Ambulance Services

1 Request for Proposals (RFP) for Ambulance Services for the City of Pekin, Illinois Issue Date: September 16, 2022 Submission Due Date: October 14, 2022 by 3:00 p.m. City of Pekin 111 S. Capitol St. Pekin, Illinois 61554 Telephone (309) 477-2300 Sue McMillan City Clerk Pekn i LLin ais 2 Table of Contents Sections 1. Administrative Overview Provides general information on the objectives of this Request for Proposals (RFP), procurement schedule and procurement overview. 2. Scope of Work and Services Provides a description of the project and list of services and products requested that, while not comprehensive or complete in nature, will provide the City of Pekin with proposals that can be easily compared. 3. Evaluation Criteria and Contents Describes how the proposal will be evaluated and the required content for the submission. 4. Proposal Instructions Describes the submittal instructions and communications 5. Appendices I EMS Service Area Map II Insurance Requirements III RFP Posting

Information 6. Attachments A Investigative Authorization Form B Fee Proposal Form C Non-Collusive Bidding Certification 3 Section 1 Introduction This Request for Proposal (RFP) is issued by the City of Pekin, Illinois (hereinafter referred to as the City), a home rule community having jurisdiction within the corporate limits of the City as well as adjacent fire protection districts which the City provides emergency services to on a contract basis (the Service Area). The purpose of this RFP to establish a franchise agreement (the Agreement) for the provision of Advanced Life Support (ALS) ambulance response for 911 emergency calls (the Ambulance Services) within the Service Area. RFP Timeline RFP issued on September 16, 2022. Questions due by September 26, 2022, at 4 p.m. Question answers will be posted on September 30, 2022. Proposal Submission Due Date is October 14, 2022, at 3p.m. Review of Proposals from October 17, 2022, through October 24, 2022. City Council Award on November 14, 2022. Authority Proposals must be submitted by persons authorized to commit the responding qualified provider of Ambulance Services (Provider) to a service agreement. By submitting your written proposal, you represent and warrant that your submitted proposal does not contain information that will violate the rights of any third party. Costs for Proposal Preparation Any costs incurred in preparing or submitting a proposal shall be the respondents sole responsibility. Disqualification of Proposals The City reserves the right to consider only those proposals submitted in accordance with all requirements set forth in this RFP and which demonstrate an understanding of the scope of the work. It shall be the respondents sole risk to assure delivery of the proposal to the City by the designated time. The City will not consider any proposals submitted after the deadline specified in this RFP. The City in its sole discretion reserves the right to reject or refuse to consider any or all of the submitted proposals received in response to this RFP. Proposals and Materials Submitted All respondents who choose to respond to the RFP agree that the City owns all rights related to the materials submitted in response to this RFP. Such materials will not be returned to the respondents. Final Agreement The issuance of the RFP, the submission of a response by any Provider, and the receipt of such response by the City does not obligate the City in any manner. The City shall not be responsible for work done, even in good faith, prior to execution of a final Agreement. The initial term of any Agreement shall be for three (3) years with two 1-year options of annual renewal. Inspection of Proposals Information clearly marked as Confidential or Proprietary in any proposal shall be honored as such, to the extent allowable under the Freedom of Information Act (5 ILCS 140/1 et seq.). The City treats proposals as confidential until after the award is issued or all proposals rejected the City Council. At that time, they become subject to disclosure under the Freedom of Information Act. 4 Savings Clause If any provision of this RFP is found to be invalid, such invalidation will not be construed to invalidate the entire RFP. Fee Structure The Fee Structure for Ambulance Services provided in accordance with the Agreement shall be submitted on the Proposed EMS Services Rates Form attached hereto. To offset the Citys costs related to administration, implementation, monitoring, and management of the Ambulance Services provided hereunder; regulatory oversight of EMS and emergency services provided within the City; impact on City infrastructure; and any other costs related to the administration of the Agreement and monitoring of Providers performance; the Provider shall pay to the City for each year of the Agreement a minimum franchise fee of $75,000. Estimated Business Volumes and Payer Distributions The City specifically makes no representations or warranties regarding the number of requests for ambulance service, ambulance transports, payer mixes or frequency of special events coverage that may be required within the city. Statistics provided in Section 2 illustrate the historical call volume and are not a guarantee of future demand for Ambulance services. Immunity from Liability The City is immune from liability and suit for or from the Ambulance Service activities involving third parties and arising from any Agreement resulting from this RFP. Reservation of Rights The City may (i) amend, modify, or withdraw this RFP, (ii) revise requirements of this RFP, (iii) require supplemental statements or information from any firm, (iv) accept or reject any or all response hereto, (v) extend the deadline for submission of proposals hereto, (vi) negotiate or hold discussions with any respondents and waive defects and allow corrections if deficient proposals do not completely conform to the instructions contained herein, and (vii) cancel this RFP, in whole or in part, if the City deems it in its best interest to do so. The City may exercise the foregoing rights at any time without notice and without liability to any responding firm or any other party for its expenses incurred in the preparation of the responses hereto or otherwise. Existing Contracts & Agreements with Third Parties All Providers that choose to respond to the RFP are required to disclose any and all third- party contracts or agreements with organizations located within the City of Pekin corporate limits that would continue in force after the award and execution of the Agreement contemplated herein. 5 Section 2 Scope of Work and Services Background and Service Area Summary The City of Pekin is in located in Tazewell County in central Illinois. It is approximately 16 square miles in area and is home to approximately 32,796 residents (2020 Census estimate) as well as a vibrant business and industrial community. In addition, the City of Pekin provides emergency services for fire, EMS, rescue, hazardous materials, and related services to Brush Hill Fire Protection District and Powerton Fire Protection District, totaling an additional 35 square miles. The Service Area for the purposes of this agreement shall be the area served by the Pekin Fire Department, which at present time consists of the corporate limits of the City of Pekin as well as the two aforementioned fire protection districts. All 911 calls placed in Tazewell County are answered by the Tazewell County Consolidated Communications (TC3) dispatch center. TC3 will provide Public Safety Answering Point (PSAP) and dispatching services for emergency medical service calls to the appropriate agency while also providing emergency medical directions to the caller. Dispatching fees assessed by TC3 to the Ambulance Service are the responsibility of the Provider. In 2020 and 2021, approximately the following number of emergency medical calls were completed in the described service area: 2020: 4200 2021: 4600 It is expected that the Provider will be knowledgeable of and familiar with EMS rules, regulation and laws as promulgated by the Illinois Department of Public Health (IDPH) prior to responding to this RFP. Objectives The City is seeking a Provider to provide a fully integrated, high performance EMS delivery system that provides ambulance response, pre-hospital care, transportation to medical facilities, and related services within the area served by the Pekin Fire Department. The primary goal is to provide quality Advanced Life Support (ALS) ambulance service to City of Pekin residents and visitors. The City of Pekin and Pekin Fire Department will monitor service delivery and contractual compliance through a series of independent performance measurements. The successful Provider will base its delivery model on clearly defined outcome measures and not a level of effort criterion. City of Pekin Fire Department Responsibilities/Role The City of Pekin represents the interests of the local taxpayers, the general public as customers of EMS within the City corporate limits as well as contracted fire districts, and the health and welfare of the community at- large. In this performance based approached it is the City of Pekin Fire Departments responsibility to: A. Provide ALS and/or Intermediate Life Support (ILS) non-transport emergency medical service on emergency medical calls when available. B. Monitor Provider compliance and enforce agreement terms. C. Provide the Provider with the information necessary for the Provider to perform the Ambulance Services pursuant to the Agreement. 6 Provider Responsibilities In all circumstances, Ambulance Services shall be provided in keeping with all applicable Federal, State, and local laws and requirements. In addition, the Provider shall: A. Maintain a state of readiness for the purpose of responding to all emergency requests for Ambulance Services originating in the Service Area. B. Provide verification that the Provider and its key employees are licensed by the State of Illinois. C. Provide to the City of Pekin any logos, insignia and other publicly displayed identifying graphics that they plan to use to brand the and/or advertise the Provider in the City of Pekin and its associated fire districts. Any public relations material or media presentation identifying the Provider as being the provider of EMS or Ambulance Services in the City of Pekin and its associated fire districts, or otherwise referencing the City or using City logos or imagery, must be approved by the Fire Chief prior to becoming publicly available. D. Each ambulance shall provide direct notification to the TC3 dispatch center via radio or mobile computer (i) when it is enroute to a call, (ii) upon arrival on scene, and (iii) when it is available for an additional response. E. Provide to the Pekin Fire Department and to the TC3 dispatch center 24/7 real time access to the Providers automatic vehicle location (AVL) system at all times for the purposes of emergency resource management. Costs associated with implementing this real time access are the responsibility of the Provider. Response Time Standards The Ambulance Service shall meet or exceed the transport response times in the Service Area as set forth in this section. This also includes sending an ambulance to all structure fires in the Service Area. Response times for each emergency call shall be calculated commencing with the hour, minute and second that the Provider is notified by TC3 and ending with the hour, minute and second that an ALS transport unit operated by Provider arrives on scene. The Providers transport unit must notify the dispatch center directly when it is enroute to and arrives on scene for each emergency call. An ALS transport unit shall arrive at the scene of all calls categorized as class Priority 1 by the emergency medical dispatch system within eight (8) minutes of the time the call was received by the Provider from TC3. An ALS transport unit shall arrive at the scene of all calls categorized as Priority 2 by the emergency medical dispatch system within twelve (12) minutes of the time the call was received by the Provider from the dispatching agency. These time criteria must be met on at least ninety (90) percent of the individual calls received during each calendar month. The Provider shall provide to the Fire Chief and City Clerk a written monthly report of response time performance. At the request of the Fire Chief, the City may audit, or cause to be audited, the Providers response times. 7 Penalty for Failure to Meet Response Time & Performance Requirements Violation Fine(s) Failure to comply with Response Time Standards (first violation) Written Warning Failure to comply with Response Time Standards for a second time within 365 days of the written warning. $2000.00 Failure to comply with Response Time Standards for a third time within 365 days of receiving the previous violation. $5000.00 Failure to comply with Response Time Standards for a fourth time within 365 days of receiving the previous violation. $10,000.00 plus review of service agreement for potential termination of the Agreement Failure to comply with monthly data reporting. $500.00 per month, until data is received by the Fire Chief and City Clerk Failure to comply with Chapter 3 Article IV Division 1 of the City of Pekin municipal code.1 $500.00 per violation (on a one violation per emergency call basis) Response Time Exemptions: Late responses may be excused, and financial penalties waived by the Fire Chief when, in the Fire Chiefs sole discretion, the circumstances warrant such excusal. Examples of circumstances that may warrant excusal include, but are not limited to: A. Failure by dispatching agency to give accurate location information (including address or cross street) to responding unit. B. Weather conditions which impair visibility or create other unsafe driving conditions C. Wrong address provided by the requesting party. D. Unavoidable delays caused by road construction. Required Meetings The Provider shall meet with City officials as may be requested, and in no case less than quarterly, for the purpose of reviewing system issues and Ambulance Service performance. The City agrees to give reasonable notice of such meetings. The Provider agrees to accompany City officials to meetings which may affect the provision of emergency services if the City deems that it may need consultation from the Provider in order to make proper policy, operational or legal determinations regarding the delivery of emergency services and EMS within the City and associated fire protection districts. Required Reports The following reports shall be provided to the City on a monthly basis, as specified: A. Response Time Compliance B. Total Responses C. Response time summary for all responses by priority Staffing Requirements and Employment Practices Provider shall maintain sufficient qualified staff to meet Response Time Standards. The Provider shall also provide adequate supervision of personnel and operations at all times. Additional full and or part time staff shall 1 https://library.municode.com/il/pekin/codes/code_of_ordinances?nodeId=COOR_CH3CISE_ARTIVEMSE_DIV1AMSE 8 be acquired as may be necessary to ensure the smooth operation of Ambulance Services at all times. Providers employees shall act in a professional manner and maintain a professional appearance at all times when performing the Ambulance Services. Vehicle Requirements It is the Providers responsibility to provide ambulances capable of transporting patients which meet local, state, and federal standards and requirements. The vehicles must be equipped with mobile data computers capable of receiving emergency call dispatch information from TC3 and must be equipped with automatic vehicle location (AVL) technology. Supplies Requirements It is the Providers responsibility to supply and stock all vehicles used in the performance of Ambulance Services in accordance with local, state, and federal standards, regulations, and requirements. The Provider shall, at no cost to the City, replace any medications, airway management supplies, and cardiac monitor supplies used by the Pekin Fire Department. These supplies will be provided on a one-to-one basis when they are used on a patient that was ultimately transported by the Provider. Coverage and Availability requirements The City neither accepts nor rejects the Ambulance Services level of effort estimates. Rather, the City accepts the Ambulance Services commitment to employ whatever level of effort is necessary to meet Response Time Standards and the following performance specifications: A. The Provider shall dedicate sufficient fully staffed ALS ambulances to provide emergency Ambulance Services to the Service Area in accordance with the requirements of the Agreement. Ambulances dedicated to providing Ambulance Services in the Service Area shall not be dispatched by Provider to areas or calls outside the Service Area, except pursuant to the terms of a mutual aid agreement as set forth herein. Provider shall add additional ambulances to its fleet as needed to meet the requirements of this paragraph. B. The Provider must obtain written mutual aid agreements with surrounding ambulance service providers or must have the ability to provide its own mutual aid. C. The Provider will ensure the Ambulance Services will be available within the Service Area on a 24- hour a day basis. Emergency Response & Training The Provider must be familiar with and adhere to the provisions of Chapter 3 Article IV Division 1 of the City of Pekin Municipal Code regarding ambulance service operational requirements. The Pekin Municipal Code is available online at: https://library.municode.com/il/pekin/codes/code_of_ordinances?nodeId=COOR_CH3CISE_ARTIVEMSE_DIV1AMSE The Provider shall also participate in training, drills and exercises as may be required by the Fire Chief from time to time, without additional charge to the City. Ambulance Fees and Guidelines for Rate Increases The Provider shall provide as part of their proposal a comprehensive rate schedule for all services, materials, medications, and other actions or items that may be billed to a patient in the course of their treatment and https://library.municode.com/il/pekin/codes/code_of_ordinances?nodeId=COOR_CH3CISE_ARTIVEMSE_DIV1AMSE 9 transport. All emergency transport rates shall be based on the patient condition, or the services rendered. The contents and description of the Proposed Rate Schedule shall include, but not be limited to the following: A. Whether a bundled or unbundled rate structure is being proposed. B. Single Base Rate Charge and what items are included and excluded from the base charge. C. If unbundled, a complete schedule of charges for medical supplies, equipment, procedures or other services that may be charged to the patient. D. Oxygen and/or Mileage charges E. Emergency stand-by charge at special events Disclosure of Fee Schedule: It is the Citys desire to provide complete disclosure of all charges and fees associated with the delivery of ambulance services. As such the Provider shall establish as part of this proposal its full and complete rate schedule for all services and charges. These charges shall be posted at the Providers business office, be made available as a handout to all patients and/or family members and be posted on the Providers web page. The proposed rate schedule shall be in effect for the initial 12 months of operations pursuant to the Agreement and shall not be increased during this timeframe. A written rate schedule shall be provided to the Fire Chief and City Clerk at any time rates change thereafter, and at least annually during the term of the Agreement. Demonstration of Financial Depth and Stability Proposers shall provide documentary evidence which clearly documents the financial history of the organization and demonstrates that the proposer has: A. The financial capacity to handle the expansion (including implementation and start-up costs) necessitated by the award of the RFP B. Included copies of its financial statements for the most recent two-year period. Audited financial records are preferable. If audited financial records are unavailable, proposer must provide un-audited financial statements supported by federal tax returns. In cases where the proposer is forming a new entity, the financial records of the parent company shall be available for review. C. Detailed description of any and all pending insurance (separate listing for auto and professional liability) claims, investigation, and settlements including both status and resolution. Mutual Aid Requirements The Ambulance Service shall participate in and are to subject to any Mutual Aid agreements as directed by the City of Pekin. Transition Provision Should Ambulance Service fail to prevail in a future procurement cycle, Ambulance Service shall agree to continue to provide all services required in and under an Agreement until the new Ambulance Service assumes service responsibilities. Under these circumstances Ambulance Service will, for a period of several months, serve as a "transition" contractor. To ensure continued performance fully consistent with the requirements of the agreement through any such period, the following provisions shall apply: 10 A. Ambulance Service shall continue all operations and support services at the same level of performance as were in effect prior to the award of the subsequent agreement to a competing organization. B. Ambulance Service shall make no changes in methods of operation which could reasonably be considered to be aimed at cutting contractor service and operating cost to maximize profits during the final stages of the agreement. C. City recognizes that if a competing organization should prevail in a future procurement cycle, the Ambulance Service may reasonably begin to prepare for transition of service to the new contractor. City shall not unreasonably withhold its approval of Ambulance Services request to begin an orderly transition process, including reasonable plans to relocate staff, scale down certain inventory items, etc., as long as such transition activity does not impair Ambulance Services performance during this period. 11 Section 3 - Proposal Format Proposal Evaluation Process The City will use a committee to evaluate proposals. The evaluation committee may select an Ambulance Service from these submissions or conduct a second stage in-person interview with selected Ambulance Service(s) from the initial offerings. In the event of second stage interviews, the selection committee will notify the selected Ambulance Service(s) of interview dates and times. This notification shall include the interview evaluation criteria. Following the interview process, a recommendation will be made by the committee to bring the staff recommendation to the Pekin City Council for review and consideration. Upon Council approval of a selected Ambulance Service, a Franchise Agreement for service will be negotiated and executed. Proposal Content Organization Respondents shall organize their submissions in such a way as to follow the general evaluation criteria listed below: A. Authority to Verify Credentials and Proposal Submission Include a completed, signed and notarized Investigative Authorization Form (Attachment A) for the Ambulance Service whose credentials are submitted for review and for owners, officers, and key personnel. If the Ambulance Service is a corporation, only the company release form and personal release forms of managers and key personnel who would be involved in the fulfillment of the agreement or in the preparation of the proposal need to be submitted. B. Table of Contents C. Qualifications Criteria 1. Financial Capabilities/ Administrative and Report Practices a) Provide all vital and accurate information relating to corporate information as registered with the State of Illinois and the federal government. Such information shall include at a minimum, but not limited to: Name/ Type of Entity. Authorization to conduct business in Illinois. Names of Officers & Shareholders. Corporate Address/ Mailing Address. FEIN and Corporate Identification. Contact person for company. Name and title of person authorized to sign legal documents on behalf of the company. b) Provide a comprehensive rate schedule for all services, materials, medications and other actions or items that may be billed to a patient in the course of their treatment and transport. c) Provide a complete outline of the billing and collection policies and procedures in the proposal. Policies about acceptance of assignment and write-off should be specifically addressed. In addition, the following financial information is to be included in the proposal: Local Pekin Access: A designated local or toll-free phone number for inquiries from patients and third-party payers will be provided by the Ambulance Service for patient use. 12 Financial Audit: Provide a copy of the most recent audited financial statement prepared by an independent public accounting firm in accordance with generally accepted accounting principles. For new start-up proposals, provide an estimated balance sheet and profit/ loss statement projections. 2. Approach to Emergency Medical Services Response Provide a copy of the Ambulance Services proposed Policies and Procedures/ Ambulance Equipment List that includes, but is not limited to: A. Proposed Ambulance Service Mandatory Inventory List. B. Proposed organizational structure and staffing levels for providing described services within the defined response time requirements. C. Plan, strategy and commitment to meet performance metrics. 3. Clinical and Employment Practices Provide a statement of clinical philosophy and employment practices held by the Ambulance Service. 4. Past Experience of Provider and Key Personnel References The City will, in part, base its award on the experience of the Ambulance Service and key staff personnel in administering, managing, and operating a 911 emergency ambulance program. Provide a listing of three (3) references for the Ambulance Service that can attest to the performance, quality and level of emergency services provided. D. Attachments Sign and include the following additional forms: A. Attachment A: Investigation Authorization B. Attachment B: Fee Proposal Form C. Attachment C: Non-Collusive Bidding Certification City Proposal The City reserves the right to submit its own proposal to the RFP. 13 Section 4 - Submittal Instructions Deadline for Written Questions Relating to the RFP The deadline for written questions is 4:00 p.m. on September 26, 2022. Please send questions to Sue McMillan by email at smcmillan@ci.pekin.il.us. Submittal Instructions Bidders shall submit their written proposals to the City Clerk by October 14, 2022, at 3 p.m. either by email (PDF Format), U.S. Mail, private courier, or hand delivery. If sending the proposal by mail, the proposal must be received by the Clerks Office by the due date and time, or it will not be considered. After the deadline and upon request, a representative of the City will have available the names of the entities submitting proposals. No other public disclosure will be made until after the award of an Agreement. Any proposal received after this date and time shall be rejected. Incomplete information will be viewed as non- responsive. Proposals submitted by mail, private courier, or hand delivery shall be mailed or delivered to: Sue McMillan, City Clerk 111 S. Capitol Street Pekin, IL 61554 Proposals submitted by mail should be in a sealed envelope marked: Firm Name, Address, and Phone Number Ambulance Service RFP Due Date: 3:00 p.m. on October 14, 2022 Proposals submitted by email shall be emailed to: Sue McMillan at smcmillan@ci.pekin.il.us Proposals submitted by email in the email body shall include: Firm Name, Address, Email Address, and Phone Number RFP Due Date: 3:00 p.m. on October 14, 2022 Sent under Subject Ambulance Service RFP The City of Pekin appreciates your time associated with providing a proposal and looks forward to working with you in the near future. mailto:smcmillan@ci.pekin.il.us. mailto:smcmillan@ci.pekin.il.us 14 Appendix I Map of EMS Service Area This map depicts the City of Pekin corporate limits broken up into the three currently existing fire station first due response areas, along with Brush Hill and Powerton FPDs. CITY OF PEKIN With Fire Response Districts and [Bruch Mill and Powerton Fire Protection Districts Pa 15 Appendix II Insurance Requirements City of Pekin 111 S. Capitol Street, Pekin, IL 61554 Ambulance Service Insurance Requirements 1. Notwithstanding any terms, conditions or provisions, in any other writing between the parties, the Ambulance/ EMS Service, herein referred to as the Provider, hereby agrees to effectuate the naming of the City of Pekin, herein referred to as the Municipality, as an additional insured on the Ambulance/ EMS Service Providers insurance policies, with the exception of workers compensation and personal liability insurance. If the policy is written on a claims-made basis, the retroactive date must precede the date of the Agreement. 2. The policy naming the Municipality as an additional insured shall be issued by an insurer licensed to do business in the State of Illinois. The decision to accept specific insurers lies exclusively with the Municipality. a. Additional insured status shall be provided by standard or other endorsements that extend coverage to the Municipality for both on-going and completed operations. The decision to accept any endorsement rests solely with the Municipality. A completed copy of the endorsements must be attached to the certificate of insurance. b. At the Municipality's request, the Provider shall provide a copy of the declaration page of the liability policies with a list of endorsements and forms. If so requested, the consultant will provide a copy of the policy endorsements and forms. 3. The Provider agrees to indemnify the Municipality for any applicable deductibles and self- insured retentions. To the fullest extent permitted by law, the Provider agrees to defend, indemnify and hold harmless the City of Pekin, its officers, directors, agents and employees from and against any and all claims, suits, liens, judgments, damages, losses and expenses including reasonable legal fees and costs arising in whole or in part and in any manner for any and all acts, omissions, breach or default of the Provider, in connection with performance of any work by the Provider, its officers, directors, agents, and employees. 4. Required Insurance: a. Commercial General Liability Insurance i. Bodily Injury & Property Damage: $1,000,000 per occurrence/ $2,000,000 aggregate b. Automobile Liability i. Bodily Injury & Property Damage: $1,000,000 combined single limit for owned, hired and borrowed and non-owned motor vehicles c. Personal Injury and Advertising Liability: i. $1,000,000 per occurrence/$2,000,000 aggregate ii. Contractual Liability with no non-standard exclusions iii. The Municipality shall be listed as an additional insured and a completed copy of the endorsement must be attached to the certificate of insurance. iv. Waiver of Subrogation 16 v. Policies must include a 30 Day Prior Written Notice to the City of Pekin in the event of cancellation or non-renewal d. Medical Malpractice Insurance $2,000,000 per occurrence/ $2,000,000 aggregate for the professional acts of the Provider performed under the Agreement for the Municipality. If written on a claims- made basis, the retroactive date must pre-date the inception of the franchise Agreement. If this coverage is provided in the General Liability proof of coverage must be indicated on the certificate of insurance. e. Excess Insurance $2,000,000 each occurrence and aggregate. Excess coverage shall be on a follow-form basis. 5. Provider acknowledges that failure to obtain such insurance on behalf of the Municipality constitutes a material breach of the Agreement. The Provider is to provide the Municipality with a certificate of insurance, evidencing the above requirements have been met, prior to the commencement of services. The failure of the Municipality to object to the contents of the certificate or the absence of same shall not be deemed a waiver of any and all rights held by the Municipality. 17 Appendix III Posting Info City of Pekin, Illinois Request for Proposals Ambulance Service Issue Date: September 16, 2022 Proposals for Ambulance Service for the City Pekin will be received at the Office of the City Clerk at 111 S. Capitol St, Pekin, IL, until 3:00 p.m. on October 14, 2022. Each proposal must be prepared and submitted in accordance with the requirements outlined in the RFP. The RFP may be obtained through the City of Pekins website at https://www.ci.pekin.il.us . The City reserves the right to reject any and all proposals, waive any informalities, and/or award a Franchise Agreement in the best interest of the City of Pekin. https://www.ci.pekin.il.us/ 18 Attachment A Investigation Authorization The undersigned organization, a prospective proposer to provide emergency advanced life support ambulance service for the City of Pekin and associated Fire Protection Districts, recognizes that public health and safety requires assurance of safe, reliable, cost-efficient ambulance service. That assurance will require inquiry into aspects of company operations deemed relevant by the City of Pekin, or its agents. The company specifically agrees that the City of Pekin or its agents may conduct an investigation into, but not limited to the following matters: 1. The financial stability of the company, including its owners and officers, any information regarding potential conflict of interests, past problems in dealing with other clients or cities where the company has rendered service, or any other aspect of the company operations or its structure, ownership, or key personnel which might reasonably be expected to influence the City of Pekins selection decision. 2. The companys current business practices, including employee compensation and benefits arrangements, pricing practices, in-service training programs, means of competing with other companies, employee discipline practices, public relations efforts, current and potential obligations to other buyers, and general internal personnel relations. 3. The attitude of current and previous customers of the company toward the companys services and general business practices, including patients or families of patients served by the company, physicians or other health care professionals knowledgeable of the companys past work, as well as other units of local government with which the company has dealt in the past. 4. Other business in which company owners and/ or other key personnel in the company currently have a business interest. 5. The accuracy and truthfulness of any information submitted by the company in connection with such evaluation. This authorization shall expire one year from the date of signature. 19 AUTHORIZATION FOR SUCH INVESTIGATION IS HEREBY EXPRESSLY GIVEN BY THE COMPANY: Company Name Date By: Signature (authorized representative) Name & Title Printed State of: County of: On this day of 2022 before me, the undersigned, a Notary Public in and for the said County and State, personally appears To me known to be the person described herein and who executed the foregoing statement and acknowledged that they have executed the same as a free act and deed. Witness my hand and Notary Seal subscribed and affixed in said County and State, the day and year above written. Notary Public 20 Attachment B Fee Proposal Form Ambulance Rate Schedule Charges are to be based on the rate schedule submitted in this proposal. If an item is included in the base rate, or if there is no charge for an item, indicate this on the form. Identify additional specific charges (i.e. charges to perform any of the identified skills) or routine charges (i.e. infection control charge) in the blanks provided. The total shall reflect all specific and routine charges that a patient would be billed. Transport Type $ Advanced Life Support (ALS)-1 Advanced Life Support (ALS)-2 Basic Life Support (BLS) *Mileage (Per Loaded Mile) Treated Onsite and No Transport 21 Attachment C NON-COLLUSIVE BIDDING CERTIFICATION By submission of this bid, bidder and each person signing on behalf of bidder certifies, and in the case of joint bid, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of his/her knowledge and belief: 1. The prices of this bid have been arrived at independently, without collusion, consultation, communication, or agreement, for the purposes of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 2. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the Bidder prior to opening, directly or indirectly, to any other bidder or to any competitor; and 3. No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting competition. A BID SHALL NOT BE CONSIDERED FOR AWARD NOR SHALL ANY AWARD BE MADE WHERE [1], [2], [3] ABOVE HAVE NOT BEEN COMPLIED WITH; PROVIDED HOWEVER, THAT IF IN ANY CASE THE BIDDER(S) CANNOT MAKE THE FORGOING CERTIFICATION, THE BIDDER SHALL SO STATE AND SHALL FURNISH BELOW A SIGNED STATEMENT WHICH SETS FORTH IN DETAIL THE REASONS THEREFORE: [AFFIX ADDENDUM TO THIS PAGE IF SPACE IS REQUIRED FOR STATEMENT.] IF BIDDER(S) (ARE) A PARTNERSHIP, COMPLETE THE FOLLOWING: NAMES OF PARTNERS OR PRINCIPALS LEGAL RESIDENCE NAMES OF PARTNERS OR PRINCIPALS LEGAL RESIDENCE 22 IF BIDDER(S) (ARE) A CORPORATION, COMPLETE THE FOLLOWING: LEGAL RESIDENCE President Secretary Treasurer President Secretary Treasurer If applicable, Responsible Corporate Officer Name If applicable, Responsible Corporate Officer Name Signature Title Signature Title Identifying Contractor Data: Potential Contractor: Potential Contractor: Street Address: Street Address: City, State, ZIP. City, State, ZIP. Telephone: Telephone: Title: Title: JOINT OR COMBINED BIDS BY COMPANIES OR FIRMS MUST BE CERTIFIED ON BEHALF OF EACH PARTICIPANT: Legal name of person, firm or corporation Legal name of person, firm or corporation By By Title Title Address Address City/State/ZIP City/State/ZIP