
with or to sign contingent employment agreements xvith competing bidders during a subsequent
bid cycle;
.
Failure of the Contractor's employees to conduct themselves in a professional and courteous
manner, and to present a professional appearance;
10. Failure by the Contractor to furnish key personnel of c~uality and experience as bid;.
11.
Failure by the Contractor to cooperate with and assist the Fire Authority in its takeover of the
Contractor's operations after termination of the proposed Agreement due to a material breach by
the Contractor, even if it is later determined a material breach did not occur.
12.
Failure to consistently meet (or exceed) the various clinical and response standards required
hereunder.
13.
Failure to correct a non-material breach after having been given notice and a reasonable
opportunity to correct said breach.
Upon termination of the proposed Agreement, the Contractor shall cooperate completely and immediately
with the County or City or Fire Authority. to effect a prompt and orderly takeover of the Contractor's
service by the Fire Authority.
Orange County Fire Authority 22 1/9/98
DRAFT RFP for Emergency ~' -~ical Transportation and Related Service, 'cember 1997
CONTRACTOR'S RELIEF UPON TERMINATION: The provisions of this Section shall be
specifically accepted and agreed to by the Contractor as reasonable and necessary in light of the unusual
public health and safety aspects associated with the proposed Agreement. Any legal action to challenge a
termination for breach Shall be initiated by the Contractor only after the emergency takeover has been
completed, and shall not under any circumstances be allowed to delay' the process of takeo~,er by the Fire
Authority. The Contractor's cooperation with, and full support of, such emergency takeover process shall
not be construed as acceptance by the Contractor of the finding of a material breach, and shall not in any
way jeopardize the Contractor's fight to recovery should a court later determine that the termination of the
proposed Agreement was made in error. However, failure on the part of the Contractor to cooperate fully
with the Fire Authority to effect a'safe and orderly takeover of operations shall itself constitute a material
breach of th.e proposed Agreement, even if it is later determined that the original termination based on a
material breach was made in error. Contractor specifically waives any right to seek declaratory or
equitable relief, including a restraining order or injunction against termination or an emergency takeover.
LAME DUCK PROVISIONS: Should the ContraCtor fail to Win the bid in a subsequent bid cycle, the
County or City or Fire Authority obviously depend upon the Contractor to continue provision of all
services required under the proposed. Agreement until the successor Contractor takes over operations.
Under these circumstances, the Contractor would, for a period of several months, be serving as a lame
duck Contractor. To ensure continued performance fully consistent With the performance requirements of
the proposed Agreement throughout any such period, the following provisions shall apply:
Throughout such lame duck period, the Contractor shall continue all operations and support
services at substantially the same levels of effort and performance as were in effect prior to the
award of the subsequent agreement to a competing bidder;
o
The Contractor shall 'make no changes' in method~ of operation which could reasonably be
considered to be aimed at cutting the Contractor's service and operating costs to maximize profits
during the final stages of the proposed Agreement;.
e
The County or City or Fire Authority recognize that, if a competing bidder is awarded the contract
in a subsequent bid cycle, the Contractor may reasonably begin to prepare for transition of service
to the new Contractor during the lame duck period, and the County or City or Fire Authority shall
not unreasonably. Mthhold its approval of the Contractor's requests to begin an orderly transition
process, including reasonable plans to relocate staff, scale down certain inventory items, etc., so
long as such transition activities do not impair the Contractor's performance during the lame duck
period, so long as such transition activities are pre-approved by the Fire Authority.
Nothing in the proposed Agreement shall be construed to supersede the County EMSA or any other duly
empowered regulatory agency from separately and/or concurrently exercising its authority to provide
oversight and take necessary action to ensure the quality of any services which are also covered by the
proposed Agreement.
Orange County Fire Authority 23 1/9/98
DRAFT RFP for Emergency Met Transportation and Related Services, [7 ber 1997
SECTION 8
RATES FOR EMERGENCY AMBULANCE SERVICE
,.
BLS SERVICE RATES: Orange County Board of Supervisors Resolution No. 87-858 establishes
maximum BLS Service Rates which may be charged by the Contractor for ambulance services to their
customers for services rendered. The Contractor may not charge more than the prevailing County
approved maximum BLS Service Rates. Current rates appear below:
MAXIMUM BLS SERVICE RATES:
Type of Charee Basis for Charee
Rate
Emergency Base Rate
Applicable for urgent or Code III response
at the request of a public safety
employee
$296.20
Mileage Per patient mile or fraction thereof $ 10.50
Oxygen Applicable when administered $ 40.90
(by mask or Cannula)
Standby Per 15 minutes after the first 15 $ 29.20
minutes and any fraction thereof
Expendable Medical Maximum per response or fair market $ 13.30
Supplies value, whichever is least
Established BLS rates are subject to periodic evaluation and modification based on economic and industry
trends.
ALS SERVICE RATES: For those calls during which ALS services are provided, the Contractor shall
be responsible for implementing and collecting an ALS ServiCe Charge not to exceed $185 per ALS call
as authorized by the County or City and Fire Authority. The disbursement of these funds shall be as
follows:
· $104 to the Fire Authority.
· The balance to the Contractor.
The purpose of .this charge is to reimburse the Fire Authority for its ALS Delivery System and its
associated ALS services, and the Contractor for ALS billing services and to offset uncollectable ALS fees.
Orange County Fire Authority 24 1/9/98
DRAFT RFP for Emergency ' 'cai Transportation and Related Servic ~cember 1997
For the purpose of calculating the ALS fees due to the Fire Authority, an ALS call shall be defined as anv
call in which the Fire Authority's Paramedics escort the patient to the hospital or provide other qualifl,'in~
ALS sen'ices.
The Contractor, as the exclusive provider of ambulance services within each awarded ASA, shall assume
the entire risk of nonpayment of ambulance service rates and ALS rates receivable by the Fire Authority.
Exemptions may be requested for each qualifying call as described above and accompany the quarterly
payment with the detail prescribed below. Exemptions will be evaluated and granted or denied at the sole
discretion of the Fire Authority. The Contractor will be notified in writing as to the disposition of each
request Mthin 30 days of the Fire Authority's receipt of the exemption requests. Payments for those
exemptions denied and granted will be due to the Fire Authority with the following calendar quarters
payment as described below.
The $104 for each qualifying ALS call, and all granted and denied exemptions from the preceding quarter,
shall be provided by the Contractor to the Fire Authority beginning 30 days from 1, 1998 and
due within 30 days after the first day of each calendar quarter thereafter for the life of the proposed
Agreement. In addition to the payment, the Contractor will provide:
o
An audit list of each ALS call invoiced to a patient or third party payor, and the name of the payor
invoiced. The audit list must contain the following data elements:
· The amount invoiced for each call.
· The amount recovered for each call.
· The date and Fire Authority incident number for each call.
.
An audit list of all requests for exemptions from the full $104 per ALS call payment due to the Fire
Authority. The audit list must contain the following data elements:
· The amount invoiced for each call.
· The amount recovered for each call.
· The date and Fire Authority incident number for each call.
· The reason for reduced reimbursement.
In the event that unforeseen changes to health care reimbursement seriously affect the Contractor's ability
to continue to provide the Fire Authority reimbursement for ALS services rendered by the Fire Authority
in the manner and amounts prescribed in the proposed Agreement, the Contractor may petition the Fire
Authority for a re-evaluation of the ALS fee schedule, payment, and exemption process. The Contractor
shall be required to provide such proof as necessary to show that the continuance of current fiscal
practices are so economically harmful to the Contractor so as to place the Contractor in danger of having
to default on the proposed Agreement. It shall be at the sole discretion of the Fire Authority whether to
agree to any modifications.
Orange County Fire Authority 25 1,'9/98
DRAFT RFP for Emergency Me
Transportation and Related Sen'ices, I'
~ber 1997
Contractor agrees to defend, indemnify and hold harmless County or City and Fire Authority, its officers,
agents, and employees from all liability, claims, losses and demands, including defense costs, whether
resulting' from court action or otherwise, arising from any and all challenges to the service rates
established herein. A challenge to service rates includes~ but is not limited to, both p..rocedural and
substantive challenges to the adequacy of, or authority to impose, either the BLS or ALS service rates set
forth herein.
SECTION 9
SUBMISSION REQUIREMENTS AND COMPETITIVE CRITERIA
m.
COMMITMENT TO CLINICAL PERFORMANCE: The initial level of clinical performance
required under this RFP shall be that level which is proposed by the winning bidder, or a lesser
level, as determined during negotiations between the winning bidder and' the County or City or
Fire Authority. Equipment and personnel furnished to perform all BLS ambulance service
furnished under the proposed Agreement shall meet EMSA's minimum requirements. The bidder's
offered level of clinical performance shall be specified by responding to each of the following
items:
le
MEDICAL PROTOCOLS. Minimum requirement: Policy and procedures for Basic Life
Support (BLS) medical protocols currently in use in the Orange County EMS System.
Additional commitment offering: Bidder may offer to operate under more extensive, more
detailed, or more clinically advanced BLS medical protocols furnished in its proposal.
ge
PROPOSED ON-BOARD EQUIPMENT ,&ND SUPPLIES. Minimum requirements:
All vehicles must carry equipment and supplies sufficient to meet EMSA requirements for
ambulances. Brand names; models, quantities, and, where appropriate, packaging
specifications for all recommended and proposed equipment and 'supplies shall be
furnished. Additional commitment offering: Bidder may offer to employ such additional
equipment and supplies which exceed EMSA requirements and are consistent with the
BLS scope of practice approved by the EMS preplan (brand names, quantities, and form 'of
packaging shall be specified).
e
COMMITMENT TO IN-SERVICE TRAINING. Minimum requirements: The
Contractor shall describe and offer an in-house or subcontracted in-service training
program adequate to allow field personnel to. meet Orange County recertification
requirements. Additional commitment offering: The Bidder may describe and offer a
program of in-service training superior to the minimum requirement.
Orange County Fire Authority 26 1/9/98
DRAFT RFP for Emergency I 'al Transportation and Related Service' ',ember 1997
.
EMPLOYEE RECRUITMENT, SCREENING, AND ORIENTATION. Minimum
requirements: Bidder shall describe the initial and ongoing, personnel recruitment,
screening, and orientation program to be utilized by the Contractor throu~hout the term of
the proposed Agreement. Additional commitment off, tiny.: The Bidder ~nay. describe and
offer a more aggressive, more stringent, and generally superior program of initial and
ongoing personnel recruitment, screening, and orientation designed to attract, select, and
thoroughly orient, prior .to field placement, the industry's most qualified candidates for
EMS employment.
e
COMPENSATION AND BENEFITS. Minimum requirements: The Contractor's
starting compensation for field EMT's and Dispatchers, exclusive of benefits and overtime
in excess of regularly scheduled shifts, shall not be less than the current average starting
salary of EMT's of the existing ambulance provider in the service area. The B~'dder shall
describe wage and benefits program currently offered. Additional commitment offerins:
The Bidder may describe and offer a comprehensive program of wages and benefits which
exceed this RFP minimum requirements.
e
DESCRIPTION OF WORKING CONDITIONS PROMISED. Minimum
requirements: The Bidder shall describe and offer a reasonable program of shift
assignments, use of mandatory overtime, worker's rights, "posting" policies, promotion
policies, and other job factors which directly or indirectly affect job satisfaction,
performance, attitude on the job, and rates of employee retention. Additional commitment
offefine: Bidder may. describe and offer a superior program of working conditions, and
may incorporate a guaranteed maximum rate of annual turnover of field personnel.
.
COMMITMENT TO INTERNAL QUALITY ASSURANCE. Minimum requirements:
The Bidder shall describe and offer a sound program of on-going internal quality
assurance. Additional commitment offerin.o: The Bidder may describe and offer a superior
program of internal quality control.'
ge
KEY PERSONNEL COMMITMENT. Minimum requirements: The Bidder shall
submit with this section of its proposal the resumes of key personnel whose duties in the
Contractor's Orange County operations shall relate directly to the fulfillment of the
Contractor's obligations relative to clinical performance. If such key personnel are not
currently employed by the bidder, contingent employment contracts, not letters of intent or
general agreements to consider an offer of employment executed by both parties shall also
be furnished. Additional commitment offering: The Bidder may offer key personnel of
national reputation in the specific area of expertise to ;vhich this section is related.
Be
QUALITY OF EQUIPMENT AND MAINTENANCE PRACTICES: Minimum
reouirements: The Bidder must propose initial equipment, replacement equipment, and a program
of maintenance which meet' EMSA requirements. The Bidder shall describe, in detail and with
brand names, the major equipment items to be furnished, and the scheduled replacement policies
related to each class of equipment. Proposal .submissions shall address the folloMng areas of
special interest to the County or City and Fire Authority:
Orange County Fire Authority 27 1/9/98
DRAFT RFP for Emergency bled 'ransportation and Related Services,. D~, ler 1997
Co
le
e
.
.
.
QUANTITY AND DESCRIPTION OF VEHICLES PROPOSED. State the minimum
number of vehicles to be initially furnished under the proposed Agreement, the type,
specifications, and manufacturer, and such other information as may assist the Proposal
Review Board in assessing the quality of vehicles proposed. ..
FLEET SIZE AND ST.~NDARDIZATION POLICIES. Describe the. policies
regarding fleet size and standardization to which the bidder would be committed if
awarded the proposed Agreement.
COMMITMENT TO DRIVER TRAINING. Describe the driver training program
which the bidder would employ if awarded the proposed Agreement.
COMMITMENT TO EQUIPMENT REPLACEMENT. Define the policies regarding
scheduled replacement and anticipated safe useful life expectancies of all types of
equipment to be furnished by the Contractor and employed in the performance of the
propo, sed A~eement.
COMMITMENT TO MAINTENANCE PRACTICES. Describe the overall program of
equipment maintenance to be employed by the bidder if awarded the proposed Agreement.
COMMITMENT TO RECORDKt;EPING PRACTICES. Describe the maintenance-
related recordkeeping system (manual or automated) to be employed by the bidder if
'awarded the proposed Agreement.
e
KEY PERSONNEL COMMITMENT. Minimum requirements: The bidder shall submit
with this section of its proposal the resumes of key personnel whoSe duties in the
Contractor's operations shall relate directly to fulfillment of the Contractor's obligations
relative to fulfillment of the bidder's equipment selection,, replacement and maintenance .
commitments. If such key personnel are 'not currently, employed by the bidder, contingent
employment contracts not letters of intent or general agreements to consider, an offer of
employment executed by both parties shall also be furnished. Additional commitment
offering: The bidder may offer key personnel of national reputation in the specific area of
expertise to which this section is related.
COMMITMENT TO FIRST RESPONDER PROGRAM: Minimum requirements: The bidder
shall detail its intentions regarding involvement in and support of the Fire 3/uthority's first
responder program. Provider shall commit to an automatic dispatching policy on all requests for
services. Additional commitment offering: The Bidder may describe' and offer a superior support
program which enhances overall patient care.
Orange County Fire Authority 28 1/9/98
DRAFT RFP for Emergency eai Transportation and Related Servic~ Cember 1997
me
F.
De
PLAN FOR TAKEOVER OF SERVICE RESPONSIBILITIES- Proposals submitted shall
meet or exceed the following requirements regarding takeover of services at start-up.
le
EQUIPSIENT AT START-UP: It may be difficult or impossible for the Contractor to
obtain, prior to start-up, a sufficient quantity of new equipment, if neede'd, to meet all
production requirements of the proposed Agreement. The bidder shall describe its plan and
·
schedule for acquiring new equipment as necessary, and for obtaining such supplemental
used equipment as may be needed until new equipment is delivered.
.
TREATMENT OF DISPLACED EMPLOYEES: The bidder shall describe the
'program and policie~ which will govern employment opportunities for employees of other
ambulance companies that may be displaced by a change of companies, if awarded the
proposed Agreement.
.
INITIAL AND ON-GOING MANAGEMENT TEAM. If the bidder anticipates initial
use of an implementation management team which is different in makeup fi.om the
permanent management team, the bidder shall describe the anticipated schedule of
personnel assignments associated with such implementation plan.
INITIAL COVERAGE PLAN. The bidder shall submit its initial coverage plan to be
employ'ed, including deployment plans, post locations, peak load staffing plans, etc.
RAPID START-UP CAPABILITY. The Bidder shall submit a description and discussion
of its capability to, if requested on short notice, rapidly institute emexZgency Services in the
service area.
COMMITMENT TO RESPONSE TIME PERFORMANCE: Minimmn requirements: The
bidder shall describe and offer a plan to meet minimum response time performance as specified in
Section 3. Additional commitment offering- The bidder may describe and offer a plan which
exceeds the minimum response time performance.
FISCAL STRENGTH OF ORGAdNIZATION: Minimum requirements: A financial statement
of the Contractor's financial status and immediate past two years must be provided. The bidder
must submit information in formats of generally accepted accounting practices, including balance
sheets, income statements, and statements of change in financial position. Audited financial
statements are preferred. In addition, a program budget must be submitted for each year with costs
broken down for major' programs and any items that may be the basis for service rate increase
negotiations during the life of the proposed Agreement.
Orange Countv Fire Authority 29 1/9/98
DRAFT RFP for Emergency Me Transportation and Related Ser-,'ices, 15 ber 1997
Ge
BILLING AND COLLECTION SERVICES: The bidder shall: 1) describe in detail its
proposed date for processing, .billing, collection, and accounts receivable management system
including time frames to accomplish specific tasks in the process, and 2).state the ALS and BLS
fee it intends to charge to recipients of these services. Minimum requirements: Itemized
statements shall list all procedures and supplies employed, whether billed separately or included in
base rate. System must be capable of responding to patient and third party payer inquiries
regarding submission of insurance claims, dates and types of payments made, itemized charges,
and other inquiries.
He
.AMBULANCE SERVICE AREA DESCRIPTIONS: Appendix I contains descriptions,
selected statistics, general maps and ~pecial requirementS, if any, for each ambulance service area
in which a proposal is requested. Service areas are listed in numerical sequence and proposals
submitted must follow this methodology. This is to include a description of proposer's design to
meet or exceed the special requirements, if any, for a designated area.
The statistical data contained within the area descriptions are based upon information available to
the Fire Authority at the time this document was prepared. The information presented is for the
convenience of the proposer and no representation is made as to the accuracy of these data or their
relevance to the projection of response volume or potential revenue for any given area.
Changes in area geographical designations may occur during the life of the proposed Agreement as
a result of area development. The County or City or Fire Authority shall reserve the right to
negotiate such changes as may be in the best interest of the general public.
Unincorporated service areas are subject to annexation or incorporation at any time. Continuance
of awarded agreements to any area affected by these ~ufisdictional changes will be subject to the
approval of the new governing authority.
Ie
EXCEPTION TAKEN TO BID REQUIREMENTS: Minimum requirements: The bidder shall
take no exceptions to the requirements specified herein. (As noted in Section 1, hereof, an
oppommity is made available for bidders to seek approval of suggested changes in these bid
requirements prior to submission of proposals. If such approval is denied prior to submission,
approval will also be denied after submission. If a change is desired but not requested prior to the
proposal submission deadline, such request shall be automatically denied if presented after that
deadline.)
Orange County Fire Authority 30 1/9/98
Appendix I
Ambulance Service Area Descriptions
and
Special Service Requirements
01/09/98 Appendix I Page 1
List of Ambulance Service Areas (ASA)
ASA
1. 5
2. 10
~. 13
4. 14
5. 17
6. 19
7. 21/36
8. 22
9. 23
10. 24
11' 2'6
12. 27
13.. 28/35
14. 29
15. 30
16. 31
17. 32
15. 33
19. 34
20.. 37
21. 38
22. 39
23. 40
24. 41
TITLE
City of Cypress
City of Irvine
City ofLa'Palma
City of Los Alamitos
City of Placentia
City of San Juan Capistrano
City of Seal Beach
City of Stanton
City of Tustin
City of Villa Park
City of Yorba Linda
Lemon/Cowan Heights/Silverado *
City of Laguna Hills/Leisure World
City of Lake Forest
City of Laguna Niguel
Midway City *
Sunset BeaCh *
Orange-Olive *
Santa Ana Heights/John Wayne Airport *
Rossmoor *
City of Mission Viejo
City of Dana Point
Ortega Highway *
Irvine Coast *
* Indicates unincorporated communities or areas of Orange County.
01/09/98 Appendix I Page 2
Current Special Serwice Requirements Listed By ASA
ASA # 5 - City of Cypress
None
ASA # 10 - City of lrvine
,o Contractor shall be a "Provider or Care" for Medi-Care and Medi-Cal, and shall, accept
payments from the Orange County Indigent Medical Services Program as full payment for
services rendered. Patients covered under any of these three programs may be billed directly
only for the deductible or the percentage of the allowable charge designated by Medi-Care,
Medi-Cal, or IMS. Patients covered under these programs who are billed by the Contractor
for the deductible portion of their bill shall be provided a form with the bill appraisal by the
City of Irvine, to be completed and returned by the patient if they are unable to pay the
deductible amount. Patients who sign and return an inability to pay form shall not be billed
for such deductible amount.
Contractor shall accept insurance payments as full payment for services rendered, provided
that payment is for at least the Medi-Care rates. Provider may bill patient with insurance
coverage for the difference between the insurance payment and the Medi-Care rate.
Contractor shall bill only three times for services rendered not covered by~ government
programs Or insurance. If the first bill is not paid, a second bill will be sent in 30 days,
together with a business letter informing the client that payment is due immediately to avoid
collection. At the third billing Contractor shall notify client by business letter that an unpaid
bill may be turned over to collections in 30 days from the date of the third billing if the client
takes no action. Included with the second and third bills will be a form from the City of
Irvine which the client may complete and return t6 the City if the client believes he is unable
to pay the bill due to financial hardship. Upon determination by the City that the client is
eligible for City assistance, City shall notify the Contractor and-Contractor shall cease
collection activity. The City shall reimburse the Contractor for'services rendered at the Medi-
Cal rates. Contractor shall accept the City payment as payment in full. Claims approved by
the City shall be paid to the Contractor quarterly. Any client who fails to respond to the
Contractor or to the City within 30 days of the third notice may be referred to a collection
agency, at the discretion of Contractor.
ASA # 13 - City of La Palma
None
ASA # 14 - City of Los Alamitos
None
ASA # 17 - City of Placentia
None
ASA # 19 - City of San Juan Capistrano
None
01/0 9/9 8
Appendix I Page 3
ASA # 21/36 - City of agal Beach
NOne
ASA # 22 - City of Stanton
The Contractor shall be responsible for all billings connected with services provided withi'fi the City in
the following manner:
· The City Pays ambulance transportation charges for City residents who comply with proper
procedure. In order to inform potential qualifying residents, it shall be the responsibility of
the Contractor to place in each billing a "billing notice". This."billing notice" shall be
provided to the Contractor by the City. Failure to place this notice in billings connected with -
services provided within the City will result in termination of the contract.
· It shall be the responsibility of the Contractor to have adequate "billing notices" on hand.
Contractor will give the City two (2) weeks notice when additional "billing notices" are
needed.
· It shall be the right of the City to make payments on behalf of City residents. These payments
will reflect an agreement between the residents and the City. Direct billings to the City for
services provided to City residents will be rejected.
o' From the first billing the Contractor shall allow 30 days for payment to be received. If after
30 days payment is not received a second billing may be sent. If after an additional 30 days
payment is not made, it shall be the fight of the Contractor to use collection procedures to
recover payment. Prior to collection procedures being used, notice will be given to affected
persons allowing reasonable time for payment.
ASA # 23 - City of TuStin
None
ASA # 24 - City of Villa Park
None
ASA # 26 - City of Yorba Linda
None
ASA # 27 - Lemon/Cowan Heights/Silverado *
None
ASA # 28/35 - City of Laguna Hills/Leisure World
None
ASA # 29 - City of Lake Forest
None
ASA # 30 -City ofLaguna Niguel
None
01/09/98 Appendix I Page 4
ASA # 31 - Midway City *
None
ASA # 32 - Sunset Beach *
None
ASA # 33 - Orange-Olive *
None
ASA # 34 - Santa Ana Heights/John Way. ne Airport *
None
ASA # 37 - Rossmoor *
None
ASA # 38 - City of Mission Viejo
· The City requires that the Contractor station an ambulance within the city limits for the
purposes of emergency response within the city and those response areas immediately
adjacent to the city.
· The City requires that the Contractor install vehicle position location equipment for the
purpose of determining the percentage of time the Contractor met the conditions as set forth
in Provision #1 above. The Contractor shall provide quarterly reports to the City detailing
what percentage of time an ambulance was located within the city limits.
· The City requires that the emergency (Code 3) response time requirement for Metro/Urban
areas as shown on page 9 of the basic RFP be amended as follows: Contractor shall respond
to not less than 90 percent of emergency requests (Code 3) in designated Metro/Urban areas
within 9 minutes.
The City requires that the reporting of responses requirement for Metro/Urban areas as shown
on page 10, item # 7 be amended as follows: Percent of Code 3 calls responded to within 9
minutes in a metro area.
ASA # 39 - City of Dana Point
None
AsA # 40 - Ortega Highway *
None
ASA # 41 - Irvine Coast *
None
01/09/98 Appendix I Page -5
Appendix II
Sample Agreement
For
Provision Of
Emergency Medical Transportation And Related Services
01/09/98
Appendix II Page 1
AGREEMENT
FOR
PROVISION OF
EMERGENCY MEDICAL TRANSPORTATION AND RELATED SERVICES
BETWEEN
CITY OF ., THE COUNTY OF ORANGE
OR THE ORANGE COUNTY FIRE AUTHORITY
AND
THIS AGREEMENT is entered into which date is enumerated for purposes
of reference only, by and between County or City or Fire Authority~ and , a
California Corporation, hereinafter referred to as Contractor. This Agreement shall be administered by
the Director of Fire Services for the Fire Authority.
WITNESSETH:
WHEREAS, County or City or Fire Authority desires to assure the availability of prompt
emergency medical transportation and related services within the City (or County) of ;
and
WHEREAS, Contractor desires to provide such services upon the terms and conditions set forth in
the A~greement;
NOW, THEREFORE, IT IS MUTUALLY AGREED AS FOLLOWS:
As referenced hereinafter, under this Agreement, the County, the City or the Fire Authority may be
the contracting authority for this Agreement. As used herein, the phrase "County or City and Fire
Authority" means that the contracting authority and the Fire Authority both have discretionary
authority over the specific obligation or matter addressed. The phrase "County or City or Fire
Authority" means that the provision applies to the specified contracting authority under this
Agreement.
01/09/98 Appendix II Page 2
CONTENTS
Paragraph
.2.
o
.
o
Page
Definitions ...................................................................................................................... ....... 4
Authority .................................................................. : .......................................................... 5
Designation ......................................................................................................................... 5
Ser~4ces ............................................................................................................................... 5
Disaster Assistance .............................................................................................................. 6
o
¸7.
Rates for Emergency' Ambulance Service ........................................................................... 6
Alteration of Terms ....................... : .............................................
o
o
10.
Delegation of Assignment ........................................................... 7
Indemnification and Insurance ............................................................................................ 7
License and Law ................................................................................................................. 8
11.
12.
Audits and Inspections ........................................................................................................ 9
Nondiscrimination ......................................................... 7 ...................................................... 9
13. Notices... . ................................................................................ 9
14.
15.
Status of Contractor ........................................................................................................... 10
Term of Contract and Renewal Provisions ......................................... : ............................. 10
16. Termination ....................................................................................................................... 11
17. Waiver of Default .............................................................................................................. 12
Exhibits
me
Request for Proposal for Basic Life Support Emergency Ambulance Service
B. Proposal in Response to the RFP
01/0 9/9 8
Appendix II Page 3
1. DEFINITIONS
The following terms and definitions shall be used in this Agreement:
Ao
Bo
Co
D.
Eo
Emergency Communications Center means the Office of the Orange County Fire
Authority, responsible for authorizing Emergency Medical Transportation Services
provided pursuant to this Agreement.
F.
Advanced attd Basic Life Support means those services set forth in Section 1797.52 and
1797.59 of the California Health and Safety Code, as now in existence or hereafter
amended or changed.
O.
Ambulance Service Area, hereinafter referred to as ASA, means a geographical region
specified by the Director of Fire Services, within which Emergency Medical
Transportation Services shall be provided pursuant to this Agreement. The following are
types of ASA's.
1)
Metro/Urban ASA - A region with a population density of 100-9.99 persons per
square mile.
2)
Rural ASA - Canyon areas of the local mountain ranges, specifically Brea, Tonner,
Carbon, Modjeska, Silverado and Trabuco Canyons; Santiago Canyon Road
between Orange County Fire Station 15 and Live Oak Canyon Road; Ortega
Highway between La Plata Avenue and the Cleveland National Forest.
3) Remote ASA - Regions of the Cleveland National Forest which are within the
County of Orange.
.
Dry Run means a response by Contractor to a request for Emergency Medical
Transportation Services by the Emergency Dispatch Center, after which such Emergency
Medical Transportation Services are determined to be unnecessary.
Primary ReSPonder means the ambulance company which shall be requested first by the
Emergency Communications Center to provide Emergency Medical Transportation
Services in a designated ASA.
Response Time means the actual elapsed time in minutes from the moment the information
from the Fire Authority Emergency Communications Center is transferred to and received
by the Contractor's Ambulance Dispatch Center, to the moment Contractor's first Basic
Life Support Unit arrives at the scene of the incident.
Code 3 means the use of red warning lamps and siren as permitted by Vehicle Code
Section 21055 if the vehicle is being driven in response to an emergency call.
01/09/98 Appendix II Page 4
2. AUTHORITY
e
The Request for Proposal for Emergency Medical Transportation and Related Services (RFP) is
attached hereto as Exhibit A. The Proposal in response to the RFP (Proposal) is attached hereto as'
Exhibit B. All provisions of the RFP and the Contractor's Proposal shall be binding on the parties
except that where the RFP and Contractor's Proposal conflict with this Agreement, this,Agreement
shall prevail.
DESIGNATION
io
In consideration of the services Contractor agrees to provide pursuant to this Agreement,
. County or City or Fire Authority designates contractor, as Primary Responder in the
following specific ASA(s). The geographical boundaries of these ASA's are set forth in
Appendix I of the RFP. County or City or Fire Authority may suspend or terminate such
designation for failure to maintain compliance with, or for violation of, any provisions of
this Agreement, and any applicable laws, rules, or regulations 'of any governmental entity.
ASA Number
B,
County or CiD' or Fire Authority assumes no financial liability for the cost'of services to be
provic(ed to patients pursuant to this Agreement, including financial liability for the costs
of Dry Runs.
SERVICES
Contractor agrees to perform emergency medical transport and related services as specified in the
RFP (Exhibit A) and Proposal (Exhibit B). It is the responsibility of the Contractor to provide and
manage the actual delivery of all emergency ambulanc6 and related services. Clinical performance
must be consistent x;Sth standards established by the EMSA. Response time performance must
meet or exceed the standards set forth in Section 4 of the RFP.
01/09/98 Appendix II Page 5
5. DISASTER ASSIS ,'CE
During a declared disaster, locally or in a neighboring jurisdiction, the normal course of business
under this Agreement shall be interrupted from the moment the disaster situation is made known to
the Contractor by the Fire Authority. Immediately upon such notification, the Contractor shall
commit such resources as are necessary and appropriate, given the nature of the disaster, and shall
assist in accordance with disaster plans and protocols applicable in the locality whei& the disaster
has occurred. The disaster-related provisions of this Agreement are:
mo
During such periods, the Contractor shall be released from response time performance
requirements until notified by the Fire Authority's authorized representative that disaster
assistance may be terminated. At the scene of such disasters, the Contractor's personnel
shall perform in accordance with local disaster protocols established by that community.
g.
When disaster assistance has been terminated, the Contractor shall resume normal
operations as rapidly as is practical considering exhaustion of personnel, need for
restocking, and other relevant considerations.
C.
..
During the course of the disaster, the Contractor shall use its best efforts to provide local
emergency coverage and shall suspend non-emergency transport work as necessary,
informing persons requesting such non-emergency service of the reason for the 'temporary
suspension.
RATES FOR EMERGENCY AMBULANCE SERVICE
me
BLS Service Rates: Orange County Board of Supervisors Resolution No. 87-858
establishes maximum BLS Service Rates which may be charged by the Contractor for
ambulance services to their customers. The 'Contractor may not charge more than the
prevailing County approved maximum BLS Service Rates as set 'forth in Section 8 of the
RFP.
Bo
ALS Service Rates: For those calls during which ALS services are provided, the
Contractor shall be responsible for implemen, ting and collecting an ALS Service Charge
not to exceed $185 per ALS call as authorized by the County or' City and Fire Authority.
The implementation, collection and disbursement of these funds shall be in accordance
with Section 8 of the RFP.
Ce
Contractor a~ees to defend, indemnify and hold harmless County or City and Fire
Author/v:,, its officers, agents, and employees from all liability, claims, losses and
demands, including defense costs, whether resulting from court action or otherwise, arising
from any and all challenges to the service rates established herein. A challenge to service
rates includes, but is not limited to, both. procedural and substantive challenges to the
adequacy of, or authority to impose, either the BLS or ALS service rates set forth herein.
01/09/98 'Appendix II Page 6
.
.
ALTERATION OF Tx__,VIS
This Agreement, together with any Exhibit(s) attached hereto, which are incorporated herein by
reference, fully expresses all understandings of County or City or Fire Authority and Contractor
with respect to the subject matter of this Agreement and shall constitute the total Agreement
between the parties for these purposes. No addition to, or alteration of, the' terms of this
Agreement or any Exhibit(s) thereto, whether written or verbal, shall be valid unl'ess made in
writing and formally approved and executed by both parties.
DELEGATION AND ASSIGNMENT
Contractor may not delegate or assign the rights or obligations hereunder, either in whole or in
part, without prior written consent of the County or City and Fire Authority. Any attempted
assignment or delegation in derogation of this paragraph shall be void. A transfer by any
shareholder of greater than ten percent (10%) of the Stock currently issued by Contractor, or a sale
or transfer of over twenty-five percent (25%) of the assets of Contractor, will be deemed an
assignment.
INDEMNIFICATION AND INSURANCE
me
Contractor agrees to defend, indemnify and hold harmless the County or City and Fire
Authority, its officers, agents, and employees, from all liability, claims, losses and
demands, including defense costs, whether resulting from court action or otherWise, arising
out of the acts or omissions of Contractor, its officers, agents, or employees, or the
condition of property used in the performance of the A~eement, excepting acts or
omissions directed by the County or City and Fire'Authority, its officers, agents, or
employees, acting within the scope Of their employment for which County or City and Fire
Authority agrees to defend and indemnify the Contractor in a like manner.
Bo
Prior to the' time the Contractor is entitled to commence any part of the project, work or
services under this Agreement, the Contractor shall procure, pay for, and maintain at least
the insurance coverages and limits specified below. Said insurance shall be evidenced by
delivery to the Fire Authority of a certificate of insurance executed by the insurers listing
coverages and limits, expiration dates and terms of policies and all endorsements, whether
or not required by the County or City or Fire Authority and all carriers issuing said
policies; and a certified copy of each policy, including all endorsements.
The following insurance requirements shall remain in effect throughout the term of this
Agreement. Failure to maintain the insurance requirements 'as specified herein shall
constitute a breach of contract.
1) Workers' Compensation limits as required by law.
2)
Comprehensive automobile liability policy shall, be in the sum of not less than $1
million for combined single limit, bodily injury and property damage.
01/09/98 Appendix II Page 7 .
Professional liability insurance shall be in the sum of not less than $1 million per
occurrence and $2 million annual aggregate.
4)
General liability insurance shall be in the sum of not less than $1 million per
occurrence, bodily injury and property damage and $2 million annual aggregate.
Co
All insurance policies except Workers' Compensation and Employer's Liability and
Professional Liability shall contain the following clauses:
1)
The County or City and Fire Authority are added as an additional insured as
respects operations of the named insured performed under contract with the County
or City or Fire Authority.
2)
It is agreed that any insurance maintained by the-County or City and Fire Authority
shall apply in excess of and not contribute with, insurance provided by this policy.
3)
This insurance shall not be cancelled, limited or allowed to lapse until 30 days
written notice has been given the County or City or Fire Authority.
10. LICENSE AND LAW
Contractor shall, throughout the term of this Agreement, maintain all necessary licenses, permits,
approvals, waivers and exemptions necessary for the provision of the services hereunder and
required by the laws and .regulations of the United States, the State of California, the City of
and all 6ther governmental agencies. Contractor shall notify Fire Authority
immediately and in writing of its inability' to obtain or maintain such permits, licenses, approvals,
waiver and exemptions. The refusal of any such appIication, irrespective of appeal, shall reqUire
written notification of Fire Authority.
01/09/98 Appendix II Page 8
11. AUDITS AND INSPE~_,ONS
12.
13.
At any time during normal business hours, and as often as may reasonably be deemed necessary.,
the Fire Authority's representatives may observe the Contractor's operations and the Contractor
shall 'make available to the Fire Authority for its examination, its records with respect to all
matters covered bv this Agreement, and the Fire Authority may audit, examine, copy, and make
excerpts or transcripts from such records, records of personnel, daily logs, conditions of
employment, and. other data related to all matters covered by this. Agreement. Fire Authority
representatives may, at any time and without notification, directly observe the Contractor's
operation of the ambulance dispatch center, maintenance facility, or any ambulance post location,
and a Fire Authority representative may ride as "observer'' on any of the Contractor's ambulance
units at any time, provided, however, that in exercising this right to inspection and observation, the
Fire Authority -representatives shall conduct themselves in a professianal and courteous manner,
shall not interfere in any way with the Contractor's employees in the performance of their duties,
and shall at all times be respectful of the Contractor's employer-employee relationships.
The Fire Authority's right to observe and inspect operations or records in the Contractor's business
office shall be restricted to normal business hours and reasonable notification shall be given the
Contractor in advance of any such visit.
NONDISCRIMINATION
Contractor shall not discriminate in the provision of services, employment practices, or in the
allocation of benefits on the basis of color, race, religion, national origin, sex, age, physical or
mental handicap in accordance with Title VI and VII of the Civil Rights Act of 1964, 42 U.S.C.
Section 2000d, rules and regulations promulgated pursuant thereto, and under the laws of the State
of California as each law, rule or regulation may now exist or hereafter be amended.
NOTICES
m.
Al! notices, correspondence, reports, and/or statements authorized or required by this
Agreement shall be addressed as follows:
COUNTY OR CITY
OR FIRE AUTHORITY:
CONTRACTOR:
01/09/98 Appendix II Page 9
14.
Bo
Unless other .... e specified herein, and then only-~o the extent inconsistent with this
subparagraph, all notices shall be written, and deemed effective when deposited in the
United States Mail. First Class postage prepaid, and addressed to the parties as indicated in
A. above. Any notices, correspOndence, reports and/or statements authorized or required
by this Agreement addressed in any other fashion than as specified in this paragraph shall
not be valid.
·
·
STATUS OF CONTRACTOR
15.
Contractor is, and shall at all times be deemed to be, an independent contractor and shall be wholly
responsible for the manner in which it performs the services 'required of it by the terms of this
Agreement. Nothing herein contained shall be construed as creating the relationship of employer
and em31oyee, or principal and agent, between the County or City and Fire Authority and
Contractor or any of Contractor's agents or employees. Contractor assumes exclusively the
responsibility for the acts of its employees as they relate to the services to be provided during the
course and scope of their employment. Contractor, its agents and employees, shall not be entitled
to any rights and privileges of County or City and Fire Authority employees and shall not be
considered in any manner to be County or City and Fire Authority employees.
Contractor agrees to defend, indemnify and hold harmless County or City and Fire Authority, its
officers, agents, and employees from all liability, claims, losses and demands, including defense
costs, whether resulting from court action or otherwise, arising from a claim of agency between
Contractor and County or City and Fire Authority,
TERM OF CONTRACT AND RENEWAL PROVISIONS
The following provisions shall govern the term of this Agreement and process of renewal:
.A.
Agreement Start Date. This Agreement shall commence at 12:01 .a.m., at
which time the Contractor shall assume full responsibility .for the provision of all
emergency medical transportation and related ambulance services throughout the
designated service area.
Bo
Term of Contract. The term of this Agreement shall be three (3) years and shall
automatically terminate at midnight , unless this Agreement is extended
pursuant to the conditions described in Section C below.
C.
Contract Extension. Prior to the end. this Agreement, the Contractor may be granted a
single extension of 1 to 3 years upon the following conditions:
1)
The Contractor provides written notice to the County or City and Fire Authority, no
sooner than 9 months and no later than 6 months prior to the expiration of this
Agreement of its desire to obtain an extension. The notice should include the
number of years extension that the Contractor is requesting.
01/09/98 Appendix II Page 10
2) The Contra provides v~ritten verification that it ,'ices rendered to date have been
consistently above the requirements as set forth"in the RFP, the Proposal and this
Agreement.
Provided these conditions are met, the Fire Authority staff will prepare: 1) a review of
performance, 2) an impact analysis of granting the extension, and 3) a recommendation for
action. The County or City or Fire Authority will review the extension request and staff
recommendations and make a determination whether to grant an extension and what the
term of that extension shall be. The decision whether to grant the extension and for what
term shall be at the sole discretion of the County or City or Fire Authority and shall be
final.
16.
TERMINATION
me
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Either party may terminate this Agreement upon providing the other party with one-
hundred eighty (180) days written notice.
This Agreement shall terminate and the duties of the parties hereto cease immediately, at
the option of County or City or Fire Authority, should Contractor fail to perform the
covenants contained in this Agreement in the time and manner specified. The reasons for
termination include, but are not limited to, the following:
1)
The provisions set forth in Section 7 of the RFP;
2)'
3)
The lapse of any license, permit, or approval issued Contractor necessary to the
services provided within this Agreement by any Federal, State, or local'
government;
Unethical conduct or malpractice by Contractor as determined either by a court of
competent jurisdiction or by such review processes as are, or may be, established
by County or City and Fire Authority;
4)
The breach by Contractor of any provision of this Agreement or any covenant
contained herein;
5) The loss by Contractor of legal capacity to contract.
01/09/95 Appendix II Page 11
C.
Any legal action to challenge a termination for breach shall be initiated by the Contractor
only after the emergency takeover has been completed, and shall not under any
circumstances be allowed to delay the process of takeover by the Fire Authority. The
Contractor's cooperation with, and full support of, such emergency takeover process shall
not be construed as acceptance by the Contractor of the finding of a material breach, and
shall not in any way jeopardize the Contractor's right to recovery should ~ court later
determine that the termination of this Agreement was made in error. However, failure on -
the part of the Contractor to cooperate fully with the Fire Authority to effect a safe and
orderly takeover of operations shall itself constitute a mater/al breach of this Agreement,
even if it is later determined that the original termination based on a material breach was
made in error. Contractor specifically waives any right to seek declaratory or equitable
relief, including a restraining order or injunction against termination or an emergency
takeover.
Do
Notice of termination shall be given in the manner set out in the Notices paragraph of this
Agreement.
17. WAIVER OF DEFAULT
Waiver of any default shall not be deemed a waiver of any subsequent default. Waiver of a breach
of any provision of this Agreement shall not be deemed to be a waiver of any other or subsequent
breach, and shall not be construed to be a modification of the terms of this Agreement unless
stated to be such, in writing, by County or City or Fire Authority and attached to the original
Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement in the County of Orange,
Califomia. -
01/09/98
Appendix II Page 12
RFP SUMMARY OF CIE
__
'~ES AND PARAMEDIC REEVII
3EMENT COST ANALYSIS
PARAMEDIC PROGRAM MARGINAL COSTS
The marginal costs of the paramedic program have been determined to be those costs that would be
eliminated if the Orange County Fire Authority no longer provided paramedic service.. In the early
seventies, when the paramedic program was implemented, the personnel utilized were obtained by reducing
the number of personnel on fire apparatus. The intent at the time was to implement the program with
minimal costs and to train the paramedics as both firefighters and paramedics, therefore capable of
responding to both fires and medical aid requests within their area.
Paramedic marginal costs include the following major categories:
· Salaries & Employee Benefits
· .Services & Supplies
· Vehicle Costs
· Equipment Costs
· Off-setting Costs
Salaries and Employee Benefits
Salaries and benefits encompass the majority of the marginal costs of the paramedic program. This
component includes the salaries for the three administrative staff of the Emergency Medical Services
Section, benefits for the staff, and paramedic bonus pay for personnel assigned to paramedic positions.
Service and Supplies
Service and supplies incorporates all contracts, paramedic training recertification costs, and medical
supplies required to place paramedic assessment units in s[rvice. For the purposes of marginal cost
calculations, the paramedic supply cost of $450,000 has not been added, as these costs are recovered
through our current supply reimbursement program.
Vehicle Costs
Vehicle costs reflect the cost of operating the paramedic vans. These costs include maintenance, fuel and
depreciation of the 10 paramedic vans.
Equipment Costs
Equipment costs reflect the depreciated value of paramedic assets such as cardiac monitors/defibrillators,
radios and other miscellaneous equipment.
Non-Paramedic EMS Administrative Costs (Offsetting Costs)
Non-paramedic EMS administrative costs are those costs in the Emergency Medical Section that would
still be necessary even if the paramedic program were eliminated; Emergency Medical Technician 0EMT)
recertification is an example. These existing and on-going costs are deducted from the total mar~nal costs.
Orange County Fire Authority 2 12/31/97
RFP SUM3IARY OF ~
AND PARAMEDIC RE- I3IBUI/
PARAMEDIC PROGRAM MARGINAL COST SUMMARY
SALARIES AND EMPLO~E BENEFITS:
Salaries
Employee Benefits
Additional Pay
176,943
45,634
1,254,810
1,477,387
SERVICE AND SUPPLIES:
159,648
VEHICLE COSTS:
156,647
EQUIPMENT COSTS:
· Gross marginal Cost
Offsetting Cost
Net Marginal Cost of Paramedic Program
25,790
1,819,473
.(51,207)
$1,768,266
~,{ENT COST ANALYSIS
_
12/31/97
Orange County Fire Authority' 3
RFP SUMMARY OF Ctt~ ES AND PARAMEDIC REIMB!
EMENT COST ANALYSIS
Marshal Cost per Paramedic
As stated in our assumptions, the cost of the paramedic supplies was eliminated from the marginal costs
since the Fire Authority is currently reimbursed for these supplies. Marginal costs are further reduced by
the fact that the recent contracts (San Clemente, Buena Park, and Westminster) included the full cost of
paramedics within these cities. In order to subtract the portion of the marginal costs paid by these recent
contracts, it is necessary to determine a cost per paramedic and subtract the cost per paramedic times the
number of paramedics in each city from the marginal costs.
$1,768,226
225 (OCFA Paramedics) = $7,858.78 (Cost per paramedic)
San Clemente
Station 50/Paramedic Assessment Engine (3 paramedics)
Station 59 /Paramedic Assessment Truck (3 paramedics)
Station 60/Paramedic Engine (6 paramedics)
'Buena Park
Station 61/Paramedic Engine (6 paramedics)
Station 62/Paramedic Engine (6 paramedics)
Station 63/Paramedic Assessment Engine (3 paramedics)
Westminster
Station' 64/Paramedic Engine (6 paramedics)
Station 65/Paramedic Engine (6 paramedics)
Station 66/Paramedic Engine (6 paramedics)
$23,576.34
23,576.34
47,152.68
$94,305.36
$47,152.68
47,152.68
23,576.34
$117,881.'70
$47,152.68
47,152.68
47,152.68
$141,458.04
Cities Total
Total Marginal Costs All Jurisdictions
Marginal Costs Already Funded (from 3 cities above)
Remaining Paramedic Program Costs
$353,645.10
1,768,226
353,645
$1,414,581
Orange County Fire Authority 4 12/31/97
RFP SUMMARY OF CItAI
AND PARAMEDIC RE~IBU~ MENT COST ANALYSIS
Paramedic Cost/Trans_oo_n
To determine the cost per patient transport, the marginal costs are divided by,the number of paramedic-
level transports. Fire Authority paramedics provided advanced life support care and accomp..anied patients
during 13,678 transports1. The cost per transport is based upon. a single year as the number of ALS calls
vary. This cost per transport should be periodically reviewed and/or audited in order, to ensure that
revenues do not exceed the actual costs of providing the services.
1,414,581
13,678 = $103.42 (unfunded cost per paramedic transport)
1The transports within the cities of San Clemente,
ALS transports.
Buena Park and Westminster were subtracted from the
Ambulance Administrative Fee
As MediCare and MediCal will only reimburse the transporting agency} the ambulance companies must
administer the billing of the unfunded cost of paramedic transport. Using the paramedic supply
reimbursement as a template, the ambulance companies will receive 7 percent from the amount collected.
Therefore, if the Fire Auth°rity's desired amount of reimbursement 'as illustrated below is approximately
$103.42, the ambulance companies will collect $7.23 to administer the billing, bringing the billing amount
to $ 110.65 for each paramedic transport. The percent figure is consistent with costs identified from a
brief survey of surrounding jurisdictions and private billing company experience.
Uncollectible Reimbursements
The ambulance industry currently is only able to collect on 60 percent of their billables. Therefore, the
industry writes off or considers 40 percent of the amount billed as uncollectible. The 40 percent
uncollectible figure used for this proposal was received from the Ambulance Association of Orange County
and based upon a published analysis of specific geographical areas throughout the nation.
Reimbursement Calculation
If the ambulance companies need to collect $110.65 to be able reimburse the Fire Authority approximately
103.42 and collect 7.23 for administrative costs, with 40 percent uncollectables, it will be necessary to bill
each paramedic transport patient approximately $184.41.
Amount Billed $184.41
Percent Collectable .60..
Amount Collected $110.65
Amount Collected
Ambulance Admin. Fee 7%
Paramedic Reimbursement $
$110.65
7.23
103.42
Total Projected Revenue: $1,414,581 .
12/31/97
Orange County Fire Authority 5
RFP SU~~RY OF CltP
·
ES AND PARAMEDIC REI3~B~
'EMENT COST ANALYSIS
AMBULANCE SERVICE AREAS
During previous Board discussion, staff had discussed the feasibility of consolidating Ambulance Service
Areas (ASA's) from the current 27 to 8, in order to align with battalion boundaries, prqvide ease of
contract administration, and allow more efficient deployment of ambulance resources. In response to the
action of the Board of Directors on AugUst 28, 1997, the RFP has been developed with the 27 ASA's
remaining intact in order to align with political boundaries and allow each local jurisdiction to select their
respective service provider.
AMBULANCE SERVICE CONTRACT TERM
Included in the Board action of August 28, 1997 was to follow staff recommendation and establish the
ambulance service contract term at 3 years with a 1 - 3 year variable extension which would require Board
of Directors action to enact.
AMBULANCE SERVICE CONTRACT CONSISTENCY
One of the benefits of the OCFA regional delivery system is in the ability to effectively manage a large
number of emergency resources in an efficient manner based upon standards 'of service delivery and
consolidated staff resources. In order to maintain these efficiencies, it is important tO recognize that
management of the ambulance service contracts for all OCFA jurisdictions and oversight of performance
compliance can be best handled only if there is consistency in the contract content in areas that include
contract term and performance standards.
APPROVAL AND IMPLEMENTATION PROCESS
Article I, Section 4(n) of the Joint Powers Agreement requirffs that each member affected shall approve
rates for paramedic and ambulance services. Accordingly, each City and the County must adopt its own
ordinance setting the maximum rate for such services. The attached table outlines the overall approval and
implementation process for this project.
Orange County Fire Authority 6 12/31/97
RFP SUMMARY OF CItAN
"AND PARAMEDIC REI~IBUR'
'ENT COST ANALYSIS
_
APPROVAL PROCESS
- Sequence "Group/Person Action Necessary
Order -.
1) Fire Executive Management Determination of operational service
parameters cost methodology and
performance criteria.
2) OCFA St~ff Revise current RH'.
- 3) OCtA Staff Public hearing for ambulance industry and
general public to provide input to RFP
changes.
4) City Managers EMS Advisory Review and comment summary of changes
Committee performance criteria cost methodology and
selection process.
5) City Managers Technical Advisory Review and comment summary of changes
Committee 0YAC) performance criteria cost methodology and
selection process.
6) OCFA BoD ReView and comment summary of changes
performance' criteria cost methodology and
selection process.
7) OCFACounsel Review full RI~I' for compliance with
procurement practices and current State
County and Municipal EMS statutes. _
8) Orange County Emergency Medical Informal review of full RFP preliminary
Services Agency agreement to specifics of performance
criteria cost component and selection
process.
9) Each OCFA City Council (except Approval_ of fees recommended by JPA
Westminster San Clemente Buena BoD.
Park) and County Board of
Supervisors
10) Orange County Emergency Medical Formal review and approval of full RI~t' and
Services Agency process. Following this approval forward to
State for review and approval.
· 11) State of California Emergency Formal review and approval of selection
Medical Services Authority process
12) OCFA Staff Issue
13) OCFA Staff Assemble review panel re-evaluate and rate
RFP responses. Present rated list of
proposers to individual cities and county.
14) Each OCFA City Council (except Review rated list of proposers select one
Westminster San Clemente Buena and enter into a service contract.
Park) and County Board of
Supervisors .
15 OCFA Staff Monitor contract erfo,alance.
12/31/97
Orange County Fire Authority 7
. .
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. ~ ~ .... ~-.-...-~-_. -' . . ...~-~-.~ ~'~. -. ~'. - ~:?. ·
. . ....
Propose , Amendments to Ambulah c Ordinances
The Orange County Fire Authority's General Counsel has recommended the following language
be added to existing County or City Ambulance related ordinances.
· Following the last sentence of the ordinance section corresponding to County Ordinance
//3 517 Section 4-9-12. "Rates" add the following:
"No licensee shall charge more for Advanced Life Support than those rates approved
by the Orange County Fire Authority or the Board of Supervisors."
· An important nonsubstantive change to the ordinance section corresponding to County
Ordinance//3 517 Section 4-9-2(m) is to define "Fire Chief' to mean:
"the Fire Chief of the Orange County Fire Authority."
Orange County Fire Authority 12/31/97
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RESOLUTION NO. 98-11
A RESOLUTION OF TEE CITY COUNCIL OF
THE CITY OF TUSTIN, DESIGNATING THE
ORANGE COUNTY FIRE AUTHORITY AS THE:
1) APPROPRIATE GOVERNMENTAL BODY TO
SELECT A QUALIFIED BIDDER UNDER THE
REQUEST FOR PROPOSAL FOR E~fERGENCY
TRANSPORTATION AND RELATED SERVICES
AND; 2) THE CONTRACTING AUTHORITY
UNDER THE AGREEMENT FOR EMERGENCY
MEDICAL TRANSPORTATION AND RELATED
SERVICES
W~EREAS, the City of Tustin has enacted Ordinance .No. 955
regulating the operation of ambulances within the City with the
intent to establish general operating procedures and 'standards for
· ambulance services to be provided within the City and to provide a
fair and impartial means of allowing responsible private ambulance
operators to provide such services as the public interest requires;
and
W~EREAS, the City of Tustin has adopted a Request for Proposal
for Emergency Medical Transportation and Related Services ("RFP"),
which provides that the Orange County Fire Authority ("Authority")
may be designated as the governmental body to select a qualified
bidder to serve the City; and
W~EREAS, the City of Tustin has also adopted the form of an
Agreement for Provision of Emergency Medical Transportation and
Related Services ("Proposed Agreement"), which provides that the
Authority may be the contracting authority for services in the City;
and
W~EREAS, Government Code Section 54980 characterizes ambulance
services as "municipal services and functions"; and
WHEREAS, Government Code Section 54981 provides that the
legislative body of a local agency may contract w~th any other local
agency for performance of municipal services or functions within the
territory of the former; and
WHEREAS, the City of Tustin has enacted Ordinance No. 955, and
adopted the RFP and Proposed Agreement in accordance with the-Orange
Caunty Emergency Medical Services Plan and the' Emergency Medical
Services System and the Prehospital Emergency Medical Act, Health and
Safety Code Section 1797, et seq.
NOW, THEREFORE, BE IT RESOLVED that the City Council:
SECTION 1- Designates the Authority as the appropriate
governmental body under the RFP and the contracting authority under
the Proposed Agreement.
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SECTION 2: Authorizes the Authority to award, execute,
implement and administer the RFP and Proposed Agreement pursuant to
the terms set forsh therein.
PASSED AND ADOPTED at a regular meeting of the City.Council of
the City of Tustin on the 17th day of February, 1998.
JEFFERY M. THOMAS, MAYOR
ATTEST:
PAMELA STOKER
CITY CLERK
1100-01
58403_1
1 ORDINANCE NO. 1195
AN ORDINANCE OF THE CITY OF TUSTIN,
CALIFORNIA, AMENDING SECTIONS 3421.5
3 AND 3426.2 OF ARTICLE 3, CHAPTER 4, PART '.
2 OF THE TUSTIN MUNICIPAL CODE
REGARDING THE · REGULATION AND
OPERATION OF AMBULANCES WITHIN THE
CITY
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THE CITY COUNCIL OF THE CITY OF TUSTIN, CALIFORNIA, HEREBY ORDAINS
AS FOLLOWS'
SECTION 1. Section 3421.5 of the Tustin Municipal Code is hereby amended by
adding a new definition of "Fire Chief" to read as follows:
"Fire Chief" means the Fire Chief of the Orange County Fire
Authority.
SECTION 2. Section 3426.2 of the Tustin Municipal Code is hereby amended by
adding a second sentence to read as follows:
"No licensee shall charge more for Advanced Life SuPport than
those rates approved by the City or the Board of Supervisors."
SECTION 3. If any section, subsection, subdivision, sentence, clause, phrase, or
14 portion of this Ordinance is, for any reason, held to be invalid or unconstitutional by the
decision of any court of competent jurisdiction, such decision shall not affect the validity of
15 the remaining portions of this Ordinance. The City Council hereby declares that it would
have adopted this Ordinance and each section, subsection, subdivision, sentence, clause,
16 phrase, Or portion thereof, irrespective of the fact that any one or more sections, subsection,
subdivision, sentence, clause, phrase, or portions thereof be declared invalid or
17 unconstitutional.
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PASSED AND ADOPTED at a regular meeting of the City Council of the City of Tustin held
on the~ day of ,1998.
JEFFERY THOMAS
Mayor
PAMELA STOKER
City Clerk
1100-01
584OO_1