Tuolumne County Ambulance Services

Request For Proposal (RFP #RFP-2025-0101)

Tuolumne County

Public Health Department

Issued: Friday, December 19, 2025

REQUEST FOR PROPOSAL (RFP No. RFP-

2025-0101)

TUOLUMNE COUNTY AMBULANCE SERVICES

Deadline for Submission of Proposals: Friday, February 13, RESPONSES MUST BE SUBMITTED ELECTRONICALLY TO:

https://procurement.opengov.com/portal/tuolumnecountyca

Table of Contents

1. Introduction

2. Scope of Services

3. Minimum Qualifications

4. Proposal Package Requirements

5. RFP Process

6. Evaluation of Proposals

7. Contract Information

Attachments:

A - Attachment 1 - Definitions

B - Attachment 2 - Pricing Proposal

C - Attachment 3 - Contractor Report Card

1. Introduction

1.1. Summary

The County of Tuolumne, through its Health and Human Services Agency, Emergency Medical

Services (EMS) Agency, hereinafter referred to as “County,” is requesting proposals from qualified organizations to provide personnel and management to operate the Tuolumne County

Ambulance Service (TCAS). The County is authorized to plan and implement an EMS system as provided under California Health and Safety Code, Section 1797.200 et seq. TCAS serves as the provider of ground ambulance services for the County.

The County intends to award one contract to a successful applicant to provide personnel and management for operating TCAS subject to the performance standards and other specifications herein. California and federal laws provide specific employment restrictions for retirees and/or current County employees that desire to contract with the County.

For CalPERS retirees: if the work performed by an employee of the contractor is the same or similar to work performed as an active employee or is work that is performed by active employees, it is most likely subject to the California Public Employee’s Retirement System

(CalPERS) retired annuitant restrictions, meaning the inclusion of said individual(s) is disallowed and the person cannot work within the County.

For current County employees: California and federal law prohibit a current employee from contracting with its employer while being an active employee. If an employee is interested in becoming an independent contractor, the employee must consider separation from employment with the County, however, should the employee retire, he/she may be subject to the CalPERS retired annuitant laws. Should a current County employee respond to an RFP while in active employment status, the employee must separate from employment prior to award of the contract.

No County time is allowed to be used to prepare for or work on a response to a County RFP.

1.2. Background

The County is a rural, "foothill" county located in the central eastern section of California, covering a large geographical area of 2,235 square miles. The population is most heavily concentrated along the Highway 108 corridor, with significant differences in climate zones and ease of transportation access. Based on the U.S. Census Bureau, the population was 55,620 in

2020. The primary service area represents all incorporated and unincorporated areas of the

County as detailed in this RFP.

TCAS provides emergency and non-emergency medical transport services within the County, excluding the portion within Yosemite National Park. On occasion, TCAS provides mutual aid outside the County as requested. TCAS has served this community for over 35 years through a public/private partnership with an ambulance company, responsible for ambulance staffing and daily operations since 1987. The contracted provider employs approximately 60 full-time and part-time paramedics and Emergency Medical Technicians (EMTs), responding to approximately

8,200 calls per year. These include Advanced Life Support (ALS), Basic Life Support (BLS), Critical Care Transport (CCT), and non-transport responses. CCT is performed using an ALS or

BLS ambulance and critical care staff from the local hospital or in partnership with the air ambulance provider; there is no expectation that the Contractor will provide nurses.

Currently, there are six (6) ALS ambulances available 24/7, stationed in Jamestown, Sonora, East Sonora, Soulsbyville/Mono Vista, and Groveland. The Groveland ambulance is maintained through a special tax that South County voters have supported for the last 35 years. This funding supports a 24/7 ALS ambulance service in Groveland where there is insufficient transport revenue to cover its expense. The County maintains a reserve fleet of ambulances used for covering maintenance needs as well as non-emergency transfers, extended fire standbys, special events, and can be called into active duty during periods of high call volume. In addition, County-provided safety cars have been used on occasion for appropriate behavioral health transfers, but are not included in this contract at this time. For reference, please see the map below for the five stations within the County:

In fiscal year 2024-25, TCAS completed 8,259 calls for service. For comparison, see the table below for call volume over the last four years. The decrease in call volume is related to the outsourcing of BLS interfacility transports (IFT) to a BLS ambulance service.

Year Call

Volume

2021-22 8,833

2022-23 8,602

2023-24 8,467

2024-25 8,259

A high percentage of BLS IFT involves behavioral health patients. Due to the increasing volume of these calls over the years, a significant portion has been sub-contracted to a private ambulance provider, which reduced the County's transport volume and associated revenue. In 2024, there were 155 BLS behavioral health transports.

EMS dispatch services in the County are coordinated through a funded partnership with the

County Sheriff’s Department, which operates the County’s central dispatch center. In 2019, the

County implemented Emergency Medical Dispatch (EMD). All dispatchers are certified in

EMD, enabling them to assess the nature and severity of medical emergencies, prioritize calls, and determine the appropriate level of response.

To support the financial sustainability of the EMS system, the County employs fiscal technicians who manage medical and ambulance billing (e.g., standby, special events, etc.) and oversee reimbursements through the Ambulance Enterprise Fund. This fund not only covers dispatch-related expenses but also supports vehicle purchases and maintenance, equipment needs, provider contracts, ambulance station acquisition and maintenance, and other operational costs.

1.3. Contact Information

Nick Olson

Staff Services Analyst

20111 Cedar Rd N

Sonora, CA 95370

Email: nolson@co.tuolumne.ca.us

Phone: (209) 533-7469

Department:

Public Health Department

Department Head:

Michelle Jachetta

Public Health Director

1.4. Timeline

Release of published RFP December 19, 2025 mailto:nolson@co.tuolumne.ca.us tel:(209)533-7469

Pre-Bidders Conference (Non-

Mandatory)

January 5, 2026, 10:00am

Agenda

Microsoft Teams (see agenda for info)

Deadline for receiving all questions January 9, 2026, 5:00pm

Deadline for Letter of Intent

(WAIVED, no longer mandatory)

January 19, 2026, 5:00pm

Deadline for RFP responses to be received by County

February 13, 2026, 5:00pm

Optional interview presentations by bidders

February 23, 2026

Review Committee evaluates and ranks proposals

February 25, 2026

Notice of contract award (Tentative) February 27, 2026

Commencement of negotiation period March 2, 2026

Deadline for protests/appeals

(Tentative)

March 13, 2026

Board of Supervisor contract approval April 7, 2026

Contract executed (Tentative) April 10, 2026

Contract Implementation July 1, 2026 https://government-project.s3.amazonaws.com/222632/17d943b5-4afa-4887-8020-702103cb0e86_Pre-Bidders_Conference_Agenda.pdf

2. Scope of Services

The County desires to ensure the delivery of high quality 911 ambulance service to include 911 emergency and non-emergent responses as well as medical and behavioral health IFTs from the local hospital to facilities in and outside of the the County to provide for the public health and safety of residents and visitors. Following EMS protocols, BLS ambulances may respond to 911 calls for low acuity service requests. This procurement process is designed as a "level of staffing" effort. Each proposer must state how they intend to maintain, or improve upon, the defined Scope of Services.

2.1. Operations Staffing

A. Describe process for ensuring sufficient field staff for

1. five (5) 24/7 ALS ambulances (currently using a 48/96 schedule)

2. two (2) 12/7 ALS ambulances

3. one (1) 10/7 BLS ambulance maintaining staffing levels through scheduling for vacations, sick calls, etc.

B. Suggest different schedules if they are advantageous for improved coverage and response times for the County's residents and visitors

C. Describe process for activating surge staffing for IFTs, standby events, first responder trainings, and MCIs

D. Describe plan for ensuring sufficient supervisors to cover 24/7 within the County and available to respond to calls

E. Provide an Operations Manager dedicated to TCAS operations (1.0 FTE)

2.2. Clinical and Training

A. Provide a Clinical and Training Manager dedicated to TCAS operations (1.0 FTE)

B. Establish a contracted medical director to oversee field crew CQI and education

C. Manage TCAS CQI program

D. Monitor Key Performance Indicators (KPIs) by person and as a system

E. Provide on-going training to field crews and first responders to improve KPIs

2.3. Administrative

A. Provide sufficient overhead leadership to support the managers assigned to TCAS

B. Complete patient care reports (PCRs) following EMS Policy #620.00

C. Complete billing information with sufficient information within 24 hours of call

D. Conduct semi-annual system call analysis to recommend optimal unit deployment plan

E. Employee mental wellness and resiliency

F. Manage supply, medication, and equipment ordering, prepare work orders, coordinate vehicle needs with fleet services, support equipment maintenance, submit capital purchases to County for approval

G. Provide reports to the County to track performance and contract adherence in a format approved by the County

1. Independent audited financials at the TCAS-level within 120 days of fiscal year end, annually

2. 911 mutual aid, received and given, quarterly

3. Use of mutual aid for IFT report, quarterly

4. Unit-hour-utilization (UHU) by unit, quarterly

5. Continuous Quality Improvement and KPI, quarterly

6. PCR submission compliance, quarterly

7. Summary of patient complaints, quarterly

8. Staffing report, monthly

9. Other reports as deemed necessary by the County

2.4. Dispatch

A. Utilize County Sheriff Communications Center for 9-1-1 ambulance requests

B. Describe approach to provide dispatch services for IFT ambulance requests (e.g., internally, Sheriff Communications)

2.5. Potential Future Services

A. The county is not currently requiring contractors to provide staffing for safety cars for behavioral health transfers. Still, it reserves the right to negotiate with the Contractor for these services in the future.

2.6. County-Provided Services (at no cost to Contractor)

A. Ambulances

B. EMS equipment

C. Disposable medical supplies

D. Ambulance stations

E. 911 dispatch

F. Office space and equipment for the contractor's staff

G. Information technology (e.g., electronic PCR, tablets, computers)

H. Automobile and property insurance

I. Billing Services

J. Communication equipment, including vehicle radios and pagers

3. Minimum Qualifications

All proposers must, at a minimum, meet the following criteria:

• Follow policy and regulatory requirements of the County EMS Agency and the California

Emergency Medical Services Authority (EMSA).

• All ambulance crews must be properly licensed and/or certified, as required by federal, state, and local EMS policies.

• Provide sufficient on and off-site leadership to properly manage all aspects of daily ambulance operations.

• Have experience managing and operating 9-1-1 ambulance services in a comparably sized EMS system or provide local management personnel with this experience.

4. Proposal Package Requirements

Proposals are to be straightforward, clear, concise and responsive to the information requested.

In order for proposals to be considered complete, proposers must provide all requested information. The proposal and appendix shall be formatted with one (1) inch margins, use 11-point or larger font, and saved as a PDF. The budget template is provided in Microsoft Excel and should be submitted in the same format. The proposal and appendix must be less than 200 pages each. Each proposer must submit their response online via Tuolumne County's e-Procurement platform https://procurement.opengov.com/portal/tuolumnecountyca. There will be three required uploads, 1) proposal, 2) appendix, and 3) budget template. Failure of a proposer to meet the requirements may result in disqualification.

1. Letter of Intent

All proposers shall submit a letter of intent by email to Nick Olson at nolson@co.tuolumne.ca.us no later than 5:00pm PST on 1/19/2026. This letter of intent should contain the name of the chief executive officer or equivalent, as well as the full name of the business.

**No file upload is required for this question. The letter of intent should be emailed per the instructions above**

As of 2/2/2026, the County is waiving the letter of intent for all proposers. See Addendum

#2 for more information.

2. Proposal Elements*

A. Statement of Understanding and Approach

▪ An implementation plan that describes in detail (i) the methods, including controls by which your firm or entity manages projects of the type sought by this RFP; (ii) methodology for soliciting and documenting the needs of existing EMS stakeholders; (iii) and any other project management or implementation strategies or techniques that the respondent intends to employ in carrying out the work.

▪ Detailed description of efforts your firm or entity will undertake to achieve client satisfaction and to satisfy the requirements of the "Scope of Services" section.

▪ Detailed description of specific tasks you will require from County staff. Explain what the respective roles of County staff and your staff would be to complete the tasks specified in the Scope of Services.

▪ Proposers are encouraged to provide additional innovative and/or creative approaches for providing the service that will maximize patient-centered, efficient, cost-effective operations or increased performance capabilities. In addition, the County will consider proposals that offer alternative service delivery means and methods for the services desired.

B. Company Information

▪ List the names and addresses and share of ownership of all owners, shareholders, directors, officers, and corporate linkages of the proposer, including "doing business as" names. An organizational chart listing all entities and owners must be provided. If the bidder is a corporation with 30 or more shareholders, provide title, names, and addresses of directors and officers only, and indicate share of ownership held by these individuals.

▪ Provide names and affiliations of all other corporations or entities potentially providing services to this contract.

▪ List all past corporations or businesses related to emergency and non-emergency transportation that any officer has had an interest in for the past five (5) years.

▪ Brief narrative description of organization's holdings together with organizational chart depicting entity's infrastructure including multi-site operations. List all financial interests of the organization or parent organization in other related businesses above $25,000.

▪ Provide a narrative description of 911 ambulance and related services currently provide by the organization and similarities to the County.

▪ Describe the organization's experience in providing paramedic-level 911 ambulance service under a contract serving an area with demographics like those of the County.

▪ The proposal shall identify any litigation (pending or closed) involving the organization or any principal officers thereof, in connection with any performance of service for the last ten years. Mediation or arbitration regarding performance of any contract similar to the Scope of Services, in which the proposer has been involved in, must be included. Explain any medical malpractice suits with a dollar loss (list the actual circumstances, conclusions, and dollar loss) for the last ten years.

▪ List and state the status and/or outcomes of any criminal or civil cases or investigations for Medicare/MediCal statute or contract violations involving the proposer or its personnel.

▪ List and state the status and/or outcomes of any investigations for affirmative action violations involving the proposer and its personnel.

C. Company Personnel

▪ The proposer shall include job descriptions and resumes for all the management team involved in the provision of the Scope of Services. This includes the on-site and off-site management team, managers, dispatch staff (if applicable). Proposals shall indicate the equivalent full-time employee (FTE) hours for TCAS for each position. Bidders must specify which of these personnel will be stationed in the

County vs. off-site. The qualifications of the key personnel are a significant factor in the evaluation process. Personnel based within the County are strongly preferred. Additionally, the proposals shall provide names and qualifications of the field supervisory staff anticipated to support this proposal. The supervisor job description shall require being in the field communicating, educating, observing, conducting outreach to first responders and hospitals, and running calls with EMS crews at least 50 percent of the time. The field supervisors shall always be immediately available to respond to any request by the County or public safety personnel and shall be authorized to represent on behalf of the Contractor until a manager is available.

D. Disclosure o Please disclose any and all past or current business and personal relationships with any current County elected official, appointed official, County employee, or family member of any current County elected official, appointed official, or County employee. Any past or current business relationship may not disqualify the proposer from consideration.

E. Experience

1. Describe contracts entered during the past five years in California regarding

ALS/BLS prehospital delivery of services showing year, type of services, location, call volume, and name and address of contracting agency.

2. Provide details, if any, of any failure, default, problems, or refusal to complete a contract by the proposer.

3. List any vehicle accidents within California that were reportable as defined by state law or insurance company policy that the proposer or its affiliates has been involved with, noting circumstances and fault determined. List accident rate per vehicle and per 100,000 miles driven for the past three years.

4. List any current or potential commitments, which could impact assets, lines of credit, guarantor letters, or otherwise affect the proposer's ability to perform the contract, if awarded.

5. Using the format below, document the number of ambulance transports and responses conducted by the organization in California in any contract or exclusive area with similar expectations, demographics, geographics, or call volume during the past 12 months (maximum of five separate jurisdictions).Call Type Contract 1Contract

2Contract 3Contract 4Contract 5911 EmergencyResponses Transports 9-1-1 Non-

EmergencyResponses Transports Inter-Facility Transports

6. Provide proposer’s annual turnover rates by category of personnel and define turnover and how it is calculated.

7. Provide supporting documentation demonstrating proposer’s current capability to deliver services like those under this procurement.

8. Demonstrate at least five years of experience as a contractor providing ALS ambulance services to a population of over 40,000 residents and approximately 1.5 million tourists annually, or equivalent experience within a single contiguous service area. The contiguous area may span multiple political jurisdictions, including cities, counties, states, or other defined regions.

9. Demonstrate experience providing both 911 ambulance services and IFTs, including

ALS, and BLS levels of care, within a contiguous service area totaling a minimum of

500 unit-hours per week.

10. Demonstrate commitment to maintaining quality personnel through staff recruitment, retention strategies, ongoing training, certification maintenance, and performance evaluation. Describe existing employee wellness programs and what will be implemented locally that will support recruitment, retention, and longevity.

11. Demonstrate ability to provide a high level of clinical performance as measured by past performance at or above the level of staffing and experience as required in this

RFP.

12. Demonstrate expertise in system management, including deployment and resource allocation, coordination with dispatch centers, personnel management, policy and compliance, and vehicle and equipment oversight.

13. Demonstrate ability to provide first response coordination and training.

14.

o 911 ambulance services o IFT ambulance services, including dispatch approach (e.g., if internal for call taking, processing, monitoring) o Approach to field crew recruitment and retention, including comparable compensation and benefits o Management and supervisor positions to ensure 24/7 administrative and operational leadership availability, including location, responsibilities, and time commitment per person o Continuous Quality Improvement (CQI) to meet and exceed KPIs o Ongoing deployment plan monitoring and recommendations o Procedures for managing fatigue, wellness, and scheduling gaps, including mandatory time off o Processes for ensuring proper documentation of patient charting and billing information o Additional operational requirements necessary to support consistent and high-quality ambulance service delivery

F. Workforce Compensation Package and Working ConditionsThe County encourages proposers to demonstrate how their wages, benefits, shift schedules, and expected productivity will attract and retain experienced personnel, especially existing employed paramedics and EMTs in the County. The Contractor shall devise a wage and benefit package to encourage personnel to remain within the EMS system, reduce the turnover rate, and meet all applicable state and federal laws (e.g., Fair Labor Standards Act). At least 51 percent of field staff must be full-time employees and not part-time or contracted. Workplace injuries should be mitigated through training, education, and supervision. Describe the steps taken to minimize physical and mental injuries in the workplace.

Note: Wages and benefits are significant areas of review for this RFP. At a minimum, the proposer shall provide a specific personnel plan which compensates personnel commensurate with area expectations, and which produces low attrition. Wages should be structured to recognize multi-cultural capability equal with the needs of the County.

The Contractor shall supply multi-cultural sensitivity training to its employees.

1. Incumbent Work Force: Proposers shall note that the handling of the incumbent workforce is a significant factor in the rating of proposals. A preference to currently employed EMTs and paramedics in the County shall be given by proposers.

Additional hirings should prioritize hiring from County residents to increase surge capacity. Interviews shall be offered to existing supervisors. Proposals shall provide specific plans to this effort. As this subject is an important aspect of the analysis of proposals, plans for a smooth transition of the workforce must be detailed.

Proposer must meet with the incumbent workforce’s recognized employee organization or official representative to review and discuss the salary scales, benefits package, and working conditions of the incumbent workforce. There will also be a request and review of any other existing collective bargaining agreements for ambulance service employees in the region. To the extent allowed by law, proposer shall provide for the recruitment, and preservation of the seniority status, of the incumbent workforce. The successful proposer will be required to certify compliance of these points prior to the Contract award.

a. Workload Management, Employee Wellness, and Scheduling Practices: The proposal shall describe its approach to ensuring staff mental wellness. This shall include workload management, mental health, and post-traumatic stress disorder

(PTSD) avoidance. The proposal should include examples of existing programs at other locations, proposed programs locally, maximum UHU for 24-hour units, and the planned expenditures in the budget file. Proposals shall describe their approach to avoiding fatigue and mandatory overtime, including the use of part-time employees, and other measures. The safety of the workforce and patients is crucial; this is of utmost importance and proposers are recommended to provide a comprehensive response for employee wellness.

At a minimum, the proposer must agree to schedule staff with at least eight hours of rest between shifts. No employee shall work more than 50% longer than the original scheduled shift without a fatigue assessment. Contractor shall have and enforce an operational policy to ensure that the staff is always rested and response ready, regardless of shift length and/or work schedule. The policy shall also describe an effective fatigue assessment. Contractor's policy shall include a mechanism for on-duty staff to be relieved from response duties if fatigued.

b. Training Programs: Contractor shall furnish, in-house or by approved subcontract, an in-service training program plan which will allow field personnel to meet the State of California recertification, or licensing requirements. This shall include leadership development, personnel management/life skills, etc.

LinkedIn Learning platform is one example. Proposers should describe their approaches to encouraging attendance at Base Hospital continuing education opportunities (see EMS Policy #501.00). Contractor shall ensure 100% of all personnel assigned to shifts within the County attend all mandatory training and educational offerings. All field personnel shall be certified at the ICS 100 and 200 levels within six months of the start of the contract.

c. Supervisors and Managers: Describe any employment consideration provided to existing supervisors or managers within the new organization, and at what level, to preserve the level of expertise within the County. All supervisors and managers shall be trained at the ICS 100-400 levels within six months of the start of the contract.

G. Commitment for Clinical Quality / Innovation o Commitment to Clinical Quality: The proposer shall prepare a CQI plan meeting the standards consistent with the California Code of Regulations title 22, Chapter 12, Section 100400, and the California EMS Authority System Model Guidelines. The plan shall describe:

• new hire training and orientation;

• a management philosophy and approach focused on achieving an environment of continuous improvement and innovation;

• continuous learning and development of staff and management;

• service to all internal and external EMS providers and customers;

• commitment to participate and contribute to the County CQI process; and

• commitment to cooperate with system research.

The plan shall include internal mechanisms such as: Contractor medical director, CQI manager, CQI committee structure and process, prospective training and education efforts, concurrent and retrospective review, establishment of performance indicators and development of personnel performance improvement plans, personnel development, problem identification, needs assessment, education/compliance remediation, problem resolution, and the documentation and tracking of implementation strategies and outcomes.

(a) Required interfaces

- County EMS Agency

- Receiving Hospital

- First Responder Agencies

- Communications Center

- County Health and Human Services Agency, including Public Health, Behavioral

Health, and Social Services

- Law Enforcement Agencies

- Attendance and participation in all County committees relating to EMS

Additionally, this program shall include the following elements:

(b) Patient Rights

The Bidder shall include a policy on the client/patient rights which shall, at a minimum, provide the following:

- fast, effective medical treatment and transportation to the most appropriate facility or a facility of their choice as per County EMS Policy 530, regardless of ability to pay;

- full information regarding the immediate treatment needed with the right to refuse any treatment or service;

confidential treatment of medical records;

- listening to patients during or after transport and answering all questions kindly and promptly;

retention of patient records and patient access to their records.

Note: Copies of these policies shall be described in the Bidder’s proposal.

o Performance Measures: As part of service delivery, the County seeks to improve patient outcomes by identifying, monitoring, and implementing data-driven, clinically proven performance measures. (see Contractor Report Card, Attachment 3.) Describe proposer’s current efforts and results to implement clinical quality improvements that have increased performance measures.

The County is considering “System Vital Signs” across all aspects of prehospital care

(e.g., bystander efforts, dispatch, first responders, hospitals) to assess the effectiveness of the EMS system. The Contractor is expected to participate in the data gathering and implementation to accomplish this goal.

It is expected that the Contractor will play a vital role improving the overall EMS system clinical standards through meeting and exceeding the KPIs. The Contractor’s medical director shall have the necessary emergency medicine experience to support the LEMSA medical director’s clinical policies and oversee a strong clinical program with excellent care review and field crew education.

o Innovation: The EMS stakeholders are committed to constantly reviewing and improving EMS services for the community. Proposer shall describe its role in other operations providing innovation and striving to meet the needs of the community.

Ultimately, the EMS system must do what is right for the patient and the selected provider will be a critical partner in that endeavor.

At a minimum, the Contractor shall agree to partner with the County and its EMS stakeholders to review and improve the EMS system. As other best practices are implemented locally, Contractor shall agree to share information and support these programs. This includes being an active participant with any EMS innovation committees established by the County and its EMS stakeholders. If a program has an impact on Contractor revenue, such as a decrease in unit hours, Contractor agrees to collaborate with the County for a “net zero” change in revenue margin.

H. References: The proposal must demonstrate that the proposer, or its key personnel, has the minimum experience required, and that the business has a legally registered business name that provides services of a similar type and scope to those described in the Scope of

Services.

The proposer shall provide up to five (5) references within the past 5 years of clients for whom services have been performed that are comparable in quality and scope to those specified in this RFP. The references shall include client names, telephone numbers, and email addresses for whom prior work was performed and include an explanation of the services provided, along with contract dates.

1. References

a. Agreements and contracts

b. Proposer's local and/or national reputation as a Contractor of ALS service

c. Clinical performance as an ALS Contractor

d. Quality Assurance/Improvement program effectiveness

e. Chute, on-scene, and hospital off-load time performance

f. Communications control center operations

g. Relationships with first responder agencies

h. Relationships with emergency departments and hospitals

i. Relationship with labor organizations

2. Letters of Reference

a. The proposer must provide letters from any EMS regulatory agencies (maximum of five [5] where it provides similar services) stating whether it has been in substantial compliance with their contract standards for the last two years.

b. List at least one hospital emergency department and two public safety agencies

(i.e., fire department, law enforcement agencies, park rangers, etc.) with which the organization has worked during the past year, and which shall serve as references.

c. Note: Letters of reference must include the following:

i. Be signed and dated by the author.

ii. Fully disclose any direct or indirect business or financial relationship between the author or organization and the bidder.

iii. Describe the extend to which the author/organization is familiar with the bidder and the bidder's work/performance.

d. Note: Letters of reference will not be supplied by County staff.

**Please submit your complete proposal here**

*Response required

3. Performance Standards

Clinical Performance

The County staff and EMS stakeholders are strong proponents of the Institute for Healthcare

Improvement (IHI) focus on the “Triple Aim” – 1) improving the patient experience of care

(including quality and satisfaction); 2) improving the health of populations; and 3) reducing the per capita cost of health care. As such, there is significant importance in providing a high level of patient care beyond arriving at the patient’s side in a timely manner. Clinical research indicates this may be more important than the speed of the response. Therefore, the LEMSA Medical

Director has identified key performance indicators that affect the patient’s likelihood of a positive outcome. The LEMSA has identified benchmarks that indicate a well-functioning EMS transport provider. These criteria and benchmarks are based on standards set by data-driven research and/or respected EMS organizations. Each criterion must meet three factors to be included; it shall be 1) measurable by the system, 2) manageable by the provider, and 3) meaningful to the patient.

Attachment 3 (Contractor Report Card) contains the proposed Contractor report card key performance indicators and expected standard benchmarks. The LEMSA Medical Director and

Administrator may revise the included criteria and related standard benchmarks quarterly as clinical research, and other factors determine the optimal care path and customer-service experience for EMS patients.

A comprehensive PCR review is expected to identify individual and overall opportunities for clinical treatment improvement. All high acuity calls (e.g., heart attack, ST-elevation myocardial infarction [STEMI], stroke, trauma) shall have 20-30 percent random chart review. Similarly, 20-

30 percent of non-transports resulting in against medical advice (AMA) or release at scene

(RAS), shall be reviewed. Five percent (5%) of the remaining charts shall be randomly audited.

The expected number of PCRs to be reviewed by the Contractor staff shall be a minimum of 50 per month; this number may be adjusted if the review process can be more automated. The results of the audit will be summarized monthly and shared with the Contract Administrator in a pre-approved format. This level of care review is expected to drive training and education and improve overall patient care.

The Contractor shall receive a quarterly sliding-scale incentive based on its performance.

Clinical Compliance Incentive

90.00%+ 1.5%

80.00% – 89.99% 1.0%

70.00% – 79.99% 0.5%

60.00% - 69.99% 0.0%

50.00% - 59.99% -0.5%

40.00% - 49.99% -1.0%

< 40.00% -1.5%

Billing Information Completeness

Collecting complete billing information increases revenue and reduces billing delays. The

County values a partner who can support its needs to collect the relevant information at the time of transport completion. As such, the Contractor is incentivized to ensure that field crews complete this task. The following items must be captured for each transport (or billable treat-and-release call) to be considered acceptable.

• Hospital face sheet

• Patient home address

• Patient insurance information

• Physician Certification Statement (PCS) for IFT

The Contractor shall receive a quarterly sliding-scale incentive based on its performance.

Billing Compliance Incentive

90.00%+ 1.5%

80.00% – 89.99% 1.0%

70.00% – 79.99% 0.5%

60.00% - 69.99% 0.0%

50.00% - 59.99% -0.5%

40.00% - 49.99% -1.0%

< 40.00% -1.5%

Note: Calculated as number of properly completed

PCRs / total PCRs

Interfacility Transports

The County has a single hospital, which requires a significant number of patients to be transported outside the County for definitive care. Because these patients’ needs cannot be met locally, it is important that they are transported timely to another hospital with the services needed. The Contractor shall work with the existing resources and hospital staff to adequately meet the patient’s needs. IFTs are expected to be completed based on the chart below (for complete detail, see EMS Policy #315).

Call Type Response Time Standard

Emergency Immediate (treat as 911)

Urgent 30 minutes

Routine 1 hour

Non-urgent 4 hours

If the Contractor cannot meet these response times, it may elect to request mutual aid from other ambulance providers authorized to transport patients from the County. These requests should be minimal and not exceed 5.00% of total IFTs on a quarterly basis. For each IFT completed by an alternate transport provider exceeding 5.00% on a quarterly basis, the Contractor shall be fined

$1,000/call to compensate for the County’s loss of revenue.

IFT Mutual Aid Penalty

> 5.00% $1,000/call

Due to the burden of long-distance IFTs on the contractor and field crews, an incentive is provided. For each IFT that has a destination outside the County, the contractor will receive

$100/call, paid on a quarterly basis. The proposer should explain how it plans to use this incentive to increase field crew satisfaction for these calls. This incentive may be billed to the

County for reimbursement.

Long-Distance IFT Incentive

Destination outside the County $100/call

Automobile Liability

The County has agreed to assume automobile liability insurance for this contract, for all County-owned vehicles. However, if there is an accident that is determined to be the fault of the

Contractor’s employee, the Contractor shall be responsible for paying the deductible on the claim.

Vehicle

Accident

Deductible

If “at-fault” $25,000/crash

**No document upload is required for this question, it is only intended to provide additional information to bidders**

4. Proposal Cost*

The County manages ambulance billing and utilizes the resulting revenue to support operations, including compensating the Contractor for services outlined in the Scope of Services. The

County requires all bidders to present detailed costs by budget category, clearly identifying all costs and any associated assumptions that drive its hourly unit rate. The County will pay the

Contractor monthly for actual unit hours deployed in the prior month. Should there be a need to adjust unit hours or add other services (e.g., safety cars) to better match service requests, each bidder shall describe how it will approach discussions and negotiations with the County.

Proposer shall upload the Pricing Proposal (see Attachment 2). Information should include all costs associated with the fulfillment of the Scope of Services.

*Response required

5. RFP Process

5.1. Submittal of Proposals

Sealed proposals must be received online, NO LATER THAN 5:00 pm on Friday, February 13, 2026.

Proposals are to be submitted electronically using Tuolumne County’s e-Procurement platform, https://procurement.opengov.com/portal/tuolumnecountyca. Proposals will be received only through this platform. Proposals shall not be submitted via hard copy, (hand delivered or mailed), facsimile, nor via email. It is the sole responsibility of the proposer to properly upload its proposal so that it is received by the time and date required. Any proposal received after said time and/or date or in any other format other than as instructed herein, cannot be considered and will not be accepted. The County’s e-Procurement Platform records the time stamp for every proposal submitted properly in the system. Once a proposal is submitted in the e-procurement platform, the Proposer will receive an email confirmation, and the proposal status will also show as “submitted.”

5.2. Submitter's Questions

Questions regarding the RFP must be submitted exclusively in writing to the County by 5:00 pm on Friday, January 9, 2026 via the County’s e-Procurement platform, in the Q&A tab. Except for questions that might render the award of this contract invalid, the County will not respond to any questions submitted after this time. The County will use an addendum to the RFP to post any questions received, along with written responses, on Tuolumne County's e-Procurement platform, https://procurement.opengov.com/portal/tuolumnecountyca. It is the responsibility of the proposers to check the County website to review the questions and responses. Any oral responses to questions are not binding on the County.

5.3. Cost of Developing the Proposal

All costs incurred in the preparation of a proposal are the responsibility of each proposer and will not be reimbursed by the County.

5.4. Proposal Terms and Conditions

It is the responsibility of each proposer to be familiar with all of the specifications, terms and conditions of the RFP. By the submission of a proposal, the proposer certifies that if awarded a contract, proposer will make no claim against the County based upon ignorance of or misunderstanding of the specifications.

Each proposer shall submit its proposal with the understanding that the proposal will become a part of the official file on this matter and shall be subject to disclosure, if requested by a member of the public, following the completion of negotiations.

By submitting a proposal, each proposer certifies that all statements in this proposal are true.

This constitutes a warranty, the falsity of which shall include the right, at the County’s option, of declaring any contract made, as a result thereof, null and void. Proposals shall be completed, executed, and submitted in accordance with the instructions of this RFP. If a proposal is not submitted in the format specified in this RFP, it may be rejected, unless the County determines that the nonconformity is either a minor irregularity or that the defect or variation in the proposal is immaterial or inconsequential. The County may give the proposer an opportunity to cure any deficiency resulting from a minor irregularity or an immaterial or inconsequential defect, or

County may waive such deficiency, whichever is most advantageous to the County.

The County cannot accept proposals from any individual who is currently employed with the

County of Tuolumne (California Government Code §29708).

5.5. Successful Proposal as Part of Contract Services

Proposals received in response to this solicitation, at the County’s discretion, may be incorporated into the awarded contract and may serve as basic terms and conditions for the ultimate contract. Therefore, proposers are advised that, if successful, they will be held responsible for levels of services proposed at the funding levels quoted. The County reserves the right to negotiate modifications or revisions to any awarded contract.

5.6. Evaluation of Proposals

See #Evaluation of Proposals.

5.7. Other Requirements

In order to contract with the County of Tuolumne, a proposer must meet the following requirements:

• Make available to the County its federal Tax Identification Number (TIN) or Social

Security Number (SSN).

• Comply with all Federal, State and local rules, regulations and policies, including but not limited to:

o Standard contract language of the County; and, o Insurance coverage to include worker’s compensation, general liability, auto liability and professional liability, unless waived by the County.

• Meet the requirements for audit of its expenditures if required in the above documents.

5.8. Non-Discrimination

Non-Discrimination: The Contractor selected through this RFP shall provide services without discrimination based on race, creed, color, ethnic or linguistic identification, gender or sexual preference, disability or handicap or any other basis prohibited by law.

5.9. Protest/Appeal Process

The following procedure is provided in the event that a proposer wishes to protest the RFP process or appeal the recommendation to award a contract for Tuolumne County Ambulance

Services once the Notices of Award/Non-Award have been issued.

https://procurement.opengov.com/portal/tuolumnecountyca/projects/222632/document?section=2098917

Any protest must be submitted in writing to Public Health Department, 20111 Cedar Rd N, Sonora, CA 95370, Attention: Nick Olson

The protest must be submitted before 5:00 p.m. of the tenth (10th) business day following the date of the Notice of Award.

The protest must contain a complete statement of the basis for the protest. The protest must include the name, address, telephone number and e-mail address of the person representing the protesting party.

The procedure and time limits are mandatory and are the proposer’s sole and exclusive remedy in the event of a bid protest.

Proposer’s failure to comply with these procedures shall constitute a waiver of any right to further pursue the protest, including filing a Government Code claim or legal proceedings.

Upon receipt of written protest/appeal, the Health & Human Services Agency Director or designee will review and provide an opportunity to settle the protest/appeal by mutual agreement, will schedule a meeting to discuss or issue a written response to advise of an appeal/protest decision within five (5) business days of receipt of the appeal/protest.

5.10. Public Records Access

Proposers should be aware that submitted proposals are subject to the California Public Records

Act and may be disclosed to members of the public upon request. It is the responsibility of the proposers to clearly identify information in their proposals that they consider to be confidential under the California Public Records Act. To the extent that the County agrees with that designation, such information will be held in confidence whenever possible. All other information will be considered public.

All information regarding the proposals will be held as confidential until such time as the

Review Committee has completed its evaluation and, or if, contract negotiations are complete.

5.11. Letter of Intent

All proposers shall submit a letter of intent by email to Nick Olson at nolson@co.tuolumne.ca.us. This letter of intent should contain the name of the chief executive officer or equivalent, as well as the full name of the business.

As of 2/2/2026, the County is waiving the letter of intent for all proposers. See Addendum

#2 for more information.

6. Evaluation of Proposals

The objective is to perform a thorough and fair evaluation of submitted proposals and facilitate the selection of a contractor/consultant that best satisfies the County’s requirements. The following describes the evaluation process and associated components.

A. Selection Process:

1. The County shall name, for the purpose of evaluating the proposals for this RFP, a

Review Committee composed of representatives chosen by the County. The County may also elect to include as part of the Review Committee qualified representatives from other agencies or entities.

2. The Review Committee may include non-evaluating subject matter experts from

Tuolumne County, including, but not limited to, County Public Health executive, County Administrative executive, (non-bidding) public safety representative, local hospital representatives, and other technical consultants as may be appropriate.

Subject matter experts will not evaluate the proposals, and they will only provide local expertise as requested by the Review Committee members to fully appreciate the benefits or weaknesses of any specific proposal components. Non-evaluating subject matter experts must keep all information and discussions confidential.

3. Proposal documentation requirements set forth in this RFP are designed to provide guidance to proposers concerning the type of information that will be used by the

Review Committee. Proposers shall be prepared to respond to requests by the Review

Committee for additional items deemed necessary to assist in the evaluation process.

B. Conflict of Interest: All Review Committee members, advisory group members, subject matter experts, and other parties involved with evaluating proposals shall be carefully screened by the County for potential conflicts of interest. Each evaluation participant must complete a disclosure statement on the issue of conflict of interest. The County shall evaluate any identified potential source of conflict. Those potential evaluation participants with a material conflict of interest, as determined by the County, will not be allowed to participate in the evaluation process.

C. Evaluation Criteria & Scoring:

1. The Review Committee shall be responsible for performing the evaluations of each proposal. Each member of the Committee shall rate the proposers separately. The scores of each of the Committee members shall then be averaged to provide a total score for each of the proposers.

2. All proposals must specify capabilities to meet or exceed the specified minimum standards identified in this RFP. Each proposal must provide enough information to demonstrate that the Bidder and their management team have the credentials, experience, scope of service, and financial capabilities for this Contract to complete an initial screening and evaluation process. Each member of the Review Committee, except the non-evaluating subject matter experts, shall evaluate individual proposals.

3. The Review Committee may request the bidders to present. Every Bidder will be allowed forty-five (45) minutes of…