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HomeMy WebLinkAboutMINUTES - 04201993 - 1.61 TO: BOARD OF SUPERVISORS FROM: Contra Mark Finucane, Health Services Director Costa By: Elizabeth A. Spooner, Contracts Administrat DATE: March 30, 1993 4§ County SUBJECT: Approve Ambulance Service Agreement #23-054-7 with Moraga Fire Protection District SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION I. RECOMMENDED ACTION: Approve and authorize the Chair, Board of Supervisors, to execute on behalf of the County, Ambulance Service Agreement #23-054-7 with Moraga Fire Protection District for provision of emergency ambulance services in County's Emergency Response Area 3, commencing on January 1, 1993 and continuing from year-to-year unless terminated as provided in the Agreement. II. FINANCIAL IMPACT: There is no County General Fund impact. Annual ambulance subsidy payments of $58,558 will be made to Moraga Fire Protection District from CSA EM-1 (Measure H) funds. The amount is subject to renegotiation from time to time based upon the CSA EM-1 assessments collected within the area of the Moraga Fire Protection District. III. REASONS FOR RECOMMENDATIONS/BACKGROUND: Paramedic ambulance service is provided in Emergency Response Area 3 by the Moraga Fire Protection District. The Fire District has provided ambulance service continuously since 1971 and has provided this service at the paramedic level since initiation of paramedic services in Contra Costa County in 1977. Moraga Fire Protection District has in the past participated in the County's competitive bidding process for emergency ambulance service. However, Health & Safety Code Section 1797.201 provides that a county may enter into a contract without need for a competitive bidding process with a city or fire district which began providing prehospital emergency medical services prior to June 1, 1980. In recognition of Moraga Fire Protection District's continuous provision of paramedic ambulance service, the CSA EM-1 (Measure H) Service Plan Supplement approved by your Board on September 15, 1989 provided that the County would enter into a noncompetitive emergency ambulance service agreement with the Fire District and that the agreement would include payment to the Fire District for those enhanced emergency medical services provided by the Fire District. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMEN ATI N OF BOARD COM ITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON 77 APPROVED AS RECOMMENDED _ OTHER VOTE OF SUPERVISORS UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact: Art Lathrop (646-4690) CC: Health Services (Contracts) ATTESTED _ 260 /7�;.3 Risk Management Phil batchelor,Clerk Of the Board of Auditor-Controller Supervisors and County Administrator Contractor M382/7-83 BY y , DEPUTY 1 - 61 Contra Costa County AMBULANCE SERVICE AGREEMENT (County Dispatched Calls) Number 23-054-7 1. Contract Identification. Department: Health Services (Office of the Director) Subject: Emergency Ambulance Services (Emergency Response Area(s) 3 ) 2. Parties. The County of Contra Costa, California (County) , for its department named above, and the following named Contractor mutually agree and promise as follows: Contractor: MORAGA FIRE PROTECTION DISTRICT Capacity: County Governmental District Address: 1280 Moraga Way Moraga, California 94556 3. Term. The effective date of this Contract is 12:01 a.m. on January 1, 1993 AND SHALL CONTINUE IN FORCE FROM YEAR TO YEAR UNLESS TERMINATED AS PROVIDED HEREIN. 4. County's Obligations. County shall refer to the Contractor those calls for emergency ambulance service it receives for Emergency Response Area(s) 3 subject to all terms and conditions contained or incorporated herein. 5. Contractor's Obligations. Contractor shall provide the emergency ambulance services and carry out that work described in the Service Plan attached hereto, which is incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein. 6. Conditions. This Contract is subject to the General Conditions and Special Conditions (if any) attached hereto, which are incorporated herein by reference. 7. Pro ect. This Contract implements in part the County's Local Emergency Medical Services Plan in that it provides for emergency ambulance service. 8. Legal Authority. This Contract is entered into under and subject to the following legal authorities: Health and Safety Code Sections 1797 et seq. , Government Code Sections 26227 and 31000, County Ordinance Code, Division 48. 9. Signatures. These signatures attest the parties' agreement hereto: COUNTY OF CONTRA COSTA, CALIFORNIA ATTEST: Phil Batchelor, Clerk of the Board BOARD OF SUPERVISORS of Supervisors and County Administrator BX y Ion By I,GL Chairman/Designee Deputy CONTRACTOR/CONSULTANT By By (Official business Capacity) (Official Business Capacity) Note to Contractor- For corporations (profit or nonprofit), the contract must be signed by two officers. Signature A must be that of the president or vice-president and Signature B must be that of the secretary or assistant secretary (Civil Code Section 1190 and Corporations Code Section 313). All signatures must be acknowledged as set forth on page two. Contra Costa County Standard Form. 1/87 APPROVALS/ACKNOWLEDGEMENT Number 23-054-7 APPROVALS RECOMMENDED BY DEPARTMENT FORM APPROVED By By De i nee APPROVED: COUNTY ADMINISTRATOR By ACKNOWLEDGEMENT State of Califor'hia ACKNOWLEDGEMENT ..(By Corporation, Partnership, or Individual) County of The person(s) signing above for Contractor, personally known to me in the individual or business capacity(ies) stated, or proved to me on the basis of satisfactory evidence to be the stated individual or the representative(s) of the partnership or corporation named above in' the capacity(ies) stated, personally appeared before me today and acknowledged that he/she/they executed it, and acknowledged to me that the partnership named above executed it or acknowledged to me that the corporation named above executed it.pursuant to its bylaws or a resolution of its board of,.directors. Dated: [Notarial Seal] Notary Public/Deputy County Clerk -2- SERVICE PLAN Number: 23-054-7 I. SERVICE ACTIVITIES. A. Scope of Service. Contractor shall provide emergency ambulance services, as requested by the Sheriff's Communications Center or other designated public safety dispatch center(s) , in County-specified Emergency Response Area(s) 3 , delineated in the current copy of the map entitled "Emergency Response Areas of Contra County", as amended, which is on file in the office of the Sheriff-Coroner and Clerk of the Board of Supervisors. Such services shall be provided in accordance with the requirements of Health and Safety Code Section 1797 et seq. , Division 48 of the Contra Costa County Ordinance Code, and all regulations promulgated thereunder, which are incorporated herein by reference, and in accordance with any amendments or revisions thereof. In performing services hereunder, Contractor shall work cooperatively with County's Health Services Director or his designee, Art Lathrop (also referred to herein as "Contract Manager") . B. Services. In consideration of the County's referral to Contractor of Emergency Ambulance Service requests originating in Emergency Response Area(s) 3 , Contractor shall perform the following services to the complete satisfaction of the County: 1. Contractor shall provide said emergency ambulance services, without interruption, 24 hours per day, 7 days per week, 52 weeks per year, for the full term of this Contract. 2. Contractor shall provide said emergency ambulance services support without regard to the patient's race, color, national origin, religious affiliation, age, sex, or ability to pay. II. Performance Standards. A. Resvonse Time Performance Standards. Contractor's response time on requests for emergency medical service originating from within the service area shall meet the following performance standards: 1. Potentially Life Threatening Emergency Response (Code 3) . Each and every month, Contractor shall respond to at least 95% of all potentially life threatening emergency ambulance requests originating within Emergency Response Area(s) 3 with a maximum response time of ten (10) minutes in sub-areas designated urban/suburban, and with a maximum response time of twenty (20) minutes in sub-areas designated as rural as set forth in Exhibit A, attached hereto and incorporated herein by this reference. A detailed map delineating urban/suburban and rural sub-areas and a detailed map description are on file at the Emergency Medical Services Agency office at 50 Glacier Drive, Martinez, CA. , which documents are incorporated herein by this reference. 2. Non-Life Threatening Emergency Response (Code 2) . Contractor shall respond to all non-life threatening Code 2 emergency ambulance requests received from a public safety agency with a maximum response time of fifteen (15) minutes in designated urban/suburban areas and a maximum response time of thirty (30) minutes in designated rural areas, or shall immediately notify the County dispatch agency if the response time will exceed the maximums set forth herein. Initials: 1 Contractor County Dept. SERVICE PLAN Number: 23-054-7 3. Response Time Calculation. Contractor"s response times shall be calculated on a monthly basis to determine compliance with the 95% standard set forth in Section II.A.1. , above. Response times are calculated from the time the ambulance unit receives the request (disconnect time) until the ambulance unit arrives at the nearest public road access to the scene. 4. Response Time Exceptions. In the monthly calculation of Contractor's performance in regard to emergency response time standards, every emergency request originating from within Contractor's assigned Emergency Response Area (ERA[s] ) , shall be included except as follows: a. Upgrades/Downgrades. Emergency responses which have been upgraded, (i.e. from response Code 2 to response Code 3) or downgraded (i.e. from response Code 3 to response Code 2) prior to the arrival of the responding ambulance. b. Standby. When one or more of Contractor's Advanced Life Support (ALS) ambulance units have been placed on stand-by status not including the first one hour of stand-by, provided, however, that Contractor gave prior notice to County that said stand- by might limit Contractor's ability to meet response time standards. C. MultiRle Responses. In case of a multiple-response incident (i.e. , where more than one ambulance is sent to the same incident) , only the response time of the first arriving paramedic ambulance shall be counted. d. Multicasualty Disaster. The response time requirements shall be suspended during a declared multicasualty incident, medical advisory, or disaster in Contra Costa County, or during a declared disaster in a neighboring jurisdiction which has requested assistance from the County. e. Good Cause. The Contract Manager may allow exceptions to the response time requirements for good cause as determined in his sole discretion. At a minimum, the asserted ground(s) for exception must have been a substantial factor in producing a particular excess response time and Contractor must have demonstrated a good faith effort to respond to the call(s) . Good cause for an exception may include, but is not limited to, incorrect or inaccurate dispatch information received from County Communications Center; disrupted voice or data radio transmission; mobile data terminal failure; material change in dispatch location; Computer Aided Dispatch (CAD) failure; unavoidable telephone communications failure; inability to locate address due to non-existent address; inability to locate patient due to patient departing the scene; delays caused by traffic secondary to the incident; unavoidable delays caused by road construction or inclement weather, e.g. , fog; unavoidable delays caused by trains; when units are providing County authorized mutual aid; when hospital(s) are on emergency department diversion or trauma center bypass when said diversion or bypass can be shown to affect response times; and off-road locations. f. Unusual System Overload. The Contract Manager may allow exceptions to the contract response time standards for responses during periods of unusual system overload. Such exceptions shall be allowed at the sole discretion of the Contract Manager. Furthermore, this provision shall apply only if an "unusual system overload" plan has been submitted by the Contractor and approved by the Contract Manager prior to any request for exception. The Contract Manager may, at his sole discretion and at any time, revoke approval of an "unusual system overload" plan by providing written notice to Contractor. Contractor may submit a new plan for approval. If a new plan is not submitted and approved, the Initials:. Sk=__ 2 Contractor C41unty Dept. SERVICE PLAN Number: 23-054-7 "unusual system overload" plan exception to response time calculations and penalties shall not apply until an approved new plan is in place. Contract Manager shall not unreasonably withhold approval of any plan. 5. Application for Exception. It is the Contractor's responsibility to apply to Contract Manager for an exception to a required response time. 6. Exception Request Procedure. For each actual response time which the Contractor believes to be an exception to a required response time, the Contractor shall submit, in writing, to the Contract Manager a detailed explanation of the incident in question. Exception requests shall be submitted with the monthly performance reports required in Section R.2.a. , herein. The Contract Manager shall grant or deny exceptions to performance standards and shall so advise the Contractor. 7. Documentation of Response Times. Contractor shall document all times necessary to determine the total ambulance response time, including but not limited to total on-scene time; total time to transport to hospital; time call received by Contractor; time ambulance crew assigned; time enroute to scene; arrival at scene time; time enroute to hospital; and arrival at hospital time. All times shall be recorded on the County Patient Care Report Form (PCR) , described in Section II. R.1. of the Service Plan (Patient Care Report Forms) , herein, and as part of Contractor's dispatch system. 8. Performance Report. Within ten (10) working days following the end of each month, Contractor shall document and report to Contract Manager in writing, in a manner required by the Contract Manager, information as specified in Paragraph R.2. (Performance Reports) of the Service Plan. Contractor shall identify the causes of failures of performance, and shall document efforts to eliminate these problems. 9. Penalty for Failure to Provide Data to Determine Compliance. a. Each and every time an emergency ambulance is dispatched and the ambulance crew fails to report and document on-scene time shall be considered a failure to report data to determine compliance. The Contractor, in order to rectify the failure to report an on-scene time may demonstrate to the satisfaction of the Contract Manager an accurate on-scene time. b. Where an on-scene time cannot be provided for a particular emergency call, the response time for that call shall be deemed to have exceeded the required response time for purposes of determining response time compliance. B. Deployment Plan. 1. Contractor shall provide Contractor Manager with a current deployment plan specifying all ambulance stations and number of vehicles to be deployed during each hour of the day, and each day of the week, upon request of Contract Manager for contract monitoring purposes. 2. Contractor shall submit proposed changes in the deployment plan in writing to the Contract Manager thirty (30) days before implementation. The thirty (30) day notice may be waived by the Contract Manager if the Contract Manager determines that an emergency adjustment to the plan is needed to correct an acute performance problem. 44 Initials: 10— � 3 Contractor County Dept. SERVICE PLAN Number: 23-054-7 3. Contractor acknowledges and agrees with the goal of the EMS system to achieve the response time standards specified herein and to achieve timely responses in each community served. a. Contractor shall therefore endeavor to deploy ambulance resources in a manner consistent with this goal. b. If, as a result of local zoning or use restrictions, Contractor is unable to obtain adequate ambulance station locations, Contractor may request exclusion of designated areas from the response time standard. The Contract Manager shall take into account Contractor's diligence in seeking station locations and any necessary permits in granting or denying an exclusion. C. Ambulance Staffing/Personnel Preparation. 1. Ambulance Staffing. Contractor shall send an Advanced Life Support (ALS) ambulance staffed with two paramedics (Emergency Medical Technicians-Paramedics) [EMT-P] to life threatening and potentially life threatening emergency medical requests. Contractor may send Basic Life Support (BLS) units staffed with two (2) EMT-Is to requests for multi-unit response and any emergency calls in which the County designated medical dispatch center determines BLS response is appropriate. 2. Work and Services. Contractor shall comply with all applicable State and local laws and regulations, and County EMS policies, procedures and protocols. 3. Certification. All of Contractor's ambulance personnel responding to emergency medical requests shall be currently certified, and., in addition, all paramedic personnel shall be currently accredited by the EMS Agency to practice in Contra Costa County. Contractor shall retain on file at all times, copies of the current and valid licenses, certifications, and/or accreditations of all emergency medical personnel performing services under this Agreement. 4. Advanced Cardiac Life Support (ACLS) Certification. All paramedics responding to potentially life threatening emergency medical requests shall be currently certified in ACLS by the American Health Association. Contractor shall retain on file at all times, copies of the current and valid certifications of all paramedics performing services under this Agreement. 5. Required Trauma Training. a. Contractor shall staff each ALS ambulance with a minimum of one paramedic certified in Prehospital Trauma Life Support (PHTLS) or Basic Trauma Life Support (BTLS) . Contractor shall retain on file at all times, copies of the current and valid certifications of all PHTLS or BTLS qualified paramedics performing services under this agreement. b. All paramedics shall be required by Contractor to obtain certification in PHTLS or BTLS within six (6) months of hire. D. Company Orientation and On-Going Preparedness. Contractor shall properly orient all field personnel before assigning them to respond to emergency medical requests. Such orientation shall include at a minimum, provider agency policies and procedures; EMS system Initials: 4 Contractor CFbunty Dept. SERVICE PLAN Number: 23-054-7 overview; EMS policies and procedures; radio communications with and between the provider agency; base hospital, receiving hospitals, and county communications centers; map reading skills including key landmarks, routes to hospitals and other major receiving facilities within the county and in surrounding areas; and ambulance and equipment utilization and maintenance. E. Field Supervision. Contractor shall provide at all times and within Contra Costa County an on-duty employee or officer, authorized to act on behalf of the Contractor in all operational matters. F. Preparation for Multicasualty Response. Contractor shall train all ambulance personnel and supervisory staff in their respective roles and responsibilities under the County Multicasualty Incident Plan (MCIP) which is on file at the County EMS Agency, and prepare them to function as the medical portion of the Incident Command System. G. Driver Training. Contractor shall maintain an on-going driver training program for ambulance personnel. The program, the number of instruction hours, and the system for integration into the Contractor's operations (e.g. , accident review boards, impact of accidents on employee performance reviews and compensation, etc. ) will be reviewed and is subject to approval by County initially and on an annual basis. Map reading shall be an integral part of driver training. H. Assaultive Behavior Management Training. Contractor shall provide ambulance personnel with the training, knowledge, understanding., and skills to effectively manage patients with psychiatric, drug/alcohol or other behavioral or stress related problems, as well as difficult or potentially difficult scenes on an on-going basis. Emphasis shall be on techniques for establishing a climate conducive to effective field management, and for preventing the escalation of potentially volatile situations. I. Infection Control. Contractor shall develop and strictly enforce policies for infection control and contaminated materials disposal to decrease the chance of communicable disease exposure. J. Quality Assurance (QA) Program. 1. Contractor shall maintain a comprehensive Quality Assurance Program designed to interface with the EMS Quality Assurance Program, which is on file at the EMS Agency. 2. Contractor shall provide a physician or a Registered Nurse to implement and oversee this on-going QA program. This individual shall be responsible for the medical quality assurance evaluation of all services provided pursuant to this Agreement. 3. The goal of Contractor's QA program shall be to evaluate patient care services provided pursuant to this Agreement. 4. Contractor shall submit for approval an annual quality assurance plan. This quality assurance plan shall meet the objectives identified in the Ambulance Quality Assurance (QA) Program, on file at the Emergency Medical Services Agency. K. Preventative Health Care. Contractor shall provide currently recommended immunizations and health screening for its high risk personnel. Initials:_ �_4= - 5 Contractor County Dept. SERVICE PLAN Number: 23-054-7 L. Critical Incident Stress Debriefing. Contractor shall establish a critical incident stress debriefing program and an ongoing stress reduction program for its employees. These programs shall be submitted to the Contract Manager for approval. M. Ambulance Vehicles and Eauipment. 1. Vehicles. Ambulance vehicles shall meet -the standards of Title XIII, California Code of Regulations. 2. Vehicle Marking. L' OP.. a. Ambulance vehicles used in providing contract services shall bear the markings "Contra Costa County Emergency Medical Services" on both sides. Such vehicles shall display the "911" emergency telephone number and state the :Level of service, "Paramedic Unit", on both sides. b. Ambulance vehicles shall be marked to identify the company name, but shall not display any telephone number other than 911 or any other advertisement. C. Overall design, color, and lettering are subject to the approval of the Contract Manager. 3. Vehicle Maintenance. Contractor shall maintain its vehicles in good working order, consistent with manufacturer's specifications. In addition, detailed records shall be maintained as to work performed, costs related to repairs, and operating and repair costs analyses where appropriate. Such repairs shall be accomplished and systems shall be maintained so as to achieve at least the industry norms in vehicle performance and reliability. 4. General Equipment. a. All of Contractor's ambulances shall carry all emergency supplies and equipment identified in the County Ambulance Equipment and Supply list on file at the EMS Agency. b. Contractor shall maintain its vehicles, equipment, and supplies in a clean, sanitary, and safe mechanical condition at all times. C. Contractor agrees that equipment and supply requirements may be changed with the approval of the Contract Manager due to changes in technology. 5. Failure To Meet Minimum In-Service Equipment/Supply Requirements. County may inspect Contractor's ambulances at any time, without prior notice. Any ambulances that fail to meet the minimum in-service requirements contained in the County Ambulance Equipment and Supply list as determined by County shall be immediately removed from service until the deficiency is corrected. The foregoing shall not preclude dispatch of the nearest available ambulance even though not fully equipped, in response to a life threatening emergency so long as another appropriately equipped ambulance of at least equal level of service is also dispatched to the scene. County may adopt protocols governing provisional dispatch of ambulances not in compliance with minimum in-service requirements and shall comply with these protocols. Initials: )L__ /____ — 6 Contractor County Dept. SERVICE PLAN Number: 23-054-7 N. Equipment Exchange and Replacement. 1. Contractor shall implement and maintain inventory control and equipment maintenance systems which will allow the ambulance fleet fully stocked with quality equipment in good working order at all times. 2. Contractor's plan for replacement of expendable equipment and supplies shall be self-sufficient and shall not rely on receiving hospital stock or billing services unless expressly agreed to in writing by receiving hospitals. 3. Contractor shall establish a mechanism to exchange non-expendable medical supplies and equipment supplied by a fire first responder agency in connection with patient transport, in those situations where said supplies and equipment are interchangeable. 0. Communications Equipment and Dispatch. 1. Dispatch Center. Contractor shall assure that its units are dispatched through a dispatch facility which is staffed, equipped and prepared to provide emergency medical dispatch and shall assure that all equipment (fixed, mobile, linkages) necessary to receive requests for emergency ambulance services via data or voice, made at the County designated public safety dispatch centers, and capable of dispatching all ambulance units used in providing services pursuant to this Agreement is maintained. 2. Dispatcher Preparedness. Contractor shall assure that emergency ambulance dispatchers are adequately trained and prepared to process emergency medical requests for service. Said dispatchers shall be given a company orientation as well as a thorough orientation to the County EMS system before being assigned to operate as part of Contractor's ambulance dispatch system. 3. Dispatch Evaluation. Contractor shall assure an on-going program for the evaluation of dispatch operations, education and training of dispatchers, and problem identification and resolution. 4. Ambulance Communication Equipment. Contractor shall equip all paramedic ambulances used in providing service to the County with 4-channel radios for communication on County's MEDARS radio system and with cellular telephones for ambulance to base hospital communications. County will lease to Contractor, or Contractor may supply in accordance with County specifications, two way vehicular or portable radio equipment under the following terms: a. All ambulances for emergency medical response under the terms of this Agreement shall operate only within Contra Costa County, or as directed by a County communications center, or in compliance with policies or protocols established by County. b. Radio frequencies shall be designated by County for the purpose of communications with a County designated communications center and for ambulance-to-hospital communications. C. Approved radio equipment must be installed in conformance with existing County policies prior to assignment of a vehicle to an emergency response area. Installations and removals will be at Contractor's expense. Initials:_ 7 Contractor C unty Dept. SERVICE PLAN Number: 23-054-7 d. Contractor shall obtain a certificate of inspection of approved radio equipment by County following installation, and on an annual basis thereafter and shall make vehicles available for inspection of County owned radios upon reasonable request of County. Alternate procedures may be adopted by Contract Manager and County Communications Division. e. Specific radio equipment purchased by County at County expense for private Contractor shall remain the property of and under control of the County at all times. f. County owned radios damaged due to accidents, malicious mischief, and acts of God, shall be repaired or replaced at County's option by County, for which Contractor shall pay County's actual cost of repair or replacement. Equipment shall remain the property of the County. g. Contractor shall operate the two-way radios in conformance with all applicable rules and regulations of the Federal Communication Commission, and in conformance with all applicable County rules and operating procedures. All operators of the two-way radios shall at all times be subject to the exclusive control of County. h. All radio equipment other than Contractor's internal company system shall be approved by the County Communications Director. P. Disaster, Multicasualty, Mutual Aid Response, Standby. 1. Disaster Response. Contractor may render emergency assistance in multicasualty or disaster situations to any location as directed by a county communications center or by Contract Manager. a. During multicasualty or disaster periods, Contractor will be exempt from all responsibilities for response time performance until notified by the County. b. At the scene of the multicasualty/disaster, Contractor's personnel shall perform in accordance with the County Multicasualty Plan. C. When Contractor is notified that multicasualty/disaster assistance is no longer required, Contractor shall return all of its resources to the primary area of responsibility and shall resume all operations in a timely manner. d. During the course of the multicasualty/disaster, the Contractor shall use best efforts to provide local standard emergency coverage. 2. Disaster Response Vehicle. Contractor shall prov' one vehicle as a disaster response vehicle. This vehicle should be kept in good ing order and available for emergency response to the scene. The vehicle should_ngxrt�e a routine ambulance used in day-to-day operations. The following equipment sha e�stored in the disaster vehicle: a. Backboard and str NST A�Q��v" LL C. Cervical col c. Head i ization sets and foam wedges d. Sp1 s for legs and arms e. xygen equipment Dressings and bandages g. Advanced life support equipment, e.g. , IV bags/start equipment Initials: _ A-- 8 Contractor dounty Dept. SERVICE PLAN Number: 23-054-7 3. Disaster/Multicasualty Training. Contractor shall, to the best of its ability, participate in disaster and multicasualty training and exercises conducted by the EMS Agency. 4. Mutual Aid. Contractor may respond in a mutual aid capacity to other service areas within and outside of Contra Costa County when directed by the Contract Manager. 5. Stand-By Service. Contractor may provide, at no charge to County or requesting agency, stand-by services at the scene of an emergency incident within its emergency response area when directed by a County communications center upon the request of a public safety agency. A unit placed on stand-by shall be dedicated to the incident for which it has been placed on stand-by. Stand-by periods exceeding eight (8) hours must be approved by the Contract Manager. 6. Ambulance Service Assistance. Contractor, to the best of its ability, shall assist in servicing any other emergency response areas where the County agreement for that response area has been suspended or terminated. Q. Public Education and Information. Contractor shall sponsor and/or participate in classes to educate the general public to emergency medical services. Contractor shall work with existing community groups, service organizations, and Chambers of Commerce to support the local community efforts for educating the public regarding emergency response, care, and transportation, including where citizen training can be obtained including CPR. R. Records, Reports, Audits, Inspections. 1. Patient Care Report Forms. Contractor shall utilize the County's "Patient Care Report Form" (PCR) for patient documentation on all patient responses including non- transports. Contractor shall complete this form accurately and include all information listed in Section 100169 of the California Code of Regulations, and distribute it according to established EMS Policies and Procedures. a. County shall provide the required PCR forms to Contractor at County's cost. At Contractor's option, Contractor may print its own supply of forms. The form is subject to revision by the Contract Manager at any time. b. At the end of each and every month, Contractor shall provide County with copies of the dispatch record and PCR form for each and every emergency response in that month, no later than ten (10) working days following the last day of the month; or, when requested by County in connection with an'incident investigation, within 72 hours of request. Contractor shall identify and provide separately, copies of PCRs for trauma transports (patients meeting trauma triage criteria) on a monthly basis. C. Contractor shall provide County with copies of any individual Patient Care Report Form on request within three (3) working days of request. 2. Performance Reports. Within ten (10) working days following the last day of each month, Contractor shall document and report to Contract Manager in writing in a form required by the Contract Manager: Initials: 9 Contractor unty Dept.. SERVICE PLAN Number: 23-054-7 a. a list of each and every emergency call dispatched for which Contractor did not meet the response time standard. b. a list of each and every emergency call where an ALS ambulance was not dispatched. C. a list of each and every call where there was a failure to properly record all times necessary to determine the response time, and for patients meeting trauma criteria, on-scene time and/or transport to hospital time. d. a list of trauma transports by city and by hospital including all times necessary to calculate each and every response time, on-scene time, and transport to hospital time. 3. Statistical Data. Within 20 working days following the last day of each month, the Contractor shall provide records in hard copy or computer readable format and suitable for statistical analysis for all ambulance responses. Records shall include the following data elements: a. unit identifier b. service level (paramedic or EMT-I) C. location of call - address, city d. location of call - Thomas Brother's map coordinates e. nature of call (dispatch info) f, code to scene g. time call received h. time call dispatched i. time unit enroute j . time unit on-scene k. time unit enroute to hospital 1. time unit at hospital M. time unit clear and available for nest call n. outcome (dry run, transport) o. receiving hospital P. code to hospital q. major trauma (MTV, non-MTV) 4. Personnel Reports. a. Contractor shall provide County with a list of paramedics currently employed by Contractor and shall update that list whenever there is a change. b. The personnel list shall include at a minimum, name, address, telephone number, ACLS expiration date, and California Driver's License number. 5. Other Reports. Contractor shall provide such other reports and records as may be reasonably required by Contract Manager. 6. Observation of Operations. County representatives may, at any time and without notification, directly observe Contractor's control center operations, maintenance facilities, and ambulance post locations, and may ride as "third person" to observe the operation of any of Contractor's ambulance units. The County's representatives shall conduct Initials:. 10 Contractor County Dept. SERVICE PLAN Number: 23-054-7 themselves in a professional and courteous manner, shall not interfere with Contractor's employees in the performance of their duties, and shall at all times be respectful of Contractor's employer/employee relationship. 7. Annual Performance Evaluation. Contractor shall participate in annual performance evaluations in accordance with procedures established by Contract Manager. S. Compensation Related Provisions. Any patient charges, if established during the contract period, shall be approved in advance by the Contract Manager. T. Payment Provisions. 1. County shall pay Contractor the amount specified in Exhibit B, attached hereto and incorporated herein by reference, for emergency ambulance services provided pursuant to this Agreement. 2. County shall make said payments to Contractor after receipt and approval by County of a properly documented invoice and performance report. U. Cooperation With Evolving_System. Contractor agrees to participate and assist in the development of system changes subject to negotiated costs, if any. V. County Approved Base Station Hospitals. County, through its Ambulance Permit Officer, shall notify Contractor in writing, upon execution of this Contract, of all County approved Base Station Hospitals. Further, County shall notify Contractor in writing of changes or additions to such approved hospitals, as such changes or additions occur. Initials: - 11 Contractor C unty Dept. SPECIAL CONDITIONS Number 23-054-7 1. Response Area Exclusivity. Except for the provision of backup services, or the suspension or termination of this Agreement, County shall not enter into any agreement with any other provider for ground response to emergency ambulance requests from the County Communications Center or other designated public safety dispatch center within Contractor's Emergency Response Area(s) during the term of this Agreement. 2. Air Ambulance Transport. County reserves the right to enter into separate transport agreements with air ambulance providers. Notwithstanding any other provisions of this Agreement, County may provide for air transport of patients when such transportation is deemed to be medically in the best interest of the patient(s) . However, no such agreement shall provide for air transport of non-critical patients or of critical patients when a ground ambulance is on-scene and transport time by ground ambulance to the most accessible emergency medical facility equipped, staffed, and prepared to administer care appropriate to the needs of the patient is the same or less than estimated air transport time. 3. Breach of Contract. a. Notice of Default. County shall have the right to terminate or cancel this Agreement or to pursue any appropriate legal remedy in the event Contractor materially breaches this Agreement and fails to correct such default within seven (7) days following the service of a written notice by County specifying the default(s) and the effective date of intended termination of this Agreement, absent cure. b. Definitions of Breach. Conditions and circumstances which shall constitute a material breach by the Contractor shall include: but are not limited to the following: 1) Failure of the Contractor to operate the ambulance service system in a manner which enables the County and the Contractor to remain in substantial compliance with the requirements of the applicable Federal, State, and County laws, rules, and regulations. Minor violations of such requirements shall not constitute a material breach except wilful and repeated violations shall constitute a material breach; 2) Falsification of data supplied to the County including by way of example but not by way of exclusion, dispatch data, patient report data, response time data, financial data, or falsification of any other data required under this Agreement; 3) Failure to maintain equipment in accordance with good maintenance practices; 4) Attempts by the Contractor to intimidate or otherwise punish employees who desire to sign contingent employment agreements with competing bidders during a subsequent bid cycle; 5) Attempts by the Contractor to intimidate or punish employees who participate in protected concerted activities, or who form or join any professional associations; 6) Chronic and persistent failure of Contractor's employees to conduct themselves in a professional and courteous manner, or to present a professional appearance; Initials: �Rt - 1 Contractor Ctinty Dept. SPECIAL CONDITIONS Number 23-054-7 7) Failure to comply with approved rate setting, billing, and collection procedures; 8) Repeated failures to meet response time requirements after receiving notice of non-compliance from the Contract Manager; 9) Repeated failures to respond to 958 of all potentially life threatening emergency medical requests with paramedic units; 10) Failure of the Contractor to provide and maintain the required insurance; or 11) Failure to comply with or exceed the minimum employee wage/salary benefit package specified in Contractor's Proposal. 4. Retention of Records. Paragraph 3. (Records) , Subparagraph a. (Retention of Records) of the General Conditions is hereby modified to read as follows: "a. Retention of Records. The Contractor shall retain all documents pertaining to this Contract for five (5) years from the end of the fiscal year following the date of service; for any further period that is required by law; and until all Federal/State audits are complete and exceptions resolved for this contract's funding period. Upon request, and except as otherwise restricted by law, Contractor shall make these records available to authorized representatives of the County, the State of California, and the United States Government. " 5. Insurance. Paragraph 19. (Insurance) is hereby deleted. Initials: 2 Contractor County Dept. EXHIBIT A AMBULANCE RESPONSE TIMES Areas Designated As Rural Thomas Brothers Map Coordinates The areas identified below by Thomas Brothers map area number and map coordinates are considered rural, therefore response times of up to 20 minutes (Code 3 response) or 30 minutes (Code 2 response) will be the maximum acceptable response times. All areas not identified below are considered urban/suburban, and are therefore subject to the urban/suburban response time standards. 04 All 30 ALL 52 ALL B1•-7 C1-6 06 A7 31 ALL 53 A4-7 70 B1 D1-7 B1-7 32 ALL B4-7 73 A3•-7 E5-7 C1-7 33 ALL C4-7 B5•-7 98 A5-6 D1-7 34 A2 D5-7 C6•-7 B5-7 E1-7 B1-2 El 74 D4•-7 101 B1 07 A2-7 C1-2 E6-7 E4•-7 Cl B5-7 D1-2 54 A3 76 D5•-7 D1-2 C7 E1-2 Bl-7 E1•-7 E1-3 D7 35 Al-7 Cl-7 77 A4•-7 102 D2-6 08 D6-7 B1 D1-7 B5•-7 E3-7 E6-7 36 C5 E1-7 C6•-7 103 A3-7 09 Al-7 D5-7 55 Al-7 D7 B3-7 B1-7 E5-7 B3-7 78 El C3-7 C1-2 38 D5 C4-7 79 ALL D3-7 C5-7 El-2 D4-7 80 ALL E1-7 D7 39 A6-7 E4-7 81 Al 104 ALL E7 B7 56 A4-7 Bl--4 105 ALL 11 ALL C2-7 B5-7 C1•-4 106 ALL 12 Al-7 D1-7 C5-7 D1--4 107 ALL B1-7 E1-7 D6-7 E1•-6 108 ALL C1-7 40 ALL E6-7 82 ALI: 109 ALL Dl-7 41 Al-44 57 ALL 83 AL], 110 ALL E3 Bl-5 58 ALL 84 ALL 111 ALL E7 Cl-7 59 A6-7 85 ALI: 112 ALL 14 Cl D1-7 B6-7 86 ALI: 113 ALL D1 El-7 C6-7 87 ALL 114 Al E1-3 42 Al-7 61 Al-7 88 A6-7 116 B1-3 17 A2-7 Bl-7 131-7 B6•-7 C1-4 B2-7 Cl-7 C1-2 C6-7 D1-5 C4-7 Dl-4 C4 D6--7 E2-5 D4-7 E1-4 C6-7 E6-7 117 E1 E6-7 43 ALL 63 Al-2 89 ALL 118 Al 18 A6-7 44 A5-7 B1-3 90 ALL B1-5 19 ALL B6-7 C1-7 91 A7 C1-5 23 ALL 45 Al-5 D1-7 B7 D1-4 24 Al-5 B1-5 E1-7 C1•-7 E1-4 B1-5 Cl-6 .64 ALL D1•-7 119 ALL C1-6 D1-6 65 C1-7 El--7 D1-5 E1-6 D1-7 92 ALL E1-6 46 Al-7 E1-7 93 ALL 25 ALL B1-2 66 ALL 94 ALL 26 ALL 50 D2-7 68 C1-2 96 D1--5 27 ALL E2-7 D1-4 El--6 28 ALL 51 D1 El-4 97 Al--6 29 ALL E1 69 Al-5 B1-6 EXHIBIT B PAYMENT SCHEDULE Payment Provisions for Emergency Ambulance Service: In consideration for the provision of emergency ambulance services described in this agreement, County shall pay Contractor $58,558.00 upon demand, upon execution of this Contract and thereafter, County shall pay Contractor $58.558.00 yearly on or after the anniversary date set forth in Paragraph 3. (Term) of this Contract. This amount shall be renegotiated at the request of either party based upon changes in the benefit assessment for Emergency Medical Services. Contra Costa County* Standard Form 1/87 GENERAL CONDITIONS (Purchase of Services) 1. Compliance with Law. Contractor shall be subject to and comply with all Federal, State and local laws and regulations applicable with respect to its performance under this Contract, including but not limited to, licensing, employment and purchasing practices; and wages, hours and conditions of employment, including nondiscrimination. 2. Inspection. Contractor's performance, place of business and records pertaining to this Contract are subject to monitoring, inspection, review and audit by authorized representatives of the County, the State of California, and the United States Government. 3. Records. Contractor shall keep and make available for inspection and copying by authorized representatives of the County, the State of California, and the United States Government, the Contractor's regular business records and such :additional records pertaining to this Contract as may be required by the County. a. Retention of Records. The Contractor shall retain all documents pertaining to this Contract for five years from the date of submission of Contractor's final payment demand or final Cost Report; for any further period that is required by law; and until all Federal/State audits are complete and exceptions resolved for this contract's funding period. Upon request, Contractor shall make these records available to authorized representatives of the County, the State of California, and the United States Government. b. Access to Books and Records of Contractor. Subcontractor. Pursuant to Section 1861(v) (1) of the Social Security Act, and any regulations promulgated thereunder, Contractor shall, upon written request and until the expiration of four years after the furnishing of services pursuant to this Contract, make available to the Secretary of Health and Human Services or to the Comptroller General, or any of their duly authorized representatives, this Contract and books, documents, and records of Contractor that are necessary to certify the nature and extent of all costs and charges hereunder. Further, if Contractor carries out any of the duties of this Contract through a subcontract with a value or cost of $10,000 or .more over a twelve-month period, such subcontract shall contain a clause to the effect that upon written request and until the expiration of four years after the furnishing of services pursuant to such subcontract, the subcontractor shall make available, to the County, to the Secretary or to the Comptroller General, or any of their duly authorized representatives, the subcontract and books, documents, and records of the subcontractor that are necessary to verify the nature and extent of all costs and charges thereunder. This special condition is in addition to any and all other terms regarding the maintenance or retention of records under this Contract and is binding on the heirs, successors, assigns and representatives of Contractor. 4. Reporting ReQuirements. Pursuant to Government Code Section 7550, Contractor shall include in all documents or written reports completed and submitted to County in accordance with this Contract, a separate section listing the numbers and dollar amounts of all contracts and subcontracts relating to the preparation of each such document or written report. This section shall apply only if the payment limit under this Contract exceeds $5,000. 1 Contra Costa County Standard Form 1/87 GENERAL CONDITIONS (Purchase of Services) 5. Termination. a. Written Notice. This Contract may be terminated by either party, at their sole discretion, upon thirty-day advance written notice thereof to the other, and may be cancelled immediately by written mutual consent. b. Failure to Perform. The County, upon written notice to Contractor, may immediately terminate this Contract should the Contractor fail to .perform properly any of its obligations hereunder. In the event of such termination, the County may proceed with the work in any reasonable manner it chooses. The cost to the County of completing Contractor's performance shall be deducted from any sum due the Contractor under this Contract, without prejudice to the County's rights otherwise to recover its damages. C. Cessation of Funding. Notwithstanding Paragraph 5.a. above, in' the event that Federal, State, or other non-County funding for this Contract ceases, this Contract is terminated without notice. 6. Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties. Except as expressly provided herein, no other understanding, oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. 7. Further Specifications for Operating Procedures. Detailed specifications of operating procedures and budgets required by this Contract, including but not limited to, monitoring, evaluating, auditing, billing, or regulatory changes, may be developed and set forth in a written Informal Agreement between the Contractor and the County. Such Informal Agreements shall be designated as such and shall not be amendments to this Contract except to the extent that they further detail or clarify that which is already required hereunder. Such Informal Agreements may not enlarge in any manner the scope of this Contract, including any sums of money to be paid the Contractor as provided herein. Informal Agreements may be approved and signed by the head of the County Department for which this Contract is made or his designee. 8. Modifications and Amendments. a. General Amendments. This Contract may be modified or amended by a written document executed by the Contractor and the Contra Costa County Board of Supervisors or, after Board approval, by its designee, subject to any required State or Federal approval. b. Administrative Amendments. Subject to the Payment Limit, the Payment Provisions and the Service Plan may be amended by a written administrative amendment executed by the Contractor and the County Administrator or his designee, subject to any required State or Federal approval, provided that such administrative amendments may not materially change the Payment Provisions or the Service Plan. 9. Disputes. Disagreements between the County and Contractor concerning the meaning, requirements, or performance of this Contract shall be subject to final determination in writing by the head of the County Department for which this Contract is made or his designee or in accordance with the applicable procedures (if any) required by the State or Federal Government. 2 Contra Costa County Standard Form 1/87 GENERAL CONDITIONS (Purchase of Services) 10. Choice of Law and Personal Jurisdiction. a. This Contract is made in Contra Costa Country and shall be governed and construed in accordance with the laws of the State of California. b. Any action relating to this Contract shall be instituted and prosecuted in the courts of Contra Costa County, State of California. 11. Conformance with Federal and State Reyulations and Laws. Should Federal or State regulations or laws touching upon the subject of this Contract be adopted or revised during the term hereof, this Contract shall be deemed amended to assure conformance with such Federal or State requirements. 12. No Waiver by County. Subject to Paragraph 9. (Disputes) of these General Conditions, inspections or approvals, or statements by any officer, agent or employee of the County indicating the Contractor's performance or any part thereof complies with the requirements of this Contract, or acceptance of the whole or any part of said performance, or payments therefor, or any combination of these actA, shall not relieve the Contractor's obligation to fulfill this Contract as prescribed; nor shall the County be thereby estopped from bringing any action for damages or enforcement arising from any failure to comply with any of the terms and conditions of this Contract. 13. Subcontract and Assignment. This Contract binds the heirs, successors, assigns and representatives of Contractor. The Contractor shall not enter into subcontracts for any work contemplated under this Contract and shall not assign this Contract or monies due or to become due, without the prior written consent of the County Administrator or his designee, subject to any required State or Federal approval. 14. Independent Contractor Status. This Contract is by and between two independent contractors and is not intended to and shall not be construed to create the relationship between the parties of agent, servant, employee, partnership, joint venture or association. 15. Conflicts of Interest. Contractor, its officers, partners, associates, agents , and employees, shall not make, participate in making, or in any way attempt to use the position afforded them by this Contract to influence any governmental decision in which he or she knows or has reason to know that he or she has a financial interest under California Government Code Sections 87100, et seq. , or otherwise. 16. Confidentiality. Contractor agrees to comply and to require its officers, partners, associates, agents and employees to comply with all. applicable State or Federal statutes or regulations respecting confidentiality, including but not limited to, the identity of persons served under this Contract, their records, or services provided them, and assures that: a. All applications and records concerning any individual made or kept by Contractor or any public officer or agency in connection with the administration of or relating to services provided under this Contract will be confidential, and will not be open to examination for any purpose not directly connected with. the administration of such service. 3 Contra Costa County Standard Form 1/87 GENERAL CONDITIONS (Purchase of Services) b. No person will publish or disclose or permit or cause to be published or disclosed, any list of persons receiving services, except as may be required in the administration of such service. Contractor agrees to inform all employees, agents and partners of the above provisions, and that any person knowingly and intentionally disclosing such information other than as authorized by law may be guilty of a misdemeanor. 17. Nondiscriminatory Services. Contractor agrees that all goods and services under this Contract shall be available to all qualified persons regardless of age, sex, race, religion, color, national origin, or ethnic background, or handicap, and that none shall be used, in whole or in part, for religious worship or instruction. 18. Indemnification. The Contractor shall defend, indemnify, save, and hold harmless the County and its officers and employees from any and all claims, costs and liability for any damages, sickness, death, or injury to person(s) or property, including without limitation all consequential damages, from any cause whatsoever arising directly or indirectly from or connected with the operations or services of the Contractor or its agents, servants, employees or subcontractors hereunder, save and except claims or litigation arising through the sole negligence or sole willful misconduct of the County or its officers or employees. Contractor will reimburse the County for any expenditures, including reasonable attorneys' fees, the County may make by reason of the matters that are the subject of this indemnification, and if requested by the County will defend any claims or litigation to which this indemnification provision applies at the sole cost and expense of the Contractor. 19. Insurance. During the entire term of this Contract and any extension or modification thereof, the Contractor shall keep in effect insurance policies meeting the following insurance requirements unless otherwise expressed in the Special Conditions: a. Liabilitv Insurance. The Contractor shall provide comprehensive liability insurance, including coverage for owned and non-owned automobiles, with a minimum combined single limit coverage of $500,000 for all damages, including consequential damages, due to bodily injury, sickness or disease, or death to any person or damage to or destruction of property, including the loss of use thereof, arising from each occurrence. Such insurance shall be endorsed to include the County and its officers and employees as additional insureds as to all services performed by Contractor under this agreement. Said policies shall constitute primary insurance as to the County, the State and Federal Governments, and their officers, agents, and employees, so that other insurance policies held by them or their self- insurance program(s) shall not be required to contribute to any loss covered under the Contractor's insurance policy or policies. b. Workers' Compensation. The Contractor shall provide workers' compensation insurance coverage for its employees. C. Certificate of Insurance. The Contractor shall provide the County with (a) certificate(s) of insurance evidencing liability and worker's compensation insurance as required herein no later than the effective date of this Contract. If the Contractor should renew the insurance policy(ies) or acquire either a new insurance policy(ies) or amend the coverage afforded through an endorsement to the policy at any time during the term of this Contract, then Contractor shall provide (a) current certificate(s) of insurance. d. Additional Insurance Provisions. The insurance policies provided by the Contractor shall include a provision for thirty (30) days written notice to County before cancellation or material changes of the above specified coverage. 4 Contra Costa County Standard Form 1/87 GENERAL CONDITIONS (Purchase of Services) 20. Notices. All notices provided for by this Contract: shall be in writing and may be delivered by deposit in the United States mail, postage prepaid. Notices to the County shall be addressed to the head of the County Department for which this Contract is made. Notices to the Contractor shall be addressed to the Contractor's address designated herein. The effective date of notice shall be the date of deposit in the mails or of other delivery, except that the effective date of notice to the County shall be the date of receipt by the head of the County Department for which this Contract is made. 21. Primacv of General Conditions. Except for Special Conditions which expressly supersede General Conditions, the Special Conditions (if any) and Service Plan do not limit any term of the General Conditions. 22. Nonrenewal. Contractor understands and agrees that: there is no representation, implication, or understanding that the services provided by Contractor under this Contract will be purchased by County under a new contract following expiration or termination of this Contract, and waives all rights or claims to notice or hearing respecting any failure to continue purchase of all or any such services from Contractor. 23. Possessory Interest. If this Contract results in the Contractor having possession of, claim to or right to the possession of land or improvements, but does not vest ownership of the land or improvements in the same person, or if this Contract results in the placement of taxable improvements on tax exempt land (Revenue & Taxation Code Section 107) , such interest or improvements may represent a possessory interest subject to property tax, and Contractor may be subject to the payment of property taxes levied on such interest. Contractor agrees that this provision complies with the notice requirements of Revenue & Taxation Code Section 107.6, and waives all rights to further notice or to damages under that or any comparable statute. 24. No Third-Party Beneficiaries. Notwithstanding mutual recognition that services under this Contract may provide some aid or assistance to members of the County's population, it is not the intention of either the County or Contractor that: such individuals occupy the position of intended third-party beneficiaries of the obligations assumed by either party to this Contract. 25. Copy rights and Rights in Data. Contractor shall not publish or transfer any materials produced or resulting from activities supported by this agreement without the express written consent of the County Administrator. If any material is subject to copyright, the County reserves the right to copyright such and the Contractor agrees not to copyright such material. If the material is copyrighted, the; County reserves a royalty- free, nonexclusive, and irrevocable license to reproduce, publish, and use such materials, in whole or in part, and to authorize others to do so. 5