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HomeMy WebLinkAbout06-17-2013 c4 city agreement with san luis ambulancecounctL âqenòa pepopt \4eel¡ng Date June I7,2013 Item Number C4 FROM: Prepared By: CITY OF SAN LUIS OBISPO Charlie Hines, Fire Chief Julie Cox, Administrative Analyst SUBJECT: CITY AGREEMENT V/ITH SAN LUIS AMBULANCE SERVICE, INC. RECOMMENDATION Approve agreement with San Luis Ambulance Service, Inc. (SLAS), authorizing SLAS to bill persons for first-response emergency medical services provided by the Fire Department First Responder Agency (FRA) and authorize the Mayor to execute the agreement. DISCUSSION The California Emergency Medical Services (EMS) Act of 1980 defined the need and purpose for local EMS agencies (LEMSA) to coordinate the development of a single EMS system, including the provision of consistent patient care and traininglaccreditation/licensing requirements for pre- hospital providers. Accordingly, the use of ambulances falls within the prevue of each LEMSA. The San Luis Obispo County Department of Public Health is the LEMSA agency with oversight for the City of San Luis Obispo, and therefore the contract for ambulance services in the City is a component of the County Code, specihcally Chapter 6.60. County Code governs the use of ambulances, and the role/formation of the Ambulance Perforrnance Operating Committee (APOC). The APOC is responsible for contractual oversight and service to their represented communities including San Luis Obispo. The San Luis Obispo Fire Department provides advanced life support medical services for patients who may be transported to an emergency room by SLAS, Since this provision of medical services assists SLAS with meeting the company's contractual obligations for patient care response times, the City is eligible for financial reimbursement under the APOC. ln 1996, the City Council approved supporting the APOC's proposed ambulance agreement between the County and the private provider, SLAS. This ambulance agreement was originally presented and approved for a contract period of five years by the Board of Supervisors on March 26, 1996. Since that time, the Board has approved the agreement and extensions with SLAS. On May 24,2011 the Board of Supervisors approved a new agreement between the County and SLAS, The current City and SLAS agreement terms have been updated to coincide with SLAS and the County agreement terms. The agreement provides for SLAS to reimburse the City for first-response emergency medical services provided by its Fire Department. To provide funds for this payment, Article 4.1 of the Memorandum of Agreement between County of San Luis Obispo and SLAS requires a separate contract be entered into between the City and SLAS allowing SLAS to directly bill persons receiving this service (Attachment, Exhibit 1). c4-1 City Agreement with San Luis Ambulance Service, lnc.Page 2 FISCAL IMPACT For FY 2012-13 the General Fund received $166,666 from this agreement. The agreement is adjusted each July 1 during the terms of the agreement equal to the percentage increase of the Los Angeles-Riverside-Orange County Consumer Price Index for All Urban Consumers as published by the bureau of Labor Statistics, to a maximum of five percent. ALTERNATIVES The Council could decide not to approve the agreement. This is not recoÍìmended as Board of Supervisors has approved the agreement. ATTACHMENT c4-2 nf rAc++r"I€NT AGREEMENT FOR ASSIGNMENT OF BILLING RIGHTS FOR FIRST RESPONDER SERVICES This Agreement for Assignment of Billing Rights for First Responder Services ("Agreement"), by and be¡¡¿een the Cþ of San Luis Obispo, a municipal corporation ("City") and San Luis Ambulance Service, lnc., a Califomia corporation ("SLAS") is entered into on the date set forth below. Collectively, the parties to this agreement are referred to as "the parties." RECITALS WHEREAS, SLAS is party to a May 24,2011 agreement with the County of San Luis Obispo to provide ambulance services within the County of San Luis Obispo of which a true and correct copy is attached hereto as Exhibit l, and WHEREAS, Aficle 4 of the l'lay 24,201 I agreement with the County of San Luis Obispo provides that SLAS shall make certain payments to the City in exchange for a general assignment of the City's rights to bill persons for certain services provided by its fire deparfrnent in connection with emergency calls for medical assistance; and WHEREAS, City's fue department meets minimum Advanced Life Support Services requirements and/or EMT-D qualifications as set forth by the County of San Luis Obispo's Emergency Medical Service Agency; and WHEREAS, Article 3 of the lvlay 24,2011 agreement with the Corurty of San Luis Obispo provides Performance standards utilizing City's First Responder Advanced Life Support and/or EMT-D services in meeting SLAS deployment plan goals; and WHEREAS, A¡ticle 4 of the May 24,201I agreement with the County of San Luis Obispo requires that the parties to this Agreement enter into a separate written agreement providing for assignment of the City's rights to bill persons for these services. NOW, THEREFORE, IN CONSIDERATION OF THE PROVISIONS SET FORTH BELOW, THE PARTIES AGREE AS FOLLOÌù/S: 1. Definitions: The parties hereby incorporate by reference all definitions set forttr in Article I of the I|day 24,2011 agæment between SLAS and the County of San Luis Obispo. 2. Assisnments: City hereby assigns its rights to SLAS to directly bill persons for fust-response emergency medical services provided by its fire departnent in connection with emergency calls for medical assistance. First-response emergency medical services provided by the City's fire departnent include, but are not limited to, providing initial stabilization and trained on-scene assistance, and assistance en-route to medical facilities as required, and extication and rescue services. c4-3 Â-rTA ct+MÉruf 3. Timing and Amount of First Responder Payment: The Contractor fi¡st responder payments for Fiscal Yea¡ 2010-ll are shown in County and SLAS Ageemen! Exhibit C. All first responder payments shall be made no later than the end of the second month following the end of the quarter for which the payment accrued (for example, payment for the period of April l't through Jure 30h will be due on or before the following August 30h). 4. Annual Adjustnent to Payments: The quarterly payments to the first responder agencies will be adjusted annually, on July 1, in proportion to the change in the Los Angeles-Riverside-Orange County Consumer Price Index. However, in no event shall the annual increase exceed five percent (5%). The indexes shall be for All Urban Consumers as published by the Bureau of Labor Statistics. 5. Equipment Exchange and Replacement: SLAS shall establish a restocking plan and replenish disposable medical zupplies and equipment used by CITY in connection with each patient transport. 6. Indemnification: SLAS shall defend, indemniff, save and hold harmless the City and its officers and employees from any and all claims, costs and liability (including without limitation, attorneys'fees) for any damages, sickness, death or injury to person(s) or property, including without limitation all consequential damages, from any cau¡ie whatsoever arising directly or indirectly from or connected with the operations or services of SLAS or its agents, servants, employees or subcontactors, save and except claims or litigation arising from the sole negligence or sole willfi¡l misconduct of the City or its ofücers or employees. 7. Term: The term of this Agreement shall be the same as set forth in Article 7 of the May 24,201I agreement between the County and SLA. If the agreement between the County and SLAS is extended, SLAS shall continue to make payments as set forth above, and City shall continue to assign its rights to directly bill persons for emergency services rendered by its fire deparhnent. 8. Early Termination: This Agreement may be terminated by either party, in irc sole discretion, upon one hundred eighty days' advance written notice to the other party. This Agreement may be terminated immediately upon written mutual agreement of the parties. Furthermore, City may terminate this Agreement immediately should the County of San Luis Obispo terminate its March 26,1996 agreement with SLAS as provided in Section 7.3 of that agreement. 9. Modification: This Agreement may be modified or amended only by a written document executed by the City and SLAS. This Agreement contains all the terms and conditions agreed upon by the parties. Except as expressly provided for in this Agreement, no other understanding or representation, oral or otherwise, regarding the subject matter of this Agreement, shall bind or affect either of the parties. c4-4 A].lAc H ¡¡rErJ r 2013.The foregoing agreement was adopted this day of Mayor Jan Manr Cþ of San Luis Obispo President and CEO Frank Kelton San Luis Ambulance Service, Ino. ATTEST: Maeve Grimes, City Clerk APPROVED A,S TO FORM: J. Christine Dienick, CþAttomey .) c4-5 É\'rTA c l-t MËA.)T ÉY Í'tt rZ t 1 L- MEMORANDUM OF AGREEMENT This agreement, entered into on VnÐ{- 2A ûÃll .by and between thq County of San Luis Obispo (hereafter "County") and San Luis Ambulance Servicg Inc., a California Corporation (hereafter "Co ntractor"), WITNESSETH WHEREAS, the County regulates the operation of ambulance providers pursuant to the provislons of Chapter 6,60 of the San Luis Obispo County Code (hereafter "Chapter 6.60"); and WHEREAS, the Contractor has been a licensed provider of ambulance services in San Luis Obispo County since 1945; and WHEREAS, on March 26,1996, the County entered into a contract with the Contractor designating the Contractor as the exclusive ambulance service provfder Ín the Northern and Central ambulance services areas of the Count¡r (hereafter "the L996 Northern/Central Area ContracÉ'); and WHEREAS, on May 6,1997,the County entered into a Eontract with Five Cities Ambulance Service, lnc. designating said company as the exclusive arnbulance selice provider in the Southern ambulance service area of the County [hereafter "the 1997 Southern Area Corttract"); and WHEREAS, by L999, Five Cities Ambulance Service,Inc. was experiencing financial and operational problems that could only be cured by an infrrsion of,capital; and WHEREAS, the Contractor becarne the successor in interest of Flve Cities Ambulance Service, Inc. in L999, subject to the approval of the County; and WHEREAS, on March L4,20A0, the County gave its approval of the Contractor's sfatus as the successor in interest of Five Cities Ambulance Service, Inc., on May 23,2000, the County approved amendmenæ to both the 1996 Northern/Central Area Contract and the L997 Southern Area Contract to effectuate the transfer; and WHEREAS, said amendments extended the duration of both contracts to make it feasÍble for the Contractor to justiff and recover the investments that would be necessary to upgrade the operation of Five Cities Ambulance Service, Inc. to an acceptable level; and WHEREAS, the 1996 Northern/Central Area Contract and the 1997 Southern Area Contract contain somewhat varying provisions that create inefficiencies aird inconsistencies; and WHEREAS, to enhance efficiency and consistency, the County desires to replace the two existing'contracts with a single contract covering the North, Central and South emergency response areas ofSan Luis Obispo County; and c4-6 Page 1 ol20 Ar-T F)( H //\Ëñ1E,{r+tetT 7- WHEREAS, the parties also desire to define an objective process for periodic review of the maximum rates that may be charged by the Contractor, as set forth below; and WHEREAS, the parties desire to clariff the language of the former contracts and to make certain other technical changes to the agreement, as set forth below; and WHEREAS, Chapter 6.60 defines the process for the development of ambulance provider agreements and selection of provÍders wherèby ambulance provÍders are designated by agreement between County and the designated provider; and WHEREAS, the Ambulance Performance/Operations Committee (hereafter "APOC") established pursuant to Chapter 6.60 has reviewed this agreement and recom¡r¡ended that County enter into this agreement with the Contractor for the provision of ambulànce servlces; NOW, THEREFORE¡ irt,consideration,of the provisions set forth below¡ the parties hereby agree as follows: ARTICLE 0.5 TR,ANSITIONAL PROVISIONS Effecdve Date. This contract shall be effective upon the date (hereafter 'iEffeæive Date") which is the latter of (1) the date that Ít is e*ecuted by the Contractor and (2) the date of the Board of Supervlsors meeting atwhfch it is approved. . ' , Rlghts and Obllgatlons with Respect to the Provlslon of Ambulance Servlces from and after the Effectlve Date. This agreement governs the rights and obligadons of the County and the Contractor with respect to ambulance services provlded on and after the Effective Date. Neither the 1996 Northern/Gentral Area Contract nor the 1997 Southern Aièa Contract shall have any effect on said rights and obligations, Rlghts and Obllgatlons with Respect to the Frovlslon of.Ambulance Servlces before the Effectlve Date. This agreement shall have no effect on the rights and obligations of the County or the'Contractor with respect to ambulance se¡vices provided be.fore the Effective Date. The 1996 Northern/Central Area Contract and the 1997 Southern Area Contract shall continue to define the rights and obligations of the parties with respect to ambulance services provided beforé the Effective Date. ARTICLE 1. DEFINITIONS : For the purpose of thÍs agreement, all words and phrases that are defined iri section 6.60,010 of the San Luis Obispo County Code shall have the meaning ascribed to them in said section of the County Code and are incorporated herein by reference, The following words and phrases that are not defined in section 6.60.010 shall have the following meaning: Page2 of20 c4-7 ATrAc r{ Msr,J'[ grl+l brr ¿ Advanced Llfe Support (AtS): For ambulance seryices, means special services designed to provide definitive prehospital emergency medical care, including but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardlac defìbrillation, advanced airway management, intravenous therapy, administratfon of specÍñed drugs and other mechanical preparations, and other medicinal preparations, and other specified techniques and proceduies administered by authorized personnel under the direct supervision of a Base Hospital as part of the local EMS system at the scene of an emergency during transport to an acute care hospital and duríng i nter-fac ility transfer. Advanced Llfe Support (AtS) Provlder¡ A public or private provider authorized to operate ALS units and provide ALS services in San Luis Obispo C-ounty. Ambulance Performance/Operatlons Committee (APOC): The advisory body created pursuant to section 6.60.050 of Chapter 6.60. ' Ambulance Servlce Area: For purposes of this contract, the North¡ Central and South Emergency Response Areas as defined in Exhibit A, attached hereto and incorporated herein by this reference. Baslc Llfe Support (BtS): Ernergency ñrst aid and cardiopulmonary resuscitation procedures which as a minimum include recognizing respiratory and cardiac arrest and startingthe proper application. of cardiopulmonary resuscitation to maintain life without invasive techniques until the victim may be transported or until Advanced Life Support Ís avallable. Chapter 6.60: Chapter 6.60 of the San Luis Obispo County Code ("Prehospital Emergency Medical Care and Transport Services"). Contract Manager: The County's Health Agency Director, or designee, or successor in responsibility. ' : Emergency: A condition.or sÍhration in which an individual has a need for immediate medical attentioll or where the potendal for such need is perceived by emergency medical personnel or a pqblic safety agency. EMS Ach California Health and Safety Code Sections 1797 et seq., or successor legislation on the same subjecL EMS system: A system of organizations, resources and individuals from whom some action is required to ensure a timely and medically appropriate response to medical emergencles. Flrst Responder Agency: Typically a public agency, such as a fire department, that responds to emergency calls for medical assistance, providing initial stabilization and tralned assistance on-scene and, when required, en-route to medical facillties; also refers to certaln Page 3 of20 c4-8 ATIA¿H MgNJr , Êxi+ itz tT'4_ extrication and rescue services. In accordance with priority dispatch protocol, a first response unit is routinely sent to all presumptively classified life-threatening calls within the Ambulance Service Area. Incident Command Sy$em: The combination of facilities, equipment personnel, procedures, and communications operating within a common organizational structure, with responsibility for the management of assigned resources to effectively accomplish stated objectives pertaining to an incident. Llfe Threatenlng Emergencles; Those situations determined in accordance with local medical direction that are likely to result in the loss of life without immediate intervention. Local EMS PIan: The emergenry'medical services plan adopted by the local EMS Agenry pursuant to the requirements of the EMS Act. Medlcal control: The medical management of the emergency rnedical services systern pursuantto the provisions ofHealth & Safep Code chapter 5, sections L978 etseq. Paramedlc: An lndividual trained and licensed to perform ALS procedures under the directíon of a physician (also referred to as an EMT-P). Paramedlc Ambulance: An ambulance staffed by a miriimum of one licensed Paramedic and one certified EMT and equipped to provide ALS. Transport: When a patient is transported by ambulance to a hospital or between medical facÍlities where the medlcal capabilities of an ambulance ane required or potentially required. ARTICLE 2. DESIGNATION AS PROVIDER AND DESCRIPTION OF SERVICES TO BE PROVIDED 2.1 Servlces - In General. Pursuant to Chapter 6.60, the County hereby designates the Contractor as the Ambulance Service Provider for the Ambulance Service Area. Within said, Ambulance Service Areas, the Contractor shall providi emergency ambulance service.without interruption, 24 hours per day, every day, for the full term of this contract, in accordance with all provisions of this contract. The Contractor shall provide said emergenc¡¡ ambulance serices ,'u without regard to the patient's race, color, national origin, religious affiliation, age, sex, sexual orientation, disabilþ, and any other protected class under state or federal law, or abilityto-pay. 2,2 Appllcable Standards and lnvolved Agencles. The Contractor shall provide Advanced Life Support (ALS) emergency ambulance seMces under nredical control as dispatched by MED- COM. Such services shall be provided in accordance with the requirements of the EMS Act, Chapter 6.60, the Local EMS Plan, this contract, and any other applicable statutes, ordinances and regulations. In performing services hereunder, the Contractor shall work cooperatively with the Page 4 of20 c4-9 hrr n¿ Fì M E,/u-l- Ê-x H'tgtt' 7_ local EMS agency. The Contractor shall also cooperate wÍth the Ambulance Performance/ Operations Committee (APOC) wÍth respect to matters within its purview. 2.3 Alr Ambulance Transport. The County resen¡/es the right to enter into sepárate transport agreements with air ambulance providers. Notwithstanding any other provision of this agreement the County may provide for air transport of patients when such transportation is deemed by the most senior medical personnel on the scene to be in the best interest of the patient(s). However, no such agreement shall provide for air transport of non-critical patients or of critical patients when a ground ambulance is on-scene and transport time by ground ambulance to the most accesslble emergency medical facility equipped, staffed, and prepared to administer care appropriate to the needs of the patient is tle same or less than the estirnated air transport time. 2.4 Non-Proflt TransportServlces. The County resertres the rightto enter into separate agreements.with non-profit agencies or districts whose purpose is to.neduce tlte travel tirne for patients residing in the more rural or inaccessible areas of the County. Such agreements will be structured so as to ensure that the Contractor will be involved in meeting non-profit transport agencies at pre-determined transfer points for the Èansfer of patient care to the Contractor. Such plans will be developed under the approval of the local EMS agency. 2;5 Requtrement for Non-Emergency Ambulance SéMces: It ls the intent of the Local EMS Plan and related ambulance provider agreements to establish Exclusive OperatingAreas ("EOAs") within which the designated ambulance seryice provider will retain the authority and responsibllity for the provlslon of all ambulance services in the EOA. When requests for non- emergency ambulance transport service are made, the Contractor may take the time necessary to mobilize resources beyond that on-duty at the time of the request. However, at any time, the lead medical personnel at the scene of the patient requirlng transport (typlcally a hospital or hospital emergency room) may upgrade the patient's status to one requiring emergency medical transport. At that time, the deslgnated Contractor in that EOA must respond immediately, as they would for any emergency requesL 2.6 Crltlcal Care Transports. Contractor may operate a program of critical care transports, which are nurse-staffed inter-facilitytransports for both emergency and non-emergency patient conditions, in compliance with the policies and procedures developed by the local EMS Agency. Contractor may charge a critical care transport base rate plus mlleage for transportatlon. That rate shall be sub)ect to the rate review process as set forth in Article 6 herein. Page S of20 c4-10 r)TrAC q ¡úl'eñ'/,' Þxr+tBr i_, ARTICLE 3. PERFORMANCE STANDARDS 3,1 Deployment PIan. Throughout the term of this agreement the Contractor shall comply with the specific Deployment Plan requirements contained Ín Exhibit B, attached hereto and incorporated herein by this reference, specÍfyÍng all the ambulance stations (general locations) and the number of vehicles to be deployed during each hour of the day, and each day of the week for each specific area or zone. The general goal of the Deployment Flan is to provide an Advanced Life Support (ALS) unit either by the Contractor or by an ALS fÌre service agency, to at least 90% of all potentially lÍfe threatening emergency ambulance requests originating withln each Ambulance Service Area with a maximum response time of 10 minutes in areas designated urban, and a maximum response time of 30 mÍnutes in areas designated as,ru,ral, and a maximum response time of 60 minutes in areas designated as remote; The various areas are set forth in Exhibit A¡,attached.hereto and incorporated herein by this reference. Upon request, for purposes of contiact administration, the Contractor shall provide documentation regarding the degree to which it has complied with the Deployment Plan. (Deployment Plan specifìcs for each zone are found in Exhibit B). 3.2 Staffing and Personnel. The ContrËrctor shall send a Paramed.ic Ambulance staffed with a minimum of nr¿o personnel¡,whose level of certification shall, as a minimum, be one Emergenry Medical Techniclan-l (EMT-l) and one Emergency Medical Technician-Paramedic (EMT-P) to all life threatening and potentially life threatening emergenc]¡ medical requests. Specific certificatíon, training, supervision and preparedness requirements are outlined below. Ä. Certlflcatlon. All of the Contractorls ambulance personnel responding to emergency medical requests shall be currently certifìed andy'or licensed by both the State of California and the local EMS agency. In addition, all of the Contractor's EMT-Ps shall be currently accredited by the local EMS agency-to practice Ín San Luis Obispo Courity. The Contractor shall retain on file at all times copies of the requlred current and valid licenses, certifications, and/or accreditations of all emergency medical personnel performing services under this agreement B. Reasónable Work Schedules and Worklng Condltlons. As an independent contractor, the Contractor shall be responsible for determining the méthods and techniques for achievÍng compliance with the requirements of this contracq provided however, that the Contractor shall utilize reasonable work schedules and work perlods for its personnel so that they are fresh enough to be able to perform safely and to provide adequate patient care. The Contractor shall ensure that any of its personnel, who work extended shifts, part-time iobs, voluntary overtime, Poge 6o120 c4-11 A'TTAct-t^ ãi\Jr Exçti Ø r ¡ or mandatory overtime, are not exhausted to such an extent that their iudgment or motor skills might be impaired. With the exception of extreme emergencies, the Contractor shall not knowingly allow its personnel to work at any provider (public or private) in excess of seventy-trNo (72) consecutive hours. The Contractor must provide each and every one of its ambulance personnel with no less tìan twenty-four (2$ hours of off-dutytime, immediately following each work period. C. Requlred Hazardous Materials Trainlng. The Contractor shall staff each ambulance with Paramedics and EMTs who shall, withfn ninety (90) days of hire by Contractor, each show sufficient evidence that theyhave successfully completed "Hazardous Materials - First Responder Operational Course," or training that has been accepted as equivalent bythe local EMS agencyand the County Fire Chiefs Haz-Mat Committee. D, Orlentatlon and On-GoingPreparedness. The Contractor shall properly orient all field personnel before assigning them to respond to emergency rnedical,requests. Such : orientation shall include at a minimum, ALS Provider policies and procedures; EMS system overview;,EMS policies and procedures; radio communications with and between t}te provider agency, Base Hospital, protocols with other agencies (fìre seruice, Sheriff/Coroner), receiving hospltals, and MED-COM; map reading skills including key landmarks, routes to hospitals and other maior receiving facilities within the County and in surrounding areas; and ambulance and equipment utilization and maintenance. E. Fleld Supervislon. The Contractor shall provide at all.times and within;San Luis Obispo County an individual authorized to act on behalf of the Contractor in all operational matters. F. Preparatlon for Mulü-Casuaþ Response,,The Contractor shall train all arnbulance personnel and;supervisory staff in their respective roles and responsibilities under the County of San Luis Obispo Dlsaster Plans which are on file at the local BMS agency and prepare them to, funcdon,in the variety of roles that are required within the Incident Command System. G. Crltlcal Incldent Stress Debrleflng. The Contractor shall make avaflable to all, Contractor employees the County FÍre Chiefs Critical Incident Stresi Debr'ieflng Program. The Contractor shall encourage program/team participation bythe Contractor's employees. The Contractor shall contribute up to $750 per zone peryear to the Fire Chiefs AssocÍation, upon their request, to assist in funding the program /team. The Contractor shall not be required to contribute such funds for any purpose other than ongoing trainlng and support that is directly linked to the program/team's needs. H. Tralnlng wtth Flre Agencles. The Contractor shall ensure that lts ambulance crews make themselves available to train with fire agencies located within all service areas covered Page 7 of20 c4-12 A"fT,.\( flfvlÈ/vi ENt+tBtr 4_ by this contract, engaging in joint training with each local fire department at least twice each calendar year. I. Communlcatlon with FÍre Agencies. The Contractor shall ensure that its Operations Manager makes hlmself or herself available to meet with fire chiefs from public agencies located within each ambulance service area on a quarterly basis. The Contractor shall schedule these meetings with reasonable notÍce to the fìre chiefs. 3.3 Vehlcles and Equlpment A. Vehlcles. Ambulance vehlcles shall at a minimum meetthe standards of Title XIII, CalÍfornia Code of Regulations. Vehicles shall dÍsplay the "911" emergencytelephone number and state the level of servíce, "Paramedic Unit," on both sides and the unit identification number/ radio designatÍon in 4-inch letters. Ambulance vehicles shall be marked to identify the company name, but shall not display any telephone number other than 911 or any other advertisement. The , Contractor shall maintain its vehicles in a good working order, consistent with the manufacturer's specifications, In addition, detailed records shall be maintained as to wsrk performed, costs.related to repairs; and operating and repair costs analyses where appropriate. Reports shall be accomplished and systems shall be maintaÍned so ¿¡s to achieve at least the industry norms in vehicle performance and reliability, B. General Equipment. All of the Contractor's ambulances shall carry all emergency supplies,and equipment Ídentified in the County Ambulance Equipment and Supply Policy on fìle at the local EMS agency on each of the licensed units. The Contractor shall maintain its vehicles, equipment,and supplies in a clean, sanitary, and safe rnechanical condition at all times. The Gontractor agrees that equipment and supply requirements may be changed with the,appr;oval of the Contract Manager due to changes in technology. . C. Communlcadons Equlpment and Dlspatch. The Contractor shall equip all Parämedic arnbulances and.supervisoryvehicles used ¡¡¡ providing serviie with a County MED- COM-capable radio. Each a¡nbulance and+upervisory vehicle shall also be equipped with a cellular telephone. All ambulances for emongency medical response under the terms of this agreement shall operate only within San Luis Obispo County, or as directed by MED-COM; or.in compliance wÍth policies and protocols established by the County. UHF.and VHF radio frequencies shall be designated by the County. The Contractor shall operate the two-way radios in conformance with all applicable rules and regulations of the Federal Communications Commíssion, and in conformance with all applicable state and,/or County rules and operating procedures. Page I of20 c4-13 âfïAc H //tE¡.rt ÞKttt 8 t( 4_ D. Failure to Meet Mlnlmum ln-Servlce Equipment/Supply Requlrements. The County may inspect the Contractor's ambulances during normal business hours, with prior notice. Any ambulance that fails to meet the minÍmum in-service requirements contained in the County Ambulance Equlpment and Supply Policy, as determined bythe County, shall be immediately removed from service until the deficiency is corrected, and shall be replaced as necessary to ensure continued compliance with the deployment requirements contained in Exhibit B. E. Equlpment Exchange and Replacement. The Contractor shall irnplement and maintain inventory control and equipment malntenance systems which keep the ambulance fleet fully stocked with approved equipment in good working order at all timês. The Contractor shall establlsh a mechanism to replenish disposable medical supplles and equipment used by a public first responder agency ln connection with each patlerrt transport. F. Ambulance Restocklng Program. The Contractor shall continue its:restocking plan for all first responders in its Ambulance Service Area. Said restocking plan shall be approved byt}re Contract Manager and local EMS agency. G. Datly Ambulance and Equlpment Inspectlon anil Gheck-Out. Each day, each ambulance unit and the equipment contained therein shall be inspected and checked out. Each ambulance unit shall be restocked following each response, êxcept in cases where back-to-back responses donf t allow for restocking prior to initiating the second response. BQuipment and supplies shall be maintained at levelsthat assure that back-to-back responses do not cause an ambulance unit to respond to an emergency medical call without sufficient equipment and supplies. H. Ambulance Type. The Contractor shall continue to maintain its entire fleet of ambulances as Type lll, with the exception of four wheel drive ambulances used by Contractor for offroad access. : ' 3;4 Dlsaste¡ Multl-casualty, Munral Ald Response and Standby. The Contraaor wlll deploy resources in accordance with emergency.and or mutual aid plan or plans approved by'the County. The Contractor shall render emergency asslstance in multi-casualty or disaster situations to any locatÍon as directed by MED-COM. At the scene of the r.nulti-casualty incident or disaster, the Contractor's personnel shall perform in accordance with the County's Emergency Response Plans and the Incident Command System. When the Contractor is notified that multi-casualty/disaster asslstance is no longer required, the Contractor shall return all of its resources to the primary area of responsibility and shall resume all operatlons in a timely manner. During the course of the multi- casualty/disaster, the Contractor shall use its best efforts to provide local standard emergency coverage by providing back up units. Pogc 9 of20 c4-14 ffi At r*MEÀJf , Ëxttr øÍ 7- A. Tralning. The Contractor shall participate ín disaster and multi-casualtyuaining and exercises conducted by the local EMS agency, the County and fire service agencies as requested. B. Stand-By Servlce. The Contractor shall prgvide, at no charge to the County or requesüng agency, stand-by services at the scene of an emergency Íncident within its ambulance service area when directed by MED-COM upon the request of a public safety agency. The Contractor may charge for stand-by at an incident where a responsible party exists. 3.5 Move Up and Cover. The Contractor shall provide ambulance move-up and coverage for service areas left uncovered due to other emergency responses, as directed by MED-COM. Nothing shall preclude contractors in each service area from developing mutual coverage agreements thatmay or may not involve financíal remuneration. When a contractor provides inter. service area coverage at the request of MED-COM, contractor shall be exempt from normal zone coverage.requirements: ARTICLE 4. FIRST RESPONDERSUPPORT .4,l,Utlllz,atlon of Flre Depaftment Personnel. The County and the Contractor acknowledç that fire service personnel play an integral part of the,County's EMS system. They'are involved in scene management, patient care at both ALS and BLS levels, auto extrication, heavy rescue and cliff/wilderness rescue and assistance in patient transportation. The number and type ofresources required ofContractor for each zone have been configured around the participation of the various fire service resources within the zone. If a public agency providing fire-based first responder services executes a separate agreement with Contractor generally assigning to Contractor its right to bill patients for ñrst responder services¡ Contractor shall pay the first responder agency for said assignment of billing rights in accordance witl section 4.2 below. In order to be eligible for support fees, fire service agencies must meet mfnimu¡n ALS requÍrements or EMT-D qualifications as outlined by the local EMS agenc¡ ln the"event that there is a request by a fire agency.for a change in its ALS Servlce or ñrst responder fees, and to the extent that such request may impact resource requirements and deployment as set out in Exhibit B, County, in consultation with County's Ambulance Performance/Operations Committee (APOC), shall consider the impact on Contractor of such change gr request during the periodÍc rate review as set out in Article 6. : 4.2 Timlng and Amount of Flrst ResponderPayments. The Contractor shall make the fÌrst responder payments shown in Exhibit C, attached hereto, and incorporated hereln bythis reference, to the agencles identified in ExhÍbit C, in the amounts shown in Exhibit C. All first Pqge 10 of20 c4-15 Aff¡( t+yrt1[rl- EXtt rß t'f !- responder payments shall be made no later than the end of the second month following the end of the quarter for which the payment accrued (for example, payment for the period of April 1st through )une 30th will be due on or before the following August 3Oth). 4.3 Annual Adfustment to Payments. The quarterly payments to the ñrst responder agencies will be adjusted annually Ín proportion to the change in the Los Angeles-Riverside-Orange County Consumer Price Index. However, in no event shall the annual increase exceed five percent (5%). The indexes shall be for All Urban Consumers as published by the Bureau of Labor Statistics using fuly as the base month. 4.4Independent Agreements wlth OtherAgencles. Nothing in this agreement shall preclude Contractor from entering into other agreements with local fire service agencies to improve the EMS system's overall efficiency. Any such agreement must be approved by the Coun!y's Ambulanee Perforrnance/Operations Committee [APOC). i" ARTICLE 5. RECORDS, REPORTING AND INSPECTIONS 5.1EMS Run Report. The Contractor shall utillze the County's apþroved format for documentation on all patient responses, including non-transports. The Contractor shall complete this form accurately and include all information listed in Section 100169 of the California Code of Regulations, and distribute it according to the local EMS agency's policies and procedures. The Contractor shall purchase any required foims. At the Contractor's option, the Contractor may print its own supply of forms. All forms are subject to revision by the local BMS agency at any time. The Contractor shall provide the County wÍth copies of indlvidual EMS rün rep.brts as requested by the local EMS agency. When so requested, reports shall be provided bythe Còntractor to the local EMS agency withinthree (3) business days of the reque$. The County wÍll'lÍmit such'requests tb circumstances that merit special handling; ' 5.2 Personnel Reports. The Contractor shall provide the local EMS agency with a list of EMS personnel currently employed by the Contractor and shall ü¡ldate that list wheriever there is a change, The personnel llst shall include, at a minimum, the name, address, telephone nurnber, Paramedic, CPR and ACLS expiration dates, and California Driverrs License number of each person on the list. 5.3 Audlts and Inspectlons. The Contractorshall maintain separate business and ñnancial records for services provided pursuant to this agreement in accordance with generally accepted accounting princlples. The County shall have the following righæ of audit and inspection: Poge 11 of20 c4-16 ATlt\( H MÉ'\r1*' Fxt-frarr ! A. lnspection and Copylng. Upon reasonable advance notification, during normal business hours, the County shall have the right to review any and all ofthe Contractor's business and financial records pertaining to this agreement. All such records shall be made available to the County at its San Luis Obispo County office or other mutually agreeable location. The County may audit, cop¡ make transcripts, or otherwise reproduce such records, including but not limited to contracts, payroll, inventory, personnel and other records, daily logs, and employment agreements. . B. Flnanclal Statements. Annuall¡ the Contractor shall obtain and provide the Countywith financial statements upon request If the Contractor has audited financial.statements in its possession, Contractor shall make those available to the County. Otherwise, the.financial statements shall be prepared by a Certifled Public Accountant and shall comply with generally accepted standards for Reviewed FinancÍal Statements. The financial statements shall cover the Contractor's ambulance operations and/or any other businesses that share overhead with the Contractor's ambulance service operation. C. Records of Bllllng. The Contractor shall provide the County upon request with periodic report(s) in the format approved by the Contract Manager to demonstrate billing compliance with approved/specifi ed rates. D, Budget Forecasts and Other Reports. The Gontract Manager may require the Contractor to assist in frrture budget forecasting for planning purposes. The Contractor sirall provide the Count¡r with such assistance and other reports and records as may be reasonably required by Contract Manager. E. Obseruatlon of Operatlons, Contractor shall allow Contract Manager or his/her representatives, at a mutually agreed upon time, tp directly observe the Contractor's control center operations, maintenance facilities, and'ambulance post locations, a¡d to ride as "third person" to observe the operation of any of the Contractor's ambulance units. The Contract manager or his/her representative shall conduct themselves in a professional and courteous rnanner, shall not interfere with the Contractoris employees in the performance of theÍr dutles, and.shall at all times be respectful of the Contractor, The Contractor shall submit to an annual performance evaluation in accordance wlth procedures established by Contract Manager. It is also understood that at any time the County may cause to be monitored the response tlme of any ambulance crew, so as to ascertaln compliance with standards that are established inArticle 3 of this àgfeement. ARTICLE 6. PATIENT CHARGES Page 12 ofl0 c4-17 ft1f1c HfvtÉAr-T É,llttØtr J* 6.1 Charges for Services Provided. The Contractor's patient charges for services provided pursuant to this agreement shall not exceed the rates as established by the County. A. Consumer Prlce lndex Adfustrnent in Charges. Adjustments in patient charges will be effective at the conclusion of each annual rate review. If for some reason a rate revÍew has not been conducted within the preceding twelve (12) months, then a Consumer Price Index (CPI) adjuÈtment will be made to the current rates on October 1 of the subsequent year. The adjustment w.ill be based upon the percentage of increase of the Los Angeles'Riverside-Orange County CPI. However, in no event shall the annual increase exceed five percent (5%). The indexes used shall be for "All Urban Customers" as published by the Bureau of Labor Statistics. B. Stgnlflcant Changes ln Flnanclal Condlttons. In the event that Contractor experiences increases in operating costs or decreases in operating revenue to the extént-that Contractor is no longer earning a reasonable rate of return; as defined in Article 6,5, the County will consider án increase in ambulance charges. In this situatlon, the Contract Manager,rlayrequire Contractor to provide County wlth financial statements and/or other pertÍnent information necessaryto support any recommended supplementalincrease in ambulance charges. In the event that Contractor projects that profits will exceed the allowable profit margin at any time, as defined in Artlcle 6.5, Contractor is obligated to immediately notÍfy County so that the County may adJust ambulance rates. 6.2 Perlodlc Rate Revlews - When Allowed¡ There shall be regular, periodic reviews of the maximum rates that the Contractor is allowed to,charge at the following times or under the following circumstances: , 1 A. Annual Revlew at:Optlon of Elther Party; Either party shall have the right, in its complete'and absolute discretion; to require a rate review for the Contractor's prior year, and everyyear thereafter. All rate reviews will cover either of the'following periods: (1) a nine-month period of October 1 through furte 30, three consecutive quarters, annualized to September 30; or (2J a twelve-month period of fuly 1 to fune 30. Should either parfy desire a rate review it shall serve the other party a written request for a rate review by f urie 30. Said review shall be completed by Countywithin 60 days after receipt of all requested financlal documents; and new Fates, lf any, shall go into effect begÍnning October L of the following Contractor's'fiscal year or thereafter. B. Bevlew Due To Slgnlflcant Change in F'lnanclal Condltlons. If there ls an unexpected development that would have'a major impact on either the expensés or income of the Contractor, either party may request a rate review within a reasonable time after the impact of that Page 13 of20 c4-18 A'lrÊcil NllN'r ÉX++¡6tr 1_' development becomes known. Additionally, if there is a level of service change whlch affects the Contractor's response time and deployment capabllities, either party may request a rate review wlthin a reasonable time after becoming aware of such change. The parly requesting the rate review shall support its request with a narrative justification for the required change(s), including reasons for the change(s), any measures taken to contain costs, and implications if the change[s) is/are not approved. The party receiving the request for rate review shall grant the request if it appears that it may be meritorious. C. Relmbursement to County. Contractor shall bear the full cost of any consultants hired by County for the purpose of conducting rate reviews, and that cost shall be t¡eated as an allowable expense in the subsequent rate review. However, Contractor's cost shall not exceed $12,000.00 per rate review. 6.3 Perlod Rate.Revlews . ' A. Dlsclosure'of Records. When a rate review is initiated pursuant to Article 6.2, Contrac,tor shall provide any requested'business records and audited or,reviewed financial statements on an accrual basis to the County covering the period in question, said records and statements to be provided wfthin 90 days of the receipt of the written request. : i¡ ' B. Rate Revlew Guldellnes. The rate review process shall be guided and controlled by the "General Guidelines for Ambulance Rate Revierd' [hereafter '(Rate Review Guidelines") as established by County and amended from time to time by County as reasonably necessary to determÍne which expeRses shall be:allowable and whÍch expenses shall be disallowable for the performance of this contracL The County may disallow other expenses not identified in the Rate Review Guidelínes if it determines, in its discretion, that said expenses were not previously identified in prior rate reviews and are not reasonable necessary to the perforrnance of this contract. Furthermore, County may allow,certain expenses not identiñed in the Rate Review Guidelines if it determines, in its discretion, and based upon changed circumstancés substantiated . by Contractor, that said expenses are reasonably necessary to the performance ofthis contract, The CountSr shall not unreasonably modify the Rate Review Guidelines and shall discuss any,. modifications of the Rate Review Guidelines with Contractor. , t 6.4 Perlodlc Rate Revlews - Findlngs by the Coun[y. The County shall review the records and statements submitted by Contractor and veriff the accuracy thereof. An Ambulance Performance/Operations Comrnittee (APOC) meeting maybe,called if signifÌcant program or fiscal issues arise. The Count¡r may require submission of confirming and/or follow-up documentation. Said confirming and/or follow-up documentation shall be submitted to County within 15 days of Page 14 of20 c4-19 flft nc H r\ l+r ( -ll,t-+-t ?stT 4_ the request, At the conclusion of its review, the County shall ascertain the value of the following terms, which shall have the meaning set forth below: A. Allowable Annual Expense. The total of expenses that were verifìed and that the County found were reasonably necessary to the performance of the contract. B. Effectlve Annual Prôflt. The amount of profÌt found by the County, including any items that Contractor reported as expenses but were disallowed by the County pursuant to the preceding subparagraph. C. Effectlve Proflt Margln. The Effective Annual Profit divided bythe Estimated Net Revenue, expressed as a percentage, 6.5 Perlodlc Rate Revlews - Settlng Fuhrre Maximum Rates. The County shall allow Contractor a reasonable rate ofreturn and County agrees to consider all rate review applicatfons in a timely manner. The County shall use the information developed in the rate review to predict the Effective ProfÌt Margin over the next 12 months (hereafter the "Predicted Fuh¡re Effective Profit Margin"). The prediction shall be made by assuming that rates are unchanged'and estimatfng the Effective Profit Margin over the next 12 months, considering (1) the rate review data which shall be used as a baseline, (2) general hÍstorical trends that are likelyto affect revenue and expense, and (3) specific, one-time factors that ari likely to cause atypical changes in revenue and,expense. The Predfcted Future Effectlve Proflt Margln shall be deemed to be reasonable lf lt falls withln the range between 5%o and 7o¡s,which shall be referred to as the "Target Frofit Range." A. Predlcted Future Effective Profit Margln Wthln Target Proflt Range. tf the Predicted Future Effeqtive Proflt Margin falls within the Target Profit Ranþe, no change in future maximum rates shall be made as a result of the rate review unless profits fell below 5o/o or exceeded 7o/o in the prior fiscal year; This is subject to Sectlonr6,5C. '8. Predlcted Fuhrre Effectlve Profit Mar$n Outslde the Target Proflt Range. If the Predicted Future Effective Profit MargÍn is outside (above orbelow).the Target ProfÌt Range, tïe future maximum rates shall be adjusted (upward or downward) by amounts sufficient to bríng the Predicted E'utute Effoctive Profit.Margin within the Target Profit Range for the fuhrre. If the Target Profit Range exceeds 7o/o¡ either due to the CPtr increase or sorne other factor or if the Target Proñt Range is,below So/o,lhe fttrure.maximum rates will be adiusted so that the Predlcted Future Effective Profit Margin will be 67o. This is subject to Section 6;5C. C. Adfustment for Proñts Outslde the Target ProfitRange. Should Contractor's profÌts earned fall belowthe 5olo minlmum, the rates shall be adjusted above theTVo maximum until the Contractor's "loss," the difference between ach¡al proffts and the 50t6, is recovered. Gonversely, Page 15 of20 c4-20 hlla,<t{ rvr¿*l , vFI+ tØ tT ,!_ Contractor shall "pay down" profits earned in excess of the 7o/omaximum allowed by havingthe rates adjusted low enough, below the 5% minimum, until such time as excess profits are fully "paid down." D. Implementation of Maximum Rates Followlng a Rate Revlew. At the conclusion of a rate review,'if the County determines that the maximum rates should be adjusted, the Contract Manager shall provide written notifÌcation to the Contractor of the revised rates. No further action by any party is necessary to implement said rates. 6.6 Bllltng and Collectlons. The Contractor shall operate a billing and accounts receivable system that is well documented, easy to audft, and which minimizes the effort required of patients to recover payment from third party sources for which they may be eligible. The Contractor shall make no attempts to collect its fees at the time of service, AR,TICLE 7. TERM AND TERMINATION 7.1 Inltlal Term. Unless terminated b¡r either party pursuant to the provisions of this agreement¡ this agreement shall remain in effect for the time pêriod (hereafter the "lnitial Term") beginning on the Effective Date and endÍng on fune 30,20L6. 7.2 Automatlc Extenslon of Term. The agreement shall remain in effectuntil June 30, 2016, and maythereefterbe extended for an additional term, not to exceed 24 months, by mutual written agreement of both parties. Said mutual agreement'must be reached prior to June 30, 2016. Prior to the expiration of the contract, County shall begin evaluating its options with regard to the extension f this contract and, thereafter,,shall commence discussions with Contractor regarding those options. 7,3 Termlnatlon by the County for Cause¡ County shall have the right to terminate thls agreement or to pursue any approprlate legal remedy in the event the Contractor materially breaches this agreernent and fails to correct such default within thirty (30) da¡rs following the service of a u¡ritten notice by the County specif¡ring the default(s) and the e.ffective date of intended termination of this agreement absent cure. Gonditions and circumstances whfch shall constitute a material breach by the Contractor shall include but are not llmited to the following: A, Failure of the Contractor to operate the ambulance seryice system in a manner that enables the County and the Contractor to remain in substantial ôompliance wlth the requirements of the applicable,Federal, State, and County [aws, rules, and regulations. Minor violatlons of such requirements shall not constih¡te a material breach except serious, willful ahd/or repeated violations shall constiftte a material breach; Page 76 of20 c4-21 krrAc it /vlE ñ-i- Éxrkr BrT -l- B. Falsification of data supplied to the County includlngbyway of example but not by way of exclusion, dispatch data, patient report dat4 response time data, financial data, or falsification of any other data required under this agreemen$ C. Failure to maintain equipment in accordance with good maintenance practices; D. Deliberate and unauthorized scaling down of operations to the detriment of performance; E. Attempts by the Contractorto intimidate or otherwise punish employees who deslre to sign contingent employment agreements with competing bidders durÍng a subsequent bid cycle; F, Attempts by the Contractor to intimidate or punish employees who participate in protected concertèd activities, or who form or join any professional associations; G. Chronic and persistent failure of the.Contractor's emþloyees.to conduct . themselves in a professÍonal and courteous manner, or to present a professional appearance; H. Failure to complywith approved rate setting, billing, and collection procedures; L Repeated failures to meet response time requirements after recelving notice of non-compliance fromthe Contract Manager; - J. Fallure of the Contractor to provlde and malntaln the requlred lnsurance and performance security bond; K. Failure of Contractor to provide patient care at a level and quality that meets establÍshed standards. wrrHREspå#lcJå"'î"''ilHåiH'ä',å',Til3'it'Ïffi RsERVrcEs 8.1 Asslgnmênt. The County hereby assigns to the Contractor Íts right to directl¡r bill persons for County-provided first response emergency medical services. First response emergency medical services provided by the County may include,'but are not limited,to, providing initial stabilization and trained on-scene assistancerand assistance en route to medical facilíties as required,, and extrication and rescue seryices. 8.2 Payment for Asslgnment. In consideration of the assignment set forth in paragraph 8.1 above, the Contractor shall pay to the Countya "first responder support" pa¡nnent in accordance with Article 4 above. ARTICLE 9, MISCELLANEOUS Poge 17 of20 c4-22 ll-rT4 ci+ l.,\Éfu{-Ext*tßtT 4- 9.1 Independent Contractor. The parties acknowledge and agree that the Contractor is an independent contractor ofthe County and that nothing herein shall be construed as creating any other type of relationship between the County and the Contractor. 9.2 Insurance. During the entire term of this Contract and any extension or modification thereofi, the Contractor shall keep in effect insurance policies meeting the following insurance requirements unless otherwise expressed in the Special Conditions: A. tiability Insurance. The Contractor shall proVide comprehensive liability insurance, including coverage for owned and non-owned automobiles, with minimum combined single limit coverage of $1,000,000 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 ofuse thereofi, arising from each occurrence, Such insurance shall be endorsed to include the County and its officers andernployees as additional insureds as.to all services performed by the Contractor under this agreement. Said policios shall constihrte 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 poliry or policies, B. Workers' Compensatlon. The Contractor shall provide and maintain throughout the term of this agreement workers' compensation insurance coverage for its employees. C. Certlflcate of Insurance. The Contractor shall provide the County with certlficate(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 or policies, or acquire either a new insurance policy or policies or amend the coverage afforded through an endgrsement to the policy at any time during the term of this Contract, then the Contractor shall provide current certificate(s) ofinsurance. D. Addltional Insurance Provlslons. The insurance policies provided by,the Contractor shall include a provision for thirty (30) days written notiee to the County before cancellatlon or material changes of the above specified coverage, Further,said policy or pollcies shall be from insurance companies admitted bythe California Department of Insurance to do business ln the State of California. 9.3 Indemniñcatlon. The Contractor shall defen{ indemniff, save, and hold harmless the County and lts ofhcers and employees from any and all claims, costs and liability for any damages, sicknesq death, or injury to person(s) or properQr, includÍng wÍthout lÍmitation all consequential Poge 78 of20 c4-23 damages, from any cause whatsoever arising, directly or indirectly from or connected with the operations or services of the Contractor or its agents, servants, employees or subcontradors hereunder; save and except claims or litigation arising through the sole negligence or sole willful misconduct of the County or its officers or employees. The Contractor shall reimburse the County for any expenditures, including reasonable attorneys' fees that the County may make by reason of the matters that are the subject of this indemnification. 9.4 Modlficatlons and Amendments. A. General Amendments. Thls contract may only be modified or amended by a written document executed by the Contractor and the San Luis Obispo County Board of Supervisors or, after Board approval, by its desig4ee, subject to any required State or Federal approval. B. Admlnlstratlve Amendrnents. To the extent required by changes in applicable State or Federal laws or regulations, this agreement shall be automatically deemed amended to conform. 9.5 Entire Agreement. This Contract contains all the terms and conditions agreed upon by the parties. Except as expressly provided hereÍn, no other understanding, oral or otherwise, regarding the subiect matter of this Contract shall be deemed to exist or to bind any of the parties hereto. 9.6 Notlces. Any notice required to be given pursuant to the terms and provisions hereof shall be in writing and shall be sent by certifìed or registered mail to the parties at the following addresses, as may be amended from time to time: To the Contrador: Frank Kelton, President and CEO San Luis Ambulance Service, Inc. 3546 South Higuera Street San Luis Obispo, CA 93401 Wlth a copyto: P. Terence Schubert, Esq. Attorney at Law 1254 Marsh Street San Luis Obispo, CA 9340L Ê1f. ¿HIAEÑT P) ¿+ I BtT 1- To the County: Health Agency Director County of San Luis Obispo P,O. Box 1489 San Luis Obispo, CA 93406 Pgga 19 of20 c4-24 IN WITNESS WHEREOF, the pafties have executed this Agieement aç of the date first set forth above SAN LUIS AMBULANCE SERVICE, INC. A Calffornia Corporatlon Frank Kelton President and CEO ATTEST: (Signaure) Name and Tltle o[Person Attesting for San Luis Ambulance SeMce, Inc. COUNTY OF SAN LUIS OBISPO ADAM HILL Chalr of the Board of Supervlsors AuthorÍzed by Board Actlon on: Vns.u 24.2ôtl APPROVED AS TO FORM AND LEGAL EFFECT WARREN R JENSEN coIrNTY couNsEI. Dated ATTEST: JULIE RODEWALD, County Cierk and Ex-Officio Clerk ofthe Board of Suþèrvtsors 4 Mahc t{ rrrÉNT ËÊtttBr T J- r/'Y¡â¡J ,â ;l^llDatod: J Pøse 20 of20 c4-25 EXHIBIT A: EMERGENCY RESPONSE AREAS oF SAN IUIS OBISPO COUNTY EXHIBIT B: DEPLOYMENT PUTN EXHIBIT C: FIRST RESPONDER FEES EXHIBIT D: SAN LUIS AMBUTANCE SERVICE,INC. SERVICE RATES M-rftLilivrBru¡ ÊX r-h ßtr A- c4-26 ATr4c F{ ¡^ E N'T t)<* tl3 t"f !*1 ' E}üTIBTT Á É1]\{ERG'!}NCÏ [r8.sFûNß'ß ÅRßAS OF SAN l..I;il8'OBISPO CjOtÍFIr-rY ztr¡\ìË oEscruPTroNs; :fhe foltowínÈ.zone tloruiptions cgincide withthe Rüaqhed rpaps thar delineuln'thç zont boundados. NOF-T.E CO,'t.9f lftN$-(Cambrfu; Saa üÍncon, Itoû.rsf Cr*tIê¡ ll*rmonfr Rcgged Foi¡t, Rucüy Bottn.Arerr) Õpnçmlly dcrcdbed astb¿No¡tùn'efl,Coastatr pordonof,S¡ur Lrds übispo Countythetiüisþdes all oÊthc Cn$tüia HeûlthCånÌ Þi,sttict pltu aditÍonal arcasfhat arc bcst scrvicud frørl the cn¿stside ârêf, åDd hfls thÈ foll.owùng genwal bou¡idnries: Wmc Facific Oa*a,û ftom Montervy ilbunty lÍÍre soutti to vill* Croelc N+rtfu,Mirurcrsry Cowrly änE tom tho P¡oilÌc Ocoan to Roeþ Butæ Truck Trail E¡ot: Coast*l Ridge.ftom Moutcrcy Cuunty line,ncar RodS, ButtE'I'rwk'frflil. ùru. gû thÌollgh ftoc*y Erfrc Ìç.poãtår sitc to tha td Érsêk/$aeh. Rona Cæs.lÊ :Rþsds (rtl. Sarta Rosa ()rcck Road sddrGÐssÐ mçincl@tin th'Norfh tx"^*r¡t ãqnô). flouth: .Fron:Hfgùwry 46 S¡*s¿ û$d Old *rnçkl$asle.Ro*+Çrwk ¡osd.r irrmmcdorr, .soufiruest*rly ffi the F*tüc of \¡lllb.Gle* npåd &ll Old Crcok Road atd Viüe CllÈsokRoûd ûo Csûbq1Ëo¡¡o). NORIXI ZON$- (Fr¡o Boål+*r:stn ùügr¡ç1, lenopleúr& Aúayedorc¡ Shnudo¡¡, Crqtuu, Snutn ìilrrgnr.itËrl¡ukc Nnclryletto' trd tarrim flffnc,rÌü¡r) ' i Genert'Hy dèsqribed ¿s t[p *t&ri]rCo'urly¿'potlionof $irn tr¡is CI.biËeo County- I¡rludi$g tltc pprthsûsrÉr.n ørd saste{flFsñnffus of ,tÌ¡e rot¡¡rty taud otrmruunities s,f'Oak Slioiès¡ lled.ta¡¡cËancb, l-aks Nusirnieffo. Adståide;:Sau Miguel,' Paso tlobten, T'ùmplero,lr, At¿cc.ddcrro, Gædon Fants, $ant¡ lb.daÍgåtit*, ßozþ, Ciestcn, PÈrlùill, \ryhit¡ry Gffdens, Shandono Loi¡iss Blàins Nation¡l MoaumorrÇ and'Cafi'fornia Valtc¡r. Tt$ Nortt?ør¡e hos t}te follov¡i¡rg gçonttl bfl¡d+rieq: NORltr[ ?âNß(Êþndaued) ' Exttibrt .4, Pagc t of 4 c4-27 tttrA< t'\lirtøf\r f ËÉrtrg tT 4- TUçstl M¿tn coqaul ridsc bount!:yy (easlern bowdruy of the Ngrtl¡ Coast Zone) frosr thp MonfcrËy (bunry liqc south$astsrly through RûcEv ButfËrçpËatÊr site. to llþhw*y 46 W.qçt ¡¡lrd Sauta Rosn Ç,¡oekl()ld Crcek Rpnd interscçtioar trú Uiglrrva¡, 4l W:ecf ncar Cemo Alto }ìoad, ro ÈIighway l0l jlut nor{b of Cucsta $ummit (.cxcludes alt of WestCqosta Ridæ Road and T¡ssåjqre Cæct'Road). Nc¡thr fulbntarcy Cotmt¡r:Lioe aast ofRocky tIt¡tts Rosd to Kom tounry linc. Eartr Kom Counly Linp noÉtr otl{lghway lúó to Krugs (þunb Ìinp. $sotù; An osørsion of. the $¡sstet{r boundsry sour.b+a*terly torn lllghway I ül juat nørh of Cuesta, $ummíf; ùenr Ío Ìtri Mountain,Pcnk theu gerremlly souùeâst ûrough Cstldæ.F6ûh snd to tlË Kerrl Couuty lùrc Ju.st north of Highwty I 66. Cü¡ffftÂI" ËflNË - (C*ytrcos, Mor:ro Dsf, Ouøf¿ Cotrlqgq Lus Oeoq 8rn'Lulr Oblspo, [rl foly, Avllr üs{cb, nortås¡T ¡ro¡Ûiqr,of Ddn¡ Vnlley'arc*r} Gctnrollydeoorlbod a¡ tho'*CøñrtlÏ! o¡ "Mid-Corrntyñpsitiorr ofSes tr uis'Obitpo Cotrry. locluding thcaffns,,and ooürùulrldcs of Ca;rucos, lrlÍurrrHay,I¡ÊOrcs, Montanâ,dc Oro$øfo F¿th G¡csta Cçllcgq Ga,l.POly $t¡¡tc Uuiv¡*sÍty. .$go Luis Öb'i¡go, Ar'ilaßoeah, P.ûrt Sun.LUi¡ Öbis¡xt, Ditblo Cdny.oa; urd lhe portion of thc Élna Vallry:area irorth of Price Canyon aärl TÍffaty Rrrßh Itmd): 'lhc Conlrsl Z-atwhas the fullowinggcncral boundarie.e: l,Vsrt PqÊifrs t¡tsgn frsry¡ !'ill¿ CilÈêk ¡orqh tö Pí¡s¡c'&Cqv*'(ius:tnorth crf Sbell Bcasb). Nortbr S&årGd tnund¡ry witb dþ Norrh çfoart.Zoñs þorr the Paclfie Oaûunjust ¡lor.h ol¡Vitlg Crcok Houd thør {Þrttrhåsterþ to the ìntereoctiou uf HigÀu/åy 4ú WrÈst and SsffB }.ösaiüld ChFËk Rnad.r. 'ßert¡' thttlÖd botndar¡ vrlifb the.Nfiù Zomu âom intersçetipucffligù,${r46 Wcs,qd$m*a nptÈ/Old Cr.cclt Roadq ,\l/eat¡r l0l' ju${Ërú,of ÇucsÌs Cumtq Rrmd). iffitrHffiffiÏfr:itfitþw¡f ?27sfld fhic{e Csnyon Ë,oaù rhen:emtjust noffhof Örcutf ßoad urd Tf,ffaayRunrn Roa* úennoriüöåst tû Hi Mountain Puaft arcnsnd:thp soutilern buq¡dagy çfthE No¡ül ãoue Exhibit li, PaüÞ ? of 4 c4-28 Ên-R¿ r1 MEñT SOIIIE UOffE, - (Shell Bericlr, .Pi.tmo Beå.c-h. 0¡over B€ocÞ, A.rr.oy0:Gäarrdu. Ûcc¡no, , Ntp'nrootlrøpe.n l¡ke, and C'uyama,*rnss) Geoûr'ally deecr¡bd as the'Sou'$¡ Caurrty" of .San lruis Obirpo Countf . tncluding rlre ø¡cas eid conrrnu[itíeÊ of Shell Beaëb, Pism¡o Bôach, On¡vcr Bench, ûoÈouo,.Arroyo Orande, Nipomo, CorbettCsÐynn. southcm portion cf Ednn V'¿trley, l{uaqrra- t¡+øl Lakc¿nd tånyorl. orccàÉo Dur¡es OH\f areû, *nd frltpocrion of Çu1'ama ùl Sg$ Luts -í-)bispo Courrty. The..\qulhZûuç hac *e tollr¡ving gcneral, bound¡ties: 'ltc¡f: Pacifi¡c, Oocan f.mrn $hcll Beach south tû thc Salrta,Il,srbärü Cr¡rmfy liaç ñortå' St¡ared bouadary 'flitb thÊ CçDtnå¡ Zone f¡o¡¡r the Pacific ûce¡n north of $lnll ßçssL thcn,eastc¡ly düough ûrqgg.escyor (.betwecnShcU Bs¿chand Squirc Canyun), tö*i0 intcr.srion of l{ig[rrnuy ?l27 àldPûce Ç*rryøn Fnsd" tl*euøstjr* north of,O¡crttt.Roø.t arrd Ttffi¡tl ÊFüçh.Roãd, thcnnonft-r¿¡r taltr Morr¡ttaÍnFÈËk s¡çå¡rr¡d tbs.souú)ffr¡ borr¡darycf tlte NortÌi.Zoue. Eortr Shûo¡t boundary wÍhrhellonh 7;r¡nø,frø¡n HI ildwu¡tt¿in Fe* a¡ea,ûøt gcmerrlly southcøc tbro¡*ù: Calie+tc Pøk ård to lhe lfurrr Coung lino jurt *orth of fdigtrs¡ay I ó6 (ånclwlitg all,of ttþhway Í6ó uöd thurgurtiorl ofthc Crrjamr¡rea in Sg!¡ L,ui* Ohispo.'Cttmty), $or¡th: T:he fi$rra Barùara Çoqffi$:l[uc ûorn the Fadfiç üepan æ Kerrr üo,unty ]ine Exftibit A, Pagc 3 af'* c4-29 A' n þ u l a n c ç En r w g e n c y Re s p o n s o Ar s a s of sç ¿ Lr ¿ í s Ðb Ì a p ea u n t y t. ì f .b #E s + S ",.trtÊfl. - û 10 -- ¡ . 1 ¡ h rf i i ¡ ¡ & Ta r c a d r r Þ .: . 't I l r F r i ú l R p l l | ff i r L l @ l t D F ù l ¿ tþ r f r C û f * ã r t Ca r f f i Z s r ;_ _ i n u t r a n '' - - - - fü g l i l ¡ q r r tl ì r Ê :& ü ¡ l z n û . F CT Þ Ësoàòìi r rÀ (ri f,>r¡ìÃ{Wo 1rt Þ n-i ¿d os I(¡ )O ) ftrrq< H rvi E,NIT- Êtr+Btr- 4 Exhlbit "B" DEPLOYMENT PLAN The general goal of the Deployment Plan is to provide an Advanced Life Support (ALSJ Unit, either by Contractor or by an ALS fire service agency, to at least 90% of all potentially life threatening emergency ambulance requests originating within each Emergency Response Area wÍth a maximum response time of 10 minutes in areas designated urban, and with a maximum response time of 30 minutes in areas designated as rural, andwith a maximum response time of 60 minutes in areas desÍgnated as remote. The terms urban, rural, and remote are defined bythe California State Emergency Medlcal Services Authority as follows: Urban: All census places with a population of 2,500 to 500,000 and a population density of 100 to 999 persons per square mile; or census tracts and enumeration distrÍcts with census tracts which .-have'apop,ulationdensity.of 100ts999-persons-persquare.m,ilei- --.,. '..- -.. -- i-- Rural: All census places with a population of less thah 2,500 and population density of 10 to 99 persons per square mile; or census tracts or enumeration districts without census tracts which have a populatfon density of 10 to 99 persons per scuare mile. Remote: Census tracts or enumeration districts without census tracts which have a population density of 5 to 9 persons per square mile. If the State EMS Authority's defìnition of urbaû rural, and remote is accepted locally, the cities and unincorporated areas of San Luis Obispo Countywould be rated as follows based on California State Department of Finance and San LuÍs Obispo County Planning Department fìgures: Urhan Areas City of Arroyo Grande Çity of Atascadero Cityof Grover Beach City of Morro Bay City of Paso Robles CityofPismo Beach City of San Luis Obispo Cambria Cal Poly Cayucos Ba¡rwood Park/Los Osos Nipomo Oceano Templeton County CIub (SLO) Rural Areas Adelaida Avila Beach Creston Garden Farms San Simeon Whitley Gardens Santa Margarita San Miguel Remote Areas California Valley/ Simmler Cholame La Panza Pozo * Oak Shores * Shandon * Heritage Ranch r Shandon, Herltage Ranch and Oak Shores would normally be tn the rural category but are moved to the remote category due to their slze, llmited number of EMS responses and location with the county. c4-31 fìfiA Lt+ ¡^ Er{î EF*' øir L- Exhlbit "B" (cont) SPEÇIFIC RESOURCE REQUIREMENTS 1. Central Zone *3.3 ambulance units per day r2 public transport units for back-up/overload response (SLO City, Morro Bay) rCurrent station locations acceptable - (Morro Bay & San Luis Obíspo) 2 North Zone 13 a'mbulance units per day (half time unit allowed to float at Twin CÍties Community Hospital rMove-up capability from cent¡al zone lCurrent station locations acceptable (Paso Robles and Atascadero) 3. South Zone +3 ambulance units per day rCurrent.station locations acceptahle (Arroyo Grande & Nipomo) Contractor shall at all times rna.intaiRand.operate-one (1) for¡rwheel-drive ambulanee unit.ThÍs special requirement shall not increase the coverage requirement set forth above for the South Zone as 3 ambulançe units pe¡ day. . c4-32 Èrrnc*wtu¡¡rBlHrErf'L Exhlblt "C" FIRST RESPONDER PAYMENTS FISCAL YEAR 2010.11 First responder payments will be made no later than the end of the 2nd month followingthe end of the quarter for which the payment accrued. NORTH ZONE QUARTERTY City of Atascadero City of Paso Robles San Miguel Fire Dlstrict County of San Luis Obispo Templeton Community Servlce Dist. Santa Margarita Fire Total North Zone CENTRAI ZONE Avila Beach Co. Water District Cayucos Fire Prevention District City of Morro Bay City of San Luis Obispo County of San Luis Oblspo County Service Area 9, Zone B fSouth Bay Fire) Total Central Zone SOUTH ZONE Five Cities Fire Authority City of Pismo Beach County of San Luis Obispo Total South Zone TOTAT Att ZONES $62,854.80 $25,650.28 sLg,965,64 $1,016.79 $L3,2L7.99 $2,079.75 $924.3s ANNUAT (7-1-10 Thru 6-30-11) sL02,60L.L2 $79,862.56 $4,067,L6 s52,87t.96 $8,319.00 $3,697.40 19.20 s3,5t2.48 s5,L76.24 $79,862.56 $159,725.00 $28,839.32 $62,669,84 $878.L2 $L,294.06 9L9,965.64 $39,93t.25 $7,209,83 sL5,667.46 $84,946.36 $33e;785.44 $5,037.65 $1,894.89 $22,368,90 $20,150.60 $7,579.56 $89,475.60 $29,?O!.44 Stti,zos,j6 $708,410.40ç177,LO2.60 c4-33 Exhlblt "D" SAN LU¡SAMBULANCE SERVICE.INC. SERVICE RATES A'TT,\¿t{fy\lNr ÉKktß\r â Service Advanced Life Support Base Rate Critical Care Transport Base Rate Ancillary Co.ghi ALS Transport Mileage (per mile) Oxygen Disposable/Supplies Stand-by (per hour) Rate ($) t,947.66 2,466.33 664.O0 18.07 69.79 17.47 139.74 c4-34