HomeMy WebLinkAboutMINUTES - 06282005 - D2 i
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TO: BOARD OF SUPERVISORS
Contra
FROM: Art Lathrop, Emergency Medical Services Director
Health Services
Costa
DATE: June 28,2005
SUBJECT: Emergency Ambulance Contract—American County
Medical Response
i
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
BECQhOONDA NS:
(1) Authorize the Health Services Director or his designee to execute the attached ambulance
service agreement with American Medical Response(AMR)for the period July 1,2005
through June 3 0,2010 with an extension through June 3 0,2014 subject to a Board finding
that AMR is in compliance with contract requirements and wards. Since you last
reviewed this matter on June 14,2005,AMR has met all of the provisions contained in the
original proposal,the AMR letter of February 9,2005,and all subsequent provisions your
Board requested,including the commitment of a minimum of 4024 weekly paramedic hours
for the entire term of the contract.
(2) In the event that the attached ambulance service is not approved,authorize the Health
Services Director or his designee to execute a one-month extension through July 31,2005 to
the existing AMR ambulance agreement.
FISCAL IMPACT:
No General Fund impact. The cost of basic ambulance and related services to be provided under
this contract will be covered through user fees charged by the contractor. Certain optional
services and resources will be identified in the contract that may be purchased by the County at
the County's sole option. Cost of optional items,if purchased,would be covered through CSA
EM-I (Measure H)funds.
BACKGRQUND:
On February 15,2005,the Board of Supervisors approved selection of American Medical
Response to provide ambulance service pursuant to the Request for Proposal(RFP)issued
September 7,2004 and authorized the Health Services Director to negotiate a contract based on
the RFP and proposal submitted by AMR. The Board finther directed that(1)there be no charge
allowed for treatment of patients not transported by AMR,(2)the number Of unit hours proposed
by AMR for the first six months be retained throughout the contract period,(3)the issues
covered in the February 9,2005 letter from AMR providing supplemental information and
conunitments be included in the contract,(4)staff pursue increasing the number of defibrillators
CONTINUED ON ATTACHMENT: �X YES SIGNATURE:
RECOI MENDATION OF COUNTY ADMINIS I ATOR �RECOMME TION OF BO T
COMMITEE
f---APPROVE
OTHER
r
SIGNATURE(S). "
1
ACTION OFWA
Gt/! � A0,_gtJAPPRonrE AS RECOWAENIXD OTHER
---
Directed that a report in regard to compliance be filed annually, for the term of the contract, with the
Internal Operations Committee, to be referred to the full board if the Committee deems it is warranted.
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT TENS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
UNANIMOUS(ABSENT .� AND ENTERED ON THE N PWMS OF THE
BOARD OF SUPE MORS ON THE DATE
AYES: NOES: SHOWN.
ABSENT: ABSTAIN:
ATTESTEQ
JOHN SWEETEN,CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
Originating Department: Emergency Medical Services 646-4690
cc: County Administrator
County Counsel
Health Services Director
2
BY )EPUTY
that AMR will provide for a Public Access Defibrillation program,(5)staff pursue inclusion of a
provision requiring AMR to"co-bill"for first responder services on behalf of fin services so
requesting,and(6)staff ine levying higher penalties for failing to meet response time
requirements those set forth in the RFP. The Board also directed that the proposed AMR
contract be placed on the"Short Discussion"portion of the Board agenda on the date scheduled
for adoption.
attached.Itached contract meets all of the requirements set forth by the Board. The contract includes
all provisions M' the RFP and all commitments made by AMR in the company's original proposal
and supplemental commitments set forth in the February 9,2005 letter referenced above.
Additionally,the proposed contract(1)prohibits patient charges in any circumstance where the
patient is not transported,(2)provides that AMR maim a minimum of 4,024 paramedic
ambulance unit hours per week throughout the term of the agreement,(3)provides ten additional
automatic electronic defibrillators.(AEDs)for co agencies and requires that AMR
undertake an extensive program of community health promotion including Public Access
Defibrillation and CPR training,(4)requires AMR to provide"co-billing"for first responder
services on behalf of any fire jurisdiction so requesting,and(5)increases the minimum penalty
for failing to meet Priority One(Code Three)response times from$10,000 to$15,000 for each
zone.
Public Access Defibrillation Pro am and CPR TraLmin Commitment. AMR's commitment
made in the February 9th letter to the PAD program was to provide 15 AEDs during the first
contract year and 25 AEDs during each subsequent contract year. Under the proposed contract,
AMR will increase the number of AEDs to 25 during year one. More significantly,however,
AMR will agree to a larger role in the County's PAD program,including assisting organizations
PAD program development,PAD installation,and PAD
training. Under the proposed contract,
AMR will also agree to an expanded role in public CPR training. In addition to providing the 24
CPR classes per year to the public,AMR will undertake an outreach program to expand the
number of persons interested in #AV* CPR *nina and will provide train-the-t classes for
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persons interested in providing CPR training to the public.
Contract Extension. Under the proposed contract,County will agree to an extension of the AMR
contract for four years beyond the initial five-year agreement. This extension will be granted
somatically upon submission of a report to the Board on AMR's contract compliance and a
finding by the Board ANIR is in sub compliance with all terms of the contract. The
report to the Board would be required one year before expiration of the five-year term.
Web Pow. A separate report summarizing the contractprovision and a copy of the full
contract were posted on the Contra Costa Emergency Medical Services web site on June 21,
2005.
Additional Contract Provisions. The contract includes by reference the County RFP,AMR's
Om
original proposal,and All letter of February 9,2005. In addition to the provisions set forth
here and in the staff suuaumary report,AMR made sub commitments to the EMS
system and to the community.
r
L
Contra Costa Health Services
Emergency Medical Services Agency
June 21,2005
Report to the Board of Supervisors on the
Proposed Ambulance Services Agreement between
Contra Costa County and American Medical Response
The proposed contract between Contra Costa County and American Medical
Response (AMR)is based on the Request for Proposal(RFP)for Emergency Ambulance
Services issued September 7,2004 and on the proposal submitted by AMR on
November 4,2004. At its February 1,2005 meeting,the Board of Supervisors requested
AMR and competitor Starwest Ambulance to submit supplemental information and to
make certain additional commitments. On February 15,2005,the Board of Supervisors
directed staff to negotiate an ambulance service agreement with AMR based on the AMR
proposal. The Board further requested that the contract include the following:
(1) No charge to be allowed for treatment of patients not transported by AMR.;
(2)The number of unit hours proposed by AMR for the first six months(4,024
paramedic unit hours per week)be retained throughout the entire contract
period;
(3)The issues covered in the February 9,2005 letter from AMR providing
supplemental information and commitments be included in the contract;
(4)The number of defibrillators to be provided by AMR for a Public Access
Defibrillation program be increased;
(5)A provision requiring AMR to"co-bill"for first responder services on behalf
of fire services so requesting; and
(6)Higher penalties for failing to meet response time requirements than those set
forth in the RFP.
The contract being proposed for Board approval includes all requirements of the
RFP,all commitments made in the AMR proposal,all commitments made in AMR's
letter of February 9, 2005,and all items set forth above from the Board's action on
February 15,2005, including a commitment by AMR.to maintain a minimum of 4,024
weekly paramedic ambulance unit hours for the life of the contract.
In addition to summarizing key provisions of the proposed ambulance service
agreement,this report provides information requested by the Board of Supervisors on the
status of AMR ownership and employee representation.
A. Summary of Proposed Ambulance Agreement Provisions
(1)Services
Services to be provided include:
J
Report to Board of Supervisors on the Proposed Ambulance Service Agreement 6/21/2005
Between Contra Costa County and American Medical Response Page 2
(a)Emergency ambulance service within a five-zone service area including all of Contra
Costa County except the areas of the San Ramon Valley and Moraga-Orinda Fire
Protection Districts.
(b)First responder paramedic services using four Quick Response Vehicles in locations
specified by County.
(c)Ambulance services requested by Contra Costa Health Services for transport of
patients to or from its facilities.
(d) Specified professional training,community education and related services.
(2) Term of Agreement
The term of the proposed agreement is five years beginning July 1,2005 plus a four-year
extension subject a Board of Supervisors finding that AMR is in substantial compliance with the
contract requirements. This is a variation from the RFP provision for a five-year contract with
two two-year extensions at County option. This provision enables AMR to amortize certain
costs over a nine-year period rather than a five-year period and is offered in exchange for
substantial enhanced commitments made by AMR over its initial proposal.
(3)Emergency Response Zones, Rural Area Classification, and Call Priorities
AMR's service area is divided in to five emergency response zones as follows:
Zone A—City of Richmond.
Zone B—West County, except Richmond.
Zone C—Central County.
Zone D—East County communities of Antioch,Pittsburg, and Bay Point
Zone E—East County communities of Oakley,Brentwood and other areas served by the
East Contra Costa Fire Protection District.
All areas of the County are further classified for ambulance response time purposes as
"urban/suburban"or"rural." "Rural"designation is by Thomas Brothers map coordinate as set
forth in the ambulance service agreement. The agreement provides for re-evaluation of rural-
designated areas at three-year intervals.
A three-tiered call prioritization system is identified in the contract. Priority One calls
correspond to current"Code 3"calls on which red lights and siren are used and which require
paramedic-level response. Priority Two calls are to be defined following recommendations
made by Fitch&Associates in their consultant report. It is anticipated that Priority Two calls
will require paramedic-level response,but not red lights and siren. Priority Three calls
correspond to current"Code 2"calls on which lights and siren are not used and which permit
EMT-1-level response when this level is requested based on County protocol. Imposition of
response time requirements for other than Priority One calls is a new contract provision.
Report to Board of Supervisors on the Proposed Ambulance Service Agreement 612112005
Between Contra Costa County and American Medical Response Page 3
(3)Ambulance Response Time and Staffing Requirements
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Zone A-urban 10:00
2 paramedics(100%)
Zone A-rural 20:00
Zones B,C,D-urban 11:45
1 paramedic/1 EMT-I
Zones B,C,D-rural 20:00
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Zone E-rural 20:00
Zone E-Bethel Island 16:45
Zone E-Discovery Bay 16:45
Zone A-rural 15:00
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Non-Life Threatening Emergency
Response
(Code 2—to be defined) Zones B,C,D,E-urban 15:00
1 paramedic/1 EMT-I
Zones B,C,D,E-rural 30:00
Priority Three All zones-urban 1 paramedic/1 EMT-I 30:00
Non-Emergency Response (2 EMT-I's for BLS-
(Existing Code 2) All zones-rural designated calls) 45:00
(4)Penalties for Failure to Meet Response Time Requirements
Penalties for failure to meet response time requirements are established for each of five
zones, for each priority level, for any consecutive 30-day period. Penalties range from$2,500 to
$50,000 per month per zone per priority level. Penalties for Priority One calls apply from the
beginning of the contract term. Penalties for lower priority calls begin when all fire/medical
dispatch centers implement and comply with dispatch protocols for prioritizing calls. Penalties
for Priority One calls are as follows:
Report to Board of Supervisors on the Proposed Ambulance Service Agreement 612112005
Between Contra Costa County and American Medical Response Page 4
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Zone A 95.0% 94.5%<95.0% $159000
94.0%<94.5% $259000
<94.0% $50,000
Zones B,C,D,E 90.0% 89.5%<90.0% $15,000
89.0%<89.5% $259000
<89.0% $50,000
The first-level penalty for missing compliance on Priority One calls has been increased from
$10,000 as specified in the RFP to$15,000 in response to the Board of Supervisors' request for
higher penalties.
(5)Paramedic Ambulance Unit Hour Requirement
AMR will maintain a minimum of 4,024 weekly paramedic ambulance unit hours for
the entire term of the agreement.
(6)Ambulance Vehicles
All front-line paramedic ambulance vehicles shall be Type III modular units and shall not
exceed 1953,000 miles on chassis.
(7) Quick Response Vehicles (QRVs)
AMR will provide four non-transporting QRVs staffed with a single paramedic assigned
as designated by the County(currently three designated to provide first responder paramedic
service in the East Contra Costa County Fire Protection District and one to supplement first
responder paramedic service in the area of Crockett,Hercules,Rodeo, and Pinole). QRV
response does not stop clock to meet ambulance response requirements, although a 10-minute
first paramedic response by ambulance or QRV is required in the urban/suburban areas of
Zone E. Should County determine that fewer than four QRVs are required,AMR and County
shall agree to an equivalent dollar amount or substitute services to be provided by AMR to
County.
(8) Quality Improvement
AMR will provide a comprehensive quality improvement program including a physician
medical director, a full-time registered nurse manager, a full-time data analyst,a full-time
information technologist, a full-time clinical education specialist, a full-time paramedic field
training coordinator, 80 hours/month field training officer time, and 20 hours/month peer field
coach time.
(9)Field Supervision
AMR will provide three on-duty supervisors on a 24/7 basis,one each assigned to west,
central, and east county.
(10)Diversity Awareness
AMR will participate with County in development of a cultural competency training
program and training materials.
Report to Board of Supervisors on the Proposed Ambulance Service Agreement 6/21/2005
Between Contra Costa County and American Medical Response Page 5
(11)Disaster Transport Units
AMR will provide and maintain six fully equipped and stocked reserve ambulance units
to be for use by fire personnel for disaster response or for use in other pre-defined,urgent
situations. AMR will provide equivalent value to County if it Contract Manager determines that
one or more of the disaster transport vehicles is not required.
(12) Training for Firefighters
AMR will offer in-county paramedic training for up to 100 firefighters (75 within first
three years of contract) at no charge for tuition,required books,or preceptor/evaluation cost.
All continuing education provided by AMR shall be offered to fire personnel on the same basis
as to AMR employees.
(13)Equipment Exchange with Fire
AMR will provide a mechanism for exchange of equipment and supplies used by fire first
responders for patients transported by AMR when items are interchangeable.
(14) Co-Billing for First Responder Services
AMR will prepare and mail invoices on behalf of fire agencies that request this service at
a charge of the lower of$20 per invoice or the lowest fee charged by AMR in California for
similar services.
(15) Community Education/CPR/Public Access Defibrillation
AMR will provide a comprehensive community education program including the
following:
- Annual plan developed in collaboration with Board members, the EMCC,and the EMS
Agency;
- Full-time Community Outreach Coordinator to provide leadership for a Public Access
Defibrillation(PAD)program and CPR training;
- 25 automatic electronic defibrillators (AED's) annually throughout the contract term
provided to community organizations at no charge;
- 24 CRR classes annually throughout the contract term provided to the public at no
charge;
- Annual community health status improvement project.
(16)Patient Charges
Proposed patient charges are those submitted in the AMR proposal and represent no
increase over existing charges. The maximum all-inclusive charge for paramedic ambulance
transport is $1,238.77 plus $20.34 per transport mile. Annual increases between 2.5%and 5.0%
depending on changes in the Consumer Price Index are permitted as set forth in the RFP. No
charges are permitted for patients not transported. Charges for patients for whom Contra
Costa Health Services is financially responsible are limited to the MediCal rate for indigent
patients and to the Medicare rate for non-indigent patients.
Report to Board of Supervisors on the Proposed Ambulance Service Agreement 612112005
Between Contra Costa County and American Medical Response Page 6
(17) Other Contract Provisions
Other contract provisions not summarized here are consistent with provisions of the
existing AMR contract,the RFP, additional commitments made by AMR in the areas of
personnel,professional training, quality assurance,disaster response,communications,EMS
research,and community education and health improvement. The RFP,AMR Proposal and the
AMR letter of February 9,2005 containing supplemental information and commitments are
incorporated into the proposed ambulance service agreement.
B. Status of AMR Ownership
The AMR proposal was submitted by American Medical Response West, a California
corporation doing business as American Medical Response. American Medical Response West
is a wholly owned subsidiary of American Medical Response,Inc.,which,at the time of
proposal submission,was a wholly owned subsidiary of Laidlaw International,Inc. Subsequent
to the proposal submission,American Medical Response and its sister company EmCare were
acquired by Onex Corporation, a Toronto-based diversified company with global operations in
the service,manufacturing and technology industries. Onex shares trade on the Toronto Stock
Exchange under the stock symbol OCX.SV.
The ownership structure places AMR, Inc. and EmCare Holding, Inc.under the
ownership of Emergency Medical Services,L.P.,a Delaware limited partnership funded through
Onex Partners,L.P. and AMR/EmCare management. Ninety-seven percent ownership interest in
Emergency Medical Services was funded by Onex and its limited partners. The transaction
through which AMR was acquired did not involve any transfer of the stock or assets of American
Medical Response West. As was the case prior to the transaction, all of the stock of American
Medical Response West remains owned by American Medical Response,Inc. American Medical
Response West continues to be the licensed ambulance service provider in the applicable
jurisdiction(s) in which it operates,as it was before the transaction. Operations Management of
American Medical Response West remains unchanged.
C. Status of AMR Employee Representation
Service Employees International Union(SEIU)Local 250 is the bargaining unit certified
by the National Labor Relations Board(NLRB)for paramedics, EMT's,nurses and various
support personnel employed by AMR in Contra Costa and most other northern California areas.
On August 20,2004 SEIU formally advised American Medical Response(AMR)that SEIU had
entered into a service agreement with the International Association of EMT's and Paramedics
(IAEP)to handle administrative functions of the bargaining unit. The service agreement does not
affect SEIU as the NLRB-certified bargaining unit.
The National Emergency Medical Service Association(NEMSA)has made an effort to
replace SEIU as the bargaining unit representing AMR employees in northern California. This
effort has resulted in two elections the results of which have been formally disputed. The results
of the most recent election held March 21,2005 are under appeal by SEIU to the NLRB. We do
not have an estimate of when the NLRB will issue a ruling.
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Contra Costa County STANDARD CONTRACT Number 23-024-2
Standard Form L-1 (Purchase of Services-Long Form) Fund/Org # 7406
Revised 2002 Account # 2310
Other #
1. Contract Identification.
Department: Health Services—Emergency Medical Services
Subject: Emergency Ambulance Services(Emergency Response Area(s) 1 2 and 5 except for
those portions of ERA 1 which are contained within the Moraga-Orinda Fire
Protection District
2. Parties. The County of Contra Costa,California(County),f epa t named above,and the following
named Contractor mutually agree and promise as follows:
Contractor: AMERICAN MEDICAL RESPONSE : ` C. RICAN MEDICAL
RESPONSE)
Capacity: Corporation
Address: 7575 Southfront Road, Live ` , Ca ni 0
J,
3. Term. The effective date of this -``ct is 1 a. n July 1 2005. It terminates on
t
12:00 midnight on June 30 2010, unless r termina vided herein.
1iI
4. Payment Limit. :..... ty's total . AY:::nts t ntractor under this Contract shall not exceed
$ Not AulAicabl :
n4y
5. County's Obligations. .... shall to the Contractor those payments described in the Payment
Provisions attached hereto ', r_e i "orated herein by reference,subject to all the terms and conditions
contained or incorporated here :::
6. Contractor's Obligations. Contractor shall provide those 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.
7. General and Special Conditions. This Contract is subject to the General Conditions and Special Conditions
(if any) attached hereto,which are incorporated herein by reference.
8. Project. This Contract implements in whole or in part the following described Project, the application and
approval documents of which are incorporated herein by reference: Not Applicable
L-1 (Page 1 of 2)
•
Contra Costa County STANDARD CO CT Number 23-024-24
Standard Form L-1 (Purchase of Services—Long Farm)
Revised 2002
9. Legal Authority. This Contract is entered into under and subject to the following legal authorities:
Health and Safety Code Sections 1797 et seq.,California Government Code§§ 26227 and 31000 and all legal
authorities cited in the attached HIPAA Business Associate Addendum, which is incorporated herein by
reference.
r;.
.3 y,
10. Signatures. These signatures attest the parties' agreement he . `
COUNTY OF CONTRA COSTA
BOARD OF SUPERVISORS Clerk Board of Supervisors
By By
/ e
OR
4.
•r.
ii
Name of business entity Name of business entity
AMERICAN MEDICAL RESPO I. _ ,. ST Y BA AMERICAN MEDICAL RESPONSE WEST, INC (DBA
AMERICAN MEDICAL RESPO 'k::.,. k `v IFORNIA AMERICAN MEDICAL RESPONSE), A CALIFORNIA
CORPORATION <<. CORPORATION
By By
(Signature of individual or officer) (Signature of individual or officer)
(Print name and title A, if applicable) (Print name and title B, if applicable)
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 form L-2.
L-1 (Page 2 of 2)
Contra Costa County APPROVALS/ACKNOWLEDGMENTS
Standard Form L-2 (Purchase of Services—Long Form)
Revised 2002 Number 23-024-24
APPROVALS
RECOMMENDED BY DEPARTMENT FORM APPROVED
COUNTY COUNSEL
By: By
Designee k. Deputy
•f.
.w
APPROVED: COUNTY ADMINIS_r.:: Rf
:
BY s,
.yew
Desi �{+
k}•: NT •jj V.-
.V�
A
ED( }
.
STATE OF CALIFORNIA
) s
i4.
k..
COUNTY OF CON A {y
Ons`
ryb e me,
{...
..........
(insert name and title of the o i :.`..erson :appeared
.t
personally known to me
(or proved to me on the basis of satisfactory evidence)to be the person(s)whose name(s)is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s)acted, executed the instrument.
WITNESS MY HAND AND OFFICIAL SEAL
(Seal)
Signature
ACKNOWLEDGMENT(by Corporation,Partnership,or Individual)
(Civil Code§1189)
L-2 (Page 1 of 1)
Contra Costa County SERVICE PLAN
Standard Form L,3 Number 24-024-24-
Revised 2002
I. SERVICE ACTIVITIES. Contractor shall provide ambulance services, subject to all the terms and
conditions contained or incorporated herein, and subject to Contractor's proposal dated November 4,2004, and
Contractor's"Supplemental Information and Commitment"dated February 9,2005 ("Contractor's Proposal"),
which are on file with County's Emergency Medical Services Agency located at 1340 Arnold Drive, Suite 126,
Martinez, CA and incorporated herein by reference, except that in the case of any conflicting provisions,the
provisions contained in the Service Plan, Special Conditions, General Conditions, and Exhibits shall prevail.
Such services shall be provided in accordance with the requirements.of j
i%.... Ithand Safety Code Sections 1797
et seq.,Division 48 of the Contra Costa County Ordinance Code,...'' ons promulgated thereunder,
ments or revisions thereof. I ices hereunder,Contractor
and in accordance with any amend
shall work cooperatively with County's Health Services Director e-Emergency Medical
Services Agency Director(also referred to herein as "Contract Ma
.;k-""A
A. Scope of Service.
I Contractor shall provide ewer ency rvices, uested by the County's
9
designated public safety dispatch center(s), in Countyifie- cy nse Areas(ERA) 1,2 and 5
except for those portions of ERA I contained within. ..'Mo Fire Protection District("Service
d- e ergency Response Areas of
Area"). Emergency ambulance ERAs are del* e
Emergency Medical Services Agency
Contra Costa County", as amended,which is e in the ice of
and Clerk of the Board of Supervisors.
2. Contracto ---.,..e am ....e services quested by Contra Costa Health Services
for transport of patients r 1 es.
B. Basic Se s. In conside . .... the s referral to Contractor of emergency ambulance
ollowing services:
service requests or, 2 in the Service :..,Co r shall perform the f
1. Contrac 11 provide em cy ambulance services,without interruption,24 hours per
day, 7 days per week, 52 er year,f e full term of this Contract,without regard to the patient's
race,color,national origin,r s a n,age, sex,or ability to pay.
2. Services outlineiactor's Proposal. Contract Manager may authorize a delay in
implementation of certain contract m. ifications for up to ninety(90)days from Contract execution.
3. Contractor shall provide 24 hours per day/7 days per week, at no cost to the County,four
(4)paramedic quick response vehicles (QRV's), staffed with at least one paramedic to be located in areas
of the County and at locations approved by Contract Manager. County will use its best efforts to help
identify locations for basing QRV's in the designated service areas. If Contractor and County are unable to
identify a suitable location for basing a QRV,County may request and Contractor shall provide additional
services or resources equivalent to the cost of providing the QRV.
H. CLINICAL AND EMPLOYEE PERFORMANCE STANDARDS.
A. Continuous Qualitv Improvement Program.
1. Contractor shall maintain a comprehensive continuous quality improvement(CQI)program
approved by Contract Manager and consistent with County's CQI program.Contractor shall not modify its
approved CQI program without prior approval by Contract Manager.
Initials:
Contractor County Dept.
L-3 (Page 1 of 2 1)
Contra Costa County SERVICE PLAN
Standard Form L-3 Number 24-024-24--
Revised 2002
2. Oualitylm rovement Processes.
a. Contractor's clinical quality improvement(CQI)program shall provide an organized,
coordinated,multidisciplinary approach to the assessment of pre-hospital emergency medical response and
patient care. Contractor's involvement will require at a minimum those activities included in Exhibit A,
attached hereto and incorporated herein by this reference.
b. Contractor agrees that Contractor's Medical Director and clinical quality
improvement staff will have high levels of interaction and collaborative involvement with the County's
EMS Medical Director and quality improvement staff.
C. Contractor's system-wide quality and pe c e i rovement programs shall
incorporate all activities and components delineated in its Pr
3. Clinical Qualitv Im rovement W01)Staff m ,..retractor shall provide CQI
Staff to coordinate andprovide Contractor's CQI activities. C d responsibilities as
described in Contractor's Proposal shall include:
a. Aphysician Medical Director. The Medical D shall gularly with the
EMS Medical Director andparticipate in County qualityent
a v: s.
b. A full time Registered Nurse C, I an wased inbra Costa County and
reportinp,directly to Contractor's Director of Operati for C to Couity,to direct Contractors
internal and system-integrated CQI activities.
c. A full time EMS Epid lyst,who shall be made available to
91 C
al D
work directly with the County and the E ical Dire analyze,and report system wide
W
clinical performance data as s ecl by
d* A anon ologist who shall be responsible for maintaining
functionality of Co electroni t C Tting system.
e. 11 time Clinic cation ialist(CES)Paramedic Coordinator to perform
assigned CQI actio
time Paramedi la i raming Coordinator to develop and conduct required
training programs for pre • personne
A e CES r.
9
h. A mini (80)compensated hours per month for Field Training Officers
(FTC's)to oversee the training an 0,11uatian of new employees and to provide critical CQI function.
i. A minim o twenty(20)additional compensated hours per month for experienced
field personnel to act as Peer Field Coaches.
4. IntMratedOual Leadership Council. Contractor shall implement and coordinate an
Integrated Quality Leadership Council to identify, evaluate and recommend solutions to common issues
related to an integrated EMS response.The Council shall include representatives from fire agencies
providing paramedic service within Contractor's service area.
5. Coordination of Data Gathering and Quality Improvement Efforts. Contractor shall
endeavor to identify and support implementation of a technological tool to fully integrate electronic records
and alignment of data sets system wide, in cooperation with the County and fire services. Full integration
shall be capable of the following within the Service Area:
a. Allow for quantitative reporting of overall clinical performance,which can be tied to
providing integrated EMS system patient care solutions,training and community prevention, meaningful
data comparison and greater collaborative research opportunities.
b. Provide real-time data to fire agencies for use in fire CQI activities.
Initials:
Contractor County Dept.
L-3 (Page 2 of 2 1)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
6. Clinical and Operational Benchmarking and Research. Contractor shall use
benchmarking of Key Clinical Indicators (KCI)and Key Performance Indicators (KPI) as tools for
measuring Contractor's performance. In addition Contractor shall:
a. Use benchmarking along with other QI tools to evaluate and set goals for improving
the clinical and non-clinical performance of Contractor's personnel. Benchmarking and Key Performance
and Clinical Indicators to be used at a minimum are identified in Exhibit A. Contractor shall provide
periodic reports detailing progress in those items according to a schedule approved by Contract Manager.
b. Provide data developed through Contractor's CQI process to the EMS Agency for
use in evaluating EMS system performance and in setting system i vement goals.
C. Incorporate any County approved benc ki "developed during the Contract
period into Contractor's CQI process.
d. Initiate and actively participate in pre h sea .::oj ects.
B. Personnel.
I. Credentials.All of Contractor's ambulan .rsonne��R. . ...nding to emergency medical
requests shall be currently and appropriately credential :z...
a. Contractor shall retain on file l time.. of al i rrent and valid licenses
certifications, and/or accreditations of all emergency r.-:dica so :: rforming services under this
Contract.
b. Contractor shall be r.. sible for g all ambulance personnel are currently
credentialed at all times when assigned to a ambul
S.
C. Co ... rovi my with a ist of Contractors currently employed
paramedics and EMT-I shall u at li never a paramedic or EMT-I leaves or enters
Contractor's employ personnel lis incl =z a minimum,the name, address, telephone number,
CPR expiration d `` "ther personnel req ents i entified in Contractor's Proposal, and California
Driver's License nu each person on list. For each paramedic, the list shall also include the
paramedic's California W. h F edic license xpiration date and ACLS, PEPP, and BTLS (or PHTLS
expiration dates. ::r±
2. Paramedic ........::. u...... ... alifications. Contractor's paramedic personnel assigned to
provide paramedic service under :.::1 ;: "ntract must meet the following minimum qualifications:
a. Currently licensed as a paramedic in the State of California.
b. Currently accredited as a paramedic in Contra Costa County.
C. Currently certified in Advanced Cardiac Life Support(ACLS) according to the
American Heart Association.
d. Currently certified in Basic Trauma Life Support(BTLS) according to the American
College of Emergency Physicians, or, in Prehospital Trauma Life Support(PHTLS) according to the
American College of Surgeons except that new paramedic employees assigned to work with a currently
BTLS or PHTLS certified partner may have up to three (3)months to obtain said certification.
e. Currently certified in Pediatric Education for Prehospital Professionals (PEPP),
except that new paramedic employees assigned to work with a currently PEPP certified partner may have
up to three (3)months to obtain said certification.
f. Currently certified in cardiopulmonary resuscitation(CPR) equivalent to the current
American Heart Association's Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care at the Healthcare Provider level and automatic electronic defibrillator utilization.
Initials:
Contractor County Dept.
L-3 (Page 3 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
g. Current State of California driver's license, ambulance driver's license,and a
Medical Examiner certificate.
h. Currently certified as an emergency vehicle operator according to the Emergency
Vehicle Operator Course (EVOC) or equivalent training or equivalent training.
3. Emergency Medical Technician-I(EMT-1)Minimum Qualifications. Contractor's
EMT-I personnel assigned to provide EMT-I service under this Contract must meet the following minimum
qualifications:
a. Currently certified as an EMT-I in the State of_California.
b. Current State of California driver's license:. a: la a driver's license,and a
Medical Examiner certificate.
C. Currently certified in cardiopulmona `usc' ,:i'�, ; .PR) equivalent to the
American Heart Association's Guidelines 2000 for Cardiopul esu 'on and Emergency
Cardiovascular Care at the Healthcare Provider level and auto ectroni r' ;:.or utilization.
d. Currently certified as an emergency vehic e o or acco 11. the Emergency
Vehicle Operator Course (EVOC)or equivalent trainingvalent = 4.{ g
4. Company Orientations and On-Go.':' re mess.
a. Contractor shall orient all fiel; :: rso ssi in.. them to respond to
�. � g p
emergency medical requests. Such orientatio41L
i A= de mini ontractor's policies and
procedures;EMS system overview;EMS polnd pro sures; r communications;map reading skills
including key landmarks,routes to hospi "I other ma' N ce' facilities within the county and in
surrounding areas;and ambul µ d equi utilizatio intenance.
b. Cotion am shall include field training and evaluation by
Contractor's Field Tra' fficers .Th -training component of Contractor's orientation shall
be a minimum of se . ;: two (72)hours rame ry: nd forty-eight(48)hours for EMT-I's.
Co Field S ... `A:..' ion.Contractor s ;,;_provide within County three Field Supervisors,one Field
Supervisor on-duty in - ea of the coup $; est,east,and central)providing 24-hour coverage, 7 days a
week. The Field Supervis 11 be autho..-. .;: to act on behalf of the Contractor in all field operational
matters. y::
D. Leadership and Su ......A`....::. I raininiz. Contractor shall provide,at no cost to the employee:
1. Educational, developmental and informational courses and materials to assist interested
employees selected by Contractor in preparing themselves to successfully compete for promotions or other
internal work opportunities.
2. On-going training and development programs for Contractor's managers and supervisors.
E. Quality Improvement Hotline. Contractor shall establish a QI Hotline giving customers and
system participants the ability to leave commendations or suggestions for service improvements on a voice
mailbox. The hotline number will be publicized at local healthcare facilities, First Responder stations, and
public safety agencies. Members of the Contractor's QI/Leadership Team are to be automatically notified
via pager of any incoming calls. Incidents that require feedback are to be attended to by the end of the next
business day.
F. Confidentiality and HIPAA. Both County and Contractor agree to take appropriate steps to
maintain confidentiality of patient data used in quality improvement processes. Both County and
Contractor agree to comply with requirements of State and federal law, including the requirements of the
Health Insurance Portability and Accountability Act(HIPAA)of 1996,as applicable.
Initials:
Contractor County Dept.
L-3 (Page 4 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
G. Co tinuina Education (CE)Proeram Requirements. Contractor shall establish a regional
EMS training program within the County. Through this program, Contractor shall provide a full spectrum
of continuing education opportunities to both Contractor's and Fire Service personnel,as specified further
in section VILD., below, including ACLS,PHTLS, and PEPP. Contractor's CE shall include the use of
performance and outcome indicators.
1. Training programs designed to meet County contract requirements for paramedics and
other educational programs shall include those requirements listed in Exhibit B,attached hereto and
incorporated herein by this reference.
2. Contractor's training program may include phy jci.1. -Yed internet based CE.
3. Contractor shall assureprogram content me go .1 nation requirements for Contra
Costa County and the State of California licensure/certificati, L"'.
4. Contractor shall work with fire service agency on Northern California
k,
l
Training Institute (NCTI) staff to accredit Contractor's persol ire Se el as instructors
for the various class offerings at NCTI. Contractor will remunerate t' : ° 'nstrruuc their agencies as
may be agreed.
H. Character Comp tence and Profession of net.
I Contractor shall require profes.sio kand rte duct and appearance at all times
from Contractor's employees. Contractor a res d co y occasional departure from this
standard of conduct. LF
2. Contractor s sure f Contra ployees in the performance of their work
are competent and hold e li s and permits in their respective professions and shall
conduct a criminal recd ck be 0 g ne loyees.
I. ALS A ante Services A itatio ithin fourteen (14) months of the beginning of the
Term of this Co Contractor shall n Accreditation as an"ALS Ambulance Service"through
the Commission on A ion of Ambu. ie Services(CAAS) or comparable organization. Contractor
shall maintain its accredi rougho -term.of this Contract.
J. Diversily Aware ....... ... ........
I Contractor sha and enforce policies and practices to assure equal employment
opportunity.
2. Contractor shall participate along with the County in the development of a cultural-
competency training program and materials for emergency responders. Contractor shall assure employees
possess culturally appropriate skills when interacting with the diverse County population.
K. Work Schedules and Human Resource Issues. Contractor shall:
I. Conduct employment matters with its employees including managing personnel and
resources fairly and effectively in a manner that ensures compliance with this Contract.
2. Fulfill all employee commitments as set forth in Contractor's Proposal and Supplemental
Information and Commitment.
111. OPERATIONS PERFORMANCE STANDARDS.
A. Emergent Response Zones(ERZ's).For ambulance staffing and response time monitoring,
reporting and compliance purposes the Service Area has been divided into five (5)ERZ's.Exhibit H,
attached hereto and incorporated herein by this reference, illustrates the following ERZs:
Initials:
Contractor County Dept.
L-3 (Page 5 of 2 1)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
1. ERZ A: The territory of the City of Richmond.
2. ERZ B: The territories of the City of El Cerrito,Kensington Fire Protection District, City of
Pinole, Rodeo-Hercules Fire Protection District, Crockett-Carquinez Fire Protection District, and that portion
of the Contra Costa County Fire Protection District covering San Pablo,El Sobrante,North Richmond,and
other areas of western Contra Costa County.
3. ERZ C: That portion of the territory of Contra Costa County Fire Protection District
covering Concord, Clayton, Lafayette,Martinez,Pleasant Hill,and other areas of central Contra Costa
County.
4. ERZ D: That portion of the territory of Contra :. ``, Fire Protection District
covering Antioch, Oakley,Pittsburg,Bay Point,and other are .:' . . eas" ..a Costa County.
5. ERZ E: The territory of the East Contra Cos ?+ `.i .tection District.
B. Ambulance Staffing/Personnel Preparation. .
.t
1. Ambulance Staffing. Subject to Sectio belo _ ambulances providing
emergency ambulance services under this Contract sh. :.` + '` and e d to provide advanced life
support(ALS)care. A paramedic shall be the prim " 'aregi A:; ;, 11 pati s, emergent and non-
emergent, and shall accompany patients in the back.. ...he a la :_accordance with current EMS
policy.
a. ERZ A: Contractor :_"staff am nces ..:i gned to provide coverage in ERZ A
with a minimum of two (2)paramedics. In ::vent that dispatches an ambulance staffed with
only a single paramedic to .locat .'thin ERZ ;Contractor shall immediately respond with
M, p
a second paramedic to :_ }" cident :.$"ll re County as"arrival on scene time"the arrival time of
the second paramedi '$
tt
b x RZ B: Contractor , :: 1 initia staff ambulances with a minimum of two (2)
paramedics, but, sub A. the approval of ontract Manager, may phase in one(1)paramedic and one
(1)EMT-I staffing as 1 .A .e agencies tr ion to paramedic staffing.
C. E d D: C 'ctor may staff ambulances with a minimum of one(1)
paramedic and one (1) EMT o Y. o requests originating in ERZ's C and D.
d. ERZ E: or shall staff ambulances primarily assigned to ERZ E with a
minimum of two (2)paramedics foiresponses to requests originating in ERZ E.
2. Contractor may send Basic Life Support(BLS)units staffed with two(2)EMT's to requests
for multi-unit response and to any calls in which a County designated Communications Center determines
BLS response is appropriate according to emergency medical dispatch protocols and procedures approved by
County.
3. At Contractor's sole option, the requirement for EMT staffing levels on any or all units
may be enhanced to higher levels of training without additional obligation of the County.
C. Response Time Performance Standards. Contractor's response time on requests for paramedic
emergency medical service originating from within Contractor's service area shall meet the response time
standard as measured within any consecutive thirty(30)day period.
1. Potentially Life Threatening Emergency Response. (Priority 1 -Currently dispatched as
Code 3).When contacted by a County designated Communications Center,Contractor shall respond
paramedic ambulances to potentially life threatening emergency ambulance requests originating within
Contractors areas of responsibility with maximum response times as follows:
Initials:
Contractor County Dept.
L-3 (Page 6 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
a. Ten minutes and zero seconds(10:00)to calls originating in ERZ A, except for rural-
designated areas as set forth in Exhibit C.
b. Eleven minutes forty-five seconds(11:45)to calls originating in ERZ's B, C,D, and E,
except for rural-designated areas as set forth in Exhibit C.
C. Sixteen minutes forty-five seconds (16:45)to calls in rural-designated areas of Bethel
Island and Discovery Bay.A map of these areas is attached hereto as Exhibit I and incorporated herein by
this reference.
d. Twenty minutes and zero seconds(20:00)to calls within other rural designated areas
as set forth in Exhibit C. °+
e. If County requires Contractor to positio. e l . within ERZ E, Contractor shall
respond either by ambulance or QRV within ten minutes and :.sect .._,_F :-00)to calls originating in non-
rural designated areas of ERZ E.
y
s
1.
2. Non-Life Threatening EmerLyency Response.(Pri "4 't -To be }ed by mutual
agreement between Contractor and County). Contractor :ond a p rdic ambulance to non-life
threatening Priority 2 emergency ambulance requests e v ` j Coun F`:u.:ignated Communications
Center with a maximum response time of fifteen mi :Ys and h : ds(1 '. 0) in designated
urban/suburban areas and a maximum response e i nut`i:.. ero seconds 30:00 in designated
rural areas,and shall immediately notify the i Ispa .'"gency to response time will exceed the
maximums set forth herein. +
fi
3. Non-Enver x es on :'ority 3 - dispatched as Code 2). Contractor shall
respond a paramedic amb -em ambulance requests received from a County designated
Communications Cent x v a maxim pon of thirty minutes and zero seconds (30:00)in
designated urban/su: n areas and a m . .:.um re +a time of forty-five minutes and zero seconds
r.
(45:00) in designate" 1 areas, and shall ediately"notify the County dispatch agency if the response
time will exceed the s set forth he
4. Res on '. a Calcula Response times shall be c time call is
p calculated from the ti
received, as defined in a. beaI ,ntil C .` ctor's ambulance arrives on scene, as defined in b. below,or is
is cancelled by a County desi unications Center.
a. Time Call .,`.t: ived. For all requests for service,the "time call received" shall be
the moment Contractor's Medical Communications Center has received(either by telephone or computer
data link)both sufficient location information to know a response is required and sufficient information to
determine the presumptive run priority designation, or thirty(30) seconds after the call is transferred from
County designated Communications Center,whichever is earlier.
b. Arrival On-scene Time. Arrival on-scene time shall mean the moment an
ambulance crew notifies Contractor's Communications Center that it is fully stopped at the location where
the ambulance shall be parked while the crew exits to approach the patient.
i. In situations where the ambulance has responded to a location other than the
scene(e.g. staging areas for hazardous materials/violent crime incidents,non-secured scenes, or wilderness
locations),arrival at scene shall be the time the ambulance arrives at the designated staging location or
nearest public road access point to the patient's location.
ii. Contract Manager may require Contractor to log time "Patient Contacted"for
medical research purposes. However, arrival time for patient contact intervals shall not be considered part
of the contractually stipulated Response Time.
Initials:
Contractor County Dept.
L-3 (Page 7 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
C. Failure to Report Arrival On-scene Time. In instances when ambulances fail to
report an "on scene"time,the time of the next communication with that ambulance shall be used as the "at
scene"time. However, Contractor may be able to document the actual arrival time through another means
(e.g. First Responder,AVL, communications tapes/logs, etc.) so long as an auditable report is produced.
d. Upgrades. If an assignment is upgraded prior to arrival on scene of emergency
ambulance, (e.g. from priority 2 to priority 1), Contractor's compliance and penalties shall be calculated
based on the shorter of:
i. Time elapsed from call receipt to time of upgrade plus the higher priority
Response Time Standard; or
ii. The lower priority Response Tim
e. Downgrades. If a call is downgr pri ' ival on scene of emergency
ambulance, (e.g. from Priority 1 to Priority 2), Contractor's .Y` ce ;:. nalties shall be determined
as follows: t..
t
i. If the time of the downgrade occurs r..v. the am :.; `�e has exceeded the
higher priority Response Time Standard,the more strip f: ""=:..:µJ er pri :A Y`` tandard will apply;or,
il. If the time of the down o .:µ::y:-'beforebulance has exceeded the
higher priority Response Time Standard, the less ;;n ent ion vial apply. In all such cases
p p � ;, g ty
documentation must be presented for validatio of v:rea r"whiority status was downgraded. If
the downgrade was justified in the sole discr ::' ±'1 o 'e act Hier,the longer standard will apply.
f. Reassignment En... : :.. e. If an Cr e 'ambulance is reassigned en route or
turned around prior to arrival a scene A e ambula4ij '"h.' '" to respond to a higher priority request),
compliance and penaltie :Y }.date :A d on the Response Time Standard applicable to the
assigned priority of A " al resp v ::.The :xise time clock will not stop until the arrival of an
emergency ambulan rt: the scene from x.. h the ±:: lance was diverted.
g:` .,�ncelled Calls. I mergency ambulance is cancelled on an assignment prior to
arrival on the scene,' ctor's complia°. . and penalties will be calculated based on the elapsed time
. p
from receipt of call to th ::::: :the call was: .�.:;celled.
S, ,tC:i• �� Z,.
5. Rural Zone `int.At intervals of not less than once eve three r
every years, County
will evaluate the call density chap s' : 'ccurring within each zone. Should the call density of any significant
contiguous area within the rural zone become equal to or eater than the call density to the adjacent
q �' ty J
urban/suburban zone,then that area will be considered urban/suburban for response time compliance upon
the next anniversary date of the Contract.Response time compliance changes pursuant to this section will
be modified by readjusting the then current map defining the rural zones.
D. Response Time Exceptions. In the calculation of Contractor's performance to determine
compliance with the response time standards, every emergency request from a County designated
Communications Center originating from within Contractor's assigned Emergency Response Zones shall be
included except as follows:
1. Multivle 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.
2. Responses During a Multicasualty Incident or Disaster. The response time requirements
may be suspended during a declared multicasualty incident or disaster within the County, or during a
Initials:
Contractor County Dept.
L-3 (Page 8 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
declared disaster in a neighboring jurisdiction to which ambulance aid is being provided as requested by
County, when Contract Manager determines that said event has had a material impact on availability of
Contractor's resources.
3. Good Cause. Under the Direction of the Health Services Department Director,the Contract
Manager may allow exceptions to response time requirements for good cause at the Contract Manager's
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 designated Q' . .munications Center, disrupted voice
or data radio transmission; mobile data terminal failure;mate Y: ispatch location; computer
aided dispatch failure; unavoidable telephone communicatio ilure•. : ..:: *....ity to locate address due to
non-existent address; inability to locate patient due toatient 'th :e; delays caused b traffic
p � Y Y
secondary to the incident; unavoidable delays caused by road c . ::.ction or e t weather, e.g., fog;
unavoidable delays caused by trains; delays resulting from dep A. esourc -.,. y ;"sult of County-
authorized
..$.mutual aid; delays resulting from depletion of : .urces a It of hospital emergency
department diversion or trauma center bypass; and del r. from ¢:. �. ad locations.
.w
E. Application for Except_. It is Contra s res . to a - to Contract Manager for an
p .�.._ pP�' g
exception to a required response time.
1. Exce tion R quest Proc request,For ` resp h. a time exemption Contractor
shall submit detailed documentation to v:t Manag d {ee) in writing within ten (10) business
days following the incident act IT shall n H.ontractor of granting or denial of said
exception request within s da eceipt of request.
2. Equi *f: failure, tr . nge of caused by the incident, ambulance failure,
Contractor dispatc:{. : ` or, or other caus emed e within Contractor's control or awareness shall not
be grounds to gran ... :.ception to compli with the Resp onse Time Standard.
F. Penal forto Comply..
..f.. . Response Time Re uirements. Penalties as set forth in
a
Exhibit D will be applied .Contract s to meet the response time standards established in III.C, in at
least ninety percent(90.0%) w': #any priority category within any ERZ except for Priority I calls
in ERZ A,where penalties shall contractor fails to meet response time standards in at least ninety-
five percent(95%)of calls.Penaltie= `ay be assessed for failure to meet the response time standards in an
30-day period. No penalty will be assessed for any day included in a 30-day period for-which penalties have
already been assessed.
G. Documentation of Response Times. Contractor shall document all times necessary to
determine total ambulance response time, including but not limited to time call received by Contractor;
time location verified; time ambulance crew assigned; time en route to scene; if cancelled en route, time
cancelled prior to arrival on scene; arrival at scene time; time en route to hospital; and arrival at hospital
time. All times shall be recorded on a Patient Care Report Form (PCR) and automatically documented in
Contractor's computer aided dispatch system.
H. Response Time Performance Report. Within ten (10)working days following the end of each
month, Contractor shall document and report response time performance to Contract Manager in writing, in a
manner specified by the Contract Manager.
Initials:
Contractor County Dept.
L-3 (Page 9 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
1. Contractor shall use response time data in an on-going manner to evaluate Contractor's
performance and compliance with response time standards in an effort to continually improve its response
time performance levels.
2. Contractor shall identify the causes of failures of performance, and shall document efforts to
eliminate these problems on an on-going basis.
I. Phase In of Penalty Provisions.
1. Imposition of the penalties for Priority 1 paramedic ambulance responses will be effective
the first day of the term of the Contract.
2. The imposition ofpenalties for Priority 2 or P ' dic ambulance responses will
take effect when ALL of the County designated Communicati. N Cen atching Contractor's
ambulances have implemented policies and procedures appro tra ager for identifying
Priority 2 and Priority 3 ambulance responses and have success mons is _ . ability for three
consecutive months.
J. Penalty Disputes. Contractor may appeal to Marrwriting within ten(10)working
days of receipt of notification,the imposition of any p. - o ding :.'s penalty calculations.
K. Work and Services. Contractor shall co ' :ly wi $_ 1 'able Federal, State and local laws
and regulations, and County EMS policies,pre
. u n `tocoL. Paramedic uick Res onse V RV'
1. Countyshall ontract s s ecifi obit E attached hereto and
p incorporated
herein by this reference, a . =:;uick �:. nse Vehicle" for any additional County-authorized
QRV's over the four ired in I., is Services".
2. If act Manager dete Y:es tha x er than four(4)QRV's are necessary,County and
x
Contractor shall m %..:..agree to the prove by Contractor of an equivalent dollar amount of substitute
services of comparabl consistent wi licable State and Federal laws and regulations.
3. Contract VN:; 1 not bill atient for services that do not result in a transport.
r.
M. Initial Deployme actor shall staff and deploy a minimum of six hundred seventy-
.~--...: ....:.. ..
two (672)QRV unit hours per we Y{ e term of this Contract. Contractor shall staff and deploy a
minimum of four thousand,twenty- �'._. r(4,024)paramedic ambulance unit hours per week throughout the
term of this Contract. Compliance with this provision shall be measured monthly. Contractor shall maintain
on file with County a current deployment plan specifying ambulance post locations by time of the day and
day of the week. Contractor shall provide County a monthly report specifying deviations from the
deployment plan on file.Contractor acknowledges and agrees with the goals of the EMS system to achieve
the response time standards specified herein and to achieve timely responses in each community served.
Contractor shall therefore endeavor to deploy ambulance resources in a manner consistent with this goal.
N. Stand-by.Contractor shall provide, at no charge to County or requesting agency, stand-by
services at the scene of an emergency incident within its service area when directed by a County designated
Communications Center. A unit placed on stand-by shall be dedicated to the incident for which it has been
placed on stand-by. Contract Manager must approve stand-by periods exceeding eight(S)hours in advance.
Contractor shall immediately notify requesting agency Incident Commander when a Stand-by exceeding one-
hour may limit Contractor's ability to meet response time standards for the impacted ERZ and shall notify
Contract Manager in writing by the following business day.
Initials:
Contractor County Dept.
L-3 (Page 10 of 21)
Contra Costa County SERVICE PLAN
Standard Form L3
Revised 2002 Number—24-024-24
0. 'Disaster Transport Units. Contractor shall acquire,insure,maintain,fully stock,equip and
deploy six(6)reserve transport-capable vehicles to be staffed by Fire Agency personnel in pre-defined and
urgent situations. These resources shall be placed in locations determined by the Contract Manager and in
accordance with Contractor's Proposal. Contract Manager may direct Contractor to provide equivalent
value to the County consistent with applicable State and Federal laws and regulations in lieu of said reserve
ambulances as identified in Exhibit E. County and Contractor will work to establish locations for units,
and policies and procedures for use.
IV. AMBULANCE VE1HCLES AND EQUIPMENT.
A. Vehicles.Ambulance vehicles shall meet the stand = I, California Code of
Regulations.
1. All ambulances used by Contractor as frontli ce .."..e provision of ALS
services under this Contract shall be Type III modular ambulanrn% i ..F
....
20 Frontline ambulances shall not exceed 195,000 mile e Chas In .
3. Contract Manner may authorize a del - ..ying ehicles for up to six(6)months
if,in hisjudgment,the time extension will facilitate anc%e h by designated
Communications Center.
B. Vehicle Mar
1. Ambulance vehicles use viding c s es shall bear the markings"Contra
Costa County Emergency Medical Service least fou etters,on both sides. Such vehicles shall
"Par
display the "911 emergen um ,state "Par e ic Unit",on both sides.
2. Amb . vehicles em o identify the company name,but shall not display any
telephone number o 911 or any dve nt.
3. esign,color,and ."...Ting are subject to the approval of the Contract Manager.
C. Vehicle Ma kance. Contract all maintain its vehicles in a good working order,consistent
with the manufacturer's spy 4 1. ..tions.In ion, detailed records shall be maintained as to work performed,
costs related to repairs,and 0 0 air costs analyses where appropriate. Repairs shall be
-ns in vehicle
accomplished and systems shall ined so as to achieve at least the industry non
performance and reliability.
D. General Equipment.
1. 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, 1340 Arnold Drive,
Suite 126 Martinez, CA. In addition, Contractor shall provide all equipment identified in Contractor's
Proposal,as approved by the Contract Manager.
2. Contractor shall maintain its vehicles, equipment, and supplies in a clean, sanitary, and safe
mechanical condition at all times.
3. Contractor agrees that equipment and supply requirements may be changed with the
4.
approval of Contract Manager due to changes in technology.
E. Failure,,to Meet Minimum In-Service Equipment and 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 may:
Initials:
Contractor County Dept.
L-3 (Page 11 of 2 1)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number__ 24-024-24
1. Immediately be removed from service until the deficiency is corrected if the missing item is
deemed a critical omission.
2. Subject Contractor to a per-incident penalty as described in Exhibit D.
3. 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
Contractor shall comply with these protocols.
F. Equipment Exchange and Replacement. ...w v
1. Contractor shall maintain inventory control qui aintenance systems which keep
the ambulance fleet fully stocked with quality equipment in gog t all times.
2. Contractor's plan for replacement of expendab.. ent a li .shall be self-
sufficient and shall not rely on receiving hospital stock or billing 'e less a in writingb
Y
receiving hospitals.
V. CO CATIONS E UIPMENT AND DISP "
A. Dispatch Center. Contractor shall opera disp } c `.sand maintain all equipment and
software(fixed,mobile, linkages)necessary to }.ei q for e cy ambulance services made by
County designated Communications Centers. .t. actor s be ca "le of receiving replying
and to such
requests for emergency ambulance servic :.oice and g P inka a as specified in the current
.s _
version of the County Messa issio ork(M lard, which is incorporated herein by
reference.A copy of the ` F on i e EMS Agency, 1340 Arnold Drive, Suite 126,
Martinez, CA. Contra . ispatch ce all b` ..ble of dispatching all ambulance units used to
provide services pu. . ::: to this Contract.
1. Co {4:n. :A::.l r shall pay for all± rfaces to its computer equipment,connectivity costs, and for
hardware at Contractor . }{atch facility.
.`Sid`
2. County s °: respons' or hardware and software at County site(s).
3. County shallosts upon Contractor for new dispatch system features not
.y��. p Y
identified in the Request for Prop :.± _ fed September 7,2004,without Contractor's agreement.
B. Dispatch Center Alternative. Paragraph V.A., above,not withstanding, Contract Manager may
Y
approve arrangements for a County designated Communications Center to dispatch Contractor's paramedic
ambulances within County. County shall not establish new dispatch requirements that impose an additional
cost to Contractor without Contractor's agreement to a cost recovery mechanism.
C. Dispatcher Preparedness. Contractor shall adequately train and prepare emergency ambulance
dispatchers 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.
D. Dispatch Evaluation. Contractor shall implement an on-going program for the evaluation of
dispatch operations, education and training of dispatchers,and problem identification and resolution.
E. Ambulance Communication Eguipment. Contractor is responsible for the communications
equipment on ambulances and supervisory units used in performance of services to County.
1. Contractor shall equip all ambulances and supervisory vehicles with radio equipment for
Initials:
Contractor County Dept.
L-3 (Page 12 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
communications with Contractor's dispatch center on Contractor's radio channels.
2. Contractor shall equip all supervisory vehicles with radio equipment suitable for operation
on the CALCOR.D California On-Scene Emergency Coordination Radio System and shall maintain a cache
of 10 portable CALCORD radios with vehicle chargers ready at all times for immediate deployment on
ambulance units that may be used for mutual aid. Contractor shall also equip all supervisory units and the
operations center with satellite telephones to allow for uninterrupted ability to communicate with
designated agencies in the event of a critical system failure or catastrophic event.
3. Contractor shall equip all ambulances and supervisory vehicles with 4-channel radios for
communication on County's MEDARS radios stem and with cef
tY y flu le ones for ambulance to base
hospital communications. County shall provide to Contractor :..A:.o =limaY supply su 1 in accordance with
County Communications' specifications, additional two-wa : :icul. r, ble radio equipment for
. :.
communications with fire or other emergency response agenc ollo : £`:.,..terms shall apply to all
radio equipment used for communications on County fre uenc'
a. Radio frequencies and communications h
q ations equip rovide e County may only
be used for emergency medical response within Contra :},: :houn the terms of this Contract or as
directed by a County designated Communications Ce_:.'y..:.v ter plian h policies and protocols
established by County. Y"
b. County shall designate radio f ue :, for #` : : ose of communications with. �. th a
County designated Communications Center h r amb :. :ce-to- dal communications.
P
c. Communications a:.}.A:. :ent used p A ce-to-hos ital communications shall be
a.
configured so that personnel .. rove � N: atient car :' t'.. t Ie to directly communicate with base or
receiving hospital staff a
d. oved radio A men t :,,be installed in conformance with existing Coun
tY
policies prior to as.. "ent of a vehicle .emerg ~ r response area. Installations and removals will be
at Contractor's exp .
e. `` ctor shall obta certificate of inspection of approved radio equipment b
pPY
County following install a '_ z d on an a y .1 basis thereafter and shall make vehicles available for
inspection of County owne . sonable request of County. Contract Manager and
County
4
Communications Division may mate procedures.
f. Specific rade quipment purchased by County at CountyexPense for the Contractor
shall remain the property of and under control of the County at all times.
g. 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 shallY a County's actual
p �'
cost of repair or replacement, or by Contractor with County's prior approval. Equipment shall remain the
property of the County.
h. Contractor shall operate communications equipment 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.
i. The County Communications Director must approve all radio equipment other than
Contractor's internal company system.
4. Under the Dispatch Center Alternative, Contractor shall provide all portable and mobile
equipment necessary for its paramedic ambulances to be dispatched by Contra Costa Fire Protection
District's Dispatch Center as described in its proposal dated November 2004.
Initials:
Contractor County Dept.
L-3 (Page 13 of 21)
Contra Costa County SERVICE PIAN
Standard Form L-3
Revised 2002 Number 24-024-24
F. Hospital Communications Network.Contractor shall provide at its dispatch center all
equipment and software necessary for participation in County-designated hospital communication network
and shall assure that all Contractor's dispatchers are trained and familiar with said hospital communications
network. Contractor's dispatchers shall notify,ambulance personnel and EMS Agency staff when alerted
through the hospital communications network that a hospital's ability to accept patients in its emergency
department has changed.
VI. RECORDS.,REPORTS,AUDITS,,INSPECTIONS.
A. Data and Reportinp.Reauirements. Contractor shallide detailed operations, clinical and
administrative data in a manner that facilitates its retrospectiv.. I
B Dispatch computer. The dispatch computer util' ..by . ..,f i. r shall include security
features preventing unauthorized access or retrospective adju nd it trail documentation.
C. Records. Contractor shall complete, maintain e to equested, adequate
records and documentation to demonstrate its performance- compli d to aunty in improving,
modifying, and monitoring the EMS system as a whole
D. Electronic Patient Care Report(PCR) em. tors I'M personnel shall use a
V
computerized patient care re ortin stem, approv C er for patient documentation on
y C
S13 -transports. The PCR shall be
-
EMS system responses including patient con c ell alis,
accurately completed to include all informat* fisted in tion 1 :70 of the California Code of
Regulations,and information shall be dis..... d accordi ished EMS Policies and Procedures.
1. Contracto a a} ems dude the ry awing characteristics at a minimum:
a. L es tom acc ' ,,,of PCR documentation
b. lity to auto-p e fie
C. bili to print lei CRs receiving facilities in accordance with EMS policy,
d. to support re e reporting and immediate access to PLR's,
e. ighly secur encrypted connection that meets Health Insurance
P
Portability and Accountabi (HIP compliance in all electronic information exchanges,
f. Ability KG strips from cardiac monitors and transmit data,
g. Ability to i . .... data from electronic monitoring equipment,
h. Ability to use the system as a communication conduit in the field,
i. Ability to map data points to the National Highway and Traffic Safety
Administration data set(NEMSIS) and the California Emergency Medical Services Authority data set
(CEMSIS)for compliance with federal and state recommendations, for clinical and demographic reporting,
and for data comparison with other EMS systems,
j. Easily queried to produce ad hoc reports specific to clinical classifications, and,
k. Compiles clinical data into a data warehouse that facilitates research and study of
patient care encounters through out Contractor's organization.
2. Contractor shall develop and implement the following enhancements to their electronic
ePCR system at a minimum:
a. Automatic e-mail notifications to Contractor whenever there is a significant"real-
time" deviation from protocol in the field,
b. Automatically create and electronically submit to Contractor daily reports of patient
vital signs outside the normal range for chart audit,
Initials:
Contractor County Dept.
L-3 (Page 14 of 2 1)
Contra Costa County SERVICE PLAN
Standard Form L,3
Revised 2002 Number 24-024-24
C. Automatically notify Contractor's critical incident stress management team leader of
critical incidents for his/or her immediate response,
d. Track and report pre-determined preventable injuries and illnesses community-wide
in order to target injury and illness prevention activities,
e. Automatically send customer satisfaction surveys within three(3)days of service.
Contractor shall provide County with reports of customer satisfaction based on survey results,quarterly,
and,
f Re-tool the ePCR interface to ensure a"user-friendly"data collection system.
G.
3. Contractor shall provide other data points wh c m.'- e reasonably requested, including
any needed modifications to support EMS system data collet . .....
E. Patient Care Report Data Submission Reauir
3.
I Within twenty-four(24)hours of each arnbul onse, actu.......,shall provide
County its PCR in computer readable format approved by Cou
a. PCB's provided to County shall co;_ All in on documented on Contractor's
original PCR and shall be submitted for all EMS syste. inclu latient contacts,cancelled
calls,non-transports, and,
b. Data points collected must in-' eal s, fied by County.
2. Contractor shall identify PC .,Or tie eeti a triage criteria.
;R'
(1 Q) days after the first of each
F. Rel!orts REguired. Contract provide in
calendar month,reports deali its P ce Buri -ce ina month as it relates to the
clinical, operational and fi ... ....... ant palated herein. Contractor shall document and report to
Contract Manager in and in a .,req the Contract Manager.Response time compliance
and customer co with resolution 11 be ed monthly. Reports shall include, at a minimum:
1. C . ,:.. .�s.
----
a. uing education liance reports,
b. Su V of clini N ice inquiries and resolutions,
C. Summ d calls due to vehicle/equipment failures,and
d. A list of 1 by city and by hospital, including all times necessary to
calculate each and every responseVon-scene time,,t" and transport to hospital time.
2. operational.
a. Calls and transports,by priority,by ERZ,
b. A list by ERZ of each call where a BLS ambulance was dispatched when an ALS
ambulance should have responded according to County dispatch standards,
C. A list by ERZ of each call where there was a failure to properly record all times
necessary to determine the response time and or transport to hospital time,
d. A list of mutual aid responses and requests,and
e. Number of paramedic ambulance hours deployed.
3. Response time compliance.
a. A list by ERZ of each emergency call dispatched for which Contractor did not meet the
response time standard,
b. A list by ERZ of responses cancelled en route,and
C. A list by ERZ of exception requests and resolution.
Initials:
Contractor County Dept.
L-3 (Page 15 of 2 1)
Contra Costa County SERVICE PIAN
Standard Form L-3
Revised 2002 Number 24-024-24
4. Response Time une Statistical Data. Within 10 working days following the last day of each
month,Contractor shall provide ambulance dispatch records to County in computer readable format specified by
the Contract Manager for all ambulance responses originating from requests by County designated
Communications Centers. Said records shall include the data elements identified in Exhibit F,attached hereto
and incorporated herein by this reference.
5. Comm unily/Governmental Affairs Reyo�rt.
a. Number, location,and outcome of conducted community education events,
b. PR activities,first responder recognition,
C. Government relations contact report.
6. Other ReI22rts. Contractor shall provide Co ith aper reports and records as may
be reasonably required by Contract Manager
V11. DEVELOPMENT OF AND INTEGRATION WITH FIRS - PON -RAMS.
I ponse- ." of
A. Contractor shall support the development and integration fire fi component
the EMS system and shall cooperate and support the ex ,.f para first response.
laboratively with fire first
B. Contractor shall insure that its personnel pro ..ally
a lresponders in the transition of patient care at the sc
C Contractor shall implement poli*ci* edul = e on ambulances to fulfill
.
paramedic training, internship, and accredi.....s_ require s for fighter paramedics working in Contra
Costa County.
D. County intends the neurial a rnovative methods proposed by Contractor
under this procurement nce me t response capabilities within the County. Contractor
shall support the dev ent of an int d fir sponse program. At a minimum Contractor shall:
-county paramed gining 75 firefighters employed within the contract service
area during the first ears of this Con X and a minimum of 100 firefighters during the full term of
this Contract.Paramed ing will be p D ed at no cost to County or fire agencies for tuition. Tuition
is defined as Paramedic tuition,, ed books, and preceptor and evaluation fees. Contractor will
not be responsible for indivi edical evaluations or immunizations which might be required,
or paying wages or stipends tot ters,
2. All of Contractor sponsored continuing education (CE)programs shall be made available
to Contra Costa fire personnel on a comparable basis as made available to Contractor's personnel. No fees
charged Fire personnel shall exceed fees charged Contractor's personnel.Fire personnel shall have access
to enrollment on the same basis as Contractor's personnel. Contractor will not be responsible for paying
wages or stipends to the firefighters for participation in CE activities.
3. Designate from among Contractor's employees a single individual as Contractor's contact
person/liaison for the fire agencies within the Service Area,
4. Establish a mechanism to exchange on a one-for-one basis medical supplies and
equipment supplied by a fire first responder agency in connection with patient transport,
5. Provide pre-arranged transportation service to return firefighters who accompany an
ambulance to the hospital promptly to their engine companies.
E. As consideration for the extended response times, detailed in Section III.C., above, granted
Contractor as a result of fire first responder services, dispatch services and other deployment benefits
received from the County and fire agencies within the County,the Contractor shall support the
Initials:
Contractor County Dept.
L-3 (Page 16 of 2 1)
Contra Costa County SERVICE PLAN
Standard Form L,3
Revised 2002 Number 24-024-24
development of an integrated fire first response program, shall support the expansion of paramedic first
response,and shall provide the County and fire agencies within the County an in-kind exchange of training,
continuing education programs and other services as outlined in this Contract.
VIII.HEALTH STATUS IMPROVEMIENT AND COMMUNITY EDUCATION.
A. Contractor shall undertake a program of health status improvement and community education
throughout contractor's service area. This program shall be planned and designed in collaboration with the
County Emergency Medical Services Agency,the Emergency Medical Care Committee, and with each
Board of Supervisors member with respect to components of the pr 6 to be carried out within that
A
Supervisor's district. Contractor shall provide the County E year with(1) a written plan
of activities the coming year and(2)a summary of that year'_ -co nts. Contractor shall endeavor
to carry out health status improvement and community educ operation with existing
healthcare and health promotion organizations, local public sa ency, er community
organizations.
B. Community Outreach Coordinator. Contra.._ hall e a full-1.1 e Community
Outreach Coordinator whose primary responsibilities Work wi my and community
organizations in carrying out Contractor's health s mpro and c unity education program.
C. Communib:CPR i rainine. Contracto eal . ement and community education
program shall include cardio-pulmonary res io C the p, of which is to recruit the public to
*
become CPR trained and to provide the a . 4 ining to an 1dents as possible..
I. Contractor shall develop, unction =i►ty Emergency Medical Services and the
County Supervisor for eac ..I dis 1--n outreac program to recruit residents to attend CPR
classes.
2. C ..... ..... ..... or shall conduc utrea gram to expand the number of citizens interested
in obtaining CPR
30 Contr . .... hall conduct a imurn of 24 CPR classes each year at different locations
throughout the County o t o the pub ithout charge
4. Contractors n-the-trainer courses to persons willing to provide CPR
training to the public without ch
D. Public Access Defibrillation(PAD)Program. Contractor's health status improvement and
community education program shall include a Public Access Defibrillation(PAD)program the purpose of which
is to promote public access defibrillation and to provide defibrillators at public locations throughout County.
Working collaboratively with County EMS Agency and with the County Supervisor in each supervisorial district
Contractor shall:
I. Identify candidate organizations and locations where public access defibrillation would be
beneficial.
2. Work with candidate organizations to develop organizational PAD programs, including training
4-1
appropriate staff.
3. Provide at Contractor's cost a minimum of 25 automatic electronic defibrillators each year to
selected organizations to be used in their PAD program,for a total of 125 units for the initial term of the contract
or 225 if the contract is extended,as provided in Section I of the Special Conditions. Each provided defibrillator
Initials:
Contractor County Dept.
L-3 (Page 17 of 2 1)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
shall include a minimum three-year warrantee and shall include appropriate installation and mounting for public
access.
E. Health Status Improvement Proiect. Contractor's health status improvement and community
education program shall include at least one project each year in addition to the above described CPR and
PAD programs that demonstrably improves the health status in the community.
1. Health status improvement programs targeted to "at risk populations"may include but are
not limited to: seat belt use, child safety seat use,bike safety program, participation in NHTSA Safe
Communities Program, CPR training, 911 awareness, gun safety,h ing safety, drowning prevention,
equestrian accident prevention, senior safety program, home h.::. ._?d "fin program.
2. The impact of the annual health status impr aA ::°-ent is to be statistically
demonstrable. This includes selecting indicators that can be :q.: . =;,t Fs. a? eprocess and outcomes of
an intervention strategy for health improvement, collecting an zing da?.;. : ` :those indicators, and
making the results available to the community to inform them{` ectiven A. :'ntervention and
the contributions of participating entities. Steps in this healt ,improv { : ro'ec" l include:
a. Analyzing the communi 's heal
b. Inventorying resources
'fifi :hi is
C. Developing a health improve mi:. strat
d. Establishing accountabi r 'ivi
e. Monitoring processe .outcomes„ 1.
3. Contractor shall use its be to obta' t.r "grant funding for health status
improvement projects. ==A:
Y,
IX. DISASTER MULTI. ALT Y T D RESPONSE.
... �ti��.
A. Multi-i.:: ...:..l /Disaster Res :.: :,. .
1. In the e .:::`::Wf a multi-casu ncident or other local emergency, Contractor shall endeavor
to perform in accordance :applicable { :: ty emergencyplans and shall use best efforts to maintain
primary emergency services :;:.: ding .,. :. :;.. rasion of non-emergency services as required.
2. County shall exe : ; ` `tractor from response time and staffing standards during
multicasualty incident and disaster ponse when such exemption is in the public interest.
3. County shall compensate Contractor for Contractor's direct costs for providing services
during a declared local emergency or disaster to the extent that said costs are not recoverable by Contractor
from a patient or third party and to the extend that said costs are recoverable by County from the state or
federal government.
B. Internal Disaster Response Notification. Contractor shall implement a plan for immediate
recall of personnel during multi-casualty incidents or other emergency condition. This plan shall include
the capability of Contractor to alert off-duty personnel.
C. Disaster Response Vehicle/Eauip_ment. Contractor shall provide one vehicle as a disaster
response vehicle. This vehicle shall not be an ambulance used in routine, day-to-day operations, but shall
be kept in good working order and available for emergency response to the scene. This vehicle may be
used to carry personnel and equipment to a disaster site. The following equipment shall be stored in this
disaster vehicle at a minimum: backboards and straps; cervical collars; head immobilization sets and foam
wedges; splints for legs and arms; oxygen equipment; extra dressing and bandages; advanced life support
equipment, especially IV therapy equipment; County approved disaster tags; and checklists for medical
Initials:
Contractor County Dept.
L-3 (Page 18 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24-
Incident Command personnel.
D. Incident Notification. Contractor shall have a mechanism in place to communicate current field
information to appropriate County Health Services and EMS staff during multi-casualty incident, disaster
or other unusual occurrences.
E. Interagengy Training for Exercises/Drills. Contractor shall participate in EMS sanctioned
exercises and disaster drills and other interagency training in preparation for this type of response.
F. Mutual Aid Requirements. Contractor shall respond in a mutual aid capacity within and outside
of the County if so directed by Contract Manager. Contractor shall b epared to respond one Ambulance
Strike Team staffed and equipped to the California Emergency s.es Agency Ambulance Strike
Team Guidelines when directed by County in accordance wit i--isast y al aid request.
G. Ambulance Service Assistance. Contractor,to be V a t all assist in servicing any
other emergency response areas where the County contract for onse ar suspended or
terminated if requested to do so by Contract Manager.
X. ADMINISTRATIVE PROVISIONS.
A. Audits/Inspections.
1. Contractor shall maintain sep rate ci ::ord S services provided pursuant to
this Contract in accordance with generally ac accou prin r es.
2. With reasonable notificAl y d during ess hours,County shall have the right
to review any and all bus' inclu ancial I Contractor pertaining to this Contract.
ines
All records shall be made my a Contra Costa County office or other mutually agreeable
location. The County dit9 COPY 9 trans otherwise reproduce such records, including but
not limited to contr... ayroll, invento onn ........... other records,daily logs, and employment
agreements.
3. Con ...hall provide C with audited financial statements by certified public
accountants for Contracto- ulance o S.
4. Contractor re s 'by County to provide County with periodic report(s) in the
format approved by the Contrac to demonstrate billing compliance with approved/specified rates.
B. Observation of Operations. Contract Manager or designee 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 person performing said observation shall conduct him or herself 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.
C. Annual Performance Evaluation. County shall formally evaluate the performance of the
Contractor at least annually to determine compliance with this Contract.An evaluation report will be
submitted to the Health Services Director and the Emergency Medical Care Committee,
D. Contractor Revenue Recovery and Compensation from County. The primary means of
Contractor compensation is through fee-for-service reimbursement of patient charges. The County provides
reimbursement for specified patients for whom it is responsible.
1. Patient Charges.
a. Contractor will not charge for any patient for whom Contractor does not provide
Initials:
Contractor County Dept.
L-3 (Page 19 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
ambulance transport,
b. Contractor's patient charges for services provided pursuant to this Contract shall not
exceed the rates set forth in Exhibit G, attached hereto and incorporated herein by this reference,
C. Contract Manager may approve an itemized schedule of patient charges, as long as
the average itemized charges for each service level does not exceed the rate for that service level as set
forth in Exhibit G.
d. Contractor shall not discount its published charges to benefit any non-governmental
third party payer or other group. This shall not, however,preclude Contractor from making billing
adjustments on a case-by-case basis for hardship or dispute resoluti.z :.
2. Reimbursement for Transports for which C. Y�,�� .:..: r..ervices is Responsible.
s onsible.
a. Contractor shall invoice County for a n #anc of patients for whom Contra
Costa Health Services is financially responsible. For patients t. ed as ;X allYindigent, Contractor
shall invoice County at a rate not to exceed the MediCal rate i :'.;. _ n July r on the date
service is provided. For all other patients, Contractor shall invoice :v:r"ht_ at a ra :'.; to exceed the
Medicare allowable charges in effect at the time service ':::w ": 'ded.
b. Contractor agrees that the pay :"Y. rs con herein include payment in
full for all ambulance services for which Contra Co egio 'cal Ce er or Contra Costa Health
Plan is financially responsible regardless of locatio sere'. ;: an ?yment provisions contained
herein include payment in full for ambulance; :4.:r.::` icepr a ":;:ed pri s;.:. ens in custody of Contra Costa
County '
C. Critical care transp Nices whespecialized staffing and equipment
exceeding the normal req .' mer -..ambulances, are not covered by this Contract.
3. Additi .. ervices. the :of this Contract County may opt purchase
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optional services or., re upgrades fro :;:.ntrac t forth in Exhibit E.
4. Fee h.2.` tments.
��� ct Manager sh_: f} '
a. g pprove annual increases to patient charges when requested
based on changes in the AY x:... er Price
(CPI)for All Urban Consumers San Francisco-Oakland
measured from April to Apr yeal.:dual rate increases, available on or after Jul 1St of each ,
. �... z Y
will be the greater of two and ov r :.v : scent(2.5%) or the CPI increase, but shall not exceed five percent
(5%) for any given year.
b. In the event of substantial and unanticipated impacts on Contractor's costs of
providing services or ability to recover patient charges from governmental third party payers, Contractor
may request and Contract Manager may approve changes in patient charges to mitigate the financial impact
of changes.
C. Contract Manager may approve charges for expendable supplies when said supplies
are newly required by EMS pre-hospital protocols adopted during the term of this Contract or when the
Contract Manager approves new items to be stocked on ambulances. The increase in patient charges for
new items shall not exceed 150%mark-up over purchase cost.
E. Billing/Collection Services.
1. Contractor shall maintain a business office within Contra Costa County and a local or toll-
free telephone number for all patient questions, complaints, or disputes made from locations within the
County.
2. Contractor shall operate a billing and accounts receivable system that is well-documented,
easy to audit, and which minimizes the effort required of patients to recover from third party sources for
Initials:
Contractor County Dept.
L-3 (Page 20 of 21)
Contra Costa County SERVICE PLAN
Standard Form L-3
Revised 2002 Number 24-024-24
which they may be eligible. The billing system shall:
a. Automatically generate Medicare and Medicaid statements;
b. Itemize all procedures and supplies employed on patient bills;
C. Be capable of responding to patient and third party payer inquiries regarding submission
of insurance claims,dates and types of payments made,itemized charges,and other inquiries.
3. Contractor shall make no attempts to collect its fees at the time of service.
4. Contractor shall agree to prepare and mail invoices for fire first responder services on
behalf of any fire jurisdiction so requesting. Contractor may charge a service requesting said service a fee
not to exceed the lower of(a) $20.00 per invoice or(b)the low :v-f:. . :5. : :::_d by Contractor of any other
fire agency in the State of California for such services.
F. Payment Provisions.
}
1. Contractor shall submit monthly invoices for a. : f : .:nal ora /. :. A:,.services or service
upgrades requested and approved by Contract Manager.
2. County will invoice Contractor monthl :: :`}:'-fines a :'::r;:d as identified in this Contract.
Contractor shall pay County's invoice within 20 days ceip.
G. Cooperation With Evolviniz Svs=. C ,...{actor e . icip ate and assist in the
development of system changes subject to ne. to
as
•x
z.r
i
x
;+ ..
<v:
Initials:
Contractor County Dept.
L-3 (Page 21 of 21)
Contra Costa County SPECIAL CONDITIONS
Standard Form L-4
Revised 2002 Number 23-024-24
1. Automatic Contract Extension. Notwithstanding, General Conditions, Paragraph 22. (Nonrenewal),
Contract Manager shall report to the Board of Supervisors on or before June 30, 2009 on Contractor's
compliance with the terms of this Contract and the Board of Supervisors shall issue a finding as to
Contractor's compliance with the terms of this Contract. Notwithstanding Paragraph 3 (Term) of this
Contract, unless this Contract is terminated by either party pursuant to Paragraph 5 (Termination) of the
General Conditions prior to June 3 0, 2010, upon a finding by the Board of Supervisors that Contractor has
been in substantial compliance with all terms of this Contract, the term of this Contract shall be extended to
June 30, 2014. During its extended term,this Contract is nevertheless s :.'ect to all the terms and conditions
applicable during its initial term, including but not limited r ;. Conditions, Paragraph 5.
(Termination). If this Contract is automatically extended, Co ntr A sh A"tinue to provide services as
set forth in the Service Plan, subject to any amendments thereto- ile .:..µ conditions of the Contract
shall remain in effect
2. Response Area Exclusivity. Except for provision of backu or sus p:' `: termination of
this Contract, County shall not enter into any agreement with any oth -..eider ound response to
emergency ambulance requests from a County designat. :: unicatl enter within Contractor's
Emergency Response Area(s)during the term of this Cont
3. Air Ambulance Transport County reserves the t to
r i arae transport agreements with
air ambulance providers. Notwithstanding any o } `sio is ct, County may provide for air
transport of patients when such transportation is, reed to b ��edical :n the best interest of the patient(s).
However, no such agreement shall provide for sport of patients or of critical patients when
a ground ambulance is on-scen ";; ort t ground a, ance to the most accessible emergency
medical facility equipped, s to a `' ter care appropriate to the needs of the patient is the
same or less than the esti `ir transport ;.
4. No Advertising.` actor shall not, in : :;;course ofg
rovidin service under this Contract, advertise,
p
promote,or endorse any o ::{ rvice or product ,vided by Contractor or any other firm.
S, '+
5. Private Work. Nothin is Contras. :.::all prevent Contractor from conducting private work that
does not interfere with the requir of tl ': ..,.::"ntract.
6. Breach of Contract. {
a. Notice of Default. County shall have the right to terminate or cancel this Contract or to pursue
any appropriate legal remedy in the event Contractor materially breaches this Contract and fails to correct such
default within seven(7)days following the service on it of a written notice by County specifying the default(s)
and the effective date of intended termination of this Contract, absent cure.
b. Definitions of Breach. Conditions and circumstances which shall constitute a material breach
by Contractor shall include but are not limited to the following:
1) Failure of Contractor to operate the ambulance service system in a manner which enables
County and 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 willful and repeated violations shall constitute a material breach;
2) Falsification of data supplied to 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 Contract;
3) Failure to maintain equipment in accordance with good maintenance practices;
Initials:
Contractor County Dept.
L-4(Page 1 of 5)
Contra Costa County SPECIAL CONDITIONS
Standard Form L-4
Revised 2002 Number 23-024-24
4) Deliberate, excessive, and unauthorized scaling down of operations to the detriment of
performance during a"lame duck"period;
5) 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;
6) Attempts by the Contractor to intimidate or punish employees who participate in protected
concerted activities, or who form or join any professional associations;
7) Chronic and persistent failure of Contractor's employees to conduct themselves in a
professional and courteous manner, or to present a professional appearan
8) Failure to comply with approved rate setting,bilk d von procedures;
x:.
9) Repeated failures to meet response time req F a �: eceiving notice of non-
compliance from Contract Manager; {
10) Repeated failure to respond to emergency medical f _.. '::-,...with a =:i unit when ALS
M:
level of response is indicated by County dispatch protocol; after receiv tice o compliance from
Contract Manager;
11) Failure of Contractor to provide and "tain '" quire rance and performance
security bond; :f
k.. y
12 Failure of Contractor to p comp 1 e ic..,r. . ase ns;
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13) Failure to comply with or ex A... . he mini :, em :;. ee wage/salary benefit package as
submitted; or f.{`
-
14) Willful and r ".bre a :'=: ..f Contractor's backup provisions.
V
7. Emergency Tak
a. In the event A ty determines th ateria' breach has occurred, or that a labor dispute will
prevent performance, an :ntract Manager :s-mines in his sole discretion that public health and safety
are endangered, and after ctor has be. iven notice and reasonable opportunity to correct the
deficiency, the matter shall be .".ited to th,: _.:. d of Supervisors. If the Board of Supervisors finds that a
breach has occurred and that he d ..: would be endangered by allowing Contractor to continue
providing services pursuant to this { " ° 't, Contractor shall cooperate fully with County to effect an
immediate emergency takeover by Co un., of Contractor's ambulances and crew stations. Such takeover shall
be completed within 72 hours after action by the Board of Supervisors.
b. In the event of an emergency takeover, Contractor shall deliver to County the ambulances and
associated equipment used in the performance of this Contract, including supervisors' vehicles. Each
ambulance shall be equipped, at a minimum, with the equipment and supplies necessary for the operation of
an ALS ambulance in accordance with Contra Costa County ALS Policies and Procedures. Equipment shall
include the supplies at the minimum stocking levels for an ALS Ambulance.
C. Contractor shall deliver all ambulances, crew stations, and other facilities located in Contra Costa
County and used pursuant to this Contract for storage or maintenance of vehicles, equipment, or supplies to
the County in mitigation of any damages to the County. However, during the County's takeover of the
ambulances, equipment, and facilities, County and Contractor shall be considered Lessee and Lessor,
respectively. Monthly rent payable to Contractor shall be equal to the aggregate monthly amount of
Contractor's debt service on the vehicles and equipment and occupancy charges as documented by Contractor
and as verified by the County Auditor. The County Auditor shall disburse these payments directly to the
Initials:
Contractor County Dept.
L4(Page 2 of 5)
Contra Costa County SPECIAL CONDITIONS
Standard Form L4
Revised 2002 Number 23-024-24
Contractor's obligee. In the event an ambulance is unencumbered, or a crew station is not being rented, the
County shall pay Contractor the rentals specified in Exhibit J,which is incorporated herein by this reference.
d. Nothing herein shall preclude County from pursuing recovery from Contractor of such rental and
debt service payments. On the other hand, Contractor shall not be precluded from disputing the Board's
findings and the nature and amount of County's alleged damages. However, failure on the part of Contractor to
cooperate fully with the County to effectuate a safe and smooth takeover of operations shall itself constitute a
breach of the contract, even if it is later determined that the original declaration of breach by the Board of
Supervisors was made in error. '
e. County shall indemnify, hold harmless, and defend C ; tot any and all claims arising
out of the County's use, care, custody, and control of the stations uipt ;.: vehicles, including but not
limited to, equipment defects, defects in material and workmans V neg .,use of the vehicles and
equipment during an emergency takeover. County shall have the ri :._ thonze e the vehicles and
equipment by another company. Should County require a substi e . ctor to :m;u-insurance on the
equipment, or should the County choose to obtain insurance vehicl ` . equipment, Contractor shall
be a"Named Additional Insured" on the policy,along with h. ndorse ,4,'" and cancellation notice.
f. County agrees to return all Contractor vehi. ...... and : t to ntractor in good working
order,normal wear and tear excepted, at the end oft. to, er od. : . of Contractors equipment not
so returned, County shall pay Contractor the fa' F et�Val. $f the .s. is a and equipment at the time of
takeover, less normal wear and tear, or shallpa.` ;ntractor aso t:: a costs of repair, or shall repair and
Y
return the vehicles and equipment. {
g. County may unil the er period at any time, and return the facilities and
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equipment to Contractor. . . :.r... eover pe 11 la e County's judgment,no longer than is necessary
to stabilize the EMS s: :; and to protect h: ublic th and safety by whatever means the County
chooses.
h. All of Contracto icles and rel . ..:� a ui ment necessaryfor the provision of Advanced Life
Support services pursuant to t ..t,ntract a.... reby leased to the County during an emergency takeover
period. Contractor shall maintain I ..ro '.'; .:, o County a listing of all vehicles used in the performance of
this Contract, including reserve vehic A;`_x license numbers, and the name and address of the lien holder, if
any. Changes in lien holder, as well as 'transfer, sale, or purchase of vehicles used to provide ALS services
hereunder shall be reported to the County within 30 days of said change, sale, transfer and purchase.
Contractor shall inform and provide a copy of the takeover provisions contained herein to the lien holder(s)
within 5 days of an emergency takeover. Emergency takeover procedures shall not apply to public safety
agencies.
S. End Term Provisions. Contractor agrees to return to County all County issued equipment in good
working order, normal wear and tear excepted, at the termination of this Contract. For any County equipment
not so returned, County shall repair or replace said equipment at Contractor's expense and deduct the cost
thereof from any payments owed to Contractor. In the event Contractor is not owed any payments under this
Contract, Contractor shall reimburse County for the actual cost of repairs and/or replacement.
9. Transition Planning.
a. Competitive Bid Re uired. Contractor acknowledges that County intends to conduct a
competitive procurement process for the provision of emergency ambulance service within Contractor's
Emergency Response Area(s) following termination of this Contract. Contractor acknowledges and agrees
Initials:
Contractor County Dept.
L-4 (Page 3 of 5)
Contra Costa County SPECIAL CONDITIONS
Standard Form L-4
Revised 2002 Number 23-024-24
that County may select a different ambulance service provider to provide exclusive emergency ambulance
services within all or some of the Emergency Response Area(s) specified herein following said competitive
procurement process.
b. Future Bid Cycles. Contractor acknowledges and agrees that supervisory personnel, EMT's,
paramedics, and control center personnel working in the EMS system have a reasonable expectation of long-
term employment in this system, even though contractors may change from time to time. Accordingly,
Contractor shall not penalize or bring personal hardship to bear upon any of its employees who applies for
work on a contingent basis with competing bidders, and shall allow w'': vout penalty its employees to sign
contingent employment agreements with competing bidders at :1 :i`.' ": cretion. Contractor may,
however,prohibit its employees from assisting competing bidders :...r ep ".it bid proposals by revealing
Contractor's trade secrets or other information about Contractor's b�. ; . `:v:`c `:.r field operations.
.ry
10. Retention of Records. Paragraph 3. (Records), Subpar :`:. r.a. (Re L,'Records) of the
General Conditions is hereby modified to read as follows: #
l S+
a. Retention of Records. The Contractor shall re x .. acumen :;:: ining to this Contract for
five (5) years from the end of the fiscal year followin }Sti , date s :v:ervice; {}:.ny further period that is
required by law; and until all Federal/State audits are : plete .:`..h tions resolved for this contract's
funding period. Upon request, and except as othe • .e r ::'cte la y.:..= actor shall make these records
available to authorized re resentatives of the :; � ~th Y to o `a fornia
p �', and the United States
s: r;.
Government." T{..
11. Termination. General Para ":; ``:-r5. (Termi is hereby deleted in its entirety and
replaced by the following par.
"5. Termination ..
+C• �!•iLi
a. Written No }. ,.x}'::{.. County may, at ole dis�lcretion, terminate this Contract without cause by
giving Contractor twelve .n. k onths advance en notice of its intent, when said termination is made in
conjunction with any redesi }: the Coun ; ".."existing EMS system. This Contract may be cancelled
immediatel y bywritten mutual c `_ fX:. :`
! }
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b. Failure to Perform. Th`' t :. , " upon written notice to Contractor, may immediately terminate
this Contract should the Contractor fai 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.
12. Insurance. Paragraph 19. (Insurance) is hereby deleted in its entirety and replaced by the following
paragraph: -
"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:
a. Liability Insurance. The Contractor shall provide malpractice insurance and comprehensive
liability insurance, including coverage for owned and non-owned vehicles, each with a minimum combined
single limit coverage of$11,000,000 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 act, omission, or occurrence. Such insurance shall be endorsed to include the
County of Contra Costa and their respective officers and employees as additional named insured as to all
Initials:
Contractor County Dept.
L-4(Page 4 of 5)
r
Contra Costa County SPECIAL CONDITIONS
Standard Form L-4
Revised 2002 Number 23-024-24
services performed by Contractor under this Contract. 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,medical malpractice and workers' com n n i.. urance as req uired herein no
later than the effective date of this Contract. If the Contractor : Id ;rY`the insurance policy(ies) or
acquire either a new insurance policy(ies) or amend the covers ::. f Aor. gh an endorsement to the
policy(ies) at any time during the term of this Contract, then Contr .y, 1 y a current certificate(s)
of insurance.
d. Additional Insurance Provisions. The insurance olid vld >..v:.. Y
_. p ed z •.� e Contractor shall
include a provision for thirty (30) days written notice to y :F:Y:" :y '.:ore ca ,' : tion or material chane of
the above specified coverage.
Performance Security Bond. The Q acto.:. ..; al 'sh performance security in the
e. ty
amount of$500,000 in one of the following forms.....}� ' s ..
V J
(1) A faithful performance bond by a °. ing >s`x :,pany, appropriately licensed and
.
acceptable to County;or, "w }
(2) An irrevocable >; :.. :Y: iss "A rsuant to this provision in a form acceptable to the
- P
County and from a bank or inancia ~:;.tion ble to the County."
aa' .• 'S;SAY:'
'•L. zs
. • tom-'ti.
f
5'
vt'v
Initials:
Contractor County Dept.
L-4 (Page 5 of 5)
Contra Costa County GENERAL CONDITIONS
Standard Form L-5(Revised 2002) (Purchase of Services-Long Form)
1. Compliance with Law. Contractor shall be subject to and comply with all applicable federal,state and local laws and regulations 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. Contractor shall retain all documents pertainin-1 -is Co r five years from the date of submission
of Contractor's final payment demand or final Cost Report;for any fuA e d by law;and until all federal/state
audits are complete and exceptions resolved for this contract's funding perio requ b tractor shall make these records
Af.
available to authorized representatives of the County,the State of Californi nited St ent.
b. Access to Books and Records of Contractor,Subcontractor. Purs to Sectio 1)of ocial Security Act,and any
of
regulations promulgated thereunder,Contractor shall,upon written r ntil the on of four years after the furnishing of
services pursuant to this Contract,make available to the County. ecre CHTlealth man Services,or the Comptroller
General,or any of their duly authorized representatives,this Co t and ents, and records of Contractor necessary to
certify the nature and extent of all costs and charges here -'.e
ith a value or cost of$10,000 or more over a
Further,if Contractor carries out any of the duties of thi tract thro subco t w
twelve-month period,such subcontract shall con se to the e written request and until the expiration of four
years after the furnishing of services r o such s ct,the su r shall make available to the County,the Secretary,
the Comptroller General,or an orize entatives,the subcontract and books,documents,and records of the
subcontractor necessary to e nature an t of a and charges thereunder.
This special condition 1, ition to any and all of ...... ..... s reg the maintenance or retention of records under this Contract and
is binding on the heirs,s rs,assigns and repre ives of Contractor.
4. Reporting Requirements. P Governmen .......6 Section 7550,Contractor shall include in all documents or written reports
completed and submitted to County in .....,ance w Contract, a separate section listing the numbers and dollar amounts of all
contracts and subcontracts relating to the p ch such document or written report. This section shall apply only if the payment
limit under this Contract exceeds$5,000.
5. Termination and Cancellation.
a. Written Notice. This Contract may be terminated by either party,in its 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. County,upon written notice to Contractor,may immediately terminate this Contract should Contractor fail to
perform properly any of its obligations hereunder. In the event of such termination, County may proceed with the work in any
reasonable manner it chooses. The cost to County of completing Contractor's performance shall be deducted from any sum due
Contractor under this Contract,without prejudice to County's rights to recover damages.
c. Cessation of Fund. Notwithstanding Paragraph 5.a.above,in the event that federal,state,or other non-County funding for this
I
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.
L-5 (Page 1 of 4)
Contra Costa County GENERAL CONDITIONS
Standard Form L-5 (Purchase of Services-Long Form)
Revised 2002
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 Contractor and County. 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. Informal
Agreements may not enlarge in any manner the scope of this Contract,including any sums of money to be paid 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 its
designee.
8. Modifications and Amendments.
a. General Amendments. This Contract may be modified or amended b. "w j:. ` ent executed by Contractor and the
Contra Costa County Board of Supervisors or,after Board approval,by its „F. "`ee,s I any required state or federal approval.
b. Administrative Amendments. Subject to the Payment Limit,the Pay IN ns Service Plan may be amended by a
written administrative amendment executed by Contractor and the County A or(or d o W.,su 'ect to any required state or
federal approval,provided that such administrative amendment may not mate t e the Pay . $t :' ions or the Service Plan.
9. Disputes. Disagreements between County and Contractor concernin� . ,g�re ur. s�or performance of this Contract shall
be subject to final written determination by the head of the county c :: en Y ich this+ Y. ct is made,or his designee,or in
accordance with the applicable procedures(if any)required by the s :.. 'or fed e v . ent.
10. Choice of Law and Personal Jurisdiction. "
a. This Contract is made in Contra Costa County " ,all be gove'. w' d 'YhV ed in accordance with the laws of the State of
California.
b. Any action relating to this titute r :{rosecuted in the courts of Contra Costa County,State of California.
11. Conformance with Fed. d State RegHlatio Laws. .x:_fi.bld federal or state regulations or laws touching upon the subject
��
of this Contract be adopted` `.: ' ed during the term h : : . this Contract shall be deemed amended to assure conformance with such
federal or state requirements.
'S
12. No Waiver by County. Subject " . ph 9.(D' : s)of these General Conditions,inspections or approvals,or statements by any
officer, agent or employee of County in Ccs; `tor's performance or any part thereof complies with the requirements of this
Contract,or acceptance of the whole or any `'id performance,or payments therefor,or any combination of these acts,shall not
relieve Contractor's obligation to fulfill this Coi t 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 Assiggment. This Contract binds the heirs,successors,assigns and representatives of Contractor. Prior written
consent of the County Administrator or his designee,subject to any required state or federal approval,is required before the Contractor may
enter into subcontracts for any work contemplated under this Contract,or before the Contractor may assign this Contract or monies due or to
become due,by operation of law or otherwise.
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 they know or have
reason to know they have 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:
L-5 (Page 2 of 4)
Contra Costa County GENERAL CONDITIONS
Standard Form L-5 (Purchase of Services-Long Form)
Revised 2002
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.
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 ; is Contract shall be available to all qualified
persons regardless of age,sex,race,religion,color,national origin,ethnic back gro d'}" ";._` sexual orientation,and that none shall
be used,in whole or in part,for religious worship or instruction.
. h d
tiSY
18. Indemnification. Contractor shall defend,indemnify,save,and hold harmle '` °"and its :k" : :;r s and employees from any and all
claims,costs and liability for any damages,sickness,death,or injury to persons)o. A: includin a itation all consequential
damages,from any cause whatsoever arising directly or indirectly from or connec'`d operatio =r. {"" ices of Contractor or its
agents,servants,employees or subcontractors hereunder,save and except .,' r litigati M. ing through the sole negligence or sole
willful misconduct of County or its officers or employees. Contractor `;.:County A h', expenditures, including reasonable
attorneys' fees,County may make by reason of the matters that are t :y: ject o emnific' `:: and,if requested by County,will
defend any claims or litigation to which this indemnification provisi. pplies'A..:.. a kst and expense of Contractor.
x.
19. Insurance. During the entire term of this Contract and ension o :`dificati ereof,Contractor shall keep in effect insurance
policies meeting the following insurance requirements F`'. ..:±therwise a `' edA' :::'Special Conditions:
a. Liability Insurance. For all "'' a the t �: ment limit o 'contract is$500,000 or less,Contractor shall provide
comprehensive liability insur a for '` and non-owned automobiles,with a minimum combined single limit
coverage of$500,000 for ages,includin quen ages,due to bodily injury,sickness or disease,or death to any
person or damage to or :...'A.:.;°ion ofproperty,incl :_the loss a thereof,arising from each occurrence. Such insurance shall be
P � ,.-
endorsed to include Cou :;A" its officers and empl : +t{A as additional insureds as to all services performed by Contractor under this
agreement. Said policies sh ".;titute primary insu t.rx as to County,the state and federal governments,and their officers,agents,
and employees,so that other in F°:._ policies held v:�em or their self-insurance program(s)shall not be required to contribute to
any loss covered under Contractor' ` ':: ce pol':.{ olicies. For all contracts where the total payment limit is above$500,000,the
aforementioned insurance coverage tos K;`'".` .:vi ::v'AContractor shall have a minimum combined single limit coverage of$1,000,000,
and Contractor shall be required to prove :_;.::;. with a copy of the endorsement making the County an additional insured on all
general liability,worker's compensation,an f applicable,all professional liability insurance policies as required herein no later than
the effective date of this Contract.
b. Workers'Compensation. 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 Contractor shall include a provision for thirty(30)days
written notice to County before cancellation or material change of the above specified coverage.
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 County shall be addressed to the head of the county department for which this Contract is made. Notices to 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 County shall be the date of receipt by the head of the county department for which
this Contract is made.
L-5 (Page 3 of 4)
Contra Costa County GENERAL CONDITIONS
Standard Form L-5 (Purchase of Services-Long Form)
Revised 2002
21. Primacy 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 purchasing all or any such services from
Contractor.
23. Possessory Interest. If this Contract results in Contractor having possession of, claim or right to the possession of land or
improvements,but does not vest ownership of the land or improvements in the sam er. or ifthis Contract results in the placement of
taxable improvements on tax exempt land (Revenue & Taxation Code Sectio x.:...) ` "est or improvements may represent a
possessory interest subject to property tax, and Contractor may be subject t pay v::operty taxes levied on such interest.
Contractor agrees that this provision complies with the notice requirements of :n<. ax :: ode Section 107.6,and waives all
rights to further notice or to damages under that or any comparable statute. `„ `
.Y:• 'y n
24. No Third-Party Beneficiaries. Notwithstanding mutual recognition that service . ;,,-this Cori` may provide some aid or
assistance to members of the County's population,it is not the intention. ; <-ounty or ctor that such individuals occupy the
position of intended third-party beneficiaries of the obligations assum eith T to this - ct.
25. Copyrights and Rights in Data. Contractor shall not publish o h'' sfer ate Y uced or resulting from activities supported
by this agreement without the express written consent of the :. A Y ini or. If erial is subject to copyright,County reserves
the right to copyright,and Contractor agrees not to copyri ich material. . he ma. ..;a: is copyrighted,County reserves a royalty-free,
nonexclusive,and irrevocable license to reproduce,pubs = "d use such hole or in part,and to authorize others to do so.
26. Endorsements. Contractor sh- as a co r with Contra Costa County publicly endorse or oppose the use of any
particular brand name or commR
'roduct witho nor a of the Board of Supervisors. In its County contractor capacity,
>,
Contractor shall not publicly ::xy. to qualities or lack lities t ':.. icular brand name or commercial product in the absence of a
well-established and widely ` :xed scientific basis for. claims or without the prior approval of the Board of Supervisors. In its
County contractor capacity,Co ':: :_.shall not participat:v�v.t ppear in any commercially produced advertisements designed to promote a
particular brand name or commerce = ; .uct,even if Co y :.r `r is not publicly endorsing a product,as long as the Contractor's presence in
the advertisement can reasonably be in.x:. d as an en..: 'ment of the product by or on behalf of Contra Costa County. Notwithstanding
the foregoing,Contractor may express its n : is to other contractors,the Board of Supervisors,County officers,or others who
may be authorized by the Board of Supervis : ;`:}i-:,<: aw to receive such views.
27. Required Audit. (A)If Contractor is funded by$300,000 or more in federal grant funds in any fiscal year from any source,Contractor
shall provide to County at Contractor's expense an audit conforming to the requirements set forth in the most current version of Office of
Management and Budget Circular A-133. (B)If Contractor is funded by less than$300,000 in federal grant funds in any fiscal year from
any source, but such grant imposes specific audit requirements; Contractor shall provide to County an audit conforming to those
requirements. (C)If Contractor is funded by less than$300,000 in federal grant funds in any fiscal year from any source,Contractor is
exempt from federal audit requirements for that year,however,Contractor's records must be available for and an audit may be required by,
appropriate officials of the federal awarding agency,the General Accounting Office(GAO),the pass-through entity and/or the County. If
any such audit is required,Contractor shall provide County with such audit. With respect to the audits specified in(A),(B)and(C)above,
Contractor is solely responsible for arranging for the conduct of the audit,and for its cost. County may withhold the estimated cost of the
audit or 10 percent of the contract amount,whichever is larger,or the final payment,from Contractor until County receives the audit from
Contractor.
28. Authorization. Contractor,or the representative(s)signing this Contract on behalf of Contractor,represents and warrants that it has
full power and authority to enter into this Contract and perform the obligations herein.
L-5 (Page 4 of 4)
EXHIBIT A
QUALITY IMPROVEMENT ACTIVITIES
1. Continuous Quality Improvement activities include at a minimum:
a. Regularly and accurately evaluating patient care oriented activities of personnel,
b. Regularly and accurately evaluating operational,administrative and procedural activities as they relate to the
delivery of patient care,
C. Accurately determining the training and educational needs of both individuals and Contractor's agency as a
whole,and evaluate the effectiveness of training and education provided,
d. Providing regular training and continuing education on both h u. au4.as needed basis to personnel in
all areas of patient care and operations,
e. Supporting discovery,investigation,and resolution of irate "or ext. plaints,
f. Facilitating the evaluation of protocols;procedures, and p Stan .. ="F n a regular basis, including
re-evaluation based on system events,training and experienc x}j
r
g. Encouraging positive involvement and interaction of indiv A} 1 levels ;e system, in ways
which improve care,
h. Objectively reporting performance of both indivi. up parte :.. . . and components for further
evaluation by Contractor's Medical Director,
L Participation in EMS system related CQI activity'. d C o Y": s,and
j. Prompt notification of the EMS An :of n' :: F;'::,t} oc s that could impact certification,
accreditation or licensure of any pre-ho '0. ersonne;. �J
2. Key Performance and Clinical Indica clude ata
:'' te .
a. Cardiac arrest survi ance } in, �v` protor ;
b. Presumptive• :,',:; a ,r; co1-1-y" field intervention,
C. Fractal me "nt of time to A_ brills '
d. Success ation rate, w f fn:
.a
e. Success fu lication rate,
f. Field proced medications, }
Pain reductio }"}
h. Fractal measuremen" -0 pons ::;e of QRV first responders,and,
L Fractal measurements o .•......::'' _ _ e of ALS transport ambulance.
3. Benchmarking to non-clinical in!• vcators include at a minimum:
a. Employee injuries,
b. Vehicle collisions(>$250 damage)per 100,000 fleet miles,
C. Critical vehicle/equipment breakdowns(interfering with a response or transport)per 100,000 fleet miles,
d. Customer satisfaction,
e. Employee turnover,and,
f. Employee satisfaction.
Initials:
Contractor County Dept.
jLDCH IBIT B
CONTINUING EDUCATION AND TRAINING REQUIREMENTS
1. Course requirements for paramedics:
a. Advanced Cardiac Life Support(ACLS)according to American Heart Association standards.
b. Basic Trauma Life Support (BTLS) course approved by the American College of Emergency
Physicians, or a Prehospital Trauma Life Support (PHTLS) course approved by the American
College of Surgeons.
C* Pediatric Education for Prehospital Professionals CP
z'
d. Basic Life Support CPR equivalent to current can sociation's Guidelines for
Cardiopulmonary Resuscitation and Emergency Car ; ;:;: r ar the Healthcare Provider
level and automatic electronic defibrillator utilization. . y
: .
e. Pediatric Advanced Life Support for Critical Care Transpo edics `:.a =P).
f. Infrequent skills update. h `
2. Additional educational programs: "r _5 `
n,
vim.:"
a. Preparation for multi-casual response in.: .::r ing..'. 1
p multi-casualty p .:,.:.:: g�.::.-Y. . ..all field employees and ICS 200
and 300 for supervisors and operati �� . a der.
b. Ambulance Strike Team Leader ;;"hg for feel erv'
.p
C. Assaultive behavior managemen g for allonnel
d. Critical Incide :,;; men
e. National In ';;- Managem tem
f. Cultural;:. : "-sity awareness
g. Hazardou `;-.axials Basic Awar :.;.v s WMD program
;. l�am� . p
h. Monthly case ::_ s and period:': ;Y of Topics"
i. Bay Area Parame urn al ori`
j. Contra Costa Coun "t.:;;: ;..„ r posium- sponsorship and involvement in planning.
_ p p g
k. Shadowing program to s R�.
: a day with a trauma surgeon or emergency department physician.
Initials:
Contractor County Dept.
EXHIBIT C
DESIGNATED AS RURAL AREAS
Thomas Brothers Map Coordinates
The areas of Contra Costa County identified below by Rand McNally 2005 Thomas Guide map coordinates
are designated rural. All areas of Contra Costa County not identified below are considered urban/suburban.
550 C6-7 05-7 609 01-2 E6-7
D6-7 H6-7 H 1-3 F4-7
E6-7 J4-7 J1-4 G4-7
F6-7 590 A4-7 610 Al-7 H4-7
05-7 B 1-7 BN J4-7
H5-7 C1-7 Cl-7 617 All
:gym
J6-7 D 1-7 618 Al-7
•y.Ji
557 All E 1-74 B 1-7
> 55
558 Al F17 ., £:� C1-
B 1-3 G1-7 G ::.t :. DI-3
570 C1-4 H1-7 H 4rY.: A:-. All
D 1r7 J 1r7 2 :z $} 635 All
.r x`o:.
4.
EN 591 A1-7 ...... :w i" •� 636 All
}` `` }
-? :.
F1 B 1-7AN
AS
X 637 All
a:
G 17 C1-7 ``x: -3 638 Al 7
r, .w. _
H1-7 D1-7 :: 1.3 ..a :.: : B 1_
J 1-7 E 1-7 = E 1-4. C5-7
571 A1-7 F5-7 `'-$, DS
B2-7 :; 613 -7 E5-7
5 7 4 A6-7 `4 A `.: :..:` B4-7 F5-7
576 E2 B1-7 C2-7 655 All
F2 4 Cl-7 _:; D2-7 656 All
01-2 :i? D 1-7 . t E2-7 657 All
H 1-3 E 1- p,. F1- 658 Al
}.. 7 7 -4
-?
J 1�4 ��.F 1 7 •.�.:�•� G2 B 1
577 Al-4 r
H3 7 Cl-4
.N r
B 1-4 �::r.�xx}�:.�:�:: J3-7 D 13
'c
Cl-7 J3- 'ry~. 614 A3-7 El
D 1-7 595 A3-7 BN Fl
EN B3-7 Cl-7 676 A1-2
Fl-7 C6-7 D 1-7 B 1-2
G 1-7 D6-7 EN C1-2
H 1-7 E6-7 F1-7 D 1
J 1-7 F6-7 G 1-7 E 1
578 A2-7 G6-7 H 1-7 F 1
B 1-7 H6-7 J 1-7 G 1
C1-6 J6-7 615 All
D3-4 597 All 616 A6-7
589 D4-5 598 A1-7 B6-7
E4-6 B2-7 C5-7
F5-7 C5-7 D6-7
Initials:
Contractor County Dept.
EXHIBIT D
PENALTY SCHEDULE
1. Priority 1 Response Time Penalties
ERZ A
$15,000 Response time standards less than 95.0%but greater than or equal to 94.5%
$25,000 Failure to meet response time standards less than 94.5%but greater than or equal to
$50,000 94.0%
..r
Failure to meet response time standards less th . �.
ERZ's B,C, D, and E (including communities of Bethel Isl :..:. nd .:;:. ..Bay)
$15,000 Response time standards less than 90.0%but g .r an or ,?: .x.A to 89.5%
$25,000 Failure to meet response time standards less tha`t.q;:. = ut gree ,3 r equal to 89.0
$50,000 %
N.
Failure to meet response time standards:.' .:.. . rY q9.0% W
s
2. Priority 2 Response Time Penalties
r:
.: Hrr •.
ERZ A
$5,000 Response time standards less . rf 95.0% it great; ..{`: an or equal to 94.5%
$10,000 Failure to meet response '` ndards le %but greater than or equal to 94.0
$15,000
Failure t et resp a st °.,. s less than 94.0%
ERZ s B,C, D, a :.:.; including com es of f: l Island and Discovery Bay)
$5,000 Re time standards le : an 90.0%but greater than or equal to 89.5%
$10,000 Failure :�- et response ti andards less than 89.5%but greater than or equal to 89.0
$15,000 % '`
Failure to meIN e standards less than 89.0%
3. Priority 3 Response Time P' 0.
S'
ERZ's A,B, C, D, and E(including communities of Bethel Island and Discovery Bay)
$2,500 Response time standards less than 90.0%but greater than or equal to 89.5%
$5,000 Failure to meet response time standards less than 89.5%but greater than or equal to
89.0%
$7,500 Failure to meet response time standards less than 89.0%
4. Failure to Meet Equipment and Supply Requirements
$500 Per failure to meet minimum in-service equipment and supply requirements
Initials:
Contractor County Dept.
EXHIBIT E
PAYMENT SCHEDULE
PAYMENT PROVISIONS. In consideration for the provision of services described below when
requested by Contract Manager in writing, County shall pay Contractor according to the following
schedule:
1. Paramedic Quick Response Vehicle (QRV). Additional QRV's beyond the four (4) required in
Section I.B.5 as requested by County: $47.30 per hour, not to exceed $34,527.92 per month per QRV.
This rate is not intended to cover the cost(s)of providing housing for : :t responder paramedic units.
2. Hourly Reimbursement Rates. Ambulance services, b ::.:; `�d uired by Contractor to meet
Contractor's response standards or minimum requirements,w ;;equ.: _:- :: :ontract Manager:
$74.20 per hour.
3. _Upgradinz Ambulance Fleet. Additional upgrades ofT ulanceJ _ III ambulances
beyond the thirty-nine(39)required in Section IV.A: $16,00 :er unit reciate diver five (5)years.
4. Reserve Ambulance Fleet. Additional reserve ariyond Y :': (6) required in Section
a. Type II ambulance -$21424 ;h
Yp � Per Y `"•"
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b. Type III ambulance-$24,624 p }"r '
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Contractor County Dept.
EXHIBIT F
RESPONSE TIME DATA ELEMENTS
a. Unit identifier
b. Service level(paramedic or EMT-I)
C. Location of call - street address
d. Location of call - city or unincorporated community
e. Location of call-Thomas Brother's map coordinates
f. Location of call -EMS ERZ-
g.
RZg. Location of call- latitude and longitude v
h. Urban or rural
i. Nature of call(EMD Code) s "
j. Code to scene
h v:
k. Call priority(one,two,or three) `
1. Time call received :y
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M. Time call dispatched
k
n. Time unit en route
o. Time cancelled prior to .. or ce
p. Response upgraded �o =onse do ed F.
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S. a unit en route spits
t. e unit at hospital :A
U. nit clear and av le for next call
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W. Rece' it
X. Code to ho z.
y. Major trauma TV,non-MTV)
Z. Number of patients transported
aa. EMS incident number
bb. Exception request reason
Initials:
Contractor County Dept.
EXHIBIT G
PATIENT CHARGES
BLS Base Rate 445.60
BLS Emergency Base Rate 543.45
ALS 1 Base Rate 11001.87
ALS 1 Emergency Base Rate 17061.61
ALS 2 Base Rate 17238.77
Loaded Ambulance Mile Rate 0.34
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Contractor County Dept.
EXHIBIT I
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1 of 2 Initials:
Contractor County Dept.
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RENTAL RATES
.Vehicle and basic egulpment
$},000 per month per unit
$ 3 5 per day per unit
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Above rates include mileage,normal wear and tear,and equip
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Initials:
Contractor County Dept
Contra Costa County PAYMENT PROVISIONS
Standard Foran P-1 (Fee Basis Contracts-Long Form)
ReVased 2002 Number 23-024-24
1. Payment Amounts. Subiect to the Payment Limit of this Contract.and subject to the followilig Payment
Provisions, County will pay Contractor the followuig fee as full compensation for all services, work,
expenses or costs provided or uncurred by Contractor. [Check one alternative only.]
monthly,
[ ] b. $ per tout,as defused in the Service Plan,
[ ] c.. $ after completion of all obligations and conditions lnereul, or
[X] d. County will reimburse Contractor for transportati w.o ie :::.for whom Comity is
funancially responsible,as provided un section X. ce Plaii. Comity will
also reimburse Contractor for optional services has it to section X.D.3.
x.
of the Service Plait.
4
2. Payment Demands. Contractor sliall submit written demands. Sai .. ands sll made on Comity
Demand Form D-15 and i.n the maiuner and form pr y Co Contractor shall submit said
demands for payment no later than 30 days from � rad N. month �.luch the contract services
upon which such demand is based were actually r ". .. tired. = royal o.A said payment demands by
p r,
the head of die Comity Department for whic: d1i .r:z1 s us designee, Comity will make
payments as specified un Paragraph 1., (Pa `Amour above..
Y.
3. Penal for Late Submissio n Cot ::•..µr fails to s 'o Comity a timely demand for payment
as specified un P� ?. em x .above, and as a result of Contractor's lane submission
the Comity is w1abl tail rei m ,lit 1e Statue of California or otherwise;to die extent the
Comity's recove. ndung is preju :. y {_, Co "1`.L..:liall not pay Contractor for such services, even
though such se ere fully provided. m
ttit�.
4. Right to withhold. Co as the rig "! �tliliold payment to the Contractor when, un the opinion of
the Comity expressed u1 to tln. F tractor, (a) the Contractor's performance, u1 whole or u1 part,
either has not been carried i T sufl`iciently documented, (b) the Contractor has iieglected, failed
or refused to furm'sh uifonnati :::yy:. to cooperate with any uispection, review or audit of its program,
work or records, or (c) Contractor has failed to sufficiently itemize or document its demand(s) for
payment.
5. Audit Exceptions. Contractor agrees to accept responsibility for receiving, replying to, and/or complying
with any audit exceptions by appropriate Comity, State or Federal audit agencies occurring as a result of
its performance of this Contract_ Contractor also agrees to pay to the County witill130 days of demand
by Comity the full amount of the Comity's obligation, if any, to die State acid/or Federal government
resulting from any audit exceptions, to the extent such are attributable to the Contractor's failure to
perform properly any of its obligations under this Contract.
Initials:
Contractor County Dept.
Form P-1 (Page 1 of 1)