REQUEST FOR PROPOSAL Job No.: 09/0110
Date Due: Monday, March 30, 2009
Cover Sheet DUE NO LATER THAN 2:00 P.M.
LOCAL TIME IN HOUSTON, TEXAS
Proposals received later than the date
and time above will not be considered.
PROPOSAL FOR: Nursing Temporary Personnel for the Harris County Hospital District
(Beginning on or about July 1, 2009 and ending twelve months thereafter)
Carefully read all instructions, requirements and Please return proposal in an appropriately sized envelope
specifications. Fill out all forms properly and completely. or box. PACKAGE MUST SHOW THE JOB NUMBER,
Submit your proposal with all appropriate supplements DESCRIPTION AND BE MARKED "SEALED
and/or samples. PROPOSAL". Designated proposals may be submitted
electronically through the BuySpeed Online system only.
RETURN PROPOSAL TO:
HARRIS COUNTY PURCHASING AGENT
1001 PRESTON AVENUE, SUITE 670
HOUSTON, TEXAS 77002
For additional information, contact: Jeanie Dang at 713.755.6457 or firstname.lastname@example.org
You must sign below in INK; failure to sign WILL disqualify the offer. All prices must be typewritten or written
Total Amount of Proposal $
City, State, Zip Code:
Taxpayer Identification Number (T.I.N.):
Telephone No.: FAX No.: E-mail:
Do you carry Health Insurance on your employees? ___Yes ___No
If yes, what is the percentage of employees insured? _____%
Page 1 of 33
TABLE OF CONTENTS
Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT
APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If any
portion of the package is missing, notify the Purchasing Department immediately.
It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the following
before you return your bid packet.
__X__ 1. Cover Sheet
Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear on this
__X__ 2. Table of Contents
This page is the Table of Contents.
__X__ 3. General Requirements
You should be familiar with all of the General Requirements.
__X__ 4. Special Requirements/Instructions
This section provides information you must know in order to make an offer properly.
__X__ 5. Specifications
This section contains the detailed description of the product/service sought by the County.
__X__ 6. Pricing/Delivery Information
This form is used to solicit exact pricing of goods/services and delivery costs.
__X__ 7. Attachments
__X__ a. Residence Certification/Tax Form
Be sure to complete this form and return with packet.
_____ b. Bid Guaranty & Performance Bond Information & Requirements
This form applies only to certain bids/proposals. All public work contracts over $25,000 require a
Payment Bond and over $100,000 must also have a Performance Bond, in a form approved by the
County. Please read carefully and fill out completely.
_____ c. Bid Check Return Authorization Form
This form applies only to certain bids/proposals. Please read carefully and fill out completely.
_____ d. Vehicle Delivery Instructions
Included only when purchasing vehicles.
__X__ e. Minimum Insurance Requirements
(Included in specific requirements when applicable (does not supersede ―Hold Harmless‖ section of
__X__ f. Worker’s Compensation Insurance Coverage Rule 110.110
This requirement is applicable for a building or construction contract.
_____ g. Financial Statement
When this information is required, you must use this form.
_____ h. Reference Sheet
When this information is required, you must use this sheet.
__X__ i. Other
From time to time other attachments may be included.
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GENERAL REQUIREMENTS FOR PROPOSALS
READ THIS ENTIRE DOCUMENT CAREFULLY. FOLLOW ALL INSTRUCTIONS. YOU ARE RESPONSIBLE FOR FULFILLING ALL
REQUIREMENTS AND SPECIFICATIONS. BE SURE YOU UNDERSTAND THEM.
General Requirements apply to all advertised requests for proposals; however, these may be superseded, whole or in part, by the SPECIAL
REQUIREMENTS/INSTRUCTIONS OTHER DATA CONTAINED HEREIN. Review the Table of Contents. Be sure your proposal package is
ACCESS TO RECORDS
In special circumstances, vendor may be required to allow duly authorized representatives of Harris County, the Harris County Hospital District or
the state and federal government access to contracts, books, documents, and records necessary to verify the nature and extent of the cost of services
provided by vendor.
When specifications are revised, the Harris County Purchasing Agent will issue an addendum addressing the nature of the change. Offerors must sign it
and include it in the returned proposal package.
The successful offeror may not assign, sell or otherwise transfer this contract without written permission of Harris County Commissioners Court.
Harris County reserves the right to award this contract on the basis of LOWEST AND BEST OFFER in accordance with the laws of the State of Texas, to
waive any formality or irregularity, to make awards to more than one offeror, to reject any or all proposals. In the event the lowest dollar offeror meeting
specifications is not awarded a contract, the offeror may appear before the Commissioners Court, Hospital District Board of Managers, the Juvenile Board
or other applicable governing body and present evidence concerning his responsibility after officially notifying the Office of the Purchasing Agent of his
intent to appear.
If this proposal requires submission of proposal guarantee and performance bond, there will be a separate page explaining those requirements. Offers
submitted without the required proposal bond or Cashier's Checks are not acceptable.
Harris County Commissioners Court must award the contract and the County Judge or other person authorized by the Harris County Commissioners
Court must sign the contract before it becomes binding on Harris County or the offeror. Department heads are NOT authorized to sign agreements for
Harris County. Binding agreements shall remain in effect until all products and/or services covered by this purchase have been satisfactorily delivered and
Renewals may be made ONLY by written agreement between Harris County and the offeror. Any price escalations are limited to those stated by the
offeror in the original proposal.
If offeror obtained the proposal specifications in digital format in order to prepare a response, the proposal must be submitted in hard copy
according to the instructions contained in this proposal package. If, in its proposal response, offeror makes any changes whatsoever to the County's
published proposal specifications, the County's proposal specifications as published shall control. Furthermore, if an alteration of any kind to the
County's published proposal specifications is only discovered after the contract is executed and is or is not being performed, the contract is subject to
DISQUALIFICATION OF OFFEROR
Upon signing this proposal document, an offeror offering to sell supplies, materials, services, or equipment to Harris County certifies that the offeror
has not violated the antitrust laws of this state codified in §15.01, et seq., Business & Commerce Code, or the federal antitrust laws, and has not
communicated directly or indirectly the offer made to any competitor or any other person engaged in such line of business. Any or all proposals may
be rejected if the County believes that collusion exists among the offerors. Proposals in which the prices are obviously unbalanced may be rejected.
If multiple proposals are submitted by an offeror and after the proposals are opened, one of the proposals is withdrawn, the result will be that all of
the proposals submitted by that offeror will be withdrawn; however, nothing herein prohibits a vendor from submitting multiple offers for different
products or services.
E-MAIL ADDRESSES CONSENT
Vendor affirmatively consents to the disclosure of its e-mail addresses that are provided to Harris County, the Harris County Flood Control District,
the Harris County Hospital District including its HMO, the Harris County Appraisal District, or any agency of Harris County. This consent is
intended to comply with the requirements of the Texas Public Information Act, Tex. Gov’t Code Ann. §522.137, as amended, and shall survive
termination of this agreement. This consent shall apply to e-mail addresses provided by Vendor, its employees, officers, and agents acting on
Vendor’s behalf and shall apply to any e-mail address provided in any form for any reason whether related to this bid/proposal or otherwise.
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Evaluation shall be used as a determinant as to which proposed items or services are the most efficient and/or most economical for the County. It shall be
based on all factors which have a bearing on price and performance of the items in the user environment. All proposals are subject to negotiations by the
Purchasing Agent and other appropriate departments, with recommendation to the appropriate governing body. Compliance with all requirements,
delivery and needs of the using department are considerations in evaluating proposals. Pricing is NOT the only criteria for making a recommendation.
A preliminary evaluation by Harris County will be held and appropriate proposals will be subjected to the negotiating process. Upon completion of the
negotiations, Harris County will make an award. All proposals that have been submitted shall be available and open for public inspection after the
contract is awarded except for trade secrets or confidential information contained in the proposals and identified as such.
A multi-year lease or lease/purchase arrangement (if requested by the specifications), or any contract continuing as a result of an extension option, must
include fiscal funding out. If, for any reason, funds are not appropriated to continue the lease or contract, said lease or contract shall become null and void
on the last day of the current appropriation of funds. After expiration of the lease, leased equipment shall be removed by the contractor from the using
department without penalty of any kind or form to Harris County. All charges and physical activity related to delivery, installation, removal and
redelivery shall be the responsibility of the offeror.
In the event of any conflict between the terms and provisions of these requirements and the specifications, the specifications shall govern. In the event of
any conflict of interpretation of any part of this overall document, Harris County's interpretation shall govern.
This request for proposals is governed by the competitive bidding requirements of the County Purchasing Act, Texas Local Government Code, §262.021
et seq., as amended. Offerors shall comply with all applicable federal, state and local laws and regulations. Offeror is further advised that these
requirements shall be fully governed by the laws of the State of Texas and that Harris County may request and rely on advice, decisions and opinions of
the Attorney General of Texas and the County Attorney concerning any portion of these requirements.
Any contract entered into by the County that is to be paid from grant funds shall be limited to payment from the grant funding and the
vendor/provider understands that the County has not set aside any County funds for the payment of obligations under a grant contract. If grant
funding should become unavailable at any time for the continuation of services paid for by the grant, and further funding cannot be obtained for the
contract, then the sole recourse of the provider shall be to terminate any further services under the contract and the contract shall be null and void.
Offeror agrees to comply with the Standards for Privacy of Individually Identifiable Health Information of the Health Insurance Portability and
Accountability Act of 1996, PL 104-191, 45 CFR Parts 160-164, as amended, and the Texas Medical Records Privacy Act, Texas Health and Safety
Code Chapter 181, as amended, collectively referred to as "HIPAA", to the extent that the Offeror uses, discloses or has access to protected health
information as defined by HIPAA. Offeror may be required to enter a Business Associate Agreement pursuant to HIPAA.
HOLD HARMLESS AGREEMENT
Contractor, the successful offeror, shall indemnify and hold Harris County harmless from all claims for personal injury, death and/or property damage
resulting directly or indirectly from contractor's performance. Contractor shall procure and maintain, with respect to the subject matter of this proposal,
appropriate insurance coverage including, as a minimum, public liability and property damage with adequate limits to cover contractor's liability as may
arise directly or indirectly from work performed under terms of this proposal. Certification of such coverage must be provided to the County upon request.
INSPECTIONS & TESTING
Harris County reserves the right to inspect any item(s) or service location for compliance with specifications and requirements and needs of the using
department. If an offeror cannot furnish a sample of a bid item, where applicable, for review, or fails to satisfactorily show an ability to perform, the
County can reject the bid as inadequate.
INVOICES AND PAYMENTS
Offerors shall submit an original invoice on each purchase order or purchase release after each delivery, indicating the purchase order number.
Invoices must be itemized. Any invoice which cannot be verified by the contract price and/or is otherwise incorrect will be returned to the offeror for
correction. Under term contracts, when multiple deliveries and/or services are required, the offeror may invoice following each delivery and the
County will pay on invoice. Contracts providing for a monthly charge will be billed and paid on a monthly basis only. Prior to any and all payments
made for goods and/or services provided under this contract, the offeror should provide his Taxpayer Identification Number or social security
number as applicable. This information must be on file with the Harris County Auditor’s office. Failure to provide this information may result in a
delay in payment and/or back-up withholding as required by the Internal Revenue Service.
Maintenance required for equipment proposed should be available in Harris County by a manufacturer-authorized maintenance facility. Costs for this
service shall be shown on the Pricing/Delivery Information. If Harris County opts to include maintenance, it shall be so stated in the purchase order and
said cost will be included. Service will commence only upon expiration of applicable warranties and should be priced accordingly.
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MATERIAL SAFETY DATA SHEETS
Under the "Hazardous Communication Act", commonly known as the "Texas Right To Know Act", an offeror must provide to the County with each
delivery, material safety data sheets which are applicable to hazardous substances defined in the Act. Failure of the offeror to furnish this documentation
will be cause to reject any bid applying thereto.
NEW MILLENIUM COMPLIANCE
All products and/or services furnished as part of this contract must be compliant for the present year and forward. This applies to all computers
including hardware and software as well as all other commodities with date sensitive embedded chips.
POTENTIAL CONFLICTS OF INTEREST
An outside consultant or contractor is prohibited from submitting a proposal for services on a Harris County project of which the consultant or
contractor was a designer or other previous contributor, or was an affiliate, subsidiary, joint venturer or was in any other manner associated by
ownership to any party that was a designer or other previous contributor. If such a consultant or contractor submits a prohibited proposal, that
proposal shall be disqualified on the basis of conflict of interest, no matter when the conflict is discovered by Harris County.
Prices for all goods and/or services shall be negotiated to a firm amount for the duration of this contract or as agreed to in terms of time frame. All prices
must be written in ink or typewritten. Where unit pricing and extended pricing differ, unit pricing prevails.
Fill out and return to Purchasing, ONE (1) complete proposal form in an appropriately sized envelope or box. PACKAGE MUST SHOW THE JOB
NUMBER, DESCRIPTION AND BE MARKED “SEALED PROPOSAL.” An authorized company representative should sign the Proposal Cover
Sheet. Completion of these forms is intended to verify that the offeror has submitted the proposal, is familiar with its contents and has submitted the
material in accordance with all requirements.
Offerors must return all completed proposals to the office of the Harris County Purchasing Agent reception desk at 1001 Preston Avenue, Suite 670,
Houston, Texas before 2:00 P.M. LOCAL TIME IN HOUSTON, TEXAS on the date specified. Late proposals will not be accepted.
PURCHASE ORDER AND DELIVERY
The successful offeror shall not deliver products or provide services without a Harris County Purchase Order, signed by an authorized agent of the Harris
County Purchasing Agent. The fastest, most reasonable delivery time shall be indicated by the offeror in the proper place on the proposal document. Any
special information concerning delivery should also be included, on a separate sheet, if necessary. All items shall be shipped F.O.B. INSIDE
DELIVERY unless otherwise stated in the specifications. This shall be understood to include bringing merchandise to the appropriate room or place
designated by the using department. Every tender or delivery of goods must fully comply with all provisions of these requirements and the specifications
including time, delivery and quality. Nonconformance shall constitute a breach which must be rectified prior to expiration of the time for performance.
Failure to rectify within the performance period will be considered cause to reject future deliveries and cancellation of the contract by Harris County
without prejudice to other remedies provided by law. Where delivery times are critical, Harris County reserves the right to award accordingly.
Harris County encourages the use of products made of recycled materials and shall give preference in purchasing to products made of recycled materials if
the products meet applicable specifications as to quantity and quality. Harris County will be the sole judge in determining product preference application.
SCANNED OR RE-TYPED RESPONSE
If in its response, offeror either electronically scans, re-types, or in some way reproduces the County's published proposal package, then in the event of any
conflict between the terms and provisions of the County's published proposal package, or any portion thereof, and the terms and provisions of the
response made by offeror, the County's proposal package as published shall control. Furthermore, if an alteration of any kind to the County's published
proposal package is only discovered after the contract is executed and is or is not being performed, the contract is subject to immediate cancellation.
If any section, subsection, paragraph, sentence, clause, phrase or word of these requirements or the specifications shall be held invalid, such holding shall
not affect the remaining portions of these requirements and the specifications and it is hereby declared that such remaining portions would have been
included in these requirements and the specifications as though the invalid portion had been omitted.
SILENCE OF SPECIFICATIONS
The apparent silence of specifications as to any detail, or the apparent omission from it of a detailed description concerning any point, shall be regarded as
meaning that only the best commercial practice is to prevail and that only material and workmanship of the finest quality are to be used. All
interpretations of specifications shall be made on the basis of this statement. The items furnished under this contract shall be new, unused of the latest
product in production to commercial trade and shall be of the highest quality as to materials used and workmanship. Manufacturer furnishing these items
shall be experienced in design and construction of such items and shall be an established supplier of the item proposed.
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Offerors are responsible for including all pertinent product data in the returned proposal package. Literature, brochures, data sheets, specification
information, completed forms requested as part of the proposal package and any other facts which may affect the evaluation and subsequent contract
award should be included. Materials such as legal documents and contractual agreements, which the offeror wishes to include as a condition of the
proposal, must also be in the returned proposal package. Failure to include all necessary and proper supplemental materials may be cause to reject the
Harris County is exempt from all federal excise, state and local taxes unless otherwise stated in this document. Harris County claims exemption from all
sales and/or use taxes under Texas Tax Code §151.309, as amended. Texas Limited Sales Tax Exemption Certificates will be furnished upon written
request to the Harris County Purchasing Agent.
If the contract is intended to cover a specific time period, the term will be given in the specifications under SCOPE.
Harris County reserves the right to terminate the contract for default if Seller breaches any of the terms therein, including warranties of offeror or if the
offeror becomes insolvent or commits acts of bankruptcy. Such right of termination is in addition to and not in lieu of any other remedies which Harris
County may have in law or equity. Default may be construed as, but not limited to, failure to deliver the proper goods and/or services within the proper
amount of time, and/or to properly perform any and all services required to Harris County's satisfaction and/or to meet all other obligations and
requirements. Harris County may terminate the contract without cause upon thirty (30) days written notice.
Termination for Health and Safety Violations
Harris County has the option to terminate this contract immediately without prior notice if offeror fails to perform any of its obligations in this contract if
the failure (a) created a potential threat to health or safety or (b) violated a law, ordinance, or regulation designed to protect health or safety.
Harris County reserves the right to test equipment, supplies, material and goods proposed for quality, compliance with specifications and ability to meet
the needs of the user. Demonstration units must be available for review. Should the goods or services fail to meet requirements and/or be unavailable for
evaluation, the offer is subject to rejection.
Title and Risk of Loss of goods shall not pass to Harris County until Harris County actually receives and takes possession of the goods at the point or
points of delivery. Receiving times may vary with the using department. Generally, deliveries may be made between 8:30 a.m. and 4:00 p.m., Monday
through Friday. Offerors are advised to consult the using department for instructions. The place of delivery shall be shown under the "Special
Requirements/Instructions" section of this proposal and/or on the Purchase Order as a "Deliver To:" address.
WAIVER OF SUBROGATION
Offeror and offeror's insurance carrier waive any and all rights whatsoever with regard to subrogation against Harris County as an indirect party to any suit
arising out of personal or property damages resulting from offeror's performance under this agreement.
Offerors shall furnish all data pertinent to warranties or guarantees which may apply to items in the proposal. Offerors may not limit or exclude any
implied warranties. Offeror warrants that product sold to the County shall conform to the standards established by the U.S. Department of Labor under
the Occupational Safety and Health Act of 1970. In the event product does not conform to OSHA Standards, where applicable, Harris County may return
the product for correction or replacement at the offeror's expense. If offeror fails to make the appropriate correction within a reasonable time, Harris
County may correct at the offeror's expense.
VENDORS OWING TAXES
Pursuant to TX Local Government Code 262.0276, the Hospital District Board of Managers has adopted a policy which requires that vendors’ taxes
be current as of the date bids/proposals are due. Bidders/proposers with delinquent county taxes on the due date will not be eligible for award.
Whether or not a vendor’s taxes are delinquent will be determined by an independent review of the Tax Office records. Vendors who believe a
delinquency is reflected in error must contact the Tax Office to correct any errors or discrepancies prior to submitting their bid in order to ensure that
their bid will be considered. Tax records are available online at the Tax Office website—www.hctax.net. Prior to submitting a bid, vendors are
encouraged to visit the Tax Office website, set up a portfolio of their accounts and make their own initial determination of the status of their tax
accounts. This policy is effective for all bids due on or after July 1, 2004.
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The following requirements and instructions supersede General Requirements where applicable. The term
“Harris County” is understood to include the Harris County Hospital District (District) and Community Health
Choice, Inc. (CHC).
Responses to this Request for Proposal (RFP) shall be formatted as follows:
All proposals must be typed on standard 8-1/2" X 11" paper, indexed and placed in a 2 or 3-ring binder. Proposal
should be organized in the following order for consistency and easy screening:
Section I: Table of Contents
Section II: RFP Cover Sheet, Transmittal Letter, and Residence Certification - The transmittal letter
should include company name and address; name, title, telephone and fax number of person(s) to be contacted for
clarifications or additional information regarding proposal; name, title, telephone and fax number of person
authorized to contractually obligate your company with proposal and any future negotiations; and a brief summary
explaining how all requirements of this RFP will be met and proposer’s ability to meet the needs and requirements
of the RFP.
Section III: Scope of Service – Scope of Service must address each Requirement in the Specifications and
include a Corporate Overview and Qualifications.
Corporate Overview and Qualifications should contain:
1. A brief description of company’s history.
2. A detailed overview of the services offered by company.
Section IV: Pricing Information
Section V: Questionnaire (See Attachment k) – All vendors must complete and return all answers of the
questionnaire/requirements along with their RFP response, as failure to do so will result in disqualification. The
completed questionnaire must appear in the body of the RFP and must be provided electronically in Microsoft
Excel format on CD-ROM.
Section VI: References – Vendor will provide a minimum of three letters of reference from companies for
whom Vendor has provided similar services in the last twelve months as demonstration of Vendor’s prior
experience. Letters must include the following information:
Name of Contact Person
Telephone Number for Contact
Vendor services provided to this Client
The professional relationship with the Organization/Client
Description of Vendor’s ability fill staffing requests
Description of quality of the nurses provided by Vendor
Whether the Organization/Client would recommend Vendor
References provided must be current and verifiable. Harris County will conduct reference checks to verify and
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SPECIAL REQUIREMENTS/INSTRUCTIONS – Continued
validate Vendor’s past performance. Reference checks indicating poor or failed performance by Vendor will be
cause for rejection of the bid submitted. In addition, failure to provide verifiable letters of reference will be cause
for rejection of bid submitted.
Section VII: Standard Agreement(s) (if applicable) – Include any standard agreement(s) and/or contract(s)
associated with the proposal with all applicable exhibits included.
Section VIII: Special Requirements – Include Certificate(s) of Insurance, Vendor Certification – Attachment
i; exceptions to any of the requirements in this RFP, if any, and appropriate company brochures, etc. may be
Proposers should include ONE (1) ORIGINAL (CLEARLY MARKED “ORIGINAL”) and THREE (3)
COPIES (CLEARLY MARKED “COPY”) of the response sealed in an envelope or package for delivery to the
Harris County Purchasing Agent per the instructions in the General Requirements (see Proposal Completion and
Proposal Returns). All documents included in the proposal and the outside of the envelope or package must be
marked with the vendor's name and the job number that corresponds to this RFP.
Harris County will not be liable for any costs incurred by the vendor in preparing a response to this RFP. Vendors
submit proposals at their own risk and expense. Harris County makes no guarantee that any services will be
purchased as a result of this RFP, and reserves the right to reject any and all proposals. All proposals and
accompanying documentation will become the property of Harris County. All proposals are open to negotiation.
While Harris County appreciates a brief, straightforward, concise reply, the proposer must fully understand that the
evaluation is based on the information provided. Accuracy and completeness are essential. Omissions, ambiguous
and equivocal statements may be construed against the proposer. The proposal response may be incorporated into
any contract which results from this RFP, and vendors are cautioned not to make claims or statements it is not
prepared to commit to contractually. Failure of the vendor to meet such claims will result in a requirement that the
vendor provide resources necessary to meet submitted claims.
The vendor is expected to examine all documents, forms, specifications, and all instructions. Failure to do so
will be at vendor’s risk.
All documents will be held by Harris County and are NOT subject to public view until an award is made and an
agreement executed. Under the Request for Proposal process, sealed offers will be received and opened in the
Office of the Harris County Purchasing Agent. At and after opening, proposals will NOT be part of the public
record and subject to disclosure, but will be kept confidential until time of award and an agreement executed.
When an award is made and an agreement is executed, proposals are subject to review under the ―Public
Information Act‖. To the extent permitted by law, vendors may request in writing non-disclosure of confidential
data. Such data shall accompany the proposal, be readily separable from the proposal, and shall be CLEARLY
All proposals will be examined by an evaluation committee.
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SPECIAL REQUIREMENTS/INSTRUCTIONS – Continued
Proposals that do not conform to the instructions or which do not address all the services as specified may be
eliminated from consideration. However, Harris County, reserves the right to accept such a proposal if it is
determined to be in the best interest of Harris County.
Harris County may initiate discussions with selected vendors; however, discussions may not be initiated by
vendors. Harris County expects to conduct discussions with vendor’s representatives authorized to contractually
obligate the vendor with an offer. Vendors shall not contact any Harris County Hospital District personnel during
the RFP process without the express permission from the Office of the Harris County Purchasing Agent. Harris
County Purchasing may disqualify any vendor who has made site visits, contacted Harris County Hospital District
personnel or distributed any literature without authorization from the Purchasing Department.
All correspondence relating to this RFP, from advertisement to award shall be sent to the Harris County Purchasing
Department. All presentations and/or meetings between Harris County Hospital District and the vendor relating to
this RFP shall be coordinated by the Harris County Purchasing Department.
Selected vendors may be expected to make a presentation to an evaluation committee. Presentations may result
in negotiating sessions. Harris County expects to conduct negotiations with vendor’s representatives authorized
to contractually obligate the vendor with an offer. If vendor is unable to agree to contract terms and conditions,
Harris County reserves the right to terminate contract negotiations with that vendor and initiate negotiations
with another vendor.
The award shall be made to the responsible vendor(s) whose proposal is determined to be the best evaluated
proposal resulting from negotiations, compliance with instructions, the importance of service and demonstrated
ability to respond to Harris County’s needs on a timely basis, and taking into consideration the following in order
of relative importance:
1. Joint Commission Accreditation
2. Number of available specialty nurses currently on staff that are readily available to Harris County
3. Ability to comply with current or new federal, state, and local laws, rules and regulations, and standards
that may not be outlined in the contract
4. Past performance history with Harris County (if applicable)
5. Rate comparisons
6. Willingness to participate in a vendor management system
7. Experience based on references submitted with the bid (Minimum of three (3) years of experience
providing healthcare in a hospital setting)
8. Agency qualifications, (i.e., federal, state and city requirements, length of time in service, etc.)
9. Ability to comply with Harris County’s invoicing policies and proof of delivery
Vendor’s ability to provide bilingual Temporary Personnel will be evaluated independently from the vendor’s
ability to provide non-bilingual Temporary Personnel. Inability to provide bilingual Temporary Personnel will not
be prejudicial to Vendor.
Award does not guarantee any particular profit, revenue, or volume of work to the vendor. Estimated contract
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SPECIAL REQUIREMENTS/INSTRUCTIONS – Continued
expenditure will not exceed $10,000,000. Harris County reserves the right to purchase more or less.
No award can be made until approved by governing bodies. This RFP in no manner obligates Harris County or
any of its agencies to the eventual purchase of any service described, implied or which may be proposed. Progress
toward this end is solely at the discretion of Harris County and may be terminated at any time prior to execution of
Submission of a proposal implies the vendor's acceptance of the evaluation criteria and vendor recognition that
subjective judgments must be made by the evaluating committee. Proposals, vendor presentations and service
evaluations will develop into negotiating sessions with the vendors as selected by the Evaluation Committee.
Award of the contract shall be made to the Vendor(s) whose proposal is the best evaluated offer resulting from
negotiations, taking into consideration compliance with instructions, scoring of responses and on-site
demonstrations, and total overall costs of the solution. Harris County may use references to make judgments
directly affecting the award of this proposal. If Harris County is unable to agree to contract terms, Harris
County reserves the right to terminate contact negotiations with that Vendor and initiate negotiations with
The awarded vendor will be required to execute an agreement with Harris County and the Harris County
Hospital District which finalizes the terms and conditions set forth in the requirements of this Request for
Proposal package and offer as submitted by the vendor.
It is the intent of Harris County to award to multiple vendors. Harris County anticipates no more than ten (10)
awarded vendors. Awarded vendors will be listed in a call order from lowest to highest price per service. Harris
County will contact vendor with the lowest price for the service required first. If first vendor cannot provide the
service required within thirty (30) minutes, then the second vendor will be contacted, and so on. Vendor
understands that Harris County reserves the right to fill any and/or all requirements for Nursing Temporary
Personnel on an as-needed basis and makes no guarantee as to the number of hours requested at any given time or
during the contract term.
Award may be made for only non-bilingual Temporary Personnel, only bilingual Temporary Personnel, or for both
non-bilingual and bilingual Temporary Personnel.
Vendor shall provide, as part of its response, evidence of compliance with all governing requirements for licensure,
registration and/or certification. Photocopies of relevant documents shall be sufficient for bid submission, but
Harris County reserves the right to require presentation of original licenses or certified copies thereof prior to the
Vendor’s beginning service.
By the submission of a response to this bid, Vendor warrants and represents to Harris County that they have and
will maintain compliance with all governing regulations and laws, including Federal, State and Municipal.
ACCESS TO RECORDS
Vendor agrees to allow the Comptroller General of the United States, the Department of Health and Human
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SPECIAL REQUIREMENTS/INSTRUCTIONS – Continued
Services ("HHS"), the District Auditor, and their duly authorized representatives, access to contracts, books,
documents, and records necessary to verify the nature and extent of the costs of the services provided by vendor.
Vendor agrees to allow such access until the expiration of four (4) years after the services are furnished under
the contract or subcontract or until the completion of any audit or audit period, whichever is later. Such access
will be provided in accordance with the regulations of the Centers for Medicare and Medicaid Services
("CMS"). Vendor agrees to allow similar access to books, records, and documents related to contracts between
vendor and organizations related to or subcontracted by Vendor, as defined by the regulations of CMS.
Vendor may be placed on probation, or the contract may be suspended or terminated, by Harris County.
Circumstances resulting in probation of service or suspension or termination of the contract may include, but are
not limited to, the following:
1. Failure to meet and maintain minimum quality or performance standards;
2. Failure to provide qualified temporary healthcare personnel three consecutive times where consecutive
times are defined as one-day with multiple shifts or three consecutive occurrences;
3. Failure to maintain required insurance coverage;
4. Failure to provide 24 hour coverage including weekends;
5. Failure of temporary healthcare personnel to have and maintain required licensure and certifications;
6. Failure to cure any deficiencies found as a result of tests or other analyses or performance of services;
7. Failure to follow Harris County procedures when accepting/filling work requests;
8. Failure to provide accurate invoices timely in Harris County approved format;
9. Violations of the Board of Nurse Examiners Section 217.11 (1) (B) and (K) (i), (ii), (iv) and (T) will
be cause for immediate contract termination;
10. Actions exposing a patient or other persons unnecessarily to a risk of harm, engage in unprofessional
conduct, or whose practice fails to conform to the minimum standards of acceptable practice for their
area/profession will be cause for immediate contract termination; and
11. Failure to comply with Harris County’s Code of Conduct.
Probation shall be for a three to six month period based on offense. Harris County may deem it appropriate to
change the probation period to more or less time. Failure to satisfactorily cure any deficiency within that time
may result in suspension of services or termination of contract. Under conditions of suspension/termination, the
vendor will not be entitled to damages or compensation beyond payment for goods and/or services already
rendered through the end of the probation period and Harris County shall not be liable for any penalties,
attorneys’ fees, costs, consequential or liquidated damages as a result of this action.
PRICING, INVOICING AND PAYMENTS
Correct purchase order numbers must be noted on each invoice for services. All services shall be all-inclusive.
"All-inclusive" shall be construed as costs incorporating all charges for personnel, travel, and any other cost
incurred to produce the desired results. No separate line item charges for these will be accepted.
Vendor must furnish to the appropriate user departments all invoices for services in a timely manner.
Page 11 of 33
SPECIAL REQUIREMENTS/INSTRUCTIONS – Continued
Invoices submitted sixty (60) days after services were rendered will not be honored (this procedure will be strictly
enforced). In addition to the daily time sheet or charge slip, Vendor will submit a monthly invoice for payment in
the approved Harris County format indicating at a minimum: Name of the Harris County department/nursing unit
that utilized Vendor’s services, Temporary’s name, title or classification, billing rate and total cost for that
Temporary based on hours worked. The invoice should also include sub-totals by department/nursing unit, a total
number of Temporaries, total hours worked and a total billing amount. This monthly invoice must be submitted to
the specific Harris County facility that utilized Vendor’s services. Invoices submitted in any other format will be
Temporaries reporting to the District and/or CHC facilities are required to follow clocking in and out procedure
indicated in the Administrative Services Section of this RFP, Page 20, Item 10.
Failure to provide accurate invoices in a timely manner will result in contractor being placed on probation
or contract suspension or termination.
PROOF OF BUSINESS
Vendor must have been in business under its current name and in its current form (e.g., proprietorship, Chapter S
Corporation) for no less than three (3) full years. Written evidence is required and must be included in Section
CONFLICTS OF INTEREST
Vendor must disclose any financial interest held by a Harris County employee in Vendor’s business. Vendor must
also disclose an interest between Vendor, Vendor’s employees and any Harris County employees arising from
relationships within the first degree of consanguinity or affinity. A financial interest arises if the Harris County
Owns 10 percent or more of the voting stock or shares of Vendor’s business;
Owns either 10 percent or more or $15,000 or more of the fair market value of Vendor’s
Receives funds from Vendor’s business that exceed 10 percent of the Harris County employee’s
gross income from the previous year.
Vendor must fully disclose the existence of any relationships as defined above in its response to this bid.
Additionally, Vendor must notify Harris County if the information provided in its response changes at any time
Include all agreements which are required by Vendor’s organization to enter into a contract with Harris County.
These agreements are subject to review and amendment by the Harris County Attorney's Office and approval by
Page 12 of 33
Nursing Temporary Personnel for the Harris County Hospital District
Harris County is accepting proposals from qualified vendors to provide Nursing Temporary Personnel for the
Harris County Hospital District (District) and Community Health Choice, Inc. (CHC) (collectively as Harris
County) beginning on or about July 1, 2009 and ending twelve months thereafter.
Vendors are encouraged to review this entire Request for Proposal upon receipt. All questions must be
addressed in writing by emailing email@example.com or by faxing to (713) 755-6695, Attention: Jeanie
Dang, before 4:00 p.m. March 12, 2009.
Harris County may consider four (4) one-year renewal options, renewable one year at a time, based upon the same
terms, conditions and pricing as the original year. Renewal is subject to approval by governing bodies each period.
Once the renewal option is exhausted, the contract must be rebid. If a vendor does not wish to consider a renewal,
write "N.A." in the space for the year indicated on Page 23. Otherwise, leave the space blank.
Harris County retains the option to rebid at any time if in its best interest and is not automatically bound to
renewal or rebid.
Nursing Temporary Personnel (Temporary or Temporaries) staffed under the contract(s) resulting from this RFP
are expected to be qualified and experienced to deliver high quality patient care with a treatment focus within a
team environment to meet the overall mission of Harris County. The awarded vendor(s) will provide
Temporaries on an as-needed basis for the following job categories:
Group I: Psychiatric Nursing Personnel
Group II: Pediatric Nursing Personnel
Group III: Medical/Surgical Nursing Personnel/Telemetry
Group IV: OB/L&D Nursing Personnel
Group V: OR/PACU Nursing Personnel
Group VI: Critical Care/IMU/Special Procedures Nursing Personnel
Group VII: Emergency Room Nursing Personnel
Group VIII: Neonatal/Pediatric ICU & IMU Nursing Personnel
Group IX: RN Case Managers
Group X: Primary Care (Outpatient Clinic) LVN
Vendor must indicate in its proposal whether it has and shall maintain a minimum of ten (10) non-bilingual
specialty nurses and three (3) bilingual specialty nurses currently available and willing to work for Harris
County on its roster. Specialty nurses are defined as experience in the Adult, Pediatric and Neonatal
Intermediate Care Unit (ICU), Adult and Pediatric Emergency Care (EC), Labor and Delivery (L&D)/OB, Adult
Pediatric and Neonatal Critical Care, OR/PACU, and Medical Surgical (Med Surg). Preference will be
extended to vendors possessing available staff either non-bilingual specialty nursing or bilingual specialty
Page 13 of 33
SPECIFICATIONS – Continued
Qualifications and Standards for Temporaries
The qualifications of the Temporaries proposed by Vendor to perform the requirements of this RFP will be
subjectively evaluated. Therefore, Vendor should submit detailed information related to the experience and
qualifications, including education and training, of proposed personnel.
Temporaries shall be subject to the continuing acceptance of Harris County. Harris County reserves the right to
reject any of Vendor’s assigned Temporaries when it is in the opinion of Harris County that the retention of that
Temporary is not in the best interest of Harris County, its employees, medical staff, patients and/or visitors. Such
rejection may be exercised with or without cause and without effect on the contract. Vendor is responsible for
notifying the assigned Temporary of the rejections after notification by Harris County representative.
Temporaries are assigned to work for a specific department. They may be reassigned within the department, based
on their level of competency, patient care experience and the healthcare needs of the patients. Temporaries whose
performance exposes a patient or other person unnecessarily to a risk of harm, engages in unprofessional conduct,
or whose practice fails to conform to the minimum standards of acceptable practice for their area/profession may
be designated as a ―Do Not Return.‖
Vendor agrees that any Temporary identified by Harris County as "Do Not Return‖ may not work nor be
dispatched to work at any Harris County facility. Temporaries designated as ―Do Not Return‖ may be dispatched
to a Harris County facility only after Harris County removes the ―Do Not Return‖ status in writing to Vendor.
Violation by Vendor may result in probation of service or suspension or termination of the contract.
All background checks and competency tests must be performed by Vendor even if the Temporary is transferring
from another Vendor and claims to have had previous assignments with Harris County. Every Vendor must
perform its own annual checks and may not rely on information received from the Temporary or another Vendor.
1. Temporaries must have the necessary education, training, certification and registration for each position to
be filled. Any documentation (licenses, certifications, etc.) necessary to demonstrate fitness for position(s)
being filled must be made available to Harris County prior to assignment and upon request.
Vendor will administer (at Vendor’s expense) all applicable testing and evaluation of Temporaries for
Harris County. A copy of said testing and evaluation will be submitted to Harris County prior to
assignment and upon request. The various using departments may require additional testing and/or
evaluation (i.e., testing for area of specialty, basic nursing skills assessment, medication calculation, etc.).
Additional testing required by Harris County shall be administered by Harris County at Vendor’s expense.
Vendor must submit job descriptions, minimum number of years of service requirement and minimum
qualifications requirements of Temporaries seeking employment through its agency. Vendor must warrant
that all Temporaries assigned to Harris County possess minimum qualifications and that credentials have
been verified. Vendor must provide, as part of their response, credential verification process in Section III.
Vendor shall submit detailed resumes for proposed Temporaries.
Page 14 of 33
SPECIFICATIONS – Continued
Resumes should be structured to emphasize relevant qualifications and experience of the
Temporary in successfully completing contracts/performing services of a similar size and scope to
the requirements of this proposal.
Information submitted should clearly identify previous experience in performing similar services
and should include beginning and ending dates, a description of the role of the Temporary in such
performances, results of the services performed, and how the Temporary’s involvement in that
project will relate to the Temporary’s ability to contribute to Harris County.
Before Temporary is accepted by Harris County, Vendor shall provide copies of:
License (from original source)
Cardiopulmonary Resuscitation card (American Heart Association)
Advanced Cardiopulmonary Life Support card (American Heart Association)
Any professional certifications
Trauma Nurse Core Course or Course in Advanced Trauma Nursing card (Trauma Centers only)
Pediatric Advanced Life Support or Emergency Nursing Pediatric Course card (Pediatrics &
Trauma Centers (American Heart Association)
Neonatal Resuscitation Program card (American Heart Association)
Skills Check list
Any recent professional references/performance evaluations
Any test scores
Satori Alternatives to Managing Aggression (SAMA) certification card (Trauma Centers,
Harris County reserves the right to conduct interviews with selected individuals after review of such
information and the right to reject any or all individuals selected by Vendor.
2. Temporaries must meet, on a continuing basis, all regulatory requirements appropriate to their duties.
3. Temporaries must meet, on a continuing basis, all training requirements appropriate to their duties.
4. Temporaries shall maintain a professional appearance and demeanor, and a courteous attitude at all times.
5. Temporaries must wear uniforms appropriate to and clearly representative of their position and function,
which includes a photo ID badge. Uniform color and style shall be subject to continuing Harris County
Temporaries assigned to the District are required to have a District ID badge prior to assignment and must
attend orientation regarding procedure of clocking in and out for their shift and meal period. Managers will
enforce the clocking in and out process.
6. Temporaries must be informed of and comply with the prohibition on the use of cell phones in the building
and the prohibition of personal belongings in patient care areas.
Page 15 of 33
SPECIFICATIONS – Continued
7. Temporaries must disclose their entire name including aliases, assumed names, nicknames, previous names
or name usage if there is a difference.
8. Temporaries having access to Harris County facilities shall be bonded to the degree appropriate to their
access and duties and subject to Harris County approval.
9. Temporaries must show proof of their respective professional license or certification. Vendor must check
and clear all Temporaries prior to services provided by those Temporaries to Harris County.
10. In accordance with Harris County employment policies for new hires, including Temporaries, the following
requirements must be met (at Vendor’s expense) a background check, including but not limited to:
verification of previous employment; verification of licensure and/or certification; criminal activity
background check; a general physical examination; immunization records (see below); serological test;
tuberculin skin test or chest x-ray; a pre-employment drug screen with confirmatory testing in the event of a
positive screen; and fit-testing for N95 respirator (isolation mask).
Background checks must be performed on all Temporaries annually per contract period. Background
checks include verification of employment, criminal background checks and Office of Inspector General
exclusions. Vendor must provide results annually and upon request. The document must be completed
and approved prior to the Temporary’s assignment.
Immunization – Vendor shall comply with Harris County immunization requirements for all Temporaries
providing direct patient care. All Temporaries assigned to Harris County facilities shall meet, at a
minimum, the following requirements:
a. TUBERCULIN (PPD) SKIN TEST – Vendor shall perform PPD skin testing yearly on all
Temporaries who have not previously tested positive. For any Temporary whose test becomes
positive, Vendor must present documentation of treatment status. For Temporaries with previous
known positive skin tests, Vendor will present a yearly screening of clinical symptoms for active
b. HEPATITIS B – Vendor shall maintain information as to whether each Temporary has received
Hepatitis B vaccination or has been offered the vaccine and declined.
c. CHICKEN POX (VARICELLA) - Vendor shall ensure that Temporaries are immune to varicella
by providing acceptable documentation of varicella vaccination, serologic testing for the presence
of varicella antibodies, or a positive medical history for varicella disease. All histories of varicella
illness must be supported by a written documentation such as a statement from a physician
containing wording such as: "This is to verify that (name of patient) had varicella disease
(chickenpox) on or about (date) and does not need varicella vaccine." If the Temporary is unable to
submit such a statement or serologic evidence, then Vendor will not assign such Temporary to any
Harris County facility.
d. MEASLES, MUMPS AND RUBELLA (MMR) – Vendor shall ensure that Temporaries are
Page 16 of 33
SPECIFICATIONS – Continued
immune to measles, mumps and rubella by providing acceptable documentation of 2 doses of
measles-containing vaccine, mumps and rubella vaccine. Serologic confirmation of immunity to
measles, mumps and rubella is acceptable in lieu of vaccine.
Vendor agrees to provide documentation to Harris County that each Temporary has met the above
requirements prior to assignment to a Harris County facility. Vendor will bear the costs associated with
providing any testing, documentation, examination, vaccinations or immunizations necessary to comply
with the requirements of this bid and any Harris County policies. Vendor agrees not to assign any
Temporary that fails or refuses to meet these requirements.
11. At all times, Temporary shall be subject to, and Vendor shall provide for, the satisfaction of the following
a. No Temporary may be under the influence of, show evidence of having recently consumed, or
be in possession of alcohol, Cannabis in any form, or any other "Controlled Substance" as
defined by applicable Texas Controlled Substance Act as amended, including legally prescribed
medications, while on Harris County grounds.
b. No Temporary may be under the influence of, show evidence of having recently consumed, or,
with the exception of authorized Harris County patient medications handled in the course of his
or her directed responsibilities, be in possession of any sedative, hypnotic, tranquilizer or
antidepressant, as identified by the United States Pharmacopoeia or the current Physician's Desk
Reference Manual, including legally prescribed medications, while on Harris County grounds
c. No Temporary may be under the influence of, show evidence of having recently consumed,
or be in possession of any product required by law to carry a warning to the effect that
consumption of the product may cause drowsiness, reduce alertness, or reduce motor control.
12. Vendor agrees not to assign or refer any Temporary for duties at Harris County facilities if the Temporary
a. under indictment for any crime of violence or violation of the Texas or U.S. Controlled
b. subject to other judicial action and has posted bail or bond while awaiting trial for any crime of
violence or violation of the Texas or U.S. Controlled Substances Acts;
c. on deferred adjudication or parole for any crime of violence or violation of the Texas or U.S.
Controlled Substances Acts;
d. under suspension by Vendor, whether that suspension has been placed in effect for a confirmed
impropriety or for investigative purposes;
e. suffering any degree of physical or mental incapacitation; or
f. carrying restrictions on his or her license through the regulating board.
13. Vendor will report to Harris County any assigned Temporary undergoing investigation by his or her
appropriate regulatory board or who is participating in any substance abuse rehab program. Such
notification will be made verbally to the designated contact person of the using department within 24 hours
of Vendor’s becoming aware of such status, followed in writing to Corporate Compliance for the District
Page 17 of 33
SPECIFICATIONS – Continued
14. Temporaries must park in designated lots. Harris County will not be responsible for payment of parking
fees, towing, mileage, fuel, damage or loss to vehicle. Furthermore, Harris County does not provide free or
15. Temporaries must sign in and out of designated areas according to standard written procedures and report
to the person in charge.
16. Temporaries must complete a ―Patient Care Experience‖ form (Attachment m) prior to working the
assignment for each nursing department of specialty care area.
17. Upon discovering an error that meets the definition as described in the patient safety plan (see Attachment
l), the Temporary must report the error before the completion of the shift. Failure to do so will result in an
investigation of the incident with appropriate actions taken at the conclusion of the investigation.
18. Patient safety medical/health care errors are defined as:
a. unintended acts, either of omission or commission, or acts that do not achieve their intended
b. the failure of a planned action to be completed as intended (i.e., error of execution) or the use of a
wrong plan to achieve an aim (i.e., error of planning).
19. Temporaries must possess a BLS card (with a ―hands on‖ component) from the American Heart
Association. Web-based only certifications are not acceptable.
20. Temporaries must receive (10) ten hours of CEUs annually (not to include mandatory safety, HPAA, etc.
educational sessions); proof of completion must be submitted annually to the Director of Nursing Support
Services for the District.
21. Temporaries assigned to the District must attend District-sponsored orientation/competency validation
annually, at Vendor’s expense.
22. Bilingual – Temporaries bilingual in English and Spanish may be required. The standard fluency required
for all nurses in this RFP will be writing, speaking, and reading English. In such cases where a bilingual
Temporary is needed, the Temporary must successfully pass a proficiency examination which may consist
of written and oral components. If Temporary passed a proficiency examination administered through
Vendor, proof of passage must be supplied. Should Harris County be dissatisfied with the proficiency
examination administered through Vendor, Temporary may be required to take a proficiency examination
administered through Harris County. The examination will be at Vendor’s expense regardless of whether it
was administered through Harris County or Vendor.
1. Vendor will be expected to maintain records for all requests submitted by the designated Harris County
representatives and invoices sent to Harris County for payment. All such records shall be kept at a location
suitably accessible to Harris county representatives and other authorized individuals.
Page 18 of 33
SPECIFICATIONS – Continued
2. Vendor shall identify, or assign, one representative and/or designee within Vendor’s organization to be
responsible for handling all needs, facilitating communication, and insuring quality. If the assigned
individual is replaced, Harris County using departments must be notified in writing immediately. This
representative must become familiar with the personnel needs and job requirements of Harris County. A
visit must be made quarterly by a senior staff representative of Vendor to the using departments.
3. All requests for Temporaries will be sent via fax or email using a ―Request for Temporary Personnel
Form.‖ Vendor is to respond within 30 minutes of receipt of request. Detailed instructions of this
procedure will be mailed to all awarded Vendors. Failure to respond within the allotted 30 minute
timeframe will be considered as non-compliance with the contract and marked as a ―cannot fill,‖ which
may result in probation of service or suspension or termination of the Agreement.
Vendor must provide 24-hour coverage (NO EXCEPTIONS). Faxes or emails will be sent to the fax
number or email address identified on the questionnaire (Attachment k). Fax numbers provided must be
local fax numbers or toll-free. Failure to provide 24-hour coverage will result in probation of service or
suspension or termination of the Agreement.
4. Requests for Temporaries must be accepted only from designated Harris County representatives. Any
requests accepted from departments and/or representatives other than those designated will not be honored
or paid by Harris County.
5. Vendor must provide written confirmation by fax or email via the ―Request for Temporary Personnel
Form‖ to the designated Harris County representative with the name(s) and title(s) of temporary personnel
who will report for assignment within the allotted 30 minute timeframe.
In the event a Temporary identified on the ―Request for Temporary Personnel Form‖ changes, Vendor must
provide a replacement name to the requesting department/unit. Changes will be monitored by the
requesting department/unit. Harris County reserves the right to take disciplinary action against any Vendor
that abuses the system (i.e. bait and switch).
6. Vendor must stress proper dress codes, including a photo ID badge, reliability, punctuality, and work habits
to Temporaries in accordance with the needs of Harris County as determined by the using departments.
7. Vendor shall submit annual verification of: orientation provided to staff, peer review mechanism,
performance improvement (QA, CQI) programs, and annual credentialing for staff. Verification must be
submitted immediately upon request by Harris County facilities.
8. Peer Review – Vendor assumes full responsibility for conducting peer review of Temporaries in
accordance with the laws of the State of Texas. Upon request, Vendor shall disclose written and oral
communications and the records and proceedings of the peer review to Harris County as applicable.
9. Payroll Services – Vendor will prepare payroll checks, make all necessary deductions, pay all taxes and
insurance required by Federal, State or Local laws. Harris County will be billed for the applicable rate of
Page 19 of 33
SPECIFICATIONS – Continued
Vendor accepts full responsibility for the payment of wages, compensation and benefits to its personnel.
Vendor further accepts responsibility for payment of all taxes, assessments, fees, and fines that may be due
and owing to any State or Federal government.
10. Time and Attendance Record – Temporaries assigned to the District and/or CHC must participate in the
District’s time and attendance time card system. The time and attendance time card system will be the
main source from which Temporaries are paid.
Harris County expects each Temporary to work through only one Vendor. When a Temporary moves from
one Vendor to another, the accepting Vendor must follow Harris County’s on-boarding process; i.e., submit
the Temporary’s profile for review and acceptance.
11. Off-boarding Process – Vendor shall pay a fee of $25.00 for Harris County ID badges and $25.00 for
parking decals that are not returned by temporaries on the last day of their assignment. Once collected,
such fee is non-refundable.
An administration fee of $25.00 will be accessed to invoices, at time of reconciliation, to any invoice
indicating incorrect bill rates and/or time worked. Invoices will be short paid the administrative fee to
recoup additional man hours used to correct invalid invoices.
Vendor must resubmit an incorrect invoice within seven (7) business days via certified or registered mail.
13. Orientation/Training – Vendor must pay all required orientation costs. Temporaries new to Harris
County must have at least eight (8) hours of on-site orientation and eight (8) hours of computer training at
Orientation classes will be scheduled by the District staffing office. It is Vendor’s responsibility to ensure
that Temporaries attend orientation. Temporaries incapable of passing entry-level testing will not be placed
in any Harris County facility.
a. Vendor must provide twenty-four (24) hour staffing services.
b. Vendor will respond to all staffing requests within thirty (30) minutes.
c. Requests are considered ―late call‖ if Vendor receives a fax and accepts a work assignment from an
authorized Harris County representative one (1) hour prior to beginning of a shift or one (1) hour
after the start of the shift. The Temporary must then arrive at the assigned department within one
(1) hour and thirty (30) minutes after acceptance of the work assignment by Vendor and Temporary
must complete the shift to be paid for the entire shift. If the Temporary is unable to complete the
shift, Temporary will be paid for actual worked hours only.
d. Once Vendor confirms acceptance of a work assignment, Harris County may cancel the assignment
at any time.
Page 20 of 33
SPECIFICATIONS – Continued
e. If Harris County cancels less than one (1) hour and thirty (30) minutes prior to the start of the shift
and the employee arrives on time at the assigned department, Harris County may pay two (2) hours
f. Temporaries should not be scheduled more than 40 hours per week. (HARRIS COUNTY WILL
NOT PAY OVERTIME DIFFERENTIAL) It is Vendor’s responsibility to track the number of
hours a Temporary is scheduled.
g. Holiday pay rates may be available but will be for approved holidays only. Holidays are considered
midnight to midnight.
Approved Holidays are
New Years Day
h. Weekends are from midnight Friday to midnight Sunday.
Vendor Performance Standards
No person currently employed by Harris County may be assigned to work as a Temporary at any Harris County
facility. No person previously employed by Harris County may be dispatched to a Harris County facility as a
Temporary within twelve months of their last day of employment with Harris County.
1. Harris County must be completely satisfied with the performance of every assigned Temporary. If not
satisfied, and upon notification to Vendor, all charges for the unsatisfactory Temporary will not be paid.
2. Vendor will be evaluated on ability to perform satisfactorily including, but not limited to: a) number of staff
designated as ―Do Not Return‖; b) number of, and types of, deficiencies; and c) a quarterly review of
Vendor’s ability to fill staffing requests with qualified personnel.
Temporary to Permanent Option
Vendor will permit Harris County to hire the Temporary within ninety (90) calendar days after the effective date of
the contract between Harris County and Vendor without charge or penalty to Harris County or to the Temporary.
Page 21 of 33
Award may be made for only non-bilingual Temporary Personnel, only bilingual Temporary Personnel, or for both
non-bilingual and bilingual Temporary Personnel. Partial proposals will be accepted.
Please provide the fixed bill rate for the Temporary Nursing Personnel in the following format:
No. Description Weekday Rate Weekend Rate Holiday Rate
CATEGORY I – NON-BILINGUAL NURSING
1. Psychiatric RN $______________ $______________ $______________
2. Medical/Surgical/Telemetry RN $______________ $______________ $______________
3. Pediatric RN $______________ $______________ $______________
4. OB/L&D RN $______________ $______________ $______________
5. OR/PACU RN $______________ $______________ $______________
6. Critical Care/Intermediate Care/ $______________ $______________ $______________
Special Procedures RN
7. Emergency Room RN $______________ $______________ $______________
8. Neonatal/Pediatric ICU/IMU RN $______________ $______________ $______________
9. RN Case Manager $______________ $______________ $______________
10. Primary Care (Outpatient) LVN $______________ $______________ $______________
11. Psychiatric RN, Bilingual $______________ $______________ $______________
12. Medical/Surgical/Telemetry RN, $______________ $______________ $______________
CATEGORY II – BILINGUAL NURSING
13. Pediatric RN, Bilingual $______________ $______________ $______________
14. OB/L&D RN, Bilingual $______________ $______________ $______________
15. OR/PACU RN, Bilingual $______________ $______________ $______________
Page 22 of 33
PRICING/DELIVERY INFORMATION – Continued
No. Description Weekday Rate Weekend Rate Holiday Rate
16. Critical Care/Intermediate Care/ $______________ $______________ $______________
Special Procedures RN, Bilingual
17. Emergency Room RN, Bilingual $______________ $______________ $______________
18. Neonatal/Pediatric ICU/IMU RN, $______________ $______________ $______________
19. RN Case Manager, Bilingual $______________ $______________ $______________
20. Primary Care (Outpatient) LVN, $______________ $______________ $______________
Does Vendor have Joint Commission Accreditation? (Place an ―X‖ in one of the following)
___ Yes ___ No
The Harris County Hospital District intends to move to a Vendor Management System. Is Vendor is willing to
participate in a vendor management system? (Place an ―X‖ in one of the following)
___ Yes ___ No
Vendor agrees to renew this contract for the time frame stated below under the same terms and conditions and
pricing as the original contract by leaving the space blank. If vendor does not wish to be considered for renewal,
write ―N.A.‖ in the space provided.
Renewal Year 1: (2010 – 2011) _______
Renewal Year 2: (2011 – 2012) _______
Renewal Year 3: (2012 – 2013) _______
Renewal Year 4: (2013 – 2014) _______
Page 23 of 33
Job No. 09/0110
RESIDENCE CERTIFICATION/TAX FORM
Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests Residence
Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of
governmental contracts; pertinent provisions of §2252.001 are stated below:
(3) "Nonresident bidder" refers to a person who is not a resident.
(4) "Resident bidder" refers to a person whose principal place of business is in this state, including a
contractor whose ultimate parent company or majority owner has its principal place of business in
I certify that is a Resident Bidder of Texas as defined in
Government Code §2252.001.
I certify that is a Nonresident Bidder as defined in
Government Code §2252.001 and our principal place of business is .
[City and State]
Taxpayer Identification Number (T. I. N.):
Company Name submitting Bid/Proposal:
If you are an individual, list the names and addresses of any partnership of which you are a general partner:
PROPERTY: List all taxable property owned by you or above partnerships in Harris County.
Harris County Tax Acct. No.* Property address or location**
* This is the property account identification number assigned by the Harris County Appraisal District.
** For real property, specify the property address or legal description. For business personal property, specify the
address where the property is located. For example, office equipment will normally be at your office, but inventory
may be stored at a warehouse or other location.
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Minimum Insurance Requirements
• The contractor shall, at all times during the term of this contract, maintain insurance coverage with not less
than the type and requirements shown below. Such insurance is to be provided at the sole cost of the
contractor. These requirements do not establish limits of the contractor's liability.
• All policies of insurance shall waive all rights of subrogation against the County, its officers, employees
• Upon request, certified copies of original insurance policies shall be furnished to Harris County.
• The County reserves the right to require additional insurance should it be deemed necessary.
A. Workers' Compensation (with Waiver of subrogation to Harris County) Employer's Liability, including all
states, U.S. Longshoremen, Harbor Workers and other endorsements, if applicable to the Project.
Statutory, and Bodily Injury by Accident: $100,000 each employee. Bodily Injury by Disease: $500,000
policy limit $100,000 each employee.
B. Commercial General Liability Occurrence Form including, but not limited to, Premises and Operations,
Products Liability Broad Form Property Damage, Contractual Liability, Personal and Advertising Injury
Liability and where the exposure exists, coverage for watercraft, blasting collapse, and explosions,
blowout, cratering and underground damage.
$300,000 each occurrence Limit Bodily Injury and Property Damage Combined $300,000 Products-
Completed Operations Aggregate Limit $500,000 Per Job Aggregate $300,000 Personal and Advertising
Injury Limit. Harris County shall be named as "additional insured" on commercial general liability policy.
C. Automobile Liability Coverage:
$300,000 Combined Liability Limits. Bodily Injury and Property Damage Combined. Harris County shall
be named as "additional insured" on automobile policy.
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TWCC RULE 110.110 WORKERS' COMPENSATION INSURANCE COVERAGE
If this bid/proposal package is for a building or construction contract, all of the provisions of this rule as shown
below apply. Since this is a mandatory requirement, cost increases should not be experienced because of the need to
comply with the Texas Workers' Compensation Law. For additional information contact the Texas Workers'
Compensation Commission, Southfield Building, 400 S. IH-35, Austin, Texas 78704-7491, (512) 440-3618.
Certificate of coverage ("Certificate") - A copy of a certificate of insurance, a certificate of authority to self-
insure issued by the commission, or a coverage agreement, TWCC-81, TWCC-82, TWCC-83, or TWCC-84
showing statutory workers' compensation insurance coverage for the person's or entity's employees
providing services on a project, for the duration of the project.
Duration of the project - Includes the time from the beginning of the work on the project until the
contractor's/person's work on the project has been completed and accepted by the governmental entity.
Persons providing services on the project ("subcontractor" in §406.096) - Includes all persons or entities
performing all or part of the services the contractor has undertaken to perform on the project, regardless of
whether that person contracted directly with the contractor and regardless of whether that person has
employees. This includes, without limitation, independent contractors, subcontractors, leasing companies,
motor carriers, owner-operators, employees of any such entity, or employees of any entity which furnishes
persons to provide services on the project. "Services" include, without limitation, providing, hauling or
delivering equipment or materials, or providing labor, transportation, or other service related to a project.
"Services" does not include activities unrelated to the project, such as food/beverage vendors, office supply
deliveries, and delivery of portable toilets.
B. The Contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and
filing of any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section
401.011(44) for all employees of the contractor providing services on the project, for the duration of the project.
C. The Contractor must provide a certificate of coverage to the governmental entity prior to being awarded the contract.
D. If the coverage period shown on the Contractor's current certificate of coverage ends during the duration of the
project, the Contractor must, prior to the end of the coverage period, file a new certificate of coverage with the
governmental entity showing that coverage has been extended.
E. The Contractor shall obtain from each person providing services on a project, and provide to the governmental
(1) A certificate of coverage, prior to that person beginning work on the project, so the governmental entity will
have on file certificates of coverage showing coverage for all persons providing services on the project; and
(2) No later than seven (7) days after receipt by the Contractor, a new certificate of coverage showing extension
of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of
F. The Contractor shall retain all required certificates of coverage for the duration of the project and for one (1) year
BF10/9.95/1 of 2
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G. The Contractor shall notify the governmental entity in writing by certified mail or personal delivery, within ten (10)
days after the contractor knew or should have known, of any change that materially affects the provision of coverage
of any person providing services on the project.
H. The Contractor shall post on each project site a notice, in the text, form and manner prescribed by the Texas
Workers' Compensation Commission, informing all persons providing services on the project that they are required
to be covered, and stating how a person may verify coverage and report lack of coverage.
I. The Contractor shall contractually require each person with whom it contracts to provide services on a project to:
(1) Provide coverage, based on reporting of classification codes and payroll amounts and filing of any coverage
agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all its
employees providing services on the project, for the duration of the project.
(2) Provide to the Contractor, prior to that person beginning work on the project a certificate of coverage
showing that coverage is being provided for all employees of the person providing services on the project,
for the duration of the project.
(3) Provide the Contractor, prior to the end of coverage period, a new certificate of coverage showing extension
of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of
(4) Obtain from each other person with whom it contracts, and provide to the Contractor:
(a) A certificate of coverage, prior to the other person beginning work on the project, and
(b) a new certificate of coverage showing extension of coverage, prior to the end of the coverage
period, if the coverage period shown on the current certificate of coverage ends during the duration
of the project;
(5) Retain all required certificates of coverage on file for the duration of the project and for one (1) year
(6) Notify the government entity in writing by certified mail or personal delivery, within ten (10) days after the
person knew or should have known, of any change that materially affects the provision of coverage of any
person providing services on the project; and
(7) Contractually require each person with whom it contracts, to perform as required by paragraphs (1) - (7),
with the certificates of coverage to be provided to the person for whom they are providing services.
J. By signing this contract or providing or causing to be provided a certificate of coverage, the Contractor is
representing to the governmental entity that all employees of the contractor who will provide services on the project
will be covered by workers' compensation coverage for the duration of the project, that the coverage will be based
on proper reporting of classification codes and payroll amounts, and that all coverage agreements will be filed with
the appropriate insurance carrier or, in the case of a self-insured, with the commission's Division of Self-Insurance
Regulation. Providing false or misleading information may subject the contractor to administrative penalties,
criminal penalties, civil penalties, or other civil actions.
K. The Contractor's failure to comply with any of these provisions is a breach of contract by the contractor which
entitles the governmental entity to declare the contract void if the Contractor does not remedy the breach within ten
(10) days after receipt of notice of breach from the governmental entity.
BF10/9.95/2 of 2
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CONTRACTOR’S RESPONSIBILITIES REGARDING USE AND DISCLOSURE OF PROTECTED
HEALTH INFORMATION (―PHI‖) AND ELECTRONIC PROTECTED HEALTH INFORMATION (―EPHI‖)
A. General: Contractor agrees to
1. hold all Protected Health Information (―PHI‖) confidential except to the extent that disclosure is
required by Federal or State law, including the Texas Public Information Act, Chapter 552, Texas
Government Code. Tex. Gov’t Code Ann. §§ 552.001 et seq., as amended. PHI is defined in 45
CFR § 164.501 and is limited to information created or received by Contractor from or on behalf
of District. Electronic protected health information (EPHI) is defined in 45 CFR § 160.103 and
means individually identifiable health information that is transmitted by or maintained in
2. be bound by all applicable Federal and State of Texas licensing authorities’ laws, rules, and
regulations regarding records and governmental records, including the Health Insurance
Portability and Accountability Act of 1996, PL 104-191, the HIPAA regulations (codified at 45
CFR Parts 160 and 164) referred to herein as ―Privacy and Security Requirements.‖
3. cooperate with the Texas Medicaid Fraud Control Unit and to make appropriate personnel
available for interviews, consultation, grand jury proceedings, pre-trial conference, hearings,
trial, and in any other process, including investigations that are required as a result of
Contractor’s Services to District. Compliance with this paragraph is at Contractor’s own
4. terms used in this agreement shall have the same meaning as those terms in the Privacy and
B. Representations: Contractor represents that he/she is familiar with Privacy and Security Requirements,
State HIV/AIDS and mental health information, and State and Federal drug/alcohol-related health
C. Contractor: Contractor is a ―Business Associate‖ of District as that term is defined under the Privacy
Requirements. Contractor agrees:
1. Nondisclosure of PHI: Not to use or disclose the PHI received from District or on behalf of
District other than as permitted or required by this Agreement, or as otherwise required by law;
2. Limitation on Further Use or Disclosure: Not to further use or disclose the PHI received from or
on behalf of District in a manner that would be prohibited by the Privacy and Security
Requirements of HIPAA if disclosure was made by District, or if either Contractor or District is
otherwise prohibited from making such disclosure by any present or future State or federal law,
regulation, or rule;
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3. Safeguards: To use appropriate safeguards to prevent use or disclosure of the PHI other than as
provided for by this Agreement or as required by State or federal law, regulation, or rule;
4. EPHI Safeguards. To implement and use reasonable administrative, physical, and technical
safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability
of the EPHI that it creates, receives, maintains, or transmits on behalf of the covered entity;
5. Reporting Unauthorized Disclosures: To report to District any use or disclosure of PHI that is
not authorized by this Agreement immediately upon becoming aware of such unauthorized use or
6. EPHI and Subcontractors: To ensure that any agent to whom it provides EPHI, including a
subcontractor, agrees to implement reasonable and appropriate safeguards to protect such EPHI;
7. Reporting: To report to Covered Entity any security incident within 5 business days of becoming
aware of such incident. For the purposes of this paragraph, ―security incident‖ shall mean the
attempted or successful unauthorized access, use, disclosure, modification, or destruction of
information or interference with systems operations in an information system;
8. Subcontractors and Agents: To make all reasonable efforts to ensure than any subcontractor or
agent to whom Contractor provides PHI received from District agrees to the same restrictions and
conditions that apply to Contractor with respect to such PHI;
9. Mitigation: To inform the District in advance and mitigate, to the extent practicable, any harmful
effect that is known to Contractor of a use or disclosure of PHI by Contractor or by a
subcontractor or agent of Contractor resulting from a violation of this Agreement;
10. Notice – Access by Individual: To notify District in writing within three business days of any
request by the individual for access to the individual’s PHI and upon receipt of such request from
the individual, direct the individual to contact the District to obtain access to the individual’s
PHI. Upon request by District, Contractor agrees to make available PHI, to the District or, as
directed by District, to an individual in accordance with 45 CFR § 164.524;
11. Notice – Request for Amendment: To notify District in writing within three business days of any
request by the individual for amendment to the individual’s PHI and upon receipt of such request
from the individual, direct the individual to District to request amendment of the individual’s
PHI. Contractor agrees to make available upon request PHI for amendment and incorporate any
amendments to PHI agreed to or directed by District in accordance with 45 CFR § 164.526;
12. Notice – Request for Accounting: To notify District in writing within three business days of any
request by the individual for an accounting of disclosures made of the individual’s PHI and upon
receipt of such request from the individual, direct the individual to District for an accounting of
the disclosures of the individual’s PHI. Contractor agrees to make available upon request the
information required to provide an accounting of disclosures in accordance with 45 CFR §
13. HHS Inspection: Upon written request, to make available to the Secretary of Health and Human
Services ("HHS") or his designee, Contractor’s internal practices, books, and records relating to
the use and disclosure of PHI received from, or created or received on behalf of, District in a time
or manner designated by the Secretary for purposes of the Secretary determining District’s
compliance with the HIPAA Privacy and Security Requirements;
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14. District Inspection: Upon written request, to make available to District during normal business
hours Contractor’s internal practices, books, and records relating to the use and disclosure of PHI
received from, or created or received on behalf of, District in a time and manner designated by
District for the purposes of the District determining compliance with the HIPAA Privacy and
15. Notice-Termination: Upon written notice to Contractor, District may terminate any portion of
the Agreement under which Contractor maintains, compiles, or has access to PHI. Additionally,
upon written notice to Contractor, District may terminate the entire Agreement if District
determines, at its sole discretion, that Contractor has violated a material term of this contract; and
16. Termination Procedures: Upon termination of this Agreement for any reason, to return all PHI
received from District, or created or received by Contractor on behalf of District, to District or, if
specially requested to do so by District in writing, destroy all PHI received from District. This
provision applies when Contractor maintains PHI from District in any form. If Contractor
determines that returning or destroying the PHI received from District, or created or received on
behalf of District is infeasible, Contractor shall (i) provide to District notification of the
conditions that make return or destruction infeasible; (ii) extend the protections of this
Agreement to such PHI; and (iii) limit any further uses and disclosures of such PHI to those
purposes that make the return or destruction infeasible.
17. Uses and Disclosures by Contractor: Except as otherwise limited in this agreement, Contractor
may use District PHI for the proper management and administration of Contractor or to carry out
legal responsibilities of the Contractor.
18. Uses and Disclosures by Contractor: Except as otherwise limited in this agreement and only if
requested by the District, Contractor may use District PHI to provide data aggregation services
relating to the health care operations of the District.
D. Survival of Privacy Provisions: Contractor’s obligations with regard to District PHI shall survive the
termination of this Agreement.
E. Amendment Related to Privacy and Security Requirements: The Parties agree to take such action as is
necessary to amend this Agreement if District, in its reasonable discretion, determines that amendment is
necessary to comply with the Privacy and Security Requirements of HIPAA and Tex. Health & Safety
Code Ann. §§ 181.001 et seq., as amended, and any other law or regulation affecting the use or
disclosure of PHI. Any ambiguity in this Agreement shall be resolved to permit District to comply with
the Privacy and Security Requirements of HIPAA and Tex. Health & Safety Code Ann. §§ 181.001 et
seq., as amended.
F. Indemnification: Contractor agrees to indemnify and hold harmless District and its directors, officers,
employees, and agents (individually and collectively ―District Indemnitees‖) against any and all losses,
liabilities, judgments, penalties, awards and costs (including costs of investigation and legal fees and
expenses) arising out of or related to (a) a breach of this Agreement relating to the Privacy and Security
Requirements by Contractor, or (b) any negligent or wrongful acts or omissions of Contractor or its
employees, directors, officers, subcontractors, or agents, relating to the Privacy and Security
Requirements including failure to perform their obligation under the Privacy and Security Requirements.
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G. Assignment: Contractor may not assign its rights and obligations under this Agreement without the prior
written consent of District; District may assign its rights and obligations under this Agreement upon
providing prior written notice of assignment to Contractor.
H. Electronic Mail Addresses: Contractor affirmatively consents to the disclosure of its e-mail addresses
that are provided to District including any agency or department of District. This consent is intended to
comply with the requirements of the Texas Public Information Act, Tex. Gov’t Code Ann. § 552.137, et
seq., as amended, and shall survive termination of this Agreement. This consent shall apply to e-mail
addresses provided by Contractor and agents acting on Contractor’s behalf and shall apply to any e-mail
address provided in any form for any reason whether related to this Agreement or otherwise.
This Agreement shall be interpreted under the laws of the State of Texas and applicable federal law. Exclusive
venue for any cause of action arising out of or in relation to this Agreement shall be in Harris County, Texas.
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Job No. 09/0110
CERTIFICATION OF ELIGIBILITY TO PARTICIPATE
IN FEDERAL HEALTH CARE PROGRAMS
The Harris County Hospital District (HCHD) entered into an agreement with the Office of Inspector
General, the Certification of Compliance Agreement (CCA), to ensure that HCHD complies with all Federal
Health Care Program regulations. The CCA requires that HCHD vendors must be eligible to participate in
Federal Health Care Programs.
Harris County Hospital District (―HCHD‖) screens all vendors upon engagement, and, at least, annually
thereafter against the General Services Administration’s List of Parties Excluded from Federal Programs and the
HHS/OIG List of Excluded Individuals/Entities (―LEIE/EPLS‖) to ensure that they are not an ―Ineligible
Person‖ as defined below. All vendors are required to disclose whether they or any of their owners, officers,
directors, employees, or principals (collectively, ―Principals‖) are, or become, an Ineligible Person.
An ―Ineligible Person‖ is an individual or entity who:
(i) Is currently excluded, debarred, suspended, or otherwise ineligible to participate in the Federal
health care programs or in Federal procurement or nonprocurement programs. This includes
Persons who are on the LEIE/EPLS or the Medicaid Sanction List; or
(ii) Has been convicted of a criminal offense related to the provision of healthcare items or
services (within the rules and regulations of 42 U.S.C. § 1320a-7(a)), but has not yet been
excluded, debarred, suspended, or otherwise declared ineligible.
I hereby certify that neither the vendor listed below itself nor any of its Principals is an Ineligible Person
and that the vendor will report immediately to the HCHD’s Vice President of Corporate Compliance if either the
vendor or any of its Principals becomes an Ineligible Person at any time in the future while the vendor is
associated with HCHD. I understand that if the vendor is now or subsequently becomes an Ineligible Person,
HCHD will remove the vendor from responsibility for, or involvement with, HCHD’s business operations. I
further understand that if the vendor fails to immediately terminate any of its Principals who become an
Ineligible Person, HCHD will remove the vendor from responsibility for, or involvement with, HCHD’s
If the vendor listed below provides patient care items or services or performs billing, coding, or claims
submission functions on behalf of HCHD, I also certify that the vendor’s Principals attend at least one hour of
annual compliance training that addresses compliance codes of conduct and the operation of a compliance
program, and, to the extent the vendor’s Principals provide patient care items or services, or perform billing,
coding, or claims submission functions on behalf of HCHD, attend additional hours of training that addresses:
(a) the Federal health care program requirements regarding the accurate coding and submission of claims; (b)
policies, procedures, and other requirements applicable to the documentation of medical records; (c) the
personal obligation of each individual involved in the claims submission process to ensure that such claims are
accurate; (d) applicable reimbursement statutes, regulations, and program requirements and directives; (e) the
Page 32 of 33
CERTIFICATION OF ELIGIBILITY TO PARTICIPATE – (Continued)
sanctions for violations of Federal health care program requirements; (f) examples of proper and improper
claims submission practices; and (g) proper procedures for processing Medicare secondary payer claims. If
training is required as per this paragraph, the vendor maintains written or electronic records that identify the type
of annual training provided, the date(s) of the training, and the attendees. Persons providing the training must
be knowledgeable about the subject matter. The vendor reviews the training content on an annual basis and, as
appropriate, updates the training to reflect changes in Federal health care program requirements.
I certify that the vendor understands that its Principals are expected to disclose or report to HCHD’s
Vice President of Corporate Compliance or other appropriate individual designated by HCHD any suspected
violation of any state or Federal health care program requirements or of HCHD’s own Policies and Procedures.
HCHD’s Disclosure Program emphasizes a no retribution, no retaliation policy and includes a reporting
mechanisms for anonymous communications for which appropriate confidentiality is maintained. The address
for the Post Office Box is:
P.O. Box 300033
Houston, Texas 77230-0033
HCHD has also arranged for a hotline service with an outside agency. The applicable number is:
Hotline Phone Number: 1-800-500-0333
_________________________ ____________________ __________________
City State Zip Code
Title Phone Number
Email Address Date
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