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Address Info: 1150 O Street, P.O. Box 758, Greeley, CO 80632 | Phone:
(970) 400-4225
| Fax: (970) 336-7233 | Email:
egesick@weld.gov
| Official: Esther Gesick -
Clerk to the Board
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940328.tiff
HEARING CERTIFICATION DOCKET NO. 94-31 RE: PUBLIC FORUM TO DISCUSS THE REQUEST FOR PROPOSAL FOR EMERGENCY MEDICAL SERVICES IN WELD COUNTY AND THE FUTURE OF THE WELD COUNTY AMBULANCE SERVICE A public hearing was conducted on March 29, 1994, at 7:00 p.m. , with the following present: Commissioner W. H. Webster, Chairman Commissioner Dale K. Hall, Pro-Tem Commissioner George E. Baxter Commissioner Constance L. Harbert Commissioner Barbara J. Kirkmeyer Also present: Acting Clerk to the Board, Carol Harding County Attorney, Bruce Barker Assistant County Attorney, Cyndy Giauque Director of Finance and Administration, Donald D. Warden Ambulance Services Director, Gary McCabe The following business was transacted: I hereby certify that pursuant to a notice dated March 14, 1994, and duly published March 17, 1994, in the Windsor Beacon, a public hearing was conducted to discuss the Request For Proposal for emergency medical services in Weld County and the future of the Weld County Ambulance Service. Chairman Webster called the meeting to order. Don Warden, Director of Finance and Administration, presented an overview of the nationwide situation and reiterated the market is not Weld County, instead it is the entire Front Range, which totals over four million people. Mr. Warden discussed external forces which are changing Emergency Medical Services (EMS) : a changing EMS market with acquisition of providers by large companies; creation of integration (mergers) of health care providers within large health systems; affiliation of large health care providers with prepaid health programs, such as HMO's; health reform; and restructuring of the health care industry. He pointed out the key EMS goals remain the high quality of patient care, County-wide service, and affordable service. Mr. Warden also reviewed characteristics of a high quality, emergency ambulance provider, and he discussed the following options available as follows: 1) maintain the status quo; 2) regionalization with other ambulance services in Northeastern Colorado; 3) affiliation with a health system, such as NCMC/LHS; 4) transition to non- profit organization; 5) merge with City of Greeley Fire Department; 6) create an ambulance taxing district; and 7) privatization. He stated the threat to our ambulance service is real and discussed the reasons why the threat exists. Gary McCabe, Ambulance Services Director, introduced Dr. James Eastham who is a highly acclaimed national and international expert on quality of care issues in emergency medical services. Dr. Eastham is Associate Professor and Chairman of the Emergency Health Services Department at the University of Maryland, Baltimore Campus. He also holds faculty appointments in the Department of Health, Policy and Management at John Hopkins School of Hygiene and Public Health, and the Division of Emergency Medicine, Department of Surgery at the University of Maryland School of Medicine. His teaching, seminars and consultations focus on the application of continuous quality improvement in trauma and EMS systems. 940328 PUBLIC FORUM - EMERGENCY MEDICAL SERVICES PAGE 2 Dr. Eastham discussed the progression of health care systems in the nation toward managed care due to the continuing rise in cost of all medical services. As medical care becomes more expensive, people find better ways to manage that care, which leads to capitation as the way health care wants to manage the situation. Dr. Eastham stated capitation is the way managed health care wants to pay for services. It means the health care provider agrees to accept a lump sum of money to support an individual's health care delivery services. Dr. Eastham pointed out that this, in turn, leads to chronically ill individuals who will not be able to obtain reasonably-priced health care; therefore, the government steps in and says the company must provide health care by community. He stated that a few managed care companies will compete on quality of care and price for each community's business. Dr. Eastham reviewed some predictions on the future trends of ambulance service companies as follows: 1) less retail, more wholesale; 2) less fee-for-service, more capitation; 3) competition based on quality, not price; 4) providers will need to show improved health status impact, not just price benefit; 5) consolidation of health care organizations will move into high gear; 6) basic life support services will become obsolete, not as a concept, but the idea of having a service that only provides basic life support will be seen as inadequate; 7) ambulance services market will begin to align with medical trade areas, not municipal jurisdictional boundaries; 8) fire departments and third service providers will be pressured to change or stop providing service because managed care will not like public service jurisdictional limitations; 9) by the year 2000 only 30-40 corporations will be in the ambulance business with many local subsidiaries; 10) those 30-40 companies will contract with managed care organizations for larger regions; 11) expanded scope providers, such as EMT-P and Nurse Practitioners, will be utilized, especially in rural areas; 12) primary care provided in the home will expand and be more profitable than transportation to the hospital; and 13) EMT-P salaries will double and leadership salaries in ambulance companies will triple. Dr. Eastham reiterated that quality is going to have to be quantifiable, as a measure of health. Each managed care organization will be required to show, for instance, how they provide cardiac care to each victim in the entire community with successful results. He said the present standard is 90% of the market is provided with a response time of less than eight minutes for each emergency call. Dr. Eastham concluded by addressing the structure, process and outcome of a medical services system and continuous quality improvement in the areas of quality planning, control and improvement. Mr. Warden briefly reviewed the sections included in the Request For Proposal and discussed the method to be used for evaluation of the proposal. Chairman Webster requested public testimony. Leonard Wiest, City of Greeley, questioned the Board's authority to contract 911 calls without an Intergovernmental Agreement with the City of Greeley and other municipalities. He mentioned the involvement of the Greeley Fire Department and stated they are not prepared at this time to submit a proposal. Mr. Wiest asked for a delay of at least six months to allow time for the City of Greeley to evaluate the possibilities. Commissioner Hall stated the schedule presented in the draft Request For Proposal is only a tentative schedule and nothing makes those dates unchangeable. (Changed to Tape #94-16 while Commissioner Hall was speaking. ) 940328 PUBLIC FORUM - EMERGENCY MEDICAL SERVICES PAGE 3 Rick Weber, Greeley, stated his concerns regarding the RFP, indicating he sees no incentive for other companies to come in when Weld County already has the 911 dispatch service. Mr. Warden responded to his questions stating it is a question of whether they want to deal with one larger company or a number of smaller companies. Dr. Eastham stated the Board can buy time for awhile, but will be going through this process again in the near future, unless government steps in and interferes with the free enterprise market system. Patty Lynch, Platteville, expressed her concerns with private ambulance services and stated the county could be pro-active by making adjustments to its system. Jerry Wones, past Ambulance Services Director, explained he had suggested a non-profit community corporation in 1986. At that time, the Board decided it was not necessary. Since that time, Mr. Wones pointed out, the Ambulance Service has been getting stronger each year both financially and medically. He stated managed care organizations will be looking for consistent service, high quality service, service at a reasonable cost, and well-trained paramedics, which are all components of WCAS as it is today. Commissioner Hall clarified that the Board does not have a problem with the service provided by WCAS. He reiterated the Board is going through this process to learn and gather information about what is going on in the ambulance service area in order to establish the best quality care. He pointed out the board is open minded and nothing has been decided as to whether or not the RFP will be sent out. Commissioner Harbert also clarified that the ambulance service is not "for sale" at this time. She reiterated this is a hearing to gather information. Commissioner Harbert also pointed out there is a list of at least 30 amendments to this RFP which were suggested by the various agencies who reviewed the draft, to be included if it does proceed. Commissioner Baxter also stated the Board is looking for information and has met with ambulance employees and EMS Council to let them know that nothing has been decided. He reiterated a decision will be made after review of the information gathered tonight. Herb Brady of Greeley stated he is a paramedic at WCAS and it is the process the Commissioners followed which created the rumors and concerns. Mr. Brady reviewed his background in the private ambulance service area and discussed the problems inherent in that industry. He requested additional time to allow some innovative measures, such as regionalization. Greg Graves of Greeley, an employee of WCAS, discussed his background with a private ambulance company in Oklahoma. He stated that over the past few years since the company was bought out by a private ambulance company, prices have skyrocketed. He also pointed out the support organizations and community services provided by WCAS employees on their own time. Tony Fahrenbruch of Greeley, asked questions concerning the RFP. Mr. Warden responded that the issues discussed earlier are present in Weld County, private companies are on our borders, and several companies have been doing routine transports between Denver and Southern Weld County. Commissioner Harbert responded that there are many articles being written discussing the types of mergers, etc. that have been discussed here tonight. She pointed out the Commissioners are attempting to be pro- active. Commissioner Kirkmeyer reiterated the changing market is causing the Commissioners to look at options and the other external forces which were mentioned by Mr. Warden and Dr. Eastham are real and must be dealt with by the Commissioners. She reiterated the board is looking for quality input and suggestions concerning WCAS. 940328 PUBLIC FORUM - EMERGENCY MEDICAL SERVICES PAGE 4 Bob Walter of Eaton questioned Dr. Eastham regarding cases where private ambulance companies have bought out a governmental entity. Dr. Eastham stated in most cases the entity usually requested the private service to come in through the RFP process. Mr. Walter discussed the possibility of competing with the managed care organizations. When asked by Commissioner Kirkmeyer to be more specific, he stated the County controls the 911 calls; therefore those calls can be dispatched at its pleasure. He also suggested that with less equipment in an ambulance, it could compete with the private companies on routine transfers at a reduced rate. In response to Commissioner Kirkmeyer, he stated he sees the expansion of WCAS with other services, such as nurse practitioners. He stated WCAS does currently treat individuals at home without transport for certain conditions; and suggested the County keep the money-making business in Weld County. Keith Kennedy, Pierce, suggested combining with NCMC and keeping a semblance of local control. He also stated regionalization is an acceptable remedy if the services could be combined while maintaining local control. Commissioner Baxter stated that NCMC's merger with Lutheran Health Services (LHS) is now apparently eight or nine months away; therefore, NCMC is not presently interested in combining with WCAS. Arlyn Litfin, LaSalle, asked who would monitor the system, what qualifications that individual(s) would have, and who the private company would to answer to. Mr. Warden explained the RFP includes a variety of people who would be involved in monitoring, including administrative matters, legal matters, and service. He stated fire departments have requested a variety of reports in order to assist in monitoring. Mr. Warden stated that is an area of the RFP that can be revised to include more specific monitoring criteria. Bob Winter, Windsor, discussed what is good for the people of Weld County and how 30 to 40 conglomerates become dictators. This in turn will lead to lower cost and lower patient care. Hopefully, capitation would cause a 180 degree turnaround in that; however, in most instances in the private sector when things get cheaper, someone has to pay the price. Dr. Eastham responded that the market will correct itself, otherwise it will price itself right out of the market. Mr. Winter reiterated that when the cost is lowered, quality will suffer. He fears a private company would submit a bid at a loss in order to get the award, thus lowering the quality. Commissioner Baxter explained the RFP is not the final determination; the Board can decide not to award the bid even after proposals have been received. He also noted a contract will be negotiated and no decision will be made only on the price; instead, the decision will be made on quality and service issues. Commissioner Baxter reiterated the RFP process is one way for the Board to understand how the market is changing. Rachel Kolokoff asked why a private company would want to come into Weld County and make dry runs to New Raymer, in other words, what would stop them from comin in and taking the lucrative market regardless of the RFP. Mr. Warden responded the only control the County has is through the dispatching of 911 calls. He stated routine transfers are one issue, the other issue is capitation. He reiterated the market is not Weld County, it is the entire Front Range with over four million people. Ms. Kolokoff reiterated that giving away the 911 calls does not take care of the issue of a private company coming in and taking the lucrative part of the market. Angela Colgrove, Fort Lupton, read a prepared speech in support of the WCAS. 940328 PUBLIC FORUM - EMERGENCY MEDICAL SERVICES PAGE 5 Don Cadwallader, representing the Eaton Fire Department, stated he understands the emotional issues involved in this type of decision. He said he is proud of the EMS developed throughout Weld County and feels the team works well together. He is used to working with public entities and supports the concept of changing WCAS to fit the future requirements for emergency services. Mr. Cadwallader questioned whether a fire department would be able to work in conjunction with a private ambulance company in the same way they now do, for instance, if fire department personnel ride along in the ambulance to administer CPR. Commissioner Webster stated this issue could be put on a ballot to see if the citizens support it, but pointed out the second part of the question on the ballot would be whether they are willing to be taxed to support it. David Dreitlein, Platte Valley Medical Center, Ambulance Division, discussed the differences between public and private ambulance services. He stated he has observed a very significant difference between the quality of care provided to patients by an entity such as Weld County, and one such as AMRI or the Denver private companies. Commissioners Hall and Kirkmeyer questioned Mr. Dreitlein regarding the present service delivery system and definition of the service area. He stated Platte Valley was a private non-profit service, but is now a health care based operation. He stated the patient can request transport to another facility and that request will be honored whenever possible. He explained further that when the merger occurred the benefit was in having equipment added, as well as an additional car. Jerry Hettinger, Evans, discussed the current preventative maintenance program for equipment and staff time involved in testing new items to ensure WCAS remains in good shape. He feels a private company would not spend its profits in this manner, and the quality would suffer. Commissioners Kirkmeyer and Harbert pointed out the Commissioners do want to preserve the quality to the entire service area, and the RFP is to allow local control over those issues. (Let the record reflect a ten- minute recess was taken at this time. ) Mark Gray agreed with the positive comments and suggestions given tonight. He stated he would like privatization deleted entirely from the list of options. The people of the communities in Weld County feel this is an essential service and the RFP should be taken back to those individuals for input. Commissioner Kirkmeyer asked that further information be forwarded to her office. Susan Tomlinson, Greeley, stated the individuals here tonight are not a special interest group; however, it is people who have the ultimate daily responsibility of providing emergency care. She stated her concerns of extremely slow response time, low morale of employees, and double billings of patients. Larry Tomlinson, Greeley, questioned the timetable and stated he felt it was going to happen as scheduled in the draft RFP. Commissioner Kirkmeyer explained the intent of the Board to acquire information which was distributed as a draft. Jim Abbott, Windsor Fire Department, asked whether the policy of transporting to the hospital of choice will continue. Mr. McCabe stated that would not change, medical protocol would still be followed. Bob Walter stated that the insurance policy for most fire departments would prohibit ride-alongs, etc. In response to a question from Commissioner Harbert, Mr. Barker said coverage could be required in the RFP; however, mutual aid agreements would cover those situations. 940328 PUBLIC FORUM - EMERGENCY MEDICAL SERVICES PAGE 6 Fred Hoover, Ault Town Board, asked if this action is an attempt to circumvent the Bruce Amendment. Commissioner Kirkmeyer reiterated this RFP is in response to the forces that are external to the County. She said she is fully responsible to the voters of Weld County as an elected official. Chairman Webster stated it is a decision that can be made by the Commissioners, or a referendum could be a possibility. Ron Adams, Windsor, stated his concerns of poor quality of service and urged the Commissioners to look at other options. He indicated there are many problems with AMRI and Laidlaw, who are the County's source for most of the information received. Mr. Adams discussed the problems of low response time; exhausted personnel caused by too many work hours; inexperienced, poorly motivated help; and low quality care. He stated documentation is available for problems with AMRI, and the main problem is the quality of care. He also mentioned the profits would travel out of the County. Mr. Adams suggested the RFP be tabled for six months, a steering committee comprised of a County Commissioner, a City Council member, representatives of County and City staff, WCAS employees, and volunteer fire services be created to look at other options available to the Board. In response to Commissioner Kirkmeyer, Mr. Adams said he would submit copies of the information he submitted to the County. Rodger Anders, Greeley, expressed his concern that there is not enough business to compete with private ambulance services. He feels that when health organizations begin looking for emergency services, WCAS will be at the top of their list and would get the contracts. Mr. Anders discussed one situation in which privatization did work, and asked that the Commissioners evaluate all options, such as creating an EMS authority, and an employee buy-out of the service. Alvarita Thomas, Nunn, asked for a firm decision to delay the RFP because of the effect this situation has on each employee. The WCAS employees would like time to investigate a possible employee buy-out; and Ms. Thomas stated that creative, progressive options do take time. She reiterated that the emotional and human cost is far greater than the fiscal. Commissioners Harbert and Baxter reiterated that the Board wants some control over what happens to the employees. Chairman Webster stated that a written schedule will be distributed as soon as a decision is made. David Barnes, Nunn, discussed the cohesiveness between the ALS systems and Aims Community College. As training officer at Nunn Fire Department, he appreciates that extra service being available to outside regions. Dale Barnaby, Nunn Fire Department, spoke briefly in support of WCAS. Debbie Shipps, Nunn Fire Department, reiterated concerns about private ambulance services which have previously been mentioned tonight. Mike Lewis, Nunn, stated that quality of care from a private ambulance company cannot compare with the WCAS. Jim Campain, emergency physician in Greeley, suggested that there are experts available to provide an analysis of the WCAS system. He stated that he can provide a list of names of those individuals to analyze our system and determine whether or not our system is working and to give viable options for change. Don Lippitt, Gilcrest Fire Department, agreed with the comments made by others tonight, and stated it all boils down to dependable, timely response. 940328 PUBLIC FORUM - EMERGENCY MEDICAL SERVICES PAGE 7 David Wright asked questions regarding a tax subsidy, which were answered by Mr. Warden. Mr. Wright stated Greeley Fire Department would be the first choice if a private ambulance company is decided upon. Walt Leffler stated he has been trying to understand the Weld County addressing system for 35 years; and wondered how anyone can expect a new company to come in and understand it in a few days. Chairman Webster presented a letter received from the City of Greeley to be included in the record, asking that a committee be formed to study this issue. In response to Chairman Webster's request, Dr. Eastham summarized that the Commissioners need to define quality; identify what quality of service is desired; protect the welfare of employees; and cautiously decide the direction to be taken. This Certification was approved on the 11th day of April, 1994. APPROVED: ATTEST: D� BOARD OF COUNTY COMMISSIONERS qqpp / J' �2 � WELD COUNTY, COLORADO Weld Cou �C1'fk Zo he Board ,77 By: �.-Aetiy Q H. Webster, Chai an Deputy Cle to the BSa�cL� Dal . K. Hall, pro Tem TAPE #94-15 & #94-16 Hall ( Geor e E. Baxter DOCKET #94-31 177d70; 74.•O Co stance L. Harbert AM0008 %S /- t. Barbara J. Kir yer o 940328 ,,, , -------- OFFICE OF BOARD OF COUNTY COMMISSIONERS `\ PHONE (303)356-4000, EXT. 4200 mim FAX(303(352-0242 P.O. BOX 758 CGREELEY COLORADO 80632 COLORADO March 30, 1994 After exploring the trends of the ambulance industry and the options available for the direction of the Weld County Ambulance Service (WCAS) , the Board of County Commissioners has decided not to pursue the Request for Proposal and to retain the current structure. The board has also decided to form a six-member employee working group to make recommendations to the board on expanding the scope of services of WCAS. This decision was reached after much study and a great deal of input from WCAS employees, fire departments, and citizens. It is evident to the board that many of the external forces in the emergency medical services market place have the potential of impacting WCAS' finances, market, and service delivery. It is also very apparent that WCAS is an extremely high quality service with very dedicated employees who are held in very high regard by the first responders and citizens served in this county. The board believes the current system has earned the support of the commissioners and citizens to have the continued opportunity to compete in the changing emergency medical services market. We are also confident that the WCAS can compete effectively in the new market for some time with the support of the commissioners and public. We wish to convey our support to Gary McCabe, the WCAS Director, and the WCAS employees. We ask them to work with the board in pursuing the many ideas developed in the recent process of examining the future of the WCAS to make WCAS an even better service and improve its competitive position in the future emergency medical services market place. We believe our resources and efforts can best be spent continuing to improve and market the WCAS and the current emergency medical services system in Weld County. Very truly yours, i BOARD OF COUNTY COMMISSIONERS gPO ja-W. H. Webster, Chairman Georg E. Baxter Dale K. Hall • Chet, Constance L. Harbert Aarbara J. 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NAME ADDRESS HEARING ATTENDING C/snnT Eurl.,;S ?c e6ao, -n /r 3/-Ind O arrnvo Fuck R? _0 Gob Err trrl erkAtts 5_cti4 ,23 s, ay s 4 Cq Salt ore „ 5 71 1 50.1±` Rue (7 re& (e. C., g061/43 `( CC"ae Cauc5 I 1 601j" Ave- Greek Cr 4Oe3 E e, ,9,Z40/ / 107 // LC Avg 6=,- .2$4,4 g‘'65/ . Kft-dricire, rsct a ozz -- `ThPbaN.\ 2iegrkt \qO1 11 Ave_ eareel,ey AoGA1 04//6 Hg H z/ eeZ 9v Toth PER doe , S10 is- .asl I \Colokc F4 lot 4 A-o-c. 6vee SC63 ti i4/1 Ltrialbrsm 16 2q ih v is2.4 X 9 '31 4mbaka,t,c /C> ,t:7.)1xd ;/G; C�0 tla 7 542 32(4 flue: Cz , Cr% Ca .35/ 7 5. 11±-611. 4-,.T 1AL) co. G�r�' friicf7e 1e. 4a'oc ra //o `/9 ,%1 G�`��/z1, Cn, cUZy G?� fincied i/o 191/7 /doe "C eeIe�v et) 0610 lapN,E Wi I .A c1Oi 1�k\lz e 03'0ru cod, 1z-so uY;)x2 coaza l r r" c 6 A /9 c cm sit. _Le .Sc�� ✓4 < cisKirr ,,7,)7 /c G <Sc/% Tdd • _.3329 ATTENDANCE RECORD HEARINGS ARE AS FOLLOWS ON THIS DAY OF 1994: DOCKET # DOCKET U DOCKET {I DOCKET /I PLEASE write or print your name legibly, your address and the DOCKET /I (as listed above) or the name of the applicant of the hearing you are attending. NAME ADDRESS �7 HEARING ATTENDING (R, -\ i,c 1,� (SI!IS (1S Ltt RC ) ,,,p,,‘ � L.C� lc i 9,4 l s��s�r GUc4 IlL1 C.�: 6�� -11 /� %i7` 4yC. ' ti afr . .. 47-45- w 1, , gl fdio2y 484,44 k130 i tz':. '7w`` If d� 8-c'k3( e Ape, .2y Act Lf, 07‘,.1r A ry /a rs lie r PO ide x ,L_6 5- A e,rl Cy C tf>6-5'5' S4-ip in 8 �t;v, Ew,vnav: s /q& o 4/`l' 0-cc. Greeley Co . QOcu ; i( jeC746 i if7k,S--y nPite V Al_gai 1 it 6- /4 Pp xo, 49 n /4) . O≤kt- 3a/ a jrnivon!I Lt. Fce k4 c SoCF/s nn ‘1). Yxrk Pis&. '- H. 5`rrnx-- n ii' h. �{�(GZ L 2 l,t?�.-14 , 5-�z L /-s" S i. aP�i i) l� 7)O1 LAard y 411/ a FOe w.,1i/vd 61-"d. 6 e4 CO Po( 3/ frtra. Opp nog W. as -t Pri 4=62p9 On .50631 iv t, }IGAl auf f,!,i1 nl i41 cfu.evz lk 6aleA1 La _ 2t6 3 a.7! 14/V/ aellie i 7aa iyt`'s:. 61eleitet a, a6si har Harr s 303 3STI ' FA Evc fps, (1_(7 able DO _zet ti_ avo64 uio2 9 2eac 6 (06(57 Q6L / —�''f.GG4s? ....11/4 2 1't,e_-7 )4i_e�-Epy � !J- 3/ ,y l n • , l // t- A,' 6 tico 6-ti-, c + x(,)\ Gre c iet Cc . yo6 3 '1 60c6, I-nnI R.4.3 tin 33 Au P U eu- y (s) X31 IJaimeL alb1.'D i.z ? 741- - aiokI6. fak. !S ,cO :go 12143 7,4 .45.e /IS/;a1cf 4..c_ leeeizeSbicr� 4 I?eY3 Taw 3300 i3 , . 104- G;& leyC0 0�%_ ( /4,/kit?/ , ;a) /3y/ ' 1/v. 62 rotir 910328 ATTENDANCE RECORD HEARINGS ARE AS FOLLOWS ON THIS DAY OF 1994: DOCKET # DOCKET P DOCKET U DOCKET U PLEASE write or print your name legibly, your address and the DOCKET 0 (as listed above) or the name of the applicant of the hearing you are attending. NAME ADDRESS HEARING ATTENDING IA.,-6-:--1.-- 1 37 M Zee hn icy-v ti�/a) Csa —�—.7 ,c-7y0 4.S/ R.,/I C' �f/ey d Soo Air,-ri /levee 0/ ?A//tt Me Ki f/ j Z04 03 c c,[) 4o/q Ce). (S Srizec G ,24_,„ c F-..l 8c 4_.3 y cil_ S'Nfeici 3c32 w 71- s+- C, e,i0, 1 Je.o,v/Frd W.. c, rX 6%U l9 r /U©U / 6/ .ree// 9063 i 61O n �c ry a), had,n7e f- 919 - -27// C9 S F - / 807 .�( 9-4--ldit 6. �9Nl aA1 ) 7 / 3o/6is+ 2d (rk_r&k/ R6:3i LA-LAAci l ` P-up Z5/? 14/ A/ ('r ` a eite., WGCrl l d o c eeN IMcr11 aii-oLr1 )0as 5% Sjrezi 6)-7-OA) /j- J✓ac.lc Sta.t-<er rill its sl: ( -ree 5 8b(o3/ )c,4nvrtt �C.tlrirc ?/ 2 '7 n S; C.> R/f..c y' k, �S) Dc v ,:d a reef- e rr.i elf 3 e (.L?m,-,i,:ira J tc)(Seu Cc7 :if 0l:: ".. t,-.1„ Si-o/4--c_ 76y S z re, ,4 e Vrr5;47v,, d-obo/ = v-ilA.1�.esv.X/s.��' t. s/n ,Y //1 /7. 4,,f/I z4- tiA,, C`� Jart-w L. Q?lndrzt.. 34o /7 Ave: < v ii /VS CO(40 VI,v(- ,2 I; 3UliNsc.),) go,y 377 64 (co QS ! c.L n613' .. 14-1 ' .1i - 2: {LbA ii., �4 �.S /'✓o(.Q�9LiK , - q � �1��!(7`l.< c�1L cZ17 rcr ��""-9L " Hay15 �Z ;Aft /Q/ 1-0,rr (q-737 /'Cv'ty;,i-��'� G,,/�/r�1 `/c/q Xal�^ )7 <.4 . I G' r eai.�'+� / C � $k l�/� /c-,..-c,.Ycy..-)tY ,r u J 7 1\aivJ c, /1ei 4 IS VI, e / -Q 61-12g rte'-e fa 6°K 2°8 ( ,/tc-0€/crcR 09 gas-307 "2 c.A... hil\*r I r Iqr� Avnd 110 Urls �l d o.{a> )7e hu a r 8o 2 o2- J oftr 11111 /l025 n„el s+ Rd g -rt; gals` r AtN IISU14- /tan) -eoI 1/4'Pitic1Liak? ir bi fie,3/ 3 l0329 ATTENDANCE RECORD HEARINGS ARE AS FOLLOWS ON THIS DAY OF ..3 — Z7- 7/ 1994: DOCKET /1 DOCKET P DOCKET P DOCKET P PLEASE write or print your name legibly, your address and the DOCKET 11 (as listed above) or the name of the applicant of the hearing you are attending. NAME ADDRESS HEARING ATTENDING t)i-,s he:•-Ib,--I Poi-►1 5.2,1,0 T ikth (2 ZL'Q) /R.-Li. 1-_,,,,,t40117 U/c 2 3 6 J7�, /Li 62 ?'0,657/ ( 40 elect/0,6.e e 2yjo c (.4..ic:k< /2 l .D A-4-.04. C Jc) ))/ a \ bri l- /935r-LA'ne SF, Cir GiLGies-k- CO S)1DR3 /Cult cm,' 2' z ?c,k-1c F+ L..- c.-062._i ysiLa' l e it. ` R. IZ 1 « C_C 3G-, retiturc Co 5106 5 7 'l • 1 . 1 n/01442 501\ /dl ✓3 ,S* ri If 0 .Saedr2�7J AA,itcrt, 4:27 ,{q SI /�Litl_t C, -3/;2-09 ' r . • Isc oeP ')P_ Ria z & men 1(-(S i.} d,0 it. .r) / (( knc (`) I? . 5 b:rtj (ix 1Z 65J7 c-Lb c ll (,-) '570-7:3t) 7 � µ1/�Am Amin:di 1/ ..x'9 A)(C ,5,2 na/« ilea) ro /5 n53/3 6o4Acr 'I '.&rj oe 1121 0 EA4)aA Panic t 'l . L,Ftti, cc, tcc:?/ •':M tto rs>=y, 44:2S- E1, A!/r_')1/ SiA7: 1./P/fo.uj Go. 5'06.Q / © Yana. /(,-Mode 5-04"4r tvcR33 Nunn Cc) `io6'/' ' lei tt--- /3.23 a't' Sr-,/ 62,5=;_iel . Zo kb fc- / / C old e (cnLe1Yr 3'ItL A3 51-RG� 6 f e1-e71ee ff1 631 1, Jl tick L c)T 4 U'cy. '-r" `1 ('‘N C i k. .s ' Cr, (',->a kF) td;0;w, a Ott Lei Cry-) deA_v , '<i' 1„ R L,tLlk ,G./) tO V11,LeCE 77k /hi /02q 42‘14•7Are rA eag;is e i& cc-2-41 .evM r \''t j/ cr✓' ii'`6.2,/ ,if'Z .!' �:1.,JflJ_ k C(C/rc-. ,C '.r��-1,-re_n {-iJ c,2.- CJ &VArA2.� 'tr ) j,x5 c\o4 \,.to„,- A''e -1)... t. l; \--Cu;� Cola % 06- I l y -. fs 1, 2_> i'.a/ " � : `r`> ,�,,l< e,:, t„4, 6'/6!-? Wei Ili,4,?-1 LA,l1, )_3 i (7LtAa_. g{ /toms k, et- X0441 10323 NOTICE The Board of Commissioners of Weld County, Colorado, will hold a public meeting in the First Floor Hearing Room of the Weld County Centennial Center, 915 Tenth Street, Greeley, Colorado, at the time specified. The purpose of the meeting is to discuss the Request For Proposal for emergency medical services in Weld County and the future of the Weld County Ambulance Service. All persons in any manner interested in the matter are requested to attend and may be heard. BE IT ALSO KNOWN that copies of the proposed Request For Proposal may be examined in the office of the Clerk to the Board of County Commissioners, located in the Weld County Centennial Center, 915 10th Street, Third Floor, Greeley, Colorado. Written comments may be mailed to the Clerk to the Board's Office, P.O. Box 758, Greeley, Colorado 80632. DOCKET NO. 94-31 DATE: March 29, 1994 TIME: 7:00 p.m. MATTER: To discuss the Request For Proposal for emergency medical services in Weld County and the future of the Weld County Ambulance Service BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO BY: DONALD D. WARDEN WELD COUNTY CLERK THE BOARD BY: Carol A. Harding Deputy Clerk to the Board DATED: March 14, 1994 PUBLISHED: March 17, 1994, in the Windsor Beacon en(1'Z'ic Oa= of II AFFIDAVIT OF PUBLICATION `A STATE OF COLORADO Colorado, al ss COUNTY OF WELD speai5pd. 1110 purpose ..lb the meeting.'. to 6swss the I, ROGER A. LIPKER, of said County of Weld, being duly fee el ,servi- sworn,say that I am publisher of County of the WINDSOR BEACON Amb , ll per rep In a weekly newspaper having a general circulation in said matt County and State, published in the town of WINDSOR, in to aria said County and State; and that the notice, of which the annexed is a true copy, has been published in said weekly k1'ALSO for / successive weeks, that the notice was Bs published in the regular and entire issue of every number of I f1 m the paper during the period and time of publication, and in in die el the newspaper proper and not in a supplement, and that tot °f the first publication of said notice was in said paper bearing in the thedate of they 510th en /` ii(day of , e-I 4/- A.D., 19 ! and the r, Gr last publication bearing the date of the day of A.D., 19_ and that m the said WINDSOR BEACON has been published the 0ffi continuously and uninterruptedly for the period of 5 ,y G consecutive weeks, in said County and State, prior to the o _ date of first publication of said notice, and the same is a D0CKEYiJ0 9441'? newspaper within the meaning of an Act to regulate printing of legal notices and advertisements, approved May 18, DATE. March 29.1.4 1931, and all prior acts so far as in force. T 7-00 p.m. lic, " d . M jt-A- JJ8 ISHER Welltutur t#a Subscribed and sworn to befor. .me-this oaf day of ated -2(), r knwo NOTARY PUBLIC 1D My commission expiresc�f �, /t/9G, G IV: I. ,,pp. Fro county $11,5 TO TMkM ritrallittrikartdelep DATED:klarah 14,1M4 9t0328 PRESS RELEASE The Board of Commissioners of Weld County, Colorado, will hold a public meeting on Tuesday, March 29, 1994, at 7:00 p.m. in the First Floor Hearing Room of Weld County Centennial Center, 915 Tenth Street, Greeley, Colorado. The purpose of the meeting is to discuss the request for proposal for emergency medical services in Weld County and the future of the Weld County Ambulance Service. The Board of County Commissioners is considering releasing a Request For Proposal in early April 1994 in order to evaluate the possibilities of contracting for emergency ambulance services in Weld County. The need to consider changes are associated with forces external to Weld County, and in many ways beyond the County's control. Specifically, the forces are the changing market with the acquisition of nearly every ambulance provider from Pueblo to Cheyenne by two major private ambulance companies. Secondly, the integration of health care providers within large health systems that are in turn affiliated with prepaid health care programs (e.g. HMO's, IPA's, PPO's, insurance companies, etc. ) Thirdly, the impact of health reform and the restructuring of the health care industry. The Weld County Board of County Commissioners believes it is essential that a county-wide ambulance service with a high quality of patient care at an affordable price to all citizens be maintained. To that end, the Request For Proposal being considered is for an exclusive 911 service area where the ambulance provider, in exchange for the right of exclusive dispatch to all emergency medical request, guarantees contractually to: 1) certain performance standards of quality of care with penalty provision for failure to perform; 2) respond to all ambulance requests in the Weld County service area; 3) performance standards for equipment, vehicles, training, and. staff; and 4) approval of the rate structure by the Board of County Commissioners. Citizen input at the above meeting is strongly encoufaged. -30- 940323 March 28, 1994 Weld County Commissioners 915 10th Street Greeley, CO 80631 RE: Weld County Ambulance Service Dear Commissioners: As EMT-Basic Physician Advisor for Weld County over the past one and a half years and North Colorado Medical Center Emergency Physician for nearly two years, I would like to state for the record that I have never seen, in my experience in Emergency Medicine and Pre-hospital care, a more impressive pre-hospital care system. The quality of care of the EMT-Paramedics and Basics is exceptional and more importantly is the quality of caring. There has been a tremendous amount of work and effort put forth to establish such a successful system and many years and man-hours invested. I also feel strongly that the tight integration of the EMT-Basic program be preserved and continued as it has, in my opinion, significantly benefited the residents of Weld County. Particularly important to this aspect to the system is the EMT-Basic coordinator, a position presently held by Mr. Lyle Achziger. Mr Achziger has preformed in a superlative manner and has been a pleasure to work with. This is a premiere program and would be devastating to lose. To allow this system to be taken over by outside factions who's interests are not based in Weld County could potentially be severely detrimental to this high standard of pre-hospital care we have grown so accustomed to and perhaps in many ways taken for granted. Sincerely, Ai+ Thomas P. Dykstra, M. D. EMT-Basic Physician Advisor North Colorado Medical Center �� •' en;nnz'; 940328 Eaton Fire Department 224 First Street Eaton, CO 80615 March 22, 1994 MR. WILLIAM WEBSTER WELD COUNTY COMMISSIONER 915 10th ST. GREELEY, CO. 80631 Eaton Fire Department has some concerns with the possible take-over of WCAS by a private-profit driven corporation. 1. The current exemplary standard of care may decrease. Profits from the fee base in WCAS are turned back to purchase of updated equipment and to training of personnel. Profits in a private ambulance company are turned to the investors. Thus, we fear that ambulances and equipment may not be as well maintained, may not be replaced as often as needed, and may be purchased with cost rather than need as the criteria. In order to produce a profit, cuts must be made. One area to reduce expense is in the compensation of employees. Profit-driven companies traditionally pay lower than WCAS, offer fewer benefits and do not make available the most current education. Thus, we fear that turn- over will drastically increase as these companies provide the inexperienced person a "starting point"for their resume so they may seek more lucrative employment at the earliest opportunity. WCAS currently enjoys a very low turn over. They can attract and keep the finest and most experienced paramedics available. These are people who are making their homes in Weld County and consider their position with WCAS a career rather than a job. As first-response EMT's in the county, this means that we will know the ALS personnel who are responding with us. Our methods and protocols will be together. We can all anticipate each other which makes the call flow more smoothly than it would if we encountered new faces on each call. Air Life is a major factor in Weld EMS. Currently, neither WCAS nor the fire departments look on Air Life as being a competitor of any sort. Consequently, since patient care is the bottom line, we do not hesitate to choose Air Life transport for those who need it. However, Air Life would be a competitor to a profit driven company. We do not see that such a company would look kindly on Air Life "stealing their transport" thereby creating a "dry run" that produces no fee for them. Or, will the patient pay for both Air Life and the ground ambulance? When the fire department arrives on scene prior to WCAS, patient care begins. Any supplies that are used (i.e. dressings, head immobilizers, fluids, etc.) are billed to the patient by WCAS and replaced to the fire department's inventory. Thus, the individual fire departments do not stand the cost of these disposables. We do not foresee this working well with a profit driven company that will require us to account for every minute item in order to obtain replacement. What we foresee is either increased cost to the departments or possibly our reluctance to use these items prior to the arrival of the ambulance. When the ambulance arrives on scene, the fire department personnel continue patient care assisting the ambulance crew. We provide additional man-power to care for multiple patients, to ready any needed equipment or supplies from the ambulance, to "load" the patient, to provide additional hands for care during transport, or to drive the vehicle which allows both trained medics from the ambulance crew to care for the patient. Currently, we feel we all work for the same employer- the people of Weld County. This makes us a team. Would the tax payers in our individual districts have any cause for concern if we were providing free man-power to a private LAC- : dig /9m!', fl; (s°'4) 940329 Eaton Fire Department Page 2 profit-driven company using equipment and training paid for by tax dollars? And where would our liability lie in event of a catastrophe? This team practice may have to cease which could decrease the level of care to the patient. 2. An ambulance company that is other than Weld County supported may exhibit less concern with the out-lying areas. Weld is geographically a large county. It is not profitable to send an ambulance to many areas outside the city of Greeley. Currently, the ambulance goes in route when called. If they sometimes get canceled, so be it. We consider that the bottom line is the patient, not fuel cost. Do SOME residents of Weld County deserve a lower standard of care simply due to the location of their emergency? Would a profit-driven company hesitate to roll a car toward Grover on the chance that they may not transport thereby loosing their fee? When they must account to investors, would they have a "transport regardless" policy? Now, WCAS will allow a patient to refuse transport by ambulance if the qualified personnel deems that the situation is not serious enough to require emergency transport. This not only is an asset to those residents who truly cannot afford an unneeded ambulance ride but it frees that ambulance to possibly respond to someone else who may indeed require emergency transport. 3. With the profits from the fee base being returned to the investors a private company, these dollars will consistently leave the county, the state, and possible the country. We feel a need for Weld County to support Weld County, not New York state. 4. We fear that the fee for ambulance transport from outside the city of Greeley will drastically increase. Private companies seeking to provide municipal services bid low initially to obtain the contract. Once in place, fees are increased to the level of their true costs which are normally higher than what it was costing the municipality to provide the service. Someone has to make up the cost during their"low fee" period. Would it not be easy for the company to justify higher fees to the out-lying areas? 5. We have recently made great progress in unifying EMS in Weld County with the implementation of Weld EMS. Nearly all EMT Basics now practice under one physician advisor. We have an EMS coordinator who provides us with county-wide protocols and otherwise keeps us united in an effort to all provide the same standard of care. We fear that an ambulance service that is other than county supported may cause our constituents in the individual fire protection districts to request fire department based BLS ambulances. Thus, we would have less unity in EMS as each department would be "doing their own thing". Standard of care would vary depending upon whose district your emergency is located in. And, this would create a delay in ALS intervention as the private ambulance company may wait to go enroute to until the BLS unit determined the actual need for ALS. Now, ALS rolls and is on scene when needed rather than still sitting in Greeley waiting to see if they are needed. 940329 Eaton Fire Department Page 3 In light of these concerns, we request that the ambulance service remain as is. We understand that a private company currently can contract for transfers that comprise up to 15% of WCAS's fee base. This would make it difficult if not impossible for WCAS to operate without some sort of subsidy. Our solution would be one or a combination of two choices: 1. Allow WCAS to contract these transfers to maintain that revenue which would otherwise be lost to the private companies. 2. Propose to your constituents that an ambulance protection district be formed that would encompass all of Weld County so that a tax base would be available to subsidize the ambulance service. We feel that the volunteer firefighters and Weld EMS can be a great force in educating the public and promoting a solution of this nature. Sincerely, A 6 C-4-11-9- Don Cadwallader, Chief Eaton Fire Department 940328 Ken rney March 26-94 box _.J6 Keenesburg, co 80643 Dear Dale , We were up to Charley D' s this evening and Eddie picked up a bulletin about the proposed changes in the ambulance service . First off, if we lose the valued services of the Fire Depts we will realize just what a valuable thing we really had . My problem with the services given us is that the costs are always born by those least able to afford them. Just like the paying patient who enters Northern General Hospital and finds he has had to pay for himself or herself plus the indigent . Now a fellow or lady who is sick has enough problems meeting their own financial burdens at this time without having to pickup those of the less fortunate . Quite often it reduces their own monetary worth to the level of those they are paying for. The same thing occurs when you get aboard an ambulance . I really believe that things are pretty well as they are now but if I had any recommendation it would be that all citizens should share in the burdens of cost , whether in the ride to or while they are in the hospital . There are no free rides or lunches are there? Why do those unfortunate enough to be in an accident or become ill have to bear such a financial load while those of us fortunate enough to enjoy good health and the benefits of a good insurance can overlook just what the cost really was . Dale , We really think the board of commissioners of Weld have been doing a great job . I think we would be considered as supporters of the present Emergency Medical Services in Weld County with both the sick and healthy paying for those services. Ken Barney PS That sounds like a new tax doesn 't it? Probably the tax would be no harder to pay than it is for the ambulance and hospital patient to pay the total bill they now have to . e (,t �� pa,-7-92�� 1Lc `��� r � 111{.L ee ; ei9; /ai Aei Gll ho -9403'8 56 ° e You're Pointin That Thing!Hey! Watch Where '''.' t I had my work all caught up and I was relaxed Willie just as a big snowball hit him right in the , l sitting in an old swivel office chair in my service face. He was just furious. station. My friend Earl walked in and we "Who threw that?" He yelled. "I'm going to exchanged small talk. Earl enjoyed showing get them." He shot into the back room. I later ,; people his gold coins. He had them in cellophane found out that the snowball had been meant for j tl, and they were very impressive. I worried about me and that the fellow(Johnny)who had thrown it I r i!j w,u the wrong person seeing them and doing him in was visiting innocently with Sonny. Just at that but he carried a small .22 revolver. Just he and I moment another fellow mechanic named Dude `:, were there and he handed me his little gun and walked in from a side door. Willie asked him if he i,:i ' :r, told me to just notice how well it was balanced. I had thrown the snowball and Dude replied rather ' leaned back, pointed it at the ceiling and pulled flippantly that he had. Willie was on him like a x the trigger. Kerpow! flash. Dude was younger and quicker but I said, "I didn't know it was loaded." completely unaware of what had transpired. Willie He said, "I didn't think you would pull the was handicapped by a heavy sheepskin coat and y trigger!" when we got over to where the wrestling match tYx`£' Following one fourth of July celebration I was going on Willie was laying across an old car N„ came across a pop bottle rocket. My pal Sonny seat and Dude was holding him down trying to Paul ran the back room of the station and had a find out what kind of a play he was in. I ' good business as a mechanic. I decided to fire off Be careful when you point something at t il' the little pop bottle rocket at him. I had it pointed somebody. 4tr. just about right and lit it off and it hadn't gone one ,. !Ii !!,0 foot when I noticed that a farm wife was sitting on It never turns out '' an upside down five gallon bucket, right beside the way you think. I z him. That stupid firecracker was headed right for (4 her. She was wearing a dress and facing me. ---- Ken Barney `--,., Sonny later said, "Yeah, I saw it was headed , ,r:‘`, 1` right for her knees." Well at the last second it ' " veered to one side and blew up just behind her. .1° i' One day I was putting on a tire on the rim of -. '', Zvi a customers car. It was bright in the front room ,. ,,'h' and my cousin Willie was standing across from ; ,,,t, me. I heard the shop door slam and I looked up at S 5 3'— �p� 1 R WJ\f LRR1 BUSINESS OPPORTLITY Windy Plains Bike Shop ' Schwinn Bicycles & Fitness Equipment Windy Plains Bike Shop is for SALE! 1118 Main Goodland, KS .1, 913-899-3911 1-800-BIKE-911 Windy Plains is a good, i k thriving business. Spring is the Why not own your own ; ���. time to buy those .s w ,, bike shop? - '�, ,_� .r ':44 Call ,, � `�,�4 new bikes. Call Harold for details r� /�� �% � \. 40 �► 'lam i! a yr .r OARTeri Prairie Times - March 1994 ! ,'N ".0329 TO: WELD COUNTY BOARD OF COMMISSIONERS FROM: WELD COUNTY CLERK TO THE BOARD'S OFFICE RE: AMBULANCE SERVICE PROPOSAL The following phone messages were taken at the request of the callers: March 28, 1994 2:30 PM: Annie Potts, 302 Marion Ave. , Platteville, CO. , 785-2913, is 86 years old and is unable to attend the hearing 3/29/84. Her main concern is response time since she lives in a small town. Had good experiences with WC Ambulance with her husband's illness several years ago and it "gives her peace of mind" just knowing they'll be there if she needs them. 3: 10 PM: Victoria and Raymond Alm, 22459 WCR 70, Eaton, CO. , feel WC Ambulance parademdics are doing a good job and are against sale to a private company. A private company would be doing business for the money, WC would be for the people. March 29, 1994 8:05 AM: Gene Sirios, 4792 Hwy 79, Keenesburg, CO. , 732-4435, wanted to state opposition to sale of Ambulance Service because it is working good the way it is and we had a private company before and it pulled out. (r�! C4;4P1&>A7j „o CC_ 940328 March 28 , 1994 Mr. W. H. Webster Weld County Commissioner Commissioner Webster: The Weld County EMS Council voted to request a delay in the time table that has been set up on the Weld County Ambulance Service Request For Proposals . The EMS Council feels that under the present time line only private companies who have bid on proposals like this before will be able to submit true bids . The EMS Council would like to have more time for those interested entities to explore other options . The vote on this motion was : 7 for, 0 against, and 1 abstained. A second motion was made to include in the RFP that the winning bidder will pay for the state required physician advisor for the Weld County Fire Departments . The vote on the second motion was : 4 for, 1 against, and 3 abstained. Thank you for your consideration of these recommendations . Net, ( Cloyd Conley Chairman //; C/91a0A5 LVnr-cCscky 94 329 7a \ WELT COUNTY AMBULANCE SERVICE PHONE(303)353-5700 (303)356-4000 1121 NI STREET I pC GREELEY,COLORADO 80631 COLORADO Weld County Commissioners, After reviewing the present Request For Proposal (R.F.P.) that Weld County has developed for Weld County Ambulance Service (WCAS), the employees at WCAS would like to propose a six month extension to the April 26th deadline for R.F.P. offers. The reason for an extension would be to allow for further research into options that presently have not been thoroughly examined: ie. E.S.O.P., ambulance authority, public utility model etc. Our main concern is that the most effective and efficient emergency medical system be maintained. Quality of care is of the upmost importance and we would like to evaluate all options before your final decision is made. In light of questions and some confusion over the R.F.P./"sale" of the ambulance service, the employees of WCAS would also like to request a one hour session with the Weld County Commissioners and Don Warden. We realize your schedule is very busy at this time, however, we feel the importance of answering questions, eliminating misconceptions and exchanging information would benefit all of us involved. A session scheduled as soon as possible would probably be best. Please inform Gary McCabe or Dave Bressler with your reply and schedule as needed. Thank you for your time and consideration. L< I Sincerely, Rick A. Weber WCAS Paramedic 34032s g/i-al .3515-2->t d. 0 —0 X06/�h de-} A6cee_y Vci-c -mac t� _ A0L _r-c-ey 7S 2 - VScra c/xie cL 4 /1_,A, 4229/)-74t, < Ayes 3 `.0325 March 28, 1994 TO: WELD COUNTY BOARD OF COMMISSIONERS FROM: WELD COUNTY CLERK TO THE BOARD'S OFFICE RE: AMBULANCE SERVICE PROPOSAL The following phone messages were taken at the request of the callers: 10:30 AM: Dennis Kitzman, 6976, Kennesburg, CO. , is adamantly against sale of the Ambulance Service. He feels the proposal needs more study. The Ambulance Service is cost-effective and self-maintaining now, so why change? 11:00 AM: Jean Hagen (would give no address) is opposed to selling the Ambulance Service to a private company. It should stay under County supervision. 9Y0 28 March 23, 1994 Bill Webster Office of County Commissioners P.O. Box 758 Greeley, CO 80632 Dear Commissioner Webster: I am quite concerned at the possibility of the Weld County Ambulance Service being taken over by a private company. Will a profit-driven ambulance service be as willing as Weld County Ambulance Service to drive to outlying areas of Weld County? Will their fee for far-out areas be so high that farmers and ranchers will suffer? Living 15 miles northwest of Greeley, I am in a position to protest! What of those who live in Grover, Briggsdale, Nunn, and Barnsville? I know that it took a while for the WCAS to accomplish a certain goal, the goal of being completely fee-supported. Has the WCAS not been in the black (budget-wise) for about the past 4 years? If they were using a large amount of tax monies, then maybe the taxpayers would like to see a private company take over. But that is not the case. Would it not be wise to keep the Weld County Ambulance Service in place as it is and keep the fees paid for its service right here in Weld County to serve the citizens? SHOP AT HOME! With the profits from the fee base being returned to the investors of a private company, the money will leave the county, leave the state, and maybe even the country. I urge you, please, to reconsider this proposal. WCAS is an asset to Weld County, one we should not be so willing to let go. Sincerely, Gloria Lister 13350 WCR 80 Eaton, CO 80615 940328 Weld County Commissioners ; As a concerned citizen and member of 1a aural Weld county Volunteer fire department . I feel it is my duty to write this letter concerning the proposed sale of the Weld County Ambulance Service. 85 percent of the calls we have on our department are medical calls, be it traffic accidents with injuries , sick or injured, industrial accidents or agricultural accidents . When we are paged out WCAS is paged at the same time . The Fire Dept . usually arrives on scene 5 to 10 minutes before the ambulance ( depending on the location of the call , and where the ambulance is responding from ) . During this time we extricate patients , start medical care, try to stabilize the patient for transport by WCAS, start CPR, if necessary. We do whatever is necessary to assist the Paramedics in their job, to see that the patient gets the best and immediate medical care . Our department also has the luxury of three WCAS Paramedics as volunteers , with these people on the Dept . WCAS has donated equipment and supplies that are used by these three individuals to do the job as if they were working from a Weld County unit . Having these people and equipment have saved countless lives that quite possibly would have been lost waiting for another Advanced Life Support unit . With this " hurry up " sale of this service, along with the exclusive rights to the E-911 service for medical calls , is a private ambulance contractor going to be reluctant to work with the Volunteer Fire Departments in Weld County ? How are we to be assured that a private contractor will maintain a staff of qualified and caring paramedics that we now have ? Do we trust the County Commissioners and their good judgement to take care of us ? I for one don' t think so, they are the ones that are selling us out ! This proposed sale is moving too quickly, leaving too many unanswered questions . Everyone in Weld County should take a good look at this situation, and think about the possibilities of one of your loved ones , or close friend needing immediate medical attention. Do you want to rely on an ambulance service that is not from Weld County, and doesn' t want to maintain the same qualified personnel and philosophy that WCAS has provided to us ? Weld County Ambulance Service is a self supporting entity, and if a sale is necessary let ' s explore the avenues and possibilities before it is completed, give the people of the county a voice in this matter . I don' t like the thought of the Commissioners telling us we are going to have to start using a new ambulance service . Mike Evans , Platteville Fire Chief 940329 NORTH COLORADO EMERGENCY PHYSICIANS.P.C. 2105 44th Avenue Greeley, CO 80634 Business ( 303 ) 330-7053 Office ( 303) 350-6244 March 21 , 1994 Mr. Bill Webster, Chairman Board of County Commissioners Weld County 915 Tenth Street Greeley, Colorado 80631 Dear Mr. Webster: I am writing on behalf of the North Colorado Emergency Physicians(NCEP) regarding the proposed change in the ownership and management of the Weld County Ambulance Service. Since the present service provides a high level of care at reasonable rates and with very few complaints, we doubt that a for-profit service could match what the community has presently. However, if the Commissioners feel that a change is mandatory, then we have several concerns about medical control which should be part of the Request For Proposal. As you are aware, North Colorado Emergency Physicians has been the physician advisors to Weld County Ambulance since 1981 . We have enjoyed that relationship over the years and plan to continue it over the foreseeable future. We are proud of our contribution in making the Weld County Ambulance recognized around the State for its quality medical care. As physician advisors, we have four specific concerns regarding the RFP. 1 . The RFP should require that any new ownership contract with a local physician who meets the minimum State requirements for physician advisor. We, of course, feel that a Board Certified Emergency Physician is best able to fulfill the physician advisor role. 2 . The RFP should require any new ownership to provide for on- line medical control at North Colorado Medical Center, which receives the vast majority of patient's transported. The direction provided over the radio is a vital link in assuring the best possible care in an emergency. 3 . The RFP should require any new ownership to have its protocols, continuing education, and quality assurance performed by the same physician who provides the on-line medical control. This would assure that the treatments rendered in the field will meet the expectations of the receiving physician and follow an established standard of care. 940328 4 . The RFP should require that all 911 calls and other emergency responses be handled by a crew which includes at least one experienced paramedic. It has often been the practice of private ambulance services to use inexperienced paramedics because of their lower payroll cost. We would recommend that each unit be staffed with a paramedic with at least one year's experience. Our group feels these are important concerns which need to be addressed in the RFP. As the County moves forward with its deliberations, we would appreciate the opportunity to comment on the various alternatives that are proposed. Our present EMS system is state of the art and we are anxious that it remain at that level . Cordially, • ames J. Ca,ppain, M b. Physician Advisor, WCAS cc. Gary McCabe, WCAS Director Karl Gills, NCMC Senior Vice-President 940328 March 19, 1994 Bill Webster Herbert Brady PO Box 758 1901 11th Ave. Greeley, Co. 80632 Greeley, Co. 80631 353-3938 Dear Sir: I am writing you in regards to the impending Weld County Ambulance Service proposal. I have been a Paramedic for WCAS and Air Life for over 5 years, with over 10 years experience in the Emergency Medical Services. While I agree with the County's proactive stance on this issue, I feel they are taking a unrealistic and possibly detrimental approach. As you know the county runs the ambulance service as an enterprise fund, and since 1990 has operated successfully without a subsidy. Don Warden stated in his cover letter that he is trying to avoid fragmentation of the county wide service in the changing health care environment. This is a legitimate concern given governments historic inflexibility during times of change. Mr. Warden goes on to say that he wants to preserve the excellent service that WCAS has provided with out having to go back to taxpayer subsidy. The letter also states the premise for this fear is based on the fact that practically all of the ambulance services from Pueblo to Cheyenne were purchased by two large corporations. The county's plan is to put forth a RFP for private providers to bid for the exclusive right to receive 911 calls in the county. They have written certain performance standards that they feel will assure a level of service that the citizens have come accustom to. I must point out the following points: 1. Like you, I feel that EMS should not be heavily subsidized. 2. Fragmentation will only occur if another service is able to provide better service at a better price. 3. All of the acquisitions were of private EMS companies, that wanted to be purchased. When AMR Inc. bought A-1 Ambulance, they purchased all of the operations in Longmont, Boulder and Colorado Springs. 4. No public EMS was purchased, nor is there any intention of this to my knowledge. 5. Private Ambulance corporations have a long history of labor and quality problems. 6. Publicly held ambulance corporations export revenue out of the community. 7. Despite their claims, for profit companies cannot serve the population equally. 940328 2 I am requesting that you look at my proposal for implementation of a Weld County Emergency Medical Service Authority Inc. (WCEMSA). This would be a non profit corporation that is not under the auspices of the government. I have personal experience with this type of EMS model. This would have a similar setup as our Island Grove Regional Detox Center, and use a community based structure such as Cypress Creek EMSA in Texas. This is a proven and very successful non tax subsidized system. The framework and features of this system is as follows: I. Governed by a board of directors, consisting of a cross section of professionals, elected officials, and consumers. 2. All rates, salaries, purchases and standards would be set by the board. 3. All income would remain in the community, not skimmed off of operations and exported. 4. Not being a government agency, WCEMSA would be free to pursue contracts with HMO's, Industries, and Hospitals. 5. WCEMSA would be able to form mergers and alliances with other EMS providers and possible regionalization to gain a greater economy of scale. 6. Would be able to pursue all Federal, State and Private grants for equipment, community education, and under/un insured citizens. 7. Provide other needed services such as 24 hour transport of handicapped citizens (this population is grossly underserved in this community) 8. Provide EMS stand by's at a much more affordable rate than currently used by developing a reserve/intern system. 9. Provide public EMS education through community involvement 10. Provide top quality EMS while protecting both the patient, consumer and the tax payer. 11. Maintain maximum flexibility in the changing health care environment. I am asking that you work to give this proposal a chance. The time frame given to us by the county is unrealistic. The acquisition positioned corporations probably have their proposals in place. This does not give our local interests a chance to respond. This is an innovative system for our area but proven nationally. I ask that you give myself and my coworkers a chance to prove this type of system and that you put us to the test. I am sure as a public official you will find that being a part of this EMSA will be rewarding. Please feel free to contact me for more details about this system . I will be in Houston until] 3/26/94. Respectfully, Herbert Brady Jr. MTr 940328 March 23, 1994 Bill Webster Office of County Commissioners, P.O. Box 758 Greeley, CO 80632 Dear Mr. Webster: I am writing to you with concerns on the possible take-over of the Weld County Ambulance Service by private profit driven corporation. For 4 years I have been a volunteer firefighter and EMT on the Eaton Volunteer Fire Department. I have seen great changes come about in the working order and relationship between the WCAS and the fire depart- ments in Weld County. We all work as a team and the citizens of the county are provided with the best possible standard of care. One of my concerns is that with privatization the standard of care will drop as the cost of service is raised. I feel that a private company will be less likely to respond to outlying areas on a chance that they may be cancelled or the patient ends up either not sick or injured to the point of being transported, or the patient refuses transport. At present, the WCAS responds on all calls and allows the patient the right to refuse without being billed. What about when Air Life is needed -- is there going to be a conflict over who transports because the private company arrived first? How many people will die because of this? A private company is going to have stockholders to answer to. Are they going to be willing to hire the quality of paramedics now on crew at WCAS, or are they going to hire first-time paramedics seeking experience to move on to better positions, or hire EMT's to assist one lightly qualified paramedic? There again, the standard of care for the citizens of Weld County is jepordized. It is my request that you seriously think about leaving the Weld County Ambulance Serivce as it is. Maybe you have never had the opportunity to work with or be provided the care which WCAS provides. I have worked with them for 4 years and watched as the fire protection districts and the ambulance service have come together to form an outstanding team. I have also had to rely on the WCAS for assistance with injuries to my children and other loved ones. It would be a great mistake to take away such a great team. Thank you for your time and consideration. Sincerely, Cheri Lathrop, EMT, Firefighter 413 Collins Eaton, Colorado 80615 940325 Bill Webster r7 County Commissioner Office Greeley, Co. 80631 RE: Potential privatization of Weld County Ambulance Services As a citizen of Weld County and a twenty year member of the Eaton Fire Department, I am very opposed to privatizing the Weld County Ambulance Service. Over the past few years the existing service has been improved to the point where it is self supporting and highly professional . As a volunteer fireman, I am proud to assist the county paramedics, even to the point of driving the ambulance, etc . I 'm not so sure we would be as anxious to provide the same level of assistance to a profit-driven company, with less chance of cost savings being passed back to the citizens . I also believe there would be a potential for more turnover of paramedic personnel, which would impact the working relationship on emergency scenes . I am not overly concerned about private sector ambulance companies entering the area and offering an alternative to citizens for routine transports, etc . I am concerned about the 911 response being contracted. I would support citizen-wide subsidy of the Weld County Ambulance Service, if necessary, to maintain it 's professional integrity it has earned. I am confident that if such a subsidy is required it would be a small cost per citizen compared to the professional service rendered . I have worked for local government (City of Greeley Public Works Engineering) for 10 years . I have seen government services privatized; some successfully, some not so successfully. I am convinced that, in general, private profit driven companies cannot successfully compete with properly managed local government programs which are major full-time programs . I am also convinced that control of issues which are difficult to quantify by contract are lost when services are contracted . I believe that is the case with equipment maintenance services contracted by the City and County, for instance. Fortunately, that program is not so critical to the overall citizen welfare . . . .only their pocketbook . I will not ramble about all the intricate details of this major issue, such as Air-Life coordination, Greeley Fire, outlying areas, dollars leaving Weld County, etc . etc . We always need to consider potential changes to enhance our quality of lives, but this is a bad choice for consideration. We have developed a well-tuned efficient program. If we privatize this service, we potentially will decrease the quality of a critical service with very little potential for any benefit . I would be pleased to discuss this personally if you have time, but I understand your daily demands. Sincerely, Steven G. Bagley, P. E. 350-9792 (W) 1220 4th St . ' 454-3606 (H) Eaton, CO 80615 940328 JpuNrq,,t, MOUNTAIN VIEW FIRE PROTtCTION DISTRICT Administrative Office: 9119 County Line Road •Longmont, CO 80501 E (303)772-0710 Metro (303) 666-4404 FAX (303) 651-7702 �'■Lr. B VIEW March 16, 1994 • Board of County Commissioners Weld County, Colorado v- P.O. Box 758 Greeley, Co 80632 RE: Proposed County-Wide Ambulance Service Contract Dear Honorable Commissioners: Our District currently serves approximately 123 square miles of Weld County, providing basic emergency medical services and fire suppression. The approximate boundaries are Weld County Road 36 on the North, State Highway 7 on the South, Weld County Road 1 on the West and Weld County Road 13 on the East. Ambulance services are provided by American Medical Response, out of Longmont and Tri-Area Ambulance service. Our District service plan filed with the Division of Local Government specifically includes a statement that the District retains the right to provide ambulance service. Therefore, upon completing the request for bid for county- wide ambulance service, please request the bidders to provide a separate price quote for our service area. Upon receipt of the bids, we would like the opportunity to discuss the service with the County Representative to determine if our service area is to be included in the County contract or not. Thank you for your consideration. Sincerely, Gerald Ward District Fire Chief dlm cc: Richard N. Lyons, II, Esq. Don Warden, Weld County Treasurer Gary McCabe, Director, Weld County Ambulance John Fryar, President, Tri-Area Ambulance Service Ed Garbarino, Supervisor, Tri-Area Ambulance Service AMB.L Station 1 Station 2 Station 3 Station 4 Station 5 Station 6 Station 7 9119 Cnty Line Rd. 10971 WCR 13 P.O.Box 575 P.O.Box 11 10911 Dobbin Run P.O.Box 666 P.O.Box 40 Longmont,CO Longmont,CO 299 Palmer Ave. 8500 Niwot Road Lafayette,CO 600 Briggs 100 So.Forest St. 80501 80504 Mead.CO 80542 Niwot,CO 80544 80026 Erie,CO 80516 Dacono,CO 80514 ex, 2 6;-; Fi; "i-1 ; 16"CC. 940329 COLLINS AND COCKRMAIJ.,, p.c. - I TELEPHONE PAUL R. COCKREL ATTORNEYS AT LAW - JAMES P.COLLINS 390 UNION BOULEVARD, SUITE 400 (303)986-1551 TIMOTHYJ. BEATON DENVER, COLORADO 80228-1556_.. ^ 1 ROBERT G.COLE .... - i WATS (BOO)354-5941 PAUL C. RUFIEN --- . TELEFAX 1303)986-1755 March 10, 1994 Board of County Commissioners Weld County, Colorado P. O. Box 758 Greeley, Colorado 80632 Re: Proposed County-Wide Ambulance Service Contract Dear Honorable Commissioners: I represent the Tri-Area Ambulance District, which provides ambulance and emergency medical service to approximately 26, 000 acres located in southwest Weld County, including the Towns of Frederick, Firestone and Dacono. The District also provides service within the Mountainview Fire Protection District by agreement. The Tri-Area Board of Directors is greatly concerned with the potential negative impact on the cost and efficiency of providing ambulance and emergency medical services within the Tri- Area service area which would result from an exclusive county-wide contract provider. The Board of Directors of Tri-Area Ambulance District requests that you exclude the Tri-Area service area from the proposed county-wide ambulance service contract. Further, all emergency calls for assistance within the Tri-Area District should be routed to the District as the primary provider; if needed, the District can then request assistance from the contract provider. Contract ambulance service within the Tri-Area service area would result in increased costs, longer response times, and elimination of no charge public education and standby services. Tri-Area's response time with advanced life support services to all areas within its service area in well less than the nationally prescribed standards. Based on existing charges by contract providers within the region, contract service charges would likely be double the District's current charges for calls within the Tri- Area District boundary. Outside the District but within its service area, contract service charges would result in a thirty to forty percent increase. Tri-Area currently provides education services to local schools and senior citizen centers, and at local fire station programs. The District also provides without charge standby services for local public school athletic events such as football games and gymnastic meets. 6O : cla fl ; r1HH , >>.>1 . 940328 COLIANS AND COCK 12]lu , Board of County Commissioners March 10, 1994 Page 2 The Tri-Area Ambulance District has a history of providing professional, efficient and cost-effective ambulance and emergency medical services. The District evolved out of the Tri-Area Volunteer Ambulance Service which was organized by people in the local communities in 1971. In voting to approve the formation of the District in 1984, and biennial election of its Board of Directors, the taxpayers of the District have shown their continued support of publicly-provided ambulance and emergency medical services. As a local government which evolved out of public support, Tri-Area's elected Board of Directors is necessarily responsive to the needs of its taxpayers and residents. The District's taxpayers and residents have continued to show their support of the District and have not requested that an additional ambulance service provider be licensed, and the same has not been shown to be necessary within Tri-Area's service area. Board President John Fryar and I would be happy to meet with you to discuss this matter at your earliest convenience. We are also available to assist you with preparation of your proposal for contract ambulance service, and any revisions to the County regulations for ambulance service, so as to ensure the best interests of Weld County's residents. Thank you for your consideration. Sincerely, COL NS AND COCKREL, P.C. ACC_ Robert G. Cole Attorneys for Tri-Area Ambulance District RGC:val cc: Mr. John Fryar, President Board of Directors - Tri-Area Ambulance District Mr. Ed Garbarino, Supervisor Mr. Richard Lyons, General Counsel, Mountain View Fire Protection District Mr. Don Warden, Weld County Treasurer Mr. Gary McCabe, Director Weld County Ambulance Service 340328 ;SDPI :11 OFFICE OF BOARD OF COUNTY COMMISSIONERS A \\ PHONE 1303)3564000, EXT. 4200 ' FAX 1303,352-0242 P 0. BOX 758 C. GREELEY. COLORADO 80632 COLORADO March 22, 1994 All Fire Districts E911 Advisory Board Tri-Area Ambulance District North Colorado Emergency Room Physicians NCMC EMS Advisory Board Members To Whom It May Concern: We are pleased to announce that Dr. James N. Eastham will be attending the meeting concerning the Request For Proposal for emergency ambulance services on March 29, 1994, at 7:00 p.m. , in the Centennial Center, 915 Tenth Street, Greeley, Colorado. Dr. Eastham is a highly acclaimed national and international expert on quality of care issues in emergency medical services. He will address Continuous Quality Improvement concerns and assist in answering other questions posed by the emerging changes in health care delivery systems. All interested parties are encouraged to attend and participate. Very truly yours, BOARD OF COUNTY COMMISSIONERS etilyI ' )1 0 W. H. Webste f Chairman el George ,. Baxter Dale K. Hall Constance L. Har ert arbara J. Kir meyer v BOCC/cah cc: All Municipalities 9 u "\ OFFICE OF BOARD OF COUNTY COMMISSIONERS PHONE(303)356-4000. EXL 4200 N ' FAX X3031 3520242 P.O. BOX 758 C. GREELEV. COLORADO 80632 COLORADO March 11, 1994 TO: All Fire Districts E911 Advisory Board Tri-Area Ambulance District North Colorado Emergency Room Physicians NCMC EMS Advisory Board Members To Whom It May Concern: Attached please find a Request For Proposal (RFP) for emergency ambulance services for Weld County. You and any other interested members of your organization are invited to submit comments in writing to the Commissioners concerning the RFP and to attend a public meeting to be held on March 29, 1994, at 7:00 p.m. in the Centennial Complex at 915 10th Street, Greeley, Colorado, to discuss the RFP. Any written comments on the RFP should be sent to the following address by March 25, 1994: Don Warden, Director Finance and Administration P.O. Box 758 Greeley, CO 80632 The Board of County Commissioners is considering releasing the RFP in early April, 1994 in order to evaluate the possibilities of contracting for emergency ambulance services in Weld County. This consideration is in no way a negative reflection of the quality of service or staff of the Weld County Ambulance Service (WCAS) . WCAS is a quality service offered at an affordable fee without government subsidy. The need to consider changes are associated with forces external to Weld County, and in many ways beyond our control. Specifically, the forces are the changing market with the acquisition of nearly every ambulance provider from Pueblo to Cheyenne by two major private ambulance companies. 940328 Secondly, the integration of health care providers within large health systems that are in turn affiliated with prepaid health care programs (e.g. HMO's, IPA's, PPO's, insurance companies, etc. ) Thirdly, the impact of health reform and the restructuring of the health care industry. The risk of all the above forces converging together is the fragmentation of the County's ambulance market geographically, by patient's ability to pay, and/or service type. The ability of the WCAS to remain self- sufficient by fees and without tax subsidy is jeopardized with any of these potential market fragmentation types or combinations. The Board believes WCAS is in a position currently with the quality of care and financial stability to negotiate an exclusive 911 service area from a position of strength; however, in a very short time this position could erode with the external forces at work. The phenomena occurring in the Front Range of Colorado is not atypical to what has happened in recent years in other ambulance markets across the country, when major private ambulance providers enter the local market in a significant way. Those entities that have reacted on a proactive basis, as Weld County is proposing, have been able to achieve the key component the Weld County Board of County Commissioners believes is essential for the citizen of Weld County: a county-wide service with a high quality of patient care at an affordable price to all citizens. We have achieved this goal with WCAS in recent years, and feel we must act now to retain it in the future. To that end, the RFP is for an exclusive 911 service area where the ambulance provider, in exchange for the right of exclusive dispatch to all emergency medical request, guarantees contractually to: 1) certain performance standards of quality of care with penalty provision for failure to perform; 2) respond to all ambulance requests in the Weld County service area; 3) performance standards for equipment, vehicles, training, and staff; and 4) approval of the rate structure by the Board of County Commissioners. The RFP has been modeled after other successful RFP' s used nationwide. We are confident it can lead to the selection of a qualified provider meeting all the essential criteria for Weld County's emergency ambulance service. The proposal will be evaluated by a review committee of key representatives in the emergency medical response system to insure all interests are covered. Your input, through comments on the proposal prior to release, and attendance at the above meeting will be most helpful. If you have questions, please do not hesitate to contact Don Warden, Director of Finance and Administration, at (303) 356-4000, extension 4218, Gary McCabe, Director, Weld County Ambulance Service, at (303) 356-4000, extension 3200, or any of the Board members at (303) 356-4000, extension 4200. Very truly yours, BOARD OF COUNTY COMMISSIONERS W. "II l5s' tNr, Chairman L George-E. Baxter Dale K. Hall �5 � u L Constance L. Harbert arbara J. Kir eyer BOCC/cah cc: All Municipalities DEPARTMENT OF FINANCE AND ADMINISTRATION PHONE(303)356-4000 EXT.4218 P.O.BOX 758 ikGREELEY,COLORADO 80632 COLORADO AFT March 31, 1994 Dear Proposers: Attached is a copy of a Request For Proposal for emergency ambulance services for Weld County. You are invited to a pre-proposal conference on Tuesday, April. 5, 1994, at 10:00 a.m. in the Personnel Conference Room, Second Floor of the Centennial Center, 915 Tenth Street, Greeley, Colorado. This will be the only walk-through provided to proposers unless other arrangements are made prior to the scheduled time. The anticipated schedule of key dates is as follows: March 31, 1994 Advertise RFP April 5, 1994 Pre-Proposal Conference and Walk-Through April 26, 1994 Proposals due to Weld County Purchasing Office by 3:00 p.m. May 9, 1994 Award July 1, 1994 Contract Effective Date Your interest in this RFP is greatly appreciated. If you have questions regarding this Request for Proposal please call me at (303) 356-4000, Extension 4218. Very truly yours, Donald D. Warden, Director Finance and Administration DDW/ch 940328 D RA F WELD COUNTY , COLORADO REQUEST FOR PROPOSAL F O R AMBULANCE SERVICES MARCH , 1994 940328 AMBULANC E S E RV=C E RE QIJE S T FOR PROPOSAL I NO E X GENERAL TERMS REQUIREMENTS FOR SUBMISSION OF PROPOSAL EVALUATION OF PROPOSAL SERVICE/PERFORMANCE STANDARDS PERSONNEL LOCATIONS AND FACILITIES COMMUNICATIONS/DISPATCH FINANCIAL AND RATEE STRUCTURE COMPUTER SYSTEMS VEHICLE, EQUIPMENT, AND SUPPLIES DISPUTES/DEFICIENCIES/DEFAULT FORMS FOR REQUIREMENTS FOR SUBMISSION ATTACHMENTS: A. SERVICE CALLS B. SERVICE AREA C. 1992/93 ACTUAL COSTS 1994 BUDGET D. EQUIPMENT/DEPRECIATION LISTING E. SALARY AND BENEFIT SCHEDULE 940328 ' GENE RAL T E RM S :0329 REQUEST FOR PROPOSAL Weld County, Colorado is soliciting proposals for Emergency Ambulance Services. Proposals will be received until 3:00 p.m. local time, Tuesday, April 26, 1994, at the Weld County Purchasing Office, 915 Tenth Street, Greeley, Colorado 80631. Late proposals will not be accepted under any circumstances. Any proposal(s) received after the scheduled time for closing will be returned unopened to the proposing firm. Sole responsibility rests with the proposing firm to see that their proposal is received on time. This Request For Proposal is intended to secure the services of a qualified contractor to provide quality emergency ambulance services. 1.1 PREAMBLE The County of Weld wants to ensure that its citizens and visitors have high quality emergency medical care. The general characteristics of a high quality emergency ambulance provider include: 1. Has a work force both clinical and non-clinical that is well-trained, experienced and acts in a professional, caring and courteous manner with all of their customers, including patients, the patient's family, bystanders, first responders, hospital personnel and the media. 2. Has a commitment to providing well-maintained and reliable vehicles and equipment that maintain a like-new appearance and operation at all times. 3. Has a commitment to caring about the work force in terms of exemplary pay and benefits, providing opportunities for professional growth and development and ensuring a safe work environment. 4. Has a commitment to the community in terms of providing community education programs and participating in the life of the community through participation in community-based organizations. 5. Has a commitment to continuous quality improvement of all phases of the business with a goal of obtaining accreditation by the Commission of the Accreditation of Ambulance Services. 1 940328 1.2 SCOPE The County of Weld invites sealed proposals for providing ambulance service, without cost to the County, for the transportation of individuals who are sick, injured, wounded or otherwise incapacitated or helpless within the boundaries of the County of Weld from accident sites and other locations to hospitals' emergency care facilities as requested by the patient, family, or public safety agencies. Attachment A provides statistics relating to total emergency medical call volume estimations including transports by ambulance and other pertinent information relating to service calls. The County of Weld does not guarantee that a minimum number of requests for transport or actual transports will occur. Proposer should be aware that the transportation service will be on an "as needed" basis. The only assurance the County makes is that if it is determined that the service is required and falls within the defined service boundaries (Attachment B) of the County of Weld, the selected provider will be sole source for this service. Please note that proposals will be accepted only from single business entities or single corporations for services to be provided by such entities or single corporations for services to be provided by such entity or corporation only. Sub-contracting or assignment of any of the proposers' responsibilities will not be permitted. Any questions in regard to the proposal should be directed to Don Warden, Director of Finance and Administration, at (303) 356-4000, Ext. 4218. 1.3 PRE-PROPOSAL CONFERENCE A pre-proposal conference will be held on Tuesday, April 5, 1994, to provide prospective proposers with an opportunity to ask questions regarding the proposal and tour the ambulance facility. The pre- proposal conference will be held at 10:00 a.m. in the Personnel Conference Room, Second Floor of the Weld County Centennial Building, 915 Tenth Street, Greeley, Colorado. County staff will be available to answer questions. Attendance at the pre-proposal conference is not mandatory, but is recommended. It will be the only opportunity for proposers to tour the facilities. 1.4 ETHICS PROVISION It is unlawful for any person to offer, give or agree to give to any public or former public employee or for any public or former public employee to solicit, demand, accept or agree to accept from another person gifts or offers of employment because of: 1. An official public action taken, or to be taken, or which could be taken, or 2 940328 2. A legal duty performed, or to be performed, or which could be performed, or 3. A legal duty violated, or to be violated, or which could be violated by such public or former public employee. It is unlawful for any payment, gift or benefit to be made by or on behalf of a subcontractor or higher tier subcontractor or any person associated therewith as an inducement for the award of a subcontract or order. 1.5 CONDITIONS OF PROPOSAL SUBMITTAL 1. All proposing firms shall comply with all conditions, requirements, and specifications contained herein, with any departure constituting sufficient cause for rejection of the proposal. 2. The proposal must be signed by a duly authorized official of the firm submitting the proposal. 3. No proposal will be accepted from any person, firm, or corporation that is in arrears for any obligation to the County. 4. Only one proposal will be accepted from any person, firm, or corporation. 5. All prices quoted must be firm for a period of one hundred and twenty (120) days following the date proposals are due. 6. Proposals may be pulled and/or resubmitted provided the proposer makes a written request before the date proposals are due. 7. Weld County, Colorado reserves the right to reject any and all proposals or any part thereof. County reserves the right to waive any formalities or informalities contained in this RFP, and to award to the most responsive and responsible proposing firm as determined in the best interest of the County. The decision of the County shall be final and conclusive. 8. All proposals shall be prepared in a comprehensive manner as to content, but no necessity exists for expensive binders or promotional material. 9. All costs, including travel and expenses, incurred in the preparation of any proposal shall be borne solely by the proposing firm(s) . 3 940329 10. Written approval by the Weld County Director of Finance and Administration is required prior to any public disclosure regarding this RFP or any subsequent awards. 11. No advantage shall be taken by proposers based on omission of any parts or details which are necessary in the provision of ambulance services in Weld County, even though such details are not specifically addressed in this RFP. 12. Any proposer, by submitting a proposal herein, waives any right of confidentiality as to any aspect, part or portion of the proposal and agrees that such proposal shall constitute public information and a public record of the County of Weld. 13. Proposers will fully inform themselves of conditions, requirements, and specifications before submitting their proposal. Failure to do so will be at Proposer's own risk and the Proposer cannot secure relief by plea of error. 14. Neither law nor regulations make allowance for error of omission or error of commission on the part of the Proposer. 15. Submittal of a proposal shall be taken as prima facia evidence that the proposer has full knowledge of the scope, nature, quality, and quantity of the work to be preformed, and the detailed requirements and conditions under which the work is to be performed. 16. FAILURE TO INCLUDE ALL REQUIRED SUBMISSION MATERIALS MAY RENDER THE PROPOSAL NON-RESPONSIVE, AS DETERMINED BY WELD COUNTY. This Request For Proposal does not commit the County of Weld to award a contract. All proposals submitted become the property of Weld County. Nothing in this contract will prohibit any ambulance companies from providing non-emergency transports within the County of Weld. This contract is limited to all emergency request calls received by the Weld County Regional Communications Center for the defined service areas. 1.6 CONTRACTUAL OBLIGATION The contents of the submission of the successful proposer shall be considered as a contractual obligation. Failure to meet this obligation may result in a voidance of the contract and damages. 4 94®328 1 1. 7 CONTRACT FORM AND LANGUAGE The contract document or documents will be drafted by the Office of the County Attorney, County of Weld. The submission of a proposal herein by a proposer constitutes an agreement by the proposer that it will not insist on or use any standard contract agreements, documents or forms, and that it waives all provisions of its standard agreements. The language for the contract to be executed will be drafted by the County under the supervision of the County Attorney of the County of Weld and shall be the controlling document. 1.8 CONTRACT DOCUMENTS The documents that will form the contract include the Request For Proposal and all attachments thereto, the proposer's proposal, subsequent correspondence, and contract agreements. County reserves the right to negotiate specific terms, if necessary, with successful proposer for the mutual benefit of both parties. 1.9 CONTRACT TERM The duration of the contract will be from July 1, 1994, to June 30, 1997, for thirty-six (36) months. Further, County may exercise options, with the agreement of the contractor, to extend the contract for up to three (3) additional years. 1.10 CONTRACT PERIOD, EXTENSIONS, CANCELLATION 1. The contract shall be in effect for the term stated in the specifications. 2. All contracts and extensions are subject to approval of the Board of County Commissioners (if required) . 3. All notices are in effect commencing with the date of mailing. Written notices may be delivered in person or by First Class mail to the last known address. 4. If cancellation is for default of contract due to non- performance, the contract may be canceled at any time. 1.11 REQUEST FOR PROPOSAL AS CONTRACT Should modifications (after proposal opening) NOT be necessary; this Request For Proposal (RFP) will be executed as the contract. In the event modifications of any nature do occur, a separate agreement shall be negotiated containing mutually agreeable terms and conditions from this Request For Proposals and any addenda. 5 940328 ! 1.12 CHANGES AND/OR CONTRACT MODIFICATIONS The County reserves the right to increase or decrease services or requirements, or make any change necessary at any time during the term of this contract, or any negotiated extension thereof. Price adjustments due to any of the foregoing changes shall be negotiated and mutually agreed upon by the contractor and the County. Rate increases requested by the contractor commensurate with any higher standards imposed by the County as well as other local, state, and/or federal laws of regulations will be considered by the County. Changes of any nature after contract award which reflect an increase or decrease in requirements or costs shall not be permitted unless properly drafted change order forms are submitted to the Contract Administration. Board of County Commissioner approval may be required. 1.13 INDEPENDENT CONTRACTOR At all times the contractor, any of his/her employees, or his/her sub- contractors and their subsequent employees shall be considered independent contractors and not as County employees. The contractor shall exercise all supervisory control and general control over all worker's duties, payment of wages to contractor's employees and the right to hire, fire and discipline their employees and workers. As an independent contractor, payment under this contract shall not be subject to any withholding for tax, social security or other purposes, nor shall the contractor or his/her employees be entitled to sick leave, pension benefit, vacation, medical benefits, life insurance or workers' unemployment compensation or the like. The contractor's employees shall wear a uniform which identifies them as employees of the contractor. 1.14 ASSIGNMENT OF CONTRACTOR DUTIES AND OBLIGATIONS The duties and obligations assumed by the contractor are non- transferable or assignable without prior written consent of the County. 1.15 APPLICABLE LAW Any agreements shall be interpreted, construed, and governed by the laws of the State of Colorado. 6 940328 1.16 LAWS, ORDINANCES AND REGULATIONS The contractor shall keep himself/herself fully informed of all local, state and federal laws, ordinances and regulations in any manner affecting those engaged or employed in the work and the equipment used. Contractor and/or employees shall, at all times, serve and comply with such laws, ordinances and regulations. Any permits, licenses, certificates or fees required for the performance of the work shall be obtained and paid for by the contractor. Contract shall fully comply with Weld County Ordinance Numbers '7 /7_ 0__ amended. 1. 17 PERFORMANCE BOND The contractor shall be required to furnish County with performance bonds or other acceptable security not later than thirty (30) calendar days after notice of award in the amount of $1, 000, 000. Performance bonds or other security shall be in such form and with such sureties as are satisfactory to the County. Performance bonds or other security shall be executed to secure fulfillment of all the contractor's obligations. In the event the performance bond is not delivered within thirty (30) calendar days of notice of award, the award may be ruled null and void. The performance bond or other security will provide assurance of faithful performance and discharge of all duties and responsibilities as required by law, and under the terms and conditions of the contract. At the County's option, performance bond may be waived. 1.18 INDEMNIFICATION The contractor agrees to protect, defend, indemnify and hold the County, its officers, employees and agents free and harmless from any and all losses, penalties, damages, settlements, costs, charges, professional fees, or other expenses or liabilities of every kind and character arising out of or relating to any and all claims, liens, demands, obligations, actions, proceedings, or causes of action of every kind and character in connection with or arising directly or indirectly out of this agreement and/or performance thereof. Without limiting the generality of the foregoing, and all such claims related to personal injury, infringement of any patent, trademark, copyright (or application for any thereof) or of any other tangible or intangible personal or property right, or actual or alleged violation of any other tangible or intangible personal or property right, or actual or alleged violation of any applicable statute, ordinance, administrative order, rule or regulations, or decree of any court, shall be included in the indemnity hereunder. The contractor further 7 940328 agrees to investigate, handle, respond to, provide defense for, and defend any such claims at its sole expense, including claims related to accidents and injuries resulting from poor vehicle maintenance, and agrees to bear all other costs and expenses related thereto, even if such claim is groundless, false or fraudulent. 1.19 INSURANCE A. The contractor shall procure and maintain in force during the term of the contract, at its own cost, the following coverage: 1. Workers' Compensation Insurance of statutory limits as required by the Labor Code of the State of Colorado and Employer's Liability Insurance with minimum limits of one million ($1,000,000) dollars bodily injury by accident and one million ($1, 000, 000) dollars bodily injury by disease. B. Comprehensive General Liability Insurance - Including premises and operations, malpractice coverage. Product and completed operations, contractual and independent contractor's protection with limits as follows: Bodily Injury $ 500, 000 each/$1, 000,000 occurrence $1,000, 000 aggregate Property Damage $ 100,000 occurrence/ OR $ 100,000 aggregate Bodily Injury/ Property Damage $1, 000,000 CSL Umbrella Policy $5, 000, 000 aggregate C. Automobile Liability Insurance - Including owned, non-owned and hired motor vehicles, as well as (??Michigan Property Protection) Insurance as required by statute. Limits as follows: Bodily Injury $ 500,000 occurrence/ $ 500,000 aggregate Property Damage $ 100,000 occurrence/ OR $ 100,000 aggregate Bodily Injury/ Property Damage $ 500,000 CSL The above requirements should not be interpreted to limit the liability of the Contractor under this contract. ALL INSURERS SHALL BE EITHER LICENSED OR AUTHORIZED TO DO BUSINESS IN THE STATE OF COLORADO. 8 940328 These coverages shall protect the contractor, its employees, agents, representatives and subcontractors against claims arising out of the work performed. THE COUNTY OF WELD, ITS AGENTS AND EMPLOYEES SHALL BE INCLUDED AS ADDITIONALLY INSURED WITH RESPECT TO ALL LIABILITY POLICIES HEREIN. A thirty (30) day cancellation clause with notice to the County of Weld shall be included; words modifying the cancellation clause such as "endeavor to" provide notice will be unacceptable and must be stricken. 1.2O ABILITY TO PERFORM CONTRACT REQUIREMENTS Proposer must provide evidence of demonstrated history of ability to provide specified service in system similar to Weld County's (including statistical data) . 1.21 BUSINESS QUALIFICATIONS Proposer must provide information demonstrating business qualifications in the following areas: 1. Longevity in the EMS/ALS field. 2. Capacity of business resources to provide required services. 3. Prior experience providing primary ALS response to 911 requests. 4. Any national certification, awards, or recognition for service excellence. 9 9efvtig REQUIREMENTS F O R SUBMISSION OF PROPOSAL 10 940328 2. 1 PROPOSAL ELEMENTS AND FORMAT Proposals submitted shall contain all information as requested herein, and any additional information necessary to summarize the overall benefit of the proposal to the County. Proposals shall include the following: 1. A cover letter stating the name, address, and telephone number of the proposing firm, with the signature of the person having the authority to make the proposal for the firm. 2. A list of personnel assigned to the project team, including resumes and work experience. 3. A response that defines the methods and means by which the proposing firm will perform the services outlined in the Request For Proposal. 4. A project timeline outlining the dates and specific tasks necessary for project start up, including the specific employees involved. 5. A list of all references for which similar services have been provided. Include contact names, addresses, telephone numbers, and approximate annual contract price. 6. Any other information deemed necessary by the proposing firm. 7. TEN COPIES OF PROPOSAL MUST BE PROVIDED. 2.2 REQUIREMENTS FOR SUBMISSION OF PROPOSAL SUBMISSION REQUIREMENTS SUMMARY. The following section summarizes all submission requirements to be supplied by the proposer in bid proposals: A. REQUEST FOR PROPOSAL 1. Qualifications Question 2. Summary of Terms and Conditions Checklist 3. Cost Proposal Summary 4. Rate Structure 5. Required Attachments by Reference Section Number 6. Signature Requirements 11 9L149:3'28 E VALUATION O F P RO P O S AL 12 9i0-'C9 3.1 EVALUATION OF PROPOSALS This is a competitive procurement for professional services. While price is an important factor, the successful proposal will be one which offers the County the best combination of price, quality of performance, and effectiveness at addressing the scope of work. A committee will evaluate the proposals and make a recommendation to the County Commissioners. The proposals will be evaluated to determine if they are in accordance with the terms of the RFP. Once an initial screening has identified those proposals which are responsive, the review committee will evaluate the proposals based on the evaluation criteria. The finalist(s) may be requested to make oral presentations to allow the review committee to meet and interview key personnel and gather additional information about the firm and the proposal. Insufficient management experience and/or support services, poor past performance, and insufficient financial capacity as determined by the review committee may be cause for rejection of proposal. 3.2 EVALUATION CRITERIA The following criteria will be used to evaluate the proposals received. Points are assigned to indicate the relative weight of each category. Examples are provided for the criteria which will be used, but is not limited to evaluating each category. The EMS/ALS provider is responsible for submitting a proposal which provides sufficient information to evaluate their capabilities to meet the requirements of this contract. RFP section reference number follows requirement. A. BUSINESS QUALIFICATION: 150 POINTS 1. Longevity in the EMS/ALS field (§ 1.21. 1) 2. Capacity of business resources to provide required services (§ 1.21.2) 3. Prior experience providing primary ALS response to 911 requests (§ 1.21.3) 4. Qualifications of on-site management personnel (§ 5. 16.6) 5. Qualifications of off-site (corporate) management personnel and resources (§ 5. 16. 7) 6. Quality of information management systems (§ 8.5 and 8.6) 7. Any national certification, awards, or recognition for service excellence (§ 1.21.4) 13 94032,8 B. QUALITY OF PERSONNEL (Including field personnel, customer service, dispatch, fleet and equipment maintenance) : 200 POINTS 1. Qualifications of supervisor(s) (§ 5. 16. 1) 2. Number of technicians, level of certification, other training received (e.g. fail safe driving, etc. ) (§ 5. 16.2) 3. In-service training programs (frequency, topics, attendance policy) (§ 5.16.3) 4. Any other information which demonstrates a high level of quality of personnel providing services. (§ 5. 16.4) C. ABILITY TO PERFORM CONTRACT REQUIREMENTS: 200 POINTS 1. Demonstrated history of ability to provide specified service in system similar to Weld County's (including statistical data) (§ 1.20) 2. Shift hours proposed which balance staffing requirements against need for effective personnel (§ 5. 1) 3. Any other information which demonstrates a high level of quality of personnel providing services (§ 5. 16.8) 4. MIS system to be provided under the contract (§ 8.6) D. EMS/ALS EQUIPMENT AND SUPPLIES: 200 POINTS 1. Qualifications of person responsible for supervising the maintaining and repairing of the fleet (provide resume) (§ 5. 16.5) 2. Scheduled maintenance program (§ 9.4) 3. Vehicle and equipment replacement policies and/or schedules (§ 9.5) 14 94029 E. COMMITMENT TO AFFIRMATIVE ACTION AND FAIR EMPLOYMENT PRACTICES: 100 POINTS 1. Affirmative action policy (§ 5.14) 2. Employment statistics (page 49, numbers 10 and 11) 3. Salary and Benefit Comparison (§ 5.10) F. PRICING: 150 POINTS 1. Charges for response and transporting (§ 8.2) 2. Coordination with Medicare/Medicaid (§ 8.2) 3. Handling of unpaid bills (§ 8.4) G. COMMUNITY SERVICE, TRAINING AND EDUCATION: 100 POINTS What community services will your firm provide over and above the requirements of this contract which will promote the general health and well being of our community (i.e. , provide information displays at public festivals, CPR training and other training and other training sessions, standby ambulance at public events, etc. )? (§ 4. 10) 15 940325 S E RV I C E AND P E R F O RMANC E STANDARDS 16 sS 0328 1 4.1 EMERGENCY ASSISTANCE The contractor shall be capable of responding to major emergency situations that require more than the minimum number of vehicles during any period of the day. The contractor shall submit a detailed and separate plan that includes the available units and personnel for immediate dispatch, an acceptable response time, and a fair and equitable rate structure for services rendered for major emergency situations. 4.2 RESPONSE TIME EVALUATION A response time evaluation will be conducted by the County and made available to the contractor each month to assure compliance with the provisions of the contract. The response time shall be calculated from the time the County notifies the contractor of the request for service to the time the contractor notifies the County of its arrival at the scene. 4.3 RESPONSE TIME NON-COMPLIANCE The contractor shall provide at the County's request a written explanation for any and all incidents in which the response time requirements of the contract are not met within the standard time. This report shall include a full discussion of the circumstances of the incident, the status of the patient, and any corrective action required to comply with the provisions of the contract during the remainder of the term. 4.4 EVALUATION RECORDS The contractor shall maintain and make available to the County complete records regarding user evaluation of the service. This shall include data, time, name and incident. The County may survey users periodically to determine level of satisfaction with the service provided by the contractor. 4.5 ANNUAL REPORT The contractor shall submit an annual report by July 1 each year. This report shall include a complete and accurate accounting of all evaluation criteria identified in the contract. 17 4.6 INSPECTION OF SERVICE The contractor shall furnish the County authorized representative(s) with every reasonable opportunity to determine whether or not the service is performed in accordance with the requirements of the contract(s) . The County may appoint qualified persons to inspect the contractor's operations and equipment, and contractor shall permit these authorized representative(s) to make such inspections at a reasonable time and place. 4.7 TREATMENT PROTOCOLS: All pre-hospital treatment must be per approved physician advisor protocols, standing orders, and/or on-line medical control. 4.8 PHYSICIAN ADVISOR: Contractor is responsible for the provision of a Board certified emergency medical physician advisor and all costs thereof. Physician advisor must meet all of the qualifications and responsibilities as promulgated under the Colorado Code of Regulations 3-CCR-713-6. 4.9 MEDICAL COMPETENCY: Contractor is responsible for the medical competency of all technical personnel. Medical competency of personnel shall be demonstrated by: 1. Quarterly tests on protocols and standing orders. 2. Bi-annual skills labs. 3. Field Instructor and physician advisor audits of trip reports and medical data. 4.10 PUBLIC RELATIONS: Contractor will provide public information and education including, but not limited to, the following: 1. Appropriate medical use of 911. 2. Local public school education and demonstrations (without charge) on Emergency Medical Service. 3. Ride-along programs. 4. Internships for EMS students. 18 94032,9 5. Speakers bureau for service organizations, senior citizen centers, etc. 6. Representation on Weld County EMS Advisory Council. 7. Promotion of CPR training. S. Injury prevention and wellness promotion. 9. Health Fair participation. 10. National EMS Week promotion. Community Service What community services will your firm provide over and above the requirements of this contract which will promote the general health and well being of our community (i.e. , provide information displays at public festivals, CPR training and other training and other training sessions, standby ambulance at public events, etc. )? 4.11 INTER-AGENCY RELATIONS: Contractor will participate in the following: 1. Local and regional disaster planning, training, and response. 2. Mutual Aid agreements with region's fire rescue, air and ground ambulance services, and other emergency service providers. 3. Annual County EMS Plan update to meet State EMS Division requirements. 4. Compliance with all Fire Departments' Incident Command Systems. 5. Provide standby and rehabilitation care at major fires, hazmat incidents, or any other major situation when requested. 6. Participate in joint grant proposals that benefit the provision and/or enhancement of EMS in Weld County. 19 940325 P E R S O NN E L 20 940328 5.1 CREW MANNING Contractor shall present a staffing plan that will ensure that staff on duty are physically and mentally capable to respond and perform effectively. The plan shall include provisions for obtaining additional staffing in the event of disaster conditions, inclement weather, labor actions, or other unusual situations. At lease one lead paramedic shall be assigned to each MICU Ambulance. Lead paramedic or his/her partner must have at least two years full time EMS field experience. A sample shift schedule for coverage of each crew and supervision along with local management positions should be provided. Demonstrate how shift hours proposed will balance staffing requirements against need for effective personnel. Current manning includes 24 hour coverage with three Advanced Life Support crews of two staff and a fourth backup with one paramedic. Equivalent manning must be provided. See standards section for personnel requirements. The following is the service area for each ambulance: Paramedic 1: North third of Weld County: From 16th Street in the City of Greeley north to the Weld County border/Wyoming State line. Paramedic 2: Middle third of Weld County: From 16th Street in the City of Greeley south to Weld County Road 38. Paramedic 3: South third of Weld County: From Weld County Road 38 south to Weld/Adams County border. Paramedic 4: Backs up emergency calls when P-1 or P-2 are on other calls. This car is staffed with one paramedic and utilizes fire department personnel as drivers. Duties are as assigned by supervisors. Paramedic 5: First back-up ambulance used primarily for stand-bys and transfers. Routine or emergency transfers and stand-bys are arranged through the Weld County Ambulance Office. All transfers are staffed by at least one EMT-B and one EMT-P. If personnel are unavailable to cover transfers, P-1 will cover transfers between the hours of 0800-1700. P-2 will cover transfers from 1700-0800. All transfers done by P-1 or P-2 must be approved by the shift supervisor. 21 940328 Paramedic 6: Second back-up ambulance for transfers and stand-bys. Paramedic 7: Third back-up ambulance for transfers and stand-bys. 5.2 ORGANIZATIONAL CHART An organizational chart for the proposer's ambulance service should be provided. 5.3 QUALIFICATIONS: Technical personnel must meet all qualifications as established by: 1. The Colorado Department of Health 2. The Colorado Board of Medical Examiners 3. Weld County, Colorado ordinances 4. The designated physician advisor 5.4 CREDENTIALS: Technical personnel must maintain the following minimum credentials on a current, valid basis: 1. Colorado driver's license 2. Colorado Medical Technician certification 3. Basic Life Support CPR Certification 4. Advanced Cardiac Life Support Certification (Paramedics only) 5. Neonatal Resuscitation Program (NRP) provider certification (Paramedics only) Completion of BTLS, PHTS, PALS, NREMTP is recommended. New hires must complete system orientation, training, and testing procedures prior to being assigned to duty. 5.5 COMPETENCY: Contractor shall demonstrate a commitment to clinical and operational personnel competency by providing the following: 22 940328 1. Monthly continuing medical education and case reviews. 2. Bi-annual employee performance appraisals. 3. Quarterly protocol testing. 4. On-going Field Instructorship (F.I. ) program. 5. Emergency vehicle driver training/review. 6. A continuous quality improvement (CQI) program that assures medical and operational improvement. 5.6 WELLNESS/SAFETY: Contractor shall provide a written wellness and safety plan which addresses, but is not limited to: 1. Injury prevention and care including appropriate inoculations. 2. Physical strength and flexibility. 3. Physical/mental wellness and fitness (i.e. , CISD, EAP) . 4. OSHA and CDC requirements. 5. Hazardous materials. 6. Emergency vehicle driving, maintenance, and repair. 7. No smoking will be allowed in buildings or vehicles. 8. Opticom equipment will be installed and properly maintained on all emergency response units. 5.7 UNIFORMS/PROTECTIVE GEAR: Contractor shall provide technical personnel appropriate uniforms and protective equipment which meets the following requirements: 1. Properly and professionally identifies the EMS provider. 2. Protects from the elements and scene hazards (i.e. , bunker gear) . 23 94:0328 3. Presents a positive image to public and patients. 5.8 FIELD SUPERVISION: Contractor shall, at all times, provide at least one field supervisor/ coordinator for the purpose of coordinating and directing EMS resources during multi-casualty and/or extraordinary incidents. Said employee must: 1. Be a paramedic with at least three years experience in grade. 2. Be very knowledgeable about the geographic coverage area, as well as the Weld County EMS system itself. 3. Demonstrate strong leadership skills. 5.9 FIRST RESPONDER/EMT-B COORDINATOR: Contractor shall provide a paramedic level employee who will devote 60% of his/her time coordinating EMT-B's located in fire departments throughout the county. Said employee will also be an active street paramedic 40% of his/her time. 5.10 SALARY AND BENEFIT COMPARISON Proposer shall provide a salary and employee benefit comparison schedule comparing Weld County's benefit program to that offered by the proposing company. This analysis will include a detailed comparison of medical and dental plans, including such areas as level of coverage, co-insurance, deductibles, and employee out-of-pocket maximums. The benefits analysis shall also address other benefits offered such as disability insurance, life insurance, retirement, etc. A salary schedule of comparable classification shall be provided and a sample scheduling of hours per month for employee manning. List average number of hours worked per week by full time employees. See Attachment E for Weld County Salary and Benefit Schedule. 5.11 TRANSITIONAL EMPLOYMENT Proposer must extend offers of employment to all persons who, as of the effective date of the Ambulance Service Contract, were employees of the Weld County Ambulance Service. Proposer must employ said employees for a minimum of ninety days and if any said employee is terminated without cause during the first ninety days of employment, proposer must pay said employee through the end of the initial ninety-day period. 24 940328 5.12 ACCRUED BENEFITS The County shall pay current Weld County Ambulance Service employees for all accrued pay, vacation, sick, and personal days as of the effective date of the Ambulance Service Contract, per Weld County Personnel Policies. Thus, proposer assumes no accrued employee compensation liability upon effective date of contract. 5.13 TENURE Provide average tenure with company of EMT and Paramedic positions. 5.14 EQUAL EMPLOYMENT OPPORTUNITY In connection with this procurement, the contractor shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, age, marital status, or disability. The contractor will take affirmative action to ensure that all applicants are employed, and that employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital status, or disability. Such action shall 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. 5.15 PERSONNEL RECORDS The contractor shall maintain and make available to the county a complete and current record of all personnel employed to perform the provisions of the contract. These records shall include employment history, education and training, confirmation of appropriate certification and licensing, and other standard employment information. 5.16 QUALITY OF PERSONNEL Provide evidence of quality of personnel (including field personnel, customer service, dispatch, fleet and equipment maintenance) : 1. Qualifications of supervisor(s) 2. Number of technicians, level of certification, other training received (e.g. fail safe driving, etc. ) 3. In-service training programs (frequency, topics, attendance policy) 25 94,0328 4. Any other information which demonstrates a high level of quality of personnel providing services. 5. Qualifications of person responsible for supervising the maintaining and repairing of the fleet (provide resume) 6. Qualifications of on-site management personnel 7. Qualifications of off-site (corporate) management personnel and resources 8. Any other information which demonstrates a high level of quality of personnel providing services 26 940328 L O CATION S AND F AC I L I T I E S 27 940328 6.1 LOCATIONS The contractor shall station a minimum of five dedicated vehicles and associated equipment and personnel at a minimum of 3 fixed-based locations within the County of Weld. These locations must be geographically distributed to provide equal service to every area of the County and meet the response rate and other provisions of the contract. Each location must have a minimum of one fully-equipped vehicle and properly trained personnel assigned and available for dispatch on a 24-hour basis. The contractor must identify the specific fixed-bases locations from which the contractor will dispatch the services if other than the existing three locations listed below. These locations must be on contractor-owned or leased property. The terms of any leases for locations other than on county-owned property shall be reviewed by the County to assure compliance with the objectives of the agreement. Any change of locations during the term of the contract shall be subject to the approval of the County. The proposal shall indicate how the fixed-based locations will be provided if different than the three listed below: 1. North Station -- 1121 "M" Street, Greeley, Colorado 2. South Station -- 3401 South 11th Avenue, Evans, Colorado 3. Fort Lupton Station -- 330 Park Avenue, Fort Lupton, Colorado 6.2 FACILITIES AND SERVICES County shall provide the following ambulance facilities on a standard lease basis for the following annual rental amount for contract term: North Site $ 13,245 South Site 7,935 Fort Lupton Site 3, 000 TOTAL $ 24, 180 All utilities, landscape maintenance, and janitorial support shall be the obligation of the proposer (contractor) . County will provide all repairs for said facilities. 28 903,2S C OMMUN I C AT I (Dims AND D I S P AT C 29 9'W328 7.1 COMMUNICATIONS The contractor shall coordinate all requests for emergency transportation services through the Weld County Regional Communications Center. This system shall serve as the central depository for the receipt, retention and release of all information relating to requests for service delivery. Contractor shall demonstrate the capability to meet or exceed all Weld County Regional Communication Center (WCRCC) standard operating procedures and protocols. 7.2 CALL LOAD DEMANDS: Contractor shall provide a plan, acceptable to Weld County, that demonstrates the ability to meet peak load demands. 7.3 MOBILE COMMUNICATIONS The contractor shall acquire, install and maintain mobile communication devices in all vehicles that are used to perform the provisions of the contract. The devices shall be compatible with the County's communication frequencies and acceptable to the County's Communication system. This shall include an multi-channel, 100-watt VHF radio, a multi-channel, 100-watt UHF radio, one cellular phone, and a mobile digital terminal in each vehicle. Contractor shall provide the necessary portable handheld UHF and VHF radios and pagers carried by personnel. In no event shall contractor provide fewer units than currently utilized by Weld County Ambulance Service. 7.4 COMMUNICATIONS PERSONNEL At an optional stated cost in the rate structure, the contractor shall provide one staff position at all times to be responsible for coordinating all requests for service and dispatching of vehicles, personnel and other resources. The individual shall be licensed and certified as a Paramedic and shall have received the appropriate training and education for proper use of the EMD Computer Aided Dispatch System. Position shall be located in the Weld County Regional Communications Center and under the direction of the Weld County Regional Communications Center while on dispatch duty. 30 940329 7.5 ADDITIONAL COMMUNICATIONS SYSTEM COSTS The contractor shall identify all costs associated with developing and integrating a communication system with the County's Computer Aided Dispatch System, if above and beyond current system requirements. 7.6 RESPONSE TIME: Contractor shall provide monthly reports of response time performance at no cost to the county. Reports shall include: 1. Dispatch to enroute 2. Enroute to on-scene 3. Total on-scene time 4. On-scene to destination Code 1 (10-39) responses shall have the ambulances on scene within eight minutes zero seconds on 90% of the calls in any given month for: 1. Greeley 2. Evans 3. Fort Lupton 31 940328 FINANCIAL AND RATE STRUCTURE AND COMPUTER SYSTEM 32 940329 8. 1 ACCOUNTING RECORD The contractor shall maintain and make available to the county accurate and complete accounting records for the operation of the service. These shall be maintained and reported in accordance with standard accounting procedures and subject to periodic audit as determined by the County. The accounting records for providing emergency transportation services shall be identified separate and distinct from all other business conducted by the contractor. The contractor shall be responsible for all billing and collection activities. 8.2 RATE STRUCTURE COST OF SERVICE. The proposer shall submit a sealed proposal for providing emergency transportation services. This shall include an annual operating budget for the term of the agreement as well as the proposer's most recent audited financial statement. The budget shall include all costs for administration, personnel, vehicles and equipment, commodities, communications, debt service, all other costs necessary to comply with the contract, and overhead/profit. The cost of service shall be expressed in total dollars and in cost-per- billable item terms. The cost-per-transport shall be all inclusive with no extra or additional charges assessed to the County except in those circumstances as stated in this document. The above operating budget shall be expressed in the following format. Two cost proposal summaries must be provided, one without Paramedic dispatching and one with Paramedic dispatching. COST PROPOSAL SUMMARY. ITEM 1$T YEAR 2ND YEAR 3RD YEAR TOTAL Personnel Vehicles Communications System Facilities Commodities Debt Service All other costs necessary to comply with the contract Overhead/Profit GRAND TOTAL $ $ $ $ 33 94032s Rate structure shall be expressed in the following format. Two rate structures must be provided, one with Paramedic dispatching and one without Paramedic dispatching: CURRENT YEAR YEAR 1 YEAR 2 YEAR 3 AMBULANCE SERVICES: Base Rate (Routine) 210.00 Base Rate (Emergency) 365.00 Paramedic Assist 140.00 Air Ambulance Assist 365.00 Return Trip 210.00 Standby Ambulance 60.00/HR Standby (Public 30.00/HR School One Person Standby 20.00/HR Mileage (one way) 8.50 PROFESSIONAL SERVICES:` Oxygen 40.00 Suction 30.00 IV Set Up 35.00 IV With Blood Tubing 50.00 IV Additional Solution 17.00 Medications (Per Item) 25.00 Dressing and Bandages 10.00 Quick Cold/Hot 6.00 NG Tube 35.00 Endotracheal Intubation 125.00 Cricothyrotomy 187.00 Irrigation Solution 10.00 Contamination Control 200.00 Burn Kit 120.00 34 .. ................ . ... CURRENT YEAR YEAR 1 YEAR 2 YEAR 3 PROFESSIONAL SERVICES (CONTINUED): OB Kit 300.00 Foley Catheter 45.00 Pharyngeal Airway 95.00 Tension Pneumothorax Decompression 100.00 Cardiac Monitor 50.00 Defib 50.00 Cervical Spine Care 40.00 MAST Pants 45.00 Splinting 25.00 Doppler/Diascan/ Pulse Ox 15.00 SPECIFY OTHER RATES: Medicare/Medicaid A. Do you accept the Medicare allowable amount as payment in full for covered services? Yes No B. Do you accept the Medicaid allowable amount as payment in full for covered services? Yes No If not, what additional charges above Medicaid or Medicare do you charge? 35 940328 8.3 ACCOUNTS RECEIVABLE All collections from accounts receivable prior to the effective date of the contract shall accrue to Weld County. Proposer shall provide accounts receivable management, billing, and collection of said accounts receivables for 135 days after effective date of contract with all said collections remitted to Weld County on a monthly basis. County will maintain current computerized billing and accounts receivable system at County cost for the 135 collection period. Any uncollected accounts at the end of the 135-day period will be turned over to Professional Finance for collection with all proceeds going to Weld County. 8.4 COLLECTION PROCEDURES A narrative description of billing and collection procedures must be provided. 8.5 COMPUTER SYSTEM If the County's current computer billing system is to be used, proposer must specify. County system will only be available through 12/31/95, and costs to operate will be billed at current County cost. If contractor is to use its own system, briefly describe computer system. 8.6 MIS SYSTEM Detail any MIS System(s) to be provided under the contract. System at a minimum should maintain the following components: A. PATIENT CARE RECORDS (PCR) DATABASE: 1. All patient records must be entered into PCR database within 24 hours of call. 2. Database must be linked to Weld County Regional Communications Center CAD system to incorporate response time information. 3. Database must provide for clinical, operational, and administrative quality assurance/improvement. 4. Database must be easily queried for special studies and/or research. 5. Database must generate billing and accounts receivable information. 36 940328 6. There must be local office database access in order to provide billing, collection, and customer relations service. B. FLEET MAINTENANCE DATABASE: 1. Must include preventive maintenance schedule. 2. Must include complete maintenance history record (preventive, repair, replacement, etc. ) 3. Chronic problem flagging. C. INVENTORY MANAGEMENT DATABASE: 1. Must include preventative maintenance schedule for equipment. 2. Must include complete maintenance history record (preventive, repair, replacement, etc. ) D. PERSONNEL DATABASE: 1. Must include scheduling, training, and skill utilization/review. 2. Immunization, health, workers compensation claims, and emergency information. 3. Credentials (expiration dates) . 37 940328 V E H S C L ES , E QU T PME NT 4. AND S U P P L S E S 38 940325 9.1 EQUIPMENT ACQUISITION Contractor will be required to purchase all capitalized equipment of the Weld County Ambulance Service, including vehicles, at book value at the time of the effective date of the contract. Book value is defined as equaling acquisition cost less depreciation. Equipment listing with description, acquisition date, acquisition cost, depreciable life in months, depreciation to date, and book value as of 12/31/93 is attached as Attachment D. 9.2 VEHICLE TYPES Contractor may operate with Type I, II, or III ambulances so long as they are equipped, licensed, and maintained per Weld County Ordinance i77-C, plus the following: A. REQUIREMENTS: Contractor shall provide and maintain all bio-medical, communications, and treatment equipment in accordance with manufacturer, bio-medical engineer, and physician advisor standards. Equipment requirements must meet or exceed Colorado, Weld County, and ACLS standards for ambulances. B. MAINTENANCE: Preventative maintenance a repair plan must meet or exceed current Weld County equipment maintenance program. Contractor agrees to immediately remove from service any piece of equipment with a known or suspected defect. Contractor agrees to equip and maintain all MICU Ambulances (front-line and back-up) on a uniform basis. Contractor agrees to meet or exceed current Weld County equipment replacement program. 9.3 VEHICLE MAINTENANCE All vehicles acquired from Weld County will be required to be maintained at Weld County Motor Pool Shops per contract with Tecom through 12/31/94 at contractor's cost. Cost billed to contractor shall be at the same rate billed to County by Tecom. 9.4 VEHICLE MAINTENANCE SCHEDULE Proposer must provide a vehicle maintenance schedule used. At a minimum: 1. Preventative maintenance and repair program meets or exceeds current Weld County Ambulance fleet maintenance program. 39 940328 2. Maintenance and repairs must be in accord with manufacturer standards. A certified diesel mechanic must be utilized. 3. Agree to immediately remove from service any vehicle with a known or suspected safety defect, or that Weld County requests because of appearance reasons. 4. Meet or exceed the same ratio of back-up to front line ambulance provided. 9.5 VEHICLE AND EQUIPMENT REPLACEMENT Proposer must provide vehicle and equipment replacement policies and/or schedules. At a minimum, contractor must meet or exceed current ambulance replacement or rechassis program. 9.6 SUPPLIES Contractor will be required to purchase, at County original cost, all medical supplies on hand as of effective date of contract. 9.7 EQUIPMENT ON VEHICLES If proposer's ALS vehicles carry equipment different than what is currently carried by Weld County Ambulance Service, ALS vehicle proposer must so note. 40 940328 ' D S S P UT E S ,. D E F S C S E NC S E S AND D E F AUL T 41 940328 1 10.1 MEETINGS The contractor representative(s) shall be available to meet with the County representatives at a mutually agreeable time to discuss problems, issues or concerns relative to the contract. Either party may call a meeting at any time. When such a request for a meeting is made, the meeting date shall, in no case exceed five (5) working days after the request; and, if in the sole opinion of the County, the severity of the circumstance warrants, no more than one (1) working day. 10.2 DISPUTES Except as otherwise provided for in the contract, any disputes arising under this contract, which are not disposed of by agreement with the County's contract administrator will be submitted in writing to the Board of County Commissioners. The Board will afford an opportunity to the contractor to be heard and offer evidence to support any claims. Pending final decision of a dispute hereunder, the contractor must proceed diligently with the contract performance. The Board shall notify the contractor in writing of his determination and the decision of the Board will be final and conclusive with respect to all factual determinations and may be appealed to a court of competent jurisdiction. Failure to appeal to the Board constitutes acceptance by the contractor of the decision by the contract administrator. 10.3 CONTINUATION DURING DISPUTES The vendor will agree that notwithstanding the existence of any dispute between the parties, insofar as possible under the terms of the contract to be entered into, each party will continue to perform the obligations required of it during the continuation of any such dispute, unless enjoined or prohibited by any court. 10.4 RIGHT TO REQUIRE PERFORMANCE The failure of the County at any time to require performance by the contractor of any provisions hereof shall in no way affect the right of the County thereafter to enforce same. Nor shall waiver by the County of any breach of any provision hereof be taken or held to be a waiver of any succeeding breach of such provision or as a waiver of any provision itself. 42 940328 10.5 DEFICIENCIES IN SERVICE In the event the County determines there are deficiencies in the service and work provided by contractor, the contract administrator shall notify contractor in writing as to the precise nature of any such deficiencies. Within ten (10) working days of receipt of such notice, contractor shall correct or take reasonable steps to correct the deficiencies complained of, including, if necessary, increasing the work force, equipment, or modifying the policies and procedures used by contractor in performing services pursuant to this contract. If the contractor fails to correct or take reasonable steps to correct the deficiencies within ten (10) working days the County may declare the contractor in default and invoke the termination provisions of the contract or take other actions it considers necessary in the circumstances. 10.6 DEFAULT The County may at any time, by written notice to the contractor, terminate this contract and the contractor's right to proceed with the work, for just, cause, which shall include, but is not limited to the following: Failure to provide insurance and bonds (when called for) , in the exact amounts and within the time specified or any extension thereof. Failure to perform the services within the time specified herein, or any extension thereof. Failure to make progress if such failure endangers performance of the contract in accordance with its terms. Failure to perform in compliance with any provision of the contract. Loss of certification. 1. Failure to respond in a timely and appropriate manner to any allegation of failure to maintain standards of personnel, or equipment, brought by the Department of Health Services. 2. The receipt by the County of four or more valid complaints of rude, impolite or demeaning treatment of injured persons, their relatives or friends at an accident scene, during transportation, or at a hospital or emergency care facility , in any 30-day period; the validity of which complaints are determined to exist by the County at its sole discretion. 43 9'ZQ28 3. Failure to maintain the specified minimum number of units available 90% of the time for each 24- hour period. 4. Failure to respond to routine (10-40) call within fifteen minutes 90% of time in a 30-day period within Greeley, Evans, or Fort Lupton city limits. 5. "Availability" of equipment or personnel shall mean the physical presence of such equipment or personnel at the sites assigned, in physical and mechanical condition to perform the required services. 6. Revocation, termination, surrender or lapse of contractor's certification by the state or local Health Department as an ambulance service licensee. 7. Revocation, termination, surrender or lapse of any insurance (including workmen's compensation and occupational disease insurance) required by law or under this proposal. 8. Initiation of any proceedings by or against the contractor under Chapter 7, U.S. Bankruptcy Code (Title 11, U.S.C. ) . 9. Maintaining, circulating or providing to the County any false records or documentation relating to the providing of service or financial information as required under contract or this proposal. 10. Revocation, termination, surrender or lapse of the performance bond required herein. 11. Refusal to respond to emergency dispatch direction of the County when equipment and personnel are physically able to respond. 44 940328 10.7 TERMINATION FOR DEFAULT The contract may be terminated for default if the contractor fails to correct or take reasonable steps to correct deficiencies in service. The County Attorney shall provide written notice to the contractor of County's intent to invoke the termination provisions of the contract, state the reasons for such action, and reference the previous request to correct the deficiencies. contractor will be provided twenty (20) working days from receipt of written notice of intent to terminate the contract for default to correct deficiencies. If the contractor fails to correct deficiencies within this time, the County may declare the contract terminated. 10.8 TRANSFER OF OPERATIONS In that the contractor is performing an essential service for the County, in the event the contractor defaults by failing to begin service at the time specified or discontinues a material portion of the service provided for by this Agreement, the County may, at its election and upon seven (7) calendar days prior written notice to the contractor, take possession of all County and contractor owned equipment and facilities used by the contractor in connection with these Agreement(s) and operate and use the same in the performance of the services described herein. The contractor agrees to surrender peacefully said equipment and facilities upon receiving an itemized receipt from the County for said items, and to cooperate to the extent necessary to enable the County to take over and carry out the services herein described. The County agrees to pay a reasonable rental for use of the contractor's equipment. The contractor agrees that in the event it disputes the County's right to invoke the provisions of this section, it will not seek injunctive or other similar relief, but will either negotiate an adjustment of the matter with the County or seek, as its remedy, damages in a court of competent jurisdiction. 10.9 COUNTY'S RIGHT TO PERFORM SERVICE If the contractor should fail to provide the services properly and diligently, or to default in performance of any provision of the Contract, the County, after written notice to the contractor, may perform said service. 45 940328 10.10 WORK STOPPAGE/DISPUTE In the event of a work stoppage for any reason by contractor's employees, county has the right to perform service. In such an event, contractor shall make all vehicles and equipment used to service Weld County under this contract available to Weld County or its designee to operate the essential service until work stoppage or work dispute ends. 46 940 328 FORMS F O R REQUIREMENTS FOR SUBMISSION OF PROPOSAL 47 940328 REQUIREMENTS FOR SUBMISSION OF PROPOSAL REQUEST FOR PROPOSAL 1. Qualifications Question 2. Summary of Terms and Conditions Checklist 3. Cost Proposal Summary 4. Rate Structure 5. Required Attachments by Reference Section Number 6. Signature Requirements on all parts 48 94,0329 C OLIN IC O F WELD QUALim I F I CATIONS QUE S T I O 1ST NA I RE Please answer the following questions completely. You are not required to submit answers on this form and additional information (brochures, illustrations, etc. ) will be used in determining qualifications. If not using this form, please follow its format. 1. Firm name: 2. Established: Year State 3. Type of organization: A. Individual B. Partnership C. Corporation C. Other 4. A cover letter stating the name, address, and telephone number of the proposing firm, with the signature of the person having the authority to make the proposal for the firm. 5. A list of personnel assigned to the project team, including resumes and work experience. 6. A response that defines the methods and means by which the proposing firm will perform the services outlined in the Request For Proposal. 7. A project timeline outlining the dates and specific tasks necessary for project start up, including the specific employees involved. 8. A list of all references for which similar services have been provided. Include contact names, addresses, telephone numbers, and approximate annual contract price. 9. Any other information deemed necessary by the proposing firm. 49 940328 10. Total personnel of firm: A. Professional/Technical: B. Managerial EMT C. Dispatcher Specialist D. Other Paramedic E. Provide a copy of your policies and procedures to recruit and retain quality EMS personnel. 11. For each operation currently providing emergency response and transport, describe the following. For each of the following positions: EMT-B EMT-I Paramedic Dispatcher AR Clerk Field Supervisor Director of Operations Provide the following: Average hourly base pay Average number of hours worked per week by full-time employees (define your full-time employees) Average tenure with company Benefits (If not included in benefit comparison) I hereby state that all of the information I have provided is true, accurate and complete. I hereby state that I have the authority to submit this proposal which will become a binding contract if accepted by the County of Weld. I hereby state that I have not communication with nor otherwise colluded with any other proposer, nor have I made any agreement with nor offered or accepted anything of value from an official or employee of the County of Weld that would tend to destroy or hinder free competition. 50 940328 I I hereby state that I have read, understand and agree to be bound by all the terms of this proposal document. SIGNED: NAME: TITLE: DATE: FIRM NAME: PHONE: ADDRESS: ACCEPTED BY: BOARD OF COUNTY COMMISSIONERS ATTEST: WELD COUNTY, COLORADO Weld County Clerk to the Board W. H. Webster, Chairman BY: Deputy Clerk to the Board 51 940328 I SUMMARY OF TE RMS AND C OND I T IONS CHE CKL I S T The undersigned, having become thoroughly familiar with and understand all the proposal documents attached hereto, agrees to provide the services as specified herein as stipulated below. Any item not meeting specifications must have an attached explanation or details of optional proposal with section reference number and title of term or condition on it. Section with "X" by "Attachment Required" indicate need to provide specified data requested. SECTION REFERENCE MEET ATTACHMENT NUMBER TERMS AND CONDITIONS SPECIFICATIONS REQUIRED YES NO GENERAL TERMS: 1.6 Contractual Obligation 1. 7 Contract Form and Language 1.8 Contract Documents 1.9 Contract Term 1.10 Contract Period, Extensions, Cancellation 1. 11 Request for Proposal as Contract 1.12 Changes and/or Contract Modifications 1. 13 Independent Contractor 1. 14 Assignment of Contractor Duties and Obligations 1.15 Applicable Law 1. 16 Laws, Ordinances and Regulations 1.17 Performance Bond 1.18 Indemnification 1.19 Insurance 1.20 Ability to Perform Contract Requirements X 1.21 Business Qualifications X REQUIREMENTS FOR SUBMISSION OF PROPOSAL: 2. 1 Proposal Elements and Format X 2.2 Requirements for Submission of Proposal X 52 9d032.,8 SECTION REFERENCE ' MEET ATTACHMENT NUMBER TERMS AND CONDITIONS SPECIFICATIONS REQUIRED,, YES NO EVALUATION ;.OF PROPOSAL: 3. 1 Evaluation of Proposals 3.2 Evaluation Criteria SERVICE/PERFORMANCE STANDARDS; 4. 1 Emergency Assistance X 4.2 Response Time Evaluation 4.3 Response Time Non-Compliance 4.4 Evaluation Records 4.5 Annual Report 4.6 Inspection of Service 4.7 Treatment Protocols 4.8 Physician Advisor 4.9 Medical Competency 4. 10 Public Relations X 4. 11 Inter-Agency Relations PERSONNEL: 5. 1 Crew Manning X 5.2 Organizational Chart X 5.3 Qualifications 5.4 Credentials 5.5 Competency 5.6 Wellness/Safety 5. 7 Uniforms/Protective Gear 5.8 Field Supervision 5. 9 First Responder/EMT-B Coordinator 5. 10 Salary and Benefit Comparison X 5.11 Transitional Employment 5.12 Accrued Benefits 5. 13 Tenure X 5.14 Equal Employment Opportunity 5. 15 Personnel Records 5.16 Quality of Personnel X 53 9032S SECTION REFERENCE, MEET ATTACHMENT NUMBER TERMS. AND CONDITIONS SPECIFICATIONS REQUIRED • YES NO LOCATIONS AND FACILITIES: ................. . ......... 6.1 Locations 6.2 Facilities and Services COMMUNICATIONS/DISPATCH! 7. 1 Communications X 7.2 Call Load Demands X 7.3 Mobile Communications 7.4 Communications Personnel 7.5 Additional Communications System Costs X 7.6 Response Time FINANCIAL AND RATE STRUCTURE 8. 1 Accounting Record 8.2 Rate Structure X 8.3 Accounts Receivable 8.4 Collection Procedures X 8.5 Computer System X 8.6 MIS System X VEHICLES/EQUIPMENT/SUPPL.IES . ... .. .. ...... . _ 9.1 Equipment Acquisition 9.2 Vehicle Types 9.3 Vehicle Maintenance 9.4 Vehicle Maintenance Schedule X 9.5 Vehicle and Equipment Replacement X 9.6 Supplies 9.7 Equipment on Vehicles X DISPUTES/DEFICIENCIES/DEFAULT. 10. 1 Meetings 10.2 Disputes 10.3 Continuation During Disputes 10.4 Right to Require Performance 10.5 Deficiencies in Service 54 94'0328 SECTION REFERENCE MEET ATTACHMENT NUMBER TERMS AND CONDITIONS SPECIFICATIONS REQUIRED YES NO DISPUTES/DEFICIENCIES/DEFAULT (CON'T): 10.6 Default 10. 7 Termination for Default 10.8 Transfer of Operations 10.9 County's Right to Perform Service 10. 10 Work Stoppage/Dispute I hereby certify that all of the information provided above is true and answered to the best of my ability. SIGNED: NAME: TITLE: PHONE: DATE: 55 940328 C O S T P ROPO SAL S UMMARY WITH PARAME D I C DISPATCH ITEM 1ST; YEAR 2ND YEAR 3RD YEAR TOTAL Personnel Vehicles Communications System Facilities Commodities Debt Service All other costs necessary to comply with the contract Overhead/Profit GRAND TOTAL $ $ $ $ 56 9402x23 COST P ROPO SAL SUMMARY WITHOUT PARAMEDIC DISPATCH ITEM 1ST YEAR 2ND YEAR 3111) YEAR TOTAL Personnel Vehicles Communications System Facilities Commodities Debt Service All other costs necessary to comply with the contract Overhead/Profit GRAND TOTAL $ $ $ $ 57 940328 RATE STRUCTURE `irI THOUT PARAMEDIC DISPATCH CURRENT YEAR - YEAR 1 YEAR 2 YEAR 3 AMBULANCE SERVICES: Base Rate (Routine) 210.00 Base Rate (Emergency) 365.00 Paramedic Assist 140.00 Air Ambulance Assist 365.00 Return Trip 210.00 Standby Ambulance 60.00/HR Standby (Public 30.00/HR School One Person Standby 20.00/HR Mileage (one way) 8.50 . ........ ........... . ........................ PROFESSIONAL SERVICES; Oxygen 40.00 Suction 30.00 IV Set Up 35.00 IV With Blood Tubing 50.00 IV Additional Solution 17.00 Medications (Per Item) 25.00 Dressing and Bandages 10.00 Quick Cold/Hot 6.00 NG Tube 35.00 Endotracheal Intubation 125.00 Cricothyrotomy 187.00 Irrigation Solution 10.00 Contamination Control 200.00 Burn Kit 120.00 58 91032 CURRENT YEAR YEAR 1 YEAR 2 YEAR 3 PROFESSIONAL SERVICES (CONTINUED): OB Kit 300.00 Foley Catheter 45.00 Pharyngeal Airway 95.00 Tension Pneumothorax Decompression 100.00 Cardiac Monitor 50.00 Defib 50.00 Cervical Spine Care 40.00 MAST Pants 45.00 Splinting 25.00 Doppler/Diascan/ Pulse Ox 15.00 SPECIFY OTHER RATES; Medicare/Medicaid A. Do you accept the Medicare allowable amount as payment in full for covered services? Yes No B. Do you accept the Medicaid allowable amount as payment in full for covered services? Yes No If not, what additional charges above Medicaid or Medicare do you charge? 59 940328 RATE STRUCTURE WITH PARAMEDIC DX S PATC H CURRENT YEAR YEAR 1 YEAR 2 YEAR 3 AMBULANCE SERVICES Base Rate (Routine) 210.00 Base Rate (Emergency) 365.00 Paramedic Assist 140.00 Air Ambulance Assist 365.00 Return Trip 210.00 Standby Ambulance 60.00/HR Standby (Public 30.00/HR School One Person Standby 20.00/HR Mileage (one way) 8.50 PROFESSIONAL SERVICES: Oxygen 40.00 Suction 30.00 IV Set Up 35.00 IV With Blood Tubing 50.00 IV Additional Solution 17.00 Medications (Per Item) 25.00 Dressing and Bandages 10.00 Quick Cold/Hot 6.00 NG Tube 35.00 Endotracheal Intubation 125.00 Cricothyrotomy 187.00 Irrigation Solution 10.00 Contamination Control 200.00 Burn Kit 120.00 60 940328 CURRENT YEAR YEAR 1 YEAR 2 YEAR 3 PROFESSIONAL. SERVICES (CONTINUED); OB Kit 300.00 Foley Catheter 45.00 Pharyngeal Airway 95.00 Tension Pneumothorax Decompression 100.00 Cardiac Monitor 50.00 Defib 50.00 Cervical Spine Care 40.00 MAST Pants 45.00 Splinting 25.00 Doppler/Diascan/ Pulse Ox 15.00 SPECIFY OTHER RATES Medicare/Medicaid A. Do you accept the Medicare allowable amount as payment in full for covered services? Yes No B. Do you accept the Medicaid allowable amount as payment in full for covered services? Yes No If not, what additional charges above Medicaid or Medicare do you charge? 61 9032S ATTACHMENT S E RV S C E C ALL S 940328 •• f• . : I I f f. I . I f I 1 • • ,•• .3 I I .� 1 f i 1 • I ;cc I I I I I ! • • s I .• I . 2 • u. y aV:Jo0Vv0006.0OO 'OOO . oO•J000UOU0O00NII',N ,: O IU: `J 0:0 ,, 004, 00 00000000 .30000000000000 .I It •� .. W u • • • • • • • • • • '• • • • • • • • • • •. • • • • II •. . It; ) .:,:0 O N in O• r O d.O in O 10 O.O O IO :) J 0 N 0 U 0 0 4 00 O IAN 11: 01'.,-,, I , .1 . 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U I- W VI a 1. . `' ''1 z; J _Jim I- I- O a : Ja 0zdu o- . O J 0 ft iM 0 14 U VI •• 0 2 '.. ID S 0 In:z X•X a • W' 0.• IU!aO. mlmZ I .' z 0a 00 ' \M .M IdO.,•• • Q I- CI •- .• S.J a :Z 0 -.J ,-4 U , Z 444 •+ " I , 0 0: W W IU 0: aI0. -1 'O = d m !- 0- . IJ a 0 0 I. a O. 0 1k 0 f.- • U! I- F I•. 1• O IN 'O Iy m. ..I O 0 m w W Z Z CC•Z - r I i I aa'O }i} coW,ac Ij mot- azluJl-.maaizwzlzrl ' cc {I I Id, cc cc co O W z ' r VjWzal•• t- gQV w, ti w0 HI- F W W aO4 ' oO ,;.] • .I • 0. L 0: O 0 K a,a. W M W ,• a U M N!Y Z u QIIti O .. O .Z•.M on J I • IY. WUJZ W Oat VI 2 I 0•+ bin.U ..-• 1•.�Z H4-, 1- N U ►i Y w 0. to • Q' 00 O: N a Q cc JIW } C A K W M 4.10: N J V Z M J .LL d ..• ,• LI a a1a W I•- I- w •, Z x Q a > > W.W Ot'J I• min a I-Im 0 w at a 41 111 o z' • Vi O 010. 0[ u)'0 a * a O U.w «I I� M ILI "It° r 04: , z "I° IA CI t_ "I II) I I I I • •••• - Is j ca W` I I I I i 0! 0 r N.M t 0 0 P 10101.0 .4 N M 4 in to p. c0 T OI N MIO in IOIP O .. N M) N • = V NNNNNNNNNNM►InMMOMM !IYIMO ♦ 4 4 I: `• • • • I j I „ ,,,,::,:t••••,., i I I I i I i ! • . I I I ' I . I n I _ _ , 94032 r I . CALLS FOR SERVICE A. History: 1977 1978 1979 1980 1981 1982 1983 19$4 N 2,869 3, 181 3,630 3,878 3,645 3, 859 3,922 3,905 S _ 635 722 913 405 T 2,869 3, 181 3, 630 3,878 4,280 4,581 4,835 4,310 Av/ 8 9 10 11 12 13 13 12 Day 1985 1985 1987 1988 1989 1990 1991 1992 N 4,056 4, 135 4,319 4,688 4;764 5,029 5,310 5,597 S 65?, 668 819 718 748 783 813 799 T 4,708 4,803 5, 138 5,406 5,512 5,812 6, 123 6, 396 Av/ 13 13 14 15 15 16 17 18 Day B. Pro,jectiona: 1993 1994 1;395 1996 1997 1998 1999 2000 N 5,877 6, 171 6,479 6,803 7 , 143 7,501 7,876 8,269 S 839 881 925 871 1,020 1.071 1. 124 1 . 180 T 6,716 7,052 7,404 7,674 8, 163 8,572 9,000 9,449 Av/ 18 19 20 21 22 24 25 26 Day - _ 942032S r II . BILLINGS/CASH RECEIPTS A. History: 1977 1978 1979 1980 1981 1982 B 207,288 256,224 293,467 344,947 403,261 561,932 R 164,179 203,347 237,100 290,814 320,573 425,739 q 79 79 81 84 80 76 1983 1984 1985 1986 1987_ 1988 B 789,589 866,562 986,050 1,089,037 1,198,518 1,308,655 R 642,832 737,651 783,995 927,631 .1,007,852 1,059,231 % 81 85 80 85 84 81 1989 199090 1221 1992 B 1,621,477 1,784,734 1,991,154 2,086,757 R 1,205,650 1,382,310 1,366,632 1,438,240 74 77 69 69 B_ ' Projections; 1223 19. 4 1225 1926 B 2,211,962 2,344,680 2,485,360 2,634,482 R 1,548,373 1,641,276 1,739,752 1,844,137 % 70 70 70 70 1291 1998 1449 2000 B 2,792,551 2,960,104 3,137,710 3,325,973 R 1,954,785 2,072,072 2,072,072 2,328,181 % 70 70 70 70 940328 AT TAC HME NT B S E RV I C E ARE 940329 EXCLUSIVE SERVICE AREA Exclusive Service Area is all of Weld County, Colorado, excluding the following: 1. All of Tri-Area Ambulance District and portions of Longmont Fire Protection District noted on attached map. 2. All of Platte Valley Fire District for Basic Life Support Transports only, Advanced Life Supports are included. 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N c940 X28 1 9 9 4 HEALTH INSURANCE' 1994 Insurance rates are as follows: HIGH DEDUCT HMO PP0 PP0 Employee: Health $144.29 $212. 17 $165. 79 Dental/Vision 10.00 10.00 10.00 Total $154.29 $222. 17 $175. 79 County $138.29 $138.29 $138.29 Employee 16.00 83.88 37.50 Dependent: Health $253.95 $368.88 $288.24 Dental/Vision 16. 00 16.00 16.00 Total $269.95 $384.88 $304. 24 Total Employee $285. 95 $468. 76 Total County $341. 74 138.29 138.29 138.29 Employee Costs: 1994 $285. 95 1993 $468. 76 $341.74 271.80 436. 26 349. 78 DIFFERENCE $ 14. 15 $ 32.50 $ (8. 04) PP0 AND HIGH PPO PLAN COMPARISON: HIGH DEDUCTIBLE PP0 PP0 $20 office visit co-pay $15 office visit co-pay $500 deductible $150 deductible 807. PP0 benefit/ 802 PP0 benefit 60% non-PPO benefit (up to $5, 000 - (up to $10, 000 - 100% thereafter) 1002 thereafter) $5 generic/$8 brand $5 generic/$8 brand prescriptions prescriptions 940328 • DENTAL: PROGRAM: • COVERAGE FOLLOWS HEALTH ' INSURANCE PROGRAM COVERAGE FOR BOTH SINGLE AND FAMILY PLANS • 100% PREVENTIVE CARE • 50Z/50z CARE OTHER THAN PREVENTIVE • EXCLUDES ORTHODONTIC CARE • MAXIMUM AMOUNT PAID FOR SINGLE OR FAMILY $1000/YEAR VISION: • PROGRAM: • COVERAGE FOLLOWS HEALTH INSURANCE PROGRAM COVERAGE- FOR BOTH SINGLE AND FAMILY PLANS • MAXIMUM AMOUNT PAID FOR SINGLE $300/YEAR OR FAMILY $600/YEAR • NO DEDUCTIBLE • 50% OF COVERED EXPENSES INCURRED • EXAMINATION, LENSES, AND FRAMES LIMITED TO ONE EACH YEAR LIFE: Three times annual salary up to $300, 000 at 26.5¢/$1, 000 DISABILITY: $.51/$100 compensation WELLNESS: Wellness program will be continued to all county employees. RETIREMENT: 6% of Base Earnings - County 6% of Base Earnings - Employee SOCIAL SERVICES: 7.65% of Earnings - County • 7.65% of Earnings - Employee 9110328 TIME OFF VACATION Continuous Years of County Service Hours Earned Monthly Under 5 8.00 hours Over 5, but under 10 10. 00 hours Over 10, but under 20 12. 00 hours Over 20 13.33 hours SICK LEAVE All regular employees are eligible for sick leave 30 days after employment. Sick leave is accrued at 8 hours per month from date of hire with no maximum accrual limit. For employees hired prior to January 1, 1985, accumulated sick leave is payable upon termination at one-half the hours of accumulated unused sick leave, not to exceed one month's salary. Employees hired after January 1, 1985 will not be paid for accumulated sick leave upon termination of employment. PERSONAL LEAVE DAYS Personal leave is a privilege granted to regular employees. Employees in their initial review period are not eligible. Each year, with supervisory approval, a regular employee may convert two days of sick leave into two personal leave days. Personal leave days may not be .carried over from year to year. The method of scheduling and the timing of personal leave days is at the discretion of the Elected Official or Department Head. Because of the payroll system, personal leave days must be used by December 15 of the same year during which they are granted. HOLIDAYS All regular employees working 32 hours or more per week will receive paid holidays. Dates will be established annually and will be published by resolution of the Board of County Commissioners. 1. New Years Day 6. Colorado Day (floating) 2. Martin Luther King Day 7. Labor Day (floating) 8. Columbus Day (floating) 3. President's Day 9. Veteran's Day 4. Memorial Day 10. Thanksgiving Day 5. Fourth of July 11. Christmas Day FUNERAL LEAVE Leave of absence with pay because of death in the immediate family may be granted to regular employees by the Department Head/Elected Official for a period not to exceed three days. Entitlement to leave of absence under this section shall be in addition to any other leave. For purposes of this section "immediate family" means mother, stepmother, father, stepfather, spouse, son, stepson, daughter, stepdaughter, brother, sister, mother-in-law, father-in-law, grandparents, foster parent, foster child, or guardian. 940 29 III. PERSONNEL COSTS A. History 1985 1986 1987 1988 Budget $702,094 $739,505 $666,128 $667,108 Actual $655,986 $642,477 $675,926 $678,063 12E12 1990 1991 1992 Budget $754,900 $809,476 $870,750 $901,347 Actual $751,592 $801,934 $870,433 $915,835 B. Projections 1993 1994 1995 1996 $921,080 $976,345 $1,015,398 $1,056,015 1997 1998 1999 2000 $1,098,255 $1,142,185 $1,187,872 $1,235,387 r DATE: NOV. 1 1992 ORGANIZATION CHART BOARD OF COUNTY COMMISSIONERS DIRECTOR OF AMBULANCE SERVICES[ EMS COORDINATOR OFFICE MANAGER 40% [ 60% OFFICE TECHS "A" CREW "B" CREW "C" CREW SUPPORT STAFF SUPERVISOR SUPERVISOR SUPERVISOR (PART- TIME ) PARAMEDICS PARAMEDICS PARAMEDICS PARAMEDICS EMTS EMTS EMTS EMTS 940328
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