HomeMy WebLinkAboutRFP - P 863REQUEST FOR PROPOSAL
CITY OF FORT COLLINS
MEDICAL PROVIDER -RISK MANAGEMENT
PROPOSAL NUMBER P-863
PROPOSAL DATE: 2:00 p.m. (our clock) November 15 9 2002
11. Warranty.
(a) Service Provider warrants that all work performed hereunder shall be
performed with the highest degree of competence and care in accordance
with accepted standards for work of a similar nature.
(b) Unless otherwise provided in the Agreement, all materials and equipment
incorporated into any work shall be new and, where not specified, of the most
suitable grade of their respective kinds for their intended use, and all
workmanship shall be acceptable to City.
(c) Service Provider warrants all equipment, materials, labor and other work,
provided under this Agreement, except City -furnished materials, equipment
and labor, against defects and nonconformances in design, materials and
workmanship/workwomanship for a period beginning with the start of the
work and ending twelve (12) months from and after final acceptance under
the Agreement, regardless whetherthe same were furnished or performed by
Service Provider or by any of its subcontractors of any tier. Upon receipt of
written notice from City of any such defect or nonconformances, the affected
item or part thereof shall be redesigned, repaired or replaced by Service
Provider in a manner and at a time acceptable to City.
12. Default. Each and every term and condition hereof shall be deemed to be a material
element of this Agreement. In the event either party should fail or refuse to perform according to the
terms of this agreement, such party may be declared in default thereof.
13. Remedies. In the event a party has been declared in default, such defaulting party
shall be allowed a period of ten (10) days within which to cure said default. In the event the default
remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek
damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail
himself of any other remedy at law or equity. If the non -defaulting party commences legal or
equitable actions against the defaulting party, the defaulting party shall be liable to the non -
defaulting party for the non -defaulting parry's reasonable attorney fees and costs incurred because
of the default.
14. Binding Effect. This writing, togetherwith the exhibits hereto, constitutes the entire
agreement between the parties and shall be binding upon said parties, their officers, employees,
agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal
representatives, successors and assigns of said parties.
15. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save
harmless the City, its officers, agents and employees against and from any and all actions, suits,
claims, demands or liability of any character whatsoever brought or asserted for injuries to or death
of any person or persons, or damages to property arising out of, result from or occurring in
connection with the performance of any service hereunder.
b. The Service Provider shall take all necessary precautions in performing the work
hereunder to prevent injury to persons and property.
c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider
shall provide and maintain insurance coverage naming the City as an additional insured under this
Agreement of the type and with the limits specified within Exhibit _, consisting of (_)
pages[s], attached hereto and incorporated herein by this reference. The Service Provider before
commencing services hereunder, shall deliver to the City's Director of Purchasing and Risk
Management, P. O. Box 580 Fort Collins, Colorado 80522 one copy of a certificate evidencing the
insurance coverage required from an insurance company acceptable to the City.
16. Entire Agreement. This Agreement, along with all Exhibits and other documents
incorporated herein, shall constitute the entire Agreement of the parties. Covenants or
representations not contained in this Agreement shall not be binding on the parties.
17. Law/Severability. The laws of the State of Colorado shall govern the construction
interpretation, execution and enforcement of this Agreement. In the event any provision of this
Agreement shall be held invalid or unenforceable by any court of competent jurisdiction, such
holding shall not invalidate or render unenforceable any other provision of this Agreement.
5
18. Special Provisions. [Optional] Special provisions or conditions relating to the
services to be performed pursuant to this Agreement are set forth in Exhibit_, consisting of
(_) page[s], attached hereto and incorporated herein by this reference.
ATTEST:
Clerk
APPROVED AS TO FORM:
Assistant City Attorney
CITY OF FORT COLLINS, COLORADO
a municipal corporation
0
John F. Fischbach
City Manager
By:
James B. O'Neill Il, CPPO, FNIGP
Director of Purchasing and Risk Management
Date:
[Insert Corporation's name] or
[Insert Partnership name] or
[Insert individual's name]
Doing business as _[insert name of business]
By:
PRINT NAME
CORPORATE PRESIDENT OR VICE PRESIDENT
Date:
ATTEST: (Corporate Seal)
CORPORATE SECRETARY
0
EXHIBIT "B"
INSURANCE REQUIREMENTS
The Service Provider will provide, from insurance companies acceptable to the City, the
insurance coverage designated hereinafter and pay all costs. Before commencing work
under this bid, the Service Provider shall furnish the City with certificates of insurance
showing the type, amount, class of operations covered, effective dates and date of expiration
of policies, and containing substantially the following statement:
"The insurance evidenced by this Certificate will not be cancelled or materially altered,
except after ten (10) days written notice has been received by the City of Fort Collins."
In case of the breach of any provision of the Insurance Requirements, the City, at its option,
may take out and maintain, at the expense of the Service Provider, such insurance as the
City may deem proper and may deduct the cost of such insurance from any monies which
may be due or become due the Service Provider under this Agreement. The City, its officers,
agents and employees shall be named as additional insureds on the Service Provider's
general liability and automobile liability insurance policies for any claims arising out of work
performed under this Agreement.
Insurance coverages shall be as follows:
A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain
during the life of this Agreement for all of the Service Provider's employees engaged in work
performed under this agreement:
Workers' Compensation insurance with statutory limits as required by
Colorado law.
Employer's Liability insurance with limits of $100,000 per accident, $500,000
disease aggregate, and $100,000 disease each employee.
B. Commercial General & Vehicle Liability. The Service Provider shall maintain during
the life of this Agreement such commercial general liability and automobile liability insurance
as will provide coverage for damage claims of personal injury, including accidental death, as
well as for claims for property damage, which may arise directly or indirectly from the
performance of work under this Agreement. Coverage for property damage shall be on a
"broad form" basis. The amount of insurance for each coverage, Commercial General and
Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property
damage.
In the event any work is performed by a subcontractor, the Service Provider shall be responsible for
any liability directly or indirectly arising out of the work performed under this Agreement by a
subcontractor, which liability is not covered by the subcontractor's insurance.
10/22/02
Occupational Health Services
1330 Oakridge Dr.
Fort Collins, CO 80525
INJURY TREND ANALYSIS
Injury Date Range from 1/1/2002 to 9/30/2002
For Company ID: FC
AVERAGES
Light Days Lost Days
Duration
ICD9
Description
# Cases
Visits
CL
CO
CL
CO
Of Case
Cost
274.9
Gout, unspecified
1
3
3.0
3.0
0.0
0.0
24.0
274.88
354.0
Carpal tunnel syndrome
4
12
10.5
10.5
0.0
0.0
61.5
876.55
372.14
Chronic conjunctivitis
1
1
0.0
0.0
0.0
0.0
0.0
142.24
380.10
Infective ptotos externa, unspecified
1
1
0.0
0.0
0.0
0.0
0.0
100.24
389.9
Hearing loss, unspecified
1
4
0.0
0.0
0.0
0.0
114.0
377.56
506.3
Asthma, due to inhalation of fumes
1
4
0.0
0.0
0.0
0.0
8.0
399.04
682.0
Cellulitis/abscess other sites
I
1
0.0
0.0
0.0
0.0
69.0
142.24
692.9
Contact dermatitis
4
2
0.0
0.0
0.0
0.0
10.8
279.73
722.10
Disc syndrome, lumbar
1
1
3.0
3.0
0.0
0.0
21.0
42.00
726.0
Tendinitis, shoulder
1
10
39.0
39.0
0.0
0.0
59.0
716.56
726.31
Epicondylitis, medial
1
11
12.0
12.0
0.0
0.0
50.0
889.84
726.32
Epicondylitis, lateral
2
31
74.5
74.5
0.0
0.0
137.5
1,722.58
727.05
Tenosynovitis, finger,hand,wrist
2
8
4.0
4.0
0.0
0.0
75.0
615.78
727.42
Ganglion, tendon sheath
1
2
0.0
0.0
0.0
0.0
22.0
274.20
729.1
Myofascial pain
2
8
3.0
3.0
0.0
0.0
39.5
735.32
729.5
Pain in limb
1
2
0.0
0.0
0.0
0.0
10.0
282.82
780.2
Syncope and collapse
1
I
0.0
0.0
0.0
0.0
3.0
228.16
784.0
Pain, Headache
1
3
1.0
1.0
0.0
0.0
12.0
291.64
816.00
Fracture, finger/thumb (closed)
I
38
73.0
73.0
0.0
0.0
122.0
2,399.16
824.8
Fracture, ankle (malleolus)
1
43
126.0
126.0
0.0
0.0
185.0
2,403.54
826.0
Fracture, one or more phalanges closed
1
3
3.0
3.0
0.0
0.0
26.0
248.68
834.00
Dislocation, finger (closed)
1
17
45.0
45.0
0.0
0.0
84.0
1,166.32
840.4
Rotator cuff tear/impingement
1
11
31.0
31.0
0.0
0.0
101.0
433.00
840.8
Trapezious Muscle Sprain/Strain
1
7
13.0
13.0
0.0
0.0
32.0
335.56
840.9
Sprain/Strain, Shoulder/arm
4
4
16.8
16.8
0.0
0.0
26.5
365.31
842.00
Sprain/strain, wrist
2
6
51.5
51.5
0.0
0.0
93.0
313.12
842.10
Sprain/strain, hand/finger
1
2
15.0
15.0
0.0
0.0
23.0
248.68
11/25/2002
Page 1
Occupational Health Services
1330 Oakridge Dr.
Fort Collins, CO 80525
INJURY TREND ANALYSIS
Injury Date Range from 1/1/2002 to 9/30/2002
For Company ID: FC
AVERAGES
Light Days Lost Days
Duration
ICD9
Description
*Cases
Visits
CL
CO
CL
CO
Of Case
Cost
843.9
Sprain/strain, hip & thigh
1
6
0.0
0.0
0.0
0.0
75.0
460.88
844.9
Sprain/strain, knee and leg
11
9
7.4
7.4
0.0
0.0
57.5
675.68
845.00
Sprain/sprain, ankle
9
5
13.1
13.1
0.1
0.1
30.4
416.96
845.09
Sprain/strain, achilles tendon
1
7
22.0
22.0
0.0
0.0
34.0
503.44
845.10
Sprain/strain, foot/toe
2
5
16.5
16.5
0.0
0.0
50.0
399.79
846.0
Sprain/Strain, Lumbosacral region
1
5
0.0
0.0
0.0
0.0
0.0
471.44
846.1
Sprain/Strain, Sacroiliac ligament
4
8
25.0
25.0
0.0
0.0
42.5
607.23
847.0
Sprain/Strains, cervical
5
3
4.8
4.8
0.0
0.0
25.0
343.84
847.1
Sprain/Strain, thoracic
7
8
20.7
20.7
0.0
0.0
64.1
552.24
847.2
Sprain/Strain, lumbar
12
6
18.0
18.0
0.3
0.3
36.3
584.11
848.3
Sprain/strain, (Chest Wall)
1
3
0.0
0.0
0.0
0.0
45.0
313.12
850.9
Concussion
1
2
6.0
6.0
0.0
0.0
11.0
91.00
854.00
Closed Head Injury
1
3
0.0
0.0
0.0
0.0
15.0
142.24
873.0
Open wound, scalp
1
3
6.0
6.0
0.0
0.0
8.0
42.00
881.00
Open wound, forearm
1
3
0.0
0.0
0.0
0.0
57.0
152.02
882.0
Open wound, hand
1
2
7.0
7.0
0.0
0.0
9.0
42.00
883.0
Open wound, finger
5
3
9.2
9.2
0.0
0.0
14.2
331.44
884.0
Open wound, arm
1
2
2.0
2.0
0.0
0.0
2.0
291.64
886.0
Amputation, Finger(s)
1
16
20.0
20.0
11.0
11.0
88.0
942.20
891.0
Open wound, lower leg/ankle/knee/calf
2
3
2.5
2.5
0.0
0.0
16.0
206.83
918.1
Corneal abrasion
2
3
0.0
0.0
0.0
0.0
5.0
291.64
920
Contusion, face and head
1
3
1.0
1.0
0.0
0.0
3.0
297.70
922.1
Contusion, chest wall, thorax
1
2
0.0
0.0
0.0
0.0
23.0
278.44
922.31
Contusion, back
2
2
0.0
0.0
0.0
0.0
20.5
163.24
922.32
Contusion, buttock
1
27
79.0
79.0
1.0
1.0
131.0
1,623.70
923.11
Contusion, elbow
2
4
0.0
0.0
0.0
0.0
54.5
357.64
923.20
Contusion, hand
2
2
3.0
3.0
0.0
0.0
10.5
138.00
11/25/2002
Page 2
Occupational Health Services
ANALYSIS OF INVOICES
For Entry Date 0710112002 thru 09/30/2002 1st Level Sort: Account ID
2nd Level Sort: Cost Center
No Service Date Range Specified 3rd Level Sort: Fee Code
AccountlD: FC Fee Type: C R A
Account Type: C E
Responsible Party: 1 2 S W
Account ID: FC
City of Fort Collins
Cost Center:
ADJ Adjustments
ADJTF
Denial Due to Timely Filing
ADJWC
Adjustment for WC fee schedule
ADJWO
Adminstrative adjustment
Subtotals for: ADJ
Adjustments
Cost Center:
CLIN Clinical Services
2042
Special Reports (30 min)
Subtotals for: CLIN
Clinical Services
Cost Center:
DNU Do Not Use These Codes
DNU1060
TB and Coordination Fee
DNU2000
Physician Fee
DNU2015
OHS Coordination Fee
DNU2025
Pulmonary Function Test & Interp.
DNU3000
Therapeutic Massage (15 min)
DNU4034
Soft Tissue Mobilization (15 min)
DNU4064
Joint Mobilization (15 min)
DNU4094
Functional Capacity Evaluation (15 min)
DNU4100
Biomechanics Eval
DNU5019
Hot or Cold Pack Application
DNU5022
Paraffin Bath
DNU5025
Fluidotherapy
DNU5028
lontophoreses (15 min)
DNU5037
E-Stim Unattended
DNU5043
Orthotic Fit/Train (15 min)
DNU5049
Therapeutic Exercise (15 min)
DNU5052
Joint Mobilization (15 min)
DNU5055
Ultrasound (15 min)
DNU5058
Self Care/Home Management Training
DNU5061
Functional Activity
DNU5067
Soft Tissue Mobilization (15 min)
DNU5073
Neuromuscular Re-ed (15 min)
DNU5079
Dressing Change
DNU7272
Heel/Bow Protector Pad
DNU8082
Massage (15 min)
Subtotals for: DNU Do Not Use These Codes
Quantity
Charges
Receipts
Adjustments
1
0.00
0.00
-18.00
297
0.00
0.00
-853.26
69
0.00
0.00
-1,259.98
367
0.00
0.00
-2,131.24
1
112.50
0.00
0.00
1
112.50
0.00
0.00
6
108.00
0.00
0.00
45
1,012.50
0.00
0.00
44
990.00
0.00
0.00
40
1,120.00
0.00
0.00
19
399.00
0.00
0.00
36
972.00
0.00
0.00
15
405.00
0.00
0.00
8
336.00
0.00
0.00
1
25.00
0.00
0.00
5
45.00
0.00
0.00
3
39.00
0.00
0.00
19
380.00
0.00
0.00
4
88.00
0.00
0.00
1
16.00
0.00
0.00
3
63.00
0.00
0.00
18
396.00
0.00
0.00
14
378.00
0.00
0.00
12
216.00
0.00
0.00
8
264.00
0.00
0.00
2
44.00
0.00
0.00
4
108.00
0.00
0.00
7
154.00
0.00
0.00
2
30.00
0.00
0.00
1
11.90
0.00
0.00
8
192.00
0.00
0.00
325 7,792.40 0.00 0.00
11/25/2002 Page 1
Quanti
^harges
Receipts
Adiustments
Account ID: FC
City of Fort Collins
Cost Center:
E&M Evaluation&Management
99202
New Patient Limited Visit
12
816.24
0.00
0.00
99203
New Patient Intermediate Visit
38
3,818.36
0.00
0.00
99204
New Patient Extended Visit
14
2,031.20
0.00
0.00
99205
New Patient Comprehensive Visit
1
186.16
0.00
0.00
99212
Established Patient Limited Visit
0
3.96
0.00
0.00
99213
Established Patient Intermediate Visit
112
7,239.04
0.00
0.00
99214
Established Patient Extended Visit
38
3,673.08
0.00
0.00
99215
Established Patient Comprehensive Visit
2
279.24
0.00
0.00
99371
Telephone Brief
1
14.32
0.00
0.00
99372
Telephone Intermediate
1
28.64
0.00
0.00
99455
Medical Impair Rating Treating Phy/30 mi
12
1,360.00
0.00
0.00
99960
Initial Report (M1)
55
2,310.00
0.00
0.00
99961
Progress Report (Payer Requested)
2
84.00
0.00
0.00
99962
Closing Report (M3)
36
1,512.00
0.00
0.00
Subtotals for: E&M
Evaluation & Management
324
23,346.24
0.00
0.00
Cost Center:
MEDI Medicine
90471
Immunization Administration
5
50.00
0.00
0.00
90632
Hepatitis A Vaccine
2
120.00
0.00
0.00
90746
Hep, B Vaccine
4
170.00
0.00
0.00
99080
Special Report/Procedure /.5 hr.
4
900.00
0.00
0.00
Subtotals for: MEDI
Medicine
15
1,240.00
0.00
0.00
Cost Center:
PHY Physicals
1052
Fit for Duty each add 1/2 hour.
3
337.50
0.00
0.00
1109
OSHA Physician Fee
27
810.00
0.00
0.00
Subtotals for: PHY
Physicals
30
1,147.50
0.00
0.00
Cost Center:
PHYM Physical Medicine
97001
Initial Eval PT
15
1,065.00
0.00
0.00
97002
Reeval PT
18
864.00
0.00
0.00
97003
Initial Eval OT
9
639.00
0.00
0.00
97004
Re-evalOT
3
144.00
0.00
0.00
97010
Hot or Cold Pack Application
51
459.00
0.00
0.00
97014
E-Stim Unattended
37
592.00
0.00
0.00
97022
Whirlpool
3
60.00
0.00
0.00
97035
Ultrasound (15 min)
28
504.00
0.00
0.00
97110
Therapeutic Exercise (15 min)
34
748.00
0.00
0.00
97112
Neuromuscular Re-ed (15 min)
1
22.00
0.00
0.00
97124
Massage (15 min)
2
48.00
0.00
0.00
97140
Manual Therapy (15 min)
14
378.00
0.00
0.00
97530
Therapeutic Activity (15 min)
3
66.00
0.00
0.00
97535
Self Care/Home Management Training
24
792.00
0.00
0.00
Subtotals for: PHYM
Physical Medicine
242
6,381.00
0.00
0.00
Cost Center:
RECP Receipts
RECCO
Payment received from company
263
0.00
7,147.46
0.00
RECINS
Payment received from insurance co.
757
0.00
32,263.73
0.00
11 /25/2002 Page 2
Account ID: FC
City of Fort Collins
Subtotals for: RECP
Receipts
Cost Center:
RPN Rehab Provider Network
09511
Splint, Finger Simple Static
09532
Splint, Hand Dynamic
09561
Modification - 15 mins.
09562
Modification - 30 mins.
D1006
Wrist Support w/Thumb Spica
D3004
Elastic Bandage
D3768
Knee Sleeve
D5214
Theraband
D5215
Theracane
D5798
Hand Putty
D6192
Wrist Support
D7406
McConnell Tape Set
D8939
Shoulder Pulleys/Over the door
Subtotals for: RPN
Rehab Provider Network
Cost Center:
SCRN Screening
1003
Breath Alcohol Test
1009
Urine Drug Collection
1012
On Site Drug Testing 1
1015
On Site Drug Testing II
1027
Dipstick Urine Analysis
Subtotals for: SCRN
Screening
Cost Center:
SUPP Supply
7256
Gauze, Xerofoam 1x8
7287
Kerlix Roll, 2
7306
Splint, Thimble (1,2,3)
7353
Telfa Pad, 3x2
Subtotals for: SUPP
Supply
Cost Center:
SURG Surgery
20550
Joint A/I Trigger
20605
Joint A/I Intermediate
Subtotals for: SURG
Surgery
Totals for: FC
City of Fort Collins
Grand Totals:
Quanti
"haraes
Receipts
Adjustments
1,020
0.00
39,411.19
0.00
1
27.30
0.00
0.00
1
88.20
0.00
0.00
5
136.50
0.00
0.00
1
39.90
0.00
0.00
1
33.00
0.00
0.00
2
6.00
0.00
0.00
1
25.00
0.00
0.00
10
30.00
0.00
0.00
1
40.00
0.00
0.00
2
12.00
0.00
0.00
3
127.20
0.00
0.00
3
105.00
0.00
0.00
1
15.00
0.00
0.00
32
685.10
0.00
0.00
5
125.00
0.00
0.00
24
360.00
0.00
0.00
-1
-30.00
0.00
0.00
53
1,325.00
0.00
0.00
44
220.00
0.00
0.00
125
2,000.00
0.00
0.00
2
5.70
0.00
0.00
-1
-3.50
0.00
0.00
1
1.22
0.00
0.00
20
12.00
0.00
0.00
22
15.42
0.00
0.00
2
62.80
0.00
0.00
3
141.00
0.00
0.00
5
203.80
0.00
0.00
2,508
42,923.96
39,411.19
-2,131.24
91.8%
-5.0%
RcpUChrgs
Adj/Chrgs
2,508
42,923.96
39,411.19
-2,131.24
91.8%
-5.0%
RcpUChrgs
Adj/Chrgs
11/25/2002 Page 3
REQUEST FOR PROPOSAL
CITY OF FORT COLLINS
Proposal Number P-863
The City of Fort Collins is seeking proposals from qualified medical facilities to provide medical
treatment to City employees injured in the course of employment, pre -employment testing required
by Risk Management and other medical services as may be deemed beneficial to City employees.
Written proposals, five (5) will be received at the City of Fort Collins' Purchasing Division, 215 North
Mason St., 2nd floor, Fort Collins, Colorado 80521. Proposals will be received before 2:00 pm. (our
clock), November 15, 2002. Proposal No. P-863. If delivered, they are to be sent to 215 North
Mason Street, 2nd Floor, Fort Collins, Colorado 80521. If mailed, the address is P.O. Box 580, Fort
Collins, 80522-0580.
Questions concerning the scope of the project should be directed to Project Manager, Blair Miller at
(970) 221-6807.
Questions regarding proposals submittal or process should be directed to James B. O'Neill Il,
CPPO, FNIGP at (970) 221-6775.
A copy of the Proposal may be obtained as follows:
1. Call the Purchasing Fax -line, 970-416-2033 and follow the verbal instruction to
request document #30863.
2. Download the Proposal/Bid from the Purchasing Webpage,
www.fcqov.com/purchasing.
3. Come by Purchasing at 215 North Mason St., 2nd floor, Fort Collins, and request a
copy of the Bid.
Sales Prohibited/Conflict of Interest: No officer, employee, or member of City Council, shall have a
financial interest in the sale to the City of any real or personal property, equipment, material,
supplies or services where such officer or employee exercises directly or indirectly any decision -
making authority concerning such sale orany supervisory authority over the services to be rendered.
This rule also applies to subcontracts with the City. Soliciting or accepting any gift, gratuity favor,
entertainment, kickback or any items of monetary value from any person who has or is seeking to do
business with the City of Fort Collins is prohibited.
Collusive or sham proposals: Any proposal deemed to be collusive or a sham proposal will be
rejected and reported to authorities as such. Your authorized signature of this proposal assures that
such proposal is genuine and is not a collusive or sham proposal.
The City of Fort Collins reserves the right to reject any and all proposals and to waive any
irregularities or informalities.
Sincerely,
es . O'Neill ll, CPPO, FNIGP
Dire r of Purchasing & Risk Management
BACKGROUND
The City implemented a designated physician program in May 1986 to provide medical
treatment for employees injured on the job. Under the Colorado Workers' Compensation
Act, (8-51-110(5)(a), the employer has the right to first choice of physician(s) when an
employee is injured on the job.
Effective January 1, 1989, the City commenced a workers' compensation self-insurance
program. A local third party administrator manages claims and processes payments.
This service is currently being provided by Poudre Valley Hospital's Occupational Health
Services.
It is the City's intent that this contract be for a five (5) year period. Fees will be reviewed
and negotiated on an annual basis ninety (90) days prior to each annual expiration date.
PROPOSAL GUIDELINES:
Qualified firms interested in the work described in this request should submit a minimum of
the following information to the City:
Qualifications of your firm and staff.
2. Copy of fee schedule, including hourly fee for hearing testimony. Are these fees at or
below the Colorado Fee Schedule for workers' compensation cases? Do you discount
bills for prompt payment?
3. Complete description of your facilities, including details on x-rays, audiogram, physical
therapy procedures, back testing equipment, pharmacy services, etc.
4. Explanation of how your firm will meet requested scope of work.
5. References from other firms for whom you provide a similar service.
6. A list of referral specialist that maybe utilized by your firm. Indicate when a specialist will
be utilized and typical time frame for referrals.
7. Indicate you treatment protocol when an employee claims mental disability as a result of
a physical injury.
8. Indicate the percentage of your business that pertains to the treatment and management
of occupational injuries.
9. If an employee is referred to a specialist outside of your firm, please indicate how you will
still maintain control.
10. Indicate how an employee will receive treatment should they be injured during office
hours and when your office is closed.
11. Indicate time allotted for office visits. Are Doctors scheduled to see patients every 10, 15
or 20 minutes?
REVIEW AND ASSESSMENT
Professional firms will be evaluated on the following criteria. These criteria will be the basis for
review of the written proposals and interview session.
The rating scale shall be from 1 to 5, with 1 being a poor rating, 3 being an average rating, and 5
being an outstanding rating.
WEIGHTING
QUALIFICATION
STANDARD
FACTOR
2.0
Scope of Proposal
Does the proposal show an understanding of the
project objective, methodology to be used and results
that are desired?
2.0
Assigned Personnel
Do the persons who will be working on the project
have the necessary skills? Are sufficient people of
the requisite skills assigned?
1.0
Availability
Existing workload and staff.
1.0
Motivation
Is the firm interested and are they capable of doing
the work in the required time frame?
2.0
Cost and
Are any incentives offered? Usual and customary
Work Hours
charges.
2.0
Firm Capability
Does the firm have the support capabilities the
assigned personnel require? Has the firm done
previous projects of this type and scope?
Reference evaluation (Top Ranked Firm)
The Project Manager will check references using the following criteria. The evaluation rankings
will be labeled Satisfactory/Unsatisfactory.
QUALIFICATION
STANDARD
Overall Performance
Are you pleased with the services provided?
Thoroughness
Does the provider follow through with cases,
keeping you informed of status?
Knowledge of Workers'
Is there an understanding of compensation
procedures for specific work related injury
problems?
Record keeping
Is record keeping timely and efficient?
Is the provider able to provide specific needs
Specific contract requirements
or are all services from the "mold"?
SCOPE OF WORK
Provide appropriate medical care and case management five (5) days a week
from 7:00 a.m. to 5:00 p.m., for City of Fort Collins employees that have injuries
or illnesses alleged to have occurred as a result of their employment. Facility
should be in a location which will minimize employee travel time.
Maintain accurate medical records for every City employee receiving medical
care. Individual patient records and reporting systems necessary to carry out
program administrative, planning, and legal requirements will be established and
maintained.
3. Contact Risk Management after medical treatment is rendered. The severity of
the injury and/or type of visit will determine when a report must be made. The
report will include information on the accident/exposure, work restrictions, and
prognosis for return to work. This information should be transmitted to the city's
electronic mail system. The successful provider shall be on-line electronically
within 30 days of contract award.
4. Notify Risk Management upon referral of employee from your facility to another
physician, or upon admission to a hospital or other facility. All information for on-
going treatment shall be sent promptly to the receiving physician, hospital or other
facility.
5. Provide employee with written "status" report outlining work restrictions, if any, for
every visit.
6. Provide a written report within five (5) days of initial treatment to claim
administrator.
7. Provide specialty services as requested, by Risk Management, such as physical
examinations, audiograms, x-rays, EKG's, immunizations, physical therapy, and
inclinometer testing for the back.
8. Familiar with Workers' Compensation Laws and provide hearing testimony when
needed.
9. City employees shall be treated only by Level II accredited physicians.
10. Cooperate with the City's claim administrator and risk management staff in
submitting information at their request as needed in a timely manner.
11. Participate in consultations with employer and claim administrator as requested to
discuss specific cases and procedures. Meetings are held every two weeks with
the current medical provider.
12. Provide a written medical treatment plan when requested.
13. Provide appointment, arrival and departure times of all city employees.
14. Employees will be given a "Patient Satisfaction Survey" on their visit to OHS and
when they reach MMI.
SERVICES AGREEMENT
THIS AGREEMENT made and entered into the day and year set forth below by and between
THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the
"City" and , hereinafter referred to as "Service Provider".
W ITNESSETH:
In consideration of the mutual covenants and obligations herein expressed, it is agreed by
and between the parties hereto as follows:
1. Scope of Services. The Service Provider agrees to provide services in accordance
with the scope of services attached hereto as Exhibit "A", consisting of _ (_) page[s], and
incorporated herein by this reference.
2. The Work Schedule. [Optional] The services to be performed pursuant to this
Agreement shall be performed in accordance with the Work Schedule attached hereto as Exhibit
"B", consisting of (_) page[s], and incorporated herein by this reference.
3. Time of Commencement and Completion of Services The services to be performed
pursuant to this Agreement shall be initiated within (_) days following
execution of this Agreement. Services shall be completed no later than _ . Time is
of the essence. Any extensions of the time limit set forth above must be agreed upon in a writing
signed by the parties.
4. Contract Period. [Option 1] This Agreement shall commence upon the date of
execution shown on the signature page of this Agreement and shall continue in full force and effect
for one (1) year, unless sooner terminated as herein provided. In addition, at the option of the City,
the Agreement may be extended for an additional period of one (1) year at the rates provided with
written notice to the Professional mailed no later than ninety (90) days prior to contract end.
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4. Contract Period. [Option 2] This Agreement shall commence , 200 , and
shall continue in full force and effect until , 200_, unless sooner terminated as herein
provided. In addition, at the option of the City, the Agreement may be extended for additional one
year periods not to exceed _ (_) additional one year periods. Pricing changes shall be negotiated
by and agreed to by both parties and may not exceed the Denver - Boulder CPI-U as published by
the Colorado State Planning and Budget Office. Written notice of renewal shall be provided to the
Service Provider and mailed no later than ninety (90) days prior to contract end.
5. Delay. If either party is prevented in whole or in part from performing its obligations
by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the
party so prevented shall be excused from whatever performance is prevented by such cause. To
the extent that the performance is actually prevented, the Service Provider must provide written
notice to the City of such condition within fifteen (15) days from the onset of such condition.
[Early Termination clause here as an option.
6. Early Termination by City/Notice. Notwithstanding the time periods contained herein,
the City may terminate this Agreement at any time without cause by providing written notice of
termination to the Service Provider. Such notice shall be delivered at least fifteen (15) days prior to
the termination date contained in said notice unless otherwise agreed in writing by the parties. All
notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to
the following addresses:
City: Service Provider:
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In the event of early termination by the City, the Service Provider shall be paid for services rendered
to the date of termination, subject only to the satisfactory performance of the Service Provider's
obligations under this Agreement. Such payment shall be the Service Provider's sole right and
remedy for such termination.
7. City Representative. The City will designate, prior to commencement of the work, its
representative who shall make, within the scope of his or her authority, all necessary and proper
decisions with reference to the services provided under this agreement. All requests concerning this
agreement shall be directed to the City Representative.
8. Independent Service provider. The services to be performed by Service Provider are
those of an independent service provider and not of an employee of the City of Fort Collins. The
City shall not be responsible for withholding any portion of Service Provider's compensation
hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any
other purpose.
9. Personal Services. It is understood that the City enters into the Agreement based on
the special abilities of the Service Provider and that this Agreement shall be considered as an
agreement for personal services. Accordingly, the Service Provider shall neither assign any
responsibilities nor delegate any duties arising under the Agreement without the prior written
consent of the City.
10. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of
the services shall not be construed to operate as a waiver of any rights or benefits provided to the
City under this Agreement or cause of action arising out of performance of this Agreement.
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