Billing and Collection Services for Columbus Fire and EMS Department (Annual Contract)

RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 1 of 43 FINANCE DEPARTMENT PURCHASING DIVISION 1111 1st AVENUE – 1ST FLOOR, COLUMBUS, GEORGIA 31901 P. O. BOX 1340, COLUMBUS, GEORGIA 31902-1340 706-225-4087, Fax 706-225-3033 www.columbusga.gov Date: October 13, 2023 REQUEST FOR PROPOSALS: RFP No. 24-0004 Qualified firms are requested to submit proposals, subject to conditions and instructions as specified, for the furnishing of: BILLING AND COLLECTION SERVICES FOR COLUMBUS FIRE & EMS DEPARTMENT (ANNUAL CONTRACT) GENERAL SCOPE Columbus Consolidated Government (the City) invites qualified vendors to provide billing and collection services for the Columbus Fire & EMS Department. The services are required to enhance and develop an internal revenue cycle and will be procured on an as-needed basis. DUE DATE NOVEMBER 17, 2023 - 5:00 PM (EASTERN) SUBMISSION

REQUIREMENTS See Appendix A for information and instructions on how to register and submit a proposal through DemandStar. ADDENDA The Purchasing Division will post addenda (if any) for this project at https://www.columbusga.gov/finance/Bid-Opportunities. Vendors are responsible for periodically visiting the web page for addenda, before the due date and prior to submitting a response. NO SUBMITTAL If you are not interested in this solicitation, complete and return page 3. Andrea J. McCorvey, Purchasing Manager COLUMBUS CONSOLIDATED GOVERNMENT Georgia’s First Consolidated Government RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 2 of 43 IMPORTANT INFORMATION E-Notification The City uses the Georgia Procurement Registry e- notification system. You must register with the Team Georgia Marketplace to receive future procurement notifications at https://doas.ga.gov/state- purchasing/getting-started-supplier. If you have any questions or encounter any problems while registering, please contact the Team Georgia Marketplace Procurement Helpdesk: Telephone: 404-657-6000 Fax: 404-657-8444 Email: procurementhelp@doas.ga.gov RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 3 of 43 STATEMENT OF "NO PROPOSAL SUBMISSION" Notify the Purchasing Division if you do not intend to submit a Proposal: Email: BidOpportunities@ColumbusGa.org Attn: Della Lewis, CPPB, GCPA Columbus Consolidated Government Purchasing Division P. O. Box 1340 We, the undersigned decline to submit a proposal for RFP No. 24-0004 for Billing and Collection Services for the Columbus Fire & EMS Department (Annual Contract) for the following reason(s): Specifications are too “tight”, i.e., geared towards one brand or manufacturer (explain below) There is insufficient time to respond. We do not offer this product and/or service. We are unable to meet specifications. We are unable to meet bond requirements. Specifications are unclear (explain below). We are unable to meet insurance requirements. Other (specify below) Comments: COMPANY NAME: REPRESENTATIVE: DATE: TELEPHONE: EMAIL: RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 4 of 43 PROPOSALS WILL BE EVALUATED IN ACCORDANCE WITH THE PROCEDURES AS OUTLINED BELOW IN SECTION 3-110 OF THE PROCUREMENT ORDINANCE. ALL PROPOSALS WILL BE KEPT CONFIDENTIAL UNTIL AFTER AWARD. 3-110. Competitive Sealed Proposals (Negotiations) (1) Conditions for Use When the Purchasing Manager determines that the use of competitive sealed bidding for any procurement is either not practicable or not advantageous to the City, a contract may be entered into using the competitive sealed proposals (negotiation) method. In addition, the competitive sealed proposal process shall be used for the procurement of professional services, specialized equipment or supplies. The competitive sealed proposal process may be used for procurements with an estimated total cost less than $25,000.00, if deemed to be in the best interest of the City. If the total cost can be determined, the authority to approve such solicitations will be as prescribed by article 3-104, Purchasing Limits. If, due to the required services, a total cost cannot be determined then the award recommendation will be approved by Council. A. Request for Proposals Proposals shall be solicited through Request for Proposals. The Purchasing Division shall establish the specifications with the using agency and set the date and time to receive proposals. The request for proposal shall include a clear and accurate description of the technical requirements for the service or item to be procured. B. Public Notice The public will be given adequate notice of the request for proposals, provided that, adequate notice shall mean at least fifteen (15) business days before the due date, which is stated in the request. The City reserves the right to seek request for proposals in a shorter period, if necessary, as determined by the Purchasing Manager. Notice shall be published in a reasonable time before due date, contain a description of the procurement in general terms, as well as, the place and due date for proposals, and appear in a newspaper(s) of general circulation, specifically the City’s legal organ. In addition to publication in newspapers, notice shall also be made by electronic means, including posting on the internet and on the City's government access television channel. Public works construction projects shall be advertised in accordance with Georgia State Law. The City reserves the right to mail or e-mail invitations directly to vendors under the following circumstances: − Solicitations for specialized equipment/supplies. − Solicitations for specialized services. − Re-bid of solicitations where normal advertising procedures netted no responses. − Whenever deemed necessary by the purchasing manager. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 5 of 43 C. Receipt of Proposals Proposals must be received by the deadline date established. No public opening will be held. No proposals shall be handled to permit disclosure of the identity of any offeror or the contents of any proposal to competing offerors during the process of discussion. A register of proposals shall be prepared as part of the contract file, and shall contain the name of each offeror, the number of modifications received (if any), and a description sufficient to identify the item offered. The register of proposals shall be open for public inspection only after contract award. D. Evaluation Factors The request for proposals shall identify the relative importance of cost (when applicable) and other evaluation criteria. E. Evaluation Process An odd number of voting members of a Selection or Evaluation Committee shall evaluate all proposals received based upon the criteria stated in the request for proposals. Each voting committee member shall grade each submitted proposal based upon the evaluation criteria. F. Discussion with Responsible Offerors and Revisions to Proposals As provided in the Request for Proposals, discussions (negotiations) may be conducted with responsible offerors who submit proposals determined to be reasonably susceptible of being selected for award, to assure full understanding of and conformance to the solicitation requirements. All qualified, responsible offerors shall be given fair and equal treatment with respect to any opportunity for discussion and revision of proposals, and such revisions may be permitted after submissions and prior to award for the purpose of obtaining best and final offers. In conducting discussions, there shall be no disclosure of the identity of competing offerors or any information derived from proposals submitted by competing offerors. If only one proposal response is received, then the award recommendation shall be to the single offeror, if the offeror meets all requirements. G. Award After negotiations, the award recommendation must be presented to Columbus City Council for final approval. Award will be made to the responsible offeror whose proposal is determined to be the most advantageous to the City, taking into consideration total cost (if determined) and all other evaluation factors set forth in the Request for Proposals. After Council approval, a contract based on the negotiations (if negotiations were necessary) will be drawn and signed by all necessary parties. If Council does not approve the award, it may direct that further negotiations may take place with the recommended offeror, or that negotiations begin with the next most qualified offeror. Council may also exercise the option to reject all offers and instruct the Purchasing Manager to begin the procurement process again. The contract file shall contain the basis on which the award is made. After contract award, the contract file, will be made public. Unsuccessful offerors will be afforded the opportunity to make an appointment with the Purchasing Division for a debriefing. After the award, the contract file and the unsuccessful proposals will become subject to disclosure under the Georgia Open Records Act. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 6 of 43 DO YOU HAVE QUESTIONS, CONCERNS OR NEED CLARIFICATION ABOUT THIS SOLICITATION? COMMUNICATION CONCERNING ANY SOLICITATION CURRENTLY ADVERTISED MUST TAKE PLACE IN WRITTEN FORM AND ADDRESSED TO THE PURCHASING DIVISION. ALL QUESTIONS OR CLARIFICATIONS CONCERNING THIS SOLICITATION SHALL BE SUBMITTED IN WRITING. THE CITY WILL NOT ORALLY OR TELEPHONICALLY ADDRESS ANY QUESTION OR CLARIFICATION REGARDING BID/PROPOSAL SPECIFICATIONS. IF A VENDOR VISITS OR CALLS THE PURCHASING DIVISION WITH SUCH QUESTIONS, HE OR SHE WILL BE INSTRUCTED TO SUBMIT THE QUESTIONS IN WRITING. ALL CONTACT CONCERNING THIS SOLICITATION SHALL BE MADE THROUGH THE PURCHASING DIVISION. BIDDERS SHALL NOT CONTACT CITY EMPLOYEES, DEPARTMENT HEADS, USING AGENCIES, EVALUATION COMMITTEE MEMBERS OR ELECTED OFFICIALS WITH QUESTIONS OR ANY OTHER CONCERNS ABOUT THE SOLICITATION. QUESTIONS, CLARIFICATIONS, OR CONCERNS SHALL BE SUBMITTED TO THE PURCHASING DIVISION IN WRITING. IF IT IS NECESSARY THAT A TECHNICAL QUESTION NEEDS ADDRESSING, THE PURCHASING DIVISION WILL FORWARD SUCH TO THE USING AGENCY, WHO WILL SUBMIT A WRITTEN RESPONSE. THE PURCHASING DIVISION WILL FORWARD WRITTEN RESPONSES TO THE RESPECTIVE BIDDER OR IF IT BECOMES NECESSARY TO REVISE ANY PART OF THIS SOLICITATION, A WRITTEN ADDENDUM WILL BE ISSUED TO ALL BIDDERS. THE CITY IS NOT BOUND BY ANY ORAL REPRESENTATIONS, CLARIFICATIONS, OR CHANGES MADE TO THE WRITTEN SPECIFICATIONS BY CITY EMPLOYEES, UNLESS SUCH CLARIFICATION OR CHANGE IS PROVIDED TO THE BIDDERS IN A WRITTEN ADDENDUM FROM THE PURCHASING MANAGER. BIDDERS ARE INSTRUCTED TO USE THE ENCLOSED “QUESTION/CLARIFICATION FORM” TO FAX OR EMAIL QUESTION. ANY REQUEST, AFTER A SOLICITATION HAS CLOSED AND PENDING AWARD MUST ALSO BE SUBMITTED IN WRITING TO THE PURCHASING DIVISION. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 7 of 43 QUESTION/CLARIFICATION FORM Date: To: Della Lewis, Buyer Specialist Email BidOpportunities@ColumbusGA.org or Fax (706) 225-3033 Re: Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) – RFP No. 24-0004 Questions and requests for clarification must be submitted at least five (5) business days before the due date: From: Company Name Website Representative Email Address Complete Address City State Zip Telephone Number Fax Number RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 8 of 43 COLUMBUS CONSOLIDATED GOVERNMENT GENERAL PROVISIONS FOR REQUEST FOR PROPOSALS Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) RFP No. 24-0004 Columbus Consolidated Government (the City) invites qualified vendors to provide billing and collection services for the Columbus Fire & EMS Department. The services are required to enhance and develop an internal revenue cycle and will be procured on an as-needed basis. A. PROPOSAL SUBMITTAL DATE: PROPOSALS ARE DUE: NOVEMBER 17, 2023, NO LATER THAN 5:00 PM (EASTERN). Submit one electronic response via DemandStar. After award of the contract by Columbus Council, awarded vendor will be notified to provide one identical hard copy of submitted proposal with original signatures. The awarded vendor will receive a digital copy of the executed contract. The City shall not be held liable for any expenses incurred by the respondent in preparing and submitting the proposal and/or attendance at any interviews, final contract negotiations or applicable site visits. The City reserves the right to award this project or to reject any and all proposals; whichever is in the best interest of the City. B. RECEIPT OF PROPOSALS: Unless otherwise stated in the technical specifications of the RFP, the City will accept one, and only one, proposal per Offeror. In the event a team of firms is entering into a joint venture to respond to the RFP, one firm shall be named the prime contractor and the proposal shall be submitted in the name of the prime contractor. All correspondence concerning the RFP will be between the City and prime contractor. C. SUBCONTRACTING: Should the offeror intend to subcontract all or any part of the work specified, names and address of subcontractors must be provided in proposal response. The offeror shall be responsible for subcontractors’ full compliance with the requirements of the RFP specifications. If awarded the contract, payments will only be made to the offerors submitting the proposal. The Columbus Consolidated Government will not be responsible for payments to subcontractors. D. QUESTIONS ABOUT THE RFP: Communication concerning any solicitation currently advertised must take place in writing and addressed to the Purchasing Division. See page titled “Do You Have Questions ...” within this proposal package. Questions and Requests for Clarification will be received until five business days prior to the proposal due date. E. PUBLIC INFORMATION: All information and materials submitted will become the property of the Columbus Consolidated Government, Columbus, Georgia; and shall be subject to the provisions of the Georgia public records law. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 9 of 43 If awarded the contract, the proposal submission, in its entirety, will be included as part of the contract documents and filed, as public record, with the Clerk of Council. F. ADDENDA: The proposer shall include acknowledgment of receipt of addenda (if any) in their sealed proposal. The proposer should include an initialed copy of each addendum in the proposal package. It is the proposer’s responsibility to contact the City for copies of addenda if they receive the proposal document from any other source other than the City. G. CONTRACT: Each proposal is received with the understanding that an acceptance in writing by the City of the offer to furnish any or all of the services and materials described shall constitute a contract between the proposer and the City. This contract shall bind the proposers to furnish and deliver the services and materials quoted, at the prices stated and in accordance with the condition of said accepted proposal. It is agreed that the successful respondent will not assign, transfer, convey or otherwise dispose of the contract or its right, title or interest in or to the same, or any part thereof, without previous consent of the City and any sureties. H. NON-COLLUSION: Proposer declares that the proposal is not made in connection with any other proposer submitting a proposal for the same commodity or commodities, and that the proposal is bona fide and is in all respects fair and without collusion or fraud. I. INDEMNITY: The Contractor covenants to save, defend, hold harmless, and indemnify the City, and all of its officers, departments, agencies, agents, and employees (collectively the "City") from and against any and all claims, losses, damages, injuries, fines, penalties, costs (including court costs and attorney’s fees), charges, liability, or exposure, however caused, resulting from, arising out of, or in any way connected with the Contractor’s intentional, negligent, or grossly negligent acts or omissions in performance or nonperformance of its work called for by the Contract Documents. J. DISADVANTAGED BUSINESS ENTERPRISE CLAUSE: Disadvantaged Business Enterprises (minority or women owned businesses) will be afforded full opportunity to submit proposals in response to this invitation and will not be discriminated against on the grounds of race, color, creed, sex, sexual orientation, gender identity or national origin in consideration for an award. It is the policy of the City that disadvantaged business enterprises and minority business enterprises have an opportunity to participate at all levels of contracting in the performance of City contracts to the extent practical and consistent with the efficient performance of the contract. K. AFFIRMATIVE ACTION PROGRAM - NON-DISCRIMINATION CLAUSE: The City has an Affirmative Action Program in connection with Equal Employment Opportunities. The successful vendor will comply with all Federal and State requirements concerning fair employment and employment of the handicapped, and concerning the treatment of all employees, and will not discriminate between or among them by reason of race, color, age, religion, sex, sexual orientation, gender identity, national origin or physical handicap. L. SPECIFICATION DESCRIPTIONS: The specifications detailed herein represent the quality of equipment, goods or services required by the City. Whenever in this invitation any particular process, service or equipment is indicated or specified by patent, proprietary or brand name of manufacturer/developer/inventor, such wording will be deemed to be RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 10 of 43 used for the purpose of facilitating descriptions of the process, service or equipment desired by the City. It is not meant to eliminate offerors or restrict competition in any RFP process. Proposals that are equivalent or surpass stated specifications will be considered. Determination of equivalency shall rest solely with the City. M. TAXES: The City is exempt from State Retail Tax and Federal Excise Tax. Tax Exemption No. GA Code Sec. 48- 8-3. Federal ID No. 58-1097948. N. DRUG-FREE WORKPLACE: Per Ordinance No. 93-55, in compliance with Federal and State Drug Free Workplace Acts, the Council of Columbus, Georgia adopted a drug free Workplace Policy. Consequently, any vendor providing goods or services to Columbus Consolidated Government must comply with all applicable Federal and State Drug Free Workplace Acts. O. FEDERAL, STATE, LOCAL LAWS: All respondents will comply with all Federal, State and Local laws, ordinances, rules and regulations relative to conducting business in Columbus, Georgia and performing the prescribed service. Ignorance on the part of the respondent shall not, in any way, relieve the respondent from responsibility for compliance with said laws and regulations or any of the provisions of these documents. P. PROVISIONS OF THE PROCUREMENT ORDINANCE: The provisions of the Procurement Ordinance for the Consolidated Government of Columbus, Georgia as adopted and amended by Council shall apply to all invitations to respond to Requests for Proposals and is specifically incorporated herein by this reference. The procurement ordinance is codified on Section 2- 3.03 of the Columbus Code and can be accessed through the City’s web-site at https://library.municode.com/ga/columbus/codes/code_of_ordinances. Q. INSURANCE: All respondents shall maintain, and if requested, show proof of insurance applicable for services described in these specifications. R. HOLD HARMLESS AGREEMENT: The successful respondent hereby agrees to indemnify, hold free and harmless Columbus Consolidated Government (The City), its agents, servants, employees, officers, directors and elected officials or any other person(s) against any loss or expense including attorney fees, by reason of any liability imposed by law upon the City, except in cases of the City’s sole negligence, sustained by any person(s) on account of bodily injury or property damage arising out of or in the consequence of this agreement. S. TERMINATION OF CONTRACT: 1. Default: If the contractor refuses or fails to perform any of the provisions of this contract with such diligence as will ensure its completion within the time specified in this contract, or any extension thereof, otherwise fails to timely satisfy the contract provisions, or commits any other substantial breach of this contract, the Purchasing Division Director may notify the contractor in writing of the delay or nonperformance and if not cured within thirty (30) days or any longer time specified in writing by the Purchasing Division Director, such director may terminate the contractor’s right to proceed with the contract or such part of the contract as to which there has been delay or a failure to properly perform. In the event of termination in whole or in part the Purchasing Division Director may procure similar supplies or services, from other sources, in a manner and upon terms deemed appropriate RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 11 of 43 by the Purchasing Division Director. The contractor will continue performance of the contract to the extent it is not terminated and will be liable for excess costs incurred in procuring similar goods or services. 2. Compensation: Payment for completed supplies or services delivered and accepted by the City will be at the contract price. The City may withhold from amounts due the contractor such sums as the Purchasing Director deems to be necessary to protect the City against loss because of outstanding liens or claims of former lien holders and to reimburse the City for the excess costs incurred in procuring similar goods and services. 3. Excuse for Nonperformance or Delayed Performance. Except with respect to defaults of subcontractors, the contractor shall not be in default by reason of any failure in performance of this contract in accordance with its terms (including any failure by the contractor to make progress in the prosecution of the work hereunder which endangers such performance) if the contractor has notified the Purchasing Division Director within 15 days after the cause of the delay and the failure arises out of causes such as: acts of God; acts of public enemy; acts of the City and any other governmental entity in its sovereign or contractual capacity; fires; floods; epidemics; quarantine restrictions; strikes or other labor disputes; freight embargoes; or unusually severe weather, If the failure to perform is caused by the failure of a subcontractor to perform or to make progress, and if such failure arises out of causes similar to those set forth above, the contractor shall not be deemed to be in default, unless the supplies or services to be furnished by the subcontractor was reasonably obtainable from other sources in sufficient time to permit the contractor to meet the contract requirements. Upon request of the contractor, the Purchasing Division Director shall ascertain the facts and extent of such failure, and, if such director determines that any failure to perform was occasioned by anyone or more of the excusable causes, and that, but for the excusable cause, the contractor’s progress and performance would have met the terms of the contract, the delivery schedule shall be revised accordingly. T. TIME FOR CONSIDERATION: Due to the evaluation process, proposals must remain in effect for at least 180 days after date of receipt. U. CONTRACT AWARD: Award of this contract will be made in the best interest of the City. V. REQUEST FOR EVALUATION RESULTS: Per the City’s Procurement Ordinance, evaluation results cannot be divulged until after the award of the contract. After contract award, proponents desiring to review documents relevant to the RFP evaluation results will be afforded an opportunity by appointment only. W. GOVERNING LAW: The parties agree that this Agreement shall be governed by the laws of Georgia, both as to interpretations and performance. X. FINAL CONTRACT DOCUMENTS: It is understood that the final contract shall include the following: 1) The RFP; 2) Addenda; 3) Awarded Vendors(s) response; 4) Awarded Vendor(s) Clarifications; 5) Negotiated Components; and 6) Awarded Vendor(s) Business Requirements. Y. PAYMENT DEDUCTIONS: RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 12 of 43 The City reserves the right to deduct, from payments to awarded vendor(s), any amount owed to the City for various fees, to include, but not limited to: False Alarm fees, Ambulance fees, Occupation License Fees, Landfill fees, etc. Z. PAYMENT TERMS: The City's standard payment term is usually net 30 days, after successful receipt of goods or services. Payment may take longer if invoice is not properly documented or not easily identifiable, goods/services are not acceptable, or invoice is in dispute. AA. RIGHT TO PROTEST: (1) Right of Protest. Any actual or prospective bidder offeror, or contractor who is aggrieved in connection with a solicitation or award of a contract may protest to the Purchasing Manager initially. All protests shall be filed in the manner prescribed herein. Protests that do not comply with the following rules shall be deemed invalid and of no effect. (2) The protest must be in writing, executed by a company officer that is authorized to execute agreements on behalf of the bidder or offeror or provided by an authorized legal representative of the protestor. (3) A protest with respect to an invitation for Bids or Request for Proposals shall be submitted in writing no less than five (5) business days prior to the opening of bids or the closing date of proposals or qualification statements. (4) Stay of Procurement During Protests. If there is a timely protest submitted as described above, the Purchasing Manager shall not proceed further with the solicitation or award of the contract until all administrative remedies have been exhausted or until the City Council, Mayor, or City Manager makes a determination on the record that the award of the contract without delay is necessary to protect substantial interests of the City. NOTICE TO VENDORS Sec. 2-3.05. - Submitting bids to Consolidated Government, etc.—By mayor or councilmembers. Neither the mayor nor any member of the Columbus Council shall submit any bid to the consolidated government, nor shall the mayor or any member of the Columbus Council own or have a substantial pecuniary interest in any business that submits a bid to the consolidated government. (Ord. No. 92-60, 6-23-92) Sec. 2-3.06. - Same—By members of boards, authorities, commissions. No member of any board or authority or commission or other independent or subordinate entity of the consolidated government shall submit any bid to the consolidated government or have a substantial pecuniary interest in any business that submits a bid to the consolidated government if such bid pertains to the board or authority or commission on which such person holds such membership. (Ord. No. 92-61, 6-23-92) RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 13 of 43 GENERAL SPECIFICATIONS Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) RFP No. 24-0004 I. SCOPE Columbus Consolidated Government (the City) invites qualified vendors to provide billing and collection services for the Columbus Fire & EMS Department. The services are required to enhance and develop an internal revenue cycle and will be procured on an as-needed basis. Refer to page 19 for Technical Specifications. II. BACKGROUND The Columbus Fire & EMS Department processed 9,886 claims in the prior fiscal year 2023 (FY23), from July 1, 2022 – June 30, 2023, and collected $2,803,418.90 during the same period. The Payer Mix breakdown for FY 2023 was:  Medicare 53.86%  Medicaid 20.71%  Primary 19.91%  Private Pay 5.52% The Transport Mix for FY 2023 was:  A0425 5.08%  A0426 N/A  A0427 48.27%  A0428 N/A  A0429 46.65%  A0433 N/A  A0435 N/A III. TERM OF CONTRACT A. The initial term of the contract will be for two years, with the option to renew for three additional twelve-month periods. Contract renewal shall be contingent upon the mutual agreement of the City and the Contractor. Notice of intent to renew will be given to the contractor in writing by the City Purchasing Manager, normally sixty days before the expiration date of the current contract period. This notice will not be deemed to commit the City to a contract renewal. It should be noted that multi-year contracts may be continued each fiscal year only after funding appropriations and program approvals have been granted by the Council of the Consolidated Government of Columbus, Georgia. In the event that the necessary funding is not approved, then the affected multi-year contract becomes null and void, effective July 1st of the fiscal year for which such approval has been denied. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 14 of 43 B. Termination for Convenience: For the protection of both parties, either party giving 90 days prior notice, in writing to the other party, may cancel this contract. IV. INDEMNITY CLAUSE The Contractor covenants to save, defend, hold harmless, and indemnify the City, and all of its officers, departments, agencies, agents, and employees (collectively the “City”) from and against any and all claims, losses, damages, injuries, fines, penalties, costs (including court costs and attorney’s fees), charges, liability, or exposure, however caused, resulting from, arising out of, or in any way connected with the Contractor’s intentional, negligent, or grossly negligent acts or omissions in performance or nonperformance of its work called for by the Contract Documents. V. INSURANCE The vendors shall be required, at their own expense, to furnish to the City of Columbus Purchasing Division, evidence showing the insurance coverage to be in force throughout the term of the contract. Insurance requirements are listed on the attached Insurance Checklist. The limits shown are minimum limits. Vendor shall indicate the actual limit they will provide for each insurance requirement. The bidder shall complete the Insurance Checklist and include with bid response. Certificate of Insurance is acceptable. The Insurance Checklist will indicate to the City, the bidder’s ability and agreement to provide the required insurance, in the event of contract award. The successful candidate shall provide the required Certificates of Insurance within 10 business days after award notification. The Certificates of Insurance will name Columbus Consolidated Government as an additional insured, as well as list the applicable project or annual contract name, and/or solicitation name and number. The Certificate of Insurance will be included with the contract documents prior to signing. VI. E-VERIFY AFFIDAVIT Pursuant to O.C.G.A. § 13-10-91, a public employer shall not enter into a contract for the performance of services unless the contractor registers and participates in the federal work authorization program. If a supplier is providing services under a contract with a total compensation amount of $2,500 or greater, (even if such services will be performed outside of the State of Georgia), Columbus Consolidated Government requires a notarized affidavit from the supplier attesting to the following: (A) The affiant has registered with, is authorized to use, and uses the federal work authorization program; (B) The user identification number and date of authorization for the affiant; (C) The affiant will continue to use the federal work authorization program throughout the contract period; and, (D) The affiant will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the same information required by subparagraphs (A), (B), and (C) of this paragraph. Additional information regarding the State’s E-Verify requirements can be found at: https://www.audits2.ga.gov/wp-content/uploads/2021/10/13-10-91.pdf. A completed, notarized E- Verify Affidavit must be included with sealed proposal; failure to do so will render the firm’s or individual’s proposal non-responsive and ineligible for award consideration. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 15 of 43 VII. PROPOSAL PREPARATION AND SUBMISSION See Appendix A for information and instructions on how to register and submit proposals through DemandStar. Firms should submit proposals that address each of the sections specified below. With the exception of the E-Verify Affidavit (Form 1), the form titled “Communication Concerning This Solicitation” (Form 2), and the proposed cost, fees, rates, revenue, etc., the City reserves the right to request any omitted information. Firms shall be notified, in writing, and shall have two (2) days, after notification, to submit the omitted information. If the omitted information is not received within two (2) days, the firm shall be deemed non-responsive, and the proposal will not receive further consideration. Section 1: Transmittal Letter The transmittal letter shall: Introduce the business and include the name and email address(es) of contact person(s) during this proposal process. A. List the complete address, telephone number and fax number for the corporate office as well as for the office/branch that will administer the contract. B. Include a statement to the effect that the proposal is binding for at least 180 days from the proposal date. An authorized agent of the business must sign the transmittal letter. Section 2: E-Verify Affidavit (Form 1) A properly completed, notarized E-Verify Affidavit must be included with proposal; failure to do so will render the firm’s proposal non-responsive and ineligible for further consideration. Additional information regarding the State’s E-Verify requirements can be found at: https://www.audits2.ga.gov/wp-content/uploads/2021/10/13- 10-91.pdf. Section 3: Communication Concerning This Solicitation (Form 2) Complete the form titled Communication Concerning This Solicitation. Section 4: Addenda Acknowledgement (Form 3) Use Form 3 to acknowledge receipt for all addenda (if any). The Purchasing Division will post addenda (if any) for this project at https://www.columbusga.gov/finance/Bid- Opportunities. Vendors are responsible for periodically visiting the web page for addenda, before the due date and prior to submitting a response. Section 5: Federal Compliance Complete the form titled Federal Compliance (Form 4) Section 6: Conflict of Interest Affidavit (Form 5) Form 5 must be signed and returned with the vendor’s proposal. Failure to include the form will automatically render vendor’s response non-responsive. Section 7: Exceptions to RFP A. List ANY AND ALL exceptions to the RFP specifications in this section of proposal submission. Exceptions listed in other areas of the vendor’s submission will not be considered. All exceptions will be vetted during the RFP process, and if found unacceptable, the vendor’s proposal will be rejected and no longer considered for RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 16 of 43 award. Exceptions shall be considered by the Evaluation Committee. The vendor’s proposal may not receive further consideration if exceptions are not acceptable and/or cannot be clarified to the Committee’s satisfaction. Vendors shall be notified in writing if exceptions are not acceptable. PLEASE NOTE: EXCEPTIONS TO THE RFP GENERAL PROVISIONS WILL NOT BE CONSIDERED, AND IF SUBMITTED WILL AUTOMATICALLY RENDER THE RESPONSE NON- RESPONSIVE. B. VENDOR AGREEMENT/CONTRACT FORM: Exceptions also include the terms of any contract or other agreements which the vendor or any subcontractors will require to be executed by the City. C. If there are no exceptions, vendor must include a statement for this Section stating the following: No Exceptions. Section 8: Company Profile A. Indicate the contractual entity to be held responsible for performance of all aspects of this contract, if awarded. Provide the legal name of your company and if doing business under some other name, list the name by which the company is commonly recognized. If the company is owned or controlled by a parent organization, proposers are requested to provide the name of that organization, its address and the name and title of the person responsible for your business unit. B. Include the number and locations in the United States and a list of the total number of customers. C. Provide a list of your customers that are government entities and the length of time they have used your services. Section 9: Qualifications/Experience A. Provide a brief history of your company and include the length of time your company has been providing the specified services. Highlight any features or areas that differentiate your services and products from competitors. B. Include your firm’s specific abilities, expertise and qualifications to provide the specified services. C. Provide proof that demonstrates your firm meets all Eligibility Requirements listed in Section A of the Technical Specifications. D. List key personnel proposed as project team members; include résumés and certifications for each. Section 10: Client Work History A. Use Form 6 to provide details of the last three contracts of similar size and scope, completed by your firm. B. Provide a list of ALL Georgia city and county government accounts held or lost within the last 5 years. Disclose any services terminated and the reasons for termination of the contract, either voluntary or other. This information will be used to determine experience with Georgia local governments. *In rating proposals, the Evaluation Committee reserves the right to include the company’s performance on previous and current contracts for Columbus Consolidated Government (if any). RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 17 of 43 Section 11: Understanding and Approach A. Submit a brief overview of the key elements of your proposal that describes your firm’s understanding of the required services and how your firm intends to meet the stated requirements. Include any concerns regarding scheduling, concepts, or expectations. B. Provide a description of your company’s solution to be offered to meet the needs described in this RFP. Include samples of requested reports, as specified in the Technical Specifications, section B. item 4. C. Include a list of all products and services being proposed. D. Include a description of all warranties and describe any maintenance requirements. E. Provide in detail the billing system and billing processes utilized as well as the identity of the software utilized and whether it is third-party or proprietary. F. Describe and discuss the firm’s compliance program and how the program meets or exceeds the requirements of Centers for Medicare and Medicaid Services (CMS) and Health Insurance Portability and Accountability Act (HIPAA). G. Describe any services provided by the firm that are not specified in this RFP but would assist the Columbus Fire and EMS Department in enhancing its cash collections. H. Describe the mediation procedure for a customer complaint about one of your employees. Section 12: Implementation and Training A. Elaborate on your firm’s implementation process and the approximate time frame for a successful transition. B. Provide a detailed and realistic schedule, including milestones. Do not use actual dates in the timeline, instead use days, weeks and months. C. Describe your system’s testing procedure and how you will ensure that the system is working properly. D. Describe the type of training that will be provided. Indicate if on-site training and/or off-site training is available to users and administrators. E. Describe your options for customer support. Section 13: Cost Proposal (subject to negotiation) The cost proposal shall be a percentage-based fee of the amount collected. List any and all additional fees or charges, including maintenance costs. Section 14: Contract Signature Page Complete Form 7. City officials will sign the copies after Columbus Council approves the contract award with the successful firm (see note below). Per the General Provisions, Page 12, Item X, the final contract shall include the following: 1) The RFP; 2) Addenda; 3) Awarded Vendor(s) response; 4) Awarded Vendor(s) Clarifications; 5) Negotiated Components; and 6) Awarded Vendor(s) Business Requirements. Please note: After award of the contract by Columbus Council, awarded vendors will be notified to provide one identical hard copy of submitted proposal with original signatures. The awarded vendors will receive a digital copy of the executed contract. Section 15: Proof of Insurance Provide Insurance Checklist (Form 8) or Certificate of Insurance. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 18 of 43 Section 16: Form W-9, Request for Taxpayer Identification Number and Certification Complete and return Page 1 of the Form W-9, which is available at https://www.irs.gov/pub/irs-pdf/fw9.pdf Section 17: Business License (Occupation License) Provide a current copy of the Business License (Occupation License) that is required to conduct business at your location. If awarded the contract, the successful vendor must obtain a business license from the City of Columbus. However, if the business is located in Georgia and has proof of being properly licensed by a municipality in Georgia, and paid applicable occupation taxes in that city, the contractor will not be required to pay occupation taxes in Columbus, Georgia. If you have questions regarding this requirement, please contact Yvonne Ivey, Revenue Division Manager, telephone 706-225-3091. VIII. EVALUATION OF PROPOSALS Each submittal will be evaluated to determine the ability of each offeror to provide the required services. The following weighted criteria will be used to evaluate proposals: Each of the above criteria (A-E) will be given a rating by each voting member of the Evaluation Committee. The ratings are as follows: Description Value Poor = Is not qualified. 20 Points Marginal = Is minimally qualified but one or more area is lacking in some essential aspect. 40 Points Adequate = Is qualified and is generally capable of achieving the objectives of this RFP. 60 Points Good = Is more than qualified and exceeds in some areas. 80 Points Excellent = Is fully qualified and exceeds in several or more areas. 100 Points After the review and rating of proposal (s) by the evaluation committee, individual scores will be averaged and ranked. Offerors will be ranked in descending order of numerical predominance. Criteria Weight A. Qualifications & Experience 40% B. Client Work History 20% C. Understanding and Approach 20% D. Implementation and Training 15% E. Cost Proposal 5% Total 100% Acceptable performance on previous contracts with Columbus Consolidated Government for similar services. +5 No previous contracts with Columbus Consolidated Government for similar services. 0 Unacceptable performance on previous contracts with Columbus Consolidated Government for similar services. -5 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 19 of 43 TECHNICAL SPECIFICATIONS Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) RFP No. 24-0004 A. ELIGIBILITY REQUIREMENTS To be considered, firms must provide proof of meeting the following requirements. 1. All of the firm’s operations; including but not limited to billing, collections, reporting, technology, compliance, customer service, etc. shall be performed within the continental United States of America. In no case shall any of the services, provided to Columbus Consolidated Government as part of this contract, be performed outside of the continental United States. Violation of this condition shall result in the immediate termination of the contract. 2. The Firm shall maintain a staff of certified ambulance coders. Certification should be through the National Academy of Ambulance Coders (NAAC). 3. Vast experience in Georgia with EMS billing including Medicare and Georgia Medicaid and has operated in Georgia as an EMS billing contractor for the last five years. 4. At least one client in Georgia who used Image Trend Elite with the GEMSIS configuration as ePCR system. 5. Operates solely in the EMS Billing space (greater than 90% of gross revenue) 6. Can appropriately manage the volume of the City’s service (currently up to 40,000 EMS claims annually) 7. Completed an SSAE16 Type II audit and will provide said audit results to Columbus. B. SCOPE OF WORK This section outlines the minimum contract requirements for ambulance billing, collection, financial reporting, and analytical services. Columbus Consolidated Government (the City) desires to engage a vendor to enhance and develop an optimal revenue cycle. The City is open to alternatives to meet the requirements that may or may not be described below. 1. Billing a. The firm will commence billing the patient care reports with the start-up date established by the firm and the City. b. The firm will retrieve on a daily basis the electronic billing data and other related billing information by way of an encrypted FTP file or batch filing process. The firm will be responsible for providing the appropriate software that will be compatible to interface with Image Trend Elite ePCR. c. Process claims within 2 business days of receipt of ePCR information. d. The firm will be responsible for reviewing each Patient Contact Report (PCR) for content and accuracy for billing purposes. The firm will be responsible for contacting the designated Columbus Fire and EMS Department employee to correct any discrepancies. e. Records and histories for services processed by the firm shall be available and accessible by authorized City staff through online access to the firm’s billing system. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 20 of 43 f. The firm must have access to and will utilize insurance coverage databases to provide billing information when not collected by the Columbus Fire and EMS crews. g. All client complaints concerning service rendered will be referred to the designated individual within Columbus Fire & EMS and tracked in a ticketing system provided by the firm. 2. Invoicing a. All invoicing must be in accordance with the correct rates established by the City of Columbus. b. All invoicing must be in accordance with the guidelines and procedures established by the Firm and the City. c. All invoicing must be in accordance with all applicable laws and regulations including those from Medicare and Medicaid services (CMS). d. All invoices shall also be billed in compliance with the Fair Debt Collection Practices Act. e. Electronic filing is the required method of filing primary Medicare, Medicaid, and commercial insurance claims. Electronic filing is the preferred method of filing to all other guarantors, if applicable. Otherwise, paper invoices may be issued directly to appropriate patient guarantors. f. The Firm shall pre-screen all claims to confirm compliance with guarantors’ guidelines. (i.e. physician certification statements, assignment of benefit signature forms, medical necessity documentation) g. The Firm shall verify insurance eligibility utilizing available resources and commercial databases prior to the submission of any patient claim for reimbursement. h. The expectation of the City is that the initial invoices will be processed within two (2) days of the approval by Columbus Fire & EMS employees for billing. 3. Collections a. The Firm is responsible for all collections and data tracking. Collections shall be into dedicated fund accounts for Columbus Fire and EMS. b. The Firm shall process all claims according to timelines agreed upon between the City and the Firm. The claims shall be divided into multiple revenue categories: Medicare, Medicaid, Commercial Insurance, Auto Insurance, Worker’s Compensation and Patient Pay. c. Claims shall be appropriately re-categorized after receiving payment from the primary payer. All denials shall be processed within three (3) business days or receipt. d. Customer service shall be provided from 8:00 a.m. until 5:00 p.m. Eastern Time using a tollfree phone number. The telephone systems utilized by the Firm must be able to accept voice mail messages and route incoming calls to the appropriate persons. The Firm must make a good faith effort to make return contact to all customers within 24 business hours after initial contact from any customer has been received. e. The Firm will treat all debtors fairly with professionalism, honesty, courtesy and integrity while obtaining the maximum results. The City will be the final arbitrator of disputes between the successful Firm and customers. The City’s decision shall be final. The Firm shall record all incoming phone calls and be able to produce audio files to the city when requested. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 21 of 43 f. Act as the advocate for the client with Medicare, Medicaid and private insurance in an endeavor to optimize payment on behalf of the client. g. The Firm may reserve the right to hold off on any write-offs that are waiting for insurance payments or in the case that a patient is making monthly payments. h. The Firm will be the only agency accepting payments. All checks should go to the Firm for processing. Medicare and Medicaid should be electronically deposited into the City’s dedicated account managed by the Firm. i. Fees charged by the Firm for billing and collections services will be based upon net cash collections. j. The City regards “net cash collections” as total funds collected less refunds issued as a result of overpayments or erroneous payments. An active quality assurance and auditing controls program for detecting, correcting, and avoiding process errors shall be maintained. k. The Firm will provide access to the billing system, via web-interface to City staff. This access should be provided to all authorized users at the City. The Firm should clearly define how this access would be granted in the Proposal. 4. Accounting and Reporting a. The City reserves the right to audit the records of the Firm related to the City’s billing and collection efforts. The Firm shall make and keep full and complete records and books of accounts for revenue and income, and all costs and expenses that specifically relate to performance under this contract. Records and books of accounts, together with any of all other memoranda pertaining thereto that may be kept, maintained or possessed by the Firm, shall be open to examination during regular business hours by the City or its representatives for the purpose of inspection, auditing, verifying, or copying the same or making extracts there from. The Firm shall make and keep said records and books of account in accordance with generally accepted accounting principles. b. Accounting for all billing pursuant to Generally Accepted Accounting Principles shall be provided on a daily, monthly, quarterly and annual basis, or as requested by the City. Such reports and all supporting documentation shall be submitted to the City within five (5) business days after the end of the month. c. The Firm shall provide a secured portal or similar for communication, reports, patient information. The firm’s portal shall be in compliance with all Medicare, Medicaid and HIPAA regulations. d. Detailed below are reports required by the City to monitor the billing and collections process. The list is not all-inclusive. The reports noted below must be provided to the appointed Columbus Fire & EMS Department billing and collections contact by the time period specified. Reports should be submitted electronically either via e-mail or secure server. Reports should be provided in MS Excel and/or as a PDF document as required or when requested. Additional reports may be requested on an “as needed” basis. Any report may require modification periodically on specific issues or other needs that might arise. Any report modification shall be the responsibility of the Firm. Please provide sample reports with your proposal (see Section 11 of the Proposal Preparation and Submission). Weekly Reports shall include, at minimum, the following: i. A revenue report showing all transports billed. At a minimum, the report shall include the date of transport or service, the incident number, the patient name, origin, destination, procedure code and gross charges. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 22 of 43 ii. A payment report showing all payments posted by payer class. Monthly Reports shall include, at minimum, the following: i. A revenue report showing all transports billed. At a minimum, the report shall include the date of service, incident number, procedure code and gross charges. ii. An outstanding aged accounts receivable report sorted by payer including a total outstanding aged report. The report should show four (4) categories of outstanding accounts: 30, 60, 90 and more than 120 days outstanding. The report shall also show the last date of activity on the account. The report shall break down the categories into the current financial class of the account (where the next dollar payment is expected from). iii. A monthly listing of all refund requests processed for the month. iv. Report of all claims “written off” during the month. The City prior to removing any outstanding balance shall authorize any write-off. The City may elect to set a monetary threshold of accounts that may be written off without advanced approval. v. Any report deemed required on an “as needed” basis that would be useful to the City in monitoring and evaluating the City’s ambulance service and/or accounts receivable process. vi. Date of Service performance monitoring and account reconciliation. vii. Account Analysis by Month of all City accounts. viii. Account Analysis by Month, by Payer. ix. Aging Report by Current Payer and Aging Category. (Accounting Period Based) x. Accounts Receivables Reconciliation Report (Accounting Period Based) Yearly Information i. Year End Accounts Receivable Report ii. Financial reports as required by City auditors. 5. Analytical Services a. At the beginning of the contract, the Firm will be expected to meet with Columbus Fire & EMS and/or City of Columbus representatives on a scheduled basis to review billing consistency, receivables performance, and other issues that have been encountered. Upon agreement of relevant entities, these meetings may become less frequent but will be held not less than twice a year. Also, the Firm must prepare and deliver a written report reviewing the performance of the accounts receivables, identifying outstanding issues, and list any strengths, weaknesses, and opportunities for improved performance. Additionally, this written report must identify key issues that might arise in the future, accompanied by strategies, procedures, and timelines to address these issues. This report shall be due six (6) months after the original contract date. The report will then be due on a yearly basis unless Columbus Fire & EMS and/or the City of Columbus or the Firm request or determine the report is needed on a more frequent basis. b. The Firm shall schedule regular meetings with the City and/or the Department to review performance. Also, at a minimum, a written report reviewing the performance of the accounts receivable shall be prepared, identifying among other issues, the strengths, weaknesses and opportunities of the performance. Also, key RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 23 of 43 issues that might arise in the future should be identified, along with strategies to address the issues. This report should be prepared monthly or as deemed necessary by the City. c. The Firm shall be required to provide analysis and expertise in all issues related to ambulance billing and operations. This analysis shall include developing trends within the Columbus Fire & EMS billing services and other pertinent issues that may develop. The Firm shall provide other analytical services as requested or required by the City. 6. Technology Requirements a. Upon awarding of the bid, the Firm shall evaluate the current data collection configuration of the City and shall be responsible to make recommendations to the City any reconfiguration that might be required to assure minimal interruption of the data stream. b. ImageTrend Elite ePCR is the current data collection software utilized by the Columbus Fire & EMS Department. The billing software of the Firm must configure billing export and import setup as needed. The Firm’s personnel must have experience working in and using the Citys ePCR system, ImageTrend Elite. Should the Columbus Fire and EMS Department change its data collection and PCR reporting system, the Firm shall be provided sufficient notice to be able to adapt all the requirements of this agreement to the new reporting system. The timing of such a transition shall be negotiated between the Firm, the City and Columbus Fire & EMS. c. The Firm shall provide all necessary software associated with the billing and collections process and must provide any required interface with ImageTrend (or other product as indicated above), the Citys ePCR system. d. Records shall be retained according to an agreed upon and legally compliant record retention plan. e. The Firm shall have the ability to utilize a secure FTP platform via VPN for extract file transfer. If the Firm recommends an alternative method for file transfer, the Firm shall provide a detailed description of the recommended process. f. The Firm will provide a system that will ensure complete and uninterrupted flow of service via backup systems and a Data Recovery Project Plan/System should a disaster occur. 7. Training of EMS Personnel a. Firm shall provide, at no additional cost, in-depth documentation compliance training of the complex Medicare and Medicaid regulations as they relate to the pre-hospital delivery of emergency medical care. The training shall include all necessary visual training aids and handout materials that personnel may reference at the conclusion of any training session. b. The Firm shall provide, at a minimum, an initial training of Fire-EMS personnel spanning two (2) Compliance and Documentation sessions. The first training session shall be at least two (2) weeks prior to the Firm commencing billing and collections on behalf of the city. The second, supplemental training session shall be provided within one month after the completion of the first quarter. Training sessions shall be provided at a time and place designated by the city. No travel cost outside of the submitted project cost will be considered for required mandated training sessions. c. The Firm shall provide any additional training as requested by the city and RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 24 of 43 may include training sessions for any group or individual, at no additional cost to the city. d. The Firm shall provide sufficient HIPAA compliance training to all employees dealing with applicable information. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 25 of 43 FORM 1 E-VERIFY AFFIDAVIT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of Columbus Consolidated Government has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows: Company ID Number (numerical, 4-7 digits) Date of Authorization **See https://e-verify.uscis.gov/emp/vislogin.aspx?JS=YES to access your E-Verify Company Identification Number. Name of Contractor Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) – RFP No. 24-0004 Name of Project Columbus Consolidated Government Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on , ___, 20 __ in (city), ______ (state). Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent Subscribed and sworn before me on this the day of , 20 . NOTARY PUBLIC My Commission Expires: A properly completed, notarized E-Verify Affidavit must be included with sealed proposal; failure to do so will render the firm’s proposal non-responsive and ineligible for further consideration. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 26 of 43 FORM 1 FORM 2 COMMUNICATION CONCERNING THIS SOLICITATION THIS PAGE MUST BE SIGNED AND RETURNED WITH THE VENDOR’S BID/PROPOSAL. FAILURE TO INCLUDE THIS FORM WILL AUTOMATICALLY RENDER VENDOR’S RESPONSE NON-RESPONSIVE. ALL QUESTIONS OR CLARIFICATIONS CONCERNING THIS SOLICITATION SHALL BE SUBMITTED IN WRITING. THE CITY WILL NOT ORALLY OR TELEPHONICALLY ADDRESS ANY QUESTION OR CLARIFICATION REGARDING BID/PROPOSAL SPECIFICATIONS. IF A VENDOR VISITS OR CALLS THE PURCHASING DIVISION WITH SUCH QUESTIONS, HE OR SHE WILL BE INSTRUCTED TO SUBMIT THE QUESTIONS IN WRITING. ALL CONTACT CONCERNING THIS SOLICITATION SHALL BE MADE THROUGH THE PURCHASING DIVISION. BIDDERS SHALL NOT CONTACT CITY EMPLOYEES, DEPARTMENT HEADS, USING AGENCIES, EVALUATION COMMITTEE MEMBERS, INCLUDING NON-CCG EMPLOYEES, CONTRACTED PERSONNEL ASSOCIATED WITH THIS PARTICULAR PROJECT (I.E. ARCHITECTS, ENGINEERS, CONSULTANTS), OR ELECTED OFFICIALS WITH QUESTIONS OR ANY OTHER CONCERNS ABOUT THE SOLICITATION. QUESTIONS, CLARIFICATIONS, OR CONCERNS SHALL BE SUBMITTED TO THE PURCHASING DIVISION IN WRITING. IF IT IS NECESSARY THAT A TECHNICAL QUESTION NEEDS ADDRESSING, THE PURCHASING DIVISION WILL FORWARD SUCH TO THE USING AGENCY, WHO WILL SUBMIT A WRITTEN RESPONSE. THE PURCHASING DIVISION WILL FORWARD WRITTEN RESPONSES TO THE RESPECTIVE BIDDER. IF IT BECOMES NECESSARY TO REVISE ANY PART OF THIS SOLICITATION, A WRITTEN ADDENDUM WILL BE ISSUED TO ALL BIDDERS. THE CITY IS NOT BOUND BY ANY ORAL REPRESENTATIONS, CLARIFICATIONS, OR CHANGES MADE TO THE WRITTEN SPECIFICATIONS BY CITY EMPLOYEES, UNLESS SUCH CLARIFICATION OR CHANGE IS PROVIDED TO THE BIDDERS IN A WRITTEN ADDENDUM FROM THE PURCHASING MANAGER. BIDDERS ARE INSTRUCTED TO USE THE ENCLOSED “QUESTION/CLARIFICATION FORM” TO FAX OR EMAIL QUESTION. QUESTIONS AND REQUESTS FOR CLARIFICATION MUST BE SUBMITTED AT LEAST FIVE (5) BUSINESS DAYS BEFORE THE DUE DATE. ANY REQUEST/CONCERN/PROTEST, AFTER A SOLICITATION HAS CLOSED AND PENDING AWARD, MUST ALSO BE SUBMITTED IN WRITING TO THE PURCHASING DIVISION. ----------------------------------------------------- I agree to forward all communication about this solicitation, in writing, to the Purchasing Division. I understand that communication with other persons, other than the Purchasing Division, will render my Bid/Proposal response non-responsive and I will no longer be considered in the solicitation process. Vendor Name: Print Name of Authorized Agent: Signature of Authorized Agent: RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 27 of 43 FORM 3 ___________________________________ (date) ADDENDA ACKNOWLEDGEMENT Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) RFP No. 24-0004 The Purchasing Division will post addenda (if any) on the Bid Opportunities page: https://www.columbusga.gov/finance/Bid-Opportunities. t is the vendors’ responsibility to periodically visit the page to check for addenda, both before the due date and prior to submitting a response in DemandStar. IF ADDENDA WERE ISSUED: By signing below, I acknowledge 1) I have received the addenda (if any) as indicated below, 2) my submittal reflects the changes to the specifications, and 3) my submittal includes the most recently revised forms: Addendum No. dated Addendum No. dated Addendum No. dated Addendum No. dated Addendum No. dated Addendum No. dated Addendum No. dated Addendum No. dated Addendum No. dated Addendum No. dated IF NO ADDENDA WERE ISSUED: By signing below, I acknowledge that I reviewed the Bid Opportunities page referenced above on and did not see any addenda listed for this solicitation. Business Name Date Authorized Signature Print Name RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 28 of 43 FORM 4 FEDERAL COMPLIANCE In the event a procurement under this contract is federally funded, the Contractor agrees to comply with all federal statutes relating to nondiscrimination, labor standards, and environmental compliance. The Contractor will be notified if the procurement is federally funded. With regards to “Rights to Inventions Made Under a Contract or Agreement,” If the Federal award meets the definition of “funding agreement” under 37 CFR § 401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that “funding agreement,” the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, “Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,” and any implementing regulations issued by the awarding agency. Contractor agrees to be wholly compliant with the provisions of 2 CFR 200, Appendix II. Additionally, for work to be performed under the Agreement or subcontract thereof, including procurement of materials or leases of equipment. Contractor shall comply and shall notify each potential subcontractor or supplier of the Contractor's federal compliance obligations. These may include, but are not limited to: (a) Title VII of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) the Fair Labor Standards Act of 1938 (29 USC 676 et. seq.), (d) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. § 794), which prohibits discrimination on the basis of handicaps and the Americans with Disabilities Act of 1990; (e) the Age Discrimination in Employment Act of 1967 (29 USC 621 et. seq.) and the Age Discrimination Act of 1974, as amended (42 U.S.C. §§ 6101-6107), which prohibits discrimination on the basis of age; (f) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (g) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to the nondiscrimination on the basis of alcohol abuse or alcoholism; (h) §§ 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (i) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. § 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (j) any other nondiscrimination provisions in any specific statute(s) applicable to any Federal funding for this Agreement; (k) the requirements of any other nondiscrimination statute(s) which may apply to this Agreement; (l) Applicable provisions of the Clean Air Act (42 U.S.C. §7401 et seq.), the Federal Water Pollution Control Act, as amended (33 U.S.C. §1251 et seq.), Section 508 of the Clean Water Act (33 U.S.C. 1368), Executive Order 11738, and the Environmental Protection Agency regulations at 40 CPR Part 15; (m) applicable provisions of the Davis- Bacon Act (40 U.S.C. 276a - 276a-7), the Copeland Act (40 U.S.C. 276c), and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-332), as set forth in Department of Labor Regulations at 20 CPR 5.5a; (n) the mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (P.L. 94-163). To demonstrate acknowledgement and understanding of the above listed Federal Requirements, vendor is required to sign below and return with bid response: Vendor Name: Signature of Authorized Agent: Print Name and Title of above Agent: RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 29 of 43 FORM 5 CONFLICT OF INTEREST AFFIDAVIT: THIS PAGE MUST BE SIGNED AND RETURNED WITH THE VENDOR’S BID/PROPOSAL. FAILURE TO INCLUDE THIS FORM WILL AUTOMATICALLY RENDER VENDOR’S RESPONSE NON-RESPONSIVE. Pursuant to Columbus Georgia Code Part I – Charter, Appendix Two Code of Ethics and Prohibited Practices: I hereby declare that any person(s) employed by the City of Columbus, who has direct or indirect personal or financial interest in this solicitation, has been identified and the interest disclosed below. (Please include in your disclosure any interest which you know of). An example of a direct interest would be a City of Columbus employee, City of Columbus City Council Member, who would be paid to perform services if awarded the contract. An example of indirect interest would be a City of Columbus employee who is related to any officers, employees, principal, or shareholders of your firm or to you. (If in doubt as to status or interest, please disclose to the extent known). ------------------------------------------------------ Disclosed Conflict of Interests: I hereby certify that the information on this form is complete and accurate. If necessary, I will provide the information required to verify this data (e.g., pay stubs, bank account statements, etc.). I, therefore, authorize such verification, and I will provide the supporting documentation, if necessary. Vendor Name: Print Name of Authorized Agent: Signature of Authorized Agent: I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on , , 20 in (city), (state). Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent Subscribed and sworn before me on this the day of , 20 . NOTARY PUBLIC My Commission Expires: RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 30 of 43 CLIENT WORK HISTORY Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) RFP No. 24-0004 Provide details of the last three contracts of similar size and scope, completed by your firm. Client Name: Contact Name: Annual Contract Value: $ Contract Begin Date: Contract End Date: Address: Telephone Number: E-Mail Address: Description of services provided: Client Name: Contact Name: Annual Contract Value: $ Contract Begin Date: Contract End Date: Address: Telephone Number: E-Mail Address: Description of services provided: Client Name: Contact Name: Annual Contract Value: $ Contract Begin Date: Contract End Date: Address: Telephone Number: E-Mail Address: Description of services provided: Company Name Authorized Signature Print Name Date FORM 6 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 31 of 43 CONTRACT SIGNATURE PAGE Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) – RFP No. 24-0004 THE UNDERSIGNED HEREBY DECLARES THAT HE HAS/THEY HAVE CAREFULLY EXAMINED THE SPECIFICATIONS HEREIN REFERRED TO AND WILL PROVIDE ALL EQUIPMENT, TERMS AND SERVICES TO THE CONSOLIDATED GOVERNMENT OF COLUMBUS, GEORGIA. Company Name Signature of Authorized Representative Date Title of Authorized Representative Print Name of Authorized Signatory (Corporate seal, if applicable) Company Street Address Company Payment Address Contact: Contact: Email: Email: Telephone: Telephone: CONSOLIDATED GOVERNMENT OF COLUMBUS, GEORGIA Accepted this day of 20 Isaiah Hugley, City Manager Clifton C. Fay, City Attorney Sandra T. Davis, Clerk of Council APPROVED AS TO LEGAL FORM: ATTEST: FORM 7 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 32 of 43 INSURANCE CHECKLIST Billing and Collection Services for Columbus Fire and EMS Department (Annual Contract) RFP No. 24-0004 CERTIFICATE OF INSURANCE MUST SHOW ALL COVERAGE AND ENDORSEMENTS INDICATED BY "X" CSL = Combined Single Limit; BI = Bodily Injury; PD=Property Damage Required Coverage(s) Limits (Figures denote minimums) Bidders Limits/Response X 1. Worker’s Compensation and Employer’s Liability STATUTORY REQUIREMENTS Comprehensive General Liability X 2. General Liability Premises/Operations $1 Million CSL BI/PD each occurrence, $1 Million annual aggregate 3. Independent Contractors and Subcontractors $1 Million CSL BI/PD each occurrence, $1 Million annual aggregate X 4. Products Liability $1 Million CSL BI/PD each occurrence, $1 Million annual aggregate X 5. Completed Operations $1 Million CSL BI/PD each occurrence, $1 Million annual aggregate 6. Contractual Liability (Must be shown on Certificate) $ 1 Million CSL BI/PD each occurrence, $1 Million annual aggregate Automobile Liability X 7. *Owned/Hired/Non-Owned Vehicles/ Employer non ownership $1 Million BI/PD each Accident, Uninsured Motorist Others 8. Miscellaneous Errors and Omissions $1 Million per occurrence/claim 9. Umbrella/Excess Liability $1 Million Bodily Injury, Property Damage and Personal Injury X 10. Personal and Advertising Injury Liability $1 Million each offense, $1 Million annual aggregate X 11. Professional Liability $1 Million per occurrence/claim 12. Architects and Engineers $1 Million per occurrence/claim 13. Asbestos Removal Liability $2 Million per occurrence/claim 14. Medical Malpractice $1 Million per occurrence/claim 15. Medical Professional Liability $1 Million per occurrence/claim 16. Dishonesty Bond FORM 8 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 33 of 43 Required Coverage(s) Limits (Figures denote minimums) Bidders Limits/Response 17. Builder’s Risk Provide Coverage in the full amount of contract 18. XCU (Explosive, Collapse, Underground) Coverage 19. USL&H (Long Shore Harbor Worker’s Compensation Act) 20. Contractor Pollution Liability $2 Million per occurrence/claim 21. Environmental Impairment Liability $2 Million per occurrence/claim X 22. Carrier Rating shall be Best’s Rating of A-VII or its equivalents X 23. Notice of Cancellation, non-renewal or material change in coverage shall be provided to City at least 30 days prior to action. X 24. The City shall be named Additional Insured on all policies X 25. Certificate of Insurance shall show Solicitation Number (RFP No. 24-0004) and Solicitation Title (Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract)) in box: Description of Operations 26. Pollution: $2 Million per occurrence/claim *If offeror’s employees will be using their privately owned vehicles while working on this contract and are privately insured, please state that fact in the Bidders Limits/Response column of the insurance checklist. VENDOR’S STATEMENT: If awarded the contract, I will comply with contract insurance requirements and provide the required certificate(s). Company Name Signature of Authorized Agent Date Title of Authorized Agent Print Name of Authorized Agent RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 34 of 43 DEMANDSTAR SUBMISSION INFORMATION Responses must be submitted via DemandStar. See the following pages for Submission Requirements Checklist, Registering for DemandStar and Responding to an Electronic Bid in DemandStar. There is no cost to submit responses electronically through DemandStar; you will only incur a fee if you opt to receive e-notifications directly from DemandStar. You must select “Columbus Consolidated Government” as your free agency (see registration instructions). Solicitations may be accessed thru the DemandStar link that is posted at https://www.columbusga.gov/finance/Bid-Opportunities. Per Georgia HB489, the Purchasing Division will continue to post solicitations on the Georgia Procurement Registry. To receive future procurement notifications, you must register with the Team Georgia Marketplace at https://doas.ga.gov/state- purchasing/getting-started-supplier. Excluding responses to Requests for Proposals (RFP), a tabulation of responses will be available on DemandStar shortly after the solicitation closes. The Purchasing Division will also continue to post tabulations at https://www.columbusga.gov/finance-2/Bid- Tabulations. Failure to submit electronic responses, via DemandStar, will result in the rejection of your response. Submittals received via U.S. Postal Service, FedEx, UPS, etc., will be returned unopened at the expense of the sender. The Purchasing Division will not accept hand-delivered submittals and will immediately discard any submittal left in the reception area of the Finance Department. The Purchasing Division sincerely appreciates your cooperation. APPENDIX A RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 35 of 43 ELECTRONIC SUBMITTAL CHECKLIST Billing and Collection Services for Columbus Fire and EMS Department (Annual Contract) - RFP No. 24-0004 Submit your electronic response as instructed below: 1. Vendors shall submit only the required documents listed using the “Bidder Response ALL Documents” function. 2. Zip files with multiple files are not acceptable; vendors shall submit one PDF file of their submittal. 3. Due to file size limitations, please do not resend the City’s full specifications as this information is already on file. 4. In the event DemandStar requires a dollar value for your submittal, enter “0”.  1. Transmittal Letter  2. E-Verify Affidavit (Form 1)  3. Communication Concerning this Solicitation (Form 2)  4. Addenda Acknowledgement (Form 3)  5. Federal Compliance (Form 4)  6. Conflict of Interest Affidavit (Form 5)  7. Exceptions to RFP  8. Company Profile  9. Qualifications and Experience  10. Client Work History (Form 6)  11. Understanding and Approach  12. Implementation and Training  13. Cost Proposal (subject to negotiation)  14. Contract Signature Page (Form 7)  15. Insurance Checklist (Form 8) or Sample Certificate of Liability Insurance  16. Page 1 of Form W-9 (https://www.irs.gov/pub/irs-pdf/fw9.pdf)  17. Business License/Occupation License NOTE: After award of the contract by Columbus Council, awarded vendor will be notified to provide one identical hard copy of submitted proposal with original signatures. The awarded vendor will receive a digital copy of the executed contract. RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 36 of 43 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 37 of 43 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 38 of 43 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 39 of 43 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 40 of 43 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 41 of 43 Enter “0” as your bid (proposal) amount. (As cost proposals remain confidential until after contract award (if any), Columbus Consolidated Government will not consider proposed costs, fees, revenues, etc., that are entered directly into DemandStar.) RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 42 of 43 RFP No. 24-0004 Billing and Collection Services for Columbus Fire & EMS Department (Annual Contract) Page 43 of 43