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C
AGREEMENT FOR
EMERGENCY MEDICAL [TRANSPORTATION] SERVICES
City of Glendale Solicitation No. RFP 23-36
This Agreement for Emergency Medical [Transportation] Services ("Agreement") is effective and entered into between
CITY OF GLENDALE, an Arizona municipal corporation ("City"), and Maricopa Ambulance, LLC, a Delaware
limited liability company, authorized to do business in the State of Arizona, ("Contractor"), as of the _____ day of
____________, 2023.
RECITALS
A.
City intends to undertake a project for the benefit of the public and with public funds that is more fully set
forth in Exhibit A, pursuant to Solicitation No. RFP 23-36 (the "Project");
B.
City desires to retain the services of Contractor to perform those specific duties and produce the specific
work as set forth in the Project attached hereto; and
C.
City and Contractor desire to memorialize their agreement with this document.
AGREEMENT
In consideration of the Recitals, which are confirmed as true and correct and incorporated by this reference, the
mutual promises and covenants contained in this Agreement, and other good and valuable consideration, City and
Contractor agree as follows:
1.
Key Personnel; Sub-contractors.
1.1
Services. Contractor will provide all services necessary to assure the Project is completed timely and
efficiently consistent with Project requirements, including, but not limited to, working in close
interaction and interfacing with City and its designated employees, and working closely with others,
including other contractors or consultants, retained by City.
1.2
Project Team.
a.
Project Manager.
(1)
Contractor will designate an employee as Project Manager with sufficient training,
knowledge, and experience to, in the City's option, complete the Project and handle
all aspects of the Project such that the work produced by Contractor is consistent
with applicable standards as detailed in this Agreement;
(2)
The City must approve the designated Project Manager; and
(3)
To assure the Project schedule is met, Project Manager may be required to devote
no less than a specific amount of time as set out in Exhibit A.
b.
Project Team.
(1)
The Project Manager and all other employees assigned to the project by Contractor
will comprise the "Project Team."
(2)
Project Manager will have responsibility for and will supervise all other employees
assigned to the Project by Contractor.
c.
Discharge, Reassign, Replacement.
(1)
Contractor acknowledges the Project Team is comprised of the same persons and
roles for each as may have been identified in the response to the Project's
solicitation.
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(2)
Contractor will not discharge, reassign or replace or diminish the responsibilities of
any of the employees assigned to the Project who have been approved by City
without City's prior written consent unless that person leaves the employment of
Contractor, in which event the substitute must first be approved in writing by City.
(3)
Contractor will change any of the members of the Project Team at the City's request
if an employee's performance does not equal or exceed the level of competence that
the City may reasonably expect of a person performing those duties or if the acts or
omissions of that person are detrimental to the development of the Project.
d.
Sub-contractors.
(1)
Contractor may engage specific technical contractor (each a "Sub-contractor") to
furnish certain service functions.
(2)
Contractor will remain fully responsible for Sub-contractor's services.
(3)
Sub-contractors must be approved by the City, unless the Sub-contractor was
previously mentioned in the response to the solicitation.
(4)
Contractor shall certify by letter that contracts with Sub-contractors have been
executed incorporating requirements and standards as set forth in this Agreement.
2.
Schedule. The services will be undertaken in a manner that ensures the Project is completed timely and
efficiently in accordance with the Project.
3.
Contractor’s Work.
3.1
Standard. Contractor must perform services in accordance with the standards of due diligence, care,
and quality prevailing among contractors having substantial experience with the successful furnishing
of services for projects that are equivalent in size, scope, quality, and other criteria under the Project
and identified in this Agreement.
3.2
Licensing. Contractor warrants that:
a.
Contractor and Sub-contractors will hold all appropriate and required licenses, registrations
and other approvals necessary for the lawful furnishing of services ("Approvals"); and
b.
Neither Contractor nor any Sub-contractor has been debarred or otherwise legally excluded
from contracting with any federal, state, or local governmental entity ("Debarment").
(1)
City is under no obligation to ascertain or confirm the existence or issuance of any
Approvals or Debarments or to examine Contractor's contracting ability.
(2)
Contractor must notify City immediately if any Approvals or Debarment changes
during the Agreement's duration and the failure of the Contractor to notify City as
required will constitute a material default under the Agreement.
3.3
Compliance. Services will be furnished in compliance with applicable federal, state, county and local
statutes, rules, regulations, ordinances, building codes, life safety codes, and other standards and
criteria designated by City.
Contractor must not discriminate against any employee or applicant for employment on the basis of
race, color, religion, sex, national origin, age, marital status, sexual orientation, gender identity or
expression, genetic characteristics, familial status, U.S. military veteran status or any
disability. Contractor will require any Sub-contractor to be bound to the same requirements as stated
within this section. Contractor, and on behalf of any subcontractors, warrants compliance with this
section.
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3.4
Coordination; Interaction.
a.
For projects that the City believes requires the coordination of various professional services,
Contractor will work in close consultation with City to proactively interact with any other
professionals retained by City on the Project ("Coordinating Project Professionals").
b.
Subject to any limitations expressly stated in the Project Budget, Contractor will meet to
review the Project, Schedule, Project Budget, and in-progress work with Coordinating
Project Professionals and City as often and for durations as City reasonably considers
necessary in order to ensure the timely work delivery and Project completion.
c.
For projects not involving Coordinating Project Professionals, Contractor will proactively
interact with any other contractors when directed by City to obtain or disseminate timely
information for the proper execution of the Project.
3.5
Work Product.
a.
Ownership. Upon receipt of payment for services furnished, Contractor grants to City, and
will cause its Sub-contractors to grant to the City, the exclusive ownership of and all
copyrights, if any, to evaluations, reports, drawings, specifications, project manuals, surveys,
estimates, reviews, minutes, all "architectural work" as defined in the United States Copyright
Act, 17 U.S.C § 101, et seq., and other intellectual work product as may be applicable ("Work
Product").
(1)
This grant is effective whether the Work Product is on paper (e.g., a "hard copy"),
in electronic format, or in some other form.
(2)
Contractor warrants, and agrees to indemnify, hold harmless and defend City for,
from and against any claim that any Work Product infringes on third-party
proprietary interests.
b.
Delivery. Contractor will deliver to City copies of the preliminary and completed Work
Product promptly as they are prepared.
c.
City Use.
(1)
City may reuse the Work Product at its sole discretion.
(2)
In the event the Work Product is used for another project without further
consultations with Contractor, the City agrees to indemnify and hold Contractor
harmless from any claim arising out of the Work Product.
(3)
In such case, City shall also remove any seal and title block from the Work Product.
4.
Compensation for the Project.
4.1
4.2
Compensation. Contractor's compensation for the Project, including those furnished by its
Sub-contractors will not exceed $1,500,000 over the entire term of the Agreement, including all
extensions, as specifically detailed in Exhibit B (the "Compensation").
Change in Scope of Project. The Compensation may be equitably adjusted if the originally
contemplated scope of services as outlined in the Project is significantly modified.
a.
Adjustments to the Compensation require a written amendment to this Agreement and may
require City Council approval.
b.
Additional services which are outside the scope of the Project contained in this Agreement
may not be performed by the Contractor without prior written authorization from the City.
c.
Notwithstanding the incorporation of the Exhibits to this Agreement by reference, should
any conflict arise between the provisions of this Agreement and the provisions found in the
Exhibits and accompanying attachments, the provisions of this Agreement shall take priority
and govern the conduct of the parties.
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5.
Billings and Payment.
5.1
Applications.
a.
Contractor will submit monthly invoices (each, a "Payment Application") to City's Project
Manager and City will remit payments based upon the Payment Application as stated below.
b.
The period covered by each Payment Application will be one calendar month ending on the
last day of the month or as specified in the solicitation.
5.2
Payment.
a.
After a full and complete Payment Application is received, City will process and remit
payment within 30 days.
b.
Payment may be subject to or conditioned upon City's receipt of:
(1)
Completed work generated by Contractor and its Sub-contractors; and
(2)
Unconditional waivers and releases on final payment from Sub-contractors as City
may reasonably request to assure the Project will be free of claims arising from
required performances under this Agreement.
5.3
Review and Withholding. City's Project Manager will timely review and certify Payment Applications.
a.
If the Payment Application is rejected, the Project Manager will issue a written listing of the
items not approved for payment.
b.
City may withhold an amount sufficient to pay expenses that City reasonably expects to incur
in correcting the deficiency or deficiencies rejected for payment.
6.
Termination.
6.1
For Convenience. City may terminate this Agreement for convenience, without cause, by delivering
a written termination notice stating the Effective Termination date, which may not be less than 30
days following the date of delivery.
a.
Contractor will be equitably compensated for Goods or Services furnished prior to receipt
of the termination notice and for reasonable costs incurred.
b.
Contractor will also be similarly compensated for any approved effort expended and
approved costs incurred that are directly associated with project closeout and delivery of the
required items to the City.
6.2
For Cause. City may terminate this Agreement for cause if Contractor fails to cure any breach of this
Agreement within seven days after receipt of written notice specifying the breach.
a.
Contractor will not be entitled to further payment until after City has determined its damages.
If City's damages resulting from the breach, as determined by City, are less than the equitable
amount due but not paid Contractor for Service and Repair furnished, City will pay the
amount due to Contractor, less City's damages, in accordance with the provision of § 5.
b.
If City's direct damages exceed amounts otherwise due to Contractor, Contractor must pay
the difference to City immediately upon demand; however, Contractor will not be subject to
consequential damages of more than $1,000,000 or the amount of this Agreement, whichever
is greater.
7.
Conflict. Contractor acknowledges this Agreement is subject to A.R.S. § 38-511, which allows for
cancellation of this Agreement in the event any person who is significantly involved in initiating, negotiating,
securing, drafting, or creating the Agreement on City's behalf is also an employee, agent, or consultant of any
other party to this Agreement.
8.
Insurance.
8.1
Requirements. Contractor must obtain and maintain the following insurance ("Required Insurance"):
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a.
Contractor and Sub-contractors. Contractor, and each Sub-contractor performing work or
providing materials related to this Agreement must procure and maintain the insurance
coverages described below (collectively referred to herein as the "Contractor's Policies"),
until each Party's obligations under this Agreement are completed.
b.
General Liability.
(1)
Contractor must at all times relevant hereto carry a commercial general liability
policy with a combined single limit of at least $1,000,000 per occurrence and
$3,000,000 annual aggregate for each property damage and contractual property
damage.
(2)
Sub-contactors must at all times relevant hereto carry a general commercial liability
policy with a combined single limit of at least $1,000,000 per occurrence.
(3)
This commercial general liability insurance must include independent contractors'
liability, contractual liability, broad form property coverage, XCU hazards if
requested by the City, and a separation of insurance provision.
(4)
These limits may be met through a combination of primary and excess liability
coverage.
c.
Auto. A business auto policy providing a liability limit of at least $1,000,000 per accident for
Contractor and $1,000,000 per accident for Sub-contractors and covering owned, non-
owned and hired automobiles.
d.
Workers' Compensation and Employer's Liability. A workers' compensation and employer's
liability policy providing at least the minimum benefits required by Arizona law.
e.
Notice of Changes. Contractor's Policies must provide for not less than 30 days' advance
written notice to City Representative of:
(1)
Cancellation or termination of Contractor or Sub-contractor's Policies;
(2)
Reduction of the coverage limits of any of Contractor or and Sub-contractor's
Policies; and
(3)
Any other material modification of Contractor or Sub-contractor's Policies related
to this Agreement.
f.
Certificates of Insurance.
(1)
Within 10 business days after the execution of the Agreement, Contractor must
deliver to City Representative certificates of insurance for each of Contractor and
Sub-contractor's Policies, which will confirm the existence or issuance of Contractor
and Sub-contractor's Policies in accordance with the provisions of this section, and
copies of the endorsements of Contractor and Sub-contractor's Policies in
accordance with the provisions of this section.
(2)
City is and will be under no obligation either to ascertain or confirm the existence
or issuance of Contractor and Sub-contractor's Policies, or to examine Contractor
and Sub-contractor’s Policies, or to inform Contractor or Sub-contractor in the
event that any coverage does not comply with the requirements of this section.
(3)
Contractor's failure to secure and maintain Contractor Policies and to assure Sub-
contractor policies as required will constitute a material default under the
Agreement.
g.
Other Contractors or Vendors.
(1)
Other contractors or vendors that may be contracted with in connection with the
Project must procure and maintain insurance coverage as is appropriate to their
particular contract.
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(2)
This insurance coverage must comply with the requirements set forth above for
Contractor's Policies (e.g., the requirements pertaining to endorsements to name the
parties as additional insured parties and certificates of insurance).
h.
Policies. Except with respect to workers' compensation and employer's liability coverages,
City must be named and properly endorsed as additional insureds on all liability policies
required by this section.
(1)
The coverage extended to additional insureds must be primary and must not
contribute with any insurance or self insurance policies or programs maintained by
the additional insureds.
(2)
All insurance policies obtained pursuant to this section must be with companies
legally authorized to do business in the State of Arizona and reasonably acceptable
to all parties.
8.2
Sub-contractors.
a.
Contractor must also cause its Sub-contractors to obtain and maintain the Required
Insurance.
b.
City may consider waiving these insurance requirements for a specific Sub-contractor if City
is satisfied the amounts required are not commercially available to the Sub-contractor and
the insurance the Sub-contractor does have is appropriate for the Sub-contractor's work
under this Agreement.
c.
Contractor and Sub-contractors must provide to the City proof of the Required Insurance
whenever requested.
8.3
Indemnification.
a.
To the fullest extent permitted by law, Contractor must defend, indemnify, and hold
harmless City and its elected officials, officers, employees and agents (each, an "Indemnified
Party," collectively, the "Indemnified Parties"), for, from, and against any and all claims,
demands, actions, damages, judgments, settlements, personal injury (including sickness,
disease, death, and bodily harm), property damage (including loss of use), infringement,
governmental action and all other losses and expenses, including attorneys' fees and litigation
expenses (each, a "Demand or Expense"; collectively, "Demands or Expenses") asserted by
a third-party (i.e. a person or entity other than City or Contractor) and that arises out of or
results from the breach of this Agreement by the Contractor or the Contractor’s negligent
actions, errors or omissions (including any Sub-contractor or other person or firm employed
by Contractor), whether sustained before or after completion of the Project.
b.
This indemnity and hold harmless provision applies even if a Demand or Expense is in part
due to the Indemnified Party's negligence or breach of a responsibility under this Agreement,
but in that event, Contractor shall be liable only to the extent the Demand or Expense results
from the negligence or breach of a responsibility of Contractor or of any person or entity
for whom Contractor is responsible.
c.
Contractor is not required to indemnify any Indemnified Parties for, from, or against any
Demand or Expense resulting from the Indemnified Party's sole negligence or other fault
solely attributable to the Indemnified Party.
9.
E-verify, Records and Audits. To the extent applicable under A.R.S. § 41-4401, the Contractor warrants
their compliance and that of its subcontractors with all federal immigration laws and regulations that relate to
their employees and compliance with the E-verify requirements under A.R.S. § 23-214(A). The Contractor or
subcontractor’s breach of this warranty shall be deemed a material breach of the Agreement and may result
in the termination of the Agreement by the City under the terms of this Agreement. The City retains the legal
right to randomly inspect the papers and records of the other party to ensure that the other party is complying
with the above-mentioned warranty. The Contractor and subcontractor warrant to keep their respective
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papers and records open for random inspection during normal business hours by the other party. The parties
shall cooperate with the City’s random inspections, including granting the inspecting party entry rights onto
their respective properties to perform the random inspections and waiving their respective rights to keep such
papers and records confidential.
10.
No Boycott of Israel. To the extent A.R.S § 35-393 through § 35-393.03 are applicable, the parties hereby
certify that they are not currently engaged in, and agree for the duration of the Agreement to not engage in, a
boycott of goods or services from Israel, as that term is defined in A.R.S § 35-393.
11.
Uyghur Forced Labor Prevention Act (UFLPA). Contractor certifies that it does not currently, and during
the term of this Agreement, will not use:
a.
the forced labor of ethnic Uyghurs in the People’s Republic of China;
b.
any goods or services produced by the forced labor of ethnic Uyghurs in the People’s
Republic of China; and
c.
any contractors, subcontractors or suppliers that use the forced labor or any goods or
services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China.
12.
Attestation of PCI Compliance. When applicable, the Contractor will provide the City annually with a
Payment Card Industry Data Security Standard (PCI DSS) attestation of compliance certificate signed by an
officer of Contractor with oversight responsibility.
13.
Notices.
13.1
A notice, request or other communication that is required or permitted under this Agreement (each
a "Notice") will be effective only if:
a.
The Notice is in writing; and
b.
Delivered in person or by overnight courier service (delivery charges prepaid), certified or
registered mail (return receipt requested); and
c.
Notice will be deemed to have been delivered to the person to whom it is addressed as of
the date of receipt, if:
(1)
Received on a business day, or before 5:00 p.m., at the address for Notices identified
for the Party in this Agreement by U.S. Mail, hand delivery, or overnight courier
service on or before 5:00 p.m.; or
(2)
As of the next business day after receipt, if received after 5:00 p.m.
d.
The burden of proof of the place and time of delivery is upon the Party giving the Notice;
and
e.
Digitalized signatures and copies of signatures will have the same effect as original signatures.
13.2
Representatives.
a.
Contractor. Contractor's representative (the "Contractor's Representative") authorized to
act on Contractor's behalf with respect to the Project, and his or her address for Notice
delivery is:
Maricopa Ambulance, LLC
c/o Alan Smith
8501 E Princess Drive
Suite 195
Scottsdale, AZ 85255
b.
City. City's representative ("City's Representative") authorized to act on City's behalf, and
his or her address for Notice delivery is:
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City of Glendale
c/o Christopher Gustafson, Deputy Fire Chief
11550 W Glendale Ave
Glendale, Arizona 85301
(623) 772-7108
With required copy to:
City Manager
City Attorney
City of Glendale
City of Glendale
5850 West Glendale Avenue
5850 West Glendale Avenue
Glendale, Arizona 85301
Glendale, Arizona 85301
c.
Concurrent Notices.
(1)
All notices to City's representative must be given concurrently to City Manager and
City Attorney.
(2)
A notice will not be deemed to have been received by City's representative until the
time that it has also been received by City Manager and City Attorney.
(3)
City may appoint one or more designees for the purpose of receiving notice by
delivery of a written notice to Contractor identifying the designee(s) and their
respective addresses for notices.
d.
Changes. Contractor or City may change its representative or information on Notice, by
giving Notice of the change in accordance with this section at least ten days prior to the
change.
14.
Financing Assignment. City may assign this Agreement to any City-affiliated entity, including a non-profit
corporation or other entity whose primary purpose is to own or manage the Project.
15.
Entire Agreement; Survival; Counterparts; Signatures.
15.1
Integration. This Agreement contains, except as stated below, the entire agreement between City
and Contractor and supersedes all prior conversations and negotiations between the parties regarding
the Project or this Agreement.
a.
Neither Party has made any representations, warranties or agreements as to any matters
concerning the Agreement's subject matter.
b.
Representations, statements, conditions, or warranties not contained in this Agreement will
not be binding on the parties.
c.
The solicitation, any addendums and the response submitted by the Contractor are
incorporated into this Agreement as if attached hereto. Any Contractor response modifies
the original solicitation as stated. Inconsistencies between the solicitation, any addendums
and the response or any excerpts attached as Exhibit A and this Agreement will be resolved
by the terms and conditions stated in this Agreement.
15.2
Interpretation.
a.
The parties fairly negotiated the Agreement's provisions to the extent they believed necessary
and with the legal representation they deemed appropriate.
b.
The parties are of equal bargaining position and this Agreement must be construed equally
between the parties without consideration of which of the parties may have drafted this
Agreement.
c.
The Agreement will be interpreted in accordance with the laws of the State of Arizona.
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15.3
Survival. Except as specifically provided otherwise in this Agreement, each warranty, representation,
indemnification and hold harmless provision, insurance requirement, and every other right, remedy
and responsibility of a Party, will survive completion of the Project, or the earlier termination of this
Agreement.
15.4
Amendment. No amendment to this Agreement will be binding unless in writing and executed by
the parties. Any amendment may be subject to City Council approval. Electronic signature blocks
do not constitute execution.
15.5
Remedies. All rights and remedies provided in this Agreement are cumulative and the exercise of
any one or more right or remedy will not affect any other rights or remedies under this Agreement
or applicable law.
15.6
Severability. If any provision of this Agreement is voided or found unenforceable, that determination
will not affect the validity of the other provisions, and the voided or unenforceable provision will be
deemed reformed to conform to applicable law.
15.7
Counterparts. This Agreement may be executed in counterparts, and all counterparts will together
comprise one instrument.
16.
Term.
16.1
Renewals. The term of this Agreement commences upon the date the Agreement is approved by the
Arizona Department of Health Services (ADHS), or upon such other effective date set by ADHS in
its approval, and continues for a two (2)-year initial period. The City may, at its option and with the
approval of the Contractor, extend the term of this Agreement an additional four (4) years, renewable
on an annual basis. Contractor will be notified in writing by the City of its intent to extend the
Agreement period at least thirty (30) calendar days prior to the expiration of the original or any
renewal Agreement period. Price adjustments will only be reviewed during the Agreement renewal
period and any such price adjustment will be a determining factor for any renewal. There are no
automatic renewals of this Agreement and renewals shall be subject to approval by ADHS.
16.2
Extension for Procurement Process. Upon the expiration of the Term of this Agreement,
including the initial term and any renewals, at the City’s sole discretion, this Agreement may be
extended on a month-to-month basis for a maximum of six (6) months to allow for the City to
complete its procurement process to select a vendor to provide the services/materials similar to those
provided under this Agreement. The City will notify the Contractor in writing of its intent to extend
the Agreement at least thirty (30) calendar days prior to the expiration of the Term. Any extension
provided under this subsection will continue under the same terms and conditions as in effect
immediately prior to the expiration of the then-current term.
17.
Dispute Resolution. Any controversy or claim arising out of or relating to this contract, or the breach
thereof, shall be settled by arbitration administered according to the American Arbitration Association’s
Commercial Arbitration Rules, and judgment on the award rendered by the arbitrator may be entered in any
court having jurisdiction thereof.
18.
Cooperative Use of Contract. This agreement may be extended for use by other governmental agencies
and political subdivisions of the State. Any such usage by other entities must be in accord with the ordinances,
charter, rules and regulations of the respective entity and the approval of the Contractor and City. For a list
of SAVE members, click on the following link: http://www.mesaaz.gov/business/purchasing/save
19.
Exhibits. The following exhibits, with reference to the term in which they are first referenced, are
incorporated by this reference.
Exhibit A
Project
Exhibit B
Compensation
Exhibit C
2022 Annual Report and Consolidated Financial Statements (Audited)
(Signatures appear on the following page.)
EXHIBIT A
EMERGENCY MEDICAL [TRANSPORTATION] SERVICES
PROJECT
Contractor to provide designated ambulances for emergency medical transportation services
to meet the needs of the Glendale Fire Department per the scope of work in RFP 23-36, with the
changes listed in this exhibit.
City of Glendale, may at their discretion, sit on the panel with Maricopa Ambulance when
interviewing current and potential employees of Maricopa Ambulance who would be working
in the City of Glendale via this agreement.
City of Glendale Fire Department chooses Option A as shown below with the following changes:
7. SPECIFICATIONS, RESPONSE TIME PERFORMANCE
Minimum compliance is achieved when 90% or more of responses for Code 3 Calls and Code 2 Calls
meet the specified Response Time requirements.
To be in compliance for Code 3 Calls, each Proposer must be able to place an Ambulance on the scene of
each presumptively life-threatening emergency within ten (10) minutes and zero (00) seconds for not less
than 90% of all Code 3 Calls.
To be in compliance for Code 2 Calls, each Proposer must be able to place an Ambulance on the scene of
each non-life-threatening emergency within twenty (20) minutes and zero (00) seconds for not less than
90% of all Code 2 Calls.
If 90% is not achieved in Code 3 or Code 2 responses in any month, the Contractor will conduct a three-
month review/assessment of the code response level that was not met.
7. SPECIFICATIONS, RESPONSE TIME MEASUREMENT
Code 3 Responses. The Contractor must arrive on the scene where emergency care is required
within ten (10) minutes and zero (00) seconds for ninety percent (90%) of all Code 3 cumulative
calls received by Contractor for transportation requests within the City’s city limits for each calendar
month. The Parties agree arrival at ten (10) minutes and one (01) second is deemed late.
Code 2 Responses. Contractor must arrive at the scene where emergency care is required
within twenty (20) minutes and zero (00) seconds for ninety percent (90%) of all Code 2
cumulative calls received by Contractor for transportation requests within the City’s city limits for each
calendar month. The Parties agree arrival at twenty (20) minutes and one (01) second is deemed late.
7. SPECIFICATIONS, LIQUIDATED DAMAGES FOR FAILURE TO MEET REQUIREMENTS
Failure to Meet 90% Response Time Requirement in EMS Service Area: The following
liquidated damages will be assessed when the Cumulative Response Time compliance for Code 3
calls and Code 2 calls combined fall below 90% for any given month in the EMS Service Area.
7. SPECIFICATIONS, ADDITIONAL AMUBLANCES is deleted from this solicitation as the
requirement was made without an understanding that the City does not have the authority to
mandate additional units without addressing associated rate increases with AZ DHS.
Add: Contractor will provide thirteen (13) ambulances assigned to the system, or 125% of
peak deployment. To address the need for additional ambulances in the city, the Contractor
agrees to the following:
Table 2 - REVISED
Compliance Percentage
Liquidated Damages
89.9%-88.0%
87.9%-87.0%
86.9%-86.0%
85.9%-85.0%
84.9% and below
$7,000
$9,000
$11,000
$13,000
$15,000 plus $3,000 per percentage point
•
The
The
The number
number
number of
of
of twenty-four
twenty-four
twenty-four (24)
(24)
(24) hour
hour
hour ALS equipped
ALS equipped
ALS equipped ambulances
ambulances
ambulances will
will
will remain
remain
remain the same
the same
the same at
at
at four
four
four (4)
(4)
(4)
•
The
The
The number
number
number of
of
of peak-time
peak-time
peak-time ALS equipped
ALS equipped
ALS equipped ambulances
ambulances
ambulances will remain at six (6)
•
Additional
Additional
Additional “flex”
“flex”
“flex” interfacility
interfacility
interfacility (IF)
(IF)
(IF) units
units
units will
will
will be
be
be called
called
called in
in
in when
when
when the
the
the number
number
number of
of
of available units
available units
available units drops to
five (5) or less (see
(see
(see table
table
table below).
below).
below). Each
Each
Each of
of
of these
these
these units
units
units will
will
will be
be
be equipped the
the
the proper
proper
proper radios.
radios.
radios. MCTs will be
provided when possible.
# OF REMAINING UNITS INTERFACILITY (IF) UNIT
Level 5 One (1) additional IF unit moved into the system
Level 4 One (1) additional IF unit moved into the system
Level 3 One (1) additional IF unit moved into the system
Level 2 One (1) additional IF unit moved into the system
Maricopa Ambulance will match the ambulance standards established in the contract in effect currently
(July 12, 2023) and intends to replace their Glendale fleet as ambulances are available through their best
efforts utilizing our national supply chain. This will allow a financially responsible approach that recognizes
the constraints of the post-Covid national ambulance shortages that are resulting in multiple year fulfillment
delays for replacement ambulances. No mandatory replacement (before 175,000 miles or 60 months) is required.
Contract includes the initial purchase and placement of specifically configured medical supply vending machines in
all Glendale Fire stations at no cost to the City within one year of the contract being signed.
1
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
1.
INTRODUCTION
The City of Glendale (City) is soliciting Requests for Proposals (RFP) from qualified
companies to provide Dedicated Ambulances for emergency medical transportation
services to meet the needs of the Glendale Fire Department. Basic Life Support
(BLS) and Advanced Life Support (ALS) staffing, in conjunction with stand-by
ambulance services, may be requested for Special Events.
The resulting contract from this solicitation will be a two (2)-year contract with four (4)
one (1)-year renewals.
2.
CITY MISSION, VISION, AND VALUES
All work will be performed by understanding and adhering to the City of Glendale’s
Mission, Vision, and Values, as listed in Appendix C.
3.
SCOPE OF WORK
Contractor will be required to provide all emergency medical transportation services
(Services) to meet the needs of the City of Glendale Fire Department with Dedicated
Ambulances to meet the Response Times identified in this solicitation. All
ambulances will be certified at the ALS level of service. The Contractor will also
provide ambulances for medical stand-by and transportation at Special Events and
provide BLS and ALS staffing in conjunction with a stand-by ambulance and fire
department staffing for Special Events if requested by Glendale Fire Department.
Additionally, the Contractor will be required to provide communications and
dispatch Services in accordance with the EMS System, this RFP, and the Contract.
Aeromedical helicopter rescue services are not the responsibility of the Contractor.
The Contractor may not furnish standby coverage for Special Events or conduct
inter-facility transfers with Dedicated Ambulances. Contractor may not use any
Dedicated Ambulance, equipment, or personnel of the Glendale-required EMS
System to provide Services for any such purposes not permitted by this RFP and
Contract without written permission from the Glendale Fire Department.
4.
DEFINITIONS
The definitions set forth apply to this RFP and are provided to assist Proposers.
Generally, throughout the RFP, defined terms are identified by beginning such
defined terms with a capital letter. Terms may also be defined in the text of the
RFP, as applicable and where indicated.
“Addendum” shall mean a change to the RFP that the City determines requires the
issuance of an addendum to each Proposer.
“Administrative Medical Director” shall mean the individual appointed by the City to
act as Administrative Medical Director for the Fire Department and who has the
qualifications set forth in Arizona Administrative Code (AAC) Regulation 9-25-204.
2
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
“Affiliate” of a specified Person means a Person who (a) Controls, is directly or
indirectly Controlled by, or is under common Control with, the specified Person; (b)
owns, directly or indirectly, ten percent (10%) or more of the equity interest of the
specified Person; or (c) is a general partner (if the specified Person is a partnership),
managing member or manager (if the specified Person is a limited liability
company), officer, director, non-financial institution trustee or fiduciary of the
specified Person or of any Person described in clause (a) or (b); or (d) is a member
of the Immediate Family of the specified Person or the Person described in clauses
(a) through (c) above. A Person shall be deemed to Control another Person for the
purposes of this definition if the first Person possesses, directly or indirectly, the
power to direct, or cause the direction of, the management and policies of the
second Person, whether through the ownership of voting securities, common
directors, trustees or officers, by contract or otherwise.
“ALS” shall mean “Advanced Life Support” and those medical treatments,
procedures (including assessment), and techniques that may be administered or
performed by ALS personnel established under Arizona Revised Statutes (A.R.S.) §
36-2205.
“Ambulance” shall have the meaning outlined in and meeting the requirements of
A.R.S. § 36-2201 and which meets the additional requirements outlined inthe Scope
of Work portion of this RFP and, where indicated in the text of the RFP, also meets
the requirements set forth in Appendices A and B of this RFP.
“Ambulance Fleet” shall mean all Dedicated Ambulances and any additional
Ambulances (Substitute Ambulances) the City requires Contractor to provide
pursuant to this RFP and to the Contract contemplated by this RFP.
“Ambulance Response” shall mean the response of an Ambulance pursuant to a
dispatch issued by PFDRDC in connection with a services request that is a Code 3
Call and/or Code 2 Call.
“Arizona Department of Health Services (ADHS)” shall mean the department of the
State of Arizona responsible for regulating health services.
"Authorized Agency” shall mean a fire agency providing automatic aid within the EMS
Service Area.
“Authorized Representative” shall mean the duly authorized representative of a
Proposer and his or her duly authorized successor who signs the Proposal Offer
Form on behalf of such Proposer.
“AVL” shall mean automatic vehicle locator.
3
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
“Award Recommendation” shall mean the recommendation or recommendations of
the City to the City Council of a Proposer or Proposers for Contract Award or
Awards.
“BLS” shall mean basic life support.
“Budget & Finance Director” shall mean Levi Gibson (and any successor appointed
by the City).
“CAD” shall mean computer assisted dispatch.
“Certificate of Necessity (CON)” shall have the meaning set forth in A.R.S. § 36- 2201.
“City (City of Glendale)” shall mean the municipal corporation now existing and
known as the City of Glendale, Arizona.
“City Council” shall mean the governing body for the City (the City Council includes
the Mayor of the City).
“City Procurement Office” shall mean the City’s Material’s Management Office
located at 5850 West Glendale Avenue, Suite 317 Glendale, AZ 85301-2599
“City Procurement Administrator” shall mean Connie Schneider (and any successor
appointed by the Budget & Finance Director for the City of Glendale).
“Code 2 Call” shall mean:
•
A call for which the use of red lights and sirens is not requested by PFDRDC for
Ambulance Response to the scene of an incident.
•
A call in which the initial request by PFDRDC was for a Code 3 Call, but was
downgraded by PFDRDC to a Code 2 Call prior to arrival on the scene of an
incident.
“Code 3 Call” shall mean:
•
A call for which the use of red lights and sirens are requested by the PFDRDC
for Ambulance Response at the time of the initial request and red lights and
sirens are used until arrival on the scene of an incident.
•
A call in which the initial request by the PFDRDC was for a Code 2 Call but was
upgraded by the PFDRDC or responding fire unit to a Code 3 Call prior to arrival
on the scene of an incident.
“Commencement Date” means the date designated as the date performance of
service is set to begin.
4
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
“Contract” shall mean a Contract to be entered into between a Contractor (or
Contractors) and City through the RFP Process.
“Contract Administrator” shall mean the EMS Deputy Chief and his/her designee.
“Contract Award” shall mean the award of a Contract (or Contracts) by the City
Council to a Proposer or Proposers, subject to each selected Proposer signing a
Contract by the City.
“Contractor” shall mean each Proposer, if any, that receives a Contract Award and
enters into a Contract with the City pursuant to this RFP process.
“Control” shall mean the power directly or indirectly to direct the management or
policies of an entity whether through the ownership of voting securities, other equity
interests, by contract or otherwise. Without limiting the generality of the preceding,
Control includes actual working or effective Control of an entity however exercised;
and an agreement among the holders of voting stock or rights of an entity which
effectively assigns voting Control and/or decision making to any person or entity
other than the entity in question.
“Control of Scene” shall mean the Fire Department current protocol for control of
the scene (including incident scene command structure and patient transfer
process) to which an Ambulance has been dispatched and is known as the current
Volume II of the Phoenix Fire Department Regional Operations Manual.
“Cumulative Response Time” shall mean the total elapsed time from 911 emergency
dispatch to the arrival on scene on the Ambulance and crew.
“Dedicated Ambulance” shall have the meaning set forth in the definitions and Scope
of Work part of this RFP.
“EMS” shall mean emergency medical services as described in A.R.S. § 36-2201.
“EMS Deputy Chief” shall mean the Deputy Chief of the Fire Department responsible
for EMS.
“EMS Service Area” shall mean all areas within the boundaries of the City of Glendale.
Any use of the phrase “EMS Service Area,” or similar terms, will in all respects be
limited to the geographical boundaries of the City of Glendale, and any
automatic/mutual aid partners, special districts, state lands, and county islands
contained therein. Both Parties acknowledge that these boundaries may change by
annexation or otherwise by law.
“EMS System” shall mean the system, in which the City participates, describing
certain emergency medical services and ambulance transportation services for the
5
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
City and other participating cities, agencies, etc. in the Greater Metropolitan
Phoenix Area or Areas.
“EMT-B” shall mean Emergency Medical Technician -Basic.
“EMT-P” shall mean Emergency Medical Technician-Paramedic; a person who has
been trained in an emergency paramedic training program and is certified to act as
a paramedic under the laws, rules, or regulations of the State of Arizona.
“EPCR” shall mean Electronic Patient Care Reporting.
“Evaluator” shall mean a member of the Proposal Evaluation Committee.
“Exception” shall mean Ambulance responses not meeting the minimum response
requirements established herein.
“Fire Department” shall mean the City of Glendale (AZ) Fire Department.
“Fire Chief” shall mean the Ryan Freeburg (and any successor appointed by the
City).
“Firefighter” shall mean a member of the Fire Department with the firefighter
employment designation.
“Firefighter Paramedic” shall mean a Firefighter with the employment designation of
Firefighter Paramedic.
“First Responder” shall have the meaning set forth in A.R.S.§ 36-2201, including
qualified personnel of the Fire Department and the Contractor.
“Immediate Family” shall mean any spouse, son, daughter or parent of any individual
(by blood or by marriage), or any trust, estate, partnership, joint venture, limited
liability company, corporation, operation or any other legal entity or business or
investment enterprise directly or indirectly controlled by such spouse, son,
daughter or parent.
“Inter-facility Transfers” shall mean non-911 Emergency Medical Services based
ambulance transports between medical facilities.
“Key Personnel” shall mean the key personnel of Contractor identified by job position
and personal information in the Scope of Work part of this RFP.
“Mobile Computer Terminal (MCT)” shall mean the mobile computer located in
response vehicles that are part of the PFDRDC dispatch system.
“Payor” shall mean those billed for services by Contractor.
6
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
“Peak Times” shall mean times of anticipated increased caller volume in the Primary
Service Area or Areas as established by the Fire Department.
“Person” means an individual, general or limited partnership, corporation, joint
stock company, trust (including a business trust), unincorporated association, joint
venture, limited liability company, governmental authority or other entity.
“Phoenix Fire Department Regional Dispatch Center (PFDRDC or the Dispatch Center)”
shall mean the Dispatch Center at the City of Phoenix Fire Department.
“Primary Service Area” shall mean the defined geographical areas within the City of
Glendale.
“Procurement Code” shall mean the Procurement Code of the City.
“Procurement Administrator” shall mean the City Procurement Office person
designated to administer the procurement aspects of the Contract.
“Proposal” shall mean a complete proposal submitted pursuant to and in
accordance with this RFP, including any and all attachments, addendums, if
necessary and applicable, and a proposal submitted as a Best and Final Offer, if
invited by the City.
“Proposal Evaluation” shall mean the process for evaluation of Proposals by the
Proposal Evaluation Committee.
“Proposal Evaluation Committee” shall mean the members of the Committee of
Evaluators selected and approved by the City.
“Proposal Due Date and Time” shall mean the date and time set forth for the delivery
of Proposals as set forth herein and as otherwise specified by the Procurement
Administrator.
“Proposer” shall mean an entity submitting a Proposal through its Authorized
Representative.
“Response Time” means the calculation of time beginning when a 911 call is
dispatched to the responding unit(s) and entered into CAD by the PFDPRC Dispatch
Center and ends when the Contractor physically arrives on the scene of the incident
and reports via radio or via MCT to the PFDRDC that Contractor is on scene and
ready to deliver Services.
“Responsible Proposer” shall mean a Proposer who has the capability to perform the
Services described in this RFP and who has the integrity and reliability required by
the City.
7
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
“Responsive Proposer” means a Responsible Proposer who submits a Proposal which
appropriately responds, in the judgment of the City, to this RFP.
“RFP” shall mean this request for proposal (City of Glendale RFP 23-36), together
with any Addendum thereto.
“Services” shall mean those Services provided to meet the requirements set forth in
this RFP in order to deliver emergency medical transportation.
“Special Events” shall mean any event that the Glendale Fire Department has been
contracted with to provide Emergency Medical Services. Examples include, but are
not limited to, events at State Farm Stadium, Desert Diamond Arena, City of
Glendale Signature events and other Special Events within the City of Glendale.
“Specifications” shall mean those requirements for Ambulance equipment and
Ambulance materials and supplies as to quality (including brand names) and
features as set forth in Appendices A and B.
“Station” shall have the meaning set forth in the Scope of Work part of this RFP.
“Subcontractor” shall have the meaning set forth in the City Procurement Code.
“Substitute Ambulance” shall have the meaning of any Ambulance used in place of
Dedicated Ambulance that is temporarily unavailable due to maintenance or repair.
5.
PERFORMANCE SURETY FUND
Creation of a Performance Surety Fund and the process by which the City may
withdraw the funds from the Performance Surety Fund.
A. Contractor shall submit to City a check in the amount of Fifty Thousand Dollars
($50,000). The City shall deposit the check into a dedicated account (the
“Performance Surety Fund”) which may only be used for City of Glendale Fire
Department EMS programs, including training or equipment for both Fire
Department and ambulance personnel. At least quarterly, City shall provide to
Contractor a statement or other documentation showing the fund’s current
balance. For accounting purposes, the funds shall be considered funds of
Contractor held in escrow account or some similar designation that describes
the City’s right to draw down these funds for only the purposes designated
herein.
B.
City shall not use or distribute funds from the Performance Surety Fund except
in accordance with the process set forth in the Agreement.
C. City shall provide Contractor with a notice documenting the date and amount of
any withdrawal from the Performance Surety Fund.
8
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
6.
PERFORMANCE BOND
Contractor will be required to provide the City a performance bond in the amount
of 10% of the entire contract term in form and substance acceptable to the City.
The Contractor will be required to maintain the Performance Bond throughout the
term(s) of the Contract and for a reasonable time thereafter.
7.
SPECIFICATIONS
EXCLUSIVE CONTRACT
Pursuant to this RFP, a Contractor will be awarded an exclusive contract for
Services.
COMMENCEMENT DATE
The Commencement Date will follow approval of the award by the Glendale City
Council during a regularly scheduled evening council meeting. The Commencement
Date is considered to be the date of the start of Service.
EMS SYSTEM
The City and the Fire Department participate in an automatic aid agreement,
including an EMS System, with twenty-seven (27) other cities and their fire
departments in the greater metropolitan Phoenix area. Through their participation,
the City and the Fire Department have agreed to the roles assigned to the City and
the Fire Department within such EMS System and the City has thus adopted the
EMS System as its system for the Services to meet certain assigned responsibilities.
In accordance with the EMS System, the City contracts for Services pursuant to an
exclusive contract with a single emergency medical ground transport provider. The
EMS System permits the interests of the City and such exclusive provider or
providers to be aligned to provide emergency ground transportation ambulance
Services as called for within the EMS System and as otherwise necessary.
NO SUBSIDY AND NO PAYMENT
The Arizona Department of Health Services (ADHS) sets rates that may be charged
by ambulance companies having a Certificate of Necessity (CON). The City will
provide no financial subsidy or payment of any kind to Proposers for emergency
transports or associated expenses. The Contractor derives its operating revenue
from user fees.
The City will reimburse expenses for staffing at Special Events if that staffing is
requested by the Glendale Fire Department. Reimbursed expenses will include
staffing to supplement Glendale Fire Department staffing without inclusion of
standby ambulance personnel.
PRIMARY SERVICE AREA OR AREAS
The corporate limits of the City includes a current population of approximately two
hundred fifty thousand (250,000) people (U.S. Census Bureau, 2021). The current
area is approximately sixty-one (61) square miles (U.S. Census Bureau, 2020).
9
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
CALL VOLUME
The current available volume of dispatches for the Glendale Fire Department in the
Primary Service Area for January 1, 2022, through December 31, 2022, was 35,929
incidents, of which 19,557 were ALS and 12,481 were BLS medical calls.
The City makes no representation as to the accuracy of such information and it is
provided to the Proposers for such use in the preparation of. The City guarantees
no minimum number of instances requiring Services or dispatches for Services
within or for any period of time.
CITY’S RESPONSIBILITIES / EMS SYSTEM
Proposers acknowledge that they are fully aware of the responsibilities of the City
and the Fire Department within the EMS System.
ADMINISTRATIVE MEDICAL DIRECTOR
The position of Administrative Medical Director is established by the City in
accordance with Arizona Administrative Code Regulation 9-25-201, which also sets
forth qualifications and duties of the Administrative Medical Director.
CONTRACTOR CONTACT PERSON
It is the City’s desire to have continual involvement in a Contractor’s operations in
the Primary Service Area or Areas. Therefore, the Contractor is required to provide
the title, reporting relationship, and limits of authority for a senior executive, who
will office within the Primary Service Area in general and serve as the Contractor’s
Contact Person with the Fire Department and receive all written correspondence
and notices from the city.
CONTRACTOR’S RESPONSIBILITIES
In accordance with the EMS System and this RFP, Contractor will furnish the
Services in response to appropriate dispatch and field operation directives
including, but not limited to the following:
a. Employment of all of Contractor’s personnel required for the Services and
related functions.
b. Administrative supervision, training and management of Contractor’s
employees, agents and Subcontractor(s) (if any).
c.
Provision and maintenance of the Contractor Dedicated or Special Events
Ambulances and the equipment, materials, and supplies required and necessary
to provide the Services.
d. Accurate completion and timely submission of all required data and reports of
every kind, including notices.
e.
Meeting Response Times and other performance requirements in compliance
with applicable law including, but not limited to, ADHS laws and regulations,
this RFP, and the EMS System.
10
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
f.
Participate and cooperate with the Administrative Medical Director and City
representatives in audits, inspections and investigations, with timely responses
and completion of requirements.
g.
Provide indemnification, insurance performance guarantees, and other security
as required by the City.
PERFORMANCE VS. LEVEL OF EFFORT
This Contract is a performance contract rather than a level-of-effort contract. The
City accepts the Contractor’s financially guaranteed commitment to employ
whatever level of effort is necessary to achieve the clinical response time and other
performance results required by the terms of the Contract. Acceptance by the City
of a Contract shall not be construed as acceptance of the Contractor’s proposed
level of effort; rather, Contractor shall meet the stated performance requirements
in the contract regardless of the level of effort required. The Contract requirements
are over and above the CON minimum requirements.
RESPONSE TIME PERFORMANCE
Medical research has shown that the emergency response time from the point of
injury or serious physical illness is one of the key factors in determining the survival
of critically ill or injured patients, particularly in cardiac-related emergencies.
Therefore, the City has determined that the response times contained herein are
vital to its citizens' health, safety, and welfare.
Response times will be evaluated monthly on an individual basis and will not be
averaged. A superior response time early in the month does not justify allowing
inferior response time performance later in the month.
Each Proposer will demonstrate that it will provide the Services within the Primary
Service Area or Areas and within the EMS System to achieve compliance with the
requirements of this RFP.
Minimum compliance is achieved when 95% or more of responses for Code 3 Calls
and Code 2 Calls meet the specified Response Time requirements.
To be in compliance for Code 3 Calls, each Proposer must be able to place an
Ambulance on the scene of each presumptively life-threatening emergency within
eight minutes (8) fifty-nine (59) seconds for not less than 95% of all Code 3 Calls.
To be in compliance for Code 2 Calls, each Proposer must be able to place an
Ambulance on the scene of each non-life-threatening emergency within fourteen
(14) minutes and fifty-nine (59) seconds for not less than 95% of all Code 2 Calls.
If 95% is not achieved in Code 3 or Code 2 responses in any month, the Contractor
will conduct a three-month review/assessment of the code response level that was
not met.
11
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
Each Proposer must show that it can meet the following Response Time
requirements.
Table 1
Priority
Maximum Response
Time
Definition
Code 3 Calls-First Priority 8:59 minutes
Life-Threatening Emergencies
Code 2 Calls-Secondary
Priority
14:59 minutes
Nonlife-Threatening Emergencies
Response priorities are defined according to a priority dispatch protocol approved
by the Fire Chief, consistent with ADHS guidelines and PFDRDC’s protocols.
Currently, all dispatches of Ambulances are Code 3 Calls or Code 2 Calls. The City
may adopt additional priorities and associated Response Times as circumstances
require.
REPORTING
In every instance concerning the specified Response Time criteria, the Contractor
shall submit a written report, at least monthly, in a format approved by the City, to
the EMS Deputy Chief, documenting the cause of each late response and efforts to
eliminate recurrence.
The Contractor shall furnish a written explanation for each Code 3 response that
exceeds eight (8) minutes fifty-nine (59) seconds and each Code 2 response that
exceeds fourteen (14) minutes fifty-nine (59) seconds to the EMS Deputy Chief.
RESPONSE TIME MEASUREMENT
The Response Time measurement methodology employed will influence the
operational requirements of the EMS System and the Contract.
For all dispatches for Services, the measurement of the Response Time will begin
when a 911 call is dispatched to the responding unit(s) and entered into CAD by
the PFDPRC Dispatch Center.
Arrival on scene means the moment an Ambulance crew member notifies the
PFDRDC via radio or a mobile computer terminal (MCT) that the Ambulance is fully
stopped at the location where it is required to be stopped while Ambulance
personnel exit to attend to those in need of service. In situations where the
Ambulance has been requested to respond to a location other than the scene (e.g.
staging areas for hazardous scenes), arrival on scene shall be the time the
Ambulance arrives at the designated location.
For all dispatches for Services, the arrival of the Ambulance (staffed as required)
shall be signaled by a Contractor’s transmission to the PFDRDC. Such
communication shall not be made until the Ambulance actually arrives and is
12
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
stopped at the specific location to which it has been dispatched. In the case of
apartment or business complexes, such transmission shall not be made until the
Ambulance actually arrives at the point closest to the apartment or business to
which it has been dispatched and to which its Ambulance can be driven. Only arrival
at a location by a Contractor’s Ambulance is a measurement of Response Time.
In instances when an Ambulance crew fails to timely report arrival on scene, the
time of the next communication by the Ambulance crew with PFDRDC will be used
as the on-scene time. However, a Contractor may appeal such instances when it can
document the actual arrival time through other means, such as Fire Department
personnel or PFDRDC CAD system Automated Vehicle Locator (AVL) position
reporting. Although the appeal can be made by the Contractor, there is no obligation
for the Fire Department to accept these appeals.
Code 3 Responses. The Contractor must arrive on the scene where emergency care
is required within eight (8) minutes fifty-nine (59) seconds for ninety-five percent
(95%) of all Code 3 cumulative calls received by Contractor for transportation
requests within the City’s city limits for each calendar month. The Parties agree
arrival at nine (9) minutes zero (00) seconds is deemed late.
Code 2 Responses. Contractor must arrive at the scene where emergency care is
required within fourteen (14) minutes and fifty-nine (59) seconds for ninety-five
percent (95%) of all Code 2 cumulative calls received by Contractor for
transportation requests within the City’s city limits for each calendar month. The
Parties agree arrival at fifteen (15) minutes zero (00) seconds is deemed late.
Switch in Response Type After Dispatch. If Contractor was originally requested to
provide a Code 3 response but was later requested to provide a Code 2 response
on a particular call, Contractor must arrive on the scene where emergency care is
required within fourteen (14) minutes fifty-nine (59) seconds from the time that
Contractor was originally dispatched to provide a Code 3 response. If Contractor
was originally requested to provide a Code 2 response but was later requested to
provide a Code 3 response on a particular call, Contractor must arrive on the scene
where emergency care is required within the shorter of the following:
•
Eight (8) minutes fifty-nine (59) seconds from the time that Contractor was
requested to go to a Code 3 response: or
•
Fourteen (14) minutes fifty-nine (59) seconds from the time that Contractor was
originally dispatched to provide a Code 2 response.
•
If an Ambulance is cancelled by an Authorized Agency, after an assignment has
been made, but prior to the arrival of the Ambulance at the scene (and no
ambulance is required at the scene), the Response Time will be measured to
the moment of cancellation. If the elapsed Response Time at the moment of
cancellation exceeds the Response Time requirement for the assigned priority
of the call, the unit will be determined to be late.
13
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
•
In the presumed rare instance when the Contractor is unable to provide an
ambulance in a timely manner, requiring a mutual aid response, the Response
Time will be calculated from the time of initial contact with Contractor’s
Dispatch Center to the on-scene arrival of the mutual aid ambulance. For
compliance evaluation, this time will be used.
o For example: Contractor’s Dispatch Center has a call for service that they
are unable to fill. Contractor’s Dispatch makes a mutual aid request from
another CON holder for the city of Glendale. The time used for Response
Time compliance will be the time from the initial contact to the Contractor’s
Dispatch Center until the time the mutual aid ambo arrives on scene and
transmits this via MCT or radio.
Contractor will not be held accountable for emergency or non-emergency Response
Time compliance for any response dispatched to a location outside the Primary
Service Area or Areas. Responses to requests for service outside of the Primary
Service Area or Areas will not be counted in the total number of responses used to
determine compliance with the Contract.
Each incident requiring response will be counted as a single response regardless
of the number of Ambulances that respond.
Contractor shall be required to provide for reserve service capacity in order to
increase service should temporary EMS System or dispatch overload occur.
However, it is understood that from time to time unusual factors beyond
Contractor’s reasonable control may affect the achievement of the specified
Response Time requirement. Unusual factors are limited to unusually severe
weather conditions, declared disasters, or periods of unusually high demand for
emergency Services. Unusually high demand for emergency Services will be
determined by the Fire Department. Equipment failures, traffic congestion,
Ambulance failures, dispatch errors, inability to staff Ambulances, and other similar
causes will not be grounds for granting an exception to compliance with the
Response Time requirements. Proposer shall describe the process that will be
utilized for compliance with reserve service capacity.
APPEAL PROCESS FOR RESPONSE TIME REQUIREMENTS
If Contractor thinks that any response or group of responses should be excluded
from the compliance calculations due to unusual factors beyond Contractor’s
reasonable control, Contractor may provide detailed supporting information in
writing to the EMS Deputy Chief. Contractor may request that the City exclude a
response or group of responses from Response Time calculations and liquidated
damages. Any such request must be made in writing and be received by the EMS
Deputy Chief within five (5) business days after the end of each month. The EMS
Deputy Chief will review the request and issue a written determination. Should
Contractor dispute the determination, Contractor may appeal in writing to the Fire
Chief for a definitive written ruling within five (5) business days. The Fire Chief’s
ruling will be final and binding.
14
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
Each Proposer will describe its system to ensure a complete audit trail for all
Response Times. The EMS Deputy Chief shall have prompt access to all relevant
data in order to ensure compliance and to calculate penalties. Access to and
security of data will be considered in assessing Proposals.
REPORTING REQUIREMENTS
Contractor will provide, by the seventh day of each calendar month, reports
detailing its performance during the preceding month as it relates to every
performance requirement stipulated herein.
LIQUIDATED DAMAGES FOR FAILURE TO MEET REQUIREMENTS
Proposers should understand that the liquidated damages amounts are not to be
considered a penalty, but shall be deemed, taken, and treated as reasonable
liquidated damages. It is also understood that and agreed that the City’s remedies
in the event of the Contractor’s default, minor or major breach of any
noncompliance, are not limited to the Contract’s liquidated damages provisions. All
liquidated damages will be billed first to the Contractor, and if not paid within thirty
(30) days from the date of invoice, then may be subject to be withdrawn from the
performance surety bond.
The City will notify Contractor in writing of any liquidated damages being assessed
not less than thirty (30) days after they first become known to the City. Upon
notification of any liquidated damage assessments, Contractor will have fifteen (15)
days to dispute any assessment. Any dispute must be submitted in writing. The
EMS Deputy Chief, or designee, will meet with Contractor to review the
assessment and Contractor's response to determine the validity or invalidity of
the assessment. Should the City and Contractor fail to reach an agreement on
the validity or invalidity of the assessment, the matter will be referred to the Fire
Chief, or designee, who will review the circumstances of the assessment with the
Contractor and City personnel. The determination of the Fire Chief will be final.
Failure to Meet 95% Response Time Requirement in EMS Service Area: The
following liquidated damages will be assessed when the Cumulative Response
Time compliance for Code 3 calls and Code 2 calls combined fall below 95% for
any given month in the EMS Service Area.
Table 2
Compliance
Percentage
Liquidated Damages
94.9%-90.0%
$5,000
89.9%-88.0%
$7,000
87.9%-87.0%
$9,000
86.9%-86.0%
$11,000
85.9%-85.0%
$13,000
84.9% and below
$15,000
plus $3,000
per percentage point
15
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
Notwithstanding liquidated damages in Table 2, each Code 3 Cumulative
Response Time in excess of nineteen (19) minutes fifty-nine (59) seconds will
be assessed additional liquidated damages of $1,000 per occurrence.
Notwithstanding liquidated damages in Table 2, each Code 2 Cumulative
Response Time in excess of twenty-nine (29) minutes fifty-nine (59) seconds will
be assessed additional liquidated damages of $1,000 per occurrence.
Failure to meet requirement for having a unit able to respond to an incident, either
with Dedicated Ambulances or Mutual Aid units, will result in liquidated damages
of $2,000 per occurrence.
EMERGENCY AND DISASTER ASSISTANCE
Contractor must set forth its plans for responding to major emergency and disaster
situations within Glendale’s city limits and its city limits where Designated
Ambulances may be involved. In addition, Contractor must set forth its plans for
declared disaster situations and required assistance. All such plans must be in
accordance with, and comply with applicable laws, regulations, rules, policies, and
protocols.
DISPATCH CENTER / COMMUNICATION CENTER RESPONSE
Required equipment will include mobile computer terminals (MCTs) and radios
(mobile and portable) at the Proposer’s sole expense and include expenses to be
paid to the City of Phoenix or the City as a pass thru expense reimbursement. This
reimbursement will be paid monthly, quarterly, or annually at the discretion of the
City of Glendale.
•
The City currently uses a dual band VHF (154-155 MHz)/800 MHz radio system.
Contractor must provide base, mobile, and portable radios that enable voice
interoperability by allowing Contractor’s dispatch center, ambulances, and
supervisors to communicate directly with Fire units and PFRDC on appropriate
radio channels and according to procedures established by the Fire Department.
Field unit radios (mobile and portable) and MCTs are to be acquired by the
Contractor. Failure to comply will result in liquidated damages of $1,000 per
occurrence where the responding ambulance does not have communication
capabilities.
Each Proposer shall detail its abilities to meet these requirements prior to
commencement of Services.
A Proposer’s failure to establish to the City’s satisfaction that the Proposer will be
able to reimburse, install, maintain, and operate the ability to interface with the
PFDRDC shall be found to be non-responsive.
RADIO SYSTEMS
thereafter
16
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
The Proposer is advised that during the term of any awarded contract, the Dispatch
Center may change the radio system and Contractor will be required to change to
such a radio system at no cost to the City.
EMERGENCY RESPONSE
Required equipment will include traffic signal pre-emption devices compatible with
the system currently in use by the City at the Proposer’s sole expense and include
expenses to repair or replace damaged equipment on the Contractor’s units.
Each Proposer shall detail its abilities to meet these requirements prior to
commencement of Services.
A Proposer’s failure to establish to the City’s satisfaction that the Proposer will be
able to install, maintain, and operate the traffic signal pre-emption system shall be
found to be non-responsive.
CONTRACTOR PROVIDED EQUIPMENT, MATERIALS AND SUPPLIES
The City will not provide equipment, materials, or supplies for the use by Contractor
other than equipment identified in the DISPATCH CENTER/COMMUNICATION
CENTER RESPONSE, RADIO SYSTEMS, and EMERGENCY RESPONSE section of this
RFP. Each Proposer must specify in its Proposal what equipment, materials and
supplies it will provide for performing the Services. At a minimum, equipment,
materials, and supplies set forth in Appendices A and B must be provided by the
name and type, etc. where specifications are set forth in such Appendices. Failure
to meet this section requirement will result in liquidated damages of $1,000 per
occurrence. Each Proposer must provide a detailed plan for the management of its
equipment, materials, and supplies.
Additionally, the City reserves the right to require Contractor, at Contractor’s
expense, to carry additional equipment other than those listed in Appendices A and
B during the term of this contract if reasonably necessary and will give Contractor
ninety (90) days’ notice of intent to require such additional equipment.
CONTRACTOR PROVIDED AMBULANCES
Each Contractor must provide Dedicated Ambulances for ALS Service in the City of
Glendale to meet required Response Times and as stand-by EMS and transportation
for Special Events. The Contractor will ensure a minimum of six (6) full-time (24-
hour) Dedicated Ambulances and six (6) part- or peak-time Dedicated Ambulances
every day. Each Dedicated Ambulance must meet or exceed ADHS requirements for
Ambulances providing ALS Services. Additionally, each Dedicated Ambulance must
always meet the criteria listed in Appendices A and B, attached hereto.
Each Dedicated Ambulance will have a dedicated cell phone pre-programmed with
all phone numbers needed for medical communications. Programming shall be
updated occasionally to reflect the needs of the City and Contractor, at Contractor’s
expense.
17
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
Ambulances must meet all applicable Federal, State and local requirements and it
shall be the responsibility of the Contractor to assure appropriate certifications
from ambulance manufacturers and to assure that all Ambulances are operated
within Federal (U.S. Department of Transportation), State (Arizona Department of
Health Services and other State of Arizona agencies imposing requirements) and
local guidelines (City, Fire Department and all other applicable local guidelines and
requirements). Guidelines include all applicable limitations on gross vehicle weight.
Substitute Ambulances in the place of Dedicated Ambulances shall be similarly
equipped as the Dedicated Ambulances. Use of Substitute Ambulances for periods
greater than twelve (12) hours shall require notification by Contractor to the
Glendale Fire Department EMS Deputy Chief via phone call and email.
Contractor shall monitor and be responsible for, through their established
maintenance program, the condition, safety and reliability of all Dedicated,
Substitute, and Special Events Ambulances. Contractor shall be responsible for
maintaining current maintenance records and such records shall be available to the
City upon request. Dedicated Ambulances that accumulate one hundred seventy-
five thousand (175,000) miles or reach sixty (60) months in total service time shall
be replaced by new ambulances at Contractor’s expense. Contractor has sixty (60)
days from the date of either mileage or age occurrence to replace the identified
ambulance with a new ambulance.
ADDITIONAL AMBULANCES
In addition to minimum obligations for required Dedicated Ambulances and
Contractor’s right to designate additional units from time to time to meet its
obligations, the City or the Contractor may increase the required number of twenty-
four (24) hour ALS equipped ambulances by one (1) to address any of the following
circumstances:
•
Increased ambulance call volume by ten (10) percent over the call volume
experienced during the first year of the Agreement; or
•
Population increases within the City limits of twenty (20) percent or more over
the population in effect during the preceding calendar year of the Agreement; or
•
Increased traffic congestion within the City limits resulting in on-scene wait time
increases experienced by the Fire Department of ten (10) percent or more over
the preceding calendar year of the Agreement; or
•
Increased 95th percentile ambulance response times of ten (10) percent or more
of the 95th percentile response times from the preceding calendar year of the
Agreement.
CONTRACTOR BILLING AND COLLECTION FOR FIRE DEPARTMENT EMT-P
SERVICES
Contractor will charge fees for its Services and the Services of Firefighter EMT-Ps
as appropriate and permitted. All billing and collection Services will also be the
responsibility of Contractor. Fees may only be charged as established by the
18
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
Arizona Department of Health Services and in accordance with arrangements
applicable to each Payer (including federal, state and local government Payers).
Without considering any amounts collected, Contractor shall be entirely responsible
for paying the Fire Department for the Services of Fire Department’s employees
providing Services in accordance with the provisions set forth in the Arizona Ground
Ambulance Service Rate Schedule.
SCHEDULING AND STAFFING
The Contractor will provide continuity of personnel by scheduling the required
Ambulance staff. The Contractor will schedule and staff Ambulance staff for
Dedicated Ambulances, Special Events Ambulances, and any additional staff
utilized for Special Events.
All Ambulance crew personnel assigned to or available to drive Contractor’s
Ambulances must complete a comprehensive emergency driver-training program
and possess a valid Arizona driver’s license in accordance with the Arizona
Department of Transportation, Motor Vehicle Division requirements, and all
certification/licensing required by the Arizona Department of Health Services and
the City; and Contractor shall prohibit required Contractor’s staff from working
more than sixty (60) consecutive hours without a ten (10) hour off duty rest interval.
REPORTING
Contractor agrees to provide the City on a quarterly (every three months) basis
information and analysis necessary for the City to evaluate the performance of
Contractor’s Ambulance personnel (including direct supervision, medical direction,
and support personnel) in order for the City to assess compliance with the Contract.
The Contract will set forth Contractor obligations to notify the City of the terminated
employment of its Dedicated Ambulance personnel (both voluntary and
involuntary); and the immediate notification of the employment of new personnel
(to include direct supervisory and support personnel).
CONTRACTOR’S AMBULANCE CREWS
The Contractor shall staff the dedicated ambulances and Special Events
Ambulances with one (1) EMT-B Qualified Driver and one (1) EMT-P.
CONTRACTOR TRAINING OF AMBULANCE PERSONNEL
Contractor shall be responsible for the permits, licenses and certifications of its
Ambulance personnel required by all agencies having authority in such matters.
Each Proposer shall describe in detail its training plan for assuring the training of
its EMT-B, other personnel and its drivers of Ambulances as required by all agencies
having authority in such matters, including the City, and assure continued
compliance with all permits, licenses, and certification requirements.
SCENE CONTROL
The Glendale Fire Department has the responsibility for overall scene safety and
management of all responders and patients. Where City emergency personnel are
19
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
present, City is the control authority at the scene. Contactor is included in the
standard operating procedures within the command system. Contractor will be
liable for any actions taken by Contractor’s employees that are outside City’s EMS
System and contrary to any instructions given by the Fire Department incident
commander on scene.
INCIDENT COMMAND STRUCTURE
Contractor will require its employees, including EMTs, paramedics, supervisors,
dispatchers, and management personnel, to adhere to and participate in the Fire
Department’s incident Command procedures. Ambulance crews and other
personnel will participate in, and fully comply with accountability procedures when
involved in any incident in which the Incident Commander requires them to use the
accountability system.
RETURN TO STATION
Any Fire personnel used in the transport of a patient to a hospital in the Contractor’s
ambulance as a part of providing ALS services, will be promptly returned by
Contractor personnel to the appropriate fire station. The transport will be
accomplished either by the transporting ambulance or one of the Contractor’s field
supervisors. If a timely return is impossible using the Contractor’s resources and
the Fire Department is unable to pick up its personnel, and with prior approval of
the Fire Department, a taxicab, or similar ride service, will be immediately
dispatched to pick up the personnel and will be paid for by the Contractor.
Contractor will be permitted to use the ambulance returning Fire personnel to the
station to respond to another 911 call in the City in the event that the ambulance
returning the Fire personnel is the closest available ambulance to respond to the
911 call.
STATIONS
Contractors will provide Stations for all Dedicated Ambulances as described in the
CONTRACTOR PROVIDED AMBULANCES section of this RFP. Such Stations shall
be staffed and in locations that will permit Contractor to comply with Response
Time Requirements as set forth in this RFP. All Stations shall be subject to
inspection by the City. Each Proposer shall submit to the City the proposed
locations for the required stations. Contractor’s Stations must accommodate
Ambulances indoors or under cover and, at such Stations or in immediate proximity
thereto, provide accommodations for crew and other necessary Ambulance
personnel as required and as necessary to provide the Services. The Contract will
contain a provision requiring Contractor to obtain advance written approval of
changes with regard to the location of its Stations within the service area or areas
throughout the term(s) of the Contract from the Fire Chief. The Fire Chief will only
approve changes if the Contractor establishes that the changes will not impair the
Contractor’s ability to meet Response Time requirements as set forth in this RFP
and resulting Contract.
20
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
Each Proposer must submit detailed information concerning any station (and
related sites) from which Proposer offers services. Such information about stations
(and related sites) shall include: (a) description of the living quarters; (b)
description of kitchen and bathroom facilities; (c) ambulance storage areas; and (d)
the ability to install PFDRDC system, at the Proposer’s sole expense.
MOVE-UP POLICY
Contractor agrees to comply with all applicable provisions of the EMS System, the
Glendale Fire Department and PFDRDC regarding move-up policies. Contractor’s
plan for compliance with such policies will be submitted with its Proposal. Changes
to Contractor’s approved plan during the term of the Contract will require written
approval in advance from the Fire Chief.
SOLICITATION OF INFORMATION/PATIENTS
Contractor will never attempt to solicit such information or to collect Services or
fees from a patient, patient’s representatives, or any other Payor until the patient
has been accepted at a receiving medical facility or upon refusal of emergency
transportation for disposable items used during treatment. Nothing herein shall be
construed to prohibit Contractor from soliciting authorization for transport, but only
as long as the solicitation of such authorization does not compromise or
detrimentally affect patient care.
SURVEY OF PATIENTS
The Contractor and the City may survey patients transported pursuant to the
Contract. All such survey information shall be shared by the parties, to the extent
allowed by law.
COMPLAINTS
Contractor will notify the City of all written or electronically received complaints
concerning ambulance services with the City or involving a City Dedicated
Ambulance. Issues will be reported to the EMS Deputy Chief, or their designee, no
later than the close of the business day following receipt of the complaint.
Contractor will provide the City any investigational findings and a disposition of all
complaints described in this paragraph within twenty (20) days of the of the receipt
of the complaint.
Complaints of a financial or billing nature do not need to be reported to the City.
ALTERNATIVE TRANSPORTATION
As Arizona Statute and ADHS regulations are revised to encompass the
implementation of alternative transportation option and destinations for service
originated within public safety dispatch, Contractor will work cooperatively with the
City to provide equipment, personnel, joint guidelines, and performance criteria in
order to provide such alternative transportation. This process may include, but is
not limited to stretcher vans, BLS assessment and transportation units, community
21
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
paramedicine, treat and refer, nurse navigator, triage nurse, or other vehicles or
personnel as necessary to meet future needs.
ELECTRONIC PATIENT CARE REPORTING
The contractor agrees to incur all costs associated with the Electronic Patient Care
Reporting (EPCR) system for use by their personnel. Contractor agrees to use the
same EPCR system as Glendale Fire Department, and ensure that communication
between systems, heart monitors, and other EMS equipment is seamless and
reliable.
SUPPLIES,
MATERIALS AND PHARMACEUTICALS TO BE PROVIDED AND
REIMBURSED TO THE CITY
Contractor will be responsible for providing supplies, materials, and
pharmaceuticals to the Fire Department in replacement of supplies, materials and
pharmaceuticals utilized by the Fire Department in providing Services to patients
(including supplies, materials, and pharmaceuticals utilized by the City’s EMT-P
personnel involved in transport). A list of supplies and materials are identified in
Appendix B of this RFP
.
Within one (1) year from Contract signature, the Contractor will provide controlled
medical supply dispensers in each Glendale Fire Department station. Initial
purchase and placement will be at the cost of the Contractor; the City will assume
ongoing maintenance costs following initial placement.
CERTIFICATE OF NECESSITY (CON)
At some point during the Contract period, the City may apply for a Certificate of
Necessity (CON) to provide ground ambulance transport services in the Primary
Service Area that aligns with the City’s jurisdictional boundaries. If applied for and
granted, the City would introduce ground ambulance transport assets and
personnel gradually as its transport system ramps up over a period of 3-5 years. As
consideration for this multiple-year Contract, the Contractor (and its subsidiaries,
affiliates, employees, agents, contractors, subcontractors, and legal counsel) would
support the City’s CON Application initiative as requested by City. Contractor will
obtain any and all regulatory approvals necessary for this agreement and shall
exclusively bear liability for failure to obtain any such approvals.
SUCCESSORS AND ASSIGNS
Contractor shall not Transfer or Assign:
Any Contract shall not be sold, assigned, or transferred, either in whole or in part,
or leased, sublet nor shall title thereto, either legal or equitable or any right, interest,
or property therein, pass to or vest in any Person, without the prior written consent
of City, which consent shall not be unreasonably delayed or withheld. The sale,
assignment, or transfer of the Contract to an Affiliate or Parent of Contractor does
require prior approval of City if: (i) the sale, assignment, or transfer of the
22
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
existing or newly created interest in the Contract results, directly or indirectly, in a
transfer of Control of the Contract.
i.
Such consent shall not be required for a transfer in trust, mortgage, or other
hypothecation in whole or in part to secure an indebtedness.
ii.
The proposed assignee must show the transfer will not cause any increased
risks of nonperformance of the Contract or any loss to the City of its
bargained for consideration in the RFP and resultant Contract. The
assignee’s showings must detail facts sufficient to show the assignee’s
technical ability, financial capability, legal qualifications, current and past
contractual obligations and performances, personnel qualifications and
general character qualifications and such other qualifications as reasonably
determined by City and the assignee must agree to comply with all provisions
of this RFP and resulting Contract.
iii. A new entity, if allowed, must assume in writing all of a Contractor’s
obligations and liabilities under this RFP and resulting Contract (including
assuming
and
being
responsible
for
the
performance,
defaults,
noncompliance with applicable law, obligations and liabilities under this RFP
and resulting Contract) and shall agree in writing to comply with all
provisions of this RFP, resulting Contact and become a signatory to the
Contract.
In no event shall a transfer of ownership be approved without the successor-in-
interest becoming a signatory to and Contract.
29
rev.
12.11.2020
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
APPENDIX A
Ambulances to be put in service in the City of Glendale by the contractor shall be Type III,
Class I and shall be furnished with a 2-door cutaway chassis. Manufacturer shall be Dodge
or equal, model shall be Dodge 4500 or equal and compliant with current Federal
Specification KKK-A-1822 at a minimum. Units are also required to have a minimum GVRW
of 16,500, be equipped with secondary (auxiliary) air conditioner condensers and must
have a 150” body module.
30
rev.
12.11.2020
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
APPENDIX B:
AMBULANCE EQUIPMENT LIST
The items below are representative of equipment the Contractor may be required to supply
on Dedicated Ambulances.
For General carry items inside the ambulance the company is to adhere to the current
Arizona Department of Health Services required items to carry
1
Motorized gurneys in all Glendale dedicated ambulances, including power
loaders for each unit
2
Physio Control Lucas 3 device or equivalent hands-free CPR device
3
Stair chair
4
Soft breakdown or scoop stretcher
5
Resupply or refill portable O2 cylinders "D" size and "M9" size
6
Precision Xtra glucose monitors with test strips
Airway
1
Ambu- bag- Smart Bag- 01BM3201-MO-Cs- adult and Pediatric
2
I-gel Resus pack- Adult sizes 3, 4 and 5.
3
Adult and pediatric stylets
4
Adult and pediatric Endolocks
5
Cricothyrotomy kits with tools, 5.5 and 6.5
6
Pediatric cuffed ET tubes with stylets combo 2.5-5.0
7
Adult ET tube with stylets combo 5.5-9.5
8
McGrath video laryngoscopes and accessories
9
6.0 and 7.0 Endotrol nasal intubation tubes
10
BAAM for Endotrol tubes
11
OPA's, sizes 5.5-12
12
NPA's, sizes 22fr-36fr
13
Combo in-line/handheld SVN setup
14
Pediatric oxygen masks
15
Pediatric nasal cannulas
16
Adult non-rebreather masks
17
Adult nasal cannulas
18
CPAP Masks- Flow Safe II
19
Green line disposable Laryngoscope blades Miller 0-4
20
Green line disposable Laryngoscope blades Macintosh 2-4
21
Flex Guide ET tube introducer (Bougie) adult and Pediatric
22
SSCOR Quickdraw replacement canister with hose attached
23
Suction Catheters 6,8,10,12,14,16,18fr.
24
Oxygen supply tubing
25
Magill forceps- adult and pediatric
31
rev.
12.11.2020
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
26
Oxygen wrench
Intravenous Supplies
1
0.9% normal Saline - 1000cc, 250cc, 100cc, 50cc bags
2
Lactated Ringers, 1000cc bags
3
15g Blue Jamshedi I.O. needle (manual)
4
3.25" Angiocath chest needle-12G
5
Insyte auto guard IV 14-24g IV Needles
6
Select 3 IV administration tubing
7
Blood pump 10gtts tubing
8
IV start kits to include:
1
Rubber TQ
2
Op site
3
Band-Aid
4
Alcohol prep
5
Small roll of 3M tape
6
1"x1" gauze pads
7
Iodine swab
9
Sharp Shuttle-Pocket Shuttle Med Tech Resource MTR-64250
10
6.9 QT. Sharps Collector
11
EZ IO drill with:
Yellow
Blue
Pink
Needles
45mm
25mm
15mm
15G
15G
15G
12
Peds arm board
13
3ml and 10ml saline bullet and pre-filled syringe
14
Nail polish remover
15
EZ IO stabilizer
16
IV pressure infusers
Bandaging/Tape/Splinting
1
Med Tape - 1",2",3" cloth
2
1" 3M Transpore tape
3
10"x30" trauma dressing
4
5"x9" trauma dressing
5
Sterile 4x4 pads
6
Non-sterile 4x4 pads
7
Triangular bandages
8
3" Kling
9
Band aids
10
Sterile Burn Sheets
11
Water Jel burn dressing- Face, and body
32
rev.
12.11.2020
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
12
3"x5" elastic bandages
13
Small, Medium, and Large cardboard splints
14
Orange Flex All splint
15
Emergency Highway Blanket
16
Adult and Pediatric Ambu perfit and mini perfit Cervical Collars
17
Ambu Head Wedge
18
Coban
19
Disposable C-Spine straps
20
Hyfin Vent Ind. Chest Seal
21
SOF Tactical Tourniquet
22
Blood Clotting Bandages
23
Trauma "H" bandages
24
Combat gauze
25
50ml sterile irrigation bottles
Monitoring Supplies
1
All Ambulances dedicated to the City of Glendale will carry the same cardiac
monitor as Glendale Fire units
2
ECG 100mm paper Medical Recording Chart paper 4" 3/16 x 73'
3
Ambu - Blue Sensor R (Adult) and SP (Peds) ECG Electrodes / 10Pk
4
Physio-Control Quik-combo pads
5
Physio-Control Pediatric Quik-combo RTS
6
Nasal CO2 detector Adult and Pediatric
7
Adult/Peds intubated CO2 detector
8
Infant oxisensor Pulse Oximeter probe
9
Masimo single use SpO2 adult and peds
10
Disposable prep razors
11
Disposable BP cuffs for LP15 Adult/Peds/inf.
Syringes/Needles
1
60cc syringe with Luer lock
2
20cc syringe with luer lock
3
10cc-12cc syringe with luer lock
4
5cc syringe with luer lock
5
3cc syringe with luer lock
6
1cc syringe with luer lock
7
22g x1 surgard needle (black)
8
20g x1.5" surgard needle
9
23g x1 needle (blue)
10
19x 1.5 needle (Gold)
11
21g x 1.5 needle (Green)
SOLICITATION NUMBER: IFB 23-36 / 42300051
EMERGENCY MEDICAL SERVICES
CITY OF GLENDALE
Procurement Division
5850 West Glendale Avenue,
Suite 317
Glendale, Arizona 85301
12
1cc syringe with needle (TB)
Miscellaneous
1
Disposable Penlights
2
Ammonia Inhalants
3
Alcohol preps
4
Vionex hand wipes
5
Cold packs
6
Hot packs
7
Trauma Sheers
8
Full OB kit (Disposable)
9
Glutose 15
10
Water soluble lubricant
11
Scalpel #11
12
Soft restraints
Personal Protective Equipment
1
Trauma Sleeves
2
Biohazard Bags: small, Med, Lg.
3
Nitrile free form EC gloves: sm, med, lg, xl, xxl.
4
N95 Respirator masks: sm, med, lg Moldex 1500 series, 1511 (S), 1512(M),
1513(L)
5
Clear eyeglasses
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RFP 23-36 / 42300078 EMERGENCY MEDICAL SERVICES
COVER LETTER & EXECUTIVE SUMMARY
April 26, 2023
Anne Shadle, Procurement Officer
Purchasing-Procurement Division
City of Glendale
City Hall – 3rd Floor
5850 W. Glendale Ave., Suite 317
Glendale, AZ 85301
Re: RFP 23-36 / 42300078 – Emergency Medical Services
Dear Ms. Shadle:
Maricopa Ambulance is proud to submit the following proposal in response to the City of
Glendale’s RFP for Emergency Medical Services. Maricopa Ambulance has worked alongside
the Glendale Fire Department as the City’s trusted 9-1-1 ambulance provider since March
2019 and values our role as a trusted service partner.
In the time we have served the citizens of Glendale, we have forged exceptional relationships
with our fellow first responders and have met all requirements under the contract. We value
the opportunity to continue to serve the City and to continue to deliver innovation,
collaboration and the best possible care to the citizens of Glendale.
Maricopa Ambulance is a leading provider of 9-1-1 emergency ambulance services, as well
as the extensive provision of interfacility services throughout the Valley, with key 9-1-1
municipal partnerships in Scottsdale, Chandler and Goodyear, in addition to Glendale. Our
hospital and healthcare system clients include Dignity Health, HonorHealth, Abrazo Health,
and Valleywise Health. Evidenced by our contract and customer list, the Maricopa
Ambulance team is invested in ensuring service excellece. Our reputation as a patient-centric
provider is known, and we put a tremendous value on our ability to collaborate with our fire
service partners.
The Maricopa Ambulance leadership team has decades of experience in emergency
ambulance and fire services in Arizona. And our national leadership teams throughout the
Priority family of companies have experience managing and operating many of the largest
emergency ambulance services in the nation.
Our proposal includes state-of-the-art equipment and technology, the highest safety
standards for our personnel, vehicles and equipment, and years of experience serving the
City of Glendale. Maricopa Ambulance is a trusted partner with an outstanding reputation
and commitment to the community. As we describe in this proposal, we our mission is to
deliver care in a safe, accountable, friendly and efficient manner.
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Maricopa is proposing two model options. Any option that results in a subsequent
Agreement for Emergency Medical Transportation will be subject to Maricopa Ambulance
submitting and receiving approval of the contract from the Arizone Department of Health
Services.:
Option A: Meets or exceeds most specifications of the RFP, including the 95% response time
threshold, with compliance determined by a combined Code 3 and Code 2
standard. Option A increases the number of peak ambulances to 12, with the attendant
increase in costs. The increase in the number of ambuances to meet the 95% response time
performance shall be subject to AZDHS approval and a General Rate Increase in excess of the
automatic rate increases proscribed in ARS 36-2234 E sufficient to cover the increased cost of
captial and resources sufficient to maintain the required level of preparedness.
Option B: Meets all requirements under the current City of Glendale emergency medical
services contract, including current response time requirements. Option B maintains the
current AZDHS approved rates and charges. Option B includes the initial purchase and
placement of specifically configured medical supply vending machines, in order to more
accurately track replacement medical suppies, in all Glendale Fire stations at no cost to the
City within one year of the contract being approved by AZDHS.
We appreciate the opportunity to present our proposal and qualifications and look forward
to the selection process and any questions you may have. This proposal is a firm offer for a
120-day period.
Respectfully,
Alan Smith, West Region President
Maricopa Ambulance, LLC
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RFP 23-36 / 42300078 EMERGENCY MEDICAL SERVICES
EXECUTIVE SUMMARY
In the following pages, Maricopa Ambulance has provided detailed responses to every
topic identified in the RFP and has provided evidence of qualifications, licensures, insurance
and access to performance bonds required. We include this brief executive summary as a
high-level review of our credentials, methodology and key points within the proposal.
MARICOPA AMBULANCE PROPOSAL AT-A-GLANCE
Maricopa Ambulance proposes two model options, both of which will include improved
deployment plans and station locations, subject to the availability of commecial real estate that
meets city code requirements:
Option A: Maricopa Ambulance will provide 15 ambulances dedicated to the system, or 125% of
peak deployment. Peak ambulance deployment of 12 ambulances would include six 24-hour
ambulaces and six peak hour ambulances, with three spare ambulances in service in our
Interfacility fleet for peak utilization
Maricopa Ambulance cannot agree to the provision in the Additional Ambulances section of
the RFP, which allows the City to require additional 24-hour ambulances unilaterally. As a
CON provider, AZDHS has indicated to us that determining the number of ambulances in a
political subdivision 911 contract is the responsibility of the CON holder. We do not believe
that this responsibility can be delegated via contract to a political subdivision, such as the City
of Glendale. As pointed out in the “PERFORMANCE VS. LEVEL OF EFFORT” section of the
RFP, this is a performance contract. Thus, it is the responsibility of the CON holder to provide
the appropriate number of resources to meet the contractual commitment.
All ambulances under Option A will include Dodge 1500s, or equal, with solar panels and the
latest safety features, including ATLAS driver monitoring, SDS Lane Departure/Collision
Avoidance, Opticom technology. All vehicles will be replaced before 175,000 miles or 60
months.
Option B: Meets all requirements under the current City of Glendale emergency medical services
contract, including current response time requirements. Option B maintains current AZDHS
reimbursement rates and includes the initial purchase and placement of specifically configured
medical supply vending machines in all Glendale Fire stations at no cost to the City within one year
of the contract being signed. Maricopa Ambulance will provide 13 ambulances dedicated to the
system, or 125% of peak deployment. Peak ambulance deployment of 10 ambulances would
include four 24-hour ambulaces and six peak hour ambulances, with three ambulances in in
service in our Interfacility fleet for peak utilization.
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Ambulances under Option B will match the ambulance standards established in the current
contract and will not be subject to mandatory replacement before 175,000 miles or 60
months.
Proposal Items that apply to both Option A & Option B:
Ambulances will be staffed with one paramedic and one EMT. Additionally, paramedic
supervisors will provide around the clock ALS support to the system to assist on-scene and
for resupply.
Maricopa Ambulance are experts at System Status Management and have developed a
comprehensive initial deployment plan to ensure response compliance with Optional A or
Option B models. As a performance-based contract, Maricopa will continually review and
hone resource allocation and vehicle deployment to match demand.
Ambulances will house Glendale Fire Department compliant equipment, including the
LifePak 15 cardiac monitor, LUCAS 3 chest compression devices, power cots and stair chairs,
as well as PRFDCDC compliant MDTs and radios. Maricopa Ambulance is already operating
9-1-1 systems dispatched through PRFDCDC, so the integration for Glendale will be seamless.
Maricopa Ambulance will provide supplies to the Glendale Fire Department free of
charge in a one-for-one, on-scene exchange and through medical supply vending
machines at all Glendale Fire stations in order to more accurately track replacement
medical suppies in order to more accurately track replacement medical suppies
As our current experience has proven, Maricopa Ambulance is well-financed and will invest
the capital required to meet the terms of the RFP Option selected. Maricopa Ambulance
is prepared to invest in capital, infrastructure and startup costs in Glendale and has secured a
letter certifying a $1 million performance bond. A Surety Fund for $50,000 will be created.
Maricopa Ambulance is willing to review and negotiate the terms of use for any Surety that is
required, should Maricopa’s offer be selected as the winning bid.
EXHIBIT B
EMERGENCY MEDICAL [TRANSPORTATION] SERVICES
COMPENSATION
NOT-TO-EXCEED AMOUNT
The total amount of compensation paid to Contractor for full completion of all work required by the Project during
the entire term of the Project must not exceed $1,500,000.
TRANSPORT FEE TO PATIENTS
Patient and/or their insurance will be billed for ambulance services at the then current ADHS applicable rate at the
time of service.
DETAILED PROJECT COMPENSATION TO CITY OF GLENDALE
Contractor will bill City of Glendale for standby ambulances and supplemental crew members at special events
required by the Glendale Fire Department.
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RFP 23-36 EMERGENCY MEDICAL SERVICES
PRICING WORKBOOKPRICING WORKBOOK
1. COSTS FOR SERVICES
Contractor shall provide detailed costs for providing emergency medical
transportation services for special events as stated in the Scope of Work and
Specifications.
Excerpt from Scope of Work:
The Contractor will also provide ambulances for medical stand-by and transportation at Special
Events and provide BLS and ALS staffing in conjunction with a stand-by ambulance and fire
department staffing for Special Events if requested by Glendale Fire Department
Contractor may not furnish standby coverage for Special Events … with Dedicated Ambulances.
Maricopa Ambulance will provide medical stand-by and transportation at Special Events and
provide BLS and ALS staffing at the request of the Glendale Fire Department. The
ambulances, personnel and equipment used to provide these services will be in addition to
that dedicated to 911 ambulance services, so there is no degradation of service to the
community during a Special Event.
Maricopa Ambulance will bill patients (or their insurance) for any medical transport services at
the published and regulated rates approved by ADHS. There is no expectation of transport
fees charged to the City of Glendale.
Supplemental BLS, ALS or on-scene coordination requested by the Glendale Fire
Department will be reimbursed by either the Glendale Fire Department or the promoter of
the Special Event. These rates are not regulated by ADHS, but Maricopa Ambulance
proposes a rate structure based on the underlying economics contained in the State rate
development that is competitive with the rates in the market.
Maricopa Ambulance Special Event Rates Glendale 2023
Maricopa
Rates
Transport (charged to patient)
ALS Transport
$952.81
BLS Transport
$848.73
Mileage
$19.75
Separate charge for Supplies
Yes
Optional Special Event Support
(when Glendale is the paying entity)
Ambulance Standby / hour*
$200.00
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RFP 23-36 EMERGENCY MEDICAL SERVICES
Because Special Events sometimes require specialized equipment (e.g., golf carts, first aid
tents, multiple radios). Maricopa Ambulance is interested in further understanding the
support needs of the Fire Department’s Special Event program and can tailor a supplemental
proposal for infrastructure based on the needs of the system. Maricopa Ambulance is also the
Special Event medical transportation partner to neighboring Scottsdale Fire Department, and
we propose a collaborative discussion about shared use of certain special event
infrastructure.
PAYMENT The Contractor shall provide monthly statements of itemized services.
Payment will be reviewed and approved by the Contract Administrator or designee.
Maricopa Ambulance agrees to provide monthly statements of itemIzed services to be
reviewed and approved by the Contract Administrator or designee.
TAX AMOUNT Do not include a use tax or federal tax in your proposal.
OFFEROR NAME: Maricopa Ambulance, LLC
PRICING CLARIFICATION
Rates
Ambulance and two -crew member Standby / hour - to
include one (1) ALS crew member and one (1) BLS crew
member
$200.00
Supplemental ALS Crew member / hour
$75.00
Supplemental BLS Crew member / hour
$60.00
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RFP 23-36 / 42300078 EMERGENCY MEDICAL SERVICES
Employee Orientation and Training
Maricopa Ambulance’s 40-hour classroom orientation includes all information needed for an
EMT and Paramedic to be successful within the Glendale system. Maricopa Ambulance will
place significant attention on ensuring a thorough understanding of the clinical protocols as
set and approved by the system Medical Director.
Customer Service Training
Company overview and history
Organizational structure
Five Fundamentals of MARICOPA AMBULANCE safety
HIPAA, Bloodborne, Airborne, Hazardous Communications
Benefits and Personal Time Off (PTO)
Billing procedures
Safety, stretcher use, lifting techniques
Equipment familiarity: cardiac monitor, Easy IO
Tablet PCR and CQI process
CEVO training and driving course
Classroom
40 Hours
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Field Training and Competency Checks
After being introduced to the preceptor/field training officer, Maricopa Ambulance recruits
will complete online protocol familiarization training, shadowing and competency checks.
The field training piece is only concluded when all skills have been checked for competency
and patient care and driving techniques have been observed and scored. Once this is
completed, the employee will enter a probationary period.
Clinical
Introduction to Mentor and Field Training Officer
Driving Checklist
Driving Critiques (5 emergency runs)
Professional Conduct and Behavior
Competency check including:
Shift Start Procedures
Interpersonal Communications
Roles and Responsibilities
Equipment Familiarity
Body Mechanics
Driving
End of Shift Procedures
Communications
Documentation
Safety Procedures
Employment Records, Certification, Licensure
All Maricopa Ambulance personnel are currently and appropriately licensed and/or
credentialed with records housed in our ePRO system, which also serves as our training hub.
ePRO sends notifications to employees about upcoming renewal deadlines and makes it easy
to update employee records with new certifications by uploading a photo of the certificate
into the system.
If an employee fails to update any certification or a license has expired, the ePro system will
lock out the employee. The employee will be unable to clock in for a shift, thereby providing
an additional layer of protection.
Professional Standards of Conduct
Maricopa Ambulance prides itself on being quality-driven and customer-focused. Each
employee receives customer service training as part of the initial company orientation.
Maricopa Ambulance understands that as a contractor for the City of Glendale, our
employees in the field are an extension of the city and take this responsibility very seriously.
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From professional dress to extensive Customer Service training on how to communicate
effectively with patients, families or other health care providers, Maricopa Ambulance is
committed to providing high-quality patient care and excellent customer service.
Clinical Training
Programs that are provided to Maricopa Ambulance
employees include Advanced Cardiac Life Support (ACLS)
Pediatric Advanced Life Support (PALs) and Basic Life
Support (BLS).
A brief description of the proposed courses and our rationale
for offering them are provided below.
Pediatrics Advanced Life Support (PALS) is a 16-hour course
developed by the American Academy of Pediatrics to
provide BLS and ALS providers with a comprehensive source
of information for the emergent care of infants and children.
PALS is a training program that provides a high-quality
pediatric curriculum focused on the pre-hospital setting.
Advanced Cardiac Life Support (ACLS) allows providers to enhance skills in the treatment of
the adult victim of cardiac arrest or other cardiopulmonary emergencies. ACLS emphasizes
the importance of basic life support CPR to patient survival; the integration of effective basic
life support with advanced cardiovascular life support interventions; and the importance of
team interaction and communication during resuscitation.
In addition to these nationally recognized certification programs, Maricopa Ambulance
utilizes state of the art software from Vector Solutions to provide EMTs and Paramedics with a
modern learning management system that provides curriculum that meets and exceeds all
training and education requirements for the State of Arizona. This continuing education
allows them to certifications and be confident and excel in the City of Glendale EMS system.
Additionally, our Training Center provides curriculum prepares medics through an overview
of the medical protocols The focus on cardiac arrest management, STEMI recognition and
referral, stroke and trauma management is an ongoing priority due to the clinical impact in
for critical patients.
Additional Training
Airway management lecture both at a BLS and ALS level.
Airway lab Includes: BLS ventilations with airway adjuncts, I-gel,CPAP indications,
contraindications, and the setup of CPAP. Paramedics and RN intubation review
and practice, Airway management scenarios for EMTs and Paramedics.
ZOLL Monitor review. 4 and 12 lead electrode-placement-review and practice.
IV setup, BLS to ALS assist.
IO overview, and pressure bag setup.
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RFP 23-36 / 42300078 EMERGENCY MEDICAL SERVICES
Restraints, when and how to use them.
Vent and pump training.
Driver training, in lecture and out on the trucks.
Safe lifting, gurney ops, and scene safety.
BLS Provider class.
ACLS/PALS are every other month.
Remedial training for driving.
DQA and charting as needed.
Online training is done for the LUCAS 3 Compression device on ESO.
Airborne bloodborne pathogens are also done online in ESO.
Customer Service Training
Clinical excellence and employee training are top priorities at Maricopa Ambulance. Equally
important is the customer service training that we provide.
EMTs and paramedics are on the frontlines and are the face of Maricopa Ambulances in the
West Valley. We are a highly visible representation of the City of Glendale. Our employees
have daily contact with patients, health care workers and fire service partners.
Meeting and exceeding the needs of our customers is a priority that is engrained at every
level within our organization from our dispatchers, EMTs, paramedics and nurses to our
support staff and management. To ensure that our commitment to customer service does not
fall short, Maricopa Ambulance has developed a comprehensive and innovative training
program that begins during each new hire orientation.
During new hire orientation, our employees are
introduced to the various elements of customer
service. We start with the basics: identifying your
customer, identifying your customers’ needs and
responding to those needs with the appropriate
resources and service delivery. We walk our
employees through the course of each call: how to
prepare for arrival, what to do once on scene,
appropriate interaction with all involved in patient
care, how to appropriately provide the continuum of
patient care while in transport and completing the
call with patient delivery and transfer of care. Although this level of customer service training
may seem very basic, during our interview process, we found many employees had not
previously received any form of customer service training.
At the end of our new hire orientation, our employees have a great understanding of the
importance in consistently delivering exceptional customer service. They understand that it is
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RFP 23-36 / 42300078 EMERGENCY MEDICAL SERVICES
through consistency that Maricopa Ambulance has had the opportunity to make a positive
change in the delivery of ambulance service throughout the Valley.
b. Provision and maintenance of the Contractor Dedicated or Special Events
Ambulances and the equipment, materials, and supplies required and necessary
to provide the services.
Proposed Ambulances & Equipment
Ensuring the right fleet resources are deployed efficiently to the right place and within
contracted response times is of utmost importance to Maricopa Ambulance.
As the incumbent provider, our current fleet of 10 Ford F-450 heavy-duty Type III
ambulances are equipped with advanced medical equipment and supplies that meet all
specifications preferred by the Glendale Fire Department.
In accordance with Maricopa Ambulance’s Option A discussed in the Executive Summary,
we propose all new ambulances are Dodge 1500s, or equal, with solar panels and the latest
safety features, including ATLAS driver monitoring, SDS Lane Departure/Collision
Avoidance, Opticom technology. All vehicles will be replaced before 175,000 miles or 60
months.
Under Option A, Maricopa Ambulance agrees to the ambulance mileage and age
replacement requirements of 175,000 miles or 60 months. Ambulances will be replaced as
quickly as possible within the constraints of the post-Covid national ambulance shortages.
The Maricopa Ambulance dedicated fleet is deployed for ALS service in the City of Glendale
to meet required response times and as stand-by EMS and transportation for special events.
In addition:
All dedicated and special event Maricopa Ambulances meet or exceed ADHS
requirements for ambulances providing ALS services in Arizona, and also meet the
specifications outlined in the RFP Appendix A and Appendix B. Maricopa
Ambulances feature a two-door cutaway chassis. All units meet current federal
specifications KKK-A-1822 and have a minimum GVRW of 16,500, are equipped with
auxiliary air conditioner condensers and have a 150” body module. Further, all units
meet all other applicable federal state and local requirements.
All ambulances and support vehicles will have GPS automatic vehicle locators, and the
geographic data will be provided in real-time to the Phoenix Fire Department
Regional Dispatch Center (PFDRDC) and the Glendale Fire Department through
Mobile Data Terminals (MDT) that are compatible with PFDRDC’s CAD. These MDTs
will be purchased by Maricopa Ambulance and installed in every vehicle.
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Maricopa Ambulance Maricopa Ambulance also uses ATLAS hardware with either
MobileCAD, VLI Mobilis or other accepted software to allow dispatch. The system
automatically time stamps the vehicle in service, responding to a call and on-scene.
The system also provides crews with instant real-time, turn-by-turn voice and visual
routing guidance. The GPS system also monitors speed of the ambulance and will
notify the management if the set speed limit is exceeded by any vehicle.
The Maricopa Ambulance Glendale ambulances are advanced medical vehicles with
solar panels to reduce the carbon footprint of the vehicles, as well as to provide
emergency backup power for the lifesaving medical equipment.
Every dedicated and special event Maricopa Ambulance in the Glendale EMS system
carries the required ALS supplies as prescribed by the Arizona Department of Health
Services (as described in RFP Appendix B).
Additional Ambulances
Maricopa Ambulance agrees it is the contractor’s right to designate additional units from
time to time to meet obligations under the contract. Maricopa Ambulance does not
agree and cannot comply with provisions that allow the City to unilaterally require the
number of 24-hour ALS ambulances be increased. We do, however, agree that there
should be a process developed to address sustained circumstances described below,
which may allow for additional ambulance requests from the City. These circumstances, if
mutually agreed upon, would require an amendment to the Ambulance Services
Agreement (along with the normal contract change approval process.)
Sustained Circumstances:
Increased ambulance call volume by 10 percent over the call volume experienced
during the first year of the agreement; or
Population increases within the City limits of 20 percent or more over the
population in effect during the preceding calendar year of the agreement; or
Increased traffic congestion within the City limits resulting in on-scene wait time
increases experienced by the Fire Department or 10 percent or more over the
preceding calendar year of the agreement; or
If the year-over-year number of late calls exceeds 10 percent of the total late calls
from preceding calendar year.
Substitute Ambulances
In the event Maricopa Ambulance must substitute an ambulance in place of a dedicated
City of Glendale ambulance for a period of more than 12 hours, Maricopa Ambulance
will ensure the unit is similarly equipped to the dedicated City of Glendale units.
Maricopa Ambulance also will notify the Glendale Fire Department EMS Deputy Chief via
a phone call or email that the unit has been substituted.
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Traffic Signal Pre-Emption Devices
In addition, all Glendale EMS system Maricopa Ambulances are equipped with traffic
signal pre-emption devices compatible with the system currently in use by the city and
are the sole expense and responsibility of Maricopa Ambulance. Each unit also is
equipped with a dedicated cell phone pre-programmed with all phone numbers needed
for medical communications and will be regularly updated to meet the needs of the City
and the Company, at Maricopa Ambulance’s expense.
MEDICAL EQUIPMENT
All Maricopa Ambulance medical equipment will be in good repair and safe working order
and is monitored and tracked to ensure optimal operation at all times. Maricopa Ambulance
follows manufacturer’s recommended maintenance schedules to ensure all medical
equipment is always in good working order. If we find deficiencies in any equipment, it is
immediately removed from the system and replaced.
Every Maricopa Ambulance is equipped with the following equipment and technology:
LifePak 15 Cardiac Monitors
LifePak 15 ECG Cardiac Monitors are carried on
board every ambulance in the City. The cardiac
monitors transmit 12-lead ECG data to the
emergency department at to evaluate the patient’s
condition prior to arrival and allow for early
notification of key hospital staff such as the
catheterization lab and cardiologist. The ECG
monitors include all diagnostic accessories and the software, including wireless transmission
of data via tablets to the electronic patient care reporting (ePCR) software.
Lucas 3 Automatic Chest Compression Devices
To save the lives of sudden cardiac arrest patients and
avoid neurological damage, a steady supply of oxygen to
the heart and brain is necessary. Life-sustaining circulation
can be created through effective and uninterrupted chest
compressions. The LUCAS Chest Compression System is a
safe and efficient tool that standardises chest
compressions in accordance with the latest scientific
guidelines. It provides the same quality for all patients and
over time, independent of transport conditions, rescuer
fatigue, or variability in the experience level of the caregiver. By doing this, it frees up
rescuers to focus on other life-saving tasks and creates new rescue opportunities.
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Battery Powered Stryker Power Pro Cots
Stryker Pro XT power ambulance cots utilize a
battery-powered hydraulic system for effectively
and efficiently raising and lowering a cot at the
touch of a button. The hydraulic lifts dramatically
reduce back injuries, which affect 25 percent of
EMS workers in their first four years in the field.
The stretcher also will be equipped with a
bariatric extender.
Performance-Load Manual Cot
Fastener
Our safest, most advanced manual cot fastener meets crash safety recommendations for SAE
J3027 and guides loading and unloading to improve operator efficiencies. The Performance
Load Cot Mounts protect the lives of both the patient and the caregiver during the loading
and unloading process and secures the cot during transportation. The equipment also
improves operator efficiency by reducing cot drift. The mounts are easily removable for
maximum decontamination and lowered potential for biohazards.
Stryker Stair-Pro
The Stair-Pro is designed to allow paramedics and EMTs to easily raise and lower a patient
safely up and down stairs, while preventing lifting injuries of employees.
Pediatric Restraint System
The Pedi Mate Pediatric Restraint System quickly adapts any ambulance cot for the safe
transport of children ranging in size from 10-100 pounds.
Bariatric Stretcher and TranSafe Bariatric Ramp
Maricopa Ambulance currently uses the Stryker bariatric
stretcher, which uses motorized technology to raise and
lower the stretcher, minimizing the effort required by EMTs
and paramedics. The TranSafe ramp will use a motorized
track to load the bariatric stretcher into the ambulance,
allowing for an overall easier, more dignified transport
process. The ramp easily attaches to the exterior of the
bariatric ambulance for EMTs and paramedics to place a
standard or bariatric stretcher that will be automatically
loaded into the ambulance using a motorized track.
Maricopa Ambulance equips one of the dedicated City of
Glendale units with the Trans Safe system and a specialized
Stryker bariatric cot.
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BuckleGarde
For patient and crew safety, Maricopa Ambulance
implements BuckleGarde technology on all stretchers. A
BuckleGarde ensures that only the EMT or paramedic with
the key will be able to unlock the strap buckles and remove
the stretchers in an ambulance. With behavioral health
patients or patients experiencing confusion or intoxication,
this will ensure the patient is restrained in a safe and
dignified way and that the patient remains inside the vehicle
until arriving at the destination.
MEDICAL SUPPLIES
As the incumbent provider, Maricopa Ambulance carries the required supplies aboard its
dedicated City of Glendale ambulances and will continue to do so. Please refer to Exhibit 5
of this proposal – Ambulance Equipment List – for a detailed list of all items.
Maricopa Ambulance will ensure each ambulance is fully stocked at all times with required
medical equipment and supplies to accommodate replacement during repair and for times
of excessive demand. Vehicle and station par levels are checked daily, and supply needs are
communicated to our equipment and supply logistics manager.
As our emergency partners, Maricopa Ambulance is committed to supplying and restocking
the Glendale Fire Department with supplies and medications at no cost to the department
and in the most efficient, convenient manner possible.
When supplies are used on the scene, Maricopa Ambulance will restock the fire department
unit one-for-one item on the scene. Additionally, Maricopa Ambulance will have ALS supplies
in locked safes on the ambulances and firefighter paramedics will use a code to access these
supply lockers at any time.
Maricopa Ambulance also will commit to placing specially configured, secure medical supply
vending machines at all fire stations and/or at the local hospital if desired. These vending
machines will allow the Glendale Fire Department to restock on a one-for-one basis without
delay and allow for more accurate tracking of medical supplies. Maricopa Ambulance will
check and restock the vending machines regularly to ensure supplies are always current. All
medications must be stored and received from the hospital itself, and Maricopa Ambulance
will keep a current supply of all medications dedicated for the Glendale Fire Department’s
use at the hospital.
CribMaster Controlled Medical Supply Dispensers
Maricopa Ambulance will purchase and install CribMaster or similar controlled medical
supply machines in all Glendale Fire stations. These devices provide 24/7 controlled access
to and available of medical supplies with the simple swipe of an employee badge.
Automation is secure and simple with weight-sensing bins with software options that allow for
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all machines to be connected for reporting across multiple sites. Maricopa Ambulance is
proposing the use of the company’s Express Toolbox or Express Locker models pictured
below.
Because Maricopa Ambulance is incurring the full cost of the medical supplies used in patient
care, it will include charges for consumable supplies and medications in fees to patients and
their medical insurance. This is an efficient way to maximize health care reimbursement and,
thereby, minimize cost to the City of Glendale.
Additionally, if requested, Maricopa Ambulance will provide regular resupply deliveries
directly to the fire stations. Maricopa Ambulance will always be responsive to its partners and
if a supply or medication is running low, we will immediately respond. While not currently
required in the Ambulance Services Agreement, Maricopa Ambulance has implemented a
Supply Service Technician position to improve service to Glendale Fire Stations. Combined
with the supply vending machines, Maricopa Ambulance intends to meet or exceed
expectations of the Glendale Fire crews.
DISPATCH CENTER/ COMMUNICATION CENTER RESPONSE
Maricopa Ambulance operations in the City of Glendale currently meet the City’s
specifications for dispatch and communications equipment. Utilizing a dual-band VHF (154-
155MHz)/800 MHz radio system, Maricopa Ambulance provides base, mobile and portable
radios that enable voice interoperability with Glendale Fire Department units and PFRDC on
appropriate radio channels and according to procedures established by the Fire
Department.
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Maricopa Ambulance will coordinate, purchase and install
Mobile Data Terminals (MDT) that connect to the Phoenix
Fire Department Regional Dispatch Center to allow
dispatchers to view the location of our ambulances at all
times and dispatch the closest vehicle.
Maricopa Ambulance uses the RescueNet suite of CAD
software technologies. Maricopa Ambulance’s RescueNet
CAD will receive the same GPS and call data that is
transmitted to the Phoenix Fire Department Regional
Dispatch Center through the Mobile Data Terminals on all
ambulances.
The ZOLL RescueNet ePCR system ties into Maricopa Ambulance’s CAD and billing systems
for seamless and accurate patient care documentation.
Maricopa Ambulance’s advanced vehicle locator (AVL) software is provided by MobileCAD,
VLI Mobilis or other accepted software to allow dispatchers to continually track vehicle locations
location and status in real-time and allows for the appropriate dispatch of the closest
available ambulance at any given time.
ZOLL software creates detailed, easy-to-use reports that Maricopa Ambulance management
uses for quality improvement programs, clinical evaluation and operational efficiency. The
ZOLL system can create more than 200 standard reports and can customize for any search
criteria and specified period of time.
c. Accurate completion and timely submission of all required data and reports of
every kind, including notices.
Reporting
Maricopa Ambulance is committed to ensuring not only the highest levels of performance to
the City of Glendale, but also to timely and regular reporting to the City. Maricopa
Ambulance will provide the City with a quarterly (every three months) performance report,
including data analysis necessary for the City to evaluate the Company’s performance and
contract compliance. Maricopa Ambulance agrees to notify the City immediately of
terminated (voluntary and involuntary) dedicated ambulance personnel, as well as the
immediate notification of the employment of new personnel (to include direct supervisory
and support personnel).
d. Meeting Response Times and other performance requirements in compliance
with applicable law including, but not limited to, ADHS laws and regulations,
this RFP, and the EMS system.
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Response Times
Maricopa Ambulance will provide an ambulance
response time report in a format approved by the
contract manager to the City of Glendale by the fifth of
the following month, which will include contract
compliance, supporting call data, explanations of call
exceptions and any other data as directed by the
contract manager. The report also will include
exceptions and requested exemptions to performance.
Maricopa Ambulance understands the City of Glendale
may audit data and operations with 48 hours of notice.
Maricopa Ambulance uses the RescueNet suite of CAD
software technologies. Maricopa Ambulance’s
RescueNet CAD will receive the same GPS and call data
that is transmitted to the Phoenix Fire Department Regional Dispatch Center through the
Mobile Data Terminals on all ambulances. The ZOLL RescueNet ePCR system ties into
Maricopa Ambulance’s CAD and billing systems for seamless and accurate patient care
documentation.
ZOLL software creates detailed, easy-to-use reports that Maricopa Ambulance management
uses for quality improvement programs, clinical evaluation and operational efficiency. The
ZOLL system can create more than 200 standard reports and can customize for any search
criteria and specified period of time. Additionally, Maricopa Ambulance uses a BI Query
software reporting program that is customer designed for response time reporting in
Glendale. Between ZOLL and BI reporting, reports can include:
Emergency life threatening and non-life-threatening response times by jurisdiction
and by user definition
Out-of-chute response times by crew members
On-scene times
Hospital drop times by crew members
Emergency and non-emergency responses by hour and day
Dispatch personnel response time reports
Canceled run report
Demand analysis report
Problem hour assessment
Call mode by hour and day
Ambulance alert exception report
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e. Participate and cooperate with the Administrative Medical Director and City
representatives in audits, inspections and investigations, with timely responses
and completion of requirements.
Maricopa Ambulance agrees to participate and cooperate with the Administrative
Medical Director and City representatives in audits, inspections, and investigations, with
timely responses and completion of requirements, as prescribed in this RFP.
f.
Provide indemnification, insurance performance guarantees, and other security
as required by the City.
Maricopa Ambulance agrees to provide the required indemnification, insurance
performance guarantees and other security as prescribed by the City. Please refer to
Exhibit 4 – Performance Surety Fund and Performance Bond for additional details.
1.2 Provide a thorough description of all capabilities and methods of the
Proposer’s operations.
EMS Experience
Maricopa Ambulance provides Central Arizona
with a veteran leadership team with decades of
experience in ambulance service management.
Maricopa Ambulance is part of the Priority
Ambulance family of companies. Founded in
2013 by ambulance executives with a deep and
rich history in Maricopa County, Priority
Ambulance now operates more than 850
ambulances in 14 states across the United
States. Priority Ambulance employs approximately 4,000 employees and mor than half of its
600,000 annual ambulance transports are in response to a 9-1-1 call.
Maricopa Ambulance is well-funded, well-led and ready to continue provide service
excellence to the City of Glendale. Each of Priority Ambulance’s companies maintains strong
local ties with an empowered local leadership structure and local brand identity.
Between Priority Ambulance corporate executives and the Maricopa Ambulance local
leadership team, the Company brings unmatched experience in emergency services in
Arizona and a proven track record of success in 14 states nationally. The Company’s
leadership teams also have extensive expertise in EMS system design – creating and
operating some of the largest, highest-performing EMS systems in the country – and
specifically in EMS operations in Central Arizona. Last year our sister company, Priority
Ambulance of Yavapai, LLC started operations after receiving a CON from AZDHS.
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Continuity of Arizona Operations is maintained by our management structure that is led by
our West Region President.
In October 2016, Maricopa Ambulance was granted a certificate of necessity (CON) from the
Arizona Department of Health Services’ Emergency Medical Services & Trauma System to
provide emergency and nonemergency transport and offer medical facilities and hospitals a
choice. That CON includes all the areas in the City of Glendale as demonstrated by Maricopa
Ambulance’s service area map.
Maricopa Ambulance is proud to serve the City of Glendale as the incumbent 9-1-1 ground
ambulance provider. The Company is an active member of the Glendale Area Chamber of
Commerce and is committed to supporting fellow local businesses and building relationships
with community members.
MARICOPA AMBULANCE OPERATIONS CENTER
10243 N. 19th Ave., Building B
Phoenix, AZ 85025
Office: 480-485-2900
Dispatch Fax: 480-907-1685
www.maricopaambulance.com
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PRIORITY AMBULANCE WEST REGION HEADQUARTERS
8501 E. Princess Drive, Suite 195
Scottsdale, AZ 85255
Maricopa Ambulance is a member of the Priority Ambulance family of companies.
Priority Ambulance is the fastest-growing national ambulance company in the country, with
about half of the company’s 600,000 calls annually in response to 911 calls and the balance in
response to requests for interfacility medical transports ranging from BLS, ALS, CCT to
neonatal transport requests. Priority pre-hospital professionals are highly skilled and
experienced in all levels of ambulance care and transportation.
Priority was founded in 2013 and currently operates in 14 states. In 2018, Priority was first
recognized on the Inc. 5000 list of the fastest-growing private companies in America and has
appeared on that list for five consecutive years.
Corporate Values
As a member of the Priority Ambulance family, Maricopa Ambulance shares common values
that focus first on patients and clnical outcomes while valuing our team members who serve
on the front lines of care. Trust build with communities, first responders, healthcare facility
partners, patients and employees is at the heart of our mission.
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We build this trust through the daily delivery of services that are safe, accountable, friendly
and efficient. This simple foundation and the acronym S.A.F.E. represent the fundamental
behavioral principles that drive our commitment to delivering tailored ambulance solutions
that are professional, courteous, on time and to the highest standards of clinical care.
Priority Ambulance’s Corporate Support Team includes
the departments of compliance, information technology,
marketing and communications, risk and safety, finance
and human resources. These corporate teams enhance
the local operations by providing national expertise and
support to the local operations.
Our structure allows operational decisions to remain
local, close to the customer - while still retaining the
expertise and efficiencies that come with a national
ambulance company. These efficiencies are passed
along to our community partners in increased
purchasing power for medical supplies and equipment,
as well as cost savings from a more stable, sustainable
EMS system that will be reinvested in community
infrastructure.
Ethical Standards
Priority holds its management team to the highest standards of compliance and ethics. As an
organization, Priority operates a robust compliance program that covers the prevention of all
areas of fraud, abuse, malpractice and discrimination. We encourage all employees to report
violations of our Compliance and Ethics Policy to our Chief Compliance Officer and/or via our
confidential, anonymous employee hotline. All reporting is summarized and reported to our
board of directors.
850+ ambulances & support
vehicles nationally
~600K transports annually
3M+ citizens served under
current 9-1-1 contracts
Operating in 14 states
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EMS System Design
EMS system design is the underlying legal administrative structure and operational framework
that governs behaviors for any agency, resource or individual from whom action is required to
ensure a timely and medically appropriate response to a medical emergency.
A high-performance EMS (HPEMS) system is designed around the concept of balancing high-
quality patient care, an excellent workforce environment, provider engagement and fiscal
responsibility to convert available resources into a highly reliable ambulance service. System
Status Management (SSM) is the operations science and experiential art used by HPEMS
systems to achieve these key goals in the most effective and efficient way possible. This
concept uses predictive modeling for the determination of time-of-day and day-of-week
human behavior patterns that drive EMS demand for both the number of EMS calls per hour
and the geographic location of calls within a given service area.
SSM uses specialized custom deployment plans that are derived from predictive demand
models to determine how many ambulances are required and where these ambulances should
be located by time of day and day of week, with a unique plan for each hour of each day,
totaling 168 custom plans per week. These plans then are operationally executed using
sophisticated decision support technology to provide EMS services to the service area using
peak-load staffing schedules that match the number of staffed ambulances to the demand
patterns, as well as providing a geographic deployment plan that optimally positions available
ambulances for the next call based on geospatial demand patterns and geographic coverage.
The system is continuously optimized 24 hours a day, seven days a week on a minute-by-minute
basis as EMS calls for service are assigned to ambulances and as ambulances become available
from previous calls to ensure ambulance placement first matches anticipated demand
locations and then distributes ambulances for geographic low-probability call coverage areas,
while also allowing for EMS crew workload management balancing and rest periods.
While the practices involved in SSM are complex, the underlying objective is simple: Have the
appropriate number of ambulances located at the appropriate place and time they are
needed, which improves response time reliability and economic efficiency for our patients and
the communities we serve.
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System Status Management allows Maricopa Ambulance to accomplish three main goals:
1. Assure enough units are available and properly positioned to provide prompt response
times necessary for high-quality patient care.
2. Assure safety of operations for employees, patients and the public by establishing limits
for consecutive hours worked and by adopting workload management and fatigue
countermeasure practices.
3. Provide an ongoing forum for fine-tuning plans to address changes in the community
or ambulance demand patterns over time.
Please see Section 3 – System Planning and Deployment for details.
Commitment to Innovation
Telehealth Solutions Powered by OnDemand Visit
People trust the 9-1-1 system and are socially conditioned
to call whenever they need to immediately access the
healthcare system. It is understood that not every
emergency is a matter of life and death, sometimes the 9-1-
1 system is not always the optimal or efficient way to
manage low-acuity illnesses or injuries.
Meeting the challenge of health equity and access means
delivering a model of emergency medical care that provides the right solutions at the right
time and in the right place. The US Centers for Disease Control and Prevent reports that only
14.2% of patients who are treated at an emergency department require admission to the
hospital and that over 60 percent of patients transported by ambulance to hospital
emergency departments are never admitted. It also is proven that low-acuity patients can be
safely treated at home or at alternative care sites, such as urgent care centers or behavioral
health centers.
Designed for EMS systems and powered by the
proprietary telehealth technology of OnDemand
Visit, a subsidiary of Priority Ambulance, we can
provide the right solution for integrated EMS system
telehealth.
OnDemand Visit is the nexus between exigent demands and clinically effective/operationally
efficient healthcare services. It features an emergency medicine experienced, U.S.-based
physician lead provider panel that is available 24/7 which is accessed with the click of a
button on any first responders’ ePCR electronic tablets. Healthcare where and when you
need it. With this capable mobile model of medical care, patients get the right care at the
right time with the right resources.
1.3 Provide a list of specific sub-contractor(s), if any.
Maricopa Ambulance will not utilize subcontractors to perform services under this contract.
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1.4 Service Performance: The Contractor shall provide a detailed description of
their capabilities of meeting the following requirements:
1.4.1 Response Time Performance as specified under the section ”Response
Time Performance,” ”Reporting,” and ”Response Time Measurement.”
Across its footprint, half of Priority Ambulance’s more than 600,000 patients served
each year originate within 9-1-1 system designed by our companies across the
country. Maricopa Ambulance is the exclusive 9-1-1 ambulance service provider to the
City of Scottsdale and the City of Chandler, a back-up 9-1-1 provider in the City of
Surprise, and a 9-1-1 provider in Yavapai County. As detailed in the EMS experience
section, Maricopa Ambulance and all of its sister companies across the country have
never been out of compliance under any contract and have provided excellent
response time compliance – in some cases for decades.
We accomplish response time compliance through thorough, data-driven EMS system
design and continuous deployment plan optimization that allows us to constantly
review data and adjust deployment, staffing and posting based on a fluctuating
system. Advanced tools and expert data analysts ensure the Maricopa Ambulance
community will always receive the best care as quickly as possible.
Please refer to the Maricopa Ambulance system planning and deployment section for
details regarding our approach, methodology and statistical analysis to meet
response time standards in the City of Glendale.
1.4.2 Reporting as specified under the section ”Reporting.”
In every instance concerning the specificed Response Time criteria, the Contractor
shall submit a written report, at least monthly, in a format approved by the City, to the
EMS Deputy Chief, documenting the cause of each late response and efforts to
eliminate recurrence.
The Contractor shall furnish a written explanation for each Code 3 response that
exceeds eight (8) minutes fifty-nine (59) seconds and each Code 2 response that
exceeds fourteeen (14) minutes fifty-nine (59) seconds to the EMS Deputy Chief.
Maricopa Ambulance will work closely with the City and the Fire Department to
evaluate response time performance monthly, understanding that minimum
compliance is achieved. We will submit a written report in a format approved by the
City to document each late response and in an effort to eliminate recurrence.
Option A: When 95% or more of responses for Code 3 Calls and Code 2 Calls
combined meet the specified Response Time requirements. Maricopa Ambulance
agrees to conduct a three-month review/assessment should the combined Code 3
and/or Code 2 response time levels not be met in any month.
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Option B: When 90% or more of responses for Code 3 Calls and Code 2 Calls meet
the specified Response Time requirements under the current City of Glendale
Emergency Medical Services contract. Maricopa Ambulance agrees to conduct a
three-month review/assessment should the combined Code 3 and/or Code 2
response time levels not be met in any month.
1.4 3 Response Time Measurement as specified under the section
”Response Time Measurement.”
Maricopa Ambulance uses the ZOLL RescueNet suite of CAD software technologies to
monitor and produce reports on response time compliance. Maricopa Ambulance’s
RescueNet CAD will receive the same GPS and call data that is transmitted to the
Phoenix Fire Department Regional Dispatch Center through the Mobile Data
Terminals on all ambulances.
Maricopa Ambulance’s advanced vehicle locator (AVL) software is provided by the
Rescue Navigator. This system allows our dispatchers to view ambulance location and
status in real-time and ensures the dispatching of the closest available ambulance at
any given time. The GPS technology also allows the CAD system to timestamp from
when the ambulance is dispatched, begins moving toward the scene and when an
ambulance arrives on scene. The AVL system eliminates the need for radio
communication and provide a more accurate measurement of when the response to
the dispatched call.
ZOLL software creates detailed, easy-to-use reports that Maricopa Ambulance
management uses for quality improvement programs, clinical evaluation and
operational efficiency. The ZOLL system can create more than 200 standard reports
and can customize for any search criteria and specified period of time.
These reports can include:
Emergency life threatening and non-life-threatening response times by
jurisdiction and by user definition
Out-of-chute response times by crew members
On-scene times
Hospital drop times by crew members
Emergency and non-emergency responses by hour and day
Dispatch personnel response time reports
Canceled run report
Demand analysis report
Problem hour assessment
Call mode by hour and day
Ambulance alert exception report
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Maricopa Ambulance will provide regular reports to Glendale Fire Department
directly from the CAD on response time compliance.
1.4.4 Move-Up Policy as specified under the section ”Move-Up Policy.”
Contractor agrees to comply with all applicable provisions of the EMS System, the
Glendale Fire Department and PFDRDC regarding move-up policies. Contractor’s
plan for compliance with such policies will be submitted with its Proposal. Changes to
Contractor’s approved plan during the term of the Contract will require written
approval in advance from the Fire Chief
Maricopa Ambulance agrees to comply with all applicable provisions of the EMS
System, the Glendale Fire Department and PFDRC regarding move-up policies. The
Company understand that any changes to the approved plan during the contract term
require advance approval from the Fire Chief. Maricopa Ambulance will provide
monthly reports to the City of Glendale of its response time performance and will
also set up a direct data terminal with the Fire Department that will allow the Fire
Department to directly see performance and data from the PFDRDC.
Maricopa Ambulance has included its deployment plans (move-up plans) in this
proposal that will serve as the basis for a new contract agreement.
1.5 EQUIPMENT AND RESOURCES
The Contractor must provide detailed proof of ability to provide required
ambulances and a plan for the management of its equipment, materials and
supplies.
Since 2019, when Maricopa Ambulance first became the 9-1-1 ambulance service to the City
of Glendale, the Company has continuously and faithfully demonstrated its ability to provide
the required ambulances and a plan for the management of equipment, materials and
supplies.
MEDICAL EQUIPMENT & SUPPLIES
All Maricopa Ambulance medical equipment will be in good repair and safe working order
and is monitored and tracked to ensure optimal operation at all times. Maricopa Ambulance
follows manufacturer’s recommended maintenance schedules to ensure all medical
equipment is always in good working order. If we find deficiencies in any equipment, it is
immediately removed from the system and replaced.
As mentioned earlier in this proposal, every Maricopa Ambulance is equipped with the
following equipment and technology:
LifePak 15 Cardiac Monitors
Lucas 3 Automatic Chest Compression Devices
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Battery Powered Stryker Power Pro Cots
Performance Load Manual Cost Fastener
Stryker Stair Pro
Pedi Mate Pediatric Restraint System
Stryker Bariatric Stretcher and TranSafe Bariatric Ramp
BuckleGarde
As the incumbent provider, Maricopa Ambulance carries the required supplies aboard its
dedicated City of Glendale ambulances and will continue to do so. Please refer to Exhibit 5
of this proposal – Ambulance Equipment List – for a detailed list of all items.
Maricopa Ambulance will ensure each ambulance is fully stocked at all times with required
medical equipment and supplies to accommodate replacement during repair and for times
of excessive demand. Vehicle and station par levels are checked daily, and supply needs are
communicated to our equipment and supply logistics manager.
As our emergency partners, Maricopa Ambulance is committed to supplying and restocking
the Glendale Fire Department with supplies and medications at no cost to the department
and in the most efficient, convenient manner possible.
When supplies are used on the scene, Maricopa Ambulance will restock the fire department
unit one-for-one item on the scene. Additionally, Maricopa Ambulance will have ALS supplies
in locked safes on the ambulances and firefighter paramedics will use a code to access these
supply lockers at any time.
Maricopa Ambulance also will commit to placing specially configured, secure medical supply
vending machines at all fire stations and/or at the local hospital if desired. These vending
machines will allow the Glendale Fire Department to restock on a one-for-one basis without
delay. Maricopa Ambulance will check and restock the vending machines regularly to ensure
supplies are always current. All medications must be stored and received from the hospital
itself, and Maricopa Ambulance will keep a current supply of all medications dedicated for
the Glendale Fire Department’s use at the hospital.
Because Maricopa Ambulance is incurring the full cost of the medical supplies used in patient
care, it will include charges for consumable supplies and medications in fees to patients and
their medical insurance. This is an efficient way to maximize health care reimbursement and,
thereby, minimize cost to the City of Glendale.
Additionally, if requested, Maricopa Ambulance will provide regular resupply deliveries
directly to the fire stations. Maricopa Ambulance will always be responsive to its partners and
if a supply or medication is running low, we will immediately respond. Maricopa Ambulance
has a shift supervisor with a dedicated SUV quick response vehicle available during all shifts
to assist in resupply or provide additional assistance to field operations.
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1.6 KEY PERSONNNEL & RESUMES
1.6.1 Offerors shall submit an organizational chart that identifies key project
personnel by name, title, role for this project, and other individuals anticipated
roles in the project. Key personnel shall include, but not limited to, Chief Executive
Officer, Operations Manager, Communications Manager and Medical Director.
Maricopa Ambulance Organizational Chart
1.6.2 Offerors shall include relevant experience and expertise of key personnel for
the last two (2) years.
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BRYAN GIBSON
Chief Executive Officer – Priority OnDemand
Bryan Gibson has more than 30 years of service in the
emergency medical services industry. Gibson founded Priority
Ambulance in 2013 with a vision to set a higher national standard
of clinical excellence and care in emergency medical services.
Since that time, he has led the company through significant
growth. The Priority Ambulance family of companies provides
exclusive 9-1-1 emergency and nonemergency ambulance services in 14 states. In 2021,
Priority’s parent company name was changed to Priority OnDemand to reflect the addition of
innovative new healthcare and technology service lines, including telehealth services. Today,
the company employs more than 4,000 EMS and healthcare professionals.
Gibson began his career as a hospital-based paramedic in Corinth, Mississippi, and later
joined the in Memphis (Tenn.) Fire Department. In 1995, Bryan founded his first ambulance
company, Priority EMS, based in Memphis. He served as president and CEO of Priority EMS
and its 125 staff members and 45 ambulances. In 1997, Bryan sold his company to
Rural/Metro and joined its management team as Mid-South division general manager. Later
that year, he was promoted to oversee business development and was responsible for
operational productivity and profitability throughout the 10-state South Zone region.
From 2005 to 2010, Bryan served as group president of the South Region and then the
Southwest Region, overseeing operations and business development in both territories and
securing new contracts and renewals for key markets. In 2010, Bryan became chief operating
officer at Rural/Metro Corporation, overseeing all operating aspects of one of the largest
emergency services companies in the country. Gibson earned a bachelor’s degree in
business administration from Colorado Tech University.
STEVE BLACKBURN
Chief Operating Officer – Priority Ambulance
Steve Blackburn has more than 30 years of experience in the
emergency medical services industry and is considered an industry
expert in developing and implementing successful operational
strategies and designs. As Priority’s chief operating officer,
Blackburn oversees all regional leadership and operations and
focuses on strategic planning and implementation of infrastructure
improvements and systems to meet the demands of future
enterprise growth. He previously served as regional president of MidSouth and Northeast
regions for Priority.
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Prior to joining Priority at its founding in 2013, Blackburn worked for Rural/Metro Corporation
based in Scottsdale, Arizona. He began his tenure in Nashville, Tennessee, as division general
manager and was promoted to vice president of the company’s East Zone, overseeing six
EMS and fire protection divisions. He holds a master’s degree in business administration from
Franklin University and a bachelor’s degree in health education from Ohio State University.
ALAN SMITH
West Region President – Maricopa Ambulance
West Region President Alan Smith began in his career in EMS 35
years ago, devoting more than 20 years in the industry.
Smith has experience managing high-performing 9-1-1 EMS
systems, including experience in Richmond, Virginia’s EMS system
under Mercy Ambulance of Richmond. Smith also oversaw the
Memphis, Tennessee area for Rural/Metro Corporation as area
general manager once the company purchased Priority EMS.
Smith became an EMT in 1981 and quickly advanced as a paramedic, emergency dispatcher,
field training officer and quality improvement manager in Colorado and Missouri over the
next decade. He joined Priority EMS in 1996 as area general manager.
In 2000, Smith joined FedEx as marketing manager in Memphis and spent the next 16 years
with the organization, returning to the healthcare industry in 2016 as Senior Manager of
Marketing operations for ResMed Americas.
He holds a master’s degree in business administration from Christian Brother University in
Memphis.
MICHELLE ANGLE
Vice President of Operations
Michelle Angle has more than 22 years of experience in the
healthcare industry and serves as Maricopa Ambulance’s vice
president of operations. Prior to her current role, Angle was director
of marketing and business development for Maricopa Ambulance.
Angle began her ambulance career as vice president of marketing
and business development with a startup company, Tempe-based
StarWest Associates, in August 2001. While in this role, Angle
interfaced with local hospital systems, nursing facilities, nonprofits, community groups and
state and local elected officials. In 2003, she took the position of vice president of operations
and communications.
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Over the course of her ambulance career and through acquisitions, Angle also was employed
by Professional Medical Transport (PMT), Rural/Metro Corporation and American Medical
Response (AMR), in which she held the positions of vice president of community relations and
government affairs and as an independent consultant.
During her time with PMT, from 2004 to 2012, she played a vital role in the implementation
and operational management of various municipal high-performance EMS contracts. While
with Rural/Metro Corporation, representing Southwest Ambulance and PMT, Angle worked
closely with valley fire departments to ensure contract compliance, as well as maintain the
oversight of marketing and community relations. Working with local fire departments, Angle
promoted health and safety through educational public service announcements and annual
safety campaigns. Angle focuses on providing excellent customer service and service
delivery, which is directly attributed to her past and present industry successes.
JASON DUPONT, NRP
Director of Operations – Glendale and Scottsdale
Jason Dupont has more than 15 years of experience in EMS, joining
Maricopa Ambulance in 2021. Dupont’s experience includes a
variety of pre-hospital settings, including hospitals and working as a
paramedic technician in emergency departments.
Dupont’s experience includes 9-1-1 high performance systems,
interfacility and critical care transports in Illinois and Arizona. He oversees two key Maricopa
Ambulance municipal contracts: Glendale and Scottsdale.
LINDSEY PINGEL, NRP
Director of Operations – Goodyear, Chandler
Lindsey Pingel has more than 20 years of experience in the
healthcare field, with the last six years as a key member of the team
at Maricopa Ambulance.
Pingel joined Maricopa Ambulance as a paramedic and has risen
through the ranks to become Director of Operations for the
company’s EMS contracts in Goodyear and Chandler. She was
integral to the success of Maricopa Ambulance’s start-up and
implementation of ambulance services for the City of Chandler and managing the working
relationship with Chandler Fire Department.
She is currently pursuing a bachelor’s degree in emergency medical systems administration
and expects to graduate in 2024.
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MICHAEL NORTON, NRP
Director of Operations – Interfacility
Michael Norton has more than 20 years of experience in EMS, in
both Arizona and New Mexico. He joined Maricopa Ambulance six
years ago and oversees the Company’s interfacility medical
transport division, including critical care transports.
Norton was one of the first graduates of the Company’s paramedic
cohort program. He has a strong back ground in fire prevention and
investigations, in addition to his EMS experience. He has served as the IAFF-60 Executive
Board Vice President (2018). Norton is a long-time resident of the City of Glendale and is
currently pursuing a bachelor’s degree in fire science and ambulance operations.
JAMIE PATTERSON
Director of Communications
Jamie Patterson joined Maricopa Ambulance in 2019, bringing
more than 15 years’ experience in communication center
operations and management in Arizona.
Jamie directs all communications and dispatch functions, including
system status management deployment and related strategies, as
well as efficient 9-1-1 response management for municipal, hospital
and healthcare facility customers. Her role also includes oversight of
regulatory performance reporting to the Arizona State Bureau of
Emergency Medical Services & Trauma System.
Prior to joining Maricopa Ambulance, Jamie served for more than 10 years as
communications manager for American Medical Response in Tucson, AZ.
Jamie is a licensed emergency medical technician and holds numerous Federal Emergency
Management Agency incident command certifications. She is also an ED-Q certified member
of the International Association of Emergency Medical Dispatchers.
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ADAM LIZARDI
Support Services Manager
Adam Lizardi has more than 29 years of experience in EMS,
primarily in the West Valley. He joined Maricopa Ambulance in
2020 to develop and implement the Company’s support services
division.
Lizardi oversees the inventory and distribution of medical supplies
for all Maricopa Ambulance operations in Arizona and for its sister
company Frontier Ambulance in Wyoming.
Lizardi is past president of IAFF-60 and has served multiple positions on the Executive Board.
RICARDO “RIC” ROJAS
Fleet Manager
Ric Rojas is a career fleet professional, with more than 15 years of
experience in fleet management, fleet maintenance, fleet
operations, and fleet life-cycle management.
Rojas oversees all fleet maintenance and repairs for Maricopa
Ambulance end works to ensure vehicles are always functioning the
highest possible levels. Proactive fleet maintenance also ensures the safety of crew members.
Prior to joining Maricopa Ambulance, Rojas was responsible for a fleet of more than 400
vehicles and 25 mechanics.
1.6.3 All resumes shall be limited to one (1) page and include a brief summary of
past accomplishments, academic credentials, professional certifications,
professional memberships, etc.
Please refer to Exhibit 2 – Key Personnel Resumes – for one-page resumes for Mariciopa
Ambulance key personnel.
1.6.4 Title of Contact Person: Reporting Relationship of Person and Limits of
Authority.
Maricopa Ambulance Contact Person: Michelle Angle, Vice President of Operations is
responsible for the oversight and management day-to-day operational performance for
Maricopa Ambulance and all of the company’s 9-1-1 and interfacility ambulance contracts in
Maricopa County. Mrs. Angle is fully authorized to make all operational decisions on behalf of
Maricopa Ambulance.
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1.7 Contractor shall describe in detail its training plan for assuring the training of
its EMT-B, EMT-P, other personnel, and its drivers of ambulances as required by all
agencies having authority in such matters, including the City, and assure continued
compliance with all permits, licenses and certification requirements.
As detailed in section 1.1, Maricopa Ambulance is committed to assuring the quality and
regularity of training of all EMT-B, EMT-P, other personnel and drivers. Maricopa Ambulance
provides all such training as required by local, city, county and state regulations and tracks all
permits, licenses and certifications in its automated ePRO system.
All Maricopa Ambulance personnel are currently and appropriately licensed and/or
credentialed with records housed in our ePRO system, which also serves as our training hub.
ePRO sends notifications to employees about upcoming renewal deadlines and makes it easy
to update employee records with new certifications by uploading a photo of the certificate
into the system.
If an employee fails to update any certification or a license has expired, the ePro system will
lock out the employee. The employee will be unable to clock in for a shift, thereby providing
an additional layer of protection.
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SECTION 2. FINANCIALS AND REFERENCES
2.1 Provide record and data that set forth the financial history of the Proposer. All
financial information should be reported for the legal entity submitting and
responsible for the Proposal and providing ambulance transportation Services. The
same legal entity must be the legal entity responsible for the proposal, responsible
for the financial information and responsible for providing the ambulance
transportation services. If the entity is a multi-site entity or subsidiary entity, it may
report consolidated financial information if the multi-site entity or subsidiary entity
or parent entity is not a Proposer. If reporting consolidated financial information, a
letter guaranteeing the Proposer’s performance with the full faith and credit of the
parent or affiliated organization(s) must be included with the Proposer’s financial
data.
Please see the following page for our letter guaranteeing Maricopa Ambulance’s
performance with the full faith and credit of its parent company, Priority OnDemand:
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2.2 Provide detailed sources of sufficient capital to provide for the implementation
and start-up of the services.
In July 2022, Maricopa Ambulance, a subsidiary of Priority Ambulance, joined the
Consonance Capital Partners portfolio of national health-care companies, a well-capitalized
strategic investment firm that focuses exclusively on the longer-term success of companies in
the health-care sector. The firm is currently investing out of Consonance Private Equity II, L.P.,
an $856 million fund and have more than $1.3 billion of capital under management.
Consonance prides itself on partnering with world-class management teams to build and
grow transformative and market leading health-care companies. In addition to its partnership
with Priority OnDemand, Consonance has partnered with management teams and founders
across 12 companies creating seven platform enterprises. With the support, expertise and
multi-faceted health-care experience of the Consonance team, Priority will continue to invest
in our core ambulance services foundation and grow our newest platforms: patient logistics
technology and telehealth. Priority Ambulance, parent of Maricopa Ambulance, will fund all
capital required for the implementation and start-up of services through a combination of
Balance Sheet cash, excess existing revolver capacity and existing term loan capacity.
2.3 Provide financial reserves and/or net worth sufficient to sustain the operation
of the services.
Maricopa Ambulance’s parent company, Priority Ambulance, has 2022 audited net worth
calculated as Total Assets less Total Liabilities of $109.1 million at Dec. 31, 2022. Liquid
assets calculated as Current Assets less Current Liabilities was $28.7 million at Dec. 31, 2022.
2.4 Provide details of any event or circumstance or reasonably anticipated event or
circumstance that may have a material bearing on the financial condition, solvency,
or credit worthiness of the Proposer. This should include, but is not limited to, the
disclosure ofo any material contingent liabilities or uninsured material contingent
liabilities, reasonably anticipated losses, voluntary or involuntary bankruptcy filings,
involuntary ambulance services contract terminations in other jurisdictions
nationwide, pending contracts or porposals in other jurisdictions nationwide.
Maricopa Ambulance has no outstanding issues that may have financial bearing on the
financial condition, solvency or credit worthiness of the organization.
2.5 If the Proposer or any parent/affiliate(s) is publicly traded, provide a copy of
the most recent annual report and SEC forms 10-(K) and 10-(Q). These must include
financial statements for at least the most recent two (2) year period.
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Maricopa Ambulance and its parent company, Priority Ambulance, LLC, are not publicly
traded entities.
2.6 If the Proposer is not publicly traded, provide copies of independently audited
financial statements (conducted in accordance with applicable independent audit
standards) for the last two (2) years are required (if a Proposer has not been in
operation for two (2) years, the required information should be provided for the
shorter period of time the Proposer has been in operation). Should independently
audited statements not be available, the Proposer shall submit financial statements
together with notarized attestations of accuracy (satisfactory in substance to the
City) signed by the Chief Financial Officer and Chief Executive Officer of the
Proposer (as well as owners having a greater than ten percent (10%) interest in
such Proposer). Current interim financial statements, prepared by a certified public
accountant (which may be unaudited) must also be provided. Audited financial
statements are preferred.
Please refer to Addendum 3 – 2021 and 2022 Annual Report and Consolidated Financial
Statements for Priority OnDemand, parent company of Priority Ambulance, LLC and
Maricopa Ambulance, LLC.
2.7 Provide detailed processes applicable to billing federal and state programs
and other Payor programs to ensure required billing, documentation, and
compliance. Proposer should identify its guidlines and implementation processes
and procedures. Proposer’s compliance reporting and resolution of compliance
issues should be set forth, together with the qualifications and experience of the
Proposer’s compliance officer(s).
Maricopa Ambulance’s patient billing is conducted at Priority Ambulance’s national billing
office in Indianapolis, Indiana. This national billing office processes the billing and collections
for all Priority Ambulance-owned subsidiaries in the corporation’s 14-state service area.
Maricopa Ambulance organizes its billing function into two phases. The first is managed
locally and is based in Arizona. The second is managed centrally at Priority’s national billing
service center in Indiana.
The first phase we refer to as document quality assurance or “DQA”. The local billing team
reviews the ePCR and other records to ensure the most accurate and complete information
prior to submission to the billing service center. The Maricopa Ambulance DQA team will
also manage any special event or unique local billing arrangements The second phase is the
actual filling of claims and billing to patients, as applicable and appropriate.
As an organization, Priority operates a robust compliance program that covers the prevention
of all areas of fraud, abuse, malpractice and discrimination. We encourage all employees to
report violations of our Compliance and Ethics Policy to our Chief Compliance Officer and/or
via our confidential, anonymous employee hotline. All reporting is summarized and reported
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to our board of directors.
Our billing center managers are Certified Ambulance Compliance Officers (CACO), and our
billing managers and supervisors (as well as several of our billing personnel) are Certified
Ambulance Coders (CAC) through the National Academy of Ambulance Coders. Our
national billing center processes more than 600,000 claims per year to Medicare, Medicaid,
private insurance and other payors with nearly one-half being emergency transports.
Contractor Billing and Collection for Fire Department EMT-P
Services
Maricopa Ambulance will continue to charge fees for its services to Firefighter EMT-Ps as
appropriate and permitted, and in accordance with charges established by the Arizona
Department of Health Services and each Payer. Maricopa Ambulance will remain responsible
for paying the Fire Department for the Services of Fire Department’s employees providing
services in accordance with the provisions set forth in the Arizona Ground Ambulance Rate
Schedule.
Regulatory Compliance
The goal of the Maricopa Ambulance Compliance Plan is to ensure that we adhere to all
applicable Medicare, Medicaid and any other federally funded health care (for ease of
reference, collectively referred to as “Medicare”) laws, rules and policies relating to the
submission of claims for ambulance services. This includes, among other things, to ensure
proper documentation of services, billing, coding and claims submission, as well as the
prevention, prompt detection and appropriate action steps for health care fraud and abuse.
Other purposes of the plan are to:
Outline and emphasize the organizational commitment to accurate and lawful
documentation and submission of all claims for ambulance service to Medicare and
other third-party payors.
Promote the prevention, detection and resolution of instances of conduct that is not in
conformance with applicable federal or state laws, rules and regulations.
Minimize, through early detection and reporting, any potential loss to the government
from erroneous claims, as well as reduce Maricopa Ambulance’s potential exposure to
damages and civil and criminal penalties that might result from questionable activities.
Maricopa Ambulance/Priority Ambulance’s compliance officer should be contacted when
questions about compliance arise or to report potential violations or any concerns regarding
compliance. To the fullest extent possible, all communication to the compliance officer will
be treated confidentially. We also encourage the voluntary reporting of potential compliance
issues. To this end and to encourage an open atmosphere of support for the Compliance
Plan, there will be no adverse action or retaliation against any person who makes a good faith
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report of a compliance concern. Reports can be made to the Maricopa Ambulance/Priority
Ambulance compliance officer anonymously whenever possible.
Please see below for qualifications and experience of Maricopa Ambulance’s/Priority
Ambulance’s Chief Compliance Officer:
DIAHAN UNDERWOOD
Chief Nursing/Compliance Officer – Priority Ambulance
Diahan Underwood interfaces with local medical
directors on clinical programs and oversees compliance
programs. Underwood is a Certified Ambulance
Compliance Officer (CACO) through the National
Academy of Ambulance Compliance.
Underwood has more than 20 years of experience in EMS and critical care
nursing. Prior to joining Priority, Underwood worked at Central EMS in Georgia,
as director of nursing and critical care services and chief flight nurse for Central
Air Ambulance from 2010 to 2017.
Underwood is a member of the American Association of Critical Care Nurses
Foundation and serves on the Georgia State Medical Assessment Team
Advisory Board Foundation and serves on the Georgia State Medical
Assessment Team Advisory Board.
2.8 REFERENCES: Firms shall include a brief background on all existing municipal
ambulance service accounts in the State of Arizona and nationwide. Information
shall include the name of the account, contact person, phone number, and length of
time servicing the account.
Maricopa Ambulance was founded in 2016 with a leadership team that has extensive
experience successfully designing EMS systems, overseeing operations and working with first
responder agencies in Maricopa County and the City of Glendale. Maricopa Ambulance is
the incumbent 9-1-1 provider for the City of Glendale, as well as the current provider for the
City of Scottsdale, City of Chandler and City of Surprise (9-1-1 backup), responding
collectively to more than 46,000 emergency 9-1-1 calls annually. Maricopa Ambulance’s sister
company, Priority Ambulance of Arizona, also provides 9-1-1 responses in Yavapai County
under the company’s Certificate of Necessity for that county granted in 2022.
In 2016, Priority entered Maricopa County and the Phoenix-area market – the fourth-largest
county in the country – after being granted a certificate of necessity to provide a choice in a
market that previously had been a monopoly. The operation was branded Maricopa
Ambulance to reflect the expansive county, which covers more than 9,000 square miles of
urban, suburban, rural and desert land with a population of 4.6 million.
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Over the next six years, Maricopa Ambulance built additional customized response models
with its fire department partners, including supplemental response to fire department
ambulance services and fully shared staffing.
City of Scottsdale
In 2018, Maricopa Ambulance began serving as the exclusive 9-1-1 EMS provider with
Scottsdale Fire Department, a deeply integrated public-private partnership model where
firefighter-paramedics ride in on BLS ambulances, allowing for ALS response capabilities.
Maricopa Ambulance dedicated 14 ambulances to the Scottsdale 9-1-1 EMS system, with
ambulances staffed by two EMTs. Scottsdale Fire Department paramedics ride along in the
ambulances to provide advanced life support (ALS) levels of care.
Maricopa Ambulance’s contract with the City of Scottsdale was renewed in 2021 for an
additional three years, with Scottsdale Fire Chief Tom Shannon saying: “Maricopa Ambulance
has met our expectations and together we have built a true partnership starting with
collaborative leadership and extending to the firefighters, EMTs and paramedics in the field.
The Scottsdale EMS system delivers consistently excellent and responsive care, and we look
forward to continuing that relationship in the future.”
City of Glendale
In 2019, Maricopa Ambulance was selected as the 9-1-1 EMS provider to the City of Glendale
in partnership with the Glendale Fire Department. Maricopa Ambulance provided 13 new
ambulances to the Glendale EMS system, as well as ALS-equipped quick response vehicles
for paramedic supervisors, Lucas automated chest compression devices.
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Since that time, Maricopa Amblance has responded to more than 25,825 calls for 9-1-1
service in the City of Glendale and transported more than 18,828 patients.
City of Chandler
In early 2021, the City of Chandler selected Maricopa Ambulance as its 9-1-1 ambulance
service partner followign a competitive bidding process. The four-year contract began
January 2022, with 10 new co-branded ambulances dedicated to the contract.
In Chandler, Maricopa Ambulance staffs seven ambulances during day-time hours with one
EMT, and the Chandler Fire Department provides one firefighter-paramedic to deliver ALS
services. Each ambulance is specially configured to house firefighter turnout gear and
extrication equipment, providing maximum flexibiity during responses to any type of
emergency.
Yavapai County
In June 2022, the Arizona Department Health Services granted a Certificate of Necessity to
Priority Ambulance of Arizona to provide emergency and nonemergency ground ambulance
service to the majority of Yavapai County and portions of Coconino and Maricopa counties.
Priority Ambulance of Arizona responds to 9-1-1 calls in conjunction with Central Arizona Fire
& Medical Authority, as well as provides nonemergency medical transportation services to
healthcare facilities in the region.
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Please see the following for details and contacts for Maricopa Ambulance’s Arizona, municipal
and county 911 service areas:
Contract:
City of Scottsdale, Arizona
Community Makeup: 258,069 – Urban/Suburban/Rural
Service Period:
2018-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response –
BLS (Fire Department provides ride-
along ALS)
Contact:
Tom Shannon, Fire
Chief 480-312-8000
tshannon@scottsdaleaz.gov
Contract:
City of Glendale, Arizona
Community Makeup: 252,381 – Urban/Suburban/Rural
Service Period:
2019-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response
Contact:
Ryan Freeburg, Fire Chief
623-930-4400
rfreeburg@glendaleaz.com
Contract:
City of Chandler, Arizona
Community Makeup: 257,076 – Suburban/Rural
Service Period:
2022-present
Type & Level of
Service:
9-1-1 Ambulance Response – Shared
staffing model with fire department
paramedics
Contact:
Tom Dwiggins, Fire Chief
480-782-2120
Tom.dwiggins@chandleraz.gov
Contract:
City of Goodyear, Arizona (previous contract ended February 2023)
Community Makeup: 85,840 – Suburban/Rural
Service Period:
2019-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response
Contact:
Paul Luizzi, Fire Chief
623-882-7109
paul.luizzi@goodyearaz.gov
Additionally, the Company provides the following information for 9-1-1 contract references
across the nation:
Contract:
Cobb County, Georgia (South Zone)
Community Makeup:
350,000 – Urban/Suburban
Service Period:
2001-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response &
Interfacility Service
Contract
Administrator:
Nick Adams Deputy Chief of EMS
770-528-8304
nick.adams@cobbcounty.org
Contract:
Baptist Memorial Health Care (10 9-1-1 contracts in Tennessee, Mississippi & Arkansas)
Community Makeup:
TOTAL: 327,892
Tipton County, TN; Lafayette County,
MS; Crittenden County, AR; Obion
County, TN; Carroll County, TN;
Prentiss County, MS; Union County, MS;
Attala County,
MS; Chickasaw County, MS; Calhoun
Service Period:
2017-present
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County, MS
Type & Level of
Service:
Primary 9-1-1 Ambulance Response –
ALS & Interfacility Service
Contract
Administrator:
Derick Ziegler, SVP
derick.ziegler@bmhcc.org
(901) 227-5197
Contract:
Loudon County, Tennessee
Community Makeup
54,058 – Suburban/Rural
Service Period:
2015-present
Type & Level of Service:
Primary 9-1-1 Ambulance Response –
ALS
Contact:
Don White
Public Safety Director (865)
986-2715
dwhite@lenoircitytn.gov
Contract:
Forsyth County, Georgia
Community Makeup:
244,252 -
Urban/Suburban/Rural
Service Period:
2016-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
Barry Head, Fire Chief
770-781-2180
bghead@forsythco.com
Contract:
Anderson County, South Carolina
Community Makeup:
202,558 – Suburban/Rural
Service Period:
1982-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response -
ALS
Contact:
Don McCown, Asst. EMS Director
(864) 260-4057
dmccown@andersoncountysc.gov
Contract:
Athens-Clarke County, Georgia
Community Makeup:
126,913 – Suburban/Rural
Service Period:
2008-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response –
ALS
Contact:
Jeff Scarbrough, Fire Chief
Jeferry.Scarborough@accg
ov.com
706-613-3360
Contract:
Newton County, GA
Community Makeup:
111,744 - Suburban/Rural
Service Period:
2021-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response –
ALS
Contact:
Bill Love, COO, Piedmont Newton
William.Love@piedmont.org
(770) 786-7053
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Contract:
Rockdale County, Georgia
Community Makeup:
90,896 – Suburban/Rural
Service Period:
1983-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
Dan Morgan, Director of
Emergency Management
Dan.Morgan@rockdalecountyga.g
ov
770-278-8401
Contract:
City of Greenwood, Indiana
Community Makeup
59,458 – Suburban
Service Period:
2016-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response -
ALS
Contact:
Darin Hoggatt, Fire Chief
317-882-2599
hoggattd@greenwood.in.gov
Contract:
Franklin County, Tennessee
Community Makeup
42,208 – Suburban/Rural
Service Period:
2019-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
Chris Guess, County Mayor
931-967-2905
cguess@franklincotn.us
Contract:
Oconee County, Georgia
Community Makeup:
40,280 – Suburban/Rural
Service Period:
2008-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response –
ALS
Contact:
Dee Burkett, VP
Piedmont Athens Regional
Dee.Burkett@piedmont.org
706-278-8401
Contract:
Fremont County, WY
Community Makeup:
39,234 - Rural
Service Period:
2021-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response –
ALS
Contact:
Larry Allen, County Commissioner
larry.allen@fremontcountywy.gov
307-876-2696
Contract:
Marion County, Tennessee
Community Makeup:
28,907 – Rural
Service Period:
2012-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
David Jackson, Mayor
423-942-2552
djackson@marioncountytn.net
Contract:
City of Bessemer, Alabama
Community Makeup
26,472 – Suburban
Service Period:
2015-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
Randall McFarland, Fire Chief
(205) 915-6899
rmcfarland@bessemeral.org
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Contract:
City of Franklin, Indiana
Community Makeup
25,608 – Suburban/Rural
Service Period:
2009-present
Type & Level of
Service:
Primary 9-1-1 Ambulance Response –
ALS
Contact:
Dan McElyea, Fire Chief
317-736-3650
dmcelyea@franklin.in.gov
Contract:
Morgan County, Georgia
Community Makeup:
19,276 – Suburban/Rural
Service Period:
1988-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
Adam Mestres, County Manager
706-342-0725
amestres@morgancountyga.gov
Contract:
Tipton County, Indiana
Community Makeup
15,148 – Suburban
Service Period:
2010-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
Jeff Ogden, Fire Chief
(765) 675-4633
firechief@tipton.in.gov
Contract:
Sequatchie County, Tennessee
Community Makeup:
15,026 – Rural
Service Period:
2014-present
Type & Level of
Service:
Primary 9-1-1 Ambulance
Response – ALS
Contact:
Keith Cartwright, Mayor
423-322-5492
seqexec@bledsoe.net
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SECTION 3. CAPABILITIES AND METHODS OF OPERATIONS
3. PROVIDE A THOROUGH DESCRIPTION OF ALL CAPABILITIES AND METHODS
IN THE FOLLOWING AREAS OF OPERATIONS:
3. a. System planning and deployment capabilities and methods.
System Planning and Deployment
A data-driven approach to design an EMS system is critical to ensuring that Maricopa
Ambulance is maximizing its resources to provide the best possible emergency coverage to
the City.
Maricopa Ambulance has the expertise, knowledge of system status management and
experience as the current provider in the City of Glendale to design the best EMS system
possible. In partnership with our executive leadership team, which are recognized experts in
SSM and EMS system design, world-renowned SSM consultant Jonathan Washko assisted in
the analysis and development of this deployment plan based on data made available by the
City of Glendale.
Deployment planning is a continuously ongoing process. As the community shifts and
changes with time and seasonal changes, the ambulance posting and resource plan is ever-
evolving to meet call demand and to ensure that response time requirements are always met.
Maricopa Ambulance will review data on an ongoing basis and will work with the Glendale
Fire Department to adjust the posting plan as needed to best meet the system’s needs.
The use of system status management allows us to ensure we will perform to responses to
first priority calls in the required time frame. Continuous deployment planning allows us to
adjust as the community changes and grows to always meet the needs of the community.
As discussed earlier in this proposal, Maricopa Ambulance is presenting options for system
and deployment planning that take into consideration a 95% combined response time
performance threshold (as clarified in RFP Addendum 2 and the City’s response to Question
8) and the 90% response time performance threshold contained in the current ambulance
services contract.
Option A: Meets or exceeds most specifications of the RFP, including the 95% response time
threshold, with compliance determined by a combined Code 3 and Code 2
standard. Option A increases the number of peak ambulances to 12, with the attendant
increase in costs. The increase in the number of ambuances to meet the 95% response time
performance shall be subject to AZDHS approval and a General Rate Increase in excess of the
automatic rate increases proscribed in ARS 36-2234 E sufficient to cover the increased cost of
captial and resources sufficient to maintain the required level of preparedness.
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Option B: Meets all requirements under the current City of Glendale emergency medical
services contract, including current response time requirements. Option B maintains the
current AZDHS approved rates and charges. Option B includes the initial purchase and
placement of specifically configured medical supply vending machines, in order to more
accurately track replacement medical suppies, in all Glendale Fire stations at no cost to the
City within one year of the contract being approved by AZDHS.
In the following pages, Maricopa Ambulance will explain its approach to the development of
its deployment plan and provide statistical evidence that the plan will be effective in
providing excellent service to the people of Glendale. Additionally, Maricopa Ambulance will
further detail its continuous analysis and deployment optimization process to further
customize our service to the communities we serve.
Methodology
Reliability in meeting response time
performance outcomes is a function of
many variables. These include unit
availability, proprietary EMS agency
deployment practices and technologies,
optimized operational processes,
understanding network impedance
(road speed / traffic impact) and travel
distance. Additionally, response time
performance requires an understanding
of the local topography, geography,
road network density and finally EMS
geospatial demand patterns to ensure
successful, reliable and safe responses
to the community’s EMS needs.
Maricopa Ambulance is leveraging its experience in high-performance EMS system design
and deployment planning to provide a proposed deployment plan, combined with a
continuous plan optimization process, to ensure response time performance continuously
exceeds the RFP requirements and is a testament to our commitment to the community.
Our due diligence in the development of our deployment plan includes an expert
assessment of the community, development of proposed station locations based on an
analysis of drive time capability, the use of GIS mapping technology to test initial geographic
posting locations, a road network assessment to confirm road impedance values, an initial
deployment plan which prioritizes our resources deployment based on geographic coverage
and a proposed customized methodology for continuous deployment plan optimization as
the system gathers data and then learns from this data.
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Understanding Deployment Needs Through Data
Data driven deployment planning is a vital piece in the response time equation.
Understanding various patterns within the community’s EMS data informs a sophisticated
EMS provider with the information necessary to proactively develop methods and plans to
ensure that the right number of ambulances, are available in the right place and at the right
time. By doing this, an EMS provider can achieve efficient and effective response times that
are safe, reliable, affordable and are employee friendly.
As part of our analytics package, Maricopa Ambulance looks at many different variables in
order to shape our deployment plans to the communities we serve. These include
understanding the EMS system’s call volume, seasonality, geo-spatial demands, geo-
temporal demands, temporal demands and temporal consumption of EMS resources.
With this information in hand, we are then able to build coverage plans and schedules that
minimally meets the standards of the RFP but ultimately exceed the expectations of the
community we serve.
Geotemporal / Geospatial Demand
Our geotemporal and geospatial demand assessment reveals how EMS demand for service
changes over day and time. In the examples below, we compare and contrast EMS demands
for different hours of the day and different days of the week to highlight the changes that can
happen as the human behavior patterns that drive population movement within a community
ebb and flow over time, thus driving the need for EMS resources to be at different locations
at different times.
The daily demand analysis charts on the following pages show three-year historical demand
and consumption in the Glendale EMS system through Dec. 31, 2022 at 95% as well as 90%
response times.
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95% Response Times (Option A)
Significantly more unit hours and two additional ambulances are added to the deployment
plan under the 95% combined coverage Option A.
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90% Response Time Coverage with New Stations & Posts (Option B)
Maricopa Ambulance identified an opportunity through this proccess to review historic
demand patterns and to develop a schedule that will result in improved coverage.
Additionally, new station locations also improve the ablity to meet response time standards.
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Drive-Time Maps
Maricopa Ambulance has determined through its drive-time and station location analysis that
new station locations and one additional crew station can significantly improve deployment
and response times.
For example, the following map illustrates that at Level 2 (when there are two ambulances
available in the City), the ambulances would be assigned to stations GL2 (N. 67th Ave. & W.
Glendale Ave.) and GL3 (59th Ave. & W. Thunderbird Road). From those locations, the drive-
time map demonstrates that the ambulances will arrive on-scene to 97% of the three-year
historical calls for service within 7 ½ minutes of drive time.
In Exhibit 7, we include a specific drive-time analysis map for each level on the System Status
Plan, as well as for each station location.
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Temporal Demand and Temporal Consumption
As part of our deployment planning, we analyze the temporal demand (Average Peak
Demand) and temporal consumption (Average Peak Demand C) of the service area to ensure
that the number of resources to meet demand is optimized. In this analysis, we are able to
use predictive modeling to determine the likelihood of the number of EMS calls during a
given hour of a given day. Additionally, we are also able to predict the amount of time
consumed performing this work, so that calls that can take longer to complete (such as those
that originate in the far outreaches of the service area that have longer transport times to the
hospital) can be included in our resource calculations.
Initial Deployment Plan
Based on the above-mentioned analytics and approach, our initial deployment plan includes
three elements: A Unit Hour Coverage Plan (UHCP), a list of proposed station and street
corner posting locations and a Geographic Deployment Plan (or System Status Plan) that
provides a prioritized list of stations and posts to be covered as hours, days and system levels
change to continuously optimize our resources and minimize response times to the patients
we serve.
Option A: Unit Hour Coverage Plan (UHCP):
Our initial UHCP includes a combination of 24-hour and 12 hour-shifts producing a total of
1500 Unit Hours per week. The proposed coverage plan was developed using our
proprietary approach to predictive modeling that ensures we have the right number of
ambulances available for each hour of the day and each day of the week combined with our
assessment of the geographic coverage needs, seasonality and consumption expectations of
the system.
The following table represents Maricopa Ambulance’s initial UHCP by hour of day and day of
week.
Option A Maricopa Ambulance station locations relative to City of Glendale Fire Department
stations are shown in the following map:
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Option B: Unit Hour Coverage Plan (UHCP)
Our initial UHCP includes a combination of 24-hour and 12 hour-shifts producing a total of
1184 Unit Hours per week. The proposed coverage plan was developed using our
proprietary approach to predictive modeling that ensures we have the right number of
ambulances available for each hour of the day and each day of the week combined with our
assessment of the geographic coverage needs, seasonality and consumption expectations of
the system.
The following table represents initial UHCP by hour of day and day of week.
Option B Maricopa Ambulance station locations relative to City of Glendale Fire Department
stations are shown in the following map:
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Posting Locations and Type:
The following station and posting locations are in close proximity to the existing fire station
infrastructure or in areas where additional geographic coverage is anticipated for both
Option A and Option B.
Option A:
Maricopa Ambulance will operate a total of eight stations within the City of Glendale,
including one Glendale headquarters that will also include a satellite fleet maintenance
department. Each station will include crew living quarters, kitchen and bathroom facilities to
house at least two crew members.
Proposed Station & Post Locations:
Name
Address
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Station 150
8345 W. Glendale Ave.
Station 151
N. 67th Ave. & Bethany Home Road
Station 152
5134-5140 W. Peoria Ave.
Station 153
N. 67th Ave. & W. Union Hills Drive
Station 154
N. 59th Ave. & Northern Ave.
GL 2
N 67th Ave. & Glendale Ave.
GL 3
59th Ave. & W. Thunderbird Road
GL 4
83rd Ave. & Bethany Home Road
H (St. Joseph’s Westgate Medical Center)
7300 N 99th Ave.
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Option B:
Maricopa Ambulance will operate a total of eight stations within the City of Glendale,
including one Glendale headquarters that will also include a satellite fleet maintenance
department. Each station will include crew living quarters, kitchen and bathroom facilities to
house at least two crew members.
Station & Post Locations:
Name
Address
Station 150
8345 W. Glendale Ave.
Station 151
N. 67th Ave. & Bethany Home Road
Station 152
5134-5140 W. Peoria Ave.
Station 153
N. 67th Ave. & W. Union Hills Drive
Station 154
N. 59th Ave. & Northern Ave.
GL 2
N 67th Ave. & Glendale Ave.
GL 3
59th Ave. & W. Thunderbird Road
GL 4
83rd Ave. & Bethany Home Road
H (St. Joseph’s Westgate Medical Center)
7300 N 99th Ave.
Option A Deployment Plan
Location
12
11
10
9
8
7
6
5
4
3a* 3b
3c
2
1
H (St Joseph's Westgate)
1
1
GL2
1
1
GL3
1
1
1
1
Station 150 / GL4**
1
1
1
1
1
1
1
1
1
1
1
1
Station 151
2
2
2
2
2
2
2
1
Station 152
2
2
2
2
2
1
1
1
1
1
Station 153
2
2
2
2
1
1
1
1
1
1
1
1
Station 154
2
2
2
2
2
2
1
1
1
1
1
1
Unit Level 12
11
10
9
8
7
6
5
4
3a* 3b
3c
2
1
Grid displays number of units to be stationed or posted at the Location
*Level 3 can be equivalently covered as noted in 3a or 3b or 3c
**GL4 is an alternate post at levels 3 and above for Station 150 during AZ Cardinal Home game & 2 hours post-game
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Post and Station Coverage:
For both Option A and Option B, Maricopa Ambulance will adjust resources geographically
within the system based on call demand to statistically provide for the best response times
possible. Please see below for a priority posting matrix that shows the ambulance posting
plans at each system level. System levels correspond to the number of ambulances in the
system at any given time.
Option A:
Option B Deployment Plan
Location
10
9
8
7
6
5
4
3a* 3b
3c
2
1
GL2
1
GL3
1
1
Station 150 / GL4**
1
1
1
1
1
1
1
1
1
1
Station 151
2
2
2
2
2
1
Station 152
2
2
2
1
1
1
1
1
Station 153
2
2
1
1
1
1
1
1
1
1
Station 154
2
2
2
2
1
1
1
1
1
1
Unit Level 10
9
8
7
6
5
4
3a* 3b
3c
2
1
Grid displays number of units to be stationed or posted at the Location
*Level 3 can be equivalently covered as noted in 3a or 3b or 3c
**GL4 is an alternate post at levels 3 and above for Station 150 during AZ Cardinal Home game & 2 hours post-game
Option A Deployment Plan
Location
12
11
10
9
8
7
6
5
4
3a*
3b
2
1
H (St Joseph's Westgate)
1
1
GL2
1
1
GL3
1
1
1
1
Station 150 / GL4**
1
1
1
1
1
1
1
1
1
1
1
Station 151
2
2
2
2
2
2
2
1
Station 152
2
2
2
2
2
1
1
1
1
1
Station 153
2
2
2
2
1
1
1
1
1
1
1
Station 154
2
2
2
2
2
2
1
1
1
1
1
Unit Level
12
11
10
9
8
7
6
5
4
3a*
3b
2
1
Percent of historic calls reachable within 7.5 mins †
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.4%
97.2%
77.4%
Grid displays number of units to be stationed or posted at the Location
* Level 3 can be equivalently covered as noted in 3a or 3b or 3c
**GL4 is an alternate post at levels 3 and above for Station 150 when there is a AZ Cardinal Home game, and 2 hours post-game
† Measures calls by latitude & longitude can be reached from the station or group of stations divided by all the calls in the last 3 years within the Primary Service Area
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Option B:
Continuous Deployment Plan Optimization Framework
Our Continuous Deployment Plan Optimization Frameworks includes the collecting of
operational data to help set a foundation for future temporal and geo-temporal predictive
modeling. This approach enables us to fine-tune our initial UHCP and GDP to ensure demand
for services are being met and response time performance output exceeds expectations.
Continuous system optimization requires data collection such as CAD timestamp and
location data, but more importantly includes our proprietary Root Cause Analysis (RCA) tool
for determination of system failures. A failure of the system is defined as any late Priority 1 or
Priority 2 response in the system. Knowing the causes of system failures are key to fixing the
problem at its roots. As root cause adjudications are discovered and categorized, patterns
emerge that reveal opportunities for optimization in a variety of categories including
deployment plans, operational processes, individual behaviors, unit hour supply and other
cause and effect situations that can be mitigated and fixed. This improves system
effectiveness, system efficiency and ultimately improves response time reliability.
3. b. Field supervision and capabilities and methods.
Maricopa Ambulances field operations for the City of Glendale will be led by Jason Dupont,
Glendale EMS Director.
Dupont will be responsible for overseeing all facets of Maricopa Ambulance’s City of
Glendale operation. He will be responsible for the daily oversight of all personnel,
equipment and operations. Assisted by support staff he will direct all recruiting, hiring,
onboarding, orientation and training of field staff. He will also represent Maricopa
Option B Deployment Plan
Location
10
9
8
7
6
5
4
3a*
3b
2
1
GL2
1
GL3
1
1
Station 150 / GL4**
1
1
1
1
1
1
1
1
1
Station 151
2
2
2
2
2
1
Station 152
2
2
2
1
1
1
1
1
Station 153
2
2
1
1
1
1
1
1
1
Station 154
2
2
2
2
1
1
1
1
1
Unit Level
10
9
8
7
6
5
4
3a*
3b
2
1
Percent of historic calls reachable within 7.5 mins †
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.8%
99.4%
97.2%
77.4%
Grid displays number of units to be stationed or posted at the Location
*Level 3 can be equivalently covered as noted in 3a or 3b or 3c
**GL4 is an alternate post at levels 3 and above for Station 150 when there is a AZ Cardinal Home game, and 2 hours post-game
† Measures calls by latitude & longitude can be reached from the station or group of stations divided by all the calls in the last 3 years within the Primary Service Area
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Ambulance to Glendale Fire Department dealing with and solving any issues, concerns or
problems that may present themselves.
Dupont will be Maricopa Ambulance’s direct liaison to the City of Glendale and the Glendale
Fire Department for all aspects of this contract.
Supporting Dupont as EMS Director will also be four Paramedic Field Supervisors. These
four Field Supervisors will be available to support and assist around the clock. They will be
based at the main Glendale station and will work 12-hour shifts providing coverage 24 hour
per day, 365 days per year.
Field Supervisors are provided with a response vehicle (SUV or Pickup) that is fully equipped
to the ALS level per Arizona regulations and City of Glendale contract specifications. This
allows Field Supervisors at any time requested to respond to a scene and assist in any way
needed. While on scene during any call they will operate under the direction of City of
Glendale Fire Department personnel.
Field Supervisors handle all regular daily operational issues including staffing, scheduling,
customer service, supply distribution, facility upkeep, fleet availability and clinical
operations.
3. c. Training, management, recruitment, orientation, and retention of personnel
capabilities and methods.
Employee Recruitment & Retention
Maricopa Ambulance knows its most
important asset is the people on the
frontline providing patient care to our
communities.
Maricopa Ambulance recognizes that its
most important asset is the people on the
front lines providing patient care to our
communities. We bring an extensive
employee recruitment and retention plan in
place to ensure we attract top talent and
succeed in retaining our employees for the
long term.
Maricopa Ambulance offers competitive wages and a host of incentives, such as continuing
education, tuition reimbursement, bonuses, award programs, comprehensive health,
wellness and family benefits and a defined career path forward for promotions and
advancement.
We have an extensive employee recruitment and retention plan in place that ensures we
attract top talent and retain our employees, including referral bonuses paid to our current
employees.
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In the realm of traditional recruiting, Maricopa Ambulance also will deploy digital recruiting
platforms such as Indeed, conduct robust social media advertising campaigns to target
potential employees, as well as host onsite job fairs and recruitment events at local venues
and community colleges.
Maricopa Ambulance has found our employees often are our best recruiters, as they have
established connections within the EMS community. CONFIRE EMS will also offer generous
recruitment referral bonuses to current employees. In addition, we will provide signing
bonuses and education assistance programs to assist new employee recruitment efforts when
needed.
Employee Retention
The first step toward employee retention is creating a culture of inclusion, belonging and
purpose. Individuals who are committed to public safety and healthcare careers will find paths
open to explore either or both options. Maricopa Ambulance’s employee retention program
includes:
Career Investment – Maricopa Ambulance invests in our employees’ careers through
continuing education, cross-training, industry workshops, seminars and conferences, as well as
a financial assistance program, to pursue higher levels of education.
Competitive Wages, Benefits & Wellness Offerings – Maricopa Ambulance pays competitive
wages and offers a comprehensive package of health, wellness, fitness and family benefits and
programs.
Recruitment Bonuses – Our best industry ambassadors are our own employees, and we
recognize their efforts through the award of recruitment bonuses whenever they refer a
qualified friend or family member who is hired.
Employee Recognition – Every employee wants to feel appreciated for the work they do, and
employers who express gratitude and thanks can make a big impact. We conduct regular
employee service award and recognition programs to honor our colleagues and to incentivize
great ideas and innovation. Acknowledging milestones is an essential element of our culture.
Prioritizing Work-Life Balance – The EMS business is a 24/7 experience and understanding a
healthy work-life balance is essential to job satisfaction. We encourage employees to take their
vacation time and host events for employees and their families to socialize.
Pathways for Growth – Maricopa Ambulance’s ability to retain employees is also rooted in the
investments we make in their future career growth, along with the Priority Ambulance
Leadership Foundation, which focuses on executive leadership training tracks for EMS
personnel. Maricopa Ambulance employees are provided the opportunity to participate in this
highly successful program at no cost to them.
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3. d. Interactions with First Responders capabilities and methods.
First Responder Capabilities & Methods
Maricopa Ambulance and its sister
companies within Priority Ambulance have
extensive experience working with fire
service agencies and first responders. We
work within the command structure and
pride ourselves on becoming true partners
with our fire service first responders.
Maricopa Ambulance has a strong
relationship with the International
Association of Fire Fighters, the labor
union for both firefighters and ambulance
EMTs and paramedics in Glendale. Our organization has an understanding and respect for
fire service agencies throughout all levels of our operations. We know that an EMS system
works best when there is open communication and collaboration between all agencies in
the market.
Throughout its national footprint, the Company has extensive experience operating within or
in the chain of command of fire service agencies. A few examples include:
Maricopa Ambulance was awarded the 9-1-1 contract for the City of Scottsdale
beginning February 2018. As the ambulance service partner, Maricopa Ambulance
provides two EMTs on every ambulance. A Scottsdale firefighter serves as the ALS first
responder and will ride along with the patient on the ambulance to the hospital to
ensure the continuity of care for the patient from first response to the emergency
department. Maricopa Ambulance then provides transportation for the firefighter
paramedics to rendezvous with their engine. Maricopa Ambulance also provides one-
to-one resupply on-scene and will place supply vending machines in each fire station.
Maricopa Ambulance was awarded the 9-1-1 contract for the City of Chandler that
began in January 2022. The Chandler contract model is a collaborative system with
the Chandler Fire Department that increases staffed ambulance resources, introduced
new, advanced medical equipment and elevated 9-1-1 response in the city. Maricopa
Ambulance staffs a total of seven ambulances during the system’s busiest peak hours
of the day and three backup units for an additional layer of redundancy for
maintenance, surge and special events.
In Forsyth County, Georgia, Central EMS is the exclusive 9-1-1 provider with the
contractor administrator within the Forsyth County Fire Department. Central EMS
provides more than 120 hours of joint clinical training to the fire department, consults
with the fire department on disaster drills and community health initiatives and houses
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its ambulances and crews within the fire stations. Central EMS operates within the
county’s dispatch system and its computer automated dispatch (CAD) system.
In Cobb County, Georgia, Puckett EMS works closely with the Cobb County Fire
Department and partners on many programs. Puckett EMS provides training to the fire
department through its continuing education center and invites firefighters to take
part in the paramedic school to increase certifications.
First Responder Resupply Methods
Maricopa Ambulance is committed to continue supplying and restocking the Glendale Fire
Department with supplies and medications at no cost to the department and in the most
efficient, convenient manner possible.
When supplies are used on the scene, Maricopa Ambulance will restock the fire department
unit one-for-one item on the scene. Additionally, Maricopa Ambulance will have ALS supplies
in locked safes on the ambulances and firefighter paramedics will use a code to access these
supply lockers at any time.
Additionally, Maricopa Ambulance provides regular resupply deliveries directly to the fire
stations. Maricopa Ambulance will always be responsive to its partners and if a supply or
medication is running low, we will immediately respond. A Maricopa Ambulance shift
supervisor with a dedicated SUV quick response vehicle is available during all shifts to assist
in resupply or provide additional assistance to field operations.
As stipulated in the RFP, Maricopa ambulance is committed to placing specifically configured
medical supply vending machines in each Glendale Fire Department station within one year
from the contract being signed. Initial purchase and placement will be at the cost of Maricopa
Ambulance, with the City of Glendale to assume ongoing maintenance costs thereafter.
Maricopa Ambulance intend to procure CribMaster branded supply vending machines and
work collaboratively with Glendale Fire Department regarding specs, footprint,
communications capabilities/requirements, specific model, configuration and maintenance.
CribMaster:
Ethernet router hardwired to the machine, with a cellular option available.
Software option “Enterprise”
o Machines can be tied together for reporting, potentially across multiple sites
Reports on usage: coil machine by selection, locker by manually quantity entry.
Small items, vials, breakable can be packaged into sleeves or pillow packs to avoid
breakage or slippage.
We will likely use a combo of Express Toolbox of Express locker. These devices have an
approximately 3 month estimated lead time including installation and training.
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o
3. e. Fleet management capabilities and methods.
Fleet Management & Maintenance
At Maricopa Ambulance, a high-quality
preventive maintenance program is essential to
ensure the safety of our crew members and the
quality and reliability of the services we provide.
The following Preventive Vehicle Maintenance
(PVM) program has been established to prevent
in-service failures through aggressive preventive
vehicle maintenance and in-depth inspection
procedures intended to locate and correct
mechanical defects before they occur. The
program is designed to reduce parts failure and
extend vehicle life.
All maintenance of response vehicles, electrical, suspension, mechanical, etc., shall be
provided in Maricopa Ambulance’s Fleet Services Department. During schedule maintenance
and repairs, Maricopa Ambulance will move one of the identically configured reserve units to
cover the area. Body repairs, transmission, upholstery and other specialty work may be sent
out to local qualified vendors. All preventive maintenance such as tire rotation and oil
changes will be completed in-house.
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Fleet Service Technicians shall be screened thoroughly, and background inquiries made
prior to employment to ensure that their work history is reputable. Fleet Technicians will be
provided incentives for attaining advanced mechanical repair qualifications.
Fleet Management Software
Maricopa Ambulance uses Fleetio fleet management software to track its preventive
maintenance schedule as detailed below.
Fleetio software allows the fleet manager to track complete maintenance histories, out-of-
service time, scheduled preventive maintenance and vehicle health. Crew members may
submit maintenance requests directly to the fleet manager via the system. The system also
allows for warning messages to be automatically sent to appropriate personnel if a critical
vehicle fault is detected.
The database will assist Fleet Services in ensuring registrations and preventive maintenance
(PVM) schedules are current and that repair and other routine checks are done in a timely
fashion. Operative IQ will automatically flag a unit file when the maintenance checkup is due.
It will note any unusual circumstances in the vehicle history file, which allows mechanics to
continually evaluate, monitor and update the historical performance of each unit.
Fleetio will pinpoint recurring problems, generate service notices for maintenance personnel
to ensure accuracy, organize vehicle and equipment downtime based on necessary
maintenance, schedule equipment or vehicle maintenance based on miles, hours and/or
days, establish documentation for legal purposes, and generate reports for contract audit
and cost control. All computer files are backed up daily.
StreetEagle Vehicle Diagnostics
The ATLAS software suite provides vital data, including fuel usage and economy data and
driver behavior records, to the full fleet management software, which allows managers to
track driver behavior as it relates to vehicles repair and maintenance.
Vehicle Maintenance & Inspection Guidelines
All vehicles will maintain scheduled PVM services per the following Inspections Level
Criteria:
Level of Service
Overview
Schedule
Activities
“A” Level PVM
Inspection/Service
Basic service interval
for all vehicles.
Goal: Basic servicing
of the vehicle and
conduct an extensive
safety inspection to
Every 4,000
miles
Pre-Service Test Drive
Preventive Vehicle Maintenance
Inspection
Oil and Filter Replacement
Chassis and Body Lubrication
Inspect, Clean and Adjust Brakes
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identify and prevent
vehicle failures.
Cranking/Charging System Test
Lighting Systems Inspection
Warning Systems Inspection
Ambulance Cot Safety
Inspection/Service or Trade Out
Document
Inspection/Replacement
Overall Vehicle Assessment
Engine and Chassis Cleaning
Post-Service Test Drive
Work Order Completion and PM
Update
“B” Level PVM
Inspection/Service
Basic service interval
for fuel filter
replacement service.
Goal: Basic servicing
of the vehicle and
ensure the proper
operation of the
transmission and
related components
Every
25,000
miles
Any Concurrent PVM Scheduled
Pre-Service Test Drive with Special
Attention to Shift Points and
Smoothness of Operation
Fuel Filter Replacement
Internal Inspection during Filter
Replacement
Inspection/Adjustment of Linkage,
Cables, Hoses, Mounts and Valves
Final Test Drive
Work Order Completion and PVM
Update
“C” Level PVM
Inspection/Service
Basic service interval
for air system filter
replacement,
transmission fluid and
filter.
Goal: Prevent any loss
of engine performance
and to maximize fuel
economy
Every
30,000
miles
Any Concurrent PVM Scheduled
Pre-Service Test Drive with Special
Attention to Engine Performance
Replacement of Transmission Fluid
& Filter
Visual or Vacuum Inspection of Air
Filter and Replacement if Indicated
Final Test Drive
Work Order Completion and PVM
Update
“D” Level PVM
Inspection/Service
Basic service interval
for engine tune-up
procedures on
gasoline-powered
vehicles.
Goal: Prevent loss of
engine performance,
maximize fuel
economy and ensure
reliable ignition.
Every
50,000
miles
Any Concurrent PVM Due
Pre-Service Test Drive with Special
Attention to Engine Performance
Replacement/Service of Tune-Up
Items
Replacement of Rear Differential
Fluid
Evaluation of Ignition System with
Diagnostic Scope
Work Order Completion and PM
Update
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“E” Level PVM
Inspection/Service
Basic service interval
for engine V-belt
replacement
Goal: Extensive
inspection of the
cooling system or V-
belts and the loss of
performance of belt-
driven accessories due
to slippage
Every
75,000
miles
Any Concurrent PM Scheduled
Pre-Service Test Drive
Replacement of V-Belts
Inspection of Cooling System
Components
Final Test Drive
Work Order Completion and PM
Update
3. f. Driver training and risk management capabilities and methods.
Driver Training
Maricopa Ambulance requires that every employee receive Company Equipment and
Vehicle Operation (CEVO) training upon hire with annual recertification. The course includes
classroom work and practical driving training and is specifically designed for an emergency
medical services vehicle.
The Coaching System CEVO 3 Ambulance Certification classroom portion covers the
following:
Comprehensive coverage of collision-prevention techniques, including:
Cushion of safety
Scanning
Vehicle positioning
Handling blind spots
Parking procedures and more
Coverage of a wide range of other safety-related topics, including:
Vehicle inspection
Vehicle handling and design characteristics
Emergency and non-emergency driving differences
Safety at the scene
Additionally, the CEVO 3 Ambulance Certification course includes a practical driving portion
with a certified instructor.
Risk Management Program
At Maricopa Ambulance, we rigorously implement a safe work environment for our
employees and require that everyone practices safety.
Our management team is evaluated on achieving the company’s strict goals for workplace
safety and implementing safety initiatives, such as daily communications messages about
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safety to employees. It also includes regular performance audits to ensure we are achieving
our goals.
Maricopa Ambulance involves its employees in the planning and implementation of its safety
program and is organizing a joint Safety Committee with IAFF I-60 consisting of four field
members and four members of management.
Risk Management Principles
At Maricopa Ambulance, we understand that risk management and health safety programs
have to be a focus and be reinforce through our leadership and our entire workforce through
consistent education and training.
Our risk management program is guided by the following principles:
Integrate risk management into all phases of operations
Effective risk management requires that the process be integrated into all phases of mission
or operational planning, preparation, execution and recovery on a continuing basis. It is more
cost effective to proactively plan during building construction and renovation to imbed
safety, fire and environmental protection systems than to retrofit after the fact.
Make risk decisions at the appropriate level
As a decision-making tool, risk management is
only effective when the information is
concentrated on the appropriate supervisory
level for decision. The higher the risk, the
higher the management level of who should
make the decision to accept a risk or not.
Often, this will require the decision to apply
resources, whether manpower, dollars or both,
to mitigate risks to an acceptable level so the
management decision-making level must be
where the purse strings are controlled.
Accept no unnecessary risk.
Risk management is a decision-making tool to assist the supervisor or individual in
identifying, assessing, and controlling risks in order to make informed decisions that balance
risk costs (potential losses) against mission benefits (potential gains). An unnecessary risk is
one that if not taken, you can still accomplish the mission. For example, an employee forgets
or refuses to use eye protection during grinding operations. The risk is painful damage to
eyes, maybe even loss of sight, yet the grinding can be successfully accomplished without
risk of eye injury, simply by using eye protection.
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Apply the process cyclically and continuously.
Risk Management is a continuous process applied across the full spectrum of museum and
research operations, individual and collective day-to-day activities and events, and facility
operations. It is a cyclical process that is used to continuously identify and assess hazards,
develop and implement controls and evaluate outcomes particularly when changes occur in
operations or environment.
3. g. OSHA compliance and exposure control capabilities and methods.
OSHA Compliance
Maricopa Ambulance operates to evolving OSHA and other state and local regulatory
requirements related to occupational health and safety. We monitor and adopt changes to
procedures to ensure we always meet or exceed all regulatory requirements.
Maricopa Ambulance requires mandatory OSHA and Chemical Hazards Controls training for
every employee upon hire and on an annual basis.
3. h. Medicare and AHCCCS (Medicaid) compliance program capabilities and
methods.
Medicare and AHCCCS Compliance
Maricopa Ambulance and the entire Priority Ambulance family of companies is committed to
complying with all laws and regulations associated with Medicare and Medicaid claim
submission and to ensure no fraudulent acts are committed intentionally or remain
uncorrected when discovered.
An exceptional compliance program must have a basic foundation based on a code of
conduct, which applies to all staff members. All employees are expected to read and
understand this policy. Upon hire and each year thereafter, staff members are required to
complete an exam demonstrating they understand the expectations of their behavior to be
beyond reproach.
The goal of the Compliance Plan (“the Plan”) is to ensure the Company adheres to all
applicable Medicare, Medicaid, and any other federally funded health care (for ease of
reference, collectively referred to as “Medicare”) laws, rules and policies relating to the
submission of claims for ambulance services.
This includes, among other things, to ensure proper:
Documentation of services
Billing, coding, and claims submission
Prevention, prompt detection, and appropriate action steps for health care fraud and
abuse.
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Maricopa Ambulance’s staff members who fail to comply with the elements of this Plan may
face disciplinary action including, but not limited to, reprimand, suspension without pay,
termination, or even civil and/or criminal charges when violations are severe. To ensure
employees understand the requirements and adhere to them, Maricopa Ambulance provides
superior education in the form of:
Local in-person training programs
Periodic fair and impartial skills evaluations
Online training programs and courses
Maricopa Ambulance provides thorough appropriate documentation training to all
employees upon hire and annually to ensure all patient care reports are clear, accurate,
complete, timely and well-organized. All records are kept according to appropriate
document retention policy and stored in a secure, HIPAA-compliant location.
Additionally, Maricopa Ambulance is committed to hiring employees of the highest caliber
and ensuring that all employees are eligible to participate in federal or state health care
programs. The Office of the Inspector General (OIG) website lists numerous entities or
persons from the ambulance industry who have been excluded from participation in federal
health care programs. Our third-party vendor conducts criminal background checks and
confirms that it has completed an initial Office of Inspector General (OIG) check of the List of
Excluded Individuals and Entities (LEIE) prior to any employee beginning work at Priority
Ambulance. Additionally, the Company conducts ongoing screenings of all employees
against the OIG exclusion list to ensure that our workforce remains in compliance with
Medicare/Medicaid programs.
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3. i. Diversity Plan in the workplace and programs in place that support diversity.
Diversity Program & Commitment
We strive to champion a work environment that promotes the values of diversity, equality and
inclusiveness. Our culture of caring and doing the right thing is rooted in principled,
stakeholder-driven sustainability. We are committed to fostering and embracing a diverse
community in which employees share a mutual understanding and respect for each other.
Maricopa Ambulance’s pledge to diversity, equity and inclusion encompasses our
commitment to create a work environment that embraces inclusion, regardless of race, color,
religion, gender, sexual orientation, gender identity, national origin, age, genetic
information, marital status, amnesty, disability, veteran status or based on pregnancy,
childbirth or related medical conditions.
The inclusion of people with disabilities helps drive sustainable practices for our employees,
communities and customers. Reasonable accommodations include adaptive equipment,
allowances for on-site service animals, flexible work arrangements, special parking
assignments, hotlines and a number of other
inclusive services.
Maricopa Ambulance is a committed supporter of
veteran communities. Veterans bring strong
leadership, team building and analytical skills, as
well as unwavering commitment to a job well
done, making decisions in the face of uncertainty
and ensuring safe operations in high-risk
environments. We value the outstanding
contributions veterans make to our contract
performance and overall business success.
Maricopa Ambulance is committed to implementing annual diversity, equity and inclusion
training for all personnel that addresses preventing sexual harassment, bystander
intervention, managing unconscious bias, fostering an inclusive culture, anti-racism,
transgender inclusion and more.
Maricopa Ambulance strives to provide culturally equitable health care through (1) recruiting
a diverse workforce, (2) recruiting and promoting diverse leadership, (3) providing language
skills training and cultural sensitivity training and (4) developing and promoting community
outreach programs for the community.
Maricopa Ambulance’s goal is to have a workforce that is reflective of the communities we
serve. As such, we propose to create a diversity committee with representation from the
workforce, quality improvement management, local public health, community
organizations/nonprofits and hospitals to address internal and external programs to improve
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health equity to the community. Collaboration and building
plans from many diverse viewpoints are the best ways to
accomplish our goals in the community.
Maricopa Ambulance’s parent company, Priority OnDemand,
published its first annual Environmental, Social and
Governance report in 2023, which describes in detail the
company’s dedication to not only diversity, equity and
inclusion, but also environmental, social and governance best
practices.
To read the report, click here:
https://priorityondemand.com/esg-commitment/
3.1 Detail any and all regulatory investigations, findings, actions, complaints and
their respective resolutions. Each Proposer will include details about any and all
emergency medical services and ground ambulance transportation services
contract terminations or contract amendments within the last five (5) years in any
jurisdiction in the United States. Additionally, each Proposer will detail the
circumstances and resolution of any emergency medical services and ground
ambulance transportation services contract disputes or notices of non-compliance,
or notices of failure to perform.
Maricopa Ambulance has no regulatory investigations, findings, actions or complaints. The
Company has never terminated any contracts or received notices of non-compliance or non-
performance in the last five years that are responsive to this question.
3.2 Each Proposer will provide a detailed list of all litigation with a reserved value
in excess of $100,000 in which the Proposer or an affiliated organization(s) or
subcontractor is involved, together with such threatened and anticipated litigation
and claims and anticipated claims.
From time to time, the company is party to, or otherwise involved in, threatened, pending
and/or anticipated litigation that arises in the ordinary course of conducting its business. The
company cannot predict with certainty the ultimate outcome of such threatened, pending
and/or anticipated litigation matters, due to, among other things, the inherent uncertainties
of litigation. The company cannot identify a particular legal matter as having a reserved value
in excess of a certain amount because to do so in a publicly available document would violate
the company’s attorney-client and litigation work product privileges and would otherwise
prejudice the company’s ability to defend that legal matter. The company is not aware of
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any pending or threatened litigation that would impair its ability to perform the
contract if awarded
3.3 Should a proposer intent to utilize a Subcontractor(s) to provide any of
Contractor’s substantial responsibilities, including, but not limited to, dispatch
coordination, ambulance response, ambulance transportation services, staffing,
training, communications and call center management and/or services, protocol
development, financial management, ambulance fleet and equipment
maintenance, andn similar services, the Proposer must include the credentials of
each such Subcontrctor and any relationship to the Proposer in order to permite the
City to evaluate the circumstances. Copies of existing subcontracts (or proposed
subcontracts) must also be included. The City will look only to teach Proposer with
regard to responsibility for performance in accordance with the Contract. The City
may approve or disapprove any subcontractor identified by any Proposer. The
inability or failure of any Subcontractor to perform any duty or deliver contracted
for performance will not excuse the Proposer from the responsibility or
performance.
Maricopa Ambulance will not utilize the services of subcontractors to provide services under
the City of Glendale emergency medical services contract.
3.4. Each Proposer must set forth its plans for responding to major emergency
situations within and outside the City of Glendale where dedicated ambulances
may be involved. In addition, each Proposer must set forth its plans for declared
disaster situations and required assistance, ”automatic aid” and ”automatic aid
arrangements” and ”mutual aid” and ”mutual aid arrangements” All such plans
must be in accordance with and comply with applicable laws, regulations, rules,
policies, questions, and protocols.
Maricopa Ambulance has a robust internal multi-hazard plan that
includes triggers for the activations, notifications, communications
and all required staffing for any natural disaster, multi-casualty
incidents or other large-scale emergencies that may arise.
Additionally, Maricopa Ambulance protocols include all necessary
EMS communications, staffing, vehicle and equipment needs on
hand and available in accordance and compliance with applicable
laws, regulations, rules, policies, questions, and protocols.
In a natural disaster or mass-casualty incident, planning,
coordination and communication among all community EMS, first
responders, medical facilities and law enforcement are key to an effective, coordinated
response. We understand the City and the Fire Department participate in an automatic aid
agreement, including the EMS system, with 27 other cities and their fire departments in the
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metropolitan Phoenix area. Maricopa Ambulance disaster response experts will continue to
work with the City and first responder agencies to bring additional experience and
exceptional disaster management skills to the City of Glendale.
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SECTION 4. FUNDING AND REIMBURSEMENT
The Contractor shall show an ability to provide funding and reimbursement for:
4.1 Installation, Operation, and Maintenance of PFDRDC Equipment on Dedicated
and Special Events Ambulances
Maricopa Ambulance will purchase and install all PFDRDC equipment and provide funds for
the installation, operation and management of the system on Dedicated and Special Events
ambulances.
As the 9-1-1 provider for the City of Glendale, which also operates on the PFDRDC
communications system, Maricopa Ambulance already has experience in the installation and
maintenance of these systems
4.2 Installation, Operation, and Maintenance of traffic preemption equipment on
Dedicated Ambulances if implemented by the City of Glendale.
All Maricopa Ambulances in the Glendale EMS system Maricopa Ambulances are equipped
with Opticom traffic signal pre-emption devices compatible with the system currently in use
by the City and are the sole expense and responsibility of Maricopa Ambulance. Maricopa
Ambulance will continue to install and maintain this equipment on all Dedicated and Special
Event ambulances in the City through the contract term.
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COST
As specified in the RFP, Maricopa Ambulance has submitted a separate electronic file
containing the Company’s cost proposal (Maricopa Ambulance Pricing Workbook).
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EXHIBIT 1 – Alternative Offer
As required in the RFP Exhibits Package provided by the City, Maricopa Ambulance is
submitting as an attachment the following Exhibit 1 – Alternative Offer.
This Exhibit 1 provides details for exceptions to specfic conditions of purchase and/or
required specifications, referencing the paragraphich number(s) and defining the alternative
or exception submitted.
3. a. System planning and deployment capabilities and methods.
As discussed earlier in this proposal, Maricopa Ambulance is presenting options for system
status management and deployment planning that take into consideration the 95% response
time performance threshold requested in the RFP, and the 90% response time performance
threshold contained in the current ambulance services contract.
Please refer to Section 3 – System Planning and Deployment for details.
RFP Page 19 – ADDITIONAL AMBULANCES
In addition to minimum obligations for required Dedicated Amblances and Contractor’s right
to designate additional units from time to time to meet its obligations, the City of the
Contractor may incfrease th erequired number of twenty-four (24) hour ALS equipped
ambulances by one (1) to address any of the following circumstances:
•
Increased ambulance call volume by ten (10) percent over the call volume
experienced during the first year of the Agreement; or
•
Population increases within the City limits of twnety (20) ercent or more over the
population in effect during the preceding calendar year of the Agreemnet; or
•
Increased traffic congestion wtihin the City lmits resulting in on-scene wati time
increases experienced by the Fire Department of ten (1) percent or more over th
epreceding calendar year of the Agreement; or
•
Increased 95th percentile response times from the preceding calendar year of the
Agreement.
Maricopa Ambulance agrees it is the contractor’s right to designate additional units from
time to time to meet obligations under the contract. Maricopa Ambulance does not agree
and cannot comply with provisions that allow the City to unilaterally require the number of
24-hour ALS ambulances be increased. We do, however, agree that there should be a
process developed to address sustained circumstances described in the RFP and reiterated
below. These circumstances, if mutually agreed upon, would require an amendment to the
Ambulance Services Agreement (along with the normal contract change approval process.)
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EXHIBIT 4 - PERFORMANCE BOND
Contractor will be required to provide the City a performance bond in the amount of 10% of
the entire contract term in form and substance acceptable to the City. The Contractor will be
required to maintain the Performance Bond throughout the term(s) of the Contract and for a
reasonable time thereafter.
Because the Contract contains no provision for a subsidy, Maricopa Ambulance is unclear
regarding the definition of 10% of the entire contract term in form and substance acceptable
to the City, as set forth in the Agreement. However, Maricopa Ambulance agrees to provide a
performance bond in an amount that is commercially reasonable, consistent with past
practice, and acceptable to the Arizona Department of Health Services. Maricopa Ambulance
will maintain the Performance Bond throughout the term(s) of the Contract and for a
reasonable time thereafter.
We are uncertain if our proposal with regard to Exhibit 4 – Performance Bond – constitutes an
Alternative Offer. Mariciopa Ambulance obtained a performance bond in accordance with
the terms of the current contract in the amount of $1 million that remains in effect today.
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EXHIBIT 2 – Key Personnel Resumes
Please see the following pages for each of Maricopa Ambulance’s key perosnnel.
Bryan Gibson – Chief Executive Officer
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Steve Blackburn, Chief Operating Officer
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Alan Smith - West Region President
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Michelle Angle – Vice President of Operations
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Jason Dupont, NRP – Operations Director, Glendale
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Lindsey Pingel – Operations Director, Chandler/Goodyear
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Michael Norton – Director Interfacility Transports
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Jamie Patterson – Communications Director
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Adam Lizardi – Support Services Manager
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Ricardo ”Ric” Rojas – Fleet Manager
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EXHIBIT 3 - Annual Reports and Consolidated Financial
Statements
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EXHIBIT 4 – Performance Surety Fund and Performance Bond
Obligations
PERFORMANCE SURETY FUND
Creation of a Performance Surety Fund and the process by which the City may withdraw
funds from the Performance Surety Fund.
A. Contractor shall submit to City a check in the amount of Fifty Thousand Dollars
($50,000). The City shall deposit the check into a dedicated account (the
”Performance Surety Fund”) which may only be used for City of Glendale Fire
Department EMS programs, including training or equipment for both Fire Department
and ambulance personnel. At least quarterly, City shall provide to Contractor a
statement or other documentation showing the fund’s current balance. For accounting
purposes, the funds shall be considered funds of Contractor held in escrow account
or some similar designation that describes the City’s right to draw down these funds
for only the purposes designated herein.
B. The City shall not use or distribute funds from the Performance Surety Fund except in
accordance with the process set forth in the Agreement.
C. City shall provide Contractor with a notice documenting the date and amoutn of any
withdrawal from the Performance Surety Fund.
Maricopa Ambuance agrees to submit a check to the City of Glendale in the amount of
$50,000 to fund a dedicated Performance Surety Fund to be used for the purposes described
above.
PERFORMANCE BOND
Contractor will be required to provide the City a performance bond in the amount of 10% of
the entire contract term in form and substance acceptable to the City. The Contractor will be
required to maintain the Performance Bond throughout the term(s) of the Contract and for a
reasonable time thereafter.
Because the Contract contains no provision for a subsidy, Maricopa Ambulance is unclear
regarding the definition of 10% of the entire contract term in form and substance acceptable
to the City, as set forth in the Agreement. However, Maricopa Ambulance agrees to provide a
performance bond in an amount that is commercially reasonable, consistent with past
practice, and acceptable to the Arizona Department of Health Services. Maricopa Ambulance
will maintain the Performance Bond throughout the term(s) ofo the Contract and for a
reasonable time thereafter.
We are uncertain if our proposal with regard to Exhibit 4 – Performance Bond – constitutes an
Alternative Offer. Mariciopa Ambulance obtained a performance bond in accordance with
the current contract in the amount of $1 million that remains in effect today.
182
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EXHIBIT 5 – Ambulance Equipment List
183
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186
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187
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188
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190
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191
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192
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193
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EXHIBIT 6 – Certificate of Insurance
195
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196
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EXHIBIT 7 – Drive-Time Maps
Level 1
197
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Level 2
198
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Level 3a
199
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Level 3b
200
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Level 4
201
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Level 5-9
202
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Level 10
203
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Level 11
204
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Level 12
205
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Station 150
206
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Station 151
207
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Station 152
208
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Station 153
209
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Station 154
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Post GL2
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Post GL3
212
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Post GL4
213
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Post H
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EXHIBIT 8 - Certificate of Necessity – Maricopa Ambulance
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EXHIBIT C
EMERGENCY MEDICAL [TRANSPORTATION] SERVICES
2022 ANNUAL REPORT AND CONSOLIDATED FINANCIAL STATEMENTS (AUDITED)
2022 Annual Report and Consolidated
Financial Statements (Audited)
Parent Company of Priority Ambulance, LLC
Healthcare
Anywhere.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Consolidated Financial Statements
As of December 31, 2022 (Successor) and for the Period from
July 15, 2022, to December 31, 2022 (Successor) and for the Period from
January 1, 2022, to July 14, 2022 (Predecessor), and
As of December 31, 2021 (Predecessor) and for the
year ended December 31, 2021 (Predecessor)
(With Independent Auditors’ Report Thereon)
KPMG LLP
60 East Rio Salado Parkway
Tempe, AZ 85281-9125
KPMG LLP, a Delaware limited liability partnership and a member firm of
the KPMG global organization of independent member firms affiliated with
KPMG International Limited, a private English company limited by guarantee.
Independent Auditors’ Report
To the Members
Priority OnDemand, LLC:
Opinion
We have audited the consolidated financial statements of Priority OnDemand, LLC and its subsidiaries (the
Company), which comprise the consolidated balance sheets as of December 31, 2022 (Successor) and 2021
(Predecessor), and the related consolidated statements of operations, changes in members’ equity, and cash
flows for the period from July 15, 2022 to December 31, 2022 (Successor) and the period from January 1, 2022
to July 14, 2022 (Predecessor) and the year ended December 31, 2021 (Predecessor), and the related notes to
the consolidated financial statements.
In our opinion, the accompanying consolidated financial statements present fairly, in all material respects, the
financial position of the Company as of December 31, 2022 (Successor) and 2021 (Predecessor), and the
results of its operations and its cash flows for the period from July 15, 2022 to December 31, 2022 (Successor)
and the period from January 1, 2022 to July 14, 2022 (Predecessor) and the year ended December 31, 2021
(Predecessor) in accordance with U.S. generally accepted accounting principles.
Basis for Opinion
We conducted our audits in accordance with auditing standards generally accepted in the United States of
America (GAAS). Our responsibilities under those standards are further described in the Auditors’
Responsibilities for the Audit of the Consolidated Financial Statements section of our report. We are required to
be independent of the Company and to meet our other ethical responsibilities, in accordance with the relevant
ethical requirements relating to our audits. We believe that the audit evidence we have obtained is sufficient
and appropriate to provide a basis for our audit opinion.
Emphasis of Matter
As discussed in Note 2(t) to the consolidated financial statements, in 2022, the Company adopted new
accounting guidance ASU No. 2016-02, Leases. Our opinion is not modified with respect to this matter.
Responsibilities of Management for the Consolidated Financial Statements
Management is responsible for the preparation and fair presentation of the consolidated financial statements in
accordance with U.S. generally accepted accounting principles, and for the design, implementation, and
maintenance of internal control relevant to the preparation and fair presentation of consolidated financial
statements that are free from material misstatement, whether due to fraud or error.
In preparing the consolidated financial statements, management is required to evaluate whether there are
conditions or events, considered in the aggregate, that raise substantial doubt about the Company’s ability to
continue as a going concern for one year after the date that the consolidated financial statements are available
to be issued.
Auditors’ Responsibilities for the Audit of the Consolidated Financial Statements
Our objectives are to obtain reasonable assurance about whether the consolidated financial statements as a
whole are free from material misstatement, whether due to fraud or error, and to issue an auditors’ report that
2
includes our opinion. Reasonable assurance is a high level of assurance but is not absolute assurance and
therefore is not a guarantee that an audit conducted in accordance with GAAS will always detect a material
misstatement when it exists. The risk of not detecting a material misstatement resulting from fraud is higher
than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions,
misrepresentations, or the override of internal control. Misstatements are considered material if there is a
substantial likelihood that, individually or in the aggregate, they would influence the judgment made by a
reasonable user based on the consolidated financial statements.
In performing an audit in accordance with GAAS, we:
●
Exercise professional judgment and maintain professional skepticism throughout the audit.
●
Identify and assess the risks of material misstatement of the consolidated financial statements, whether
due to fraud or error, and design and perform audit procedures responsive to those risks. Such
procedures include examining, on a test basis, evidence regarding the amounts and disclosures in the
consolidated financial statements.
●
Obtain an understanding of internal control relevant to the audit in order to design audit procedures that
are appropriate in the circumstances, but not for the purpose of expressing an opinion on the
effectiveness of the Company’s internal control. Accordingly, no such opinion is expressed.
●
Evaluate the appropriateness of accounting policies used and the reasonableness of significant
accounting estimates made by management, as well as evaluate the overall presentation of the
consolidated financial statements.
●
Conclude whether, in our judgment, there are conditions or events, considered in the aggregate, that
raise substantial doubt about the Company’s ability to continue as a going concern for a reasonable
period of time.
We are required to communicate with those charged with governance regarding, among other matters, the
planned scope and timing of the audit, significant audit findings, and certain internal control related matters that
we identified during the audit.
Phoenix, Arizona
April 18, 2023
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Consolidated Balance Sheets
3
Successor
Predecessor
December 31,
December 31,
Assets
2022
2021
Current assets:
Cash and cash equivalents
$
569,629
801,803
Accounts receivable
54,945,788
50,191,754
Inventory
3,769,236
3,705,319
Prepaid expenses and other current assets
8,102,750
12,164,497
Total current assets
67,387,403
66,863,373
Equipment and leasehold improvements, net
54,351,185
44,931,438
Intangible assets, net
78,334,620
43,912,391
Goodwill
74,391,205
66,877,582
Other assets
21,411,170
670,132
Total assets
$
295,875,583
223,254,916
Liabilities and Member’s Equity
Current liabilities:
Accounts payable
$
8,952,056
12,005,996
Accrued and other current liabilities
25,055,091
24,418,756
Debt
4,649,100
1,779,967
Total current liabilities
38,656,247
38,204,719
Debt, net of current portion
135,141,473
147,289,388
Deferred tax liabilities
761,518
3,443,587
Other liabilities
12,243,107
486,363
Total liabilities
186,802,345
189,424,057
Equity:
Member contributions
113,067,804
64,350,067
Accumulated deficit
(3,994,566)
(35,980,595)
Total member’s equity
109,073,238
28,369,472
Noncontrolling interests
—
5,461,387
Total equity
109,073,238
33,830,859
Total liabilities and equity
$
295,875,583
223,254,916
See accompanying notes to consolidated financial statements.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Consolidated Statements of Operations
4
Successor
Predecessor
Period from
Period from
July 15,
January 1,
2022 through
2022 through
2021 through
December 31,
July 14,
December 31,
2022
2022
2021
Net revenue
$
139,213,843
151,369,333
267,029,162
Operating expenses:
Payroll and employee benefits
86,298,918
101,904,744
163,434,548
Depreciation, amortization and impairment
8,735,389
9,774,439
16,673,119
Vehicle, equipment and station
18,800,943
22,165,771
33,871,193
Auto and professional/general insurance
6,213,527
6,055,619
10,164,657
Acquisition and transaction related
606,830
2,410,945
14,725,779
General and administrative
15,036,240
14,646,525
20,067,973
Other (income) expense, net
(112,166)
(887,816)
(2,432,083)
(Gain) loss on disposition of equipment and leasehold
improvements, net
672,234
218,431
(12,893)
Total operating expenses
136,251,915
156,288,658
256,492,293
Operating income (loss)
2,961,928
(4,919,325)
10,536,869
Interest expense
(6,714,601)
(7,033,103)
(10,658,156)
Loss before income taxes
(3,752,673)
(11,952,428)
(121,287)
Income tax expense
(241,893)
(756,360)
(1,702,888)
Net loss
(3,994,566)
(12,708,788)
(1,824,175)
Net income attributable to noncontrolling interests
—
(164,718)
(464,365)
Net loss attributable to Member
$
(3,994,566)
(12,873,506)
(2,288,540)
See accompanying notes to consolidated financial statements.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Consolidated Statements of Changes in Member’s Equity
5
Total
Member
Accumulated
member’s
Noncontrolling
Total
Predecessor
contributions
deficit
equity
interests
equity
Balance as of December 31, 2020
$
78,042,385
(33,692,055)
44,350,330
4,997,022
49,347,352
Member contributions
4,811,250
—
4,811,250
—
4,811,250
Member distributions
(18,503,568)
—
(18,503,568)
—
(18,503,568)
Net (loss) income
—
(2,288,540)
(2,288,540)
464,365
(1,824,175)
Balance as of December 31, 2021
$
64,350,067
(35,980,595)
28,369,472
5,461,387
33,830,859
Successor
Balance as of July 15, 2022
$
—
—
—
—
—
Net assets contributed by members
103,067,804
—
103,067,804
—
103,067,804
Member contributions
10,000,000
—
10,000,000
—
10,000,000
Net loss
—
(3,994,566)
(3,994,566)
—
(3,994,566)
Balance as of December 31, 2022
$
113,067,804
(3,994,566)
109,073,238
—
109,073,238
See accompanying notes to consolidated financial statements.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Consolidated Statements of Cash Flows
6
Successor
Predecessor
Period from
Period from
July 15,
January 1,
2022 through
2022 through
2021 through
December 31,
July 14,
December 31,
2022
2022
2021
Cash flows from operating activities:
Net loss
$
(3,994,566)
(12,708,788)
(1,824,175)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation, amortization and impairment
8,735,389
9,774,439
16,673,119
(Gain) Loss on disposition of equipment and leasehold improvements
672,234
218,430
(12,893)
Amortization of debt issuance costs and discounts
305,595
594,932
1,391,107
Adjustment of earnout liability
—
624,225
10,678,060
Deferred taxes
(661,823)
(126,253)
(194,735)
Changes in operating assets and liabilities, net of effect of acquisitions:
Accounts receivable
(9,327,843)
(3,803,171)
(18,390,294)
Inventory
(97,755)
33,838
(844,546)
Prepaid expenses and other assets
3,046,108
(1,944,755)
(2,144,731)
Accounts payable
(1,085,599)
(276,889)
3,987,779
Accrued and other liabilities
(1,295,259)
2,995,263
(3,103,666)
Net cash provided by (used in) operating activities
(3,703,519)
(4,618,729)
6,215,025
Cash flows from investing activities:
Acquisitions and investments, net of cash acquired
(231,917,076)
—
(20,705,679)
Capital expenditures
(4,412,677)
(5,271,543)
(18,909,862)
Proceeds from sale of equipment and leasehold improvements
290,296
154,997
599,910
Net cash used in investing activities
(236,039,457)
(5,116,546)
(39,015,631)
Cash flows from financing activities:
Proceeds from revolving loans
8,407,734
2,800,000
7,000,000
Payments on revolving loans
(6,407,734)
(902,604)
—
Proceeds from term loans
140,000,000
—
45,193,000
Payments on term loans
—
—
(4,150,198)
Proceeds from promissory notes
—
11,527,766
4,374,304
Payments on promissory notes
(3,610,793)
(3,260,793)
(3,132,956)
Payments of finance lease obligations
(15,090)
—
—
Deferred financing costs
(3,946,818)
—
(803,860)
Member contributions
107,094,791
—
—
Distributions
—
—
(18,503,568)
Payment of earnout liability
(1,209,485)
—
(250,000)
Other
—
—
(4,962)
Net cash provided by financing activities
240,312,605
10,164,369
29,721,760
Net increase (decrease) in cash and cash equivalents
569,629
429,094
(3,078,846)
Cash and cash equivalents – beginning of period
—
801,803
3,880,649
Cash and cash equivalents – end of period
$
569,629
1,230,897
801,803
Supplemental disclosures of cash flow information:
Interest paid
$
6,576,928
5,840,438
9,278,490
Income taxes paid, net of refunds
961,383
1,518,327
725,554
Supplemental disclosures of noncash activities:
Accounts payable for capital expenditures
$
1,341,472
996,908
3,032,924
Ownership interests rolled over into the Company at July 15, 2022
5,973,013
—
—
Member contribution of ODV interest
—
—
2,186,250
Conversion of earnout to units of Priority Holdings
—
—
2,625,000
Conversion of accrued interest to note
—
—
1,186,616
Conversion of earnout to note
—
—
7,665,000
See accompanying notes to consolidated financial statements.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
7
(Continued)
(1) The Company and Principles of Consolidation
Nature of Business and Operations
Priority OnDemand, LLC, a Delaware limited liability corporation, along with its operating subsidiaries
Ambucare, LLC, Central Emergency Medical Service, LLC, EMS Fleet Services, LLC, First Call
Ambulance, LLC, Frontier Ambulance, LLC, Kunkel Ambulance Service, Inc., LifeCare Medical Transports,
LLC, Maricopa Ambulance, LLC, Medshore Ambulance Service, LLC, National Emergency Medical
Services, Inc., OnDemand Visit, Inc., Priority Ambulance Billing, LLC, Priority Emergency Medical Service,
LLC, Puckett Emergency Medical Services, LLC, Puckett Medvan, LLC, Randseco, LLC, Seals Ambulance
Service, Inc., Shoals Ambulance, LLC and Trans Am Ambulance Services, Inc. (collectively, the Company
or Priority OnDemand) was founded in December 2013.
The Company is a leading provider of medical ambulance response services, which consists primarily of
emergency and nonemergency ambulance services throughout the United States, with operations focused
in Alabama, Arizona, Georgia, Indiana, Mississippi, New York, South Carolina, Tennessee and Virginia.
These services are provided under contracts and agreements with government entities, hospitals, nursing
homes and other healthcare facilities and organizations. Included as part of medical ambulances response
services the Company also manages a patient transfer center under a master services agreement with a
major healthcare organization.
In 2021 the Company acquired two software solutions companies. First, Randseco, LLC a software
solutions company that connects disparate healthcare technology systems to streamline patient
transportation logistics for hospitals, patients and payers. Second, OnDemand Visit, Inc. an early stage
virtual telehealth application enabling the Company to combine telehealth and emergency medical services
platforms with physicians and mid-level practitioners to provide care.
The Company was a wholly owned subsidiary of Priority Ambulance Holdings, LLC (a Delaware limited
liability corporation) throughout 2021 and until July 15, 2022 when Priority Ambulance Holdings, LLC sold
100% of its ownership to Priority Ambulance Blocker Corp. (a Delaware corporation) and to Priority
OnDemand Company Purchaser, LLC (a Delaware limited liability corporation) in the security purchase
agreement (“SPA”) entered into on March 10, 2022, which closed on July 15, 2022. In the SPA, Priority
Ambulance Holdings, LLC, sold all of the rights, title and equity in Priority OnDemand, LLC’s membership
interests for approximately $265,000,000, subject to certain adjustments and contingent consideration in
the form of earnouts based on the performance of the Company after the close of the transaction.
Priority Ambulance Blocker Corp. and Priority OnDemand Company Purchaser, LLC are referred to herein
collectively as the “Member.” Various investors held preferred shares of Priority Ambulance Holdings, LLC
throughout 2021 and until July 15, 2022 and are referred to herein as “Holders.”
As a result of the SPA, the Member elected to apply pushdown accounting to the Company’s consolidated
financial statements under the provisions of purchase accounting for business combinations. References to
the “Predecessor” or “Predecessor Period” refer to Priority OnDemand, LLC, for the year ended
December 31, 2021, and for the period from January 1, 2022 to July 14, 2022. References to “Successor”
or “Successor Period” refer to the Company on or after July 15, 2022, from the closing date of the SPA.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
8
(Continued)
The Company does not have any components of other comprehensive income within its consolidated
financial statements, and, therefore, does not separately present a statement of comprehensive income in
its consolidated financial statements.
Principles of Consolidation
The accompanying consolidated financial statements have been prepared in accordance with accounting
principles generally accepted in the United States of America (GAAP), and intercompany balances and
transactions have been eliminated in consolidation. Unless the context requires otherwise, references in
these financial statements to the Company include its consolidated subsidiaries.
(2) Summary of Significant Accounting Policies
(a) Use of Estimates
The preparation of consolidated financial statements in accordance with GAAP requires management
to make estimates and assumptions that affect the reported amounts of assets, liabilities, and related
disclosure of contingent assets and liabilities at the date of the financial statements and the reported
amounts of revenue and expenses recognized during the reporting period. Significant estimates have
been made by management in connection with the net realizable value of accounts receivable, the
valuation for deferred tax assets, workers’ compensation and auto liability claim reserves, fair value of
reporting units for purposes of goodwill impairment testing and future cash flows associated with
long-lived assets. These estimates are made and evaluated on an ongoing basis using information that
is currently available, as well as various other assumptions believed to be reasonable under the
circumstances. Actual results could differ from those estimates and those estimates could be different
under different assumptions or conditions.
(b) Concentration of Credit Risk
Financial instruments, which potentially subject the Company to concentrations of credit risk, consist
principally of cash and cash equivalents and accounts receivable. Deposits with financial institutions
exceeding the Federal Deposit Insurance Corporation federally insured limits as of December 31, 2022,
were $289,631. No losses have been experienced to date. Concentrations of credit risk with respect to
accounts receivable are limited due to large numbers of customers and their geographical dispersion.
(c) Acquisitions
The Company accounts for acquisitions as business combinations. Under this method of accounting,
assets acquired, liabilities assumed and any noncontrolling interest in the acquiree are recognized at
their acquisition date fair value, while transaction costs are expensed as incurred.
Consistent with the discussion of the SPA above, the Company applied the provisions of pushdown
accounting pursuant to Accounting Standards Codification No. 805 to the Company’s consolidated
financial statements. Acquisition-related expenses that are contingent on the execution of the
transaction are not recognized in either the Predecessor or the Successor periods. Rather, these
expenses have been recognized “on the line” (the black line separating the Predecessor and
Successor periods).
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
9
(Continued)
(d) Revenue
Medical Transportation
Net revenue is recorded at the transaction price estimated by the Company to reflect the total
consideration due in exchange for providing patient care or services. In the ambulance industry these
amounts are traditionally due from government programs such as Medicare and Medicaid, commercial
insurance carriers, nursing homes or hospital facilities, the individual receiving care and other
third-party payors (collectively, the Payors). The Company invoices the Payors within days of
performing the service. The service provided is considered a single performance obligation as
determined at the time patient care is provided. Revenue is recognized at the point in time the
performance obligations are satisfied.
The Company determines the transaction price based on the patient acuity at time of care, mileage
incurred, and under certain contracts medical supplies utilized during the transport, reduced by
Medicare and Medicaid governmental contractual adjustments, or certain commercial insurance carrier
negotiated in-network pricing. In addition, in certain situations, the Company provides services to
patients regardless of their ability to pay. Services to these patients are not considered to be charity
care and are included in net revenue based on the estimated consideration expected to be received.
Technology
Net revenue is recorded at the transaction price estimated by the Company to reflect the total
consideration due in exchange for providing products and services. The Company’s invoicing to the
Payors doesn’t always align with when the products or services are provided, typically occurring in
advance. The products and services are generally capable of being distinct and accounted for as
separate performance obligations. Revenue is recognized at a point in time when the promised goods
and services are transferred, in an amount that reflects the consideration allocated to the respective
performance obligation. The Company began recognizing technology revenue during the year ended
December 31, 2021. Net revenue of approximately $650,000, $700,000, and $600,000 for the
Successor Period, the period from January 1, 2022 to July 14, 2022, and the year ended December 31,
2021, respectively, is included in “Other” in the table below.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
10
(Continued)
The following table summarizes the Company’s net revenue during the Successor Period, Predecessor
Period and year ended December 31, 2021 by primary payor:
Successor
Predecessor
Period from
Period from
Period from
July 15,
January 1,
January 1,
2022 through
2022 through
2021 through
December 31,
July 14,
December 31,
2022
2022
2021
Medicare
$
49,763,218
36 %
52,765,643
35 %
103,752,721
39 %
Commercial
31,522,685
23
33,784,350
22
58,514,080
22
Facility
10,777,339
8
25,331,242
17
45,692,536
17
Medicaid
24,435,619
18
20,324,174
13
38,710,987
14
Self-pay
13,963,509
10
12,347,531
8
10,257,126
4
Other
8,751,473
5
6,816,393
5
10,101,712
4
$ 139,213,843
100 %
151,369,333
100 %
267,029,162
100 %
(e) Accounts Receivable
Accounts receivable are recorded at net realizable value based on certain assumptions determined for
each payor. For third-party payors including Medicare and Medicaid, the net realizable value is based
on contractual adjustments, historical collection trends and other relevant information.
Significant changes in payor mix, economic conditions or trends in federal and state government
healthcare coverage could affect the net realizable value of accounts receivable. The Company
continually reviews the net realizable value of accounts receivable by monitoring historical cash
collections.
(f) Fair Value
Fair value is a market-based measurement and is the price that would be received to sell an asset or
paid to transfer a liability in an orderly transaction between market participants at the measurement
date. Depending on the nature of the asset or liability, various techniques and assumptions can be
used to estimate the fair value. Financial assets and liabilities are measured using inputs from three
levels of the fair value hierarchy, as follows:
Level 1 – Inputs are quoted prices for identical assets or liabilities in active markets.
Level 2 – Inputs include quoted prices for similar assets or liabilities in active markets, quoted prices for
identical or similar assets or liabilities in markets that are not active, or inputs other than quoted prices
that are observable for the asset or liability.
Level 3 – Unobservable inputs, only used to the extent observable inputs are not available, reflect the
Company’s assumptions about the pricing of an asset or liability.
The Company uses fair value measurements to record the fair value of certain assets and liabilities and
to estimate fair value of financial instruments not recorded at fair value but required to be disclosed at
fair value.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
11
(Continued)
(g) Cash and Cash Equivalents
The Company considers all highly liquid financial instruments with original maturities of three
(3) months or less to be cash equivalents. Under the Company’s cash management practices,
outstanding checks are netted against cash when there is sufficient cash available in the Company’s
bank accounts to cover the outstanding amount and a legally enforceable right of offset exists. Where
there is no legally enforceable right of offset against cash balances and a form of overdraft protection
does not exist, outstanding checks are classified as accounts payable within the accompanying
consolidated balance sheets and the change in the related balances is reflected in operating activities
in the accompanying consolidated statements of cash flows. There was $244,719 and $1,690,540 of
outstanding checks included in accounts payable as of December 31, 2022 and 2021, respectively.
(h) Inventory
Inventory consists of disposable medical supplies and are carried at the lower of cost or net realizable
value. Cost is determined on a first-in, first-out basis.
(i) Equipment and Leasehold Improvements
Equipment and leasehold improvements are carried at cost, less accumulated depreciation and are
depreciated over the estimated useful life using the straight-line method. Equipment and vehicles are
depreciated over three (3) years to ten (10) years. Leasehold improvements are capitalized and
depreciated over the shorter of the contractual lease term or the estimated useful life. Depreciation
expense was $7,800,010, $7,559,476 and $13,095,157 for the Successor Period, the period from
January 1, 2022 to July 14, 2022, and the year ended December 31, 2021, respectively.
Maintenance and repair costs that do not improve or extend the useful life of assets are expensed as
incurred.
(j) Goodwill
Goodwill represents the excess of the purchase price of an acquired company over the net fair value
assigned to assets acquired, liabilities assumed and any noncontrolling interest in the acquiree.
Goodwill is assessed for impairment annually or more frequently if events or changes in circumstances
make it likely that impairment may have occurred. The Company performs its annual goodwill
impairment test as of November 30. The Company has two (2) reporting units.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
12
(Continued)
In evaluating goodwill for impairment, the Company may assess qualitative factors to determine
whether it is more likely than not (a likelihood of more than 50%) that the fair value of a reporting unit is
less than its carrying amount. If the qualitative assessment indicates that it is more likely than not that a
reporting unit’s fair value is not greater than its carrying amount, the Company must perform a
quantitative impairment test. The fair value of a reporting unit is determined by a market approach
based on each reporting unit’s estimated discount rate and long-term growth rate or by (or in
combination with) an income approach based on discounted estimated future cash flows from each
reporting unit. If the estimated fair value of a reporting unit exceeds the carrying amount of a reporting
unit, goodwill is not impaired. If the estimated fair value of a reporting unit is less than the carrying
amount of the reporting unit, then a goodwill impairment loss is measured on such difference. The
determination of fair value requires the Company to make significant judgments and estimates about
future events. The estimated fair value of the Company’s reporting units could change if there were
future changes in the Company’s capital structure, cost of debt, interest rates, capital expenditure
levels, ability to perform at levels that were forecasted or changes in the capitalization of the Company.
Due to inherent uncertainty involved in making these estimates, actual results could differ materially
from the estimates. The Company evaluated the significant estimates used to determine the fair value
of each reporting unit, both individually and in aggregate, and concluded they are reasonable. There
were no impairment charges for the Successor Period, the period from January 1, 2022 to July 14,
2022, and the year ended December 31, 2021.
(k) Long-Lived Intangibles
All of the Company’s long-lived intangible assets as of December 31, 2022, resulted from the SPA that
closed on July 15, 2022, and were as follows (see further information in Note 3 Acquisitions):
Indefinite lives
An indefinite useful life is utilized if the Company believes the contract will be extended and renewed
for an indefinite period. The Company evaluates the useful lives of its indefinite-lived intangible assets
each reporting period to determine whether events and circumstances continue to support an indefinite
useful life and performs an impairment analysis consistent with the guidance above for goodwill. The
Company performs its annual impairment test as of November 30. Intangible assets with indefinite
useful lives include:
(i)
Certificate of Need (CON)
A legal document required by certain states to operate a ground ambulance service within a
particular county. Obtaining a CON is a formal process whereby the applicant must prove a
community has need for another ground ambulance provider. Once need is proven, the CON is
issued to a specific applicant and cannot be transferred without a hearing and approval by the
respective state agency. Consequently, obtaining a CON is a significant barrier to entry.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
13
(Continued)
(ii)
911 contracts
Entered into with a city, county or in certain cases directly with a hospital to provide emergency and
nonemergency ambulance transport services. The 911 contracts are renewed regularly and based
on historical experience and management’s knowledge of these contracts, the Company believes
they will be extended and renewed for an indefinite period. As the benefit of the contract extends
for the foreseeable future, the Company considered the intangible asset to have an indefinite life.
(iii)
Trade name
The value of the right to continue to utilize the acquired entity’s operating name. The Company
continues to operate under the names of its operating subsidiaries (see Note 1) and anticipates
doing so for the foreseeable future, and therefore considers the trade name intangible asset to
have an indefinite life.
Finite lives
The Company reviews its finite-lived intangible assets for impairment whenever events or changes in
circumstances indicate that the related carrying amounts may not be recoverable, by comparing the
carrying amount of such assets to the undiscounted future cash flows expected to result from the use
and eventual disposition of the asset or asset group. In cases where the undiscounted cash flows are
less than the related carrying amount, an impairment loss is recognized for an amount equal to the
excess of the carrying amount over the fair value. The fair value is based on quoted market prices or, in
instances where quoted market prices are not available, the present value of future cash flows using a
discount rate commensurate with the risks involved. Intangible assets with finite useful lives include:
(iv)
Non-911 agreements
Do not have any contractual rights or obligations but allow the Company to provide service to
certain hospitals, nursing homes, and other facility-based customers. Based on historical
experience and management’s knowledge of these agreements, the Company believes that each
year a certain percentage of its customer base will turnover, and based on this assessment,
considered these intangible assets to have a finite life and has estimated useful lives of
approximately sixteen (16) years.
(v)
Technology platform and customer relationships
The value of the acquired software technology and relationships with customers who purchase the
technology from the Company. The Company’s technology platforms and customer relationships
have an estimated useful life of approximately three (3) to eight (8) years.
The Company expenses all costs incurred to renew or extend intangible assets.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
14
(Continued)
(l) Equity Investments
During the year ended December 31, 2021 the Company recognized $3,751 of equity method income
included in other (income) expense, net in the accompanying consolidated statements of operations for
investments held during that period in which it could exercise significant influence under the equity
method of accounting. Under this method the investment is initially measured at cost, including
transaction costs and included in other assets. As of December 31, 2022, and 2021, the Company did
not hold any investments accounted for under the equity method investments.
(m) Contingent Consideration
For certain acquisitions, the total purchase price includes payments contingent on the achievement of
certain financial objectives. The fair value of the associated liability is evaluated on an annual basis
based on the expected achievement of the financial objectives.
(n) Noncontrolling Interests
During the Predecessor Period, the noncontrolling interests were attributable to two (2) subsidiaries
(Priority Ambulance Georgia, LLC and Priority Ambulance South Carolina, LLC) in which the Company
did not own 100% of the entity. The Company allocated a portion of these two (2) subsidiaries net
income or loss to the noncontrolling interests during the Predecessor Period. As a result of the SPA,
the Company owned 100% of these entities during the Successor Period.
(o) Income Taxes
The income taxes for the Company’s C-corporation subsidiaries are accounted for using the
asset-and-liability method. Under this method, deferred income tax assets and liabilities are recognized
for the expected future tax consequences attributable to temporary differences between the financial
statements carrying amounts of existing assets and liabilities and their respective tax basis. Deferred
tax assets are also recognized for net operating losses, capital losses and tax credit carryforwards.
Deferred income tax assets and liabilities are measured using enacted tax rates expected to apply to
taxable income in the years in which the related temporary differences are expected to be recovered or
settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income
in the period that includes the enacted rate. The Company’s limited liability subsidiaries are not tax
paying entities for federal income tax purposes. Accordingly, each of these entities’ taxable income or
loss is allocated to the Holders in accordance with provisions of its operating agreement. The Company
recognizes interest and/or penalties related to unrecognized tax benefits in income tax expense in the
accompanying consolidated statements of operations.
(p) Advertising
The Company expenses advertising (which in our industry are more accurately described as marketing
costs) as incurred. Advertising expenses were $198,153, $149,786 and $299,394 for the Successor
Period, the period from January 1, 2022 to July 14, 2022, and the year ended December 31, 2021,
respectively. Advertising expense is included in general and administrative expense in the
accompanying consolidated statements of operations.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
15
(Continued)
(q) 401(k) Plan
The Company has a defined contribution plan (401(k) Plan) covering eligible employees. The
401(k) Plan allows employees to contribute a portion of their compensation on a pretax basis in
accordance with plan and statutory rules. The Company had no match or discretionary contributions for
the Successor Period, the period from January 1, 2022 to July 14, 2022, and the year ended
December 31, 2021.
(r) COVID-19 Pandemic
In January 2020, the Secretary of the U.S. Department of Health and Human Services (HHS) declared
a national public health emergency due to a strain of coronavirus, generally referred to as COVID-19.
The resulting measures to contain the spread and impact of COVID-19 and other developments related
to COVID-19 affected the Company’s results of operations during the Successor Period and the
Predecessor Period. Where applicable, the impact resulting from the COVID-19 pandemic has been
considered, including updated assessments of the recoverability of assets and evaluation of potential
credit losses. As a result of the COVID-19 pandemic, federal and state governments passed legislation
and took other administrative actions intended to assist healthcare providers in providing care to
COVID-19 and other patients during the public health emergency. In March 2020, the federal
government enacted the Coronavirus Aid, Relief and Economic Security Act (the CARES Act) which
included the Provider Relief Fund, the Medicare Accelerated and Advance Payment Program and the
Employee Retention Credit. The following is the Company’s accounting policies for the recognition of
these stimulus monies:
Provider Relief Fund – For the year ended December 31, 2021, the Company received $1,973,172
under the Provider Relief Fund. The recognition of amounts received is conditional upon the provision
of care for individuals with possible or actual cases of COVID-19, certification that payment will be used
to prevent, prepare for and respond to coronavirus and shall reimburse the recipient only for healthcare
related expenses or lost revenue as defined by HHS. Amounts are recognized only to the extent the
Company is reasonably assured that the underlying conditions have been met. For the year ended
December 31, 2021, the Company recognized the full amount of the funds received under the Provider
Relief Fund, which are included in other (income) expense, net in the accompanying consolidated
statements of operations.
Accelerated and Advance Payment (AAP) Program – The AAP Program was a payment intended to
provide necessary funds in circumstances such as a national emergency in order to accelerate cash
flow to the impacted healthcare providers. Eligible healthcare providers were able to receive advanced
payments of up to 100% of Medicare payments received in the previous six-month period to be repaid
through withholding of future Medicare fee-for-service payments. During the year ended December 31,
2021, Medicare recouped $6,937,374 from the Company of the total $11,125,864 of AAP Program
funds the Company had received. The remaining balance of $4,188,490 of AAP Program funds was
due by September 2022 and was fully recouped by Medicare during the period January 1, 2022, to
July 14, 2022.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
16
(Continued)
Employee Retention Credit (ERC) – The ERC is a payroll tax refund from the United States Treasury
Department applicable to businesses who kept employees on payroll during the pandemic throughout
2020 and for the first three quarters of 2021. The ERC offers a payroll tax refund through the IRS to
eligible businesses of up to $5,000 per employee for all of 2020 and up to $7,000 per employee kept on
the payroll for each quarter for Q1 through Q3 of 2021. During the Successor Period the Company
recognized a benefit of $3,950,408, included in payroll and employee benefits in the accompanying
consolidated statements of operations, with a receivable for the same amount that remained
outstanding as of December 31, 2022, within other assets on the consolidated balance sheet for the
ERC refund it expects to receive.
(s) Leases
The Company determines if an arrangement is a lease at its inception. Operating lease arrangements
are comprised primarily of real estate agreements for which the right-of-use (“ROU”) assets are
included in other assets and the corresponding lease liabilities, depending on their maturity, are
included in accrued and other current liabilities or other liabilities in the Consolidated Balance Sheet.
ROU assets represent the right to use an underlying asset for the lease term and lease liabilities
represent the obligation to make lease payments arising from the lease. ROU assets and lease
liabilities are recognized at the lease commencement date based on the estimated present value of
lease payments over the lease term. The lease term includes options to extend the lease. Because the
Company is not reasonably certain to exercise these renewal options, the options are not considered in
determining the lease term, and associated potential option payments are excluded from lease
payments. Leases with a term of 12 months or less are not recorded on the Consolidated Balance
Sheet.
The Company monitors for events or changes in circumstances that require a reassessment of one of
its leases. When a reassessment results in the remeasurement of a lease liability, a corresponding
adjustment is made to the carrying amount of the corresponding ROU asset unless doing so would
reduce the carrying amount of the ROU asset to an amount less than zero. In that case, the ROU asset
is reduced to zero and the remainder of the adjustment is recorded in profit or loss.
The Company uses its estimated incremental borrowing rate in determining the present value of lease
payments considering the term of the lease, which is derived from information available at the lease
commencement date, giving consideration to publicly available data for instruments with similar
characteristics. The Company accounts for the lease and non-lease components as a single lease
component.
(t) Recently Adopted Accounting Pronouncements
In October 2021, the Financial Accounting Standards Board (FASB) issued Accounting Standards
Update (ASU) No. 2021-08, Business Combinations. ASU No. 2021-08 requires that an acquirer
recognize and measure contract assets and liabilities in a business combination as if the acquirer had
originated the contracts. ASU 2021-08 is effective for fiscal years beginning after December 15, 2023.
The Company adopted ASU 2021-08 upon issuance and applied the standard retrospectively to the
beginning of the year. The adoption of ASU 2021-08 did not have a material impact on the Company’s
consolidated financial statements.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
17
(Continued)
In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform. ASU 2020-04 is intended
to ease the potential burden in accounting for or recognizing the effects of the phase out of LIBOR at
the end of 2021. The ASU is optional and provides relief around modification accounting as it
specifically arises from changing reference rates. ASU No. 2020-04 is effective from March 12, 2020,
through December 31, 2022, and the adoption did not have a material impact on the Company’s
consolidated financial statements.
In February 2016, the FASB issued ASU No. 2016-02, Leases. ASU No. 2016-02 amends the existing
accounting standards for lease accounting, including requiring lessees to recognize most leases in the
consolidated balance sheets and making targeted changes to lessor accounting. The new leases
standard requires a modified retrospective approach for all leases existing at, or entered into after, the
date of initial application, with an option to use certain transition relief. ASU No. 2016-02 is effective for
fiscal years beginning after December 15, 2021. The Company adopted the ASU No 2016-02 as of
January 1, 2022, using the effective date method by recording right-of-use assets of $18,007,832, net
of deferred rent liabilities of $390,752 that were reclassified to right-of-use assets, and lease liabilities
of $17,617,080. Under this method, periods prior to 2022 remain unchanged. The Company applied the
practical expedients relating to the leases that commenced before January 1, 2022 whereby the
Company elected to not reassess the following: (i) whether any expired or existing contracts contain
leases; (ii) the lease classification for any expired or existing leases; and (iii) initial direct costs for any
existing leases. See Note 12 Leases for further information and disclosures relating to ASU No
2016-02.
(u) Recently Issued Accounting Pronouncements
In June 2016, the FASB issued ASU No. 2016-13, Measurement of Credit Losses on Financial
Instruments. ASU No. 2016-13 amends the current incurred loss impairment methodology and requires
a broader range of reasonable and supportable information to inform credit loss estimates. The new
standard requires that financial statement assets measured at an amortized cost be presented at the
net amount expected to be collected through an allowance for credit losses that is deducted from the
amortized cost basis. ASU No. 2016-13 will be effective for fiscal years beginning after December 15,
2022 with early adoption permitted. On adoption, the Company does not expect a material impact on its
consolidated financial statements.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
18
(Continued)
(3) Acquisitions
Successor Period
(a) SPA
On July 15, 2022, when Priority Ambulance Holdings, LLC sold 100% of its ownership to Priority
Ambulance Blocker Corp. and to Priority OnDemand Company Purchaser, LLC in the SPA entered into
on March 10, 2022, which closed on July 15, 2022, for $265,000,000, subject to certain adjustments
and contingent consideration in the form of earnouts based on the performance of the Company after
the close of the transaction. As a result of the SPA, the Member elected to apply pushdown accounting
to the Company’s consolidated financial statements under the provisions of purchase accounting for
business combinations. Based on the value of consideration transferred, the purchase price was
determined to be $239,120,986, which included $233,147,973 of cash consideration and $5,973,013 of
interests that certain previous owners rolled over into the acquired company. The purchase price was
allocated to the assets and liabilities acquired based on their respective fair values:
Cash
$
1,230,897
Accounts receivable
49,806,435
Inventory
3,671,481
Prepaid expenses and other current assets
14,470,496
Equipment and leasehold improvements
58,356,483
Intangible assets
79,270,000
Goodwill
74,407,600
Other assets
18,089,531
Accounts payable and accrued liabilities
(40,685,079)
Debt
(4,936,468)
Deferred tax liabilities
(1,423,341)
Other liabilities
(13,137,049)
Total net assets
$
239,120,986
The purchase price was funded in part by $136,053,182 of net proceeds, after debt issuance costs,
from the 2022 Credit Agreement, for which the Company is jointly and severely liable, and has
recorded as an obligation on its consolidated balance sheet.
The $233,147,973 of cash consideration transferred includes $60,805,408 issued to the selling
shareholders, $2,000,000 that was remitted to an escrow account to be released to the selling
shareholders subject to certain working capital and indemnity related adjustments, $13,122,257 was
used to pay off transaction expenses on the sellers’ behalf, and $157,220,308 to extinguish the
Company’s Predecessor debt upon closing the acquisition, including the obligations outstanding under
the 2017 Credit Agreement. These pay offs are not reflected as activity within the accompany
statements of cash flows as they were recognized “on the line” (the black line separating the
Predecessor and Successor periods).
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
19
(Continued)
The consideration transferred also includes two separate contingent consideration arrangements, both
of which have de minimus fair value as of the close date:
•
Cash collection shortfall payment: Subsequent to closing, an updated estimate of the projected
cash shortfall from receivables earned from January 1, 2022, through May 31, 2022, will be
prepared. Any reduction in the estimated cash shortfall from the amount estimated as of the
Acquisition close date used in a formula to determine the amount of additional cash consideration
to be paid to the selling shareholders. Based on the formula, the maximum additional cash
consideration that can be paid is $7,500,000.
•
Earn-out payment: An earn-out payment ranging from zero to $27,000,000 would be earned based
on the Company’s adjusted earnings before interest, taxes, depreciation and amortization
(EBITDA) calculated for the 12-month period from February 1, 2022, through January 31, 2023. No
earn-out payment was expected at the time of the acquisition.
At the time of acquisition, the intangible assets were as follows, with their fair values determined as
indicated:
Estimated useful
Fair value
Fair value determination method
life (in years)
Finite lived:
Non-911 agreements
$
6,770,000
Multiple Period Excess Earnings Method (MPEEM)
16
Tech platforms:
Randesco technology
140,000
MPEEM
3 – 8
Randesco customer relationships
260,000
Distributor Method
3 – 8
Ondemand visit technology
4,120,000
Cost Approach
3 – 8
Total tech platforms
4,520,000
Total finite lived intangible assets
11,290,000
Indefinite lived:
Cons
43,290,000
MPEEM
n/a
911 contracts
13,210,000
MPEEM
n/a
Trade names
11,480,000
Relief From Royalty Method
n/a
Total indefinite lived intangible assets
67,980,000
Total intangible assets
$
79,270,000
The Company incurred acquisition-related expenses during the Predecessor Period of $3,022,258.
Additionally, certain acquisition-related expenses were contingent on the execution of the transaction
and have not been recognized in either the Predecessor or the Successor periods. Rather, these
contingent fees have been recognized “on the line” (the black line separating the Predecessor and
Successor periods), as a policy election made by the Company. Contingent fees incurred totaling
$17,237,954 were recognized on the line.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
20
(Continued)
The goodwill recorded for this acquisition primarily represents the value the Company expects to obtain
from synergies and growth opportunities.
Predecessor Period
The following acquisitions occurred during the Predecessor Period, with financial statement amounts
as they were during the Predecessor Period. The net book values of assets and liabilities, from these
acquisitions, which existed as of July 15, 2022, were revalued, and recorded at fair market value and
remaining useful lives were reassessed and updated accordingly, as a result of the SPA that occurred
on the first day of the Successor Period, as described above.
(b) First Call, LLC (First Call)
In October 2021, Priority acquired 100% of the ownership interest of First Call. First Call operates
emergency and nonemergency ground ambulance transportation in the state of Tennessee. The cash
purchase price of $15,572,351 was funded by term loan and revolving loan borrowings.
The purchase price was allocated to the assets and liabilities acquired based on their respective fair
values:
Cash
$
335,380
Accounts receivable
1,274,917
Inventory
116,330
Prepaid expenses and other current assets
151,569
Equipment and leasehold improvements
3,049,690
Intangible assets
4,310,000
Goodwill
8,013,441
Accounts payable and accrued liabilities
(1,678,976)
Total net assets
$
15,572,351
The Centers for Medicare and Medicaid Services (CMS) challenged certain aspects of an enhanced
Medicaid Reimbursement Program in the State of Tennessee; however, the final valuation of accounts
receivable and accounts payable and accrued liabilities was unchanged during 2021 from amounts
reported in 2022, based upon the final determination of the program.
At the time of acquisition, the intangible assets were comprised of a 911 contract ($1,550,000),
non-911 agreements ($2,550,000) and a trade name ($210,000). The fair value of the 911 contract and
non-911 agreements were determined using the multiple period excess earnings method and include
contributory asset charges. The fair value of the trade name was determined using the relief from
royalty method.
The 911 contract is renewed regularly and based on historical experience and management’s
knowledge of the contract, the Company believes the contract will be extended and renewed for an
indefinite period. As the benefit of the contract extends for the foreseeable future, the Company
considered the intangible asset to have an indefinite life.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
21
(Continued)
The non-911 agreements do not have contracted rights or obligations but allow First Call to provide
service to certain hospitals, nursing homes, and other facility-based customers. Based on historical
experience and management’s knowledge of these agreements, the Company believes that each year
a certain percentage of its customer base will turnover. As such, the Company considered the
intangible asset to have a finite life and it was amortizing the intangible asset over eight (8) years.
The acquired entity continues to operate under the First Call name and the Company anticipates doing
so for the foreseeable future, and therefore considered the trade name intangible asset to have an
indefinite life.
The Company incurred acquisition-related expenses of $140,199 during the year ended December 31,
2021.
The goodwill recorded for this acquisition primarily represents the value the Company expects to obtain
from synergies and growth opportunities.
(c) OnDemand Visit, Inc. (ODV)
In July 2021, Priority acquired 100% ownership interest of ODV. ODV designed and developed a virtual
telehealth software solution to combine telehealth and emergency services platforms with physicians
and mid-level practitioners to provide care. The acquisition was achieved in multiple transactions that
were completed simultaneously: (i) Priority Ambulance Holdings, LLC (Priority Holdings) acquired
51.5% of ODV for $2,186,250 of Class A common units (Common Units) of Priority Holdings, (ii)
Priority Holdings contributed the 50.1% ownership of ODV to Priority Ambulance and (iii) Priority
Ambulance acquired the remaining 48.5% of ODV directly for cash of $2,058,557.
The purchase agreement requires a certain amount of cash and net working capital as of the
acquisition date. The finalization of these calculations did not result in an adjustment to the purchase
price.
The purchase price was allocated to the assets and liabilities acquired based on their respective fair
value:
Cash
$
1,596
Accounts receivable
72,894
Prepaid and other assets
202,184
Equipment and leasehold improvements
20,000
Intangible assets
4,572,700
Goodwill
381,262
Accounts payable and accrued liabilities
(1,005,829)
Total net assets
$
4,244,807
The intangible assets were comprised of technology platform ($4,570,000) and trade name ($2,700).
The fair value of the technology platform was determined under the cost of replacement methodology.
The fair value of the trade name was determined using the relief from royalty method.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
22
(Continued)
The underlying software in the technology platform was determined to have a finite life, as such the
Company was amortizing the intangible asset over four (4) years.
The acquired entity continues to operate under the ODV name and Company anticipates doing so for
the foreseeable future, and therefore considered the trade name intangible asset to have an indefinite
life.
The Company incurred acquisition related expenses of $163,621 for the year ended December 31,
2021.
The goodwill recorded for this acquisition primarily represents the value the Company expects to obtain
from synergies and growth opportunities.
(d) Randseco, LLC (Randseco)
Priority had acquired a 20% ownership interest in Randseco in June 2020 for $800,000. In June 2021,
Priority acquired the remaining 80% of Randseco. Randseco is a software developer located in
Massachusetts focused on designing and developing software solutions for healthcare organizations
and emergency medical transportation organizations. The cash purchase price for the 80% interest of
$3,161,471 was funded with cash flow from operations.
The purchase price was allocated to the assets and liabilities acquired based on their respective fair
value:
Cash
$
23,684
Accounts receivable
218,475
Prepaid and other assets
314,878
Equipment and leasehold improvements
6,000
Intangible assets
1,641,900
Goodwill
1,961,752
Accounts payable and accrued liabilities
(205,218)
Total net assets
$
3,961,471
The intangible assets were comprised of technology platform ($1,120,000), customer contracts
($397,000) and trade name ($124,900). The fair value of the technology was determined using the
multiple period excess earnings method and included contributory asset charges. The fair value of the
customer contracts was determined using the distributor method under the income approach. The fair
value of the trade name was determined using the relief from royalty method.
The acquired entity continues to operate under the Randseco name and the Company anticipates
doing so for the foreseeable future, and therefore has considered the trade name intangible asset to
have an indefinite life.
The Company incurred acquisition related expenses of $62,582 for the year ended December 31,
2021.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
23
(Continued)
The goodwill recorded for this acquisition primarily represents the value the Company expects to obtain
from synergies and growth opportunities.
(e) Newton
In May 2021, Priority acquired through a business combination certain operating assets and liabilities of
an ambulance company located in Newton County, Georgia. The cash purchase price of $403,289 was
funded with cash flow from operations.
The purchase price was allocated to the assets and liabilities acquired based on their respective fair
value:
Inventory
$
34,169
Equipment and leasehold improvements
369,120
Total net assets
$
403,289
The Company incurred acquisition related expenses of $18,885 for the year ended December 31,
2021.
(4) Fair Value Measurements
Financial Instruments Reported at Fair Value – Recurring
The table below presents the assets and liabilities measured at fair value on a recurring basis as of
December 31, 2022 and 2021, aggregated by the applicable level in the fair value hierarchy:
Successor
2022
Level 1
Level 2
Level 3
Total
Contingent consideration
$
—
—
—
—
Predecessor
2022
Level 1
Level 2
Level 3
Total
Contingent consideration
$
—
—
585,260
585,260
The contingent consideration in the table for 2021 relates to an acquisition in 2020 and was valued as of
December 31, 2021, based on the Company’s judgment as to the probability of achieving certain financial
targets obligating the Company to pay additional consideration to the seller. The additional consideration
was settled for $1,209,485 and this amount was paid to the seller during the Successor Period.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
24
(Continued)
The table below presents the reconciliation of the contingent consideration liability measured and recorded
at fair value on a recurring basis using significant unobservable inputs:
Balance as of December 31, 2020
$
1,600,000
Adjustments
10,678,060
Payments
(4,027,800)
Conversion to debt
(7,665,000)
Balance as of December 31, 2021
585,260
Adjustments (period from January 1, 2022 to July 14, 2022)
624,225
Payments (Successor Period)
(1,209,485)
Balance as of December 31, 2022
$
—
Financial Instruments Disclosed at Fair Value
As of December 31, 2022 and 2021, the Company considers the carrying values of cash and cash
equivalents, accounts receivable, accounts payable and accrued and other current liabilities to approximate
fair value for these financial instruments because of the relatively short period of time between origination
of these instruments and their expected realization. As of December 31, 2022 and 2021, the Company
considers the carrying value of debt to approximate fair value for this financial instrument because of the
relatively short period of time since the last amendment or borrowing.
(5) Prepaid Expenses and Other Current Assets
Prepaid expenses and other current assets consist of the following:
Successor
Predecessor
2022
2021
Receivables from insurers
$
90,163
2,444,770
Prepaid insurance and workers’ compensation premiums
5,109,495
3,567,421
Federal & State tax credits
—
344,270
Income taxes receivable
57,277
37,033
Tuition reimbursement & In-House training
159,311
1,037,266
Other
2,686,504
4,733,737
$
8,102,750
12,164,497
Other consists of deposits, prepaid rent, employee advanced Medic or EMT certification loans and other
miscellaneous items.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
25
(Continued)
(6) Equipment and Leasehold Improvements
Equipment and leasehold improvements consist of the following:
Successor
Predecessor
2022
2021
Vehicles
$
37,274,213
55,160,751
Medical and communication equipment
19,630,373
23,655,722
Furniture and fixtures
465,216
509,739
Computer and office equipment
5,685,538
7,748,525
Leasehold improvements
590,193
613,060
63,645,533
87,687,797
Accumulated depreciation and amortization
(9,294,348)
(42,756,359)
Total
$
54,351,185
44,931,438
(7) Goodwill and Intangible Assets
Goodwill
The following table is a rollforward of the carrying amount of goodwill for the Predecessor Period:
Balance as of December 31, 2020
$
57,047,886
LifeCare acquisition adjustment
(246,606)
Ambucare acquisition adjustment
(280,153)
Randesco acquisition
1,961,752
ODV acquisition
381,262
First Call acquisition
8,013,441
Balance as of December 31, 2021
66,877,582
ODV acquisition
284,700
Balance as of July 14, 2022
$
67,162,282
The following table is a rollforward of the carrying amount of goodwill for the Successor Period:
Balance as of July 15, 2022
$
74,407,600
SPA
(16,395)
Balance as of December 31, 2022
$
74,391,205
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
26
(Continued)
Intangible Assets
Intangible assets consist of the following:
Successor
Predecessor
December 31, 2022
December 31, 2021
Gross
Gross
Carrying
Accumulated
Carrying
Accumulated
Amount
Amortization
Net
Amount
Amortization
Net
Finite Lived:
Non-911 Agreements $
6,770,000
(204,242)
6,565,758
27,827,000
(10,213,900)
17,613,100
911 Contracts
—
—
—
589,205
(589,205)
—
Tech Platforms
4,520,000
(731,138)
3,788,862
5,690,000
(672,890)
5,017,110
11,290,000
(935,380)
10,354,620
34,106,205
(11,475,995)
22,630,210
Indefinite Lived:
CONs
43,290,000
—
43,290,000
5,749,581
—
5,749,581
911 Contracts
13,210,000
—
13,210,000
11,970,000
—
11,970,000
Trade Names
11,480,000
—
11,480,000
3,562,600
—
3,562,600
67,980,000
—
67,980,000
21,282,181
—
21,282,181
Total
$
79,270,000
(935,380)
78,334,620
55,388,386
(11,475,995)
43,912,391
Amortization expense was $935,380, $2,214,964 and $3,440,473 for the Successor Period, the period from
January 1, 2022 to July 14, 2022, and the year ended December 31, 2021, respectively. As of
December 31, 2022, the future amortization expense of intangible assets for the next five (5) years is
expected to be:
Amount
Year:
2023
$
1,870,759
2024
1,870,759
2025
1,128,093
2026
441,426
2027
441,426
Thereafter
4,602,157
Total
$
10,354,620
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
27
(Continued)
(8) Accrued and Other Current Liabilities
Accrued and other current liabilities consist of the following:
Successor
Predecessor
2022
2021
Medicare advance payments
$
—
4,188,490
Operating leases
5,102,727
—
Payroll related
6,717,287
6,027,545
Employee benefits
4,898,075
3,587,054
Insurance and workers’ compensation claim reserves
1,658,879
4,172,126
Contingent consideration
—
585,260
Other
6,678,123
5,858,281
Total
$
25,055,091
24,418,756
Other consists of expenses not invoiced, deferred rent, escheatment liabilities, billing refunds, federal and
state taxes and other miscellaneous items.
(9) Debt
The following is a summary of the Company’s outstanding debt:
Successor
Predecessor
2022
2021
Term Loan
$
140,000,000
117,622,553
Seller note
—
23,251,616
Revolving loan
2,000,000
7,000,000
Promissory note
1,431,795
1,773,717
Capital lease
—
16,401
143,431,795
149,664,287
Debt issuance costs and discounts
(3,641,222)
(594,932)
139,790,573
149,069,355
Current portion
(4,649,100)
(1,779,967)
Long-term portion
$
135,141,473
147,289,388
(a) 2017 Credit Facility
In April 2017, the Company entered into a Credit Facility (2017 Credit Facility) consisting of a five-year
term loan and a five-year revolving commitment. The Company was the guarantor of the obligation and
all assets were pledged as collateral under the 2017 Credit Facility. As of December 31, 2021,
$117,622,553 of the term loan and $7,000,000 of the $15,000,000 revolving loan, respectively, was
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
28
(Continued)
outstanding. Also, as of December 31, 2021, $5,188,368 of letters of credit were outstanding. The 2017
Credit Facility was terminated in July 2022 as part of the SPA that closed on July 15, 2022, and all
outstanding obligations were repaid with proceeds from the SPA.
(b) Seller Note
In October 2020, the Company executed a $14,400,000 promissory note with the sellers of LifeCare
(Seller Note). During the year ended December 31, 2021, $7,665,000 of earnout and $1,186,616 of
accrued interest were added to the principal balance. As of December 31, 2021, $23,251,616 was
outstanding on the Seller Note. The Seller Note bore interest of 8.00% per annum, which was added to
the principal balance annually. The Seller Note was repaid in July 2022 with proceeds from the SPA
that closed on July 15, 2022.
(c) Promissory Note
In June 2021, the Company executed a $4,374,304 Promissory Note that bears interest at 5.49% per
annum that required monthly payments and had an outstanding balance of $1,773,717 as of
December 31, 2021, which was paid in full in March 2022.
In March 2022, the Company entered a $2,000,000 subordinated promissory note and in June 2022,
the Company entered a $3,213,660 subordinated promissory note, both of which were repaid in
July 2022 with proceeds from the SPA that closed on July 15, 2022.
In July 2022, prior to the SPA that closed on July 15, 2022, the Company executed a $6,314,106
Promissory Note that bears interest at 6.99% per annum that requires monthly payments and had an
outstanding balance of $1,431,795 as of December 31, 2022.
(d) 2022 Credit Facility
Contemporaneous with the close of the SPA on July 15, 2022, certain of the Company’s existing
indebtedness at that time, including obligations under the 2017 Credit Facility, were extinguished using
the proceeds from the transaction. The acquiring entity funded the transaction through a combination of
equity and debt financing. The debt financing was in the form of a new credit facility (the 2022 Credit
Facility). Priority OnDemand Midco 2, L.P., which became the 100% owner of Priority Ambulance
Blocker Corp. and Priority OnDemand Company Purchaser, LLC, is the borrower and the Company is
jointly and severally liable under the 2022 Credit Facility, with all assets of the Company pledged as
collateral. The 2022 Credit Facility consists of a six-year $140,000,000 term loan (Term Loan) and a
five-year $25,000,000 revolving commitment (Revolving Loan), and $50,000,000 of aggregate principal
available in the future under delayed draw commitments. The Term Loan and Revolving Loan mature
in May 2028.
The 2022 Credit Facility requires the Company to meet certain financial tests, including adjusted
EBITDA, interest charge coverage ratio, fixed charge coverage ratio, total net funded debt to EBITDA
ratio and a limit on capital expenditures. The Credit Facility also contains covenants which, among
other things, limit the incurrence of additional indebtedness, dividends, transactions with affiliates,
asset sales, acquisitions without prior review and approval, mergers, prepayments of other
indebtedness, liens and encumbrances, and other matters customarily restricted in such agreements.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
29
(Continued)
The Company was in compliance with all the applicable covenants under the Credit Facility as of
December 31, 2022.
Term Loan
As of December 31, 2022, $140,000,000 of the Term Loan was outstanding. The Term Loan bears
interest based on the Secured Overnight Financing Rate (SOFR) plus a margin ranging from 5.25% to
5.75% per annum (subject to a SOFR adjustment of 1.0%) based on the Company’s leverage ratio. As
of December 31, 2022, the margin was 5.50% per annum and the SOFR was 4.758%, for a total rate of
10.258%. The Term Loan requires quarterly principal payments with a final installment payment due at
maturity. The Term Loan may be prepaid without penalty (other than payment of certain losses and
expenses incurred by the lender as a result of such prepayment) at any time at the option of the
Company.
Revolving Loan
The $25,000,000 Revolving Loan includes a letter of credit sub-line, whereby $15,000,000 of the facility
can be utilized to issue letters of credit. Outstanding letters of credit reduce the borrowing capacity of
the Revolving Loan. As of December 31, 2022, there were $6,102,604 of outstanding letters of credit.
Borrowings on the Revolving Loan bear interest at Term SOFR plus a margin of 3.5%. As of
December 31, 2022, the total interest rate was approximately 8.258% per annum. The Revolving Loan
is also subject to a 0.50% commitment fee, which is equal to the total amount of the facility minus any
outstanding draws and/or letters of credit. At issuance all letters of credit are charged a fee of 3.5% of
the total of each letter of credit.
(e) Future Debt Maturities and Principal Payments
The following table summarizes the debt maturities and scheduled principal payments as of
December 31, 2022:
Year:
2023
$
1,391,272
2024
1,377,411
2025
1,363,689
2026
1,350,103
2027
1,336,652
Thereafter
133,180,873
Total
$
140,000,000
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
30
(Continued)
(10) Workers’ Compensation and Property/Casualty Insurance Programs
The Company carries a broad range of insurance policies, including workers’ compensation, auto liability,
professional/general liability, property, auto yard coverage, and other lines of coverage in order to minimize
the risk of loss due to accident, injury, automobile and professional liability claims resulting from operations
and to comply with certain legal and contractual requirements. The Company retains certain levels of
exposure and purchases coverage from third-party insurers for exposure in excess of those levels. The
Company establishes reserves for both claims reported and incurred but not reported on a gross basis. A
receivable is recognized for amounts expected to be recovered from insurers in excess of the retention
limits. The Company regularly evaluates the financial capacity of its insurers to assess the recoverability of
the receivable.
(a) Captive Insurance Program
The Company (Captive Member) has an equity interest in a captive insurance (Captive) company. The
Captive provides statutory workers’ compensation coverage and the first $1,000,000 of primary auto
liability coverage. All of the Company’s workers’ compensation and primary auto liability are covered
under the Captive except in states that require participation in state fund workers’ compensation
programs. The Captive evaluates actual and actuarially developed insurance claims history and
charges the Captive Member an annual premium by line of coverage accordingly. The annual
premiums are then allocated as follows: (a) Fund A covering the first $100,000 of each occurrence,
(b) Fund B covers the remainder of the Captive Member’s loss layer of $400,000 total per occurrence
effective with 2021 renewal (previously $300,000) plus a proportional share of allocated loss
adjustment expense, and (c) administrative costs that include reinsurance, fronting costs, claims
administration, and other general costs. In any given plan year, the Captive Member can be charged a
premium experience adjustment of up to 100% of its Fund A premium allocation to cover adverse loss
experience. In addition, by plan year, if the Captive Member’s Fund B contribution is exhausted and no
excess premiums remain in the Fund A layer, then the other Captive members fund the Captive
Member’s Fund B balance. If another Captive member exhausts their Fund B, the Captive Member
may be charged a proportional share of allocated losses on behalf of the other member. Both the
workers’ compensation and the primary auto liability program are written as occurrence-based policies.
Each policy year’s claims experience and financial results stand-alone by member. For any given policy
year, if the Captive Member claims experience, plus the allocated loss adjustment expense are less
than the premiums paid the Captive may return the remaining balance to the Captive Member.
(b) Other Insurance Programs
The Company purchases first dollar coverage on the majority of its insurance programs but did retain
levels of self-insured retention on professional/general liability programs ($100,000/occurrence
effective with 2021 renewal, previously $25,000/occurrence), auto yard coverage ($25,000/occurrence)
and directors and officers coverage ($100,000/occurrence).
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
31
(Continued)
(c) Receivables from Insurers and Claims Reserves
The following table presents the classification in the accompanying consolidated balance sheets of the
receivables from insurers and claim reserves as of December 31, 2022 and 2021:
Successor
Predecessor
2022
2021
Receivables from insurers:
Prepaid expenses and other current assets
$
90,163
2,444,770
Insurance and workers’ compensation claim reserves:
Accrued and other current liabilities
1,658,879
4,172,126
Other liabilities
755,398
486,363
Total
2,414,277
4,658,489
Net liabilities
$
2,324,114
2,213,719
(11) Commitments and Contingencies
(a) Indemnifications
The Company is a party to a variety of agreements entered into in the ordinary course of business
pursuant to which it may be obligated to indemnify other parties for certain liabilities that arise out of or
relate to the subject matter of the agreements. Some of the agreements entered into by the Company
require it to indemnify other parties against losses due to property damage, including environmental
contamination, personal injury, failure to comply with applicable laws, the Company’s negligence or
reckless or willful misconduct, or breach of representations, warranties and covenants.
The Company provides for indemnification of directors, officers and other persons in accordance with
limited liability agreements, certificates of incorporation, bylaws, articles of association or similar
organizational documents. In addition, the Company has entered into indemnification agreements with
certain members of management of the Company. The Company maintains directors’ and officers’
insurance, which should enable it to recover a portion of any future amounts paid, although there can
be no assurance that the amounts available under such policies would be sufficient to satisfy fully the
Company’s payment obligations.
While the Company’s future obligations under certain agreements may contain limitations on liability for
indemnification, other agreements do not contain such limitations, and under such agreements, it is not
possible to predict the maximum potential amount of future payments due to the conditional nature of
the Company’s obligations and the unique facts and circumstances involved in each particular
agreement. Historically, payments made by the Company under any of these indemnities have not had
a material effect on the Company’s business, financial condition, results of operations or cash flows.
Additionally, based on facts and circumstances currently known to the Company, it does not believe
that any amounts that it may be required to pay under these indemnities in the future will be material to
its business, financial condition, results of operations or cash flows.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
32
(Continued)
(b) Legal Proceedings
From time to time, the Company is party to, or otherwise involved in, lawsuits, claims, proceedings,
investigations and other legal matters that arise in the ordinary course of conducting its business. The
Company cannot predict with certainty the ultimate outcome of any such lawsuits, claims, proceedings,
investigations and other legal matters to which it may be a party, or in which it may otherwise be
involved, due to, among other things, the inherent uncertainties of litigation, government investigations
and proceedings and legal matters in general. The Company may also be subject to requests and
subpoenas for information in independent investigations. An unfavorable outcome in such lawsuits
against the Company or in a government investigation or proceeding could result in substantial
potential liabilities and have a material adverse effect on the Company’s business, financial condition,
results of operations and cash flows. Further, such proceedings and investigations, and the Company’s
actions in response to them, could result in substantial potential liabilities, additional defense and other
costs, increase the Company’s indemnification obligations, divert management’s attention, and/or
adversely affect the Company’s ability to execute its business and financial strategies. The Company
believes that there are no matters that would have a material adverse effect on the Company’s financial
position, results of operations or cash flows.
(c) Regulatory Compliance
The Company is subject to numerous laws and regulations of federal, state and local governments.
These laws and regulations include, but are not limited to, matters such as licensure, accreditation,
government healthcare program participation requirements, reimbursement for patient services and
Medicare and Medicaid fraud and abuse. Within the healthcare industry, government investigations and
allegations concerning possible violations of fraud and abuse statutes and regulations by healthcare
providers is ongoing. From time to time, the Company is subject to investigations relating to Medicare
and Medicaid laws pertaining to its industry. The Company cooperates fully with the government
agencies that conduct these investigations. Violations of these laws and regulations could result in
exclusion from government healthcare programs together with the imposition of significant fines and
penalties, as well as significant repayment obligations for patient services previously billed.
Additionally, under the Company’s existing compliance program, the Company initiates its own
investigations and conducts audits to examine compliance with various policies and regulations,
including periodic reviews of the levels of service and corresponding rates the Company bills to various
payers. Internal investigations or audits may result in significant repayment obligations for patient
services previously billed or the modification of estimates relating to reimbursements. The Company
believes that it is substantially in compliance with fraud and abuse statutes and their applicable
governmental interpretation. The Company believes the outcome of any of these investigations or
audits would not have a material adverse effect on the Company’s financial position, results of
operations or cash flows.
(d) Services Agreement – Related Party
The Company has a services agreement with a Holder. The agreement provides for the Company to
pay a management fee and a fee for certain transactions. Management and transaction fee expense
for the Successor Period, the period from January 1, 2022 to July 14, 2022, and the year ended
December 31, 2021 was $474,866, $300,904, and $644,956, respectively.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
33
(Continued)
(e) Collective Bargaining Agreement
Approximately 8% of the Company’s employees were covered by a collective bargaining agreement as
of December 31, 2022 and 2021. The collective bargaining agreement expires in December 2023.
(12) Leases
The Company has various real estate and equipment lease agreements that generally require fixed rental
payments and may also include escalation and renewal options. There are also certain insignificant finance
leases recorded in the Consolidated Balance Sheet. The Company’s existing leases do not contain
significant restrictive provisions or residual value guarantees.
The components of lease expense are as follows:
Successor
Predecessor
Period from
Period from
July 15,
January 1,
2022 through
2022 through
December 31,
July 14,
2022
2022
Operating lease
$
2,333,480
2,825,803
Variable lease
—
—
Short-term lease
1,117,787
1,174,779
Total lease expense
$
3,451,267
4,000,582
The lease liabilities were included in the following captions in the Consolidated Balance Sheet:
As of
December 31,
2022
Accrued and other current liabilities
$
5,102,727
Other liabilities
11,487,709
$
16,590,436
Operating lease assets of $16,767,687 are included in other assets in the Consolidated Balance Sheet as
of December 31, 2022. As of December 31, 2022, the weighted-average remaining lease-term was
approximately 3.9 years and the weighted-average discount rate was approximately 5.2%.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
34
(Continued)
The reconciliation of the maturities of the operating leases to the lease liabilities recorded in the
Consolidated Balance Sheet as of December 31, 2022 is as follows:
Year:
2023
$
5,263,036
2024
4,780,386
2025
3,976,667
2026
2,800,734
2027
1,156,636
Thereafter
477,282
Total lease payments
18,454,741
Less interest
(1,864,305)
Amounts recorded in the Consolidated Balance Sheet
$
16,590,436
Other information related to leases was as follows:
Successor
Predecessor
Period from
Period from
July 15,
January 1,
2022 through
2022 through
December 31,
July 14,
2022
2022
Supplemental cash flow information:
Cash paid for amounts included in the measurement of lease liabilities:
Cash used in operations for operating leases
$
2,532,675
2,559,546
ROU assets obtained in exchange for operation lease obligations
1,113,288
1,824,243
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
35
(Continued)
Total rent expense for the year ended December 31, 2021, was $6,298,861. There was no material
contingent rentals or sublease income for the year ended December 31, 2021. Rent expense is included in
vehicle, equipment and station expense in the accompanying consolidated statements of operations. As of
December 31, 2021, future minimum lease obligations under noncancelable leases were as follows:
Year:
2022
$
5,024,081
2023
4,708,111
2024
4,277,504
2025
3,572,835
2026
2,305,259
Thereafter
1,479,421
Total
$
21,367,211
(13) Related Party Transactions
The Company rents real estate and obtains software and consulting services with related parties who are
Holders or own the noncontrolling interests. During the Successor Period and the period from January 1,
2022 to July 14, 2022, and the Company incurred $1,034,723 and $1,928,237, respectively, of expenses
with related parties of which $91,554 was payable as of December 31, 2022. As of December 31, 2022,
included in other assets in the consolidated balance sheet is $161,534 of receivables due from Priority
Ambulance Blocker Corp. for various taxes paid by the Company on its behalf.
During the year ended December 31, 2021, the Company incurred $2,272,170 of expenses with related
parties of which $380,710 was payable as of December 31, 2021.
(14) Income Taxes
The Company has five (5) tax paying subsidiaries for federal income tax purposes and the others are
pass-through entities. However, some states impose entity-level taxes on pass-through entities, and those
state tax liabilities are included in the Company’s income tax provision.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
36
(Continued)
The tax effects of temporary differences that give rise to significant portions of deferred tax assets and
liabilities are as follows:
Successor
Predecessor
2022
2021
Deferred tax assets:
Allowance for uncompensated care
$
253,038
178,668
Accrued expenses
202,185
179,524
Other
847,904
410,543
Total
1,303,127
768,735
Deferred tax liabilities:
Intangible assets
—
2,656,086
Equipment and leasehold improvements
1,631,988
1,349,068
Other
432,657
207,168
Total
2,064,645
4,212,322
Net deferred tax liabilities
$
761,518
3,443,587
The provision for income taxes charged to operations in the accompanying consolidated statements of
operations are as follows:
Successor
Predecessor
Period from
Period from
Period from
July 15,
January 1,
January 1,
2022 through
2022 through
2021 through
December 31,
July 14,
December 31,
2022
2022
2021
Current tax expense
$
903,716
882,613
1,897,622
Deferred tax expense
(661,823)
(126,253)
(194,734)
Total
$
241,893
756,360
1,702,888
The effective tax rate for the Successor Period, the period from January 1, 2022 to July 14, 2022, and the
year ended December 31, 2021 related to the C-corporations was 17%, 27%, 26%, respectively. The
effective tax rate for the Successor Period related to the C-corporations is lower than the statutory rate of
21% due primarily to the SPA that closed on July 15, 2022. The effective tax rate for the periods from
January 1, 2022 to July 14, 2022, and the year ended December 31, 2021 related to the C-corporations are
higher than the statutory rate of 21% primarily due to state taxes.
The Company believes that its tax positions meet the more-likely than-not standard required under the
recognition phase of the authoritative guidance; therefore, the Company did not record any liabilities
associated with uncertain tax positions.
PRIORITY ONDEMAND, LLC
(A Wholly Owned Subsidiary of Priority Ambulance Blocker Corp. and
Priority OnDemand Company Purchaser, LLC)
Notes to Consolidated Financial Statements
37
The Company files income tax returns in the United States, Alabama, Arizona, Georgia, Indiana,
Mississippi, New York, South Carolina, Tennessee and Virginia. The statute of limitations for a tax year for
examination by the Internal Revenue Service is generally three (3) years subsequent to the filing of the
associated tax return. The statute of limitations is generally three (3) years to four (4) years for many of the
states the Company operates in. The Company is not under examination for income tax purposes in any
jurisdiction.
(15) Subsequent Events
The Company has evaluated new information and events through April 18, 2023, which is the date these
consolidated financial statements were available to be issued, to determine the need to either update these
consolidated financial statements or to provide additional disclosures about those events.
(a) New borrowings
In January 2023, the Company borrowed $3,500,000 on its Revolving Loan.
In March 2023, the Company borrowed $3,000,000 on its Revolving Loan.
PRIORITYONDEMAND.COM