RFP 860-14-020 TAPI .PDF

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CONTRACT PURSUANT TO PH REP 14-020
CONTRACT #: 860-14-020
This Contract is entered into this 4 th day of March, 2014 by and between Maricopa County ("County"), a political
subdivision of the State of Arizona, and The Arizona Partnership for Immunization (TAPI), for the purchase of
Billing Research services,
1.0 CONTRACT TERM:
1.1 This Contract is for a term of four (4) months, beginning on the 4 th day of March, 2014 and ending
the 30th day of June, 2014,
1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this
Contract for additional terms up to a maximum of five (5) years, (or at the County's sole
discretion, extend the contract on a month-to-month basis for a maximum of six (6) months after
expiration). The County shall notify the Contractor in writing of its intent to extend the Contract
term at least thirty (30) calendar days prior to the expiration of the original contract term, or any
additional term thereafter.
2.0 FEE ADJUSTMENTS:
Any request for a fee adjustment must be submitted sixty (60) days prior to the current Contract expiration
date. Requests for adjustment in cost of labor and/or materials must be supported by appropriate
documentation. If County agrees to the adjusted fee, County shall issue written approval of the change.
The reasonableness of the request will be determined by comparing the request with the (Consumer Price
Index) or by performing a market survey.
3.0 PAYMENTS:
3.1 As consideration for performance of the duties described herein, County shall pay Contractor the
sum(s) stated in Exhibit "A."
3,2 Payment shall be made upon the County's receipt of a properly completed invoice.
3.3 INVOICES:
3.3.1 The Contractor shall submit one (1) legible copy of their detailed invoice before
payment(s) can be made. At a minimum, the invoice must provide the following
information:
• Company name, address and contact
• County bill-to name and contact information
• Contract serial number
• County purchase order number
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CONTRACT #: 860-14-020
• Invoice number and date
• Payment terms
• Date of service or delivery
• Quantity
• Contract Item number(s)
• Description of service provided
• Pricing per unit of service
• Extended price
• Total Amount Due
3.3.2 Problems regarding billing or invoicing shall be directed to the County as listed on the
Purchase Order.
3.3.3 Payment shall be made to the Contractor by Accounts Payable through the Maricopa
County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT)
process. After Contract Award the Contractor shall complete the Vendor Registration
Form located on the County Depai tment of Finance Vendor Registration Web Site
(http://www.marieopa.gov/FinaneeNendors.asp30
3.3.4 EFT payments to the routing and account numbers designated by the Contractor will
include the details on the specific invoices that the payment covers. The Contractor is
required to discuss remittance delivery capabilities with their designated financial
institution for access to those details.
3.4 STRATEGIC ALLIANCE for VOLUME EXPENDITURES (SAVE):
3.4.1 The County is a member of the SAVE cooperative purchasing group. SAVE includes the
State of Arizona, many Phoenix metropolitan area municipalities, and many K-12 unified
school districts. Under the SAVE Cooperative Purchasing Agreement, and with the
concurrence of the successful Respondent under this solicitation, a member of SAVE
may access a contract resulting from a solicitation issued by the County. If you do not
want to grant such access to a member of SAVE, please so state in your proposal. In the
absence of a statement to the contrary, the County will assume that you do wish to grant
access to any contract that may result from this Request for Proposal.
3.5 INTERGOVERNMENTAL COOPERATIVE PURCHASING AGREEMENTS (ICPA's)
3.5.1 County currently holds 'CPA's with numerous governmental entities throughout the State
of Arizona. These agreements allow those entities, with the approval of the Contractor,
to purchase their requirements under the terms and conditions of the County Contract.
Please indicate on Attachment A, your acceptance or rejection regarding such
participation of other governmental entities. Your response will not be considered as an
evaluation factor in awarding a contract
4.0 AVAILABILITY OF FUNDS:
4.1 The provisions of this Contract relating to payment for services shall become effective when funds
assigned for the purpose of compensating the Contractor as herein provided are actually available
to County for disbursement. The County shall be the sole judge and authority in determining the
availability of funds under this Contract. County shall keep the Contractor fully informed as to the
availability of funds.
4.2 If any action is taken by any state agency, Federal department or any other agency or
instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in connection
with, this Contract, County may amend, suspend, decrease, or terminate its obligations under, or in
connection with, this Contract. In the event of termination, County shall be liable for payment
only for services rendered prior to the effective date of the termination, provided that such services
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CONTRACT #: 860-14-020
are performed in accordance with the provisions of this Contract. County shall give written notice
of the effective date of any suspension, amendment, or termination under this Section, at least ten
(10) days in advance.
5.0 DUTIES:
5.1 The Contractor shall perform al] duties stated in Exhibit "B", or as otherwise directed in writing
by the Procurement Officer.
5.2 During the Contract term, County shall provide Contractor's personnel with adequate workspace
for consultants and such other related facilities as may be required by Contractor to carry out its
contractual obligations.
6.0 TERMS and CONDITIONS:
6.1 INDEMNIFICATION:
6.1.1 To the fullest extent permitted by law, Contractor shall defend, indemnify, and hold
harmless County, its agents, representatives, officers, directors, officials, and employees
from and against all claims, damages, losses and expenses, including, but not limited to,
attorney fees, court costs, expert witness fees, and the cost of appellate proceedings,
relating to, arising out of, or alleged to have resulted from the negligent acts, errors,
omissions, mistakes or malfeasance relating to the performance of this Contract.
Contractor's duty to defend, indemnify and hold harmless County, its agents,
representatives, officers, directors, officials, and employees shall arise in connection with
any claim, damage, loss or expense that is caused by any negligent acts, errors, omissions
or mistakes in the performance of this Contract by the Contractor, as well as any person
or entity for whose acts, errors, omissions, mistakes or malfeasance Contractor may be
legally liable.
6.1.2 The amount and type of insurance coverage requirements set forth herein will in no way
be construed as limiting the scope of the indemnity in this paragraph.
6,1,3 The scope of this indemnification does not extend to the sole negligence of County.
6,2 INSURANCE REQUIREMENTS:
6,2.1 Contractor, at Contactor's own expense, shall purchase and maintain the herein stipulated
minimum insurance from a company or companies duly licensed by the State of Arizona
and possessing a current A.M. Best, Inc. rating of A-, VII or higher. In lieu of State of
Arizona licensing, the stipulated insurance may be purchased from a company or
companies, which are authorized to do business in the State of Arizona, provided that
said insurance companies meet the approval of County. The form of any insurance
policies and forms must be acceptable to County.
6.2,2 All insurance required herein shall be maintained in full force and effect until all work or
service required to be performed under the terms of the Contract is satisfactorily
completed and formally accepted. Failure to do so may, at the sole discretion of County,
constitute a material breach of this Contract,
6.2.3 Contractor's insurance shall be primary insurance as respects County, and any insurance
or self-insurance maintained by County shall not contribute to it.
6.2.4 Any failure to comply with the claim reporting provisions of the insurance policies or any
breach of an insurance policy warranty shall not affect the County's right to coverage
afforded under the insurance policies.
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CONTRACT #: 860-14-020
6.2.5 The insurance policies may provide coverage that contains deductibles or self-insured
retentions. Such deductible and/or self-insured retentions shall not be applicable with
respect to the coverage provided to County under such policies. Contactor shall be solely
responsible for the deductible and/or self-insured retention and County, at its option, may
require Contractor to secure payment of such deductibles or self-insured retentions by a
surety bond or an irrevocable and unconditional letter of credit.
6.2.6 County reserves the right to request and to receive, within 10 working days, certified
copies of any or all of the herein required insurance certificates. County shall not be
obligated to review policies and/or endorsements or to advise Contractor of any
deficiencies in such policies and endorsements, and such receipt shall not relieve
Contractor from, or be deemed a waiver of County's right to insist on strict fulfillment of
Contractor's obligations under this Contract.
6.2.7 The insurance policies required by this Contract, except Workers' Compensation, and
Errors and Omissions, shall name County, its agents, representatives, officers, directors,
officials and employees as Additional Insureds.
6.2.8 The policies required hereunder, except Workers' Compensation, and Errors and
Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) against
County, its agents, representatives, officers, directors, officials and employees for any
claims arising out of Contractor's work or service.
6.2.9 Commercial General Liability.
Commercial General Liability insurance and, if necessary, Commercial Umbrella
insurance with a limit of not less than $2,000,000 for each occurrence, $2,000,000
Products/Completed Operations Aggregate, and $4,000,000 General Aggregate Limit.
The policy shall include coverage for bodily injury, broad form property damage,
personal injury, products and completed operations and blanket contractual coverage, and
shall not contain any provision which would serve to limit third party action over claims.
There shall be no endorsement or modification of the CGL limiting the scope of coverage
for liability arising from explosion, collapse, or underground property damage.
6.2.10 Automobile Liability.
Commercial/Business Automobile Liability insurance and, if necessary, Commercial
Umbrella insurance with a combined single limit for bodily injury and property damage
of not less than $2,000,000 each occurrence with respect to any of the Contractor's
owned, hired, and non-owned vehicles assigned to or used in performance of the
Contractor's work or services under this Contract.
6.2.11 Workers' Compensation.
6.2.11.1 Workers' Compensation insurance to cover obligations imposed by federal and
state statutes having jurisdiction of Contractor's employees engaged in the
performance of the work or services under this Contract; and Employer's
Liability insurance of not less than $100,000 for each accident, $100,000 disease
for each employee, and $500,000 disease policy limit.
6.2.11.2 Contractor waives all rights against County and its agents, officers, directors and
employees for recovery of damages to the extent these damages are covered by
the Workers' Compensation and Employer's Liability or commercial umbrella
liability insurance obtained by Contractor pursuant to this Contract.
6.2.12 Errors and Omissions Insurance.
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CONTRACT #: 860-14-020
Errors and Omissions insurance and, if necessary, Commercial Umbrella insurance,
which will insure and provide coverage for errors or omissions of the Contractor, with
limits of no less than $1,000,000 for each claim.
6.2.13 Certificates of Insurance.
6.2.13.1 Prior to commencing work or services under this Contract, Contractor
shall have insurance in effect as required by the Contract in the form
provided by the County, issued by Contractor's insurer(s), as evidence
that policies providing the required coverage, conditions and limits
required by this Contract are in full force and effect. Such certificates
shall be made available to the County upon 48 hours notice. BY
SIGNING THE AGREEM_ENT PAGE THE CONTRACTOR
AGREES TO THIS REQUIREMENT AND UNDERSTANDS THAT
FAILURE TO MEET THIS REQUIREMENT WILL RESULT IN
CANCELLATION OF THIS CONTRACT.
6.2.13.2 In the event any insurance policy (ies) required by this Contract is (are)
written on a "claims made" basis, coverage shall extend for two (2)
years past completion and acceptance of Contractor's work or services
and as evidenced by annual Certificates of Insurance.
6.2.13.3 If a policy does expire during the life of the Contract, a renewal
certificate must be sent to County fifteen (15) days prior to the
expiration date.
6.2.14 Cancellation and Expiration Notice.
Insurance required herein shall not be permitted to expire, be canceled, or materially
changed without thirty (30) days prior written notice to the County.
6.3 NOTICES:
• All notices given pursuant to the terms of this Contract shall be addressed to:
For County:
Maricopa County
Department of Public Health
Attn: Cheryl Rentscheler, Procurement Officer
4041 N. Central Avenue, #1400
Phoenix, AZ 85012
(602) 506-6886
cherylrentscheler@maiLmaricopa.gov
For Contractor:
The Arizona Partnership for Immunization (TAN)
Patty Gast, Program Manager
700 East Jefferson Street, Suite 100
Phoenix, AZ 85034
(602) 288-7568
pattyG@TAPLorg
6,4 TERMINATION FOR CONVENIENCE:
The County reserves the right to terminate the Contract, in whole or in part at any time, when in
the best interests of the County without penalty or recourse. Upon receipt of the written notice,
the Contractor shall immediately stop all work, as directed in the notice, notify all subcontractors
of the effective date of the termination and minimize all further costs to the County. In the event
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CONTRACT #: 860-14-020
of termination under this paragraph, all documents, data and reports prepared by the Contractor
under the Contract shall become the property of and be delivered to the County upon demand.
The Contractor shall be entitled to receive just and equitable compensation for work in progress,
work completed and materials accepted before the effective date of the termination,
6.5 TERMINATION FOR DEFAULT;
6.5,1 In addition to the rights reserved in the Contract, the County may terminate the Contract
in whole or in part due to the failure of the Contractor to comply with any term or
condition of the Contract, to acquire and maintain all required insurance policies, bonds,
licenses and permits, or to make satisfactory progress in performing the Contract. The
Procurement Officer shall provide written notice of the termination and the reasons for it
to the Contractor.
6.5.2 Upon termination under this paragraph, all goods, materials, documents, data and reports
prepared by the Contractor under the Contract shall become the property of and be
delivered to the County on demand.
6.5.3 The County may, upon termination of this Contract, procure, on terms and in the manner
that it deems appropriate, materials or services to replace those under this Contract. The
Contractor shall be liable to the County for any excess costs incurred by the County in
procuring materials or services in substitution for those due from the Contractor.
6.5.4 The Contractor shall continue to perform, in accordance with the requirements of the
Contract, up to the date of termination, as directed in the termination notice.
6.6 TERMINATION BY THE COUNTY;
If the Contractor should be adjudged bankrupt or should make a general assignment for the benefit
of its creditors, or if a receiver should be appointed on account of its insolvency, the County may
terminate the Contract. If the Contractor should persistently or repeatedly refuse or should fail,
except in cases for which extension of time is provided, to provide enough properly skilled
workers or proper materials, or persistently disregard laws and ordinances, or not proceed with
work or otherwise be guilty of a substantial violation of any provision of this Contract, then the
County may terminate the Contract, Prior to termination of the Contract, the County shall give the•
Contractor fifteen- (15) calendar day's written notice. Upon receipt of such termination notice, the
Contractor shall be allowed fifteen (15) calendar days to cure such deficiencies.
6.7 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST:
Notice is given that pursuant to A.R.S. §38-511 the County may cancel this Contract without
penalty or further obligation within three years after execution of the contract, if any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County is at any time while the Contract or any extension of the Contract is in effect,
an employee or agent of any other party to the Contract in any capacity or consultant to any other
party of the Contract with respect to the subject matter of the Contract, Additionally, pursuant to
A.R.S §38-511 the County may recoup any fee or commission paid or due to any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on
behalf of the County from any other party to the contract arising as the result of the Contract.
6.8 OFFSET FOR DAMAGES;
In addition to all other remedies at law or equity, the County may offset from any money due to
the Contractor any amounts Contractor owes to the County for damages resulting from breach or
deficiencies in performance under this contract.
6.9 ADDITIONS/DELETIONS OF SERVICE;
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CONTRACT #: 860-14-020
The County reserves the right to add and/or delete products and/or services provided under this
Contract. If a requirement is deleted, payment to the Contractor will be reduced proportionately to
the amount of service reduced in accordance with the proposal price. If additional services and/or
products are required from this Contract, prices for such additions will be negotiated between the
Contractor and the County.
6.10 RELATIONSHIPS:
In the performance of the services described herein, the Contractor shall act solely as an
independent contractor, and nothing herein or implied herein shall at any time be construed as to
create the relationship of employer and employee, partnership, principal and agent, or joint venture
between the District and the Contractor.
6.11 SUBCONTRACTING:
The Contractor may not assign this Contract or subcontract to another party for performance of the
terms and conditions hereof without the written consent of the County, which shall not be
unreasonably withheld. All correspondence authorizing subcontracting must reference the
Proposal Serial Number and identify the job project.
6.12 AMENDMENTS:
All amendments to this Contract shall be in writing and approved/signed by both parties. The
Public Health Procurement Officer and/or the Office of Procurement Services' Chief Procurement
Officer shall be responsible for approving all amendments for Maricopa County.
6.13 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR
OTHER REVIEW:
6.13.1 In accordance with section MCI 367 of the Maricopa County Procurement Code the
Contractor agrees to retain all books, records, accounts, statements, reports, files, and
other records and back-up documentation relevant to this Contract for six (6) years after
final payment or until after the resolution of any audit questions which could be more
than six (6) years, whichever is latest. The County, Federal or State auditors and any
other persons duly authorized by the Department shall have fall access to, and the right to
examine, copy and make use of, any and all said materials.
6.13.2 If the Contractor's books, records, accounts, statements, reports, files, and other records
and back-up documentation relevant to this Contract are not sufficient to support and
document that requested services were provided, the Contractor shall reimburse Maricopa
County for the services not so adequately supported and documented.
6.13.3 If at any time it is determined by the County that a cost for which payment has been made
is a disallowed cost, the County shall notify the Contractor in writing of the
disallowance. The course of action to address the disallowance shall be at sole discretion
of the County, and may include either an adjustment to future claim submitted by the
Contractor by the amount of the disallowance, or to require reimbursement forthwith of
the disallowed amount by the Contractor by issuing a check payable to Maricopa County.
6.14 AUDIT DISALLOWANCES:
If at any time, County determines that a cost for which payment has been made is a disallowed
cost, such as overpayment, County shall notify the Contractor in writing of the disallowance,
County shall also state the means of correction, which may be but shall not be limited to
adjustment of any future claim submitted by the Contractor by the amount of the disallowance, or
to require repayment of the disallowed amount by the Contractor.
6.15 SEVERABILITY:
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CONTRACT tt: 860-14-020
The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the
validity of any other provision of this Contract.
6.16 RIGHTS IN DATA;
The County shall own have the use of all data and reports resulting from this Contract without
additional cost or other restriction except as provided by law. Each party shall supply to the other
party, upon request, any available information that is relevant to this Contract and to the
performance hereunder.
6.17 INTEGRATION:
This Contract represents the entire and integrated agreement between the parties and supersedes
all prior negotiations, proposals, communications, understandings, representations, or agreements,
whether oral or written, express or implied.
6,18 VERIFICATION REGARDING COMPLIANCE WITH ARIZONA REVISED STATUTES §41-
4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS:
6.18.1 By entering into the Contract, the Contractor warrants compliance with the Immigration
and Nationality Act (INA using e-verify) and all other federal immigration laws and
regulations related to the immigration status of its employees and A.R,S. §23-214(A), The
contractor shall obtain statements from its subcontractors certifying compliance and shall
furnish the statements to the Procurement Officer upon request. These warranties shall
remain in effect through the tem of the Contract. The Contractor and its subcontractors
shall also maintain Employment Eligibility Verification forms (I-9) as required by the
Immigration Reform and Control Act of 1986, as amended from time to time, for all
employees performing work under the Contract and verify employee compliance using the
E-verify system and shall keep a record of the verification for the duration of the
employee's employment or at least three years, whichever is longer. 1-9 forms are available
for download at USCIS.GOV .
6.18.2 The County retains the legal right to inspect contractor and subcontractor employee
documents performing work under this Contract to verify compliance with paragraph
6.18.1 of this Section. Contractor and subcontractor shall be given reasonable notice of the
County's intent to inspect and shall make the documents available at the time and date
specified. Should the County suspect or find that the Contractor or any of its subcontractors
are not in compliance, the County will consider this a material breach of the contract and
may pursue any and all remedies allowed by law, including, but not limited to: suspension
of work, termination of the Contract for default, and suspension and/or debarment of the
Contractor. All costs necessary to verify compliance are the responsibility of the
Contractor.
6.19 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
6.19.1 The undersigned (authorized official signing for the Contractor) certifies to the best of his
or her knowledge and belief that the Contractor, defined as the primary participant in
accordance with 45 CFR Part 76, and its principals:
6.27.1.1 are not presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from covered transactions by any Federal
Department or agency;
6.27.1,2 have not within 3-year period preceding this Contract been convicted of or
had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or
performing a public (Federal, State or local) transaction or contract under a
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CONTRACT #: 860-14-020
public transaction; violation of Federal or State antitrust statues or
commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, or receiving stolen property;
6.27.1.3 are not presently indicted or otherwise criminally or civilly charged by a
government entity (Federal, State or local.) with commission of any of the
offenses enumerated in paragraph (2) of this certification; and
6,27.1.4 have not within a 3-year period preceding this Contract had one Or more
public transaction (Federal, State or local) terminated for cause of default.
6,192 Should the Contractor not be able to provide this certification, an explanation as to why
should be attached to the Contact.
6.19.3 The Contractor agrees to include, without modification, this clause in all lower tier
covered transactions (i.e. transactions with subcontractors) and in all solicitations for
lower tier covered transactions related to this Contract.
6.20 GOVERNING LAW:
This Contract shall be governed by the laws of the state of Arizona. Venue for any actions or
lawsuits involving this Contract will be in Maricopa County Superior Court or in the United States
District Court for the District of Arizona, sitting in Phoenix, Arizona
6.21 ORDER OF PRECEDENCE:
In the event of a conflict in the provisions of this Contract and Contractor's license agreement, if
applicable, the terms of this Contract shall prevail.
6.22 AUDIT REQUIREMENTS
622,1 If the Contractor expends $500,000 or more from all contracts administered and/or
funded via County, and/or receives $500,000 or more per year from any federal funding
sources, the Contractor may be subject to Federal audit requirements per P.L. 98-502
"The Single Audit Act". The Contractor shall comply with OMB Circulars A-128, A-
110, and A-133 as applicable. The audit report shall be submitted to the Maricopa
County Department of Public Health for review within the twelve months following the
close of the fiscal year. The Contractor shall take any necessary corrective action to
remedy any material weaknesses identified in the audit report within six months after the
release date of the report. Maricopa County may consider sanctions as described in OMB
Circular A-128 for contractors not in compliance with the audit requirements. All books
and records shall be maintained in accordance with Generally Accepted Accounting
Principles (GAAP).
6.22.2 The Contractor shall schedule an annual financial audit to be submitted to County for
review within twelve months following the close of the program's fiscal year. Contractor
understands that failure to meet this requirement may result in loss of current funding and
disqualification from consideration for future County-administered funding.
6.22.3 The Contractor shall comply with the requirement of the Federal Office of Management
and Budget (OMB) Circular A-133. The Contractor is responsible for having an audit
performed in accordance with, and when required, by OMB Circular A-133, and for
sending a copy of the report issued as a results of the audit to the COUNTY within 30
days of issuance. The County reserves the right to engage an auditor, at the Contractor's
expense, to perform an OMB Circular A-133 audit of the Contractor in the event that the
Contractor shall fall to engage an auditor or the County shall reject or disapprove of the
auditor engaged by the Contractor.
6.22.4 The Contractor must also comply with the following OMB Circulars:
1,0 A-102 Uniform Administrative Requirements for Grants to State and Local
Government.
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CONTRACT #: 860-14-020
2.0 A-110 Uniform Administrative Requirements for Grants and Agreement with
Institutions of Higher Education, Hospitals and other non-profit organizations.
3.0 A-122 Cost Principles for Non-Profit Organizations.
4.0 A-87 Cost Principles for State and Local Governments,
5.0 A-21 Cost principles for Education Institutions,
6.23 INFLUENCE
As prescribed in MC1-1202 of the Maricopa County Procurement Code, any effort to influence an
employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct,
may be grounds for Disbarment or Suspension under MC1-902.
An attempt to influence includes, but is not limited to:
6.23,1 A Person offering or providing a gratuity, gift, tip, present, donation, money,
entertainment or educational passes or tickets, or any type valuable contribution or
subsidy,
6.23.2 That is offered or given with the intent to influence a decision, obtain a contract, garner
favorable treatment, or gain favorable consideration of any kind,
If a Person attempts to influence any employee or agent of Maricopa County, the Chief
Procurement Officer, or his designee, reserves the right to seek any remedy provided by the
Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided
by this contract.
6.24 PUBLIC RECORDS:
All Offers submitted and opened are public records and must be retained by the Records Manager
at the Office of Procurement Services. Offers shall be open to public inspection after Contract
award and execution, except for such Offers deemed to be confidential by the Office of
Procurement Services. If an Offeror believes that information in its Offer should remain
confidential, it shall indicate as confidential, the specific information and submit a statement with
its offer detailing the reasons that the information should not be disclosed. Such reasons shall
include the specific harm or prejudice which may arise, The Records Manager of the Office of
Procurement Services shall determine whether the identified information is confidential pursuant
to the Maricopa County Procurement Code.
6.25 INCORPORATION OF DOCUMENTS:
The following are to be attached to and made part of this Contract:
6.25.1 Exhibit A, Pricing;
6.25.2 Exhibit B, Scope of Work
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CONTRACT #: 860-14-020
IN WITNESS WHEREOF, this Contract is executed on the date set forth above.
CONTRACTOR
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AUTHORIZVD SIGNATURE
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PRINTED NAME AND TITLE
700 1-eccorsi-7-, 5-14;i /00
ADDRESS
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DATE
MARICOPA COUNTY
DATE
CHIEF PROCUREMENT OFFICER, OFFICE OF DATE
PROCUREMENT SERVICES
APPROVED AS TO FORM:
MeL4Z -D-e(
LEGAL COUNSEL DATE
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CONTRACT #: 860-14-020
EXHIBIT A
PRICING
BIDDER NAME: The Arizona Partnership for Immunization (TAFT)
F.I.D.NENDOR #: 45-4185015
BIDDER ADDRESS: 700 East Jefferson Street, Suite 100, Phoenix, Arizona 85034
P,0, ADDRESS:
BIDDER PHONE #: 602-288-7568
BIDDER FAX 4: 602-262-2654
COMPANY WEB SITE: www.whyiminunize.org
COMPANY CONTACT (REP): Patty Gast, Program Mariaer — Billing and Funding
E-MAIL ADDRESS (REP): PattyG@TAPLorg
PAYMENT TERMS: BIDDER IS REQUIRED TO SELECT ONE OF THE FOLLOWING:
TERMS WILL BE CONSIDERED IN DETERMINING LOW BID.
FAILURE TO CHOOSE A TERM WILL RESULT IN A DEFAULT TO NET 30.
BIDDER MUST INITIAL THE SELECTION BELOW.
NET 10
NET 15
NET 20
NET 30 X
NET 45
NET 60
NET 90
2% 10 DAYS NET 30
1% 10 DAYS NET 30
2%30 DAYS NET 31
1% 30 DAYS NET 31
5%30 DAYS NET 31
COMPENSATION/FEES: TOTAL AMOUNT
Billing Services Research $ 100,000
(As defined herein) (Please fill in)
Respondent's signature below indicates understanding and agreement to perform the services outlined in the Request
for Proposal indicated above for the total amount they have listed above.
1Y7
Signature (REQUIRED) REQUIRED) Date
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EXHIBIT B
SCOPE OF WORK
Original Scope of Work from RFP:
2.1 Contractor shalt:
2.1.1 Review all state statutes the could be a barrier to public health billing
2.1.1 Review Arizona Health Care Cost Containment System's (AHCCCS) policies that
prohibit public health from billing for services outside the medical home; Review these
AHCCCS policies in light of Center for Medicaid and Medicare Services (CMS) policies,
Affordable Care Act requirements and health plan needs
2.1.2 Audit top services provided by public health by Current Procedural Terminology (CPT)
code to determine impact in the community
2.1.3 Develop a pilot program with relevant program or program(s) to determine public
reaction to billing, percent of Medicaid patients and privately insured population
breakdown
2.1.4 Survey physicians/patients to determine most frequently referred services
2.1.5 Perform a cost savings analysis of the top public health services and future outcomes
2.1.6 Research the pros and cons of the possibility of public health services becoming
classified as a "Community Health Urgent Care" for better billing as an ancillary services
that supports the medial home
2.1.7 Develop sample policies that can be used to refer patients back to the Primary Care
Provider showcasing public health as supportive care in a care coordination model
2.1.8 Hold a public health stakeholders meeting that partners health leadership and health plans
to educate decision makers about the Affordable Care Act's population-based health
provisions and showcases how public health meets those goals as subject matter experts.
2.1.9 Develop monthly summary reports updating MCDPH on the status of the project.
2.1.10 Provide a final summary report with findings and recommendations.
Contractor's Proposal:
1.1.4 PROPOSAL
The Arizona Partnership for Immunization (TAPI) proposes to explore, adjust, and transform policies and
system structure to allow public health departments to receive full insurance reimbursement for public health
services they provide as safety net services that prevent and treat infectious diseases and improve population
health, through such programs as clinic services, home consultation services, tobacco cessation services,
community health workers and others. Objectives are: 1) to research policy and collect data, 2) to use the data to
develop stories and strategies, 3) to communicate the stories and strategies to convince insurance and health
leadership of our state to sustainably support public health services through insurance billing and
reimbursement, 4) to help stakeholders see the role of public health as an important partner in healthcare,
community health and prevention services, and 5) to assist county health depai talents in addressing internal
policies and procedures to assist them in billing and communicating billing need to customers. These activities
will focus on the four main areas:
• Policy (RFP sections 2.1.1, 2.1.2, 2.1.7)
• Community Impact and Role of PH (REP sections 2.1.3, 2.1.4, 2.1.5, 2.1.6,2.1.8)
• Public Messaging (REP section 2.1.9)
• Contract Requirements (REP sections 2.1.10, 2.1.11)
Studies show that patients who utilize the public health depai LE lent for treatment of infectious disease are
treated faster eliminating spread in the community. Public health departments often treat and provide
prevention services to those who do not access mainstream healthcare. Cuts to public health budgets threaten
clinical services leaving many without healthcare treatment. Insurance billing and reimbursement will poise
public health to transition their services to a sustainable funding source allowing clinics to stay open and offer
services to promote health in Arizona communities.
New Affordable Care Act guidelines encourage all health care providers to focus on prevention and community
health, and public health departments' core functions achieve these goals. Sustainability of public programs not
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only has the potential to keep communities well, but also to be a fundamental resource for health systems
learning a new model of care.
This is a quick and fluid project that will change with findings and recommendations, but all activities and the
report will be completed by June 30, 2014.
Policy Research (RFP Sections 2.1.1, 2.1.2, 2.1.7)
Activities/Tasks: The Subcontractors will review state statutes (RFP 2.1.1), and Arizona Health Care Cost
Containment System (AHCCCS) policies, Centers for Medicare and Medicaid Services (CMS) policies, Affordable
Care Act (ACA) policies and requirements, and health plan policies (RFP 2.1.2) that could be opportunities for or
barriers to public health billing. This will include, but not be limited to, the following:
• AHCCCS has a policy to reimburse only those services deemed necessary by the Primary Care Provider
and prohibits public health from billing for services 1) that are not covered by AHCCCS, specifically not
deemed medically necessary by a doctor, with the only exception being childhood immunizations. For
example, adult immunizations would not be reimbursable, although currently an exception in policy has
been made to cover child immunization services. Also, home consultation services performed by a nurse
would not be reimbursable, nor would pre-conception health counseling performed outside of a Well-
Woman Check.
• AHCCCS' approach of cost containment and capitated reimbursement rates punishes a plan for contracting
with providers outside typical specialty groupings. AHCCCS audits and pays health plans only at the end
of the year — if a contract with a public health department bumps up the number and dollar amounts of
claims, the health plan will see a loss until AHCCCS reaudits, acts on its audits and changes its utilization
estimates and capitated rates in the next year.
• CMS had a very restrictive policy allowing only physicians to be reimbursed for preventive services,
However, CMS recentlychanged their regulations to coincide with Affordable Care Act (ACA) intent by
allowing nonphysicians and unlicensed practitioners to be eligible to be paid by Medicaid for these
preventive services, such as public health staff and community workers, but there appears to be much
discretion in this approach that is left up to the state, which may allow AHCCCS to forgo reimbursing
public health. County health departments, through TAN and, for some counties, through their own efforts,
have attempted to contract with private health plans, but not all will recognize public health as an in-
network provider. Some plans are hesitant to contract with public health because it does not fit any
specialty groupings, which makes contracting, rate capitation and other assessments challenging.
• Juvenile detention in Arizona is statutorily the responsibility of each county.
(courts.gov/Portals/29/JJSD%20Publication%20Reports/JDTF_Operational Guidelines.pdf ) Arizona
counties are required to provide health screenings, medical evaluation, medical care and treatment,
pharmaceuticals, medical isolation, suicide prevention and intervention, crisis intervention, as necessary.
The ability to bill AHCCCS or the child's private insurance will be explored to offset county costs.
• The ACA requires increased access to insurance for everyone. It makes sense that county health
departments should be allowed reimbursement by the patient's public or private insurance company,
otherwise taxpayer dollars cover the service that the patient has already paid for through insurance
premiums, thereby providing a windfall to the insurance company. In all of the following situations, a
county health department should be able to bill the patient's public or private insurance company:
o Many patients go to the county health department for services because their provider refers them
there. One example is tuberculosis treatment. A majority of private providers do not have the
expertise and staffing to appropriately treat tuberculosis due to the complexity of the drug
regimen, effort needed to monitor compliance with the regimen and to watch for negative side-
affects, and the expertise involved with multi-drug resistant TB.
o Many patients go to the county health department for services for confidentiality reasons — the
patient does not want to go to his/her doctor. An example of this is a patient with a sexually
transmitted disease (STD). The stigma associated with this disease may prevent a patient from
seeing his or her primary care provider. A county prefers not to turn away a patient with syphilis,
for example, because delayed treatment may result in serious health consequences for the patient
and further spread of the disease in the community.
o The county health department offers many preventive services that for which private providers
may not have resources or expertise in, such as smoking cessation, home visiting for at-risk
pregnancy or contact investigations for infectious diseases. For example, county health
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CONTRACT #: 860-14-020
departments have the expertise and staffing resources to conduct TB testing and counseling on
prevention for individuals who are exposed to a TB patient. Such contact investigations could
involve dozens of individuals.
• The ACA mandates new care delivery models for hospitals and practitioners that require emphasis on
population-based prevention, community and outcomes. Public health practitioners will have the
opportunity to share their expertise on assessing the health of populations, implementing community and
broad-based solutions, and evaluating the outcomes of these solutions. If they are able to work in
partnership, public health's data could be shared with insurance companies and hospitals, for example, to
help meet accountability and HEDIS benchmarks.
• Under the ACA, "public health services can reach more people: Programs and services such as, home
visiting and other maternal child health programs and specialized behavioral health services will be made
available to the general population, in addition to programs on prevention and protection." (Dr. Georges
Benjamin, president of the American Public Health Association, http://www.rwjf.org/en/blogs/new-public-
health/2012/12/how will the afforda.htmlete )
• "Insurance companies that offer plan on the Health Insurance Marketplace (Exchange) now have a
requirement under the ACA to include in their network a sufficient number and geographic distribution of
providers that serve predominately low-income, medically underserved individuals (referred to as Essential
Community Providers." Public health is designated as an ECP, yet AHCCCS currently refuses to reimburse
public health for health care services. littp://www.crns.gov/CCIIO/ResourceslFact-Sheets-and-
FAQ s/Downloads/ecp-faq-20130513 .pdf
During this policy research, the Subcontractors will review CMS provider groupings and explore other avenues to
categorize public health services as an ancillary provider, such as "Community Health Urgent Care" or other
designations such as "Rural Health Provider." Public health does not typically fit the categories of providers used by
insurance companies, and is not considered the patient's medical home, making it difficult for public health to have
its providers credentialed and making it difficult for insurance companies to assess utilization and determine contract
pricing. In addition, since AHCCCS pays its managed care health plans only at the end of the year, a health plan
could lose a lot of money by contracting with an entity such as public health that isn't figured into its capitation
rates. However, making a case for how public health aligns with one or more existing ancillary provider categories
can make it easier to contract with and be served by insurance companies. One way that TAPI recently dealt with a
similar issue with immunization reimbursement was to leave out the public health immunization provider out of the
provider from the referral book — thus, no patient assignment is made, the patient stays in the medical home and
there is no self-referral using the book. Similar other types of solutions are expected to be identified from this policy
research. Note that this issue also relates to the public health role section of this RFP.
The Subcontractors will interview subject matter experts in these policy areas, including meeting with public and
private insurance company leadership, obtaining legal opinions about statutes and policies, and obtaining
information from other states' best practices, as necessary.
The Subcontractors will produce a report that explains the identified laws/policies that support or impede public
health billing, which will include 1) recommendations for changing unsupportive laws/policies or promoting
supportive laws/policies and 2) recommendations for approaching stakeholders with convincing arguments about the
need for in-network reimbursement of all public health services.
COMMUNITY IMPACT AND ROLE OF PUBLIC HEALTH (RFP sections 2.1.3, 2.1.4, 2.1.5, 2.1.6, 2.1.8)
Background: County health departments play important roles in medical diagnosis, treatment, disease control and
prevention for individuals and communities in their jurisdictions. Each county health department potentially
provides different types and levels of services depending on the needs of the population served and its budget.
Major areas of services include Immunizations, Tuberculosis Prevention and Control, STD Prevention and Control,
Family Planning, Home Consultation, Tobacco Cessation, Community Health Workers and others. County health
departments provide a safety net for patients who do not have a medical home or who are not able or willing to
access a specific service in their medical home, despite the ACA. Additionally, state statutes mandate county health
departments to address some diseases and health programs such as tuberculosis, STD and childhood immunizations.
Public health provider feels the moral responsibility to treat the syphilis patient and NOT to miss an opportunity for
treatment that would be caused by refusing to see the patient and letting him or her leave, not knowing if the patient
will follow-up with his/her PCP (if the patient has one). Many health care providers refer their tuberculosis patients
and STD patients, for example, to county health departments because of the complexities in diagnosing and treating
and preventing these diseases. Public health understands behavior and culture for health behavior change — and has
data that can help insurance companies and hospitals, for example, use in meeting ACO or HEDIS benchmarks.
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CONTRACT 860-14-020
Public health can reinforce the alignment of messages. The healthcare provider can rely on PH to give messages to
the community and their patients, from doctor to patient, to media and to the community.
Another way that public health participates in care coordination is that under the ACA, public health is an Essential
Community Care Provider (BCP). ECPs are providers who predominantly serve low-income, medically
underserved individuals. Health insurance companies that offer plans on the Health Insurance Marketplaces are
required by ACA to include in their network a sufficient number and geographic distribution of ECPs. At least 20%
of available ECPS in the plan's service area must participate in the issuer's provider networks(s).
http ://www.ems.gov/CCTIO/Resources/Regulations-and-Gui dance/Downloads/2014 letter to is suers 04052013 .pdf
The American Academy of Pediatrics (AAP) defines a Medical Home as not a building, house, or hospital, but
rather an approach to providing health care services in a high-quality and cost-effective manner. Children and their
families who have a medical home receive the care that they need from a pediatrician or physician (pediatric health
care professional) whom they trust. The pediatric health care professionals and parents act as partners in a medical
home to identify and access all the medical and non-medical services needed to help children and their families
achieve their maximum potential. The American Academy of Family Physicians (AAFP), the American Academy of
Pediatrics (AAP), the American College of Physicians (ACP), and the American Osteopathic Association (AOA)
published Joint Principles of the "Patient-Centered Medical Home" in February, 2007, The Patient-Centered
Medical Home (PC-MH) is an approach to providing comprehensive primary care for children, youth and adults,
The PC-MH is a health care setting that facilitates partnerships between individual patients, and their personal
physicians, and when appropriates, the patient's family.
Public health needs to be viewed in a new light as our medical system changes -- supporting the medical home by
referring patients back to their primary care provider, when possible, yet treating/providing preventive services to
patients as necessary and being an integral part of the care coordination model, sharing data, outcomes and messages
with providers and the community, as appropriate. The activities below will result in data, cost savings analyses and
assessments of county health impacts that will be used to convince stakeholders of the beneficial impact of county-
based services, and convey the risk of losing public health services.
Activities/Tasks:
• The TAPI Program Coordinator will survey physicians/patients to determine most frequently referred services
(RFP 2.1.5)
o A survey questionnaire of healthcare providers will be developed in coordination with the TAPI
Provider Committee and the medical associations in Arizona.
o The questionnaire will ask healthcare providers qualitative and quantitative questions about the number
and percentage of their patients that access Public Health services, how many patients they directly
refer to public health depal intents, the healthcare providers' capacity to provide services offered by
public health and the value the healthcare provider places on public health department services.
o The survey will be developed in SurveyMorikey and AZ medical associations will distribute and
promote the survey to their membership. TAP1 staff will attend any medical association conferences
held during this contract period to promote the completion of the survey and open discussions about
sustaining public health services
o MCDPH programs will also be surveyed on the # or % of patients they know have been referred or
have private insurance
o The Subcontractor will analyze the data for inclusion in the final report. The data will provide
evidence about the value of public health services that will be shared with stakeholders.
• The Subcontractor will audit top services provided by public health by Current Procedural Terminology (CPT)
code to determine impact in the community (RFP 2.1.3), and perform a cost savings analysis of the top public
health services and future outcomes (RFP 2.1.6).
o TAPI has already worked directly with county health departments statewide and identified the public
health services they would like to bill for by CPT code and volume of patients/visits. These services
include immunizations, STD, HIV, family planning and home visiting services. See the list of these
services and associate CPT codes in the 1.1.13 Qualifications Attachment H.
o These public health services will be assessed by the volume of services, cost savings provided by the
service (ex., each immunization saves $10 in healthcare-related costs), special resources needed (ex.,
the staffing and expertise to conduct contact investigations), mandates to perform the service, and the
availability of similar services in the marketplace (ex., lack of TB treatment expertise and resources in
private sector), and services most referred to Public Health by private providers (see RFP 2.1.5) to
measure the community health impact.
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o Another way that public health participates in care coordination is that under the ACA, public health is
an Essential Community Care Provider (ECP), ECPs are providers who predominantly serve low-
income, medically underserved individuals. Health insurance companies that offer plans on the Health
Insurance Marketplaces are required by ACA to include in their network a sufficient number and
geographic distribution of ECPs. At least 20% of available ECPS in the plan's service area must
participate in the issuer's provider networks(s). http://www.ems.gov/CC110/Resources/Regulations-
and-Guidance/Downloads/2014 letter to issuers 04052013.pdf
• The TAPI Program Coordinator will develop a pilot program with relevant program or programs to determine
public reaction to billing, percent of Medicaid patients and privately insured population breakdown,
o It is important to get an indication whether a public health billing system is feasible for the different
public health services. Do patients have insurance, and if so, what percent are on public vs private
insurance? Are the patients willing to present their insurance information or are the unwilling to,
based on confidentiality concerns — especially when Explanation of Benefit (EOB) statements may be
sent to their homes after the service is provided. Patients with STDs or other diseases may be
reluctant to receive EOBs. Can steps be developed to allow patients to opt out of providing their
insurance information in that case?
o Another critical piece, which can be challenging, is changing the culture and staff attitudes about
collecting insurance cards. Public health staff have traditionally been most concerned with not missing
opportunities to treat or educate, while having free services to provide. For some staff, asking patients
for insurance cards may be seen as an obstacle to service. It will be important to educate staff about
the importance of billing as a way to maintain long-term sustainable services, Educating staff about
how to approach insurance questions with patients is important too.
o TAPI has already accomplished this activity with billing for immunizations and developed materials,
• systems and education that have helped public health department staff with improved approaches.
Sharing these resources and best practices with all counties has helped with efficiency in not
"reinventing the wheel," TAPI will use the model developed and implemented for immunizations for
the other public health services, as described hi the bullets below.
o TAPI staff will develop the survey questionnaire that public health staff will present to patients. The
survey will ask patients if they are willing to provide their insurance information for billing. The
survey will explain to the patient the county's approach:
• Our (the county's) first priority is your health and wellness, You will receive all services
regardless of your insurance status. Our second priority is continued funding for Public
Health Services. Would you feel comfortable with us billing your insurance? If we do bill
your insurance company, chances are you will get an E013 at home from the insurance
company, not from Public Health. If you are OK with this, please complete this insurance
form.
o TAPI will develop 1) a script for each program's staff and 2) a frequently asked questions (FAQ)
document. TAPI will hold one meeting with each program to rehearse the script and potential
questions arid answers that patients may have.
o TAPI will develop signs to hang in the clinic and patient handouts about why public health is asking
for insurance cards. Similar signs were developed previously, as shown in Attachment G in 1.1.13.
o TAPI will ask the program staff to conduct the survey with every patient over a month-long period of
time,
o TAPI will collect the completed patient questionnaires, tally the results about patients' insurance
status, types of insurance, and willingness to provide insurance information. TAPI will recommend
changes to approaches based on the findings. TAPI will share and discuss findings and
recommendations with program staff and address any feedback and recommendations from staff.
o Examples of a possible recommendation based on findings may include the option to allow the patient
to opt out of providing insurance card information, if the county budget can allow this,
• The TAPI Program Coordinator will develop sample policies that can be used to refer patients back to the
Primary Care Provider showcasing public health as supportive care in a care coordination model
o TAPI will collect and summarize current care coordination policies.
TAPI will meet with each Maricopa County Department of Public Health program, for which billing is
relevant, to discuss additional opportunities for care coordination and challenges. For example,
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CONTRACT #: 860-14-020
referring patients to their PCPs and not treating them may be unethical and lead to poor outcomes for
the patient and disease prevention, especially if the patient does not want to go to his/her PCP out of
embarrassment or for confidentiality reasons.
o TAPI will compile these opportunities and challenges in a report, make recommendations to the
director of the public health agency for improvement of care coordination, and will summarize issues,
challenges and benefits in a document to be shared with insurers and the medical community to
increase their understanding and appreciation of the role public health plays in care coordination.
PUBLIC MESSAGING (RFP 2.1.9)
TAPI will sponsor a public health stakeholders meeting that partners Arizona health/medical leadership, health
plans, public health departments, governmental agencies, non-profits, community organizations and other subject
matter experts in Arizona The purpose of the meeting is to educate decision makers about the Affordable Care Act's
population-based health and prevention provisions and showcase how public health services meet those goals. TAPI
has held vaccine congresses and many successful meetings like these.
• The approach of the meeting will be to have the leaders and experts share ideas and sow seeds for change.
The data and evidence collected in the activities of this contract (listed above) will tell the story of how we
are a healthier community with sustainable (and billable/reimbursable) public health programs. Attendees
will be asked to share their perspectives, experiences, challenges, and opportunities in promoting health
during these times of transformation and budget reductions. Recommendations for sustaining public health
services and the formation of a Leadership Workgroup to address insurance reimbursement of public health
and other sustainability issues will be specifically asked for.
Having the right types of people in the room to be able to listen to and engage in the discussion and have
future conversations and make changes is important. TAN has demonstrated an ability to engage these key
stakeholders and invitees will include: Arizona Department of Health Services Director, local health
department directors, including counties and tribes; AHCCCS director; Insurance health plan
representatives, medical and hospital associations, Indian Health Services representatives, First Things
First, Children's Action Alliance, a variety of community-based organizations, HIV, STD and Family
Planning coalitions, and ACA experts.
• A large conference ro0111 will be rented, with audiovisual equipment, for a partial day (possibly 6-hour
long) meeting.
• Food and beverages for attendees will provided and paid for by another funding source (not through this
contract)
• Supplies include agenda, handout materials, flip charts, markers, notepads, pens and name tags
• TAPI staff will plan the meeting, develop the agenda, develop and distribute electronic invitations to
stakeholders and to medical and professional associations for further distribution, take meeting notes,
identify recommendations and action items, and convey the recommendations and action items to the
attendees.
• Some follow-up activities resulting from this meeting and other activities in this contract are expected to
culminate in long-term outcomes beyond this contract. TAPI is making the commitment to continue
pursuing the issues and strategies into the future, including the organizing and implementing of the
Leadership Work Group and continued strategizing through the TAPI committees.
CONTRACT REQUIREMENTS (RFP sections 2.1.10, 2.1.11)
TAN will develop a template for the monthly report, will complete the template with updates on activities and
expenses, and submit the report in a timely manner according to contract requirements.
TAPI will provide a written summary report by June 30, 2014, that will include:
o A summary of activities
o Highlights of important outcomes and achievements
o Any barriers or obstacles encountered in implementing activities
o Achievements, outcomes, findings and recommendations related to policy research, meetings and other
contract activities
o How findings, recommendations and outcomes were shared with stakeholders
o Impact achieved by the end of this contract
o Future efforts and expected impacts beyond the contract.
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CONTRACT #: 860-14-020
ADDITIONAL OPPORTUNITIES FOR SYNERGY AND SUCCESS
TAPI is applying for additional grant funding to support needed long-term follow-up efforts resulting from the
activities in this proposal. St. Luke's Health Initiative (SLHI) has approved TAPI's letter of intent for the public
health billing project as a healthcare transformational project. The TAP! SLHI application will request two years of
additional funding.
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