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HomeMy WebLinkAbout13 AMBULANCE CONTRACT 07-06-04 AGENDA REPORT Agenda Item 13 Reviewed: !Bi City Manager Finance Director N/A MEETING DATE: JULY 6, 2004 FROM: SUBJECT: HONORABLE MAYOR AND MEMBERS OF CITY COUNCIL WilLIAM A. HUSTON, CITY MANAGER~ AMBULANCE CONTRACT TO: RECOMMENDATION Pleasure of the City Council. BACKGROUND Per the attached report dated June 24, 2004 from Orange County Fire Authority (OCFA) Chief Chip Prather, OCFA has completed its review of proposals to provide ambulance service in Tustin. As indicated .in the Chief's report, the request for proposal process was based on the requirements of state law and policy direction provided by the OCFA Board of Directors. The Tustin City Council decided earlier this year to select the ambulance provider following OCFA's screening and rating of the ambulance companies that submitted proposals. FISCAL IMPACT There is no fiscal impact to the City. Ambulance fees are set by the Orange County Board of Supervisors as required by state law. DISCUSSION The current contract with Doctors Ambulance expires September 1, 2004. The new contract is for five years. Two companies, Doctors and Medix, submitted proposals for Tustin (Exclusive Operating Area 23). Both companies are qualified based on OCFA performance standards and have a history of providing quality service. Through the OCFA Professional Grading Panel review process, Medix received 318.40 points and Doctors received 312.60 points (out of a possible 360). Given the relatively close scores, City staff believes either ambulance company is highly qualified. Upon selection of the ambulance company, the City Attorney's office will prepare an agreement for services in coordination with OCFA. ORANGE COUNTY FIRE AUTHORITY P. O. Box 57115, Irvine, CA 92619-7115 -I Fire Authority Road, Irvine, CA 92602 Chip Prather, Fire Chief (714) 573-6000 www.ocfa.org June 24, 2004 William Huston, City Manager City of Tustin 300 Centennial Way Tustin, California 92780 Re: Award of Exclusive Operating Area Ambulance Agreement (RFP No. RL972) Dear Bill: The Orange County Fire Authority ("OCF A") has completed the competitive selection process concerning the award of an exclusive operating area ambulance franchise agreement for Exclusive Operating Area (EOA) No. 23, which includes the City of Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas. Since the Tustin City Council has elected to retain final selection and contracting authority, OCF A is now forwarding to the City for its review and consideration the OCF A professional Grading Panel's final award recommendation. The OCF A professional Grading Panel recommends that the contract be awarded to Medix Ambulance Service, Inc. Your City Council is free to either accept the Grading Panel's award recommendation, or award the contract to the second qualified bidder based on its review and evaluation of the grading criteria and other pertinent information. We wish to emphasize the fact that both Medix Ambulance Service, Inc. and Doctor's Ambulance Service, Inc., are well qualified to provide the requested services. For your convenience, 'vve have enclosed a comprehensive report on the OCF A professional Grading Panel's award recommendation, which may be used either as your Agenda Report for this item, or as an attachment to your Agenda Report. The enclosed OCF A report also includes a binder containing the following information: (1) Composite Grading Scoring Chart; (2) Supporting Grading Detail by Grader; (3) Submittal Requirements and Grading Criteria; (4) Amended OCFA 2004 FirelEMS Emergency Ambulance Transportation and Related Services (RFP No. RL972); (5) Exclusive Operating Area (Draft) Agreement for the City of Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas (EOA No. 23); (6) Medix Ambulance Service, Inc.'s Bid Proposal; and (7) Doctor's Ambulance Service, Inc. 's Bid Proposal. Upon Serving the Cities of: Aliso Viejo' Buena Park' Cypress' Dana Point. Irvine' Laguna Hi1Js . Laguna Niguel . Laguna Woods, Lake Forest. La Palma Los Alamitos . Mission Viejo. Placentia . Rancho Santa Margarita 'San Clemente' San Juan Capistrano' Sea] Beach' Stanton' Tustin' ViJla Park Westminster' Yorba Linda' and Unincorporated Areas of Orange County RESIDENTIAL SPRINKLERS AND SMOKE DETECTORS SAVE LIVES agendizing this matter, it is our recommendation that you forward copies of OCFA's report and the attached binder to your City Council for their review and consideration. We also recommend that copies of the bid proposals be kept on file with the City Clerk. Once again, we request that your City Council not make the final award until thé City Council adopts the updated model ambulance ordinance. Additionally, OCF A requests that the City not make any changes to the draft EOA agreement, unless approved in advance by OCFA General Counsel. Toward this end, we request that OCFAfinalize the agreement after the City Council makes a final decision on award of the contract. We will continue to keep you apprised on all issues concerning the RFP. In the meantime, if you have any questions or concerns, please feel free to contact me at (714) 573-6022 or Finance Manager Jim Ruane at (714) 573-6304. If your city attorney has any questions or concerns about the ambulance ordinance, draft EOA agreement, and/or the procurement process, please refer them to our Assistant General Counsel Gregory E. Simonian at (714) 564-2621. Sincerely, /Û1 CHIP PRATHER, FIRE CHIEF Enclosures REPORT ON FILE IN THE CITY CLERK'S OFFICE Inter-Com DATE: JUNE 28,2004 TO: FROM: HONORABLE MAYOR AND MEMBERS OF CITY COUNCIL WilliAM A. HUSTON, CITY MANAGER W AMBULANCE CONTRACT SUBJECT: The City Council is scheduled to award the ambulance contract at its July 6, 2004 meeting. Pursuant to the regulatory system set forth in State law, the Orange County Fire Authority solicited proposals and prepared a technical evaluation of the ambulance providers which responded. Attached is a memorandum from the OCFA Fire Chief which explains the process and transmits the evaluations of the two ambulance companies that submitted proposals for Tustin. The Tustin City Council previously decided to make the selection in lieu of the OCFA Board of Directors. Because of the volume of material, I wanted to be sure the City Council had ample opportunity to review it before the normal distribution of agenda material. Please do not hesitate to contact me or Lois Jeffrey if you have any questions. c: Lois Jeffrey ~ fl.. '.. '. ". .. .'... '. ". ~.. .:... ' '. .., .. .. i / ¡ '~-~II ~ ORANGE COUNTY FIRE AUTHORITY P. O. Box 57115, Irvine, CA 92619-7115 - 1 Fire Authority Road. Irvine, CA 92602 Chip Prather, Fire Chief (714) 573-6000 www.ocfa.org June 24, 2004 William Huston, City Manager City of Tustin 300 Centennial Way Tustin, California 92780 Re: Award of Exclusive Operating Area Ambulance Agreement (RFP No. RL972) Dear Bill: The Orange County Fire Authority ("OCF A") has completed the competitive selection process concerning the award of an exclusive operating area ambulance franchise agreement for Exclusive Operating Area (EOA) No. 23, which includes the City of Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas. Since the Tustin City Council has elected to retain final selection and contracting authority, OCF A is now forwarding to the City for its review and consideration the OCF A professional Grading Panel's final award recommendation. The OCF A professional Grading Panel recommends that the contract be awarded to Medix Ambulance Service, Inc. Your City Council is free to either accept the Grading Panel's award recommendation, or award the contract to the second qualified bidder based on its review and evaluation of the grading criteria and other pertinent information. We wish to emphasize the fact that both Medix Ambulance Service, Inc. and Doctor's Ambulance Service, Inc., are well qualified to provide the requested services. For your convenience, we have enclosed a comprehensive report on the OCF A professional Grading Panel's award recommendation, which may be used either as your Agenda Report for this item, or as an attachment to your Agenda Report. The enclosed OCFA report also includes a binder containing the following information: (1) Composite Grading Scoring Chart; (2) Supporting Grading Detail by Grader; (3) Submittal Requirements and Grading Criteria; (4) Amended OCFA 2004 FirelEMS Emergency Ambulance Transportation and Related Services (RFP No. RL972); (5) Exclusive Operating Area (Draft) Agreement for the City of Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas (EOA No. 23); (6) Medix Ambulance Service, Inc.'s Bid Proposal; and (7) Doctor's Ambulance Service, Inc.' S Bid Proposal. Upon Serving the Cities of: Aliso Viejo' Buena Park, Cypress' Dana Point. Irvine' Laguna Hills' Laguna Nigue] . Laguna Woods' Lake Forest. La Palma Los Alamitos . Mission Viejo' P]acentia . Rancho Santa Margarita 'San Clemente' San Juan Capistrano' Sea] Beach' Stanton' Tustin' Villa Park Westminster' Yorba Linda' and Unincorporated Areas of Orange County RESIDENTIAL SPRINKLERS AND SMOKE DETECTORS SAVE LIVES agendizing this matter, it is our recommendation that you forward copies of OCFA's report and the attached binder to your City Council for their review and consideration. We also recommend that copies of the bid proposals be kept on file with the City Clerk. Once again, we request that your City Council not make the final award until thé City Council adopts the updated model ambulance ordinance. Additionally, OCF A requests that the City not make any changes to the draft EOA agreement, unless approved in advance by OCF A General Counsel. Toward this end, we request that OCF A finalize the agreement after the City Council makes a final decision on award of the contract. We will continue to keep you apprised on all issues concerning the RFP. In the meantime, if you have any questions or concerns, please feel free to contact me at (714) 573-6022 or Finance Manager Jim Ruane at (714) 573-6304. If your city attorney has any questions or concerns about the ambulance ordinance, draft EOA agreement, and/or the procurement process, please refer them to our Assistant General Counsel Gregory E. Simonian at (714) 564-2621. Sincerely, /PJ CHIP PRATHER, FIRE CHIEF Enclosures REPORT ON FILE IN THE CITY CLERK'S OFFICE CITY OF TUSTIN THE OCFA PROFESSIONAL GRADING PANEL'S AMBULANCE CONTRACT AWARD RECOMMENDATION EXCLUSIVE OPERATING AREA (EOA) NO. 23 SUMMARY: The Orange County Fire Authority (OCF A) has completed, on behalf of the Orange County Emergency Medical Services Agency (OCEMS), the legally required competitive process for the award of an exclusive operating area ambulance service agreement within the City of Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas (collectively referred to as "EOA No. 23"). Since the City of Tustin has elected to retain final selection and contracting authority for the award of the exclusive operating area contract within EOA No. 23, OCFA is forwarding to the City for its review and consideration the OCFA professional.Grading Panel's award recommendation. The City Council may accept the OCF A professional Grading Panel's award recommendation and award the contract pursuant to that recommendation or, upon conducting its own review and evaluation of the OCF A grading criteria, scoring materials, final scores, bid proposal submission materials, and other pertinent information, the City Council may award the contract to the second qualified bidder. AWARD RECOMMENDATION: Based on the results of the competitive selection process (RFP No. RL972), including the overall quality of the bid proposals received for EOA No. 23, it is the recommendation of the OCF A professional Grading Panel that the exclusive operating area agreement be awarded to Medix Ambulance Service. Inc. RECOMMENDATION: THAT THE CITY COUNCIL EVALUATE THE OCFA PROFESSIONAL GRADING PANEL'S AMBULANCE CONTRACT AWARD RECOMMENDATION AND AWARD AN EXCLUSIVE OPERATING AREA (EOA) AGREEMENT FOR THE PROVISION OF AMBULANCE SERVICES WITHIN EOA NO. 23; AUTHORIZE THE MAYOR TO EXECUTE AN EXCLUSIVE OPERATING AREA AGREEMENT WITH THE SUCCESSFUL BIDDER IN THE FORM ATTACHED HERETO SUBJECT TO ADOPTION OF ORDINANCE NO. Page 2 BACKGROUND: A. Orane:e County EMS System Pursuant to the Emergency Medical Services (EMS) Act, only the County may create exclusive operating areas for the provision of ambulance services. In addition, in order to avoid anti-trust liability, the County must conduct a competitive process for the selection and award of exclusive operating area ambulance contracts. The County, however, has delegated its responsibility for conducting the competitive process to OCF A for all OCF A jurisdictional areas except the cities of Buena Park, San Clemente and Westminster. The County approved the competitive selection process utilized by OCF A, including the Request for Proposal (RFP) and the model EOA contract attached hereto, as well as the grading criteria, which have been included as part of the local EMS Plan and referred to the State EMS Authority. The County, however, allows OCFA or the OCFA-member cities to make the final award selection and to enter into the contract with the successful bidder. B. Existine: Ambulance Service Contract and 2003 EOA Consolidation On July 1, 1998, the City of Tustin entered into a three-year agreement with Doctor's Ambulance Service, Inc., for the provision of exclusive emergency medical transportation services within the City of Tustin. In 2001, the City took action to extend the 1998 contract for three years commencing on July 1,2001. In June 2003, the Orange County Board of Supervisors took action to update the former ambulance service areas (ASAs), which are currently referred to as exclusive operating areas (EOAs), to reflect demographic changes and city incorporations since 1985. This action resulted in a consolidation of several former ambulance service areas and reduced the total number of exclusive operating areas to twenty-two (22) effective July 1, 2004. This action also resulted in the consolidation of the former County unincorporated ambulance service areas with adjacent city exclusive operating areas, which was supported by OCF A, the County, and the Orange County Ambulance Association. As a result of this consolidation effort, EOA No. 23 now includes the City of Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas. In 2003,69.05% of the transportation call volume for ambulance services in EOA No. 23 was in the City of Tustin. The current exclusive operating area contract for EOA No. 23 is scheduled to automatically terminate on June 30, 2004. Due to unforeseen delays in the administration and completion of the procurement process, the final selection and award of exclusive operating area contracts within OCF A jurisdictional areas would not have been completed in time for successful bidders to take over and commence services on July 1, 2004. Therefore, the City took action on June 7, 2004 to extend the existing 1998 contract for an additional two months. The amended contract will automatically expire on August 31, 2004. Page 3 SUMMARY OF PROCUREMENT PROCESS: A. 2004 RFP and Model EOA Contract On December 22, 2003, OCF A requested applications from qualified private ambulance service operators for the award of new exclusive operating contracts within its jurisdictional areas. Providers were pre-qualified to bid on February 11,2004. On February 19,2004, OCFA issued its Request for Proposals for Fire/EMS Emergency Ambulance Transportation and Related Services (RFP No. RL972). Pre-qualified providers submitted bid proposals in response to the RFP on May 10, 2004. All bids received by OCF A in response to the RFP were referred to the OCF A Professional Grading Panel for evaluation and scoring. B. OCFA Professional Gradin2 Panel A professional bid proposal Grading Panel was assembled by OCF A to evaluate and rate each bid proposal received according to established criteria. The primary competitive bid criteria for the RFP was: (1) quality of service; (2) level of service; (3) cost of service; (4) cost, if any, to the awarding agency; (5) experience; and (6) whether a bidder is responsible. The term "responsible" refers not only to the attribute of trustworthiness, but also to the quality, fitness, and capacity of the bidder to perform the proposed services satisfactorily and in accordance with the specifications and delivery criteria set forth in the RFP and model EOA contract. The five-member Grading Panel was comprised of: (1) Mary 10 Vincent, RN, County of Orange Emergency Medical Services Agency (EMSA); (2) Ron Blaul, OCF A Battalion Chief and former OCF A EMS Chief and State EMS Chair; (3) Tim Perkins, OCF A EMS Paramedic; (4) Dr. Ken Miller, OCFA Medical Director; and, (5) Michael Boyle, OCFA Battalion Chief. The five-member OCF A professional Grading Panel has over 125 years of combined practical EMS experience. c. Summarv of Actions Taken by OCFA Staff In order to ensure compliance with the complex rules, regulations, and statutes governing the award of exclusive operating area ambulance contracts, and to ensure the completion of a thorough and fair competitive process, OCF A staff worked closely with its General Counsel (Woodruff, Spradlin & Smart) and also engaged the consulting services of two EMS experts: Page, Wolfberg & Worth LLC, a national EMS, ambulance, Medicare, and medical transportation industry law firm; and EMS Consultant Peter Lawrence. OCF A held several workshops with interested private ambulance service operators and solicited their input concerning the terms and conditions of the County-approved RFP and model EOA contract. Additional workshops for city managers and staff were also conducted. In January 2004, the OCF A Board of Directors approved the maximum Advanced Life Support (ALS) rate and the OCFA ALS Reimbursement Rate, as well as the key terms of the RFP. In response to concerns raised by the bidders, on May 27, 2004, the OCF A Board of Directors unanimously approved a revision to the reimbursement schedule that takes into account the Medicare and Medi -Cal payer mixes. Page 4 Additionally, OCF A staff presented the terms of the ambulance procurement process, as well as the updated service rates, to the Orange County Emergency Medical Services (EMS) Transportation Advisory Committee on April 12, 2004, and to the Emergency Medical Care Committee on April 16, 2004. Both EMS committees approved the reports unanimously. The Orange County Emergency Medical Services Agency (OCEMS) delegated responsibility for conducting the competitive process to OCF A and approved the RFP, model EOA contract, and grading criteria. On May 11, 2004, the Orange County Board of Supervisors adopted a resolution approving the maximum BLS and ALS service rates and authorized OCF A to conduct a competitive process on behalf of OCEMS for the selection and award of exclusive operating area ambulance franchise agreements within OCF A jurisdictional areas. D. ContractiDl! Authority Under the current County EMS system, OCF A-member cities may decide whether they wish to retain final selection and contracting authority for themselves, or whether they wish to delegate such authority to the OCF A Board of Directors. Currently, approximately half of the OCF A cities have elected to retain final selection and contracting authority, while the other half have delegated such responsibility to OCF A. Many of the cities that have elected to retain final selection and contracting authority do so on the theory that they wish to maintain an element of local control relative to the provision of ambulance services within their cities. On the other hand, cities that have opted to delegate such authority to OCFA do so on the theory that OCFA is the city's fire department and possesses the technical EMS expertise necessary to make a fully informed decision concerning the service needs of the ambulance service area. The City of Tustin has elected to retain final provider selection and contracting authority. E. Phase I - Provider Preaualification The procurement process was divided into two phases. The first was Phase I - the provider prequalification phase. Ambulance service operators not satisfying all of the minimum prequalification criteria and requirements were not eligible to continue in the RFP and selection process. The second was Phase II - the proposal submission, grading, recommendation, and selection phase. The prequalification phase was developed to ensure that only qualified, experienced providers meeting the established minimum performance standards, experience, and delivery criteria were identified. As a result of the prequalification phase, OCF A determined that each bidder is qualified to provide the requested services. F. Key Provisions of the New Contract Key provisions of the model EOA contract include: Contract Term . Five-year contract term effective September 1, 2004, with option for extension(s) up to an additional five years (for a possible total contract term not to exceed ten (10) years). Page 5 Advanced Life Support Rates . The maximum ALS rate that the ambulance provider may charge patients cannot exceed $282; the maximum rate will be updated annually based on the County's percentage increase to the BLS rates. . For Medicare patients, Ambulance provider cannot collect more than the maximum allowable Medicare rate, including applicable co-payments. . Ambulance provider is required to reimburse OCF A for the cost of providing ALS (paramedic) services as follows: 0 $200 per transport (except as noted below) . Medicare and Medicare+Choice programs: Approved allowable Medicare ALS increment; . Medi-cal, CalOptima and Children Services patients: No reimbursement required. Insurance . Provider shall, at its sole cost and expense, purchase and maintain throughout the term of the Agreement, the following insurance policies: 0 Commercial General Liability Insurance (Bodilv Injurv and Property Damage): with a limit not less than $3,000,000 combined single limit, per occurrence; $5,000,000 annual aggregate. 0 Business Automobile Liability Insurance: with a limit not less than $3,000,000 combined single limit, per occurrence; $5,000,000 annual aggregate. 0 Ambulance Medical Malpractice Insurance: with a limit of not less than $3,000,000 per occurrence; $5,000,000 annual aggregate. . These insurance amounts may, however, be increased prior to award of contract, if required by the City. Breach/Enforcement Penalties . The Agreement contains strict terms and conditions concerning provider breach and performance-related compliance provisions, including comprehensive remedial action plan requirements and appeal provisions. G. Impact of the ALS Rate on Patients Served within Tustin For Medicare, Medicare+Choice (HMO), Medicare with Secondary Insurance, and Medi- Cal patients, there will be no increase in out of pocket expenses. Medicare sets the maximum reimbursable amount allowed to the ambulance providers. For Medi-Cal, CalOptima, and patients on other public assistance programs, there will be no impact since these patients will not be charged for ALS reimbursements. For patients with Health Maintenance Organization (HMO) Coverage (PacifiCare, Kaiser, etc.), staff does not believe there would be any impact in the form of increased out-of-pocket expense because HMO's set the maximum reimbursable amount to the ambulance providers. For patients with Preferred Physician Organization (PPO) Page 6 coverage, there will be an Increase of $19.40 or 15% in out-of-pocket expenses. For uninsured patients, there will be an Increase of $97 or 15% in out-of- pocket expenses. H. Bid Proposals Received for Tustin (EOA No. 23) OCF A received bid proposals to provide exclusive operating area ambulance service within the City of Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas from the following two ambulance service providers, both of which are well qualified to provide the requested services: * * Medix Ambulance Service, Inc.; and Doctor's Ambulance Service, Inc. The RFP and the proposals from the two bidders are included as Attachments 2, 4, and 5. I. Gradine Criteria The focus of the grading criteria was to select a bidder that could meet or exceed the performance standards set forth in the RFP and which provided the most thorough and competitive bid proposal and program design for providing ambulance services to the City of Tustin. The grading criteria was matched to the RFP submittal requirements, provided to the bidders, and graded accordingly. Bidders were asked to submit twenty-three (23) separate submission items and to make an oral presentation. Of the twenty-three (23) submission items identified in the RFP, the Grading Panel members graded and assigned points to eighteen (18) request items and to the oral presentation component. The most qualified, responsible bidder that offered the highest overall level of service, as determined by the Grading Panel's overall scoring, and either meets or exceeds the specifications and delivery criteria set forth in the contract documents, is being recommended for award of a contract by the OCF A professional Grading Panel. OCFA PROFESSIONAL GRADING PANEL RESULTS: A. Bidder Ratines The OCF A professional Grading Panel rated the bidders for EOA No. 23 (Tustin) as follows: Provider: Total Points: Averaee Score: Medix Ambulance Service, Inc. 318.40 88.44% Doctor's Ambulance Service, Inc. 312.60 86.83% TOTAL POSSIBLE POINTS 360 Page 7 B. RFP Gradim! Results and Criteria For your review and convenience, a composite scoring chart that itemizes the relevant bid submission items, allowable points, total points awarded, and the composite average scores expressed in percentages is attached as Attachment 1. Also included in Attachment 1 is a copy of the Supporting Grading Detail by Grader and a copy of the OCF A Submittal Requirements and Grading Criteria. ADDITIONAL INFORMATION: Listed below are some of the key similarities and differences between the bidders' proposals. The list is not intended to be all-inclusive. Proposals submitted by both Medix Ambulance Service, Inc. and Doctor's Ambulance Service, Inc., include: A. Similarities . Achievement of national accreditation by the Commission on Accreditation of Ambulance Services (CAAS). "The Commission on Accreditation of Ambulance Services is an independent accrediting agency, which exists to encourage and promote the highest standards for medical transport systems." (source - www.caas.org). Fewer than 200 ambulance companies nationwide have received this accreditation. The accreditation is only awarded to ambulance providers that have passed stringent guidelines and an on~site survey by nationally recognized industry experts. . Commitment to dedicate Type III Modular ambulances to provide service to Tustin. Type III ambulances were preferred by OCF A for bid submission. Type III ambulances are a van-like cab with a box-like patient compartment vehicle. This type gives emergency services personnel walk-through capabilities from the patient compartment (the back of the ambulance) to the cab (front of the ambulance) without having to exit the vehicle. The turning radius on the Type III is shorter than other types of ambulances and is suitable for narrow streets and heavy traffic; conditions that are typical in an urban environment. B. Medix Ambulance Service. Inc. . Has been providing ambulance services to the residents and visitors of Orange County for over 25 years. Specific cities served in Orange County include Cypress, Lake Forest, Los Alamitos, San Juan Capistrano, Seal Beach, Aliso Viejo, Sunset Beach, Laguna Woods, Mission Viejo, Laguna Niguel, Irvine, La Palma, Stanton, Laguna Hills, and Villa Park. (See Tab 19 of the proposal, which is included in Tab 4 of this binder.) . Medix is headquartered in the City of Mission Viejo. . If awarded the contract, has committed to purchase and dedicate three (3) brand new Type III ambulances to provide service to the City of Tustin. All new ambulances will be equipped with a Reddi-net computer system. Reddi-net is a real time hospital status report that Ambulance Emergency Medical Technicians (EMT) and paramedics will be able use to determine what hospital emergency rooms are available to receive patients. This allows the Page 8 EMS crew to determine a hospital's diversion status. Diversion is a medical decision dependent upon the hospital's ability to provide safe and efficient patient care. . If awarded the contract for Tustin, Medix has offered to provide Basic Life Support (BLS) services at $21.75 and Advanced Life Support (ALS) ambulance services at $83.75 below the maximum allowable service rates. These rates would be in effect for the first year of the contract. Medix has also proposed a discount for year two of the contract. c. Doctor's Ambulance Service. Inc. . Has been providing ambulance services to the residents and visitors of Orange County for over 30 years. Has been providing ambulance services to Tustin for 29 years. Other cities served in Orange County include Aliso Viejo, Dana Point, Irvine, Laguna Beach, Laguna Hills, and Laguna Woods. (See the Tab labeled "911 Fire/EMS Resume" of the proposal, which is included in Tab 4 of this binder.) . Doctor's Ambulance Service, Inc. is headquartered in the City of Laguna Hills. . Has committed to dedicate two (2) Type III ambulances to provide ambulance services to the City of Tustin. . Is heavily involved in Tustin community outreach programs, including a Patient Assistance Program, which offers to assist citizens with non-emergency, non-medical needs. . Has committed to using only back-up units to support a high call volume period in an EOA, thereby ensuring that no dedicated units will be moved from any EOA to support another EOA. CEQA FINDINGS: The proposed action does not constitute a project under CEQA Guidelines §15378(a) (14 CCR §15378). DRAFT EXCLUSIVE OPERATING AREA AGREEMENT: The Exclusive Operating Area Agreement (Draft) for the City of Tustin (EOA No. 23) is submitted as Attachment 3. Page 9 ATTACHMENTS: . . . . . Attachment 1 Attachment 2 Attachment 3 Attachment 4 Attachment 5 RFP Grading Results and Criteria . A. Composite Bidder Scoring Chart . B. Supporting Grading Detail by Grader . C. Submittal Requirements and Grading Criteria Amendment No.1 to the OCFA 2004 Fire\EMS Emergency Ambulance Transportation and Related Services (RFP No. RL972) Exclusive Operating Area Agreement (Draft) for the City of Tustin (EOA No. 23) Medix Ambulance Service, Supplemental Bid Information Inc.'s Bid Proposal and Doctor's Ambulance Service, Inc.'s Bid Proposal and Supplemental Bid Information City of Tustin and the Adjacent Unincorporated Cowan and Lell1on Heights Areas EO A No. 23 Grading Results and Criteria A. Composite Bidders Scores B. Supporting Grading Detail C. Submittal Requirements and Grading Criteria Amended Request for Proposal (RFP) for Fire/EMS Emergency Ambulance Transportation and Related Services Model Exclusive Operating Area Agreement Medix Ambulance Service Inc. Ambulance Service Proposal and Supplemental Information Doctor's Ambulance Service Inc. Ambulance Service Proposal and Supplemental Information I' 1ft ( Grading Results and Criteria Attachment lA Composite Bidders Scores Attachment IB Supporting Grading Detail Attachment 1 C Submittal Requirements and Grading Criteria ~ --' ..¡: ~ ~ A TT ACHMENT 1 A COMPOSITE BIDDERS SCORES IIi rl= ,.. TUSTIN --,ùA 23 COMPOSITE BIDDER SCORES TUSTIN AND THE ADJACENT UNINCORPORATED COWAN AND LEMON HEIGHTS AREAS (EOA # 23) MAX. PTS. DOCTORS % OF MEDIX ALLOWED AVERAGE POSSIBLE AVERAGE (wlExtra Pts.) SCORE TOTAL SCORE Attacru. .1 A ITEM # CATEGORY %OF POSSIBLE TOTAL 1 Cover letter 20 17.60 88.00% 15.60 78.00% 3 Operational System 55 49.80 90.55% 51.60 93.82% 4 Communications 25 15.60 62.40% 21.00 84.00% 5 Ambulances 35 33.00 94.29% 33.00 94.29% 6 Service Rates 10 10.00 100.00% 10.00 100.00% 7 On-BoardE&S 20 11.00 55.00% 16.60 83.00% 8 Response Times 25 23.40 93.60% 22.80 91.20% 9' Maintenance 10 9.60 96.00% 7.60 76.00% 10 Driver.Training 5 . 5.00 100.00% 5.00 100.00% 11 CQI . 10 8.80 88.00% 6.00 60.00% 12 Mutual Aid 10 10.00 100.00% 10.00 100.00% 13 Personnel 25 15.80 63.20% 18.40 73.60% 14 Billing & Collection 15 12.00 80.00% 13.40 89.33% 15 HIPAA 10 9.40 94.00% 9.20 92.00% 16 Corporate Compliance 5 5.00 100.00% 5.00 100.00% 17 Monthly Payment 10 9.40 94.00% 8.20 82.00% 18 Takeover Plan 15 14.60 97.33% 14.00 93.33% 19 9-1-1 Resume . 30 30.00 100.00% 30.00 100.00% Personal Interview/Oral Presentation 25 22.60 90.40% 21.00 84.00% JUNE 21, 2004 ATTACHMENT IB SUPPORTING GRADING DETAIL Supporting Gra ""tail by Grader EO City of Tustin and the Adjacent UnincOI¡ .,."Led Cowan and Lemon Heights Areas Al ~nt I B Doctor's AlDbülalÍceServiCêInc. 1M"'U" >.. > ..... GRADER GRADER Gradinl!: Criteria A B C D E Gradinl!: Criteria A B C D E Item 1 17.00 18.00 15.00 20.00 18.00 Item I 1~.00 18.00 15.00 15.00 15.00 Item 3 55.00 46.00 50.00 43.00 55.00 Item 3 51.00 50.00 55.00 47.00 55.00 Item 3.1 15,00 14,00 15,00 10,00 15,00 Item 3.1 14,00 15,00 15,00 11.00 15.00 Item 3.2 5,00 4,00 5,00 4,00 5,00 Item 3.2 5.00 4,00 5,00 5,00 5,00 Item 3.3 5,00 3,00 0,00 1.00 5,00 Item 3.3 4,00 3,00 5,00 4,00 5,00 Item 3.4 10,00 5,00 1000 8,00 10,00 Item 3.4 8,00 8,00 10,00 7,00 10.00 Item 3.X 20,00 20,00 20,00 20.00 20,00 Item 3.X 20,00 20,00 20,00 20,00 20.00 Item 4 18.00 14.00 16.00 12.00 18.00 Item 4 21.00 18.00 23.00 22.00 21.00 Item 4.1 1.00 1.00 1.00 1.00 Item 4.1 2.00 2,00 2,00 2,00 Item 4.2 2,00 1.00 1.00 2,00 Item 4.2 3,00 2,00 2,00 3.00 Item 4.3 8,00 8,00 6,00 8,00 Item 4.3 9,00 7.00 10,00 900 Item 4.4 2,00 1.00 1.00 2,00 Item 4.4 0,00 0,00 2,00 0,00 Item 4.5 2,00 1.00 1.00 2.00 Item 4.5 4,00 5,00 4,00 4,00 Item 4.6 2,00 1.00 1.00 2,00 Item 4.6 2,00 1.00 1.00 2.00 Item 4.7 1.00 1.00 1.00 1.00 Item 4.7 1.00 1.00 1.00 1.00 Item 5 31.00 31.00 33.00 35.00 35.00 Item 5 33.00 33.00 35.00 29.00 35.00 Item 5.1 12.00 12.00 15,00 15,00 Item 5.1 14,00 15,00 12,00 15,00 Item 5.2 4,00 4,00 5,00 5,00 Item 5.2 4.00 4.00 4,00 5.00 Item 5.3 5,00 5,00 5,00 5,00 Item 5.3 5,00 4,00 ),00 5,00 Item 5.X 10,00 10,00 10,00 10,00 Item 5.X 10,00 10,00 10,00 10.00 Item 6 10.00 10.00 10.00 10.00 10.00 Item 6 10.00 10.00 10.00 10.00 10.00 Item 7 12.00 10.00 12.00 9.00 12.00 Item 7 17.00 13.00 20.00 16.00 17.00 Item 7.1 5,00 4,00 3,00 5,00 Item 7.1 8,00 7,00 8,00 8,00 Item 7.2 2,00 1.00 LOO LOO Item 7.2 4,00 3,00 4,00 4,00 Item 7.3 5,00 5,00 5,00 6,00 Item 7.3 5,00 3,00 4,00 5,00 Item 8 25.00 24.00 20.00 23.00 25.00 Item 8 23.00 24.00 25.00 19.00 23.00 Item 8.1 5.00 5,00 5,00 5,00 5,00 Item 8.1 5.00 5,00 5,00 4,00 5,00 Item 8.2 5,00 5,00 5,00 5,00 5,00 Item 8.2 5,00 5,00 5,00 4,00 5,00 Item 8.3 5.00 5,00 5,00 5,00 5,00 Item 8.3 5.00 5,00 5,00 4,00 5,00 Item 8.4 10,00 9,00 5,00 8,00 10,00 Item 8.4 8,00 9,00 10,00 7,00 8,00 Item 9 8.00 10.00 10.00 10.00 10.00 Item 9 7.00 7.00 10.00 7.00 7.00 Item 9.1 5,00 5,00 5.00 5,00 Item 9.1 4,00 4,00 ),00 4,00 Item 9.2 3,00 5,00 5,00 5.00 Item 9.2 3,00 3,00 4.00 3,00 Item 10 5.00 5.00 5.00 5.00 5.00 Item 10 5.00 5.00 5.00 5.00 5.00 Item 10.1 3,00 3,00 3,00 3,00 Item 10.1 3,00 3,00 3,00 3.00 Item 10.2 1.00 LOO 1.00 1.00 Item 10.2 1.00 1.00 1.00 1.00 Item 10.3 1.00 LOO 1.00 1.00 Item 10.3 1.00 1.00 1.00 1.00 Item 11 8.00 8.00 10.00 8.00 10.00 Itemll 8.00 6.00 5.00 6.00 5.00 Item 12 10.00 10.00 10.00 10.00 10.00 Item 12 10.00 10.00 10.00 10.00 10.00 Item 13 12.00 16.00 15.00 19.00 17.00 Item 13 16.00 15.00 22.00 19.00 20.00 Item 13.1 1.00 2,00 4,00 3,00 Item 13.1 1.00 LOO 4,00 5,00 Item 13.2 6,00 6,00 5,00 7,00 Item 13.2 6,00 6.00 7,00 7,00 Item 13.3 3,00 3,00 5,00 3,00 Item 13.3 4,00 3,00 5,00 3,00 Item 13.4 1.00 3,00 ),00 2.00 Item 13.4 ),00 3,00 2,00 ),00 Item 13.5 1.00 2,00 2.00 2,00 Item 13.5 2,00 2.00 1.00 2,00 Page 1 of2 June 21, 2004 Supporting Gra. '\lil by Grader EO, ' City of Tustin and the Adjacent UnincorpOiated Cowan and Lemon Heights Areas At 'It 1 B Doctor's AlDbulaneeSel'vice Ine. > UiWll'¡ .,." ."", GRADER GRADER Gradin2 Criteria A B C D E Gradinl! Criteria A B C D E Item 14 11.00 13.00 15.00 9.00 12.00 Item 14 14.00 14.00 15.00 10.00 14.00 Item 14.1 4,00 5,00 3.00 5.00 Item 14.1 5,00 5,00 4.00 5.00 Item 14.2 3.00 2,00 2,00 3,00 Item 14.2 3,00 3,00 2,00 3.00 Item 14.3 2.00 4,00 3,00 2.00 Item 14.3 4,00 4,00 3.00 4.00 Item 14.4 2,00 2,00 1.00 2,00 Item 14.4 2,00 2,00 1.00 2,00 Item 15 ' 8.00 10.00 10.00 9.00 10.00 Item 15 8.00 10.00 10.00 10.00 8.00 Item 16 5.00 5.00 5.00 5.00 5.00 Item 16 5.00 5.00 5.00 5.00 5.00 Item 17 9.00 10.00 10.00 8.00 10.00 Item 17 8.00 10.00 10.00 5.00 8.00 Item 17.1 3,00 4.00 400 4,00 Item 17.1 3,00 4,00 3,00 Item 17.2 3.00 3,00 3,00 3.00 Item 17.2 2,00 3,00 1.00 Item 17.3 3,00 3,00 1.00 3,00 Item 17.3 3,00 3.00 1.00 Item 18 15.00 15.00 15.00 13.00 15.00 Item 18 12.00 15.00 15.00 13.00 15.00 Item 18.1 3,00 3.00 3,00 200 3,00 Item 18.1 3,00 3,00 2,00 3,00 Item 18.2 4,00 4,00 4,00 4,00 4,00 Item 18.2 3,00 4,00 4,00 4,00 Item 18.3 8.00 8,00 8,00 7.00 8,00 Item 18.3 6.00 8,00 7.00 8,00 Item 19 30.00 30.00 30.00 30.00 30.00 Item 19 30.00 30.00 30.00 30.00 30.00 Oral Presentation 20.00 23.00 20.00 25.00 25.00 Oral Presentation 20.00 20.00 25.00 20.00 20.00 I TOTAL I 309.00 I 308.00 I 311.00 I 303.00 I 332;00 I TOTAL 313.00, WO .345,00". 298;011' ~23mO Total Possible Points 360.00 Total Possible Points 360.00 AVERAGE TOTAL SCORE I 312.60 1 AVERAGE TOTAL SCORE I 318.40 I Page 2 of 2 June 21, 2004 ~ 't A TT ACHMENT 1 C S UBMITT AL REQUIREMENTS AND GRADING CRITERIA rf+. ¡¡ Attachment 1 C Request for Proposals For Fire / EMS Emergency Ambulance Transportation and Related Services RFP # RL972 S ubmi ttal Requiremen t8 And Grading Criteria ORANGE COUNTY FIRE AUTHORITY If! ~ - S UBMITT AL REQUIREMENTS ~ .i SECTION VIII - BID PROPOSAL SUBMISSION FORMS BIDDER CHECKLIST 0 BINDER (ORIGINAL + 9 COPIES) ONE BID PROPOSAL PER EOA PAGE SIZE, FONT SIZE, PAGE LIMITS TITLE PAGE BID PROPOSAL DEPOSIT TABLE OF CONTENTS ITEM 1 - COVER LETTER ITEM 2 - NOTIFICATION OF PROVIDER PREQUALIFICATION ITEM 3 - OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN ITEM 4 - EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEM ITEM 5 - TOTAL NUMBER OF AMBULANCES ITEM 6 - SERVICE RATES ITEM 7 - ON-BOARD EQUIPMENT & SUPPLIES ITEM 8 - RESPONSE TIME REQUIREMENTS ITEM 9 - VEHICLE & EQUIPMENT MAINTENANCE PROGRAM ITEM 10 - DRIVER TRAINING ITEM 11 - INTERNAL MEDICAL QUALITY CONTROL ITEM 12 - MUTUAL AID PROVIDER ITEM 13 - PERSONNEL AND TRAINING ITEM 14 - BILLING AND COLLECTION PRACTICES ITEMI5-HIPAACOMœL~CEPLAN ITEM 16 - CORPORATE COMœL~CE PLAN ITEM 17 - COMPL~CE WITH QUARTERLY PAYMENTS ITEM 18 - PLAN FOR TAKEOVER OF SERVICE/START-UP ITEM 19 - 911 FIREÆMS RESUME ITEM 20 - CONFLICT OF INTEREST CERTIFICATION ITEM 21 - STATEMENT OF TRUTH ITEM 22 - NON-COLLUSION CERTIFICATION ITEM 23 - PHOTOGRAPHS (OPTIONAL) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I . April 2004 179999,6 TITLE PAGE/COVER SHEET (1 PAGE LIMIT) Orange County Fire Authority Request for Proposals for FirelEMS Emergency Ambulance Transportation and Related Services RFP # RL972 Insert Bidder Name Insert Bidder Address Insert Bidder Authorized ContactJRepresentative Signature of Authorized ContactJRepresentative Insert EOA Name & EOA Number Proposed Insert Bidder Telephone Number Insert Date of Bid Proposal Submission Designate as "Original" or Copy 41 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 BID PROPOSAL DEPOSIT (1 PAGE LIMIT) Please attach below (either staple or otherwise affix) the required Bid Proposal Deposit, as described in Section II (F). 42 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 TABLE OF CONTENTS Please include in the Bid Proposal a Table of Contents listing the following request items and submission forms in the order provided: ITEM 1 - COVER LETTER ITEM 2 - NOTIFICATION OF PROVIDER PREQUALIFICATION ITEM 3 - OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN ITEM 4 - EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEM ITEM 5 - TOTAL NUMBER OF AMBULANCES ITEM 6 - SERVICE RATES ITEM 7 - ON-BOARD EQUIPMENT & SUPPLIES ITEM 8 - RESPONSE TIME REQUIREMENTS ITEM 9 - VEHICLE & EQUIPMENT MAINTENANCE PROGRAM ITEM 10 - DRIVER TRAINING ITEM 11 - INTERNAL MEDICAL QUALITY CONTROL ITEM 12 - MUTUAL AID PROVIDER ITEM 13 - PERSONNEL AND TRAINING ITEM 14 - BILLING AND COLLECTION PRACTICES ITEM 15 - HIPAA COMPLIANCE PLAN ITEM 16 - CORPORATE COMPLIANCE PLAN ITEM 17 - COMPLIANCE WITH MONTHLY PAYMENTS ITEM 18 - PLAN FOR TAKEOVER OF SERVICE/START-UP ITEM 19 - 911 FIREÆMS RESUME ITEM 20 - CONFLICT OF INTEREST CERTIFICATION ITEM 21 - STATEMENT OF TRlITH ITEM 22 - NON-COLLUSION CERTIFICATION ITEM 23 - PHOTOGRAPHS (OPTIONAL) 43 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 i). ii). iii). iv). v). vi). vii). viii). ITEM 1: COVER LETTER ~PAGELIMIT) Please include a cover letter, on official Bidder letterhead, that describes the Bidder and its qualifications, and include the following information, as described in Section ll(C)(2)(j): The official name of the Bidder; The Bidder's organizational structure (e.g. corporation, partnership, limited liability corporation, or otherwise); The jurisdiction in which the Bidder is organized and the date of such organization; The address and telephone number of the Bidder's headquarters and of any local office involved in the bid proposal; The Bidder's Federal Tax Identification Number; The name, address, telephone, fax numbers and e-mail address of the person(s) who will serve as the authorized contact(s) to the City and OCFA with regards to the bid proposal, the RFP process, the Contract Documents, and the administration of the contract, if awarded, with authorization to make representations on behalf of and to bind the Bidder; Provide applicable authorized signature documentation, pursuant to Bidder's organizational structurelbylaws, verifying the authority of the person signing the original bid proposal to commit to the proposal on behalf of the Bidder (attach to cover letter); A representation that the Bidder is in good standing in the State of California and has obtained all necessary licenses, permits, certifications, approvals and governmental authorizations necessary in order to perform all of the required performance obligations specified in the RFP; ix). A representation that the Bidder is in good standing in the Medicare and Medi-Cal programs and is not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to their billing or reimbursement practices, and that Bidder has not been excluded from any state or federal healthcare program or employs any individual who has been excluded from any state or federal healthcare program; x). Statement of acceptance of all tenns, conditions, requirements, and performance criteria contained in the Contract Documents; and, xi). Any additional information Bidder deems relevant for consideration during the selection process. 44 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 2: NOTIFICATION OF PROVIDER PREOUALIFICATION Please attach (either staple or otherwise affix) a copy of the OCFA notification of pre qualification letter that was sent to Bidder. 45 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. 1 - April 2004 179999,6 ITEM 3: OVERALL OPERATIONAL SYSTEM AND DESIGN (8 PAGE LIMIT) Please provide a detailed summary of the operational system and program design Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area (EOA), and describe in detail how the proposed operational system and program design will either meet or exceed the competitive bid criteria, specifications, requirements, and perfonnance expectations set forth in this RFP. Additional Specific Submission Data: 1. Provide the number and proposed location of all emergency vehicles for service in the subject EOA. In the alternative to a flXed station(s) in the EOA, provide a detailed map of the system status management or provide a detailed system plan. 2. Provide the hours of operation for each unit in the subject EOA. 3. Provide the crew configuration for each unit in the subject EOA. 4. Provide description of supervisory plan of crews, including number and location of supervisory personnel. 5. Provide an overall summary of Bidder's Southern California system operations including: a. total number of ambulances in fleet; b. total number of employees including line staff, supervisors, managers, administrative, billing, etc.; c. contact information for third party billing agency and third party collection agency (where applicable); and d. contact information for medical director; contact information for continuing education program, driver training, etc. 46 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 4: EMERGENCY RESPONSE AND VEIDCLE COMMUNICATIONS SYSTEM (3 PAGE LIMIT) Please provide a detailed summary of the Emergency Response and Vehicle Communications System Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Emergency Response and Vehicle Communications System will either meet or exceed the communications specifications, requirements, and performance expectations set forth in Section IV. Additional Specific Submission Data: 1. Provide a statement that Bidder is or will be compliant by the Effective Date with all communications requirements set forth in Section IV of this RFP. 2. Provide a detailed summary of CAD (Computerized Aided Dispatch) program capabilities. 3. Provide a detailed summary of other communications equipment used by Bidder (if applicable) including, but not limited to: a. Cellular phones; b. Personal digital assistants (PDAs); c. Mobile computers. 4. Provide a detailed summary of the proposed operational design for the Emergency Response Communications System and methods proposed for dispatching ambulances. 5. Provide a detailed summary of the Bidder's internal and external infonnation technology capabilities. 6. Provide detailed summary of communications capabilities, including: a. Hours of operation; and b. Personnel devoted to communications. 7. Provide a statement on Bidder's ability to upgrade communication systems. 8. Provide a detailed summary of all field data collection systems and the process by which data is collected, inputted and used by the Bidder. 47 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. 1 - April 2004 179999,6 ITEM 5: TOTAL NUMBER OF AMBULANCES (4 PAGE LIMIT) Please provide a detailed summary of all emergency vehicles and ambulances Bidder proposes for use in its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed vehicles and ambulances that are proposed for use within the subject EOA will either meet or exceed the specifications, requirements, and performance expectations set forth in Section VI. Please also include the following specific ambulance information, as well as a detailed summary of Bidder's proposed ambulance replacement program. A). Units Proposed for Exclusive. Dedicated Use in the Subiect EOA Service Area: Ambulance Unit #s: CHASSIS MAKE MODEL YR. MILEAGE CONDITION TYPE B). Other Proposed Regional Units that will be Available to Reasonablv Support the Subiect EOA: Ambulance Unit #s: CHASSIS MAKE MODEL YR. Mll..EAGE CONDITION LOCATION TYPE NOTE: Mil~age provided must be estimated based on unit in service to the EOA as of July 1,2004. 48 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 6: SERVICE RATES (2 PAGE LIMIT) Please provide a detailed summary and/or schedule of all ambulance service rates and fees that Bidder proposes to charge all \ payers and patients in connection with its provision of emergency ambulance transportation and related services within the subject EOA, in accordance with the established maximum rates, requirements, and reimbursements set forth in Section Vll, including but not limited to all costs of service and/or cost, if any, to the awarding agency. 49 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - Apri12004 179999,6 ITEM 7: ON-BOARD EQUIPMENT AND SUPPLIES (3 PAGE LIMIT) Please provide a detailed summary of the On-Board Equipment and Supplies Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed On- Board Equipment and Supplies will either meet or exceed the specifications, requirements, and performance expectations set forth in Section VI. Additional Specific Submission Data: 1. Provide a detailed summary of Bidder's OSHA compliance program; 2. Describe Bidder's capabilities to respond to terrorist threats or disasters. 50 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. 1- April 2004 179999,6 ITEM 8: RESPONSE TIME REOUIREMENTS (4 PAGE LIMIT) Please provide a detailed summary of how Bidder's operational system and program design, proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, will consistently and continuously meet or exceed the response time requirements and performance expectations set forth in Section N. Additional Specific Submission Data: 1. Please provide detailed fracti1e summary response time reports for the three- month period of April 2003 to June 2003 for the subject EOA or a geographic/call volume related area similar to the subject EOA, and include both Code 2 and Code 3 calls, separately delineated. 2. If your proposed operational system and program design will exceed the response time requirements and performance expectations set forth in this RFP, please clearly explain in a detailed summary how such requirements will be exceeded. 51 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 9: VEIDCLE AND EQUIPMENT AND MAINTENANCE (4 PAGE LIMIT) Please provide a detailed summary of how Bidder's Vehicle and Equipment Maintenance Program proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently and continuously meet or exceed the vehicle and equipment maintenance standards, requirements, and performance expectations set forth in Section VI. Additional Specific Submission Data: 1. Provide a description of the vehicle maintenance plan or schedule; 2. ' Provide a description of the vehicle replacement plan; 3. Provide a detailed summary of equipment maintenance program including replacement plan. 52 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - Apri12004 179999,6 ITEM 10: DRIVER TRAINING (2 PAGE) Please provide a detailed summary of the Driver Training Program Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Driver Training Program will either meet or exceed the perfonnance expectations and requirements set forth in Section V. Additional Specific Submission Data: 1. Provide a detailed course syllabus or curriculum for driver training program offered to employees; 2. Provide the total number of course hours per course offered; 3. Describe the internal training plan, including timeframe for completion and retraining; 4. Provide the name of the institution providing the training, if applicable. 53 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 11: INTERNAL MEDICAL OUALITY CONTROL (3 PAGE LIMIT) Please provide a detailed summary of how Bidder's Internal Medical Quality Control and Continuous Quality Improvement ("CQI") Programs proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently meet or exceed the standards, requirements, and perfonnance expectations set forth in Section N(J). Additional Specific Submission Data: 1. Provide a detailed summary of Bidder's quality assurance/improvement process, including tirnefrarnes for process completion; 2. If your proposed Internal Medical Quality Control and Continuous Quality Improvement ("cQr') Programs will exceed the standards and requirements set forth in this RFP, please clearly explain in a detailed summary how such requirements will be exceeded 54 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 12: MUTUAL AID PROVIDER (2 PAGE LIMIT) Please provide a detailed summary of how Bidder's Mutual Aid Provider Program proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently and continuously meet or exceed the standards, requirements, and performance expectations set forth in Section N(D)(lO). Additional Specific Submission Data: Provide a copy of all current mutual aid agreements that would apply to the subject EOA or provide a copy of Bidder's proposed mutual aid plan, including: a. Name of mutual aid provider (if known); b. Location of mutual aid provider; c. Staffmg capabilities of mutual aid provider, ifknown. 55 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 13: PERSONNEL AND TRAINING (A). ASSIGNED PERSONNEL PROFILE (3 PAGE LIMIT) Please provide a detailed spreadsheet of the individual personnel, including proposed management team, employee names, current certification/license level of service, certificate/license number, and number of years as an employee of Bidder, proposed by Bidder for the performance of services under the Contract Documents within the subject Exclusive Operating Area. (B). FIELD TRAINING OFFICERS (1 PAGE) Please provide the ratio of field training officers to EMTs or other ambulance personnel that Bidder proposes to commit to the subject EOA, and provide a detailed explanation of Bidder's proposed Field Supervisor and Training Programs and management/field supervisor oversight plan for the subject EOA. (C). PRIMARY PERSONNEL (5 PAGE LIMIT) Please provide the resumes of no more than five (5) proposed key personnel (maximum one page each) whose job duties for Bidder's Orange County operations will relate solely and exclusively to the fulfillment of the tern1s, conditions, performance expectations, and obligations relative to Bidder's performance under the Contract Documents. (D). EMPLOYEE RECRUITMENT. SCREENING AND ORIENTATION (2 PAGE LIMIT) Please provide a detailed summary of the current personnel Recruitment, Screening, and Orientation Program Bidder currently employs and modifications Bidder proposes to utilize in connection with its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Recruitment, Screening, and Orientation Program will enable Bidder to consistently and continuously meet or exceed the training standards, personnel requirements, and performance expectations set forth in Section V. 56 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - Apri12004 179999.6 ITEM 13: PERSONNEL AND TRAINING CONTINUED (E). CONTINUING EDUCATION PROGRAMS (2 PAGE LIMIT) Please provide a detailed summary of any and all continuing education programs, including continuing medical education programs, that will be provided to all employees who perfonn services under the Contract Documents, as well as a discussion of Bidder's commitment to providing such programs at all times throughout the contract tenD. (F). HIPAA ~G PROGRAMS (2 PAGE LIMIT) Please provide a detailed summary of Bidder's HIPAA training program that has been provided to aU employees and will be provided to aU new employees who perform services under the Contract Documents. 57 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 14: BILLING AND COLLECTION PRACTICES (3 PAGE LIMIT) Please provide a detailed summary and explanation of the billing and collection practices Bidder proposes for use and implementation within the subject EOA, including Bidder's proposed system, procedures, practices, policies and protocols for responding to and timely processing all customer complaints. Please also include a detailed summary and explanation of Bidder's proposed record keeping and auditing practices and how such systems will either meet or exceed the requirements and performance expectations set forth in Section VIT. Additional Specific Submission Data: 1. Provide a detailed description of the billing and data information flow from dispatch through initial billing; 2. Provide process flow and timeframes for collections process, including but not limited to: a. The number of monthly statements sent prior to collections; b. Timeframe for write-offs; 3. Provide overall billing and collection practices, including but not limited to: a. Statement cycle; b. Collection rate; 4. Provide statistical data for subject EOA (if applicable), including but not limited to: a. Payer mix; b. Patient demographics; c. Collection rate by payer. 58 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 ITEM 15: HIPAA COMPLIANCE PLAN (1 PAGE LIMIT) Please provide a detailed summary and explanation of Bidder's HIPAA Compliance Plan, including Bidder's certification that all personnel have signed a confidentiality agreement and have undergone HIP AA Privacy Training. 59 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 16: CORPORATE COMPLIANCE PLAN (2 PAGE LIMIT) Please provide a detailed summary and explanation of Bidder's Corporate Compliance Plan, if applicable. A Corporate Compliance Plan should include those elements identified in the Office of Inspector General's Compliance Program Guidance for Ambulance Suppliers [Federal Register: March 24,2003 (Volume 68, Number 56)]. 60 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 17: COMPLIANCE WITH MONTHLY PAYMENTS (4 PAGE LIMIT) Please provide a detailed summary and explanation of the system for providing timely, monthly payments to OCF A that addresses how Bidder intends to satisfy the procedures and requirements set forth in Section Vll, including: (a) Bidder's proposed system for inspection of all billing records and its monthly payment record keeping and auditing practices; (b) Bidder's proposed system for making the required ALS Reimbursement Rate payments; and (c) Bidder's proposed system for making the required Medical Supply Reimbursement Rate payments to OCF A. 61 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 18: PLAN FOR TAKEOVER OF SERVICE/START-UP (4 PAGE LIMIT) Please describe in detail Bidder's proposed implementation plan for the takeover of services/start-up, or resumption of services under the new contract, as applicable, within the subject EOA by the Effective Date; including but not limited to: (a) Bidder's transition or implementation management team; (b) proposed start-up schedule for ensuring timely commencement of services on July 1, 2004; and (c) proposed initial service response and coverage plan, including deployment plans, post locations, housing, and staffmg plans. 62 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 ITEM 19: 911 FlREIEMS RESUME (LAST 10 YEARS) (5 PAGE LIMIT) Please provide a detailed resume of Bidder's 911 FirelEMS Emergency Ambulance Transportation experience. 63 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 20: CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of ("Bidder"), and hereby declares under penalty of peIjury under the laws of the State of California, that Bidder is not, and will not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a contract and if authorized to perform the services described in this RFP. Signed, this day of , 2004 in . California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (]FA or meTlzer): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 64 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 21: STATEMENT OF TRUTH The undersigned hereby certifies on behalf of ("Bidder"), and hereby declares under penalty of petjury under the laws of the State of California, that the infonnation provided by Bidder and contained in this 2004 Fire/EMS Emergency Ambulance Transportation and Related Services RFP is accurate, complete, true and correct to the best of our knowledge. We are aware that should any of the infonnation contained herein be found to be false, incorrect, or otherwise untruthful, or if the information contained herein contains material misrepresentations and/or material omissions of fact, OCFA may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option of OCF A, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and/or to declare any contract awarded as the result thereof void. Signed, this day of , 2004 in - . California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JP A or merlZer): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 65 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 22: NON-COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of ("Bidder"), and hereby declares under penalty of petjury under the laws of the State of California, that this 2004 FireÆMS Emergency Ambulance Transportation and Related Services RFP is genuine and not sham or collusive, nor made in the interest of or on behalf of any person not herein named; the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a sham proposal nor solicited any other person, firm or corporation to refrain from submitting a proposal; the Bidder has not communicated, directly or indirectly, with any other Bidder regarding the amount, price, and/or service rates proposed herein; and Bidder has not in any manner sought by collusion to secure for himse1f1herselfJitself any advantage over any other Bidder. We declare the foregoing is true and correct under penalty ofpetjury under the laws of the State of California. Signed, this day of ' 2004 In . California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 66 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 23: PHOTOGRAPHS (OPTIONAL) (3 PAGE LIMIT) Bidders may provide, at their option, any color photographs or other renderings depicting Bidders' emergency ambulance service facilities, operations, vehicles, equipment, perfonnance, and/or personnel. 67 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 It' "t GRADING CRITERIA AND INSTRUCTIONS I+' ., ORANGE COUNTY FIRE AUTHORITY REQUEST FOR PROPOSALS FOR FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES RFP # RL972 FY 2003/2004 GRADING & SELECTION CRITERIA SCORE SHEETS ORANGE COUNTY FIRE AUTHORITY GRADING INSTRUCTIONS General Information Welcome to the 2004 Orange County Fire Authority ("OCF A") Grading Panel for Request for Proposals for Fire/EMS Emergency Ambulance Transportation and Related Services, RFP # RL972. We appreciate your participation in the grading process. As you are aware, the provision of emergency medical services in our jurisdiction is important to all of us. The OCF A strives to ensure that the emergency service providers operating within all OCF A jurisdictional areas are the best this industry has to offer. To this end, OCFA is asking each of you to review and grade the bid information submitted by each provider for a given Exclusive Operating Area ("EO A") in response to OCFA's Request for Proposals for FirelEMS Emergency Ambulance Transportation And Related Services. Currently there are 19 EOAs in which a Bidder may submit a bid to provide emergency services. There are approximately 9 Bidders that have completed and passed the pre-qualification phase. However, each Bidder is not required to submit a bid for all 19 EOAs. A Bidder may choose to submit a bid for only 1 EOA or for any and/or all EOAs. The ultimate decision on what area(s) to bid for services resides with the Bidder. In any event, a Bidder must bid each given EOA separately. OCF A has been authorized to conduct the competitive process for the selection and award of EOA contracts within OCF A jurisdictional areas on behalf of Orange County Emergency Medical Services ("OCEMS"). OCF A, however, will not choose the contracted Bidder for all of the EOAs. Some cities have retained their authority to choose the Bidder most appropriate for their respective EOA. As such, for those jurisdictions that have retained authority to choose, it is not your job to suggest one (1) Bidder for an EOA but rather to develop a list of the top three (3) Bidders you believe are qualified to be the contracted provider for a given EOA. Grading sheets Attached are the grading sheets and corresponding attachments for each important area of the RFP, which has been communicated to the Bidder. Every sheet must be filled out for a Bidder who has chosen to bid on a given EOA. At the top of each sheet the EOA # is identified for your convenience. Please identify the Bidder you are scoring by writing the Bidder's abbreviation at the top of each grading sheet, as well as all the attachments including the scorecard (Attachment H). A list of abbreviations for Bidder names has been provided for you. In order to ensure consistency among the graders and the grading sheets, please use only the abbreviations provided. Each Item will provide the standard with which the information submitted by the Bidder must meet according to the terms of the RFP. Again, the Bidders have been provided a full copy of the RFP prior to submitting their bids. Therefore, all submitted bids should include information supporting the standard identified for each Item. The "Requirements" column is a brief summary of what the Bidder should be submitting in support of the standard. The "Specific Submission Data" column is the specific Confidential - 11 - ORANGE COUNTY FIRE AUTHORITY GRADING INSTRUCTIONS informational data that the Bidder has been asked to supply in addition to any detailed summary or explanation listed in the "Requirements" column. The "Documentation" column is simply a checklist that has been provided for your grading convenience. This column lists the Items that the Bidder was asked to provide in the first two columns of the grading sheet. This column is not to be used for scoring purposes but rather to assist the grader in ensuring that a Bidder has provided all requested information and documentation for a particular EOA. The last column represents the minimum number of points that may be awarded for a given Item, as well as the maximum points a Bidder may receive for information submitted in support of the standard identified for a given Item. Please read on for more information on scoring. Scorinf! Each section is worth a maximum amount of points ranging from 5 pts. to 55 pts. Each section has a mandatory minimum (0 pts.) and mandatory maximum amount of points, which differs by Item. You may score a Bidder anywhere between the minimum up to and including the maximum points allowed in a given section. For example, Item 4 provides for 0 minimum points to 25 maximum points. You receive and organize all the information and documentation a Bidder submitted for the subject EOA. As you check off the boxes in the Documentation column, you find that the Bidder did supply all the information requested. Now you begin to look at the actual content of the information and you fmd that some of it is sloppy or with little detail to support the standard identified for the Item you are grading. Based on the point scale, you decide to award this Bidder a score of 10 points for this Item. In order to assist you on what OCF A finds most important with regards to the submitted documentation, the "Specific Submission Data" section contains not only the documentation or information specifically requested from the Bidder in support of the Item's standard but also the maximum number of points that can be awarded a Bidder for a requested document or informational summary/explanation. You will notice that the' number of points in this section add up to the total number of points possible (excluding extra points) for the Item, as identified in the last column of the grading sheet. Please do not add the points from the "Specific Submission Data" column to the total maximum points identified in the "Reviewer Notes" column. Remember, the points you award a Bidder in the "Specific Submission Data" should not exceed the maximum number of points (excluding extra points) a Bidder can earn as identified in the last Confidential - iii - ORANGE COUNTY FIRE AUTHORITY GRADING INSTRUCTIONS column. At no time should you score a Bidder beyond the maximum number of points possible, except for those Items that provide for extra points. You may also notice that some Items contain an "Extra Point" section. The ability to earn and award these extra points is dependent on the qualification material listed in this section and whether the points are "Automatic" or "Optional". Ifa Bidder, for example in Item 3, is CAAS accredited, you must award the Bidder the Automatic 20 extra points. Therefore, the new maximum number of points a CAAS accredited Bidder could earn for Item 3 is now 55 points. It is important that you award a Bidder all extra points for which that Bidder qualifies, for each EOA that Bidder has submitted a bid. In contrast, Item 1 provides for 20 Optional extra points. For this Item you may award at your discretion based on the quality of the information you received from the Bidder any and all of the 20 Optional extra points. Please note that for some Items only Extra points apply and the ability to award these extra points may either be mandatory or at the discretion of the Grader. Please read the extra point terms for each Item carefully. For example, Item 16: Corporate Compliance Plan has an extra point total of 5 points. If a Bidder submits evidence that its organization has a corporate compliance plan you should give that Bidder 5 points in this Item for each EOA that the Bidder submits a bid. However, in Item 1: Cover Letter, you are asked only to award extra points if the Bidder provides additional information that you find favorable to the Bidder for a given EOA. Therefore, in this situation, a Bidder mayor may not receive extra points for Item 1 for every bid submitted by the Bidder. At the bottom of each page is a line for you to record the total number of points you award a Bidder for each Item, in a given EOA. As mentioned prior, your total number of points should not exceed the maximum allowed points for a given Item, unless extra points may be earned for a particular Item and the Bidder has provided documentation to satisfy or qualify for the extra point requirement stated for the Item. Attachments Attachments may be referenced in a given Item. All attachments can be found at the end of the Item grading sheets. The information provided on the attachments is for your information only and may be used to assist you in the scoring of that Item. Those attachments that should only be used by the grader as a guideline, and not as specific criteria for which the Bidder must comply, will conspicuously state this purpose. At the end of the score sheets is a scorecard where you may tally the sub-total points for each Item, for a given Bidder and subject EOA. A separate column for the award of extra points has been provided. For auditing and informational purposes, please use the appropriate column for points awarded. Please do not enter any scores in a shaded area. These areas are shaded for the purpose of alerting the grader that particular points do not apply for a given Item. The total from your sub-total point score for an Item and any extra points awarded should be identified in the Total Points Awarded Confidential - IV - ORANGE COUNTY FIRE AUTHORITY GRADING INSTRUCTIONS column. The maximum total number of points that could be awarded for a given Item, including any extra points, has been provided for your convenience. Scorecard At the conclusion of the grading packet for each Bidder in a given EOA are the scoring guidelines and a scorecard. The scoring guideline is broken down by Item number for your convenience and is to be used by each grader to ensure an appropriate level of consistency and objectivity in the grading process. We asked that you adhere to this guideline when grading each section of the RFP submission packet. The scorecard is designed to allow each grader to record the final score awarded for each item on one sheet. Some sections have been shaded on the scorecard to alert the grader that points in this category do not apply for a given Item. For example, Item 1 only has extra points available. Therefore the "Sub-total awarded points" has been shaded. Please do not write points in the shaded sections of the scorecard. Once you have reviewed and graded all Items for a Bidder in a given EOA please add all of the scores in the "Total Points Awarded" and write the total in the box next to the total amount of points that could have been awarded, 360 pts. Again, OCF A thanks you for your assistance in this important project. Confidential - v - ORANGE COUNTY FIRE AUTHORITY GRADING INSTRUCTIONS PRE-QUALIFIED BIDDERS ABBREVIATION LIST NAME American Medical Response Americare Ambulance Service Care Ambulance Service Doctor's Ambulance Service Emergency Ambulance Service, Inc. Gerber Ambulance Service Medix Ambulance Service Schaefer Ambulance Service Westmed Ambulance, Inc. Confidential ABBREVIA nON AMR AAS CAS DOC EMA GER MDX SAS WAI - vi- ORANGE COUNTY FIRE AUTHORITY GRADING INSTRUCTIONS EXCLUSIVE OPERATING AREAS NAME EOA# Cypress 5 Irvine (Santa Ana Hts area, JW A)* 10 La Palma 13 Los Alamitos (Rossmoor) 14 P1acentia (Brea Unincorp & Tonner Cyn area) 17 San Juan Capistrano (Ortega Hwy) 19 Seal Beach (Sunset Beach, Bolsa Chica) 21 Stanton (Midway City) 22 Tustin (Cowan, Lemon Hts) 23 Villa Park (Orange/Olive, Orange Park, Silverado) 24 Yorba Linda (Chino Hills State Park) 26 Laguna Hills 28 Rancho Santa Margarita (Trabuco, O'Neill Park, Las Flores, Coto de Caza) 29 Laguna Niguel 30 Aliso Viejo (Woods, Aliso Cyn) 32 Laguna Woods (Crystal Cove, Laguna wilderness, Emerald Bay) 35 Mission Viejo 38 Dana Point 39 Lake Forest (Modjeska, upper Trabuco/Cooks) 42 *(County unincorporated areas) Confidential - vii - ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION II ADMINISTRATION Item 1: Cover Letter Bidder ST ANDARD: Bidder shall include a cover letter, on official Bidder letterhead, that describes the Bidder and its qualifications, and includes specific information outlined below. REQUIREMENTS Bidder shall provide a cover letter outlining specific organizational information about the Bidder, its operations and personnel. Bidder may obtain extra points for providing additional organizational information for consideration, relevant to the selection process. Please Note: Only extra points are applicable or this Item. Panel Member's Name SPECIFIC SUBMISSION DATA Specific Submission Data: I. Official Name of Bidder 2. Bidder's corporate structure 3. Jurisdiction of Bidder's organization as a business entity and the date of its organization. 4. Bidder's address and telephone number of headquarters and local offices. 5. Bidder's federal tax ID number. 6. Name, address, telephone, fax and email address of Bidder's authorized contacts. 7. Authorized signatures of Bidder representatives. 8. Representation of good standing in California and all necessary licenses and permits. 9. Representation of good standing in federal health care programs, Medicare. 10. Statement of contract acceptance. DOCUMENTATION PROVIDED [J Official Name of Bidder [I Bidder's Corp. structure [] Jurisdiction of Bidder's Organization & date [] Bidder's address and telephone numbers [] Federal tax ID number [] Bidder's authorized contacts [] Authorized signatures [] Representation of good standing in state & with all required licenses/permits [] Representation of good standing in federal health care programs [J Statement of acceptance of contract terms D Additional infonnation [J 4 page limit Confidential REVIEWER NOTES Optional Extra Points 20pts. Additional information provided for consideration by Bidder relevant to selection process. Page I ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION IV OPERATIONAL STANDARDS Item 3: Overall Operational System and Design Bidder Bidder shall provide a detailed summary of the operational system and program design Bidder proposes for its provision of private, emergency ambulance transportation and related services within the subject Exclusive Operating Area ("EOA"). ST ANDARD: REQUIREMENTS Bidder shall provide a detailed summary of the operational system and program design Bidder proposes for its provision of emergency services within the subject EOA, and describe in detail how the proposed operational system will either meet or exceed the bid criteria specifications, requirements, and performance expectations set forth in the RFP. Bidder may earn extra points for being accredited by the Commission on Accreditation of Ambulance Services. Panel Member's Name SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Number and proposed location of all emergency vehicles dedicated/regional to service the EOA, or in the alternative a detailed map of the system status management or detailed system plan of deployment of emergency vehicles dedicated/regional to service the EOA. (15 pts.) 2. Hours of operation for each unit in the subject EOA. (5 pts.) 3. Description of the supervisory plan of crews, including number and location of supervisory personnel. (5 pts.) 4. Overall summary of Bidder's So. Cal. system operations, including crew configuration. (10 pts.) DOCUMENTATION PROVIDED u Total number of vehicles for the EOA [] Location of vehicles dedicated to the EOA [] Location of vehicles regional to the EOA [] Deployment plan U Hours of operation/unit 0 Crew configuration 0 Supervisory plan [J Number of Supervisors [J Location of Supervisors II Summary of Southern California system operations [J Proof of CAAS accreditation (where applicable) 0 8 page limit Confidential REVIEWER NOTES 35 pts. Full Compliance All necessary information has been provided and is complete for substance & form. Bidder's operational plan exceeds the needs of the EOA, 0 pts. Non-Compliance Necessary information is missing or incomplete and/or Bidder's operational plan fails to meet the needs ofthe EOA. Automatic Extra Points 20ots. Bidder is CAAS accredited. Page 2 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Bidder SECTION IV OPERATIONAL STANDARDS Item 4: Emergency Response and Vehicle Communications S~stem SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Statement of Compliance or statement of intent to comply by Effective Date. , (2 pts.) 2. Detailed summary of CAD program capabilities. (3 pts.) 3. Detailed summary of communications capabilities and communications equipment. (10 pts.) 4. Detailed summary of Bidder's internal and external infornmtion technology capabilities. (2 pts.) 5. Detailed summary of proposed operational design. - 6. Detailed summary of field data collection systems and processes. (5 pts.) (2 pts.) 7. Statement on Bidder's ability to upgrade. (I pt.) Bidder shall install, provide, operate, and maintain at their sole cost and expense, an ambulance dispatch center, telephone, 800 MHz mobile radio system, mobile data computer/radio system, personal computers, a telephone ring-down line, and a secondary dispatch response system. STANDARD: REQ UIREMENTS Bidder shall describe in a detailed summary the proposed Emergency Response and Vehicle Communications system for the provision of private, emergency ambulance transportation and related services within the subject EOA. Panel Member's Name DOCUMENT A TION PROVIDED [] [] Statement of Compliance Summary of CAD capabilities Summary of CAD Communications equipment Summary of IT capabiIties Hours of operation Personnel devoted to iJ [] [J [] communications [J [] Ability to upgrade systems Summary of field data collection and processes 3 page limit [] Confidential REVIEWER NOTES 25 pts. Full Compliance All necessary infonnation has been provided and is complete for substance & fonn. Bidder's communications system exceeds the standards of the RFP. 0 pts. Non-Compliance Necessary infonnation is missing or incomplete and/or Bidder's communications system fails to meet the standards of the RFP. Page 3 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION IV OPERATIONAL STANDARDS Item 5: Total Number of Ambulances Bidder Bidder shall provide a detailed summary of all emergency vehicles and ambulances Bidder proposes for exclusive and regional use in its provision of private, emergency ambulance transportation and related services in the subject Exclusive Operating Area. A suggested optimum number of units for dedicated and regional use in a given EOA can be found in Attachment A. STANDARD: REQUIREMENTS Bidder shall describe in detail the make, model and year of the chassis, as well as the mileage and overall condition of the vehicle. Bidder shall desigate its intended number of emergency vehicles exclusively dedicated to services in the EOA, as well as those units regionally available to provide services to the EOA. Please Note: Optimum units located in the last 2 columns of Attachment A for illustration purposes only and are not based on actual call volumes 'or any EOA, Panel Member's Name SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Chassis make, model, year and mileage and overall condition documented per vehicle. (I5 pts.) 2. Detailed summary of proposed replacement plan. (5 pts.) 3. Detailed explanation of dedicated and regionally available vehicles for the subject EOA. (5 pts.) DOCUMENT A TION PROVIDED IJ Make Model [J Year [J Mileage [] Overall Condition [J Type [] Location [J Proposed replacement program [1 4 page limit Confidential REVIEWER NOTES 25 pts. Full Compliance All necessary infonnation has been provided and is complete for substance & fonn. Bidder's proposed number of units exceeds the standards of the RFP and attachment. 0 pts. Non-Compliance Necessary information is missing or incomplete and/or Bidder's proposed number of units fails to meet the standards of the RFP and attachment. Automatic Extra Points 10 pts. Bidder uses all Type III vehicles. Page 4 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION VII RATES FOR AMBULANCE SERVICE Item 6: Service Rates STANDARD: Bidder adheres to maximum service rates and reimbursement rates as defined in the RFP. (All rates are provided in Attachment B.) REQUIREMENTS Bidder shall provide a detailed summary and/or schedule of all ambulance service rates and fees that Bidder proposes to charge in connection with its provision of. private, emergency ambulance transporation and related services within the subject EOA. Panel Member's Name SPECIFIC SUBMISSION DATA DOCUMENT A TION PROVIDED Specific Submission Data: 1, Bidder submitted rate schedule for subject EOA and rates do not exceed rates in Attachment B. [J BLS service rate (/0 pts.) [J ALS service rate [J ALS Reimbursement rate [] Medical Supply Reimbursement rate [J 2 page limit Confidential Bidder REVIEWER NOTES 10 pts. Full Compliance None of Bidder's proposed rates exceed the maximum established service rates and all reimbursement rates comply with stated standards set forth in the RFP. 0 pts. Non-Compliance Any of Bidder's proposed rates exceed the maximum established service rate standards set forth in the RFP. PLEASE NOTE: For this category only, a Bidder shall be given a score of either 10 pts. or 0 }!ts. Page 5 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Bidder SECTION VI SUPPLIES, EQUIPMENT AND VEIDCLES Item 7: On-Board Equipment and Supplies SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Detailed summary of Bidder's OSHA Compliance program. DOCUMENT A TION PROVIDED 0 0 0 OSHA Compliance Program Disaster Plan Standard Inventory (see attachment) 3 page limit Bidder shall comply with all federal, state, and local laws, rules, statutes and regulations applicable to BLS equipment, supplies protocols, vehicles, etc. in its provision of private, emergency ambulance transportation. (See Attachment c.) ST ANDARD: REQ UIREMENTS Bidder shan provide a detailed summary of the on-board equipment and supplies proposed for the subject EOA, as wen as a detailed summary of how the proposed equipment and supplies will meet or exceed the stated specifications, requirements, and performance standards set forth in this RFP. Panel Member's Name (/0 pts.) 2. Summary of Bidder's capabilities to respond to terrorist threats or diasters. (5 pts.) 3. Detailed summary of on-board equipment and supplies exceeding standard inventory. 0 (5 pts.) Confidential REVIEWER NOTES 20 pts. Full Compliance All necessary information has been provided and is complete for substance & form. Bidder's equipment and supplies exceed the standards of the RFP and attachment. 0 pts. Non-Compliance Necessary information is missing or incomplete and/or Bidder's equipment and supplies fail to meet the standards of the RFP and attachment. Page 6 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION IV OPERATIONAL STANDARDS Item 8: Response Time Requirements Bidder ST ANDARD: Bidders must respond to OCF A's requests for emergency ambulance transportation service within the response times set forth in Attachment D. REQUIREMENTS Bidder shall provide a detailed summary of how Bidder's proposed operational system and program design will consistently and continuously meet or exceed the response time and perfonnance expectations set forth in the RFP. Panel Member's Name SPECIFIC SUBMISSION DATA Specific Submission Data: I. April 2003 fractile summary response time report. (5 pts.) 2. May 2003 fractile summary response time report. (5 pts.) 3. June 2003 fractile summary response time report. (5 pts.) 4. Detailed summary of proposed operational system and program design for service in subject EOA or in another area similar to subject EOA. (10 pts.) DOCUMENTATION PROVIDED D [] April 2003 report May 2003 report June 2003 report Detailed summary of proposed operational system 4 page limit lJ [J [] Confidential REVIEWER NOTES 25 pts. Full Compliance All necessary infonnation has been provided and is complete for substance & fonD. Bidder's response times exceed the standards in the RFP for 90% or more of the calls reported. 0 pts. Non-Compliance Necessary infonnation is missing or incomplete and/or Bidder's response times meet the standards in the RFP for less than 75% of the calls reported. Page 7 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Bidder SECTION VI SUPPLIES, EQUIPMENT AND VEHICLES Item 9: Vehicle and Equipment and Maintenance SPECIFIC SUBMISSION DATA DOCUMENTATION PROVIDED STANDARD: Bidders must maintain all equipment and vehicles used in the performance of the required services under this contract in excellent condition. Bidder shall provide a copy of maintenance plans for vehicles and equipment. REQ UIREMENTS Bidder shall provide a detailed summary of how Bidder's Vehicle and Equipment Maintenance Program proposed for its provision of private, emergency ambulance transporation and related services within the subject EOA, and show how it will consistently and continuously meet or exceed the standard set forth in this RFP. Panel Member's Name Specific Submission Data: I. Detailed description of vehicle maintenance and replacement plan or schedule. [J [l 0 Vehicle maintenance plan Vehicle replacement plan Capital equipment maintenance program 4 page limit (5 pts.) [] 2. Detailed summary of capital equipment maintenance/replacement program. (5 pts.) Confidential REVIEWER NOTES 10 pts. Full Compliance All necessary information has been provided and is complete for substance & form. Bidder's maintenance plans exceed the standards in the RFP. 0 pts. Non-Compliance Necessary information is missing or incomplete and/or Bidder's maintenance plans fail to meet the standards in the RFP. Page 8 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION V PERSONNEL Item 10: Driver Training Bidder STANDARD: Bidder's employees and ambulance attendants shall be sufficiently trained and capable to ensure the safe and proper discharge of their service responsibilities. REQUIREMENTS Bidder shall provide a detailed summary of the Driver Training Program Bidder proposes for its provision of private emergency ambulance transportation and related services within the subject EOA and how such program will consistently and continuously meet or exceed the standards set forth in this RFP. Panel Member's Name SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Summary of course syllabus or curriculum for driver training program. (3 pts.) 2, Total number of course hours per course offered. (1 pt.) 3. Internal training plan with timeframes for completion and retraining, (1 pt.) DOCUMENTATION PROVIDED [J Course curriculum [J Number of course hours lJ Internal training plan with timeframes [J 2 page limit Confidential REVIEWER NOTES 5 pts. Full Compliance All necessary information has been provided and is complete for substance & form. 0 pts. Non-Compliance Necessary information is missing or incomplete. Page 9 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION IV OPERATIONAL STANDARDS Item 11: Internal Medical Qualit~ Control Bidder Bidder must establish a Continuous Quality Improvement ("CQI") program directed at, but not limited to, effective administration and management of clinical performance, response time performance, driver performance, dispatch performance, and for all other BLS service levels. (See Attachment E.) STANDARD: REQ UIREMENTS Bidder shall provide a detailed summary of how Bidder's Internal Medical Quality Control and CQI programs proposed for its provision of private, emergency ambulance transporation and related services within the subject EOA, will consistently and continuously meet or exceed the standards set forth in this RFP. Please Note: Attachment E is a sample CQI Process from Sierra-Sacramento Valley EMS Agency for the review of ALS patient care reports. Bidder's submission for this Item should be comparable to this sample. Panel Member's Name SPECIFIC SUBMISSION DATA DOCUMENTATION PROVIDED Specific Submission Data: 1. Detailed summary of quality assurance or improvement process including timeframes for process completion. 0 Continuous Quality Improvement Program Timeframes or flowchart of process c~pJ.etion 3 page limit ~. 0 (IO pts.) 0 Confidential REVIEWER NOTES 10 pts. Full Compliance Bidder has provided full and complete Internal Medical Quality Control and CQI programs. Bidder's Internal Medical Quality Control and CQI programs exceed the standards in the RFP. 0 pts. Non-Compliance Necessary information is missing or incomplete and/or Bidder's Internal Medical Quality Control and CQI programs fail to meet the standards in the RFP. Page 10 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION IV OPERATIONAL STANDARDS Item 12: Mutual Aid Provider Bidder ST ANDARD: Bidders must negotiate and enter into separate mutual aid agreements with neighboring ambulance service operators for the provision of mutual aid services within designated EOAs. REQUIREMENTS Bidder shall provide a detailed summary of Bidder's Mutual Aid Provider program proposed for its provision of private, emergency ambulance transporation and related services within the subject EOA. Panel Member's Name SPECIFIC SUBMISSION DATA DOCUMENT A TION PROVIDED Specific Submission Data: 1. Copy of all current mutual aid agreements that would apply to the subject EOA, or in the alternative a copy of Bidder's proposed mutual aid plan, including the name of the mutual aid provider; location of mutual aid provider; and staffing capabilities of mutual aid provider, if known. rJ Current/Proposed mutual aid agreements 2 page limit [] (10 pts.) Confidential REVIEWER NOTES 10 pis. Full Compliance Bidder has/proposed a mutual aid agreement with other providers in corresponding areas for the subject EOA. 0 pis. Non-Compliance Bidder failed to provide a current or proposed copy of its intended! suggested mutual aid agreement or the subject EOA. Page 11 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION V PERSONNEL Item 13: Personnel and Training Bidder STANDARD: Bidders must employ only competent and trained personnel, and shall provide a sufficient number of employees to perform the s~:rvices provided under the Contract Documents. (See Attachment F.) REQ UIREMENTS Bidder shall provide detailed summaries of assigned personnel, management, field training officers, and primary personnel. Bidder shaH provide a detailed summary of the current personnel Recruitment, Screening and Orientation Program Bidder currently employs and modifications Bidder proposes to utilize in connection with the provision of services within the subject EOA. Bidder shaH provide a detailed summary of its continuing education program. Bidder shaH provide a detailed summary of its HIP AA training program. Panel Member's Name SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Detailed summary of individual personnel proposed by Bidder for the performance of the services in the subject EOA. 2. Detailed summary of the management team proposed by Bidder for the performance of services in the subject EOA. (5 pts.) (10 pts.) 3. Detailed summary of the field training officers proposed by Bidder for the performance of services in the subject EOA. (5 pts.) 4. Detailed summary of continuing education program. (3 pts.) 5. Detailed summary ofHIPAA training program. (2 pts.) Confidential DOCUMENT A TION PROVIDED LJ Ii Employee names Employee certifications/ licenses, including number Number of years as an employee of Bidder Ratio of field training officers to EMTs or other ambulance personnel. Resumes of key personnel Recruitment, Screening and Orientation Program Con Ed program HIP AA Training program Assigned Personnel - 3 pgs. Field Officers - 1 page Primary Personnel - 5 pgs. Recruitment, Screening and Orientation Program - 2 pgs. Con Ed program - 2 pgs. HIP AA Training - 2 pgs. [J [] [I [] LJ [J [] [J [J [I LJ [J REVIEWER NOTES 25 pts. Full Compliance AH necessary information has been provided and is complete for substance & fonn. AH standard programs or curricula is in place for each category identified in the RFP. 0 pts. Non-Compliance Necessary information is missing or incomplete and/or Bidder's programs or curriculum fails to meet the standards set forth in the RFP. Page 12 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Bidder SECTION VII RATES FOR AMBULANCE SERVICE Item 14: Billing and Collection Practices SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Policies and protocols for responding to customer complaints. (5 pts.) 2. Record keeping and auditing practices, including statement cycle. (3 pts.) 3. Detailed description of the billing and data flow from dispatch through initial billing. (5 pts.) 4. Process flow and timeframes for collection process. (2 pts.) Panel Member's Name DOCUMENTATION PROVIDED 0 0 Customer complaint process Record keeping practices Audit practices Billing and data flow from dispatch to billing Collection process Statistical EOA data (if applicable) 3 page limit Bidder may only bill according to the approved service rate schedules set forth in the Contract Documents, with no additional fees or charges imposed unless approved in writing by the contracted city, OCF A or OCEMSA. Contractors must establish an auditable billing system approved by OCF A, which shall be available for review by OCF A on a periodic basis. ST ANDARD: REQ UIREMENTS Bidder shall provide a detailed summary and explanation of the billing and collection practices the Bidder proposes for use and implement within the subject EOA. Bidder shall include a detailed summary and explanation of Bidder's proposed record keeping and auditing practices and how the systems will either meet or exceed the requirements set forth in the RFP. [] 0 [] 0 0 Confidential REVIEWER NOTES 15 pts. Full Compliance Bidder has provided a complete account of its Billing and Collection practices. Bidder's billing and collection practices exceed the standards in the RFP, 0 pts. Non-Compliance Necessary infonnation is missing or incomplete and/or Bidder's billing and collection practices fail to meet the standards in the RFP. Page I3 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Item 15: HIP AA Com}!liance Plan Bidder STANDARD: Bidder shall comply with the requirements set forth by the Health Insurance Portability and Accountability Act as stated in 45 CFR Parts 160 and 164. REQUIREMENTS Bidder shan provide a detailed summary and explanation of Bidder's HIPAA Compliance Plan, including Bidder's certification that an personnel have been appropriately trained and have signed a confidentiality agreement. Panel Member's Name SPECIFIC SUBMISSION DATA DOCUMENT A TION PROVIDED Specific Submission Data: 1. Bidder submitted evidence ofHIPAA Compliance Plan. [J HIPAA Compliance Plan summary Statement of certification of u (I 0 pts.) personnel training. Statement of certification of signed confidentiality agreement I page limit [J [] Confidential REVIEWER NOTES 10 pts. Full Compliance Bidder provided a detailed summary of its HIP AA Compliance Plan. 0 pts. Non-Compliance Bidder failed to provide a copy of its HIPAA Compliance Plan or the information provided for this Item is incomplete. Page 14 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Bidder Item 16: Corporate Com}!liance Plan Bidder may provide a detailed summary and explanation of Bidder's Corporate Compliance Plan. Bidder may show proof of compliance with the elements identified in the Office oflnspector General's Compliance Program Guidance for Ambulance Suppliers [Federal Register: March 24, 2003 (Volume 68, Number 56)]. Bidders are not required, as a condition of the contract, to have or submit a copy of any Corporate Compliance Plan and such a Plan is not required by OCFA for the provision of ambulance services in any EOA. REQUIREMENTS I SPECIFIC SUBMISSION DOCUMENTATION REVIEWER DATA PROVIDED NOTES Specific Submission Data: U Policies and procedures Automatic Extra Points 1. Bidder submitted evidence of a [J Internal auditing procedures 5pts. Bidder submitted evidence Corporate Compliance Plan. for pre-bill and post- of a Corporate Compliance (5 pts.) payment claims Plan. [] 2 page limit ST ANDARD: Please Note: Neither state nor federal law requires an ambulance provider to have a Corporate Compliance Program/Plan. Therefore, submission of any p'lan by the Bidder is voluntary, Only extra points are applicable "or this Item, Panel Member's Name Confidential Page 15 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET SECTION VII RATES FOR AMBULANCE SERVICE Item 17: Com:(!liance with M()nthly Payment Bidder ST ANDARD: Bidder shall pay all ALS reimbursements and medical supply reimbursements promptly to the OCF A Finance Section within 90 days after the first day of each month, beginning August 1, 2004. REQ UlREMENTS Bidder shall provide a detailed summary and explanation of the system for providing timely monthly payments to OCFA and which addresses how Bidder intends to satisfy the procedures and requirements set forth in the RFP, i.e., Bidder's proposed system for inspection of all billing records and monthly payment record keeping and auditing practices; Bidder's proposed system for making ALS Reimbursement payments; and Bidder's proposed system for making the required Medical Supply Reimbursement Rate payments to OCF A. Panel Member's Name SPECIFIC SUBMISSION DATA DOCUMENT A TION PROVIDED Specific Submission Data: 1. Bidder's proposed system for inspection of all biIling records and its monthly payment record keeping and auditing practices. System for inspecting billing records Record keeping and auditing practices Proposed system for making monthly payments to OCFA 4 page limit [] [ I [] (4 pts.) 2. Bidder's proposed system for making the required ALS Reimbursement Rate payments. [] (3 pts.) 3. Bidder's proposed system for making the required Medical Supply Reimbursement Rate payments to OCFA. (3 pts.) Confidential REVIEWER NOTES 10 pis. Full Compliance Bidder has provided a complete summary of its system for providing monthly payments, record keeping and auditing practices, and its ability to make all rate payments. Bidder's systems exceed the standards in the RFP. 0 pis. Non-Compliance Necessary information is missing or incomplete and/or Bidder's documentation and payment systems fail to meet the standards in the RFP. Page 16 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Item 18: Plan for Takeover of Service/Start-u Bidder STANDARD: Bidder shall provide an implentation plan for the takeover or start-up of services within the subject EOA. REQUIREMENTS Bidder shan provide a detailed summary and explanation of the proposed implementation plan for the takeover or start-up of services under the new contract. Panel Member's Name SPECIFIC SUBMISSION DATA Specific Submission Data: 1. Bidder's transition or implementation management team. (3 pts.) 2. Proposed start-up schedule for ensuring timely commencement of services on July I, 2004. (4 pts.) 3. Proposed initial service response and coverage plan, including deployment plans, post locations, and staffing plans, (8 pts.) DOCUMENT A TION PROVIDED [J Implementation management team 0 Start-up schedule Initial service response coverage plan Deployment plan, post locations and staffing 4 page limit [] [I [I Confidential REVIEWER NOTES 15 pts. Full Compliance Bidder provided a detailed summary of the takeover implementation plan. Bidder's implementation plan exceeds the standards in the RFP. 0 pts. Non-Compliance Necessary infonnation is missing or incomplete and/or Bidder's implementation plan fails to meet the standards in the RFP, Page 17 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Item 19: FirelEMS 911 Resume (Last 10 years) STANDARD: Bidder shall provide a detailed resume of its 911 experience for the last 10 years. *See AttachmenLG for grading assistance for this Item. REQUIREMENTS Bidder shall provide a detailed resume of Bidder's Fire/EMS 911 emergency ambulance transportation relevant experience for the last 10 yrs. Pallel Member's Name SPECIFIC SUBMISSION DATA DOCUMENT A TION PROVIDED Specific Submission Data: 1. Bidder submitted resume for last 10 years. [J Detailed resume of 911 experience for last 10 yrs. 5 page limit LJ (10 pts.) Confidential Bidder REVIEWER NOTES 30 pts. Full Compliance Bidder provided a 10 yr. Detailed resume of911 experience. Bidder's experience exceeds the standards in the RFP. 0 pts. Non-Compliance Necessary infonnation is missing or incomplete and/or Bidder's 911 experience fails to meet the standards in the RFP. Page 18 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEET Bidder Personal Interview / Oral Presentation ST ANDARD: OCF A may request a personal interview with or an oral presentation by any Bidder, to be conducted by and presented to members of the OCF A Grading Panel. REQUIREMENTS Bidder shall comply with OCF A's request for either a personal interview or an oral presentation. Please Note: A Grader may award any and all oints up to and including 25 pts. 'or any Bidder that succëssfully Jrovides information during a personal interview or oral presentation that is favorable to the selection of this Bidder for a given EOA. Panel Member's Name SPECIFIC SUBMISSION DATA DOCUMENTATION PROVIDED REVIEWER NOTES Optional Extra Points 2Spts. Bidder provided favorable information about its operations and intentions for a given EOA. Specific Submission Data: None. None. Confidential Page 19 ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder ATTACHMENT A Page 1 of Attachment A GUIDELINE USE ONLY! ESTIMATED UNITS BY EXCLUSIVE OPERATING AREA GRADER NOTE: When reviewing Bidder's proposed operational plan, please consider the units represented in the last 2 columns independently. A Bidder must represent in its bid both dedicated and regionally available units for a given EOA, regardless of a Bidder's ability to secure additional EOAs. EOA # CITY OF: INCLUDES COUNTY 2003 TOTAL OPTIMUM UNITS OPTIMUM UNITS REGIONALLY AREAS OF: TRANSPORTS DEDICA TED/DA Y* A V AILABLE/DA Y* 5 Cypress 1,208 1+ 1+ Santa Ana Hts 10 Irvine area, JW A 4,662 3+ 2+ 13 La Palma 417 1+ 1 14 Los Alamitos Rossmoor 733 1+ 1 Brea Unincorp & 17 P1acentia Tonner Cynarea 1,279 1+ 1+ 19 San Juan Capistrano Ortega Hwy 1,282 1+ 1+ Sunset Beach, 21 Seal Beach Bolsa Chica 1,790 2+ 1+ 22 Stanton .. Midway City 1,865 2+ 1+ Cowan, Lemon 23 Tustin Hts 2,807 2+ 1+ Orange/Olive, Orange Park, 24 Villa Park Silverado 136 1 1 Chino Hills State 26 Yorba Linda Park 1,355 1+ 1+ Panel Member's Name Confidential Attachment ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder Page 2 of Attachment A A TT ACHMENT A GUIDELINE USE ONLY! ESTIMATED UNITS BY EXCLUSIVE OPERATING AREA EOA # CITY OF: INCLUDES COUNT'\' 2003 TOTAL OPTIMUM UNITS OPTIMUM UNITS REGIONALLY AREAS OF: TRANSPORTS DEDICA TEDIDA Y* A V AILABLEIDA Y* 28 Laguna Hills 1,276 1+ 1+ Trabuco, O'Neill Rancho Santa Park, Las Flores, 29 Margarita Coto de Caza 1,524 2+ 1+ 30 Laguna Niguel 1,461 1+ 1+ 32 Aliso Viejo Woods/ Aliso Cyn 599 1+ 1+ Crystal Cove, unincorp Laguna wilderness, . 35 Laguna Woods Emerald Bay 3,116 3+ 1+ 38 Mission Viejo 3,150 3+ 1+ 39 Dana Point 1,276 1+ 1+ Modjeska, upper 42 Lake Forest Trabuco/Cooks 2,011 2+ 1+ * Optimum units dedicated or regionally available per day (last two columns of the spreadsheet) are an estimated number based on total transports for 2003. This optimum number of units is not based on call volume or dispatch infonnation and does not take into consideration data such as peak call volume hours of the day, as would be necessary infonnation to accurately estimate the number of units needed for an EOA by hour, by day. The optimum units estimated in the last two columns are for grading purposes only and should not be relied on for system status management, unit deployment or any particular utilization pattern. Panel Member's Name Confidential Attachment ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS ATTACHMENT A AMBULANCE - GRADING GUIDELINES Average Average Average Aee of Ambulances Points Mileaee Points Condition ~oints less than 1 year 5 > 50,000 5 Excellent 5 1 - 2 years 4 50,000- 75,000 4 Very Good 4 2- 3 years 3 75,001-100,000 3 Good 3 3 - 4 years 2 100,001-125,000 2 Fair 2 4 - 5 years 1 125,001-150,000 1 Poor 1 greater than 5 years 0 > 150,000 0 Panel Member's Name Confidential Bidder Page 3 of Attachment A Attachment Maximum BLS Service Rate Maximum ALS Service Rate ALS Reimbursement Rate Medical Supply Reimbursement Rate Panel Member's Name ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder ATTACHMENT B RATE SCHEDULE Per Transport $ 531.00 $ 282.00 (Total Billable ALS Rate = $813.00) $ 200.00 $ 22.38 Confidential Attachment ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder ATTACHMENT C Page 1 of Attachment C STANDARD INVENTORY (a) Essential equipment and supplies to be carried shall include as a minimum: (1) An ambulance cot and collapsible stretcher; or two stretchers, one of which is collapsible. (2) Straps to secure the patient to the stretcher or ambulance cot, and means of securing the stretcher or ambulance cot in the vehicle. (3) Ankle and wrist restraints. Soft ties are acceptable. (4) Sheets, pillow cases, blankets, and towels for each stretcher or ambulance cot, and two pillows for each ambulance. (5) Three oropharyngeal airways, one each of a size for adults, children and infants. (6) At least four pneumatic or rigid splints capable of splinting all extremities. (7) A resuscitator that meets the requirements of Vehicle Code Section 2418.5. A hand operated bag-valve-mask unit with clear masks of adult, child, and infant sizes capable of use with oxygen will meet this requirement. (8) Oxygen (USP), regulator, and means for administering oxygen, including adequate tubing and semiopen, valveless, transparent masks in adult, child, and infant sizes. Oxygen may be administered by resuscitator, bag mask unit, or inhalator. (Portability required.) Oxygen supply must be sufficient to provide a patient with not less than 10 liters per minute for 20 minutes. (9) Clean bandages and bandaging supplies: Twelve sterile bandage compresses or equivalent Four 3- by 3-in. sterile gauze pads Six 2-, 3-, 4-, or 6 -in. roller bandages Two rolls of 1-, 2- or 3-in. adhesive tape Bandage shears Two 10- by 30-in. or larger universal dressings Panel Member's Name Confidential Attachment ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder ATTACHMENT C Page 2 of Attachment C STANDARD INVENTORY' (10) An emesis basin, or disposable bags and covered waste container. (11) Portable suction equipment. Squeeze syringes alone are not sufficient. Must comply with OCEMSA policies and procedures. (12) Two sandbags, loosely filled, or equivalent material to restrict movement. (13) Two spinal immobilization devices, one at least 30-in. in length and the other at least 60-in. in length with straps for adequately securing patients to the devices. Combination short-long boards are acceptable. (14) Half-ring traction splint for lower extremity with limb support slings, padded ankle hitch traction strap, and heel rest or an equivalent device. (15) Blood pressure manometer, cuff, and stethoscope. (16) Sterile obstetrical supplies including as a minimum: gloves, umbilical cord tape or clamps, dressings, towels, bulb syringe, and clean plastic bags. (17) A gallon or more of potable water or two liters, saline solution in covered, secured plastic container. (18) One bedpan or fracture pan. (19) One urinal. (20) Sterile gloves, disposable, all sizes, four (4) pair. (21) Heavy gloves to be used for blood or body fluid protection. I Title 13 California Code of Regulations, section 1103.2 Panel Member's Name Confidential Attachment ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder ATTACHMENT D Page 1 of Attachment 0 RESPONSE TIME REQUIREMENTS Contractors must strictly adhere to the following response times at a quarterly compliance rate of ninety percent (90%) in each Code 2 and Code 3 category. 1. MetrolUrban Requirements: (All other EOAs) a. Code 3 - Response time must not exceed 10 minutes, 0 seconds. b. Code 2 - Response time must not exceed 15 minutes and 0 seconds. 2. SuburbanlRural Requirements: (Brea, Tonner Cyn, Ortega Hwy, Newport Coast, Laguna, Modjeska and Trabuco/Cooks) a. Code 3 - Response time must not exceed 20 minutes, 0 seconds. b. Code 2 - Response time must not exceed 25 minutes, 0 seconds. 3. Wilderness Requirements: (Cleveland National Forest areas, i.e., Rancho Santa Margarita) a. Code 3 - Response time must not exceed 30 minutes, 0 seconds. b. Code 2 - Response time must not exceed 40 minutes, 0 seconds. Panel Member's Name Confidential Attachment ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder A TT A CHMENT D Page 2 of Attachment D RESPONSE TIME REQUIREMENTS - GRADING GUIDELINES GRADER NOTE: The following worksheet is provided to assist each grader in scoring the Bidder's level of compliance. Grader should review Bidder's response time reports for each month to determine if the standard of 90% response time compliance is met. Bidder met response time requirements for each month: 95% - 100% 90% - 94.9% 85% - 89.9% = 5 pts. = 4 pts. = 3pts. 80% - 84.9% 75% - 79.9% less than 75% = 2 pts. = 1 pt. = 0 pts. Panel Member's Name Confidential Attachment Bidder ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS ATTACHMENT F PERSONNEL REQUIREMENTS & GRADING GUIDELINES 1. Valid California Driver's License 2. Drug and alcohol program 3. Pre-employment procedures 4. Random testing program 5. Participation in California Department of Motor Vehicles Employer Pull Notice Program 6. Criminal background checks 7. Dress code policies 8. Compliance with federal, state and local laws, rules, statutes, and regulations 9. Provider in good standing in the MediCare and Medi-Cal programs 10. Continuing education programs II. HIP AA Privacy training and signed acknowledgement that personnel completed training. (May be submitted with Item 16). Mana2ement - Experience with Employer Manal!ement - Professional Experience > 20 years 15 - 20 years 10 - 15 years 5 - 10 years < 5 years = 5 pts. = 4 pts. = 3 pts. = 2 pts. = 1 pt. > 20 years 15 - 20 years 10 - 15 years 5 - 10 years < 5 years = 5 pts. = 4 pts. = 3 pts. = 2 pts. = 1 pt. Field Personnel - ProfessionalE:xperience Field Personnel - Experience with Employer > 20 years 15 - 20 years 10 - 15 years 5 - 10 years < 5 years = 2.5 pts. = 2 pts. = 1.5 pts. = 1 pts. = 0.5 pt. > 20 years 15 - 20 years 10 - 15 years 5 - 10 years < 5 years Panel Member's Name Confidential = 2.5 pts. = 2 pts. = 1.5 pts. = 1 pts. = 0.5 pt. Attachment ORANGE COUNTY FIRE AUTHORITY RFP GRADING SHEETS Bidder ATTACHMENTG 911 EXPERIENCE GRADER NOTE: This worksheet is meant to be used as a grading guideline ONLY. Grader should review Bidder's resume to determine total number of years of relevant 911 experience and choose a grade. Then the Grader should review the comparability of the service area to a given EOA for which the bid was submitted and choose a grade. Total both grades and document the total points given in Item 19. Comparability of Sgrvice Area Experience Years of 911 experience 5-10 years of experience = 5 points Experience in a less populated, geographically smaller area than the given EOA. 10-15 years of experience = 10 points = 4 points Experience in a similarly populated and geographically sized area than the given EOA. 15-20 years of experience = 15 points = 7 points Experience in a greater populated, geographically larger area than the given EOA. >20 years of experience = 20 points = 10 points Panel Member's Name Confidential Attachment ATTACHMENT H Page 1 of Attachment H SCORING GUIDELINE Definitions: Non-Compliance The Bidder has failed to provide all necessary and required information to comply with the standards outlined in the RFP for a particular Item. The information provided by the Bidder is incomplete or fails to meet the standards set forth in the RFP for a particular Item. Fairly Compliant The Bidder provided most of the necessary and required information to comply with the standards outlined in the RFP for a particular Item. The information provided by the Bidder is adequate and meets most but fails to meet all of the stanards set forth in the RFP for a particular Item. Overall the Bidder is qualified to meet the basic needs of a given EOA but the information provided by the Bidder shows that the Bidder has areas of improvement or deficiencies that need to be addressed. Compliant The Bidder provided all necessary and required information to comply with the standards outlined in the RFP for a particular Item and the information provided is complete for form and substance. The Bidder's information for a particular Item meets all standards and requirements set forth in the RFP for a particular Item. Overall the Bidder is competent and is qualified to meet the needs of a given EOA. The Bidder professionally provided complete information to support the high quality of its operations and service as a whole. Full Compliance The Bidder provided all necessary and required information to comply with the standards outlined in the RFP for a particular Item and the information provided is complete for form and substance. The Bidder's information for a particular Item exceeds the standards and requirements set forth in the RFP for a particular Item. Overall the Bidder is highly competent and is more than qualified to meet the needs of a given EOA. The Bidder professionally provided complete information to support the high qualify of its operations and service as a whole and showed outstanding commitment to service quality and patient care. ATTACHMENT H Page 2 of Attachment H SCORING GUIDELINE FULL ITEM # CATEGORY NON-COMPLIANCE FAIRLY COMPLIANT COMPLIANT COMPLIANCE 0 N/A N/A 20 0 15 25 35 0 10 18 25 0 15 20 25 0 10 0 10 15 20 0 12 18 25 0 5 7 10 0 2 4 5 0 4 7 10 0 4 7 10 0 8 15 25 0 6 12 15 0 4 7 10 0 5 0 4 7 10 0 6 12 15 0 10 20 30 0 N/A N/A 25 Please Note: Extra points have not been included in the scoring guidelines above. The point spread above reflects standard points only for a given Item. ATTACHMENT H GRADING SCORECARD ITEM # CATEGORY SUB-TOTAL AWARDED POINTS EXTRA POINTS AWARDED TOTALS Panel Member Name: Panel Member Signature: TOTAL POINTS AWARDED Date: Page 3 of Attachment H MAX. PTS. ALLOWED (w/Extra Pts.) ORANGE COUNTY FIRE A UTH 0 RITY AMENDMENT NO.1 TO REQUEST FOR PROPOSALS FOR FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES RFP # RL972 SERVICES EFFECTIVE JULY 1,2004 PHASE 2 - PROPOSAL, GRADING, RECOMMENDATION AND SELECTION 179999,6 TABLE OF CONTENTS PAGE SECTION I - GENERAL INFORMATION ..................,...........................................................,.......................1 A. 1. 2. B. C. D. E. F. G. H. BACKGROUND............................................................................................................................................1 Orange County Fire Authority................................................................................................................1 Orange County EMS ................................................................................................................................1 SCOPE OF SERVICES ...........,....................................................................................................................2 RFP PROCESS...............................................""""""""""""""""""""""""""'"........................................3 NOTICE INVITING PROPOSALS ............................................................................................................3 PUBLIC BIDDING STATUTES..................................................................................................................3 COST OF PREPARATION ...................,.....................................................................................................3 UNDERSTANDING PROPOSAL .....,.........................................................................................................3 CONTRACTOR SELECTION AND AWARD ..........................................................................................4 SECTION IT - ADMINISTRATION...............................................................................................,...................5 A. 1. 2. B. C. 1. 2. D. 1. 2. 3. E. 1. 2. F. 179999,6 BID PROPOSAL SUBMISSION PROCESS..............................................................................................5 Phase I - Prequalification ....................,.............................................,.....................................................5 Phase 2 - Proposal, Grading, Recommendation and Selection ............................................................5 MANDATORY BID PROPOSAL PRE-SUBMISSION CONFERENCE ...............................................5 BID PROPOSAL SUBMISSION REQUIREMENTS ...............................................................................6 Bid Proposal Submission Due Date.........................................................,...............................................6 Bid Proposal Submission Instructions: Required Format ....................................................................6 PUBLIC OPENING OF BID PROPOSALS...............................................................................................8 Bid Proposal Op"ening ..........,................."................................................................................................8 Announcement """"""""""""""""""""""""""""","""""""""""""""""""""""'".........,....................9 Late Submission...............,..,..,.................................................,..................................,......,.,..........,.........9 BID PROPOSAL EVALUATIONS ........................................................................................,....................9 Competitive Process .........................,.....................................................,.......................................,.....,...9 Proposal Grading Panel.......,..................................,................................................................................9 ADMINISTRATIVE ...,...,............,....................................,......................................,....................................9 1. 2. 3. 4. 5. 6. G. H. I. Bid Proposal Deposit ................................................................................................................................9 OCFA Travel Expenses.,.............,........,.....,..........,........................,....................................................,..10 Oral Presentations..............,....,........,..........................,.....,...,................................................................10 Proprietary Information ........................................................................................................................10 Voluntary Withdrawal of Bid Proposal...................................,...................................................,........10 Cancellation ofRFP Process.............................,................,.........................,..........................,..............10 BID PROPOSAL REJECTION ......................................................,..........................................................10 AWARD PROTEST....................................................................................................................,...............11 PROPOSED SCHEDULE OF EVENTS (ESTIMATED) .......................................................................12 SECTION III - GENERAL TERMS AND CONDITIONS ............................................................................13 A. B. C. D. E. 1. 2. 3. F. G. H. 1. 2. I. J. L. M. 1. 2. 179999,6 CONTRACT DOCUMENTS ........................................................................................................,............13 CONTRACT MODIFICATION AND AMENDMENTS ........................................................................13 CONTRACT ADMINISTRATION ...........................................................................................................13 CONTRACT EFFECTIVE DATE ..........................................................................................................,.13 CONTRACT TERM ...................................................................................................................................13 Term ........................................................................................................................................................13 Contract Extension .................................................................................................................................13 Termination..............................................................................,....................................,.........................14 INSURANCE .................................................................................................................................,.............14 ASSIGNMENT ............................................................................................................................................14 AUDITS AND INSPECTIONS ..................................................................................................................14 Business Office .....................,........................................................................................................,.........14 FacilitiesNehicles ....................,.......,......................................................................................................15 COOPERATION......................................................................................................,..................................15 NON-COLLUSION CERTIFICATE ..,.............................................................................................,.......15 INDEPENDENT CONTRACTOR......................................................,.....................................................15 INDEMNIFICATION ...................................,...............................................................................,.............15 General.,.......,.,.....................,.......,....................................,.,............................,..........,...........................15 Rates ..............,...,............................................................................,........,...............................................15 11 N. O. P. Q. R. COMPLIANCE WITH LAWS """"""""""""""""""""""""""""""""""""""'"..........................,..,.....16 RISK...............................,..................................,.......,..,...............................................................,.............,.16 RESPONSffilLITY .......................,............................................................................,....,....................,......16 ACTS OR OMISSIONS OF REPRESENTATIVES................................................................................16 INSOLVENCY ...............,...................................,.,...,..................................................................................16 SECTION IV - OPERATIONAL STANDARDS, PROCEDURES ...............................................................17 A. 1. 2. 3. 4. 5. B. 1. 2. C. 1. 2. D. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 179999,6 EMERGENCY RESPONSE COMMUNICATIONS SYSTEM ................................................,............17 Compliance with Laws ...........................................................................................................................17 Communications Requirements """""""""""""""""""""""""""""""""""""""""""......................17 800 MHz County-wide Coordinated Communications System ..........................................................17 CAD Interface............,..........................................................................,.................................................18 System Upgrades ...........................................:...........""""""""""""""""""""""""""'"......................18 VEIDCLE COMMUNICATIONS.............................................................................................................18 800 MHz Mobile Radio .................................,...,....................................................................................18 Mobile Data Computer System .............................................................................................................18 SERVICE HOURS......................................................................................................................................19 Service...............................,...............................,...,..................................................................................19 Field Supervisor ......................................................................................................................................19 RESPONSE TIMES....................................................................................................................................19 General Requirements .........................................................."...............................................................19 Response Time Measurement................................................................................................................19 Definition of Geographical Areas & Response Priority Codes........................................................... 19 Response Times Required......................................................................................................................20 Response Time Reporting ......................................................................................................................20 Call Cancellation ................................,...........................,.,...............,...............,.....................................21 Quarterly Response Time Report - Format .........................................................................................21 Exemptions to Response Time Requirements """""""""""""""""""""""""""""""""""""""'".....21 Procedures to Request Response Time Exemption..............................................................................22 Use of Alternative Methods to Meet Response Time Requirements ..................................................22 11l 11. E. F. G. H. 1. 2. 3. 4. 5. 6. 7. 8. 9. I. J. Disciplinary Actions for Failure to Meet Response Time Requirements...........................................22 EMERGENCY ON-SCENE PROCEDURES..,....,..,..,..............................,........"...................................,24 DISASTER ASSISTANCE .......................,..............................................,......,...........................................25 STANDARD OF PERFORMANCE,.....................,...................................................................................26 GENERAL PROVISIONS .........................,.......................................................................,.......................26 Return ofOCFA Personnel............"......................................................................................................26 911 Calls for Service/Referral...............................................................,................................................26 Performance........................................,.......................................,................................,..........................26 Conflict of Interest........................................................................ ..........................................................27 Complaints .......,...........................................................................................................,..........................27 Traffic Signal Preemption..............,.......................................................................................................27 CAAS Accreditation...............................................................................................................................27 mp AA Business Associate Assurances.................................................................................................27 MedicarelMedi-Cal Participation ...,.....................................................................................................28 EXTERNAL MEDICAL QUALITY CONTROL....................................................................................28 INTERNAL MEDICAL QUALITY CONTROL .....................................................................................28 SECTION V - PERSONNEL.............................................................................................................................29 A. 1. 2. B. PERSONNEL REQUIREMENTS .................,......................,...............................,.,..................................29 Employee Performance ................................................................,.........................................................29 Employee Removal.................................................................................................................................31 CONTROL.............,......................................................................................,..............................................31 SECTION VI - SUPPLIES, EQUIPMENT AND VEmCLES.......................................................................32 A. 1. 2. B. 1. 2. 3. 179999,6 SUPPLIES AND EQUIPMENT................,............................................................................,...................32 Standards ..........................,......................................,..............................................................................32 Standard Inventory ..,...................................,...,.....................................................................................32 VEmCLES AND MAINTENANCE .,....................,..................................................................................32 Standards ...........................,.....................,.......,........................................,..,..........................................32 Modular (Type Ill) ..............................,..................................................................................................32 Inspection """"""""""""""""""""""""""""""""""""""'"..............................................,..................33 iv 4. Maintenance....,........................,..............,..,..............""""""""""",""""""""""""""""""""""""""...33 5. Personal Safety Equipment..............................,.....,...............................................................................33 SECTION Vll - RATES FOR AMBULANCE SERVICE..............................................................................34 A. 1. 2. 3. 4. 5. 6. 7. B. 1. 2. 3. 4. C. 1. 2. 3. 4. D. BLS AND ALS SERVICE RATES ..................................,....................................,..................,.................34 Maximum BLS Service Rate..................................................................................................................34 Maximum ALS Service Rate """""""""""""""""""""""""""""""""""""""""""".........................34 ALS Reimbursement Rate .....................................................................................................................34 Medical Supply Reimbursement Rate .............................,....................................................................35 Zero Pay Patient .....................................................................................................................................36 Risk ofNon-Payment..............................................................................................................................36 Medicare Patients ...................................................................................................................................36 BILLING, AUDIT AND ACCESS TO RECORDS..................................................................................36 Billing System.......................................................'..............................................,...................................36 Accounting...............................................................................................................................................36 Responsibility for Submission of Claims ..............................................................................................37 Medicare Audits......................................................................................................................................37 CONTRACTOR MONTHLY PAYMENTS .............................................................................................37 Monthly Payments to OCFA .................................................................................................................37 Zero Pay Patient Exemption Requests..................................................................................................38 Monthly Payment Report ......................................................................................................................38 Audit Report ............................................................;..............................................................................38 SECTION VIll - BID PROPOSAL SUBMISSION FORMS .........................................................................40 CHANGED CIRCUMSTANCES ..............,...............................................................................................39 SECTION IX - ATTACHMENTS ....................................................................................................................68 SELECTION AND CONTRACTING AUTHORITY...,........................................................................................69 ESTIMATED TRANSPORT VOLUMES BY EXCLUSIVE OPERATING AREA...........................................70 EXCLUSIVE OPERATING AREAS AND CORRESPONDING MAP ..............................................................71 PROPOSED (DRAFT) MODEL EXCLUSIVE OPERATING AREA AGREEMENT......................................72 SAMPLE QUARTERLY RESPONSE TIME REPORT .............................................,......................................... 73 179999.6 v SECTION I - GENERAL INFORMATION A. BACKGROUND 1. Oran2e County Fire Authority The Orange County Fire Authority ("OCF A") is a governmental entity providing fire and life safety services to over one million residents within the County of Orange, California. OCF A is a Joint, Powers Agency ("JPA") organized pursuant to the provisions of Article 1, Chapter 5, Division 7, Title I (commencing with Section 6500) of the California Government Code. OCFA consists of 22 member cities and the County of Orange. Each OCF A JP A member agency individually has the statutory ability to provide fire suppression, protection, prevention and related and incidental services, including emergency ambulance response services, within their respective jurisdictions. By entering into a Joint Powers Agreement, each JPA member agency vested OCFA with the power to exercise each member agency's legal ability to provide fire suppression, protection, prevention and related and incidental services, including emergency medical and transportation services, and other fire related services authorized by law within their respective jurisdictional boundaries. Each OCF A JP A member agency has elected to jointly exercise their powers to provide for such services through the formation of OCF A. 2. Oran2e County EMS The Legislature has enacted the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (EMS Act), which creates a comprehensive statutory system governing virtually every aspect of prehospital emergency medical services. The purpose of enacting the EMS Act was to achieve state-wide coordination and integration of prehospital emergency medical servIces. The EMS Act accomplishes this integration through what is essentially a two-tiered system of regulation. At the state level, the Emergency Medical Services Authority (EMS Authority) performs a number of different functions relating to the coordination of EMS throughout the state. The second tier of governance under the EMS Act is occupied by counties and their local EMS agency (LEMSA). The EMS Act authorizes each comity's LEMSA to develop an emergency services program. Each county developing such a program is required to desigtlate the county health department as the local EMS agency. In Orange County, this function is performed by Orange County EMS, a division of the County Health Care Agency (OCEMSA). All Orange County providers of prehospital emergency medical services are required to operate within the local EMS system developed by OCEMSA. The Orange County Board of Supervisors designated OCEMSA as the LEMSA for purþosesof administering the local EMS Plan within the County. The County, however, does not regulate ambulance transport services within cities. Rather, the County allows cities to administer their EMS/ambulance programs in coordination and cooperation with the local EMS Plan and OCEMSA. In 1985, the County of Orange adopted County model ambulance ordinance no. 3517, which is a mechanism for licensure of emergency medical transport services and for establishing transport service areas. The County adopted Ordinance No. 3517 ("model Ambulance Ordinance") with the intention that it serve as a model city ambulance ordinance for adoption by cities within Orange County. Under this approach, the County's EMS Plan allows cities to provide ambulance transport services in accordance with the model Ambulance Ordinance. OCF A administers the ambulance programs on behalf of its member agencies. 1 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 Health and Safety Code § 1797.224 authorizes OCEMSA to create exclusive operating areas in the development of its local EMS Plan. The creation of exclusive operating areas is authorized by state law, provided a competitive process is utilized to select providers of the services pursuant to the local EMS Plan. Through input and recommendation by the OCF A EMS Section, exclusive ambulance service areas have been approved and created by OCEMSA for all OCF A jurisdictional areas. Only to the extent that OCEMSA designates an exclusive operating area and consents to the current Ambulance Ordinance structure may such services be provided by cities. In short, OCF A and/or its member agencies award ambulance service contracts by acting under the authority of OCEMSA and its state approved EMS Plan. Exclusive operating area maps for OCFAjurisdictional areas are attached in Section IX, Attachment C. Unincorporated service areas are subject to annexation or incorporation at any time as determined by the Orange County Local Agency Fonnation Commission ("LAFCO"). Exclusive operating areas may be changed, adjusted, or redrawn by OCEMSA at any time during the contract period. OCF A has no control over such Wlanticipated service area and/or jurisdictional changes. Any contract awarded pursuant to this RFP that is affected by a service area or jurisdictional change is subject to review and approval by the new governing authority, if any. For reference, the Orange COWlty Fire Authority will hereinafter be referred to as "OCFA." Interested ambulance service operators will be referred to as "Providers." Companies responding to this RFP will be referred to as "Bidders," and ambulance service operators selected to provide services within exclusive operating areas pursuant to this RFP will be referred to as "Contractors." "City" will refer to an OCF A member city only. "COWlty" will refer to the COWlty of Orange. B. SCOPE OF SERVICES OCF A is soliciting proposals fÌ'om pre-qualified ambulance service operators for emergency ambulance transportation and related services on behalf of all OCF A member agencies (except Buena Park, San Clemente, and Westminster) for the award of exclusive operating contracts in accordance with the specifications set forth in this Request for Proposal ("RFP"). OCF A, in cooperation with selected ambulance service providers, will provide on-scene Advanced Life Support ("ALS") services, and selected ambulance service providers will provide Basic Life Support ("BLS") services and transport patients to medical facilities, when required. Based on the specifications, delivery criteria, and competitive process set forth in this RFP, exclusive operating area ("EOA") contracts will be awarded to successful Bidders for each of the exclusive operating areas identified in Section IX, Attachment C. Each EOA is assigned a number based on a geographical area. The current EOA contracts for emergency medical transportation and related services within the OCF A jurisdictional areas are set to expire on June 30, 2004. OCF A is requesting proposals fÌ'om pre- qualified Providers only for the provision of emergency medical transportation and related services commencing July 1, 2004. The contracts awarded Wlder this RFP are for an initial five (5) year term ending on JWle 30, 2009. With mutual written agreement of the parties, and at the sole discretion of the OCF A Fire Chief and/or the awarding agency, if applicable, the contracts may be extended for up to an additional five (5) years. The total contract tenn, however, shall not exceed ten (10) years. 2 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 C. RFP PROCESS The 2004 FirelEMS Emergency Ambulance Transportation and Related Services RFP process encompasses two separate and distinct components. The first is Phase I - the provider prequalification phase. Ambulance service operators not satisfying all of the minimum prequalification criteria and requirements are not eligible to continue in the RFP and selection process. The second component is Phase 2 - the proposal, grading, recommendation, and selection phase. Both components are discussed further in Section II. D. NOTICE INVITING PROPOSALS Notice of this RFP has been published in multiple media outlets and has been advertised with the Ambulance Association of Orange County (AAOC) , the Los Angeles County Ambulance Association, the American Ambulance Association (AAA), and the California Ambulance Association (CAA). Notice of this RFP and prequalification application materials were issued December 22, 2003. The prequalification application submission period closed on January 15,2004. Notices inviting bid proposals from approved, pre-qualified Providers and announcing issuance of this RFP were sent to all approved, pre-qualified ambulance service operators, along with a copy of the RFP, on February 19,2004. Copies of the RFP will also be made available to the public on or after February 19, 2004 by calling the Clerk of the Authority at (714) 744-0400. E. PUBLIC BIDDING STATUTES The award of exclusive operating area contracts for ambulance services under this RFP is not subject to public bidding statutes, although the rates charged for services to be provided will be a factor in the consideration for award of contracts. At the sole discretion of OCF A, OCF A reserves the right to reject any or all prequalification applications and RFP bids, in whole or in part, and is not bound to accept the lowest bid (or the bid prices for services). OCFA reserves the right to waive any prequalification application and RFP bid irregularities. A pre qualification application or RFP bid may be rejected by OCF A if it is in any way incomplete or irregular, or if it contains material misrepresentations of fact or omits material infonnation required. F. COST OF PREPARATION Bidders assume all costs associated with the preparation of their bid proposals and any oral presentations that may be necessary or required throughout the procurement process. G. UNDERSTANDING PROPOSAL It is the responsibility of each Provider to inquire about any criteria, condition, term, provision, or requirement of the RFP that the Provider does not understand. Responses to inquiries, if they significantly change or clarify the RFP requirements or any aspect of the procurement process, will be forwarded by addenda to all Bidders. OCF A will not be bound by any oral responses to inquiries. By submitting bid proposals, Bidders agree and assure that .the RFP and contract tenus and conditions are adequate and acceptable, and each Bidder accepts the terms and conditions of the Contract Documents (as defined in Section III), and indicate their ability and willingness to perform the requested services under such terms and conditions. Any exceptions to the terms and conditions set forth in the Contract Documents should be clearly noted in each Bidder's proposal. Please direct all questions regarding the procurement process to: 3 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 John K. Howlind, Battalion Chief Orange County Fire Authority/EMS Section 1 Fire Authority Road , Irvine, California 92602 (714) 573-6071 H. CONTRACTOR SELECTION AND AWARD The award of EOA contracts under this RFP will be made by either the OCF A Board of Directors or by individual OCF A member cities that retain provider selection and contracting authority. The contract awards are final and may not be appealed and are not subject to the protest provisions of state public bidding statutes. OCFA and its member cities may, however, reconsider any award upon a finding of good cause at their sole discretion. Selection and contracting authority information, along with estimated transport volumes per EOA, are included in Section IX, Attachments A and B respectively. All Bidders will be notified in writing at the conclusion of the procurement process as to the results of the bid proposal evaluation process and the fmal award recommendations. Bidders will receive mailed award/non-award notification, which will include the name of the Bidders awarded EOA contracts. 4 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 SECTION II - ADMINISTRATION A. BID PROPOSAL SUBMISSION PROCESS The Orange County Fire Authority is committed to providing and maintaining the highest levels of emergency response service as possible to the public on behalf of its member agencies. The provision of emergency ambulance transportation and related services within the OCF A jurisdictional areas is a critical part of OCFA's continuing efforts to achieve this objective. The 2004 Fire/EMS Emergency Ambulance Transportation and Related Services RFP process encompasses the following two components: 1. Phase I - Preaualification On December 22, 2003, OCFA issued the Phase I prequalification application materials to all interested ambulance service operators. Providers not satisfying all of the minimum prequalification criteria and requirements are not eligible to continue in the procurement process and will not be eligible for the award of an EOA contract. Pursuant to the Phase I prequalification application materials, all Providers that wish to submit bid proposals and compete in the procurement process must have submitted complete prequalification applications by no later than 5:00 p.m., Thursday, January 15, 2004, and received prequalification notification from OCF A in order to be considered for the award of an EOA contract. All Providers that submitted prequalification applications were contacted by OCF A and notified in writing as to whether their prequalification applications satisfied the minimum criteria and requirements and whether the Provider may advance to Phase 2 of the procurement process. 2. Phase 2 - Proposal. Gradin2. Recommendation and Selection Upon notification by OCF A of successful completion of the Phase 1 prequalification application process, Providers may prepare and submit a bid proposal(s), pursuant to the requirements, format, and specifications set forth in this RFP. Only those Providers that are notified in writing by OCF A that they have satisfied all Phase 1 prequalification criteria and requirements will be eligible to submit a bid proposal and compete in the Phase 2 RFP process. Phase 2 of the procurement process will include grading of specific Provider bid proposals according to EOA. B. MANDATORY BID PROPOSAL PRE-SUBMISSION CONFERENCE A bid proposal pre-submission conference will be held at 10:00 a.m. on March 2,2004. Attendance at the bid proposal pre-submission conference is mandatory for all ambulance service operators who wish to submit a bid proposal and compete in the RFP process. The conference will be held at OCF A Fire Station No. 58 (Ladera Ranch), located at 58 Station Way, Ladera Ranch, California 92694. Reservations are required and can be made by calling (714) 289-3740. The purpose of the conference is for OCF A EMS staff to respond to any questions, concerns, comments and/or suggestions concerning the procurement process, which have been submitted in advance and in writing to the OCFA EMS Section Battalion Chief by February 27, 2004. The conference is also an opportunity for OCF A EMS staff to clarify bid specifications and requirements before submission. All written inquiries submitted by Providers and the answers given by OCF A staff during the bid proposal pre-submission conference will be posted at www.ocfa.org at the conclusion of the conference; copies will also be made available by the OCF AJEMS Section upon request. Providers who do not attend the bid 5 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 proposal pre-submission conference, or who do not make arrangements to send a representative to attend the conference, may not be eligible to continue in the RFP process. C. BID PROPOSAL SUBMISSION REQIDREMENTS 1. Bid Proposal Submission Due Date In order to compete in the RFP process, all bid proposals submitted by pre-qualified ambulance service operators must be completed and received by the Clerk of the Authority no later than 10:00 a.m.. May 10. 2004 ("Submission Due Date"). Bid proposals must be hand-delivered or sent via courier/messenger to the Clerk of the Authority, Orange County Fire Authority, located at 1 Fire Authority Road, Irvine, California 92602. Do not send bid proposals via U.s. Mail. All proposals must be sealed and submitted to OCF A in accordance with the required format and in the manner prescribed herein by the Submission Due Date. A signed original bid proposal plus nine (9) copies of the proposal must be received by OCF A !!Q later than 10:00 a.m.. on May 10. 2004 for public opening. Providers are strongly encouraged to submit their bid proposals in advance of the due date to avoid the possibility of missing the 10:00 a.m. deadline due to unforeseen circumstances. Providers assume the risk of the methods of dispatch chosen. OCF A assumes no responsibility for any delays whatsoever caused by any courier, delivery, or messenger service. Bid proposals must be date and time stamped by the Clerk of the Authority on time by the 10:00 a.m. Submission Due Date in order to be considered. Additional time will not be granted to any single Bidder; however, additional time may be granted to all Bidders when, at its sole discretion, OCF A determines that circumstances require additional submission time. Bid proposals sent to OCFA via U.S. Mail. Fax. or E-mail will NOT be accepted. No amendments, additions, deletions, or alterations to submitted bid proposals will be accepted by OCF A after the Submission Due Date. Bid proposals received after 10:00 a.m. on the Submission Due Date will be returned unopened. 2. Bid Proposal Submission Instructions: Required Format All bid proposals must be submitted in accordance with the following requirements: a. Proposal Binders: All bid proposals must be submitted in three-ring binders, which are not larger than twelve inches by twelve inches (12"x12"); b. Original + Copies: The original signed bid proposal shall be clearly marked "ORIGINAL" and nine (9) copies of the bid proposal, including any attachments, must be sent under seal to OCF A by the Submission Due Date; c. Early Bids: Bid proposals received by OCF A prior to the Submission Due Date will be date and time stamped and secured by the Clerk of the Authority; d. Title Page: All bid proposals must be clearly marked on the outside binder cover with a title page containing the following information: (a) name of ambulance service operator (i.e., the Bidder); (b) name ofRFP and RFP #RL972; (c) Bidder address and telephone number; (d) Bidder authorized contact person; (e) Bidder authorized contact person's signature; (f) identification of specific EOA proposed for service and the corresponding EOA number; (g) bid proposal submission date; and (h) original or copy. 6 FirelEMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 e. EOA Identification: Providers must clearly identify by name and geographical number on the outside binder cover/title page and within the bid proposal cover letter, which specific EOA is being proposed for service; f. Multiple EOA Submissions: A Bidder may desire to submit for consideration a proposal that includes a proposed operational system, program design, and level of service for more than one EOA. While it is not the intent of OCF A to discourage multiple EOA submissions, the Proposal Grading Panel will recommend awards based on proposals for individual EOAs. To facilitate this process, Bidders wishing to submit bids proposing an operational system, program design, and level of service for more than one EOA must submit a separate proposal for each EOA; however, only one Bid Proposal Deposit will be required; g. Bid Format: To facilitate the bid proposal review process, all bid proposals must strictly adhere to the fonnat, table of contents, titles, page limits, and numbering for requested infonnation items as set forth in Section VID, Bid Proposal Submission Fonns. Any deviation from the Section VID fonnat and the required Bid Proposal Submission Fonns may result in disqualification. All Bidders must strictly adhere to the following rules in preparing their bid proposals, and any deviation may result in disqualification: i. Use only standard one inch (1") margins; ii. Use only size 12 font; iii. Use only single-sided pages; iv. Observe all page limit requirements, as specified; v. Use proposal binders no larger than 12"x12"; vi. Use tabs or dividers to separate bid response sections. h. Complete Answers & Responses: All bid proposals must provide answers to all questions and provide complete responses to each and every request item and category as specified in Section VID. Specific submission data has been provided for your convenience for each submission item. Bidders are required to supply, at a minimum, the items listed for specific submission. Bidders are pennitted, within the prescribed page limits, to submit additional infonnation that it deems helpful in the evaluation and grading process. Failure to provide answers to all questions and complete responses to all request item categories may result in disqualification; i. Table of Contents: Bid proposals must include a table of contents listing the individual infonnation request sections as set forth in Section VIII, Bid Proposal Submission Fonns, and their corresponding page numbers. Tabs or dividers must be used to clearly separate each of the individual sections; j. Cover Letter: Bid proposals must include a cover letter on official letterhead describing the Bidder and must include the following infonnation: i) The official name of the Bidder; ii) The Bidder's organizational structure (e.g. corporation, partnership, limited liability corporation, or otherwise); iii) The jurisdiction in which the Bidder is organized and the date of such organization; 7 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 iv) The address and telephone number of the Bidder's headquarters and of any local office involved in the bid proposal; v) The Bidder's Federal Tax Identification Number; vi) The name, address, telephone, fax numbers and e-mail address of the person(s) who will serve as the authorized contact(s) to the City and OCFA with regards to the bid proposal, the RFP process, the Contract Documents, and the administration of the contract, if awarded, with authorization to make representations on behalf of and to bind the Bidder; vii) Provide applicable authorized signature documentation, pursuant to Bidder's organizational structurelbylaws, verifying the authority of the person signing the original bid proposal to commit to the proposal on behalf of the Bidder; viii) A representation that the Bidder is in good standing in the State of California and has obtained all necessary licenses, permits, certifications, approvals and governmental authorizations necessary in order to perform all of the required performance obligations specified herein; ix) A representation that the Bidder is in good standing in the Medicare and Medi-Cal programs and is not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to their billing or reimbursement practices, and that Bidder has not been excluded from any state or federal healthcare program or employs any individual who has been excluded from any state or federal healthcare program. x) Statement of acceptance of all terms, conditions, requirements, and performance criteria contained in the Contract Documents; and, xi) Any additional information Bidder deems relevant for consideration during the selection process. k. Photographs: Bidders may submit, as part of their bid proposal, a maximum of three (3) pages of color photographs or other renderings depicting their ambulance service facilities, operation, vehicles, equipment, and/or personnel. Such photographs are to be inserted at the end of the bid proposal; I. Non-Collusion Certificate: Each Bidder must execute and submit with each bid proposal the Non-Collusion Certificate in Section VID; and m. Compliance: Bid proposals that do not strictly adhere to the format requirements and rules set forth herein may be disqualified at the sole discretion of OCF A. D. PUBLIC OPENING OF BID PROPOSALS 1. Bid Proposal Openin2.All bid proposals received on time by the Submission Due Date will be publicly opened. The public opening will be held at 2:00 p.m. on May 10, 2004, at the Orange County Fire Authority, located at located at I Fire Authority Road, Irvine, California 92602 ("Public Opening"). 8 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 2. Announcement. At the Public Opening, each sealed bid proposal will be opened and the following infonnation will be publicly stated and recorded by the Clerk of the Authority: a. Name of Bidder; b. Name of the authorized individual that signed the bid proposal; and c. Name of the EOA and EOA number proposed for service. 3. Late Submission. Bid proposals received after 10:00 a.m. on the Submission Due Date will be returned unopened and will not be considered. E. BID PROPOSAL EVALUATIONS 1. Competitive Process. The Proposal Grading Panel will evaluate and rate each bid proposal according to established criteria. The primary competitive bid criteria for this RFP are: (1) quality of service; (2) level of service; (3) the rates charged for services to be provided; (4) cost, if any, to the awarding agency; (5) experience; and (6) whether a Bidder is responsible. The tenn "responsible" refers not only to the attribute of trustworthiness, but also to the quality, fitness, and capacity of the Bidder to perfonn the proposed services satisfactorily and in accordance with the specifications and delivery criteria set forth herein. At the conclusion of the evaluation process, the Proposal Grading Panel will make a final contract award recomrnendation(s) for each EOA, which will be presented to the OCFA Board of Directors, or to the member city retaining provider selection and contracting authority, for approval. Qualified, responsible bidders that offer the highest overall level of service, and either meet or exceed the specifications and delivery criteria set forth in the Contract Documents, as detennined by the Proposal Grading Panel, will be recommended for award of a contract. 2. Proposal Grading: Panel. Bid proposals will be reviewed and evaluated by a Proposal Grading Panel. The OCF A EMS Battalion Chief will appoint the members of the Proposal Grading Panel. The Proposal Grading Panel may consist of the following: (1) the OCF A EMS Section Battalion Chief's designee; (2) an OCFA Chief Officer; (3) a Medical Director; (4) an OCEMSA Program Manager or designee; and (5) an OCFA Paramedic. The Proposal Grading Panel may invite all Bidders to make an oral presentation concerning their proposal, all of which may be videotape recorded. During presentations, the Proposal Grading Panel will listen to the Bidder's presentation and may ask questions of the Bidders and/or request amplification, explanation, or further infonnation regarding their proposal. Each Bidder will be given 20 minutes to make an oral presentation. Additional presentation time may be allotted at the sole discretion of the panel. F. ADMINISTRATIVE 1. Bid Proposal Deposit. All bid proposals must include a $2,500 deposit in the form ofa cashier's check made payable to the Orange County Fire Authority ("Bid Proposal Deposit"). Bid Proposal Deposits will be refunded in their entirety to all Bidders that voluntarily withdraw their proposal prior to the Public Opening, and to all Bidders who complete the evaluation at the conclusion of the procurement process. However, bid proposals that are voluntarily withdrawn after the Public Opening, rejected, or disqualified will result in a 100% deposit forfeiture. 9 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 2. OCFA Travel Expenses. Bidders may be required to pay reasonable travel expenses for three (3) OCF A, or awarding agency, personnel and/or consultants to inspect Bidder facilities, operations, vehicles, equipment, personnel, and/or records outside of Orange County at any time during the procurement process. 3. Oral Presentations. Oral presentations may be requested of all Bidders at any time throughout the procurement process. 4. Proprietary Information. All bid proposals and documents submitted in response to this RFP shall become the property of OCF A. It is the responsibility of each Bidder to clearly identify any and all information contained in their bid proposal that it considers to be confidential and/or proprietary. To the extent that OCF A agrees with that designation, such information will be held in confidence whenever possible. All other information will be considered public. However, all information regarding the procurement process will not be disclosed to the public or be subject to disclosure pursuant to the California Public Records Act (Government Code §6250 et seq.) during the deliberative process until such time as evaluations have been completed, final award recommendations have been made, and contracts are awarded. In the event that a demand for disclosure of information designated as "confidential and/or proprietary" by the Bidder is made, OCF A will notify the Bidder in writing of such demand and shall furnish a copy of OCF A's written response to the requestor. Bidders may then pursue, at their sole cost and expense, all appropriate legal action necessary to maintain the confidentiality of such information. 5. Voluntary Withdrawal of Bid Proposal. A Bidder may, upon written notice to OCFA, voluntarily withdraw their bid proposal at any time prior to the Public Opening. Withdrawal of a bid proposal will be subject to verification of the identity of the requestor and confirmed with the Bidder's authorized representative. A receipt for the return of any unopened bid proposal will be prepared by the Clerk of the Authority and signed by the Bidder's authorized representative. Bidders requesting to withdrawal their bid proposal prior to the Public Opening will be entitled to a full refund of their Bid Proposal Deposit. Bidders requesting to withdraw their bid proposal after the Public Opening will forfeit their Bid Proposal Deposit and the same return procedures will be followed. 6. Cancellation of RFP Process. This RFP may be cancelled at any time during the procurement process prior to the award of a contract for any EOA or for all EOAs when it is determined by OCF A, at its sole discretion, that cancellation is in the best interest of OCF A or any of its member agencies. G. BID PROPOSAL REJECTION 1. At the sole discretion of OCF A, OCF A reserves the right to reject any and all bid proposals, in whole or in part, and is not bound to accept the lowest proposal (or the proposal prices for services). The OCF A Fire Chief, at his sole discretion, may reject all bids for any reason or for no reason at all and may direct the issuance of a new RFP in the future. 2. A bid proposal may be rejected by OCF A, at its sole discretion, for failure to comply with the requirements set forth in this RFP, or for other reasons determined by OCF A that create or may create a hindrance or impairment to the objective evaluation of such proposal. 3. OCFA reserves the right, at its sole discretion, to waive any and all bid proposal irregularities or informalities that OCF A deems correctible or otherwise not relevant. In the event of a bid proposal 10 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 irregularity or informality, the Bidder may be required to immediately correct and/or resubmit, in whole or in part, its bid proposal. 4. A bid proposal may be rejected by OCF A, at its sole discretion, if it is in any way incomplete or irregular, or if it contains material misrepresentations of fact or omits material information required. Bid proposals that do not strictly adhere to the format requirements set forth in this RFP may be rejected. 5. A bid proposal may be rejected or disqualified by OCF A upon substantial evidence that the Bidder has engaged in corrupt, fraudulent, and/or illegal practices involving the perfoffi1ance, administration, or award of a similar contract in another jurisdiction. 6. Bid proposals that take exception to the RFP specifications and/or delivery criteria, or tenns and conditions of the Contract Documents, may be rej ected. 7. Bid proposals that do not provide all information requested in this RFP may be rejected as incomplete. 8. In the event a bid proposal is rejected, OCFA will notify the Bidder in writing, which shall explain the specific reason(s) for the rejection. H. AWARD PROTEST The award of EOA contracts under this RFP will be made by either the OCF A Board of Directors or by individual OCF A member cities that retain provider selection and contracting authority. The contract award decisions are final and may not be appealed and are not subject to the protest provisions of the state public bidding statutes. However, at its sole discretion, the OCF A Board of Directors, or member cities where applicable, may reconsider any contract award upon a rIDding of good cause. 11 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 I. PROPOSED SCHEDULE OF EVENTS (ESTIMATED) Issuance of Prequalification Application: Prequalification Application Submission Deadline: Pre qualification Notification: Issuance of Notice Inviting Proposals: Issuance of Request for Proposals: Prequalification Denial - Appeal Deadline: Pre-Submission Conference Questions Deadline: Mandatory Bid Proposal Pre-Submission Conference: Bid Proposal Submission Due Date: Bid Proposal Submission Public Opening: Proposal Grading Panel Evaluation Process: Proposal Grading Panel- Recommendations: Final Recommendations Final Selection and Contract Awards Final EOA Contract Execution of Contracts Contract Perfonnance Start Date: Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 December 22, 2003 January 15,2004; 5:00 p.m. February 11,2004 February 19,2004 February 19,2004 February 23, 2004; 5:00 p.m. February 27,2004; 5:00 p.m. March 4, 2004; 10:00 a.m. May 10, 2004; 10:00 a.m. May 10, 2004; 2:00 p.m. May/June 2004 June 2004 June 2004 July 1,2004; 12:01 a.m. 12 SECTION III - GENERAL TERMS AND CONDITIONS A. CONTRACT DOCUMENTS The draft EOA contract contained in Section IX, Attachment D, must be agreed to and signed by all Bidders who are awarded contracts. The contract will designate the successful Bidder as the exclusive provider of emergency ambulance transportation services within a given EOA. The draft contract is, however, subject to modification prior to award. The contracts entered into by all successful Bidders shall consist of: (a) the RFP, (b) the signed, original bid proposal(s) submitted ("Bid Proposal"), and (c) the executed EOA contract, which shall all be referred to collectively herein as the "Contract Documents." The RFP and the Bid Proposal(s) submitted by the successful Bidders will be incorporated and made a part of the contract. All provisions of the RFP and the Bid Proposal(s) shall be binding on the parties. Should any inconsistency or ambiguity occur or exist in the Contract Documents, the provisions of the contract, then the provisions of the RFP, then the provisions of the original bid proposal shall control. B. CONTRACT MODIFICATION AND AMENDMENTS The parties may adjust the specific terms of the Contract Documents where circumstances beyond the control of either party require modification or amendment. Any modification or amendment proposed by the Contractor must be submitted in writing to OCF A for consideration. The decision to modify or amend any term or condition of the Contract Documents shall be at the sole discretion of OCFA and/or the awarding agency, if applicable. Any agreed upon modification or amendment must be in writing, approved by the OCF A Fire Chief, and signed by both parties. C. CONTRACT ADMINISTRATION The OCF A Fire Chief, or his designee, shall be the authorized representative for each OCF A member agency in all matters pertaining to the RFP process. All contracts awarded pursuant to this RFP for the provision of emergency ambulance transportation and related services within the OCF A jurisdictional areas shall be administered by the OCF A Fire Chief, or his designee. D. CONTRACT EFFECTIVE DATE The effective date of the EOA contracts awarded pursuant this RFP shall be 12:01 a.m., Thursday, July 1, 2004, ("Effective Date") at which time Contractors will assume full responsibility for the provision of emergency ambulance transportation services within their designated EOA(s). The Effective Date may be postponed at the sole discretion of the OCF A Fire Chief in order to protect public health and safety in the event a successful Bidder/Contractor is for any reason unable to commence performance at that time. E. CONTRACT TERM 1. Term. The exclusive contracts awarded pursuant to this RFP are for an initial five (5) year term, ending on June 30, 2009. The contracts shall automatically expire at the end of the initial five year term, unless extended as provided below. 2. Contract Extension. The contracts awarded pursuant to this RFP may, at the sole discretion of the OCF A Fire Chief and/or the awarding agency, if applicable, be extended. With mutual written agreement of the parties, the contracts may be extended for up to an additional five (5) years (for a 13 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 possible 10-year total contract period). Any extension(s) granted shall not exceed a total of five (5) years. Successful past perfonnance during the initial contract period will be a critical factor in the decision to grant an extension. The decision to either grant or deny a contract extension(s) shall be final. At the end of the initial contract tenn, or contract extension tenn(s), if granted, all EOA contracts awarded pursuant to this RFP shall automatically tenninate. 3. Termination. The contracts awarded may be tenninated by either party upon one hundred eighty (180) days written notice. Contractors shall provide such written notice to the City and OCFA. F. INSURANCE Upon execution of the contract, Contractors must provide, to the satisfaction of OCF A, certificates of insurance and endorsements evidencing the policy or policies of insurance in the types and amounts fulfilling the requirements set forth in the contract. G. ASSIGNMENT Except as provided herein, Contractors may not delegate or assign their rights or otherwise transfer their obligations, in whole or in part, under the proposed contract to any other person or entity without the prior written consent of OCFA and/or the awarding agency, if applicable. Any such assignment without the prior written consent of OCF A and/or the awarding agency, if applicable, shall be void and the attempted assignment shall constitute breach of the contract. The following will be considered to be a "transfer": 1. Any change in the business structure, including but not limited to, changes ftom or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; 2. Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 3. A transfer by any shareholder of greater than ten percent (10%) of the stock issued as of the Effective Date by the Contractor, or a sale or transfer of over twenty-five percent (25%) of the assets of the Contractor. In the event a Contractor experiences regular stock exchanges in excess of the ten percent (10%) threshold, a separate agreement may be negotiated to set a threshold that still provides OCFA and/or the awarding agency with the protections intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. H. AUDITS AND INSPECTIONS 1. Business Office. At any time during nonnal business hours, and as often as may reasonably be deemed necessary by OCFA, OCFA may observe and inspect Contractors' business office, and Contractors must make promptly available to OCF A for its examination all Contractor records that pertain to perfonnance of the contract. OCF A may audit, examine, and copy any and all Contractor records pertaining to their perfonnance of the contract, including but not limited to, personnel records, daily logs, conditions of employment, and all other data. OCFA's right to inspect Contractors' business office and any and all records pertaining to their perfonnance of the contract will be restricted to nonnal business hours and reasonable notice shall be given to Contractors in advance of such inspection. 14 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 2. FaciIitiesNehicles. OCFA may, at any time and without prior notice, observe and inspect Contractor vehicles, ambulance dispatch center, maintenance facilities, personnel, and/or any ambulance post location(s). OCFA employees may be assigned to ride as observers on any Contractor vehicle at any time provided, however, that in exercising this right to inspect and observe, OCF A employees will conduct themselves in a professional and courteous manner, shall not interfere in any way with Contractors' employees in the performance of their duties, and shall at all times be respectful of Contractors' employer-employee relationships. I. COOPERATION Contractors must cooperate with OCF A and the City and take all actions necessary to ensure that all terms and conditions, and required perfonnance levels, set forth in the Contract Documents are satisfied at all times throughout the contract term. J. NON-COLLUSION CERTIFICATE Each Bidder must execute and submit with each bid proposal the Non-Collusion Certificate in Section VIII. If there is reason to believe that collusion exists among Bidders, all bid proposals submitted will be rejected and none of the participants in such collusion will be considered in any future RFP. L. INDEPENDENT CONTRACTOR Both parties in the performance of the contract shall be acting in an independent capacity and not as agents, employees, partners, or joint ventures with one another. Contractor and its employees are not employees of the City, the County, or OCF A and are not entitled to any of the rights, benefits, or privileges of City, County, or OCF A employees including, but not limited to, medical, unemployment, or workers' compensation insurance. M. INDEMNIFICATION 1. General. All Contractors must agree to defend, indemnify and hold harmless the City and OCF A, their officers, agents, elected officials, and employees, from all liability, claims, losses and demands, including defense costs and reasonable attorneys' fees, whether resulting from court action or otherwise, arising out of the acts or omissions of Contractor, their officers, agents, or employees, or the condition of property used, in the performance of the contract, excepting acts or omissions directed by the City and OCF A, their officers, agents, or employees, acting within the scope of their employment, for which the City and OCFA agrees to defend and indemnify Contractor in a like manner. 2. Rates. All Contractors must agree to defend, indemnify and hold harmless the City and OCF A, their officers, agents, elected officials, and employees, from all liability, claims, losses and demands, including defense costs and reasonable attorneys' fees, whether resulting from court action or otherwise, arising from any and all challenges to the service rates established in the Contract Documents. 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 service rate, the ALS service rate, the ALS reimbursement rate, and/or the medical supply reimbursement rate as set forth in the Contract Documents. 15 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 N. COMPLIANCE WITH LAWS All services provided by Contractors pursuant to the Contract Documents must be rendered in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It will be Contractors' sole responsibility to detennine which federal, state, and local laws, rules, statutes, and regulations apply to the services to be perfonned pursuant to the Contract Documents, and to maintain compliance at all times throughout the contract term. O. RISK 1. Notwithstanding any other term or condition herein, in responding to a call for service, Contractors will have no claim whatsoever against the County, City and/or OCFA or have any right to recover from the County, the City, and/or OCF A for the cost of any of the services it renders in the perfonnance of the contract. Contractors must look solely and exclusively to the service recipient, their insurers, applicable state or federal health care programs, or other responsible party for payment of services rendered. 2. Contractors assume the entire risk of non-payment for any and all of the services rendered and the charges inculTed in connection with its perfonnance under the Contract Documents, including but not limited to all BLS and ALS charges inculTed, the ALS reimbursement rate, and/or the medical supply reimbursement rate. P. RESPONSmILITY It shall be the responsibility of Contractors to provide all equipment, to satisfy all terms and conditions set forth in the Contract Documents, and to perfonn all required duties and responsibilities expressed in the Contract Documents at all times during the contract tenn. Contractors may utilize additional resources whenever deemed necessary to perfonn its emergency ambulance services pursuant to the contract. This may include, but is not limited to, use of personnel and/or equipment of another approved ambulance provider. This, however, shall not relieve Contractors of their duties and responsibilities under the contract, and any additional cost incUlTed shall not be charged to the County, City, and/or OCFA. Q. ACTS OR OMISSIONS OF REPRESENTATIVES The acts and/or omissions of the owner(s) , officers, operators, officials, employees, agents, and representatives of the Contractor in the perfonnance of the services and obligations under the Contract Documents shall constitute the acts and/or omissions of the Contractor. R. INSOLVENCY Contractors shall not, without the prior written consent of the OCF A Fire Chief, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of Contractor, or make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by Contractors under any insolvency or bankruptcy proceeding constitutes a breach of contract by Contractors, and all property assigned by OCF A, the City, or the County for safe care shall be "released" to another assigned service provider, as specified by the OCF A Fire Chief. 16 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 SECTION IV - OPERATIONAL STANDARDS, PROCEDURES AND PERFORMANCE REQUIREMENTS A. EMERGENCY RESPONSE COMMUNICATIONS SYSTEM 1. Compliance with Laws. Prior to the Effective Date, Contractors must install, provide, operate, and maintain at their sole cost and expense, an ambulance dispatch center, telephone service, including ring-down line, 800 MHz mobile radio system, mobile data computer/radio system, personal computer, and a secondary dispatch response system (hereinafter collectively referred to as "Emergency Response Communications System") according to the tenns, conditions, and requirements contained in this Section. Contractors' Emergency Response Communications System must comply with all federal, state, and local laws, rules, statutes, and regulations, including licensing requirements, concerning the broadcast of public safety and emergency communications over approved Federal Communications Commission ("FCC") frequencies at all times during the term of the contract. 2. Communications Requirements. Contractors must comply with the following requirements concerning the installation, use, operation, and maintenance of their Emergency Response Communications System: a. Prior to the Effective Date, Contractors must obtain any and all FCC licenses and authorizations required for the engineering, assembling, installation, use, operation, and maintenance of the Emergency Response Communications System, which is necessary to provide emergency ambulance response services under the contract; b. Contractors must provide documentation, as set forth in Section Vill, describing in detail their operational design for their Emergency Response Communications System and methods proposed for dispatching ambulances under the contract; c. Emergency Response Communications System must be operated and maintained by Contractors twenty-four (24) hours per day, seven (7) days per week; d. Contractor dispatch centers must be equipped with a secondary, emergency back-up electrical system to insure uninterrupted twenty-four (24) service; and, e. Contractor must provide and maintain, at its sole cost and expense, a dedicated point-to-point telephone ring-down line between the OCFA Emergency Communications Center and the Contractor's ambulance dispatch center. 3. 800 MHz County-wide Coordinated Communications System. The Orange County Sheriff- Coroner Department, County of Orange, Communications Division ("OCC"), currently serves as the central coordination point for the Orange County Emergency Response Communications System. As such, OCC operates, maintains, administers, and oversees the existing 800 MHz County-wide Coordinated Communications System, which is the existing communications network that is responsible for providing emergency response system communications throughout Orange County, thereby, effectively linking emergency response calls for law enforcement, fire, public works, lifeguards, and public utilities within Orange County on a shared 800 MHz backbone County-wide Coordinated Communications System ("800 MHz c.c.C.S."). OCFA is one of many participating and subscribing 17 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 agencies to the 800 MHz C.C.C.S. Contractors' Emergency Response Communications System must be fully compatible with the 800 MHz C.C.c.S. 4. CAD Interface. At the discretion of OCF A, Contractors must establish and maintain a Computer Aided Dispatch (CAD) interface, or other equivalent electronic data system, that is compatible with the OCF A Emergency Command Center ("ECC"). This may include, but is not limited to: hardware; software; and telecommunications lines, which shall meet OCF A specifications. Contractors assume all costs associated with the purchase, installation, implementation, operation, and maintenance of a CAD interface. Contractors will be given six (6) months to establish and assume operation of a CAD interface, if OCF A detennines that such interface is required. 5. System Umzrades. As OCF A upgrades its emergency response communications systems with new or improved technologies, Contractors must likewise upgrade their Emergency Response Communications System with comparable and compatible technology, at their sole cost and expense. B. VEIDCLE COMMUNICATIONS 1. 800 MHz Mobile Radio. Contractors must install and maintain at their sole cost and expense, an OCFA approved 800MHz mobile radio in the front passenger area (with a remote head in the rear patient area) of each ambulance that will be used for patient transport in the perfonnance of the contract. The 800MHz mobile radios are to be used by Contractors' EMTs and ambulance personnel to communicate response status with OCF A dispatch and by OCF A paramedics to communicate with base and receiving hospitals during patient transport. Contractors must comply with the following 800 MHz mobile radio requirements: a. Contractors must obtain all necessary licenses, permits, and/or approvals from OCC (and any other applicable licensing or pennitting agency) to operate and maintain their 800 MHz mobile radios as required herein in conjunction with the 800 MHz C.C.C.S.; b. Contractors must comply with all federal, state, and local laws, rules, statutes, and regulations governing the operation of 800 MHz mobile radios, including compliance with 800 MHz C.C.c.S. Standard Operating Procedures; c. Contractors must ensure that their 800 MHz mobile radios are pre-assigned to a vehicle with a pre-identified radio identifier and are configured to send status and message data compatible with OCF A SmartNet Infonnation Management System (SIMS), and must include an OCF A approved and issued Motorola DEKbox with 8 status/message keys to transmit unit status (e.g., en route, on scene, and available status functions); OCFA will configure the SIMS system to enable this feature on all Contractor radios enabled on the 800 MHz C.c.C.S.; and d. All Contractor 800MHz mobile radios must meet OCFA, OCC, ECC, 800 MHz C.C.c.S., and OCEMSA specifications and requirements. 2. Mobile Data Computer System. Contractors must install and maintain, at their sole cost and expense, an OCF A approved and issued mobile data radio at Contractors' dispatch center for purposes of sending and receiving electronic emergency dispatch infonnation, instructions, and call status. Contractors must comply with the following mobile data radio system requirements: 18 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No, 1 - April 2004 179999,6 a. MDC Radio: Upon the award of a contract and prior to the Effective Date, Contractors must pay OCF A a one time, non-refundable communications start-up fee of $3,500, which shall cover the following: (a) OCFA-issued mobile data radio; (b) OCFA-issued mobile data application software; (c) mobile data installation; (d) mobile data programming; and (e) OCFA-issued Motorola DEKbox. All communications equipment issued to Contractors by OCF A pursuant to this Section shall remain the property of OCF A. The communications systems described in this Section must be installed and fully operational prior to the Effective Date. Upon contract tennination, all OCF A-issued communications equipment must be returned to OCF A within thirty (30) days. b. Annual MDC Fee: Contractors must pay OCF A a $250 annual fee for MDC system operation and maintenance, which shall be due and payable by July 1,2005 and annually thereafter. c. Personal Computer: Contractors must provide, at their sole cost and expense, and as part of their Emergency Response Communications System, a personal computer having the following minimum specifications: Intel Pentium 500 MHz or greater; 10.0 GB Hard Drive; 256 Mb SDRAM; WIN2000 OS; Color display VGA; Com Ports - 1 serial, 1 USB, 1 Parallel; CD ROM; and, Keyboard - Standard Qwerty 104. d. Mobile Application Software: Motorola Tx Messenger v3.0 software or greater as specified by OCF A. C. SERVICE HOURS 1. Service. Contractors must provide twenty-four (24) hour emergency ambulance transportation and related services within designated EOAs, seven (7) days a week during the tenn of the contract. 2. Field Supervisor. Contractors must have an authorized field supervisor available to OCFA personnel, either by radio or in person, and physically present within the County of Orange, on a twenty- four (24) hour, seven (7) day per week basis during the term of the contract. D. RESPONSE TIMES 1. General ReQuirements. Contractors must respond to OCFA's requests for emergency ambulance transportation service within the response times set forth in this Section. Response ,times will be calculated as the actual elapsed time in minutes from the moment the request is received by the Contractor's dispatch center to the time that the Contractor's first ambulance arrives on scene. Where multiple ambulances are dispatched to the same emergency scene, only the response time of the ambulance arriving first will be counted for purposes of calculating the response time. 2. Response Time Measurement. Response times are measured in full minutes, rounded upward. For purposes of measuring compliance and for the imposition of any penalties, any partial minute will be rounded to the next full minute. For example, a response time of 10:01 or 11:00 is counted as eleven minutes. 3. Definition of Geoeraphical Areas & Response Priority Codes. The following geographical areas, response priority codes, and definitions will apply with regard to calculating response times (based upon changes in population densities, these geographical area defmitions may be changed at the sole discretion of OCF A; OCF A will advise Contractors in writing when these changes occur): 19 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 a. MetrofUrban: Those areas with a population density greater than 100 persons per square mile; b. SuburbanIRural: Areas with a population density of 7 to 100 persons per square mile. These areas generally include the roads and contiguous canyon areas of the local mountain ranges, including: Brea Canyon, Tonner Canyon, Carbon Canyon, Modjeska Canyon, Silverado Canyon and Trabuco Canyon; the areas of Santiago Canyon Road between Jamboree and Live Oak Canyon Road; and the Ortega Highway (Highway 74) between La Plata Avenue and the County line; c. Wilderness: 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, with the exception of incidents on or immediately adjacent to Highway 74; d. Code 3: Emergency ambulance vehicles responding to an emergency scene or request for service with red lights and sirens on. e. Code 2: Emergency ambulance vehicles responding to an emergency scene or request for service expeditiously, without red lights and sirens on. 4. Response Times Reauired. Contractors must strictly adhere to the following required response times at a quarterly compliance rate of ninety percent (90%) in each Code 2 and Code 3 category, which shall be reported separately: a. MetrofUrban Requirements: i) Code 3- Response time must not exceed ten (10) minutes, zero (0) seconds. ii) Code 2- Response time must not exceed fifteen (15) minutes, zero (0) seconds. b. SuburbanIRural Requirements: i) Code 3- Response time must not exceed twenty (20) minutes, zero (0) seconds. ii) Code 2- Response time must not exceed twenty-five (25) minutes, zero (0) seconds. c. Wilderness Requirements: i) Code 3- Response time must not exceed thirty (30) minutes, zero (0) seconds. ii) Code 2- Response time must not exceed forty (40) minutes, zero (0) seconds. 5. Response Time Reporting:. Contractors must provide quarterly response time reports to OCF A ("Quarterly Response Time Reports") that contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Attachment "E". Each Quarterly Response Time Report must be submitted to the OCF A EMS Section Battalion Chief via e-mail (in a format approved by the OCF A EMS Section Battalion Chief) by the 10th day of the month following the end of the quarter. For example, January, February, March reports are due April 10th. If the Quarterly Response Time Reports are not submitted in a timely manner, a Contractor may be assessed a $500 penalty per occurence. If the Quarterly Response Time Reports are not submitted to OCF A as prescribed herein two (2) or more times in a single 12-month period, such ommissions may constitute breach of contract. 20 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 6. Call Cancellation. In the event a call for service is cancelled prior to arrival, the response will be considered to be within the response time requirement so long as the elapsed time between the call for service and the cancellation does not exceed the applicable response time requirement. In the event the elapsed time between the call for service and the cancellation is in excess of the applicable response time requirement, the call will be considered late. 7. Quarterly Response Time Report - Format. The Quarterly Response Time Reports must be submitted by Contractors using an electronic spreadsheet fonnat that will be provided to Contractors by OCF A. The Quarterly Response Time Reports must contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Attachment "E," for the EOA. Whenever response times in either Code 2 or Code 3 categories fall below the 90% compliance rate in any given quarter, Contractor shall include a nan-ative assessment as to the cause of any response delay, and, if requested, shall meet and confer with the OCF A EMS Section Battalion Chief for purposes of establishing a plan for avoiding such delay in the future. 8. Exemptions to Response Time Requirements. The response time requirements set forth in this Section may be suspended and not enforced, at the discretion of the OCF A EMS Section Battalion Chief, in unusual circumstances. There shall be no exemption for response delays due to vehicle mechanical problems, driver en-or, traffic, weather, or mistake. The response time requirements set forth in this Section will be suspended and not enforced under the following limited circumstances: a. High Call Volume: Responses to calls for service during periods of unusual system overload or high call volume, which shall be at the sole determination of OCF A; b. Disasters: Responses to calls for service during an OCF A declared disaster occurring within an EOA or during a declared disaster in a neighboring jurisdiction, which has requested emergency ambulance transportation or other mutual aid assistance from OCFA. For purposes of this Section, a "declared disaster" means any condition of disaster as declared or affIrmed by the OCF A Fire Chief or his designee; c. Multiple Ambulance Response: For responses to calls for service where more than one ambulance is dispatched to the same incident, only the response time of the ambulance fIrst to respond will be required to meet the required response time requirements; d. Response UplDowngrade: For Code 3 calls where the response priority code is downgraded to Code 2 by OCF A while the ambulance is en route to the scene, the response time standard for that call shall be recorded as a Code 2 call. If the response priority code is upgraded from Code 2 to Code 3 by OCF A while the ambulance is en route to the scene, the response time standard for that call shall be recorded as the number of minutes for a Code 3 call plus the number of minutes already elapsed, not to exceed the original total minutes for a Code 2 call; e. Return of OCF A Personnel: In the event that an ambulance is delayed in responding to a call for service, or is hindered from providing a timely response, due to the need to comply with the requirement that it return all OCF A personnel to their respective fire stations, as described herein, the response time requirement for that call will be suspended. This exemption will only apply for a call for. service dispatch that occurs while the ambulance is waiting for or actually returning OCF A personnel. It shall be the Contractor's responsibility to document such circumstances, including the length of time and the affected call(s) for service. Contractors must apply for a specific exemption as provided below. Calls 21 FirelEMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 for service dispatches that occur after the ambulance has returned OCF A personnel and while returning to any ambulance post location are not eligible for this exemption. 9. Procedures to Request Response Time Exemption. Applications for receiving an exemption to the response time requirements must be submitted by Contractor to the OCF A EMS Section Battalion Chief for approval. Such requests must accompany the Quarterly Response Time Report for the period in which the exemption is requested. Requests for exemptions outside of the CUITent quarterly reporting period will not be considered. Each request for exemption must include the following information: (a) the incident date; (b) the OCFA Incident Number(s); (c) a naITative summary of the incident; (d) explanation for the cause of the response time delay; and (e) the specific exemption requested. The decision to either grant or deny a response time exemption request will be made by the OCF A EMS Section Battalion Chief within thirty (30) days; the decision to deny may be appealed to the OCF A Fire Chief, whose decision shall be final. 10. Use of Alternative Methods to Meet Response Time Requirements. For purposes of maintaining compliance with the response time requirements established herein, Contractors must negotiate and enter into separate mutual aid agreements with neighboring ambulance service operators for the provision of back-up, secondary emergency ambulance transportation services within designated EOAs. Any secondary ambulance provider selected to provide such services, and any agreement to provide such services pursuant to this Section, must satisfy the following requirements: a. All secondary mutual aid provider draft agreements must be reviewed and approved by OCF A prior to execution of the contracts awarded pursuant to this RFP and a copy of the final agreement must be sent to the OCF A EMS Section Battalion Chief; b. All secondary mutual aid providers will be expected to perform back-up emergency ambulance transportation services in accordance with the operational standards, procedures, and performance requirements set forth in the Contract Documents; c. All secondary mutual aid providers and their employees must cooperate with OCF A and must participate in any audit requested by OCF A concerning their performance; and d. Notwithstanding the above, Contractors and not the secondary mutual aid provider will be responsible for ensuring compliance with all terms, conditions, standards, and performance requirements set forth in the Contract Documents, including but not limited to, the imposition of all applicable penalties and payment of all fees and reimbursements. 11. Disciplinary Actions for Failure to Meet Response Time ReQuirements/ Performance Deficiency a. Meet and Confer. Should a Contractor fail to meet the response time requirements, set forth in this section, in any quarterly period for any single Code category or for the cumulative total of Code 2 and Code 3 calls, as outlined in Attachment E, the OCF A EMS Section Battalion Chief shall notify the Contractor and meet and confer with said Contractor regarding performance and response time deficiencies. The purpose of this meeting is to notify the Contractor of its deficiencies and to work with the Contractor to ensure proper response time performance in the immediate future. b. Penalties. At the discretion of the OCF A EMS Section Battalion Chief, monetary penalties may be assessed against a non-compliant Contractor for failure to meet the response time requirements set 22 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 forth in this Section. For each EOA, quarterly aggregate response times (i.e., in any quarterly period for any single Code category) that are not in compliance with the response time requirements set forth in this Section may result in OCF A assessing the non-compliant Contractor with a monetary penalty according to the following compliance and fine schedule: Quarterly Responses That Are In Compliance With Response Time Requirements Per Geographical Area And Per Response Priority Code: Penalty Imposed*: 90% or Better None 80% - 84.9% $1,000 $2,000 85% - 89.9% Less than 79.9% $3,000 *Note: Penalties are for Code 2/Code 3 reported separately and calculated separately within each geographical area in the EOA. In addition to the above response time penalties, OCF A may assess monetary penalties against Contractors for the following: (i) Turned Call Penalties: Any calls for service that are not handled by the Contractor, either through their own equipment and personnel or secondary mutual aid providers, and that require OCF A to request service from another ambulance service operator may result in the assessment of a "Turned Call" penalty in the amount of $500 per occurrence. (ii) Late ReuortlLate Payment Penalties: Any reports, fees, or reimbursements that are required to be submitted to OCFA by Contractors pursuant to the Contract Documents (e.g., Quarterly Response Time Reports, CQI, monthly reimbursements, etc.) and that are not submitted on time may result in the imposition of a $500 penalty per occurrence. c. Corrective Action Plan. Situations which come to the attention of, or are reported to, the OCF A EMS Section Battalion Chief and which appear to constitute a Contractor service or performance deficiency or substantial inadequacy, as determined by the OCFA EMS Section Battalion Chief, shall be immediately investigated by the OCF A EMS Section Battalion Chief. An example of such situation may be the Contractor's failure to achieve at least a 90% response time performance in any single Code category for a quarterly reporting period. At the discretion of the OCF A EMS Section Battalion Chief, a Corrective Action Plan may be imposed on the Contractor to correct identified and verified performance deficiencies and inadequacies. The OCFA EMS Section Battalion Chief and Contractor's authorized representative shall meet to develop a written Corrective Action Plan (CAP) within fifteen (15) working days of the identification and verification of the service or performance deficiency, or substantial inadequacy, in accordance with the following CAP requirements: (i) CAP Format. The CAP shall describe the following: (1) the service or performance deficiency, or substantial inadequacy shall be identified; and (2) the method by which Contractor is to correct the service or performance deficiency, or substantial inadequacy, shall be outlined. Contractor 23 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 shall sign the CAP, thereby agreeing to the corrective action set forth in the CAP, with any areas of disagreement noted in writing. A copy of the signed CAP shall be furnished to Contractor at the conclusion of the CAP meeting. (ii) Correction Period. Correction of the service or performance deficiency, or substantial inadequacy, shall occur within a period of not to exceed sixty (60) days from the development of the CAP, unless the OCF A EMS Section Battalion Chief determines that correction cannot be accomplished within the specified time frame. When correction will take longer than sixty (60) days from the development of the CAP, the CAP shall specify interim dates by which specific steps toward correction of the service or performance deficiency, or substantial inadequacy, will take place with the total time period not to exceed three (3) months. (iii) CAP InsDectionlCoIDDliance. The OCFA EMS Section Battalion Chief, or his designee, shall visit and inspect Contractor's business office, facilities, vehicles, personnel, and/or records to review and document actions taken by Contractor to implement the CAP and shall document any continuing service or performance deficiency, or substantial inadequacy, which is not corrected within the specified time frame. In the event Contractor fails to correct the service or performance deficiency, or substantial inadequacy identified in the CAP within the time frame provided, OCFA and/or the Awarding Agency, if applicable, may find Contractor to be in material breach of the Agreement. d. Timely Performance Required. Assessment of penalties, or the imposition of a CAP, pursuant to this Section will not relieve Contractors of the responsibility to meet all performance expectations as set forth in the Contract Documents. Substandard cumulative response time performance (i.e., below the 90% compliance rate for combined Code 2 and Code 3 calls) in any two (2) quarters in a single twelve (12) month period will constitute breach of contract, resulting in the imposition of a Remedial Action Plan (RAP). Failure to timely correct and cure any response time deficiency, after having been given notice and a reasonable opportunity to cure such violation in accordance with an established Corrective Action Plan (CAP) or failure to cure a breach of contract after the imposition of a Remedial Action Plan (RAP), may constitute a material breach of the Agreement. Additionally, consistent problems in meeting and/or maintaining the response time requirements will be a key factor in determining whether to grant contract extensions. This RFP requires the highest levels of performance, reliability, and compliance with the established performance criteria and service delivery criteria, and the mere demonstration of effort, even diligent and well-intentioned effort, will not substitute for proper compliance. e. Waiver. Any monetary penalty that may be imposed pursuant to this Section may be waived, upon a showing of good cause, at the sole discretion of the OCF A Fire Chief, whose decision shall be [mal. E. EMERGENCY ON-SCENE PROCEDURES 1. Contractors must perform as a part of the patient care team and must be able to perform all BLS treatment modalities within their scope of practice, as required by OCEMSA. 24 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 2. All ambulance personnel assigned by Contractor to perform services under the contract must: a. be trained in Orange County disaster response procedures, multiple victim, and mass casualty incident protocols, pursuant to the Orange County Fire Services Operational Area Annex; b. work under the direction of the OCFA Incident Commander and/or the OCFA EMT- Paramedic in charge of the patient(s) and/or incident; c. fully cooperate with and abide by the instructions of the OCF A Incident Commander and/or the OCFA EMT-Paramedic in charge ofthe patient(s) and/or incident; d. place their apparatus and equipment at the scene in a safe location or as deemed appropriate by the OCF A Incident Commander and must be mindful of the need for safe operations, including the avoidance of exhaust fumes; e. not interfere with or assist OCF A personnel in any fire fighting or emergency rescue operation; f. request a secondary ambulance and/or field supervisor immediately upon determining that their unit has suffered a mechanical failure or is or may become disabled, or upon the request of an OCF A Incident Commander, and must likewise immediately inform the OCF A Incident Commander of any mechanical failures; and, g. be aware that safety is the responsibility of all personnel on scene; ambulance personnel shall not enter or operate in unsafe environments. F. DISASTER ASSISTANCE During a disaster, declared locally or in a neighboring jurisdiction, strict application of the performance standards set forth in the Contract Documents may be temporarily suspended by OCF A in order to provide an appropriate response. While disaster coordination shall be provided by OCF A, Contractors are expected to be actively involved in the planning and response to any declared disaster. Upon notification of a disaster by OCF A, Contractors must immediately commit any and all available resources and assist OCF A in accordance with disaster plans and protocols applicable in the locality where the disaster has occurred. In the event of a disaster, the following shall apply: 1. During such periods, Contractors will be released from the response time requirements until notified by the OCF A Duty Officer that disaster assistance is no longer needed; 2. When disaster assistance is no longer needed, Contractors are to resume performance pursuant to the Contract Documents as quickly as is practical considering personnel exhaustion, medical supply restocking needs, and other relevant considerations; 3. While performing disaster assistance, Contractors are to provide supervisory assistance at the command post or emergency operations center as requested and are to use best efforts to provide local emergency coverage; Contractors must also suspend non-emergency transport services as necessary, informing persons requesting non-emergency transport of the reason for the temporary suspension; 25 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 4. During the course of a disaster, OCF A will work with Contractors to utilize mutual aid providers who are authorized to perfonn such services within the County to meet the service demands of the disaster; and, 5. Contractor's supervisory personnel will be required to complete, or show proof of completion, incident command training, hazardous materials training, and supervisory training in cooperation with OCF A. G. STANDARD OF PERFORMANCE Contractors must perfonn all work and services pursuant to the Contract Documents in a skillful and workmanlike manner, and consistent with the standards generally recognized as being employed by professionals in the private, emergency ambulance transportation field in the State of California. Contractors must warrant that they are skilled in the professional calling necessary to perfonn all work and services under the Contract Documents. Contractors must warrant that all employees and authorized subcontractors shall have sufficient skill and experience to perfonn the work and services assigned to them under the contract. Finally, Contractors must further represent that they, their employees, and authorized subcontractors have all licenses, permits, qualifications and approvals of whatever nature that are legally required to perfonn the work and services under the contract, and that such licenses and approvals shall be maintained at all times during the tenn of the contract. H. GENERAL PROVISIONS 1. Return of OCF A Personnel. OCF A provides Advanced Life Support ("ALS") services from a variety of delivery platfonns, including engine and truck companies. In cases where OCF A personnel accompany patients in the ambulance en route to hospitals or to other receiving facilities, and the OCF A ALS unit does not follow-up to the hospital/receiving facility, Contractors must return those personnel to their assigned fire station(s) within 30 minutes from the conclusion of the run. The conclusion of the run is defined as the moment when the patient has been transferred into the care of hospital/medical staff, the ambulance crew has completed all required documentation, and the ambulance has been restocked and is ready to be placed back in service. At the conclusion of the run, the ambulance crew is to advise the accompanying OCF A personnel that they are ready to return them to their station. If while returning OCF A personnel to their station, the ambulance receives another emergency call, the ambulance may accept that call for service and take those returning OCF A personnel to the new call at the discretion of the OCF A personnel on board. ' 2. 911 Calls for Service/Referral. Contractors must immediately refer to OCF A any and all calls for emergency 911 service that are made by any person directly to a Contractor's dispatch center or business office. 3. Performance., The most important aspect of this RFP is that it will result in the award of contracts that stress "perfonnance." Contractors must demonstrate a continuous effort to detect and correct service level perfonnance deficiencies, as determined by OCF A, and to continuously upgrade the perfonnance and reliability of the EMS system within their designated EOA. Clinical and response time perfonnance must be extremely reliable, with equipment failure and human error held to an absolute minimum through constant attention to perfonnance, protocol, procedure, perfonnance auditing, proper management oversight, employee training, continuing education, and prompt and defmitive service level corrective actions plans. 26 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 4. Conflict of Interest. Bidders must certify that they are not, and will not be, violating either directly or indirectly any conflict of interest statute, rule, or regulation by their perfonnance of the services described herein. 5. Complaints. Contractors must immediately notify OCF A in writing of any complaints, inquiries, or investigations initiated by OCEMSA, the California Emergency Medical Services Authority, and/or any other federal, state, or local regulatory agency regarding Contractor services performed pursuant to the Contract Documents, including but not limited to: level of service; service delivery; service quality; billing practices; medical training; and personnel. Nothing in the Contract Documents shall be construed as superceding the authority of OCEMSA or any other duly empowered regulatory agency from separately and/or concurrently exercising its authority to provide regulatory oversight and to take action to ensure that emergency ambulance response services are administered according to law. 6. Traffic Sienal Preemption. Contractors may be required to purchase, install, and maintain, at their sole cost and expense, City or OCF A approved traffic signal preemption and security gate access devices/equipment on all ambulances serving certain EOAs, subject to individual EOA requirements. 7. CAAS Accreditation. Commission on Accreditation of Ambulance Services ("CAAS") accreditation will be a factor in the overall grading and evaluation process. 8. IllPAA Business Associate Assurances. Effective April14, 2003, or such other implementation date established by law, to the extent that the parties have a "business associate" relationship, the parties shall carry out their obligations under the contract in compliance with the privacy regulations published at 65 Federal Register 82462 (December 28,2000) (the "Privacy Regulations") pursuant to Public Law 104- 191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F - Administrative Simplification, Sections 261, et seq., as amended ("HIPAA"), to protect the privacy of any personally identifiable, protected health infonnation ("PHI") that is collected, processed or learned as a result of the services provided pursuant to the contract. In confonnity therewith, both parties must agree that they will: a. Not use or further disclose PHI except: (i) as permitted under the contract (that is, for the purpose of maintaining accurate records of the services provided pursuant to the contract and for the billing of such services to patients, guarantors, insurers, carriers or other responsible parties; the issuance of reports to the other party pertaining to same; and related administrative functions pertaining to these activities); (ii) as required for the proper management and administration of ALS and BLS in their capacity as HIP AA "Business Associates" of each other; or (iii) as required by law; b. Use appropriate, safeguards to prevent use or disclosure of PHI except as pennitted by the contract; c. Report to each other any use or disclosure of PHI not provided for by the contract of which a party becomes aware; d. Ensure that any agents or subcontractors to whom either party provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to both parties with respect to such PHI; e. Make PHI available to the individual who has a right of access as required under HIP AA; 27 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 f. Make available for amendment and incorporate any amendments to PHI when notified to do so by either party; g. Make available to either party the information required to provide an accounting of the disclosures of PHI made by the one party on the other party's behalf, provided such disclosures are of the type for which an accounting must be made under the Privacy Regulations; h. Make their internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of detennining either party's compliance with HIP AA and the Privacy Regulations; and i. At the termination of the contract, return or destroy all PHI received from, or created or received by one party on behalf of the other party. In the event the return or destruction of such PHI is infeasible, both parties' obligations under this Section shall continue in full force and effect so long as either party possesses any PHI, notwithstanding the termination of the contract for any reason. 9. Medicare/Medi-Cal Participation. Contractors must warrant and represent that they are enrolled providers in good standing in the Medicare and Medi-Cal programs and are not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to their billing or reimbursement practices, and that Contractors shall not employ or utilize individuals for the performance of services hereunder who have been excluded fÌ"om any state or federal health care program. Contractor must warrant that: (i) it is not currently excluded, or threatened with exclusion, fÌ"om participating in any federal or state funded health care program, including but not limited to Medicare and Medi-Cal, and (ii) it has never been excluded by any of the aforementioned programs. Contractor must agree to notify OCFA of any imposed exclusions or sanctions covered by this warranty, and OCFA reserves the right to terminate the contract upon receipt of such notice. I. EXTERNAL MEDICAL QUALITY CONTROL Contractors must fully comply with all federal, state, and local medical standards, protocols, and rules and regulations applicable to the provision of private, emergency BLS ambulance transportation, including those established by OCEMSA. Contractors must at all times during the contract term cooperate with the OCEMSA program managers and the OCEMSA Medical Director in the monitoring, regulation, management, oversight, and administration of the County EMS system. The OCEMSA Medical Director, or his designee, has both the authority and responsibility to routinely establish and monitor private, emergency ambulance system performance, including but not limited to: ambulance equipment standards; medical protocols; personnel standards; training standards; medical dispatch procedures; first responder practices and training; medical control; and to effect corrective and disciplinary action as necessary. J. INTERNAL MEDICAL QUALITY CONTROL Contractors must establish a Continuous Quality Improvement ("CQI") program directed at, but not limited to, effective administration and management of clinical performance, response time performance, driver performance, dispatch performance, and for all other BLS service levels. Contractors must submit to the OCF A EMS Section Battalion Chief quarterly summary reports showing the results of all CQI program performance elements, in a form approved by the OCF A EMS Section Battalion Chief. 28 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 SECTION V - PERSONNEL A. PERSONNEL REQUIREMENTS 1. Employee Performance. Contractors must employ only competent and trained personnel, and shall provide a sufficient number of employees to perfonn the services provided under the Contract Documents. Each Contractor must comply with the following personnel requirements: a. All Contractor employees and ambulance personnel shall be sufficiently trained and capable to ensure the safe and proper discharge of their service responsibilities; b. All Contractor ambulance personnel must possess valid California Driver's Licenses in the proper class, including any required certifications, and must be compliant with all relevant provisions of the California Vehicle Code, Health and Safety Code, and all other laws applicable to private, emergency ambulance response personnel; c. All Contractors must have an employee alcohol and drug program that includes at a minimum, an alcohol and drug free workplace policy, and an employee alcohol/drug-testing program that complies with the U.S. Department of Transportation requirements to the extent allowed by law, including random alcohol and drug testing. Any Contractor employee found working under the influence of alcohol or drugs must be immediately removed from performing any further duties under the Contract Documents. The alcohol and drug program must meet the following requirements: i. A contract with a program administrator and authorized lab certified by the u.s. Department of Transportation; and ii. Procedures and components substantially as in Part 40 of Title 49 of the Code of Federal Regulations for pre-employment; and iii. Procedures and components substantially as in Part 382 of Title 49 of the Code of Federal Regulations for rehabilitation, return-to-duty and follow up testing; and iv. Procedures and components for random testing following U.S. Department of Transportation guidelines, and additional tests as required following accidents, rehabilitation, return-to- service, and other circumstances providing reasonable suspicion to test; and v. Upon request by the OCF A EMS Section Battalion Chief, yearly reports of the random testing component must be filed by the program administrator, in redacted form concealing employee identifiable infonnation, with OCF A; and vi. Contractors and program administrator's alcohol and drug program records shall be made available, in redacted form concealing individual employee identities, to OCF A upon request; and vii. Contractor employees must show a valid California driver's license at the time and place of testing; and viii.AlI test results are kept confidential except that OCF A is authorized to receive copies, in redacted fonn concealing individual employee identities, for its administrative purposes, and except as otherwise authorized or required by law. 29 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 d. All Contractors must participate in the California Department of Motor Vehicles (DMV) Employer Pull Notice Program; e. Contractors must not employ in the performance of services pursuant to the Contract Documents any ambulance operator or attendant or employee convicted of or having pled nolo contendere to a crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fÌ'aud, or misdemeanor or felony driving while under the influence of alcohol or drugs. If any Contractor employee is charged with any of the above listed crimes, Contractor must immediately suspend that employee fÌ'om performing any further duties under the Contract Documents pending the outcome of the criminal case; f. Contractor employees must maintain acceptable standards of dress, including uniforms, and cleanliness while on duty in the community and must at all times conduct themselves in a professional manner; g. Contractors' employees must fully cooperate with and abide by the instructions of OCF A personnel while on scene; h. If any employee becomes ineligible to provide services under the Contract Documents, Contractor must immediately notify the OCF A EMS Section Battalion Chief in writing of such ineligibility and the reason(s) therefore; i. Contractors must ensure that all of its employees and ambulances are, at all times during the term of the contract, in full compliance with all federal, state, and local laws, rules, statutes, and regulations, including but not limited to: the California Vehicle Code; the California Health & Safety Code; Orange County Ordinance No. 3517; applicable City ambulance ordinances; and any and all OCEMSA or State EMS Authority policies, standards, procedures, regulations, and/or protocols. All Contractor employees must have in their possession, at all times while on duty, applicable licenses, certifications, and/or permits, as may be required by the agencies and authorities listed above; j. Contractors' emergency response personnel must can)' and furnish to any OCFA personnel upon request any required licenses, certifications, and/or permits, including proper identification, for purposes of verifying validity, ensuring compliance with licensing, certification, and permitting requirements, and for the proper reporting of employee performance-related issues to Contractor. k. The OCF A EMS Section Battalion Chief may request Contractor to participate in emergency response joint training exercises to improve the capability and coordination of both OCF A and Contractor's response to a given emergency or disaster. Such training will be scheduled and mutually coordinated by the OCF A EMS Section Battalion Chief and the Contractor. Such training shall not exceed twenty (20) hours per year per EOA; 1. Any additional training that may be deemed necessary by OCF A shall be attended by Contractor's personnel upon reasonable notice and at the sole cost and expense of Contractor. Such additional training may include, but is not limited to, mass casualty, weapons of mass destruction, and/or other emergency response training; m. Contractors must make available to the OCF A EMS Battalion Chief upon request any and all Contractor personnel training records for those employees who perform services pursuant to the Contract Documents; 30 FireÆMS Emergency Àmbulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 n. Contractor employees shall perform the duties required under the Contract Documents in an ethical, professional, and orderly manner and shall endeavor at all times to obtain and keep the confidence of the public. Contractor employee performance of all terms and conditions contained in the Contract Documents shall be monitored and maintained by the OCF A EMS Section Battalion Chief; and, o. Contractors must utilize management practices that ensure that its emergency response personnel working extended shifts, part-time jobs, voluntary overtime, or mandatory overtime are not exhausted, overworked, or exhibiting impaired judgment or motor skills. 2. Emplovee Removal. At the request of the OCF A EMS Section Battalion Chief, and based on a demonstrated pattern of either poor performance or service complaints, Contractors must remove certain personnel £rom performing further duties under the Contract Documents. B. CONTROL Neither the County, the City, or OCF A, or any of their officers, elected officials, agents, representatives, or employees shall have any control over the conduct of Contractors' employees except as set forth in the Contract Documents. Contractors must agree to not represent that either it or its agents or employees are in any manner agents or employees of the County, the City, or OCF A, it being understood that Contractor its agents and employees are as to the County, the City, and OCFA wholly independent contractors and that Contractors' obligations to the City and OCF A are solely those prescribed by the Contract Documents. Contractors must further acknowledge and agree that the City, the County, and OCFA shall have no responsibility whatsoever for salary, health benefits, retirement benefits, taxes, or any other benefits that may be due to Contractor employees. 31 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 SECTION VI - SUPPLIES, EQUIPMENT AND VEHICLES A. SUPPLIES AND EQUIPMENT 1. Standards. All equipment and supplies furnished by Contractors to perform BLS services under the Contract Documents must comply with all federal, state, and local laws, rules, statutes, and regulations applicable to the provision of private, emergency ambulance transportation, including but not limited to, those BLS equipment and supply standards and protocols established by the OCEMSA Medical Director. Such equipment and supplies must be stocked at all times on each ambulance performing services under the Contract Documents. 2. Standard Inventory. In addition to the above equipment and supply standards, Contractors must carry and stock at all times throughout the contract term on each ambulance performing services within an assigned EOA the following emergency medical equipment, which shall all be readily available and accessible from the interior portions of the patient transportation compartment: a. Bag valve mask resuscitator, adult with variable mask sizes; b. Bag valve mask resuscitator, pediatric with variable mask sizes; c. Heavy gloves to be used for blood or body fluid protection; d. Disposable Latex gloves, medium, large and x-large, two (2) boxes; e. Suction unit that complies with OCEMSA policies and procedures; f. Non-invasive blood pressure device (various cuff sizes, including thigh cuff); g. Child safety seats (when approved by federal agencies); and, B. VEIDCLES AND MAINTENANCE 1. Standards. All vehicles furnished by Contractors in the performance of BLS services under the Contract Documents must comply with all federal, state, and local laws, rules, statutes, and regulations applicable to the provision of private, emergency ambulance transportation, including but not limited to, those BLS vehicle standards and protocols established by OCEMSA. 2. Modular (TVDe lID. Use of modular (Type III, dual rear wheeled) ambulances will be a factor in the overall grading and evaluation process. Contractors must specify within their bid proposal the make, model, year, license plate, type, and mileage for: (a) each ambulance proposed for exclusive, dedicated use within the EOA; and (b) each ambulance proposed for non-exclusive use within the EOA and/or regionally available for use within the EOA. Contractors must agree to expand, at the sole discretion ofOCFA: (a) the total number of ambulances proposed and committed for exclusive, dedicated use within the EOA; and/or, (b) the total number of ambulances proposed for non-exclusive use within the EOA and/or regionally available for use within the EOA, if either response time requirements are not consistently being met or if the EOA experiences a significant call volume increase. Contractors must, at all times during the contract term, maintain: (a) the total number of ambulances proposed and committed for exclusive, dedicated use within the EOA; and, (b) the total number of ambulances proposed and committed for non-exclusive use within the EOA and/or regionally available for use within the EOA. Any reduction in the total number of ambulances proposed and committed, as provided in the bid proposal, will be deemed breach of contract. Ambulances that are taken out of service either temporarily for maintenance or permanently, must be immediately replaced by Contractors to maintain the total ambulances proposed and committed. 32 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 3. Inspection. Contractors must agree that the Proposal Grading Panel may, at any time throughout the procurement process, and that the OCF A EMS Section Battalion Chief may, at any time during either the procurement process or the contract term, inspect Bidder/Contractors' ambulances, ambulance maintenance facilities, ambulance maintenance records, ambulance manufacturer suggested maintenance program, and/or ambulance purchase/lease/acquisition documentation. 4. Maintenance. Contractors shall be responsible for providing all necessary vehicles and equipment to provide the required services under the Contract Documents. OCF A expects that all vehicles and equipment used in the performance of the required services under the contract will be maintained in excellent condition. Contractors shall comply with or exceed the maintenance standard as outlined in the Standards- Accreditation of Ambulance Services published by the Commission on Accreditation of Ambulance Services. Contractors' failure to service and maintain all ambulances and equipment dedicated to an assigned EOA under the Contract Documents pursuant to the manufacturer's suggested maintenance program will be deemed breach of contract and cause for immediate contract termination. 5. Personal Safety EQuipment. Contractors shall provide personal safety equipment for all employees in accordance with applicable federal and state laws or standards. It shall be the sole responsibility and expense of the Contractor to maintain or replace, or cause to be maintained or replaced, any personal safety equipment required. Contractors are solely responsible for ensuring that all of its personnel abide by all federal, state and local safety standards. 33 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 SECTION VII - RATES FOR AMBULANCE SERVICE A. BLS AND ALS SERVICE RATES 1. Maximum BLS Service Rate. The Orange County Board of Supervisors establishes the maximum Basic Life Support ("BLS") service rate ("BLS Service Rate") that may be charged by Contractors to their patients for the provision of emergency ambulance transportation services. Contractors may not charge more than the maximum BLS Service Rate approved by the Orange County Board of Supervisors for each BLS patient transport. BLS means the same as is defined in the EMS Act. The BLS Service Rate is reviewed annually by OCEMSA, which makes rate adjustment recommendations to the Board of Supervisors. As such, the maximum approved BLS Service Rate is subject to change at any time during the contract term. As of the RFP issuance date, the approved maximum BLS Service Rate is as follows: ' Type of Charge Maximum Rate BLS Service Rate $480 per BLS transport 2. Maximum ALS Service Rate. The OCF A Board of Directors establishes the maximum Advanced Life Support ("ALS") service rate ("ALS Service Rate") that may be charged by Contractors for OCFA-provided emergency ALS services to patients transported either ALS or BLS, subject to approval by the Orange County Board of Supervisors. For those calls for service in which ALS services are provided by OCF A to patients that are transported either ALS or BLS, Contractors shall be responsible for charging and collecting the ALS Service Rate, as set forth herein, in addition to Contractors' BLS Service Rate. Contractors may not charge more than the maximum ALS Service Rate approved by the OCFA Board of Directors. ALS means the same as is defined in the EMS Act. The ALS Service Rate is reviewed annually by OCF A. The maximum approved ALS Service Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. As of the Effective Date, the approved maximum ALS Service Rate is as follows: TyPe of Charge Maximum Rate ALS Service Rate $282 per transport wi ALS services 3. ALS Reimbursement Rate. The OCF A Board of Directors establishes the OCF A ALS reimbursement rate ("ALS Reimbursement Rate"), which Contractors must pay OCFA for ALS services provided to patients that are transported either ALS or BLS in order to cover OCF A's costs for providing such services. Contractors shall pay OCF A the established ALS Reimbursement Rate for each call for service in which OCFA provides ALS services to patients that are transported either ALS or BLS. a. Medicare Patients. The ALS Reimbursement Rate for Medicare patients, including patients covered under Medi-Medi or Medicare+Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is based on the Medicare allowed amounts for each Contractor. The ALS Increment is derIDed as the difference between the Medicare allowed amount for a given ALS service (i.e., AL8-lE or AL8-2) and the Medicare allowed amount for BLS emergency services, prior to the 20% co-payment deduction. 34 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 i. ALS-l Emergency Services. The ALS Reimbursement Rate for ALS-l emergency transports and ALS-l emergency assessments with BLS transports for Medicare patients, including patients covered under Medi-Medi or Medicare+Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS-l emergency services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co-payment deduction. ii. ALS-2 Services. The ALS Reimbursement Rate for ALS-2 services for Medicare patients, including patients covered under Medi-Medi or Medicare+Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS-2 services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co-payment deduction. b. Medicare Profile. Contractors must submit a copy of their Medicare Profile for 2004 to the OCF A EMS Battalion Chief on or before the Effective Date and no later than March 1 st each year thereafter. Each year the submitted Medicare Profile shall be used by OCFA for purposes of calculating the ALS Increment. c. Annual Adjustments. The ALS Reimbursement Rate is reviewed annually by OCF A. The ALS Reimbursement Rate payable to OCF A by Contractors for all ALS services provided to patients, excluding Medicare patients and patients covered under Medi-Medi or Medicare + Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. d. ALS Reimbursement Rate. As of the Effective Date, the approved ALS Reimbursement Rate is as follows: Type of Charge Amount 1. ALS Reimbursement Rate $200 per transport wi ALS services 2. ALS Reimbursement Rate for Medicare patients or patients with Medi-Medi or Medicare+Choice plans ALS-l E or ALS-2 Increment 4. Medical Supply Reimbursement Rate. The OCF A Board of Directors establishes the medical supply reimbursement rate ("Medical Supply Reimbursement Rate"), which Contractors must pay OCF A per BLS/ALS transport. Contractors shall pay OCF A the Medical Supply Reimbursement Rate for each BLSI ALS patient transport to cover OCF A's costs for providing expendable medical supplies to Contractors. The Medical Supply Reimbursement Rate is reviewed annually by OCF A. The Medical Supply Reimbursement Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. As of the Effective Date, the proposed Medical Supply Reimbursement Rate will be as follows: Type of Charge Amount Medical Supply Reimbursement Rate $22.38 per transport (BLS/ALS) 35 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ' 5. Zero Pay Patients. OCF A will not require Contractors to pay the established ALS Reimbursement Rate or Medical Supply Reimbursement Rate (nor any portion thereof) for "zero pay patients." "Zero pay patients" are those calls for service to patients whose only method of healthcare coverage or insurance is provided by a state or local subsidized health care program (i.e., patients receiving health care benefits pursuant to anyone of the following state or local subsidized health care programs: (a) Medi-Cal; (b) CalOptima; (c) California Child Services ("CCS"); and/or (d) County Medical Services for the Indigent ("CountyIMSI"). Patients who have other means of payment or who are covered by additional or supplemental insurers, other than subsidized health care programs, are not "zero pay patients." Contractors may seek relief from making the required reimbursement payments to OCF A by applying for a Zero Pay Patient Exemption, as provided below. 6. Risk or Non-Pavment. Except as provided otherwise herein, Contractors assume the entire risk of non-payment for any and all of the services rendered and the charges incurred in connection with their performance under the Contract Documents, including all BLS and ALS charges incurred, as well as all ALS reimbursements and medical supply reimbursements. 7. Medicare Patients. Contractors may not charge Medicare patients more than the maximum Medicare rate. B. BILLING, AUDIT AND ACCESS TO RECORDS 1. BilDo!! System. Contractors may only bill for services according to the approved service rates and schedules set forth in the Contract Documents and as authorized by OCEMSA, with no additional fees or charges imposed unless approved in writing in advance by the OCF A Fire Chief and/or the awarding agency, if applicable. Prior to the Effective Date, Contractors must establish an auditable billing system approved by OCF A, which shall be available for review by OCF A on a periodic basis. Contractors' patient billing/records system must be organized so that search and retrieval of all billing records can readily be made by OCF A according to the following individual criteria: BLS BLS Transport ALS Assessment/BLS Transport ALS Transport 911 Calls DaylMonthIY ear OCF A Incident No. Patient Name ALS 2. AccouotiO!!. Contractors must maintain accurate and complete records of all patient accounting, including but not limited to: (i) all patient invoices, (ii) all patient/insurer payments; (iii) all BLS service charges; (iv) all ALS service charges; (v) all ALS reimbursement payments; (vi) all medical supply reimbursements; (vii) all invoices, payments, and correspondence to and from private insurers, federal or state health care programs, and other responsible third parties; and (viii) all records..evidencing payments made by Contractors to OCF A in connection with their performance under the Contract Documents. Such accounting shall be performed by Contractor in accordance with generally accepted accounting principles and practices consistently applied. OCF A shall have access to such records and information upon seventy-two (72) hours advanced written notice at all times during normal business hours for the purpose of inspection, audit, review, evaluation, and duplication. Contractors must, at no cost to OCFA, provide proper facilities for OCFA's access, inspection, audit, review, evaluation, and duplication of such infonnation. 36 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 3. Responsibility for Submission of Claims. Contractor shall be responsible for submitting claims for services provided hereunder, and may utilize the services of a third party billing agent for this purpose. In the event that a third party billing agent is used, Contractor shall infonn the billing agent of the provisions of the Contract Documents. Contractor shall be responsible to bill for all transports in which ALS services are rendered, specifically including the perfonnance of ALS assessments as defined in 42 c.F.R. §414.605, in accordance with applicable Medicare guidelines for the level of service provided. a. Submission of Claims. For services provided pursuant to the contract, Contractor shall submit one claim covering both ALS and BLS services to the appropriate camer or payer utilizing Contractor's provider number. In no event shall more than one claim per trip be submitted where not pennitted by law. b. Sharing of Information and Documentation and Respect of Privacy. Contractors must pennit access by OCFA to Contractor's respective books and records as they relate to billing and reimbursement for services hereunder. Contractors must share all patient care and billing information necessary to properly submit Medicare claims, including patient care reports and billing slips. Contractors shall within thirty (30) days of receiving any requests for information or documents from the patient, the Centers for Medicare and Medicaid Services (CMS) (formerly HCF A) or its authorized carrier or intermediary, other payment source, or other state or federal agency with oversight of the billing and patient care practices of the parties pursuant to the contract, make available to OCF A any and all such records requested. All information or documents exchanged between the parties related to personal health information of a patient shall be exchanged in compliance with all privacy laws and rules, including the privacy rule established under the Health Insurance Portability and Accountability Act (HIP AA). Both parties will agree to maintain policies to protect the confidentiality of patient infonnation to the extent required by law and to educate and enforce such policies with their respective personnel. 4. Medicare Audits. In the event that Contractor is obligated to repay any amounts, related to ALS billed services or medical supplies, to Medicare or other carrier pursuant to a post-payment audit, OCF A shall repay Contractor the ALS Reimbursement Rate or Medical Supply Reimbursement Rate, as applicable, on those claims for which payment is recouped by Medicare or other carrier. However, OCF A will only be responsible for repaying the Contractor in two situations: when a claim is downgraded by the Medicare contractor from an ALS-lE call to a BLS emergency call, or from an ALS-2 to an ALS-lE call. In these situations, OCF A will only repay the Contractor an amount equal to the total ALS Increment (i.e., when a call is downgraded from ALS to BLS) or a portion of the ALS Increment, which is the difference between the ALS Increment of an ALS-2 services and the ALS Increment of an ALS-IE service (i.e., when a call is downgraded from an ALS-2 to an ALS-lE). The Contractor must supply documentation supporting the overpayment demand by the Medicare Contractor prior to any OCF A repayment. C. CONTRACTOR MONTHLY PAYMENTS 1. Monthly Payments to OCFA. All ALS reimbursements and medical supply reimbursements, as required in this Section, (hereinafter referred to as "Monthly Payments") must be promptly paid by Contractors to OCF A beginning ninety (90) days from August 1, 2004, and such payments shall continue to be promptly remitted by Contractors to OCF A thereafter within ninety (90) days after the first day of each month throughout the contract tenn. Zero Pay Patient Exemptions may be requested by Contractors for each qualifying call by following the procedures below. A penalty of $500 may be imposed for each late payment. Contractors whose monthly payments are sixty (60) days late (or more) may be assessed a 37 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RI..972 Amendment No. I - April 2004 179999,6 1 Yå'o late fee for each month that payments are not made. Failure to make timely Monthly Payments may be deemed breach of contract. 2. Zero Pay Patient Exemption Requests. Contractors must submit to OCF A for approval all Zero Pay Patient Exemption requests and all documentation justifying each request. Zero Pay Patient Exemption requests must be submitted by Contractors with their monthly ALS reimbursement and medical supply reimbursement payments for the month in which the exemption is requested and must be reflected as a credit on the current Monthly Payment remittance. Requests for exemptions outside the current monthly payment period will not be considered, except as provided herein. Each Zero Pay Patient Exemption will be evaluated and either granted or denied at the sole discretion of the OCF A EMS Section Battalion Chief. Contractors will be notified in writing by the OCF A EMS Section Battalion Chief if any exemption request will be denied within thirty (30) days of receipt of the request. The decision may be appealed by the Contractor to the OCF A Fire Chief, whose decision shall be fmal. In the event a Zero Pay Patient Exemption request is denied, the requesting Contractor shall adjust its next Monthly Payment remittance for the amount of the credit denied. Exemption requests for "Retro Credits" should be made within the month the Contractor receives notification of the retroactive enrollment in a qualified zero pay patient program. 3. Monthly Payment Report. Contractors must submit a Monthly Payment Report (in electronic fonnat) to the OCF A Accounts Receivable Section along with all Monthly Payments. The Monthly Payment Report must contain the following infonnation: a. EOA number; b. Name of responsible party invoiced per transport; c. Patient name and address; d. Indicate BLS, ALS, or ALS Assessment/BLS Transport; e. Date of call for service; f. OCF A incident number; g. ALS reimbursement amount remitted to OCF A per transport; and, h. Medical supply reimbursement amount remitted to OCF A per transport. 4. Audit Report. An audit concerning Monthly Payments may be conducted at the sole discretion of OCF A at any time throughout the contract term. If instructed, Contractors must promptly produce an audit list (in an approved electronic format) to OCF A auditors, which contains the following information: a. Name of responsible party invoiced per transport; b. Patient name and address; c. Indicate BLS, ALS, or ALS Assessment/BLS Transport; d. Date of call for service; e. OCF A incident number; f. Amount invoiced per transport; g. Amount recovered per transport; h. Any exemption requests for transports included in the audit sample; and, 1. Any other requested relevant infonnation required to perfonn an audit. 38 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 AmendmentNo. 1 - April 2004 179999,6 D. CHANGED CIRCUMSTANCES In the event that unforeseen changes in either the health care industry or laws (federal, state, or local laws, rules, regulations or statutes) seriously affect the Contractors' ability to continue to perform the services and at the rates required under the Contract Documents, Contractors may petition OCF A for a re-evaluation of the level of service and/or established maximum rates or approved Contractor rates, including the maximum ALS Reimbursement Rate and the Medical Supply Reimbursement Rate, as well as the exemption process. Contractors shall be required to provide such proof as necessary to show that the continuance of the current services, rates, charges, reimbursements, etc. are so economically harmful to Contractors so as to place Contractors in danger of having to default on the contract. This may include requiring Contractors to hire, at their sole cost and expense, an approved independent auditing firm. It shall be at the sole discretion of the OCF A Fire Chief and/or the awarding agency, if applicable, whether to agree to any modifications of the Contract Documents. The parties may by written amendment adjust the terms of the Contract Documents where circumstances beyond the control of either party require modification or amendment. 39 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 SECTION vm - BID PROPOSAL SUBMISSION FORMS BIDDER CHECKLIST 0 BINDER (ORIGINAL + 9 COPIES) ONE BID PROPOSAL PER EOA PAGE SIZE, FONT SIZE, PAGE LIMITS TITLE PAGE BID PROPOSAL DEPOSIT TABLE OF CONTENTS ITEM 1 - COVER LETTER ITEM 2 - NOTIFICATION OF PROVIDER PREQUALIFICATION ITEM 3 - OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN ITEM 4 - EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEM ITEM 5 - TOTAL NUMBER OF AMBULANCES ITEM 6 - SERVICE RATES ITEM 7 - ON-BOARD EQUIPMENT & SUPPLIES ITEM 8 - RESPONSE TIME REQUIREMENTS ITEM 9 - VEHICLE & EQUIPMENT MAINTENANCE PROGRAM ITEM 10 - DRIVER TRAINING ITEM 11 - INTERNAL MEDICAL QUALITY CONTROL ITEM 12 - MUTUAL AID PROVIDER ITEM 13 - PERSONNEL AND TRAINING ITEM 14 - BILLING AND COLLECTION PRACTICES ITEM 15 - HIP AA COMPLIANCE PLAN ITEM 16 - CORPORATE COMPLIANCE PLAN ITEM 17 - COMPLIANCE WITH QUARTERLY PAYMENTS ITEM 18 - PLAN FOR TAKEOVER OF SERVICE/START-UP ITEM 19 - 911 FIRE/EMS RESUME ITEM 20 - CONFLICT OF INTEREST CERTIFICATION ITEM 21 - STATEMENT OF TRUTH ITEM 22 - NON-COLLUSION CERTIFICATION ITEM 23 - PHOTOGRAPHS (OPTIONAL) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 TITLE PAGE/COVER SHEET (1 PAGE LIMIT) Orange County Fire Authority Request for Proposals for Fire/EMS Emergency Ambulance Transportation and Related Services RFP # RL972 Insert Bidder Name Insert Bidder Address Insert Bidder Authorized ContactJRepresentative Signature of Authorized Contact/Representative Insert EOA Name & EOA Number Proposed Insert Bidder Telephone Number Insert Date of Bid Proposal Submission Designate as "Original" or Copy 41 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 BID PROPOSAL DEPOSIT (1 PAGE LIMIT) Please attach below (either staple or otherwise affix) the required Bid Proposal Deposit, as described in Section II (F). 42 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 TABLE OF CONTENTS Please include in the Bid Proposal a Table of Contents listing the following request items and submission forms in the order provided: ITEM I - COVER LETTER ITEM 2 - NOTIFICATION OF PROVIDER PREQU ALIFICA TION ITEM 3 - OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN ITEM 4 - EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEM ITEM 5 - TOTAL NUMBER OF AMBULANCES ITEM 6 - SERVICE RATES ITEM 7 - ON-BOARD EQUIPMENT & SUPPLIES ITEM 8 - RESPONSE TIME REQUIREMENTS ITEM 9 - VEHICLE & EQUIPMENT MAINTENANCE PROGRAM ITEM 10 - DRNER TRAINING ITEM 11 - INTERNAL MEDICAL QUALITY CONTROL ITEM 12 - MUTUAL AID PROVIDER ITEM 13 - PERSONNEL AND TRAINING ITEM 14 - BILLING AND COLLECTION PRACTICES ITEM 15 - HIPAA COMPLIANCE PLAN ITEM 16-CORPORATECOMPLIANCEPLAN ITEM 17 - COMPLIANCE WITH MONTHLY PAYMENTS ITEM 18 - PLAN FOR TAKEOVER OF SERVICE/START-UP ITEM 19 - 911 FIREÆMS RESUME ITEM 20 - CONFLICT OF INTEREST CERTIFICATION ITEM 21 - STATEMENT OF TRUTH ITEM 22 - NON-COLLUSION CERTIFICATION ITEM 23 - PHOTOGRAPHS (OPTIONAL) 43 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 i). ii). iii). iv). v). vi). vii). viii). ix). x). ITEM 1: COVER LETTER (4 PAGE LIMIT) Please include a cover letter, on official Bidder letterhead, that describes the Bidder and its qualifications, and include the following infonnation, as described in Section II(C)(2)(j): The official name of the Bidder; The Bidder's organizational structure (e.g. corporation, partnership, limited liability corporation, or otherwise); The jurisdiction in which the Bidder is organized and the date of such organization; The address and telephone number of the Bidder's headquarters and of any local office involved in the bid proposal; The Bidder's Federal Tax Identification Number; The name, address, telephone, fax numbers and e-mail address of the person(s) who will serve as the authorized contact(s) to the City and OCFA with regards to the bid proposal, the RFP process, the Contract Documents, and the administration of the contract, if awarded, with authorization to make representations on behalf of and to bind the Bidder; Provide applicable authorized signature documentation, pursuant to Bidder's organizational structure/bylaws, verifying the authority of the person signing the original bid proposal to commit to the proposal on behalf of the Bidder (attach to cover letter); A representation that the Bidder is in good standing in the State of California and has obtained all necessary licenses, permits, certifications, approvals and governmental authorizations necessary in order to perfonn all of the required performance obligations specified in the RFP; A representation that the Bidder is in good standing in the Medicare and Medi-Cal programs and is not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to their billing or reimbursement practices, and that Bidder has not been excluded from any state or federal healthcare program or employs any individual who has been excluded from any state or federal healthcare program; Statement of acceptance of all terms, conditions, requirements, and perfonnance criteria contained in the Contract Documents; and, xi). Any additional infonnation Bidder deems relevant for consideration during the selection process. 44 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 2: NOTIFICATION OF PROVIDER PREOUALIFICATION Please attach (either staple or otherwise affix) a copy of the OCF A notification of pre qualification letter that was sent to Bidder. 45 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 3: OVERALL OPERATIONAL SYSTEM AND DESIGN (8 PAGE LIMIT) Please provide a detailed summary of the operational system and program design Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area (EOA), and describe in detail how the proposed operational system and program design will either meet or exceed the competitive bid criteria, specifications, requirements, and perfonnance expectations set forth in this RFP. Additional Specific Submission Data: 1. . Provide the number and proposed location of all emergency vehicles for service in the subject EOA. In the alternative to a fIXed station(s) in the EOA, provide a detailed map of the system status management or provide a detailed system plan. 2. Provide the hours of operation for each unit in the subject EOA. 3. Provide the crew configuration for each unit in the subject EOA. 4. Provide description of supervisory plan of crews, including number and location of supervisory personnel. 5. Provide an overall summary of Bidder's Southern California system operations including: a. total number of ambulances in fleet; b. total number of employees including line staff, supervisors, managers, administrative, billing, etc.; c. contact infonnation for third party billing agency and third party collection agency (where applicable); and d. contact infonnation for medical director; contact infonnation for continuing education program, driver training, etc. 46 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 4: EMERGENCY RESPONSE AND VEmCLE COMMUNICA nONS SYSTEM (3 PAGE LIMIT) Please provide a detailed summary of the Emergency Response and Vehicle Communications System Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Emergency Response and Vehicle Communications System will either meet or exceed the communications specifications, requirements, and performance expectations set forth in Section IV. Additional Specific Submission Data: 1. Provide a statement that Bidder is or will be compliant by the Effective Date with all communications requirements set forth in Section IV of this RFP. 2. Provide a detailed summary of CAD (Computerized Aided Dispatch) program capabilities. 3. Provide a detailed summary of other communications equipment used by Bidder (if applicable) including, but not limited to: a. Cellular phones; b. Personal digital assistants (PDAs); c. Mobile computers. 4. Provide a detailed summary of the proposed operational design for the Emergency Response Communications System and methods proposed for dispatching ambulances. 5. Provide a detailed summary of the Bidder's internal and external information technology capabilities. 6. Provide detailed summary of communications capabilities, including: a. Hours of operation; and b. Personnel devoted to communications. 7. Provide a statement on Bidder's ability to upgrade communication systems. 8. Provide a detailed summary of all field data collection systems and the process by which data is collected, inputted and used by the Bidder. 47 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 5: TOTAL NUMBER OF AMBULANCES (4 PAGE LIMIT) Please provide a detailed summary of all emergency vehicles and ambulances Bidder proposes for use in its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed vehicles and ambulances that are proposed for use within the subject EOA will either meet or exceed the specifications, requirements, and performance expectations set forth in Section VI. Please also include the following specific ambulance information, as well as a detailed summary of Bidder's proposed ambulance replacement program. A). Units Proposed for Exclusive. Dedicated Use in the Subject EOA Service Area: Ambulance Unit #s: CHASSIS MAKE MODEL YR. Mll..EAGE CONDITION TYPE B). Other Proposed Rel!ional Units that will be Available to Reasonab1v Support the Subject EOA: Ambulance Unit #s: CHASSIS MAKE MODEL YR. MILEAGE CONDITION LOCATION TYPE NOTE: Mileage provided must be estimated based on unit in service to the EOA as of July 1,2004. 48 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 6: SERVICE RATES (2 PAGE LIMIT) Please provide a detailed summary and/or schedule of all ambulance service rates and fees that Bidder proposes to charge all. payers and patients in connection with its provision of emergency ambulance transportation and related services within the subject EOA, in accordance with the established maximum rates, requirements, and reimbursements set forth in Section vll, including but not limited to all costs of service and/or cost, if any, to the awarding agency. 49 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 ITEM 7: ON-BOARD EQUIPMENT AND SUPPLIES (3 PAGE LIMIT) Please provide a detailed summary of the On-Board Equipment and Supplies Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed On- Board Equipment and Supplies will either meet or exceed the specifications, requirements, and performance expectations set forth in Section VI. Additional Specific Submission Data: 1. Provide a detailed summary of Bidder's OSHA compliance program; 2. Describe Bidder's capabilities to respond to terrorist threats or disasters. 50 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 ITEM 8: RESPONSE TIME REOUIREMENTS (4 PAGE LIMIT) Please provide a detailed summary of how Bidder's operational system and program design, proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, will consistently and continuously meet or exceed the response time requirements and perfonnance expectations set forth in Section IV. Additional Specific Submission Data: 1. Please provide detailed fractile summary response time reports for the three- month period of April 2003 to June 2003 for the subject EOA or a geographic/call volume related area similar to the subject EOA, and include both Code 2 and Code 3 calls, separately delineated. 2. If your proposed operational system and program design will exceed the response time requirements and perfonnance expectations set forth in this RFP, please clearly explain in a detailed summary how such requirements will be exceeded. 51 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. 1 - Apri12004 179999,6 ITEM 9: VEmCLE AND EQUIPMENT AND MAINTENANCE (4 PAGE LIMIT) Please provide a detailed summary of how Bidder's Vehicle and Equipment Maintenance Program proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently and continuously meet or exceed the vehicle and equipment maintenance standards, requirements, and performance expectations set forth in Section VI. Additional Specific Submission Data: 1. Provide a description of the vehicle maintenance plan or schedule; 2. Provide a description of the vehicle replacement plan; 3. Provide a detailed summary of equipment maintenance program including replacement plan. 52 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 ITEM 10: DRIVER TRAINING (2 PAGE) Please provide a detailed summary of the Driver Training Program Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Driver Training Program will either meet or exceed the performance expectations and requirements set forth in Section V. Additional Specific Submission Data: 1. Provide a detailed course syllabus or curriculum for driver training program offered to employees; 2. Provide the total number of course hours per course offered; 3. Describe the internal training plan, including timeframe for completion and retraining; 4. Provide the name of the institution providing the training, if applicable. 53 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 11: INTERNAL MEDICAL QUALITY CONTROL (3PAGELIMITI Please provide a detailed summary of how Bidder's Internal Medical Quality Control and Continuous Quality Improvement ("CQI") Programs proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently meet or exceed the standards, requirements, and performance expectations set forth in Section IY(J). Additional Specific Submission Data: 1. Provide a detailed summary of Bidder's quality assurance/improvement process, including time frames for process completion; 2. If your proposed Internal Medical Quality Control and Continuous Quality Improvement ("CQf') Programs will exceed the standards and requirements set forth in this RFP, please clearly explain in a detailed summary how such requirements will be exceeded 54 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 ITEM 12: MUTUAL AID PROVIDER (2 PAGE LIMIT) Please provide a detailed summary of how Bidder's Mutual Aid Provider Program proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently and continuously meet or exceed the standards, requirements, and perfonnance expectations set forth in Section IV(D)(IO). Additional Specific Submission Data: Provide a copy of all current mutual aid agreements that would apply to the subject EOA or provide a copy of Bidder's proposed mutual aid plan, including: a. Name of mutual aid provider (if known); b. Location of mutual aid provider; c. Staffing capabilities of mutual aid provider, if known. 55 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 13: PERSONNEL AND TRAINING (A). ASSIGNED PERSONNEL PROFILE (3 PAGE LIMIT) Please provide a detailed spreadsheet of the individual personnel, including proposed management team, employee names, current certification/license level of service, certificate/license number, and number of years as an employee of Bidder, proposed by Bidder for the performance of services under the Contract Documents within the subject Exclusive Operating Area. (B). FIELD TRAINING OFFICERS (1 PAGE) Please provide the ratio of field training officers to EMTs or other ambulance personnel that Bidder proposes to commit to the subject EOA, and provide a detailed explanation of Bidder's proposed Field Supervisor and Training Programs and management/field supervisor oversight plan for the subject EOA. (C). P~YPERSONNEL (5 PAGE LIMIT) Please provide the resumes of no more than five (5) proposed key personnel (maximum one page each) whose job duties for Bidder's Orange County operations will relate solely and exclusively to the fulfillment of the terms, conditions, performance expectations, and obligations relative to Bidder's performance under the Contract Documents. (D). EMPLOYEE RECRUITMENT. SCREENING AND ORIENTATION (2 PAGE LIMIT) Please provide a detailed summary of the CUITent personnel Recruitment, Screening, and Orientation Program Bidder currently employs and modifications Bidder proposes to utilize in connection with its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Recruitment, Screening, and Orientation Program will enable Bidder to consistently and continuously meet or exceed the training standards, personnel requirements, and performance expectations set forth in Section V. 56 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 13: PERSONNEL AND TRAINING CONTINUED (E). CONTINUING EDUCATION PROGRAMS (2 PAGE LIMIT) Please provide a detailed summary of any and all continuing education programs, including continuing medical education programs, that will be provided to all employees who perfonn services under the Contract Documents, as well as a discussion of Bidder's commitment to providing such programs at all times throughout the contract tenn. (F). HIP AA TRAINING PROGRAMS (2 PAGE LIMIT) Please provide a detailed summary of Bidder's HIPAA training program that has been provided to all employees and will be provided to all new employees who perfonn services under the Contract Documents. 57 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 14: BILLING AND COLLECTION PRACTICES (3 PAGE LIMIT) Please provide a detailed summary and explanation of the billing and collection practices Bidder proposes for use and implementation within the subject EOA, including Bidder's proposed system, procedures, practices, policies and protocols for responding to and timely processing all customer complaints. Please also include a detailed summary and explanation of Bidder's proposed record keeping and auditing practices and how such systems will either meet or exceed the requirements and perfonnance expectations set forth in Section VII. Additional Specific Submission Data: 1. Provide a detailed description of the billing and data information flow from dispatch through initial billing; 2. Provide process flow and time frames for collections process, including but not limited to: a. The number of monthly statements sent prior to collections; b. Timeframe for write-offs; 3. Provide overall billing and collection practices, including but not limited to: a. Statement cycle; b. Collection rate; 4. Provide statistical data for subject EOA (if applicable), including but not limited to: a. Payer mix; b. Patient demographics; c. Collection rate by payer. 58 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM IS: IDP AA COMPLIANCE PLAN (1 PAGE LIMIT) Please provide a detailed summary and explanation of Bidder's HIPAA Compliance Plan, including Bidder's certification that all personnel have signed a confidentiality agreement and have undergone HIP AA Privacy Training. 59 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 J 79999,6 ITEM 16: CORPORATE COMPLIANCE PLAN (2 PAGE LIMIT) Please provide a detailed summary and explanation of Bidder's Corporate Compliance Plan, if applicable. A Corporate Compliance Plan should include those elements identified in the Office of Inspector General's Compliance Program Guidance for Ambulance Suppliers [Federal Register: March 24, 2003 (Volume 68, Number 56)]. 60 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 17: COMPLIANCE WITH MONTID..V PAYMENTS (4 PAGE LIMIT) Please provide a detailed summary and explanation of the system for providing timely, monthly payments to OCF A that addresses how Bidder intends to satisfy the procedures and requirements set forth in Section Vll, including: (a) Bidder's proposed system for inspection of all billing records and its monthly payment record keeping and auditing practices; (b) Bidder's proposed system for making the required ALS Reimbursement Rate payments; and (c) Bidder's proposed system for making the required Medical Supply Reimbursement Rate payments to OCF A. 61 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 18: PLAN FOR TAKEOVER OF SERVICE/START-UP (4 PAGE LIMIT) Please describe in detail Bidder's proposed implementation plan for the takeover of services/start-up, or resumption of services under the new contract, as applicable, within the subject EOA by the Effective Date; including but not limited to: (a) Bidder's transition or implementation management team; (b) proposed start-up schedule for ensuring timely commencement of services on July 1, 2004; and (c) proposed initial service response and coverage plan, including deployment plans, post locations, housing, and staffing plans. 62 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ITEM 19: 911 FIRE/EMS RESUME (LAST 10 YEARS) (S PAGE LIMIT) Please provide a detailed resume of Bidder's 911 FireÆMS Emergency Ambulance Transportation experience. 63 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 ITEM 20: CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that Bidder is not, and will not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a contract and if authorized to perfonn the services described in this RFP. Signed, this day of , 2004 in . California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 64 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 ITEM 21: STATEMENT OF TRUTH The undersigned hereby certifies on behalf of ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that the information provided by Bidder and contained in this 2004 FireÆMS Emergency Ambulance Transportation and Related Services RFP is accurate, complete, true and COITect to the best of our lmowledge. We are aware that should any of the information contained herein be found to be false, incorrect, or otherwise untruthful, or if the information contained herein contains material misrepresentations and/or material omissions of fact, OCFA may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option of OCF A, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and/or to declare any contract awarded as the result thereof void. Signed, this day of , 2004 in - . California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JP A or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 65 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999,6 ITEM 22: NON-COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of ("Bidder"), and hereby declares under penalty of petjury under the laws of the State of California, that this 2004 FireÆMS Emergency Ambulance Transportation and Related Services RFP is genuine and not sham or collusive, nor made in the interest of or on behalf of any person not herein named; the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a sham proposal nor solicited any other person, firm ,or corporation to refrain from submitting a proposal; the Bidder has not communicated, directly or indirectly, with any other Bidder regarding the amount, price, and/or service rates proposed herein; and Bidder has not in any manner sought by collusion to secure for himselflherselfi'itself any advantage over any other Bidder. We declare the foregoing is true and correct under penalty ofpetjury under the laws of the State of California. Signed, this day of , 2004 m . California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 66 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 ITEM 23: PHOTOGRAPHS (OPTIONAL) (3 PAGE LIMIT) Bidders may provide, at their option, any color photographs or other renderings depicting Bidders' emergency ambulance service facilities, operations, vehicles, equipment, performance, and/or personnel. 67 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 . Amendment No. I - April 2004 179999,6 SECTION IX - ATTACHMENTS ATTACHMENT "A" CITY SELECTION & CONTRACTING AUTHORITY (AS OF FEBRUARY 10,2004) ATTACHMENT "B" TRANSPORT DATA FOR EOAs (ESTIMATED) ATTACHMENT "C" EXCLUSIVE OPERATING AREAS AND MAP ATTACHMENT "D" FORM: (DRAFf) PROPOSED MODEL EOA AGREEMENT ATTACHMENT "E" SAMPLE QUARTERLY RESPONSE TIME REPORT 68 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999,6 ATTACHMENT "A" SELECTION AND CONTRACTING AUTHORITY [As of February 10,2004] Cities Retaining Cities Delegating to OCF A Au tho ritv /Resoo nsibilitv Aliso Viejo Cypress Dana Point Irvine Laguna Nigue1 La Palma Laguna Woods Laguna Hills Lake Forest Los Alamitos Mission Viejo Rancho Santa Margarita Placentia Seal Beach San Juan Capistrano Stanton Tustin Villa Park Yorba Linda NOTE: Decisions to retain or delegate selection and contracting authority are not final and are subject to change at any time during the procurement process. 69 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 AmendmentNo. 1 - April 2004 179999,6 ATTACHMENT "B" ESTIMATED TRANSPORT VOLUMES BY EXCLUSIVE OPERATING AREA INCLUDES 2003 2003 2003 EOA CITY OF: COUNTY AREAS TOTAL BLS ALS # OF: TRANSPORTS TRANSPORTS TRANSPORTS 5 Cypress 1,208 553 /46% 655/ 54% 10 Irvine Santa Ana Hts 4,662 2,197/47% 2,465 / 53% area, JW A 13 La Palma 417 180/43% 237/57% 14 Los Rossmoor 733 302/41% 431/59% A1amitos 17 P1acentia Brea Unincorp & 1,279 555 /43% 724 / 57% Tonner Cyn area 19 San Juan Ortega Hwy 1,282 496 / 39% 786/61% Capistrano 21 Seal Beach Sunset Beach, 1,790 713 /40% 1,077 1 60% Bolsa Chica 22 Stanton Midway City 1,865 880 / 47% 985 / 53% 23 Tustin Cowan, Lemon 2,807 1,349/48% 1,458/52% Hts Orange/Olive, 24 Villa Park Orange Park, 136 62/46% 74/54% Silverado 26 Yorba Linda Chino Hills State 1,355 589/43% 7661 57% Park 28 Laguna Hills 1,276 503 / 39% 773/61% Rancho Trabuco, O'Neill 29 Santa Park, Las Flores, 1,524 719/47% 805 1 53% Margarita Coto de Caza 30 Laguna 1,461 570 1 39% 891/61% Nigue1 32 Aliso Viejo W oodsl Aliso Cyn 599 242 1 40% 3571 60% Crystal Cove, 35 Laguna unincorp Laguna 3,116 1,412/45% 1,704155% Woods wilderness, Emerald Bay 38 Mission 3,150 1,381/44% 1,769/56% Viejo 39 Dana Point 1,276 584 / 46% 6921 54% 42 Lake Forest Modjeska, upper 2,011 855 /43% 1,156157% Trabuco/Cooks * Transport volumes are estimated due to multiple EOAs being recently eliminated and/or realigned for this new contract period. 70 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - Apri12004 179999,6 ATTACHMENT "C" EXCLUSIVE OPERATING AREAS AND CORRESPONDING MAP 71 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 ATTACHMENT"D" PROPOSED (DRAFT) MODEL EXCLUSIVE OPERATING AREA AGREEMENT - SEPARATELY ATTACHED- 72 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No. I - April 2004 179999.6 AITACBMENT "E" SAMPLE OlJARTERL Y RESPONSE TIME REPORT Contractor Name: EOA Name: EOA Number: Quarter Ending: Completed by: Title: Date: MetrolUrban SuburbanlRuraI Wilderness Totals Code 2 Code 3 Combined Code 2 Code 3 Combined Code 2 Code 3 Combined Code 2 Code 3 Combined Number of patients transported Number of responses Number of "on-time" responses PercentaJ!;e of "on-time" responses. Number of calls for service that were refused or not accepted by the Contractor Number of calls referred to approved, secondary mutual aid providers .If percentage of "on-time" responses in either Code 2 or Code 3 categories falls below 90% regardless of geographical area, include a narrative assessment as to the cause of any response delay below. (Attach additional sheets and documentation, as needed.) At his discretion, the OCF A EMS Battalion Chief shall meet and confer with the Contractor for purposes of establishing a plan for avoiding such delay in the future. 73 FireÆMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #RL972 Amendment No.1 - April 2004 179999.6 D R A F T AGREEMENT FOR PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES WITHIN EXCLUSIVE OPERATING AREA Exclusive Operating Area Name: Tustin! Adjacent Unincorporated Cowan and Lemon Heights Areas No. 23 Contractor: City: City of Tustin September 1, 2004 City of Tustin Effective Date: Awarding Agency: TABLE OF CONTENTS RECITALS....,........,..........,..................................................,.........",...,............,..".............."",....,.......,............... 1 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 186777.1 SCOPE OF SERVICES .,.,...........,.......,............................,..,...........................,....."..,...,...........,............2 CONSIDERATION ..............".....,.............."."............,.....,....................................................................,3 CONTRACT DOCUMENTS ,....................,.......,........,...,.......,.,......................,.....,............ .,..,..............3 MODIFICATION AND AMENDMENTS ............................................................................................ 3 CONTRACT ADMINISTRATION ..................................................',.................,.,,....,...... ..."........,.....3 EFFECTIVE DATE ..,.,.,..................................................,.,.......,.......,..............,...,.....,...,..........,...,.".....3 TERM.... . . .. . . . . . . . . . . . . .. . . . . .. . , . , .. , .. . . . ... , ., . ... ... , , . , .. , ... . . . .. . .. . . . . . . , . . .. . . . ... . .. .. . , , .... ,... . . . . , . , . .. . . , , .. . . . .. . .. . , . . . ,. . . .. . . .. .. . ..... 4 EXTENSION...,......,...................................",.".....,..,...,...................,.,.......,...,.,.,..........,...,.............,........ 4 TERMINATION,...,...,....,.........,.,.,."....,."....,......,..............,..........,."......".,...,.....,.........,...........,.....,..,...4 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 10.0 11.0 12.0 12.1 12.2 13.0 14.0 15.0 15.1 15.2 16.0 17.0 18.0 19.0 20.0 186777,1 D A T F R INSURANCE .........,.,.......,....",......,............,................,....,..,....,.......,........,............,...........,....",..",........5 ASSIGNMENT .......................,.................................,...,...,........,....,............................,...........,."..".....".6 AUDITS AND INSPECTIONS ....,....."...............,......."...................,..,................,....,....,..............,........6 Business Office......,.............".................,..,..........................................,....................".......,........,..........6 FacilitiesN ehicles. ..........".........,..,....,.................... ....,..........., ............. ................................. ................6 COOPERATION ...............,..........,..,...................................,................................,.................................. 7 INDEPENDENT CONTRACTOR """""""""""""""""""""""""""""""""""""".................,.......,.,7 INDEMNIFICATION ............"......,.................,............,........"..,......,....,.............,.............,....................7 General....."..................,...........,........,............,.....,.,...........................,.,.,....,.,.........................................7 Rates. ....,........................,.....,.....,..,...,'...."","""""""""""""""""""""""'".....,............,........,...........,..7 COMPLIANCE WITH LAWS .................."...........,.........................................."""""""'" ...................7 RISK ....,...,..,....."........,.....,...............,....,.........""'"....,..,.........."...,..".....,..........................,..........,..,.,.....7 RESPONSIBILITY ,.......,.................,.,............................................,..............."...................................,.. 8 ACTS OR OMISSIONS OF ..REPRESENTATIVES....................,..................................................... 8 INSOLVENCY..........,.,....................,....,..",........."............,.......,...,.............."..,.,...,..................."...........8 11 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 21.0 OPERATIONAL STANDARDS, PROCEDURES, & PERFORMANCE REQUIREMENTS .......8 21.1 Emergency Response Communications System..................,....,........"......................,........".......,......,...8 21.1.1 Compliance with Laws. .............................,.........................,.....................,......................8 21.1.2 Communications Requirements. ....,.,.....................,.................,............,......................... 8 21.1.3 800 MHz County-wide Coordinated Communications System....,.........,...,................. 9 21.1.4 CAD Interface............................,.................................................,....................................9 21.1.5 System Upgrades....,.................,.............,...,...,.,..........,.................................................,...9 21.2 Vehicle Communications,.............................,.... ,...................... .............,..........".......,........,... ...., ,...... ....9 21.2.1 800 MHz Mobile Radio. ....."..........,..,.....................................................................,....,...9 21.2.2 Mobile Data Computer System. ,............................................................................,...... 10 21.3 Service Hours ...............,...,.................................,..."......,...........................................................,.......,.11 21.3.1 Service.......,.,..............,..................,...................,...........,...,..............................................11 21.3,2 Field Supervisor,...,......................................................,.....,.......,..............................,.....11 21.4 Response Times........,.,........".,....................".....,..................................,.................,.......",...."...........,11 21.4.1 21.4.2 21.4.3 21.4.4 21.4.5 21.4.6 21.4.7 21.4.8 21.4.9 186777,1 General Requirements ....,................,.......,...,.....,...,......,....".,.....,...............................,..11 Response Time Measurement".....,...,............,.....................................",.,.".......,........,.11 Definition of Geographical Areas & Response Priority Codes...............,....,............., 11 Response Times Required...,....".,......................,.................,.....,...,....,...,.,....................12 Response Time Reporting................,....,........,....................."....................................,.,.12 Call Cancellation,..,......................,.,...,.....",.,...................................,.,.........."..,...,...,....,12 Quarterly Response Time Report - Format ,.............,.....,.........................,...,....,......... 12 Exemptions to Response Time Requirements.......,..,............................,.........,.,.......... 12 Procedures to Request Response Time Exemption ............................................,........ 13 111 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.5 21.6 21.7 21.8 21.9 D R A F T 21.4.10 Use of Alternative Methods to Meet Response Time Requirements........,......... ........13 21.4.11 Disciplinary Actions for Failure to Meet Response Time Requirements / Performance Deficiency ...................,..............,......,...,..........,..,.....................,.,.............................,...............,...14 Emergency On-Scene Procedures...,.....................,.........................,....................,...,............. .,......"....,17 Disaster Assistance..................................,........................................................................,...................17 Standard of Performance ........,.....................,...,...............,."......,..:........................................,.............18 General Provisions........,.....,.,................,....................................,.......,.,...........................,.............,.....18 21.8.1 Return of OCFA Personnel........................................................................................... 18 21.8,2 911 Calls for Service/Referral. ........................................................:............................. 18 21.8.3 Performance.................................................................................................................... 18 21,8.4 Conflict of Interest............................................................................ .............................. 19 21.8.5 Complaints. ....................................................,................................................................19 21.8.6 Traffic Signal Preemption.............................................................................................. 19 21.8.7 CAAS Accreditation....................................................................................................... 19 21.8.8 HIPAA Business Associate Assurances ........................................................................ 19 21.8.9 MedicareIMedi-Cal Participation. ...,.......,......,........,...,...............,........,......,...,............ 20 External Medical Quality Co!1trol.........................,........,.....,........,..,....,........,.............,................,......20 21.10 Internal Medical Quality ControL............................ ...... ....................................................... .............. 21 22.0 22.1 186777.1 PERSONNEL.....................".,.............,............,.,,.....,.........,..................,..,...........,.....'...,......,......"...,... 21 Personnel Requirements .........."....."......"...",......,.......................................,.,.,....,.,.,.....,......."".........21 22.1.1 Employee Performance. ................................,.........................................................."....21 IV Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 22.2 23.0 23,1 23.2 186777,1 22.1.2 22.1.3 22.1.4 22,1.5 22.1.6 22.1.7 22.1.8 22.1.9 D R A F T Employee Drug Program. ...................................................................................... ........ 21 DMV Employer Pull Notice Program................................................................... ........22 Criminal Background Checks ............................................................................... ........22 Uniforms and Decorum.....................",.,.......................,...."......"""""""""""""""""" 22 Cooperation..........................................,..,............,..............,...........................................22 Employee Ineligibility..................,..............,....,..,.,..,...,.......,.........................................,22 Compliance with Laws ..,.....,...........................................................,..,.........................,.22 Licensinglldentification............ ....,........,.,...................... ................. ,..........,........,... ,...... 22 22.1.10 Joint Training Exercises ...............................................................................................: 23 22.1.11 Employee Training Records ,......................"................................................................, 23 22.1.12 Professionalism. .............................................................................................,...."""""" 23 22.1.13 Management Oversight..................................................................................................23 22.1.14 Employee Removal. ........................................................................................................23 Control.,..........,.....................,........,......"..........".......................,....,............"..".....,........,..............,.....23 SUPPLIES, EQUIPMENT AND VEIDCLES .................................................................................... 23 Supplies and Equipment......................................,...,............................,.....,.......................,.........,.,...,.23 23.1.1 23.1.2 Standards..,..,.................................,.,.,..................................,....,...........,...........,..:..........23 Standard Inventory ........,...,..,.,....................,................,............,..,....,..........................,24 Vehicles and Maintenance .................. ......... ,.... ....... ................. ............................. ....................... ........24 23.2.1 23.2.2 23,2.3 23.2.4 Standards....................,...,.........,....,......,.....,.,......,....,....,.....",....,......"............................24 Ambulances. ..,..................................,..........................,.............,.............,..,....,........ .....,.24 Inspection. .....,......,.......,....,.,.......................,.."..,.........,....,...........,.................".............. 24 Maintenance..........,........"............",........,................",...........,...,....,..,.,.,.......................,24 v Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 24.0 24.1 24.2 24.3 24.4 186777,1 D R A F T 23.2.5 Personal Safety Equipment.....................................,...........,.................,.............."........25 RATES FOR AMBULANCE SERVICE..........,......,..,.......,................................"......,........,.............. 25 BLS and ALS Service Rates......,..................,.,.....,....,..,..........,........................................,...,...............25 24.1.1 Maximum BLS Service Rate .................................................................................. .......25 24.1.2 Maximum ALS Service Rate. ........................................................................................ 25 24.1,3 ALS Reimbursement Rate ....,............".........,......................"..."................................... 25 24.1.4 Medical Supply Reimbursement Rate .......................................................................... 27 24.1.5 Zero Pay Patients....,....................,...................,.....................,..............,......,........,.........27 24.1.6 Risk of Non-Payment.......................,...........,...................... ,.....,......................,.............. 27 24.1.7 Medicare Patients.... ..........................,.. ........................ """" ............. .......... ....."..... ....... 27 Billing, Audit and Access to Records...................................................................................................27 24.2,1 Billing System,......................."..............,........,..,.,................................,..........."".... ....... 27 24,2.2 Accounting..........~....,.....,......."........,..,.....,.,.......................................,......,.,................... 28 24.2.3 Responsibility for Submission of Claims ............................................................... .......28 22.2.4 Medicare Audits............,.,.......,.............,......................"......,.....".......................,.... ....... 29 Contractor Monthly Pay¡nents ....,.,.........,......................,...,..........,........., ".,.........................,. .........,.... 29 24.3.1 Monthly Payments to OCFA ......................................................................................... 29 24.3.2 Zero Pay Patient Exemption Requests .................................................................. ....... 29 24.3.3 Monthly Payment Report ............................................................................"................ 29 24.3.4 Audit Report ............,...................................."........"..............,............."..,............,........30 Changed Circumstances,..."..................,.,....,..................",.........,..............,.,..,...,......,."......... ...,...,....., 30 VI Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 25.0 25.1 25.2 25,3 186777,1 D R A F T BREACH OF CONTRACT..........,..............,.............................,.......................................................... 30 Breach of Contract """""""""""""""""""""""""""""""""" ...,..........."............,..............................30 25.1.1 25,1.2 25.1.3 25.1.4 25.1.5 25.1.6 25.1. 7 25.1.8 25.1.9 Response Time Requirements ."..........,.........,..............,........,.......,..,.........................,.. 30 Response Time Reporting ........,........,....,..,..."............,........"......,.,.."...........,...............30 Proof of Insurance .........,.....,..,......"....,.......................................................................... 30 Communications System...........,...,..........,.,....................."..................,................,........ 31 Service Hours ...........,.........".................,.,.........,..............,.............................................. 31 Emergency On-Scene Procedures .......................,.................................................. .......31 Internal Medical Quality Control.......................................................................... .......31 Personnel........................".,........",..,...........,...........,..................,............................. ....... 31 Decorum .................,...,..,.,.......,.".,.".,.......,.,......,....,..."......,......"................................... 31 25.1.10 Billing System......................,........................................................................................... 31 25.1.11 Any Other Non-Material Terms or Conditions .................................................... ....... 31 Remedial Action Plan. ............................... ................ .................................. .......... ................. .............. 31 25.2.1 25.2.2 25.2.3 25.2.4 RAP Format ...........,.....,.,.....,.".....,............,.........,....,.......".,....."....,..............,........ ....... 31 Remedial Period...,........,.....".....,.,.........,....,......,..........,.,......,....",..............,..,............... 31 RAP InspectioniCompliance..,.....,.,...".,....."......,....,........,.,................................... ....... 31 RAP Appeal Process...................................................,...,..........,...,.....,.....,..",.,............. 32 Material Breach .......,................,..........,.,..........,.........,....,...,.............,.,.....,.........."..,....,...,...........,.,..,.33 25.3.1 25.3,2 25.3.3 25.3.4 Assignment ..,.,.,..........................,.,....,........,......",..........,.,....,....,.,......,........,..,.,.........,...33 Insolvency ............................................,............,...,....,....,...",......,......,............................ 33 Vehicle/Equipment Maintenance """"""""""""""""""""""""""""""""""""""""" 33 On-Time Monthly Payments ...........,...................................................................... ....... 33 VB Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 26.0 27.0 28.0 29.0 30.0 186777,1 D R T A F 25.3.5 Insurance...................,...................,.............,...............,..."..."............................,.....-....., 33 25.3,6 Audits and Inspections ..........,................,....,...................................................""""""'" 33 25.3.7 Rates.................,...,......"..................,........,.......,..,........,.................,.....,................,..........33 25.3.8 Disaster Assistance .................................................................................................-....... 33 25.3.9 Compliance with Laws .......,......,...,.....................,..........................,.....,.,....................,..33 25.3,10 Licensing/Permitting ,............,....................................,...,.....................................,.-....... 34 25.3.11 Corrective Action Plan Compliance.............................................................................. 34 25.3.12 Remedial Action Plan ..Compliance.............................................................................. 34 25.3.13 Bid Proposal....,.......................................................................,....................................... 34 25.3.14 OCEMSA Reporting ........ ........... ........ .......................... ......... ....................... """""""'" 34 25,3.15 Number of Ambulances/Types and Equipment Committed....................................... 34 25,3.16 Equipment Maintenance........................................................................................-....... 34 25.3.17 Employee and Management Staffing Levels ........................................................-....... 34 25.3.18 External Medical Quality Control.............................................................................,.. 34 25.3.19 Loss of Legal Capacity ...............'................................................................................... 34 - PUBLIC SAFEGUARDS AND EMERGENCY TAKEOVER """""""""""""""""""""""""""'" 35 CONTRACTOR'S RELIEF UPON TERMINATION ...................................................................... 35 HOLDOVER PROVISION ..,....,......,........,............."...,............................,.........,...."....,..,..,.,.............35 CHANGED CIRCUMSTANCES...,..."..........,...........".............,...,...........................,..............,..........,36 SUCCESSORS ...............,....................,............................,..,...,........,....,..................".....................,......36 Vlll Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 31.0 32.0 33.0 34.0 35.0 36.0 37.0 38.0 39.0 EXHIBITS ] 86777,1 D R T A F INTEGRATION .......,......,.....,.......,.......................,.....,.........,""""""""""""""""""""""""""""""'" 36 NO WAIVER ........"........,...........,....,.................,.................,....".........,.............,....,........,.....,........,....., 36 THIRD PARTY BENEFICIARIES..........................."..........................,.....,.......................................36 EXECUTION OF AGREEMENT .......................,..........................,..."...........................,................,.,37 NOTICES ................................,.........................,.....,................,...,.,......................................,................37 SEVERABILITY ,.........,......................."...,..,.......................,...............................................,....'..."...... 37 EOA BOUNDARY CHANGE ..,.......................,...,."................."..,...................................,........,....,....37 AMENDMENT .......................,............,.,.....,......,........,....,.......,................,........,...........,.........,....,....... 37 VENUE ...,...............................,..,.......""..,..,....,..............,....,...,..,..,..........,...........,..,..............,.........,...,.37 EXHIBIT "A"- DEPICTION OF SUBJECT EOA EXHIBIT "B" - AMENDMENT NO.1 TO OCF A 2004 FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES REQUEST FOR PROPOSALS (RFP NO. RL972) EXHIBrr "c" - CONTRACTOR'S SIGNED, ORIGINAL BID PROPOSAL SUBMITTED FOR OCF A RFP NO. RL972 EXHIBIT "D"- SAMPLE QUARTERLY RESPONSE TIME REPORT IX Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T AGREEMENT BETWEEN CITY OF TUSTIN AND [NAME OF CONTRACTOR] FOR PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES WITHIN EXCLUSIVE OPERATING AREA NO. 23 THIS AGREEMENT FOR THE PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES (the "Agreement") is made and entered into the - day of , 2004 by and between the CITY OF TUSTIN, a California municipal corporation, hereinafter referred to as "City", and [NAME OF CONTRACTOR AND CORPORATE STATU~, hereinafterreferred to as "Contractor." RECITALS 1. The Orange County Fire Authority ("OCF A") is a governmental entity providing fire and life safety services to over one million residents within the County of Orange, California, OCFA is a Joint Powers Agency ("JP A") organized pursuant to the provisions of Article 1, Chapter 5, Division 7, Title I (commencing with Section 6500) of the California Government Code. OCF A consists of twenty-two (22) member cities and the County of Orange. Each OCF A JP A member agency individually has the statutory ability to provide fire suppression, protection, prevention and related and incidental services, including emergency ambulance response services, within their respective jurisdictions. 2. By entering into a Joint Powers Agreement, each JP A member agency vested OCF A with the power to exercise each member agency's legal ability to provide fire suppression, protection, prevention and related and incidental services, including emergency medical and transportation services, and other fire related services authorized by law within their respective jurisdictional boundaries. Each OCF A JP A member agency has elected to jointly exercise their powers to provide for such services through the fonnation of OCF A. 3. The State Legislature has enacted the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act ("EMS Act"), which creates a comprehensive statutory system governing virtually every aspect of prehospital emergency medical services. The purpose of enacting the EMS Act was to achieve state-wide coordination and integration of prehospital emergency medical services. 4, The EMS Act accomplishes this integration through what is essentially a two-tiered system of regulation. At the state level, the Emergency Medical Services Authority ("EMS Authority") perfonns a number of different functions relating to the coordination of EMS throughout the state. The second tier of governance under the EMS Act is occupied by counties and their local EMS agency ("LEMSA"). The EMS Act authorizes each county's LEMSA to develop an emergency services program. Each county developing such a program is required to designate the county health department as the local EMS agency. In Orange County, this function is perfonned by the Orange County EMS agency, a division of the County Health Care Agency ("OCEMSA"). All Orange County providers of prehospital emergency medical services are required to operate within the local EMS system developed by OCEMSA. 186777.1 1 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 5. The Orange County Board of Supervisors designated OCEMSA as the LEMSA for purposes of administering the local EMS Plan within the County. The County, however, does not directly regulate ambulance Tansport services within cities. Rather, the County allows cities to contract for ambulance services in coordination and .::ooperation with the local EMS Plan and OCEMSA. In 1985, the County of Orange adopted County model ambulance ordinance no. 3517, which is a mechanism for licensure of emergency medical transport services and for establishing transport service areas. The County adopted Ordinance No. 3517 ("model Ambulance Ordinance") with the intention that it serve as a model city ambulance ordinance for adoption by cities within Orange County. Under this approach, the County's EMS Plan allows cities to provide ambulance transport services in accordance with the model Ambulance Ordinance. OCF A administers the ambulance programs on behalf of its member agencies, 6. Health and Safety Code § 1797.224 authorizes OCEMSA to create exclusive operating areas in the development of its local EMS Plan. The creation of exclusive operating areas is authorized by state law, provided a competitive process is utilized to select service providers pursuant to the local EMS Plan. In Orange County, the competitive process for the selection of ambulance providers within established OCF A exclusive operating areas is administered by OCF A. The competitive process is, however, subject to review and approval by OCEMSA. Through input and recommendation of OCF A, exclusive ambulance service areas have been approved and created by OCEMSA for all OCF A jurisdictional areas. Only to the extent that OCEMSA designates an exclusive operating area, as defined by the EMS Act, consents to the current model Ambulance Ordinance structure, and approves of the competitive process utilized may such services be provided by cities. OCF A and/or its member agencies award ambulance service contracts by acting under the authority of OCEMSA and its state approved EMS Plan. 7. The current exclusive operating area contracts for all OCF A jurisdictional areas are set to expire on June 30, 2004. Since the last exclusive operating area contracts were awarded, OCEMSA has redrawn and consolidated several exclusive operating areas within OCF A jurisdictional areas. Currently, there are nineteen (19) exclusive operating areas within the OCF A jurisdictional area. Exclusive Operating Area No. 23 is more particularly described as Tustin and the adjacent unincorporated Cowan and Lemon Heights Areas and is depicted in Exhibit "A," ¡hich is attached hereto and incorporated herein by reference (hereinafter referred to as the "Subject EOA"). 8. City desires to designate Contractor and Contractor desires to be designated by City, as an independent contractor, for purposes of providing exclusive 911-Fire/EMS Emergency Ambulance Transportation and Related Services within the Subject EOA as of September 1, 2004, pursuant to the terms and conditions set forth in this Agreement. 9. For reference, the Orange County Fire Authority shall hereinafter be referred to as "OCFA." [Name of Contractor] ambulance service, which has been selected to provide services within the Subject EOA pursuant to the OCFA 2004 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals (RFP No. RL972), shall hereinafter be referred to as the "Contractor." The City of Tustin shall hereinafter be referred to as the "City." "Awarding Agency" shall hereinafter either refer to the OCFA Board of Directors or, when applicable, the legislative body that retains emergency ambulance provider contracting and selection authority for the Subject EOA. The County of Orange shall hereinafter be referred to as the "County." NOW, THEREFORE, for valuable consideration, receipt of which is hereby acknowledged, and in consideration of the foregoing recitals, which are hereby incorporated by reference into the Agreement below, and the mutual promises, covenants, and conditions contained herein, the parties hereto agree as follows: AGREEMENT 1.0 SCOPE OF SERVICES 1.1 Contractor shall provide exclusive 911-Fire/EMS Emergency Ambulance Transportation and Related Services within the Subject EOA in accordance with the terms and conditions set forth in this Agreement and shall serve at all times as the "Primary Responder" within the Subject EOA. The term "Primary Responder" shall 2 186777,1 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 2.0 2.1 3.0 3.1 4.0 4,1 5.0 5.1 6.0 6,1 186777.1 D R A F T mean the ambulance service operator that is assigned and dispatched first by the OCF A Emergency Communications Center to respond to all calls for emergency medical transportation service within the Subject EOA throughout the term of this Agreement. 1.2 Contractor is hereby assigned and designated as the authorized, exclusive Primary Provider for all 911- FirelEMS emergency ambulance transportation calls for service within the Subj ect EOA. OCF A, in cooperation with Contractor, shall provide on-scene Advanced Life Support ("ALS") services, and Contractor shall provide Basic Life Support ("BLS") services and transport patients to medical facilities, when required. The terms Advanced Life Support and Basic Life Support shall mean the same as defined in the EMS Act. CONSIDERATION In consideration of Contractor's agreement to be designated and to provide and perform the services described herein, City agrees that throughout the term of this Agreement, Contractor shall have the sole and exclusive right to provide all 911-Fire1EMS Emergency Ambulance Transportation and Related Services as the Primary Provider within the Subject EOA, subject to the terms and conditions contained herein. CONTRACT DOCUMENTS The Agreement between the parties hereto shall consist of the following: (1) this Agreement; (2) Amendment No.1 to the OCF A 2004 FirelEMS Emergency Ambulance Transportation and Related Services Request for Proposals (RFP No. RL972) ("RFP"); and (3), Contractor's signed, original bid proposal for RFP No, RL972 submitted to OCF A ("Bid Proposal"), which shall all be referred to collectively hereinafter as the "Contract Documents." The RFP and the Contractor's signed, original Bid Proposal, which are both attached hereto as Exhibits "B" and "c" respectively, are hereby incorporated by reference and are made part of this Agreement. All provisions of the RFP and the Bid Proposal shall be binding on the parties. Should any inconsistency or ambiguity occur or exist in the Contract Documents, the provisions of the Agreement, then the provisions of the RFP, then the provisions of the Bid Proposal shall control. MODIFICATION AND AMENDMENTS The parties may adjust the specific terms of the Contract Documents where circumstances beyond the control of either party require modification or amendment. Any modification or amendment proposed by Contractor must be submitted in writing to OCF A for consideration. The decision to modify or amend any term or condition of the Contract Documents shall be at the sole discretion of OCFA and the Awarding Agency, if applicable. Any agreed upon modification or amendment must be in writing, approved by the OCF A Fire Chief, and signed by both parties. CONTRACT ADMINISTRATION The OCFA Fire Chief, or his designee(s), shall be the authorized representative of the City concerning all matters that pertain to the Agreement. This Agreement shall be administered and enforced by the OCF A Fire Chief, or his designee(s). EFFECTIVE DATE The effective date of this Agreement shall be 12:01 a.m., Wednesday, September 1,2004, ("Effective Date") at which time Contractor shall assume full responsibility for the provision of all 911-Fire/EMS emergency ambulance transportation services within the Subject EOA. The Effective Date may, however, be postponed at the sole discretion of the OCF A Fire Chief in order to protect public health and safety in the event Contractor is for any reason unable to commence performance at that time. 3 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 8.0 9.0 9.1 9,2 9.3 9.4 9.5 9.6 186777,1 D R A F T 7.0 TERM 7.1 The term of this Agreement is for an initial five (5) year period, ending on August 31, 2009. This Agreement shall automatically expire at the end of the initial five (5) year term at midnight on August 31, 2009, unless extended as provided below. EXTENSION 8.1 This Agreement may, at the sole discretion of the OCF A Fire Chief and the Awarding Agency, if applicable, be extended as provided herein. With mutual written agreement of the parties, this Agreement may be extended for up to an additional five (5) years (for a possible ten (10) year total contract term). Any extension(s) granted shall not exceed a total of five (5) years. Successful past performance during the initial contract period will be a critical factor in any decision to grant an extension(s). The decision to either grant or deny a contract extension(s) shall be final. At the end of the initial contract term, or contract extension term(s), if granted, this Agreement shall automatically terminate. TERMINATION Except as provided otherwise herein, this Agreement may be terminated by either party upon one hundred eighty (180) days written notice. Contractor shall provide such written notice to both the City and OCF A. This Agreement may be cancelled by OCFA and the Awarding Agency, if applicable, at any time during the initial five (5) year term, or the subsequent term(s) if extended, upon Contractor's material breach of this Agreement. In the event of termination for cause by OCFA and the Awarding Agency, if applicable, Contractor may be compensated by responsible parties for those services that have been fully and adequately completed, rendered, and accepted as of the date of termination. Contractor shall provide documentation deemed adequate by OCF A to show the services actually completed and rendered by Contractor prior to the effective date of the termination. Termination of this Agreement for cause may be considered by OCF A and the A warding Agency, if applicable, in determining whether to enter into future contracts with Contractor. This Agreement may also be terminated without cause upon one hundred eighty (180) days written notice provided by either party. In the event that OCFA and the Awarding Agency, if applicable, terminate Contractor's work, Contractor may be entitled to payment, by responsible parties, for services fully and adequately provided hereunder prior to the effective date of the termination, in accordance with this Agreement, Contractor shall provide documentation deemed adequate by OCF A to show the services actually completed by Contractor prior to the effective date oftermination. In the event this Agreement is terminated, in whole or in part, as provided by this Section, OCF A and the Awarding Agency, if applicable, may procure, upon such terms and in such manner as it deems appropriate, services similar to those terminated, The rights and remedies of the parties provided in this Section are in addition to any other rights and remedies provided by law or under this Agreement. In order to protect public health and safety, Contractor hereby agrees to fully cooperate with and to immediately assist OCFA and the City to effectuate a prompt and orderly takeover of 911-Fire1EMS emergency ambulance service within the Subject EOA upon termination of this Agreement, so as to ensure that there will be no service interruption to the public, 4 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 10.0 10.1 10.2 10.3 lOA 10.5 186777,1 D R A F T INSURANCE Prior to the Effective Date, Contractor shall, at its sole cost and expense, purchase and maintain throughout the term of this Agreement, the following insurance policies: 10.1.1 Commercial General Liability Insurance (Bodilv Injury and Property Damage): with a limit not less than $3,000,000 combined single limit, per occurrence; $5,000,000 annual aggregate. 10.1.2 Business Automobile Liability Insurance: with a limit not less than $3,000,000 combined single limit, per occurrence; $5,000,000 annual aggregate, 10.1.3 Ambulance Medical Malpractice Insurance: with a limit of not less than $3,000,000 per occurrence; $5,000,000 annual aggregate, If the Ambulance Medical Malpractice policy is written as a "claims made" policy, the retro date shall be prior to the first day of service under this Agreement. Furthermore, Contractor shall maintain such coverage, including coverage for "prior acts," for three (3) consecutive years following termination of this Agreement, and thereafter, submit annual evidence of continued coverage. Additionally, Contractor shall provide certified copies of the claims reporting requirements contained within any policy secured to meet this requirement. 10.lA Workers' Compensation and Employers' Liability Insurance: meeting statutory limits. Such insurance shall contain a waiver-of-subrogation clause in favor of OCF A, the City, and the County, their officers, elected officials, agents, volunteers, and employees. All insurance required pursuant to this Section shall be issued by a company authorized by the Insurance Department of the State of California and rated A-, .vII or better by the latest edition of Best's Key Rating Guide, except that OCF A will accept workers' compensation insurance rated B, VII or better or ITom the State Compensation Fund. The workers' compensation insurance company shall agree to waive all rights of subrogation ~gainst OCF A, the City, and the County for losses paid under the terms of the policy, which arose from the work performed by the named insured. All insurance policies, except Workers' Compensation and Employers' Liability and Professional Liability, shall contain the following clauses: 10.3.1 "The City, the County, and OCF A are added as additional insureds as respects operations to the named insured performed under contract with the City or OCF A Such policies shall be primary, and any other policies maintained by or providing protection for the City, the County, or OCF A shall be excess or secondary, but noncontributing." 10.3.2 "This insurance shall not be canceled, limited, or allowed to lapse until after thirty (30) days written notice has been give to the City, the County, and OCF A" Upon execution of this Agreement, Contractor shall provide to OCF A, and to the satisfaction of OCF A, certificates of insurance and endorsements evidencing the policies fulfilling the requirements of this Section. If self-insured for workers' compensation, Contractor shall submit to OCF A a copy of its certification of self- insurance issued by the Department of Industrial Relations, If Contractor does not keep all of the insurance policies required by this Section in full force and effect at all times during the term of this Agreement, OCF A may elect to treat the failure to maintain the requisite insurance as a material breach of contract, which may result in immediate termination of the Agreement. 5 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 10.6 10.7 10.8 11.0 11.1 11.2 12.0 12.1 12.2 186777.1 D R A F T At any time during the term of this Agreement, if OCF A reasonably determines, at its sole discretion, that the amounts of insurance held by Contractor pursuant to this Section are no longer sufficient, or that additional types of coverage are needed, Contractor shall modify the existing coverage or obtain additional policies, as OCF A shall reasonably detennine. All new policies shall be on the tenus and conditions contained herein. Contractor shall annually, within ten (10) days of the anniversary of the Effective Date of this Agreement, provide to OCF A evidence that all insurance required pursuant to this Section continues to be in full force and effect. In the event the Agreement is extended at the end of the initial five (5) year tenn, pursuant to Section 8,1 above, the insurance amounts specified in Sections 10.1.1, 10.1.2, and 10.1.3 may be amended to require increased insurance coverage in the amount of $5,000,000 combined single limit, per occurrence/$lO,OOO,OOO annual aggregate, or otherwise. ASSIGNMENT Except as provided herein, Contractor shall not delegate or assign its rights or otherwise transfer its obligations, in whole or in part, under this Agreement to any other person or entity without the prior written consent of OCFA and the Awarding Agency, if applicable. Any such assignment without the prior written consent of OCF A shall be void and the attempted assignment may constitute a material breach of contract. The following shall be considered to be a "transfer" for purposes of this Section: 11.2,1 Any change in the business structure, including but not limited to, changes from or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; 11.2.2 Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 11.2.3 A transfer by any shareholder of greater than ten percent (10%) of the stock issued as of the Effective Date by Contractor, or a sale or transfer of over twenty-five percent (25%) of the assets of Contractor. In the event Contractor experiences regular stock exchanges in excess of the ten percent (10%) threshold, a separate agreement may be negotiated to set a threshold that still provides OCF A and the Awarding Agency, if applicable, with the protections intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. AUDITS AND INSPECTIONS Business Office. At any time during nonnal business hours, and as often as may reasonably be deemed necessary by OCFA, OCFA may observe and inspect Contractor's business office, and Contractor must make promptly available to OCF A for its examination all Contractor records that pertain to its perfonnance of the Agreement. OCF A may audit, examine, and copy any and all Contractor records pertaining to its perfonnance of the Agreement, including but not limited to, personnel records, daily logs, conditions of employment, financial/bi11ing records, and all other records or data. OCF A's right to inspect Contractor's business office and any and all records pertaining to its perfonnance of the Agreement will be restricted to nonnal business hours and reasonable notice shall be given to Contractor in advance of such inspection, FacilitiesNehicIes. OCFA may, at any time and without prior notice, observe and inspect Contractor's vehicles, ambulance dispatch center, maintenance facilities, personnel, and/or any ambulance post location(s). OCF A employees may be assigned to ride as observers on any Contractor vehicle at any time provided, 6 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 13.0 13.1 14.0 14.1 15.0 15.1 15,2 16.0 16.1 17.0 17.1 186777,1 D R A F T however, that in exercising this right to inspect and observe OCF A employees shall conduct themselves in a professional and courteous manner, shall not interfere in any way with Contractor's employees in the performance of their duties, and shall at all times be respectful of Contractor's employer-employee relationships. COOPERATION Contractor shall fully cooperate with OCF A and the Awarding Agency, if applicable, and shall take all actions necessary to ensure that all terms and conditions, and required performance levels, set forth in the Contract Documents are satisfied at all times throughout the term of the Agreement. INDEPENDENT CONTRACTOR Both parties in the performance of the Agreement shall be acting in an independent capacity and not as agents, employees, partners, or joint ventures with one another. Contractor and its employees are not employees of the City, the County, or OCF A and are not entitled to any of the rights, benefits, or privileges of City, County, or OCF A employees including, but not limited to, medical, unemployment, or workers' compensation insurance, INDEMNIFICATION General. Contractor shall defend, indemnify and hold harmless the City, the County, and OCF A, their officers, agents, elected officials, and employees, ITom all liability, claims, losses and demands, including defense costs and reasonable attorneys' fees, whether resulting ITom 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 Agreement, excepting acts or omissions directed by the City, the County, and OCF A, their officers, agents, or employees, acting within the scope of their employment, for which the City, the County, and OCF A agree to defend and indemnify Contractor in a like manner. Rates. Contractor shall defend, indemnify and hold harmless the City, the County, and OCF A, their officers, agents, elected officials, and employees, ITom all liability, claims, losse§ and demands, including defense costs and reasonable attorneys' fees, whether resulting from court action or otherwise, arising from any and all challenges to the service rates established in the Contract Documents. 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 service rate, the ALS service rate, the ALS reimbursement rate, and/or the medical supply reimbursement rate as set forth in the Contract Documents, COMPLIANCE WITH LAWS All services provided and duties performed by Contractor pursuant to this Agreement must be rendered in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It shall be Contractor's sole responsibility to determine which federal, state, and local laws, rules, statutes, and regulations apply to the services and duties to be performed pursuant to this Agreement, and to maintain compliance at all times throughout the term of the Agreement. RISK Notwithstanding any other term or condition herein, in responding to a call for service, Contractor shall have no claim whatsoever against OCF A, the City, or the County or have any right to recover ITom OCF A, the City, or the County for the cost of any of the services it renders in its performance of services under this Agreement. Contractor must look solely and exclusively to the service recipient, their insurers, applicable state or federal health care programs, or other responsible party for payment of the services it renders, 7 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 17.2 18.0 18,1 19.0 19.1 20.0 20.1 21.0 21.1 186777.1 0 R A F T Contractor shall assume the entire risk of non-payment for any and all of the services rendered, duties performed, and charges incurred in connection with its performance of services under this Agreement, including, but not limited to, all BLS and ALS charges incurred, the ALS reimbursement rate, and/or the medical supply reimbursement rate, as required herein. RESPONSIBILITY It shall be the responsibility of Contractor to provide all equipment, to satisfy all terms and conditions set forth in the Agreement, and to perform all required duties, obligations, and responsibilities expressed in the Contract Documents at all times during the term of the Agreement. Contractor may utilize additional resources whenever deemed necessary to perform its emergency ambulance services pursuant to the Agreement. This may include, but is not limited to, use of personnel and/or equipment of another OCF A-approved ambulance provider. This, however, shall not relieve Contractor of its duties and responsibilities under the Agreement, and any additional cost incurred shall not be charged to OCFA, the City, or the County. ACTS OR OMISSIONS OF REPRESENTATIVES The acts and/or omissions of the owner(s), officers, operators, officials, employees, agents, and representatives of Contractor in the performance of the services and obligations under the Agreement shall constitute the acts and/or omissions of Contractor. INSOLVENCY Contractor shall not, without the prior written consent of the OCF A Fire Chief, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of Contractor, or make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by Contractor under any insolvency or bankruptcy proceeding may constitute a material breach of contract by Contractor, and all property assigned by OCF A, the City, and/or the County for safe care shall be immediately "released" to another assigned service provider, as specified by the OCF A Fire Chief. - OPERATIONAL STANDARDS, PROCEDURES, & PERFORMANCE REQUIREMENTS Emergency Response Communications System 21.1.1 Compliance with Laws. Prior to the Effective Date, Contractor shall provide, install, operate, and maintain, at its sole cost and expense, an ambulance dispatch center, telephone service, including ring- down line, 800 MHz mobile radio system, mobile data computer/radio system, personal computer, and a secondary dispatch response system (hereinafter collectively referred to as "Emergency Response Communications System") according to the terms, conditions, and requirements contained in this Section. Contractor's Emergency Response Communications System shall comply with all federal, state, and local laws, rules, statutes, and regulations, including licensing requirements, concerning the broadcast of public safety and emergency communications over approved Federal Communications Commission ("FCC") frequencies at all times during the term of the Agreement. 21.1.2 Communications Requirements. Contractor shall comply with the following requirements concerning the installation, use, operation, and maintenance of its Emergency Response Communications System: 21.1.2.1 Prior to the Effective Date, Contractor shall obtain any and all FCC licenses and authorizations required for the engineering, assembling, installation, use, operation, and maintenance of the Emergency Response Communications System, which is necessary to provide emergency ambulance response services under the Agreement; 8 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.1.3 21.1.4 D R A F T 21.1.2.2 Contractor shall provide to OCF A documentation describing in detail its operational design for its Emergency Response Communications System and methods of dispatching ambulances under the Agreement; 21.1.2.3 Emergency Response Communications System shall be operated and maintained by Contractor twenty-four (24) hours per day, seven (7) days per week; 21.1.2.4 Contractor's dispatch center must be equipped with an approved secondary, emergency back-up electrical system to insure uninterrupted twenty-four (24) service; and, 21.1.2.5 Contractor must provide and maintain, at its sole cost and expense, a dedicated point- to-point telephone ring-do\V11 line between the OCF A Emergency Communications Center and Contractor's ambulance dispatch center. 800 MHz County-wide Coordinated Communications System. The Orange County Sheriff- Coroner Department, County of Orange, Communications Division ("OCC"), currently serves as the central coordination point for the Orange County Emergency Response Communications System. As such, OCC operates, maintains, administers, and oversees the existing 800 MHz County-wide Coordinated Communications System, which is the existing communications network that is responsible for providing emergency response system communications throughout Orange County, thereby, effectively linking emergency response calls for law enforcement, fire, public works, lifeguards, and public utilities within Orange County on a shared 800 MHz backbone County-wide Coordinated Communications System ("800 MHz C.c.c.S."). OCFA is one of many participating and subscribing agencies to the 800 MHz c.c.C.S. Contractor's Emergency Response Communications System shall be fully compatible with the 800 MHz C.C.C.S. CAD Interface. At the discretion of OCF A, Contractor shall establish and maintain a Computer Aided Dispatch (CAD) interface, or other equivalent electronic data system, that is compatible with the OCF A Emergency Command Center ("ECC"). This may include, but is not limited to: hardware; software; and telecommunications lines, which shall meet OCF A specifications. Contractor shall assume all costs associated with the purchase, installation, implementation, operation, and maintenance of a CAD interface, or other equivalent electronic data system. Contractor shall be given six (6) months to establish and assume operation of a CAD interface, if OCFA determines that such interface is required at any time during the term of the Agreement. 21.1.5 System Upgrades. As OCF A upgrades its emergency response communications systems with new or improved technologies, Contractor shall likewise promptly upgrade its Emergency Response Communications System with comparable and compatible technology, at its sole cost and expense. 21.2 Vehicle Communications 21.2.1 186777,1 800 MHz Mobile Radio. Contractor shall install and maintain, at its sole cost and expense, an OCFA approved 800MHz mobile radio in the front passenger area (with a remote head in the rear patient area) of each ambulance that will be used for patient transport in the perfonnance of services under the Agreement. The 800MHz mobile radios are to be used by Contractor's EMTs and/or other ambulance personnel to communicate response status with OCF A dispatch and by OCF A paramedics to communicate with base and receiving hospitals during patient transport. Contractor shall comply with the following 800 MHz mobile radio requirements: 9 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.2,1.1 21.2.1.2 21.2,1.3 21.2.1.4 D A T R F Contractor shall obtain all necessary licenses, pennits, and/or approvals from OCC (and any other applicable licensing or permitting agency) to operate and maintain its 800 MHz mobile radios as required herein in conjunction with the 800 MHz C.c.c.S.; Contractor shall comply with all federal, state, and local laws, rules, statutes, and regulations governing the operation of 800 MHz mobile radios, including compliance with 800 MHz c.c.C.S. Standard Operating Procedures; Contractor shall ensure that its 800 MHz mobile radios are pre-assigned to a vehicle with a pre-identified radio identifier and are configured to send status and message data compatible with OCF A SmartNet Information Management System (SIMS), and shall include an OCF A approved and issued Motorola DEKbox with 8 status/message keys to transmit unit status (e.g., en route, on scene, and available status functions); OCF A shall configure the SIMS system to enable this feature on all Contractor radios enabled on the 800 MHz c.C.C.S.; and All Contractor 800MHz mobile radios must meet OCF A, OCC, ECC, 800 MHz C.c.c.S., and OCEMSA specifications and requirements. 21,2.2 Mobile Data Computer System. Contractor shall install and maintain, at its sole cost and expense, an OCFA approved and issued mobile data radio at Contractor's dispatch center for purposes of sending and receiving electronic emergency dispatch information, instructions, and call status. Contractor shall comply with the following mobile data radio system requirements: 21.2.2.1 21.2.2.2 21.2.2,3 21.2.2.4 186777,1 MDC Radio: Prior to the Effective Date, Contractor shall pay OCFA a one time, non-refundable communications start-up fee of $3,500, which shall cover the following: (a) OCFA-issued mobile data radio; (b) OCFA-issued mobile data application software; (c) mobile data installation; (d) mobile data programming; and (e) OCFA-issued Motorola DEKbox. All communications equipment issued to Contractor by OCF A pursuant to this Section shall remain the property of OCF A. The communications systems described in this Section must be installed and fully operational prior to the Effective Date. Upon termination of the Agreement, all OCF A-issued communications equipment must be returned by Contractor to OCF A within thirty (30) days. Annual MDC Fee: Contractor shall pay OCF A a $250 annual fee for MDC system operation and maintenance, which shall be due and payable by July 1, 2005 and annually thereafter. Personal Computer: Contractor shall provide, at its sole cost and expense, and as part of its Emergency Response Communications System, a personal computer having the following minimum specifications: Intel Pentium 500 MHz or greater; 10.0 GB Hard Drive; 256 Mb SDRAM; WIN2000 OS; Color display VGA; Com Ports - 1 serial, 1 USB, 1 Parallel; CD ROM; and, Keyboard - Standard Qwerty 104. Mobile Application Software: Motorola Tx Messenger v3.0 software or greater as specified by OCF A. 10 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.3 Service Hours D R A F T 21.3.1 Service. Contractor shall provide twenty-four (24) hour 911-Fire\EMS Emergency Ambulance Transportation and Related Services within the Subject EOA, seven (7) days a week throughout the term of the Agreement. Field Supervisor. Contractor shall assign an authorized and qualified field supervisor available to OCF A personnel, either by radio or in person, who shall be physically present within the County of Orange, on a twenty-four (24) hour, seven (7) day per week basis throughout the term of the Agreement. 21.3.2 21.4 Response Times 21.4.1 General Requirements. Contractor shall respond to OCFA's requests for 911-Fire1EMS emergency ambulance transportation service within the response times set forth in this Section. Response times shall be calculated as the actual elapsed time in minutes from the moment the request is received by the Contractor's dispatch center to the time that the Contractor's first ambulance arrives on scene. Where multiple ambulances are dispatched to the same emergency scene, only the response time of the ambulance arriving first will be counted for purposes of calculating the response time. 21.4.2 Response Time Measurement. Response times shall be measured in full minutes, rounded upward. For purposes of measuring compliance and for the imposition of any penalties, any partial minute shall be rounded to the next full minute. For example, a response time of 10:01 or 11:00 is counted as eleven minutes. 21.4.3 Definition of Geographical Areas & Response Priority Codes. The following geographical areas, response priority codes, and definitions shall apply with regard to calculating response times (based upon changes in population densities, these geographical area definitions may be changed at the sole discretion of OCF A; OCF A shall advise Contractor in writing when these changes occur): 21.4,3,1 21.4.3,2 21.4.3.3 21.4.3.4 21.4.3.5 186777,1 MetrolUrban: square mile; Those areas with a population density greater than 100 persons per SuburbanIRural: Areas with a population density of 7 to 100 persons per square mile. These areas generally include the roads and contiguous canyon areas of the local mountain ranges, including: Brea Canyon, Tonner Canyon, Carbon Canyon, Modjeska Canyon, Silverado Canyon and Trabuco Canyon; the areas of Santiago Canyon Road between Jamboree and Live Oak Canyon Road; and the Ortega Highway (Highway 74) between La Plata Avenue and the County line; Wilderness: 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, with the exception of incidents on or immediately adjacent to Highway 74; Code 3: Emergency ambulance vehicles responding to an emergency scene or request for service with red lights and sirens on, Code 2: Emergency ambulance vehicles responding to an emergency scene or request for service expeditiously, without red lights and sirens on. 11 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 21.4.4 Response Times Required, Contractor shall strictly adhere to the following required response times at a quarterly compliance rate of ninety percent (90%) in each Code 2 and Code 3 category, which shall be reported separately: 21.4.4,1 MetrofUrban Requirements: Code 3- Response time must not exceed ten (10) minutes, zero (0) seconds. Code 2- Response time must not exceed fifteen (15) minutes, zero (0) seconds. 21.4.4.2 SuburbanlRural Requirements: Code 3- Response time must not exceed twenty (20) minutes, zero (0) seconds. Code 2- Response time must not exceed twenty-five (25) minutes, zero (0) seconds. 21.4.4.3 Wilderness Requirements: Code 3- Response time must not exceed thirty (30) minutes, zero (0) seconds. Code 2- Response time must not exceed forty (40) minutes, zero (0) seconds. 21.4.5 Response Time Reporting. Contractor shall provide quarterly response time reports to OCF A ("Quarterly Response Time Reports") that contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Exhibit "D". Each Quarterly Response Time Report shall be submitted to the OCF A EMS Section Battalion Chief via e-mail (in a format approved by the OCF A EMS Section Battalion Chief) by the 10th day of the month following the end of the quarter. For example, January, February, March reports are due April 10th. If the Quarterly Response Time Reports are not submitted in a timely manner, Contractor may be assessed a $500 penalty per occurence. If the Q1.!.arterly Response Time Reports are not submitted to OCF A as prescribed herein two (2) or more times in a single 12-month period, such ornmissions may constitute breach of contract. 21.4.6 Call Cancellation. In the event a call for service is cancelled prior to arrival, the response will be considered to be within the response time requirement so long as the elapsed time between the call for service and the cancellation does not exceed the applicable response time requirement. In the event the elapsed time between the call for service and the cancellation is in excess of the applicable response time requirement, the call will be considered late. 21.4.7 Quarterly Response Time Report - Format. The Quarterly Response Time Reports shall be submitted by Contractor using an electronic spreadsheet format that will be provided to Contractor by OCF A. The Quarterly Response Time Reports shall contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Exhibit "D," for the EOA. Whenever response times in either Code 2 or Code 3 categories fall below the 90% compliance rate in any given quarter, Contractor shall include a narrative assessment as to the cause of any response delay, and, if requested, shall meet and confer with the OCF A EMS Section Battalion Chief for purposes of establishing a plan for avoiding such delay in the future. 21.4.8 Exemptions to Response Time Requirements. The response time requirements set forth in this Section may be suspended and not enforced, at the discretion of the OCF A EMS Section Battalion Chief, in unusual circumstances. There shall be no exemption for response delays due to vehicle .86777.1 12 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R T A F mechanical problems, driver error, traffic, weather, or mistake, The response time requirements set forth in this Section shall be suspended and not enforced under the following limited circumstances: 21.4.8.1 21.4.8.2 21.4.8.3 21.4.8.4 21.4.8.5 21.4.9 High Call Volume: Responses to calls for service during periods of unusual system overload or high call volume, which shall be at the sole detennination of OCFA; Disasters: Responses to calIs for service during an OCF A declared disaster occurring within an EOA or during a declared disaster in a neighboring jurisdiction, which has requested emergency ambulance transportation or other mutual aid assistance from OCF A. For purposes of this Section, a "declared disaster" means any condition of disaster as declared or affinned by the OCF A Fire Chief or his designee; Multiple Ambulance Response: For responses to calls for service where more than one ambulance is dispatched to the same incident, only the response time of the ambulance first to respond shall be required to meet the required response time requirements; Response Upillowngrade: For Code 3 calls where the response priority code is downgraded to Code 2 by OCF A while the ambulance is en route to the scene, the response time standard for that call shall be recorded as a Code 2 call. If the response priority code is upgraded from Code 2 to Code 3 by OCF A while the ambulance is en route to the scene, the response time standard for that call shall be recorded as the number of minutes for a Code 3 call plus the number of minutes already elapsed, not to exceed the original total minutes for a Code 2 call; Return of OCF A Personnel: In the event that an ambulance is delayed in responding to a call for service, or is hindered from providing a timely response, due to the need to comply with the requirement that it return all OCF A personnel to their respective fire stations, as described herein, the response time requirement for that call will be suspended. This exemption will only apply for a call for service dispatch that occurs while the ambulance is waiting for or actually returning OCF A personne1. It shalI be the Contractor's responsibility to document such circumstances, including the length oftime and the affected call(s) for service. Contractor shall apply for a specific exemption as provided below. Calls for service dispatches that occur after the ambulance has returned OCF A personnel and while returning to any ambulance post location are not eligible for this exemption. Procedures to Request Response Time Exemption. Applications for receiving an exemption to the response time requirements shall be submitted by Contractor to the OCF A EMS Section Battalion Chief for approva1. Such requests must accompany the Quarterly Response Time Report for the period in which the exemption is requested, Requests for exemptions outside of the current quarterly reporting period shall not be considered, Each request for exemption shall include the following infonnation: (a) the incident date; (b) the OCFA Incident Number(s); (c) a narrative summary of the incident; (d) explanation for the cause of the response time delay; and (e) the specific exemption requested, The decision to either grant or deny a response time exemption request shall be made by the OCF A EMS Section Battalion Chief within thirty (30) days; the decision to deny may be appealed to the OCF A Fire Chief, whose decision shall be final. 21.4.10 Use of Alternative Methods to Meet Response Time Requirements. For purposes of maintaining compliance with the response time requirements established herein, Contractor shall negotiate and enter into a separate mutual aid agreement(s) with neighboring ambulance service operators for the 13 186777,1 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R T A F provision of back-up, secondary emergency ambulance transportation services within the Subject EOA. Any secondary ambulance provider(s) selected to provide such services, and anyagreement(s) to provide such services pursuant to this Section, shall satisfy the following requirements: 21.4.10.1 21.4.10.2 21.4.10.3 21.4,10.4 All secondary mutual aid provider draft agreements shall be reviewed and approved by OCF A prior to execution of the Agreement and a copy of the final, signed agreement shall be sent to the OCF A EMS Section Battalion Chief; All OCF A-approved secondary mutual aid providers shall be expected to perfonn back-up emergency ambulance transportation services in accordance with the operational standards, procedures, and perfonnance requirements set forth in the Contract Documents; All OCF A-approved secondary mutual aid providers and their employees shall cooperate with OCF A and shall participate in any audit requested by OCF A concerning their perfonnance; and Notwithstanding the above, Contractor and not the secondary mutual aid provider shall be responsible for ensuring compliance with all tenns, conditions, standards, and perfonnance requirements set forth in the Contract Documents, including but not limited to, the imposition of all applicable penalties and payment of all fees and reimbursements. 21.4.11 Disciplinary Actions for Failure to Meet Response Time Requirements / Performance Deficiency 21.4.11.1 21.4.11.2 186777,1 Meet and Confer. Should Contractor fail to meet the response time requirements, set forth in this Section, in any quarterly period for any single Code category or for the cumulative total of Code 2 and Code 3 calls, as outlined in Exhibit "D," the OCF A EMS Section Battalion Chief shall notify the Contractor and meet and confer with the Contractor regarding perfonnance and response time deficiencies. The purpose of this meeting is to notify the Contractor of its deficiencies and to work with the Contractor to ensure proper response time perfonnance in the immediate future. Penalties. At the discretion of the OCF A EMS Section Battalion Chief, monetary penalties may be assessed against the non-compliant Contractor for failure to meet the response time requirements set forth in this Section. For each EOA, quarterly aggregate response times (i,e., in any quarterly period for any single Code category) that are not in compliance with the response time requirements set forth in this Section may result in OCF A assessing the non-compliant Contractor with a monetary penalty according to the following compliance and fine schedule: 14 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.4,11.3 186777.1 D R A F T Quarterly Responses That Are In Compliance With Response Time Requirements Per Geographical Area And Per Response Priority Code: Penalty Imposed*: 90% or Better None 85% -89.9% $1,000 80% - 84.9% $2,000 Less than 79.9% $3,000 *Note: Penalties a,re for Code 2/Code 3 reported separately and calculated separately within each geographical area in the Subject EOA. In addition to the above response time penalties, OCF A may assess monetary penalties against Contractor for the following: 21.4.11.2.1 Turned Call Penalties: Any calls for service that are not handled by the Contractor, either through its own equipment and personnel or secondary mutual aid providers, and that require OCF A to request service from another ambulance service operator may result in the assessment of a "Turned Call" penalty in the amount of $500 per occurrence. 21.4.11.2,2 Late Report/Late Payment Penalties: Any reports, fees, or reimbursements that are required to be submitted to OCF A by Contractor pursuant to the Con_tract Documents (e,g., Quarterly Response Time Reports, CQI, monthly reimbursements, etc.) and that are not submitted on time may result in the imposition of a $500 penalty per occurrence. Corrective Action Plan. Situations which come to the attention of, or are reported to, the OCF A EMS Section Battalion Chief and which appear to constitute a Contractor service or perfonnance deficiency or substantial inadequacy, as detennined by the OCF A EMS Section Battalion Chief, shall be immediately investigated by the OCF A EMS Section Battalion Chief. An example of such situation may be the Contractor's failure to achieve at least a 90% response time perfonnance in any single Code category for a quarterly reporting period, At the discretion of the OCF A EMS Section Battalion Chief, a Corrective Action Plan may be imposed on the Contractor to correct identified and verified perfonnance deficiencies and inadequacies. The OCFA EMS Section Battalion Chief and Contractor's authorized representative shall meet to develop a written Corrective Action Plan (CAP) within fifteen (15) working days of the identification and verification of the service or perfonnance deficiency, or substantial inadequacy, in accordance with the following CAP requirements: 21.4,11.3.1 CAP Format. The CAP shall describe the following: (1) the service or perfonnance deficiency, or substantial inadequacy shall be identified; and (2) the method by which Contractor is to correct the service or perfonnance deficiency, or substantial inadequacy, shall be 15 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.4.11.4 21.4.11.5 186777.1 D R A F T outlined. Contractor shall sign the CAP, thereby agreeing to the corrective action set forth in the CAP, with any areas of disagreement noted in writing. A copy of the signed CAP shall be furnished to Contractor at the conclusion of the CAP meeting, 21.4,11.3.2 Correction Period. Correction of the service or performance deficiency, or substantial inadequacy, shall occur within a period. of not to exceed sixty (60) days from the development of the CAP, unless the OCF A EMS Section Battalion Chief determines that correction cannot be accomplished within the specified time frame. When correction will take longer than sixty (60) days from the development of the CAP, the CAP shall specify interim dates by which specific steps toward correction of the service or performance deficiency, or substantial inadequacy, will take place with the total time period not to exceed three (3) months, 21.4.11.3.3 CAP Inspection/Compliance. The OCF A EMS Section Battalion Chief, or his designee, shall visit and inspect Contractor's business office, facilities, vehicles, personnel, and/or records to review and document actions taken by Contractor to implement the CAP and shall document any continuing service or performance deficiency, or substantial inadequacy, which is not corrected within the specified time frame. In the event Contractor fails to correct the service or perfoIDlance deficiency, or substantial inadequacy identified in the CAP within the time frame provided, OCF A and! or the Awarding Agency, if applicable, may find Contractor to be in material breach of the Agreement. Timely Performance Required. Assessment of penalties, or the imposition of a CAP, pu~suant to this Section shall not relieve Contractor of the responsibility to meet all performance expectations as set forth in the Contract Documents. Substandard cumulative response time performance (i.e" below the 90% compliance rate for combined Code 2 and Code 3 calls) in any two (2) quarters in a single twelve (12) month period shall constitute breach of contract, resulting in the imposition of a Remedial Action Plan (RAP). Failure to timely correct and cure any response time deficiency, after having been given notice and a reasonable opportunity to cure such violation in accordance with an established Corrective Action Plan (CAP) or failure to cure a breach of contract after the imposition of a Remedial Action Plan (RAP), may constitute a material breach of the Agreement. Additionally, consistent problems in meeting and/or maintaining the response time requirements shall be a key factor in determining whether to grant contract extensions. This Agreement requires the highest levels of performance, reliability, and compliance with the established performance criteria and service delivery criteria, and the mere demonstration of effort, even diligent and well- intentioned effort, shall not substitute for proper compliance. Waiver. Any monetary penalty that may be imposed pursuant to this Section may be waived, upon a showing of good cause, at the sole discretion of the OCF A Fire Chief, whose decision shall be final. 16 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 21.5, Emergency On-Scene Procedures 21.5.1 Contractor shall perfonn as a part of the patient care team and shall be able to perform all BLS treatment modalities within its scope of practice, as required by OCEMSA. 21.5.2 All EMTs and other ambulance personnel assigned by Contractor to perfonn services under the Agreement shall: 21.5.2.1 21.5.2.2 21.5.2.3 21.5.2.4 21.5.2.5 21.5.2.6 21.5.2.7 21.6 Disaster Assistance Be trained in Orange County disaster response procedures, multiple victim, and mass casualty incident protocols, pursuant to the Orange County Fire Services Operational Area Annex; Work under the direction of the OCF A Incident Commander and/or the OCF A EMT- Paramedic in charge of the patient(s) and/or incident; Fully cooperate with and abide by the instructions of the OCF A Incident Commander and/or the OCFA EMT-Paramedic in charge of the patient(s) and/or incident; Place their apparatus and equipment at the scene in a safe location or as deemed appropriate by the OCF A Incident Commander and shall be mindful of the need for safe operations, including the avoidance of exhaust fumes; Not interfere with or assist OCF A personnel in any fire fighting or emergency rescue operation; Request a secondary ambulance and/or Contractor field supervisor immediately upon determining that their unit has suffered a mechanical failure or is or may become disabled, or upon the request of an OCF A Incident Commander, and must likewise immediately inform the OCF A Incident Commander of any mechanical failures; and, Be aware that safety is the responsibility of all personnel on scene; ambulance personnel shall not enter or operate in unsafe environments. During a disaster, declared locally or in a neighboring jurisdiction, strict application of the performance standards set forth in the Contract Documents may be temporarily suspended by OCF A in order to provide an appropriate response. While disaster coordination shall be provided by OCF A, Contractor shall be actively involved in the planning and response to any declared disaster. Upon notification of a disaster by OCF A, Contractor shall immediately commit any and all available resources and assist OCF A in accordance with disaster plans and protocols applicable in the locality where the disaster has occurred. In the event of a disaster, the following shall apply: 21.6,1 21.6.1.1 21.6.1.2 186777,1 During such periods, Contractor shall be released from the response time requirements until notified by the OCF A Duty Officer that disaster assistance is no longer needed; When disaster assistance is no longer needed, Contractor shall resume performance pursuant to the Agreement as quickly as is practical considering personnel exhaustion, medical supply restocking needs, and other relevant considerations; 17 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.7 D R A F T 21.6.1.3 While perfonning disaster assistance, Contractor shall provide supervisory assistance at the command post or emergency operations center as requested and shall use best efforts to provide local emergency coverage; Contractor shall also suspend non- emergency transport services as necessary, infonning persons requesting non- emergency transport of the reason for the temporary suspension; 21.6.1.4 During the course of a disaster, OCF A shall work with Contractor to utilize mutual aid providers who are authorized to perform such services within the County to meet the service demands of the disaster; and, 21.6.1.5 Contractor's supervisory personnel shall complete, or show proof of completion, incident command training, hazardous materials training, and supervisory training in cooperation with OCF A. Standard of Performance 21.7.1 21.8 Contractor shall perform all work and services pursuant to this Agreement in a skillful and workmanlike manner, and consistent with the standards generally recognized as being employed by professionals in the private, emergency ambulance transportation field in the State of California, Contractor hereby waITants and represents that it is skilled in the professional calling necessary to perfonn all work and services under the Agreement. Contractor hereby further waITants and represents that all of its employees and authorized subcontractors shall have sufficient skill and experience to perform the work and services assigned to tpem under the Agreement. Finally, Contractor hereby waITants and represents that it, its employees, and authorized subcontractors have all licenses, pennits, qualifications and approvals of whatever nature that are legally required to perform the work and services under the Agreement, and that such licenses and approvals shall be maintained at all times' throughout the tenn of the Agreement. General Provisions 21.8.1 Return of OCF A Personnel. OCF A provides Advanced Life Support ("ALS") services from a variety of delivery platfonns, including engine and truck companies. ill cases where OCF A personnel accompany patients in the ambulance en route to hospitals or to other receiving facilities, and the OCF A ALS unit does not follow-up to the hospital/receiving facility, Contractor shall return those personnel to their assigned fire station(s) within thirty (30) minutes from the conclusion of the run. The conclusion of the run is defined as the moment when the patient has been transfeITed into the care of hospital/medical staff, the ambulance crew has completed all required documentation, and the ambulance has been restocked and is ready to be placed back in service. At the conclusion of the run, the ambulance crew is to advise the accompanying OCF A personnel that they are ready to return them to their station. If while returning OCF A personnel to their station, the ambulance receives another emergency call, the ambulance may accept that call for service and take those returning OCF A personnel to the new call at the discretion of the OCF A personnel on board. 21.8.2 911 Calls for Service/Referral. Contractor shall immediately refer to OCFA any and all incoming calls for 911-Fire/EMS emergency ambulance service that are made by any person directly to a Contractor's ambulance dispatch center or business office. 21.8,3 186777,1 Performance. The most important aspect of this Agreement is that it stresses "performance." Contractor shall demonstrate a continuous effort to detect and COITect service level performance deficiencies, as detennined by OCF A, and to continuously upgrade the performance and reliability of the EMS transportation system within the Subject EOA. Contractor's clinical and response time 18 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T performance shall be extremely reliable, with equipment failure and human eITor held to an absolute minimum through constant attention to performance, protocol, procedure, performance auditing, proper management oversight, employee training, continuing education, and prompt and definitive service level coITective actions plans. 21.8.4 Conflict ofInterest. Contractor hereby waITants and represents 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 services under this Agreement. 21.8.5 Complaints. Contractor shall immediately notify OCF A in writing of any complaints, inquiries, or investigations initiated by OCEMSA, the California Emergency Medical Services Authority, and/or any other federal, state, or local regulatory agency regarding Contractor services performed pursuant to this Agreement, including but not limited to: level of service; service delivery; service quality; , billing practices; medical training and/or care; and personnel. Nothing in this Agreement shall be construed as superceding the authority of OCEMSA or any other duly empowered regulatory agency . from separately and/or concurrently exercising its authority to provide regulatory oversight and to take action to ensure that Contractor's private, emergency ambulance response services are administered according to law. 21.8.6 Traffic Signal Preemption. Contractor shall be required to purchase, install, and maintain, at its sole cost and expense, City or OCF A-approved traffic signal preemption and security gate access devices/equipment on all ambulances serving the Subject EOA, ifrequired. 21.8.7 CAAS Accreditation. Although not required under the terms and conditions of this Agreement, Commission on Accreditation of Ambulance Services ("CAAS") accreditation is preferred. 21.8.8 IDPAA Business Associate Assurances. Effective April 14,2003, or such other implementation date established by law, to the extent that the parties have a "business associate" relationship, the parties shall carry out their obligations under this Agreement in compliance with the privacy regulations published at 65 Federal Register 82462 (December 28, 2000) (the "Privacy Regulations") pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F - Administrative Simplification, Sections 261, et seq., as amended (" HIP AA"), to protect the privacy of any personal1y identifiable, protected health information ("PHI") that is collected, processed or learned as a result ofthe services provided pursuant to the contract. In conformity therewith, both parties agree that they shal1: 21.8.8.1 Not use or further disclose PHI except: (i) as permitted under the Agreement (that is, for the purpose of maintaining accurate records of the services provided pursuant to the Agreement and for the billing of such services to patients, guarantors, insurers, carriers or other responsible parties; the issuance of reports to the other party pertaining to same; and related administrative functions pertaining to these activities); (ii) as required for the proper management and administration of ALS and BLS in their capacity as HIP AA "Business Associates" of each other; or (iii) as required by law; 21.8.8.2 Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by the Agreement; 21.8,8.3 Report to each other any use or disclosure of PHI not provided for by the contract of which a party becomes aware; .86777,1 19 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.8.9 21.9 D R A F T 21.8.8.4 Ensure that any agents or subcontractors to whom either party provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to both parties with respect to such PHI; 21.8.8.5 Make PHI available to the individual who has a right of access as required under HIP AA; 21.8,8.6 Make available for amendment and incorporate any amendments to PHI when notified to do so by either party; 21.8.8.7 Make available to either party the infonnation required to provide an accounting of the disclosures of PHI made by the one party on the other party's behalf, provided such disclosures are of the type for which an accounting must be made under the Privacy Regulations; 21.8.8.8 Make their internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining either party's compliance with HIPAA and the Privacy Regulations; and 21.8.8.9 Upon tennination of the Agreement, return or destroy all PHI received from, or created or received by one party on behalf of the other party. In the event the return or destruction of such PHI is infeasible, both parties' obligations under this Section shall continue in full force and effect so long as either party possesses any PHI, notwithstanding the termination of the Agreement for any reason. MedicareIMedi-Cal Participation. Contractor hereby warrants and represents that it is an enrolled provider in good standing in the Medicare and Medi-Cal programs and is not the subject of any pending actions, investigations, or prosecutions, whether civil, criminal, or administrative, relating to its billing or reimbur~ement practices, and that Contractor shall not employ or utilize individuals for the perfonnance of services hereunder who have been excluded from any state or federal health care program. Contractor further warrants and represents that: (i) it is not currently excluded, or threatened with exclusion, from participating in any federal or state funded health care program, including but not limited to Medicare and Medi-Cal, and (ii) it has never been excluded by any of the aforementioned programs. Contractor shall promptly notify OCF A of any imposed exclusions or sanctions covered by this warranty, and OCF A reserves the right to terminate the Agreement upon receipt of such notice. External Medical Quality Control 21.9.1 21.9.2 186777.1 Contractor shall fully comply with all federal, state, and local medical standards, protocols, and rules and regulations applicable to the provision of private, emergency BLS ambulance transportation, including those established by OCEMSA. Contractor shall at all times during the term of this Agreement fully cooperate with the OCEMSA Program Managers and the OCEMSA Medical Director in the monitoring, regulation, management, oversight, and administration of the County EMS system, The OCEMSA Medical Director, or his designee(s), has both the authority and responsibility to routinely establish and monitor private, emergency ambulance system perfonnance, including but not limited to: ambulance equipment standards; medical protocols; personnel standards; training standards; medical dispatch procedures; first responder practices and training; medical control; and to effect corrective and disciplinary action as necessary, 20 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 21.10 D R A F T Internal Medical Quality Control 21.10.1 Contractor shall establish a Continuous Quality Improvement ("CQI") program directed at, but not limited to, effective administration and management of clinical perfonnance, response time perfonnance, driver perfonnance, dispatch perfonnance, and for all other BL S service levels. Contractor shall submit to the OCF A EMS Section Battalion Chief quarterly summary reports showing the results of all CQI program perfonnance elements, in a fonn approved by the OCF A EMS Section Battalion Chief, throughout the tenn of the Agreement. 22.0 PERSONNEL 22.1 Personnel Requirements 22,1.1 Employee Performance. Contractor shall employ only competent and trained personnel, and shall provide a sufficient number of employees to perfonn the services provided under the Contract Documents. Each Contractor must comply with the following personnel requirements: 22.1.1.1 22.1.1.2 22.1.2 All Contractor employees and ambulance personnel shall be sufficiently trained and capable to ensure the safe and proper discharge of their service responsibilities; All Contractor ambulance personnel must possess valid California Driver's Licenses in the proper class, including any required certifications, and must be compliant with all relevant provisions of the California Vehicle Code, Health and Safety Code, and all other laws applicable to private, emergency ambulance response personnel. Employee Drug Program. Contractor shall have an employee alcohol and drug program that includes at a minimum, an alcohol and drug free workplace policy, and an employee alcohol/drug- testing program that complies with the U.S, Department of Transportation requirements to the extent allowed by law, including random alcohol and drug testing. Any Contractor employee found working under the influence of alcohol or drugs shall be immediately removed from perfonning any further duties under this Agreement. The alcohol and drug program shall meet the following requirements: 22.1.2.1 22.1.2.2, 22.1,2.3 22.1.2.4 22.1.2.5 186777,1 A contract with a program administrator and authorized lab certified by the U.S. Department of Transportation; and Procedures and components substantially as in Part 40 of Title 49 of the Code of Federal Regulations for pre-employment; and Procedures and components substantially as in Part 382 of Title 49 of the Code of Federal Regulations for rehabilitation, return-to-duty and follow up testing; and Procedures and components for random testing following U.S. Department of Transportation guidelines, and additional tests as required following accidents, rehabilitation, return-to-service, and other circumstances providing reasonable suspicion to test; and Upon request by the OCF A EMS Section Battalion Chief, yearly reports of the random testing component shall be filed by the program administrator, in redacted fonn concealing employee identifiable infonnation, with OCF A; and 21 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 22.1.2,6 Contractor and program administrator's alcohol and drug program records shan be made available, in redacted fonn concealing individual employee identities, to OCF A upon request; and 22.1.2.7 Contractor employees must show a valid California driver's license at the time and place of testing; and 22.1.2.8 An test results are kept confidential except that OCF A is authorized to receive copies, in redacted fonn concealing individual employee identities, for its administrative purposes, and except as otherwise authorized or required by law. 22.1.3 DMV Employer Pull Notice Program. Contractor shall participate in the California Department of Motor Vehicles (DMV) Employer Pull Notice Program at all times throughout the tenn of the Agreement. 22.1.4 Criminal Background Checks. Contractor shall not employ in the perfonnance of services pursuant to the Agreement any EMT or ambulance personnel or employee convicted of or having pled nolo contendere to a crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fraud, or misdemeanor or felony driving while under the influence of alcohol or drugs. If any Contractor employee is charged with any of the above-listed crimes, Contractor shall immediately suspend that employee from perfonning any further duties under the Agreement pending the outcome of the criminal case. It shall be the responsibility of Contractor to ensure that criminal background checks are perfonned on an Contractor employees prior their assignment of any duties within the Subject EOA under the Agreement. 22.1.5 Uniforms and Decorum. Contractor employees shall maintain acceptable standards of dress, including the wearing of Contractor-issued unifonns, and cleanliness while on duty in the community and must at all times conduct themselves in a professional manner. 22.1,6 Cooperation. An Contractor employees shan fully cooperate with and abide by the iQstructions of OCF A personnel while on scene at an emergency incident. 22.1.7 Employee Ineligibility. If any Contractor employee becomes ineligible to provide services under the Agreement, Contractor shall immediately notify the OCF A EMS Section Battalion Chief in writing of such ineligibility and the reason(s) therefore, 22.1.8 22.1.9 186777,1 Compliance with Laws. Contractor shall ensure that all of its employees and ambulances that are used in the perfonnance of services under the Agreement are at all times during the tenn of the Agreement in full compliance with all federal, state, and local laws, rules, statutes, and regulations, including but not limited to: the California Vehicle Code; the California Health & Safety Code; Orange County Ordinance No. 3517; applicable City ambulance ordinances; and any and all applicable OCEMSA or State EMS Authority policies, standards, procedures, regulations, and/or protocols. All Contractor employees shall have in their possession, at all times while on duty, applicable licenses, certifications, and/or pennits, as may be required by the agencies and authorities listed herein. LicensinglIdentification. All Contractor emergency response personnel assigned to perfonn services under the Agreement shall furnish to any OCF A personnel, upon request, any required licenses, certifications, and/or pennits, including proper identification, for purposes of verifying validity, ensuring compliance with licensing, certification, and pennitting requirements, and for the proper reporting of employee perfonnance-related issues to Contractor, 22 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 22.1.10 Joint Training Exercises. The OCF A EMS Section Battalion Chief may request Contractor to participate, at its sole cost and expense, in emergency response joint training exercises to improve the capability and coordination of both OCFA and Contractor's response to a given emergency or disaster. Such training shall be scheduled and mutually coordinated by the OCF A EMS Section Battalion Chief and Contractor. Such training shall not exceed twenty (20) hours per year per EOA. Any additional training that may be deemed necessary by OCF A shall be attended by Contractor's personnel upon reasonable notice and at the sole cost and expense of Contractor. Such additional training may include, but is not limited to, mass casualty, weapons of mass destruction, and/or other emergency response training. 22.1.11 Employee Training Records. Contractor shall promptly make available to the OCF A EMS Battalion Chief, upon request, any and all Contractor personnel training records for those employees who perfonn any duties or services under the Agreement; 22.1.12 Professionalism. All Contractor employees shall perfonn the duties, obligations, and services required under the Agreement in an ethical, professional, and orderly manner and shall endeavor at all times to obtain and keep the confidence of the public, Contractor employee performance of all tern1S and conditions contained in the Contract Documents shall be monitored, maintained, and enforced at all times during the tenn of the Agreement by the OCF A EMS Section Battalion Chief. 22.1.13 Management Oversight. Contractor shall utilize management practices that ensure that its emergency response personnel working extended shifts, part-time jobs, voluntary overtime, or mandatory overtime are not exhausted, overworked, or exhibiting impaired judgment or motor skills while perfonning any duties or services under the Agreement. 22.1.14 Employee Removal. At the request and instruction of the OCFA EMS Section Battalion Chief, and based on a demonstrated pattern of either poor perfonnance or service-related complaints, as detennined by the OCF A EMS Section Battalion Chief, Contractor shall immediately remove certain personnel from perfonning further services or duties under the Agreement. 22.2 Control 22.2.1 Neither OCF A, the City, or the County, or any of their officers, elected officials, agents, representatives, or employees shall have any control whatsoever over the conduct of Contractor's employees, except as set forth in the Agreement. Contractor shall not represent that either it or its agents or employees or officers are in any manner agents or employees of the County, the City, or OCF A, it being understood that Contractor, its agents, employees, and officers are as to the County, the City, and OCFA wholly independent contractors and that Contractor's obligations to the City and OCF A are solely those that are set forth by this Agreement. Contractor hereby further acknowledges and agrees that the City, the County, and OCF A shall have no responsibility whatsoever for salary, health benefits, retirement benefits, taxes, or any other benefits of any kind that may be due to Contractor's employees. 23.0 SUPPLIES, EQUIPMENT AND VEHICLES 23.1 Supplies and Equipment 23.1.1 Standards. All equipment and supplies furnished by Contractor to perfonn BLS services under this Agreement shall comply with all federal, state, and local laws, rules, statutes, and regulations applicable to the provision of private, emergency ambulance transportation, including but not limited to, those BLS equipment and supply standards and protocols established by the OCEMSA Medical 23 186777,1 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 23,1.2 23.2 D R A F T Director. Such equipment and supplies shall be stocked at all times on each ambulance performing services under the Contract Documents. Standard Inventory. In addition to the above equipment and supply standards, Contractor must carry and stock at all times throughout the contract term on each ambulance performing services within an assigned EOA the following emergency medical equipment, which shall all be readily available and accessible from the interior portions of the patient transportation compartment: a, b. Bag valve mask resuscitator, adult with variable mask sizes; Bag valve mask resuscitator, pediatric with variable mask sizes; Heavy gloves to be used for blood or body fluid protection; Disposable Latex gloves, medium, large and x-large, two (2) boxes; Suction unit that complies with OCEMSA policies and procedures; Non-invasive blood pressure device (various cuff sizes, including thigh cuff); Child safety seats (when approved by federal agencies); and, c. d. e. f. g. Vehicles and Maintenance 23.2.1 23.2.2 23.2,3 Standards. All vehicles furnished and made available by Contractor in the performance of BLS services under the Agreement shall comply with all federal, state, and local laws, rules, statutes, and regulations applicable to the provision of private, emergency ambulance transportation, including but not limited to, those BLS vehicle standards and protocols established by OCEMSA. Ambulances. Although not a term or condition of this Agreement, Modular (Type III, dual rear wheeled) ambulances are the preferred type of ambulance for use within the Subject EOA. Contractor shall specify within the Bid Proposal the make, model, year, license plate, type, and mileage for: (a) each ambulance proposed and committed for exclusive, dedicated use within the Subj ect EOA; and (b) each ambulance proposed and committed for non-exclusive use within the Subject EOA and/or regionally available for use within the Subject EOA. Contractor shall agree to expand, at its sole cost and expense, and at the sole discretion of OCFA: (a) the total number of ambulances proposed and committed for exclusive, dedicated use within the Subject EOA; and/or, (b) the total number of ambulances proposed and committed for non-exclusive use within the Subject EOA and/or regionally available for use within the Subject EOA, if either response time requirements are not consistently being met or if the Subject EOA experiences a significant call volume increase. Contractor shall, at all times during the term of the Agreement, maintain: (a) the total number of ambulances proposed and committed for exclusive, dedicated use within the Subject EOA; and, (b) the total number of ambulances proposed and committed for non-exclusive use within the Subject EOA and/or regionally available for use within the Subject EOA. Any reduction in the total number of ambulances proposed and committed, as provided in the Bid Proposal and as required herein, shall constitute a material breach of contract. Contractor ambulances that are taken out of service either temporarily for maintenance or permanently shall be immediately replaced by Contractor, at its sole cost and expense, to maintain the total number of ambulances proposed for and committed to the Subject EOA, as specified in the Bid Proposal. Inspection. Contractor hereby agrees that the OCF A EMS Section Battalion Chief, or his designee(s), may at any time during the term of the Agreement inspect Contractor's ambulances, ambulance maintenance facilities, ambulance maintenance records, ambulance manufacturer suggested maintenance program, and/or ambulance purchase/lease/acquisition documentation, as such documentation relates to Contractor's performance of services under the Agreement. 23.2.4 Maintenance. Contractor shall, at its sole cost and expense, be responsible for providing all necessary vehicles and equipment necessary to provide services within the Subject EOA under the ,~.1 ~ Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 23,2.5 D R A F T Agreement. All vehicles and equipment used by Contractor in the perfonnance of the required services under the Agreement shall be maintained in excellent working condition. Contractor shall comply with or exceed the maintenance standards as outlined in the Standards- Accreditation of Ambulance Services published by the Commission on Accreditation of Ambulance Services ("CAAS"). Contractor's failure to service and maintain all ambulances and equipment dedicated or assigned to the Subject EOA under the Agreement pursuant to the manufacturer's suggested maintenance program shall be deemed a material breach of contract and cause for immediate contract tennination. Personal Safety Equipment. Contractor shall provide personal safety equipment for all employees in accordance with applicable federal and state laws or standards. It shall be the sole responsibility and expense of Contractor to maintain or replace, or cause to be maintained or replaced, any employee personal safety equipment required. Contractor shall be solely responsible for ensuring that all of its personnel abide by all federal, state, and local safety standards. 24.0 RATES FOR AMBULANCE SERVICE 24.1 BLS and ALS Service Rates 24.1.1 24.1.2 24.1.3 186777,1 Maximum BLS Service Rate. The Orange County Board of Supervisors establishes the maximum Basic Life Support ("BLS") service rate ("BLS Service Rate") that may be charged by Contractor to its patients for the provision of emergency ambulance transportation services, Contractor shall not charge more than the maximum BLS Service Rate approved by the Orange County Board of Supervisors for each BLS patient transport. BLS means the same as is defined in the EMS Act. The BLS Service Rate is reviewed annually by OCEMSA, which makes rate adjustment recommendations to the Board of Supervisors. As such, the maximum approved BLS Service Rate is subject to change at any time during the contract tenn. The maximum BLS Service Rate is as follows: Type of Charge Maximum Rate BLS Service Rate $531.75 per BLS transport Maximum ALS Service Rate. The OCF A Board of Directors establishes the maximum Advanced Life Support ("ALS") service rate ("ALS Service Rate") that may be charged by Contractor for OCFA-provided emergency ALS services to patients transported either ALS or BLS, subject to approval by the Orange County Board of Supervisors, For those calls for service in which ALS services are provided by OCF A to patients that are transported either ALS or BLS, Contractor shall be responsible for charging and collecting the ALS Service Rate, as set forth herein, in addition to Contractor's BLS Service Rate. Contractor shall not charge more than the maximum ALS Service Rate approved by the OCF A Board of Directors. ALS means the same as is defined in the EMS Act. The ALS Service Rate is reviewed annually by OCFA. The maximum approved ALS Service Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. As of the Effective Date, the approved maximum ALS Service Rate is as follows: Type of Charge Maximum Rate ALS Service Rate $282 per ALS service w/transport ALS Reimbursement Rate. The OCF A Board of Directors establishes the OCF A ALS reimbursement rate ("ALS Reimbursement Rate"), which Contractor shall pay OCF A for ALS services provided to patients that are transported either ALS or BLS in order to cover OCFA's costs for providing such services, Contractor shall pay OCF A the established ALS Reimbursement Rate for 25 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D ,R A F T each call for service in which OCF A provides ALS services to patients that are transported either ALS or BLS. 24.1.3.1 24.1.3.2 24.1.3.3 186777,1 Medicare Patients. The ALS Reimbursement Rate for Medicare patients, including patients covered under Medi-Medi or Medicare+Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is based on the Medicare allowed amounts for each Contractor, The ALS Increment is defined as the difference between the Medicare allowed amount for a given ALS service (i.e., ALS- IE or ALS-2) and the Medicare allowed amount for BLS emergency services, prior to the 20% co-payment deduction. 24.1.3.1.1 24.1.3,1.2 ALS-l Emergency Services. The ALS Reimbursement Rate for ALS-l emergency transports and ALS-l emergency assessments with BLS transports for Medicare patients, including patients covered under Medi-Medi or Medicare+Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS-I emergency services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co-payment deduction, ALS-2 Services. The ALS Reimbursement Rate for ALS-2 services for Medicare patients, including patients covered under Medi-Medi or Medicare+Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS-2 services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co- payment deduction. Medicare Profile. Contractor shall submit a copy of its Medicare Profile for 2004 to the OCF A EMS Battalion Chief on or before the Effective Date and no later than March 151 each year thereafter. Each year the submitted Medicare Profile shall be used by OCF A for purposes of calculating the ALS Increment. Annual Adjustments. The ALS Reimbursement Rate is reviewed annually by OCF A. The ALS Reimbursement Rate payable to OCF A by Contractor for all ALS services provided to patients, excluding Medicare patients and patients covered under Medi-Medi or Medicare + Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. 26 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 24.1.4 24,1.5 24.1.6 D R T A F 24.1.3.4 ALS Reimbursement Rate. As of the Effective Date, the approved ALS Reimbursement Rate is as follows: Type of Charge Amount 1. ALS Reimbursement Rate $200 per transport wi ALS services 2. ALS Reimbursement Rate for Medicare patients or patients with Medi-Medi or Medicare+Choice plans ALS-1E or ALS-2 Increment Medical Supply Reimbursement Rate. The OCF A Board of Directors establishes the medical supply reimbursement rate ("Medical Supply Reimbursement Rate"), which Contractor shall pay OCFA per BLS/ALS transport. Contractor shall pay OCFA the Medical Supply Reimbursement Rate for each BLS/ALS patient transport to cover OCFA's costs for providing expendable medical supplies to Contractor. The Medical Supply Reimbursement Rate is reviewed annually by OCF A. The Medical Supply Reimbursement Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any, As of the Effective Date, the Medical Supply Reimbursement Rate shall be as follows: Tvpe of Charge Amount Medical Supply Reimbursement Rate $22.38 per transport (BLS/ALS) Zero Pay Patients. OCF A will not require Contractor to pay the established ALS Reimbursement Rate or Medical Supply Reimbursement Rate (nor any portion thereof) for "zero pay patients." "Zero pay patients" are those calls for service to patients whose only method of healthcare coverage or insurance is provided by a state or locat subsidized health care program (i.e., patients receiving health care benefits pursuant to anyone of the following state or local subsidized health care programs: (a) Medi-Cal; (b) CalOptima; (c) California Child Services ("CCS"); and/or (d) County' Medical Services for the Indigent ("County/MSI")). Patients who have other means of payment or who are covered by additional or supplemental insurers, other than subsidized health care programs, are not "zero pay patients," Contractor may seek relief from making the required reimbursement payments to OCF A by applying for a Zero Pay Patient Exemption, as provided below. Risk of Non-Payment. Except as provided otherwise herein, Contractor assumes the entire risk of non-payment for any and all of the services rendered and the charges incurred in connection with its performance under the Agreement, including all BLS and ALS charges incurred, as well as all ALS reimbursements and medical supply reimbursements, 24.1.7 Medicare Patients. Contractor shall not charge Medicare patients more than the maximum Medicare rate. 24.2 Billing, Audit and Access to Records 24.2,1 186777.1 Billing System. Contractor shall only bill for services according to the approved service rates and schedules set forth in the Contract Documents and as authorized by OCEMSA, with no additional fees or charges imposed unless approved in writing in advance by the OCF A Fire Chief and/or the awarding agency, if applicable, Prior to the Effective Date, Contractor shall establish an auditable billing system approved by OCF A, which shall be available for review by OCF A on a periodic basis. 27 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 24.2.2 24.2.3 186777,1 D R A F T Contractor's patient billing/records system shall be organized so that search and retrieval of all billing records can readily be made by OCF A according to the following individual criteria: Patient Name ALS 911 Calls Day/MonthlYear OCFA Incident No. BLS ALS Assessment/BLS Transport ALS Transport BLS Transport Accounting. Contractor shall maintain accurate and complete records of all patient accounting, including but not limited to: (i) all patient invoices, (ii) all patientlinsurer payments; (iii) all BLS service charges; (iv) all ALS service charges; (v) all ALS reimbursement payments; (vi) all medical supply reimbursements; (vii) all invoices, payments, and correspondence to and from private insurers, federal or state health care programs, and other responsible third parties; and (viii) all records evidencing payments made by Contractors to OCF A in connection with its performance under the Agreement. Such accounting shall be performed by Contractor in accordance with generally accepted accounting principles and practices consistently applied. OCF A shall have access to such records and information upon seventy-two (72) hours advanced written notice at all times during normal business hours for the purpose of inspection, audit, review, evaluation, and duplication. Contractor shall, at no cost to OCFA, provide proper facilities for OCFA's access, inspection, audit, review, evaluation, and duplication of such information. Responsibility for Submission of Claims. Contractor shall be responsible for submitting claims for services provided hereunder, and may utilize the services of a third party billing agent for this purpose, In the event that a third party billing agent is used, Contractor shall inform the billing agent of the provisions of the Contract Documents. Contractor shall be responsible to bill for all transports in which ALS services are rendered, specifically including the performance of ALS assessments as defined in 42 C.F.R. §414.605, in accordance with applicable Medicare guidelines for the level of service provided. -24,2,3,1 Submission of Claims. For services provided pursuant to the contract, Contractor shall submit one claim covering both ALS and BLS services to the appropriate carrier or payer utilizing Contractor's provider number. In no event shall more than one claim per trip be submitted where not permitted by law. 24.2.3.2 Sharing of Information and Documentation and Respect of Privacy. Contractor shall permit access by OCFA to Contractor's respective books and records as they relate to billing and reimbursement for services hereunder, Contractor shall share all patient care and billing information necessary to properly submit Medicare claims, including patient care reports and billing slips. Contractor shall within thirty (30) days of receiving any requests for information or documents from the patient, the Centers for Medicare and Medicaid Services (CMS) (formerly HCF A) or its authorized carrier or intermediary, other payment source, or other state or federal agency with oversight of the billing and patient care practices of the parties pursuant to the contract, make available to OCF A any and all such records requested. All information or documents exchanged between the parties related to personal health information of a patient shall be exchanged in compliance with all privacy laws and rules, including the privacy rule established under the Health Insurance Portability and Accountability Act (HIP AA). Both parties will agree to maintain policies to protect the confidentiality of patient information to the extent required by law and to educate and enforce such policies with their respective personnel. 28 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 22.2.4 24.3 D R T A F Medicare Audits. In the event that Contractor is obligated to repay any amounts, related to ALS billed services or medical supplies, to Medicare or other carrier pursuant to a post-payment audit, OCF A shall repay Contractor the ALS Reimbursement Rate or Medical Supply Reimbursement Rate, as applicable, on those claims for which payment is recouped by Medicare or other carrier. However, OCF A will only be responsible for repaying the Contractor in two situations: when a claim is downgraded by the Medicare contractor from an ALS-lE call to a BLS emergency call, or from an ALS-2 to an ALS-IE call. In these situations, OCFA will only repay the Contractor an amount equal to the total ALS Increment (i.e., when a call is downgraded from ALS to BLS) or a portion of the ALS Increment, which is the difference between the ALS Increment of an ALS-2 services and the ALS Increment of an ALS-lE service (i.e., when a call is downgraded from an ALS-2 to an ALS-lE). The Contractor shall supply documentation supporting the overpayment demand by the Medicare Contractor prior to any OCF A repayment. Contractor Monthly Payments 24.3.1 24.3.2 Monthly Payments to OCF A. All ALS reimbursements and medical supply reimbursements, as required in this Section, (hereinafter referred to as "Monthly Payments") shall be promptly paid by Contractor to OCF A beginning ninety (90) days from August 1, 2004, and such payments shall continue to be promptly remitted by Contractor to OCF A thereafter within ninety (90) days after the first day of each month throughout the contract term. Zero Pay Patient Exemptions may be requested by Contractor for each qualifying call by following the procedures below. A penalty of $500 may be imposed for each late payment. If Contractor's monthly payments are sixty (60) days late (or more), Contractor may be assessed a 11'2% late fee for each month that payments are not made. Failure to make timely Monthly Payments may be deemed breach of contract. Zero Pay Patient Exemption Requests. Contractor shall submit to OCF A for approval all Zero Pay Patient Exemption requests and all documentation justifying each request. Zero Pay Patient Exemption requests shall be submitted by Contractor with its monthly ALS reimbursement and medical supply reimbursement payments for the month in which the exemption is requested and must be reflected as a credit on the current Monthly Payment remittance. Requests for exemptions outside the current monthly payment period will not be considered, except as provided herein. Each Zero Pay Patient Exemption will be evaluated and either granted or denied at the sole discretion of the OCF A EMS Section Battalion Chief. Contractor shall be notified in writing by the OCF A EMS Section Battalion Chief if any exemption request will be denied within thirty (30) days of receipt of the request. The decision may be appealed by the Contractor to the OCF A Fire Chief, whose decision shall be final. In the event a Zero Pay Patient Exemption request is denied, Contractor shall adjust its next Monthly Payment remittance for the amount of the credit denied, Exemption requests for "Retro Credits" must be made within the month the Contractor receives notification of the retroactive enrollment in a qualified zero pay patient program. 24.3.3 Monthly Payment Report. Contractor shall submit a Monthly Payment Report (in electronic format) to the OCFA Accounts Receivable Section along with all Monthly Payments. The Monthly Payment Report shall contain the following information: 186777.1 a. EOA number; b. Name of responsible party invoiced per transport; c. Patient name and address; d, Indicate BLS, ALS, or ALS Assessment/BLS Transport; e. Date of call for service; f. OCF A incident number; g. ALS reimbursement amount remitted to OCF A per transport; and, h. Medical supply reimbursement amount remitted to OCF A per transport, 29 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 24.3.4 Audit Report. An audit concerning Monthly Payments may be conducted at the sole discretion of OCF A at any time throughout the contract term. If instructed, Contractor shall promptly produce an audit list (in an approved electronic format) to OCF A auditors, which contains the following information: a, Name of responsible party invoiced per transport; b. Patient name and address; c. Indicate BLS, ALS, or ALS Assessment/BLS Transport; d. Date of call for service; e. OCF A incident number; f. Amount invoiced per transport; g. Amount recovered per transport; h. Any exemption requests for transports included in the audit sample; and, i. Any other requested relevant information required to perform an audit. 24.4 Changed Circumstances In the event that unforeseen changes in either the health care industry or laws (federal, state, or local laws, rules, regulations or statutes) seriously affect the Contractors' ability to continue to perform the services and at the rates required under the Contract Documents, Contractors may petition OCF A for a re-evaluation of the level of service and/or established maximum rates or approved Contractor rates, including the maximum ALS Reimbursement Rate and the Medical Supply Reimbursement Rate, as well as the exemption process. Contractors shall be required to provide such proof as necessary to show that the continuance of the current services, rates, charges, reimbursements, etc. are so economically harmful to Contractors so as to place Contractors in danger of having to default on the contract. This may include requiring Contractors to hire, at their sole cost and expense, an approved independent auditing firm. It shall be at the sole discretion of the OCF A Fire Chief and/or the awarding agency, if applicable, whether to agree to any modifications of the Contract Documents. The parties may by written amendment adjust the terms of the Contract Documents . where circumstances beyond the control of either party require modification or amendment. 25.0 25.1 BREACH OF CONTRACT Breach of Contract. If OCFA and the Awarding Agency, if applicable, determines that Contractor has breached this Agreement, OCF A shall give Contractor prompt written notice explaining the basis for concluding that a breach of the Agreement has occurred and shall afford Contractor a reasonable opportunity to correct such breach, subject to the remedial action planning requirements set forth below. A breach of this Agreement shall include, but shall not be limited to, the following specific acts or omissions if committed by Contractor at any time during the performance of this Agreement: 25.1.1 Response Time Requirements. Substandard cumulative response time performance (i,e., below the 90% compliance rate for combined Code 2 and Code 3 calls) in any two (2) quarters in a single twelve (12) month period may constitute breach of contract; 25.1.2 Response Time Reporting. Failure to timely submit Quarterly Response Time Reports as required herein two (2) or more quarters in a single twelve (12) month period; 25.1.3 Proof ofInsurance. Failure to annually provide to the satisfaction of OCF A evidence that all insurance required to be obtained and maintained by Contractor continues to be in full force and effect; J86777,1 30 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 25.1.4 Communications System. Failure to provide and maintain the Emergency Response Communications System, and/or failure to satisfy the communications system requirements, as set forth herein; 25.1.5 Service Hours. Failure to satisfy the service hour requirements, as set forth herein; 25,1.6 Emergency On-Scene Procedures. requirements, as set forth herein; Failure to comply with and to satisfy all emergency on-scene 25.1.7 Internal Medical Quality Control. Failure to comply with and to satisfy all internal medical quality control requirements, as set forth herein; 25.1.8 Personnel. Failure to comply with and to satisfy all personnel requirements, standards, and/or management oversight responsibilities, as set forth herein; 25.1.9 Decorum. Failure on the part of Contractor and/or any Contractor employee to perfonn the duties, obligations, responsibilities, and services required under the Agreement in an ethical, professional, and orderly manner; 25.1.1 0 Billing System. Failure to comply with and to satisfy all tenns and conditions related to Contractor's billings system, audit, and access to records, as set forth herein; and, 25,1.11 Any Other Non-Material Terms or Conditions. Failure to provide exclusive 9ll-Fire\EMS emergency ambulance transportation and related services within the Subject EOA in accordance with any other non-material tenns or conditions ofthis Agreement. 5.2 Remedial Action Plan. Situations which come to the attention of, or are reported to, the OCFA EMS Section Battalion Chief and which appear to constitute a non-material breach of this Agreement under Section 25.1, as detennined by the OCFA EMS Section Battalion Chief, shall be immediately investigated by the OCF A EMS Section Battalion Chief. The OCF A EMS Section Battalion Chief and Contractor's authorized representative shall meet to develop a written Remedial Action Plan (RAP) within ten (10) working days of the identification and verification of the breach in accordance with the following RAP requirements: 25.2.1 RAP Format. The RAP shall describe the following: (1) the nature of the breach, and shall cite the applicable provisions of the Agreement for which non-compliance is identified and shall infonn Contractor of the right to appeal the findings of the OCF A EMS Section Battalion Chief to the OCF A Fire Chief; and (2) the method by which Contractor is to correct the breach. Contractor shall sign the RAP, thereby agreeing to the remedial action set forth in the RAP, with any areas of disagreement noted in writing. A copy of the signed RAP shall be furnished to Contractor at the conclusion of the RAP meeting, 25.2.2 Remedial Period. Correction of the breach shall occur within a period of not to exceed thirty (30) days from the development of the RAP, unless the OCFA EMS Section Battalion Chief detennines that correction cannot be accomplished within the specified time frame. When correction will take longer than thirty (30) days from the development of the RAP, the RAP shall specify interim dates by which specific steps toward correction of the breach will take place, with the total time period not to exceed two (2) months. 25.2.3 RAP Inspection/Compliance. The OCF A EMS Section Battalion Chief, or his designee, shall visit and inspect Contractor's business office, facilities, vehicles, personnel, and/or records to review and document actions taken by Contractor to implement the RAP and shall document any continuing breach that is not corrected within the specified time frame. In the event Contractor fails to correct the 31 186777.1 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T breach identified in the RAP within the time frame provided, OCF A and the Awarding Agency, if applicable, may find Contractor to be in material breach of the Agreement. 25.2.4 RAP Appeal Process. Contractor may appeal the decision of the OCFA EMS Section Battalion Chief to issue a RAP, or may appeal the findings justifying the RAP or the corrective action requirements set forth in the RAP to the OCF A Fire Chief, of his designee, as follows: 25.2.4.1 Contents of Appeal and Hearing. Contractor's written appeal request shall be submitted to the OCFA Fire Chief, or his designee, within thirty (30) days after receipt of written notification of the breach and shall: (1) Indicate the name and address of Contractor; (2) Identify the EOA Name and EOA Number; (3) Identify the specific action being appealed; (4) Describe the specific basis for the appeal; (5) Include all infonnation necessary to substantiate the legal and/or factual basis of the appeal; (6) Be signed by an authorized representative of Contractor; and, (7) Be deemed filed on the date submitted to and received by OCF A; 25.2.4.2 Appeal Review. Within fifteen (15) days of receipt of the appeal, the OCFA Fire Chief, or his designee shall review the appeal to detennine whether it includes the infonnation required by section 25.2.4.1 above. If all the required infonnation has not been included and/or additional infonnation is needed, the OCF A Fire Chief, or his designee, shall request, in writing, the additional infonnation trom Contractor. The request shall be made no later than twenty (20) days from receipt of the appeal. Contractor shall submit the required infonnation no later than fifteen (15) days trom the receipt of the request. If the infonnation requested of Contractor is not submitted within the time specified, the appeal shall be deemed withdrawn and no further action will be taken unless Contractor establishes good cause for the late submission, as detennined by the OCF A Fire Chief, or his designee. If all the required information has been received, notice of a hearing date shall be sent to Contractor by certified mail, return receipt requested, within fifteen (IS) days of receipt of the information, specifying the date, time, and place of the hearing and the matter(s) to be heard. 25,2.4.3 Appeal Hearing. The hearing date shall be set no later than twenty-five (25) days from receipt of all required information. Both parties must agree to any extension of the hearing date. The appeal process does not preclude Contractor from tenninating the proceeding at any time prior to the hearing date if the matter is settled to the satisfaction of the OCF A EMS Section Battalion Chief. With regard to the hearing, Contractor shall have the right to: (1) Examine, prior to the hearing, all documents on file pertaining to the subject of the appeal, which are not confidential or otherwise not discoverable under existing statutes or regulations; (2) Be represented by counsel; (3) Attend the hearing and present any written and/or oral evidence; and, (4) Cross-examine witnesses. 186777.1 32 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 25.2.4.4 Decision. Within thirty (30) days of the date of the hearing, the OCF A Fire Chief, or his designee, shall: (1) Render a written decision, which shall be final, and submit a written notification of the decision to Contractor by certified mail, return receipt requested; (2) The written notification shall: (a) Identify the specific issue(s) in dispute; (b) rule on each issue( s); and state the facts supporting each ruling; (c) specify the statute, regulation, rule, or Agreement provision upon which the ruling is based; and (d) specify that the decision of the OCF A Fire Chief, or his designee, shall be final. 25.3 Material Breach. Any of the following acts or omissions if committed by Contractor at any time during the performance of this Agreement shall be considered a material breach of this Agreement, which may, at the sole discretion of OCFA and the Awarding Agency, if applicable, result in the immediate termination of the Agreement. Under such circumstances, Contractor shall be afforded reasonable notice of such material breach; however, Contractor may not be afforded an opportunity to correct or to cure such material breach, as the Agreement may be immediately terminated. 25.3.1 Assignment. Any delegation or assignment or transfer, or any attempted delegation or assignment or transfer by Contractor of its rights or obligations, in whole or in part, under the Agreement to any other person or entity without the prior written consent of OCFA and the Awarding Agency, if applicable; 25,3.2 Insolvency. Suffering either the appointment of a receiver to take possession of all, or substantially all of the assets of Contractor, or making or attempting to make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by Contractor under any insolvency or bankruptcy proceeding may constitute a material breach of the Agreement; 25.3.3 Vehicle/Equipment Maintenance. Failure to safely maintain and/or service and maintain all Contractor ambulances and equipment dedicated or assigned to the Subject EOA pursuant to the manufacturer's suggested maintenance program, as required herein; 25.3.4 On- Time Monthly Payments. herein; Failure to make timely Monthly Payments to OCF A, as required 25.3.5 Insurance. Failure to maintain all of the insurance policies required by this Agreement in full force and effect at all times during the term of the Agreement; and/or failure to modify existing coverage or to obtain additional coverage and/or policies, as determined to be necessary by OCF A; 25.3.6 Audits and Inspections. Failure to allow OCFA and/or its auditor(s) to conduct audits and inspections of Contractor facilities, business office(s), vehicles, records, billings, personnel, ambulance post location(s), or otherwise as provided herein; 25.3.7 Rates. Failure to comply with and to satisfy all terms and conditions related to the maximum rates for ambulance services that may be charged by Contractor, as established herein, and/or failure to adhere to the rates and charges agreed upon, as set forth in the Bid Proposal; 25.3.8 Disaster Assistance. Failure to provide disaster assistance, as required herein; 25.3.9 Compliance with Laws. Failure to perform all services, duties, and obligations required under this Agreement in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations; 186777.1 33 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 25.3.10 LicensingIPermitting. Failure to obtain and maintain any and all required Contractor and Contractor- employee licenses, permits, and/or certifications trom all applicable governmental agencies that are, or may become, required for the provision of private, emergency ambulance transportation services within the Subject EOA; 25.3.11 Corrective Action Plan Compliance. Failure to timely correct and cure any service or performance deficiency or substantial inadequacy having been given notice and a reasonable opportunity to cure in accordance with an established Corrective Action Plan (CAP); 25.3.12 Remedial Action Plan Compliance. Failure to timely correct and cure any non-material breach having been given notice and a reasonable opportunity to cure in accordance with an established Remedial Action Plan (RAP); 25.3.13 Bid Proposal. Providing false or misleading information in the Bid Proposal, and/or making material misrepresentations of fact or material omissions of information either in the Bid Proposal or at any time during the RFP No. RL972 competitive process; and, any deviation by Contractor trom the specifications and service level commitments set forth in the Bid Proposal, without the prior written consent ofthe OCFA Fire Chief and the Awarding Agency, if applicable; 25.3.14 OCEMSA Reporting. Withholding or falsifying data or information supplied to OCFA or OCEMSA, including by way of example, but not by way of exclusion, dispatch data, patient report data, response time data, financial/patient bi11ing data, Monthly Payment data, CQI reporting data, and/or falsification or withholding of any other data that is required to be reported under this Agreement; 25.3.15 Number of Ambulances/Types and Equipment Committed. Any reduction in the total number of ambulances (and types of ambulances) proposed for and committed to, as provided in the Bid Proposal, the Subject EOA. Ambulances that are taken out of service either temporarily for maintenance, permanently, or otherwise, and which are not immediately replaced by Contractor to maintain the total ambulances proposed and committed to the Subject EOA; reducing any of the agreed upon vehicles (types of vehicles) and/or equipment either designated for exclusive use or made regionally available to the Subject EO A, pursuant to the Bid Proposal and relevant terms and conditions of this Agreement, without the prior written consent of the OCF A Fire Chief and the A warding Agency, if applicable, may constitute material breach of this Agreement; 25.3.16 Equipment Maintenance. Failure to maintain equipment and vehicles in accordance with good maintenance practices, or to replace equipment or vehicles in accordance with the equipment and vehicle maintenance and replacement programs submitted and accepted in the Bid Proposal, without the prior written consent of the OCF A Fire Chief and the Awarding Agency, if applicable; 25.3.17 Employee and Management Staffing Levels. Failure to provide and maintain the employee staffing levels and management staffing levels submitted and accepted in the Bid Proposal, without the prior written consent of the OCFA Fire Chief and the Awarding Agency, if applicable; 25.3.18 External Medical Quality Control. Failure to comply with all federal, state, and local medical standards, protocols, and rules and regulations applicable to Contractor's provision of private, emergency BLS ambulance transportation, including those established by OCEMSA; 25.3.19 Loss of Legal Capacity. The loss by Contractor of legal capacity to contract. 186777,1 34 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 26.0 26,1 26.2 27.0 27.1 28.0 28.1 186777.1 D R A F T PUBLIC SAFEGUARDS AND EMERGENCY T AIŒOVER This Agreement is structured with the objective of protecting public health and safety at all times and to protect the public from any loss of service or loss of life as a result of Contractor's breach, service or performance deficiency, or substantial inadequacy under the Agreement. Contractor understands and agrees that OCFA and the Awarding Agency, if applicable, shall undertake a safe, orderly, rapid, and immediate takeover of all services under the Agreement in the event the OCF A Fire Chief and the A warding Agency, if applicable, determines after reasonable investigation that Contractor is in material breacÞ of this Agreement. Such takeover of services shall occur immediately upon finding by the OCFA Fire Chief and the Awarding Agency, if applicable, at their sole and exclusive discretion, that Contractor's performance, or lack thereof, constitutes a material breach of this Agreement. OCEMSA may provide independent expert evaluation and opinion to OCF A concerning all questions involving Contractor breach of contract matters affecting patient care, In the event such finding and determination is made, Contractor hereby understands and agrees that the Agreement sha1l be terminated immediately, and Contractor shall fully cooperate with and sha1l immediately assist OCF A, the City, and the successor ambulance service operator to effectuate an immediate, efficient, and orderly takeover of all 911-Fire/EMS emergency ambulance services within the Subject EOA upon termination of this Agreement, so as to ensure that there will be no service interruption to the public. CONTRACTOR'S RELIEF UPON TERMINATION The provisions of this Section are specifica1ly understood and agreed to by Contractor as being reasonable and necessary in light of the serious public health and safety aspects associated with the provision of services under the Agreement. Any legal action taken by Contractor to cha1lenge either a termination or emergency takeover of this Agreement for material breach sha1l only be initiated by Contractor after the emergency takeover, as provided in Section 26.0 above, has been completed, and sha1l not under any circumstances whatsoever be allowed to delay the process of takeover by OCFA. Contractor's cooperation with, and fu1l support of, such emergency takeover process shall not be construed as acceptance by Contractor of OCF A and the Awarding Agency's, if applicable, finding and determination of material breach, and shall not in any way jeopardize or limit Contractor's right to recover damages should a court of competent jurisdiction determine that Contractor was not in material breach of the Agreement prior to the takeover. However, failure on the part of Contractor to fully cooperate with OCF A, the City, and the successor ambulance service operator to effectuate an immediate, efficient, and orderly takeover of all 911-Fire/EMS emergency ambulance services within the Subject EOA upon termination of this Agreement shall itself constitute a material breach of the Agreement, even it is later determined by a court of competent jurisdiction that Contractor was not in material breach of the Agreement prior to the takeover. Contractor hereby specifically waives any right to seek any type of declaratory or equitable relief, including but not limited to a restraining order or injunction, against either the termination or an emergency takeover. HOLDOVER PROVISION For purposes of protecting public health and safety, in the event this Agreement is terminated, either with or without cause, or is terminated as the result of a Contractor action(s) that constitutes a material breach of the Agreement, or if no extension of the Agreement is awarded at the end of the initial term of the Agreement, or if Contractor is not awarded a subsequent exclusive operating contract for the Subject EOA upon teTIllination of this Agreement, Contractor hereby agrees to continue providing services under the Agreement until the successor ambulance service operator takes over ambulance service operations and assumes full responsibility for the provision of 911-Fire\EMS emergency ambulance transportation and related services within the Subject EOA. Under such circumstances, Contractor shall agree in writing to extend the Agreement and shall serve as a holdover exclusive operator until such time as the successor ambulance service operator takes over ambulance service operations and assumes fully responsibility for the provision of 9ll-Fire\EMS emergency ambulance transportation and related services within the Subject EOA. 35 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 28.2 28,3 29.0 29.1 30.0 30.1 31.0 31.1 32.0 32.1 32.2 33.0 33.1 186777,1 D R T A F OCF A recognizes that if a competing ambulance service operator is awarded an exclusive operating area agreement for the Subject EOA upon tennination of this Agreement, Con1:)."actor may reasonably begin to prepare for the transition of services to the new provider either prior to the Agreement termination date or during the holdover period described in section 28,1 above, OCFA and the Awarding Agency, if applicable, shall not unreasonably withhold its approval of any Contractor request to begin an orderly transition process, including reasonable plans to relocate Contractor staff, scale down or reduce certain inventory, supplies, or otherwise, so long as such transition activities and/or reductions do not impair or impede Contractor's ability to perfonn services under the Agreement and provided such transition activities and/or proposed reductions receive the prior written consent of the OCFA Fire Chief and the Awarding Agency, if applicable. In order to protect public health and safety, Contractor hereby agrees to fully cooperate with and to immediately assist OCFA, the City, and the successor ambulance service operator to effectuate a prompt, efficient, and orderly takeover of all 911-FireÆMS emergency ambulance services within the Subject EOA upon tennination of this Agreement, so as to ensure that there will be no service interruption to the public. CHANGED CIRCUMSTANCES Each party shall promptly notify the other party in writing of any legal impediment, change of circumstance, pending litigation, or any other event, occurrence, or condition that may adversely affect such party's ability to carry out and perform any of the duties, services, and/or obligations under the Agreement. SU CCESSO RS Each of the terms and conditions of this Agreement shall inure to the benefit of and shall bind, as the case may be, not only the parties hereto, but each and every one of the heirs, executors, administrators, successors, assignees, and legal representatives of the parties. INTEGRATION this Agreement, including all exhibits attached hereto and incorporated herein by reference, supersedes all previous communications, transactions, and understandings, whether oral or written, and constitutes the sole and entire Agreement between the parties pertaining to the subject matter hereof. No modification or deletion of, or addition to, these tenus or conditions is binding on either party unless made in writing and signed by a duly authorized representative of both parties. NO WAIVER No delay or omission in the exercise of any right or remedy available hereunder shall impair such right or remedy or be construed as a waiver. Any waiver of any default or condition hereunder must be in writing and shall not be construed as a waiver of any other default concerning the same or any other provision of this Agreement. The waiver by OCF A of any breach by Contractor of any of the provisions of this Agreement shall not constitute a continuing waiver or a waiver of any subsequent breach or default by Contractor either of the same or a different provision of this Agreement. THIRD PARTY BENEFICIARIES The tenus of this Agreement are intended to confer benefits only on the parties to this Agreement. No rights of action shall accrue to any other persons or entities under this Agreement. 36 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 34.0 14.1 35.0 35.1 36.0 36.1 37.0 37.1 38.0 38.1 19.0 186777,1 D R A F T EXECUTION OF AGREEMENT The person(s) executing this Agreement hereby warrant and represent that the execution of this Agreement and the performance of the tenDS and conditions of this Agreement have been authorized by all requisite corporation, federal, state, municipal or other entity requirements and that the undersigned have the right, power, legal capacity and authority to execute, to bind Contractor, and to enter into this Agreement. NOTICES Any notices required or pennitted under this Agreement shall be in writing and shall be delivered personally or sent by u.s. Mail, First Class, postage prepaid, return receipt requested, and addressed as follows: Orange County Fire Authority: Orange County Fire Authority Attn.: EMS Section Battalion Chief One Fire Authority Road Irvine, California 92602 City of Tustin: City of Tustin Attn: City Manager 300 Centennial Way Tustin, California 92780 [Name of Contractor]: [Contractor] [Address] SEVERABILITY If any term or condition of this Agreement, or the application thereof to any person or circumstance, shall to any extent be held by a court of competent jurisdiction to be invalid, void, or otherwise unenforceable, the remainder of this Agreement, or the application thereof to any person or circumstance, shall remain in full force and effect and shall in no way be affected, impaired, or invalidated thereby. EOA BOUNDARY CHANGE Unincorporated service areas are subject to annexation or incorporation at any time as determined by the Orange County Local Agency Formation Commission ("LAFCO"). The Subject EOA may be changed, adjusted, or redrawn by OCEMSA at any time during the term of the Agreement. OCF A has no control over such unanticipated service area and/or jurisdictional changes. This Agreement, if affected by a service area or jurisdictional change imposed by LAFCO, OCEMSA, or otherwise, is subject to review, approval, and/or tennination by the new governing authority, if any. AMENDMENT No modification, amendment, addition to, deletion, or alteration of the terms of this Agreement, whether written or oral, shall be valid unless made in writing and formally approved and executed by both parties. VENUE 37 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T 39.1 This Agreement shall be governed and construed in accordance with the laws of the State of California. In the event of any legal action to enforce or interpret this Agreement, the sole and exclusive venue shall be a court of competent jurisdiction located in Orange County, California, and the parties hereto agree to and do hereby submit to the jurisdiction of such court, notwithstanding Code of Civil Procedure section 394. [SIGNATURE PAGE FOLLOWS] 186777,1 38 Tustin (Draft) Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F T SIGNATURE PAGE 'N WITNESS WHEREOF, the parties hereto have executed this Agreement as follows, to be effective on the Effective Date as set forth above. "CONTRACTOR": Date: Name: Title: Date: Name: Title: "CITY OF TUSTIN" By: Anthony Kawashima, Mayor City of Tustin Date: APPROVED AS TO FORM: By: Lois Jeffrey, City Attorney ATTEST: By: Pamela Stoker, City Clerk 186777.1 39 Tustin (Draft) FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 Exhibit A ( J @~~~@~ ~@M~ìJW [F~~~ ~MìJ~@~~ìJW EXCL USIVE OPERA TING AREA 23 ST / z:' Cony art odDgnFDo. 'CoM opa '00023 ,dgn 17-JUN-2004 D R AFT EXHIBIT "B" AMENDMENT NO.1 TO THE OCF A 2004 FIRE/EMS EMERGENCY AMBULANCE TRANSPORT A TI 0 N AND RELATED SERVICES REQUEST FOR PROPOSALS (RFP NO. RL972) Not Included 186777,1 Tustin (Draft) Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R AFT EXHIBIT "C" CONTRACTOR'S SIGNED, ORIGINAL BID PROPOSAL SUBMITTED FOR OCFA RFP NO. RL972 Not Included 186777,1 Tustin (Draft) Model FirelEMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R AFT EXHIBIT "D" SAMPLE QUARTERLY RESPONSE TIME REPORT 186777,1 Tustin (Draft) Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 D R A F EXHIBIT "D" SAMPLE QUARTERLY RESPONSE TIME REPORT Contractor Name: EOA Name: EOA Number: 23 Quarter Ending: Completed by: Title: Date: Metro/Urban Code 2 Code 3 Combined Suburban/Rural Code 2 Code 3 Combined Code 2 Wilderness Code 3 Combined Code 2 Totals Code 3 Combined Number of patients transported Number ofresponses Number of "on-time" responses Percentage of "on-time" responses* Number of calls for service that were refused or not accepted by the Contractor N umber of calls referred to approved, secondary mutual aid providers *If percentage of "on-time" responses in either Code 2 or Code 3 categories falls below 90% regardless of geographical area, include a narrative assessment as to the cause of any response delay below, (Attach additional sheets and documentation, as needed,) At his discretion, the OCF A EMS Battalion Chief shall meet and confer with the Contractor for purposes of establishing a plan for avoiding such delay in the future. 186777,1 Tustin (Draft) Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement June 2004 ---i ONE: ARTicLES OF INCORPORATION OF MEDIX AMBULANCE SERVICE, INC. MARCH FONG EU. SccfttiryOfState Gloria J. Cä"ofl Depl1f)r The name of this corporation is MEDIX AMBULANCE SERVICE,INC. ENDORSED F J L£ D, .. 8M office of the ~ of ... of the StaIt 01 CaIifoñIio JUN 3 1982 1113687 TWO: The purpose of this corporstion is to engage in any lawful act or activity for which a corporation may be organized under the generàl corporation law of California other than the banking business, the trust company business, or the practice of a profession permitted to be incorpo- rated by the California Corporations Code. THREE: The name and address in this State of the Corporation's initial agent for service, or process is MICHAEL DI}!AS, 661 West First Street, Suite D-2, TustfD, California 92680. FOUR: The total number of shares which the corporation is authorized to issue is 10,000. ; Dated: 25 May 1982 , , .! I, ¡r '. I declare that I am the Incorporation. and that such person who execut instrume~t:is my J . / ' f :¡ ; ¡ \ the above Articles of t and deed. " CHASSIS MAKE MODEL YEAR 18 2726 Ford E350 1996 246,082 Good III 20 2739 Ford E450 1998 272,000 Good III Units Scheduled for Deliverv: Auaust 2004 - Januarv 2005 UNIT # CHASSIS MAKE MODEL YEAR MILEAGE 2 TBD Ford E450 2004 0 4 TBD Ford E450 2004 0 New III 6 TBD Ford E450 2004 0 New III 10 TBD Ford E450 2004 0 New III 14 16 TBD Ford 18 TBD Ford E450 2005 0 New III B. Other Reaional Units that will be Available to Reasonablv Support the EOA Regional Units/Location: If Medixis only awarded this EOA, five (5) Medix specialty units, three (3) Major Incident-Disaster Response Units, the Field Supervisor Unit, and the Mobile Communications Unit will be available to the EOA for use during any mass casualty or disaster event. These units will be located within the EOA or not more than five (5) miles distance from the EOA. Medix proposes two (2) additional Major Incident-Disaster Response Units. If Medix is awarded only this EOA, the following six (6) new Type III Modular Rescue Ambulances will become available to reasonably support the EOA when it experiences unusual and/or unanticipated demand. These units will be located within the EOA or not more than seven miles distance from the EOA and always maintained to Medix standards. 2 TBD Ford E450 2003 0 New III 4 TBD Ford E450 2003 0 New III 6 TBD Ford E450 2003 0 New III MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 15 Ambulance Service May 18, 2004 Chief John Howlind, Battalion Chief OCF AlEMS Section 1 Fire Authority Road Irvine, California 92602 Dear Chief Howlind: On behalf of the entire team at Medix Ambulance Service, I am pleased to clarify our response to the Authority's Request for Proposals (RFP) for services to be provided to ~iI&1!Tustin. While we hope to continue to serve all our current contract areas and, if fortunate, to extend the benefits of our services to new EOAs, we understand the County's request to clarify our proposal in tenns of being awarded Tustin alone out of all nineteen Exclusive Operating Areas. In response to your request for additional Tustin-specific information, Medix proposes the following in terms of being solely awarded EOA #23. We further detail herein only those sections from Items 3, 5 and 8 of our proposal that will be impacted by an individual EO A approach. ITEM 3: OVERALL OPERATIONAL SYSTEM & PROGRAM DESIGN 1. Provide the number and proposed location of all emergency vehicles for service in the subject EOA. In the alternative to a fIXed station(s) in the EOA provide a detailed map of the system status management or provide a detailed system plan. Medix will operate seven (7) days a week, twenty-four (24) hours a day, in EOA #23. Medix will provide base coverage from two (2) permanent stations strategically positioned to allow for the geographically based coverage necessary for the excellent response time performance currently enjoyed by Tustin. The stations will be manned around the clock by Medix BLS crews permanently assigned exclusively for 9-1-1 response coverage. TUSTIN EOA #23 RESPONSE PLAN LEVEL' 'RESP'ONSE.LOCÁTIONS . ." .' .. ' 1 RL31 2 3 RL 31,26 RL 31, 26, 37 26021 Pala Drive, Mission Viejo, California 92691 Telephone: (949) 470-8921 Facsimile: (949) 470-8951 RL 26 17th St & Newport Av Rl31 Redhill Av & Walnut Av (Tustin Station) Rl37 2942 East Chapman Av, #G (Orange/North Tustin Station) 2. Provide the hours of operation for each unit in the subject EOA. For EOA #23, Medix will continue to operate from two (2) permanently staffed 24-hour Tustin stations located at Redhill Avenue and Walnut Avenue (Tustin Station) and at 2942 East Chapman Avenue, #G (OrangelNorth Tustin Station). 3. Provide the crew configuration for each unit in the subject EOA. Medix will provide EOA #23, Tustin, the same crew configuration of two (2) California-certified EMTs as previously described in Item 3 of our original RFP response. 4. Provide description of supervisory plan of crews, including number and location of supervisory personneL Medix will provide EOA #23, Tustin, the same supervisory plan of crews as previously described in Item 3 of our original RFP response. 5. Provide an overall summary of Bidder's Southern California system operations. Medix will provide EOA #23, Tustin, the same Southern California system operations as previously summarized in Item 3 of our original RFP response. a. Total number of ambulances in fleet Medix offers EOA #23, Tustin, the same total number of ambulances infleet description of our system operation as previously submitted in Item 3 of our original RFP response. For EOA #23, Tustin, Medix commits three (3) new Type III ambulances as previously described in Item 5 of our original RFP response. b. Total number of employees including line staff, supervisors, managers, administrative, billing, etc. Medix will provide EOA #23, Tustin, the same total number of employees including line staff, supervisors, managers, administrative, billing, etc. as previously described in Item 3 of our original RFP response. c. Contact information for third party billing agency and third party collection agency (where applicable). For EOA #23, Tustin, the same contact information for third party billing agency and third party collection agency applies as previously described in Item 3 of our original RFP response. iL Contact information for medical director; contact information for continuing education program, driver training, etc. For EOA #23, Tustin, the same contact information for medical director, contact information for continuing education program, driver training, etc. applies as previously described in Item 3 of our original RFP response. ITEM 5: TOTAL NUMBER OF AMBULANCES Medix will provide EOA #23, Tustin, the same total number of ambulances, fleet enhancement, Medix ambulance enhancements, ambulance replacement schedule, specialty units and Mobile Communications Unit 2500 as previously described in Item 5 of our original RFP response. SPECIFIC AMBULANCE INFORMATION Mileage provided is estimated based on the unit in service as of July 1,2004. A. Units Proposed for Exclusive. Dedicated Use: July 2004 - August 2004 Transition If awarded all nineteen (19) EOAs, Medix will almost double the company's current commitment to Orange County response by supporting the OCF A with at least twenty (20) permanently stationed 9-1-1 units. The units listed below will ensure compliant base coverage through the rapid transition to a complete fleet of new Type III units. UNIT # CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 1 IBD Ford E450 2003 o New III 2 IBD Ford E450 2003 0 New III 3 TBD Ford E450 2003 o New III 4 TBD Ford E450 2003 0 New III 5 TBD Ford E450 2003 0 New III 6 TBD Ford E450 2003 o New III 7 TBD Ford E450 2003 0 New III 8 TBD Ford E450 2003 0 New III 9 TBD Ford E450 2003 0 New III 10 TBD Ford E450 2003 0 New III 11 IBD Ford E450 2003 0 New III 12 TBD Ford E450 2003 0 New III 13 2741 Ford E450 1998 193,027 Excellent III 14 2744 Ford E450 1998 198,470 Excellent III 15 2737 Ford E450 1998 210,000 Excellent III 16 2740 Ford E450 1998 230,000 Good III 17 2743 Ford E450 1998 241.343 Good III 18 2726 Ford E350 1996 246,082 Good III 19 2736 Ford E450 1998 272,000 Good III 20 2739 Ford E450 1998 272,000 Good III Units Scheduled for Delivery: August 2004 - January 2005 UNIT # CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 1 TBD Ford E450 2003 0 New III 2 TBD Ford E450 2003 0 New III 3 TBD Ford E450 2003 0 New III 4 TBD Ford E450 2003 0 New III 5 TBD Ford E450 2003 0 New III 6 TBD Ford E450 2003 0 New III 7 TBD Ford E450 2003 0 New III 8 TBD Ford E450 2003 0 New III UNIT # CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 9 TBD Ford E450 2003 0 New III 10 TBD Ford E450 2003 0 New ill 11 TBD Ford E450 2003 0 New III 12 TBD Ford E450 2003 0 New III 13 TBD Ford E450 2003 0 New III 14 TBD Ford E450 2003 0 New III 15 TBD Ford E450 2003 0 New III 16 TBD Ford E450 2003 0 New III 17 TBD Ford E450 2003 0 New III 18 TBD Ford E450 2003 0 New III If awarded only EOA #23, Medix will dedicate the following units for service in Tustin. UNIT # CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 1 TBD Ford E450 2003 0 New III 2 TBD Ford E450 2003 0 New III 3 TBD Ford E450 2003 0 New III B. Other Regional Units that will be Available to Reasonably Support the EOA Five (5) Medix specialty units (three (3) Major IncidentlDisaster Response Units, the Field Supervisor Unit and the Mobile Communications Unit) will be available to any and all Orange County EOAs for use during any mass casualty or disaster event and upon the request of the Fire Authority. Contingent upon contract awards, Medix proposes to provide two (2) additional Major IncidentlDisaster Response Units. Used units proposed for frontline service at Contract start will be almost immediately replaced with new Type III units scheduled for delivery beginning in August 2004. Listed below are just a few of the high quality Medix Type III units that will become available to reasonably support any EOA experiencing unusual and/or unanticipated demand. All Medix vehicles are maintained to strict Medix standards. UNIT # CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 1 2741 Ford E450 1998 193,027 Excellent III 2 2744 Ford E450 1998 198,470 Excellent III 3 2737 Ford E450 1998 210,000 Excellent III 4 2740 Ford E450 1998 230,000 Good III 5 2743 Ford E450 1998 241,343 Good III 6 2726 Ford E350 1996 246,082 Good III ITEM 8: RESPO NSE TIME REQUIREMENTS Medix offers EOA #23, Tustin, the description of response time requirements and proposed response time enhancements previously submitted in Item 8 of our proposal. Specific to EOA #23 as the company's only awarded EOA, Medix provides the following description of our initial coverage plan for Tustin. PROPOSED INITIAL COVERAGE PLAN For EOA #23, Medix will continue to operate from two (2) pennanently staffed 24-hour Tustin stations located at Redhill Avenue and Walnut Avenue (Tustin Station) and at 2942 East Chapman Avenue, #G (Orange/North Tustin Station). Exclusive 9-1-1 ambulances will respond to Tustin calls from the pennanent stations as well as from one (1) additional response location in the City of Tustin near 17th Street and Newport Avenue. Our plan for EOA #23 will allow Medix to continue to provide the excellent response times currently enjoyed in the Tustin area. We sincerely appreciate the County's willingness to allow us to clarify our proposal. Please let us know if you have any additional questions regarding our RFP response. Very truly yours, Michael Dimas President Orange County Fire Authority Request for Proposals for Fire/EMS Emergency Ambulance Transportation and Related Services RFP # RL972 Medix Ambulance SefVlœ, inc. Insert Bidder Name 26021 Pals Drive, Mission Viejo. California 92691 Insert Bidder Address Michael Dimas Insert Bidder Authorized ContactlRepresentative ~ Con tactIR e prese ntativ e Signature of Au TUSTIN / EOA #23 Insert EOA Name & EOA Number Proposed 949.470.8915 Insert Bidder Telephone Number May 10, 2004 Insert Date of Bid Proposal Submission COpy Designate as nOñginar or Copy BID PROPOSAL DEPOSIT Medix Ambulance Service's $2,500 bid proposal deposit (in the form of a cashier's check made payable to the Orange County Fire Authority) has been submitted separately. ITEM 1: ITEM 2: ITEM 3: ITEM 4: ITEM 5: ITEM 6: ITEM 7: ITEM 8: ITEM 9: ITEM 10: ITEM 11: ITEM 12: ITEM 13: ITEM 14: ITEM 15: ITEM 16: ITEM 17: ITEM 18: ITEM 19: ITEM 20: ITEM 21 : ITEM 22: ITEM 23: TABLE OF CONTENTS COVER LETTER NOTIFICATION OF PROVIDER PREQUALIFICATION Overall Operational System & Program Design ........................................... 1 Ernergency Response & Vehicle Communications Systems........................ 9 Total Number of Ambulances ................................ ..................................... 12 Service Rates. ..... ..................... .................................................................. 16 On-Board Equipment & ..Supplies.............................................................. 18 Response Time Requirements........................................................... ........ 21 Vehicle/Equipment Maintenance Program ................................................. 25 Driver Training................... .................. ........................................oo............. 29 Internal Medical Quality Control................................................................. 31 Mutual Aid Provider .................................................................................... 34 Personnel & Training... ...............................oo.......................... .................... 36 Billing & Collection Practices ............................oo......................oo..............oo 49 HIPAA Compliance Plan oo...oo.....oooo..:....oo.......................oo.oo....................... 52 Corporate Compliance Plan ....................................................................... 53 Compliance with Monthly Payments........................................................... 55 Plan For Takeover of .Service/Start-Up...................................................... 59 9-1-1 Fire/EMS Resume.............................................................................63 Conflict of Interest Certification........................................................;........" 68 Statement of Truth..... ........... ....... """""""""""""""'OO'oo""""""""'" ........ 69 Non-Collusion Certification......................................................................... 70 PHOTOGRAPHS Ambulance Service May 10,2004 Chief John Howlind, Battalion Chief OCF A/EMS Section 1 Fire Authority Road Irvine, California 92602 Dear Chief Howlind: On behalf of the entire team at Medix Ambulance Service, I am pleased to submit our response to the Authority's Request for Proposals (RFP) for services to be provided to Tustin, Exclusive Operating Area #23. In presenting om qualifications, Medix hopes to continue to earn the right to support the Authority's paramedic program by providing exclusive basic life support (BLS) emergency ambulance transportation and related services. As a local company that cares deeply about our neighbors, we are so pleased to see the continuing dedication of EMS policymakers to the communities of Tustin, Cowan, and Lemon Heights. Medix responds to nearly 30,000 9-1-1 calls annually in Orange County, ensuring pre-hospital patients the benefits of highly trained professional caregivers and expertly equipped ambulance services. Medix stands by an exceptional response time performance record. Currently operating in nineteen (19) Orange County Ambulance Service Areas (ASAs), Medix continually provides at least 95% system-wide Code 3 compliance, far exceeding the 90% requirement. On Code 2 responses, the company performs extremely well, exceeding the 90% requirement with at least 98% overall compliance. Medix response time performance in EOA #23 during the third quarter of2003 realized one hundred percent (100%) compliance on Code 3 responses and over ninety-seven percent (97%) compliance on Code2 responses. By focusing on the needs of one patient at a time, we proudly perform our EMS function with professionalism and expertise. Over more than twenty-five years, Medix has evolved to become the Authority's largest privately ht:?ld, family-founded and locally operated ambulance service. Despite staggering increases in operational costs and increasingly limited revenue opportunities, the company's future continues to be about building on a heritage of caring. We strive to anticipate and meet the needs.of our public partners and ourpatieritsfrom a foundation of financial security. Medix' proposed discounted service rates reflect our attention to keeping costs competitive while maintaining a level of financial viability that supports quality operations. To ensure the highest standards of performance, our strategy over the last several years has been to refine the company's role to that of a virtually exclusive emergency BLS ambulance services provider. By concentrating our efforts on emergency response, Medix has been able to remain fully staffed while providers who must juggle demanding emergency and non-emergency books 26021 Pala Drive, Mission Viejo, California 92691 Telephone: (949) 470-8921 Facsimile: (949) 470-8951 of business struggle to attract and retain employees. Mentored by Fire Authority leadership, Medix has honed company operations to compliment the rescue and first response skills of Orange County's exceptional firefighters and paramedics. Medix is one of the few companies to date to receive a perfect accreditation score fi-om the Commission for the Accreditation of Ambulance Services (CAAS). As no other bidder's RFP response can, our proposal demonstrates how Medix will ensure the following turnkey system- specific quality elements for the future of ambulance services in Tustin: . New, custom-designed Type ill ambulances for emergency response . Comprehensive vehicle maintenance and an aggressive ambulance replacement plan . Enhanced six-phase driver education incorporating state-of-the-art simulator training . High quality ambulance operations, including disaster readiness programs . On-time response surpassing County expectations . Triple redundancy for ambulance communications and disaster response . Thoughtfully implemented data collection technology . An Internet-based contract compliance tracking tool, The Virtual Solutions Manager . Meticulously ethical and correct internal business office practices . Progressive and comprehensive educational programs . Work.place safety programs . A positive work environment and competitive compensation that foster a fulfilled workforce Responding to, caring for and transporting patients serves as only the basis for the company's larger role as a contributing member of society, a commitment demonstrated in the mutually rewarding relationship Medix enjoys with the communities the company serves. Over our long service to Orange County, Joanna Dimas and L the company's owners, and all of our employees have come to consider our neighbors our valued friends. Medix considers corporate citizenship a duty and community service a privilege. In 2003 alone, Medix participated in and/or sponsored more than 300 community events and educational programs, donating more than $500,000 in financial and in-kind contributions to the quality of life in Orange County. Medix serves as an active member of many County Chambers of Commerce and a wide range of community organizations. The following highlights offer just a sampling ofMedix contributions over the past year that already benefit the emergency medical services system and EO A #23 communities. . Serving as executive producer, Medix worked with the Fire Authority, the Sheriff s Department and County 9-1-1 patients to develop and produce the area's own illness and injury prevention television program, Close Call: Orange County 's Emergencies. Featuring local heroes and community members, the program continues to be broadcast countywide. . Medix has broadcast two television public safety announcements countywide,' one urging drowning prevention and the other teaching viewers to recognize the warning signs of a heart attack. Medix would be honored to contribute directly to Tustin neighborhoods and commerce. Medix would welcome an opportunity to join the Tustin Chamber of Commerce and to participate in EOA #23 community programs and events such as the events appearing in the following list: . Spring Egg Hunt . Tustin Chamber of Commerce Business EXPO . Annual State of the City Luncheon . Tustin Chamber of Commerce Annual Golf Classic . Tustin Promenade . Street Fair and Chili Cook-off . Concerts in the Park . Tustin Tiller Days . Dinosaur Dash . Christmas Tree Lighting In keeping with the tenants of the Authority's RFP, I am pleased to introduce Tustin reviewers to our company's proposal for EOA #23 through the following required information. 1. Our official name is Medix Ambulance Service, Inc. Ü. Medix is an "S" Corporation. üi. Medix filed incorporation papers in California on June 3, 1982. (Articles of incorporation are available upon request.) iv. Medix is headquartered at 26021 Pala Drive, Mission Viejo, California, 92691. The Headquarters telephone number is 949.470.8915. Medix maintains no other administrative offices. v. The Federal Tax Identification Number for Medix Ambulance Service is: 95-3829207. vi, I, Michael Dimas, President and Joanna Dimas, Vice President, will serve as the contacts to the OCF A with regards to the company's response to the OCF A RFP, with authorization to make representations on behalf ofMedix and to bind Medix. ' Joanna and I can be contacted at Medix headquarters in Mission Viejo. We can be reached by phone at 949.470.8915 until 4:00 P.M. and at 949.470.8900 between 4:00 P.M. and 8:00 A.M. Our fax number is 949.470.8951. My email address is mdimas@medixamb.com. Joanna's email address is jdimas@medixamb.com. vii. As company president, I, Michael Dimas, am authorized to sign the original bid proposal, committing to the company's proposal on behalf of Medix Ambulance Service, Inc. Applicable authorized signature documentation, pursuant to the company's organization structurelbylaws, verifYing my authority is provided through the company's Articles of Incorporation signature page appearing immediately following this cover letter. viii. Medix Ambulance Service is in good standing in the State of California and has all necessary licenses, permits, certifications, approvals and governmental authorizations necessary to perform all obligations in connection with this response to the OCF A RFP. IX. Medix Ambulance Service is in good standing in the Medicare and Medi-Cal programs and is not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to the companýs billing or reimbursement practices. Medíx has not been excluded ftom any state or federal healthcare program, nor does Medix employ any individual who has been excluded from any state or federal healthcare program. x. On behalf of Medix and co-owner Joanna Dimas, I, Michael Dimas, accept aU terms, conditions, requirements and performance criteria contained in the Contract Documents. We have worked hard for twenty-five years, continually reinvesting in our company and in the communities we serve. Medix welcomes the procurement process as an opportunity to reaffirm that commitment and to extend that level of dedication to additiona] Omnge County communities. Our local presence and proven deployment plans make us a natural fit and an easy transition for EO A #23. Economies of scale allow Medix to offer Tustin policymakers a cost- effective choice for estab~ community-focused ambulance services. Making a difference for Orange CO\IDty's citizens is the very reason Medix exists. With the Fire Authority leading the way, Orange County EMS offers the very best emergency medical care in the nation. I am proud that the Medix team has earned its place as the County's primary ambulance transport provider. All of us at Medix look forward to your review of our proposal. 7;;i¡ ()~ Michae1 Dimas President ORANGE COUNTY FIRE AUTHORITY P.o. Box 86, Orange, CA 92856-9086 . 145 South Water St., Orange, CA 92866-2123 Chip Prather, Fire Cbief (714) 744-:0400 www.ocfa.org SENT VIA U.S. MAIL, FIRST CLASS & CERTIFIED RETURN-RECEIPT REQUESTED February 11 , 2004 Michael J. Dimas, President Medix Ambulance Service, Inc. 26021 Pala Drive Mission Viejo, California 92691 Re: NOTICE OF APPROVAL OF PREQUALIFICA TION APPLICATION 2004 Fire/EMS Emergency Ambulance Transportation & Related Services Request for Proposals (RFP #RL972) Dear Mr. Dimas: The Orange County Fire Authority ("OCF A") has thoroughly reviewed and evaluated your Prequalification Submission application that was filed on behalf of Medix Ambulance Service, Inc;, in connection with the above-referenced Request for Proposals ("RFP"). We are pleased to inform you that your Phase I Prequalification Submission application has been approved. Consequently, Medix Ambulance Service, Inc., is eligible to submit a bid proposal and is eligible to compete further in Phase 2 of the procurement process. We expect to deliver a copy of the RFP to Medix Ambulance Service, Inc., via courier on February 19, 2004. Again, thank you for your interest in working with the Orange County Fire Authority. We look forward to receiving a bid proposal from your compa~y_. Sincerely, -x. 4-~. '-ß hn K. Howlind, Battalion Chief OCFAlEMS Section cc: Chip Prather, Fire Chief Joan Steiner, Assistant Fire Chief Terry C. Andrus, Esq. Serving the Cities of: Aliso Viejo' Buena Park' Cypress' Dana Point. Irvine' Laguna Hills' Laguna Niguel . Laguna Woods' Lake Forest. La Palma Los Alamitos' Mission Viejo' Placentia . Rancho Santa Margarita 'San Clemente' San Juan Capistrano' Seal Beach' Stanton' Tustin' ViJla Park 161412,1 Westminster' Yorba Linda' and Unincorporated Areas of Orange County RESIDENTIAL SPRINKLERS AND SMOKE DETECTORS SAVE LIVES ITEM 3: OVERALL OPERATIONAL SYSTEM & PROGRAM DESIGN Medix Ambulance Service has been performing ambulance transportation and related services in Orange County since the owners, Michael and Joanna Dimas, formed the company in 1978. From those early days, Medix has grown steadily and sensibly to become the largest provider in Orange County while maintaining a local focus for accountability and community-specific service. Last year, Medix was awarded full accreditation by the Commission for Accreditation of Ambulance Services (CAAS), earning a perfect score. Under the current operational system and program design, Medix provides continuously compliant BLS operations that meet all performance expectations and regularly exceed response time requirements in nineteen (19) Orange County Ambulance Service Areas (ASAs). A centrally located Orange County base of operations in Mission Viejo includes Medix Headquarters, a newly upgraded communications center and the company's own state-of-the-art fleet maintenance facility. To further ensure performance for Orange County and for each and every service area in which the company operates, Medix maintains North County Headquarters in Los Alamitos complete with a back-up dispatch center and a training center. Medix offers the OCFA decades of experience meeting the emergency transportation needs of Orange County citizens. Medix takes great pride in the commendable service record the company has earned responding to nearly 30,000 annual requests for service. Medix welcomes the opportunity to continue refining an already established operational system and a historically proven program design for even better results through the next contract period. Medix confidently proposes a system-specific operational system that will meet, and in most cases exceed, the competitive bid criteria, specifications, requirements and performance expectations set forth in the RFP. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Provide the number and proposed location of all emergency vehicles for service in the subject EOA. In the alternative to a fixed station(s) in the EOA provide a detailed map of the system status management or provide a detailed system plan. Medix operates seven (7) days a week, twenty-four (24) hours a day, in each of its .. ëontracted Orange County service areas. Medix currently provides base coverage frám . eleven (11) permanent stations strategically positioned throughout the County. The permanent stations allow for the geographically based-coverage necessary for the excellent response time performance currently enjoyed by the Orange County system. The stations are manned around the clock by Medix BLS crews permanently assigned -. exëlusively for 9-1-1 response coverage. .. . If awarded all nineteen (19) Orange County EOAs under the current procurement, Medix will maintain a minimum of twenty (20) ambulances at twenty (20) permanent stations, adding units to a peak of twenty-five (25) ambulances during periods of MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 1 increased call volume. To enhance system flexibility, Medix will add units using crews on shorter eight (8)-hour shifts. Additional crews targeted to meet increased demand can be placed around the County at any of fifty-five (55) carefully considered response locations. Units may be "doubled up" in permanent stations experiencing unusually high call volume. RESPONSE ZONES Accustomed to exceeding Orange County's Code 2 and Code 3 response time requirements in urban, suburban/rural and wilderness areas, Medix knows better than to attempt a single system approach for such a vast and diverse region. To achieve exemplary response times under the new Contract, Medix crews will be consistently assigned to one of the following response zones. Northwest Response Zone South Response Zone . #5 Cypress . #19 San Juan Capistrano . #13 La Palma . #28 Laguna Hills . #14 Los Alamitos . #29 Rancho Santa Margarita . #21 Seal Beach . #30 Laguna Niguel . #22 Stanton . #32 AlisoViejo Northeast Response Zone . #35 Laguna Woods . #17 Placentia . #38 Mission Viejo . #26 Yorba Linda . #39 Dana Point Central Response Zone . #42 Lake Forest . #10 Irvine . #23 Tustin . #24 Villa Park Response zones minimize any need for street corner posting, extended periods in the ambulance or unnecessary out-of-station time. An added benefit of response zone assignments is the opportunity Medix crews have to gain familiarity with the OCFA paramedic teams consistently stationed in the same area, encouraging the development of stronger interagency teamwork and improved patient care. REGIONAL SYSTEM STATUS PLAN Strategically consolidating geographically contiguous response areas promotes more efficient utilization of resources, ultimately leading to better response performance both overall and in individual service areas. In keeping with the OCFA's philosophy on service regionalization, Medix's program design takes advantage of the operational efficiencies inherent in a regional coverage approach. Medix is pleased to offer the OCFA system-specific Orange County system status plans that will ensure reliable performance that continuously meets or exceeds all response time requirements. Following is the proposed regional system status plan for EOA #23 as part of the Central Response Zone. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 2 CENTRAL COUNTY COVERAGE LEVELS 1 2 3 4 5 6 7 8 9 10 RL27 RL 27, RL 29 RL 27, RL 29, RL 37 RL 27, RL 37, RL 30, RL 36 RL27,RL37,RL30,RL36,RL31 RL 27, RL 37, RL 38, RL 36, RL 31, RL 32 RL 27, RL 37, RL 38, RL 36, RL 31, RL 32, RL 39 RL 27, RL 37, RL 38, RL 36, RL 31, RL 32, RL 39, RL 26 RL 27, RL 37, RL 38, RL 36, RL 31, RL 32, RL 39, RL 26, RL 29 RL 27, RL 37, RL 38, RL 36, RL 31, RL 32, RL 39, RL 26, RL 29, RL 30 CENTRAL COUNTY RESPONSE LOCATIONS RL 26 17TH ST & NEWPORT AV RL 27 5 FWY & TUSTIN RANCH RD RL 28 CHAPMAN A V & HEWES ST RL 29 CULVER DR & BARRANCA PKWY RL 30 CULVER DR & MICHELSON DR RL 31 REDHILL AV & WALNUT AV (TUSTIN STATION) RL 32 IRVINE SPECTRUM RL 33 JAMBOREE RD & BARRANCA PKWY RL 34 MAIN ST & MACARTHUR BLVD RL 35 NEWPORT BLVD & IRVINE BLVD RL 36 4200 TRABUCO RD, #250 (NORTH IRVINE STATION) RL 37 2942 EAST CHAPMAN AV, #G RL 38 17895 SKY PARK CL, BLDG 42-C (SOUTH IRVINE STATION) RL 39 KATELLA AV & SANTIAGO BLVD (VILLA PARK STATION) 2. Provide the hours of operation for each unit in the subject EOA. For EOA #23, Medix will operate from a permanently staffed 24-hour station located at Redhill Avenue and Walnut Avenue. Page 3 MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Exclusive 9-1-1 ambulances will respond to Tustin calls from the 24-hour station as well as from two (2) additional response locations in the City of Tustin near: 1. Newport and 17th Street, and 2. 1-5 and Tustin Ranch. The above plan for EOA #23 will allow Medix to continue to provide the excellent response times currently enjoyed in the Tustin area. 3. Provide the crew configuration for each unit in the subject EOA. The crew configuration for each Medix unit is two (2) California-certified EMTs. EMTs wishing to join the Medix team undergo significant screening before being offered Medix employment and must successfully complete a comprehensive orientation and training process prior to being released to full duty as a Medix crewmember, as detailed in Item 13. Listed below are just a few of the milestones on an EMT's path to Orange County service with Medix. . EMT applicants must have current certification as an EMT -Basic in California. . EMT applicants must have a clean driving record. . EMT applicants must pass several pre-employment knowledge exams and skills tests as well as a clinical interview. . EMT applicants undergo a physical exam and a drug screen. . Newly hired EMTs must complete a comprehensive orientation program focusing on Medix and Orange County operational specifics and performance expectations including company policies, customer service, HIPAA and corporate compliance and documentation, quality assurance, map orientation, safety and OSHA compliance. . All employees are required to complete the company's newly enhanced six (6)- phase comprehensive Driver Training Program before they can be eligible to operate a Medix ambulance. All new Medix EMTs are placed with a Field Training Officer (FTO) for supervised field training and evaluation and personalized reinforcement of all education received. No EMT is released to probationary field duty in Orange County until all phases of orientation, driver training and field training have been successfully completed. Probationary employees are subject to regular performance evaluations before advancing to become permanent Medix crew members. 4. Provide description of supervisory plan of crews, including number and location of supervisory personnel. . Medix Ambulance Service fills the company's supervisory ranks with only seasoned EMTs who have demonstrated excellence through years of service within Orange County. Established FTOs and Field Supervisors identified for their leadership potential are encouraged to develop their abilities and pursue additional management experience. The company provides formal leadership training through an EMS MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 4 consulting firm. Medix is pleased to promote from within wherever possible and is honored to serve as a training ground for future Orange County EMS leaders. , Medix proposes dedicated supervisory coverage for Orange County and EOA #23 and immediate access to the company's owners twenty-four (24) hours a day, seven (7) days a week. Operating out of his offices at Medix Headquarters in Mission Viejo, the Operations Manager, Chris Rossetti, will provide weekday supervisory coverage from 7:00 A.M. to 6:00 P.M., Monday through Friday. Also stationed at Medix Headquarters, a staff of four (4) Medix Field Supervisors will share responsibility for overnight and weekend supervisory coverage. The Operations Manager and/or a Field Supervisor(s) will be immediately available to the OCFA at any time through the company's communications center. One of the benefits of a locally owned and operated ambulance service is the direct access to contractor authority. An owner can solve problems when and where they occur. A Medix owner is always on call and available for the immediate resolution of any situation that may require administrative intervention. 5. Provide an overall summary of Bidder's Southern California system operations. Medix Ambulance Service only operates in Orange County and therefore does not have to worry about allocating system resources across county or state lines. The company's considerable resources are dedicated for use in Orange County service areas alone. Providing 9-1-1 support for the OCFA remains virtually the sole focus of Medix operations. Since Medix's founding in 1978, the company's owners, Michael Dimas and Joanna Dimas, have guided the company with a singular vision for service excellence, building an infrastructure, organization and facilities tailored to meet Orange County's evolving emergency ambulance transportation needs. Medix's centrally located base of operations in Mission Viejo includes the company's own in-house communications center, fleet maintenance facility and billing department. Administrative offices provide support for an experienced management team intimately familiar with the BLS business in Orange County. Medix ensures continual operational performance through the leadership and oversight of the company's owners and the following seven (7) key personnel: 1. Eric Saline, Director of Resource Utilization 2. Walter Garcia, Director of Training & Recruitment 3. Chris Rossetti, Operations Manager 4. Kevin Sliter, RN, CCT Manager 5. Deanne Hoover, Business Office Manager 6. Patricia Reynolds, Human Resources/Payroll Manager 7. Dan Meziere, Chief Mechanic MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 5 Medix also maintains North County Headquarters in Los Alamitos that house the company's training center and a completely functional back-up dispatch center featuring a full complement of communications capabilities and back-up power generators and other redundancies. a. Total number of ambulances in fleet. As the primary OCFA-contracted emergency BLS provider, Medix Ambulance Service operates the largest and most standardized fleet in Orange County. Medix currently maintains twenty-three (23) ambulances, eleven (11) Type III units and twelve (12) Type II units, for exclusive 9-1-1 response. Medix is expanding the company's fleet with twelve (12) new Type III ambulances scheduled for delivery by the Contract start date of July 1. Medix has been promised delivery of an additional eighteen (18) new Type III ambulances by January 2005, with two (2) to four (4) units arriving every month commencing in August 2004. All current and proposed ambulances in the fully accredited Medix fleet comply with all federal, state and local laws, rules, statutes and regulations applicable to the provision of private, emergency ambulance transportation, including, but not limited to, those BLS vehicle standards and protocols established by OCEMSA. The vehicles and ambulances proposed are in full compliance with all of the requirements for ambulance type, inspection and maintenance set forth in Section VI of the RFP. Medix utilizes one of the industry's most comprehensive preventive maintenance programs, as described in Item 9. As a result, Medix critical failures are almost unheard of. To ensure the continued integrity of the company's 9-1-1 fleet, Medix is pleased to propose to continue the company's aggressive maintenance practices. As an EMS partner and a member of the Orange County community, Medix is highly aware of the increased dangers threatening our area and fully appreciates the dynamic challenges faced by all emergency services providers, both public and private. Frontline Medix ambulances replaced by new units will be fully maintained and made available to the OCFA and EOA #23 for additional system support in the case of any unusual demand, mass casualty incident or disaster situation. SPECIALTY UNITS Over decades of service to Orange County communities, Medix has learned through experience what specialized services are invaluable to each EOA and to the County in general. Medix is pleased to offer to continue to provide the following specialty units for service to Orange County EOAs. . Medix deploys three (3) Major Incident/Disaster Response Units in strategic locations around the County. Each is configured for Code 3 operation and equipped with sixty-four (64) backboards and support equipment and related supplies for the complete on-scene packaging of sixty-four (64) patients. Currently, one (1) disaster response vehicle is staged in Mission Viejo, one (1) in Irvine and one (1) in Los Alamitos. Contingent upon the award of contracts, Medix proposes to purchase and completely equip and stock two (2) additional Major Incident/Disaster Response Units for staging in Yorba Linda and Dana Point. MEDIX AMBULANCE SERVICE RESPONSE TO OCF A RFP #RL972 Page 6 . Medix operates a state-licensed Chevrolet Suburban Field Supervisor Unit specially configured as an emergency vehicle that carries oxygen, backboards, radios and other equipment. The Field Supervisor Unit can function as a mobile command post and continues to be available to the OCFA upon request. MOBILE COMMUNICATIONS UNIT (UNIT 2500) The Medix commitment to disaster response preparation and system support is epitomized by the company's investment in a state-of-the-art specialty communications vehicle. Built on a Ford F-550 Superduty Cab Chassis with significant lighting, vehicle power and warning systems upgrades, Medix Unit 2500 is California-licensed as an Authorized Emergency Vehicle (AEV) for Code 3 response and deployment. Unit 2500 is intended to serve as a mobile dispatch center should the primary and secondary Medix dispatch facilities both become inoperative and/or to assist with the delivery of emergency services upon the request of a public safety agency. Unit 2500's extensive communications capabilities feature a trunked radio system configured for three (3) dispatchers in addition to the driver, a Flexcomm Communications Management System and two (2) multi-band transceivers. On-board CAD capabilities are supported by an amazing array of mobile technologies including dual Intel processors, a server board, multiple hard drives, four (4) Panasonic Toughbooks, two (2) wireless modems, a printer/fax machine, three (3) Lind power converters and a Vital vehicle alternator system. The unit is also equipped with an AED and a full complement of cervical collars and other clinical equipment and supplies. Unit 2500 will be staffed around the clock for immediate deployment under the command and control of the OCFA. All Medix Field Supervisors and any other Medix employees authorized to operate the unit will be required to be FCC-licensed, at least at Technician level, to execute emergency communications under a declared disaster. b. Total number of employees including line staff, supervisors, managers, administrative, billing, etc. For the pay period ending April 15,2004, Medix Ambulance Service had a total of 146 employees, not including the company's owners. A Medix personnel profile appears in Item 13. c. Contact information for third party billing agency and third party collection agency (where applicable). For decades, Medix Ambulance Service has observed compassionate billing and collection practices designed to maximize available revenue while at the same time ensuring that the company's commitment to Orange County patients extends to service given after the call. A perfect accreditation score recently validated the high standards Medix sets for the company's billing professionals. The seventeen (17) dedicated employees who staff the Medix billing department function under very high levels of efficiencies. All services are performed in house with the exception of those collections requiring a level of specialized attention that Medix cannot appropriately or effectively perform. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 7 For those collections beyond the scope of the company's expertise, Medix contracts with Southwest Collections, a fully licensed professional collections agency located at 635 North Main, Orange, California 92668. The Southwest Collections representative with responsibility for Medix accounts, Marlene Denny, can be contacted by telephone at 714.532.6651. d. Contact information for medical director; contact information for continuing education program, driver training, etc. Medical Director Carl B. Stilson, Jr., M.D., maintains administrative offices at Medix Headquarters at 26021 Pala Drive, Mission Viejo, California 92621. He can be contacted by telephone at 949.831.7832. Dr. Stilson's email address is amazingdoctor@hotmail.com. Walter Garcia functions as Medix Director of Training & Recruitment. He can be contacted at Medix Headquarters for information regarding Medix personnel issues including recruitment, screening and orientation and all continuing education and training programs. Walter's direct telephone number is 949.470.8960. His email address is training@medixamb.com. Questions about all other Medix services should be directed to Director of Resource Utilization Eric Saline. With offices at Medix Headquarters, Eric can be reached by telephone at 949.470.8980. His email address is esaline@medixamb.com. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 8 ITEM 4: EMERGENCY RESPONSE & VEHICLE COMMUNICATIONS SYSTEMS Medix's Mission Viejo communications center has supported Orange County EMS for nine (9) years and holds all appropriate FCC licenses. The accredited emergency response and vehicle communications system Medix proposes has already been implemented and tested and is successfully operating now with the following fully functional components: a sophisticated loll RescueNet RightCAD, a county-wide coordinated 800 MHz communications system with call-linking for law enforcement, fire and public works and mobile radios in the ambulances; round-the-clock staffing of qualified, caring Emergency Medical Dispatchers (EMDs); address crisscross capabilities; an emergency back-up electrical system; a CAD interface between Medix and OCFA communications centers; a ReddiNet system that instantly alerts Medix to any hospital closures; Teletrac vehicle location technology; and the Medical Priority Dispatch System (MPDS) caller interrogation system. Medix proposes numerous communications enhancements for the next contract period, as detailed in this Item. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Provide a statement that Bidder is or will be compliant by the Effective Date with all communications requirements set forth in Section IV of the RFP. Medix has read, understands and agrees to continue to accommodate the OCFA regarding all communications specifications, requirements and performance expectations set forth in Section IV of the RFP. 2. Provide a detailed summary of CAD program capabilities. Medix uses the loll RightCAD in the company's Mission Viejo communications center. Specially designed for EMS and representing Windows-based state-of-the-art technology, the RightCAD offers many communications enhancements including: a dispatcher/caller instruction system, unit status tracking, flexible report configurations for customer and management reporting, comprehensive compliance and exception reporting, loll's integrated vehicle GPS system, audible and visual warnings for dispatchers and performance tracking for vehicles and personnel. All CAD system data is replicated on two (2) redundant servers using Microsoft's SOL replication utility to ensure data protection. 3. Provide a detailed summary of other communications equipment used by Bidder (if applicable), including, but not limited to, cellular phones, personal - digital assistants (PDAs) and mobile computers. The other communications equipment Medix uses meets or exceeds all requirements. . Radios: Each Medix unit has two distinct (2) radio systems, a trunked EL Johnson 900 MHz radio and an Orange County 800 MHz radio for contact with all hospitals, the OCFA communications center and OCFA responding units. Each unit also features a hard-wired UHF Med 10 radio. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 9 . Cellular Phones: Medix crew members carry a Nextel phone offering three-way talking capability and each Medix unit is equipped with another cellular phone from a different provider, either Verizon or AT&T, to ensure system-wide cellular coverage. . Telecommunications Device for the Deaf (TDD): Medix EMDs are TDD-trained to assist deaf callers requesting emergency or non-emergency medical transportation. . Pagers: Alpha-numeric digital pagers currently facilitate call dispatching as well as full roster notification for response to mass casualty incidents or other unexpected or unusual occurrences. . Zoll RescueNet Mobile Data Terminals/Data Gathering System: For the new OCFA contract period, Medix has purchased fully RightCad-compatible technologies incorporating Zoll mobile data terminal (MDT) hardware and wireless software, pen- based computers and the RescueNet Field Data tor PC collection application. . CADAssistant Technology: Medix has purchased, installed and is now using Hamilton Systems' CADAssistant. CADAssistant acts as a virtual call taker, facilitating instantaneous dispatch with the ability to transfer incident data from the OCFA MDT to Medix's RightCAD. 4. Provide a detailed summary of the proposed operational design for the Emergency Response Communications System and methods proposed for dispatching ambulances. Receivina the Call: Medix's existing state-of-the-art MPDS-capable communications center serves as the hub for all ambulance service requests. The company's Mission Viejo center surpasses cosmetic and operational standards, far exceeding the communications requirements set forth in the RFP. Call taking is facilitated by newly purchased and installed Pentium 4 2.8 GHz computers; four (4) new ergonomically sound dispatch consoles, each with four (4) new, large flat-screen monitors; and the new CADAssistant link with the OCFA's CAD. Upon award of contracts, Medix will also purchase and implement a new voice phone recorder featuring "Instant Recall" that will allow each EMD to immediately access and review telephone or radio traffic records. Dispatchina the Call: Medix's historically proven system for efficiently and appropriately alerting and deploying ambulance crews will be facilitated through the sophisticated CAD, the new vehicle tracking GPS system, newly purchased MDT technologies, unit and portable radios, redundant cellular communications and the ReddiNet system. Company policy requires Medix personnel to be en route within one (1) minute of dispatch notification during the day and two (2) minutes at night. Compliance is closely monitored as out-at-chute times impact both safety and response time performance. Medix automatically dispatches units for multiple victim incidents and also deploys units for automatic medical standby services for any second alarm fire. Failsafe Redundancies: Medix can dispatch ambulances anywhere in the County, at anytime. Triple dispatch redundancy capability limits the possibility of missed calls and ensures response time compliance. Electrical power back-up systems at Medix's main communications center in Mission Viejo, a second, fully operational dispatch center at MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 10 the company's North County Headquarters in Los Alamitos and a fully equipped, disaster-ready Mobile Communications Unit (Unit 2500), described in Item 3 and Item 5, offer failsafe redundancies far outpacing any other ambulance provider. 5. Provide a detailed summary of Bidder's internal and external information technology capabilities. The Mission Viejo communications center's RightCAD serves as the primary collection point for Medix dispatch and response data. Collected data is shar~d internally and with oversight agencies to facilitate Medix and Orange County COI initiatives. Sanitas ambulance billing software by loll smoothly integrates CAD information for superior customer service. The company's new loll suite of field data gathering technologies fosters efficient call processing, business office proficiency and quality patient care. 6. Provide a detailed summary of communications capabilities, including hours of operation and personnel devoted to communications. As described, Medix operates a fully accredited, technologically advanced communications center at Medix Headquarters in Mission Viejo. Medix proposes to staff the center around the clock, seven (7) days a week, generally with two (2) or three (3) trained and experienced nationally certified EMDs cross-certified as California EMTs. Medix proposes to only hire communications personnel with at least six (6) months experience as an ambulance EMT and to require all dispatchers to maintain EMD certification. New dispatchers will be required to attain EMD certification within ninety (90) days of hire. Medix will conduct biweekly quality assurance meetings that will interface field, operations and communications managers and supervisors. 7. Provide a statement on Bidder's ability to upgrade communications systems. The new communications enhancements currently being installed and implemented to upgrade Medix's communications center and field communications and data gathering systems offer Orange County the most sophisticated and modern technologies available in the industry. As the OCFA upgrades its emergency response communications systems with new or improved technologies, Medix will continue to proactively enhance its own communications systems with comparable and compatible technology. 8. Provide a detailed summary of all field data collection systems and the process by which data is collected, inputted and used by the Bidder. After extensive field trials, Medix has purchased the loll RescueNet MDT/Data Gathering System described earlier to upgrade the collection, input and use of field data. Pen-based computers feature extensive management, reporting and analysis tools. A vehicle cradle provides a direct data link between the RightCad and the MDT. User-defined programs and reports can be refined through the application of a wide variety of filters to easily create, clone or customize a standard report. Once developed, reports can be saved and automatically run at preset times. Reports can be easily exported into a variety of formats or to other commonly used applications. For the next OCFA contract period, Medix has purchased the exclusive rights to implement the AcuJert medical identification system for OCFA patients. MEDIX AMBULANCE SERVICE RESPONSE TO OCF A RFP #RL972 Page 11 ITEM 5: TOTAL NUMBER OF AMBULANCES As the major OCF A-contracted BLS provider, Medix Ambulance Service operates the largest emergency ambulance fleet in Orange County. For the new contract period, Medix is pleased to offer Orange County communities an enhanced fleet of new, reliable, custom-designed ambulances and invaluable specialty units that will continue to exceed response standards and surpass performance expectations. Medix agrees to further expand the company's fleet if EOA #23 response time requirements are ever not met or if Tustin experiences a significant call volume increase. All current and proposed ambulances in the fully accredited Medix fleet comply with all federal, state and local laws, rules, statutes and regulations applicable to the provision of private, emergency ambulance transportation, including, but not limited to, those BLS vehicle standards and protocols established by OCEMSA. The vehicles and ambulances proposed are in full compliance with all of the requirements for ambulance type, inspection and maintenance set forth in Section VI of the RFP. FLEET ENHANCEMENT Medix currently maintains twenty-three (23) ambulances, eleven (11) Type III and twelve (12) Type 11 units, for exclusive 9-1-1 response. Medix is expanding the company's fleet with twelve (12) new Horton and Road Rescue Type III units scheduled for delivery by the Contract start date of July 1. Medix has been promised delivery of an additional eighteen (18) new Horton and Road Rescue Type III units by January 2005, with two (2) to four (4) units arriving every month commencing in August 2004. MEDIX AMBULANCE ENHANCEMENTS Popular with Medix EMTs and OCFA paramedics alike, Medix's custom-designed spacious Type III units are the safest, most comfortable and most efficient ambulances available. The company is particularly proud of the following ambulance upgrades. . Custom Lightbars: Medix is the only Orange County provider to mount the lightbar on top of Type III units to promote maximum OVR (over vehicle recognition) while responding CocJe 3. Much more expensive to acquire, install and maintain than the standard equipment, the specially configured, lightbars afford an extra margin of safety for all Medix passengers and for other travelers on County roadways. . Tomar Neobes: To heighten scene safety for EMS responders and patients alike, ,Medix ambulances are equipped with Tomar Neobes, a unique,.coOlbination of high power warning systems and intersection, reverse, scene and underbody lights. . Siren Upgrade: Most accidents involving emergency vehicles occur at intersections. Medix designed a siren upgrade to mitigate this risk. Factory bumpers are. replaced by brand-new Ford bumpers modified by Medix to hold speaker housings for the company's exclusive intersection siren system. . Custom Consoles: Inside Medix units, safety is further enhanced through custom- designed overhead consoles. The factory console for driver operation of emergency lights, normally installed below the dash, is installed overhead in a housing designed MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 12 and built by Medix to allow the driver to operate warning systems and other controls without having to take his/her eyes off the road to look down at the console. . Camera Systems: Medix installs a back-up camera system with a viewer in the driver's visor and a Drive-Cam system for the monitoring of driver performance. . Patient Compartment Upgrades: Medix patient compartments feature a custom- designed and fabricated oxygen bottle storage system and a special monitor for continuous ReddiNet access. Mark-1 antidote kits are installed in special housings along the action area of the wall and special cargo systems made by Medix are installed for the storage of flashlights and hazardous waste containers. . Stretcher Upgrade: Medix upgrades the Stryker gurney with custom-made storage space and signage and a breakaway flat for effective and safe patient movement. AMBULANCE REPLACEMENT SCHEDULE Medix utilizes one of the industry's most comprehensive preventive maintenance programs, as described in Item 9, and replaces older ambulances long before performance ever becomes an issue. As a result, Medix ambulances remain continuously reliable. To ensure the continued integrity of the company's 9-1-1 fleet, Medix is pleased to propose an aggressive ambulance replacement schedule. For the life of the EOA #23 Contract, Medix commits to removing frontline ambulances from 9-1-1 operation after four (4) years of service or 200,000 miles. Medix's proposed replacement schedule far exceeds any manufacturer requirements and, coupled with the company's aggressive Vehicle Preventive Maintenance Program, effectively removes mechanical failure as a concern for Medix and the Fire Authority the company supports. SPECIALTY UNITS Over decades of service to Orange County communities, Medix has learned through experience what specialized services are invaluable to each EOA and to the County in general. Medix is pleased to offer to continue to provide the following specialty units for service to Orange County EOAs. . Medix deploys three (3) Major Incident/Disaster Response Units (Units 2700, 2701 and 2702) in strategic locations around the County. Each is configured for Code 3 operation and equipped with sixty-four (64) backboards and support equipment and related supplies for the. complete on-scene packaging of. sixty-four (64). patients. Currently, one (1) disaster response vehicle is staged in Mission Viejo, one (1) in Irvine and one (1) in Los Alamitos. Contingent upon the awé)rd of contracts, Medix proposes to purchase and completely equip and stock two (2) additional Major Incident/Disaster Response Units for staging in Yorba Linda and Dana Point. . Medix operates a state-licensed Chevrolet Suburban Field Supervisor Unit (Unit 2600) specially configured as an emergency vehicle that carries oxygen, backboards, radios and other equipment. The Field Supervisor Unit can function as a mobile command post and continues to be available to the OCFA upon request. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 13 MOBILE COMMUNICATIONS UNIT 2500 Medix's commitment to disaster response preparation and system support is epitomized by the company's investment in a state-of-the-art specialty communications unit. California-licensed as an Authorized Emergency Vehicle (AEV) for Code 3 response and deployment, Unit 2500 is intended to serve as a mobile dispatch center should the primary and secondary dispatch facilities both become inoperative and/or to assist with the delivery of emergency services upon the request of a public safety agency. Unit 2500's extensive communications capabilities feature a trunked radio system configured for three (3) dispatchers in addition to the driver, a Flexcomm Communications Management System and two (2) multi-band transceivers. On-board CAD capabilities are supported by an amazing array of mobile technologies including dual Intel processors, a server board, multiple hard drives, four (4) Panasonic Toughbooks, two (2) wireless modems and a printer/fax machine. The unit is also equipped with an AED and a full complement of cervical collars and other supplies. Unit 2500 will be staffed around the clock for immediate deployment under the command and control of the OCF A. All Medix Field Supervisors and any other Medix employees authorized to operate the unit will be required to be FCC-licensed, at least at Technician level, to execute emergency communications under a declared disaster. SPECIFIC AMBULANCE INFORMATION Mileage provided is estimated based on unit in service to the EOA as of July 1, 2004. A. Units Proposed for Exclusive. Dedicated Use: Julv 2004 - AuGust 2004 Transition If awarded all nineteen (19) EOAs, Medix will almost double the company's current commitment to Orange County response by supporting the OCFA with at least twenty (20) permanently stationed 9-1-1 units. The units listed below will ensure compliant base coverage through the rapid transition to a complete fleet of new Type III units. UNIT# CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 2 TBD Ford E450 2003 0 New 111 4 TBD Ford E450 2003 0 New III 6 TBD Ford E450 2003 0 New III 8 TBD Ford E450 2003 o New III 10 TBD Ford E450 2003 0 New III 12 TBD Ford E450 2003 0 New III 14 2744 Ford E450 1998 198,470 Excellent III 16 2740 Ford E450 1998 230,000 Good III MEDIX AMBULANCE SERVICE Page 14 RESPONSETO OCFA RFP #RL972 UNIT # CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 18 2726 Ford E350 1996 246,082 Good III 20 2739 Ford E450 1998 272,000 Good III Units Scheduled for Deliverv: AuQust 2004 - Januarv 2005 UNIT# CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 2 TBD Ford E450 2003 0 New III 4 TBD Ford E450 2003 0 New III 6 TBD Ford E450 2003 0 New III 8 TBD Ford E450 2003 0 New III 10 TBD Ford E450 2003 0 New III 12 TBD Ford E450 2003 0 New III 14 TBD Ford E450 2003 0 New III 16 TBD Ford E450 2003 0 New III 18 TBD Ford E450 2003 0 New III B. Other Reaional Units that will be A vailable to Reasonablv Sw:morl the EOA Five (5) Medix specialty units (three (3) Major Incident/Disaster Response Units, the Field Supervisor Unit and the Mobile Communications Unit) will be available to any and all Orange County EOAs for use during any mass casualty or disaster event and upon the request of the Fire Authority. Contingent upon contract awards, Medix proposes to provide two (2) additional Major Incident/Disaster Response Units. Used units proposed for frontline service at Contract start will be almost immediately replaced with new Type III units scheduled for delivery beginning in August 2004. Listed below are just a few of the high quality Medix Type III units that will become available to reasonably support any EOA experiencing unusual and/or unanticipated demand. All Medix vehicles are maintained to strict Medix standards. UNIT # CHASSIS MAKE MODEL YEAR MILEAGE CONDITION TYPE 2 2744 Ford E450 1998 198,470 Excellent III 4 2740 Ford E450 1998 230,000 Good III 6 2726 Ford E350 1996 246,082 Good III MEDIX AMBULANCE SERVICE Page 15 RESPONSE TO OCFA RFP #RL972 ITEM 6: SERVICE RATES COST - OUR COMMITMENT TO VALUE Medix Ambulance Service has a long history of providing ambulance services of the highest possible quality at a reasonable cost while participating in all communities served as a financially invested corporate citizen. Medix will continue to comply with OCFA service rates and has read, understands and agrees to meet or exceed the requirements stipulated in Section VII of the RFP. COST COMPARISON - COUNTY AND STATE Medix research regarding ambulance service rates in Orange, Newport Beach and Huntington Beach and across California indicates that OCFA-served communities receive a substantial value for their current and projected EMS services. Added to the equation, all emergency and non-emergency ambulance service providers will continue to experience decreasing revenues as the Medicare reimbursement fee schedule evolves to even lower reimbursement levels. Fuel and insurance and other operating costs are expected to spiral ever upward. Nonetheless, Medix is proposing attractive service rates for EOA #23 and other OCFA operating areas that surpass expectations. This Medix proposal for Tustin innovates savings for EOA #23 patients that the company believes are far beyond anything the competition may be prepared to offer. COOPERATIVE ALS BILLING Medix offers Tustin and the OCFA the following schedules of ambulance service rates that Medix proposes to charge all payers and patients in connection with the company's provision of emergency ambulance transportation and related services within EOA #23, in accordance with the established maximum rates, requirements and reimbursements set forth in Section VII of the RFP, including, but not limited to, all costs of service and/or cost, if any, to the OCFA. ALS & BLS SERVICE RATES Medix proposes to discount EOA #23 rates during Year 1 and Year 2 of the Contract. ..,."... -- _.- $531.00 If awarded contracts for all OCFA EOAs, Medix would be able to offer even more savings to Orange County citizens through Year 3 of the contract. $520.00 $528,00 $531.00 $531,00 MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 16 Medix agrees to pay the established ALS Reimbursement Rate for each call for service in which the OCFA provides ALS services to patients transported either ALS or BLS. Medix also agrees to pay the Medical Supply Reimbursement Rate for each BLS/ALS patient transport to cover the OCFA's costs for providing expendable medical supplies. Medix understands that the OCFA will not require Medix to pay the ALS Reimbursement Rate or the Medical Supply Reimbursement Rate for zero pay patients. Medix will assume the entire risk of non-payment for any and all services rendered and the charges incurred with their performance under the EOA #23 Contract Documents. BILLING. AUDIT & ACCESS TO RECORDS Medix accepts responsibility for the submission of all claims for services provided under the EOA #23 Contract and for the billing of all Tustin transports in which ALS services are rendered, specifically including the performance of all ALS assessments. Medix maintains comprehensive HIPM and Corporate Compliance programs to ensure patient privacy and proper reimbursement. As described in Item 14, Medix already provides a fully functioning, accredited, auditable billing system organized according to OCFA criteria. Medix recordkeeping and auditing systems will continue to exceed RFP requirements. Within privacy guidelines, Medix will gladly submit to an OCFA billing and collections audit at any time. ILLNESS AND INJURY PREVENTION In an effort to reduce County 9-1-1 costs generated by unsafe behaviors, Medix would be honored to continue cosponsoring injury and illness prevention outreach with the OCFA such as Close Call: Orange County's Emergencies, the award-winning television show produced by Medix with the OCFA for ongoing broadcast. Medix will work with the Authority to identify any way Medix can assist the OCFA with community education. AMBULANCE SUBSCRIPTION MEMBERSHIP PROGRAM Medix understands and appreciates that elected officials want to mitigate the impact of increased ambulance fees for their constituents. Medix proposes to work with the OCFA to develop and market a countywide ambulance subscription program that would eliminate out-of-pocket ambulance costs for members. Medix would sponsor the legal process to establish the program and an annual membership drive. With OCFA approval, annual membership fees could potentially reimburse Medix for program marketing costs and might also provide funding for joint community education initiatives.. ACULERT PATIENT INFORMATION ACCESS TOOL Medix has purchased the exclusive rights to offer OCFA communities the same Aculert patient information tool now being marketed by the Newport Beach Fire Department. Aculert captures and stores information for immediate access in a medical emergency. Medix looks forward to offering this lifesaving technology to OCFA patients. INSURANCE UPGRADE Medix proposes to far exceed RFP insurance requirements by continuing to provide a $10/5 million dollar insurance policy for all contracted OCFA service areas. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 17 ITEM 7: ON-BOARD EQUIPMENT & SUPPLIES As the largest BLS provider for the OCFA and a fully accredited operator, Medix Ambulance Service consistently and continuously surpasses expectations for on-board equipment and supplies and can confidently commit to exceed the standards and inventory requirements stipulated in RFP Section VI. Medix will continue to equip units with a priority placed on patient comfort and employee safety. All equipment and supplies furnished by Medix will meet all federal, state and local laws, rules, statutes and regulations applicable to the provision of emergency ambulance transportation. Medix takes even the needs of the patient's family and friends into consideration, stocking hospital location guidelines in every ambulance. STANDARDIZED FLEET/EQUIPMENT EXCHANGE PROGRAM The system-specific, standardized ambulance fleet Medix has refined over years of Orange County service provides OCFA paramedics the benefit of finding the tools they need in the same general area on every Medix ambulance, resulting in shorter scene times and better patient care. A comprehensive daily inspection by assigned crews ensures that all necessary equipment and supplies are fully stocked on each Medix unit before it is placed into service. First-responding Fire Authority units may restock on scene any essential equipment item from Medix supplies until Authority supplies become available. EQUIPMENT & SUPPLY INVENTORY Medix responds to Orange County emergencies with an inventory that greatly exceeds the County's expectations, often at a level six (6) times the requirement. With any need for re-supply downtime thereby eliminated, Medix units can remain in service and immediately available to the Fire Authority throughout an entire shift. . Mobile Data Terminals (MDTs)/Pen-based Computers: As described in Item 4, Medix has purchased loll RescueNet field data hardware and software technologies featuring wireless data communications, including MDTs and pen-based computers. . Aculert Patient Information Access Tool: Medix has purchased the exclusive rights to implement the Aculert medical identification system for OCFA patients. . Stryker StretcherslStair Chairs: Medix ensures the comfort and safety of Orange County pre-hospital patients with durably constructed Rugged MX-PRO R3 ambulance cots by Stryker. Medix also has an MX-PRO Bariatric Transport cot available for the comfortable and safe transport of patients weighing more than 850 pounds. Stryker's innovative STAIR-PRO stair chair system allows caregivers to safely transport a patient from a confined space and/or over stairs. . Breakaway Flat Stretchers: Breakaway flat stretchers used on top of the Stryker stretchers allow Medix to perform nearly painless patient moving and loading. . 02 Brackets: Special holding brackets installed on the end of Medix stretchers are convenient for crews and promote patient comfort. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 18 . Hearing Protection: Medix proposes to augment crew safety by providing protective headphones that screen out siren noise. . Isolation Kits: As a vital element of the personal protection inventory, Medix will continue to stock Isolation kits (including gown, gloves, mask, etc.) on every unit. . Pulse Oximeters: Medix will equip each on-duty ambulance with a pulse oximeter. . Spinal Immobilization Devices: The Ambu Perfect ACE neck collar Medix uses adjusts to fit all patient sizes, effectively restricting neck movement. . Backboard Immobilizer: The adjustable Sta-Block head immobilizer Medix uses on suspected head or neck trauma patients will fit on any backboard. . Kendrick Extrication Device (KED): The Ferno Kendrick Extrication Device employed by Medix offers a versatile means of immobilizing and extricating patients trapped in automobiles or other confined spaces. The device adapts for children and pregnant women and can also be inverted for use as a hip splint. . Adult and Pediatric Traction Splint: Medix ambulances carry the Hare traction splint for use with patients exhibiting femur fracture symptoms. . Scoop Stretcher: Medix immobilizes patients using Ferno Washington Aluminum Break-Apart Scoop Stretchers designed to gently maneuver under the patient without undue rolling or lifting. . Portable Suction: On contract award, Medix will upgrade the V-VAG manual portable suction used now to a battery-powered device meeting OCFA approval. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Provide a detailed summary of Bidder's OSHA compliance program. Medix's full compliance with all OSHA standards and regulations is the direct result of an aggressive Safety Program overseen by the company's Safety Committee. The Committee is chaired by the Medix Safety Officer, an experienced Field Supervisor certified through CaIOSHA's thirty (30)-hour Essentials of Safety training course. The Medix Safety Program is founded on the comprehensive safety training provided as part of orientation. Employees are trained using the company's Illness and Injury Prevention Policy (IIPP) Manual. The IIPP Manual provides instruction in safety procedures and emphasizes the company's safety expectations. Medix contracts Stericycle to provide annual Bloodborne Pathogens training and to conduct simulated OSHA safety inspections for the identification of potential violations or safety issues. Medix always scores exceptionally well OD inspection simulations. Medix Safety Committee personnel fully investigate any and all crew concerns, safety issues, employee injuries and vehicular incidents. The Safety Committee completes all required CalOSHA 300 and 300A reports, with the Safety Officer bearing ultimate responsibility for safety-reporting and OSHA compliance. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 19 2. Describe Bidder's capabilities to respond to terrorist threats or disasters. As the OCF A's largest BLS provider, Medix Ambulance Service stands ready to participate in any area mass casualty rescue or transportation effort. Medix continues to implement operational components vital to the efficient delivery of emergency ambulance transportation and related services for any disaster or multi-victim incident. Medix dispatchers constantly monitor weather and news reports and Homeland Security terror alert levels. In a natural or other disaster, the communications center can page every off-duty Medix employee for an immediate response. All available ambulances can be manned in less than one (1) hour. Medix successfully conducted an April 2004 drill to assess disaster response performance and identify areas for improvement. BACK-UP SYSTEMS Medix's Mission Viejo communications center is equipped with three (3) back-up power and redundancy systems, virtually eliminating the possibility of a communications interruption. However, should physical damage shut down the Mission Viejo center, dispatch capabilities can be completely and immediately replicated at the company's North County Headquarters back-up dispatch center through duplicate trunked radio frequencies and telephone lines and six (6) successive alternate repeater locations. In the improbable event of damage to both dispatch centers, Medix has a fully equipped Mobile Communications Unit that can function as a self-contained mobile dispatch center with all dispatch and communications capabilities, as described in Item 3. Medix provides Orange County EOAs access to the three (3) California-licensed Major Incident/Disaster Response Units described in Item 5. Each is configured for Code 3 operation and equipped with sixty-four (64) backboards and support equipment and related supplies for the complete on-scene packaging of sixty-four (64) patients. Currently, one (1) disaster response unit is staged in Mission Viejo, one (1) in Irvine and one (1) in Los Alamitos. Contingent upon contract awards, Medix proposes to provide two (2) additional disaster response units for staging in Yorba Linda and Dana Point. Medix also makes available the support of a state-licensed Chevrolet Suburban Field Supervisor Unit specially configured as an emergency vehicle that carries oxygen, backboards, radios and other equipment. The Field Supervisor Unit can function as a mobile command post and continues to be available to the OCFA upon request. DISASTER RESPONSE EDUCATION & PLANNING The California State Technical Institute (CSTI) provides HAZMAT and First Responder Awareness training for Medix EMTs. Medix is currently providing Incident Command System (JCS) 200 training for all field employees through the State Fire Marshal's office. Managers and Field Supervisors will be trained to ICS 300 and 400 levels, respectively. Medix commits to.continued participation in comprehensive, system-wide planning for terrorist threats and natural disasters. Medix personnel were honored to participate as members of the Orange County Fire Services Mass Casualty Restructuring Team chaired by Chief Tom Arnold of the Newport Beach Fire Department. The Team incorporated the area's different Mass Casualty Incident (MCI) and Multi-Victim Incident (MVI) plans into a single comprehensive program of countywide response. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 20 ITEM 8: RESPONSE TIME REQUIREMENTS Medix emergency ambulances arrive on time in Orange County. Medix Ambulance Service sacrificed ninety-eight percent (98%) of the company's non-9-1-1 patient transport book of business in 1999 to ensure exemplary response times for OCFA emergency calls. Currently operating in nineteen (19) Orange County Ambulance Service Areas (ASAs), Medix takes great pride in exceeding the County's Code 3 emergency response requirement of ninety percent (90%) compliance by at least five (5) percentage points every quarter, with greater than ninety-five percent (95%) continuous system-wide compliance. On Code 2 responses, Medix performs equally well, exceeding the ninety percent (90%) requirement with at least ninety-eight percent (98%) continuous compliance overall. Medix hopes to extend the historical benefits of the company's response time performance to future contracts by continuing the implementation of an expanded, dedicated emergency fleet of new, customized Type III ambulances for Orange County's nineteen (19) redefined Exclusive Operating Areas (EOAs). Medix will continue to arrive on time by strategically locating fully staffed units at stations and response locations throughout awarded service areas. In proposing to provide emergency ambulance transportation and related services within EOA #23, Medix is able to commit to meeting or exceeding the requirements and expectations set forth in Section IV of the RFP by offering the same fully accredited operational system and program design that is already consistently and continuously exceeding response time requirements and performance expectations throughout Orange County. PROPOSED RESPONSE TIME ENHANCEMENT Medix response time performance in EOA #23 during the third quarter of 2003 realized one hundred percent (100%) compliance on Code 3 responses and over ninety-seven percent (97%) compliance on Code 2 responses. Medix Ambulancé Service stands by its outstanding response time record and is confident in the company's continued ability to exceed all response standards and expectations. Upon the award of a similar or greater 9-1-1 market share in Orange County, Medix will commit to a ninety-five percent (95%) response time standard for Tustin in each response category, an enhanced commitment that far exceeds the ninety percent (90%) standard set in the RFP. OPERATIONAL SYSTEM & PROGRAM DESIGN Medix's response time success is the direct result of a tried and true, system-specific approach based on actual system data. Other bidders can only use computer models, guess work and similar system data to attempt to predict the best times and places to post ambulances. Medix has been making reliable posting decisions based on continuous Orange County experience for years. MEDIX AMBULANCE SERVICE RESPONSE TO OCF A RFP #RL972 Page 21 Round-the-clock coverage has benefited from fixed base locations strategically spread throughout the coverage area with additional crews facilitating efficient response during short periods of higher call volume. Medix responds dynamically to increased system demand with crews on shorter eight (B)-hour shifts, constantly adjusting response locations to ensure the fastest response possible as system demands change. Currently, Medix maintains eleven (11) base stations manned seven (7) days a week by twenty-four (24)-hour BLS crews permanently assigned for exclusive 9-1-1 response. Additional response locations are selected to ensure optimum response times while accommodating the comfort and convenience of crews to the extent possible. For the new contract period, Medix proposes an enhanced response time commitment with full area coverage ensured through fifty-five (55) response locations as listed in Item 3. 24-hour Medix crews that respond from the company's base locations as well as response crews on shorter shifts who occasionally pass through all enjoy the benefits of a modern station, including sleeping quarters, televisions and kitchen facilities. RESPONSE ZONES Accustomed to meeting Orange County's unique response challenges, Medix knows better than to attempt a single system approach for such a vast and diverse region. Medix crews will be consistently assigned to a Northwest, Northeast, Central or South response zone, minimizing any need for street corner posting, extended periods in the ambulance or unnecessary out-of-station time. An added benefit of zone assignments is the opportunity Medix crews have to gain familiarity with the OCFA paramedic teams consistently stationed in the same area, encouraging the development of stronger interagency teamwork and better patient care. PROPOSED INITIAL COVERAGE PLAN For EOA #23, Medix will operate from a permanently staffed 24-hour station located at Redhill Avenue and Walnut Avenue. Exclusive 9-1-1 ambulances will respond to Tustin calls from the 24-hour station as well as from two (2) additional response locations in the City of Tustin near: 1. Newport and 1 ih Street, and 2, 1-5 and Tustin Ranch. The ,above plan for EOA #23 will allow Medix to continue to provide the excellent response times currently enjoyed in the Tustin area. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Please provide detailed fractile summary response time reports for the three- month period of April 2003 to June 2003 for the subject EOA or a geographic/call volume related area similar to the subject EOA, and include both Code 2 and Code 3 calls, separately delineated. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 22 . . . II II JUNE 2003 . . . . . . . . . . . . . . . . ' CYlj'RfSS #:5 f . Metro Code 3 13 13 100% 8 8 100% 8 8 100% Metro Code 2 119 118 99% 118 117 99% 142 140 99% " .Ik f/11iJ£'t/{J - ~ "eV,"""'" Metro Code 3 37 36 97% I 30 30 100% 34 34 100% Metro Code 2 417 MJ9 ~50 98% 455 445 98% ~ 2 2 100% 1 1 100% 2 2 100% ~ 38 37 97% 37 37 100% 48 47 98% IDS AJ1Ifjl1rQS #111"cé.!k. ;.; ~;;: . .~,.;., """,,:.';;ï~'~~;:¡\~<.. Metro Code 3 5 5 100% 9 9 100% 2 2 100% ~ro COOe 2 67 67 100% 65 64 98% 61 60 98% 161 ' '.. sAllfJIIl!I# . ""4",.,..."1,,,*,.. Metro Code 3 15 94% 14 14 100% 12 12 100% ~tro Code 2 110 109 ~ 98% 112 110 98% Metro Code 3 14 14 100% 14 14 100% 13 13 100% Metro Code 2 192 192 100% 179 176 98% 159 I 158 99% : . srA'lmR#22 - . c'" '.. ,...... Metro Code 3 15 14 93% 12 12 100% 14 14 100% Metro Code 2 147 145 99% 169 168 99% 190 186 98% TO!; IC' f' ~3 ' " )1fJfl'M Metro Code 3 11 11 100% 8 8 100% 3 3 100% Suburban Code 3 2 2 100% Metro Code 2 84 83 99% 81 79 98% 75 72 96% Suburban Code 2 7 7 100% 5 5 100% 4 4 ¡' . tl~~~~~1 ,,~~~I;:i/f;:,;,;, Metro Code 3 0 0 100% 1 1 100% 2 2 100% Metro Code 2 13 13 100% 6 6 100% 9 9 100% ~ ;,,';"CH.<1f$."i'F.MHfK..~GARltrji 29.;' " Fll'1.(il. ,fIßIK'¡'h.,.c~ ,,)~,# " Metro Code 3 11 11 100% 15 14 93% 9 9 100% Suburban Code 3 8 8 100% Metro Code 2 118 115 97% 141 139 99% 140 137 98% Suburban Code 2 16 16 100% 26 26 100% 19 19 ~ ~)i~d} Metro Code 3 18 I 18 100% 12 12 100% 8 8 100% Metro Code 2 149 145 97% 144 142 99% 171 168 98% 'WI.'~ . A!JSQ~;,: f:lf:Q Metro Code 3 3 3 100% 3 3 100% 4 4 100% Metro Code 2 52 51 98% 52 50 96% 63 62 98% lli~ltfQ'X!iJø./{Qlj~~ is;};}' Metro Code 3 29 28 97% 14 14 100% 19 18 95% Metro Code 2 314 311 99;,~ .9~'/:, 329 326 99% ~I 4J.1j . .'. 19 19 100% 22 21 95% 15 15 100% Metro Code 2 187 184 98% 215 211 98% 203 201 99% MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 23 2. If the proposed operational system and program design will exceed the response time requirements and performance expectations set forth in the RFP, please clearly explain in a detailed summary how such requirements will be exceeded. Medix's documented response time performance clearly proves the company's ability to exceed response time requirements and performance expectations. Should the company receive a similar or greater 9-1-1 market share, Medix will offer EOA #23 an enhanced response standard of ninety-five percent (95%) compliance in each response category that will far exceed the ninety percent (90%) minimum set forth in the RFP. If awarded all nineteen (19) EOAs, Medix will almost double the company's current commitment to Orange County response by supporting the OCFA with at least twenty (20) exclusive 9-1-1 ambulances on duty at all times, strategically posted at twenty (20) 24-hour permanent stations throughout the County. (Medix currently locates eleven (11) 24-hour crews at eleven (11) permanent stations throughout the County). Medix will add additional ambulances during high demand, peaking at twenty-five (25) exclusive 9-1-1 units responding from fifty-five (55) response locations. (Medix currently peaks at eighteen (18) units responding from twenty-two (22) response locations.) The program design Medix proposes benefits from a uniquely informed perspective on the challenging realities of Orange County response. Medix already meets those challenges with a fully compliant, accredited operational system that can only improve as each of the following elements impacting response performance are further refined. EXCEPTIONAL AREA COVERAGE Strategically consolidating geographically contiguous response areas promotes more efficient utilization of resources, ultimately leading to better response performance both overall and in individual service areas. In keeping with the OCFA's philosophy on service regionalization, Medix's program design takes advantage of the operational efficiencies inherent in a regional coverage approach. . EXCELLENCE IN COMMUNICATIONS & DISPATCHING As detailed in Item 4, Medix already operates a nationally accredited Orange County communications system. The company's state-of-the art technology offers graphically presented map locations, active/historical call screens and electronic time-stamping. Medix understands the value of saving minutes at the front-end of an emergency call. Medix personnel are currently required to be en route within one (1) minute of dispatch notification during the day and two (2) minutes at night. Triple crew notification redundancy eliminates any possibility of missed calls and ensures immediate response. RESPONSE TIME CONSISTENT QUALITY IMPROVEMENT (CQI) Always aiming for one hundred percent (100%) compliance, Medix employs quality mechanisms to monitor and improve response times including a daily review of exceptions by the Director of Resource Utilization. Collected data contributes to the investigation of trends and the development of system solutions to response problems. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 24 \. -. \....... ITEM 9: VEHICLE/EQUIPMENT MAINTENANCE PROGRAM Medix Ambulance Service operates a fleet that travels well over a million miles a year safely and efficiently with an incredibly high reliability rate. The consistently solid performance of the company's vehicles and equipment is by design, resulting from a carefully considered approach that involves first researching and purchasing only the finest ambulances and equipment available and then maintaining that equipment in a meticulous fashion. Medix knows that the finest patient care can only be delivered to the citizens of Tustin with the finest tools. Vehicles and equipment and maintenance are not areas for cost- cutting measures. Rather than economizing, Medix has invested in an advanced driver training program that contributes to a reduction in wear on critical ambulance parts and is in the process of expanding the program to further improve employee driving performance. Medix follows stringent daily inspection procedures designed to derive the best possible performance from the company's ambulances and equipment. To ensure the best maintenance practices for Orange County, Medix owns and operates its own world-class maintenance facility. As one of the few ambulance services to date to receive a perfect accreditation score, Medix clearly exceeds the maintenance standards set by the Commission for the Accreditation of Ambulance Services. Medix will continue to maintain all vehicles and equipment used in the performance of required services in excellent condition. Medix understands and agrees that failure to service and maintain all ambulances and equipment dedicated to EOA #23 pursuant to the manufacturer's suggested maintenance program will be deemed breach of contract and considered cause for immediate contract termination. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Provide a description of the vehicle maintenance plan or schedule. Medix's Vehicle Preventive Maintenance Program has been designed to eliminate mechanical failure as a field concern. As the company that provides more emergency BLS transports than anyone else in the County, Medix has to pay attention to details and has learned from experience to prevent repair problems instead of simply reacting to maintenance issues as they occur. All parts are replaced while twenty percent (20%) of their useful life still remains. Only the best Michelin tires are installed on Medix units. Chief Mechanic Dan Meziere has been with Medix for nearly twelve (12) years. He brings Orange County more than forty (40) years of experience in the automotive field, including close to twenty (20) years specializing in diesel fleet services. Dan is responsible for leading the Medix team of professional fleet mechanics and overseeing vehicle and equipment maintenance on a daily basis. He himself is considereda-w master ASE (Automotive Service Excellence) technician. Medix accomplishes most necessary vehicle and equipment maintenance and repairs on-site in the company's own state-of-the-art, 10,000 square foot maintenance facility. Equipped with all necessary shop manuals, database access, a Ford STAR diagnostic MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 25 scanner, brake lathes, multiple lifts and a full supply of parts, the facility functions at a level of sophistication that offers the mechanic team the freedom to perform services when needed without the interruption of scheduling through an outside shop. THE PREVENTIVE MAINTENANCE PROGRAM Medix field crews are actively involved in preventive maintenance through the performance of a comprehensive daily vehicle and equipment inspection. No unit or equipment will be released to duty in EOA #23 without passing inspection by the assigned crew. When any operational integrity discrepancy is discovered, the involved unit will be immediately placed out-of-service and scheduled for repairs. Medix preventive maintenance centers on a series of regularly scheduled inspections performed every 3000 miles. Rotated progressively through a continuous cycle of A, B and C maintenance schedules, each unit undergoes regular servicing of every major system and sub-system according to Medix standards, standards which far exceed the manufacturer's requirements. The following chart provides an overview of ongoing preventive maintenance performed on every Medix ambulance. Service Item Bumper-to- Bumper Vehicle Check Electrical System Check Fluid Level Check Hose and Clamp Inspection Brakes Check Belts, Blades and Batteries Brake Lines and Underbody Inspection Change/Bleed Fuel Filter and Water Separator Check and Service Transmission Check Differential Oil Drain Coolant and Service Radiator Replace Batteries v v v v v v v v v v v v v v v v v v v v v v v v v Medix uses only Michelin steel-belted radial tires. Tires are inspected daily for wear and foreign object damage. Medix will replace tires after 20,000 miles or when tire tread depth reaches 4/32 of an inch or should uneven wear patterns develop. INSPECTIONS & ENHANCEMENTS Prior to accepting delivery of any new ambulance, MediKsüblects the vehicle to a thorough road safety and systems integrity inspection performed by the company's fleet maintenance team. Medix mechanics then install a wide range of company-specific vehicle enhancements prior to the unit being placed in service. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 26 The company is particularly proud of the following Medix ambulance upgrades. . Custom Lightbars: Medix is the only Orange County provider to mount the lightbar on top of Type III units to promote maximum OVR (over vehicle recognition) while responding Code 3. Much more expensive to acquire, install and maintain than the standard equipment, the specially configured lightbars afford an extra margin of safety for all Medix passengers and for other travelers on County roadways. . Tomar Neobes: To heighten scene safety for EMS responders and patients alike, Medix ambulances are equipped with Tomar Neobes, a unique combination of high power warning systems and intersection, reverse, scene and underbody lights. . Siren Upgrade: Most accidents involving emergency vehicles occur at intersections. Medix designed a siren upgrade to mitigate this risk. Factory bumpers are replaced by brand new Ford bumpers modified by Medix to hold speaker housings for the company's exclusive intersection siren system. . Custom Consoles: Inside Medix units, safety is further enhanced through custom- designed overhead consoles. The factory console for driver operation of emergency lights, normally installed below the dash, is installed overhead in a housing designed and built by Medix to allow the driver to operate warning systems and other controls without having to take his/her eyes off the road to look down at the console. . Camera Systems: Medix installs a back-up camera system with a viewer in the driver's visor and a Drive-Cam system for the monitoring of driver performance. . Patient Compartment Upgrades: Medix patient compartments feature a custom- designed and fabricated oxygen bottle storage system and a special monitor for continuous ReddiNet access. Mark-1 antidote kits are installed in special housings along the action area of the wall and special cargo systems made by Medix are installed for the storage of flashlights and hazardous waste containers. . Stretcher Upgrade: Medíx upgrades the Stryker gurney with custom-made storage space and signage and a breakaway flat for effective and safe patient movement. MAINTENANCE QUALITY CONTROL The Chief Mechanic is responsible for the production and review of all Medix vehicle and equipment and maintenance reports. Required reports include, but are not limited to: accounting and analysis to the company and/or oversight agencies regarding parts and labor utilization, timeliness and effectiveness of shop functions, program costs, unit hour utilization, field failures, out-of-stock situations, enhancement recommendations and deployment practices. Medix keeps complete and detailed maintenance reports on every ambulance. In addition to ensuring the optimum performance of each individual unit, maintenance reports assist in the identification of unusual repair patterns and/or trends in parts usage across the fleet as a whole. The Chief Mechanic is charged with the performance of regular analyses of the maintenance database and the identification and mitigation of any potential vehicle, equipment and/or maintenance problems. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 27 2. Provide a description of the vehicle replacement plan. As detailed in Item 5, Medix currently maintains twenty-three (23) ambulances, eleven (11) Type III units and twelve (12) Type II, for exclusive 9-1-1 response within contracted Orange County service areas. Medix is expanding the company's fleet with twelve (12) new Horton and Road Rescue Type III ambulances scheduled for delivery by the Contract start date of July 1. Medix has been promised delivery of an additional eighteen (18) new Horton and Road Rescue Type III ambulances by January 2005, with two (2) to four (4) units arriving every month commencing in August 2004. For the life of the EOA #23 Contract, Medix commits to removing frontline ambulances from 9-1-1 operation after four (4) years of service or 200,000 miles. Medix's proposed replacement schedule far exceeds any manufacturer requirements and, coupled with the company's aggressive Vehicle Preventive Maintenance Program, effectively removes mechanical failure as a concern for Medix and the Fire Authority the company supports. 3. Provide a detailed summary of equipment maintenance program, including replacement plan. Medix recognizes that the company's commitment to the highest quality patient care tools necessitates the proper maintenance of all equipment. Continuous equipment performance is ensured through a series of checks and balances including inspections, periodic servicing and an aggressive replacement schedule. On-board equipment is inspected daily for function and appearance. When an ambulance is in the shop for scheduled preventive maintenance, all unit equipment is thoroughly inspected and documented. Equipment that is not in perfect working order is immediately pulled from the unit for closer inspection and then repaired or replaced. Medix has contracted service specialist EMSAR to provide Gold Level maintenance service for the company's Stryker stretchers. EMSAR inspects and services each stretcher, tags it as in-service and notes the next scheduled inspection date. EQUIPMENT REPLACEMENT PLAN With Medix, there will never be a situation where a Tustin patient's condition is compromised due to a shortage of equipment or supplies caused by an ambulance crew running back-to-back calls or responding to a disaster. Implementing the philosophy, "If your only one doesn't work, it's not your only one," Medix has continually stocked supplies at six (6) times the level required by EMSA since 1995. Medix units carry the most reliable and modern equipment available, including stair chairs, child seats, stretchers, backboards and automatic external defibrillators (AEDs). Back-up equipment is readily available at the company's centrally located maintenance facility. For EOA #23, Medix commits to continue the company's aggressive equipment replacement plan that limits the useful life of major equipment to five (5) years. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 28 ITEM 10: DRIVER TRAINING Medix Ambulance Service considers the ambulance EMT scope of practice to be twofold. Equally important to clinical performance and professionalism are driving proficiency and safety. Medix proposes an exceptional Driver Training Program for the company's provision of emergency ambulance transportation and related services within EOA #23 that greatly exceeds all requirements set forth in Section Vof the RFP. Medix employs instructors who are qualified to train drivers to the same high standards set for Police Academy cadets. As an accredited service, Medix can guarantee that drivers responding to Tustin calls for service will be of the highest quality. The driving performance of Medix employees continues to surpass expectations, reflecting the company's insistence on safe driving and underscoring the effectiveness of the innovative Medix Driver Training Program. Over the course of the company's current OCFA Contracts, there have been no injuries due to any at-fault Medix accident. DRIVER ELIGIBILITY Medix requires all ambulance personnel to possess valid California Driver's Licenses .in the proper class, including all required certifications, and to remain compliant with all relevant provisions of the California Vehicle Code. Medix performs background checks to identify and eliminate any job applicants who have been convicted of or pled no 10 contendere to a crime involving a stolen vehicle or misdemeanor or felony driving while under the influence of alcohol or drugs. Medix insists that the driving performance of every employee both on and off the job continually meet the standards set by the OCFA and the company's insurance carrier. Medix uses the California Department of Motor Vehicle's (DMV) Employer Pull Notice Program as a pre-hire screening tool and for automatic monitoring of driving records. Any employee who receives a driving citation or a written warning while operating a company vehicle is required to notify Medix immediately. Any employee given a citation while off-duty must so notify a manager or supervisor before their next shift. . QtJALI-TYASSURANCE __un_- Any incident involving a Medix vehicle that results in personal injury and/or vehicle or property damage, regardless of severity, is considered a vehicle accident that must be reported and reviewed. After a complete investigation, including automatic drug/alcohol t~sting of the driver, the Accident Review Board [~yiews the incident, recQJ11meJ1Qs discipline as appropriate and considers any indicated adjustments to driver training. SIX (6)-PHASE DRIVER TRAINING PROGRAM Employees must complete comprehensive Ambulance Driver Attendant Associate training before they can be eligible to drive a Medix unit. Training covers all aspects of driving policy and performance including eligibility, professional driving behavior, emergency driving, backing and parking, adverse conditions, vehicle security, fueling and maintenance. Medix will further enhance the company's commitment to driver training under the new EOA #23 Contract by expanding the Driver Training Program to encompass six (6) phases, including a state-of-the-art driving simulator component. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 29 Phase 1 (4 hrs): The first phase of Medix's Driver Training Program provides instruction in the company's nationally accredited driving policies and procedures. State rules and regulations pertaining to the safe transport of patients are also reviewed. Phase 2 (4 hrs): Phase 2 is a National Safety Council Defensive Driving Course that trains drivers in collision prevention techniques. Defensive driving training also promotes an attitude of mutual understanding, courtesy and cooperation on the road. Phase 3 (8 hrs): The third phase of driver training is the National Safety Council's CEVO II course (Coaching the Emergency Vehicle Operator) based upon emergency vehicle standards set by the National Highway Traffic Safety Administration (NHTSA). Phase 4 (6 hrs): Phase 4 is an Emergency Vehicle Operations Course (EVOC) focusing on California Police Officers Standards of Training (POST) for defensive driving. Simulator training allows for an immediate application of didactic lessons in video-simulated scenarios. Simulators also allow students to obtain driving experience and improve physiomotor responses before actually driving on County roadways. Phase 5 (8 hrs): The fifth phase of training teaches and tests driver execution of slow speed maneuvers, skid control, braking and collision avoidance techniques. Phase 6 (3 24-hr shifts): Following FTO testing on emergency driving policies and regulations, the final phase of training is behind-the-wheel driver training and evaluation. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Provide a detailed course syllabus or curriculum for Driver Training Program. CEVO Curriculum: Self-appraisalNehicle Inspection/Cushion of Safety/City Driving/ Multi- & 2-Lane Roadways/Special Considerations/Emergency Driving/Certificate. EVOC Curriculum: Siren Demo/Slow Speed Maneuvers/Accident Avoidance/ Cornering/Skid Pan (Basic)/Skid Pan (Advanced)/Skid Pan (Wheel-locked & ABS)/ Code 3/PursuitlPursuit & Safety Officer (Evaluation)/Role of Rabbit Driver (Evaluation). 2. Provide the total number of course hours per course offered. Medix provides thirty (30) course hours over six (6) training phases, including CEVO and EVOC courses, and three (3) twenty-four (24 )-hour behind-the-wheel training shifts. 3. Describe internal training plan, !nc.l!Jding timeframe for completion/retraining. Medix's internal driver training plan builds on the company's accredited program. Enhanced six (6)-phase training is currently being implemented. All Medix drivers will be EVOC-certified by Contract start. Annual refresher driver training will be required. 4. Provide the name of the institution providing the training, if applicable. Medix provides all driver training in-house based on National Safety Council courses and Police Academy standards. Medix has two (2) in-house POST and National Safety Council driving instructors. The Orange County Sheriff's Department will facilitate the EVOC driving simulator component using Medix instructors. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 30 ITEM 11: INTERNAL MEDICAL QUALITY CONTROL The perfect accreditation score Medix Ambulance Service recently received was the direct result of a continuous process of quality control and improvement. Orange County already benefits from an established Medix Continuous Quality Improvement (CQI) program directed at the effective administration and management of emergency ambulance transportation and related services to continually improve performance at all levels including, but not limited to, clinical performance, response time performance, driver performance and communications performance. The COI program Medix proposes for Tustin will exceed OCFA expectations with new technologies, illness and injury prevention outreach efforts and new training programs. Medix will be happy to submit to the OCFA EMS Section Battalion Chief quarterly summary reports showing the results of all COI program performance elements in a form approved by the Battalion Chief. HIPPA regulations permitting, Medix will also submit EOA #23 CQI data to the Orange County Emergency Medical Care Committee. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Provide a detailed summary of Bidder's quality assurance/improvement process, including timeframes for process completion. As a nationally accredited ambulance service, Medix continually tracks and evaluates performance to continuously improve through prospective, concurrent and retrospective Continuous Quality Improvement (CQI) practices. Prospective and concurrent COI practices provide the foundation for the company's quality commitment. Retrospective CQI measures provide perspective, facilitating further improvement and informing the development and implementation of any indicated educational programs. Medix monitors COI through the following data points: nature of the measurement, responsible parties for measurement, gathering of the measurement, documentation of the measurement, frequency and count of the measure, specified tolerances, items to be tracked, performance correction plan, process map and report form. . Medix CQI focuses on the following core quality initiatives. Medix is pleased to offer to provide reviewers a copy of the Medix COI Program upon request. PROSPECTIVE COI '- Hiring Process Field Training and Evaluation Process Orientation Process CONCURRENT & RETROSPECTIVE COI BLS Run Report Documentation CCT Care and Treatment Ambulance Chute Times (Emergency Only) Dispatch - Late Runs (Emergency Only) CCT Run Report Documentation Hospital Drop Times (Emergency Only) Dispatch - Call to Queue (Emergency Only) Automated External Defibrillator Evaluation MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 31 CME Training Requirements PROSPECTIVE CQI Medix believes that EOA #23 citizens will benefit from the company's prospective commitment to quality. Medix considers illness and injury prevention programs, exacting hiring standards and comprehensive orientation and field training to be lifesaving measures. . INJURY & ILLNESS PREVENTION Preventing medical emergencies and ensuring access to EMS services has always been a priority for Medix. Television ensures the greatest impact for the company's injury and illness prevention messages. Over the course of the last OCFA contract period, Medix produced and broadcast two (2) television public safety announcements countywide, one urging drowning prevention and the other teaching viewers to recognize the warning signs of a heart attack. Featuring local heroes, OCF A personnel and Orange County community members, the first half hour episode of Close Call: Orange County's Emergencies debuted this year, winning a national injury and illness prevention award at the 2004 EMS Today National Conference. Medix continues to broadcast Close Call throughout the County. RECRUITMENT/SELECTION/ORIENTATION Quality performance can best be assured by quality personnel. Medix EMTs undergo a rigorous selection process and must successfully complete comprehensive orientation before they are entrusted with patient care. Medix recruits only the best in the industry. All potential EMTs are required to meet or exceed stringent education, health and certification standards to even be considered for employment. Applicants must then successfully complete a series of interviews, tests and background checks. Orientation includes classroom and driver education, field training and probationary supervision. CONCURRENT CQI . . Concurrent CQI practices will measure and monitor real-time activities related to the implementation of Medix's contract with Tustin. Comprehensive training programs, as described in Item 13, provide the cornerstones of concurrent CQI at Medix. Through the OCFA's mentorship and under the direction of the company's Medical Director, continuous education opportunities benefit Medix employees and the Orange County patients they serve. Adherence to Orange County EMS protocols is ensured through the documentation and monitoring of dispatcher performance, patient care activities and billing information documentation. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 32 RETROSPECTIVE COI Retrospective CQI occurs as Medix regularly reviews EMT performance, identifying exemplary performance or performance not meeting expectations or deviating from the prescribed scope of practice. The company's registered nurse CCT Manager and Director of Training and Recruitment work continually with the Medix Medical Director to develop ways to further improve clinical performance. The CCT Manager and the Director of Training and Recruitment perform one hundred percent (100%) chart review, collecting information to track individual skill success rates and analyzing data to determine overall clinical trends. The Medical Director meets with employees directly to encourage continued excellence and/or to provide individualized coaching as appropriate. Remedial training and continuing education are targeted to address any identified individual or systemic trends. 2. If your proposed Internal Medical Quality Control and Continuous Quality Improvement ("CQI'~ Programs will exceed the standards and requirements set forth in this RFP, please clearly explain in a detailed summary how such requirements will be exceeded. Internal medical quality control processes proposed by Medix will exceed the standards and requirements set forth in the RFP. Medix's accredited CQI Program continues to surpass industry and OCFA quality standards. . Medix commits to producing additional episodes of Close Call: Orange County's Emergencies and/or similar high production value illness and injury prevention television and/or radio programming. . Medix will maintain the company's rigorous selection process. New hires will continue to be closely monitored for a probationary period of a minimum of ninety (90) days before joining the Medix ranks as a permanent crew member. . Medix will continue the company's extensive orientation process, including classroom and driver education and training and FTO-supervised field training. Enhanced six (6)-phase driver training includes a driving simulator component. VIRTUAL SOLUTIONS MANAGER Medix proposes the Internet-based Virtual Solutions Manager (VSM) to further enhance CQI monitoring of employee and company performance. Both Medix and the OCFA can use the VSM to track continuing education and EMS certifications as well as for trend analysis to guide the improvement of health and safety programs. The completely private and secure VSM will facilitate the collection and storage of critical workplace data, provide immediate access to regulatory information and generate the up-to-the minute reporting necessary to manage important compliance and clinical oversight tasks. The VSM serves as a clinical services specialist, offering accredited online courses, concise journal reviews and customized news alerts. Medix EMTs and participating OCFA paramedics can log on to the VSM from any computer to update personal records with new credentials and completed coursework. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 33 ITEM 12: MUTUAL AID PROVIDER Medix Ambulance Service is honored to provide BLS transport services for nineteen (19) current Orange County Ambulance Service Areas (ASAs). At any given time, Medix has enough ambulance resources deployed throughout the County to cover each individual contracted ASA and to ensure back-up coverage for all contracted service areas. Medix rarely needs assistance and only requests mutual aid once or twice each quarter. Medix is happy to provide mutual aid assistance/ambulance back-up service to the Authority's San Clemente Fire Department on the average of once per day. While Medix does not routinely rely on the services of another provider as an alternative method to meet response time requirements, the company recognizes that the mutual aid process is important to ensure structured assistance for maximum system response to mass casualty situations and during periods of unusually high demand. Medix is therefore pleased to maintain mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and natural disaster. Medix understands and agrees that should a mutual aid provider provide back-up services for Tustin, Medix and not the secondary mutual aid provider will be responsible for ensuring compliance with all terms, conditions, standards and performance requirements set forth in the EOA #23 Contract Documents, including, but not limited to, the imposition of all applicable penalties and payment of all fees and reimbursements. ADDITIONAL SPECIFIC SUBMISSION DATA Provide a copy of all current mutual aid agreements that would apply to the subject EOA or provide a copy of the proposed mutual aid plan, including name of mutual aid provider (if known), location of mutual aid provider and staffing capabilities of mutual aid provider, if known. As a current OCFA contractor, Medix is party to the Master Mutual Aid Agreement among all neighboring ambulance services with membership in the Ambulance Association of Orange County (MOC). Medix has also negotiated separate mutual aid, agreements with neighboring operators and recently signed two (2)-party mutual aid agreement letters with Doctor's Ambulance, Shaeffer Ambulance, Care Ambulance and Emergency Ambulance that would apply to EOA #23. All of the secondary mutual aid providers signing a two (2)-party mutual aid agreement with Medix for the provision of back-up, secondary emergency ambulance transportation services are current Orange County 9-1-1 providers already contracted to operate in accordance with current OCFA operational standards, procedures and performance requirements. - Medix is aware that current mutual aid agreements will have to be updated to reflect the specifics of the new Contract Documents and the distribution of the County's newly defined Exclusive Operating Areas (EOAs). Medix understands that all secondary mutual aid provider draft agreements must be reviewed and approved by the OCFA prior to the execution of awarded contracts. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 34 Medix will continue to require all secondary mutual aid providers and their employees to cooperate with the OCF A and to participate in any OCF A-requested performance audit. CURRENT SECONDARY MUTUAL AID PROVIDERS Following are brief descriptions of each secondary mutual aid provider that has signed a two (2)-party letter of mutual aid agreement with Medix Ambulance Service. The letters of mutual aid agreement are available for review upon request. Care Ambulance: Doctor's Ambulance: Emergency Ambulance: Schaeffer Ambulance: Care Ambulance is a current Orange County BLS provider operating in Fountain Valley, Anaheim, Fullerton and Buena Park. Care uses a crew configuration of two (2) EMTs and registers fifty-four (54) county-licensed BLS ambulances. Care Ambulance is headquartered at 8932 Katella, Suite 201, Anaheim, California 92804. Doctor's Ambulance is a current Orange County BLS provider operating in Dana Point, Tustin, Laguna Beach, Laguna Woods and Laguna Hills and in the unincorporated areas of Emerald Bay. Doctor's uses a crew configuration of two (2) EMTs and registers fifteen (15) county-licensed BLS ambulances. Doctor's Ambulance is headquartered at 23091 Terra Drive, Laguna Hills, California 92653. Emergency Ambulance is a current Orange County BLS provider operating in Brea, Fullerton, Yorba Linda and Placentia. Emergency uses a crew configuration of two (2) EMTs and registers sixteen (16) county-licensed BLS ambulances. Emergency Ambulance is headquartered at 3200 East Birch Street, Brea, California 92821. Schaeffer Ambulance is a current Orange County BLS provider operating in Costa Mesa. Schaeffer Ambulance uses a crew configuration of two (2) EMTs and registers nine (9) county-licensed BLS ambulances. Schaeffer Ambulance is headquartered at 2215 S. Bristol Street, Santa Ana, California 92704. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 35 ITEM 13: PERSONNEL & TRAINING Medix is a nationally accredited, family-owned ambulance service operated locally under a carefully considered tight chain of command. Competitive wage scales, attractive benefits (including profit sharing, a 401 k plan and a substantial insurance package), positive management practices, comprehensive continuing education and progressive human resources programs all act in concert to create a family-like work environment conducive to high morale and performance efficiencies. ORGANIZATIONAL STRUCTURE Owners Michael Dimas and Joanna Dimas provide vision and oversight for Medix Ambulance Service. Day-to-day operations are entrusted to a Medical Director and seven (7) top managers who lead over 140 employees. Field Training Officers, Field Supervisors and a full-time Human Resources/Payroll Manager facilitate company functions. Administrative and billing professionals, vehicle/equipment maintenance specialists, dispatchers, nurses and emergency medical technicians (EMTs) perform skilled ambulance transportation and related services in support of the OCFA. Medix maintains an open door policy to encourage and ensure communication between all employees at all levels of the company. Frequent staff meetings and electronic policy updates keep everyone involved and informed. (An organizational chart is available for review upon request.) A. ASSIGNED PERSONNEL PROFILE Medix proposes the following management team for Tustin and all other awarded OCFA service areas. Michael Dimas Joanna Dimas Eric Saline Walter Garcia Chris Rossetti Kevin Sliter, RN Deanne Hoover Patricia Reynolds Dan Meziere President/CEO Vice President, Marketing & Public Relations/CFO Director of Resource Utilization Director of Training & Recruitment Operations Manager CCT Manager Business Office Manager Human Resources/Payroll Manager Chief Mechanic 25 25 12 8 8 11 15 8 12 Medix proposes to expand the management team by hiring a full-time Community Relations. Manager to spearhead the company's commitment to Tustin charitable organizations and community events and to inspire and implement injury and illness prevention efforts in EOA #23 and across Orange County. Medix is pleased to provide the following detailed spreadsheet of the 105 state-certified EMTs proposed for the performance of services within EOA #23. All Medix EMTs are trained in CPR and AED use. Under the new Tustin Contract, Medix will also require BTLS and HAZMA T First Responder training. Page 36 MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 MEDIX AMBULANCE EMT PERSONNEL PROFILE YRS/MOS (As of March 2004) I NAME I CA EMT CERTIFICATE I OC LICENSE 11/6 Detviler, John ZOOO0469A ZOOO0468A 10/6 Sutherland, Robert 549359765 549359765 10 Blakeman, David BGFB31R 552963129 6/7 Tovar, David 545175896 545175896 6/6 Nielsen, Jasen 545930751 545930751 5/4 Bode, Dane 311920693 311920693 4/9 Escalante, Ted BGSXPFX 565173759 4/5 Stokes, Jason 602053157 602053157 4 Guzman, Jason 558891356 558891356 4 Ordaz, Jose BGSRJJR 564972121 3/8 Navarro, Kieran 1-9895 560593347 3/7 Ellis, Zackrv 559693204 559693204 3/6 Voelkl, Jason ZOOO0393 ZOOO0393A 3/4 Davis, Gregory 1-4179 559776860 3/4 Thomas, Nate 549654587 549654587 3/1 Murphy, Terry 610140291 610140291 3/1 Schuetz, Michael 563778620 563778620 3 Banks, Roaer 562939629 562939629 3 Spradlinç¡, Shawn 12309 606344784 2/9 Almand, Cody ZOOO0166 ZOOO0166A 2/8 Hollowav, Michael 621340446 621340446 2/7 Mancera, Frank B1156603 B1156603A 2/7 Walker, Chris 550590024 550590024 2/5 Saba, Heather 127620500 127620500 2/1 Newell, David 622079565 622079565 2/1 Rich, Adam 623010300 623010300 2 Ballen, Linette 568513648 568513648 2 Crabbe, Tanya 556394198 556394198 2 Gordon, Joshua 1-6474 567774744 1/9 Keim, Ryan 608126738 608126738 1/9 Medina, James RE 7186 567650360 1/9 Sayeç¡h, Rockan 547699344 547699344 1/8 Marcus, Russell 555574601 555574601 1/8 Thorn, Brac 1-11131 B1379853A 1/7 Fritchle, Nathanniel B1385237 B1385237A 1/7 Guarcello, Robert 603187361 603187361 1/7 Ratcliffe, Dennis BGLGS5M 558393525 1/7 Vu, Hung BJ5UU8J 610169106 1/6 Meek, Kevin 572618188 572618188 1/6 Meketarian, Chad 551894150 551894150 1/6 Metcalfe, Timothy 605010372 605010372 1/5 CrUz, Márco 558870011- . 558870011 1/5 Goodman, Chris B1409982 B1409982A 1/5 Miller, Glenn 562714656 562714656 1/5 Rich, Jonathan 608384640 608384640 1/5 Schwarze, Erik 593615954 573615954 1/5 Sullenç¡er, Jacob 520986494 520986494 1/3 Bowyer, Quinn 557837874 557837874 1/3 Brannam, James 554579453 554579453 1/3 Demel, Jennifer 506171227 506171227 1/3 Lyon, Todd E15655 549938229 1/3 Murphy, Timothy UB527021 613019461 1/3 Sarbu, Florin BGC8H2C B1382452A MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 37 MEDIX AMBULANCE EMT PERSONNEL PROFILE YRS/MOS (As of March 2004) I NAME I CA EMT CERTIFICATE I OC LICENSE 1/3 Woodward, Marc 545438913 545438913 1/10 Leftige, Jason 551992690 551992690 1 Ankerman, Eric 1-9732 602013019 1 Arthur, Scott 572593652 B1448440A 1 Bently, Matthew 602074485 602074485 1 Thompson, Nickalas 563699705 563699705 11 MOS LundQren, Cherise 81448489 B1448489A 11 MOS Santoro, Stephanie RE 7924 604077695 11 MOS StromberQ, Evan 32095A 618207604 10 MOS Marshall, Cade 557592033 B1421261A 10 MOS pryor, Donna 545459987 545459987 9MOS McAllister, Micah B1448490 B1448490A 9MOS Rich, Michael 560812141 560812141 9MOS Sarjeant, Bryan BJL6H01 625165313 8MOS Adams, Michael 554812171 554812171 8MOS Hanley, Ryan 555692755 555692755 6MOS Charlot, Timothy 547717620 547717620 6MOS ColDean, Cory 606011608 606011608 6MOS Lvnch, Brandon BJEGKLW 619204254 6MOS Pedrini, Jonathan 610241523 610241523 6MOS Polinski, Teressa 607076887 607076887 6MOS Reed, Kiley 545894607 545894607 6 MOS Tavis, Erik 573392804 573392804 4MOS Gross, Kevin 221561157 221561157 3MOS Black, Matthew 608204426 608204426 3MOS Bovd, Brian 14606 619747274 3MOS Boyd, Jeffrey 625011355 625011355 3MOS Cox, Chad 1-10988 570778482 3MOS Erie, Chris BJ41EFG 608221680 3MOS Francis, Andrew 1-10376 572771097 3 MOS Friedman, Robert 563693116 563693116 3MOS Hong, Peter 497861050 497861050 3MOS Johnson, Matthew 614098045 624098045 3MOS Long, Everett E16034 570858238 3MOS Ravmundo, Mich B6FTMHJ 217962034 3MOS Soonthornsawad, BGPP9U3 561751939 2MOS Schweaman, Adam BHEJPEJ ZOOO0185A 2MOS Varker, Michael 565993412 565993412 1 MO Cassidy, Michael 280687523 280687523 1 MO Dowis, Courtney BHWDKV9 ZOOO0479A 1 MO Johnson, Derek B1352917 B1352917A 1 MO " Mendoza, Nicholas BJ5X2VJ ZOOO0150A 1 MO Pedroza, Jose 614033760 614033760 1 MO Sieger, Jeffrey BJ3VTUF ZOOO0284A 1 MO Stirlinq, Curtis B1309194 B1309194A 1 MO Velasco, Jose BJCQCAC 617361548 Leave Burke, Michael E02403 573818421 Leave Byrne, Noah 609036t66 609036166 Leave Dengate, Lauren 1-7521 546792570 Leave Heinsohn, Shiloh 567859894 567859894 Leave Rich,Nichole 601724045 601724045 Leave Royer, Bradley 1-10138 560511188 MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 38 B. FIELD TRAINING OFFICERS The perfect score Medix Ambulance Service received from the Commission for the Accreditation of Ambulance Services is attributable in large measure to the way the company educates and prepares managers, Field Supervisors and Field Training Officers (FTOs) to lead employees. Management/field supervisor oversight processes at Medix include ongoing Field Training Officer and Management Development programs. Established FTOs and Field Supervisors identified for their leadership potential are encouraged to develop their abilities and pursue additional management experience. Medix is pleased to promote from within wherever possible and is honored to serve as a training ground for future Orange County EMS leaders. Medix is committed to ensuring an immediate response to any concern and a mutually agreeable solution for any issue that arises in the delivery of service to Tustin. EOA #23 and all other contracting OCFA service areas will have direct access to a Medix Field Supervisor, as well as the company's owners, twenty-four (24) hours a day. FIELD TRAINING OFFICER PROGRAM Field Training Officers set the management tone for all new Medix employees. FTOs foster an appreciation for the company's culture and values and define company expectations. FTOs offer immediate feedback and guidance to new employees regarding training performance and provide invaluable insight to management concerning the level of ability and professionalism demonstrated by new hires. Medix will continue to publicize FTO opportunities through a paycheck insert and on the in-house bulletin board and soon will also post FTO openings on a company website. Interested EMTs submit a letter of interest and complete an FTO application. The screening process involves testing on policies and procedures, a skills evaluation and interviews to establish leadership talent and measure abilities to communicate, handle stress and resolve problems. The company's owners make the final FTO selection in consultation with the Human Resources/Payroll Manager, the Director of Training and Recruitment and/or the Operations Manager. The current ratio of Field Training Officers to field employees at Medix of one (1) FTO to fifteen (15) EMTs easily accommodates the company's training needs at the current hiring rate. Medix will train more FTOs as necessary to maintain the current ratio. MANAGEMENT DEVELOPMENT PROGRAM Medix actively supports leadership growth with a formal Management Development Program administered by an EMS consulting firm, Health Care Visions. Courses provided on a quarterly basis to managers, Field Supervisors and FTOs focus on topics such as marketing, SSM, business ethics, preparing to respond to an RFP, motivating employees, employee recognition programs and recruitment/hiring practices. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 39 c. PRIMARY PERSONNEL Medix Ambulance Service employs more than just qualified people to implement the company's plans for Orange County. Medix has assembled the right people for the job. The OCFA can count on an experienced Medix management team to fully accomplish the service fundamentals and enhancements detailed in this proposal, skillfully ensuring continued quality performance while rolling out new equipment and programs and responsibly facilitating all in-service training and education required for superior emergency ambulance transportation and related services. Medix is proud to introduce the following five (5) key personnel whose job duties for the company's Orange County operations will relate solely and exclusively to the fulfillment of the terms, conditions, performance expectations and obligations relative to Medix's performance under the Contract Documents. (Complete resumes for all key personnel are available for review upon request.) 1. MICHAEL DIMAS - President/CEO President/CEO Michael Dimas is an EMS innovator who continues to make significant contributions to Medix and to the Orange County EMS system. Personal career milestones include the following: . Became a California-certified EMT in 1974. . Created and implemented Orange County's first and largest ACLS mobile CCT program for the interfacility transfer of critical patients. . Designed and implemented Orange County's first cardiac intensive care unit and the County's first and only pediatric/neonatal intensive care ambulance. . Designed and implemented the first Type "M" modular ambulances in Orange County with a walk-around CPR seat/wall cabinet configuration that allows OCFA firefighter paramedics to work on a patient from both sides of the ambulance stretcher while enroute to a medical facility. . Implemented the first computer-aided dispatch system utilizing status management (SSM) in Orange County in 1988. . Designed, authored and established Medix's Driver Training and Injury and Illness Prevention programs and the Medical Transport Resource Specialist Training Program. Michael is truly a hands-on manager who provides on-site leadership support for managers and supervisors with an open-door policy that encourages frequent interaction and regular performance review, feedback and follow-up. Michael's attitude of not expecting anything from employees that he would not expect from himself raises the quality bar at Medix. Michael is committed to continued personal and company involvement in the activities of EMS and community organizations to further solidify Medix Ambulance Service's position as an EMS leader in the southern California healthcare marketplace. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 40 2. JOANNA DIMAS - Vice President, Marketing & Public Relations/CFO Since co-founding Medix in 1978, Vice President Joanna Dimas has innovated and overseen a progressive reimbursement, billing and collections system that encourages company growth, ensures financial stability for customers and employees and supports the clinical sophistication of the company's vehicles and equipment. Joanna also directs human resources at Medix as well as overseeing communications center operations and community relations. Always insistent on Medix's responsibility to serve, Joanna coordinates and often personally implements the company's corporate citizenship and community involvement activities. Joanna's financial leadership at Medix has led to the development of a comprehensive growth strategy that has seen the company through thoughtful expansion spanning more than a decade. She has implemented a business office management system that ensures a billing and collections process that helps Orange County citizens maximize Medicare and other healthcare benefits and limit any out-of-pocket EMS expenses. As a company founder, Joanna has participated at all levels of Medix operations. Her leadership ability has grown out of her exposure to all aspects of the business. She has personally worked as a dispatcher and an EMT and has helped patients after the call with billing and collections. Joanna's experience builds credibility with employees, facilitating the continued success of many of the day-to-day functions she oversees. Before launching Medix, Joanna was in charge of an Orange County School District foreign language department. Fluent in Spanish and French and state-certified in math, she has served the community as both a foreign language and a mathematics teacher. Joanna is an active member in good standing of the following organizations: . Cypress Chamber of Commerce . Los Alamitos Chamber of Commerce . San Juan Capistrano Chamber of Commerce . Seal Beach Chamber of Commerce . Laguna Hills Chamber of Commerce . Lake Forest Chamber of Commerce . Laguna Niguel Chamber of Commerce . Mission Viejo Chamber of Commerce MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 41 3. ERIC SALINE - Director of Resource Utilization Contributing twelve (12) years of EMS communications experience in the Medix Ambulance Service communications center, Director of Resource Utilization Eric Saline plays a pivotal role in the company's day-to-day performance. Eric's progressive ideas and ability to motivate and inspire employees help position Medix as the company to work for in Orange County. Drawing on his immense communications management expertise, Eric demonstrates industry excellence in maximizing the capabilities of one of the most renowned EMS computer-aided dispatch systems, the Zoll RightCAD. He is accountable for all call- volume monitoring and responsible for ensuring the staffing required to meet peak load ambulance scheduling. The company's continuous response time reliability has been achieved largely because of Eric's commitment to performance and skill at matching resources to demand. In addition to participating in the hiring and training of Medix EMTs, Eric also oversees the recruitment, screening, hiring and supervision of the company's communications center staff. He has previously functioned as a dispatcher, personally serving callers making emergency and non-emergency requests for service. Eric is a manager who has been promoted due to his consistently outstanding execution of duties and his unwavering commitment to Medix and to the Orange County EMS system. Eric currently serves the community as Vice President of the Ambulance Association of Orange County and also sits on the County Emergency Medical Care Committee. 4. CHRIS ROSSETTI - Operations Manager Chris Rossetti offers Orange County valuable expertise in delivering emergency BLS ambulance service operations and ensuring BLS clinical competency. As Operations Manager, Chris is charged with the day-to-day oversight of all Medix field personnel, both ambulance crews and supervisory staff. Chris maintains an ongoing relationship with over one hundred (100) field employees. He participates in employee evaluations and also plays an integral part in the recruitment, screening and hiring process. Since his California EMT certification in 1996, Chris has served the community continuously as an EMT for both emergency and non-emergency transports. He is also a registered instructor in both CPR and AED. He functioned previously as a Medix FTO, with responsibility for the orientation and training of new employees regarding company standards, company rules and EMT responsibilities. Chris earned an Associate's Degree in Fine Art from Saddleback College. Prior to joining Medix, he served as an assistant to an LA. County Fire Department magazine editor. ' MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 42 5. WALTER GARCIA - Director of Training & Recruitment Walter Garcia has been an important member of the Medix management team since 1996. As Director of Training and Recruitment, Walter administers employee recruitment and selection, oversees initial and ongoing training and is accountable for the medical performance of all Medix EMTs. Walter acts as field liaison, linking Medix field employees to allied agencies as well as to Medix managers. He is also responsible for maintaining relationships with local community colleges and training institutions for the publicizing and promotion of Medix employment opportunities. With the oversight of the Medical Director, Walter sets and monitors Medix guidelines for continuing education and protocol compliance. He attends and contributes to regularly scheduled supervisor meetings and assists in implementing and maintaining company policies and procedures. He regularly reviews patient transport reports to ensure company-wide adherence to company, local and state protocols. Walter also supervises the daily performance of FTOs and is charged with conducting random inspections of ambulance stations and units. In overseeing Medix orientation, Walter has been pivotal in establishing an in-house Emergency Vehicle Operations Course. He is certified as a Driver Training Instructor by the California Commission on Peace Officer Standards & Training (POST). Also certified as an instructor by the American Heart Association, Walter has been actively teaching BLS CPR for five (5) years. He is a member of the National Association of Educators. In addition to his supervisory duties, Walter has served Medix and Orange County as an exemplary field EMT, responding to emergency calls with OCFA paramedics and providing basic life support and transport to receiving hospitals in a safe and efficient manner. He continues to serve as a volunteer firefighter for the Riverside County Fire Department/CDF. Walter holds a Bachelor of Science degree in Chemistry from the University of California, Los Angeles and an Associate of Arts Degree in Photolithography Technology from Don Bosco Technical Institute. He is bilingual, writing and speaking fluent Spanish. Before working at Medix, Walter was a Center Stage Attractions Lead at Disneyland in Anaheim, California. Page 43 MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 D. EMPLOYEE RECRUITMENT, SCREENING & ORIENTATION Medix Ambulance Service commits to a generally superior employee recruitment, screening and orientation program that meets or exceeds all personnel requirements stipulated in Section Vof the RFP. As an accredited ambulance service, Medix can guarantee that personnel assigned to the EOA #23 Contract will be of only the highest quality. Medix strives to ensure that personnel at all levels understand and internalize the company's primary mission of quality patient care and transportation. The consistently superior performance of Medix employees has been one of the main factors in the company's achievements over a quarter century serving Orange County and will no doubt contribute greatly to the future success of the company. Medix will continue to offer competitive wages that position the company as the County's EMS employer of choice. For the new Contract in Tustin and all other contracting OCFA EOAs, Medix will add a profit sharing program to the company's generous benefits package as well as credit union membership and a Critical Incident Intervention Program. Medix has never had to be an aggressive recruiter. The company's rewarding work environment and the consistent mentorship of the OCFA have made it no accident that Medix generally only loses employees to the firefighter ranks. Medix currently holds a waiting list of thirty (30) to forty (40) applicants for EMT positions. Medix accepts full control of all company employees and holds all employees to strict standards of professional and business conduct. Medix understands and agrees that, employment law permitting, any employee may be removed at the request of the OCFA Battalion Chief. RECRUITMENT EMTs are attracted to Medix Ambulance Service because of the experience they can receive working for one of the area's largest and most successful emergency ambulance providers. Medix has developed a reputation as an excellent training ground for future firefighters and paramedics. Medix believes that there should be at least ten (10) applicants for each opening. To ensure a pool of applicants rich in talent and potential, Medix will announce job openings and promote service in the OCFA system internally, across the EMS industry, at community colleges, online and in a number of industry publications. Medix further expands the applicant pool through a ride-along program that gives potential employees a chance to see Medix and the OCFA system at work while allowing Medix an opportunity to pre-screen future applicants. Medix currently maintains training agreements to provide the primary ride-along experience for students in six (6) institutions with EMT curriculum: Orange Coast College, Santa Ana College, Saddleback College and North County, Central and South ROP. Medix also maintains a recruitment relationship with the Link to Life training program. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 44 SCREENING Prospective Medix employees must establish all necessary credentials, successfully complete pre-interview testing, including a Medix EMT exam and a map test, and pass alcohol and drug screening and a DMV check before they are even considered as candidates for Medix employment. Driving records of permanent employees are regularly monitored through participation in the DMV Employer Pull-Notice Program. Medix has a comprehensive drug and alcohol program to ensure continued compliance with the company's alcohol- and drug-free workplace policy. Competitive hiring at Medix is a multi-step process that includes a scenario-based oral interview, a physical agility test and background checks of past employers and schools. The hiring process incorporates field employee input to ensure that prospective employees will work well with existing staff in the current environment. Medix knows that people are the very foundation of the company's business. Personnel standards are therefore extremely high. Medix selects only the industry's most qualified candidates, ultimately hiring less than twenty-five percent (25%) of all applicants. Medix will designate a selection committee to be charged with the immediate recruitment, screening and selection of any additional personnel required for service to contracted EOAs under the next contract period. Employment opportunities in any areas new to Medix will be initially offered to qualified incumbent employees. Fire Authority personnel will be invited to serve on the selection committee to assist in the interview and selection of the working team members for the new Contract. ORIENTATION Medix requires new hires to complete a comprehensive initial training program designed specifically to ensure thorough orientation to the company and the EMS system prior to field or dispatch assignment. The seven (7)-day orientation program encompasses over fifty-six (56) hours of training and evaluation focusing on Medix and Orange County operational specifics and performance expectations. Communications personnel receive further specialized orientation training. All Medix employees receive instruction in disaster response, infection and hazardous materials exposure, on-the-job injury and illness prevention, fire safety, workplace violence and EMS legal issues. Additional training is provided throughout the Medix employee's career at the company's initiative or at the request of the Fire Authority. Joint training with allied agencies ensures overall system performance. Following classroom instruction, new employees are assigned to Medix Field Training Officers (FTOs) whose responsibility it is to coordinate and facilitate the completion -of. all orientation and training. Candidates who fail to successfully complete all required training and assessments are not offered continued employment at Medix. New employees must successfully complete orientation, including field training and the company's Driver Training Program, before joining Medix as a probationary hire. Probationary employees are subject to regular performance evaluation throughout a ninety (90)-day probationary period before becoming permanent Medix employees. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 45 E. CONTINUING EDUCATION PROGRAMS The provision of Emergency Medical Services is a dynamic process tied closely to the emerging needs of contemporary American society. September 11 th prompted EMS systems across America to prepare for the horrific possibility of terrorism. American soldiers are integrating new high tech communications and new trauma care protocols in the field. Here in southern California, EMS medics staged at wildland fires cared for residents and injured firefighters using the most up-to-date equipment and supplies. The evolving challenges of EMS demand comprehensive continuing education. Medix Ambulance Service commits to continue providing a nationally accredited and superior Continuing Education Program that meets or exceeds RFP requirements at all times throughout the term of the EOA #23 Contract. All Medix continuing education and training benefits from the oversight of the company's medical director, Dr. Carl Stilson. COMMUNITY EDUCATION COMMITMENT A priority of Medix's Continuing Education Program will be to assist Tustin citizens in accessing emergency medical training so that they can help themselves, their families and their neighbors in a time of need. To offer education benefits directly to EOA #23 communities, Medix will become an American Heart Association Community Training Center and will also serve as a basic level First Aid Training Center for the American Red Cross. In addition, Medix commits to producing additional episodes of Close Cal/- Orange County's Emergencies or like television programming to reach the greatest possible number of people with illness and injury prevention education. CONTINUING EDUCATION PROGRAM Medix's Continuing Education Program is designed to dynamically address EMS developments and to provide ample opportunities for employees to meet recertification requirements while accommodating busy employee schedules. Coursework includes local EMS issues and EMS literature reviews in addition to certification subject areas. The Director of Training and Recruitment develops and administers courses through the Medix training department with the participation of the registered nurse CCT Manager and the oversight of the Medical Director. Medix employees will be able to satisfy all necessary hours for recertification on-site through County-approved CEU courses sponsored or taught by the company. EMTs are required by the State of California and Orange County to complete twenty-four (24) hours of continuing education units (CEUs) or a state-approved refresher course every two (2) years. CEU courses available at Medix will offer each employee a total of forty- ' eight (48) hours of training annually, far exceeding current requirements. Medix is pleased to offer to extend the company's Continuing Education Program to the OCFA. Medix will post course schedules and all Fire Authority paramedics and firefighter EMTs will be invited to attend any and all training free of charge. Medix understands that the Fire Authority may request joint training exercises between the two (2) agencies and Medix looks forward to those opportunities to build the most effective patient care team possible for Orange County. ' MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 46 CONTINUING EDUCATION ENHANCEMENTS For the Tustin Contract, Medix commits to offering a program of in-service training and continuing education superior to the minimum requirements that includes the following enhancements. ' . Electronic Tracking: Medix is implementing an Internet-based compliance tool, The Virtual Solutions Manager (VSM), that both Medix and the OCF A can use to track continuing education and EMS certifications as well as for trend analysis to guide the development of health and safety training. . ICS Hazmat Training: Medix field employees will be certified as Incident Command Specialists through ICS 200 level training provided by the State Fire Marshal's office. Managers and Field Supervisors will be trained at levels ICS 300 and 400, respectively. . EVOC Driving Simulator Training: Medix's Driver Training Program will include six (6) hours of state-of-the-art EVOC Driving Simulator training. . Paramedic Assist Training: OCFA captain Bill Lockhart provides Paramedic Assist Training for all Medix EMTs. Paramedic Assist Training covers ALS equipment, where equipment is located in OCFA vehicles and assisting with ALS procedures. . Training Partnerships: Medix maintains cooperative relationships with a number of training institutions in Orange County. In exchange for ride-along time provided EMT students, Medix employees may attend refresher courses at those institutions, at no expense to the employee. This mutually beneficial training partnership allows Medix employees to schedule continuing education at their convenience, without concern for personal cost. . Quality-driven Targeted Training: Occasionally, Medix's quality program identifies a specific problem affecting an individual or the entire system that prompts the development of additional education outside of the normal in-service training program. Targeted quality training may include one-on-one remediation and/or company-wide education. . Back Safety Training: Medix orientation includes back safety training that teaches proper body mechanics for lifting and carrying. Instruction in stretching exercises and other behaviors that encourage skeletal health promotes injury prevention. . Elder Care Awareness Program: To ensure optimum service for the OCFA's many elderly patients, Medix will educate and sensitize employees regarding the sensory and ambulatory changes that occur with aging such as hearing loss, loss of visual acuity and difficulty walking or bending. A representative of the Orange County Alzheimer's Association will provide insight concerning mental health issues. . Sudden Infant Death Syndrome (SIDS) Training: Medix will train all field employees and dispatchers in the proper policies and procedures for accurately identifying SIDS and sensitively responding to parents experiencing such a tragedy. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 47 F. HIPAA TRAINING PROGRAMS Following the enactment of patient privacy legislation, all Medix managers and supervisors attended mandatory in-house HIPAA seminars and planning sessions where industry consultants reviewed the law and associated regulations and provided detailed information on the factors of compliance. The Medix management team then conducted an internal company analysis to assess the company's privacy practices and compare them to the pending HIPAA requirements. All Medix policies and procedures related to privacy issues were reviewed and amended as necessary. Medix developed and implemented a HIPPA Training Program to ensure continuous patient privacy. HIPAA training includes documentation, current policies, identifying and understanding protected health information (PHI), the rules of access, proper patient notifications, proper run report documentation and the company's internal privacy review process. HIPAA training has been provided to all current Medix employees and will be provided to all new employees who perform services under the Contract Documents. Medix provides additional HIPAA training as ,necessary to support ongoing updates of privacy policies and practices resulting from regular company privacy compliance reviews. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 48 ITEM 14: BilliNG & COllECTION PRACTICES As Orange County's major provider of ambulance transportation and related services, Medix Ambulance Service issues an average of 4,000 monthly invoices for OCFA patients. The company's historical commitment to professional, effective and compassionate billing and collection practices is evidenced by a perfect accreditation score and a demonstrated ability to maximize available revenues. Medix already provides the Fire Authority a fully functioning system-specific auditable billing system organized for the ready search and retrieval of all billing data according to OCFA criteria. Medix already maintains accurate and complete records of all patient accounting according to OCFA requirements. Medix record keeping and auditing systems will continue to exceed the requirements and performance expectations set forth in Section VII of the RFP. Medix accepts continued responsibility for the submission of all claims for services provided under the contract and for the billing of all transports in which ALS services are rendered, specifically including the performance of all ALS assessments. Medix maintains comprehensive HIPAA and Corporate Compliance programs to ensure patient privacy and proper company and system reimbursement. Medix will gladly submit to an OCFA billing and collections audit at any time. BILLING & COLLECTIONS SYSTEM Medix offers EOA #23 an established, locally based billing and collections system that boasts efficiency refined through twenty-five years (25) of Orange County experience. The processes and personnel already in place make it possible for Medix to commit to the immediate startup of a technologically advanced accounts receivable system. Medix uses Zoll's accounts receivable program, Sanitas, the first Windows-based reimbursement and collection system specifically designed for the EMS industry. As a Zoll product, Sanitas integrates naturally with the loll RightCad dispatch system Medix uses and the immediately compatible Zoll pen-based computers Medix is implementing. The Sanitas software offers a wide range of comprehensive tools and benefits, including: - . Simplification of data entry . Electronic claims/payment processing . Maximizing of billing efficiencies . Batch posting for minimized billing time . Improved cash flow . Improved reimbursements The flexible system can be adjusted for EOA-specific billing and collection elements. CUSTOMER COMPLAINTS Medix Ambulance Service practices ethical billing. Every effort is made to assist the patient or the patient's representative through the billing process and the company is very selective in determining which accounts are collected aggressively and which are written off as charity cases. Clearly defined and closely monitored compassionate and professional practices generate few billing and collection complaints from Medix MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 49 customers. Patient account representatives are available during regular business hours to resolve any customer concerns. A voicemail system records customer calls after hours so they can be returned the following business day. Medix aggressively investigates any customer complaint within forty-eight (48) hours. Findings and resolutions are documented in a customer comment/complaint database for future reference and to guide quality improvement. The Assistant Office Manager reviews all complaint reports. ADDITIONAL SPECIFIC SUBMISSION DATA 1. Provide a detailed description of the billing and data information flow from dispatch through initial billing. The integration of the loll Sanitas billing system with the loll RightCAD dispatch system allows Medix to store data collected at time-of-call on a shared database available to both dispatch and the business office. Every patient contact generates a Patient Care Report (PCR). PCRs are gathered and cross-checked against dispatch logs on a daily basis by Field Supervisors and the Operations Manager and then turned in to the billing department to be matched against run numbers. The Operations Manager fully investigates any data discrepancies. A Medix patient account representative completes an extensive verification process for each transport before any billing takes place. Call information and mileage are verified, detailed charges are assigned, a patient's contact and billing information is verified and the appropriate insurance company is called to confirm patient and service eligibility and coverage on the date of service. The account representative then contacts the patient or their representative to attain any missing information and to explain the billing process and Medix policies. If the patient has no benefits, a payment plan is arranged. The patient account representative enters all applicable data into the company's Sanitas system within seventy-two (72) hours of the time of the transport. 2. Provide process flow and timeframes for collections process, including but not limited to the number of monthly statements sent prior to collections and the timeframe for write-offs. Each patient account is assigned a specific account type by payor source (Medicare, Medi-Cal, Private Pay and Insurance). Each account type has an associated billing cycle schedule that determines the timeframe for the generation of invoices, statements and letters. If partial remittance is received on an account, the schedule is reset so that the patient does not receive a bill immediately after making a payment. Accounts are generally set up on a thirty (30)-day schedule. Medix issues an initial bill within seventy-two (72) hours of the transport. Typically, if payment is not received within thirty (30) days, a past due invoice is sent. If no payment is received after sixty (60) days, a third and final invoice is issued. If no payment is received after ninety (gO) days and no other arrangements have been made, the account enters collections. Medix utilizes the specialized services of Southwest Collections in Orange, California. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 50 Medix does not follow a timeframe for write-offs. Each case is evaluated individually. Cases with special circumstances requiring more time are handled with particular care. Medix makes every effort to reach a mutually agreeable resolution of every account. 3. Provide overall billing and collection practices, including but not limited to the statement cycle and collection rate. Medix billing and collection practices are designed to maximize third-party reimbursement to reduce out of pocket expenses for Orange County patients. A thirty (30)-day statement cycle is typical. Collection rates are included in the Trip Summary at the bottom of this page. (The Billing and Collections Manual is available for review upon request.) Medix bills Medicare claims on an assigned basis, except under circumstances where there is patient or physician preference or where the service is not a benefit of the Medicare program and a waiver has been signed. All Waiver of Liability regulations are followed. Medicare claims are submitted electronically. Some transports not eligible for benefits may still be submitted to Medicare in order to obtain denials. Medix recognizes and files claims with the state of California and the County of Orange for indigent and partially indigent patients. The allowed amount is accepted as payment in full and the patient does not receive a bill from Medix unless the service is not a benefit or the patient is assigned partial responsibility for the cost of services received. 4. Provide statistical data for subject EOA (if applicable), including but not limited to payer mix, patient demographics and collection rate by payer. Medix doesn't capture complete demographic information by EOA. Overall County patient demographics provide the following age distribution data. The Proprietary Trip Summary below covers billed/closed Medix trips. 2003 <None> 24 $15,109.50 $1,732.86 $13,376.64 $4,162,75 Bill Patient 3,005 $1,997,029.62 $80,570,92 $1,916,458.70 $10,440.03 Facilit Contract 56 $34,601,13 $14,525.66 $20,075.47 $1,031.72 Insurance 13,665 $9,345,170.70 $1,541,210,19 $7,803,960.51 $101,506,22 Medicaid 1,888 $1,248,818.78 $934,329.94 $314,488,84 $4,403.05 Medicare 7,655 $5,232,708.38 $1,913,056,87 $3,319,651,51 $9,712.51 Private Pa 1 $400.00 $0.00 $400,00 $0.00 26,294 $17,873,838.11 $4,485,426.44 $13,388,411.67 $131,256.28 2003 <None> $1,989,65 $7,224,24 $0.00 $0.00 13.17% 14.87% 0.09% Bill Patient $550,948.43 $162,038.35 $7,718.70 $1,200,750,59 27,20% 28,35% 11.43% Facilit Contract $13,708,12 $928.68 $32.30 $4,439,25 39,52% 68,12% 0.21% Insurance $7,459,123.66 $46,339.86 $99,576.59 $296,567,36 78.75% 94.31% 51.97% Medicaid $295,762,04 $3,665.67 $3,617,53 $14,275.61 23.39% 92.90% 7.18% Medicare $3,212,756.05 $101,982,81 $29,473.27 $24,673.41 60,83% 95,89% 29,11 % Private Pa $400,00 $0.00 $0.00 $0.00 100,00% 100,00% 0.00% $11,534,687.95 $322,179.61 $140,418.39 $1,540,706.22 63.75% 85.11% 100% MEDIX AMBULANCE SERVICE Page 51 RESPONSE TO OCFA RFP #RL972 ITEM 15: HIPAA COMPLIANCE PLAN Medix Ambulance Service is in full compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the associated Privacy Act. Medix certifies that all existing employees have undergone HIPAA privacy training and have signed confidentiality agreements. Every new Medix hire, regardless of department, is required to complete privacy training and sign a confidentiality agreement prior to release to active duty. Business Office Manager Deanne Hoover oversees HIPAA compliance as Medix Privacy Officer. Deanne has served Medix for nearly fifteen (15) years, facilitating a most efficient and circumspect ambulance accounts receivable billing and collections office that observes all compliance and privacy requirements. She has been instrumental in the development of Medix's HIPAA Compliance Plan as well as the company's Corporate Compliance Plan. HIPAA COMPLIANCE PLAN Following the enactment of the patient privacy legislation, all Medix managers and supervisors attended mandatory in-house HIPAA seminars and planning sessions where industry consultants reviewed the law and associated regulations and provided detailed information on the factors of compliance. The Medix management team then conducted an internal company analysis to assess the company's privacy practices and compare them to the pending HIPAA requirements. Using the internal assessment as a guide, Medix was able to meet all new privacy requirements prior to the compliance deadline of April 2003. Medix identified all 'Business Associates' and executed written privacy agreements for each as required. Privacy Notices were created for patient distribution. All company policies and procedures related to privacy issues were reviewed and amended as necessary. A HIPAA Training Program was developed and implemented. HIPAA training includes documentation, current policies, identifying and understanding protected health information (PHI), the rules of access, proper patient notifications, proper run report documentation and the company's internal privacy review process. As Medix does not consider HIPAA compliance a static process, privacy remains an ongoing agenda item for senior management. Medix performs periodic privacy evaluations and executes revisions of company policies and practices as necessary to ensure the continuous protection of patient privacy. Medix provides additional HIPAA training as privacy regulations and procedures evolve. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 52 ITEM 16: CORPORATE COMPLIANCE PLAN Medix Ambulance Service remains in good standing with every federal, state and local regulatory agency having jurisdiction over ambulance transportation and related services provided to the citizens of Orange County. It is Medix policy to consistently and fully comply with all laws and regulations pertaining to service delivery and billing, including those that apply to Medicare and Medi-Cal. An aggressive Corporate Compliance Plan ensures continuous compliance now and in the future. Due to the importance of corporate compliance in accounts receivables management and across the Medix organization, Business Office Manager Deanne Hoover functions in the role of Corporate Compliance Officer. Corporate Compliance Officer responsibilities include, but are not limited to, the following: setting, implementing and reviewing standards and associated training manuals; ensuring that employee and vendor screening mechanisms function properly; ensuring that each employee receives the necessary compliance education and training; and auditing and ensuring the correction of any identified problems. CORPORATE COMPLIANCE PLAN The Medix Corporate Compliance Plan centers on employee education and the setting of high personal and professional standards to assure compliance with all federal, state and local regulations. Focusing on those elements identified in the Inspector General's Compliance Program Guidance for Ambulance Suppliers, Medix has compiled a complete set of policies and procedures designed to eliminate any potential for fraud and abuse. The company's Corporate Compliance Officer reviews compliance procedures regularly and revises or adds policies as necessary. Medix Ambulance Service is well aware of the compliance issues surrounding billing and collecting efforts for those patients covered by federal and state reimbursement programs. Because of the complexity associated with governmental billing, Medix places special emphasis on Medicare and Medi-Cal compliance. Medix makes it clear from the first day of employment that it is the responsibility of every - employee to abide by applicable laws and regulations and to support the company's overall compliance efforts. Medix orientation stresses the importance of complete regulatory compliance. All employees receive copies of the company's Mission Statement, Unification Principles and Professional Conduct Policy. All employees are encour..ag~qaDd requir~dJ9 report é3JlY compUance violation, with protective anonymity if so desired. COMPLIANCE EDUCATION. Medix compliance policies serve as the template for compliance education provided to employees. All Medix employees receive initial compliance training during orientation and undergo refresher training on an annúal basis. Compliance education includes instruction in fraud and abuse laws, Medix policies and procedures regarding fraud and abuse, medical necessity and patient documentation, claim development and non- compliance consequences for both Medix and the employee. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 53 Ambulance crews receive supplementary instruction in patient documentation. Administrative and billing personnel receive specialized training regarding claims preparation and submission. Medix develops and implements additional compliance training in response to any changes in compliance regulations and associated company policies. COMPLIANCE MONITORING Medix monitors compliance through several levels of quality control. At the field level, a daily check of patient reports includes the review of proper billing documentation. At the billing and collections stage, the Business Officer Manager performs a regular review of the claims submission process and reports on compliance. Finally, overall organizational compliance is evaluated through an annual independent audit and risk assessment performed by the industry's premier reimbursement expert, David Werfel. David Werfel is a highly regarded attorney specializing in Medicare and Medicaid reimbursement for ambulance services. He serves as the counsel of record for the American Ambulance Association in regards to reimbursement issues. David has been under retainer to Medix Ambulance Service for seven (7) years. He advises Medix leadership on compliance and continues to provide invaluable guidance as the company sets its business course through the challenges of reimbursement reform. In 1997, Medix's Medicare carrier, Trans America, conducted a routine audit of the company's Medicare claims that involved a complete, independent and thorough inspection of Medix billing practices and procedures. The company's billing department received a clean bill of health. In fact, Medix's tight controls and conservative practices earned the company additional reimbursements from the federal Medicare system. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 54 ITEM 17: COMPLIANCE WITH MONTHLY PAYMENTS Medix Ambulance Service has consistently provided timely quarterly payments to the Orange County Fire Authority since the inception of the current Contracts. To date, the invoice and payment system has proven reliable and relatively problem free. Medix commits to render the same quick payment for OCFA invoices under the new EOA #23 Contract with modifications to the present process as necessitated by the new monthly payment system stipulated in the amended RFP. Medix is committed to ensuring a system for providing timely, monthly payments to the OCFA that will satisfy the procedures and requirements set forth in RFP Section VII, including all requirements for the inspection of all billing records and recordkeeping and auditing practices, within patient privacy guidelines. IMPLEMENTING A MONTHLY PAYMENT SYSTEM Medix has been providing quarterly payments under the OCFA's current system for the last six (6) years. Adapting current procedures to accommodate monthly payments, Medix will expect to receive a monthly invoice from the OCFA seven (7) days after the start of each month requesting reimbursement for those ambulance calls made during the month occurring ninety (90) days prior to the invoice date. Medix will review the invoice and remit payment within the sixty (60)-day limit specified in the RFP. Medix will work during the following month to resolve any disputed payment methodologies or amounts to the satisfaction of both parties. Any over/underpayment will be adjusted on future invoices. Under the new monthly payment system, Medix will not be required to pay the established ALS Reimbursement Rate or Medical Supply Reimbursement Rate (nor any portion thereof) for zero pay patients, those patients whose only method of healthcare coverage or insurance is provided by a state or local subsidized health care program. Patients who have other means of payment or who are covered by additional or supplemental insurers, other than subsidized health care programs, will not be considered zero pay patients. Medix will be able to seek relief from making the required reimbursement payments to the OCFA by applying for a Zero Pay Patient Exemption. Medix assumes the entire risk of non-payment for any and all of the services rendered Tustin and the charges incurred in connection with their performance under the EOA #23 Contract Documents, including all BLS and ALS charges incurred, as well as all ALS reimbursements and medical supply reimbursements. ZERO PAY PATIENT EXEMPTION REQUESTS Medix will submit to the OCFA for approval all Zero Pay Patient Exemption requests and all documentation justifying each request with the company's monthly ALS reimbursement and medical supply payments for the month in which the exemption is requested. Medii< understands and agrees that all zero pay patient exemption requests must be reflected as a credit on the current monthly payment remittance. Medix also understands and agrees that requests for exemptions outside the current monthly payment period will not be considered, except as provided in the RFP. In the MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 55 event a Zero Pay Patient Exemption request is denied, Medix will adjust its next monthly payment remittance for the amount of the credit denied. Exemption requests for "Retro Credits" will be made within the month Medix receives notification of the retroactive enrollment in a qualified zero pay patient program. IMPLEMENTING A MONTHLY PAYMENT ACCOUNTING SYSTEM As Orange County's largest BLS provider, Medix offers Tustin an already functioning system-specific auditable billing system organized for the ready search and retrieval of all billing data according to OCFA criteria. Medix already maintains accurate and complete records of all patient accounting according to OCFA requirements. The processes and personnel currently in place make it possible for Medix to commit to the immediate startup of a technologically advanced billing, record keeping and auditing system for EOA #23. Medix greatly desires that there be mutual understanding and agreement regarding the monthly payment system and proposes that both parties meet after contract award to clarify the specific needs of the OCFA and jointly design report formats, a reporting structure and auditing procedures that meet with the Authority's expectations. MONTHLY PAYMENTS RECORDKEEPING PRACTICES Medix uses Zoll's accounts receivable program, Sanitas, the first Windows-based reimbursement and collection system specifically tailored to meet the unique billing and data collection demands of mobile healthcare. Sanitas is a powerful but flexible processing and reporting system that automates every function in the accounts receivables process, allowing a claim to be tracked throughout billing and collections to maximize reimbursement and ensure complete documentation. As a Zoll product, Sanitas integrates organically with the Zoll RightCad dispatch system Medix uses and will offer additional data collection design possibilities with the company's implementation of immediately compatible Zoll RescueNet technologies for the improved collection of field data. User-defined reports can be generated by the dispatch CAD and/or the billing software to provide all the Monthly Payment Report and Audit Report information required by the RFP in a variety of formats to facilitate OCFA review. Medix agrees to submit a Monthly Payment Report to the OCFA Accounts Receivable Section along with all monthly payments. The Monthly Payment Report will include, at a minimum, the following information: . EOA number; . Name of responsible party invoiced per transport; . Patient name and address; . Indication of ALS, BLS or ALS assessment/BLS transport; . Date of call for service; MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 56 . OCFA incident number; . ALS reimbursement amount remitted to OCFA per transport; and . Medical supply reimbursement amount remitted to OCFA per transport. Medix proposes to adapt the form and format of the company's current Quarterly Payment Report to meet RFP requirements for the Monthly Payment Report in consultation with the OCFA upon contract award. All patient information reporting is subject to HIPPA regulations. MONTHLY PAYMENTS AUDITING PRACTICES Medix understands and agrees that an audit concerning monthly payments may be conducted at the sole discretion of the OCFA at any time throughout the contract term. Medix will remain prepared to promptly produce an audit list for OCFA auditors which contains the following information: . Name of responsible party invoiced per transport; . Patient name and address; . Indication of BLS, ALS, or ALS assessment/BLS transport; . Date of call for service; . OCF A incident number; . Amount invoiced per transport; . Amount recovered per transport; . Any exemption requests for transports included in the audit sample; and . Any other requested relevant information required to perform an audit. Medix proposes to adapt the form and format of the company's current Audit Report to meet new RFP requirements in consultation with the OCFA upon contract award. All patient records are subject to HIPPA regulations. INSPECTIONOF BILLING RECORDS Within patient privacy guidelines, Medix will gladly submit to an OCFA billing and collections inspection at any time. Medix agrees to provide the OCFA access to patient accounting records and information upon seventy-two (72) hours advanced written notice at all times during normal business hours for the purpose of inspection, audit, review, evaluation and duplication. Medix agrees to provide proper facilities for OCFA access, inspection, audit, review, evaluation and duplication of such information, at no cost to the Authority. ALS REIMBURSEMENT RATE PAYMENT SYSTEM MEDIX AMBULANCE SERVICE RESPONSE TO OCF A RFP #RL972 Page 57 The OCFA Board of Directors establishes the OCFA ALS Reimbursement Rate which Medix must pay for ALS services provided to patients that are transported either ALS or BLS in order to cover the OCF A's costs for providing such services. The ALS reimbursement rate for Medicare patients and patients covered under plans that use Medicare rates as a basis for payment in full is based on the amounts Medicare allows Medix. Medix will continue to submit a copy of the company's Medicare Profile to the OCFA EMS Battalion Chief no later than March 1 of each year to be used for the purpose of calculating the company's ALS Increment. Under the new monthly payments system, the Fire Authority will include the ALS Reimbursement Rate in the OCFA's monthly invoice to Medix. Medix will not be required to pay the established ALS Reimbursement Rate (nor any portion thereof) for zero pay patients. As described earlier in this Item, Medix will submit Zero Pay Patient Exemption requests with the company's monthly ALS reimbursement payment for the month in which the exemption is requested. Medix agrees to the approved ALS Reimbursement Rate of $200 stipulated in the RFP. MEDICAL SUPPLY REIMBURSEMENT RATE PAYMENT SYSTEM The OCFA Board of Directors also establishes the Medical Supply Reimbursement Rate which Medix must pay per BLS/ALS transport to cover the Authority's costs for providing expendable medical supplies. Under the new monthly payments system, the Fire Authority will include the Medical Supply Reimbursement Rate in the OCFA's monthly invoice to Medix. Medix will not be required to pay the Medical Supply Reimbursement Rate (nor any portion thereof) for zero pay patients. As described earlier in this Item, Medix will submit Zero Pay Patient Exemption requests with the company's monthly medical supply payment for the month in which the exemption is requested. Medix agrees to implement the new Medical Supply Reimbursement rate of $22.38 proposed in the RFP at contract start. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 58 ( " "- ITEM 18: PLAN FOR TAKEOVER OF SERVICE/ST ART -UP Medix Ambulance Service is the Authority's largest contractor, currently providing fully compliant, nationally accredited emergency ambulance transportation and related services to nineteen (19) Orange County Ambulance Service Areas (ASAs). Operating from headquarters centrally located in Mission Viejo, Medix offers Orange County communities the benefits of an established organization that continues to exceed and improve upon performance expectations. In selecting Medix to continue as provider for EOA #23, Tustin communities will experience no interruption of the excellent pre-hospital services they already enjoy. Tustin decision makers can count on the seamless continuation of stable, consistent, accountable services without fear of service halts or concern for performance decline. PROPOSED ENHANCEMENTS Medix continually strives to proactively improve the level of the company's contribution and is pleased to propose a range of service enhancements that will positively impact continued service delivery in Tustin, all of which will be implemented prior to the EOA #23 Contract effective date of July 1, 2004. Highlights of the many enhancements detailed throughout this proposal appear below. . A pen-based computing system will allow Medix to capture information in the field electronically, facilitating more efficient data collection and data application for the enrichment of quality improvement and patient billing. . An upgraded communications center with new monitors and advanced workstation computers offers more efficient dispatch services and improved data storage. . A larger fleet, upgraded with twelve (12) new Type III units delivered by the end of July 2004 and another eighteen (18) new Type III units slated for delivery from August 2004 through January 2005, will support the OCFA with thirty (30) new ambulances to further enhance already exceptional response time performance. . V~hicle upgrades unique to Medix are designed to meet the Orange County EMS~- system's demands for high quality ambulance operations. Medix is particularly proud of the upgrades performed on each of the company's ambulances prior to release to street duty as detailed in Item 5 and Item 7 of this proposal. Unit "extras" enhance safety and comfort for all passengers and improve efficiency for both Medix ---0_." ---...and OCFApersonnel while limiting risk for the community at large. . Specially configured and stocked disaster response vehicles offer the entire County - -- - addItional support to meet the challenges of any mass casualty incident. . Standardized stocking of an ext~nsive inventory far exceeding requirements makes the best equipment and supplies immediately available to OCFA paramedics. . An exceptional six (6)-phase Driver Training Program featuring state-of-the-art simulator training promotes driving safety and performance and extends vehicle life. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 59 TRANSITION TEAM Medix managers and supervisors will be honored to continue serving Orange County in Tustin. The management team for the transition to a new EOA #23 Contract will be comprised of the same Medix professionals who for many years have contributed personally and professionally to the communities where they live and work. Those local leaders include: . President Michael Dimas and Vice President Joanna Dimas: Owners Michael and Joanna have provided vision and leadership for Medix since founding the company in 1978. Michael is an EMS innovator who continues to make significant contributions to Medix and to the Orange County EMS system. Truly a hands-on leader, he supports managers and supervisors with an open-door policy that encourages frequent interaction, follow-up and review of performance. 'Joanna's financial leadership at Medix has led to the development of a comprehensive growth strategy that has seen the company through thoughtful expansion spanning more than a decade. Always insistent on Medix's responsibility to serve, Joanna coordinates and often personally implements the company's corporate citizenship and community involvement activities. . Director of Resource Utilization Eric Saline: An experienced EMS manager, Eric demonstrates industry excellence in maximizing dispatch and response capabilities. In addition to participating in the hiring and training of EMTs, Eric oversees the hiring and supervision of communications center staff. Medix's continuous response time reliability is largely due to Eric's commitment to system performance and skill at matching resources to demand. . Operations Manager Chris Rossetti: Charged with the day-to-day supervision of all Medix Field Supervisors and ambulance crews, Chris is also responsible for monitoring all employee credentials and certifications to ensure continuous compliance. Since achieving certification in 1996, Chris has served the community continuously as an EMT for both emergency and non-emergency transports. He is also a registered instructor in both CPR and AED. . Medical Director Carl B. Stilson, Jr., M.D.: Having served Medix as Medical Director for over a decade, Dr. Stilson offers invaluable experience in system- specific emergency medicine and ambulance transportation. He provides clinical direction for the development and implementation of all Medix policies, procedures, protocols and hiring standards as well as overseeing the company's continuing education and Gal programs. . Director of Training & Recruitment Walter Garcia: An important member of the Medix management team since 1996, Walter oversees initial and ongoing training and is accountable for the medical performance of all Medix EMTs. He leads recruitment efforts and facilitates the screening and selection of new Medix employees. Walter is also responsible for setting and meeting guidelines for Medix continuing education and protocol compliance. In addition to his supervisory duties, Walter has served the company and the system as an exemplary field EMT. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 60 . Business Office Manager Deanne Hoover: Deanne has served Medix for nearly fifteen (15) years, facilitating a most efficient and circumspect billing and collections system that observes all local, regional and federal compliance requirements while ensuring patient privacy. Deanne hires all business office personnel and oversees all billing and collections activities. She serves as the company's HI PM Privacy Officer and Corporate Compliance Officer. . Human Resources/Payroll Manager Patricia Reynolds: Trained and certified in a wide range of workplace matters, Patti has provided a full-time focus on Medix personnel issues since 1996. She facilitates communications between employees and managers, assists with hiring and orientation and administers payroll and benefits for all Medix employees. Patti serves as Affirmative Action Officer. . Chief Mechanic Dan Meziere: Dan has been with Medix for nearly twelve (12) years, bringing more than forty (40) years of automotive experience to Orange County. Responsible for leading the Medix team of professional fleet mechanics and overseeing vehicle and equipment maintenance on a daily basis, he himself is considered a master ASE (Automotive Service Excellence) technician. START-UP SCHEDULE As the current provider, Medix presents a unique opportunity for the continuation of compliant, accredited services with no interruption and can therefore guarantee absolutely the timely commencement of EOA #23 services on July 1, 2004. PROPOSED INiTIAL SERVICE RESPONSE & COVERAGE PLAN As discussed in Item 8, Medix uses a sophisticated coverage approach that has proven extremely successful in Tustin. The company's impressive response time performance has been the direct result of a tried and true, system-specific approach based on actual system data. Other bidders can only use computer models, guess work and similar system data to attempt to predict the best times and places to post ambulances. Medix has been making reliable posting decisions in EOA #23 for years based on continuous Orange County experience. Medix response time performance in EOA #23 during the third quarter of 2003 realized one hundred percent (100%) compliance on Code 3 responses and over ninety-seven percent (97%) compliance on Code 2 responses. Round-the-clock coverage has benefited from fixed base locations strategically spread throughout the coverage area with additional crews facilitating efficient response during short periods of higher call volume. Medix responds dynamically to increased system demand with crews on shorter eight (B)-hour shifts, constantly adjusting response locations to ensure the fastest response possible as system demands change. 24-hour Medix crews that respond from the company's base locations as well as response crews on shorter shifts who occasionally pass through all enjoy the benefits of a modern station, including sleeping quarters, televisions and kitchen facilities. Additional response locations are selected to ensure optimum response times while accommodating the comfort and convenience of crews to the extent possible. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 61 RESPONSE ZONES Accustomed to meeting Orange County's unique response challenges, Medix knows better than to attempt a single system approach for such a vast and diverse region. Medix crews will be consistently assigned to a Northwest, Northeast, Central or South response zone, minimizing any need for street corner posting, extended periods in the ambulance or unnecessary out-of-station time. An added benefit of response zone assignments is the opportunity Medix crews have to gain familiarity with the OCFA paramedic teams consistently stationed in the same area, encouraging the development of stronger interagency teamwork and better patient ære. PROPOSED INITIAL DEPLOYMENT Strategically placed fixed stations will allow for the geographically based coverage necessary to continue to produce the excellent response time performance currently enjoyed by EOA #23 and the Orange County system. Response crews deployed from fifty-five (55) response locations across Orange County will ensure full area coverage and may also be "doubled up" in any service area experiencing unusually high call volume. For EOA #23, Medix will operate from a permanently staffed 24-hour station located at Redhill Avenue and Walnut Avenue. Exclusive 9-1-1 ambulances will respond to Tustin calls from the 24-hour station as well as from two (2) additional response loætions in the City of Tustin near: 1. Newport and 17th Street, and 2. 1-5 and Tustin Ranch. The above plan for EOA #23 will allow Medix to continue to provide the excellent response times currently enjoyed in the Tustin area. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 62 ITEM 19: 9-1-1 FIRE/EMS RESUME (LAST 10 YEARS) In this proposal to provide fire/EMS emergency ambulance transportation and related services for EOA #23, Medix Ambulance Service presents an aggressive and enthusiastic plan to continue to support the Orange County Fire Authority with integrity and sophistication. Medix's plan for Tustin is backed by a sincere promise on the part of the company's owners and employees to honor the OCFA's invitation to serve as EOA #23's ambulance provider. Medix takes great pride in the company's rich history in the Southern California area. With an unwavering commitment to ongoing performance improvement, Medix intends to build upon the company's current resume to contribute to the realization of the very best EMS system possible for Orange County patients. COMPANY MISSION AND VALUES So that others may live. Medix Ambulance Service is in the business of providing cost-effective quality medical transportation. As an integral part of Orange County's pre-hospital system, Medix offers Basic (BLS) and Advanced Life Support (ALS) services and neonatal, pediatric and maternal transport specialized services. The company's operational philosophy is to create, sustain and manage the demand for Medix services in a manner consistent with the highest standards attainable. Medix articulates company values as the following Unification Principles: Adhere to the golden rule. Accept responsibility for your actions. Make a difference every day. Treat all those that we come in contact with in a courteous and professional manner at all times. The very first pages of the Medix Employee Manual declare the company's insistence that all employees behave in a courteous and professional manner when dealing with patients, medical facility personnel and particularly when assisting OCFA firefighters and paramedics. Medix employees embrace the opportunity to playa supporting role in the Orange County EMS system by providing skilled, competent, professional BLS care. COMPANY HISTORY Michael Dimas and Joanna Dimas founded Medix Ambulance Service in January 1978 and they continue today as the company's sole owners. Michael and Joanna have steadfastly adhered to their conviction that only the best in personnel, vehicles and methods will carry the Medix name. They insist and ensure that all company activities reflect an unwavering passion for treating every patient and customer as a dear member of the family. It is precisely because of Michael and Joanna's no compromise attitude that the company has grown so dramatically over the years. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 63 How IT ALL STARTED Michael Dimas built the first Medix ambulance in his parent's garage. The unit number, 2671, was inspired by one of Medix's first EMTs who recommended that the unit take the last four (4) digits of the company's emergency phone number, then 643-2761. Although still licensed for emergency service by the California Highway Patrol, Unit 2671 has stopped running calls and is now permanently housed at Medix Headquarters in Mission Viejo. From that first handmade unit, Medix has built a fleet of state-of-the-art ambulances that responds to nearly 30,000 emergency calls a year. The company has come to employ almost 150 EMS professionals, including over a hundred Medix EMTs who provide care for Orange County patients around the clock. THE LAST DECADE Over the last ten (10) years of formal EMS contracting between ambulance providers and the OCF A, Medix performance has earned the loyalty of scores of city and county elected officials as reflected in the company's customer list. . Ten (10) Years of Medix Emergency Service: Cypress, Los Alamitos, San Juan Capistrano, Seal Beach, unincorporated North Tustin, unincorporated Coto de Caza area, Laguna Niguel, Aliso Viejo area, Sunset Beach, Leisure World, Mission Viejo, Ortega Highway and Lake Forest. . Six (6) Years of Medix Emergency Service: Irvine, La Palma, Stanton, Villa Park, Orange/Olive, Midway City and Rossmoor. Medix also served the communities of Laguna Hills and Laguna Woods from 1994 until 1998. IMPLEMENTING THE COMPANY MISSION Medix enforces the company's mission, "So that others may live," without compromise. Dedication to service rose to another level in 1998 when Medix sacrificed ninety-eight percent (98%) of the company's non-emergency business to achieve optimal emergency response time performance for OCFA-contractedcommunities. In fact, by evolving into a predominantly emergency and critical care transport (CCT) ambulance company, Medix is now: . Truly in the business of supporting the OCFA's determination to save lives whenever possible; . Able to attract EMTs from a large pool of applicants to select the most compassionate and competent EMTs available; and . Able to maintain a company culture focused on public safety and paramedic support. THE MEDIX COMMITMENT TO SAFETY The Medix commitment to safety is most evident in the selection and design of the company's ambulances. The safety of OCFA patients and the welfare of all who travel Orange County's roadways depend on it. Medix has invested heavily in the enhanced MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 64 Type III fleet proposed for EOA #23. The company is particularly proud of the following ambulance upgrades. . Medix ambulances are the only Orange County units with the lightbar mounted on top to promote maximum OVR (over vehicle recognition) while responding Code 3. . Medix ambulances are equipped with Tomar Neobes, a unique combination of warning systems, intersection lights, reverse lights, scene lights and underbody lights that increase emergency scene safety for patients and EMS responders alike. . Medix ambulances have custom-designed overhead consoles that allow EMT drivers to keep their eyes on the road. . Medix ambulances are equipped with six (6) times the EMSA standard for most supplies, limiting the chances of a shortage that could impact a patient's condition. . Medix ambulances carry redundant communications systems, including hardwired and portable radios, pagers, cell phones with multiple wireless carriers, GPS and a ReddiNet screen, to ensure effective response and efficient patient transport. Medix strives for continuous improvement and the company's vehicles are no exception. Medix has purchased loll mobile data terminals and other field data collection technologies for implementation under the new Tustin Contract. THE MEDIX COMMITMENT TO EDUCATION The Medix commitment to education is demonstrated in the company's comprehensive continuing education and training programs. Employee education at Medix takes that extra step. . Highly trained to operate the company's custom ambulances, Medix drivers also learn how to operate the automatic electronic defibrillators the vehicles carry. . State-certified Medix EMTs undergo Paramedic Assist Training. . Medix BLS crews are trained to assist Medix CCT teams during routine CCT calls. . Clinically advanced Medix caregivers receive education regarding the special needs of Alzheimer and trauma patients and children. Medix will offer education benefits directly to EOA #23 communities by serving as an American Heart Association Community Training Center and a basic level First Aid Training Center for the American Red Cross. MEDIX COMMITMENT TO THE COMMUNITY A commitment to the community lies at the heart of the Medix mission. Medix considers corporate citizenship a duty and community service a privilege. In 2003 alone, Medix participated in and/or sponsored more than 300 community events and educational programs, donating more than $500,000 in financial and in-kind contributions to the quality of life in Orange County. Focusing on illness and injury prevention, Medix has produced two (2) television public service announcements and the award-winning MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 65 television program Close Call: Orange County's Emergencies. THE MEDIX COMMITMENT TO DISASTER PREPAREDNESS The Medix mission is reflected in the company's high level of disaster preparedness. Medix maintains a fully operational back-up communications center and now a fully equipped Mobile Communications Unit. Medix offers the OCF A a Field Supervisor Unit that can serve as a mobile command post. Medix provides three (3) Major Incident/Disaster Response Vehicles and proposes to deploy up to five (5) for the new contract period. Medix EMTs receive HAZMAT and First Responder Awareness training through the California State Technical Institute. Medix is currently providing Incident Command System training for all field employees, managers and supervisors through the State Fire Marshal's office. MEDIX MILESTONES . In 1978, the first Medix ambulance was licensed for emergency service by the California Highway Patrol. . In 1978, Medix was awarded a Certificate of Public Convenience and Necessity by the Santa Ana City Council. . In 1979, Medix began performing Advanced Cardiac Support Mobile Critical Care Transportation services for Orange County. . In 1982, Medix became the first ambulance service granted a Certificate of Public Convenience and Necessity by the Orange County Board of Supervisors. . In 2003, Medix became the first ambulance provider in Orange County to implement driver simulator training. . In 2003, with the help of the OCFA, Medix initiated production of the first episode of the injury and illness television series Close Call: Orange County's Emergencies. . In 2004, Medix broadcast Close Call for the first time. . In 2004, Close Call: Orange County's Emergencies won a national injury and illness prevention award at the 2004 EMS Today National Conference. . In 2004, Medix initiated ICS training for employees, managers and supervisors. . In 2004, Medix updated the communications center at Medix Headquarters in Mission Viejo, installing new Pentium computers and four (4) new consoles, each with four (4) new, large flat-screen monitors. . In 2004, Medix received delivery of Medix Unit 2500, a highly advanced mobile communications vehicle. . In 2004, Medix ordered thirty (30) new Type III units for delivery through January of 2005. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 66 MAJOR ACCOMPLISHMENTS Medix is the oldest and largest operator of the Horton Type III Modular Rescue Ambulance in Orange County. Medix was the first company to bring the walk-around CPR seat/wall cabinet configuration ambulance design specification to Orange County. Medix designed and built the first neonatal/intensive care ambulance ever used by Children's Hospital of Orange County. Medix provides Orange County the only available Major Incident/Disaster Response Units. Medix is the only ambulance service ever to have been awarded a Certificate of Public Convenience and Necessity for all levels of medical transportation. Medix became the first ambulance service ever to be contracted with Disneyland and to have an actual office inside the park grounds. Medix continues to realize at least ninety-five percent (95%) compliance on Code 3 responses and over ninety-eight percent (98%) compliance on Code 2 responses system-wide and in each of the company's nineteen (19) Orange County ASAs. MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 67 ITEM 20: CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of Medix Ambulance Service, Inc. ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that Bidder is not, and will not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a contract and if authorized to perform the services described in this RFP. Signed, this 10th day of Mav, 2004 in Mission Viejo. California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP JPA or mer er : Signature of Partner (General Partner) Date Print Name IF CORPORA~~1/ Q~ Signature of President . / Michael Dimas May 10, 2004 Date Print Name Signature of seJ~ fj"""", May 10, 2004 Date Joanna Dimas Print Name MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 68 ITEM 21: STATEMENT OF TRUTH The undersigned hereby certifies on behalf of Medix Ambulance Service. Inc. ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that the information provided by Bidder and contained in this 2004 Fire/EMS Emergency Ambulance Transportation and Related Services RFP is accurate, complete, true and correct to the best of our knowledge. We are aware that should any of the information contained herein be found to be false, incorrect or otherwise untruthful, or if the information contained herein contains material misrepresentations and/or material omissions of fact, OCFA may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option of OCFA, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and/or to declare any contract awarded as the result thereof void. Signed, this 10th day of May, 2004 in Mission Viejo. California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP JPA or mer er : Signature of Partner (General Partner) Date Print Name IF CORPORA~~ 1/ {}:L:... Signature_otPresident.~_L .,- ------- - Michael Dimas May 10, 2004 - ,...... ---...-...---'" ----P-...-.........-- Date .....-._u.... -.. Print Name - . Signature of seJ~ fj ~ May 10, 2004 Date Joanna Dimas Print Name MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 69 ITEM 22: NON-COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of Medix Ambulance Service. Inc. ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that this 2004 Fire/EMS Emergency Ambulance Transportation and Related Services RFP is genuine and not sham or collusive, nor made in the interest of or on behalf of any person not herein named; the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a sham proposal nor solicited any other person, firm or corporation to refrain from submitting a proposal; the Bidder has not communicated, directly or indirectly, with any other Bidder regarding the amount, price, and/or service rates proposed herein; and Bidder has not in any manner sought by collusion to secure for himself/herself/itself any advantage over any other Bidder. We declare the foregoing is true and correct under penalty of perjury under the laws of the State of California. Signed, this 10th day of May, 2004 in Mission Viejo. California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP JPA or mer er : Signature of Partner (General Partner) Date Print Name IF CORPORA~~1/ G~ Signature of President. . I Michael Dimas May 10, 2004 . Date Print Name S i 9 nature of SfJC8. ~ fJ """"'" May 10, 2004 Date Joanna Dimas Print Name MEDIX AMBULANCE SERVICE RESPONSE TO OCFA RFP #RL972 Page 70 Tustin Cowan LemonHei hts . "',' ITEM 5: TOTAL NUMBER OF AMBULANCES ( supplement) EOA # 23 - City of Tustin Other Proposed Regional Units that will be Available to Reasonably Support this EOA: Unit # Chassis Model Year Milea e Condition T Location 56 Ford E-350 Horton 2000 122,408 Excellent III Laguna Hills Modular Lake Forest/Moulton Pk 53 Ford E-350 Road 1998 162,195 Excellent III Laguna Hills Rescue Lake Forest /Moulton Pkwy Mod In the unlikely event for the need of a third tier of available support vehicles: Unit # Chassis Model Year Mileage Condition Type Location 54 Ford E-350 Horton 1999 138,522 Excellent III Aliso Viejo Modular Glenwood Dr./Aliso Creek 58 Ford E-350 Leader 2001 122,408 Excellent II Irvine 5 Fwv / Jeffrey A visual reference of the locations of the secondary back-up-support vehicles can be found in ITEM 3: OPERATIONAL SYSTEM DESIGN - Service Coverage & Assigned Ambulances. A map is provided to illustrate the relative locations of these noted ambulances. These back-up ambulance locations are based on the ambulance assignments for our current Contract Agreements. These locations may vary slightly upon award of Contract Agreement for RFP #RL972. DOCTOR'S AMBULANCE - RFP #RL972 ~ ....--- 1/ ~ Bruce W. Herren Owner/CEO Doctor's Ambulance 1.~~ President Doctor's Ambulance 23091 Terra Drive. laQuna Hills. California 92653 . Tel: 949.951.6600 . Fax: 949,951.2891 , .., , ~ ' , I "'¡\' 1""-!!O'.>J\~'~ ,1'\ I ,¡ """~1t0!-,1"'I,!:.:~."f"I""^"'J-""'I¡;"""T"""'.!,J"':)¡,,¡]"'" . <...."",.J..4~~'l';~n~':¡iI~;/O,""J.."':1""\,;J.H"".""".iJooi>'l'""J~:I'~Y'I[fi¡~;::...\¡,.IH\l1~¡¡"'" ::":." ,.~ \>1 :;<{ {\ :n \) '\"1 ~J I) Xi ',\j \: :'¡ ':-,4 <\) 'ì) '\! t\) \j "iI .{, .,1 :1 .:1 \¡ ii-- - ~/ if' -' "" ¿? ""'" ~: ~ '": r. '" -,,~ "'-22 P"- ~ ¿ ¿:?22i ~ == ~ ~~~~:fOf" Ç\CI~\~'C;'~:~( (...' ~,@oíDJ. W, .. " :,..',1 'i I I "'" , '" "I, Vi,. u-:.,.n 'I.. .,': On ~1,'",:~; \ \. ! ,Y Celt before me ,'",) Lì\j:;\;.~, i; \ L\\/,',':', î\_( \¡: \ i ¡\(\, , ";1 "-', ',' , ""',',' , ',",OW --'~'.'; " ."",_...,1; , ),DATE ,.- 'N.AME. TITLE OF OFFICER. E.G,,' JANE DOE. NOT AA'!', PU8ÙC' ' " personally appeared L,~L"-~ (ç ~\: \-\(1 \} C \., \l~;' \~j, --¡ \£\\.i~~" \1" .,}';:::: , ", ,'----C ,,-2! NAME(SI OF SIGNER(S) .. ' I,' '/- \.., r '-"'~': O--per-senaHy--kAGWA-,te-me .. OR -JSt~roved to me on the basis of satisfactory evidence> // to be the person(s) whose name(s) tsíâ~'-' subscribed to the within instrument and'ac- knowledged to me that Re/sh~ltfl'eÿ~ executed the same in his/heðthe¡¡:-~ã"uthorized '-- /.,--"'--. capacity(ies), and that by h+s-ffl-eil.their, signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. r:a¡.~ r 5YLVI ADLER & (I) COMM...1366280 (l ~ '. NOTARY PUBUC.CALIFORNIA - m ORANGE COUNTY W a . MYTermExp,AUGUST13.2~ ~~---~-- --' ITEM 4: EMERGENCY RESPONSE and VEHICLE COMMUNICATIONS SYSTEM (supplement) Doctor's Ambulance will be compliant by the Effective Date of this Contract Agreement with all communications requirements set forth in Section IV of this RFP #RL972. Additionally, as OCFA upgrades its emergency response communications systems with new or improved technologies, Doctor's Ambulance commits to likewise upgrade our Emergency Response Communications System with comparable and compatiblè technology at our sole cost and expense. The following Doctor's Ambulance personnel are, and will be, devoted to the function and integrity of the communications system and its operation. All Doctor's Ambulance dispatchers achieve Emergency Medical Dispatch Certification (EMD): "'j""" Michael Liebe, EMT Jennifer Kazeck, EMT Michael Corcoran, EMT Aaron Rosen, EMT Dan Lancaster, EMT Jonathan Mattson, EMT Tim Lan ham, EMT Alex Landa, EMT Mike Herren, IT 'iti'."""':""""""';"""";;"""';-'E'Nlia"::,;,,. , O"'n",':,T""",,,,+,,,);,,',',",i,"":',",",';,".' , .".; .:.,..:",t:',1':.".,".,.T,.,;f:'-.'.".<~, Dis atch Supervisor 12/ 04/2004 Dis tacher 01/31/2005 Dispatcher 12/04/2004 Dis atcher 01/29/2006 Lead Dispatcher 12/04/2004 Dis atcher In rocess Dispatcher 01/29/2006 Dis atcher 01/29/2006 Information T echnolo MSCE 'êWtWii':,t),åtê¡;)¡¡~~êií$)'ôf$êJvJçêC ' 4 rs 3 mo 4 rs 10 mo 3 rs 4 mo 3 rs3mo 3 rs10mo 3 rs10mo 2 yrs 3 mo 2 rs 3 mo 2 yrs 2 mo As has been demonstrated to date, Doctor's Ambulance is committed to acquiring the equipment, supplies and personnel deemed necessary by the OCFA for the performance levels required by it's Contract Agreement. DOCTOR'S AMBULANCE - RFP #RL972 ITEM 13. A: ASSIGNED PERSONNEL PROFILE . . . .. . -..... . . .. - Agrelius, B 14548 6/30/04 1131/06 1/26/06 567774478 6/30/04 7/14/05 X 7/14103 10mo Armstrong, N 61494745 3/31/06 1/17/05 555979760 8/31/04 8/12/05 X 8/11103 9mo Balsz, R B1428169 3/31/05 6/18/04 6/8/07 559754687 10/31/04 2/11/05 X 2/10/03 1yr 3mo Carlson, C 61385180 3/31/04 9/30/05 5/12/08 618037304 2/28/04 5/9/04 X 5/8/02 1yr Clifford, R 622344954 9/4/05 10/12/04 622344954 9/30/04 11/6/05 X 11/3/03 7mo Conner, 6 547399637 5/31/04 11/6/04 3/13/05 547399637 2/28/05 11/6/05 X 11/3/03 7mo Da Costa, I 624301297 10/31/04 4/30/04 9/18/08 62430129 12/31/03 1/14/05 X 1/13/03 1yrSmo Edgar, D B1442392 3/31/05 3/31/05 602202605 2/28/05 7/14/05 X 7/14/03 10mo Edmonson, C 6GFAW4H 6/30/04 5/31/04 2/9/06 552958097 11/30/03 1/31/04 X 10/23/00 3yr7 mo Emter, D 16090 5/31/05 6/1/04 6/4/05 603222015 8/31/04 6/1/04 X 8/11/03 9mo Fix, J 31008A 5/31/04 1/31/06 10/4/07 561958281 5/31/04 8/21/04 X 8/20/02 9mo Gillespie, 0 569831825 6/30/04 4/30/05 11/24/07 569831825 6/30/04 11/30/04 X 11/18/02 6mo Gray, J 609347790 3/31/05 4/30/05 5/15/08 609347790 3/31/05 4/30/05 X 6/26/00 3yr11mo Harris, K B1501568 3/31/06 4/30/05 570750803 8/31/05 1/5/06 X 1/5/04 Smo Hartman, D 606441351 11/30/05 4/12/05 606441351 11/30/05 11/6/05 X 11/3/03 6mo Hendricks, J 573873619 7/31/05 1/2/06 573873619 7/31/04 7/14/05 X 7/14/03 10mo Hicks, R 620092351 1/31/06 1/31/06 1/2/06 620092351 1/31/06 1/6/05 X 7/13/01 10mo Hildenbrand, J 571992872 9/30/04 8/31/04 8/12/07 571992872 9/30/04 1/14/05 X 1/13/03 1yrSmo Holley, J 554891262 12/31/05 3/31/05 554891262 12/31/04 4/30/05 X 3/24/03 1yr2mo Johnson,K 302889336 8/31/04 4/30/04 2/2/06 302889336 12/31/03 8/20/04 X 8/20/02 9mo Lauderdale, J BHOU7 JU 1/31/05 12/31/04 571350620 8/31/04 12/31/04 X 7/28/03 10mo Lilly, G 621685326 6/30/04 1/31/06 11/28/07 621685326 6/30/04 6/19/04 X 6/19/02 1yr11mo Lindenberg, F B1492315 3/31/06 8/31/05 8/31/04 519048311 8/31/04 1/5/06 X 1/5/04 Smo Lopez, B 554851135 2/28/06 3/1/06 7/21/05 554851135 2/28/06 11/19/05 X 11/18/02 1yr6mo Lowery, S B1485448 3/31/05 2/28/05 231371832 8/31/04 9/23/05 X 9/22/03 8mo Lucas, M 553393509 9/30/05 6/30/04 553393509 9/30105 5/31/05 X 5/12/03 1yr Mattson, J 493902767 3/3/05 11/30/04 10/21/05 3629417 3/31/05 2/21/05 X 7/10/01 2yr10mo McConachie, C RE7260 2/23/03 8/31/05 6/20/07 546935039 1/31/05 2/11/05 X 2/10/03 1 yr3mo Meza, S 563678303 1/31/05 9/30/04 1/27/06 563678303 1/31/05 1/31/05 X 12/5/01 2yr6mo Miranda, E 604017329 9/3/05 10/31/05 604017329 1/12/05 1/5/06 X 1/5/04 Smo ITEM 13. A: ASSIGNED PERSONNEL PROFILE Nguyen, T BGRQS2U 1/31/05 12/31/04 2/22/06 563898460 6/30/04 7/14/05 X 7/14/03 10mo O'leary, R 566818106 8/31/05 2/28/05 566818106 8/31/05 8/12/05 X 8/11/03 91110 Oxford, J BJOQXHB 6/30/04 6/30/04 11/26/08 618429995 6/30/04 4130/05 X 3/24/03 1yr2mo Park,D 621161610 6/30/05 6/30/04 1/26/07 621161610 6/30/05 7/29/05 X 7/28/03 10mo Portet, T B1435932 3/31/05 4/30/05 12/6/06 551992566 2/28/04 6/16/05 X 6/16/03 11 mo Porto,M BJ16341 1/31/05 12/31/04 605228161 11/30/04 7/29/05 X 7/28/03 10010 Reade,C BJOQSUC 9/30/04 1/31/06 6/13/07 618425228 9/30/04 11/19/04 X 11/18/02 1yr6mo Reans,D 614141162 8/31/05 5/1/05 614141162 8/31/05 11/6/05 X 11/3/03 6mo Reed, A B1367512 3/31/04 9/30/04 10/21/05 3629417 12/31/03 9/23/05 X 12/20/01 3yr4 mo Sato, K ZOOO026A 9/30/04 6/30/04 10/25/07 ZOOO0226A 9/30/04 9/19/04 X 9/18/02 1yr8mo Schlice, G BGL1EEL 12/31/04 11/30/04 557890004 7/31/04 9/29/05 X 7/28/03 10mo Shank,D 559951396 10/31/04 11/30/05 1/31/06 559951396 11/30/05 7/29/05 X 7/28/03 10010 Sigler, J 559512383 1/31/06 11/30/05 559512383 1/31/06 1/5/06 X 1/5/04 51110 Siino, M 566952273 5/31/05 9/30/05 8/16/07 566952273 5/31/04 6/16/05 X 6/16/03 11 mo Spiker, C BGXC972 12/31/04 1/31/05 569779426 8/31/04 7/14/05 X 7/14/03 10mo Thorn, G 555953130 9/30/04 3/5/06 12/28/06 555953130 5/31/04 7/14/05 X 7/14/03 10010 Thompson, J 17165 8/31/05 9/30/04 10/27/07 607300071 8/31/04 11/19/04 X 11/18/02 ()mo Thorn,W 621124313 8/31/05 12/17/05 3/29/07 621124313 8/31/04 1/5/06 X 1/5/04 5mo Toohey,P 614222389 8/31/05 4/30/05 614222389 8/31/04 9/23/05 X 9/22/03 8010 Valdivia, M BGNUG29 4/30/05 4/30/05 4/14/06 560873545 9/30/04 8/12/05 X 8/11/03 9010 Valladares, P 625342043 9/30/04 4/30/04 3/27/04 625342043 9/30/04 11/19/04 X 11/18/02 1yr6mo Veires, J RE8391 8/31/05 7/31/05 9/14/08 611074062 9/30/04 9/23/05 X 9/22/03 8mo Vitolo, G 14611 5/31/05 2/28/05 6/30/08 546778257 5/31/05 5/12/05 X 5/12/03 1yr Winters, R BBGT2D2 10/31/04 3/30/05 386763170 4/30/04 2/20/05 X 7/24/00 3yr10mo Woolgar, J 614240170 3/31/05 9/10/04 9/9/06 614240170 3/31/05 6/16/05 X 6/16/03 11 mo Young, T BJSS79R 8/31/04 817104 564993337 7/12/27 8/12/05 X 8/11/03 9mo BID PROPOSAL DEPOSIT Below is a copy of the Bid Proposal Check in the amount of $2,500 which has been submitted under separate cover as part of this response. ",.n". .,~ ..:.18" '."0' II 0 "" ~I' ....... ""..,n,.." 0 ; ~":I" .'0' II." "111"'," """.'1""""'."""""""1'1.1"".."""","""". ..~"" I ;'" .;. ,;." \1'1 ".;",;;., .111. ,".. ""'" .It". ~ll PACIFIC ,. MERCANTILE ,....--- BANK 501 N. EI Camino Real Suite 100 San Clemente, CA 92672 (949)498-1804 CASffiER'S CHECK 20022750 May 04, 2004 9Q-4286/1222 ¡ , PAY Two Thousand Five Hundred And,.oOll'OO iì******************** I ,~ ~fr b~~~ *****ORANGE COUNTY FIRE AUTHORI~u~!tÐ!r$'1",>"~ . OF , .. /~.. ~_... , CdÜ/ZJ;IJicti ö $2,500.00 .: ¡ , ~ ' ...-JlIemo BIDS PROPOSAL DEPOSIT / , "'- ~t n 11"2002275011" 1:.222L,28(;!:j1:(;.00.00C¡811" 500 :'~'>:::,;::.::fi~ ,.,,;:,.' .','".. ',.-"" " ,.." """'Õ,\ \",.,"",,) " . DOCTORS AmbulanCE TABLE OF CONTENTS ITEM 1 ITEM 2 ITEM 3 ITEM 4 ITEM 5 ITEM 6 ITEM 7 ITEM 8 ITEM 9 ITEM 10 ITEM 11 ITEM 12 ITEM 13 ITEM 14 ITEM 15 ITEM 16 ITEM 17 ITEM 18 ITEM 19 ITEM 20 ITEM 21 ITEM 22 ITEM 23 Cover Letter Prequalification Notice Overall Operational System/Program Design Emergency ResponseN ehic1e Communications System Total Number of Ambulances Service Rates On-Board Equipment and Supplies Response Time Requirements Vehicle and Equipment Maintenance Program Driver Training Internal Medical Quality Control Mutual Aid Provider Personnel and Training Billing and Collection Practices HIP AA Compliance Plan Corporate Compliance Plan Compliance with Monthly Payments Plan For Takeover of Services/Start Up 9-1-1 Fire/EMS Resume Conflict of Interest Certification Statement of Truth Non-Collusion Certification Photographs DOCTORS AmbulanCE May 10, 2004 John K. Howlind, Battalion Chief Orange County Fire Authority/EMS Section 1 Fire Authority Road Irvine, CA 92602 Re: RFP #RL972 - Phase n Greetings ChiefHowlind and Grading Panel Members: We are grateful for this opportunity to participate in Phase n ofRFP #RL972. We are equally excited about showcasing the history, pro-active community involvement and demonstrated performance reliability of Doctor's Ambulance to substantiate our case that Doctor's Ambulance is a perfect fit for the City of Tustin. We welcome this new RFP format as a return to concise, no-ftills proposals that focus on substance and documented performance. I commend Chief Hovvlipd ()n11Ï~tÏ1'el~§,§.~ffQrt to devise and produce an RFP format that is fair to all and, facilitatèsthe grading panel's' älièady daunting RFP review process. Doctor's Ambulance is proud of the IDaIly~businessàn.d. indllstry accomplishments we~ve achieved during our 30 years of providing emergency medical traI1SpQrtatio11. in OråD.g~ çQtlnty. Our close collaboration with the Oran.ge COlmtry Fij:'e Auth()rity through the years bashèlped~Ûs successfully evolve with the complexities of IIlöderndayeIIlergency response. The attachments to- this cover letter provide tl:1einformationrequiredf()rItein.l.():fthisRFP. Once you have reviewed our proposal in its entirety, I believe yoU-will agr~èthatDoctor's Ambulance is the right choice for the residents, businesse§and visitors oftheÇity of Tustin. On behalf of Doctor' s Ambulance, I thank you for your thoughtful considerati()Ilof ourpr()po§al! ,- . . - ., .' ..., Respectfully, ~ President - __"n_____---"-"- 23091 Terra Drive. Laguna Hills. California 92653 . Tel: 949.951.6600 . Fax: 949.951.2891 www.drsambulëlnèe.corn ITEM I: COVER LETTER DOCTOR'S AMBULANCE SERVICE Qualifications and Information i). The official name of the Bidder: Herren Enterprises, Inc. - dba: Doctor's Ambulance Service ii). The Bidder's organizational structure (e.g. corporation, partnership, limited liability corporation, or otherwise: Herren Enterprises, Inc. - dba: Doctor's Ambulance Service is a California Corporation iii). The jurisdiction in which the Bidder is organized and the date of such organization: California County of Orange - April 1, 1974 iv). The address and telephone number of the Bidder's headquarters and of any local office involved in the bid proposal: Doctor's Ambulance Service 23091 Terra Drive Laguna Hills, CA 92653 (949)951-6600 Fax (949) 951-2891 v). The Bidder's Federal Tax Identification Number: Federal ID #95-3327978 vi). The name, address, telephone, fax numbers and e-mail address of the person(s) who will serve as the authorized contact(s) to the City and OCFA with regards to the bid proposal, the RFP process, the Contract Documents and the administration of the contract, if awarded, with authorization to make representation on behalf of and to bind the Bidder: James V. Ignacio, President 23091 Terra Drive Laguna Hills, CA 92653 (949) 951-8535 ext 206 fax (949) 951-2891 Jignacio@doctorsambulance.com Bruce W. Herren, Owner-CEO 23091 Terra Drive Laguna Hills, CA 92653 (949) 951-8535 ext 215 fax (949) 951-2891 Bb erren@doctorsambulance.com vii). Provide applicable authorized signature documentation, pursuant to Bidder's organizational structurelbylaws, verifying the authority of the person signing the original bid proposal to commit to the proposal on behalf of the Bidder: DOCTORS AmbulanCE ITEM I: COVER LETTER The following individuals are authorized to sign the original bid proposal and commit to the proposal on behalf of the Bidder: Jam~- viii). A representation that the Bidder is in good standing in the State of California and has obtained all necessary licenses, permits, certifications, approvals and governmental authorizations necessary in order to perform all of the required performance obligations specified in the RFP: ~~~ Bruce W. Herren Doctor's Ambulance is in good standing with the State of California and has all necessary licenses, permits, certifications, approvals and authorizations necessary to perform the obligations of this RFP. ix). A representation that the Bidder is on good standing in the Medicare and Medi-Cal programs and is not the subject of any pending actions, investigations or prosecutions, whether civil, criminal or administrative, relating to their billing or reimbursement practices, and that Bidder has not been excluded from any state or federal healthcare program or employs any individual who has been excluded from any state or federal healthcare program: Doctor's Ambulance is in good standing in the Medicare and Medi-Cal programs and is not subject to any pending actions of any sort. Doctor's Ambulance has not been excluded from any state or federal healthcare program, and does not hire individuals who have been excluded from said programs. x). Statement of acceptance of all terms, conditions, requirements and performance criteria contained in the Contract Documents: Doctor's Ambulance accepts all terms, conditions, requirements and performance criteria contained in the Contract Documents with NO EXCEPTIONS. xi). Any additional information Bidder deems relevant for consideration during the selection process: Doctor's Ambulance has achieved many business and industry awards in its 30 year history. We are particularly proud of being recognized by Chapman University in conjunction with the California State Senate and Assembly with the "Ethics in America Award," the "Large Business of the Year" awarded by the six cities represented in the South County Chambers of Commerce, and the "Spirit of Philanthropy - Corporation of the Year" award from the Saddleback Memorial Foundation. ! DOCTORS AmbulanCE ITEM I: COVER LETTER Doctor's Ambulance is also especially proud of achieving national accreditation by the Commission on Accreditation of Ambulance Services (CAAS). Fewer than 200 ambulance companies nationwide have successfully passed the stringent guidelines and on-site survey by nationally recognized industry experts required for this recognition. Please visit our website www.DoctorsAmbulance.com for narratives, film clips and details about our company. DOCTORS AmbulanCE ITEM 2: NOTIFICATION OF PROVIDER PREOUALIFICATION ORANGE COUNT\:' FIRE AUTHORITY P.O. Bo, 8(>, Oratl~c.. CA 928%-9086 . i 45 South W3lcr St., ()ran~c, CA 92861>.212J Chip Prather, Fire ChIef (7 ì4) 744-0400 www,ocfa.org February 19,2004 Mr, James Ignacio Doctor's Ambulance Service 23091 Terra Drive Laguna Hills, CA 92653 Dear Mr. Ignacio: Congratulations, Doctor's Ambulance Service has successfully met aIJ the minimum requirements necessary to compete in the Orange County Fire Authority RFP. This approval is contingent upon verification of information provided in your Prequalifications Package. and required insurance levels established, You will be advised when the RFP is finalized and available on our Internet site (www,ocf\ic,t,!r:g), After your review of the RFP. you.will be required to attend a mandatory pre-bid conference to continue in the process, When you submit your proposal. please include this letter of confim1ation of your successful qualification in your submission. Again. congratulations' We sincerely appreciate your interest in continuing to provide outstanding ambulance services to the citizens of Orange County. Respectfully, (~"'(-~ y John K. Howlind. Battalion Chief Emergency Medical Services Sectíon JKH/np ,'. \.",-,.~:::¡:"I.,..\:';:: ~::'-.!~' 1~.:,I~:;~~,::~:~:::;,;;t~~~~~~,,~1~~:~;::'.)":"~~::;'):'"I;~~;:;:;e~::~:<~~'::;~~~::'~':';:~::': '~~~:::::\~~::,,:,I :'~~,:,'::O:\',;.;: ~::;','" ""'""""1'1 \I "1'~I"'" FR" ,"I) "'HIKF nFTFI'TOR" "~\'F 11\'1'" DOCTORS AmbulanCE ITEM 3: OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN Doctor's Ambulance utilizes a modified System Status Management plan designed to ensure consistent and reliable response time performance over maximizing productivity. We call this our Resource Deployment Plan, which we develop for each Exclusive Operating Area assigned to Doctor's Ambulance. Doctor's Ambulance will dedicate two (2) Type III Modular ambulances for service in the City of Tustin when awarded the Contract Agreement for the City of Tustin. Each of these two emergency response vehicles will be staffed by two (2) expertly trained Emergency Medical Technicians (EMT-l) twenty-four hours a day, year-round with local supervisory and support staff available around the clock as detailed in Item 13B. The following details the existing processes that have enabled Doctor's Ambulance to consistently exceed the response time thresholds of its previous and current OCF A assigned service areas. This same documented performance will be implemented for the City of Tustin. SYSTEM STATUS MANAGEMENT Ambulance providers typically choose a strategy for deploying their ambulance fleet based on their resources and business plan. Strategies range from assigning each ambulance to a permanent home base where it stays until dispatched to a call, to automated deployment systems which utilize various deployment plans based on the number of calls and units available. Matching the production capacity of an ambulance to the changing patterns of demand placed on the available fleet is typically referred to as System Status Management (SSM). If the emphasis of a particular SSM plan is to maximize productivity, it usually does so at the risk of subjecting employees to undue fatigue. Street corner or parking lot posting, excessive post-to-post maneuvering and constantly varying work schedules are all characteristics of this type of SSM plan. This is not how Doctor's Ambulance utilizes its resources. Doctor's Ambulance develops a Resource Deployment Plan (RDP) for each Exclusive Operating Area (EOA). Th~ foundation of this RDP is fixed sÜltion locations (rented or leased offi~~space) and event-driven redeployment post locations. The fixed stations (which are located throughout south Orange County) are utilized as much a possible, particularly during evening and night hours. These stations provide each two-man crew on 24-hour assignment a facility where they can relax in a comfortable environment and rest/eat/sleep/shower when duty allows. ~ ~_. ~_. ..... .... Event-driven redeployment posts are utilized during peak load conditions when ambulances must relocate to cover portions of adjacent regions when the ambulance assigned to that particular area is dispatched to a call. This RDP outlines specific strategic deployment of ambulances based on time of day and day of the week. This plan also provides move-up protocols when one or more ambulances have been dispatched to a call for medical aid. DOCTORS AmbulanCE ITEM 3: OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN RESOURCE DEPLOYMENT PLAN RESEARCH AND DEVELOPMENT Using computerized historical data, we are able to evaluate the daily ambulance utilization in the communities we serve. The development of our plan takes into account various factors which include response location, time of response, plus 9-1-1 system requirements and local medical facility location, requirements and bed availability. We study and evaluate the area's call volume, response time of day, response day of week, number of canceled calls, particular geographical considerations including road systems, railroads, bridges, areas of construction, and special community events. Additional traffic factors include traffic congestion, natural barriers, weather and the geographic shape of the EOA. To begin the process we prepare a demand analysis chart. Utilizing standard distribution statistics calculations, we are able to determine the average number of requests for each hour of the day and each day of the week. Thro.ugh statistical modeling, we are able to develop criteria for station locations, ambulance shift locations and duration and additional resource needs during peak hours.W e are also able to determine how many ambulances are to be staffed to continually exceed the response time requirements for each hour of each day of the week. DEMAND PATTERN ANALYSIS After reviewing all available statistical information, we will conduct a demand pattern analysis. Through this analysis we are able to accurately determine the most efficient post locations within each area which will result in complete area coverage and the best possible response time performance. We will then determine a staffing plan which will result in surplus ambulance coverage for each area. This staffing plan will utilize a combination of 24-hour regular shifts and eight-hour peak load staffing shifts. Our peak load staffing utilizes shift schedules and staffing that match deployment to increased demand. More units will be required on the road during periods of predictably higher demand, and vice versa. For example, during rush-hour traffic congestion more units are required for coverage than periods with identical demand but little or no traffic. Our peak load staffing, use of fixed stations and dispatching methods are designed to prevent fatigue that may possibly prevent our employees from otherwise functioning at peak performance. These factors all lend to our ability to consistently exceed response time r~qllir~ments. ESTABLISHMENT OF PERMANENT POSTS Doctor's Ambulance is committed to continuing our policy of establishing stations as permanent posts within each of our EOAs. Establishing stations is essential for response time performance, employee job satisfaction and overall safety. Doctor's Ambulance currently has a permanent post in the City of Tustin. DOCTORS AmbulanCE ITEM 3: OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN EVENT -DRIVEN REDEPLOYMENT Our RDP specifically addresses event-driven post-to-post movement. Geographic patterns of demand for ambulance service can cycle widely on a weekly basis with the movement of people and changing patterns of traffic behavior. Cyclical patterns of geographic demand distribution, as well as changes in patterns of traffic congestion, require redeployment strategies that are closely monitored to meet the need for medical aid. To maintain proper ambulance coverage, our policy is to send emergency ambulances to strategic cover locations during times of increased system demand. In other words, if an ambulance in a particular EOA is dispatched to a 9-1-1 request, our Emergency Communications Center immediately follows up by relocating an available ambulance to a predetermined post to provide back-up coverage for that area. FLEET SIZE DETERMINATION Peak load staffing data is instrumental in the development of an optimal fleet size. Ambulance industry standards suggest that a company maintain a fleet size that is 125% of the maximum amount of vehicles needed during times of peak load. Our operational policy, however, is to maintain a fleet size standard of 150% of peak load staffing. This enhanced fleet size standard provides for routine repairs and maintenance of all vehicles in a timely manner without compromising our required ambulance coverage for any specific area's patient services. PLAN IMPLEMENTATION. MONITORING AND RE-EV ALUATION Once an RDP is implemented, ongoing monitoring and re-evaluation is conducted in order to maintain the outstanding response time performance that continues to be the trademark of Doctor's Ambulance. Our SSM program is a dynamic plan that can be modified when needed to address occurrences in the systems that are identified as non-compliant with the response time objective of the RDP. Our Computer Assisted Dispatch (CAD) system gives us the capability to quickly retrieve stored data such as out-of-chute times and on-scene times. RESOURCE DEPLOYMENT PLAN This sample demand analysis chart represents a six-month time frame. This chart illustrates the number and time of day of calls received on Tuesdays. There is a similar chart available for every other day of the week. The 50% value is the average number of calls received. The 90% and 95% values are the values at which 90% and 95% of the number of responses fall below this value. The MAX is the maximum number of calls to be received in that time of day. Adjacent to the demand analysis chart is our staffmg plan for the same time period. This chart shows the number of actual units being staffed for this sample EOA plus backup units from our surrounding areas. DOCTORS AmbulanCE ITEM 3: OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN I . " , I I . I . I. 110m" , \ IImht", of Rt'slHlnst's Pt. "('t'ntik I 50'y,.--¡ ... -- -. ... ... ... -. ... -. ... l ) ~ 90% i 95'1'.. . I' ': . . I . I. Bast' ~, Pt'ak I~oad & Bal'k- up 0.23 1.26 1.55 0.23 0.77 0.92 0.15 0.06 0.75 0.15 0.74 0.90 0.23 0.88 1.06 0.31 1.08 1.30 0.38 1.19 1.41 0.46 1.27 1.50 0.73 1.89 2.21 10 0.50 1.46 1.73 3 10 3 7 11 0.73 2.13 2.53 5 11 3 7 12 1.00 2.74 3.23 5 12 3 7 13 0.85 2.16 2.53 3 13 3 7 14 1.00 2.23 2.58 3 14 3 7 15 0.81 2.14 2.52 4 15 3 7 16 0.92 2.04 2.36 3 16 3 6 17 0.58 1.59 1.88 2 17 3 5 18 0.58 1.59 1.88 3 18 2 4 19 0.46 1.54 1.85 3 19 2 4 20 0.27 0.84 1.00 1 20 2 4 21 0.65 1.52 1.77 2 21 2 4 22 0.54 1.35 1.58 2 22 2 4 23 0.46 1.48 1.77 3 23 2 4 \1"" 110111' Bast' ~, "t'ak I.oad StaftÏng For example: on Tuesdays, between 9:00 am and 9:59 am, the average number of calls is 0.50, or one call every two days. The most calls on this day and time during the period January 1 to June 30 is three. Ninety-five percent of the time, however, there were 1.73 calls. Our staffing plan for this hour shows that three units are assigned to cover this region with three additional units from neighboring regions for backup. This staffing plan well exceeds our needs and allows us the flexibility to easily exceed response time requirements and additional commitments. I - .. .. .. .. .. .. .. .. i I --- -- --- -- -- -- --- -- -- Through the use of this RDP, service performance can be fine-tuned to meet the specific need of a particular area. Doctor's Ambulance has been successful in utilizing this RDP to exceed the response time requirements in all our current contract areas. DOCTORS AmbulanCE ITEM 3: OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN EMERGENCY COMMUNICATIONS CENTER The success of Doctor's Ambulance in exceeding the response time requirements in its contracted areas is well documented. A key factor in our ability and endeavor to continue this high performance level is the staff in our Emergency Communications Center (ECC). Our dispatchers have the huge responsibility of maintaining smooth coordination, tracking and dispatching of our emergency and non-emergency units throughout Orange County through all hours of the day, while maintaining accurate documentation and entry of all patient data into the integrated CAD system. To ensure a competent and professional crew, all Doctor's Ambulance dispatchers are veteran EMTs who are required to achieve Emergency Medical Dispatcher (EMD) certification, Automatic External Defibrillator (AED) and CPR certification. The equipment found in the ECC also plays a vital role in the efficiency of our dispatch team: ~ OCFA Mobile Data Terminal (MDT) Interface - This is connected directly to OCFA's ECC, allowing for immediate notification of a call from OCF A. It provides all call information including special instructions and subsequent updates. It dramatically reduces time and communication error in dispatching emergency units. ~ GPS NavTrak Fleet Locator System - This system uses satellite positioning technology to locate each vehicle in our fleet (within 50 ft), its direction and speed, and can be used to assist routing. A monitor in our ECC gives easy visualization of our fleet's location throughout Orange County. ~ RaCal@ Digital Voice Log system - This system digitally records all radio and telephone communication coming into our ECC. This recording system allows for recall and review of all communications within our ECC for accuracy and systems management. ~ Battery (UPS) back-up for every computer server in service in our ECC - This provides for maintenance of computer integrity in the event of a power outage. ~ Yanmar Diesel Emergency Power Generator - This generator automatically activates in the event of electrical power outage. It has the capacity to power all computer servers, radio equipment and phone systems involved with the function of our ECC. This generator can supply this power indefinitely or until power is restored. At the completion of each shift every dispatcher completes a compliance report. This report is used to detail any response time exceptions, unusual events or circumstances and verify accuracy of all call information taken during their shift. These reports are reviewed by the Dispatch Supervisor for determination of any warranted follow-up, and QAlCQI or training issues. This dispatch report also documents all calls from public safety agencies regarding service issues, operation concerns or personnel matters and the subsequent notification of the appropriate supervisor or manager. DOCTORS AmbulanCE ITEM 3: OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN THUMBNAIL REVIEW OF DOCTOR'S AMBULANCE OPERATIONS ~ Total number of ambulances by effective date of Contract Agreement: 20 = 12 Type III + 8 Type II ~ Total number of employees by effective date of Contract Agreement: 149 = (95 EMTs) + (8 FTOs) + (12 RNs) + (9 EMDs) + (12 Billing/Office) + (6 Spvrs) + (7 Mgrs) ~ Additional details or direct e-mail link with any supervisor and management staff at Doctor's Ambulance can be accessed at www.DoctorsAmbulance.com: . Third Party Billing and Collection Charles Perry, Office Manager (949) 951-8535 ext 303 . Medical Director Dr. Ramon Johnson (949) 951-8535 ext 209 . Continuing Education Scott Arden, BSN, Director Nursing & Education (949) 951-8535 ext 250 . Driver Training Ron Taggart, Operations Manager (949) 951-8535 ext 227 . Emergency Communications Center Mike Liebe, Dispatch Supervisor (949) 951-8535 ext 208 . Operations Cory Osburn, Director ofOperations/General Manager (949) 951-8535 ext 207 SERVICE COVERAGE - ASSIGNED AMBULANCES Our primary coverage plan for the City of Tustin incorporates two (2) Type III Modular ambulances operating from a central location in the city. These vehicles will operate 24 hours a day, year-round. Red flags on the map below illustrate the existing location of our ambulance station in Tustin and the location of the ambulance cover position in an adjacent area (Culver/5 Freeway) that may be utilized during peak load conditions. Not pictured are ambulances available (2) at Doctor's Ambulance headquarters in Laguna Hills (Lake Forest/5 Freeway). The current location of Doctor's Ambulance Station #2 in the City of Tustin is: 14771 Plaza Drive (Irvine Ave / Newport Ave) DOCTORS AmbulanCE ITEM 3: OVERALL OPERATIONAL SYSTEM AND PROGRAM DESIGN Tustin - EOA #23 '-AmbUlance Station 0 Ambulance Service Area ¡ DOCTORS AmbulanCE ITEM 4: EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEMS Doctor's Ambulance demonstrates our commitment to supporting the OCFA's first responder program by consistently providing first-rate vehicles and equipment for the safe and reliable performance of services required by the Contract Agreement. AMBULANCE FEATURES Vehicles The commitment to purchase only top-notch equipment begins with the acquisition of Type III modular units manufactured by Horton Emergency Vehicles in Columbus, Ohio. Anyone in the industry will tell you that Horton is the gold standard for modular ambulance units. Doctor's Ambulance utilizes the services of the premier ambulance manufacturer in Southern California, Leader Industries, to further customize these ambulances. These additional touches are standardized warning devises and electronics for safety and dependability and benchmarked cabinetry for better familiarization which facilitates timely patient care. Each ambulance is also fitted with a power inverter to provide the capacity to power emergency equipment requiring either l2V or 11OV. Safety Lighting All Doctor's ambulances are outfitted with customized light bars, warning and safety lights manufactured by Whelen Engineering. These lights are of the brightest halogen or LED type, depending on their position and function on the unit. A solid state Unitrol control switch makes for easy one-touch control of these lights and siren modes. These emergency warning and scene lights are designed to be highly visible in day, night or inclement weather conditions. Warning Devices Doctor's Ambulance installs dual siren warning devises on each ambulance for additional public safety. These are the Unitro1480K 100 watt electronic siren and the Federal EQ2B (commonly referred to as a "growler"). This dual siren system, in conjunction with the brilliance of our halogen/LED strobe lights, provides a commanding alert of an approaching emergency vehicle. COMMUNICATIONS SYSTEM 900 MHz Radios Doctor's Ambulanc-e utilizes the extremely relÍable -.r\.1òtòrola Maratrac VHF- 900 MHz Radio Communication System. We have a dedicated radio system located on top of Santiago Peak, at our corporate office in Laguna Hills and also on top of the Laguna Beach Fire Station #2. Because we own our own radio frequency and equipment, these sites allow for the complete unrestricted communication between - all-of our units, paging system ----and- our Emergency Communication Center (ECC). Each site operates independently to provide superior coverage even during periods of high volume such as local disasters. Each radio operates in a coordinated fashion through the use of a special Motorola voting system. This voting system determines which site should be utilized depending on radio signal strength. DOCTORS AmbulanCE -. ITEM 4: EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEMS Doctor's Ambulance will also have in place during the term of this Contract Agreement, hand- held portable radios, the Motorola HT-1000. These units will provide each of our ambulance crews instant communication with our ECC while they are working outside or away from the ambulance. 800 MHZ Radios With approval from the OCF A, Doctor's Ambulance has installed, at our sole cost and expense, Motorola Astro Spectra W -5 800 MHz radios on all of our ambulances. These radios enable firefighters to communicate directly with our responding ambulance crews to relay response times or on-scene location. These radios also enable the paramedic on board our ambulance to communicate directly with OCF A ECC or receiving hospitals while providing pre- hospital care to the patient. Med-1O Radios Doctor's Ambulance's ECC and our ambulances have Motorola CDM-75 Med- 10 radios. This radio provides communications to Orange County Communications Center (OCC) to receive base station information, disaster coordination or vehicle-to-vehicle communications. This radio system adds redundancy to our communication abilities in the event of a local disaster or any catastrophic event. Alpha-Numeric Paging System Each ambulance crew is also equipped with a Motorola AE6 Advisor Elite alpha-numeric pager with voice message and numeric messaging capabilities. This additional redundancy in our telecommunication system further enhances the reliability of our communication capabilities. Cellular Phones Each Doctor's ambulance is hard-wired for cellular phone use (antenna and charging receptacle) utilizing Nokia 3390 cell phones. This provides yet another means of wireless communication available in our ambulance fleet. Dispatch System The cornerstone of our ECC is our state-of-the-art computer assisted dispatch system (CAD), the Zoll Rescue Net Dispatch/Sanitas. This multi-dispatcher station integrates dispatch data, vehicle GPS locator, alpha-numeric paging and billing programs. The instant the data for an emergency call is entered, the pager system is activated which alerts the appropriate ambulance to respond to the call. The CAD system denotes alnongst other data, the location of emergency, type of emergency and time stamps. The integrated GPS NavTrak fleet locator enables the dispatchers to track each unit's pinpoint location as well as direction, speed, -stops and mileage. Management can use the tracking information to analyze route efficiencies and vehicle activity. The CAD system also enables the dispatchers t() relocate or move-up available units as back-up for assigned ambulances on medical aid calls. In the event of a local disaster or any such catastrophe, the Doctor's Ambulance Supervisor's vehicle (Ford Explorer) has the ability to function as a Mobile Dispatch Unit with the same capabilities as our ECC dispatch system. DOCTORS AmbulanCE ITEM 4: EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEMS FIELD DATA COLLECTION Upon the completion of each call, each ambulance crew retains a copy of the OCF A field report and a patient face sheet from the hospital or receiving facility. This information is used to verify and update the information already entered into our Rescue Net Dispatch Program (CAD) system for each patient. The claims processor/billing clerk further edits or verifies the information for each patient for any discrepancies or missing information. This is done utilizing the integrated ZolVSanitas billing program which then generates the proper invoice to bill the appropriate insurance payer or financially responsible party. The quality assurance clerk conducts a random audit/review of this documentation for accuracy and completion. Results are tracked for review at routinely scheduled QA/CQI meetings. INFORMATION TECHNOLOGIES AND SUPPORT All CAD and communication systems are computer driven systems based on Microsoft@ applications. Doctor's Ambulance has a full time MCSE certified technician employed to maintain the integrity and updates for each of these systems. Additional expertise is provided by outsourced vendor Network Support GroupTM based in Tustin. The following outsourced vendors provide maintenance, repair and updates for: Radio System: ComSerCoTM, Inc. Westminster, CA Phone System: Comm WorldTM Orange Coast Anaheim, CA All telecommunication and computer systems within the Doctor's Ambulance organization are maintained at peak operating performance 24 hours a day and are updated or replaced as warranted. DOCTORS AmbulanCE ITEM 5: TOTAL NUMBER OF AMBULANCES Doctor's Ambulance will place two (2) of our TYPE III modular ambulances for exclusive use in the City of Tustin. at strategic response locations within the city, Each unit will display the axiom "Proudly Serving the City of Tustin," Every vehicle in the ambulance fleet of Doctor's Ambulance is purchased (not leased) as new and built to tried and true specifications. To assure the timely ordering, benchmarked manufacture and delivery of new emergency vehicles, Doctor's Ambulance purchases exclusively from the premier ambulance manufacturer in Southern California, Leader Industries, located in South El Monte. These front-line vehicles will be TYPE III Horton/Leader ambulances built to exacting specifications that exceed the conditions and requirements of this RFP. The detailed description of those units will follow later in this item. FRONT LINE AMBULANCES Vehicles that will be assigned as frontline units within the City of Tustin are: Unit # Chassis Model Year Milea2e Condition Type 59 Ford E-350 Horton Modular 2001 99,392 Excellent III 61 Ford E-350 Horton Modular 2003 36,882 Excellent III BACK-UP/SUPPORT AMBULANCES Vehicles that will be providing support/back-up as needed for the front-line units are: Unit # Chassis Model Year Mileage Condition Type 56 Ford E-350 Horton Modular 2000 122,408 Excellent III 54 Ford E-350 Horton Modular 1999 138,522 Excellent III Vehicles to be used in the unlikely event for the need of a third tier of available support vehicles are: Unit # Chassis Model Year Milea~e Condition Type 53 Ford E-350 Road Rescue Mod 1998 162,195 Excellent III 58 Ford E-350 Leader 2001 122,408 Excellent II Doctor's Ambulance maintains afleet size standard of no less that-150% of projected peak load (industry standard is 125%). This ratio of in-service units to reserve units assures a more than adequate number of available emergency response vehicles and uncompromised response time performance. . . DOCTORS AmbulanCE ITEM 5: TOTAL NUMBER OF AMBULANCES AMBULANCE REPLACEMENT PLAN Doctor's Ambulance utilizes a two-stage vehicle replacement plan to assure that only the most reliable and response-ready vehicles remain in service. Front-Line Units While some companies will operate their vehicles for extended years and miles (some at ~400,000 miles) to maximize the investment return on vehicles equipped with expensive (and usually superfluous) whistles and buzzers, Doctor's Ambulance will retire a unit from front-line duty when it reaches; Five (5) years or 1 ì 5,000 miles (whichever comes first). Reserve Units When a front-line vehicle reaches either of these milestones, it is typically then considered for reserve unit status. Depending on the vehicle's service/repair history and general condition, it will either be refurbished and designated as a reserve unit or liquidated. Reserve units will then function for: Two (2) years or log no more than 220,000 miles (whichever comes first). One guideline that Doctor's Ambulance uses to determine whether a vehicle is refurbished for reserve status or liquidated is annual vehicle repair costs. If the vehicles' annual repair cost exceeds 15% of its original purchase price, it will be retired from service. DET AILED UNIT DESCRIPTION On the Effective Date of this Contract Agreement the average age of the vehicles in Doctor's Ambulance Type III ambulance fleet will be 30 months. These Type III dual rear wheeled ambulances feature: ~ A Horton Emergency Vehic1e modular system with extruded web membrane reinforced vertical corner posts and roof rails for unmatched structural integrity and safety. ~ A Ford E-350 chassis powered by a state-of-the-art 7.3L Turbo-Diesel engine. Both Ford components are known for superb durability and reliability. ~ Whel~p. .E~ergency Lighting Systems utilizing both Halogen and LED strobe lights for superior visibility and safety. ~ Air-Ride Suspension for patient comfort and to facilitate patient assessment or treatment by Paramedics. DOCTORS AmbulanCE ITEM 5: TOTAL NUMBER OF AMBULANCES ~ Upgrading Standard Ford systems for additional safety and reliability with items such as super-duty high output alternators, high pressure silicone hoses and clamps, super-duty leaf springs and shock absorbers, all batteries upgraded to 27 class batteries to handle extreme load conditions and Michelin steel belted high performance tires. Special features installed for additional safety and accessibility are: ~ CO (Carbon Monoxide) Detectors in patient compartment for the safety of paramedics and , patients on scene and during transport. ~ Motorola Radios with Dual Control Heads located in both the front cab and patient compartments to facilitate paramedics' communication with receiving hospitals or fire dispatch. ~ Voltage Inverter to power either 12V or 11 OV emergency equipment. ~ Dual Sirens for increased public awareness. These are the Federal Emergency System Model E-"Q"2B electronic ,siren and Unitro1480, both driven through 200 watt speakers. ~ Emergency Battery Backup System for reliable vehicle and equipment start-up. ~ NavTrak GPS Fleet Locator utilizing satellite technology for indicating exact location and direction of vehicles. ~ FasTrak for Toll Road access. ~ Cellular Phone Capabilities to supplement existing communication capability. ~ Basic Life Support, Advanced Life Support and Specialty Care Capabilities. Several ambulances are equipped with hydraulic lifts for transport of Neonatal Incubators or other such equipment. ~ DriveCam@ mounted in each vehicle's driving compartment for driving event analysis utilizing video and software technology. INSPECTION Doctor's Ambulance avails these vehicles and equipment for inspection by the Proposal Grading Panel or the OCF A EMS Section Battalion Chief anytime during the procurement process or term of this Contract Agreement. DOCTORS AmbulanCE ITEM 5: TOTAL NUMBER OF AMBULANCES MAINTENANCE All vehicles and equipment assigned to the performance of services required by this Contract Agreement will be maintained in excellent operating condition at all times. Our fleet size standard of 150% enables Doctor's Ambulance to pull and replace any vehicle from service for maintenance or repair without disruption of service. PERSO N A~Y EO UIPMENT Doctor's Ambulance will provide personal safety equipment for all employees in accordance with applicable federal and state laws or standards. Doctor's Ambulance has programs in place to assure that its employees are familiar with the proper use of this equipment and shall abide by all federal, state and local safety standards. DOCTORS AmbulanCE ITEM 6: SERVICE RATES Doctor's Ambulance avails the benefit of its services to all patients regardless of their ability to pay. Doctor's Ambulance will bill patients according to the service rate schedules approved by the Orange County Board of Supervisors. Doctor's Ambulance also assumes the risk of non- payment for such services or supplies rendered. No fees will be incurred by either OCF A or the EOA for services provided by Doctor's Ambulance in this Contract Agreement. MAXIMUM BASIC LIFE SUPPORT BLS SERVICE RATES Doctor's Ambulance Service will charge for BLS services, no more than the maximum BLS rates as established by the Orange County Board of Supervisors. As of the issuance date of this RFP, the approved maximum BLS Service Rate is $480 per BLS transport. MAXIMUM ADVANCED LIFE SUPPORT (ALS) SERVICE RATES For those calls during which ALS services or assessments are provided (as defined in the current EMS Act) with subsequent transports being either ALS or BLS, we will charge, in addition to the BLS Rate, an ALS Service Rate not to exceed $282 or as currently established by the Orange County Board of Supervisors. . ALS REIMBURSEMENT RATES This table illustrates the fees that Doctor's Ambulance will reimburse to OCF A for ALS services provided to patients that are transported either ALS or BLS: ! O( 'FA Rcimhllrsement pt.'r Patit.'l1t Billed ('haq~t.' Ikst.Tiption I-T¡)~~-'~)¡"'~'i~,T i- ----- í)()~~)~:'~.\n~i~;lil~l~.~mnn I I Account i\Ü'dican' :\lIowed Amount I I ALS Service $200 ALS Service for Medicare Patients or Patients with Medi-Medi or ALS-IE = $107.47 Medicare+Choice .. --. ALS -2::=: $208.81- -.- These reimbursement fees are for the expressed purpose of offsetting OCF A's marginal operating costs for providing paramedic services and will be paid monthly to OCF A. MED I CAL SUPPLY REIMBURSEMENT RATE .- n' ...... ..... n .. Patients transported by Doctor's Ambulance, either ALS or BLS, typically receive a charge for medical supplies (as approved by the Orange County Board of Supervisors). For each patient billed for medical supplies under the auspices of RFP #RL972 , Doctor's Ambulance will disburse $22.38 to the OCFA as reimbursement for medical supplies provided by OCFA paramedics. As described in Section VII of RFP #RL972, Zero Pay Patients will be exempt from this reimbursement schedule. DOCTORS AmbulanCE ITEM 6: SERVICE RATES DISCOUNTED SERVICE RATES Doctor's Ambulance interfaces with more than 200 insurance agencies (a partial listing is provided below). We also accept assignment from Medicare, Medi-Cal, Champus, CCS and MSI. Contractual arrangements with these organizations include discounts, adjustments, write- downs and hardship write-offs, which result in contractual discounts up to 24%. Last year alone these price cuts amounted to more than $1,418,315 in savings to our clientele. We will continue to offer health care agencies the most affordable quality medical transportation available. ~ ARTA . Blue Cross of California ~ Blue Shield of California . Bristol Park Medical Group . LA Fireman's Relief Assoc. ~ Mission Hospital . Memorial Healthcare . MSC-Workers Comp ~ Monarch Healthcare ~ PacifiCare ~ Prospect Medical Group . Secure Horizons . San Clemente Medical Center ~ Adventist Medical Centers ~ St. Joseph's Health Care ~ Tenet Health Systems MEDICARE ASSIGNMENT In addition to our private health care agreements, Doctor's Ambulance accepts Medicare assignment. This means eligible seniors, patients with qualifying disabilities and those enrolled in SSI programs (Social Security) will receive service rates that have been discounted up to 40%. MED I -CAL ASSIGNMENT The intent of state and county programs such as Medi-Cal, Cal-Optima and MSI is to assist the poor and indigent who otherwise would have no access to health benefits. The billing status of patients enrolled in these programs is reviewed on a case-by-case basis. However, patients enrolled in these programs will typically pay less than 20% of established base service rates. RISK OF NON-PAYMENT Doctor's Ambulance will assume the risk of non-payment for any of the services rendered and charges incurred in connection with the Contract Documents ofRFP.#RL972 to include all BLS, ALS charges as well as ALS reimbursement and medical supply reimbursement. AUDIT AND ACCESS TO RECORDS We will bill for services according to the approved service rates and schedules set forth in the Contract Documents and authorized by OCEMSA. No additional fees or charges will be imposed without advance written approval by the OCF A Fire Chief and/or the awarding agency. Doctor's Ambulance maintains accurate and complete records of all patient accounting in accordance with the Contract Documents and generally accepted accounting principles. With the courtesy of forty eight (48) hours advance notice, OCF A may access these records and information anytime during normal business hours for the purpose of inspection, audit, review, evaluation or duplication. DOCTORS AmbulanCE ITEM 7: ON-BOARD EQUIPMENT AND SUPPLIES We are committed to maintaining an ambulance fleet with a surplus of all the equipment and supplies required by local licensing agencies. the OCEMA. the CHP. and additional supplies requested by the OCFA. Daily Vehicle Equipment and Inventory Checklist Doctor's Ambulance oncoming crews conduct a thorough inventory at the beginning of each shift. A checklist is used to note any mechanical problems or supply deficiencies, which are reported immediately to the Dispatch Supervisor. Equipment or supplies are replaced, repaired or re- stocked as warranted. This checklist is also used to determine supply usage, frequency of reorder, quality of supplies and equipment, average equipment life and failure rate. This monitoring helps determine system reliability and cost containment. If the on-board disposable supply of any given ambulance is depleted below acceptable levels, we dispatch the closest available unit to cover that ambulance while it returns to base for restocking of supplies and oxygen if necessary. Warehouse Inventory and Re-Supply Doctor's Ambulance warehouses a 30-day minimum inventory of all expendable medical supplies to meet the typical daily usage and as preparedness for unforeseen conditions that would compromise our ability to properly stock our ambulances. Oxygen Supply Each ambulance carries several oxygen cylinders in various sizes (M, D, E). We use only aluminum cylinders because of their durability and light weight, which minimizes crew fatigue brought on by the constant maneuvering and portage of this equipment, plus patients. To keep the oxygen tanks properly filled, we have an in-house Cascade Filling System (a three-tank process using a stair-step method to safely refill oxygen tanks to the proper level). This system is routinely inspected by the OCFA for safety and integrity. We maintain a three-week supply of oxygen, for reliable access to oxygen during periods of heavy work loads or local disaster. Ambulance Cot (Gurney) We were one of the first ambulance providers in Orange County to utilize the Stryker RuggedTM ambulance cot. This state-of-the-art gurney features: ~ Bright yellow powder-coat finish for enhanced nighttime visibility . ~. Pfietimatiêhëád lift forþátient comfort ~ Oversized casters for easy handling ~ 8-position height adjustment ~ Trendelenburg ability (lowered head position) ~ 500lb+ weight capacity - ~ RetractablelRe-positionable IV poles ~ 4-point restraint system . Every new employee is oriented to the .safe and proper use of all equipment and supplies used in the performance of their duties. In complying with OSHA guidelines, we require our employees to demonstrate a working knowledge of the company Injury and Illness Prevention Program and safe practices in ergonomics, infection control, vehicle safety policies, and bio-hazard exposure. Doctor's Ambulance is an active participant in the OCEMSA Drug and Equipment Advisory Group as well as the Disaster Advisory Group which addresses preparedness for terrorist threats. The following lists the on-board minimum quantities of equipment and supplies. A virtual tour of our ambulance and on-board equipment is at }F}vw.DoctorsAmbulance.com. DOCTORS AmbulanCE ITEM 7: ON-BOARD EQUIPMENT AND SUPPLIES On-Board Oxygen System Catalina / Luxfer 'M' Aluminum 02 1 On-Board Oxygen System Catalina I Luxfor 'M' Aluminum Air 1 Oxygen Wall Mount Outlet Precision Medical - 1 Portable Oxygen Catalina / Luxfer 'D' Aluminum tank 3 Portable Oxygen Catalina I Luxfer 'E' Aluminum tank 2 Liter Flow Regulator Boundtree #P1305300041 2 Oxygen Masks Hudson Adult 6 Oxygen Masks Hudson Child 6 Oxygen Masks Hudson Infant 6 Oxygen Tubing Hudson 7' 4 Oxygen Cannula Hudson Adult 6 Oxygen Cannula Hudson Child 4 Bag Mask Resuscitator Boundtree I MX-Pro Adult 1 Bag Mask Resuscitator Boundtree / MX-Pro Child 1 Resuscitator Mask King Systems Corp Adult 2 Resuscitator Mask King Systems Corp Child 2 Resuscitator Mask King Systems Corp Infant 2 Oropharyngeal Airways Hudson Adt/Chld/Inft/N ewbn 2 ea O' 1 A' Hudson Sizes 5.5-12 2 ea ro\Jll- "'"' ),",i)i) ')f ) ",,', '~::~~),) <::: ,':,: '": ",'T~:~~~:~" ~~,'I:~»~'~ i< ":",: ,::, " ~ Built-in Suction System/canisters Rico -/2100cc 1-2 Catheter Sizes Hudson 10, 14, 18 2 ea Rigid Yankauer Tip & tubing Medline Industries Rigid Tip 6 Suction Tubing and Inserts Medline Industries - 2 Bulb Syringe Medline industries - 2 V-Vac Suction Unit V-V ac #142-VC200 2 V -V ac Suction Cartridge V-Vac #142-VC250 2 set V-Vac -;.., " Adaptor V-Vac #142-VC300 1 set CO" ";"' :.. i.' j'.."'..:.:..:'j:.::'~.:~::),'.j.:" )...",".):~\)""'...:".:""", ,'~T.",,::" ~~~~X Ambulance Cot Stryker Medical Rugged 1 Collapsible Stretcher Femo Washington Model12C 1 Break-away Flat Ferno Washington Model l2C 1 Stair Chair Junkin SAF800 1 - Short Spine Board I CPR boards Boundtree Mise 1 Stabilizing Backboard Stabilizer Stabilizer 1 CotlBackboard Restraints Stry ker M edicallBoundtree Misc 1 set Adjustable C-Collar Ambu Perfit Ace - Adult 6 Adjustable C-Collar Ambu Mini Ace - Child 2 - Traction Splint F emo I DynaMed FemoTrac 1 Child Transport Seat Restraint Femo Pedimate 1 Ankle & Wrist Restraints (soft) Stockinet #813230 4 Rigid Cardboard Splints Boundtree/Wrist-Arm- Leg 12" - 18" - 24" 4 ea StaBlok Head Immobilizer Laerdal StaBlok 6 DOCTORS AmbulanCE ITEM 7: ON-BOARD EQUIPMENT AND SUPPLIES ic/;/!" ,i!ff'~fifX;!~~ '~~ .i.;!!!; .. !,,~/.,."."c,' .',.ii ";"',c'cii;.'i,c"';!;ix);f ,;!N.;;!!;~f~ .';/{f'iii".; .X ;;;;CC.'" c...i).'i).'c,'"ffii .ii Bandage Shears Boundtree - 1 4"x4" Gauze Sponges Johnson & Johnson/Dukal Bulk 2 box 4" Bandage Compress Swift Bulk 12 Band-aid Sheer Strip Johnson & Johnson/Dukal Bulk 1 box Triangular Bandage w/pins Kendall Bulk 6 Roller Bandages I Blood Stopper Johnson & Johnson 2" or 3" 12 Adhesive Tape Johnson & Johnson 1" and 2" 2 ea Trauma Dressing Banta Accolade 10"x30" 2 Abdominal Pads Johnson & JohnsonlDukal Combine 5" 9" 4 Bum Sheets Roehampton 60"x96" 2 Petroleum Gauze Dressings Sparta 2 Instant Cold Packs Boundtree Bulk 4 Tourniquet Kent Latex Products/Dukal 2 Kling Bandages Johnson & JohnsonlDukal 3" 2pk Dermicle Tape Johnson & JohnsonlDukal 2"x10 yards 4 Dermic1e Ta e Johnson & JohnsonlDukal 1 "x 10 yards 4 ;;i"cc'c.;~yi.',',.';',i; fcif.'n!i!"~.if~;!!." .f! .i.;;;:,;~i;;"..;i",i. f;fiei ""i.','.c'!' C X',1/ Blankets (cloth) Boundtree Bulk 1 Disposable Blanket Emergency Linen QB 1 00-20 2 Pillows American Fiber Bulk 2 Disposable Cot Sheets Banta I Emergency Linen Bulk I ES200-20 24 Disposable Pillow Cases Banta Bulk 24 í . 1 Towels Mise Bulk 2 ...;, 'c""'c .i,Ci"i""i.'cci"'i" ii ,'"c"cc ii';Y'c' "'i C' ii"'" c " 'i.i,,'ii' c.i.,f.',i, i,i .'C'..cC' ,., .,.... Surgical Masks I Face Shields 3M I Busse N95 4 Disposable Gloves (S-M-L-XL) MicroFlex Latex & Nitrile Diamond Grip- all 1 bx ea Protective Eye Goggles MSA Aurora 4 Fluid Resistant Protective Gowns Boundtree Bulk 4 Infectious Waste "Red" bags Boundtree Bulk 5 Disinfectant Hand Wipes PDI Sani-Dex 1 box Disinfectant Spray Waxie Stat III TB 1 Sharps Container Pro-Tec Bulk 1 "";0' ...i "c",,' ,i'.;',;", i.i!i" "'!c!!,'c,if" ,"Cc,',',i. ,if, ""'",, ",,', "" ,,'. i,',; Blood Pressure Cuff Boundtree Adult/Child/Thigh 1 ea Stethoscope Mabis Healthcare Spectrum 2 Emesis Basin - large, small Medline Bulk 3 ea Bed Pan Medline Bulk 1 Urinal Medline Bulk 1 Wash Basin Medline Bulk 6 Sterile Obstetric Kit Boundtree #121-40-01 - 1 Latex Tourniquet Boundtree Bulk 5 Triage Tag OCEMS Specified Bulk 30 Facial Tissue Georgia Pacific Bulk 1 box Sterile Water Braun 1000ml 2 DOCTORS AmbulanCE ITEM 8: RESPONSE TIME REQUIREMENTS Doctor's Ambulance has 29 years of exemplary performance in the City of Tustin. RESPONSE TIME THRESHOLDS The City of Tustin (EO A #23) has a population density greater than 100 persons per square mile and is therefore categorized by this RFP as a metropolitan/urban area. In light of this, the following response time thresholds apply: For Code-3: Emergency Response With Red Lights And Sirens Activated Ambulance provider's on-scene response time must not exceed ten (10) minutes. Response times are measured in full minutes rounded upward. The compliance threshold is 90%. For Code-2: Urgent Response Without Red Lights And Sirens Ambulance provider's on-scene response time must not exceed fifteen (15) minutes. Response times are measured in full minutes rounded upward. The compliance threshold is 90%. Doctor's Ambulance not only commits to meeting these response time requirements but will continue to exceed these requirements with demonstrated and documented consistency. Doctor's Ambulance commits to an enhanced response time criteria of ~ Emergency (Code-3): on-scene response within six (6) minutes ~ Urgent (Code-2) on-scene re/Jponse within nine (9) minutes Doctor's Ambulance will provide the OCF A EMS Section a Response Time Report at the end of each quarter that will document our performance history for each quarter. This information will be transmitted via e-mail to the EMS Section Battalion Chief by the 10th day of the month following the end of the quarter. This report will contain the following information: ~ Total number of patients transported per priority code ~ Total number of responses per priority code ~ Total number of on-time responses per priority code ~ Percentage of on-time responses per priority code ~ Total number of "turned calls" ~ Total number of calls deferred to mutual aid ~ Narrative assessment for responses out of compliance with remedy outlined (if warranted) RESPONSE TIME SUPPORT SYSTEM Doctor's Ambulance pledges to undertake the following to further complement our endeavor to consistently meet and exceed routine response performance standards: Mutual Aid Agreements To further assure that all calls for medical aid receive timely response, Doctor's Ambulance will secure, as an alternative method of meeting response time requirements, separate mutual aid agreements with neighboring qualified ambulance providers who can provide back-up resources/ambulances during extreme load conditions. DOCTORS AmbulanCE ITEM 8: RESPONSE TIME REQUIREMENTS These mutual aid agreements will be provided to the OCF A EMS Section Battalion Chief for review and approval before implementation. 800 MHz County-wide Coordinated Communications System This radio link is centrally coordinated by the Orange County Communications Division (OCC). Each Doctor's Ambulance emergency vehicle will have this 800 MHz radio equipment on board to enable the ambulance personnel to communicate response time and location status directly with OCF A dispatch and for OCF A paramedics to communicate with receiving hospitals during patient transport. Computer Assisted Dispatch (CAD) Interface This electronic data interface will assure dispatch compatibility with the OCF A Emergency Command Center and will be upgraded as warranted by similar OCF A upgrades. This system will be installed in our ECC at the discretion of the OCF A and maintained by Doctor's Ambulance. Computer Hardware/Software Doctor's Ambulance will install within its ECC all computer and supporting software (programs) necessary to assure uncompromisedcommunication capabilities with the OCF A Emergency Command Center. The minimum specifications of this system will be: Intel Pentium 500MHZ; 10.0 GB hard drive; 256 Mb SDRAM; WIN2000 OS; Motorola TX Messenger v3.0 software. Traffic Signal Preemption Doctor's Ambulance commits to installing Traffic Preemption and Gate Security access devises in its vehicles if they are required during the term of this RFP. Enhanced 10-8 Times (out-of-chute) Out-of-chute time is the time elapsed between activating the responding crew and the time that ambulance leaves the station. Doctor's Ambulance commits to having an emergency vehicle en route to the incident scene within a maximum elapsed time of: Emergency (Code-3) = one minute Urgent (Code-2) = {H'O minutes Fire Personnel Return Transportation There will be occasion when OCF A personnel accompany patients in the ambulance en route to the hospital, and the OCF A ALS unit does not follow. In these cases, Doctor's Ambulance commits to providing these paramedics return transport to their respective stations within 30 minutes. This endeavor will assure the timely availability of paramedics for medical aid. Patient Assistance Then~ will be occasion when members of our senior communities find themselves in need of assistance but do not require medical aid. The inability to contact a family member or friend may find these citizens relying on assistance from the 9-1-1 system. In these situations, we promptly respond at the request of the OCF A dispatch to the home of the calling senior and provide whatever assistance is required. This may include assistance to or from a bed or chair or examination of any possible injury or blood pressure if necessary. Doctor's Ambulance has provided thisfree service to the OCFA in our assigned service areas for more than 29 years. Doctor's Ambulance commits to continuing this service policy in order to lessen unnecessw:v reduction ofavailable/ìre department resources. DOCTORS AmbulanCE ITEM 8: RESPONSE TIME REQUIREMENTS District and Special Area Maps The OCF A has established a special mapping system to assist emergency personnel in locating call addresses. This system breaks down the entire county into Y2 mile square blocks called Districts. Special Area maps further detail apartment complexes, commercial areas and mobile home parks. Our Emergency Communications Center and each of our ambulances have a complete set of these District and Special Area maps for all 9-1-1 contract areas. NavTrak Vehicle Location System NavTrak@ is installed on every Doctor's Ambulance and enables the Dispatchers in our Emergency Communications Center to visually locate every company ambulance within 50', detect its direction and speed and aid with directions all through the technology of Global Positioning Satellites (GPS). Field Supervisors Doctor's Ambulance will have an assigned Field Supervisor for each EOA who will be available 24 hours a day, seven days a week through the term of this contract. The Field Supervisor can be easily contacted by our ECC at the request of the OCF A scene commander, EMS Section Battalion Chief or his designee. PERFORMANCE HISTORY This RFP asks for a fractile summary response report for the three-month period of April 2003 through June 2003 in this EOA. The following Response Time Report gives a thumbnail view of our outstanding performance history in the City of Tustin. Doctor's AmhulanCt' OCFA / FY 2(Hl2-200J / .t'li Quarkr EOA #23 / City of Tustin ( ;Vlctm / lirhan an'a) r - Total # of responses 254 253 236 743 Total # of patients transported 164 163 154 481 Total # of "in compliance" responses 223 228 207 658 Comhined (Code-2/J) (1., of "In Compliance" I ) 00% I )(10% IlJlJ.S2% I lJ9.SS% responses I Total # of Code-2 calls cancelled en-route Total # of Code-3 calls cancelled en-route Total # of calls cancelled on scene (dry runs) Total # of calls referred to Mutual Aid Provider Total # of "turned calls" Total # of Code-3 responses Total # ofCode-3 responses within 10 minutes 4/03 31 0 59 0 0 19 19 5/03 25 0 65 0 0 17 17 6/03 4 Qt 02 03 25 3 54 0 0 13 10 81 3 178 0 0 49 46 DOCTOR '5 AmbulanCE ITEM 8: RESPONSE TIME REQUIREMENTS SERVICE COVERAGE - ASSIGNED AMBULANCES Our primary coverage plan for the City of Tustin incorporates two (2) Type III Modular ambulances operating from a central location in the city. These vehicles will operate 24 hours a day, year-round. Red flags on the map below illustrate the existing location of our ambulance station in Tustin and the location of the ambulance cover position in an adjacent area (Culver/5 Freeway) that may be utilized during peak load conditions. Not pictured are ambulances available (2) at Doctor's Ambulance headquarters in Laguna Hills (Lake Forest/5 Freeway). The current location of Doctor's Ambulance Station #2 in the City of Tustin is: 14771 Plaza Drive (Irvine Ave /Newport Ave) Tustin - EOA#23 III .A,mbulance Station 0 Ambulance Service Area DOCTORS AmbulanCE ITEM 9: VEHICLE AND EQUIPMENT AND MAINTENANCE The superior vehicle readiness and professional appearance of Doctor's Ambulance vehicles are a direct result of employee pride and an aggressive vehicle and equipment maintenance program. VEHICLE MAINTENANCE PLAN AND SCHEDULE Our rigorous maintenance program has proven successful in consistently providing: ~ Safe and Reliable Emergency Vehicles ~ Reduced Unscheduled Vehicle Down Time ~ Extended Useful Life of Vehicles ~ Reduced Operating Costs and Expenses ~ Input Reference for Vehicle Improvements ~ Employee Pride and Loyalty An important step in reducing vehicle downtime and cost effective maintenance is to reduce the need for maintenance in the first place. We have been very successful in dramatically reducing both scheduled and unscheduled maintenance through driver training programs and initial upgrades (such as high grade silicone coolant hoses and clamps, high performance steel-belted tires, super-duty shock absorbers, super-duty batteries, etc.). All Doctor's Ambulance vehicles are equipped with the DržveCam(ß) monitoring 5ystem. This system coupled with an effective driver training program not only increases the level of employee and patient safety but also significantly reduces wear and tear on the vehicle. The old adage of "look sharp - feel sharp" is part of our vehicle maintenance philosophy. The sense of pride that is cultivated throughout the organization is reflected in our maintenance and EMT crews taking the extra effort to keep their rigs sparkling clean and in tip-top shape. So whether you see a vehicle from Doctor's Ambulance responding to a call or at a healthcare facility, the first thing you will notice is its well-kept condition and appearance. The sparkling blue graphics against the gleaming white background and highly polished wheels exemplifies pride-of-ownership and employee self-esteem. Daily Vehicle Check Out At the beginning of each shift, the oncoming ambulance crew performs all extensive visual checkout of their assigned ambulance including its equipment and supplies. Any significant mechanical abnormalities or equipment failure is reported to the dispatch center and maintenance department. Appropriate corrective measures are implemented as per company policy. Scheduled Maintenance and Service The maintenance department records odometer readings each week to track and coordinate scheduled maintenance and service. The chart on the u -.- - .. following page is a sample of items tracked for this purpose. ---..- .-.-- ----..-- --_..~--- DOCTORS AmbulanCE ITEM 9: VEHICLE AND EQUIPMENT AND MAINTENANCE Oil/Filter Change, Lube, Check/Repair 4,000 101 Check Fluids As Needed 303 Suspension Oil/Filter Change, Lube, Check/Repair Cooling 4,500 100 Check Fluids As Needed 309 System 8,000 213 Front Brakes: 49 - 50 - 53 As Needed 302 Differential and U-Joints 9,000 215 Front Brakes: 54 As Needed 310 Drive-Line Service Fuel and Air Filters, 10,000 221 Front Brakes: 48 As Needed 102 Crankcase Vent Inspect Front Brake General Body Work and 10,000 201 System As Needed 900 Repair General Emergency 12,000 211 Front Brakes: 45 - 47 As Needed 800 Equip. Repair 15,000 217 Front Brakes: 55 As Needed 501 General Engine Repair Check/Repair Heating 15,000 219 Front Brakes: 56 As Needed 307 andAlC Inspect Rear Brake 20,000 202 System As Needed 306 Check/Repair Ignition Inspect/Repair Brake 20,000 212 Rear Brakes: 45 - 47 - 48 As Needed 204 System Transmission and Drive Inspect/Repair 25,000 300 Line Service As Needed 701 Wiring/Lights 30,000 400 Tune-Up As Needed 312 Radiator Service 35,000 214 Rear Brakes: 49 - 50 - 53 As Needed 222 Radius Arm Bushings Check/Replace Hoses and Rebuild/Replace Master 40,000 600 Belts As Needed 203 Cylinder 40,000 216 Rear Brakes: 54 As Needed 103 Refuel Vehicle Repair/Replace 40,000 Rear Brakes: 55 As Needed 700 Alternator 40,000 Rear Brakes: 56 As Needed 703 Repair/Replace Battery Thermostat As Needed 650 Replace Belts As Needed 651 Retighten Belts As Needed 305 Alignment As Needed 210 Balance and Rotate Tires Adjust/Repair /Rep lace As Needed 401 Injectors As Needed 404 Smog Equipment Check/Repair Exhaust As Needed 403 System As Needed 799 Steam Clean As Needed 503 Check/Repair Fuel System As Needed 209 Tire Replacement/Repair Check/Repair As Needed 702 Horn/Steering Column As Needed 301 Transmission Repair As Needed 304 Check/Repair Steering As Needed 308 Rear Differential Repair DOCTORS AmbulanCE ITEM 9: VEHICLE AND EQUIPMENT AND MAINTENANCE Routine Maintenance and Repair Facilities Through 30 years of experience, Doctor's Ambulance has determined that exclusive use of factory authorized dealers and specialized repair facilities Œ'i'SUres constant compliance 'with the ever-changing DEAf maintenance and repair requirements of our vehicle manufacturer and equipment vendors. While there are providers who retain an in- house "jack-of-all-trades" mechanic(s), Doctor's Ambulance does not believe that this scenario can keep a modern day ambulance fleet abreast of constantly changing vehicle specifications, maintain current state-of-the-art diagnostic equipment or be remotely cost effective. Doctor's Ambulance has cultivated a long-standing relationship with local Ford Motor Company dealerships as well as several factory authorized specialty shops which has resulted in quick and reliable service. The specialty shops we utilize have proven to be consistent and timely with vehicle turn-around. These respective shops specialize in: ~ Mechanical, Electrical and A/C ~ Transmission and Drive Line ~ Cooling System ~ Brake and Suspension ~ General Lubrication and Filters ~ Tires and Wheels We also purchase and store various major vehicle replacement items (transmissions, brake rotors, etc.) at respective repair facilities to further minimize vehicle downtime due to shipment delays. This has helped Doctor's Ambulance keep vehicle downtime to a minimum and maintain cost- effective repair. VEHICLE REPLACEMENT PLAN On the effective date of this Contract Agreement, the average age of the vehicles in Doctor's Ambulance current Type III ambulance fleet will be 30 months! Front-Line Units Doctor's Ambulance utilizes a two-stage vehicle replacement plan to assure that only the most reliable and response-ready vehicles remain in service. While some companies will operate their vehicles for extended years and miles to maximize the investment return on vehicles equipped with expensive (and usually superfluous) whistles and buzzers, Doctor's Ambulance will retire a unit from front-line duty when it reachesfìve (5) years or 175. 000 miles (whichever comesfzrs!), Reserve Units When a front-line unit reaches either of these milestones, it is typically then considered for reserve unit status. Depending on the vehicle's service/repair history and general condition, it will either be refurbished and designated as a reserve unit or liquidated. Reserve units will then function for two (2) years or log no more than 220,000 miles (whichever comes jìrst). A guideline that Doctor's Ambulance uses to determine whether a vehicle is refurbished for reserve status or liquidated is annual vehicle repair cost. If the vehicle's annual repair cost exceeds 15% of its original purchase price, it will be retired from service. DOCTORS AmbulanCE ITEM 9: VEHICLE AND EQUIPMENT AND MAINTENANCE EQUIPMENT MAINTENANCE AND REPLACEMENT The useful life of durable medical equipment (DME) such as stretchers, backboards, splints, oxygen equipment, AED, cardiac monitors, IV pumps, and automatic blood pressure will vary greatly with the manner and frequency of usage. A thorough inventory assessment is performed at the beginning of each shift by every oncoming ambulance crew. A detailed checklist is used in to note any mechanical problems or supply deficiencies which are reported immediately to the Dispatch Supervisor. Established processes are then implemented to replace, repair or re-stock as warranted. This inventory checklist is also used to determine supply usage, frequency of supply reorder, quality of supplies and equipment purchased, average equipment life and failure rate of equipment. This system of checking and monitoring helps determine system reliability and cost containment. Doctor's Ambulance routinely purchases only quality equipment with specifications that typically exceed OCEMS and RFP requirements. All equipment is inspected daily and receives regularly scheduled preventative maintenance (or sooner if needed). Specialized equipment such as gurneys and electronic equipment receive regular inspections and preventative maintenance by factory approved service vendors. In addition to expendable medical supplies, Doctor's Ambulance maintains a surplus inventory of all DME to assure the capability to immediately replace equipment that cannot provide optimal performance. . DOCTORS AmbulanCE ITEM 10: DRIVER TRAINING The success of our driver training ,programs is evident not only in the company's safety record but also in our consistent response time performance. Our vigilance for public safety is the driving force behind the extensive training programs that driver candidates at Doctor's Ambulance must complete. The following synopses of the major components of our Driver Training Program demonstrates how Doctor's Ambulance exceeds the existing performance requirements of this RFP section. INTERNAL DRIVER TRAINING AND EXPERIENCE RE UIREMENTS All EMT applicants who have successfully passed the new hire selection process spend the first three (3) months of their employee tenure as attendants. Along with the minimum age requirement (21 years of age), exemplary personal driving record and driving skill maturity, this attendant experience is required for eligibility to become a driver. During this three-month period, training personnel are able to observe and document the driver candidate's skills and personal demeanor. The driver candidate also has an opportunity to gain a working familiarity with the geographic lay-out of a given area, the major roadways and directions to area hospitals and optional routing during heavy traffic congestion and inclement weather. Only after consistently demonstrating to the training staff the ability to function competently in map reading (Fire District Maps), effective routing and skill maturity can the driver candidate proceed as a driver in training. Licensing Requirements ~ Possession of valid California Drivers License and minimum 21 years of age. ~ Possession of valid California DMV Ambulance Driver's Certificate. ~ Possession of valid California DMV Medical Examination Report. ~ Successfully passing all required drug screen tests. ~ Participation in California DMV Employer Pull Notice Program (employer access to driving records)., CLASSROOM TRAINING AND CURRICULUM Only after successfully completing three months as an attendant, having demonstrated professionalism and competency with excellent map reading and routing skills, will the driver candidate progress to the classroom stage of training. Doctor's Ambulance supplements its internal. driver training with the National Safety Council's Emergency Vehicle Operator Course. This course entails eight hours of didactic training with slide and video presentation as well as extensive scenario discussion. DOCTORS AmbulanCE ITEM 10: DRIVER TRAINING Topics explained and demonstrated in detail include: ~ Vehicle Inspection ~ Special Conditions and Vehicle Backing ~ Multi- and Two-Lane Driving ~ Signaling, Exiting and Lane Change Techniques ~ City Driving ~ Emergency Driving ~ Visual Considerations ~ Cushion of Safety ~ Vehicle Acceleration and Braking ~ Driver Appraisal FIELD TRAINING After successfully completing classroom training, field training for driver candidates begins with a full day (8-hours) at the San Bernardino Sheriff Department Emergency Vehicle Operations Course (EVOC). This driver course was developed by the San Bernardino Sheriff Department to train operators of emergency vehicles with hands-on driving experience while subjected to various driving challenges. The EVOC ambulance module is an 8-hour course which includes: ~ Safety Procedures .~ Legal Aspects of Driving Code-3 ~ Driving Under Emergency Conditions ~ Code-3 Decision-making Skills ~ Slow Speed Precision Driving Exercises ~ Emergency Lane Changes ~ Vehicle Control Techniques ~ Skid Control and Recovery ~ Operating While Code-3 ~ Driver Evaluation Each driver that successfully completes this EVOC course receives an EVOC Driver Certificate with a copy kept in their personnel files. After successfully completing the EVOC training, the driver candidate is then assigned with a field training officer who rides as attendant while observing the driver candidate's driving technique and skills. During this period of training the driver candidate must successfully complete a checklist of driving skills designed to demonstrate proficiency and observation skills. That checklist includes: ~ Responding safely to Code-2 ~ Responding safely to Code-3 ~ Responding safely to Hospital Zones ~ Responding safely to Commercial Zones ~ Code-3 at intersections ~ Maneuvering around parking structure obstacles and road hazards ~ Appropriate speeds in various zones and driving conditions ~ Backing vehicle with backer (spotter) and appropriate hand signals This portion of the driver training process typically takes 14 to 21 days to experience all driving conditions. Drivers are required to pass a Driver Skills Verification Test every six months. Drivers that demonstrate poor driving skills or careless driving habits are relieved of their driving privileges or terminated as warranted. DOCTORS AmbulanCE ITEM II: INTERNAL MEDICAL QUALITY CONTROL Doctor's Ambulance is nationally accredited by the Commission on Accreditation of Ambulance Services (CAAS). There are less than 200 ambulance companies in the nation that have earned this recognition (inclusive of private, hospital and rITe department based services). CAAS standards and guidelines have been established by nationally recognized industry experts and these standards of operation, which include quality assurance programs, typically exceed state and local regulations. In light of this, we believe each of the following components exceeds the requirements of this RFP. .Q!lMdLY ASSURANCE/CON.I!IDlQ..US OUALITY IMPROVEMENT PROGRAM The objective of Doctor's Ambulance is to provide personalized, caring and professional treatment and transportation services to its patients. Doctor's Ambulance is committed to the cultivation of excellence by providing the resources and work environment necessary to achieve this objective. The objectives of our Quality Assurance/Continuous Quality Improvement (QA/CQI) program are to: ~ Assure the delivery of medical transportation service is of the highest quality. ~ Assure that all personnel are provided with expert training, as necessary, for professional and competent performance of duties. ~ Assure that procedure and practices conform to regulatory or patient requirements as warranted. ~ Assure that required records and documentation for each patient are complete and properly maintained. ~ Assure that all vehicles and equipment are maintained on an aggressive maintenance schedule. Doctor's Ambulance will submit quarterly reports showing the results of all QA/CQI program performance elements. The QA/CQI program is extensive and far reaching, and includes the following components: Schedule of Quality Control Activity Our QA/CQI program clearly outlines the schedule of all quality control activity. This includes daily vehicle inspections, vehicle maintenance, and equipment inspection. These inspections are in addition to the annual OCEMSA, CHP and OCC inspections. Operations managers and supervisors meet on a regular basis to discuss and implement proper procedures that are the direct result of this internal monitoring. The QA/CQI officer conducts quarterly meetings of the QA/CQI Committee to thoroughly review all QA/CQI monitors. Key QAlCQI Personnel Our program is administered by our director of QA/CQI and QA/CQI officer. The director of QA/CQI is responsible for ensuring that all documents, audits, and new procedures are reviewed and approved. The director of QA/CQI is also responsible for issuing directives to prevent actions which are not in compliance with the requirements of the plan. The QA/CQI officer is also responsible for evaluating current procedures and recommending new policies where necessary, monitoring activities or personnel to determine conformance with the QA/CQI program, performing audits and maintaining records on all audits. DOCTORS AmbulanCE ITEM II: INTERNAL MEDICAL QUALITY CONTROL Employee Qualification The QAlCQI Program clearly outlines all minimum requirements and qualifications for employment as attendants, drivers, dispatchers, medical billers, RNs and management personnel. These qualifications are reviewed and updated as warranted by changes in state and local regulations. Recruitment, Screening and Orientation All job applicants at Doctor's Ambulance arrive by word-oj-mouth. This is a manifest of our management team's reputation. After a reference and background check, a formal job offer is presented to the successful applicant. An extensive orientation is provided for each new employee to familiarize them with our policies and procedures that affect their individual job classification. This includes a proper introduction to duties to be performed, as outlined in their respective job description. Training Our QAlCQI program clearly outlines the training, observation, and certification process for ambulance attendant, driver, dispatcher, claims processor, RN and management personnel. The curriculum for new employee training and orientation is maintained by our director of training. Evidence of successful completion of the screening and training programs is maintained in each employee's personnel file and tracked by a computerized human resource program. Standard Operating Procedures It is the intent of Doctor's Ambulance that QA/CQI practices are incorporated into all standard operating procedures. Doctor's Ambulance requires every employee to read and pass a test on standard operating procedures. Additionally employees learn how to refer to these manuals for specific information on standard operating procedures. Company handbooks include written management policies, directives, protocols, and procedures which refer to our operations. They describe all aspects of the ambulance operation including a break down for each job classification. Doctor's Ambulance regularly updates and distributes to all employees, where applicable, the following handbooks: ~ Employee Handbook ~ Attendant Handbook ~ Driver Handbook ~ Dispatch Handbook ~ Billing Handbook ~ EMT Medical Protocols ~ Training Checklist ~ Corporate Compliance/HIPP A To ensure that QA/CQI audits are reflective of our total scope of practice, Doctor's Ambulance has implemented random sampling audits of all claims using key indicators. Each department has between 10 and 50 indicators. An example of an indicator for field personnel is "sign a trip card every day." The audits, listed below, are reviewed at the quarterly QA/CQI Committee meetings. I E:\IPLOYEES (9(1-1>A Y) i VETER\l\ EMPIJ)'.EES I : PROBATION I I Billing Yz of the employees work load in a 15% of all claims processe-d in a month for month each employee Field all charts/forms in 60 days 100% of charts for 10 Days of each month Dispatch 20% of all calls taken 20% of calls each taken for each employee CCT RN 100% of all charts 100% of all Charts DOCTORS AmbulanCE ITEM II: INTERNAL MEDICAL QUALITY CONTROL Any indicator that falls below the indicated 90% threshold is brought before the committee for discussion, review and systemic correction. The corrective action is reviewed at the next regular meeting or as directed by the QAlCQI Committee. If indications show a threshold now ranges above 90% only an annual review will be required. If not, new guidelines will be established by the committee and reviewed at the next QAlCQI meeting. Any indicator that has a 100% threshold for two quarters is removed from the current list of indicators. A new indicator will be initiated at the direction of the QAlCQI director and committee. The purpose of the indicator change is to measure accurately and assist in maintaining a consistent level for all aspects of patient quality care. All indicators that have been addressed before the committee during the year are reviewed annually. This is to ensure that the new benchmarks and procedures are still being adhered to, and if needed, adjustments can be made. Not only are standards for quality set and their attainment measured, they are continually improved through this iterative process. Response Time Review Each week Doctor's Ambulance' Response Time Review Committee meets to discuss response time performance for the previous period. This committee consists of the director of operations, dispatch manager and the director of training. This committee reviews factors which directly impact response time performance such as Resource Deployment Plan, population growth, highway construction, road map changes and seasonal fluctuations. Driver Performance All Doctor's Ambulance drivers receive training at Emergency Vehicle Operations Course (EVOC). This the same training program attended by county Sheriff's and local law enforcement. This program emphasizes driver safety during emergency response as well as routine transports. A DriveCam<RJ camera mounted to the inside of the driving compartment of the ambulance allows us to collect, view, hear, organize and track driving events. Each day the data is collected, downloaded, reviewed and assigned to the appropriate driver. The operations manager is then able to look for trends in driving habits and correct them quickly and efficiently. Dispatch Compliance Reporting At the completion of each dispatcher's shift a compliance report is generated. This compliance report provides each dispatcher with various call information including a listing of any response time exceptions which may have occurred during the shift and a section which allows the dispatcher to document the specific circumstances, a worksheet which allows the dispatcher to calculate their response time compliance, and also a call log which the dispatcher can verify that all call information has been entered correctly. Once this report has been completed it is submitted to the director of operations for review. All information or exceptions which are included in the compliance report are categorized so that the appropriate action can be taken. Examples of categories include whether it is a dispatch system or ambulance crew issue, whether a company policy must be revisited, or if it is a training or disciplinary situation. DOCTORS AmbulanCE ITEM 12: MUTUAL AID PROVIDER All of the proposed mutual aid providers have met the pre- qualification standards of this RFP. including staffing capabilities. There may be instances of demand, albeit on very rare occasion, that will severely tax the resources Doctor's Ambulance has designated for any given EOA (as with any provider). These conditions could be brought on by catastrophic events such as the Laguna Canyon Fire, the train collision in the City of Fullerton, a multiple vehicle collision on any of our busy Interstate Highways, or any such mass casualty disaster. Doctor's Ambulance has always been cognizant of these potential calamities and has taken steps to assure that we comply with the performance requirements of our municipal agreements on a consistent basis. Doctor's Ambulance will secure Mutual Aid Agreements with the following ambulance providers ~s a backup plan to meet this RFP's response time requirements. ~ American Medical Response (AMR), Cerritos ~ Care Ambulance Service, Anaheim ~ Medix Ambulance Service, Mission Viejo ~ Schaefer Ambulance Service, Santa Ana The main points of the Mutual Aid Agreement between Doctor's Ambulance and these noted providers will be: ~ The intent to present a coordinated effort in utilizing the resources of each provider to provide their respective communities with multiple ambulances for 9-1-1 BLS emergency calls during adverse operating conditions. Mutual Aid will not be used for primary area coverage. ~ A statement that the respective rights and responsibilities of any provider will be not delegated or imply a sub-contracting arrangement between ambulance providers. ~ Parties will agree to provide to the limit of each provider's capability, backup BLS emergency ambulance service 24 hours a day, seven days a week. ~ Mutual aid providers and their employees will cooperate with OCF A and participate in any audit requested by OCF A concerning their performance. . .. ......-L.Doctor 's AmJmlancLLwiJI.b.el'espfmsible for ensuring compliance vvith all terms, conditions. standards, and performance requirements setfÒrth in the ('ontract Documents resulting/rom this RFP. ~ Doctor's Ambulance will make the proper determination to implement Mutual Aid backup. ~.~." .. Upon award of the contract for this RFP, Doctor's Ambulance will forward a draft of this Mutual Aid Agreement to the OCF A EMS Section Battalion Chief for review, recommendations and approval before implementation. Once signed by all parties, Doctor's Ambulance will provide a copy of the final agreements to the OCF A EMS Section Battalion Chief. DOCTORS AmbulanCE ITEM 13A: ASSIGNED PERSONNEL PROFILE The following table illustrates the personnel who will be performing the services required by the Contract Agreement. Agrelius, B 14548 6/30/04 1/31/06 1/26/06 567774478 6/30/04 7/14/05 X 7/14/03 Armstrong, N B1494745 3/31/06 1/17/05 555979760 8/31/04 8/12/05 X 8/11/03 Balsz, R B1428169 3/31/05 6/18/04 6/8/07 559754687 10/31/04 2/11/05 X 2/10/03 Carlson, C B1385180 3/31/04 9/30/05 5/12/08 618037304 2/28/04 5/9/04 X 5/8/02 Clifford, R 622344954 9/4/05 10/12/04 622344954 9130/04 11/6/05 X 11/3/03 Conner, B 547399637 5/31/04 11/6/04 3/13/05 547399637 2/28/05 11/6/05 X 11/3/03 Da Costa, I 624301297 10/31/04 4130/04 9/18/08 62430129 12/31/03 1/14/05 X 1/13/03 Edgar, D B1442392 3/31/05 3/31/05 602202605 2/28/05 7/14/05 X 7/14/03 Edmonson, C BGFAW4H 6/30/04 5/31/04 2/9/06 552958097 11/30/03 1/31/04 X 10/23/00 Emter, D I6090 5/31/05 6/1/04 6/4/05 603222015 8/31/04 6/1/04 X 8/11/03 -Fix, J 31008A 5/31/04 1/31/06 10/4/07 561958281 5/31/04 8/21/04 X 8/20/02 Gillespie, 0 569831825 6/30/04 4/30/05 11/24/07 569831825 6/30/04 11/30/04 X 11/18/02 Gray, J 609347790 3/31/05 4/30/05 5/15/08 609347790 3/31/05 4/30/05 X 6/26/00 Harris, K B1501568 3/31/06 4/30/05 570750803 8/31/05 1/5/06 X 1/5/04 Hartman, D 606441351 11/30/05 4/12/05 6064413 51 11/30/05 11/6/05 X 11/3/03 Hendricks, J 573873619 7/31/05 1/2/06 573873619 7/31/04 7/14/05 X 7/14/03 Hicks, R 620092351 1/31/06 1/31/06 1/2/06 620092351 1/31/06 1/6/05 X 7/13/01 Hildenbrand, J 571992872 9130/04 8/31/04 8/12/07 571992872 9/30/04 1/14/05 X 1/13/03 DOCTORS AmbulanCE ITEM 13A: ASSIGNED PERSONNEL PROFILE Holley, J 554891262 12/31/05 3/31/05 554891262 12/31/04 4/30/05 X 3/24/03 Johnson, K 302889336 8/3 1/04 4/30/04 2/2/06 302889336 12/31/03 8/20/04 X 8/20/02 Lauderdale, J BHOU7JU 1/31/05 12/31/04 571350620 8/31/04 12/31/04 X 7/28/03 Lilly, G 621685326 6/30/04 1/31/06 11/28/07 621685326 6/30/04 6/19/04 X 6/19/02 Lindenberg, F B14923l5 3/31/06 8/31/05 8/3 1/04 519048311 8/3 1/04 1/5/06 X 1/5/04 Lopez, B 554851135 2/28/06 3/1/06 7/21/05 554851135 2/28/06 11/19/05 X 11/18/02 Lowery, S B 1485448 3/31/05 2/28/05 231371832 8/31/04 9/23/05 X 9/22/03 Lucas, M 553393509 9/30/05 6/30/04 553393509 9/30/05 5/31/05 X 5/12/03 Mattson, J 493902767 3/3/05 11/30/04 10/21/05 3629417 3/31/05 2/21/05 X 7/10/01 McConachie, C RE7260 2/23/03 8/31/05 6/20/07 546935039 1/31/05 2/11/05 X 2/1 0/203 Meza, S 563678303 1/31/05 9/30/04 1/27/06 563678303 1/31/05 1/31/05 X 12/5/01 Miranda, E 604017329 9/3/05 10/31/05 604017329 1/12/05 1/5/06 X 1/5/04 Nguyen, T BGRQS2U 1/31/05 12/31/04 2/22/06 563898460 6/30/04 7/14/05 X 7/14/03 O'leary, R 566818106 8/31/05 2/28/05 566818106 8/31/05 8/12/05 X 8/11/03 Oxford, J BJDQXHB 6/30/04 6/30/04 11/26/08 618429995 6/30/04 4/30/05 X 3/24/03 Park, D 621161610 6/30/05 6/30/04 1/26/07 621161610 6/30/05 7/29/05 X 7/28/03 Portet, T B1435932 3/31/05 4/30/05 12/6/06 551992566 2/28/04 6/16/05 X 6/16/03 Porto, M BJ16341 1/31/05 12/31/04 605228161 11/30/04 7/29/05 X 7/28/03 Reade, C BJIDQSUÇ 9/30/04 1/31/06 6/13/07 618425228 9/30/04 11/19/04 X 11/18/02 Reans, D 614141162 8/31/05 5/1/05 614141162 8/31/05 11/6/05 X 11/3/03 DOCTORS AmbulanCE ITEM 13A: ASSIGNED PERSONNEL PROFILE Reed, A B1367512 3/31/04 9/30/04 10/21/05 3629417 112/31/03 I 9/23/05 I X 12/20/01 Sato, K ZOOO026A 9/30/04 6130/04 10/25/07 ZOOO0226A 9/30/04 9/19/04 X 9/18/02 Schlice, G BGLlEEL 12/31/04 11/30/04 557890004 7/31/04 9/29/05 X 7/28/03 Shank, D 559951396 10/31/04 11/30/05 1/31/06 559951396 11/30/05 7/29/05 X 7/28/03 Sigler, J 559512383 1/31/06 11/30/05 559512383 1/31/06 1/5/06 X 1/5/04 Siino, M 566952273 5/31/05 9/30/05 8/16/07 566952273 5/31/04 6/16/05 X 6/16/03 Spiker, C BGXC972 12/31/04 1/31/05 569779426 8/31/04 7/14/05 X 7/14/03 Thorn, G 555953130 9/30/04 3/5/06 12/28/06 555953130 5/31/04 7/14/05 X 7/14/03 - Thompson, J 17165 8/31/05 9/30/04 10/27/07 607300071 8/31/04 11/19/04 X 11/18/02 Thorn,W 621124313 8/31/05 12/17/05 3/29/07 621124313 8/31/04 1/5/06 X 1/5/04 Toohey, P 614222389 8/31/05 4/30/05 614222389 8/31/04 9/23/05 X 9/22/03 Valdivia, M BGNUG29 4/30/05 4/30/05 4/14/06 560873545 9/30/04 8/12/05 X 8/11/03 Valladares, P 625342043 9/30/04 4/30/04 3/27/04 625342043 9/30/04 11/19/04 X 11/18/02 Veires, J RE8391 8/31/05 7/31/05 9/14/08 611 074062 9/30/04 9/23/05 X 9/22/03 Vitolo, G 14611 5/31/05 2/28/05 6/30/08 546778257 5/31/05 5/12/05 X 5/12/03 Winters, R BBGT2D2 10/31/04 3/30/05 386763170 4/30/04 2/20/05 X 7/24/00 Woolgar, J 614240170 3/31/05 9/10/04 9/9/06 614240170 3/31/05 6/16/05 X 6/16/03 Young, T BJSS79R 8/31/04 8/7/04 564993337 7/12/27 8/12/05 X 8/11/03 DOCTORS AmbulanCE ITEM 138: FIELD TRAINING OFFICERS All supervisory personnel are located within Orange County and can be on scene within 30 minutes. FIELD TRAINING OFFICERS At Doctor's Ambulance, Field Training Officers (FTO) playa key role in assuring that established company policies and procedures are adhered to and are consistently performed. We have found that an FTO to EMT ratio of 1: 10 is both efficient and cost effective in accomplishing complete and proper orientation of new employees and skill verification of seasoned EMTs. The FTO has the following responsibilities: ~ Oversee the daily functions of on duty EMTs ~ Function as field liaison to public safety officials ~ Monitor and assist in the training/orientation process of new employees ~ Assure procedures/practices conform to regulatory or patient requirements where necessary ~ Determine capability and readiness of EMTs for assignment as attendant or driver ~ Assure that all vehicles, equipment and sub-stations are properly maintained Only experienced EMT employees who have consistently demonstrated a commitment to personal and company excellence are considered for an FTO position. Those FTO candidates successfully passing an interview and testing process undergo a 90-day observation of their training skills and interaction with others. There are typically three FTOs assigned to each EOA. FTOs must conduct on a monthly basis: ~ Safety in-service, disaster drill updates ~ Crew meetings to update policy or procedure or field recommendations ~ Verify all EMTs' licensure and certificates as current and valid FIELD SUPERVISORS FTOs report to a Field Supervisor with one Field Supervisor assigned to each EOA. The Field Supervisor is responsible for: ~ Coordinating the FTOs' assignments and documents and observing each FTO's effectiveness ~ Effective coordination and supervision of FTOs and EMT crews assigned to a particular EOA ~ Initiating corrective or disciplinary action with follow-up reported to Operations Manager ~ Maintaining a liaison with the OCF A Station Captains in their assigned EOA. The Field Supervisor will strive to cultivate open lines of communication with OCF A personnel.ior the purpose of service excellence ~ Field Supervisors report to the Operations Manager. The Operations manager is responsible for the overall function and effectiveness of company field operations FTOs and Field Supervisors routinely attend courses relating to Human Resources and OCEMSA updates for Treatment Guidelines. Doctor's Ambulance is enrolled with an Employee Assistance Program (a confìdential grievance and counseling program) and a Trauma Intervention Program (a program that provides posttraumatic counseling) fÒr the "veU-being oj" all its employees. DOCTORS AmbulanCE ITEM 13C: PRIMARY PERSONNEL BRUCE W. HERREN. OWNER - CEO Born and raised in Orange County, Bruce Herren began his healthcare career shortly after graduating from Tustin High School. His early experience in emergency medical transportation led him to recognize the need for quality consistency in Orange County medical transportation. Based on that goal, Bruce Herren founded Doctor's Ambulance Service in April of 1974. With Bruce's guidance, Doctor's Ambulance has evolved with the dynamic complexities of medical transportation and each year responds to more than 25,000 calls for medical aid including 9-1-1 Emergency Response, Critical Care Transport, Critical Neonate Transport, inter- facility and patient assistance. Demonstrated expertise, proven reliability and active community involvement are key factors in many cities choosing Doctor's Ambulance as their contracted provider of emergency ambulance service. As a result of Bruce's business philosophy, Doctor's Ambulance has been the recipient of many awards and commendations throughout its 30 years of service. Bruce is especially proud of having his company recognized as "Large Business of the Year" by the six cities represented in the South Orange County Chambers of Commerce, the "Ethics in America Award" presented by Chapman University School of Business and Saddleback Memorial Foundation's Spirit of Philanthropy "Corporation of the Year" award. Doctor's Ambulance has also received national accreditation by the Commission on Accreditation of Ambulance Services (CAAS). Bruce's company is one of 10 in California with this honor and joins an elite group of less than 150 ambulance companies nationwide that merit this recognition. With regard to this RFP, Bruce's role as Chief Executive Officer of Doctor's Ambulance will be: . Oversight of all corporate affairs . Vehicle design specifications and modifications . Support company Quality Assurance and Continuous Quality Improvement programs . Support company liaison with various local and state regulatory agencies Bruce maintains his residence in Dana Point and likes to keep himself busy with various home or boat remodel projects. He is also an avid fisherman who enjoys being on his sport-fisher boat "Raven" reeling in marlin or swordfish. DOCTORS AmbulanCE ITEM 13C: PRIMARY PERSONNEL JAMES V. IGNACIO. PRESIDENT Originally from the Pacific island of Guam, Jim Ignacio grew up in Southern California, graduated from Artesia High School and served this country as a U.S. Air Force Medic during the Vietnam War era. Following his military tour of duty, Jim developed a successful career as Director of CardioPulmonary and NeuroDiagnostic Departments in various acute care hospitals in Southern California. His most recent hospital assignment was Fountain Valley Regional Hospital and Medical Center. In his role as Department Director, Jim provided Administrative, Management and Clinical direction for Respiratory Therapy, Cardiac Diagnostic Labs, Neurology Diagnostic Labs, and both Pulmonary and Cardiac Rehabilitation. After 25 years of management in hospital operations Jim made a career change and was recruited in 1999 by Bruce Herren, owner of Herren Enterprises, Inc., to accept the position as president of Doctor's Ambulance. Jim has been instrumental in establishing Doctor's Ambulance as an award winning, nationally accredited company with very pro-active involvement in community programs throughout Orange County. Jim and Bruce collaborate on the overall corporate development and function of the company. With regard to this RFP, Jim's role as President of Doctor's Ambulance will be: ~ Provide direction and support to Company Managers of Operations, Communications and Finance ~ Maintain open line of communications with OCF A , OCEMSA and other governmental agencies with assistance from: . Phil Robinson, Government Affairs - PIG; Phil represents Doctor's Ambulance at all OFCA, OCEMS and OCC meetings. He is currently Chairman of the County Disaster Advisory Committee as well as on a private sector Terrorism Response Group, Education & Training Advisory Committee and Yellow Net & Red Net Disaster Planning Committees ~ Maintain all required insurance and licensure ~ Oversee and support company Quality Assurance and Continuous Quality Improvement programs ~ Cultivate employee loyalty and pride in providing best service possible Recently, Jim has been selected by a panel- of his peers as president of the Ambulance Association of Orange County (AAOC). The AAOC is volunteer membership of ambulance service providers licensed in Orange County and as a group, monitor and address local and federal issues pertinent to emergency medical transportation. Jim and his wife, Ginny, reside in Turtle Rock and take every opportunity to spoil their four grandchildren. They are avid sailors, enjoy traveling and off-road exploration. DOCTORS AmbulanCE ITEM 13C: PRIMARY PERSONNEL CORY OSBURN. DIRECTOR OF OPERATIONS Cory Osburn has been an employee of Doctor's Ambulance since 1991. During his tenure with this company he has worked as an EMT Field Training Officer, Lead Dispatcher, Claims Processor and General Manager. This experience has given Cory great insight as to the responsibilities and operational challenges of every aspect in maintaining efficient and timely delivery of emergency medical transportation. Cory's extensive experiences in each of these noted areas combined with his demonstrated professionalism, competency, work ethic and personal demeanor are all elements that brought Cory to his current position of Director of Operations. He has been instrumental in the development of Doctor's Ambulance Training and Orientation programs that establish Doctor's Ambulance employees (particularly EMTs) above others. Word of Cory's style of management is widespread and has afforded Doctor's Ambulance the luxury of filling all EMT Field positions, purely by word-of-mouth, with more than enough capable candidates. Due to this phenomenon, and in spite of the EMT shortage experienced by other providers, we have not had the need to advertise or recruit for open positions. With regard to this RFP, Cory's role as Director of Operations will be an essential element in: . Overseeing day-to-day function of Field Operations with assistance from: . Ron Taggart, Operations Manager/Training Officer . Ed Rikimaru, Field Supervisor - Scheduling . Dan Lancaster, Field Supervisor - Fleet Maintenance . Overseeing day-to-day function of Dispatch/Communications with assistance from: . Mike Liebe, Dispatch Supervisor . Mike Herren, Information Technologies Supervisor . Overseeing day-to-day function of Human Resources with assistance from: . Prudence Zullo, Assistant Human Resources . Maintaining open lines of communication with OCF A with regard to performance aspects of this RFP Cory maintains his resident in Corona and enjoys remodel projects in his new home. When Cory is not at work (which seems to be all the time because we have to force him to take time away from the office) activities that occupy his free time are surfing and backyard bar-b-ques. DOCTORS AmbulanCE ITEM 13C: PRIMARY PERSONNEL KAY KEARNEY. DIRECTOR OF BUSINESS DEVELOPMENT As director of Business Development for Doctor's Ambulance, Kay Kearney keeps very busy maintaining the company's private and municipal 9-1-1 contracts and related emergency services throughout Orange County. Kay has 12 years experience in Medical Billing and Government Health Care Finance Administration (HCFA) guidelines. Her expert background was instrumental in guiding Doctor's Ambulance through the process of national accreditation by the Commission on Accreditation of Ambulance Services (CAAS) as well as developing the company's Compliance, HIPAA and QAlCQI programs. With regard to this RFP, Kay's role as Director of Business Development will be: ~ Oversee compliance with all Centers for Medicare/Medical Services billing guidelines (CMS - formerly known as HCFA) ~ Oversee company Quality Assurance and Continuous Quality Assurance programs (QAlCQI) During her six-year tenure with Doctor's Ambulance, Kay has been appointed to numerous positions which include but are not limited to: ~ South Orange County Regional Chambers of Commerce (SOCRCC), vice-chair of Government Affairs ~ SOCRCC, Chairman Workers' Comp Reform Task Group ~ Laguna Hills Chamber of Commerce, President ~ Irvine Chamber of Commerce, Board of Directors ~ Saddleback College Foundation, Board of Directors ~ South County Senior Services, Vice President Board of Directors ~ Trauma Intervention Program, Advisory Board As a native Southern Californian, Kay maintains her residence in Lake Forest while enjoying traveling and scuba diving. DOCTORS AmbulanCE ITEM 130: EMPLOYEE RECRUITMENT. SCREENING AND ORIENTATION RECRUITMENT The reputation of the management team and working conditions at Doctor's Ambulance is wide- spread. We have not had the need to advertise or market open job positions because word-of- mouth draws numerous employee applicants from throughout Orange County as well as from our neighboring counties of San Diego, Riverside, Los Angeles and San Bernardino. A direct result of this word-of-mouth phenomenon is the luxury of hiring only the most capable employee applicants. This subsequently results in our company's consistent high marks on customer satisfaction surveys, our outstanding safety record and just as importantly our OCEMSA and OCF A complaint track record. Additionally, Doctor's Ambulance takes a pro-active role in local college EMT training programs as well as Regional Occupational Programs (ROP). This involvement begins by assisting class instructors with student orientation to ambulance components and equipment function plus skills testing during selected class periods throughout the semester. Students also have the opportunity to ride along as an observer with an ambulance crew. SCREENING Each employee applicant undergoes a detailed screening process that includes: ~ Job Application verification to include: . Background check for any criminal history . Employment history for employee stability . Education and experience background . Prior job responsibilities and reason for leaving . Verify additional skills, training or certification enhancing employee's performance . DMV print-out ~ Interview process conducted by Operations Manager which includes: . Written skills and aptitude exam . Solicit personal description of strengths or weaknesses . Determination of map reading skills . Assessment and decision making in ethical and clinical scenarios . Work schedule availability . Career goals and objectives Each applicant successfully passing the application and interview process must report to clinic for: ~ Drug screen and physical examination . DOT drug screen (pre-employment, annual and random) . TB PPD skin test (pre-employment and annual) . Hepatitis-B vaccination (optional- employee discretion to sign waiver) . Physical lift test DOCTORS AmbulanCE ITEM 130: EMPLOYEE RECRUITMENT. SCREENING AND ORIENTATION ORIENTATION Employee candidates successfully passing the interview and pre-employment medical screen are scheduled for orientation. This is a six-day process with 64 hours of training and evaluation. New employee orientation begins with two eight-hour sessions of classroom time that includes: ~ Introduction and Welcome by Senior Managers, Department Directors ~ Orientation to Job Description, Employee Handbook and Performance Evaluation ~ EMSA regulations and procedures ~ Overview of company policies and procedures ~ Company documentation requirements and HIP AA standards ~ Injury and Illness Prevention Plan ~ Infection Control and Hazardous Material Awareness training ~ Grievance Procedure and Employee Assistance Program ~ Human Resource Department completes each new hire's checklist for payroll, COBRA, etc. Once in-house orientation and training has been completed and all tests successfully passed, the new hire continues on to field orientation. New hires must complete a minimum of four twelve hour shifts with a Field Training Officer. Observation and assessment of new hire skills include: ~ Assigned as third crew member ride-along for first shift ~ Orientation to ambulance check-out, equipment and supply ~ Gurney operation, body mechanics, lifting techniques and patient transfers ~ Orientation to assisting fire paramedics ~ Radio codes and protocol ~ Map reading skills and geographic familiarization ~ Hospital locations and ER entrances and parking protocol ~ Procedures for proper and safe backing of emergency vehicles ~ Staging on scene, crew and public safety concerns Throughout the field orientation process, FTOs and Field Supervisors provide employee candidates feedback on their progress as specific training needs are identified and addressed. Candidates who fail to consistently demonstrate competency and professionalism in all aspects of their job responsibilities are not allowed to continue employment with Doctor's Ambulance. Those employee candidates successfully completing their orientation/training will continue their employment with a specified assignment based on their preference and availability. Doctor's Ambulance is enrolled in an Employee Assistance Program that offers each employee avenues for confidential 3rd party grievances with total anonymity and follow-up, and resources for independent counsel on matters of personal, financial, emotional or family matters. Doctor's Ambulance is also involved with Trauma Intervention Program (TIP). This program offers: ~ Individual and personal counseling following an unusually traumatic incident ~ Counseling and support following a crisis event on the job or in personal matters DOCTOR '5 AmbulanCE ITEM 13E: CONTINUING EDUCATION PROGRAMS An integral part of the Quality Assurance and Continuing Quality Improvement (QAlCQI) programs at Doctor's Ambulance is a comprehensive continuing education program. Doctor's Ambulance commits to offering its (field) employees the best training available in order to maintain the highest level of service possible. Our training credentials include: ~ EMSA approved continuing education provider #30-0056 ~ California Board of Registered Nursing approved instructor - Provider #CEP13157 ~ American Heart Association designated full-line community training center Classes available free to Doctor's Ambulance employees include: ~ Basic EKG ~ Pre-Hospital 12-Lead EKG ~ Automated External Defibrillator (AED) ~ CPR ~ First Aid ~ CPR/First Aid Instructor ~ Monthly Case Reviews ~ Mini Grand Rounds Other advanced classes available include: ~ Pre Hospital Trauma Life Support (PHTLS) ~ Advanced Cardiac Life Support (ACLS) ~ Pediatric Advanced Life Support (PALS) ~ Geriatric Education for EMS personnel (GEMS) ~ Pediatric Education for Pre Hospital Personnel (PEPP) DOCTORS AmbulanCE ITEM 13E: CONTINUING EDUCATION PROGRAMS Qualified staff instructors include: ~ Ramon Johnson, MD - Doctor's Ambulance, Medical Director . Board Certified Emergency Medicine . Board Certified Pediatric Emergency Medicine ~ Scott Arden, RN - Doctor's Ambulance, Director of Nursing and Education . Bachelors Degree in NursinglNursing Education . Regional Faculty Member American Heart Association . Certified Instructor - National Association of EMS Instructors ~ Shadrach Smith, EMT-P . Bachelors Degree in Biology . Vocational Education Teaching Credential . Certified Instructor - National Association of EMS Instructors ~ Tina Heineman, RN . Pre-Hospital Care Coordinator - Mission Regional Medical Center . Staff Critical Care Nurse - Doctor's Ambulance All CEU courses provided at Doctor's Ambulance are also (dlered to the communžties we serve as well as localfìrefighter and lent' en!Òrcement agencies. We have a large, comfortable training room located at our Laguna Hills headquarters which is also available for our local firefighters. DOCTORS AmbulanCE ITEM 13F: HIPAA TRAINING PROGRAMS Doctor's Ambulance has utilized patient confidentiality policies similar to HIPAA years before this Congressional mandate. The Health Insurance Portability and Accountability Act (HIP AA) was created to protect the privacy of patients' Protected Health Information ("PHI"). This policy was mandated by Congress to be effective April 15, 2003. Failure to comply would result in sanctions imposed by the Department of Health and Human Services. In addition, Congress enacted that all PHI must be secured with access only to those authorized to see or handle such information. EVS, maintenance personnel or office visitors should not be able to view or have access to any PHI. Doctor's Ambulance safe keeps all PHI in locked and secure areas. We have also installed privacy screens on all computer monitors that could possibly display PHI and be seen by the casual passer-by. Unless you are seated directly in front of the computer, images on the computer monitor appear blurred and distorted. Doctor's Ambulance personnel are trained to understand that only very specific information necessary to process a patient claim can be shared mutually among the provider of services and the insurance carrier. All personnel are required to verify any person( s) asking for information regarding a billing claim or a patient. This is done by asking key questions that only the insurance company or patient would know (such as the last four numbers of the patient's insurance card or social security card). Each of our employees must attend the HIP AA and Corporate Compliance Training program before they are allowed to interact with patients, PHI or billing agents. All agencies that contract with Doctor's Ambulance and share mutual information related to processing of patient claims must sign a HIPAA Compliance Contract. As part of our employee training and orientation, a discussion on HIP AA regulations and how they apply to each individual team member and to the organization as a whole are reviewed in detail. After each employee attends the HIP AA orientation they are quizzed on their knowledge and understanding of HIP AA. Each of our employees signs a confidentiality agreement acknowledging that they have read and understand the HIP AA guidelines. These signature sheets can be found in the employees' personnel files. Doctor's Ambulance has also redesigned its Patient Care reports to include Patients' Informed Rights. Copies of each signature page are left with the patient and/or their authorized agent. PHI forms are transported in sealed envelopes to the patients' destination. Only pertinent medical information is recorded on our Patient Care Report, and these are then placed in a separate envelope to further ensure patient privacy. Doctor's Ambulance has incorporated Patient JnfÒrmed Rights into much oj"its documentation to a,\:\'urethat each patient has several opportunities to be exposed to and made aware of the,<,'e Rights. These forms are available for viewing at your request. DOCTORS AmbulanCE ITEM 14: BILLING AND COLLECTION PRACTICES With the help of RightCAD-SanitaS@, Dodor's Ambulance has consistently demonstrated the ability to effectively manage and retrieve patient transport data with relative ease. To manage the challenging task of categorizing and maintaining patient transport data, Doctor's Ambulance utilizes the Pinpoint Technologies software, RightCAD-Sanitas@. All transport data received or generated in dispatch, including patient information, invoice and accounts receivable data is integrated through this program. Doctor's Ambulance's exceptional information management system was best demonstrated during a recent collaboration with the OCFA's System Analyst on validating Paramedic ALS/BLS transport statistics. That project exemplified how Doctor's Ambulance Billing and Collection Practices exceed the requirements of this RFP. MANAGEMENT INFORMATION SYSTEM (MIS) Doctor's Ambulance's computer system is able to generate, in minutes, any type of specially designed report by simply selecting any combination of variables found in the system. Consequently, our database can easily facilitate any audit or review required by the OCF A. The MIS complements our Quality Assurance/Continuous Quality Improvement (QA/CQI) programs, generating various account management reports that are routinely reviewed by senior management and at regularly scheduled QAlCQI meetings. DATA ENTRY AND VERIFICATION Ambulance crews complete a Patient Care Report for each transport. Information from these reports is entered into our MIS (Pinpoint@), which is fully integrated with the Computer Assisted Dispatch (CAD) system. This information supplements the patient data initially received by the dispatcher on duty. ELECTRONIC AND PAPER INVOICING Once all account information is entered and verified, the appropriate electronic or paper billing statement is generated. Depending on the patient's insurance coverage Doctor's Ambulance", Service 'will generate, on the patient ',<; beha(f: the proper claim form to be .fÓrwarded to the appropriate insurance payer, CLAIMS BILLING CYCLE (from date of service) ~ 5 days Account processed and verified/sent to appropriate primary insurance carrier ~ 30 days Aging call made to insurance carrier if payment not received ~ 45-60 days Insurance payment received, if applicable, insurance or patient billed for co-pay ~ 90 days Payments received are posted to patient account. If all payments have been received, the account is closed and kept on file for seven years or as required by law Ifwe do not have adequate information to properly bill an insurance carrier on the patient's behalf, we will forward the invoice directly to the patient with a form outlining the information required to complete the billing process. DOCTORS AmbulanCE ITEM 14: BILLING AND COLLECTION PRACTICES INVOICE STATEMENT CYCLE ~ 5 days from date of service ~ 20 days from first notice ~ 40 days from first notice ~ 60 days from first notice ~ 60 days from first notice ~ 65 days from first notice 1 st notice request of insurance information 2nd notice request of insurance information 3 rd notice request of insurance information/phone call Final notice before account is forwarded to collections Phone call requesting insurance or payment information Account turned over to collections CLAIM RESUBMISSION ASSISTANCE If a claim for service reimbursement is denied by an insurance payer, our Claims Processors will assist the patient to resubmit their claim with additional information, in lieu of billing the patient, so that the insurance carrier may reconsider payment for the services rendered. Our Claims Processing Agents complement our QA/CQI program by consistently: ~ Providing clients with immediate access to account information ~ Returning calls as soon as any new or additional account information is obtained ~ Providing 24 hour message capability and returning calls promptly ~ Providing clients with all resources available to obtain the maximum insurance benefit SPECIAL ACCOUNT SERVICES The objective of our Special Account Service is to minimize the apprehension and out-of-pocket expense of emergency medical transportation for patients experiencing financial hardship. Depending on the situation, a reduction, payment plan or in some cases a waiver is implemented. In 2003 alone, Doctor's Ambulance reduced or H.'aived over 9.351 accounts. These adjustments totaled over $1,418,315 in direct savings to our patients. PATIENT ACCOUNT LIENS Occasionally a patient enters into litigation with an individual or organization to recover medical expenses. Due to the time required to settle these cases, we accept liens drafted by the patient's legal counsel as an agreement to defer payment on an outstanding account. ... ACCOUNT CLOSURE/FOLLOW-UP When all account payments have been received from insurance carrieres) or patients, our Claims Processing Agents will audit each account to determine the need for any additional follow-up. At this point the account will be closed, the balance waived, sent to collections or correspondence will be sent to the patient alerting them to the status of their account. COLLECTION PROCEDURES After all insurance reimbursement possibilities are exhausted and other arrangements with the patient have not been successful, we will classify the account as a collection account. We have established thorough yet flexible collection procedures to allow for each individual's situation. In 2003, 18% of our outstanding receivables were sent to our outside collection agency. DOCTORS AmbulanCE ITEM 14: BILLING AND COLLECTION PRACTICES COLLECTION AGENCY INVOICE CYCLE ~ 65 days from first notice ~ 15 days of collection process ~ 20 days of collection process ~ 30 days of collection process ~ 90 days of collection process Account turned over to outside agency Courtesy letter to patient Attempt phone contact Collection letter Account signed to credit reporting agencies DisCOUNTED SERVICE RATES Doctor's Ambulance has contractual relationships with many insurance carriers and health maintenance organizations. These partnerships offer service consistency and cost effective rates to the paying organizations and can affect discounts up to 24% oil the current established rates. PATIENT AND THIRD PARTY INOUIRIES Our Claim Processors are experts in all aspects of the billing process. Team building and effective cross training enables each Claims Processor to offer our patients expert assistance in navigating through the maze of insurance questions or problems that may be presented to them, including submission of claims, dates and types of payments made, itemized charges, etc. CUSTOMER COMPLAINTS Every invoice includes a postage paid "Customer Satisfaction" survey. Any patient complaints received are reviewed by the Accounts Receivable Office Manager, entered in the QAlCQI program and forwarded to the appropriate department manager for immediate evaluation and follow-up. All complaints/concerns are answered within 10 business days. Often, complaints are resolved by calling the patient and addressing their concerns. A follow-up letter is sent on behalf of the company president thanking the patient for alerting us with their concern(s). COLLECTION RATES EOA #23 - CITY OF TUSTIN (Collection Data) I ALS I BLS I II I # of I PaYl'r I Collcction A~c Group 911 911 Total I Payc.' trips Mix ley., 0 to 10 years 50 43 93 10 to 20 years 52 78 130 20 to 30 years 74 124 198 30 to 40 years 105 154 259 40 to 50 years 126 206 332 50 to 60 years 113 101 214 60 to 70 years 115 85 200 70 years or older 317 291 608 DOB not Recorded 8 1030 1,038 Total 960 2,112 3,072 Bill Patient 367 18% 11% Facilities 13 1% 79% Insurance 970 47% 90% Medicaid 218 11% 96% Medicare 465 23% 97% 2033 100% 74% DOCTORS AmbulanCE ITEM 15: HIPAA COMPLIANCE PLAN Doctor's Ambulance practiced patient confidentiality policies similar to HIPAA years before this Congressional mandate. The Health Insurance Portability and Accountability Act (HIP AA) was created to protect the privacy of patients' Protected Health Information (PHI). This policy was mandated by Congress to be effective April 15, 2003. Failure to comply would result in sanctions imposed by the Department of Health and Human Services. SECURE ACCESS TO PHI In addition, Congress enacted that all PHI must be secured with access only to those authorized to see or handle such information. EVS, maintenance personnel or office visitors should not be able to view or have access to any PHI. Doctor's Ambulance keeps all PHI in locked and secure areas. We have also installed privacy screens on all computer monitors that could possibly display PHI and be seen by the casual passer-by. Unless you are seated directly in front of the computer, images on the computer monitor appear blurred and distorted. Doctor's Ambulance personnel understand that only very specific information necessary to process a patient claim can be shared mutually among the provider of services and the insurance carrier. All personnel are required to verify any person(s) asking for information regarding a billing claim or a patient. This is done by asking key questions that only the insurance company or patient would know (such as the last four numbers of the patient's insurance card or social security card). EMPLOYEE HIP AA PRIVACY TRAINING Each of our employees must attend the HIP AA and Corporate Compliance Training Program before they are allowed to interact with patients, PHI or billing agents. All agencies that contract with Doctor's Ambulance and share mutual information related to processing of patient claims rnust sign a HIPAA Compliance Contract. As part of our employee training and orientation,' a discussion on HIP AA regulations and how they apply to each individual team member and to the organization as a whole are reviewed in detail. After each employee attends the HIP AA orientation they are quizzed on their knowledge and understanding òf'HIPAA. -Doctor's Ambulance hereby certifies that all personnel have signed a confidentiality agreement and undergone HIP AA Privacy Training. These signature sheets can be found in the employees' persoilllel file. P A TIENT'S.RIGHTSINFORMA TION Doctor's Ambulance has also redesigned its Patient Care Reports to include Patient's Informed Rights. Copies of each sigI1á.tùïehpage are left with the patient and/or their authorized agent. PHI forms are transported in sealed envelopes to the patient's destination. Only pertinent medical information is recorded on our Patient Care Report, and these are then placed in a separate envelope to further ensure ~p-ã.tìerit privacy. Doctor's Ambulance has incorporated Patient Informed Rights into much of its documentation to assure that each patient has several opportunities to be e:rposed to and lnade mvare (?! these Rights. These forms are available for viewing at OCFA's request. DOCTORS AmbulanCE ITEM 16: CORPORATE COMPLIANCE PLAN Doctor's Ambulance strives to meet this commitment through the individual efforts of our expertly trained ambulance crews and highly skilled support personnel. We earn patients' trust and the respect of the agencies we work with by continually conducting our daily affairs with honesty, integrity, and in compliance with the letter and spirit of all applicable laws. Although honesty and integrity are personal attributes, Doctor's Ambulance is committed to maintaining a work environment that cultivates and promotes these ideals and encourages our employees and agents to demonstrate the highest ethical and professional standards while performing their daily tasks. This commitment is man{j'ested in the 2000 "Ethics in America Award" given to Doctors Ambulance by Chapman University School o/Business. Doctor's Ambulance is committed to conducting its business in an ethical, professional and competent manner while complying with all relative state and federal laws and regulations. BOARD RESOLUTION Purpose This Code of Conduct has been adopted by Doctor's Ambulance Senior Management to provide standards by which employees of Doctor's Ambulance will conduct themselves, in order to protect and promote organization-wide integrity and to enhance the company's ability to achieve its Resolution. Wherefore, Be It Resolved On This Date, January 1,2001. 1. That Senior Management of Doctor's Ambulance is directed to dedicate the necessary resources toward development and implementation of an effective Corporate Compliance Program ("the Program") designed to detect and prevent violations of federal or state law in the conduct of Doctor's Ambulance's operations by its employees and agents. 2. The Program will meet or exceed the elements of an effective compliance program, which require this organization to: a. Establish compliance standards and procedures reasonably capable of reducing the prospect of wrongful conduct; b. Appoint a Compliance Officer with overall responsibility to oversee compliance with such standards and procedures; .-' c. Take steps to effectively communicate the compliance standards and procedures to all employees and agents by, for example, mandatory training sessions or the dissemination of publications; d. Take reasonable steps to achieve compliance by, .forexample, utilizing monitoring and auditing systems, and by publicizing a reporting system whereby employees and agents can report perceived wrongful conduct by others within the organization without fear or retribution; e. Consistently enforce its standards through appropriate disciplinary mechanisms, including, as appropriate, discipline of individuals for failure to detectnen-compliance; and f. Take responsible steps to respond appropriately to non-compliance after detection and to prevent recurrence, which may require modifications to the compliance program. DOCTORS AmbulanCE ITEM 16: CORPORATE COMPLIANCE PLAN 3. The Program will develop and implement specific standards for educating and training employees with respect to those specific standards, and reviewing and enhancing internal controls and monitoring systems. The Compliance Officer shall provide periodic progress reports to Senior Management. DOCTOR'S AMBULANCE CORPORATE COMPLIANCE PLAN INCLUDES Principle 1 - Legal Compliance * Fraud and Abuse * Antitrust Information * Environmental * Discrimination Principle 2 - Business Ethics * Honest Communication * Misappropriation of Proprietary * Fraud and Abuse Principle 3 - Confidentiality/HIP AA * Patient Information * Proprietary Information * Personnel Actions, Decisions Principle 4 - Conflicts of Interest * Outside Financial Interests * Services for Competitors/Vendors * Participation on Board of Directors * Honoraria Principle 5 - Business Relationships * Gifts and Gratuities * Workshops, seminars and training * Contracting * Business Inducements Principle 6 - Protection of Assets * Internal Control * Financial Reporting * Travel and Entertainment * Personal use of Corporate Assets Additional Standards Employee Education Policy * Development and Submission Process * Classifying Personnel * Documentation Employee / Vendor Screening * Employees * Vendors and Contractors * Inquiry Enforcement and Discipline Policy Monitoring and Auditing * Auditing Process * Audit Plan Policy on Reporting, Investigating, and Correcting Compliance Problems * Lines of Communication * Investigation * Ambulance Response Time Fraud and Abuse Overview * Prohibited Conduct * Federal Statutes * Penalties DOCTORS AmbulanCE ITEM 17: COMPLIANCE WITH MONTHLY PAYMENTS Doctor's Ambulance has demonstrated our diligence in record-keeping through prior project collaborations with the OCFA. Those projects involved a streamlining process in cross- referencing OCF A incident numbers to provider transports. Doctor's Ambulance will continue our practice of accurate and complete record keeping of all patient accounts pertinent to this RFP in order to provide OCF A a concise and easy-to-reference monthly payment report with subsequent reimbursements. Doctor '8 Ambulance utilizes a RightCad-SanitasR software program (Zoll- formerly Pinpoint Technologies) 'which makes patient records simple to retrieve and available in an.v format desired. As the incumbent provider in several EOAs, we currently have a report in our system titled "Call Log OCF A." In this report we have various selector fields that can be used to break down a report in numerous ways for easy retrieval. Those fields include: ~ Patient Name and Address ~ OCF A Incident # ~ Date of Service ~ Transporting Priority ~ EOA Number ~ Payors ~ Ordering Facility ~ Vehicles Assigned ~ Transport Times This system is currently in place at Doctor's Ambulance and will facilitate OCF A access to all patient databases for the purpose of inspection, audit, review, evaluation or duplication. OCF A may access these records anytime during normal business hours with the courtesy of 48 hours notice. BILLING PROCESSES With regard to the invoice process for services rendered under the auspices of this Contract Agreement, Doctor's Ambulance will essentially function as a third party billing agent for the OCF A. These services will be billed according to the service rates and schedules set forth in the Contract Agreement and as authorized by OCEMSA with no additional fees or charges imposed. . . , . , For the purpose of facilitating retrieval of all billing (invoice) records for OCF A review, the following criteria, or any additional fields as required by OCF A, will be used as report fields: .~ PatientName ~ BLS Transport ~ ALS ~ BLS ~ ,ALS Assessment/BLS Transport ~ ALS Transport ~ 9-1-1 Calls ~ Day/MonthlYear ~ OCF A Incident # Doctor's Ambulance will assume responsibility for billing and utilize due diligence in recording all transports4n.which ALS services are rendered, specifically including the performance of ALS assessments as defined in 42 C.F.R. 1;414.605, and in accordance with applicable Medicare guidelines for the level of service provided. For these services one (1) claim covering both ALS and BLS services will be submitted to the appropriate carrier or payer utilizing Doctor's Ambulance provider number. DOCTORS AmbulanCE ITEM 17: COMPLIANCE WITH MONTHLY PAYMENTS ZERO PAY PATIENT EXEMPTIONS Patients receiving ALS services or who are transported, and whose only method of healthcare coverage or insurance is provided by a state or local subsidized health care program (i.e., a. Medi-Cal, b. CalOptima, c. California Child Services "CCS", or d. County Medical Services for the Indigent "MSI"), have been classified by RFP #RL972 as "Zero Pay Patients." Doctor's Ambulance understands and acknowledges that patients with other means of payment or are covered by supplemental insurers, other than subsidized health care programs, do not qualify as "Zero Pay Patients." With regard to "Zero Pay Patients," OCF A has the discretion of accepting or denying providers' applications for exemptions from the ALS Rate Reimbursement or Medical Supply Reimbursement. For patients that may fall under the "Zero Pay" category, Doctor's Ambulance will submit an exemption request with all supporting documentation for review by the OCF A EMS Battalion Chief. Doctor's Ambulance will submit any exemption requests along with the respective monthly reimbursement payments. Transports for Zero Pay Patients in question will be reflected as a credit for that month. In the event that a Zero Pay exemption is denied, Doctor's Ambulance will adjust the subsequent monthly payment for the amount credited. In the event that a patient's insurance classification is unclear at the time of transport, and that patient is later determined to fall in the Zero Pay classification, Doctor's Ambulance will submit a "retro credit" request within 30 days of notification of that patient's enrollment in a qualified Zero Pay patient program. MONTHLY PAYMENTS Upon award of this Contract Agreement, Doctor's Ambulance will promptly pay all appropriate ALS reimbursements and medical supply reimbursements beginning 90 days from the effective date of this Contract Agreement. Doctor's Ambulance shall continue making these monthly payments to OCF A for ALS and medical supplies by the 1 sl of each month through the term of this Contract Agreement. These monthly payments shall be hand-delivered to the Finance Section at the OCF A Headquarters in the City of Irvine. Monthly payments will reflect reimbursements for services and supplies as illustrated in the following table: ALS Service ALS Service for Medicare Patients Or Patients with Medi-Medi or Medicare+Choice Medical Supplies $200 ALS-1E = $107.47 ALS-2 = $208.81 $22.38 DOCTORS AmbulanCE ITEM 17: COMPLIANCE WITH MONTHLY PAYMENTS Doctor's Ambulance assumes all risk of non-payment for any of the services provided and subsequent charges incurred, including all BLS and ALS charges, in the performance of this Contract Agreement. MONTHLY PAYMENT REPORT The monthly payment report submitted by Doctor's Ambulance will be in an electronic format acceptable to OCF A with the following information: ~ EOA identification number ~ Name of responsible party invoiced per transport ~ Patient name and address ~ Indication ofBLS, ALS, or ALS Assessment/BLS transport ~ Date of service ~ OCF A incident number ~ ALS reimbursement amount per transport ~ Medical supply reimbursement amount per transport AUDIT REPORT If requested by OCFA at any time throughout the contract term, Doctor's Ambulance will produce an audit list, in an approved electronic format, to OCF A auditors which contains the following information: ~ Name of responsible party invoiced per transport ~ Patient name and address ~ Indication of BLS, ALS, or ALS Assessment/BLS transport ~ Date of service ~ OCF A incident number ~ Amount invoiced per transport ~ Amount recovered per transport ~ Any exemption requests for transportation included 'in the audit sample ~ Any other requested relevant information DOCTORS AmbulanCE ITEM 18: PLAN FOR TAKEOVER OF SERVICE/STARTUP Doctor's Ambulance has a 29-year history of providing the City of Tustin exemplary Emergency Medical Transportation services. Our exceptional response time performance is well documented and manifests the success of our Resource Deployment Plan (RDP) in the City of Tustin. This RDP will continue to be utilized, and with monitoring systems like our QA/CQI programs in place, we expect to continue to exceed the requirements of this RFP with competence, professionalism and timely response. As the current provider of Emergency Medical Transportation within the City of Tustin, all appropriate equipment, resources and personnel are currently in service within the city. The management expertise provided in operations, business and financial practices will continue with the following key personnel, whose background information is detailed in ITEM 13- Personnel and Training: ~ Bruce W. Herren, CEO/Owner ~ James V. Ignacio, President ~ Cory Osburn, Director of Operations ~ Kay Kearney, Director of Business Development The RDP for the City of Tustin (EOA #23) will continue, as detailed in ITEM 3-0perational System and Program Design, with the following vehicles: ~ Two (2) 24-hour Type III Modular Ambulances: . Satellite Station: 14771 Plaza Drive, Tustin (Newport & Irvine) ~ Peak load coverage will utilize additional ambulance resources located at: . Move-up/Cover position (Jeffrey & 5 Freeway) . Company Headquarters (Lake Forest & Moulton Parkway) . For a map reference of our ambulance station locations see ITEM 3 - Operational System and Program Design These vehicles operate 24 hours a day, 365 days a year. Vehicle maintenance and replacement --- -._-.. -aredetailediri-ffEM--9:YehíCTe-ancfEquipment Maintenance. Since the necess-arystaffiiig, equipment and supplies are currently operational within the City of Tustin, no additional resources will be required. .. As the incumbent p¡:(.)vid€,.¡:-fJj'-Emergency Medical Transportation services for the Cityol Tus/in, and vvith resources alreacÓ in place continuation of services .will he seamless- DOCTORS AmbulanCE ITEM 19: 9-1-1 FIRE/EMS RESUME In April 2004 Doctor's Ambulance celebrated 30 years of providing exemplary Emergency Medical Transportation in Orange County. To continually meet the challenges of providing medical response and to maintain our status as one of the County's premier ambulance companies has been no simple task. With a population that has grown to more than 3,000,000 people, a tremendous influx of visitors to beaches and entertainment venues within the county, plus overburdened freeways, Orange County requires a mobile healthcare system that is sophisticated, highly specialized and readily available. EXPERIENCE Doctor's Ambulance has met this challenge and continues to successfully evolve with the dynamic complexities of modern medical transport. Each year, Doctor's Ambulance responds to more than 25,000 calls for medical aid, including 9-1-1 Emergency Response, Specialty Care Transports, Critical Neonatal transport, inter-facility transfers and in-home patient assistance. Just as the OCFA has evolved from the California Division of Forestry, Doctor's Ambulance has evolved from a one-ambulance, five-employee company to its present day configuration of 16 ambulances and 100 employees. As a matter of fact, jÒur 1]e1,j' ~vpe III amhulances ~vill he added to ourfleet over the next 90 da.vsf Throughout our 30-year history, we have continually demonstrated our total commitment to providing the ultimate in patient-care with the most modern equipment available and the best trained personnel in our industry. How, you may ask, can we make such a bold statement? Quite simply, by being ranked at the top of previous RFP's conducted by the OCF A and by achieving National Accreditation by the Commission on Accreditation of Ambulance Services (CAAS). CAAS standards and guidelines have been established by nationally recognized industry experts. These standards of operation exceed state and local regulations, compliance with such is verified by an extensive on-site audit of company personnel, equipment, operations and record keeping. Nationwide, there are less than 150 ambulance companies that have attained this recognition (inclusive of private, hospital and fire department-based ambulance services). In the state o( - CàlifÒnÚa, Doctor's AmhuTÓnce is one or Ônly to companies to have successfully passed the level of scrutiny applied h)~ the C.4AS Operating at a higher level of efficiency, reliability and performance is evident in all aspects of ., ao_'- our operation, from equipment maintenance to .out-of-chute times. Excellent response time perfonnance, pro-active participation in EMSA committees, and hands-on involvement in community programs are all well documented with the OCF A, city managers and council members of the areas we serve. The listing on the following page outlines the public safety agencies with which Doctor's Ambulance has provided emergency 9-1-1 ambulance services as primary provider: DOCTORS AmbulanCE ITEM 19: 9-1-1 FIRE/EMS RESUME Public Safety A2ency Contact Orange County Fire Authority Chip Prather, Fire Chief 145 S. Water Street Orange, CA 92866-2123 John Howlind, Battalion Chief Laguna Beach Fire Department Ken MacLeod, Fire Chief 505 Forest Avenue Laguna Beach, CA 92651 Jeff LaTendresse, Battalion Chief Doctor's Ambulance operates as a licensed ambulance provider in the following emergency medical system: EMS System Contact Orange County Emergency Services Agency Bruce Haynes, MD 405 West 5th Street, Suite 301 EMS Medical Director Santa Ana, CA 92702 Darlene Isbell EMS Program Manager CONTRACTS. CONTACTS AND YEARS OF SERVICE The following are contract names, contacts and phone numbers plus the years of continuous service provided in each respective area: Contract Name Contact Name & Phone Number Years of Contract Carmen V ali-Cave City of Aliso Viejo Councilmember 6 (949) 425-3800 Deputy Mike Rose City of Dana Point Emergency Services Coordinator 6 (949) 248-3513 Michael Ward City of Irvine Councilmember 10. (949) 724-6000 Jeff LaTendresse City of Laguna Beach Fire Battalion Chief 6 (949) 497-0381 Bruce Channing City of Laguna Hills City Manager 28 (949) 707-2610 Dr. Brenda Ross City of Laguna Woods Mayor Pro-Tempore 28 (949) 452-0600 Jeff Thomas City of Tustin Councilmem ber 29 (949) 573-3010 DOCTORS AmbulanCE ITEM 19: 9-1-1 FIRE/EMS RESUME Febrclary 2' 2('\ ,... h" !gmiCio. Preslcen: [)C1ClO'" s -\mhui;neè Sen lee 23U9 T eITa Ome LagU:13 H'" C \ --J2f,~' REFERE:\CE: LETTER OF RF.CO\l\Œ'\DATlO\ Dear \k 19m¡c'¡o' The ;"Ò¡!o\\ing mformat;o2l 1S m ;-esponse!O a req,¡es¡ tram ¡he Orangè County Fire AUthomy as a par: of¡he¡r E\15 Contract vendor quaiificarion pweess Doco,'s-\mbu:anc: Com pan:. has sened the CiTY of Laguna Beach hr" ,;, year :1eno," i'1 providing Emergene\ \kdica Transpor: Sen ¡CêS. The annual caL \O'Lme IS approxImate!:, : .501, cali:; per '-ear Doell'r' S .\mou:ance Company has pcrfo1111cd \\ c: ¡ Res:)on,;c: ,1m;;:,; are eonslSlent'\ good Pe:-sonne] are '..\.cil trained and conduct them"eh c,; profession all;. Tlleir equipment is modem and \\ d' mamtamed. FïDaìJy. :he comnan:, '135 heèr1 respons'\ è co addressing. ,¡n\ :SSUèS. \\ hleD tbe fire Ocpanmen! has rèques¡ed 0\ erail rector-manee is :-,,¡cd as abo\e average l "age of the :nfcrm31ior: co'Haineè ;n :n15 ¡CHCf is rcs:r¡eteè :0 ¡ne Orange COU1l!~ F¡"e AUlnO:l¡~ E\IS :omrae¡ Dracess and :11a~ nO1 he .:):hen'. lse used ,\.¡¡hm;t Üle \\ f1nen consent or¡hc Lagum: Beach Fin:: Departmen', ~meerei:' . ~- --"-"'oY Ke:- \1aci euu Fire Ch¡e;' :;.. DOCTORS AmbulanCE ITEM 19: 9-1-1 FIRE/EMS RESUME c:~ 1\)\ E tv\C) R I ALe RE \ ~ i' ;- .\\ '\member J.2, ~(\Î" \\ I h' m ì t L,)ll>..:em , ' ¡ ".",'," ¡')c,"'l,'f s\rnhuLlI1C,' i hi;; letter I' 111 ¡defenCe te, ilnü ¡¡; - \1\ comment:: ,\1<' made after more than :,: \ ears as d ::emor ':,,;:(".111\( .it Saddleback \femcna! \fedlCal C.'nTl'r rc!atJ,.m~Ììlp \< nÌi ,\mbulanc:: date" beL to the be~l1mmg .,1 tenure and Dolt"", 'd I ' 1. '1t' 11;"11 tLick rdancllsim;\\l1hS\!\tL preCèlÖi11\ d!TJ\a t;\ l11al.\ \'-" - ""f\I'" ,I' ,'~ l!l"I\"¡""1irh,."ntlrc, rccor.jIJl"é:'r\î!1~~.\ ',i. Ll'¡..:ure ""Ill¡ ¡J:ell u \.I,V.,-".","", ~,.. '- ,,1uth".unt', ,~,\l11l11!mlP, ~,¡ be lee ,,' I i,1,'"',.c'¡,1;,,',~,"'I,,t,',1',I""",'..,".;,',I:':,e ",he:::; iì ""; ll'l'se > edr:~ lC['c'. -., .. . ..;,~"" lC'~ rei ¿J11d !lr(;1c~,¡;;na!1~m c'\!!:!"i!;::d '." E)",,1 : ianlc .:'s ¡".i! h I :,tleCI!' '1: ¡hc" ".h.k tl12\1 the: .:,',anc!e! ,,¡,¡nc'd " 'tk K<'\ ¡!1è:' . ':1:..- i;::,_en' reCIDien> I;!:;" id,ad \1('1',,'11,:1 \kd:.:a; c':\'C id ¡ ,,<1L'tk¡ "1' ¡h~ r;::!'~i 'i1,1 ¡;]',: ¡d::!';::!":~' t, ,. L\'ct.',;, :¿inc,' ";:'\ -- " :;1-':(:1'(! " ' DOCTORS AmbulanCE ITEM 20: CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of Herren Enterprises, Inc. dba DOCTOR'S AMB ULANCE ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that Bidder is not, and will not, be violating either directly or indirectly any conflict on interest statute, rule, or regulation if awarded a contract and if authorized to perform the services described in this RFP. Signed this 10th day of May , 2004 in Laguna Hills , California IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: ~~~ Signature of President and Secretary, Herren Enterprises, Inc. May 10,2004 Date .. ,---,,-,"". Bruce Herren Print Name . . /'¡./!Æ t 4./..{ £>1.../- ~'\"/.I'(FV"( ".......,.. . Signature of P~ésident, Doctor's Ambulance , May 10,2004- Date - -"-~'~"" -.., James V. Ignacio Print Name DOCTORS AmbulanCE '. ITEM 21: STATEMENT OF TRUTH The undersigned hereby certifies on behalf of Herren Enterprises, Inc. dba DOCTOR '5 AMB ULANCE ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that the information provided by Bidder and contained in this 2004 Fire/EMS Emergency Ambulance Transportation and Related Services RFP is accurate, complete, true and correct to the best of our knowledge. Weare aware that should any of the information contained herein be found to be false, incorrect, or otherwise untruthful, or if the information contained herein contains material misrepresentations and/or material omissions of fact, OCF A may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option OCF A, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and/or to declare any contract awarded as the result thereof void. Signed, this 10th day of May, 2004 in Laguna Hills , California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: ~~~ Signature of President and Secretary, Herren Enterprises, Inc. May 10, 2004 Date Bruce Herren Print N: ame /IAM ¡,¿"i ..L»v-.-- . Ivur r T ~ t .'Y--fj" Sign.ature of prèsident, Doctor's Ambulance May 10,2004 Date James V. Ignacio Print Name DOCTORS AmbulanCE ITEM 22: NON-COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of Herren Enterprises, Inc. dba DOCTOR'S AMBULANCE ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that this 2004 Fire/EMS Emergency Ambulance Transportation and Related Services RFP is genuine and not sham or collusive, nor made in the interest of or on behalf of any person not herein named; the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a sham proposal nor solicited any other person, firm or corporation to refrain from submitting a proposal; the Bidder has not communicated, directly or indirectly, with any other Bidder regarding the amount, price, and/or service rates proposed herein; and Bidder has not in any manner sought by collusion to secure for himself/herself/itself any advantage over any other Bidder. We declare the forgoing is true and correct under penalty of perjury under the laws of the State of California. Signed, this loth day of May, 2004 in Laguna Hills, California. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: ~~~ Signature of President and Secretary, Herren Enterprises, Inc. May 10, 2004 Date --BrUce -Hi:~ITen Print N~me líj .¡fj L;/.( , '~- '\..,f/!'Tifl{ ">---f¡ . / Signature of PreMdeIltj)octor' s Ambulance May 10,2004 Date James V. Ignacio Print Name DOCTORS AmbulanCE ITEM 23: PHOTOGRAPHS Doctor's Ambulance has a longstanding history of providing quality ambulance services in Orange County. ~~___~H____. Owner Bruce Herren and Staff iii1976 DOCTORS AmbulanCE ITEM 23: PHOTOGRAPHS ([a li torn iaStaÍl' Seuab.' , ".,' Ii'," , SENATOR BILL MORROW THIP-', EIGHTH St,NA TORI'\! n'1!C r .., January 30. lOin ~ s, Kay Keamey OIl'., Business Dt~\'cI()pment Doc:tor's Ambuhmce Service 21091 TeITa Dr. Laguna Hills, Ca. 92653 rkar :l.1s, Kearney May I offer all at Doctor's i\mbulancc SC1\lC:C my heartIes! Cmlb'Tatu!allons on your recent accreditation received from the Commission .111 AccredlliJtípll or Ambulanc...: Services, Semg OIlC' nul ov only five CAAS-accredited ambulance companlcs H1 the state "I' ('al1fÒrnia is am Impressive accmnpJishment' It I" very satisfying to know that the citi¿('n~ "I Orange (ounty can rely on vour companv to proVIde the highest standard of ambulatory care and that DoctOr', Ambulance ServIce strives to not merely fulli! bUt cxcœJ local and state rcq um":IIlC:llh , \'Oll arc, IfHiceJ. scumg a standard, ()nee agam, con¡""Tatulatwm on your achlc\ ClnCIlI and a JI.) ) well done' Smcerel). 1~{ , BILL MORROW Senator 38th DIstncr '-.. .',L..,t..',.. ,-f-"""""'" IHv1:s1 DOCTORS AmbulanCE ITEM 23: PHOTOGRAPHS M. . H . I ælJlb 'ISSlon ospJta 1J1F )] ¡()SEFr! rnoo rvt"u",;", {:(ii"',' M,¡s:u' ,;,\ ~2¡¡" 94,1354 i4f)(¡ f'wvem!)f'f 3, 2003 ',,"h'.V. To I/.Jnom it ConceiTI' The intPr1t oí thl'3 letter IS to express Mission Hospital's suppor1 of Doctor's AmtJu!ance Service" MIssion Hospital rlas had a contractua' relationship with Doctoi"s Ambulance for over h:e years, The services provided by Doctor's Ambulance have proven to be reliable and professional, The fV1<3nagement and Staff of Doctor's ,A,rnbulance are always willing tOv'/ork witt, HosoÎtal staff In a collaborative manner and seek to Identify waVs to "'nhance communication and operations, Their cornmltnH;;nt to qualitv cine! excellence is dDparent through the services they provide Aejd'tlonaIIV, DUCU.Jr's Ambulance dedication to serving tht co'll,rnunity is e/ldent through I:Iv:.?ir pcJrtiCipaton in variOUS cornn1ufllt'y' outreach effoÎt5; CJVF" the vi~ars, [Jocror~, Þmbulance r,a'; bc'c', a dedicated partner to rv11SSIon Hospital and regularly partiCIpates In ;mllanthrop!c events trial help to expand acccs~; [0 «Jr':' our COflHTJUnitv, Cinej to serve the cnderSfTied" :',i";:;:!)11 Hu:';Plla ¡cuke; fcFVidrd d continuE'c ,,""T Doctors, ¡\'lîiJui,;¡nc,;' P!(I3';'" f~'c: fire(' te c"ii ny' at 9'19, 3f~,1 1400 exle:lsion ¡4DS ,. VOL; ,vOllie] like to dISCi:~" rhs matt",;, r¡¡ltn,> P,:~tEf' r ß¿blor!!, Pn,s¡,j¡?n1' ,,~Chl,,"l E",è": uti')' DOCTORS AmbulanCE