EMS Billing and Collection Services DUE: 08/19/16

EMS Billing and Collection Services DUE: 08/19/16

SOLICITATION OVERVIEW

The City of Irving is soliciting proposals for:

TITLE: Billing and Collection of Emergency Medical Services RFP Number: 182M-16F Commodity: 2355 Collection Services Due Date: 3:00 p.m. August 19, 2016 Location: City of Irving, Purchasing Division 835 W. Irving Blvd. Irving, Texas 75060

Pre - Proposal Conference: Date: August 5, 2016 Time: 2:00 p.m. Location: Purchasing Conference Room 835 W. Irving Blvd. Irving, Texas 75060 This conference is recommended, but not mandatory

Public Opening of Proposals: There will be a public opening of proposals in the Purchasing Division conference room immediately following the proposal due time/date. Only the names of proposers will be read aloud. Interested parties are invited to attend.

Written Questions: Submit written questions to: Marsha Hughes, Purchasing Agent at [email protected] Questions may be submitted through 10:00 am, August 11, 2016 No verbal questions will be accepted. Questions of a substantial nature will be addressed in an addendum, posted on the City’s Purchasing Web page for all interested parties.

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mailto:[email protected]

TABLE OF CONTENTS for RFP #182M-16F

Solicitation Overview ....................................................................................................... 1

Table of Contents ........................................................................................................... 2

Specifications ............................................................................................................. 3-10

Proposal Pricing Page ................................................................................................... 11

Attachment A-2, Standard Terms and Conditions .................................................... 12-15

Attachment B-6, General Instructions to Proposers ................................................. 16-17

Attachment B-7, Special Instructions to Proposers ....................................................... 18

Attachment B-3, Checklist for Proposers ....................................................................... 19

Attachment B-5, Map Locating Purchasing Division ...................................................... 20

Summary Response Page ............................................................................................ 21

Attachment C-1, Conflict of Interest Instructions .......................................................... 22

Attachment C-2, Conflict of Interest Statement ............................................................. 23

Attachment C-3, Federal Debarment Certification ........................................................ 24

Attachment C-6, Discretionary Contract Disclosure Form ....................................... 25-26

Attachment D-1, Insurance Requirements for Services............................................ 27-29

Attachment D-4, Insurance Affidavit ............................................................................. 30

Attachment D-6, Indemnification by Contractor ............................................................ 31

Attachment E-1, Environmental Commitment ............................................................... 32

Attachment E-2, Environmental Stewardship ................................................................ 33

Attachment F-1, Good Faith Effort Program Overview .................................................. 34

Attachment F-2, Good Faith Effort Affidavit .................................................................. 35

Attachment G-2, Bonding Requirements for Services ................................................. 36

Attachment H-8, Contract ......................................................................................... 37-43

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SPECIFICATIONS AND GENERAL REQUIREMENTS

I. BACKGROUND The City of Irving has a population of 228,653. The Fire Department utilizes 9 front line ambulances with a 10th unit going into service on or about January 2017. During FY14-15, a total of 18,404 incidents required the dispatch of an ambulance; number of transports was 9,406. Current charges: Transport:

Service Type Resident

65 or Older Resident Non-Resident

Basic Life Support (BLS) $400 $450 $600

Advanced Life Support (ALS)1 $400 $450 $600

Advanced Life Support (ALS)2 $400 $450 $600

Consumables 30% above cost Mileage to hospital $10 per mile Advanced treatment- no transport Resident $100 Non-resident $150 Technology Fee – electronic data $5 per patient The rates shown above have been in place since 2009. The city is considering a rate increase for Fiscal Year 2016-17. II. SERVICE SOUGHT 1. Billing and collection of EMS Ambulance Service using the necessary billing forms for various

third party payers in the following financial classes:

a. Self pay b. Commercial insurance c. Medicare d. Medicaid e. Medicare supplements f. Workers’ compensation g. Personal injury protection The contract shall also require collecting delinquent accounts, resolving fee-related inquires and complaints from EMS users and reporting all such activity daily, monthly, quarterly, and annually (fully reconciled) to the City with the necessary supporting documents.

2. Contractor shall be able to export the patient report data from the current ePCR provider (ESO

Solutions, Austin, TX) and pull that data into the billing software for a more accurate and faster billing process. If the ePCR system is changed during the contract term, the contractor shall

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be responsible for all necessary interface components (hardware/software) and technical support for receiving and translating transport records from the new ePCR system.

3. Since information for ambulance billing is often gathered under urgent conditions, the contractor shall obtain any missing data necessary for billing through telephone queries either from the receiving hospital or from the patient. Relationships should be established with insurance companies, hospitals, extended care centers, etc. to obtain insurance data and assure the timeliness of claim processing and reimbursement. Contractor shall contact hospitals within 2 days of receiving incomplete information from the Irving Fire-Rescue Department unless contact is made electronically. Use of the mail service for such inquiries is discouraged and only viable if telephone contact numbers are unavailable. The contractor shall respond to all ambulance users’ inquiries and complaints regarding the billing and collection of ambulance fees within 48 hours and resolve complaints within 5 days of receipt.

4. The contractor shall be cognizant of and abide by the billing requirements dictated by Health

Committee finance administration for Medicare patients, National Heritage Insurance Company for Medicaid patients, and TWCC for workers’ compensation patients. The contractor shall be aware of the contractual restrictions inherent in these billings and shall hold the City of Irving Emergency Medical Services harmless for any billing errors due to the contractor’s activity. The contractor is also required to be aware of and abide by any other normal billing practices in the industry.

5. Collection methods shall comply with all applicable Federal, State, and Local laws. 6. The contractor shall, concurrently with insurance billing, send the patient or the patient’s

responsible party a statement advising the status of the claim every thirty days. 7. In order to obtain prompt payment of accounts the contractor shall request patients, insurance

carriers, or other responsible party to pay any outstanding balance within forty-five days of the transport date. All payments shall be made payable to the City of Irving and directed to the City’s lockbox. Payments can also be made online via the Fire Department’s web page. Contractor will be given access to the lockbox for purposes of reviewing payments and EOBs. The deposits will be recorded in the City’s financial accounting system upon receipt. Payments received at the City will be scanned to the contractor.

8. The contractor may authorize patients to liquidate any outstanding balance of a self-pay or

patient portion of a billing on the installment method. The minimum payment on installment plans shall be $5.00 per month. No interest shall be charged to patients.

9. The contractor shall provide a method of collection for all accounts unpaid 45 days after

transport. A systematic collection procedure shall be established including telephone, mail, and/or personal contact to obtain collection. The contractor shall describe the system in the proposal narrative including the methodology, expected collection rate, and past history in collecting 45-120 day accounts.

10. When 120 days has passed since transport with no contact from the patient, the contractor

shall either proceed to make collection as a delinquent account or turn the account over to a collection agency of the city’s choosing. The contractor shall state whether it will act as a collection agency for delinquent accounts and if so, the charges for this service.

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11. At a minimum, the following reports shall be provided on a monthly basis in electronic (Excel,

Access, or Adobe) format:

a. Amount billed by patient b. Amount collected by patient and by type of payee c. Accounts receivable aging report d. A vendor performance analysis report, detailing billing, collection, adjustments with dollar

amounts and quantities as well as collections rates. Two collections rates will be calculated, one rate including adjustments and one rate without adjustments.

e. ALS-BLS service mix.

Samples of these reports, as well as other standard reports available from the contractor shall be provided with proposal response.

12. Other reports may be requested by the City as needed. 13. Contractor shall assume collection activity for all active EMS accounts receivable on the

contract commencement date. In addition, the city requests that proposers provide pricing for the following services with regard to participation in the Texas Ambulance Supplemental Payment Program (TASPP) for consideration. Pricing for these services should be provided separately from the required services outlined above, and may or may not be included in the final contract.

14. Provide supplemental payment recovery assistance services to assist City in participation in

the TASPP, with responsibilities to include:

Advising and assisting City with annual enrollment in the TASPP;

Managing the program applications and required cost reports for City in accordance with the TASPP;

Managing the TASPP pre-cost report submittal process for City, which may also include:

Developing and submitting the Provider Approval materials to the Texas Health and Human Services Commission (HHSC) on behalf of City;

Receiving the Provider Approval from HHSC for City’s participation in the TASPP; and

Developing and submitting the Cost Allocation Model and Report to HHSC on behalf of City for review as part of the TASPP.

Changing and finalizing the Cost Allocation Model during HHSC’s review of the Cost Allocation Model and Report, to meet HHSC’s requirements;

Preparing and submitting HHSC Ambulance Services Cost Report on an annual basis, as required by TASPP;

Assisting City with submitting other annual reports as required by the TASPP;

Ensuring that cost report preparer(s) engaged on behalf of City by the vendor are certified in accordance will all applicable rules, laws and regulations; and

Ensuring that it utilizes separate staff for all billing and cost report preparation services provided to City.

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III. BILLING AND COLLECTION INFORMATION

Billed Revenues

Gross Billing $4,892,449.00 $3,632,013.55

Adjustments (455,784.51) (346,709.50)

Total Adjusted Billings $4,436,664.49 $3,285,304.05

Private $1,295,506.03 29% $1,215,562.50 37%

Private Ins 1,206,772.74 27% 689,913.85 21%

Medicare 1,379,802.66 31% 952,738.17 29%

Medicaid 554,583.06 13% 427,089.53 13%

Total Adjusted Billings $4,436,664.49 100% $3,285,304.05 100%

Payments

Private $248,702.00 11% $204,384.00 13%

Private Ins 653,621.00 29% 522,974.00 33%

Medicare 1,055,226.00 47% 692,893.00 43%

Medicaid 291,985.00 13% 223,788.00 14%

Refunds/Recoups (20,999.24) -1% (46,533.88) -3%

Total Payments $2,228,534.76 100% $1,597,505.12 100%

Collection Rate 51% 49%

Breakdown by Transport

Number of

Transports Total Billed

Number of

Transports Total Billed

ALS Resident Transports Under 65 3,913 1,696,050.00 35% 2,880 1,243,900.00 34%

ALS Resident Transports Over 65 391 156,400.00 3% 234 93,600.00 3%

ALS Non Resident Transports 1,212 726,450.00 15% 907 544,200.00 15%

BLS Resident Transports Under 65 2,740 1,200,000.00 25% 2,107 924,300.00 25%

BLS Resident Transports Over 65 270 108,050.00 2% 134 53,600.00 1%

BLS Non Resident Transports 817 490,050.00 10% 666 399,400.00 11%

Mileage 37,556 372,401.00 8% 27,793 274,346.00 8%

Supplies 143,047.65 3% 98,667.55 3%

Total Gross Billings 9,343 $4,892,448.65 100% 6,928 $3,632,013.55 100%

Average Miles per transport 4.02 4.01

Average Supplies per run 15.31 14.24

FY16 (as of 6/30/16)FY15

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IV. PROPOSAL NARRATIVE The proposal narrative should describe how the contractor will accomplish the requested services and clearly identify any alternatives proposed. Responses to questions and inquiries should be concise and specific and indicate that the contractor understands the services to be performed and the responsibilities inherent therein. 1. Briefly describe the services the contractor proposes to offer to the City including a clear

delineation of any alternatives. 2. Briefly describe your operating procedures for Accounts Receivable Management. 3. Describe in detail your operating procedures for Delinquent Collection Service if you propose

to offer this service. 4. Provide an organizational chart of proposed team or staff for this project.

5. Provide resumes of key personnel who will be responsible for the delivery of the

services/project.

6. Describe whether your firm has ever lost an account due to concerns of improper billing practices, accusations or clients’ concerns of fraud as defined by CMS and other applicable Federal or State authorities.

7. If the contractor is a non-local firm, briefly describe procedures for data transmission and

communication. List local contact address and number of local employees, if any. Contractor agrees to have in operation within three (3) days after the execution of this contract, a local phone number, which shall be without cost or expense to the caller. The number shall be answered during regular business hours by an employee of contractor who will be able to answer any questions regarding the bills or other services provided by contractor under this agreement. The phone number shall be published on all statements sent by contractor in its efforts of collection under this agreement.

8. Provide specific experience the contractor has in billing ambulance fees including information

on any other municipal or similar accounts the contractor handles. 9. Provide a list of similar size professional references (contact name and number) and a brief

summary of work performed for each reference listed. 10. Provide a copy of the contractor’s most recent fiscal year’s financial report upon request by

the City of Irving.

11. Provide a copy of the latest Statement on Standards for Attestation Engagements (SSAE) 16 or proof of process engagement.

12. Provide any clause(s), which are conditional or non-negotiable in sample contract provided

as Attachment H-8. The contract period is anticipated to be for a three-year period with one two-year renewal option under the same terms and conditions.

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V. GENERAL CONDITIONS

Billings

The contractor shall bill the City for any fee due the contractor on regular monthly statements at the agreed rates. Bills shall be based on flat fee, fee per account, or percent of collection in accordance with the service proposal. The contractor shall honor requests by the City to withdraw accounts from collection upon the city’s request. Once an account has been turned back over to the city, the contractor is relieved of all responsibility and rights of collection. The billings shall reflect any such withdrawn account if required by the billing proposal. The contractor shall maintain adequate records of the services performed, invoicing, statement and dunning letter processing, and all such records shall be available for inspection and audit by the City of Irving. Contract Period This contract will be awarded to one contractor for a three-year period, with one two--year option to renew. The contract period will begin with date of award by the Irving City Council. The renewal option may be exercised by the City of Irving upon agreement by contractor to honor the same terms and conditions and subsequent approval by the Irving City Council. Legal Services The proposal shall identify how the contractor will obtain legal advice regarding its collection methods to assure that such methods will be in compliance with all applicable local, state, and federal laws. The proposal shall contain assurance the contractor will comply with all such laws, methods, and procedures.

Reservations

The City reserves the right to: 1. Reject any or all proposals and to disregard typographical, mathematical, or obvious errors 2. Reissue a Request for Proposal 3. Extend the opening time and date 4. Change any and all rates and fees charged or billed for the provision of ambulance service

without approval by or prior notice to the contractor Insurance If selected, the contractor shall procure, pay for, and maintain during the term of the contract, with a company authorized to do business in the State of Texas and acceptable to the City, the insurance coverage listed in Attachment D-2.

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Payment for Services

It is understood that ambulance services payments, for a number of valid causes, may be delayed for up to one hundred fifty days from date of service. In that instance, contractor collections will be based upon collections received as a result of billings during the contract period. This determination will extend for a period of one hundred fifty (150) days after the end of the initial period and apply only to billings generated within the contract period.

V. EVALUATION PROCESS

Each proposer is responsible for submitting all relevant, factual, and correct information with their response. An evaluation committee will assign a ranking score to each response based on the available data and determine the most advantageous proposal based on the evaluation criteria listed below. City staff reserves the right to consider any other factors that may be relevant to this contract.

A full evaluation of the proposals will be made following opening of the proposals on as timely a basis as possible. The selection team may request clarification of any submitted response. Each response shall be subject to the same review and assessment process. After evaluating the proposals, if necessary, the city may conduct oral interviews with the highest ranked firms. The purpose of the interviews is to allow expansion upon the written responses. The City of Irving reserves the right to award a contract solely on the written proposal. The city reserves the right to accept or reject, in part or in whole, any response submitted; and to waive any technicalities in the best interest of the City. This Request for Proposals does not commit the city to award any contract. The final selection will be based on the highest total of all evaluator’s points.

1. Proposed Fee Max points 30

Evaluation of the lowest overall cost is a key factor whether flat fee, fee per account, or percent

of collections.

2. Capability/Qualifications/Experience/Financial Stability Max points 25

Experience of the personnel who are identified as primary personnel to be assigned to this account. A minimum of three years of contractor experience is required. Also, a minimum of two years of personnel experience in the Emergency Medical Services Billing and Collection field is required.

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3. References/Resources Max points 15

This evaluation criterion will consist of verifying the four (4) required references provided by

the offeror. The City of Irving prefers that offerors provide governmental and/or private

ambulance transport service providers as references, if possible. Special attention will be

given to verifying the degree of customer service provided by the proposer to EMS customers

4. Responsiveness of Proposal Max points 30

Points for this criterion will be based upon the following: evidence of a system that transmits the captured patient information via interface where the capture includes any and all data, processes for billing, collecting, following up, reporting and handling customer service complaints and issues, etc.

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Proposal Pricing Page EMS Billing and Collection Services

RFP #182M-16F

Item Description Cost

1 2

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Fee Options

a. Fee per account for billing and collections of ambulance bills.

b. Percentage of collections charged for billing of ambulance

bills Percentage of collections charged for collection of current outstanding receivables at time of award.

a. Up to 90 days old b. Past 90 days old

Fee Options for Optional TASPP Services

a. Flat Fee for Services.

b. Percentage of collections from the State

$__________ __________% __________% __________% $__________ __________%

Vendor’s Signature_________________________ Company Name________________________

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STANDARD TERMS AND CONDITIONS Attachment A-2

1. Application These standard terms and conditions shall apply to all City of Irving (hereafter “City”) solicitations and procurements, unless specifically excepted in the solicitation specifications or additional documents negotiated by the parties prior to formal award.

2. Requirements By submitting a proposal, the respondent agrees to provide the City of Irving with the agreed-upon services described in the solicitation in accordance with these standard terms and conditions, at the agreed upon price and in compliance with the stated specifications, any subsequent addendums issued prior to the date of the opening, and any negotiated terms subsequent to the acceptance of proposals.

3. Legal Compliance Proposer must comply with all Federal, State and Local laws, statutes, ordinances, regulations and

standards in effect at the time of delivery of goods and services, and must maintain any and all required licenses and certificates required under the same laws, statutes, ordinances, regulations and standards for services and/or goods provided in response to this solicitation.

4. Estimated Quantities If the solicitation indicates estimated quantities, such quantities are estimates only and not guaranteed amounts. The actual amount ordered over the contract period may be more or less than the estimate. Quantities represent the City’s best estimate, based on past history and anticipated purchases.

5. Modifications and Addendums The City shall have the right to modify any of the solicitation documents prior to submission deadline and will endeavor to notify potential bidders, but failure to notify shall impose no liability or obligation on the City. All modifications and addendums must be in written form prepared by the City department issuing the solicitation. Proposers are responsible for incorporating any and all modifications and addendums into their submissions.

6. Interpretation of Solicitation Documents The City is the final judge of the meaning of any word(s) sentences, paragraphs or other parts of the solicitation documents. Proposers are encouraged to seek clarification, before submitting a proposal, of any portion of the bid documents that appears to be ambiguous, unclear, inconsistent, or otherwise in error. Clarifications will be in writing.

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7. Late Proposals Proposals must be received in the Purchasing Office by the time specified in the solicitation. The City will not accept late submissions and is not responsible for the lateness or non-delivery of proposals by the Postal Service or any private delivery firm. The time/date stamp in the Purchasing Office shall be the official time of receipt.

8. Minor Irregularities The City reserves the right to waive any minor irregularities that do not materially affect the scope or pricing of submitted proposals

9. Responsiveness of Proposals The City wants to receive competitive proposals, but will declare “non-responsive” submissions that fail to meet significant requirements outlined in the solicitation documents.

10. Withdrawal of Proposals Proposers may withdraw any submitted proposals prior to the submission deadline. Proposers may not withdraw once the proposals have been publicly opened, without the approval of the City’s purchasing manager. Proposers who no longer wish to negotiate with City will be allowed to withdraw proposals. However, once a proposal has been withdrawn, it can no longer be considered.

11. Disqualification of Proposer The City may disqualify proposers, and their proposals not be considered, for any of the following reasons: Collusion among proposers; Proposer’s default on an existing or previous contract with the City, including failure to deliver goods and/or services of the quality and price bid or agreed upon; Proposer’s lack of financial stability; any factor concerning the proposer’s inability to provide the quantity, quality, and timeliness of services specified in the solicitation; proposer involved in a current or pending lawsuit with City; proposer’s attempt to influence the outcome of the solicitation through unauthorized contact with City officials outside of those listed in the solicitation documents; and proposer’s attempt to offer gifts, gratuities, or bribes to any City employee or elected official in connection with a solicitation.

12. Cost of Submission The cost of submitting proposals shall be borne by the proposers, and the City will not be liable for any costs incurred by a bidder responding to this solicitation.

13. Failure to Deliver Services If a proposer is unable to deliver the quantity or quality of specified services, or is unable to deliver within a time period agreed upon prior to award, the City shall be authorized to purchase from any other available source, consistent with State of Texas procurement statutes.

14. Taxpayer Identification Proposers must provide the City a current W-9 “Request for Taxpayer Identification and Certification”

before services can be procured from the proposer.

15. Taxes The City is exempt from all federal excise taxes and all state and local sales and use taxes. If such taxes are listed on a proposer’s invoice, they will not be paid. Additionally, proposers cannot use the City’s tax exemption status to purchase goods or services related to this solicitation.

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16. Payment Payment will be made as agreed upon in the deliverables section of the final proposal. Proposer is entitled to interest, at a rate stipulated by state law, if payment is not made within thirty days.

17. Outstanding Liabilities Proposers shall not have outstanding, unpaid liabilities owed to the City. Liabilities may include, but are not limited to, property taxes, hotel occupancy taxes, license or permit fees, and water bills. Proposals will be considered non-responsible and not given further consideration if submitted by a proposer with such outstanding liabilities.

18. Offset The City may, at its option, offset any amounts due and payable under a contract award under this solicitation against any debt lawfully due the City from a vendor, whether or not the amount due arises pursuant to the terms of the contract and whether or not the debt has been reduced to judgment by a court.

19. Independent Contractors It is expressly agreed and understood by both parties that the City is contracting with the successful proposer as an independent contractor. The City shall not be liable for any claims which may be asserted by any third party occurring in connection with services performed by the successful bidder, and the successful bidder has no authority to bind the City.

20. Governing Law All proposals submitted in response to this solicitation and any resulting contract shall be governed by, and construed in accordance with, the charter and ordinances of the City of Irving, and the laws and court decisions of the State of Texas.

21. Controlling Document In the case of a discrepancy between this solicitation and the formal contract, the formal contract will prevail and control.

22. Assignment Proposer shall not assign, transfer, or pledge a contract awarded under this solicitation, in whole or in part, with the prior written consent of the City’s purchasing manager. Assignment of this contract, if approved by the City, shall not relieve the proposer’s obligations under the contract. Approval by the City of one assignment shall not constitute approval of any future assignment of the contract.

23. Termination If an awarded proposer fails in any manner to fully perform each and all of the terms, conditions and covenants of a contract awarded by this solicitation, he shall be in default and notice of default shall be given to the bidder by the City’s purchasing manager. In the event that Vendor continues in default for a period of seven (7) days after receipt of the above-mentioned notice of default, City may terminate or cancel the contract. The City may also cancel a contract for convenience and without cause with thirty days notice. In any cancellation of contract, the City will pay the bidder for any and all services provided and accepted up to and including the date of termination.

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24. Indemnification Proposer shall defend, indemnify, and hold harmless the City of Irving, its officers, agents, employees, appointees and volunteers against any and all claims, lawsuits, judgments, costs and expenses for personal injury (including death), property damage or other harm for which recovery of damages is sought, suffered by any person or persons, that may arise out of or be occasioned by bidder’s breach of any of the terms or provisions of any contract awarded as a result of this solicitation, or by any negligent or strictly liable act or omission of the bidder, its officers, agents, employees, or subcontractors, in the performance of an awarded contract; except that the indemnity provided for in this paragraph shall not apply to any liability resulting from the sole negligence or fault of the City, its officers, agents or employees, and in the event of joint and concurrent negligence or fault of the bidder and City, responsibility and indemnity, if any, shall be apportioned comparatively in accordance with the laws of the State of Texas, without waiving any governmental immunity available to the City under Texas law and without waiving any defenses of the parties under Texas law. The provisions of this paragraph are solely for the benefit of the parties hereto and are not intended to create or grant any rights, contractual or otherwise, to any other person or entity.

25. Venue The obligations of the parties under a contract awarded through this solicitation are performed in

Dallas County, Texas, and if legal action is necessary to enforce same, exclusive venue shall be within Dallas County, Texas.

26. Funding State of Texas statutes prohibit the obligation and expenditure of public funds beyond the fiscal year for which a budget has been approved. Orders or other obligations that may arise beyond the end of the current fiscal year shall be subject to approval of budget funds.

27. Solicitation Results The City normally posts solicitation results on-line by the end of the next business day after submissions are received. The City’s website is www.cityofirving.org. Results are on the Purchasing Solicitation page, in the same place as the original solicitation documents. In the case of RFP’s, only the names of the proposers are listed. Results are for informational purposes only, and is not a notice of award.

28. Open Records Proposals do not become public record until an award is made. Trade secrets and other material considered confidential by the bidder should be clearly marked as such. If a request is made under the Texas Open Records Act to inspect information designated as trade secret or confidential in a bid, the City will forward the appropriate documents to the Attorney General of Texas who will contact the bidder to request sufficient written reasons and information as to why the information should be protected from disclosure. Upon review of the proposer’s response, the Attorney General will make a determination as to the confidentiality of the requested material(s), or lack thereof, and the City will respond accordingly.

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http://www.cityofirving.org/

GENERAL INSTRUCTIONS TO PROPOSERS Attachment B-6

1. Securing Request for Proposals Request for Proposals may be downloaded at no cost from the Purchasing page of the City’s website, www.cityofirving.org. The City of Irving does not charge for solicitation documents. If third-parties offer specifications or solicitation information for a fee, they do not represent the City. The City may charge for plans and drawings for construction solicitations.

2. Submission of Sealed Proposals/Late Proposals Proposals are to be submitted in a sealed envelope or package and labeled with the proposer’s name and the solicitation name & number. All proposals must be submitted to the City of Irving Purchasing Division no later than the date and time indicated in the solicitation. All times listed are local times. It is the proposer’s responsibility to ensure that proposals are delivered/received by the specified time. Late proposals will not be accepted and will be returned unopened. If pricing is submitted, it must be in US dollars and cents.

3. Legal Name of Proposer In completing the Summary Response Page, the proposer must list the legal name of the proposer’s company. This is the name that will be on all contracts, awards, and purchase orders. The Summary Response Page also requires a statement as to the legal status of the proposer (corporation, partnership, sole proprietorship, etc.). The Summary Response Page should be the first document in the proposer’s response.

4. Signature The signature on the Summary Response Page must be in ink and from an individual with the authority to commit the company to the delivery of the goods or services at the prices and terms stated.

5. Altered Proposals Any alterations, erasures or strikethroughs made by the proposer prior to submission of the proposals must be initialed by the proposer to guarantee authenticity.

6. Payment Terms, Discount & Type of Payment N/A

7. References When references are requested, the Summary Response Page will indicate how many references and will state what other conditions may apply to the references. Proposer will attach a separate page with the requested references.

8. Conflict of Interest Proposers should review the instructions on conflict of interest (Attachment C-1). Proposers are to complete and submit the Conflict of Interest form (Attachment C-2), when a conflict of interest exists.

9. Environmental Stewardship Proposers are encouraged to review the City’s commitment to the environment (Attachment E-1). Proposers are to complete and submit the Environmental Stewardship form (Attachment E-2).

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10. Good Faith Effort Proposers are encouraged to review information on the City’s Good Faith Effort program (Attachment G-1). Proposers are to complete and submit the Good Faith Effort Affidavit (Attachment G-2). Recommended proposer(s) will be required to complete the additional GFE forms as part of the award process.

11. Addendums It is the proposer’s responsibility to alter his proposal response based on information updated in one or more addendums to this solicitation. Addendums will be posted on the Purchasing solicitation page of the City’s website at least four days before the proposal due date. Efforts will be made to ensure that proposers receive notice of addendums, but the ultimate responsibility rests with the proposer.

12. Checklist A Proposer’s Checklist (Attachment B-4) is included with the solicitation package. The checklist is an aid to the proposer in knowing which documents to submit.

13. Hot Line Vendors may call 888-223-9524 to anonymously report instances of fraud, waste or abuse. Please provide as many details as possible.

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SPECIAL INSTRUCTIONS TO PROPOSERS Attachment B-7

1. Proposal Process/Contact Information The City of Irving is aware of the time and effort proposers spend in preparing and submitting proposals. We will work with you to make the process as easy as possible. If you have questions or concerns about the proposal process, please contact:

Marsha Hughes [email protected]

972.721.3754

2. Method of Award Award will be made to the responsive respondent scoring the highest points, as determined by the City’s evaluation team and based on the evaluation criteria specified in this solicitation. Awards totaling $50,000 or more will be made by the Irving City Council.

3. Public Opening of Proposals A public opening of proposals will be held at 3:00 p.m. on August 19, 2016, in the Purchasing Conference Room, 835 W. Irving Blvd., Irving, TX 75060. The only information required to be made public in this opening is a list of who responded. Following negotiations with one or more proposers and the subsequent award, proposals become open to public review, within the guidelines of the State Attorney General.

4. Presentations & Interviews

The City may choose to interview and/or receive oral presentations from selected finalists. However, award may be made without discussion with the respondents, so proposers are cautioned that proposals should be submitted initially on the most favorable terms.

5. Organization of Proposal Responses The response should be organized in the same reference sequence as the specifications. Proposals may be submitted in loose-leaf binders, but not spiral-bound or perfect-bound.

6. Required Contract City’s Contract and Acknowledgement are only required of those vendors who are

recommended for award and do not need to be submitted with your bid. Should your

company be recommended for award, you will have seven (7) days to provide a signed,

notarized contract along with State of Texas Form 1295, Certificate of Interested Parties.

Instructions for registering your company with the Texas Ethics Commission and generating

Form 1295 will accompany any recommendation for award.

7. Insurance Requirements This solicitation has insurance requirements. They are listed as Attachment D-1, D-4, and D-6. Please review the requirements with your insurance agent and submit insurance affidavit (Attachment D-4) with your proposal.

8. Background Check The City of Irving reserves the right to run background checks on employees of the proposers and will determine if background is acceptable for award of the contract.

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CITY OF IRVING RFP #182M-16F

CHECKLIST FOR PROPOSERS Attachment B-4

PROPOSERS CHECKLIST: (Documents to be submitted in response to this RFP)

PROPOSAL (including all requested information)

PROPOSAL COVER PAGE: Completed Summary Response Page

DUE DATE (Proposal must be received & stamped in Purchasing no later than 3:00 pm on August 19, 2016)

Proposals failing to comply with the above will be deemed non-responsive.

These items are also be turned in with your proposal.

FOUR COMPLETE COPIES AND ONE ELECTRONIC COPY OF YOUR PROPOSAL ON CD OR FLASH DRIVE (in addition to the original)

CONFLICT OF INTEREST STATEMENT (If applicable) (Attachment C-2)

______ FEDERAL DEBARMENT CERTIFICATION (Attachment C-3)

______ DISCRETIONARY CONTRACT DISCLOSURE (Attachment C-6)

INSURANCE AFFIDAVIT (Attachment D-4)

______ INDEMNIFICATION BY CONTRACTOR (Attachment D-6)

ENVIRONMENTAL STEWARDSHIP (Attachment E-2)

GOOD FAITH EFFORT AFFIDAVIT (Attachment F-2)

STANDARD CONTRACT FOR SERVICES (Attachment H-7)

______ IRS FORM W-9

These items are to be submitted within 7 days after award recommendation

CITY’S CONTRACT AND ACKNOWLEDGMENT (Attachment H-8)

CERTIFICATE OF INTERESTED PARTIES (State of Texas Form 1295)

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CITY OF IRVING

SUMMARY RESPONSE PAGE for RFP #182M-16F COMPLETE LEGAL NAME of firm submitting proposal:

___________________________________________________________________

Mailing Address:

City, State, & Zip:

Phone: ___________________ E-mail Contact: __________________________________

Authorized Signature ___________________________________Date _________ Signature indicates bidder accepts the specifications, terms and conditions of this solicitation and that bidder is not delinquent on any payment due the City nor involved in any lawsuit against the City.

Print Name_____________________________________ Title PROPOSING as a ________Corporation ___________ Non-Profit Corporation

___________ Limited Liability Company ___________ Partnership _________ Individual or Sole Proprietor

M/WBE: If you are a minority-owned or woman-owned business, please check which type and list any certification number _____Black _____Hispanic _____Asia-India _____Asia-Pacific

____Native American _____ Woman-Owned Certification # ____________________

PAYMENT PREFERENCE: Check all that apply:

_____EBT (electronic bank transfer) ______Check ______Credit card

A current W-9 must be submitted by vendors receiving an initial award from the City of Irving. COOPERATIVE PURCHASES: Should other governmental entities decide to participate in this contract, would you agree that all terms, conditions, specifications and pricing would apply? Yes________ No ________. If other governmental entities choose to participate, each entity will place its own order and be responsible for its own payments.

REFERENCES: This solicitation requires references. Please attach to this page a list of FOUR references either currently doing business with you or having purchased goods or services within the past 24 months. For each reference list name, contact person, address, telephone, and e-mail address. The City may utilize other available information in gaining a comprehensive overview of the bidder’s qualifications and record of performance

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INSTRUCTIONS for CONFLICT OF INTEREST QUESTIONNAIRE

Attachment C-1

1. If you have a conflict of interest in doing business with the City of Irving, use Attachment C-2, Conflict of Interest questionnaire. Conflicts of interest are addressed in Texas Local Government Code, Chapter 176. 2. You may consult your attorney on questions arising from the reading of Texas Local Government Code, Chapter 176, and you may contact the Texas Ethics Commission at 512-463-5800 or 800-325-8506. 3. If you complete Attachment C-2, Conflict of Interest questionnaire:

Put the name of bidder and name of company in block #1.

If any person employed by bidder or bidder’s company has any known business conflicts, other than previous contracts awarded through a competitive bidding process, or has an existing relationship with any employee of the City of Irving, list that information in block #3 as appropriate.

Sign in block #4. 4. COI form is good for one year, and must be re-filed if conflict still exists. 5. Listings of City elected officials and local government officers may be found on the

City’s website: www.cityofirving.org.

6. A person failing to file a Conflict of Interest questionnaire, when required by Local Government Code, Chapter 176, commits a Class C misdemeanor.

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Solicitation # ATTACHMENT C-2 Adopted 8/7/2015

ATTACHMENT C-2

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rev. 4/15/10

Federal Debarment Certification Attachment C-3

Under Executive Order 12549, bidders and proposers must complete the following certification in order to receive a contract or award in which Federal dollars are utilized. Bidders or proposers who are debarred or suspended by the Federal government are ineligible to receive award. City of Irving staff will verify accuracy of this certification.

PLEASE CHECK APPROPRIATE SPACES: To the best of my knowledge and belief, (1) The bidder/proposer and/or any of its principals (check one) are or are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; and (2) The bidder/proposer and/or any of its principals (check one) have or have not within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for; commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of proposers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property; and (check one) are or are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses.

Company Name Signature Title Date

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DISCRETIONARY CONTRACT DISCLOSURE FORM

SECTION I: BASIC GUIDELINES

The Irving Ethics Code requires individuals or entities who seek a contract with the City of Irving which is

awarded on a basis other than competitive bidding, and which exceeds $100,000 in payments by the

City, to file certain disclosures with the City. This form should be filed with any proposal by the

individual or entity, with extra pages attached as needed to complete the responses. In the case of any

change in the information, this form should be supplemented within five (5) days of such change or prior

to any Council action, whichever is first.

SECTION II: PROJECT

A. Project Description: ________________________________________________________

B. RFP or RFQ, Number and Date of Issuance: ______________________________________

SECTION III: IDENTITY OF PARTIES AND SUBCONTRACTORS TO THE DISCRETIONARY CONTRACT

A. Individual Parties to the Contract

(Includes all natural persons who are parties, partners or subcontractors of the contract)

Name: ___________________________________________________________________

Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

Name: ___________________________________________________________________

Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

Name: ___________________________________________________________________

Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

B. Entity Parties to the Discretionary Contract

(Includes all business entities such as corporations, partnerships, and limited liability companies,

and also includes any subcontractors, parent and subsidiary corporations to the entity parties).

Entity Name: ______________________________________________________________

Officer, Agent or other Contact: _______________________________________________

Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

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Entity Name: ______________________________________________________________


Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

C. Identity of all lobbyists, attorneys or other consultants to be utilized in seeking or executing the

proposed discretionary contract with the City of Irving.

Name: ___________________________________________________________________


Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

□ Lobbyist □ Attorney □ Consultant

Name: ___________________________________________________________________


Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

Name: ___________________________________________________________________


Name: ___________________________________________________________________


Address: __________________________________ City: _____________ Zip: __________

Email: __________________________________________ Telephone: ________________

Name: ___________________________________________________________________


SECTION IV: INDIVIDUAL, OFFICER, EMPLOYEE OR AGENT SIGNATURE

_______________________________________________________ Date: _____________________

Individual, Officer, Employee or Agent

Printed Name: ____________________________________________________________________

Position: ____________________________________ Entity: __________________________

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INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES & CONSULTANTS

Attachment D-2 (rev. 1/15/10)

At his own expense, contractor shall procure and maintain for the duration of the proposed contract, insurance against claims for injuries to persons or damages to property which may arise from, or in connection with, the performance of the work hereunder by the contractor, his agents, representatives, employees, or subcontractors. Said insurance shall be in the type(s) and minimum(s) listed below.

Workers’ Compensation and Employers’ Liability Workers’ Compensation Insurance with statutory limits as required by the Labor Code of the State of Texas and Employers’ Liability Insurance with minimum limits of $100,000 per each accident, $500,000 disease policy limit, and $100,000 occupational disease per employee.

Workers’ Compensation coverage shall be based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements which meet the statutory requirements of the Texas Labor Code and shall apply to all employees of the contractor providing services under the proposed contract. Sole proprietors may request a waiver of this requirement if they have no employees. If services under this contract will not be performed on City property, contractor may make a written request for exemption from this requirement

Commercial General Liability Commercial General Liability minimum limits of $1,000,000 per occurrence for bodily injury, personal injury, and property damage. Aggregate Policy minimum limit of $1,000,000 will include coverage for, but is not limited to, Premises-Operations, Broad Form Contractual Liability, Broad Form Property Damage, Products and Completed Operations, Personal Injury, and Independent Contractors and Contractual Liability. Coverage under this policy shall be on an “occurrence” basis.

Business Automobile Liability Insurance Automobile Liability Insurance with a coverage minimum of $500,000 Combined Single Limit. Coverage shall include all owned, hired, and non-owned vehicles used in performance of the proposed contract. The combined coverage limits of this insurance shall include bodily injury (including death) and property damage. If services performed under this contract will not require the use of vehicle(s), contractor may request, in writing, exemption from this requirement.

Collection Agents Errors and Omission Insurance to include coverage for losses resulting from error, omission, or negligent acts, including identity theft committed by you or your employees in the performance of services under this contract. $1,000,000 each claim. Commercial Crime Insurance to include coverage for employee dishonesty, blanket form, theft and disappearance, and destruction of money and securities, also including forgery or alteration. City of Irving shall be named as loss payee.

By submitting a bid or proposal without previously approved exceptions, contractor agrees to the following general provisions. Requests for exceptions to general provisions and/or coverages must be submitted at least one week prior to bid due date. Exceptions must be approved in writing by City’s representative prior to bid or proposal submission. The City will not accept requests for exceptions after bids have been received.

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General Provisions

1. SCOPE – These provisions apply to all contracted vendors unless specifically exempted in the proposed contract. Coverage shall state that the Contractor’s insurance shall apply separately to each insured against whose claim is made, or suit is brought, except to the limits of the insured’s liability. 2. COVERAGE APPLICATION – Contractor’s insurance must be primary as respect to the City, its officers, employees, elected officials, appointees, and volunteers and noncontributory with any other insurance, including self-insurance, maintained by the City for its benefit. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the City. 3. DEDUCTIBLES AND SELF-INSURED RETENTIONS – Any deductibles or self-insured retentions must be disclosed to the City. The City reserves the right to review the insurance obtained by the contractor, in comparison to the requirements specified in this section. 4. ADDITIONAL INSURED – The City of Irving, including its officers, officials, employees, Boards and Commissions, and volunteers shall be named as an additional insured by endorsement to the coverage listed herein, excluding Workers’ Compensation and Employers’ Liability (for which a waiver of subrogation is required to be issued in favor of the City), with regard to the insured’s activities as required by written contract. The coverage shall contain no special limitations on the scope of protection afforded to the City, and all premiums arising from the coverage herein shall be the responsibility of the insured. 5. COVERAGE CONTINUATION AND CANCELLATION -- In the event any insurance policy shown on the certificate(s) of insurance has an expiration date prior to the completion of the contract, the contractor shall furnish the City proof of identical continued coverage no later than thirty days prior to the expiration date shown on the certificate. Failure to maintain continuous coverage during the term of the proposed contract, or failure to provide proof of coverage at any time during the term of the contract, may result in cessation of work and/or termination of the contract. Coverage shall not be canceled, non-renewed, or materially altered except after thirty days prior written notice by certified mail (return receipt requested) to Purchasing Manager, 845 W. Irving Blvd., Irving, Texas 75060. 6. SUBROGATION – Contractor must waive all rights of subrogation against the City of Irving for bodily injury (including death), property damage, or any other loss arising from work performed by the vendor for the City. 7. RESPONSIBILITY – Approval, disapproval, or failure to act by the City regarding any insurance supplied by the contractor or its subcontractors shall not relieve the contractor of full responsibility or liability for damages and accidents as set forth in the contract documents. 8. ACCEPTABILITY – The City retains the right to approve the acceptability of insurers. As a general rule, the City will accept insurers authorized to transact business in the State of Texas with an A. M. Best rating of “A- VI “or better. 9. PAYMENT OF PREMIUMS – Companies issuing insurance policies shall have no recourse against the City for payment of any premiums or assessments for any deductibles which are the sole responsibility and liability of the contractor.

10. INDEMNIFICATION – The contractor agrees to defend, indemnify, and hold harmless the City of Irving, its officers, agents, employees, appointees, and volunteers against any and all claims, lawsuits, judgments, costs and expenses for personal injury (including death), property damage, or other harm for which recovery of damages is sought, suffered by any person or persons, that may arise out of or be occasioned by contractor’s breach of any of the terms or provisions of this contract, or by any negligent or strictly liable act or omission of contractor, its officers, agents, employees, or subcontractors, in the performance of this contract; except that the indemnity provided for in this paragraph shall not apply to any liability resulting from the sole negligence or fault of the City, its officers, agents, or employees, and in the event of joint and concurrent negligence or fault of contractor and City, responsibility and indemnity, if any, shall be apportioned

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comparatively in accordance with the laws of the State of Texas, without waiving any governmental immunity available to the City under Texas law and without waiving any defenses of the parties under Texas law. The provisions of this paragraph are solely for the benefit of the parties hereto and are not intended to create or grant any rights, contractual or otherwise, to any other person or entity.

Proof of Insurance

1. To show ability to meet these insurance requirements, bidders should submit insurance affidavit (Attachment D-4) as part of their response to this solicitation.

2. Upon notice of award, awarded contractor must submit to the City of Irving, within fifteen business days, proof of all insurance coverages required by this solicitation.

3. Proof of insurance shall be furnished to the City on the ACORD certificate form, provided the appropriate endorsements for Additional Insured and Amendment of Cancellation with 30-day notice are included.

4. If requested by the City, the contractor must provide copy of the Declaration Page of the policy with all relevant policy endorsements, including endorsement showing City of Irving as additional insured, within fifteen days of request. Copy must be signed by the contractor and notarized.

5. Required proof of insurance must be provided by awarded contractor before the City will authorize any work to be performed under this proposed contract

6. The City reserves the right to request a complete copy of all insurance policies at any time.

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AFFIDAVIT FOR INSURANCE REQUIREMENTS Attachment D-4

Section 1 I, the undersigned Agent/Broker, reviewed the insurance requirements contained in

Solicitation #182M-16F. If the Proposer listed below is awarded a contract by the City of Irving for this solicitation, I will furnish the City, within fifteen calendar days of notification of award, an insurance certificate and Declaration Page with Endorsements to show that all insurance requirements have been met, including naming the City of Irving as additional insured.

Agent’s Name: Agency Name: Address: City/State/ZIP: Telephone No: ( ) ___________ E-mail Address: __________________________ Bidder’s Name/Company: Name of RFP: EMS Billing and Collection Service Insurance Agent/Broker Signature: ____________________________ Date: ___________

Section 2 If the above fifteen day requirement is not met, the City of Irving has the right to reject

this bid and award the contract to the next lowest bidder meeting specifications or to the next most favorable proposal. Questions concerning these requirements, and requests for exceptions, must be submitted by date included in Proposer’s Instructions.

Signature: ______________________________________ Date: ____________________

To Be Completed By Insurance Agent/Broker and Proposer

By submitting a proposal and signing below I affirm the following: I am aware of all costs to provide the required insurance, will do so

pending contract award, and will provide a valid insurance certificate meeting all requirements and policy endorsement within fifteen calendar

days of notification of award. I further agree to the indemnification statement listed in the insurance requirements.

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INDEMNIFICATION BY CONTRACTOR Attachment D-6

The contractor agrees to defend, indemnify, and hold harmless the City of Irving, its officers, agents, employees, appointees and volunteers against any and all claims, lawsuits, judgments, costs and expenses for personal injury (including death), property damage or other harm for which recovery of damages is sought, suffered by any person or persons, that may arise out of or be occasioned by contractor’s breach of any of the terms or provisions of this contract, or by any negligent or strictly liable act or omission of contractor, its officers, agents, employees, or subcontractors, in the performance of this contract; except that the indemnity provided for in this paragraph shall not apply to any liability resulting from the sole negligence or fault of the City, its officers, agents or employees, and in the event of joint and concurrent negligence or fault of contractor and City, responsibility and indemnity, if any, shall be apportioned comparatively in accordance with the laws of the State of Texas, without waiving any governmental immunity available to the City under Texas law and without waiving any defenses of the parties under Texas law. The provisions of this paragraph are solely for the benefit of the parties hereto and are not intended to create or grant any rights, contractual or otherwise, to any other person or entity. Contractor further agrees to defend, at its own expense, and on behalf of City and in the name of City, any claim or litigation brought in connection with any such injury, death, or damage. The liability that is assumed by Contractor under the terms of this paragraph shall not exceed the sum of the required amount of liability coverage to be carried by the Contractor under this contract.

CONTRACTOR (Company Name) _________________________________________

SIGNATURE __________________________________________________________

PRINTED NAME _______________________________________________________

PRINTED TITLE _______________________________________________________

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ENVIRONMENTAL COMMITMENT & COMPLIANCE Attachment E-1

In January, 2009, the Irving City Council adopted an environmental policy, acknowledging that it is our financial, social, and environmental responsibility to our citizens to ensure a greater future for Irving and its residents. The City of Irving is committed to becoming an environmentally sustainable community by providing leadership to conserve, protect, and improve the environment for the benefit of our citizens. The City will integrate sustainable social, economic and environmental objectives into decision-making processes to maintain high standards of living, social harmony, and environmental quality. Because the City of Irving is committed to protecting the environment and becoming a successful environmentally sustainable community, it is essential that environmental considerations be a part of all City activities and operations. This commitment is demonstrated through;

Compliance Environmental Sustainability Continued Improvement Pollution Prevention

As a contactor/vendor/consultant for the City of Irving your environmental performance is critical in meeting the City’s commitment to protect the environment and comply with all environmental laws and regulations. It is your responsibility as a contractor to know which of the many laws, ordinances, and regulations relating to the protection of the environment relate to the work you are doing for the City of Irving. It is also your responsibility as a contractor to comply with all applicable laws and ensure all requirements imposed by these laws are met

The City of Irving has is committed to being a good steward of the environment. We expect your commitment, as a City contractor, vendor, or consultant, to the same goal.

Current information about the City’s various green initiatives may be found on the City’s website at http://www.ci.irving.tx.us/begreen.

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http://www.ci.irving.tx.us/begreen

ENVIRONMENTAL STEWARDSHIP Attachment E-2

Recognizing the importance of exercising positive environmental stewardship, The City of Irving is pro-active in encouraging environmentally-sound practices in our operations and among our residents, businesses, and suppliers. Please review the specifications or scope of work for this solicitation for any environmental requirements.

Check any of the following which apply to your business operation, and list details:

_____ Recycling

_____ Energy Efficiency Practices

_____ Environmentally Preferred

_____ Water/Energy Conservation

_____ Air Quality/Emissions

_____ Disposal Practices

_____ Other Environmentally Friendly Practices

Proposer: Solicitation Number: 182M-16F Date: ___________________________

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GOOD FAITH EFFORT PROGRAM OVERVIEW Attachment F-1

All bid documents and proposal packages must include the signed GFE affidavit affirming the bidder/proposer’s intent to comply with the City’s Good Faith Effort program. Unless otherwise indicated in the ITB or RFP documents, no other GFE documentation will be required at time of bid or submission. Upon notification of intent to recommend award of contract, the apparent low bidder/most advantageous proposer has up to five (5) business days to submit the appropriate GFE forms to the City’s M/WBE Program Administrator. Required GFE forms must be submitted prior to award by City Council.

The GFE forms are:

GFE-1 Good Faith Effort Affidavit (included as Attachment F-2) GFE-2 Schedule of M/WBE Participation GFE-3 Good Faith Effort Log GFE-4 Intent to Perform as a Sub-Contractor GFE-5 Payment Report

NOTE: Forms GFE-2 thru GFE-5 are available on the City’s website in the Purchasing section, under “Forms.”

1. All bidders or proposers must submit form GFE-1, Good Faith Effort Affidavit.

2. Prime contractors who are tentatively recommended for award and who will meet or exceed the GFE goal must submit the following additional forms: GFE-2 Schedule of M/WBE Participation GFE-4 Intent to Perform as Sub-Contractor (one for each sub-contractor)

3. Prime contractors who are tentatively recommended for award and who will NOT meet or exceed the GFE goal must submit the following form: GFE-3 Good Faith Effort Log In addition, if the contractor has partial participation toward the goal, the following forms are also submitted: GFE-2 Schedule of M/WBE Participation GFE-4 Intent to Perform as Sub-Contractor (one for each sub-contractor)

4. The awarded contractor will submit the following form monthly to verify that the sub-contracting work is being done as agreed upon: GFE-5 Payment Report

______________________________________ For any GFE communication: Call 972-721-3753 or 972-721-2631

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GOOD FAITH EFFORT AFFIDAVIT

Attachment F-2

On January 11, 2007, the Irving City Council adopted a policy to equitably and conscientiously include Minority- and Women-owned Business Enterprises (M/WBE’s) in the City procurement process for all basic goods, services, professional services, and construction solicitations. The City and its contractors shall not discriminate on the basis of race, color, religion, national origin, or sex in the award and performance of contracts. In consideration of this policy, the City of Irving has implemented the Good Faith Effort (GFE) Program.

M/WBE Participation Goals The GFE Plan establishes subcontracting goals for all prospective bidders, proposers, and submitters to ensure a reasonable degree of M/WBE participation in City contracts. It is the goal of the City of Irving that a certain percentage of work under each contract be executed by one or more M/WBEs. The following M/WBE participation goals have been established without consideration for a specific ethnicity or gender:

Professional Other Construction Architectural & Engineering Services Services Goods 30.00% 28.00% 33.00% 20.00% 10.00%

The apparent low bidder/most advantageous proposer shall agree to meet the established goals or must demonstrate and document a “good faith effort” to include M/WBEs in subcontracting opportunities. The apparent low bidder/most advantageous proposer who fails to adequately document good faith efforts to subcontract or purchase significant material supplies from M/WBEs may be denied award of the contract by the City based on the contractor’s failure to be a “responsive” proposer or bidder.

By signing below, I agree to provide the City of Irving with a completed copy of all forms required by Good Faith Effort Program. I understand that if I fail to provide all of the required documents within five (5) business days after notification, my bid or proposal may be deemed “non-responsive” and I may be denied award of the contract.

Solicitation Number: 182M-16F Date _____________________________

Name of Company _______________________________________________________________

__________________________________________ _______________________________ Printed Name of Certifying Official of Company Title

______________________ ____________ Signature of Certifying Official of Company Phone Number

Form GFE-1

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BONDING REQUIREMENTS

Attachment G-9

Bonding Requirements will be provided via addendum.

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CONTRACT BY AND BETWEEN

THE CITY OF IRVING, TEXAS, AND

________________

FOR BILLING AND COLLECTION OF EMERGENCY MEDICAL SERVICES

H-8

THIS CONTRACT ("Contract") is made and entered into this ____, by and between ________., hereinafter referred to as "Contractor," and the CITY OF IRVING, TEXAS, hereinafter referred to as "City", on _____, 2016.

For and in consideration of the covenants and agreements contained herein, and for the mutual benefits to be obtained hereby, the parties agreed as follows:

I. SCOPE OF WORK

Contractor shall provide all supervision, labor, materials and equipment necessary for ground ambulance billing, collection, and electronic payment care reporting (EPCR) services. Such work shall be performed in accordance with the terms and conditions of the City's Specifications for Billing and Collection of Emergency Medical Services. In the event there exists a conflict among these documents, they shall have control in the following order:

(a) This Contract by and between the City of Irving and ______.; and (b) The Specifications for Billing and Collection of Emergency Medical Services and addendums

and (c) The Contractor’s Proposal

II. TERM OF CONTRACT

Unless otherwise terminated as provided for herein, and subject to the annual appropriation of funds by the City to make the City's payments hereunder, the initial term of this Contract shall be a period of three (3) years commencing upon the last date of execution hereof ("Initial Term"); provided, however, that the City shall have the right and option to renew this Contract for one two (2) year renewal (after the Initial Term being an “Additional Term”) under the same terms and conditions as set forth herein by giving written notice to Contractor of City's election to so extend the term hereof, such notice to be given not more than ninety (90) nor fewer than thirty (30) days prior to the expiration of the Initial Term. Either City or Contractor may cancel and terminate this Contract at any time and for any reason by giving written notice of such termination to the non-terminating party, and this Contract shall terminate at 12:00 A.M. on the sixty-first (61st) day following the date such notice is given to the non-terminating party. In the event of termination of this Contract, Contractor shall be compensated for all work and services properly performed.

Contractor acknowledges and agrees that the provision of ambulance service may or may not change over the term of this agreement. The rates charged may change, the service may change, and/or the service may cease to be a City function. The parties agree that, if the service is stopped, neither party will have any further obligation under this contract.

III. WARRANTY

Contractor agrees that the products and services are warranted as provided in the proposal.

IV. PAYMENT Payments will be received at the City’s lockbox. Contractor will have online view access for purposes of

updating customer accounts. City agrees to pay Contractor fees in an amount equal to _____ percent (___ %) of net amounts collected. For purposes of this section “net amounts collected” shall mean the gross collections less refunds. Terms of payment shall be thirty (30) days from receipt of Contractor’s invoice.

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V. PROTECTION AGAINST ACCIDENT TO EMPLOYEES AND THE PUBLIC Contractor shall at all times exercise reasonable precautions for the safety of employees and others on or near the work and shall comply with all applicable provisions of Federal, State, and County safety laws. The safety precautions actually taken and the adequacy thereof shall be the sole responsibility of the Contractor. CONTRACTOR SHALL INDEMNIFY CITY FOR ANY AND ALL LOSSES ARISING OUT OF OR RELATED TO A BREACH OF THIS DUTY BY CONTRACTOR PURSUANT TO PARAGRAPH VII. INDEMNIFICATION AND PARAGRAPH VIII. COMPLIANCE WITH APPLICABLE LAWS SET FORTH HEREIN.

VI. LOSSES FROM NATURAL CAUSES

Unless otherwise specified, all loss or damage to Contractor arising out of the nature of the work and services to be performed, or from the action of the elements, or from any unforeseen circumstances in the prosecution of the same, or from unusual obstructions or difficulties which may be encountered in the prosecution of the work, shall be sustained and borne by the Contractor at its own cost and expense.

VII. INDEMNIFICATION

(a) CONTRACTOR AGREES TO AND SHALL DEFEND, INDEMNIFY AND HOLD HARMLESS THE CITY, ITS OFFICIALS, OFFICERS, AGENTS AND EMPLOYEES (IN BOTH THEIR OFFICIAL AND PRIVATE CAPACITIES) (TOGETHER, "INDEMNIFIED PERSONS") FROM AND AGAINST ANY AND ALL SUITS, ACTIONS, CLAIMS, JUDGMENTS, LIABILITIES, PENALTIES, FINES, EXPENSES, FEES AND COSTS (INCLUDING REASONABLE ATTORNEY'S FEES AND OTHER COSTS OF DEFENSE), AND DAMAGES (TOGETHER, "DAMAGES") ARISING OUT OF OR IN CONNECTION WITH (A) CONTRACTOR'S PERFORMANCE OF THIS CONTRACT, (B) THE USE OF THE FACILITIES, OR ANY OTHER PREMISES OR ACCOUNT, IN CONNECTION WITH THIS CONTRACT BY CONTRACTOR OR CONTRACTOR'S OFFICERS, EMPLOYEES, REPRESENTATIVES, AGENTS, MANAGERS, CONTRACTORS, SUBCONTRACTORS, ASSOCIATES, CONCESSIONAIRES, MEMBERS, PATRONS, CUSTOMERS, INVITEES, OR ANY PERSON FOR WHOM CONTRACTOR IS LIABLE ("CONTRACTOR PARTIES"), OR ANY OF THEM, (C) THE CONDUCT OF CONTRACTOR'S BUSINESS OR ANYTHING ELSE DONE OR PERMITTED BY CONTRACTOR TO BE DONE IN OR ABOUT ANY PREMISES WHERE THE WORK OR ANY PORTION THEREOF IS BEING PERFORMED, (D) ANY BREACH OR DEFAULT IN THE PERFORMANCE OF CONTRACTOR'S OBLIGATIONS UNDER THIS CONTRACT, (E) ANY MISREPRESENTATION OR BREACH OF WARRANTY BY CONTRACTOR UNDER THIS CONTRACT, AND (E) WITHOUT LIMITING ANY OF THE FOREGOING, ANY NEGLIGENT ACT OR OMISSION OF CONTRACTOR OR ANY OF CONTRACTOR PARTIES UNDER, RELATED TO, OR IN CONNECTION WITH, THIS CONTRACT, INCLUDING DAMAGES CAUSED BY THE NEGLIGENCE OF ANY OF THE INDEMNIFIED PERSONS. (b) WITH RESPECT TO THE CONTRACTOR'S INDEMNITY OBLIGATION SET FORTH IN SUBSECTION (A), CONTRACTOR SHALL HAVE NO DUTY TO INDEMNIFY AN INDEMNIFIED PERSON FOR ANY DAMAGES CAUSED BY THE SOLE NEGLIGENCE OF THE INDEMNIFIED PERSON. (c) IF ANY OF THE INDEMNIFIED PERSONS SUFFERS DAMAGES ARISING OUT OF OR IN CONNECTION WITH THE PERFORMANCE OF THIS CONTRACT THAT ARE CAUSED BY THE CONCURRENT NEGLIGENCE OF BOTH CONTRACTOR AND AN INDEMNIFIED PERSON, CONTRACTOR'S INDEMNITY OBLIGATION SET FORTH IN SUBSECTION SHALL BE APPORTIONED COMPARATIVELY IN ACCORDANCE WITH THE LAWS OF THE STATE OF TEXAS, WITHOUT, HOWEVER, WAIVING ANY GOVERNMENTAL IMMUNITY AVAILABLE TO THE CITY AND WITHOUT WAIVING ANY DEFENSES OF THE PARTIES UNDER TEXAS LAW. (d) IF ANY ACTION OR PROCEEDING SHALL BE BROUGHT BY OR AGAINST CITY IN CONNECTION WITH ANY SUCH LIABILITY OR CLAIM, CONTRACTOR SHALL BE REQUIRED, ON NOTICE FROM CITY, TO DEFEND SUCH ACTION OR PROCEEDINGS AT THE CONTRACTOR’S EXPENSE, BY OR THROUGH ATTORNEYS REASONABLY SATISFACTORY TO THE CITY. THE PROVISIONS OF THIS SECTION ARE SOLELY FOR THE BENEFIT OF THE PARTIES HERETO AND

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NOT INTENDED TO CREATE OR GRANT ANY RIGHTS, CONTRACTUAL OR OTHERWISE, TO ANY OTHER PERSON OR ENTITY.

VIII. COMPLIANCE WITH APPLICABLE LAWS The Contractor shall at all times observe and comply with all Federal, State, and local laws,

ordinances, regulations and policies of the City including all amendments and revisions thereto, which in any manner affect the Contractor or the work. Contractor shall indemnify and save harmless the City against any claims arising from the violation of any such laws, ordinances and regulations whether by the Contractor or his employees. If the Contractor observes that the work is at variance therewith, Contractor shall promptly notify City in writing.

IX. INDEPENDENT CONTRACTOR

The Contractor is and shall be an Independent Contractor and shall not, with respect to its acts or omissions or otherwise, be deemed an agent or employee of the City; that Contractor shall have exclusive control of an exclusive right to control the details of the work performed hereunder and all persons performing same, and shall be responsible for the acts and omissions of its officers, agents, employees, contractors, subcontractors and consultants; that the doctrine of respondent superior shall not apply as between City and Contractor, its officers, agents, employees, contractors, subcontractors and consultants, and nothing herein shall be construed as creating a partnership, joint venture, or joint enterprise between City and Contractor.

X. HINDRANCES AND DELAYS

Contractor shall make no claims for damages resulting from hindrances or delays from any cause during the progress of any portion of the work embraced in this Contract.

XI. CONTRACT INTERPRETATION This Contract shall, in the event of any dispute over its meaning or application, be interpreted fairly and

reasonably, and neither more nor less strongly for or against either party.

XII. SUCCESSORS AND ASSIGNS This Contract shall be binding upon the parties hereto, their successors, heirs, personal representatives

and assigns. Notwithstanding any other provision of this Contract, Contractor shall not assign, transfer, subcontract, sell, or otherwise convey, nor have the right or power to assign, transfer, subcontract, sell, or otherwise convey, any or all of its rights, duties or obligations under this Contract without the prior written consent of the City, and any such attempted assignment, transfer, subcontract, sale or other conveyance without the prior written consent of the City shall be null and void ab initio.

XIII. HEADINGS

The headings of this Contract are for the convenience of reference only and shall not affect in any manner any of the terms and conditions hereof.

XIV. TEXAS LAW TO APPLY This Contract shall be construed under, and in accordance with, the law of Texas without reference to its conflict of law provisions, and all obligations of the parties created hereunder are performable in Dallas County, Texas. Exclusive venue of any suit concerning this Contract shall be a state district court of Dallas County, Texas. The contractor agree to submit to the personal and subject matter jurisdiction of said court.

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XV. NOTICE Any notice required or permitted to be delivered hereunder shall be deemed received three (3) days thereafter sent by United States Mail, postage prepaid, certified mail, return receipt requested, addressed to the party at the address set forth below or on the day actually received when sent by courier or otherwise hand delivered.

City Contractor City Manager City of Irving 825 W Irving Blvd Irving, Texas 75060 PH: (972) 721-2600

____________________

XVI. PROTECTED HEALTH INFORMATION

1. Contractor shall carry out its obligations under this Agreement in compliance with the privacy

regulations pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F – Administrative Simplification, Sections 261, et seq. as amended (“HIPAA”), to protect the privacy of any personally identifiable protected health information (“PHI”) that is collected, processed or learned as a result of the Billing Services provided hereunder to the City of Irving, hereinafter referred to as “CITY”. In conformity therewith, Contractor agrees that it will:

a. Not use or further disclose PHI except as permitted under this Agreement or required by

law.

b. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by this Agreement.

c. To mitigate, to the extent practicable, any harmful effect that is known to Contractor of a use or disclosure of PHI by Contractor in violation of this Agreement.

d. Report to the CITY any use or disclosure of PHI not provided for by this Agreement of which Contractor becomes aware.

e. Ensure that any agents or subcontractors to whom Contractor provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to Contractor with respect to such PHI;

f. Make PHI available to the CITY and to the individual who has a right of access as required under HIPAA within 30 days of the request by the CITY on the individual;

g. Incorporate any amendments to PHI when notified to do so by the CITY;

h. Provide an accounting of all uses or disclosures of PHI made by Contractor as required under the HIPAA privacy rule within 60 days;

i. Make its internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining Contractor and the CITY’S compliance with HIPAA; and

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j. At the termination of this Agreement, return or destroy all PHI received from, or created or received by Contractor on behalf of the CITY, and if return is infeasible, the protections of this agreement will extend to such PHI.

2. The specific uses and disclosures of PHI that may be made by Contractor on behalf of the CITY include:

a. The preparation of invoices to patients, carriers, insurers and others responsible for payment or reimbursement of the services provided by the CITY to its patients;

b. Preparation of reminder notices and documents pertaining to collections of overdue accounts;

c. The submission of supporting documentation to carriers, insurers and other payers to substantiate the health care services provided by the CITY to its patients or to appeal denials of payment for same.

d. Uses required for the proper management of the Contractor as a business associate.

e. Other uses or disclosures of PHI as permitted by HIPAA privacy rule.

3. Notwithstanding any other provisions of this Agreement, this Agreement may be terminated by the CITY, in its sole discretion, if the CITY determines that Contractor has violated a term or provision of the Agreement pertaining to the CITY’S obligations under the HIPAA privacy rule, or if Contractor engages in conduct which would, if committed by the CITY, result in a violation of the HIPAA privacy rule by the CITY.

XVIII. MISCELLANEOUS

A. All accounts receivable, including documentation of any kind furnished by the City or created by Contractor, shall be and at all times remain the property of the City.

B. CONTRACTOR agrees and covenants that all work and services hereunder shall be completed in

a timely and diligent manner. C. CONTRACTOR shall keep and make available for inspection and copying by City all records and

other documents and materials, whether written or electronically generated and stored, which sufficiently and adequately contain all bills and collections, accounts, activity, disposition, etc., relative to this Contract. These records shall be available for inspection upon request by City from the inception of the Contract and for two years following termination or expiration of the Contract.

D. CONTRACTOR agrees that all inbound patient phone calls for the City will be recorded and made

available for review by the City via email upon request. E. CONTRACTOR agrees to provide on line portal for patients to make on-line payments.

F. CONTRACTOR agrees that all inbound patient phone calls for the City will be recorded and made

available for review by the City via email upon request. G. CONTRACTOR agrees to provide a training program with the most up to date information on all

components of the billing program and the key items necessary for success at no additional cost.

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H. The provisions of this Contract are solely for the benefit of the parties hereto and are not intended to create or grant any rights, contractual or otherwise, to any third person or entity.

I. The entire agreement of the parties is contained herein and this Contract supersedes all oral

agreements and negotiations between the parties relating to the subject matter hereof as well as any previous agreements presently in effect between the parties relating to the subject matter hereof.

J. The rights and remedies provided by this Agreement are cumulative and the use of any one right

or remedy by either party shall not preclude or waive its right to use any or all other rights and remedies, and said rights and remedies are given in addition to any other rights and remedies the parties or either of them may have in law, in equity, or otherwise.

K. The undersigned officers and/or agents of the parties hereto are the properly authorized officials

and have the necessary authority to execute this Agreement on behalf of the parties hereto. L. Counterparts. This Contract may be executed in counterparts. Each of the counterparts shall be

deemed an original instrument, but all of the counterparts shall constitute one and the same instrument.

M. Exhibits. Any exhibits to this Contract are incorporated herein by reference for all purposes

wherever reference is made to the same. N. Survival of Covenants. Any of the representations, warranties, covenants, and obligations of the parties, as well as any rights and benefits of the parties, pertaining to a period of time following the termination of this Agreement shall survive termination.

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IN WITNESS WHEREOF, the parties have executed this Contract in the year and on the day set forth below.

CONTRACTOR:

_________________________

Date: _____________________ By: _____________________________

Title

ATTEST:

__________________________________

CITY OF IRVING, TEXAS

Date: _____________________ By: ___________________________________

Beth Van Duyne, Mayor

ATTEST

__________________________

City Secretary

___________________________

APPROVED AS TO FORM:

_______________________

City Attorney

(Complete Only if You are Awarded This Contract.)

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