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HomeMy WebLinkAboutItem 17 - Agreement for Ambulance and Paramedic Billing Collection ServicesFinance and Management Services www.santa-ana.org/finance Item # 17 City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 Staff Report December 17, 2024 TOPIC: Ambulance and Paramedic Billing and Collection Services AGENDA TITLE Agreement with Wittman Enterprises, Collection Services (Specification No, RECOMMENDED ACTION LLC for Ambulance and Paramedic Billing and 24-104) (General Fund) Authorize the City Manager to execute an agreement with Wittman Enterprises, LLC to provide ambulance and paramedic/medical billing and collection recovery services, based on a contingent collection fee rate of 3.75%, for a term beginning January 1, 2025 and expiring December 31, 2027, with provisions for three optional one-year extensions (Agreement No. A-2024-XXX). GOVERNMENT CODE §84308 APPLIES: Yes DISCUSSION The Treasury and Customer Service Division of the Finance and Management Services Agency ("FMSA") is responsible for the administration of the City's ambulance/ paramedic billing and cost recovery services. The primary tasks include the following: • Assure the City is reimbursed in a timely manner for emergency medical services ("EMS") and transport provided through the City's contracts with the Orange County Fire Authority ("OCFA") and Falck dba Care Ambulance Services ("CARE"). • Maximize the legal cost recovery to the City from all resources, including but not limited to, Medicare, Medi-Cal, Private Insurance, and Private Pay for the EMS and transport provided. • Manage provider compliance with Medicare and Medi-Cal to ensure the City has a record of clean claims and a history of proper billing. • Supply comprehensive revenue recovery involving appeal of Medicare, Medi-Cal, and private insurance denials, researching all private pays to find viable insurance, and working with patients to arrange alternate methods of repayment. • Help coordinate patient participation in the City's paramedic subscription program with other insurance coverage payments. • Support the City's efforts in the upcoming contract cycle to develop policies pertaining to billing and collection efforts, as well as hardship guidelines. These Ambulance and Paramedic Billing and Collection Services December 17, 2024 Page 2 efforts will incorporate standard and accepted industry practices to ensure compliance with the most recent legislation. EMS billing and collections is a complex service that entails gathering patient insurance information, processing Medicare and Medi-Cal claims for reimbursement, continuously training on governmental regulatory requirements, and maintaining compliance with dynamic health care laws and regulations. The tasks listed above are accomplished using a third -party billing and collection recovery service provider. Request for Proposals (RFP) 24-104 was issued on August 22, 2024 on the City's online bid management and publication system. A summary of vendor participation and results is as follows: 351 Vendors notified 1 Santa Ana vendor notified 20 Vendors downloaded the RFP packet 3 Proposals received 0 Proposals received from Santa Ana vendors Proposals were solicited, opened on September 26, 2024, and evaluated. Three proposals were submitted by the RFP deadline and all three were determined to be responsive to the specifications and meet the City's requirements. An evaluation committee reviewed and rated the proposals according to the criteria listed in the RFP. The following summarizes the responding firms and their rankings: Firm Location Rank Wittman Enterprises, LLC Rancho Cordova, CA 1 Di itech Chappaqua, NY 2 GeBBS Healthcare Solutions, Inc. Culver City, CA 3 The evaluation committee of three City FMSA staff members evaluated proposals in accordance with the RFP criteria, and determined that Wittman Enterprises, LLC best met the City's specifications, demonstrated vast experience working in this field, and has the capacity to meet the City's current and future needs. Staff recommends the selection of Wittman due to its extensive experience and its specialty with invoicing, categorizing, recording, monitoring, supervising, and managing of ambulance billing and EMS cost recovery systems and services. Furthermore, staff is confident in Wittman's capability to promote, administer, and collect on the City's Paramedic Subscription Program if that optional service is triggered. For the City Council's knowledge, the Paramedic Subscription Program is currently managed by the Treasury and Customer Services Division. The Program is voluntary and provides coverage of emergency paramedic services within the City of Santa Ana to permanent residents at the cost of one annual subscription fee, presently $70. The Ambulance and Paramedic Billing and Collection Services December 17, 2024 Page 3 subscription fee, included as part of the Miscellaneous Fee Schedule, may be changed by the City Council in compliance with certain Medicare guidelines. Lastly, for the City Council's knowledge, Wittman Enterprises has provided their clients complete ambulance billing services in compliance with current local, state, and federal laws and statutes since 1991. Additionally, Wittman presently provides services to more than 140 public EMS clients in California, including 12 cities in Orange County such as Santa Ana's neighboring cities of Anaheim, Orange, Costa Mesa, and Fountain Valley. ENVIRONMENTAL IMPACT There is no environmental impact associated with this action. FISCAL IMPACT Payment for services is contingent upon successful collection; Wittman will share in the total revenue recovered from their billing/collection efforts and paid from the Fire Suppression / EMS Contract Services Professional account (no. 01115330-62300). Revenues generated as a result of this agreement will be as follows: • Paramedic Subscription Fee (Ambulance Transport) — 01115002 - 53509 • Paramedic Services Charge (Paramedic Subscription Program) — 01115002 53510 EXHIBIT(S) 1. Consultant Agreement for Wittman Enterprises, LLC 2. RFP No. 24-104 Submitted By: Kathryn Downs, FMSA Executive Director Approved By: Alvaro Nunez, City Manager CONSULTANTAGREEMENT CITY OF SANTA ANA THIS AGREEMENT is made and entered into on this 17�' day of December, 2024 by and between Wittman Enterprises, LLC, a California Limited Liability company, ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. On August 22, 2024, the City issued a Request for Proposals No. 24-104 ("UP"), by which it sought a consultant to provide ambulance and paramedic billing and collection services for the City's Emergency Medical Services (EMS) and Emergency Medical Transport Services (EMTS) Programs. B. Consultant submitted a responsive proposal that was selected by the City. Consultant represents that Consultant is able and willing to provide such services to the City described in the scope of work that was included in the RFP. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES 1. Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services - Exhibit A, attached hereto and incorporated by reference. 2. At the sole discretion of the City (upon a writing to Consultant by City Manager or his/her designee and City Attorney), Consultant shall perform the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Optional Services — EXHIBIT B, attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services as set forth in EXHIBIT A, a percentage fee of 3.75% of net collections obtained by Consultant for each contract year, including any extensions granted by the City. b. City agrees to pay, and Consultant agrees to accept as total payment for its optional Page 1 of 14 #456646v1 services the rates and charges as set forth in EXHIBIT B. c. Consultant shall bill for Emergency Medical Services at the rates established by City Council Resolution. d. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Consultant agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Consultant agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Consultant's account(s) with financial institutions. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on January 1, 2025 for a three (3) year term with the option for the City to grant up to three (3) 1-year renewals, exercisable by a writing by the City Manager and the City Attorney, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent Consultant and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in Page 2 of 14 #456646vl any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 6. INSURANCE Consultant shall procure and maintain for the duration of the contract insurance against claims for security breaches, system failures, injuries to persons, damages to software, and damages to property (including computer equipment), theft, or other misuse of City's data, infringement of intellectual property, invasion of privacy and breach of data, which may arise from or in connection with the performance of the work hereunder by Consultant, its agents, representatives, or employees. MINIMUM SCOPE OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 general aggregate. 2. Cyber Liability (CL): Insurance, with limits not less than $2,000,000 per occurrence or claim and $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by Consultant in this agreement and shall include, but not be limited to, claims involving security breach, system failure, data recovery, business interruption, cyber extortion, social engineering, infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, and release of private information. The policy shall provide coverage for breach response costs, regulatory fines and penalties as well as credit monitoring expenses. 3. Professional Liability Insurance (PL) with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. 4. Workers' Compensation (WC) as required by the State of California, with statutory limits, and Employer's Liability insurance with limits of no less than $1,000,000 per accident, policy, employee, for bodily injury or disease. If Consultant maintains broader coverage and/or higher limits than the minimums shown above for any line of coverage, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: Page 3 of 14 #456646vl 1. City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds, under Company's CGL, CL, and PL policies, with respect to any liability arising out of work or operations performed by or on behalf of the Consultant. 2. Consultant's Insurance companies agree to waive all rights of subrogation against City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of the CGL, CL, PL, WC policies which arise from work performed by Consultant under this Agreement. 3. For any claims related to this contract, Consultant's insurance coverage shall be primary and any insurance maintained by City of Santa Ana, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. A severability of interest provision must apply for all the additional insureds, ensuring that Consultant's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5. Insurance policies required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non -renewal due to non-payment of premium. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Finance and Management Services Agency, Executive Director, 20 Civic Center Plaza M-15, Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. Self -Insured Retentions Self -insured retentions must be declared to and approved by City. City may require Consultant to provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. Acceptability of Insurers Insurance is to be placed with insurers authorized to conduct business in the state of California with a current A.M. Best rating of no less than A-:VII, unless otherwise acceptable to City. Claims Made Policies If any of the required policies provide coverage on a claims -made basis: 1. The retroactive date must be shown and must be before the date of the contract. 2. Insurance must be maintained and evidence of insurance must be provided for at least three (3) years after completion of work. Page 4 of 14 #456646v1 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a retroactive date prior to the contract effective date, Consultant must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. Verification of Coverage Consultant shall furnish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause). Failure to obtain the required documents prior to the work beginning shall not waive City's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Subcontractors Consultant shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein. Special Risks or Circumstances City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Failure to Maintain Insurance Coverage If Consultant, for any reason, fails to maintain insurance coverage, which is required pursuant to this Agreement, for the entire term of this contract, the same shall be deemed a material breach of Agreement. City, at its sole option, may terminate this Agreement at any time and obtain damages from Company resulting from said breach. 7. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, Page 5 of 14 #456646v1 to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 9. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 10. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. Page 6 of 14 #456646v1 12. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of Page 7 of 14 #456646v1 performance specified in the Recitals of this Agreement. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Kathryn Downs, CPA, Executive Director Page 8 of 14 #456646v1 Finance and Management Services Agency City of Santa Ana 20 Civic Center Plaza (M-15) P.O. Box 1988 Santa Ana, California 92702 To Consultant: Corinne Wittman -Wong, CEO Wittman Enterprises, LLC 11093 Sun Center Drive Rancho Cordova, California 95670 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. {Signatures on Following Page) Page 9 of 14 #456646vl IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Jennifer L. Hall City Clerk APPROVED AS TO FORM: SONIA R CARVALHO City Attorney B &/ ( V �". S�iti•`.� 1 Andrea GMarcia-Miller Assistant City Attorney RECOMMENDED FOP, APPROVAL: Kathryn Downs, CPA Executive Director Finance and Management Services Agency CITY OF SANTA ANA Alvaro Nunez City Manager WITTMAN ENTERPRISES, LLC: 4 ^y9 orinne Wittman -Wong CEO Tax ID# 68-0456021 Page 10 of 14 #456646vl EXHIBIT A SCOPE OF SERVICES General Requirements 1. Consultant shall be responsible for modifying their billing systems to capture all necessary data generated from the ambulance & paramedic billing and collection services program as an electronic file and provide a description of the electronic file needed to receive data transmitted from OCFA. 2. Consultant shall work with OCFA and their electronic Prehospital Care Report (ePCR) vendor to identify data input gaps, errors and other data needs, and describe a means of obtaining solutions to these problems. 3. Consultant must be able to accurately transfer all necessary information from the OCFA ImageTrend database, based on the information provided by the electronic OCFA's ePCR, and obtain any additional information needed that is not included in the ePCR for proper and correct invoicing. 4. Consultant must have the capability to fully integrate and support OCFA's selected ePCR application. 5. Consultant shall bill for emergency medical services in a timely manner, including but not limited to the billing of Medicare, Medical/Medicaid, private insurances, supplemental insurances, secondary insurances and workers' compensation carriers according to specific requirements. 6. Consultant shall provide to the City and the City's contracted collection agency, listings of accounts, which the company feels are uncollectable, through normal collection processes, for further action by the City and the City's contracted collection agency. 7. Contactor must be able to forward and work with the City's contracted collection agency on listings of uncollectable accounts. 8. Consultant shall have the ability to handle third -party payer submission inquiries regarding insurance claims. 9. Consultant must work with County of Orange and perform screening of all medically indigent patients. 10. Consultant shall process all customer payments in accordance with the applicable Payment Card Industry (PCI) security requirements. 11. Consultant shall research and follow-up on all accounts with inadequate billing information. This shall include the following at minimum: a. Contact OCFA and/or Falck dba Care Ambulance for missing and/ or incomplete information, which may be found in their records; b. Contact receiving hospital for missing and/ or incomplete billing information needed from the admitting/ registration records; c. Contact patient family members or emergency contacts for information; d. Refer to zip code/ street directories for incomplete/ missing address information; and/or e. Mail inquiries to the patient. 12. Consultant shall have the ability to cross reference patient files in various methods (i.e. Last Name, Social Security Number, Service or Residence Address, Date of Birth, Date of Service, etc.). 13. Consultant shall have the ability to receive patient care documentation on paper and electronically. 14. Consultant shall maintain updated and current technology that will continuously provide the highest level of reimbursement and customer service possible. 15. Consultant must meet or exceed mutually agreed upon collection targets. 16. Consultant must instruct customers to submit all payments to Consultant, and not the City of Santa Ana. 17. Consultant shall collect and deposit payments on no less than a weekly basis, within three (3) days following receipt of payment. Customer Service Requirements 1. Consultant shall designate a single manager for the City's account, who will be the City's primary contact with their agency. 2. Consultant shall provide all supplies, equipment, personnel, computer software and hardware, billing forms, insurance forms, lien forms, envelopes, postage and supplies necessary to administer, on a day-to-day basis, the City's EMS billing and accounts receivable functions. 3. The company shall provide all billing statements in English and Spanish, and maintain a necessary staff of bilingual account representatives. 4. Consultant shall provide excellent customer service to citizens of Santa Ana who have billing questions or problems, by providing a nationwide toll -free phone number and an email address so individuals with questions or requiring assistance with invoices, may contact the company directly at no additional cost to the City. 5. Consultant shall have demonstrated experience and ability to act as the City's authorized agent for liaising on the City's behalf with the Centers for Medicare Services and/or their designated agents as well as associated state agencies. 6. Consultant shall have demonstrated experience and ability to act as the City's authorized agent for liaising with the City's contract EMS provider (OCFA). Records and Reports 1. Consultant shall maintain complete records of each bill, including all correspondence, documents, account records, transactions and a detailed log of all payments. These records shall be retained for a minimum of three (3) years. a. Consultant shall provide the City with electronic access to these billing records. 2. Consultant shall maintain records that are in accordance with the Generally Accepted Accounting Principles (GAAP). The Proposer agrees that all account files are the property of the City and will relinquish them to the City at the termination of the contract. 3. Consultant shall provide monthly finance, billing, account receivable aging reports, billing summaries, details for current month invoicing, current write-off, refund reports (including pending refunds), detail of monthly receipts account reconciliation, and any additional reports that the City may need or request, in the specific format requested. 4. Upon request, Consultant shall make all books and records available to both internal and external auditors. 5. Consultant shall provide annual and semi-annual EMS revenue collection projections to City staff upon request. 6. Consultant will conduct ePCR documentation training and/or workshops for personnel associated with the Orange County Fire Authority and the City's ground emergency transport provider to enhance cost recovery efficiencies. This includes (4) hours of teleconference, webinar, or Zoom -facilitated training, and (6) hours for Santa Ana EMS Management. Additional and onsite training as requested by the City of Santa Ana will be at the contracted rate of $125 per hour (personnel rate) plus associated travel expenses. Compliance 1. Consultant must comply with all applicable provisions and specifications of the Health Insurance Portability and Accountability Act (HIPAA), as well as other federal, state, and local statues and regulations addressing patient privacy issues throughout the term of the contract. 2. Consultant shall maintain proficiency and comply with all statutory, regulatory, and other legal requirements, including amendments to such requirements, which impact billing, reimbursement and/or collections for EMS and release of private medical information. 3. Consultant agrees to cooperate with the City regarding the handling of accounts. These accounts may be included, but are not limited to accounts of the specific age classifications, handicapped, and certain dependent situations. 4. Consultant shall provide regular and continuous education and training for Consultant's staff, updating them immediately on all changes in the industry or government regulations that may have an impact on services being provided to the City. Consultant will extend education and training to City staff to support in the development of policies pertaining to billing and collections, as well as hardship guidelines. Meetings 1. Consultant must meet with City staff upon execution of contract to discuss goals of the relationship, the services to be provided, and other topics relevant to the ambulance & paramedic billing and collection services program. 2. Consultant agrees to meet with the City routinely and on request to discuss problems, special needs, future changes, and updates in software, technology, statistical data requests, or other relevant issues. EXHIBIT B SCOPE OF OPTIONAL SERVICES A. City Paramedic Subscription Program City at the sole discretion of the City Manager and City Attorney shall have the option to transfer the promotion and administration of the City's Paramedic Subscription Program to Consultant under the following terms: 1. As a condition to participation in Consultant's optional City Paramedic Subscription Program and to ensure that City is compliant with Medicare guidelines on subscription fees, City shall impose a minimum paramedic services subscription fee of not less than $70.00. 2. City shall thereafter inform Consultant in writing of City's decision to participate in Consultant's optional City Paramedic Subscription Program within the time -frame parameters set forth in Section 9, below. 3. Upon receipt of City's written decision to participate in Optional City Paramedic Subscription Program, Consultant shall assist City in generating and formatting an initial mass mailer to solicit participation by residents of the City of Santa Ana in the paramedic services subscription program, to be mailed by the City. Consultant shall assist in generating and formatting a renewal paramedic services subscription program mailer and will assist in formatting that mailer for mass mailing. Basic mailer and renewal mailer shall include a multi -color, double - sided City Paramedic Subscription Program solicitation letter/application, and prepaid return envelope. Use of additional colors, inserts, or enclosures may be added at the direction of the City. Consultant's cost shall reflect increased service costs, materials, and postage. Consultant shall prepare a statement of additional costs per mailing piece for approval by City prior to incurring additional costs. 4. City shall generate the initial mass mailing list from residential billing accounts listed in the City's Municipal Utility Billing System database for the most current billing period applicable. The Mailing List shall be comprised of all residential paramedic billing accounts in the City's Municipal Utility Billing System. Consultant shall annually, not less than sixty (60) days prior to the expiration of each registered City Paramedic Subscription Program member, send a renewal mailer/renewal application to such subscriber; and collect all Paramedic Subscription Program applications and membership fees remitted. City agrees to pay the cost of mailing materials and the postage charges associated to mailing said renewal mailers/applications including prepaid return envelope. 5. Consultant shall thereafter, on an on -going basis send an initial paramedic services subscription program mailer to any non -subscription paramedic service recipient with hardship requests and/or private pay installment discussions occurring by telephone between the patient and Consultant's customer service agent. City agrees to pay the cost of mailing materials and the postage charges associated to mailing said mailers/applications including prepaid return envelope. 6. Consultant shall receive and process each subscription application by adding the member to Consultant's system and posting the payment. This database will be used to identify any subscription member that may be transported upon the input to Consultant's billing system. City will receive separate monthly reports for the subscription program. 7. Fees. The City agrees to pay the cost of designing and distributing any marketing or outreach materials, mailing materials and the postage charges associated to distributing the mailers including prepaid return envelopes. Consultant agrees no other fees may be charged to City beyond the 3.75% of net collections from each subscription payment collected. B. Implementation of EMS Treat -No -Transport Call and First Responder Call Fees The City, by a Resolution of the City Council, may impose fees associated with EMS Treat -No - Transport calls and First Responder calls at any point during the term of this agreement. If such fees become active during the initial term, the City will notify the Consultant in writing and agrees to pay to Consultant a percentage fee of 3.75% of net collections obtained by Consultant for each initial contract year. The City and Consultant agree to negotiate a revised percentage of net collections for the following extension years but in no event may the revised percentage exceed 8% of net collections. Wittman Consultant Agreement - 12-02-2024(456648.1) Final Audit Report Created: 2024-12-02 By: Kristin Andrade (kandrade@santa-ana.org) Status: Signed Transaction ID: CBJCHBCAABAAW18WOuAm-CaSE11yFAe1dDETb5o0tFkl CAO signed 2024-12-02 "Wittman Consultant Agreement - CAO signed 12-02-2024(4566 48.1)" History Document created by Kristin Andrade (kandrade@santa-ana.org) 2024-12-02 - 8:54:24 PM GMT Document emailed to Kathryn Downs (kdowns@santa-ana.org) for signature 2024-12-02 - 8:55:04 PM GMT Email viewed by Kathryn Downs (kdowns@santa-ana.org) 2024-12-02 - 9:55:53 PM GMT &0 Document e-signed by Kathryn Downs (kdowns@santa-ana.org) Signature Date: 2024-12-02 - 9:56:05 PM GMT - Time Source: server Agreement completed. 2024-12-02 - 9:56:05 PM GMT a Adobe Acrobat Sign EXHIBIT 2 REQUEST FOR PROPOSALS NO. 24-104 FOR AMBULANCE & PARAMEDIC BILLING AND COLLECTION SERVICES CITY OF SANTA ANA KEY RFP DATES: The schedule below is tentative and subject to change at the discretion of City, with appropriate notice to prospective Proposers. Issue Date: Thursday, August 22, 2024 Deadline for Questions: Thursday, August 29, 2024, 4:00 P.M. Proposal Due Date: Thursday, September 26, 2024, 4:00 P.M. w "1 CITY OF SANTA ANA TABLE OF CONTENTS I. BACKGROUND...........................................................................................................................3 II. OVERVIEW OF PROJECT..........................................................................................................3 III. TERM OF AGREEMENT............................................................................................................ 3 IV. MINIMUM QUALIFICATIONS......................................................................................................4 V. RESPONSE TO RFP..................................................................................................................4 VI. CERTIFICATIONS (ATTACHMENTS)....................................................................................... 10 VII. REFERENCES..........................................................................................................................11 VIII. MINIMUM SCOPE AND LIMIT OF INSURANCE....................................................................... 11 IX. SELECTION PROCEDURES & CRITERIA............................................................................... 11 X. WITHDRAWALS........................................................................................................................12 XI. GENERAL TERMS AND CONDITIONS.................................................................................... 12 XII. AWARD OF AGREEMENT........................................................................................................ 17 XII I. IMPLEMENTATION................................................................................................................... 17 EXHIBITS Exhibits provided herein for Proposers'reference only. EXHIBIT I — SCOPE OF SERVICES EXHIBIT II — SAMPLE AGREEMENT ATTACHMENTS A PROPOSER'S CERTIFICATION, PROPOSAL ITEM PRICING B REFERENCES C PROPOSER'S STATEMENT D NON -COLLUSION AFFIDAVIT E NON -LOBBYING CERTIFICATION F NON-DISCRIMINATION CERTIFICATION (9) A. BACKGROUND CITY OF SANTA ANA The City of Santa Ana, California, is rich in culture and pride, the county seat of Orange County, and encompasses an area of approximately 27 square miles. The City of Santa Ana contracts with the Orange County Fire Authority (OCFA) to provide primary response for fire suppression and Emergency Medical Services (EMS). The City also contracts with a private ambulance provider to provide emergency medical transport; the current contractor for ambulance service is Falck dba CARE Ambulance. The City's current EMS billing and collection service provider is Wittman Enterprises, LLC. In addition, the City maintains a paramedic subscription program that is available to residents to help offset the cost of ambulance transport. For more information, please visit https://www.santa-ana.org/ B. OVERVIEW OF PROJECT The City of Santa Ana (City) is seeking proposals from qualified firms and organizations (Proposers) to provide ambulance & paramedic billing and collection services for EMS. The City seeks an experienced and effective Contractor that minimizes City costs, maximizes the use of available technology, provides excellent client and customer service, and performs thorough and complete paramedic billing and cost recovery. The City wishes to create efficiencies and make improvements wherever possible, and take advantage of new technologies. It is the City's intent to maintain all emergency medical and ambulance transportation billing with one institution to maximize systems and minimize administrative costs. The City currently transports approximately 16,000+ patients per year through its third -party ambulance provider. The current payer mix consists of the following: Medicare/Medicare HMO 27.56% Medi-Cal/HMO 31.71 % Commercial Insurance 5.06% Private Pay 35.48% See EXHIBIT I for complete Scope of Services. The term "Vendor", "Proposer", "Firm", "Consultants", and "Contractor" shall refer to any legal entity or entities submitting a proposal in response to this Request for Proposals (RFP). C. TERM OF AGREEMENT The anticipated term of the agreement is for an initial period of three (3) years. The City may, at its discretion, extend the agreement with the same or more limited scope of required services for two (2) additional one (1) year periods, upon mutual agreement contingent upon City Council approval, or City Manager or City Attorney authorization, as appropriate. The total term of the awarded agreement shall not exceed five (5) years. Usage is not guaranteed. Execution of an agreement between the City and successful firm(s) and/or individual(s) does not guarantee work throughout the duration of the contract period. Numerous factors will be evaluated by the City in its delivery of project and assignments, including technical expertise required. City of Santa Ana RFP No. 24-104 Page 3 of 35 (9)CITY OF SANTA ANA Transition Period: The successful Proposer/Contractor shall facilitate a transition for the City from the current ambulance & paramedic billing and collection services company to the new company within a 6-month period from January 1, 2025 to June 30, 2025. In the event the incumbent provider is the successful Proposer/Contractor the term of contract will commence January 1, 2025. D. MINIMUM QUALIFICATIONS 1) Contractor must have been in business continuously for the most recent five (5) years prior to the date of this RFP. 2) Minimum three (3) most recent years of experience performing similar services to other government agencies, preferably municipalities, as those detailed in the Scope of Services section of this RFP. 3) The Proposer must have expertise needed to correctly invoice for services specified herein to Medicare/Medicaid HMO, commercial insurance companies, and private pay individuals, based on the City's fee schedule and the City's Paramedic Subscription Program. E. RESPONSE TO RFP A. SUBMITTAL INSTRUCTIONS It is the responsibility of the Proposer to ensure that any proposals submitted have been uploaded to PlanetBids prior to the RFP due date and time. Proposals, including all required sections and forms, shall be submitted electronically via the City's Bid Management System, PlanetBids. No other form of submittal will be accepted. PlanetBids will not accept late proposals and no exceptions shall be made. Proposers will receive an e-bid confirmation number with a time stamp from PlanetBids indicating that their proposal was submitted successfully. The City will only receive and consider those proposals that were transmitted successfully. Submit proposal online at: http://www.planetbids.com/portal/portal.cfm?CompanvlD=20137. Proposer shall be solely responsible for informing itself with respect to the proper utilization of the bid management system, for ensuring the capability of their computer system to upload the required documents, and for the stability of their internet service. Failure of the Proposer to successfully submit an electronic proposal shall be at the Proposer's sole risk and no relief will be given for late and/or improperly submitted proposals. Proposers experiencing any technical difficulties with the bid submission process may contact PlanetBids at (818) 992- 1771. Questions of an operational nature may be directed to the City's assigned Buyer. Neither the City, nor PlanetBids, makes any guarantee as to the timely availability of assistance, or assurance that any given problem will be resolved by the bid submission deadline. Proposals shall NOT be sent via telegraphic, electronic, or facsimile means. All notifications, updates and addenda will be posted online on PlanetBids at https://www.planetbids.com/portal/portal.cfm?CompanvlD=20137. Proposers shall be responsible for monitoring the site to obtain information regarding this solicitation. Failure to respond to required updates may result in a determination of a nonresponsive proposal. City of Santa Ana RFP No. 24-104 Page 4 of 35 (9) CITY OF SANTA ANA B. COMMUNICATION / CONTACT WITH CITY STAFF Unless otherwise authorized herein, Proposers who are considering submitting a proposal in response to this RFP, or who submit a proposal in response to this RFP, are only to communicate with the assigned Project Coordinator(s), and no other City staff about this RFP from the date this RFP is issued until a contract is awarded. The City will provide all official communication concerning this RFP in writing via the City's Bid Management System, PlanetBids. The City will not be responsible for or bound by any oral communication or any other information or contact that occurs outside the official communication process specified herein, unless confirmed in writing by the designated Project Manager(s). C. REQUEST FOR INFORMATION OR CLARIFICATION / QUESTIONS Questions regarding this RFP shall be submitted via PlanetBids. Responses to all questions will be posted on PlanetBids no later than the date and time shown at the schedule of key RFP dates on the cover page of this RFP. All prospective Proposers are advised to visit PlanetBids on a regular basis as responses may be posted earlier than the date above (if applicable). No verbal requests or responses will be accepted. Significant interpretations or clarifications will be addressed via addenda to this RFP. Significant interpretations or clarifications and responses to questions received by the deadline will be addressed via addenda to this RFP, which will be released and posted on PlanetBids under the "Addenda/Emails" tab. General process questions may be directed to the following: Jacques Lam Buyer Email: jlam(a�santa-ana.orq D. EXCEPTIONS Requests submitted for City's consideration of proposed terms and conditions, including modifications to the City's RFP and/or Contract terms and conditions must be submitted by the deadline for questions. Such requests should include an attachment in Word or PDF format on formal company letterhead that shows the requested modifications. Should the Proposer be considered for award recommendation and progress into the negotiations phase, the requests for exceptions or modifications to the City's terms and conditions will be discussed at that time. The City will not accept any requests after the deadline for questions and reserves the right to reject or strike any requests for exceptions or additional terms and conditions related to Agreement, RFP, and insurance and indemnification terms and conditions. E. ADDENDA Any changes in RFP from the date of release to date of submittal will result in an addendum or amendment. Notification of such addendum or amendment shall be posted on City's PlanetBids system, https://www.planetbids.com/portal/portal.cfm?CompanvlD=20137. Proposers shall be responsible for monitoring the site to obtain information regarding this solicitation. City of Santa Ana RFP No. 24-104 Page 5 of 35 (9) CITY OF SANTA ANA F. UNDERSTANDING PROPOSAL It is the responsibility of each Proposer to inquire about any criteria, condition, term, provision, or requirement of the RFP that the Proposer 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 Proposers. The City will not be bound by any oral responses to inquiries. By submitting proposals, Proposers assert that they have fully read the RFP and any addenda issued by the City, the proposed Contract and any other Contract Documents, and affirm that the terms and conditions stated therein are fully understood and are acceptable to the Proposer. Each Proposer accepts the terms and conditions of the Contract Documents and indicates 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 Document shall be submitted to the City by the deadline to submit requests for information or clarification/questions set forth herein. G. PROPOSAL CONTENTS Proposals are to be prepared in such a way as to provide a straightforward, concise delineation of capabilities to satisfy the requirements of this RFP. Colored displays, promotional materials, photographs etc., are not necessary or desired. Emphasis should be concentrated on conformance to RFP instructions, responsiveness to the RFP requirements, and on completeness and clarity of content. Digital dividers and clear organization of content and material are encouraged. Statement of Qualifications (SOQ) SOQ must include a Table of Contents and be limited to a maximum of 20 pages (excluding City's required Certifications listed in Section VIII below; Proposal Cover Letter, section dividers, table of contents, front/back cover pages). The page limitation includes all appendices, attachments, and supplemental information. Additionally, SOQ must include the following: a. Cover Letter Proposals shall include a letter signed by a principal or authorized representative who can make legally binding commitments for the entity. Include type of business entity. Cover Letter shall not exceed one page. Cover letter must be addressed to the following City Project Manager: Alejandra Gutierrez, Treasury & Customer Services Manager City of Santa Ana — Finance & Management Services 20 Civic Center Plaza Santa Ana, CA 92701 b. Services Provided A description of proposed services to be provided and how they meet the needs of the City as described in Exhibit I — Scope of Services. c. Agreement Statement Proposal shall include a statement outlining your concurrence or reference to concerns previously submitted with any and all provisions as contained in EXHIBIT II — Sample Agreement of this RFP (if any). d. Firm and Team Experience Proposal shall include a profile of the firm's experience including the following: City of Santa Ana RFP No. 24-104 Page 6 of 35 (9)CITY OF SANTA ANA A general description of the firm, including size and number of employees working directly with the City on this agreement. Firm's nearest address serving the City of Santa Ana and headquarters address. iii. Name and contact information of the supervising Project Manager/Principal Agent, to be assigned to the agreement. The Project Manager/Principal Agent shall be the primary contact person to represent your firm and will be the person to conduct the presentation, if invited to an interview. iv. Describe the qualifications of the firm, key staff, and sub -contractors performing projects within the past five (5) years that are similar in size and scope to demonstrate competence to perform these services. V. List all business names to which Proposer provides ambulance & paramedic billing and collection services for EMS Services in the County of Orange. vi. Provide a list of current and previous contracts awarded to Proposer for the provision of similar services to the requirements for the City of Santa Ana. Include all public agencies served. For each, provide a brief description of the SOS, length of time Proposer has been providing services, and name, title and telephone number of the person who may be contacted regarding the firm's service record. vii. Provide information regarding their organization's experience with ePCR software, specifically ImageTrend, including a complete list of their customers utilizing ePCRs and the name and contact information of the software companies utilized. viii. Include a complete package describing billing and collections, follow-up, account posting, and accounts receivable reconciliation and reporting services. ix. Provide copies of Proposer's ethical standards, confidentiality policies, managerial philosophy, customer service standards and standards of service quality. State manner in which Proposer ensures these standards will be evaluated and maintained. The materials may include, but are not limited to: a. Membership in and/or good standing with an organization that is devoted to ensuring high standards of customer service and consumer protection, such as the Better Business Bureau. b. Membership in and/or good standing with a professional organization devoted to encouraging and maintaining ethical or service standards. c. Evidence of training and education in customer service, maintaining quality standards and/or maintaining quality standards received by the firm, its employees and its subcontractors. d. Letters of recommendation from customers and contracting agencies. City of Santa Ana RFP No. 24-104 Page 7 of 35 (9) CITY OF SANTA ANA e. Copies of instructional material used to ensure employee adherence to ethical, quality and customer service standards. A list of references that will attest to the firm's ethical, quality and service standards. The list should include the name, address and telephone number of the person who may be contacted and a description of the relationship between the firm and the reference. X. The City is interested in knowing how Proposers support communities they serve. Please provide information on Proposer's company participation in local community, charitable and civic organizations and events, including membership in civic organizations, charitable contributions made by Proposer's company, etc., for consideration in the RFP evaluation. e. Proposed Work Plan Proposal shall include a statement demonstrating the firm's understanding of the Scope of Services. Additionally, proposed work plan shall include: Description, in detail, of company's method of approach to the Scope of Services as defined in Exhibit I. Address the manner in which the firm proposes to meet the specific requirements of the Scope of Services including, but not limited to, business office and hours and reporting requirements. List of names, titles, responsibilities and telephone numbers of the persons to be contacted, at any hour, in the event of an emergency. iii. Information on whether any of the services proposed will be subcontracted out to another company and if so, then describe the portion of work and who will be providing the service. iv. Company's policies and procedures for receiving and resolving complaints from the public. Including the name, qualifications, and contact information for the person(s) responsible for receiving and resolving complaints. Report to the City response to complaint and resolution time. V. Description of manner in which the company will inform the City and public of changes to policies and procedures. Include samples of any informational materials the company would use. Describe the procedures for monitoring employee adherence to procedures, whether new or established. vi. Detailed description of manner in which the company intends to meet the reporting requirements of Attachment A. Include a detailed description of the company's record keeping tools and methods. Describe any additional information the company is capable of recording that may be of use to the City. vii. Propose a method of receiving completed forms electronically from the City by the firm, if one is available. viii. Electronically provide monthly reports of ambulance & paramedic billing and City of Santa Ana RFP No. 24-104 Page 8 of 35 (9)CITY OF SANTA ANA collection services. ix. Propose any informational or reporting enhancements the company is capable of providing. Example: secure web -based access to reports and records under this contract by the City. X. Proposers are encouraged to provide additional innovative, value -adding features and/ or services, and/ or creative approaches for providing the service that will maximize efficient, cost-effective operations or increased performance capabilities. A. Optional: The City desires to increase promotion of its paramedic subscription program to residents that may benefit from subscribing to this program. Although not required, Proposers capable of providing such services at minimal or no cost should demonstrate experience and ability to independently promote the City's paramedic subscription program (htti)s://www.santa-ana.org/paramedic-subscription/). Examples of previous work should be included for the City's consideration. f. References: Attachment B — References shall be submitted for similar projects performed for state and/or similar government clients. 2. Cost Proposal All Proposers are required to submit a fixed rate fee with their Cost Proposal. Pricing instructions should be clearly defined to ensure fees proposed can be compared and evaluated. Cost Proposal must include a payment schedule that includes fees for the following for collections obtained by Contractor: a. With EMS Treat -No -Transport Call Fees and First Responder Call Fees; and b. Without EMS Treat -No -Transport Call Fees and First Responder Call Fees. c. Fixed rate fee for additional services (if any), including promotion of City services if offered by Proposer. Fixed rate fees shall be structured for each of the categories a. and b. listed above as fnI IMAIQ • Agreement Year 1 (Initial Term) — equal to: a) % or b) % of net collections obtained by Contractor • Agreement Year 2 (Initial Term) —equal to: a) % or b) % of net collections obtained by Contractor • Agreement Year 3 (Initial Term) — equal to: a) % or b) % of net collections obtained by Contractor • Agreement Year 4 (Optional Term) — equal to: a) % or b) % of net collections obtained by Contractor City of Santa Ana RFP No. 24-104 Page 9 of 35 (9)CITY OF SANTA ANA • Agreement Year 5 (Optional Term) — equal to: a) % or b) % of net collections obtained by Contractor City reserves the right to negotiate compensation and/or payment schedule prior to award of any resulting agreement. When applicable, if providing hourly rate sheets, Proposer shall not include rate ranges or averages. The City shall not provide reimbursement for travel -related expenses, mileage, parking, lodging, meals, incidental fees, insurance, freight/shipping and handling/delivery, and any other business expenses, supplies and materials related to providing services as specified herein. Additional costs will not be considered and will not be reimbursed by the City, therefore, such costs must be absorbed in Proposer's cost proposal fee structure. Any language related to travel reimbursement shall be stricken from the document by the City and if not stricken, shall be deemed invalid. Proposals shall be valid for a minimum of one hundred eighty (180) days following Proposal deadline. The cost for developing the Proposal is the sole responsibility of the Proposer. All Proposals submitted become property of the City. Pricing shall remain firm for the entire initial Agreement term. Thereafter, any proposed pricing adjustment for follow-on renewal periods shall be submitted to the City Representative in writing at least ninety (90) days prior to the new Agreement term. The City reserves the right to accept, reject, or negotiate any proposed pricing adjustment not to exceed the Bureau of Labor Statistics Consumer Price Index (CPI) data as follows: Los Angeles -Long Beach -Anaheim, CA; All Urban Consumers; Not Seasonally Adjusted; annualized change comparing the most recent month's reported data to the same month of the prior year. (This information may be found on the U.S. Department of Labor's website at www.bls.gov.) F. CERTIFICATIONS (ATTACHMENTS) In addition to the SOQ, Narrative/Technical Proposal, and Cost Proposal, the following forms, included in this RFP, shall be signed and included as part of the proposal submittal package: • Attachment A: Proposer's Certification and Proposal Item Pricing • Attachment B: References • Attachment C: Proposer's Statement • Attachment D: Non -Collusion Affidavit • Attachment E: Non -Lobbying Certification • Attachment F: Non -Discrimination Certification The proposal must be completely responsive to the RFP. Incomplete proposals will be deemed as nonresponsive and will be rejected. The City reserves the right to reject any or all proposals submitted and no representation is made hereby that any commitment will be awarded pursuant to this RFP or otherwise. PLEASE NOTE: • All forms above must be signed by a representative of the Firm that is legally authorized to contractually bind the Proposer. City of Santa Ana RFP No. 24-104 Page 10 of 35 (9)CITY OF SANTA ANA • City will not waive notarization requirement when applicable on any of the required attachments. G. REFERENCES Contractor shall provide three (3) references from other similar public agencies for which services similar to those specified in this RFP have been performed, including contact names and telephone numbers. Use ATTACHMENT B — References. The respondent grants permission for the City to contact any individuals listed as references. City may disqualify a Proposer if - References fail to substantiate Proposer's description of services and deliverables provided; or • References fail to support that Proposer has a continuing pattern of providing capable, productive, and skilled personnel, or • City is unable to reach the point of contact with reasonable effort. It is the Proposer's responsibility to inform the point of contact(s) of normal City working hours. H. MINIMUM SCOPE AND LIMIT OF INSURANCE See Exhibit 11 — Sample Agreement I. SELECTION PROCEDURES & CRITERIA A. Evaluation: The City will establish a proposal review committee. The review committee will evaluate proposals based on the response to the RFP, which includes adherence to outlined directions and format, and the City evaluation criteria set forth below. B. Scoring Criteria: Proposers will be ranked by the review committee based on the following criteria: CATEGORY POINTS Responsiveness to RFP • Proposal's compliance with the requirements of this RFP. • Scope of Services offered including ability to provide optional services. 20 • The value to any new and/or innovative product or service suggestions or other new ideas and enhancements. Experience of Firm and Personnel • The experience, resources, and qualifications of the firm and individuals 50 assigned to this account, including manager, supervisor and assigned staff. Proposed Pricing 20 • Reasonableness of Cost References • References that are similar in size and project scope to the City. 10 City of Santa Ana RFP No. 24-104 Page 11 of 35 (9) CITY OF SANTA ANA TOTAL POSSIBLE SCORE Before interviews - if held 100 Interviews • The City reserves the right to conduct interviews with the two highest - rated firm(s). In the event the City does perform an interview process, the 20 following is the maximum number of additive points that may be applied to the proposal score. Total possible score may exceed 100 points. C. Rankings: A final score will be calculated for each submitted proposal and used to rank Proposers. Based upon the foregoing criteria, all proposals shall be ranked by score. Only those proposals receiving a score above 70 will be considered for award. The City reserves the right to award the contract to any proposer(s) with a score above 70. The review committee will evaluate proposers based on their response to the RFP and the City evaluation criteria set forth above. D. Interviews: The review committee may invite the proposers to interview. If invited to interview, Proposers must be prepared to include key personnel in the interview and/or presentation. The City reserves the right to seek additional information from any or all Proposers invited to present proposals. A final score will be calculated for each submitted proposal and used to rank Proposers. City reserves the right to begin negotiations and enter into a contract without holding interviews, or further discussions. E. Selection: The City is under no obligation to accept any proposal and reserves the right to negotiate with respondents as to fees and terms. The City may reject proposals at its sole discretion. If proposal fails to satisfy any requirements outlined in this RFP, it may be considered non -responsive and may be rejected. The City shall not be obligated to accept the lowest priced proposals, but will make awards in the best interests of the City after all factors have been evaluated. The review committee will recommend the qualified Proposers to the City Council or City Manager for award of contract, as appropriate. J. WITHDRAWALS Proposers are responsible for verifying all prices and information before submitting a proposal. Prior to the proposal due date, the Proposer or Proposer's representative may withdraw the proposal by providing written notice of the proposal withdrawal to the City Contact/Project Manager. Verbal or telephonic withdrawals are not permissible. K. GENERAL TERMS AND CONDITIONS A. AMERICANS WITH DISABILITIES ACT The awarded Contractor hereby certifies that it will comply, as applicable, with the Americans with Disabilities Act of 1990 ("ADA"), 42 USC §§ 12101 et seq., and its implementing regulations, including Subtitle A, Title II of the ADA. Contractor will not discriminate against persons with disabilities nor against persons due to their relationship to or association with a person with a disability. Any contract entered into by the awarded Contractor (or any subcontract thereof), relating to this RFP, shall be subject to the provisions of this paragraph. City of Santa Ana RFP No. 24-104 Page 12 of 35 (9) CITY OF SANTA ANA B. CITY BUSINESS LICENSE The selected proposer must obtain a City of Santa Ana Business License prior to the execution of a contract and must provide a copy to the Buyer assigned to this RFP. The awarded party shall maintain a current business license throughout the term of the resulting contract. Procedure to obtain a City of Santa Ana Business License is available by contacting the Finance and Management Services, Business Tax Office at (714) 647-5447 or on the City's website: www.santa-ana.org C. CITY RIGHT TO REJECT The City reserves the right to reject any or all proposals submitted and no representation is made hereby that any agreement will be awarded pursuant to this RFP or otherwise. The City reserves the right to accept or reject the combined or separate components of this proposal in part or in its entirety or to waive any minor inconsistency, informality or technical defect in the proposal. D. CONFLICT OF INTEREST Contractor shall exercise reasonable care and diligence to prevent any actions or conditions that could result in a conflict with the best interests of the City. This obligation shall apply to the Contractor; the Contractor's employees, agents, and Subcontractors associated with accomplishing work and services hereunder. The Contractor's efforts shall include, but not be limited to, establishing precautions to prevent its employees, agents, and Subcontractors from providing or offering gifts, entertainment, payments, loans or other considerations which could be deemed to influence or appear to influence City staff or elected officers from acting in the best interests of the City. Each Proposer must disclose any existing or potential conflict of interest relative to the performance of the contractual services resulting from this RFP. Any such relationship that might be perceived or represented as a conflict should be disclosed. The City reserves the right to disqualify any Proposer on the grounds of actual or apparent conflict of interest. No person, firm, or subsidiary thereof who has been awarded this Contract may be awarded a Contract for the provision of services, the delivery of supplies, or the provision of any other related action which is required, suggested, or otherwise deemed appropriate as an end product of this Contract. Therefore, Contractor is precluded from contracting for any work recommended as a result of this Contract. E. CONTRACTOR'S EXPENSE Pre -Contractual Expenses: The City is not liable for any costs incurred by Proposers prior to entering into a formal contract. Costs of developing a response to this RFP, are entirely the responsibility of the Proposer, and shall not be reimbursed in any manner by the City. Pre - contractual expenses are not to be included in the cost proposal. Pre -contractual expenses include, but are not limited to, preparation of the proposal, submission of the proposal and additional information, attendance at pre -proposal conference, negotiating any matter related to this RFP with City, and/or any other expenses incurred by the Proposer prior to the date of award and execution, if any, of the contract. Other Expenses: The Contractor will be responsible for all costs related to photo copying, telephone communications, fax communications, and parking while on City sites during the performance of work and services under this Contract. City of Santa Ana RFP No. 24-104 Page 13 of 35 (9) CITY OF SANTA ANA F. CONTRACTOR'S PROJECT MANAGER/KEY PERSONNEL Except as formally approved by the City, the key personnel identified in Contractor's proposal shall be the individuals who will actually complete the work. Changes in staffing must be reported in writing and approved by the City. The City shall have the right to require the removal and replacement of the Contractor's Project Manager and key personnel under the awarded contract. The City shall notify the Contractor in writing of such action. The City is not required to provide any reason, rationale, or additional factual information if it elects to request any specific key personnel be removed from performing services under the awarded contract. The City shall review and approve the appointment of the replacement for the Contractor's personnel. Said approval shall not be unreasonably withheld. Standards of Conduct: Contractor's personnel shall be courteous and maintain good working relationships with all stakeholders, state or outside agencies, other team members and staff within the City. G. COST PROPOSAL The awarded Contractor agrees to provide the purchased services at the costs, rates, and fees as set forth in their Fee Schedule in response to this RFP. No other costs, rates or fees shall be payable to the awarded Subcontractor for implementation of their proposal. H. DATA RETENTION Contractor shall be responsible for retaining data, records, and documentation for the preparation of required items. These materials shall be made available to and as requested by City. All materials, documents, data or information obtained from the City Data files or any City medium furnished to Contractor in the performance of an awarded contract will at all times remain the property of the City. Such data or information may not be used or copied for direct or indirect use by Contractor after completion or termination of this Contract without the express written consent of the City. All materials, documents, data or information, including copies, must be returned to the City at the end of the contract. All data, documents and other products used, developed, or produced during response preparation of the RFP will become property of the City. All responses to the RFP shall become property of the City. Proposer information identified as proprietary shall be maintained confidential, to the extent allowed under the California Public Records Act. I. DRUG -FREE WORKPLACE The awarded Contractor certifies compliance with Government Code Section 8355 in matters relating to providing a drug -free workplace. Failure to comply with these requirements may result in suspension of payments under the Contract or termination of the contract or both, and the Contractor may be ineligible for award of any future City contracts. EXAMINATION Proposer represents that it has thoroughly examined and become familiar with the services and responsibilities required this RFP and that it is capable of effectively and efficiently performing quality work to achieve the City's objectives. Any attachments referenced herein or any interpretations, clarifications or amendments subsequently posted in relation to this RFP are fully incorporated. City of Santa Ana RFP No. 24-104 Page 14 of 35 (9)CITY OF SANTA ANA Any irregularities or lack of clarity in the RFP should be brought to the designated City Contact/Project Manager's attention as soon as possible so that corrective addenda may be furnished to prospective Proposers. Proposals which appear unrealistic in the terms of technical commitments, lack of technical competence, or are indicative of failure to comprehend the complexity and risk of this contract, may be rejected. K. EXECUTION OF AGREEMENT Upon successful negotiations, the City and the selected Proposer will enter into an Agreement similar to that as shown in EXHIBIT II — Sample Agreement of this RFP. If a Proposer is unwilling or unable to execute an Agreement within thirty (30) days after being notified of selection under this RFP, the City reserves the right to disqualify them without any further obligation L. FISCAL NONFUNDING CLAUSE In the event sufficient budgeted funds are not available for a new fiscal period, the City shall retain the right to notify the provider of such occurrence in writing at least thirty (30) days before the end of the current fiscal period and terminate the contract on the last day of the current fiscal period without penalty or expense to the City. M. INDEPENDENT CONTRACTOR Contractor is considered an independent Contractor and neither Contractor, its employees, nor anyone working under Contractor will be considered an agent or an employee of City. Neither Contractor, its employees, nor anyone working under Contractor, will qualify for workers' compensation or other fringe benefits of any kind through City. N. JOINT OFFERS/SUBCONSULTANTS Where two or more Proposers desire to submit a single proposal in response to this RFP, they should do so on a prime sub -consultant basis. The City intends to contract with a single firm, also known as the prime, and not with multiple firms doing business as a joint venture. Should the use of sub -consultants be offered, the Proposer shall provide the same assurances of competence for the sub -consultant plus the demonstrated ability to manage and supervise the subcontracted work. Sub -consultants shall not be allowed to further subcontract with others for work under the Agreement. The provisions of the Agreement shall apply to all sub -consultants in the same manner as the Proposer. The proposer is responsible for all the actions taken by their sub -contractor. The City reserves the right to reject, replace and approve any and all Subcontractors. All Subcontractor(s) shall be identified in the response to the RFP and the City reserves the right to reject any proposed Subcontractor(s). Subcontractors shall be the responsibility of the prime Contractor and the City shall assume no liability of such Subcontractors. O. LITIGATION STATUS Each Proposer must include in its proposal a complete disclosure of any alleged significant prior or ongoing contract failures, any civil or criminal litigation or investigation pending which involves the Proposer or in which the Proposer has been judged guilty or liable. Failure to comply with the terms of this provision will disqualify any proposal. The City reserves the right to reject any proposal based upon the Proposer's prior history with the City or with any other party, which documents, without limitation, unsatisfactory performance, adversarial or contentious demeanor, significant failure(s) to meet contract milestones or other contractual failures. City of Santa Ana RFP No. 24-104 Page 15 of 35 (9) CITY OF SANTA ANA P. NEGOTIATIONS The City reserves the right to negotiate final contract terms with any Proposer selected. The contract between the parties will consist of the RFP together with any modifications thereto, and the awarded Contractor's proposal, together with any modifications and clarifications thereto that are submitted at the request of the City during the evaluation and negotiation process. In the event of any conflict or contradiction between or among these documents, the documents shall control in the following order of precedence: the final executed contract, the RFP, any modifications and clarifications to the awarded Contractor's proposal, and the awarded Contractor's proposal. Specific exceptions to this general rule may be noted in the final executed contract. Negotiations shall be confidential and not subject to disclosure to competing Contractors unless and until an agreement is reached. If contract negotiations cannot be concluded successfully, the City reserves the right to negotiate a contract with another Contractor or withdraw the RFP. Q. NON -PAYMENTS Note that payments will NOT be made for any unsatisfactory work until corrected. In the event of nonpayment of undisputed sums by the City, Contractor shall give the City thirty (30) working days to cure the alleged breach. R. OWNERSHIP OF DOCUMENTS The City has permanent ownership of all directly connected and derivative materials produced under this contract by the Contractor. All documents, reports and other incidental or derivative work or materials furnished hereunder shall become and remains the sole property of the City and may be used by the City as it may require without additional cost to the City. Contractor shall provide the City copies of documents upon its request at any time. None of the documents, reports and other incidental or derivative work or furnished materials shall be used by the Contractor without the express written consent of the City. S. PARKING The City will not provide free parking and/or reimbursement for the cost of parking while providing services and conducting business with the City. T. PROFESSIONAL STANDARDS Contractor staff shall be courteous to the public and City staff utilizing facilities where Contractor is performing work, but shall be responsive only to the requests of the City's Project Manager or designee. Contractor staff shall direct all inquiries to Project Manager or designee. Contractor acknowledges that City locations consist of public -use facilities and recognizes the obligation to ensure Contractor personnel and agents maintain the highest level of professional standards in attire, decorum, and interaction with the public and City personnel. U. PROJECT MANAGER The selected Proposer will assume responsibility for all services in its proposal. The selected Proposer shall identify a sole point of contact, Project Manager, with the greatest knowledge in regard to the required service operations and contractual matters, including payment of any and all charges resulting from the Agreement. City of Santa Ana RFP No. 24-104 Page 16 of 35 (9) CITY OF SANTA ANA V. PROPOSAL VALIDITY Services, pricing, and warranties indicated in a Proposer's Proposal must be valid for a period of 180 days at minimum after the submission of the Proposal. W. PUBLIC AGENCIES Other public agencies, as defined by California Government Code Section 6500, may choose to use the terms of this Contract, subject to Contractor's acceptance. The City is not liable or responsible for any obligations related to a subsequent contract between Contractor and another public agency. X. PUBLIC RECORDS Proposals will become public record after the award of a contract unless the proposal or specific parts of the proposal can be shown to be exempt by law. Each Proposer may clearly label all or part of a proposal as "CONFIDENTIAL" provided that the Proposer thereby agrees to indemnify and defend the City for honoring such a designation. The failure to so label any information that is released by the City shall constitute a complete waiver of any and all claims for damages caused by any release of the information. Proposer information identified as proprietary shall be maintained confidential, to the extent allowed under the California Public Records Act. Y. SUBCONTRACTORS Proposals in response to this RFP must identify any Subcontractors, and outline the contractual relationship between the Awarded Subcontractor and each Subcontractor. An official of each proposed Subcontractor must sign, and include as part of the proposal submitted by the Prime Contractor, a statement to the effect that the Subcontractor has read and will agree to abide by the awarded Contractor's obligations. Any Subcontractor proposed after award of contract must be approved by the City before commencement of work. The City will look solely to the awarded Contractor for the performance of all contractual obligations which may result from an award based on this RFP, and the awarded Contractor shall not be relieved for the non-performance of any or all Subcontractors. L. AWARD OF AGREEMENT Selected Contractor(s) will be notified in writing. Any award is contingent upon the successful negotiation of final contract terms. A. EXECUTION OF AGREEMENT A standard agreement is included as EXHIBIT II Sample Agreement of this RFP. "Proposer" will hereinafter be referred to as "Consultant" or "Contractor" in standard agreement. The term of the agreement will begin after the agreement is fully executed, and all required bonds, insurance documents and contents of the payment information packet have been received and approved. M. IMPLEMENTATION A. KICK-OFF MEETINGS The successful proposer will be required to meet with City staff prior to commencement of services or at any time as required by the City, to discuss and agree on operational issues including transition of services and scheduling. City of Santa Ana RFP No. 24-104 Page 17 of 35 (9) CITY OF SANTA ANA EXHIBIT I SCOPE OF SERVICES Contractor shall perform services at set forth below. A. General Requirements 1. Contractor shall be responsible for modifying their billing systems to capture all necessary data generated from the ambulance & paramedic billing and collection services program as an electronic file and provide a description of the electronic file needed to receive data transmitted from OCFA. 2. Contractor shall work with OCFA and their electronic Prehospital Care Report (ePCR) vendor to identify data input gaps, errors and other data needs, and describe a means of obtaining solutions to these problems. 3. Contractor must be able to accurately transfer all necessary information from the OCFA ImageTrend database, based on the information provided by the electronic OCFA's ePCR, and obtain any additional information needed that is not included in the ePCR for proper and correct invoicing. 4. Contractor must have the capability to fully integrate and support OCFA's selected ePCR application. 5. Contractor shall bill for emergency medical services in a timely manner, including but not limited to the billing of Medicare, Medical/Medicaid, private insurances, supplemental insurances, secondary insurances and workers' compensation carriers according to specific requirements. 6. Contractor shall provide to the City and the City's contracted collection agency, listings of accounts, which the company feels are uncollectable, through normal collection processes, for further action by the City and the City's contracted collection agency. 7. Contactor must be able to forward and work with the City's contracted collection agency on listings of uncollectable accounts. 8. Contractor shall have the ability to handle third -party payer submission inquiries regarding insurance claims. 9. Contractor must work with County of Orange and perform screening of all medically indigent patients. 10. Contractor shall process all customer payments in accordance with the applicable Payment Card Industry (PCI) security requirements. City of Santa Ana RFP No. 24-104 Page 18 of 35 (9)CITY OF SANTA ANA 11. Contractor shall research and follow-up on all accounts with inadequate billing information. This shall include the following at minimum: a. Contact OCFA and/or Falck dba Care Ambulance for missing and/ or incomplete information, which may be found in their records; b. Contact receiving hospital for missing and/ or incomplete billing information needed from the admitting/ registration records; c. Contact patient family members or emergency contacts for information; d. Refer to zip code/ street directories for incomplete/ missing address information; and/or e. Mail inquiries to the patient. 12. Contractor shall have the ability to cross reference patient files in various methods (i.e. Last Name, Social Security Number, Service or Residence Address, Date of Birth, Date of Service, etc.). 13. Contractor shall have the ability to receive patient care documentation on paper and electronically. 14. Contractor shall maintain updated and current technology that will continuously provide the highest level of reimbursement and customer service possible. 15. Contractor must meet or exceed mutually agreed upon collection targets. 16. Contractor must instruct customers to submit all payments to Contractor, and not the City of Santa Ana. 17. Contractor shall collect and deposit payments on no less than a weekly basis, within three (3) days following receipt of payment. B. Optional Services Independently promote the City's paramedic subscription program (https://www.santa- ana.orq/paramedic-subscription/). C. Customer Service Requirements 1. Contractor shall designate a single manager for the City's account, who will be the City's primary contact with their agency. 2. Contractor shall provide all supplies, equipment, personnel, computer software and hardware, billing forms, insurance forms, lien forms, envelopes, postage and supplies necessary to administer, on a day-to-day basis, the City's EMS billing and accounts receivable functions. 3. The company shall provide all billing statements in English and Spanish, and maintain a necessary staff of bilingual account representatives. City of Santa Ana RFP No. 24-104 Page 19 of 35 (9) CITY OF SANTA ANA 4. Contractor shall provide excellent customer service to citizens of Santa Ana who have billing questions or problems, by providing a nationwide toll -free phone number and an email address so individuals with questions or requiring assistance with invoices, may contact the company directly at no additional cost to the City. 5. Contractor shall have demonstrated experience and ability to act as the City's authorized agent for liaising on the City's behalf with the Centers for Medicare Services and/or their designated agents as well as associated state agencies. 6. Contractor shall have demonstrated experience and ability to act as the City's authorized agent for liaising with the City's contract EMS provider (OCFA). D. Records and Reports Contractor shall maintain complete records of each bill, including all correspondence, documents, account records, transactions and a detailed log of all payments. These records shall be retained for a minimum of three (3) years. a. Contractor shall provide the City with electronic access to these billing records. 2. Contractor shall maintain records that are in accordance with the Generally Accepted Accounting Principles (GAAP). The Proposer agrees that all account files are the property of the City and will relinquish them to the City at the termination of the contract. 3. Contractor shall provide monthly finance, billing, account receivable aging reports, billing summaries, details for current month invoicing, current write-off, refund reports (including pending refunds), detail of monthly receipts account reconciliation, and any additional reports that the City may need or request, in the specific format requested. 4. Upon request, Contractor shall make all books and records available to both internal and external auditors. 5. Contractor shall provide annual and semi-annual EMS revenue collection projections to City staff upon request. E. Compliance 1. Contractor must comply with all applicable provisions and specifications of the Health Insurance Portability and Accountability Act (HIPAA), as well as other federal, state, and local statues and regulations addressing patient privacy issues throughout the term of the contract. 2. Contractor shall maintain proficiency and comply with all statutory, regulatory, and other legal requirements, including amendments to such requirements, which impact billing, reimbursement and/or collections for EMS and release of private medical information. City of Santa Ana RFP No. 24-104 Page 20 of 35 (9)CITY OF SANTA ANA 3. Contractor agrees to cooperate with the City regarding the handling of accounts. These accounts may be included, but are not limited to accounts of the specific age classifications, handicapped, and certain dependent situations. 4. Contractor shall provide regular and continuous education and training for Contractor's staff, updating them immediately on all changes in the industry or government regulations that may have an impact on services being provided to the City. F. Meetings Contractor must meet with City staff upon execution of contract to discuss goals of the relationship, the services to be provided, and other topics relevant to the ambulance & paramedic billing and collection services program. 2. Contractor agrees to meet with the City routinely and on request to discuss problems, special needs, future changes, and updates in software, technology, statistical data requests, or other relevant issues. G. Transition (If Applicable) 1. Contractor agrees to coordinate with existing service provider to transition current accounts with minimal disruption to service, and deliver to the City a computerized file of active accounts in an agreeable format. 2. Upon implementation of contract, Contractor must be able to process any backlog of billing within thirty (30) days of the implementation date. City of Santa Ana RFP No. 24-104 Page 21 of 35 CITY OF SANTA ANA EXHIBIT II SAMPLE AGREEMENT CONSULTANT -AGREEMENT CITY OF SANTA ANA THIS AGREEMENT is made and entered into on this day of , 20 by and between , ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a Consultant having special skill and knowledge in the field of: B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: SCOPE OF SERVICES Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Scope of Services - Exhibit A, attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges identified in Compensation - Exhibit B. The total amount to be expended during the term of this Agreement shall not exceed $xxxxxx. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above for a three (3)-year term with the option for the City to grant up to two 1 - ear renewals, exercisable by a writing by the City Manager and the City Attorney, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent Consultant and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer - employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social City of Santa Ana RFP No. 24-104 Page 22 of 35 (9) CITY OF SANTA ANA security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 6. INSURANCE Company shall procure and maintain for the duration of the contract insurance against claims for security breaches, system failures, injuries to persons, damages to software, and damages to property (including computer equipment), theft, or other misuse of Customer's data, infringement of intellectual property, invasion of privacy and breach of data, which may arise from or in connection with the performance of the work hereunder by Company, its agents, representatives, or employees. MINIMUM SCOPE OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 general aggregate. 2. Cyber Liability (CL): Insurance, with limits not less than $2,000,000 per occurrence or claim and $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by Company in this agreement and shall include, but not be limited to, claims involving security breach, system failure, data recovery, business interruption, cyber extortion, social engineering, infringement of intellectual property, including but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, and release of private information. The policy shall provide coverage for breach response costs, regulatory fines and penalties as well as credit monitoring expenses. 3. Workers' Compensation: as required by the State of California, with statutory limits, and Employer's Liability insurance with limits of no less than $1,000,000 per accident, policy, employee, for bodily injury or disease . 4. Professional Liability (PL): with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. If Company maintains broader coverage and/or higher limits than the minimums shown above for any line of coverage, Customer requires and shall be entitled to the broader coverage and/or the higher limits maintained by Company. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to Customer. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: City of Santa Ana RFP No. 24-104 Page 23 of 35 (9) CITY OF SANTA ANA 1. City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds, under Company's CGL, CL, and PL policies, with respect to any liability arising out of work or operations performed by or on behalf of the Company. 2. Company's Insurance companies agree to waive all rights of subrogation against City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of the CGL, CL, PL, WC policies which arise from work performed by Company under this Agreement. 3. For any claims related to this contract, Company's insurance coverage shall be primary and any insurance maintained by City of Santa Ana, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. A severability of interest provision must apply for all the additional insureds, ensuring that Company's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5. Insurance policies required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written notice shall be provided to City for policy cancellation or non -renewal due to non-payment of premium. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: (Name of Department Staff Responsible for Agreement), 20 Civic Center Plaza M-XX (Responsible Staff's Department Mail Box), Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. Self -Insured Retentions Self -insured retentions must be declared to and approved by Customer. Customer may require Company to provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. Acceptability of Insurers Insurance is to be placed with insurers authorized to conduct business in the state of California with a current A.M. Best rating of no less than A-:VII, unless otherwise acceptable to Customer. Claims Made Policies If any of the required policies provide coverage on a claims -made basis: 1. The retroactive date must be shown and must be before the date of the contract. 2. Insurance must be maintained and evidence of insurance must be provided for at least three (3) years after completion of work. 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a retroactive date prior to the contract effective date, Company must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. Verification of Coverage Company shall furnish Customer with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause). Failure to obtain the required documents prior to the work beginning shall not waive Company's obligation to provide them. Customer reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Subcontractors Company shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein. Special Risks or Circumstances Customer reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Failure to Maintain Insurance Coverage City of Santa Ana RFP No. 24-104 Page 24 of 35 (9) CITY OF SANTA ANA If Company, for any reason, fails to maintain insurance coverage, which is required pursuant to this Agreement, for the entire term of this contract, the same shall be deemed a material breach of Agreement. Customer, at its sole option, may terminate this Agreement at any time and obtain damages from Company resulting from said breach. 7. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. 9. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 10. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. City of Santa Ana RFP No. 24-104 Page 25 of 35 (9) CITY OF SANTA ANA 11. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION -VENUE City of Santa Ana RFP No. 24-104 Page 26 of 35 (9) CITY OF SANTA ANA This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Executive Director, Finance & Management Services Agency City of Santa Ana 20 Civic Center Plaza (M-15) P.O. Box 1988 Santa Ana, California 92702 Fax: To Contractor: First & Last Name Title Consultant Firm Name Address City, State, Zip Fax: A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the City of Santa Ana RFP No. 24-104 Page 27 of 35 (9) CITY OF SANTA ANA transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. The Agreement is the final and complete agreement and any prior or contemporaneous agreements for similar services between the parties is superseded by this Agreement. This shall not apply where the Parties are currently engaged and Consultant is providing services not contemplated by this Agreement. C. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Jennifer L. Hall City Clerk APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney 0 Assistant City Attorney RECOMMENDED FOR APPROVAL: Kathryn Downs Executive Director Finance & Management Services Agency CITY OF SANTA ANA Alvaro Nunez City Manager CONSULTANT: (name) (title) SAMPLE ONLY City of Santa Ana RFP No. 24-104 Page 28 of 35 (9) CITY OF SANTA ANA ATTACHMENT A PROPOSER'S CERTIFICATION, PROPOSAL PRICING Certification - I certify that I have read, understand and agree to the terms and conditions of this Request for Proposals. I have examined the Scope of Services (Exhibit 1) and am qualified to provide services being requested as specified herein. I understand and agree that I am responsible for reporting any errors, omissions or discrepancies to the City for clarification prior to the submission of my proposal. PROPOSER'S STATEMENT: I have read, understood and agree to the terms and conditions on all pages of the Request for Proposals. Upon request, I will transfer and deliver goods or services to the City in accordance with said terms and conditions. LEGAL NAME OF COMPANY PHONE AND FAX NUMBERS BUSINESS ADDRESS PRINTED NAME OF AUTHORIZED AGENT TITLE SIGNATURE OF AUTHORIZED AGENT DATE E-MAIL ADDRESS FEDERAL ID NUMBER (IF APPLICABLE) CONTRACTOR LICENSE NUMBER (IFAPPLICABLE) CITY OF SANTA ANA BUSINESS LICENSE NUMBER (PLEASE PROVIDE IF AVAILABLE, BUT NOT REQUIRED UNTIL AND IF AN AWARD IS MADE TO PROPOSER.) THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana RFP No. 24-104 Page 29 of 35 (9) CITY OF SANTA ANA ATTACHMENT B REFERENCES List and describe fully the contracts performed by your firm which demonstrate your ability to provide the supplies, equipment or services included in the scope of the proposal specifications. Attach additional pages if required. The City reserves the right to contact each of the references listed for additional information regarding your firm's qualifications. REFERENCE Customer Name: Contact Individual: Address: Phone Number: EMAIL: Contract Amount: Year: Description of supplies, equipment, or services provided: REFERENCE Customer Name: Address: Contact Individual: Phone Number: . EMAIL: Contract Amount: Year: Description of supplies, equipment, or services provided: REFERENCE Customer Name: Address: Contact Individual: Phone Number: . EMAIL: Contract Amount: Year: Description of supplies, equipment, or services provided: THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana RFP No. 24-104 Page 30 of 35 (9) CITY OF SANTA ANA ATTACHMENT C PROPOSER'S STATEMENT Proposer understands and agrees that this written RFP (or any part thereof specifically designated and accepted by the City of Santa Ana, hereinafter City) shall constitute the entire agreement between proposer and the City only after it has been accepted by the City Council, endorsed by the Clerk of the Council with her signature and official seal noting hereon the action of approval of the Council, signed by the Executive Director or his duly authorized agent, and signed by the City Attorney, denoting his approval of the form of this document, and its execution, and when it or an exact copy of it has been either delivered to proposer or deposited with the United States Postal Service properly addressed to the proposer with the correct postage affixed thereto. Proposer further agrees that upon delivery (as defined above) of the accepted agreement he/she will furnish City all required bonds and certificate of liability insurance within ten (10) days (excluding Saturdays, Sundays and City's legal holidays), or the funds, check, draft, or proposer's bond substituted in lieu thereof accompanying this proposal shall become the property of the City and shall be considered as payment of damages due to the delay and other causes suffered by City because of the failure to furnish the necessary bonds and because it is distinctly agreed that the proof of damages actually suffered by City is difficult to ascertain; otherwise said funds, check drafts, or proposer's bond substituted in lieu thereof shall be returned to the undersigned. Proposer understands that a proposal is required for the entire work, that the estimated quantities set forth in the RFP schedule are solely for the purpose of comparing proposals, and that final compensation under the contract will be based upon the actual quantities of work satisfactorily completed. All terms contained in the specifications, the certification of nondiscrimination by contractors, and the required insurance certificates are to be incorporated by reference into this agreement and are made specifically as part of this RFP. Firm Signed and Printed Name: Title Date THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana RFP No. 24-104 Page 31 of 35 (9) CITY OF SANTA ANA ATTACHMENT D NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the CITY OF SANTA ANA In accordance with Title 23 United States Code Section 112 and Public Contract Code 7106 the proposer declares that the proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the proposal is genuine and not collusive or sham; that the proposer has not directly or indirectly induced or solicited any other proposer to put in a false or sham proposal, and has not directly or indirectly colluded, conspired, connived or agreed with any proposer or anyone else to put in a sham proposal, or that anyone shall refrain from bidding; that the proposer has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the proposal price of the proposer or any proposer, or to fix any overhead, profit, or cost element of the proposal price, or of that of any other proposer, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the proposal are true; and, further, that the proposer has not, directly or indirectly, submitted his or her proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham proposal. Note: The above non -collusion affidavit is part of the proposal. Signing this proposal on the signature portion thereof shall also constitute signature of this non -collusion affidavit. Proposers are cautioned that making a false certification may subject the certifier to criminal prosecution. Signed State of , County of Subscribed and sworn to (or affirmed) before me on this day of , 20 , by , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. Notary Public Signature Notary Public Seal THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana RFP No. 24-104 Page 32 of 35 (9) CITY OF SANTA ANA ATTACHMENT E NON -LOBBYING CERTIFICATION The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. The prospective participant also agrees by submitting his or her bid or proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. Signed: Title: Firm: Date: THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana RFP No. 24-104 Page 33 of 35 (9) CITY OF SANTA ANA ATTACHMENT F NON-DISCRIMINATION CERTIFICATION The undersigned consultant or corporate officer, during the performance of this contract, certifies as follows: The Consultant shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The Consultant shall take affirmative action to ensure that applicants are employed, and that employees are treated during employment without, regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Consultant agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. 2. The Consultant shall, in all solicitations or advertisements for employees placed by or on behalf of the Consultant, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. 3. The Consultant shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Consultant's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Consultant shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Consultant shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his/her books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation, to ascertain compliance with such rules, regulations, and orders. In the event of the Consultant's non-compliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, the contract may be canceled, terminated, or suspended in whole or in part and the Consultant may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Execution Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulations, or order of the Secretary of Labor, or as otherwise provided by law. 2. The Consultant shall include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to Section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontract City of Santa Ana RFP No. 24-104 Page 34 of 35 (9) CITY OF SANTA ANA or purchase order as the administering agency may direct as means of enforcing such provisions, including sanctions for noncompliance; provided, however, that in the event the Consultant becomes involved in, or is threatened with, litigation with a subconsultant or vendor as a result of such direction by the administering agency, the Consultant may request that the United States enter into such litigation to protect the interests of the United States. 8. Pursuant to California Labor Code Section 1735, as added by Chapter 643 Stats. 1939, and as amended, no discrimination shall be made in the employment of persons upon public works because of race, religious creed, color, national origin, ancestry, physical handicaps, mental condition, marital status, or sex of such persons, except as provided in Section 1420, and any consultant of public works violating this Section is subject to all the penalties imposed for a violation of the Chapter. Signed: Title: Firm: Date: THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. City of Santa Ana RFP No. 24-104 Page 35 of 35