011-25 Medical Debt Collections (Ambulance).pdf

Wayne County, New York

Request For Proposal Medical Debt Collections (Ambulance)

RFP Number: 011-25

RFP Release Date: 04/03/2025

Questions Due: 04/10/2025

Proposals Due: 04/24/2025

Refer Questions to:

Christopher O’Connor, NIGP-CPP, CPPB

Wayne County Purchasing Agent

16 William Street

Lyons, NY 14489

Purchasing@waynecountyny.gov

Submit Sealed Proposals To:

Kelley P Loveless

Clerk - Wayne County Board of Supervisors

26 Church Street

Lyons, NY 14489

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RFP CONTENTS

Section 1 Specifications/Scope of Work Page 1 Section 2 Proposal Requirements Page 3 Section 3 Evaluation Procedures Page 6 Section 4 Administrative Requirements Page 8 Section 5 Proposal Forms Page 12 Section 6 Attachments & Exhibits Page 23

NOTICE TO CONTRACTORS

NOTICE IS HEREBY GIVEN that the County of Wayne will receive sealed proposals for Medical Debt Collection services for Wayne County Emergency Medical Services

Such proposals may be submitted electronically using the BidNet platform at https://www.bidnetdirect.com/new-york/waynecountyny OR by mail in a sealed envelope clearly identified and filed with the Clerk of the Wayne County Board of Supervisors, 26 Church Street, Lyons, New York 14489, on or before 2:00

PM prevailing time on April 21, 2025.

An electronic copy of proposal forms, specifications, and plans can be obtained by visiting https://www.bidnetdirect.com/new-york/waynecountyny or by requesting them directly from the Purchasing

Department Office located at 26 Church Street, Lyons, NY by email request to purchasing@co.wayne.ny.us (Telephone:

315-946-7675)

NOTICE: The County of Wayne (hereinafter “County”), shall not be held responsible for the completeness or accuracy of any proposal documents received by a contractor that was not directly issued to that contractor by the Purchasing

Department.

Any contractor submitting a proposal based on incomplete or inaccurate information resulting from documentation received from any third party, shall not have cause for relief from award or completion of a contract in accordance with the official documents on file with the Clerk of the Board of Supervisors.

It is HIGHLY suggested that all contractors interested in participating in this proposal, contact the Purchasing

Department directly at the above address or telephone number to assure they have received the most accurate and up-to-date material concerning this contract.

The County does not offer or supply anyone the list of people that have obtained a copy of these proposal specifications or cost estimates for the project prior to the opening of the proposals. NO EXCEPTIONS ARE MADE TO THIS POLICY.

*The County reserves the right to reject any or all proposals.

COUNTY OF WAYNE

Dated: 3/27/2025 Kelley P Loveless, Clerk

Lyons, New York WC Board of

Supervisors https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fwww.bidnetdirect.com%2fnew-york%2fwaynecountyny&c=E,1,2_nQ4oW01JU8rIt5fe190UI1s3wksAhzdR7SsijwiHToN2iboa4awbwoPtJKyvPFKGLwjVqmYhoBD9ceqgr5uoEH00iNPy0ajF5iDzG0f8bc&typo=1 https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fwww.bidnetdirect.com%2fnew-york%2fwaynecountyny&c=E,1,2_nQ4oW01JU8rIt5fe190UI1s3wksAhzdR7SsijwiHToN2iboa4awbwoPtJKyvPFKGLwjVqmYhoBD9ceqgr5uoEH00iNPy0ajF5iDzG0f8bc&typo=1 mailto:purchasing@co.wayne.ny.us

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Section 1

SPECIFICATIONS/ SCOPE OF WORK

1.1 PROJECT SUMMARY

The County of Wayne is seeking proposals to contract with a medical debt collection agency for the Wayne

County Emergency Medical Services Department

1.2 SCOPE OF SERVICES

The County intends to contract with a medical debt collection agency for the EMS department. The scope of services will include, but not be limited to, the following:

1) The County will support communication between the contracted medical billing company and contracted medical debt collection agency.

2) The medical debt collection agency will process for medical debt collection in consultation with the

County and the County's contracted medical billing company, currently EMS Management and

Consultants, based on criteria and processes developed by the County

3) The medical debt collection agency will initiate the debt collection process for all such patients referred to collections unless specifically directed otherwise by the County.

4) All typical types of patient correspondence sent by the debt collection agency shall be pre-approved by the County.

5) Debt collection notices and other written communications must contain, at a minimum, the name of the County; the medical debt collection agency's address and telephone number; the patient's name, street address, city, state, zip code; the statement date and date of service; the level of service provided; and the total amount due to the County, in addition to the assigned run number

6) The medical debt collection agency shall bear the full cost of its collection efforts, including printing forms and envelopes, postage, telephone charges, labor, and maintenance of computer software and hardware.

7) The medical debt collection agency shall be accessible for inquiries during normal business hours, Monday through Friday, to include from 9:00 a.m. to 5:00 p.m. Eastern Time, excluding weekends and holidays. Phone messages shall be returned within 24 hours excluding weekends and holidays. The debt collection agency will handle all telephone inquiries and written correspondence pertaining to patient accounts in a timely manner.

8) The medical debt collection agency shall staff a nationwide toll-free telephone number Monday through Friday, to include from 9:00 a.m. to 5:00 p.m. Eastern Time, to answer any and all questions from patients.

9) The medical debt collection agency shall process payments received and ensure that all collected revenue is deposited not less often than monthly into a County designated bank account. EFT for Fund Deposits is preferable

10) The medical debt collection agency shall post all payments received to applicable patient accounts.

11) The medical debt collection agency shall keep and maintain accurate and updated records pertaining to all patient accounts.

12) The medical debt collection agency shall provide monthly reports to the County that provides both summary and details of collection efforts and monies collected. An online dashboard for live, real time indications of progress/performance/income is preferable

13) The medical debt collection agency shall provide a monthly statement to the County that lists amount of monies collected and fee due to the medical debt collection agency for services provided. This statement will be submitted to the County by the 15th day of the next month. The County shall remit payment to the medical debt collection agency within 30 days of receipt of the billing company's statement.

14) The medical debt collection agency shall maintain debt collection records electronically stored and made available to the County upon request. These records shall be kept a minimum of 7 years.

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15) The medical debt collection agency shall be available to meet with County representative on an emergency basis within 48 hours of notification excluding weekends and holidays.

16) The medical debt collection agency's principal business must be medical debt collection.

17) The medical debt collection agency shall have an established reputation in the field with experience in medical debt collection for ambulance services in New York State.

18) The county’s preference is to have the medical debt collection agency deposit all revenue collected for the County into the County specified account by EFT (or make monthly payments), and shall separately bill the County for the amount due in payment to the debt collection agency. The medical debt collection agency should not deduct the amount due by the County from the funds it collects on behalf of the County. This is being requested to provide a clear breakdown of revenue and expenses

1.3 CURRENT CONDITIONS

Wayne County Emergency Medical Services (WCEMS) provides the residents of, and visitors to, Wayne County with the highest quality pre-hospital EMS care, currently through its Ambulances and strategically placed ALS fly cars in the County.

WCALS also assists the EMS transporting agencies of Wayne County by any means possible and appropriate in the pursuit of their goals and missions. This is done by providing direct patient care for their patients transported, assistance with training and quality assurance related activities, and other activities and services as requested.

2024 As of 3/23/2025

Billing Data

Total Billable Calls 3849 Total Gross Charges $3,350,688.00

Total Net Charges $2,338,000.88 Total Net Payments $941,029.64 Average Loaded Mileage 15.75

Fee Schedule Ground Mileage $30/mile BLS Non-Emergency $400 BLS Emergency $700 ALS 1 Non-Emergency $500 ALS 1 Emergency $1,000

ALS 2 $1,500

Specialty Care Transport (SCT) $2,000 ALS Intercept / Medicare Interagency charge $100 ALS Intercept $525

Payor Mix Commercial 11% Facility 23% Medicaid 15% Medicare 32% Self Pay 19% Other

Call Type Qtys BLS Non-Emergency 0% BLS Emergency 27% ALS 1 Non-Emergency 0% ALS 1 Emergency 51%

ALS 2 2%

Specialty Care Transport (SCT) 0% ALS Intercept 10% Treat, No Transport 9%

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Section 2

PROPOSAL REQUIREMENTS

2.1 DATE AND TIME REQUIREMENT

All proposal packages MUST be received on or before the date and time indicated in the Procurement Schedule in Section 4

(Administrative Requirements). Late submittals will not be accepted or considered and will be returned to the Offeror unopened. It is the responsibility of the offeror to ascertain any additional security requirements with respect to packaging and delivery to the County. Offerors should be mindful of any potential delays due to weather, connectivity issues, or other delays whether foreseeable or unforeseeable. Failure to submit a response before the Proposal Due Date will result in disqualification of the Proposal

2.2 GENERAL FORMAT

All material submitted SHALL become part of the proposal and may be incorporated in a subsequent contract between the

County and the selected Offeror. All responses/submittals to this RFP SHALL be made in accordance with the format outline below. Failure to submit in the requested format or failure to submit all the required forms may cause a proposal to be deemed non-responsive. The format for the proposal includes the following:

Shall be written in the English Language

Submitted on standard 8 ½” x 11” paper size using the format that is specified and required in this RFP and each

Proposal form

Use Arial or Calibri font, or a font incorporated into fillable forms and must have a minimum font size of 10

2.3 SUBMISSION REQUIREMENTS

Proposals may be submitted via hardcopy, or online electronically utilizing the BidNet Platform

Hardcopy Submissions:

The Offeror SHALL submit one (1) hardcopy proposal package. The Proposal package SHALL contain the offeror proposal in a sealed envelopes, and a USB data stick containing the following information:

ENVELOPE 1: Contains Offerors Proposal and Proposal forms

USB Data Stick: Containing an electronic copy of the hardcopy proposal response

The Proposal package SHALL be submitted in a sealed package containing the offerors response. The proposal should be stapled together or bound in a three-ring binder. Please do not bind the proposal in any other fashion to allow for easy duplication and distribution. The package SHALL include all required Proposal Forms. The package MUST also contain 1 USB data stick containing a copy of the hardcopy proposal. Note: if there are any discrepancies between the USB documents and the Hardcopy Documents, the Hardcopy documents will take precedence. The package SHALL be addressed and mailed or delivered to the County and Clearly labeled as follows:

Kelley Loveless

Clerk of the Board of Supervisors, Wayne County, NY

26 Church Street, Lyons NY 14489

RFP #

Electronic Submission:

Proposals shall be submitted via electronic submission on BidNet (https://www.bidnetdirect.com/new-york/waynecountyny) no later than the time and date specified in the Section 4.3. Please note that Offerors must register on BidNet (https://www.bidnetdirect.com/ ) in order to submit their proposals electronically. Late proposals will not be accepted. For assistance with the Bidnet platform please contact BidNet’s Support Department at (800)835-4603, Option

(ext) 2.

https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fwww.bidnetdirect.com%2fnew-york%2fwaynecountyny&c=E,1,78LP3Gaf2KO-sa_yaUm8mUPkaVt_N3ocsQbaR0uOxjulx__j_WHZhcHXr-n40RX_reZGPIBsz6aIGUuB06XA3-ZrJZ-ZYX779RKzjIOlvjc4l6Nt6e6Tsw,,&typo=1 https://linkprotect.cudasvc.com/url?a=https%3a%2f%2fwww.bidnetdirect.com%2fnew-york%2fwaynecountyny&c=E,1,78LP3Gaf2KO-sa_yaUm8mUPkaVt_N3ocsQbaR0uOxjulx__j_WHZhcHXr-n40RX_reZGPIBsz6aIGUuB06XA3-ZrJZ-ZYX779RKzjIOlvjc4l6Nt6e6Tsw,,&typo=1 https://www.bidnetdirect.com/

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2.4 PROPOSAL REQUIREMENTS

It is NOT required to include a copy of the entire RFP in your proposal only the information required below. Proposals must include:

1. Completed and signed Proposal Forms

2. Background and Experience: Provide a brief history of your business and experience with similar projects. Identify proposed project staffing and include copies of resumes/C.V.'s for all personnel as well as any applicable certifications, licenses, etc. Include specific information on the staff’s experience with the requested service.

Describe successful outcomes

3. Technical Proposal Narrative: Describe how Consultant will perform the required work described in the

Specifications section of this RFP:

a. Provide a statement describing the scope of work as you understand it, and how you propose the work will be done. Describe the approach, means, methods, and procedures to be used to gather the data, analyze findings, and develop recommendations as requested.

b. Provide a detailed breakdown and description of the specific steps, services, and products that will be provided. Describe how the final product will be structured and presented upon completion.

Include any computer/software compatibility information, if applicable.

c. Include a sample final report, tables, schedules, charts, spreadsheets, and other forms you intend to use to perform the work under this RFP.

d. Provide a detailed timeline indicating tasks required and the start and completion dates for each. It is expected that the work will commence as soon as possible after the contract is awarded finalized.

e. Provide any other related and recommended products or service not specified in the RFP which may be considered essential or benefitted by the Consultant. These services should be priced separately from the lump sum estimate for the Services described in the Specifications section of this RFP requested in section

5 “Cost Proposal/Pricing” below.

4. References: Scoring for this RFP will include an experience component. In order to maximize scoring opportunities, Offerors should provide names and contact information for up to three (3) other public entities wherein similar projects have been completed, references for New York government entities are preferable, but not required. (provided as Proposal Form B)

5. Cost Proposal/ Pricing: On the Proposal Form provide a total lump sum cost estimate, including travel, printing and technology related expenses, for the work described in Specifications section of this RFP; a fee or a rate schedule for computing any extra work not specified in this RFP (as noted in section f of the Technical proposal).

Wayne County reserves the right to award/not award the extra work not specified in this RFP. (provided as Proposal

Form G)

6. Non- Collusion Certification (provided as Proposal Form C)

7. Certification Regarding Debarment, Suspension, and Responsibility (provided as Proposal Form D)

8. Certification of Compliance with the Iran Divestment Act (provided as Proposal Form E)

9. Certification Regarding Lobbying (provided as Proposal Form F)

10. Insurance Documentation: the proposal shall contain the required insurance documentation as documented in

Section 4 “Administrative Requirements” or a letter of intent to acquire and provide necessary coverage if awarded a contract. Certificates of insurance evidencing compliance with the Vendor’s/Consultant’s compliance

Page | 5 with the insurance requirements of this RFP must be provided prior to execution of the contract by the County.

Failure to submit insurance documents may result in disqualification of the Vendor/Consultant as non-responsive

2.5 PROPOSAL FORM TEMPLATES

The offeror must ensure that their response meets all form and content requirements detailed within this RFP. This RFP contains Proposal Forms, which shall be incorporated into the offerors proposal. Offerors shall NOT re-create these

Proposal Forms, create their own Proposal Forms, or edit the format structure of the Forms (page sizing, font type, font size, page margins, etc.) An electronic copy of each Form will be provided along with this RFP. The Offeror must download, complete, and submit each proposal formal in their Proposal Package. Any proposal that does not adhere to these requirements may be deemed nonresponsive and rejected. Additional copies of Submittal Forms may be used and submitted.

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Section 3

EVALUATION PROCEDURES

EVALUATION SUMMARY

Proposals will be evaluated based upon their overall value to the County, which included both cost and technical factors (as outlined in this section).

CRITERIA AND WEIGHTS

Proposals that are found to be responsive, will be evaluated and assessed in accordance with the evaluation criteria below.

Criteria Points

Compensation Arrangement 250

Management Capabilities 200

Qualifications/Experience 250

Ability to meet the County’s Needs 300

Total Maximum Points Available 1,000

CALCULATIONS

The Purchasing Department will prepare a spreadsheet to input and analyze all Offeror information and evaluation scores.

The following approach will be used to calculate an Offeror’s score for cost:

(Lowest Cost / Cost of Proposal being evaluated) *(Weight Point Possible)

Lowest cost will receive maximum points for that category and subsequent proposals will receive a proportionate amount using the above formula. For example, if the Offeror provides a cost of $5, and the lowest cost was $3, and the maximum points was “30”, the Offeror would receive: ($3)/ ($5) *(30) = 18 points

RESPONSIVENESS

To be considered responsive, at a minimum, Offerors must complete and submit all of the required information (requested in this RFP and the Proposal Forms) on time and submitted as specified in this RFP.

EVALUATION COMMITTEE

An Evaluation Committee will be used to evaluate proposals of all responsive Proposals and participate in the Interview process (if required). The Evaluation Committee is expected to contain approximately 3-5 individuals that may, or may not, have technical expertise with this particular type of project or service. Therefore, it is important that the Offerors prepare and submit non-technical documents (to the maximum extent possible).

The Evaluation Committee will be asked to independently review and score the Submittals/Interviews comparatively to one another based on a 0 to 10 scale. The scale is based on the following criteria:

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Points Awarded

Quality Criteria

10 Exceptional Exceptional; far exceeds expectations

8 Very Good Exceeds expectations

6 Acceptable Meets expectations and all minimum requirements

4 Below Requirements

Does not meet expectations or minimum requirements

2 Well Below Requirements

Fails to meet minimum requirements; proposes a solution that is not acceptable

0 Unacceptable Proposed solution deemed unacceptable in every aspect

The score as a percentage will then be multiplied by the weight of the category

The Purchasing Department will verify each Evaluation Committee member's score and average the scores to obtain the final average score for each offeror.

EVALUATION PROCESS

The following procedures will be followed to evaluate Proposals:

1. The Purchasing Department will review all proposals for compliance with mandatory requirements as stipulated within the RFP. Proposals deemed non-responsive will be eliminated from further consideration. The Purchasing Department may contact Offerors for clarification of the responses.

2. The Purchasing Department will provide Proposals to the Evaluation Committee,

3. The Evaluation Committee members will independently evaluate and score the documents and submit their scores back to the Purchasing Department.

4. The Purchasing Department will input, calculate, and prioritize the data and evaluator scores.

5. The Purchasing Department may identify and invite, the Offerors to participate in an Interview Process.

INTERVIEWS

The County may conduct interviews with the Key Personnel/Teams from each of the selected Offerors. Should interviews be conducted, the same criteria will be used to select the finalist. Once the interviews and/or on-site presentations have been conducted and references checked, the Evaluation Committee will meet and decide as to the finalist. In the event an on-site presentation is conducted, the Offeror(s) will be notified and to be scheduled to present to the selection committee.

Interviewees may be asked questions regarding their experience, knowledge, and understanding of the scope of work, obstacles and challenges, strategies, and their plan/approach. The County may request additional information prior to interviews.

AWARD PROCEDURE AND AGREEMENT

The successful Offeror will be notified, in writing, when a recommendation for award has been completed, and of the award date of the contract. No payment can be made for action taken or work started prior to the execution of the contract. This selection is subject to the approval of the Wayne County Board of Supervisors.

The selected Offeror will enter into a contract with the County for the performance of the work specified in the RFP and must agree to conditions incorporated into the standard contract used by Wayne County, subject to the approval of the County

Attorney (Exhibit 3)

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Section 4

ADMINISTRATIVE REQUIREMENTS

4.1 COMMUNICATIONS

The individual listed below is responsible for the conduct of this procurement. All questions, inquiries, concerns, or clarifications regarding this solicitation must be submitted electronically (via email or to the BidNet Platform) to this individual or their designee. Offerors shall not contact or communicate with any other County employees. Unauthorized contact about this RFP with any other County employees may result in immediate disqualification. The County will not be responsible for any oral representations or instructions. All contact with any county official must take place during normal work hours, at the county office, or a site related to the service being proposed.

Contact Name: Christopher O’Connor, NIGP-CPP, CPPB Title: Purchasing Agent

Address: 16 William St Lyons, NY 14489 Phone #: (315)946-7674

Email: purchasing@waynecountyny.gov

Pursuant to State Finance Law §139-j and §139-k, this solicitation includes and imposes certain restrictions on communications between the County and an Offeror during the procurement process. An Offeror is restricted from contacting other than designated staff from the earliest notice of intent to solicit offers through final award and approval of the Procurement Contract by the County Executive ("Restricted Period") unless it is a contact that is included among certain statutory exceptions set forth in State Finance Law §139-j(3)(a).

Offerors responding to this RFP must familiarize themselves with these State Finance Law requirements and will be expected to affirm that they understand and agree to comply on the Proposal Form.

4.2 PROCUREMENT SCHEDULE

The Owner will make every effort to adhere to the schedule below. However, the Owner reserves the right, at its sole discretion, to adjust the RFP Schedule of Events as it deems necessary.

NO Activity Time Date

1 RFP Issued 4/03/2025

2 Pre-Proposal Meeting & Site Visit N/A

3 Deadline for Questions 3:00 PM EST 4/14/2025

4 Questions Answers as an Addendum (if any) 4/16/2025

5 Deadline for Proposal Submission (Proposal Due Date) 2:00 PM EST 4/21/2025

6 Anticipated Award Date 5/20/2025

Right to withdraw proposals expire on the date and time for deadline for proposal submission listed above

4.3 QUESTIONS, INQUIRES, CLARIFICATIONS, REQUESTS FOR INFORMATION

Offerors are expected to promptly review this solicitation, including all of the submittals, exhibits, appendix, and addendum.

If there are any discrepancies, inconsistencies, or omissions, the Offeror shall immediately notify the Purchasing Department.

If the Offeror has questions or requires clarification of the scope of work, the intent, or any aspect of this solicitation, they shall immediately notify the Purchasing Department. All questions, inquiries, clarifications, must be submitted to the

Purchasing Department by the due date identified in the Procurement Schedule.

4.4 ADDENDA

The County may issue addenda to make changes to the RFP, changes to the scope, respond to any questions, or provide clarification to the information stated within the RFP. All written/published addenda shall become part of this RFP and must be included by the Offeror in its proposal. All other communications are unofficial and non-binding.

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GENERAL TERMS OF THIS SOLICITATION

The following terms and conditions apply to this RFP

A. PREPARATION COSTS

All proposal responses and supporting documentation submitted to the County by the Offeror will become the property of the County. The County will not reimburse the

Offeror for any costs associated with the preparation of the response to this RFP.

B. PUBLIC DISCLOSURE REQUIREMENTS

All documents submitted in response to the RFP will become a matter of public record and shall be thereupon considered public records within the state of New York law, for inspection subsequent to the award process. The County will not be responsible for any proprietary information that finds its way to the general public.

Pursuant to New York’s Freedom of Information Law (“FOIL”)

(Public Officers Law, Article 6, Sections 84-90) all government records are presumptively open for public inspection unless specifically exempted from disclosure under FOIL.

Offerors who have a good faith belief that information contained in their Proposal is exempt from disclosure under

FOIL must, at the time of their submission, request the exemption in writing, setting forth the basis for the claimed exemption. In addition, the Offeror must mark each page of its submission claimed to be exempt from disclosure under

FOIL with the following legend: “THE OFFEROR BELIEVES

THAT THIS INFORMATION IS PROTECTED FROM

DISCLOSURE UNDER THE NEW YORK STATE FREEDOM OF

INFORMATION LAW.” Neither the Offeror’s classification of materials as exempt under FOIL, nor the County’s acceptance of Offeror’s Proposal with the claimed exemption(s), should be considered a final determination as to whether the designated materials are exempt from disclosure under FOIL. Any and all determinations as to the propriety of claimed exemptions will be made by the County and/or a court of law in accordance with applicable law.

C. ERRORS OR OMISSIONS

The County will not be liable for any errors or omissions in

Offeror’s proposal.

D. REJECTION OF ALL PROPOSALS

The County expressly reserves the right to reject any or all

Proposals. The County may cancel this RFP at any time. The

County is not responsible for any costs incurred by Offerors in the preparation and presentation of Proposals submitted in response to this RFP.

E. VALIDITY OF PROPOSAL

Proposals submitted in response to this RFP shall be valid for a period of 120 days after the ‘Proposal Due Date’ in Section

5.3.

F. NEGOTIATION

The Owner expressly reserves the right to negotiate with any, all, or none of the Offerors, waive informalities, minor irregularities, and discrepancies, and award a Contract without interviews, discussions, or negotiations.

G. EXECUTION OF CONTRACT

The Bidder, whose proposal has been accepted, shall have a legally authorized representative execute the contract and submit it to the County within ten (10) calendar days of the date of Notice of Award.

H. CANCELLATION CLAUSE

The COUNTY reserves the right to cancel the contract at any time during the contract term by written ten (10) days’ notice mailed to the address of the vendor.

I. CONTRACTUAL CONSIDERATIONS

The selected Contractor must agree to conditions incorporated into the standard contract used by Wayne

County, subject to approval of the County Attorney.

The selected Contractor will enter into a contract with the

County for performance of the work specified in the RFP.

All work obviously necessary for the completion of the contract shall be included in the Contractor’s Proposal.

The Agreement will be governed by the laws of New York

State. The Contractor shall comply with all applicable laws including those regarding labor, discrimination, and equal employment opportunity.

The preparation and submittal of proposals shall be the sole expense of the contractors. The County is a political subdivision of New York State and as such is tax exempt.

J. TERM

The contract period will be one (1) year(s) or as per the consultant’s proposed schedule with the option for three (3) additional one (1) year periods or a date mutually agreed upon by both parties. The final Contract for this project will involve, at a minimum, the terms and conditions set forth in this RFP (including the General Conditions) and may include those reflected in the specific proposal submitted. The content shall be the exclusive source of the proposer's rights and remedies, and shall supersede any and all prior writings, negotiations or agreements of any kind

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4.5 INSURANCE REQUIREMENTS

A. The contractor shall furnish:

a. ACORD Form 25 - Certificate of Insurance to evidence all liability coverages as outlined in the table below.

b. A copy of the applicable Additional Insured endorsement form evidencing the coverage endorsed onto the liability policies as required in the table below.

c. New York State Workers’ Compensation Form C105.2 or New York State Insurance Fund form U26.3 to evidence New York State workers’ compensation coverage.

d. A copy of the applicable Waiver of Subrogation Endorsement Form, evidencing the coverage endorsed onto the Workers’ Compensation policy, either on a specific/schedule or blanket basis.

B. The County of Wayne and its officers, employees, and agents shall be named as Additional Insureds under the liability policies issued for the above coverages.

C. A Waiver of Subrogation in favor of The County of Wayne and its officers, elected officials, employees, and agents shall apply to the Workers’ Compensation policy listed above.

D. If the contractor maintains broader coverage and/or higher limits than the minimums shown in the table, the County requires and shall be entitled to the broader coverage and/or the higher limits. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the County.

E. The County reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances.

F. The per occurrence and aggregate limits for specified coverage shall apply on a per-location or per-project basis.

G. The contractor shall maintain insurance with the required limits above for the duration of this contract. Completed Operations coverage must be maintained and evidenced for at least two (2) years after completion of the project.

H. All certificates of Insurance must be approved by either the Wayne County Attorney or the Self-Insurance Specialist prior to commencing work under the contract.

I. The insurance carriers providing the above coverages shall be licensed to do so in New York State and shall also be rated no lower than "A-" by the most recent Best's Key Rating Guide or Best's Agent's Guide or must be otherwise acceptable to the County Board of Supervisors.

J. It is expressly understood and agreed by the Contractor that the insurance requirements specified above contemplates the use of occurrence liability forms. If claims-made coverage is evidenced to satisfy any of these requirements the contractor shall comply with the following requirements:

a. If the claims-made coverage terms designate a specific retroactive date, the contractor shall maintain a retroactive date which is not later than the earlier of (a) the date of the commencement of the term of this agreement, or (b) the original coverage retroactive date for the Contractor’s first claims-made policy for each and every coverage provided on a claims-made basis.

K. For the duration of this contract or its subsequent renewals, if the retroactive date is advanced or if the policy is non-renewed, cancelled or is otherwise materially changed, the contractor agrees to purchase at its own expense, an Extended Reporting Endorsement. This endorsement must provide for extended reporting period (“Tail” coverage) in compliance with the minimum standards promulgated by the Department of Financial Services (Insurance Department) of the State of the New York as contemplated in Regulation No. 121 (11 NYCRR 73) or its subsequent amendments or revisions.

L. Upon termination of the services provided to the County by the contractor, it is agreed that such claims-made coverage will be maintained without interruption for a period of time equal to the length of any Extended Reporting Period requirement as cited above. If the retroactive date is advanced or if the policy is non-renewed, cancelled, or is otherwise materially changed during this period of time the Contractor agrees to purchase, at its own expense, an Extended Reporting Endorsement that is in compliance with the minimum insurance standards promulgated by the Department of Financial Services (Insurance Department) of the State of the New York as cited above.

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VENDOR CLASSIFICATION: Professional Contract Services

Insurance Type Coverage amount

Commercial General Liability

Each Occur. $1,000,000

Fire Damage/Damage to Rented Premises $50,000

General Agg. $2,000,000

Prod. Comp. Op. $1,000,000

Personal & Adv. Injury $1,000,000

Med. Expense $5,000

Auto Liability

Any Auto OR $1,000,000

Owned $1,000,000

Hired $1,000,000

Non-Owned $1,000,000

Excess/ Umbrella

Aggregate $1,000,000

Professional Liability

Aggregate $3,000,000

Cyber Liability (if applicable)

Each Occur. N/A

Aggregate N/A

Additional Insured on a Primary & Non- Contributory Basis with a Waiver of Subrogation and 30 Days’ Notice of Cancellation or Non- Renewal

General Liability, Auto, Excess & Work Comp (waiver of subrogation)

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Section 5

PROPOSAL FORMS

Proposal Form A Offeror Background Proposal Form B References Proposal Form C Non-Collusion Certification Proposal Form D Certification Regarding Debarment, Suspension, and Responsibility Proposal Form E Certification of Compliance with the Iran

Divestment Act Proposal Form F Certification Regarding Lobbying Proposal Form G Cost Proposal

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PROPOSAL FORM A – OFFEROR BACKGROUND

PROJECT INFORMATION

RFP Number:

Project Name:

OFFEROR INFORMATION

Name of Company:

Web URL:

Address:

Number of Years in Business (Under Current Business Name):

CONTACT INFORMATION

Identify an individual that can be contacted for clarification on this proposal

Name:

Title:

Email:

Telephone:

ADDENDA ACKNOWLEDGEMENT

The Offeror acknowledges receipt of any addenda and has incorporated the requirements of such addenda into their proposal. Failure to identify and sign for all addenda may subject the Offeror to disqualification. The Offeror must list all addenda’s (by number), then initial and date to confirm that you have received and incorporated them into your Proposal. The Offeror may add more rows as necessary

Number Initials & Date Number Initials & Date Number Initials & Date

CRITICAL TEAM MEMBERS

Identification of the critical project team (shown below), which shall be used by Offeror for the duration of the Contract resulting from this RFP. These individuals cannot be removed or replaced, unless requested or approved to do so by the County.

Name of Project Manager

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The Project Manager: this individual shall be the daily single-point-of-contact and the primary point of contact to resolve any issues, clarify cost, clarify schedule, and answer any questions. This individual will be the project lead for the execution of this project for the entire duration of the project.

STATEMENT OF CERTIFICATIONS AND ASSURANCES

The Offeror does, hereby, expressly affirm, declare, confirm, certify, and assure ALL of the following:

1. The Offeror has thoroughly reviewed this RFP, contract documents, including the sample agreement, and all pertinent appendices, exhibits, and attachments include as part thereof, and that we fully understand all elements required for the full completion of the project as defined therein.

2. The Offeror further certifies that, if selected as the successful firm, we will enter into the contract agreement included with this RFP.

3. The prices in his Proposal 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 firms or with any other competitor.

4. The Prices quoted in his Proposal have not been and will not be knowingly disclosed directly or indirectly by respondent to any other firm or competitor prior to the final date and time for submission of such proposal.

5. No attempt has been made or will be made by respondent to induce any other person, partnership, or corporation to submit or not to submit a proposal for the purpose of restricting competition.

6. The Response submitted in response to the RFP shall remain valid for at least 60 days subsequent to the date of the Response opening and thereafter in accordance with any contract pursuant to the RFP.

By signature below, the signatory certifies legal authority to bind the responding entity to the provisions of this RFP and any contract awarded pursuant to it. The Owner may, at its sole discretion and at any time, require evidence documenting the signatory’s authority to be personally bound or to legally bind the responding entity.

DO NOT SIGN THIS DOCUMENT IF YOU ARE NOT LEGALLY

AUTHORIZED TO DO SO BY THE ENTITY RESPONDING TO THIS RFP.

SIGNATURE:

PRINTED NAME:

TITLE:

NAME OF FIRM:

FEDERAL ID NUMBER:

DATE:

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PROPOSAL FORM B – REFERENCES

Vendor must identify three (3) related project in size, complexity, scope, and technical environment in which the Vendor provided similar services. For each project provide the following in the form

Reference # 1

Name of Contact

Contact’s Position

Contacts Company Address

Contact Phone Number

Contact Email Address

Scope of Services

Contract Length

Reference # 2

Name of Contact

Contact’s Position

Contacts Company Address

Contact Phone Number

Contact Email Address

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Reference # 3

Name of Contact

Contact’s Position

Contacts Company Address

Contact Phone Number

Contact Email Address

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PROPOSAL FORM C – NON-COLLUSION CERTIFICATION

By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid, each party thereto certifies to its own organization, under penalty of perjury, that to the best of knowledge and belief:

1. The prices in this bid have been arrived at independently without collusion, consultation communication, or agreement for the purpose 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 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.

The signature of the Bidder to this Bid shall be deemed a specific subscription to the certificate required under

Section 103-d of the General Municipal Law of the State of New York, and the Bidder affirms that the statements herein contained are true under the penalties of perjury.

Sincerely Yours, Bidder:

By:

Signature of Authorized Representative

Title:

Address:

Phone Number:

Date:

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PROPOSAL FORM D – CERTIFICATION REGARDING DEBARMENT,

SUSPENSION, AND RESPONSIBILITY

The undersigned certified, to the best of his/her knowledge and belief, that the Contractor and its principals:

1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency.

2. Have not within a three-year period preceding the proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

3. Are not presently indicted or otherwise criminally or civilly charged by a government entity

(Federal, State or Local) with commission of any of the offenses enumerated in paragraph (2) of this certification; and

4. Have not within a three-year period preceding the Agreement had one or more public transactions

(Federal, State or Local) terminated for cause or default.

Print Name of Contractor:

By:

Signature of Authorized Representative

Print Name:

Title:

Date:

Page | 19

A disclosure statement should be provided by each firm stating whether the firm or employee was (1) ever found guilty of violating any laws, rules, or regulations relating to its services by a court or a Federal or State Agency or (2) was ever involved in any litigation related to its services

Please respond to the following: Within the past five years has the firm or any member been the subject of any of the following: (respond to each question and describe in detail the circumstance of each affirmative answer; attach additional pages if necessary)

A judgment of conviction for any business-related conduct constituting a crime under state or federal law? No Yes

A grant of immunity for any business-related conduct constituting a crime under state or federal law? No Yes

A federal or state suspension or debarment? No Yes

A rejection of any bid for lack of qualification or responsibility? No Yes

A Rejection of any proposed subcontract for lack of qualifications or responsibility? No Yes

Any assessment of liquidated damages under any contract? No Yes

A denial or revocation of prequalification? No Yes

A prevailing wage or supplement payment violation which is deem to be founded? No Yes

A State Labor Law final determination for a violation deemed willful? No Yes

Any criminal conviction concerning formation of, or any business association with, an allegedly false or fraudulent women’s or minority business enterprise? No Yes

Any denial, decertification, revocation or forfeiture of Women’s Business Enterprise or Minority Business Enterprise status? No Yes

A consent order with the NYS Department of Environmental Conservation, or a federal, state or local government enforcement determination involving a violation of federal or state environmental law? No Yes

Any bankruptcy proceeding? No Yes

Any suspension or revocation of any business or professional license? No Yes

Any determination of violations:

Federal, state or local health laws, rules or regulations

Unemployment insurance or workers compensation coverage or claim requirements

Federal, state or local human rights laws No Yes

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PROPOSAL FORM E– CERTIFICATION OF COMPLIANCE WITH THE IRAN

DIVESTMENT ACT

As a result of the Iran Divestment Act of 2012 (the “Act”), Chapter 1 of the 2012 Laws of New York, a new provision has been added to State Finance Law (SFL) §165-a and New York General Municipal Law §103-g, both effective April 12, 2012. Under the Act, the Commissioner of the Office of General Services (OGS) will be developing a list of “persons” who are engaged in “investment activities in Iran” (both are defined terms in the law) (the “Prohibited Entities List”). Pursuant to SFL §165-a (3)(b), the initial list is expected to be issued no later than 120 days after the Act’s effective date at which time will be posted on the OGS website.

By submitting a bid in response to this solicitation or by assuming the responsibility of a Contract awarded hereunder, each Bidder/Contractor, any person signing on behalf of any Bidder/Contractor and any assignee or subcontractor and, in the case of a joint bid, each party thereto, certifies, under penalty of perjury, that once the Prohibited Entities List is posted on the OGS website, that to the best of its knowledge and belief, that each Bidder/Contractor and any subcontractor or assignee is not identified on the Prohibited Entities List created pursuant to SFL §165-a(3)(b).

Additionally, Bidder/Contractor is advised that once the Prohibited Entities List is posted on the OGS Website, any Bidder/Contractor seeking to renew or extend a Contract or assume the responsibility of a Contract awarded in response to this solicitation must certify at the time of the Contract is renewed, extended, or assigned that it is not included on the Prohibited Entities List.

During the term of the Contract, should the County receive information that a Bidder/Contractor is in violation of the above-referenced certification, the County will offer the person or entity an opportunity to respond. If the person or entity fails to demonstrate that he/she/it has ceased engagement in the investment which is in violation of the Act within 90 days after the determination of such violation, then the County shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking compliance, recovering damages, or declaring the Bidder/Contractor in default.

The County reserves the right to reject any bid or request for assignment for a Bidder/Contractor that appears on the Prohibited Entities List prior to the award of a contract and to pursue a responsibility review with respect to any Bidder/Contractor that is awarded a contract and subsequently appears on the Prohibited Entities List.

I, ______________________________________, being duly sworn, deposes and says that he/she is the

________________________________ of the __________________________________ Corporation and that neither the Bidder/Contractor nor any proposed subcontractor is identified on the Prohibited Entities List.

SIGNED

Sworn to before me this ______ Day of _______________, 20__ Notary Public

Page | 21

PROPOSAL FORM F– CERTIFICATION REGARDING LOBBYING

The undersigned certifies, to the best of his or her knowledge and belief, that:

1. No federal appropriated funds have been paid or will be paid, by or on behalf of the Undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.

2. If any funds other than federal appropriated funds have been paid or will be paid to any Person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all* sub-awards at all tiers (including sub-contacts, sub-grants, and Contracts under grants, loans, and cooperative agreements) and that all* sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Grantee/Contractor Organization Program Title

Name of Certifying Official Signature

Date

Page | 22

PROPOSAL FORM G–COST PROPOSAL

Vendor: Phone Number: Email:

SECTION 1 – PROJECT COSTS

The Offeror is required to provide a clear breakdown in this Proposal Form. The Offeror’s Total Project Cost shall include the cost for everything that is necessary to meet the intent of the County as described in this RFP, including, but not limited to: materials, products, labor, subcontractors, suppliers, equipment, applicable taxes, fees, overhead, profits, travel, direct and indirect costs, etc.

Percentage of Revenue Collected:

Is the percentage fixed for four (4) years YES ☐ NO ☐

If No:

Percentage (Year 1):

Percentage (Year 2):

Percentage (Year 3):

Percentage (Year 4):

The undersigned proposes to furnish and deliver the services described in Specifications and its responding Proposal to the County of Wayne, at the prices stated in the Proposal submitted. The individual submitting this Proposal on behalf of the business entity noted above, certifies by their signature below that:

they understand and have complied with the requirements of State Finance Law Sections 139-j and 139-k and will continue to do so throughout the…