318-22 Exhibit A-Coronis Health for Emergency Transport Third Party Billing - 2022.pdf

TOWNSHIP OF WEST ORANGE THIRD PARTY BILLING FOR EMERGENCY AMBULANCE SERVICES PROPOSAL FORM The Township of West Orange is seeking an incentive based scale to maximize the collection of the billable ambulance services. An example is provided below. Example: Percentage Range of Collections by Vendor 5% $0 to $100,000.00 10 % $101,000.00 to $200,000.00 month period. The undersigned hereby agtees to furnish all services, labor, materials, supetvision, equipment, and other means as necessary to perform all the work in accordance with these specifications. 5 % $ 0 to 750,000.00 % $ 751,000.00 to 1,000,000.00 Lf % $ 1,000,001.00 to 1,500,000.00 {/_ % $ 1,551,000.00 and above Sip.t17 Loree Eocsbbst- iGiced SigGat Print Name & Title Company Name Coron Cade Lit 50-5 Keghuw Pt!» ff, 4 Address LL-LY- 2 Togumislle be FF 7G Date j City, State, Zip 92-578 -OV7S Telephone Number 20