HomeMy WebLinkAbout2006 CON American Medical Response - Life Support SystemAGREEMENT BY AND BETWEEN THE CITY OF
NATIONAL CITY AND AMERICAN MEDICAL
RESPONSE AMBULANCE SERVICE, INC.
This agreement is entered into this 1st day of July 1, 2006 by and between the City of National
City (CA), a municipal CITY ("CITY") and American Medical Response Ambulance Service,
Inc. ("AMR")
1. RECITALS
A. The CITY, is a municipal corporation operating under general law of the State of
California.
B. The County of San Diego has contracted with CITY to administer the provision of
paramedic ambulance services for the geographic area that is within the corporate boundaries of
CITY and the Lower Sweetwater Fire Protection District.
C. After a competitive selection process, CITY has selected AMR to provide exclusive
ALS transport services within the exclusive operating area administered by CITY. AMR is an
experienced and qualified provider of ALS transport services and is willing to enter into a
performance based agreement with the CITY to provide such services within the exclusive
operating area. It is not the intent of the parties to create, by this recital, any contractual rights of
the above referenced entities that do not otherwise exist in law.
IT IS, THEREFORE, AGREED BETWEEN THE CITY AND AMR AS FOLLOWS:
D. Administration. The CITY designates the City Manager of the City of National City,
or his/her designated representative, to administer this agreement on behalf of the CITY. AMR
designates the CEO of AMR; West Region or his/her designated representative to administer
this agreement on behalf of AMR. All reports, proposal, letters, notices and/or other
correspondence shall be sent to the attention of the designated representatives at their respective
addresses.
E. Service Area. The service area shall be the exclusive operating area defined by the
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
1.
corporate boundaries of the City of National City and Lower Sweetwater Fire Protection District,
hereinafter referred to as "CONTRACT SERVICE AREA," and may be modified as these
corporate boundaries change and exist from time to time. This Agreement does not prohibit
AMR from serving territory outside of these boundaries. AMR shall advise the CITY of the
locations where AMR ALS ambulances that service areas adjacent to the CONTRACT
SERVICE AREA are based, and shall advise the CITY of any changes in such service areas or
base locations
F. Term: This agreement shall begin July 1, 2006 and be in full force and effect through
June 30, 2011, unless either party invokes Section IV number 3, :Termination" or it is extended
through the provisions of extension clauses (Section IV number 4).
II. RESPONSIBILITIES OF THE PARTIES
A. Responsibilities of AMR. In furtherance of this agreement, AMR shall:
Provide and maintain, at no cost to CITY, a minimum of two (2) fully equipped,
supplied and staffed advanced life support (ALS) type I or II Ambulances available for
providing paramedic services seven (7) days a week, twenty-four (24) hours per day on a
year round basis. These units shall have as their principle station a location within the City
of National City, or other mutually agreeable location. AMR shall notify CITY of the
locations where each Advanced Life Support Unit is principally posted and shall seek
advice from CITY if a change of such location is determined necessary. Each ALS
Ambulance shall be staffed at a level consistent with County of San Diego protocols and/or
requirements. For purposes of this agreement, Paramedics shall be individuals licensed by
the State of California according to Title 22, CCR Division 9, Chapter 4 and accredited to
practice as a paramedic by San Diego County.
2. Ensure all ALS ambulances be supplied and equipped in accordance with the standards
promulgated by the County of San Diego.
3. Provide and maintain one mobile radio per ALS unit with status transmission
capability, and one portable radio per ALS unit compatible with first responder fire
agencies within the Contract Service Area.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
4. Provide to the CITY copies of all written complaints received by AMR concerning
ALS ambulance service within the contract area, within seven (7) days of receipt. The
CITY will provide AMR with copies of all written complaints concerning the ALS
ambulance service received by the CITY. AMR will prepare and, where appropriate,
submit all reports required of paramedic provider agencies by the County of San Diego in
connection with the ALS ambulance service, and AMR shall collect and maintain any other
information or data required by the County.
5. Comply with all applicable governmental regulations and requirements in connection
with the operation of each ALS ambulance, including the San Diego County Ambulance
Ordinance and applicable Division of EMS policies and protocols.
6. Provide suitable facilities for stationing and maintaining each ALS ambulance in fully
operational condition; develop mutual aid and/or call-up plans to provide ALS ambulance
service in the area in the event the assigned ALS ambulances are not operable or are away
from the area for other reasons. AMR agrees to work collaboratively with CITY in an
effort to identify and implement opportunities to house ambulance units in City Fire Station
Facilities for mutually agreed upon, market based rent or lease rates.
7. Maintain a comprehensive Advanced Life Support (ALS) Quality Assurance and
Quality Improvement Program (QA/QI) designed to act proactively to improve the quality
and efficiency of services in addition to identifying potential or existing clinical,
operational, or equipment problems. This program shall utilize Six Sigma and Statistical
Process Control techniques to identify, in a format that is mutually agreeable to the parties,
improvement opportunities, trends, root causes and process variability. The focus of this
program shall be to both ensure that the minimum standards and requirements of this
contract are maintained and that the overall system and processes improve over time where
reasonably possible.
8. Make available, and allow access, to First Responders employed by City, AMR's
Continuing Education programs. Such training shall not result in any additional cost to
AMR including, but not limited to, costs of educational materials, licensing fees,
certification fees, employee compensation or other governmental fees.
9. AMR field supervisory staff shall be trained at ICS 300 level within 12 months of
implementation of this agreement.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
10. Include, or cause to be included, a mutually agreeable presentation of CITY name
and/or logo on the two primary ALS units primarily stationed in the City.
11.
As specifically requested by City in its Request for Proposals, pay City a Franchise Fee
on a monthly basis. The amount of such fee is determined solely at the discretion of CITY.
City represents, herein, that the purpose, need and necessity of such fee is to offset CITY
costs for activities associated with providing and maintaining programs associated with
emergency medical services care at an ALS-level and oversight of the ambulance
contract:. Such costs are further defined, solely by CITY, based upon the criteria as set
forth below:
a)
b)
c)
d)
Contract compliance (monitoring and enforcement)
Medical Director services
Support of the National City Fire Department's Paramedic Program, to
include equipment, supplies, training and salary differentials. As this
program is formally implemented, it may enable AMR to utilize less
stringent response time standards
Franchise Fee payments shall be made in the following amounts by the
loth of each calendar month during the term of this contract. CITY
represents that these amounts reflect anticipated phased implementation of
the NCFD Paramedic Program. Payments will not be made by AMR
unless and until CITY certifies that actual liabilities for these costs
reasonably exist at the time of payment. Such certification shall be made
no later than February 28 of each year of this contract.
• Year 1 (July 1, 2006 - June 30, 2007)
annual fee of $172,837.00
• Year 2 (July 1, 2007 - June 30, 2008)
annual fee of $165,806.00
• Year 3 (July1, 2008 - June30, 2009) -
annual fee of $199,992.00
• Year 4 (July1, 2009 - June 30, 2010)
annual fee of $244,255.00
- $14,403 per month for a total
- $13,817 per month for a total
$16,666 per month for a total
- $20,355 per month for a total
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
• Year 5 (July 1, 2010 - June 30, 2011) - $24,253 per month for a total
annual fee of $291,034.00
e) As specifically defined and requested by CITY in its Request for
Proposals, provide City with funding up to $6,000 per year during the term
of this contract, for uniforms, books and approved supplies for an Explorer
Scout program whose purpose is to enhance EMS services within CITY.
AMR will provide related training for the participants in this program.
Such training shall not exceed a commitment of more than 40 hours/year
for each year of the term of this contract.
f) As specifically defined and requested by CITY in its issued Request for
Proposals, provide support and assistance in the development of a Fire /
EMS Technology Program in conjunction with National City Fire
Department and Sweetwater High School. Provide funding of up to
$6,000 per year for uniforms, books and supplies, or to fund scholarships
for students to attend EMT training at Southwestern College.
g)
h)
As specifically defined and requested by CITY in it's issued Request for
Proposals, establish an "Equipment Fund" of up to $50,000/year, to be
funded annually by June 30th of each year of the term of this contract.
These funds will only be provided to CITY to the extent that appropriate
system costs, certified by CITY, are not met by other funding mechanisms
included in this contract, including but not limited to Franchise Fees
and/or Response Time Performance Penalties. Any monies remaining in
the Equipment Fund from one year to the next may be retained for use in
future years. Unless otherwise permitted under federal or state law, at the
expiration and/or termination of this Agreement all unspent Equipment
Funds shall be returned to AMR or at the election of National City,
donated to a qualified 501C3 Charity.
Provide and/or fund "Six -Sigma training to a "Yellow -Belt Certification
Level" for a maximum of 6 National City Fire Department Officers -
with at least two officers during the first 12 months of this contract and the
remaining 4 officers within the first 24 months of this contract.
i) Maintain CAAS accreditation for the San Diego Operating Division for
the term of this agreement.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
J)
k)
Implement an Electronic Patient Record System (ePCR) utilizing ROAM
I.T., ePCR software or other mutually agreed upon software solution for
ePCR purposes within 180 days of contract execution.
Provide CITY with licensed access to AMR's Virtual Solutions Manager
(VSM) platform within 30 days after implementation of this agreement.
This includes passwords for Web access only and does not obligate AMR
for any hardware or software implementation or support of this effort.
1) Make available to CITY, EMT recertification / Refresher Training for
National City Fire Department personnel twice annually during the term of
this agreement.
m) Provide to City a weekly Performance Report Card to the Contract
Compliance Officer or designee. This weekly report card will include the
following and be of a format mutually agreed upon by the parties:
n)
• System utilization and performance,
• Weekly response time performance summary,
• Response time and other performance data in the form of and
capability indices and statistical process control charts for variable
data by response zone (or other mutually agreeable aggregation to
meet reasonable statistical validity standards) and level of
response,
• Results of any investigation into presumed 'special cause'
variations in statistical process control chart data of response
times or other key clinical or operational processes
• Specific action planning to address any sub -standard response
performance.
Make available flu vaccine administration on an annual basis consistent
with the program administered for AMR employees during the term of this
Agreement. This program will be limited to "field staff' personnel
employed in the Fire Department.
o) Develop and implement a community education and outreach program
which will include:
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
(1)
Design, carry out and report on a quarterly basis the results of a
comprehensive public education program designed to meet the
specific needs of the citizens within the service area and carried
out, to the reasonable ability of AMR, in a coordinated fashion
with similar efforts of CITY. The programs should focus on child,
elderly and family health and safety issues and will include, but not
be limited to, infant/child injury prevention and rescue, proper use
of the 911 EMS system, and other programs related to widespread
health system access issues.
(2) Development of a resource guide in conjunction with National City
and other community stakeholders to educate the public about
where low-cost or free resources exist, encouraging and
empowering individuals to seek care proactively.
(3)
p)
q)
r)
s)
Assure availability of a School Bus Safety Program, designed by
AMR.
Re -supply ALS and BLS First Responder supplies, on a one for one basis,
all Medicare Allowable reimbursable supplies and equipment and
medicines, excluding controlled substances, used on joint incidents only to
the extent that AMR is able to bill for use of those supplies. Replacement
of specific supplies will occur on scene when possible.
Properly transport and dispose of all biological/medical waste generated
by CITY within the service area while rendering services pursuant to this
agreement.
Provide ambulance support to the Fire Departments operating within the
Contracted Service Area at major emergencies and multiple alarm fires.
Nothing in this section is deemed to require AMR to take units out -of -
service for this function unless a EMS patient situation develops on -scene
— in which case an incident will be generated and a unit will be assigned to
it. However, AMR will make reasonable efforts to provide such `stand-by'
support as requested.
Participate in disaster preparedness planning and training activities carried
out by the governmental agencies within the service area and the County
of San Diego.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
1.
B. RESPONSIBILITIES OF CITY: In furtherance of this agreement, City shall:
Allocate and expend funds paid by AMR in ways consistent with federal government
guidelines, law, rules, regulations and/or standing legal opinions offered by the Office of
Inspector General, Department of Health and Human Services.
2. Provide annual, or upon special request of AMR, written certification of costs and
allocation of funds provided City for Explorer Program support demonstrating consistency
of such costs and allocations with all applicable federal government guidelines, law, rules,
regulations and/or standing legal opinions of the Office of Inspection General, Department
of Health and Human Services.
3. Provide annual, or upon special request of AMR, written certification of costs and
allocation of funds related to the franchise fee paid by AMR demonstrating consistency of
such costs and allocations with all applicable federal government guidelines, law, rules,
regulations and/or standing legal opinions of the Office of Inspection General, Department
of Health and Human Services.
4. Provide annual, or upon special request of AMR, written certification of costs and
allocation of funds related to Equipment Fund payments made by AMR demonstrating
consistency of such costs and allocations with all applicable federal government guidelines,
law, rules, regulations and/or standing legal opinions of the Office of Inspection General,
Department of Health and Human Services.
5. Provide annual, or upon special request of AMR, written certification of costs and
allocation of funds related to the payments made by AMR in furtherance of the
development of a college Fire/EMS Technology Program made by AMR demonstrating
consistency of such costs and allocations with all applicable federal government guidelines,
law, rules, regulations and/or standing legal opinions of the Office of Inspection General,
Department of Health and Human Services..
6. Work in good faith in collaborating with AMR in aspects of this contract that require
mutual agreement in furtherance of the services defined in this agreement.
7. Provide for a process for review and hearing of timely appeals for response time
penalty assessments.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
8. Act in good faith in the implementation of ALS services consistent with the defined
Franchise Fee amounts.
Ill. INDEPENDENT AMR
A. In the performance of the work, duties and obligations devolving upon AMR under
this Agreement, it is mutually understood and agreed that AMR, acting by and through its
employees, is at all times acting and performing as an independent Contractor. CITY shall
neither have, nor exercise, any control or direction over the methods by which AMR shall
perform work services and functions except those expressly stated in this agreement. No
relationship of employer and employee is created by this Agreement, and AMR and its
employees shall have no claim under this Agreement or otherwise against the CITY for
employee benefits of any kind.
IV. FEE AND CHARGES FOR SERVICES ALLOWED
A. Fee Schedule. The CITY shall pay no fee or compensation of any kind to AMR
under this Agreement, nor shall the CITY reimburse AMR for any costs or expenses in
connection with this Agreement. AMR shall directly bill the individuals utilizing its services or
appropriate third -party insurance carriers.
B. Fees. AMR may charge the following fees for services rendered pursuant to this
Agreement:
1. Ambulance Services Base Rate: $ 1,028.60 per transport
2. Calls for service during which patient care meets the criteria of "ALS2" as defined in
the Medicare Ambulance Fee Schedule or successor versions thereof: $1,148.60
3. Charges. AMR may additionally charge for other related services, supplies and
equipment. These services, supplies and equipment and the maximum allowable charges,
subject to modification in paragraph 4 below, are identified in Exhibit "A" of this
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
document and made a part herein.
4. Modification: AMR may modify fees and charges allowed by this agreement
consistent with the following:
a)
b)
(1)
On June 30, 2007 and each year thereafter on June 30, through and
including June 30, 2011, AMR may, at it's sole and absolute discretion
increase fees and/or charges for services provided under this contract in
order to fully realize revenues sufficient to make up the projected annual
increase in Franchise Fees. AMR shall make available to CITY for
review, sufficient financial data including collection rates, to verify the
needed rate increases to offset increases in Franchise Fee charges. Such
financial data shall remain proprietary information of AMR and shall not
be reproduced or disclosed in any manner which will make such
information public record or accessible to public review without prior
consent of AMR.
On June 30, 2007, and each year thereafter, through and including June
30, 2011, AMR may, at its sole and absolute discretion, and if it has
complied with the provisions of Chapter VII, Section G "CRITERIA TO
BE CONSIDERED FOR EARNED CONTRACT EXTENSIONS AND
RATE INCREASES" in the ambulance service RFP (RFP# GS0506-6),
submit a request to National City to increase fees and charges for services
provided under this agreement by a percentage equal to the greater of the
following percentages:
The percentage change on a year-to-year basis, measured on
December 31 of each year of this agreement, of the "All Cities —
Medical Care Services" component of the Consumer Price Index
as published by the Bureau of Labor Statistics for the San Diego
area or the State of California (whichever is lowest), or comparable
successor data; or, b). The percentage change on a year-to-year
basis, measured on June 30 of each year of this agreement of the
median ALS Base Rate of the non -subsidized ALS Transport
systems identified in Exhibit `B" of this agreement and made a
part hereto. Should the jurisdictions change or the nature of the
systems change such that they are no longer representative of non -
subsidized ALS systems, the parties shall make reasonable efforts
at modifying the jurisdictions or agencies in Exhibit `B" such that
the intent of finding an approximate average of non -subsidized
ALS systems in California is maintained.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
(2) AMR shall be responsible for providing CITY with the relevant
data necessary for the implementation of the provisions of this
section.
V. OPERATIONAL AGREEMENT
A. Calculation of Emergency Response Times. Response times shall be calculated from
the time of verification of address until the time that the ambulance notifies the dispatcher of its
arrival at the scene of the incident, or such arrival is verified by technological means of vehicle
location, or until the ambulance is cancelled by the dispatcher. When an ALS unit fails to reach
the scene within the response time standard, it is considered a response time compliance
violation.
B. Response Time Standards. AMR shall comply with the following response time
standards (listed in Table 1) for all emergency ambulance responses within the service area
defined within this agreement subject to the exemptions listed in C.4 and D.4.
Table 1- Response Time Standards
Emergency Incident in District(s) with
ALS Engine Company Coverage
11 minutes, 59
seconds
90% of applicable
incidents or
greater
Emergency Incident in District(s) without
ALS Engine Company Coverage
9 minutes, 59
seconds
90% of applicable
incidents or
greater
Non -Emergency ALS Incident response
received through 911
19 minutes, 59
seconds
90% of applicable
incidents or
greater
C. Response Time Definitions and Change Requirements
1. District Definitions - With specific reference to Table 1 above, Districts are defined as
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
the geographic boundaries of the National City Fire Department "Battalion Designations"
of District 31 and District 34 as they exist on June 30, 2006. "Districts with ALS
Coverage" are those districts that CITY has identified and provided notice to AMR, of
having ALS/paramedic first responder level services available consistent with County
protocols and regulations. Such notice shall be provided to AMR at least 30 days prior to
any change in this status and response time standards will apply at the end of that 30 day
period. Inability of CITY to staff consistent with this notice shall not mandate a change in
response time standards until a 30-day period has passed from the receipt of written notice
by AMR.
2. "Emergency Responses" are defined as all calls received and dispatched by AMR
through the 911 system. At such time as CITY adopts priority dispatch protocols, the
parties will meet in good faith to determine definitions of "Emergency" and "Non -
Emergency" response categories relative to this section.
3. City Wide Response Time Compliance - In addition to the District response time
identified above, AMR shall maintain a city-wide response time compliance level of 90%
or greater to both "Emergency" and "Non -Emergency' Incidents.
4. Automatic Response Time Exemptions — Calculation of monthly response time
performance in relation to the standards defined in Table 1 above shall include all
emergency responses within the service area to which AMR is dispatched and which results
in an emergency response and a patient contact, except that the following calls shall be
exempted:
a)
In case of multiple ambulance responses to a single incident, only the
response time of the first arriving unit shall be counted in the compliance
computation.
b) Priority of call upgraded/downgraded during call. If a call is upgraded
during progress of a call, the response time shall be measured from the
point of notification of the ambulance that the call has been upgraded in
priority. If a call is downgraded during responses, the ambulance shall
have 15 minutes from point of the notification of downgrade to arrive on
scene.
c) Calls received during a declared local emergency, state of war or disaster.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
1.
d) Calls to a scene or scenes related to an activation of "Annex D" of the San
Diego County Multi -Hazard Disaster Plan.
D. Response Time Exemptions and Reports — AMR shall provide CITY with reports as
outlined below. All reports shall be submitted to the Contract Compliance Officer on or by the
loth day of each calendar month. Each report will be developed collaboratively between AMR
and Contract Compliance Officer within thirty (30) days of the execution of this agreement and
modified over time at the request of the Contract Compliance Officer
Response Time Exception Report shall be submitted to the Contract Compliance
Officer for all incidents over the response time performance standard in accordance with
Section V.A through V.0 above. The Contract Compliance Officer shall be responsible for
determining response time compliance and to which incidents will be granted an exemption
from the Response Time standard. Such determinations shall be based upon a reasonable
person standard.
2. An "Emergency Response Time Performance Report"
3. A "Non- Emergency Response Time Report"
4. CITY shall ensure that the Contract Compliance Officer shall provide a written
recommendation to AMR and CITY within seven (7) days of receipt of the Response Time
Exception Report. AMR may appeal the Contract Compliance Officer's recommendation
to the CITY Contract Compliance Committee. After review and consideration of
appropriate information and/or evidence in support of the appeal, the decision of the CITY
Contract Compliance Committee shall be provided to AMR in writing. The monthly
calculations of AMR's response time performance shall include every non -exempted
emergency request origination from within the district that results in an emergency
response (for emergency response time compliance rate calculation purposes) or a non -
emergency response (for non -emergency response time compliance calculation purposes).
The types of situations for which exceptions may be considered include:
a)
Canceled Responses Response canceled prior to the unit's arrival at scene
(except for excessive response times). These cases may be removed from
response time interval calculations.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
b)
c)
d)
e)
g)
Declared disaster - The Contractor may apply for an exception to response
time standards during times of declared "emergencies" as determined by
the Fire Chief or their designee.
Unusually severe weather - Responses during a period of unusually severe
weather conditions when such response time compliance is either
impossible or could only be achieved at a greater risk to EMS personnel
and the public than would result from a delayed response. The contractor
shall make such requests in advance of the coming weather event to the
Contract Compliance Officer.
Incorrect, inaccurate or incomplete dispatch information received from the
reporting party or other Public Safety dispatching agency.
Non-existent address.
Unavoidable delay caused by traffic congestion which is the direct result
of the incident to which the ambulance is responding and to which there is
no easily identifiable alternative route identified prior to the ambulance's
commitment to that route.
On incidents requiring crew "stand -back" for safety of ambulance
personnel, the on -scene time shall be recorded as the time the unit arrives
at an appropriate staging area.
h) Any other exception for "good cause" that CITY may, at CITY'S sole and
absolute discretion grant.
5. AMR may appeal the findings of the Contract Compliance Committee to the City
Attorney of CITY. City Attorney shall review the applicable facts, contract requirements
and relevant circumstances and the aspects of AMR's appeal. The City Attorney may
uphold, deny or modify the findings of the Contract Compliance Committee consistent with
the provisions of this Agreement. The decision of the City Attorney shall be final and
binding.
6. Use of Consultants by City - CITY may seek and utilize input and consultation from
any source it may deem appropriate to assist it in rendering a reasonable and prudent
determination of response time exemptions, except that any delays caused by such
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
consultation shall not result in a material detriment to AMR. CITY agrees that no
proprietary information including system status management plans, shall be divulged to
any entity or organization in, or likely to be in, competition with AMR.
7. Inclusion of Exempted Calls in Compliance Reports - Calls granted exempt status shall
be reported as a category within the compliance reports required herein and shall be
excluded from compliance calculations and their number shall be included in the total
population of calls received.
8. Monthly Compliance Reporting: AMR shall file a report of response time compliance
on a monthly basis. A report with the corrected; uncorrected response time compliance
data shall be submitted. Such uncorrected data shall be used for planning purposes only.
The monthly compliance reporting form and format will be developed by the CITY and
AMR within thirty (30) days of signing the contract agreement and modified over time at
the request of the Contract Compliance Officer
1.
E. Penalties Provisions for Performance Deficiencies:
Failure to Properly Equip and Supply Unit — AMR shall make reasonable efforts to
ensure that all units are supplied and equipped to standards defined by the County of San
Diego. In the event that, after investigation, CITY finds that either:
a)
b)
an ambulance controlled by AMR responded to an incident not equipped
and/or supplied to such standards, and the lack of equipment or supplies
impacted care to a patient or patients
proper equipment or supplies were discovered to be missing upon an
unannounced or scheduled inspection of an ambulance available for
service by the Contract Compliance Officer or their designee.
AMR shall be assessed a penalty of $500 for each call so responded to or for each
failed inspection.
2. Failure to Furnish Required Documentation — In the event AMR fails to furnish
normally prepared or readily available reports or data to CITY subject to request of CITY,
CITY shall provide notice to AMR giving reasonable time to deliver said data or reports.
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
Reasonable shall be mutually agreed to by the parties considering such variables as,
including but not limited to, AMR's access to data, degree of data segregation and/or
analysis, AMR's capabilities to produce and provide such data or reports and the relative
cost/benefit relationship of such request. In such event as AMR does not provide CITY
with such data or report in such mutually agreed upon time frame, CITY may impose a
penalty of fifty dollars ($50) per day for each day that requested data or report is not
provided to CITY. Such penalty shall not be applied in cases where the cause of the
reporting deficiency is beyond the reasonable control of AMR.
3. Preventable Mechanical Failure — In the event that an ambulance providing services
pursuant to this agreement experiences a preventable mechanical failure (vehicular
breakdown causing the vehicle to be no longer operable) while responding to a call and/or
while transporting a patient to the hospital, a penalty of $500 may be assessed.
4. Failure of Crew to Report On -Scene Time — For each incident that an ambulance crews
fails to report an on -scene time, and the on -scene time for that incident cannot be captured
by other electronic mechanism, CITY shall assess AMR a penalty of $500.
5. Emergency Response Time Compliance Fines for Response Districts - In the event that
the aggregated response time compliance rate for Emergency Responses in either Response
District, subject to exemptions based upon this agreement (Adjusted Compliance Rate),
falls below 90%, the following fines will be imposed on AMR:
• Adjusted Compliance Rate of 87.50% to 89.99% - $1,000 penalty
• Adjusted Compliance Rate of 85.00% to 87.49% - $2,000 penalty
• Adjusted Compliance Rate less that 85.00% - $3,000 penalty
6. Non -Emergency Response Time Compliance Fines for Response Districts - In the event
that the aggregated response time compliance rate for Non -Emergency Responses in either
Response District, subject to exemptions based upon this agreement (Adjusted Compliance
Rate), falls below 90%, the following fines will be imposed on AMR:
• Adjusted Compliance Rate of 87.50% to 89.99% - $1,000 penalty
• Adjusted Compliance Rate of 85.00% to 87.49% - $2,000 penalty
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NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
• Adjusted Compliance Rate less that 85.00% - $3,000 penalty
7. NATIONAL CITY will inform Contractor of all final decisions of the Contract
Compliance Officer (CCO) as to their final decisions regarding any performance failure for
which Contractor was responsible and shall invoice Contractor for any fines and penalties
assessed at the end of the monthly performance review meeting with the CCO. Contractor
shall pay NATIONAL CITY all fines within 45 days of receipt of the notification. A late
payment charge of five percent (5%) will be assessed monthly if no payment is received
after the 45th day of receipt of the notification.
8. The Contract Compliance Officer's decision may be appealed within 30 days of receipt
of final decision to the Contract Compliance Committee.
VI. ADMINISTRATIVE PROVISIONS
A. Modification. This Agreement may be modified at any time by the written consent of
the parties. This document, however, fully expresses all understandings of the parties concerning
the matters covered herein. No addition to or alteration of the terms of this Agreement and no
verbal understanding of the parties, their officers, agents of employees, shall be valid unless
made in the form of a written amendment of this Agreement, and duly approved and executed by
the parties' authorized representatives.
B. Title to property. Title to expendable and non -expendable property whose cost was
borne in whole by CITY shall remain vested in the CITY upon termination of this agreement.
Title to such property whose cost was borne in whole by AMR shall remain vested in AMR upon
termination of this agreement , with the exception of items purchased with franchise fees,
equipment fund, explorer post or school fund monies.
C. Assignability — Neither party shall assign this Agreement, or any interest therein,
without the prior written consent of the other party.
D. Termination: This agreement may be terminated by either Party at any time, without
cause, by mutual consent, subject to the following conditions:
Page 17
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
1. Party wishing termination must give written notice to the other Party of desire to
terminate; and,
2. Both parties must agree to attempt good faith negotiation to resolve any differences,
unless otherwise is agreed to by both parties; and,
3. The date of termination shall not be less than one hundred eighty (180) calendar days
from the end of negotiations, unless otherwise agreed to by both Parties.
4. Terms for termination and plans for continuation of service are agreed to by both
parties
5. Ultimately, both parties must agree to any termination of contract on a `without cause'
basis.
1.
E. Extensions:
AMR will be eligible for two (2) additional extensions of this agreement with mutually
agreed to amendments, each for a period of two (2) additional years. Such extensions shall
be granted at the absolute and sole discretion of CITY. AMR will be eligible for
consideration of extensions if it has demonstrated compliance to the following:
a) Clear evidence that the management staff has training in contemporary
ambulance industry techniques for quality/performance management
b) Clear evidence that the management staff has training in the interpretation
of statistical process control (SPC) charts and capability indices (CI) (e.g.
six sigma green belt certification; SPC and CI training from a recognized
educational program; or equivalent as determined by the CCO)
c)
Consistent demonstration of use of statistical process control methods to
monitor and improve overall performance and performance of individual
operational and clinical processes
Page 18
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
d)
e)
Consistent demonstration of actions taken by AMR to differentiate
between common and special cause sources of variation where SPC chart
data points fall outside control limits or data point patterns met the special
cause criteria of the Western Electric or other widely recognized rule sets
for SPC pattern analysis.
Consistent demonstration that where unfavorable special cause variations
were discovered, investigations were made to identify and mitigate or
remove contributing root cause factors.
f) Consistent demonstration of a regular schedule of AMR self -assessments
(e.g. annually or bi-annually) using the Baldrige Criteria for Healthcare
Excellence (www.quality.nist.gov) and the execution of action plans for
improvement based on the results of those self -assessments. The criteria
set used for the California Excellence Award (www.calexcellence.org)
may be used in lieu of the Baldrige Criteria.
g)
h)
j)
k)
Consistent submission of response time performance data in the form of
statistical process control charts for variable data, in X-bar S format,
where each day represents one data point on the control charts.
Consistent submission of monthly reports of aggregated emergency
response time performance data in the form of a one -tailed capability
index where the specification limit corresponds to the emergency response
time requirement set forth in this RFP
Consistent submission of monthly reports of aggregated non -emergency
immediate response time performance data in the form of a one -tailed
capability index where the specification limit corresponds to the non -
emergency immediate response time requirement set forth in this
agreement
Demonstration of efforts and significant results to improve time process
performance over time, as reflected by improvements in the process
capability indices.
With respect to all response time reports in this section, the data reported
shall not be utilized to judge response time conformance unless and until a
minimum of 100 data points have been achieved, regardless of whether
such time exceeds a given calendar month. Those 100 data points may
Page 19
1.
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
include the underlying data points from which individually charted data
points, corresponding to individual calls, are plotted in the SPC charts,
F. Hold Harmless
AMR shall indemnify and hold harmless CITY, their agents and employees from and
against all claims, damages, losses, and expenses, including attorneys' fees, arising out of
or resulting from the performance by AMR of the services specified in this Agreement
which are caused by any negligent act or omission of AMR, any subcontractor of AMR, or
anyone directly or indirectly employed by AMR or its subcontractors.
2. CITY shall indemnify and hold harmless AMR and its agents and employees from and
against all claims, damages, losses, and expenses including attorneys' fees, arising out of or
resulting from the performances by CITY of its obligations specified in this Agreement
which are caused by any negligent act or omission of CITY, any subcontractor, or anyone
directly or indirectly employed by CITY or its subcontractors.
1.
G. Insurance
General Liability. AMR shall obtain and maintain at all times any insurance policy
insuring against loss from any personal liability or property damage arising from any
operation or activity of AMR, its agents or employees as provided for in this Agreement.
Minimum coverage shall be $10,000,000 combined Single Limit Liability. The policy
shall include comprehensive, premises -operations, products/completed operations hazard,
contractual insurance, broad form property damage, personal injury and ambulance
attendants' error and omissions coverage.
2. Automobile Liability. AMR shall maintain a comprehensive formincluding owned,
non -owned and hired vehicles.
3. Workers Compensation and Employer's Liability. AMR shall have in effect during the
contract period, Workers Compensation and employer's Liability Insurance providing full
statutory coverage.
4. A Certificate of Insurance evidencing coverage for all policies of insurance shall be
Page 20
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
1.
filed with CITY and shall name the CITY as an additional insured. Such policies shall
specify that the policy may not be terminated, altered or cancelled without thirty (30) days
prior written notice to CITY by the insurance company.
H. Non -Discrimination Provisions: AMR shall not discriminate against any employee or
applicant for employment because of age, race, color, ancestry, religion, sex, sexual orientation,
marital status, national origin, physical handicap, or medical condition. AMR will take positive
action to insure that applicants are employed without regard to their age, race, color ancestry,
religion, sex, sexual orientation, marital status, national origin, physical handicap, or medical
condition. Such action shall include but not be limited to the following: employment, upgrading,
demotion, transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or
other forms of compensation, and selection for training, including apprenticeship. AMR agrees
to post in conspicuous places available to employees and applicants for employment any notices
provided by the City setting forth the provisions of this non-discrimination clause.
I. Records.
AMR shall maintain accurate books and accounting records relative to this Agreement.
Such books and records shall be open for inspection and/or copying at any reasonable time
by the CITY or their designated representatives, and the auditor of the County of San
Diego or his/her designated representatives.
2. CITY and AMR shall cooperatively establish mechanisms for compliance with HIPAA
and/or any subsequent regulations or standards specifically addressing privacy of patient
medical records related to performance of this agreement.
1.
J. Major Breach — Certain conditions and circumstances shall, as determined by CITY,
constitute a major breach of this Agreement by AMR. These conditions and circumstances
include, but are not limited to:
Failure of AMR to operate the ambulance service system in a manner which enables the
CITY and AMR to remain in substantial compliance with the requirements of applicable
federal and state laws, rules and regulations
2. Failure of AMR to maintain adjusted response time compliance so that in any 12
consecutive month period AMR maintains a response time performance level at less than
Page 21
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
90% monthly compliance in any four (4) months or two consecutive months in aggregate
and/or in any of the fire districts.
3. Intentionally, or a pattern of, supplying to the CITY false or misleading information or
supplying information so incomplete as to effectively mislead.
4. Falsification of data supplied to the CITY during the course of operations, including by
way of example but not by way of exclusion, dispatch data, patient report data, response
time data, financial data, or downgrading of presumptive run code designations to enhance
AMR's apparent performance, or falsification or deliberate omission of any other data
required under this Agreement.
5. Failure by AMR to cooperate with and assist the CITY in its takeover of AMR's
operations after a Major Breach has been declared by CITY, as provided for herein, even if
it is later determined that such breach never occurred or that the cause of such breach was
beyond AMR's reasonable control.
K. Declaration of Major Breach and Takeover of Service — In the event that the CITY
designated CONTRACT administrator determines that a major breach has occurred and such
determination is brought to and approved by the City Council, and if the nature of the breach is,
in the Director of Health Services' of San Diego County opinion, such that public health and
safety are endangered, and after AMR has been given notice and an opportunity to appear before
the City Council and the Director of Health Services, AMR shall cooperate completely and
immediately with CITY to effect a prompt and orderly takeover by CITY of AMR's operation in
the Contract Service Area, subject to AMR's right to seek an injunction or other alternative
provided AMR by law.
L. Severability: Should any provision, section, paragraph, sentence or work of this
Agreement be rendered or declared invalid by any final court action in a court of competent
jurisdiction, or by reason of any preemptive legislation, then the remaining provisions, sections,
paragraphs, sentences and words shall remain in full force and effect.
M. No Third Party Beneficiaries: This agreement shall not be construed as, or deemed to
be, an agreement for the benefit of any third party or parties; and no third party or parties shall
have any right of action hereunder for any cause whatsoever.
Page 22
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
N. Waiver Provision: The waiver by any party to this agreement of a breach of any
provision hereof shall be in writing and shall not operate or be construed as a waiver of any other
or subsequent breach hereof unless specifically stated in writing.
O. Applicable Laws: CITY and AMR shall provide services in accordance with all
applicable administrative regulations, local, state and federal laws, regulations and directives,
and any changes or amendments thereto, including those described in this Agreement and any
exhibits to this Agreement. The laws of the State of California shall govern this Agreement.
P. Contract Amendments: No alteration or variation of the terms of this contract shall
be valid unless made in writing and signed by the parties hereto, and no oral understanding or
agreement not incorporated herein, shall be binding on any of the parties.
Q. No Influence on Referrals: It is not the intent of either party to this agreement that
any remuneration, benefit or privilege provided for under this Agreement shall influence or in
any way be biased on the referral or recommended referral by either party of patients to the other
party or its affiliated providers, if any, or the purchasing, leasing, or ordering of any services
other than specific services described in this Agreement. Any payments specified in this
Agreement are consistent with what the parties reasonably believe to be the fair market value for
the services provided.
R. RFP #GS0506-6: Refer to RFP #GS0506-6 for clarification regarding the
implementation and enforcement of this agreement. Items which are found within RFP
#GS0506-6 are in effect and covered within this agreement.
VII. PERFORMANCE SECURITY PROVISIONS
A. NATIONAL CITY shall require a Performance Security, provided that the Contractor
may furnish such performance security by either the two methods listed below, or by a
combination of the two methods approved by NATIONAL CITY. Contractor must obtain and
maintain, throughout the term of the contract, a performance security in the amount of two
hundred fifty thousand dollars ($250,000.00) in one of the following forms:
1. An irrevocable letter of credit issued pursuant to this provision in a form acceptable to
NATIONAL CITY Counsel and from a bank or other financial institution acceptable to
Page 23
r
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
NATIONAL CITY, the terms of which shall recognize and accept the contract's
requirements for immediate payment of funds to NATIONAL CITY upon determination by
NATIONAL CITY that, pursuant to provisions set forth herein, the Contractor is in major
default and that the nature of the default is such that the public health and safety are
endangered, and recognizing that any legal dispute by the Contractor or the creditor shall
be initiated and resolved only after release of the performance security funds to
NATIONAL CITY; or
2. A cash deposit, which must be deposited with an escrow holder acceptable to
NATIONAL CITY and subject to an escrow agreement approved by NATIONAL CITY.
Any interest earned on the cash deposited as the performance security shall accrue to the
benefit of NATIONAL CITY; or
3. A Performance Bond issued pursuant to this provision in a form acceptable to
NATIONAL CITY Counsel and from a insurance company or other financial institution
acceptable to NATIONAL CITY, the terms of which shall recognize and accept the
contract's requirements for immediate payment of funds to NATIONAL CITY upon
determination by NATIONAL CITY that, pursuant to provisions set forth herein, the
Contractor is in major default and that the nature of the default is such that the public health
and safety are endangered, and recognizing that any legal dispute by the Contractor or the
creditor shall be initiated and resolved only after release of the performance security funds
to NATIONAL CITY
B. The performance bond or irrevocable letter of credit furnished by the Contractor in
fulfillment of this requirement shall provide that such bond or letter of credit shall not be
canceled by the issuer of such bond or letter for any reason except upon thirty (30) calendar days
advanced written notice to NATIONAL CITY of the intention to cancel said bond or letter of
credit. Not later than 20 days following the commencement of the 30 day notice period,
Contractor shall provide to NATIONAL CITY replacement security acceptable to NATIONAL
CITY. Failure to meet the bonding requirements after cancellation of a bond shall be determined
to be a material breach of contract.
Vlll. LAME -DUCK PROVISIONS
A. Should the Contractor fail to win the proposal in a subsequent competitive process,
NATIONAL CITY shall depend upon the Contractor to continue the provision of services
required under this contract in the manner and scope and at the level so prescribed until such
Page 24
1.
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
time as the subsequent winning proposer takes over.
B. Under these circumstances, NATIONAL CITY recognizes that the Contractor would,
for a period of at least several months, be functioning as a "lame -duck" operator.
C. During such period of time, the Contractor is expected to continue all operations at
essentially the same level of effort and level of performance as were in effect prior to the award
of the subsequent proposal. The Contractor shall specifically be prohibited from making any
changes in the Contractor's methods of operation which would reasonably be considered to be
designed primarily to reduce Contractor's cost of operations during the final stages of the
Contract without the express written approval of NATIONAL CITY.
D. In addition, the following shall apply in a given situation of "Lame -Duck" Contractor:
It is recognized that if a competing organization prevails in a future procurement cycle,
or a Contract extension is not granted, the Contractor may reasonably begin to prepare for
transition of service to the new Contractor during the "lame -duck" period, and NATIONAL
CITY shall not unreasonably withhold its approval of Contractor's request to begin an
orderly transition process, including reasonable plans to relocate staff, scale down
inventory, etc., so long as such transition activities do not impair Contractor's performance
during the "lame -duck" period and said activities have received the prior approval of
NATIONAL CITY.
2. Contractor agrees not to unreasonably impede, penalize or otherwise create hardship for
any employee desiring to explore employment opportunities with the subsequent
Contractor. Specifically, employees shall be allowed to sign contingent employment
agreements with the subsequent Contractor at the employee's discretion. However, in no
way does this provision permit employees sharing with or divulging to the subsequent
Contractor any information about the Contractor, current operations, personnel matters, etc.
3. The parties agree that copies of raw data from the Contractor's CAD for responses to
National City during the period of this contract and any extensions as well as copies of any
other information, spreadsheets, reports, or data sets which may be required by this
contract, whether in hard copy, tape or other electronic media, shall be made available to
NATIONAL CITY at the conclusion of the Contract, subject to City complying with State
and Federal privacy laws.
Page 25
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
4. Contractor shall insure that compliance to all vehicle preventative maintenance
schedules is current, and that all repairs are made on deficiencies found during routine
inspections. Any alteration in the maintenance schedule of vehicles shall be expressly
prohibited.
5. Copies of any records required of NATIONAL CITY to maintain compliance with
State or Federal laws shall be provided to NATIONAL CITY upon request..
6. Personnel records of employees shall, with the proper consent of employees, be
released to NATIONAL CITY in a timely manner. However, any and all materials related
to current employee salaries, wages, private contact information and/or benefits (medical,
dental, pension, disability, etc.,) shall not be subject to public disclosure.
7. Unless otherwise specifically instructed, all requests for documents by NATIONAL
CITY to the Contractor shall be met within two (2) weeks of written request for said
documents. If not specifically requested, documents shall be provided by the Contractor to
NATIONAL CITY at the end of the Contract term.
8. It is expressly understood and agreed to by both parties that any delay, lack of submittal
of requested or required information, or impedance of any kind on the part of the
Contractor as NATIONAL CITY attempts to exercise any or all of these provisions shall
constitute an immediate breach of contract. In such case, the performance security shall be
immediately encumbered by NATIONAL CITY.
IX. EMERGENCY TAKEOVER
A. In the event NATIONAL CITY determines in its sole reasonable discretion that a
Default has occurred and the nature of the Default could endanger the public's health or safety,
such Default shall constitute a Default of the Contract. In such event NATIONAL CITY shall
give the Contractor written notice setting forth with reasonable specificity the nature of the
default and the reason such default endangers the public health or safety. Contractor shall have
the right to cure such default within thirty (30) calendar days of receipt of such notice unless to
do so would likely immediately endanger the public's health, safety or welfare. Within five (5)
days of receipt of such notice, Contractor shall deliver to NATIONAL CITY, in writing, a plan
of action to cure and/or mitigate such default. If the Contractor fails to deliver such plan and/or
fails to cure and/or mitigate such default (the determination of which shall be at the sole
Page 26
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
discretion of NATIONAL CITY), NATIONAL CITY may, in exercising an emergency takeover,
utilize funds in the performance security escrow account to facilitate securing another temporary
contractor or for temporary operation of ambulance services by NATIONAL CITY Fire
Department personnel or another long-term contractor is engaged to perform the service.
B. The Contractor shall have the right of appeal of findings of Default. The Contractor
shall also not be prohibited from disputing any finding of Default through litigation, provided,
however that such litigation shall not have the effect of delaying, in any way, the immediate
takeover of operations by NATIONAL CITY. Nor shall such dispute by the Contractor delay
NATIONAL CITY'S access to the funds made available by the performance security escrow
account. The contractor specifically stipulates and agrees that the foregoing conditions are
reasonable and necessary for the protection of the public health and safety, and any legal dispute
concerning the finding that Default has occurred shall be initiated and take place only after the
emergency takeover has been completed, and shall not under any circumstances delay the
process of an emergency takeover or NATIONAL CITY'S access to performance security funds
as needed by NATIONAL CITY to finance such takeover of operations.
C. Contractor's cooperation with and full support of such emergency takeover shall not
be construed as acceptance by the Contractor of the findings of Default, and shall not in any way
jeopardize the Contractor's right of recovery should a court later find that the declaration of
Default was made in error. However, failure on the part of the Contractor to cooperate fully with
NATIONAL CITY to affect a smooth and safe takeover of operations, shall itself constitute a
breach of the Contract, even if it is later determined that the original declaration of Default by
NATIONAL CITY was made in error.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed the
day and year first herein set forth.
For the City of National City:
Nick Inzunza
Name
Mayor
Title
For American Medical Response Ambulance
Service, Inc. (AMR):
M&VicePent esi c4
Page 27
National City
Services, Supplies and Equipment Charges
DESCRIPTION
CPR $0.00
OXYGEN $69.47
AIRWAY SERVICE I $0.00
PULSE E OXI_METRY $35.09
PULSE OX. DISP.SENSOR $42.09
COMBITUBE 1 $98.22
INTUBATION $152.07
NASAL PHARYNGEAL AIRWAY $25.19
ORAL PHARYNGEAL AIRWAY $8.34
KY JELLY
G-TUBE
BITE STICK
BULB SYRING
SUCTION SERVICE
SALEM SUMP PUMP
$000
$5.26
$4.29
$7.37
$0.00
$20.96
BVM DISPOSABLE UNIT $93.28
BVM, DISPOSABLE MASK $25.78
BVM TO ET ADAPTER $3.78
NASAL CANNULA $3.78
OXYGEN CONNECTING TUBIN $2 72
OXYGEN MASK, PEDIATRIC $11.15
NON-REBREATHER MASK $11.83
NEBULIZER SET-UP . $9.06
IPPB TUBING W/MOUTHPIECE $5.26
OXYGEN RESERVOIR $10.53
HUMIDIFIER WITH ADAPTER $18.85
ALCOHOL PREPS $0
BETADINE OINTMENT $0.00
BETADINE PREPS $0.00
IV SET-UP 250CC $59.89
VSET-UP 1000CC $59-45
ADDITIONAL 250CC BAG(S) $7.77
ADDITIONAL 1000CC BAG(S) $7.01
ADDITIONAL IV CATHETERS $12.42
PREP RAZOR $355
PRESSURE INFUSER 1 $0
RM BOARD L $5.74
HYPODERMIC NEEDLE
SYRINGE - ALL SIZES
SYRINGE 60CC CATH-TIP
LANCETS
NEEDLE COFFIN
$0.89
$4.93
$6.70
$0.42
$0
CARDIAC DEFIBRILLATION $0
BENZION SWABS $1.60
DEFIB. GEL $11.40
DEFIB- PADS $39.96
ELECTRODE SET (ADULT/CHIL $9.15
12 LEAD EKG ZIP -STRIP $11.24
DEFIB QUICK COMBO PAK $4.40
FILTER LINE H (ADULT/PED) $16.26
Exhibit A
FILTER LINE REG (ADULT/PED)
NASAL LINE -ADULT
NASAL LINE-PED
NASAL LINE -INFANT
OXISENSOR-ADULT LONG
OXISENSOR-ADULT REG
OXISENSOR-PED
OXISENSOR-INFANT
ACTIVATED CHARCOAL
ADENOSINE
ALBUTEROL
ASPRIN, BABY
ATROPINE IMG PLS
ATROPINE MULTI -DOSE VIAL
ATROVENT
BRETYLIUM
CALCIUM CHLORIDE 10ML
DEXTROSE
DIPHENHYDRAMINE
DOPAMINE
EPINEPHRINE 1: 1000 AMP
EPINEPHRINE 1: 1000 MULTI.
EPINEPHRINE 1: 10000 PLS
GLUCAGON
LASIX
LIDOCAINE
MORPHINE SULFATE
NARCAN
NITROGLYCERINE 0.4MG SPRAY
NITROGLYCERINE 0.4MG TAB
NITROGLYCERINE OINTMENT
PITOCIN
SODIUM BICARB.
VERAPAMIL
VERSED
OB DELIVERY ASSIST
OB KIT
PORTA WARMER
SKULL CAP
101#1014=
SPINAL PRECAUTION SERVICE
ADHESIVE TAPE
BANDAGING SERVICE
ABD PAD
ACE WRAP
EYE PAD
KERLIX ROLL
MULTI -TRAUMA DRESSING
$9.94
$8.14
$13.11_
$13 11
$20.75
$1995
$21.85
$21 85
$60.48
$70.15
$14.93
$1.96
$25.78
$46.17
$1.09
$0.00
$25.78
$0.00
$25.78
$25.04
$10.20
$91.41
$25.78
$116.13
$25.78_
$28.96
$14.49
$72.90
$50.51
$36.49
$36.49
$11.03
$26.97
$0.00
$20.88
$0.00
$59.76
$75.76
$1.72
$191.40
$1.71
$0.00
$2.20
$6.19
$0 00
$8.85
$15.88
TRANSPORE TAPE
TRIANGULAR BANDAGE
VASELINE GAUZE
4X4 STERILE
4X4 NON -STERILE
SPLINTING SERVICE
SAM SPLINT
CARDBOARD SPLINT
MAST SUIT
�)yj{
BED PAN
URINAL
EMISIS BASIN
WASH BASIN
COLD PACK
HOT PACK
$0.00
$8.73
$7.37
$2.11
$0.00
$0.00
$96.26
$9.89
$0
$8.20
$4.84
$1.29
$5.04
$8.43
$7.89
SCALPEL $737
GLUCOSE TEST STRIPS $11.58
THERMOMETER SHEATH $0.00
TYMPANIC COVER
$0
RESTRAINT SEVICE $42.09
SOFT RESTRAINTS $20.62
BLANKET, DESPOSABLE $30.88
CHUX $2.46
NORMAL SALINE $7.58
STERIL WATER $10.53
INFECTIOUS PRECAUTION SE RV ! $0
STERILE GLOVES $3.78
NON -STERILE GLOVES $0.00
BODILY WASTES DISP. BAG $1.90
ISOLATION MASK $8.43
ISOLATION SUIT/KIT $56.13
ADDITIONAL AMR ATTENDANT $0.00
EXTRACREW/LIFT ASSIST $0.00
TOLL CHARGE $0
BORDER CROSSING $0.00
ALS2 CHARGE
MILEAGE
NIGHT CHARGE
DRY RUN CHARGE
L $125.00
$17.55
$70 87
$182.60
May 2006
Exhibit B
Modification of fees and charges
Percentage equal to the greater of the following percentage:
(A) The Percentage change on a year-to-year basis, of "All Cities --Medical
Care Services component of the Consumer Price Index as published by the
Bureau of Labor Statistics. See below web address.
http://www.bls.00v
(B) The median ALS Base rate of the non -subsidized ALS Transport
systems identified below:
Statewide Survey of Non -Subsidized ALS Systems
Alameda $ 750.00
Contra Costa $ 801.49
El Dorado $ 609.00
Imperial $ 690.00
Kern County $ 678.50
Los Angeles County $ 764.00
Marin $ 844.71
Merced $ 740.00
Monterey $ 614.56
Orange n/a
Riverside $ 820.00
Sacramento n/a
San Diego $ 704.28
San Benito $ 561.92
San Joaquin $ 580.00
San Luis Obispo $ 935.60
San Mateo $ 1,070.15
Santa Barbara $ 702.08
Santa Clara $ 799.00
Santa Cruz $ 738.50
Solano $ 575.00
Tuolumne $ 765.00
Ventura $ 765.25
Coastal Valleys (Napa, Sonoma, Medocino) $ 802.00
Fresno Kings Madera (Fresno, Kings, Madera) $ 712.36
Mountain Valley(Alpine, Amador, Calaveras, Mariposa,
Stanislaus) $ 901.35
North Coast(Lake, Del Norte, Humbolt) n/a
Inland Counties(San Bernardino, lnyo, Mono) $ 825.69
Sierra Sacramento Valley(Nevada, Placer, Sutter, Yolo, Yuba) $ 745.69
AVERAGES (Mean)
Increase Percentage
$ 749.85
8.06%
Source: AMR rates and Statewide rate survey from Ventura EMS
RESOLUTION NO. 2006-106
RESOLUTION OF THE CITY COUNCIL
OF THE CITY OF NATIONAL CITY
AUTHORIZING THE MAYOR TO EXECUTE AN
AGREEMENT WITH AMERICAN MEDICAL RESPONSE (`AMR)
TO PROVIDE BASIC AND ADVANCED LIFE SUPPORT SERVICES
WHEREAS, the City desires to employ a contractor to provide basic and advanced
life support services within National City; and
WHEREAS, after conducting an RFP process, the City has determined that
American Medical Response is qualified by experience and ability to perform the services
desired by the City, and is willing to perform such services.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of
National City hereby authorizes the Mayor to execute an agreement with American Medical
Response to provide basic and advanced fife support services within National City. Said
Amendment is on file in the office of the City Clerk.
PASSED and ADOPTED this 20th day of June, 2006.
NI27i
ATTEST:
4
Mich. el Della, ' ity Clerk
APPROVED AS TO FORM:
George H. Eiser, III
City Attorney
Passed and adopted by the Council of the City of National City, California, on June 20,
2006, by the following vote, to -wit:
Ayes: Councilmembers Inzunza, Morrison, Natividad, Parra, Zarate.
Nays: None.
Absent: None.
Abstain: None.
AUTHENTICATED BY:
NICK INZUNZA
Mayor of the City o National City, California
4
City Clerk of the City of`National City, California
By:
Deputy
I HEREBY CERTIFY that the above and foregoing is a full, true and correct copy of
RESOLUTION NO. 2006-106 of the City of National City, California, passed and
adopted by the Council of said City on June 20, 2006.
City Clerk of the City of National City, California
By:
Deputy
City of National City
Office of the City Clerk
1243 National City Boulevard, National City, CA 91950-4397
(619) 336-4226
July 3, 2006
Louis K Meyer, Vice President
American Medical Response Ambulance Service, Inc.
8808 Balboa Suite 150
San Diego, CA 92123
Project: National City — Advanced Life Support Ambulance Services,
Resolution No. 2006-106
Dear Mr. Meyer:
On June 20, 2006, the City Council of the City of National City passed and
adopted Resolution No. 2006 - 106, awarding a contract for service between the
City and American Medical Response Ambulance Service, Inc.
We are pleased to enclose one fully executed original contract and one certified
copy of the Resolution for your records.
Sincerely,
Michael R. Dalia
City Clerk
MRD
Enclosure
cc: Fire
File C86-47
® Recycled Paper
MEETING DATE 06/20/06
City of National City, California
COUNCIL AGENDA STATEMENT
13
AGENDA ITEM NO.
ITEM TITLE Resolution of the City Council of the City of National City Authorizing the Mayor to
Execute an Agreement with American Medical Response to Provide for Advance Life Support and Basic
Life Support Ambulance Service to the City of National City
PREPARED BY Donald Condon, DEPARTMENT Fire
EXPLANATION Battalion Chief (619) 336-4550
The City's ambulance services contract with American Medical Response (AMR) will expire on July 30, 2006. The
City released a Request for Proposal (RFP) seeking qualified providers to provide exclusive emergency and non -
emergency ambulance service in National City. Through this RFP process, AMR was selected as the most qualified
responding provider. City and AMR representatives have met, discussed and produced the attached agreement.
AMR, at no cost to the City, will provide basic and advance life support ambulance transportation services to the
City. To ensure the continued delivery of quality emergency medical services and provide for future quality
enhancements to the system, induding the implementation of a Fire Department Paramedic First . Responder
Program, Staff recommends that this Ambulance Service Agreement with AMR be approved. This agreement will be
in effect for a period of five (5) years with the ability to be extended twice for two (2) years each extension. This
Agreement will provide for the City's ambulance service needs, ensuring that these services are delivered in an
effective and efficient manner without a City revenue subsidy, while also supporting the Fire Department's Paramedic
First Responder Program.
Environmental Review X N/A
Financial Statement
No financial impact; Ambulance Services Agreement is a fee for service with no City revenue subsidy.
Account No.
STAFF RECOMMENDATION
Adoption of City Council Resolution authorizing the execution of the Agreement.
BOARD / COMMISSION RECOMMENDATION
N/A
ATTACHMENTS ( Listed Below) Resolution No. QOpr e I O&
1. Agreement between the City of National City and American Medical Response.
2. Resolution.
A-200 (9/80)
% g
RESOLUTION NO. 2006 —
RESOLUTION OF THE CITY COUNCIL
OF THE CITY OF NATIONAL CITY
AUTHORIZING THE MAYOR TO EXECUTE AN
AGREEMENT WITH AMERICAN MEDICAL RESPONSE ("AMR")
TO PROVIDE BASIC AND ADVANCED LIFE SUPPORT SERVICES
WHEREAS, the City desires to employ a contractor to provide basic and
advanced life support services within National City; and
WHEREAS, after conducting an RFP process, the City has determined that
American Medical Response is qualified by experience and ability to perform the services
desired by the City, and is willing to perform such services.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of
National City hereby authorizes the Mayor to execute an agreement with American Medical
Response to provide basic and advanced life support services within National City. Said
Amendment is on file in the office of the City Clerk.
PASSED and ADOPTED this 20th day of June, 2006.
Nick Inzunza, Mayor
ATTEST:
Michael Dalla, City Clerk
APPROVED AS TO FORM:
George H. Eiser, III
City Attorney
AGREEMENT BY AND BETWEEN THE CITY OF
NATIONAL CITY AND AMERICAN MEDICAL
RESPONSE AMBULANCE SERVICE, INC.
This agreement is entered into this 1st day of June 1, 2006 by and between the City of National
City (CA), a municipal CITY ("CITY") and American Medical Response Ambulance Service,
Inc. ("AMR")
1, RECITALS
A. The CITY, is a municipal corporation operating under general law of the State of
California.
B. The County of San Diego has contracted with CITY to administer the provision of
paramedic ambulance services for the geographic area that is within the corporate boundaries of
CITY and the Lower Sweetwater Fire Protection District.
C. After a competitive selection process, CITY has selected AMR to provide exclusive
ALS transport services within the exclusive operating` area administered by CITY. AMR is an
experienced and qualified provider of ALS transport services and is willing to enter into a
performance based agreement with the CITY to provide such services within the exclusive
operating area. It is not the intent of the parties to create, by this recital, any contractual rights of
the above referenced entities that do not otherwise exist in law.
IT IS, THEREFORE, AGREED BETWEEN THE CITY AND AMR AS FOLLOWS:
D. Administration. The CITY designates the City Manager of the City of National City,
or his/her designated representative, to administer this agreement on behalf of the CITY. AMR
designates the CEO of AMR; West Region or his/her designated representative to administer
this agreement on behalf of AMR. All reports, proposal, letters, notices and/or other
correspondence shall be sent to the attention of the designated representatives at their respective
addresses.
E. Service Area. The service area shall be the exclusive operating area defined by the
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
4. Provide to the CITY copies of all written complaints received by AMR
concerning ALS ambulance service within the contract area, within seven (7) days
of receipt. The CITY will provide AMR with copies of all written complaints
concerning the ALS ambulance service received by the CITY. AMR will prepare
and, where appropriate, submit all reports required of paramedic provider
agencies by the County of San Diego in connection with the ALS ambulance
service, and AMR shall collect and maintain any other information or data
required by the County.
5. Comply with all applicable governmental regulations and requirements in
connection with the operation of each ALS ambulance, including the San Diego
County Ambulance Ordinance and applicable Division of EMS policies and
protocols.
6. Provide suitable facilities for stationing and maintaining each ALS ambulance in
fully operational condition; develop mutual aid and/or call-up plans to provide
ALS ambulance service in the area in the event the assigned ALS ambulances are
not operable or are away from the area for other reasons. AMR agrees to work
collaboratively with CITY in an effort to identify and implement opportunities to
house ambulance units in City Fire Station Facilities for mutually agreed upon,
market based rent or lease rates.
7. Maintain a comprehensive Advanced Life Support (ALS) Quality Assurance and
Quality Improvement Program (QA/Q.I) designed to act proactively to improve
the quality and efficiency of services in addition to identifying potential or
existing clinical, operational, or equipment problems. This program shall utilize
Six Sigma and Statistical Process Control techniques to identify, in a format that
is mutually agreeable to the parties, improvement opportunities, trends, root
causes and process variability. The focus of this program shall be to both ensure
that the minimum standards and requirements of this contract are maintained and
that the overall system and processes improve over time where reasonably
possible.
8. Make available, and allow access, to First Responders employed by City,
AMR's Continuing Education programs: Such training shall not result in any
additional cost to AMR including, but not limited to, costs of educational
materials, licensing fees, certification fees, employee compensation or other
governmental fees.
Page 3
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
• Year 4 (June 1, 2009 — May 30, 2010) -
annual fee of $244,255.00
• Year 5 (June 1, 2010 - May 30, 2011) -
annual fee of $291,034.00
$20,355 per month for a total
$24,253 per month for a total
e) As specifically defined and requested by CITY in its Request for
Proposals, provide City with funding up to $6,000 per year during the term
of this contract, for uniforms, books and approved supplies for an Explorer
Scout program whose purpose is to enhance EMS services within CITY.
AMR will provide related training for the participants in this program.
Such training shall not exceed a commitment of more than 40 hours/year
for each year of the term of this contract.
f) As specifically defined and requested by CITY in its issued Request for
Proposals, provide support and assistance in the development of a Fire /
EMS Technology Program in conjunction with National City Fire
Department and Sweetwater High School. Provide funding of up to
$6,000 per year for uniforms, books and supplies, or to fund scholarships
for students to attend EMT training at Southwestern College.
g)
h)
j)
As specifically defined and requested by CITY in it's issued Request for
Proposals, establish an "Equipment Fund" of up to $50,000/year, to be
funded annually by June 30th of each year of the term of this contract.
These funds will only be provided to CITY to the extent that appropriate
system costs, certified by CITY, are not met by other funding mechanisms
included in this contract, including but not limited to Franchise Fees
and/or Response Time Performance Penalties.
Provide and/or fund "Six -Sigma training to a "Yellow -Belt Certification
Level" for a maximum of 6 National City Fire Department Officers —
with at least two officers during the first 12 months of this contract and the
remaining 4 officers within the first 24 months of this contract.
Maintain CAAS accreditation for the San Diego Operating Division for
the term of this agreement.
Implement an Electronic Patient Record System (ePCR) utilizing ROAM
I.T., (ePCR) software or other mutually agreed upon software solution for
ePCR purposes within 180 days of contract execution.
Page 5
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
q)
CITY. The programs should focus on child, elderly and family health and
safety issues and will include, but not be limited to, infant/child injury
prevention and rescue, proper use of the 911 EMS system, and other
programs related to widespread health system access issues.
Development of a resource guide in conjunction with National City and
other community stakeholders to educate the public about where low-cost
or free resources exist, encouraging and empowering individuals to seek
care proactively.
r) Assure availability of a School Bus Safety Program, designed by AMR.
s)
t)
u)
v)
Re -supply ALS and BLS First Responder supplies, on a one for one basis,
all Medicare Allowable reimbursable supplies and equipment and
medicines, excluding controlled substances, used on joint incidents only to
the extent that AMR is able to billfor use of those supplies. Replacement
of specific supplies will occur on scene when possible.
Properly transport and dispose of all biological/medical waste generated
by CITY within the service area while rendering services pursuant to this
agreement.
Provide ambulance support to the Fire Departments operating within the
Contracted Service Area at major emergencies and multiple alarm fires.
Nothing in this section is deemed to require AMR to take units out -of -
service for this function unless a EMS patient situation develops on -scene
— in which case an incident will be generated and a unit will be assigned to
it. However, AMR will make reasonable efforts to provide such `stand-by'
support as requested.
Participate in disaster preparedness planning and training activities carried
out by the governmental agencies within the service area and the County
of San Diego.
B. RESPONSIBILITIES OF CITY: In furtherance of this agreement, City shall:
1. Allocate and expend funds paid by AMR in ways consistent with federal
government guidelines, law, rules, regulations and/or standing legal opinions
Page 7
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
Ill. INDEPENDENT AMR
A. In the performance of the work, duties and obligations devolving upon AMR under
this Agreement, it is mutually understood and agreed that AMR, acting by and through its
employees, is at all times acting and performing as an independent Contractor. CITY shall
neither have, nor exercise, any control or direction over the methods by which AMR shall
perform work services and functions except those expressly stated in this agreement. No
relationship of employer and employee is created by this Agreement, and AMR and its
employees shall have no claim under this Agreement or otherwise against the CITY for
employee benefits of any kind.
IV. FEE AND CHARGES FOR SERVICES ALLOWED
A. Fee Schedule. The CITY shall pay no fee or compensation of any kind to AMR
under this Agreement, nor shall the CITY reimburse AMR for any costs or expenses in
connection with this Agreement. AMR shall directly bill the individuals utilizing its services or
appropriate third -party insurance carriers.
B. Fees. AMR may charge the following fees for services rendered pursuant to this
Agreement:
1. Ambulance Services Base Rate: $ 1,028.60 per transport
2. Calls for service during which patient care meets the criteria of "ALS2" as
defined in the Medicare Ambulance Fee Schedule or successor versions thereof:
$1,148.60
3. Charges. AMR may additionally charge for other related services, supplies and
equipment. These services, supplies and equipment and the maximum allowable
charges, subject to modification in paragraph "c" below, are identified in Exhibit
"A" of this document and made a part herein.
Page 9
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
V. OPERATIONAL AGREEMENT
A. Calculation of Emergency Response Times. Response times shall be calculated from
the time of verification of address until the time that the ambulance notifies the dispatcher of its
arrival at the scene of the incident, or such arrival is verified by technological means of vehicle
location, or until the ambulance is cancelled by the dispatcher. When an ALS unit fails to reach
the scene within the response time standard, it is considered an response time compliance
violation.
B. Response Time Standards. AMR shall comply with the following response time
standards (listed in Table 1) for all emergency ambulance responses within the service area
defined within this agreement subject to the exemptions listed in subparagraph 18a through 18i.
Table 1— Response Time Standards
Emergency Incident in District(s) with
ALS Engine Company Coverage
11 minutes, 59
seconds
90% of applicable
incidents or
greater
Emergency Incident in District(s) without
ALS Engine Company Coverage
9 minutes, 59
seconds
90% of applicable
incidents or
greater
Non -Emergency ALS Incident response
received through 911
19 minutes, 59
seconds
90% of applicable
incidents or
greater
C. Response Time Definitions and Change Requirements
1.
District Definitions - With specific reference to Table 1 above, Districts are
defined as the geographic boundaries of the National City Fire Department
"Battalion Designations" of District 31 and District 34 as they exist on May 31,
2006. "Districts with ALS Coverage" are those districts that CITY has identified
and provided notice to AMR, of having ALS/paramedic first responder level
services available consistent with County protocols and regulations. Such notice
shall be provided to AMR at least 30 days prior to any change in this status and
Page 11
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
10th day of each calendar month. Each report will be developed collaboratively between AMR
and Contract Compliance Officer within thirty (30) days of the execution of this agreement and
modified over time at the request of the Contract Compliance Officer
1.
Response Time Exception Report shall be submitted to the Contract Compliance
Officer for all incidents over the response time performance standard in
accordance with Section 16 above. The Contract Compliance Officer shall be
responsible for determining response time compliance and to which incidents will
be granted an exemption from the Response Time standard. Such determinations
shall be based upon a reasonable person standard.
2. An "Emergency Response Time Performance Report"
3. A "Non- Emergency Response Time Report"
4. CITY shall ensure that the Contract Compliance Officer shall provide a written
recommendation to AMR and CITY within seven (7) days of receipt of the
Response Time Exception Report. AMR may appeal the Contract Compliance
Officer's recommendation to the CITY Contract Compliance Committee. After
review and consideration of appropriate information and/or evidence in support of
the appeal, the decision of the CITY Contract Compliance Committee shall be
provided to AMR in writing. The monthly calculations of AMR's response time
performance shall include every non -exempted emergency request origination
from within the district that results in an emergency response (for emergency
response time compliance rate calculation purposes) or a non -emergency response
(for non -emergency response time compliance calculation purposes). The types
of situations for which exceptions may be considered include:
a)
b)
Canceled Responses - Response canceled prior to the unit's arrival at scene
(except for excessive response times). These cases may be removed from
response time interval calculations.
Declared disaster - The Contractor may apply for an exception to response
time standards during times of declared "emergencies" as determined by
the Fire Chief or their designee.
Page 13
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
7. Inclusion of Exempted Calls in Compliance Reports - Calls granted exempt status
shall be reported as a category within the compliance reports required herein and
shall be excluded from compliance calculations and their number shall be
included in the total population of calls received.
8. Monthly Compliance Reporting: AMR shall file a report of response time
compliance on a monthly basis. A report with the corrected; uncorrected response
time compliance data shall be submitted. Such uncorrected data shall be used for
planning purposes only. The monthly compliance reporting form and format will
be developed by the CITY and AMR within thirty (30) days of signing the
contract agreement and modified over time at the request of the Contract
Compliance Officer
E. Penalties Provisions for Performance Deficiencies:
1. Failure to Properly Equip and Supply Unit — AMR shall make reasonable efforts
to ensure that all units are supplied and equipped to standards defined by the
County of San Diego. In the event that, after investigation, CITY finds that
either:
a)
b)
an ambulance controlled by AMR responded to an incident not equipped
and/or supplied to such standards, and the lack of equipment or supplies
significantly impacted care to a patient or patients
proper equipment or supplies were discovered to be missing upon an
unannounced or scheduled inspection of an ambulance available for
service by the Contract Compliance Officer or their designee.
AMR shall be assessed a penalty of $500 for each call so responded to or for each
failed inspection.
2. Failure to Furnish Required Documentation — In the event AMR fails to furnish
normally prepared or readily available reports or data to CITY subject to request
of CITY, CITY shall provide notice to AMR giving reasonable time to deliver
said data or reports. Reasonable shall be mutually agreed to by the parties
considering such variables as, including but not limited to, AMR's access to data,
degree of data segregation and/or analysis, AMR's capabilities to produce and
provide such data or reports and the relative cost/benefit relationship of such
Page 15
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
• Adjusted Compliance Rate of 85.00% to 87.49% - $2,000 penalty
• Adjusted Compliance Rate less that 85.00% - $3,000 penalty
7. NATIONAL CITY will inform Contractor of all final decisions of the Contract
Compliance Officer (CCO) as to their final decisions regarding any performance
failure for which Contractor was responsible and shall invoice Contractor for any
fines and penalties assessed at the end of the monthly performance review
meeting with the CCO. Contractor shall pay NATIONAL CITY all fines within
45 days of receipt of the notification. A late payment charge of five percent (5%)
will be assessed monthly if no payment is received after the 45th day of receipt of
the notification.
VI. ADMINISTRATIVE PROVISIONS
A. Modification. This Agreement may be modified at any time by the written consent of
the parties. This document, however, fully expresses all understandings of the parties concerning
the matters covered herein. No addition to or alteration of the terms of this Agreement and no
verbal understanding of the parties, their officers, agents of employees, shall be valid unless
made in the form of a written amendment of this Agreement, and duly approved and executed by
the parties' authorized representatives.
B. Title to property. Title to expendable and non -expendable property whose cost was
borne in whole by CITY shall remain vested in the CITY upon termination of this agreement.
Title to such property whose cost was borne in whole by AMR shall remain vested in AMR upon
termination of this agreement , with the exception of items purchased with franchise fees,
equipment fund, explorer post or school fund monies.
C. Assignability — Neither party shall assign this Agreement, or any interest therein,
without the prior written consent of the other party.
D. Termination: This agreement may be terminated by either Party at any time, without
cause, by mutual consent, subject to the following conditions:
Page 17
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
d)
e)
g)
h)
Consistent demonstration of actions taken by AMR to differentiate
between common and special cause sources of variation where SPC chart
data points fall outside control limits or data point patterns met the special
cause criteria of the Western Electric or other widely recognized rule sets
for SPC pattern analysis.
Consistent demonstration that where unfavorable special cause variations
were discovered, investigations were made to identify and mitigate or
remove contributing root cause factors.
Consistent demonstration of a regular schedule of AMR self -assessments
(e.g. annually or bi-annually) using the Baldrige Criteria for Healthcare
Excellence (www.quality.nist.gov) and the execution of action plans for
improvement based on the results of those self -assessments. The criteria
set used for the California Excellence Award (www.calexcellence.org)
may be used in lieu of the Baldrige Criteria.
Consistent submission of response time performance data in the form of
statistical process control charts for variable data, in X-bar S format,
where each day represents one data point on the control charts.
Consistent submission of monthly reports of aggregated emergency
response time performance data in the form of a one -tailed capability
index where the specification limit corresponds to the emergency response
time requirement set forth in this RFP
i) Consistent submission of monthly reports of aggregated non -emergency
immediate response time performance data in the form of a one -tailed
capability index where the specification limit corresponds to the non -
emergency immediate response time requirement set forth in this
agreement
j)
k)
Demonstration of efforts and significant results to improve time process
performance over time, as reflected by improvements in the process
capability indices.
With respect to all response time reports in this section, the data reported
shall not be utilized to judge response time conformance unless and until a
minimum of 100 data points have been achieved, regardless of whether
such time exceeds a given calendar month. Those 100 data points may
Page 19
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
4. A copy of all policies of insurance shall be filed with CITY and shall name the
CITY as an additional insured. Such policies shall specify that the policy may not
be terminated, altered or cancelled without thirty (30) days prior written notice to
CITY by the insurance company.
H. Non -Discrimination Provisions: AMR shall not discriminate against any employee or
applicant for employment because of age, race, color, ancestry, religion, sex, sexual orientation,
marital status, national origin, physical handicap, or medical condition. AMR will take positive
action to insure that applicants are employed without regard to their age, race, color ancestry,
religion, sex, sexual orientation, marital status, national origin, physical handicap, or medical
condition. Such action shall include but not be limited to the following: employment, upgrading,
demotion, transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or
other forms of compensation, and selection for training, including apprenticeship. AMR agrees
to post in conspicuous places available to employees and applicants for employment any notices
provided by the City setting forth the provisions of this non-discrimination clause.
I. Records.
AMR shall maintain accurate books and accounting records relative to this
Agreement. Such books and records shall be open for inspection and/or copying
at any reasonable time by the CITY or their designated representatives, and the
auditor of the County of San Diego or his/her designated representatives.
2. CITY and AMR shall cooperatively establish mechanisms for compliance with
HIPAA and/or any subsequent regulations or standards specifically addressing
privacy of patient medical records related to performance of this agreement.
J. Major Breech - Certain conditions and circumstances shall, as determined by CITY,
constitute a major breach of this Agreement by AMR. These conditions and circumstances
include, but are not limited to:
1.
Failure of AMR to operate the ambulance service system in a manner which
enables the CITY and AMR to remain in substantial compliance with the
requirements of applicable federal and state laws, rules and regulations
2. Failure of AMR to maintain adjusted response time compliance rates for each
Page 21
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
have any right of action hereunder for any cause whatsoever.
N. Waiver Provision: The waiver by any party to this agreement of a breach of any
provision hereof shall be in writing and shall not operate or be construed as a waiver of any other
or subsequent breach hereof unless specifically stated in writing.
O. Applicable Laws: CITY and AMR shall provide services in accordance with all
applicable administrative regulations, local, state and federal laws, regulations and directives,
and any changes or amendments thereto, including those described in this Agreement and any
exhibits to this Agreement. The laws of the State of California shall govern this Agreement.
P. Contract Amendments: No alteration or variation of the terms of this contract shall
be valid unless made in writing and signed by the parties hereto, and no oral understanding or
agreement not incorporated herein, shall be binding on any of the parties.
Q. No Influence on Referrals: It is not the intent of either party to this agreement that
any remuneration, benefit or privilege provided for under this Agreement shall influence or in
any way be biased on the referral or recommended referral by either party of patients to the other
party or its affiliated providers, if any, or the purchasing, leasing, or ordering of any services
other than specific services described in this Agreement. Any payments specified in this
Agreement are consistent with what the parties reasonably believe to be the fair market value for
the services provided.
R. RFP #GS0506-6: Refer to RFP #GS0506-6 for clarification regarding the
implementation and enforcement of this agreement. Items which are found within RFP
#GS0506-6 are in effect and covered within this agreement.
VII. PERFORMANCE SECURITY PROVISIONS
A. NATIONAL CITY shall require a Performance Security, provided that the Contractor
may furnish such performance security by either the two methods listed below, or by a
combination of the two methods approved by NATIONAL CITY. Contractor must obtain and
maintain, throughout the term of the contract, a performance security in the amount of two
hundred fifty thousand dollars ($250,000.00) in one of the following forms:
Page 23
NATIONAL CTTY AMBULANCE SERVICE CONTRACT WITH AMR
essentially the same level of effort and level of performance as were in effect prior to the award
of the subsequent proposal. The Contractor shall specifically be prohibited from making any
changes in the Contractor's methods of operation which would reasonably be considered to be
designed primarily to reduce Contractor's cost of operations during the final stages of the
Contract without the express written approval of NATIONAL CITY.
D. In addition, the following shall apply in a given situation of "Lame -Duck" Contractor:
1.
It is recognized that if a competing organization prevails in a future procurement
cycle, or a Contract extension is not granted, the Contractor may reasonably begin
to prepare for transition of service to the new Contractor during the "lame -duck"
period, and NATIONAL CITY shall not unreasonably withhold its approval of
Contractor's request to begin an orderly transition process, including reasonable
plans to relocate staff, scale down inventory, etc., so long as such transition
activities do not impair Contractor's performance during the "lame -duck" period
and said activities have received the prior approval of NATIONAL CITY.
2. Contractor agrees not to reasonably impede, penalize or otherwise create hardship
for any employee desiring to explore employment opportunities with the
subsequent Contractor. Specifically, employees shall be allowed to sign
contingent employment agreements with the subsequent Contractor at the
employee's discretion. However, in no way does this provision permit employees
sharing with or divulging to the subsequent Contractor any information about the
Contractor, current operations, personnel matters, etc.
3. The parties agree that raw data from the CAD for responses to National City
during the period of this contract and any extensions as well as any other
information, spreadsheets, reports, or data sets which may be required by this
contract, whether in hard copy, tape or other electronic media, shall become the
property of NATIONAL CITY at the conclusion of the Contract.
4. Contractor shall insure that compliance to all vehicle preventative maintenance
schedules is current, and that all repairs are made on deficiencies found during
routine inspections. Any alteration in the maintenance schedule of vehicles shall
be expressly prohibited.
5. Any records required of NATIONAL CITY to maintain compliance with State or
Page 25
NATIONAL CITY AMBULANCE SERVICE CONTRACT WITH AMR
B. The Contractor shall have the right of appeal of findings of Default. The Contractor
shall also not be prohibited from disputing any finding of Default through litigation, provided,
however that such litigation shall not have the effect of delaying, in any way, the immediate
takeover of operations by NATIONAL CITY. Nor shall such dispute by the Contractor delay
NATIONAL CITY'S access to the funds made available by the performance security escrow
account. The contractor specifically stipulates and agrees that the foregoing conditions are
reasonable and necessary for the protection of the public health and safety, and any legal dispute
concerning the finding that Default has occurred shall be initiated and take place only after the
emergency takeover has been completed, and shall not under any circumstances delay the
process of an emergency takeover or NATIONAL CITY'S access to performance security funds
as needed by NATIONAL CITY to finance such takeover of operations.
C. Contractor's cooperation with and full support of such emergency takeover shall not
be construed as acceptance by the Contractor of the findings of Default, and shall not in any way
jeopardize the Contractor's right of recovery should a court later find that the declaration of
Default was made in error. However, failure on the part of the Contractor to cooperate fully with
NATIONAL CITY to affect a smooth and safe takeover of operations, shall itself constitute a
breach of the Contract, even if it is later determined that the original declaration of Default by
NATIONAL CITY was made in error.
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed the
day and year first herein set forth.
For the City of National City: For AMR:
Signature Signature
Name Name
Title Title
Page 27
National City
Services, Supplies and Equipment Charges
DESCRIPTION Rate
CPR $0.00
OXYGEN $6947
AIRWAY SERVICE L $0.00
PULSE OXIMETRY $35.09
PULSE OX. DISP.SENSOR $42 09
COMBITUBE $98.22
INTUBATION $152 07
NASAL PHARYNGEAL AIRWAY $25.19
ORAL PHARYNGEAL AIRWAY $8.34
KY JELLY $0 00
G-TUBE $5.26
BITE STICK $4.29
BULB SYRING
SUCTION SERVICE
SALEM SUMP PUMP $20.96
$7 37
_
$0.00
BVM DISPOSABLE UNIT : $93.28
BVM, DISPOSABLE MASK ; $25.78
BVM TO ET ADAPTER $3.78
NASAL CANNULA $3.78
OXYGEN CONNECTING TUBIN $2.72
OXYGEN MASK, PEDIATRIC $11.15
NON-REBREATHER MASK $11.83
NEBULIZER SET-UP $9.06
IPPB TUBING W/MOUTHPIECE $5.26
OXYGEN RESERVOIR $10.53
HUMIDIFIER WITH ADAPTER $18.85
ALCOHOL PREPS
BETADINE OINTMENT
BETADINE PREPS
IV SET-UP 250cc
IVSET-UP 1000CC
ADDITIONAL 250CC BAG(S)
ADDITIONAL 1000CC BAG(S)
$0
$0.00
$0.00
$59 89
$59.45
$7.77
$7.01
ADDITIONAL IV CATHETERS $12.42
PREP RAZOR
PRESSURE INFUSER I $0
ARM BOARD j $5,74
,V1141431:10
HYPODERMIC NEEDLE
SYRINGE - ALL SIZES
SYRINGE 60CC CATH-TIP
ANCETS
NEEDLE COFFIN
LIN:1240irr. 414.:IT-7.L`rr
CARDIAC DEFIBRILLATION 1
BENZION SWABS
DEFIB. GEL
DEFIB. PADS
ELECTRODE SET (ADULT/CHIL_
12 LEAD EKG ZIP -STRIP
DEFIB QUICK COMBO PAK
FILTER LINE H (ADULT/PED)
, $0.89
$4 93
$6.70
$0.42
$0
$0
01.60
$11,40
$39.96
$9.15
$11.24
$4.40
$16.26
Exhibit A
FILTER LINE REG (ADULT/PED)
NASAL LINE -ADULT
NASAL LINE-PED
NASAL LINE -INFANT
OXISENSOR-ADULT LONG
OXISENSOR-ADULT REG
OXISENSOR-PED
OXISENSOR-INFANT
ACTIVATED CHARCOAL
ADENOSINE
ALBUTEROL
ASPRIN, BABY
ATROPINE IMG PLS
ATROPINE MULTI -DOSE VIAL
ATROVENT
BRETYLIUM
CALCIUM CHLORIDE 10ML
DEXTROSE
DIPHENHYDRAMINE
DOPAMINE
EPINEPHRINE 1: 1000 AMP
EPINEPHRINE 1: 1000 MULTI.
EPINEPHRINE 1: 10000 PLS
GLUCAGON
•LASIX
LIDOCAINE
MORPHINE SULFATE
NARCAN
NITROGLYCERINE 0.4MG SPRAY
NITROGLYCERINE 0.4MG TAB
NITROGLYCERINE OINTMENT
PITOCIN
SODIUM BICARB.
VERAPAMIL
VERSED
OB DELIVERY ASSIST
OB KIT
PORTA WARMER
SKULL CAP
SPINAL PRECAUTION SERVICE
ADHESIVE TAPE
BANDAGING SERVICE
ABD PAD
ACE WRAP
EYE PAD
KERLIX ROLL
MULTI -TRAUMA DRESSING
$9.94
$8.14
$13.11
$13.11
$20.75
$19.95
$21.85_
$21.85
$60.48
$70.15
$14.93
$1.96
$25.78
$46.17
$1.09
$0.00
$25.78
$0.00
$25.78
$25.04
$10.20
$91.41
$25.78
$116,13
$25,78
$28.96
$14.49
$72.90
$50.51
$36.49
$36.49
$11.03
$26.97
$0.00
$20.88
$0.00
$59.76
$75.76
•
$1.72
$191.40
$1.71
$0.00
$2.20
$6.19
$0.00
$8.85
$15.88
DESCRIPTION Rate
TRANSPORE TAPE
TRIANGULAR BANDAGE
VASELINE GAUZE
4X4 STERILE
4X4 NON -STERILE
SPLINTING SERVICE
SAM SPLINT
CARDBOARD SPLINT
MAST SUIT
00.00
$8.73
$7.37
$2.11
$0.00
$0.00
$96.26
$9,89
$0
BED PAN $8.20
URINAL
: 241.89
WASH BASIN 4
EMISIS BASIN
$5.04
COLD PACK
$8.43
HOT PACK
$7.89
SCALPEL
THERMOMETER SHEATH $$171.5387
GLUCOSE TEST STRIPS
$0.00
TYMPANIC COVER $0
'RESTRAINT SEVICE $42.09
SOFT RESTRAINTS
$$$;.:88
466
NORMAL SALINE 582
CHUX
BLANKET, DESPOSABLE $30
STERIL WATER
INFECTIOUS PRECAUTION SERV j' $$100.53
STERILE GLOVES
BODILY WASTES DISP. BAG $$$°311937038
NON -STERILE GLOVES
ISOLATION MASK
ADDITIONAL AMR ATTENDANT $$$$086:041033
ISOLATION SUIT/KIT
EXTRA CREW/LIFT ASSIST s$00.00
TOLL CHARGE
BORDER CROSSING
$: 0.00
ALS2 CHARGE L $125.00
MILEAGE $17.55
NIGHT CHARGE 1 $70.87
DRY RUN CHARGE L$182.60
May 2006