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Cor P Medic Rection Ca Roposa Al, Dent Lane C Nal Me Lifornia Al To Proposal to Provide Lane County Medical, Dental, and Mental Health Services Lane County LCP 2015/16-01 By Correctional Medical Group Companies (CMGC) dba California Forensic Medical Group April 7, 2015 INSTRUCTIONS: Please fill out the entire Section IV Response Form, (which comprises the Statement of Assurances and the Questionnaire) and submit as your official response. DO NOT include additional marketing materials. The following includes minimum requirements needed to be considered further as a qualified Proposer. Type out all responses - except required signatures. Please organize your response packet as follows: 1. Statement of Assurances 2. Questionnaire response 3. Other attachments (such as resume, etc.) 4. Contract Mark-up (if you propose revisions) STATEMENT OF ASSURANCES Solicitation Number LCP-2015/16-01 Proposer's Name: Correctional Medical Group Companies, Inc. dba California Forensic Medical Group, Inc. Proposer offers to provide the required services in accordance with the requirements of the Request for Proposals (RFP) stated above and the enclosed proposal. The undersigned Proposer declares that the Proposer has carefully examined the above-named Request for Proposals, and that, if this proposal is accepted, Proposer will execute a contract with the County to furnish the services of the proposal submitted with this form. PROPOSER'S STATEMENTS A. Proposer attests that the information provided is true and accurate to the best of the personal knowledge of the person signing this proposal, and that the person signing has the authority to represent the individual or organization in whose name this proposal is submitted. B. By execution of this Form, the undersigned Proposer accepts all terms and conditions of this Request for Proposals except as modified in writing in its proposal. Proposer agrees that the offer made in this proposal will remain irrevocable for a period of sixty (60) days from the date proposals are due. C. By execution of this Form, the undersigned Proposer acknowledges that its entire proposal is subject to Oregon Public Records Law (ORS 192.410–192.505), and may be disclosed in its entirety to any person or organization making a records request, except for such information as may be exempt from disclosure under the law. Proposer agrees that all information included in this proposal that is claimed to be exempt from disclosure has been clearly identified either in the Proposer's Statement, or in an itemization attached hereto. Proposer further acknowledges its responsibility to defend and indemnify the County for any costs associated with establishing a claimed exemption. Page 85 D. By execution of this form, the undersigned Proposer states that Proposer has a minimum of five (5) years’ experience in providing health care services for arrestees and inmates in a correctional setting. E. By execution of this form, the undersigned Proposer states that Proposer has experience in the management of health care programs in facilities of average daily population between 300-700 inmates. F. By execution of this form, the undersigned agrees to comply with all applicable federal, state, and local laws, regulations and requirements related to the RFP and performance of any resulting Contract, including but not limited to those referenced in this RFP. G. By execution of this form, the undersigned Proposer agrees that Proposer will meet the insurance requirements included in the proposed Contract included in the RFP and agrees that such coverage will be kept active during the entire term of the Contract, if awarded. H. By execution of this form, the undersigned Proposer agrees that this Proposal will irrevocable for a period of sixty (60) days from the deadline for receiving proposals under this RFP. PROPOSER'S CERTIFICATIONS I. By execution of this document, the undersigned Proposer certifies that, to the best of its knowledge and belief, neither it nor any of its principals: 1. Are presently debarred, suspended, proposed for debarment, or declared ineligible from submitting bids or proposals by any federal, state or local entity, department or agency; 2. Have within a three (3) year period preceding this offer, been convicted or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performance of a public (Federal, state or local) contract or subcontract; violation of Federal or state antitrust statues relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statement, tax evasion, or receiving stolen property; 3. Are presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph 28.2 of this certification; 4. Have within a three (3) year period preceding this offer, had one or more contracts terminated for default by any Federal, state or local public agency. J. By signing this Proposer's Certification form, Proposer certifies that: 1. Proposer is _____is not X (check one) a resident bidder, as defined in ORS 279A.120. 2. Proposer has not discriminated and will not discriminate against a subcontractor in awarding a subcontract because the subcontractor is a minority, women, or emerging small business enterprises certified under ORS 200.055 or a business enterprise that is owned or controlled by or that employs a disabled veteran, as defined in ORS 408.225. 3. This proposal is made without connection or agreement with any individual, firm, partnership, corporation, or other entity making a proposal for the same services, and is in all respects fair and free from collusion or collaboration with any other proposer. Page 86 ADDENDA Proposer has received and considered, in the accompanying proposal, the terms of the following addenda: Addendums #1, #2, #3 The undersigned, by signature here, acknowledges, accepts, and certifies to the Proposer's Statements and Certifications as stated above. 1. Company As registered with the State of Oregon: Company’s Full Legal Name: __Correctional Medical Groups Companies, Inc. City and State of Company Headquarters: __Monterey, California__________________________ 2. Contractor Authorized Signature: Name: Kip Hallman Title: Chief Executive Officer Signature: Date: 3. Office that would service Lane County: Address: 2511 Garden Road, Suite A160 Monterey, CA 93940 Phone: (831) 649-8994 Fax: (831) 649-8286 Email Address: [email protected] 4. Contractor’s RFP contact for this project: Name: Kip Hallman Title: Chief Executive Officer Phone: (831) 649-8994 Email Address: [email protected] Office Address: 2511 Garden Road, Suite A160 Monterey, CA 93940 Page 87 If you would like additional contacts to be alerted to courtesy emails regarding this RFP, please include here: Name: Patrick Turner Email Address: [email protected] Name: Email Address: Name: Email Address: 88 QUESTIONNAIRE (Attach to Exhibit E) Instructions: Please type responses directly into this page. You will be returning only Section IV RFP Response Form, which includes this questionnaire, and any other materials requested (e.g., resumes, spreadsheets, etc.), to be attached at the end of the questionnaire. DO NOT include marketing collateral. An unnecessary amount of such material may result in rejection of the RFP process. Proposers should fully answer each question, giving complete information regarding current and relevant references. A. INDUSTRY AND PROFESSIONAL EXPERIENCE: 1. Provide the date (and number of years) your company organized to provide medical services in institutional and correctional facilities in the United States and provide the same data separately for world-wide services (if applicable). California Forensic Medical Group (CFMG), the original member of Correctional Medical Group Companies, Inc., began providing service to California county jails more than 30 years ago, in October 1983, and now serves 27 California counties. In 2014 we expanded our services to other Western states under CFMG and Southwest Correctional Medical Group (SWCMG). 2. Describe briefly your corporate background. We initiated service on January 1, 1984 CFMG’s entire focus is on county jails/detention centers. As a result, serving the adult and juvenile facilities our program, services and resources in Monterey County, which is still a (and costs) are not diverted or client more than 30 years later! Over spread across programs that would not benefit the Community this time, we grew to become the Corrections Center and the largest private provider of correctional Defendant and Offender health care services in the State of Management Center. California. We currently provide services to 68 facilities in 30 counties across the Western United States, with a combined average daily population of approximately 13,300 inmates. 89 3. Provide gross sales volume and number of employees for medical services provided in institutional and correctional facilities in the United States and provide the same data separately for world-wide services (if applicable). Our annual gross sales are approximately $100 million and we employ approximately 850 team members, all in the Western United States. 4. Please provide a list of all medical services contracts with correctional facilities that your firm has had in the last five (5) years and include the number of years serving those clients. Please refer to Appendix 1, Medical Service Contracts Retained summarizing
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