THE CITY OF NEW YORK

FIRE DEPARTMENT BUREAU OF FISCAL SERVICES

CONTRACT DEVELOPMENT UNIT

REQUEST FOR PROPOSALS

FOR THE PROVISION OF

AMBULANCE TRANSPORT INVOICING, COLLECTION, AND LITIGATION SERVICES

Procurement Identification No.: 057070002577

TABLE OF CONTENTS: PAGE

SECTION I - TIMETABLE ................................................................................................................................ 1

SECTION II - SUMMARY OF THE REQUEST FOR PROPOSALS ........................................................... 3

SECTION III - SCOPE OF SERVICES............................................................................................................. 4

SECTION IV – FORMAT, CONTENT AND SUBMISSION OF THE PROPOSAL ................................. 31

SECTION V – PROPOSAL EVALUATION AND CONTRACT AWARD PROCEDURES .................... 39

SECTION VI – GENERAL INFORMATION TO PROPOSERS................................................................. 41

ATTACHMENT A - PROPOSAL COVER LETTER.................................................................................... 42

ATTACHMENT B – PRICE PROPOSAL FORM ......................................................................................... 43

ATTACHMENT C - ACKNOWLEDGEMENT OF ADDENDA.................................................................. 58

ATTACHMENT D - AFFIRMATION OF TAXES PAID.............................................................................. 59

SCHEDULE A - SCHEDULE OF CONTRACT REQUIREMENTS ........................................................... 60

APPENDIX A - NEW YORK CITY GENERAL TERMS AND CONDITIONS

MACBRIDE PRINCIPLES PROVISIONS FOR THE NEW YORK CITY CONTRACTORS ADDENDUM I – HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) BUSINESS ASSOCIATE CONTRACT PROVISIONS EXHIBITS EXHIBIT 1 – PATIENT PRE-HOSPITAL CARE REPORT EXHIBIT 2 – CURRENT FILE FORMAT EXHIBIT 3 – FDNY MEDICAL BILLING COMPLIANCE MANUAL

AUTHORIZED AGENCY CONTACT PERSON

Proposers are advised that the Authorized Agency Contact person for all matters concerning this Request for Proposals (RFP) is: Name: Joan Lipton

Title: Contract Officer

Mailing Address: Fiscal Services/Contract Development

9 MetroTech Center, 5W-12-K

Brooklyn, NY 11201

Telephone #: (718)-999-2590/1234

Fax #: (718)-999-0177 E-mail Address: liptonj@fdny.nyc.gov

Alternate Contact:

Name: Barry Greenspan

Title: Deputy Agency Chief Contracting Officer

Mailing Address: Fiscal Services/Contract Development

9 MetroTech Center, 5S-01-K

Brooklyn, NY 11201

Telephone #: (718)-999-2332

Fax #: (718)-999-0177 E-mail Address: greensb@fdny.nyc.gov

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SECTION I - TIMETABLE A. Release Date of This Request for Proposal: November 19, 2007

All questions and requests for additional information concerning this RFP should be directed to Joan Lipton, the Authorized Agency Contact Person at: Telephone #: (718) 999-2590/1234 Fax #: (718) 999-0177 E-Mail Address: liptonj@fdny.nyc.gov

Proposers should submit questions no later than December 21, 2007.

B. Pre-Proposal Conference:

Date: December 11, 2007 Time: 10:30 A.M. Location: 9 MetroTech Center, 4th Floor, Room 4S-19/4S-20

Brooklyn, New York 11201 Please note that the meeting is non-mandatory. Attendance by proposers is optional but recommended by the Agency. Those vendors wishing to attend are advised to arrive approximately 30 minutes prior to the start of the meeting in order to clear security. Vendors must have photo ID issued by government agency, and must be prepared to show such ID to police security at the entrance to the building and to the internal security desk.

C. Proposal Due Date and Time and Location:

Date: January 8, 2008 Time: 4:00 P.M. Location: Proposals shall be submitted to the attention of

Joan Lipton, Contract Officer New York City Fire Department 9 MetroTech Center 5th Floor Room 5W-12-K Brooklyn, New York 11201.

To prevent opening by unauthorized individuals, the package shall be identified as:

Proposal for Ambulance Transport Invoicing, Collections and Litigation Services – Confidential Information.

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Proposals received at this Location after the Proposal Due Date and Time are late and will not be accepted by the agency, except as provided under New York City’s Procurement Policy Board Rules. E-mailed or faxed proposals will not be accepted by this agency. The Agency will consider requests made to the Authorized Agency Contact Person to extend the Proposal Due Date and Time prescribed above. However, unless the Agency issues a written addendum to this RFP, which extends the Proposal Due Date and Time for all proposers, the Proposal Due Date and Time, prescribed above shall remain in effect.

D. Anticipated Contract Start Date: September, 2008

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SECTION II - SUMMARY OF THE REQUEST FOR PROPOSALS A. Purpose of the RFP

The Fire Department of the City of New York seeks the services of a qualified vendor to provide all labor, equipment, and materials necessary to provide a full cycle of invoicing, collection and litigation services to support the requirements of the Fire Department’s Ambulance Transport Invoicing Unit. The successful proposer would assume complete responsibility for determining the payee of ambulance services including but not limited to Medicaid, Medicare, insurance, and self-pay, preparing and mailing invoices, preparing and submitting insurance claims via appropriate method (paper or electronic), posting and tracking payments, and processing and resolving ambulance user invoicing and payment related inquiries and complaints, reviewing eligibility for financial assistance fee reductions, performing collection services on delinquent accounts, and related legal services.

B. Anticipated Contract Term It is anticipated that the term of the contract awarded from this RFP will be from the date of the written

Notice to Proceed until the expiration of five (5) consecutive years unless otherwise terminated, cancelled, abrogated, or amended in accordance with the terms of the Agreement. The Fire Department reserves the option to renew the Agreement for a period not to exceed two (2) consecutive years from the date of expiration.

C. Anticipated Payment Structure

It is anticipated that the payment structure of the contract awarded from this RFP will be based on the criteria listed below.

1. The Fire Department would compensate the Contractor for invoicing and collection services to

support the requirements of the Fire Department’s ambulance transport invoicing unit. All services would be in accordance with the pricing schedule (Price Proposal Form - Attachment B).

As per the pricing schedule, the Contractor would be compensated for the duration of the agreement as a percentage of the collections predicated upon on the Year 2007 ambulance transport rates. All funds are directly remitted to the Fire Department lockbox, and the Contractor is paid after FDNY receipt of the payments in accordance with Section IV(5)(g) and (h). However, the Agency will consider proposals to structure payments in a different manner and reserves the right to select any payment structure that is in the City's best interest.

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SECTION III - SCOPE OF SERVICES A. Definitions

1. “ACCO” means the Agency Chief Contracting Officer. 2. “ALS” means advanced life support.

3. “ALS1” means Advanced Life Support intervention using procedures beyond the scope of Basic

Life Support, or medically necessary ALS assessment. 4. “ALS2” means Advanced Life Support intervention using three (3) different intravenous

administered drugs or at least one of the following specialized skills performed by ALS personnel: manual defibrillation, endotracheal intubation, central venous line administration, cardiac pacing, chest decompression, surgical airway, or intraosseous line administration.

5. “Agreement” shall mean this Agreement as the same may be amended, modified or supplemented

from time to time in accordance with the terms of this Agreement.

6. “ANSI” means National Standards Institute (ANSI) electronic file formats, which were adopted as the national standard for health care transactions under the Federal Health Insurance Portability and Accountability Act (HIPAA). The International Association of Industrial Accident Boards and Commission (IAIABC) 837 electronic file format uses the ANSI standard 837 format for insurance carrier reporting of medical invoicing and payment information.

7. “BLS” means basic life support. 8. “City” shall mean the City of New York.

9. “Contractor” shall mean the selected proposer providing ambulance transport invoicing, collection

services, and litigation services pursuant to this Agreement

10. “DOA” means that a patient was found to be dead upon the arrival of the ambulance.

11. “FDNY” or “Department” means the Fire Department of the City of New York.

12. “FDNY Authorized Representative" shall mean a Fire Department employee designated by the Assistant Commissioner for Budget to coordinate, inspect, approve and monitor the services of the Contractor pursuant to this Agreement.

13. “FDNY Headquarters” means the Fire Department principal offices, located at 9 MetroTech Center,

Brooklyn, New York, 11201-3857.

14. “Fiscal Services” means the Fire Department Bureau of Fiscal Services. 15. “ICD-9-CM” means the International Classification of Diseases, 9th Revision, Clinical Modification

diagnostic and injury codes, or subsequent revisions, as applicable. 16. “Notice to Proceed” shall mean the written notification to the Contractor to commence work.

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17. “NSF” American National Standards Institute (ANSI) X12N 837 (HIPAA version) format electronic

claims 18. “PCR” or “Pre-hospital Care Report” means a patient care report form utilized by ambulance

transport personnel whenever an ambulance responds to a call and patient contact is made.

19. “Records” means any type of FDNY document including PCRs.

20. Services” mean any or all services performed by the Contractor pursuant to this Agreement. B. Fire Department Goals and Objectives

The primary objective with regard to ambulance fee collections is to obtain a qualified contractor that will provide a full cycle of invoicing and collection services, and effectively collect revenue due to the City, while maintaining the highest standards of service and professionalism in dealing with the public.

C. Fire Department Assumptions Regarding Contractor Approach

1. The Fire Department’s assumptions regarding which approach will best achieve the goals and objectives of providing invoicing and collection services are:

a. The Contractor would assume complete responsibility for determining the payor of ambulance

services including but not limited to Medicaid, Medicare, insurance, and self-pay, preparing and mailing invoices, tracking payments, and processing and resolving ambulance user invoicing and payment related inquiries and complaints, and performing collection services on delinquent accounts, and performing litigation services, as necessary.

b. Upon commencement and throughout the project term, the Contractor would implement

streamlining processes associated with account liquidation, by implementing customized systems to collect, integrate and manage invoicing data generated by FDNY; and by implementing electronic and/or manual invoicing to all payers, including commercial carriers.

c. The Contractor would provide the FDNY with a cutting-edge system that provides medical

invoicing and insurance and other payer determination services. d. The Contractor would be aware of and would adhere to all Federal and State invoicing

regulations. Refer to www.ftc.gov/os/statutes/fdcpa/fdcpact.htm www.ins.state.ny.us 2. Background

a. The Fire Department has established a medical invoicing compliance program to ensure that its

employees and agents comply with all applicable laws, rules, regulations, and program requirements when submitting claims for payment.

b. FDNY ambulance crews capture data on hard copy Pre-Hospital Care Reports (PCRs). The PCR

is a patient care record form used by FDNY personnel whenever an ambulance responds to a call and patient contact is made. Ambulance crews are required to fully and accurately document the

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provision of ambulance services on the PCR. The PCRs account for the ambulance services provided to the public. They are scanned at each EMS station and the data is validated by the system and crew, then uploaded to the FDNY database. This data is transmitted on a daily basis and uploaded to the medical invoicing and collection vendor’s database for reporting and review. There is a built-in delay of approximately one week from the date of scanning to allow for data verification and/or correction.

c. The Fire Department currently transports approximately 525,000 patients annually to Hospital

Emergency Departments as a result of requests for emergency services. Invoices and claims for such transports are submitted to Medicare, insurance companies (including Medicare HMOs and Medicaid HMOs), the patient, or other authorized payers. In FY06, approximately 16% of the total population served were privately insured, 41% were categorized as self pay, 19% were patients with Medicare insurance coverage (including HMOs), and 25% were Medicaid covered patients (half covered by HMOs).

d. The current transport service levels are as follows: eighty-two percent (82%) of transports are

service level BLS, seventeen percent (17%) are service level ALS1, and one percent (1%) are service level ALS2. The average number of loaded miles per transport is two and one half (2½) miles, and forty percent (40%) of patients receive billable oxygen (Medicare is not invoiced for oxygen).

e. For the Fiscal Year 2007, ending June 30, 2007, the FDNY reported $74.0 million in revenue

collected for EMS transport services, excluding income received from non-billable, non-HMO Medicaid and state subsidized programs (homeless, prisoners, etc). The revenue collected for FY07 consisted of the following:

Medicare: $25.0 million

Insurance: $43.0 million (including Medicare HMOs & Medicaid HMOs) Self Pay: $ 6.0 million

f. All revenue is remitted directly to an FDNY controlled bank lockbox. The Contractor is not

responsible for receipt of funds and does not have any control of the activities of the lockbox. Lockbox receipt reports are available for Contractor reconciliations.

3. Functional Requirements

The Contractor shall provide all Services that shall include but not be limited to:

a. Invoicing

i. Automate and streamline processes associated with account liquidation by implementing

customized systems to collect, integrate and manage invoicing data generated by FDNY; and by implementing electronic and/or manual invoicing to all payers, including commercial carriers. Electronic claims submission shall be used for any insurance payor that accepts this invoicing method.

ii. Identify billable self pay transports, and where possible, locate proper invoicing address

and invoice patient.

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iii. Take all available steps toward adjudication of Ambulance transport invoices.

iv. Provide monthly reconciliation of PCRs processed to total accounts invoiced including a

report of the on-going status on non-billable and uncollectible accounts.

v. Provide reporting of invoicing, collection, and payment activity on a monthly basis.

b. Insurance Claims and Determination Tracking

i. Respond to, and resolve in a timely manner, all insurance claim information submitted by patients, including electronic claims filing systems. Such systems should be in operation for Medicare, Medicaid HMO, and suitable for approval for all private insurance companies. Functions shall include but not be limited to the following: assisting patient claim preparation, proper assignment of claim, correction and re-filing of rejected claims, as applicable.

ii. Prompt identification, processing of refund analysis, and forwarding of analysis with

back-up documentation to FDNY. FDNY will process and issue appropriate refunds regarding duplicate payments and overpayments. FDNY will notify the Contractor to adjust the account balance when the refund is made. All adjustments shall be identifiable on the patient account record.

iii. Follow up on eligibility denials by contacting the patient to obtain accurate insurance

identification numbers and any other relevant information pertaining to invoice processing information.

iv. Reduce the number of denied claims by identifying eligible third-party coverage for

patients, when available.

v. Provide management services such as analysis and recommendations on minimizing denials/rejections which occur for operational reasons.

c. Pre Collection and Customer Service

The Contractor shall establish a dedicated toll-free phone line for pre collection and customer service care, including, but not limited to, the following functions: i. Process insurance information for patients;

ii. Process credit card payments from patients.

iii. Elicit additional or corrected information (e.g., correct date of birth) from patients in

order to re-submit claims which resulted in eligibility denials;

iv. Establish payment plans;

v. Respond to correspondence and calls from patients and payers;

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vi. Receive and follow up on denials/requests for medical record documentation from

insurers;

vii. Respond to and resolve all ambulance users’ inquires and complaints regarding the invoicing and collection of ambulance fees in a prompt and satisfactory manner.

viii. Document in the patient account record all actions and determinations made regarding a

particular patient account; including all phone and mail contact on. FDNY shall have access to patient account records in order to document comments or patient contact.

d. Accounts Receivable and Account Management

i. Keep complete and accurate books/files of accounts and records of its business

operations. Such records shall be made available to FDNY at any time requested.

ii. Maintain the Accounts Receivable (A/R) file on behalf of FDNY and receive, post and reconcile payments from electronic, paper, credit card, and check remittances.

iii. Review accounts for credit balances, including possible overpayments, and take timely

steps to provide FDNY with appropriate documentation.. Adjust accounts accordingly when required by Federal or State regulations.

e. Collections and Dunning

i. Attempt to locate missing information through other systems, which interface patient and

debtor demographic information, in order to proceed with collections. Such systems may include intake hospital databases, skip tracing databases, standardized investigation databases, Lexis, etc.

ii. Perform dunning and collection services by identifying accounts that have not previously

responded to collection efforts. Such efforts shall utilize all ethical and legal methods to obtain outstanding revenue, and may include, but not be limited to, contacting patients, taking calls and sending collection and lawyer letters. Collection efforts for each account shall be documented on each account record. (Refer to Section III (C)(4)(d) for detail and Section III (C) (6) for a Schedule for Invoicing, Collections, and Litigation).

iii. Document all reasonable efforts to routinely collect co-payments, deductibles, and co-

insurance for patients.

iv. Identify uncollectible accounts that have not responded to collection efforts. Document collection efforts on each account record.

f. Data Systems and Reporting

i. Automate and streamline processes associated with account liquidation by implementing

customized systems to collect, integrate and manage invoicing data generated by FDNY;

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and by implementing electronic and/or manual invoicing to all payers, including commercial carriers.

ii. Provide system capability and facilities for archiving and retrieving ambulance accounts.

iii. Provide an interface with the lockbox vendor, currently JP Morgan Chase, so as to receive all revenue information.

iv. Provide FDNY with a means to track progress online and in real time through access to

the Contractor’s information system.

v. Provide operational management reports for processing invoicing, collection and vendor performance activity, reports on general project operations in support of payment requests, and in support of recommendations to write-off uncollectible delinquent accounts, to be provided on a monthly basis or as specified herein, by the FDNY.

vi. Have a formal Business Continuation (Disaster Recovery) plan to ensure that FDNY data

is adequately protected and services are immediately continued in the event of a disaster, or unplanned disruption in operating capabilities due to fire, flood, or other emergencies.

g. Financial Review

i. Advise patients of the availability of a financial assistance program such that if a patient

is not eligible for public insurance, or is not covered by Medicare or private insurance, then the ambulance transport fee can be reduced to an affordable amount, based on family size and income. The FDNY and the Health and Hospitals Corporation (HHC) are currently in the process of formulating procedures to implement the program.

ii. Develop financial assistance application forms, subject to FDNY approval. iii. Receive financial assistance documentation, review such documentation, and forward the

determination to FDNY for approval. iv. Provide new invoicing at reduced levels for such patients subject to reduced fees, upon

approval by FDNY.

h. Legal Services

i. Issue a letter from a lawyer requesting payment in those cases where dunning efforts have proven unsuccessful. Commence litigation on behalf of FDNY in an agreed-upon subset of cases where litigation will be cost-effective.

4. General Requirements

a. The FDNY shall transmit the PCR data daily for upload to the Contractor’s database. Each PCR shall constitute one record of the database with all pertinent information coded on that record.

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The PCR may include for each patient account: ambulance transport information provided by the FDNY, address verification, applicable patient location information, patient status, payor status, payments, insurance and Medicare information, collection status, the current ICD-9-CM diagnostic code or patient condition code, as applicable.

b. Other information may include: the date of the ambulance call, the medical necessity

determination, the PCR number, the name of the patient, the patient address, the patient social security number, date of birth, age, the Computer Aided Dispatch (“CAD”) number, ambulance requirement, determination of emergency, motor vehicle accident information, treatment type, hospital transport, workers compensation, insurance information, hospital name and address, and other unique invoicing information. (See Exhibit 1 for example).

c. The FDNY shall endeavor to provide the following information in corresponding fields as well

as responses to the Medical Necessity Questionnaire or similar documents, as required by Medicare or other payers for claims submission.

i. Unit Type – whether the ambulance completing the PCR was ALS1, ALS2, or BLS.

ii. Service Type- from the description of the treatment provided per the PCR, an entry shall

be provided which indicates BLS, ALS1 or ALS2. This shall be recorded on the database record.

iii. Contraindication (“REQ AMB”) - whether the patient required an ambulance to go to the

hospital. An entry of “Y” for yes or “N” for no as to whether the use of another method of transportation was contraindicated by the patient’s condition.

iv. Reasonableness (“REQ HOSPITAL”)- whether the patient needed to go to the hospital

for treatment. An indication of “Y” for yes or “N” for no as to whether the patient needed to go to the hospital for assessment/treatment..

v. Emergency - An indication of “Y” for yes or “N” for no as to whether the response was

emergent, as per Federal guidelines.

vi. Special Conditions – an indicator for the following categories of calls as listed below. Otherwise no indicator is to be entered. V = Victim of Crime S = Sexual Assault

vii. Motor Vehicle Accident (“MVA”) – an indicator shall be provided if the ambulance

transport was due to an incident with a motor vehicle.

viii. Workers Compensation (“WORKER’S COMP”) – an indicator shall be provided if the ambulance transport may have resulted from a work-related incident.

d. Invoicing Services

Upon receipt of the patient information, the Contractor shall perform the following services:

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i. Verification of authorization of patient information disclosure for the purpose of invoicing and assignment is indicated by the signature of the patient on the PCR, signature of other authorized adults, or in their place, if unable to sign, signature of an FDNY crew member. The signature information will be provided by FDNY in the data file.

ii. The Contractor shall determine patient eligibility for Medicare, primary and secondary

insurance (including Medicare and Medicaid HMOs), whether the patient is responsible, or if the claim is ineligible for invoicing (i.e., Medicaid transport, homeless with no contact info).

iii. For all eligible patient claims, the Contractor shall generate a claim for payment in one of

the following formats, which complies with the data content and data condition requirements of current HIPAA rules, as applicable. (refer to http://www.hhs.gov/ ocr/hipaa/privacy.html)

a) A Medicare claim in a currently acceptable electronic format, as applicable..

b) A claim to the primary insurance company (including Medicare and Medicaid

HMOs). Claims should be submitted electronically, if the insurer accepts claims in this format. If not, standard paper claims should be submitted.

c) An invoice to the patient or responsible party together with a notification of the

availability of a financial assistance fee reduction program.

iv. Prior to any claims being invoiced to Medicare, an acceptable signature must be on file, with the exception of claims regarding pronouncement of death.

v. PCRs without the required medical release signature may not be released for claim to

Medicare. Such items shall be forwarded directly to the patient. The invoice shall include a request for patient signature for information release authorization, as well as verification of insurance information.

vi. Self Pay Accounts

a) All self pay accounts shall be invoiced to the patient or responsible party, using an

invoice series under the FDNY name. In this letter cycle, at least two pre-collection invoices shall be generated.

b) The Contractor shall issue an initial invoice for payment to the patient. It shall be

mailed to the patient in accordance with standard Untied States Postal Services mailing practices requesting payment or insurance information.

c) The invoice shall be easy to read and include, but not be limited to, the following

information: the invoice number, the name and address of the patient, the date of the invoice, the date of service, the name of the hospital transported to, the fees for each service provided, a total of the fees listed on the invoice, the PCR number, payment

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due date, and telephone number of customer service. The invoice shall also contain an area reserved for the display of a general public service message.

d) The invoice shall include either a separate return voucher or perforated voucher,

which shall include but not be limited to: the invoice number, the date of the invoice, the date of the transport, the patient information, the return address information, date payment due, the total amount of the invoice, the statement date, and the PCR number The voucher shall also include an area for credit card information indicating the type of credit card, the credit card number, the expiration date, and the authorizing signature.

e) The reverse side of the voucher shall include an area to allow patients to provide

address correction information and insurance information as well as the terms for medical records release, and an area for the signature. The voucher may also include a bar code line that will incorporate the amount of the invoice, the PCR number, and the invoice number.

f) The Contractor shall include a return envelope pre-printed with the return address

information. At the sole option of the FDNY, the postage for the return envelope may be a pre-paid format.

g) If status has not changed on the account by the due date (within 30 days), and if the

payment or insurance information is not received by the FDNY designated location (bank lockbox), the second notice shall be generated and sent. This invoice shall include additional information noting that it is a second invoice and if payment was previously sent then the invoice can be disregarded. Subsequent notices shall be sent at thirty-day intervals thereafter.

h) If status has not changed on the account, and if payment or insurance information is

not received by the bank lockbox by the second invoice due date, the account shall pass to the collections phase, and a first collection letter shall be issued. This letter shall constitute a warning notice to the patient regarding continued collection efforts. Legal remedies available shall also be indicated on the letter, as appropriate. The letter shall include the amount of the balance due , the PCR number, the date of the transport, and the return payment address. All collection efforts shall comply with the current provisions of the Fair Debt Collections Practices Act (FDCPA), the Fair Credit Reporting Act (FCRA), and any other applicable law.

i) All self-pay accounts that reach the collection stage will receive a series of collection

agency letters.

j) Financial Assistance Fee Reduction

1) The FDNY is in the process of transition to include a means-based threshold in order to provide fee-scaling for uninsured patients. The Contractor shall include a second page in self pay invoices, in order to provide this information to patients. The Contractor will be responsible for initial review of patient submission of means-based documentation for fee-scaling, and determination of eligibility.

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2) The Contractor shall work with the Fire Department to develop best practices

going forward which may include but not be limited to the development of a self-certification form and/or development of a fee reduction application.

(a) The fee reduction application may include but not be limited to criteria for

eligibility for fee reduction, details on the individual and other dependent income, number of family members and/or dependents, liabilities, and other applicable data.

(b) The Contractor may collect all applicable supporting documentation which

includes but not limited to: current tax returns, W2 forms, pay stubs, rent receipts, birth certificates, evidence of domestic partnerships, proof of residency, and other applicable financial data.

vii. Medicare Claims

a) The Contractor shall use the Medicare eligibility checking system to verify eligibility on the date of the transport.

b) It is the Contractor’s responsibility to be aware of, and abide by, all Federal Medicare

guidelines and regulations regarding the verification process (refer to http://www.cms.hhs.gov).

c) The Contractor shall utilize Medicare insurance information to generate a claim request

for Medicare. The Contractor shall verify if there is a primary insurance carrier prior to submitting the claims to Medicare. Medicare shall be considered the secondary carrier if the patient has a primary insurance carrier.

d) All claims shall be transmitted in an electronic format acceptable to Medicare. The

Contractor shall forward the claims determined to be medically necessary or medically not necessary to Medicare with all required supporting documentation. The claims shall indicate the medical necessity determination. After verification of receipt of payment from Medicare, the Contractor shall invoice the co-payment and/or deductible fees to the patient, or the patient’s secondary insurer, if applicable.

viii. Insurance Claims (excluding Medicare HMOs or Medicaid HMOs)

a) The Contractor shall generate an insurance claim in either an invoice (currently CMS

1500 form) or electronic format upon determination of the appropriate primary carrier. The Contractor shall provide all information as required by the insurance company’s standard claim format which may include such information as delineated herein and appropriate medical determination and medical coding information. The Contractor shall forward all claims to the insurance carriers with required supporting documentation, if applicable.

b) After verification of receipt of payment from the primary insurance carrier, if the balance

remains due, the Contractor shall determine if there is a secondary carrier for the patient.

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If a second carrier exists, then the Contractor shall generate an insurance claim to the second carrier. In addition to providing all standard insurance company claim information, the Contractor shall provide proof of payment from the primary carrier, as required. Proof of payment generally consists of a statement from the insurance carrier or a facsimile check.

c) In accordance with New York State insurance regulations, the patient is only responsible

for a deductible and/or co-payment/co-insurance, after payment is received from the insurance carrier.

ix. Insurance Claims (Medicare HMOs)

a) The Contractor shall generate an insurance claim in either an invoice (currently CMS

1500 form) or appropriate electronic format upon determination of the appropriate HMO. The Contractor shall provide all information as required by the insurance company’s standard claim format which may include such information as delineated herein and appropriate medical determination and medical coding criteria. The Contractor shall forward all claims to the insurance carriers with required supporting documentation.

b) Subsequent to insurance payment(s), the patient is only responsible for a deductible

and/or co-payment.

x. Insurance Claims (Medicaid HMOs)

a) The Contractor shall generate an insurance claim in either an invoice (currently CMS 1500 form) or electronic format upon determination of the appropriate HMO. The Contractor shall provide all information as required by the insurance company’s standard claim format which may include such information as delineated herein and appropriate medical determination and medical coding criteria. The Contractor shall forward all claims to the insurance carriers with required supporting documentation.

b) Subsequent to a Medicaid HMO payment, no other payment is due from any other

source.

xi. Statement of Indemnification for Incorrect Invoicing or Claims:

The FDNY shall hold harmless and indemnify the Contractor, its officers, trustees, employees, agents, or independent contractors from liability upon any and all claims for damages on account of false or incorrect invoicing or processing requests for payment, resulting solely from the reliance on medical coding and medical necessity determinations provided by the FDNY to the Contractor.

xii. Medicaid Claims

The Contractor shall not invoice or submit claims for patients that are known to be covered by Medicaid (except for Medicaid HMOs – refer to Insurance Claims, Section 4 (c)(ii)).

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xiii. Special Case Transport

a) Collection of claims involving special circumstances including, but not limited to, victims of crime and/or sexual assault, and those pronounced dead (DOAs), shall be referred to the FDNY for disposition.

b) Claims involving line of duty injury (LODI) for uniformed services (i.e., FDNY, NYPD)

shall be automatically closed at the discretion of the FDNY (FDNY will provide an additional table). These accounts shall be closed before any invoices are generated.

xiv. Insurance claims for which no payment or acceptable response is received from the

insurer after the legal time limit, shall be forwarded for appeal to the NYS Department of Insurance. At the FDNY’s sole discretion, prior to commencing the appeal process, the Contractor may advise the insurance carriers that they shall bear the costs of the appeal process, for failure to provide a timely payment.

e. Collection Services

i. The Contractor shall promptly undertake, through ethical and lawful means, to collect on all

the invoices for which the monies have not been received. All collection efforts undertaken on the Fire Department’s behalf must be in accordance with relevant laws applicable in the jurisdiction in which the collection is undertaken and must be performed pursuant to the highest standards of ethics. The Contractor shall utilize all available methods to locate debtors, conduct asset searches, issue standard collection letters, and utilize telephone-dunning techniques.

ii. The Contractor’s asset locating and judgment collection efforts shall include diligent and

timely attempts to locate and re-verify each judgment debtor’s address, place of employment and assets subject to attachment and execution.

iii. After all standard collection techniques are exhausted, the Contractor shall utilize the

services of a law firm to issue subsequent collection letters. The letters shall precede the commencement of litigation, however, it shall not advise the payer that litigation will automatically be commenced.

iv. The Contractor shall advise the FDNY of all of its collection procedures, and shall only

employ those collection procedures explicitly approved by the NYC Law Department. The NYC Law Department reserves the right to require the Contractor to modify or change its procedures, and no procedure may be used by the Contractor which in the NYC Law Department’s judgment is unfair, unethical or contrary to the best interest of the FDNY or the City.

v. Copies of all form “dunning” letters to be used by the Contractor shall be submitted to the

FDNY for approval prior to use.

a) All offers of settlement shall be submitted to the FDNY on a form to be approved by the FDNY, containing a statement of the facts and setting forth the Contractor’s recommendations, and the basis for such recommendations. The FDNY shall make all

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determinations concerning such offers of settlement subject to the requirements of the Comptroller of the City of New York (the “Comptroller”).

b) No case shall go without activity by the Contractor for more than three months

except those cases awaiting action by the courts, the sheriff or marshal, or cases in which the Contractor is awaiting a response from a debtor or debtor’s counsel and an attorney at the Contractor makes a case notation that allowing additional time for a response is appropriate.

c) Each month the Contractor shall return those cases, which, after making every

reasonable effort to collect it deems uncollectible. Returns shall be made in a manner acceptable to the FDNY. The Contractor shall return all cases within six months after assignment when the defendant cannot be located, or where the Contractor, in the reasonable exercise of its judgment, deems the claim or judgment uncollectible. The FDNY may review the cases returned, and in its sole discretion, require the Contractor to make additional collection efforts.

d) In the event that the Contractor receives correspondence, communication or payment

relating to a claim which has not been assigned to the Contractor, or which has been closed and returned, the Contractor shall at no charge inform the correspondent to contact the FDNY and shall notify the FDNY of the correspondence, communication or payment and forward such, in accordance with the FDNY’s instructions.

5. Litigation Services

a. The Contractor shall propose dollar thresholds and other criteria for determining which debts

shall be pursued through litigation. Factors may include the amount of debt, the known income and assets of the debtor, the location of the debtor, and other factors to promote an effective and economical operation. The criteria to be used must be approved by FDNY before initiation of legal action.

b. All attorneys who are assigned to perform litigation and collection services within the State of

New York shall be members in good standing of the bar of the State of New York.

c. The Contractor shall be responsible for investigation of the claim where necessary, preparing and sending notices to debtors, drafting and serving a summons and complaint (properly verified where necessary), selecting, assuring the reliability of, and paying for the process server, providing sufficient supervision and review of the process server’s actions to assure compliance with the requirements of law and to assure the validity of the affidavits of service and non-military service completed by the process server, for commencing of and/or defending all necessary motions. If any opposition to any action calls into question the lawfulness of the FDNY’s activities, the Contractor shall promptly report to the FDNY and the New York City Law Department, Affirmative Litigation Division. The Law Department, in its sole discretion, may direct the conduct of the litigation or may assume control of the litigation.

d. The Contractor shall promptly report to the FDNY and the NYC Law Department all

counterclaims served against the City. In the sole discretion of the NYC Law Department, the case may either be transferred to the NYC Law Department or litigated by the Contractor,

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subject to such supervision and control of the NYC Law Department. The Contractor shall not be entitled to a separate fee for defending any counterclaims.

e. No appeal may be filed without consent of the FDNY and the NYC Law Department, except to

protect a statutory deadline. In such case, notification must be made promptly to the FDNY and NYC Law Department. All Notices of Appeal served by the Contractor shall be delivered to the FDNY.

f. The FDNY reserves the right to direct the Contractor to discontinue use of particular process

servers on cases referred by the FDNY effective immediately upon receipt of written notice from the FDNY directing such discontinuation.

g. Prior to the service of any legal document by the Contractor, one of the attorneys assigned by the

Contractor shall review the particular file to determine that the criteria for legal action have been met, that the party to be served resides at the address appearing on the file, and that all summonses and complaints, motions, notices, income executions, restraining notices, property executions, and all other pleadings and papers are served pursuant to law. Such attorney shall also review each legal document for its content, accuracy and lawfulness.

h. Where required, litigation shall be commenced no later than six months after assignment of a

claim to the Contractor and shall be timely prosecuted.

i. Inquests shall be requested promptly after a default, where the inquest is necessary to obtain a judgment.

j. Actions to collect judgments may include, but are not limited to, service of income executions,

property executions, restraining orders, initiation of supplementary proceedings, and where appropriate, other litigation efforts. Collection activities on judgments shall commence promptly, but no later than six months after entry of judgment.

k. Delivery Of Executions To City Sheriff/City Marshals

i. All executions, either property executions or income executions, intended to result in

levies within the City of New York, shall be delivered to either the New York City Sheriff or to a New York City Marshal. The Contractor shall follow the direction of the FDNY and the NYC Law Department in regard to the procedures to be used in selecting the particular City Marshal(s) to whom executions may be delivered. The procedures will be provided to the Contractor prior to its receipt of an assignment. At any time during the term of this Agreement, the FDNY reserves the right to amend its procedures in regard to the selection of City Marshals, including the withdrawal of the FDNY’s previous approval of the use of Marshals whose collection performance is deemed to be unsatisfactory by the Fire Department.

l. All litigation and collection efforts undertaken on the Fire Department’s behalf shall be in

accordance with relevant laws applicable in the jurisdiction in which the collection is undertaken and shall be performed pursuant to the highest standards of ethics..

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m. If the Contractor pursues out of state claims directly, it shall follow all legal and ethical requirements of the foreign state including, where necessary, the use of an attorney authorized to practice law in that state.

n. If the Contractor chooses to pursue out of state or international claims through correspondent

counsel, correspondent counsel shall be a member in good standing of the bar in the state in which the claim is being pursued. The selection of correspondent counsel, and the fee charged by correspondent counsel, must be approved by the FDNY in advance and in writing.

o. The Contractor shall send a copy of this Agreement to any correspondent counsel. Correspondent

counsel will be fully subject to the terms of this Agreement. If the Contractor enters into a written contract with correspondent counsel, the contract shall contain the provisions specified in Appendix A to this Agreement. If the Contractor does not enter into a written contract with correspondent counsel, correspondent counsel shall represent in writing that it shall be fully subject to the terms of this Agreement. Correspondent counsel shall also represent in writing that it is charging the lowest fee that it charges for similar cases. Copies of contracts between the Contractor and correspondent counsel and/or the written representations required by this paragraph shall be provided to the FDNY by the Contractor.

p. Entry, Recording, And Satisfaction Of Judgments

i. The Contractor shall cause all judgments to be entered, filed and docketed in the county

where the action was brought, in the judgment debtor’s county of residence, if within New York State, and in any county within New York State where the judgment debtor owns real property (as such fact becomes known), if not already so entered.

ii. If a judgment has been satisfied, the Contractor shall prepare a satisfaction of judgment

within the time provided by law, shall file the original satisfaction with the court and shall send one copy to the judgment debtor, in accordance with applicable law.

iii. The Contractor shall compute and endeavor to collect interest on all judgments in

accordance with applicable laws, regulations and rules, from the entry of each judgment.

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q. Data Systems and Reporting

i. The Contractor shall maintain a separate file for each referred case. Each file shall contain copies of all documents pertaining to the claim or judgment, correspondence to and from all parties, and a record of all steps taken by the Contractor regarding the case. All such files shall remain the property of the City.

ii. The Contractor shall provide FDNY with a link to its system which allows:

a) Correction of data b) Audits c) Suspending accounts d) The release of suspended accounts back into production e) Closing suspended transports as per agreement f) Closing accounts for cause at FDNY’s discretion.

iii. The Contractor shall maintain and utilize a computer system to track the status of all

pending claims and pending judgments. The computer system shall generate the following reports which will be available to FDNY within ninety (90) days of the Notice to Proceed.

a) The Contractor shall work with the Fire Department to develop best practices

regarding all phases of the litigation process.

b) The Contractor will provide management reports which indicate collection rates by payer type, as well as analyze payment amounts for each commercial payer, including Medicare and Medicaid HMOs.

c) Provide monthly electronic reports for:

(1) Cumulative suspended accounts in the system. (2) Cumulative accounts with credit balances, including posting date. (3) Detailed payment posting by account, including relevant fee charged for each

payment posting. (4) Summary of Age of Receivables, from date of service.

iv. All of the reports described above, and for any other reports that may be required by the

FDNY, shall be provided in both hard copy and electronically, in formats acceptable to the FDNY, and are subject to criteria and standards to be established and set by the FDNY. The Contractor will correct any errors in any reports that are discovered by the Contractor or brought to the attention of the Contractor by the FDNY. The FDNY may, at its sole discretion, alter its reporting requirements, and the Contractor shall take reasonable steps to comply in a timely manner with any such revised reporting requirements.

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6. Schedule for Invoicing, Collections and Litigation

Description of Service Schedule for delivery of Services Claims Submission to Medicare and Insurance Carriers

Within seven (7) calendar days from receipt of the PCR and all required supporting documentation.

First Invoice to Self Pay Accounts Within thirty (30) calendar days from receipt of the PCR.

Second Invoice to Self Pay Accounts Thirty (30) calendar days from the date of the first invoice.

Collection Services Continuous collection services commencing thirty (30) calendar days from the date of the second invoice, not to exceed a total of ninety (90) days.

Litigation Service (subject to FDNY approval)

Commencing immediately after collection services.

7. Data Security

a. Access to the Contractor’s database, for both inquiry and update purposes, shall require a log-on

procedure whereby each user shall have a unique ID and password. Only those employees of the Contractor specifically assigned to perform invoicing and debt collection services may be issued identification numbers and passwords that allow authorized access to the Contractor’s database of referred accounts. Employees of the FDNY, authorized in writing by the Fire Department, also shall be given identification numbers and passwords that allow authorized inquiry access to the Contractor’s database of patient accounts. The FDNY prohibits access into the Contractor’s database by any means other than the aforementioned log-on procedure which requires each user to be identified by a unique ID and password. Any auto log-on procedure used by the Contractor must comply with all the above requirements in order to be acceptable to the Fire Department.

8. Business Continuation (Disaster Recovery) Plans

a. The Contractor shall have a formal Business Continuation (Disaster Recovery) plan to ensure that

FDNY data is adequately protected and services are immediately continued in the event of a disaster, or unplanned disruption in operating capabilities due to fire, flood, or other emergencies. Such a plan is an important part of any information protection plan for the recovery of agency operations and the continuation of business after a disruption due to a major loss of computer processing capability. The plan shall be developed and maintained by the Contractor to ensure prompt resumption of business operations and transactions, including invoicing and collections processing, after the disruption or loss of the Contractor’s primary processing or operational site through adequate alternate facilities, equipment, back-up files, documentation and procedures.

b. Business Continuation Plans - General

i. Business continuation planning prepares for events that exceed the ability of the routine back

up and operations recovery procedures that handle day to day, short term and localized outages. They map out the agency's response to the kind of major, very infrequently occurring events that are of such a magnitude that they cause the loss of, all, or major segments of, the agency's operations over a sustained period of time.

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ii. The business continuation plan, also called a contingency plan, or disaster recovery plan, enumerates the steps the Contractor will take to recover computing operations. Plans can vary widely in their breadth and scope. The most basic may consist of actions that maintain an agency's "presence" during a comprehensive loss of computing resources, simple procedural changes, or provision for manual processing and workarounds. More elaborate plans may be geared to promptly reestablishing business temporarily at alternate locations, through emergency vendor supply arrangements, reciprocal service agreements, disaster recovery site, or service bureau arrangements.

iii. In developing business continuation plans, the Contractor shall consider separate scenarios

involving the loss of a data center, satellite office, or other critical points of failure in the Contractor's information processing environment.

c. The primary elements of a business continuation plan include:

i. The steps the Contractor will take to determine whether or not an event is sufficiently serious

to invoke the plan.

ii. Responsibility assignment. The names, telephone numbers and specific responsibilities of each individual in a disaster situation

iii. A pre-arranged agreement describing the conditions under which a disaster is to be declared.

iv. Specific procedures. These can vary greatly depending on the degree of the disaster event.

Dependencies include: the parts of the organization that can work and the parts that cannot, the length of time the outage is expected to last, the availability of work space and/or staff to do workarounds or manual processing, and the identification of manual processing procedures or workarounds that may be instituted.

v. Prioritization. Establishes the order of priority in which information systems are to be

reinstated. vi. Equipment and software supply agreements. vii. Recovery assistance consultants. viii. Hot site, cold site, service bureau or reciprocal arrangements

d. Plan Updating and Testing

i. Periodic reviews and updates are necessary to insure that the business continuation plan

remains current. A comprehensive test should be conducted annually.

e. Network Recovery

i. If the Contractor operates a local area or other network, a network recovery component is a critical element of the business continuation plan. Special attention must be devoted to the accurate inventorying of workstation and PC technical specifications, configurations,

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network software and hardware, network operating hardware and software, and application software.

9. Contractor Employee Training and Qualifications of Personnel

a. The Contractor shall recruit and utilize personnel sufficiently skilled to perform the duties and

assume the responsibilities described herein.

b. The Contractor instructor(s) shall train each Contractor employee in the administration of the FDNY medical invoicing compliance program and provide such training to all employees performing or supervising the services provided pursuant to this Agreement, on a periodic and ongoing basis. The FDNY shall provide information to Contractor designated training personnel to assist in the administration of the FDNY medical invoicing compliance program.

c. The Fire Department shall provide a copy of the FDNY Medical Invoicing Compliance Program and

Operating Standards Manual ("Compliance Manual") to the Contractor. The Contractor shall provide each employee or supervisor with one (1) complete copy of the Compliance Manual.

d. The Contractor training of its employees shall include but not be limited to the following subjects:

i. The Fire Department's Medicare Invoicing Compliance Program.

ii. The requirements governing Medicare invoicing for a government Contractor, including

Medicare requirements relating to documentation, medical necessity, assignment of diagnostic and procedural codes, and preparation and submission of claims.

iii. Training regarding HIPAA Requirements.

iv. The consequences of failing to comply with applicable laws, including the penalties for fraud

and abuse.

e. Each Contractor instructor providing the training shall be proficient in each subject that will be taught. Any instructor who, in the opinion of the Fire Department is not performing satisfactorily shall be removed from service under this contract within two (2) business days from oral notification by the FDNY. If necessary, the Contractor shall fill the vacancy with another instructor who has qualifications to perform the required tasks.

f. The Contractor may utilize a short film or video to supplement training by the instructor. However,

this medium shall not be used as a substitute for instructor training and demonstrations.

10. Ethical Standards

a. The services to be provided by the Contractor shall include the invoicing services, collection, and litigation of claims and judgments and related services, including but not limited to asset location.

b. The Contractor shall use maximum, diligent and timely efforts to attempt to effect invoicing and

collection.

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c. All the Contractor’s operations must be performed in accordance with the highest standard of legal ethics.

d. The Contractor shall comply strictly with any statute, act, law, ordinance, rule, regulation, guideline

or code of conduct with respect to the collection of debts, communication with debtors and collection agency procedures, made or issued by any federal, state, city, county, town or village governmental agency in any jurisdiction or location in which any attempt to collect the debts described herein is made, including but not limited to the following: Fair Debt Collection Practices Act, 15 U.S.C. § 1692; New York City Department of Consumer Affairs Rules, 6 RCNY §§ 5-76 et seq.; New York State Judiciary Law Article 15, § 489; New York State General Business Law §§ 600 and 601; New York Executive Law § 63 subchapter 12.

11. Reports And Payment Monitoring

a. The FDNY shall provide an interface to with the lockbox vendor, currently JP Morgan/Chase, so the

Contractor has access to information indicating payments received.

b. Such information may include but not be limited to the amount of the payment, date received, invoice number, PCR number, patient name, and the credit card number or check number.

c. The contractor shall verify and balance the daily deposit. The daily summary total shall be

reconciled to the deposit information provided by the bank.

d. The check copies or images received from the lockbox shall be filed and maintained by the Contractor and posted to the Contractor’s system.

e. The Contractor shall utilize the payment information to reconcile any outstanding records in the

Contractor’s database. The Contractor shall develop as part of its reconciliation an aging report indicating the uncollected outstanding amounts.

f. The Contractor shall provide real time access to the FDNY to monitor invoicing and revenue receipt

activity. The FDNY shall have the ability to generate revenue reports and other activity information. Such reports shall include but not be limited to the following information:

i. Payment dollar amounts posted daily and monthly by payer type (Medicare, Commercial,

Self).

ii. Dollar amounts invoiced (first time invoicing only) daily and monthly by payer type.

g. The Contractor shall work with the FDNY Project Manager to develop to the appropriate database screens and reports.

h. Report of Transactions Received and Invoiced

The purpose of this report is to compare transport data received by the Vendor from the Fire Department with transports invoiced by the Vendor to provide reconciliation. This report shall include a detailed list itemizing the following:

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i. total number of transports reported by the FDNY; ii. the total number of transports invoiced by the Vendor; iii. amount invoiced by the Vendor; iv. the total number of transports not invoiced by the vendor for cause (Medicaid verified,

LODI, prisoners, etc.).

i. Records pertaining to the following matters shall be retained for a period of not less than seven (7) years:

i. supporting information relating to claims; ii. records relating to reimbursement from federal health care programs; iii. eligibility information (i.e., Medicare number) for patients served; iv. documentation of information received regarding potential compliance; v. records of internal investigations and audits, whether routine or in response to reports of

violations.

12. Write-off adjustments and Bad Debt File Processing

a. At the Fire Department’s sole option, the Contractor shall mark selected accounts as written off, make indications on the account record as required, and adjust balances as appropriate. The Contractor shall prepare and securely transmit files to a FDNY designated medical debt purchaser, on a scheduled basis mutually agreed upon by the debt purchaser and the FDNY. The file format shall be an industry acceptable standard.

13. Telephone Inquiry And Web Site Service

a. The Contractor shall establish a toll-free (for example, an 800 number) multi-line telephone inquiry

service upon project initiation to handle patient inquiries. At a minimum, the service will be provided during standard business hours (at a minimum of 8:00 am to 5:00 pm Eastern Standard Time, Monday through Friday, excluding national holidays), with voice-mail service for after hours, weekends and holidays. The Contractor shall be permitted to provide additional days and times of service.

b. Calls from patients to the service will be handled by the Contractor who will attempt to resolve the

invoicing or collection problems. Customer service representatives answering calls shall have excellent communication ability in the English language, have access to the patient invoicing information, and have the capability to resolve invoicing and payment issues. The Contractor shall also have the ability to provide call answering services in Spanish, and have the capability to utilize translation services for other languages, as necessary.

c. The Contractor shall track all problems and inquiries, and their resolutions, and shall establish a

database to document all calls to the inquiry line. This information shall be provided to the FDNY Project Manager on a monthly basis. The service shall utilize an interactive call processor or similar system to handle concurrent requests to the system. The delay period from the time the call is received by the system to the time the call is answered by a Contractor representative shall not exceed ten (10 ) minutes. The call processor shall utilize periodic prompts and messages during the waiting period, and shall also provide alternative options and estimates of the waiting time.

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d. The Contractor shall establish a secure Web site for FDNY invoicing inquiries and service information, and/or provision of insurance or credit card information. Patients may have the ability to query any outstanding invoices by entering either the patient name, the PCR number, or the invoice number. Patients may also have the ability to update their account in real time by entering insurance information, address correction, credit card, or other information. An inquiry screen may be available to enter e-mail inquiries. Medical information, such as diagnosis codes shall not be available for viewing via the internet.

14. Monitoring And Auditing

a. In order to determine whether the invoicing and collection system is serving its intended purpose,

the FDNY may, at its discretion, perform monitoring, reviews and audits.

b. Monitoring: An FDNY Authorized Representative may arrange for monitoring of the services. The monitor shall oversee the ongoing quality to ensure that the following conditions are met:

i. All invoicing information is accurate, complete and reflects the appropriate source of

information;

ii. There is proper completion and submission by Contractor staff of all required documentation;

iii. Medicare, insurance, and patient payments are properly recorded;

iv. Secondary and follow-up invoices/correspondence are issued;

v. Additional carriers are located and invoiced with proof of primary payment;

vi. Utilization of collection and litigation services.

c. Auditing

i. The FDNY may conduct, or arrange for, a review and audit of the invoicing process,

collection procedures and practices of the Contractor to verify that its submissions for reimbursement comply with all applicable federal health care program status and regulations, at any time during the term of the project.

ii. It is the intent of the FDNY to conduct an audit at least once per contract year to review the

Contractor processes and internal control procedures. The audit may be performed by the FDNY, or at the FDNY’s sole option, by an independent auditor selected by the FDNY. The audit shall be designed to address compliance with the following practices, which include but are not limited to: laws prohibiting kickback arrangements, and laws governing coding and medical necessity claim submissions.

iii. To the extent that irregularities are uncovered in the course of the review, the nature and cost

of the irregularity shall be detailed with recommendations for corrective action.

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iv. The audit shall be conducted in accordance with the approved detailed audit program developed in conjunction with the FDNY Chief Compliance Officer.

15. Confidentiality

a. While providing Services to the FDNY, the Contractor shall have access to highly confidential,

patient personal and health information which includes but is not limited to, names, addresses, telephone numbers, email addresses and other contact information, current medical conditions, patient medical history, and patient prescriptions. Information in electronic folders, on media, in documents, databases, spreadsheets, electronic mail, and any other format and or received remotely through any data transmission services shall be considered within the scope of this Agreement, as well as any written documents, mailings, reports and any other documentation associated with the Services provided by the Contractor. Accordingly, Contractor agrees not to use the information, or disclose it to any third party, at any time during or after expiration or termination of this Agreement, except (i) to Contractor subsidiaries involved in providing the Services, for the purposes of carrying out the terms of this Agreement, (ii) upon prior written consent of FDNY, or (iii) if disclosure is required by court order, subpoena, or other validly issued administrative or judicial notice or order or as a matter of applicable law, rule or regulation. The Contractor shall provide the Fire Department with immediate notice of any actual or potential requirement of any court or agency to disclose confidential information and shall permit the Fire Department to seek a protective order or other law relief limiting such disclosure and will cooperate with the Fire Department in obtaining such relief.

b. The Contractor is advised that PCRs contain such confidential patient information protected by

Federal, State and/or City laws and regulations. The Contractor, its employees, officers, subcontractors, and agents understand that such information is highly confidential and shall not communicate, by any means, the nature of such information or to any person or business, unless specifically authorized in writing by the Fire Department. The Contractor, its employees, officers, subcontractors, and agents shall not discuss the Confidential Information with persons who have not been duly assigned to work on this project. The Contractor its employees, officers, subcontractors and agents shall take all precautions necessary to safeguard the integrity of the Confidential Information.

c. All patient information and claims data stored on Contractor systems used to support the

Services and FDNY application resources, shall be the property of FDNY. Such data stored by Contractor in an offsite facility shall continue to be the sole confidential property of the FDNY and shall be subject to the same requirements. FDNY shall have access to Contractor proprietary applications for claim reporting, data entry, and real time viewing and monitoring purposes. Upon the Fire Department’s request, the Contractor shall return all Confidential Information received in written or tangible form, including copies, reproductions or other media containing Confidential Information, within five (5) business days of such request. At the Fire Department’s option, any such Confidential Information may instead be destroyed by Contractor. The Contractor shall provide a written statement to the City regarding destruction within five (5) business days thereafter.

d. In addition to the confidentiality provisions set forth herein, the Contractor agrees to comply

with all applicable provisions of federal, state, and local laws, and rules, and regulations, including the applicable terms and conditions of the privacy and security requirements set forth

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in the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated pursuant thereto (“HIPAA”).

e. The Contractor shall not transmit any information or records outside the jurisdiction of the

United States of America or its sovereign territories, unless the Contractor can adequately establish to the satisfaction of the Fire Department, that such patient information and records will be protected pursuant to the requirements set forth in HIPAA

f. The Contractor agrees that it will instruct its officers, employees, and agents to maintain the

confidentiality of any and all patient and claim information. Upon expiration or termination of the project, Contractor shall cease using the patient and claim information, except that Contractor may retain information and data necessary for its audit and compliance purposes relating to the Services and to permit audits following expiration or termination as permitted by this Agreement or applicable law; provided, however, that in no event shall the use and disclosure of patient and claim information be in violation of any applicable provisions of federal, state, or local laws, or rules and regulations, including the applicable terms and conditions of the privacy and security requirements set forth in HIPAA.

g. The above restrictions on use and disclosure shall not apply to such Confidential Information if

the same:

i. Is in the public domain or in the possession of the Contractor without restriction at the time of receipt under this Agreement.

ii. Is made available by the Fire Department or The City of New York on an unrestricted,

non-confidential basis.

h. The Contractor shall establish and maintain a secure and protected transmission format for such exchanges of information. The format and medium of the electronic data transmission shall maintain the confidentiality of all Records and conform to the standards promulgated by the United States Department of Health and Humans Services, pursuant to the requirements of Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).

D. Fire Department Assumptions Regarding Performance-Based Payment Structures

The Fire Department’s assumptions regarding which performance outcome measures and related financial incentives and/or disincentives will best assure that the selected proposer(s) will perform the work under the contract(s) awarded from this RFP in a manner that is cost effective for the Fire Department and most likely to achieve the Fire Department’s goals and objectives shall be as described: 1. If the Contractor fails to provide or complete the services within the time frames established

herein then the Contractor may be subject to liquidated damages in accordance with the following schedule:

a. Failure to issue claims or invoices: The Contractor shall be subject to fixed and liquidated

damages of the greater of ten cents ($0.10) per claim or invoice, or one hundred dollars ($100.00) per calendar day or portion thereof.

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b. Failure to commence collection services, or litigation services: The Contractor shall be

subject to fixed and liquidated damages of one hundred dollars ($100.00) per claim.

2. The Contractor shall monitor all deliverables and services and shall promptly notify the ACCO and the FDNY Authorized Representative, by telephone or other means, of any failure to provide such deliverables and services in accordance with the contract schedule. The Fire Department shall determine if failure to provide such deliverables and services have caused or are likely to cause impairment to the operation of the Fire Department or an inconvenience to the Fire Department. If it is determined that such failure to provide the deliverables and services have caused or are likely to cause such impairment or inconvenience, then the Fire Department shall notify the Contractor in writing, and provide a cure date to the Contractor. The cure date shall provide the Contractor with a time period to cure the situation to avoid liquidated damages. Decisions of the Fire Department in this regard shall be final and shall not be arbitrary or capricious.

3. All charges against the Contractor shall be deducted from the monies that is due or shall become

due to the Contractor from the City. In the event that there is no money due to the Contractor, then the Contractor shall pay the amount of the damages due for the City.

E. Qualifications of the Contractor

1. Contractors submitting a proposal in response to the work delineated in this solicitation shall meet

the following requirements:

a. The Contractor shall have a minimum of three (3) years current experience in comparable ambulance transport related accounts receivable invoicing and collection services. Individual experience of a principal as an employee of an organization may not be used to satisfy this requirement.

b. Medical debt purchaser(s) and vendor(s) providing ambulance transport medical necessity

determinations and medical coding services for the FDNY, are not eligible for award of a contract pursuant to the terms of this solicitation, and such purchaser(s) or vendor(s) may have no business relationship or fiduciary interest with the Contractor under contract with the FDNY for the provision of ambulance invoicing and collections services.

F. Qualifications of Contractor Personnel

1. The Contractor shall have in its employ at all times a sufficient number of capable and qualified

employees to enable it to perform the Services as specified in the Agreement. The employees shall have training and demonstrated ability in the specified areas, and possess all applicable licenses and qualifications.

2. A detailed resume shall be submitted to the FDNY Authorized Representative for approval prior to

the assignment of new employees. These qualification standards apply to both new and replacement personnel: the full names of the proposed supervisors, detailed descriptions of the previous 5 years' employment history, the name(s) and address(es) of the companies for whom the proposed supervisors worked for the past five (5) years, along with the name(s) and telephone number(s) of

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the immediate supervisors during the time of employment. The Contractor shall include resumes for key personnel who will be involved in the invoicing and collection process, as well as for other personnel who could be utilized should it become necessary. Resumes should include prior experience to satisfy this requirement.

3. The Contractor shall ensure that all of the Services required by this Agreement are satisfactorily

supervised. The Contractor shall provide such supervision as is sufficient to carry out all the terms and conditions of this Agreement.

4. The Contractor shall designate one of its employees to function in the role of primary contact

person. The contact person shall be the liaison for the Contractor for the term of the Agreement, and shall handle issues, problems or questions arising from the performance of Services.

5. The Fire Department reserves the right to review the credentials and qualifications of any Contractor

personnel providing Services pursuant to this Agreement, and to instruct the Contractor not to use for such purposes any individual that the Fire Department determines to be unqualified to perform the Services.

6. The Fire Department will notify the Contractor of any employee who in the opinion of the FDNY

Authorized Representative, is not performing satisfactorily. The Contractor shall resolve the problem within fifteen (15) days, to the satisfaction of the Fire Department. If the situation is not resolved to the satisfaction of the Fire Department, then the employee shall be removed from this project. If necessary, the Contractor shall fill the vacancy with another employee who has the qualifications to perform the required tasks.

7. The Contractor shall make a reasonable inquiry into the background of prospective personnel to be

employed for this program, and periodic review of employees providing services for the program. Such inquiry shall include but not be limited to a review of education, employment history, and attendance and lateness records. Personnel shall also be reviewed to determine whether they have been convicted of a criminal offense or civil or administrative adjudication related to healthcare, or listed by any Federal agency as suspended, debarred, excluded, or otherwise ineligible for Federal program participation. Such inquiry shall include, at a minimum, a review of the U.S. Office of Inspector General for the Fire Department of Health and Human Services cumulative sanction report and the General Service Agency's list of parties excluded from Federal and non-procurement programs. The Contractor shall not utilize any personnel for the provision of services that is listed by a Federal Agency as suspended, debarred, excluded or otherwise ineligible for Federal program participation.

8. The Contractor shall provide a listing of personnel to the FDNY that will be involved in the

invoicing and collection process, as well as for other personnel who could be utilized should it become necessary, within fourteen (14) days from the date of Notice to Proceed. The FDNY reserves the right to reject any Contractor personnel that the FDNY considers unqualified to perform the required services or that is found to be listed by a Federal Agency as suspended, debarred, excluded or otherwise ineligible for Federal program participation. The Contractor shall provide written notice to the FDNY within five (5) business days of any staffing changes. The Contractor shall provide a continuous and updated listing of all employees utilized to provide services.

G. Quality Control

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1. The Contractor shall establish a complete quality control program to assure the requirements of this

Agreement are provided as specified herein. The program shall include but not be limited to the following:

a. An inspection system covering all services provided by the Contractor;

b. A checklist for use in review and inspecting performance during regularly scheduled or

unscheduled inspections. The checklist shall include every area of the Contractor’s operation including but not limited to the development and maintenance of the database, backup capability, employee background review, training services, invoicing services, collection services, reporting services, customer services, and the designated individuals responsible for conducting such review and inspection.

c. The Contractor shall develop a system for identifying and correcting deficiencies in the quality

of services before the level of performance becomes unacceptable and the FDNY identifies the deficiencies.

H. Term of the Agreement 1. The term of the Agreement shall be from the date of notification until the expiration of five (5)

consecutive years unless otherwise terminated, canceled, abrogated or amended.

2. The Fire Department reserves the option to extend the Agreement for a period not to exceed two (2) consecutive years from the date of expiration.

3. The Contractor shall commence work as described in this RFP within thirty (30) calendar days from

the date of the written Notice to Proceed, or within a period mutually acceptable to the Contractor and the Fire Department.

I. Transition Services

1. If prior to the expiration or termination of the new contract, resulting from this solicitation, including any extension periods, the City has entered into a successor contract with another vendor for the provision of the services required hereunder, the Contractor agrees to assist the City and such new vendor in facilitating the transition. Such assistance shall include the turning over to the new vendor, upon the City’s request, any and all documents, work plans and records, provided by the City and/or specifically developed by the Contractor for the performance of the services under this Agreement, all data in a mutually agreed upon file format, provided the Contractor’s proprietary interest in such items is not exclusive.

2. The selected Contractor shall work with the previous vendor, as applicable, and at the direction of

the Fire Department, in order to transition processes and transfer relevant account related data. The data format shall be mutually acceptable.

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SECTION IV – FORMAT, CONTENT AND SUBMISSION OF THE PROPOSAL

Instructions: Proposers should provide all information required in the format below. The proposal should be typed on both sides of 8 1/2" x 11" paper. The City of New York request that all proposal be submitted on paper with no less than 30% post consumer material content, i.e., the minimum recovered fiber content level for reprographic papers recommended by the United States Environmental Protection Agency (for any changes to that standard please consult: http://www.epa.gov/cpg/products/printing/htm Pages should be paginated. The proposal will be evaluated on the basis of its content, not length. Failure to comply with any of theses instructions will not make the proposal non-responsive.

A. Proposal Format

1. Proposal Cover Letter

The Proposal Cover Letter form (Attachment A) transmits the proposer’s Proposal Package to the Agency. It should be completed, signed and dated by an authorized representative of the proposer.

2. Technical Proposal

The Technical Proposal is a clear, concise narrative and includes the following:

a. Table of Contents: Provide a table of contents for the materials contained in the proposal. b. Summary: Provide a summary of the important features of the proposal, including the

proposer’s understanding of the issues. c. Qualifications and Experience

i. Demonstrate the proposer’s relevant experience, background, and knowledge, both for the

Contractor as a whole, for each key staff person and, if applicable, each subcontractor the proposer intends to assign to the effort required for the proposed services.

ii. Provide a resume and/or qualifications for each proposed key staff person.

iii. Provide a synopsis of the scope of any similar project(s) conducted by the Contractor as a

whole and/or in which proposed key personnel participated. iv. State whether or not the proposer has had any other prior or present N.Y.C contracts. If so,

provide the name, address, contact and telephone number of the contracting agency, a brief summary of the nature of the contract and the approximate dollar value.

v. Provide the name, address, titles, contact and telephone number of all clients for whom the

proposer performed ambulance transport invoicing and collection services.

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d. Organizational Capability

i. Demonstrate the organizational capability of the Contractor. The proposer shall provide information concerning (1) the number of full-time people currently employed by the Contractor, (2) the projects on which the Contractor is currently working, (3) the projects the Contractor has completed, and (4) future projects to which the Contractor is committed. All project information shall include the dollar value of the contract, as well as the schedule. Provide a description of the organization and management structure. Identify how the organization carries out mission-essential and other support tasks, define operational procedures, provide a description of how the organization improves its mission, and how decisions are managed.

ii. Provide the location of all facilities that will be utilized to perform the Services as

described herein. Provide address, number of employees at each location with corresponding titles, and hours of operation. Indicate if the location(s) will provide the primary services, act as a backup or disaster recovery center, provide back-office operations, or provide any other related services.

iii Provide a projection of how this project will affect the proposer’s current workload and

standby capability. Specifically cite any on-going projects or commitments, and demonstrate that they would not impact the proposer’s capability to successfully implement this project.

iv. The Contractor shall provide detailed information regarding the computer facilities,

including hardware and software systems personnel. Describe backup/redundancy and disaster recovery plans and tests. Describe the functions and features of the invoicing and collection software to be used, prior experience with this software will be significantly considered. The Contractor shall be able to demonstrate system flexibility and the willingness to modify reporting requirements throughout the term of the Contract.

v. The Contractor shall provide a copy of the most recent policy and procedure compliance

manual. The manual should address but not be limited to standards of conduct, policies for risk areas, risk assessment, inappropriate invoicing practices, resolution of overpayments, computer system integrity, confidentiality of records, procedures to screen for employment of sanctioned individuals, and claims submission processes.

vi. Provide a statement affirming the proposer’s availability in the NYC area and for all

aspects of service required herein. vii State whether or not there are any pending legal proceedings to which the proposer and any

of its subsidiaries are a party to, of which any of their property is subject and any proceedings known to be contemplated by governmental authorities. If so, describe the nature and circumstances of the pending proceeding in detail.

viii. Attach a copy of the proposer’s latest annual financial report, audit report, or most recent

federal tax return with all schedules and sub-schedules.

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ix. Provide a narrative description of the Contractor’s internal and external quality control systems.

e. Proposed Approach

Present a DETAILED description of how the proposer will accomplish the tasks described in the Scope of Services. Specifically address the following: i. Describe the Proposer’s solution and demonstrate that it will effectively meet the goals and

objectives set forth in this RFP by providing:

a) A description of the proposed methodology to meet the goals set forth in this RFP.

b) A narrative overview of the capabilities of the Proposer and key personnel, and of the methodology to be employed in meeting the requirements of the RFP.

c) A project description including tasks and proposed time frame for start-up of the

operation, and delivery of services. Describe expectations and requirements for transition of services, if applicable.

d) A narrative overview of the proposed interaction between the Proposer and the Fire

Department with respect to managing projects as described herein. The Proposer should site specific examples of services provided for projects of similar scope and complexity.

ii. Describe and demonstrate the effectiveness of the Proposer’s plan for managing and

implementing this project. Describe proposed contractor transition requirements, if applicable.

iii. Describe and demonstrate the effectiveness of the methods of quality control the proposer

will utilize. The Proposer should site specific examples of quality control methods employed on projects of similar scope and complexity.

f. Proposer Exceptions: Define any exceptions taken to the requirements of the RFP, including

general provisions for Service Contracts. The exceptions would be included in a separate section of the Technical Proposal and clearly identified as such. Note: The technical proposal shall not include any pricing information or any exceptions or notes referencing the pricing proposal. All such pricing information shall be included only in the price proposal submission.

3. Acknowledgment of Addenda (Attachment C):

This form serves as the respondent's acknowledgment of the receipt of Addenda, which may have been distributed by the FDNY prior to the proposal due date and time. The proposer should complete this form as instructed, and include it as an attachment to the Technical Proposal.

4. Affirmation of Taxes Paid (Attachment D)

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This form serves as the respondent’s affirmation of and declaration that the proposer or bidder is not in arrears to the City of New York upon debt, contract or taxes and is not a defaulter, as surety or otherwise, upon obligation to the City of New York, and has not been declared not responsible, or disqualified, by any agency of the City of New York, nor is there any proceeding pending relating to the responsibility or qualification of the proposer or bidder to receive public contracts with the exception of listed items. The proposer should complete this form as instructed, and include it as an attachment to the Technical Proposal.

5. Price Proposal (Attachment B)

The Price Proposal shall be submitted in a separate envelope clearly marked as “Price Proposal” with the submission of the technical proposal. The Price Proposal shall consist of the following:

a. The Price Proposal Form (Attachment B) shall be utilized by the Proposer for the submission of

the Price Proposal. An authorized officer of the Contractor must sign the price proposal. Final negotiated prices shall remain fixed for the term of the contract.

b. The Proposer shall submit a price proposal consisting of fixed fee percentages of the revenue

collected by the Fire Department for the following types of invoicing and collection services:

Category 1: Medicare invoicing. Category 2: Private/Commercial Insurance Invoicing (including Medicare HMOs and

Medicaid HMOs). Category 3: Self-Payer Invoicing. Category 4: Self-Payer Invoicing and Financial Assistance Fee Reduction Review Services. Category 5: Litigation services.

c. The pricing proposal shall be subject to the following conditions: i. The Fire Department estimates for all seven (7) years are predicated on Fiscal Year

’07 collected revenue, with the exception of the financial assistance fee reduction revenue. (Note: The financial assistance fee reduction program has commenced in FY 08, therefore the revenue is only a projected estimate).

ii. The fee for the Contractor’s services shall be contingent upon actual collection. iii. Compensation for the duration of the agreement, shall be a fixed percentage of the

collections, predicated upon the Year 2007 ambulance transport rates, as follows:

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iv. The fixed fee percentage of the revenue collected for Category 1, Medicare invoicing,

shall not exceed any of the fixed fee percentages for the other categories of invoicing and collection services, individually or as a whole.

v. The fixed fee percentage of the revenue collected for Category 2, Private/Insurance

Invoicing (including Medicare HMOs and Medicaid HMOs), shall not exceed any of the fixed fee percentages for the other categories of invoicing and collection services, with the exception of Category 1, Medicare invoicing, individually or as a whole.

vi. The fixed fee percentage of revenue collected for Categories 1, 2, 3, and 4 shall

include all invoicing, collection, and legal services, with the exception of litigation services, which shall be priced separately. Category 4 shall also include financial assistance fee reduction review services, as applicable.

vii. The fixed fee percentage of revenue collected for Category 5 shall include all

litigation services.

d. The fixed fees shall be fully burdened and shall include but not be limited to all invoicing services, correspondence and dunning service, customer service inquiry services including telephone and web site inquiry (if applicable), database generation, reporting, training, compliance, auditing, postage (except for pre-paid envelopes), and collection and litigation services. The fully burdened fees shall include all labor, material, equipment, overhead, expenses, and profit necessary to complete the services pursuant to the terms of the subsequent Agreement.

e. The prices shall remain fixed for the duration of the contract and shall not be subject to any

additions, mark-ups, percentage multipliers, or cost of living increases. f. The Fire Department reserves the right to change the provisions or requirements of the Medical

Invoicing Compliance Program to comply with changes in the Federal programs, insurance requirements, or to protect against fraud and abuse, without any additional charges or fees.

g. The FDNY shall notify the Contractor of payments received, and shall pay the Contractor the

contractual rate for all such payments collected by the City provided that i) such payments were collected as a result of the Contractor’s actual invoicing and collection efforts, ii) the file was not recalled by the FDNY or the Law Department, or iii) the file was not returned by the Contractor to the FDNY prior to receipt of the payment. Such payments shall be presumed to be the result of the Contractor’s actual invoicing or collection efforts if the Contractor has issued an invoice, performed collection services, otherwise communicated with the debtor, or taken any litigation

BLS $475 ALS1 $600 ALS2 $700 Oxygen $50 Loaded Mileage

$7 per mile

36

action, within one hundred eighty (180) days prior to receipt of the payment, unless a revised schedule is mutually agreed upon by FDNY and the Contractor.

h. All funds are to be directly remitted to the Fire Department managed lockbox. In the event that

the payer shall inadvertently send the payment to the Contractor, then the Contractor shall deposit any monies collected on the assigned claims and judgments into a City account in a depository designated by the FDNY no later than one (1) business day following the date of such receipt; secure a receipted deposit slip from the depository; and immediately mail or deliver by hand the receipted deposit slip to the FDNY.

i. The FDNY shall reimburse the Contractor for all FDNY approved reasonable and necessary out-

of-pocket disbursements at cost without mark-up for process server fees, sheriff or marshal fees, court costs, or filing fees incurred in the litigation efforts. The aforementioned fees and costs shall be advanced by the Contractor. Under present law, affirmative actions and proceedings to collect on the claims of the City commenced in the New York Civil Court and New York State Supreme Court within the counties of New York are exempt from court fees and from certain county clerk’s fees. If such exemptions do not apply, the Contractor shall be reimbursed for the court and county clerk costs and fees. In the event the Contractor is informed that such exemptions do not apply, the Contractor will immediately notify and obtain consent of the FDNY before incurring such costs. No other costs or expenses will be reimbursed. The FDNY will not reimburse the Contractor for any costs incurred after a case has been recalled. The Contractor shall invoice the FDNY for fees and disbursements on a monthly basis. No fees shall be due on any case after it has been recalled by the FDNY or NYC Law Department except for fees earned prior to the notice to return a case.

B. Proposal Package Contents Checklist

The technical proposal and the price proposal shall be submitted in separate sealed envelopes as follows:

1. Technical Proposal:

a. Provide one (1) double-sided original, fifteen (15) double-sided copies, and two (2) CD-ROM electronic copies, in a sealed envelope clearly marked as:

Technical Proposal For the Provision of Ambulance Transport Invoicing, Collection and Litigation Services PIN 057070002577

b. The technical proposal submission package shall include: i. Proposal Cover Letter – Attachment A

ii. Technical Proposal

iii. Acknowledgement of Addenda – Attachment C

iv. Affirmation of Taxes Paid – Attachment D

2. Price Proposal

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a. Provide one (1) double-sided original, two (2) double-sided copies, and two (2) CD-ROM

electronic copies, in a sealed envelope clearly marked as:

Price Proposal For the Provision of Ambulance Transport Invoicing, Collection and Litigation Services PIN 057070002577

b. The price proposal submission package shall include:

i. Price Proposal Form – Attachment B

C. Proposal Delivery

1. Each proposal package must be received by January 8, 2008 no later than 4:00 PM at the following address:

Fire Department of the City of New York 9 MetroTech Center, 5W-12K Brooklyn, N.Y., 11201 Attention: Joan Lipton Contracting Officer

2. To prevent opening by unauthorized individuals, the package shall be identified as:

Proposal for Ambulance Transport Invoicing, Collections and Litigation Services – Confidential Information.

3. All proposals received in Room 5W-12-K will be time stamped and issued a receipt by the Contract Development Unit. Only Contract Development Unit receipts and time stamps will be accepted as proof of delivery; U.S. mail or messenger delivery receipts will not be accepted. A copy of the Contract Development Unit receipt will be attached to the proposal package and a duplicate provided to the messenger, if hand delivered.

4. The proposer is responsible for timely delivery of the proposal package to Room 5W-12-K. The Fire

Department is not responsible for any delays in delivery of the proposal. This includes, but is not limited to, delays due to outside mail, delivery, and messenger services; internal security delays; transportation delays; or delays due to Fire Department internal mail distribution services.

5. Proposers are advised that on occasion security delays at the building entrance can exceed one (1)

hour. Proposers delivering the proposals shall be in possession of valid government issued identification card that may be retained at the security desk until the proposer exits the building. Large packages that cannot easily fit through the security desk X-Ray scanner must be delivered through the loading platform adjacent to the mailroom (located next to the Flatbush Avenue entrance).

6. Proposers utilizing overnight delivery services should note that packages are delivered directly to the

Fire Department mailroom for distribution. Packages that are received in the mailroom in the late

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afternoon may not be distributed until the following day; therefore, if overnight services are utilized, proposers should allow at least two (2) business days for delivery.

7. Any proposal received in Room 5W-12-K of the Contracts Development Unit after the time and date

set for receipt of proposals is late and may be accepted only in the manner set forth in Section 3-03(f)(5) of the Procurement Policy Board Rules.

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SECTION V – PROPOSAL EVALUATION AND CONTRACT AWARD PROCEDURES

A. Selection Process

All proposals accepted by the Fire Department will be reviewed to determine whether they are responsive or non-responsive to the requisites of this RFP. Proposals that are determined to be non-responsive will be rejected. The Fire Department’s Evaluation Committee will evaluate and rate all remaining proposals based on the Evaluation Criteria prescribed below. The Fire Department reserves the right to conduct site visits and/or interviews and/or to request that proposers make presentations and/or demonstrations, as the Agency deems applicable and appropriate. Although discussions may be conducted with proposers submitting acceptable proposals, the Agency reserves the right to award contracts on the basis of initial proposals received, without discussions; therefore, the proposer’s initial proposal should contain its best technical and price terms. Evaluation of the technical proposals shall be based on a combination of the responsiveness of the proposal, acceptability of the proposed system, and the qualifications of the proposer as outlined below: 1. A proposal shall be deemed responsive only if all of the requirements of the RFP have been met. 2. The proposer must demonstrate satisfactory financial resources, stability, and project qualifications.

B. Proposal Evaluation Criteria

1. The criteria and the relative weight of each that will be utilized to evaluate proposals are:

Criteria Weight a. The quantity and quality of the Proposer’s successful relevant

experience providing ambulance transport invoicing and collection services.

50

b. Demonstrated level of organizational capability.

20

c. A Proposer’s demonstrated quality of proposed approach and methodology for ambulance debt invoicing and collections services.

30

3. After completion of the technical evaluations, the Evaluation Committee may require oral

presentations from qualified proposers for further evaluation.

a. At the sole option of the FDNY and if the evaluation committee deems it necessary, respondents will be required to present a 60 minute overview of their solution at Headquarters.

b. The oral presentation shall be followed by a question and answer session. A total maximum of 90 minutes in duration will be set-aside for each oral session.

c. Oral and/or Visual presentations shall not include any new information that is not included in the

written proposal. The purpose of the oral/visual presentation shall be solely to clarify the information contained in the written proposal.

40

4. As a result of the oral interview, the Evaluation Committee may re-assess its initial evaluation of the technical proposals based on an assessment of:

a. How well the total proposal meets the FDNY requirements. b. The knowledge of the Contractor’s representatives about ambulance transport invoicing and

collection services for the FDNY. c. The quality and knowledge of ambulance transport invoicing and collection services displayed

by the respondent.

NOTE: As further described below, it is important that no price information be disclosed in the Technical Proposal or the Live Demonstration. In evaluating the proposals, the Fire Department will rank technically viable proposals by the price per technical point methodology. The Fire Department will divide the proposal price by the average technical score to produce a price per technical point for each vendor. This will produce a representation of the price of the technical quality in terms of dollars. Respondents that disclose any price information (other than in the price proposal) may be declared non-responsive to this solicitation. Respondents shall be solely held responsible for ensuring that the price proposal information is contained in a separate sealed envelope and that no price information is disclosed to any City individual during the Demonstration process.

C. Basis for Contract Award

A contract will be awarded to the responsible proposer whose proposal is determined to be the most advantageous to the City, taking into consideration the price and such other factors or criteria which are set forth in this RFP. Contract award shall be subject to the timely completion of contract negotiations between the Agency and the selected proposer.

D. Contract Negotiations

The selected proposer will be invited to negotiate a contract with the City. The contents of the selected proposal, the General Provisions for Service Contracts, together with the RFP and any formal questions and answers generated during the proposal process, will be incorporated with and made part of the final contract as developed by the Fire Department. Should negotiations fail to result in a signed contract within thirty (30) days, the Fire Department reserves the right to terminate negotiations and select the proposer whose proposal is determined to be the next most advantageous to the City. The successful Contractor shall not disclose nor use any information contained in or received about this RFP or resulting contract without approval of the ACCO.

E . VENDEX and Supply and Services Information

VENDEX Business Entity and Principal Questionnaires and the Supply and Service Employment Report shall be submitted by the successful Contractor when notified and prior to registration.

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SECTION VI – GENERAL INFORMATION TO PROPOSERS A. Complaints. The New York City Comptroller is charged with the audit of contracts in New York City. Any proposer who believes that there has been unfairness, favoritism or impropriety in the proposal process should inform the Comptroller, Office of Contract Administration, 1 Centre Street, Room 1005, New York, NY 10007; the telephone number is (212) 669-2323. In addition, the New York City Department of Investigation should be informed of such complaints at its Investigations Division, 80 Maiden Lane, New York, NY 10038; the telephone number is (212) 825-5959. B. Applicable Laws. This Request for Proposals and the resulting contract award(s), if any, unless otherwise stated, are subject to all applicable provisions of New York State Law, the New York City Administrative Code, New York City Charter and New York City Procurement Policy Board (PPB) Rules. A copy of the PPB Rules may be obtained by contacting the PPB at (212) 788-0010.

C. General Contract Provisions. Contracts shall be subject to New York City’s general contract provisions, in substantially the form that they appear in “Appendix A—General Provisions Governing Contracts for Consultants, Professional and Technical Services” or, if the Agency utilizes other than the formal Appendix A, in substantially the form that they appear in the Agency’s general contract provisions. A copy of the applicable document is available through the Authorized Agency Contact Person. D. Contract Award. Contract award is subject to each of the following applicable conditions and any others that may apply: New York City Fair Share Criteria; New York City MacBride Principles Law; submission by the proposer of the New York City Department of Small Business Services/Division of Labor Services Employment Report and certification by that office; submission by the proposer of the requisite VENDEX Questionnaires/Certificates of No Change; and review of the information contained therein by the New York City Department of Investigation; all other required oversight approvals; applicable provisions of federal, state and local laws and executive orders requiring affirmative action and equal employment opportunity; and Section 6-108.1 of the New York City Administrative Code relating to the Local Based Enterprises program and its implementation rules. E. Proposer Appeal Rights. Pursuant to New York City’s Procurement Policy Board Rules, proposers have the right to appeal Agency non-responsiveness determinations and Agency non-responsibility determinations and to protest an Agency’s determination regarding the solicitation or award of a contract. F. Multi-Year Contracts. Multi-year contracts are subject to modification or cancellation if adequate funds are not appropriated to the Agency to support continuation of performance in any City fiscal year succeeding the first fiscal year and/or if the contractor’s performance is not satisfactory. The Agency will notify the contractor as soon as is practicable that the funds are, or are not, available for the continuation of the multi-year contract for each succeeding City fiscal year. In the event of cancellation, the contractor will be reimbursed for those costs, if any, which are so provided for in the contract. G. Prompt Payment Policy. Pursuant to the New York City’s Procurement Policy Board Rules, it is the policy of the City to process contract payments efficiently and expeditiously. H. Prices Irrevocable. Prices proposed by the proposer shall be irrevocable until contract award, unless the proposal is withdrawn. Proposals may only be withdrawn by submitting a written request to the Agency prior to contract award but after the expiration of 90 days after the opening of proposals. This shall not limit the discretion of the Agency to request proposers to revise proposed prices through the submission of best and final offers and/or the conduct of negotiations. I. Confidential, Proprietary Information or Trade Secrets. Proposers should give specific attention to the identification of those portions of their proposals that they deem to be confidential, proprietary information or trade secrets and provide any justification of why such materials, upon request, should not be disclosed by the City. Such information must be easily separable from the non-confidential sections of the proposal. All information not so identified may be disclosed by the City. J. RFP Postponement/Cancellation. The Agency reserves the right to postpone or cancel this RFP, in whole or in part, and to reject all proposals. K. Proposer Costs. Proposers will not be reimbursed for any costs incurred to prepare proposals. L. Charter Section 312(a) Certification. The Agency has determined that the contract(s) to be awarded through this Request for Proposals will not directly result in the displacement of any New York City employee. Signature on File__________________________________________ ___________________ [Commissioner] [Agency Chief Contracting Officer] Date

11/15/2007 42

ATTACHMENT A - PROPOSAL COVER LETTER RFP TITLE: AMBULANCE TRANSPORT INVOICING, COLLECTION, AND LITIGATION

SERVICES PIN #: 057070002577 Proposer: Name: _____________________________________________________________ Address: _____________________________________________________________

_____________________________________________________________ Tax Identification #: _________________________________________________ Proposer’s Contact Person: Name: _____________________________________________________________ Title: _____________________________________________________________ Telephone #: _____________________ Email: _______________________________ Proposer’s Authorized Representative: This is to certify that this proposal is a contractor offer. Name: __________________________________________________________ Title: ___________________________________________________________ Signature: ___________________________________________________ Date: ___________________________________ Is the response printed on both sides, on recycled paper containing the minimum percentage of recovered fiber content as requested by the City in the instructions to this solicitation?

Yes No

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ATTACHMENT B – PRICE PROPOSAL FORM

CONTRACTOR SERVICES FOR THE PROVISION OF AMBULANCE TRANSPORT INVOICING, COLLECTION, AND LITIGATION SERVICES

Vendor _____________

44

FIRE DEPARTMENT OF THE CITY OF NEW YORK Attachment B

PRICE SCHEDULE FOR AMBULANCE TRANSPORT INVOICING,

COLLECTION, AND LITIGATION SERVICES Pin No. 057070002577

YEAR 1

Category 1: MEDICARE INVOICING ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$25,000,000

0.___________

$ _____________

Category 2: PRIVATE/COMMERCIAL INSURANCE INVOICING

(including Medicare HMOs and Medicaid HMOs) ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$43,000,000

0.___________

$ _____________

Category 3: SELF PAYER INVOICING

ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$6,000,000

0.___________

$ _____________

Category 4: SELF PAYER INVOICING AND FINANCIAL ASSISTANCE FEE REDUCTION

REVIEW SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$2,000,000

0.___________

$ _____________

Vendor _____________

45

Category 5: LITIGATION SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$100,000

0.___________

$ _____________

LITIGATION EXPENSE (at Net Cost) = $5,000 TOTAL: YEAR 1 (Categories 1 + 2 + 3 + 4 + 5 + Litigation Expense) = $_________________ Note 1: The above estimates used for bid purposes. The Fire Department will not guarantee a minimum or maximum quantity of revenue. The pricing includes all services as stated within the RFP including but not limited to Section IV(A)(5) entitled “Price Proposal”. Note 2: The Fixed Fee Percentage is represented in terms of a decimal multiplier. For example, a 5% fee is a factor of 0.05, then the total price submitted would be calculated as follows: Revenue of $1,000,000 x 0.05 multiplier = $50,000 total price. SUBMITTED BY: _____________________________________________

NAME OF COMPANY PRINT NAME: _____________________________________________ SIGNATURE: _____________________________________________ DATE: _____________________________________________

Vendor _____________

46

FIRE DEPARTMENT OF THE CITY OF NEW YORK Attachment B

PRICE SCHEDULE FOR AMBULANCE TRANSPORT INVOICING,

COLLECTION, AND LITIGATION SERVICES Pin No. 057070002577

YEAR 2

Category 1: MEDICARE INVOICING ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$25,000,000

0.___________

$ _____________

Category 2: PRIVATE/COMMERCIAL INSURANCE INVOICING

(including Medicare HMOs and Medicaid HMOs) ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$43,000,000

0.___________

$ _____________

Category 3: SELF PAYER INVOICING

ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$6,000,000

0.___________

$ _____________

Category 4: SELF PAYER INVOICING AND FINANCIAL ASSISTANCE FEE REDUCTION

REVIEW SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$2,000,000

0.___________

$ _____________

Vendor _____________

47

Category 5: LITIGATION SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$100,000

0.___________

$ _____________

LITIGATION EXPENSE (at Net Cost) = $5,000 TOTAL: YEAR 2 (Categories 1 + 2 + 3 + 4 + 5 + Litigation Expense) = $_________________ Note 1: The above estimates used for bid purposes. The Fire Department will not guarantee a minimum or maximum quantity of revenue. The pricing includes all services as stated within the RFP including but not limited to Section IV(A)(5) entitled “Price Proposal”. Note 2: The Fixed Fee Percentage is represented in terms of a decimal multiplier. For example, a 5% fee is a factor of 0.05, then the total price submitted would be calculated as follows: Revenue of $1,000,000 x 0.05 multiplier = $50,000 total price. SUBMITTED BY: _____________________________________________

NAME OF COMPANY PRINT NAME: _____________________________________________ SIGNATURE: _____________________________________________ DATE: _____________________________________________

Vendor _____________

48

FIRE DEPARTMENT OF THE CITY OF NEW YORK Attachment B

PRICE SCHEDULE FOR AMBULANCE TRANSPORT INVOICING,

COLLECTION, AND LITIGATION SERVICES Pin No. 057070002577

YEAR 3

Category 1: MEDICARE INVOICING ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$25,000,000

0.___________

$ _____________

Category 2: PRIVATE/COMMERCIAL INSURANCE INVOICING

(including Medicare HMOs and Medicaid HMOs) ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$43,000,000

0.___________

$ _____________

Category 3: SELF PAYER INVOICING

ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$6,000,000

0.___________

$ _____________

Category 4: SELF PAYER INVOICING AND FINANCIAL ASSISTANCE FEE REDUCTION

REVIEW SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$2,000,000

0.___________

$ _____________

Vendor _____________

49

Category 5: LITIGATION SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$100,000

0.___________

$ _____________

LITIGATION EXPENSE (at Net Cost) = $5,000 TOTAL: YEAR 3 (Categories 1 + 2 + 3 + 4 + 5 + Litigation Expense) = $_________________ Note 1: The above estimates used for bid purposes. The Fire Department will not guarantee a minimum or maximum quantity of revenue. The pricing includes all services as stated within the RFP including but not limited to Section IV(A)(5) entitled “Price Proposal”. Note 2: The Fixed Fee Percentage is represented in terms of a decimal multiplier. For example, a 5% fee is a factor of 0.05, then the total price submitted would be calculated as follows: Revenue of $1,000,000 x 0.05 multiplier = $50,000 total price. SUBMITTED BY: _____________________________________________ NAME OF COMPANY PRINT NAME: _____________________________________________ SIGNATURE: _____________________________________________ DATE: _____________________________________________

Vendor _____________

50

FIRE DEPARTMENT OF THE CITY OF NEW YORK Attachment B

PRICE SCHEDULE FOR AMBULANCE TRANSPORT INVOICING,

COLLECTION, AND LITIGATION SERVICES Pin No. 057070002577

YEAR 4

Category 1: MEDICARE INVOICING ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$25,000,000

0.___________

$ _____________

Category 2: PRIVATE/COMMERCIAL INSURANCE INVOICING

(including Medicare HMOs and Medicaid HMOs) ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$43,000,000

0.___________

$ _____________

Category 3: SELF PAYER INVOICING

ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$6,000,000

0.___________

$ _____________

Category 4: SELF PAYER INVOICING AND FINANCIAL ASSISTANCE FEE REDUCTION

REVIEW SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$2,000,000

0.___________

$ _____________

Vendor _____________

51

Category 5: LITIGATION SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$100,000

0.___________

$ _____________

LITIGATION EXPENSE (at Net Cost) = $5,000 TOTAL: YEAR 4 (Categories 1 + 2 + 3 + 4 + 5 + Litigation Expense) = $_________________ Note 1: The above estimates used for bid purposes. The Fire Department will not guarantee a minimum or maximum quantity of revenue. The pricing includes all services as stated within the RFP including but not limited to Section IV(A)(5) entitled “Price Proposal”. Note 2: The Fixed Fee Percentage is represented in terms of a decimal multiplier. For example, a 5% fee is a factor of 0.05, then the total price submitted would be calculated as follows: Revenue of $1,000,000 x 0.05 multiplier = $50,000 total price. SUBMITTED BY: _____________________________________________

NAME OF COMPANY PRINT NAME: _____________________________________________ SIGNATURE: _____________________________________________ DATE: _____________________________________________

Vendor _____________

52

FIRE DEPARTMENT OF THE CITY OF NEW YORK Attachment B

PRICE SCHEDULE FOR AMBULANCE TRANSPORT INVOICING,

COLLECTION, AND LITIGATION SERVICES Pin No. 057070002577

YEAR 5

Category 1: MEDICARE INVOICING ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$25,000,000

0.___________

$ _____________

Category 2: PRIVATE/COMMERCIAL INSURANCE INVOICING

(including Medicare HMOs and Medicaid HMOs) ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$43,000,000

0.___________

$ _____________

Category 3: SELF PAYER INVOICING

ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$6,000,000

0.___________

$ _____________

Category 4: SELF PAYER INVOICING AND FINANCIAL ASSISTANCE FEE REDUCTION

REVIEW SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$2,000,000

0.___________

$ _____________

Vendor _____________

53

Category 5: LITIGATION SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$100,000

0.___________

$ _____________

LITIGATION EXPENSE (at Net Cost) = $5,000 TOTAL: YEAR 5 (Categories 1 + 2 + 3 + 4 + 5 + Litigation Expense) = $_________________ Note 1: The above estimates used for bid purposes. The Fire Department will not guarantee a minimum or maximum quantity of revenue. The pricing includes all services as stated within the RFP including but not limited to Section IV(A)(5) entitled “Price Proposal”. Note 2: The Fixed Fee Percentage is represented in terms of a decimal multiplier. For example, a 5% fee is a factor of 0.05, then the total price submitted would be calculated as follows: Revenue of $1,000,000 x 0.05 multiplier = $50,000 total price. SUBMITTED BY: _____________________________________________

NAME OF COMPANY PRINT NAME: _____________________________________________ SIGNATURE: _____________________________________________ DATE: _____________________________________________

Vendor _____________

54

FIRE DEPARTMENT OF THE CITY OF NEW YORK

Attachment B

PRICE SCHEDULE FOR AMBULANCE TRANSPORT INVOICING, COLLECTION, AND LITIGATION SERVICES

Pin No. 057070002577 Optional Year 6

Category 1: MEDICARE INVOICING ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$25,000,000

0.___________

$ _____________

Category 2: PRIVATE/COMMERCIAL INSURANCE INVOICING

(including Medicare HMOs and Medicaid HMOs) ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$43,000,000

0.___________

$ _____________

Category 3: SELF PAYER INVOICING

ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$6,000,000

0.___________

$ _____________

Category 4: SELF PAYER INVOICING AND FINANCIAL ASSISTANCE FEE REDUCTION

REVIEW SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$2,000,000

0.___________

$ _____________

Vendor _____________

55

Category 5: LITIGATION SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$100,000

0.___________

$ _____________

LITIGATION EXPENSE (at Net Cost) = $5,000 TOTAL: YEAR 6 (Categories 1 + 2 + 3 + 4 + 5 + Litigation Expense) = $_________________ Note 1: The above estimates used for bid purposes. The Fire Department will not guarantee a minimum or maximum quantity of revenue. The pricing includes all services as stated within the RFP including but not limited to Section IV(A)(5) entitled “Price Proposal”. Note 2: The Fixed Fee Percentage is represented in terms of a decimal multiplier. For example, a 5% fee is a factor of 0.05, then the total price submitted would be calculated as follows: Revenue of $1,000,000 x 0.05 multiplier = $50,000 total price. SUBMITTED BY: _____________________________________________

NAME OF COMPANY PRINT NAME: _____________________________________________ SIGNATURE: _____________________________________________ DATE: _____________________________________________

Vendor _____________

56

FIRE DEPARTMENT OF THE CITY OF NEW YORK Attachment B

PRICE SCHEDULE FOR AMBULANCE TRANSPORT INVOICING,

COLLECTION, AND LITIGATION SERVICES Pin No. 057070002577

Optional Year 7

Category 1: MEDICARE INVOICING ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$25,000,000

0.___________

$ _____________

Category 2: PRIVATE/COMMERCIAL INSURANCE INVOICING

(including Medicare HMOs and Medicaid HMOs) ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$43,000,000

0.___________

$ _____________

Category 3: SELF PAYER INVOICING

ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$6,000,000

0.___________

$ _____________

Category 4: SELF PAYER INVOICING AND FINANCIAL ASSISTANCE FEE REDUCTION

REVIEW SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$2,000,000

0.___________

$ _____________

Vendor _____________

57

Category 5: LITIGATION SERVICES ESTIMATED ANNUAL

REVENUE RECEIPTS Note 1

(A)

FIXED FEE AS A PERCENTAGE OF REVENUE

(IN POINTS)Note 2 (B)

TOTAL PRICE (Estimated Annual Revenue x

Fixed Fee) (A) X (B) = (C)

$100,000

0.___________

$ _____________

LITIGATION EXPENSE (at Net Cost) = $5,000 TOTAL: YEAR 7 (Categories 1 + 2 + 3 + 4 + 5 + Litigation Expense) = $_________________ Total Years 1 + 2 + 3 + 4 + 5 …………………… = $__________________ Total Optional Years 6 +7 ……………………. = $__________________ Total Proposal ( Years 1-7) …………………… = $__________________ Note 1: The above estimates used for bid purposes. The Fire Department will not guarantee a minimum or maximum quantity of revenue. The pricing includes all services as stated within the RFP including but not limited to Section IV(A)(5) entitled “Price Proposal”. Note 2: The Fixed Fee Percentage is represented in terms of a decimal multiplier. For example, a 5% fee is a factor of 0.05, then the total price submitted would be calculated as follows: Revenue of $1,000,000 x 0.05 multiplier = $50,000 total price. SUBMITTED BY: _____________________________________________

NAME OF COMPANY PRINT NAME: _____________________________________________ SIGNATURE: _____________________________________________ DATE: _____________________________________________

58

ATTACHMENT C - ACKNOWLEDGEMENT OF ADDENDA

RFP TITLE PIN # AMBULANCE TRANSPORT INVOICING, COLLECTION AND LITIGATION SERVICES 057070002577

INSTRUCTIONS: COMPLETE PART I, OR PART II WHICH EVER IS APPLICABLE

PART 1: LISTED BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN

CONNECTION WITH THIS RFP. ADDENDUM #1, DATED , 20 ADDENDUM #2, DATED , 20 ADDENDUM #3, DATED , 20 ADDENDUM #4, DATED , 20 ADDENDUM #5, DATED , 20 ADDENDUM #6, DATED , 20 ADDENDUM #7, DATED , 20 ADDENDUM #8, DATED , 20 ADDENDUM #9, DATED , 20 ADDENDUM #10, DATED , 20 PART II: NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS RFP. PROPOSER (NAME) PROPOSER (SIGNATURE) __________ PRINT NAME___________________________________________________________________________ TITLE_____________________________________________ DATE________________________________

Page 59

ATTACHMENT D - AFFIRMATION OF TAXES PAID The undersigned proposer or bidder affirms and declares that said proposer or bidder is not in arrears to the City of New York upon debt, contract or taxes and is not a defaulter, as surety or otherwise, upon obligation to the City of New York, and has not been declared not responsible, or disqualified, by any agency of the City of New York, nor is there any proceeding pending relating to the responsibility or qualification of the proposer or bidder to receive public contracts except ________________________________________________________________ Full name of Proposer or Bidder ______________________________________ Address ________________________________________________________ City __________________ State ____________________ Zip Code _________ CHECK ONE BOX AND INCLUDE APPROPRIATE NUMBER: A - Individual or Sole proprietorship* SOCIAL SECURITY NUMBER ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ B - Partnership, Joint Venture or other unincorporated organization EMPLOYER IDENTIFICATION ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ C - Corporation EMPLOYER IDENTIFICATION ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ By ________________________________________________ SIGNATURE _________________________________________________ TITLE If a corporation place seal here Must be signed by an officer or duly authorized representative. • Under the Federal Privacy Act the providing of Social Security Numbers by bidders on City contracts is

voluntary. Failure to provide a Social Security Number will not result in a bidder's disqualification. Social Security Numbers will be used to identify bidders, proposers or vendors to ensure their compliance with laws, to assist the City in enforcement of laws as well as to provide the City, a means of identifying of business which seek City contracts.

Page 60

SCHEDULE OF CONTRACT REQUIREMENTS

SCHEDULE A

REFERENCE ITEM REQUIREMENTS PART I General Information Bid Security Not Required for Bidders ARTICLE 4 Agreement Term of Contract Five (5) Consecutive Years with option to renew for

2 years ARTICLE 7 Agreement Insurance Required Amounts (a) Worker’s Compensation Statutory Employer’s Liability per accident $1,000,000.00 (b) Comprehensive General Liability Broad form combined single limit per accident for bodily Injury, personal injury, and property damage

$2,000,000.00

(c) Automobile $1,000,000.00 ALL INSURANCE FORMS SHALL NAME THE NYC FIRE DEPARTMENT AS THE CERTIFICATE HOLDER AND THE CITY OF NEW YORK AS AN ADDITIONAL INSURED. Please use the description box in the insurance form when naming the City of New York as an additional insured. See attached sample form. ARTICLE 7.4 Agreement Liquidated See page 27, Section III (D) Damages (Liquidated Damages) ARTICLE 7.5 Agreement Deposited as Guarantee Performance Bonds/ Payment Bond: Applicable Not Applicable ARTICLE 11.7 Agreement Sub-contracting

Not to exceed _0_ % of

Contract price

61

Appendix A New York City General Terms and Conditions

THIS AGREEMENT, made and entered into this _________ day of ________________in the year two thousand and ______________ by and between the City of New York, party of the first part, by the Commissioner of the Fire Department of the City of New York, and __________________________________________________Contractor, party of the second part. That the parties hereto in consideration of the mutual agreements herein contained, hereby agree as follows:

ARTICLE 1 - THE CONTRACT Except for titles, subtitles, headings, running headlines, tables of contents and indices (all of which are printed herein merely for convenience) the following, except for such portions thereof as may be specifically excluded, shall be deemed to be part of this contract. 1. Information for Bidders; 2. The Advertisement and Proposal for Bids 3. The Bid; 4. The Agreement; 5. The Specification; 6. The Contract Drawings; 7. All Addenda issued by the Commissioner prior to the receipt of bids; 8. All provisions required by law to be inserted in this contract, whether actually inserted or not; 9. The Notice of Award; 10. Payment and Performance Bonds; 11. Notice to Proceed with the work.

ARTICLE 2 - DEFINITIONS 1. "Addendum" or "Addenda" shall mean the additional contract provisions issued in writing by the

Commissioner prior to the receipt of bids. 2. "Agency" shall mean a city, county, borough or other office, position, the Fire Department,

division, bureau, board of commission, or a corporation, institution or agency of government, the expenses of which are paid in whole or in part from the City treasury.

3. "City" shall mean the City of New York, party of the first part. 4. "City Holidays" shall include the following days: New Year's Day, Martin Luther King Day,

President's Day, George Washington's Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Election Day, Veteran's Day, Thanksgiving Day, and Christmas Day.

5. "Commissioner" shall mean the Commissioner of the Fire Department of the City of New York, or

his duly authorized representative designated in writing by the Commissioner. 6. "Comptroller" shall mean the Comptroller of the City of New York.

Page 62

7. "Contract" or "Contract Documents" shall mean each of the various parts of the contract referred to in Article I hereof, both as a whole and severally.

8. "Contractor" shall mean the party of the second part thereto, whether corporation, firm or

individual, or any combination thereof, and its, their or his successors, personal representatives, executors, administrators and assigns, and any person, form or corporation who or which shall at any time be submitted in the place of the party of the second part under this contract. The Contractor shall also be referred to as "it", whether such Contractor is an individual, partnership or corporation.

9. "Contract Drawings" shall mean only those drawings specifically entitled as such and listed in the

specifications or in any addendum, or any detailed drawings furnished by the Commissioner, pertaining or supplemental thereto.

10. "Contract Work" shall mean everything required to be furnished and done by the Contractor by

any one or more of the parts of the contract referred to I Article I hereof, except extra work as hereinafter defined; it being understood that, in case of any inconsistency in or between any part or parts of this contract, the Engineer shall determine which shall prevail.

11. "Department" shall mean the Fire Department of the City of New York acting by and through the

Commissioner thereof, or his duly authorized representative. 12. "Engineer" or "Architect" shall mean the person so designated in writing by the Commissioner to

act as such in relation to this contract, including a private Architect or Engineer as the case may be. 13. "Extra Work" shall mean work other than that required by the contract at the time of its execution. 14. "Final Acceptance" shall mean Final acceptance of the work by the Commissioner, as evidenced

by his signature upon his certificate of completion & acceptance file in the Office of the Comptroller. Such acceptance shall be deemed to have taken the place as of the date so states in such certificate.

15. "Law" or "Laws" shall mean the Constitution of the State of New York, the New York City

Charter, the New York City Administrative Code, a stature of the United States or of the State of New York, a local law of the City of New York, and any ordinance, rule or regulation having the force of law.

16. "Site" shall mean the area upon or I which the Contractor's operations are carried on, and such by

the Engineer. 17. "Specifications" shall mean all of the directions, requirements and standards of performance

applying to the work as hereinafter detailed and designated under specifications. 18. "The Work" shall mean everything required to be furnished and done by the Contractor under the

contract, and shall include both contract work and extra work. 19. “Agency Chief Contracting Officer” shall mean the position delegated authority by the Fire

Commissioner to organize and supervise the procurement activity of the Fire Department.

Page 63

ARTICLE 3 - SCOPE OF SERVICES The Contractor agrees to perform all the services described in the Specifications attached hereto.

ARTICLE 4 - PERIOD OF PERFORMANCE The period of performance of this contract shall be as shown in Schedule A, commencing of the date shown in the New York City Fire Department's order to commence work letter.

ARTICLE 5 - PAYMENT 1. The City agrees to pay and the Contractor agrees to accept, as full consideration for the complete

and satisfactory performance of the services required herein, the amount set forth in this bid.

Payment(s) shall be made within 30 days after the filing with the Comptroller of voucher(s) for such payment(s). The Commissioner shall file such voucher(s) with the Comptroller within 30 days after the receipt of invoices for such payment(s). In the event any items in the billing may be questioned or disputed by the Commissioner, these items may be deleted from the billing until their resolution and the remainder of the billing shall be processed with the above period(s).

2. The Contractor shall submit numbered invoices for payment in accordance with the payment

schedule established in Part III. Such invoices shall set forth the services for which payment is requested, and approval thereof by the Department shall be a prerequisite to payment. All payments shall be subject to such provisions for set off as may be set forth in this Agreement and in the Specifications attached hereto.

All invoices are to be mailed within three (3) weeks after services are performed to the following address: New York City Fire Department - Fiscal Services, Attn: payment Processing: P.O Box 025-374, Brooklyn, New York 11201-0014. In addition it is the responsibility of the Contractor to provide the Department with the total billings to date on the invoice.

3. Payments shall be made out of such monies as may be reserved by the Comptroller of the City of

New York for the purpose herein provided. 4. This contract and all payments hereunder shall be subject to audit by the New York City Fire

Department and post audit by the Comptroller of the City in accordance with the New York City Charter and Administrative Code.

PROMPT PAYMENT

The Prompt Payment provisions set forth in Section 4-06, of the Procurement Policy Board Rules in effect at the time of this solicitation will be applicable to payments made under this contract. The provisions require the payment to contractors of interest on payments made after the required payment date except as set forth in subdivisions c(3) and d(2), (3), (4), and (5) of Section 4-06 of the Rules. The Contractor must submit a proper invoice to receive payment, except where the contract provides that the contractor will be paid at predetermined intervals without having to submit any invoice for each

Page 64

scheduled payment. Determinations of interest due will be made in accordance with the provisions of Section 4-06 of the Procurement Policy Board Rules and General Municipal Law 3-a.

PAYMENT

Upon 50% expenditure of the contract, the Contractor must notify in writing the invoice contact person indicated below, within five (5) business days. In addition, the Contractor must indicate the amount of the Fire Department expenditures to date under this contract. This expenditure amount must include the amount requested on that particular invoice. Invoices must be sent in triplicate to:

NEW YORK CITY FIRE DEPARTMENT - FISCAL SERVICES ATTENTION: PAYMENT PROCESSING

P.O. BOX 025-374 BROOKLYN, NEW YORK 11201-0014

ARTICLE 6. LIABILITY OF CONTRACTOR

1. GENERAL LIABILITY

A. The Contractor shall be solely responsible for all physical injuries or death to its agents, servants,

or employees or to any other person and for all damage to any property sustained during its operations and work under this Agreement resulting from any act of omission or commission or error in judgment of any of its officers, trustees, employees, agents, servants, or independent contractors, and shall hold harmless and indemnify the City from liability upon any and all claims for damages on account of such injures or death to any such person or damages to property on account of any neglect, fault or default of the Contractor, its officers, trustees, employees, agents, servants, or independent contractors. The Contractor shall be solely responsible for the safety and protection of all of its employees whether due to the negligence, fault or default of the Contractor or not.

B. In the event that any claim is made or any action is brought against the City arising out of

negligent or careless acts of any employee of the Contractor, either within or without the scope of his employment, or arising out of the Contractor's negligent performance of this Agreement, then the City shall have the right to withhold further payments hereunder for the purpose of set-off, in sufficient sums to cover the said claim or action. The rights and remedies of the City provided for in this clause shall not be exclusive and are in addition to any other rights and remedies provided by law or this Agreement.

2. PROTECTION OF CITY PROPERTY

A. During performance and up to the date of final acceptance, the Contractor shall abide by the

Department security procedures in effect at the premises where the work is performed. The Contractor must take all reasonable precautions to protect the property of the Department and others from damage, loss or theft resulting from his of his subcontractor's operations under this contract. At a minimum the following security procedures shall be implemented in all Department facilities, and the Contractor shall be under an absolute obligation to abide by these procedures during performance and up to date of final acceptance:

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The Contractor shall notify the Commanding Officer, Housewatch or responsible Department employee when leaving the premises. In the event that Department employees are not present, the Contractor shall immediately call the Department Notification Desk advising that the premises will be vacated. The Contractor shall lock and secure the premises when Department employees are not present. The Contractor assumes the risk of, and shall be responsible for, any loss or damage to City property, including property and equipment leased by the City, used in the performance of the Agreement, and caused, either directly or indirectly, by the acts, conduct, omissions or lack of good faith of the Contractor, its officers, managerial personnel employees, any person, firm, company, agent or others engaged by the Contractor as expert, consultant, specialist or subcontractor hereunder.

B. In the event that any such City property is lost or damaged, except for normal wear and tear, or

to the extent that such property is consumed in the performance of this Agreement then the City shall have the right to withhold further payments hereunder for the purpose of set-off, in sufficient sums to cover such loss or damage.

C. The Contractor agrees to indemnify the City and hold it harmless from any suits,

liabilities, judgments, costs, and expenses, including attorney's fees due to any such loss or damage to any such City property described in sub-section A above.

D. The rights and remedies of the City provided herein shall not be exclusive and are in addition to

any other rights and remedies provided by law or by this Agreement.

3. INFRINGEMENTS

The Contractor shall be liable to the Department and hereby agrees to indemnify and hold the Department harmless for any damage or loss or expense sustained by the Department from any infringement by the Contractor of any copyright trademark or patent rights of design, systems, drawings, graphs, charts, specifications or printed matter furnished or used by the Contractor in the performance of the Agreement.

ARTICLE 7 - BONDS, INSURANCE AND LIQUIDATED DAMAGES 1. PERFORMANCE AND PAYMENT BONDS

The Contractor shall, prior to or at the time of execution of this contract deliver to the City a performance bond and a payment bond, if such bonds are required, having as surety thereunder such surety company or companies as approved by the Comptroller. Such bonds shall be in the amount and in the form prescribed herein.

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2. INSURANCE REQUIREMENTS

The Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Contractor, his agents, representatives, employees or subcontractors. The cost of such insurance shall be included in the Contractor's bid. The Contractor shall be solely responsible for payment of all premiums for insurance contributing to satisfaction of Schedule "A" requirements.

A. WORKERS COMPENSATION AND EMPLOYEES LIABILITY

i) Worker's Compensation limits as required by the Labor Code of the State of New York (including occupational disease) and including the Other State Endorsement.

ii) Employers Liability Insurance with limits of at least $1,000,000 per accidents.

The Contractor and each Subcontractor shall provide Workers' Compensation Insurance in accordance with the Laws of the State of New York, and the United States Longshoremens' and Harbor Workers' Act where applicable, on behalf of all employees providing services under this Contract.

a. Pursuant to Section 57 of the New York State Workers' Compensation Law, the

Contractor shall have submitted to the NYC Fire Department the following as proof of Workers' Compensation and disability benefits coverage prior to the execution of this Contract.

i. C-105.21 – Statement for the NYC Fire Department that a Business DOES NOT

require workers’ compensation and/or disability benefits coverage; or

ii. C-105.2 – Certificate of Workers’ Compensation Insurance (the business’ insurance carrier will send this form to the government entity upon the business’ request) Please Note: The State Insurance Fund provides its own version of this form, the U-26.3; or

iii. SI-12 – Certificate of Workers’ Compensation Self-Insurance or GSI-105.2 –

Certificate of Group Worker’s Compensation Self-Insurance.

b. Pursuant to the amended New York State Workers' Compensation Law Section 50 (2), all out-of-state Contractors with employees working in New York State are required to carry a full, statutory New York State workers' compensation insurance policy. The out-of-state Contractor shall have statutory NYS workers' compensation coverage when New York is listed in Item 3A on the Information Page of the employer's workers' compensation insurance policy.

(Please Note: ACCORD forms are NOT acceptable proof of workers’ compensation coverage.)

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B. COMMERCIAL GENERAL LIABILITY ("CGL") with a combined single limit for Bodily Injury, Personal injury and Property Damage of a least $1,000,000 per accident and a minimum aggregate of $2,000,000. The limit may be provided through a combination of primary and umbrella/ excess liability policies.

Coverage shall include the BROAD FORM COMPREHENSIVE LIABILITY ENDORSEMENT (GL-0404) (of the ISO or an equivalent). Coverage shall provide and encompass at least the following: i) X, C, and U (explosion, collapse, and underground) hazards, where applicable; ii) Independent Contractors; iii) Blanket written contractual liability covering all indemnity agreements and

indemnification; iv) Products liability and completed operations, with the provision that coverage shall extend

for a period of at least 12 (twelve) months from Project completion; v) CGL coverage written on an occurrence form; vi) Endorsement naming the City, its officers, officials and employees as an additional

insured, and vii) Waiver of Subrogation.

The policy shall contain no exclusions or endorsements, which are not acceptable to the City and shall be of a form and by an insurance company acceptable to the City.

The Contractor, at its option, may carry, in lieu of liability insurance provided above, commercial general liability insurance with a limit per accident equal to the amount required in Schedule "A" provided that attorneys fees, costs and disbursements are not included as part of such limits.

C. If required, Comprehensive Automobile Liability (including all owned, leased, hired and non-

owned automobiles) with a combined single limit for Bodily Injury and Property Damage of at least $1,000,000 per accident. The limit may be provided through a combination of primary and umbrella/excess liability policies.

D. Umbrella and/or excess liability policies used to comply with CGL and/or Auto Liability limits

shown above shall be warranted to be in excess of limits provided by primary CGL, Auto and Employers Liability.

E. The Contractor shall furnish the City with Certificates of Insurance effecting coverage required

by this clause. The Certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The Fire Department reserves the right to obtain complete certified copies of all required insurance policies at any time. The Certificates must provide for 30 days written notice prior to cancellation, non-renewal or material modification.

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3. COMPREHENSIVE GENERAL, AUTOMOBILE AND EMPLOYERS LIABILITY

A. All insurance carriers must:

i.) be licensed in the State where the Project is located and

ii.) All required insurance policies shall be maintained with companies that may lawfully issue the required policy and have an A.M. Best rating of at least A-7 or a Standard and Poor’s rating of at least AA, unless prior written approval is obtained from the Mayor’s Office of Operations.

B. The Contractor shall secure, pay for, and maintain Property Insurance necessary for

protection against loss of owned, borrowed, or rented capital equipment and tools, including any tools owned by employees and any tools, equipment, staging, towers, and forms owned, borrowed or rented by the Contractor.

The requirement to secure and maintain such insurance is solely for the benefit of the

Contractor. Failure of the Contractor to secure such insurance or to maintain adequate levels of coverage shall not obligate the City, or its agents and employees for any losses, and the City and its agents and employees shall have no such liability. The insurance policy for such Contractor shall include a waiver of subrogation as follows:

"It is agreed that in no event shall this insurance company have any right of recovery against

the City".

C. Any deductibles or self-insured retention must be declared to and approved by the Fire Department. At the option of the Fire Department, either: the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the Fire Department, its officers, officials and employees; or the Contractor shall procure a bond guaranteeing payment of losses and related investigation, claim administration and defense expenses.

D. The City, its officers, officials and employees are to be covered as insured as respects:

liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, leased or used by the Contractor; or automobiles owned, leased, hired, or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its officers, officials and employees.

E. The Contractor's insurance coverage shall be primary insurance as respects the City, its

officers, officials, and employees. Any other insurance or self-insurance maintained by the Fire Department, its officers, officials, and employees shall be in excess of and not contribute to the Contractor's insurance.

F. Any failure to comply with reporting provisions of the policies shall not affect coverage

provided to the Fire Department, its officers, officials, and employees.

G. The Contractor's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the limits of the insurer's liability.

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H. Should the Contractor engage a subcontractor, the same conditions applicable to the

Contractor under these Insurance Requirements shall apply to each subcontractor.

I. The Contractor shall notify the City of any damage to the work or any accidents on the site within twenty-four hours of the occurrence. The twenty-four hour notice will presumably be oral notice.

J. NOTICE OF ACCIDENT OR CLAIM - Notice of accident shall be given to the

Company within one hundred twenty (120) days after such claim shall have been filed with the Comptroller of the City of New York. Notice to the Company by either party shall be deemed sufficient notice under the policy.

K. All policies purporting to insure the City of New York must explicitly name the City, its

officers, officials, and employees as the insured, and not only the Agency.

L. A provision in the insurance policy that notice of a job site accident by the Contractor to the municipality constitutes notice by the municipality to the insurer.

M. THE PRESENCE OF INSPECTORS OR OTHER EMPLOYEES OF THE

INSURED on the site of the work performed under the contract with the Insured shall not invalidate the policy of insurance.

N. This policy shall not be cancelled, terminated, modified or changed by the Insurance

Company unless at least thirty (30) Days prior written notice is sent to the Named Insured by Certified Mail and also sent by Registered Mail to both the Commissioner and to Comptroller's Office, attn: Office of Contract Administration, Municipal Building, Room 835, New York, New York 10007; and VIOLATION OF ANY OF THE TERMS of any policy issued by the Insurance Company to the Contractor shall not invalidate this policy.

O. In the event that the Contractor is self-insured pursuant to this Article 7, the Contractor

shall be excused from its obligation to purchase insurance pursuant to Article 7 (2) provided that the following conditions are met:

i. The Contractor, through its self-insurance program, must provide the Department

and the City of New York with all of the protection that would have been provided by a commercial insurance company. Accordingly, the Contactor, through its self-insurance program, shall protect the Department and the City of New York against any and all claims, loss or damage, whether in contract or tort, including claims for injuries to, or death of persons, or damage to property, whether such injuries, death or damages be attributable to the negligence or any other acts of the Contract or, its employees, or otherwise. This protection shall include both a duty to defend the Department and the City of New York in all actions alleging, in all or part, such injuries or damage and a duty to indemnify the Department and the City of New York for such claims up to One Million (1,000,000) Dollars per occurrence;

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ii. The Contractor provides the Department and the City of New York with the name and address of the office or official of the self-insurance program (1) to whom notices are to be sent and (2) who is responsible for satisfying the obligations set forth in subparagraph O(i) above, including those relating to defense and indemnification of the Department and the City of New York in all such actions; and

iii. The Contractor is fully liable to the Department and the City of New York for

satisfying the obligations set forth in subparagraph O(i) above in the event the Contractor’s self-insurance program fails to satisfy any such obligations promptly upon demand.

4. LIQUIDATED DAMAGES

If provided for in Schedule A liquidated damages for failure to perform the work in compliance with the terms of this Agreement shall be assessed by the Department against the Contractor in accordance with said provisions. In view of the difficulty of accurately ascertaining the loss which the City will suffer because of the failure to perform and/or complete the work of this contract, liquidated damages, in the amount set forth in Schedule A, are fixed and agreed upon as such liquidated damages and not as a penalty. The Comptroller will deduct and retain out of the monies, which may become due under this contract the amount of any such liquidated damages. In case the amount of liquidated damages which may become due are less than the damages suffered by the City, the Contractor will be liable to pay the difference upon demand by the Comptroller.

5. MAINTENANCE AND GUARANTY

The Contractor must promptly repair, replace, restore or rebuild, as the Commissioner may determine, any finished work in which defects of materials or workmanship may appear or to which damage may occur because of such defects, during the one-year period subsequent to the date of final acceptance, except where other periods of maintenance and guarantee are provided for.

As security for the faithful performance by the Contractor of his obligations hereunder, the Comptroller shall retain from the final payment hereunder the sum fixed in the Specifications. If the Contractor has faithfully performed all his obligations hereunder the Commissioner shall so certify to the Comptroller within five (5) days after the expiration of one (1) year from the date of completion and acceptance of the work or with five (5) days after the expiration of the guarantee period fixed in the specifications. The sum shall be repaid to the Contractor without interest within thirty (30) days after certification by the Commissioner to the Comptroller that the Contractor has faithfully performed all his obligations hereunder. Notice by the Commissioner to the Contractor to repair, replace, rebuild or restore such defective or damaged work shall be timely if given not later than ten (10) days subsequent to the expiration of the one year period or other periods provided for herein. If the Contractor shall fail to repair, replace, rebuild or restore such defective or damage work promptly after having received such notice, the Commissioner shall have the right to have the work

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done by others in the same contract, under Article 14 hereof and to deduct the cost thereof from the amount retained hereunder. The balance, if any, shall be returned to the Contractor without interest. If the amount so retained be insufficient to cover the cost of such work, the Contractor shall be liable to pay such deficiency on demand by the Comptroller. The Engineer's certificate setting forth the fair and reasonable cost of repairing, replacing, rebuilding or restoring any damaged or defective work when performed by one other than the Contractor shall be binding and conclusive as to the amount thereof upon the Contractor. The Contractor shall obtain all manufacturers' warranties and guaranties of all equipment and materials required by this Contract in the name of the City of New York and shall deliver same to the City.

ARTICLE 8 - PROVISIONS RELATING TO LABOR

1. SUPERVISION BY CONTRACTOR

A. The Contractor shall give its personal supervision to the work or have a competent manager, foreman, or supervisor, satisfactory to the Commissioner, assigned tot he work at all times during performance of the contract, with authority to act for the Contractor.

B. In the performance of the contract hereunder, the Contractor shall utilize competent and

qualified persons. All such persons are the employees of the Contractor and not of the City and the Contractor shall be responsible for their acts, personal conduct and work.

C. All services shall be performed in a skillful and workman-like manner. The

Commissioner may require and the Contractor agrees to the removal from the work of any of the Contractor's personnel or its subcontractor's personnel deemed incompetent, careless or otherwise objectionable by the Commissioner.

D. The Department may have the right to have representatives of the Department or of the

City or the State or Federal governments present at the site of the engagement to observe the work being performed.

2. PROHIBITED ACTS

The Contractor shall not employ any labor, or utilize materials or means which employment or utilization during the course of this agreement may to in any way tend cause or result in strikes, work stoppages, delays, suspension or work or similar troubles by workmen employed by the Contractor, or by any of the trades working in or about the buildings and premises where work is being performed under this agreement, or by contractors or their subcontractors pursuant to other agreements or contacts, or on any other building or premises owned or operated by the City of New York, its agencies, departments, boards or authorities. Any violation by the Contractor of these requirements shall be considered as proper and sufficient cause for declaring the Contractor to be in default.

3. NOTICE OF LABOR DISPUTED

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Whenever the Contractor has knowledge that any actual or potential labor dispute is delaying or threatens to delay the timely performance of this contract, the Contractor shall immediately give notice to the Department, including all relevant information with respect thereto.

4. MINIMUM WAGE AND WORKING CONDITIONS A. Except for those employees whose minimum wage is required to be fixed pursuant to Section

220-d of the Labor Laws of the State of New York, all persons employed by the Contractor and any subcontractor in the manufacture or furnishing of work, labor or services, used in the performance of this contract will be paid, without subsequent deduction or rebate unless expressly authorized by law, not less than the Federal minimum wage.

B. No part of the work, labor or service will be performed or rendered by the Contractor in any

plants, factories, buildings or surroundings or working under conditions which are unsanitary or hazardous or dangerous to the health and safety of employees engaged in the performance of this contract. Compliance with the safety, sanitary and factory inspection laws of the state in which the work is to be performed shall be prima facie evidence of compliance with this paragraph.

C. For any breach or violation of any of the provisions of paragraphs A and B above, the Contractor

shall be liable to the City for liquidated damages, which may be withheld from any amounts due herein or may be recovered in suits brought by the Corporation Counsel in the name of the City, in addition to damages for any other breach of this contract, a sum equal to the amount of any underpayment of wages due to any employee engaged in the performance of this contract. In addition, the Administrator shall have the right to cancel this contract for violation of this clause and enter into other contracts for the completion of this contract, charging any additional cost to the Contractor. All sums withheld or recovered as deductions, rebates, refunds or underpayment of wages in violation of the provisions of this clause, shall be held in a special deposit account and shall be paid without interest, on order of the City Commissioner of Labor, directly to the employees who have been paid less than minimum rates of pay as set forth herein and on whose account such sums were withheld or recovered, provided that no claims by employees for such payments shall be entertained unless made within one year from the date of actual notice to the Contractor of the withholding or recovery of such sums by the City.

5. HOURS AND WAGES Pursuant to the provisions of the New York State Labor Law:

A. No laborer, workman or mechanic in the employ of the Contractor, subcontractor or other person

doing or contracting to do the whole or a part of the work contemplated by the contract shall be permitted or required to work more than eight hours in any one calendar day or more than five days in any one week except in cases of extraordinary emergency including fire, flood or danger to life or property.

No such person shall be so employed more than eight hours in any day or more than five days in

any one week except in such emergency, and unless specific dispensation shall have been granted by the Industrial Commissioner. Whenever such a dispensation is granted, all work in excess of eight hours per day and five days per week shall be considered overtime work, and the

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laborers, workmen and mechanics performing such work shall be paid a premium wage commensurate with the premium wages prevailing in the area in which the work is performed.

B. The wages to be paid and the supplements to be provided, for a legal day's work, to laborers,

workmen or mechanics employed by the Contractor shall not be less than the prevailing wages and supplement required to be paid to such employees, as ascertained and prescribed by the Comptroller in the Specifications attached hereto.

6. ARTICLE 8, SECTION 7-11 APPLY TO CONTRACTS FOR BUILDING SERVICE WORK,

AS INDICATED BELOW: [ ] These sections are applicable to this contract.

Prevailing Wage Rates are available at: http://www.comptroller.nyc.gov/

[X] These sections are not applicable to this contract.

7. PREVAILING WAGE AND SUPPLEMENTS (Sec. 231 - Labor Law) A. The wages which the Contractor shall pay for a legal day's work and supplements to be provided

to building service employees, as defined in Section 230 of the Labor Law, employed upon the whole or part of the building service work contemplated by this contract, shall not be less than the prevailing rate of wages and any supplements required to be paid to the various classes of employees on such work, ascertained and determined by the Comptroller as set forth in a schedule which is set forth in Section B of Part III of the Proposal for Bid.

B. No later than the first day upon which work on this contract is to commence, the Contractor shall

post in a prominent and accessible place on the site of work a legible statement of the wages to e paid to the employees for the building service work contemplated.

C. An apprentice in a craft or trade may be permitted to work at a wage lower than that established for the journeyman in such craft or trade only if all of the following conditions are met:

i) such apprentice has been individually registered in an apprenticeship program which is duly

registered with the New York State Industrial Commissioner in conformity with Article 23 of the Labor Law;

ii) such apprentice's registration occurred prior to his/her employment as an apprentice on such

craft or trade services work, and; iii) written proof of such individual registration is submitted to the Agency prior to such

apprentice's employment as an apprentice. The proof submitted shall include evidence of the appropriate ratios and apprentice's wage rates. In no event shall the ratio of apprentice to journeyman employed on such service work be greater than the lesser of the following ratios:

a) the ratio permitted in the apprenticeship program approved by the Industrial

Commissioner, or b) the ratio prevailing in the locality where the service work will be performed.

8. OVERTIME (See 232 - Labor Law)

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All building service employees, who work more than eight hours in any one day or more than forty

hours in any work week, shall be paid wages for such overtime by the Contractor, at a rate not less than one-and-one-half times his prevailing basic cash hourly rate.

9. RECORD KEEPING Sec. 233 - Labor Law

A. The Contractor shall keep original payrolls or transcripts thereof, subscribed and confirmed by it as true, under penalties of perjury, showing the hours and days worked by each employee, the craft, trade or occupation at which he/she was employed, and the wages paid.

B. Where the wages paid include sums which are not paid directly to the employee weekly and which are expended for supplements, the records shall include the hourly payment of behalf of such employees, the supplement for which such payment has been made, and the name and address of the person to whom such payment has been made. In all cases, the Contractor shall keep a true and inscribed copy of the agreement under which such payments are made, a record of all net payments made thereunder, and a list of all persons for whom such payments are made.

C. The records required herein shall be kept on the site of the work during all of the time that work

hereunder is being performed. Upon a formal order of the City, the Contractor shall produce within five (5) days on the site of work, such records subscribed and affirmed by it as true under the penalties of perjury.

10. CERTIFICATION OF WAGE AMOUNTS (Sec. 237 - Labor Law)

As a prerequisite to any payment by the City, the Contractor and his subcontractors shall file a statement in writing and in a form satisfactory to the Comptroller, certifying to the amounts then due for daily or weekly wages on account of labor performed upon the work hereunder, setting forth therein the names of the persons whose wages are unpaid and the amount due to or on behalf of each respectively, which statement so to be filed shall be certified by the oath of the Contractor or subcontractor, as the case may be that he has read such statement subscribed by him and knows the contents thereof, and that the same is true of his own knowledge.

11. DISCRIMINATION IN NEW YORK STATE (Sec. 239 - Labor Law)

A. In the hiring of employees for the performance of work under this contract or any subcontract

hereunder, the Contractor or subcontractor, shall not, by any reason of race, creed, color, sex or national origin, discriminate against any citizen of the State of New York who is qualified and available to perform the work to which the employment relates.

B. The Contractor, subcontractor, or any person on his behalf shall not, in any manner, discriminate

against or intimidate any employee hired for the performance of work under this contract on account of race, creed, color, sex or national origin.

C. The City may deduct from any amount due and payable to the Contractor under this contract a

penalty of five dollars ($5.00) for each person for each day during which such person was discriminated against or intimidated in violation of this section.

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D. The City may terminate this contract, and all monies due or to become due hereunder may be forfeited, for a second or subsequent violation of this section.

ARTICLE 9 - BOOKS AND RECORDS

1. MAINTENANCE

The Contractor agrees to maintain separate and accurate books, records, documents and other evidence and accounting procedures and practices which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Agreement.

2. RETENTION OF RECORDS The Contractor agrees to retain all books, records, and other documents relevant to this Agreement for six (6) years after the final payment or termination of this Agreement, whichever is later. City, State, and federal auditors and any other persons duly authorized by the Department shall have full access to and the right to examine any of said materials during said period.

3. NO REMOVAL OF RECORDS FROM PREMISES Where performance of this Agreement involves use by the Contractor of Departmental papers, files, data or records at Departmental facilities or offices, the Contractor shall not remove any such papers, files, data or records therefrom without the prior approval of the Department's designated official.

4. AUDIT BY THE DEPARTMENT AND CITY A. All vouchers or invoices presented for payment to be made hereunder, and the books, records

and accounts upon which said vouchers or in voices are based are subject to audit by the Fire Department and by the Comptroller of the City of New York pursuant to the powers and responsibilities as conferred upon said Department and said Comptroller by the New York City Charter and Administrative Code of the City of New York, as well as all orders and regulations promulgated pursuant thereto.

B. The Contractor shall submit any and all documentation and justification in support of

expenditures or fees under this Agreement as may be required by said Department and said Comptroller so that they may evaluate the reasonableness of the charges and shall make its records available to the Department and to the Comptroller as they consider necessary.

C. All books, vouchers, records, cancelled checks and any and all similar material may be subject to

periodic inspection, review and audit by the State of New York, Federal Government and other persons duly authorized by the City.

D. The Contractor shall not be entitled to final payment under the Agreement until all requirements

have been satisfactorily met.

ARTICLE 10 - REPRESENTATIONS AND WARRANTIES 1. PROCUREMENT OF AGREEMENT

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A. The Contractor represents and warrants that no person or selling agency has been employed or

retained to solicit or secure this Agreement upon an agreement or understanding for a commission, percentage, brokerage fee, contingent fee or any other compensation. The Contractor further represents and warrants that no payment, gift or thing of value has been made, given or promised to obtain this or any other agreement between the parties. The Contractor makes such representations and warranties to induce the City to enter into this Agreement and the City relies upon such representations and warranties in the execution hereof.

B. For a breach or violation of such representations or warranties, the Administrator shall have the

right to annul this Agreement without liability, entitling the City to recover all monies paid hereunder and the Contractor shall not make claim for, or be entitled to recover, any sum or sums due under this Agreement. This remedy, if effected, shall not constitute the sole remedy afforded The City for the falsity or breach, not shall it constitute a waiver of the City's right to claim damages or refuse payment or to make any other action provided for by law or pursuant to this Agreement.

2. CONFLICT OF INTEREST

The Contractor represents and warrants that neither it nor any of its directors, officers, members, partners or employees, has any interest not shall they acquire any interest, directly or indirectly which would or may conflict in any manner or degree with the performance or rendering of the services herein provided. The Contractor further represents and warrants that in the performance of this Agreement no person having such interest or possible interest shall be employed by it. No elected official or other officer or employee of the City or Department, nor any person whose salary is payable, in whole or in part, from the City Treasury, shall participate in any decision relating to this Agreement which affects his/her personal interest of the interest of any corporation, partnership or association in which he/she is, directly or indirectly, interested nor shall any such person have any interest, direct or indirect, in this Agreement or in the proceeds thereof.

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3. FAIR PRACTICES The Contractor and each person signing on behalf of any Contractor represents and warrants and certifies, under penalty of perjury, that to the best of its knowledge and belief: A. The prices in this Agreement have been arrived at independently without collusion, consultation,

communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor;

B. Unless otherwise required by law, the prices which have been quoted in this Agreement and on

the proposal submitted by the Contractor have not been knowingly disclosed by the Contractor prior to the proposal opening, directly or indirectly, to any other bidder or to any competitor, and;

C. No attempt has been made or will be made by the Contractor to induce any other person,

partnership or corporation to submit or not to submit a proposal for the purpose of restricting competition.

The fact that the Contractor:

I) has published price lists, rates, or tariffs covering items being procured, ii) has informed prospective customers of proposed or pending publication of new or revised

price lists for such items, or iii) has sold the same items to other customers at the same prices being bid, does not

constitute a disclosure within the meaning of the above. 4. PRICING

A. The Contractor shall whenever required during the contract, including but not limited to the time

of bidding, submit cost or pricing data and formally certify that, to the best of its knowledge and belief, the cost or pricing data submitted was accurate, complete, and current as of a specified date. The Contractor shall be required to keep its submission of cost and pricing data current until the contract has been completed.

B. The price of any change order, or contract modification subject to the conditions of paragraph A,

shall be adjusted to exclude any significant sums by which the City finds that such price was based on cost or price data furnished by the supplier which was inaccurate, incomplete, or not current as of the date agreed upon between the parties.

C. Time for Certification. The Contractor must certify that the cost or pricing data submitted is

accurate, complete, and current as of a mutually determined date. D. Refusal to Submit Data. When any Contractor refuses to submit the required data to support a

price, the Contracting Officer shall not allow the price. E. Certificate Current Cost or Pricing Data. Form of Certificate. In those cases when cost or

pricing data is required, certification shall be made using a certificate substantially similar to the

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one contained in Chapter 4 of the PPB rules and such certification shall be retained in the agency contract file.

ARTICLE 11 - COVENANTS OF THE CONTRACTOR

1. EMPLOYEES

All experts or consultants or employees of the Contractor who are employed by the Contractor to perform work under this Agreement are neither employees of the City nor under contract to the City and the Contractor alone is responsible for their work, direction, compensation and personal conduct while engaged under this Agreement. Nothing in this Agreement shall impose any liability or duty on the City for the acts, omissions, liabilities or obligations of the Contractor or any person, firm, company, agency, association, corporation or organization engaged by the Contractor as expert, consultant, independent contractor, specialist, trainee, employee, servant, or agent, or for taxes of any nature including but not limited to unemployment insurance, worker's compensation, disability benefits and social security, or, except as specifically stated in this Agreement, to any person, firm or corporation.

2. INDEPENDENT CONTRACTOR STATUS The Contractor and the Department agree that the Contractor is an independent contractor, and not an employee of the Department or the City of New York, and that in accordance with such status as independent contractor, the Contractor covenants and agrees that neither it nor its employees or agents will hold themselves out as, nor claim to be, officers or employees of the City of New York, or of any department, agency or unit thereof, by reason hereof, and that they will not, by reason hereof, make any claim, demand or application to or for any right or privilege applicable to an officer of or employee of the City of New York, including but not limited to Worker's Compensation coverage, Unemployment Insurance Benefits, Social Security coverage or employee retirement membership or credit.

3. COMPLIANCE WITH LAW The Contractor shall render all services under this Agreement in accordance with the applicable provision of Federal, State and local Laws, rules and regulations as are in effect at the time such services are rendered.

4. FEDERAL EMPLOYMENT PRACTICES The Contractor and its subcontractors shall comply with the Civil Rights Acts of 1964 and any amendment thereto, and the rules and regulations thereunder.

5. INVESTIGATION CLAUSE A. The parties to this agreement agree to cooperate fully and faithfully with any investigation, audit

or inquiry conducted by a State of New York (State) or City of New York (City) governmental agency or authority that is empowered directly or by designation to compel the attendance of witnesses and to examine witnesses under oath, or conducted by the Inspector General of a governmental agency that is a party in interest to the transaction, submitted bid, submitted

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proposal, contract, lease, permit, or license that is the subject of the investigation, audit or inquiry.

B. If any person who has been advised that his or her statement, and any information from such

statement, will not be used against him or her in any subsequent criminal proceeding refuses to testify before a grand jury or other governmental agency or authority empowered directly or by designation to compel the attendance of witnesses and to examine witnesses under oath concerning the award of or performance under any transaction, agreement, lease, permit, contract, or license entered into with the City, the State, or any political subdivision or public authority thereof, or the port Authority of New York and New Jersey, or any local development corporation organized under the laws of the State of New York, or;

If any person refuses to testify for a reason other than the assertion of his or her privilege against

self-conducted by a City or State governmental agency or authority empowered directly or by designation to compel the attendance of witnessed and to take testimony under oath, or by the Inspector General of the governmental agency that is a party in interest in, and is seeking testimony concerning the award of, or performance under, any transaction, agreement, lease, permit, contract, or license entered into with the City, the State, or any political subdivision thereof or any local development corporation within the City, then;

C. The Commissioner or agency head whose agency is a party in interest to the transaction,

submitted bid, submitted proposal, contract, lease, permit, or license shall convene a hearing, upon not less that five (5) days written notice to the parties involved to determine if any penalties should attach for the failure of a person to testify.

If any not-governmental party to the hearing requests an adjournment, the commissioner or

agency head who convene the hearing may, upon granting the adjournment, suspend any contract, lease, permit, or license pending the final determination pursuant to paragraph E below without the City incurring any penalty or damages for delay or otherwise.

D. The penalties which may attach after a final determination by the commissioner or agency head

may include but shall not exceed: i) The disqualification for a period not to exceed five (5) years from the date of an adverse

determination for any person, or any entity of which such person was a member at the time the testimony was sought, from submitting bids for, or transacting business with, or entering into or obtaining any contract, lease, permit or license with or from the City, and/or;

ii) The cancellation or termination of any and all such existing City contracts, leases,

permits or licenses that the refusal to testify concerns and that have not been assigned as permitted under this agreement, not the proceeds of which pledged, to an unaffiliated and unrelated institutional lender for fair value prior to the issuance of the notice scheduling the hearing, without the City incurring any penalty or damages on account of such cancellation or termination; monies lawfully due for goods delivered, work done, rentals, or fees accrued prior to the cancellation or termination shall be paid by the City.

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E. The Commissioner or agency head shall consider and address in reaching his or her determination and in assessing an appropriate penalty the factors in paragraph 1 and 2 below. He or she may also consider, if relevant and appropriate, the criteria established in paragraphs 3 and 4 below in addition to any other information which may be relevant and appropriate: i) The party's good faith endeavors or lack thereof to cooperate fully and faithfully with any

governmental investigation or audit, including but not limited to the discipline, discharge, of disassociation of any person failing to testify, the production of accurate and complete books and records, and the forthcoming testimony of all other members, agents, assignees or fiduciaries whose testimony is sought.

ii) The relationship of the person who refused to testify to any entity that is a party to the

hearing, including, but not limited to, whether the person whose testimony is sought has an ownership interest in the entity and/or the degree of authority and responsibility the person has within the entity.

iii) The nexus of the testimony sought to the subject entity and its contracts, leases, permits

or licenses with the City. iv) The effect a penalty may have on an unaffiliated and unrelated party or entity that has a

significant interest that the party or entity has given actual notice to the commissioner or agency head upon the acquisition of the interest, or at the hearing called for in C above gives notice and proves that such interest was previously acquired. Under either circumstance the party or entity must present evidence at the hearing demonstrating the potential adverse impact a penalty will have on such person or entity.

F. DEFINITIONS

i) The term "license" or "permit" as used herein shall be defined as a license, permit,

franchise or concession not granted as a matter of right. ii) The term "person" as used herein shall be defined as any natural person doing business

alone or associated with another person or entity as a partner, director, officer, principal or employee.

iii) The term "entity" as used herein shall be defined as any firm, partnership, corporation,

association, or person that receives monies, benefits, licenses, leases, or permits from or through the City or otherwise transacts business with the City.

iv) The term "member" as used herein shall be defined as any person associated with

another person or entity as a partner, director, officer, principal or employee.

G. In addition to and notwithstanding any other provision of this agreement the Commissioner or agency head may in his or her sole discretion terminate this agreement upon not less than three (3) days written notice in the event the Contractor fails to promptly report in writing to the Commissioner of Investigation of the City of New York any solicitation of money, goods, requests for future employment or other benefit of thing of value, by or on behalf of any employee of the City or other person, firm, corporation or entity for any purpose which may be

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related to the procurement or obtaining of this agreement by the Contractor, or affecting the performance of this contract.

6. ASSIGNMENT

A. The Contractor shall not assign, transfer, convey, sublet or otherwise dispose of this Agreement,

or of the Contractor's rights, title, interest, obligations or duties herein, or the Contractor's power to execute such Agreement, or assign, by power of attorney or otherwise, any of its rights to receive monies due or to become due under this Agreement, unless the prior written consent of the Department shall be obtained. Any such assignment, transfer, conveyance, sublease or other disposition without such consent shall be void.

B. In the event that the Contractor assigns, transfers, conveys, sublets or otherwise disposes of this Agreement as specified in subdivision A, above, without prior written consent of the Department, the Department shall revoke and annul this Agreement and the Department shall be relieved and discharged from any and all liability and obligations growing out of such Agreement to the Contractor, its assignees, transferee or sublessee. The Contractor shall forfeit and lose all monies theretofore earned under this Agreement, except so much thereof as may be required to pay the Contractor's employees. The provisions of this section shall not hinder, prevent or affect an assignment by the Contractor for the benefit of its creditors made pursuant to the Laws of the State of New York.

C. This Agreement may be assigned by the City to any corporation, agency or instrumentality having authority to accept such assignment.

7. SUBCONTRACTING

A. The Contractor agrees not to enter into any subcontracts for the performance of the obligations,

in whole or in part, under this Agreement without the prior written approval of the Department. Two copies of each such proposed subcontract shall be submitted to the Department with the Contractors' written request for approval.

B. All such subcontracts shall contain provisions specifying:

i) that the work performed by the subcontractor must be in accordance with the terms of the

Agreement between the Department and the Contractor; ii) that nothing contained in such contract shall impair the rights of the Department; iii) that nothing contained therein, or under the Agreement between the Department and the

Contractor, shall create any contractual relationship between the subcontractor and the Department, and

iv) that the subcontractor specifically agrees to be bound by the confidentiality provision set forth in this Agreement between the Department and the Contractor.

C. The Contractor agrees that it is fully responsible to the Department for the acts and omissions of

the subcontractors and of persons either directly or indirectly employed by them as it is for the acts and omissions of persons directly employed by it.

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D. The aforesaid approval is required in all cases other than individual employer-employee contracts.

E. The Contractor shall not in any way be relieved of any responsibility under this Agreement by

any subcontractor. 8. PUBLICITY

A. The prior written approval of the Department is required before the Contractor or any of its

employees, servants, agents, or independent contractors may, at any time, either during or after completion or termination of this Agreement, make any statement to the press of issue any material for publication through the media of communication bearing on the work performed or data collected under this agreement.

B. If the Contractor publishes a work dealing with any aspect of performance under this Agreement,

or of the results and accomplishments attained in such performance, the Department shall have a royalty-free, nonexclusive and irrevocable license to reproduce, publish or otherwise use and to authorize others to use the publication.

9. PARTICIPATION IN AN INTERNATIONAL BOYCOTT

A. The Contractor agrees that neither the Contractor nor any substantially owned affiliated company

is participating or shall participate in an international boycott in violation of the provisions of the Export Administration Act of 1969, as amended, or the regulations of the United States Department of Commerce promulgated thereunder.

B. Upon final determination by the Commerce Department or any other agency of the United States

as to, or conviction of the Contractor or a substantially-owned affiliate company thereof, of participation in an international boycott in violation of the provisions of the Export Administration Act of 1969, as amended, or the regulations promulgated thereunder, the Comptroller may, at his option, render forfeit and void this contract.

C. The Contractor shall comply in all respects, with the provisions of section 343-10.0 of the

Administrative Code of the City of New York and the rules and regulations issued by the Comptroller thereunder.

10. INVENTIONS, PATENTS AND COPYRIGHTS

A. Any discovery or invention arising out of or developed in the course of performance of this

Agreement shall be promptly and fully reported to the Department, and if this work is supported by a Federal grant of funds, it shall be promptly and fully reported to the Federal Government for determination as to whether patent protection on such invention shall be sought and how the rights in the invention or discovery, including rights under any patent issued thereon, shall be disposed of and administered in order to protect the public interest.

B. No report, document or other data produced in whole or in part with contract funds shall be

copyrighted by the Contractor nor shall any notice of copyright be registered by the Contractor in connection with any report, document or other data developed for the Agreement.

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C. If any copyrightable material is developed under, or in the course of performing this Agreement,

any Federal Agency providing federal financial participation for the Agreement shall have a royalty-free, non exclusive and irrevocable right to reproduce, publish of otherwise use, and to authorize others to use, the work for governmental purposes.

D. In no event shall subsections A, B, and C of this section be deemed to apply to any report,

document or other data, or any invention of the Contractor which existed prior to, or was developed or discovered independently from, its activities related to or funded by this Agreement.

11. ANTI-TRUST

The Contractor hereby assigns, sells, and transfers to the City all rights, title and interest in and any claims and causes of action arising under the anti-trust Laws of the State of New York or of the United States relating to the particular goods or services purchased or procured by the City under this Agreement.

12. POLITICAL ACTIVITY A. There shall be no partisan political activity to any activity to further the election or defeat of any

candidate for public, political or party office as part of or in connection with this Agreement, not shall any of the funds provided under this Agreement be used for such purposes.

B. No funds provided under this Agreement shall be used, for publicity or propaganda purposes, for

the preparation distribution, or use of any kit, pamphlet, booklet, publication, radio, television or film presentation designed to support or defeat legislation or appropriations pending before the Congress of the United States, except in presentation to the Congress itself.

C. No funds provided under this Agreement shall be used to pay the salary or expenses of any

person to engage in any activity designed to influence legislation or appropriations pending before the Congress of the United States.

13. CETA AND PUBLIC WORKS PROGRAM

A. The Contractor shall, when hiring into unsubsidized jobs in its workforce, give consideration to

those persons presently employed in CETA public service positions in the City of New York, whose qualifications and skills are commensurate with those required for the positions to be filled.

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14. CLEAN AIR PROVISIONS A. If the amount of this Agreement is in excess of $100,000.00 the Contractor shall comply with all

applicable standards, orders or regulations issued pursuant to the Clean Air Act of 1970, as amended (42 U.S.C 1857B, et. seq.) and the Federal Water Pollution Act (33 U.S.C. 1251, et. seq.)

B. Should a harmful dust hazard be created in performing the work of this Contract, for the

elimination of which appliances or methods have been approved by the Board of Standards and Appeals of the State of New York, such appliances and methods shall be installed, maintained, and effectively operated during the continuance of such harmful dust hazard. Failure to comply with this provision after notice shall make this Contract void.

C. In accordance with the provisions of Section 1403.3.2.25, noise abatement contract compliance,

of Part III of Chapter 57 of the Administrative Code of the City of New York.

i) Devices and activities which will be operated, conducted, constructed or manufactured pursuant to this Contract and which are subject to the provisions of the New York City Noise Control Code shall be operated, conducted, constructed, or manufactured without causing a violation of the Code.

ARTICLE 12 - EXTENSION OF TIME

Upon written application by the Contractor, the Agency Chief Contracting Officer may grant an extension of time for performance of the contract. Said application must state, at a minimum, in detail, each cause for delay, the date the cause of the alleged delay occurred, and the total number of delay in days attributable to such cause. The ruling of the Agency Chief Contracting Officer shall be final and binding as to the allowance of an extension and the number of days allowed.

ARTICLE 13 - NO DAMAGE FOR DELAY

The Contractor agrees to make no claim for damages for delay in the performance of this Contract occasioned by any act or omission to act of the City or any of its representatives, and agrees that any such claim shall be fully compensated for by an extension of time to complete performance of the work as provided herein.

ARTICLE 14 - RESOLUTION OF DISPUTES

1. Except as provided in 1(a) and 1(b) below, all disputes between the City and the vendor that arise under, or by virtue of, this contract shall be finally resolved in accordance with the provisions of this section and Section 4-09 of the Rules of the Procurement Policy Board (“PPB Rules”). This procedure shall be the exclusive means of resolving any such disputes.

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(a) This section shall not apply to disputes concerning matters dealt with in other sections of the PPB Rules or to disputes involving patents, copyrights, trademarks, or trade secrets (as interpreted by the courts of New York State) relating to proprietary rights in computer software.

(b) For construction and construction-related services this section shall apply only to

disputes about the scope of work delineated by the contract, the interpretation of contract documents, the amount to be paid for extra work or disputed work performed in connection with the contract, the conformity of the vendor’s work to the contract, and the acceptability and quality of the vendor’s work; such disputes arise when the Engineer, Resident Engineer, Engineering Audit Officer, or other designee of the Commissioner makes a determination with which the vendor disagrees.

2. All determinations required by this section shall be clearly stated, with a reasoned

explanation for the determination based on the information and evidence presented to the party making the determination. Failure to make such determination within the time required by this section shall be deemed a non-determination without prejudice that will allow application to the next level.

3. During such time as any dispute is being presented, heard, and considered pursuant to

this section, the contract terms shall remain in full force and effect and the vendor shall continue to perform work in accordance with the contract and as directed by the Agency Chief Contracting Officer (“ACCO”) or Engineer, Resident Engineer, Engineering Audit Officer, or other designee of the Commissioner. Failure of the vendor to continue the work as directed shall constitute a waiver by the vendor of any and all claims being presented pursuant to this section and a material breach of contract.

4. Presentation of Dispute to Agency Head.

(a) Notice of Dispute and Agency Response. The vendor shall present its dispute in

writing (“Notice of Dispute”) to the Agency Head within the time specified herein, or, if no time is specified, within thirty (30) days of receiving written notice of the determination or action that is the subject of the dispute. This notice requirement shall not be read to replace any other notice requirements contained in the contract. The Notice of Dispute shall include all the facts, evidence, documents, or other basis upon which the vendor relies in support of its position, as well as a detailed computation demonstrating how any amount of money claimed by the vendor in the dispute was arrived at. Within thirty (30) days after receipt of the complete Notice of Dispute, the ACCO or, in the case of construction or construction-related services, the Engineer, Resident Engineer, Engineering Audit Officer, or other designee of the Commissioner, shall submit to the Agency Head all materials he or she deems pertinent to the dispute. Following initial submissions to the Agency Head, either party may demand of the other the production of any document or other material the demanding party believes may be relevant to the dispute. The requested party shall produce all relevant materials that are not otherwise protected by a legal privilege recognized by the courts of New York State. Any question of relevancy shall be determined by the Agency Head whose decision shall be final.

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Willful failure of the vendor to produce any requested material whose relevancy the vendor has not disputed, or whose relevancy has been affirmatively determined, shall constitute a waiver by the vendor of its claim.

(b) Agency Head Inquiry. The Agency Head shall examine the material and may, in

his or her discretion, convene an informal conference with the vendor and the ACCO and, in the case of construction or construction-related services, the Engineer, Resident Engineer, Engineering Audit Officer, or other designee of the Commissioner, to resolve the issue by mutual consent prior to reaching a determination. The Agency Head may seek such technical or other expertise as he or she shall deem appropriate, including the use of neutral mediators, and require any such additional material from either or both parties as he or she deems fit. The Agency Head’s ability to render, and the effect of, a decision hereunder shall not be impaired by any negotiations in connection with the dispute presented, whether or not the Agency Head participated therein. The Agency Head may or, at the request of any party to the dispute, shall compel the participation of any other vendor with a contract related to the work of this contract and that vendor shall be bound by the decision of the Agency Head. Any vendor thus brought into the dispute resolution proceeding shall have the same rights and obligations under this section as the vendor initiating the dispute.

(c) Agency Head Determination. Within thirty (30) days after the receipt of all

materials and information, or such longer time as may be agreed to by the parties, the Agency Head shall make his or her determination and shall deliver or send a copy of such determination to the vendor and ACCO and, in the case of construction or construction-related services, the Engineer, Resident Engineer, Engineering Audit Officer, or other designee of the Commissioner, together with a statement concerning how the decision may be appealed.

(d) Finality of Agency Head Decision. The Agency Head’s decision shall be final and

binding on all parties, unless presented to the Contract Dispute Resolution Board (“CDRB”) pursuant to this section. The City may not take a petition to the CDRB. However, should the vendor take such a petition, the City may seek, and the CDRB may render, a determination less favorable to the vendor and more favorable to the City than the decision of the Agency Head.

5. Presentation of Dispute to the Comptroller. Before any dispute may be brought by the

vendor to the CDRB, the vendor must first present its claim to the Comptroller for his or her review, investigation, and possible adjustment.

(a) Time, Form, and Content of Notice. Within thirty (30) days of receipt of a decision

by the Agency Head, the vendor shall submit to the Comptroller and to the Agency Head a Notice of Claim regarding its dispute with the agency. The Notice of Claim shall consist of (i) a brief statement of the substance of the dispute, the amount of money, if any, claimed and the reason(s) the vendor contends the dispute was wrongly decided by the Agency Head; (ii) a copy of the decision of the Agency Head, and (iii) a copy of all materials submitted by the vendor to the agency,

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including the Notice of Dispute. The vendor may not present to the Comptroller any material not presented to the Agency Head, except at the request of the Comptroller.

(b) Agency Response. Within thirty (30) days of receipt of the Notice of Claim, the

agency shall make available to the Comptroller a copy of all material submitted by the agency to the Agency Head in connection with the dispute. The agency may not present to the Comptroller any material not presented to the Agency Head, except at the request of the Comptroller.

(c) Comptroller Investigation. The Comptroller may investigate the claim in dispute

and, in the course of such investigation, may exercise all powers provided in sections 7-201 and 7-203 of the New York City Administrative Code. In addition, the Comptroller may demand of either party, and such party shall provide, whatever additional material the Comptroller deems pertinent to the claim, including original business records of the vendor. Willful failure of the vendor to produce within fifteen (15) days any material requested by the Comptroller shall constitute a waiver by the vendor of its claim. The Comptroller may also schedule an informal conference to be attended by the supplier, agency representatives, and any other personnel desired by the Comptroller.

(d) Opportunity of Comptroller to Compromise or Adjust Claim. The Comptroller shall

have forty-five (45) days from his or her receipt of all materials referred to in 5(c) to investigate the disputed claim. The period for investigation and compromise may be further extended by agreement between the vendor and the Comptroller, to a maximum of ninety (90) days from the Comptroller’s receipt of all the materials. The vendor may not present its petition to the CDRB until the period for investigation and compromise delineated in this paragraph has expired. In compromising or adjusting any claim hereunder, the Comptroller may not revise or disregard the terms of the contract between the parties.

6. Contract Dispute Resolution Board. There shall be a Contract Dispute Resolution Board

composed of:

(a) the chief administrative law judge of the Office of Administrative Trials and Hearings (“OATH”) or his/her designated OATH administrative law judge, who shall act as chairperson, and may adopt operational procedures and issue such orders consistent with this section as may be necessary in the execution of the CDRB’s functions, including, but not limited to, granting extensions of time to present or respond to submissions;

(b) the City Chief Procurement Officer (“CCPO”) or his/her designee, or in the case of

disputes involving construction, the Director of the Office of Construction or his/her designee; any designee shall have the requisite background to consider and resolve the merits of the dispute and shall not have participated personally and substantially in the particular matter that is the subject of the dispute or report to anyone who so participated , and

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(c) a person with appropriate expertise who is not an employee of the City. This person shall be selected by the presiding administrative law judge from a prequalified panel of individuals, established and administered by OATH, with appropriate background to act as decision-makers in a dispute. Such individuals may not have a contract or dispute with the City or be an officer or employee of any company or organization that does, or regularly represent persons, companies, or organizations having disputes with the City.

7. Petition to CDRB. In the event the claim has not been settled or adjusted by the

Comptroller within the period provided in this section, the vendor, within thirty (30) days thereafter, may petition the CDRB to review the Agency Head determination.

(a) Form and Content of Petition by Vendor. The vendor shall present its dispute to the

CDRB in the form of a Petition, which shall include (i) a brief statement of the substance of the dispute, the amount of money, if any, claimed, and the reason(s) the vendor contends that the dispute was wrongly decided by the Agency Head; (ii) a copy of the decision of the Agency Head; (iii) copies of all materials submitted by the vendor to the agency; (iv) a copy of the decision of the Comptroller, if any, and (v) copies of all correspondence with, and material submitted by the vendor to, the Comptroller’s Office. The vendor shall concurrently submit four complete sets of the Petition: one to the Corporation Counsel (Attn: Commercial and Real Estate Litigation Division), and three to the CDRB at OATH’s offices, with proof of service on the Corporation Counsel. In addition, the vendor shall submit a copy of the statement of the substance of the dispute, cited in (i) above, to both the Agency Head and the Comptroller.

(b) Agency Response. Within thirty (30) days of receipt of the Petition by the

Corporation Counsel, the agency shall respond to the statement of the vendor and make available to the CDRB all material it submitted to the Agency Head and Comptroller. Three complete copies of the agency response shall be submitted to the CDRB at OATH’s offices and one to the vendor. Extensions of time for submittal of the agency response shall be given as necessary upon a showing of good cause or, upon the consent of the parties, for an initial period of up to thirty (30) days.

(c) Further Proceedings. The Board shall permit the vendor to present its case by

submission of memoranda, briefs, and oral argument. The Board shall also permit the agency to present its case in response to the vendor by submission of memoranda, briefs, and oral argument. If requested by the Corporation Counsel, the Comptroller shall provide reasonable assistance in the preparation of the agency’s case. Neither the vendor nor the agency may support its case with any documentation or other material that was not considered by the Comptroller, unless requested by the CDRB. The CDRB, in its discretion, may seek such technical or other expert advice as it shall deem appropriate and may seek, on it own or upon application of a party, any such additional material from any party as it deems fit. The CDRB, in its discretion, may combine more than one dispute between the parties for concurrent resolution.

(d) CDRB Determination. Within forty-five (45) days of the conclusion of all submissions and oral arguments, the CDRB shall render a decision resolving the dispute. In an unusually complex case, the CDRB may render its decision in a

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longer period of time, not to exceed ninety (90) days, and shall so advise the parties at the commencement of this period. The CDRB’s decision must be consistent with the terms of the contract. Decisions of the CDRB shall only resolve matters before the CDRB and shall not have precedential effect with respect to matters not before the CDRB.

(e) Notification of CDRB Decision. The CDRB shall send a copy of its decision to the

vendor, the ACCO, the Corporation Counsel, the Comptroller, the CCPO, the Office of Construction, the PPB, and, in the case of construction or construction-related services, the Engineer, Resident Engineer, Engineering Audit Officer, or other designee of the Commissioner. A decision in favor of the vendor shall be subject to the prompt payment provisions of the PPB Rules. The Required Payment Date shall be thirty (30) days after the date the parties are formally notified of the CDRB’s decision.

(f) Finality of CDRB Decision. The CDRB’s decision shall be final and binding on all

parties. Any party may seek review of the CDRB’s decision solely in the form of a challenge, filed within four months of the date of the CDRB’s decision, in a court of competent jurisdiction of the State of New York, County of New York pursuant to Article 78 of the Civil Practice Law and Rules. Such review by the court shall be limited to the question of whether or not the CDRB’s decision was made in violation of lawful procedure, was affected by an error of law, or was arbitrary and capricious or an abuse of discretion. No evidence or information shall be introduced or relied upon in such proceeding that was not presented to the CDRB in accordance with Section 4-09 of the PPB Rules.

8. Any termination, cancellation, or alleged breach of the contract prior to or during the

pendency of any proceedings pursuant to this section shall not affect or impair the ability of the Agency Head or CDRB to make a binding and final decision pursuant to this section.

ARTICLE 15 - EQUAL EMPLOYMENT

1. EXECUTIVE ORDER NO. 50

The Contractor shall comply with the provisions relating to Equal Employment Opportunity as set forth in the Addendum, which is attached hereto and incorporated herein.

2. WHERE REQUIRED BY NEW YORK STATE LABOR LAW SECTION 220-E THE CONTACTOR AGREES: A. That in the hiring of employees for the performance of work under this Agreement or any sub-

contract hereunder, neither the Contractor, subcontractor, nor any person acting on behalf of such Contractor or subcontractor shall be reason of race, creed, color, sex, national origin or sexual orientation discriminate against any citizen of the State of New York who is qualified and available to perform the work to which the employment relates;

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B. That neither the Contractor, subcontractor, nor any person on its behalf shall, in any manner, discriminate against or intimidate any employee hired for the performance of work under this Agreement on account of race, creed, color, sex, national origin or sexual orientation;

C. That there may be deducted from the amounts payable to the Contractor by the City under this

Agreement a penalty of five dollars for each person for each calendar day during which such person was discriminated against or intimidated in violation of the provisions of this Agreement and;

D. That this Agreement may be cancelled or terminated by the City and all monies due or to become

due hereunder may be forfeited, for a second or any subsequent violation of the terms or conditions of this section of the Agreement.

E. The aforesaid provisions of this section covering every contract for or on behalf of the State or a

municipality for the manufacture, sale or distribution of materials, equipment or supplies shall be limited to operations performed within the territorial limits of the State of New York.

3. AS REQUIRED BY NEW YORK CITY ADMINISTRATIVE CODE SECTION 343-8.0:

A. It shall be unlawful for any person engaged in the construction, alteration or repair of buildings

or engaged in the construction or repair of streets or highways pursuant to a contract with the City or engaged in the manufacture, sale or distribution of materials, equipment or supplies pursuant to a contract with the City to refuse to employ or to refuse to continue in any employment any person on account of the race, color or creed of such person.

B. It shall be unlawful for any person or any servant, agent or employee of any person, described in

subdivision (A) above, to ask, indicate or transmit orally or in writing, directly or indirectly, the race, color, or creed or religious affiliation of any person employed or seeking employment from such person, firm or corporation.

C. Disobedience of the foregoing provisions shall be deemed a violation of a material provision of

this Agreement. D. Any person, or the employee, manager or owner of or officer of such firm or corporation who

shall violate any of the provisions of this section shall, upon conviction thereof, be punished by a fine of not more than one hundred dollars or by imprisonment for not more than thirty (30) days, or both.

4. NON-DISCRIMINATION AGAINST THE HANDICAPPED:

The Contractor agrees that it will comply with the provisions of Section 504 of the Rehabilitation Act of 1973, as amended, and all regulations, guidelines and interpretations issued pursuant thereto.

ARTICLE 16 - TERMINATION

1. The Department and/or City shall have the rights to terminate this Agreement, in whole or in part:

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A. At any time during the period of this Agreement the Department upon ten (10) days written notice to the Contractor may cancel the Agreement and terminate the service. In such event the Contractor shall be paid whatever sum has become due to him for services performed prior to the effective date of the cancellation without further liability to the City.

B. The Contractor shall be entitled to apply to the Department by reason of any failure in

performance of this Agreement (including any failure by the Contractor to make progress in the prosecution of work hereunder which endangers such performance), if such failure arises out of causes beyond the control and without the fault or negligence of the Contractor. Such causes may include, but are not restricted to: acts of God or of the public enemy; acts of the Government in either its sovereign or contractual capacity; fires; flood; epidemics; quarantine restrictions; strikes; freight embargoes, or any other cause beyond the reasonable control of the Contractor.

C. The determination that such failure arises out of causes beyond the control and without

the fault or negligence of the Contractor shall be made by the Department which agrees to exercise reasonable judgment therein. If such a determination is made and the Agreement terminated by the Department pursuant to such application by the Contractor, such termination shall be deemed to be without cause.

D. All payments pursuant to this Section 16.1 shall be accepted by the Contractor in full

satisfaction of all claims against the City arising out of termination.

2. The Contractor may be declared in default by this administration and the Department may terminate the Agreement in whole or in part by written notice to the Contractor:

A. The Contractor becomes insolvent, or B. The Contractor makes an assignment for the benefit of creditors pursuant to the Statutes

of the State of New York, or C. A voluntary or involuntary petition in bankruptcy be filed by or against the Contractor, or D. A receiver or receivers are appointed to take charge of the Contractor's property or

affairs, or E. The Contractor sublets, assigns, transfers, conveys or otherwise disposes of this

Agreement other than as herein specified, or F. The Contractor fails or refuses to proceed with the work when and as directed by the

Administrator, or G. The Contractor is or has been unnecessarily or unreasonably or willfully delaying:

i) the performance, and completion of the work, or ii) the award of necessary subcontracts, or iii) the placement of necessary material and equipment order, or

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H. The Contractor, without just cause, reduces his working force to a number which, if maintained, would jeopardize the timely performance of the contract, and fails or refuses to increase such working force when ordered to do so by the Administrator, or

I. The work cannot be completed or is not completed within the time herein provided

therefore or within the time to which such completion may have been extended; unless, however, the delay is caused by circumstances under the Administrator's control, or

J. The Contractor abandons work, or K. The Contractor is or has been willfully or in bad faith violating any of the provisions of

this contract.

3. Before the Administrator shall exercise his right to declare the Contractor in default by reason of the conditions set forth in Section 16-.2 A, F, G, H, I, and K, and he shall give the Contractor an opportunity to be heard, on two (2) days written notice, at which hearing the Contractor may have a stenographer present; provided, however, that a copy of such stenographic notes, if any, shall be furnished to the Administrator.

4. In the event the Administrator terminates this Agreement in whole or in part as provided in

Section 16.2 above, the City may procure, upon such terms and in such manner deemed appropriate, supplies or services similar to those so terminated, and the Contractor shall be liable to the City for any excess costs for such similar supplies or services: provided that, the Contractor shall continue the performance of this Agreement to the extent not terminated hereby.

5. The right to declare in default for any of the grounds specified or referred to herein, shall be

exercised by sending the Contractor a notice, signed by the Commissioner, setting forth the ground or grounds upon which such default is declared.

6. Upon receipt of such notice, the Contractor shall immediately discontinue all further operations

under this contract and shall immediately quit the site leaving untouched all plant, materials, equipment, tools, and supplies then on the site.

7. The Commissioner, after declaring the Contractor in default, may then have the work completed

by means and in such manner, by contract with or without public letting, or otherwise, as he may deem advisable, utilizing for such public letting, or otherwise, as he may deem advisable, utilizing for such purpose such of the Contractor's plant, materials, equipment, tools and supplies, remaining on the site, and also such subcontractors, as he may deem advisable.

8. Notwithstanding any other provisions of this Agreement, the Contractor shall not be relieved of

liability to the City for damages sustained by the City by virtue of Contractor's default, and the City may withhold payments to the Contractor for the purpose of set off until such time as the exact amount of damages due to the City from the Contractor is determined.

9. The provisions of the Agreement regarding confidentiality of information shall remain in full

force and effect following any termination.

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10. The rights and remedies of the City provided in this article shall not be exclusive and are in addition to all other rights and remedies provided by law or under this Agreement.

ARTICLE 17 - MISCELLANEOUS

1. CHOICE OF LAW, CONSENT TO JURISDICTION AND VENUE

This Agreement shall be deemed to be executed in the City of New York, regardless of the domicile of the Contractor, and shall be governed by and construed in accordance with the laws of the State of New York. The parties agree that any and all claims asserted by or against the City arising under this Agreement or related thereto shall be heard and determined either in the courts of the United States located in New York City ("Federal Courts") or in the courts of the State of New York ("New York State Courts") located in the City and County of New York. To effectuate this agreement and intent, the Contractor agrees: A. If the City initiates any action against the Contractor in Federal Court or in New York State

Court, service of process may be made on the Contractor either in person, wherever such Contractor may be found, or by registered mail addressed to the Contractor at its address as set forth in this Agreement, or to such other address as the Contractor may provide to the City in writing, and

B. With respect to any action between the City and the Contractor in New York State Court, the

Contractor hereby expressly waives and relinquishes any rights it might otherwise have

i) to move to dismiss on grounds of forum non conveniens; ii) to remove to Federal Court, and iii) to move for a change of venue to a New York State Court outside New York County.

C. With respect to any action between the City and the Contractor in Federal Court located in New

York City, the Contractor expressly waives and relinquishes any right it might otherwise have to move to transfer the action to a United States Court outside the City of New York.

D. If the Contractor commences any action against the City in a court located other than in the City

and State of New York, upon request of the City, the contractor shall either consent to a transfer of the action to a court of competent jurisdiction located in the City and State of New York or, if the court where the action is initially brought will not or cannot transfer the action, the Contractor shall consent to dismiss such action without prejudice and may thereafter reinstitute the action in a court of competent jurisdiction in New York City.

If any provision(s) of this Article is held unenforceable for any reason, each and all other

provision(s) shall nevertheless remain in full force and effect. 2. GENERAL RELEASE

The acceptance by the Contractor or its assignees of the final payment under this Agreement, whether by voucher, judgment of any court of competent jurisdiction or any other administrative

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means, shall constitute and operate as a general release to the City from any and all claims of and liability to the Contractor arising out of the performance of this Agreement.

3. CLAIMS AND ACTIONS THEREON A. No action at law or proceeding in equity against the City or Department shall lie or be

maintained upon any claim based upon this Agreement or arising out of this Agreement unless the Contractor shall have strictly complied with all requirements relating to the giving of notice and of information with respect to such claims, all as herein provided.

B. No action at law or proceeding in equity shall lie or be maintained against the Department or the

City upon any claim based upon this Agreement or arising out of this Agreement unless such action shall be commenced within six (6) months after the date of final payment hereunder, or within six (6) months of termination or conclusion of this Agreement, or within six (6) months of accrual of the cause of action, whichever is earliest.

C. In the event any claim is made or any action brought in any way relating to the Agreement

herein, the Contractor shall diligently render to the Department and/or the City of New York without additional compensation any and all assistance which the Department and/or the City of New York may require of the Contractor.

D. The Contractor shall report to the Department in writing within three (3) working days of the

initiation by or against the Contractor of any legal action or proceeding in connection with or relating to this Agreement.

4. NO CLAIM AGAINST OFFICERS, AGENTS OR EMPLOYEES

No claim whatsoever shall be made by the Contractor against any officer, agent or employee of the City for, or on account of, anything done or omitted in connection with this Agreement.

5. WAIVER Waiver by the Department of a breach of any provision of this Agreement shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of the Agreement unless and until the same shall be agreed to in writing by the Department or City as required and attached to the original agreement.

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6. NOTICE The Contractor and the Department hereby designate the business addresses specified in the Bid as the places where all notices, directions or communications from one such party to the other party shall be delivered, or to which they shall be mailed. Actual delivery of any such notice, direction or communication to a party at the aforesaid place, or delivery by certified mail shall be conclusive and deemed to be sufficient service thereof upon such party as of the date such notice, direction or communication is received by the party. Such address may be changed at any time by an instrument in writing executed and acknowledged by the party making such change and delivered to the other party in the manner as specified above. Nothing in this section shall be deemed to serve as a waiver of any requirements for the service of notice or process in the institution of an action or proceeding as provided by law.

7. ALL LEGAL PROVISIONS DEEMED INCLUDED It is the intent and understanding of the parties to this Agreement that each and every provision of law required to be inserted in this Agreement shall be and is inserted herein. Furthermore, it is hereby stipulated that every such provision is to be deemed to be inserted herein, and if, through mistake or otherwise, any such provision is not inserted, or is not inserted in correct form, then this Agreement shall forthwith upon the application of either party be amended by such insertion so as to comply strictly with the law and without prejudice to the rights of either party hereunder.

8. SEVERABILITY If this Agreement contains any unlawful provision not any essential part of the Agreement and which shall not appear to have been a controlling or material inducement to the making thereof, the same shall be deemed of no effect and shall upon notice by either party, be deemed stricken from the Agreement without affecting the binding force of the remainder.

9. PARAGRAPH HEADING Paragraph headings are inserted only as a matter of convenience and for reference and in no way define, limit or describe the scope or intent of this Agreement and in no way affect this Agreement.

10. INSPECTION AT SITE The Department shall have the right to have representatives of the Department, of the City, or of the State or Federal governments present at the site of the engagement to observe the work being performed.

ARTICLE 18 - APPROVALS

1. THE CITY OF NEW YORK

This Agreement shall not become effective or binding unless:

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A. The Comptroller shall have endorsed his certificate that there remains unexpended and unapplied a balance of the appropriation of funds applicable hereto sufficient to pay the estimated expense of executing this, and

B. Approved by the Mayor pursuant to the provisions of Executive Order No. 42, dated October 9,

1975 in the event the Executive Order requires such approval, and C. Certified by the Mayor (Mayor's Fiscal Committee created pursuant to Executive Order No. 43,

dated October 14, 1975) that performance thereof will be in accordance with the City's financial plan.

2. OTHER APPORVALS OR AUTHORIZATION

The requirement of the Article shall be in addition to, and not in lieu of, any approval or authorization otherwise required for this Agreement to be effective and for the expenditure of City funds.

ARTICLE 19 - ADDITIONAL COVENANTS

1. CONVERSION OF DEFAULT TO TERMINATION FOR CONVENIENCE

If, after a declaration of default under Article 16.2, it is determined that for any reason the Contractor was not in default under the provision of such Article, or that such default was excusable, the rights ad obligation of the parties shall be the same as if a notice of termination had been issued under Article 16.00 (A) of this Agreement.

2. CONTRACT CHANGES Changes may be made to this contract only as duly authorized by the Agency Chief Contracting Officer or the Agency Chief Contracting Officer’s designee Contractors deviating from the requirements of an original purchase order or contract without a duly approved change order, do so at their own risk. All such changes, modifications, and amendments will become a part of the original contract. Contract changes will be made only for work necessary to complete the work included in the original scope of the contract, and for non-material changes to the scope of the contract. Changes are not permitted for any material alteration in the scope of work. Changes may include any one or more of the following:

A. Specification changes to account for design errors or omissions; B. Changes in contract amount due to authorized additional or omitted work. Any such

changes require appropriate price and cost analysis to determine reasonableness. In addition, except for non-construction requirements contracts, all changes that cumulatively exceed the greater of ten percent of the original contract amount or $100,000 shall be approved by the CCPO (for non-construction contracts) or the Director of the Office of Construction (for construction and construction-related contracts);

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C. Extensions of a contract term for good and sufficient cause for a cumulative period not to exceed one year from the date of expiration of the current contract. Requirements contracts shall be subject to this limitation;

D. Changes in delivery location; E. Changes in shipment method; and F. Any other change not inconsistent with §4-02 of the P.P.B. Rules, in effect at the time of

contract award. The Contractor may be entitled to a price adjustment for extra work performed or to be performed pursuant to a written change order. If any part of the contract work is necessarily delayed by a change order, the Contractor may be entitled to an extension to time for performance. Adjustments to price shall be validated for reasonableness by using appropriate price and cost analysis. A. by unit prices specified in the contract; B. by time and material record, and /or C. in any other manner approved by the City Chief procurement Officer.

Where the cost of the change order has been negotiated in the absence of established cost history, the costs are subject to verification by post audit. If the post-audit reveals that the Contractor's costs for the change order work were inaccurately stated during negotiations, the agency shall recoup the amount by which the costs were inaccurately stated by proportionately reducing the price of the change order. This remedy is not exclusive and in addition to all other rights and remedies of the City. Except in the case of requirement contracts, any contract increases which cumulatively exceed the greater of 10% or $100,000.00 must be approved in writing by the City Chief Procurement Officer. Any contract amendment, which amends a unit price, cancels required units, or adds a new type of unit item to the contract must be approved in writing by the Agency Chief Contracting Officer.

ARTICLE 20 - ENTIRE AGREEMENT

This written Agreement including any attachment or references which have been incorporated herein, contains all the terms and conditions agreed upon by the parties hereto, and no other agreement, oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto, or to vary any of the terms contained herein.

ARTICLE 21 - PPB RULES

This contract is subject to the Rules of the Procurement Policy Board of the City of New York in effect at the time of award. In the event of a conflict between said Rules and a provision of this contract, the Rules shall take precedence. The New York City Comptroller is charged with the audit of contracts in New York City. Any vendor who believes that there has been unfairness, favoritism or impropriety in the bid process should inform the Comptroller, Office of Contract Administration, 1 Centre Street, Room 835, New York, NY 10007, telephone number (212) 669-3000.

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ADDENDUM I

The addendum is inserted in the Agreement for the purpose of complying with and obtaining the exemption provided by Section 1115 (6) (15) of the New York State Tax Law, as added by Laws of 1969, Chapter 473 from New York State Sales Tax and Compensating Use Tax, for the purchase of materials required by this contract, except materials consumed by the Contractor in the performance thereof. The Contractor, when bidding, should not include an amount to cover such New York State or New York City taxes.

a) The City of New York (City) is exempt from payment of Federal, State, Local taxes and Sales

and Compensating Use Taxes of the State of New York and of cities and counties on all materials and supplies sold to the City pursuant to the provisions of this contract. These taxes are not to be included in bids. However, this exemption does not apply to tools, machinery, subcontractor, or to supplies and materials which, even though they are consumed, are not incorporated into the completed work (the Contractor and his subcontractors shall be responsible for and pay any and all applicable taxes, including Sales and Compensation Use taxes, on such leased tools, machinery, equipment or other property and upon all such unincorporated supplies and materials and consumable supplies).

b) The Contractor agrees to sell and the City agrees to purchase all supplies and materials, other

than consumable supplies, required, necessary or proper for or incidental to the construction of the Project covered by this Agreement. The sum paid under this Agreement for such supplies and materials shall be in full payment and consideration for the sale of such supplies and materials under this Agreement.

The Contractor agrees to construct the Project and to perform all work, labor and services required, necessary or proper for or incidental thereto for the sum shown in the bid for the performance of such work, labor and services, and the sum so paid pursuant to this Agreement for such work, labor, etc. shall be in full consideration for the performance by the Contractor of all his duties and obligations under this Agreement in connection with said work and labor.

c) The purchase by the Contractor of the supplies and materials sold hereunder shall be a purchase or procurement for resale and therefore not subject to the New York State or New York City Sales or Compensating Use Taxes or any such taxes of cities or counties. The sale of such supplies and materials by the Contractor to the City is exempt from the aforesaid sales or compensating use taxes.

With respect to such supplies and materials the Contractor, at the request of the City, shall furnish to the City such bills of sale and other instruments as may be required by it, properly executed, acknowledged and delivered assuring to the City title to such supplies and materials, free of liens or encumbrances, and the Contractor shall mark or otherwise identify all such materials as the property of the City.

d) Title to all materials to be sold by the Contractor to the City, pursuant to the provisions of the

Contract, shall immediately vest in and become the sole property of the City upon delivery of such supplies and materials to the site and prior to its becoming a part of the permanent structure. Notwithstanding such transfer of title, the Contractor shall have the full and continuing responsibility to install such materials and supplies in accordance with the provisions of the

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Agreement, protect them, maintain them in a proper condition and forthwith repair, replace, and make good any damage thereto, theft or disappearance thereof, theft or disappearance thereof, and furnish additional materials in place of any that may be lost, stolen or rendered unusable, without cost to the City, until such time as the work covered by the Contract is fully accepted by the City. Such transfer of title shall in no way affect any of the Contractor's obligations hereunder. In the event that, after title has passed to the City, any of such supplies and materials are rejected as being defective or otherwise unsatisfactory, title to all such supplies and materials shall be deemed to have been transferred back to the Contractor.

e) The purchase by subcontractors of supplies and materials to be sold hereunder shall also be a

purchase or procurement for resale to the Contractor (either directly or through other subcontractors) and therefore not subject to the aforesaid subcontract agreements provide for the resale of such supplies incorporation of such supplies and materials into the permanent construction and that such subcontract agreements are in a form similar to this Contract with respect to the separation of the sale of materials from the work and labor, services, consumable supplies and any other matters to be provided and provided further that the subcontract agreements provide separate prices for (1) materials and (2) all other services and matters. Such separation shall actually be followed in practice, including the separation of payments for supplies and materials from the payments for other work and labor and other things to be provided.

f) The Contractor and his subcontractors and material men shall obtain any and all necessary

Contractor Exempt Purchase Certificates or resale certificates from the appropriate governmental agency or agencies, and furnish a Contractor Exempt Purchase Certificate or resale certificate to all persons, firms or corporations from which they purchase supplies and materials for the performance of the work covered by this Contract.

g) In the event any of the provisions of the agreement to which this is an addendum shall be

deemed to be in conflict with this addendum or shall be deemed to be in conflict with this addendum or shall create any ambiguity, then the addendum shall control.

SUPPLY AND SERVICE BID LANGUAGE This contract will be subject to the Mayor's Executive Order No. 50 (1980) (E.O. 50) and the rules and regulations promulgated thereunder. E.O 50 requires municipal contractors to be equal opportunity employers who do not discriminate against employees and applicants for employment in any employment decision, based on race, color, creed, national origin, sex, age disability, marital status or sexual orientation. Before the contracting agency may award the contract, the proposed Contractor (low bidder or identified vendor) must fulfill E.O. 50's requirements in their entirety. The proposed Contractor on a contract in excess of $50,000 must submit to the contracting agency a fully completed Supply and Service Employment Report (ER), if the Contractor employs at least 50 employees. (Such covered Contractors who employ less than 50 employees must complete and submit an affidavit to that effect. The affidavit is part of the ER). The contracting agency will send the ER to the Bureau of Labor Services (Bureau) for pre-award review. The Contractor must file an ER for each facility involved in performing the contract. The ER requires the Contractor to submit four kinds of information:

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1) information about the nature and results of previous government audits or complaints concerning the Contractor's compliance with equal employment opportunity (EEO) requirements, along with copies of existing Affirmative Action Plan (AAP's);

2) copies of fringe benefit plan, personnel manuals, employment applications and collective bargaining

agreements where applicable; 3) information concerning the Contractor's employment policies and practices in such areas as

recruitment, selection and promotion of employees, validation of selection devices, content and dissemination of EEO policies, preemployment physical exams, architectural barriers and facilities for disable employees, compensation and fringe benefits, and;

4) a detailed analysis of the racial and sexual composition of the Contractor's workforce by job group.

The Contractor must fill out four data tables, including a job match/job group form. The job match/group form gathers the Contractor's job titles into job groups. The other forms require among other things, incumbent, new hire (including salary), promotion and termination (including age) information by race and sex.

Effective September 1, 1984, instead of completing the data tables (including job/match group form) Contractors that maintain personnel information on a computerized data base will be expected to submit the information on computer tapes in the format set forth by the Bureau. Copies of the format, the ER, E.O. 50 and the rules and regulations are available upon request from the contracting agency. The Bureau will review the completed ER and will authorize the contracting agency to award the contract if the Bureau finds that the Contractor complies with E.O. 50 and the implementing regulations. However, if the Bureau's review identifies under-utilization of minorities or women or employment practices that do not comply with E.O. 50, the Bureau may first confer with the Contractor to develop an Employment Program to correct these problems. Failure to meet the requirements of E.O. 50 may result in the imposition of sanctions including disapproval of the Contractor, or suspension of termination of the contract. Every subcontract or purchase order (performing part of the prime contract) in excess of $50, 000 is also subject to the mandates of E.O. 50 and its rules and regulations. The prime Contractor must notify each of its subcontractors or vendors of the requirements and the obligation to submit an ER and must ensure that each subcontractor or vendor submits the ER to the contracting agency. The contract that the vendor and agency will enter into is mandated to contain E.O. 50 language. The required contractual language is part of Appendix A, General Provisions and is included herein for your information: This contract is subject to the requirements of Executive Order No. 50 (April 25, 1980) (E.O. 50") and the Rules and Regulations promulgated thereunder. No contract will be awarded unless and until these requirements have been complied within their entirety. By signing this contract, the Contractor agrees that it: (1) will not discriminate against any employee or applicant for employment because of race, creed,

color, national origin, sex, age, disability, marital status, sexual orientation, with respect to all employment decisions including, by not limited to recruitment, hiring, upgrading, demotion,

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downgrading, transfer, training, rates of pay or other forms of compensation, layoff, termination and all other terms and conditions of employment;

(2) will not discriminate in the selection of subcontractors on the basis of the owner's, partner's or

shareholders' race, color, creed, national origin, sex, age, disability, marital status or sexual orientation;

(3) will state in all solicitations or advertisements for employees placed by or on behalf of the

Contractor that all qualified applicants will receive consideration for employment without regard to race, creed, color, national origin, sex, age, disability, marital status, sexual orientation, or is an equal employment opportunity employer;

(4) will send to each labor organization or representative of workers with which it has a collective

bargaining agreement or other contract or memorandum of understanding, written notification of its equal employment opportunity commitments under E.O. 50, and the rules and regulations promulgated thereunder,

(5) will furnish before the contract is awarded all information and reports including an Employment

Report which are required by E.O. 50, the rules and regulations promulgated thereunder, and orders of the Director of the Bureau of Labor Services ("Bureau"). Copies of all required reports are available upon request from the contracting agency, and;

(6) will permit the Bureau to have access to all relevant books, records and accounts by the Bureau

for the purpose of investigation to ascertain compliance with such rules, regulations and orders. The Contractor understands that in the event of its noncompliance with the nondiscrimination

clauses of this contract or with any of such rules, regulations, or orders, such noncompliance shall constitute a breach of contract and noncompliance with E.O. 50 and the rules and regulations promulgated thereunder. After a hearing held pursuant to the rules of the Bureau, the Director may direct the imposition by the contracting agency head of any of all of the following sanctions:

i. disapproval of the Contractor; ii. suspension or termination of the contract; iii. declaring the Contractor in default, or; iv. in lieu of any of the foregoing sanctions, the Director may impose an employment

program.

The Director of the Bureau may recommend to the contracting agency head that a Board of Responsibility constituted pursuant to the PPB rules and regulations be convened for purposes of declaring a Contractor who has repeatedly failed to comply with E.O. 50 and the rules and regulations promulgated thereunder to be non-responsible.

The Contractor agrees to include the provisions of the foregoing paragraph in every subcontract or purchase order in excess of $50, 000 to which it becomes a party unless exempted by E.O. 50 and the rules and regulations promulgated thereunder, so that such provisions will be binding upon each subcontractor or vendor. The Contractor will take such action with respect to any subcontract or

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purchase order as may be directed by the Director of the Bureau of Labor Services as a means of enforcing such provisions including sanctions for noncompliance. The Contractor further agrees that it will refrain from entering into any contract or contract modification subject to E.O. 50 and the rules and regulations promulgated thereunder with a subcontractor who is not in compliance with the requirements of E.O. 50 and the rules and regulations promulgated thereunder.

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MACBRIDE PRINCIPLES PROVISIONS FOR THE NEW YORK CITY CONTRACTORS

ARTICLE I. MACBRIDE PRINCIPLES

NOTICE TO ALL PROSPECTIVE CONTRACTORS

Local Law No. 34 of 1991 became effective on September 10, 1991 and added section 6-115.1 to the Administrative Code of the City of New York. The local law provides for certain restrictions on City contracts to express the opposition of the people of the City of New York to employment discrimination practices in Northern Ireland and to encourage companies doing business in Northern Ireland to promote freedom of workplace opportunity. Pursuant to Section 6-115.1, prospective contractors for contracts to provide goods or services involving an expenditure of an amount greater than ten thousand dollars, or for construction involving an amount greater than fifteen thousand dollars, are asked to sign a rider in which they covenant and represent, as a material condition of their contract, that any business in Northern Ireland operations conducted by the contractor bolds a ten percent or greater ownership interest in the contractor will be conducted in accordance with the MacBride Principles of non discrimination in employment. Prospective contractors are not required to agree to these conditions. However, in the case of contracts let by competitive sealed bidding, whenever the lowest responsible bidder has not agreed to stipulate to the conditions set forth in this notice and another bidder who has agreed to stipulate to such conditions has submitted a bid within five percent of the lowest responsible bid for a contract to supply goods, services or construction of comparable quality, the contracting entity shall refer such bids to the Mayor, the Speaker or other officials, as appropriate, who may determine, in accordance with applicable law and rules, that it is in the best interest of the city that the contract be awarded to other than the lowest responsible bidder pursuant to Section 313(b)(2) of the City Charter. In the case of contracts let by other than competitive sealed bidding, if a prospective contractor does not agree to these condition, no agency, elected official or the Council shall award the contract to that bidder unless the entity seeking to use the goods, services or construction certifies in writing that the contract is necessary for the entity to perform its functions and there is no other responsible contractor who will supply goods, services or construction of comparable quality at a comparable price.

PART A

In accordance with section 6-115.1 of the Administrative Code of the City of New York, the contractor stipulates that such contractor and any individual or legal entity in which the contractor holds a ten percent or greater ownership interest and any individual or legal entity that holds a ten percent or greater ownership interest in the contractor either (a) have no business operations in Northern Ireland or (b) shall take lawful steps in good faith to conduct any business operations they have in Northern Ireland in accordance with the MacBride Principles, and shall permit independent monitoring of their compliance with such principles.

PART B

For purposes of this section, the following terms shall have the following meanings:

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1. “MacBride Principles” shall mean those principles relating to nondiscrimination in employment and freedom of workplace opportunity which require employers doing business in Northern Ireland to:

(1) increase the representation of individuals from underrepresented religious groups in the work force, including managerial, supervisory, administrative, clerical and technical jobs; (2) take steps to promote adequate security for the protection of employees from underrepresented religious groups both at the workplace and while traveling to and from work; (3) ban provocative religious or political emblems from the workplace; (4) publicly advertise all job openings and make special recruitment efforts to attract applicants from underrepresented religious groups. (5) establish layoff, recall and termination procedures which do not in practice favor a particular religious group; (6) abolish all job reservations, apprenticeship restrictions and different employment criteria which discriminate on the basis of religion; (7) develop training programs that will prepare substantial numbers of current employees from underrepresented religious groups for skilled hobs, including the expansion of existing programs and the creation of new programs to train, upgrade and improve the skills of workers from underrepresented religious groups; (8) establish procedures to assess, identify and actively recruit employees from underrepresented religious groups with potential for further advancement; and (9) appoint a senior management staff member to oversee affirmative action efforts and develop a timetable to ensure their full implementation.

ARTICLE II. ENFORCEMENT OF ARTICLE I The contractor agrees that the covenants and representation in Article I above are material conditions to this contract. In the event the contracting entity receives information that the contractor who made the stipulation required by this section is in violation thereof, the contracting entity shall review such information and give the contractor an opportunity to respond. If the contracting entity finds that a violation has occurred, the entity shall have the right to declare the contractor in default and/or terminate this contract for cause and procure the supplies, services or work from another source in any manner the entity deems proper. In the event of such termination, the contractor shall pay to the entity in its sole discretion may withhold from any amounts otherwise payable to the contractor, the difference between the contract price for the uncompleted portion of this contract and the cost to the contracting entity of completing performance of this contract either itself or by engaging another contractor or contractors. In the case of a requirements contract, the contractor shall be liable for such difference in price for the entire amount of supplies required by the contracting entity for the uncompleted term of its contract. In the case of a construction contract, the contracting entity shall also have the right to hold the contractor in partial or total default in accordance with the default provisions of this contract, and/or may seek debarment or suspension of the contractor. The rights and

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remedies of the entity hereunder shall be in addition to, and not in lieu of, any rights and remedies the entity has pursuant to this contract or by operation of law.

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Health Insurance Portability and Accountability Act Business Associate Contract Provisions

I. Definitions

Except as otherwise defined herein, any and all terms used in this Attachment shall have the same meaning as those terms in the Privacy Rule. As used in this Attachment, the following terms shall have the following meanings:

(a) “Attachment” shall mean the Health Insurance Portability and Accountability Act Business Associate Contract Provisions constituting this attachment.

(b) "Business Associate" shall mean [Insert Name of Business Associate].

(c) "Covered Entity" shall mean [Insert Name of Covered Entity] or Health Care Component(s) (as defined in 45 CFR §164.103) of [Insert Name of Covered Entity], as applicable.

(d) “HIPAA” shall mean the Health Insurance Portability and Accountability Act of 1996, Public Law No. 104-191, and the regulations promulgated thereunder, as they may be amended.

(e) "Individual" shall have the same meaning as the term "individual" in 45 CFR §160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR §164.502(g).

(f) "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A, C and E.

(g) "Protected Health Information" shall have the same meaning as the term "protected health information" in 45 CFR §160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity.

(h) "Required By Law" shall have the same meaning as the term "required by law" in 45 CFR §164.103.

(i) "Secretary" shall mean the Secretary of the Department of Health and Human Services or his designee.

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II. Obligations and Activities of Business Associate

(a) Business Associate agrees to not use or disclose Protected Health Information other than as permitted or required by this Attachment or as Required By Law.

(b) Business Associate agrees to use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Attachment.

(c) Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Attachment.

(d) Business Associate agrees to report to Covered Entity any use or disclosure of the Protected Health Information not provided for by this Attachment of which it becomes aware as soon as reasonably practicable.

(e) Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Business Associate on behalf of Covered Entity, agrees to the same restrictions and conditions that apply through this Attachment to Business Associate with respect to such information.

(f) Business Associate agrees to provide access, at the request of Covered Entity, and in the time and manner designated by the Covered Entity, to Protected Health Information in a Designated Record Set, to Covered Entity or, as directed by Covered Entity, to an Individual in order to meet the requirements under 45 CFR §164.524, if the Business Associate has Protected Health Information in a Designated Record Set.

(g) Business Associate agrees to make any amendment(s) to Protected Health Information in a Designated Record Set that the Covered Entity directs or agrees to pursuant to 45 CFR §164.526 at the request of Covered Entity or an Individual, and in the time and manner designated by the Covered Entity, if the Business Associate has Protected Health Information in a Designated Record Set.

(h) Business Associate agrees to make internal practices, books, and records, including policies and procedures, relating to the use and disclosure of Protected Health Information received from, or created or received by Business Associate on behalf of, Covered Entity available to the Covered Entity, and to the Secretary, in the time and manner designated by the Covered Entity or the Secretary, for purposes of the Secretary determining Covered Entity's compliance with the Privacy Rule.

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(i) Business Associate agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR §164.528.

(j) Business Associate agrees to provide to Covered Entity or an Individual, in the time and manner designated by the Covered Entity, information collected in accordance with paragraph (i) of this Section II of this Attachment, to permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR §164.528.

(k) Business Associate agrees to implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of the Covered Entity.

(l) Business Associate agrees to ensure that any agent, including a subcontractor, to which it provides electronic Protected Health Information agrees to implement reasonable and appropriate safeguards to protect such Protected Health Information.

(m) Business Associate agrees to report to the Covered Entity any security incident of which Business Associate becomes aware as soon as reasonably practicable.

III. Permitted Uses and Disclosures by Business Associate

(a) Except as otherwise limited in this Attachment, Business Associate may use or disclose Protected Health Information to perform functions, activities, or services for, or on behalf of, Covered Entity as specified in the Agreement to which this is an Attachment, provided that such use or disclosure would not violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered Entity.

(b) Except as otherwise limited in this Attachment, Business Associate may use Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate.

(c) Except as otherwise limited in this Attachment, Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate, provided that disclosures are Required By Law, or Business Associate obtains reasonable assurances from the person to whom the information is

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disclosed that it will remain confidential and used or further disclosed only as Required By Law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

(d) Except as otherwise limited in this Attachment, Business Associate may use Protected Health Information to provide Data Aggregation services to Covered Entity as permitted by 45 CFR §164.504(e)(2)(i)(B).

(e) Business Associate may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR §164.502(j)(1).

IV. Obligations of Covered Entity

(a) Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices of Covered Entity in accordance with 45 CFR §164.520, to the extent that such limitation may affect Business Associate's use or disclosure of Protected Health Information.

(b) Covered Entity shall notify Business Associate of any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, to the extent that such changes may affect Business Associate's use or disclosure of Protected Health Information.

(c) Covered Entity shall notify Business Associate of any restriction to the use or disclosure of Protected Health Information that Covered Entity has agreed to in accordance with 45 CFR §164.522, to the extent that such restriction may affect Business Associate's use or disclosure of Protected Health Information.

V. Permissible Requests by Covered Entity

Covered Entity shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by Covered Entity. Nothing in this Section V shall be construed to affect or limit the Business Associate’s right to use or disclose Protected Health Information as provided in paragraphs (b), (c), and (d) of Section III of this Attachment.

VI. Term and Termination

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(a) Term. The Term of this Attachment shall be effective during the term of the Agreement to which this is an Attachment, or until earlier termination of the Agreement, after which time all of the Protected Health Information provided by Covered Entity to Business Associate, or created or received by Business Associate on behalf of Covered Entity, shall be destroyed or returned to Covered Entity, or, if it is infeasible to return or destroy Protected Health Information, protections are extended to such information, in accordance with the termination provisions in this Section.

(b) Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate of any of the terms and conditions of this Attachment, Covered Entity shall either:

(1) Provide an opportunity for Business Associate to cure the breach or end the violation and terminate the Agreement to which this is an Attachment if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity;

(2) Immediately terminate the Agreement to which this is an Attachment if Business Associate has breached a material term of this Attachment and cure is not possible; or

(3) If neither termination nor cure are feasible, Covered Entity shall report the violation to the Secretary.

(c) Effect of Termination.

(1) Except as provided in paragraph (2) of this subsection, upon termination of the Agreement to which this is an Attachment, for any reason, Business Associate shall return or destroy all Protected Health Information received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information.

(2) In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction infeasible. Upon receipt by Covered Entity of such notification that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Attachment to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make

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the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information.

(d) The termination provisions of this Section VI. are in addition to, and not in lieu of, the termination provisions provided elsewhere in the Agreement to which this is an Attachment and any other rights and remedies of the Covered Entity that are provided by law or by the Agreement to which this is an Attachment.

VII. Miscellaneous

(a) Indemnification. Business Associate agrees to defend, indemnify and hold harmless Covered Entity, the City of New York, and their respective employees, officers, subcontractors and agents (each of the foregoing hereinafter referred to as “indemnified party”) against all losses suffered by the indemnified party and all liability to third parties arising from or in connection with: (i) any breach of the provisions of this Attachment; (ii) any breach of the provisions of the Agreement to which this is an Attachment relating to the use or disclosure of Protected Health Information; or (iii) any negligence or wrongful acts or omissions by Business Associate, its employees, directors, officers, subcontractors, or agents that result in a violation of HIPAA. Accordingly, on demand, the Business Associate shall reimburse the indemnified party for any and all losses, liabilities, fines, penalties, costs, or expenses (including reasonable attorneys’ fees) which may for any reason be imposed upon indemnified party by reason of any suit, claim, action, proceeding, or demand by any third party which results from the conduct described in (i), (ii) or (iii) above.

(b) Regulatory References. A reference in this Attachment to a section in the Privacy Rule means the section as in effect or as amended.

(c) Amendment. In order to ensure that this Attachment at all times remains consistent with applicable law regarding use and disclosure of Protected Health Information (including, but not limited to, HIPAA), Business Associate agrees that this Attachment may be amended from time to time upon written notice from Covered Entity to Business Associate as to the revisions required to make this Attachment consistent with applicable law.

(d) Survival. The respective rights and obligations of Business Associate and Covered Entity under the provisions of Section VI(c), Section VII(a) and (f), and Section II (solely with respect to Protected Health Information that Business Associate retains in accordance with Section VI(c) where it is not feasible to return or destroy such Protected Health Information), shall survive the expiration or termination of the Agreement to which this is an Attachment.

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(e) Interpretation. Any ambiguity in this Attachment shall be resolved in favor of a meaning that permits Covered Entity to comply with the Privacy Rule.

(f) No Third Party Beneficiaries. Nothing express or implied in this Attachment is intended to confer, nor shall anything herein confer, upon any person other than the parties and the respective successors or assigns of the parties, any rights, remedies, obligations, or liabilities whatsoever.

(g) More Restrictive Provisions Control. In the event that the Agreement to which this is an Attachment contains provisions relating to the use or disclosure of Protected Health Information which are more restrictive than the provisions of this Attachment, the provisions which are more restrictive shall control.

(h) Requirements of Public Health Law Article 27-F. If HIV/AIDS information is to be disclosed under the Agreement to which this is an Attachment, the Business Associate acknowledges that it is aware of the confidentiality requirements of Public Health Law Article 27-F.

EXHIBIT 1 – PATIENT PRE-HOSPITAL CARE REPORT

EXHIBIT 2 – CURRENT FILE FORMAT

CURRENT FILE FORMAT

Field # Field Name Data Type Length Allowable Values Comments1 ACR_NUM Number 8 PCR Number2 CAD Number* 4

3 TIME (assigned time from CAD) Number* 4 Valid Time

If the same person gets two bills for one day, the time helps us identify whether the person was actually transported twice.

4 PATH Text 8 PCR Number

5 NOTRANS_IND Number 1 1 - 6

1 - Assisted in Transport, 2 - Transferred Care, 3 - RMA, 4 - Pronounced on Scene, 5 - Onscene Triage, 6 - Other

6 DOS Date 10 Valid Date mm/dd/yyyy (zero pad month and day to 2 digits)7 UNIT Text 4 Valid Unit8 UNIT_TYPE Text 1 A,B ALS / BLS9 D_SHIELD Number 6 Valid employee

10 T_SHIELD Number 6 Valid employee11 CALL_LOCATION Text 50 Free Text Incident Address12 CALL_LOCATION_TYPE Text 1 R, S Residence,Scene (if unknown pass 'S')13 CALL_LOCATION_ZIP Number 5 Valid Zip Code14 HOSPITAL Number* 4 Lookup table - Hospital Number15 DEST_TYPE Text 1 H, M Hospital, Morgue

16 HOSP_SEL Text 1 A,C,D,EA - Nearest Facility, C - Hospital Diversion, D - Patient / Family Choice, E - Specialty Referral

17 HOSP_AGENT Text 1 Y, N18 SIGN Text 1 P, U, R, B patient, unable to obtain, refused, blank19 MILES Number* 2 Integer20 NUM_PATS Number 1 0 - 921 L_NAME Text 25 Free Text22 F_NAME Text 25 Free Text23 ADDRESS_1 Text 50 Free Text Including Apt No25 CITY Text 25 Free Text26 STATE Text 2 Valid State27 ZIP Number 528 SSN Number 9

AREA_CODE Number 329 TELEPHONE Text 8 NNN-NNNN

30 DOB Date 10 Valid Date mm/dd/yyyy (zero pad month and day to 2 digits)

31 AGE Number* 3 IntegerAge in years (?Units should be the Modifier field not always years?)

32 AGE_MODIFIER Number 1 1, 2, 3 1 = Days, 2 = Months, 3 = Years33 SEX Text 1 M, F34 ICD91 Text 6 Valid ICD-9 May change to condition codes?35 ICD92 Text 6 Valid ICD-936 ICD93 Text 6 Valid ICD-937 ICD94 Text 6 Valid ICD-944 SERVICE_LEVEL Number 1 1, 2, 3 1 = BLS,2 = ALS1, 3 = ALS2 treatment

45 O2_IND Number 1 1 - 51 - Bag Valve Mask w/O2, 2 - Mouth to Mask, 3 - Cannula, 4 - Non-Rebreather, 5 - Nebulizer

46 VOC Text 1 S, V, BLANK S = Sexual Assault, V = Victim of Crime

47 INSURANCE_TYPE Number 1 1 - 4 1 - Auto, 2 - Private, 3 - Employment, 4 - Self Pay48 INSURANCE_NAME Text 30 Free Text49 MEDICARE_NUM Text 10 Free Text50 MEDICAID_NUM Text 10 Free Text51 POLICY_NUM Text 20 Free Text52 GROUP_NUM Text 20 Free Text53 REMOVED_STRETCHER Text 1 Y, N54 VISABLE_HEMORRHAGING Text 1 Y, N55 UNCONSCIOUS_SHOCK Text 1 Y, N56 RESTRAINTS_NEEDED Text 1 Y, N57 BED_CONFINED Text 1 Y, N58 REQAMB Text 1 Y, N59 REQHOSP Text 1 Y, N60 EMERG Text 1 Y, N

Data Type 'Number*' indicates value will include leading zeros to make it the specified length when necessary

EXHIBIT 3 – FDNY MEDICAL BILLING COMPLIANCE MANUAL

DRAFT - 1 -

New York City Fire Department

Medical Billing Compliance Program and Operating Standards

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New York City Fire Department Medical Billing Compliance Program I. Purpose 4 II. Introduction 5 III. Overall Structure and Elements of the Program 5 1. Compliance Standards 5 2. Employee Participation and Reporting 5 3. Compliance Committee and Compliance Officer 6 5. Responsibility of Managers and Supervisors 7 6. Employee Education and Training 7 7. Employee / Vendor Screening Process 8 8. Enforcement and Discipline 9 9. Monitoring and Auditing 10

A. Monitoring 10 B. Auditing 10

10. Reporting, Investigating, and Correcting Compliance Problems 10 A. Lines of Communication 10 B. Investigation 11

IV. An Overview of the Legal Framework within which the FDNY must

operate in relation to FDNY’s claims submission for ambulance transports 13 1. Social Security Act 13 2. Centers for Medicare and Medicaid Services (CMS) 13 3. Medicare Benefit Policy and Claims Processing Manual 14 4. National Government Services (NGS) - Ambulance Reference Guide and

Fee Schedule 16 V. An Overview of the Laws that Create a Compliance Obligation and Provide

Penalties for Failure to Comply 16 1. Fraud and Abuse Overview 16 2. False Claims Act 17 3. Anti-Kickback Laws 20 4. Contracting with Outside Billing Agents 22 VI. Principles and Standards Regarding the Submission of Claims For Ambulance

Services 22 1. Conflicts of Interest 22 2. Legal Compliance 23 3. Claims Development and Submission Process 23 4. Record Retention 25

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VII. Procedures that will Assist Employees in Performing their Job Functions in Accordance with Applicable Laws 25

1. General Documentation 26 2. Documentation of Medical Condition to Support the Services Billed 26 3. Information Release and Assignment of Claim 26 4. Insurance Information 28 5. Mileage 28 6. Receiving Hospital Information 28 7. Scanning of EPCRs 29 8. Reviewing EPCRs 29 9. Disposal Of EPCRs 29 10. Identifying Billable Claims 29 11. Medical Necessity Review 30 11. Diagnostic Coding 32 12. Billing 33 13. Customer Service 34 VIII. Elements of Training and Education Programs 35 1. All Employees Involved in the Development and Submission of Claims 35 2. Medical Necessity 35 3. Diagnostic Coding 36 IX. Audit Requirements 36 Appendix I 38 FIRE DEPARTMENT COMPLIANCE PROGRAM 38 Appendix II 39 Medical Compliance Committee Charter 39 Appendix III 40 Electronic Patient’s Care Report Form(EPCR) 40 Appendix IV 41 Medical Necessity Questionnaire 41 Appendix V 42 Federal and New York Statutes Relating to Filing False Claims 42

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New York City Fire Department Medical Billing Compliance Program I. Purpose The New York City Fire Department (“FDNY”) has established a medical billing compliance program to ensure that its employees and agents, either through an employment agreement or independent contract (“employees”), comply with all applicable laws, regulations, and program requirements when submitting claims for payment and reimbursement of ambulance services. This program is intended to provide a comprehensive statement of the responsibilities and obligations of employees regarding claims submissions for ambulance services to patients, private insurance companies and Medicare. In addition, this program is intended to apply to business arrangements with vendors, hospitals, and other persons or entities, which may be impacted by federal or state laws relating to fraud and abuse. Included in this program are standards and procedures whose purpose is to provide guidance regarding how employees must conduct themselves in order to protect and promote integrity in the billing process. It is the responsibility and obligation of all employees to abide by and conduct themselves in a manner consistent with these guidelines. Failure to abide may lead to disciplinary action or, in appropriate instances, criminal or civil penalties under federal, state, or local law. This program is primarily designed to address billing requirements. Employees should be guided by its principles and procedures, as applicable, when submitting claims to patients, private insurance and other federal health care programs, such as Medicare, Medicaid, CHAMPUS, etc.

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II. Introduction This Medical Billing Compliance Program is comprised of the following components:

Overall structure and elements of the program.

An overview of the legal framework within which the FDNY must operate in relation to claims submission for ambulance transports.

An overview of the laws that create a compliance obligation and provide

penalties for failure to comply.

Principles and standards regarding the submission of claims for ambulance services.

Procedures that will assist employees in performing their job functions in

accordance with applicable laws.

Elements of training and education programs.

Audit requirements. III. Overall Structure and Elements of the Program

1. Compliance Standards

Compliance standards and procedures have been developed by the Fire Commissioner to provide guidance to employees regarding how they must conduct themselves in order to protect and promote integrity in the billing process. All employees are responsible to ensure that their behavior and activity are consistent with these guidelines and applicable program requirements.

It shall be the responsibility of the Compliance Officer to ensure that the standards and procedures remain current and are updated as necessary.

In addition, the designated manager and/or supervisor in each affected area shall be responsible for ensuring that the compliance standards and procedures are adhered to, assessing particular compliance risks that relate to his or her area, and making recommendations to the Compliance Officer for changes to address those risks.

2. Employee Participation and Reporting

It is the responsibility of all employees to abide by applicable laws, regulations, and program requirements and to support the FDNY’s billing compliance efforts.

All employees are required to report any violation of the compliance program or applicable law, if they have a good faith belief that a violation has occurred. Violations shall be reported, either orally or in writing, to the employee’s manager or

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supervisor, or if the employee prefers, directly to the Compliance Officer. Employees wishing to report violations may also use the twenty-four hour, seven day-a-week, telephone hotline(s). These number(s) will be disseminated to all employees, prominently posted1 at central locations, and at all ambulance stations.

The FDNY encourages reporting of violations. The FDNY will not retaliate against an employee or take any action adverse to the terms and conditions of his or her employment for reporting a violation in good faith. The FDNY will honor employee requests for anonymity to the maximum extent possible under the circumstances, consistent with the FDNY’s obligations to investigate reported violations and to take corrective action.

3. Compliance Committee and Compliance Officer

The Fire Commissioner has created a Compliance Committee2 for the purpose of establishing and implementing the integrity obligations of the billing compliance program. In addition, the Fire Commissioner has designated the Compliance Officer as the individual within the FDNY with day-to-day responsibility for implementation and operation of this billing compliance program.

The members of the Compliance Committee include the Medical Director, Fire Department General Counsel, Chief of Emergency Medical Services, Assistant Commissioner for Investigations and Trials, Director of Personnel, Assistant Commissioner for Finance, Compliance Officer, or appointed designees of such employees.

The Compliance Officer, in cooperation with the Compliance Committee, shall be responsible for ensuring that:

standards and procedures are reviewed and updated as necessary; mechanisms are in place for employee and vendor screening and are operating

properly; employees are receiving adequate education and training and such education

and training are documented; independent contractors are made aware of the requirements of the compliance

program; monitoring and audit procedures are implemented; employee complaints and other concerns regarding compliance are promptly

investigated; adequate steps are taken to correct any identified problems and prevent their

recurrence; and applicable requirements are met, including reporting requirements of the

compliance program. All HIPAA rules and regulations are adhered to.

1 see Appendix I: Compliance Program Posting 2 see Appendix II: Medical Compliance Committee Charter

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4. Reporting

The Compliance Officer shall report, as necessary, to the Fire Commissioner on the status of billing compliance. These reports shall include a summary of findings and recommendations, ongoing investigations, and any other information requested by the Fire Commissioner.

In addition, the Compliance Officer shall submit Implementation and Annual Reports, including audit results, to all parties affected by the findings.

The FDNY shall maintain all information (including supporting documentation) relating to the Annual Reports on its premises, arranged by report year, so that it will be readily available for a minimum of six years.

5. Responsibility of Managers and Supervisors

Each manager and supervisor shall:

ensure that all billing activities in his or her area of responsibility are conducted in accordance with this compliance program;

inform the Compliance Officer of any problems he or she observes, or becomes aware of, that could have a detrimental effect on the FDNY’s billing compliance efforts;

identify training and compliance needs; and actively promote compliance.

6. Employee Education and Training

It is FDNY policy to provide employees involved in the development and submission of claims with such education and training as may be reasonably necessary and appropriate to ensure compliance with applicable laws, regulations, and program requirements.

This policy, and the education and training provided pursuant to this policy, are intended to ensure that employees have sufficient subject matter knowledge and experience to carry out their duties in full compliance with all applicable requirements.

The Compliance Officer, in conjunction with other FDNY personnel and consultants, shall be responsible to ensure employee’s education and training. Such education and training may consist of lectures, workshops, case studies, videos, and classes. In addition to the training related to the FDNY Medical Billing Compliance program, all employees must receive training related to HIPAA rules and regulations regarding patient’s privacy. All employees involved in the development and submission of claims shall receive at least two hours of initial training, which they must attend and successfully complete. Likewise, all new hires for these functions will be trained as part of the orientation program provided to new employees. Thereafter, employees directly involved in billing will receive at least 1 hour of annual retraining. All other employees will receive retraining (at least 1 hour) every three years.

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The Compliance Officer shall also ensure that all education and training provided to employees is documented. The documentation shall include the names and positions, including the division and/or unit, of the individuals conducting and receiving the training, the date and duration of the educational activity or training program, and a brief description of the subject matter. In addition, each employee will be required to sign a certification that he or she has received, read, understood, and will abide by billing compliance policies. The documentation and certifications shall be kept on file.

7. Employee / Vendor Screening Process

It is FDNY policy to inquire into the background of any potential employee or independent contractor.

As part of this process, the Compliance Officer shall ensure that mechanisms are in place to effectively screen those potential employees and independent contractors whose job functions or activities impact the claims development or submission process. In particular, prospective employees and vendors shall be screened to determine whether they have been:

convicted of a criminal offense related to health care; or listed by a federal agency as excluded, suspended, or otherwise ineligible for

participation in any federal health care program.

With regard to exclusion, suspension, and ineligibility, this screening shall include a review of the OIG’s Cumulative Sanctions Report and the General Services Administration’s (“GSA’s”) List of Parties Excluded from Federal Procurement and Non-Procurement Programs. These reports can be found on the “Internet” at “www.dhhs.gov/progorg/oig” and “www.arnet.gov/epls,” respectively. The Compliance Officer will periodically review these reports to ensure that the FDNY is meeting its obligations. Questions may also be directed to: Office of Inspector General, Office of Enforcement and Compliance, 7500 Security Boulevard, Room N2-01-26, Baltimore, Maryland, 21244, or by telephone at (410) 786-9603.

Additionally, in the event that the FDNY learns that an employee or contractor is listed by a federal agency as excluded, suspended, or otherwise ineligible for participation in any federal health care program, the FDNY will report such finding to OIG, and make reasonable efforts to remedy the situation in accordance with applicable federal law and contracting, civil service, collective bargaining requirements, and other state law. The FDNY will remove from responsibility for, or involvement with, the FDNY’s federal health care program business operations any employee or independent contractor who becomes suspended or is proposed for exclusion during the individual’s employment or contract with the FDNY, until the resolution of such suspension or proposed exclusion.

In addition, if any employee or independent contractor of the FDNY is charged with a criminal offense relating to its federal health care program business, the FDNY will remove that individual immediately from responsibility for, or involvement with, the FDNY’s Federal Health Care Program affairs. If an employee or independent contractor is

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convicted or debarred, the FDNY shall remove that individual from any position for which the individual’s salary or the services rendered by the individual are paid in whole or in part, directly or indirectly, by the federal health care programs or otherwise with federal funds.

The FDNY shall not knowingly allow, or cause to be allowed, any person convicted in any local, state, or federal court of any felony involving health care matters to hold a management position within the FDNY’s billing operation or a similar capacity with any of its agents, either through an employment agreement or an independent contract.

8. Enforcement and Discipline

Employees who fail to adhere to the FDNY’s billing compliance efforts shall be subject to appropriate discipline. Violating conduct may include, but shall not be limited to:

conduct that leads to the filing of a false claim or that is otherwise responsible

for the filing of a claim in violation of state or federal law, or conduct that results in violation of any other law relating to participation in the Medicare or other federal health care programs;

the failure to comply with all laws, regulations, and program requirements regarding the development and submission of claims;

the failure to perform any obligation required by this billing compliance program; the failure to report suspected violations of this compliance program or

applicable laws, regulations, or program requirements to the appropriate person; or

the failure on the part of the Compliance Officer, or a managerial or supervisory employee, to implement and maintain policies and procedures reasonably necessary to ensure compliance with the terms of this compliance program, as well as all applicable laws, regulations, and directives.

Discipline shall follow existing FDNY guidelines and may include formal admonishment, reprimand, suspension, probation, demotion, transfer, and any other measures calculated to eliminate illegal or inappropriate behavior.

In addition to any actions, which may be taken by the FDNY, some violations may be subject to review by appropriate local, state, or federal authorities.

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9. Monitoring and Auditing

In order to determine whether this billing compliance program is being adhered to and serving its intended purpose, the FDNY shall perform, or cause to be performed, monitoring and annual reviews and audits. a. Monitoring

The Compliance Officer shall arrange for monitoring of the billing compliance program. This may include recommending to the Fire Commissioner that independent firms be retained to carry out this function. In addition, the Compliance Officer shall oversee ongoing quality assurance reviews by managers and supervisors to ensure that:

there is proper completion and submission by ambulance staff of all required documentation;

appropriate decisions are being made regarding issues of medical necessity and coding;

all billing information is accurate and complete and reflects the appropriate sources of information; and

all computer software used in billing is consistent with the billing compliance program.

b. Auditing

On an annual basis, the FDNY shall conduct, or arrange for, a review and audit of the billing policies, procedures, and practices of the FDNY to verify that its submissions for reimbursement comply with all applicable federal health care program statutes, regulations, program and carrier directives relating to medical necessity and diagnostic coding, and to identify any and all instances where claims fail to meet these standards. The annual reviews and audits shall be aimed at ensuring that these programs are billed appropriately for services rendered. To the extent that other irregularities are uncovered in the course of the review, the annual audit shall identify the nature and cost of the irregularity and shall take the necessary steps to end the irregularity and prevent recurrences.

The audits shall be conducted in accordance with professionally accepted standards. Where billing deficiencies are identified, the FDNY shall give timely notification, as appropriate, to payers and authorities, make necessary refunds, and take steps to correct problems and prevent recurrences.

10. Reporting, Investigating, and Correcting Compliance Problems

a. Lines of Communication

The FDNY shall maintain a hotline as a means through which employees may report any policies, procedures, or other acts which amount to a violation of the law or deviation from billing compliance standards. A Compliance Hot Line

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Poster shall be displayed at all locations where employees involved in the preparation and or submission of claims performs their duties, including vendors and contractors. In addition, all managers and supervisors shall inform their employees that they are always available to receive any reports of misconduct or other violations of law or of compliance standards. b. Investigation

(i) Conducting an Investigation

All reports, whether received through the hotline or by a managerial or supervisory employee, shall be forwarded to the Compliance Officer. In each instance where a report is received, either the Compliance Officer or the Bureau of Investigations and Trials (“BITS”) shall prepare a Billing Compliance Report and make a preliminary inquiry to ensure all necessary information is obtained that is reasonably required to determine whether an internal review shall be conducted.

An internal review shall be conducted for any report that is sufficiently specific so that it (I) permits a determination of the appropriateness of the billing practice alleged to be involved; and (ii) reasonably permits corrective action to be taken and ensures that proper follow-up is conducted. The Compliance Officer, or BITS, shall be responsible to arrange for, or direct, the internal review and may enlist the support of the Department of Investigation of the City of New York, Legal Counsel, and/or the Internal Audit Unit. The FDNY shall develop an internal tracking system to record or log and follow up on all disclosures received.

(ii) Purpose of Investigation

The purpose of the investigation shall be to:

identify those situations in which the laws, rules, and standards relating

to the development and submission of claims may not have been followed;

identify individuals who may have knowingly or inadvertently caused claims to be submitted or processed in a manner which violated laws, regulations, or standards;

contribute to the development of procedures necessary to ensure future compliance;

protect the FDNY in the event of civil or criminal enforcement actions; and

initiate appropriate disciplinary action.

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(iii) Investigative Findings and FDNY Response

Possible Criminal Activity

In the event the FDNY uncovers what appears to be criminal activity on the part of an employee, it shall take the following steps, as deemed appropriate:

ensure that ongoing billing conforms fully to all applicable laws,

procedures, and program requirements; based upon review of the matter and advice by BITS or legal counsel,

initiate appropriate disciplinary action against the person or persons whose conduct appears to have been intentional, willfully indifferent, or with reckless disregard for applicable laws. Disciplinary action may include, as appropriate, the removal of the person from any position with oversight for, or impact upon, the claims development or submission process. It may also include formal admonishment, reprimand, suspension, probation, demotion, transfer, and any other measures calculated to eliminate illegal or inappropriate behavior. If the matter warrants, based upon the review and advice of legal counsel, FDNY may notify the local United States Attorney’s Office, the OIG, or the Department of Investigation of the City of New York. In appropriate circumstances, the FDNY, through its counsel, may wish to consider negotiating a voluntary disclosure agreement; and

undertake appropriate education to prevent similar problems in the future.

Other Non-Compliance

In the event the investigation reveals billing or other problems, which do not appear to be the result of conduct which is intentional, willfully indifferent, or with reckless disregard, the FDNY shall nevertheless undertake the following steps:

Improper Payments In the event the problem results in duplicate payments or payments for services not rendered or provided as claimed, it shall:

correct the defective practice or procedure as quickly as possible; contact the entity in charge of processing the claim for reimbursement with

respect to making the appropriate payment adjustment; initiate such disciplinary action as may be appropriate given the facts and

circumstances. Appropriate disciplinary action may include formal admonishment, reprimand, suspension, probation, demotion, transfer, and any other measures calculated to eliminate inappropriate behavior; and

undertake appropriate education to prevent similar problems in the future.

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No Improper Payments

In the event the problem did not result in an overpayment, the FDNY shall:

correct the defective practice or procedure as quickly as possible; initiate such disciplinary action as may be appropriate given the facts and

circumstances. Appropriate disciplinary action may include formal admonishment, reprimand, suspension, probation, demotion, transfer, and any other measures calculated to eliminate inappropriate behavior; and

undertake appropriate education to prevent similar problems in the future. IV. An Overview of the Legal Framework within which the FDNY Operates in Relation to the Federal Program3 1. Social Security Act

The Social Security Act (“SSA”) contains the basic requirements for coverage and payment for ambulance services. The SSA permits coverage of ambulance services under Medicare Part B, supplementary medical insurance, where the services provided are medically reasonable and necessary, and the use of another method of transportation is contraindicated by the patient’s condition [SSA Section 1861(s)(7) and 42 U.S.C. Sections 1395x(s)(7) and 1395y(a)].

2. Centers for Medicare and Medicaid Services (CMS)

CMS’s regulations regarding ambulance services expand upon the statutory requirements regarding Medicare coverage, billing, and payment. These regulations are contained in 42 CFR 410, subpart B. In particular: Section 410.10(I) - includes ambulance services as one of the covered medical and health services under Medicare Part B. Section 410.12 - states that medical and other health services are subject to certain basic conditions and limitations on payments. Sections 410.40 and 410.41 identifies the basic rules for coverage of ambulance services, including:

vehicle, staff, and billing and reporting requirements; medical necessity requirements; and origin and destination requirements.

3 This overview is intended to serve as a practical training tool for non-legal personnel and is not intended as a comprehensive statement of all applicable laws or their requirements. Any specific questions regarding an employee’s legal obligations should be referred to Legal Counsel.

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3. Medicare Benefit Policy Manual & Medicare Claims Processing Manual for Ambulance Services

The Medicare Benefit Policy Manual and the Medicare Claims Processing Manual, authored by CMS, provides instructions on how Medicare carriers should implement Medicare Part B. It contains more detailed instructions than the statute and regulations as to the Medicare requirements imposed on ambulance suppliers on issues such as coverage, billing, and payment. The provisions regarding coverage and payment of ambulance services appear in Chapters 10 and 15 of the Medicare Benefit Policy Manual and the Medicare Claims processing Manual for ambulance services respectively. a. Medicare Benefit Policy Manual - Chapter 10

Under the Medicare coverage guidelines, reimbursement for ground ambulance services is covered provided that vehicle and crew, necessity and reasonableness, and destination requirements as specified in the following subsections are met.

10.1 - Vehicle and Crew Requirements

10.1.1 - The vehicle must be specially designed and equipped to

respond to medical emergencies and, in non-emergency situations, be capable of transporting beneficiaries with acute medical conditions. The vehicle must comply with State or local laws governing the licensing and certification of an emergency medical transportation vehicle. At minimum, the ambulance must contain a stretcher, linens, emergency medical supplies, oxygen equipment, and other lifesaving emergency medical equipment and be equipped with emergency warning lights, sirens, and telecommunications equipment as required by the State or local law. This should include, at minimum, one 2-way voice radio or wireless telephone.

10.1.2 The ambulance crew must consist of the following:

(a) Basic Life Support (BLS) – must be staffed with at least two members, one of whom must be certified as an Emergency Medical Technician (EMT) by the State or local authority where the services are being furnished; (b) Advanced Life Support (ALS) – must be staffed by at least two members, of one whom must be certified by the State or local authority as an EMT-intermediate or an EMT-Paramedic.

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10.2 - Necessity and Reasonableness

Ambulance services must be both medically necessary and reasonable.

10.2.1 - Necessity for the Service - medical necessity is established when the patient’s condition is such that the use of any other method of transportation is contraindicated.

10.2.2 - Reasonableness of the Ambulance Trip - a claim may be denied on the ground that the use of the ambulance service was not reasonable in the treatment of the illness or injury involved, notwithstanding that the Patient’s condition may have contraindicated the use of other means of Transportation.

10.3 The Destination

This section provides guidance regarding the requirement that patients be transported to the nearest hospital that is capable of furnishing the required level and type of care for the beneficiary’s illness or injury.

b. Medicare Claims Processing Manual – Chapter 15

Section 20.2 – Reasonable Charges This section discusses billing methods for ambulance services. Medicare accepts only one billing method for ambulance services.

Medicare accepts charges only for standard base rate plus a mileage charge based on “loaded” miles traveled from the point at which the patient is picked up to the destination, usually a hospital.

All items and services related to the ambulance service (for example, oxygen, drugs, EKG testing) are bundled into Medicare’s base rate payment.

Section 20.4 – Payment for Mileage

In carrier service areas where suppliers routinely bill a mileage charge

for ambulance services in addition to a base rate, an additional payment based on customary and prevailing mileage charges may be allowed. Charges for mileage must be based on loaded mileage only, i.e., from the pick up of a patient to his/her arrival at destination. It is presumed that all unloaded mileage costs are taken into account when a supplier establishes his basic charge for ambulance services and his rate for loaded mileage. Suppliers should be notified that separate charges for unloaded mileage will be denied.

4. National Government Services (NGS) - Ambulance Reference Guide and Fee Schedule

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In addition to the foregoing, employees will be required to comply with the local carrier’s coverage, billing, and reimbursement requirements. Copies of the most recent Reference Guide and Fee Schedules will be made available for use by all appropriate employees.

V. An Overview of the Laws that Provide Penalties for Failure to Comply4

1. Fraud and Abuse Overview

This section is designed to provide general information to employees on the federal fraud and abuse laws. The phrase “fraud and abuse laws” generally describes a number of federal and, where applicable, state laws that contain the penalties for violation of laws that regulate the provision of services to beneficiaries of government programs and the requirements for submitting claims for services rendered. These laws are designed both to protect the patient and to prevent the government from paying more for a service than it is obligated to pay. These laws, in certain instances, also provide a mechanism for punishing individuals and organizations that submit claims for services that are:

4 This overview is intended to serve as a practical training tool for non-legal personnel and is not intended as a comprehensive statement of all applicable laws or their requirements. Any specific questions regarding an employee’s legal obligations should be referred to Legal Counsel.

not provided; Duplicate billing which occurs when a provider bills Medicare/Medicaid and

also bills private insurance and/or the recipient. Having an unlicensed person perform services that only a licensed

professional should render, and bills as if the professional provided the service.

billed in a manner other than as actually provided; not medically necessary without clearly indicating such status; provided by an improper person; accompanied by an illegal inducement to utilize, or refrain from utilizing, a

service or product; or billed in a manner that does not comply with applicable government

requirements.

Generally, the fraud and abuse laws relating to the provision of ambulance services fall into two categories:

laws prohibiting the submission of false claims; and laws prohibiting payments of kickbacks or other payments in exchange for

referrals.

2. False Claims Act

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There are a number of federal statutory provisions that authorize the imposition of significant penalties for the submission of false or improper claims. Some are specific to the programs subject to the SSA, while others apply to all government programs. The laws described briefly below are applicable to ambulance suppliers participating in the Medicare and Medicaid programs. a. SSA Provisions (U.S.C. 3729-3733)

The SSA includes both civil and criminal provisions. The criminal provisions prohibit persons or entities from:

> knowingly and willfully making, or causing to be made, any false statement or representation of a material fact in any application for a benefit or payment under a federal health care program [42 U.S.C. Section 1320a-7b(a)(1)];

> knowingly and willfully making, or causing to be made, any false statement

or representation of a material fact for use in determining rights to a benefit or payment under Medicare [42 U.S.C. Section 1320a-7b(a)(2)];

> knowingly and willfully making, or causing to be made, any false

statement with respect to the Medicare conditions of participation [42 U.S.C. Section 1320a-7b(c)].

> knowingly and willfully conspiring to defraud the Government by getting a

false or fraudulent claim paid or approved by the Government 31 U.S.C. Section 3719)}; and

> knowingly and willfully making, using or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the Government. In addition, the SSA civil false claims provisions (the “Civil Monetary Penalties” law) prohibit any person from knowingly billing for services not rendered; misrepresenting the services actually rendered; submitting a claim for payment that is inconsistent with, or contrary to, Medicare payment requirements; and submitting a claim for service furnished while the person was excluded from the program [42 U.S.C. Section 1320a-7a(a)].

b. Federal (non-SSA) Provisions

The most frequently invoked non-SSA false claims statute is the “Civil False Claims Act,” which prohibits individuals and entities from knowingly presenting, or causing to be presented, to an employee of the United States a false or fraudulent claim for payment or approval [31 U.S.C. Section 3729]. The following elements must be established to prove a violation of this provision:

the individual and/or entity presented, or caused to be presented, a claim for payment or approval;

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the claim was false or fraudulent; and the individual and/or entity’s acts were undertaken knowingly. “Knowingly” includes actual knowledge, deliberate ignorance of truth or falsity, or reckless disregard of truth or falsity.

There are also other criminal federal statutes that could apply to ambulance suppliers. Their prohibitions include:

the submission of false or fraudulent claims; making false statements; engaging in health care fraud; and obstructing the criminal investigation of health care matters.

[See 18 U.S.C. Sections 287 (fictitious claims), 1001 (false statements), 1035 (false statements on health care matters), 1347 (health care fraud), and 1518 (obstructing investigation of a health care offense)].

c. Penalties

1. Criminal Penalties/Program Exclusion

Each of the above statutes sets forth the penalties to be imposed on those engaging in the prohibited activities. Virtually all of the statutes containing criminal penalties authorize imprisonment for up to five years, as well as substantial fines. In addition, persons convicted of criminal false claims violations may be excluded from the Medicare and Medicaid programs. Certain violations trigger mandatory exclusion, while others allow the Department of Health and Human Services (“DHHS”) to determine if exclusion is appropriate. [NYS false claims law does not generally apply to claims made by New York City agencies; claims by these agencies are usually covered under the Federal False Claims Act.

2. Civil Penalties

Violations of the civil statutes (i.e., the Civil Monetary Penalties Law and the Civil False Claims Act) include penalties of not less than $5,000 and not more than $10,000 per claim, plus 3 times the amount of damages which the Government sustains because of the act of that person. In addition, violators of the civil statutes may also be excluded from the Medicare and Medicaid programs.

d. Avoiding False and Improper Claims

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Employees are required to exercise diligence in documenting, handling, and submitting claims for payment or reimbursement. In addition, it is the obligation of every employee to immediately report to his or her manager, supervisor, the Compliance Officer, or the hotline, any known or suspected submission of false, fictitious, fraudulent, or improper claims. Examples of such claims may include the following:

Misrepresenting Services Rendered – Overcharging

Claims must accurately reflect the service provided. No bill shall be submitted without full documentation of the service that was provided.

Billing for Services that are Not Rendered

Claims shall only be submitted for payment for services actually rendered.

Services that are Not Medically Necessary

Any claims submissions in cases not meeting the criteria for medical necessity must clearly indicate, in a form acceptable to the carrier, that the services are not considered medically necessary.

Upcoding and/or Inaccurate Coding

Claims must be accurately coded to reflect the service provided and the patient’s condition at the time of transport.

False Statements

No employee should ever knowingly or willfully make false statements or representations, or conceal or fail to disclose information, to any governmental entity or third-party payer.

Duplicate Billing

No employee may submit bills for any service to more than one payer at the same time, except for purposes of coordinating benefits.

Multiple Coverage and Secondary Payers

No employee shall bill Medicare as the primary payer if he or she knows that another payer is, or is likely to be, the primary insurer. Examples of such insurance are worker’s compensation, automobile no fault, and employer group health plans.

Failure to Report Credit Balances

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Credit balances may occur when overpayments are made or when claims for which a payment has been made are ultimately denied. In such cases, employees shall report the existence of the balance to Medicare or other payers. This may result in requests for refunds or adjustments to current payments. Employees should not permit any continuing failure to report such credit balances. Refund Process No employee shall create or process a refund where overpayment to the FDNY is not documented. All refunds must be processed in accordance with Revenue Management’s refund policy.

e. Protection Against Retaliation - Whistleblower Protection

FDNY policy strictly prohibits retaliation, in any form, against individual making a report, complaint or inquiry in good faith, concerned suspected fraud, waste and abuse or other suspected violation of law. Employees shall be assured that they should feel free to make such reports without fear of retaliation or other adverse action, and that all such reports will be investigated by the FDNY or other appropriate authority in accordance with the following:

The Federal False Claims Act (31 U.S.C. Section 3730(h)); New York False Claim Act (State Finance Law Section 191) and New York Labor Law (Sections 740 and 741) The City’s Whistleblower Law under section 12.113 of the City

Administrative;

In addition to the information set forth in this program, a detail summary of the Federal and New York Statutes relating to filling false claims is attached as “Appendix V” on page 42 of this manual as well as on the FDNY intranet under “Compliance”.

3. Anti-Kickback Laws

a. Prohibited Conduct

Under the federal anti-kickback statute [42 U.S.C. Section 1320a-7b(b)], it is unlawful for any person to:

offer or pay any remuneration to induce someone to refer patients for

any item or service for which payment may be made by a federal health care program;

offer or pay any remuneration to induce someone to purchase, lease, or order (or arrange for or recommend the purchase, lease, or order of) any facility, item, or service for which payment may be made by a federal health care program; or

solicit or receive any remuneration in exchange for engaging in any of the above activities.

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The general purpose of this statute is to prohibit anyone from offering or accepting anything of value in exchange for the referral of a patient for services, which might be covered by a federal health care program. In its most obvious form, the statute would prohibit an ambulance company from receiving money from a hospital for each patient it transports to that hospital. In addition, however, the prohibitions extend to arrangements or agreements whose substance has the same effect. It should also be noted that this statute prohibits providers from offering patients incentives to utilize services. The anti-kickback statute is an intent-based statute. Specifically, there must be an intent for the remuneration to induce the other party to take certain actions, such as sending patients to a specific hospital. The statute may be violated if just one purpose of the remuneration was to induce the referral of patients. Moreover, the fact that an activity is common in the industry does not mean that it does not violate the statute.

b. Safe Harbors

A number of arrangements are excepted from the anti-kickback statute as the result of a statutory exception or a regulatory “safe harbor” issued by DHHS. These exceptions and safe harbors include:

certain investment interests; and fair market value space and equipment leases.

Each exception or safe harbor contains criteria, which must be met in order to qualify for protection from the anti-kickback statute. The Compliance Officer and/or Legal Counsel should be consulted as to whether an arrangement satisfies the pertinent criteria.

c. Penalties

Similar to false claims statute violations, penalties for violations of the anti-kickback statute are severe. They may include criminal prosecution with potential fines and imprisonment up to five years. Alternatively, violations may be punished through civil monetary penalties of $50,000 per kickback violation and up to three times the remuneration offered, paid, solicited, or received. Finally, a person violating the anti-kickback law may be excluded from participation in the Medicare and Medicaid programs. Certain violations trigger mandatory exclusion from the program, while others allow DHHS to determine if exclusion is appropriate.

d. Anti-Kickback Concerns

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Employees must exercise the utmost care in avoiding violation (or the appearance of violation) of the above prohibitions and remain highly sensitized to the potential for kickback violations when carrying out their daily activities. Particular areas of concern include: Contracts Employees involved in the negotiating, drafting, and/or reviewing of contracts with outside entities (e.g., hospitals and voluntary ambulance companies) shall be made fully aware of the prohibitions in federal and state law regarding illegal kickbacks.

Arrangements with Hospitals Because situations and circumstances may vary, and because the issues are often complex, every arrangement with a hospital or other health care provider to which patients are transported shall be subject to the prior approval of Legal Counsel.

Waiver of Co-Insurance and Deductibles A general policy of waiving co-payments and deductibles is not permissible. However, a lesser amount may be accepted in discharge of a patient’s liability, or liability may be waived, if the decision is based on the supplier’s determination of a particular patient’s indigence.

4. Contracting with Outside Billing Agents

The FDNY shall not have any contract and/or arrangement with an outside billing service, which provides or creates an unlawful inducement for false billing by the billing agent.

VI. Principles and Standards Regarding the Submission of Claims For

Ambulance Services

All employees are responsible to ensure that their behavior and activity is consistent with the following principles and standards regarding the submission of claims for ambulance services.

1. Conflicts of Interest

Employees shall not violate the Conflicts of Interest provisions of the New York City Charter or any law, rule, or regulation of the City of New York pertaining to the proper conduct of employees. As an example, no employee shall engage in any business transaction, or private employment, or have any financial or other private interest, direct or indirect,

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which is in conflict with the proper discharge of official duties, unless a waiver is obtained. Moreover, no employee shall accept any valuable gift, as defined by the New York City Conflicts of Interest Board, from any person or firm that such employee knows is, or intends to become, engaged in business dealings with the FDNY. In addition, no employee shall receive compensation, except from the FDNY, for performing any official duty or accept or receive any gratuity from any person whose interests may be affected by the employee’s official action.

2. Legal Compliance

Employees shall comply with all laws, regulations, and program requirements when submitting claims for payment and reimbursement of ambulance services. The FDNY expects employees to refrain from conduct, which may violate the fraud and abuse laws. In general, these laws prohibit (i) the submission of false, fraudulent, or misleading claims to any government entity or third-party payer, including misrepresenting services rendered, billing for services not rendered, or filing claims which do not otherwise comply with applicable program or contractual requirements; (ii) direct, indirect, or disguised payments in exchange for the referral of patients; and (iii) making false representations to any person or entity in order to gain or retain participation in a program or to obtain payment for any service.

3. Claims Development and Submission Process

a. General Documentation

The Electronic Prehospital Care Report5 (“EPCR”) is a document to be used by FDNY personnel whenever an ambulance responds to a call and patient contact is made.

Ambulance staff must document the provision of ambulance services in a full and timely manner to ensure that only accurate and properly documented services are billed.

All information should be written in a clear, legible, and organized manner. Ambulance staff must remain cognizant of the fact, that in order to appropriately bill for services, the required information must be accurately documented.

5 Appendix III: Electronic Prehospital Care Report Form

b. Documentation of Medical Condition to Support the Services Billed

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Ambulance staff must clearly and accurately document the patient’s symptoms or injuries at the time of transport.

c. Obtaining Insurance Information and Patient Signature

Ambulance staff are expected to attempt to obtain insurance information from the patient or a representative at the time of service, as well as a signature, where possible, that will authorize billing Medicare and other insurers, the assignment of benefits, and the release of medical information.

d. Signature of Hospital Receiving Agent

Ambulance staff transporting a patient to the hospital should obtain the signature of the receiving agent at the hospital.

e. Mileage

The miles traveled from the point of pick up to the destination shall be recorded for billing purposes.

f. Claim Processing

Billing staff must ensure that claims are submitted to Medicare only when the signature of the patient, or his or her representative for insurance purposes, which could include FDNY personnel in certain circumstances, has been obtained. In addition, appropriate documentation must support the claim and must be sufficiently legible so it can be audited and reviewed.

g. Medical Necessity

Medical necessity determination must comply with Medicare guidelines.

A Medical Necessity Questionnaire6 must be completed for each Medicare claim.

The information on the Medical Necessity Questionnaire shall accurately and completely reflect the patient’s condition at the time of incident.

Upon request of the carrier, billing staff must provide documentation to support the medical necessity of a service.

6 Appendix IV: Medical Necessity Questionnaire

h. Coding

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In making coding determination, the ICD-CM codes must reflect the patient’s conditions at the time of incident and it must reflect date on which the service was delivered. It must comply with Medicare and AHIMA coding guidelines.

I. Billing

Billing and claim information must be consistent with the information contained in the source documents.

j. Collection of Co-Payments and Deductibles

Reasonable efforts must be made to collect co-payments and deductibles from patients. However, a lesser amount may be accepted in discharge of a patient’s liability, or liability may be waived, if the decision is based on the FDNY’s determination of a particular patient’s indigence.

4 Record Retention

Records pertaining to the following matters shall be retained for at least 6 years:

supporting information relating to filed claims; records relating to reimbursement from the federal health care programs; eligibility information (i.e., Medicare number) for patients served; information relating to the qualifications of crew and vehicles; records of the training provided to staff; documentation of information received regarding potential compliance issues;

and records of internal investigations and audits, whether routine or in response

to reports of violations.

5 Bad Debt

All internal and external write off procedures should be followed, including any subsequent disposal (sale) of debt.

VII. Procedures that will Assist Employees in Performing their Job Functions

in Accordance with Applicable Laws

The following procedures shall be employed by FDNY personnel in the development and submission of claims for ambulance services.

1. Field Personnel

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a. General Documentation

a.1 An EPCR shall be completed whenever patient contact is made. a.2 All appropriate areas must be completed. a.3 Ambulance staff should attempt to obtain the patient’s complete

name, address, including street number, apartment number, borough, and zip code, and social security number.

a.4 All data regarding call dispatch, the position in which the patient

was found, patient assessment, medical history, treatment rendered, billing and insurance information, method of transport, and hospital information should be documented as completely as possible.

a.5 Ambulance Staff must comply with guidelines described on the

EMSC OGP 102-15 “Preparation and Review of Electronic Prehospital Care Reports”.

b. Documentation of Medical Condition to Support the Services

Billed

b.1 Ambulance staff must clearly and accurately document the patient’s symptoms or injuries at the time of transport.

b.2 In documenting the EPCR’s fields, medical descriptors of an illness

or injury should be used.

b.3 In the field for “chief complaint,” objective clinical observations should, as a general rule, be entered, except where reflecting the patient’s own words. In this regard, the specific symptom or condition which triggered the call should be captured.

b.4 The physical findings entered in the narrative field should, to the

extent possible, be objective. They should expand upon the condition of the patient addressed in the “chief complaint” field, and should document critical findings.

c. Information Release and Assignment of Claim

c.1 The signature of the patient, or his or her representative for

insurance purposes, should be obtained whenever possible for each transport on the Information Release and Assignment of Claim portion of the EPCR. The information release and assignment of claim language is designed to authorize the release of information to parties financially liable, such as Medicare, for ambulance or other services furnished to the patient for the

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express purpose of processing a claim. It is also designed to authorize the assignment of benefits to the New York City Fire Department for services rendered.

c.2 When the patient is able to execute the information release and

assignment, he or she should read and sign the appropriate section in the space provided.

c.3 When the patient is unable to execute the information release and

assignment due to physical and/or mental condition, the patient is a minor, or due to his or her emergency condition, and a guardian, representative, adult relative, or other adult arranging treatment or exercising responsibility for the patient’s affairs is present, said other individual should read and sign the appropriate section in the space provided.

c.4 When the patient is unable to execute the information release and

assignment due to physical and/or mental condition, the patient is a minor, or due to the patient’s emergency needs, and the patient is alone, the FDNY personnel completing the EPCR shall sign as the patient’s representative for insurance purposes and document the condition in the “Comments” section of the EPCR. The signature shall be placed in the “Information Release Patient/Authorized Rep. Signature” section.

c.5 If the patient or his or her representative is capable but refuses to

sign the information release and assignment, the FDNY personnel completing the EPCR shall check the “Patient Refused to Sign” box on the patient signature line. Under these circumstances, the FDNY personnel shall inform the patient, or his or her representative, that failure to sign will result in the patient being billed directly for services rendered.

c.6 When more than one unit is involved in the treatment of a patient,

only one EPCR requires a signed information release and assignment of claim. This is the same EPCR that will obtain the hospital receiving agent’s signature. As an example, if two units each complete an EPCR for a patient, only the unit transporting the patient to the hospital should indicate the hospital number, mileage and number of patients transported, obtain a signed information release and assignment of claim, and obtain the receiving agent’s signature. The other unit should indicate “Assisted in Transport” (treatment but not transport) disposition and should not indicate any hospital, mileage, or number of patients.

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d. Insurance Information

d.1 Ambulance staff should attempt to obtain insurance information from the patient, or his or her representative, at the time of service.

d.2 To the extent possible, the patient’s Medicare or other insurance

card should be reviewed for verification of this information. For Medicare patients, this will help ensure that a complete health insurance claim number is obtained that includes not only a Social Security number, but also an alphabetical suffix.

e. Mileage

e.1 The miles traveled from the point of pick up to the destination

must be recorded. e.2 The number of miles should be indicated on the EPCR in the box

provided.

e.3 The mileage should be indicated in whole numbers. Per Federal guidelines, any portion of a mile should be considered one mile. For example, 4.1 miles should be documented as 5 miles.

e.4 Mileage under one (1) mile should be documented as one (1)

mile.

e.5 If the destination is beyond a reasonable travel time and is the result of the patient’s selection (based upon preferred hospital or physician or family convenience), ambulance staff shall clearly indicate this in the appropriate section of the EPCR. In all other circumstances, ambulance staff shall check the nearest or specialty designations, as appropriate.

f. Receiving Hospital Information

f.1 Ambulance staff transporting a patient to the hospital should

obtain the signature of the receiving agent at the hospital. f.2 After obtaining the signature of the receiving agent, ambulance

staff shall leave the second sheet of the EPCR with the receiving agent. The top page (with the signed information release and assignment of claim), shall be retained and submitted to the station supervisor at the end of the tour, and the green page containing information disclosure and assignment information should be given to the patient.

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g. Scanning, Review and Disposal of EPCRs by EMS Divisions

g.1 Scanning of EPCRs - At the end of each tour, crewmembers shall scan each completed EPCR in accordance with EMSC OGP 102-15.

g.2 Review of EPCRs - The station supervisor shall regularly

perform an administrative review of EPCRs for legibility and completeness in accordance with EMSC OGP 102-15. Any deficiencies in accuracy or in compliance with accepted standards shall be identified and corrective action taken.

g.3 Disposal of EPCRs - After each EPCR is scanned into the Sansio System, EPCRs should be kept at each Division in a safe location for 30 days to allow enough time for

proper review. After 30 days from the date of service, all EPCRs should be sent to headquarters in a secured recycle container and placed in the designated locked bin to

be properly shredded.

2. Billing Personnel a. EPCRs Review

The billing unit shall periodically review a sample of incoming EPCRs to assure compliance with requirements for obtaining patient signatures, insurance information, mileage, etc. Reports containing statistical results of these reviews shall be provided to the Compliance Officer and field staff supervisors, so that corrective action can be taken if necessary.

b. Billable/Non-Billable Claims

b.1 All billable-related EPCRs shall be uniquely identified and readily

Retrievable.

b.2 When the billing unit is aware that other types of primary insurance are available, Medicare shall not be designated as the primary payer. In that event, Medicare is a secondary payer and will not reimburse when other types of primary insurance exist. Examples of such insurance are worker’s compensation, automobile no fault, and employer group health plans.

b.3 Revenue shall take the appropriate steps to ensure proper

submission and collection efforts for all claims submitted resulting from ambulance transports. Transports provided to New York City Fire Department, EMS and Police Department personnel while on duty should not be billed. Transport provided to Medicaid fee-for-service patients should not be billed.

b.4 A billing unit supervisor shall regularly review a percentage of the

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EPCRs to ensure that appropriate decisions are being made regarding billable and non-billable services. Any deficiencies in accuracy or in compliance with accepted standards shall be identified and corrective action taken.

b.5 Billing personnel must follow guidelines described in the Business

Rules for EMS Outsourcing Engagement.

c. Medical Necessity Review

c.1 With the implementation of the scannable EPCRs, medical necessity determination is assigned based on information entered by the crew while treating the patient. The system algorithm shall be designed to determine proper medical necessity determination in accordance with guidelines set by Medicare as follows:

c.2 Medicare has defined an emergency service response as responding

immediately at the BLS or ALS1 level of service to a 911 call or the equivalent in areas without a 911 call system. An immediate response is one in which the ambulance supplier begins as quickly as possible to take the steps necessary to respond to the call.

c.3 All Medicare claims shall be reviewed for medical necessity. In order to support a finding of medical necessity, the ambulance service must have been reasonable in the treatment of the illness or injury and the use of another method of transportation contraindicated by the patient’s condition.

c.4 Medicare has issued guidelines describing the documentation

needed to establish that the patient was suffering from an illness or injury, which contraindicated transportation by other means. Under MCM Section 2125, this condition will be presumed to have been met if the EPCR and, if deemed appropriate, any other medical document reflect that the patient:

was transported in an emergency situation, e.g., as a

result of an accident, injury, or acute illness; needed to be restrained; was unconscious or in shock; required oxygen or other emergency treatment on the way

to his or her destination; had to remain immobile because of a fracture that had not

been set or the possibility of a fracture; sustained an acute stroke or myocardial infarction; was experiencing severe hemorrhage; was bed confined before and after the ambulance trip; or could be moved only by stretcher

c.5 Data from the following sections of the EPCR should be

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considered for making medical necessity determinations and answering the Medical Necessity Questionnaire:

Call Data Presenting Problems Cause Of Injury (COI) Body Matrix Pain Scale Vital Signs Transport Disposition Narrative History Flowchart

c.6 Any claim submissions to Medicare in cases where the services do

not meet the criteria for medical necessity must clearly indicate, in a form acceptable to the carrier, that the services are not considered medically necessary.

c.7 A Medical Necessity Questionnaire must be completed for each

Medicare claim. c.8 The information on the Medical Necessity Questionnaire shall

accurately and completely reflect the patient’s condition at the time of incident.

c.9 No assumptions shall be made or inferences drawn to make up

for lack of information or contradictory information on an EPCR or other medical source document. Any questions should be referred to a supervisor.

c.10 The Medical Necessity Questionnaire requires a response to each

field.

c.11 The format of the Medical Necessity Questionnaire shall comply with Medicare requirements.

c.12 A procedure code, based on the call type, unit type, and the

actual level of service provided to the beneficiary, shall be assigned to all claims.

c.13 The Unit responsible for Billing shall regularly review a percentage

of claims to ensure that all relevant information such as level of service provided, emergency/non-emergency status, medical necessity and medical necessity questionnaire on EPCRs are being properly reflected on the billing system for accurate claim submission. Any deficiencies in accuracy, or in compliance with accepted standards, shall be identified and corrective action taken.

c.14. The Compliance Unit shall regularly review a percentage of claims

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from the scannable software as well as from the billing system to ensure that both systems are functioning as expected.

c.15 Prior to filing any appeal on the basis of medical necessity, the

case shall be reviewed and the appeal authorized by billing supervisor.

d. Diagnostic Coding

With the implementation of the scannable EPCRs, ICD-CM coding is assigned by the system based on information documented by the crew. The System must be designed to follow the basic coding guidelines recognized by the Center for Medicare and Medicaid Services (CMS) as the authoritative source on coding rules and guidelines. These guidelines currently provide as follows:

d.1 Diagnostic coding for ambulance services requires the assignment

of a code from the most current International Classification of Diseases (ICD-CM).

d.2 The system must be updated to ensure that the current version of

ICD-CM Volume 1, Tabular List of Diseases and Injuries, and Volume 2, Alphabetic Index of Diseases and Injuries is being used when coding diagnostic information.

d.3 When coding diagnostic information from an earlier time period,

the system must use the version of ICD-CM and Volumes that coordinates with the time period of the transport service.

d.4 When coding diagnostic information, the system should translate

the text or description of the illness, injury, sign or symptom that was the chief reason for the ambulance service into the corresponding ICD-CM diagnostic code.

d.5 The appropriate code or codes must be used to identify the reason for the ambulance transport.

d.6 The code range required for a diagnosis or symptom is 001.0

through 999.9.

d.7 The code selected should be the one that best describes the reason chiefly responsible for the service provided.

d.8 The patient’s condition should be coded to the highest level of

certainty. d.9 Codes should be assigned at the highest level of specificity, i.e.,

extended to the furthest digit.

d.10 Chronic diseases, when treated on an ongoing basis, may be coded as often as treatment and care is provided to the patient

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for that condition.

d.11 Codes should be capturing information from the following medical fields on the EPCR:

Presenting Problems Medical Cause of Injury (COI) Body Matrix Blood Pressure

d.12 Codes should not be based on information relating to past medical

history, unless such information appears to relate to the patient’s condition at the time of transport.

d.13 In the absence of documentation, no assumptions should be

made nor inferences drawn to assign a code.

d.14 Any questions or concerns shall be directed to the supervisor responsible for overseeing diagnostic coding (the “coding supervisor”).

d.15 The coding supervisor shall regularly review a small percentage of

claims to ensure that appropriate diagnostic codes have been assigned. Any deficiencies in accuracy or in compliance with accepted standards shall be identified and corrective action taken.

3. Billing System

a. The FDNY employs an external billing vendor whose system and software perform billing related functions.

b. All demographic and insurance information, ICD-CM and procedure codes, and data regarding services, such as emergency/non-emergency, ALS/BLS, shall be input to the System for billing.

c. Claims shall be billed only when the file contains appropriately required

information and signatures. In cases where a Medicare patient refuses to sign, the patient may be billed directly.

d. All billed procedure codes should be consistent with the approved list

provided by the Medicare carrier. For Medicare claims, oxygen shall not be billed because Medicare has factored its cost into the all-inclusive transport charge. When administered, oxygen shall be billed for all other payers.

e. If mileage is billed, it shall be billed routinely for all payers and as a separate

item, based on the number of miles traveled from the point of pick up to the destination.

f. Billing shall accurately reflect information on the source documents and, for

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Medicare patients, the required Medical Necessity Questionnaire. g. As a general rule, only information clearly stated on the source documents

shall be entered into the system. Billing personnel must obtain supervisory approval prior to inputting any data not shown on these documents.

h. Billing system defaults should not be positioned to reflect emergency or non-

emergency status, a standard medical condition, medical necessity, or insurance eligibility. If such defaults are encountered, they should be referred to the FDNY Compliance Committee.

i. Patients shall routinely be billed, either directly or through their supplemental

insurance policies, for deductibles, co-insurance, and for co-payments. However, a lesser amount may be accepted in discharge of a patient’s liability, or liability may be waived, if the decision is based on the FDNY’s determination of a particular patient’s indigence.

j. If a vendor is utilized to assist in helping establish insurance eligibility for

patients, it shall not be authorized to make any changes in the claim information developed by the billing unit, other than obtaining the Medicare health insurance claim number. Moreover, if the vendor’s compensation varies depending on whether payment for a claim is collected, such collections shall not go directly to the vendor.

l. If billing personnel have any questions or concerns regarding the billing

system, they should promptly discuss them with a supervisor.

m. A billing unit supervisor shall regularly review a small percentage of data entered to ensure that only appropriate information is being transferred into the system. Any deficiencies in accuracy, or in compliance with accepted standards, shall be identified and corrective action taken.

4 Customer Service

Questions or complaints regarding billing, treatment or other customer service matters, should be documented, investigated, and answered with appropriate response within a reasonable time frame. Customer service personnel should follow the guidelines described on the Business Rules for EMS Outsourcing Engagement. The Compliance Officer shall be responsible for ensuring that proper procedures are implemented.

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VIII. Elements of Training and Education Programs

It is the policy of the FDNY to provide employees involved in the development and submission of claims with such education and training as may be reasonably necessary and appropriate to ensure compliance with applicable laws, regulations, and program requirements.

This policy, and the education and training provided pursuant to this policy, are intended to ensure that employees have sufficient subject matter knowledge and experience to carry out their duties in full compliance with all applicable requirements.

The following are mandatory elements of the education and training program:

1. All Employees Involved in the Development and Submission of

Claims

All employees, including supervisors and managers, involved in the development and submission of claims shall receive education and training in the following subjects:

the billing compliance program; the legal framework within which the FDNY must operate; Federal, State and local statutes relating to filing false claims; fraud and abuse laws as they relate to the claims development and

submissions process; requirements relating to documentation; requirements relating to medical necessity; requirements relating to the assignment of diagnostic and procedural

codes; requirements applicable to the preparation and submission of claims for

service; the consequences to both individuals and the FDNY of failing to comply

with applicable laws; and HIPAA rules and regulations regarding patient privacy.

Each employee, including new hires, shall receive at least two hours of initial training regarding the above subjects. Thereafter, employees directly involved in billing will receive at least one hour of annual retraining. All other employees will receive retraining (at least one hour) every three years.

2. Employee Qualifications .

a. Medical Necessity:

An employee responsible for reviewing medical necessity Determinations and Medical Necessity Questionnaires to ensure accuracy, shall, at a minimum, be a health information management professional (i.e., a Registered Record Administrator, Accredited Record Technician, Certified Coding Specialist, or Certified Coding Specialist for Physicians), a

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Paramedic, or a Registered Nurse. b. Diagnostic Coding

In addition to the education and training provided to all employees involved in the development and submission of claims, all personnel responsible for performing reviews to ensure accuracy of diagnostic coding shall receive training, as necessary, specific to the following subjects:

the use of the most current ICD-CM Volume (Tabular List of Diseases and Injuries) and ICD-CM Volume (Alphabetical Index of Diseases and Injuries) in assigning a diagnostic code;

the ICD-CM Coding Conventions used in the most current Volumes diagnostic coding guidelines for ambulance services as contained in

the version of the Coding Clinic ICD-CM Diagnostic and Reporting guidelines for Outpatient Services.

This person shall, at a minimum, be a health information management professional or someone with a comparable educational and health professional background.

IX. Audit Requirements

On an annual basis, the FDNY shall conduct, or arrange for, a review and audit of the billing policies, procedures, and practices of the FDNY to verify that its submissions for reimbursement comply with all applicable federal health care program statutes, regulations, program and carrier directives relating to medical necessity and diagnostic coding, and to identify any and all instances where claims fail to meet these standards. The review and audit shall be aimed at ensuring that claims are billed appropriately for services rendered and shall be conducted in accordance with all applicable rules and regulations. To the extent that other irregularities are uncovered in the course of the review, the annual audit shall identify the nature and cost of the irregularity and shall take the necessary steps to end the irregularity and prevent recurrences. If any of these annual reviews and audits uncover billing policies, procedures, and/or practices that result in material billing deficiencies, the FDNY shall notify the entity in charge of processing the claim for reimbursement (e.g., Medicare Part B, private insurance companies, patients) within sixty days of discovering the deficiency and take remedial steps within ninety days (or such additional time as may be agreed to by the carrier or other payer) to correct the problem, including preventing the deficiency from recurring.

A “material billing deficiency” shall mean any isolated event or a series of occurrences that: (i) has a significant, adverse financial impact; (ii) significantly affects the veracity of the information upon which the claim is based, even if it does not have a financial impact; or (iii) would result, or has resulted in, the FDNY submitting an improper claim for reimbursement (including, but not be limited to, a claim not in compliance with the

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False Claims Act [codified at 31 USC Sections 3729 - 3733] and the Anti-Kickback Statute [codified at 42 USC Section 1320a-7b]) and which claim lacks conformity with the programs’ reimbursement principles or other applicable statutes, and the regulations and written directives issued by CMS and/or its agents, or any other agency charged with administering the affected health care program and/or its agents. Nothing in this paragraph shall preclude the FDNY from taking appropriate steps to challenge any statute, regulation, program, or carrier directive.

Appendix I

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FIRE DEPARTMENT COMPLIANCE PROGRAM

The New York City Fire Department (“FDNY”) is committed to consistently and fully complying with all laws and regulations and to performing in accordance with the highest professional and business standards. In support of this commitment, the Department has established a compliance program to ensure that our employees and agents, either through employment agreements, or independent contracts (“employees”), comply with all applicable laws, regulations, and program requirements. To review the Compliance Program and related compliance standards and operating procedures, contact the Compliance Officer. Information is also periodically posted to the FDNY Intranet and the headquarters LAN shared directory “policies”. The mission of the Fire Department is to save lives and improve the quality of life within New York City by rapidly responding to emergency situations, by providing emergency medical, fire suppression and rescue services, by code enforcement, investigation, and education activities and by staff, administrative and operational support functions. All employees are expected to promote organization-wide integrity, preserve public trust, promote confidence in government, protect the integrity of government decision-making, and enhance government efficiency and the FDNY's ability to achieve our mission. Employees have a responsibility to ensure that their conduct does not violate the public trust placed in them. Their actions in all relationships, not just with the public, but also with coworkers, colleagues and vendors, must be governed at all times by the highest standards of honesty. Each employee shall make a personal commitment to adhere to the guiding principles set forth in the applicable policies and procedures by: Fostering leadership at all levels to sustain a culture where ethical conduct is recognized, exemplified

and valued by all employees and others doing business with the Fire Department Obeying the laws and regulations governing our organization and your professions Being honest, fair, and trustworthy in all activities and relationships Avoiding all conflicts of interest between work and personal affairs Fostering an atmosphere in which equal opportunity extends to every member of our diverse community Striving to create a safe workplace and protecting the environment Establishing accountability for compliance at all times

If you have any questions or concerns about what is appropriate conduct for you or your colleagues or the organization itself, please promptly contact your supervisor, or the Compliance Officer, or feel free to call or write, even on an anonymous basis, the Conflicts of Interest Board. Concerns about appropriate conduct will be promptly addressed with professionalism, care, and respect. Every officer and employee of the City has a duty and responsibility to report any and all information concerning conduct, which they know, or reasonably should know, to involve corrupt or other criminal activity or conflict of interest to: Chief Compliance Officer Ray Saylor, Fire Department Headquarters 718-999-2033

9 Metrotech Center, Brooklyn, NY 11201 Confidential Complaint Line FDNY, Bureau of Investigations and Trials 718-999-2646

9 Metrotech Center, Brooklyn, NY, 11201 Conflict of Interest Line NYC, Conflict of Interest Board 212-442-1400

2 Lafayette Street, NY, NY 10007 Office of the Inspector General NYC, Department of Investigation 212-825-5959

80 Maiden Lane, NY, NY 10038

The Fire Department does not condone misconduct by employees or others. The FDNY encourages reporting of any concern or violation and will not retaliate against any employee, in any way. The FDNY will honor employee requests for anonymity to the maximum extent possible under the circumstances, consistent with the FDNY’s obligation to investigate reported violations and take corrective action.

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Appendix II

Medical Compliance Committee Charter

The purpose of this statement is to provide, in summary form, a general understanding of the Compliance Program and the responsibilities of the Medical Compliance Committee. OBJECTIVE AND SCOPE Our authority and purpose is derived from Section 16 of the City Charter which outlines activities to be undertaken by Heads of Mayoral Agencies pertaining to planning, management, and internal control. The authority and purpose of this committee has been further refined by the Department’s commitment to ensure compliance with all applicable rules and regulations related to claim submission pertaining to EMS ambulance transportation services and participation in federal health care programs. RESPONSIBILITY AND AUTHORITY Issues of compliance are part of the responsibility of every manager of an organization. This committee is comprised of managers in key positions related to emergency medical services. This committee will promote an environment of integrity and compliance and shall administer the compliance program. A compliance program is a system of internal controls established to ensure compliance with those policies, plans, procedures, laws, regulations and contracts, which could have significant impact on operations and reports, and to determine whether the organization is in compliance. In conjunction with the Chief Compliance Officer, who reports to the Fire Commissioner and has responsibility for the day-to-day administration of the Compliance Program, this committee shall foster an environment, which promotes integrity and optimal adherence to sound business and professional standards. This includes development of written policies, procedures and employment standards for areas under your jurisdiction; Analyze the compliance environment within the ambulance industry to identify particular areas of risk and ensure policies and procedures exist to minimize those risks; Review, enforce, recommend, and institute the operational components as they relate to compliance and internal control; Foster a system to solicit, evaluate and appropriately deal with compliance issues; Aid in the development and review of reports on compliance activities. The Charter Members of the Committee are: Julian Bazel, Counsel to the Department 718-999-0294 Ray Saylor, Chief Compliance Officer 718-999-2033 Douglas White, Deputy Commissioner for Administration 718-999-2007 Dr. David Prezant, Medical Director, EMS 718-999-2696 Donay Queenan, Director of Personnel 728-999-2165 John Peruggia, Chief of EMS Operations 718-999-2772 Stephen Rush, Assistant Commissioner for Budget and Finance 718-999-2022 Robert Wallace, Assistant Commissioner for Investigations and Trials 718-999-2116 In addition, the following, non-chartered members are participating: Frank Buccellato, Director of OMA 718-999-0734 Richard Brennan, Director of Revenue 718-999-1265