HomeMy WebLinkAboutCity of Tamarac Resolution R-2004-1801
Temp. Reso. #10498
July 6, 2004
Page 1
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2004-15"P
A RESOLUTION OF THE CITY COMMISSION OF THE CITY
OF TAMARAC, FLORIDA AUTHORIZING THE APPROPRIATE
CITY OFFICIALS TO AWARD RFP 04-14R, "MEDICAL
BILLING SERVICES" AND TO EXECUTE AN AGREEMENT
WITH ADVANCED DATA PROCESSING, INC.TO PROVIDE
ADMINISTRATION, PROCESSING AND COLLECTION OF
THE COSTS OF TRANSPORTING EMS PATIENTS ON
BEHALF OF THE CITY OF TAMARAC FIRE RESCUE
DEPARTMENT; PROVIDING FOR CONFLICTS; PROVIDING
FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE
DATE.
WHEREAS, Tamarac Fire Rescue is required to provide basic and advanced life
support services to the citizens and visitors of the City of Tamarac and to properly invoice
and collect fees from the patients who utilize these services; and
WHEREAS, Tamarac Fire Rescue transports an estimated 6,000 patients per year,
which generates an average of approximately $1.6 million in gross revenue annually; and
WHEREAS, the existing contract with Advanced Data Processing, Inc. for medical
billing services will expire on September 30, 2004 with no additional renewals available;
and
WHEREAS, the complexity and accounting requirements of providing these services
require the City to formally solicit competitive sealed proposals; and
WHEREAS, the City publicly advertised RFP 04-14R, "Medical Billing Services" in
the Sun -Sentinel on March 21 and March 28, 2004, a copy of said RFP is attached as
Exhibit 1; and
WHEREAS, proposals were solicited from seven (7) vendors and two (2) proposals
Temp. Reso. #10498
July 6, 2004
Page 2
were received from Advanced Data Processing, Inc. and iLiant Medbill, Inc.; and
WHEREAS, the proposals were evaluated by a Selection and Evaluation Committee
consisting of the Assistant Fire Chief, EMS Chief, Controller, and Management Analyst to
determine responsiveness to the City's specifications; and
WHEREAS, Advanced Data Processing, Inc. was determined to be the highest
ranked, most responsive and responsible vendor based upon the criteria established in the
RFP, as evidenced by Exhibit 2; and
WHEREAS, Advanced Data Processing, Inc. will charge the City seven percent
(7%) of the monthly collections for non -Medicaid accounts, a flat rate of $150.00 per month
for Medicaid accounts and $1.00 per transport to meet HIPAA requirements; and
WHEREAS, Advanced Data Processing, Inc. has agreed to the terms and
conditions of RFP 04-14R and has executed the City's Agreement, as evidenced by Exhibit
3; and
WHEREAS, it is the recommendation of the Fire Chief and Purchasing and
Contracts Manager that RFP 04-14R be awarded to and an agreement executed with
Advanced Data Processing, Inc.; for a three (3) year term effective October 1, 2004
through September 30, 2007 with two (2) additional two-year renewals, for a total contract
term not to exceed seven (7) years; and
WHEREAS, the City Commission deems it to be in the best interest of the citizens
and residents of the City of Tamarac to award RFP 04-14R, "Medical Billing Services" and
to execute an agreement with Advanced Data Processing, Inc., to provide administration,
processing and collection of the costs of transporting EMS patients on behalf of the City of
Tamarac Fire Rescue Department.
Temp. Reso. #10498
July 6, 2004
Page 3
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF TAMARAC, FLORIDA:
SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and confirmed
as being true and correct and are hereby made a specific part of this Resolution upon
adoption hereof.
SECTION 2: the appropriate City officials are hereby authorized to award RFP 04-
14R, "Medical Billing Services" and to execute an agreement with Advanced Data
Processing, Inc. to provide administration, processing and collection of the costs of
transporting EMS patients on behalf of the City of Tamarac Fire Rescue Department.
SECTION 3: All resolutions or parts of resolutions in conflict herewith are HEREBY
repealed to the extent of such conflict.
SECTION 4: If any clause, section, other part or application of this Resolution is
held by any court of competent jurisdiction to be unconstitutional or invalid, in part or
application, it shall not affect the validity of the remaining portions or applications of this
Resolution.
Temp. Reso. #10498
July 6, 2004
Page 4
SECTION 5: This Resolution shall become effective immediately upon its passage
and adoption.
PASSED, ADOPTED AND APPROVED this 25th day of August, 2004.
I_1t20NO
MARION SWENSON, CMC
CITY CLERK
I HEREBY CERTIFY that
I have approved this
RESOLUTION as to form.
l
E SCHREIBER
MAYOR
RECORD OF COMMISSION VOTE:
MAYOR SCHREIBER
DIST 1: COMM. PORTNER
DIST 2: COMM. FLANSBAUMWTALAB
DIST 3: V/M SULTANOF
DIST 4: COMM. ROBERTS
[-I
1
Purchasing and
Contracts Division
March 26, 2004
City of Tamarac
"Committed to Excellence ... Always"
EXHIBIT 1
TR 10468
REQUEST FOR PROPOSALS
RFP 04-14R
ALL QUALIFIED PROPOSERS:
RFP NO. 04-14R
Sealed Proposals, addressed to the Purchasing and Contracts Manager of the City of
Tamarac, Broward County, Florida, will be received in the Purchasing Office, 7525 NW 88th
Avenue, Tamarac, Florida 33321-2401 until 4:00 PM local time, Wednesday, April 28,
2004 for:
MEDICAL BILLING SERVICES
The City is soliciting proposals on behalf of the Tamarac Fire Rescue Department to obtain
the services of a qualified firm for the administration, processing and collection of the costs
of transporting Emergency Medical Services (EMS) patients.
Sealed Proposals must be received and time stamped in the Purchasing Office, either by mail
or hand delivery, on or before the date and time referenced above. Any Proposals received
after 4:00 p.m. on said date will not be accepted under any circumstances. Any uncertainty
regarding the time a Proposal is received will be resolved against the Proposer. Official time
will be measured by the time stamp in the Purchasing Office.
City reserves the right to reject any or all Proposals, to waive any informalities or
irregularities in any Proposals received, to re -advertise for Proposals, to award in whole or
in part to one or more Proposers, or take any other such actions that may be deemed to be
in the best interests of the City.
Proposal documents may be obtained from the Purchasing Office or via the Internet at
hftp://www,tamarac.org/Dept/fin/purch/solicitations.html. For inquiries, contact the
Purchasing Office at (954) 724-2450.
Keith K. Glatz, CPPO
Purchasing and Contracts Manager
Publish Sun -Sentinel: Sunday 3/21 and 3/28/2004
7525 NW 88th Avenue ■ Tamarac, Florida 33321-2401 ■ (954) 724-2450 ■ Fax (954) 724.2408 ■ www,tamarac.org
Equal Opportunity Employer
City of Tamarac P,.irchasirxa & Contracts Division
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REQUEST FOR PROPOSALS
RFP 04-14R
MEDICAL BILLING SERVICES
I. INTRODUCTION
The City is soliciting proposals on behalf of the Tamarac Fire Rescue Department to obtain
the services of a qualified firm to administer, process and collect the costs of transporting
Emergency Medical Services (EMS) patients.
11. INFORMATION
For information pertaining to this Request for Proposals (RFP), contact Purchasing
at (954) 724-2450 or Assistant Fire Chief Paul Forsberg at (954) 724-2528. Such
contact shall be for clarification purposes only. Material changes, if any, to the scope
of services or proposal procedures will be transmitted only by written addendum.
It is preferred that all questions be submitted in writing, either via fax or email. Fax
questions to (954) 724-2408 or email to purchasing(W-tamarac.org.
III. SCHEDULE OF EVENTS
The schedule of events related to this Request for Proposals shall be as follows:
RFP Document issued
March 22, 2004
Deadline for Receipt of Proposals
April 28, 2004
Evaluation of Proposals
May 10, 2004
Presentations by Short-listed Proposers (if applicable)
May 25, 2004
Final Ranking of Firms
May 28, 2004
Anticipated Award by Commission
June 23, 2004
All dates are tentative. City reserves the right to change scheduled dates.
IV. GENERAL TERMS AND CONDITIONS
These General Terms and Conditions apply to all offers made to the City of Tamarac by all
prospective Proposers, including but not limited to, Requests for Quotes, Requests for
Proposal and Requests for Bid. As such the words "bid", "proposal" and "offer' are used
interchangeably in reference to all offers submitted by prospective Proposers. The City of
Tamarac reserves the right to reject any or all proposals, to waive any informalities or
irregularities in any proposals received, to re -advertise for proposals, to enter into contract
negotiations with the selected Proposer or take any other actions that may be deemed to
be in the best interest of the City of Tamarac.
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INSTRUCTIONS TO OFFERORS
STANDARD TERMS AND CONDITIONS
104��
1. DEFINED TERMS
Terms used in these Instructions to Offerors are defined as follows:
1.1. "Offeror'- one who submits a Proposal in response to a solicitation, as distinct
from a Sub -Offeror, who submits a Proposal to the Offeror.
1.2. "Proposer''- one who submits a Proposal in response to a solicitation. The
terms "Offeror" and "Proposer" are used interchangeably and have the same
meaning.
1.3. "Successful Offeror" - the qualified, responsible and responsive Offeror to
whom City (on the basis of City's evaluation as hereinafter provided) makes an
award.
1.4. "City" - the City of Tamarac, a municipal corporation of the State of Florida.
1.5. "Proposal Documents" - the Request for Proposals, Instructions to Offerors,
Offemi's Qualifications Statement, Non -Collusive Affidavit, Certified Resolution,
Vendor Drug -Free Workplace, Offeror's Proposal, Proposal Security and
Specifications, if any, and the proposed Contract Documents (including all
Addenda issued prior to opening of Proposals).
1.6. "Contractor" - the individual(s) or firm(s) to whom the award is made and who
executes the Contract Documents.
2. SPECIAL CONDITIONS
Any and all Special Conditions that may vary from the General Conditions shall have
precedence.
3. EXAMINATION OF CONTRACT DOCUMENTS AND SITE
3.1. Before submitting a Proposal, each Offeror must visit the site (if applicable) to
familiarize himself with the facilities and equipment that may in any manner
affect cost or performance of the work; must consider federal, state and local
laws, ordinances, rules and regulations that may in any manner affect cost or
performance of the work, must carefully compare the Offeror's observations
made during site visits or in review of applicable laws with the Proposal
Documents; and must promptly notify the Purchasing and Contracts Manager of
all conflicts, errors and discrepancies, if any, in the Proposal Documents.
3.2. The Offeror, by and through the submission of a Proposal, agrees that Offeror
shall be held responsible for having examined the facilities and equipment (if
applicable); familiarized himself with the nature and extent of the work and any
local conditions that may affect the work, and is familiar with the equipment,
materials, parts and labor required to successfully perform the work.
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of Tamarac Pur,hasirq 3 Contracts Givisian
4. SCOPE OF WORK
4.1. The apparent silence of the requirements as to any detail, or the apparent
omission of a detailed description concerning any point, shall be regarded as
meaning that only the best commercial practice is to prevail, and that only
material and workmanship of the finest quality is to be used. All interpretations
of the specifications shall be made on the basis of this statement.
4.2. For the purpose of evaluation, the Offeror must indicate any variance or
exceptions to the stated requirements, no matter how slight. Deviations should
be explained in detail. Absence of variations and/or corrections will be
interpreted to mean that the Offeror meets all the requirements in every respect.
5. INTERPRETATIONS AND ADDENDA
If the Offeror is in doubt as to the meaning of any of the Proposal Documents, believes
that the General Conditions, Special Conditions and/or Technical Specifications contain
errors, contradictions or obvious omissions, or has any questions concerning the
information contained in the RFP documents, the Offeror shall submit a written request
to the Purchasing Office for interpretation or clarification. Such request must reference
RFP name and number, and should be received by the Purchasing Office at least ten
(10) calendar days prior to the Proposal opening date. Questions received less than
ten (10) calendar days prior to the Proposal opening may not be answered.
Interpretations or clarifications in response to such questions will be issued in the form
of a written addendum transmitted via either fax or email to all parties recorded by the
Purchasing Office as having received the Proposal Documents. The issuance of a
written addendum shall be the only official method whereby such an interpretation or
clarification will be made.
6. COSTS AND COMPENSATION
6.1. Costs and compensation shall be shown in both unit prices and extensions
whenever applicable. In the event of discrepancies existing between unit prices
and extensions or totals, the unit prices shall govern.
6.2. All costs and compensation shall remain firm and fixed for acceptance for 60
calendar days after the day of the Proposal opening.
6.3. The price proposal shall include all franchise fees, royalties, license fees, etc.,
as well as all costs for transportation or delivery as applicable within the scope
of the solicitation.
7. NON -COLLUSIVE AFFIDAVIT
Each Offeror shall complete the Non -Collusive Affidavit form and shall submit the form
with their Proposal. City considers the failure of the Offeror to submit this document to
be a major irregularity, and may be cause for rejection of the Proposal.
8. PUBLIC ENTITY CRIMES
In accordance with Florida Statutes 287.133 2 a : A person or affiliate who has
been placed on the convicted vendor list following a conviction for public entity crime
may not submit a bid on a contract to provide any goods or services to a public
entity, may not submit a bid on a contract with a public entity for the construction or
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repair of a public building or public work, may not submit bids on leases of real
property to public entity, may not be awarded or perform work as a contractor,
supplier, subcontractor, or consultant under a contract with any public entity, and
may not transact business with any public entity in excess of the threshold amount
provided in Florida Statutes §287.017 for Category Two, for a period of 36 months
from the date of being placed on the convicted vendor list.
CONFLICT OF INTEREST
The award of any contract hereunder is subject to the provisions of Chapter 112,
Florida Statutes. Offerors must disclose with their Proposal the name of any officer,
director, partner, proprietor, associate or agent who is also an officer or employee of
City or any of its agencies. Further, all Offerors must disclose the name of any officer
or employee of City who owns, directly or indirectly, an interest of five percent (5%) or
more in the Offeror's firm or any of its branches or affiliate companies.
PERFORMANCE BONDS AND INSURANCE
Upon award of a contract, the Successful Offeror, as required within the scope of the
solicitation, may be required to submit performance bonds and/or payment bonds.
Offeror shall provide certificates of insurance in the manner, form and amount(s)
specified.
SUMMARY OF DOCUMENTS TO BE SUBMITTED WITH PROPOSALS
The following is a summary of documents to be submitted by each Offeror:
a. Proposal
b. Certification Form
C. Certified Resolution Form (or firm's own Corporate Resolution)
d. Offeror's Qualifications Statement Form
e. Vendor Drug Free Workplace Form
f. Non -Collusive Affidavit Form
g. Proof of applicable insurance
SUBMISSION OF PROPOSALS
12.1. Proposals must be typed or printed in ink. Use of erasable ink is not permitted.
All corrections to prices made by the Offeror must be initialed.
12.2. Proposals must contain a manual signature of a corporate officer or designee
with the proven authority to bind the firm in matters of this nature. The address
and telephone number for any communications regarding the Proposal must be
included.
12.3. Proposals shall contain an acknowledgment of receipt of all addenda.
12.4. Proposals by corporations must be executed in the corporation's legal name by
the President or other corporate officer, accompanied by evidence of authority
to sign. Evidence of authority shall be provided on the enclosed Certified
Resolution form, or by the company's own Corporate Resolution_
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of Tamarac �� Parchasirq & contracts Division
12.5. Proposals by partnerships must be executed in the partnership name and
signed by a partner, whose title must appear under the signature.
12.6. Proposals shall be submitted to the Purchasing Office on or before the time
indicated in the Request for Proposals. Proposals shall be submitted in a sealed
envelope (faxed proposals will not be accepted under any circumstances). The
envelope should be clearly marked on the exterior with the applicable
solicitation name and number. The envelope should state the name and
address of the Offeror and should be include all documents as specified in the
Request for Proposals. Purchasing and Contracts Division staff is not
responsible for the premature opening of a Proposal that is not properly
addressed and identified.
12.7. In accordance with Florida Statutes, Chapter §119.07(1)(a) and except as may
be provided by other applicable state and federal law, the Request for
Proposals and the responses thereto are in the public domain. However,
Proposers are requested to specifically identify in the submitted Proposal any
financial information considered confidential and/or proprietary which may be
considered exempt under Florida Statute §119.07(t).
12.8. All Proposals received from Offerors in response to the Request for Proposals
will become the property of City and will not be returned. In the event of
Contract award, all documentation produced as part of the Contract shall
become the exclusive property of City.
12.9. The Proposer preparing a submittal in response to this RFP shall bear all
expenses associated with its preparation. The Proposer shall prepare a
submittal, with the understanding that no claim for reimbursement shall be
submitted to the City for the expense of proposal preparation and/or
presentation.
13. MODIFICATION AND WITHDRAWAL OF PROPOSALS
13.1. Proposals may be modified or withdrawn by a duly executed document signed
by a corporate officer or other employee with designated signature authority.
Evidence of such authority must accompany the request for withdrawal or
modification. The request must be delivered to the Purchasing Office at any
time prior to the deadline for submitting Proposals. Withdrawal of a Proposal
will not prejudice the rights of an Offeror to submit a new Proposal prior to the
Proposal opening date and time. No Proposal may be withdrawn or modified
after the date of proposal opening has passed.
13.2. If, within twenty-four (24) hours after Proposals are opened, any Offeror files a
duly signed, written notice with the Purchasing Office, and within five (5)
calendar days thereafter demonstrates to the reasonable satisfaction of City, by
clear and convincing evidence, that there was a material and substantial
mistake in the preparation of its Proposal, or that the mistake is clearly evident
on the face of the Proposal, but the intended correct Proposal is not similarly
evident, Offeror may withdraw its Proposal and any bid security will be returned.
Thereafter, the Offeror will be disqualified from further bidding on the subject
Contract.
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14. REJECTION OF PROPOSALS
14.1. To the extent permitted by applicable state and federal laws and regulations,
City reserves the right to reject any and all Proposals, to waive any and all
informalities not involving price, time or changes in the work with the Successful
Offeror, and to disregard all nonconforming, non -responsive, unbalanced or
conditional Proposals. Proposals will be considered irregular and may be
rejected if they show serious omissions, alterations in form, additions not called
for, conditions or unauthorized alterations, or irregularities of any kind.
14.2. City reserves the right to reject the Proposal of any Offeror if City believes that it
would not be in its best interest of to make an award to that Offeror, whether
because the Proposal is not responsive, the Offeror is unqualified, of doubtful
financial ability, or fails to meet any other pertinent criteria established by City
within the scope of the solicitation.
15. QUALIFICATIONS OF PROPOSERS
15.1. Each Offeror shall complete the Offeror's Qualifications Statement and submit
the form with the Proposal. Failure to submit the Offeror's Qualifications
Statement and the documents required thereunder may constitute grounds for
rejection of the Proposal.
15.2. As a part of the Proposal evaluation process, City may conduct a background
check which may include a records check by the Broward Sheriffs Office.
Offeror's submission of a Proposal constitutes acknowledgement of the process
and consent to such investigation.
15.3. No proposal shall be accepted from, nor will any contract be awarded to, any
person who is in arrears to City for any debt or contract, who is a defaulter, as
surety or otherwise, of any obligation to City, or who is deemed irresponsible for
unreliable by City. City will be the sole judge of said determination.
15.4. City reserves the right to make a pre -award inspection of the Offeror's facilities
and equipment prior to award of Contract.
15.5. Employees of the Proposer shall at all times be under its sole direction and
not an employee or agent of the City. The Proposer shall supply competent
and physically capable employees. The City may require the Proposer to
remove an employee it deems careless, incompetent, insubordinate or
otherwise objectionable. Proposer shall be responsible to the City for the
acts and omissions of all employees working under its directions.
16. INSURANCE
16.1. Offeror agrees to, in the performance of work and services under this
Agreement, comply with all federal, state, and local laws and regulations now
in effect, or hereinafter enacted during the term of this agreement that are
applicable to Offeror, its employees, agents, or subcontractors, if any, with
respect to the work and services described herein.
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16.2. Offeror shall obtain at Offeror's expense all necessary insurance in such form
and amount as required by the City's Risk Manager before beginning work
under this Agreement. Offeror shall maintain such insurance in full force and
effect during the life of this Agreement. Offeror shall provide to the City's Risk
Manager current certificates of all insurance required under this section prior
to beginning any work under this Agreement.
16.3. Offeror shall indemnify and save the City harmless from any damage
resulting to it for failure of either Offeror or any Sub -Offeror to obtain or
maintain such insurance.
16.4. The following are required types and minimum limits of insurance coverage,
which the Offeror agrees to maintain during the term of this contract:
Line of Business/ Coverage
Commercial General Liability
Including:
Premises/Operations
Contractual Liability
Personal Injury
Explosion, Collapse, Underground Hazard
Occurrence Aggregate
$1,000,000 $1,000,000
Products/Completed Operations
Broad Form Property Damage
Cross Liability and Severability of Interest Clause
Automobile Liability $1,000,000 $1,000,000
Workers' Compensation & Employer's Statutory
Liability
16.5. The City reserves the right to require higher limits depending upon the
scope of work under this Agreement.
16.6. Neither Offeror nor any Sub -Offeror shall commence work under this
contract until they have obtained all insurance required under this section
and have supplied the City with evidence of such coverage in the form of
an insurance certificate and endorsement. The Offeror will ensure that all
Sub -Offerors will comply with the above guidelines and will maintain the
necessary coverages throughout the term of this Agreement.
16.7. All insurance carriers shall be rated at least A-VII per Best's Key Rating
Guide and shall be licensed to do business in Florida. Policies shall be
"Occurrence" form. Each carrier will give the City sixty (60) days notice
prior to cancellation..
16.8. The Offeror's liability insurance policies shall be endorsed to add the City of
Tamarac as an "additional insured". The Offeror's Workers' Compensation
carrier will provide a Waiver of Subrogation to the City.
City o/ Tamarac
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16.9. The Offeror shall be responsible for the payment of all deductibles and self -
insured retentions. The City may require that the Offeror purchase a bond
to cover the full amount of the deductible or self -insured retention.
16.10. If the Offeror is to provide professional services under this Agreement, the
Offeror must provide the City with evidence of Professional Liability
insurance with, at a minimum, a limit of $1,000,000 per occurrence and in
the aggregate. "Claims -Made" forms are acceptable for Professional
Liability.
16.11. The Successful Offeror agrees to perform the work under the Contract as
an independent contractor, and not as a subcontractor, agent or employee
of City.
17. INDEMNIFICATION
17.1. To the fullest extent permitted by laws and regulations, Successful Offeror shall
indemnify, defend, save and hold harmless the City, its officers, elected officials,
agents and employees from any and all claims, damages, losses, liabilities and
expenses, direct, indirect, consequential or inconsequential, arising out of or
alleged to have arisen out of the products, goods or services furnished by, or
the operations of, the Successful Offeror or its subcontractors, agents, officers,
employees or independent contractors pursuant to the Contract, specifically
including, but not limited to, those caused by or arising out of the following
conditions:
17.1.1 any act, omission or default of the Successful Offeror and/or its
subcontractors, agents, servants or employees in the provision of the
goods and/or services under the Contract;
17.2.1 any and all bodily injuries, sickness, disease or death;
17.3.1 injury to or destruction of tangible property, including the loss of use
resulting therefrom;
17.4.1 the use of any improper materials;
17.5.1 a defective condition in any goods provided pursuant to the Contract,
whether patent or latent;
17.6.1 the violation of any federal, state, county or municipal laws,
ordinances or regulations by Successful Offeror, its subcontractors,
agents, servants, independent contractors or employees;
17.7.1 the breach or alleged breach by Successful Offeror of any term,
warranty or guarantee of the Contract.
17.2. The Successful Offeror shall pay all claims, losses, liens, settlements or
judgments of any nature whatsoever in connection with the foregoing
indemnifications including, but not limited to, reasonable attorney's fees
(including appellate attorney's fees) and costs.
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17.3. City reserves the right to select its own legal counsel to conduct any defense in
any such proceeding and all costs and fees associated therewith shall be the
responsibility of Successful Offeror under the indemnification agreement.
Nothing contained herein is intended nor shall it be construed to waive City's
rights and immunities under the common law or Florida Statute 768.28 as
amended from time to time.
18. WARRANTIES
18.1. Successful Offeror warrants to City that the consummation of the work provided
for in the Contract documents will not result in the breach of any term or
provision of, or constitute a default under any indenture, mortgage, contract, or
agreement to which Successful Offeror is a party.
18.2. Successful Offeror warrants to City that it is not insolvent, it is not in bankruptcy
proceedings or receivership, nor is it engaged in or threatened with any
litigation, arbitration or other legal or administrative proceedings or
investigations of any kind which would have an adverse effect on its ability to
perform its obligations under the Contract.
18.3. Successful Offeror warrants to City that it will comply with all applicable federal,
state and local laws, regulations and orders in carrying out its obligations under
the Contract.
18.4. All warranties made by Successful Offeror together with service warranties and
guarantees shall run to City and the successors and assigns of City.
19. NON-DISCRIMINATION AND EQUAL OPPORTUNITY EMPLOYMENT
During the performance of the Contract, the Successful Offeror shall not discriminate
against any employee or applicant for employment because of race, religion, color, sex
or national origin. The Successful Offeror will take affirmative action to ensure that
employees are treated during employment, without regard to their race, creed, color, or
national original. Such action must include, but not be limited to, the following:
employment, upgrading; demotion or transfer; recruitment or recruitment advertising,
layoff or termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship. The Successful Offerors) shall agree to post in
conspicuous places, available to employees and applicants for employment, notices to
be provided by the contracting officer setting forth the provisions of this
nondiscrimination clause.
20. TAXES
Successful Offeror shall pay all applicable sales, consumer use and other similar taxes
required by law.
21. PERMITS, FEES AND NOTICES
Successful Offeror shall secure and pay for all permits and fees, licenses and charges
necessary for the proper execution and completion of the work, if applicable. The costs
of all permits, fees, licenses and charges shall be included in the Price Proposal except
where expressly noted in the specifications.
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22. TERMINATION FOR CAUSE AND DEFAULT
22.1. In the event Successful Offeror shall default in any of the terms, obligations,
restrictions or conditions in any of the Proposal documents, City shall give
written notice by certified mail, return receipt requested to Successful Offeror of
the default and that such default shall be corrected, or the actions taken to
correct such default, shall be commenced within seven (7) calendar days
thereof. In the event Successful Offeror has failed to correct the conditions of
default or the default is not remedied to the satisfaction and approval of City,
City shall have all legal remedies available to it, including, but not limited to
termination of the Contract, in which case Successful Offeror shall be liable for
all procurement or re -procurement costs, and any and all damages permitted by
law arising from the default and breach of the Contract.
22.2. Failure on the part of the Proposer to comply with the conditions, terms,
specifications and requirements of the RFP shall be just cause for the
cancellation of the RFP award. The City may, by written notice to the
Proposer, terminate the contract for failure to perform. The date of
termination shall be stated in the notice. The City shall be the sole judge of
non-performance.
23. TERMINATION FOR CONVENIENCE OF CITY
Upon seven (7) calendar days written notice delivered by certified mail, return receipt
requested, to Successful Offeror, City may without cause and without prejudice to any
other right or remedy, terminate the agreement for City's convenience whenever City
determines that such termination is in the best interests of City. Where the agreement
is terminated for the convenience of City, the notice of termination to Successful Offeror
must state that the Contract is being terminated for the convenience of City under the
termination clause and the extent of termination. Upon receipt of the notice of
termination for convenience, Successful Offeror shall promptly discontinue all work
and, to the extent indicated on the notice of termination, shall terminate all outstanding
subcontracts and purchase orders as they relate to the terminated portion of the
Contract, shall refrain from placing further orders and/or contracting with
subcontractors, and shall complete any continued portions of the work.
24, AUDIT RIGHTS
City reserves the right to audit the records of Successful Offeror, relating to this
contract, at any time during the term of the Contract, and for a period of three (3) years
after completion of contract. If required by City, Successful Offeror shall agree to
submit to an audit by an independent Certified Public Accountant selected by City.
Successful Offeror shall allow City to examine and review the records of Successful
Offeror at any and all times during normal business hours during the term of the
Contract.
25. ASSIGNMENT
25.1. Successful Offeror shall not assign, transfer or subject the Contractor its rights,
title, interests or obligations therein without City's prior written approval.
City of Tamarac
Purchasing & C-:;ntracts Division
e. - I. I. -- - - 11.1 - I. - -- -1 ..' ....... .... -
25.2. Violation of the terms of this paragraph shall constitute a breach of the Contract
by Successful Offeror and City may, at its discretion, cancel the Contract. All
rights, title, interest and obligations of Successful Offeror shall thereupon cease
and terminate.
GOVERNING LAW:
THE LAWS OF THE STATE OF FLORIDA SHALL GOVERN THIS CONTRACT. VENUE
SHALL BE BROWARD COUNTY, FLORIDA.
12
City of 7-1malrac
V.
A. SCOPE OF PROPOSAL
14
C.
Porchasu;a & Contracts Division
STATEMENT OF WORK
The purpose of this Request for Proposals is to obtain the services of a qualified firm
to administrate the task of processing, invoicing and collecting the costs for
transporting Emergency Medical Service (EMS) patients on behalf of the City of
Tamarac Fire Rescue Department, in conformity with the requirements contained
herein.
The City is seeking a contract for an initial term of three (3) years, with two (2)
additional two-year renewal terms based upon satisfactory performance and mutual
agreement of both parties.
The City of Tamarac provides Basic Life Support (BLS) and Advanced Life Support
(ALS) services to the citizens and visitors of Tamarac, and bills for medical services
rendered by the Fire Rescue Department. Annual transports are estimated to
exceed 5,900 per year.
Charges have been established for Advanced Life Support Transport, Basic Life
Support Transport, mileage and civil assists. The Fire Rescue Department is
projecting this fee structure to result in greater than $2 million in annual gross
billings. During the past three years, collections from Medicaid have been
approximately 2% of total collections.
SERVICES TO BE PROVIDED
1. Invoice patient and/or other third party responsible for payment of services
rendered in accordance with time frames as stated herein.
2. Collection and generation of any and all insurance forms, filings and record
maintenance.
3. Provide HIPAA privacy practices requirements to all patients transported.
4. Provide and administer a compliance program to ensure compliance with all
State and Federal regulations.
5. Provide the City's Finance Department with all monthly finance, billing and
receivable reports as stated herein.
6. Provide a Customer Service Representative to assist patients and/or other
third party payors in all billing inquiries in a timely fashion as specified herein.
7. Conduct any follow up required to obtain the necessary insurance information
to process invoices for payment.
MINIMUM REQUIREMENTS
1. Successful Proposer shall accept hard copy or electronically transmitted
information.
2. Successful Proposer shall be responsible for invoicing, collection, and
generation of any and all insurance forms, insurance filings, records
13
City of Tamarac
Purrl7a3i11g & Contracts Division
L1
maintenance, and preparation of standard and/or custom reports, as
requested or required by City.
CONTRACTOR RESPONSIBILITIES
1. When preparing invoices, the Successful Proposer shall include the following
information on every invoice:
a. Account number.
b. Invoice number and date.
C. Name of transported patient.
d. Name of responsible party, if different from patient.
e. Complete patient address.
f. Date of transport.
g. Location of transport (address or location patient was transported
from).
h. Destination of transport (hospital or other facility).
I. Detailed cost of transport by line item.
j. Incident number ("Run" number provided by Tamarac Fire Rescue).
2. The invoice will also contain a message stating "This is an invoice for
services provided by the City of Tamarac". Sample invoices should be
included with proposals.
3. All invoicing and reporting systems shall be computerized. Provide computer
operating system information, hardware configuration and software used.
4. Mail invoices to patients within five (5) days of receipt of patient information
from Tamarac Fire Rescue. This mailing shall include a pre-printed return
payment envelope, with the payment address specified by the City of
Tamarac.
5. Second notices shall be sent to patient, in the event of non -response to initial
invoice, at thirty-five day intervals. Third notices shall be sent at sixty-five day
intervals. Provide samples of second and third notices.
6. Provide Electronic Claims Processing for Medicare and Medicaid.
7. Mail or electronically process applicable insurance forms to third party payors
as required or requested by the patient. Either method shall include
information on where to send payments to City of Tamarac.
8. Post all payments as received by the City's bank through the lock box.
9. Invoice the City on a monthly basis for services rendered based on flat fee for
Medicaid and percentage of other fees collected, as indicated on Price
Proposal page included herein.
10. Respond promptly to all patient requests and inquiries, whether written or
verbal.
14
of Tair,&i ac Purchasing & Contracts Civision
---------... _..............._........_......_..._..._-....__._...._......._.._..............._..Y..�._-..__._.._....---.............._....-.... .................._........___._._...._...-----.._...._................ . -...._............_................--....-_._......__...--
11. Comply with all applicable Federal, state and local laws as they apply to the
services being provided, such as, but not limited to, the Federal Debit
Collection Practices Law. This further includes all requirements to maintain
confidentiality for all medical and patient information as referenced in state
and local laws, ordinances and/or regulations.
12. Negotiate and arrange modified payment schedules for those individuals
unable to pay the full amount at time of initial billing.
13. Maintain any and all documentation, records and patient information in a safe
and secure manner that will allow inspection and audit by the City of Tamarac
or its agents upon proper notification and within the scope of the awarded
Contract.
14. Provide the City with a report of all accounts past due more than 180 days
(except where a modified payment schedule has been arranged), including
all pertinent facts regarding said accounts. Accounts past due for more than
one year may be withdrawn from the Successful Proposer and returned to
the City of Tamarac for further collection.
15. Verify, correct and maintain accurate billing address information for all
transported patients
16. Maintain a working arrangement with all of the Tamarac Fire Rescue -
serviced hospitals wherein said hospitals provide copies of patient run sheets
for each transport to their respective facilities.
17. Include a citizen satisfaction survey and a return, self-addressed, postage
paid envelope with each invoiced mailed. This survey shall be no more than
one 8 Y2 x 11 page.
E. RESPONSIBILITIES OF THE CITY OF TAMARAC
The City of Tamarac will provide the necessary patient information to the
Successful Proposer on a weekly basis, for all transported patients within the
specified time frame.
2. The City of Tamarac will comply with all Federal, State and local laws, rules
and regulations as applicable to the contracted services.
3. The City of Tamarac will agree to use the Successful Proposer exclusively for
the services specified herein as long as the contract term is current and in
force.
4. The City of Tamarac will make every effort to obtain the proper billing
address for all billable patients prior to forwarding said information to the
Successful Proposer.
15
of Tamarac r Ftrrc?using & Contracts Divisinr7
1�
- ---_...................�,_��l"------.....-._.._..........._........ _......... _.__._-......
F. DELIVERABLES
1. Distribution of Charges and Collections — This report will track the changes,
payments and financial class mix of all patients for a given month. Provide
sample.
2. Aged Receivable Report — This report will have outstanding invoices sorted
by date with amounts for thirty days, sixty days and ninety days. This report
will provide totals for these categories.
3. New Charges Alpha Listing-- This report lists all invoices alphabetically by
patient name or responsible payor. Provide sample.
4. Monthly Payment Listing - This report lists payment, bad checks, charge offs,
write offs and refunds posted to each patient's account. Provide sample
5. Check Edit Listing - This report lists all patients due refunds as a result of
overpayment of account. Provide sample.
6. Additional reports as required or requested by City.
G. PERFORMANCE SCHEDULE
1. Pricing should reflect costs for services during the initial three (3) year
contract term, from October 1, 2004 to September 30, 2007. The Price
Proposal should reflect the total costs for all services and should detail the
different fees for each service.
2. The Proposer shall include sample invoices and the messages that will be
used on 35- and 65-day notices as part of the submittal. All invoice and
notice text, layout, color of ink and paper stock is subject to approval by City.
VII. PROPOSAL SELECTION
The City Manager will appoint an Evaluation and Selection Committee to review Proposals.
The City reserves the right to select the Proposer who represents the best value, and to
accept or reject any proposal submitted in response to this solicitation. The City's
Evaluation and Selection Committee will act in what they consider to be the best interest of
the City and its residents.
Price shall not be the sole determining factor for selection, as indicated in the following
section.
Vill. EVALUATION OF PROPOSALS
A. Evaluation Method and Criteria
A Selection/Negotiation Committee has been appointed by the City Manager and will
be responsible for selecting the most qualified firm and then negotiating a contract.
The Proposers with the highest -ranked submittals may be asked to make a detailed
presentation of their product/service to the Evaluation and Selection Committee.
16
of T.�rraar,:i �y�, Pr,,rcl?asirrg Contracts Division
_....__.........._...._......_......_....._........_...._....-...._..__....... - - .._.__.._._.__._._.... --- _.... ........... _........... --....
All Proposers are advised that in the event of receipt of an adequate number of
Proposals which in the opinion of the Evaluation Committee require no clarification
and/or supplementary information, such Proposals may be evaluated without
discussion. Hence, proposals should be initially submitted on the most complete and
favorable terms which Proposers are capable of offering to the City.
After presentations, firms will be assigned a final score, with the highest -ranked firm
moving forward to the negotiation phase. Upon successful negotiation, a
recommendation for award will be considered by the City Commission. No work on
this project shall proceed without written authorization from the City of Tamarac.
The City reserves the right to enter into contract negotiations with the selected
Proposer. If the City and the selected Proposer cannot negotiate a successful
contract, the City may terminate such negotiations and begin negotiations with the
next selected Proposer. No Proposer shall have any rights against the City arising
from such negotiations.
The City's evaluation criteria may include, but shall not be limited to, the following:
Qualifications
a. Verification of availability of qualified personnel.
b. Verification of availability of equipment.
C. Ability to meet set standards.
d. Expertise of staff.
e. Qualifications of the firm.
f. Experience.
g. References from other municipalities providing similar services.
2. Technical
a. Understanding of the requirements.
b. Approach.
C. Technical soundness of the proposal.
d. Proposed scope of work.
3. Financial
a. Cost Effectiveness.
b. Reasonableness of proposed price.
C. Evidence of insurance and/or bonding.
4. Other
a. Location of firm (within Tri-County area of Miami -Dade, Broward
and Palm Beach Counties).
b. Previous contracting experience with the City, if any.
C. Performance under past contracts with the City, if any.
17
City of Tamarac �+ Purchasing & Crr.•t=:acts Oivision
B. Weighted Criteria
Points will be assigned to each proposal based on the following weighted criteria:
CRITERIA MAXIMUM POINTS
1.
Expertise/Qualifications
20 points
2.
Experience in Stated Criteria/Medical Billing
20 points
3.
Governmental/Municipal Experience
25 points
4.
Technology and Equipment Availability
10 points
5.
Collection Philosophy
10 points
6.
Price
10 points
7.
Location — Office within the Tri-County Area
5 points
These weighted criteria are provided to assist Proposers in the allocation of their
time and efforts during the proposal preparation process. The criteria also guide the
Evaluation Committee during the short -listing and final ranking of proposers by
establishing a general framework for those deliberations.
Once the Proposals are evaluated, a "short-list" may be selected to make
presentations to the Evaluation and Selection Committee, prior to a recommendation
for award.
C. PRESENTATIONS
The short-listed Proposers may be requested to make presentations to the
Committee. The City may require additional information after evaluation of the
submittals, and Proposers agree to furnish such information upon the City's request.
D. RIGHT TO REJECT PROPOSALS
To the extent permitted by applicable state and federal laws and regulations, City
reserves the right to reject any and all Proposals, to waive any and all informalities not
involving price, time or changes in the work, and to disregard all nonconforming, non-
responsive, unbalanced or conditional Proposals. Proposals will be considered
irregular and may be rejected if they show serious omissions, alterations in form,
additions not called for, conditions, unauthorized alterations, or irregularities of any
kind.
City reserves the right to reject any Proposal if City believes that it would not be in its
best interest to make an award to a particular Proposer, either because the Proposal is
not responsive, the Proposer is unqualified, of doubtful financial ability, or fails to meet
any other pertinent criteria established by City within the scope of this solicitation.
CONTACT WITH PERSONNEL OF THE CITY OF TAMARAC OTHER THAN THE
PURCHASING AND CONTRACTS MANAGER OR DESIGNATED REPRESENTATIVE
REGARDING THEIR REQUEST FOR PROPOSALS MAY BE GROUNDS FOR
ELIMINATION FROM THE SELECTION PROCESS.
is
oIF
t a�oPm
Purchasing and
Contracts Division
City of Tamarac
"Committed to Excellence... Always"
ADDENDUM NO. 1
REQUEST FOR PROPOSALS
RFP 04-14R
MEDICAL BILLING SERVICES
DATE OF ADDENDUM: APRIL 20, 2004
ALL POTENTIAL PROPOSERS:
PLEASE NOTE:
Please include five (5) copies of your Proposal in addition to an Original
submittal.
All other terms and conditions remain the same as of this date.
This addendum should be signed and returned with your Proposal.
NAME OF PROPOSER: /i�i:cz�acs i�z.c�Ct'� r�:c.►-t �:..
SIGNATURE: `` :.�_____ DATE:"`
7525 NW 88th Avenue ■ Tamarac, Florida 33321-2401 ■ (954) 724-2450 ■ Fax (954) 724-2408 ■ www.tomaroc.org
Equal Opportunity Employer
Purchasing and
Contracts Division
City of Tamarac
"Committed to Excellence... Always"
ADDENDUM NO. 2
REQUEST FOR PROPOSALS
RFP 04-14R
MEDICAL BILLING SERVICES
DATE OF ADDENDUM: APRIL 27, 2004
ALL POTENTIAL PROPOSERS:
PLEASE NOTE:
The Due Date for Proposal submissions has been extended until Tuesday,
May 4, 2004, at 4:00 P.M. local time.
The following questions have been submitted for clarification. The clarifications are
shown in bold faced type.
1. Please provide the number of Billable Transports (calls) for each of the past two
(2) years.
September 2001-August 2002 — 5,490 billable transports
September 2002-August 2003 — 5,893 billable transports
2. Please provide GROSS CHARGES and COLLECTIONS (RECEIPTS) for the
past two (2) years.
(Estimates):
September 2001-August 2002 — $1,745,399.00 gross and $1,496,003.00
collected to date.
September 2002-August 2003 — $2,087,191.00 gross and $1,444,860.00
collected to date.
3. Please provide the current Payor mix (by percentage if available).
(i.e.Medicare/Medicaid/Private Ins./Self Pays)
The following are approximate values; however, each month's values
change as revenues are added and subtracted in each category.
7525 NW 88th Avenue ■ Tamarac, Florida 33321-2401 ■ (954) 724-2450 ■ Fax (954) 724-2406 ■ www.tomarac.org
Equal Opportunity Employer
City of Tamarac Purchasing & Contracts Division
Self pay:
3.5%
Medicaid:
2%
Medicare:
34.5%
Insurance:
60%
Total:
100%
4. Please provide a listing of your current rates (fees) charged. (i.e.
ALS/BLS/Oxygen/Mileage/IV/Medications)
BLS: $310.00
ALS: $335.00
Per mile: $7.00
Non -emergency patient assist fee (after 3 such assists in a six month
period) - $50.00
No charge for Oxygen, IV Meds, etc.
There is a new fee proposal for FY05, not yet passed. The rates for this period,
however, are anticipated to be as follows:
BLS:
$360.00
ALS1:
$400.00
ALS2:
$500.00
Mileage:
$7.25
All other terms and conditions of this Request for Proposals remain the same as of this
date.
This addendum should be signed and returned with your Proposal.
SIGNATURE:
2
DATE:, _ !_��04L4�
cOf 1: Pzirchasii:(g CallfraL'iS aiViS;u�
PROPOSAL FORM
RFP 04-14R
MEDICAL BILLING SERVICES
PROPOSAL PRICE
1. Flat Fee Percentage of 7.0% % to administer billing and collections
tt
2. Flat Rate of $ 150.00 per month for Medicaid.
($e,--- 5e-c�,&
SUBMITTED BY:
Advanced Data Processing, Inc.
Company Name:
Address: 520 NW 165th Street, Suite 201
City: Miami State: FL Zip: 33169
Telephone:305-459-0652 FAX: 305-521-0777
Email: dpassaro@emsclaims.com
NOTE: To be considered eligible for award, one (1) original copy of this proposal form
must be submitted with the Proposal.
NO BID INDICATION (IF "NO BID" IS OFFERED):
Please indicate reason(s) why a Proposal is not being submitted at this time.
y�F
CERTIFICATION
THIS DOCUMENT MUST BE SUBMITTED WITH THE BID
We (1), the undersigned, hereby agree to furnish the items)/service(s) described in the
Invitation to Bid. We (1) certify that we(I) have read the entire document, including the
Specifications, Additional Requirements, Supplemental Attachments, Instructions to
Bidders, Terms and Conditions, and any addenda issued. We agree to comply with all of
the requirements of the entire Invitation To Bid.
Indicate which type of organization below:
INDIVIDUAL ❑ PARTNERSHIPO CORPORATION OTHER
If "Other", Explain:
Authorized Signature
Vice President- Client Relations
Title
Advanced Data Processing, Inc.
Company Name
520 NW 165th Street, Suite 201
Address
Miami, Florida 33169
City/State/Zip
P
assaro anemsclaims.com
Contact Email address
Donald Passaro
Name (Printed Or Typed)
22-3875190
Federal Employer I.D./Social Security No.
305-459-0652
Telephone
305-521-0777
Fax Number
Donald Passaro
Contact Person
Page 1 on Ceftirirafiuft
7f T`11naraC -,. • r't1�';:hds111J Coiu actr, Oivison
OFFEROWS QUALIFICATION STATEMENT
The undersigned certifies under oath the truth and correctness of all statements and of
all answers to questions made hereinafter:
SUBMITTED TO: City of Tamarac
Purchasing and Contracts Manager
7525 NW 88"' Avenue
Tamarac, Florida 33321
Advanced Data Processing, Inc.
Company:
Check One
Contact Name: Donald Passaro . .. .... ...
a
Corporation
Address: 520 NW 165th Street, Suite 201
❑Partnership
City, State, Zip Miami, Florida 33169
305-459 0652
Telephone No.
Individual
Fax No, 305-521 0777
Other
1. State the true, exact, correct and complete name of the partnership,
corporation,
trade or fictitious name under which you do business and the address
of the place
of business.
The correct name of the Offeror is:
Advanced Data Processing, Inc.
The address of the principal place of business is:
520 NW 165th Street, Suite 201
Miami. Florida 33169
2. If Offeror is a corporation, answer the following:
a) Date of Incorporation: October2002
b) State of Incorporation: DelawareM-.-
c) President's name:-. Doug
d) Vice President's name: Don Passaro
e) Secretary's name: Greg Elliot
f) Treasurer's name: Doug Shamon
g) Name and address of Resident Agent:CT ,,,.____, ration
orpo....... .._.__..__..-....�..
Pape 1 of 5 Offc: of s Qtla1ihC 0t1(W SG�teme:nt
& c or rr ! c Div sic�rr
3. If Offeror is an individual or a partnership, answer the following.,
a) Date of organization: N/A
b) Name, address and ownership units of all partners:
c) State whether general or limited partnership:
4. If Offeror is other than an individual, corporation or partnership, describe the
organization and give the name and address of principals:
N/A
5. If Offeror is operating under a fictitious name, submit evidence of compliance with
the Florida Fictitious Name Statute, N/A
6. How many years has your organization been in business under its present
business name? 20 years_
a) Under what other former names has your organization operated?
None
7. Indicate registration, license numbers or certificate numbers for the businesses or
Professions, which are the subject of this Sid. Please attach certificate of
competency and/or state registration.
Occupational License Number 137178-0 Miami -Dade County, Florida
Please refer to Part H. Attachments of this doc
ument for a copy of ADPI's occupational license and for a
PY_...._--------__._—_ .............._.____._..
co _o ADPI 's license to do business in Florida.
6. Have you personally inspected the site of the proposed work?
E]YES ❑ NO
9. Do you have a complete set of documents, including drawings and addenda?
EYES [:] NO
10. Did you attend the Pre -Proposal Conference if any such conference was held?
❑ YES NO N/A- No Pre -proposal Conference was held in relation to this RFP.
[x—]
Page 2 of 5 C,raliftatier, Statr meat
c4;1
& Division
11 Have you ever failed to complete any work awarded to you?, if so, state when,
where and why:
No.
.. ...... . .... .... .. .. ............. ...
. .........
12, State the names, telephone numbers and last known addresses of three ()
owners, individuals or representatives of owners with the most knowledge of wor3k
which you have performed and to which you refer (government owners are
preferred as references).
Name
Address Telephone
City of Tamarac- Chief Paul Forsberg 6000 Hiatus Road, Tamarac, FL 33321 954-724-2436
- .. .. ... . ... ... .. ..
Palm Beach County- Captain John Wilson 50 S Military Trail #101, WPB, FL 33415 561-616-6800
... .......
Lee County- David Kainrad 14752 Six Mile Cypress Pkwy, Ft. Myers, FL 33912 239-335-1614
Br yjW County A Fosburr. 10ftS Fl9rida Ave.. Rockledae, FL 32955 321-663-2056
1 1 experience
13. 1 e pertinenn of the ey individuals of your organization (continue
on insert sheet, if necessary).
Please refer to Part B: Staff Credentials of the ADPI proposal for qualitfication of all employees.
You may also refer to the resumes that have been included in the Attachments section of this
----------
document.
. ... .... ... ......
14. State the name of the individual who will have personal supervision of the work:
Darryl Hartung
15. State the name and address of attorney, if any, for the business of the Offeror:
Smith Gambrell and Russell, LILP.
Suite 3100, Promenade 11, 1230 Peachtree Street, N.E.
. ....... ...... -------
A!!anta, GA 30309-3592
16. State the names and addresses of all businesses and/or individuals who own an
interest of more than five percent (5%) of the Offeror's business and indicate the
percentage owned of each such business and/or individual:
ADPI Holdings, Inc. owns 100% of Advanced Data Processing, Inc.
17. State the names, addresses and the type of business of all firms that are partially
or wholly owned by Offeror:
None
.. ..... ... ...
p1ge 3 rif 5
City,f 1aimarac
18. State the name of Surety Company which will be providing the bond, and name
and address of agent:
N/A No Surety Bond was required.
-- — -------- . .... .
19. Bank References:
Bank Address Telephone
Merrill Lynch 45 William Street, Suite 100, Wellesley, MA 02481 800-201-9509
Wachovia Bank NC 8502, PO Box 563966, Charlotte, NC 28262-3966 704-427-7199
----- ---- ----
----------
20. Attach a financial statement including Offeror's latest balance sheet and income
statement showing the following items: —Please see the back pocket of the proposal.
a) Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes
receivable, accrued income, deposits, materials, real estate, stocks and
bonds, equipment, furniture and fixtures, inventory and prepaid expenses):
b) Net Fixed Assets
c) Other Assets
d) Current Liabilities (e.g., accounts payable, notes payable, accrued
expenses, provision for income taxes, advances, accrued salaries, real
estate encumbrances and accrued payroll taxes).
e) Other Liabilities (e.g., capital, capital stock, authorized and outstanding
shares par values, earned surplus, and retained earnings):
21. State the name of the firm preparing the financial statement and date thereof:
Miller, Ray, Healey and Houser Date: 12/31/2003
22. Is this financial statement for the identical organization named on page one?
EYES FINO
23. If not, explain the relationship and financial responsibility of the organization whose
financial statement is provided (e.g., parent -subsidiary).
P19t9 4 of 5 Offefor's Qoah,'j�,,31,,otj Stalon)c-I)f
-City of Tarn ar tr;
.__ _ ..._ __,..m_. I• _.._ .._.-__.,- W. �r"'urchasrrn.� � r r�rrlra to ��rvrson
The Offeror acknowledges and understands that the information contained in response
to this Qualification Statement shall be relied upon by owner in awarding the contract
and such information is warranted by Offeror to be true. The discovery of any omission
or misstatement that materially affects the Offeror's qualifications to perform under the
contract shall cause the owner to reject the proposal, and if after the award, to cancel
and terminate the award and/or contract.
Signature
State of Florida
County of Miami -Dade
ACKNOWLEDGEMENT
OFFEROR'S QUALIFICATION STATEMENT
On this the 27th day of April
20 D-4- , before me,
the undersigned Notary Public of the State of Florida, personally appeared
Donald Passaro
(Name(s) of individual(s) who appeared before notary)
whose name(s) is/are Subscribed to within the instrument, and he/she/they
acknowledge that he/she/they executed it.
WITNESS my hand and official seal.
NO RVF)(JBftLIC,STAT OF LO A
NOTARY PUBLIC r''rr,a- ..�. t._r�. ,.
SEAL OF OFFICE:>-,;`��;; ;r+„ M !`,l}/�� I rs
:3j
(Name of Notary Public: Print
Stamp, or Type as Commissioned)
X Personally known to me, or
❑ Produced identification:
(Type of Identification Produced)
❑ DID take an oath, or
DID NOT take an oath
'age 5 of 5 - Offetcr s Q(talification �taterr>errt
UEk...-
VENDOR DRUG -FREE WORKPLACE
Preference may be given to vendors submitting a certification with their bid/proposal
certifying they have a drug -free workplace in accordance with Section 287.087, Florida
Statutes. This requirement affects all public entities of the State and becomes effective
January 1, 1991. The special condition is as follows:
IDENTICAL TIE BIDS - Preference may be given to businesses with drug -free
workplace programs. Whenever two or more bids that are equal with respect to price,
quality, and service are received by the State or by any political subdivision for the
procurement of commodities or contractual services, a bid received from a business that
certifies that it has implemented a drug -free workplace program shall be given
preference in the award process. Established procedures for processing tie bids will be
followed if none of the tied vendors have a drug -free workplace program. In order to have
a drug -free workplace program, a business shall:
1. Publish a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is
prohibited in the workplace and specifying the actions that will be taken against
employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the
business's policy of maintaining a drug -free workplace, any available drug
counseling, rehabilitation, and employee assistance programs, and the penalties
that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual
services that are under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a
condition of working on the commodities or contractual services that are under
bid, the employee will abide by the terms of the statement and will notify the
employer of any conviction of, or plea of guilty or polo contenders to, any
violation of chapter 893 or of any controlled substance law of the United States or
any state, for a violation occurring in the workplace no later that five (5) days
after each conviction.
5. Impose a section on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's
community, by any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug -free workplace through
implementation of this section. As the person authorized to sign the statement, I
ify that this form complies fully with the above requirements.
.� Advanced Data Processing, Inc.
Au horized Signature Company Name
Page 7 off ( my-rrPt bVr,6c �r�rn
Gil y of rarn.ar oc ' 'trr n i rrrr� d Cortr r tti 7ivrsrori _ \ . ...-... _ .........
NON -COLLUSIVE AFFIDAVIT
State of Florida
)ss.
County of Miami -Dade )
Donald Passaro being first duly sworn,
deposes and says that:
1. He/she is the Officer- Vice President (Owner, Partner, Officer,
Representative or Agent) of Advanced Data Processing, Inc. , the Offeror
that has submitted the attached Proposal;
2. He/she is fully informed respecting the preparation and contents of the attached
Proposal and of all pertinent circumstances respecting such Proposal;
3. Such Proposal is genuine and is not a collusive or sham Proposal;
4. Neither the said Offeror nor any of its officers, partners, owners, agents,
representatives, employees or parties in interest, including this affiant, have in any
way colluded, conspired, connived or agreed, directly or indirectly, with any other
Offeror, firm, or person to submit a collusive or sham Proposal in connection with
the Work for which the attached Proposal has been submitted; or to refrain from
bidding in connection with such Work; or have in any manner, directly or indirectly,
sought by agreement or collusion, or communication, or conference with any
Offeror, firm, or person to fix the price or prices in the attached Proposal or of any
other Offeror, or to fix any overhead, profit, or cost elements of the Proposal price
or the Proposal price of any other Offeror, or to secure through any collusion,
conspiracy, connivance, or unlawful agreement any advantage against (Recipient),
or any person interested in the proposed Work;
5. The .price or prices quoted in the attached Proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance, or unlawful agreement on the
part of the Offeror or any other of its agents, representatives, owners, employees
or parties in interest, including this affiant.
Signe sealed and delivered in the presence of:
By' ,-
Witness
ru Donald Passaro
Witness Printed Name
Vice President- Client Relations
Title
Flnue 7 o/ 2 NGn-%afh.rsivc Affidavit
Ar�
C'h'y of Toimwac
.. .. . ....... .. ..... . . ........ ... .. . .
ACKNOWLEDGMENT
NON -COLLUSIVE AFFIDAVIT
State of Florida
County of Miami -Dade
On this the 27th day of April 1 2004 , before me, the undersigned Notary Public
of the State of Florida, personally appeared
Donald Passaro
and
(Name(s) of individual(s) who appeared before notary)
whose name(s) is/are Subscribed to within the instrument, and he/she/they
acknowledge that he/she/they executed it.
WITNESS my hand
and official seal.
Ry D,&.-,-vl M. liartun�AOTARY VUBLIC, STATE OF FLUAIDA
NOTARY PUBLIC
SEAL OF OFFICE: ,-
i7t (Name of Notary Public: Print,
Stamp, or Type as Commissioned)
P(Personally known to me, or
11 Produced identification:
(Type of Identification Produced)
11 DID take an oath, or CdDID NOT take an oath
Page 2 of 2 Nan-Collusivo Affic f,--?vit
7/6/2004 MEDICAL BILLING RFP 04-14R
Committee Evaluation Totals
Proposer's Name:
Advanced
il.iant
Data Proc.
MedBlll
No Conflict of Interest
No
No
Adhered to the Instructions
Yes
Yes
Expertise/Qualifications (20 points)
Assistant Fire Chief
20
18
EMS Chief
20
18
Controller
20
15
Management Analyst
20
15
Experience in Stated Criteria (20
points)
Assistant Fire Chief
20
18
EMS Chief
20
15
Controller
20
15
Management Analyst
20
20
Governmental/Municipal Experience (25 points)
Assistant Fire Chief
25
20
EMS Chief
25
20
Controller
25
20
Management Analyst
25
25
Technology and Equipment Availability
(10 points)
Assistant Fire Chief
10
10
EMS Chief
10
10
Controller
10
10
Management Analyst
10
10
Collection Philosophy (10 points)
Assistant Fire Chief
10
7
EMS Chief
10
10
Controller
10
7
Management Analyst
10
10
Price (10 points)
Assistant Fire Chief
8
8
EMS Chief
8
10
Controller
6
7
Management Analyst
5
10
Location (Tri-County Area) (5
points)
Assistant Fire Chief
5
1
EMS Chief
5
0
Controller
5
0
Management Analyst
5
0
TOTAL PROPOSAL POINTS
Assistant Fire Chief
98
82
EMS Chief
98
83
Controller
96
74
Manage ent Analyst
95
90
387
329
TOTAL PROPOSAL RANKING
Assistant Fire Chief
1
2
EMS Chief
1
2
Controller
1
2
Management Analyst
1
2
FINAL RANK
1
2
EXHIBIT 2
TR 10468
Udrive/2004 Bids/04-14R/04-14R Proposal Evaluation Worksheet.xls PROPOSAL EVALUATION
City of Tamarac
0 Purchasing and Contracts Division
AGREEMENT
BETWEEN THE CITY OF TAMARAC
AND
ADVANCED DATA PROCESSING, INC.
1�
THIS AGREEMENT is made and entered into this day of ,
2004 by and between the City of Tamarac, a municipal corporation with principal offices
located at 7525 N.W. 88th Ave., Tamarac, FL 33321 (the "CITY") and Advanced Data
Processing, Inc., a Delaware corporation with principal offices located at 520 NW 165t"
Street, Suite 201, Miami FL 33169 (the "Contractor') to provide for the administration,
processing and receipt of payments associated with transporting Emergency Medical
Service (EMS) patients on behalf of the City of Tamarac Fire Rescue Department.
Now therefore, in consideration of the mutual covenants hereinafter set forth, the
City and Contractor agree as follows:
1) The Contract Documents
The contract documents consist of this Agreement, conditions of Request for
Proposals (RFP)_04-14R, "Medical Billing Services", (General Terms and Conditions,
Instructions to Offerors, and Statement of Work), all addenda issued prior to, and all
modifications issued after execution of this Agreement. These contract documents form the
Agreement, and all are as fully a part of the Agreement as if attached to this Agreement or
repeated therein.
2) The Work
The Contractor shall perform all work for the City required by the contract documents
as set forth below:
a) Contractor shall furnish all labor, materials, and equipment necessary to administer,
process, and receive payments associated with transporting EMS patients as
specified in RFP 04-14R.
b) Contractor shall supervise the work force to ensure that all workers conduct
themselves and perform their work in a safe and professional manner. Contractor
shall comply with all OSHA safety rules and regulations in the operation of
equipment and in the performance of the work. Contractor shall at all times have a
competent field supervisor on the job site to enforce these policies and procedures
at the Contractor's expense.
c) Contractor shall provide the City with seventy-two (72) hours written notice prior to
the beginning of work under this Agreement and prior to any schedule change with
the exception of changes caused by inclement weather.
d) Contractor shall comply with any and all Federal, State, and local laws and
regulations now in effect, or hereinafter enacted during the term of this Agreement,
which are applicable to the Contractor, its employees, agents or subcontractors, if
any, with respect to the work and services described herein.
City of Tamarac
Purchasing and Contracts Division
3) Insurance
Contractor shall obtain at Contractor's expense all necessary insurance in such form
and amount as required by the City's Risk and Safety Manager before beginning work
under this Agreement including, but not limited to, Workers' Compensation, Commercial
General Liability, and all other insurance as required by the City, including Professional
Liability when appropriate. Contractor shall maintain such insurance in full force and effect
during the life of this Agreement. Contractor shall provide to the City's Risk and Safety
Manager certificates of all insurances required under this section prior to beginning any
work under this Agreement. The Contractor will ensure that all subcontractors comply with
the above guidelines and will retain all necessary insurance in force throughout the term of
this agreement.
Contractor shall indemnify and hold the City harmless for any damages resulting
from failure of the Contractor to take out and maintain such insurance. Contractor's
Liability Insurance policies shall be endorsed to add the City as an additional insured.
Contractor shall be responsible for payment of all deductibles and self-insurance retentions
on Contractor's Liability Insurance policies.
4) Contract Term
The contract term begins October 1, 2004 and shall continue for a three (3) year
period, with two (2) additional two-year renewal terms based upon satisfactory performance
and mutual agreement of both parties. The entire term of the contract shall not exceed
seven (7) years.
5) Contract Sum
The contract sum shall be a flat fee percentage of seven percent (7%) of collections
of non -Medicaid accounts computed by incident month, plus $150.00 per month for
Medicaid accounts billed. Costs are less a "Lock -box" credit of $200.00 per month. Price
includes but is not limited to all materials, postage and phone costs. Contractor retains the
right to pass on to City any significant postage increase; said increase being determined by
any increase in the cost of first class postage by the U.S. Postal Service. Costs also include
$1.00 charge per transport at current transport level for optional mailing of HIPAA Privacy
Notices sent with initial invoice of all transported/billed patients.
6) Payments
The City shall pay the Contractor monthly for Work performed as outlined in the
Statement of Work and upon receipt of an approved invoice.
7) Indemnification
To the fullest extent permitted by laws and regulations, Contractor shall indemnify,
defend, save and hold harmless the City, its officers, elected officials, agents and employees
from any and all claims, damages, losses, liabilities and expenses, direct, indirect,
consequential or inconsequential, arising out of or alleged to have arisen out of the products,
goods or services furnished by, or the operations of, Contractor or its subcontractors, agents,
officers, employees or independent contractors pursuant to the Contract, specifically including,
City of Tamarac
P0 —urchasing and Contracts Division
but not limited to, those caused by or arising out of the following conditions: (a) any act,
omission or default of the Contractor and/or its subcontractors, agents, servants or employees
in the provision of the goods and/or services under the Contract; (b) any and all bodily injuries,
sickness, disease or death; (c) injury to or destruction of tangible property, including the loss of
use resulting therefrom; (d) the use of any improper materials; (e) a defective condition in any
goods provided pursuant to the Contract, whether patent or latent; (f) the violation of any
federal, state, county or municipal laws, ordinances or regulations by Contractor, its
subcontractors, agents, servants, independent contractors or employees; (g) the breach or
alleged breach by Contractor of any term, warranty or guarantee of the Contract.
The Contractor shall pay all claims, losses, liens, settlements or judgments of any
nature whatsoever in connection with the foregoing indemnifications including, but not limited
to, reasonable attorney's fees (including appellate attorney's fees) and costs.
City reserves the right to select its own legal counsel to conduct any defense in any
such proceeding and all costs and fees associated therewith shall be the responsibility of
Contractor under the indemnification agreement. Nothing contained herein is intended nor
shall it be construed to waive City's rights and immunities under the common law or Florida
Statute 768.28 as amended from time to time. Sec ti n 7 Revision Accepted by:
Initials _ Date-tl-�
8) Non -Discrimination (Doug Shamon)
The Contractor agrees that it shall not discriminate against any of its employees or
applicants for employment because of their age, handicap, race, color, religion, sex, or
national origin, and to abide by all federal and State laws regarding non-discrimination. The
Contractor further agrees to insert the foregoing provisions in all subcontracts hereunder
except subcontracts for standard commercial supplies or raw materials. Any violation of
such provisions shall constitute a material breach of this Agreement.
9) Independent Contractor
Contractor is an independent Contractor under this Agreement. Personal services
provided by the Contractor shall be by employees of the Contractor and subject to
supervision by the Contractor, and not as officers, employees, or agents of the City.
Personnel policies, tax responsibilities, social security and health insurance, employee
benefits, purchasing policies and other similar administrative procedures applicable to
services rendered under this Agreement shall be those of the Contractor.
10) Administrative Delegation
To the extent necessary to fulfill its billing efforts under the Agreement, Contractor is
authorized to sign in an administrative capacity for the City the following types of standard
forms and correspondences only: probate filing; letters to patients or their representatives
verifying that an account is paid in full; forms verifying the tax-exempt status of the City;
and insurance filings and related forms. The Contractor has no authority to sign any
document that imposes liability upon the City of Tamarac.
City of Tamarac
11) Assignment and Subcontracting
0 Purchasing and Contracts Division
Contractor shall not transfer or assign the performance required by this Agreement
without the prior consent of the City. This Agreement, or any portion thereof, shall not be
subcontracted without the prior written consent of the City.
12) Notice
Whenever either party desires or is required under this Agreement to give notice to
any other party, it must be given by written notice, sent by registered United States mail,
with return receipt requested, addressed to the party for whom it is intended at the following
addresses.
CITY
City Manager
City of Tamarac
7525 N.W. 88th Avenue
Tamarac, FL 33321
With a copy to City Attorney at the same address.
CONTRACTOR
Brad Williams
Vice President — Finance
Advanced Data Processing Inc.
520 NW 165t" Street, Suite 201
Miami FL 33169
PH: 305-459-0658
13) Termination
This Agreement may be terminated by City or Contractor for cause, or by the City for
convenience, upon thirty (30) calendar days of written notice by the terminating party to the
other party, in which event the Contractor shall be paid its compensation for services
performed to termination date, including services reasonably related to termination. In the
event that the Contractor abandons this Agreement or causes it to be terminated,
Contractor shall indemnify the City against loss pertaining to this termination.
Default by Contractor: In the event Contractor shall default in any of the terms,
obligations, restrictions or conditions in any of the Proposal documents, City shall give
written notice of default to Contractor by certified mail, return receipt requested, and such
default shall be corrected, or the actions to begin correction of said default, shall
commence within thirty (30) calendar days of the date of said notice.
14) Uncontrollable Forces
Neither the City nor Contractor shall be considered to be in default of this Agreement
if delays in or failure of performance shall be due to Uncontrollable Forces, the effect of
which, by the exercise of reasonable diligence, the non -performing party could not avoid.
4
of Tamarac
and Contracts Division
The term "Uncontrollable Forces" shall mean any event which results in the prevention or
delay of performance by a party of its obligations under this Agreement and which is
beyond the reasonable control of the non -performing party. It includes, but is not limited to
fire, flood, earthquakes, storms lightning, epidemic, war, riot, civil disturbance, sabotage,
terrorism and governmental actions.
Neither party shall, however, be excused from performance if non-performance is
due to forces that are preventable, removable, or remediable nor which the non -performing
party could have, with the exercise of reasonable diligence, prevented, removed, or
remedied with reasonable dispatch. The non -performing party shall, within a reasonable
time of being prevented or delayed from performance by an uncontrollable force, give
written notice to the other party describing the circumstances and uncontrollable forces
preventing continued performance of the obligations of this Agreement.
15) Agreement Subject to Funding
This agreement shall remain in full force and effect only as long as the expenditures
provided for in the Agreement have been appropriated by the City Commission of the City
of Tamarac in the annual budget for each fiscal year of this Agreement, and is subject to
termination based on lack of funding.
16) Venue
This Agreement shall be governed by the laws of the State of Florida as now and
hereafter in force. The venue for actions arising out of this agreement is fixed in Broward
County, Florida.
17) Signatory Authority
The Contractor shall provide the City with copies of requisite documentation
evidencing that the signatory for Contractor has the authority to enter into this Agreement.
18) Severability; Waiver of Provisions
Any provision in this Agreement that is prohibited or unenforceable in any jurisdiction
shall, as to such jurisdiction, be ineffective to the extent of such prohibition or
unenforceability without invalidating the remaining provisions hereof or affecting the validity
or enforceability of such provisions in any other jurisdiction. The non -enforcement of any
provision by either party shall not constitute a waiver of that provision nor shall it affect the
enforceability of that provision or of the remainder of this Agreement.
19) Merger; Amendment
This Agreement constitutes the entire Agreement between the Contractor and the
City, and negotiations and oral understandings between the parties are merged herein.
This Agreement can be supplemented and/or amended only by a written document
executed by both the Contractor and the City.
5
r
IN WITNESS WHEREOF, the parties have made and executed this Agreement on
the respective dates under each signature. CITY OF TAMARAC, signing by and through its
Mayor and City Manager, and Advanced Data Processing, Inc., signing by and through its
President, duly authorized to execute same.
ATTEST: a
Marion Swenson, CIVIC
City Clerk
d 3LO/®y..-- .....-- -
Date
CITY OF TAMARAC
40 Schreiber, Mayor
Date
Jeffrey L. MilleF, City Manager
�-1')'<1oq
Date
Date
ell &.Raft, Vty Qtt, hey
-j')/
sufficiency:
ATTEST: Advanced Data Processing, Inc.
Company ame
(Cofporate Secretary) Sig6afdre 61 President
Greg Elliot
Type/Print Name of Corporate Secy
(CORPORATE SEAL)
Doug Shamon
Type/Print Name of President
_July 13, IoN
Date T I
M
i,rri a tc; Pw h acing Land C ona .r acl, D vi<;ir;r.
.....
CORPORATE ACKNOWLEDGEMENT
:SS
COUNTY OF
I HEREBY CERTIFY that on this day, before me, an Officer duly authorized in the State
aforesaid and in the County aforesaid to take acknowledgments, personally appeared Doug
Shamon, President of Advanced Data Processing, Inc., a Delaware Corporation, to me
known to be the person(s) described in and who executed the foregoing instrument and
acknowledged before me that he/she executed the same.
t-�
WITNESS my hand and official seal this ay of T t14 , 2004.
gASdioature of Notary Public
DarrylM.Hartung State of Florid at Large
�COIr1A15SZAA i i)IiI�S /
14il-es gone 17, 2006
AtIa'a13C RondLng Cc., Inc
Print, Type or Stamp
Name of Notary Public
Personally known to me or
❑ Produced Identification
Type of I.D. Produced
DID take an oath, or
❑ DID NOT take an oath.
7.
Client#: 15220 . ADVADAT
ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY)
PRODU10/10/03
Wach - ER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
achovia Insurance Services � C \! ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4401 Northside Pkwy Suite 400 C iT y � 't, rf''M t ti i t� IypLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Atlanta, GA 30327-3078 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
770 850-0050 3 (SCOT 15 INSURERS AFFORDING COVERAGE NAIC #
INSURED
ADPI Holding, Inc. I I.s ERA: FCCI Insurance Company
Advanced Data Processing, Inc. ► «�/ �� ``' ti� I I J ER B: Illinois Union Insurance Company �'I
INSURER C:
520 NW 165th Street Road; Suite 201 INSURER D:
Miami, FL 33169-6303
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLII
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH'
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_TR INSR TYPE OF INSURANCE POLICY NUMBER POLI Y EFFECTIVE P L Y EXPIRATIC
TE M/DD/YYDATE MM/DD/YY
A X GENERA LIaBr ITY CPP00019C5 110110103 10/10/04
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE FE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JE T LOC
A
AUTOMOBILE LIABILITY
CA0002425
10/10/03
10/10/04
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
WndW
X HIRED AUTOS
X NON -OWNED AUTOS
000 0f R!
r
X Hired Card PD
$100 Comp.
Deductibles
$250 Call
GARAGE LIABILITY
ANY AUTO
%�'1$�b
A
LIABILITY
�J
UMB00001097
10/10/04
[EZXCESS/UMBRELLA
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $$1000O
A WORKERS COMPENSATION AND 001 WCO2A51763 10/10/03 10/10/04
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
B OTHER Errors & BM120009844 10/10/03 10/10/04
Omissions
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
TE
City of Tamarac
Attn: Jeffrey L. Miller, City of Manager
7525 N.W. 88th Avenue
Tamarac, FL 33321
ACORD 25 (2001/08) 1 of 2 #S173187/M173156
;Y PERIOD INDICATED, NOTWITHSTANDING
'HIS CERTIFICATE MAY BE ISSUED OR
EXCLUSIONS AND CONDITIONS OF SUCH
LIMITS
EACH OCCURRENCE $1 DDD 000
DAMAGE TO RENTED ncel
$100 ODO
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1 000 000
GENERAL AGGREGATE
$Z 00O 000
PRODUCTS - COMP/OP AGG
$2 000 000
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
BODILY INJURY
$
(Per person)
BODILY INJURY
$
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
$
AUTO ONLY: AGG
EACH OCCURRENCE
$2 DOD 000
AGGREGATE
$2 00D ODD
$
$
WC STATU- I OTH-
I.ImIT,i
E.L. EACH ACCIDENT
_-
$500,000
E.L. DISEASE - EA EMPLOYEE
$500,000
E.L. DISEASE • POLICY LIMIT $500,000
Limit: $2,000,000
Retention: $25,000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ a DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AU HORIZED REPRESENTATIVE I
MJJ 0 ACORD CORPORATION 1988
v-4
f ,,� il'URio0A