05/19/2010 BOCC Agreement
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
May 25, 2010
TO:
Fire Chief James Callahan
Fire-Rescue Department
A TTN:
FROM:
Camille Dubroff
Pamela G. Hanc(l::?J;c.
At the May 19, 2010, Board of County Commissioners meeting the granted approval to
award bid and enter into an Agreement between the Board of Governors Fire and Ambulance
District 1 of Monroe County and Advanced Data Processing Inc. (dba ADPI-Intermedix) for
ground and air rescue transport billing and related professional services.
Enclosed is a duplicate original of the above-mentioned (Item C29 and Item G2) for your
handling. Should you have any questions please do not hesitate to contact this office.
cc: County Attorney
Finance
File/'
CONTRACT BETWEEN
THE BOARD OF COUNTY COMMISSIONERS, MONROE COUNTY, FLORIDA
AND
THE BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT 1
OF MONROE COUNTY, FLORIDA
AND
ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX)
FOR GROUND AND AIR RESCUE TRANSPORT BILLING
AND RELATED PROFESSIONAL SERVICES \
THIS CONTRACT, hereinafter "CONTRACT OR AGREEMENT" is made and entered
into this 19th day of May, 2010 by and between the BOARD OF COUNTY
COMMISSIONERS and the BOARD OF GOVERNORS OF FIRE AND AMBULANCE
DISTRICT 1, MONROE COUNTY, a political subdivision of the State of Florida, with
principal offices located at 490 63rd Street, Marathon, FL 33050 (the District and Monroe
County are hereinafter referred to collectively as the "COUNTY"), and ADVANCED
DATA PROCESSING, INC. DBA ADPI-INTERMEDIX, hereinafter referred to as
"CONTRACTOR":
WITNESSETH:
WHEREAS, the COUNTY advertised a notice of request for proposals for GROUND
AND AIR RESCUE TRANSPORT BILLING;
WHEREAS, the successful Respondent was Advanced Data Processing Inc. (DBA ADPI
- Intermedix., and;
WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide
such services, and;
WHEREAS, the COUNTY intends to enter into an agreement for the provision of rescue
air and ground transport billing and related professional services by the CONTRACTOR
to the COUNTY; and,
WHEREAS, the CONTRACTOR represents that it is capable and prepared to provide
such Services:
NOW THEREFORE, in consideration of the promises contained herein, the parties
hereto agree as follows:
1. CONTRACT PERIOD AND RENEWAL - The term. of this Agreement shall be for a
three (3) year term from June 1. 2010 through May 31. 2013. with the option to renew for
two (2) additional one year periods at the sole option of COUNTY, subject to
cancellation as provided herein. The COUNTY'S performance and obligation to pay
under this contract, is contingent upon an annual appropriation by the Board of County
Commissioners.
2. SERVICE TO BE PERFORMED BY CONTRACTOR - The CONTRACTOR shall
perform the services as specifically stated in the Scope of Services (Attachment A)
without requirement for the issuance of any additional work orders. Additional services
may be issued in the form of a Work Order. Each Work order will set forth a specific
Scope of Services, amount of compensation, deliverables and completion date and shall
be subject to the approval of the COUNTY. CONTRACTOR shall perform no additional
services until any applicable Work Order is obtained from the COUNTY and
countersigned by the CONTRACTOR.
3. COMPENSATION - The CONTRACTOR shall provide to the COUNTY a monthly
invoice representing fees for the services provided computed as:
A. Five point five zero percent (5.50%) for ground accounts and four point zero per
cent (4.00%) for air accounts, of all monies collected by the CONTRACTOR,
excluding Medicaid accounts, during the previous month.
B. In compliance with Florida Statutes 409.913 (9), the CONTRACTOR shall
include in the same invoice an amount of $11.00 per processed Medicaid account
for both ground and air accounts providing all billing services related to such
accounts processed in the previous month, regardless of whether or not payment
was received.
C. Price shall include but not be limited to all stationery, fax forms, envelopes,
mailings, postage and. telecommunications/phone facilities/charges.
D. Ground and Air Rescue Transport Billing shall be invoiced separately.
4. STANDARD OF CARE - CONTRACTOR shall exercise the same degree of care,
skill, and diligence in the performance of Services as is ordinarily provided by a
professional CONTRACTOR, offering services for local governments in South Florida,
under similar circumstances and CONTRACTOR shall, at no additional cost to the
COUNTY, re-perform services which fail to satisfy the foregoing standard of care.
5. INDEPENDENT CONTRACTOR - The CONTRACTOR is an independent
contractor and not an employee or agent of the COUNTY except that CONTRACTOR
shall be authorized as an agent as follows: To the extent necessary to fulfill its billing and
collection efforts under this Agreement, the CONTRACTOR is authorized to execute the
following types of standard forms and correspondences only: probate filings; letters to
patients or their representatives verifying that an account is paid in full; forms verifying
the tax-exempt status of the COUNTY; and insurance filings and related forms. The
CONTRACTOR has no authority to sign any other document's except as specifically
authorized by the COUNTY.
CONTRACTOR undertakes performance of the Services as an independent contractor
and shall be wholly responsible for the methods of performance. CONTRACTOR shall
work closely with the COUNTY in performing Services under this Agreement.
The CONTRACTOR shall retain full control over the employment, direction,
compensation and discharge of all persons assisting in the performance of service by
CONTRACTOR. The CONTRACTOR shall be fully responsible for all matters relating
to payment of employees, including compliance with Social Security, withholding tax
and all other laws and regulations governing such matters. The CONTRACTOR shall be
responsible for its own acts and those of its agents and employees during the term of this
contract. The CONTRACTOR shall not receive any the COUNTY benefits, stipend or
privileges afforded by the COUNTY employees.
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6. COMPLIANCE WITH LAWS - In performance of the Services, CONTRACTOR will
comply with applicable regulatory and other applicable requirements including federal,
state, and local laws, rules regulations, orders, codes, criteria and standards.
7. ADDITIONAL REQUIRED ST A TEMENTSNERIFICA TION/ AFF ADA VITS -
Attached hereto and incorporated herein are Attachments B, C, D, E, and F are Non-
Collusion Affidavit, Public Entity Crime Statement, Drug Free Workplace Form, Conflict
of Interest Clause and Indemnification to Hold Harmless.
8. INSURANCE - During the term of this contract, the CONTRACTOR must keep in
force and affect the insurance required by Attachments G. Attachment G is attached and
incorporated into this contract.
The insurance coverage and conditions afforded by this policy(s) shall not be suspended,
voided, canceled or modified, except after thirty (30) days prior written notice by
Certified Mail Return Receipt Requested, has been given to the COUNTY department
that originated this contract.
Certificates of Insurance meeting the specific required provision specified within this
Contract! Agreement shall be forwarded to the COUNTY department that originated the
contract, and approved prior to the start of any work or the possession of any the
COUNTY property or the commencement of services, as application.
9. MONROE COUNTY'S RESPONSffiILITIES - The COUNTY, during the term of
this Agreement, shall:
A. Supply the electronic "Run Report" to CONTRACTOR with the necessary patient
information on a timely basis for those patients that have been transported by
Fire-Rescue Services and in sufficient detail to support diagnosis and procedure
coding and make reasonable efforts to provide patient demographic information
necessary for accurate patient identification including name, address, social
security number, date of birth, and telephone number.
B. Provide CONTRACTOR with its approved billing policies and procedures
including fee schedules and collection protocols. The COUNTY shall be
responsible for engaging any third party collection service for uncollectible
accounts after CONTRACTOR has exhausted its collection efforts.
C. Make reasonable efforts to timely process refunds identified by CONTRACTOR
for account overpayments.
D. Provide a Lock Box address to CONTRACTOR and will instruct Lock Box to
forward all Lock Box documents to CONTRACTOR for processing.
E. Provide for CONTRACTOR to have daily bank balance reporting capabilities via
internet access with bank.
F. Comply and cooperate with CONTRACTOR in all matters to ensure proper
compliance with all Federal, State and local laws rules and regulations as
applicable to the services being contracted for.
10. TERMINATION OF AGREEMENT - During the time of this Agreement either
party may terminate this Agreement for convenience by first giving to other party at least
thirty (30) days prior written notice. Upon notice of termination CONTRACTOR shall
take all steps necessary to close out any accounts with an open balance and will be
responsible for complying with all provisions of this contract until the termination date.
CONTRACTOR will not assume new accounts after such notice of termination.
3
CONTRACTOR will be paid for its services through the termination date and
CONTRACTOR will not incur any expense after notice of termination except those
necessary to properly wind up its obligations under this contract and properly perform
this contract. All money received on accounts by CONTRACTOR after the termination
date will be forwarded to the COUNTY without regular compensation being paid to the
CONTRACTOR. CONTRACTOR will further cooperate with any successor by turning
over all records and any other documents or equipment in hard copy to useable electronic
format to the COUNTY or the new billing company. CONTRACTOR will pay the
COUNTY all funds due and owing to it as the termination of this contract. The provision
for CONTRACTOR to turn over documents and to provide all funds due and owing the
COUNTY will survive the termination of this contract.
In the event the acts constituting default are a violation of law, CONTRACTOR shall be
subject to immediate termination. Notwithstanding the provisions above, the COUNTY
shall not have any right to cancel this contract without cause.
Upon termination, the CONTRACTOR shall submit an invoice(s) to the COUNTY in an
amount(s) representing fees for services actually performed or obligations incurred to the
date of effective termination for which the CONTRACTOR has not been previously
compensated. Upon payment of all sums found due, the COUNTY shall be under no
further obligation to the CONTRACTOR, financial or otherwise.
11. NONDISCLOSURE OF PROPRIETARY INFORMATION - CONTRACTOR shall
consider all information provided by the COUNTY and all reports, studies calculations,
and other documentation resulting from the Contractor's performance of the Services to
be proprietary unless such information is available from public sources or is a public
record under Florida law. CONTRACTOR shall not publish or disclose proprietary
information for any purpose other than the performance of the Services without the prior
written authorization of the COUNTY or in response to legal process or orders of a court
of competent jurisdiction.
Public Access -The County and Contractor shall allow and permit reasonable access to,
and inspection of, all documents, papers, letters or other materials in its possession or
under its control, which are public records and which are subject to the provisions of
Chapter 119, Florida Statutes, and made or received by the County and Contractor in
conjunction with this Agreement; and the County shall have the right to unilaterally
cancel this Agreement upon violation of this provision by Contractor.
12. UNCONTROLLABLE FORCES - Neither the COUNTY 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. 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,
hurricanes, storms, lightning, epidemic, war, riot, civil disturbance, sabotage, Acts of
God and governmental actions.
Neither party shall, however, be excused from performance ifnon-performance is due to
forces which are preventable, removable, or remediable and 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
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written notice to the other party describing the circumstances and uncontrollable forces
preventing continued performance of the obligations of this Agreement.
13. MISCELLANEOUS
A. Non Waiver - A waiver by either the COUNTY or CONTRACTOR of any breach
of this Agreement shall not be binding upon the waiving party unless such waiver
is in writing and duly signed by both parties to this agreement. In the event of a
written waiver, such a waiver shall not affect the waiving party's rights with
respect to any other or further breach. The making or acceptance of a payment by
either party with knowledge of the existence of a default or breach shall not
operate or be construed to operate as a waiver of any subsequent default or
breach.
B. Severability - The invalidity, illegality, or unenforceability of any provision of
this Agreement, or the occurrence of any event rendering any portion or provision
of this Agreement void or voidable, shall in no way affect the validity or
enforceability of any other portion or provision of the Agreement. Any void or
voidable provision shall be deemed severed from the Agreement and the balance
of the Agreement shall be construed and enforced as if the Agreement did not
contain the particular portion or provision held to be void. The parties further
agree to reform the Agreement to replace any stricken provision with a valid
provision that comes as close as possible to the intent of the stricken provision.
The provisions of this section shall not prevent the entire Agreement from being
held void should a provision which is of the essence of the Agreement be
determined to be void by a court of competent jurisdiction.
C. Political Campaigns - During the term of this Agreement, the CONTRACTOR or
any employee or associate, shall not be involved in any political campaign for the
COUNTY elective office nor make financial contribution to any such campaign.
D. Contractor Records - Contractor shall maintain all books, records, and documents
directly pertinent to performance under this Agreement in accordance with
generally accepted accounting principles consistently applied. Each party to this
Agreement or their authorized representatives shall have reasonable and timely
access to such records of each other party to this Agreement for public records
purposes during the term of the Agreement and for four years following the
termination of this Agreement. If an auditor employed by the County or Clerk
determines that monies paid to Contractor pursuant to this Agreement were spent
for purposes not authorized by this Agreement, the Contractor shall repay the
monies together with interest calculated pursuant to Sec. 55.03, FS, running from
the date the monies were paid to Contractor.
E. Attorney's Fees and Costs - The County and Contractor agree that in the event
any cause of action or administrative proceeding is initiated or defended by any
party relative to the enforcement or interpretation of this Agreement, the
prevailing party shall be entitled to reasonable attorney's fees, court costs,
investigative, and out-of-pocket expenses, as an award against the non-prevailing
party, and shall include attorney's fees, courts costs, investigative, and out-of-
pocket expenses in appellate proceedings. Mediation proceedings initiated and
conducted pursuant to this Agreement shall be in accordance with the Florida
Rules of Civil ProcedUre and usual and customary procedures required by the
circuit court of Monroe County.
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F. Binding Effect - The terms, covenants, conditions, and provisions of this
Agreement shall bind and inure to the benefit of the County and Contractor and
their respective legal representatives, successors, and assigns.
G. Authority - Each party represents and warrants to the other that the execution,
delivery and performance of this Agreement have been duly authorized by all
necessary County and corporate action, as required by law.
H. Claims for Federal or State Aid - Contractor and County agree that each shall be,
and is, empowered to apply for, seek, and obtain federal and state funds to further
the purpose of this Agreement; provided that all such applications, requests, grant
proposals, and funding solicitations shall be approved by each party prior to
submission.
I. Adjudication of Disputes or Disagreements - County and Contractor agree that all
disputes and disagreements shall be attempted to be resolved by meet and confer
sessions between representatives of each of the parties. If the issue or issues are
still not resolved to the satisfaction of the parties, then any party shall have the
right to seek such relief or remedy as may be provided by this Agreement or by
Florida law.
J. Cooperation - In the event any administrative or legal proceeding is instituted
against either party relating to the formation, execution, performance, or breach of
this Agreement, County and Contractor agree to participate, to the extent required
by the other party, in all proceedings, hearings, processes, meetings, and other
activities related to the substance of this Agreement or provision of the services
under this Agreement. County and Contractor specifically agree that no party to
this Agreement shall be required to enter into any arbitration proceedings related
to this Agreement.
K. Nondiscrimination - County and Contractor agree that there will be no
discrimination against any person, and it is expressly understood that upon a
determination by a court of competent jurisdiction that discrimination has
occurred, this Agreement automatically terminates without any further action on
the part of any party, effective the date of the court order. County or Contractor
agree to comply with all Federal and Florida statutes, and all local ordinances, as
applicable, relating to nondiscrimination. These include but are not limited to: 1)
Title VI of the Civil Rights Act of 1964 (PL 88-352) which prohibits
discrimination on the basis of race, color or national origin; 2) Title IX of the
Education Amendment of 1972, as amended (20 USC SSe 1681-1683, and 1685-
1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the
Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits
discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975,
as amended (42 USC SSe 6101-6107) which prohibits discrimination on the basis
of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as
amended, relating to nondiscrimination on the basis of drug abuse; 6) The
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (PL 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public
Health Service Act of 1912, SSe 523 and 527 (42 USC SSe 690dd-3 and 290ee-3),
as amended, relating to confidentiality of alcohol and drug abuse patent records;
8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended,
relating to nondiscrimination in the sale, rental or financing of housing; 9) The
6
Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe
amended from time to time, relating to nondiscrimination on the basis of
disability; 10) Monroe County Code Ch. 13, Art. VI, prohibiting discrimination
on the bases of race, color, sex, religion, disability, national origin, ancestry,
sexual orientation, gender identity or expression, familial status or age; and 11)
any other nondiscrimination provisions in any Federal or state statutes which may
apply to the parti~s to, or the subject matter of, this Agreement.
L. Covenant of No Interest - County and Contractor covenant that neither presently
has any interest, and shall not acquire any interest, which would conflict in any
manner or degree with its performance under this Agreement, and that only
interest of each is to perform and receive benefits as recited in this Agreement.
M. Code of Ethics - County agrees that officers and employees of the County
recognize and will be required to comply with the standards of conduct for public
officers and employees as delineated in Section 112.313, Florida Statutes,
regarding, but not limited to, solicitation or acceptance of gifts; doing business
with one's agency; unauthorized compensation; misuse of public position,
conflicting employment or contractual relationship; and disclosure or use of
certain information.
N. No Solicitation/Payment - The County and Contractor warrant that, in respect to
itself: it has neither employed nor retained any company or person, other than a
bona fide employee working solely for it, to solicit or secure this Agreement and
that it has not paid or agreed to pay any person, company, corporation, individual,
or firm, other than a bona fide employee working solely for it, any fee,
commission, percentage, gift, or other consideration contingent upon or resulting
from the award or making of this Agreement. For the breach or violation of the
provision, the Contractor agrees that the County shall have the right to terminate
this Agreement without liability and, at its discretion, to offset from monies owed,
or otherwise recover, the full amount of such fee, commission, percentage, gift, or
consideration.
O. Privileges and Immunities - All of the privileges and immunities from liability,
exemptions from laws, ordinances, and rules and pensions and relief, disability,
workers' compensation, and other benefits which apply to the activity of officers,
agents, or employees of any public agents or employees of the County, when
performing their respective functions under this Agreement within the territorial
limits of the County shall apply to the same degree and extent to the performance
of such functions and duties of such officers, agents, volunteers, or employees
outside the territorial limits of the County.
P. Legal Obligations and Responsibilities: Non-Delegation of Constitutional or
Statutory Duties - This Agreement is not intended to, nor shall it be construed as,
relieving any participating entity from any obligation or responsibility imposed
upon the entity by law except to the extent of actual and timely performance
thereofby any participating entity, in which case the performance may be offered
in satisfaction of the obligation or responsibility. Further, this Agreement is not
intended to, nor shall it be construed as, authorizing the delegation of the
constitutional or statutory duties of the County, except to the extent permitted by
the Florida constitution, state statute, and case law.
7
Q. Non-Reliance by Non-Parties - No person or entity shall be entitled to rely upon
the terms, or any of them, of this Agreement to enforce or attempt to enforce any
third-party claim or entitlement to or benefit of any service or program
contemplated hereunder, and the County and the Contractor agree that neither the
County nor the Contractor or any agent, officer, or employee of either shall have
the authority to inform, counsel, or otherwise indicate that any particular
individual or group of individuals, entity or entities, have entitlements or benefits
under this Agreement separate and apart, inferior to, or superior to the community
in general or for the purposes contemplated in this Agreement.
R. Attestations - Contractor agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics
Statement, and a Drug-Free Workplace Statement.
S. No Personal Liability - No covenant or agreement contained herein shall be
deemed to be a covenant or agreement of any member, officer, agent or employee
of Monroe County in his or her individual capacity, and no member, officer, agent
or employee of Monroe County shall be liable personally on this Agreement or be
subject to any personal liability or accountability by reason of the execution of
this Agreement.
T. Execution in Counterparts - This Agreement may be executed in any number of
counterparts, each of which shall be regarded as an original, all of which taken
together shall constitute one and the same instrument and any of the parties hereto
may execute this Agreement by singing any such counterpart.
14. INTEGRATION AND MODIFICATION - This Agreement is adopted by the
COUNTY and CONTRACTOR as a final, complete and exclusive statement of the terms
of the Agreement between the COUNTY and CONTRACTOR. This Agreement
supersedes all prior agreements, contracts, proposals, representations, negotiations, letters
or other communications between the COUNTY and CONTRACTOR pertaining to the
Services, whether written or oral. The Agreement may not be modified unless such
modifications are evidenced by an amendment in writing signed by both the COUNTY
and CONTRACTOR.
15. OWNERSHIP OF DOCUMENTS - CONTRACTOR shall be required to work in
harmony with other CONTRACTOR'S relative to providing information requested in a
timely manner and in the specified form. Any and all documents, records, disks, original
drawings, or other information shall become the property of the COUNTY upon
completion for its use and distribution as may be deemed appropriate by the COUNTY.
Failure to turn over such documents within seven (7) days of when requested may be
cause for the COUNTY to withhold any payments due CONTRACTOR or to enforce this
clause by legal remedies.
16. NOTICE - Any notice, demand, communication, or request required or permitted
hereunder shall be in writing and delivered in person or sent by certified mail, postage
prepaid as follows:
As to the COUNTY
MONROE COUNTY EMERGENCY SERVICES
Attention: Fire Chief James Callahan
490 63rd Street Ocean
~arathon,FI33050
8
As to CONTRACTOR
Advanced Data Processing Inc. (DBA ADPI-INTERMEDIX)
6451 North Federal Highway, Suite 1002
Fort Lauderdale, FL 33308
Notices shall be effective when received at the address specified above. Changes in the
respective addresses to which such notice may be directed may be made from time to
time by any party by written notice to the other party. Facsimile is acceptable notice
effective when received, however, facsimiles received (i.e. printed) after 5:00 p.m. or on
weekends or holidays, will be deemed received on the next business day. The original of
the notice must additionally be mailed as required herein.
Nothing contained in this Article shall be construed to restrict the transmission of routine
communications between representatives of CONTRACTOR and the COUNTY.
17. Monroe County's performance and obligation to pay under this contract is contingent
upon an annual appropriation by the Board of County Commissioners of Monroe County,
Florida.
18 · Venue for any litigation arising under this contract must be in a court of competent
jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration.
WITNESS WHEREOF, each party hereto has caused this contract to be executed by
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By:
BOARD OF COUNTY
COMMISSIONERS OF
MONROE COUNTY, FLORIDA
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9
ATTACHMENTS AND FORMS:
Attachment A
Attachment B
Attachment C
Attachment D
Attachment E
Attachment F
Attachment G
Scope of Work
Non-Collusion Affidavit
Public Entity Crime Statement
Drug Free Workplace Form
Lobbying & Conflict of Interest Clause- (Ethics Clause)
Indemnification and Hold Harmless
Insurance Documents
10
Attachment A
SCOPE OF WORK
The CONTRACTOR shall provide the COUNTY with timely and accurate complete
medical billing and accounts receivable management services for the COUNTY'S ground
and air rescue transport billing services and related professional services in accordance
with the responsibilities outlined as follows:
1. Initial Patient Treatment and Information
A. On a case by case basis, the COUNTY will respond to patients requiring
immediate medical treatment and emergency medical transportation services.
Upon treating each patient, the COUNTY shall provide the CONTRACTOR with
patient information identified on the "Run Report". CONTRACTOR shall be
solely responsible for retrieving insurance information and any additional patient
information which was not identified on the "Run Report" provided by the
COUNTY. CONTRACTOR shall utilize "Run Report" information and any
additional information retrieved by CONTRACTOR to file proper patient billing
and insurance information. CONTRACTOR shall establish arrangements with
hospitals to obtain/verify patient insurance and contact information.
CONTRACTOR shall contact the u.S. Post Office's National Change of Address
(NCOA) files or other similar services to obtain the correct billing addresses and
phone numbers for patients that have left the area, or whom have invalid
information.
B. CONTRACTOR shall reconcile the number of patients that are transported for
emergency medical services with those received. The CONTRACTOR shall
report discrepancies to the COUNTY within three (3) business days of receipt.
C. As requested by the COUNTY, CONTRACTOR shall provide the COUNTY'S
Fire Rescue Services Paramedics Personnel with training on the gathering of
necessary information to be adhered on Run Reports for the purpose of assisting
CONTRACTOR with the proper submission and processing of patient data.
2. Patient Billing
A. CONTRACTOR shall mail an invoice to each patient for emergency
transportation service at current rates set forth by the COUNTY as follows:
Ground Ambulance:
$600.00 for Basic Life Support (BLS)
$600.00 for Advance Life Support One (ALSI)
$800.00 for Advance Life Support Two (ALS2)
$12.00 per mile
Air Ambulance:
$5500.00 for Air Ambulance Transport Fee
$80.00 per mile
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B. The aforementioned rates shall be subject to change at the COUNTY'S discretion
at any time throughout the term of the agreement; the COUNTY agrees to notify
CONTRACTOR a minimum of seven (7) days prior to any rate changes.
C. The CONTRACTOR shall provide all self pay patients with a comprehensive
statement/invoice including a courtesy return payment envelope. The front of the
statement shall describe all charges and payments. The reverse side of the
statement shall have clearly marked entry blocks for information needed to file
private insurance claims. CONTRACTOR shall file claims and send an invoice
to all self pay patient/payors with return envelope and address as specified by the
COUNTY within five (5) days of receipt of incident information. Subsequent
invoices to self-pay patient/payor will be sent at thirty-five (35) day intervals, up
to a maximum of six invoices.
CONTRACTOR shall send one initial statement/invoice to a patient for whom
Medicare, Medicaid or private insurance (payor) information is available when
an account is filed to the insurance company. These statements will be mailed at
45 days from filing the insurance claim. Thereafter, CONTRACTOR will send a
maximum of six invoices to payor.
In the course of time that the six invoices are sent to patient/payor and payment
in full has not yet been received, CONTRACTOR shall provide follow-up on
rejected and inactive claims and establish payor remittance accounts and
procedures. In the case of patients for whom payor information is available,
CONTRACTOR at that time shall resume sending invoices to patient and shall,
within fourteen (14) days of receiving a final decision from the payor, send a
maximum of five (5) additional invoices to the patient every thirty-five (35) days
thereafter in an attempt to collect the claim.
Unless insurance, Medicare, Medicaid or secondary insurance payment is
pending, CONTRACTOR shall on a monthly basis send all eligible accounts that
have not had activity for 210 days or more from the date of service a Pre-
Collection Letter. The Pre-Collection Letter will be provided to the
CONTRACTOR by the COUNTY. These accounts have thirty (30) days to
respond to the CONTRACTOR. Once the thirty (30) days have expired, the
CONTRACTOR shall send the COUNTY a list of all accounts along with a
complete processing history once collection efforts are exhausted. These
uncollectible accounts will be forwarded by the CONTRACTOR onto a third
party collection agency named by the COUNTY for further attempts at collecting.
These accounts sent to the third party collection agency will be sent via a secure
site provided by the CONTRACTOR. The CONTRACTOR will continue to work
with the third party collection agency on a case by case basis for those accounts
requiring additional information.
D. CONTRACTOR shall negotiate and arrange modified payment schedules for
patients unable to pay the full amount when billed. CONTRACTOR shall not
reduce the amount owed and shall not negotiate settlements. All settlement
requests shall be forwarded to the COUNTY for review, processing and BOARD
approval.
12
E. CONTRACTOR shall process refund requests within the month following an
overpayment and provide the COUNTY with documentation substantiating each
refund requested.
F. Where CONTRACTOR has found no method of payment for a patient after all
insurance avenues are exhausted including State Medicaid and local HRS or
municipal programs, such cases that cannot be forwarded to the collection
agency will be submitted to the COUNTY in writing once a year, for final
resolution along with appropriate documentation (i.e. hospital credit status, credit
file information, activity file). At the instruction of the COUNTY,
CONTRACTOR shall write off any amounts or make any adjustments to a bill,
including, but not limited to; patient disputes regarding mileage, special handling
charges or the bill in its entirety.
G. CONTRACTOR shall provide the COUNTY with real-time read only electronic
look-up access of CONTRACTOR'S patient data and billing information system.
CONTRACTOR shall provide the facilities to receive patient billing information
from the COUNTY electronically. CONTRACTOR- This may be done through
email or other method that meets Patient Privacy requirements.
H. Via Resolution 152-2009, the COUNTY provides a Trauma Star Air Ambulance
Resident Fee Waiver Program, whereby the COUNTY has agreed to accept
insurance proceeds as full payment for the air transport using Trauma Star for
qualified residents (trauma scene and interfacility transport).
CONTRACTOR shall provide all air ambulance accounts with a Trauma Star Air
Ambulance Resident Fee Waiver Program application in each monthly statement.
This application will be provided to the CONTRACTOR by the COUNTY. The
application contains eligibility requirements for the Trauma Star Resident Fee
Waiver Program and directs the patient on how to apply. The CONTRACTOR
will provide the COUNTY with all completed applications for verification and
determination. The COUNTY will notify the CONTRACTOR of the conclusion
on all applications. The CONTRACTOR will verify that all billing sources have
been exhausted and then place a hold on all Approved accounts. The
CONTRACTOR will adjust balances on these accounts as directed by the
COUNTY.
I. CONTRACTOR shall not bill Monroe County Sheriff's Office or Monroe
County for transportation services rendered via Trauma Star to arrestees, which
are arrested for violation of state law or county ordinance, when all other
reimbursement sources have been sought since the transportation services are
already funded by Monroe County and to bill for such services would be a
misuse of time and resources per Resolution #449-2009 approved November 18,
2009.
3. Patient Filing
A. CONTRACTOR shall file all insurance claim forms for all patients based upon
information received from Run Report and research performed by
13
CONTRACTOR. CONTRACTOR shall provide prompt submission of required
paperwork to Medicare, Medicaid, Insurance Companies or Third Party Payers
for claims, reviews, resubmission, provider agreements and other as required
within 72 hours after receiving the requested "Run Report" from the COUNTY.
CONTRACTOR shall submit secondary insurance provider claims after the
primary insurance provider has paid within 30 days after receipt of payment from
primary insurer. Upon receipt of notice of claim denial, requirement for
additional information, Explanation of Benefits reflecting underpayment or other
notice requiring submission of documents to the third party provider
CONTRACTOR shall within 45 days re-file Medicare, Medicaid, or Insurance
claims to obtain payment. CONTRACTOR shall maintain responsibility for
obtaining missing or incomplete insurance information. CONTRACTOR shall
process all third party reimbursements within one week after receipt of
appropriate billing information from primary payor.
B. CONTRACTOR shall utilize the most up-to-date knowledge and information
with regard to coding requirements and standards and proper preparation of
electronic and paper insurance filings to ensure compliance with applicable
Federal, State and local regulations.
4. Maintaining Records
A. CONTRACTOR shall maintain records in an electronic format that is readily
accessible by the COUNTY and meets all federal and state requirements for
maintaining patient medical records.
B. CONTRACTOR shall maintain appropriate accounting procedures for reconciling
all deposits, receivables, billings, patient accounts, adjustments and refunds.
C. CONTRACTOR shall facilitate proper security of confidential information and
further shred and dispose of materials containing such information.
D. CONTRACTOR shall implement and comply with a Compliance Plan consistent
with the intent and activities included in the U.S. Office of Inspector General
(OIG) Compliance Program Guidance for Third Party Medical Billing Companies
63 FR 70138; (December 18, 1998).
E. CONTRACTOR shall retain all accounts for a minimum of twelve (12) months
(unless otherwise specified by mutual agreement).
F. CONTRACTOR shall ensure that all required documentation and agreements
with payors (e.g. Medicare, Medicaid, Champus, etc.) are filed and maintained
and that the COUNTY is kept apprised of important changes to industry
regulations.
G. CONTRACTOR shall be knowledged of different industry insurance plans and
shall ensure the COUNTY that every billable claim is pursued accordingly by
CONTRACTOR.
H. CONTRACTOR shall advise the COUNTY on statutes and industry regulations
which would affect emergency transportation service rates.
5. Customer Service:
A. CONTRACTOR shall provide a toll free telephone number for patients with
CONTRACTOR'S own facilities and workforce. CONTRACTOR'S toll free
14
telephone number must be a dedicated phone number only for accounts from the
COUNTY. CONTRACTOR shall provide a designated liaison for patient/payor
concerns.
B. CONTRACTOR shall conduct all written and verbal communication in the most
professional manner. The CONTRACTOR shall never in any way represent them
in a way that might be interpreted as intimidating or threatening.
C. CONTRACTOR shall respond within three (3) business days of any verbal or
written requests made by Patients and/or the COUNTY for information or
records. CONTRACTOR shall assist patients that are not able to speak the
English language. Difficult calls such as, but not limited to: special insurance
issues, taxpayer questions, irate calls shall be handled in a professional manner by
a supervisor employed with CONTRACTOR'S firm.
D. CONTRACTOR shall provide all customer inquiry services and prepare
additional third-party claims or patient payment arrangements based on this
information exchange.
E. At the COUNTY'S request, CONTRACTOR shall provide survey questionnaires
or mail inserts to patients. CONTRACTOR shall mail requested citizen
satisfaction surveys.
F. CONTRACTOR shall provide for facilities to permit dial-up access to retrieve
patient data and billing information.
6. Audits
A. CONTRACTOR shall provide access to the COUNTY for all requested
information in order for the COUNTY to perform appropriate and periodic
audits. The COUNTY will provide CONTRACTOR with reasonable notice for
any planned audit and CONTRACTOR shall conduct audit during normal
business hours.
7. Monthly Reports
Unless otherwise indicated, CONTRACTOR shall provide the following reports
on a monthly basis as identified and prescribed by the COUNTY. Monthly reports
shall be produced after the month's closing and provided to the COUNTY no later
than the tenth of each month. Ground and Air Rescue accounts will be reported
separately.
A. Ambulance Unit Report: On a monthly basis, CONTRACTOR shall provide a
report of number of calls and gross billed by ambulance unit for the current
period.
B. Ambulance New Billing Report: CONTRACTOR shall produce a report
showing all billing (new charges) processed alpha sorted by Last Name and
summarized total billing for period. CONTRACTOR shall add column for date
received from the COUNTY.
C. Ambulance Payment Report: CONTRACTOR shall provide a batch oriented
listing of all payments processed including check number and type of payment
(selfpay, Medicare, Medicaid, private insurance).
15
D. Gross Collection Statistics Summary: CONTRACTOR shall provide a running
summary of Interfacility transactions including monthly amount billed, collected,
Percentage collected, number of Accounts and Gross Billed .
E. Schedule of Transport Charges & Collections: CONTRACTOR shall provide a
running month summary of charge, payment and adjustments for the closing
month period showing gross and net collection percentages for each period.
Information provided shall be for last five fiscal years only.
F. Report of Accounts Receivable: CONTRACTOR shall provide a summary for
period ending of Accounts Receivable showing gross billing, payments
received/processed, reflected write-offs and adjustments, reversals and ending
balance.
G. Monthly Billing and Collection Summary: CONTRACTOR shall produce a
report showing receivables as applied to month rwining or original billed month.
Information provided shall be for last five fiscal years only.
H. Insurance Receivable ReDort: CONTRACTOR shall provide a summary of billed
month the number of patient bills having an outstanding insurance balance. This
will show the balance and number of bills outstanding by class.
I. Collection by Financial Class: CONTRACTOR shall provide a running month
summary for the closing month period of collections by Payor Class (Self-Pay,
Medicare, Medicaid and Private Insurance). CONTRACTOR shall denote billing
numbers for each category and total. Information provided shall be for last five
fiscal years only.
J. Collection Schedule: CONTRACTOR shall provide a running summary of
collected amounts to include monthly, fiscal and cumulative amounts.
K. Ambulance Billing Adjustments-Write Offs-Reversals: CONTRACTOR shall
provide a running summary showing all adjustments, write-offs and reversals
from Medicare, Medicaid and Insurance.
L. Report of Accounts Receivable Removed: CONTRACTOR shall provide a report
showing Accounts sent to Collections with Original Amount Billed, Payments
made, Adjusted Amounts and Balance owed. These accounts will have had no
activity for 12 months or more. This report will only be provided on the months
that the CONTRACTOR sent accounts to collections.
M. ReDort by Incident Date: CONTRACTOR shall provide a report by account detail
of all accounts outstanding to include Original Amount billed, Adjusted Amount,
and Balance due.
N. Monthly Refund Schedule: CONTRACTOR shall provide a report by account
detail of associated payments reflecting an overpayment and necessary refund to
be processed.
o. Aging Report: On a monthly basis, CONTRACTOR shall provide a report which
lists patients' accounts receivable amounts by age to alert the COUNTY of any
slow paying patients.
P. Timeliness of Billing Report: On a monthly basis, CONTRACTOR shall provide
a report which lists the number of times invoices were sent to each patient. This
16
report will be used by the COUNTY to verify compliance with Attachment A
Section B2 of the Agreement.
Q. Air Ambulance Resident Waiver Rel>ort: On a monthly basis the CONTRACTOR
shall provide a report which lists the air transport accounts that have been
approved for the Trauma Star Resident Fee Waiver Program. These accounts will
be placed on hold until the COUNTY directs the CONTRACTOR to adjust the
balances.
8. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The CONTRACTOR shall comply with the privacy regulations pursuant to Public Law
104-191 of August 21, 1996, known as the Health Insurance Portability and
Accountability Act of 1996, Subtitle F - Administrative Simplification, Sections 261, et
seq., as amended ("HIP AA"), to protect the privacy of any personally identifiable
protected health information ("PHr') that is collected, processed or learned as a result of
the Billing Services provided hereunder.
A. CONTRACTOR shall not use or further disclose PHI except as permitted herein
or required by law.
B. CONTRACTOR shall use appropriate safeguards to prevent use or disclosure of
PHI except as permitted herein.
C. CONTRACTOR shall mitigate, to the extent practicable, any harmful effect that
is known to CONTRACTOR, its agents or subcontractors of a use or disclosure of
PHI by the CONTRACTOR, its agents or subcontractors.
D. CONTRACTOR shall report to the COUNTY any use or disclosure of PHI not
provided for by this Agreement of which the CONTRACTOR, its agents or
subcontractors become aware.
E. CONTRACTOR shall ensure that any agents or subcontractors to whom the
CONTRACTOR provide PHI or who have access to PHI, agree to the same
restrictions and conditions that apply to the CONTRACTOR with respect to such
PHI.
F. CONTRACTOR shall make PHI available to the COUNTY and to the individual
who has a right of access as required under HIP AA within 30 days of the request
by the COUNTY regarding the individual.
G. CONTRACTOR shall incorporate ally amendments to PHI when notified to do so
by the COUNTY.
H. CONTRACTOR shall provide an accounting of all uses or disclosures of PHI
made by the CONTRACTOR its agents or subcontractors as required under the
HIP AA privacy rule within sixty (60) days.
I. CONTRACTOR shall make their internal practices, books and records relating to
the use and disclosure of PHI available to the Secretary of the Department of
Health and Human Services for purposes of determining the CONTRACTOR'S,
its agents' and subcontractors' and the COUNTY'S compliance with HIPAA.
J. CONTRACTOR shall at the termination of the agreement, return or destroy all
PHI received from, or created or received by the CONTRACTOR, its agents or
17
subcontractors on behalf of the COUNTY and if return is infeasible, ensure that
the protections of this Agreement will extend to such PHI.
K. The specific uses and disclosures of PHI that may be made by the
CONTRACTOR, its agents or contractors on behalf of the COUNTY include:
1) Preparation of invoices to patients, carriers, insurers and others
responsible for payment or reimbursement of the services provided by the
COUNTY to its patients.
2) Preparation of reminder notices and documents pertaining to collections of
overdue accounts.
3) The submission of supporting documentation to carriers, insurers and
other payers to substantiate the health care services provided by the
COUNTY to its patients or to appeal denials of payment for same.
4) Other uses or disclosures of PHI as permitted by the HIP AA privacy rule.
5) Mail HIPAA Notice of Privacy Practices to all emergency transport
patients within the timeframe allowed under the HIP AA and FlIP AA
rules.
6) Mail subpoenas, attorney's requests to Fire Rescue immediately upon
receipt
9. Lockbox
A. The County will provide a Lock Box address to the CONTRACTOR and will
instruct Lock Box to forward all Lock Box documents to CONTRACTOR for
payment processing.
B. Price for services does not include the cost of "Locked-box" service. The
COUNTY shall bear the cost of the Locked-box.
C. The County will provide the CONTRACTOR acce,ss to have daily bank balance
reporting capabilities via internet access with Lockbox bank.
D. The "Locked-box" service selected shall be at the sole discretion of the
COUNTY and shall provide a secure postal address and box for receipt of all
correspondence (especially including all insurance and patient payments,
correspondence and benefits determination and denials). The "Locked-box"
service will on a daily basis perform the following:
1) Open all mail (except clearly marked returned-mail).
2) Make a copy of every check and attach copy with original document
accompanying each check.
3) Deposit all receivables into designated the COUNTY account.
4) Prepare and provide a daily deposit slip totaling and accounting for all
receivables deposited for the identified day.
5) Mail (daily) to the CONTRACTOR separated bundles of; copies of checks
attached to supporting documents, other correspondence and, returned-
mail along with deposit slip.
6) Mail (daily) to the COUNTY copies of checks and daily dOeposit slip.
7) Mail (monthly) to the COUNTY reconciliation of account.
18
E. CONTRACTOR shall maintain daily deposit control sheets and original
documentation.
19
Attachment B
NON- COLLUSION AFFIDAVIT
I, 1) d lA..J S-it c., """ t"I
city of ,.1. L ~ _ ~ Jrn!. /Ia
and under penalty of perjury, depose and say that;
, of the
according to law on my oath,
1) I am P~..r'~A-f I/Ju.~Jra/7J~P/,(jti7.L~N'1 f~( , the respondent
making the Proposal for the project described as follows: -'
Tra h .r(Jtl r j' :Jj'. ') t '2;
2) The prices in this proposal have been arrived at independently without
collusion, consultation, communication or agreement for the purpose of restricting
competition, as to any matter relating to such prices with any other respondent or with
any competitor;
3) Unless otherwise required by law, the prices which have been quoted in this
proposal have not been knowingly disclosed by the respondent and will not knowingly be
disclosed by the respondent prior to proposal opening, directly or indirectly, to any other
respondent or to any competitor; and
4) No attempt has been made or will be made by the respondent to induce any
other person, partnership or corporation to submit, or not to submit, a proposal for the
purpose of restricting competition; and
5) The statements contained in this affidavit are true and correct, and made with
full knowledge that Monroe County relies upon the truth of the statements contained in
this affidavit in awarding contracts for said project.
COUNTY OF
8rt?4JtLrd
Q~
(Signature of Respondent)
'-I/2A /1 P
STATE OF
Plor /ltL
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
bo~ 5---h tl-mOn who, after first being sworn by me, (name of
indivi al sIgnIng) affixed hls/her sIgnature In the space prOVIded above on this
day of
, 20 Jo
OMB - MCP FORM #1
~y ,.~ Notary Public State of Florida
, ~ ~ Cindy R Gardner
~ ~ .,; My Commission 00879720
~ 0, f\-d'f- Expires 05/12/2013
20
Attachment C
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a
conviction for public entity crime may not submit a proposal on a contract to provide any
goods or services to a public entity, may not submit a proposal on a contract with a public
entity for the construction or repair of a public building or public work, may not submit
proposals on leases of real property to public entity, may not be awarded or perform work
as a bidder, supplier, subbidder, or RESPONDENT under a contract with any public
entity, and may not transact business with any public entity in excess of the threshold
amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a
period of36 months from the date of being placed on the convicted vendor list."
By executing this form, I acknowledge that limy company is in compliance with the
above.
OR-
(Signature of Respondent)
'1/7- t( !t)
Date
STATE OF
Pion Ill.-
COUNTY OF J10iU dI J
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
D()~ S,A tLn1&'1 who, after first being sworn by me, (name of
individ I sIgmng) affixed hIs/her SIgnature In the space prOVIded above on thIS
d-1
tn
dayof hrlL
, 20 10
My comm sion expires:
NOTARY PUBLIC
~..,.'f"~ . Notary Public State of Florida
~~.~ Cindy R Gardner
~ c: ... ; My Commission 00879720
~ OJ ,,-0' Expires 05/12;2013
21
Attachment D
DRUG-FREE WORKPLACE FORM
The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies
that:
Advanced Data Processing Inc. (DBA ADPI Intermedix)
(Name of Business)
1. Publishes 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. Informs 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. Gives each employee engaged in providing the commodities or contractual services
that are under proposal a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notifies the employees that, as a condition
of working on the commodities or contractual services that are under proposal, the
employee will abide by the terms of the statement and will notify the employer of any
conviction of, or plea of guilty or nolo contendre to, any violation of Chapter 893
(Florida Statutes) or of any controlled substance law of the United States or any state, for
a violation occurring in the workplace no later than five (5) days after such conviction.
5. Imposes a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's community, or
any employee who is so convicted.
6. Makes 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 certify that this firm complies fully with
the above requirements.
rQ-~
Respondents Signature
'II :2- q 110
Date
OMB - MCP FORM #5
22
Attachment E
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
STATE OF
flor/d CL
8/tJtVar /
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Douy 5J, ttrn 0'1 who, after first being sworn by me, affixed
hislher
signature (name of individual signing) in the space provided above on this ;l. r; day
of
r,'-
t!/l ~
PUBLIC
My commission expires: 5 } L/ J- (J / 3
~~..-~Y .~~ Notary Public State of Florida
. . Cindy R Gardner
~ c.: ~ My Commission 00879720
~ 0, ;".df Exprres 05/12/2013
OMB - MCP FORM #4
23
Attachment F
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
Indemnification and Hold Harmless
for
Other Bidders and Subbidders
The Bidder covenants and agrees to indemnify and hold harmless Monroe County Board
of County Commissioners AND Board of Governors for District I, its servants, agents
and employees from any and all claims for bodily injury (including death), personal
injury, and property damage (including property owned by Monroe County) and any
other losses, damages, and expenses (including attorney's fees) which arise out of, in
connection with, or by reason of services provided by the Bidder or any of its
Subbidder(s) in any tier, occasioned by the negligence, errors, or other wrongful act or
omission of The Bidder or its Subbidders in any tier, their employees, or agents.
In the event the completion of the project (to include the work of others) is delayed or
suspended as a result of the Bidder's failure to purchase or maintain the required
insurance, the Respondent shall indemnify the County from any and all increased
expenses resulting from such delay.
The fIrst ten dollars ($10.00) of remuneration paid to the Respondent is for the
indemnification provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance
requirements contained elsewhere within this agreement.
Q--a
Respondent's Signature
'1 L"t 1 //0
Date
TCS
24
Attachment G (1 of 4)
INSURANCE REQUIREMENTS
FOR CONTRACT
GROUND AND AIR RESCUE TRANSPORT BILLNG
AND RELATED SERVICES
BETWEEN
MONROE COUNTY, FLORIDA
AND
ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX)
Prior to the commencement of work governed by this contract, the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the
contract and include, as a minimum:
· Premises Operations
· Products and Completed Operations
· Blanket Contractual Liability
. Personal Injury Liability
· Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$500,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$250,000 per Person
$500,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made
policy, its provisions should include coverage for claims filed on or after the effective
date of this contract. In addition, the period for which claims may be reported should
extend for a minimum of twelve (12) months following the acceptance of work by the
County.
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
GL2
25
Attachment G (2 of 4)
PROFESSIONAL LIABILITY
INSURANCE REQUIREMENTS
FOR CONTRACT
GROUND AND AIR RESCUE TRANSPORT BILLNG
AND RELATED SERVICES
BETWEEN
MONROE COUNTY, FLORIDA,
AND
ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX)
Recognizing that the work governed by this contract involves the furnishing of advice or
services of a professional nature, the Contractor shall purchase and maintain, throughout
the life of the contract, Professional Liability Insurance which will respond to damages
resulting from any claim arising out of the performance of professional services or any
error or omission of the Contractor arising out of work governed by this contract.
The minimum limits of liability shall be:
$500,000 per Occurrence/$! ,000,000 Aggregate
PR02
26
Attachment G (3 of 4)
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR CONTRACT
GROUND AND AIR RESCUE TRANSPORT BILLNG
AND RELATED SERVICES
BETWEEN
MONROE COUNTY, FLORIDA
AND
ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX)
Recognizing that the work governed by this contract requires the use of vehicles, the
Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance.
Coverage shall be maintained throughout the life of the contract and include, as a
minimum, liability coverage for:
· Owned, Non-Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
VL2
27
Attachment G (4 of 4)
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR CONTRACT
GROUND AND AIR RESCUE TRANSPORT BILLNG
AND RELATED SERVICES
BETWEEN
MONROE COUNTY, FLORIDA
AND
ADVANCED DATA PROCESSING INC. (DBA ADPI-INTERMEDIX)
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to the applicable state
statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not
less than:
$500,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$500,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in
the state of Florida.
If the Contractor has been approved by the Florida's Department of Labor, as an
authorized self-insurer, the County shall recognize and honor the Contractor's status. The
Contractor may be required to submit a Letter of Authorization issued by the Department
of Labor and a Certificate of Insurance, providing details on the Contractor's Excess
Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be
required. In addition, the Contractor may be required to submit updated financial
statements from the fund upon request from the County.
WC2
28
Attachment G (4 of 4)
MONROE COUNTY, FLORIDA
Request for Waiver
of
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Requirements, be waived or modified on the following contract.
Contractor:
Contract for:
Address of Contractor:
Phone:
Scope of Work:
Reason for Waiver:
Policies Waiver
will apply to:
Signature of Contractor:
Approved
Not Approved
Risk Management
Date
County Administrator appeal:
Approved:
Not Approved:
Date:
Board of County Commissioners appeal:
Approved:
Not Approved:
Meeting Date:
29
Cllent#: 16916
MCIHOLD
AeORDTM CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
07/02109
PR(!bUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wells Fargo Insurance Services USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
~1 North.lde Pkwy, Suite 400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Atlanta, GA. 30327-3078.
770 850-0050 INSURERS AFFORDING COVERAGE NAle.
INSURED INSURERA: St Paul Fire & Marine Insurance Co 24767
Met Holdings, LLC I~RER B: The Standard Fire Insurance Company 19070
Advanced Data Processing, Inc. INSURER c:
6451 North Federal Highway, Suite 1002 INSURER D:
Fort Lauderdale, FL 3~308 INSURER E:
COVERAGES
THE POliCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POliCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
EL EACH ACCIENT $500 000
E.L DISEASE - EA EMPLOYE $500 000
EL DISEASE - POlICY UMlT .500,000
SHOULD ANY OIl TIE ABOVE DE1ICRlBED POUCI!8 BE CANCEU.ED BEFORE THe EXPIRATION
Monroe County Board of DATE THERElDF. THE I81UrNG INSURER WILL ENDEAVOR TO MAIL --30... DAYS WRlnEN .
Commissioners MOrICI! TO THE CERTIFICATE HOLDER HAlED TO TtE LEFT, BUT FAILURE TO DO 80 SHALL
490 63rd Street, Suit. 170 IIFOBE NO OBLIGATION OR UA8lJTY OF MY KIND UPON TtE INSURER. ITa AGENTS OR
Marathon, FL 33050-1028 REPRE8ENTAT1VE8.
~Rl9"RE8ENTA::Z
e'1~ .
A
TYPE OF INSURANCE
GENERAL LIABIUTY
X COMMERCIAL. GENERAL UABlJ1Y
ClAIMS MADE [iJ OCCUR
MED EXP (Any one
PERSONAL & NJV INJURY
GENERAL AGGREGATE
PRODUCTS - COMPlOP AGG
POUCY NUMBER
TE0&804558
EACH OCCURRENCE
DAMAGE TO RENTED
08130109
0&130/10
A
COMBINED SINGLE UMlT
(Ea accident)
DEDUCTIBlE
X RETENTION $ 10 000
B WORKER8~TIONAND
E..-..oYERIr LlA8lJTY
ANY PROPRIETORIPARTNERlEXECUTIVE
OFFICERIMEMBER EXClUDED?
If . -.crIbe under
Pfl)VISION8 below
HCUB324OM13809
TE0&804558
X ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON-<MINED AUTOS
':-oD\
., .
...
w .... ~
BOOI. Y INJURY
(Per person)
BOOL Y INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE UA8IJTY
ANY AUTO
AUTO ONLY - EA ACCIDENT
EAACC
AGO
OTHER THAN
AUTO ONLY:
A EXCEUlUMBRELLA LIABIUlY TE08804558
X OCCUR D ClAIMS MADE...
OTHER
DE8CRlPTION OF OPERATIONS I LOCATIONS I VEI-ICLElI EXCLU8ION8 Aboeo BY ENDORtIEIENT I.ECIAL PROVISIONS
If required by written ag....ment, the Monroe County Board of County Commissioners Is
included 88 an additional insuntd under the general. automobile, and umbrella liability
Insurance.
CERTIFICATE HOLDER
CANCELLATION
ACORD 25 (2001/08) 1 of 2
#S14983581M1492141
UIIITS
$1 000 000
5250 000
$10000
$1000000
s2 000 000
.2 000 000
$1,000,000
$
$
$
S
$
$
$5 000 000
$5 000 000
$
S
S
ESE01
e ACORD CORPORA nON 1988