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HomeMy WebLinkAbout2019-218 20200042 Fire Recovery EMS GOODS & SERVICES AGREEMENT CITY OF PROVIDER: Fire Recovery EMS,LLC ASHLAND PROVIDER'S CONTACT: Justin Powell 20 East Main Street Ashland, Oregon 97520 ADDRESS: 3223 North Wilke Road,Arlington Heights,IL 60004 Telephone: 541/488-5587 Fax: 541/488-6006 , PHONE: (916)297-0205 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter"City"), and Fire Recovery EMS,LLC, a limited liability company("hereinafter"Provider"), for ambulance billing services. 1. PROVIDER'S OBLIGATIONS 1.1 Provide ambulance billing services as set forth in the "SUPPORTING DOCUMENTS" attached hereto and,by this reference,incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The goods and services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a'certificate or certificates of such insurance approved by the City. 1.3 All subject employers working under this Agreement are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126. As evidence of the insurance required by Page 1 of 6: Agreement between the City of Ashland and Fire Recovery EMS,LLC this Agreement,the Provider shall furnish an acceptable insurance certificate prior to commencing any Work under this Agreement. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider a fee of 4.95% of all monies collected by Provider as provided in the SUPPORTING DOCUMENTS as full compensation for all Work performed hereunder. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed a fee of 4.95% of all monies collected by Provider without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations, and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: . ORS 279B.220,279B.230 and 279B.235. Page 2 of 6: Agreement between the City of Ashland and Fire Recovery EMS,LLC 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives and all rights to maintain an action under this Agreement in any other venue, and P Y any expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees, contractors, or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God,strikes,lockouts, accidents, or other events beyond the control of the other or the Y Y other's officers, employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects, fraud, and warranties. 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture. Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS 4.1 The following documents are attached hereto; by this reference,expressly incorporated herein; and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS": • The City's written Request for Proposal,Intermediate Procurement,with a release date of March 29,2019, attached hereto as Exhibit"A"; and • The Provider's complete written Emergency Ambulance Billing Services Bid Proposal dated April 11, 2019, attached hereto as Exhibit"B"; and • The Business Associate Agreement between Ashland Fire & Rescue and Fire Recovery EMS attached hereto as Exhibit"C"; and • The Agreement dated May 13, 2019, between Ashland Fires and Rescue and Fire Recovery EMS, LLC, attached hereto as Exhibit"D." Page 3 of 6: Agreement between the City of Ashland and Fire Recovery EMS,LLC 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the Order listed in Subsection 4.1. 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective as of July 1, 2019 (the "Effective Date"), and unless sooner terminated as provided in Subsection 6.2, shall continue in full force and effect for a period of three(3) years, until June 30, 2022. This Agreement shall automatically renew for an additional two (2) year term unless either'party gives written notice of its intent not to renew to the other party not less than sixty(60) days prior to June 30, 2022. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty(30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Fire&Rescue Department Attn: David Shepherd 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 552-2217 Page 4 of 6: Agreement between the City of Ashland and Fire Recovery EMS,LLC With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 If to Provider: Fire Recovery EMS LLC Attn: Justin Powell 3223 North Wilke Road Arlington Heights, IL 60004 Phone: 916-297-0205 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider, for a period of no fewer than six(6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. • Page 5 of 6: Agreement between the City of Ashland and Fire Recovery EMS,LLC • IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. // CITY OF AS ! AN i FIRE RECO\ Y EMS,LLC (PROVIDER): i By: � A By: Kelly A. Madding, Cit AAdministrator Signature V6N c Printed Name v Printed Name I LI ee-0 ate Title 6- 2y - (el Date Purchase Order No. (W-9 is to be submitted with this signed Agreement) APPROVED AS TO FORM: Xlair Assistant City Attorney ,Q1,44,,t_ /3, ,26/ 9 Date Page 6 of 6: Agreement between the City of Ashland and Fire Recovery EMS,LLC 1 XHIS Pam__--/ of 1Y- Fire Recovery Hvis This Agreement is entered into as of May 13, 2019 between Ashland Fire and Rescue, OR, hereinafter referred to as AFR and Fire Recovery EMS, LLC, hereinafter referred to as FR EMS. WHEREAS, AFR has determined that it is in their best interest to retain the services of an outside billing service to collect monies for services rendered by AFR. WHEREAS, FR EMS does hereby hold itself as being ready and able to perform a billing service program as described herein. NOW, THEREFORE, in consideration of the aforementioned promises and mutual covenants and promises stated herein, the parties hereby agree as follows: 1. FR EMS shall provide an Accounts Receivable program within FR EMS's computer billing system for the exclusive purpose of collections for AFR. FR EMS will enter into said computer billing system, any and all FR EMS ambulance trips received from AFR. FR EMS shall abstract, from the documentation provided by AFR, all diagnosis and procedure information necessary to determine the level and type of service provided, any billable diagnostic and therapeutic procedures performed, any billable supplies and ancillary services rendered, and the appropriate diagnosis codes to be billed for all FR EMS ambulance run information provided by FR EMS by the client for that purpose. FR EMS will follow established billing industry guidelines, including those established by state and federal government programs, for AFR ambulance services. AFR retains responsibility for providing accurate and complete documentation of services provided. AFR understands that FR EMS will code/bill only from the documentation provided. 2. FR EMS shall provide electronic billing of Medicare, Medicaid, Insurance claims, including 3rd party payors, when applicable. It is the responsibility of AFR to inform FR EMS of any changes in the company's status that would affect billing. f 3. FR EMS will invoice all patients as directed by AFR, in accordance with state and federal programs. Patient invoicing will be done on a billing form specific for AFR. Invoicing/collection activities will be conducted on the following standard schedule: 1st invoice within 3 days of receipt Insurance request 30 days after 1st invoice Automated phone call 20 days after insurance request 2nd invoice 10 days after phone call Final notice 20 days after 2' invoice Collections or W/O review 30 days after final notice Bill schedules may vary based on parameters set by department. Collection agency or write off if no results from above as pre-determined by AFR. 4. All monies received by FR EMS on behalf of AFR will be posted to the patients' accounts on a schedule set forth by AFR. All checks will be made payable to AFR. It is the responsibility of AFR to notify FR EMS of any payments and/or documents pertaining to billing received at AFR relating to the services heretofore described. 5. FR EMS will maintain an 800-phone line for the purpose of customer service. This line will be staffed Monday through Friday from 8:30 am to 7:30 pm Central time. FR EMS will promptly respond to all AFRs' service recipient concerns related to all billing practices conducted herein. 6. FR EMS will submit monthly reports detailing the transports billed from the previous month. It is the responsibility of AFR to verify these reports and provide FR EMS with any missing data. All reports currently within the software of FR EMS's billing system will be provided to AFR at no additional cost. 7. FR EMS shall recognize and comply with the right of authorized AFR representatives to review any and all payment records pursuant to claims and/or collection procedures conducted herein. AFR shall have the right to audit such reports at reasonable times. 8. AFR agrees to pay FR EMS in accordance with the following fee schedule for the aforementioned service for a term of one (1) year so long as this Agreement has not been terminated: a. FR EMS shall be paid a fee of 4.95% of all payments collected. b. Payments to FR EMS shall be based upon revenues received in the preceding month. FR EMS will provide a monthly billing to AFR calculating amounts owed to FR EMS based upon the above stated formula. c. Failure to pay FR EMS within 30 days of the monthly bill may constitute immediate termination of the contract and possible legal action at the cost of AFR. 9. If AFR determines it is in their best interest to use a collection agency, AFR will deal directly with the collection agency regarding their fees. 10. It is expressly understood and agreed that FR EMS is an independent contractor who shall at all times maintain insurance in force as herein provided and FR EMS shall in all events defend and save and hold harmless AFR from any and all liabilities, obligations, debts, charges, or judgments arising from claims, injuries or debts, charges, or judgments arising from injuries or property damage claims attributable to the activities of FR EMS while engaged in the performance of its duties under this Agreement. 11. It is the sole determination of AFR as to fees for services that will be charged to its patients and/or facilities. It is recommended such fees should be based on fair market value. 12. This agreement shall be effective on the date hereof and shall remain in full force and effect for a term of one (1) year. Thereafter, this Agreement shall be automatically extended for successive one (1) year periods unless terminated as hereinafter set forth. All terms and provisions of this Agreement shall continue in full force and effect unless otherwise modified. Either party may terminate this agreement at any time by giving the other party ninety (90) days written notice. Notwithstanding the aforementioned, this agreement shall be subject to immediate termination by AFR if FR EMS fails to maintain insurance as in part 13. 13. FR EMS maintains General Liability $1,000,000 per occurrence/ $2,000,000 aggregate; Commercial Auto w/ hired non-owned coverage $1,000,000; Workers Compensation $500,000/$500,000/$500,000; Professional Liability of $1,000,000; Employment Practices Liability $250,000 14. If this contract is terminated prior to the (1) year agreement AFR allows FR EMS to continue collections efforts for a period of 6 months following the contract termination, unless other arrangements have been agreed to by both parties in writing. AFR understands that they will be responsible to pay FR EMS their commission on their collections during this time period in accordance with section 8(c). Proper notice may be given by certified or registered mail to: Patrick J. Mannix Chief Executive Officer Fire Recovery EMS 3223 N. Wilke Road Arlington Heights, IL60004 OR TO: At termination of the Agreement it is the responsibility of FR EMS to return to AFR any and all records and documents submitted to FR EMS, except as required by Federal Law. IN WITNESS WHEREOF, the Responsible Party of AFR and an Authorized Agent of FR EMS have executed this agreement. ASHLAND FIRE AND RESCUE, OR FIRE RECOVERY EMS, LLC. f BY: ., ..// BY: DATE: 7////7 DATE: Zy -1c] 1 1 ��---�� ANDRE-1 OP ID: LP a► . C�Rt�m CERTIFICATE OF LIABILITY INSURANCE DATE 06/24/2019 ) �'� 06/24/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject,to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 847-670-8700 CONTACT Brian J.Burda BGS Insurance Agency,Inc NAME: Q- Y> ! PHONE 847-670-8700 I FAX g4'7.67U_873U 3295 N.Arlington}its.Rd.#111 (A/c,No,Ext): (A/c,No►: Arlington Heights,IL 60004 E-MAIL Brian J.Burda ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:CNA Insurance Company 20443 INSURED INSURER B:Metlife Insurance Compamy 4069 Andres Medical Billing Ltd Continental Casualty Co. 20443 3223 North Wilke Road INSURER C: `7 Arlington Heights,IL 60004 INSURER D Landmark American Insurance Co INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER: 21 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSL yip POLICY NUMBER POLICY EFF POLICY EXP LIMITS JMM/DD/YYYYI (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 CLAIMS-MADE X OCCUR 6012182473 05/29/2019 05/29/2020 DAMAGE TO RENTED 300,000 X PREMISES(Ea occurrence) $ X Prim Non-Contra MED EXP(Any one person) $ 10,000 Blkt.&WOS Blkt PERSONALSAOVINJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO CA024320P2019 05/29/2019 05/29/2020 BODILY INJURY(Per person) $ 1,000,000 X OS ONLY X AUTOSULED BODILY INJURY(Per accident) $ 1,000,000 HIRED_ X NON-OWNED PROPERTY DAMAGE 1,000,000 AUTO ONLY _ AUTOS ONLY (Per accident) $ ' $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE 6012183168 05/29/2019 05/29/2020 AGGREGATE $ 2,000,000 DED RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY • Y/N X STATUTE ERH WC6012182540 05/29/2019 05/29/2020 500,000 OANFY EXCLUDEDX ECUTIVE N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ D Professional Liab. LHR771738 09/12/2018 09/12/2019 Clm/Aggre 2,000,000 A Cyber/Data Breach 6012182473 05/29/2019 05/29/2020 Clm/Aggre 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Additional Insured in respects to the General Liability for work performed by the named insured when required per written contract:City of Ashland, Oregon,its officers,agents and employees. • CERTIFICATE HOLDER I CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Mainstreet Oregon,IL 97502 AUTHORIZED REPRESENTATIVE lala. 114, I ACORD 25(2016/03) I ©1988-2015 ACORD CORPORATION. All rights reserved. The ACOR,D name and logo are registered marks of ACORD r Fi All , Purchase Order ,ali Fiscal Year 2020 Page: 1 of: 1 B City of Ashland ATTN: Accounts Payable L Purchase 20200042 L 20 E. Main Order# Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable @ashland.or.us V H C/O Fire and Rescue Department E FIRE RECOVERY EMS, LLC I 455 Siskiyou Blvd N 3223 N WILKE RD p Ashland, OR 97520 D ARLINGTON HEIGHTS, IL 60004 Phone: 541/482-2770 R T Fax: 541/488-5318 O Emil Matlock 07/10/2019 4777 FOB ASHLAND OR/NET30 Ci i • • '- able .:-- --,- ,- -, -[_ Ambulance Billing Services 1 Ambulance Billing Services 1 $69,300.0000 $69,300.00 4.95% of Collections FY 2020 -Approximately $69,300.00 Goods and Services Agreement Completion date: June 30, 2022 Project Account: 2 FY 2021 -Approximately $69,300.00 1 $0.0100 $0.01 Project Account: 3 FY 2022 -Approximately $69,300.00 1 $0.0100 $0.01 Project Account: ............... GL SUMMARY ............... 071200 -604100 $69,300.02 I I I , tS By: ( 1. - 31T H i 11 Authorized Signature ,;ag T`ntak `_ $69 300.02 FORM•#3 9 A request for t1rCi3SP, Order Y ASHLAND REQUISITION 0 Date of request: 07/0812019 Vendor Name Fire Recovery EMS,LLC Address,City,State,Zip 3223 North Wilke Road,Arlington Heights,IL 60004 Contact Name Justin Powell Telephone Number 888-640-7222 x102 . Email address i.powell1V firerecovervusa.com SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form#13,Written findings and Authorization ❑ AMC 250 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached _ (Attach copy of council communication) _ (If council approval required,attach copy of CC) ❑ Small Procurement Cooperative Procurement Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon Date approved by Council: 21 2019 DI Direct Awad / / Contract# ❑ VerbalMritten quote(s)or proposal(s) • (Attach copy of council communication) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) ❑ Other government agency contract $5,000 to$100,000 ❑ Written quote or proposal attached Agency ❑ (3)Written quotes and solicitation attached ❑ Form#4, Personal Services$5K to$75K Contract# PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to$75,000 ❑ Form#9,Request for Approval ❑ Agency ❑ Less than$35,000,by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3)Written proposals/written solicitation Date approved by Council: (Date) ❑ Form#4, Personal Services$5K to$75K Valid until: (Date) —(Attach copy of council communication) Description of SERVICES Total Cost Ambulance Billing Services q:,q.%D Di ca litth Olt s Item# Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal $ Project Number -_ _ Account Number: t rib •lid [OQ $_,_ _ _,_ _ _•_ _ Project Number _ _ _ Account Number - . $_,_ _ _,_ _ _ _ _ Project Number •_ _ _ Account Number - $ , , _ *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisif0n form,I certify that the City's public contracting requirements have been satisfied. %_I2 Employee: /I t;�.h'�''�I��1?:,L�i1G Department Head: 1 �i .� 1 . 9,j' �r .r grea erthan$5,000) Department Manager/Sup irvisor: City Administrator: 41�►L _ a- (Equal to or.4;77r than$25,000) Funds appropriated for current fiscal year. C., / NO 6cl-6441++4 el 131 1/I Deputy Finance Director-(Equal to orgreaterthan$5,000) Date Comments: Form#3-Requisition Council Business Meeting May 21 , 2019 Agenda Item EMS Billing Services Contract From Michael D'Orazi Fire Chief Contact michael.dorazi(a�ashland.or.us; 541-552-2217 SUMMARY The City Council is being asked to approve a three year goods and services contract with Fire Recovery EMS LLC for Ambulance Billing Services. POLICIES, PLANS & GOALS SUPPORTED Resolution No. 2019-02 - Council goals for the 2019-2021 biennium state that Fire Department operations are an "essential service". Approval of this contract helps the City provide these essential services while managing costs. PREVIOUS COUNCIL ACTION None BACKGROUND AND ADDITIONAL INFORMATION Ashland Fire &Rescue provides ambulance services through its agreement with Jackson County. As an ambulance provider, the Department is allowed to bill patients and their insurance companies for services rendered. As ambulance billing requires the use of medical coding experts, the Department has traditionally hired third party to provide the goods and services associated with this process. With the contract from our current provider expiring on June 30, 2019, we felt it would be a good time to get a few other quotes for this service. A Request for Proposals was sent out to several interested parties on March 29, 2019. A review of three proposals (Springfield Fire &Life Safety, Fire Recovery EMS and RPM Billing) found that Fire Recovery EMS LLC would provide the needed service for the lowest cost. One reason for this is that Fire Recovery EMS LLC only charges on collections, so they are motivated to collect appropriately. In addition, they have years of experience working through the Ground Emergency Medical Transportation Act which will serve the City well as AFR rolls out this program for cost recovery from Medicaid. FISCAL IMPACTS Fire Recovery EMS will receive 4.95% of all ambulance revenues collected on behalf of the City of Ashland. We estimate that this will equate to about$55,000 a year in revenue for Fire Recovery EMS. This amount has been budgeted for in the Fire Operations FY 20/21 biennium budget. The initial contract is for a period of three years. The proposals that the City received are compared below: For calendar year 2018 AFR had 2012 ambulance transports. Based on the proposals received below is the comparison of fees AFR would pay. Springfield-Eugene FD Billing Services (our current contractor)=$104,624 (@$52/transport) RPM Billing=$63.680 (based on 6%of collections) Fire Recovery= $52,536 (based on 4.95%of collections) STAFF RECOMMENDATION Staff recommends approval of contract with Fire Recovery EMS LLC. ACTIONS, OPTIONS & POTENTIAL MOTIONS I move to approve a goods and services agreement with Fire Recovery EMS LLC. Page 1 of 2 CITY OF ASHLAND REFERENCES&ATTACHMENTS Attachment 1: Form#2—Request for Proposal/Intermediate Procurement with Appendices Attachment 2: Fire Recovery EMS LLC Emergency Ambulance Billing Services Bid Proposal Attachment 3: Unsigned contract between the City and Fire Recovery EMS LLC Page 2 of 2 CITY OF ASHLAND