ORREROR5 OFFEROR NAME: Request for Proposal for EMERGENCY MEDICAL SERVICE DELIVERY (Ambulance and Paramedic Services)

Transcription

1 ORREROR5 OFFEROR NAME: Request for Proposal for EMERGENCY MEDICAL SERVICE DELIVERY (Ambulance and Paramedic Services) 1

2 TABLE OF CONTENTS I. General Instructions.. 6 II. Terms of Contract. 10 III. Insurance Requirements 14 IV. Evaluation Factors. 19 V. Special Terms and Conditions VI. Proposal Format. 42 VII. Appendix A 46 VIII. Appendix B 447 IX. Appendix C. 48 X. Appendix D. 49 XI. Ellis County Map 50 XII. Signature Form XIII. Conflict of Interest Questionnaire.. 53 XIV. Certification of Eligibility.. 54 XV. Statement of No Bid 55 XVI. Residence Certification XVII. Affidavit of Compliance 57 XVIII. W

3 Bid Number RFP EMERGENCY MEDICAL SERVICE DELIVERY (Paramedic and Ambulance Services) Bid Title Ambulance Services) Emergency Medical Service Delivery (Paramedic and Bid Start Date April 17, 2015 Bid End Date May 15, 2015 at 3:00 p.m. Question & Answer End Date May 1, 2015 Bid Contact Jodi Platt County Interim Purchasing Agent Contract Duration 3 years Contract Renewal Optional Prices Good for 120 days Pre- Bid Conference April 27, 2015 Attendance is mandatory Location: MANDATORY PRE- PROPOSAL CONFERENCE: A mandatory pre-proposal conference will be conducted by the Ellis County Selection Committee beginning at 9:00 a.m. on April 27, 2015 at Ellis County Courts Building, Room: TBA, 109 S. Jackson Street, Waxahachie, Texas. This is to provide an opportunity for all interested Vendors to ask questions. Participation in the conference is mandatory for any Vendor intending to submit a proposal. Standard Disclaimer ***Note to Bidders/Offerors***The following standard disclaimer applies to Invitation to Bid (IFB), Competitive Sealed Proposal (CSP), and Request for Proposal (RFP) ONLY, not applicable to Request for Qualifications (RFQ) or Request for Information (RFI).*** 3

4 Mailing Address: Ellis County Attn: Jodi Platt, Ellis County Interim Purchasing Agent 101 West Main, Suite 203 Waxahachie, Texas Prices bid/proposed shall only be considered if they are provided in the appropriate space(s) on the Waxahachie bid form(s). For consideration, any additions or deductions to the bid/proposal prices offered must be shown under the exceptions section of the bid/proposal in the case of electronic submittal, ONLY in the case of a hard copy submittal will an additional attachment be allowed. Extraneous numbers, prices, comments, etc. or bidder/offeror generated documents appearing elsewhere on the bid or as an additional attachment shall be deemed to have no effect on the prices offered in the designated locations. All delivery and freight charges (F.O.B. inside delivery in Ellis County designated locations) are to be included as part of the bid/quote/proposal price. All components required to render the item complete, installed and operational shall be included in the total bid/quote/proposal price. Waxahachie will pay no additional freight/delivery/installation/set up fees. Bid Comments The successful Offeror shall be responsible for providing MICU level ambulances staffed with two (2) Paramedics for response to 911 calls for emergency requests throughout Ellis County Texas excluding City of Midlothian, City of Ferris, ESD2, and ESD5 (the Service Area) with a response time according to those listed in Appendix B for at least 96% of all calls. It is the desire of the Entities to pay no subsidy. 4

5 Item Response Form Item SEE SECTION 6.6 FOR COST PROPOSAL Quantity Unit Price 1 month Delivery Location Ellis County Attn: Jodi Platt, Ellis County Interim Purchasing Agent 101 West Main, Suite 304 Waxahachie, Texas Qty 1 Description Offeror s cost proposal shall include the (1) cost to the Entities (subsidy) if any; (2) charges for services to citizens for MICU Base Transport; (3) mileage rate; (4) Billing Methodology (i.e. Soft vs. Hard Billing, Residents vs. Nonresidents, and Transports vs. Non-transports). Statement for charges that says, Medicare allowable will be permitted. 5

6 1.0 GENERAL INSTRUCTIONS 1.1 Definitions TERMS AND CONDITIONS Bidder/Quoter/Offeror: refers to submitter Vendor/Contractor/Provider: refers to a Successful Bidder/Quoter/Contractor/ Service Provider Submittal: refers to those documents required to be submitted to Entities by a Bidder/ Quoter/Offeror IFB: refers to Invitation for Bid RFQ: refers to Request for Qualifications RFP: refers to Request for Proposal RFI: refers to Request for Information CSP: refers to Competitive Sealed Proposal Quotation: refers to Request for Quotation Quality Review Council (QRC) refers to a Committee to oversee compliance and performance issues of the Offeror. The QRC shall be made up of at least one (1) representative of each Entity of the Offeror in Ellis County Emergency ambulance(s): refers to ambulances designated for response only to 911 calls for ambulance response Transfer ambulance(s): refers to ambulances that are designated for facility to facility transfers of patients Entity(ies): refers to the County of Ellis and/or those Cities located in Ellis County Texas covered by the Offeror s Contract Service Area: refers to all unincorporated areas and Cities in Ellis County excluding the unincorporated areas within ESD2 and ESD5 and the Cities of Ferris and Midlothian (Appendix C) Rural Area: refers to areas outside the city limits of Red Oak, Ennis, and Waxahachie (Ellis County Map). 6

7 Rural Remote Area: refers to areas 10 miles outside the city center of Red Oak, Italy, Ennis and Waxahachie (Appendix D) If Bidder/Quoter/Offeror do not wish to submit an offer at this time, please submit a No Bid Form. 1.3 Awards shall be made not more than ninety (90) days after the time set for opening of submittals. 1.4 Entities are always conscious and extremely appreciative of your time and effort in preparing your submittal. 1.5 A Bid/quote/submittal may not be withdrawn or canceled by the bidder/quoter/offeror prior to the ninety-first (91 st ) day following public opening of submittals and only prior to award. 1.6 It is understood that each Entity reserves the right to accept or reject any and/or All Bids/Quotes/Proposals/Submittals for any or all products and/or services covered in an Invitation for Bid (IFB), Request for Qualifications (RFQ), Request for Proposal (RFP), Request For Information (RFI), Competitive Sealed Proposal (CSP), and Quotation, and to waive informalities or defects in submittals or to accept such submittals as it shall deem to be in the best interest of the Entity(ies). 1.7 All IFBs, RFPs, CSPs, RFQs and RFIs submitted in hard copy paper form shall be submitted in a sealed envelope plainly marked on the outside with the IFB/RFP/RFQ/RFI/CSP/Quotation number and name. A hard copy paper form submittal shall be manually signed in ink by a person having the authority to bind the firm in a Contract. Submittals shall be mailed or hand delivered to the Ellis County Purchasing Agent. 1.8 No Oral, telegraphic or telephonic submittals will be accepted. 1.9 All Invitation for Bids (IFB), Request For Proposals (RFP), Request For Qualifications (RFQ), Competitive Sealed Proposals (CS), and Request For Information (RFI) shall remain sealed until official date and time of opening as stated in the Special Terms and Conditions of the IFB, RFP, RFQ, CSP, and/ or RFI Time/date stamp clock in the Ellis County Purchasing Agent s Office shall be the official time of receipt for all Invitation For Bids (IFB), Request For Proposals (RFP), Request For Qualifications (RFQ), Competitive Sealed Proposals (CSP), and Request For Information (RFI) submitted in hard copy paper form. IFBs/RFPs/RFQs/CSPs/RFIs received in the County Purchasing Agent s Office after submission deadline shall be considered void and unacceptable. Absolutely no late submittals will be considered. 7

8 1.11 For hard copy paper form submittals, any alterations made prior to opening date and time must be initialed by the signer of the IFB/RFQ/RFP/CSP/RFI guaranteeing authenticity. Submittals cannot be altered or amended after submission deadline The Entities are by statute exempt from the state Sales Tax and Federal Excise Tax. Therefore, the prices submitted shall not include taxes Any interpretations, corrections and/or changes to an IFB/RFQ/RFP/CSP/RFI and related specifications or extensions to the opening/receipt date will be made by addenda to the respective document by the Ellis County Purchasing Agent s Office Sole authority to authorize addenda shall be vested in the Ellis County Purchasing Agent s Office. Addenda may be transmitted by facsimile, transmission or mailed via the US Postal Service. Addenda will be transmitted to all that are known to have received a copy of the IFB/RFQ/RFP/RFI/CSP and related Specifications Questions and/or clarification requests must be submitted no later than seven (7) days prior to the opening/receipt date. Those received at a later date may not be addressed prior to the public opening However, it shall be the sole responsibility of the Bidder/Quoter/Offeror to verify issuance/non-issuance of addenda and to check all avenues of document availability (i.e. telephoning County Purchasing Agent s Office directly, etc.) prior to opening/receipt date and time to insure Bidder/Quoter/Offeror s receipt of any addenda issued Bidder/Quoter/Offeror shall acknowledge receipt of all addenda All materials and services shall be subject to the approval of each Entity The Entities individually reserves the right to make award in whole or in part as it deems to be in the best interest of the Entities The Bidder/Quoter/Offeror shall comply with all state and local purchasing requirements regarding ethics and contact with local elected officials Any reference to model/make and/or manufacturer used in specifications is for descriptive purposes only. Products/materials of like quality will be considered Bidders/Quoters/Offerors taking exception to the specifications shall do so at their own risk. By offering substitutions, Bidder/Quoter/Offeror shall state these exceptions in the section provided in the IFB/RFQ/RFP/CSP/Quotation or by attachment. Exception/substitution, if accepted, must meet or exceed specifications stated therein. The Entities reserve the right to accept or reject any and/or all of the exceptions(s)/substitutions(s) deemed to be in the best interest of the Entity(ies). 8

9 1.19 Minimum Standards for Responsible Prospective Bidders/Quoters/Offerors: A prospective Bidder/Quoter/Offeror must meet the following minimum requirements: Have adequate financial resources, or the ability to obtain such resources as required Be able to comply with the required or proposed delivery/completion schedule Have a satisfactory record of performance Have a satisfactory record of integrity of ethics Be otherwise qualified and eligible to receive an award. The Entities may request documentation and other information sufficient to determine Bidder s/quoter s/offeror s ability to meet these minimum standards listed above Vendor shall bear any/all costs associated with its preparation of and RFI/IFB/RFQ/RFP/CSP/Quotation submittal CONFIDENTIALITY: Any material that is to be considered confidential in nature must be clearly marked as such and shall be treated as confidential to the extent allowable in the Public Information Act. Pricing information is not considered confidential. Trade secrets or confidential information MUST be placed in a separate envelope marked CONFIDENTIAL INFORMATION and EACH PAGE must be marked CONFIDENTIAL INFORMATION. Entities will make every effort to protect these papers from public disclosure as outlined in LGC, Section (c) of the State of Texas County Purchasing Act Public Information Act: The Texas Public Information Act gives the public the right to request access to government information, subject to certain narrow exceptions. Entities are subject to this Act. Therefore, please be advised that your company s declaration that certain information submitted in response to the RFP is confidential will not be treated as such if Entities receive a request for a copy of the Proposal. Entities will of course make every effort to inform your company of such a request and to provide you with an opportunity to object to the release of any proprietary information, but Entities cannot and will not make an agreement to withhold information from the public contrary to its responsibilities under the Act Interlocal Agreement: Successful bidder agrees to extend prices and terms to all Entities that has entered into or will enter into joint purchasing interlocal cooperation agreements with each other Bid Opening: All bids submitted will be read at the County s regularly scheduled bid opening for designated project. However, the reading of a bid at bid opening should not be construed as a comment on the responsiveness of such bid or as any indication that the Entity(ies) accepts such bid as responsive. 9

10 1.25 The Entities will make a determination as to the responsiveness of bids submitted based upon compliance with all applicable laws, purchasing guidelines, and project documents including, but not limited to, the project specifications and Contract documents. The Entities will notify the successful bidder upon award of the Contract and, according to state law, all bids received will be available for inspection at that time. 2.0 TERMS OF CONTRACT 2.1 A bid/quote/proposal, when properly accepted by the Entity(ies), shall constitute a Contract equally binding between the Vendor/Contractor/Provider and the Entity(ies) subject to approval by the governing bodies of the Entity(ies). No different or additional terms will become part of this contract with the exception of an Amendment and/or a Change Order. 2.2 No oral statement of any person shall modify or otherwise change or affect the terms, conditions or specifications stated in the resulting Contract. All Amendments and/or Change Orders to the Contract will be made in writing by the County Purchasing Agent 2.3 No public official shall have interest in the Contract in accordance with Vernon s Texas Codes Annotated, Local Government Code Title 5, Subtitle C, Chapter The Bidder/Quoter/Offeror shall comply with all state and local purchasing requirements regarding ethics and contact with local elected officials. 2.5 Design, strength, quality of materials and workmanship must conform to the highest standards or manufacturing and engineering practice. 2.6 Bids/Quotes/Proposals must comply with all federal, state, county and local laws concerning the type(s) of products(s)/service(s)/equipment(s)/project(s) contracted for and the fulfillment of all Americans with Disabilities Act (ADA) requirements. 2.7 All products must be new and unused, unless otherwise specified, in first-class condition and of current manufacture. Obsolete products, including products or any parts not compatible with existing hardware/software configurations will not be accepted. 2.8 Vendor/Contractor/Provider shall defend, indemnify and save harmless the Entities and all its officers, agents and employees and all Vendors, their officers, agents and employees who are participating in this Contract from all suits, claims, actions, damages (including personal injury and/or property damages), or demands of any character, name and description, (including attorneys fees, expenses and other defense costs of any nature) brought for or on account of any injuries or damages received or sustained by any person, persons, or property on account of Vendor/Contractor/Provider s breach of the Contract arising from an award, and/or any negligent act, error, omission or fault of the Vendor/Contractor/Provider, or of any agent, employee, subcontractor or supplier of Vendor/Contractor/Provider in the execution of, or performance under, any Contract 10

11 which may result from an award. Vendor/Contractor/Provider shall pay in full any judgment with costs, including attorneys fees and expenses which are rendered against any participating Entity arising out of such breach, act, error, omission and/or fault. 2.9 Vendor/Contractor/Provider shall provide any and all notices as may be required under the Drug-Free Work Place Act of 1988, 28 CFR Part 67, Subpart F, to its employees and all subcontractors to insure that the Entities maintains a drug-free work place If a Contract, resulting from an IFB/RFP/RFQ/CSP/RFQ is for the execution of a public work, the following shall apply: In accordance with Texas Government Code , a governmental agency that makes a public work Contract with a prime Contractor shall require the Contractor, before beginning work, to execute to the Entities a Payment Bond if the Contract is in excess of $50, Such bond shall be in the amount of the Contract payable to the Entities and must be executed by a corporate surety in accordance with Texas law In accordance with Texas Government Code , a governmental agency that makes a public work Contract with a prime Contractor shall require the Contractor, before beginning work, to execute to the Entities a Performance Bond if the Contract is in excess of $1,000,000. Such bond shall be in the amount of the Contract payable to the Entities and must be executed by a corporate surety in accordance with Texas law Purchase Order(s) shall be generated by the individual Entities to the Vendor. The Entities will not be responsible for any orders place/delivered without a valid purchase order number The Contract shall remain in effect until any of the following occurs: delivery of product(s) and/or completion and acceptance by the Entity(ies) of product(s) and/or service(s), Contract expires or is terminated by either party with ninety (90) days written notice prior to cancellation and notice must state therein the reasons for such cancellation. The Entities reserve the right to terminate the Contract immediately in the event the Vendor/Contractor/Provider fails to meet delivery or completion schedules or otherwise perform in accordance with the specifications. Breach of Contract or default authorizes the Entities to purchase elsewhere and charge the full increase in cost and handling to the defaulting Vendor/Contractor/Provider The City Managers and the County Judge shall designate who shall serve as the Contract Administrator for their Entity All delivery and freight charges (FOB Inside delivery at the Entity s designated locations) are to be included as part of the bid/quote/proposal price. All components required to render the item complete, installed and operational shall be included in the 11

12 total bid/quote/ proposal price. The Entities will pay no additional freight/delivery/installation/setup fees Vendor/Contractor/Provider shall notify the Purchasing Department immediately if delivery/completion schedule cannot be met. If delay is foreseen, the Vendor/Contractor/Provider shall give written notice to the County Purchasing Agent. The Entities have the right to extend delivery/completion time if reason appears valid The title and risk of loss of the product(s) shall not pass to the Entities until the Entities actually receives and takes possession of the product(s) at the points of delivery. The Entities shall generate a purchase order(s) to the Vendor/Contractor/Provider and the purchase order number must appear on all itemized invoices Invoices shall be mailed directly to the appropriate Entity as below: Ellis County, 101 West Main Street, Waxahachie, TX Ennis, PO Box 220, Ennis, TX Red Oak, 547 N. Methodist, Red Oak, TX Waxahachie Fire-Rescue, PO Box 757, Waxahachie, TX All invoices shall show: Entity Purchase Order Number; Vendor s/contractor s/provider s Name, Address and Tax Identification Number; Detailed breakdown of all charges for the product(s) and/or service(s) including applicable time frames Payment will be made in accordance with Texas Government Code Chapter All warranties shall be stated as required in the Uniform Commercial Code The Vendor/Contractor/Provider and the Entities agree that both parties have all rights, duties, and remedies available as stated in the Uniform Commercial Code The Vendor/Contractor/Provider agree to protect the Entities from any claims involving infringements of patents and/or copyrights The Contract will be governed by the laws of the State of Texas. Should any portion of the Contract be in conflict with the laws of the State of Texas, the State laws shall invalidate only that portion. The remaining portion of the Contract shall remain in effect. The Contract is performable in Ellis County, Texas The Vendor/Contractor/Provider shall not sell, assign, transfer or convey the Contract, in whole or in part, unless the Entities oversee the transition and approves same in writing. 12

13 If the Offeror desires to assign the Contract, the Entities shall be given a minimum notice of 120 days The apparent silence of any part of the specification as to any detail or to the apparent omission from it of a detailed description concerning any point, shall be regarded as meaning that only the best commercial practices are to prevail. All interpretations of the specification shall be made on the basis of this statement Vendor/Contractor/Provider shall not fraudulently advertise, publish or otherwise make reference to the existence of a Contract between the Entities and Vendor/Contractor/Provider for purposes of solicitation. As exception, Vendor/Contractor/Provider may refer to the Entities as an evaluating reference for purposes of establishing a Contract with other Entities The Vendor/Contractor/Provider understands, acknowledges and agrees that if the Vendor/Contractor/Provider subcontracts with a third party for services and/or material, the primary Vendor/Contractor/Provider (awardee) accepts responsibility for full and prompt payment to the third party. Any dispute between the primary Vendor/Contractor/Provider and the third party, including any payment dispute, will be promptly remedied by the primary Vendor. Failure to promptly render a remedy or to make prompt payment to the third party subcontractor) may result in the withholding of funds from the primary Vendor/Contractor/Provider by the Entities for any payments owed to the third party Vendor/Contractor/Provider shall provide the Entities with diagnostic access tools at no additional cost to the Entities for all Electrical and Mechanical systems, components, etc., procured through this Contract Criminal History Background Check: If required, ALL individuals may be subject to a criminal history background check performed by the Entities Police Department prior to access being granted to any of the Entities buildings/properties. Upon request, Vendor/Contractor/Provider shall provide list of individuals to the County Purchasing Agent within five (5) working days Non-Disclosure Agreement: Where applicable, Vendor shall be required to sign a nondisclosure agreement acknowledging that all information to be furnished is in all respects confidential in nature, other than information which is in the public domain through other means and that any disclosure or use of same by Vendor, except as provided in the contract/agreement, may cause serious harm or damage to the Entities. Therefore, Vendor agrees that Vendor will not use the information furnished for any purpose other than that stated in contract/agreement, and agrees that Vendor will not either directly or indirectly by agent, employee, or representative disclose this information, either in whole or in part, to any third party, except on a need to know basis for the purpose of evaluating any possible transaction. This agreement shall be binding upon the Entities and Vendor and upon the directors, officers, employees and agents of each. 13

14 2.30 Vendors/Contractors/Providers must be in compliance with the Immigration and Reform Act of 1986 and all employees specific to this solicitation must be legally eligible to work in the United States of America Certification of Eligibility: This provision applies if the anticipated Contract exceeds $100, and as it relates to the expenditure of federal grant funds. By submitting a bid or proposal in response to this solicitation, the Bidder/Quoter/Offeror certifies that at the time of submission, he/she is not on the Federal Government s list of suspended, ineligible, or debarred contractors. In the event of placement on the list between the time of bid/proposal submission and time of award, the Bidder/Quoter/Offeror will notify the County Purchasing Agent. Failure to do so may result in terminating this Contract for default Notice to Vendors/Contractors/Providers delivering goods or performing services within the Ellis County Jail: The Ellis County jail houses persons who have been charged with criminal offenses. When entering the jail, you could: (1) hear obscene or graphic language (2) view partially clothed inmates; (3) be subjected to verbal abuse or taunting; (4) risk physical altercations or physical contact, which could be minimal or possible serious; (5) be exposed to communicable or infectious diseases; (6) be temporarily detained or prevented from immediately leaving the jail in the case of an emergency or lockdown ; and (7) subjected to a search of your person or property. While County personnel take every reasonable precaution to protect the safety of visitors to the jail, because of the inherently dangerous nature of a jail and the type of the persons incarcerated therein, please be advised of the possibility of such situations exist and you should carefully consider such risks when entering the jail. By entering the Ellis County jail, you acknowledge that you are aware that such potential risks and willingly and knowingly choose to enter the Ellis County jail All other terms and conditions (i.e. Insurance Requirements, Bond Requirements, etc.) shall be stated in the individual IFB/RFQ/RFP/RFI/CSP/Quotation Solicitation documents as Special Terms, Conditions and Specifications. 3.0 INSURANCE REQUIREMENTS 3.1 Before commencing work, the Vendor shall be required, at its own expense, to furnish the Designated Representative for each Entity with certified copies of all insurance certificate(s) indicating the coverage to remain in force throughout the term of this Contract and name each Entity as a co-insured Commercial and Comprehensive Liability insurance at minimum combines single limits of ($1,000,000 per occurrence and $2,000,000 general aggregate) for bodily injury and property damage, which coverage shall include products/completed operations, independent contractors and contractual liability each at $2,000,000 per occurrence. Coverage must be written on an occurrence form. 14

15 3.1.2 Workers Compensation insurance at statutory limits, including employer s liability coverage at minimum limits. In addition to these, the Contractor must meet each stipulation below as required by the Texas Workers Compensation Commission. (Note: If you have questions concerning these requirements, you are instructed to contact the TWCC at (512) ) Certificate of coverage ( certificate ) defined: A copy of a certificate of authority of self-insurance issued by the commission, or a coverage agreement (TWCC-81, TWCC-83, TWCC-83, or TWCC-84), showing statutory workers compensation insurance coverage for the person s or Vendor s employees providing services on a project for the duration of the project. Duration of the project includes the time from the beginning of the work on the project until the contractor s/person s work on the project has been completed and accepted by the Entities. Person s providing services on the project ( subcontractor in ) includes all persons or Vendors performing all or part of the services the Contractor has undertaken to perform on the project regardless of whether that person has employees. This includes, without limitation, independent Contractors, subcontractors, leasing companies, motor carriers, owner/operators, employees of any such Vendor, or employees of any Vendor which furnishes persons to provide services on the project. Services include, without limitation, providing, hauling or delivering equipment or materials or providing labor, transportation, or other service related to a project. Services does not include activities unrelated to the project, such as food/beverage Vendors, office supply deliveries and delivery of portable toilets The Contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section (44) for all employees of the Contractor providing services on the project for the duration of the project The Contractor must provide a certificate of coverage to the Entity(ies) prior to being awarded the Contract If the coverage period shown on the Contractor s current certificate of coverage ends during the duration of the project, the Contractor must, prior to the end of the coverage period, file a new certificate of coverage with the Entity(ies) showing that coverage has been extended The Contractor shall obtain from each person providing services on a project, and provide to the Entity(ies): 15

16 A certificate of coverage, prior to that person beginning work on the project, so the Entity(ies) will have on file certificates of coverage showing coverage for all persons providing services on the project; and no later than seven (7) days after receipt by the Contractor, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project The Contractor shall retain all required certificates of coverage for the duration of the project and for one (1) year thereafter The Contractor shall notify the Entity(ies) in writing by certified mail or personal delivery, within ten (10) days after the Contractor knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project The Contractor shall post on each project site a notice in the text, form and manner prescribed by the Texas Workers Compensation Commission informing all persons providing services on the project that they are required to be covered and stating how a person may verify coverage and report lack of coverage The Contractor shall contractually require each person with whom it Contracts to provide services on a project, to: provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section (44) for all of its employees providing services on the project for the duration of the project; provide to the Contractor, prior to that person beginning work on the project, a certificate of coverage showing that coverage is being provided for all employees of the person providing services on the project, for the duration of the project; provide the Contractor, prior to the end of the coverage period, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project; 16

17 obtain from each other person with whom it Contracts, and provide to the Contractor: a certificate of coverage, prior to the other person beginning work on the project; and a new certificate of coverage showing extension of coverage, prior to the end of the coverage period, if the coverage period show on the current certificate of coverage ends during the duration of the project; notify the Entity(ies) in writing by certified mail or personal delivery, within ten (10) days after the person knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project; retain all required certificates of coverage on file for the duration of the project and for one year thereafter; and contractually require each person with whom it contracts, to perform as required by paragraphs through , with the certificates of coverage to be provided to the person for whom they are providing services By signing this Contract or providing or causing to be provided a certificate of coverage, the Contractor is representing to the Entity(ies) that all employees of the Contractor who will provide services on the project will be covered by workers compensation coverage for the duration of the project, that the coverage will be based on proper reporting of classification codes and payroll amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, in the case of a self-insured with the commission s Division of Self-Insurance Regulation. Providing false or misleading information may subject the Contractor to administrative penalties, criminal penalties, civil penalties, or other civil actions The Contractor s failure to comply with any of these provisions is a breach of Contract by the Contractor which entitles the Entity(ies) to declare the Contract void if the Contractor does not remedy the breach within ten (10) days after receipt of notice of breach from the Entity(ies) Commercial Automobile Liability insurance shall be no less than $1,000,000 combined single limits per accident for bodily injury and property damage, including owned, non-owned, and hired vehicle coverage. 17

18 3.1.4 Professional Liability Insurance at minimum limits of $1,000,000 for each claim. This policy must have a two (2) year extended period of coverage (i.e..tail coverage). If you choose to have project coverage endorsed onto your base policy, this would be acceptable. 3.2 The required limits may be satisfied by any combination of primary, excess or umbrella liability insurance, provided the primary policy complies with the above requirements and the excess umbrella is following form. The Vendor may maintain reasonable and customary deductibles, subject to approval by the Entities. 3.3 With reference to the foregoing insurance requirement, the Vendor shall endorse applicable insurance policies as follows: A waiver of subrogation in favor of the Entities, their officials, employees, volunteers and officers shall be contained in the workers compensation coverage The Vendor s insurance coverage shall name the Entities as additional insured under the General Liability policy All insurance policies shall be endorsed to require the insurer to immediately notify the Entities of any decrease in the insurance coverage limits All insurance policies shall be endorsed to the effect that the Entities will receive, at least thirty (30) days prior to cancellation, non-renewal or termination of the policy All copies of Certificates of Insurance shall reference the Project/Contract number. 3.4 All insurance is to be placed with insurers licensed in the State of Texas, rated by Moody s Investors Service, Inc., and rated A- or better by A.M. Best or A or better by Standard and Poors. 3.5 Certificates of Insurance shall be prepared and executed by the insurance company or its authorized agent and shall contain provisions representing and warranting the following: Sets forth all endorsements and insurance coverage according to requirements and instructions contained herein Sets forth the notice of cancellation or termination to the Entities. 18

19 4.0 EVALUATION FACTORS 4.1 A Selection Team with representatives of all Entities will review all proposals received by the opening date and time as part of a documented evaluation process. For each decision point in the process, the Selection Team will evaluate Offerors according to specific criteria and will elevate a certain number of Offerors to complete against each other. The proposals will be evaluated on the following criteria: Conformance with RFP guidelines and submittal requirements Compatibility with the Entity s desired terms and conditions Cost Interviews (optional) 4.2 The Selection Team reserves the right to determine the suitability of proposals on the basis of all of these criteria. 4.3 The Selection Team will use a competitive process based upon selection levels. The Selection Team recognizes that if an Offeror fails to meet expectations during any part of the process, it reserves the right to proceed with the remaining Offerors or to elevate an Offeror that was not elevated before. The selection levels are described in the following sections: Level 1- Procurement Requirements Assessment. Criteria assessed during Level 1: Conformance with RFP guidelines and submittal requirements The first part of the evaluation process is to validate the completeness of the proposal and ensure that all the RFP guidelines and submittal requirements are met Those Offerors who do not meet all the requirements for the RFP may, at the discretion of the Selection Team, be contacted to submit the missing information within two (2) business days Incomplete or noncompliant RFPs may be disqualified Level 2- Detailed Proposal Assessment. The Selection Team will conduct a detailed assessment of all proposals elevated to this Level. Criteria evaluated in Level 2: 19

20 Public Sector Experience and References- 20% Offerors who have proven experience at public sector sites similar in scope, size and complexity to the Entities will provide higher confidence to the Selection Team References may be called during this phase of the evaluation and the quality of the clients provided as references will be analyzed Offerors who provide clients with active contracts are most desirable The listing of all public sector clients in the RFP will also be used during this evaluation Implementation Staffing- 20% The Selection Team will examine implantation methodologies and plans that are well suited for the Entities This analysis will include staffing effort, staffing level, implementation schedule, team make-up (project managers, team leaders, etc.), and training Scope of Services (analysis of the Offerors responses to the Special Terms and Conditions) - 30% Cost- 30% It is anticipated that no more than three (3) Offerors will advance to Level 3 but the Selection Team reserves the right to adjust the number as necessary Level 3- Demonstrations and Implementation Firm Interview. Oral Presentations: The Selection Team may hear oral presentations (if required). Vendors are cautioned, however, that oral presentations are at the sole discretion of the Selection Team and the Selection Team is not obligated to request it. The oral presentation is an opportunity for the Selection Team to ask questions and seek clarification of the proposal submitted. The presentation is not meant as an opportunity for the Vendor to simply provide generic background information about the corporation or its experience. Thus, the time will be structured with a minimum time for the Vendor to present and the majority of time dedicated to addressing questions from the Selection Team. The oral presentations, if held, will 20

21 be scheduled accordingly and all presenting Offerors will be notified of time and date. The following criteria is optional and will be used to evaluate those Offerors elevated for interviews in Level 3: Interviews- 50% Public Sector Experience and References- 50% The Selection Team will contact the Offeror references These references will be asked a series of questions regarding their satisfaction with the services being provided. It is anticipated that no more than two (2) Offerors will advance to Level 4 but the Selection Team reserves the right to adjust the number as necessary Level 4- Discovery Sessions Offerors elevated to Level 4 will be asked to respond in writing to issues and questions raised by the Selection Team at the interviews, as well as any other cost and implementation planning considerations in the proposal, and may be invited to present their responses onsite. The Selection Team reserves the right to bypass Level 3 in the evaluation process and move directly to Discovery Sessions. Criteria evaluated during Level 4 include: Updated Implementation Strategy/Staffing- 35% Updated Cost- 35% Scope of Work- 30% Based on the information collected in this phase, a single Offeror will be identified as the finalist for Contract negotiations. If a Contract cannot be reached after a period of time deemed reasonable by the Selection Team, it reserves the right to contact any of the other Offerors that have submitted bids and enter into negotiations with them Level 5- Best and Final Offer At its sole option, the Selection Team reserves the right to extend a Best and Final Offer (BAFO) opportunity to any or all of the top scoring Offerors. 21

22 Offerors may be asked to submit additional information specific to program specifications and cost. 5.0 SPECIAL TERMS AND CONDITIONS 5.1 SCOPE OF PROJECT The Entities are soliciting competitive proposals to provide 911 Emergency Medical Service (EMS) with Mobile Intensive Care Unit (MICU) Ambulance Service for the Entities The Entities are seeking the highest quality, most reliable Paramedic ambulance services at the most reasonable price. Proposals not meeting this intent will be considered unresponsive The Entities desire a professional and courteous image, clinical excellence, superb response time performance, and cost containment Under the Contract, the relationship between the Entities and the Offeror should always be one of cooperation and not conflict The services shall include, but no be limited to, the management and operation of all ambulances, including Advanced Life Support. Additionally, the service shall include medical supply purchasing, all fleet maintenance, and public education. 5.2 AUTHORIZATION: By order of the Councilmembers or Commissioners of the Entities, sealed proposals will be received for Emergency Medical Service Delivery (Paramedic Care and Ambulance Services). 5.3 PERFORMANCE BOND: A performance bond in the amount of $500,000 will be required of the successful Vendor to each Entity upon award of Contract. The bond shall remain in effect for the term of the Contract. 5.4 PERMITS, TAXES, and LICENSES: The Offeror is responsible for all necessary permits, licenses, fees and taxes required to carry out the provisions of the RFP. The financial burden for such expenses rests entirely with the company providing the services under the Contract. 5.5 INTENT OF RFP: The successful Offeror shall be responsible for providing MICU level ambulances for response to 911 calls for emergency requests throughout the Service Area of the Contract with a response time according to those listed in Appendix B for at least 96% of all calls. 5.6 TRANSPORT OF PUBLIC SAFETY EMPLOYEES: The Offeror will transport professional and/or volunteer County Sheriff, Police Department and Fire Department 22

23 personnel of any Entity who is injured in the line of duty at no additional charge to either the Entity or the injured individual(s). 5.7 EMS ADMINISTRATORS: The Fire Chief of each Entity and the County Emergency Management Coordinator or their designee is designated as the EMS Administrator who will be the liaison between the Offeror and the Entity. The Coordinator shall report to the EMS Quality Review Council (QRC) on a monthly basis or as designated by the Entities. Oversight and review of and compliance with performance standards of the Contract will be conducted by the EMS QRC. 5.8 SUBSIDY: It is the desire of the Entities to pay no subsidy, but, the Offeror shall provide a proposed cost, if any, for services described in accordance with this RFP (see section 6.6). If a subsidy is agreed upon, the subsidy amount for any individual Entity shall not be altered by the subsidy amount or lack thereof for any other Entity in Ellis County for which the Offeror provides ambulance services. 5.9 MANDATORY PRE-PROPOSAL CONFERENCE: A mandatory pre-proposal conference will be conducted by the Selection Committee on April 27, 2015 at the Ellis County Courts Building, Room TBA, 109 S. Jackson Street, Waxahachie, Texas This conference is to provide an opportunity for all interested Vendors to ask questions. Participation in the conference is mandatory for any Vendor intending to submit a proposal TERM Provide for a term Contract commencing at 7:00 a.m. on January 3, 2016 and continuing through 7:00 a.m. January 3, 2019 with two (2) optional two (2) year renewal periods The initial term of the Contract shall commence at 7:00 a.m. January 3, 2016 and continue until 7:00 a.m. January 3, Renewal(s) shall be exercised only if the Offeror is successful at meeting response time stated in the Contract and the Entities are satisfied with the services provided by the Offeror Renewals shall only occur with written approval by the Entities which shall occur at least ninety (90) days prior to the end of the present term. Failure of an Entity to submit a Letter of Renewal shall serve as Notice of Nonrenewal FUNDING: Funds for payment have been provided through the Entities budgets approved by the Councilmembers or Commissioners for this fiscal year only. State of Texas statutes prohibit the Entities from any obligation of public funds beyond the fiscal year for which a budget has been approved. Therefore, anticipated orders or other 23

24 obligations that arise past the end of the current Entities fiscal year shall be subject to budget approval PRICE REDETERMINATION A price redetermination may be considered by the Entities only on October 1 st of each year of the Contract. All requests for price redetermination shall be in written form, shall be submitted at least ninety (90) days prior to October 1 st of each year and shall include supporting documentation Requests for price redetermination shall be based on the percentage increase for the previous twelve (12) month period in the medical component of the Consumer Price Index (CPI) calculated to the next 1/19 th of one percent (1%) of the South region for All Urban Consumers as published by the United State Department of Labor. For purposes of this Contract, the Medical CPI shall not exceed an annual increase of three percent (3%) In order to receive consideration for a price redetermination, the Offeror must be in good standing, meet the minimum requirements of the Contract, and be performing at or above the 96% level of response times ASSERTION OF ESTIMATES: Any information herein is provided as an estimate of volume based on past history. This data is provided for the general information of Vendors and is not guaranteed to be relied upon for future volumes SCHEDULE OF EVENTS RFP release: April 17, 2015 Pre-Proposal Conference: April 27, 2015 Deadline for submission of Vendor questions: May 1, 2015 Proposals due: May 15, 2015 Vendors notified of selection for presentation: May 29, 2015 Bid presentations: Week of June 1, 2015 Recommendation to Entities Governing Bodies June 26, 2015 Selection of Provider On or Before July 15, 2015 Award of Contract: By October 1, 2015 Effective date of Contract: January 3, 2016 The Entities reserve the right to change the schedule of events as it deems necessary OFFEROR COMMUNICATIONS: Offerors are prohibited from communication directly with any employee of the Entities except as described herein. The Entities will not be 24

25 responsible for verbal information given by any Entity employee or other person. The issuance of an Addendum is the only official method whereby interpretation, clarification or additional information will be communicated and authorized AUDITS AND RECORDS: The Offeror agrees that at any time during normal business hours, and as often as an Entity may deem necessary, Offeror shall make available to representatives of the Entity for examination all of its records with respect to all matters covered by the resulting Contract and will permit such representatives of the Entity to audit, examine, copy and make excerpts or transcripts from such records, and to make audits of all Contracts, invoices, materials, payrolls, records of personnel, conditions of employment and other data relating to all matters covered by the resulting Contract all for a period of three (3) years from the date of final settlement of Contract or of such other or longer period, if any, as may be required by applicable statute or other lawful requirements. Offeror agrees to provide any information to Entity to ensure transparency CONFIDENTIALITY: All completed and submitted proposals become the property of the Entity. An Entity may use the proposal for any purpose it deems appropriate. After approval by the Entities, the proposal material becomes part of the Contract between the Vendor and the Entity(ies). Upon signing of a Contract, proposals and Contracts are subject to the State of Texas Public Information Act. If any information is to be considered proprietary, the Vendor shall place it in a separate envelope and mark it Proprietary Information. The Entities retain the final authority as to the extent of material that is considered proprietary or confidential BINDING EFFECT: This resulting agreement shall be interpreted and enforced under the laws and jurisdiction of the State of Texas. The RFP, the Offeror s proposal in response to the RFP and any additional negotiated conditions reduced to writing will constitute the Contract between the successful Vendor and the Entity(ies). This agreement then constitutes the entire understanding between the parties and is not subject to amendment unless agreed upon in writing by all parties hereto. Offeror acknowledges and agrees that it will perform its obligations hereunder in compliance with all applicable state, local or federal laws, rules, regulations and orders COSTS INCURRED IN RESPONDING The Entities will not pay any costs incurred in the preparation, presentation, demonstration or negotiation of the RFP, nor does it commit to procure or Contract for any services. All costs of proposal preparation will be borne by the Offeror It is understood that all proposals, inquiries, and correspondence relating to this RFP and all reports, charts, displays, schedules, exhibits, and other documentation will become the property of the Entities when received by the Entities and many be considered public information under applicable law. 25

26 The Entities assume no liability for any costs incurred by Offerors throughout the entire selection process ADDITIONAL INFORMATION The award will be made to the most responsible, responsive and reliable Offeror that can provide the best service to the Entities The Selection Team may schedule site visits to the Offeror s facilities in order to assess the Offeror s capability and ability to fulfill the requirements of this RFP If during the evaluation process the Selection Team unable to determine an Offeror s ability to perform, the Selection Team has the option of requesting evidence of the Offeror s ability. The Offeror will be notified and permitted five (5) working days to comply with any such request The Entities reserve the right to cancel this solicitation at any time prior to or after the submittal deadline MINIMUM REQUIREMENTS: Successful proposals will include, at minimum, the following: GENERAL DUTIES Offeror shall maintain compliance with the Texas Administrative Code, Chapter 157 Emergency Medical Care Offeror shall provide and pay for all professional expertise, insurance, administration, labor, materials, vehicles, and equipment necessary to respond to all emergency and nonemergency calls referred to the Offeror by the Entities The Offeror will be responsible for supplying vehicles, equipment and supplies, and mobile and portable radios that meet or exceed standards for interoperable communications with the Dispatch System of each Entity in Ellis County covered by the Offeror s Contract (see Appendix B for radio system type(s) of each Entity) The Entities may install Automatic Vehicle Locators (AVL) hardware compatible with the Entities CAD providers to be used by 911 Dispatch to track and locate the closest appropriate ambulance for emergency calls All vehicles shall be equipped with a compatible transponder to be tracked by Offeror dispatch. 26

27 All vehicles and equipment shall be fully operational when placed in service initially and throughout the term of the Contract for response to public needs Offeror shall furnish all manpower and supervision for the operation of a centralized dispatch center. The Offeror shall provide sufficient certified personnel in the dispatch center at all times to allow prompt answering of all requests for emergency service The Offeror shall apply for, secure, and renew all licenses, permits, certificates or similar government approvals which are or may be required by applicable law and shall provide copies of all such pertinent documents to the EMS Administrators or their designees The Offeror shall make emergency services (as defined by NFPA standards) available to all persons within the Service Area of Ellis County Texas The Offeror shall participate in required community disaster drills as directed by the Entities and within the Offeror s resources and guidelines for such activities The Offeror may not offer incentives by way of additional salaries or wages or compensated leave of absence to employees based upon the number of procedures performed or based upon mileage for the provision of ambulance transport The Offeror shall provide a standby ambulance and emergency medical personnel for standby upon request of the EMS Administrators or their designees or the Chiefs of Police at no additional charge to the Entities when there is reason to believe a life threatening public emergency presently exists or is imminent in the Service Area which includes mass gathering events, inclement weather forecasts of snow, ice, thunderstorm warnings, and tornado warnings as well as structure fires, technical rescues, water rescues, and hazardous materials responses. This shall be within the guidelines approved by the QRC. The number of additional units shall be coordinated by the Offeror and the EMS Administrators or their designees Subject to the Offeror s reasonable policies and procedures regarding same, the Offeror shall permit Entity dignitaries and members of the Law Enforcement Departments to ride out as observers. Likewise, the Offeror shall permit members of the Entity Fire Departments to ride out as interns. The Offeror s 27

28 TRANSPORT policies and procedures may address, among other things, the requirement of written waiver and indemnity agreements, dress codes, conduct codes and the like The Offeror shall comply with all adopted and approved Emergency Operations Plans or Successor Plans of the Entities. The Offeror will participate in the Ellis County Local Emergency Planning Committee The Offeror will maintain emergency, full time MICU level ambulances staffed with two (2) Paramedics and one (1) supervisor not assigned to an ambulance to service calls for the Service Area 24 hours per day The Offeror will provide a response time according to those listed in Appendix B for at least 96% of all calls The Offeror shall describe their policies for response to emergencies in the RFP response. As a minimum, the Offeror must describe their driving policies including their Code 3 driving practices (i.e. exceeding the speed limit while responding Code 3, if so by how many mph over the speed limit, what guidelines are used to differentiate a Code 1 vs. a Code 3 response and/or transport, etc.) The Offeror shall have a minimum of five (5) years of experience in providing 911 emergency ambulance services The Offeror shall provide emergency medical treatment and transport from the scene to the closest appropriate health facility based upon the chief complaint/illness/injury The Offeror shall utilize the North Central Texas Trauma Regional Advisory Council (NCTTRAC) guidelines for appropriate destination determination Patients and/or guardians have the right to request transport to a facility of their choice. However, it is the responsibility of the Offeror s staff to communicate to the patient and/or guardian the potential adverse effects on the outcome of the patient s condition if the requested hospital is not the closest, most appropriate facility to treat their condition. Once this is communicated, the patient and/or guardian retains the privilege of making the final decision of the hospital the patient shall be transported to as long as said 28

29 hospital is within the Dallas/Ft. Worth metroplex and/or within the Offeror s normal transport destination guidelines (Offerors shall be required to describe their normal response destination guidelines in the RFP response) COMMUNICATIONS EQUIPMENT The Offeror shall supply and maintain fully operational vehicle and portable radios as required for it to perform hereunder. All radios shall operate on frequencies used by all Entities covered by the Offeror s Contract in the Service Area The Offeror s radios must be of the type which is accepted for use with each Entity s radio systems. Programming for the radios will only be approved through QRC authorized programmers and programming shall be at the expense of the Offeror As a minimum, the Offeror shall provide the following communications via radio immediately: Emergency calls Acknowledgment of the call Unit identification of responding unit Location unit is responding from Response priority ETA if responding from outside of Service Area Ambulance diversion Transport destination and priority Available emergency ambulances is < 3 in the Service Area NOTIFICATION The EMS Administrators or their designees shall be notified immediately whenever mass casualty incidents or motor vehicle accidents involving the Offeror operated ambulance occurs The EMS Administrators or their designees shall be notified within four (4) hours whenever the following occurs: the employment of any person involved in the delivery of services related to the subject of the Contract and the notification shall provide necessary certification of the person, 29

30 AVAILABLE AMBULANCES the separation/termination or the employee status change of any of the Offeror s employees involved in the delivery of services related to the Contract, and a change in the Offeror s method of delivery of services, management or supervisory structure (such changes shall require prior approval by the EMS Administrators or their designees) The Offeror shall provide a minimum number of MICU level emergency ambulances staffed with two (2) Paramedics twentyfour (24) hours a day, seven (7) days a week while the Contract is in effect. The Offeror shall propose the minimum number of emergency ambulances based upon their ability to meet the response time requirements of the Contract. The number of ambulances will be determined on geographic data, response time data, and request for service activity. Deployment models shall follow NFPA The Offeror will provide at least one (1) supervisor assigned to a quick response vehicle, twenty-four (24) hours a day, seven (7) days a week, who will be available for immediate response to emergencies, deliver supplies and equipment to the ambulances, supervise Offeror personnel on a daily basis and be on call if needed If the Offeror provides routine transfer services in the Contract response area, the following shall apply: Emergency ambulances shall not be utilized for transfer services Transfer ambulances shall be equipped and staffed at the MICU level with a minimum of one (1) EMT and one (1) Paramedic When an ambulance is taken out of service for preventative or routine maintenance or repairs of any kind, another ambulance shall be put in place of the ambulance being taken out of service until such time as the other ambulance is returned to service. If the downtime of the unit shall be over four (4) hours, the EMS Administrators or their designees shall be notified of such and shall also be notified when a replacement unit is put in service in its place. 30

31 Offeror will utilize the closest available air ambulance for each run, regardless of the provider of the air ambulance RESPONSE TIME As used herein, the term emergency request shall include any response by the Offeror under the Contract on an emergency service request received by the Offeror from the Dispatch Center of any Entity or a call received directly from the public within the Service Area of the Contract Response Time to an emergency request shall be determined from the moment the Offeror s Dispatch Center PSAP is notified of the emergency service request until the arrival of the Offerer s ambulance at the scene of the emergency. Therefore, Response Time shall include Total Dispatch Transaction Time, Turnout Time and Travel Time If, in each monthly period, the Offeror fails to respond to emergency requests in accordance with the times stated in Appendix B, it shall be assessed penalties set forth in this RFP For purposes of determining the Offeror s compliance with response time standards as set forth in this RFP and for calculating assessments every emergency request for ambulance service shall be counted except as follows: Requests during the first twelve (12) hours of a disaster locally or in a neighboring jurisdiction that an Offeror s ambulance is dispatched to An inclement weather condition of ice, snow or heavy rain exists The response for an emergency request may also be excluded when the EMS Administrators or their designees and the QRC determines there is a good cause for an exception Note: the arrival of the Offeror s County Supervisor or a fire department company does not stop the clock. Only the response time of an Offeror s ambulance shall count as to the response time requirements. 31

32 Response Damages In each monthly period (beginning on the first day of each month), not less than one hundred percent (100%) of the Offeror s response to emergency requests shall be performed as set forth in the RFP. Offeror will provide access to all information Entity may request to resolve any dispute relating to damages Failure of the Offeror to meet response time requirements shall result in an assessment of fees (collected quarterly and deposited in the each Entity s bank account of choice by the 10 th day of the month following the end of quarter) based on the following: Service Area response time according to those listed in Appendix B for at least 96% of all calls The table below shows assessment of fees per monthly period (such assessments are cumulative): % MICU Responses % MICU Responses No Assessment $1,000 Assessment/Call Not Compliant with the Response Time Compliance Chart Requirements Outlined in Appendix B % MICU responses $2,000 Assessment/Call Not Compliant with the Response Time Compliance Chart Requirements Outlined in Appendix B + 3 Month Probation Probation for Response Time Noncompliance: If the Offeror does not meet the 91% response time or greater in any monthly period, the Offeror shall be placed on probation for three (3) months. The Entity(ies) will notify the Offeror when/if they are placed on probation If the Offeror is put on probation, the Offeror will be required to submit a written plan within ten (10) days of 32

33 AMBULANCE SPECIFICATIONS being notified of Probation detailing how the Offeror intends to remove itself from probation In order to be removed from Probation, the Offeror shall achieve 96% or better response time compliance for the next three (3) months All ambulances used for emergency patient transportation shall be in good physical appearance as well as working operational and mechanical condition for the patient and crew members. This shall remain in effect unless otherwise approved in writing by the EMS Administrators or their designees and the QRC Each ambulance used in the emergency transportation of patients shall be equipped with all items required by Texas Administrative Code 157, Emergency Medical Care and NFPA vehicle standards 1901 and Equipment shall be available to allow ambulances to travel in inclement weather conditions including snow or ice Each ambulance shall have a standalone box with an independent AC unit capable of shoreline power as well as generator or alternator power Each ambulance shall meet current FDA requirements for drug storage Each ambulance will be Type I Each ambulance shall not exceed mileage of 150,000 miles. Likewise, all EMS equipment assigned to the Offeror s ambulances shall be properly maintained and serviceable at all times. Additionally, the Offeror shall provide monthly maintenance records for all ambulances and EMS equipment utilized in the Contract area Each ambulance shall permanently display its name or other suitable corporate identification or logo on the outside of the vehicle along with the vehicle DSHS license numbers. 33

34 Any ambulance used by the Offeror for transporting patients shall conform to all standards as promulgated and defined by the EMS Medical Director and all rules and regulations promulgated and set forth in any state and local ordinance All ambulances shall be equipped with power patient cots to reduce possible injury of responders PERSONNEL The Offeror should attempt to employ EMTs, Paramedics and clerical staff with local knowledge and experience. All reasonable efforts to employ EMTs and Paramedics with experience, knowledge and history of the Service Area should be considered first The parties understand that the EMS System requires professional and courteous conduct at all times from Offeror s field personnel, middle management, and top executives. The Offeror shall employ highly trained EMTs, Paramedics and support staff to provide patient care and to operate Offeror s vehicles and equipment Each EMT and Paramedic shall be physically capable of performing the tasks assigned by the Offeror, shall be clean in dress and person, and shall display their name and certification in an appropriate manner visible to the patient. Any of the Offeror s employees who operate under the Contract shall conform to the Offeror s dress code which shall conform to DSHS guidelines The parties understand that training and educational requirements change from time to time for EMTs and Paramedics as new protocols and medical treatments are approved by the EMS Medical Director. The Offeror agrees that the EMS QRC may require additional training or education for EMTs and Paramedics for the benefit of patients receiving care under the Contract. The cost of such training or education shall be the sole responsibility of the Offeror The Offeror shall utilize reasonable work schedules and shift assignments that allow personnel to work no more than thirty-six (36) consecutive hours followed by a minimum of twelve (12) hours off duty. The Offeror shall utilize management practices that ensure that field personnel working extended shifts, part-time jobs, and voluntary or mandatory overtime are not exhausted to an extent that might impair judgment or motor skills. 34

35 The Offeror shall provide working conditions that assist in attracting and retaining highly qualified personnel. The Offeror shall offer its employees a compensation and benefits package designed to attract and retain highly qualified field personnel and clerical personnel. Salary and benefits should be comparable to the same positions in the industry and surrounding counties. Please provide a representative compensation and benefits package with your proposal All Contract personnel shall be trained and receive certification as current level National Incident Management System (NIMS) compliant The Offeror shall have in place a third party independent testing program for random drug screening of all personnel providing response under the Contract. Further, the Offeror will transport to a facility for testing any employee suspected to be using or under the influence of drugs or alcohol or other intoxicant, or have an agent of a testing facility come to the location of the employee to obtain a necessary sample. Any employee suspected of being under the influence of any drug or intoxicating substance will be immediately relieved of duty until there is clinical proof to the contrary The Offeror shall have a Standard Operations Manual (SOP) that describes how complaints regarding level of care, response or employee action or inaction are handled. This SOP will be given to the EMS Administrators or their designees at the beginning of the Contract. Likewise, any updates must be given the EMS Administrators or their designees immediately upon being implemented Complaints from the EMS Administrators or their designees directed at level of care, response or employee action or inaction shall be answered within forty-eight (48) hours to include actions taken (i.e. disciplinary action and other corrective measures) It shall be of the utmost importance that employees of the Offeror strive to gain proficient knowledge of the streets and highways in the coverage areas in order to choose the quickest, most direct route to the scene of an emergency The Offeror shall provide a mechanism or approved method for monitoring driver performance for all ambulances providing service under the Contract. The Entities are to be provided with 35

36 reports on driver performance as requested by the EMS Administrators or their designees and the QRC The Offeror shall have staff available and a toll free phone number capable of discussing and resolving billing questions QUALITY IMPROVEMENT & MITIGATION PROGRAMS: The Offeror shall develop and have in place a comprehensive quality improvement program for the EMS System and provide a copy of such program and implementation to the EMS Administrators or their designees prior to commencement of the Contract. Likewise, any updates must be given the EMS Administrators or their designees immediately upon being implemented. This should also address a weather mitigation plan to maximize response times and decrease injuries when threatening weather is approaching FIRST RESPONDERS The Fire Departments have first responder programs in place. The Offeror shall cooperate and coordinate its activities and services with the first responder s services, the primary goal being to enhance patient care through mutual cooperation The first certified registered responding agency on the scene shall have primary responsibility for patient care until such time as care is turned over to the Offeror. The highest ranking Fire Department officer on the scene shall have scene control as Incident Commander. Therefore, at the emergency scene, the FD Incident Commander shall be in charge of the Offeror s personnel Additionally, the first certified registered responding agency on the scene shall have the following privileges: The ability to disregard the other responding agency via radio prior to their arrival to the scene of the emergency. The ability to request air ambulance(s) prior to the arrival of the other agency The ability to request additional ground ambulances from the Offeror The ability to request a ground ambulance from another area fire department with which a mutual aid agreement is in place The Offeror shall provide an exchange of disposable medical supplies used by the Fire Department at no charge on a 1:1 basis 36

37 either at the scene or after the incident via the County Supervisor within twenty-four (24) hours of the incidents The Offeror shall be responsible for providing first responder education upon the request of the EMS Administrators or their designees for each FRO OVERVIEW OF THE ENTITIES AND EMS STATISTICS The new Contract will be for 911 emergency services with fully staffed and equipped Paramedic units for the area described in this RFP Population: See Appendix B Call History: See Appendix B PERFORMANCE BASED CONTRACT: This procurement is intended to result in the award of a Performance Based Contract. Penalties will be assessed for failures to achieve minimum standards set forth in the Contract. This procurement requires the highest levels of performance and reliability and the mere demonstration of effort, even diligent and well intentioned effort, shall not substitute for performance results. Specifically: Ambulance response times shall meet the response requirements set forth in the RFP The Offeror will be responsible for dispatch of ambulances under this Contract Every ambulance unit shall at all times be equipped and staffed to operate at the Paramedic level on all calls received under the Contract Clinical performance shall be consistent with approved medical standards and guidelines set forth by the State of Texas (refer to Appendix A for Performance Measures) The conduct of personnel shall be professional and courteous at all times There shall be an unrelenting effort to detect and correct performance deficiencies and to continuously upgrade the performance and reliability of the entire EMS System. 37

38 Clinical and response time performance shall be extremely reliable, with equipment failure and human error held to an absolute minimum through constant attention to performance, protocol, procedure, performance auditing, and prompt and definitive correction action as set forth herein This is not a level of effort Contract. Because human lives and not merely inconvenience or money are at stake, an Offeror who fails to perform shall be promptly replaced. In accepting an Offeror s offer, the Entities neither accept nor reject the Offeror s level of effort estimates. Rather, the Entities accept the Offeror s promise to employ whatever level of effort is necessary to achieve the clinical, response time, and other performance standards required by the terms of the Contract Penalties for Failure to Comply with Contract Requirements Other Than Response Time Requirements In the event Offerer fails to comply with any of the terms of the Contract, the Offerer may be issued a written warning describing such failure Should Offerer s noncompliance continue after receipt of such warning, an Entity may deduct penalties from any subsidy, or assess a penalty that is payable within sixty (60) days of notification, in the amount of One Hundred Dollars ($100) for each day the Offerer remains in noncompliance following receipt of the written warning Should the noncompliance continue for more than five (5) consecutive days, an Entity may increase penalties to Two Hundred Fifty Dollars ($250) for each additional day the Offerer remains noncompliant The Offerer may appeal the decision to assess penalties to the QRC in writing within ten (10) days of notification of assessment Penalties may be withheld from any subsidy or invoiced to the Offerer as an assessment. Assessments must be paid within ten (10) days of final determination. 38

39 Provisions for Default and Early Termination Determination of default shall be the responsibility of the QRC The Offeror shall be notified in writing if a default condition exists The Offeror shall provide the QRC a written plan for correcting the default within ten (10) days of notification of the default The Offeror shall be given sixty (60) days to correct the default Failure to correct the default condition shall be considered a breach of Contract subject to early termination of the Contract Default conditions include, but are not limited to, the following: Failure to operate the system in a manner consistent with Federal, State and Local laws, rules and regulations. Intentionally supplying misleading information with regard to records, documents, dates or time kept for the purpose of determining Offerer s performance under the terms of the Contract. Upon detection of accidental or unintentional error, the Offerer shall notify the Entity(ies) immediately. Failure of the Offerer, its employees, its agents, or its representatives to conduct themselves in a professional and courteous manner and including professional appearance. Failure of the Offerer to provide to Entities data generated in the course of operations, including, but not limited to, patient report data, response time data, and financial data as specified in the Contract. 39

40 Failure to substantially and consistently meet or exceed the response time standards and/or the various clinical standards provided for in the Contract. Failure of the Offerer to maintain equipment in accordance with manufacturer or industry maintenance practices as outlined in the Contract. Failure to furnish key personnel of quality and experience. Failure to submit scheduled or ad hoc reports, or other information. Making an assignment for the benefit of creditors; filing a petition for bankruptcy; being adjudicated insolvent or bankrupt; petitioning by custodian, receiver or trustee for a substantial part of its property; or commencing any proceeding relating to it under the bankruptcy, reorganization arrangements, readjustment of debt, dissolution or liquidation law or statute. Failure of the Offerer to maintain insurance requirements or provide timely notification of policy changes. Any other failure of performance required in the Contract which is determined to constitute an endangerment to public health and safety, or not be in the best interest of the Entities. Failure of the Offerer to pay penalties within the requirements of the RFP. Failure to maintain any type of license, permit, or certification required by law in order to fulfill the requirements of the Contract or in order to avoid fines and penalties imposed by law. Persistent and repeated failures of Offerer to comply with any of the performance 40

41 USE OWN EXPERTISE AND JUDGMENT requirements may be considered a condition of default Offeror is specifically advised to use its own best expertise and professional judgment in deciding upon the methods to be employed to achieve and maintain the high performance required under the Contract. By methods the Entities mean compensation programs, shift schedules, personnel policies, supervisory structures, fluid vehicle deployment techniques, and other internal matters which, taken together, comprise each Offeror s own strategies and tactics for getting the job done The Entities desire to promote innovation, efficiency, and superior levels of high performance The Offeror shall track and report cardiac survivability rates, STEMI and stroke data PERFORMANCE REVIEW The EMS QRC shall conduct a monthly evaluation of the performance of the Offeror for the first six (6) months of the Contract and quarterly evaluations thereafter utilizing criteria the QRC determines to be relevant In addition, the EMS Administrators or their designees may conduct intermittent evaluations as directed by the QRC or at such times specified by the Entities. This will include but not be limited to issues of mere compliance with the terms of the Contract The Offeror s performance should exceed the minimum requirements of the Contract REPORTING: At a minimum, the Offeror shall provide the following reports: Each month, a response time report and a response time exception report shall be submitted to the EMS Administrators or their designees by the close of business on the 10 th of each following month. This report shall include statistical data, but not limited to dispatch time, turn out time, drive time, patient contact to treatment, transport time and total incident time. 41

42 Monthly cardiac survivability rates, STEMI and stroke data Monthly performance statistic reports, to include any clinical performance issues (i.e. IV attempts, IV success rate, etc.) and to include individualized action plans to improve performance when it is lacking Monthly statistics on prioritization of calls, locations, call type, and hospital transport destination Patient payer mix report submitted to the EMS Administrators or their designees each quarter Driver performance reports shall be provided as requested The EMS Administrators or their designees and the QRC shall be given access to create reports as needed. 6.0 PROPOSAL FORMAT: To facilitate the evaluation process, responses will reference the numerical section described in the RFP. Additionally, the following guidelines shall be adhered to: 6.1 EXECUTIVE SUMMARY (PROPOSAL SECTION 1.0) This part of the response to the RFP should be limited to a brief narrative highlighting the Offeror s proposal The summary should contain as little technical jargon as possible and should be oriented toward non-technical personnel This section should not include cost quotations This section should identify the primary contacts for the Offeror The Executive Summary shall also state the number of years the Offeror has provided emergency 911 ambulance services in areas similar to Waxahachie. As previously mentioned, the Offeror shall have a minimum of five (5) years of experience providing 911 emergency ambulance services. Proposals that do not meet this requirement will not be considered. 6.2 SCOPE OF SERVICES (PROPOSAL SECTION 2.0): This section of the proposal shall include a general discussion of the Offeror s understanding of the overall project with a response to each item in Section 5.0 of the RFP. 42

43 6.3 COMPANY BACKGROUND (PROPOSAL SECTION 3.0): While the Selection Committee, at its option, may require an Offeror to provide additional support and/or clarity of requested information, the Offeror shall provide the following minimum information about its company so that the Selection Committee can evaluate the corporate stability and Offeror s ability to support the commitments set forth in response to the RFP: Amount of time the company has been in business A brief description of the company size and organizational structure Most recent audited financial statements List of current public sector customers by name and by state. Texas customers, preferably cities, are to be listed first. The population of area serviced shall also be included Any material (including letters of support or endorsement from clients) indicative of the Offeror s capabilities List of any terminated Contracts. Disclose the jurisdiction and explain the termination List of all resolved or ongoing litigation of the Offeror s organizations within the past five (5) years. This list shall include litigation brought against the Offeror s organization or affiliated organization and any litigation initiated by the Offeror s organization or affiliated organization against any governmental or competing ambulance service within the last five (5) years. Offeror must provide documentation that it has resolved all issues arising from litigation or describe status of open litigation Is your firm nationally accredited? If yes, please state accreditations. 6.4 IMPLEMENTATION PLAN/STAFFING (PROPOSAL SECTION 4.0): The Offeror shall provide a detailed plan for implementing the proposed Contract which shall include the following information: Detailed methodology and plan for implementing the Contract. The implementation plan shall include the following elements: The estimated implementation timeframe An overview of project phases and major milestones A matrix of proposed roles/responsibilities for Entities staffs and the Offeror. 43

44 All project assumptions The description of the implementation plan shall include the specific components which are included in each phase of the implementation based on the scope of work for the project Organizational chart Resumes and qualifications of the Proposed Operations Manager, Field Supervisors, Medical Director and Company Executives as well as clinical and Quality Assurance Staff. 6.5 CLIENT REFERENCES (PROPOSAL SECTION 5.0) The Entities considers references to be important in its decision to award a Contract. All references provided shall be contacted by the Selection Committee during the selection process Offerors shall provide at least five (5) client references that are similar in size and complexity to this procurement (preferably cities or counties). In addition to contact information, each reference shall include the following: Type and level of service Geographic size of area Population serviced Number of emergency/non-emergency calls Start and end date (if applicable) of the Contract. 6.6 COST PROPOSAL (PROPOSAL SECTION 6.0): The Offeror s cost proposal shall include the following: Cost to each Entity (Subsidy) if any Charges for services to citizens for MICU Based Transport Mileage Rate Billing Methodology (i.e. Soft vs. Hard Billing, Residents vs. Nonresidents, and Transports vs. Non-transports). Statement for charges that says Medicare allowable will be permitted Subscription plan offered (if any). 44

45 6.7 EXCEPTIONS TO THE RFP (PROPOSAL SECTION 7.0) All requested information in this RFP shall be supplied with the proposal The Offeror may take exception to certain requirements in this RFP All exceptions shall be clearly identified in this section and the written explanation shall include the scope of the exceptions, the ramifications of the exceptions for the Entities, and the description of the advantages or disadvantages to the Entities as a result of such exceptions The Entities, at their sole discretion, may reject any exceptions or specifications within the proposal. 45

46 APPENDIX A: Outcome-Centered, Prehospital Emergency Care *Note: minimum compliance of 96% for each requirement of all applicable patients Deteriorating Patient 1. Adult patients receive an early warning score assessment 2. Patients with an early warning score of four (4) or greater transported within ten (10) minutes of MICU arrival with early hospital notification ST-segment elevation myocardial infarction (STEMI) 1. Adult patients with non-traumatic chest pain administered aspirin (if not allergic) 2. Adult patients with non-traumatic chest pain to have 12-lead electrocardiogram (ECG) performed with direct activation of interventional cardiology team 3. Adult patients >35 years old with non-traumatic chest pain treated and transported by EMS who receive a pre-hospital 12 lead ECG 4. Suspected STEMI patients transported to a STEMI Receiving Center with prehospital call received at EMS PSAP to Device (PCI) < ninety (90) minutes Pulmonary Edema 1. Nitroglycerin administered (if no contraindications) 2. Continuous positive airway pressure (CPAP) attempted before endotracheal intubation Asthma 1. Beta-agonist administered Seizure 1. Blood glucose measured 2. Benzodiazepine administered for status epilepticus Trauma 1. Scene time limited to < ten (10) minutes (Excluding entrapped time) 2. Direct transport to trauma center (or transfer to air transport) for patients meeting criteria Cardiac Arrest 1. Cardiac arrests identified by MPDS receive pre-arrival CPR instructions 2. Response interval for CPR and defibrillator < five (5) minutes Stroke 1. Suspected stroke patients receive an evidence-based stroke scale assessment (FAST, Cincinnati, LA Stroke Scale) 2. Suspected stroke patients receive a blood sugar assessment 3. Patients arrive at the designated Stroke Center within three (3) hours of symptom onset 46

47 APPENDIX B Response Time Compliance Entity Urban Response Time Rural Response Time Rural Remote Response Time Ellis County NA < 15:00 Minutes < 20:00 Minutes Ennis < 9:00 Minutes NA NA Red Oak < 9:00 Minutes NA NA Waxahachie < 9:00 Minutes NA NA Entity Radio System Types Entity Primary Other Ellis County VHF Analog VHF Analog Ennis VHF Red Oak VHF Analog VHF Digital, 400 UHF Waxahachie 800 mhz VHF Population Entity Population Ellis County 155,976 Ennis 19,500 Red Oak 13,000 Waxahachie 32,000 Run Data Year EMS Transports 911 EMS Transports Entity Calls Calls Ellis County 1034 Unknown 1449 Unknown Ennis 2,660 2,155 2,882 2,282 Red Oak 1,348 1,186 1, Waxahachie 3,746 2,659 (70.9%) 4,076 2,935 (72%) 47

48 APPENDIX C 48

49 APPENDIX D 49

50 ELLIS COUNTY MAP 50

51 SIGNATURE FORM ELLIS COUNTY TEXAS DELIVERY WILL BE F.O.B. INSIDE DELIVERY AT THE ELLIS COUNTY DESIGNATED LOCATION AND ALL TRANSPORTATION CHARGES PAID BY THE SUPPLIER TO DESTINATION. DELIVERY TO BE SPECIFIED IN CALENDAR DAYS FROM DATE OF ORDER. WE DO NOT TAKE EXCEPTION TO THE BID SPECIFICATIONS. WE TAKE EXCEPTION TO THE BID SPECIFICATIONS (EXPLAIN): Click here to enter text. COMPANY INFORMATION / PROFILE / REFERENCE Preferential Requirement: The Entities, as governmental agencies of the State of Texas, may not award a Contract to a nonresident bidder unless the nonresident's bid is lower than the lowest bid submitted by a responsible Texas resident bidder by the same amount that a Texas resident bidder would be required to underbid a nonresident bidder to obtain a comparable Contract in the state in which the nonresident's principal place of business is located (Government Code, Title 10, V.T.C.A., Chapter 2252, Subchapter A). Bidder shall make answer to the following questions by selecting the appropriate radio button or inserting information in the box provided: Is your principal place of business in the State of Texas? Yes No If the answer to question is yes, no further information is necessary; if no, please indicate in which state your principal place of business is located: Click here to enter text. If that state favors resident bidders (bidders in your state) by some dollar increment or percentage: Yes No If yes, what is that dollar increment or percentage? Click here to enter text. Company Profile: Is your firm? Sole Proprietorship Yes No General Partnership Yes No Limited Partnership Yes No Corporation Yes No Other Click here to enter text. Yes No List Legal Names in Company: Click here to enter text. List at least three (3) companies or governmental agencies where these same/like products/services, as stated herein, have been provided. Include company name address, contact name and telephone number. 1. Click here to enter text. 2. Click here to enter text. 3. Click here to enter text. 51

52 AS PERMITTED UNDER TITLE 8, CHAPTER 271, SUBCHAPTER F, SECTION AND V.T.C.A. AND TITLE 7, CHAPTER 791, SUBCHAPTER C, SECTION , V.T.C.A., OTHER LOCAL GOVERNMENTAL ENTITIES MAY WISH TO ALSO PARTICIPATE UNDER THE SAME TERMS AND CONDITIONS CONTAINED IN THIS CONTRACT. EACH ENTITY WISHING TO PARTICIPATE MUST ENTER INTO AN INTERLOCAL AGREEMENT WITH THE ENTITIES AND HAVE PRIOR AUTHORIZATION FROM VENDOR. IF SUCH PARTICIPATION IS AUTHORIZED, ALL PURCHASE ORDERS WILL BE ISSUED DIRECTLY FROM AND SHIPPED DIRECTLY TO THE LOCAL GOVERNMENTAL ENTITY REQUIRING SUPPLIES/SERVICES. THE ENTITIES SHALL NOT BE HELD RESPONSIBLE FOR ANY ORDERS PLACED, DELIVERIES MADE OR PAYMENT FOR SUPPLIES/SERVICES ORDERED BY THESE ENTITIES. EACH ENTITY RESERVES THE RIGHT TO DETERMINE THEIR PARTICIPATION IN THIS CONTRACT. WOULD BIDDER BE WILLING TO ALLOW OTHER LOCAL GOVERNMENTAL ENTITIES TO PARTICIPATE IN THIS CONTRACT, IF AWARDED, UNDER THE SAME TERMS AND CONDITIONS? Yes No By signing and submitting this Bid/Proposal, Bidder/Offeror acknowledges, understands the specifications, any and all addenda, and agrees to the bid/proposal terms and conditions and can provide the minimum requirements stated herein. Bidder/Offeror acknowledges they have read the document in its entirety, visited the site, performed investigations and verifications as deemed necessary, is familiar with local conditions under which work is to be performed and will be responsible for any and all errors in Bid/Proposal submittal resulting from Bidder/Offeror s failure to do so. Bidder/Offeror acknowledges the prices submitted in this Bid/Proposal have been carefully reviewed and are submitted as correct and final. If Bid/Proposal is accepted, Vendor further certifies and agrees to furnish any and all products/services upon which prices are extended at the price submitted, and upon conditions in the specifications of the Invitation for Bid/Request for Proposal. THE UNDERSIGNED HEREBY CERTIFIES THE FOREGOING BID/PROPOSAL SUBMITTED BY THE COMPANY LISTED BELOW HEREINAFTER CALLED BIDDER/OFFEROR IS THE DULY AUT H O RI ZED AGE N T OF SAID CO MP ANY AND THE P ERS ON S IGNI N G SAID BID/PROPOSAL HAS BEEN DULY AUTHORIZED TO EXECUTE SAME. BIDDER/OFFEROR AFFIRMS THAT THEY ARE DULY AUTHORIZED TO EXECUTE THIS CONTRACT; THIS COMPANY; CORPORATION, FIRM, PARTNERSHIP OR INDIVIDUAL HAS NOT PREPARED THIS BID/PROPOSAL IN COLLUSION WITH ANY OTHER BIDDER/OFFEROR OR OTHER PERSON OR PERSONS ENGAGED IN THE SAME LINE OF BUSINESS; AND THAT THE CONTENTS OF THIS BID/PROPOSAL AS TO PRICES, TERMS AND CONDITIONS OF SAID BID/PROPOSAL HAVE NOT BEEN COMMUNICATED BY THE UNDERSIGNED NOR BY ANY EMPLOYEE OR AGENT TO ANY OTHER PERSON ENGAGED IN THIS TYPE OF BUSINESS PRIOR TO THE OFFICIAL OPENING OF THIS BID/PROPOSAL. Company Name: Click here to enter text. Phone of Principal Place of Business: Click here to enter text. Fax of Principal Place of Business: Click here to enter text. Address of Representative: Click here to enter text. Federal Identification Number: Click here to enter text. Date: Click here to enter text. Acknowledgement of Addenda: #1 #2 #3 #4 #5 #6 Authorized Representative Name: Click here to enter text. Authorized Representative Title: Click here to enter text. Signature (required): This Form Must be SIGNED. The original with original signature and ten (10) copies must be returned with proposal. 52

53 CONFLICT OF INTEREST QUESTIONNAIRE For Vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80 th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a person who has a business relationship as defined by Section (1-a) with a local governmental entity and the person meets requirements under Section (a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7 th business day after the date the person becomes aware of facts that require the statement to be filed. See Section , Local Government Code. A person commits an offense if the person knowingly violates Section , Local Government Code. An offense under this section is a Class C misdemeanor. 1 Name of person who has a business relationship with local governmental entity. Click here to enter text. FORM CIQ OFFICE USE ONLY Date Received 2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7 th business day after the date of the originally filed questionnaire becomes incomplete or inaccurate.) 3 Name of local government officer with whom filer has employment or business relationship. _Click here to enter text. Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Secction (1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer or the questionnaire? Yes No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? Yes No C. Is the filer of this quionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? Yes No D. Describe each employemnet or business relationship with the local government officer named in this section. Click here to enter text. 4 53

54 Signature of person doing business with the governmental entity Date CERTIFICATION OF ELIGIBILITY (This provision applies if the anticipated contract exceeds $25,000) By submitting a Proposal in response to this solicitation, the Offeror certifies that at the time of submission, he/she is NOT on the State of Texas or the Federal Government s list of suspended, ineligible, or debarred proposers. In the event of placement on the list between the time of Proposal submission and time of aware, the Offeror will notify the Ellis County Purchasing Agent. Failure to do so may result in terminating this contract for default. Authorized Signature 54

55 STATEMENT OF NO BID If you do not intend to bid, please return this form immediately to: Ellis County Purchasing 101 West Main Street, Suite 203 Waxahachie, TX We, the undersigned, have declined to big on Bid/Proposed # Reason: Specification too tight, geared toward one brand or manufacturer (explain) Insufficient time to respond Specifications unclear (explain) We do not offer this product or an equivalent Our product schedule does not permit us to perform Unable to meet specifications Unable to meet bond requirements Remarks: We understand if this statement of No Bid is not executed and returned, our name may be deleted from the list of qualified bidders. Company Name: Address: City/State/Zip: Phone: Signature: 55

56 RESIDENCE CERTIFICATION Pursuant to Texas Government Code et seq., as amended, Entity requires a Residence Certification. Section et seq. of the Texas Government Code provides some restrictions on the awarding of governmental contracts; pertinent provisions of are stated below: (3) Nonresident bidder refers to a person who is not a resident. (4) Resident bidder refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. I certify that is a Resident Bidder of Texas as defined in Texas Government Code I certify that is a Nonresident Bidder of Texas as defined in Texas Government Code and our principal place of business is (City and State). Signature 56

57 AFFIDAVIT OF COMPLIANCE I, the undersigned, declare and affirm that my company is in compliance with the Immigration and Reform Act of 1986 and all employees are legally eligible to work in the United States of America. I further understand and acknowledge that any non-compliance with the Immigration and Reform Act of 1986 at any time during the term of this Contract will render the Contract voidable. Name of Company: Click here to enter text. Title of Officer: Click here to enter text. Name of Officer: Click here to enter text. Date: Click here to enter a date. 57

58 Dear Vendor: In order for the Entities to comply with Internal Revenue Service Guidelines, we are required to keep a W-9 on file for each Vendor to whom we have remitted payment(s). Please complete the attached W-9 form. Thank you. 58

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