Third_Party_Billing_Service_for_Emergency_Medical_Services.pdf

For more information, please visit our online supplier portal, located at https://procurement.opengov.com/portal/pennsauken

RFP No.2026-RFP-04

THIRD PARTY BILLING SERVICE FOR EMERGENCY MEDICAL

SERVICES

RELEASE DATE: March 20, 2026

RESPONSE DEADLINE: April 24, 2026, 10:00 am

Please refer to the project timeline in this document for all important deadlines.

#2026-RFP-04

Title: Third Party Billing Service for Emergency Medical Services

Table Of Contents

1. NOTICE TO PROPOSERS

2. REQUEST FOR PROPOSALS

3. DESCRIPTION OF SERVICE

4. TERMS OF CONTRACT

5. METHOD OF AWARD

6. TRUTH IN CONTRACTING

7. ADDENDA

8. ASSIGNMENT OF CONTRACT

9. INSURANCE

10. MANDATORY AFFIRMATIVE ACTION LANGUAGE

11. NEW JERSEY BUSINESS REGISTRATION REQUIREMENTS

12. STOCKHOLDERS DISCLOSURE

13. PURCHASE ORDER REQUIREMENTS

14. Americans with Disabilities Act of 1990

15. DISCLOSURE OF CONTRIBUTIONS

16. PRICING PROPOSAL

17. EVALUATION CRITERA

18. VENDOR QUESTIONNAIRE

19. ATTACHMENTS

NOTICE TO PROPOSERS

1. PROPOSALS: Sealed proposals for the following: Third Party Billing Service for Emergency Medical

Services for the Township of Pennsauken will be received at 10:00 am on Friday, April 24, 2026 at which time proposals will be opened via the OpenGov Procurement Portal. Proposals will not be accepted after the specified time. All proposals shall be submitted through the https://procurement.opengov.com/portal/pennsauken. Proposals will be publicly posted on the OpenGov eProcurement portal.

The Township Committee and its Solicitor will be the sole discretionary body for consideration or rejection of the proposals.

2. SPECIFICATIONS: Specifications and the RFP for “Third Party Billing Service for Emergency

Medical Services” can be downloaded from https://procurement.opengov.com/portal/pennsauken.

3. AFFIRMATIVE ACTION REGULATIONS: Proposers are required to comply with the requirements of N.J.S.A. 10:5-31 and N.J.A.C. 17:27 et seq.

Sinead Rider

Purchasing Agent

Township of Pennsauken

REQUEST FOR PROPOSALS

The Pennsauken Township, NJ , is soliciting proposals for Third Party Billing Service for Emergency Medical

Services. Proposals are to be submitted via the Township's eProcurement Portal via https://procurement.opengov.com/portal/pennsauken PRIOR TO 10:00 am on Friday, April 24, 2026. Late proposals will not be accepted.

Project work includes to obtain proposals from qualified contractors to act as the third-party billing service for

Emergency Medical Services as outlined.

DESCRIPTION OF SERVICE

Open-end Contract

Pennsauken has attempted to identify the estimated numbers of calls to cover its requirements; however, experience shows that the number of actual calls may be different than that submitted for proposal purposes.

Background

Pennsauken realized over $1.4 million (net billing agency expense) of gross revenue in 2025. Total calls for service were 7,648 calls (not all billable). For Township of Pennsauken residents, worker comp injuries at local businesses and Pennsauken Township employees, there shall be no further collection effort after insurance payment is received.

Prior to contract award, the Pennsauken Township reserves the right to visit the contractor’s business location to help determine the contractor’s ability to perform the services as required.

Subcontracting any portion of the contract is strictly prohibited.

Proposal pricing shall be based on a percentage of funds collected (not billed). If the Township of

Pennsaukenwishes to cancel an individual charge, the successful contractor shall cease billing and receive no payment for that account.

Required Reports

Upon request, the following items will be made available at our request and at no charge.:

Standard Customer Reports

Billing Account Status Reports (30,60,90-day status)

Patient Summary Reports Collection Reports

Billing Receivables Reports Contractor Reports

Closed Accounts Reports Open Account Reports

Billing A/R Reconciliation Reports Medicare/Medicaid Reports

NJ Quarterly Trip Statistic Reports ALS Billing to Hospitals

Aged Accounts Receivable Adjustment Report

Write-Off Analysis Pending Bills Reports

The above will be on a calendar month and calendar year basis and in a format deemed acceptable to the

Township of Pennsauken.

In addition, Collection Reports shall be supplied bi-weekly and provide the following information on collections received:

Source of monies that were received and year of service:

Insurance payments, medical or commercial, with company name

Medicare payments

Individual Payments

Source of any other payments

Annual Reports as required to comply with the Township of Pennsauken’s Annual Audit.

Samples of all reports are required to be submitted with all proposals.

All correspondence/invoices shall indicate that all payments shall be made payable to the Township of

Pennsauken.

The Township of Pennsauken shall select the banking institution to be utilized for the deposit of all checks. Only the Township of Pennsauken shall be authorized to withdraw monies from said account.

The Township of Pennsauken requires copies of all checks received for services rendered. All funds collected must be deposited within 48 hours in accordance with state law.

The successful contractor shall be responsible for any additional reports which may be required by the

Township of Pennsauken in a format acceptable to the Township of Pennsauken.

Other Requirements

The successful contractor shall be responsible for all costs of this service, including the costs of printing all ambulance call sheets and required forms for each call.

Certify compatibility of billing software with emsCharts (or other electronic patient care reporting software) as specified by the Township of Pennsauken.

Seven (7) years of records must be maintained for audit purposes by Medicare or any other agency (including the Township of Pennsauken).

Electronic filing for Medicare, NJ Medicaid and commercial insurance companies is a requirement.

This claim processing is not to be confused with collection of bad debts. At least three (3) collection attempts shall be made, with a written record of same maintained. If a claim has not been paid within thirty (30) days, the contractor shall be required to contact the respective insurance carrier to determine the status of the claim. In addition, the contractor shall send a notice to the patient informing him that thirty (30) days has passed since the billing, that the bill has not been paid by the insurance carrier, and that the patient should contact his insurance carrier as soon as possible to resolve the outstanding obligation.

If said claim has not been paid within sixty (60) days, the contractor shall be required to contact the respective insurance carrier to determine the status of the claim. In addition, the contractor shall send a notice to the patient informing him that sixty (60) days has passed since the billing and that the bill has not been paid by the insurance carrier as soon as possible to resolve this outstanding obligation. If said claim is not paid in thirty (30) days of this notice, the bill in the full amount shall then become the full responsibility of the patient.

After 3 unsuccessful attempts within a reasonable time, the successful contractor shall return all non-collected billing amounts to the Township of Pennsauken Fire Department, with no claim for payment against the

Township of Pennsauken for the costs involved in the attempt to collect the funds. At a minimum, quarterly reports shall be provided.

The successful contractor shall provide a toll-free long distance as well as a local telephone number in order to provide responses to patient’s questions regarding services rendered and charges billed. Contractor office staff will be adequate in size, well-trained and qualified to answer patient’s questions and experienced in dealing with an older population. Contractor is responsible for picking up or paying for overnight delivery of ambulance call sheets at least once weekly.

The contractor shall furnish with his proposal a full description of the handling of incomplete data from the

Township of Pennsauken, denied claims, partial reimbursements by payer type, undeliverable mail and accounts in arrears.

The contractor shall furnish with their proposal a full description of their policies and procedures for the protection of the confidentiality of the entire Township of Pennsauken’s records in his possession.

All documents and reports shall remain the property of Township of Pennsauken and shall be remitted to the

Township of Pennsauken upon request.

If directed by the Township of Pennsauken, the successful contractor shall be required to have the accounts audited by the Township of Pennsauken’s auditor. This audit shall be performed annually with compliance reviews on a need-to-be basis that may take place after completion of the contract year. All costs associated with this portion of the contract shall be the sole responsibility of the Township of Pennsauken.

The contractor fully complies with all applicable requirements of the Health Insurance Portability and

Accountability Act of 1996, P.L.104-191 (HIPAA)

Confidentiality - the contractor will abide by all written confidentiality requirements of the Township of

Pennsauken. The contractor shall be considered as a Business Associate of the Township of Pennsauken as defined by the Privacy Regulations promulgated under the Health Insurance Portability and Accountability Act of 1996. The contractor shall notify the Township of Pennsauken of any known or potential violations of the

Privacy Regulations as well as Privacy Related Polices and Procedures of the Township of Pennsauken. All financial, medical and other personal information supplied to the Contractor are confidential. The Contractor is required to use reasonable care to protect the confidentiality of information. Any use, sale or offering of this information in any form by the Contractor, or any individual or entity in the Contractor’s charge or employ, will be considered a violation of the Agreement and may result in termination of the Agreement. In addition, such conduct may be reported for possible criminal prosecution.

The Contractor shall agree to indemnify and hold harmless the Township of Pennsauken, its employees, officers and directors for any and all claims or damages resulting from any breach of confidentiality regarding insurance, health, or personal information of any party.

The Contractor shall have all employees sign a written confidentiality agreement.

Contractor acknowledges that it follows a specified Accounts Receivable Process. The intended process is to be described in comprehensive fashion in response to this RFP solicitation. The process shall include all dunning schedules, collections placement, denial management, case posting and the provisions for program. Successful

Contractor warrants that he will follow this process with his best efforts. Township of Pennsauken reserves the right to audit this process on a quarterly basis or randomly as determined by Township of Pennsauken. If it is determined based on the audit that the Accounts Receivable Process is not followed with substantial compliance with the requirements of the contract (as reasonably determined by the Township of Pennsauken), the

Contractor shall have thirty (30) days to correct identified deficiencies. If after thirty (30) days the process deficiency is not corrected to the satisfaction of the Township of Pennsauken, the rate charged to the Township of Pennsauken shall be reduced by one half of one (0.5 %) percent for the three (3) month period following the audit. The Township of Pennsauken reserves the right to execute the audit process throughout the term of any executed agreement and for the one hundred and twenty (120) days follow up period after termination of any executed agreement. Repeated failures to comply with this “substantial compliance” requirement will be considered grounds for termination of the agreement that the successful Contractor shall enter into.

TERMS OF CONTRACT

The term of this contract shall be 3 years with option to renew for one 2-year renewal.

If, through any cause, the successful contractor shall fail in a timely and proper manner obligations under this contract or if the contractor shall violate any of the requirements of this contract, the Township of Pennsauken shall thereupon have the right to terminate this contract by giving written notice to the contractor of such termination and specifying the effective date of termination. Such termination shall relieve the Township of

Pennsauken of any obligation for balances to the contractor of any sum or sums set forth in the contract.

METHOD OF AWARD

Methodolgy

The methodology for awarding this competitive contract shall be based on an evaluation and ranking including a weighting of criteria. Proposals will be evaluated and ranked by the Qualified Purchasing Agent, using the predetermined section evaluation weighting. A report will be issued with a recommendation which shall be made public at least 48 hours prior to the Governing Body awarding or rejecting the proposal.

The initial term award of the contract will be a minimum of three (3) years. There will be an optional extension period of one (1) two (2) year term at the option of the Township of Pennsauken, and agreement of the Bidder.

All prices and amounts must be completed through the online pricing table.

TRUTH IN CONTRACTING

Truth in Contracting Laws:

1. NJSA 2C:21-34, et seq. governs false claims and representations by the bidder. It is a serious crime for the bidder to knowingly submit a false claim and/or knowingly make material misrepresentations. The statutes state the following penalties for these crimes at:

A. Under $2,500, 18 months in prison and a $10,000 fine;

B. Between $2,500 and $25,000, 3 to 5 years in prison and a $15,000 fine;

C. Over $25,000, 5 to 10 years in prison and a $150,000 fine.

2. NJSA 2C:27-10 provides that a person commits a crime if said person offers a benefit to a public servant for an official act performed or to be performed by a public servant, which is a violation of official duty.

3. NJSA 2C:27-11 provides that a bidder commits a crime if said person, directly or indirectly, confers or agrees to confer any benefit not allowed by law to a public servant.

4. Bidder should consult the statutes or legal counsel for further information.

ADDENDA

Interpretation and Addenda

1. The contractor understands and agrees that its proposal is submitted on the basis of the specifications prepared by the TOWNSHIP OF PENNSAUKEN. The contractor accepts the obligation to become familiar with these specifications.

2. Contractors are expected to examine the specifications and related documents with care and observe all their requirements. Ambiguities, errors or omissions noted by them should be promptly reported in writing to the appropriate official. In the event the bidder fails to notify the TOWNSHIP OF

PENNSAUKEN of such ambiguities, errors or omissions, the bidder shall be bound by the proposal.

3. No oral interpretation of the meaning of the specifications will be made to any contractor. Every request for an interpretation shall be in writing, addressed to the TOWNSHIP OF PENNSAUKEN'S representative stipulated in the proposal. In order to be given consideration; written requests for interpretation must be received at least ten (10) days prior to the date fixed for the opening of proposals.

Any and all such interpretations and any supplemental instructions will be in the form of written addenda to the specifications, and will be distributed to all prospective contractors, in accordance with

N.J.S.A. 40A: 11-23. The TOWNSHIP OF PENNSAUKEN'S interpretations or corrections thereof shall be final.

4. Indemnification: Successful contractor will indemnify and hold harmless the TOWNSHIP OF

PENNSAUKEN from all claims, suits or actions and damages or costs of every name and description to which the TOWNSHIP OF PENNSAUKEN may be subjected or put by reason of bodily injury to the person or property of another, or the property of the TOWNSHIP OF PENNSAUKEN resulting from negligent acts or omission on the part of the bidder, the contractor's agents, servants or subcontractors in the delivery of materials and supplies, or in the performance of the work under this agreement.

ASSIGNMENT OF CONTRACT

The successful contractor shall not assign, transfer, convey, sublet or otherwise dispose of the contract or any part thereof to anyone without the written consent of the Township of Pennsauken.

INSURANCE

Applicable insurance certificates must be furnished by the successful bidder with the contract naming the

Township of Pennsauken as additionally insured and certificate holder, upon request, and/or as more particularly set forth herein on the attached Certificate of Insurance and Insurance Coverage Requirements pages. The vendor shall submit their Certificate of Insurance to the Township upon intent of award.

MANDATORY AFFIRMATIVE ACTION LANGUAGE

No firm may be issued a contract unless it complies with the affirmative action regulations of N.J.S.A. 10:5-31 et seq. (P.L. 1975, c.127)

a. Goods and Services (including professional services) Contracts - All successful contractors must submit, within seven (7) days after the receipt of the notice of intent to award the contract or the receipt of the contract, one of the following:

1. A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned affirmative action program (good for one year from the date of the letter), or

2. A photocopy of their approved Certificate of Employee Information report, or

3. If the contractor has none of the above, the public agency is required to provide the contractor with an initial Affirmative Action Employee Information Report (AA-30).

NEW JERSEY BUSINESS REGISTRATION REQUIREMENTS

In accordance with N.J.S.A. 52:32-44 proposers may provide with their proposal a Business Registration

Certificate issued by the State of New Jersey. Contractors are required to be registered at the time of submittal. A Business Registration Certificate must be provided prior to award.

N.J.S.A. 52:32-44 imposes the following requirements on contractors and all subcontractors that knowingly provide goods or perform services for a contractor fulfilling this contract:

1. The contractor shall provide written notice to its subcontractors and suppliers to submit proof of business registration to the contractor;

2. Subcontractors through all tiers of a project must provide written notice to their subcontractors and suppliers to submit proof of business registration and subcontractors shall collect such proofs of business registration and maintain them on file;

3. Prior to receipt of final payment from a contracting agency, a contractor must submit to the contracting agency an accurate list of all subcontractors and suppliers and the proof of business registration or attest that no subcontractors were used;

4. During the term of this contract, the contractor and its affiliates shall collect and remit, and shall notify all subcontractors and their affiliates that they must collect and remit, to the Director, New Jersey

Division of Taxation, the use tax due pursuant to the Sales and Use Tax Act, (N.J.S.A 54:32B-1 et seq.)

on all sales of tangible personal property delivered into this State.

A contractor, subcontractor or supplier who fails to provide proof of business registration or provides false business registration information shall be liable to a penalty of $25 for each day of violation, not to exceed

$50,000 for each business registration not provided or maintained under a contract with a contracting agency. Information on the law and its requirements are available by calling 609-292-9292.

STOCKHOLDERS DISCLOSURE

If proposer is a corporation or partnership, there must accompany its proposal, a statement setting forth the names and addresses of all stockholders in the corporation or partnership who own ten (10%) percent, or more of its stock, of any class, or of all individual partners in the partnership who own a ten (10%) percent or greater interest therein. If one or more stockholders or partnership, the stockholders holding ten (10%) percent or more of that corporation’s stock, or the individual partner owning ten (10%) percent, or greater interest in that partnership, must be set forth as aforesaid.

All proposers shall comply with the act relating to a disclosure statement to conflict of interest as per P.L., 1977, c.33, and shall submit the completed and signed disclosure statement as attached. Failure to submit this information may be cause for the rejection of the proposal, at the option of the Township.

PURCHASE ORDER REQUIREMENTS

No work shall be performed, services rendered or material provided by the successful proposer unless a proper purchase order number has been issued by the Township of Pennsauken.

Requests for payment of goods or services delivered shall be made on Township of Pennsauken vouchers with copies of supplier’s invoices attached which shall specify the quantity, description, unit and extended prices of each item delivered. Payments shall not be provided on a frequency less than a monthly basis after services are rendered and vouchers are timely submitted for review and processing.

Americans with Disabilities Act of 1990

Equal Opportunity for Individuals with Disability

The contractor and the Township of Pennsauken, (hereafter “owner”) do hereby agree that the provisions of

Title 11 of the Americans With Disabilities Act of 1990 (the "Act") (42 U.S.C. S121 01 et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs, and activities provided or made available by public entities, and the rules and regulations promulgated pursuant there unto, are made a part of this contract. In providing any aid, benefit, or service on behalf of the owner pursuant to this contract, the contractor agrees that the performance shall be in strict compliance with the Act. In the event that the contractor, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the contractor shall defend the owner in any action or administrative proceeding commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the owner, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or damages, of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The contractor shall, at its own expense, appear, defend, and pay any and all charges for legal services and any and all costs and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the owner’s grievance procedure, the contractor agrees to abide by any decision of the owner which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the owner, or if the owner incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the contractor shall satisfy and discharge the same at its own expense.

The owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor along with full and complete particulars of the claim, If any action or administrative proceeding is brought against the owner or any of its agents, servants, and employees, the owner shall expeditiously forward or have forwarded to the contractor every demand, complaint, notice, summons, pleading, or other process received by the owner or its representatives.

It is expressly agreed and understood that any approval by the owner of the services provided by the contractor pursuant to this contract will not relieve the contractor of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the owner pursuant to this paragraph.

It is further agreed and understood that the owner assumes no obligation to indemnify or save harmless the contractor, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the contractor’s obligations assumed in this

Agreement, nor shall they be construed to relieve the contractor from any liability, nor preclude the owner from taking any other actions available to it under any other provisions of the Agreement or otherwise at law.

DISCLOSURE OF CONTRIBUTIONS

Starting in January 2007, all business entities are advised of their responsibility to file an annual disclosure statement of political contributions with the New Jersey Election Law Enforcement Commission (ELEC) pursuant to N.J.S.A. 19:44A-20.27 if they receive contracts in excess of $50,000 from public entities in a calendar year. Business entities are responsible for determining if filing is necessary. Additional information on this requirement is available from ELEC at 888-313-3532 or at www.elec.state.nj.us.

PRICING PROPOSAL

Bidder shall enter their pricing percentage for each year.

SERVICE COST AS A PERCENTAGE OF FUNDS COLLECTED (NOT BILLED)

INITIAL TERM OF 3 YEARS WITH OPTIONAL 2 YEARS

Line Item Description Unit of Measure Percentage

1 YEAR 1 Monthly

2 YEAR 2 Monthly

3 YEAR 3 Monthly

4 YEAR 4 OPTIONAL Monthly

5 YEAR 5 OPTIONAL Monthly

EVALUATION CRITERA

The following, as applicable to this RFP, shall be used as criteria for evaluating requests for proposals (RFPs) under the competitive contracting process described in N.J.S.A. 40A:11-4.1 et seq. The section weighting will be announced after the proposal opening.

No. Evaluation Criteria Scoring Method Weight (Points)

1. TECHNICAL CRITERIA

Proposed methodology:

1. Does the contractor's proposal demonstrate a clear understanding of the scope of work and related objectives?

2. Is the contractor's proposal complete and responsive to the specific RFP requirements?

3. Has the past performance of the contractor's proposed methodology been documented?

4. Does the contractor's proposal use innovative technology and techniques?

5. Are sound environmental practices such as recycling, energy efficiency, and waste reduction used?

0-5 Points 10 (10% of Total)

2. MANAGEMENT CRITERIA

1. Project management:

A. How well does the proposed scheduling timeline meet the contracting unit's needs?

B. Is there a project management plan?

2. History and experience in performing the work:

A. Does the contractor document a record of reliability of timely delivery and on-time and on-budget implementation?

B. Does the contractor demonstrate a track record of service as evidenced by on-time, on-budget, and contract compliance performance?

C. Does the contractor document industry or program experience?

D. Does the contractor have a record of moral integrity?

3. Availability of personnel, facilities, equipment and other resources:

A. To what extent does the contractor rely on in-house resources vs. contracted resources?

B. Are the availability of in-house and contract resources documented?

4. Qualification and experience of personnel:

A. Documentation of experience in performing similar work by employees?

B. Does the contractor make use of business capabilities or initiatives that involve women, the disadvantaged, small and/or

0-5 Points 55 (55% of Total) minority owned business establishments?

C. Does the contractor demonstrate cultural sensitivity in hiring and training staff?

I.

3. COST CRITERIA

1. Cost of goods to be provided or services to be performed:

A. Relative cost: How does the cost compare to other similarly scored proposals?

B. Full explanation: Is the price and its component charges, fees, etc.

adequately explained or documented?

2. Assurances of performance:

A. If required, are suitable bonds, warranties, or guarantees provided?

B. Does the proposal include quality control and assurance programs?

3. Contractor's financial stability and strength:

A. Does the contractor have sufficient financial resources to meet its obligations?

0-5 Points 35 (35% of Total)

VENDOR QUESTIONNAIRE

Stockholder Disclosure Certification*

Please download the below documents, complete, and upload.

• STOCKHOLDER_DISCLOSURE_CERT...

*Response required

Upload the bid guarantee as required by NJSA 40A:11-21.*

*Response required

Bidder acknowledgement of receipt, or not, of addenda.*

☐ Yes

☐ No

*Response required

Sample Certificate of Insurance

Please download the below documents, complete, and upload.

• CERTIFICATE_OF_INSURANCE_-_...

Contractor must provide a State of New Jersey Third Party Billing Registration Certificate to demonstrate compliance with NJSA 17B:27B-1 with the proposal submission.*

*Response required

Certification that no subcontractors will be used for the term of contract awarded.*

☐ Yes

☐ No

*Response required

Upload completed Political Disclosure Document.*

Please download the below documents, complete, and upload.

• 2026_Political_Contribution...

*Response required

TECHNICAL CRITERIA

Technical Proposal (without cost)*

Please provide with your proposal a detailed description of the capabilities of your computer software. Please ensure a description as it relates to the billing process and report generation.

*Response required

Years of experience as third-party billing agency for pre-hospital EMS services.*

*Response required https://government-project.s3.us-west-2.amazonaws.com/153369/31d644c7-9e98-4199-a878-7f47eb2f6dea_STOCKHOLDER_DISCLOSURE_CERTIFICATION.docx?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA47RIURE4NA7J4S3A%2F20260320%2Fus-west-2%2Fs3%2Faws4_request&X-Amz-Date=20260320T123001Z&X-Amz-Expires=72000&X-Amz-Security-Token=IQoJb3JpZ2luX2VjEGsaCXVzLXdlc3QtMiJHMEUCIFWuZQyGmDur7eukUY2ANAfSLk5SnNhv%2FC3N2siobZyoAiEAiI3Qn%2Fhi7NI40Mi9oeJ3pcqU6fq4uWRpINpoXWjeqJUqjAUINBACGgw4OTIzNjQ2ODc2NzIiDDYT7yanXIr7Lpvx6yrpBNky81An1ssZXG6utLKKjmp%2B1h3gZSz3YxANb8b0%2FeV4OOGKVIh3hA0BRsIdPYtbmgzowxrhTMexJngBtTUli0O5TfAV%2Fk1ULOK2Sv8xtHcc5SQWwoWUPwp3fBDwSzzgNno6iDhVJp9FXQsdgwEtG3R0r3RPyv2IMpGoMY29z%2Bh9PJQH7HWDLd4hM6Qu7vIoJ3cr%2FCn4BbxB3aYDgIR5Cw0naptxQL60MPdgsQEEY6VOenC29y8GDckorYiU%2Fe9xnZ%2Fc7RMRS17d2yqi8kk5qfVHLwMuMr2ejB3QibvVbOL3Y%2Fg4NFm2GvrjhGDkqtThEC7EkpWGDJxsEmB7ueKQzxmqCYKMCJCYEgSmJbdIYhL7Xo93z2xNxccugzkBn6vfWEPdJiAJj97%2FitG0DVY2JDwNUwEKlVtaR7EdI3AqyIUlIpry7%2FR6a4YNjP%2BXMrxObJCbDAZoltEjYzi%2FJgpsv6wczWawGQrIyggk6tq%2BHMvofXYoZ0DLUhBocHLXuXstN1U66cGE4fbrRLWHdURKDD9swOIk3ej6zxu1BejBVNPDhj%2BygtP%2FsZA5D5pK%2FVKl1eV1vM5hICDWBKhP1W%2BP1AiVqPCA6VgZunKbCu4ImV6s2HUPWvRU0QzXfdlskr%2BdbqdYFeoGn%2Fbql2Xqt44wJcWnfC3DwkJrjqTj8yOzxKMCBCvcw6DWq5AdCa85clAth1MiYQDjLzLB5woQ%2BFAmEFo6nzbx2Q7sBTe3IRwRJJCLxUAoSu%2Blhei%2BH3GsjpchWNfQZoFiXUEdvbK%2FsMIRytStoPwAdPAi4BZEynW7gphHjhcL8qiEDgvRMJ3W9M0GOpkBxrVg3Sl4SQ8Ei%2FzNS%2BZoPT0KnaT59rExtBbE5YlBo%2FjFhBmYWYogYiwC1qC6iGyy3njEtX%2BzTsvgMb%2F59KiM5zHgYHNrJA7TgAUAF%2B0EsKAQY43gV%2FyIEDkKPVGxFqQukrMNO290UEqdsK00hRueMa%2FSFYrFCcgWEfMBo%2F7ex4klH%2FXt1hdaCy6Pj8%2FMvbdwANpjKtmtl6ap&X-Amz-Signature=edce1684e429f0c0a50b6ac779f81a5ebfeb6ecdb247d93a44396161978d90b4&X-Amz-SignedHeaders=host&response-content-disposition=attachment%3B%20filename%3D%22STOCKHOLDER_DISCLOSURE_CERTIFICATION.docx%22&x-id=GetObject https://government-project.s3.us-west-2.amazonaws.com/153369/96d39516-61c6-4710-b4bc-dd8fefe6f43a_CERTIFICATE_OF_INSURANCE_-_SAMPLE.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA47RIURE4NA7J4S3A%2F20260320%2Fus-west-2%2Fs3%2Faws4_request&X-Amz-Date=20260320T123001Z&X-Amz-Expires=72000&X-Amz-Security-Token=IQoJb3JpZ2luX2VjEGsaCXVzLXdlc3QtMiJHMEUCIFWuZQyGmDur7eukUY2ANAfSLk5SnNhv%2FC3N2siobZyoAiEAiI3Qn%2Fhi7NI40Mi9oeJ3pcqU6fq4uWRpINpoXWjeqJUqjAUINBACGgw4OTIzNjQ2ODc2NzIiDDYT7yanXIr7Lpvx6yrpBNky81An1ssZXG6utLKKjmp%2B1h3gZSz3YxANb8b0%2FeV4OOGKVIh3hA0BRsIdPYtbmgzowxrhTMexJngBtTUli0O5TfAV%2Fk1ULOK2Sv8xtHcc5SQWwoWUPwp3fBDwSzzgNno6iDhVJp9FXQsdgwEtG3R0r3RPyv2IMpGoMY29z%2Bh9PJQH7HWDLd4hM6Qu7vIoJ3cr%2FCn4BbxB3aYDgIR5Cw0naptxQL60MPdgsQEEY6VOenC29y8GDckorYiU%2Fe9xnZ%2Fc7RMRS17d2yqi8kk5qfVHLwMuMr2ejB3QibvVbOL3Y%2Fg4NFm2GvrjhGDkqtThEC7EkpWGDJxsEmB7ueKQzxmqCYKMCJCYEgSmJbdIYhL7Xo93z2xNxccugzkBn6vfWEPdJiAJj97%2FitG0DVY2JDwNUwEKlVtaR7EdI3AqyIUlIpry7%2FR6a4YNjP%2BXMrxObJCbDAZoltEjYzi%2FJgpsv6wczWawGQrIyggk6tq%2BHMvofXYoZ0DLUhBocHLXuXstN1U66cGE4fbrRLWHdURKDD9swOIk3ej6zxu1BejBVNPDhj%2BygtP%2FsZA5D5pK%2FVKl1eV1vM5hICDWBKhP1W%2BP1AiVqPCA6VgZunKbCu4ImV6s2HUPWvRU0QzXfdlskr%2BdbqdYFeoGn%2Fbql2Xqt44wJcWnfC3DwkJrjqTj8yOzxKMCBCvcw6DWq5AdCa85clAth1MiYQDjLzLB5woQ%2BFAmEFo6nzbx2Q7sBTe3IRwRJJCLxUAoSu%2Blhei%2BH3GsjpchWNfQZoFiXUEdvbK%2FsMIRytStoPwAdPAi4BZEynW7gphHjhcL8qiEDgvRMJ3W9M0GOpkBxrVg3Sl4SQ8Ei%2FzNS%2BZoPT0KnaT59rExtBbE5YlBo%2FjFhBmYWYogYiwC1qC6iGyy3njEtX%2BzTsvgMb%2F59KiM5zHgYHNrJA7TgAUAF%2B0EsKAQY43gV%2FyIEDkKPVGxFqQukrMNO290UEqdsK00hRueMa%2FSFYrFCcgWEfMBo%2F7ex4klH%2FXt1hdaCy6Pj8%2FMvbdwANpjKtmtl6ap&X-Amz-Signature=97467bc08f4cae6ecc786c041b14ca3ac6b5e0f24a94146c66c2c1c1d3e5b294&X-Amz-SignedHeaders=host&response-content-disposition=attachment%3B%20filename%3D%22CERTIFICATE_OF_INSURANCE_-_SAMPLE.pdf%22&x-id=GetObject https://government-project.s3.us-west-2.amazonaws.com/244480/89950b63-7c61-4e67-a8a2-826619d8f606_2026_Political_Contribution_Disclosure_Form_-_updated.pdf

Number of third-party pre-hospital EMS billing clients (Provide names)*

*Response required

Years of experience with New Jersey pre-hospital EMS services and demonstrated knowledge and experience with NJ Medicaid and New Jersey Department of Health EMS licensing requirements.*

*Response required

Number of New Jersey third-party pre-hospital billing clients (provide names and contact information). Looking for other local government entities.*

*Response required

Years of experience with Medicare (due to high senior population).*

*Response required

Do you currently have the capability to initiate electronic billing for pre-hospital EMS services to Medicare, NJ

Medicaid, and commercial insurance companies?*

☐ Yes

☐ No

*Response required

MANAGEMENT CRITERIA

Number of toll-free telephone lines.*

*Response required

Number of telephone lines.*

*Response required

Office location, mileage from Township of Pennsauken.*

*Response required

Number of and experience of staff in local office to handle account.*

*Response required

Will you dedicate one full-time person or more to handle Pennsauken’s account (vs. distributing work among entire staff). *

☐ Yes

☐ No

*Response required

Number of days between receipt of call sheet to initiation of billing.*

*Response required

COST CRITERIA

Please provide a copy of the last three (3) years of your company’s annual financial statements.*

Prohibited Russia-Belarus Activities & Iran Investment Activities

Disclosure of Investment of Iran*

Please download the below documents, complete, and upload.

• Disclosure_of_Investment_Ac...

*Response required

Certification of Non-Involvement in Russia or Belarus Pursuant*

Please download the below documents, complete, and upload.

• Disclosure_of_Prohibited_Ac...

https://government-project.s3.us-west-2.amazonaws.com/176096/cf8947bd-c18e-4a4e-b3f9-ed7661d373fa_Disclosure_of_Investment_Activities_in_Iran.pdf https://government-project.s3.us-west-2.amazonaws.com/176096/b7bf8038-9474-4e38-8f0e-5888887ff586_Disclosure_of_Prohibited_Activites_in_Russia_Belarus.pdf