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HomeMy WebLinkAboutAGMT - OCFA and CARE Ambulance • ,10 4% itil) T'. dti,„fogyck w ie ORANGE COUNTY FIRE AUTHORITY AGREEMENT BETWEEN ORANGE COUNTY FIRE AUTHORITY • AND CARE AMBULANCE SERVICE, INC. FOR PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES WITHIN EXCLUSIVE OPERATING AREA NO. 21 (SEAL BEACH) • • AGREEMENT FOR PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES WITHIN EXCLUSIVE OPERATING AREA Exclusive Operating Area (EOA) Name: Seal Beach EOA No.: 21 Contractor: Care Ambulance Service, Inc. City: Orange Effective Date: August 31, 2009 Awarding Agency: OCFA TABLE OF CONTENTS RECITALS 1 AGREEMENT 3 • 1.0 SCOPE OF SERVICES 3 2.0 CONSIDERATION 3 3.0 CONTRACT DOCUMENTS 4 4.0 MODIFICATION AND AMENDMENTS 4 5.0 CONTRACT ADMINISTRATION 4 6.0 EFFECTIVE DATE 4 7.0 TERM 4 8.0 TERMINATION 5 9.0 INSURANCE 5 10.0 ASSIGNMENT 7 11.0 AUDITS AND INSPECTIONS 7 11.1 Business Office 7 • 11.2 Facilities/Vehicles 8 i 643201 2 • 12.0 COOPERATION 8 13.0 INDEPENDENT CONTRACTOR 8 14.0 INDEMNIFICATION 8 14.1 General 8 14.2 Rates 8 15.0 COMPLIANCE WITH LAWS 9 16.0 RISK 9 17.0 RESPONSIBILITY 9 18.0 ACTS OR OMISSIONS OF REPRESENTATIVES 9 19.0 INSOLVENCY 9 20.0 OPERATIONAL STANDARDS, PROCEDURES, & PERFORMANCE REQUIREMENTS 10 20.1 Service Hours 10 • 20.1.1 Service 10 20.1.2 Field Supervisor 10 20.2 Response Times 10 20.2.1 Response Time Reporting 10 20.2.2 Quarterly Response Time Report - Format 11 20.2.3 Exemptions to Response Time Requirements 12 20.2.4 Procedures to Request Response Time Exemption 13 20.2.5 Use of Alternative Methods to Meet Response Time Requirements 13 20.2.6 Disciplinary Actions for Failure to Meet Response Time Requirements / Performance Deficiency 13 20.3 Emergency On -Scene Procedures 15 20.4 Disaster Assistance 16 • 20.5 Standard of Performance 16 ii 643201.2 • 20.6 General Provisions 17 20.6.1 Return of OCFA Personnel 17 20.6.2 911 Calls for Service/Referral 17 20.6.3 Performance 17 20.6.4 Conflict of Interest 18 20.6.5 Complaints 18 20.6.6 Traffic Signal Preemption 18 20.6.7 HIPAA Compliance Plan. 18 20.6.8 Medicare/Medi -Cal Participation 19 20.7 External Medical Quality Control 19 21.0 PERSONNEL 20 21.1 Personnel Requirements 20 21.1.1 Employee Performance 20 21.1.2 Employee Drug Program 20 • 21.1.3 DMV Employer Pull Notice Program 21 21.1.4 Criminal Background Checks 21 21.1.5 Uniforms and Decorum 21 21.1.6 Cooperation 21 21.1.7 Employee Ineligibility 22 21.1.8 Compliance with Laws 22 21.1.9 Licensing/Identification 22 21.1.10 Joint Training Exercies 22 21.1.11 Employee Training Records 22 21.1.12 Professionalism 22 21.1.13 Management Oversight . 22 21.1.14 Employee Removal 23 21.2 Independent Contractor 23 • 22.0 RATES FOR AMBULANCE SERVICE 23 iii 643201.2 • 22.1 BLS and ALS Service Rates 23 22.1.1 Maximum BLS Service Rate 23 22.1.2 Maximum ALS Service Rate 23 22.1.3 ALS Reimbursement Rate 24 22.1.4 Medical Supply Reimbursement Rate 25 22.1.5 Zero Pay Patients 25 22.1.6 Risk of Non - Payment 25 22.1.7 Medicare Patients 25 22.2 Billing, Audit and Access to Records 26 22.2.1 Billing System 26 22.2.2 Accounting 26 22.2.3 Responsibility for Submission of Claims 26 22.2.4 Medicare Audits 27 22.3 Contractor Monthly Payment 27 • 22.3.1 Monthly Payments to OCFA 27 22.3.2 Zero Pay Patient Exemption Requests 28 22.3.3 Monthly Payment Report 28 22.3.4 Audit Report 29 22.4 Changed Circumstances 29 23.0 BREACH OF CONTRACT 29 23.1 Breach of Contract 29 24.0 PUBLIC SAFEGUARDS AND EMERGENCY TAKEOVER 29 25.0 CONTRACTOR'S RELIEF UPON TERMINATION 30 26.0 HOLDOVER PROVISION 30 27.0 SUCCESSORS 31 28.0 INTEGRATION 31 • 29.0 NO WAIVER 31 iv 643201 2 • 30.0 THIRD PARTY BENEFICIARIES 31 31.0 EXECUTION OF AGREEMENT 31 32.0 NOTICES 32 33.0 SEVERABILITY 32 34.0 EOA BOUNDARY CHANGE 32 35.0 AMENDMENT 33 36.0 VENUE 33 SIGNATURE PAGE 33 • 410 v 643201.2 • EXHIBITS EXHIBIT "A" DEPICTION OF SUBJECT EOA EXHIBIT "B" OCFA 2008 FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES REQUEST FOR PROPOSALS (RFP NO. JR1494) EXHIBIT "C" CONTRACTOR'S SIGNED, ORIGINAL BID PROPOSAL SUBMITTED FOR OCFA RFP NO. JR1494, DATED December 10, 2008. EXHIBIT "D" SAMPLE QUARTERLY RESPONSE TIME REPORT • 111 643201 2 • AGREEMENT BETWEEN THE ORANGE COUNTY FIRE AUTHORITY AND CARE AMBULANCE SERVICE, INC. FOR PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES WITHIN EXCLUSIVE OPERATING AREA No. 21 THIS AGREEMENT FOR THE PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES (the "Agreement ") is made and entered into this day of , 2009, by and between the ORANGE COUNTY FIRE AUTHORITY /SEAL BEACH, a Joint Powers Agency ( "JPA ") organized pursuant to the provisions of Article 1, Chapter 5, Division 7, Title 1 (commencing with Section 6500) of the California Government Code, hereinafter referred to as "OCFA," and • CARE AMBULANCE SERVICE, INC., a California corporation, hereinafter referred to as "Contractor." OCFA and Contractor may be referred to collectively herein as the "parties." RECITALS 1. The Orange County Fire Authority ( "OCFA ") is a governmental entity providing fire and life safety services to over one million residents within the County of Orange, California. OCFA is a Joint Powers Agency ( "JPA ") organized pursuant to the provisions of Article 1, Chapter 5, Division 7, Title I (commencing with Section 6500) of the California Government Code. OCFA consists of twenty -two (22) member cities and the County of Orange. Each OCFA JPA member agency individually has the statutory ability to provide fire suppression, protection, prevention and related and incidental services, including emergency ambulance response services, within their respective jurisdictions. 2. By entering into a Joint Powers Agreement, each JPA member agency vested OCFA with the power to exercise each member agency's legal ability to provide fire suppression, protection, prevention and related and incidental services, including emergency medical and transportation services, and other fire related services authorized by law within their respective jurisdictional boundaries. Each OCFA JPA member agency has elected to jointly exercise their powers to provide for such services through the formation of OCFA. • 1 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 3. The State Legislature has enacted the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act ( "EMS Act "), which creates a comprehensive statutory system governing virtually every aspect of prehospital emergency medical services. The purpose of enacting the EMS Act was to achieve state -wide coordination and integration of prehospital emergency medical services. 4. The EMS Act accomplishes this integration through what is essentially a two - tiered system of regulation. At the state level, the Emergency Medical Services Authority ( "EMS Authority ") performs a number of different functions relating to the coordination of EMS throughout the state. The second tier of governance under the EMS Act is occupied by counties and their local EMS agency ( "LEMSA "). The EMS Act authorizes each county's LEMSA to develop an emergency services program. Each county developing such a program is required to designate the county health department as the local EMS agency. In Orange County, this function is performed by the Orange County EMS agency, a division of the County Health Care Agency ( "OCEMS "). All Orange County providers of prehospital emergency medical services are required to operate within the local EMS system developed by OCEMS. 5. The Orange County Board of Supervisors designated OCEMS as the LEMSA for purposes of administering the local EMS Plan within the County. The County, however, does not regulate ambulance transport services within cities. Rather, the County allows cities to administer their EMS /ambulance programs in coordination and cooperation with the local EMS Plan and OCEMS. In 1985, the County of Orange adopted County model ambulance ordinance • no. 3517, which is a mechanism for licensure of emergency medical transport services and for establishing transport service areas. The County adopted Ordinance No. 3517 ( "model Ambulance Ordinance ") with the intention that it serve as a model city ambulance ordinance for adoption by cities within Orange County. Under this approach, the County's EMS Plan allows cities to provide ambulance transport services in accordance with the model Ambulance Ordinance. OCFA administers the ambulance programs. 6. Health and Safety Code §1797.224 authorizes OCEMS to create exclusive operating areas in the development of its local EMS Plan. The creation of exclusive operating areas is authorized by state law, provided a competitive process is utilized to select service providers pursuant to the local EMS Plan. In Orange County, the competitive process for the selection of ambulance providers within established OCFA exclusive operating areas is administered by OCFA. The competitive process is, however, subject to review and approval by OCEMS. Through input and recommendation of OCFA, exclusive ambulance service areas have been approved and created by OCEMS for all OCFA jurisdictional areas. Only to the extent that OCEMS designates an exclusive operating area, as defined by the EMS Act, consents to the current model Ambulance Ordinance structure, and approves of the competitive process utilized may such services be provided by cities. OCFA and/or its member agencies award ambulance service contracts by acting under the authority of OCEMS and its state approved EMS Plan. 7. The current exclusive operating area contracts for all OCFA jurisdictional areas are set to expire on August 31, 2009. Currently, there are nineteen (19) exclusive operating areas • 2 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • within the OCFA jurisdictional area. Exclusive Operating Area No. 21 (Seal Beach) is more particularly described and depicted in Exhibit "A," which is attached hereto and incorporated herein by reference (hereinafter referred to as the "Subject EOA "). 8. OCFA desires to designate Contractor and Contractor desires to be designated by OCFA, as an independent contractor, for purposes of providing exclusive 911 - Fire/EMS Emergency Ambulance Transportation and Related Services within the Subject EOA as of September 1, 2009, pursuant to the terms and conditions set forth in this Agreement. 9. For reference, the Orange County Fire Authority shall hereinafter be referred to as "OCFA." Care Ambulance Service, Inc., which has been selected to provide services within the Subject EOA pursuant to the OCFA 2008 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals (RFP No. JR1494) shall hereinafter be referred to as the "Contractor." The City of Seal Beach shall hereinafter be referred to as the "City." The County of Orange shall hereinafter be referred to as the "County." NOW, THEREFORE, for valuable consideration, receipt of which is hereby acknowledged, and in consideration of the foregoing recitals, which are hereby incorporated by reference into the Agreement below, and the mutual promises, covenants, and conditions contained herein, the parties hereto agree as follows: AGREEMENT • 1.0 SCOPE OF SERVICES 1.1 Contractor shall provide exclusive 911- Fire/EMS Emergency Ambulance Transportation and Related Services within the Subject EOA in accordance with the terms and conditions set forth in this Agreement and shall serve at all times as the "Primary Responder" within the Subject EOA. The term "Primary Responder" shall mean the ambulance service operator that is assigned and dispatched first by the OCFA Emergency Communications Center to respond to all calls for emergency medical transportation service within the Subject EOA throughout the term of this Agreement. 1.2 Contractor is hereby assigned and designated as the authorized, exclusive Primary Provider for all 911- Fire/EMS emergency ambulance transportation calls for service within the Subject EOA. OCFA, in cooperation with Contractor, shall provide on -scene Advanced Life Support ( "ALS ") services, and Contractor shall provide Basic Life Support ( "BLS ") services and transport patients to medical facilities, when required. The terms Advanced Life Support and Basic Life Support shall mean the same as defined in the EMS Act. 2.0 CONSIDERATION 2.1 In consideration of Contractor's agreement to be designated and to provide and perform the services described herein, OCFA agrees that throughout the term of this Agreement, • 3 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • Contractor shall have the sole and exclusive right to provide all 911 - Fire/EMS Emergency Ambulance Transportation and Related Services as the Primary Provider within the Subject EOA, subject to the terms and conditions contained herein. 3.0 CONTRACT DOCUMENTS 3.1 The Agreement between the parties hereto shall consist of the following: (1) this 34 page document, (plus exhibits hereto); (2) the OCFA 2008 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals (RFP No. JR1494) ( "RFP "); and (3) Contractor's signed original bid proposal for RFP No. JR1494 submitted to OCFA, including the Prequalification documents submitted by Bidder for this EOA ( "Bid Proposal"), which shall all be referred to collectively hereinafter as the "Agreement" or the "Contract Documents." The RFP and the Contractor's signed Bid Proposal, which are both attached hereto as Exhibits "B" and "C" respectively are hereby incorporated by reference and are made part of this Agreement. All provisions of the RFP and the Bid Proposal shall be binding on the parties. Should any inconsistency or ambiguity occur or exist in the Contract Documents, the provisions of this document, then the provisions of the RFP, then the provisions of the Bid Proposal shall control. 4.0 MODIFICATION AND AMENDMENTS 4.1 The parties may adjust the specific terms of the Contract Documents where the modification or amendment is not a material change to the contract, as agreed upon by the parties. Any modification or amendment proposed by the Contractor must be submitted in • writing to OCFA for consideration. The decision to modify or amend any term or condition of the Contract Documents shall be at the sole discretion of OCFA. Any agreed upon modification or amendment must be in writing, approved by the OCFA Fire Chief, and signed by all parties, and may be subject to approval by OCEMS and the State EMS Authority. 5.0 CONTRACT ADMINISTRATION 5.1 This Agreement shall be administered and enforced by the OCFA Fire Chief, or his designee(s). 6.0 EFFECTIVE DATE 6.1 The effective date of this Agreement shall be 12:00 a.m., Tuesday, September 1, 2009, ( "Effective Date ") at which time Contractor shall assume full responsibility for the provision of all 911 - Fire/EMS emergency ambulance transportation services within the Subject EOA. The Effective Date may, however, be postponed at the sole discretion of the OCFA Fire Chief in order to protect public health and safety in the event Contractor is for any reason unable to commence performance at that time. 7.0 TERM • 4 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 7.1 The term of this Agreement is for a five (5) year period, ending on August 31, 2014 with no extensions, unless there are unavoidable or unforeseeable circumstances beyond the control of OCFA that would preclude a new RFP process and contract award. In such circumstances, the contract may be extended up to one additional year. 8.0 TERMINATION 8.1 Either party may terminate this Agreement (1) immediately, upon the breach of this Agreement by the other party or (2) upon 180 days written notice given at the sole discretion of either party regardless of the existence, or non - existence, of any breach of this Agreement by the other party. 8.2 In the event of termination, Contractor may be compensated by responsible parties for those services that have been fully and adequately completed, rendered, and accepted as of the date of termination. Contractor shall provide documentation deemed adequate by OCFA to show the services actually completed and rendered by Contractor prior to the effective date of the termination. 8.3 In the event this Agreement is terminated, in whole or in part, as provided by this Section, OCFA or City may procure, upon such terms and in such manner as it deems appropriate, services similar to those terminated. • 8.4 The rights and remedies of the parties provided in this Section are in addition to any other rights and remedies provided by law or under this Agreement. 8.5 In order to protect public health and safety, Contractor hereby agrees to fully cooperate with and to immediately assist OCFA and the City to effectuate a prompt and orderly takeover of 911 - Fire/EMS emergency ambulance service within the Subject EOA upon termination of this Agreement, so as to ensure that there will be no service interruption to the public. 9.0 INSURANCE 9.1 Prior to the Effective Date, Contractor shall, at its sole cost and expense, purchase and maintain throughout the term of this Agreement, the following insurance policies: 9.1.1 Commercial General Liability Insurance (Bodily Injury and Property Damage): with a limit not less than $3,000,000 combined single limit, per occurrence; $5,000,000 annual aggregate. 9.1.2 Business Automobile Liability Insurance: with a limit not less than $3,000,000 combined single limit, per occurrence; $5,000,000 annual aggregate. • 5 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 9.1.3 Ambulance Medical Malpractice Insurance: with a limit of not less than $3,000,000 per occurrence; $5,000,000 annual aggregate. If the Ambulance Medical Malpractice policy is written as a "claims made" policy, the retro date shall be prior to the first day of service under this Agreement. Furthermore, Contractor shall maintain such coverage, including coverage for "prior acts," for three (3) consecutive years following termination of this Agreement, and thereafter, submit annual evidence of continued coverage. Additionally, Contractor shall provide certified copies of the claims reporting requirements contained within any policy secured to meet this requirement. 9.1.4 Workers' Compensation and Employers' Liability Insurance: meeting statutory limits. Such insurance shall contain a waiver -of- subrogation clause in favor of OCFA, the City, and the County, their officers, elected officials, agents, volunteers, and employees. 9.2 All insurance required pursuant to this Section shall be issued by a company authorized by the Insurance Department of the State of California and rated A -, VII or better by the latest edition of Best's Key Rating Guide, except that OCFA will accept workers' compensation insurance rated B, VII or better or from the State Compensation Fund. The workers' compensation insurance company shall agree to waive all rights of subrogation against OCFA, the City, and the County for losses paid under the terms of the policy, which arose from the work performed by the named insured. 9.3 All insurance policies, except Workers' Compensation and Employers' Liability • and Professional Liability, shall contain the following clauses: 9.3.1 "The City, the County, and OCFA are added as additional insureds as respects operations to the named insured performed under contract with the City or OCFA. Such policies shall be primary, and any other policies maintained by or providing protection for the City, the County, or OCFA shall be excess or secondary, but noncontributing." 9.3.2 "This insurance shall not be canceled, limited, or allowed to lapse until after thirty (30) days written notice has been give to the City, the County, and OCFA." 9.4 Upon execution of this Agreement, Contractor shall provide to OCFA, and to the satisfaction of OCFA, certificates of insurance and endorsements evidencing the policies fulfilling the requirements of this Section. If self - insured for workers' compensation, Contractor shall submit to OCFA a copy of its certification of self - insurance issued by the Department of Industrial Relations. 9,5 If Contractor does not keep all of the insurance policies required by this Section in full force and effect at all times during the term of this Agreement, OCFA may elect to treat the failure to maintain the requisite insurance as a breach of contract, which may result in immediate termination of the Agreement. • 6 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 9.6 At any time during the term of this Agreement, if OCFA reasonably determines, a t its sole discretion, that the amounts of insurance held by Contractor pursuant to this Section are no longer sufficient, or that additional types of coverage are needed, Contractor shall modify the existing coverage or obtain additional policies, as OCFA shall reasonably determine. All new policies shall be on the terms and conditions contained herein. 9.7 Contractor shall annually, within ten (10) days of the anniversary of the Effective Date of this Agreement, provide to OCFA evidence that all insurance required pursuant to this Section continues to be in full force and effect. 10.0 ASSIGNMENT 10.1 Except as provided herein, Contractor shall not delegate or assign its rights or otherwise transfer its obligations, in whole or in part, under this Agreement to any other person or entity without the prior written consent of OCFA. Any such assignment without the prior written consent of OCFA shall be void and the attempted assignment may constitute a breach of contract. 10.2 The following shall be considered to be a "transfer" for purposes of this Section: 10.2.1 Any change in the business structure, including but not limited to, changes from or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; • 10.2.2 Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 10.2.3 A transfer by any shareholder of greater than ten percent (10 %) of the stock issued as of the Effective Date by Contractor, or a sale or transfer of over twenty -five percent (25 %) of the assets of Contractor. In the event Contractor experiences regular stock exchanges in excess of the ten percent (10 %) threshold, a separate agreement may be negotiated to set a threshold that still provides OCFA with the protections intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. 11.0 AUDITS AND INSPECTIONS 11.1 Business Office. At any time during normal business hours, and as often as may reasonably be deemed necessary by OCFA, OCFA may observe and inspect Contractor's business office, and Contractor must make promptly available to OCFA for its examination all Contractor records that pertain to its performance of the Agreement. OCFA may audit, examine, and copy any and all Contractor records pertaining to its performance of the Agreement, including but not limited to, personnel records, daily logs, conditions of employment, fmancial/billing records, and all other records or data. OCFA's right to inspect Contractor's business office and any and all records pertaining to its performance of the Agreement will be • 7 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • restricted to normal business hours and reasonable notice shall be given to Contractor in advance of such inspection. 11.2 Facilities/VehicIes. OCFA may, at any time and without prior notice, observe and inspect Contractor's vehicles, ambulance dispatch center, maintenance facilities, personnel, and/or any ambulance post location(s). OCFA employees may be assigned to ride as observers on any Contractor vehicle at any time provided, however, that in exercising this right to inspect and observe OCFA employees shall conduct themselves in a professional and courteous manner, shall not interfere in any way with Contractor's employees sin the performance of their duties, and shall at all times be respectful of Contractor's employer - employee relationships. 12.0 COOPERATION 12.1 Contractor shall fully cooperate with OCFA and shall take all actions necessary to ensure that all terms and conditions, and required performance levels, set forth in the Contract Documents are satisfied at all times throughout the term of the Agreement. 13.0 INDEPENDENT CONTRACTOR 13.1 Both parties in the performance of the Agreement shall be acting in an independent capacity and not as agents, employees, partners, or joint ventures with one another. Contractor and its employees are not employees of the City, the County, or OCFA and are not 411 entitled to any of the rights, benefits, or privileges of City, County, or OCFA employees including, but not limited to, medical, unemployment, or workers' compensation insurance. 14.0 INDEMNIFICATION 14.1 General. Contractor shall defend, indemnify and hold harmless the City, the County, and OCFA, their officers, agents, elected officials, and employees, from all liability, claims, losses and demands, including defense costs and reasonable attorneys' fees, whether resulting from court action or otherwise, arising out of the acts or omissions of Contractor, its officers, agents, or employees, or the condition of property used, in the performance of the Agreement, excepting acts or omissions directed by the City, the County, and OCFA, their officers, agents, or employees, acting within the scope of their employment, for which the City, the County, and OCFA agree to defend and indemnify Contractor in a like manner. 14.2 Rates. Contractor shall defend, indemnify and hold harmless the City, the County, and OCFA, their officers, agents, elected officials, and employees, from all liability, claims, losses and demands, including defense costs and reasonable attorneys' fees, whether resulting from court action or otherwise, arising from any and all challenges to the service rates established in the Contract Documents. A challenge to service rates includes, but is not limited to, both procedural and substantive challenges to the adequacy of, or authority to impose, either the BLS service rate, the ALS service rate, the ALS reimbursement rate, and/or the medical supply reimbursement rate as set forth in the Contract Documents. • 8 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 15.0 COMPLIANCE WITH LAWS 15.1 All services provided and duties performed by Contractor pursuant to this Agreement must be rendered in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It shall be Contractor's sole responsibility to determine which federal, state, and local laws, rules, statutes, and regulations apply to the services and duties to be performed pursuant to this Agreement, and to maintain compliance at all times throughout the term of the Agreement. 16.0 RISK 16.1 Notwithstanding any other term or condition herein, in responding to a call for service, Contractor shall have no claim whatsoever against OCFA, the City, or the County or have any right to recover from OCFA, the City, or the County for the cost of any of the services it renders in its performance of services under this Agreement. Contractor must look solely and exclusively to the service recipient, their insurers, applicable state or federal health care programs, or other responsible party for payment of the services it renders. 16.2 Contractor shall assume the entire risk of non - payment for any and all of the services rendered, duties performed, and charges incurred in connection with its performance of services under this Agreement, including, but not limited to, all BLS and ALS charges incurred, the ALS reimbursement rate, and/or the medical supply reimbursement rate. • 17.0 RESPONSIBILITY 17.1 It shall be the responsibility of Contractor to provide all equipment, to satisfy all terms and conditions set forth in the Agreement, and to perform all required duties, obligations, and responsibilities expressed in the Contract Documents at all times during the term of the Agreement. Contractor may utilize additional resources whenever deemed necessary to perform its emergency ambulance services pursuant to the Agreement. This may include, but is not limited to, use of personnel and/or equipment of another OCFA - approved ambulance provider. This, however, shall not relieve Contractor of its duties and responsibilities under the Agreement, and any additional cost incurred shall not be charged to OCFA, the City, or the County. 18.0 ACTS OR OMISSIONS OF REPRESENTATIVES 18.1 The acts and/or omissions of the owner(s), officers, operators, officials, employees, agents, and representatives of Contractor in the performance of the services and obligations under the Agreement shall constitute the acts and/or omissions of Contractor. 19.0 INSOLVENCY 19.1 Contractor shall not, without the prior written consent of the OCFA Fire Chief, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of Contractor, or make a general assignment of such assets for the benefit of creditors. • 9 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • Any such action taken or suffered by Contractor under any insolvency or bankruptcy proceeding may constitute a breach of contract by Contractor, and all property assigned by OCFA, the City, and/or the County for safe care shall be immediately "released" to another assigned service provider, as specified by the OCFA Fire Chief. 20.0 OPERATIONAL STANDARDS, PROCEDURES, & PERFORMANCE REQUIREMENTS. 20.1 Service Hours 20.1.1 Service. Contractor shall provide twenty -four (24) hour 911 - Fire\EMS Emergency Ambulance Transportation and Related Services within the Subject EOA, at or above the level agreed to in the Contract Documents, seven (7) days a week throughout the term of the Agreement. 20.1.2 Field Supervisor. Contractor shall assign an authorized and qualified field supervisor available to OCFA personnel, either by radio or in person, who shall be physically present within the County of Orange, on a twenty -four (24) hour, seven (7) day per week basis throughout the term of the Agreement. 20.2 Response Times 20.2.1 Response Time Reporting. Contractor shall provide quarterly response • time reports to OCFA and OCEMS ( "Quarterly Response Time Reports ") that contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Exhibit "D ". Each Quarterly Response Time Report shall be submitted to the OCFA EMS Section Battalion Chief and the OCEMS Program Manager via e-mail (in a format approved by the OCFA EMS Section Battalion Chief) by the 10th day of the month following the end of the quarter. For example, January, February, March reports are due April 10th. If the Quarterly Response Time Reports are not submitted in a timely manner, Contractor may be assessed a $500 penalty per occurrence. If the Quarterly Response Time Reports are not submitted to OCFA as prescribed herein two (2) or more times in a single 12 -month period, such omissions may constitute breach of contract. 20.2.1.1 General Requirements. Contractors must respond to OCFA' s requests for emergency ambulance transportation service within the response times set forth in this Section. Response times will be calculated as the actual elapsed time in minutes from the moment the request is received by the Contractor's dispatch center to the time that the Contractor's first ambulance arrives on scene. Where multiple ambulances are dispatched to the same emergency scene, only the response time of the ambulance arriving first will be counted for purposes of calculating the response time. Contractors will be responsible for providing quarterly response time reports to OCFA and OCEMS 20.2.1.2 Response Time Measurement. Response times are measured in full minutes, rounded upward. For purposes of measuring compliance and for the imposition of • 10 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • any penalties, any partial minute will be rounded to the next full minute. For example, a response time of 10:01 or 11:00 is counted as eleven minutes. 20.2.1.3 Definition of Geographical Areas & Response Priority Codes. The following geographical areas, response priority codes, and definitions will apply with regard to calculating response times (based upon changes in population densities, these geographical area definitions may be changed at the sole discretion of OCFA; OCFA will advise Contractors in writing when these changes occur): • Metro/Urban: Those areas with a population density greater than 100 persons per square mile. Response time not to exceed 10 minutes for Code 3; not to exceed 15 minutes for Code 2. • Suburban/Rural: Areas with a population density of 7 to 100 persons per square mile. These areas generally include the roads and contiguous canyon areas of the local mountain ranges, including: Brea Canyon, Tonner Canyon, Carbon Canyon, Modjeska Canyon, Silverado Canyon and Trabuco Canyon; the areas of Santiago Canyon Road between Jamboree and Live Oak Canyon Road; and the Ortega Highway (Highway 74) between La Plata Avenue and the County line. . Response time not to exceed 20 minutes for Code 3; not to exceed 25 minutes for Code 2. • • Wilderness: Those areas with a population density of less than 7 persons per square mile. These are generally the areas of the Cleveland National Forest within the County of Orange, with the exception of incidents on or immediately adjacent to Highway 74. Response time not to exceed 30 minutes for Code 3; not to exceed 45 minutes for Code 2. • Code 2: Emergency ambulance vehicles responding to an emergency scene or request for service expeditiously, without red lights and sirens on. • Code 3: Emergency ambulance vehicles responding to an emergency scene or request for service with red lights and sirens on. 20.2.2 Quarterly Response Time Report - Format. The Quarterly Response Time Reports shall be submitted by Contractor using an electronic spreadsheet format that will be provided to Contractor by OCFA. The Quarterly Response Time Reports shall contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Exhibit "D," for the EOA. Whenever response times in either Code 2 or Code 3 categories fall below the 93% compliance rate in any given quarter, Contractor shall include a • 11 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • narrative assessment as to the cause of any response delay, and, if requested, shall meet and confer with the OCFA EMS Section Battalion Chief for purposes of establishing a plan for avoiding such delay in the future. 20.2.3 Exemptions to Response Time Requirements. The response time requirements set forth in this Section may be suspended and not enforced, at the discretion of the OCFA EMS Section Battalion Chief, in unusual circumstances. There shall be no exemption for response delays due to vehicle mechanical problems, driver error, traffic, weather, or mistake. The response time requirements set forth in this Section shall be suspended and not enforced under the following limited circumstances: 20.2.3.1 High Call Volume: Responses to calls for service during periods of unusual system overload or high call volume, which shall be at the sole determination of OCFA; 20.2.3.2 Disasters: Responses to calls for service during an OCFA declared disaster occurring within an EOA or during a declared disaster in a neighboring jurisdiction, which has requested emergency ambulance transportation or other mutual aid assistance from OCFA. For purposes of this Section, a "declared disaster" means any condition of disaster as declared or affirmed by the OCFA Fire Chief or his designee; 20.2.3.3 Multiple Ambulance Response: For responses to calls for • service where more than one ambulance is dispatched to the same incident, only the response time of the ambulance first to respond shall be required to meet the required response time requirements; 20.2.3.4 Response Up/Downgrade: For Code 3 calls where the response priority code is downgraded to Code 2 by OCFA while the ambulance is en route to the scene, the response time standard for that call shall be recorded as a Code 2 call. If the response priority code is upgraded from Code 2 to Code 3 by OCFA while the ambulance is en route to the scene, the response time standard for that call shall be recorded as the number of minutes for a Code 3 call plus the number of minutes already elapsed, not to exceed the original total minutes for a Code 2 call; 20.2.3.5 Return of OCFA Personnel: In the event that an ambulance is delayed in responding to a call for service, or is hindered from providing a timely response, due to the need to comply with the requirement that it return all OCFA personnel to their respective fire stations, as described herein, the response time requirement for that call will be suspended. This exemption will only apply for a call for service dispatch that occurs while the ambulance is waiting for or actually returning OCFA personnel. It shall be the Contractor's responsibility to document such circumstances, including the length of time and the affected call(s) for service. Contractor shall apply for a specific exemption as provided below. Calls for service dispatches that occur after the ambulance has returned OCFA personnel and while returning to any ambulance post location are not eligible for this exemption. • 12 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 20.2.4 Procedures to Request Response Time Exemption. Applications for receiving an exemption to the response time requirements shall be submitted by Contractor to the OCFA EMS Section Battalion Chief for approval. Such requests must accompany the Quarterly Response Time Report for the period in which the exemption is requested. Requests for exemptions outside of the current quarterly reporting period shall not be considered. Each request for exemption shall include the following information: (a) the incident date; (b) the OCFA Incident Number(s); (c) a narrative summary of the incident; (d) explanation for the cause of the response time delay; and (e) the specific exemption requested. The decision to either grant or deny a response time exemption request shall be made by the OCFA EMS Section Battalion Chief within thirty (30) days; the decision to deny may be appealed to the OCFA Fire Chief, whose decision shall be final. 20.2.5 Use of Alternative Methods to Meet Response Time Requirements. For purposes of maintaining compliance with the response time requirements established herein, Contractor shall negotiate and enter into a separate mutual aid agreement(s) with neighboring ambulance service operators for the provision of back -up, secondary emergency ambulance transportation services within the Subject EOA. Any secondary ambulance provider(s) selected to provide such services, and any agreement(s) to provide such services pursuant to this Section, shall satisfy the following requirements: 20.2.5.1 All secondary mutual aid provider draft agreements shall be reviewed and approved by OCFA prior to execution of the Agreement and a copy of the • final, signed agreement shall be sent to the OCFA EMS Section Battalion Chief; 20.2.5.2 All OCFA — approved secondary mutual aid providers shall be expected to perform back -up emergency ambulance transportation services in accordance with the operational standards, procedures, and performance requirements set forth in the Contract Documents; 20.2.5.3 All OCFA — approved secondary mutual aid providers and their employees shall cooperate with OCFA and shall participate in any audit requested by OCFA concerning their performance; and 20.2.5.4 Notwithstanding the above, Contractor and not the secondary mutual aid provider shall be responsible for ensuring compliance with all terms, conditions, standards, and performance requirements set forth in the Contract Documents, including but not limited to, the imposition of all applicable penalties and payment of all fees and reimbursements. 20.2.6 Disciplinary Actions for Failure to Meet Response Time Requirements / Performance Deficiency 20.2.6.1 Meet and Confer. Should Contractor fail to meet the response time requirements, set forth in this Section, in any quarterly period for any single Code • 13 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • category or for the cumulative total of Code 2 and Code 3 calls, as outlined in Exhibit "D," the OCFA EMS Section Battalion Chief shall notify the Contractor and may meet and confer with the Contractor regarding performance and response time deficiencies. The purpose of this meeting is to notify the Contractor of its deficiencies and to work with the Contractor to ensure proper response time performance in the immediate future. 20.2.6.2 Penalties. At the discretion of the OCFA EMS Section Battalion Chief, monetary penalties may be assessed against the non - compliant Contractor for failure to meet the response time requirements set forth in this Section. For each EOA, quarterly aggregate response times (i.e., in any quarterly period for any single Code category) that are not in compliance with the response time requirements set forth in this Section may result in OCFA assessing the non - compliant Contractor with a monetary penalty according to the following compliance and fine schedule: Quarterly Responses That Are In Compliance With Response Time Requirements Per Geographical Area (EOM And Per Response Priority Code Penalty Imposed *: 93% or Better None • • 90% - 92.9% $1,000 85% - 89.9% $2,000 Less than 85% $3,000 *Note: Penalties are for Code 2 /Code 3 reported separately and calculated separately within each geographical area in the Subject EOA. In addition to the above response time penalties, OCFA may assess monetary penalties against Contractor for the following: 20.2.6.2.1 Turned Call Penalties: Any calls for service that are not handled by the Contractor, either through its own equipment and personnel or secondary mutual aid providers, and that require OCFA to request service from another ambulance service operator may result in the assessment of a "Turned Call" penalty in the amount of $500 per occurrence. 20.2.6.2.2 Late Report/Late Payment Penalties: Any reports, fees, or reimbursements that are required to be submitted to OCFA by Contractor pursuant to the Contract Documents (e.g., Quarterly Response Time Reports, CQI, monthly • 14 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 reimbursements, etc.) and that are not submitted on time may result in the imposition of a $500 penalty per occurrence. 20.2.6.3 Timely Performance Required. Assessment of penalties pursuant to this Section shall not relieve Contractor of the responsibility to meet all performance expectations as set forth in the Contract Documents. Substandard cumulative response time performance (i.e., below the 93% compliance rate for combined Code 2 and Code 3 calls) in any two (2) quarters in a single twelve (12) month period shall constitute breach of contract. Failure to timely correct and cure any response time deficiency may constitute a breach of the Agreement. This Agreement requires the highest levels of performance, reliability, and compliance with the established performance criteria and service delivery criteria, and the mere demonstration of effort, even diligent and well - intentioned effort, shall not substitute for proper compliance. 20.2.6.4 Waiver. Any monetary penalty that may be imposed pursuant to this Section may be waived, upon a showing of good cause, at the sole discretion of the OCFA Fire Chief, whose decision shall be final. 20.3 Emergency On - Scene Procedures 20.3.1 Contractor shall perform as a part of the patient care team and shall be able to perform all BLS treatment modalities within its scope of practice, as required by • OCEMS. 20.3.2 All EMTs and other ambulance personnel assigned by Contractor to perform services under the Agreement shall: 20.3.2.1 Be trained in Orange County disaster response procedures, multiple victim, and mass casualty incident protocols, pursuant to the Orange County Fire Services Operational Area Annex; 20.3.2.2 Work under the direction of the OCFA Incident Commander and/or the OCFA EMT - Paramedic in charge of the patient(s) and/or incident; 20.3.2.3 Fully cooperate with and abide by the instructions of the OCFA Incident Commander and/or the OCFA EMT - Paramedic in charge of the patient(s) and/or incident; 20.3.2.4 Place their apparatus and equipment at the scene in a safe location or as deemed appropriate by the OCFA Incident Commander and shall be mindful of the need for safe operations, including the avoidance of exhaust fumes; 20.3.2.5 Not interfere with or assist OCFA personnel in any fire fighting or emergency rescue operation; • 15 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 20.3.2.6 Request a secondary ambulance and/or Contractor field supervisor immediately upon determining that their unit has suffered a mechanical failure or is or may become disabled, or upon the request of an OCFA Incident Commander, and must likewise immediately inform the OCFA Incident Commander of any mechanical failures; and, 20.3.2.7 Be aware that safety is the responsibility of all personnel on scene; ambulance personnel shall not enter or operate in unsafe environments. 20.4 Disaster Assistance 20.4.1 During a disaster, declared locally or in a neighboring jurisdiction, strict application of the performance standards set forth in the Contract Documents may be temporarily suspended by OCFA in order to provide an appropriate response. While disaster coordination shall be provided by OCFA, Contractor shall be actively involved in the planning and response to any declared disaster. Upon notification of a disaster by OCFA, Contractor shall immediately commit any and all available resources and assist OCFA in accordance with disaster plans and protocols applicable in the locality where the disaster has occurred. In the event of a disaster, the following shall apply: 20.4.1.1 During such periods, Contractor shall be released from the response time requirements until notified by the OCFA Duty Officer that disaster assistance is no longer needed; • 20.4.1.2 When disaster assistance is no longer needed, Contractor shall resume performance pursuant to the Agreement as quickly as is practical considering personnel exhaustion, medical supply restocking needs, and other relevant considerations; 20.4.1.3 While performing disaster assistance, Contractor shall provide supervisory assistance at the command post or emergency operations center as requested and shall use best efforts to provide local emergency coverage; Contractor shall also suspend non - emergency transport services as necessary, informing persons requesting non - emergency transport of the reason for the temporary suspension; 20.4.1.4 During the course of a disaster, OCFA shall work with Contractor to utilize mutual aid providers who are authorized to perform such services within the County to meet the service demands of the disaster; and, 20.4.1.5 Contractor's supervisory personnel shall complete, or show proof of completion, incident command training, hazardous materials training, and supervisory training in cooperation with OCFA. 20.5 Standard of Performance • 16 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 20.5.1 Contractor shall perform all work and services pursuant to this Agreement in a skillful and workmanlike manner, and consistent with the standards generally recognized as being employed by professionals in the private, emergency ambulance transportation field in the State of California. Contractor hereby warrants and represents that it is skilled in the professional calling necessary to perform all work and services under the Agreement. Contractor hereby further warrants and represents that all of its employees and authorized subcontractors shall have sufficient skill and experience to perform the work and services assigned to them under the Agreement. Finally, Contractor hereby warrants and represents that it, its employees, and authorized subcontractors have all licenses, permits, qualifications and approvals of whatever nature that are legally required to perform the work and services under the Agreement, and that such licenses and approvals shall be maintained at all times throughout the term of the Agreement. 20.6 General Provisions 20.6.1 Return of OCFA Personnel. OCFA provides Advanced Life Support ( "ALS ") services from a variety of delivery platforms, including engine and truck companies. In cases where OCFA personnel accompany patients in the ambulance en route to hospitals or to other receiving facilities, and the OCFA ALS unit does not follow -up to the hospital/receiving facility, Contractor shall return those OCFA personnel to their assigned fire station(s) within - thirty (30) minutes from the conclusion of the run. The conclusion of the run is defined as the moment when the patient has been transferred into the care of hospital/medical staff, the • ambulance crew has completed all required documentation, and the ambulance has been restocked and is ready to be placed back in service. At the conclusion of the run, the ambulance crew is to advise the accompanying OCFA personnel that they are ready to return them to their station. If while returning OCFA personnel to their station, the ambulance receives another emergency call, the ambulance may accept that call for service and take those returning OCFA personnel to the new call at the discretion of the OCFA personnel on board. 20.6.2 911 Calls for Service/Referral. Contractor shall immediately refer to OCFA any and all incoming calls for 911 - Fire/EMS emergency ambulance service that are made by any person directly to a Contractor's ambulance dispatch center or business office. 20.6.3 Performance. The most important aspect of this Agreement is that it stresses "performance." Contractor shall demonstrate a continuous effort to detect and correct service level performance deficiencies, as determined by OCFA, and to continuously upgrade the performance and reliability of the EMS transportation system within the Subject EOA. Contractor's 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, proper management oversight, employee training and continuing education. • 17 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 20.6.4 Conflict of Interest. Contractor hereby warrants and represents that it is not, and will not be, violating either directly or indirectly any conflict of interest statute, rule, or regulation by its performance of services under this Agreement. 20.6.5 Complaints. Contractor shall immediately notify OCFA in writing of any complaints, inquiries, or investigations initiated by OCEMS, the California Emergency Medical Services Authority, and/or any other federal, state, or local regulatory agency regarding Contractor services performed pursuant to this Agreement, including but not limited to: level of service; service delivery; service quality; billing practices; medical training and/or care; and personnel. Nothing in this Agreement shall be construed as superseding the authority of OCEMS or any other duly empowered regulatory agency from separately and/or concurrently exercising its authority to provide regulatory oversight and to take action to ensure that Contractor's private, emergency ambulance response services are administered according to law. 20.6.6 Traffic Signal Preemption. Contractor shall be required to purchase, install, and maintain, at its sole cost and expense, City or OCFA - approved traffic signal preemption and security gate access devices /equipment on all ambulances serving the Subject EOA, if required. 20.6.7 HIPAA Compliance Plan. Effective April 14, 2003, or such other implementation date established by law, to the extent that the parties have a "business associate" relationship, the parties shall carry out their obligations under this Agreement in compliance with • the privacy regulations published at 65 Federal Register 82462 (December 28, 2000) (the "Privacy Regulations ") pursuant to Public Law 104 -191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq., as amended ( "HIPAA "), to protect the privacy of any personally identifiable, protected health information ( "PHI ") that is collected, processed or learned as a result of the services provided pursuant to the contract. In conformity therewith, both parties agree that they shall: 20.6.7.1 Not use or further disclose PHI except: (i) as permitted under the Agreement (that is, for the purpose of maintaining accurate records of the services provided pursuant to the Agreement and for the billing of such services to patients, guarantors, insurers, carriers or other responsible parties; the issuance of reports to the other party pertaining to same; and related administrative functions pertaining to these activities); (ii) as required for the proper management and administration of ALS and BLS in their capacity as HIPAA "Business Associates" of each other; or (iii) as required by law; 20.6.7.2 Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by the Agreement; 20.6.7.3 Report to each other any use or disclosure of PHI not provided for by the contract of which a party becomes aware; • 18 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 20.6.7.4 Ensure that any agents or subcontractors to whom either party provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to both parties with respect to such PHI; 20.6.7.5 Make PHI available to the individual who has a right of access as required under HIPAA; 20.6.7.6 Make available for amendment and incorporate any amendments to PHI when notified to do so by either party; 20.6.7.7 Make available to either party the information required to provide an accounting of the disclosures of PHI made by the one party on the other party's behalf, provided such disclosures are of the type for which an accounting must be made under the Privacy Regulations; 20.6.7.8 Make their internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining either party's compliance with HIPAA and the Privacy Regulations; and 20.6.7.9 Upon termination of the Agreement, return or destroy all PHI received from, or created or received by one party on behalf of the other party. In the event the return or destruction of such PHI is infeasible, both parties' obligations under this • Section shall continue in full force and effect so long as either party possesses any PHI, notwithstanding the termination of the Agreement for any reason. 20.6.8 Medicare/Medi - Cal Participation. Contractor hereby warrants and represents that it is an enrolled provider in good standing in the Medicare and Medi -Cal programs and is not the subject of any pending actions, investigations, or prosecutions, whether civil, criminal, or administrative, relating to its billing or reimbursement practices, and that Contractor shall not employ or utilize individuals for the performance of services hereunder who have been excluded from any state or federal health care program. Contractor further warrants and represents that: (i) it is not currently excluded, or threatened with exclusion, from participating in any federal or state funded health care program, including but not limited to Medicare and Medi -Cal, and (ii) it has never been excluded by any of the aforementioned programs. Contractor shall promptly notify OCFA of any imposed exclusions or sanctions covered by this warranty, and OCFA reserves the right to terminate the Agreement upon receipt of such notice. 20.7 External Medical Quality Control 20.7.1 The OCEMS Medical Director, or his designee(s), has both the authority and responsibility to routinely establish and monitor private, emergency ambulance system performance, including but not limited to: ambulance equipment standards; medical protocols; • 19 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • personnel standards; training standards; medical dispatch procedures; first responder practices and training; medical control; and to effect corrective and disciplinary action as necessary. 20.7.2 Contractor shall fully comply with all federal, state, and local medical standards, protocols, and rules and regulations applicable to the provision of private, emergency BLS ambulance transportation, including those established by OCEMS. Contractor shall at all times during the term of this Agreement fully cooperate with the OCEMS Program Manager and the OCEMS Medical Director in the monitoring, regulation, management, oversight, and administration of the County EMS system. 21.0 PERSONNEL 21.1 Personnel Requirements 21.1.1 Employee Performance. Contractor shall employ only competent and trained personnel, and shall provide a sufficient number of employees to perform the services provided under the Contract Documents. Each Contractor must comply with the following personnel requirements: 21.1.1.1 All Contractor employees and ambulance personnel shall be sufficiently trained and capable to ensure the safe and proper discharge of their service responsibilities; • 21.1.1.2 All Contractor ambulance personnel must possess valid California Driver's Licenses in the proper class, including any required certifications, and must be compliant with all relevant provisions of the California Vehicle Code, Health and Safety Code, and all other laws applicable to private, emergency ambulance response personnel. 21.1.2 Employee Drug Program. Contractor shall have an employee alcohol and drug program that includes at a minimum, an alcohol and drug free workplace policy, and an employee alcohol/drug- testing program that complies with the U.S. Department of Transportation requirements to the extent allowed by law, including random alcohol and drug testing. Any Contractor employee found working under the influence of alcohol or drugs shall be immediately removed from performing any further duties under this Agreement. The alcohol and drug program shall meet the following requirements: 21.1.2.1 A contract with a program administrator and authorized lab certified by the U.S. Department of Transportation; and 21.1.2.2. Procedures and components substantially as in Part 40 of Title 49 of the Code of Federal Regulations for pre - employment; and 21.1.2.3 Procedures and components substantially as in Part 382 of Title 49 of the Code of Federal Regulations for rehabilitation, return -to -duty and follow up testing; and • 20 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 21.1.2.4 Procedures and components for random testing following U.S. Department of Transportation guidelines, and additional tests as required following accidents, rehabilitation, return-to- service, and other circumstances providing reasonable suspicion to test; and 21.1.2.5 Upon request by the OCFA EMS Section Battalion Chief, yearly reports of the random testing component shall be filed by the program administrator, in redacted form concealing employee identifiable information, with OCFA; and 21.1.2.6 Contractor and program administrator's alcohol and drug program records shall be made available, in redacted form concealing individual employee identities, to OCFA upon request; and 21.1.2.7 Contractor employees must show a valid California driver's license at the time and place of testing; and 21.1.2.8 All test results are kept confidential except that OCFA is authorized to receive copies, in redacted form concealing individual employee identities, for its administrative purposes, and except as otherwise authorized or required by law. 21.1.3 DMV Employer Pull Notice Program. Contractor shall participate in the California Department of Motor Vehicles (DMV) Employer Pull Notice Program at all times throughout the term of the Agreement. • 21.1.4 Criminal Background Checks. Contractor shall not employ in the performance of services pursuant to the Agreement any EMT or ambulance personnel or employee convicted of or having pled nolo contendere to a crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fraud, or misdemeanor or felony driving while under the influence of alcohol or drugs. If any Contractor employee is charged with any of the above - listed crimes, Contractor shall immediately suspend that employee from performing any further duties under the Agreement pending the outcome of the criminal case. It shall be the responsibility of Contractor to ensure that criminal background checks are performed on all Contractor employees prior their assignment of any duties within the Subject EOA under the Agreement. 21.1.5 Uniforms and Decorum. Contractor employees shall maintain acceptable standards of dress, including the wearing of Contractor - issued uniforms, and cleanliness while on duty in the community and must at all times conduct themselves in a professional manner. 21.1.6 Cooperation. All Contractor employees shall fully cooperate with and abide by the instructions of OCFA personnel while on scene at an emergency incident. • 21 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 21.1.7 Employee Ineligibility. If any Contractor employee becomes ineligible to provide services under the Agreement, Contractor shall immediately notify the OCFA EMS Section Battalion Chief in writing of such ineligibility and the reason(s) therefore. 21.1.8 Compliance with Laws. Contractor shall ensure that all of its employees and ambulances that are used in the performance of services under the Agreement are at all times during the term of the Agreement in full compliance with all federal, state, and local laws, rules, statutes, and regulations, including but not limited to: the California Vehicle Code; the California Health & Safety Code; Orange County Ordinance No. 3517; applicable City ambulance ordinances; and any and all applicable OCEMS or State EMS Authority policies, standards, procedures, regulations, and/or protocols. All Contractor employees shall have in their possession, at all times while on duty, applicable licenses, certifications, and/or permits, as may be required by the agencies and authorities listed herein. 21.1.9 Licensing/Identification. All Contractor emergency response personnel assigned to perform services under the Agreement shall furnish to any OCFA personnel, upon request, any required licenses, certifications, and/or permits, including proper identification, for purposes of verifying validity, ensuring compliance with licensing, certification, and permitting requirements, and for the proper reporting of employee performance- related issues to Contractor. 21.1.10 Joint Training Exercises. The OCFA EMS Section Battalion Chief may request Contractor to participate, at its sole cost and expense, in emergency response joint • training exercises to improve the capability and coordination of both OCFA and Contractor's response to a given emergency or disaster. Such training shall be scheduled and mutually coordinated by the OCFA EMS Section Battalion Chief and Contractor. Such training shall not exceed twenty (20) hours per year per EOA. Any additional training that may be deemed necessary by OCFA shall be attended by Contractor's personnel upon reasonable notice and at the sole cost and expense of Contractor. Such additional training may include, but is not limited to, mass casualty, weapons of mass destruction, and/or other emergency response training. 21.1.11 Employee Training Records. Contractor shall promptly make available to the OCFA EMS Battalion Chief, upon request, any and all Contractor personnel training records for those employees who perform any duties or services under the Agreement; 21.1.12 Professionalism. All Contractor employees shall perform the duties, obligations, and services required under the Agreement in an ethical, professional, and orderly manner and shall endeavor at all times to obtain and keep the confidence of the public. Contractor employee performance of all terms and conditions contained in the Contract Documents shall be monitored, maintained, and enforced at all times during the term of the Agreement by the OCFA EMS Section Battalion Chief. 21.1.13 Management Oversight. Contractor shall utilize management practices that ensure that its emergency response personnel working extended shifts, part-time jobs, • 22 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201.2 • voluntary overtime, or mandatory overtime are not exhausted, overworked, or exhibiting impaired judgment or motor skills while performing any duties or services under the Agreement. 21.1.14 Employee Removal. At the request of the OCFA EMS Section Battalion Chief, and based on a demonstrated pattern of either poor performance or service- related complaints, as determined by the OCFA EMS Section Battalion Chief, Contractor shall immediately remove certain personnel from performing further services or duties under the Agreement. 21.2 Independent Contractor 21.2.1 Neither OCFA, the City, or the County, or any of their officers, elected officials, agents, representatives, or employees shall have any control whatsoever over the conduct of Contractor's employees, except as set forth in the Agreement. Contractor shall not represent that either it or its agents or employees or officers are in any manner agents or employees of the County, the City, or OCFA, it being understood that Contractor, its agents, employees, and officers are as to the County, the City, and OCFA wholly independent contractors and that Contractor's obligations to the City and OCFA are solely those that are set forth by this Agreement. Contractor hereby further acknowledges and agrees that the City, the County, and OCFA shall have no responsibility whatsoever for salary, health benefits, retirement benefits, taxes, or any other benefits of any kind that may be due to Contractor's employees. • 22.0 RATES FOR AMBULANCE SERVICE 22.1 BLS and ALS Service Rates 22.1.1 Maximum BLS Service Rate. The Orange County Board of Supervisors establishes the maximum Basic Life Support ( "BLS ") service rate ( "BLS Service Rate ") that may be charged by Contractor to its patients for the provision of emergency ambulance transportation services. Contractor shall not charge more than the maximum BLS Service Rate approved by the Orange County Board of Supervisors for each BLS patient transport. BLS means the same as is defined in the EMS Act. The BLS Service Rate is reviewed annually by OCEMS, which makes rate adjustment recommendations to the Board of Supervisors. As such, the maximum approved BLS Service Rate is subject to change at any time during the contract term. The maximum BLS Service Rate (as of July 1, 2008) is as follows: Type of Charge Maximum Rate BLS Service Rate $671.75 per BLS transport 22.1.2 Maximum ALS Service Rate. The OCFA Board of Directors establishes the maximum Advanced Life Support ( "ALS ") service rate ( "ALS Service Rate ") that may be charged by Contractor for OCFA - provided emergency ALS services to patients transported either ALS or BLS, subject to approval by the Orange County Board of Supervisors. For those • 23 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • calls for service in which ALS services are provided by OCFA to patients that are transported either ALS or BLS, Contractor shall be responsible for charging and collecting the ALS Service Rate, in addition to Contractor's BLS Service Rate. Contractor shall not charge more than the maximum ALS Service Rate approved by the OCFA Board of Directors. ALS means the same as is defined in the EMS Act. The ALS Service Rate is reviewed annually by OCFA. The maximum approved ALS Service Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. The approved maximum ALS Service Rate (as of July 1, 2008) is as follows: Type of Charge Maximum Rate ALS Service Rate $355.75 per ALS service w /transport 22.1.3 ALS Reimbursement Rate. The OCFA Board of Directors establishes the OCFA ALS reimbursement rate ( "ALS Reimbursement Rate "), which Contractor shall pay OCFA for ALS services provided to patients that are transported either ALS or BLS in order to cover OCFA's costs for providing such services. Contractor shall pay OCFA the established ALS Reimbursement Rate for each call for service in which OCFA provides ALS services to patients that are transported either ALS or BLS. 22.1.3.1 Medicare Patients. The ALS Reimbursement Rate for Medicare patients, including patients covered under Medi -Medi or Medicare+Choice plans (e.g., • Secure Horizons) that use Medicare rates as a basis for payment in full, is based on the Medicare allowed amounts for each Contractor. The ALS Increment is defined as the difference between the Medicare allowed amount for a given ALS service (i.e., ALS -1E or ALS -2) and the Medicare allowed amount for BLS emergency services, prior to the 20% co- payment deduction. 22.1.3.1.1 ALS -1 Emergency Services. The ALS Reimbursement Rate for ALS -1 emergency transports and ALS -1 emergency assessments with BLS transports for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a•basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS -1 emergency services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co- payment deduction. 22.1.3.1.2 ALS -2 Services. The ALS Reimbursement Rate for ALS -2 services for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS -2 services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co- payment deduction. 22.1.3.2 Annual Adjustments. The ALS Reimbursement Rate is reviewed annually by OCFA. The ALS Reimbursement Rate payable to OCFA by Contractor for • 24 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • all ALS services provided to patients, excluding Medicare patients and patients covered under Medi -Medi or Medicare + Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. 22.1.3.3 ALS Reimbursement Rate. As of July 1, 2008, the approved ALS Reimbursement Rate is as follows: Type of Charge Amount 1. ALS Reimbursement Rate $252.00 per transport w /ALS services 2. ALS Reimbursement Rate for Medicare patients or patients with Medi -Medi or Medicare +Choice plans ALS -1E or ALS -2 Increment 22.1.4 Medical Supply Reimbursement Rate. The OCFA Board of Directors establishes the medical supply reimbursement rate ( "Medical Supply Reimbursement Rate "), which Contractor shall pay OCFA per BLS /ALS transport. Contractor shall pay OCFA the Medical Supply Reimbursement Rate for each BLS /ALS patient transport to cover OCFA's costs • for providing expendable medical supplies to Contractor. The Medical Supply Reimbursement Rate is reviewed annually by OCFA. The Medical Supply Reimbursement Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. As of July 1, 2008, the Medical Supply Reimbursement Rate shall be as follows: Type of Charge Amount Medical Supply Reimbursement Rate $28.15 per transport (BLS /ALS) 22.1.5 Zero Pay Patients. OCFA will not require Contractor to pay the established ALS Reimbursement Rate or Medical Supply Reimbursement Rate (nor any portion thereof) for "zero pay patients." "Zero pay patients" are those calls for service to patients whose only method of healthcare coverage or insurance is provided by a state or local subsidized health care program (i.e., patients receiving health care benefits pursuant to any one of the following state or local subsidized health care programs: (a) Medi -Cal; (b) Cal Optima; (c) California Child Services ( "CCS "); and/or (d) County Medical Services for the Indigent ( "County/MSI ")). Patients who have other means of payment or who are covered by additional or supplemental insurers, other than subsidized health care programs, are not "zero pay patients." Contractor may seek relief from making the required reimbursement payments to OCFA by applying for a Zero Pay Patient Exemption, as provided below. • 25 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201.2 • 22.1.6 Risk of Non - Payment. Except as provided otherwise herein, Contractor assumes the entire risk of non - payment for any and all of the services rendered and the charges incurred in connection with its performance under the Agreement, including all BLS and ALS charges incurred, as well as all ALS reimbursements and medical supply reimbursements regardless of whether Contractor receives payment for services from any source. 22.1.7 Medicare Patients. Contractor shall not charge Medicare patients more than the maximum Medicare rate. 22.2 Billing, Audit and Access to Records 22.2.1 Billing System. Contractor shall only bill for services according to the approved service rates and schedules set forth in the Contract Documents and as authorized by OCEMS, with no additional fees or charges imposed unless approved in writing in advance by the OCFA Fire Chief and/or the awarding agency, if applicable. Prior to the Effective Date, Contractor shall establish an auditable billing system approved by OCFA, which shall be available for review by OCFA on a periodic basis. Contractor's patient billing/records system shall be organized so that search and retrieval of all billing records can readily be made by OCFA according to the following individual criteria: Patient Name ALS 911 Calls • BLS ALS Assessment/BLS Transport Day/Month/Year BLS Transport ALS Transport OCFA Incident No. 22.2.2 Accounting. Contractor shall maintain accurate and complete records of all patient accounting, including but not limited to: (i) all patient invoices, (ii) all patient/insurer payments; (iii) all BLS service charges; (iv) all ALS service charges; (v) all ALS reimbursement payments; (vi) all medical supply reimbursements; (vii) all invoices, payments, and correspondence to and from private insurers, federal or state health care programs, and other responsible third parties; and (viii) all records evidencing payments made by Contractors to OCFA in connection with its performance under the Agreement. Such accounting shall be performed by Contractor in accordance with generally accepted accounting principles and practices consistently applied. OCFA shall have access to such records and information upon seventy -two (72) hours advanced written notice at all times during normal business hours for the purpose of inspection, audit, review, evaluation, and duplication. Contractor shall, at no cost to OCFA, provide proper facilities for OCFA's access, inspection, audit, review, evaluation, and duplication of such information. 22.2.3 Responsibility for Submission of Claims. Contractor shall be responsible for submitting claims for services provided hereunder, and may utilize the services of a third party billing agent for this purpose. In the event that a third party billing agent is used, • 26 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201.2 • Contractor shall inform the billing agent of the provisions of the Contract Documents. Contractor shall be responsible to bill for all transports in which ALS services are rendered, specifically including the performance of ALS assessments as defined in 42 C.F.R. §414.605, in accordance with applicable Medicare guidelines for the level of service provided. 22.2.3.1 Submission of Claims. For services provided pursuant to the contract, Contractor shall submit one claim covering both ALS and BLS services to the appropriate carrier or payer utilizing Contractor's provider number. In no event shall more than one claim per trip be submitted where not permitted by law. 22.2.3.2 Sharing of Information and Documentation and Respect of Privacy. Contractor shall permit access by OCFA to Contractor's respective books and records as they relate to billing and reimbursement for services hereunder. Contractor shall share all patient care and billing information necessary to properly submit Medicare claims, including patient care reports and billing slips. Contractor shall within thirty (30) days of receiving any requests for information or documents from the patient, the Centers for Medicare and Medicaid Services (CMS) (formerly HCFA) or its authorized carrier or intermediary, other payment source, or other state or federal agency with oversight of the billing and patient care practices of the parties pursuant to the contract, make available to OCFA any and all such records requested. All information or documents exchanged between the parties related to personal health information of a patient shall be exchanged in compliance with all privacy laws and rules, including the privacy rule established under the Health Insurance Portability and • Accountability Act (HIPAA). Both parties will agree to maintain policies to protect the confidentiality of patient information to the extent required by law and to educate and enforce such policies with their respective personnel. 22.2.4 Medicare Audits. In the event that Contractor is obligated to repay any amounts, related to ALS billed services or medical supplies, to Medicare or other carrier pursuant to a post - payment audit, OCFA shall repay Contractor the ALS Reimbursement Rate or Medical Supply Reimbursement Rate, as applicable, on those claims for which payment is recouped by Medicare or other carrier. However, OCFA will only be responsible for repaying the Contractor in two situations: when a claim is downgraded by the Medicare contractor from an ALS -1E call to a BLS emergency call, or from an ALS -2 to an ALS -1E call. In these situations, OCFA will only repay the Contractor an amount equal to the total ALS Increment (i.e., when a call is downgraded from ALS to BLS) or a portion of the ALS Increment, which is the difference between the ALS Increment of an ALS -2 services and the ALS Increment of an ALS -1E service (i.e., when a call is downgraded from an ALS -2 to an ALS -1E). The Contractor shall supply documentation supporting the overpayment demand by the Medicare Contractor prior to any OCFA repayment. 22.3 Contractor Monthly Payment 22.3.1 Monthly Payments to OCFA. All ALS reimbursements and medical supply reimbursements, as required in this Section, (hereinafter referred to as "Monthly 27 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • Payments ") shall be promptly paid by Contractor to OCFA beginning ninety (90) days from September 1, 2009, and such payments shall continue to be promptly remitted by Contractor to OCFA thereafter within ninety (90) days after the first day of each month throughout the contract term. Zero Pay Patient Exemptions may be requested by Contractor for each qualifying call by following the procedures below. A penalty of $500 may be imposed for each late payment. If Contractor's monthly payments are sixty (60) days late (or more), Contractor may be assessed a 11/2% late fee for each month that payments are not made. Failure to make timely Monthly Payments may be deemed breach of contract. 22.3.2 Zero Pay Patient Exemption Requests. Contractor shall submit to OCFA for approval all Zero Pay Patient Exemption requests and all documentation justifying each request. Zero Pay Patient Exemption requests shall be submitted by Contractor with its monthly ALS reimbursement and medical supply reimbursement payments for the month in which the exemption is requested and must be reflected as a credit on the current Monthly Payment remittance. Requests for exemptions outside the current monthly payment period will not be considered, except as provided herein. Each Zero Pay Patient Exemption will be evaluated and either granted or denied at the sole discretion of the OCFA EMS Section Battalion Chief. Contractor shall be notified in writing by the OCFA EMS Section Battalion Chief if any exemption request will be denied within thirty (30) days of receipt of the request. The decision may be appealed by the Contractor to the OCFA Fire Chief, whose decision shall be final. In the event a Zero Pay Patient Exemption request is denied, Contractor shall adjust its next Monthly Payment remittance for the amount of the credit denied. Exemption requests for "Retro Credits" • must be made within the month the Contractor receives notification of the retroactive enrollment in a qualified zero pay patient program. 22.3.3 Monthly Payment Report. Contractor shall submit a Monthly Payment Report (in electronic format) to the OCFA Accounts Receivable Section along with all Monthly Payments. The Monthly Payment Report shall contain the following information: a. EOA number; b. Name of responsible party invoiced per transport; c. Patient name and address; d. Indicate BLS, ALS, or ALS Assessment/BLS Transport; e. Date of call for service; f. OCFA incident number; g. ALS reimbursement amount remitted to OCFA per transport; and, h. Medical supply reimbursement amount remitted to OCFA per transport. • 28 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 22.3.4 Audit Report. An audit concerning Monthly Payments may be conducted at the sole discretion of OCFA at any time throughout the contract term. If instructed, Contractor shall promptly produce an audit list (in an approved electronic format) to OCFA auditors, which contains the following information: a. Name of responsible party invoiced per transport; b. Patient name and address; c. Indicate BLS, ALS, or ALS Assessment/BLS Transport; d. Date of call for service; e. OCFA incident number; f. Amount invoiced per transport; g. Amount recovered per transport; h. Any exemption requests for transports included in the audit sample; and, i. Any other requested relevant information required to perform an audit. 22.4 Changed Circumstances In the event that unforeseen changes in either the health care industry or laws (federal, state, or local laws, rules, regulations or statutes) seriously affect the Contractors' ability to continue to perform the services and at the rates required under the Contract Documents, Contractor may petition OCFA for a re- evaluation of the level of service and/or established maximum rates or approved Contractor rates, including the maximum ALS Reimbursement Rate • and the Medical Supply Reimbursement Rate, as well as the exemption process. Contractor shall be required to provide such proof as necessary to show that the continuance of the current services, rates, charges, reimbursements, etc. are so economically harmful to Contractor so as to place Contractors in danger of having to default on the contract. This may include requiring Contractor to hire, at its sole cost and expense, an approved independent auditing firm. It shall be at the sole discretion of the OCFA Fire Chief whether to agree to any modifications of the • Contract Documents. An agreed -upon modification or amendment must be in writing and signed by the parties, and may be subject to approval by OCEMS and the State EMS Authority. 23.0 BREACH OF CONTRACT 23.1 Breach of Contract. In the event of a breach of this Agreement by Contractor, OCFA may, in its sole and absolute discretion, elect to (1) give Contractor an opportunity to cure the breach, or (2) immediately terminate the Agreement, or (3) terminate the Agreement after giving 180 days written notice of its intent to do so, whether or not a breach has occurred. Similarly, in the event of a breach of this Agreement by OCFA, Contractor may in its sole and absolute discretion, elect to give (1) OCFA an opportunity to cure the breach, or (2) immediately terminate the Agreement, or (3) terminate the Agreement after giving 180 days written notice of its intent to do so to OCFA whether or not a breach has occurred. 24.0 PUBLIC SAFEGUARDS AND EMERGENCY TAKEOVER • 29 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 24.1 This Agreement is structured with the objective of protecting public health and safety at all times and to protect the public from any loss of service or loss of life as a result of termination of this Agreement. 24.2 In the event of termination, Contractor shall fully cooperate with and shall immediately assist OCFA, the City, and the successor ambulance service operator to effectuate an immediate, efficient, and orderly takeover of all 911- Fire/EMS emergency ambulance services within the Subject EOA so as to ensure that there will be no service interruption to the public. 25.0 CONTRACTOR'S RELIEF UPON TERMINATION 25.1 The provisions of this Section are specifically understood and agreed to by Contractor as being reasonable and necessary in light of the serious public health and safety aspects associated with the provision of services under the Agreement. Any legal action taken by Contractor to challenge either a termination or emergency takeover of this Agreement shall only be initiated by Contractor after the emergency takeover, as provided in Section 24.0 above, has been completed, and shall not under any circumstances whatsoever be allowed to delay the process of takeover by OCFA. Contractor's cooperation with, and full support of, such emergency takeover process shall not in any way jeopardize or limit Contractor's right to recover damages should a court of competent jurisdiction determine that OCFA wrongfully terminated the Agreement. Contractor hereby specifically waives any right to seek any type of declaratory • or equitable relief, including but not limited to a restraining order or injunction, against either the termination or an emergency takeover. 26.0 HOLDOVER PROVISION 26.1 For purposes of protecting public health and safety, in the event this Agreement is terminated, or if no extension of the Agreement is awarded at the end of the initial term of the Agreement, or if Contractor is not awarded a subsequent exclusive operating contract for the Subject EOA upon termination of this Agreement, Contractor hereby agrees to continue providing services under the Agreement until the successor ambulance service operator takes over ambulance service operations and assumes full responsibility for the provision of 911 - Fire \EMS emergency ambulance transportation and related services within the Subject EOA. Under such circumstances, Contractor shall serve as a holdover operator until such time as the successor ambulance service operator takes over ambulance service operations and assumes responsibility for the provision of 911- Fire\EMS emergency ambulance transportation and related services within the Subject EOA. 26.2 OCFA recognizes that if a competing ambulance service operator is awarded an exclusive operating area agreement for the Subject EOA upon termination of this Agreement, Contractor may reasonably begin to prepare for the transition of services to the new provider either prior to the Agreement termination date or during the holdover period described in Section 26.1 above. OCFA and City shall not unreasonably withhold its approval of any Contractor • 30 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • request to begin an orderly transition process, including reasonable plans to relocate Contractor staff, scale down or reduce certain inventory, supplies, or otherwise, so long as such transition activities and/or reductions do not impair or impede Contractor's ability to perform services under the Agreement and provided such transition activities and/or proposed reductions receive the prior written consent of the OCFA Fire Chief and City. 26.3 In order to protect public health and safety, Contractor hereby agrees to fully cooperate with and to immediately assist OCFA, the City, and the successor ambulance service operator to effectuate a prompt, efficient, and orderly takeover of all 911- Fire/EMS emergency ambulance services within the Subject EOA upon termination of this Agreement, so as to ensure that there will be no service interruption to the public. 27.0 SUCCESSORS 27.1 Each of the terms and conditions of this Agreement shall inure to the benefit of and shall bind, as the case may be, not only the parties hereto, but each and every one of the heirs, executors, administrators, successors, assignees, and legal representatives of the parties. 28.0 INTEGRATION 28.1 This Agreement, including all exhibits attached hereto and incorporated herein by reference, supersedes all previous communications, transactions, and understandings, whether oral or written, and constitutes the sole and entire Agreement between the parties pertaining to • the subject matter hereof. No modification or deletion of, or addition to, these terms or conditions is binding on either party unless made in writing and signed by a duly authorized representative of both parties. 29.0 NO WAIVER 29.1 No delay or omission in the exercise of any right or remedy available hereunder shall impair such right or remedy or be construed as a waiver. Any waiver of any breach, default, or condition hereunder must be in writing and shall not be construed as a waiver of any other breach or default concerning the same or any other provision of this Agreement. 29.2 The waiver by OCFA of any breach by Contractor of any of the provisions of this Agreement shall not constitute a continuing waiver or a waiver of any subsequent breach or default by Contractor either of the same or a different provision of this Agreement. 30.0 THIRD PARTY BENEFICIARIES 30.1 The terms of this Agreement are intended to confer benefits only on the parties to this Agreement and to City and County. No rights of action shall accrue to any other persons or entities under this Agreement. 31.0 EXECUTION OF AGREEMENT • 31 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • 31.1 The person(s) executing this Agreement hereby warrant and represent that the execution of this Agreement and the performance of the terms and conditions of this Agreement have been authorized by all requisite corporate, federal, state, municipal or other entity requirements and that the undersigned have the right, power, legal capacity and authority to execute, to bind Contractor, and to enter into this Agreement. 32.0 NOTICES 32.1 Any notices required or permitted under this Agreement shall be in writing and shall be delivered personally or sent by U.S. Mail, First Class, postage prepaid, return receipt requested, and addressed as follows: Orange County Fire Authority: Orange County Fire Authority Attn: EMS Section Battalion Chief One Fire Authority Road Irvine, California 92602 City of Seal Beach: City of Seal Beach Attn: City Manager 211 8 Street Seal Beach, California 90740 • Care Ambulance Service, Inc.: Care Ambulance Service, Inc. Attn: Rick Richardson 1517 W. Braden Ct. Orange, California 92868 33.0 SEVERABILITY 33.1 If any term or condition of this Agreement, or the application thereof to any person or circumstance, shall to any extent be held by a court of competent jurisdiction to be invalid, void, or otherwise unenforceable, the remainder of this Agreement, or the application thereof to any person or circumstance, shall remain in full force and effect and shall in no way be affected, impaired, or invalidated thereby. 34.0 EOA BOUNDARY CHANGE 34.1 Unincorporated service areas are subject to annexation or incorporation at any time as determined by the Orange County Local Agency Formation Commission ( "LAFCO "). The Subject EOA may be changed, adjusted, or redrawn by OCEMS at any time during the term of the Agreement. OCFA has no control over such unanticipated service area and/or jurisdictional changes. This Agreement, if affected by a service area or jurisdictional change • 32 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • imposed by LAFCO, OCEMS, or otherwise, is subject to review, approval, and/or termination by the new governing authority, if any. 35.0 AMENDMENT 35.1 No modification, amendment, addition to, deletion, or alteration of the terms of this Agreement, whether written or oral, shall be valid unless made in writing and formally approved and executed by both parties. 36.0 VENUE 36.1 This Agreement shall be governed and construed in accordance with the laws of the State of California. In the event of any legal action to enforce or interpret this Agreement, the sole and exclusive venue shall be a court of competent jurisdiction located in Orange County, California, and the parties hereto agree to and do hereby submit to the jurisdiction of such court, notwithstanding Code of Civil Procedure section 394. [SIGNATURE PAGE FOLLOWS] • • 33 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • SIGNATURE PAGE IN WITNESS WHEREOF, the parties hereto have executed this Agreement as follows, to be effective on the Effective Date as set forth above. "CARE AMBULANCE SERVICE, INC. ": Sign: Date: ? , 6 Name: Rick Richardson Title: Co -CEO "ORANGE COUNTY FIRE AUTHORITY ": By: t 1)J1 C Date: Don McCay , Chairman Orange County Fire Authority • Board of Directors APPROVED AS TO FORM: Terry C. Andrus General Counsel By. Signa e ATTEST: / By: d , . 7 erry A/+ e ► ,f rk of re Authority • 34 Agreement Between Orange County Fire Authority and Care Ambulance For Provision of Fire/EMS Emergency Ambulance Transportation and Related Services Within EOA No. 21 643201 2 • EXHIBIT "A" DEPICTION OF SUBJECT EOA • • 643201 2 (....**.*-- 40;) • 1 CRA NE ©©TY IFoRE AUTKO DTY EXCLUSIVE OPERATING AREA 21 I 11114 o (D I Lag BILL — .■ii irmilliM -,..- 1,,-- 1 411111 inigat mm,,& .." -- __ riling mil % 1 ra 1 -......- I .. , li \; 4 ' ; a0 MMij R ®'!'�► ® ®!� �� AV 1 s 1 im u „-- - SEAL, - - m, d P .:BEAcH z/ , :,. li , , , II 6 7, e :-- - -y o il , 11, it p I V i l 914, IN IN MEM SUNSET I '1 BEACH ' > .-. � Y H ' 1 '� ri • _::::,...,...,,_.,.,,, .. .,72. GI \\-...... lir 27 -NOV -2006 v\ ConvertedOgnFdes \CoMaps \soa27.dgn • EXHIBIT "B" OCFA 2008 FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES REQUEST FOR PROPOSALS (RFP NO. JR1494) • 0 643201 2 • ORANGE COUNTY FIRE AUTHORITY 1 Fire Authority Road, Irvine 802 MdMr� +�- .y �j i t,,, s ! t*Atg 46 klosve'• • FIRE /EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES PHASE 2 PROPOSAL, GRADING, RECOMMENDATION AND SELECTION RFP # JR1494 DATE OF ISSUANCE • September 19, 2008 Revised 9 -19 -08 TABLE OF CONTENTS • PAGE SECTION I - GENERAL INFORMATION 1 BACKGROUND 1 Orange County Fire Authority 1 Orange County EMS 1 SCOPE OF SERVICES 3 RFP PROCESS 4 NOTICE INVITING PROPOSALS 4 PUBLIC BIDDING STATUTES 4 COST OF PREPARATION 5 UNDERSTANDING PROPOSAL 5 CONTRACTOR SELECTION AND AWARD 6 SECTION II — ADMINISTRATION 7 BID PROPOSAL SUBMISSION PROCESS 7 Phase I — Prequalification 7 • Phase 2 — Proposal, Grading, Recom mendation and Selection 8 MANDATORY BID PROPOSAL PRE - SUBMISSION CONFERENCE 8 BID PROPOSAL SUBMISSION REQUIREMENTS 9 Bid Proposal Submission Due Date 9 Bid Proposal Submission Format 10 COMPLIANCE 10 MULTIPLE EOA SUBMISSIONS 10 PUBLIC OPENING OF BID PROPOSALS 11 Bid Proposal Opening 11 Announcement 11 Late Submission 11 BID PROPOSAL EVALUATIONS 11 Proposal Grading Panel 11 Competitive Process 12 ADMINISTRATIVE 13 Bid Proposal Deposit 13 OCFA Travel Expenses 13 • i • Oral Presentations 13 Proprietary Information 13 Voluntary Withdrawal of Bid Proposal 14 Delayed or Cancellation of RFP Process 14 BID PROPOSAL REJECTION 15 AWARD PROTEST 16 PROPOSED SCHEDULE OF EVENTS (ESTIMATED) 17 SECTION III - GENERAL TERMS AND CONDITIONS 18 CONTRACT DOCUMENTS 18 CONTRACT MODIFICATION AND AMENDMENTS 18 CONTRACT ADMINISTRATION 19 CONTRACT EFFECTIVE DATE 19 CONTRACT TERM 19 Term 19 Termination 19 • INSURANCE 20 NON - COLLUSION CERTIFICATE 20 SECTION IV - OPERATIONAL STANDARDS, PROCEDURES, AND PERFORMANCE REQUIREMENTS 21 EMERGENCY RESPONSE COMMUNICATIONS SYSTEM 21 Compliance with Laws 21 Communications Requirements 21 800 MHz County -wide Coordinated Communications System 22 CAD Interface 22 System Upgrades 22 VEHICLE COMMUNICATIONS 23 800 MHz Mobile Radio 23 Mobile Data Computer System 23 SERVICE HOURS 25 Service 25 • Field Supervisor 25 ii RESPONSE TIMES 25 • General Requirem ents 25 Response Time Measurement 25 Definition of Geographical Areas & Response Priority Codes 25 Response Times Required 26 Call Cancellation 27 GENERAL PROVISIONS 27 Performance 27 Conflict of Interest 27 CAAS Accreditation 27 HIPAA Compliance Plan 27 INTERNAL MEDICAL QUALITY CONTROL 29 SECTION V — PERSONNEL 30 PERSONNEL REQUIREMENTS 30 Employee Performance 30 Field Training Officers 30 • Training 30 SECTION VI - SUPPLIES, EQUIPMENT AND VEHICLES 31 SUPPLIES AND EQUIPMENT 31 Standards 31 Standard Inventory 31 Desirable, but not required, Equipment 31 Personal Safety Equipment 31 VEHICLES AND MAINTENANCE 32 Standards 32 Modular (Type III) 32 Inspection 33 Maintenance 33 Restraint Devices 33 Additional Vehicle Equipment 33 • iii • SECTION VII - RATES FOR AMBULANCE SERVICE 34 BLS AND ALS SERVICE RATES 34 Maximum BLS Service Rate 34 Maximum ALS Service Rate 34 ALS Reimbursement Rate 35 Medicare Patients 35 Annual Adjustments 36 Current ALS Reimbursement Rate 36 Medical Supply Reimbursement Rate 36 Zero Pay Patient 36 Risk of Non - Payment 37 Medicare Patients 37 BILLING, AUDIT AND ACCESS TO RECORDS 37 Billing System 37 Accounting 38 Responsibility for Submission of Claims 38 CONTRACTOR MONTHLY PAYMENTS 38 • Monthly Payments to OCFA 38 Zero Pay Patient Exemption Requests 39 SECTION VIII - BID PROPOSAL SUBMISSION FORMAT 40 Title Page 41 Binder Tab #1 Cover Letter 42 Binder Tab #2 Bid Deposit 43 Binder Tab #3 Table of Contents 44 Binder Tab #4 Notification of Provider Prequalification 45 Binder Tab #5 Emergency Response and Vehicle Com munication System 46 Binder Tab #6 Service Rates 48 Binder Tab #7 On -Board Equipment and Supplies 49 Binder Tab #8 Vehicle and Equipment Maintenance Program 50 Binder Tab #9 Personnel and Training 51 Binder Tab #10 Driver Training 53 • Binder Tab #11 Internal Medical Quality Control 54 iv Binder Tab #12 Billing and Collection Practices 55 • Binder Tab #13 HIPAA Compliance Plan 56 Binder Tab #14 Corporate Com pliance Plan 57 Binder Tab #15 Compliance with Monthly Payments 58 Binder Tab #16 911 Fire /EMS Resume 59 Binder Tab #17 Conflict of Interest Certification 60 Binder Tab #18 Statement of Truth 61 Binder Tab #19 Non - Collusion Certificate 62 Binder Tab #20 CAAS Certification 63 Binder Tab #21 Overall Operational System and Program Design 64 Binder Tab #22 Ambulances Proposed for Each EOA 66 Binder Tab #23 Response Time Requirements 68 Binder Tab #24 Mutual Aid Provider 69 Binder Tab #25 Plan for Takeover of Service /Start-up 70 Binder Tab #26 Letters of Reference 71 Binder Tab #27 Photographs (optional) 72 SECTION IX — APPENDICES 73 • A TITLE PAGE 74 B TABLE OF CONTENTS 75 C SELECTION AND CONTRACTING AUTHORITY 76 D ESTIMATED TRANSPORT VOLUMES BY EXCLUSIVE OPERATING AREA 77 E EXCLUSIVE OPERATING AREAS AND CORRESPONDING MAP 78 F PROPOSED (DRAFT) MODEL EXCLUSIVE OPERATING AREA AGREEMENT 79 G SAMPLE QUARTERLY RESPONSE TIME REPORT 80 III v • SECTION I - GENERAL INFORMATION BACKGROUND Orange County Fire Authority The Orange County Fire Authority ( "OCFA ") is a governmental entity providing fire and life safety services to over one million residents within the County of Orange, California. OCFA is a Joint Powers Agency ( "JPA ") organized pursuant to the provisions of Article 1, Chapter 5, Division 7, Title I (commencing with Section 6500) of the California Government Code. OCFA consists of 22 member cities and the County of Orange. Each OCFA JPA member agency individually has the statutory ability to provide fire suppression, protection, prevention and related and incidental services, including emergency ambulance response services, within their respective jurisdictions. By entering into a Joint Powers Agreement, each JPA member agency vested OCFA with the III power to exercise each member agency's legal ability to provide fire suppression, protection, prevention and related and incidental services, including emergency medical and transportation services, and other fire related services authorized by law within their respective jurisdictional boundaries. Each OCFA JPA member agency has elected to jointly exercise their powers to provide for such services through the formation of OCFA. Orange County EMS The Legislature has enacted the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (EMS Act), which creates a comprehensive statutory system governing virtually every aspect of prehospital emergency medical services. The purpose of enacting the EMS Act was to achieve state -wide coordination and integration of prehospital emergency medical services. The EMS Act accomplishes this integration through what is essentially a two- tiered system of regulation. At the state level, the Emergency Medical Services Authority (EMS Authority) performs a number of different functions relating to the coordination of EMS throughout the • 1 Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • state. The second tier of governance under the EMS Act is occupied by counties and their local EMS agency (LEMSA). The EMS Act authorizes each county's LEMSA to develop an emergency services program. Each county developing such a program is required to designate the county health department as the local EMS agency. In Orange County, this function is performed by Orange County EMS, a division of the County Health Care Agency (OCEMS). All Orange County providers of prehospital emergency medical services are required to operate within the local EMS system developed by OCEMS. The Orange County Board of Supervisors designated OCEMS as the LEMSA for purposes of administering the local EMS Plan within the County. The County allows cities to administer their EMS /ambulance programs in coordination and cooperation with the local EMS Plan and OCEMS. In 1985, the County of Orange adopted County model ambulance ordinance no. 3517, which is a mechanism for licensure of emergency medical transport services and for establishing transport service areas. The County adopted Ordinance No. 3517 ( "model Ambulance Ordinance ") with the intention that it serve as a model city ambulance ordinance for adoption by cities within Orange County. Under this approach, the County's EMS Plan allows cities to provide ambulance transport services in accordance with the model Ambulance • Ordinance. OCFA administers the ambulance programs on behalf of its member agencies. Health and Safety Code §1797.224 authorizes OCEMS to create exclusive operating areas in the development of its local EMS Plan. The creation of exclusive operating areas is authorized by state law, provided a competitive process is utilized to select providers of the services pursuant to the local E MS Plan. Through input and recom mendation by the OCFA EMS Section, exclusive ambulance service areas have been approved and created by OCEMS for all OCFA jurisdictional areas. Only to the extent that OCEMS designates an exclusive operating area and consents to the current Ambulance Ordinance structure may such services be provided by cities. In short, OCFA and /or its member agencies award ambulance service contracts by acting under the authority of OCEMS and its state approved EM S Plan. Unincorporated service areas are subject to annexation or incorporation at any time as determined by the Orange County Local Agency Formation Commission ( "LAFCO "). Exclusive operating areas may be changed, adjusted, or redrawn by OCEMS at any time during the contract period. OCFA has no control over such unanticipated service area and /or jurisdictional 2 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • changes. Any contract awarded pursuant to this RFP that is affected by a service area or jurisdictional change is subject to review and approval by the new governing authority, if any. For reference, the Orange County Fire Authority will hereinafter be referred to as "OCFA." Interested ambulance service operators will be referred to as "Providers." Companies responding to this RFP will be referred to as "Bidders," and ambulance service operators selected to provide services within exclusive operating areas pursuant to this RFP will be referred to as "Contractors." "City" will refer to an OCFA member city only. "County" will refer to the County of Orange. SCOPE OF SERVICES OCFA is soliciting proposals from pre - qualified ambulance service operators for emergency ambulance transportation and related services on behalf of ten (10) OCFA member agencies ( "Biddable EOAs "), identified in Section IX, Appendix E, for the award of exclusive operating contracts in accordance with the specifications set forth in this Request for Proposal ( "RFP "). • OCFA, in cooperation with selected ambulance service providers, will provide on -scene Advanced Life Support ( "ALS ") services, and selected ambulance service providers will provide Basic Life Support ( "BLS ") services and transport patients to medical facilities, when required. Ambulance service operators will also provide emergency transportation for patients requiring ALS; however, ALS patient care will be provided by OCFA paramedics who will accompany the patient/s to the hospital. Based on the specifications, delivery criteria, and competitive process set forth in this RFP, exclusive operating area ( "EOA ") contracts will be awarded to successful Bidders for each of the exclusive operating areas identified in Section IX, Appendix E. Each EOA is assigned a num ber based on a geographical area. The current EOA contracts for emergency medical transportation and related services within the Biddable EOAs are set to expire on August 31, 2009. OCFA is requesting proposals from qualified providers only for the provision of emergency medical transportation and related services commencing September 1, 2009. The contracts awarded under this RFP are for a five (5) year term ending on August 31, 2014. • Fire/EMS Emergency Ambulance Transportation and Related Services 3 Request for Proposals - RFP OR 1494 September 19, 2008 RFP PROCESS • The 2008 Fire /EMS Emergency Ambulance Transportation and Related Services RFP process encompasses two separate and distinct components. The first is Phase 1 — the Prequalification Phase. Interested ambulance providers must satisfy all of the minimum prequalification criteria and requirements to be eligible to submit a proposal under this competitive bid process. Those ambulance providers not satisfying all of the minimum prequalification criteria and requirements are not eligible to continue in the RFP and selection process. The second component is Phase 2 — the Proposal Grading, Recommendation, and Selection Phase. Both components are discussed further in Section II. NOTICE INVITING PROPOSALS Notice of this RFP has been published in multiple media outlets and has been advertised with the Ambulance Association of Orange County (AAOC), the Los Angeles County Ambulance Association, the San Diego Ambulance Association (AAA), and the California Ambulance Association (CAA). Notice of this RFP and prequalification application materials were issued • May 27, 2008. The prequalification application submission period closed on June 26, 2008. Notices announcing eligibility to participate in Phase 2 of this RFP were sent to all approved, pre - qualified ambulance service operators on August 22, 2008. Copies of the RFP will be made available to the pre - qualified providers on or after September 19, 2008. Copies will also be available to the public on or after this date by calling the Clerk of the Authority at (714) 573- 6041. PUBLIC BIDDING STATUTES The award of exclusive operating area contracts for ambulance services under this RFP is not subject to public bidding statutes, although the rates charged for services to be provided will be a factor in the consideration for the award of contracts. At the sole discretion of OCFA, OCFA reserves the right to reject any or all prequalification applications and RFP bids, in whole or in part, and is not bound to accept the lowest bid (or the bid prices for services). OCFA reserves the right to waive qualification application and RFP bid irregularities. A prequalification 4 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • application or RFP bid may be rejected by OCFA if it is in any way incomplete or irregular or if it contains material misrepresentations of fact or omits material information required. COST OF PREPARATION Bidders assume all costs associated with the preparation of their bid proposals and any oral presentations that may be necessary or required throughout the procurement process. UNDERSTANDING PROPOSAL It is the responsibility of each Provider to inquire about any criteria, condition, term, provision, or requirement of the RFP that the Provider does not understand. Responses to inquiries, if they significantly change or clarify the RFP requirements or any aspect of the procurement process, will be forwarded by addenda to all Bidders. OCFA will not be bound by any oral responses to inquiries. By submitting bid proposals, Bidders agree and assure that the RFP and contract terms and conditions are adequate and acceptable, and each Bidder accepts the terms and • conditions of the Contract Documents (as defined in Section III), and indicate their ability and willingness to perform the requested services under such terms and conditions. Any exceptions to the terms and conditions set forth in the Contract Documents should be clearly noted in each Bidder's proposal. Please direct all questions regarding the procurement process, in writing, to: James Ruane, Finance Manager Orange County Fire Authority 1 Fire Authority Road Irvine, California 92602 jimruane @ocfa.org • Fire/EMS Emergency Ambulance Transportation and Related Services 5 Request for Proposals - RFP #JR 1494 September 19, 2008 • CONTRACTOR SELECTION AND AWARD The award of EOA contracts under this RFP will be made by either the OCFA Board of Directors or by individual OCFA member cities that retain provider selection and contracting authority. The contract awards are final and may not be appealed and are not subject to the protest provisions of state public bidding statutes. OCFA and its member cities may, however, reconsider any award upon a finding of good cause at their sole discretion. Selection and contracting authority information, along with estimated transport volumes per EOA, are included in Section IX, Appendices C and D respectively. All Bidders will be notified in writing at the conclusion of the procurement process as to the results of the bid proposal evaluation process and the final award recommendations. Bidders will receive mailed award /non -award notification, which will include the name of the Bidders awarded EOA contracts. • 6 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • SECTION II - ADMINISTRATION BID PROPOSAL SUBMISSION PROCESS The Orange County Fire Authority is committed to providing and maintaining the highest levels of emergency response service as possible to the public on behalf of its member agencies. The provision of emergency ambulance transportation and related services within the Biddable EOAs is a critical part of OCFA's continuing efforts to achieve this objective. The 2008 Fire /EMS Emergency Ambulance Transportation and Related Services RFP process encompasses the following two components: Phase I — Prequalification The purpose of Phase 1 was to insure that only qualified and experienced providers meeting the minimum standards performance criteria were offered the opportunity to participate in Phase 2 of the RFP process. In this phase the Provider's qualifications were reviewed to determine • whether or not the Provider met or exceeded minimum qualifications or did not meet minimum qualification s. On May 27, 2008, OCFA issued the Phase 1 Prequalification application materials to all interested ambulance service operators. Providers not satisfying all of the minimum prequalification criteria and requirements are not eligible to continue in the procurement process and will not be eligible for the award of an EOA contract. Pursuant to the Phase 1 Prequalification application materials, all Providers that intended to submit bid proposals and compete in the procurement process must have submitted complete prequalification applications no later than 10:00 a.m. local time, June 26, 2008, and received prequalification notification from OCFA in order to be considered for the award of an EOA contract. All Providers that submitted prequalification applications were contacted by OCFA and notified in writing as to whether their prequalification applications satisfied the minimum criteria and requirements and whether the Provider was approved to participate in Phase 2 of the procurement process. • 7 Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 Phase 2 — Proposal. Grading, Recommendation and Selection • In Phase 2, proposals are reviewed, evaluated and ranked by the Proposal Grading Panel to determine the best overall proposal for each of the respective EOAs included in this competitive bid process. A recommendation for the awarding of EOAs is made to the OCFA Board of Directors and /or respective cities retaining contracting authority. The OCFA Board of Directors and /or respective cities retaining contracting authority are responsible for the final selection and awarding of EOA contracts. Those Providers who have received written confirmation from OCFA that they have met the minimum requirements to participate in Phase 2 of the RFP process may prepare and submit a bid proposal(s), pursuan t to the requirements, format, and specifications set forth in this RFP. MANDATORY BID PROPOSAL PRE - SUBMISSION CONFERENCE A bid proposal pre- submission conference will be conducted on October 21, 2008. Attendance • at the bid proposal pre- submission conference is mandatory for all pre - qualified ambulance service operators who wish to submit a bid proposal and compete in Phase 2 of the RFP process. The conference will be held at the Orange County Fire Authority, located at 1 Fire Authority Road, Irvine, California 92602. Reservations are required and can be made by calling OCFA EMS Chief Jim Bailey (714) 573 -6070. The purpose of the conference is for OCFA EMS staff: • To respond to questions previously submitted in writing. • To explain the rationale behind any of the RFP requirements. • To review the overall goals and expectati ons of OCFA regarding the R FP. All written inquiries submitted by Providers and the answers given by OCFA staff during the bid proposal pre- submission conference will be posted at www.ocfa.org at the conclusion of the conference; copies will also be made available by the OCFA /EMS Section upon request. Providers who do not attend the bid proposal pre- submission conference, or who do not make arrangements to send a representative to attend the conference, will not be eligible to continue 8 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • in Phase 2 of the RFP process. Questions submitted after the Provider Conference will not be answered, though OCFA shall reserve the right to answer post- Provider Conference questions should it determine, in its sole discretion, that such information is necessary to ensure an effective and fair RFP process. In such an event, both the question and answer will be put in writing and mailed to all proposers. BID PROPOSAL SUBMISSION REQUIREMENTS Bid Proposal Submission Due Date In order to compete in the RFP process, a signed original bid proposal plus nine (9) copies of the proposal must be submitted by pre - qualified ambulance service operators to the Clerk of the Authority no later than 10:00 a.m. December 11. 2008 ( "Submission Due Date ") for a public opening. Bid proposals must be hand - delivered or sent via courier /messenger to: • Clerk of the Authority Orange County Fire Authority 1 Fire Authority Road Irvine, California 92602 Do not send bid proposals via U.S. Mail. All proposals must be sealed and submitted to OCFA in accordance with the required format and in the manner prescribed herein by the Submission Due Date. Providers are strongly encouraged to submit their bid proposals in advance of the due date to avoid the possibility of missing the deadline due to unforeseen circumstances. Providers assume the risk of the methods of delivery chosen. OCFA assumes no responsibility for any delays whatsoever caused by any courier, delivery, or messenger service. Bid proposals must be date and time stamped by the Clerk of the Authority by the 10:00 a.m. Submission Due Date in order to be considered. Additional time will not be granted to any single Bidder; however, additional time may be granted to all Bidders when, at its sole discretion, OCFA determines that circumstances require additional submission time. Bid proposals sent to OCFA via U.S. Mail, • Fire/EMS Emergency Ambulance Transportation and Related Services 9 Request for Proposals - RFP #JR 1494 September 19, 2008 • Fax, or email will NOT be accepted. No amendments, additions, deletions, or alterations to submitted bid proposals will be accepted by OCFA after the Submission Due Date. Bid proposals received after 10:00 a.m. on the Submission Due Date will be returned unopened. Bid Proposal Submission Format To facilitate the bid proposal review process, all bid proposals must strictly adhere to the format, table of contents, titles, page limits, and numbering for requested information items as set forth in Section VIII, Bid Proposal Submission Format. COMPLIANCE Bid proposals that do not strictly adhere to the format requirements and rules set forth herein may be disqualified at the sole discretion of OCFA. All bid proposals must provide answers to all questions and provide complete responses to each and every request item and category as specified in Section VIII. Specific submission data • has been provided for your convenience for each submission item. Bidders are required to supply, at a minimum, the items listed for specific submission. Bidders are permitted, within the prescribed page limits, to submit additional information that it deems helpful in the evaluation and grading process. Failure to provide answers to all questions and complete responses to all requested item categories may result in disqualification. MULTIPLE EOA SUBMISSIONS • Unless restricted by the prequalification letter, Bidders are invited to bid on any number of EOAs. To facilitate this process, Bidders must submit a separate proposal for each EOA in a separate sub - section of Binder Tab #21. Only one Bid Proposal Deposit will be required regardless of the number of EOA proposals submitted. 10 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • PUBLIC OPENING OF BID PROPOSALS Bid Proposal Opening. All bid proposals received prior to the submission due date will be kept unopened and secured in a locked receptacle until the public opening. The public opening will be held on December 11, 2008 at 10:00 a.m. at the Orange County Fire Authority, located at 1 Fire Authority Road, Irvine, Cal ifornia 92602 ( "Public Opening "). Announcement. At the Public Opening, each sealed bid proposal will be opened and the following information will be publicly stated and recorded by the Clerk of the Authority: 1. Name of Bidder (Provider); 2. RFP number; 3. Submission date; 4. General description of service being procured; 5. Name of the authorized individual that signed the bid proposal; and 6. Name of the EOA and EOA number proposed for service. • Late Submission. Bid proposals received after 10:00 a.m. on the Submission Due Date will be returned unopened and will not be considered. BID PROPOSAL EVALUATIONS Proposal Grading Panel. Bid proposals will be reviewed and evaluated by a Proposal Grading Panel appointed by the OCFA EMS Battalion Chief. OCFA staff will not participate as evaluators on the Proposal Grading Panel. The Panel may consist of the following individuals: (1) a non -OCFA member of a fire department that is comparable to OCFA who is knowledgeable about ambulance contracting; (2) a member of the Orange County Fire Chief's Association; (3) a medical professional knowledgeable in emergency medical services; (4) a local EMS agency program manager designee, (OCEMS personnel will not participate as evaluators, but will observe the entire process to ensure a fair and competitive process); (5) a member of the California Ambulance Association who is not affiliated with any of the Bidders and (6) a representative of the city for which the EOA is part of the competitive bid process. • 11 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 0 The Proposal Grading Panel will invite all Bidders to make an oral presentation concerning their proposal, all of which will be videotape recorded. During presentations, the Proposal Grading Panel will listen to the Bidder's presentation and may ask questions of the Bidders and /or request amplification, explanation, or further information regarding their proposal. Each Bidder will be given 30 minutes to make an oral presentation. Additional presentation time may be allotted at the sole discretion of the panel. There will be two, equally weighted, overall sections to the evaluation of each proposal — one section will include those elements of the proposal that pertain to the overall strength and quality of the company as a whole; the other section will contain those elements of the proposal that pertain specifically to the proposal for a given EOA. The final cumulative score will reflect the results of these two sections. The methodology will be further discussed at the mandatory Bidders' Conference. Prior to, during, or after the completion of the grading process, the Proposal Grading Panel may request a site visit. Site visits shall be coordinated by the OCFA EMS Battalion Chief and shall be conducted during the normal business hours of a Provider. • In order for bid proposals to be fairly evaluated, oral presentations and site visits may be conducted, if necessary, to answer questions and clarify information provided in the bid proposal. No rankings, scores, or points will be awarded for oral presentations or site visits. Competitive Process. The Proposal Grading Panel will evaluate and rank each bid proposal according to established criteria. The primary competitive bid criteria for this RFP are: (1) quality of service; (2) level of service; (3) the rates charged for services to be provided; (4) experience; (5) cost, if any, to the awarding agency; and (6) whether a Bidder is responsible. The term "responsible" refers to the quality, fitness, and capacity of the Bidder to perform the proposed services satisfactorily and in accordance with the specifications and delivery criteria set forth herein. At the conclusion of the evaluation process, the Proposal Grading Panel will make a contract award recommendation for each EOA. Recommendations will be presented to the OCFA Board of Directors, or to the member city retaining provider selection and contracting authority, for 12 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP OR 1494 September 19, 2008 0 approval. Qualified, responsible bidders that offer the highest overall level of service, and either meet or exceed the specifications and delivery criteria set forth in the Contract Documents, as determined by the Proposal Grading Panel, will be recommended for award of a contract. The OCFA Board of Directors or member cities (that have not delegated authority to OCFA for provider selection and contracting authority) retain the right and responsibility for final selection of the Provider and awarding of the EOA contracts. ADMINISTRATIVE Bid Proposal Deposit. All bid proposals must include a $2,500 deposit in the form of a cashier's check made payable to the Orange County Fire Authority ( "Bid Proposal Deposit "). Bidders are only required to submit one deposit regardless of the number of EOAs bid. Bid Proposal Deposits will be refunded in their entirety to all Bidders that voluntarily withdraw their proposal prior to the Public Opening, and at the conclusion of the RFP Proposal Grading Panel • process to all Bidders who complete the evaluation. Bid proposals that are voluntarily withdrawn after the Public Opening, rejected, or disqualified will result in 100% deposit forfeiture. OCFA Travel Expenses. Bidders may be required to pay reasonable travel expenses for three (3) OCFA, or awarding agency, personnel and /or consultants to inspect Bidder facilities, operations, vehicles, equipment, personnel, and /or records outside of Orange County at any time during the procure ment process. Oral Presentations. Oral presentations may be requested of all Bidders at any time throughout the procurement process. Proprietary Information. All bid proposals and documents submitted in response to this RFP shall become the property of OCFA. It is the responsibility of each Bidder to clearly identify any and all information contained in their bid proposal that it considers to be confidential and /or proprietary. To the extent that OCFA agrees with that designation, such information will be held in confidence whenever legally possible. All other information will be considered public. • 13 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • However, bid proposals, and information relating to those bid proposals, will not be disclosed to the public or be subject to disclosure pursuant to the California Public Records Act (Government Code §6250 et seq.) during the deliberative process until such time as evaluations have been completed, final award recommendations have been made, and contracts are awarded. In the event that a demand for disclosure of information designated as "confidential and /or proprietary" by the Bidder is made, OCFA will notify the Bidder in writing of such demand and shall furnish a copy of OCFA's written response to the requestor. Bidders may then pursue, at their sole cost and expense, all appropriate legal action necessary to maintain the confidentiality of such information. Voluntary Withdrawal of Bid Proposal. A Bidder may, upon written notice to OCFA, voluntarily withdraw their bid proposal at any time prior to the Public Opening. Withdrawal of a bid proposal will be subject to verification of the identity of the requestor and confirmed with the Bidder's authorized representative. A receipt for the return of any unopened bid proposal will be prepared by the Clerk of the Authority and signed by the Bidder's authorized representative. Bidders requesting to withdrawal their bid proposal prior to the Public Opening will be entitled to a full refund of their Bid Proposal Deposit. Bidders requesting to withdraw their bid proposal after the Public Opening will forfeit their Bid Proposal Deposit and the same return procedures will be followed. Delay or Cancellation of RFP Process. This RFP process may be delayed or cancelled at any time during the procurement process prior to the award of a contract for any EOA or for all EOAs when it is determined by OCFA, at its sole discretion that delay or cancellation is in the best interest of OCFA or any of its member agencies. This may include a determination that the number of responses to the RFP is inadequate. Should administrative difficulties delay the contract award beyond the stated deadline for contract award, the responders will be notified before that date to determine their willingness to remain a part of the competitive process even though the contract award is extended. This will avoid the need for re- advertisement. 14 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BID PROPOSAL REJECTION At the sole discretion of the OCFA Fire Chief, OCFA reserves the right to reject any and all bid proposals, in whole or in part, and may direct the issuance of a new RFP in the future. OCFA is not bound to accept the best ranked proposal (or the lowest proposed prices for services). By way of example, a bid proposal may be rejected by OCFA, at its sole discretion, for failure to comply with the requirements set forth in this RFP, or for other reasons determined by OCFA that create or may create a hindrance or impairment to the objective evaluation of such proposal. 1. OCFA reserves the right, at its sole discretion, to waive any and all bid proposal irregularities or informalities that OCFA deems correctible or otherwise not relevant. In the event of a bid proposal irregularity or informality, the Bidder may be required to immediately correct and /or resubmit, in whole or in part, its bid proposal. 2. A bid proposal may be rejected by OCFA, at its sole discretion, if it is in any way • incomplete or irregular, or if it contains material misrepresentations of fact or omits material information required. 3. A bid proposal may be rejected or disqualified by OCFA upon substantial evidence that the Bidder has engaged in corrupt, fraudulent, and /or illegal practices involving the performance, administration, or award of a similar contract in another jurisdiction. 4. Bid proposals that take exception to the RFP specifications and /or delivery criteria, or terms and conditions of the Contract Documents, may be rejected. 5. Bid proposals that do not provide all information requested in this RFP may be rejected as non - responsive. In the event a bid proposal is rejected, OCFA will notify the Bidder in writing explaining the specific reason(s) for the rejection. • Fire/EMS Emergency Ambulance Transportation and Related Services 15 Request for Proposals - RFP #JR 1494 September 19, 2008 • AWARD PROTEST The award of EOA contracts under this RFP will be made by either the OCFA Board of Directors or by individual OCFA member cities that retain provider selection and contracting authority. The contract award decisions are final, may not be appealed, and are not subject to the protest provisions of the state public bidding statutes. However, at its sole discretion, the OCFA Board of Directors, or member cities where applicable, may reconsider any contract award upon a finding of good cause prior to commencement of services. 16 1114111 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • PROPOSED SCHEDULE OF EVENTS (ESTIMATED) Phase 1: Prequalification Process: Issuance of Notice Inviting Proposals May 9, 2008 Issuance of Prequalification Application: May 27, 2008 Prequalification Application Submission Deadline: June 26, 2008 Prequalification Notification: August 22, 2008 Prequalification Denial - Appeal Deadline: September 1, 2008 Appeal Panel Hearings September 15, 2008 Phase 2: Proposal Submission, Grading and Selection of Providers Process: Issuance of Request for Proposals: September 19, 2008 Pre - Submission Conference Questions Deadl ine: October 3, 2008 • Mandatory Bid Proposal Pre - Submission Conference: October 21, 2008 Bid Proposal Submission Due Date: December 11, 2008 Bid Proposal Submission Public Opening: December 11, 2008 Proposal Grading Panel Evaluation Process: December 11, 2008 - January 31, 2009 On -site Proposal Grading Panel Evaluation Process January 12 -16, 2009 (includes site visits /oral presentations) Proposal Grading Panel- Recommendations: February 6, 2009 Final Selection and Contract Awards March 26, 2009 Execution of Contracts April -May, 2009 Contract Performance Start Date: September 1, 2009; 12:00 a.m. • 17 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • SECTION III - GENERAL TERMS AND CONDITIONS CONTRACT DOCUMENTS The draft EOA contract (Model Agreement) contained in Section IX, Appendix F, must be agreed to and signed by all Bidders who are awarded contracts. The contract will designate the successful Bidder as the exclusive provider of emergency ambulance transportation services within a given EOA. The draft contract is, however, subject to modification prior to award. The contracts entered into by all successful Bidders shall consist of: (a) the RFP, including the Prequalification document submittal (hereinafter collectively the "RFP "), (b) the signed, original bid proposal(s) subm itted ( "Bid Proposal "), and (c) the executed EOA contract, which shall all be referred to collectively herein as the "Contract Documents." The RFP and the Bid Proposal(s) submitted by the successful Bidders will be incorporated and made a part of the contract. All provisions of the RFP and the Bid Proposal(s) shall be binding on the parties. Should any inconsistency or ambiguity occur or exist in the Contract Documents, the provisions of the contract, then the provisions of the RFP, then the provisions of the original bid proposal shall control. • CONTRACT MODIFICATION AND AMENDMENTS The parties may adjust the specific terms of the Contract Documents where the modification or amendment is not a material change to the contract, as agreed upon by the parties. Any modification or amendment proposed by the Contractor must be submitted in writing to OCFA for consideration. The decision to modify or amend any term or condition of the Contract Documents shall be at the sole discretion of OCFA and /or the Awarding Agency, if applicable. Any agreed upon modification or amendment must be in writing, approved by the OCFA Fire Chief, and signed by all parties, and may be subject to approval by OCEMS and the State EMS Authority. 18 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • CONTRACT ADMINISTRATION The OCFA Fire Chief, or his designee, shall be the authorized representative for each OCFA member agency in all matters pertaining to the RFP process. All contracts awarded pursuant to this RFP for the provision of emergency ambulance transportation and related services within the OCFA jurisdictional areas shall be administered by the OCFA Fire Chief, or his designee. CONTRACT EFFECTIVE DATE The effective date of the EOA contracts awarded pursuant this RFP shall be 12:00 a.m., Tuesday, September 1, 2009, ( "Effective Date ") at which time Contractors will assume full responsibility for the provision of emergency ambulance transportation services within their designated EOA(s). The Effective Date may be postponed at the sole discretion of the OCFA Fire Chief in order to protect public health and safety in the event a successful Bidder /Contractor is for any reason unable to com mence performance at that time. • CONTRACT TERM Term. The exclusive contracts awarded pursuant to this RFP are for a five (5) year term, commencing on September 1, 2009 at 12:00 a.m. and ending on August 31, 2014 at 11:59 p.m., with no extensions, unless there are unavoidable or unforeseeable circumstances beyond the control of OCFA that would preclude a new RFP process and contract award. In such circumstances, the contract may be extended up to one addit ional year. Termination. The contracts awarded may be terminated by either party upon one hundred eighty (180) days written notice. Contractors shall provide such written notice to the City and OCFA. Should a contract be terminated at any time during the contract term, OCFA shall contact the other qualified bidders for the respective EOA and determine their interest and willingness to provide service to the EOA/s in question. Bidders must be willing to honor the terms of their original RFP proposal for that specific EOA. A new Contractor will be selected from among those original bidders. However, the operational area in question may then be considered a "non- exclusive operating area" because no new RFP was conducted following the • Fire/EMS Emergency Ambulance Transportation and Related Services 19 Request for Proposals - RFP #JR 1494 September 19, 2008 • termination of the original Contractor. Should no Bidders from the 2008 RFP desire to contract for the EOA vacated by the original Contractor of the EOA, a new Request for Proposal will be developed for a competitive bid process. INSURANCE Upon execution of the contract, Contractors must provide, to the satisfaction of OCFA, certificates of insurance and endorsements evidencing the policy or policies of insurance in the types and amounts fulfilling the requirements set forth in the contract. NON - COLLUSION CERTIFICATE Each Bidder must execute and submit with each bid proposal the Non - Collusion Certificate in Section VIII. If there is reason to believe that collusion exists among Bidders, all bid proposals submitted will be rejected and none of the participants in such collusion will be considered in • any future RFP. 20 411 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • SECTION IV - OPERATIONAL STANDARDS, PROCEDURES, AND PERFORMANCE REQUIREMENTS EMERGENCY RESPONSE COMMUNICATIONS SYSTEM Compliance with Laws. Prior to the Effective Date, Contractors must install, provide, operate, and maintain at their sole cost and expense, an ambulance dispatch center, telephone service, including ring -down line, 800 MHz mobile radio system, mobile data computer /radio system, personal computer, and a secondary dispatch response system (hereinafter collectively referred to as "Emergency Response Communications System ") according to the terms, conditions, and requirements contained in this Section. Contractors' Emergency Response Communications System must comply with all federal, state, and local laws, rules, statutes, and regulations, including licensing requirements, concerning the broadcast of public safety and emergency communications over approved Federal Communications Commission ( "FCC ") frequencies at all times during the term of the contract. • Communications Requirements. Contractors must comply with the following requirements concerning the installation, use, operation, and maintenance of their Emergency Response Communications System: 1. Prior to the Effective Date, Contractors must obtain any and all FCC licenses and authorizations required for the engineering, assembling, installation, use, operation, and maintenance of the Emergency Response Communications System, which is necessary to provide emergency ambulance response sery ices under the contract; 2. Contractors must provide documentation, as set forth in Section VIII, describing in detail their operational design for their Emergency Response Communications System and methods proposed for dispatching ambulances under the contract; 3. Emergency Response Communications System must be operated and maintained by Contractors twenty -four (24) hours per day, seven (7) days per week; III Fire/EMS Emergency Ambulance Transportation and Related Services 21 Request for Proposals - RFP #JR 1494 September 19, 2008 III 4. Contractor dispatch centers must be equipped with a secondary, emergency back -up ,electrical system to insure uninterrupted twenty -four (24) service; and, 5. Contractor must provide and maintain, at its sole cost and expense, a dedicated point -to- point telephone ring -down line between the OCFA Emergency Communications Center and the Contractor's am bulance dispatch center. 800 MHz County -wide Coordinated Communications System. The Orange County Sheriff - Coroner Department, County of Orange, Communications Division ( "OCC "), currently serves as the central coordination point for the Orange County Emergency Response Communications System. As such, OCC operates, maintains, administers, and oversees the existing 800 MHz County -wide Coordinated Communications System, which is the existing communications network that is responsible for providing emergency response system communications throughout Orange County, thereby, effectively linking emergency response calls for law enforcement, fire, public works, lifeguards, and. public utilities within Orange County on a shared 800 MHz backbone County -wide Coordinated Communications System ( "800 MHz C.C.C.S."). OCFA is one of many participating and subscribing agencies to the 800 MHz C.C.C.S. • Contractors' Emergency Response Communications System must be fully compatible with the 800 MHz C.C.C.S. CAD Interface. At the discretion of OCFA, Contractors must establish and maintain a Computer Aided Dispatch (CAD) interface, or other equivalent electronic data system, that is compatible with the OCFA Emergency Command Center ( "ECC "). This may include, but is not limited to: hardware; software; and telecommunications lines, which shall meet OCFA specifications. Contractors assume all costs associated with the purchase, installation, implementation, operation, and maintenance of a CAD interface. Contractors will be given six (6) months to establish and assume operation of a CAD interface, if OCFA determines that such / interface is required. System Upgrades. As OCFA upgrades its emergency response communications systems with new or improved technologies, Contractors must likewise upgrade their Emergency Response Communications System with comparable and compatible technology, at their sole cost and expense. 22 Ill Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • VEHICLE COMMUNICATIONS 800 MHz Mobile Radio. Contractors must install and maintain at their sole cost and expense, an OCFA approved 800MHz mobile radio in the front passenger area (with a remote head in the rear patient area) of each ambulance that will be used for patient transport in the performance of the contract. The 800M Hz mobile radios with a pre - identified radio identifier and at the discretion of the OCFA, configured to send status and message data, are to be used by Contractors' EMTs and ambulance personnel to communicate response status with OCFA dispatch and by OCFA paramedics to communicate with base and receiving hospitals during patient transport. Contractors must comply with the following 800 MHz mobile radio requirements: 1. Contractors must obtain all necessary licenses, permits, and /or approvals from OCC (and any other applicable licensing or permitting agency) to operate and maintain their 800 MHz mobile radios as required herein in conjunction with the 800 MHz C.C.C.S.; 2. Contractors must comply with all federal, state, and local laws, rules, statutes, and • regulations governing the operation of 800 MHz mobile radios, including compliance with 800 MHz C.C.C.S. Standard Operating Procedures; 3. Contractors must ensure that their 800 MHz mobile radios are pre- assigned to a vehicle with a pre - identified radio identifier and are configured to send status and message data compatible with OCFA SmartNet Information Management System (SIMS), and must include an OCFA approved and issued Motorola DEKbox with 8 status /message keys to transmit unit status (e.g., en route, on scene, and available status functions); OCFA will configure the SIMS system to enable this feature on all Contractor radios enabled on the 800 MHz C.C.C.S.; and 4. All Contractor 800MHz mobile radios must meet OCFA, OCC, ECC, 800 MHz C.C.C.S., and OCEMS specifications and requirements. Mobile Data Computer System. Contractors must install and maintain, at their sole cost and expense, an OCFA approved and issued mobile data radio at Contractors' dispatch center for Ill Fire/EMS Emergency Ambulance Transportation and Related Services 23 Request for Proposals - RFP #JR 1494 September 19, 2008 • purposes of sending and receiving electronic emergency dispatch information, instructions, and call status. Contractors must comply with the following mobile data radio system requirements: 1. MDC Radio: Upon the award of a contract and prior to the Effective Date, Contractors must pay OCFA a one time, non - refundable communications start -up fee of $3,500, which shall cover the following: (a) OCFA- issued and owned mobile data radio; (b) OCFA- issued mobile data application software; (c) mobile data installation; (d) mobile data programming; and (e) Mobile Data Radio and antenna to be installed at the Contractor's expense, as specified by OCFA. All communications equipment issued to Contractors by OCFA pursuant to this Section shall remain the property of OCFA. The communications systems described in this Section must be installed and fully operational prior to the Effective Date. Upon contract termination, all OCFA- issued communications equipment must be returned to OCFA within thirty (30) days. This fee may be waived by OCFA if Contractor currently meets the specified requirements of this paragraph. 2. Annual MDC Fee: Contractors must pay OCFA a $250 annual fee for MDC system • operation and maintenance, which shall be due and payable upon contract award and annually thereafter. 3. Personal Computer: Contractors must provide, at their sole cost and expense, and as part of their Emergency Response Communications System, a personal computer having the following minimum specifications: Intel Pentium 500 MHz or greater; 10.0 GB Hard Drive; 256 Mb SDRAM; 2000XP OS; Color display VGA; Com Ports — 1 serial, 1 USB, 1 Parallel; CD ROM; and, Keyboard — Standard Qwerty 104. 4. Mobile Application Software: Motorola Tx Messenger v3.0 software or greater as specified by OCFA. 24 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • SERVICE HOURS Service. Contractors must provide twenty -four (24) hour emergency ambulance transportation and related services within designated EOAs, at or above the level agreed to in the Contract Documents, seven (7) days a week during the term of the contract. Field Supervisor. Contractors must have an authorized field supervisor available to OCFA personnel, either by radio or in person, and physically present within the County of Orange, on a twenty -four (24) hour, seven (7) day per week basis during the term of the contract. RESPONSE TIMES General Requirements. Contractors must respond to OCFA's requests for emergency ambulance transportation service within the response times set forth in this Section. Response times will be calculated as the actual elapsed time in minutes from the moment the request is • received by the Contractor's dispatch center to the time that the Contractor's first ambulance arrives on scene. Where multiple ambulances are dispatched to the same emergency scene, only the response time of the ambulance arriving first will be counted for purposes of calculating the response time. Contractors will be responsible for providing quarterly response time reports to OCFA and OCEMS. Response Time Measurement. Response times are measured in full minutes, rounded upward. For purposes of measuring compliance and for the imposition of any penalties, any partial minute will be rounded to the next full minute. For example, a response time of 10:01 or 11:00 is counted as eleven minutes. Definition of Geographical Areas & Response Priority Codes. The following geographical areas, response priority codes, and definitions will apply with regard to calculating response times (based upon changes in population densities, these geographical area definitions may be changed at the sole discretion of OCFA; OCFA will advise Contractors in writing when these changes occur): 1111 Fire/EMS Emergency Ambulance Transportation and Related Services 25 Request for Proposals - RFP #JR 1494 September 19, 2008 Ill 1. Metro /Urban: Those areas with a population density greater than 100 persons per square mile; 2. Suburban /Rural: Areas with a population density of 7 to 100 persons per square mile. These areas generally include the roads and contiguous canyon areas of the local mountain ranges, including: Brea Canyon, Tonner Canyon, Carbon Canyon, Modjeska Canyon, Silverado Canyon and Trabuco Canyon; the areas of Santiago Canyon Road between Jamboree and Live Oak Canyon Road; and the Ortega Highway (Highway 74) between La Plata Avenue and the County line; 3. Wilderness: Those areas with a population density of less than 7 persons per square mile. These are generally the areas of the Cleveland National Forest within the County of Orange, with the exception of incidents on or immediately adjacent to Highway 74; 4. Code 2: Emergency ambulance vehicles responding to an emergency scene or request for service expeditiously, without red lights and sirens on. • 5. Code 3: Emergency ambulance vehicles responding to an emergency scene or request for service with red lights and sirens on. Response Times Required. Contractors must strictly adhere to the following required response times at a quarterly compliance rate of ninety percent (90 %) in each Code 2 and Code 3 category, which shall be reported separately: 1. Metro /Urban Requirements: i) Code 3- Response time must not exceed ten (10) minutes, zero (0) seconds. ii) Code 2- Response time must not exceed fifteen (15) minutes, zero (0) seconds. 2. Suburban /Rural Requirements: i) Code 3- Response tim e must not exceed twenty (20) minutes, zero (0) seconds. ii) Code 2- Response time must not exceed twenty -five (25) minutes, zero (0) seconds. 26 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP OR 1494 • September 19, 2008 • 3. Wilderness Requirements: i) Code 3- Response ti me must not exceed thirty (30) minutes, zero (0) seconds. ii) Code 2- Response tim e must not exceed forty (40) minutes, zero (0) seconds. CaII Cancellation. In the event a call for service is cancelled prior to arrival, the response will be considered to be within the response time requirement so long as the elapsed time between the call for service and the cancellation does not exceed the applicable response time requirement. In the event the elapsed time between the call for service and the cancellation is in excess of the applicable response time requirement, the call will be considered late. GENERAL PROVISIONS Performance. The most important aspect of this RFP is that it will result in the award of contracts that stress "performance." Contractors must demonstrate a continuous effort to detect and correct service level performance deficiencies, as determined by OCFA, and to continuously upgrade the performance and reliability of the EMS system within their designated • EOA. Clinical and response time performance must be extremely reliable, with equipment failure and human error held to an absolute minimum through constant attention to performance, protocol, procedure, performance auditing, proper management oversight, employee training, continuing education, and prompt and definitive service level corrective actions pl ans. Conflict of Interest. Bidders must certify that they are not, and will not be, violating either directly or indirectly any conflict of interest statute, rule, or regulation by their performance of the services described herein. CAAS Accreditation. Commission on Accreditation of Ambulance Services ( "CAAS ") accreditation will be a factor in the overall grading and evaluation process. Please see Section VIII for more detail on submission requirements for those Bidders that are CAAS accredited. HIPAA Compliance Plan. Effective April 14, 2003, or such other implementation date established by law, to the extent that the parties have a "business associate" relationship, the parties shall carry out their obligations under the contract in compliance with the privacy regulations published at 65 Federal Register 82462 (December 28, 2000) (the "Privacy ID Fire/EMS Emergency Ambulance Transportation and Related Services 27 Request for Proposals - RFP OR 1494 September 19, 2008 • Regulations ") pursuant to Public Law 104 -191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq., as amended ( "HIPAA "), to protect the privacy of any personally identifiable, protected health information ( "PHI ") that is collected, processed or learned as a result of the services provided pursuant to the contract. In conformity therewith, both parties must agree that they will: 1. Not use or further disclose PHI except: (i) as permitted under the contract (that is, for the purpose of maintaining accurate records of the services provided pursuant to the contract and for the billing of such services to patients, guarantors, insurers, carriers or other responsible parties; the issuance of reports to the other party pertaining to same; and related administrative functions pertaining to these activities); (ii) as required for the proper management and administration of ALS and BLS in their capacity as HIPAA "Business Associates" of each other; or (iii) as required by law; 2. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by the contract; • 3. Report to each other any use or disclosure of PHI not provided for by the contract of which a party becomes aware; 4. Ensure that any agents or subcontractors to whom either party provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to both parties with respect to such PHI; 5. Make PHI available to the individual who has a right of access as required under HIPAA; 6. Make available for amendment and incorporate any amendments to PHI when notified to do so by either party; 7. Make available to either party the information required to provide an accounting of the disclosures of PHI made by the one party on the other party's behalf, provided such 28 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • disclosures are of the type for which an accounting must be made under the Privacy Regulations; 8. Make their internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining either party's compliance with HIPAA and the Privacy Regulations; and 9. At the termination of the contract, return or destroy all PHI received from, or created or received by one party on behalf of the other party. In the event the return or destruction of such PHI is infeasible, both parties' obligations under this Section shall continue in full force and effect so long as either party possesses any PHI, notwithstanding the termination of the contract for any reason. Bidders are required to submit a copy of its HIPAA Compliance Plan, which shall include Business Associate Agreements, evidence that employees have signed a confidentiality • statement and have undergone privacy training. Please see Section VIII for submission requirements. INTERNAL MEDICAL QUALITY CONTROL Contractors must establish a Continuous Quality Improvement ( "CQI ") program directed at, but not limited to, effective administration and management of clinical performance, response time performance, driver performance, dispatch performance, and for all other BLS service levels. Contractors must submit to the OCFA EMS Section Battalion Chief quarterly summary reports showing the results of all CQI program performance elements, in a form approved by the OCFA EMS Section Battalion Chief. Bidders are required by this RFP to submit a description of Bidder's Internal Medical Quality Control program or similar program. Please see Section VIII for submission requirements. OP Fire/EMS Emergency Ambulance Transportation and Related Services 29 Request for Proposals - RFP #JR 1494 September 19, 2008 III SECTION V - PERSONNEL PERSONNEL REQUIREMENTS Employee Performance. Contractors must employ only competent and trained personnel, and shall provide a sufficient number of employees to perform the services provided under the Contract Documents. Each Contractor must comply with the following personnel requirements: 1. All Contractor employees and ambulance personnel shall be sufficiently trained and capable to ensure the safe and proper discharge of their service responsibilities. 2. All Contractor ambulance personnel must possess a valid and current California Emergency Medical Technician (EMT) —I certificates and a valid California Driver's Licenses in the proper class, including any required certifications, and must be compliant with all relevant provisions of the California Vehicle Code, Health and Safety Code, and all other laws and county regulations applicable to emergency ambulance response personnel. • 3. All Contractors must have an employee alcohol and drug program that includes at a minimum, an alcohol and drug free workplace policy, and an employee alcohol /drug- testing program that complies with the U.S. Department of Transportation requirements to the extent allowed by law, including random alcohol and drug testing. Any Contractor employee found working under the influence of alcohol or drugs must be immediately removed from performing any further duties under the Contract Documents. The alcohol and drug program requirements are discussed in more detail in the Model Agreement in Appendix F. Field Training Officers. Contractor is required to submit information regarding its field training officer ratio to EMTs and other ambulance personnel, as well as its training program of field training officers. Training. Please see Section VIII for Bidder submission requirements regarding personnel information, resumes, training programs, and field training officers. 30 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP OR 1494 September 19, 2008 • SECTION VI - SUPPLIES, EQUIPMENT AND VEHICLES SUPPLIES AND EQUIPMENT Standards. All equipment and supplies furnished by Contractors to perform BLS services under the Contract Documents must comply with all federal, state, and local laws, rules, statutes, and regulations applicable to the provision of emergency ambulance transportation, including but not limited to, those BLS equipment and supply standards and protocols established by the OCEMS Medical Director. Such equipment and supplies must be stocked at all times on each'ambulance performing services under the Contract Docum ents. Standard Inventory. In addition to the above equipment and supply standards, Contractors must carry and stock at all times throughout the contract term on each ambulance performing services within an assigned EOA the following emergency medical equipment, which shall all be readily available and accessible from the interior portions of the patient transportation compartment: • • 1. Bag valve mask resuscitator, adult with variable mask sizes; 2. Bag valve mask resuscitator, pediatric with variable mask sizes; 3. Heavy gloves to be used for blood or body fluid protection; 4. Disposable Latex gloves, medium, large and x- large, two (2) boxes; 5. Suction unit that complies with OCEMS policies and procedures; 6. Non - invasive blood pressure device (various cuff sizes, including thigh cuff); 7. Child safety seats (when approved by federal agencies). Desirable, but not required, Equipment. Automated External Defibrillator (in conjunction with trained and qualified employees). Personal Safety Equipment. Contractors shall provide personal safety equipment for all employees in accordance with applicable federal and state laws or standards. It shall be the sole responsibility and expense of the Contractor to maintain or replace, or cause to be maintained or replaced, any personal safety equipment required. Contractors are solely • Fire/EMS Emergency Ambulance Transportation and Related Services 31 Request for Proposals - RFP #JR 1494 September 19, 2008 • responsible for ensuring that all of its personnel abide by all federal, state and local safety standards. To ensure that each ambulance responder has emergency scene personal protective equipment they may need to keep them safe in a potentially hazardous environment, Contractors shall comply with State EMSA Guideline 216 regarding recommended PPE for Ambulance Personnel (OSHA's General Description and Discussion of the levels of Personal Protective Gear, 29CFR 1926.65, App. B, Part IV, Level D) for each ambulance dedicated to 911 emergency transportation, including: 1. Full- length blue (EMS) jacket with reflective stripes. (NFPA 1999, EMS Standards) 2. Hard hat, Work Helmet Blue 3. Leather gloves VEHICLES AND MAINTENANCE Standards. All vehicles furnished by Contractors in the performance of BLS services under the • Contract Documents must comply with all federal, state, and local laws, rules, statutes, and regulations applicable to the provision of private, emergency ambulance transportation, including but not limited to, those BLS vehicle standards and protocols establis hed by OCEMS. Modular (Type III). Use of modular (Type III, dual rear wheeled) ambulances is desired and will be a factor in the overall evaluation process. Contractors must specify within their bid proposal the make, model, year, license plate, type, and mileage for: (a) each ambulance proposed for use within the EOA; and (b) each ambulance regionally available for use within the EOA. Contractors must agree to expand, at the sole discretion of OCFA: (a) the total number of ambulances available for use within the EOA; and /or, (b) the total number of ambulances regionally available for use within the EOA, if either response time requirements are not consistently being met or if the EOA experiences a significant call volume increase. Contractors shall be responsible for providing all necessary vehicles, personnel, and equipment to provide the required services under the Contract Docum ent. 32 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • Inspection. Contractors must agree that the Proposal Grading Panel may, at any time throughout the procurement process, and that the OCFA EMS Section Battalion Chief may, at any time during either the procurement process or the contract term, inspect Bidder /Contractors' ambulances, ambulance maintenance facilities, ambulance maintenance records, ambulance manufacturer suggested maintenance program, and /or ambulance purchase /lease /acquisition documentation. Maintenance. Contractors shall be responsible for providing all necessary vehicles, personnel, and equipment to provide the required services under the Contract Documents. OCFA expects that all vehicles and equipment used in the performance of the required services under the contract will be maintained in excellent condition. Contractors shall comply with or exceed the maintenance standard as outlined in the Standards- Accreditation of Ambulance Services published by the Commission on Accreditation of Ambulance Services. Contractors' failure to service and maintain all ambulances and equipment used in the performance of a contract pursuant to the manufacturer's suggested maintenance program will be deemed breach of contract and cause for immediate contract termination. • Restraint Devices. Contractor shall meet or exceed all passenger restraint requirements as prescribed by law. Additional Vehicle Equipment: Use of an Automatic Vehicle Locator System that interfaces with Contractor's dispatch center is desired and w ill be a factor in the overall evaluation process. • Fire/EMS Emergency Ambulance Transportation and Related Services 33 Request for Proposals - RFP #JR 1494 September 19, 2008 • SECTION VII - RATES FOR AMBULANCE SERVICE BLS AND ALS SERVICE RATES Maximum BLS Service Rate. The Orange County Board of Supervisors establishes the maximum Basic Life Support ( "BLS ") service rate ( "BLS Service Rate ") that may be charged by Contractors to their patients for the provision of emergency ambulance transportation services. Contractors may not charge more than the maximum BLS Service Rate approved by the Orange County Board of Supervisors for each BLS patient transport. BLS means the same as is defined in the EMS Act. The BLS Service Rate is reviewed annually by OCEMS, which makes rate adjustment recommendations to the Board of Supervisors. As such, the maximum approved BLS Service Rate is subject to change at any time during the contract term. The proposed maximum BLS Service Rate as of July 1, 2008 is as follows: Type of Charge Maximum Rate BLS Service Rate $671.75 per BLS transport • Maximum ALS Service Rate. The Orange County Board of Supervisors establishes the maximum Advanced Life Support ( "ALS ") service rate ( "ALS Service Rate ") that may be charged by Contractors for OCFA - provided emergency ALS services to patients transported either ALS or BLS. For those calls for service in which ALS services are provided by OCFA to patients that are transported either ALS or BLS, Contractors shall be responsible for charging and collecting the ALS Service Rate. Contractors may not charge more than the maximum ALS Service Rate approved by the Orange County Board of Supervisors. ALS means the same as is defined in the EMS Act. The ALS Service Rate is reviewed annually by OCFA. The maximum approved ALS Service Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. As of as of July 1, 2008, the approved maximum ALS Service Rate is as follows: Type of Charge Maximum Rate ALS Service Rate $355.75 per transport w /ALS services 34 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • ALS Reimbursement Rate. The OCFA Board of Directors establishes the OCFA ALS reimbursement rate ( "ALS Reimbursement Rate "), which Contractors must reimburse OCFA for ALS services provided to patients that are transported either ALS or BLS in order to cover OCFA's costs for providing such services, including ALS assessments. Contractors shall reimburse OCFA the established ALS Reimbursement Rate for each call for service in which OCFA provides ALS services, including ALS assessments, to patients that are transported either ALS or BLS. Medicare Patients. The ALS Reimbursement Rate for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is based on the Medicare allowed amounts for each Contractor. The ALS Increment is defined as the difference between the Medicare allowed amount for a given ALS service (i.e., ALS -1 or ALS -2) and the Medicare allowed amount for BLS emergency services, prior to the 20% co- payment deduction. 1. ALS -1 Emergency Services. The ALS Reimbursement Rate for ALS -1 emergency i transports and ALS -1 emergency assessments with BLS transports for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS -1 emergency services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co- payment deduction. 2. ALS -2 Services. The ALS Reimbursement Rate for ALS -2 services for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS -2 services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co- payment deduction. • 35 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • Annual Adjustments. The ALS Reimbursement Rate is reviewed annually by OCFA. The ALS Reimbursement Rate reimbursable to OCFA by Contractors for all ALS services provided to patients, excluding Medicare patients and patients covered under Medi -Medi or Medicare + Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. Current ALS Reimbursement Rate. As of as of July 1, 2008, the approved ALS Reimbursement Rate is as follows: Type of Charge Amount 1. ALS Reimbursement Rate $252.00 per transport w /ALS services 2. ALS Reimbursement Rate for Medicare patients or patients with Medi -Medi or Medicare +Choice plans ALS -1 or ALS -2 Increment • Medical Supply Reimbursement Rate. The OCFA Board of Directors establishes the medical supply reimbursement rate ( "Medical Supply Reimbursement Rate "), which Contractors must reimburse OCFA per BLS /ALS transport. Contractors shall pay OCFA the Medical Supply Reimbursement Rate for each BLS /ALS patient transport to cover OCFA's costs for providing expendable medical supplies to Contractors. The Medical Supply Reimbursement Rate is reviewed annually by OCFA. The Medical Supply Reimbursement Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. As of July 1, 2008, the proposed Medical Supply Reimbursement Rate is as follows: Type of Charge Amount Medical Supply Reimbursement Rate $28.15 per transport (BLS /ALS) Zero Pay Patients. OCFA will not require Contractors to pay the established ALS Reimbursement Rate or Medical Supply Reimbursement Rate (nor any portion thereof) for "zero pay patients." "Zero pay patients" are those calls for service to patients whose only method of 36 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • healthcare coverage or insurance is provided by a state or local subsidized health care program (i.e., patients receiving health care benefits pursuant to any one of the following state or local subsidized health care programs: (a) Medi -Cal; (b) CalOptima; (c) California Child Services ( "CCS "); and /or (d) County Medical Services for the Indigent ( "County /MSI "). Patients who have other means of payment or who are covered by additional or supplemental insurers, other than subsidized health' care programs, are not "zero pay patients." Contractors may seek relief from making the required reimbursement payments to OCFA by applying for a Zero Pay Patient Exemption, as provided below. , Risk of Non - Payment. Except as provided otherwise herein, Contractors assume the entire risk of non - payment for any and all of the services rendered and the charges incurred in connection with their performance under the Contract Documents, including all BLS and ALS charges incurred, as well as all ALS reimbursements and medical supply reimbursements. Medicare Patients. Contractors may not charge Medicare patients more than the maximum Medicare rate. • BILLING, AUDIT AND ACCESS TO RECORDS Billing System. Contractors may only bill for services according to the approved service rates and schedules set forth in the Contract Documents and as authorized by OCEMS, with no additional fees or charges imposed unless approved in writing in advance by the OCFA Fire Chief and /or the awarding agency, if applicable. Prior to the Effective Date, Contractors must establish an auditable billing system approved by OCFA, which shall be available for review by OCFA on a periodic basis. Contractors' patient billing /records system must be organized so that search and retrieval of all billing records can readily be made by OCFA according to the following individual criteria: Patient Name ALS 911 Calls BLS ALS Assessment/BLS Transport Day /Month/Year BLS Transport ALS Transport OCFA Incident No. • 37 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • Accounting. Contractors must maintain accurate and complete records of all patient accounting, including but not limited to: (a) all patient invoices, (b) all patient/insurer payments; (c) all BLS service charges; (d) all ALS service charges; (e) all ALS reimbursement payments; (f) all medical supply reimbursements; (g) all invoices, payments, and correspondence to and from private insurers, federal or state health care programs, and other responsible third parties; and (h) all records evidencing payments made by Contractors to OCFA in connection with their performance under the Contract Documents. Such accounting shall be performed by Contractor in accordance with generally accepted accounting principles and practices consistently applied. OCFA shall have access to such records and information upon seventy - two (72) hours advanced written notice at all times during normal business hours for the purpose of inspection, audit, review, evaluation, and duplication. Contractors must, at no cost to OCFA, provide proper facilities for OCFA's access, inspection, audit, review, evaluation, and duplication of such information. Responsibility for Submission of Claims. Contractor shall be responsible for submitting claims for services provided hereunder, and may utilize the services of a third party billing agent for this purpose. In the event that a third party billing agent is used, Contractor shall inform the • billing agent of the provisions of the Contract Documents. Contractor shall be responsible to bill for all transports in which ALS services are rendered, specifically including the performance of ALS assessments as defined in 42 C.F.R. §414.605, in accordance with applicable Medicare guidelines for the level of service provided. CONTRACTOR MONTHLY PAYMENTS Monthly Payments to OCFA. All ALS reimbursements and medical supply reimbursements, as required in this Section, (hereinafter referred to as "Monthly Payments ") must be promptly paid by Contractors to OCFA beginning ninety (90) days from September 1, 2009, and such payments shall continue to be promptly remitted by Contractors to OCFA thereafter within ninety (90) days after the first day of each month throughout the contract term. Zero Pay Patient Exemptions may be requested by Contractors for each qualifying call by following the procedures below. A penalty of $500 may be imposed for each late payment. Contractors whose monthly payments are sixty (60) days late (or more) may be assessed a 1'/% late fee for 38 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • each month that payments are not made. Failure to make timely Monthly Payments may be deemed breach of contract. Zero Pay Patient Exemption Requests. Contractors must submit to OCFA for approval all Zero Pay Patient Exemption requests and all documentation justifying each request. Zero Pay Patient Exemption requests must be submitted by Contractors with their monthly ALS reimbursement and medical supply reimbursement payments for the month in which the exemption is requested and must be reflected as a credit on the current Monthly Payment remittance. Requests for exemptions outside the current monthly payment period will not be considered, except as provided herein. Each Zero Pay Patient Exemption will be evaluated and either granted or denied at the sole discretion of the OCFA EMS Section Battalion Chief. Contractors will be notified in writing by the OCFA EMS Section Battalion Chief if any exemption request will be denied within thirty (30) days of receipt of the request. The decision may be appealed by the Contractor to the OCFA Fire Chief, whose decision shall be final. In the event a Zero Pay Patient Exemption request is denied, the requesting Contractor shall adjust its next Monthly Payment remittance for the amount of the credit denied. Exemption requests for "Retro • Credits" should be made within the month the Contractor receives notification of the retroactive enrollment in a qualified zero pay patient program. • 39 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • • SECTION Vlll - PHASE 2 PROPOSAL SUBMISSION FORMAT The following pages describe exactly how the Proposal Submission Binder shall be organized. Please adhere strictly to this format to ensure that all information is included and can be found easily by the reviewers. This will facilitate an expeditious and thorough review process. • Unless unspecified, all Phase 2 proposal documents are restricted to the number of pages specified for each item. • Size 12 font and 1 inch margins will be considered standard. • Use only single -sided pages. • All bid proposals must be submitted in three -ring binders (`Binder /s "), which are no larger than 12 "x12 "; • The Binder shall be organized using numbered tab dividers that correspond to Binder Tab Numbers specified in this document. Original + Copies: The original signed bid proposal shall be clearly marked "ORIGINAL" and nine (9) copies of the bid proposal, including any attachments, must be sent under seal to • OCFA by the Submission Due Date. EOA Identification: Providers must clearly identify by name and geographical number on the outside binder cover /title page and within the bid proposal cover letter, which specific EOA(s) is /are being pro posed for service. 40 III Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • TITLE PAGE This is the cover sheet that should be placed behind the clear plastic cover on the front of the Binder. (Appendix A) All bid proposals must be clearly marked on the outside binder cover with a title page containing the following information: 1. Name of ambulance service operator (i.e., the Bidder); 2. Name of RFP and RFP #JR 1494; 3. Bidder address and telephone number; 4. Bidder authorized contact person; 5. Bidder authorized contact person's signature; 6. Identification of all EOA/s proposed for service and the corresponding EOA number; 7. Bid proposal submission date; and 8. Original or copy. 9. Binder 1 of 2, 2 of 2, etc. • • 41 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #1 COVER LETTER (I PAGE LIMIT) Provide a brief cover letter on company letterhead stating the provider's interest in participating in Phase 2 of the RFP competitive bid process. Bidder must clearly identify by name and geographical num ber the specific EOA(s) being proposed for service. The letter must be signed by an official authorized to enter into a contractual agreement with the Orange County Fire Authority and its participating cities. • r 42 1 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #2 BID PROPOSAL DEPOSIT (1 PAGE LIMIT) Please attach (either staple or otherwise affix) the required Bid Proposal Deposit, as described in Section II. • • 43 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #3 TABLE OF CONTENTS Provide a Table of Contents listing the Binder Tab Number and its corresponding page numbers. (Appendix B) • 44 III Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #4 NOTIFICATION OF PROVIDER PREQUALIFICATION Please attach (either staple or other wise affix) a copy of the OC FA notification of prequalification letter that was sent to Bidder. • 0 45 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #5 EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEM (3 PAGE LIMIT) Provide a description of the Emergency Response and Vehicle Communications System Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Emergency Response and Vehicle Communications System will either meet or exceed the communications specifications, requirements, and performance expectations set forth in Section IV. Additional Specific Submission Data: 1. Provide a statement that Bidder is or will be compliant by the Effective Date with all communications requirem ents set forth in Section IV of this RFP. 2. Provide a detailed sum mary of CAD (Computerized Aided Dispatch) program capabilities. • 3. Provide a description of other communications equipment used by Bidder (if applicable) including, but not limited to: a. Cellular phones; b. Personal digital assistants (PDAs); c. Mobile computers. 4. Provide a description of the proposed operational design for the Emergency Response Communications System and methods proposed for dispatching ambulances. 5. Provide a description of the Bidder's internal and external information technology capabilities. 6. Provide a description of communications capabilities, including: a. Hours of operation; and 46 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • b. Personnel devoted to communications. 7. Provide a statement on Bidder's ability to upgrade communication systems. 8. Provide a description of all field data collection systems and the process by which data is collected, inputted and used by the Bidder. • • 47 F ire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #6 SERVICE RATES (2 PAGE LIMIT) Please provide a description and /or schedule of all ambulance service rates and fees that Bidder proposes to charge all payers and patients in connection with its provision of emergency ambulance transportation and related services within the subject EOA, in accordance with the established maximum rates, requirements, and reimbursements set forth in Section VII, including but not limited to all costs of service and /or cost, if any, to the awarding agency. • 48 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #7 ON -BOARD EQUIPMENT AND SUPPLIES (3 PAGE LIMIT) Provide a description of the On -Board Equipment and Supplies Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed On -Board Equipment and Supplies will either meet or exceed the specifications, requirements, and performance expectations set forth in Section VI. Additional Specific Submission Data: 1. Provide a description of Bidder's OSHA compliance program; 2. Describe Bidder's capabiliti es to respond to terrorist threats or disasters. • • 49 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #8 VEHICLE AND EQUIPMENT MAINTENANCE PROGRAM (4 PAGE LIMIT) Provide a description of how Bidder's Vehicle and Equipment Maintenance Program proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently and continuously meet or exceed the vehicle and equipment maintenance standards, requirements, and performance expectations set forth in Section VI. Additional Specific Submission Data: 1. Provide a description of the vehicle maintenance plan or schedule; 2. Provide a description of the vehicle replacement plan; 3. Provide a description of equipment maintenance program including replacement plan. ill 50 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • • BINDER TAB #9 PERSONNEL AND TRAINING 1. ASSIGNED PERSONNEL PROFILE (3 PAGE LIMIT) Provide a detailed spreadsheet of the individual personnel, including proposed management team, employee names, current certification /license level of service, certificate /license number, and number of years as an employee of Bidder, proposed by Bidder for the performance of services under the Contract Docum ents within the subject Exclusive Operating Area. 2. FIELD TRAINING OFFICERS (1 PAGE) Provide the ratio of field training officers to EMTs or other ambulance personnel that Bidder proposes to commit to the subject EOA, and provide a detailed explanation of Bidder's proposed Field Supervisor and Training Programs and management/field supervisor oversight plan for the subject EOA. • 3. PRIMARY PERSONNEL (5 PAGE LIMIT) Provide the resumes of no more than five (5) proposed key personnel (maximum one page each) whose job duties for Bidder's Orange County operations will relate solely and exclusively to the fulfillment of the terms, conditions, performance expectations, and obligations relative to Bidder's performance under the Contract Documents. 4. EMPLOYEE RECRUITMENT, SCREENING AND ORIENTATION (2 PAGE LIMIT) Provide a description of the current personnel Recruitment, Screening, and Orientation Program Bidder currently employs and any modifications Bidder proposes to utilize in connection with its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Recruitment, Screening, and Orientation Program will enable Bidder to consistently and continuously meet or exceed the training standards, personnel requirements, and performance expectations set forth in Section V. 411 51 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • 5. CONTINUING EDUCATION PROGRAMS (2 PAGE LIMIT) Provide a description of any and all continuing education programs, including continuing medical education programs, that will be provided to all employees who perform services under the Contract Documents, as well as a discussion of Bidder's commitment to providing such programs at all times throughout the contract term. 6. HIPAA TRAINING PROGRAMS (2 PAGE LIMIT) Provide a description of Bidder's HIPAA training program that has been provided to all employees and will be provided to all new employees who perform services under the Contract Documents. • 52 III Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB # 10 DRIVER TRAINING (2 PAGE) Provide a description of the Driver Training Program Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area, and describe in detail how the proposed Driver Training Program will either meet or exceed the performance expectations and requirements set forth in Section V. Additional Specific Submission Data: 1. Provide a detailed course syllabus or curriculum for driver training program offered to employees; 2. Provide the total num ber of course hours per course offered; 3. Describe the internal training plan, including timeframe for completion and retraining; III 4. Provide the name of the institution providing the training, if applicable. • 53 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 0 BINDER TAB #11 INTERNAL MEDICAL QUALITY CONTROL (3 PAGE LIMIT) Provide a description of how Bidder's Internal Medical Quality Control and Continuous Quality Improvement ( "CQI ") Programs proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently meet or exceed the standards, requirements, and performance expectations set forth in Section Iv. Additional Specific Submission Data: 1. Provide a description of Bidder's quality assurance /improvement process, including timeframes for process completion. 2. If proposed Internal Medical Quality Control and Continuous Quality Improvement ( "CQI ") Programs will exceed the standards and requirements set • forth in this RFP, please clearly explain in a detailed summary how such requirements will be exceeded. 54 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #12 BILLING AND COLLECTION PRACTICES (3 PAGE LIMIT) Provide a description and explanation of the billing and collection practices Bidder proposes for use and implementation within the subject EOA, including Bidder's proposed system, procedures, practices, policies and protocols for responding to and timely processing all customer complaints. Please also include a detailed summary and explanation of Bidder's proposed record keeping and auditing practices and how such systems will either meet or exceed the requirements and performance expectations set forth in Section VII. Additional Specific Submission Data: 1. Provide a detailed description of the billing and data information flow from dispatch through initial billing; • 2. Provide process flow and timeframes for collections process, including but not limited to: a. The number of monthly statements sent prior to collections; b. Timeframe for write -offs; 3. Provide overall billing and collection practices, including but not limited to`. a. Statement cycle; b. Collection rate; 4. Provide statistical data for subject EOA (if applicable), including but not limited to: a. Payer mix; b. Patient demographics; c. Collection rate by payer. • 55 Fire/EMS Emergency Ambulance,Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #13 HIPAA COMPLIANCE PLAN (1 PAGE LIMIT) Provide a description and explanation of Bidder's HIPAA Compliance Plan, including Bidder's certification that all personnel have signed a confidentiality agreement and have undergone HIPAA Privacy Training. II 56 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #14 CORPORATE COMPLIANCE PLAN (2 PAGE LIMIT) Provide a description of Bidder's Corporate Compliance Plan, if applicable. A Corporate Compliance Plan should include those elements identified in the Office of Inspector General's Compliance Program Guidance for Ambulance Suppliers [Federal Register: March 24, 2003 (Volume 68, Number 56)]. • • 57 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #15 COMPLIANCE WITH MONTHLY PAYMENTS (4 PAGE LIMIT) Provide a description of the system for providing timely, monthly payments to OCFA that addresses how Bidder intends to satisfy the procedures and requirements set forth in Section VII, including: 1. Bidder's proposed system for inspection of all billing records and its monthly payment record keeping and auditing practices; 2. Bidder's proposed system for making the required ALS Reimbursement Rate payments; and 3. Bidder's proposed system for making the required Medical Supply Reimbursement Rate payments to OCFA. II 58 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #16 911 FIRE /EMS RESUME (LAST 10 YEARS) (5 PAGE LIMIT) Provide a detailed resume of Bidder's 911 Fire /EMS Emergency Ambulance Transportation experience. (Bidder may attach Phase 1 Binder Tab #5 "Emergency Ambulance Transportation Experience" to fulfill this section.) • • 59 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #17 CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of ( "Bidder "), and hereby declares under penalty of perjury under the laws of the State of California, that Bidder is not, and will not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a contract and if authorized to perform the services described in this R FP. Signed, this _ day of , 2008 in .Cali fornia. IF SOLE OWNER: Signature of Owner Date Print Name IF PARTNERSHIP (JPA or merger): • • Signature of Partner (General P artner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 60 • Fire/EMS Emergency Ambulance Transportation and Related Services • Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #18 STATEMENT OF TRUTH The undersigned hereby certifies on behalf of ("Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that the information provided by Bidder and contained in this 2008 Fire /EMS Emergency Ambulance Transportation and Related Services RFP is accurate, complete, true and correct to the best of our knowledge. We are aware that should any of the information contained herein be found to be false, incorrect, or otherwise untruthful, or if the information contained herein contains material misrepresentations and /or material omissions of fact, OCFA may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option of OCFA, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and /or to declare any contract subsequently awarded void. Signed, this - day of , 2008 in California. IF SOLE OWNER: Signature of Owner Date Print Name • IF PARTNERSHIP (JPA or mercer): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name • 61 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #19 NON - COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of ( "Bidder"), and hereby declares under penalty of perjury under the laws of the State of California, that this 2008 Fire /EMS Emergency Ambulance Transportation and Related Services RFP is genuine and not sham or collusive, nor made in the interest of or on behalf of any person not herein named; the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a sham proposal nor solicited any other person, firm or corporation to refrain from submitting a proposal; the Bidder has not communicated, directly or indirectly, with any other Bidder regarding the amount, price, and /or service rates proposed herein; and Bidder has not in any manner sought by collusion to secure for himself /herself /itself any advantage over any other Bidder. We declare the foregoing is true and correct under penalty of perjury under the laws of the State of California. Signed, this day of _, 2008 in _ .Cali fornia. IF SOLE OWNER: Signature of Owner Date Print Name • • IF PARTNERSHIP (JPA or merger): Signature of Partner (General Partner) Date Print Name IF CORPORATION: Signature of President Date Print Name Signature of Secretary Date Print Name 62 S Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #20 Commission on Accreditation of Ambulance Services ( "CAAS ") Certification If CAAS certified, please provide a copy of your CAAS Certification. • / • 63 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #21 OVERALL OPERATIONAL SYSTEM AND DESIGN (8 PAGE LIMIT PER EOA) Within Binder Tab #21, Bidder shall provide a sub - section for each EOA being bid (i.e. 21A Cypress (EOA 5); 21B La Palma (EOA 13), etc.). The sub - sections should be plainly marked for each proposal. Please do not submit a separate bin der for each EOA proposal. For each EOA being bid, provide a description of the operational system and program design Bidder proposes for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area (EOA). Such description shall i nclude: 1. How the proposed operational system and program design will either meet or exceed the competitive bid criteria, specifications, requirements, and performance expectations set forth in • this RFP. This may include the number and proposed location of all emergency vehicles that will provide service to the subject EOA or a detailed map of the system status management or provide a detailed system plan. Dedicated units within an EOA are not required. 2. The crew configuration for the ambulances. 3. The supervisory plan of crews, including number and location of supervisory personnel. 4. An overall summary of Bidder's Southern California system operations inci uding: a. total number of ambulances in fleet; b. total number of employees including line staff, supervisors, managers, administrative, billing, etc.; c. contact information for third party billing agency and third party collection agency (where applicable); and 64 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 IP d. contact information for medical director; contact information for continuing education program, driver training, etc. 5. A budget, which shall include but is not limited to: a. Financial information which will estimate the cost of the proposed operation and the intended source of all funding related to the provision of services in the RFP; b. A list of commitments, and potential commitments which may impact assets, lines of credit, guarantor letters, or otherwise affect the Bidder's financial ability to perform the contract services. • • 65 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 BINDER TAB #22 AMBULANCES PROPOSED FOR EACH EOA (Provide a separate sheet for each EOA.) Please provide: 1. A description of all emergency vehicles and ambulances Bidder proposes for use in its provision of emergency ambulance transportation and related services for the subject EOA. 2. A description of how the proposed vehicles and ambulances for the subject EOA will either meet or exceed the specifications, requirements, and performance expectations set forth in Section VI. 3. A description of Bidder's proposed am bulance replacem ent program. 4. In the following charts, specific information about each propo sed ambulance: A). Proposed ambulance units to be available for 911 responses in the subject EOA #: (if applicable): Unit Chassis Model Year Mileage* Condition** Type • Manufacturer • B).Other regional ambulance units that will be available to reasonably support 911 responses in the subject EOA #: Unit Chassis Model Year Mileage* Condition ** Type Manufacturer 66 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • • *Mileage provided must be estimated based on unit in service to the EOA as of July 1, 2008. • * *Statement of Condition Using the information below, indicate the condition of the ambulance by the corresponding letter that most closely describes the ambulance: A New /Bristol: An ambulance that is new or is maintained in mint or a fashion usually better than factory new - loaded with extras. B Above Average Condition: Has had above average care and is equipped with extra equipment and gear. C Average Condition: Clean. Attractive inside and out. Normally equipped. Mechanically sound, mid -time on mechanicals. D Good Condition: Mechanically sound, requiring some interior and exterior cosmetic work. Some mechanicals on the down side of life expectancy. E Fair Condition: Cosmetics still show noticeable areas of wear and tear after clean -up. Mechanically sound, but definitely on the down side of life. • F Poor Condition: Needs significant amount of repair. Most mechanicals need overhaul or replacement. Cosmetics almost not restorable. Cost of repairs may exceed market value. • 67 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #23 RESPONSE TIME HISTORY Please provide detailed fractile summary response time reports for the three -month period of January 2008 to April 2008 (or for the most recent timeframe available for Providers without recent 911 experiences) for the subject EOA or a geographic /call volume related area similar to the subject EOA, and include both Code 2 and Code 3 calls, separately delineated. • 68 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #24 MUTUAL AID PROVIDER (2 PAGE LIMIT PER EOA) Provide a description of how Bidder's Mutual Aid Provider Program proposed for its provision of emergency ambulance transportation and related services within the subject Exclusive Operating Area will consistently and continuously meet or exceed the standards, requirements, and performance expectations set forth in Section IV. Additional Specific Submission Data: Provide a copy of all current mutual aid agreements that would apply to the subject EOA or provide a copy of Bidder's proposed mutual aid plan, including: a. Name of mutual aid provider (if known); • b. Location of mutual aid provider; c. Staffing capabilities of mutual aid provider, if known. • Fire/EMS Emergency Ambulance Transportation and Related Services 69 Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #25 PLAN FOR TAKEOVER OF SERVICE /START -UP (1 PAGE LIMIT PER EOA) Describe in detail Bidder's proposed implementation plan for the takeover of services /start -up, or resumption of services under the new contract, as applicable, within the subject EOA by the Effective Date; including but not limited to: 1. Bidder's transition or implementation management team; 2. Proposed start -up schedule for ensuring timely commencement of services on September 1, 2009; and 3. Proposed initial service response and coverage plan, including deployment plans, post locations, housing, and staffing plans. • , 70 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB #26 LETTERS OF REFERENCE Provide letters of reference from cities or fire departments with whom Bidder has provided primary or back -up emergency ambulance transportation. • • Fire/EMS Emergency Ambulance Transportation and Related Services 71 Request for Proposals - RFP #JR 1494 September 19, 2008 • BINDER TAB # 27 PHOTOGRAPHS (OPTIONAL) (3 PAGE LIMIT) Bidders may provide, at their option, any color photographs or other renderings depicting Bidders' emergency ambulance service facilities, operations, vehicles, equipment, performance, and /or personnel. • 72 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • SECTION IX - APPENDICES APPENDIX A TITLE PAGE APPENDIX B . TABLE OF CONTENTS APPENDIX C CITY SELECTION & CONTRACTING AUTHORITY (AS OF MARCH 12, 2008) APPENDIX D TRANSPORT DATA FOR EOAs APPENDIX E EXCLUSIVE OPERATING AREAS AND MAP APPENDIX F FORM: (DRAFT) PROPOSED MODEL EOA AGREEMENT APPENDIX G SAMPLE QUARTERLY RESPONSE TIME REPORT • • Fire/EMS Emergency Ambulance Transportation and Related Services 73 Request for Proposals - RFP #JR 1494 September 19, 2008 • APPENDIX A TITLE PAGE /COVER SHEET Orange County Fire Authority Request for Proposals For Fire /EMS Emergency Ambulance Transportation and Related Services RFP # JR 1494 Insert Bidder Name Insert Bidder Address Insert Bidder Authorized Contact/Representative • Signature of Authorized Contact/Representative Insert EOA Name /s & EOA Number /s Proposed Insert Bidder Telephone Number Insert Date of Bid Proposal Submission Designate as "Original" or Copy Binder Number (i.e. 1 of 1, 1 of 2 etc.) 74 II Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • APPENDIX B TABLE OF CONTENTS Please include in the Bid Proposal a Table of Contents listing the following request items and submission forms in the order provided: BINDER ITEM Page Number TAB # 1 Cover Letter 2 Bid Deposit 3 Table of Contents 4 Notification of Provider Prequalification 5 Emergency Response and Vehicle Communications System 6 Service Rates 7 On -Board Equipment and Supplies 8 Vehicle and Equipment Maintenance Program 9 Personnel and Traini ng 10 Driver Training 11 Internal Medical Quality Control 12 Billing and Collection Practices • 13 HIPAA Compliance Plan 14 Corporate Compliance Plan 15 Compliance with Monthly Payments 16 911 Fire /EMS Resume 17 Conflict of Interest Certification 18 Statement of Truth 19 Non - Collusion Certificate 20 CAAS Certification 21 Overall Operational System and Program Design Subsection A: EOA # Subsection B: EOA # Subsection C: EOA # ETC. 22 Ambulances Proposed for Each EOA 23 Response Time Requirements 24 Mutual Aid Provider 25 Plan for Takeover of Service /Start-up 26 Letters of Reference 27 Photographs (optional) • Fire/EMS Emergency Ambulance Transportation and Related Services 75 Request for Proposals - RFP #JR 1494 September 19, 2008 • APPENDIX C SELECTION AND CONTRACTING AUTHORITY (As of March 12, 2008] Cities Retaining Cities Delegating to OCFA Authority /Responsibility Laguna Niguel Cypress Lake Forest La Palma San Juan Capistrano Los Alamitos Rancho Santa Margarita Seal Beach Stanton Villa Park • NOTE: Decisions to retain or delegate selection and contracting authority are not final and are subject to change at any time during the procurement process. 76 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • APPENDIX D ESTIMATED TRANSPORT VOLUMES BY EXCLUSIVE OPERATING AREA INCLUDES 2007 2007 2007 EOA CITY OF: COUNTY ESTIMATED ESTIMATED ESTIMATED # AREAS OF: TOTAL BLS ALS TRANSPORTS TRANSPORTS TRANSPORTS 5 Cypress 1430 455 (32 %) 975 (68 %) 13 La Palma 451 110 (24 %) 341 (76 %) Los 14 Alamitos Rossmoor 879 217 (25 %) 662 (75 %) 19 San Juan Ortega Hwy 1554 426 (27 %) 1128 (73 %) Capistrano 21 Seal Sunset Beach, 2398 613 (26 %) 1785 (74 %) Beach Bolsa Chica 22 Stanton Midway City 1872 549 (29 %) 1328 (71%) Orange /Olive, 24 Villa Park Orange Park, 361 54 (15 %) 307 (85 %) • Silverado Trabuco, 29 Santa Rancho O'Neill Park, 1524 719 (47 %) 805 (53 %) Margarita Las Flores, Coto de Caza 30 Laguna 1635 455 (25 %) 1220 (75 %) Niguel Lake Modjeska, 42 Forest upper 2382 615 (26 %) 1767 (74 %) Trabuco /Cooks • 77 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • APPENDIX E EXCLUSIVE OPERATING AREAS AND CORRESPONDING MAP EOA # CITY 5 Cypress 13 La Palma 14 Los Alamitos 19 San Juan Capistrano 21 Seal Beach 22 Stanton 24 Villa Park 29 Rancho Santa Margarita 30 Laguna Niguel • 42 Lake Forest 78 • Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals - RFP #JR 1494 September 19, 2008 • APPENDIX F PROPOSED (DRAFT) MODEL EXCLUSIVE OPERATING AREA AGREEMENT -- SEPARATELY ATTACHED -- • • Fire/EMS Emergency Ambulance Transportation and Related Services 79 Request for Proposals - RFP #JR 1494 September 19, 2008 • APPENDIX G SAMPLE QUARTERLY RESPONSE TIME REPORT Contractor Name: Completed by: Title: EOA Name: EOA Number: Quarter Ending: Date: Metro /Urban Suburban /Rural Wilderness Code 2 Code 3 Combined Code 2 Code 3 Combined Code 2 Code 3 Combined Number of patients transported Number of responses • Number of "on- time" responses Percentage of "on- time" responses* Number of calls for service that were refused or not accepted by the Contractor Number of calls referred to approved, secondary mutual aid providers *If percentage of "on- time" responses in either Code 2 or Code 3 categories falls below 90% regardless of geographical area, include a narrative assessment as to the cause of any response delay below. (Attach additional sheets and documentation, as needed.) At his discretion, the OCFA EMS Battalion Chief shall meet and confer with the Contractor for purposes of establishing a plan for avoiding such delay in the future. Fire/EMS Emergency Ambulance Transportation and Related Services • Request for Proposals - RFP #JR 1494 September 19, 2008 • l < 010 1N ( 4.,r *" ;:1 44 : t a4, L ' It) ; M 4111 ORANGE COUNTY FIRE AUTHORITY REQUEST FOR PROPOSALS FOR • FIRE /EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES RFP # JR1494 APPENDIX "F" PROPOSED MODEL EXCLUSIVE OPERATING AREA AGREEMENT • Revised 9 -10 -08 5678 ?6 7 AGREEMENT FOR PROVISION • OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES WITHIN EXCLUSIVE OPERATING AREA Exclusive Operating Area (EOA) Name: EOA No. Contractor: City: Effective Date: Awarding Agency: TABLE OF CONTENTS 1.0 SCOPE OF SERVICES 3 2.0 CONSIDERATION 3 3.0 CONTRACT DOCUMENTS 3 4.0 MODIFICATION AND AMENDMENTS 3 • 5.0 CONTRACT ADMINISTRATION 4 6.0 EFFECTIVE DATE 4 7.0 TERM 4 8.0 TERMINATION 4 9.0 INSURANCE 4 10.0 ASSIGNMENT 6 11.0 AUDITS AND INSPECTIONS 6 11.1 Business Office 6 11.2 FacilitiesNehicles 6 12.0 COOPERATION 7 i • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 13.0 INDEPENDENT CONTRACTOR 7 14.0 INDEMNIFICATION 7 14.1 General 7 14.2 Rates 7 • 15.0 COMPLIANCE WITH LAWS 7 16.0 RISK 7 17.0 RESPONSIBILITY 8 18.0 ACTS OR OMISSIONS OF REPRESENTATIVES 8 19.0 INSOLVENCY 8 20.0 OPERATIONAL STANDARDS, PROCEDURES, & PERFORMANCE REQUIREMENTS 8 20.1 Service Hours 8 20.1.1 Service 8 • 20.1.2 Field Supervisor 8 20.2 Response Times 8 20.2.1 Response Time Reporting 8 20.2.2 Quarterly Response Time Report - Format 10 20.2.3 Exemptions to Response Time Requirements 10 20.2.4 Procedures to Request Response Time Exemption 11 20.2.5 Use of Alternative Methods to Meet Response Time Requirements 11 20.2.6 Disciplinary Actions for Failure to Meet Response Time Requirements / Performance Deficiency 12 20.3 Emergency On -Scene Procedures 13 20.4 Disaster Assistance 13 20.5 Standard of Performance 14 20.6 General Provisions 14 20.6.1 Return of OCFA Personnel 14 20.6.2 911 Calls for Service/Referral 15 • ii Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 20.6.3 Performance 15 • 20.6.4 Conflict of Interest 15 20.6.5 Complaints 15 20.6.6 Traffic Signal Preemption 15 20.6.7 HIPAA Compliance Plan. 15 20.6.8 Medicare/Medi -Cal Participation 16 20.7 External Medical Quality Control 16 21.0 PERSONNEL 17 21.1 Personnel Requirements 17 21.1.2 Employee Drug Program 17 21.1.3 DMV Employer Pull Notice Program 18 21.1.4 Criminal Background Checks 18 21.1.5 Uniforms and Decorum 18 21.1.6 Cooperation 18 21.1.7 Employee Ineligibility 18 21.1.8 Compliance with Laws 18 21.1.9 Licensing/Identification 18 II 21.1.10 Joint Training Exercises 18 21.1.11 Employee Training Records 19 21.1.12 Professionalism 19 21.1.13 Management Oversight 19 21.1.14 Employee Removal 19 21.2 Independent Contractor 19 22.0 RATES FOR AMBULANCE SERVICE 19 22.1 BLS and ALS Service Rates 19 22.1.1 Maximum BLS Service Rate 19 22.1.2 Maximum ALS Service Rate 20 22.1.3 ALS Reimbursement Rate 20 22.1.4 Medical Supply Reimbursement Rate 21 22.1.5 Zero Pay Patients 21 22.1.6 Risk of Non - Payment 21 22.1.7 Medicare Patients 21 • iii Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 22.2 Billing, Audit and Access to Records 22 22.2.1 Billing System 22 22.2.2 Accounting 22 22.2.3 Responsibility for Submission of Claims 22 22.2.4 Medicare Audits 23 22.3 Contractor Monthly Payment 23 22.3.1 Monthly Payments to OCFA 23 22.3.2 Zero Pay Patient Exemption Requests 23 22.3.3 Monthly Payment Report 23 22.3.4 Audit Report 24 22.4 Changed Circumstances 24 23.0 BREACH OF CONTRACT 24 23.1 Breach of Contract 24 24.0 PUBLIC SAFEGUARDS AND EMERGENCY TAKEOVER 25 • 25.0 CONTRACTOR'S RELIEF UPON TERMINATION 25 26.0 HOLDOVER PROVISION 25 27.0 SUCCESSORS 26 28.0 INTEGRATION 26 29.0 NO WAIVER 26 30.0 THIRD PARTY BENEFICIARIES 26 31.0 EXECUTION OF AGREEMENT 26 32.0 NOTICES 26 33.0 SEVERABILITY 27 34.0 EOA BOUNDARY CHANGE 27 35.0 AMENDMENT 27 111) iv Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 36.0 VENUE 27 • • v • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 III EXHIBITS EXHIBIT "A" - DEPICTION OF SUBJECT EOA EXHIBIT "B" - OCFA 2004 FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES REQUEST FOR PROPOSALS (RFP NO. JR1494) EXHIBIT "C" - CONTRACTOR'S SIGNED, ORIGINAL BID PROPOSAL SUBMITTED FOR OCFA RFP NO. JR1494 EXHIBIT "D" - SAMPLE QUARTERLY RESPONSE TIME REPORT • III vi Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 AGREEMENT BETWEEN [THE ORANGE COUNTY FIRE AUTHORITY /OR CITY] AND [NAME OF CONTRACTOR] FOR PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES WITHIN EXCLUSIVE OPERATING AREA No. THIS AGREEMENT FOR THE PROVISION OF FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES (the "Agreement ") is made and entered into the day of , 2009 by and between the [ORANGE COUNTY FIRE AUTHORITY /OR CITY], [a Joint Powers Agency ( "JPA ") organized pursuant to the provisions of Article 1, Chapter 5, Division 7, Title 1 (commencing with Section 6500) of the California Government Code /or a California municipal corporation], hereinafter referred to as [ "OCFA" or "City "], and [NAME OF CONTRACTOR AND CORPORATE STATUS], hereinafter referred to as "Contractor." RECITALS 1. The Orange County Fire Authority ( "OCFA ") is a governmental entity providing fire and life safety services to over one million residents within the County of Orange, California. OCFA is a Joint Powers Agency ( "JPA ") organized pursuant to the provisions of Article 1, Chapter 5, Division 7, Title I • (commencing with Section 6500) of the California Government Code. OCFA consists of twenty -two (22) member cities and the County of Orange. Each OCFA JPA member agency individually has the statutory ability to provide fire suppression, protection, prevention and related and incidental services, including emergency ambulance response services, within their respective jurisdictions. 2. By entering into a Joint Powers Agreement, each JPA member agency vested OCFA with the power to exercise each member agency's legal ability to provide fire suppression, protection, prevention and related and incidental services, including emergency medical and transportation services, and other fire related services authorized by law within their respective jurisdictional boundaries. Each OCFA JPA member agency has elected to jointly exercise their powers to provide for such services through the formation of OCFA. 3. The State Legislature has enacted the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act ( "EMS Act "), which creates a comprehensive statutory system governing virtually every aspect of prehospital emergency medical services. The purpose of enacting the EMS Act was to achieve state -wide coordination and integration of prehospital emergency medical services. 4. The EMS Act accomplishes this integration through what is essentially a two- tiered system of regulation. At the state level, the Emergency Medical Services Authority ( "EMS Authority ") performs a number of different functions relating to the coordination of EMS throughout the state. The second tier of governance under the EMS Act is occupied by counties and their local EMS agency ( "LEMSA "). The EMS Act authorizes each county's LEMSA to develop an emergency services program. Each county developing such a program is required to designate the county health department as the local EMS agency. In Orange County, this function is performed by the Orange County EMS agency, a 1 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • division of the County Health Care Agency ( "OCEMS "). All Orange County providers of prehospital emergency medical services are required to operate within the local EMS system developed by OCEMS. 5. The Orange County Board of Supervisors designated OCEMS as the LEMSA for purposes of administering the local EMS Plan within the County. The County, however, does not regulate ambulance transport services within cities. Rather, the County allows cities to administer their EMS /ambulance programs in coordination and cooperation with the local EMS Plan and OCEMS. In 1985, the County of Orange adopted County model ambulance ordinance no. 3517, which is a mechanism for licensure of emergency medical transport services and for establishing transport service areas. The County adopted Ordinance No. 3517 ( "model Ambulance Ordinance ") with the intention that it serve as a model city ambulance ordinance for adoption by cities within Orange County. Under this approach, the County's EMS Plan allows cities to provide ambulance transport services in accordance with the model Ambulance Ordinance. OCFA administers the ambulance programs on behalf of its member agencies. 6. Health and Safety Code §1797.224 authorizes OCEMS to create exclusive operating areas in the development of its local EMS Plan. The creation of exclusive operating areas is authorized by state law, provided a competitive process is utilized to select service providers pursuant to the local EMS Plan. In Orange County, the competitive process for the selection of ambulance providers within established OCFA exclusive operating areas is administered by OCFA. The competitive process is, however, subject to review and approval by OCEMS. Through input and recommendation of OCFA, exclusive ambulance service areas have been approved and created by OCEMS for all OCFA jurisdictional areas. Only to the extent that OCEMS designates an exclusive operating area, as defined by the EMS Act, consents to the current model Ambulance Ordinance structure, and approves of the competitive process utilized may such services be provided by cities. OCFA and/or its member agencies award ambulance service contracts by acting under the authority of OCEMS and its state approved EMS Plan. • 7. The current exclusive operating area contracts for all OCFA jurisdictional areas are set to expire on August 31, 2009. Currently, there are nineteen (19) exclusive operating areas within the OCFA jurisdictional area. Exclusive Operating Area No. (Name of EOA) is more particularly described and depicted in Exhibit "A," which is attached hereto and incorporated herein by reference (hereinafter referred to as the "Subject EOA "). 8. OCFA/or City desires to designate Contractor and Contractor desires to be designated by OCFA/or City, as an independent contractor, for purposes of providing exclusive 911 - Fire/EMS Emergency Ambulance Transportation and Related Services within the Subject EOA as of September 1, 2009, pursuant to the terms and conditions set forth in this Agreement. 9. For reference, the Orange County Fire Authority shall hereinafter be referred to as "OCFA." [Name of Contractor] ambulance service, which has been selected to provide services within the Subject EOA pursuant to the OCFA 2008 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals (RFP No. JR1494) shall hereinafter be referred to as the "Contractor." The City of [ 1 shall hereinafter be referred to as the "City." "Awarding Agency" shall hereinafter either refer to the OCFA Board of Directors or, when applicable, the legislative body that retains emergency ambulance provider contracting and selection authority for the Subject EOA. The County of Orange shall hereinafter be referred to as the "County." NOW, THEREFORE, for valuable consideration, receipt of which is hereby acknowledged, and in consideration of the foregoing recitals, which are hereby incorporated by reference into the Agreement below, and the mutual promises, covenants, and conditions contained herein, the parties hereto agree as follows: • 2 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 AGREEMENT • 1.0 SCOPE OF SERVICES 1.1 Contractor shall provide exclusive 911 - Fire/EMS Emergency Ambulance Transportation and Related Services within the Subject EOA in accordance with the terms and conditions set forth in this Agreement and shall serve at all times as the "Primary Responder" within the Subject EOA. The term "Primary Responder" shall mean the ambulance service operator that is assigned and dispatched first by the OCFA Emergency Communications Center to respond to all calls for emergency medical transportation service within the Subject EOA throughout the term of this Agreement. • 1.2 Contractor is hereby assigned and designated as the authorized, exclusive Primary Provider for all 911 - Fire/EMS emergency ambulance transportation calls for service within the Subject EOA. OCFA, in cooperation with Contractor, shall provide on -scene Advanced Life Support ( "ALS ") services, and Contractor shall provide Basic Life Support ( "BLS ") services and transport patients to medical facilities, when required. The terms Advanced Life Support and Basic Life Support shall mean the same as defined in the EMS Act. 2.0 CONSIDERATION 2.1 In consideration of Contractor's agreement to be designated and to provide and perform the services described herein, OCFA/or City agrees that throughout the term of this Agreement, Contractor shall have the sole and exclusive right to provide all 911 - Fire/EMS Emergency Ambulance Transportation and Related Services as the Primary Provider within the Subject EOA, subject to the terms and conditions contained herein. • 3.0 CONTRACT DOCUMENTS 3.1 The Agreement between the parties hereto shall consist of the following: (1) this page document, ( "this document"); (2) the OCFA 2008 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals (RFP No. JR1494) ( "RFP "); and (3) Contractor's signed original bid proposal for RFP No. JR1494 submitted to OCFA, including the Prequalification documents submitted by Bidder for this EOA ( "Bid Proposal"), which shall all be referred to collectively hereinafter as the "Agreement" or the "Contract Documents." The RFP and the Contractor's signed Bid Proposal, which are both attached hereto as Exhibits "B" and "C" respectively are hereby incorporated by reference and are made part of this Agreement. All provisions of the RFP and the Bid Proposal shall be binding on the parties. Should any conflict occur or exist in the Contract Documents, the provisions of this document, then the provisions of the RFP, then the provisions of the Bid Proposal shall control. 4.0 MODIFICATION AND AMENDMENTS 4.1 The parties may adjust the specific terms of the Contract Documents where the modification or amendment is not a material change to the contract, as agreed upon by the parties. Any modification or amendment proposed by the Contractor must be submitted in writing to OCFA for consideration. The decision to modify or amend any term or condition of the Contract Documents shall be at the sole discretion of OCFA and/or the Awarding Agency, if applicable. Any agreed upon modification or amendment must be in writing, approved by the OCFA Fire Chief, and signed by all parties, and may be subject to approval by OCEMS and the State EMS Authority. 3 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 5.0 CONTRACT ADMINISTRATION 5.1 The OCFA Fire Chief, or his designee(s), shall be the authorized representative of the City concerning all matters that pertain to the Agreement. This Agreement shall be administered and enforced by the OCFA Fire Chief, or his designee(s). 6.0 EFFECTIVE DATE 6.1 The effective date of this Agreement shall be 12:00 a.m., Tuesday, September 1, 2009, ( "Effective Date ") at which time Contractor shall assume full responsibility for the provision of all 911 - Fire/EMS emergency ambulance transportation services within the Subject EOA. The Effective Date may, however, be postponed at the sole discretion of the OCFA Fire Chief in order to protect public health and safety in the event Contractor is for any reason unable to commence performance at that time. 7.0 TERM 7.1 The term of this Agreement is for a five (5) year period, ending on August 31, 2014 with no extensions, unless there are unavoidable or unforeseeable circumstances beyond the control of OCFA that would preclude a new RFP process and contract award. In such circumstances, the contract may be extended up to one additional year. 8.0 TERMINATION 8.1 Either party may terminate this Agreement (1) immediately, upon the breach of this Agreement by the other party or (2) upon 180 days written notice given at the sole discretion of either • party regardless of the existence, or non - existence, of any breach of this Agreement by the other party. 8.2 In the event of termination, Contractor may be compensated by responsible parties for those services that have been fully and adequately completed, rendered, and accepted as of the date of termination. Contractor shall provide documentation deemed adequate by OCFA to show the services actually completed and rendered by Contractor prior to the effective date of the termination. 8.3 In the event this Agreement is terminated, in whole or in part, as provided by this Section, OCFA and the Awarding Agency, if applicable, may procure, upon such terms and in such manner as it deems appropriate, services similar to those terminated. 8.4 The rights and remedies of the parties provided in this Section are in addition to any other rights and remedies provided by law or under this Agreement. 8.5 In order to protect public health and safety, Contractor hereby agrees to fully cooperate with and to immediately assist OCFA and the City to effectuate a prompt and orderly takeover of 911 - Fire/EMS emergency ambulance service within the Subject EOA upon termination of this Agreement, so as to ensure that there will be no service interruption to the public. 9.0 INSURANCE 9.1 Prior to the Effective Date, Contractor shall, at its sole cost and expense, purchase and maintain throughout the term of this Agreement, the following insurance policies: 9.1.1 Commercial General Liability Insurance (Bodily Injury and Property Damage): with a limit not less than $3,000,000 combined single limit, per occurrence; $5,000,000 annual aggregate. • 4 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 9.1.2 Business Automobile Liability Insurance: with a limit not less than $3,000,000 • combined single limit, per occurrence; $5,000,000 annual aggregate. 9.1.3 Ambulance Medical Malpractice Insurance: with a limit of not less than $3,000,000 per occurrence; $5,000,000 annual aggregate. If the Ambulance Medical Malpractice policy is written as a "claims made" policy, the retro date shall be prior to the first day of service under this Agreement. Furthermore, Contractor shall maintain such coverage, including coverage for "prior acts," for three (3) consecutive years following termination of this Agreement, and thereafter, submit annual evidence of continued coverage. Additionally, Contractor shall provide certified copies of the claims reporting requirements contained within any policy secured to meet this requirement. 9.1.4 Workers' Compensation and Employers' Liability Insurance: meeting statutory limits. Such insurance shall contain a waiver -of- subrogation clause in favor of OCFA, the City, and the County, their officers, elected officials, agents, volunteers, and employees. 9.2 All insurance required pursuant to this Section shall be issued by a company authorized by the Insurance Department of the State of California and rated A -, VII or better by the latest edition of Best's Key Rating Guide, except that OCFA will accept workers' compensation insurance rated B, VII or better or from the State Compensation Fund. The workers' compensation insurance company shall agree to waive all rights of subrogation against OCFA, the City, and the County for losses paid under the terms of the policy, which arose from the work performed by the named insured. 9.3 All insurance policies, except Workers' Compensation and Employers' Liability and Professional Liability, shall contain the following clauses: 9.3.1 "The City, the County, and OCFA are added as additional insureds as respects • operations to the named insured performed under contract with the City or OCFA. Such policies shall be primary, and any other policies maintained by or providing protection for the City, the County, or OCFA shall be excess or secondary, but noncontributing." 9.3.2 "This insurance shall not be canceled, limited, or allowed to lapse until after thirty (30) days written notice has been give to the City, the County, and OCFA." 9.4 Upon execution of this Agreement, Contractor shall provide to OCFA, and to the satisfaction of OCFA, certificates of insurance and endorsements evidencing the policies fulfilling the requirements of this Section. If self - insured for workers' compensation, Contractor shall submit to OCFA a copy of its certification of self - insurance issued by the Department of Industrial Relations. 9.5 If Contractor does not keep all of the insurance policies required by this Section in full force and effect at all times during the term of this Agreement, OCFA may elect to treat the failure to maintain the requisite insurance as a breach of contract, which may result in immediate termination of the Agreement. 9.6 At any time during the term of this Agreement, if OCFA reasonably determines, at its sole discretion, that the amounts of insurance held by Contractor pursuant to this Section are no longer sufficient, or that additional types of coverage are needed, Contractor shall modify the existing coverage or obtain additional policies, as OCFA shall reasonably determine. All new policies shall be on the terms and conditions contained herein. 5 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 9.7 Contractor shall annually, within ten (10) days of the anniversary of the Effective Date of this Agreement, provide to OCFA evidence that all insurance required pursuant to this Section continues to be in full force and effect. 10.0 ASSIGNMENT 10.1 Except as provided herein, Contractor shall not delegate or assign its rights or otherwise transfer its obligations, in whole or in part, under this Agreement to any other person or entity without the prior written consent of OCFA and the Awarding Agency, if applicable. Any such assignment without the prior written consent of OCFA shall be void and the attempted assignment may constitute a breach of contract. 10.2 The following shall be considered to be a "transfer" for purposes of this Section: 10.2.1 Any change in the business structure, including but not limited to, changes from or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; 10.2.2 Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 10.2.3 A transfer by any shareholder of greater than ten percent (10 %) of the stock issued as of the Effective Date by Contractor, or a sale or transfer of over twenty-five percent (25 %) of the assets of Contractor. In the event Contractor experiences regular stock exchanges in excess of the ten percent (10 %) threshold, a separate agreement may be negotiated to set a threshold that still provides • OCFA and the Awarding Agency, if applicable, with the protections intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. 11.0 AUDITS AND INSPECTIONS 11.1 Business Office. At any time during normal business hours, and as often as may reasonably be deemed necessary by OCFA, OCFA may observe and inspect Contractor's business office, and Contractor must .make promptly available to OCFA for its examination all Contractor records that pertain to its performance of the Agreement. OCFA may audit, examine, and copy any and all Contractor records pertaining to its performance of the Agreement, including but not limited to, personnel records, daily logs, conditions of employment, financial/billing records, and all other records or data. OCFA's right to inspect Contractor's business office and any and all records pertaining to its performance of the Agreement will be restricted to normal business hours and reasonable notice shall be given to Contractor in advance of such inspection. 11.2 Facilities/Vehicles. OCFA may, at any time and without prior notice, observe and inspect Contractor's vehicles, ambulance dispatch center, maintenance facilities, personnel, and/or any ambulance post location(s). OCFA employees may be assigned to ride as observers on any Contractor vehicle at any time provided, however, that in exercising this right to inspect and observe OCFA employees shall conduct themselves in a professional and courteous manner, shall not interfere in any way with Contractor's employees in the performance of their duties, and shall at all times be respectful of Contractor's employer - employee relationships. • 6 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 12.0 COOPERATION • 12.1 Contractor shall fully cooperate with OCFA and the Awarding Agency, if applicable, and shall take all actions necessary to ensure that all terms and conditions, and required performance levels, set forth in the Contract Documents are satisfied at all times throughout the term of the Agreement. 13.0 INDEPENDENT CONTRACTOR 13.1 Both parties in the performance of the Agreement shall be acting in an independent capacity and not as agents, employees, partners, or joint ventures with one another. Contractor and its employees are not employees of the City, the County, or OCFA and are not entitled to any of the rights, benefits, or privileges of City, County, or OCFA employees including, but not limited to, medical, unemployment, or workers' compensation insurance. 14.0 INDEMNIFICATION 14.1 General. Contractor shall defend, indemnify and hold harmless the City, the County, and OCFA, their officers, agents, elected officials, and employees, from all liability, claims, losses and demands, including defense costs and reasonable attorneys' fees, whether resulting from court action or otherwise, arising out of the acts or omissions of Contractor, its officers, agents, or employees, or the condition of property used, in the performance of the Agreement, excepting acts or omissions directed by the City, the County, and OCFA, their officers, agents, or employees, acting within the scope of their employment, for which the City, the County, and OCFA agree to defend and indemnify Contractor in a like manner. 14.2 Rates. Contractor shall defend, indemnify and hold harmless the City, the County, and OCFA, their officers, agents, elected officials, and employees, from all liability, claims, losses and • demands, including defense costs and reasonable attorneys' fees, whether resulting from court action or otherwise, arising from any and all challenges to the service rates established in the Contract Documents. A challenge to service rates includes, but is not limited to, both procedural and substantive challenges to the adequacy of, or authority to impose, either the BLS service rate, the ALS service rate, the ALS reimbursement rate, and/or the medical supply reimbursement rate as set forth in the Contract Documents. 15.0 COMPLIANCE WITH LAWS 15.1 All services provided and duties performed by Contractor pursuant to this Agreement must be rendered in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It shall be Contractor's sole responsibility to determine which federal, state, and local laws, rules, statutes, and regulations apply to the services and duties to be performed pursuant to this Agreement, and to maintain compliance at all times throughout the term of the Agreement. 16.0 RISK 16.1 Notwithstanding any other term or condition herein, in responding to a call for service, Contractor shall have no claim whatsoever against OCFA, the City, or the County or have any right to recover from OCFA, the City, or the County for the cost of any of the services it renders in its performance of services under this Agreement. Contractor must look solely and exclusively to the service recipient, their insurers, applicable state or federal health care programs, or other responsible party for payment of the services it renders. 16.2 Contractor shall assume the entire risk of non - payment for any and all of the services rendered, duties performed, and charges incurred in connection with its performance of services under • 7 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • this Agreement, including, but not limited to, all BLS and ALS charges incurred, the ALS reimbursement rate, and/or the medical supply reimbursement rate. 17.0 RESPONSIBILITY 17.1 It shall be the responsibility of Contractor to provide all equipment, to satisfy all terms and conditions set forth in the Agreement, and to perform all required duties, obligations, and responsibilities expressed in the Contract Documents at all times during the term of the Agreement. Contractor may utilize additional resources whenever deemed necessary to perform its emergency ambulance services pursuant to the Agreement. This may include, but is not limited to, use of personnel and/or equipment of another OCFA - approved ambulance provider. This, however, shall not relieve Contractor of its duties and responsibilities under the Agreement, and any additional cost incurred shall not be charged to OCFA, the City, or the County. 18.0 ACTS OR OMISSIONS OF REPRESENTATIVES 18.1 The acts and/or omissions of the owner(s), officers, operators, officials, employees, agents, and representatives of Contractor in the performance of the services and obligations under the Agreement shall constitute the acts and/or omissions of Contractor. 19.0 INSOLVENCY 19.1 Contractor shall not, without the prior written consent of the OCFA Fire Chief, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of Contractor, or make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by Contractor under any insolvency or bankruptcy proceeding may constitute a breach • of contract by Contractor, and all property assigned by OCFA, the City, and /or the County for safe care shall be immediately "released" to another assigned service provider, as specified by the OCFA Fire Chief. 20.0 OPERATIONAL STANDARDS, PROCEDURES, & PERFORMANCE REQUIREMENTS 20.1 Service Hours 20.1.1 Service. Contractor shall provide twenty -four (24) hour 911 - Fire\EMS Emergency Ambulance Transportation and Related Services within the Subject EOA, at or above the level agreed to in the Contract Documents, seven (7) days a week throughout the term of the Agreement. 20.1.2 Field Supervisor. Contractor shall assign an authorized and qualified field supervisor available to OCFA personnel, either by radio or in person, who shall be physically present within the County of Orange, on a twenty -four (24) hour, seven (7) day per week basis throughout the term of the Agreement. 202 Response Times 20.2.1 Response Time Reporting. Contractor shall provide quarterly response time reports to OCFA and OCEMS ( "Quarterly Response Time Reports ") that contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Exhibit "D ". Each Quarterly Response Time Report shall be submitted to the OCFA EMS Section Battalion Chief and the OCEMS Program Manager via e-mail (in a format approved by the OCFA EMS Section Battalion Chief) by the 10th day of the month following the end of the quarter. For example, January, February, March • reports are due April 10th. If the Quarterly Response Time Reports are not submitted in a timely manner, 8 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 Contractor may be assessed a $500 penalty per occurrence. If the Quarterly Response Time Reports are not submitted to OCFA as prescribed herein two (2) or more times in a single 12 -month period, such omissions may constitute breach of contract. 20.2.1.1 General Requirements. Contractors must respond to OCFA's requests for emergency ambulance transportation service within the response times set forth in this Section. Response times will be calculated as the actual elapsed time in minutes from the moment the request is received by the Contractor's dispatch center to the time that the Contractor's first ambulance arrives on scene. Where multiple ambulances are dispatched to the same emergency scene, only the response time of the ambulance arriving first will be counted for purposes of calculating the response time. Contractors will be responsible for providing quarterly response time reports to OCFA and OCEMS 20.2.1.2 Response Time Measurement. Response times are measured in full minutes, rounded upward. For purposes of measuring compliance and for the imposition of any penalties, any partial minute will be rounded to the next full minute. For example, a response time of 10:01 or 11:00 is counted as eleven minutes. 20.2.1.3 Definition of Geographical Areas & Response Priority Codes. The following geographical areas, response priority codes, and definitions will apply with regard to calculating response times (based upon changes in population densities, these geographical area definitions may be changed at the sole discretion of OCFA; OCFA will advise Contractors in writing when these changes occur): 1. Metro/Urban: Those areas with a population density greater than 100 persons per square mile; 2. Suburban/Rural: Areas with a population density of 7 to 100 persons per square • mile. These areas generally include the roads and contiguous canyon areas of the local mountain ranges, including: Brea Canyon, Tonner Canyon, Carbon Canyon, Modjeska Canyon, Silverado Canyon and Trabuco Canyon; the areas of Santiago Canyon Road between Jamboree and Live Oak Canyon Road; and the Ortega Highway (Highway 74) between La Plata Avenue and the County line; 3. Wilderness: Those areas with a population density of less than 7 persons per square mile. These, are generally the areas of the Cleveland National Forest within the County of Orange, with the exception of incidents on or immediately adjacent to Highway 74; 4. Code 2: Emergency ambulance vehicles responding to an emergency scene or request for service expeditiously, without red lights and sirens on. 5. Code 3: Emergency ambulance vehicles responding to an emergency scene or request for service with red lights and sirens on. 20.2.1.4 Response Times Required. Contractors must strictly adhere to the following required response times at a quarterly compliance rate of ninety percent (90 %) in each Code 2 and Code 3 category, which shall be reported separately: 1. Metro/Urban Requirements: i) Code 3- Response time must not exceed ten (10) minutes, zero (0) seconds. 9 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • ii) Code 2- Response time must not exceed fifteen (15) minutes, zero (0) seconds. 2. Suburban/Rura 1 Requirements: i) Code 3- Response time must not exceed twenty (20) minutes, zero (0) seconds. ii) Code 2- Response time must not exceed twenty -five (25) minutes, zero (0) seconds. 3. Wilderness Requirements: i) Code 3- Response time must not exceed thirty (30) minutes, zero (0) seconds. ii) Code 2- Response time must not exceed forty (40) minutes, zero (0) seconds. 20.2.1.5 Call Cancellation. In the event a call for service is cancelled prior to arrival, the response will be considered to be within the response time requirement so long as the elapsed time between the call for service and the cancellation does not exceed the applicable response time requirement. In the event the elapsed time between the call for service and the cancellation is in excess of the applicable response time requirement, the call will be considered late. 20.2.2 Quarterly Response Time Report - Format. The Quarterly Response Time Reports shall be submitted by Contractor using an electronic spreadsheet format that will be provided to Contractor by OCFA. The Quarterly Response Time Reports shall contain the response time data provided in the sample Quarterly Response Time Report, which is attached hereto as Exhibit "D," for the EOA. Whenever response times in either Code 2 or Code 3 categories fall below the 90% compliance rate in any given quarter, Contractor shall include a narrative assessment as to the cause of any response delay, and, if requested, shall meet and confer with the OCFA EMS Section Battalion Chief for purposes of establishing a plan for avoiding such delay in the future. 20.2.3 Exemptions to Response Time Requirements. The response time requirements set forth in this Section may be suspended and not enforced, at the discretion of the OCFA EMS Section Battalion Chief, in unusual circumstances. There shall be no exemption for response delays due to vehicle mechanical problems, driver error, traffic, weather, or mistake. The response time requirements set forth in this Section shall be suspended and not enforced under the following limited circumstances: 20.2.3.1 High Call Volume: Responses to calls for service during periods of unusual system overload or high call volume, which shall be at the sole determination of OCFA; 20.2.3.2 Disasters: Responses to calls for service during an OCFA declared disaster occurring within an EOA or during a declared disaster in a neighboring jurisdiction, which has requested emergency ambulance transportation or other mutual aid assistance from OCFA. For purposes of this Section, a "declared disaster" means any condition of disaster as declared or affirmed by the OCFA Fire Chief or his designee; 20.2.3.3 Multiple Ambulance Response: For responses to calls for service where more than one ambulance is dispatched to the same incident, only the response time of the ambulance first to respond shall be required to meet the required response time requirements; . 10 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 20.2.3.4 Response Up/Downgrade: For Code 3 calls where the • response priority code is downgraded to Code 2 by OCFA while the ambulance is en route to the scene, the response time standard for that call shall be recorded as a Code 2 call. If the response priority code is upgraded from Code 2 to Code 3 by OCFA while the ambulance is en route to the scene, the response time standard for that call shall be recorded as the number of minutes for a Code 3 call plus the number of minutes already elapsed, not to exceed the original total minutes for a Code 2 call; 20.2.3.5 Return of OCFA Personnel: In the event that an ambulance is delayed in responding to a call for service, or is hindered from providing a timely response, due to the need to comply with the requirement that it return all OCFA personnel to their respective fire stations, as described herein, the response time requirement for that call will be suspended. This exemption will only apply for a call for service dispatch that occurs while the ambulance is waiting for or actually returning OCFA personnel. It shall be the Contractor's responsibility to document such circumstances, including the length of time and the affected call(s) for service. Contractor shall apply for a specific exemption as provided below. Calls for service dispatches that occur after the ambulance has returned OCFA personnel and while returning to any ambulance post location are not eligible for this exemption. 20.2.4 Procedures to Request Response Time Exemption. Applications for receiving an exemption to the response time requirements shall be submitted by Contractor to the OCFA EMS Section Battalion Chief for approval. Such requests must accompany the Quarterly Response Time Report for the period in which the exemption is requested. Requests for exemptions outside of the current quarterly reporting period shall not be considered. Each request for exemption shall include the following information: (a) the incident date; (b) the OCFA Incident Number(s); (c) a narrative summary of the incident; (d) explanation for the cause of the response time delay; and (e) the specific exemption requested. The decision to either grant or deny a response time exemption request shall be made by the OCFA EMS Section Battalion Chief within thirty (30) days; the decision to deny may be appealed to the OCFA Fire Chief, whose decision shall be final. 410 20.2.5 Use of Alternative Methods to Meet Response Time Requirements. For purposes of maintaining compliance with the response time requirements established herein, Contractor shall negotiate and enter into a separate mutual aid agreement(s) with neighboring ambulance service operators for the provision of back -up, secondary emergency ambulance transportation services within the Subject EOA. Any secondary ambulance provider(s) selected to provide such services, and any agreement(s) to provide such services pursuant to this Section, shall satisfy the following requirements: 20.2.5.1 All secondary mutual aid provider draft agreements shall be reviewed and approved by OCFA prior to execution of the Agreement and a copy of the final, signed agreement shall be sent to the OCFA EMS Section Battalion Chief; 20.2.5.2 All OCFA — approved secondary mutual aid providers shall be expected to perform back -up emergency ambulance transportation services in accordance with the operational standards, procedures, and performance requirements set forth in the Contract Documents; 20.2.5.3 All OCFA— approved secondary mutual aid providers and their employees shall cooperate with OCFA and shall participate in any audit requested by OCFA concerning their performance; and 20.2.5.4 Notwithstanding the above, Contractor and not the secondary mutual aid provider shall be responsible for ensuring compliance with all terms, conditions, standards, and performance requirements set forth in the Contract Documents, including but not limited to, the imposition of all applicable penalties and payment of all fees and reimbursements. 11 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 20.2.6 Disciplinary Actions for Failure to Meet Response Time Requirements / Performance D eficiency 20.2.6.1 Meet and Confer. Should Contractor fail to meet the response time requirements, set forth in this Section, in any quarterly period for any single Code category or for the cumulative total of Code 2 and Code 3 calls, as outlined in Exhibit "D," the OCFA EMS Section Battalion Chief shall notify the Contractor and may meet and confer with the Contractor regarding performance and response time deficiencies. The purpose of this meeting is to notify the Contractor of its deficiencies and to work with the Contractor to ensure proper response time performance in the immediate future. 20.2.6.2 Penalties. At the discretion of the OCFA EMS Section Battalion Chief, monetary penalties may be assessed against the non - compliant Contractor for failure to meet the response time requirements set forth in this Section. For each EOA, quarterly aggregate response times (i.e., in any quarterly period for any single Code category) that are not in compliance with the response time requirements set forth in this Section may result in OCFA assessing the non - compliant Contractor with a monetary penalty according to the following compliance and fine schedule: Quarterly Responses That Are In Compliance With Response Time Requirements Per Geographical Area (EOA) And Per Response Priority Code: Penalty Imposed *: 90% or Better None • 85% - 89.9% $1,000 80% - 84.9% $2,000 Less than 79.9% $3,000 *Note: Penalties are for Code 2 /Code 3 reported separately and calculated separately within each geographical area in the Subject EOA. In addition to the above response time penalties, OCFA may assess monetary penalties against Contractor for the following: 20.2.6.2.1 Turned Call Penalties: Any calls for service that are not handled by the Contractor, either through its own equipment and personnel or secondary mutual aid providers, and that require OCFA to request service from another ambulance service operator may result in the assessment of a "Turned Call" penalty in the amount of $500 per occurrence. 20.2.6.2.2 Late Report/Late Payment Penalties: Any reports, fees, or reimbursements that are required to be submitted to OCFA by Contractor pursuant to the Contract Documents (e.g., Quarterly Response Time Reports, CQI, monthly reimbursements, etc.) and that are not submitted on time may result in the imposition of a $500 penalty per occurrence. 20.2.6.3 Timely Performance Required. Assessment of penalties pursuant to this Section shall not relieve Contractor of the responsibility to meet all performance expectations as set forth in the Contract Documents. Substandard cumulative response time performance (i.e., below the 90% compliance rate for combined Code 2 and Code 3 calls) in any two (2) quarters in a • single twelve (12) month period shall constitute breach of contract. 12 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 Failure to timely correct and cure any response time deficiency may • constitute a breach of the Agreement. This Agreement requires the highest levels of performance, reliability, and compliance with the established performance criteria and service delivery criteria, and the mere demonstration of effort, even diligent and well- intentioned effort, shall not substitute for proper compliance. 20.2.6.4 Waiver. Any monetary penalty that may be imposed pursuant to this Section may be waived, upon a showing of good cause, at the sole discretion of the OCFA Fire Chief, whose decision shall be final. 20.3 Emergency On -Scene Procedures 20.3.1 Contractor shall perform as a part of the patient care team and shall be able to perform all BLS treatment modalities within its scope of practice, as required by OCEMS. 20.3.2 All EMTs and other ambulance personnel assigned by Contractor to perform services under the Agreement shall: 20.3.2.1 Be trained in Orange County disaster response procedures, multiple victim, and mass casualty incident protocols, pursuant to the Orange County Fire Services Operational Area Annex; 20.3.2.2 Work under the direction of the OCFA Incident Commander and/or the OCFA EMT - Paramedic in charge of the patient(s) and/or incident; 20.3.2.3 Fully cooperate with and abide by the instructions of the OCFA • Incident Commander and/or the OCFA EMT - Paramedic in charge of the patient(s) and/or incident; 20.3.2.4 Place their apparatus and equipment at the scene in a safe location or as deemed appropriate by the OCFA Incident Commander and shall be mindful of the need for safe operations, including the avoidance of exhaust fumes; 20.3.2.5 Not interfere with or assist OCFA personnel in any fire fighting or emergency rescue operation; 20.3.2.6 Request a secondary ambulance and/or Contractor field supervisor immediately upon determining that their unit has suffered a mechanical failure or is or may become disabled, or upon the request of an OCFA Incident Commander, and must likewise immediately inform the OCFA Incident Commander of any mechanical failures; and, 20.3.2.7 Be aware that safety is the responsibility of all personnel on scene; ambulance personnel shall not enter or operate in unsafe environments. 20.4 Disaster Assistance 20.4.1 During a disaster, declared locally or in a neighboring jurisdiction, strict application of the performance standards set forth in the Contract Documents may be temporarily suspended by OCFA in order to provide an appropriate response. While disaster coordination shall be provided by OCFA, Contractor shall be actively involved in the planning and response to any declared disaster. Upon notification of a disaster by OCFA, Contractor shall immediately commit any and all 13 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • available resources and assist OCFA in accordance with disaster plans and protocols applicable in the locality where the disaster has occurred. In the event of a disaster, the following shall apply: 20.4.1.1 During such periods, Contractor shall be released from the response time requirements until notified by the OCFA Duty Officer that disaster assistance is no longer needed; 20.4.1.2 When disaster assistance is no longer needed, Contractor shall resume performance pursuant to the Agreement as quickly as is practical considering personnel exhaustion, medical supply restocking needs, and other relevant considerations; 20.4.1.3 While performing disaster assistance, Contractor shall provide supervisory assistance at the command post or emergency operations center as requested and shall use best efforts to provide local emergency coverage; Contractor shall also suspend non - emergency transport services as necessary, informing persons requesting non - emergency transport of the reason for the temporary suspension; 20.4.1.4 During the course of a disaster, OCFA shall work with Contractor to utilize mutual aid providers who are authorized to perform such services within the County to meet the service demands of the disaster; and, 20.4.1.5 Contractor's supervisory personnel shall complete, or show proof of completion, incident command training, hazardous materials training, and supervisory training in cooperation with OCFA. 20.5 Standard of Performance • 20.5.1 Contractor shall perform all work and services pursuant to this Agreement in a skillful and workmanlike manner, and consistent with the standards generally recognized as being employed by professionals in the private, emergency ambulance transportation field in the State of California. Contractor hereby warrants and represents that it is skilled in the professional calling necessary to perform all work and services under the Agreement. Contractor hereby further warrants and represents that all of its employees and authorized subcontractors shall have sufficient skill and experience to perform the work and services assigned to them under the Agreement. Finally, Contractor hereby warrants and represents that it, its employees, and authorized subcontractors have all licenses, permits, qualifications and approvals of whatever nature that are legally required to perform the work and services under the Agreement, and that such licenses and approvals shall be maintained at all times throughout the term of the Agreement. 20.6 General Provisions 20.6.1 Return of OCFA Personnel. OCFA provides Advanced Life Support ( "ALS ") services from a variety of delivery platforms, including engine and truck companies. In cases where OCFA personnel accompany patients in the ambulance en route to hospitals or to other receiving facilities, and the OCFA ALS unit does not follow -up to the hospital/receiving facility, Contractor shall return those OCFA personnel to their assigned fire station(s) within thirty (30) minutes from the conclusion of the run. The conclusion of the run is defined as the moment when the patient has been transferred into the care of hospital/medical staff, the ambulance crew has completed all required documentation, and the ambulance has been restocked and is ready to be placed back in service. At the conclusion of the run, the ambulance crew is to advise the accompanying OCFA personnel that they are ready to return them to their station. If while returning OCFA personnel to their station, the ambulance • 14 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 receives another emergency call, the ambulance may accept that call for service and take those returning • OCFA personnel to the new call at the discretion of the OCFA personnel on board. 20.6.2 911 Calls for Service/Referral. Contractor shall immediately refer to OCFA any and all incoming calls for 911 - Fire/EMS emergency ambulance service that are made by any person directly to a Contractor's ambulance dispatch center or business office. 20.6.3 Performance. The most important aspect of this Agreement is that it stresses "performance." Contractor shall demonstrate a continuous effort to detect and correct service level performance deficiencies, as determined by OCFA, and to continuously upgrade the performance and reliability of the EMS transportation system within the Subject EOA. Contractor's 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, proper management oversight, employee training and continuing education. 20.6.4 Conflict of Interest. Contractor hereby warrants and represents that it is not, and will not be, violating either directly or indirectly any conflict of interest statute, rule, or regulation by its performance of services under this Agreement. 20.6.5 Complaints. Contractor shall immediately notify OCFA in writing of any complaints, inquiries, or investigations initiated by OCEMS, the California Emergency Medical Services Authority, and/or any other federal, state, or local regulatory agency regarding Contractor services performed pursuant to this Agreement, including but not limited to: level of service; service delivery; service quality; billing practices; medical training and/or care; and personnel. Nothing in this Agreement shall be construed as superseding the authority of OCEMS or any other duly empowered regulatory agency from separately and/or concurrently exercising its authority to provide regulatory oversight and to • take action to ensure that Contractor's private, emergency ambulance response services are administered according to law. 20.6.6 Traffic Signal Preemption. Contractor shall be required to purchase, install, and maintain, at its sole cost and expense, City or OCFA- approved traffic signal preemption and security gate access devices /equipment on all ambulances serving the Subject EOA, if required. 20.6.7 HIPAA Compliance Plan. Effective April 14, 2003, or such other implementation date established by law, to the extent that the parties have a "business associate" relationship, the parties shall carry out their obligations under this Agreement in compliance with the privacy regulations published at 65 Federal Register 82462 (December 28, 2000) (the "Privacy Regulations ") pursuant to Public Law 104 -191 of August 21, 1996, known as the Health Insurance Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq., as amended ( "HIPAA "), to protect the privacy of any personally identifiable, protected health information ( "PHI ") that is collected, processed or learned as a result of the services provided pursuant to the contract. In conformity therewith, both parties agree that they shall: 20.6.7.1 Not use or further disclose PHI except: (i) as permitted under the Agreement (that is, for the purpose of maintaining accurate records of the services provided pursuant to the Agreement and for the billing of such services to patients, guarantors, insurers, carriers or other responsible parties; the issuance of reports to the other party pertaining to same; and related administrative functions pertaining to these activities); (ii) as required for the proper management and administration of ALS and BLS in their capacity as HIPAA "Business Associates" of each other; or (iii) as required by law; 15 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 20.6.7.2 except as permitted by the Agreement; Use appropriate safeguards to prevent use or disclosure of PHI 20.6.7.3 Report to each other any use or disclosure of PHI not provided for by the contract of which a party becomes aware; 20.6.7.4 Ensure that any agents or subcontractors to whom either party provides PHI, or who have access to PHI, agree to the same restrictions and conditions that apply to both parties with respect to such PHI; 20.6.7.5 Make PHI available to the individual who has a right of access as required under HIPAA; 20.6.7.6 Make available for amendment and incorporate any amendments to PHI when notified to do so by either party; 20.6.7.7 Make available to either party the information required to provide an accounting of the disclosures of PHI made by the one party on the other party's behalf, provided such disclosures are of the type for which an accounting must be made under the Privacy Regulations; 20.6.7.8 Make their internal practices, books and records relating to the use and disclosure of PHI available to the Secretary of the Department of Health and Human Services for purposes of determining either party's compliance with HIPAA and the Privacy Regulations; and 20.6.7.9 Upon termination of the Agreement, return or destroy all PHI • received from, or created or received by one party on behalf of the other party. In the event the return or destruction of such PHI is infeasible, both parties' obligations under this Section shall continue in full force and effect so long as either party possesses any PHI, notwithstanding the termination of the Agreement for any reason. 20.6.8 Medicare/Medi - Cal Participation. Contractor hereby warrants and represents that it is an enrolled provider in good standing in the Medicare and Medi -Cal programs and is not the subject of any pending actions, investigations, or prosecutions, whether civil, criminal, or administrative, relating to its billing or reimbursement practices, and that Contractor shall not employ or utilize individuals for the performance of services hereunder who have been excluded from any state or federal health care program. Contractor further warrants and represents that: (i) it is not currently excluded, or threatened with exclusion, from participating in any federal or state funded health care program, including but not limited to Medicare and Medi -Cal, and (ii) it has never been excluded by any of the aforementioned programs. Contractor shall promptly notify OCFA of any imposed exclusions or sanctions covered by this warranty, and OCFA reserves the right to terminate the Agreement upon receipt of such notice. 20.7 External Medical Quality Control 20.7.1 The OCEMS Medical Director, or his designee(s), has both the authority and responsibility to routinely establish and monitor private, emergency ambulance system performance, including but not limited to: ambulance equipment standards; medical protocols; personnel standards; training standards; medical dispatch procedures; first responder practices and training; medical control; and to effect corrective and disciplinary action as necessary. • 16 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 20.7.2 Contractor shall fully comply with all federal, state, and local medical standards, • protocols, and rules and regulations applicable to the provision of private, emergency BLS ambulance transportation, including those established by OCEMS. Contractor shall at all times during the term of this Agreement fully cooperate with the OCEMS Program Manager and the OCEMS Medical Director in the monitoring, regulation, management, oversight, and administration of the County EMS system. 21.0 PERSONNEL 21.1 Personnel Requirements 21.1.1 Employee Performance. Contractor shall employ only competent and trained personnel, and shall provide a sufficient number of employees to perform the services provided under the Contract Documents. Each Contractor must comply with the following personnel requirements: 21.1.1.1 All Contractor employees and ambulance personnel shall be sufficiently trained and capable to ensure the safe and proper discharge of their service responsibilities; 21.1.1.2 All Contractor ambulance personnel must possess valid California Driver's Licenses in the proper class, including any required certifications, and must be compliant with all relevant provisions of the California Vehicle Code, Health and Safety Code, and all other laws applicable to private, emergency ambulance response personnel. 21.1.2 Employee Drug Program. Contractor shall have an employee alcohol and drug program that includes at a minimum, an alcohol and drug free workplace policy, and an employee alcohol/drug- testing program that complies with the U.S. Department of Transportation requirements to the extent allowed by law, including random alcohol and drug testing. Any Contractor employee found working under the influence of alcohol or drugs shall be immediately removed from performing any • further duties under this Agreement. The alcohol and drug program shall meet the following requirements: 21.1.2.1 A contract with a program administrator and authorized lab certified by the U.S. Department of Transportation; and 21.1.2.2. Procedures and components substantially as in Part 40 of Title 49 of the Code of Federal Regulations for pre - employment; and 21.1.2.3 Procedures and components substantially as in Part 382 of Title 49 of the Code of Federal Regulations for rehabilitation, return -to -duty and follow up testing; and 21.1.2.4 Procedures and components for random testing following U.S. Department of Transportation guidelines, and additional tests as required following accidents, rehabilitation, return-to- service, and other circumstances providing reasonable suspicion to test; and 21.1.2.5 Upon request by the OCFA EMS Section Battalion Chief, yearly reports of the random testing component shall be filed by the program administrator, in redacted form concealing employee identifiable information, with OCFA; and 21.1.2.6 Contractor and program administrator's alcohol and drug program records shall be made available, in redacted form concealing individual employee identities, to OCFA upon request; and 17 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 21.1.2.7 license at the time and place of testing; and Contractor employees must show a valid Califomia driver's 21.1.2.8 All test results are kept confidential except that OCFA is authorized to receive copies, in redacted form concealing individual employee identities, for its administrative purposes, and except as otherwise authorized or required by law. 21.1.3 DMV Employer Pull Notice Program. Contractor shall participate in the California Department of Motor Vehicles (DMV) Employer Pull Notice Program at all times throughout the term of the Agreement. 21.1.4 Criminal Background Checks . Contractor shall not employ in the performance of services pursuant to the Agreement any EMT or ambulance personnel or employee convicted of or having pled nolo contendere to a crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fraud, or misdemeanor or felony driving while under the influence of alcohol or drugs. If any Contractor employee is charged with any of the above - listed crimes, Contractor shall immediately suspend that employee from performing any further duties under the Agreement pending the outcome of the criminal case. It shall be the responsibility of Contractor to ensure that criminal background checks are performed on all Contractor employees prior their assignment of any duties within the Subject EOA under the Agreement. 21.1.5 Uniforms and Decorum. Contractor employees shall maintain acceptable standards of dress, including the wearing of Contractor - issued uniforms, and cleanliness while on duty in the community and must at all times conduct themselves in a professional manner. 21.1.6 Cooperation. All Contractor employees shall fully cooperate with and abide by • the instructions of OCFA personnel while on scene at an emergency incident. 21.1.7 Employee Ineligibility. If any Contractor employee becomes ineligible to provide services under the Agreement, Contractor shall immediately notify the OCFA EMS Section Battalion Chief in writing of such ineligibility and the reason(s) therefore. 21.1.8 Compliance with Laws. Contractor shall ensure that all of its employees and ambulances that are used in the performance of services under the Agreement are at all times during the term of the Agreement in full compliance with all federal, state, and local laws, rules, statutes, and regulations, including but not limited to: the California Vehicle Code; the California Health & Safety Code; Orange County Ordinance No. 3517; applicable City ambulance ordinances; and any and all applicable OCEMS or State EMS Authority policies, standards, procedures, regulations, and/or protocols. All Contractor employees shall have in their possession, at all times while on duty, applicable licenses, certifications, and/or permits, as may be required by the agencies and authorities listed herein. 21.1.9 Licensing/Identification. All Contractor emergency response personnel assigned to perform services under the Agreement shall furnish to any OCFA personnel, upon request, any required licenses, certifications, and/or permits, including proper identification, for purposes of verifying validity, ensuring compliance with licensing, certification, and permitting requirements, and for the proper reporting of employee performance- related issues to Contractor. 21.1.10 Joint Training Exercises. The OCFA EMS Section Battalion Chief may request Contractor to participate, at its sole cost and expense, in emergency response joint training exercises to improve the capability and coordination of both OCFA and Contractor's response to a given emergency or disaster. Such training shall be scheduled and mutually coordinated by the OCFA EMS • Section Battalion Chief and Contractor. Such training shall not exceed twenty (20) hours per year per 18 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 EOA. Any additional training that may be deemed necessary by OCFA shall be attended by Contractor's • personnel upon reasonable notice and at the sole cost and expense of Contractor. Such additional training may include, but is not limited to, mass casualty, weapons of mass destruction, and/or other emergency response training. 21.1.11 Employee Training Records. Contractor shall promptly make available to the OCFA EMS Battalion Chief, upon request, any and all Contractor personnel training records for those employees who perform any duties or services under the Agreement; 21.1.12 Professionalism. All Contractor employees shall perform the duties, obligations, and services required under the Agreement in an ethical, professional, and orderly manner and shall endeavor at all times to obtain and keep the confidence of the public. Contractor employee performance of all terms and conditions contained in the Contract Documents shall be monitored, maintained, and enforced at all times during the term of the Agreement by the OCFA EMS Section Battalion Chief. 21.1.13 Management Oversight. Contractor shall utilize management practices that ensure that its emergency response personnel working extended shifts, part-time jobs, voluntary overtime, or mandatory overtime are not exhausted, overworked, or exhibiting impaired judgment or motor skills while performing any duties.or services under the Agreement. 21.1.14 Employee Removal. At the request of the OCFA EMS Section Battalion Chief, and based on a demonstrated pattern of either poor performance or service - related complaints, as determined by the OCFA EMS Section Battalion Chief, Contractor shall immediately remove certain personnel from performing further services or duties under the Agreement. 21.2 Independent Contrac tor • 21.2.1 Neither OCFA, the City, or the County, or any of their officers, elected officials, agents, representatives, or employees shall have any control whatsoever over the conduct of Contractor's employees, except as set forth in the Agreement. Contractor shall not represent that either it or its agents or employees or officers are in any manner agents or employees of the County, the City, or OCFA, it being understood that Contractor, its agents, employees, and officers are as to the County, the City, and OCFA wholly independent contractors and that Contractor's obligations to the City and OCFA are solely those that are set forth by this Agreement. Contractor hereby further acknowledges and agrees that the City, the County, and OCFA shall have no responsibility whatsoever for salary, health benefits, retirement benefits, taxes, or any other benefits of any kind that may be due to Contractor's employees. 22.0 RATES FOR AMBULANCE SERVICE 22.1 BLS and ALS Service Rates 22.1.1 Maximum BLS Service Rate. The Orange County Board of Supervisors establishes the maximum Basic Life Support ( "BLS ") service rate ( "BLS Service Rate ") that may be charged by Contractor to its patients for the provision of emergency ambulance transportation services. Contractor shall not charge more than the maximum BLS Service Rate approved by the Orange County Board of Supervisors for each BLS patient transport. BLS means the same as is defined in the EMS Act. The BLS Service Rate is reviewed annually by OCEMS, which makes rate adjustment recommendations to the Board of Supervisors. As such, the maximum approved BLS Service Rate is subject to change at any time during the contract term. The maximum BLS Service Rate (as of July 1, 2008) is as follows: 19 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • Type of Charge Maximum Rate BLS Service Rate $671.75 per BLS transport 22.1.2 Maximum ALS Service Rate. The OCFA Board of Directors establishes the maximum Advanced Life Support ( "ALS ") service rate ( "ALS Service Rate ") that may be charged by Contractor for OCFA - provided emergency ALS services to patients transported either ALS or BLS, subject to approval by the Orange County Board of Supervisors. For those calls for service in which ALS services are provided by OCFA to patients that are transported either ALS or BLS, Contractor shall be responsible for charging and collecting the ALS Service Rate, in addition to Contractor's BLS Service Rate. Contractor shall not charge more than the maximum ALS Service Rate approved by the OCFA Board of Directors. ALS means the same as is defined in the EMS Act. The ALS Service Rate is reviewed annually by OCFA. The maximum approved ALS Service Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. The approved maximum ALS Service Rate (as of July 1, 2008) is as follows: Tyne of Charge Maximum Rate ALS Service Rate $355.75 per ALS service w /transport 22.1.3 ALS Reimbursement Rate. The OCFA Board of Directors establishes the OCFA ALS reimbursement rate ( "ALS Reimbursement Rate "), which Contractor shall pay OCFA for ALS services provided to patients that are transported either ALS or BLS in order to cover OCFA's costs for providing such services. Contractor shall pay OCFA the established ALS Reimbursement Rate for • each call for service in which OCFA provides ALS services to patients that are transported either ALS or BLS. 22.1.3.1 Medicare Patients. The ALS Reimbursement Rate for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is based on the Medicare allowed amounts for each Contractor. The ALS Increment is defined as the difference between the Medicare allowed amount for a given ALS service (i.e., ALS -1E or ALS -2) and the Medicare allowed amount for BLS emergency services, prior to the 20% co- payment deduction. 22.1.3.1.1 ALS -1 Emergency Services. The ALS Reimbursement Rate for ALS -1 emergency transports and ALS -1 emergency assessments with BLS transports for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS -1 emergency services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co- payment deduction. 22.1.3.1.2 ALS -2 Services. The ALS Reimbursement Rate for ALS -2 services for Medicare patients, including patients covered under Medi -Medi or Medicare +Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is the ALS Increment, which is the difference between the Medicare allowed amount for ALS -2 services and the Medicare allowed amount for BLS emergency services for a given Contractor, prior to the 20% co- payment deduction. 22.1.3.2 Annual Adjustm ents. The ALS Reimbursement Rate is • reviewed annually by OCFA. The ALS Reimbursement Rate payable to OCFA by Contractor for all ALS 20 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 services provided to patients, excluding Medicare patients and patients covered under Medi -Medi or • Medicare + Choice plans (e.g., Secure Horizons) that use Medicare rates as a basis for payment in full, is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. 22.1.3.3 ALS Reimbursement Rate. As of July 1, 2008, the approved ALS Reimbursement Rate is as follows: Type of Charge Amount 1. ALS Reimbursement Rate $252.00 per transport w /ALS services 2. ALS Reimbursement Rate for Medicare patients or patients with Medi -Medi or Medicare +Choice plans ALS -1E or ALS -2 Increment 22.1.4 Medical Supply Reimbursement Rate. The OCFA Board of Directors establishes the medical supply reimbursement rate ( "Medical Supply Reimbursement Rate "), which Contractor shall pay OCFA per BLS /ALS transport. Contractor shall pay OCFA the Medical Supply Reimbursement Rate for each BLS /ALS patient transport to cover OCFA's costs for providing expendable medical supplies to Contractor. The Medical Supply Reimbursement Rate is reviewed annually by OCFA. The Medical Supply Reimbursement Rate is subject to the same annual percentage adjustment increase as the County's emergency BLS base rate increase, if any. As of July 1, 2008, the Medical Supply Reimbursement Rate shall be as follows: Tvpe of Charge Amount • Medical Supply Reimbursement Rate $28.15 per transport (BLS /ALS) 22.1.5 Zero Pay Patients. OCFA will not require Contractor to pay the established ALS Reimbursement Rate or Medical Supply Reimbursement Rate (nor any portion thereof) for "zero pay patients." "Zero pay patients" are those calls for service to patients whose only method of healthcare coverage or insurance is provided by a state or local subsidized health care program (i.e., patients receiving health care benefits pursuant to any one of the following state or local subsidized health care programs: (a) Medi -Cal; (b) CalOptima; (c) California Child Services ( "CCS "); and /or (d) County Medical Services for the Indigent ( "County/MSI ")). Patients who have other means of payment or who are covered by additional or supplemental insurers, other than subsidized health care programs, are not "zero pay patients." Contractor may seek relief from making the required reimbursement payments to OCFA by applying for a Zero Pay Patient Exemption, as provided below. 22.1.6 Risk of Non- Payment. Except as provided otherwise herein, Contractor assumes the entire risk of non - payment for any and all of the services rendered and the charges incurred in connection with its performance under the Agreement, including all BLS and ALS charges incurred, as well as all ALS reimbursements and medical supply reimbursements regardless of whether Contractor receives payment for services from any source. 22.1.7 Medicare Patients. Contractor shall not charge Medicare patients more than the maximum Medicare rate. 21 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • 22.2 Billing, Audit and Access to Records 22.2.1 Billing System. Contractor shall only bill for services according to the approved service rates and schedules set forth in the Contract Documents and as authorized by OCEMS, with no additional fees or charges imposed unless approved in writing in advance by the OCFA Fire Chief and/or the awarding agency, if applicable. Prior to the Effective Date, Contractor shall establish an auditable billing system approved by OCFA, which shall be available for review by OCFA on a periodic basis. Contractor's patient billing /records system shall be organized so that search and retrieval of all billing records can readily be made by OCFA according to the following individual criteria: Patient Name ALS 911 Calls BLS ALS Assessment/BLS Transport Day/Month/Year BLS Transport ALS Transport OCFA Incident No. 22.2.2 Accounting. Contractor shall maintain accurate and complete records of all patient accounting, including but not limited to: (i) all patient invoices, (ii) all patient/insurer payments; (iii) all BLS service charges; (iv) all ALS service charges; (v) all ALS reimbursement payments; (vi) all medical supply reimbursements; (vii) all invoices, payments, and correspondence to and from private insurers, federal or state health care programs, and other responsible third parties; and (viii) all records evidencing payments made by Contractors to OCFA in connection with its performance under the Agreement. Such accounting shall be performed by Contractor in accordance with generally accepted accounting principles and practices consistently applied. OCFA shall have access to such records and information upon seventy -two (72) hours advanced written notice at all times during normal business hours for the purpose of inspection, audit, review, evaluation, and duplication. Contractor shall, at no cost • to OCFA, provide proper facilities for OCFA's access, inspection, audit, review, evaluation, and duplication of such information. 22.2.3 Responsibility for Submission of Claims. Contractor shall be responsible for submitting claims for services provided hereunder, and may utilize the services of a third party billing agent for this purpose. In the event that a third party billing agent is used, Contractor shall inform the billing agent of the provisions of the Contract Documents. Contractor shall be responsible to bill for all transports in which ALS services are rendered, specifically including the performance of ALS assessments as defined in 42 C.F.R. §414.605, in accordance with applicable Medicare guidelines for the level of service provided. 22.2.3.1 Submission of Claims. For services provided pursuant to the contract, Contractor shall submit one claim covering both ALS and BLS services to the appropriate carrier or payer utilizing Contractor's provider number. In no event shall more than one claim per trip be submitted where not permitted by law. 22.2.3.2 Sharing of Information and Documentation and Respect of Privacy. Contractor shall permit access by OCFA to Contractor's respective books and records as they relate to billing and reimbursement for services hereunder. Contractor shall share all patient care and billing information necessary to properly submit Medicare claims, including patient care reports and billing slips. Contractor shall within thirty (30) days of receiving any requests for information or documents from the patient, the Centers for Medicare and Medicaid Services (CMS) (formerly HCFA) or its authorized carrier or intermediary, other payment source, or other state or federal agency with oversight of the billing and patient care practices of the parties pursuant to the contract, make available to OCFA any and all such records requested. All information or documents exchanged between the parties related to personal health information of a patient shall be exchanged in compliance with all privacy laws • 22 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 and rules, including the privacy rule established under the Health Insurance Portability and Accountability • Act (HIPAA). Both parties will agree to maintain policies to protect the confidentiality of patient information to the extent required by law and to educate and enforce such policies with their respective personnel. 22.2.4 Medicare Audits. In the event that Contractor is obligated to repay any amounts, related to ALS billed services or medical supplies, to Medicare or other carrier pursuant to a post - payment audit, OCFA shall repay Contractor the ALS Reimbursement Rate or Medical Supply Reimbursement Rate, as applicable, on those claims for which payment is recouped by Medicare or other carrier. However, OCFA will only be responsible for repaying the Contractor in two situations: when a claim is downgraded by the Medicare contractor from an ALS -1E call to a BLS emergency call, or from an ALS -2 to an ALS -1E call. In these situations, OCFA will only repay the Contractor an amount equal to the total ALS Increment (i.e., when a call is downgraded from ALS to BLS) or a portion of the ALS Increment, which is the difference between the ALS Increment of an ALS -2 services and the ALS Increment of an ALS -1E service (i.e., when a call is downgraded from an ALS -2 to an ALS -1E). The Contractor shall supply documentation supporting the overpayment demand by the Medicare Contractor prior to any OCFA repayment. 22.3 Contractor Monthly Payment 22.3.1 Monthly Payments to OCFA. All ALS reimbursements and medical supply reimbursements, as required in this Section, (hereinafter referred to as "Monthly Payments ") shall be promptly paid by Contractor to OCFA beginning ninety (90) days from September 1, 2009, and such payments shall continue to be promptly remitted by Contractor to OCFA thereafter within ninety (90) days after the first day of each month throughout the contract term. Zero Pay Patient Exemptions may be requested by Contractor for each qualifying call by following the procedures below. A penalty of $500 may be imposed for each late payment. If Contractor's monthly payments are sixty (60) days late (or • more), Contractor may be assessed a 1' /Z% late fee for each month that payments are not made. Failure to make timely Monthly Payments may be deemed breach of contract. 22.3.2 Zero Pay Patient Exemption Requests. Contractor shall submit to OCFA for approval all Zero Pay Patient Exemption requests and all documentation justifying each request. Zero Pay Patient Exemption requests shall be submitted by Contractor with its monthly ALS reimbursement and medical supply reimbursement payments for the month in which the exemption is requested and must be reflected as a credit on the current Monthly Payment remittance. Requests for exemptions outside the current monthly payment period will not be considered, except as provided herein. Each Zero Pay Patient Exemption will be evaluated and either granted or denied at the sole discretion of the OCFA EMS Section Battalion Chief. Contractor shall be notified in writing by the OCFA EMS Section Battalion Chief if any exemption request will be denied within thirty (30) days of receipt of the request. The decision may be appealed by the Contractor to the OCFA Fire Chief, whose decision shall be final. In the event a Zero Pay Patient Exemption request is denied, Contractor shall adjust its next Monthly Payment remittance for the amount of the credit denied. Exemption requests for "Retro Credits" must be made within the month the Contractor receives notification of the retroactive enrollment in a qualified zero pay patient program. 22.3.3 Monthly Payment Report. Contractor shall submit a Monthly Payment Report (in electronic format) to the OCFA Accounts Receivable Section along with all Monthly Payments. The Monthly Payment Report shall contain the following information: a. EOA number; b. Name of responsible party invoiced per transport; c. Patient name and address; • 23 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • d. Indicate BLS, ALS, or ALS Assessment/BLS Transport; e. Date of call for service; f. OCFA incident number; g. ALS reimbursement amount remitted to OCFA per transport; and, h. Medical supply reimbursement amount remitted to OCFA per transport. 22.3.4 Audit Report. An audit concerning Monthly Payments may be conducted at the sole discretion of OCFA at any time throughout the contract term. If instructed, Contractor shall promptly produce an audit list (in an approved electronic format) to OCFA auditors, which contains the following information: a. Name of responsible party invoiced per transport; b. Patient name and address; c. Indicate BLS, ALS, or ALS Assessment/BLS Transport; d. Date of call for service; e. OCFA incident number; f. Amount invoiced per transport; g. Amount recovered per transport; h. Any exemption requests for transports included in the audit sample; and, i. Any other requested relevant information required to perform an audit. 22.4 Changed Circumstances. In the event that unforeseen changes in either the health care industry or laws (federal, state, or local laws, rules, regulations or statutes) seriously affect the Contractors' ability to continue to perform the services and at the rates required under the Contract Documents, Contractor may petition OCFA for a re- evaluation of the level of service and/or established • • maximum rates or approved Contractor rates, including the maximum ALS Reimbursement Rate and the Medical Supply Reimbursement Rate, as well as the exemption process. Contractor shall be required to provide such proof as necessary to show that the continuance of the current services, rates, charges, reimbursements, etc. are so economically harmful to Contractor so as to place Contractors in danger of having to default on the contract. This may include requiring Contractor to hire, at its sole cost and expense, an approved independent auditing firm. It shall be at the sole discretion of the OCFA Fire Chief and/or the awarding agency, if applicable, whether to agree to any modifications of the Contract Documents. The parties may by written amendment adjust the terms of the Contract Documents where circumstances beyond the control of either party require modification or amendment. 23.0 BREACH OF CONTRACT 23.1 Breach of Contract. In the event of a breach of this Agreement by Contractor, OCFA and the Awarding Agency, if applicable, may, in its sole and absolute discretion, elect to (1) give Contractor an opportunity to cure the breach, or (2) immediately terminate the Agreement, or (3) terminate the Agreement after giving 180 days written notice of its intent to do so, whether or not a breach has occurred. Similarly, in the event of a breach of this Agreement by OCFA and/or the Awarding Agency, if applicable, Contractor may in its sole and absolute discretion, elect to give (1) OCFA and/or the Awarding Agency, if applicable, an opportunity to cure the breach, or (2) immediately terminate the Agreement, or (3) terminate the Agreement after giving 180 days written notice of its intent to do so to OCFA and/or the Awarding Agency, if applicable, whether or not a breach has occurred. • 24 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 24.0 PUBLIC SAFEGUARDS AND EMERGENCY TAKEOVER • 24.1 This Agreement is structured with the objective of protecting public health and safety at all times and to protect the public from any loss of service or loss of life as a result of termination of this Agreement. 24.2 In the event of termination, Contractor shall fully cooperate with and shall immediately assist OCFA, the City, and the successor ambulance service operator to effectuate an immediate, efficient, and orderly takeover of all 911- Fire/EMS emergency ambulance services within the Subject EOA so as to ensure that there will be no s ervice interruption to the public. 25.0 CONTRACTOR'S RELIEF UPON TERMINATION 25.1 The provisions of this Section are specifically understood and agreed to by Contractor as being reasonable and necessary in light of the serious public health and safety aspects associated with the provision of services under the Agreement. Any legal action taken by Contractor to challenge either a termination or emergency takeover of this Agreement shall only be initiated by Contractor after the emergency takeover, as provided in Section 24.0 above, has been completed, and shall not under any circumstances whatsoever be allowed to delay the process of takeover by OCFA. Contractor's cooperation with, and full support of, such emergency takeover process shall not in any way jeopardize or limit Contractor's right to recover damages should a court of competent jurisdiction determine that OCFA or the Awarding Agency wrongfully terminated the Agreement. Contractor hereby specifically waives any right to seek any type of declaratory or equitable relief, including but not limited to a restraining order or injunction, against either the termination or an emergency takeover. 26.0 HOLDOVER PROVISION 26.1 For purposes of protecting public health and safety, in the event this Agreement is • terminated, or if no extension of the Agreement is awarded at the end of the initial term of the Agreement, or if Contractor is not awarded a subsequent exclusive operating contract for the Subject EOA upon termination of this Agreement, Contractor hereby agrees to continue providing services under the Agreement until the successor ambulance service operator takes over ambulance service operations and assumes full responsibility for the provision of 911 - Fire\EMS emergency ambulance transportation and related services within the Subject EOA. Under such circumstances, Contractor shall serve as a holdover exclusive operator until such time as the successor ambulance service operator takes over ambulance service operations and assumes responsibility for the provision of 911 - Fire \EMS emergency ambulance transportation and related services within the Subject EOA. 26.2 OCFA recognizes that if a competing ambulance service operator is awarded an exclusive operating area agreement for the Subject EOA upon termination of this Agreement, Contractor may reasonably begin to prepare for the transition of services to the new provider either prior to the Agreement termination date or during the holdover period described in Section 26.1 above. OCFA and the Awarding Agency, if applicable, shall not unreasonably withhold its approval of any Contractor request to begin an orderly transition process, including reasonable plans to relocate Contractor staff, scale down or reduce certain inventory, supplies, or otherwise, so long as such transition activities and/or reductions do not impair or impede Contractor's ability to perform services under the Agreement and provided such transition activities and/or proposed reductions receive the prior written consent of the OCFA Fire Chief and the Awarding Agency, if applicable. 26.3 In order to protect public health and safety, Contractor hereby agrees to fully cooperate with and to immediately assist OCFA, the City, and the successor ambulance service operator to effectuate a prompt, efficient, and orderly takeover of all 911 - Fire/EMS emergency ambulance services • 25 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • within the Subject EOA upon termination of this Agreement, so as to ensure that there will be no service interruption to the public. 27.0 SUCCESSORS 27.1 Each of the terms and conditions of this Agreement shall inure to the benefit of and shall bind, as the case may be, not only the parties hereto, but each and every one of the heirs, executors, administrators, successors, assignees, and legal representatives of the parties. 28.0 INTEGRATION 28.1 This Agreement, including all exhibits attached hereto and incorporated herein by reference, supersedes all previous communications, transactions, and understandings, whether oral or written, and constitutes the sole and entire Agreement between the parties pertaining to the subject matter hereof. No modification or deletion of, or addition to, these terms or conditions is binding on either party unless made in writing and signed by a duly authorized representative of both parties. 29.0 NO WAIVER 29.1 No delay or omission in the exercise of any right or remedy available hereunder shall impair such right or remedy or be construed as a waiver. Any waiver of any breach, default, or condition hereunder must be in writing and shall not be construed as a waiver of any other breach or default concerning the same or any other provision of this Agreement. 29.2 The waiver by OCFA of any breach by Contractor of any of the provisions of this Agreement shall not constitute a continuing waiver or a waiver of any subsequent breach or default by • Contractor either of the same or a different provision of this Agreement. 30.0 THIRD PARTY BENEFICIARIES 30.1 The terms of this Agreement are intended to confer benefits only on the parties to this Agreement. No rights of action shall accrue to any other persons or entities under this Agreement. 31.0 EXECUTION OF AGREEMENT 31.1 The person(s) executing this Agreement hereby warrant and represent that the execution of this Agreement and the performance of the terms and conditions of this Agreement have been authorized by all requisite corporate, federal, state, municipal or other entity requirements and that the undersigned have the right, power, legal capacity and authority to execute, to bind Contractor, and to enter into this Agreement. 32.0 NOTICES 32.1 Any notices required or permitted under this Agreement shall be in writing and shall be delivered personally or sent by U.S. Mail, First Class, postage prepaid, return receipt requested, and addressed as follows: Orange County Fire Authority: Orange County Fire Authority Attn.: EMS Section Battalion Chief One Fire Authority Road Irvine, California 92602 • 26 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 [Name ofCiiy orAwardi,wAQencv]: [ ] • [Address] [Name of Contractor[: [Contractor] [Address] 33.0 SEVERABILITY 33.1 If any term or condition of this Agreement, or the application thereof to any person or circumstance, shall to any extent be held by a court of competent jurisdiction to be invalid, void, or otherwise unenforceable, the remainder of this Agreement, or the application thereof to any person or circumstance, shall remain in full force and effect and shall in no way be affected, impaired, or invalidated thereby. 34.0 EOA BOUNDARY CHANGE 34.1 Unincorporated service areas are subject to annexation or incorporation at any time as determined by the Orange County Local Agency Formation Commission ( "LAFCO "). The Subject EOA may be changed, adjusted, or redrawn by OCEMS at any time during the term of the Agreement. OCFA has no control over such unanticipated service area and/or jurisdictional changes. This Agreement, if affected by a service area or jurisdictional change imposed by LAFCO, OCEMS, or otherwise, is subject • to review, approval, and /or termination by the new governing authority, if any. 35.0 AMENDMENT • 35.1 No modification, amendment, addition to, deletion, or alteration of the terms of this Agreement, whether written or oral, shall be valid unless made in writing and formally approved and executed by both parties. 36.0 VENUE 36.1 This Agreement shall be governed and construed in accordance with the laws of the State of California. In the event of any legal action to enforce or interpret this Agreement, the sole and exclusive venue shall be a court of competent jurisdiction located in Orange County, California, and the parties hereto agree to and do hereby submit to the jurisdiction of such court, notwithstanding Code of Civil Procedure section 394. [SIGNATURE PAGE FOLLOWS] 27 • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 • SIGNATURE PAGE IN WITNESS WHEREOF, the parties hereto have executed this Agreement as follows, to be effective on the Effective Date as set forth above. "CONTRACTOR ": Date: Name: Title: Date: Name: Title: "ORANGE COUNTY FIRE AUTHORITY ": By: Date: , Chairman Orange County Fire Authority Board of Directors APPROVED AS TO FORM: • Terry C. Andrus General Counsel By: [Name] ATTEST: By: Jill Ingram, Clerk of the Authority * ** OR * ** [NAME OF CITY RETAINING AWARD /CONTRACTING AUTHORITY]: By: Date: [Name of Mayor or City Manager] [Name of City] APPROVED AS TO FORM: By: [Name of City Attorney] ATTEST: By: [Name of City Clerk] • 28 Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement September 19, 2008 567836.7 EXHIBIT "A" • DEPICTION OF SUBJECT EOA • • Model Fire/EMS Emergency Ambulance Transportation II Exclusive Operating Area Agreement May 2008 567836.7 • EXHIBIT "B" OCFA 2008 FIRE/EMS EMERGENCY AMBULANCE TRANSPORTATION AND RELATED SERVICES REQUEST FOR PROPOSALS (RFP NO. JR1494) • • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement May 2008 567836 7 • EXHIBIT "C" CONTRACTOR'S SIGNED ORIGINAL BID PROPOSAL SUBMITTED FOR OCFA RFP NO. JR1494 • Model Fire/EMS Emergency Ambulance Transportation • Exclusive Operating Area Agreement May 2008 567836 7 • EXHIBIT "D" SAMPLE QUARTERLY RESPONSE TIME REPORT • • • Model Fire/EMS Emergency Ambulance Transportation Exclusive Operating Area Agreement May 2008 567836 7 d C C • g « p d N U y O a b es 9 en U Q 6.. 0 F ' d « E� . 1 ; 4 ' U bra g C O lif N a '3 . C�+ V . 9 Q O N d o ca G > b U N E i W W O 0 _. U co 7,4 u ra • y F ' M ? w U . O y a �� O 3 U a[ w s o N U 0 U a CO o R` U o mQ o U z 2. ao -0 A p � -aU m a 0 ' bp o • en 0 $ • U 0 1 y U 3 '4 W .0 Q N y W N 0 O N O C 0 .8 an . 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Afr /* ' VON ,,:1 4 0,;,:- , . 11.* . 4: - ril likt#0,11 . lk allir* ' ,lit 2 0 , ,. p # 14 flois Awl!, i .t#T1 OPP *A, / ' ' , ko I i f p-Af , z Eh. r7t� , 0 ® SAN . � A t • r 'Y 0 F 1 P Il aV -7/ ,) iNi ...... ,. - zi' RINGS • I ; li A ......... j 1 ,,i ,„ ...... t,, 0 ' if S j : a r• 1 r \ \\ t 1 Olt I l r -j , _, N .' i 0 ( il I : ir i JUAN I ; , lir, . I 1 1 i AP1ST RANOA c • .. ir. , 1 1 jilt illalk . / . A pp, > �� 4 , �� ~ �✓ 5 14 ' . / ® ale ie 1 i 0 0 * .. �' 1 j f � f l • q tAConverbid gnFit.Aceiwo.‘.ale..an 27 -Nov -2001 : .::-...?4, 5 j • rT ©RANGE ©©ijNfl FORE AUTHORITY ) EXCLUSIVE OPERATING AREA 21 „, ,- PiiiiimiisinilliFil ) ,,,.., t: .... -- .II 0 : t I ' illhAll: ( IToSr , di .1. . . . .. 0 AV 4 '. ,,:„,,,,tr-f,..-.5,:.-:,f:.:5:-.-:,4--,,,,:er. amp i i .^P. � 4 a , ,,, , yam. - • ....-:-,---A" 4'.."-"I'” ' ':', 0. ‘,,, ' - 5 9F05.. 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I A ' ' SL + ' ■ • „ fi 1 4 1. 7, 4 ,,Pig 1 ...- " wir 01111r 1„,..4 * IiiiIIIIiir NrilV.4 CA . i \ 0 ■ : . Hillri eits, 440rD ./. imor,V'il•,, 4 * Aigti , ...„ !: A , e w-4K 40 \ 7 / . , ,.„ t:or.z;75z.,oviitA zA „.1 ; s 4 , ,.., . 0 , . i t tl,,e.--rs 414,,,if. .....2..-.. ., , , A,„ me vb. - tafiriMI 4,r+ PR oriforimborail* k-..t i • U4 AL. . TifflitTh 4 4 1 4%0;,7.1. ' s''' pip" . 7iitair IL 4.0 VITO II; jr. ‘ ,2 _ , _., ,,,. 1 ,, j .. . . A. 4111. 41" Aitigitrallal 9 \ ComartedDgnigea •Cottapaleoo24.dga 27 - NOV - 3006 r • ( ORANOE COUNTY FORE AETE ©E OTY EXCLUSIVE OPERATING AREA 29 • \.,,, 11F► \ 0 *AV ii ' AilL 741 fm A 1 r __.... .,..........\\ . Alo 4 i Aoki , l - . �� / im A , Au.. ... , t , . i . . . VAIII40% ziter 1 - - d ...... / , 0 trilr i C .10k#AINP ,,,,, 7,,,, * , ' l /' rt / � Lam.!, ,,,.,..„ .„, • )1:1 . - , e • r r i or Aii . I . 1. !0--",,,, , ,,, .,,,..., • . , �" -`fit o ( i. lo, / 4 , Ili CD ' SAN !.., at' ‘4.0f / et) Allk61,...it,.. ^ A.. - . e ( .L _ . 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A.FISTRA. - .1tDwii■ 1bl * ,, j/ A t e . ___,,,,..,_ _ , 411 All :+ ‘Carwert�dDQnFilsa�CoMkpslaoa30dgn 27-14011-20013 s' • 0�� 1�� C�O��� FIM �a���Q��� l ; EXCLUSIVE OPERATING AREA 42 r \,........., ii ' , le , A . ° „.+, , ,4,,, ,,,•,w;:;*?-i;,;',,::::,!,:::::,:‘,‘• +,: . : , -,F .: . , ,.: ,•,i. '',- RIVE' _.... EI CD • ,� • • •,,',..,64,a, V-2,+.''..E' t f. 101 ** •• , * •••• ,,, s;c4 ,,,,,,8,..: , ir , , I A I/' � .�1_ t/ 1 � Y s t 4 ' . i 5"a� 4 •e. � . +sue \.r 'i� f� *1 % .7:,,,44 P A illi v+. !, { t CO —s' ;-{ � e krill* 74 / 1\ - .,. /MOO r, eir---14+ 4 . • 1 offr ..?„. \,,,,,,,,, '' ,`�,� O t sax 4 ,, oil : . • Rig ....... 11(114, 4 r • i• / 4 ...... 1 ti fir diA011° A 0 ty pow ri Il lt , l � fl 1' z =\CorrvatIdD Iaa \ CcFlap a\ e oa 42.Qgn 29- NOY -P006 • EXHIBIT "C" CONTRACTOR'S SIGNED, ORIGINAL BID PROPOSAL SUBMITTED FOR OCFA RFP NO. JR1494 DATED December 10, 2008. • • 643201 2 TAB 1 fah itbtr Sei v,. t . 1517 W. Braden Court, Orange CA 92888 714.288.3800 582.531.2525 December 10, 2008 James Ruane, Finance Manager Orange County Fire Authority 1 Fire Authority Road Irvine, CA 92602 Dear Mr. Ruane: On behalf of the entire team at Care Ambulance Service, I am pleased to submit our response to the Orange County Fire Authority's Request for Proposal (RFP # JR1494). As the incumbent pro- vider for the Cities of La Palma and Stanton, we look forward to continuing to serve those com- munities, while expanding our services to adjacent cities. Listed below are the EOAs, identified by name and geographical number, that Care Ambulance Service proposes to serve: • City of Cypress — EOA #5 16"); • City of La Palma — EOA #13 • City of Los Alamitos — EOA #14 • City of Seal Beach — EOA #21 • City of Stanton — EOA #22 I, Rick Richardson, Co-CEO will serve as the official contact to the Orange County Fire Authority regarding Care's response to this RFP. I am a company official authorized to enter into a contrac- tual agreement with the Orange County Fire Authority and any participating cities. All of us at Care Ambulance Service look forward to participating in Phase 2 of the RFP competi- tive bid process and your review of our proposal. During your review of our proposal, if you have any questions regarding our submission, please do not hesitate to contact me at (714) 288 -3801. Sincerely, 0 l Rick W. Richardson, Co-CEO • ,• f 1 • • • 1 1 4) TAB 2 1 0 . 1 f r: r . t { ( r i t A , • • • • 0 ITEM 2 : BID PROPOSAL DEPOSIT Please attach (either staple or otherwise adz) the required Bid Proposal Deposit, as described in Section II. Care Ambulance Service has attached the required $2,500.00 Bid Proposal Deposit in the form of a cashier's check made payable to the Orange County Fire Authorioc ell • • 2 • • • Ilk, PACI Costa Mesa 1 MERCANTIL 949 South Coast Drive, Suite 105 0080631 ® AN K Costa Mesa. CA 92626 t e+t222 Tel: (714) 438 -2600 November 12, 2008 .L .. *.., .c. I$ "+ r. F A rr, A . ,.-Lo. ,.-Lo. *id f�Ns2 500.00"•**... I AMOUNT r , ♦ ♦ ♦.1. '1. / •..4, 1 11 f ! 1 1 r � +� 11 t_ • J V v ■ M V 'J .. - --..- no - - 11e m1. NMI MO .. REMITTER Cashiers Check CARE AMBULANCE SERVICE, INC. PAY ***ORANGE COUNTY FIRE AUTHORITY*"" * ************** TO THE ORDER OF I ' 1 • aa0080 3 lo 1: L 2 2 24 28691:6 L00 & 50 913u 500 PACIFIC Costa Mesa _� I MERCANTILE 949 South Coast Drive, Suite 105 0080631 1 BANK Costa Mesa, CA 92626 9o- 4206/1222 Tel: (714) 438-2600 November 12, 2008 ..L ..,. ..11. #I _ 1 A _ A • **** *• * *•**** . •UNT .r .- .. 1, .41,, $ 1 v I 52,500.00 I .0 . -I v - NUM 111. NM ea 1M ma MOO NM aa. • • REMITTER Cashiers Check CARE AMBULANCE SERVICE, INC. CUSTOMER COPY PAY ** *ORANGE COUNTY FIRE AUTHORITY *******'****"` TO THE ORDER OF NOTICE TO PURCHASER: The purchaser does not have the fight to place a stop payment co this check. If the check is lost. destroyed or stolen, we will require the payee or remitter to deliver a claim to the bank and include our Declaration of Loss form signed wider penalty of prejury. We are not obligated to pay the amount of the check untll the Rath day from the date of the check. If the bank has paid the check before the 901h day. we will not be required to pay the claim. Section 5812 of the CA Comml Code. 1 • • • • • fve TAB 3 1 i- E • • • • 410 ITEM 3 : TABLE OF CONTENTS Tab 1 Cover Letter 1 Tab 2 Bid Proposal Deposit. 2 Tab 3 Table of Contents 3 Tab 4 Notification of Provider Prequalification 5 Tab 5 Emergency Response and Vehicle Communications System. 6 Tab 6 Service Rates 9 Tab 7 On -Board Equipment and Supplies 11 Tab 8 Vehicle and Equipment Maintenance Program 14 Tab 9 Personnel and Training. 18 Assigned Personnel Profile 18 Field Training Officers 21 Primary Personnel 22 Employee Recruitment, Screening and Orientation 27 Continuing Education Programs 29 HIPAA Training Programs 31 Tab 10 Driver Training 33 Tab 11 Internal Medical Quality Control 35 Tab 12 Billing and Collection Practices • 38 Tab 13 HIPAA Compliance Plan. 41 Tab 14 Corporate Compliance Plan 42 imp Tab 15 Compliance with Monthly Payments 44 Tab 16 911 Fire / EMS Resume. 47 Tab 17 Conflict of Interest Certification 52 Tab 18 Statement of Truth 53 Tab 19 Non - Collusion Certificate. 54 Tab 20 CAAS Certification. 55 Tab 21 Overall Operational System and Design. 56 City of Cypress — EOA #5 56 City of La Palma — EOA #13 64 City of Los Alamitos — EOA #14 72 City of Seal Beach — EOA #21 80 City of Stanton — EOA #22 88 Tab 22 Ambulances Proposed for Each EOA. 96 City of Cypress — EOA #5 96 City of LaPalma— EOA #13 101 City of Los Alamitos — EOA #14 106 City of Seal Beach — EOA #21 111 City of Stanton — EOA #22 116 Tab 23 Response Time History 121 City of Cypress — EOA #5 121 City of La Palma — EOA #13 124 411 City of Los Alamitos — EOA #14 127 City of Seal Beach — EOA #21 130 • 3 • • • Ill fa City of Stanton — EOA #22 133 Tab 24 Mutual Aid Provider 136 City of Cypress — EOA #5 136 City of La Palma — EOA #13 138 City of Los Alamitos — EOA #14 140 City of Seal Beach — EOA #21 142 City of Stanton — EOA #22 144 Tab 25 Plan for Takeover of Service / Start-up 146 City of Cypress — EOA #5 146 City of La Palma — EOA #13 151 City of Los Alamitos — EOA #14 156 City of Seal Beach — EOA #21 161 City of Stanton — EOA #22 166 Tab 26 Letters of Reference 171 Tab 27 Photographs 172 OS 411 Ill . 4 • • • F L S ro TAB 4 1 t P E f E . ! i I r I I- k i E r. G E k L 1. f- 1 t L k 0 E. k t i p 1 a f i F E E f i t s F e t 1 1 i i a R • S G a • • • • 0 ITEM 4 : NOTIFICATION OF PROVIDER PREc UALIFICATION Please attach (either staple or otherwise affix) a copy of the OCFA notification of prequalification letter that was sent to Bidder. Care Ambulance Service has attached the required prequabfication letter, behind this page. IIIIII • 5 • • • • . 111 10-NP. , ,,, ORANGE COUNTY FIRE AUTHORITY t ' *`' P.O. Box 57115 Irvine, CA 92619-7115 • 1 Fire Author :r. ty Road, twine, CA 92602 c o f Chip Prather, Fire Chief (714) 573 -6000 www.ocfa.org f:.,-„:„. .c - August 22, 2008 Dan C. Richardson, Co -CEO Care Ambulance Service Via Fax and U.S. Mail 1517 W. Braden Court Orange, CA 92868 Dear Mr. Richardson: Re: NOTICE OF APPROVAL OF PREQUALIFICATION APPLICATION 2008 Fire/EMS Emergency Ambulance Transportation and Related Services Request for Proposals (RFP# JR1494) Dear Mr. Richardson: The Orange County Fire Authority (OCFA) has thoroughly reviewed and evaluated your Phase I Prequalification Submission application that was filed on behalf of Care Ambulance Service in connection with the above - referenced Request for Proposal. We are pleased to inform you that your application has been approved. Consequently, Care Ambulance Service is eligible to submit a bid proposal and compete in Phase 2 of the procurement process. • • . . We anticipate emailing you a copy of Phase 2 of the RFP on September 19, 2008, pending approval by the OCFA Board of Directors on September 18, 2008. A Bid Proposal Pre- Submission Conference has been tentatively scheduled for October 21, 2008. Attendance at this conference is mandatory. You will receive additional information about this conference in a separate letter. Thank you for your interest in working with the Orange County Fire Authority. We look forward to receiving a bid proposal from your company. Very truly yours, R uan e , Finance Manager /Auditor for Jim Bailey, Battalion Chief Emergency Medical Services Section Orange County Fire Authority (714) 573-6071 jimbailey@ocfa.org cc: . Lori Zeller, Assistant Chief, Business Services . Jim Ruane, Finance Manager /Auditor Darlene Gidley, OCFA EMS Consultant 10 Serving the Cities of Aliso Viejo • Buena Park • Cypress • Dana Point • Irvine • Laguna Hills • Laguna Niguel • Laguna Woods • Lake Forest • La Palma Los Alamitos • Mission Viejo • Placentia • Rancho Santa Margarita •San Clemente • San Juan Capistrano • Seal Beach • Stanton • Tustin.. Villa Park 11111 Westminster • Yorke Linda • and Unincorporated Arras of Orange County RESIDENTIAL SPRINKLERS AND SMOKE DETECTORS SAVE LIVES • • • 0 TAB 5 MIF 7 1 .1 • • • • • • ITEM 5 : EMERGENCY RESPONSE AND VEHICLE COMMUNICATIONS SYSTEM Care Ambulance Service's Emergency Response and Vehicle Communications System exceeds all specifications, requirements and performance expectations set forth in Section IV of the RFP. Com- munications are conducted from our state of the art communications center located at 1517 W Braden Ct, in the City of Orange. Care's Communications Center is accredited by the Commission of Ambulance Accreditation Services (CHAS) and each dispatch employee is certified through the National Academy of Emergency Dispatch (NAED). Care Ambulance Service has implemented redundant radio systems, telephone systems, communica- tions systems and power systems to ensure uninterrupted transfer of critical information. Further, we transmit all of our data in real time to a secondary communications facility in Los Angeles County that was built solely for redundancy. Care Ambulance Service surpasses the RFP requirements of having a secondary back -up electrical system to insure uninterrupted twenty-four (24) hour service. First, Care Ambulance has our own electrical generation station on -site creating the necessary electrical power for our corporate offices and emergency dispatch center. Second, in the unlikely event of a generator station failure, our sys- tem automatically converts to power supplied by the Southern California Edison power grid. Finally, should both systems fail simultaneously, a third level of electrical system redundancy is provided by Care's 1,200 gallon, diesel powered Generator. The generator is large enough to power Care's entire communication center and offices under critical conditions. 1— Statement of Compliance As a current contracted emergency ambulance provider to OCFA, are Ambulance Service is cur- rently compliant with all communications requirements set forth in Section IV of the RFP. Care ambulance service has previously installed, provided, operated, and maintained at our sole cost and expense, an ambulance dispatch center, telephone service, including ring -down line, 800 MHz radios, mobile data computer /radio system, personal computer, and a secondary dispatch response system. These communications systems comply with all federal, state, and local laws, rules, statues and regulations, including licensing requirements, concerning the broadcast of public safety and emergency communications over approved FCC frequencies at all times. Care Ambulance Service will continue to maintain the above items as outlined in the OCFA RFP. 2 — CAD Program Capabilities Care Ambulance Service uses the state -of- the -art Rescue Net CAD system manufactured by ZOLL Data Systems to allocate calls for service and dispatch ambulance resources. Care Ambulance Service maintains a service maintenance agreement with ZOLL Data Systems to continuously receive the most up to date technology. Care Ambulance developed and uses the CAD Assistant which automatically receives 9 -1 -1 calls from • OCFA and electronically inputs the call for service into our CAD system. CAD Assistant automatically sends an electronic response back to OCFA when an ambulance has been dispatched to the incident. • 6 • • • • 411 An Automatic Vehicle Location (AVL) system is interfaced with the CAD system to constantly receive Global Positioning Satellite (GPS) information from every ambulance in the fleet (updated every five seconds). When a call for service from OCFA is automatically populated (through CAD Assistant) into our CAD system, the computer recommends the closest ambulance to the 9 -1 -1 in- cident. The dispatcher simply verifies the information and dispatches the ambulance to the call. The transmission of information from the OCFA computer system to Care Ambulance CAD system to the field crew is extremely accurate and occurs within seconds. The Rescue Net CAD system is fully equipped with a Rescue Net Reporting software program. The Rescue Net Reporting program is fully customizable allowing our I.T. staff to create custom reports based on each managers needs. A wide range of data can be analyzed to detect any patterns of under - served areas. The deployment plan can be adjusted as needed to ensure the ambulances responding in the contracted cities receive the fastest response times with the most accurate ambulance deployment plan. For redundancy, two separate real time computer aided dispatch systems are on line at all times. In addition, a separate and complete Mini -CAD computer system is in place as an additional and fully functional safety net. Moreover, the main CAD system is continuously replicated at an off site com- munications center, allowing for the transfer of dispatch to a new location without the loss of vital CAD data. 010 3 — Additional Communications Equipment In addition to the GPS /AVL and MDC technologies previously mentioned, two (2) cellular phones are deployed on every ambulance. In addition to normal cellular phone functions, each phone is programmed with a translation service which will allow EMS personal to communicate with patients no matter what the language. Other communications equipment includes alphanumeric pagers, 500MHz radios, 800MHz radios, GPS navigation with Mobile Data Terminals (MDTs), digital audio recorders, direct connect, MCC5500 dispatch consoles, and the RediNet system which allows instant notification of hospital diversion status. 4 — Operational Design for Emergency Response Currently, Care Ambulance Service has an OCFA MDC installed in our communicadons center along with CAD Assistant which allows for a flawless transfer of call information. Without delay, and without human intervention, the call for service is automatically electronically transferred into our CAD system and the response time starts immediately. Our CAD system suggests the dosest ambulance to the 911 request based on the last five (5) seconds of GPS information. As soon as an ambulance is assigned to the call, a message is automatically electronically sent back to OCFA to verify that an ambulance is en route. That call information is simultaneously sent to the ambulance crew's alphanumeric pager as well as the wireless MDT in the dedicated ambulance. In addition, the crew is radioed to go enroute and given the call information over the air. The route to the call will be automatically displayed on the crew's in- vehicle navigation device which will assist in faster response times. II The crew will acknowledge the call and respond en route with OCFA on the assigned 800 MHz two- • 7 • • • • tical radio channel. The crew uses the 800 MHz County -wide coordinated communications system to follow appropriate radio procedures through the completion of the call. The crew is also able to contact the Care Ambulance Communications Center throughout the call and all time stamps are electronically recorded in the Rescue Net CAD system. 5 — Information Technology Capabilities Care Ambulance Service has a highly trained Information Technology (IT) staff. To meet our inter- nal IT needs, Care Ambulance Service uses a combination of employed staff and contracted staff. The internal IT staff includes a Network Administrator, a Systems Engineer, and a Computer Tech- nician. These individuals use their skills to maintain and upgrade hardware as well as develop and program software. External IT capabilities are supported by outside vendors. the vendors include, but are not limited to AT&I', Radio Service, Zoll Data Systems, Vision Communications, USA Mo- bility, and Road Safety. Internal IT staff is available for emergencies twenty -four (24) hours a day, seven (7) days a week. Contracts are also maintained with external IT partners for critical systems to ensure twenty -four (24) hours a day, seven (7) days a week emergency response. 6 — Communications Center Capabilities Care Ambulance Service emergency response communications system is operated and maintained twenty-four (24) hours per day, seven (7) days per week. Twenty -two full -time dispatchers 2 .x:7 - ! " ^w 4 staff the communications center on rotating shifts. All dispatchers — -, $ =* r A ;, go through a rigorous internal training process and are also certi- { fied by the National Academy of Emergency Dispatch (NASD). In addition to the RFP requirement that a field supervisor be s E, physically present twenty-four (24) hours a day, seven (7) days a week within the County of Orange, Care Ambulance Service maintains an on-duty Communications Supervisor twenty-four (24) hours a day, seven (7) days a week in the County of Orange. 7 — Ability to Upgrade Communications System Care Ambulance Service is capable of implementing a CAD interface at the discretion of OCFA as outlined in the RFP. Care Ambulance Service is also willing and able to upgrade our Emergency Response Communications System at our expense with comparable technology to that of OCFA as new and improved technologies become available. 8 — Field Data Collection System Care Ambulance Service currently creates a carbon copied Patient Care Report (PCR) to document all services that are provided to the patient. Time stamped information that is synchronized on the net clock and captured in the CAD is electronically transferred to the field crew for PCR documen- tation. After the PCR has been completed, it is turned in where it is matched with the calls that were completed in the CAD system. The PCR's are randomly audited for QA/QI information. The PCR's are scanned into a billing system where they can be stored and easily recalled. All data collection information is handled in fulfillment with HIPAA regulations. • 411 8 • • • € TAB 6 f r t t p L� f L • ITEM 6 : SERVICE RATES OD Care Ambulance has a long history of providing quality, cost - effective ambulance services to the residents and visitors of Orange County. Our size and strong fiscal position allows Care Ambulance to service these new contracts with the Orange County Fire Authority and their partner cities unlike any other provider. Our fiscal strength not only allows for capital improvements that can enhance patient care but also ensures the continued fiscal viability of the system. The following table outlines the service rates Care Ambu lance proposes to charge for the provision of emergency ambulance transportation services. These rates, previously approved by the Orange County Board of Supervisors and the Orange County Fire Authority Board of Directors, will maintain a consistent and viable ambulance service- -even in the face of declining state and federal government reimbursements. While the service rates identified below list the fee- for - service charges, Care Ambulance will not bill MediCare and MediCal eligible patients for more than the maximum MediCare or MediCal rates allowed by contract or law. Further, Care Ambulance warrants that all ambulance service rates and fees shall be in accordance with Orange County established maximum rates, requirements and reim- bursements as set forth in Section VII of the RFP. PROPOSED ORANGE COUNTY EMERGENCY AMBULANCE SERVICE RATES BLS Base . '' $671.75 .. ALS Service Rate (In addition to BLS Base Rate) $355.75 Mileage Rate . • . • • • : $15.50 • . • OS. Oxygen Standby Cha • $76.00 by cge, I'er 15 Minutes $37.70 . Expendable Medical Supplies $30.00 The following table provides the reimbursement fees Care Ambulance will pay to the Orange County Fire Authority for ALS services provided to patients that are transported either ALS or BLS in order to cover OCFA's costs for providing such services, including ALS assessments. Care Ambulance shall reimburse OCFA the established ALS Reimbursement Rate for each call for service in which OCFA provides ALS services, induding ALS assessments, to patients that are transported ALS or BLS. REIMBURSEMENT TO OCFA ALS Reing:mrscment Rate $252.00. . • ALS Reimbursement Rate for MediCare, including ALS -1 or ALS-2 Increment, patients covered under Medi -Medi or MediCare+ choice plans Zero Pay pacrents • • • .. - Thiti The will •■be no reimbuizianalt - • • - • pa ;as defd:hy nadteOC FAasp __e sft: . ��.striaeor act l ace (b) CilOptinu: (c • ifbrma Gild SeMces (CCU 40 Cow* Motcal Smiles f the•Ltdigpnt rCouncy/MSI")• Medical Supply Reimbursement Rate. The rate $28.15 per transport shall be subject to the same annual percentage • adjustment increase as the County's emergency BLS base rate, if any. 9 • MEDICARE PATIENTS C:ait Ambulancrwilt• not barge MAGaiie pannts mite than t ie maximurn estabbsl ed - • - Med C.a:: ats. • • • • - • • Care Ambulance agrees to only bill for provided services according to the approved service rates and schedules set forth in the Contract Documents and as authorized by the Orange County EMS Agen- cy and OCFA, with no additional fees or charges imposed unless approved in writing in advance by the OCFA Fire Chief and/or the awarding agency, if applicable. Care Ambulance shall assume the entire risk of non - payment for any and all of the services rendered and the charges incurred in connection with our performance under the Contract Documents, induding all ALS and BLS charges incurred, as well as all ALS reimbursements and medical supply reimbursements. • 10 4 TAB 7 ink VP F Ank wp • ITEM 7 : ON -BOARD EQUIPMENT AND SUPPLIES Care Ambulance Service is committed to providing equipment and supplies that exceed the specifica- tions, requirements and performance expectations set forth in Section VI of the Request for Propos- als (RFP). All equipment and supplies furnished by Care Ambulance meet all federal, state and local laws, rules, statutes and regulations applicable to the provision of emergency ambulance service. To ensure to Care's ambulances are fully equipped with medical supplies and that all on -board equip- ment is in working order, our ambulance personnel perform daily inventories and vehicle / equip- ment checks, replenishing supplies before they go into service. If additional supplies are needed, they are ordered and delivered by our operations route drivers that day. On -duty Managers are also available to replenish supplies in the field. Bulls supply warehousing is maintained at our corporate offices in Orange, where a minimum 30-day supply of disposable and medical supplies are available. An additional medical supply cache is also maintained at our Los Angeles County Division offices in the City of Santa Fe Springs. On Board Equipment and Supply Inventory All Care Ambulance units carry at a minimum the inventory designated in the standard supply list detailed in the RFP and/or required by the Orange County EMS Agency. A complete Equipment and Supplies list, detailing all equipment and supplies carried on -board our ambulances is available upon request. Equipment and Supply Enhancements or Upgrades •0 Care Ambulance Service proposes the following enhancements or upgrades for all ambulances pro- viding services to the Orange County Fire Authority and contract Cities: • All ambulances in the Care Ambulance fleet are equipped with an AED that A has pediatric capabilities. • Each ambulance will be equipped with Stryker Power -Pro XT Gurney. - • The Power -Pro provides an innovative battery powered 1 C,y hydraulic system to raise and lower patients with a simple ,; touch of a button, with an easy to use manual back-up sys- tem. The automatic retract feature reduces patient loading and unloading times, while reducing possible back injury - ; - to rescuers. • All assigned Care Ambulance units will be equipped with Mobile Data Terminals (MOTs) outfitted with an Automatic Vehicle Loca- _ for (AVL) mapping system and interfaced with our Computer Aided Dispatch (CAD) system. • Each ambulance may be stocked with a complete supply of Advanced Life Support (ALS) disposable, cardiac monitor / defibrillator and medical equipment for use by OCFA Paramedics. This will allow the OCFA Paramedic Engine or Truck to remain in service con- tinually as a Paramedic Assessment unit with its ALS supplies and equipment in tact. • All Care Ambulance units are equipped with the following additional pediatric equipment: ;• pediatric traction splint, pediatric immobilizer, pediatric cervical collars, pediatric oral and ' pharyngeal airways, pediatric oxygen masks and cannulas, pediatric blood pressure cuffs, • 11 • " and pediatric bag value masks. l t r • All Care Ambulances are equipped with a Pedimate Child Transportation System to allow for the safe transport of children as patients or uninjured I passengers. • All assigned Care Ambulance units will be equipped with a Stryker Stair Chair. These devices are extremely useful for moving patients down stairs and around tight areas. r ' 1. Care's OSHA Compliance Program Care Ambulance Service believes that the safety of our employees is one of our fwida- 1; r mental responsibilities. It is the philosophy of Care Ambulance that every employee is entitled to a safe and healthful place in which to work. We are current and compliant -_ with all Occupational Safety and Health Administration (OSHA) requirements. The prevention of illness and injuries is a goal worthy of our concern, diligence and job performance. To attain this, Care Ambulance has developed our own "Injury and Illness Prevention Program ". Our Injury and Illness Prevention Program exceeds all state and federal OSHA requirements and includes the following sections: Safety Policies, Codes of Safe Practice, Hazard Evaluations, Exposure Control Plans for Bloodborne and Airborne Pathogens, Respiratory Protection Program and Hazard Communications. Care's Safety Program is founded on the comprehensive safety training provided as part of an OD employee's initial orientation and then follow-up with annual mandatory training. In an attempt to learn from past incidents, Care Ambulance has also established our own Safety Committee. The Safety Committee is made up of managers, supervisors, training officers and peers. The Safety Com- mittee is charged with reviewing all employee safety concerns or issues, employee injuries and vehide incidents. The goal of the committee is not to punish safety violators but to ensure that safety issues are properly identified and any corrective training is established. Care's Safety Program has been so successful in reducing employee injury incidents that for the last five (5) years, Care Ambulance Service has received annual safety awards from State Compensation Insurance Fund for the "Lowest Experience Modification" and "Lost Time Accidents" for all partici- pating California ambulance companies. Care's stringent safety program is designed to save lives, prevent injuries and to protect our employ- ees and patients, while ensuring full OSHA compliance. 2. Care's Capabilities to Respond to Terrorist Threats or Disasters Care Ambulance has the proven ability to respond quickly and efficiently to natural and man-made disasters. From hurricanes in the Gulf Coast (Katrina, Rita and Gustav) to the 2007 and 2008 Cali- fornia wildfires, we have been a key member of the disaster response and support network. Care's disaster preparation begins in our Communications Center. All essential dispatch systems are powered through Care's own electrical generation station, with backup services provided by Southern California Edison and a 1,200 gallon diesel - powered electric generator. Recognizing the value of resources and how they can serve the region as a whole, Care Ambulance has created our own Emergency Operations Center (EOC) at our Orange corporate offices that is • 12 activated during disaster events. Following the activation of our EOC, Care Ambulance representa- tives are available to work with local Fire Department and County EOCs for the specific purpose of fostering rapid and accurate communications. The Center proved its effectiveness during the 2007 California wildfires, when it was used to deploy 50 ambulances from nine (9) ambulance companies throughout Orange County to provide EMS services to Firefighters battling wildfires in Orange, San Diego and Los Angeles Counties. • On a county-wide level, Care Ambulance has taken a leadership position in developing standardized training for an operational response to terrorism and other Multi - Causality Incidents (MCI) and creating a master mutual aid agreement with seven (7) other ambulance providers. We actively par- ticipate in disaster training and preparation throughout the region, including joint training with our local fire department partners, other area ambulance providers and area hospitals. Care has worked towards strengthening the continuum of medical care response to any disaster event and the local utilization of "Ambulance Strike Teams." Care Ambulance was the first ambulance company in the State of California to equip all ambulances with Nerve Agent Antidote Auto - Injectors and ensure that all EMT personnel are trained in Under- standing Terrorism and Chemical Agent Exposures. Area fire departments, police departments and other ambulance companies have since adopted Care's training curriculum. Care's preparation does not end there. Each day, Care Ambulance FieldY. Supervisors are on -duty in specially equipped disaster support vehicles. -'- These vehicles are configured for Code 3 operations and are equipped "? with supplies to handle up to thirty -six (36) patients. Care deploys theses ' !; { K vehicles every day in the field. They are not left at an ambulance station • waiting to be staffed. Care Ambulance recognizes our important role ;- in disaster preparation and pledges support for continuing disaster ' 4 ' preparedness. - • t .f • • Fabancemcnts Care Ambulance is offering to deploy two (2) Disaster Supply Trailers and a state furnished Disaster Medical Support Ualt (DMSU) strategically located in Central Orange County. The DMSU and Disaster Supply linnets are equipped with sufficient medical supplies and equipment to support any major event within the County. The DMSU and Disaster Supply Tipilena may be activated by OCFA and delivered to an , disaster scent by Care personnel, These critksul resources will ensure an instihnt restock of both OCFA and Cane Ambulance units in the event of a major incident • 13 TAB 8 I F E t E } • ITEM 8 : VEHICLE AND EQUIPMENT MAINTENANCE PROGRAM Care Ambulance Service commits to provide a program of vehicle and equipment maintenance that meets and exceeds all vehicle and maintenance standards, requirements and performance expecta- tions set forth in Section VI of the RFP and is approved by the Commission on Accreditation of Ambulance Services (CAAS). Care Ambulance subscribes to the principle underlying aircraft maintenance programs, that is, me- chanical failure is predicted to occur and parts are replaced before actual failure can occur. Our Fleet Manager and Fleet Technicians are tasked with the responsibility to maximize the availability of every vehicle in our fleet, 24 hours a day, 365 days per year. In order to ensure this level of vehicle availability and maximum assurance of vehicle and system reli- ability, our Fleet Manager and Fleet Technicians are empowered to use the highest quality parts and subcontracted services. Care Ambulance believes that our fleet care team must have the flexibility to do their job right the first time and must also have the support from our management team to ensure that end. Our Preventative Maintenance Program has several goals. When EMT crews begin their work shifts, the time spent preparing a unit for service is essentially nonproductive time. Maintenance of re- sponse -ready vehicles that require the minimum crew preparation time before entering the system is not only cost - effective, but substantially enhances morale and professional attitude of personnel. Employees have more respect for, and therefore care for, vehicles and equipment that are clean, op- erative, and well maintained. This has a further effect of enhancing the overall quality and delivery of pre-hospital medical care in the field. Care Ambulance realizes that a quality fleet care program improves equipment through maintenance and establishes appropriate relationships between field personnel and mechanical per- sonnel. This relationship is reinforced through regular inspections, accountability, paper trails and scheduled preventative maintenance. Our fleet department, at a minimum, sees each Care Ambu- lance unit every 5,000 miles for an extensive preventative maintenance check. Care Ambulance exceeds industry and manufacturer maintenance standards. Care Ambulance oper- ates an aggressive maintenance program described below for first line and reserve ambulance units. Inspection and maintenance is performed at these intervals: • Daily, prior to operation • Monthly (Schedule A) • Every 5,000 miles, inspection and service (Schedule B) • Every 10,000 miles, inspection and service (Schedule B and C) • Every 20,000 miles, inspection and service (Schedule B, C and D) • Care Ambulance obtains maximum efficiency from vehicle components and patient -care equipment and replaces them before they fail. Following are the details on the inspections and servicing de- l l scribed above: • 14 • 1. Description of Vehicle Maintenance Plan or Schedule • Upon delivery, Care Ambulance thoroughly inspects each new vehicle to assure that all purchase specifications were met. Information from the inspection then becomes the baseline data to track repair and operating history for each vehicle. Once ambulances are placed into service, the following preventative maintenance schedules are strictly followed: Pre-Shift Vehicle Inspection - Performed BO)rie Each Shift Prior to the start of each shift, our ambulances undergo an inspection of fluids, tire pressure and system components such as emergency lighting, non - emergency lighting and oxygen systems. Each ambulance is inventoried, restocked, and receives a detailed cleaning and sanitizing. Engine per- formance, transmission shifting, brake function and overall vehicle ride are checked. Field crews complete the Pre -Shift Vehicle Inspection. If any deficiencies are found, the ambulance is removed from service until corrected. Schedule A Inspection — Performed Monthly Every month each ambulance in the fleet is inspected by one of Care's fleet mechanics. Each Sched- ule A inspection includes a checking of all fluid levels (oil, transmission, brake, power steering, coolant and washer reservoir); all tires and shock absorbers are inspected. Any deficiency is corrected before the ambulance is returned to service. 044? Schedule B Inspection - 5,000-mile Performance Interval Every 5,000 miles we thoroughly inspect major system components including dicascembly for visu- alization and system diagnostics. Batteries are load tested, oil and filters changed, brakes inspected, fluid replacement, and tires rotated and balanced. These frequent, aggressive checks allow us to identify and resolve potential problems, hopefully precluding an in- service failure. Schedule C Inspection -10, 000 -mile Performance Interval This begins with a Schedule B Inspection. Highlights of the Schedule C Inspection include fuel filter replacement, pitman arm inspection, air leaner replacement and a detailed electrical system check. Schedule D Inspection - 20,000-mile Performance Interval Added to a Schedule B and C Inspection, the Schedule D Inspection includes several checks such as a complete transmission service, cooling system service and an air conditioning service. Management Plan All of Care's fleet mechanics staff are certified "ASE" mechan- ics and have been trained to study malfunctions and mechanical difficulties that have occurred and to investigate developments and improvements that have been, or should be, made to vehicles L systems. The scope of these efforts includes electrical systems and 7 instrumentation, tires and wheels, engines and transmissions, " 444 441k, 4 cooling systems, driver and patient compartments, and vehicle • ^ eY 15 • chassis. Our fleet staff is required to stay abreast of technical procedures and shop tools, and to be knowledgeable about vehicle energy conservation. Preventative maintenance programs for ambulance vehicle fleets are documented throughout this section. We feel that the underlying message behind Care Ambulance's preventative maintenance programs and the people that implement them demonstrates the high degree of accountability that the citizens of Orange County should expect from their provider of emergency ambulance services. Fleet Maintenance Facility Care Ambulance provides all vehicle maintenance at our own a • state -of- the -art facility located at our corporate office in the City Orange. The 4,800 square foot facility is among the most so- 's [4;1,71- Q' phisticated in the emergency response industry and features four ' t' (4) garage bays, two (2) 15,000 pound capacity hydraulic lifts, a ,: • parts room, administrative office and a touch -less car wash. ° The fleet maintenance facility is open from 7 a.m. to 9 p.m., 4 r Monday through Friday and 1 p.m. to 9 p.m. on Sunday. Dur- 1-7 ` ing other hours, Care's fleet manager and line mechanics are r , on an on -call schedule for immediate response to any kind of mechanical problem. {• " "` '�' In maintaining our vehicles, Care Ambulance complies with all applicable laws and regulations from Federal Environmental Protection Agency and the State of California's Environmental Protection Agency. We will continue with this commitment, disposing of all used parts, accessories, lubricants, refrigerants and tires to allow for recycling and reduced impact on our environment. 2. Description ofVehide Replacement Plan Care is committed to the replacement of any ambulance or vehicle prior to reaching the end of its useful life. This commitment provides our patients the guarantee that we will do everything pos- sible to ensure their safe transport. The expected life cycle of our vehicles is determined through the manufacturer's recommendations and by the track record established by our fleet maintenance department. Listed below is our schedule of vehicle replacement: RsstwcEMENT ITEM BRAND • LIFE • SCHEDULE • Ambulance Road Rescue 5 years 150,000 miles 3. Description of Capital Equipment Maintenance Program and Replacement Plan Care Ambulance recognizes that the company's commitment to the highest quality patient care necessitates the proper maintenance of all equipment. The Failure of EMS medical equipment may Kl �P eq �P • 16 • II) have a severe consequence for the patient and is therefore unacceptable by Care's performance stan- dards. For that reason, Care Ambulance has established a durable equipment maintenance program and replacement plan that safeguards against that potential consequence. All on -board equipment is inspected daily for function and appearance. Equipment that is not in working perfectly is immedi- ately removed from service and then repaired or replaced. Care's primary capital equipment is maintained and replaced as follows: • Stryker Patient Gurney — Care Ambulance contracts with Stryker Medical, our gurney manufacture, to perform all preventive maintenance and repairs according to their specifica- tions. Twice annually, Stryker technicians inspect and maintain all gurneys in our fleet. If a Stryker gurney is found to be out of repair, it is immediately removed from service and re- placed with a replacement gurney, until all proper repairs can be made by Stryker technicians. Maintenance records are maintained by Stryker Medical and are available for review Several replacement gurneys are maintained at our Orange corporate offices. All gurneys are replaced on a five (5) year lifecycle. • Stryker Stair Chsir — Similar to our Stryker Patient Gurney, Care Ambulance contracts with Stryker Medical, our stair chair manufacture, to perform all preventive maintenance and re- pairs according to their specifications. Twice annually, Stryker technicians inspect and main- tain all stair chairs in our fleet. If a Stryker stair chair is found to be out of repair, it is im- mediately removed from service and replaced with a replacement stair chair, until all proper repairs can be made by Stryker technicians. Maintenance records are maintained by Stryker Medical and are available for review. Several replacement stair chairs are maintained at our Orange corporate offices. Stair chairs are replaced on a five (5) year lifecyde. • Philips FR2 Semi - Automatic Defibrillator (AED) — Care Ambulance contracts with Philips Medical to perform all maintenance and repairs in accordance with their recommen- dations. Due to the sealed nature of the unit and its battery system, daily maintenance is not necessary. AEDs are scheduled for replacement on a ten (10) year lifecycle. • Oxygen Delivery Devices — Care Ambulance contracts with Independent Medical Sale and Service for the twice annual scheduled testing and calibration of all oxygen delivery devices. Maintenance records are maintained by Independent Medical and are available for review Oxygen delivery devices are replaced on a five (5) year lifecycle. • Radios and Communication Equipment — Radios are tested daily by the crew to confirm that they are in working order. Orange County Med -10 radios are tested monthly with Orange County Communications and then inspected annually by Orange County Commu- nication technicians to ensure proper working order. Maintenance records are maintained by the County of Orange, Sheriff's Communications Department. Radios and communication equipment is replaced on a five (5) year lifecycle. • Traction Splints and Extrication Devices — Each of these pieces of equipment are inspected daily to ensure that all components are present, clean and ready for use. If problems are noted with the equipment, it is immediately removed from service and repaired or replaced. Due to the very limited use of traction splints and extraction devices they are only replaced as needed and not on a scheduled replacement plan. • 17 TAB 9 [ 10 1 1 I , K i K 1 i i • K R 5 [ . F 1 f K s E� k i i E t h P E 1 I [ i. • F f 1 1 IIII ITEM 9 : PERSONNEL AND TRAINING :,..,•1 � " Care Ambulance Service is a nationally accredited and local, family -owned emergency ambulance • service. Our management team and employee personnel have proven our long-term commitment to Orange County, having worked with die Orange County Fire Authority and other Orange County public safety partners over the years to develop innovative system enhancements. Nowhere is that more evident then in Care's positive management practices, comprehensive employee continuing education and employee recruitment, screening and orientation programs. 1. ASSIGNED PERSONNEL PROFILE Management Team During Care's thirty-nine (39) years of providing ambulance services to the residents and visitors of Orange County, we have developed an outstanding management team, which will oversee and manage our contract with the OCFA and partner cities. These individuals will oversee the implemen- tation of any new contract, ensuring a seamless transition and continued oversight throughout the term of the contract. Their resumes are available upon request. NAME POSITION YEARS IN EMS/ YEARS WITH CARE HEALTHCARE Dan Richrardsori • Co-CEO .. 33 Years • . - 33 Years . ' Rick Richardson Co -CEO 29 Years 29 Years Dr. Michael Martin Medical Director - . • 25.Years • • • 20 Years • , . Bill Weston Director of Operations 26 Years 12 Years . Gene vii silo wild Director of Finance • 25 Years ' . • • 10 Years • . Ben Baker Director of Communications 9 Years 9 Years Kevin Chao . . Training Manager .. . 22 Years • 7 Years'" - John Sanders Operations Manager 8 Years 8 Years Rick * Mount : , Operations Manager . ' • 32 Yea 32 Years • . . Marc Jessner Operations Manager 18 Years 18 Years Field EMT Personnel Throughout our history, Care Ambulance Service has offered and will - p •"''v; ;, ffr continue to offer, the highest clinical and staffing levels. These profes- . , , 1 sional standards comply with all applicable State of California laws and *- regulations, as well as Orange County EMS Agency statutes, rules and :� "... `— regulations. 1 w e . Minimum requirements for Care Ambulance Service's field personnel z ' ' . , � 1 ; , - -- . i include the following: _ - : ` il • California recognized EMT Certification !, • . • California Driver's License ° s ; ,� ,� :. • Ambulance Driver's License Endorsement • CPR / AED Certification • Orange County Provider's License y • Medical Examiner's Certification III 18 • Care Ambulance Service has 576 Orange County certified Emergency Medical Technicians (EMTs) and 40 Field Training Officers (FTOs). The following table shows the name, years of experience as a Care employee, languages spoken in addition to English and certification level of EMT personnel who are currently assigned to Care's Ambulance Transport programs in La Palma and Stanton and those that may be assigned to the Cities of Cypress, Los Alamitos and Seal Beach. LA PALMA EMTS YRS. OF ADDITIONAL EMT CERT. 0 PROVIDER LIC. SERVICE LANGUAGES NUMBER NUMBER SPOKEN • Beach, jointer , 10 • - Z000129044 Z00012904 • . Boyd, Brandon 2 B 1770870A B1770870A Jorge • 3 24002784A ' . • Z00027844. Crow, Kris 1 B1860340A B1860340A , 26 . • Tom Z0000289A Z0000289A • : Vietnamese 8c Wong, Keith 1 Cantonese 52610 Z0006488A STANTON EMTs YRS. OF ADDITIONAL EMT CERT. O C PROVIDER LIC. SERVICE LANGUAGES NUMBER NUMBER SPOKEN Glit4 : 8 • • • • • • #8551 • • Z00018 Parra, Randel 3 B7662062A B7662062A Sal 3 • ' Z0003748A 20003748A ' • Schmid, Jonathan 3 E17271 Z0004725A • U . • • • ' 3 • 1.0727431A : • B 1727631A • • • . Yuriar, Steve 2 Spanish B1835396 A000144 STANTON EMTs YRS. OF ADDITIONAL EMT CERT. 0 PROVIDER LIC. SERVICE LANGUAGES NUMBER NUMBER SPOKEN Barran, Bdin • • . 8 • •• • . ' •116997 • Z0001666A : • Bissell, Thomas 1 Spanish Z0006493A Z0006493A 1 6042A • 20000044'. .• Chu, James 1 B1829494 B1829494 i ; : •`: • .880443.94A" • 81 Jex, enna 1 S .anish Z0006643A Z0006643Z Kitas; Bdiui . .. 1 • 885 49 B1 .3 Kratka, James * 18 Z0002704A B0002704A Lay Stoat . • 10 ' • E18647 . • • Z0005970A Le . e, Omar * 10 S . anish Z0000471 Z0000471A Matheio, CUM. • 2 • • ...gpanish • 816)4403A 8161403A •. Melendrez, Gerardo * 14 S • anish 23244A Z0001933A 1+1 , 1 • : M • : - 81857534. . 840534 . Nguyen, Dat 1 Vietnamese Z0006616A Z0006616A • 19 III 0 Tam William • 2 1-2179 Z0006077A Tran, Christopher 1 Chinese 52792 Z0006330A • Vbdkv Andrea 2 Sp h • . E17524 _ Z0003093A Wyzykowski, Tim 2 B1844244A B1844244A Note - * Denotes a Field Training Officer (FTO) A complete listing of Carel EMT and FTO personnel is provided as an Attachment to this section of the proposaL Communications Personnel Minimum requirements for our communications personnel include the following: • National Emergency Telecommunicator Certification, from the National Academies of Emergency Dispatch • CPR / AED Certification The forty (40) hour, Emergency Telecommunicator Course is a joint effort between the National Academy, The National Emergency Number Association (NENA), and Jones and Bartlett publishers. The course is designed to train new employees who are unfamiliar with communication centers and their technology, legal guidelines, stress factors, and methods of communication. Topics covered in the Emergency Telecommunwator Course: • Roles and responsibilities — essendal knowledge and skills • Technologies • Interpersonal communication -the communication cycle, listening, language problems 410 • Communication and call processing - customer service, types of callers, high risk calls • Call classification • Radio broadcast procedures • Legal aspects of emergency telecommunication -risk management and liability • Stress management — pressures of the job and stress management techniques The following table shows the name, years of experience as a Care employee, and certification level of com- munication center personnel who are responsible for dispatching of Care's emergency ambulance units: NAME YRS. OF POSITION NAME YRS. OF POSITION SERVICE SERVICE r. • 2 ' ds Infante; Sean_ 2 . . . DisPatcher Aguilar, Erik 3 Supervisor Knudson, Candice 1 Dispatcher ;Abibri - . .1. • . Disluatthet ' ; • . :. . • • Andre, Amanda 5 Dispatcher Love, Lorraine 2 Dispatcher , • Anthony . . .224 , .Supr 2 Clip** . Bribiesca, Sam 1 Dispatcher Morales, Pete 17 Supervisor Bn Blom 1 • Der Ohre; Maqhew• . 2 ' • 1:Xspatcher' Ce�arra, Eileen 3 Dispatcher Perez, Steven 1 Dispatcher 4aivde4 jmnes - •.. 21 .. Setperviipe Smelt, dad 2 Dispatcher • Genis, Kim 1 Dispatcher Stark, Katie 1 Dispatcher 0 C ter ter sea • . • • 2 k• Dispatcher SueslrerAlialmet • 2 Llepardter. Horowitz, Ryan 3 Dispatcher • 20 • 2. FIELD TRAINING OFFICERS Field Training Officers Care's Field Training Officers (FTOs) are responsible for all aspects of EMT training, including ongoing observation in the field. The ratio of FTOs to EMTs committed to the Orange County Fire Authority and each contract city is 1 to 6. FTO Training and Job Functions The FTO job training program is an intensive familiarization with preceptor training objectives, including but not limited to evaluation forms, rating factors, EMT standards, inter - personal com- munications, patient care documentation, FTO ethics and standards, teaching and support services. FTOs must have at least one (1) year of experience and undergo an intensive selection process before being chosen. The Field Training Officers perform many functions, including • New employee selection process and field orientation of new employees • Driver training • Classroom, refresher training and EMT B skills testing • Provide outside training (CPR, First Aid, etc.) • wCareer Days and Ambulance Demonstrations Supervisory Training and Job Functions Care's Operations Managers are responsible for overseeing all EMT personnel in the field. All Opera - � tions Managers employed by Care Ambulance Service have successfully completed training at the +,' ICS 300 level and Ambulance Strike Leader training. All have completed the Ambulance Service Manager (ASM) training offered by the American Ambulance Association (AAA) and most recently all completed the Ambulance Supervisors Course offered by Texas A&M University. All Operations Managers have completed required FEMA training, including IS 700, IS 703 and IS 800. In addi- tion, all Operations Managers have completed the Orange County EMS Agency courses in Bio -Ter- rorism (CBRNE) and First Responder Awareness (FRA) and First Responder Operations (FRO). Management / Field Supervisor Oversight Plan Currendy, Care provides an on-duty Operations Manager on a twenty -four (24) hour basis, seven (7) days a week. The Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Manager is located at our corporate offices in Orange. The on-duty Operations Manager is available at all times and may be contacted im- 1/4 mediateiy via radio through Care's communications center or directly / . 4 S - through his cellular telephone. ",_ fuE On a daily basis, Care's Operations are in the field, suer- 1'.' Y Pe Managers P s 1° • vising the activities of all assigned personnel. They are deployed in a 5 : = Code 3 capable vehicle equipped with all necessary fire department radios and extra medical equipment, including backboards, medical supplies and oxygen. • 21 • • 3. PRIMARY PERSONNEL Care Ambulance Service provides a very comprehensive management team with over 200 years of collective experience in the management and supervision of emergency ambulance operations. The OCFA and their partner cities can count on an experienced Care Ambulance management team to fully accomplish the service fundamentals and enhancements described in our proposal, skillfully en- suring continued quality performance necessary for an outstanding delivery of emergency ambulance transportation and related services. The following are biographies and resumes of the four (4) key members of Care's management team who will be directly responsible for fulfilling the terms, conditions, performance, expectations and obligations relative to our performance under the Contract Documents. Dan C. Richardson, Co - Chief Executive Officer Dan C. Richardson, Co-Chief Executive Officer, has been employed at Care Ambulance Service, Inc. since 1975. Dan leads the on -site management team having over 33 years of EMS and medical service management experience. He is responsible for the coordination and monitoring of overall system performance to ensure high standards of service. His management strengths including team building, goal setting, perfonnance recognition, and discipline to ensure motivated and highly pro- ductive middle management, supervisory, support, and field staff. Rick Richardson, Co - Chief Executive Officer Rick Richardson, Co-Chief Executive Officer, has been employed at Care Ambulance Service, Inc., since 1979. Rick directs all businesses, financial operations, communications and I.T. functions at Care Ambulance Service. Rick has served as the President of the Ambulance Association of Orange County and has participated as the committee member on the Emergency Medical Care Commit- tee and Weapons of Mass Destruction Task Group. Rick's financial leadership at Care has led to the development of a comprehensive growth strategy that has seen the company through thoughtful expansion spanning more than a decade. Bill Weston, Director of Operations Bill Weston, Director of Operations, is responsible for the daily operations of Care Ambulance Ser- vice. Bill began his EMS career as an EMT in Orange County and has daily oversight of field opera- tions, training, EMT hiring and risk management. Bill frequently acts as Care's representative before government commissions or regulatory bodies as it relates to ambulance operations and is the current President of the Ambulance Association of Orange County. Ben Baker, Director of Communications Ben Baker, Director of Communications, provides ambulance Deployment Management and Com- munication Center supervision. Ben is responsible for Care Ambulance Service's Deployment Plan- ning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is an industry leader in maximizing the capabili- ties of our EMS computer -aided dispatching system. 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' ocao D lay fret -cff •m e d e . t� tt atiibG rp'soi t q'expec 'prob !ems efficiently • ' ro�i uEt doiitisltf. li)oct incn �C i_ i _ tl} a c ctl },; 6 d, • s 1 . r C n t a g t c contact 1 . 'Y _ t 1RS • 2T r d n t " ; Y • , • '. •,' -' f ar-iKY Tr i; J'{ ' _ « ? N.,1,A . '� . • • x �• ' - _ . • ,^ r,� w 4 4 .. i t • • , x - " • ' , • . : ' ' m ao � mii r .p . ,. , 4 `• �d •P''--;;It,' i F ountain Valley • . ▪ • a i' �g 1,in. n *:*, 3. y ,. .- e "'T t ftu bes , � l a s i c or ientation, and . • - ; , J' '�. 'ra un ed. "T n - _ • ,-.1_,,, ' ' r y ' an s ubmi tt ed performance L ' 1 } err o y R V ,�j� +d'" i �*•° y Y } � .,� •- 1-...ii e • i' y • �-^ e C _ ; i. .a 9 . • . '..� '`♦' ° `�`A '!''"7`ei ' • • r :�, - +a. • . : - , • . �•�y�. yam i .ti : • �ys ,�.�y' � • t. ° -8 � :.H4R "'� g i• 4-f..„.• '•_ • Aciiiewi�' ^ e ° T'c •. s ,1 - .. , • ' .° s .... , ,A, " s ' !V ' � k. ,g F � , Y es . - ^ � g4 M•[ ' R : , r , t * '•e F 4 1 ,1 a '1.1 a` i y %,1 „ S ° ' • . cai T e ch niy an .r ` ,i• � ) r, :, ,' �_ : 3 ▪ •'r : ' 10. - -ter n A � q � } , '° • `.' • ". ' , fir- .' f' •w'-ft„':- - i•, n ii ii -R °a s ,. v. a s: , �y,Y��� a _ J r, r -' .' ; ° �a7s.T'•r '4+F[ :•'r 1 0i V _ ",,, ,. • ., ^a „ ° °' .••'y s - '1',. ▪ , }.iYr.q - .4%' l i .. .. ' r , � .' !. ''; - • r F R -r . • _ ' • . ''` i . - °7 ° Fc: v = °, +•,•' • L -i.. c.�l ,� . _ ' ” .� £ „d ' - , E, _° . ; 3 1 1- aV i•— � ,•4 b ::1•y 4. - k : F ., - . : - ., � � J. • A � r n,. ,� M1 .,� . h , �. ^ N i � •f - j n ` .R� t , '•� • A r :$; M T x 4R rr ..T`' • 444 , . .R• _ ,.;.. •. S• i ° • :,• 4: . i ,� : s 4 • •n•+, ". ,r- '''....r.:'.•.• J •• 4 ` 5 ' 6'. i '' :^,4,147,52q.'...,,• • ! t S r ,E p „ - � .a °Y ks .3 0' ° r . . 1•`..,„ •S. rr, (r7 1y •- `• *"•a ;: ?. � `. • 4. EMPLOYEE RECRUITMENT, SCREENING AND ORIENTATION Care Ambulance Service commits that our program for employee recruitment, screening and ori- entation will enable Care Ambulance Service to consistently and continuously meet and exceed the training standards, personnel requirements and performance expectations set forth in Section V of the RFP. Recruitment: If there were only one function a manager could control to provide high quality ambulance service, it would be recruitment. By starting with only qualified and motivated candi- dates, the remainder of the management process is simplified, allowing management to focus on quality improvement. The majority of our job applicants are experienced EMT personnel, drawn to Care Ambulance Service because of our core values, working conditions, and comprehensive wage and benefits package. Care's recruitment program includes the following: • A full-time manager, Siti Williams, assigned to employee recruitment. • Partnerships with local EMT schools, providing opportunities for EMTs to conduct their clinical experiences with Care Ambulance Service and a commitment to assist the EMT instructors in the classroom during EMT skill practice and testing. It is the policy of Care Ambulance Service to be fair and impartial to all employees and applicants for employment, without regard to race, religion, age, gender, color, national origin, sexual orientation or ancestry. Care Ambulance Service conforms to all applicable federal, state, and local regulations and guidelines guaranteeing equal employment opportunity for all qualified disabled individuals, disabled veterans, and veterans of the Vietnam Era. Screening: Care Ambulance Service EMT candidates are required to complete the following can- didate screening process. This process is very stringent and modeled after the same selection criteria used by local fire departments and law enforcement agencies. • CREDENTIAL VERIFICATION - All EMT candidates are required to submit current proof of a valid and current California EMT certification, an Orange County EMT Provider's License, valid California Driver's License in the proper class and a valid California Ambulance Driver's Certificate with a Medical Examiner's Certificate. EMT personnel must be compliant with all relevant provisions of the California Vehicle Code, Health and Safety Code and all other laws and regulations applicable to ambulance personnel. • DRIVING HISTORY- All EMT candidates must provide a current Department of Motor Vehicles Report of Driving Record. If the EMT candidate is a non - California licensed driver, the candidate must submit a driving record from the state in which the applicant is cur- rently licensed. Any candidate with a poor driving history is not considered for employment. • CRIMINAL HISTORY AND BACKGROUND INVESTIGATION- Care Ambulance Service uses the services of a retired police officer and currently licensed private investigator to conduct a thorough background investigation for prospective EMT employees: • This includes a complete criminal history check, DMV search, reference check with former employers, social security check and credit history check. 27 • • ORAL INTERVIEW- Qualified candidates are invited to an oral interview conducted by our Operations Managers and Field Training Officers. The candidate's prior work history, goals and EMT knowledge are reviewed. • STRENGTH AND FLEXIBILITY TESTING - Strength and flexibility testing is conducted by a licensed physical therapist. The test is done to simulate the physical strength necessary for the position, flexibility, and use of proper lifting techniques. • PHYSICAL EXAMINATIONAND DRUG SCREENING - The final step in the process is a pre - placement medical examination, including a personal health history, vision testing, hearing tests, musculoskeletal evaluation, spinal x -ray and urinalysis drug screening. Orientation : Because a new employee's most important learning takes place, and good work habits develop, during the formal training process, Care Ambulance Service uses a minimum of one hundred and twenty-four (124) hours or an organized structure and rigid training format to ensure all ambulance personnel are sufficiently trained and capable to safely and properly discharge their ser- vice responsibilities. Orientation begins on the first day of employment and ends when scheduled, without interruption. The orientation program is taught by our Field Training Officers who maintain written documenta- tion throughout the process. The program begins with a 30 -hour classroom — didactic program that includes a general overview, OSHA requirements and Policy Manual Review. During the next phase of the orientation process the new EMT is assigned to a Training Coordinator and rides as a third person ride -along in an ambulance. Basic skills are reviewed and tested. Training is continued until the EMT is able to function as a primary partner. The final phase of Care's orientation program is our in -house comprehensive emergency vehicle driver training program. We present the "Emergency Vehicle Operators Course National Standard Curriculum" and "Coaching the Emergency Vehicle Operators" courses. These programs provide the necessary classroom instruction, competency field training, and testing for new and existing drivers. Our program verifies proficiency in the understanding of emergency vehicle driving, as well as the practical application of that knowledge. Employee Alcohol and Drug Testing: Care Ambulance Service enforces an alcohol and drug free workplace policy. Any employee thought to be working under the influence of alcohol or drugs is immediately removed from performing any further duties and sent to our medical clinic for confirmation testing. Care's alcohol and drug testing policy complies with the U.S. Department of Transportation requirements to the extent allowed by law, including "for cause" testing, post - accident investigation testing and pre - employment testing. Care maintains a contract with Quest Diagnostics, Inc. as authorized laboratory certified by the U.S. Department of Transportation, to serve as our alcohol and drug testing program coordinator. • 28 • 5. CONTINUING EDUCATION PROGRAMS Care Ambulance Service has always had a commitment to and a reputation for service excellence. This well deserved reputation can be attributed to the Care Ambulance Service philosophy that employees are our most important asset. We treat employees as valuable customers and give them the tools to be successful. These tools include training and education, and equip the employee to provide exceptional service to external customers. The applicants that make it through the rigorous selection process are assigned to New Employee Orientation. New Employee Orientation provides a combination of education and training that begins in the classroom and finishes in the field with a Field Training Officer. This New Employee Orientation is the foundation for ongoing continuing education. Care Ambulance Service provides continuing education through a variety of venues, described in detail below. Care commits to provide these programs at all times throughout the contract term. • Annual Mandatory Training • On -Line Training • In -House Training • Tailboard Training • Classes on Various Topics • Field Training Officer Meetings ` • Conference Attendance • Management Development Annual Mandatory Training Annual Mandatory Training is a requirement for all field employees. Topics such as Blood and Air- borne Pathogens, Emergency Vehide Operations, Customer Service, Incident Command System, Hazardous Materials, and Patient Care Documentation are covered. Continuing Education credit is given for those subjects that meet the criteria for CE approval. The Ninth Brain Suite (NBS) Online Education et.. Training Tool Care Ambulance Service pays for every field employee to be enrolled in the Ninth Brain on -line ed- ucation program. The Education & Training Tool offers over 100 online CEU /CE courses for EMT personnel. NBS provides a convenient, flexible way of meeting the continuing education require- ments of our EMT employees. Our employees can take the courses when and where it is convenient, whether it be at work, at home, or at any Internet hotspot. Plus, we get the assurance of knowing that all of the courses are nationally accredited through either Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) and the California Board of Registered Nurs- ing. The program is explained to employees in the New Employee Orientation. Each employee is given their personal password to access the program. In House Training There are times when training and education is facilitated in -house by outside providers. Examples of • this are Incident Command System 200 and 300, EMS Basic Supervisory Workshop (Texas A&M), Sex- ual Harassment Prevention and Investigation, Terrorism Awareness, and Emergency Medical Dispatch. 29 El et E i Tailboard Training �� h r ▪ ••..wwr .-w ••••••• w w..... w This is a written informative training update that is distributed to field """'�"""" ""� personnel on a regular basis. It is designed to be a quick, easy read. The ∎ ' '== = == Tailboard Training is very effective to address current issues of interest. "' f. . ::= .. Or_■mr■r•._wl = . w w== M . .w.+ww. wwmrY.rwg1 ` 1.w w ow. Ilaw _e Classes on Various Topics == == =w = Continuing education classes are offered on a variety of subjects. Subjects Ems ,,,:; such as Basic EKG Rhythm Recognition, Pharmacology, and Terrorism rz: � '`� ...ON., Awareness and Response are popular. Many times these classes are fa- .:. %On cilitated by Registered Nurses from the Care Ambulance Specialty Care a . . M ' :114.2." Transport Program. _.._... rr-- :=-..- Field Training Officer Meetings Field Training Officer Meetings are held on a bi- monthly basis. This is an opportunity to meet with all Training Officers at the same time. Each meeting has an agenda and an educational component. Field Training Officers can then share information with field employees. Conference Attendance Operations and Training personnel frequently attend EMS conferences. Any personnel that attend conferences are required to share information that was learned with other employees. Information can be shared in Annual Mandatory Training, CE Classes, Employee Company Meetings, Tailboard 10 Training, or in small informal settings with employees. Management Development The Care Ambulance Service Management Team must provide direction, guidance and leadership to field personnel. To accomplish this it is important that the Management Team is participating in on- going training. Managers and Supervisors attend professional conferences and Iocal training sessions. Some of the local training is public provider agency or hospital facilitated education. Managers from the Operations and Training departments also participate in Article Review. Article Review involves the selection of a business or management article from a relevant source. The artide is then distribut- ed to all managers for review and preparation for discussion. Two (2) weeks after distribution of the article the managers share perspectives and insights on the article. These sessions are valuable learn- ing environments allowing individuals to learn from each other and appreciate different perspectives. Ongoing training and education are important in every job. The dynamics of healthcare requires the healthcare professional to stay current on changes in the delivery of care to patients. • , 30 • • 6. HIPAA TRAINING PROGRAMS Care Ambulance Service believes that compliance with patient privacy issues is an extremely impor- tant standard. In the spring of 2003, Care Ambulance Service developed a training program to meet the requirements of HIPAA and Medicare Compliance. Care Ambulance Service also decided that it would be feasible and cost effective to conduct training on Corporate (Medicare) Compliance and HIPAA policies at the same training sessions. To meet this combined goal a course outline and objectives were created to include: • Ensure regulatory compliance with federal, state and local laws regarding patient privacy and Medicare compliance. • Provide staff with a basic knowledge of patient privacy and Care's policies regarding patient privacy. • Provide staff with skills, knowledge and ability to complete Patient Care Records (PCRs) and provide patients with required privacy notices. • Ensure staff is aware of Care Ambulance Service's Compliance and Privacy Officer. • Provide staff with a basic knowledge of Medicare Compliance. • Ensure staff is aware of Federal Fraud and Abuse Statutes. In summary, HIPAA Compliance and Medicare Compliance training is mandated for every em- ployee and is provided to all new employees, including any new employee who performs services to the Orange County Fire Authority and any contract city. This training is structured to provide Care employees with the necessary information to adequately protect Patient Health Information (PHI) and understand the issues of fraud and abuse. HIPAA Training Program — Implementation of Privacy Act The following represents the key points of HIPAA training that are included in the company wide training that was developed in the Spring of 2003. • History of Privacy Act • Basic Primary Rule • Impact of HIPAA — How each of us are affected by the new regulations. • HIPAA Training Requirements — Who must be trained — Why? • What Must Training Include — workforce training on privacy policies and procedures. • Required Employee Certification. • Enforcement and Penalties — What agency of government is responsible for enforcement and mandatory practices? • Criminal Sanctions — It is extremely important to share this point in training so that staff members will understand and appreciate the need to follow the procedures. • 31 • Salient Points of HIPAA legislation • Overview of Privacy rule • What is Protected Health Information (PHI)? • Permitted uses of PHI • Other permitted Disclosures of PHI such as to Law Enforcement, Family, etc. • Review of "The Minimum Necessary Rule" • Notice of Privacy Procedures • Emergency Treatment Situations • Minors and PHI • Workforce Training Obligation Medicare Compliance Training • Elements of Compliance • Compliance Policies and Procedures • • Education and Training • Monitoring & Review (QA/QI) • Open Lines of Communication 11" • Response to Detected Misconduct • Identification of Compliance Officer • Fraud and Abuse Risks • Keys to Coverage • Medical Necessity • Destination / Origin issues • Non - Emergency Transports • What is bed confined? • Kick backs and inducements The above is representative of the HIPAA and Medicare Compliance training programs at Care Am- bulance Service. These are dynamic programs. Attendee participation is required and at the conclu- sion of training, each participant signs Care's Policy on Confidentiality and Dissemination of Patient Information and Staff Member Verification Certifying Attendance at the Training Session. By the signing the certification, a number of goals are achieved. First, it certifies that the employee attended the training. Secondly, the employee acknowledges that compliance with patient privacy is- sues and Medicare Compliance issues are taken very seriously at Care Ambulance Service. Finally, the employee acknowledges he or she will comply with these important policies and regulations. • 32 • a t ATTACHMENT TAB 9: PERSONNEL AND TRAINING F f Complete Listing of Care's EMT and FTO Personnel i 5 f S 4 • , e • • °8 Ei •1 E i a A co W O 0) O O O O O O O p p� - O O r O O S S S r S 0 O p g p 0 Or r $ T- D O o 0 0 0 0 0 O O 6 Qs p r r 1� gaagiag515 0O QQ0� � O c) QQ :„... „ �� �V MO�r 1 - O) :2 r MMp J i i N i' a r O r r r S r O I N p o N 00 r 5 ai t' C r a r 0l Go I- a QQ ,�, p p� ER pP p WO 11 ci. r r �� ��� � r 2 O OOa� d a • S m °il §1 QQQ gcc °go § Q 0 0 °� o a c o8 o o 0 0 0 a� O $ c w c$ O O rr r 0 ,QQ pp p �p�p��ppO 11 ti a a § §' ' M M c l rrr "A� C7 M MMM M r m '' cococo v) 5; r� r, ii §§14114122§.(44 d§ E Cj 8 0 1 4 m 448411 e e e e e R vm,�, wo ex E Em mcu me c om W e cm 000 oo6Q,0 0 oNoc45o .5o 6egoo=0000 M Q p NCO to J r cha • ' ^ ' J 2 §J g A "' "„ ni 0, _ x 1 , N -- --. „ I t �p p r.- --e4 --[�7� MOO r CI N' -•N li O il OO 0cco ER pcco03 � OO p 400 0 r g '- Cr1 NR 112 gR cCt� 'C`Na�l cctt • O 1tt 1n 0 �- W NNN N F N E 1� Wnlu mEEl mmWni NcAmNmN ° E 3� ' Q g c I c c E� c10>, c c y _ cco E g g. v `° ° 0° Pg yy �0p m C7 — W N Y O rA l0 C C 41 3 ® E 1 - c a � i coa ca m4' 17 al E .Q °"°'�� co ca . °� t E c °gW� v,v v ui �i �� t c m � ca ° _� U ` 4 ai m ea0 a� a� ' ° co >m°3 mw E EEC a .°� cc=E aa aa �� F a a aaa a aaaaJi aaa A! 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F • (E) ITEM 1 0 : DRIVER TRAINING Care's in -house comprehensive emergency vehicle driver program exceeds the performance expecta- tions and requirements set forth in Section V of the RFP. Care's Driver Training programs include the "Emergency Vehicle Operators Course National Standard Curriculum" and "Coaching the Emer- gency Vehicle Operators" courses. These programs provide the necessary classroom instruction, competency field training, and testing for new and existing drivers. Our program verifies proficiency in the understanding of emergency vehide driving, as well as the practical application of that knowledge. Care's driver training program exceeds the performance standards established for the ambulance industry by the National Highway Traffic Safety Administration, Department of Transportation (NHTSA DOT); the National Commission on the Accreditation of Ambulance Services (CAAS); the California State Department of Motor Vehicles; and the California Highway Patrol. Pre-Employment Screening Care's risk management approach to driving safety begins with the insistence on high- caliber person- nel. Care Ambulance requires all ambulance personnel to possess a valid California Driver's License, with all required certifications, and to remain compliant with all provisions of the California Vehicle Code. Care Ambulance performs an extensive background check of all ambulance applicants and ensures that no Care Ambulance drivers have been convicted of or have pled nolo contender to any crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fraud or misde- meanor or felony driving under the influence of alcohol or drugs. Driver Training Program The Care Ambulance driver training program is a three - phased " S r °�� ` �° f` comprehensive instructional based program incorporating: lass- - ' ` N srr"` : r ° Y ' . t_ room Instruction (Phase 1), with a dosed cone- course practice (Phase 2) and supervised on the road practical experience (Phase 3). 1";' l � Students are required to complete a minimum of fifty -six (56) hours • '� of driving instruction. This time may be extended if our trainer de- ; -^ cides more experience or training is necessary before the trainee can operate an emergency ambulance on their own. Phase 1— Classroom Instruction Please 1 consists of eight (8) hours of class instruction and covers the basic components of driving and emergency vehicle operations. The driver trainee is taught low force driving techniques, vehicle dynamics, vehicle code law, due regard and Care's polices and procedures relative to ambulance operations. Specific topics covered in Phase 1 include: backing, lane changes, intersection and skid control, special awareness, following distances, fatigue recognition, on -scene vehicle placement, daily crew responsibilities and operator liabilities. The classroom session includes case -study reviews of actual emergency vehicle collisions and actions that could have been taken to avoid those collisions. The final component of the classroom experience is a fifty (50) question written final. Examinations are submitted to the National Safety Council for independent grading. Phase 2 — Closed Cone Course Upon successful completion of Phase 1, the driver trainee moves to Phase 2, the Closed Cone • 33 ■5- , •,- ° '14 ill )11 ' 1C"C'! -S(e)r. l'ii:47i'll't:(t:''''..1:' 9';'11 ..tic:)0'118.' rt*-s()'' , , ,. , . ,_ ,, . ,.. ,, Z -', .7 i g t - # / o I N,s1„.. 11:,(1-,1t(tell ' . ,t4n: Ri(, .. , r 0 , iltril.:!1•1:1:11111111a(::'titt.';', 1)-e-t°::'/Titlt:r \i'::'1';41t:11-'1, .„1',:,,,,,,,,,:„:„.•,,,,,,,..,..,..t.i' i lt li i ik i l ti S 1(1 : 11 il ,14,1 .....- t Tiler"' . „ , 7 ,,,„'",r,--= 1 a t , ,, ,.,,,,,„ . .....„.... , ., � .r,� � '' 5 z 1 � thr ,." � � d ,„ ,,,, ,, _. w,. m v r .t - ' ,1- •‘ - ' ;‘- --:-"-! "' ' ?1." d 4- py p y:: 1 04. „,.., . , a sE c ' ,;45i:7:1't i'' ' ' '' '' , - ' ' ' ',' -,, 4 , - ,),, 4 . ", „:-,:- I , - i ,, . ; r - p3. 1 i �„ fir ...,,,, d - * ot.-„ ' ,. -_,,,;.-...,;,--f_tit.,),., - ..,p_--,..„... 4-41.,„.$.47.;.;;,....75.,,,,,,„...f7,-,-.....,,-,„.71.-,;:_,,,..1„--- ,,, ., .,..,,, ,,,,, ' 9 ,,,,, ''`,. , ,„-. ,.. ::.,3.: ,,; ("* ._,:i b- 4::-'1)*: 4,it.:,:.':=,i4,4:14.1-!"4„,:tr.7::::/",.,;.;'f-;,:.„:-:::-_,,:-'4,i,'-',"-..,.: ''''':'i::;•:'''''. ''' -‘ ' '' ' ' ' � ss. � 6,, A,/ . ',01* AO '''' r Re(lut"-it ic)r 0 c . , ... ) : \ : 4 11 5.) \1•S it l : ' , 11 : 11: 1 1 : :: t )iv,,, :_ .,,,-- ‘1,......:,,I.11))ttikli' '1 - ' ' - t :' °P9 • • 0 Orange County Fire Authority Request for Proposal For Fire / EMS Emergency Ambulance Transportation And Related Services RFP # JR 1494 Care Ambulance Service. Inc. Insert Bidder Name 1517 W. Braden Court. Orange. CA 92868 Insert Bidder Address Rick W. Richardson C0 - CEO Ogh Insert Bidder Authorized Contact / Representative Signature of Authorized Contact / Representative City of Cypress — EOA #5 City of La Palma — EOA #13 City of Los Alamitos — EOA #14 City of Seal Beach — EOA #21 City of Stanton — EOA #22 (714) 288 -3801 Insert Bidder Telephone P hone December 10.2008 Insert Date of Bid Proposal Submission "COIN" Designate as "Original" or Copy • Binder 6 of 10 Binder Number • III Course. The Closed Cone Course is conducted at Anaheim Stadium, under the watchful eyes of t Care's certified driving instructors. The course consists of eight (8) hours of practice, where trainees hone their driving skills in a controlled environment. During the cone course, trainees are required to safely drive their ambulance through a series of obstacles, such as diminishing lanes, backing, evasive maneuvers, forward and reverse serpentines, . „, controlled braking and turning movements. Trainees are f. •= :) ` "r #” ,�'.:r ' I j* scored on their control of the vehicle and must score one hun- ` ¢ ,�-; ..,,, j dred per (100 %) before proceeding to the next phase. ' • 1 i r �% . ' " Phase 3 — Supervised Practical Road Experience a Driver trainees must successfully complete both Phase 1 and t`= � Phase 2 of Care's driver training program, before being as- signed to work with a Field Training Officer (FTO), in our behind - the -wheel driving experience. Phase 3 is forty (40) i hours of supervised practical road experience in which ? the trainee is paired with a FTO who continues to coach the __»: trainee on an as- needed basis. This behind- the -wheel experi- ence allows trainees to practice their driving skills in Southern California's unique driving environ- ment, enhancing their ability to understand local traffic patterns, road and weather conditions and the reaction of other drivers to emergency vehicles. Road Safety Computer Systems All Care ambulances and supervisor vehicles are equipped with a Road Safety Driving Computer OD System. The same technologies that monitor commercial airline performance dynamics are used to . monitor our drivers' performance. The system works as a full-time, unbiased driving coach, provid- ing an audible warning as our drivers approach an unsafe condition, allowing sufficient time for the driver to take corrective action before an incident occurs. In addition to monitoring driving habits, the Road Safety Computer System provides data that al- lows Care to monitor incidents such as unsafe backings and emergency light and siren activation. All data generated from the Road Safety Computer System becomes a key component of Care's QA/QI process, allowing Care to monitor and provide important feedback to our drivers regarding their vehide operations. Additional Specific Submission Data 1. A detailed course syllabus and curriculum for Care's driver training program has been provided as an Attachment to this section of the proposal. • 2. Care's driver training program consists of a minimum of fifty-six (56) hours of instructor -led education. The program may be extended for trainees that have difficulty mastering a section of the program. 3. Care's three (3) phased training program is described above. Driver training begins approximately three (3) months after an EMT has successfully completed our employee orientation and new- hire training process. Care's Driver Training Program takes approximately two (2) weeks to com- plete. If a driver trainee is unsuccessful in completing the program, remedial training is provided. If still unsuccessful, the trainee is removed from driver trainee status and returned to Ambulance Operations as an Ambulance Attendant. 4. N /A. Care Ambulance conducts all drivers' training in- house. • 34 • CZ i ATTACHMENT TAB 10: DRIVER TRAINING Detailed Course Syllabus and Curriculum for Care's Driver Training Program • • 110 t • PANEL MEMBERS WERE ADVISED NOT TO REVIEW THIS PORTION • • 1 , • . -,, 0 CAR i 1 (,,/ E Ambultince Sentice, In . f Driver Training Manual • • 1 . .,.,-. ..1 t,'..., ' . _ . - _ _ .. - . ' '' i 4 ,..... • . ' i • •• Pt. /....4•5,,,,,,,,,41,,,,,M,rx.15.1. • ,... , " - .... :.".,-".''''. .. -I'-;.%■.,_ ' ,-;"..j ' ',.' ' . . - . 'Tr' '' '2-",':417*1.°! : :-t ; ..'...". -...; P.,, -: . -'1:-•'.."'- _ It7t,':!" __St..1.-.'47"'", , ,,, : .. 4. ir.;.,:. . ,,,...,"A„f ' ' . , ' ' t., . ' ,:":1:; -• , . , -!;"-:•••: . _ . .....i ';•-:*-*--•;''''4;.1;74,- _....._ . . .. ,.. .,,... . - _, • ,-..,,, 1 . . _ ...... .. . . _ . ..... .. - • . '• **) .. .,., ., . ,. 1, „.•• -, ' ' d , • e , .-. 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III 1111 Cone Avoidance 111111' En •..d 1111 1111 E :in on imimin r:�® an ■o • n e ' I -.. 11E1 EEO AEI 111 Cone Avoidance 1111111111:111111111111 Co ' -' SW' IIIII,Mllit MIMI 111111111111111111111111111111111 Control o Vehicle = Shy _ Steers ' 11111111111111111111111111 Mirror Utilization ! Use o Pivot Points Cone Avoidance : ep ;a:6 Itrol o Vehicle iii orzuffie Steering Mirror Utilization ; Use o Pivot Points ��, CaneAvo • . mar■ ®11�'11111111 Control o Vehicle li nu ■■ um Side '1. • • Cushion ■®lm sap gm Use o Pivot Points I II Mirror Unizzation Cone Avoidance 111 „ Control o Vehicle 1111'111111;111111. Mirror Utilization IIIII 1111111111111 11111 Use of Pivot Points MR 11111 ■N EMI Shuffle Steering 111111 111111 11111 111111 Cone A. voidance MO Nom: MR ■N control o Vehicle .111:11111111111 NM Mirror Utilization 1111111111111111111111 —____ Use o Pivot Points 1111111111111111111111 Cone Avoidance 111 1 111111 11111111 111111 Student Signature: OVERALL Lead Instructor Signature: Pass: ❑ FPalk o Range Master Signature: Date: • ____ ..... _ . . . . ___ . . . . _____ ______ _________ . _ ....____. ... . ______ . ,. . 1. Forward /Reverse Three Point • t o v 14' - -o+--- 14' —•o 33' 33' " —4-1 • • - 33' . 0 33' • 0 E . L 33' i.b.".. 1 04 10'-- - 20' 00 0 -- - ' 9` 0 0 0 r ._______ ._ ______. .__ . 0 AO 2. Six Point Turn • , • i 1 . 1 • .. . .1. . . 6 • • . 2' --1 • • - 1 o i o o- o- al- r • • • • • • 1 ‘110 24 0 I o o o o o 1 LIF.4 . • • . • • . . • • • • : • . .. . • • I • 11 - •F;1,z3 1 _ • 0 , . • .. 1 ' L__________ • .. 3. Diminishing Lane / Straight Line Braking . _ 8' 2" o o o . o 1 0 o 00 00 . ... -- 0 0 • ... : - 200' 0 o o 0 . . 0 0 ... ..„ .: e• - 9' 6" . _ .. , • ... . . <..." 0 ... 0 .. 1 i • 4. Controned Braldng and 5. Safe Response to Directions 'CO 0 r--- o All lanes are o o 11'- O"wide 50 , o! i 0 0 S0' • 0 0 0 0 0 0 0 0 50' o o 0 0 0 0 0 0 o 0 0 0 ' • • 50' • O O 00 00 • 0 0 . • 250' o o 0 0 • 0 0 0 0 • • • I • • • • • Trainee Name: Date: Class Room Instructor's Name: Ambulance Driver's License # Expiration Date: Date of Birth: Care Ambulance Driver Training Program / The purpose of the Driver's Training program is to orient andtrain the EMT to safe operation of the ambulance. The training is comprised of two parts. The first part is the classroom and cone course. The second part is the practical application, which requires a minimum of forty (40) hours of behind the wheel training under the guidance of a Field • Training Officer. This practical part of the training also encompasses vehicle check out, and all policies and procedures relevant to vehicle operations. The training is based on the Coaching the Emergency Vehicle Operator (CEVO) curriculum. This is a nationally recognized standard for emergency vehicle operations. Successful completion of all phases of the training is required to allow the EMT to function as an ambulance driver. Driver's 'Raining Completion List CEVO II Classroom Training Date Attended: Ambulance Cone Course Date Completed: Signed Emergency Driving Policy Date Signed: Vehicle Check Out Date Completed: Total Driving Hours (Minimum of 40 hours) Field Training Officer Signature: Date: Field Training Officer Signature: Date: Field Training Officer Signature: Date: Field Training Officer Signature: Date: Trainee Signature: Date: 411 Driver Training / Safety Manager: Date: • The trainee by signing certifies that they have received training in all of the above areas. The Field Training O by signing certifies that the trainee has received instruction in all of these areas • Trainee Name: Date: ( 0 Emergency Driving Policies 1. When driving emergency status, all of the emergency lights and the siren should be operating as reasonably necessary. 2. When parking on scene attempt to park out of any traffic areas. If it is not possible to stay out of traffic lanes, leave emergency lights on. 3. Come to a COMPLETE STOP at all red lights and stop sign intersection and proceed only and with caution, when each lane is clear to pass. 4. When approaching green traffic lights or intersections in which you have the right of way, speed should be reduced sufficient to bring the emergency vehicle to a complete stop if necessary. . 5. Vehicles are to be driven at a safe speed. At no time should an ambulance exceed a speed of 10 miles an hour over the posted speed limit. This speed is to be reduce as road and weather conditions may warrant. 6. At no time should one emergency vehicle pass another going the same direction while running emergency. Follow at a safe distance (at least 300 feet) and alter siren IP siren tone in order to alert traffic of the presence of additional emergency vehicles. 7. An ambulance must stop for a school bus when it is displaying it's red lights. Proceed only when waved past by the driver or the red flashers are turned off. 8. When driving on an emergency call, remain in the lane. Passing on the right is dangerous due to cars yielding for the siren. 9. Do not force uncooperative or inattentive drivers to yield by tailgating, swerving or manipulating in any other unsafe manner. Remember safe following distance and your rate of closure. 10. Do not drive in or over medians unless utilizing an established and marked tum around. 11. Do not cross private property or parking lots as a short cut. 12. At no time will any Care Ambulance Service vehicle escort any other emergency vehicle. 13. When parking at the scene of an accident / fire you shall park at the direction of the police / fire officer. In the absence of their direction you may park in a manner as to not impede traffic, investigation, or execution of fire / police personnel in the performance or their job and park as to provide the optimum safety of the patients and responding ambulance crews. • • Employee Signature: Date: Training Officer Signature: Date: • • CARS • AMBW.ANCE SERVICE; INC. Trainee Name: Ambulance Driver's License Number.' Expiration Date: Driving Hours Log Trainee must complete a minimum of 40 hours of vehicle operation instructions. Date Hours Comments Print FTO Name • • Total Hours Completed: Comments: • • ( AMBULANCE SERVICE: liVo. Initial Driver Vehicle Check Out • Vehkk Operator: Date: Instructor: Shfft: Operating Area: Vehick # Emergency Lights W'md.thield / Wipers /Blades Tire Pressure Doors /Compartments Directional Signals Body Damage Standard Mirror / Convex Visible Fluid Under Vehicle Road Safety Computer Road , S aker Fluid Levels Belts Hoses Batt Cable • • - Page 2 AMBULANCE SERVICE. INC. Key FOB Port � ��� Off Battery Cut Emergency Switches -= Display Gauges /Siren Dispatch Radio Interior Lights Mirror /Seat Adjustments Safety Belt - -� Wait To Start - -1111111111101 Maps /Districts - - -� Flash Li ht - -- • YES onnsd NO = Not P., omved NZ.. Needs 1. - revelment N.A. Not , - . :. le Directions • Please hand in this form to your appointed FTO at the beginning of your training shift. Receiving FTO • At this time the above named trainee has successfully completed their initial driver check - out. Please add this form to your daily paperwork and reference as necessary. • Vehicle • . rater Si: - e Initial Instructor Si: - ure Daily Driver Eva !Emden Form page 1 • MINIS Vehicle Operator: Instructor: Vehicle #: Shift: AMBULANCE SERVICE INC. Operating Area: Date: • Complies views:pony vehide safety policy 0 I 2 MBA 4 • Complies uut`.4 traffic safety codes 0 MM. 1 3 4 Complies wlmonitoring system 0 1 2 3 . 4 Demonstrates' CEVO standar& 0 1 1 3 4 • Complies mlintersection procedures 0 I 2 1 4 Approved warnbtg tones (wail/pip) 0 I 2 3 4 Appropriate decision making 0 1 2 3 4 Complies nVloed freeway procedures 0 I 2 3 4 • Demonstrates Das - , ' 0 1 2 3 4 , . . , • Adequate foilowing distance 04 seconds) 0 1 2 3 4 Aware ofside space cushion 0 1 2 3 4 Appropriate mirror use and scanning 0 1 2 3 maim • Bacla up safirly & accordbig to policy 0 / 2 3 4 IIII4S ' • • , use o turn si,, • adttal lane chan 0 1 2 3 4 Fully engage •E"' brake 0 1 2 3 4 Place transmission in "P" 0 I 2 3 4 Park bt secure area 0 1 2 3 4 . Pre-deterstined nit route 0 1 2 3 4 Lock 1 seaav vehicle 0 1 2 3 4 Consistently provides smooth transports 0 1 . 2 3 4 • A4ust driving per pt. Condition 0 1 2 3 4 • , • • . • to most • !...•_c., • lam Hos • hal _ 0 1 2 3 4 • Utilizes Thomas Guide/ district maps effidently 0 I 2 3 4 Locates calls accurately and timely 0 1 2 3 4 0 • Knowledge ofresponze area 0 1 I . , i - ... • •,, as , H • - or streets WM/ 3 masa 0 maim 2 3 Illiriiii • • Daily Driver Evaluation form page 2 i - CRE Vehicle Operator: Vehicle #: ' AMBULANCE sEnwc.. INC Instructor: Shift: ( Operating Area: Date: Totals = 0 l 2 3 0 - 51= May not operate vehicles Consistently below Ertarded Meets or exceeds Standard Standard 52 - 77 = Must successfully complete an action 0- 51 52 - 77 78 - 104 Ian for improvement. Must notify and receive approval from local Training Manager. Total student points: III 78 -104 = Meets or exceeds standards Cleared to operate company vehicles student signature: • Items will require a 3 or above in order to s thatskill Instructor Signature: • • • • • • Daily Driver Evaluation Form page 1 • CI ME Vehicle Operator: Vehicle #: Instructor: - Shi ft: AMBULANCE SERVICE. INC Operating Area: Date: • Complies wkompanyvehick safety policy 0 1 2 1 4 • Complies %0C4 traffic safety codes 0 1 MUNI 3 4 Complies whnonitoring system 0 1 1 3 4 Demonstrates CEVO standards 0 1 Mal 3 4 IiiiMINIMOMIIIIIIIIIIIIIIIIIIIIIIIIIIII1111111111111111111111111.111111111............ • Complies Iv/Intersection procedures 0 12 3 4 . -proved warning tones (wail/yelp) 0 1 1 3 4 - propriate decision making 0 1 1 3 4 Complies w/local freeway procedures 0 1 2 3 4 ' • Demonstrates Due ' - ard 0 1 2 3 4 • Adequate foilosving distance (4-5 seconds) 0 1 2 3 4 Aware of side space cushion 0 1 2 3 4 ' Appropriate mirror use and scanning 0 1 1 3 4 03 Backs up safely & according to policy 0 1 NEM 3 4 sae o turns als _, adual lane - - e 0 1 2 3 4 Fully engage "E" brake 0 1 1 3 4 Place transmission in "P" 0 1 2 3 4 Park in secure area 0 1 2 3 4 Pre-determined eth route 0 1 1 3 4 Lock/ secure vehicle 0 1 2 3 4 N1111111111111111111111111111111111111.1111111111.1........................ Consistently provider smooth transports 0 1 2 3 4 • Asflust drkkg per pt Condition 0 1 2 3 NIWNII • i ). - - , to most , : ,, , „ A l, , late H. , ital 0 1 2 3 4 m....m.m.m.....mm...m...m...............__._____.___ 11.11.IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIINIIIIIIIMIIIIIIIIIIIIMMIIIIIIIMIIIIIMIIII III -----.................. . , .. ,,„,,,,, n........mll=IIIIIIIIIIIIIIIIIIIIIIIIIMIIIMMIIIIIII • Utilises Thonsas Go*/ district maps eider* 0 1 2 3 Locales calls accrete& and timely 0 WM 2 3 4 CA • Knowledge ((response area 0 1 2 3 4 tii00 t . , -, ts. Ho,. tals, ma or streets 0 1 2 3 4 • • • - Daily Driver Evaluation forms Page 2 mires Vehicle Operator: Vehicle #: Instructor: SW: tieliZANceBEI/fcE. IN Operating Area: Date: r - Totals am 0 1 2 3 4 Q - 51 = May not operate vehicles Consistently below Extended Meets or moods Standard Standard Sat - 77 = Must successfully complete an action 0- 51 52 - 77 78 - 104 plan for improvement. Must notify and receive approval from local Training Manager. Taal stuff points: 78 - 104 = Meets or exceeds standards. Cleared to operate company vehicles. Student Signature: • Items will require a 3 or above in order to pass that skill. lnstniaor Signature: a • Daily Evaluation Form pap 1 II gi/Apas Vehicle Oper Vehicle #: Instructor: Shift: :41maiii.Ame..E serance INC: Operating Area: Date: • Complies wlcompany vehide safety policy 0 1 2 3 4 • Complies w1CA traffic safety codes 0 1 2 3 4 Complies whnonitoring system 0 I 2 3 4 Demonstrates CEVO standards 0 I 1 3 4 • • Complies to/Intersection procedures 0 1 2 3 4 Approved warning tones (waillyelp) 0 MM. RIE1111111111111111 4 Appropriate decision making 0 1 2 3 11111211 Complies w/local freeway procedures 0 1 2 3 4 • Demonstrates Due R . , d 0 Niiiiiillilliffailigign. 4 Adequate following distance (4-5 seconds) 0 I 1 3 4 Aware ofside space cushion 0 I 1 3 4 , propriate mirror use and scanning 0 1 2 3 4 Backs up safely & according to policy 0 1 2 3 4 l ikg ' , , , use , turn al ., als . adual lane cha e 0 3 MUNI 3 4 FOY totliotte "E brake 0 1 2 3 4 Place transmission In 7" 0 1 2 111111111/115.1 • Pork in secure area 0 1 2 3 4 Pre-detenitined erit route 0 1 2 3 4 Lack/ soave veldde 0 1 2 3 4 Consistently provides smooth transports 0 1 2 .3 4 • Must driving per pt. Condition 0 1 2 3 4 • to man . , :AL , late Hos ital 0 1 2 3 WW1 • (lakes Thomas Guide/ &Irks 'naps eificiere0 0 1 2 3 4 Locates calk accurately and finely 0 1 2 3 4 ?..,,.. ...,;11 • Knowledge of response area 0 1 1 3 4 Vi- 1— , — , . H , Itak I ft . streets 0 1 2 11111.iiiirill • • • Daily Driver Evaluation form Page 2 J , Veldde Operator: Vebide Shi : ( hector: ACE. t Operating Area Date: Totals = 0 1 2 3 4 0 - 51 = May not operate vehicles ConsWuendy blow Emended Meets Of axcseda Standard Standard 52 - 77 = Must successfully complete an action 0 - sl 52 - 77 78 - 104 • lan for improvement. Must notify and receive approval from local Training Manager. Total student points: 11111 78 -104 = Meets or exceeds standards. Cleared to operate company vehicles Student Signature: • Items will require a 3 or above in order to • • s that skill. Instructor Sign lure: 4 • • A tlN • • • Daily Driver Evaluation Form Page 1 • - CARE Vehicle Operator: Vehicle #: , ...-..• Instructor: Shift: ( ,,,L, • :44BUL4NCE SERVICE. wc. Operating Area: Date: • Complier iv/company vehide safety policy 0 1 WM 3 4 • Complies w/C4 traffic safety coda 0 1 2 3 4 Complies utinonitoring system 0 111111111111111 2 =B. 4 Demonstraa CEVO standardt 0 1 2 3 4 • Complia wlintersealon procedures 0 1 2 giffilliellirM pproved warning tones (wail/yelp) 0 1 2 3 4 . • , • late decision making 0 1 2 MOO 4 Complies wilocal freeway procedures 0 1 2 3 4 • Demonstrates Due • d 0 gillgaillifilli 3 garilli • Adequate following distance (4-3 seconds) 0 MEM 2 3 4 Aware ofside space cushion 0 1 2 3 4 . ppropriate mirror use and scanning 0 1 2 3 - B ria .....-;r:, ach up sa fely & according to policy 0 1 2 3 4 . ,... use , teen 0 , els , actual lane char 0 1 2 3 4 Filly mgAge "L"' brake 0 1 2 3 4 Place trauntission in "P" 0 1 2 3 4 Park In snare area 0 I 2 3 4 Pre-determined exit route 0 1 2 3 4 Lock/ secure vehide 0 1 2 3 4 Consistently provides smooth mports 0 1 2 3 4 • Adjust driving per pt. Condition 0 1 2 3 4 • • • • • • to most • !...•.„ e, • • e 1 1 •-• ital 0 1 2 3 4 • ' • , • Utilises Thomas Guide/ district maps efficiently 0 1 2 3 4 Locates adir accurately and timely 0 1 1 3 4 a • Knowledge of raponse area 0 1 2 3 4 1. ■ • - - 11 . air m • • streets 0 1 2 111113.11 4 • • Daily Driver Evaluation form page 2' Vehicle Operator: Vehicle #: z _ gArea . Totals 0 1 2 2 Q - 51= May not operate vehicles Consistent" below Extended Moots or exceeds Standard Standard 52 - 77 = Must successf dly complete an action 8 - St 52 - » - 78.104 plan for improvement. Must notify and receive approval from local ?raining Manager. Toot student panes: - 78 -104 = Meets or exceeds standards. Cleared to operate company vehicles Student Sigma • Items will require a 3 or above in order to pass that skill. lratrnrator Signature: • • a • • Daily Driver Evaluation Ferns Pagel • ' Vehicle Operator: Vehicle it: _ • Wa Instructor: Sh$: • ( ( E 'AMBULANCE Sagi ' NC:* Operating Area: Date: • Comphis whsompany vehicle safety policy 0 1 2 3 4 • Complies iss/CA tree safety codes 0 1 2 3 4 Complies whnonftering *awn 0 1 2 3 4 Demonstrates CEVO standards 0 1 Mini 3 4 • • Caaplies la/Intersection proem:byes 0 1 2 3 4 wailing tones (wag/yelp) 0 I 2 3 4 Appropriate decision making 0 1 2 3 4 Complies w4ocal freeway procedures 0 gliffilli 2 3 MOM • Demonstrates Due • d 0 1 2 3 4 • Adequate follow's,* distance (4-5 seconds) 0 1 2 3 4 ware ofside space =Won 0 1 2 3 4 A B ppropriate mirror use and scanning 0 1 2 3 4 ads up safely & according to policy 0 1 2 3 4 ea • .... use • turn s als • &aflame - - , 0 1 filifiNEWIffitailifiiiii Filly engage "E'' brake 0 1 2 3 4 Place transmission in "P" 0 1 2 3 4 Park by sear, area 0 1 2 3 4 Pre-detennbsed ath rode 0 1 2 I MIMI Lock I secure veldcle 0 1 2 3 4 Consistently provides snoods transports 0 1 2 3 4 • Adjust driving per pt. Condidon 0 1 2 3 4 • , • , • , , , to most • ,, ., a , c ,, ate H. , bat 0 1 2 iliffraillillnill • Utilises Thomas Guide/ sharks maps didendy 0 1 2 3 4 Locates calls accurately and shady 0 1 2 3 4 • Knowledge of response area 0 I 2 3 4 i) - I • - ,, - : „.:_k_ Hos , , alt. m' , streets 0 1 2 3 4 . II • Daily Driver Evaluation form ' page 2 Vehicle Operator: Vehicle #: C 1 saaawra. [ma Instructor: Ste: Operating Area: Date: Totals = 0 1 2 .1 4 0 - S1= May not operate vehicles Consistently glow Extended U..tv orszcseds Standard Standard ,52 - 77 = Must successfully complete an action 0 - st _ 52 - n 78 104 plan for improvement. Must notify and receive approval from local Training Manager. Total student points: EN 78 -104 = Meets or exceeds standards. Cleared to operate company vehicles. Student Signature: • Items will require a 3 or above in order to pass that skill. Instructor Signature: • • Daily Driver Evaluation Form Page 1 0 Vehicle Operator: Vehicle #: 1:41111 I i 1 Ii 1 E Instructor: Shit • ( ,, f.' 11• ° :oessznAtaza isartvitie. ma v4 ) Operating Area Date: • Complies w/companyvehiek safety policy 0 1 2 3 4 • Complies w/CA traffic sarfety codes 0 1 2 3 4 Complies whnonitoring system 0 1 2 3 4 Demonstrates CUD standards 0 1 2 3 4 • Complks w/intersection procedures 0 1 2 3 4 Approved warning tones (wail/yelp) 0 1 2 3 4 Appropriate decision mating 0 011E1111111 2 3 4 Complies milocal freeway procedures 0 1 2 3 4 • Demonstrate s Due . .- • 0 1 2 3 4 . • Adequate followbqg distance (4-5 seconds) 0 1 2 3 4 Aware qf side space cushion 0 1 2 3 4 Appropriate mkror sue and scanning 0 1 2 3 MM. o r, Backs up safely & awarding to policy 0 1 2 3 4 0,310 Pro • .• um • turn 11 - - .• *dual km - 0 1 2 3 4 • Fully engage V" brake 0 1 2 3 4 Place transmission in •P• 0 1 2 3 4 Park in secure area 0 Mr= 2 1 4 Pre-de:enabled exit route 0 1 2 3 4 Lock / scare vehicle 0 1 2 3 4 Consistently provides .ustooth trtuaspons 0 1 2 3 4 . • Atgrat detain g per pt Condition 0 1 2 3 4 • Tr • •• • • • to most • • L A , • ate Hos • hal 0 1 2 3 4 • • Utilises Thomas Guide/ &aria limps efficiently 0 1 2 9 4 Locates calls accurately and timely 0 1 2 3 4 - 0 • Knowledge of response area 0 1 2 MEM 4 1 • .• • ' es • • • , H • Atals a t• or strum 0 1 2 3 4 • • • 1 Daily Driver Evaluation form page 2 Vehicle Operator: Vehicle #: k. Amematoe SERVICE. tiva' Operating Area: Date: Totals = 0 1 2 3 4 9- 51 = May not operate vehicles Consistently below £treaded Heats or exceeds Standard Standard 2 - 77 = Must successfully complete an action 0- 51 _ 52 - 77 78.104 plan for improvement. Must notify and receive approval from local Training Manager. Total student points: 78 -104 = Meets or exceeds standards Cleared to operate company vehicles. Student Signature: • Items will require a 3 or above in order to pass that skill. luoua„r Sig Qa • • • • • CAIRE AMBULANCE SERVICE, INC. (. DRIVER FINAL CLEARANCE • NEW OPERATOR As a member of Care Ambulance Service, I , agree t abide by and uphold the policies, procedures and instructions as they pertain to safe ambulance operation. These standards and maneuvers ensure the safety of our crews, patients and the public we serve. I understand that, while operating an ambulance, 1 must adhere to the policies and procedures outlined in the Care Ambulance Service employee hand book at all times. Failure to follow these standards and maneuvers may result in loss of driver status up to and including discharge from the Company. At this time I accept the responsibility placed upon me as an ambulance operator for . Care Ambulance Service. The signatures below confirm my ability to safely maneuver these vehicles in accordance with state and local laws goveming ambulance operation. All questions regarding safe vehicle operation were reviewed with me by a Care Field Training Officer and /or management staff. Print Name ( New Operator) Signature Date INSTRUCTOR VERIFICATION The operator named above has successfully demonstrated the minimum requirements necessary to operate company vehicles safely as outlined in the Care Ambulance Service employee hand book. At this time 1 feel confident in this employee's ability to operate Care ambulances in accordance with state and local laws governing ambulance operation. My signature below confirms all associated paperwork is complete and driver status is granted at this time. • FTO Print Name FTO Signature t o k Date Driver Training / Safety Manager o • Care Ambulance Education/Training Department I (( Action Plan for Improvement Employee/Trainee: Date: Education/Trainee Dept. Representative: . 0 New Employee/Trainee 0 Existing Employee In Training Remedial Training Total number of shifts Evaluated Performance Issue(s): Was the above communicated to the employee? Yes 0 No 0 Have Care Field Performance Standards been made clear? Yes 0 No 0 Check for employee understanding and discussion? Yes 0 No 0 Plan for Improvement: Solicit the employee involvement in the plan for improvement. What are 0 his/her Ideas and thoughts on how they can improve their performance. If the employee presents some good ideas, include the ideas in the plan. • • 2 • ( '® Employee Ideas: Action Plan: (Include all aspects of the plan: didactic, psychomotor, etc) IP Exi ected Results: • 3 ( � The objective of a plan for improvement is to provide every opportunity for the employee to improve performance and succeed in meeting all company standards. Standards do not change and are the same for everybody. Have the expected results been discussed with the trainee? Yes 0 No ❑ Have you discussed some of the trainee stronger points? Yes 0 No 0 Does the trainee have a clear understanding of this plan? Yes 0 No 0 Check for Understanding, have trainee repeat back what they need to do, to reach the Goal for this Action Plan. 4 Please notify the appropriate Training Manager of the Action Plan for Improvement. Date of notification / / Manager notified Education/Training Dept. Representative Signature: Date: / / Employee/Trainee Signature: Date: / / Witness: Date: / / • • • ( CO ASPECTS OF LAW TYPES OF REGULATIONS (Power Point) These will help you to know how laws work, which law applies to a given situation and when you are exempt from doing what the law says to do. Constitutional Law: Written, Federal laws. Good in all states. Protects person's privacy. These laws explain patients' rights before, during and after transport. . Ex: All automobiles must have working brake lights, 140 headlights, turn signals and working restraint systems. Statutory Laws: Government or State written laws. Come from legislative acts. Vary from state to state. Ex: CA- must have seatbelts on while car is in operation. Ex: CA- Went from 4/40 to 6/60 child restraint system. Ex: CA- NO passengers in the bed of a truck unless restrained, this is not so in AZ. STATE LAW= WHAT IS ALLOWED DUE REGARD = HOW TO DO IT ( 0 • 1 • (S Ordinances: Written laws for Cities, Counties or Municipalities. Generally made because someone did something stupid or something big happened which injured or destroyed a large amount. Any law can be enacted so long as it doesn't violate State or Federal Law. Ex: Rancho- NO code -3 in the neighborhood around operations and other comfort stations. Ex: Some housing associations, NO painting the outside of houses unless they fall under certain color schemes. Ex: NO fireworks in certain places - too many houses burned Ile one year. Policies / Procedures :. Company Rules / Regulations, Standard Operating Procedures. These are intended to provide more information about Statutory laws. These supercede all other laws. Should include and must NOT contradict State, Federal or Local Laws. Generally stricter penalties if broken. Ex: State of CA allows 15 mph over posted speed limit when code -3, however Care Ambulance Service is 10 mph over. State law will not help you if you are caught going over 15 even though it allows it..... must include but not contradict. .Instructor Note • 2 • c• 6: Due Regard LAW OF DUE REGARD A reasonably careful person, performing similar duties and under similar circumstances, would act in the same manner. The Law of Due Regard says that "a reasonably careful person, performing similar duties and under similar circumstances, would act in the same manner." 11 0° This means that you must drive your ambulance with due regard for the safety of your passengers and patients, and all other persons and drivers using the streets, highways, and freeways, and to protect them from the consequences of your actions when operating your ambulance. As you can see, due regard is not a hard and fast rule, such as "the speed limit is 55 mph." Instead, it requires that the courts look at each crash and determine if the ambulance operator was abiding by the law of due regard at the time a traffic crash occurred. To do so, they must get answers to questions like the following: ' Module A Ambulance operation: The Basics LIP . • 3 • (.10 Was it necessary to use the emergency warning system under the circumstances of the call you were responding to and the medical condition of the patient you were transporting? Did the ambulance operator give enough warning of the vehicle's approach to allow other motorists and pedestrians to clear the way for the ambulance? Was the emergency warning system activated and operating. prior to the crash? IP Was the ambulance operator using the emergency warning system in the manner for which the system was designed to be used? Was the operator of the ambulance operating the vehicle at "a speed greater than necessary to allow the complete control of the ambulance in relation to traffic, road, and weather conditions? As you can see, your performance as the operator is going to be closely looked at in relation to the nature of the emergency and the traffic, road, and weather conditions. With a law such as this, rules cannot be 0 written that cover all situations. • 4 • (, The National Voluntary Consensus Standard The standards have used the ASTM guideline as a reference. The. standards for controlled intersection management during emergency response mode are- - Insbnxxor(3uide 8-14 Module A Ambulance Operation: The Basics NEGLIGENCE: Any action which violates a standard of practice or care. A careless act while performing a duty. 411 Basically the operator should have done something differently or something was done incorrectly and as a result a person was injured or killed or property became damaged. Q: How many of you have been pulled over for speeding? A: Did you know that this is a form of negligence. • Simple Negligence: Failure to conform to a reasonable standard. Ex: Simply going to fast (simpl)i speeding). 4 0 Ex: Runnin a sto si in ' ' ' • Running stop sign an unfamiliar neighborhood. 5 • , r Ex: Changing a lane without signaling. (All are examples of Simple Negligence if done only once and no repetition had taken place) Now if you see an intersection is clear and you decide to CA stop, that was thought about (premeditated) and still done - we now go from Simple Negligence to Gross Negligence. • • Gross Negligence: Involved in an action when injury is likely to occur. Ex: Excessive lane changes at a high rate of speed. k b Ex: A driver on the I -5 cuts from the #1 lane to the off ramp in about 5 seconds. (Bad- need a 12- second lane change per lane ). Ex: On a 2 -lane highway - passing 3 cars over a double yellow. Thought about it and did it. You can not pass more than one car at a time on a broken line, and none over a double yellow line. Now if you decide to do rapid lane changes with excessive speed, while running stop signs, above 70 mph, you are now considered operating via Reckless Behavior. Reckless Behavior: 0 . • 6 • ( ® Even further removed from a reasonable standard. A conscious decision to do so repeatedly, when injury or death is likely to occur. Ex: Anything that will be seen as jeopardizing life or limb to any person (passengers or pedestrians). Ex: Illegal street racing Ex: Operating a vehicle while ETOH or use of Drugs (can include prescription or over the counter medications as well). . 4t41. Ex: Failure to stop for a railroad crossing. Ex: Failure to stop when involved in an accident. Recently a unit was enroute to a call, with the fire department following behind them, the unit was involved in an accident. The fire squad told the unit to continue on the call and they would take care of the accident. This is considered to be a hit and run incident. The outcome of this situation is still pending. (All considered Reckless Behavior and can be charged with criminal behavior - Manslaughter conviction possible. Also you can receive up to 90 days in jail for any action which causes just a slight injury. IP- • ® To avoid Negligence issues; keep in mind these 3 things: 1. Do you have a duty to act? 2. What must I do to avoid a breach of duty? 3. How can I avoid other's suffering injury or loss to my duty? LIABILITY: Who's responsible for what has happened? Direct Liability: Liable for one's own actions. It* Ex: A fight at the bar - one on one. Ex: (far- fetched) You go to 7 -11 for a slurpee and the machine is broken, you get mad at the clerk and decide to beat him up - you are liable for your own actions. (Basically things that happen on a one on one nature) Vicarious Liability: Where you are responsible for the actions of someone else. Q: Do we have any FTO's or Preceptors in here? A: This is where you really need to pay attention. 0 Ex: Partner decides to go Code -3 on a transport that is • 8 • (i not deemed medically necessary, and patient man says nothing about it nor tries to stop it, patient man is Vicariously Liable if something happens. Ex: FTO doesn't stop the new hire from going over 70 mph - crash / injury occurs, FTO is Vicariously Liable. Ex: Driver runs a stop sign, crashes and kills someone, you are Vicariously Liable due to the fact you are supposed to be scanning for traffic signals / signs and autos that your partner may not see. Municipal Liability: lita Q: What is a municipality? A: That isCare, Co. Fire, PD, etc.. This is where the Company is held liable for the actions of their employee, if employee causes injury / death and is within Policy, Custom or Practice. Ex: If you cause an accident / injury they will go for the deep pockets, Company doesn't want to pay. Co. will see if you broke a "LAW" ignored a "NEGLECT" or failed to follow a "POLICY, CUSTOM or PRACTICE. 0 4D 9 • ,/® Policy: Written law for the company. Custom: Something that is taught, generally done (shut down in an area). Practice: Done by practice, haven't enacted a policy to stop the action IP This is where you loose your toys, cars, homes, 401K, • savings, and families.. Your Liability will also be judged by determining whether or not a "True Emergency" existed. A True Emergency: Involves a high possibility of death or serious injury to an individual and actions by the operator will reduce the seriousness of the situation. These are the points that will be used to determine if there was a true emergency: 0 • 10 i • ;C® 1. Is there a high probability of death or serious injury to the pt. 2. Will my actions reduce the seriousness of the incident? The Law of Due Regard: (2 -7) (Overhead) A reasonably careful person, performing similar duties under similar circumstances would act in the same manner. ADD: with similar training (after similar circumstances). 4106 EX. A pregnant female goes down in a shopping center; she is bent over in pain. A "Ricky Rescue" EMT, who overzealously watches ER & Chicago Hope, finds the lady is in active labor with Limb Presentation. . -He . performs a field C- section to save the baby, but in turn he kills the mother. - He acted out of Due Regard and out of Scope of Practice. EX DRIVING: Code -3 when not necessary. Lights with NO siren. Any type of driving that breaks CA State Law and or company policy or Procedure. 0 0 11 • ' (0 Once involved in an accident, the court will judge your actions according to this principal. To determine if "Due Regard" was used these guidelines will be used: 1: Was code -3 necessary for circumstances and pt. Condition? 2: Was enough warning given for approaching cars? . 3 : Was warning system activated and operating? 4: Was warning system used in manner it was designed for? 5: Was operator driving a higher speed necessary to Ile allow complete control of the ambulance with road, weather and traffic conditions? A funny reminder of your "All -or- nothing" (proper warning system utilization) necessity; there was once a case where a drunk driver backed down a driveway right into an ambulance. The ambulance had its lights on but NO siren. The drunk driver got a settlement for the accident due to the illegal code -s operation. SHOCK THE CONCIOUS: (of a reasonable person) This protects agencies against liability . for actions of employees. - Basically, someone did something wrong and someone 0 got hurt. • 12 • (• - Individual acted out of standards of training causing injury / death. - Training must reflect the expectation of the public. - A case is reviewed to see if individuals were acting within Policy, Custom and Practice. Ex :. (far- fetched) PD shoots a jaywalker - not taught in academy, not written policy, and not general practice among other police departments. Ex: (Lewis vs. Sacramento)- PD is NOT to chase motorcycles in high -speed pursuits. PD chases a motorcycle - fleeing arrest at speeds above 90 mph with passenger on board. Driver goes over a blind 0 hill, parks the bike, gets off and runs on foot. PD comes over the same blind hill, and strikes the bike - killing the passenger. The officer - broke policy, custom and practice and had training and policies against such actions. The officer was held liable for his actions. Since there had been training, and was not custom, policy or practice, he Shocked the Conscious. DELIBERATE INDIFFERENCE: To purposely disregard your duties. You can be held liable by the courts if the job you are obligated to do is not done to the fullest extent. To deliberately disregard constitutional, statutory, ordinances, or policy and procedures. 0 • 13 • (• Company uses this to see if you did something out of the training you've been 'given. Ex: (Gardner V's Tennessee)- A hospital accepted an ICU patient for transport to their facility and they had NO ICU beds available. They put the pt. in a step down unit. The pt. died. The hospital is liable due to neglect and deliberately braking their obligation to pt. care. Ex: State of Florida - An electric company contracted electrician built a bus bench with overhang lighting. A boy ended up being electrocuted by the bench. The electric company was charged due to the fact they used an employee that had an expired license. BEFORE VIDEO: Think twice about what you have and what you want in life. • Think about it every time you get in your POV or your ambulance. Remember how much you love all your toys, home, family ect... that you may loose by braking Due Regard or Neglect. You're about to see a video about • 14 • (4 An attendant who was found culpable because policy dictated that attendant chooses Code -2 or Code -3 for transport, and he didn't attempt to stop the actions of his partner. An example of Vicarious Liability. A man who went to prison for trying to do his job in a way all of us have tried on a day that all of us have experienced but was convicted for braking Due Regard. AFTER VIDEO: Now you have seen what happened to the three men on 0 the video. That is what I encourage you to ponder every time you are driving a motor vehicle cle (personal or . company). IN SHORT - PAY ATTENTION - UNLESS YOU HAVE A FEW YEARS AND A LOT OF MONEY TO TBROW AWAY! ! ! • 0 • 15 TAB 11 1 611 i t • • ITEM 1 1 : INTERNAL MEDICAL QUALITY CONTROL Excellence in customer service requires a commitment and systems in place to allow continuous evaluation and improvement. Continuous Quality Improvement (CQI) is the process that meets this need. Care's Internal Medical Quality Control and Continuous Quality Control Programs are in place today and exceed all established standards, requirements and performance expectations set forth in Section IV of the RFP. Our CQI processes are incorporated throughout our organization, from the traditional clinical ap- plication, to our communications center and fleet maintenance facility, to our billing office and our relationships with external providers and oversight agencies. The Care Ambulance Service Quality Assurance/Quality Improvement Manager, Chris Wilson, is responsible for the overall management of Care's Quality Improvement Program. While it is called a program, it is really a philosophy that is embedded in the fiber of every part of our organization. Quality is just a word until the people in an organization give it meaning. At Care Ambulance, qual- ity is the responsibility and commitment of every employee. 1. Description of Care's "CQI" Process An effective CQI program must provide the education, resources and support staff needed to provide 41IP quality service and outstanding patient care. This is best accomplished through observation, review, discussion and exchange of ideas when areas for improvement are identified. These components are found in Care's CQI process in the following distinct but connected phases: Prospective — This phase includes employee recruitment, employee screening and selection, writ- ten protocols, operational policies and employee orientation. Care Ambulance has a comprehensive set of policies that address clinical, safety and operational issues, as wells as performance expectations for all personnel. Policies are updated and distributed to all employees as needed to stay current with new laws, industry standards and EMS Agency guidelines. Employee selection and screening is a part of prospective quality assurance. It is critically important to be able to recognize and choose the right personnel when they apply. EMT candidates are required to pass several rigorous tests before employment is given to them. These tests include a written EMT knowledge test, EMT skills testing, oral interview, strength and flexibility testing, medical examination and drug screening test and a complete background check conducted by a licensed private investigator. As part of the prospective phase new employees are assigned to New Employee Orientation. All employees receive a large amount of education and training to create their personal foundation for delivering exceptional service. Each class has a pre- sentation on Customer Service and Quality Improvement. These presentations ensure that all Care employees understand the importance, concepts, and the expectations in both of these areas. Concurrent The concurrent phase of the quality process encompasses the delivery of service and patient care. It focuses on monitoring of performance and application of procedures. The Operations • Managers are the primary resource for this evaluation. The Care Ambulance Operations Managers are actively engaging with field employees, public safety personnel, and facility staff. During this 35 interaction, the Operations Managers are observing patient care and crew interpersonal skills with other members of the patient care team. The concurrent evaluation provides the environment for al- most immediate feedback on job performance. The concurrent evaluation is where many exceptional performances are recognized. The real time aspect of concurrent evaluation allows issues or concerns to be identified and addressed immediately. Quality improvement is ongoing and does not need to wait for the end of month report. Operational changes to improve system performance can be implemented quickly when organizations are committed to quality. Care Ambulance, through a variety of mechanisms, has the ability to notify employees of changes that are then put into practice. These immediate changes are approved by appropriate company officials prior to implementation. Retrospective - All phases of the quality process are important. The retrospective phase is the af- ter- event evaluation of system performance. To ensure positive findings retrospectively it is important to invest heavily in quality control that is prospective (hiring, training etc.) and concurrent (evalu- ation of the service / care at the time of delivery). Retrospective quality control is looking back on service or care that has already been delivered. Examples of areas of retrospective review are: • Patient Care • Use of an Automated External Defibrillator • Documentation of the Need for Patient Restraints • Emergency Vehicle Operations • Unexpected Clinical Events The results of the retrospective review provide data to facilitate changes in operating procedures to improve performance. This data also allows the organization to identify trends. Data is wonderful, but improvement only occurs when the data is acted on. The QA/QI Manager works closely with the Training Department to identify areas for additional training or the need for a change in train- ing curriculum. There may be times when the quality process identifies an individual or individual(s) who require refresher training. These situations are referred to the Training Department where the necessary training is provided. Upon completion of the training, the Training Manager will advise the QA/QI Manager that the required training has been completed. The individual(s) will be moni- tored to ensure compliance. This action of "dosing the loop" is one of the fundamental concepts of continuous quality improvement. Many organizations say that they are driven by the CQI process, yet only invest in the retrospec- tive component of the process. Care Ambulance truly embraces CQI and has the systems in place to facilitate continual improvement: Prospective, Concurrent, and Retrospective. It is with great pride that Care Ambulance employees provide exceptional service to each and every customer because of our commitment to quality. Data Management and Time Frames The Care Ambulance Quality Improvement Program is designed to be dynamic and change as the company and customer needs change. Our ability to collect and manage data is a key to the success • of our CQI program. Information that is collected is evaluated and maintained in a data base for :future reference. 36 • The QA/QI Manager generates monthly reports on identified quality indicators. These reports are shared with the Company Owners, Company Medical Director, Department Directors, and other appropriate managers. Quality indicators specific to patient care are shared with field employees. Field employees have open communication in the quality process. In fact, the employees performing the job many times have the best perspective. They can direct questions, comments, or suggestions directly to the QA/QI Manager. 2. Meeting and Exceeding RFP CQI Standards Care Ambulance fully complies with all federal, state and local medical standards, protocols, rules and regulations applicable to the provision of emergency BLS ambulance transportation, induding those established by the Orange County EMS Agency. In addition, Care's internal CQI process is directed at, but not limited to, effective administration and management of clinical performance, response time performance, driver performance, dispatch performance and other BLS service levels. We believe that our CQI process exceeds the standards and requirements set forth in the RFP. Our CQI process dearly covers all conceivable topics related to BLS ambulance transportation and is overseen by a full-time manager. Care's CQI Program responsibility is not something extra added to a manager's already busy daily task list but the full-time responsibility of a trained manager. Our CQI Program goes beyond the specified requirements of the effective administration and IP management of clinical performance, response time performance, driver performance and dispatch performance. It also covers records, reports and documentation, radio and telephone communica- tions, compliance with preventative maintenance and repair of ambulances and on -board equipment, infection control and employee safe practices, medical supply management, human resource prac- tices, and employee education and training. We propose to further expand our existing CQI process to include a commitment to meet monthly and/or quarterly with Orange County Fire Authority officials and representatives of contracted cities to discuss areas of mutual concern. We propose to work jointly with the OCFA and or contracted cities to develop CQI processes that are essential to the safe, efficient operations of their emergency ambulance service. By understanding what is important to the OCFA and our contracted cities, Care Ambulance can fine tune our CQI process to ensure that our EMS and Emergency Ambulance Transportation Services are fiscally, clinically and morally accountable to the patients served. • 37 TAB 12 { ! S `L EF r F (� E r i ` 4 ( C ( � { i { • ITEM 1 2 : BILLING AND COLLECTION PRACTICES Care Ambulance has long been at the forefront of ensuring that the most ethical and sophisticated billing methods are employed within our company. As a current contracted OCFA Ambulance pro- vider, Care Ambulance maintains record keeping and auditing practices that exceed the requirements set forth in Section VII of the RFP and has passed all financial and operational audits by the OCFA team of independent CPA auditors with no identified deficiencies or issues. Care Ambulance already provides the OCFA a fully functioning system - specific auditable billing system according to OCFA crite- ria. Using the advanced ambulance billing platform provided by Zoll Data Billing Systems, Care Ambulance maintains accurate and compete records of all patient accounting according to OCFA requirements. The Zoll Data Billing System allows electronic data --- exchange with many payors, provides data security, and ensures compliance with HIPAA standards. Care Ambulance accepts responsibility for all patient billing and ;,rte collections for services rendered. Care Ambulance abides by a strict ethical billing standard, which is outlined in our Corporate Compliance Program and described in Item 14. We agree to allow OCFA the ability to inspect and audit our business office records per - taining to performance of the contract. As specified by the RFP, we agree to maintain complete and accurate records of all patient accounting items listed. These records will be available to OCFA with 72 hours written notice. 1. Detailed Description of the Billing and Data Information The billing and data information process starts when Care Ambulance receives a call for service. OCFA run information is recorded in the Computer Aided Dispatch (CAD) system and it is one of the data dements for completion of a Patient Care Record (PCR). Care Ambulance's systems are integrated and the system seamlessly transfers data to the Accounts Receivable Management System. The CAD and PCR contain all data associated with the transport including any notes provided by the dispatcher. Through coordination with OCFA, incident numbers are captured in our CAD, thus allowing for a detailed reconciliation of all calls. The next element of documentation is the Patient Care Report (PCR). It is completed by the crew at the time of the transport and includes all clinical, demographic and billing information obtained during the transport. The final element of documentation is the report from the OCFA paramedic crew. To properly docu- ment the care given at the scene, and where required during transport, OCFA's documentation of pa- tient care is crucial. At the end of their shift, our crew delivers to operations personnel all PCRs and other associated documentation. A pre - billing audit of the documentation is completed to determine • the completeness of the PCRs. Missing information is identified and corrected by the crew, where applicable. 38 • The next step involves matching the PCR with the CAD record before the PCRs are delivered to our Billing Department. Both a Iog of daily trips and a printed document summary of CAD information are used to reconcile and verify that all trip tickets are accounted for each day. 2. Process Flow and Timeframes for Collections Process On receipt of the daily batch of trip tickets from operations, billing personnel "check in" the ticket package. This involves matching the ticket to the CAD record that was uploaded to the billing sys- tem. Although it is a simple process to compare the documentation to the record established in the billing system, the function serves to reconcile dispatch and transport activities. Once check -in is complete, the transport is coded and verified. The ticket is reviewed to determine services performed, and system codes associated with each service are assigned for input to the billing system. Billing personnel concurrently determine the payor source and verify patient eligibility with third-party payors. In the rare instances when no payor information is provided, the record is input into the State MediCal system to search for program eligibility. This search identifies all programs that qualify as OCFA "Zero Pay Patient" exceptions and is recorded into the billing system. A data -entry representative enters the ticket into the billing system, cross- checking the coding to ensure that valid billing information has been provided. At this point in the process, an initial bill is sent either electronically or on paper to the payor source. Medicare, Medi -Cal, and many other in- surers accept claims in an electronic format. For those that do not accept these claims, a paper claim is generated and mailed. Accounts are set up set up on a thirty (30) day schedule. Care Ambulance issues an initial bill within seventy -two (72) hours of the transport. Typically, if payment is not received within thirty (30) days, a past due invoice is sent. If no payment is received after sixty (60) days, a third and final invoice is issued. 3. Overall Billing and Collections Practices While issues involving accounts with a single, well- defined payor source are resolved easily, some ac- counts for a variety of reasons are not paid during the initial billing cycle. We follow -up periodically on these accounts using both automated methods and direct contact with third -party payors and patients. Only when a third -party payor is not identified does Care Ambulance seek payment directly from the patient. The first invoice requests third -parry payment information and asks the patient to con- tact our business office. A telephone number and a return envelope are provided. Care Ambulance will continuously inquire about third -party payment possibilities to ensure that all avenues for col- lections are discovered. If a patient has no third-party coverage or is a private -pay patient, we ask the patient which alternative payment method is best, including most major credit cards. When no other means are found, Care Ambulance has a liberal installment plan policy for payment arrangements. We typically try to avoid sending bills to collections, making every effort to contact the individual • and work through the process. If there is no response to the past -due notice, we attempt to contact the individual by phone. The next action is a final notice indicating that the account will be sent to 39 • collections. If another thirty (30) days goes by with no response, ) ys g y espouse, the account is either sent to col- lections or written off. In cases where Billing is unable to locate a third -party payor, and our billing representative determines that the patient has the ability to pay the bill but is uncooperative in mak- ing payment arrangements, we will seek the services of a collection agency. Care Ambulance selects outside collection agencies with great care. We have long -term relationships with business partners that have historically delivered high recoveries while providing professional, courteous, and conscien- tious customer service to our patients and third -party payors. Accounts are referred to our collection agencies only after all other efforts to resolve the debt are exhausted. Care Ambulance currently provides ambulance service to the cities of Stanton and La Palma. Our gross emergency collection rate for these cities in 2007 is 42.48% and 58.35% respectively. Compassionate Care Allowance Occasionally, Care Ambulance encounters a patient who is unable to pay his or her bill. Care Ambu- lance maintains a "Compassionate Care Allowance" for these patients with self -pay balances. Patients who can demonstrate insufficient assets or financial hardship may have their charges written off. Customer Service Focus Care Ambulance strives to provide the highest quality customer service. All billing personnel are trained in customer service, and are the primary point of contact for patients. Care Ambulance 11P. billing staff are Located here in Orange County, many are multilingual, provide extended customer service hours (8:00 a.m. — 6:00 p.m.) and utilize a documented complaint resolution process. Using "ePro" software, customer service representatives document an incident report online. As soon as the incident is reported, it is made available to the appropriate management personnel. The software filters each report to the appropriate management personnel based on incident type. Using "ePro" all complaints are tracked and followed through to resolution. 4. Statistical Data for Subject EOAs As the incumbent provider for the Cities of La Palma and Stanton, Care Ambulance provided the following statistical data to the OCFA for the period of January through December 2007. CODE 2 CODE 3 ALS BLS TOTAL TRANSPORT TRANSPORT CITY CALLS CALLS TRANSPORTS TRANSPORTS TRANSPORTS PAYOR MIX PAYOR Mix TYPE (NUMBER) (16) 447 21.57% Zero Pay La Palma 503 0 373 130 503 763 36.82% MediCare 862 41.60% Full Pay 258 23.54% Zero Pay Stanton 2,972 2 1,467 608 2,075 407 37.14% MediCare 431 39.32% Full Pay Since Care Ambulance is not the incumbent provider for the Cities of Seal Beach, Los Alamitos or Cy- press, we are unable to provide any statistical data regarding payer mix, patient demographics or collec- • tion rate by payer. We were provided data estimates by OCFA staff and we concur with those statistics. 40 TAB 13 r 1• F • ITEM 1 3 : HIPAA COMPLIANCE PLAN Care Ambulance Service is in full compliance with all requirements set forth by the Health Insurance Portability and Accountability Act (HIPAA) for Protected Health Information (PHI). As a health care provider that transmits (PHI) electronically to Medicare and other entities, Care Ambulance meets the definition of "covered entity" under HIPAA regulations. Effective April 1, 2003, are Ambulance implemented our comprehensive program to comply with the HIPAA requirements, including those requirements specific to patient privacy. Copies of our HIPAA policies are available online at www.careambulance.net. Care Ambulance certifies that all personnel employed by our organization have been appropriately trained regarding HIPAA and have signed an approved HIPAA confidentiality agreement. As part of Care Ambulance Service's HIPAA program, Care Ambulance provides interactive HIPAA and MediCare Compliance training to all employees during each employee's orientation and requires all employees to sign a non - disclosure agreement. Under Care's HIPAA Compliance Plan, we ensure that PHI is only released as permitted under HIPAA regulations. Examples of permitted releases indude: • Treatment - We may use PHI to treat a patient and disclose PHI to doctors, nurses or technicians directly involved in patient care. • Payment - We may use and disclose PHI so that we or others may bill an insurance company or other third party payer for services rendered. • Health Care Operations - We may use and disdose PHI to ensure that our patients receive the highest quality care and to audit the care provided by our care givers in our official QA/QI processes. • By Law - We will disclose PHI when required to do so by federal, state or local law. Care Ambulance Service does not consider HIPAA compliance and the protection of a patient's private information to be a static process. The protection of a patient's privacy remains an ongoing agenda item for Care Ambulance Service's senior management and all corporate decisions are rooted in the basis of patient privacy. Care Ambulance Service performs periodic privacy audits to validate compliance with our HIPAA Program. • 41 TAB 14 F. 1 . • ITEM 1 4 : CORPORATE COMPLIANCE PLAN Care Ambulance Service has in place a Corporate Compliance Plan which reflects our commitment to the highest ethical standards and compliance with all applicable laws and regulations. Care's Plan meets all standards established by the Office of Inspector General's Compliance Program Guidance for Ambulance Suppliers. The plan, as adopted by Board of Directors Resolution, provides standards by which all management and employees of Care Ambulance Service shall conduct themselves in order to protect and promote integrity throughout the company. The Compliance Plan is structured to achieve a specific set of objectives, which are outlined below along with the key components of each section of the Plan: LEGAL COMPLIANCE OBJECTIVE : Ensure all activity by or on behalf of the organization is in compliance with all applicable laws. This standard is intended to provide guidance to employees and management to assist them in their obligation to comply with applicable laws. These standards are neither exclusive nor complete. If questions regarding the existence, interpretation or application of any law arise, they are directed to Care Ambulance Service's legal counsel. The section covers: • Fraud and Abuse • Antitrust • Environmental • Discrimination BUSINESS ETHICS OBJECTIVE : Employees must accurately and honestly represent Care Ambulance Service and not engage in any activity or venture intended to defraud anyone of money, property or honest services. The Standards set forth in this section are designed to provide guidance to employees in order to ensure that Care Ambulance Service's business activities reflect the highest standards of business ethics and integrity. This section covers: • Honest Communication • Misappropriation of Proprietary Information • Fraud and Abuse CONFIDENTIALITY OBJECTIVE : Employees must maintain the confidentiality of patient information and other confidential information in accordance with applicable legal and ethical stan- dards. Each Care Ambulance Service employee has an obligation to actively protect and safeguard confidential, sensitive and proprietary information in a manner designed to prevent the unauthorized disclosure of such information. This section covers: • Patient Information • Proprietary Information • Personnel Actions and Decisions • 42 • CONFLICTS OF INTEREST OBJECTIVE : Directors, officers, and employees owe a duty of undivided and unqualified loyalty to the organization. Therefore, individuals holding such posi- tions may not use their positions to profit personally or to assist others in profiting in any way at the expense of the organization. This section covers: • Outside Financial Interests • Services for Competitors and Vendors • Participation on Boards of Directors / Trustees • Honoraria BUSINESS RELATIONSHIPS OBJECTIVE : Business transactions with vendors, contractors and other third parties shall be transacted free from offers or solicitation of gifts and favors or other improper inducements in exchange for influence or assistance in a transaction. The standards are intended to guide employees in determining the appropriateness of the listed activities or behaviors within the context of Care Ambulance Service business relationships, including relationships with vendors, providers, contractors, third party payors and governmental entities. This section covers: • Gifts and Gratuities • Gifts from Patients or Family Members • Gifts Influencing Decisions 41P PROTECTION OF ASSETS OBJECTIVE : All employees will strive to preserve and protect the corporation's assets by making prudent and effective use of Care Ambulance Service resources and properly and accurately reporting its financial condition. The standards are intended to guide em- ployees by articulating Care Ambulance Service's expectations as they relate to the activities or behav- iors which may impact Care's financial health. This section covers: • Internal Control • Financial Reporting • Travel and Entertainment • Personal Use of Corporate Assets ADMINISTRATION AND APPLICATION OF THIS CODE OF CONDUCT OBJECTIVE : Each person to whom our Code of Conduct applies shall abide by the Principles and Standards estab- lished and shall conduct the business and affairs of Care Ambulance Service in a manner consistent with the commitment to the highest ethical standards and compliance with all applicable laws and regulations. Care Ambulance Service has designated Gene Wiskowski, Director of Finance, as Care's Corporate Compliance Officer. Mr. Wiskowski reports directly to the principals of Care Ambulance Service and is charged with the responsibility for operating and monitoring the organization's com- pliance program. • 43 TAB 15 rt • ITEM 1 5 : COMPLIANCE WITH MONTHLY PAYMENTS Care Ambulance Service is compliant with all OCFA's monthly payment requirements as outlined within the RFP. As an incumbent provider, Care Ambulance evaluates and computes all OCFA refer- rals on a monthly basis for ALS reimbursement and medical supply reimbursement. Reporting and payment occurs within 90 days after the first day of each month. Included with this reporting is a detailed listing of the current month - requested exceptions based on the Zero Pay Patient and Medi- Cal patient provisions of the contract. Care Ambulance has an operational electronic tracking and reporting methodology that meets and exceeds all the requirements set forth in Section VII of the RFP and has passed all financial and operational audits by the OCFA team of independent CPA auditors with no identified deficiencies or issues. The following details the methodology Care Ambulance uses to meet and exceed the requirements of Section VII of the RFP. 1. Billing System and Record Keeping Overview Care's Patient Accounting System contains sophisticated controls that include password - protected system administration, patient and transaction -level detail, and accounting controls that comply with Generally Accepted Accounting Principles (GAAP). Our system includes daily and periodic reporting that ensures all accounts remain in balance. The monthly payment record keeping includes a sales journal, a cash receipts journal, a dispatch log, a ticket survey, and an accounts receivable check report that validates each account. An automated process is run each day to post all updates to the appropriate areas of the system. This routine ensures a balance between the transaction totals of the system and the balance of patient ac- counts. The paper records delivered to the Billing Department (Patient Care Reports, County EMS forms, etc.) are inspected, logged and tracked through the billing process. Once the records are input into the system for billing, they are processed through Care Ambulance Service's scanning system to create an electronic archive of all documents. These images are maintained on computer hardware located on a secure computer system managed by Care Ambulance Service Information Technology personnel. All aspects of the billing department's record keeping are compliant with the Health Insurance Porta- bility and Accountability Act of 1996 (HIPAA). 2. ALS Reimbursement Payment Methodology • The key to appropriately tracking and reimbursing the OCFA for ALS-level services is having a recon- ciliation methodology that includes a tie to the OCFA incident number in the billing system. By using this unique identifier for all responses to OCFA, directed medical incidents are evaluated for payment. 44 • The OCFA incident number is passed from the OCFA system to Care's Computer Aided Dispatch (CAD) system and included in the record output to the billing system. Care Ambulance Service cre- ates a seamless reconciliation process between the responsible party's payment and OCFA's payment by including the incident number in the billing record. As such, this incident number is the key to auditing all the records associated with transports. This capability exists with other Care Ambulance Service contracts and is induded as part of the communications system interface. Each incident that is referred by OCFA is reported and indudes the following: • EOA Number • Name of Responsible Party Invoiced • Patient Name and Address • Level of Service (ALS/ BLS /ALS Assessment /BLS Assessment) • Date of Service • OCFA Incident Number • ALS Reimbursement Amount Remitted to OCFA (per transport) • Medical Supply Reimbursement Amount Submitted to OCFA (per transport) All incidents that qualify for ALS reimbursement indude the information above, along with the ap- propriate reimbursement amount. The reporting includes detail of all transports and a summary that reconciles the transport counts with the reimbursement and exemption activity. 3. Medical Supply Reimbursement Payment Methodology Care Ambulance Service has an extensive history of providing reimbursement for medical supplies. We have been providing this reimbursement for a number of Orange County cities since the process first began in 1997. As such, we have a tested and proven medical supply reimbursement payment methodology in place. This methodology includes the processes outlined earlier for ALS reimbursement, induding the tracking of all OCFA referrals to ensure that we have the ability to accurately report medical supply reimbursement on all qualified incidents. Care Ambulance Service evaluates and pays OCFA for all ALS and BLS transports, providing all necessary reports to OCFA. The reports include the same ele- ments outlined in the ALS Reimbursement Payment Methodology. Patient Exemption Requests An exemption request identifying the justification for each Zero Pay Patient is induded along with the monthly payment report. The Zero Pay Patient exemption request is for qualifying transports during the reporting period. Patients covered through Medi -Cal, CalOptima, or other Medi -Cal HMO products, and who are pre - authorized are considered Zero Pay and will be considered in the exemption reporting. • Care Ambulance understands that all "Retro Credits" should be included in the month for which Care Ambulance Service receives the notification of the retroactive enrollment in the qualified zero pay patient program. 45 • Auditing and Inspection of Records Care Ambulance maintains all records associated with ambulance transports in accordance with strict compliance policies. All records (paper, scanned images and electronic) are available for inspection and audit by OCFA. Our billing process includes testing of transactions and management oversight controls to ensure timely and accurate billing and resolution of patient accounts. We encourage OCFA staff to partici- pate in an overview of the billing process by visiting our business office. Care Ambulance already makes available to OCFA all records associated with the contract. More specifically, as stated in the RFP, we provide to OCFA and will continue to provide information that contains: • Name of Responsible Party Invoiced per Transport • Patient Name and Address • Indicate BLS, ALS, or ALS Assessment/BLS Transport • Date of Service Call • OCFA Incident Number • Amount Invoiced per Transport • Amount Recovered per Transport • Any Exemption Requests for Transports Included in the Audit Sample • Any Other Requested Relevant Information Required to Perform an Audit • 46 ,r0 TAB 16 f 0 • ITEM 1 6:91 1 FIRE / EMS RESUME Care Ambulance Service has provided ambulance service to the residents and visitors of Orange County for over thirty-nine (39) years. Founded on 1969 by Carl Richardson, Care has grown from a small one - ambulance, community based service, to the largest provider of emergency (9 -1 -1) and non - emergency ambulance services in Orange County. The company, now owned by Carl's sons Dan and Rick Richardson, has continued to grow with the basic values of excellent patient care and customer service remaining at the forefront. All of Care's experience is as a sole company. Care Ambulance provides the following services: • 9 -1 -1 Emergency Ambulance Transport • • Non - Emergency Ambulance Transport r sp - -- -~ ' • Basic Life Support Stand -by Services �� ; . � ' ` • Nurse Staffed Critical Care Transport Services, and • Neonatal /Pediatric Intensive Care Transport Services Annually, Care Ambulance Service responds and provides ambu- ".e; lance transport service to over 175,000 patients, of which more • than 110,000 are emergency 9 -1 -1 responses. Care Ambulance is easily recognized as one of the most experienced providers of 9 -1 -1 emergency ambulance transportation services in Orange County. Care Ambulance can dearly demonstrate that we have more than thirty -five (35) years of contracted primary provider emergency (9 -1 -1) ambulance transport experience. Our experience is well documented throughout this proposal and supported with recommendations from the city councils and fire chiefs of each area served. Care Ambulance Service provides contracted 9 -1 -1 emergency ambulance transportation services to the following Orange County cities and communities: Anaheim, Buena Park, Costa Mesa, Fountain Valley, Fullerton, Garden Grove, La Palma, Midway City and Stanton. In addition, Care Ambulance provides contracted 9 -1 -1 emergency ambulance transportation services to the twenty -two (22) cities and communities of South -East Los Angeles County, under contract with the Los Angeles County Board of Supervisors and Los Angeles County Fire Department. Details of the local geographic areas and emergency services provided by Care Ambulance, including a summary of the populations served, are detailed below. CITY OF ANAHEIM Population: 343,000 • Land Area: 50 Square Miles Number of Annual Responses: 14,559 Response Time Requirements: Code 3, ten (10) Minutes or less Code 2, fifteen (15) Minutes or less Calendar Years of Contract: Ten (10) Years • Average Response Time: Under six (6) Minutes 47 • Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty-four (24) hours daily, seven (7) days per week. Response to Low Income Areas: Excellent Contract Failures: None Roger Smith — Fire Chief Agency Contact: 201 S. Anaheim Blvd., Suite 300 Anaheim, California 92805 (714) 765 -4000 Notes: The City of Anaheim is the second (2nd) largest city in Orange County and the tenth (10th) largest city in California. The city has an ethnic diversity of 36% Non - Hispanic White, 2% African American, 12% Asian, 47% Hispanic or Latino and 3% all other races. CITY OF BUENA PARK Population: 80,600 Land Area: 10 Square Miles Number of Annual Responses: 6,190 Response Time Requirements: Code 3, ten (10) minutes or less Code 2, fifteen (15) minutes or Less Calendar Years of Contract: Nine (9) Years Average Response Time: Under six (6) Minutes Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty-four (24) hours daily, seven (7) days per week. Response to Low Income Areas: Excellent Contract Failures: None Jim Vanderpool — Deputy City Mgr Agency Contact: 6650 Beach Blvd. Buena Park, California 90622 (714) 562 -3552 Notes: The city has an ethnic diversity of 58.6% Non - Hispanic White, 2.4% African American, 13.8% Asian, 24.5% Hispanic or Latino and 0.7% all other races. CITY OF COSTA MESA Population: 113,440 Land Area: 16 Square Miles Number of Annual Responses: 7,300 (Estimated) Response Time Requirements: Code 3, ten (10) minutes or less Code 2, fifteen (15) minutes or less • Calendar Years of Contract: Three (3) Months Average Response Tune: Under six (6) Minutes 48 • Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty-four (24) hours daily, seven (7) days per week. Response to Low Income Areas: Excellent Contract Failures: None Mike Morgan — Fire Chief City of Costa Mesa Agency Contact: 1 Fair Drive Costa Mesa, California 92628 (714) 754 -5000 Notes: The city has a racial composition of White (69.5 %), followed by Asian (6.9%) and Black or African American (1.4 %) and American Indian, Alaskan Native, Native Hawaiian and other Pacific Islander (1.4 %). Overall, 20.9% residents identified themselves as belonging to some other race or identified themselves with two or more races. CITY OF FOUNTAIN VALLEY Population: 56,500 Land Area: 10 Square Miles Number of Annual Responses: 4,823 Response Time Requirements: Code 3, eight (8) minutes or less Code 2, fifteen (15) minutes or less Calendar Years of Contract: Ten (10) Years Average Response Time: Under five (5) Minutes Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty-four (24) hours daily, seven (7) days per week. Contract Failures: None Bill Walker — Fire Chief Agency Contact: 10200 Slater Ave Fountain Valley, California 92708 (714) 562 -3552 CITY OF FULLERTON Population: 134,200 Land Area: 22 Square Miles Number of Annual Responses: 5,481 Response Time Requirements: Code 3, ten (10) minutes or less Code 2, fifteen (15) minutes or less Calendar Years of Contract: Five (5) Years Average Response Time: Under six (6) Minutes • Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty-four (24) hours daily, seven (7) days per week. 49 • Response to Low Income Areas: Excellent Contract Failures: None Wolfgang Knabe — Fire Chief Agency Contact: 312 E. Commonwealth Ave. Fullerton, California 92832 (714) 738 -6506 Notes: The city has an ethnic diversity of 48.74% Non - Hispanic White, 2.12% African American, 15.98% Asian, 30.17% Hispanic or Latino and 2.6% all other races. CITY OF GARDEN GROVE Population: 171,000 Land Area: 18 Square Miles Number of Annual Responses: 8,841 Response Time Requirements: Code 3, ten (10) minutes or less Code 2, fifteen (15) minutes or less Calendar Years of Contract: Seven (7) Years Average Response Time: Under six (6) Minutes Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty -four (24) hours daily, seven (7) days per week. Response to Low Income Areas: Excellent Contract Failures: None David Bertka— Fire Chief cy Contact: 11301 Acacia Parkway Garden Grove, California 92842 (714) 741 -5600 Notes: The city has an ethnic diversity of 58.6% Non - Hispanic White, 2.4% African American, 13.8% Asian, 24.5% Hispanic or Latino and 0.7% all other races. OCFA CONTRACT AREAS : STANTON, MIDWAY CITY LA PALMA Population: 69,408 Number of Annual Responses: 3,645 Response Time Requirements: Code 3, ten (10) minutes or less Code 2, fifteen (15) minutes or less Calendar Years of Contract: Three (3) Years Average Response Time: Under six (6) Minutes Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty-four (24) hours daily, seven (7) days per week. Response to Low Income Areas: Excellent • Contract Failures: None 50 IP • Jim Bailey — EMS Battalion Chief Orange County Fire Authority Agency Contact: 1 Fire Authority Road Irvine, California 92602 (714) 573 -6071 Notes: These cities have an ethnic diversity of 48.74% Non - Hispanic White, 2.12% African Ameri- can, 15.98% Asian, 30.17% Hispanic or Latino and 2.6% all other races. LOS ANGELES COUNTY - SOUTH-EAST AREA - EDA 6 Population: 1,206,444 Land Area: 139 Square Miles Number of Annual Responses: 59,920 Response Time Requirements: Code 3, eight (8) minutes or less Calendar Years of Contract: Two (2) Years Average Response Time: Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty -four (24) hours daily, seven (7) days per week. Contract Failures: None Cathy Chidester — Director Los Angeles County EMS Agency Agency Contact: 5555 Ferguson Drive, Suite 220 Commerce, California. 90022 (323) 890 -7543 Notes: Zone 6 includes the cities /communities of Artesia, Bell, Bell Gardens, Bellflower, Cerritos, Commerce, Cudahy, Hawaiian Gardens, Huntington Park, La Mirada, Lakewood, Maywood, Mon- tebello, Norwalk, Paramount, Pico Rivera, Santa Fe Springs, Signal Hill, South Gate, Whittier and several unincorporated county areas. TOTAL COMMUNITIES SERVED Population: 2,174,552 Land Area: 272 Square Miles Number of Annual Responses: 110,759 Calendar Years of Contracts: Forty -Six (46) Years Types of Services Provided: EMT-Basic staffed, Basic Life Support equipped ambulances, twenty-four (24) hours daily, seven (7) days per week. Response to Low Income Areas: Excellent Contract Failures: None 410 51 TAB 17 L F F • F[r • ITEM 17 : CONFLICT OF INTEREST CERTIFICATION The undersigned hereby certifies on behalf of Care Ambulance Service, Inc. ( "Bidder "), and hereby declares under penalty of perjury under the laws of the State of California, the Bidder is not, and will not be violating either directly or indirectly any conflict of interest statute, rule, or regulation if awarded a contract and if authorized to perform the services described in this RFP. Signed, this 10th day of December, 2008 in Orange, California. IF CORPORATION: (11 12/10/08 Signature of Co-CEO Date Rick W. Richardson I P Print Name I 12/10/08 Signature of Secretary Date Dan C. Richardson Print Name • • 52 L . i 1 1° TAB 18 [ 1 l i [ L t a . 7 , , , t 5 t [ [ I i t- P 1 1- .0 . tr i ? • ITEM 1 8 : STATEMENT OF TRUTH The undersigned hereby certifies on behalf of Care Ambulance Service, Inc. ( "Bidder "), and hereby declares under penalty of perjury under the laws of the State of California, that the information provided by Bidder and contained in this 2008 Fire /EMS Emergency Ambulance Transportation and Related Services RFP is accurate, complete, true and correct to the best of our knowledge. We are aware that should any of the information contained herein be found to be false, incorrect, or other- wise untruthful, or if the information contained herein contains material misrepresentations and /or material omissions of fact, OCFA may, at its sole discretion, pursue any and all remedies available as authorized by law, which may include the right, at the option of OCFA, to either reject or disqualify this bid proposal from further consideration in the course of the procurement process and /or to declare any contract subsequently awarded void. Signed, this 10th day of December, 2008 in Orange, California. IF CORPORATION: 12/10/08 Signature of Co -CEO Date Rick W Richardson Print Name r DA 711.r71L 12/10/08 Signature of Secretary Date Dan C. Richardson Print Name • 53 i 41 ,!: mir' • TAB 19 i E I' l I 1 t 1 t [ i t . . [ I- t i t I • I. i r c !. t , r. IS. : . 1 . . 41110 I • ITEM 19 : NON - COLLUSION CERTIFICATION The undersigned hereby certifies on behalf of Care Ambulance Service, Inc. ( "Bidder "), and hereby declares under Penalty of Perjury under the laws of the State of California, that this 2008 Fire/EMS Emergency Ambulance Transportation and Related Services RFP is genuine and not sham or col- lusive, nor made in the interest of or on behalf of any person not herein named; the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a sham proposal nor solicited any other person, firm or corporation to refrain from submitting a proposal; the Bidder has not com- municated, directly or indirectly, with any other Bidder regarding the amount, price, and /or service rates proposed herein; and Bidder has not in any manner sought by collusion to secure for himself/ herself /itself any advantage over any other Bidder. We declare the foregoing is true and correct under penalty of perjury under the laws of the State of California. Signed, this 10th day of December, 2008 in Orange, California. IF CORPORATION: IP e-- --- ......1 1 , L___ , 12/10/08 Signature of Co-CEO Date Rick W. Richardson Print Name V atur e OK ` 12/10 /08 of Secretary Date Dan C. Richardson Print Name • 54 TAB 20 Id& • ITEM 20 : COMMISSION ON ACCREDITATION OF AMBULANCE SERVICES ( "CAAS ") CERTIFICATION If CAAS certified, please provide a copy of your CAAS Certification. In February 1993, Care Ambulance applied for and was the first ambulance service in California to receive a national accreditation from the Commission on Accreditation of Ambulance Services (CAAS). This accreditation for meeting the "Gold Standard of Excellence" was awarded after an exhaustive application process, on -site review by nationally recognized experts in emergency medical services and a perfectly scored graded evaluation. Care's current GAAS Certi is attached s�. t . 1 (4 I 55 • o,_y f i N iig 14"11 •Zalfl C) 0 WI ql) 44 o� 44 0 ai dam' c 0 44 a 3 ov3 t *pie c.; es 44 a : _, _ cze ..ezi "IS *.i ‘ :.I: 11 # e al gi �' c ia ° PITO CD 40 *Po I al 1.. C.) CA X131 • A) t) � 1 a it w ei, w .14 .0 !li pc ig E E :40111 w �c y v 4 qat et e �J� P�G � �f.RVI C F S g Lam. V A _ a P iSee 4 g ' i' r ^ I I q {: � i;a i 0 0 y yo 'I V _, I o Ii111=1 Vi tv z 1:4 U 0 k°I sslwwoi) o 4 cn a TAB 21 1 1 • ITEM 2 1 : OVERALL OPERATIONAL SYSTEM AND DESIGN City of Cypress — EOA # 5 Care Ambulance has prepared an operational system and design plan that exceeds the competitive bid criteria, specifications, requirements and performance expectations set forth in the RFP. One of the true advantages Care Ambulance brings to the City of Cypress emergency ambulance trans- port program is seasoned management and experience with new start -up systems. This experience is critical to ensure uninterrupted quality ambulance service. Care Ambulance's management team and implementation techniques have been tested and proven, and our capabilities have been clearly demonstrated. It is the goal of Care Ambulance to work cooperatively with the City of Cypress and the OCFA to put in place an EMS system that takes into account the priorities of clinical excellence, consistent response times and state -of- the -art systems management. Together with the City of Cypress and OCFA we will create an "Interagency Partnership ". Throughout the world, across the country and around Orange County, new relationships are being created that are fundamentally different from those of years ago. In former days, government and business were commonly conducted with competition as the main underlying theme. Today, more collaborative approaches are necessary. There are two fundamental and intertwined reasons that more collaborative processes are being used: the increasing demand for quality; and economic pressures experienced by both public and private organizations. Creating Interagency Partnerships that emphasize collaboration instead of competition is a creative way to work together that can improve the outcome for our patients and organizations. 1. Exceeding Operational Plan Requirements Care Ambulance proposes to provide a minimum of one (1) staffed and licensed Basic Life Sup- port (BLS) ambulance stationed and housed in the City of Cypress, on a twenty-four (24) hour per day /seven (7) day per week basis. The business of providing emergency ambulance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and therefore commits to the full-time deployment of ambulance resources in the City of Cypress. The ambulance shall serve as the primary ambulance, dedicated solely for use to the City of Cypress and OCFA. A number of ambulance companies have implemented flexible deployment strategies or System Status Management (SSM) in the wake of growing pressures to increase their own efficiencies and profit. They have attempted to match EMS demand with the allocation of ambulance resources. While the overall concept may appear to be financially sound, Care Ambulance believes that it actually delivers inferior service. SSM and flexible deployment takes an unnecessary toll on EMT personnel due to frequent post -loca- tion changes and places a higher priority on posting for call demand than geographic coverage. This results in unacceptable and even life- threatening response times in peripheral parts of a service area. Care Ambulance is committed to continuing our policy of establishing a fixed city - specific twenty - • four (24) hour ambulance station as permanent location within the City of Cypress. Listed below is our proposed Cypress ambulance station location: 56 • City of Cypress — 5990 Corporate Avenue, Cypress To be staffed with one exclusively dedicated 24 -hour ambulance and crew, with a minimum of two (2) EMTs. This location offers excellent area coverage for Cypress with immediate access to adjacent OCFA partner cities. With Care's proposed deployment plan, neither patients nor OCFA firefighters have to wait for an ambulance to respond from a neighboring city. Care's crews will be living and working within Cy- press. This is very similar to our current programs within the Cities of Anaheim, Buena Park, Costa Mesa, Garden Grove, Fountain Valley, Fullerton, La Palma and Stanton. These programs have been so successful that we have been able to reduce Code 3, red lights and siren. response times to less than six (6) minutes and Code 2. expeditious response without red lights and siren. response times to less than eight (8) minutes. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of Cypress to ensure consistent ambulance coverage. The automatic back -up coverage process will begin whenever the unit dedicated to the City of Cypress is dispatched on a request for service. The process is best com- pared to an inventory system, in which a piece of inventory, or in this case an emergency ambulance, is placed on a call it is immediately replaced by an additional ambulance. This ensures that the City of Cypress is constantly covered, with no lapses in emergency ambulance coverage. Care's move -up or post location for the City of Cypress is: • Intersection of Lincoln Avenue and Moody Street This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts. This allows Care Ambulance to deliver ambulance response times unmatched by any other local ambulance provider. Care Ambulance recognizes the inherent difficulty in predicting the need for emergency ambulance responses. With a single catastrophic event, it is possible to deplete the resources of the dedicated ambulances positioned in the City of Cypress. For that reason, Care Ambulance commits to utiliz- ing any and all available ambulances within its fleet of 118 other ambulances to satisfy emergency re- sponses within the City of Cypress. Further, the management team of Care Ambulance is on -site and available twenty-four (24) hours a day to respond to any inquiries Cypress City officials or OCFA department personnel may have regarding any incident. Exceeding Response Time Standards The most critical measure of an emergency ambulance service's performance is its response times. While clinical performance is essential, it is not as commonly understood or easily measured as response times. The key issue for most patients and the public is: how long does it take to get an ambulance after making the call for help? It is for that reason that Care Ambulance agrees to be held to a higher standard. Care Ambulance takes great pride in our documented delivery of superior response times. Care 57 • Ambulance commits to exceed the minimum response time requirements set forth in this RFP at the exceptional levels set forth below: • Care agrees to exceed the minimum response time requirements, as specified in the Request for Proposal by agreeing to a 9 minute, 59 second, 93% compliance standard for all requests for emergency services and a 14 minute, 59 second, 93% compliance standard for all urgent services. These response time standards are extremely stringent and concrete. Unlike other bidders, these are response time standards that Care Ambulance achieves today. We are not promising something that we haven't done before. We do it today and we will do it for the City of Cypress. To date, Care Ambulance Service has never failed to meet our 9 -1 -1 emergency contracted response time obligations, nor been penalized for any sub - standard system performance. Care Ambulance is very confident in our abilities to deliver timely ambulance services and we propose to exceed the requirements of the RFP with the below listed monetary penalties for non - compliance: PER RESPONSE PRIORITY CODE: PENALTY IMPOSED: 93% or Better None 90% – 92.9% $1,000 IP 85% – 89.9% $2,000 Less than 84.9% $3,000 We recognize that shorter response times are an integral part of quality patient care and in many emergencies may reduce mortality. EMT-D Defibrillation is the most effective treatment for out -of- hospital ventricular fibrillation. Care Am- bulance is proud to be the first ambulance service in Orange County to provide Automatic External Defibrillators (AEDs) on all ambulance vehicles. Medical research shows that the sooner defibrillation can be administered to a patient in ventricular fibrillation; the better the chances are that normal cardiac activity can be restored. With the degenera- tive nature of ventricular fibrillation, seconds can literally mean the difference between life and death. Out -of- hospital defibrillation of cardiac arrest patients was one of the primary reasons for initial development of paramedic programs in the 1970s. Since that time, the science of paramedicine has evolved, and more extensive and definitive therapy is within the scope of paramedics. Technological development of an automated defibrillator — a computerized electro - cardiographic recognition pro- gram combined with a defibrillator — allows non - paramedic level rescuers to safely and effectively administer defibrillation. Care believes that automated defibrillation is a useful adjunct to firefighter- paramedics. and Care • Ambulance is firmly committed to continuing to provide AEDs in all ambulance vehicles and for all ambulance crews. 58 • Bariatric Gurneys and Ambulances • According to the Center for Disease Control and Prevention (CDC) there are approximately 7.5 million morbidly obese adults (defined as more than 100 lbs. overweight) in the U.S. or roughly 5% of all adults. Safe ambulance transport of morbidly obese patients presents many challenges, to the patients and rescuers. For the patients, a reluctance to call for 9 -1 -1 services because the experience of being transported is so painful, hazardous and humiliating. For rescuers, the increased threat of a significant back injury. Care Ambulance recognizes the operational challenges of transporting a bariatric patient and has designed our new ambulances to safely and efficiently transport these patients. Each of our new am- bulances has been designed to transport the Stryker MX-Pro Bariatric Transport Gurney system with aluminum loading ramps and an electric wench. The Stryker MX-Pro Bariatric Transport Gurney has a maximum weight capacity of 1,600 lbs. and an additional 12 inch width for patient comfort. Us- ing this new system, we can safely and humanely transport bariatric patients without fear of injuries to our patients or rescuers. Changing Demographics of Orange County California has been a trendsetter for the nation in a variety of ways for the past three decades. In Orange County, rapid and profound ethnic transformation is one of the more significant examples of this phenomenon. With ethnic transformation come new challenges. It has been estimated by UCLA researchers that within Southern California, 224 different languages are spoken. One of the most frustrating events for a paramedic or EMT is to arrive on scene of a medical emer- gency and be unable to communicate with the patient or family members. Often, due to circum- stances beyond the control of the patient, they are unable to provide complete information regarding their past medical history or current medications. This lack of accurate information can delay emer- gency medical treatment and cause complications. Care Ambulance recognizes that immediate communication with our patients is essential, but it is impossible to teach all our EMT caregivers to speak and communicate in multiple languages. For that reason, Care Ambulance equips each ambulance within our fleet with a cellular telephone and Care Ambulance contracts with an approved telephone translation service. When our EMT personnel arrive on -scene of a medical emergency and cannot communicate with a patient or family members, EMTs are instructed to contact the telephone translation service using the cellular telephone. The translation service then connects an approved translator with our EMT and patient to ensure complete and accurate communications. The United States Census Bureau categorizes a household as "linguistically isolated" if no person over age 14 speaks only English and no person over 14 who speaks a language other than English speaks English "very well." In Southern California, 33 percent of Spanish- speaking households, 36 percent of Asian or Pacific Island households and almost 20 percent of all households are linguistically iso- lated. It is our job to ensure that these families are not isolated from receiving life - saving emergency • ambulance services. 59 • Community Oriented Ambulance Service During the last 10 years, many local public safety agencies have demonstrated the value of "commu- nity oriented" programs, including the importance of giving back to the community. Care Ambu- lance has also observed the value of these programs, and has developed similar methods to involve our EMT personnel with the communities we serve. Care's latest community program has been very innovative and we be- « lieve the first in the nation. Care Ambulance has taken the exterior sides r ; ° = ;; <i of ambulances and converted them into "rolling billboards" for in' =" " ' ` g Jury - r L .* _� prevention and child safety awareness. Our first ambulance with a ; . 1 ` Public Safety Announcement (PSA) exterior message was outfitted -Ay with a drowning prevention campaign. =� This ambulance served as the backdrop for a locally televised r press conference for drowning prevention hosted by the Or- g P Y ange County Fire Chief's Association and has been seen by thousands of different families at local health and community fairs. Our first PSA ambulance was so successful that we have recently added five additional PSA ambulances promoting the following safety messages: never leave a child unattended in a car; the importance of children wearing helmets; the importance of parents us- ing child safety seats; and anti- drowning campaign messages. Care's program of "Rolling Billboards" recently received recognition from the American Ambulance Association for Outstanding Commu- nity Service. Care Ambulance takes great pride in our community involvement and our personnel look forward to interacting with the residents of Cypress. Community Emergency Response Teams (CERT) The Community Emergency Response Team (CERT) Program educates people about disaster pre- paredness for hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations. Following a major disaster, first responders who provide fire and medical services may not be able to meet the demand for these services. Factors as number of victims, communication failures, and road blockages may prevent people from accessing emergency services they have come to expect at a moment's notice through 9 -1 -1. People will have to rely on each other for help in order to meet their immediate life saving and life sustaining needs. CERT is about readiness, people helping people, rescuer safety, and doing the greatest good for the greatest number. CERT is a positive and realistic approach to emer- gency and disaster situations where citizens will be initially on their own and their actions can make a difference. are Ambulance recognizes the important need to train community volunteers to assist in times of disaster and we pledge our support to a community based CERT program. 2. Crew Configuration • Each of Care's emergency ambulances is staffed with two (2) EMTs who, at minimum, are licensed at the EMT-Basic level. In addition, each EMT will have completed Care's "Paramedic Assist" training 60 course, Incident Command Systems 100 (ICS 100) training and an approved hazardous materials first responder awareness course. EMTs assigned to the City of Cypress dedicated emergency transport ambulance may be approved by the OCFA and shall be assigned to a fifty -six (56) hour workweek schedule consistent with the standard OCFA firefighter schedule. This staffing pattern allows for a more coordinated team effort and provides necessary familiarity with staffing. 3. Supervisory Plan of Crews Currently, Care Ambulance Service provides an on -duty Operations Manager on a twenty -four (24) hour basis, seven (7) days a week. This Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Man- ager is located at our corporate offices in Orange. The on -duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center or directly through his cellular telephone. The following individuals currently work as Operations Managers in Care's Orange County Division: • Rick Mount — Employed with Care Ambulance for 31 years. • Marc Jessner — Employed with Care Ambulance for 17 years. • John Sanders — Employed with Care Ambulance for 8 years. All Operations Managers employed by Care Ambulance have successfully com- pleted training at the ICS 300 level, California State EMS Authority approved Ambulance Strike Leader training and ' ' i t 7 , 3 have successfully lead an Ambulance Strike j : r , j �' .1 Team on a deployment. All have complet- ( the Ambulance ' Service Manager (ASM) . • -� . � , } ed t -' .. raining offered b y the American Ambu- lance Association and most recently all have completed the Ambulance Supervisors Course offered by Texas A &M University. All Operations Managers have completed all required FEMA training, including IS 700 NIMS, IS 703 NIMS Resource Management and IS 800 National Response Plan. In addition, all Operations Mangers have completed the Orange County EMS Agency courses in Bio- Terrorism (CBRNE) and First Responder Awareness (FRA) and First Responder Operations (FRO). On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 capable vehicle equipped with all necessary fire depart- ment radios and extra medical equipment, including back - boards, medical supplies and oxygen. Each Operations Manager vehicle is also equipped with a Mobile Data Computer (MDC) allowing our supervisory personnel to continually monitor the location and activities of all Care ambulances within Orange County. • 4. Overall Summary of Care's Southern California Operations A. Total Number of Ambulances in Fleet Care Ambulance provides a response ready fleet of 118 ambulances licensed to provide ambulance 61 • services in Orange County. We are the largest provider of emergency and non - emergency ambulance services in Orange County. Each emergency ambulance in Care's fleet is complete with the latest technology, including 800 MHz mobile radios and satellite -based Automatic Vehicle Locator (AVL) tracking systems. All of Care's ambulances meet and exceed the safety and equipment requirements listed in the RFP. B. Total Number of Employees By selecting Care Ambulance as the EMS Emergency Transportation Services provider for the City of Cypress, the City will gain an experienced, dedicated workforce trained to the highest clinical stan- dards. Care Ambulance employs 796 individuals. The following is a breakdown of employees accord- ing to job category: EMT Staff 576 Communications 23 Field Training Officers 40 RNs / RCPs 42 , Managers / Directors / Owners 30 Administrative / Billing 79 Fleet Maintenance 6 C. Contact Information for Third Party Billing and Collection Care Ambulance understands that public impression regarding the delivery of our services is very important. Often, the last contact patients have with an EMS provider is to resolve their bill for ser- vices. How their bill for services is handled makes a lasting impression. If performed poorly, it may tarnish even the best clinical outcome. Care Ambulance recognizes this and as a result performs all billing services in -house with the exception of third party collections. By using compassionate billing practices designed to seek reimbursements from insurance carriers (MediCare, MediCal and private insurances companies), Care's billing staff have become experts in maximizing insurance reimbursement to lessen the patients' out of pocket expense. Contact Information for our Third Party Collection Agency is as follows: The Outsource Group 1801 California, Corona, CA 92881 Representative — Scott Hall (951) 898 -4315 D. Clinical Contacts Care Ambulance provides clinical support and training for all employees through our in -house Train- ing Department. With our full -time clinical education staff, including our participatory Medical Director, Care offers the City of Cypress the highest possible clinical standards. Contacts for the Medical Director and Training Department are: • Medical Director, Dr. Michael Martin, Telephone (562) 698 -0811, Ext 7511 • Training Manager, Kevin Chao, Telephone (714) 288 -3818 • • Driver Training Manager, Sergio Montoya, Telephone (714) 288 -3920 62 ■111.11111111■ • 5. Budget for City of Cypress Emergency Ambulance Operations, combined with the other four (4) areas being proposed by Care Ambulance Service. A. Financial information which will estimate the cost of the proposed operation. Care's _Proposed Operating Budget ! LA LOS SEAL . 1--- CYPRESS . STANTON AREA TOTAL cH . PALMA ALAMITOS BEA Transports Per OCFA) _ 1,430 451 879 2,398 1 1,872 7,030 1 Gross Revenue 1,394,250 439,725 857,025 2,338,050 1 1,825,200 6,854,250 : ! I Contractual / Bad Debt i , W/O (627.413) ' a 97.876) (428.513) (1.169.025) I (1.095.120) I (3.517.947) Net Revenue 766,837 , 241,849 428,512 1,169,0251 730,080 3,336,303 1 Number of Ambulances 1 ; 1 1 ... 2_[ - 1 4---- 6 - 1 • QM&Aganfig .: .._. :. _.: '.- ._- ." 1-. 1_ Medical Supply Fees 46,255 r 12,696 24,744 67,5041_ 52,697 197,895_1 205 368 . - . 205 368 1 ' 205 368 410 736 ' 2 36 , , 8 1 232 208 ? . . 2_ I Benefits & Payroll Taxes 43,127 43,127 43,127 86,255 I 43,127 i 258,764 ! Gas & Oil _ 10,482 . 3,306 6,443 . 17,577 13,722. _51,530 t 1 Insiyance i _ Medical Supplies 6 g , , 3 1 2 6;0 1 1 6,160 6,160 12, 6,160 36,960J Repairs & Maintenance . . . _ ... 1,993 3,885 10,599 8,274 --i-- 31,0721 .__ _ 4,076 1,285 2,505 5,335 , 20,035 i 1 - -- Uniforms & Linen -- i,311 i 729 1,421 3:876 3,026 I 11,363 j ._ . _. . .... . .. _ . .. Licenses 1,250 ' 1,250 1,250 2 1,250 7,5001 Office Supplies 4,290 1,353 2,637 7,194 5,616 21,090 lier; & Utilities 18,000 , i 18,000 18 000 36 000 18,000 : 108,0001 -- ... Leased Equipment 27,600 27,600_ 27,600 55,200 27,600 I 165,6 00 ALS Fees 132.454 ; 40.015 78,846 222,115 127.764 601.194 Total Operating 501,694 ! 362,882 421,987 938,7101 517,939 2,743,211 I .. ..F17 . J_ . . . .. I I-- 0 . • . ' -----------! • t Peratul8 Gain (Loss) 265,143 ; (121,033) 230,315 212,141 ' 593,092 B. List of Commitments and Potential Commitments Care Ambulance has no commitments or potential commitments which may impact assets, lines of credit, guarantor letters or otherwise affect our financial ability to perform the contract services. • 63 • ITEM 21 : OVERALL OPERATIONAL SYSTEM AND DESIGN City of La Palma —EOA# 13 Care Ambulance Service considers it a privilege to submit our response to the OCFA'.s RFP to provide emergency ambulance services to the City of La Palma. We have proudly served the City of La Palma since 2005. We look forward to continuing our excellent working relationships with the OCFA and City of La Palma. Care Ambulance will continue to provide the City of La Palma an operational system and design plan that exceeds the competitive bid criteria, specifications, requirements and performance expecta- tions set forth in the RFP. Care Ambulance offers the City of La Palma a trusted partner in patient care, experienced local care- givers, a knowledgeable leadership team and a customer- focused organization. No other local pro- vider can match our expertise in creating innovative public-private partnerships, our proven experi- ence exceeding the City of La Palma standards and our infrastructure of Orange County resources to provide disaster support. This expertise is critical to ensure uninterrupted quality ambulance service. Care Ambulance will continue to work cooperatively with the City of La Palma and the OCFA to ensure that our continued EMS system takes into account the priorities of clinical excellence, consis- tent response times and state -of- the -art systems management. 1. Exceeding Operational Plan Requirements Care Ambulance will continue to provide a minimum of one (1) staffed and licensed Basic Life Sup- port (BLS) ambulance stationed and housed in the City of La Palma, on a twenty-four (24) hour per day /seven (7) day per week basis. The business of providing emergency ambulance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and therefore commits to the full-time deployment of ambulance resources in the City of La Palma. The ambu- lance shall serve as the primary ambulance, dedicated solely for use to the City of La Palma and OCFA. A number of ambulance companies have implemented flexible deployment strategies or System Status Management (SSM) in the wake of growing pressures to increase their own efficiencies and profit. They have attempted to match EMS demand with the allocation of ambulance resources. While the overall concept may appear to be financially sound, Care Ambulance believes that it actu- ally delivers inferior service. SSM and flexible deployment take an unnecessary toll on EMT personnel due to frequent post -loca- tion changes, placing a higher priority on posting for call demand than geographic coverage. This results in unacceptable and even life- threatening response times in peripheral parts of a service area. Care Ambulance is committed to continuing our established policy of a fixed city- specific twenty - four (24) hour ambulance station as permanent location within the City of La Palma. • Listed below is our current La Palma ambulance station location, which is (and will be) staffed with one exclusively dedicated 24 -hour ambulance and crew, with a minimum of two (2) EMTs: 64 • City of La Palma — 7872 Walker Street, Suite 103, La Palma This location offers excellent area coverage for La Palma with immediate access to adjacent OCFA partner cities. With Care's proposed deployment plan, neither patients nor OCFA firefighters have to wait for an ambulance to respond from a neighboring city. Care's crews are living and working within La Palma. This is very similar to our current programs within the Cities of Anaheim, Buena Park, Costa Mesa, Garden Grove, Fountain Valley, Fullerton, La Palma and Stanton. These programs have been so successful that we have been able to reduce Code 1 red lights and siren. response times to less than six (6) minutes and Code 1 expeditious response without red lights and siren. response times to less than eight (8) minutes. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances are automatically transferred into the City of La Palma to ensure consistent ambulance coverage. The automatic back-up coverage process begins whenever the unit dedicated to the City of La Palma is dispatched on a request for service. The process is best compared to an inventory system, in which a piece of inventory, or in this case an emergency ambulance, is placed on a call it is immediately replaced by an additional ambulance. This ensures that the City of La Palma is constantly covered, with no lapses in emergency ambulance coverage. Care's existing move -up or post location for the City of La Palma is the intersection of La Palma Ave. and Walker Street. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts, including our current service in La Palma. This allows Care Ambu- lance to deliver ambulance response times unmatched by any other local ambulance provider. Care Ambulance recognizes the inherent difficulty in predicting the need for emergency ambulance responses. With a single catastrophic event, it is possible to deplete the resources of the dedicated ambulances positioned in the City of La Palma. For that reason, Care Ambulance commits to utiliz- ing any and all available ambulances within its fleet of 118 other ambulances to satisfy emergency responses within the City of La Palma. Further, the management team of Care Ambulance is on -site and available twenty -four (24) hours a day to respond to any inquiries La Palma City officials or OCFA department personnel may have regarding any incident. Exceeding Response Time Standards The most critical measure of an emergency ambulance service's performance is its response times. While clinical performance is essential, it is not as commonly understood or easily measured as response times. The key issue for most patients and the public is: how long does it take to get an ambulance after making the call for help? It is for that reason that Care Ambulance agrees to be held to a higher standard. Care Ambulance takes great pride in our documented delivery of superior response times. Care • Ambulance commits to exceed the minimum response time requirements set forth in this RFP at the exceptional levels set forth below: 65 • • Care agrees to exceed the minimum response time requirements, as specified in the Request P � uest P q for Proposal by agreeing to a 9 minute, 59 second, 93% compliance standard for all requests for emergency services and a 14 minute, 59 second, 93% compliance standard for all urgent services. These response time standards are extremely stringent and concrete. Unlike other bidders, these are response time standards that Care Ambulance achieves today. We are not promising something that we haven't done before. We do it today and we will continue do it for the City of La Palma. To date, Care Ambulance Service has never failed to meet our 9 -1 -1 emergency contracted response time obligations, nor been penalized for any sub - standard system performance. Care Ambulance is very confident in our abilities to deliver timely ambulance services and we propose to exceed the requirements of the RFP with the below listed monetary penalties for non - compliance: PER RESPONSE PRIORITY CODE: PENALTY IMPOSED: 93% or Better None 90% — 92.9% $1,000 85% — 89.9% $2,000 Less than 84.9% $3,000 We recognize that shorter response times are an integral part of quality patient care and in many 11P emergencies may reduce mortality. City of La Palma Contract Renewed On November 15, 2007 our contract with the OCFA and City of La Palma was renewed under the same terms and conditions as our existing contract. The renewal agreement was to begin on Septem- ber 1, 2009 and expire on August 31, 2014. Following the unanimous approval by the OCFA Board of Directors of our contract renewal, new information was provided by the State of California EMS Authority to the OCFA regarding the abil- ity to extend ambulance contracts without a competitive process. Because of the identified technical issue, the OCFA, in consultation with the Orange County EMS Agency elected to include the City of La Palma in this RFP process, even though all parties desired a contract extension. EMT -D Defibrillation is the most effective treatment for out -of- hospital ventricular fibrillation. Care Am- bulance is proud to be the first ambulance service in Orange County to provide Automatic External Defibrillators (AEDs) on all ambulance vehicles. Medical research shows that the sooner defibrillation can be administered to a patient in ventricular fibrillation; the better the chances are that normal cardiac activity can be restored. With the degen- erative nature of ventricular fibrillation, seconds can literally mean the difference between life and death. • Out -of- hospital defibrillation of cardiac arrest patients was one of the primary reasons for initial 66 • development of paramedic programs p p grams zn the 1970s. Since that time, the science of paramedicine has evolved, and more extensive and definitive therapy is within the scope of paramedics. Technological development of an automated defibrillator — a computerized electro- cardiographic recognition pro- gram combined with a defibrillator — allows non - paramedic level rescuers to safely and effectively administer defibrillation. Care believes that automated defibrillation is a useful adjunct to firefighter - paramedics. and Care Ambulance is firmly committed to continuing to provide AEDs in all ambulance vehicles and for all Ambulance crews. Bariatric Gurneys and Ambulances According to the Center for Disease Control and Prevention (CDC) there are approximately 7.5 million morbidly obese adults (defined as more than 100 lbs. overweight) in the U.S. or roughly 5% of all adults. Safe ambulance transport of morbidly obese patients presents many challenges, to the patients and rescuers. For the patients, a reluctance to call for 9 -1 -1 services because the experience of being transported is so painful, hazardous and humiliating. For rescuers, the increased threat of a significant back injury. Care Ambulance recognizes the operational challenges of transporting a bariatric patient and has designed our new ambulances to safely and efficiently transport these patients. Each of our new am- bulances has been designed to transport the Stryker MX -Pro Bariatric Transport Gurney system with 4IP aluminum loading ramps and an electric wench. The Stryker MX-Pro Bariatric Transport Gurney has a maximum weight capacity of 1,600 lbs. and an additional 12 inch width for patient comfort. Us- ing this new system, we can safely and humanely transport bariatric patients without fear of injuries to our patients or rescuers. Changing Demographics of Orange County California has been a trendsetter for the nation in a variety of ways for the past three decades. In Orange County, rapid and profound ethnic transformation is one of the more significant examples of this phenomenon. With ethnic transformation come new challenges. It has been estimated by UCLA researchers that within Southern California, 224 different languages are spoken. One of the most frustrating events for a paramedic or EMT is to arrive on scene of a medical emer- gency and be unable to communicate with the patient or family members. Often, due to circum- stances beyond the control of the patient, they are unable to provide complete information regard- ing their past medical history or current medications. This lack of accurate information can delay emergency medical treatment and cause complications. Care Ambulance recognizes that immediate communication with our patients is essential, but it is impossible to teach all our EMT caregivers to speak and communicate in multiple languages. For that reason, Care Ambulance equips each ambulance within our fleet with a cellular telephone and Care Ambulance contracts with an approved telephone translation service. • When our EMT personnel arrive on -scene of a medical emergency and cannot communicate with a patient or family members, EMTs are instructed to contact the telephone translation service using 67 the cellular telephone. The translation service then connects an approved translator with our EMT and patient to ensure complete and accurate communications. The United States Census Bureau categorizes a household as "linguistically isolated" if no person over age 14 speaks only English and no person over 14 who speaks a language other than English speaks English "very well." In Southern California, 33 percent of Spanish - speaking households, 36 percent of Asian or Pacific Island households and almost 20 percent of all households are linguistically iso- lated. It is our job to ensure that these families are not isolated from receiving life - saving emergency ambulance services. Community Oriented Ambulance Service During the last 10 years, many local public safety agencies have demonstrated the value of commu- nity oriented" programs, including the importance of giving back to the community. Care Ambu- lance has also observed the value of these programs, and has developed similar methods to involve our EMT personnel with the communities we serve. Care's latest community program has been very innovative and we believe • •' ""' `� the first in the nation. Care Ambulance has taken the exterior sides of r "_ sx :. ambulances and converted them into "rolling billboards" for injury pre - vention and child safety awareness. Our first ambulance with a Public b ' Safety Announcement (PSA) exterior message was outfitted with a x ' * drowning prevention campaign. This ambulance served as the backdrop for a locally televised ' " " " '' 'pppC ' y . .. ' ) press conference for drowning prevention hosted by the Orange � County Fire Chief's Association and has been seen by thou- sands of different families at local health and community fairs. Our first PSA ambulance was so successful that we have recently >.. added five additional PSA ambulances promoting the following safety messages: never leave a child unattended in a car; the importance of children wearing helmets; the im- portance of parents using child safety seats; and anti - drowning campaign messages. Care's program of "Rolling Billboards" recently received recognition from the American Ambulance Association for Outstanding Community Service. Care Ambulance takes great pride in our community involvement and our personnel look forward to continuing their interacting with the residents of La Palma. Community Emergency Response Teams (CERT) The Community Emergency Response Team (CERT) Program educates people about disaster preparedness for hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations. Fol- lowing a major disaster, first responders who provide fire and medical services may not be able to meet the demand for these services. Factors such as number of victims, communication failures, and • road blockages may prevent people from accessing emergency services they have come to expect at a moment's notice through 9 -1 -1. People will have to rely on each other for help in order to meet their immediate life saving and life sustaining needs. CERT is about readiness, people helping people, 68 • rescuer safety, and doing the greatest good for the greatest number of people. CERT is a positive and realistic approach to emergency and disaster situations where citizens will be initially on their own and their actions can make a difference. Care Ambulance recognizes the important need to train community volunteers to assist in times of disaster and we pledge our support to a community based CERT program. 2. Crew Configuration Each of Care's emergency ambulances is staffed with two (2) EMTs who, at minimum, are licensed at the EMT-Basic level. In addition, each EMT has completed Care's "Paramedic Assist" training course, Incident Command Systems 100 (ICS 100) training and an approved hazardous materials first responder awareness course. EMTs assigned to the City of La Palma dedicated emergency transport ambulance may be approved by the OCFA and is assigned to a fifty -six (56) hour workweek schedule consistent with the standard OCFA firefighter schedule. This staffing pattern allows for a more coordinated team effort and pro- vides necessary familiarity with staffing. 3. Supervisory Plan of Crews Currently, Care Ambulance Service provides an on -duty Operations Manager on a twenty -four (24) hour basis, seven (7) days a week. This Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Man- ager is located at our corporate offices in Orange. The on -duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center or directly through his cellular telephone. The following individuals currently work as Operations Managers in Care's Orange County Division: • Rick Mount — Employed with Care Ambulance for 31 years. • Marc Jessner — Employed with Care Ambulance for 17 years. • John Sanders — Employed with Care Ambulance for 8 years. All Operations Managers employed by Care Ambulance have successfully com- pleted training at the ICS 300 level, California State EMS Authority- approved • ` * t Ambulance Strike Leader training and ° ' have successfully led an Ambulance Strike ' ` 2 Team on a deployment. All have corn- ) r' 1 w l pleted the Ambulance Service Manager 4x 4` (ASM) training offered by the American Ambulance Association and most recently all have completed the Ambulance Supervisors Course offered by Texas A&M University. All Opera- tions Managers have completed all required FEMA training, including IS 700 NIMS, IS 703 NIMS Resource Management and IS 800 National Response Plan. In addition, all Operations Mangers have completed the Orange County EMS Agency courses in Bio- Terrorism (CBRNE) and First Re- sponder Awareness (FRA) and First Responder Operations (FRO). • On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned 69 III personnel. They are deployed in a Code 3 capable vehicle equipped with p all necessary fire depart- ment radios and extra medical equipment, including back- boards, medical supplies and oxygen. Each Operations Manager vehicle is also equipped with a Mobile Data Computer (MDC) allowing our supervisory personnel to continually monitor the location and activities of all Care ambulances within Orange County. 4. Overall Summary of Care's Southern California Operations A. Total Number of Ambulances in Fleet Care Ambulance provides a response ready fleet of 118 ambulances licensed to provide ambulance services in Orange County. We are the largest provider of emergency and non - emergency ambulance services in Orange County. Each emergency ambulance in Care's fleet is outfitted with the latest technology, including 800 MHz mobile radios and satellite -based Automatic Vehicle Locator (AVL) tracking systems. All of Care's ambulances meet and exceed the safety and equipment requirements listed in the RFP. B. Total Number of Employees By selecting Care Ambulance as the EMS Emergency Transportation Services provider for the City of La Palma, the City will gain an experienced, dedicated workforce trained to the highest clinical standards. Care Ambulance employs 796 individuals. The following is a breakdown of employees ac- cording to job category: • EMT Staff 576 Communications 23 Field Training Officers 40 RNs / RCPs 42 Managers / Directors / Owners 30 Administrative / Billing 79 Fleet Maintenance 6 C. Contact Information for Third•Patty Billing and Collection Care Ambulance understands that public impression regarding the delivery of our services is very important. Often, the last contact patients have with an EMS provider is to resolve their bill for ser- vices. How their bill for services is handled makes a lasting impression. If performed poorly, it may tarnish even the best clinical outcome. Care Ambulance recognizes this and as a result performs all billing services in -house with the exception of third party collections. By using compassionate billing practices designed to seek reimbursements from insurance carriers (MediCare, MediCal and private insurances companies), Care's billing staff have become experts in maximizing insurance reimbursement to lessen the patients' out of pocket expense. Contact Information for our Third Party Collection Agency is as follows: The Outsource Group 1801 California, Corona, CA 92881 Representative — Scott Hall (951) 898 -4315 D. Clinical Contacts • Care Ambulance provides clinical support and training for all employees through our in -house Train- ing Department. With our full -time clinical education staff, including our participatory Medical Director, Care offers the City of La Palma the highest possible clinical standards. Contacts for the 70 • Medical Director and Training Department are: • Medical Director, Dr. Michael Martin, Telephone (562) 698 -0811, Ext 7511 • Training Manager, Kevin Chao, Telephone (714) 288 -3818 • Driver Training Manager, Sergio Montoya, Telephone (714) 288 -3920 5. Budget for City of La Palma Emergency Ambulance Operations, combined with the other four (4) areas being proposed by Care Ambulance Service. A. Financial information which will estimate the cost of the proposed operation. Care's Proposed Operating Budget I CYPRESS LA LOS SEAL STANTON AREA TOTAL 1 1 PALMA ALAMITOS BEACH [ranports 1,430 451 879 2,398 1,872 7,030 1 Gross Revenue 1,394,250 ; 439,725 857,025 2,338,050 1,825,200 6,854,250 j Contractual /Bad Debt I W/O 1627.413) . (197.876) (428.513) 11.169.025) (1.095.120) (3.517.947) I Net Revenue 766,837 241,849 428,512 1,169,025 730,080 3,336,303 - -- -- - -•. .... ._....._..----- - - - -- Number of Ambulances 1 _ 1 1 2 1 6 1 .- _ _ _ _ i 41P 1____ Medical Supply Fees Wages 40,255 ._ _ 12,696. 24,744 67,504 52,697 _ 1_97,89_5 _ 205,368 205,368 , 205,368 410,736 205,368 1,232,208 j - . Benefits & Payroll Taxes 43,127: 43,127 43,127 86,255 43,127 __ 258,764 1 Gas & Oil 10,482 3,306 ; 6,443 17,577 t 13,722 ; 51,5301 Insurance 6,160 6,160 . 6,160 12,320 6,160 36,960 Repairs & Maintenance 6,321 ' 1,993~ 3,885 10,599 8,274 31,072 1 Medical Supplies _ 4,076 _ 1,285: 2,505 6,834 5,335 20,035 k_ Uniforms & Linen 2,311: 729: 1,421 3,876 3,026. 11,363 _ _ Licenses 1,250: ___ 1,250 . 1,250 2,500 1,250 7,500 r Office Supplies 4,290 , 1,353 ' 2,637 7,194 5,616 21,090 L Rent & Utilities 18,000 i 18,000 ' 18,000 36,000 18,000 ; 108,000 Leased Equipment 1 27,600 -` 27,600 ! 27,600 _ 55,200 27,600 __ _ 165,600 I A IS Fees T 132.454 40.015: 78.846 _ 222.115 127.764E , 601.194 - Total Operatin 501,694 ; 362,882 421,987 I 938,710 517,939 ' - 2,743,211 Expenses I 1 ! - g am . I - • - - - - • - - . - ._ . • r -- -- ------ 265,143 : (121,033) : 6,525 230,315 212,141: 593,092 () t B. List of Commitments and Potential Commitments Care Ambulance has no commitments or potential commitments which may impact assets, lines of credit, guarantor letters or otherwise affect our financial ability to perform the contract services. 71 • ITEM 21 : OVERALL OPERATIONAL SYSTEM AND DESIGN City of Los Alamitos — EOA # 14 Care Ambulance has prepared an operational system and design plan that exceeds the competitive bid criteria, specifications, requirements and performance expectations set forth in the RFP. One of the true advantages Care Ambulance brings to the City of Los Alamitos emergency ambulance trans- port program is seasoned management and experience with new start -up systems. This experience is critical to ensure uninterrupted quality ambulance service. Care Ambulance's management team and implementation techniques have been tested and proven, and our capabilities have been dearly demonstrated. It is the goal of Care Ambulance to work cooperatively with the City of Los Alamitos and the OCFA to put in place an EMS system that takes into account the priorities of clinical excellence, consistent response times and state -of- the -art systems management. Together with the City of Los Alamitos and OCFA we will create an "Interagency Partnership ". Throughout the world, across the country and around Orange County, new relationships are being created that are fundamentally different from those of years ago. In former days, government and business were commonly conducted with competition as the main underlying theme. Today, more collaborative approaches are necessary. There are two fundamental and intertwined reasons that more collaborative processes are being used: the increasing demand for quality; and economic pressures experienced by both public and private organizations. Creating Interagency Partnerships that emphasize collaboration instead of competition is a creative way to work together that can improve the outcome for our patients and organizations. 1. Exceeding Operational Plan Requirements Care Ambulance proposes to provide a minimum of one (1) staffed and licensed Basic Life Support (BLS) ambulance stationed and housed in the City of Los Alamitos, on a twenty -four (24) hour per day /seven (7) day per week basis. The business of providing emergency ambulance services is a twenty -four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and there- fore commits to the full -time deployment of ambulance resources in the City of Los Alamitos. The ambulance shall serve as the primary ambulance, dedicated solely for use to the City of Los Alamitos and OCFA. A number of ambulance companies have implemented flexible deployment strategies or System Status Management (SSM) in the wake of growing pressures to increase their own efficiencies and profit. They have attempted to match EMS demand with the allocation of ambulance resources. While the overall concept may appear to be financially sound, Care Ambulance believes that it actu- ally delivers inferior service. SSM and flexible deployment takes an unnecessary toll on EMT personnel due to frequent post-loca- tion changes and places a higher priority on posting for call demand than geographic coverage. This results in unacceptable and even life- threatening response times in peripheral parts of a service area. • Care Ambulance is committed to continuing our policy of establishing a fixed city - specific twenty- 72 • four (24) hour ambulance station as permanent location within the City of Los Alamitos. Listed below is our proposed Los Alamitos ambulance station location: City of Los Alamitos — 4732 Katella Avenue, Los Alamitos To be staffed with one exclusively dedicated 24 -hour ambulance and crew, with a minimum of two (2) EMTs. This location offers excellent area coverage for Los Alamitos with convenient access to the 605 freeway and adjacent OCFA partner cities. With Care's proposed deployment plan, neither patients nor OCFA firefighters have to wait for an ambulance to respond from a neighboring city. Care's crews will be living and working within Los Alamitos. This is very similar to our current programs within the Cities of Anaheim, Buena Park, Costa Mesa, Garden Grove, Fountain Valley, Fullerton, La Palma and Stanton. These programs have been so successful that we have been able to reduce Code 3. red lights and siren, response times to less than six (6) inutes and Code 2. expeditious response without red lights and siren. response times to less than eight (8) minutes. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of Los Alamitos to ensure consistent ambulance coverage. The automatic back -up coverage process will begin whenever the unit dedicated to the City of Los Alamitos is dispatched on a request for service. The process is best compared to an inventory system, in which a piece of inventory, or in this case an emergency ambulance, is placed on a call it is immediately replaced by an additional ambulance. This ensures that the City of Los Alamitos is constantly covered, with no lapses in emergency ambulance coverage. Care's move -up or post location for the City of Los Alamitos is: • Intersection of Katella Avenue and Los Alamitos Blvd. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts. This allows Care Ambulance to deliver ambulance response times unmatched by any other local ambulance provider. Care Ambulance recognizes the inherent difficulty in predicting the need for emergency ambulance responses. With a single catastrophic event, it is possible to deplete the resources of the dedicated ambulances positioned in the City of Los Alamitos. For that reason, Care Ambulance commits to utilizing any and all available ambulances within its fleet of 118 other ambulances to satisfy emer- gency responses within the City of Los Alamitos. Further, the management team of Care Ambulance is on -site and available twenty -four (24) hours a day to respond to any inquiries Los Alamitos City officials or OCFA department personnel may have regarding any incident. Exceeding Response Time Standards The most critical measure of an emergency ambulance service's performance is its response times. While clinical performance is essential, it is not as commonly understood or easily measured as response times. The key issue for most patients and the public is: how long does it take to get an • ambulance after making the call for help? It is for that reason that Care Ambulance agrees to be held to a higher standard. 73 • Care Ambulance takes great pride in our documented delivery of superior response times. Care Ambulance commits to exceed the minimum response time requirements set forth in this RFP at the exceptional levels set forth below: • Care agrees to exceed the minimum response time requirements, as specified in the Request for Proposal by agreeing to a 9 minute, 59 second, 93% compliance standard for all requests for emergency services and a 14 minute, 59 second, 93% compliance standard for all urgent services. These response time standards are extremely stringent and concrete. Unlike other bidders, these are response time standards that Care Ambulance achieves today. We are not promising something that we haven't done before. We do it today and we will do it for the City of Los Alamitos. To date, Care Ambulance Service has never failed to meet our 9 -1 -1 emergency contracted response time obligations, nor been penalized for any sub - standard system performance. Care Ambulance is very confident in our abilities to deliver timely ambulance services and we propose to exceed the requirements of the RFP with the below listed monetary penalties for non - compliance:' PER RESPONSE PRIORITY CODE: PENALTY IMPOSED: 93% or Better None 90% – 92.9% $1,000 85% – 89.9% $2,000 Less than 84.9% $3,000 We recognize that shorter response times are an integral part of quality patient care and in many emergencies may reduce mortality. EMT -D Defibrillation is the most effective treatment for out -of- hospital ventricular fibrillation. Care Am- bulance is proud to be the first ambulance service in Orange County to provide Automatic External Defibrillators (AEDs) on all ambulance vehicles. Medical research shows that the sooner defibrillation can be administered to a patient in ventricular fibrillation; the better the chances are that normal cardiac activity can be restored. With the degen- erative nature of ventricular fibrillation, seconds can literally mean the difference between life and death. Out-of-hospital defibrillation of cardiac arrest patients was one of the primary reasons for initial development of paramedic programs in the 1970s. Since that time, the science of paramedicine has evolved, and more extensive and definitive therapy is within the scope of paramedics. Technological development of an automated defibrillator — a computerized electro- cardiographic recognition pro- gram combined with a defibrillator — allows non - paramedic level rescuers to safely and effectively administer defibrillation. • • Care believes that automated defibrillation is a useful adjunct to firefighter - paramedics, and Care Ambulance is firmly committed to continuing to provide AEDs in all ambulance vehicles and for all ambulance crews. 74 • Bariatric Gurneys and Ambulances According to the Center for Disease Control and Prevention (CDC) there are approximately 7.5 million morbidly obese adults (defined as more than 100 lbs. overweight) in the U.S. or roughly 5% of all adults. Safe ambulance transport of morbidly obese patients presents many challenges, to the patients and rescuers. For the patients, a reluctance to call for 9 -1 -1 services because the experience of being transported is so painful, hazardous and humiliating. For rescuers, the increased threat of a significant back injury. Care Ambulance recognizes the operational challenges of transporting a bariatric patient and has designed our new ambulances to safely and efficiently transport these patients. Each of our new am- bulances has been designed to transport the Stryker MX-Pro Bariatric Transport Gurney system with aluminum loading ramps and an electric wench. The Stryker MX -Pro Bariatric Transport Gurney has a maximum weight capacity of 1,600 lbs. and an additional 12 inch width for patient comfort. Us- ing this new system, we can safely and humanely transport bariatric patients without fear of injuries to our patients or rescuers. Changing Demographics of Orange County California has been a trendsetter for the nation in a variety of ways for the past three decades. In Orange County, rapid and profound ethnic transformation is one of the more significant examples of this phenomenon. With ethnic transformation come new challenges. It has been estimated by UCLA researchers that within Southern California, 224 different languages are spoken. One of the most frustrating events for a paramedic or EMT is to arrive on scene of a medical emer- gency and be unable to communicate with the patient or family members. Often, due to circum- stances beyond the control of the patient, they are unable to provide complete information regarding their past medical history or current medications. This lack of accurate information can delay emer- gency medical treatment and cause complications. Care Ambulance recognizes that immediate communication with our patients is essential, but it is impossible to teach all our EMT caregivers to speak and communicate in multiple languages. For that reason, Care Ambulance equips each ambulance within our fleet with a cellular telephone and Care Ambulance contracts with an approved telephone translation service. When our EMT personnel arrive on -scene of a medical emergency and cannot communicate with a patient or family members, EMTs are instructed to contact the telephone translation service using the cellular telephone. The translation service then connects an approved translator with our EMT and patient to ensure complete and accurate communications. The United States Census Bureau categorizes a household as "linguistically isolated" if no person over age 14 speaks only English and no person over 14 who speaks a language other than English speaks English "very well." In Southern California, 33 percent of Spanish - speaking households, 36 percent of Asian or Pacific Island households and almost 20 percent of all households are linguistically iso- lated. It is our job to ensure that these families are not isolated from receiving life- saving emergency • ambulance services. 75 • Community Oriented Ambulance Service During the last 10 years, many Local public safety agencies have demonstrated the value of "commu- nity oriented" programs, including the importance of giving back to the community. Care Ambu- lance has also observed the value of these programs, and has developed similar methods to involve our EMT personnel with the communities we serve. Care's latest community program has been very innovative and we believe the first in the nation Care Ambulance has taken the exterior sides of ambulances and converted them into "rolling billboards" for injury prevention and child safety awareness. Our first ambulance with a Public Safety Announcement (PSA) exterior mes- sage was outfitted with a drowning prevention campaign. This ambulance served as the backdrop for a locally televised press _ conference for drowning prevention hosted by the Orange i 4 '��*� '' .4,41 County Fire Chief's Association and has been seen by thou- a �„o . sands of different families at local health and community fairs. - ; ° Our first PSA ambulance was so successful that we have recent- - ' '• ' ly added five additional PSA ambulances promoting the fol- lowing safety messages: never leave a child unattended in a car; the importance of children wearing helmets; the importance of parents using child safety seats; and anti - drowning campaign messages. Care's program of "Rolling IP Billboards" recently received recognition from the American Ambulance Association for Outstanding Community Service. Care Ambulance takes great pride in our community involvement and our personnel look forward to interacting with the residents of Los Alamitos. Community Emergency Response Teams (CET) The Community Emergency Response Team (CERT) Program educates people about disaster preparedness for hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, Light search and rescue, team organization, and disaster medical operations. Fol- lowing a major disaster, first responders who provide fire and medical services may not be able to meet the demand for these services. Factors as number of victims, communication failures, and road blockages may prevent people from accessing emergency services they have come to expect at a moment's notice through 9 -1 -1. People will have to rely on each other for help in order to meet their immediate life saving and life sustaining needs. CERT is about readiness, people helping people, rescuer safety, and doing the greatest good for the greatest number. CERT is a positive and realistic approach to emergency and disaster situations where citizens will be initially on their own and their actions can make a difference. Care Ambulance recognizes the important need to train community volunteers to assist in times of disaster and we pledge our support to a community based CERT program. • 2. Crew Configuration Each of Care's emergency ambulances is staffed with two (2) EMTs who, at minimum, are licensed at 76 • the EMT-Basic level. In addition, each EMT will have completed Care's "Paramedic Assist" training course, Incident Command Systems 100 (ICS 100) training and an approved hazardous materials first responder awareness course. EMTs assigned to the City of Los Alamitos dedicated emergency transport ambulance may be ap- proved by the OCFA and shall be assigned to a fifty-six (56) hour workweek schedule consistent with the standard OCFA firefighter schedule. This staffing pattern allows for a more coordinated team effort and provides necessary familiarity with staffing. 3. Supervisory Plan of Crews Currently, Care Ambulance Service provides an on -duty Operations Manager on a twenty-four (24) hour basis, seven (7) days a week. This Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Man- ager is located at our corporate offices in Orange. The on -duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center or directly through his cellular telephone. The following individuals currently work as Operations Managers in Care's Orange County Division: • Rick Mount — Employed with Care Ambulance for 31 years. • Marc Jessner — Employed with Care Ambulance for 17 years. • John Sanders — Employed with Care Ambulance for 8 years. 4 1 ° All Operations Managers employed by Care Ambulance have successfully com- pleted training at the ICS 300 level, California State EMS Authority ap- { proved Ambulance Strike Leader training and have successfully lead an Ambu 3 lance Strike Team on a deployment. All .'` , have completed the Ambulance Service ' to - Manager (ASM) training offered by the American Ambulance Association and most recently all have completed the Ambulance Supervisors Course offered by Texas A&M University. All Operations Managers have completed all required FEMA training, including IS 700 NIMS, IS 703 NIMS Resource Management and IS 800 National Response Plan. In addition, all Operations Mangers have completed the Orange County EMS Agen- cy courses in Bio- Terrorism (CBRNE) and First Responder Awareness (FRA) and First Responder Operations (FRO). On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 capable vehicle equipped with all necessary fire depart- ment radios and extra medical equipment, including back- boards, medical supplies and oxygen. Each Operations Manager vehicle is also equipped with a Mobile Data Computer (MDC) allowing our supervisory personnel to continually monitor the location and activities of all Care ambulances • within Orange County. 77 • 4. Overall Summary of ary Care's Southern California Operations A. Total Number of Ambulances in Fleet Care Ambulance provides a response ready fleet of 118 ambulances licensed to provide ambulance services in Orange County. We are the largest provider of emergency and non - emergency ambulance services in Orange County. Each emergency ambulance in Care's fleet is complete with the latest technology, including 800 MHz mobile radios and satellite -based Automatic Vehicle Locator (AVL) tracking systems. All of Care's ambulances meet and exceed the safety and equipment requirements listed in the RFP. B. Total Number of Employees By selecting Care Ambulance as the EMS Emergency Transportation Services provider for the City of Los Alamitos, the City will gain an experienced, dedicated workforce trained to the highest clini- cal standards. Care Ambulance employs 796 individuals. The following is a breakdown of employees according to job category: EMT Staff 576 Communications 23 Field Training Officers 40 RNs / RCPs 42 Managers / Directors / Owners 30 Administrative / Billing 79 Fleet Maintenance 6 C. Contact Information for Third Party Billing and Collection Care Ambulance understands that public impression regarding the delivery of our services is very important. Often, the last contact patients have with an EMS provider is to resolve their bill for ser- vices. How their bill for services is handled makes a lasting impression. If performed poorly, it may tarnish even the best clinical outcome. Care Ambulance recognizes this and as a result performs all billing services in -house with the exception of third party collections. By using compassionate billing practices designed to seek reimbursements from insurance carriers (MediCare, MediCal and private insurances companies), Care's billing staff have become experts in maximizing insurance reimbursement to lessen the patients' out of pocket expense. Contact Information for our Third Party Collection Agency is as follows: The Outsource Group 1801 California, Corona, CA 92881 Representative — Scott Hall (951) 898 -4315 D. Clinical Contacts Care Ambulance provides clinical support and training for all employees through our in -house Train- ing Department. With our full-time clinical education staff, including our participatory Medical Director, Care offers the City of Los Alamitos the highest possible clinical standards. Contacts for the Medical Director and Training Department are: • • Medical Director, Dr. Michael Martin, Telephone (562) 698 -0811, Ext 7511 • Training Manager, Kevin Chao, Telephone (714) 288 -3818 78 • • Driver Training Manager, Sergio Montoya, Telephone (714) 288 -3920 5. Budget for City of Los Alamitos Emergency Ambulance Operations, combined with the other four (4) areas being proposed by Care Ambulance Service. A. Financial information which will estimate the cost of the proposed operation. Care's Proposed Operating Budget CYPRESS 1 L LOS 5EAL STANTON AREA TOTAL _ PAL MA ALAMITOS BEACH Transkorts (Per OCFA) 1,430 451 879 _ 2,398 1,872 ^ - 7,030 - -. Gross Revenue 1,394,250 1 439,725 6,854,250 Contractual / Bad Debt I 39,725 2,338,050 I 1,825,200 1 W/0 (627.413) i (197.876) (428.513) : 11.169.025) 1 (1.095.120) (3.517.947) I INet Revenu e - 766,837 • 241849 428,512 1169025730,080 3,336,303 ces 11 1 1• 2 6 I ol� - . 1 _ _ a I_-- Medical Supply 1 Fees . _ 40,255 744 . 12,696 - 24, r . _.__..._. .... - .._. 67,504 52,697 ___ 1_97,89_5 1 1 Wades + 205,368 j 205,368 _ 205,368 5,3 ' 410,736 2068 1,232,2081 f 1 Benefits & Payroll Taxes 43,127 T 43,127 • 43,127 86,255 43,127 258,764 Gas & Oil 10,4821 3,306 6,443 17,577 13,722 51,530 � . ce 6,160 6,160 _ _ _6,16_0 12,320 6,160 _36,960 1 Repairs & Maintenance _ 6,321 1,993 3,885 ; 10,599 8,274. 31,072 Medical Supplies 4,076 1,285 2,505 ; 6,834 5,335 . ... . 20,035 Uniforms & Linen 2,311 729 1,421: 3,876 3,026 11,363 • DcenSeS 1,250 1,250 1,250 Z500 1,250 • Office Supplies 4,290 1 - ,353 ' 2,637 7,194 5,616 I 21,090 I Rent & Utilities 18,000 -- 18,000 18,000 I 36,0001 18,0001 108,0001 Leased Equipment 27,600 I 27,600 _ 27,600: 55,200 ■ 27,600 - 165,600_1 Fees _ 132.454T : - .76 40_015 ; 78.846: 222.115 1274 , 601.19 t ----- Total Operating 501,694 362,882 ' 421,987 ; 938,710 T i ' 517,939 2,743,211 -- - - .. Fslenses - .... _ . .. - . - -- - - - --- .. - - - -- - -- � ____ -- - Operating Gala 265,143 (121,033) ' 6,525 230,315 212,141 593,092 B. List of Commitments and Potential Commitments Care Ambulance has no commitments or potential commitments which may impact assets, lines of credit, guarantor letters or otherwise affect our financial ability to perform the contract services. • 79 • ITEM 21 : OVERALL OPERATIONAL SYSTEM AND DESIGN City of Seal Beach — EOA #21 are Ambulance has prepared an operational system and design plan that exceeds the competitive bid criteria, specifications, requirements and performance expectations set forth in the RFP. One of the true advantages Care Ambulance brings to the City of Seal Beach emergency ambulance trans- port program is seasoned management and experience with new start -up systems. This experience is critical to ensure uninterrupted quality ambulance service. Care Ambulance's management team and implementation techniques have been tested and proven, and our capabilities have been dearly demonstrated. It is the goal of Care Ambulance to work cooperatively with the City of Seal Beach and the OCFA to put in place an EMS system that takes into account the priorities of clinical excellence, consistent response times and state -of- the -art systems management. Together with the City of Seal Beach and OCFA we will create an "Interagency Partnership ". Throughout the world, across the country and around Orange County, new relationships are being created that are fundamentally different from those of years ago. In former days, government and business were commonly conducted with competition as the main underlying theme. Today, more collaborative approaches are necessary. There are two fundamental and intertwined reasons that more collaborative processes are being used: the increasing demand for quality; and economic pressures experienced by both public and private organizations. Creating Interagency Partnerships that emphasize collaboration instead of competition is a creative way to work together that can improve the outcome for our patients and organizations. 1. Exceeding Operational Plan Requirements are Ambulance proposes to provide a minimum of two (2) staffed and licensed Basic Life Sup- port (BLS) ambulances stationed and housed in the City of Seal Beach, on a twenty -four (24) hour per day /seven (7) day per week basis. The business of providing emergency ambulance services is a twenty -four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and there- fore commits to the full-time deployment of two (2) ambulance resources in the City of Seal Beach. These two (2) ambulances shall serve as the primary ambulances, dedicated solely for use to the City of Seal Beach and OCFA. A number of ambulance companies have implemented flexible deploy- ment strategies or System Status Management (SSM) in the wake of growing pressures to increase their own efficiencies and profit. They have attempted to match EMS demand with the allocation of ambulance resources. While the overall concept may appear to be financially sound, Care Ambulance believes that it actually delivers inferior service. SSM and flexible deployment takes an unnecessary toll on EMT personnel due to frequent post -loca- tion changes and places a higher priority on posting for call demand than geographic coverage. This results in unacceptable and even life - threatening response times in peripheral parts of a service area. • Care Ambulance is committed to continuing our policy of establishing a fixed city- specific twenty- four (24) hour ambulance stations as permanent location within the City of Seal Beach. Listed below are our proposed Seal Beach ambulance station locations: 80 • Station 1- Seal Beach Leisure World To be staffed with one exclusively dedicated 24 -hour ambulance and crew, with a minimum of two (2) EMTs. Recognizing that the majority of the calls for service within the City of Seal Beach origi- nate from the Leisure World campus, Care will provide a dedicated ambulance within this gated community. Care Ambulance has had preliminary discussions with the management association from Seal Beach Leisure World and they are supportive of our proposed ambulance station. If an ambulance station cannot be located within Seal Beach Leisure World, Care Ambulance has ° identified an alternate location for our Seal Beach Station 1. The alternate location is located close to Seal Beach Leisure World, offering excellent area coverage and freeway accessibility. The alternate ambulance location is: • 12859 Seal Beach Blvd, Seal Beach, (cross of 405 Freeway) Station 2 —12850 Seal Beach BlveL, Seal Beach, (Cross Street of WestminsterAve.) To be staffed with one exclusively dedicated 24 -hour ambulance and crew, with a minimum of two (2) EMTs. This location offers excellent area coverage for all areas of Seal Beach, the unincorporated area of EOA # 21 (Sunset Beach) and also has immediate access to the 405 and 605 freeways With Care's proposed deployment plan, neither patients nor OCFA firefighters have to wait for an ambulance to respond from a neighboring city. Care's crews will be living and working within Seal 41!° Beach. This is very similar to our current programs within the Cities of Anaheim, Buena Park, Costa Mesa, Garden Grove, Fountain Valley, Fullerton, La Palma and Stanton. These programs have been so successful that we have been able to reduce Code 1 red lights and siren. response times to less than six (6) minutes and Code 1 expeditious response without red lights and siren. response times to less than eight (8) minutes. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of Seal Beach to ensure consistent ambulance coverage. The automatic back -up coverage process will begin whenever the dedicated units to the City of Seal Beach are dispatched on a request for service. The process is best compared to an inventory system, in which a piece of inventory, or in this case an emergency ambulance, is placed on a call it is immediately replaced by an additional ambulance. This ensures that the City of Seal Beach is constantly covered, with no lapses in emergency ambulance coverage. Care's move -up or post location for the City of Seal Beach is: • Intersection of Seal Beach Blvd. and Westminster Ave. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts. This allows Care Ambulance to deliver ambulance response times unmatched by any other local ambulance provider. Care Ambulance recognizes the inherent difficulty in predicting the need for emergency ambulance responses. With a single catastrophic event, it is possible to deplete the resources of both dedicated ambulances positioned in the City of Seal Beach. For that reason, Care Ambulance commits to uti- • lizing any and all available ambulances within its fleet of 118 other ambulances to satisfy emergency responses within the City of Seal Beach. Further, the management team of Care Ambulance is on- 81 • site and available twenty-four (24) hours a day to respond to any inquiries Seal Beach City officials or OCFA department personnel may have regarding any incident. Exceeding Response Time Standards The most critical measure of an emergency ambulance service's performance is its response times. While clinical performance is essential, it is not as commonly understood or easily measured as response times. The key issue for most patients and the public is: how long does it take to get an ambulance after making the call for help? It is for that reason that Care Ambulance agrees to be held to a higher standard. Care Ambulance takes great pride in our documented delivery of superior response times. Care Ambulance commits to exceed the minimum response time requirements set forth in this RFP at the exceptional levels set forth below: • Care agrees to exceed the minimum response time requirements, as specified in the Request for Proposal by agreeing to a 9 minute, 59 second, 93% compliance standard for all requests for emergency services and a 14 minute, 59 second, 93% compliance standard for all urgent services. These response time standards are extremely stringent and concrete. Unlike other bidders, these are response time standards that Care Ambulance achieves today. We are not promising something that we haven't done before. We do it today and we will do it for the City of Seal Beach. To date, Care Ambulance Service has never failed to meet our 9 -1 -1 emergency contracted response time obligations, nor been penalized for any sub - standard system performance. Care Ambulance is very confident in our abilities to deliver timely ambulance services and we propose to exceed the requirements of the RFP with the below listed monetary penalties for non - compliance: PER RESPONSE PRIORITY CODE: PENALTY IMPOSED: 93% or Better None 90% — 92.9% $1,000 85% — 89.9% $2,000 Less than 84.9% $3,000 We recognize that shorter response times are an integral part of quality patient care and in many emergencies may reduce mortality. EMT -D Defibrillation is the most effective treatment for out -of- hospital ventricular fibrillation. Care Am- bulance is proud to be the first ambulance service in Orange County to provide Automatic External Defibrillators (AEDs) on all ambulance vehicles. Medical research shows that the sooner defibrillation can be administered to a patient in ventricular fibrillation; the better the chances are that normal cardiac activity can be restored. With the degen- erative nature of ventricular fibrillation, seconds can literally mean the difference between life and death. 82 Out -of- hospital defibrillation of cardiac arrest patients was one of the primary reasons for initial development of paramedic programs in the 1970s. Since that time, the science of paramedicine has evolved, and more extensive and definitive therapy is within the scope of paramedics. Technological development of an automated defibrillator — a computerized electro- cardiographic recognition pro- gram combined with a defibrillator — allows non - paramedic level rescuers to safely and effectively administer defibrillation. Care believes that automated defibrillation is a useful adjunct to firefighter - paramedics. and Care Ambulance is firmly committed to continuing to provide AEDs in all ambulance vehicles and for all ambulance crews. Bariatric Gurneys and Ambulances According to the Center for Disease Control and Prevention (CDC) there are approximately 7.5 million morbidly obese adults (defined as more than 100 lbs. overweight) in the U.S. or roughly 5% of all adults. Safe ambulance transport of morbidly obese patients presents many challenges, to the patients and rescuers. For the patients, a reluctance to call for 9 -1 -1 services because the experience of being transported is so painful, hazardous and humiliating. For rescuers, the increased threat of a significant back injury. Care Ambulance recognizes the operational challenges of transporting a bariatric patient and has designed our new ambulances to safely and efficiently transport these patients. Each of our new arn- d bulances has been designed to transport the Stryker MX-Pro Bariatric Transport Gurney system with aluminum loading ramps and an electric wench. The Stryker MX-Pro Bariatric Transport Gurney has a maximum weight capacity of 1,6001bs. and an additional 12 inch width for patient comfort. Us- ing this new system, we can safely and humanely transport bariatric patients without fear of injuries to our patients or rescuers. Changing Demographics of Orange County California has been a trendsetter for the nation in a variety of ways for the past three decades. In Orange County, rapid and profound ethnic transformation is one of the more significant examples of this phenomenon. With ethnic transformation come new challenges. It has been estimated by UCLA researchers that within Southern California, 224 different languages are spoken. One of the most frustrating events for a paramedic or EMT is to arrive on scene of a medical emer- gency and be unable to communicate with the patient or family members. Often, due to circum- stances beyond the control of the patient, they are unable to provide complete information regarding their past medical history or current medications. This lack of accurate information can delay emer- gency medical treatment and cause complications. Care Ambulance recognizes that immediate communication with our patients is essential, but it is impossible to teach all our EMT caregivers to speak and communicate in multiple languages. For that reason, Care Ambulance equips each ambulance within our fleet with a cellular telephone and Care Ambulance contracts with an approved telephone translation service. • When our EMT personnel arrive on -scene of a medical emergency and cannot communicate with 83 • a patient or family members, EMTs are instructed to contact the telephone translation service using the cellular telephone. The translation service then connects an approved translator with our EMT and patient to ensure complete and accurate communications. The United States Census Bureau categorizes a household as "linguistically isolated" if no person over age 14 speaks only English and no person over 14 who speaks a language other than English speaks English "very well." In Southern California, 33 percent of Spanish - speaking households, 36 percent of Asian or Pacific Island households and almost 20 percent of all households are linguistically iso- lated. It is our job to ensure that these families are not isolated from receiving life- saving emergency ambulance services. Community Oriented Ambulance Service During the last 10 years, many local public safety agencies have demonstrated the value of "commu- nity oriented" programs, including the importance of giving back to the community. Care Ambu- lance has also observed the value of these programs, and has developed similar methods to involve our EMT personnel with the communities we serve. Care's latest community program has been very innovative and we believe the first in the nation, Care Ambulance has taken the exterior sides of ambulances ,• and converted them into "rolling billboards" for injury prevention and • • child safety awareness. Our first ambulance with a Public Safety An � ' ° " — 64,10 nouncement (PSA) exterior message was outfitted with a drowning prevention campaign. „or- e � . - ! f • This ambulance served as the backdrop for a locally televised ,«+ ; ”, press conference for drowning prevention hosted by the Orange �`': • County Fire Chief's Association and has been seen by thou t sands of different families at local health and community fairs. Our first PSA ambulance was so successful that we have recently added five additional PSA ambulances promoting the following safety mes- _ _ sages: never leave a child unattended in a car; the importance of children wearing helmets; the importance of parents using child safety seats; and anti - drowning campaign messages. Care's program of "Rolling Billboards" recently received recognition from the American Ambulance Asso- ciation for Outstanding Community Service. Care Ambulance takes great pride in our community involvement and our personnel look forward to interacting with the residents of Seal Beach. Community Emergency Response Teams (CERT) The Community Emergency Response Team (CERT) Program educates people about disaster preparedness for hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations. Fol- lowing a major disaster, first responders who provide fire and medical services may not be able to • meet the demand for these services. Factors as number of victims, communication failures, and road blockages may prevent people from accessing emergency services they have come to expect at a moment's notice through 9 -1 -1. People will have to rely on each other for help in order to meet their 84 III immediate life saving and life sustaining needs. g g eds. CERT is about readiness, people helping people, rescuer safety, and doing the greatest good for the greatest number. CERT is a positive and realistic approach to emergency and disaster situations where citizens will be initially on their own and their actions can make a difference. Care Ambulance recognizes the important need to train community volunteers to assist in times of disaster and we pledge our support to a community based CERT program. 2. Crew Configuration Each of Care's emergency ambulances is staffed with two (2) EMTs who, at minimum, are licensed at the EMT-Basic level. In addition, each EMT will have completed Care's "Paramedic Assist" training course, Incident Command Systems 100 (ICS 100) training and an approved hazardous materials first responder awareness course. EMTs assigned to the City of Seal Beach dedicated emergency transport ambulances may be ap- proved by the OCFA and shall be assigned to a fifty-six (56) hour workweek schedule consistent with the standard OCFA firefighter schedule. This staffing pattern allows for a more coordinated team effort and provides necessary familiarity with staffing. 3. Supervisory Plan of Crews Currently, Care Ambulance Service provides an on -duty Operations Manager on a twenty -four (24) hour basis, seven (7) days a week. This Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Man- ager is located at our corporate offices in Orange. The on -duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center or directly through his cellular telephone. The following individuals currently work as Operations Managers in Care's Orange County Division: • Rick Mount — Employed with Care Ambulance for 31 years. • Marc Jessner — Employed with Care Ambulance for 17 years. • John Sanders — Employed with Care Ambulance for 8 years. All Operations Managers employed by Care Ambulance have successfully com- pleted training at the ICS 300 level, Califomia State EMS Authority ap- j .. y} - -' A. proved Ambulance Strike Leader training ` `tt and have successfully lead an Ambu- N. j y 1 f , it , ` i y l ' " ; lance Strike Team on a deployment. All , ; 3 - I ' , i . -.4 , have completed the Ambulance Service i t. 0 Apr Manager (ASM) training offered by the American Ambulance Association and most recently all have completed the Ambulance Supervisors Course offered by Texas A&M Univer- sity. All Operations Managers have completed all required FEMA training, including IS 700 NIMS, IS 703 NIMS Resource Management and IS 800 National Response Plan. In addition, all Opera- . tions Mangers have completed the Orange County EMS Agency courses in Bio- Terrorism (CBRNE) and First Responder Awareness (FRA) and First Responder Operations (FRO). 85 • On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 capable vehicle equipped with all necessary fire depart- ment radios and extra medical equipment, including back- boards, medical supplies and oxygen. Each Operations Manager vehicle is also equipped with a Mobile Data Computer (MDC) allowing our supervisory personnel to continually monitor the location and activities of all Care ambulances within Orange County. 4. Overall Summary of Care's Southern California Operations A. Total Number of Ambulances in Fleet Care Ambulance provides a response ready fleet of 118 ambulances licensed to provide ambulance services in Orange County. We are the largest provider of emergency and non - emergency ambulance services in Orange County. Each emergency ambulance in Care's fleet is complete with the latest technology, including 800 MHz mobile radios and satellite -based Automatic Vehicle Locator (AVL) tracking systems. All of Care's ambulances meet and exceed the safety and equipment requirements listed in the RFP. B. Total Number of Employees By selecting Care Ambulance as the EMS Emergency Transportation Services provider for the City of Seal Beach, the City will gain an experienced, dedicated workforce trained to the highest clinical standards. Care Ambulance employs 796 individuals. The following is a breakdown of employees according to job category: EMT Staff 576 Communications 23 Field Training Officers 40 RNs / RCPs 42 Managers / Directors / Owners 30 Administrative / Billing 79 Fleet Maintenance 6 C. Contact Information for Third Party Billing and Collection Care Ambulance understands that public impression regarding the delivery of our services is very important. Often, the last contact patients have with an EMS provider is to resolve their bill for ser- vices. How their bill for services is handled makes a lasting impression. If performed poorly, it may tarnish even the best clinical outcome. Care Ambulance recognizes this and as a result performs all billing services in -house with the exception of third party collections. By using compassionate billing practices designed to seek reimbursements from insurance carriers (Medicare, MediCal and private insurances companies), Care's billing staff have become experts in maximizing insurance reimbursement to lessen the patients' out of pocket expense. Contact Information for our Third Party Collection Agency is as follows: The Outsource Group 1801 California, Corona, CA 92881 Representative — Scott Hall (951) 898 -4315 • D. Clinical Contacts Care Ambulance provides clinical support and training for all employees through our in -house Train - 86 • in Department. With our full-time P e clinical education staff, including our participatory Medical Director, Care offers the City of Seal Beach the highest possible clinical standards. Contacts for the Medical Director and Training Department are: • Medical Director, Dr. Michael Martin, Telephone (562) 698 -0811, Ext 7511 • Training Manager, Kevin Chao, Telephone (714) 288 -3818 • Driver Training Manager, Sergio Montoya, Telephone (714) 288 -3920 5. Budget for City of Seal Beach Emergency Ambulance Operations, combined with the other four (4) areas being proposed by Care Ambulance Service. A. Financial information which will estimate the cost of the proposed operation. Care's Proposed Operating Budget CYPRESS LA Les SEAL PALMA ALAMITOS BEACH STANTON I AREA TOTAL - Transjorts (Per ()CFA) i _ 1,430 1 451 879 2,398 1,872 r 7,030 Gross Revenue 1,394,250 439,725 • 857,025 2,338,050 1,825,200 I 6,854,250 Contractual / Bad Debt - -- - - ? - - -- ! W/O (627.413) (197.876) (428.513) (1.169.025) ;11.095.120) , (3.517.947) I L Net Revenue 766,837 241,849 i 428,512 1,169, ; 730,080 �_ 3,336,303 IP 1 j Number of Ambulances . - 1 - - 1 1 2 : 1. 6 Medical Supply Fees 40,255 T - -- 67,504 - : - - -. pP y -- 12,696. 24,744 : 52,697 ! 197,895 E -- W s 205,368 j 205,368 205,368 410,736: 205,368 1,232,208 I_ Benefits & P aa i r o ll T a x e s 43,127 I 43,127 43,127 86,255 ; 43,127 _ 258,764 L & Gas Oil 10,482 3,306 � 6,443 17,577' 13,722 _ 51,530 Insurance 6,160 6,160 6,160 ' _ 12,320 6 60 . 36,960 I Repairs &• Maintenance , 6 1,993 3,885 ~ 10,599' _ 8,274 _ _ 31,072 _ Medical Supplies 4,076 1,285 • 2,505 s & 6,834 i 5,335 ; 20,035 _ Uniforms Linen 2,311_ 729 1,421 : - - 3,876 ! 3,026 _ - _ - _ - 11,36 J Licenses 1,250 1250 1250 2 500 1 25 -- - , , 0 _ i 7,500 Office Supplies 4,290 1,353 2,637 7,194 j 5 16 i _ 21,090 Rent & Utilities 1 000 • 18,000 18,000 36, L. L. - - -- � P -... 8 - - -- +- - -- - -- - - - -- - -- • - 000 1 - - - 18,000 " - -- 108,00_0_ _ Leased Equipment _ 27,- 600 � - 27,600 27,600_ - 55,200 ! 27,600 i 165,600 - - Fees 132.454 40.015 78.846 - __ 2y2.115 127.764 601.194 Total Operating. 501,694' 362,882 ; 421,987 938,7101 517,939 i 2,743,211 Fapenses _!... • _ i Operating Grain - - - - H 265,1431 (121,033) ; 6,525 230,3151 212,141 ! 593,0921 i • B. List of Commitments and Potential Commitments Care Ambulance has no commitments or potential commitments which may impact assets, lines of credit, guarantor letters or otherwise affect our financial ability to perform the contract services. 87 • ITEM 21 : OVERALL OPERATIONAL SYSTEM AND DESIGN City of Stanton - EOA # 22 Care Ambulance Service considers it a privilege to submit our response to the OCFA's RFP to pro- vide emergency ambulance services to the City of Stanton. We have proudly served the City of Stan- ton since 2005. We look forward to continuing our excellent working relationships with the OCFA and City of Stanton. Care Ambulance will continue to provide the City of Stanton an operational system and design plan that exceeds the competitive bid criteria, specifications, requirements and performance expectations set forth in the RFP. Care Ambulance offers the City of Stanton a trusted partner in patient care, experienced local care- givers, a knowledgeable leadership team and a customer - focused organization. No other local pro-. vider can match our expertise in creating innovative public - private partnerships, our proven experi- ence exceeding the City of Stanton standards and our infrastructure of Orange County resources to provide disaster support. This expertise is critical to ensure uninterrupted quality ambulance service. Care Ambulance will continue to work cooperatively with the City of Stanton and the OCFA to ensure that our continued EMS system takes into account the priorities of clinical excellence, consis- tent response times and state -of- the -art systems management. IP 1. Exceeding Operational perational Plan Requirements Care Ambulance will continue to provide a minimum of one (1) staffed and licensed Basic Life Support (BLS) ambulance stationed and housed in the City of Stanton, on a twenty-four (24) hour per day /seven (7) day per week basis. The business of providing emergency ambulance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and therefore commits to the full -time deployment of ambulance resources in the City of Stanton. The ambulance shall serve as the primary ambulance, dedicated solely for use to the City of Stanton and OCFA. A number of ambulance companies have implemented flexible deployment strategies or System Status Management (SSM) in the wake of growing pressures to increase their own efficiencies and profit. They have attempted to match EMS demand with the allocation of ambulance resources. While the overall concept may appear to be financially sound, are Ambulance believes that it actu- ally delivers inferior service. SSM and flexible deployment take an unnecessary toll on EMT personnel due to frequent post -loca- tion changes, placing a higher priority on posting for call demand than geographic coverage. This results in unacceptable and even life - threatening response times in peripheral parts of a service area. Care Ambulance is committed to continuing our established policy of a fixed city- specific twenty- four (24) hour ambulance station as permanent location within the City of Stanton. Listed below is our current Stanton ambulance station location, which is (and will be) staffed with • one exclusively dedicated 24 -hour ambulance and crew, with a minimum of two (2) EMTs: 88 • City of Stanton —11236 Western Ave., Suite F3, Stanton This location offers excellent area coverage for Stanton with immediate access to adjacent OCFA partner cities. With Care's proposed deployment plan, neither patients nor OCFA firefighters have to wait for an ambulance to respond from a neighboring city. Care's crews are living and working within Stanton. This is very similar to our current programs within the Cities of Anaheim, Buena Park, Costa Mesa, Garden Grove, Fountain Valley, Fullerton, Stanton and Stanton. These programs have been so suc- cessful that we have been able to reduce Code 3. red lights and siren, response times to less than six (6) minutes and Code 2, expeditious response without red lights and siren. response times to less than eight (8) minutes. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances are automatically transferred into the City of Stanton to ensure consistent ambulance coverage. The automatic back-up coverage process begins whenever the unit dedicated to the City of Stanton is dispatched on a request for service. The process is best compared to an inventory system, in which a piece of inventory, or in this case an emergency ambulance, is placed on a call it is immediately replaced by an additional ambulance. This ensures that the City of Stanton is constantly covered, with no lapses in emergency ambulance coverage. Care's existing move -up or post location for the City of Stanton is the intersection of Beach Blvd. and Katella Avenue. This is a similar rocess to that already y used by Care Ambulance Service for our other contracted city emergency ambulance contracts, including our current service in Stanton. This allows Care Ambu- lance to deliver ambulance response times unmatched by any other local ambulance provider. Care Ambulance recognizes the inherent difficulty in predicting the need for emergency ambulance responses. With a single catastrophic event, it is possible to deplete the resources of the dedicated ambulances positioned in the City of Stanton. For that reason, Care Ambulance commits to utilizing any and all available ambulances within its fleet of 118 other ambulances to satisfy emergency re- sponses within the City of Stanton. Further, the management team of Care Ambulance is on -site and available twenty -four (24) hours a day to respond to any inquiries Stanton City officials or OCFA department personnel may have regarding any incident. Exceeding Response Time Standards The most critical measure of an emergency ambulance service's performance is its response times. While clinical performance is essential, it is not as commonly understood or easily measured as response times. The key issue for most patients and the public is: how long does it take to get an ambulance after making the call for help? It is for that reason that Care Ambulance agrees to be held to a higher standard. Care Ambulance takes great pride in our documented delivery of superior response times. Care Ambulance commits to exceed the minimum response time requirements set forth in this RFP at the • exceptional levels set forth below: • Care agrees to exceed the minimum response time requirements, as specified in the Request 89 • for Proposal by eei to a 9 minute, 59 second, ng d, 93% compliance standard for all requests for emergency services and a 14 minute, 59 second, 93% compliance standard for all urgent services. These response time standards are extremely stringent and concrete. Unlike other bidders, these are response time standards that Care Ambulance achieves today. We are not promising something that we haven't done before. We do it today and we will continue do it for the City of Stanton. To date, Care Ambulance Service has never failed to meet our 9 -1 -1 emergency contracted response time obligations, nor been penalized for any sub - standard system performance. Care Ambulance is very confident in our abilities to deliver timely ambulance services and we propose to exceed the requirements of the RFP with the below listed monetary penalties for non - compliance: PER RESPONSE PRIORITY CODE: PENALTY IMPOSED: 93% or Better None 90% — 92.9% $1,000 85% — 89.9% $2,000 Less than 84.9% $3,000 We recognize that shorter response times are an integral part of quality patient care and in many emergencies may reduce mortality. City of Stanton Contract Renewed On November 15, 2007 our contract with the OCFA and City of Stanton was renewed under the same terms and conditions as our existing contract. The renewal agreement was to begin on Septem- ber 1, 2009 and expire on August 31, 2014. Following the unanimous approval by the OCFA Board of Directors of our contract renewal, new information was provided by the State of California EMS Authority to the OCFA regarding the abil- ity to extend ambulance contracts without a competitive process. Because of the identified technical issue, the OCFA, in consultation with the Orange County EMS Agency elected to include the City of Stanton in this RFP process, even though all parties desired a contract extension. EMT -D Defibrillation is the most effective treatment for out -of- hospital ventricular fibrillation. Care Ain- bulance is proud to be the first ambulance service in Orange County to provide Automatic External Defibrillators (AEDs) on all ambulance vehicles. Medical research shows that the sooner defibrillation can be administered to a patient in ventricular fibrillation; the better the chances are that normal cardiac activity can be restored. With the degen- erative nature of ventricular fibrillation, seconds can literally mean the difference between life and death. Out -of- hospital defibrillation of cardiac arrest patients was one of the primary reasons for initial • development of paramedic programs in the 1970s. Since that time, the science of paramedicine has evolved, and more extensive and definitive therapy is within the scope of paramedics. Technological 90 • development of an automated — p mated defibrillator a computerized electro- cardiographic recognition pro- gram combined with a defibrillator — allows non - paramedic level rescuers to safely and effectively administer defibrillation. Care believes that automated defibrillation is a useful adjunct to firefighter - paramedics. and Care Ambulance is firmly committed to continuing to provide AEDs in all ambulance vehides and for all ambulance crews. Bariatric Gurneys andAmbulances According to the Center for Disease Control and Prevention (CDC) there are approximately 7.5 million morbidly obese adults (defined as more than 100 lbs. overweight) in the U.S. or roughly 5% of all adults. Safe ambulance transport of morbidly obese patients presents many challenges, to the patients and rescuers. For the patients, a reluctance to call for 9 -1 -1 services because the experience of being transported is so painful, hazardous and humiliating. For rescuers, the increased threat of a significant back injury. Care Ambulance recognizes the operational challenges of transporting a bariatric patient and has designed our new ambulances to safely and efficiently transport these patients. Each of our new am- bulances has been designed to transport the Stryker MX-Pro Bariatric Transport Gurney system with aluminum loading ramps and an electric wench. The Stryker MX-Pro Bariatric Transport Gurney has a maximum weight capacity of 1,600 lbs. and an additional 12 inch width for patient comfort. 41IP Using this new system, we can safely and humanely transport bariatric patients without fear of inju- ries to our patients or rescuers. Changing Demographics of Orange County California has been a trendsetter for the nation in a variety of ways for the past three decades. In Orange County, rapid and profound ethnic transformation is one of the more significant examples of this phenomenon. With ethnic transformation come new challenges. It has been estimated by UCLA researchers that within Southern California, 224 different languages are spoken. One of the most frustrating events for a paramedic or EMT is to arrive on scene of a medical emer- gency and be unable to communicate with the patient or family members. Often, due to circum- stances beyond the control of the patient, they are unable to provide complete information regarding their past medical history or current medications. This lack of accurate information can delay emer- gency medical treatment and cause complications. Care Ambulance recognizes that immediate communication with our patients is essential, but it is impossible to teach all our EMT caregivers to speak and communicate in multiple languages. For that reason, Care Ambulance equips each ambulance within our fleet with a cellular telephone and Care Ambulance contracts with an approved telephone translation service. When our EMT personnel arrive on -scene of a medical emergency and cannot communicate with a patient or family members, EMTs are instructed to contact the telephone translation service using • the cellular telephone. The translation service then connects an approved translator with our EMT and patient to ensure complete and accurate communications. 91 • The United States Census Bureau categorizes a household ego ousehold as "linguistically isolated" if no person over age 14 speaks only English and no person over 14 who speaks a language other than English speaks English "very well." In Southern California, 33 percent of Spanish - speaking households, 36 percent of Asian or Pacific Island households and almost 20 percent of all households are linguistically iso- lated. It is our job to ensure that these families are not isolated from receiving life- saving emergency ambulance services. Community Oriented Ambulance Service During the last 10 years, many local public safety agencies have demonstrated the value of "commu- nity oriented" programs, including the importance of giving back to the community. Care Ambu- lance has also observed the value of these programs, and has developed similar methods to involve our EMT personnel with the communities we serve. Care's latest community program has been very innovative and we believe the first in the nation. Care Ambulance has taken the exterior sides of ambulances - ` ` e and converted them into "rolling billboards" for injury prevention and child safety awareness. Our first ambulance with a Public Safety An- ` nouncement (PSA) exterior message was outfitted with a drowning ' " prevention campaign. This ambulance served as the backdrop for a locally televised press conference for drowning prevention hosted by the Orange .' " County Fire Chief's Association and has been seen by thou- sands of different families at local health and community fairs. � - Our first PSA ambulance was so successful that we have recently • added five additional PSA ambulances promoting the following safety mes- sages: never leave a child unattended in a car; the importance of children wearing helmets; the importance of parents using child safety seats; and anti - drowning campaign messages. Care's program of "Rolling Billboards" recently received recognition from the American Ambulance Asso- ciation for Outstanding Community Service. Care Ambulance takes great pride in our community involvement and our personnel look forward to continuing their interacting with the residents of Stanton. Community Emergency Response Teams (CERT) The Community Emergency Response Team (CERT) Program educates people about disaster preparedness for hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations. Fol- lowing a major disaster, first responders who provide fire and medical services may not be able to meet the demand for these services. Factors such as number of victims, communication failures, and road blockages may prevent people from accessing emergency services they have come to expect at a moment's notice through 9 -1 -1. People will have to rely on each other for help in order to meet their immediate life saving and life sustaining needs. CERT is about readiness, people helping people, • rescuer safety, and doing the greatest good for the greatest number of people. CERT is a positive and realistic approach to emergency and disaster situations where citizens will be initially on their own and their actions can make a difference. Care Ambulance recognizes the important need to train 92 • community volunteers to assist in times of disaster and we pledge our support to a community based CERT program. 2. Crew Configuration Each of Care's emergency ambulances is staffed with two (2) EMTs who, at minimum, are licensed at the EMT-Basic level. In addition, each EMT has completed Care's "Paramedic Assist" training course, Incident Command Systems 100 (ICS 100) training and an approved hazardous materials first responder awareness course. EMTs assigned to the City of Stanton dedicated emergency transport ambulance may be approved by the OCFA and is assigned to a fifty -six (56) hour workweek schedule consistent with the standard OCFA firefighter schedule. This staffing pattern allows for a more coordinated team effort and pro- vides necessary familiarity with staffing. 3. Supervisory Plan of Crews Currently, Care Ambulance Service provides an on -duty Operations Manager on a twenty -four (24) hour basis, seven (7) days a week. This Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Man- ager is located at our corporate offices in Orange. The on -duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center or directly through his cellular telephone. IP The following individuals currently work as Operations Managers in Care's Orange County Division: • Rick Mount — Employed with Care Ambulance for 31 years. • Marc Jessner — Employed with Care Ambulance for 17 years. • John Sanders — Employed with Care Ambulance for 8 years. All Operations Managers employed by Care Ambulance have successfully com- pleted training at the ICS 300 level, California State EMS Authority- approved - Ambulance Strike Leader training and ' `� have successfully led an Ambulance Strike ; ` °+s . s Team on a deployment. All have coin- s . t pleted the Ambulance Service Manager � , - (ASM) training offered by the American Ambulance Association and most recently all have completed the Ambulance Supervisors Course offered by Texas A&M University. All Opera- tions Managers have completed all required FEMA training, including IS 700 NIMS, IS 703 NIMS Resource Management and IS 800 National Response Plan. In addition, all Operations Mangers have completed the Orange County EMS Agency courses in Bio-Terrorism (CBRNE) and First Re- sponder Awareness (FRA) and First Responder Operations (FRO). On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 capable vehicle equipped with all necessary fire depart- ment radios and extra medical equipment, including back-boards, medical supplies and oxygen. Each Operations Manager vehicle is also equipped with a Mobile Data Computer (MDC) allowing 93 • our supervisory personnel to continually monitor the location and activities of all Care ambulances within Orange County. 4. Overall Summary of Care's Southern California Operations A. Total Number of Ambulances in Fleet Care Ambulance provides a response ready fleet of 118 ambulances licensed to provide ambulance services in Orange County. We are the largest provider of emergency and non - emergency ambulance services in Orange County. Each emergency ambulance in Care's fleet is outfitted with the latest technology, including 800 MHz mobile radios and satellite -based Automatic Vehide Locator (AVL) tracking systems. All of Care's ambulances meet and exceed the safety and equipment requirements listed in the RFP. B. Total Number of Employees By selecting Care Ambulance as the EMS Emergency Transportation Services provider for the City of Stanton, the City will gain an experienced, dedicated workforce trained to the highest clinical stan- dards. Care Ambulance employs 796 individuals. The following is a breakdown of employees accord- ing to job category: EMT Staff 576 Communications 23 Field Training Officers 40 RNs / RCPs 42 • Managers / Directors / Owners 30 Administrative / Billing 79 Fleet Maintenance 6 C. Contact Information for Third Party Billing and Collection Care Ambulance understands that public impression regarding the delivery of our services is very important. Often, the last contact patients have with an EMS provider is to resolve their bill for ser- vices. How their bill for services is handled makes a lasting impression. If performed poorly, it may tarnish even the best dinical outcome. Care Ambulance recognizes this and as a result performs all billing services in -house with the exception of third party collections. By using compassionate billing practices designed to seek reimbursements from insurance carriers (MediCare, MediCal and private insurances companies), Care's billing staff have become experts in maximizing insurance reimbursement to lessen the patients' out of pocket expense. Contact Information for our Third Party Collection Agency is as follows: The Outsource Group 1801 California, Corona, CA 92881 Representative — Scott Hall (951) 898 -4315 D. Clinical Contacts Care Ambulance provides clinical support and training for all employees through our in -house Train- ing Department. With our full -time clinical education staff, including our participatory Medical • Director, Care offers the City of Stanton the highest possible clinical standards. Contacts for the Medical Director and Training Department are: 94 • • Medical Director, Dr. Michael Martin, Telephone (562) 698 -0811, Ext 7511 • Training Manager, Kevin Chao, Telephone (714) 288 -3818 • Driver Training Manager, Sergio Montoya, Telephone (714) 288 -3920 5. Budget for City of Stanton Emergency Ambulance Operations, combined with the other four (4) areas being proposed by Care Ambulance Service. A. Financial information which will estimate the cost of the proposed operation. Care's Proposed Operating Budget I CYPRESS LA LOS ! SEAL i PALMA ALAMITDS BEACH STANTON AREA TOTAL i Transports (per OCFA) 1,430 451 879 2,398 1,872 7,030 G ross Revenue i 1,394,250 439,725 857,025 . 2,338,050 1,825,200 ' 6,854,250 I Contractual / Bad Debt -- - I W/O (627.413) (197.876) (428.513) 1 (1.169.025) (1.095.120) • (3.517.947) L - Net Revenue 766,837 241, 9 + 428,512 1 1,169,025 730,080 3,336,303 Number of Ambulances 1 1 1 2 1 6 _ Pp y 96 24 744 67, 40,255 24,744 67,504 52,6971 Medical Su l Fees 40 255 12,6 - - 197,895 2 2 205,368 410,736 205,368 4 1,232,208 1 Benefits & Payroll Taxes 43,127 43,127 43,127i 86,255 -__- 43,127 ' 258,764 Gas & Oil 10,482 3, 6,443 17,577 13,722 ; 51,530 - - - - - - -- - - -- Insurance 6,160 6,160 6,1 12,320 ' 6,160 , 36,960 Repairs & Maintenance 6,321 1,993 3,885 10,599 8,274 31,072 - Medical Supplies 4,076 1,285 2,505 6,834 5,335 20,035 Uniforms & Linen 2,311 729 1,421 3,876 3,026 ' 11,363 Licenses 1,250 1,250 1,250. - _2,500 _ 1,250; __ ___7,500_ OfTic Su2plies 4,290 1,353 2,63 - ,63 7,194 5,6161 - 21,090 Rent & Utilities 18,000 18,0 0 18,000 I 36, 000 18, 8,000 108,000 Leased Equipment 27, 0 27,600 27,600 55,200 27,600 i 165,600 ALS Fees 132.454 40.015 78.846: 222.115 __ 127,7641 601.194 Total Operating 501,694 362,882 421,987 , 938,710 517,93 Operating ) 265,143 (121,033) 6,525 i 230,315 • 212,1411 593,092 B. List of Commitments and Potential Commitments Care Ambulance has no commitments or potential commitments which may impact assets, lines of credit, guarantor letters or otherwise affect our financial ability to perform the contract services. 1111 95 r . , : 4 TAB 22 i. t t r r t r i [ t I , 1 , [ 1 r t r i. i r i f , t , . ! t t '4. i k t i. t. i 1 1 i • ITEM 22 : AMBULANCES PROPOSED FOR CITY OF CYPRESS (EOA #5) 1. Description of Vehicles and Ambulances As the largest provider of emergency and non - emergency ambulance service in Orange County, Care Ambulance currently maintains a response -ready fleet of 118 emergency ambulances. Our unique ability to provide this depth of emergency ambulance resources ensures that there will be no loss of services to the residents and visitors of Cypress, in the event that Care Ambulance needs to tempo- rarily remove an ambulance from service for maintenance or repair, or in the event of a large multi- causality incident. For the new contract period, Care Ambulance is pleased to offer the Orange County Fire Authority and the City of Cypress an enhanced fleet of new, custom - designed ambulances and specialty units. Care commits to furnish and dedicate a new specialized Chevrolet diesel chassis. "Road Rescue" Type III modular ambulance for provision of service to the City of Cypress and OCFA . Care has specifically chosen the Road Rescue ambulance because of its proven quality and safe, com- fortable patient ride. The Road Rescue company is an industry leader, designing a modular ambu- lance product that is widely recognized as one of the safest and finest ambulances available. Several unique design features are included as follows: • Safest ambulance interior for paramedics and EMTs. Two (2) separate "Captain Chairs" locations, each with its own 3- fl point safety restraint harness system and separate interior :,� � ,, restraint system netting. -; ■ �� • Storage for five (5) backboards. ' `� ,a'� • • Oxygen storage for four D -size portable oxygen cylinders. • A lighting system in the patient compartment that provides ,_ intense illumination. • All- aluminum modules and cabinets. The reduced weight resulting from this type of construction alleviates the problem of front -axle overload, thus producing a smoother ride. To assure that this ambulance and crew are entirely available to the City of Cypress and OCFA, Care Ambulance proposes to develop a city- approved distinctive lettering scheme for the ambulance exte- rior that designates the ambulance as "Proudly Serving the City of Cypress." 2. Exceeding Specifications, Requirements and Performance Expectations All current and proposed ambulances in Care's extensive ambulance fleet exceed the requirements of this RFP and comply with all federal, state and local laws, rules, statutes and regulations applicable to the provision of emergency ambulance services, including those standards established by the Orange County EMS Agency and Orange County Fire Authority. • Environmentally Cleaner Ambulances Toxic diesel emissions affect all people, but children are particularly vulnerable. New medical stud - 96 • ies in Califomia find that air pollution not only exacerbates children's asthma, but also may cause asthma in otherwise healthy children. The reduction of toxic engine exhaust is a primary goal of Care Ambulance and one example of our commitment to creating safer neighborhoods. For that reason, Care Ambulance has selected the Chevrolet diesel chassis as our platform for ambulance design to serve the City of Cypress. Currently, the Chevrolet diesel chassis is the only standardized ambulance chassis that meets and exceeds 2008 federally- mandated diesel emission standards. No other standardized ambulance chassis manufacturer can make that claim. The residents of Cypress and Orange County deserve a cleaner future. Care Ambulance is doing our part to make cleaner air a reality. Fleet Size Current trends in the EMS industry are for a standardization of fleet size in comparison to peak load demand; therefore, the EMS organization should determine how many ambulances are required at the busiest times and acquire a fleet that allows for reserves at that point. The standard that is emerg- ing in this trend is a fleet size to average peak load ratio of 1.25, or 125% of average peak load, there- by leaving at least 25% in reserve during times of high demand. Care exceeds this trend by providing a fleet size of 133% of average peak load vehicles and is committed to maintaining this fleet size. 0 Our rationale for what may seem to be an extreme position on fleet size is not solely altruistic. Our extensive fleet experience demonstrates that maintaining a large fleet allows our maintenance staff to perform preventive and repair - oriented service, without the pressure to "get the unit on the road." The result is higher quality service, strict adherence to maintenance protocols, and, as a result, lower operating costs, higher reliability and extended useful life. Additionally, Care utilizes higher quality, more reliable ambulances than most other providers. This large, high quality fleet combined with the aggressive internal maintenance program offers un- matched reliability and investment. 3. Ambulance Replacement Policies We embrace the aircraft- industry maintenance philosophy and apply its standards to prevent in -ser- vice vehicle failures. We replace critical vehicle components prior to their failure. Based on data and operating experience, we have instituted a vigorous parts replacement schedule to improve fleet reli- ability; to set our fleet maintenance operating budget and to extend the safe, useful life of our fleet. We replace parts not only at mileage intervals, but also when performance tests indicate wear limits. For example, rather than replace brakes solely at mileage intervals, we also replace brakes when brake pad and rotor thickness reaches a predetermined threshold. The expected life cycle of our vehicles is determined through the manufacturer's recommendations and by the track record established by our fleet maintenance department. • 97 • Listed below is our schedule of fleet replacement: I ITEM BRAND LIFE 1 REPLACEMENT SCHEDULE ' . Ambulance ; Road Rescue 5 years ( 150,000 miles Care is committed to the replacement of any and all equipment prior to reaching the end of its use- ful life. This commitment provides our patients the guarantee that we will do everything possible to ensure their safe transport. 4. Specific Ambulance Information A) Proposed Ambulance Units to be Available for 9 -1 -1 Responses in the City of Cypress (EOA #5) Care Ambulance is offering the City of Cypress and the Orange County Fire Authority the following Modular Type III, dual rear wheel ambulance to serve as front -line emergency ambulance. The am- bulance will be lettered with a city - approved distinctive lettering scheme that designates the ambu- lance as "Proudly Serving the City of Cypress." The Cypress ambulances will be staffed 24 hours a day, seven (7) days per week and will be dedicated to the City of Cypress and OCFA. f 1 I UNIT CHASSIS MODEL YEAR MILEAGE i CONDITION ;TYPE STATION LOCATION 1 230 ; Chevrolet Road Rescue 2009 1 500 I Brand New 1111 Cypress* Care Ambulance understands that any decrease in the number of dedicated ambulances, without the prior consent of the OCFA Fire Chief, may constitute a breach of contract. Any ambulance tempo- rarily removed from dedicated service will be replaced as soon as practical by one of Care's reserve ambulances and crews. All ambulances have been ordered with a contracted delivery date of February 2009. B. Other Regional Ambulance Units That Will Be Available to Reasonably Support 9 -1 -1 Responses in the City of Cypress (EOA # 5) The following twenty-four (24) ambulances are proposed or are already stationed in North -East Or- ange County, in communities that are proximate to Cypress and may be available to the support the City of Cypress and the Orange County Fire Authority. Each of the below identified ambulances is staffed twenty -four (24) hours per day, seven (7) days per week. UNIT CHASSIS MODEL YEAR MILEAGE CONDITION TYPE STATION LOCATION 227 Chevrolet Road Rescue 2009 500 A — New III I Seal Beach* 228 I Chevrolet Road Rescue 2009 500 A — New III Seal Beach* 229 Chevrolet Road Rescue 2009 1 500 A — New III Los Alamitos* 231 Chevrolet Road Rescue 2009 1 500 A — New i III La Palma 232 Chevrolet Road Rescue 2009 i 500 A — New j III I Stanton I 98 Ill _ 234 Chevrolet Road Rescue 2009 500 A — New ' ' III ! Buena Park 1 235 Chevrolet Road Rescue 2009 1 500 A — New III Gard. Grov #1 2 1-36 Chevrolet Road Rescue 2009 500 A — New I III Gard. Grov #2 1 237 Chevrolet Road Rescue 2009 ' 500 A — New III Gard. Grov #3 1 212 Chevrolet Road Rescue 2008 •5,000 A — New I III FV Amb 31 1 205 i Chevrolet Road Rescue 2008 1 5,000 A — New I III FV / CM 202 Chevrolet Road Rescue 2008 I 5,000 A — New + III � Costa Mesa #1 203 Chevrolet Road Rescue 2008 5,000 A — New III : Costa Mesa #2 1 204 i Chevrolet Road Rescue 2008 5,000 A — New j III Costa Mesa #3 208 Chevrolet Leader 2008 5,000 � 1 A —New � III I Fullerton #1 209 Chevrolet Leader 2008 5,000 A — New I III � Fullerton #2 210 Chevrolet Leader 2008 5,000 A — New j III Fullerton #3 215 Chevrolet Leader 2008 5,000 Anaheim #1 220 Chevrolet Leader 2008 5,000 A — New III Anaheim #3 I I 211 Chevrolet Leader 2008 5,000 A — New 1II ► Anaheim #6 221 ' Chevrolet Leader 2008 1 5,000 A — New 1111 III !Anaheim #7 222 � Chevrolet Leader 2008 1 5,000 A — New !III I Anaheim #9 � 214 I Chevrolet Leader 2008 5,000 A — New i III { Anaheim #11 1 213 i Chevrolet Road Rescue 2008 ! 5,000 A — New ' III I Placentia * Indicates a proposed ambulance station. All other stations currently exist and are operational. In addition to the above listed ambulances, Care Ambulance maintains an additional twenty (20) 10 -hour ambulances at our corporate offices in Orange; along with seventeen (17) 24 -hour ambu- lances and thirty -eight (38) 12 -hour ambulances in Los Angeles County. All of these ambulances are in areas proximate to Cypress. Each of these ambulances is licensed to provide services in Orange County and may be available for emergency ambulances responses into the City of Cypress. Due to our large fleet size and page limitations of the proposal, a complete list showing details on our entire fleet is available upon request. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of Cypress or a pre- designated staging location dose to Cypress to ensure consistent ambulance coverage. The automatic back-up coverage process will begin whenever the unit dedicated to the City of Cypress is dispatched on a request for service. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts, allowing Care Ambulance to deliver am- bulance response times unmatched by any other local ambulance provider. PROPOSED TOTAL. AMBULANCE DEPLOYMENT AVAILABLE FOR THE CITY OF CYPRESS Dedicated Unit 1 Dedicated Adjacent OCFA Partner Ambulances 6 • Other Proximate 24 -Hour Staffed Ambulances 18 Care's Other Orange County Licensed Ambulances 1 97 q9 • Increasing Ambulance Resources Should call volume increase significantly in the City of Cypress and exceed the standard daily ca- pacity of our dedicated ambulance resource, Care Ambulance commits to increase the number of dedicated and /or regional ambulances provided in order to ensure the timely delivery of services. Any temporary increases in call volume will be immediately handled by our backup ambulances until it is determined that additional permanent ambulances are needed. Upon discovering that any ambulance has suffered a mechanical failure or becomes disabled, or upon the request of an OCFA fire official, Care Ambulance will immediately dispatch a secondary ambulance. Enhancements As part of Care's commitment to disaster readiness and homeland security, Care provides two (2) Orange County EMS Agency furnished Disaster Supply Trailers (DSTs) and a State of California EMS Authority furnished Disaster Medical Support Unit (DMSU). Each DSTs is equipped with a sufficient cache of medical supplies to support any major event in the county, including 50 backboards, 1000 triage tags, 50 blankets, 15 oxygen cylinders with regulators, over 1,000 N95 HEPA masks in all sizes, assorted oxygen supplies and splints, trauma bags, easy up shelter, tarps and table. The DSTs may be requested by OCFA and will be immedi- ately dispatched to the scene. In addition to the DSTs, Care Ambulance hosts a State of California, EMS Authority DMSU, to support a deployed ambulance strike team. Similar to the DSTs, the state DMSU is fully equipped with Basic Life Support (BLS) equipment and supplies. In addition, it is also equipped with a limited amount of Advanced Life Support (ALS) equipment and supplies. These critical resources will ensure an immediate resupply of Care's ambulances and OCFA paramedics in the event of a prolonged major incident. sj , _ . . ' +� __. 1, Ili it "It 0 . •,.,,.,,./ , .QQ ? 1 no • ITEM 22 : AMBULANCES PROPOSED FOR CITY OF LA PALMA (EOA #13) 1. Description of Vehicles and Ambulances As the largest provider of emergency and non - emergency ambulance service in Orange County, Care Ambulance currently maintains a response -ready fleet of 118 emergency ambulances. Our unique ability to provide this depth of emergency ambulance resources ensures that there is no loss of servic- es to the residents and visitors of La Palma, in the event that Care Ambulance needs to temporarily remove an ambulance from service for maintenance or repair, or in the event of a large multi - casualty incident. For the new contract period, Care Ambulance is pleased to offer the Orange County Fire Authority and the City of La Palma an enhanced fleet of new, custom - designed ambulances and specialty units. Care commits to furnish and dedicate a new specialized Chevrolet diesel chassis. "Road Rescue" Type III modular ambulance for provision of service to the City of La Palma and OCFA. Care has specifically chosen the Road Rescue ambulance because of its proven quality and safe, com- fortable patient ride. The Road Rescue company is an industry leader, designing a modular ambu- lance product that is widely recognized as one of the safest and finest ambulances available. Several unique design features are included as follows: 41P • Safest ambulance interior for paramedics and EMTs. Two c % (2) separate "Captain Chairs ", each with its own 3 -point i safety restraint harness system and separate interior restraint � � � ,,• {: �t � , er system netting. - a r` • Storage for five (5) backboards. ,:` ! ! = • Oxygen storage for four D -size portable oxygen cylinders.. • A lighting system in the patient compartment that provides intense illumination. • All- aluminum modules and cabinets. The reduced weight �•T N resulting from this type of construction alleviates the problem of front -axle overload, thus producing a smoother ride. To assure that this ambulance and crew are entirely available to the City of La Palma and OCFA, Care Ambulance has developed a city - approved distinctive lettering scheme for the ambulance exte- rior that designates the ambulance as "Proudly Serving the City of La Palma." 2. Exceeding Specifications, Requirements and Performance Expectations All current and proposed ambulances in Care's extensive ambulance fleet exceed the requirements of this RFP and comply with all federal, state and local laws, rules, statutes and regulations applicable to the provision of emergency ambulance services, including those standards established by the Orange County EMS Agency and Orange County Fire Authority. • Environmentally Cleaner Ambulances Toxic diesel emissions affect all people, but children are particularly vulnerable. New medical stud- 101 • ies in California find that air pollution not only exacerbates children's asthma, but also may cause asthma in otherwise healthy children. The reduction of toxic engine exhaust is a primary goal of Care Ambulance and one example of our commitment to creating safer neighborhoods. For that reason, Care Ambulance has selected the Chevrolet diesel chassis as our platform for ambulance design to serve the City of La Palma. Currently, the Chevrolet diesel chassis is the only standardized ambulance chassis that meets and exceeds 2008 federally- mandated diesel emission standards. No other standardized ambulance chassis manufacturer can make that daim. The residents of La Palma and Orange County deserve a cleaner future. Care Ambulance is doing our part to make cleaner air a reality. Fleet Size Current trends in the EMS industry are for a standardization of fleet size in comparison to peak load demand; therefore, the EMS organization should determine how many ambulances are required at the busiest times and acquire a fleet that allows for reserves at that point. The standard that is emerg- ing in this trend is a fleet size to average peak load ratio of 1.25, or 125% of average peak load, there- by leaving at least 25% in reserve during times of high demand. Care exceeds this trend by providing a fleet size of 133% of average peak load vehicles and is committed to maintaining this fleet size. Our rationale for what may seem to be an extreme position on fleet size is not solely altruistic. Our extensive fleet experience demonstrates that maintaining a large fleet allows our maintenance staff to perform preventive and repair- oriented service, without the pressure to "get the unit on the road." The result is higher quality service, strict adherence to maintenance protocols, and, as a result, lower operating costs, higher reliability and extended useful life. Additionally, Care utilizes higher quality, more reliable ambulances than most other providers. This large, high quality fleet combined with the aggressive internal maintenance program offers un- matched reliability and investment. 3. Ambulance Replacement Policies We embrace the aircraft- industry maintenance philosophy and apply its standards to prevent in -ser- vice vehide failures. We replace critical vehicle components prior to their failure. Based on data and operating experience, we have instituted a vigorous parts replacement schedule to improve fleet reli- ability, to set our fleet maintenance operating budget and to extend the safe, useful life of our fleet. We replace parts not only at mileage intervals, but also when performance tests indicate wear limits. For example, rather than replace brakes solely at mileage intervals, we also replace brakes when brake pad and rotor thickness reaches a predetermined threshold. The expected life cyde of our vehicles is determined through the manufacturer's recommendations and by the track record established by our fleet maintenance department. • in? • Listed below is our schedule of fleet replacement: ITEM I BRAND LIFE _ REPLACEMENT SCHEDULE i I • Ambulance _ [Road Rescue 15 years 150,000 miles I Care is committed to the replacement of any and all equipment prior to reaching the end of its use- ful life. This commitment provides our patients the guarantee that we will do everything possible to ensure their safe transport. 4. Specific Ambulance Information A) Proposed Ambulance Units to be Available for 9 -1 -1 Responses in the City of La Palma (EOA # 13) Care Ambulance is offering the City of La Palma and the Orange County Fire Authority the follow- ing Modular Type III, dual rear wheel ambulance to serve as our front -line emergency ambulance. The ambulance will be lettered with a city- approved distinctive lettering scheme that designates the ' ambulance as "Proudly Serving the City of La Palma." The La Palma ambulance will be staffed 24 hours a day, seven (7) days per week and will be dedi- cated to the City of La Palma and OCFA. UNIT I CHASSIS MODEL YEAR MILEAGE CONDITION TYPE STATION • LOCATION (k,.. I 231 ; Chevrolet I Road Rescue j 2009 ; 500 Brand New I III La Palma* Care Ambulance understands that any decrease in the number of dedicated ambulances, without the prior consent of the OCFA Fire Chief, may constitute a breach of contract. Any ambulance tem- porarily removed from dedicated service will be replaced as soon as practical by one of Care's reserve ambulances and crews. All ambulances have been ordered with a contracted delivery date of February 2009. B. Other Regional Ambulance Units That Will Be Available to Reasonably Support 9 -1 -1 Responses in the City of La Palma (EOA # 13) The following twenty -four (24)) ambulances are proposed or are already stationed in North -East Orange County, in communities that are proximate to La Palma and may be available to the support the City of La Palma and the Orange County Fire Authority. Each of the below identified ambu- lances is staffed twenty -four (24) hours per day, seven (7) days per week. r UNIT CHASSIS MODEL YEAR MILEAGE CONDITION TYPE STATION LOCATION 227 Chevrolet Road Rescue 2009 500 A — New III Seal Beach* 228 Chevrolet Road Rescue 2009 500 A — New 1111 I Seal Beach* 229 1 Chevrolet Road Rescue 2009 1 500 A — New III 1 Los Alamitos* • 1231 'Chevrolet Road Rescue 2009 500 A — New III I III La Palma 232 !Chevrolet Road Rescue 2009 500 A — New ' [ Stanton j 103 • _ 234 i Chevrolet Road Rescue 2009 500 I A — New III Buena Park 235 I Chevrolet Road Rescue 2009 1 500 I — New III I Gard. Grov #1 236 i Chevrolet Road Rescue 2009 500 I A — New III 'Gard. Grov #2 1 237 I Chevrolet Road Rescue 2009 1 500 A — New • 11I 1 Gard. Grov #3 212 Chevrolet Road Rescue 2008 5,000 A — New I III I FV Amb 31 1 205 i Chevrolet Road Rescue 2008 5,000 A — New 1111 FV / CM 202 I Chevrolet Road Rescue 2008 5,000 A — New ' III I Costa Mesa #1 1 203 1 Ch Road Rescue 2008 5,000 A — New I III 1 Costa Mesa #2 1 i 204 I Chevrolet Road Rescue 2008 i 5,000 A — New I III I Costa Mesa #3 1 208 I Chevrolet Leader 2008 5,000 IA — New l III 'Fullerto #1 209 'Chevrolet Leader 2008 5,000 { 000 ' A —New III 'Fullerton #2 210 I Chevrolet Leader 2008 5,000 A — New III Fullerton #3 215 I Chevrolet Leader 2008 5,000 A — New III Anaheim #1 220 I Chevrolet Leader 2008 5,000 A — New III Anaheim #3 211 Chevrolet Leader 2008 5,000 A — New III Anaheim #6 221 Chevrolet Leader 2008 5,000 1 A — New III Anaheim #7 222 Chevrolet Leader 2008 5,000 A — New III Anaheim #9 1p - I 1214 1 Chevrolet Leader 2008 5,000 1 A — New i III I Anaheim #11 1 213 Chevrolet Road Rescue 2008 1 5,000 I A — New 1 III I Placentia I * Indicates a proposed ambulance station. All other stations currently exist and are operational. In addition to the above listed ambulances, Care Ambulance maintains an additional twenty (20) 10 -hour ambulances at our corporate offices in Orange; along with seventeen (17) 24 -hour ambu- lances and thirty -eight (38) 12 -hour ambulances in Los Angeles County. All of these ambulances are in areas proximate to La Palma. Each of these ambulances is licensed to provide services in Orange County and may be available for emergency ambulances responses into the City of La Palma. Due to our large fleet size and page limitations of the proposal, a complete list showing details on our entire fleet is available upon request. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of La Palma or a pre - designated staging location close to La Palma to ensure consistent ambulance coverage. The au- tomatic back -up coverage process will begin whenever the unit dedicated to the City of La Palma is dispatched on a request for service. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts, allowing Care Ambulance to deliver ambulance response times unmatched by any other local ambulance provider. PROPOSED TOTAL AMBULANCE DEPLOYMENT AVAILABLE FOR THE CITY OF CYPRESS Dedicated Unit I 1 Dedicated Adjacent OCFA Partner Ambulances 16 • Other Proximate 24 -Hour Staffed Ambulances ! 18 I Care's Other Orange County Licensed Ambulances 197 i 104 • IncreasingAmbulance Resources Should call volume increase significantly in the City of La Palma and exceed the standard daily capacity of our dedicated ambulance resource, Care Ambulance commits to increase the number of dedicated and/or regional ambulances provided in order to ensure the timely delivery of services. Any temporary increase in call volume will be immediately handled by our backup ambulances until it is determined that additional permanent ambulances are needed. Upon discovering that any ambulance has suffered a mechanical failure or becomes disabled, or upon the request of an OCFA fire official, Care Ambulance immediately dispatches a secondary ambulance. Enhancements As part of Care's commitment to disaster readiness and homeland security, Care provides two (2) Orange County EMS Agency furnished Disaster Supply Trailers (DSTs) and a State of California EMS Authority furnished Disaster Medical Support Unit (DMSU). Each DSTs is equipped with a sufficient cache of medical supplies to support any major event in the county, including 50 backboards, 1000 triage tags, 50 blankets, 15 oxygen cylinders with regulators, over 1,000 N95 HEPA masks in all sizes, assorted oxygen supplies and splints, trauma bags, easy up shelter, tarps and table. The DSTs may be requested by OCFA and will be immedi- ately dispatched to the scene. In addition to the DSTs, Care Ambulance hosts a State of California, EMS Authority DMSU, It° to support a deployed ambulance strike team. Similar to the DSTs, the state DMSU is fully equipped with Basic Life Support (BLS) equipment and supplies. In addition, it is also equipped with a limited amount of Advanced Life Support (ALS) equipment and supplies. These critical resources will ensure an immediate resupply of Care's ambulances and OCFA paramedics in the event of a prolonged major incident. 40000rj -'%/ - CARR ' i l ' :71 0 1 '', , z f • 0Z " � Ar A' �y 1 ' 1 • .re ." 4iii 1 '` ' i ' 1 105 • ITEM 22 : AMBULANCES PROPOSED FOR CITY OF LOS ALAMITOS (EOA # 14) 1. Description of Vehicles and Ambulances As the largest provider of emergency and non - emergency ambulance service in Orange County, Care Ambulance currently maintains a response -ready fleet of 118 emergency ambulances. Our unique ability to provide this depth of emergency ambulance resources ensures that there will be no loss of services to the residents and visitors of Los Alamitos, in the event that Care Ambulance needs to temporarily remove an ambulance from service for maintenance or repair, or in the event of a large multi - casualty incident. For the new contract period, Care Ambulance is pleased to offer the Orange County Fire Authority and the City of Los Alamitos an enhanced fleet of new, custom - designed ambulances and specialty units. Care commits to furnish and dedicate a new specialized Chevrolet diesel chassis. "Ro. s Res- cue" Type III modular ambulance for provision of service to the City of Los Alamitos and OCFA. Care has specifically chosen the Road Rescue ambulance because of its proven quality and safe, com- fortable patient ride. The Road Rescue company is an industry leader, designing a modular ambu- lance product that is widely recognized as one of the safest and finest ambulances available. Several unique design features are included as follows: • Safest ambulance interior for paramedics and EMTs. Two (2) P ¢ separate "Captain Chairs" locations, each with its own 3- point safety restraint harness system and separate interior restraint system netting. y 111 • Storage for five (5) backboards.; �' 1� ' r • Oxygen storage for four D -size portable oxygen cylinders. • A lighting system in the patient compartment that provides intense illumination. e • All- aluminum modules and cabinets. The reduced weight _ resulting from this type of construction alleviates the problem ~ -" of front -axle overload, thus producing a smoother ride. To assure that this ambulance and crew are entirely available to the City of Los Alamitos and OCFA, Care Ambulance proposes to develop a city - approved distinctive lettering scheme for the ambulance exterior that designates the ambulance as "Proudly Serving the City of Los Alamitos." 2. Exceeding Specifications, Requirements and Performance Expectations All current and proposed ambulances in Care's extensive ambulance fleet exceed the requirements of this RFP and comply with all federal, state and local laws, rules, statutes and regulations applicable to the provision of emergency ambulance services, including those standards established by the Orange County EMS Agency and Orange County Fire Authority. Environmentally Cleaner Ambulances • Toxic diesel emissions affect all people, but children are particularly vulnerable. New medical stud- ies in California find that air pollution not only exacerbates children's asthma, but also may cause 1 0F, • asthma in otherwise healthy children. The reduction of toxic engine exhaust is a primary goal of Care Ambulance and one example of our commitment to creating safer neighborhoods. For that reason, Care Ambulance has selected the Chevrolet diesel chassis as our platform for ambulance design to serve the City of Los Alamitos. Currently, the Chevrolet diesel chassis is the only standardized ambulance chassis that meets and exceeds 2008 federally - mandated diesel emission standards. No other standardized ambulance chassis manufacturer can make that claim. The residents of Los Alamitos and Orange County deserve a cleaner future. Care Ambulance is do- ing our part to make cleaner air a reality. Fleet Size Current trends in the EMS industry are for a standardization of fleet size in comparison to peak load demand; therefore, the EMS organization should determine how many ambulances are required at the busiest times and acquire a fleet that allows for reserves at that point. The standard that is emerg- ing in this trend is a fleet size to average peak load ratio of 1.25, or 125% of average peak load, there- by leaving at least 25% in reserve during times of high demand. Care exceeds this trend by providing a fleet size of 133% of average peak load vehicles and is committed to maintaining this fleet size. Our rationale for what may seem to be an extreme position on fleet size is not solely altruistic. Our extensive fleet experience demonstrates that maintaining a large fleet allows our maintenance staff to perform preventive and repair - oriented service, without the pressure to "get the unit on the road." The result is higher quality service, strict adherence to maintenance protocols, and, as a result, lower operating costs, higher reliability and extended useful life. Additionally, Care utilizes higher quality, more reliable ambulances than most other providers. This large, high quality fleet combined with the aggressive internal maintenance program offers un- matched reliability and investment. 3. Ambulance Replacement Policies We embrace the aircraft- industry maintenance philosophy and apply its standards to prevent in -ser- vice vehicle failures. We replace critical vehicle components prior to their failure. Based on data and operating experience, we have instituted a vigorous parts replacement schedule to improve fleet reli- ability, to set our fleet maintenance operating budget and to extend the safe, useful life of our fleet. We replace parts not only at mileage intervals, but also when performance tests indicate wear limits. For example, rather than replace brakes solely at mileage intervals, we also replace brakes when brake pad and rotor thickness reaches a predetermined threshold. The expected life cycle of our vehicles is determined through the manufacturer's recommendations and by the track record established by our fleet maintenance department. • 107 • Listed below is our schedule of fleet replacement: I ITEM I BRAND LIFE I REPLACEMENT SCHEDULE Ambulance E Road Rescue 5 years 1150,000 miles Care is committed to the replacement of any and all equipment prior to reaching the end of its use- ful life. This commitment provides our patients the guarantee that we will do everything possible to ensure their safe transport. 4. Specific Ambulance Information A) Proposed Ambulance Units to be Available for 9 -1 -1 Responses in the City of Los Alamitos (EOA #14) Care Ambulance is offering the City of Los Alamitos and the Orange County Fire Authority the following Modular Type III, dual rear wheel ambulance to serve as front-line emergency ambulance. The ambulances will be lettered with a city - approved distinctive lettering scheme that designates the ambulance as "Proudly Serving the City of Los Alamitos." The Los Alamitos ambulances will be staffed 24 hours a day, seven (7) days per week and will be dedicated to the City of Los Alamitos and OCFA. ( 1 UNIT I CHASSIS I MODEL I YEAR I MILEAGE 1 CONDITION TYPE STATION 7 ` LOCATION i 229 ; Chevrolet 1Road Rescue 1 2009 1 500 j Brand New + III Los Alamitos* I Care Ambulance understands that any decrease in the number of dedicated ambulances, without the prior consent of the OCFA Fire Chief, may constitute a breach of contract. Any ambulance tempo- rarily removed from dedicated service will be replaced as soon as practical by one of Care's reserve ambulances and crews. All ambulances have been ordered with a contracted delivery date of February 2009. B. Other Regional Ambulance Units That Will Be Available to Reasonably Support 9 -1 -1 Responses in the City of Los Alamitos (EOA # 14) The following twenty-four (24) ambulances are proposed or are already stationed in North -East Orange County, in communities that are proximate to Los Alamitos and may be available to the sup- port the City of Los Alamitos and the Orange County Fire Authority. Each of the below identified ambulances is staffed twenty -four (24) hours per day, seven (7) days per week. UNIT CHASSIS MODEL YEAR MILEAGE CONDITION TYPE STATION I LOCATION 227 Chevrolet Road Rescue 2009 500 A — New III Seal Beach* 1 228 1Chevrolet Road Rescue 2009 500 A — New III Seal Beach* 1 229 I Chevrolet Road Rescue 2009 500 A — New III Los Alamitos* • 2 Chevrolet Road Rescue 2009 1 500 A — New III I La Palma I 232 Chevrolet Road Rescue 2009 1 500 A — New III ;Stanton 1OR • 1 234 1 Chevrolet Road Rescue 2009 500 A — New ' III � Buena Park i 235 I Chevrolet Road Rescue - 2009 500 A — New III Gard. Grov #1 1 236 'Chevrolet Road Rescue 2009 ! 500 I A — New III 1Gard. Grov #2 1 237 i Chevrolet Road Rescue 2009 1 500 `A — New III I Gard. Grov #3 212 ' Chevrolet Road Rescue 2008 _ 1 5,000 I A — New III FV Amb 31 205 Chevrolet Road Rescue 2008 5,000 I A — New III FV / CM 202 ' Chevrolet Road Rescue 2008 1 5,000 _ Costa Mesa #1 1 203 I Chevrolet Road Rescue 2008 1 5,000 ' A — New III I Costa Mesa #2 204 Chevrolet i Road Rescue 1 2008 1 5,000 ' A — New III Costa Mesa #3 208 Chevrolet Leader 2008 1 5,000 A — New III Fullerton #1 1 209 'Chevrolet Leader 2008 1 5,000 A — New III Fullerton #2 1 210 Chevrolet Leader 2008 I 5,000 A — New III I Fullerton #3 215 Chevrolet Leader 2008 1 5,000 A — New ' III Anaheim #1 1 220 Chevrolet Leader 2008 1 5,000 A — New III Anaheim #3 211 Chevrolet Leader 2008 1 5,000 A — New III Anaheim #6 221 Chevrolet Leader 2008 1 5,000 A — New III Anaheim #7 222 Chevrolet Leader 2008 5,000 A — New III Anaheim #9 I 1 214 I Chevrolet Leader 2008 5,000 I A — New III Anaheim #11 213 I Chevrolet Road Rescue 2008 , 5,000 I A — New !III I Placentia 1 * Indicates a proposed ambulance station. All other stations currently exist and are operational. In addition to the above listed ambulances, Care Ambulance maintains an additional twenty (20) 10- hour ambulances at our corporate offices in Orange; along with seventeen (17) 24 -hour ambulances and thirty -eight (38) 12 -hour ambulances in Los Angeles County. All of these ambulances are in areas proximate to Los Alamitos. Each of these ambulances is licensed to provide services in Orange County and may be available for emergency ambulances responses into the City of Los Alamitos. Due to our large fleet size and page limitations of the proposal, a complete list showing details on our entire fleet is available upon request. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of Los Alamitos or a pre - designated staging location dose to Los Alamitos to ensure consistent ambulance coverage. The automatic back -up coverage process will begin whenever the unit dedicated to the City of Los Alamitos is dispatched on a request for service. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts, allowing Care Am- bulance to deliver ambulance response times unmatched by any other local ambulance provider. PROPOSED TOTAL AMBULANCE DEPLOYMENT AVAILABLE FOR THE CITY OF CYPRESS Dedicated Unit 1 Dedicated Adjacent OCFA Partner Ambulances 6 • 1 Other Proximate 24 -Hour Staffed Ambulances 18 L care's Other Orange County Licensed Ambulances 1 97 1 109 • Increasing Ambulance Resources Should call volume increase significantly in the City of Los Alamitos and exceed the standard daily capacity of our dedicated ambulance resource, Care Ambulance commits to increase the number of dedicated and/or regional ambulances provided in order to ensure the timely delivery of services. Any temporary increases in call volume will be immediately handled by our backup ambulances until it is determined that additional permanent ambulances are needed. Upon discovering that any ambulance has suffered a mechanical failure or becomes disabled, or upon the request of an OCFA fire official, Care Ambulance will immediately dispatch a secondary ambulance. Enhancements As part of Care's commitment to disaster readiness and homeland security, Care provides two (2) Orange County EMS Agency furnished Disaster Supply Trailers (DSTs) and a State of California EMS Authority furnished Disaster Medical Support Unit (DMSU). Each DSTs is equipped with a sufficient cache of medical supplies to support any major event in the county, including 50 backboards, 1000 triage tags, 50 blankets, 15 oxygen cylinders with regulators, over 1,000 N95 HEPA masks in all sizes, assorted oxygen supplies and splints, trauma bags, easy up shelter, tarps and table. The DSTs may be requested by OCFA and will be immedi- ately dispatched to the scene. In addition to the DSTs, Care Ambulance hosts a State of California, EMS Authority DMSU, to support a deployed ambulance strike team. Similar to the DSTs, the state DMSU is fully equipped with Basic Life Support (BLS) equipment and supplies. In addition, it is also equipped with a limited amount of Advanced Life Support (ALS) equipment and supplies. These critical resources will ensure an immediate resupply of Care's ambulances and OCFA paramedics in the event of a prolonged major incident. . • m : _ / i V ,§14 al, a I V . „ X • �, 8 111) • ITEM 22 : AMBULANCES PROPOSED FOR CITY OF SEAL BEACH (EDA # 21) 1. Description of Vehicles and Ambulances As the largest provider of emergency and non - emergency ambulance service in Orange County, Care Ambulance currently maintains a response -ready fleet of 118 emergency ambulances. Our unique ability to provide this depth of emergency ambulance resources ensures that there will be no loss of services to the residents and visitors of Seal Beach, in the event that Care Ambulance needs to temporarily remove an ambulance from service for maintenance or repair, or in the event of a large multi- casualty incident. For the new contract period, Care Ambulance is pleased to offer the Orange County Fire Author- ity and the City of Seal Beach an enhanced fleet of new, custom - designed ambulances and specialty units. Care commits to furnish and dedicate two (2) new specialized Chevrolet diesel chassis. "Road Rescue" Type III modular ambulances for provision of service to the City of Seal Beach and OCFA. Care has specifically chosen the Road Rescue ambulance because of its proven quality and safe, com- fortable patient ride. The Road Rescue company is an industry leader, designing a modular ambu- lance product that is widely recognized as one of the safest and finest ambulances available. Several unique design features are included as follows: • Safest ambulance interior for paramedics and EMTs. Two (2) _� E separate "Captain Chairs" locations, each with its own 3- point safety restraint harness system and separate interior _ A restraint system netting. ,. i • Storage for five (5) backboards. j . 1 � • Oxygen storage for four D -size portable oxygen cylinders.`. r • A lighting system in the patient compartment that provides ''` `' - intense illumination. • All - aluminum modules and cabinets. The reduced weight resulting from this type of construction alleviates the problem - of front -axle overload, thus producing a smoother ride. To assure that these dedicated ambulances and crews are entirely available to the City of Seal Beach and OCFA, Care Ambulance proposes to develop a city- approved distinctive lettering scheme for the ambulance exterior that designates the ambulances as "Proudly Serving the City of Seal Beach." 2. Exceeding Specifications, Requirements and Performance Expectations All current and proposed ambulances in Care's extensive ambulance fleet exceed the requirements of this RFP and comply with all federal, state and local laws, rules, statutes and regulations applicable to the provision of emergency ambulance services, including those standards established by the Orange County EMS Agency and Orange County Fire Authority. Environmentally Cleaner Ambulances • Toxic diesel emissions affect all people, but children are particularly vulnerable. New medical stud- ies in California find that air pollution not only exacerbates children's asthma, but also may cause 111 • asthma in otherwise healthy children. The reduction of toxic engine exhaust is a primary goal of Care Ambulance and one example of our commitment to creating safer neighborhoods. For that reason, Care Ambulance has selected the Chevrolet diesel chassis as our platform for ambulance design to serve the City of Seal Beach. Currently, the Chevrolet diesel chassis is the only standardized ambulance chassis that meets and ex- ceeds 2008 federally- mandated diesel emission standards. No other standardized ambulance chassis manufacturer can make that claim. The residents of Seal Beach and Orange County deserve a cleaner future. Care Ambulance is doing our part to make cleaner air a reality. Fleet Size Current trends in the EMS industry are for a standardization of fleet size in comparison to peak load demand; therefore, the EMS organization should determine how many ambulances are required at the busiest times and acquire a fleet that allows for reserves at that point. The standard that is emerg- ing in this trend is a fleet size to average peak load ratio of 1.25, or 125% of average peak load, there- by leaving at Least 25% in reserve during times of high demand. Care exceeds this trend by providing a fleet size of 133% of average peak load vehicles and is committed to maintaining this fleet size. Our rationale for what may seem to be an extreme position on fleet size is not solely altruistic. Our extensive fleet experience demonstrates that maintaining a large fleet allows our maintenance staff to perform preventive and repair- oriented service, without the pressure to "get the unit on the road." The result is higher quality service, strict adherence to maintenance protocols, and, as a result, lower operating costs, higher reliability and extended useful life. Additionally, Care utilizes higher quality, more reliable ambulances than most other providers. This large, high quality fleet combined with the aggressive internal maintenance program offers un- matched reliability and investment. 3. Ambulance Replacement Policies We embrace the aircraft- industry maintenance philosophy and apply its standards to prevent in -ser- vice vehicle failures. We replace critical vehicle components prior to their failure. Based on data and operating experience, we have instituted a vigorous parts replacement schedule to improve fleet reli- ability, to set our fleet maintenance operating budget and to extend the safe, useful life of our fleet. We replace parts not only at mileage intervals, but also when performance tests indicate wear limits. For example, rather than replace brakes solely at mileage intervals, we also replace brakes when brake pad and rotor thickness reaches a predetermined threshold. The expected life cycle of our vehicles is determined through the manufacturer's recommendations and by the track record established by our fleet maintenance department. • 11 ) • Listed below is our schedule of fleet replacement: ITEM BRAND LIFE REPLACEMENT SCHEDULE 1 I Ambulance Road Rescue 5 years 150,000 miles I Care is committed to the replacement of any and all equipment prior to reaching the end of its use- ful life. This commitment provides our patients the guarantee that we will do everything possible to ensure their safe transport. 4. Specific Ambulance Information A) Proposed Ambulance Units to be Available for 9 -1 -1 Responses in the City of Seal Beach (EOA #21) Care Ambulance is offering the City of Seal Beach and the Orange County Fire Authority the fol- lowing Modular Type III, dual rear wheel ambulances to serve as front -line emergency ambulances. The ambulances will be lettered with a city- approved distinctive lettering scheme that designates the ambulances as "Proudly Serving the City of Seal Beach." The Seal Beach ambulances will be staffed 24 hours a day, seven (7) days per week and will be dedi- cated to the City of Seal Beach and OCFA. � UNIT 1 CHASSIS MODEL YEAR MILEAGE CONDITION TYPE STATION � t I, 1 LOCATION 227 1 Chevrolet Road Rescue 2009 500 A — New ` III S.B. #1* 228 Chevrolet i Road Rescue 1 2009 500 7 A — New III 1 S.B. #2* Care Ambulance understands that any decrease in the number of dedicated ambulances, without the prior consent of the OCFA Fire Chief, may constitute a breach of contract. Any ambulance tem- porarily removed from dedicated service will be replaced as soon as practical by one of Care's reserve ambulances and crews. All ambulances have been ordered with a contracted delivery date of February 2009. B. Other Regional Ambulance Units That Will Be Available to Reasonably Support 9 -1 -1 Responses in the City of Seal Beach (EOA #21) The following twenty -three (23) ambulances are proposed or are already stationed in North -East Or- . ange County, in communities that are proximate to Seal Beach and may be available to the support the City of Seal Beach and the Orange County Fire Authority. Each of the below identified ambu- lances is staffed twenty -four (24) hours per day, seven (7) days per week UNIT CHASSIS MODEL YEAR MILEAGE CONDITION TYPE STATION LOCATION 227 Chevrolet Road Rescue 2009 1 500 A — New III Seal Beach* 228 Chevrolet Road Rescue 2009 ; 500 A — New III Seal Beach* 229 Chevrolet Road Rescue 2009 500 A — New III Los Alamitos* • 231 Chevrolet Road Rescue 2009 500 A — New ' III La Palma 1 232 Chevrolet Road Rescue 2009 1 500 A — New III Stanton 11 3 • �: 234 'Chevrolet Road Rescue 2009 500 A — New i III ! Buena Park 235 � Chevrolet Road Rescue i 2009 _ 500 A — New --I III I Gard. Grov #1 1 1 236 1 Chevrolet 1 Road Rescue 2009 500 A — New ' III_ Gard. Grov #2 ' 237 Chevrolet Road Rescue 2009 500 A — New III Gard. Grov #3 1 Chevrolet Road Rescue 2008 5,000 A — New III FV Amb 31 I 205 ' Chevrolet Road Rescue 1 2008 5,000 A — New III FV / CM 1 202 I Chevrolet 1 Road Rescue 1 2008 5,000 A — New ' III Costa Mesa #1 203 Chevrolet Road Rescue' 2008 5,000 : A — New III Costa Mesa #2 i 204 , Chevrolet Road Rescue 1 2008 1 5,000 A — New ; III Costa Mesa #3 208 'Chevrolet Leader 1 2008 5,000 A — New i III Fullerton #1 1 209 `Chevrolet Leader 2008 5,000 A — New III Fullerton #2 1 210 'Chevrolet Leader 2008 5,000 IA — New III Fullerton #3 1 215 !Chevrolet Leader 2008 5,000 A — New 'III Anaheim #1 220 Chevrolet Leader 2008 5,000 A — New III ( Anaheim #3 211 1 Chevrolet Leader 2008 5,000 A — New III Anaheim #6 221 1 Chevrolet Leader 2008 I 5,000 A —New � III Anaheim #7 1 222 Chevrolet Leader 2008 5,000 A— New III Anaheim #9 1 214 ! Chevrolet Leader 2008 5,000 A — New III } Anaheim #11 Ilitl 1 213 I Chevrolet Road Rescue 2008 5,000 A — New i III ! Placentia * Indicates a proposed ambulance station. All other stations currently exist and are operational. In addition to the above listed ambulances, Care Ambulance maintains an additional twenty (20) 10 -hour ambulances at our corporate offices in Orange; along with seventeen (17) 24 -hour ambu- lances and thirty-eight (38) 12 -hour ambulances in Los Angeles County. All of these ambulances are in areas proximate to Seal Beach. Each of these ambulances is licensed to provide services in Orange County and may be available for emergency ambulances responses into the City of Seal Beach. Due to our large fleet size and page limitations of the proposal, a complete list showing details on our entire fleet is available upon request. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of Seal Beach or a pre - designated staging location dose to Seal Beach to ensure consistent ambulance coverage. The au- tomatic back -up coverage process will begin whenever the units dedicated to the City of Seal Beach are dispatched on a request for service. This is a similar process to that already used by Care Ambu- lance Service for our other contracted city emergency ambulance contracts, allowing Care Ambu- lance to deliver ambulance response times unmatched by any other local ambulance provider. PROPOSED TOTAL AMBULANCE DEPLOYMENT AVAILABLE FOR THE CITY OF CYPRESS 1 Dedicated Unit 2 Dedicated Adjacent OCFA Partner Ambulances 5 • I Other Proximate 24 -Hour Staffed Ambulances 118 I Care's Other Orange County Licensed Ambulances 197 114 • • IncrearsingAmbulance Resources Should call volume increase significantly in the City of Seal Beach and exceed the standard daily capacity of our dedicated ambulance resources, Care Ambulance commits to increase the number of dedicated and/or regional ambulances provided in order to ensure the timely delivery of services. Any temporary increases in call volume will be immediately handled by our backup ambulances until it is determined that additional permanent ambulances are needed. Upon discovering that any ambulance has suffered a mechanical failure or becomes disabled, or upon the request of an OCFA fire official, Care Ambulance will immediately dispatch a secondary ambulance. Enhancements As part of Care's commitment to disaster readiness and homeland security, Care provides two (2) Orange County EMS Agency furnished Disaster Supply Trailers (DSTs) and a State of California EMS Authority furnished Disaster Medical Support Unit (DMSU). Each DSTs is equipped with a sufficient cache of medical supplies to support any major event in the county, including 50 backboards, 1000 triage tags, 50 blankets, 15 oxygen cylinders with regulators, over 1,000 N95 HEPA masks in all sizes, assorted oxygen supplies and splints, trauma bags, easy up shelter, tarps and table. The DSTs may be requested by OCFA and will be immedi- ately dispatched to the scene. IIIP In addition to the DSTs, Care Ambulance hosts a State of California, EMS Authority DMSU, to support a deployed ambulance strike team. Similar to the DSTs, the state DMSU is fully equipped with Basic Life Support (BLS) equipment and supplies. In addition, it is also equipped with a limited amount of Advanced Life Support (ALS) equipment and supplies. These critical resources will ensure an immediate resupply of Care's ambulances and OCFA paramedics in the event of a prolonged major incident. ;3 .41141. 1 • • - 4 ,, • .-, , { 115 • ITEM 22 : AMBULANCES PROPOSED FOR CITY OF STANTON (EDA # 22) 1. Description of Vehicles and Ambulances As the largest provider of emergency and non - emergency ambulance service in Orange County, Care Ambulance currently maintains a response -ready fleet of 118 emergency ambulances. Our unique ability to provide this depth of emergency ambulance resources ensures that there is no loss of ser- vices to the residents and visitors of Stanton, in the event that Care Ambulance needs to temporarily remove an ambulance from service for maintenance or repair, or in the event of a large multi - casualty incident. For the new contract period, Care Ambulance is pleased to offer the Orange County Fire Authority and the City of Stanton an enhanced fleet of new, custom - designed ambulances and specialty units. Care commits to furnish and dedicate a new specialized Chevrolet diesel chassis, "Road Rescue" Type III modular ambulance for provision of service to the City of Stanton and OCFA. Care has specifically chosen the Road Rescue ambulance because of its proven quality and safe, com- fortable patient ride. The Road Rescue company is an industry leader, designing a modular ambu- lance product that is widely recognized as one of the safest and finest ambulances available. Several unique design features are included as follows: • Safest ambulance interior for paramedics and EMTs. Two (2) 411 . separate "Captain Chairs ", each with its own 3 -point safety j r estraint harness system and separate interior restraint system r netting. ( A* .� a ► • Storage for five (5) backboards. _ • Oxygen storage for four D -size portable oxygen cylinders. '" • A lighting system in the patient compartment that provides intense illumination. • All- aluminum modules and cabinets. The reduced weight resulting from this type of construction alleviates the problem r front -axle overload, thus producing a smoother ride. To assure that this ambulance and crew are entirely available to the City of Stanton and OCFA, Care Ambulance has developed a city- approved distinctive lettering scheme for the ambulance exterior that designates the ambulance as "Proudly Serving the City of Stanton." 2. Exceeding Specifications, Requirements and Performance Expectations All current and proposed ambulances in Care's extensive ambulance fleet exceed the requirements of this RFP and comply with all federal, state and local laws, rules, statutes and regulations applicable to the provision of emergency ambulance services, including those standards established by the Orange County EMS Agency and Orange County Fire Authority. Environmentally Cleaner Ambulances • Toxic diesel emissions affect all people, but children are particularly vulnerable. New medical stud- ies in California find that air pollution not only exacerbates children's asthma, but also may cause 116 • asthma in otherwise healthy children. The reduction of toxic engine exhaust is a primary goal of Care Ambulance and one example of our commitment to creating safer neighborhoods. For that reason, Care Ambulance has selected the Chevrolet diesel chassis as our platform for ambulance design to serve the City of Stanton. Currently, the Chevrolet diesel chassis is the only standardized ambulance chassis that meets and exceeds 2008 federally- mandated diesel emission standards. No other standardized ambulance chassis manufacturer can make that claim. The residents of Stanton and Orange County deserve a cleaner future. Care Ambulance is doing our part to make cleaner air a reality. Fleet Size Current trends in the EMS industry are for a standardization of fleet size in comparison to peak load demand; therefore, the EMS organization should determine how many ambulances are required at the busiest times and acquire a fleet that allows for reserves at that point. The standard that is emerg- ing in this trend is a fleet size to average peak load ratio of 1.25, or 125% of average peak load, there- by leaving at least 25% in reserve during times of high demand. Care exceeds this trend by providing a fleet size of 133% of average peak load vehicles and is committed to maintaining this fleet size. • Our rationale for what may seem to be an extreme position on fleet size is not solely altruistic. Our extensive fleet experience demonstrates that maintaining a large fleet allows our maintenance staff to perform preventive and repair- oriented service, without the pressure to "get the unit on the road." The result is higher quality service, strict adherence to maintenance protocols, and, as a result, lower operating costs, higher reliability and extended useful life. Additionally, Care utilizes higher quality, more reliable ambulances than most other providers. This large, high quality fleet combined with the aggressive internal maintenance program offers un- matched reliability and investment. 3. Ambulance Replacement Policies We embrace the aircraft- industry maintenance philosophy and apply its standards to prevent in -ser- vice vehicle failures. We replace critical vehicle components prior to their failure. Based on data and operating experience, we have instituted a vigorous parts replacement schedule to improve fleet reli- ability, to set our fleet maintenance operating budget and to extend the safe, useful life of our fleet. We replace parts not only at mileage intervals, but also when performance tests indicate wear limits. For example, rather than replace brakes solely at mileage intervals, we also replace brakes when brake pad and rotor thickness reaches a predetermined threshold. The expected life cycle of our vehicles is determined through the manufacturer's recommendations and by the track record established by our fleet maintenance department. • 11 7 • Listed below is our schedule of fleet replacement: ITEM BRAND 1 LIFE REPLACEMENT SCHEDULE 1 Ambulance Road Rescue ; 5 years 150,000 miles I Care is committed to the replacement of any and all equipment prior to reaching the end of its use- ful life. This commitment provides our patients the guarantee that we will do everything possible to ensure their safe transport. 4. Specific Ambulance Information A) Proposed Ambulance Units to be Available for 9 -1 -1 Responses in the , City of Stanton (EOA # 22) Care Ambulance is offering the City of Stanton and the Orange County Fire Authority the follow- ing Modular Type III, dual rear wheel ambulance to serve as our front -line emergency ambulance. The ambulance will be lettered with a city- approved distinctive lettering scheme that designates the ambulance as "Proudly Serving the City of Stanton." The Stanton ambulance will be staffed 24 hours a day, seven (7) days per week and will be dedicated to the City of Stanton and OCFA. UNIT I CHASSIS MODEL YEAR MILEAGE I CONDITION TYPE I STATION • 1 LOCATION 1 23 2 -; Chevrolet ;Road Rescue 2009 I 500 Brand New 1111 Stanton Care Ambulance understands that any decrease in the number of dedicated ambulances, without the prior consent of the OCFA Fire Chief, may constitute a breach of contract. Any ambulance tempo- rarily removed from dedicated service will be replaced as soon as practical by one of Care's reserve ambulances and crews. All ambulances have been ordered with a contracted delivery date of February 2009. B. Other Regional Ambulance Units That Will Be Available to Reasonably Support 9 -1 -1 Responses in the City of Stanton (EOA # 22) The following twenty-four (24)) ambulances are proposed or are already stationed in North -East Or- ange County, in communities that are proximate to Stanton and may be available to the support the City of Stanton and the Orange County Fire Authority. Each of the below identified ambulances is staffed twenty-four (24) hours per day, seven (7) days per week. 1 UNIT CHASSIS MODEL YEAR MILEAGE CONDITION TYPE STATION LO CATION 1227 Chevrolet Road Rescue 2009 500 A — New III } Seal Beach* 228 Che vrolet Road Rescue 2009 500 A — New I III Seal Beach* 229 Chevrolet Road Rescue 2009 1 500 A — New III Los Alamitos* I 231 ! Chevrolet Road Rescue 2009 500 A — New , III La Palma • 1232 I Chevrolet Road Rescue 2009 500 A — New 1111 !Stanton i 234 I Chevrolet Road Rescue 2009 500 A — New III Buena [ Park I 118 • 23 5 Chevrolet Road Rescue 2009 500 I A — Ne w 1 I II Gard. Grov #1 236 'Chevrolet Road Rescue 2009 1 500 1 A — New , III Gard. Grov #2 1 237 I Chevrolet Road Rescue 2009 1 500 A — New ; III _ 1 Gard. Grov #3 1 212 Chevrolet Road Rescue 2008 5,000 A — New 'III 1 FV Amb 31 1 205 Chevrolet Road Rescue 2008 5,000 A — New III FV / CM 1 202 { Chevrolet Road Rescue 2008 5,000 A — New I III I Costa Mesa #1 I12_ Chevrolet Road Rescue 2008 5,000 A — New III 1 Costa Mesa #2 21--04 _ { Chevrolet Road Rescue 2008 5,000 A — New I III Costa Mesa #3 208 I Chevrolet Leader 2008 5,000 A — New 1111 I Fullerton #1 [20 9 i Chevrolet Leader 1 2008 5,000 — A — New V --- 1 2008 5,000 A — New III � Fullerton #2 � I— I 210 Chevrolet Leader 2008 5,000 A — New :III Fullerton #3 1 215 Chevrolet Leader . III Anaheim #1 220 1--- 2 0 1 Chevrolet Leader 2008 5,000 _ A — New I III Anaheim #3 _ 211 i Chevrolet Leader 2008 5,000 A — New III I Anaheim #6 221 1 Chevrolet Leader 2008 5,000 A — New III I Anaheim #7 222 'Chevrolet Leader 2008 5,000 A — New III I Anaheim #9 214 I Chevrolet Leader 2008 5,000 A — New I1I I Anaheim #11 1 213 'Chevrolet Road Rescue 2008 1 5,000 A — New j III 'Placentia * Indicates a proposed ambulance station. All other stations currently exist and are operational. In addition to the above listed ambulances, Care Ambulance maintains an additional twenty (20) 10 -hour ambulances at our corporate offices in Orange; along with seventeen (17) 24 -hour ambu- lances and thirty-eight (38) 12 -hour ambulances in Los Angeles County. All of these ambulances are in areas proximate to Stanton. Each of these ambulances is licensed to provide services in Orange County and may be available for emergency ambulances responses into the City of Stanton. Due to our large fleet size and page limitations of the proposal, a complete list showing details on our entire fleet is available upon request. Through Care's Global Positioning System (GPS) and computer -based tracking of all ambulances in our fleet, additional ambulances can be automatically transferred into the City of Stanton or a pre - designated staging location close to Stanton to ensure consistent ambulance coverage. The automatic back -up coverage process will begin whenever the unit dedicated to the City of Stanton is dispatched on a request for service. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts, allowing Care Ambulance to deliver am- bulance response times unmatched by any other local ambulance provider. PROPOSED TOTAL AMBULANCE DEPLOYMENT AVAILABLE FOR THE CITY OF CYPRESS ' Dedicated Unit 1 1 Dedicated Adjacent OCFA Partner Ambulances , • I Other Proximate 24 -Hour Staffed Ambulances 18 L Other Orange County Licensed Ambulances 197 I J 11 • Increasing Ambulance Resources Should call volume increase significantly in the City of Stanton and exceed the standard daily ca- pacity of our dedicated ambulance resource, Care Ambulance commits to increase the number of dedicated and /or regional ambulances provided in order to ensure the timely delivery of services. Any temporary increase in call volume will be immediately handled by our backup ambulances until it is determined that additional permanent ambulances are needed. Upon discovering that any ambulance has suffered a mechanical failure or becomes disabled, or upon the request of an OCFA fire official, Care Ambulance immediately dispatches a secondary ambulance. Enhancements As part of Care's commitment to disaster readiness and homeland security, Care provides two (2) Orange County EMS Agency furnished Disaster Supply Trailers (DSTs) and a State of California EMS Authority furnished Disaster Medical Support Unit (DMSU). Each DSTs is equipped with a sufficient cache of medical supplies to support any major event in the county, including 50 backboards, 1000 triage tags, 50 blankets, 15 oxygen cylinders with regulators, over 1,000 N95 HEPA masks in all sizes, assorted oxygen supplies and splints, trauma bags, easy up shelter, tarps and table. The DSTs may be requested by OCFA and will be immedi- ately dispatched to the scene. In addition to the DSTs, Care Ambulance hosts a State of California, EMS Authority DMSU, Of to support a deployed ambulance strike team. Similar to the DSTs, the state DMSU is fully equipped with Basic Life Support (BLS) equipment and supplies. In addition, it is also equipped with a limited amount of Advanced Life Support (ALS) equipment and supplies. These critical resources will ensure an immediate resupply of Care's ambulances and OCFA paramedics in the event of a prolonged major incident. .... ma /,'� Id 1 111 Illlr ' : 1 .. * • t:� ii Si - .', I'-;,.... A , ' ° i . � a c -� w { ,1';',1,. • .:',..,,..1.- , - . ,... 2 ...iv . ,./ � 120 ; • I TAB 23 i ; i i f I I 1 1 . ! 1 L . f i L 1- r , 6 , f i t t 1 . r t i :I. ; s ■ 1 I ; • t • ITEM 23 : RESPONSE TIME HISTORY City of Cypress — EOA # 5 Operating under some of the toughest response time standards in Southern California, Care Ambu- lance consistently meets and exceeds our contracted ambulance response time standards for all cities, counties and fire agencies that we serve. Care Ambulance Service provides contracted 9 -1 -1 emergency ambulance transportation services to the following Orange County cities and communities: Anaheim, Buena Park, Costa Mesa, Fountain Valley, Fullerton, Garden Grove, La Palma, 1 Midway City and Stanton. In addition, Care Ambulance ^ ` i ` provides contracted 9 -1 -1 emergency ambulance transporta- tion services to the twenty -two (22) cities and communities of • ` ` "�" South -East Los Angeles County, under contract with the Los Angeles County Board of Supervisors and Los Angeles County 0 `� Fire Department. Annually, Care Ambulance Service responds and provides ambulance transport service to over 175,000 patients, of which more than 110,000 are emergency 9 -1 -1 responses. While some ambulance providers routinely rely on `exceptions" to meet established contracted ambulance response times, Care Ambulance has never utilized an exception, or excuse. We meet and exceed all contracted ambulance response times without having to depend on exceptions for late ambulance responses. The following chart below provides a detailed fractile summary response time report for the three - month period of January 2008 to April 2008, or most recent timeframe data available, for the Cities of La Palma, Stanton and other cities served. In review of the response time data, it should be noted that in the City of Fountain Valley and the County of Los Angeles (EOA#6) Care Ambulance operates with an eight (8) minute Code 3 re- sponse time standard, compared to the OCFA requirement of a ten (10) minute Code 3 response time standard. CITY OF LA PALMA - EOA #1 3 January-08 February-08 March -08 Quarterly Totals Standard % % # 0/0 # U/ RESP RESP RESP RESP Code3 @10 Mins. 0 100% 0 100% 0 100% 0 100% • Code2 @15 Mins. 55 98.1% 49 93.80% 55 96.40% 159 96.20% 121 • CITIES OF STANTON AND MIDWAY CITY - EOA #22 January -08 February -08 March -08 Quarterly Totals Standard RESP % RESP �o RESP % RESP Code 3 @ 10 Mins. 1 100% 1 100% 0 100% 2 100% Code 2 @ 15 Mins. 264 97.30% 256 97.70% 272 96.70% 792 97.20% CITY OF BUENA PARK - EOA #3 January-08 February-08 March -08 Quarterly Totals Standard RESP % RESP % RESP % RESP ok Code 3 @ 10 Mins. 1 100% 0 100% 0 100% 1 100% Code 2 @ 15 Mins. 427 97.90% 372 98.70% 453 98.70% 1252 98.40% at. CITY OF COSTA MESA September -08 October -08 November -08 Quarterly Totals Standard RESP % RFSP % RESP % RFSP ok Code 3 @ 10 Mins. 2 100% 4 100% 0 100% 6 100% Code2@ 15 Mins. 594 99.66% 610 97.70% 571 98.07% 1775 98.48% CITY OF FOUNTAIN VALLEY January-08 February -08 March -08 Quarterly Totals Standard RESP % RESP % RESP % RESP Code 3 @ 10 Mins. 12 91.70% 8 87.50% 13 100% 33 93.90% Code 2 @ 15 Mins. 294 100% 309 99.40% 331 97.60% 934 98.90% • 122 • CITY OF GARDEN GROVE January-08 February -08 March -08 Quarterly Totals Standard RESP % RFSP % RESP % RESP Code 3 @10 Mins. 293 95.60% 363 95.00% 332 95.20% 988 95.20% Code 2 @ 15 Mins. 488 98.00% 462 98.30% 516 98.80% 1466 98.40% COUNTY OF LOS ANGELES - ECM #6 January-08 February-08 March -08 Quarterly Totals Standard RESP % RESP % RESP % RESP % Code 3 @ 10 Mins. 5641 93.30% 5808 94.80% 5851 93.90% 17,300 94.00% Not Applicable Note — Care Ambulance began service to the City of Costa Mesa in September 2008, therefore data was provided for last 3 months. Both the Cities of Anaheim and Fullerton provided dispatching of Care's emergency ambulances through contract with Metro Cities Dispatch Center. All dispatch records are maintained by Metro Net and are not in the requested format. 123 • ITEM 23 : RESPONSE TIME HISTORY City of La Palma — EOA # 13 Operating under some of the toughest response time standards in Southern California, Care Ambu- lance consistently meets and exceeds our contracted ambulance response time standards for all cities, counties and fire agencies that we serve. Care Ambulance Service provides contracted 9 -1 -1 emergency ambulance transportation services to the following Orange`__ County cities and communities: Anaheim, Buena Park, Costa , - cO .. C 3 Mesa, Fountain Valley, Fullerton, Garden Grove, La Palma, Midway City and Stanton. In addition, Care Ambulance ii r;t �,, provides contracted 9 -1 -1 emergency ambulance transports - a ,. Lion services to the twenty-two (22) cities and communities of f =�' South -East Los Angeles County, under contract with the Los Angeles County Board of Supervisors and Los Angeles County Fire Department. Annually, Care Ambulance Service responds and provides ambulance transport service to over 175,000 patients, of which more than 110,000 are emergency lit -1 -1 responses. While some ambulance providers routinely rely on `exceptions" to meet established contracted ambulance response times, Care Ambulance has never utilized an exception, or excuse. We meet and exceed all contracted ambulance response times without having to depend on exceptions for late ambulance responses. The following chart below provides a detailed fractile summary response time report for the three - month period of January 2008 to April 2008, or most recent timeframe data available, for the Cities of La Palma, Stanton and other cities served. In review of the response time data, it should be noted that in the City of Fountain Valley and the County of Los Angeles (EOA #6) Care Ambulance operates with an eight (8) minute Code 3 re- sponse time standard, compared to the OCFA requirement of a ten (10) minute Code 3 response time standard. CITY OF LA PALMA - EOA #13 January-08 February -08 March -08 Quarterly Totals Standard RESP % RESP % RFSP O/0 RESP Code 3 @ 10 Mins. 0 100% 0 100% 0 100% 0 100% • Code 2 @ 15 Mins. 55 98.1% 49 93.80% 55 96.40% 159 96.20% 124 • CITIES OF STANTON AND MIDWAY CITY - EOA #22 January-08 February-08 March -08 Quarterly Totals Standard RESP RESP % RESP °k RESP °rb Code 3 @ 10 Mins. 1 100% 1 100% 0 100% 2 100% Code 2 @ 15 Mins. 264 97.30% 256 97.70% 272 96.70% 792 97.20% CITY OF BUENA PARK - ECM #3 January-08 February-08 March -08 Quarterly Totals Standard RESP % RFSP % RESP % RFSP % Code 3 @ 10 Mins. 1 100% 0 100% 0 100% 1 100% Code 2 @ 15 Mins. 427 97.90% 372 98.70% 453 98.70% 1252 98.40% CITY OF COSTA MESA September -08 October -08 November -08 Quarterly Totals Standard RESP % % % RESP % RFSP % Code 3 @ 10 Mins. 2 100% 4 100% 0 100% 6 100% Code 2 @ 15 Mins. 594 99.66% 610 97.70% 571 98.07% 1775 98.48% CITY OF FOUNTAIN VALLEY January-08 February -08 March -08 Quarterly Totals Standard RESP % RFSP 9/o RESP % RESP Code3@ 10 Mins. 12 91.70% 8 87.50% 13 100% 33 93.90% Code 2 @ 15 • Mins. 294 100% 309 99.40% 331 97.60% 934 _ 98.90% 125 • CITY OF GARDEN GROVE January-08 February-08 March -08 Quarterly Totals Standard RESP % RESP % RFSP % RESP To Code3@ 10 Mins. 293 95.60% 363 95.00% 332 95.20% 988 95.20% Code2@ 15 Mins. 488 98.00% 462 98.30% 516 98.80% 1466 98.40% COUNTY OF LOS ANGELES - EDA #6 January-08 February-08 March -08 Quarterly Totals Standard RESP % RESP % RESP RESP RESP % Code 3 @ 10 Mins. 5641 93.30% 5808 94.80% 5851 93.90% 17,300 94.00% Not Applicable • Note — Care Ambulance began service to the City of Costa Mesa in September 2008, therefore data was provided for last 3 months. Both the Cities of Anaheim and Fullerton provided dispatching of Care's emergency ambulances through contract with Metro Cities Dispatch Center. All dispatch records are maintained by Metro Net and are not in the requested format. • 126 • ITEM 23 : RESPONSE TIME HISTORY City of Los Alamitos — EOA # 14 Operating under some of the toughest response time standards in Southern California, Care Ambu- lance consistently meets and exceeds our contracted ambulance response time standards for all cities, counties and fire agencies that we serve. Care Ambulance Service provides contracted 9 -1 -1 emergency ambulance transportation services to the following Orange w -.- w■� ow County cities and communities: Anaheim, Buena Park, Costa ,......- Hsu CARE aril Mesa, Fountain Valley, Fullerton, Garden Grove, La Palma, 1 . ;# ! i Midway City and Stanton. In addition, Care Ambulance " z . ! provides contracted 9 -1 -1 emergency ambulance transporta- . F: 7 =,' 'N ° tion services to the twenty -two (22) cities and communities of ;:w South -East Los Angeles County, under contract with the Los Angeles County Board of Supervisors and Los Angeles County Fire Department. Annually, Care Ambulance Service responds and provides ambulance transport service to over 175,000 patients, of which more than 110,000 are emergency at 9 -1 -1 responses. While some ambulance providers routinely rely on `exceptions" to meet established contracted ambulance response times, Care Ambulance has never utilized an exception, or excuse. We meet and exceed all contracted ambulance response times without having to depend on exceptions for late ambulance responses. The following chart below provides a detailed fractile summary response time report for the three - month period of January 2008 to April 2008, or most recent timeframe data available, for the Cities of La Palma, Stanton and other cities served. In review of the response time data, it should be noted that in the City of Fountain Valley and the County of Los Angeles (EOA #6) Care Ambulance operates with an eight (8) minute Code 3 re- sponse time standard, compared to the OCFA requirement of a ten (10) minute Code 3 response time standard. CITY OF LA PALMA - EOA # 1 3 January -08 February-08 March -08 Quarterly Totals Standard # % RESP RESP % RESP % RESP Code 3 @ 10 Mins. 0 100% 0 100% 0 100% 0 100% 11111 Code 2 @ 15 Mins. 55 98.1% 49 93.80% 55 96.40% 159 96.20% 127 • CITIES OF STANTON AND MIDWAY CITY - ECIA #22 January-08 February -08 March -08 Quarterly Totals Standard RESP % RESP % RFSP % RFSP Code 3 @ 10 Mins. 1 100% 1 100% 0 100% 2 100% Code 2 @ 15 Mins. 264 97.30% 256 97.70% 272 96.70% 792 97.20% CITY OF BUENA PARK - ECIA #3 January-08 February -08 March -08 Quarterly Totals Standard RESP % RESP % RESP % RESP Code 3 @ 10 Mins. 1 100% 0 100% 0 100% 1 100% Code 2 @ 15 Mins. 427 97.90% 372 98.70% 453 98.70% 1252 98.40% li t CITY OF COSTA MESA September -08 October -08 November -08 Quarterly Totals Standard RESP % RESP % RFSP % RESP Code 3 @ 10 Mins. 2 100% 4 100% 0 100% 6 100% Code 2 @ 15 Mins. 594 99.66% 610 97.70% 571 98.07% 1775 98.48% CITY OF FOUNTAIN VALLEY January-08 February -08 March -08 Quarterly Totals Standard RESP % RESP % RFSP % RESP Code 3 @ 10 Mins. 12 91.70% 8 87.50% 13 100% 33 93.90% Code 2 @ 15 Mins. 294 100% 309 99.40% 331 97.60% 934 98.90% • 128 • CITY OF GARDEN GROVE January-08 February-08 March -08 Quarterly Totals Standard % o RESP RESP RESP /0 RESP / Code 3 @ 10 Mins. 293 95.60% 363 95.00% 332 95.20% 988 95.20% Code 2 @ 15 Mins. 488 98.00% 462 98.30% 516 98.80% 1466 98.40% COUNTY OF LOS ANGELES - EDA #6 January-08 February -08 March -08 Quarterly Totals Standard RF�SP % RF�SP °� RESP % RESP Code 3 @ 10 Mins. 5641 93.30% 5808 94.80% 5851 93.90% 17,300 94.00% Not Applicable • ( Note — Care Ambulance began service to the City of Costa Mesa in September 2008, therefore data was provided for last 3 months. Both the Cities of Anaheim and Fullerton provided dispatching of Care's emergency ambulances through contract with Metro Cities Dispatch Center. All dispatch records are maintained by Metro Net and are not in the requested format. • • 129 III ITEM 23 : RESPONSE TIME HISTORY City of Sea( Beach — EOA # 21 Operating under some of the toughest response time standards in Southern California, Care Ambu- lance consistently meets and exceeds our contracted ambulance response time standards for all cities, counties and fire agencies that we serve. Care Ambulance Service provides contracted 9 -1 -1 emergency =. ambulance transportation services to the following Orange - County cities and communities: Anaheim, Buena Park, Costa ` --�_ *NM CARE ar Mesa, Fountain Valley, Fullerton, Garden Grove, La Palma, E s -i ik1/4. Midway City and Stanton. In addition, Care Ambulance ? s provides contracted 9 -1 -1 emergency ambulance transporta -R ' - •w tion services to the twenty-two (22) cities and communities of _, n- South -East Los Angeles County, under contract with the Los ,_ _; Angeles County Board of Supervisors and Los Angeles County Fire Department. Annually, Care Ambulance Service responds and provides ambulance transport service to over 175,000 patients, of which more than 110,000 are emergency • 9 -1 -1 responses. 'While some ambulance providers routinely rely on exceptions" to meet established contracted ambulance response times, Care Ambulance has never utilized an exception, or excuse. We meet and exceed all contracted ambulance response times without having to depend on exceptions for late ambulance responses. The following chart below provides a detailed fractile summary response time report for the three - month period of January 2008 to April 2008, or most recent timeframe data available, for the Cities of La Palma, Stanton and other cities served. In review of the response time data, it should be noted that in the City of Fountain Valley and the County of Los Angeles (EOA#6) Care Ambulance operates with an eight (8) minute Code 3 re- sponse time standard, compared to the OCFA requirement of a ten (10) minute Code 3 response time standard. CITY OF LA PALMA - EOA #1 3 January February -08 March -08 Quarterly Totals Standard RFSP % RESP % RFSP % RFSP Code3 @10 Mins. 0 100% 0 100% 0 100% 0 100% Code • Mins. 55 98.1% 49 93.80% 55 96.40% 159 96.20% 130 • CITIES OF STANTON AND MIDWAY CITY - EOA #22 January -08 February-08 March -08 Quarterly Totals Standard RESP % RESP % RESP % RESP ok Code 3 @ 10 Mins. 1 100% 1 100% 0 100% 2 100% Code 2 @ 15 Mins. 264 97.30% 256 97.70% 272 96.70% 792 97.20% CITY OF BUENA PARK - EOA #3 January-08 February-08 March -08 Quarterly Totals Standard RESP % RFSP To 96 % RESP Code 3 @ 10 Mins. 1 100% 0 100% 0 100% 1 100% Code 2 @ 15 Mins. 427 97.90% 372 98.70% 453 98.70% 1252 98.40% •1 1 CITY OF COSTA MESA September -08 October -08 November -08 Quarterly Totals Standard RESP % RESP % RESP % RFSP Code 3 @ 10 Mins. 2 100% 4 100% 0 100% 6 100% Code 2 @ 15 Mins. 594 99.66% 610 97.70% 571 98.07% 1775 98.48% CITY OF FOUNTAIN VALLEY January -08 February-08 March -08 Quarterly Totals Standard RFSP % RFSP % RFSP % RFSP % Code 3 @ 10 Mins. 12 91.70% 8 87.50% 13 100% 33 93.90% Code 2 @ 15 • Mins. 294 100% 309 99.40% 331 97.60% 934 98.90% 131 • CITY OF GARDEN GROVE January-08 February -08 March -08 Quarterly Totals Standard RESP RESP % RESP % RESP Code 3 @ 10 Mins. 293 95.60% 363 95.00% 332 95.20% 988 95.20% Code2 @15 Mins. 488 98.00% 462 98.30% 516 98.80% 1466 98.40% COUNTY OF LOS ANGELES - EOA #6 January -08 February -08 March -08 Quarterly Totals Standard RESP % RFSP % RESP RESP Code 3 @ 10 Mins. 5641 93.30% 5808 94.80% 5851 93.90% 17,300 94.00% Not Applicable Note — Care Ambulance began service to the City of Costa Mesa in September 2008, therefore data was provided for last 3 months. Both the Cities of Anaheim and Fullerton provided dispatching of Care's emergency ambulances through contract with Metro Cities Dispatch Center. All dispatch records are maintained by Metro Net and are not in the requested format. • 132 • ITEM 23 : RESPONSE TIME HISTORY City of Stanton - EOA # 22 Operating under some of the toughest response time standards in Southern California, Care Ambu- lance consistently meets and exceeds our contracted ambulance response time standards for all cities, counties and fire agencies that we serve. Care Ambulance Service provides contracted 9 -1 -1 emergency ._ —� "" ambulance transportation services to the following Orange "` County cities and communities: Anaheim, Buena Park, Costa '"M, -- A CAA! are Mesa, Fountain Valley, Fullerton, Garden Grove, La Palma, « ( j Midway City and Stanton. In addition, Care Ambulance - ' . 1 wi provides contracted 9 -1 -1 emergency ambulance transporta - tion services to the twenty-two (22) cities and communities of `" _, South -East Los Angeles County, under contract with the Los Angeles County Board of Supervisors and Los Angeles County "" ' Fire Department. c Annually, Care Ambulance Service responds and provides ambulance transport service to over 175,000 patients, of which more than 110,000 are emergency Ilk. 9 -1 -1 responses. While some ambulance roviders routinely rely y ely on 'exceptions" to meet established contracted ambulance response times, Care Ambulance has never utilized an exception, or excuse. We meet and exceed all contracted ambulance response times without having to depend on exceptions for late ambulance responses. The following chart below provides a detailed fractile summary response time report for the three - month period of January 2008 to April 2008, or most recent timeframe data available, for the Cities of Stanton, La Palma and other cities served. In review of the response time data, it should be noted that in the City of Fountain Valley and the County of Los Angeles (EOA #6) Care Ambulance operates with an eight (8) minute Code 3 re- sponse time standard, compared to the OCFA requirement of a ten (10) minute Code 3 response time standard. CITIES OF STANTON AND MIDWAY CITY — EOA #22 January -08 February-08 March -08 Quarterly Totals Standard RESP % RESP % RFSP % RESP % Code3 @10 Mins. 1 100% 1 100% 0 100% 2 100% • Code 2 @ 15 Mins. 264 97.30% 256 97.70% 272 96.70% 792 97.20% 133 • CITY OF LA PALMA - EOA # 1 3 January -08 February-08 March -08 Quarterly Totals Standard RESP % RESP % RESP % RESP cYo Code 3 @ 10 Mins. 0 100% 0 100% 0 100% 0 100% Code 2 @ 15 Mins. 55 98.1% 49 93.80% 55 96.40% 159 96.20% CITY OF BUENA PARK - EOA #3 January February-08 March -08 Quarterly Totals Standard RESP % RESP % RESP % RESP Code 3 @ 10 Mins. 1 100% 0 100% 0 100% 1 100% Code 2 @ 15 Mins. 427 97.90% 372 98.70% 453 98.70% 1252 98.40% Ill CITY OF COSTA MESA September -08 October -08 November -08 Quarterly Totals Standard RESP % RFSP % RESP � 0 RFSP Code 3 @ 10 Mins. 2 100% 4 100% 0 100% 6 100% Code 2 @ 15 Mins. 594 99.66% 610 97.70% 571 98.07% 1775 98.48% CITY OF FOUNTAIN VALLEY January-08 February -08 March -08 Quarterly Totals Standard RFSP % RFSP % RESP % RESP ok Code3 @10 Mins. 12 91.70% 8 87.50% 13 100% 33 93.90% Code 2 @ 15 • Mins. 294 100% 309 99.40% 331 97.60% 934 98.90% 134 • CITY OF GARDEN GROVE January-08 February-08 March -08 Quarterly Totals # # Standard RFSP % RFSP % RFSP % RFSP % Code 3 @ 10 Mins. 293 95.60% 363 95.00% 332 95.20% 988 95.20% Code 2 @ 15 Mins. 488 98.00% 462 98.30% _ 516 98.80% 1466 98.40% COUNTY OF LOS ANGELES - EOA #6 January-08 February-08 March -08 Quarterly Totals Standard P % # o # P,SP RFSP % # o RFSP / O R /o Code 3 @ 10 Mins. 5641 93.30% 5808 94.80% 5851 93.90% 17,300 94.00% Not Applicable IIP Note — Care Ambulance began service to the City of Costa Mesa in September 2008, therefore data was provided for last 3 months. Both the Cities of Anaheim and Fullerton provided dispatching of Care's emergency ambulances through contract with Metro Cities Dispatch Center. All dispatch records are maintained by Metro Net and are not in the requested format. • 135 • TAB 24 f t • I i • III ITEM 24 : MUTUAL AID PROVIDER City of Cypress — EOA # 5 Care Ambulance is honored to be the largest provider of emergency and non - emergency ambulance services in Orange County. At any given time, Care Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance very rarely needs mutual aid assistance, but frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not use the services of another provider as an alternative method to meet contracted response time requirements, Care does recog- nize that the mutual aid process is important to ensure structured responses to mass casualty inci- dents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural disasters. Care Ambulance understands and agrees that all mutual aid agreements must be approved by the Orange County Fire Authority and that all mutual aid providers must meet the operational require- ments of OCFA. Care further understands and agrees that should a mutual aid provider provide back -up services, Care and not the mutual aid provider will be responsible for ensuring compliance Ilk with all terms, conditions, standards and performance requirements set forth in contract documents. As a current OCFA emergency ambulance contra g cy contractor, Care Ambulance is party to an existing Mas- ter Mutual Aid Agreements between existing OCFA contracted emergency ambulance providers. In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each mutual aid provider used by Care Ambulance in Orange County. Each mutual aid company utilized by Care Ambulance has current OCFA emergency ambulance experience and/or has been pre - qualified to provide services to the OCFA, meeting all the operational requirements of this RFP. Care Ambulance understands that too much is at risk to experiment with new, unproven ambulance companies. AmeriCare Ambulance: AmeriCare Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the City of Villa Park. Ameri- Care uses a crew staffing of two (2) EMTs and has twenty -two (22) Orange County licensed ambu- lances. AmeriCare Ambulance began service in 1997 and is currently working towards CAAS Ac- creditation. AmeriCaze's headquarters are located at 1059 E. Bedmar Street, Carson, California 90746. Contact person is Michael Summers — CEO. Telephone number is (310) 632 -1141. Doctor's Ambulance: 411- Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA 136 • operational requirements, providing emergency ambulance services in Tustin, Dana Point, Laguna Beach, Irvine, Laguna Hills, Aliso Viejo and Laguna Woods. Doctor's uses a crew staffing of two (2) EMTs and has twenty -two (22) Orange County licensed ambulances. Doctor's Ambulance began service in 1974 and is CAAS Accredited. Doctor's Ambulance headquarters are located at 23091 Terra Drive, Laguna Hills, California 92653. Contact person is Michael Herren — Senior Vice President. Telephone number is (949) 951 -8535. Emergency Ambulance: Emergency Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the communities of Brea, Placentia and Yorba Linda. Emergency Ambulance uses a crew staffing of two (2) EMTs and has ten (10) Orange County licensed ambulances. Emergency Ambulance began service in 1977 and is CAAS Accredited. Emergency Ambulance headquarters are located at 3200 E. Birch Street, Suite A, Brea, California 92821. Contact person is Phil Davis — President. Telephone number is (714) 990 -1331. Medix Ambulance: Medix Ambulance is another contracted OCFA BLS ambulance service that meets all OCFA opera- tional requirements. Medix currently serves the cities of Seal Beach, Los Alamitos, Cypress, Rancho Santa Margarita, Lake Forest, Laguna Niguel, San Juan Capistrano and Mission Viejo. Medix Ambu- lance uses a crew staffing of two (2) EMTs and has twenty-six (26) Orange County licensed ambu- lances. Medix Ambulance began service in 1978 and is CAAS Accredited. Medix Ambulance headquarters are located at 26021 Paula Drive, Mission Viejo, California 92691. Contact person is Michael Dimas — President. Telephone number is (714) 634 -2671. Schaefer Ambulance: The oldest ambulance service in California is Schaefer Ambulance. They began service in 1932 and until recently provided emergency ambulance services to the City of Costa Mesa. Schaefer Ambu- lance still provides non - emergency ambulance services in Orange County, using a crew staffing of two (2) EMTs with five (5) Orange County licensed ambulances. Schaefer Ambulance meets all OCFA operational requirements. Schaefer's Orange County Division office is located at 2215 S. Bristol Street, Santa Ana, California 92704. Contact person is James McNeal, III. — Regional Manager. Telephone number is (800) 582- 2258. Copies of the master mutual aid agreement and separate mutual aid agreements are provided as an Attachment to this section of the proposal. > _..,....: � - ° . 1:`. r :..`. � fir= � �. 41 0 i ii : ,_ . ' , , . r ,,z. gr ''' 1 s .. , lamaipia Z''' . ,,,, ,. \ ' .)37 • ITEM 24 : MUTUAL AID PROVIDER City of La Palma —EDA# 13 Care Ambulance is honored to be the largest provider of emergency and non - emergency ambulance services in Orange County. At any given time, Care Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance very rarely needs mutual aid assistance, but frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not use the services of another provider as an alternative method to meet contracted response time requirements, Care does recog- nize that the mutual aid process is important to ensure structured responses to mass casualty inci- dents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural disasters. Care Ambulance understands and agrees that all mutual aid agreements must be approved by the Orange County Fire Authority and that all mutual aid providers must meet the operational require- ments of OCFA. Care further understands and agrees that should a mutual aid provider provide back -up services, Care and not the mutual aid provider will be responsible for ensuring compliance with all terms, conditions, standards and performance requirements set forth in contract documents. As a current OCFA emergency ambulance g ry contractor, Care Ambulance is party to an existing Mas- ter Mutual Aid Agreements between existing OCFA contracted emergency ambulance providers. In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each mutual aid provider used by Care Ambulance in Orange County Each mutual aid company utilized by Care Ambulance has current OCFA emergency ambulance experience and/or has been pre - qualified to provide services to the OCFA, meeting all the operational requirements of this RFP. Care Ambulance understands that too much is at risk to experiment with new, unproven ambulance companies. AmeriCare Ambulance: AmeriCare Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the City of Villa Park. Ameri- Care uses a crew staffing of two (2) EMTs and has twenty -two (22) Orange County licensed ambu- lances. AmeriCare Ambulance began service in 1997 and is currently working towards CAAS Ac- creditation. AmeriCare's headquarters are located at 1059 E. Bedmar Street, Carson, California 90746. Contact person is Michael Summers — CEO. Telephone number is (310) 632 -1141. ilk_ Doctor's Ambulance: Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA 138 • operational requirements, providing emergency ambulance services in Tustin, Dana Point, Laguna Beach, Irvine, Laguna Hills, Aliso Viejo and Laguna Woods. Doctor's uses a crew staffing of two (2) EMTs and has twenty-two (22) Orange County Licensed ambulances. Doctor's Ambulance began service in 1974 and is CAAS Accredited. Doctor's Ambulance headquarters are located at 23091 Terra Drive, Laguna Hills, California 92653. Contact person is Michael Herren — Senior Vice President. Telephone number is (949) 951 -8535. Emergency Ambulance: Emergency Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the communities of Brea, Placentia and Yorba Linda. Emergency Ambulance uses a crew staffing of two (2) EMTs and has ten (10) Orange County licensed ambulances. Emergency Ambulance began service in 1977 and is CAAS Accredited. Emergency Ambulance headquarters are located at 3200 E. Birch Street, Suite A, Brea, California 92821. Contact person is Phil Davis — President. Telephone number is (714) 990 -1331. Medix Ambulance: Medix Ambulance is another contracted OCFA BLS ambulance service that meets all OCFA opera- tional requirements. Medix currently serves the cities of Seal Beach, Los Alamitos, Cypress, Rancho Santa Margarita, Lake Forest, Laguna Niguel, San Juan Capistrano and Mission Viejo. Medix Ambu- 411 lance uses a crew staffing of two (2) EMTs and has twenty-six (26) Orange County licensed ambu- lances. Medix Ambulance began service in 1978 and is CAAS Accredited. Medix Ambulance headquarters are located at 26021 Paula Drive, Mission Viejo, California 92691. Contact person is Michael Dimas — President. Telephone number is (714) 634 -2671. Schaefer Ambulance: The oldest ambulance service in California is Schaefer Ambulance. They began service in 1932 and until recently provided emergency ambulance services to the City of Costa Mesa. Schaefer Ambu- lance still provides non - emergency ambulance services in Orange County, using a crew staffing of two (2) EMTs with five (5) Orange County licensed ambulances. Schaefer Ambulance meets all OCFA operational requirements. Schaefer's Orange County Division office is located at 2215 S. Bristol Street, Santa Ana, California 92704. Contact person is James McNeal, III. — Regional Manager. Telephone number is (800) 582- 2258. Copies of the master mutual aid agreement and separate mutual aid agreements are provided as an Attachment to this section of the proposal. `� ilia I i 1 ' � ..✓w, N r �, r 3 Y ti, 4.4 S ' - • ITEM 24 : MUTUAL AID PROVIDER City of Seal Beach — EOA # 21 Care Ambulance is honored to be the largest provider of emergency and non - emergency ambulance services in Orange County. At any given time, Care Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance very rarely needs mutual aid assistance, but frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not use the services of another provider as an alternative method to meet contracted response time requirements, Care does recog- nize that the mutual aid process is important to ensure structured responses to mass casualty inci- dents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural disasters. Care Ambulance understands and agrees that all mutual aid agreements must be approved by the Orange County Fire Authority and that all mutual aid providers must meet the operational require- ments of OCFA. Care further understands and agrees that should a mutual aid provider provide back -up services, Care and not the mutual aid provider will be responsible for ensuring compliance with all terms, conditions, standards and performance requirements set forth in contract documents. et As a current OCFA emergency ambulance contractor, Care Ambulance is party to an existing Mas- ter Mutual Aid Agreements between existing OCFA contracted emergency ambulance providers. In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each mutual aid provider used by Care Ambulance in Orange County. Each mutual aid company utilized by Care Ambulance has current OCFA emergency ambulance experience and/or has been pre - qualified to provide services to the OCFA, meeting all the operational requirements of this RFP. Care Ambulance understands that too much is at risk to experiment with new unproven ambulance companies. AmeriCare Ambulance: AmeriCare Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the City of Villa Park. Ameri- Care uses a crew staffing of two (2) EMTs and has twenty -two (22) Orange County licensed ambu- lances. AmeriCare Ambulance began service in 1997 and is currently working towards CARS Ac- creditation. AmeriCare's headquarters are located at 1059 E. Bedmar Street, Carson, California 90746. Contact person is Michael Summers — CEO. Telephone number is (310) 632 -1141. ik . Doctor's Ambulance: Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA 142 • ITEM 24 : MUTUAL AID PROVIDER City of Los Alamitos — EOA # 14 Care Ambulance is honored to be the largest provider of emergency and non - emergency ambulance services in Orange County. At any given time, Care Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance very rarely needs mutual aid assistance, but frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not use the services of another provider as an alternative method to meet contracted response time requirements, Care does recog- nize that the mutual aid process is important to ensure structured responses to mass casualty inci- dents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural disasters. Care Ambulance understands and agrees that all mutual aid agreements must be approved by the Orange County Fire Authority and that all mutual aid providers must meet the operational require- ments of OCFA. Care further understands and agrees that should a mutual aid provider provide back -up services, Care and not the mutual aid provider will be responsible for ensuring compliance lit with all terms, conditions, standards and performance requirements set forth in contract documents. As a current OCFA emergency ambulance contractor, Care Ambulance is party to an existing Mas- ter Mutual Aid Agreements between existing OCFA contracted emergency ambulance providers. In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each mutual aid provider used by Care Ambulance in Orange County. Each mutual aid company utilized by Care Ambulance has current OCFA emergency ambulance experience and/or has been pre - qualified to provide services to the OCFA, meeting all the operational requirements of this RFP. Care Ambulance understands that too much is at risk to experiment with new, unproven ambulance companies. AmeriCare Ambulance: AmeriCare Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the City of Villa Park. Ameri- Care uses a crew staffing of two (2) EMTs and has twenty -two (22) Orange County licensed am- bulances. AmeriCare Ambulance began service in 1997 and is currently working towards CAAS Accreditation. AmeriCare's headquarters are located at 1059 E. Bedmar Street, Carson, California 90746. Contact person is Michael Summers — CEO. Telephone number is (310) 632 -1141. III Doctor's Ambulance: Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA 140 • operational requirements, providing emergency ambulance services in Tustin, Dana Point, Laguna Beach, Irvine, Laguna Hills, Aliso Viejo and Laguna Woods. Doctor's uses a crew staffing of two (2) EMTs and has twenty -two (22) Orange County licensed ambulances. Doctor's Ambulance began service in 1974 and is CAAS Accredited. Doctor's Ambulance headquarters are located at 23091 Terra Drive, Laguna Hills, California 92653. Contact person is Michael Herren — Senior Vice President. Telephone number is (949) 951 -8535. Emergency Ambulance: Emergency Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the communities of Brea, Placentia and Yorba Linda. Emergency Ambulance uses a crew staffing of two (2) EMTs and has ten (10) Orange County licensed ambulances. Emergency Ambulance began service in 1977 and is CAAS Accredited. Emergency Ambulance headquarters are located at 3200 E. Birch Street, Suite A, Brea, California 92821. Contact person is Phil Davis — President. Telephone number is (714) 990 -1331. Medix Ambulance: Medix Ambulance is another contracted OCFA BLS ambulance service that meets all OCFA opera- tional requirements. Medix currently serves the cities of Seal Beach, Los Alamitos, Cypress, Ran- cho Santa Margarita, Lake Forest, Laguna Niguel, San Juan Capistrano and Mission Viejo. Medix iiiR. Ambulance uses a crew staffing of two (2) EMTs and has twenty -six (26) Orange County licensed ambulances. Medix Ambulance began service in 1978 and is CAAS Accredited. Medix Ambulance headquarters are located at 26021 Paula Drive, Mission Viejo, California 92691. Contact person is Michael Dimas — President. Telephone number is (714) 634 -2671. Schaefer Ambulance: The oldest ambulance service in California is Schaefer Ambulance. They began service in 1932 and until recently provided emergency ambulance services to the City of Costa Mesa. Schaefer Ambu- lance still provides non - emergency ambulance services in Orange County, using a crew staffing of two (2) EMTs with five (5) Orange County licensed ambulances. Schaefer Ambulance meets all OCFA operational requirements. Schaefer's Orange County Division office is located at 2215 S. Bristol Street, Santa Ana, California 92704. Contact person is James McNeal, III. — Regional Manager. Telephone number is (800) 582- 2258. Copies of the master mutual aid agreement and separate mutual aid agreements are provided as an Agochment to this section of the proposal. I dill MIL do ::.c y 441. c ..r • 1 ' . S • . r. * s* 4 ��� . ow 141 • ITEM 24 : MUTUAL AID PROVIDER City of Seal Beach — EOA # 21 Care Ambulance is honored to be the largest provider of emergency and non - emergency ambulance services in Orange County. At any given time, Care Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance very rarely needs mutual aid assistance, but frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not use the services of another provider as an alternative method to meet contracted response time requirements, Care does recog- nize that the mutual aid process is important to ensure structured responses to mass casualty inci- dents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural disasters. Care Ambulance understands and agrees that all mutual aid agreements must be approved by the Orange County Fire Authority and that all mutual aid providers must meet the operational require- ments of OCFA. Care further understands and agrees that should a mutual aid provider provide back -up services, Care and not the mutual aid provider will be responsible for ensuring compliance • with all terms, conditions, standards and performance requirements set forth in contract documents. As a current OCFA emergency ambulance contractor, Care Ambulance is party to an existing Mas- ter Mutual Aid Agreements between existing OCFA contracted emergency ambulance providers. In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each mutual aid provider used by Care Ambulance in Orange County. Each mutual aid company utilized by Care Ambulance has current OCFA emergency ambulance experience and /or has been pre - qualified to provide services to the OCFA, meeting all the operational requirements of this RFP. Care Ambulance understands that too much is at risk to experiment with new, unproven ambulance companies. AmeriCare Ambulance: AmeriCare Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the City of Villa Park. Ameri- Care uses a crew staffing of two (2) EMTs and has twenty -two (22) Orange County licensed ambu- lances. AmeriCare Ambulance began service in 1997 and is currently working towards CHAS Ac- creditation. AmeriCare's headquarters are located at 1059 E. Bedmar Street, Carson, California 90746. Contact person is Michael Summers — CEO. Telephone number is (310) 632 -1141. ( Doctor's Ambulance: Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA 142 • operational requirements, providing emergency ambulance services in Tustin, Dana Point, Laguna Beach, Irvine, Laguna Hills, Aliso Viejo and Laguna Woods. Doctor's uses a crew staffing of two (2) EMTs and has twenty-two (22) Orange County licensed ambulances. Doctor's Ambulance began service in 1974 and is CAAS Accredited. Doctor's Ambulance headquarters are located at 23091 Terra Drive, Laguna Hills, California 92653. Contact person is Michael Herren — Senior Vice President. Telephone number is (949) 951 -8535. Emergency Ambulance: Emergency Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the communities of Brea, Placentia and Yorba Linda. Emergency Ambulance uses a crew staffing of two (2) EMTs and has ten (10) Orange County licensed ambulances. Emergency Ambulance began service in 1977 and is CAAS Accredited. Emergency Ambulance headquarters are located at 3200 E. Birch Street, Suite A, Brea, California 92821. Contact person is Phil Davis — President. Telephone number is (714) 990 -1331. Medix Ambulance: Medix Ambulance is another Contracted OCFA BLS ambulance service that meets all OCFA opera- tional requirements. Medix currently serves the cities of Seal Beach, Los Alamitos, Cypress, Ran- cho Santa Margarita, Lake Forest, Laguna Niguel, San Juan Capistrano and Mission Viejo. Medix Ambulance uses a crew staffing of two (2) EMTs and has twenty-six (26) Orange County licensed ambulances. Medix Ambulance began service in 1978 and is CAAS Accredited. Medix Ambulance headquarters are located at 26021 Paula Drive, Mission Viejo, California 92691. Contact person is Michael Dimas — President. Telephone number is (714) 634 -2671. Schaefer Ambulance: The oldest ambulance service in California is Schaefer Ambulance. They began service in 1932 and until recently provided emergency ambulance services to the City of Costa Mesa. Schaefer Ambu- lance still provides non - emergency ambulance services in Orange County, using a crew staffing of two (2) EMTs with five (5) Orange County licensed ambulances. Schaefer Ambulance meets all OCFA operational requirements. Schaefer's Orange County Division office is located at 2215 S. Bristol Street, Santa Ana, California 92704. Contact person is James McNeal, III. — Regional Manager. Telephone number is (800) 582- 2258. Copies of the master mutual aid agreement and separate mutual aid agreements are provided as an Attachment to this section of the proposal. : i3! .r. * ; I- 4 23 . 1 1 fr 4 • '� `�0' • 143 • ITEM 24 : MUTUAL AID PROVIDER City of Stanton — EOA # 22 Care Ambulance is honored to be the largest provider of emergency and non - emergency ambulance services in Orange County. At any given time, are Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance very rarely needs mutual aid assistance, but frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not use the services of another provider as an alternative method to meet contracted response time requirements, Care does recog- nize that the mutual aid process is important to ensure structured responses to mass casualty inci- dents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural disasters. Care Ambulance understands and agrees that all mutual aid agreements must be approved by the Orange County Fire Authority and that all mutual aid providers must meet the operational require- ments of OCFA. Care further understands and agrees that should a mutual aid provider provide back-up services, Care and not the mutual aid provider will be responsible for ensuring compliance 41111 with all terms, conditions, standards and performance requirements set forth in contract documents. As a current OCFA emergency ambulance contractor, Care Ambulance is party to an existing Mas- ter Mutual Aid Agreements between existing OCFA contracted emergency ambulance providers. In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each mutual aid provider used by Care Ambulance in Orange County. Each mutual aid company utilized by Care Ambulance has current OCFA emergency ambulance experience and /or has been pre - qualified to provide services to the OCFA, meeting all the operational requirements of this RFP. Care Ambulance understands that too much is at risk to experiment with new unproven ambulance companies. AmeriCare Ambulance: AmeriCare Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the City of Villa Park. Ameri- Care uses a crew staffing of two (2) EMTs and has twenty-two (22) Orange County licensed am- bulances. AmeriCare Ambulance began service in 1997 and is currently working towards CAAS Accreditation. AmeriCare's headquarters are located at 1059 E. Bedmar Street, Carson, California 90746. Contact person is Michael Summers — CEO. Telephone number is (310) 632 -1141. 4111 Doctor's Ambulance: Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA 144 el operational requirements, providing emergency ambulance services in Tustin, Dana Point, Laguna Beach, Irvine, Laguna Hills, Aliso Viejo and Laguna Woods. Doctor's uses a crew staffing of two (2) EMTs and has twenty-two (22) Orange County licensed ambulances. Doctor's Ambulance began service in 1974 and is CAAS Accredited. Doctor's Ambulance headquarters are located at 23091 Terra Drive, Laguna Hills, California 92653. Contact person is Michael Herren — Senior Vice President. Telephone number is (949) 951 -8535. Emergency Ambulance: Emergency Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services to the communities of Brea, Placentia and Yorba Linda. Emergency Ambulance uses a crew staffing of two (2) EMTs and has ten (10) Orange County licensed ambulances. Emergency Ambulance began service in 1977 and is CAAS Accredited. Emergency Ambulance headquarters are located at 3200 E. Birch Street, Suite A, Brea, California , 92821. Contact person is Phil Davis — President. Telephone number is (714) 990 -1331. Medix Ambulance: Medix Ambulance is another contracted OCFA BLS ambulance service that meets all OCFA opera- tional requirements. Medix currently serves the cities of Seal Beach, Los Alamitos, Cypress, Ran- cho Santa Margarita, Lake Forest, Laguna Niguel, San Juan Capistrano and Mission Viejo. Medix Ambulance uses a crew staffing of two (2) EMTs and has twenty -six (26) Orange County licensed ambulances. Medix Ambulance began service in 1978 and is CAAS Accredited. Medix Ambulance headquarters are located at 26021 Paula Drive, Mission Viejo, California 92691. Contact person is Michael Dimas — President. Telephone number is (714) 634 -2671. Schaefer Ambulance: The oldest ambulance service in California is Schaefer Ambulance. They began service in 1932 and until recently provided emergency ambulance services to the City of Costa Mesa. Schaefer Ambu- lance still provides non - emergency ambulance services in Orange County, using a crew staffing of two (2) EMTs with five (5) Orange County licensed ambulances. Schaefer Ambulance meets all OCFA operational requirements. Schaefer's Orange County Division office is located at 2215 S. Bristol Street, Santa Ana, California 92704. Contact person is James McNeal, III. — Regional Manager. Telephone number is (800) 582- 2258. Copies of the master mutual aid agreement and separate mutual aid agreements are provided as i an Attachment to this section of the proposal. ar 1 — L. is 1' ...--- L. L 4 r jRR� 'xs t T. i ce ; , 1 3 ... 9' .., , 4-.:4 . x" , 44. • t 4 ` t ` + ; ,fir ,1. *j _ • TAB 25 I [ 1 6 r 1 F 1 • ITEM 25 : PLAN FOR TAKEOVER OF SERVICE / START-LIP City of Cypress — EOA # 5 Care Ambulance has prepared a plan for takeover of service / start -up for the City of Cypress that ex- ceeds the requirements of the RFP and assures uninterrupted quality ambulance service. Care Ambu- lance Service has the infrastructure already in place to ensure a smooth start -up of this contract and is a current OCFA contracted provider, serving the OCFA partner Cities of Buena Park, La Palma and Stanton. One of the true advantages Care Ambulance brings to the City of Cypress and the OCFA is seasoned management and experience with new start-up systems. With Care Ambulance, the City of Cypress can be certain you are working with a reputable, well -known firm that has a management team and implementation techniques that have been tested and proven. Care's start -up plan includes the following: • An experienced and knowledgeable local management team that is already in place with Managers who are familiar with Orange County, OCEMS practices and the Orange County Fire Authority Emergency Ambulance Transportation program. • The ability to implement our operational plan on or before the contract start -up date. Ilik In the following section, we detail our plan for takeover and implementation of the OCFA Emergen- cy Ambulance Transportation contract for the City of Cypress with a September 1, 2009 start date. 1. Implementation Management Team are Ambulance provides a very comprehensive management team with over 200 years experience in the management and supervision of emergency ambulance operations. A key to the successful growth of Care Ambulance has been the strength of our on -site management team, which includes: Dan Richardson — Co -CEO Dan Richardson has over thirty-three (33) years of ambulance industry experience and is responsible for the coordination and monitoring of overall system performance to ensure high standards of ser- vice. His exceptional management skills encompass areas such as team building, goal setting, perfor- mance recognition, and discipline to ensure motivated and highly productive middle management, supervisory, support, and field staff Rick Richardson — Co -CEO Employed at Care Ambulance Service for twenty-nine (29) years, Rick Richardson directs all busi- ness and financial operations of Care Ambulance. Rick has served as the President of the Ambulance Association of Orange County and has participated as a committee member on the Emergency Medical Services Agency's Emergency Medical Care Committee and Weapons of Mass Destruction Task Group. • 146 • Michael Martin, M.D. — Medical Director As the Medical Director for Care Ambulance for twenty (20) years, Dr. Martin is responsible for a wide variety of clinical and administrative functions. Dr. Martin oversees all medical services admin- istered by Care Ambulance staff and is a key to Care's commitment to Continuous Quality Improve- ment and EMT training programs. Dr. Martin is a Fellow of the American College of Emergency Physicians and a Diplomat of the American Board of Emergency Medicine. In addition to his role at Care Ambulance, Dr. Martin is an Emergency Department Physician at Presbyterian Intercommunity Hospital and serves on the hospital's Quality Assurance Committee. Bill Weston — Director of Operations Bill Weston is responsible for the daily operations of Care Ambulance. Bill has worked for Care Am- bulance for over eleven (11) years. Bill began his EMS career as an EMT and has responsibilities for field operations, EMT hiring, and risk management. If awarded this contract, Bill will serve as Care's liaison with the City of Cypress and OCFA. Bill has a Bachelor of Science Degree and a Masters Degree in Business Administration from the University of Phoenix. Bill also has a Designated Subjects Teaching Credential from California State University, Long Beach and is a current EMT educator. Ben Baker — Director of Communications Ambulance Deployment Management and Communication Center supervision is provided by Ben Baker. Ben is responsible for Care Ambulance's Deployment Planning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is a currently credentialed EMT and a retired Police Officer. Gene Wiskowski — Director of Finance Gene Wiskowski is Care's Director of Finance. Gene is responsible for Care's budgeting process and preparation of financial statements. Gene graduated from Pace University in New York with a Bachelor's Degree in Business Administra- tion and a Masters Degree in Financial Management. Gene previously was the Treasurer — Budget Officer for Thomas Jefferson University and the Chief Financial Officer at Eisenhower Medical Center. One of the strongest advantages Care Ambulance brings to the City of Cypress and OCFA is experienced management. Care Ambulance does not anticipate the use of an implementation management team that is different from the permanent management team. • 147 • 2. Proposed Start -Up Schedule Care Ambulance has the ability to implement all RFP requirements as outlined in the following Gantt chart. The chart outlines our proposed implementation timelines associated with the services and enhancements described in our proposal. We guarantee the absolutely timely commencement of services on or before September 1, 2009. I o.s.oswk I 1..j..1 1 — . 4 -1 -1.1 1.1-1 1 1- 1- 1..1.1..1 -..1- 1.1.1 .1.1.1 -I.j- 1..1- 1 -1 - I -L 1.1 ..1-1-1.1-1 • Y •qr .nr .•. wiii r YAP u•r .wr .. 1 1 r. wr n•r j il • Comm. r . • r•r • WM* • b. ....+ sr wr u. • . r•. .11 MO w w • r..w • •■••••••• mr ws .. Mil • •••• rsr wr u. IMES • r••■•• El i lit • rrr... .•.w sr .. Within the last five (5) years, Care's management team has implemented more emergency ambulance p g cY contracts than all other Orange County ambulance companies combined. Our management team and implementation techniques have been tested and proven. Our capabilities have been dearly demonstrated. For example, in the City of Fullerton, our emergency ambulance contract was sched- uled to begin on January 1, 2004 but due to unforeseen circumstances with the prior provider, our services were required beginning on November 25, 2003. With less than two (2) hours notice, Care Ambulance began our service to the city and has since delivered outstanding services to the residents and visitors of Fullerton. In September 2008, Care Ambulance began services to the City of Costa Mesa and most recently completed an emergency start -up with the City of La Habra, staffing EMTs for both ambulances operated by the City of La Habra. Equipment at Start -Up Care Ambulance has already secured the necessary commitments from reputable vendors of ambu- lances, medical supplies and equipment to ensure that all required equipment and inventory is avail- able for contract implementation. Having managed other procurements of vehicles and equipment, we are well prepared to manage the implementation of these contracts. Our vendors have done it before, our trucking and shipping brokers have done it before, and most important, we have done it before. • 148 • Rapid Start-Up Capability Care Ambulance maintains all the required resources and commitment to immediately begin provid- ing emergency ambulance services to the City of Cypress. Because of our unique ambulance coverage plans, current penetrations of the area's emergency and non - emergency ambulance market, current fleet size with additional capacity and vast experience in program start -ups, Care Ambulance has the necessary tools and experience to institute rapid services to OCFA. The bottom line is, if requested, "We Can Do It Today." 3. Proposed Initial Service Response Plan Care Ambulance proposes to provide EMT staffing for a minimum of one (1) staffed, dedicated Basic Life Support (BLS) ambulance stationed and housed in the City of Cypress, on a twenty-four (24) hour per day / seven (7) day per week basis. The business of providing emergency ambulance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and therefore commits to the full -time dedication of an ambulance resource to the City of Cypress and the Orange County Fire Authority. Care's proposed dedicated emergency ambulance station location is identified below: • Proposed Cypress Station 5990 Corporate Ave., Cypress In event that the City of Cypress's dedicated ambulance is dispatched on a request for service or tem- porarily removed from service, additional ambulances will be automatically posted or moved up to cover the city. Like an inventory system that immediately replaces any item from inventory, this sys- tem replaces any dedicated ambulance with a new ambulance crew posted or covering a contract city. This ensures that the City of Cypress will be constantly covered with ambulances, with no lapses in emergency ambulance coverage. This is a similar process to that already used by Care Ambulance Service for our other contracted city emergency ambulance contracts, allowing Care Ambulance to deliver ambulance response times unmatched by any other local ambulance provider. Care's move -up or post locations are identified below: • City of Cypress, intersection of Lincoln Avenue and Moody Street EMTs assigned to the dedicated City of Cypress ambulance may be approved by OCFA or the City of Cypress and shall be assigned to a fifty -six (56) hour work week schedule consistent with the stan- dard OCFA firefighter schedule. This staffing pattern will allow for a more coordinated team effort and provides necessary familiarity with staffing. As the largest provider of 9 -1 -1 emergency and non - emergency ambulance service in Orange Coun- ty, Care Ambulance maintains a significant ambulance presence in North-West Orange County cities and area hospitals. Should a situation occur that would begin to tax the resources of our dedicated Cypress ambulance, Care Ambulance agrees to utilize additional ambulances from our large ambu- lance fleet to assure OCFA and Cypress citizens of a timely emergency ambulance response. • 149 • Treatment of Incumbent Workers Care Ambulance will make every reasonable effort to offer incumbent EMT personnel employment opportunity. Care Ambulance will actively pursue three major goals in our recruitment and hiring practices for these contracts: • Active recruiting, with fair and favorable treatment of the incumbent work force. • Expansion of the existing work force with highly competent and motivated EMTs. • Active recruitment of minorities and women toward the fulfillment of our commitment to equal opportunity employment. We realize the importance of utilizing, to the greatest extent possible, the local work force in the start -up of a new EMS system. The local work force provides personnel who are familiar with the area, experienced in local protocols and procedures, and a readily available personnel resource for recruitment. Because of these advantages, Care Ambulance will place a high priority on recruitment from this work force. Actions we will take to ensure our success in recruitment and hiring of the incumbent work force include: • Initial recruitment efforts targeted to the local work force. • Provision of a strong orientation and training program, which will prepare the current work force for employment in our system. Orientation and training could be conducted in repetitive modules to allow attendance by the incumbent work force while they remain employed with the current provider. • Provision of an aggressive in- service training program which will allow a reasonable opportunity for the current work force to acquire additional skills required in the new system. Upon hiring, the incumbent workers will be entitled to the following benefits not otherwise available to starting EMT personnel: • Medical Benefit Plan - Immediate medical insurance will be provided, eliminating the waiting period so that all new employees would have medical coverage. • Priority Scheduling Plan - Incumbent workers would be allowed to maintain their current shift schedule, whenever possible. • Wages Commensurate with Experience - All incumbent EMT personnel would be hired at their current rates of pay or at rates commensurate with their experience. Some may enjoy an increase in compensation. • 150 • ITEM 25 : PLAN FOR TAKEOVER OF SERVICE / START -UP City of La Palma — EOA # 13 Care Ambulance Service is the incumbent emergency provider for the City of La Palma, currently providing fully compliant and nationally accredited emergency ambulance services to the residents and visitors of La Palma. Care Ambulance offers the City of La Palma the benefits of an established organization that continues to exceed and improve upon performance expectations. In selecting Care Ambulance as the future provider for the City of La Palma, the community will experience no interruption of the excellent ambulance services they already enjoy. OCFA and City of La Palma officials can count on our seamless continuation of stable, consistent and accountable services without fear of service halts or concern for performance decline while a new provider learns on the job. Care Ambulance Service has the infrastructure already in place to ensure a smooth start -up of this contract. One of the true advantages Care Ambulance brings to the City of La Palma and OCFA is • seasoned management and experience with the City of La Palma. With Care Ambulance, officials can be certain you are working with a reputable, well -known firm that has a management team and implementation techniques that have been tested and proven. Care's plan for continuation of service includes the following: • An experienced and knowledgeable local management team that is already in place with Managers who are familiar with the City of La Palma, Orange County, OCEMS practices and the Orange County Fire Authority Emergency Ambulance Transportation program. • The ability to implement our operational plan on or before the contract start -up date. In the following section, we detail our plan for the continuation of the OCFA Emergency Ambu- lance Transportation contract for the City of La Palma with a September 1, 2009 start date. 1. Implementation Management Team Care Ambulance provides a very comprehensive management team with over 200 years experience in the management and supervision of emergency ambulance operations. A key to the successful growth of Care Ambulance has been the strength of our on -site management team, which includes: Dan Richardson — Co -CEO Dan Richardson has over thirty-three (33) years of ambulance industry experience and is responsible for the coordination and monitoring of overall system performance to ensure high standards of ser- vice. His exceptional management skills encompass areas such as team building, goal setting, perfor- mance recognition, and discipline to ensure motivated and highly productive middle management, supervisory, support, and field staff. Rick Richardson — Co -CEO • Employed at Care Ambulance Service for twenty-nine (29) years, Rick Richardson directs all busi- ness and financial operations of Care Ambulance. Rick has served as the President of the Ambulance 151 • Association of Orange County and has participated as a committee member on the Emergency Medical Services Agency's Emergency Medical Care Committee and Weapons of Mass Destruction Task Group. Michael Martin, M.D. — Medical Director As the Medical Director for Care Ambulance for twenty (20) years, Dr. Martin is responsible for a wide variety of clinical and administrative functions. Dr. Martin oversees all medical services admin- istered by Care Ambulance staff and is a key to Care's commitment to Continuous Quality Improve- ment and EMT training programs. Dr. Martin is a Fellow of the American College of Emergency Physicians and a Diplomat of the American Board of Emergency Medicine. In addition to his role at Care Ambulance, Dr. Martin is an Emergency Department Physician at Presbyterian Intercommunity Hospital and serves on the hospital's Quality Assurance Committee. Bill Weston — Director of Operations Bill Weston is responsible for the daily operations of Care Ambulance. Bill has worked for Care Am- bulance for over eleven (11) years. Bill began his EMS career as an EMT and has responsibilities for field operations, EMT hiring, and risk management. If awarded this contract, Bill will continue to serve as Care's liaison with the City of La Palma and OCFA. • Bill has a Bachelor of Science Degree and a Masters Degree in Business Administration from the University of Phoenix. Bill also has a Designated Subjects Teaching Credential from California State University, Long Beach and is a current EMT educator. Ben Baker — Director of Communications Ambulance Deployment Management and Communication Center supervision is provided by Ben Baker. Ben is responsible for Care Ambulance's Deployment Planning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is a currently credentialed EMT and a retired Police Officer. Gene W/iskowski — Director of Finance Gene Wiskowski is Care's Director of Finance. Gene is responsible for Care's budgeting process and preparation of financial statements. Gene graduated from Pace University in New York with a Bachelor's Degree in Business Administra- tion and a Masters Degree in Financial Management. Gene previously was the Treasurer — Budget Officer for Thomas Jefferson University and the Chief Financial Officer at Eisenhower Medical Center. One of the strongest advantages are Ambulance brings to the City of La Palma and the OCFA is experienced management. Care Ambulance does not anticipate the use of an implementation management team that is different from the permanent management team. • 152 • 2. Proposed Start -Up Schedule As the current emergency ambulance transport provider for the City of La Palma, Care Ambulance presents a unique opportunity for the continuation of compliant and accredited services with abso- lutely no service interruptions to the city. We guarantee the absolutely timely commencement of services on or before September 1, 2009. Care Ambulance has the ability to implement all RFP requirements as outlined in the following Gantt chart. The chart outlines our proposed implementation timelines associated with the services and enhancements described in our proposal. o.•gterr • .r ., ll I .l.l.l.. . 1.1.1- 1.1•I.1 -1• .I- 1.1.. 1..FI -11 I -1 I -I -f I I -I -I I-1-1. ..1-1- [ -I IMMO efts. J• WIN NS MN I. .... 11 . I u._ I•l� 1• .r r I 1.I IM IN is wr ...... MN Isa 1. r. N. I I.! us M. .II.... .AIM Iss u. ..r..w Is• IN. I. • ••MI MN Ms u. • Non .n.. s• ss u. Wti NOM IY� 1. Y ...W. 11100 11.1 . •••∎•• I Ins Ia ON • r.rt. • rrr.r Within the last five (5) years, Care's management team has implemented more emergency ambulance contracts than all other Orange County ambulance companies combined. Our management team and implementation techniques have been tested and proven. Our capabilities have been clearly demonstrated. For example, in the City of Fullerton, our emergency ambulance contract was sched- uled to begin on January 1, 2004 but due to unforeseen circumstances with the prior provider, our services were required beginning on November 25, 2003. With less than two (2) hours notice, Care Ambulance began our service to the city and has since delivered outstanding services to the residents and visitors of Fullerton. In September 2008, Care Ambulance began services to the City of Costa Mesa and most recently completed an emergency start -up with the City of La Habra, staffing EMTs for both ambulances operated by the City of La Habra. Equipment at Start -Up Care Ambulance has already secured the necessary commitments from reputable vendors of ambu- lances, medical supplies and equipment to ensure that all required equipment and inventory is avail- able for contract implementation. • Having managed other procurements of vehicles and equipment, we are well prepared to manage 153 • the implementation of these contracts. Our vendors have done it before, our trucking and shipping brokers have done it before, and most important, we have done it before. Rapid Start-Up Capability Care Ambulance maintains all the required resources and commitment to continue providing emer- gency ambulance services to the City of La Palma. Because of our unique ambulance coverage plans, current penetrations of the area's emergency and non - emergency ambulance market, current fleet size with additional capacity and vast experience in program start-ups, Care Ambulance has the necessary tools and experience to continuing providing services to the City of La Palma. The bottom line is, "We Do it Today and We Guarantee that We Can Do It Tomorrow" 3. Current and Proposed Service Response Plan Care Ambulance proposes to continue to provide EMT staffing for a minimum of one (1) staffed, dedicated Basic Life Support (BLS) ambulances stationed and housed in the City of La Palma, on a twenty -four (24) hour per day / seven (7) day per week basis. The business of providing emergency ambulance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance rec- ognizes this and therefore continues to commits to the full -time dedication of an ambulance resource Ilk • to the City of La Palma and the Orange County Fire Authority. Care's existing dedicated emergency ambulance station location is identified below: • Existing La Palma Station 7872 Walker Street, Suite 103, La Palma In event that our dedicated ambulance is dispatched on a request for service or temporarily removed from service, additional ambulances are automatically posted or moved up to cover the city. Like an inventory system that immediately replaces any item from inventory, this system replaces any dedi- cated ambulance with a new ambulance crew posted or covering the city. This ensures that the City of La Palma is constantly covered with ambulances, with no lapses in emergency ambulance cover- age. This allows Care Ambulance to deliver ambulance response times unmatched by any other local ambulance provider. Care's move -up or post locations is identified below: • City of La Palma, intersection of La Palma Avenue and Walker Street Using Care's City of La Palma Service Response Plan in 2007, we were able to achieve 100% compliance on all requests for Code 3 ambulance services and 98.7% compliance on all re- quests for Code 2 ambulance services. This was done without refusing any calls for service or referring any calls to a mutual aid provider. EMTs assigned to the dedicated City of La Palma ambulance may be approved by OCFA or the City of La Palma and will be assigned to a fifty -six (56) hour work week schedule consistent with the stan- dard OCFA firefighter schedule. This staffing pattern will allow for a more coordinated team effort • and provides necessary familiarity with staffing. 154 • As the largest provider of 9 -1 -1 emergency and non - emergency ambulance service in Orange Coun- ty, Care Ambulance maintains a significant ambulance presence in North -West Orange County cities and area hospitals. Should a situation occur that would begin to tax the resources of our dedicated ambulance, Care Ambulance agrees to utilize additional ambulances from our large ambulance fleet to assure OCFA and La Palma citizens of a timely emergency ambulance response. Being the incumbent provider to the City of La Palma, Care Ambulance offers the city a trusted partner, experienced local caregivers, a knowledgeable local leadership team and the opportunity to continue emergency services with an existing partner that can provide services without interruption. While other ambulance providers can only make promises of possible future service to the city, Care Ambulance can conclusively demonstrate our actual excellent services rendered daily to the residents and visitors of La Palma. Il k III 155 • ITEM 25 : PLAN FOR TAKEOVER OF SERVICE / START -UP City of Los Alamitos — EOA # 14 Care Ambulance has prepared a plan for takeover of service / start -up for the City of Los Alamitos that exceeds the requirements of the RFP and assures uninterrupted quality ambulance service. Care Ambulance Service has the infrastructure already in place to ensure a smooth start -up of this con- tract and is a current OCFA contracted provider, serving the OCFA partner Cities of Buena Park, La Palma and Stanton. One of the true advantages Care Ambulance brings to the City of Los Alamitos and the OCFA is seasoned management and experience with new start -up systems. With Care Ambulance, the City of Los Alamitos can be certain you are working with a reputable, well -known firm that has a manage- ment team and implementation techniques that have been tested and proven. Care's start -up plan includes the following: • An experienced and knowledgeable local management team that is already in place with Managers who are familiar with Orange County, OCEMS practices and the Orange County Fire Authority Emergency Ambulance Transportation program. • The ability to implement our operational plan on or before the contract start -up date. lilt In the following section, we detail our plan for takeover and implementation of the OCFA Emer- gency Ambulance Transportation contract for the City of Los Alamitos with a September 1, 2009 start date. 1. Implementation Management Team Care Ambulance provides a very comprehensive management team with over 200 years experience in the management and supervision of emergency ambulance operations. A key to the successful growth of Care Ambulance has been the strength of our on -site management team, which includes: Dan Richardson — Co -CEO Dan Richardson has over thirty-three (33) years of ambulance industry experience and is responsible for the coordination and monitoring of overall system performance to ensure high standards of ser- vice. His exceptional management skills encompass areas such as team building, goal setting, perfor- mance recognition, and discipline to ensure motivated and highly productive middle management, supervisory, support, and field staff. Rick Richardson — Co -CEO Employed at Care Ambulance Service for twenty -nine (29) years, Rick Richardson directs all busi- ness and financial operations of Care Ambulance. Rick has served as the President of the Ambulance Association of Orange County and has participated as a committee member on the Emergency Medical Services Agency's Emergency Medical Care Committee and Weapons of Mass Destruction Task Group. • 156 • Michael Martin, M.D. — Medical Director As the Medical Director for Care Ambulance for twenty (20) years, Dr. Martin is responsible for a wide variety of clinical and administrative functions. Dr. Martin oversees all medical services admin- istered by Care Ambulance staff and is a key to Care's commitment to Continuous Quality Improve- ment and EMT training programs. Dr. Martin is a Fellow of the American College of Emergency Physicians and a Diplomat of the American Board of Emergency Medicine. In addition to his role at Care Ambulance, Dr. Martin is an Emergency Department Physician at Presbyterian Intercommunity Hospital and serves on the hospital's Quality Assurance Committee. Bill Weston — Director of Operations Bill Weston is responsible for the daily operations of Care Ambulance. Bill has worked for Care Am- bulance for over eleven (11) years. Bill began his EMS career as an EMT and has responsibilities for field operations, EMT hiring, and risk management. If awarded this contract, Bill will serve as Care's liaison with the City of Los Alamitos and OCFA. Bill has a Bachelor of Science Degree and a Masters Degree in Business Administration from the University of Phoenix. Bill also has a Designated Subjects Teaching Credential from California State University, Long Beach and is a current EMT educator. •� Ben Baker — Director of Communications Ambulance Deployment Management and Communication Center supervision is provided by Ben Baker. Ben is responsible for Care Ambulance's Deployment Planning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is a currently credentialed EMT and a retired Police Officer. Gene Wiskowski — Director of Finance Gene Wiskowski is Care's Director of Finance. Gene is responsible for Care's budgeting process and preparation of financial statements. Gene graduated from Pace University in New York with a Bachelor's Degree in Business Administra- tion and a Masters Degree in Financial Management. Gene previously was the Treasurer — Budget Officer for Thomas Jefferson University and the Chief Financial Officer at Eisenhower Medical Center. One of the strongest advantages Care Ambulance brings to the City of Los Alamitos and OCFA and is experienced management. Care Ambulance does not anticipate the use of an implemen- tation management team that is different from the permanent management team. • 157 • 2. Proposed Start-Up Schedule Care Ambulance has the ability to implement all RFP requirements as outlined in the following Gantt chart. The chart outlines our proposed implementation timelines associated with the services and enhancements described in our proposal. We guarantee the absolutely timely commencement of services on or before September 1, 2009. ll 0•9.1011.16 ll ] ) 1 • 4 1 4 • I 1 ( -Ill 1- J. 11 1-1•I•1- I I I - -I 1 I (•I•.1- 1..(•I l- I•l•••I•l -I• - !, OMR r I loam r•• r 11111111‘ I ■••1•11.1. __ .n_ r. •••rrim a_ r1_ I. • ..`1111 u_ 1_ .. ••• 1101 10 W 11■ Within the last five (5) years, Care's management team has implemented more emergency ambulance contracts than all other Orange County ambulance companies combined. Our management team and implementation techniques have been tested and proven. Our capabilities have been clearly demonstrated. For example, in the City of Fullerton, our emergency ambulance contract was sched- uled to begin on January 1, 2004 but due to unforeseen circumstances with the prior provider, our services were required beginning on November 25, 2003. With less than two (2) hours notice, Care Ambulance began our service to the city and has since delivered outstanding services to the residents and visitors of Fullerton. In September 2008, Care Ambulance began services to the City of Costa Mesa and most recently completed an emergency start -up with the City of La Habra, staffing EMTs for both ambulances operated by the City of La Habra. Equipment at Start -Up Care Ambulance has already secured the necessary commitments from reputable vendors of ambu- lances, medical supplies and equipment to ensure that all required equipment and inventory is avail- able for contract implementation. Having managed other procurements of vehicles and equipment, we are well prepared to manage the implementation of these contracts. Our vendors have done it before, our trucking and shipping brokers have done it before, and most important, we have done it before. • 158 • Rapid Start-Up Capability Care Ambulance maintains all the required resources and commitment to immediately begin provid- ing emergency ambulance services to the City of Los Alamitos. Because of our unique ambulance coverage plans, current penetrations of the area's emergency and non - emergency ambulance market, current fleet size with additional capacity and vast experience in program start -ups, Care Ambulance has the necessary tools and experience to institute rapid services to OCFA. The bottom line is, if requested, "We Can Do It Today." 3. Proposed Initial Service Response Plan Care Ambulance proposes to provide EMT staffing for a minimum of one (1) staffed, dedicated Basic Life Support (BLS) ambulance stationed and housed in the City of Los Alamitos, on a twenty- four (24) hour per day / seven (7) day per week basis. The business of providing emergency ambu- lance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and therefore commits to the full-time dedication of an ambulance resource to the City of Los Alamitos and the Orange County Fire Authority. Care's proposed dedicated emergency ambulance station location is identified below: • Proposed Los Alamitos Station 4732 Katella Ave., Los Alamitos In event that the City of Los Alamitos dedicated ambulance is dispatched on a request for service or temporarily removed from service, additional ambulances will be automatically posted or moved up to cover the city. Like an inventory system that immediately replaces any item from inventory, this system replaces any dedicated ambulance with a new ambulance crew posted or covering a contract city. This ensures that the City of Los Alamitos will be constantly covered with ambulances, with no lapses in emergency ambulance coverage. This is a similar process to that already used by Care Am- bulance Service for our other contracted city emergency ambulance contracts, allowing Care Ambu- lance to deliver ambulance response times unmatched by any other local ambulance provider. Care's move -up or post locations are identified below: • City of Los Alamitos, intersection of Lincoln Avenue and Moody Street EMTs assigned to the dedicated City of Los Alamitos ambulance may be approved by OCFA or the City of Los Alamitos and shall be assigned to a fifty -six (56) hour work week schedule consistent with the standard OCFA firefighter schedule. This staffing pattern will allow for a more coordinated team effort and provides necessary familiarity with staffing. As the largest provider of 9 -1 -1 emergency and non - emergency ambulance service in Orange Coun- ty, Care Ambulance maintains a significant ambulance presence in North -West Orange County cities and area hospitals. Should a situation occur that would begin to tax the resources of our dedicated Los Alamitos ambulance, Care Ambulance agrees to utilize additional ambulances from our large ambulance fleet to assure OCFA and Los Alamitos citizens of a timely emergency ambulance re- sponse. • 159 • Treatment oflncumbent Workers Care Ambulance will make every reasonable effort to offer incumbent EMT personnel employment opportunity. Care Ambulance will actively pursue three major goals in our recruitment and hiring practices for these contracts: • Active recruiting, with fair and favorable treatment of the incumbent work force. • Expansion of the existing work force with highly competent and motivated EMTs. • Active recruitment of minorities and women toward the fulfillment of our commitment to equal opportunity employment. We realize the importance of utilizing, to the greatest extent possible, the local work force in the start-up of a new EMS system. The local work force provides personnel who are familiar with the area, experienced in local protocols and procedures, and a readily available personnel resource for recruitment. Because of these advantages, Care Ambulance will place a high priority on recruitment from this work force. Actions we will take to ensure our success in recruitment and hiring of the incumbent work force include: • Initial recruitment efforts targeted to the local work force. • Provision of a strong orientation and training program, which will prepare the current work force for employment in our system. Orientation and training could be conducted in repeti- tive modules to allow attendance by the incumbent work force while they remain employed with the current provider. • Provision of an aggressive in- service training program which will allow a reasonable opportunity for the current work force to acquire additional skills required in the new system. Upon hiring, the incumbent workers will be entitled to the following benefits not otherwise available to starting EMT personnel: • Medical Benefit Plan - Immediate medical insurance will be provided, eliminating the waiting period so that all new employees would have medical coverage. • Priority Scheduling Plan - Incumbent workers would be allowed to maintain their current shift schedule, whenever possible. • Wages Commensurate with Experience - All incumbent EMT personnel would be hired at their current rates of pay or at rates commensurate with their experience. Some may enjoy an increase in compensation. • 160 • ITEM 25 : PLAN FOR TAKEOVER OF SERVICE / START-UP City of Seal Beach — EOA # 21 Care Ambulance has prepared a plan for takeover of service / start -up for the City of Seal Beach that exceeds the requirements of the RFP and assures uninterrupted quality ambulance service. Care Ambulance Service has the infrastructure already in place to ensure a smooth start -up of this con- tract and is a current OCFA contracted provider, serving the OCFA partner Cities of Buena Park, La Palma and Stanton. One of the true advantages Care Ambulance brings to the City of Seal Beach and the OCFA is sea- soned management and experience with new start-up systems. With Care Ambulance, the City of Seal Beach can be certain you are working with a reputable, well -known firm that has a management team and implementation techniques that have been tested and proven. Care's start-up plan includes the following: • An experienced and knowledgeable local management team that is already in place with Managers who are familiar with Orange County, OCEMS practices and the Orange County Fire Authority Emergency Ambulance Transportation program. • The ability to implement our operational plan on or before the contract start -up date. lit In the following section, we detail our plan for takeover and implementation of the OCFA Emer- gency Ambulance Transportation contract for the City of Seal Beach with a September 1, 2009 start date. 1. Implementation Management Team Care Ambulance provides a very comprehensive management team with over 200 years experience in the management and supervision of emergency ambulance operations. A key to the successful growth of Care Ambulance has been the strength of our on -site management team, which includes: Dan Richardson — Co -CEO Dan Richardson has over thirty -three (33) years of ambulance industry experience and is responsible for the coordination and monitoring of overall system performance to ensure high standards of ser- vice. His exceptional management skills encompass areas such as team building, goal setting, perfor- mance recognition, and discipline to ensure motivated and highly productive middle management, supervisory, support, and field staff. Rick Richardson — Co -CEO Employed at Care Ambulance Service for twenty-nine (29) years, Rick Richardson directs all busi- ness and financial operations of Care Ambulance. Rick has served as the President of the Ambulance Association of Orange County and has participated as a committee member on the Emergency Medical Services Agency's Emergency Medical Care Committee and Weapons of Mass Destruction Task Group. • ii,i • Michael Martin, M.D. — Medical Director As the Medical Director for Care Ambulance for twenty (20) years, Dr. Martin is responsible for a wide variety of clinical and administrative functions. Dr. Martin oversees all medical services admin- istered by Care Ambulance staff and is a key to Care's commitment to Continuous Quality Improve- ment and EMT training programs. Dr. Martin is a Fellow of the American College of Emergency Physicians and a Diplomat of the American Board of Emergency Medicine. In addition to his role at Care Ambulance, Dr. Martin is an Emergency Department Physician at Presbyterian Intercommunity Hospital and serves on the hospital's Quality Assurance Committee. Bill Weston — Director of Operations Bill Weston is responsible for the daily operations of Care Ambulance. Bill has worked for Care Am- bulance for over eleven (11) years. Bill began his EMS career as an EMT and has responsibilities for field operations, EMT hiring, and risk management. If awarded this contract, Bill will serve as Care's liaison with the City of Seal Beach and OCFA. Bill has a Bachelor of Science Degree and a Masters Degree in Business Administration from the University of Phoenix. Bill also has a Designated Subjects Teaching Credential from California State University, Long Beach and is a current EMT educator. Ben Baker — Director of Communications Ambulance Deployment Management and Communication Center supervision is provided by Ben Baker. Ben is responsible for Care Ambulance's Deployment Planning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is a currently credentialed EMT and a retired Police Officer. Gene Wiskowski — Director of Finance Gene Wiskowski is Care's Director of Finance. Gene is responsible for Care's budgeting process and preparation of financial statements. Gene graduated from Pace University in New York with a Bachelor's Degree in Business Administra- tion and a Masters Degree in Financial Management. Gene previously was the Treasurer — Budget Officer for Thomas Jefferson University and the Chief Financial Officer at Eisenhower Medical Center. One of the strongest advantages Care Ambulance brings to the City of Seal Beach and OCFA is experienced management. Care Ambulance does not anticipate the use of an implementation management team that is different from the permanent management team. • 1 A • 2. Proposed Start -Up Schedule Care Ambulance has the ability to implement all RFP requirements as outlined in the following Gantt chart. The chart outlines our proposed implementation timelines associated with the services and enhancements described in our proposal. We guarantee the absolutely timely commencement of services on or before September 1, 2009. • ... — — I l f E E I I L a.F (I j_j.l. .1..j..1. 1- 1.1 -1- 14 -1- 1.1.141.1.141.1-1.1• .RI 10_ M1 . :.•. • 1 I._ • _ 1• a 1 M_ •I•_ .. I I._ kr • Ij •• 111 W ithin the last five (5) years, Care's management team has implemented more emergency ambulance contracts than all other Orange County ambulance companies combined. Our management team and implementation techniques have been tested and proven. Our capabilities have been dearly demonstrated. For example, in the City of Fullerton, our emergency ambulance contract was sched- uled to begin on January 1, 2004 but due to unforeseen circumstances with the prior provider, our services were required beginning on November 25, 2003. With less than two (2) hours notice, Care Ambulance began our service to the city and has since delivered outstanding services to the residents and visitors of Fullerton. In September 2008, Care Ambulance began services to the City of Costa Mesa and most recently completed an emergency start -up with the City of La Habra, staffing EMTs for both ambulances operated by the City of La Habra. Equipment at Start-Up Care Ambulance has already secured the necessary commitments from reputable vendors of ambu- lances, medical supplies and equipment to ensure that all required equipment and inventory is avail- able for contract implementation. Having managed other procurements of vehicles and equipment, we are well prepared to manage the implementation of these contracts. Our vendors have done it before, our trucking and shipping brokers have done it before, and most important, we have done it before. • 163 • Rapid Start -Up Capability Care Ambulance maintains all the required resources and commitment to immediately begin provid- ing emergency ambulance services to the City of Seal Beach. Because of our unique ambulance coverage plans, current penetrations of the area's emergency and non - emergency ambulance market, current fleet size with additional capacity and vast experience in program start -ups, Care Ambulance has the necessary tools and experience to institute rapid services to OCFA. The bottom line is, if requested, "We Can Do It Today." 3. Proposed Initial Service Response Plan Care Ambulance proposes to provide EMT staffing for a minimum of two (2) staffed, dedicated Ba- sic Life Support (BLS) ambulances stationed and housed in the City of Seal Beach, on a twenty-four (24) hour per day / seven (7) day per week basis. The business of providing emergency ambulance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance recognizes this and therefore commits to the full -time dedication of ambulance resourcesto the City of Seal Beach and the Orange County Fire Authority. Care's proposed dedicated emergency ambulance station location is identified below: • Proposed Seal Beach Station 1 Seal Beach Leisure World, Seal Beach It ' • Proposed Seal Beach Station 2 12850 Seal Beach Blvd., Seal Beach In event that the City of Seal Beach's dedicated ambulances are dispatched on a request for service or temporarily removed from service, additional ambulances will be automatically posted or moved up to cover the city. Like an inventory system that immediately replaces any item from inventory, this system replaces any dedicated ambulance with a new ambulance crew posted or covering a contract city. This ensures that the City of Seal Beach will be constantly covered with ambulances, with no lapses in emergency ambulance coverage. This is a similar process to that already used by Care Am- bulance Service for our other contracted city emergency ambulance contracts, allowing Care Ambu- lance to deliver ambulance response times unmatched by any other local ambulance provider. Care's move -up or post locations are identified below: • City of Seal Beach, intersection of Seal Beach Blvd. and Westminster Ave. • EMTs assigned to the dedicated City of Seal Beach ambulance may be approved by OCFA or the City of Seal Beach and shall be assigned to a fifty -six (56) hour work week schedule consistent with the standard OCFA firefighter schedule. This staffing pattern will allow for a more coordinated team effort and provides necessary familiarity with staffing. As the largest provider of 9 -1 -1 emergency and non - emergency ambulance service in Orange Coun- ty Care Ambulance maintains a significant ambulance presence in North -West Orange County cities and area hospitals. Should a situation occur that would begin to tax the resources of our dedicated Seal Beach ambulance, Care Ambulance agrees to utilize additional ambulances from our large am- • bulance fleet to assure OCFA and Seal Beach citizens of a timely emergency ambulance response. 164 • Treatment of Incumbent Workers Care Ambulance will make every reasonable effort to offer incumbent EMT personnel employment opportunity Care Ambulance will actively pursue three major goals in our recruitment and hiring practices for these contracts: • Active recruiting, with fair and favorable treatment of the incumbent work force. • Expansion of the existing work force with highly competent and motivated EMTs. • Active recruitment of minorities and women toward the fulfillment of our commitment to equal opportunity employment. We realize the importance of utilizing, to the greatest extent possible, the local work force in the start -up of a new EMS system. The local work force provides personnel who are familiar with the area, experienced in local protocols and procedures, and a readily available personnel resource for recruitment. Because of these advantages, Care Ambulance will place a high priority on recruitment from this work force. Actions we will take to ensure our success in recruitment and hiring of the incumbent work force include: • Initial recruitment efforts targeted to the local work force. • Provision of a strong orientation and training program, which will prepare the current work force for employment in our system. Orientation and training could be conducted in repeti- tive modules to allow attendance by the incumbent work force while they remain employed with the current provider. • Provision of an aggressive in- service training program which will allow a reasonable opportunity for the current work force to acquire additional skills required in the new system. Upon hiring, the incumbent workers will be entitled to the following benefits not otherwise available to starting EMT personnel: • Medical Benefit Plan - Immediate medical insurance will be provided, eliminating the waiting period so that all new employees would have medical coverage. • Priority Scheduling Plan - Incumbent workers would be allowed to maintain their current shift schedule, whenever possible. • Wages Commensurate with Experience - All incumbent EMT personnel would be hired at their current rates of pay or at rates commensurate with their experience. Some may enjoy an increase in compensation. 410 165 • ( ITEM 25 : PLAN FOR TAKEOVER OF SERVICE / START -UP City of Stanton — EOA # 22 Care Ambulance Service is the incumbent emergency provider for the City of Stanton, currently pro- viding fully compliant and nationally accredited emergency ambulance services to the residents and visitors of Stanton. Care Ambulance offers the City of Stanton the benefits of an established organi- zation that continues to exceed and improve upon performance expectations. In selecting Care Ambulance as the future provider for the City of Stanton, the community will experience no interruption of the excellent ambulance services they already enjoy. OCFA and City of Stanton officials can count on our seamless continuation of stable, consistent and accountable services without fear of service halts or concern for performance decline while a new provider learns on the job. Care Ambulance Service has the infrastructure already in place to ensure a smooth start -up of this contract. One of the true advantages Care Ambulance brings to the City of Stanton and OCFA is seasoned management and experience with the City of Stanton. With Care Ambulance, officials can be certain you are working with a reputable, well -known firm that has a management team and implementation techniques that have been tested and proven. Care's plan for continuation of service includes the following: . Illk. • An experienced and knowledgeable local management team that is already in place with Managers who are familiar with the City of Stanton, Orange County, OCEMS practices and the Orange County Fire Authority Emergency Ambulance Transportation program. • The ability to implement our operational plan on or before the contract start -up date. In the following section, we detail our plan for the continuation of the OCFA Emergency Ambu- lance Transportation contract for the City of Stanton with a September 1, 2009 start date. 1. Implementation Management Team Care Ambulance provides a very comprehensive management team with over 200 years experience in the management and supervision of emergency ambulance operations. A key to the successful growth of Care Ambulance has been the strength of our on -site management team, which includes: Dan Richardson - Co -CEO Dan Richardson has over thirty -three (33) years of ambulance industry experience and is responsible for the coordination and monitoring of overall system performance to ensure high standards of ser- vice. His exceptional management skills encompass areas such as team building, goal setting, perfor- mance recognition, and discipline to ensure motivated and highly productive middle management, supervisory, support, and field staff. Rick Richardson - Co -CEO • Employed at Care Ambulance Service for twenty-nine (29) years, Rick Richardson directs all busi- ness and financial operations of Care Ambulance. Rick has served as the President of the Ambulance 166 • Association of Orange County and has participated as a committee member on the Emergency Medical Services Agency's Emergency Medical Care Committee and Weapons of Mass Destruction Task Group. Michael Martin, M.D. — Medical Director As the Medical Director for Care Ambulance for twenty (20) years, Dr. Martin is responsible for a wide variety of clinical and administrative functions. Dr. Martin oversees all medical services admin- istered by Care Ambulance staff and is a key to Care's commitment to Continuous Quality Improve- ment and EMT training programs. Dr. Martin is a Fellow of the American College of Emergency Physicians and a Diplomat of the American Board of Emergency Medicine. In addition to his role at Care Ambulance, Dr. Martin is an Emergency Department Physician at Presbyterian Intercommunity Hospital and serves on the hospital's Quality Assurance Committee. Bill Weston — Director of Operations Bill Weston is responsible for the daily operations of Care Ambulance. Bill has worked for Care Ambulance for over eleven (11) years. Bill began his EMS career as an EMT and has responsibilities for field operations, EMT hiring, and risk management. If awarded this contract, Bill will continue to serve as Care's liaison with the City of Stanton and OCFA. Bill has a Bachelor of Science Degree and a Masters Degree in Business Administration from the University of Phoenix. Bill also has a Designated Subjects Teaching Credential from California State University, Long Beach and is a current EMT educator. Ben Baker — Director of Communications Ambulance Deployment Management and Communication Center supervision is provided by Ben Baker. Ben is responsible for Care Ambulance's Deployment Planning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is a currently credentialed EMT and a retired Police Officer. Gene Wiskowski — Director of Finance Gene Wiskowski is Care's Director of Finance. Gene is responsible for Care's budgeting process and preparation of financial statements. Gene graduated from Pace University in New York with a Bachelor's Degree in Business Administra- tion and a Masters Degree in Financial Management. Gene previously was the Treasurer — Budget Officer for Thomas Jefferson University and the Chief Financial Officer at Eisenhower Medical Center. One of the strongest advantages Care Ambulance brings to the City of Stanton and the OCFA is experienced management. Care Ambulance does not anticipate the use of an implementation • management team that is different from the permanent management team. 1 67 • 2. Proposed Start-Up Schedule As the current emergency ambulance transport provider for the City of Stanton, Care Ambulance presents a unique opportunity for the continuation of compliant and accredited services with abso- lutely no service interruptions to the city. We guarantee the absolutely timely commencement of services on or before September 1, 2009. Care Ambulance has the ability to implement all RFP requirements as outlined in the following Gantt chart. The chart outlines our proposed implementation timelines associated with the services and enhancements described in our proposal. I r,y I 14'1.E. .44 . 1 . " +14 . 1 I I. 4.1 E F I- .�.I-11 I I-I.. I..1 .E.c -I -1 -E -I d / Yn •nr •nr 1J. VIM •nr 1 _ •nr UMW 1. . .• ••. / /n u•r 1. / ••.wa i 1 rr MI. 1. • IMO le IN .. / �r M• 1 1•r W /b / /•rr /fir 10• I. ••••• Inr VII OM •• • .Mn al IN 1.r //. • X1••••• • r tie r / • ■•••• MI Inr , ti • r../r M •11 n , • •.r.r•• /n r • r..r1 mr MI NI • ••••••• MN nr 1. ii • ••••• •sr rr I. • ••••■ NMI •M• n • Within the last five (5) years, Care's management team has implemented more emergency ambulance contracts than all other Orange County ambulance companies combined. Our management team and implementation techniques have been tested and proven. Our capabilities have been clearly demonstrated. For example, in the City of Fullerton, our emergency ambulance contract was sched- uled to begin on January 1, 2004 but due to unforeseen circumstances with the prior provider, our services were required beginning on November 25, 2003. With less than two (2) hours notice, Care Ambulance began our service to the city and has since delivered outstanding services to the residents and visitors of Fullerton. In September 2008, Care Ambulance began services to the City of Costa Mesa and most recently completed an emergency start -up with the City of La Habra, staffing EMTs for both ambulances operated by the City of La Habra. Equipment at Start -Up Care Ambulance has already secured the necessary commitments from reputable vendors of ambu- lances, medical supplies and equipment to ensure that all required equipment and inventory is avail- able for contract implementation. 11111 Having managed other procurements of vehicles and equipment, we are well prepared to manage 168 • the implementation of these contracts. Our vendors have done it before, our trucking and shipping brokers have done it before, and most important, we have done it before. Rapid Start -Up Capability Care Ambulance maintains all the required resources and commitment to continue providing emer- gency ambulance services to the City of Stanton. Because of our unique ambulance coverage plans, current penetrations of the area's emergency and non - emergency ambulance market, current fleet size with additional capacity and vast experience in program start -ups, Care Ambulance has the necessary tools and experience to continuing providing services to the City of Stanton. The bottom line is, ' We Do it Today and We Guarantee that We Can Do It Tomorrow" 3. Current and Proposed Service Response Plan Care Ambulance proposes to continue to provide EMT staffing for a minimum of one (1) staffed, dedicated Basic Life Support (BLS) ambulances stationed and housed in the City of Stanton, on a twenty-four (24) hour per day / seven (7) day per week basis. The business of providing emergency ambulance services is a twenty-four (24) hour, seven (7) day a week business. Care Ambulance rec- ognizes this and therefore continues to commits to the full -time dedication of an ambulance resource to the City of Stanton and the Orange County Fire Authority. Care's existing dedicated emergency ambulance station location is identified below: • Existing Stanton Station 11236 Western Ave, Suite F3, Stanton In event that our dedicated ambulance is dispatched on a request for service or temporarily removed from service, additional ambulances are automatically posted or moved up to cover the city. Like an inventory system that immediately replaces any item from inventory, this system replaces any dedi- cated ambulance with a new ambulance crew posted or covering the city. This ensures that the City of Stanton is constantly covered with ambulances, with no lapses in emergency ambulance cover- age. This allows Care Ambulance to deliver ambulance response times unmatched by any other local ambulance provider. Care's move -up or post locations is identified below: • City of Stanton, intersection of Stanton Avenue and Walker Street Using Care's City of Stanton Service Response Plan in 2007, we were able to achieve 100% compliance on all requests for Code 3 ambulance services and 96.30% compliance on all re- quests for Code 2 ambulance services. This was done without refusing any calls for service or referring any calls to a mutual aid provider. EMTs assigned to the dedicated City of Stanton ambulance may be approved by OCFA or the City of Stanton and will be assigned to a fifty-six (56) hour work week schedule consistent with the stan- dard OCFA firefighter schedule. This staffing pattern will allow for a more coordinated team effort • and provides necessary familiarity with staffing. • As the largest provider of 9 -1 -1 emergency and non - emergency ambulance service in Orange Coun- 169 • ty, Care Ambulance maintains a significant ambulance presence in North -West Orange County cities and area hospitals. Should a situation occur that would begin to tax the resources of our dedicated ambulance, Care Ambulance agrees to utilize additional ambulances from our large ambulance fleet to assure OCFA and Stanton citizens of a timely emergency ambulance response. Being the incumbent provider to the City of Stanton, Care Ambulance offers the city a trusted partner, experienced local caregivers, a knowledgeable local leadership team and the opportunity to continue emergency services with an existing partner that can provide services without interruption. While other ambulance providers can only make promises of possible future service to the city, Care Ambulance can conclusively demonstrate our actual excellent services rendered daily to the residents and visitors of Stanton. It 170 TAB 26 L 1 s E i t C F • • ITEM 26 : LETTERS OF REFERENCE Based on direction from OCFA staff, all Letters of Reference have been removed from this proposal. Letters of Reference are available upon request. I t. iii 171 , 1 TAB 27 i , i , [ L i. i , ; . k t 'I i [ ! . 1 1- • t [ ! i [ 1 1. [ r 1 k 1 i i I 1 • EXHIBIT "D" SAMPLE QUARTERLY RESPONSE TIME REPORT • 0 643201 2 b O .0 a O • U Ot M g0 o O d TA F7 a a y N y . N Rf 0 E " , U fi TS a, W il U .5 d W n os" M s., 'd R N O Th cn wi a ,o y a U w � O a 00 U M a .5 0. � 01 m c • 1 0 .0 • 0 . o `^ 3 b y 3 1 CA U O a�i TI p. cd id O , W N M 2 g .9 b O, a U I. "' o ° M N b N '3 O td ri W U 0 0 1 E+ ' Q i N ti O y 3 a U o 'fl c .ti 0 b O. >+ - T ° p, V p 2 O N y a - 5 a, - zrO gl W y 1"' N y v N O O A i a U ni A y w s. O 3 _° a, It p c� E. i o' z ei 2 4 w - 4-1 0 0 8 o y b1D 3 ° 3 o W O O 0 N o o 0 .- a �zZ� a a . c o o a a o;a t00 • 01 W ry 000 0 0 o aO�i� oa��i o BO rn W VI UWW z z z A4 z3'0 z a 'a g el- so MEMORANDUM OF UNDERSTANDING This MEMORANDUM OF UNDERSTANDING is entered into between the Orange County Fire Authority (OCFA) and Care Ambulance Service, Inc. (CARE), dated May 14, 2009 for reference purposes only. OCFA and CARE will be referred to as the "Parties" herein. The Parties hereto agree that the purpose of this MEMORANDUM OF UNDERSTANDING is to clarify the Parties understanding in connection with certain provisions of the Proposed Model Agreement, more particularly described below. The Parties hereto agree and each understands and interprets Paragraph 10.0 concerning "Assignment ", particularly Section 10.2.3 of the Agreement for Provision of Fire /EMS Emergency Ambulance Transportation and Related Services within Exclusive Operating Area (hereinafter referred to as the "Agreement ") and the Request for Proposal No. JR1494 ( "RFP # JR1494 ") for the Proposed Model Agreement as follows: The prohibitions against assigning shares of Stock in CARE found at Section 10.2.3 will not prohibit transfers of stocks /shares to trusts and other legal entities owned and controlled by members of the immediate families of a CARE shareholder, such as family limited partnerships formed to hold the family business or investments, entities wholly owned or controlled by the shareholder's family members or gifts or bequests of shares of • CARE to immediate family members of the shareholders of CARE. ORANGE COUNTY FIRE AUTHORITY Dated: May 14, 2009 By: J' uane, Finance Manager CARE AMBULANCE SERVICE, INC. Dated: May 14, 2009 Ira = A- By: Rick W. Richardson, Co -CEO