AMBULANCE BILLING SERVICES

**PLEASE NOTE**
In person drop-off hours are Monday- Friday between the hours of 9:00AM - 4:00PM.
All submissions must be handed in directly to the Agent or an employee of the Municipality along with
delivery confirmation.
We are NOT RESPONSIBLE for deliveries.
TOWNSHIP EAST HANOVER
REQUEST FOR QUALIFICATIONS FOR
AMBULANCE BILLING SERVICES
Township of East Hanover
Contract Term
August1, 2026 through December 31, 2028
SUBMISSION DEADLINE
July 1, 2026
11:00 A.M.
ADDRESS ALL PROPOSALS TO:
DEPARTMENT OF ADMINISTRATION
411 Ridgedale Ave
East Hanover, New Jersey 07936
ATTN:
Joseph Tempesta, Township Administrator

GENERAL INFORMATION & SUMMARY
ORGANIZATION REQUESTING PROPOSAL
Township of East Hanover
411 Ridgedale Ave
East Hanover, NJ 07936
Contact Person: Joseph Tempesta, Township Administrator
TERM OF CONTRACT
August 1, 2026 - December 31, 2028
PURPOSE OF REQUEST
The Township of East Hanover is requesting proposals from qualified individuals and firms to
provide Ambulance Billing Services of a specialized nature to the Township. Proposals will be
evaluated in accordance with the criteria set forth in this RFQ. One or more individuals/firms may
be selected to provide services.
CONTRACT FORM
The successful proposers shall be required to execute the Township's form contract, which
includes indemnification, insurance, termination and licensing provisions. A complete copy of a
draft Township form contract is available upon request.
It is also agreed and understood that the acceptance of the final payment by Contractor
shall be considered a release in full of all claims against the Township arising out of, or by reason
of, the work done and materials furnished under this Contract.

DETAILED REQUIREMENTS OF THE
REQUEST FOR QUALIFICATIONS FOR AMBULANCE BILLING SERVICES
Township of EAST Hanover Fact and Figures - The Township of East Hanover is a municipal
Governmental entity. The Township was incorporated in 1928. The legislative authority and
responsibilities of the Township of East Hanover are vested in the elected Mayor, part of the five-
member Council. The Governing Body sets policy, adopts the operating and capital budgets for the
Township, enacts ordinances and sets the direction of how the Township of East Hanover will provide
government services. The mayor is the Township's chief executive officer and conducts the policies
adopted by the Council.
1. NATURE/ SCOPE OF SERVICES - The Township of East Hanover is requesting
proposals from qualified individuals and firms to provide Ambulance Billing Services.
A) APPOINTMENT
The client hereby appoints the Contractor as the claim's collector and administrator for
the Clients third party ambulance transportation collection, recovery and subrogation
programs, for Government and Private Insurance Carriers only (hereinafter called the
"plan"), and Contractor accepts such appointment.
B) CLAIMS ADMINISTRATIVE AND RELATED SERVICES
To the best of its abilities or as otherwise defined herein, Contractor shall;
a) Receive data from Client on a weekly basis as to the prior week's ambulance services
provided to third parties, in a format agreed upon by the parties to this Agreement, which
data shall include but not limited to:
$ Name(s) and home address (es) of person(s) treated and/or transported
$ Date(s) of birth thereof
$ Social Security number(s) thereof
$ Place of collection (including zip code), and destination of ambulance transport
$ Odometer reading when patient is placed in ambulance
$ Odometer reading upon arrival at hospital
$ Details as the medical necessity of the ambulance transportation, based upon all
Available information available to the East Hanover Fire Department/EMS/First
Aid Squad at the time of transportation.
$ Details to any insurance coverage available to each transportee, which might reasonably
be expected to cover part or all the cost of the transportation.
b) Investigate each reported claim and negotiate and/or co-ordinate the adjustment
and settlement of each claim by any other applicable insurance or billing(s) to the
transportee(s), by written request for reimbursement to the transportee(s) and /or their
insurer(s) and/or the hospital receiving the transportee (where required by contract with
Medicare or the Healthcare Finance Administration)

c) Upon receipt of reimbursement of such reimbursement, it total, record such
receipt, and transmit reimbursement check or checks, net of fees, directly to the designate
bank account for deposit. If partial, continue to attempt recovery of applicable balance,
per items b) through d) above.
d) Provide the Client with periodic weekly reports as to fines collected, or pending
collections.
C) CLIENT'S RESPONSIBILITY
a) Upon receipt of a 911 or similar request for ambulance treatment and/or
transportation, to ensure that all data necessary for the proper conduct of the contractor's
duties (as defined herein) be promptly obtained and transmitted to Contractor in the
agreed manner.
b) In addition to other termination rights provided for below, in the event that the Client
shall fail to take any of the actions required of it anywhere in this Agreement, Contractor
shall have the right to terminate this agreement upon ninety (90) days written notice to the
client.
c) The client shall supply such additional information upon the request of the Contractor
as may be requested for the expeditious processing or collection of reimbursement.
d) If Ambulance run forms currently being used are not adequate, provide forms or
electronic data processing required by the contractor.
e) If (D) is necessary, provide the necessary training.
f) The Contractor shall supply, to the Client, two electronic portable devices (i.e. Microsoft
Surface/Apple iPad) to complete electronic data processing in the field at no cost to the
Client.
g) Provide data to the State of New Jersey Office of Emergency Medical Services or some
other Government Agency requesting Ambulance Data as per TOWNSHIP OF EAST
HANOVER.
2. STANDARD REQUIREMENTS OF TECHNICAL PROPOSAL - Proposers
should submit a technical proposal which contains the following:
A. The name of the proposer, the principal place of business and, if different, the place
where the services will be provided.
B. The education, qualifications, experience, and training of all people who would be
assigned to provide services along with their names and titles.
C. A listing of all other engagements where services of the types being proposed were

provided in the past five (5) years. This should include other Township governments
and other levels of government. Contact information for the recipients of similar
services must be provided. The Township may obtain references from any of the
parties listed.
A description of all other areas of Ambulance Billing Services of the proposer, with
emphasis on a description of those services of interest to a Township government client.
D. Provide examples of cost saving measures realized by your clients based upon your
recommendations.
E. Statement that neither the firm nor any individuals assigned to this engagement
are
suspended, or otherwise prohibited from professional practice by any federal,
state, or
local agency.
F. An Affirmative Action Statement (copy of form attached).
G. A completed Non-Collusion Affidavit (copy of form attached).
H. A statement that the proposer will comply with the General Terms and
Conditions required by the Township and enter into the Township's standard
Professional Services Contract.
I. A copy of the proposer's Business Registration Certificate.
3. COST PROPOSAL - The Client agrees to pay Contractor as consideration for the
foregoing services a percentage of ambulance revenue fees collected for each 12-month period of
the contract.
A) TERM
This agreement shall have an initial term of approximately two and one-half years, commencing
on the date set forth above unless terminated by a written notice given by either party at least
ninety (90) days in advance in the term then in effect. In the event Contractor gives notice of its
intention to terminate, it agrees, upon the prompt written request of the client, to continue to
provide these services for a period of up to ninety (90) days.
MISCELLANEOUS
a) It is understood and agreed that claims first opened during this contract will be
administered to the conclusion of the contract period.
b) It is agreed that the Contractor may not sub-contract any and all services provided
under

this agreement with the prior consent of the client, and such consent will not be unreasonably
withheld.
c) The captions used herein are solely for the convenience of the parties and are not
intended to affect the meaning or construction of the provisions hereof.
d) This agreement is the entire and complete agreement between the parties and may not
be modified except by an instrument in writing duly executed by the parties. Any previous
agreements or understandings, whether oral or in writing, are terminated and superseded by the
provisions of this agreement, and there are no understanding or agreements between the parties
other than those included herein.
4. PROPOSAL EVALUATION - The Township will select the most advantageous proposals
based on all of the evaluation factors set forth at the end of this RFQ. The Township will make
the award(s) that is in the best interest of the Township.
Each proposal must satisfy the objectives and requirements detailed in this RFQ. The
successful proposer shall be determined by an evaluation of the total content of the proposal
submitted. The Township reserves the right to:
a. Not select any of the proposals;
b. Select only portions of a particular proposer's proposal for further consideration;
(However, proposers may specify portions of the proposal that they consider
"bundled".)
c. Award a contract for the services requested at any time within 90 days of the
selection of the most advantageous proposal; every proposal should be valid throughout
this time.
The Township shall not be obligated to explain the results of the evaluation process to any
proposer.
The Township may require proposers to demonstrate any services described in their
proposal prior to award.
5. PROPOSAL LIMITATIONS - This RFQ is not intended to be an offer, order or contract
and should not be regarded as such, nor shall any obligation or liability be imposed on the
Township by issuance of this RFQ. The Township reserves the right at the Township's sole
discretion to refuse any proposal submitted.
6. USE OF INFORMATION - Any specifications, drawings, sketches, models, samples, data,
computer programs, documentation, technical or business information and the like
("Information") furnished or disclosed by the Township to the proposer in connection with this
RFQ shall remain the property of the Township. When in tangible form, all copies of such
information shall be returned to the Township upon request. Unless such information was
previously known to the proposer, free of any obligation to keep it confidential, or has been or is

subsequently made public by the Township or a third party, it shall be held in confidence by the
proposer, shall be used only for the purposes of this RFQ, and may not be used for other purposes
except upon such terms and conditions as may be mutually agreed upon in writing.
7. GENERAL TERMS AND CONDITIONS -
A. The Township reserves the right to reject any or all proposals, if necessary, or to
waive any informality in the proposals, and, unless otherwise specified by the
proposer, to accept any item, items or services in the proposals should it be deemed
in the best interest of the Township to do so.
B. In case of failure by the successful proposer, the Township of East Hanover may
procure the articles or services from other sources, deduct the cost of the
replacement from money due to the proposer under the contract and hold the
proposer responsible for any excess cost occasioned thereby.
C. The proposer shall maintain sufficient insurance to protect against all claims under
Workmen's Compensation, General, Professional and Automobile Liability.
D. Each proposal must be signed by the person authorized to do so.
E. The contract shall be in effect through December 31, 2028, unless otherwise stated.
F. Proposals may be hand delivered or mailed consistent with the provisions of the legal
notice to proposers. In the case of mailed proposals, the Township assumes no
responsibility for proposals received after the designated date and time and will
return late proposals unopened. Proposals will not be accepted by facsimile or e-
mail.
G. In accordance with Affirmative Action Law, P.L. 1975, c.127 (N.J.A.C. 17:27) with
implementation of July 10, 1978, successful proposers must agree to submit
individual employer certifications and number or complete Affirmative Action
employee information report (form AA-302). Also, during the performance of this
contract, the contractor agrees as follows: (a) the contractor or subcontractor,
where applicable, will not discriminate against any employee because of age, race,
creed, color, national origin, ancestry, marital status or affectional or sexual
orientation. The contractor will take affirmative action to ensure that such
applicants are recruited and employed and that employees are treated during
employment, without regard to their age, race, creed, color, national origin,
ancestry, marital status, sex or handicap. Such action should include, but not be
limited to the following: employment, upgrading, demotion or transfer, recruitment
or recruitment advertising; layoff or termination; rates of pay or other forms of
compensation; and section for training, including apprenticeship. The contractor
agrees to post in conspicuous places, available to employees and applicants for
employment, notice to be provided by the Public Agency Compliance Officer setting
forth provisions of this non-discrimination clause: (b)

the contractor or subcontractor, where applicable, will in all solicitations or
advertisements for employees placed by or on behalf of the contractor, state that all
qualified applicants will receive consideration for employment without regard to
age, race, creed, color, national origin, ancestry, marital status, sex or handicap;
(c) the contractor or subcontractor, where applicable, will send to each labor union
or representative or workers with which it has a collective bargaining agreement or
other contract or understanding, a notice, to be provided by the agency contracting
officer advising the labor union or worker's representative of the contractor's
commitments under this act and shall post copies of the notice; (d) the contractor or
subcontractor, where applicable, agrees to comply with any regulations
promulgated by the treasurer pursuant to the P.L. 1975, c.127, as amended and
supplemented from time to time.
H. By submission of the proposal, the proposer certifies that the service to be furnished
will not infringe upon any valid patent, trademark or copyright and the successful
proposer shall, at its expense, defend any and all actions or suits charging such
infringement, and will save the Township harmless in any case of any such
infringement.
I. No proposer shall influence, or attempt to influence, or cause to be influenced, any
Township officer or employee to use his/her official capacity in any manner which
might tend to impair the objectivity or independence of judgment of said officer or
employee.
J. No proposer shall cause or influence, or attempt to cause or influence, any Township
officer or employee to use his/her official capacity to secure unwarranted privileges
or advantages for the proposer or any other person.
K. Should any difference arise between the contracting parties as to the meaning or
intent of these instructions or specifications, the Township Law Department's
decision shall be final and conclusive.
L. The Township of East Hanover shall not be responsible for any expenditure of
monies or other expenses incurred by the proposer in making its proposal.
M. The checklist, affidavits, notices and the like presented at the end of this Request for
Qualifications are a part of this Request for Qualifications and shall be completed
and submitted as part of this proposal.
END OF GENERAL INSTRUCTION

BASIS OF AWARD
(To be completed by Township evaluation committee)
EVALUATION FACTORS
A. Relevance and Extent of Qualifications, Experience, Reputation and Training of
Personnel to be assigned
B. Knowledge of the Township of East Hanover and the subject matter to be addressed
under this engagement
C. Relevance and Extent of Similar Engagements performed
D. Technical Proposal contains all required information
E. Reasonableness of Cost Proposal

REQUEST FOR QUALIFICATIONS CHECKLIST
THIS CHECKLIST MUST BE COMPLETED AND SUBMITTED WITH YOUR PROPOSAL:
Please initial below, indicating that your proposal includes the itemized document.
A PROPOSAL SUBMITTED WITHOUT THE FOLLOWING DOCUMENTS IS CAUSE FOR REFUSAL.
INITIAL BELOW
A. An original and TWO (1) signed copy of your complete proposal.
B. Non-Collusion Affidavit properly notarized
C. Authorized signatures on all forms.
D. Business Registration Certificate(s)
E. Affirmative Action Statement
Note: N.J.S.A 52:32-44 provides that the Township shall not enter into a contract for goods or
services unless the other party to the contract provides a copy of its business registration certificate
and the business registration certificate of any subcontractor at the time that it submits its
proposal. The contracting party must also collect the state use tax where applicable.
THE UNDERSIGNED HEREBY ACKNOWLEDGES
THE ABOVE-LISTED REQUIREMENTS.
NAME OF PROPOSER:
Person, Firm or Corporation
BY: (NAME) (TITLE)