TOWN OF WESTFORD

Request for Proposals

26-18

Ambulance Billing and Collection Services

Office of the Town Manager 55 Main Street

Westford, MA 01886

Release Date: May 20, 2026 @ 10:00 AM

Deadline for Questions: May 27, 2026 @ 4:00 PM

Proposal Response Deadline: June 4, 2026 @ 2:00 PM

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OVERVIEW

The Town of Westford is soliciting proposals for ambulance medical billing and collection services. The Town of Westford operates an emergency-only ambulance service that is licensed for both Basic Life Support (BLS) and Advanced Life Support (ALS) services. In the last calendar year, this service performed approximately 2,300 medical calls. These medical calls resulted in approximately 1,900 ambulance transports. The town is seeking proposals for a three-year contract.

SUBMISSION OF PROPOSAL

The emergency ambulance service is operated by the Westford Fire Dept., which provides both Basic Life Support (BLS) and Advanced Life Support (ALS) services. Billing services providers interested in providing the billing/collection service, as set forth in the attached Technical Proposal Specifications, are invited to submit proposals electronically to the Town Manager’s Office no later than 2:00 PM on Wednesday, June 4, 2026.

Proposal Submission Requirements

Non-price (Technical) Proposal (as separate PDF document attached to submission):

• Executive summary, which shall include:

o Acknowledgement that any agreement resulting from this RFP shall be executed using the Town’s Standard Contract, included as Attachment A. If Proposers have questions on this contract, they are strongly encouraged to submit them by the Questions deadline set forth below.

o Acknowledgement that the Proposer has reviewed the minimum evaluation criteria and all of the appropriate sections.

o Acknowledgement that the Proposer has reviewed and will adhere to the Ambulance Billing Policy included in Attachment E.

• Delivery of services plan including, at a minimum, all of the information included in the Technical Proposal Specifications, Statement of Services, and Minimum Qualification Criteria included herein.

• Certifications o Attachment B – Certificate of Tax Compliance and Non-Collusion o Attachment C – Signing Authority (as applicable to corporate form)

Price Proposal (as separate PDF document attached to submission):

• The price proposal will require the fee for the service to be stated as a percentage (%) amount for the actual receipts

Questions Deadline: May 27, 2026 @ 4:00 PM. Questions must be submitted via email to tmaa@westfordma.gov with the subject line “26-1 RFP Ambulance Billing and Collections Services Questions”.

Proposal Due Date: June 4, 2026 @ 2:00 PM

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Submission Method: All proposals must be submitted electronically, in .pdf format, to the Town Manager’s Office via email at tmaa@westfordma.gov with the subject line “26-1 RFP Ambulance Billing and Collections Services Proposal”. Hardcopies will not be accepted. Note Technical Proposal and Price Proposal shall be labeled as such, with Proposer name, and submitted on the same email submission as separate PDF documents. If the non-price proposal contains any price information, the entire proposal shall be rejected as non-responsive.

No proposer may withdraw his/her proposal for a period of thirty (30) days after the date set for the opening thereof. The Town reserves the right to accept or reject, in whole or in part, any or all proposals or take whatever other action may be deemed necessary to be in the best interest of the Town.

Reviewing Period: All proposals meeting the minimum requirements and conditions may be held by the Town of Westford for a period of thirty (30) days from the date of opening proposals, for the purpose of reviewing the proposals and investigating the qualifications of Proposers prior to the awarding of the contract.

Vendor Selection: Following the procedures previously described, the Town of Westford will make a decision regarding selection of the vendor with whom it wishes to enter into a contract.

Proposals will be evaluated upon the basis of the Minimum Qualifications; the Comparative Evaluation Criteria for Selection set forth, prices and other appropriate factors. This may not necessarily be the low bidder.

Award: The Westford Town Manager will make the award of this contract, subject to Select Board approval. The contract shall be awarded to the responsible and responsive proposer submitting the most advantageous proposal, taking into consideration the proposal’s relative merits. The Town of Westford reserves the right to reject any and all proposals or to waive any informality in the proposals, if it appears in the Town’s best interest.

TECHNICAL PROPOSAL SPECIFICATIONS:

The non-price (technical) proposal must contain all information pertaining to the Billing/Collection Service, such as method of billing, transition timetable from the present system to the initiation of billing procedures, application for, and timetable for, the respective applications for provider numbers for Medicare and Blue/Cross Shield and Medicaid (if not already completed by the Town). The proposal must address, at a minimum, each of the issues set forth in the “Request for Proposals” in order to be considered responsive.

The Town of Westford will reject any proposal, which does not respond to each issue in the “Request for Proposals” as non-responsive.

Proposer may correct, modify, or withdraw a proposal by written notice, clearly marked as a correction, modification, or withdrawal, and received electronically by the Town Manager’s Office prior to the time and date for the submission of proposals. Modifications or proposals that are received after the proposal due date and time will not be accepted.

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STATEMENT OF SERVICES

1. Term of Contract

The contract will be for three-year period commencing on July 1, 2026 through June 30, 2029. The contract will have a fixed percentage rate for the three-year period and can be terminated for cause at any time.

2. Collection and Deposits

Per request of the Town of Westford, all checks and cash received by the billing service shall be deposited directly into the bank account specified by the Town Treasurer of Westford. Or the checks and deposits will be deposited by the Town Hall with a copy sent to the billing company. At the expiration of each month, the billing service shall bill the Town of Westford for collection charges due the billing service for the actual collections made that month.

3. Ambulance Fees

The Town of Westford Rate Schedule for ambulance services will serve as the basis for fees charges for ambulance service. (See Attachment D)

4. Expenses

• All expenses directly or indirectly related to the collection of the Town of Westford patient accounts shall be borne by the billing agent.

• Except as otherwise specifically provided herein, the billing service will not incur expenses on behalf of or without the Town of Westford’s prior consent

5. Other

• It is understood that the Town of Westford accepts assignment of Blue Cross/Blue Shield, Medicaid, Medicare or Medicare/Medicaid. Accordingly, the billing service will make the required contractual adjustments when applicable and will be reported on the monthly revenue statement.

• Write-off’s and/or reductions of charges will be handled by the Town of Westford on an abatement basis at their discretion. Requests for abatements or adjustments from patients will be sent to the billing agent, and then sent to the Town of Westford Treasurers Office.

6. Records and Reports

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The billing service will furnish to the Town of Westford the following reports:

a. As applicable, a weekly report of all collections together with a copy of the deposit slip evidencing the deposit to the Town of Westford’s bank account.

b. A monthly recap of reports including an aging report at the end of the month reflecting the balance of open receivables.

c. Commitment listings, listings of write off’s, adjustments credits, and any other report determined necessary to be able to prove the balance from month to month.

d. Must be able to provide the fiscal year revenue in a format that can be uploaded into the Massachusetts Ambulance Services Cost Report Portal so that the town can seek additional Federal funding through the CPE Program.

All records and correspondence relating to the Town of Westford Accounts Receivable and the billing services collection efforts will be available for examination by the Town of Westford or its authorized representative.

7. Miscellaneous

• The billing service will collect accounts receivable of the Town of Westford under the name of Westford Ambulance Service.

• The billing service shall delegate an authorized representative for receiving notices and day-to-day contract administration.

8. Termination

Either party may terminate this agreement at any time upon ninety (90) days written notice of termination to the billing service, and by the billing service on the anniversary of the contract upon ninety (90) days written notice to the Town of Westford. Upon termination of the agreement, for whatever reason, the billing service shall deliver up all records and pertinent correspondence concerning the accounts and collection thereto to the Town of Westford, and the billing service will otherwise cooperate with the Town of Westford or their assignees to affect an orderly transfer of the collection of the Town of Westford’s accounts receivable. If the Town of Westford should terminate this agreement, the billing service shall be entitled to receive from the Town of Westford, any and all commissions due to billing service up to and including the actual date of termination and transfer of accounts receivable, as well as reimbursement from the Town of Westford of all expenses incurred by the billing service which remain unpaid at the date of termination. The billing service must turn over all records and have them delivered to a location designated by the Town of Westford upon termination of the contract.

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9. Provision

The Town of Westford is to provide the billing agency with a copy of the Standard Ambulance Report Form to include the patient’s name, address and the date and time of transport to area hospitals. This form will have the mileage of the call clearly noted to allow the billing service to bill mileage appropriately based on the rate structure outlined.

In addition, Westford ambulance attendants will provide a reasonable effort to gather any additional information such as the responsible insurance company information, date of birth of the patient and any other information that may assist in the billing process.

10. Stipulations

a. The contract shall be governed by and shall be construed in accordance with the law of the Commonwealth of Massachusetts.

b. In the event of any conflict or any inconsistency between the Massachusetts General

Laws, as amended, and the provisions of this contract, the Massachusetts General Laws shall control. If any of the provisions of this agreement are held to be invalid, such provision or provisions shall be deemed stricken from the agreement and at the option of the Town of Westford, the remaining provisions shall remain in full force and effect.

c. The billing service shall hold the Town of Westford free and harmless from all claims, liability and losses caused by the actions or failures to act on the part of the billing service, and the billing service shall fully indemnify the Town of Westford for all such claims, liability and losses should they occur.

d. The billing service shall have Worker’s Compensation Insurance in accordance with the

Massachusetts General Laws Chapter 152, as amended, and the billing service shall furnish the Town of Westford with evidence of this coverage before the execution of the contract.

11. Waiver Handling Policy

Although the Town of Westford wishes to maximize ambulance collections, we do wish to have compassion for those with financial hardship. A strict waiver policy will be formulated by, and administered by, the Town of Westford. Please outline your capabilities in dealing with clients that express hardship. Provide copies of internal policies that you have dealt with or are dealing with presently.

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Terms and Conditions

By signing this proposal, the bidder acknowledges and agrees to the following terms and conditions:

1. This Request for Proposal is governed by the provisions of M. G. L. Chapter 30B.

2. The Town is exempt from the following taxes: sales, excise and Federal transportation.

3. The Town reserves the right to reject any or all bids when the Town determines that it is in the best interest of the Town to do so.

4. The Town will award the contract to the responsible bidder offering the needed service at the best proposal.

5. The vendor shall comply with all applicable Federal, State and Local laws.

6. In performance of this contract, the vendor shall not discriminate on the grounds of race, color, religion, national origin, age or sex, in employment practices or in the selection or retention of subcontractors, and in the procurement of material or rental of equipment. The Town may cancel, terminate or suspend the contract in whole or in part for any violation of this paragraph.

7. The vendor shall not assign, sell, subcontract or otherwise transfer any interest in this contract without prior written consent of the Town.

MINIMUM QUALIFICATION CRITERIA

In addition to addressing each of the items in the Technical Proposal Specifications, the proposer must submit, as part of their non-price proposal, the following minimum qualification criteria: Initial the appropriate response to each criterion and include the required documentation in the Non-Price (technical) proposal.

1. Vendor included letter of transmittal signed by the individual authorized to negotiate for and contractually bind the Contractor, stating that the offer is effective for at least thirty (30) calendar days from the deadline for the submission of proposals.

YES NO

2. Vendor has provided a list of Massachusetts’s municipalities for which the contractor has provided ambulance billing. This list is to include a current name, address, and telephone number of references for the selection committee to access. Any negative information generated by reference check shall be cause sufficient to dismiss the proposal as unacceptable. Negative information that shall be considered grounds to render the proposal unacceptable shall be information that shows the service operated in a fashion that reflected negatively on the community served. Illegal or unethical methods of collection, repeated instances of inappropriate treatment of recipients of the service such as rudeness or any other behavior that generates complaints from the public shall be viewed as negative information.

3. Vendor will provide toll-free number for the Town’s use and for the use by recipients/clients.

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4. Vendor has been a party (as Plaintiff or Defendant) to any lawsuits in the past five years (2021 through the present)

5. Vendor can receive payments directly from customers billed for ambulance services AND can be able to forward collected ambulance receipts on a weekly basis to the location specified by the Town of Westford

6. Vendor is able to provide an interface to work with the town’s billing software

7. Vendor employs Certified Ambulance Coders/Billers to bill Town of Westford Ambulance claims

8. Vendor’s Company is headquartered within the State of Massachusetts

COMPARATIVE EVALUATION CRITERIA

A contractor shall be deemed unacceptable if the minimum evaluation criteria are not met and as a result, as required by law, shall be rejected. However, once it has been determined that the contractor has met all the minimum evacuation criteria, the proposals will be further evaluated by the Town of Westford using the following comparative evaluation criteria. The ratings of the “Highly Advantageous”, “Advantageous”, “Not Advantageous”, and “Unacceptable”, will be used to evaluate the following features of each proposal.

1. Contractor’s computer linkage to billing information and the method of collecting data for billing.

a. Highly Advantageous: Total billing information secured and all necessary forms filled out by the billing service with no charge to operation Westford ambulance attendants.

Attendants having to fill out SARF forms and obtain hospital attendant’s

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b. Advantageous: Access to patient information at the definitive care facility. Westford ambulance attendants having to fill out only the medical forms and secure physicians’ signatures.

c. Not Advantageous: Most billing information to be provided by Westford ambulance attendants.

Attendants having to secure name of insurance carrier and insurance policy numbers.

d. Unacceptable: All billing information to be provided by the Westford ambulance attendants.

2. How many years of experience does your firm have in billing ambulance service?

a. Highly Advantageous: Greater than five years experience.

b. Advantageous: More than three years experience but less than five years experience.

c. Not Advantageous: More than one years experience but less than three years experience.

d. Unacceptable: Less than one year’s experience.

3. Collection percentage: The vendor should provide documentation as proof that they can achieve a collection percentage of between 85% and 95%. The proof should be established by comparison with another municipal ambulance service and that will show a collection percentage and the number of a municipal contact person for reference. (The Town of Westford is interested in a firm with the expertise and efficiency to perform at this level).

a. Highly Advantageous: Two or more municipalities serviced and documented at rate of 90% or greater.

b. Advantageous: At least two municipalities serviced and documented at a rate of 90% collection rate.

c. Not Advantageous: Documentation of a collection percentage of less than 80%.

d. Unacceptable: No documentation of collection percentage.

4. The billing agency will bill directly to carriers as opposed to billing recipients of the service. If clients need to be billed due to a lack of insurance information, the billing agency should be willing to assist in obtaining client information.

a. Highly Advantageous: Process claims to all insurance carriers, automobile insurance, worker’s compensation, homeowner’s insurance, etc.

b. Advantageous: Process Medicare/Medicaid, major carriers and secondary insurance applicable.

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c. Not Advantageous: Process only Medicare and Medicaid and major carrier (i.e. BC/BS)

d. Unacceptable: Process only Medicare and Medicaid claims, mail out others to client.

5. Vendor performs an all-encompassing scope of Ambulance Services billing

a. Highly Advantageous: 50,000 or more ambulance claims billed per year.

b. Advantageous: 25,000 or more ambulance claims billed per year.

c. Not Advantageous: Less than 25,000 ambulance claims billed per year.

d. Unacceptable: Less than 10,000 ambulance claims billed per year.

Attachments:

Attachment A – Town of Westford Standard Contract Attachment B – Required Certifications Attachment C – Signing Authority Certification Attachment D – Current Ambulance Billing Rates Attachment E – Town of Westford Ambulance Billing Policy

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TOWN OF WESTFORD, MASSACHUSETTS

AGREEMENT

THIS AGREEMENT made this ____ day of __________, 20__ by and between the TOWN OF WESTFORD, a municipal corporation duly organized under the laws of Massachusetts and having a usual place of business at 55 Main Street, Westford, MA 01886, hereinafter referred to as the “TOWN”, and ___________________________,[a _____________ corporation] having a usual place of business at ___________________________, hereinafter referred to as the

“CONTRACTOR”.

WITNESSETH:

WHEREAS, the TOWN invited the submission of proposals for the purchase and delivery of ___________________________________________, hereinafter “the Project”; and

WHEREAS, the CONTRACTOR submitted a proposal to perform the work required to complete the Project; and

WHEREAS, the TOWN has decided to award the contract therefor to the CONTRACTOR.

NOW, THEREFORE, the TOWN and the CONTRACTOR agree as follows:

1. CONTRACT DOCUMENTS. The Contract Documents consist of this Agreement, _______________, _______________ and the CONTRACTOR’s Proposal. The Contract Documents constitute the entire Agreement between the parties concerning the work, and all are as fully a part of this Agreement as if attached hereto. If there is any inconsistency between any of the Contract Documents, the terms most favorable to the Town shall govern.

2. THE WORK. The Work consists of providing the services required of the Project, as more fully described in the Contract Documents.

3. TERM OF CONTRACT. This Agreement shall be in effect from ___________and shall expire on _________________, unless terminated earlier pursuant to the terms hereof.

4. COMPENSATION.

A. The TOWN shall pay the CONTRACTOR as full compensation for performance of the Work outlined in Section 2 above in accordance with the payment schedule included herein as Attachment A.

Attachment A - Standard Contract

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B. The acceptance by the CONTRACTOR of final payment for performance of the Work provided herein shall be deemed a release of the TOWN from any and all claims and liabilities under this Agreement.

C. Neither the TOWN’s review, approval or acceptance of, nor payment for performance of any of the Work provided herein shall be construed to operate as a waiver of any rights of the TOWN under the Agreement or any cause of action arising out of the performance of this Agreement.

D. The TOWN shall cancel this Agreement if funds are not appropriated or otherwise made available to support continuation of performance of the Work in any fiscal year succeeding the current fiscal year as required by G.L. c. 30B, sec. 12(c)(3).

5. PAYMENT OF COMPENSATION. The TOWN shall make payments within thirty (30) days after its receipt of a complete and satisfactory written Invoice.

6. LIABILITY OF THE TOWN. The TOWN’s liability hereunder shall be to make all payments when they shall become due, and the TOWN shall be under no further obligation or liability. Nothing in this Agreement shall be construed to render the TOWN or any elected or appointed official or employee of the TOWN, or their successors in office, personally liable for any obligation under this Agreement.

7. INDEPENDENT CONTRACTOR. The CONTRACTOR acknowledges and agrees that it is acting as an independent contractor for all Work and services rendered pursuant to this Agreement, and shall not be considered an employee or agent of the TOWN for any purpose.

8. INDEMNIFICATION. The CONTRACTOR shall indemnify, defend, and hold the TOWN harmless from and against any and all claims, demands, liabilities, actions, causes of actions, costs and expenses, including attorney’s fees, arising out of the CONTRACTOR's breach of this Agreement or the negligence or misconduct of the CONTRACTOR, or the CONTRACTOR's agents or employees. This obligation shall survive the termination or expiration of this Agreement.

9. INSURANCE.

A. The CONTRACTOR shall obtain and maintain during the term of this Agreement the insurance coverage in companies licensed to do business in the Commonwealth of Massachusetts, and acceptable to the TOWN, as set forth below:

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General Liability with liability coverage for personal injury, bodily injury and property damage including Products and Completed Operations with limits not less than $1,000,000 per occurrence and $3,000,000 aggregate. Such insurance shall be written on an occurrence basis. This policy shall provide coverage on a primary and non-contributory basis and should name the Municipality as an "Additional Insured".

Automobile Liability with limits of not less than $1,000,000 covering all owned, non-owned, hired, rented or leased vehicles. The Municipality shall be named as an "Additional Insured".

Workers' Compensation and Employers' Liability Insurance including (i) Workers' Compensation Insurance providing statutory coverage as required by the Commonwealth of Massachusetts, and (ii) Employers' Liability Insurance coverage with limits of not less than $500,000 per accident. Each contractor, subcontractor, and consultant performing work on or about the Premises shall have similar policies covering their employees.

Umbrella Liability of at least $2,000,000 per occurrence with a $2,000,000 Annual Aggregate. The Municipality shall be named as an “Additional Insured”.

B. All policies shall identify the TOWN as an additional insured (except Workers' Compensation) and shall provide that the TOWN shall receive written notification at least 30 days prior to the effective date of any amendment or cancellation. Certificates evidencing all such coverages shall be provided to the TOWN upon the execution of this Agreement. Each such certificate shall specifically refer to this Agreement and shall state that such insurance is as required by this Agreement. Failure to provide or to continue in force such insurance shall be deemed a material breach of this Agreement and shall be grounds for immediate termination.

10. ASSIGNMENT. The CONTRACTOR shall not assign, sublet or otherwise transfer this Agreement, in whole or in part, without the prior written consent of the TOWN, and shall not assign any of the moneys payable under this Agreement, except by and with the written consent of the TOWN.

11. TERMINATION.

A. Termination for Cause. If at any time during the term of this Agreement the TOWN determines that the CONTRACTOR has breached the terms of this Agreement by negligently or incompetently performing the Work, or any part thereof, or by failing to perform the Work in a timely fashion, or by failing to perform the Work to the satisfaction of the TOWN, or by not complying with the direction of the TOWN or its agents, or by otherwise failing to perform this Agreement in accordance with all of its terms and provisions, the TOWN shall notify the CONTRACTOR in writing stating therein the nature of the alleged breach and directing the CONTRACTOR to cure such breach within ten (10) days. The CONTRACTOR specifically agrees that it shall indemnify and hold the TOWN harmless from any loss, damage, cost, charge, expense or claim arising out of or resulting from such

Town of Westford 26-18 Ambulance Billing Services Request for Proposals Page 13 of 22 breach regardless of its knowledge or authorization of the actions resulting in the breach. If the CONTRACTOR fails to cure said breach within ten (10) days, the TOWN may, at its election at any time after the expiration of said ten (10) days, terminate this Agreement by giving written notice thereof to the CONTRACTOR specifying the effective date of the termination. Upon receipt of said notice, the CONTRACTOR shall cease to incur additional expenses in connection with this Agreement. Upon the date specified in said notice, this Agreement shall terminate. Such termination shall not prejudice or waive any rights or action which the TOWN may have against the CONTRACTOR up to the date of such termination, and the CONTRACTOR shall be liable to the TOWN for any amount which it may be required to pay in excess of the compensation provided herein in order to complete the work specified herein in a timely manner. Upon such termination, the CONTRACTOR shall be entitled to compensation for all satisfactory Work completed prior to the termination date, as determined by the TOWN.

B. Termination for Convenience. The TOWN may terminate this Agreement at any time for convenience by providing the CONTRACTOR written notice specifying therein the termination date which shall not be sooner than ten (10) days from the issuance of said notice. Upon receipt of said notice, the CONTRACTOR shall cease to incur additional expenses in connection with this Agreement. Upon such termination, the CONTRACTOR shall be entitled to compensation for all satisfactory Work completed prior to the termination date, as determined by the TOWN, such payment not to exceed the fair value of the services provided hereunder.

12. INSPECTION AND REPORTS. The TOWN shall have the right at any time to inspect the Work of the CONTRACTOR, including the right to enter upon any property owned or occupied by CONTRACTOR, whether situated within or beyond the limits of the TOWN.

Whenever requested, CONTRACTOR shall immediately furnish to the TOWN full and complete written reports of his operation under this Contract in such detail and with such information as the TOWN may request.

13. SUCCESSOR AND ASSIGNS. This Agreement is binding upon the parties hereto, their successors, assigns and legal representatives. Neither the TOWN nor the CONTRACTOR shall assign or transfer any interest in the Agreement without the written consent of the other.

14. COMPLIANCE WITH LAWS. The CONTRACTOR shall comply with all Federal, State and local laws, rules, regulations and orders applicable to the Work provided pursuant to this Agreement, such provisions being incorporated herein by reference, and shall be responsible for obtaining all necessary licenses, permits, and approvals required for the performance of such Work.

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15. NOTICE. Any and all notices, or other communications required or permitted under this Agreement, shall be in writing and delivered by hand or mailed postage prepaid, return receipt requested, by registered or certified mail or by other reputable delivery service, to the parties at the addresses set forth on Page 1 or furnished from time to time in writing hereafter by one party to the other party. Any such notice or correspondence shall be deemed given when so delivered by hand, if so mailed, when deposited with the U.S. Postal Service or, if sent by private overnight or other delivery service, when deposited with such delivery service.

16. SEVERABILITY. If any term or condition of this Agreement or any application thereof shall to any extent be held invalid, illegal or unenforceable by the court of competent jurisdiction, the validity, legality, and enforceability of the remaining terms and conditions of this Agreement shall not be deemed affected thereby unless one or both parties would be substantially or materially prejudiced.

17. GOVERNING LAW. This Agreement shall be governed by, construed and enforced in accordance with the laws of the Commonwealth of Massachusetts and the CONTRACTOR submits to the jurisdiction of any of its appropriate courts for the adjudication of disputes arising out of this Agreement.

18. ENTIRE AGREEMENT. This Agreement, including all documents incorporated herein by reference, constitutes the entire integrated agreement between the parties with respect to the matters described. This Agreement supersedes all prior agreements, negotiations and representations, either written or oral, and it shall not be modified or amended except by a written document executed by the parties hereto.

19. ELECTRONIC SIGNATURES. Each party agrees that the electronic signatures, whether digital or encrypted, of the parties included in this Agreement, if any, are intended to authenticate this writing and to have the same force and effect as manual signatures. The term “electronic signature” means any electronic sound, symbol, or process attached to or logically associated with a record and executed and adopted by a party with the intent to sign such record, including facsimile or email electronic signatures. Without limiting the generality of the foregoing, delivery of an executed counterpart’s signature page of this Agreement, by facsimile, electronic mail in portable document format (.pdf) or by any other electronic means intended to preserve the original graphic and pictorial appearance of a document, has the same effect as delivery of an executed original of this Agreement.

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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day and year first above written.

I certify that an appropriation TOWN OF WESTFORD is available in the amount of this

Contract. By its Town Manager

Town Accountant (Signature)

CONTRACTOR

(Signature)

(Name and Title)

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CERTIFICATIONS REQUIRED BY LAW

You must COMPLETE and SIGN the following certifications. You must also print, at the bottom of this page, the name of the contractor for whom these certifications are submitted.

TAX COMPLIANCE

Pursuant to Chapter 62C of the Massachusetts General Laws, Section 49A(b), I, the undersigned, authorized signatory for the below named contractor, do hereby certify under the pains and penalties of perjury that said contractor has complied with all laws of the Commonwealth of Massachusetts relating to taxes, reporting of employees and contractors, and withholding and remitting child support.

NON-COLLUSION

The undersigned certifies under the penalties of perjury that this bid or response (as applicable) is in all respects bona fide, fair and made without collusion or fraud with any other person. As used in this subsection the word "person'' shall mean any natural person, joint venture, partnership, corporation or other business or legal entity.

COMPLETE AND SIGN BELOW:

Authorized Person’s Signature Date

Print Name & Title of Signatory

Name of Contractor

Attachment B - Required Certifications

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CERTIFICATE OF CORPORATE AUTHORITY

At a duly authorized meeting of the Board of Directors of ________________________ (Name of Corporation) held on _________________ it was VOTED that:

(Date)

(Name) (Title) of this corporation, be and he/she hereby is authorized to submit bids and proposals, execute contracts, deeds and bonds in the name and on behalf of said corporation, and affix its corporate seal thereto; and such execution of any contract, deed or obligation in this corporation's name on its behalf by such _________________________ under seal of the company, shall be valid and binding upon this corporation.

A True Copy, ATTEST: _____________________________________

TITLE: _______________________________________

PLACE OF BUSINESS: _________________________

DATE OF THIS CERTIFICATE: __________________

I hereby certify that I am the clerk of the _____________________________ (Corporation) that _________________________ is the duly elected ________________________ of (Name) (Title) said corporation, and that the above vote has not been amended or rescinded and remains in full force and effect as of the date of this Certification.

(Clerk)

CORPORATE SEAL:

241362/kope/0003

Attachment C - Signing Authority Certification

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, MASSACHUSETTS

LLC Certificate of Incumbency and Authority

, LLC

I, , do hereby certify that:

1. I am the duly elected and acting of LLC, a limited liability company organized and existing in good standing under the laws of the State of (the “Company”).

2. Attached hereto as Exhibit A is a true and correct copy of resolutions which were duly adopted by the members of the Company on , 20 .

3. The attached resolutions have not been amended, rescinded or modified and are in full forces and effect on the date hereof in the form originally adopted, and are in conformity with the Articles of Organization and Operating Agreement of the Company.

4. Attached hereto as Exhibit B is a true and correct copy of the Articles of Organization dated

, 20___ and the Operating Agreement dated , 20___.

5. The attached Articles of Organization and Operating Agreement have not been amended, rescinded, or modified and are in full forces and effect on the date hereof.

6. The following person are the Authorized Officers of the Company in the capacities indicated, and the signatures set forth after their names and titles are their true and genuine signatures.

Name Office Signature

Witness, my signature and the seal of the Company this day of , 20__.

Name:

Title:

844378/90002/0047

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ATTACHMENT D

FY26 CURRENT AMBULANCE BILLING RATES

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ATTACHMENT E

Town of Westford 26-18 Ambulance Billing Services Request for Proposals Page 21 of 22

Town of Westford 26-18 Ambulance Billing Services Request for Proposals Page 22 of 22