HomeMy WebLinkAbout2018/10/16 Item 7 CITY COUNCIL
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AGENDA STATEMENT
CITY OF
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October 16, 2018 File ID: 18-0418
TITLE
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CHULA VISTA APPROVING AN AMENDED AND
RESTATED AGREEMENT WITH AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC. FOR UP TO A
THREE YEAR TERM FOR BASIC AND ADVANCED LIFE SUPPORT (ALS) SERVICES WITHIN THE CHULA
VISTA, IMPERIAL BEACH,AND BONITA/SUNNYSIDE FIRE PROTECTION DISTRICT EXCLUSIVE OPERATING
AREA; APPROVING A RELATED AMENDED AND RESTATED ADMINISTRATIVE AGREEMENT FOR SPECIAL
TERMS FOR ALS FOR SERVICES WITHIN CHULA VISTA INCLUDING REIMBURSEMENT PAYMENTS TO CITY
FOR CITY FIRST RESPONDER ALS SERVICES; AND WAIVING THE COMPETITIVE BID PROCESS AS
IMPRACTICAL UNDER CVMC 2.56.070
RECOMMENDED ACTION
Council adopt the resolution.
SUMMARY
AMR or its predecessors has been providing emergency medical services to the City of Chula Vista and its
EOA partners for almost 40 years. During the past five years, the City implemented an Advanced Life
Support ("ALS") program whereby City paramedics provide ALS services as first responders" using City
Fire Engines. This program is referred to as First Responder Advance Life Support, or "FRALS." This item
presents for City Council Consideration, a new agreement with AMR that would continue AMR's provision
of basic and advanced life support services within the EOA for up to three years and would continue to
support the FRALS program starting on October 1, 2018. This new agreement would provide a quarterly
reimbursement payment to the City for a portion of its FRALS services costs, and allow an increase in
AMR's maximum allowed rates to cover such costs. During the contract term the City intends to explore
alternatives to providing such services including issuing an RFP to AMR and possible alternative service
providers, based on a different model of service delivery, or for the Chula Vista Fire Department to provide
emergency medical transport service itself.
ENVIRONMENTAL REVIEW
The Director of Development Services has reviewed the proposed activity for compliance with the
California Environmental Quality Act (CEQA) and has determined that the activity is not a "Project" as
defined under Section 15378 of the State CEQA Guidelines because the proposal consists of a governmental
plan of action related to the City's preparedness in the event of a natural or manmade disaster and which
will not result in direct or indirect significant physical impacts on the environment. Therefore, pursuant to
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Section 15060 (c)(3) of the State CEQA Guidelines the activity is not subject to CEQA. Thus, no
environmental review is necessary.
BOARD/COMMISSION/COMMITTEE RECOMMENDATION
Not Applicable.
DISCUSSION
Background
The County of San Diego ("County") has adopted a plan, in which it has designated an exclusive operating
area ("ECA") defined as that part of San Diego County generally known as Chula Vista, Bonita/Sunnyside
Fire Protection District, and Imperial Beach, for which Chula Vista has the authority to contract.
Chula Vista, Imperial Beach and the Sunnyside/Bonita Fire District (collectively, the Participating
Agencies") have all been under contract with AMR, or its predecessors, since 1977 for the provision of
Emergency Medical Response services within their territories. This agreement was approved by City
Council on September 27, 2011 with an expiration date of September 30, 2017 after council approved the
first extension in 2014. The contract was then extended administratively during negotiations through
March 31, 2018. Council approved an additional sixty-day extension on March 27, 2018 to run thru May 31,
2018,which was subsequently extended administratively until October 31, 2018.
Each Participating Agency also has "side letter" agreements with AMR to address service standards, cost
recovery and/or rate schedules unique to their respective jurisdictions. These services include Dispatch,
BLS Equipment, Defibrillators, Contract Administration, and First Responder Advanced Life Support
(FRALS). Maximum allowed rates that can be charged by AMR to its Emergency Medical Response
patient/customers reflect these costs. This Side Letter Agreement was approved by City Council on
September 13, 2011 and has also been extended through October 31, 2018.
During negotiations, AMR has identified that operational costs may increase, and reimbursement may
decline due to health care market challenges. AMR is requesting the ability to increase the base rate at a
maximum of 10% annually. Effective October 1, 2019 and October 2020, the AMR Primary Rates
Component may be increased annually by an amount not to exceed ten percent (10%) per year. Increases
are shown in Exhibit B, in the attached,ECA agreement.
To date, the City has never required a competitive procurement process for the provision of ambulance
transport services. A competitive bid process will provide an opportunity for the creation of a Request for
Proposal (RFP) whereby the City will determine the scope, terms, and methods for transport service to be
I rovided.The desired outcome is to not only determine a specific level of service to be provided in the City,
but to improve service with regard to response time thresholds - especially in eastern Chula Vista; as well
as reduce rates to end users. When ready, a formal RFP process should allow provided services to be
maximized,while controlling patient costs,and therefore, produce a sustainable high-quality EMS system.
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With Council approval of this agreement, the city will have up to 36 months to prepare, conduct, and award
a contract through a competitive procurement process for the EOA. City staff will begin the RFP process,
with the assistance of an outside consultant, immediately following the approval of this contract. Staff will
return to council for approval of the consultant contract for services as soon as possible. The RFP process
will be completed and a new contract or arrangement for emergency medical transport services will be
entered into no later than the end of the proposed contract term with AMR (September 30, 2021), with a
goal of completing the process for a new contract or arrangement earlier if possible.
Key Contract Provisions
EOA Agreement
The EOA Agreement is substantially similar to the previous agreement. Key provisions include:
1. Term- Three-year term (October 1, 2018 through September 30, 2018), with early termination
provisions for cause (after opportunity to cure) and convenience (upon 180 days-notice)
retained from the previous agreement.
2. Services and Response Times- AMR to provide ALS and BLS emergency medical response and
transport services throughout the EOA. ALS response requirement is 11:59 or less 90% of the
time in each EOA jurisdiction and 19:59 or less 90%of the time throughout the EOA.
3. Rates- AMR maximum "primary component rates" have been increased to reflect increased
costs and rate limits imposed by federal and private insurers. Annual increases not to exceed
10%per year are allowed.See EOA Agreement Exhibit B for details.
Administrative Agreement for Chula Vista
1. With the full implementation of First Responder Advanced Life Support, the response time
requirement for ambulances is less than 12 minutes for all emergency responses 90%of the
time or greater,in the City of Chula Vista jurisdiction as a whole.
2. Increased payments to the City for Emergency Medical Support Services; raising the City's'
reimbursement amount to $2,608,904 in year one, $2,927,916 in year two, and $3,129,205
in year three. The increase in EMS support payments is due to paramedic stipends and EMT
incentive pay caused by expansion of services when the Millenia fire station is placed into
service as well as the implementation of Squads. In addition, there is an increase in
negotiated personnel cost increases, and increases annually in supplies.
3. Increased "Maximum Authorized Rates" to allow AMR to recover the costs of the City's ALS
pass thru reimbursement for First Responder ALS Support Services.
4. A previous contract provision for possible adjustments in rates and/or City
reimbursements in the event of a greater than 3% change in "marginal collection rates" has
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been replaced by a general meet and confer provision in the event of a "material change" in
collection rates or other key economic factors.
Legal Issues
Waiver of Competitive Bid Process
Both state and local procurement laws apply to contracts for emergency medical services.
Under state law, City conduct in this area is either governed by Health and Safety Code Section 1797.201
(where the city is not subject to state procurement requirements at all), or a Health and Safety Code Section
1797.224 (where the City would be "grandfathered" and permitted to extend contracts with long-term
providers without competitive bid). In either case,the City in this instance is allowed to award a contract to
AMR without state involvement,subject only to its own local laws.
Under local law, the City's .own requirements for competitive bidding would apply unless waived with
appropriate findings. Staff is recommending that the City's standard competitive process be waived in this
instance as"impractical" and not in the best interest of the City based on the following facts:
1. AMR has been providing good quality service at competitive rates within the EOA for almost 40
years.
2. AMR familiarity with the EOA and surrounding areas, and their economies of scale as the
County's primary service provider give them unique qualifications.
3. The City's EOA partners, on behalf of whom the City acts, both desire at this time to continue
service with AMR.
4. The City is not currently in a position to conduct a formal RFP process, as significant additional
analysis.and document preparation is required. This agreement gives the City the time it needs
to complete this process.
The City Attorney advises that these facts form a lawful basis for the City Council to waive its customary
competitive bid requirements as"impractical" and as not in the best interest of the City under the authority
of CVMC Section 2.56.070.B.3.
DECISION-MAKER CONFLICT
Staff has reviewed the decision contemplated by this action and has determined that it is not site specific
and consequently the 500-foot rule found in California Code of Regulations section 18704.2(a)(1) is not
applicable to this decision.
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LINK TO STRATEGIC GOALS
The City's Strategic Plan has five major goals: Operational Excellence, Economic Vitality, Healthy
Community, Strong and Secure Neighborhoods and a Connected Community.
The agreement for ambulance services has a direct link to the City's strategic goals of Strong and Secure
Neighborhoods.
CURRENT-YEAR AND ONGOING FISCAL IMPACT
With approval of the agreement, AMR will pay the City for providing Emergency Medical Support Services.
The City will be reimbursed on a quarterly basis during the duration of the contract as summarized in the
table below. The program will continue to be part of the City Manager Proposed Budget and be considered
as part of the normal budget process.
Contract Year Oct 2018 to Sept Oct 2019 to Sept Oct 2020 to Sept
- 2019 2020 2021
Annual EMS Pass $2,608,904 $2,927,916 $3,129,205
Thru Payments
Quarterly EMS Pass $652,226 $731,979 $782,301
Thru Payments
ATTACHMENTS
Attachment 1: ECA Agreement
Attachment 2: Administrative Agreement for Chula Vista
Attachment 3: Base Rate Information
Staff Contact.-Jim Geering, Fire Chief
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RESOLUTION NO.
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CHULA VISTA APPROVING AN AMENDED AND RESTATED
AGREEMENT WITH AMERICAN MEDICAL RESPONSE
AMBULANCE SERVICE, INC. FOR UP TO A THREE YEAR
TERM FOR BASIC AND ADVANCED LIFE SUPPORT (ALS)
SERVICES WITHIN THE CHULA VISTA, IMPERIAL BEACH,
AND BONITA/SUNNYSIDE FIRE PROTECTION DISTRICT
EXCLUSIVE OPERATING AREA; APPROVING A RELATED
AMENDED AND RESTATED ADMINISTRATIVE AGREEMENT
FOR SPECIAL TERMS FOR ALS FOR SERVICES WITHIN
CHULA VISTA.INCLUDING REIMBURSEMENT PAYMENTS TO
CITY FOR CITY FIRST RESPONDER ALS SERVICES; AND
WAIVING THE COMPETITIVE BID PROCESS AS
IMPRACTICAL UNDER CVMC 2.56.070
WHEREAS, within Chula Vista, there is a public health and safety need for
effective and efficient basic and advanced life support emergency ambulance services;
WHEREAS, various studies and actual practical experience have clearly
demonstrated that communities of the approximate size and population of the EOA
Agencies are best assured of receiving the highest level of emergency ambulance
transportation services at the lowest cost to the consumer where service calls are
originated through the 911, system if said services are delivered by a single, competent
provider on an exclusive basis;
WHEREAS, under state and local law, each EOA Agency is authorized to
provide or contract for exclusive emergency ambulance services as public convenience
requires, and has been doing so since prior to June 1, 1980;
WHEREAS, the County of San Diego ("County") has adopted a plan, in which it
has designated an exclusive operating area ("EOA") defined as that part of San Diego
County generally known as Chula Vista, Bonita/Sunnyside Fire Protection District, and
Imperial Beach, for which Chula Vista has the authority to contract;
WHEREAS, the EOA Agencies participate in the EOA's first responder system
responding to all emergencies originated in the 911 system;
WHEREAS, since prior to June 1, 1980 the EOA Agencies have contracted with
AMR, or its predecessors, for the provision of emergency ambulance transport services
within their jurisdiction;
WHEREAS, the most recent agreement between the Parties for AMR'S
provision of emergency ambulance services is that certain Revised and Restated
Agreement for Basic and Advanced Life Support Ambulance Services dated effective
October 1, 2011 (the"2011 Agreement");
WHEREAS, the 2011 Agreement has been extended twice, first on October 1,
2014 pursuant to a First Amendment thereto until September 30, 2017, and second on
October 1, 2017 pursuant to a Second Amendment thereto until up to March 31, 2018.
Thereafter the 2011 Agreement was extended administratively and the parties agreed to
terminate the Agreement at 11:59 p.m. October 31, 2018 if no agreement is negotiated;
WHEREAS, the Parties now desire to enter into a new Amended and Restated
Agreement for the continuation of AMR's provision of emergency ambulance services to
the EOA Agencies.within the EOA for up to an additional three year term commencing
October 1, 2018 with some minor modifications negotiated by the parties and set forth
therein (the "New EOA Agreement");
WHEREAS, Sections 10 and 22 of the New EOA Agreement provide each
participating agency with the authority to enter into agreements with AMR that modify
EOA Agreement requirements and standards within their respective jurisdictions and/or
allow for AMR to subcontract for ALS First Responder Services therein;
WHEREAS, in accordance with this authority, City and AMR desire to enter into
an Amended and Restated Administrative Agreement in order to provide for specific
terms and standards for the administration of emergency medical response and transport
services within the City and reimbursement of a portion of City's ALS First Responder
Services;
WHEREAS, City staff is'recommending that the City Council waive the City's
competitive bid process as impractical as applied to these contracts and as not in the best
interest of the City based on the following facts: (1) AMR has been providing good
quality service at competitive rates within the EOA for almost 40 years; (2) AMR
familiarity with the EOA and surrounding areas, and their economies of scale as the
County's primary service provider gives them unique qualifications; (3) The City's EOA
partners, on behalf of whom the City acts,both desire at this time to continue service with
AMR; (4) The City is not currently in a position to conduct a formal RFP process, as
significant additional analysis and document preparation is required; the extended
agreements give the City the time it needs to complete this process.
NOW THEREFORE, BE IT RESOLVED that the City Council of the City of
Chula Vista takes the following actions:
1. Approves an Amended and Restated Agreement with American Medical
Response Ambulance Service, Inc. for up to a three-year term for Basic and Advanced
Life Support (ALS) services within the Chula Vista, Imperial Beach; and
Bonita/Sunnyside fire protection district exclusive operating area;
2. Approves a related Amended and Restated Administrative Agreement for
special terms for ALS for services within Chula Vista including reimbursement payments
to City for City First Responder ALS Services;
3. Approves such agreements in the forms presented with such minor
modifications as may be required or approved by the City Attorney; and
4. Waives the competitive bid process as impractical under CVMC 2.56.070 and
as not in the best interest of the City based on the facts set forth above.
Presented by: Approved as to form by:
Jim Geering, Glen R. Googins,
Fire Chief City Attorney
AMENDED AND RESTATED AGREEMENT FOR BASIC AND
ADVANCED LIFE SUPPORT AMBULANCE SERVICES
This AMENDED AND RESTATED AGREEMENT FOR BASIC AND ADVANCED LIFE
SUPPORT AMBULANCE SERVICE ("Agreement") is entered into effective as of October 1,
2018 ("Effective Date") by and between the CITY OF CHULA VISTA, a chartered municipal
Corporation ("Chula Vista"), together with the CITY OF IMPERIAL BEACH, a municipal
corporation, ("Imperial Beach") and BONITA/SUNNYSIDE FIRE PROTECTION DISTRICT,
an independent special district ("District'') each an "EOA Agency" and collectively the "EOA
Agencies") and AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC. F/K/A
LAIDLAW MEDICAL TRANSPORTATION, INC a Delaware corporation, dba AMERICAN
MEDICAL RESPONSE ("AMR") with referenced to the following facts:
RECITALS
A. Within Chula Vista,there is a public health and safety need for effective and efficient basic
and advanced life support emergency ambulance services.
B. Various studies and actual practical experience have clearly demonstrated that
communities of the approximate size and population of the EOA Agencies are best assured
of receiving the highest level of emergency ambulance transportation services at the lowest
cost to the consumer where service calls are originated through the 911, system if said
services are delivered by a single, competent provider on an exclusive basis;
C. Under state and local law, each EOA Agency is authorized to provide or contract for
exclusive emergency ambulance services as public convenience requires, and has been
doing so since prior to June 1, 1980;
D. The County of San Diego ("County'') has adopted a plan, in which it has designated an
exclusive operating area ("EOA") defined as that part of San Diego County generally
known as Chula Vista, Bonita/Sunnyside Fire Protection District, and Imperial Beach, for
which Chula Vista has the authority to contract;
E. The EOA Agencies participate in the EOA's first responder system responding to all
emergencies originated in the 911 system.-
F.
ystem;F. Since prior to June 1, 1980 the EOA Agencies have contracted with AMR, or its
predecessors, for the provision of emergency ambulance transport services within their
jurisdiction.
G. The most recent agreement between the Parties for AMR'S provision of emergency
.ambulance services is that certain Revised and Restated Agreement for Basic and
Advanced Life Support Ambulance Services dated effective July 1, 2011 (the "2011
Agreement").
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H. The 2011 Agreement has been extended twice, first on October 1, 2014 pursuant to a First
Amendment thereto until September 30, 2017, and second on October 1, 2017 pursuant to
a Second Amendment thereto until up to March 31, 2018. On March 23, 2018, the
Agreement was extended until May 31, 2018 to allow for negotiations. The parties agreed
to terminate the Agreement at 11:59 p.m. October 31, 2018 if no agreement is negotiated.
I. The Parties now desire to enter into this Agreement, for the continuation of AMR's
provision of emergency ambulance services to the EOA Agencies within the EOA on the
terms set forth below.
NOW, THEREFORE, in consideration of the mutual promises herein contained and for
other good and valuable consideration,receipt of which is hereby acknowledged,the parties agree
as follows:
1. SERVICES
AMR shall, without cost to the EOA Agencies, perform the following services to the satisfaction
of the EOA Agencies:
1.1 Provide pre-hospital Advanced Life Support ("ALS") and Basic Life Support
("BLS")emergency medical care and transport services in response to medical calls
for service received through 911 and/or public safety dispatch and communication
centers for calls within the EOA, twenty-four(24) hours each day, seven (7) days
a week without interruption, without regard to the patient's financial status.
1.2 AMR shall respond in 11:59 minutes or less at least ninety percent (90%) of all
ALS emergency calls (Levels 1, 2 and 3) dispatched each month within each EOA
Agency's jurisdiction.
1.3 AMR shall respond in less than twenty(20)minutes to at least ninety percent(90%)
of all BLS calls (Level 4) dispatched each month within the EOA.
1.4 Response time shall be calculated from the time that a dispatch is received by AMR
for the first dispatched ambulance until the time that the first ambulance arrives on
the scene or at the designated staging area as designated by the incident
commander.
1.5 At a minimum AMR shall provide five (5) Type III ALS capable ambulances,
operating twenty-four(24) hours per day; and an additional two (2) Type III, ALS
ambulances operating twelve (12) hours per day, posted within or immediately
adjacent to the EOA at all times as necessary to fulfill response time requirements
imposed by this Agreement. One ambulance shall be posted at Chula Vista Fire
Station # 6 pursuant to the terms of a lease to be negotiated on standard industry
terms at fair market value.
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1.6 Only ALS capable units shall be deployed in direct response to calls for Levels 1,
2 and 3, medical emergencies originating from the 911 system or requests from
public safety dispatch and/or communications centers.
1.7 AMR will provide a representative in each EOA Agency's Emergency Operations
Center (EOC) when reasonably required upon activation of such EOA Agency's
EOC.
1.8 Provide and maintain a minimum of one (1) 800 MHz mobile radio per ALS unit
compatible with first responder fire agency radio frequencies within the EOA,
"Central Zone" and "Metro Zone". i
AMR units assigned to emergency 911 incidents within the EOA will follow radio
procedures mutually agreed to between AMR and fire agencies. AMR will
participate in the RCIP project which includes AVL capabilities.
AMR units assigned to incidents will comply with the Incident Command System,
and report to the Incident Commander (IC) for assignment on the assigned
Command and Tactical radio frequencies.
All AMR dispatch data shall be captured electronically on a "real-time" basis with
a computer system capable of providing information to Chula Vista with respect to
address, times of dispatch, response times, arrival times transport code and unit
identifier.
AMR will work with each EOA Agency in developing area specific radio
identifiers and designators.
1.9 AMR agrees to attend and participate in meetings called from time to time.by Chula
Vista or any other EOA Agency for the purpose of planning and coordinating EMS
service within the EOA and to discuss any issues with response times or
performance of contract responsibilities. Throughout the term of the Agreement:
(a) AMR field supervisory staff assigned to provide services under this Agreement
shall be trained at ICS 300 level; and (b) AMR ambulance crews assigned to
provide services under this Agreement shall be trained at ICS 100 & 200 level.
1.10 Provide a complaint procedure as outlined herein:
Whenever a complaint is received,regardless of whether from a health care agency,
public safety agency, a patient, or the general public,an Incident Report Form shall
be completed. The field supervisor shall conduct the initial investigation with
emphasis placed on identification of potential system failures and deficiencies,
recommendations for short and long-range corrective actions, and the
documentation of facts for future review and reference.
Whenever possible,an immediate face-to-face response shall be made by a member
of AMR's management team.
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All documentation on complaints and criticisms shall be maintained for at least
three (3) years and a copy forwarded to the appropriate EOA Agency within thirty
(30) days of resolution or, in a case where no resolution is reached, the City
Manager of the appropriate EOA Agency, his or her designee, or, in the case of
District, District's Fire Chief shall be notified within two (2) business days of
determining that the matter is not resolvable.
1.11 AMR shall resupply the Fire Departments of each EOA Agency with medical
supplies and related emergency medical equipment, including Personal Protective
Equipment and disposable semi-automatic defibrillator supplies contained within
the list of equipment and supplies described in Exhibit "A," up to a maximum cost
"Maximum Resupply Obligation"per fiscal year(July through June).
a. For equipment and supplies not exchanged at the scene, beginning July 1,
2018, the Maximum Resupply Obligation shall be $27,000. AMR's
Maximum Resupply Obligation shall be increased each fiscal year by ten
percent (10%) each year.
b. The ratio of the resupply amount shall correspond,on a pro rata basis,to the
percentage of calls for service for each EOA Agency.
c. The cost of the items supplied by AMR shall be determined by the actual
invoice cost to AMR. Chula Vista shall be provided with an appropriate
statement on a monthly basis from AMR detailing supplies that each EOA
Agency has received through this process and the cost assigned to the same.
In no event shall AMR's obligation hereunder exceed the actual cost of the
EOA Agencies aggregate resupply needs.
d. AMR shall clearly label all items delivered to each EOA Agency and shall
provide, with the initial order, "Material Safety Data Sheets" for any new
items added to each EOA Agency's use or inventory.
e. In the event that changes in federal, state or local regulations require
additional Personal Protective Equipment or other medical equipment or
supplies in support of EMS operations, and/or if AMR and Chula Vista, by
mutual consent, agree to utilize new equipment in the field to enhance
patient care, and the Maximum Resupply Obligation by AMR is thereby
caused to be exceeded for a given fiscal year, the parties agree to negotiate
in good faith to adjust the maximum limits of AMR's contribution.
f. Establish an agreed, standardized-compliment of EMS disposable
equipment for fire stations. AMR agrees to deliver or have delivered these
inventories to a maximum of three (3) locations (one within each EOA
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Agency's service area)on a weekly basis, subject to modification by mutual
consent of the Parties.
g. Provide to Chula Vista on a monthly basis a re-supply balance sheet.
Information shall identify all itemized transactions taken from the re-supply
obligation in 1.12 (a) of the Agreement.
h. Disposable medical supplies identified in the revised "Exhibit A" that are
not typically replaced "one-for-one" on scene, or the specific make and
model are not supplied by AMR will be replaced by AMR in accordance
with the re-supply balance sheet provisions of the contract.
1.12 Properly transport and dispose of all biological/medical waste generated by Chula
Vista within the EOA while rendering services pursuant to this agreement. Includes
biological/medical waste storage sheds at Fire Station #2 and Fire Station #6.
1.13 Provide all ambulances, as well as other vehicles and equipment,that are necessary
for the provision of services required under this Agreement (including all fuel,
lubricants, maintenance, insurance, and repairs/replacement).
1.14 Provide standby ambulance support to the Fire Departments of each EOA Agency
at major emergencies as determined appropriate and necessary by each EOA
Agency's incident commander. Exemptions to response time requirements shall be
granted to AMR for calls received within the response area for the unit assigned to
such incidents during the time that unit is committed. Additionally, calls that can
be shown to be exceptions because of the deployment of this resource may also be
granted exempt status from response time compliance.
1.15 Comply with all training requirements established by the State of California, and
all applicable policies and provisions regarding medical care standards established
by the San Diego County Emergency Medical Services Division (SDCEMSD),
including any and all agreements between Chula Vista and the County with respect
thereto.
1.16 AMR will submit updated Grooming/Tattoo policies to all participating
jurisdictions for review and input within 30 days of the effective date of this
Agreement.
1.17 AMR Uniforms: Shoulder Patch: Previously agreed upon (1) work uniform
policies (namely,that(a)Rank/File 911 Paramedics: Uniform shirts and pants will
be navy blue in color, with black buttons; and (b) Administration: Uniform shirts
and pants will be navy blue in color with black buttons), and (2) shoulder patches,
shall be worn by all AMR's Paramedics and Emergency Medical Techs. throughout
the term of this agreement.
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2. SYSTEM REQUIREMENTS
2.1 All ambulance units must be equipped and staffed at all times to meet all state and
county laws and regulations affecting service delivery. AMR shall operate and
maintain all ambulances and equipment in a manner that will not endanger life or
property, and in accordance with all existing and future federal, state, and local
laws, ordinances, regulations, resolutions, policies, procedures, and protocols
applicable to AMR's performance pursuant to this Agreement.AMR shall maintain
Primary Type III Modular ALS units within the EOA in accordance with practices
in effect as of the Effective Date.
Preventable Mechanical Failure:
Ambulances dedicated to the Southbay EOA primarily assigned to 911 responses
shall be Type III units equipped as described in the EOA contract and shall have a
maximum service life of 250,000 miles or five (5) years (whichever is less).
Reserve or replacement ambulances shall be Type III units. Type III reserve units
as well as units that respond into the Southbay EOA from another area, will not be
held to the mileage or year requirements.
Chula Vista shall have the ability to designate a reserve or replacement unit as in
need of evaluation and replacement if it meets the following criteria:
• Any unit that has been out of service for more than one (1) day (24 hours),
four(4) or more times in a calendar year; or
• Any unit that has failed to respond because of a mechanical reason more
than once in a calendar year; and
• Excepting that this definition does not include units out of service for
regular scheduled maintenance. Once a unit is repaired and placed back into
service it shall be monitored for a six (6) month period.
Under extreme circumstances, including but not limited to, a disaster, local
emergency or excessive fire activity, AMR may be granted a variance to this
requirement. Once the extreme circumstance has passed, the above requirements
will be reinstated.
2.2. Staffing. For all requests for service received through the 911 system and/or public
safety dispatch and communication centers for calls within the EOA Area, AMR
shall ensure that, at a minimum, the staffing requirements of SDCEMSD or other
appropriate successor in interest with appropriate authority,will be met at all times.
In furtherance of this requirement:
a. AMR shall guarantee minimum staffing levels on all units assigned to the EOA
twenty-four(24) hours per day, 365 days a year.
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b. Such staffing levels shall be mandatory and employees needed for such
staffing shall not be released until such time as minimum staffing levels can
be maintained.
c. AMR will provide one (1)AMR supervisor/vehicle which will be available to
'the South Bay & National City EOA twenty-four (24) hours/day— seven (7)
days/week. Typical expectations include: overhead resource for incident
operations, incident support (i.e., rehab and medical monitoring), and
occasional field training. .
2.3 AMR agrees to employ paramedics who meet and/or exceed all state and county
licensing and certification requirements. AMR will ensure that all emergency
personnel meet the continuing education requirements specified by San Diego
County.
2.4 AMR shall notify the EOA Agencies immediately whenever any condition exists
which adversely affects delivery of satisfactory emergency medical services to the
EOA. For purposes of this paragraph, notification of Heartland Fire
Communications and San Diego Fire Dispatch facilities shall be deemed
appropriate notification.
2.5 Other County-permitted providers' ambulances and personnel may be used for
911 prehospital emergency medical care and transport only in accordance with
County policy and with approval of AMR.
2.6. When it becomes necessary to use other providers to assist in responding to 911
calls, AMR shall include such incidents in the monthly report.
2.7 AMR is responsible for assuring that its ambulances are staffed and equipped in
accordance with County policy and the terms of this Agreement.
2.8 AMR shall participate in and cooperate with other EMS system entities in
furthering the development of the system.
2.9 Chula Vista acknowledges AMR's responsibility to inform each Agency it contracts
with of the requirements contained in the Health Insurance & Portability Act of
1996 regarding confidentiality of patient records. The EOA Agencies agree to
uphold the law with regard to the confidentiality of patient records and bear the
costs of any violation of patient confidentiality by their respective employees.
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3. RESPONSE TIME PERFORMANCE
System response times are a key measurement of performance. This measurement is the
determining factor that drives the placement and redeployment of the system's resources
throughout the entire system.
3.1 Each incident will be counted as a single response regardless of the number of
units that respond.
3.2 AMR shall use its best efforts to minimize variations or fluctuations in response
time performance. AMR shall notify a contact person identified by Chula Vista
in real time" upon the occurrence of a non-compliant response time "outlier"
event as defined in Section 4.1.c., below.
3.3 AMR shall not be held accountable for response time compliance for any request
for service outside the EOA. Responses to requests for service outside the EOA
will not be counted in the number of total calls used to determine response time
compliance under this Agreement.
3.4 Compliance Reporting. AMR shall file a report of response time compliance on
the following basis:
a. AMR shall provide each EOA Agency its own separate report of response
time compliance within each such agency's jurisdiction on a monthly basis.
For the City of Imperial Beach and the Bonita/Sunnyside Fire Protection
District, for response time compliance purposes, AMR will only be
considered out of compliance within either service territory if response time
performance within such service territory falls below 90% for two (2)
consecutive months or for three (3) months within any twelve (12) month
time period within each separate jurisdiction.
b. Such reporting shall be filed within ten(10)days of the. end of the previous
month.
C. The format of this report is subject to reasonable approval by Chula Vista.
Reports shall be submitted in Excel or an equivalent format. This report
shall include:
i Total number of responses
ii Incident response times by unit and incident address
iii Raw compliance (without exceptions)percentage
iv Number of responses receiving exceptions.
v Number of 911 calls handled by other transport provider agencies
vi Adjusted compliance total with exceptions (if any) that have been
granted by the applicable EOA Agency (percentage)
vii Number of 911 calls handled by non-dedicated EOA units
8
viii Transport Level (code 10-50)
3.5 Response Time Exemptions. It is understood that unusual circumstances beyond
AMR's reasonable control can induce response times that exceed the
aforementioned standards. "Declared Disasters": AMR may request an exception
to response time standards during times of declared emergencies as determined by
the Fire Chief or their designee,or calls to a scene related to an activation of"Annex
D" of the San Diego County Multi-Hazard Disaster Plan.
Equipment failure, traffic collisions not involving the responding ambulance, or
lack of a nearby ambulance shall not furnish grounds for release from general
response time standards. If AMR feels that any run or group of runs should be
exempt from response time standards due to unusual circumstances beyond AMR's
reasonable control, AMR may request that these runs be excluded from response
time performance calculations. Each EOA Agency shall determine the granting of
exemptions within its service area. If the EOA Agency concurs that the
circumstances do fit the contract's exemption criteria, it shall allow such
exemptions in calculating overall response time performance.
a. Each request for exemption must be submitted in a form approved by the
applicable EOA Agency and shall be filed within ten (10) days of the end
of the previous month.
b. The EOA Agencies will have ten(10)days from the receipt of the requested
exemptions in which to notify AMR as to Whether the requested .
exemptions have been granted or denied.
3.6 Reassignment En-route. If a responding. ambulance is reassigned en route from a
first call to second call prior to arrival at the incident location, the response time
clock will not stop on the first call until the arrival of an appropriately staffed
ambulance on the scene of the first call.
a. Separate code classifications and response time measurements will be kept
on each call.
b. AMR is expected to meet the applicable response times for the calls, even
when diverted.
3.7 Notwithstanding any other provision within this Agreement, the ALS Ambulance
may be canceled en route or down graded by dispatch, or any on-duty paramedic,
EMT, or public safety officer at the scene consistent with San Diego County
medical protocols.
9
3.8 Cancellation of Calls. Calls cancelled prior to the arrival of an ambulance on scene
shall not be included in determining monthly response time compliance if the
cancellation occurs in 11:59 minutes or less.
4. PENALTIES FOR RESPONSE TIME NON-COMPLIANCE
4.1 In the event AMR fails to meet-the response time requirements in any EOA
Agency's service area,AMR shall be assessed penalties as follows:
a. If AMR fails to meet the response time criteria, after exemptions (if any)
have been granted,AMR shall add an additional six (6)ALS Type III unit-
hours per day to the EOA.
b. These additional unit-hours described in paragraph 4.1 shall remain in place
until such time and AMR has maintained response.time compliance for two
(2) consecutive months.
C. Notwithstanding paragraph 4.1, in the event that AMR has nine(9) or more
ALS calls for service in one (1) calendar month with response times of
twenty (20) minutes or longer (each on "'outlier" event"), the following
penalty shall apply: AMR shall add an additional twelve(12)ALS Type III
unit-hours per day to the EOA for as long as it takes to reduce and sustain
outlier levels to an acceptable level below the 9-event outlier threshold.
d. These additional unit-hours described in paragraphs 4.1 shall be
implemented within seven (7) days of the applicable EOA Agency's final
determination of non-compliance.
5. FEE SCHEDULES
AMR shall operate a billing and accounts receivable system that is humane, well-documented,
easy to audit,and which minimizes the effort required of patients to recover funds from third party
sources for which they may be eligible. AMR shall be able to provide quarterly and annual reports
as specified by Chula Vista-.
5.1 AMR is authorized to bill patients transported on calls originating as medical calls
for service through 911 and/or public safety dispatch and communication centers
according to AMR's fee structure attached as Exhibit "B" which may be modified
from time to time as described in Subparagraphs below.
5.2 Rates charged for Base Rate, Oxygen, Mileage,Night Charges and Treatment Only
(No Transport) ("Primary Rate Components") shall not be increased above those
set forth annually on Exhibit "B" except as expressly provided herein AMR shall
provide the most recent list of above charges for each jurisdiction for this exhibit.
10
5.3 The Primary Rate Components for the term shall be as provided on the attached
Exhibit "B" unless otherwise required and agreed to in writing in administrative
agreements for individual EOA Agency service areas. AMR may increase such
rates annually during the primary term (until September 30, 2021) as provided
below. The rates for any extended term may be increased by mutual agreement of
the parties.
Effective October 1, 2019 and October 2020, the AMR Primary Rates Component
may be increased annually by an amount not to exceed ten percent (10%)per year.
5.4 All other non-Primary Rate Component charges, while not specifically assigned
maximum rates under this Agreement, shall not exceed industry standard rates
charged by AMR and other ALSBLS service providers within the County of San
Diego.
5.5 AMR reserves the right to submit a request to the Chula Vista City Council for a
fee increase, in addition to that allowed above; for extraordinary expenses in any of
the following categories:
• Vehicle physical damage insurance
• Professional liability insurance
• Workers Compensation insurance
• General liability insurance
• Gasoline, diesel, propane, oil and petroleum products
• Pharmaceuticals or medical supplies
Extraordinary expenses are defined as an increase in cost from the previous year of
twenty (20) percent or more for a specific contract year in any of the above-stated
categories. The Chula Vista City Council reserves the right to approve or
disapprove such a request in its sole discretion.
5.6 Notwithstanding the above, AMR also reserves the right to submit a request for a
fee increase in the event of any extraordinary change in the payment or cost
recovery provisions in Medical, Medicare, or their successor programs.
5.7 Chula Vista shall notify AMR in writing of approval or disapproval of the increase
within thirty (30) calendar days of receipt of accurate and complete information
satisfactorily supporting any increase.
5.8 In the event that either District or Imperial Beach withdraws from this Agreement,
the minimum ambulance requirements in this Agreement shall be waived, and new
minimum ambulance requirements established upon mutual agreement between the
parties that adheres to less than 12-minute standard 90 percent or greater in all
participating EOA agencies. The withdrawing EOA Agency must provide no less
than 180 days notice to all parties of its intended withdrawal.
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6. INSURANCE
AMR shall obtain and maintain at all times a policy of insurance by an insurance carrier acceptable
to Chula Vista against loss from public and automobile liability arising from any operation or
activity of AMR, its agents or employees. Types and amounts of such insurance to be maintained
shall be as defined in Exhibit "C" insurance Requirements, which is hereby adopted by reference
and hereby made part of this Agreement.
7. HOLD HARMLESS & INDEMNIFICATION
AMR shall indemnify, protect, defend and hold harmless each EOA Agency and their respective
officers, agents, elected officials, volunteers and employees from and against all claims demands,
causes of action, costs, expenses, liability, loss, damage or injury, in law or equity, to property or
persons, including wrongful death, damages, losses and expenses, including attorneys' fees and
other costs of defense, arising out of or resulting from the performance by AMR, its officials,
officers,employees, agents,and contractors, of the services specified in this Agreement caused, or
alleged by third parties to have been caused, by any intentional or negligent act or omission of
AMR, any subcontractor of AMR or anyone directly or indirectly employed by AMR or its
subcontractors, except to the extent caused by the sole negligence or willful misconduct of any
EOA Agency, any subcontractor thereof or anyone directly or indirectly employed thereby.
Costs of Defense and Award. Included in the obligations in the Paragraph above, is AMR's
obligation to defend, at AMR's own cost, expense and risk, any and all suits,actions or other legal
proceedings,that may be brought or instituted against any of the EOA Agencies,or their respective
directors, officials, officers, employees, agents and/or volunteers, subject to the limitations
contained in the Paragraph above. AMR shall -pay and satisfy any judgment, award or decree that
may be rendered against any of the EOA Agencies or their respective directors, officials, officers,
employees, agents and/or volunteers, for any and all related legal expenses and costs incurred by
each of them, subject to the limitations contained in the Paragraph above..
AMR's obligation to indemnify shall not be restricted to insurance proceeds, if any, received by
the EOA Agencies, or their respective directors, officials, officers, employees, agents, and/or
volunteers. AMR agrees to pay any and all costs that the EOA Agencies incur in enforcing the
indemnity and defense provisions set forth above.
AMR's obligations under the above provisions shall survive the termination of this Agreement.
8. INDEPENDENT CONTRACTOR STATUS
8.1 All parties hereto in the performance of this Agreement will be acting in an
independent capacity and not as agents, employees, partners or joint ventures with
one another. AMR is not an employee of the EOA Agencies and is not entitled to
any of the rights, benefits, or privileges of the EOA Agencies' employees,
including, but not limited to medical, unemployment, or workers' compensation
insurance.
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8.2 This Agreement contemplates the personal service of AMR and AMR's employees
or independent contractors, and it is recognized by the parties that a substantial
inducement to the EOA Agencies for entering into this Agreement was, and is; the
professional reputation and competence of AMR.
8.3 Neither the EOA Agencies nor their respective officers, agents or employees shall
have any control over the conduct of AMR or any of AMR's employees or
independent contractors, except as herein set forth, and AMR expressly agrees not
to represent that AMR, or any of AMR's agents, servants, employees or
independent contractors, are in any manner agents, servants or employees of the
EOA Agencies, it being understood that AMR, its agents, servants, employees and
independent contractors are as to the EOA Agencies wholly independent
contractors and that AMR's obligations to the EOA Agencies are solely such as
prescribed by this Agreement.
9. ASSIGNMENT
AMR shall not assign any portion of this Agreement or the services to be rendered thereunder
without the written consent first obtained from Chula Vista, which will not be unreasonably
withheld.
10. PERMISSION TO SUBCONTRACT SERVICES
AMR may subcontract for ALS First Responder services with each EOA Agency within the
service area. Each agency may enter into an agreement with AMR for the provision of those
services. The parties agree that upon execution of such subcontracts for First Responder services,
response time performance standards may be modified and applicable paragraphs of this
Agreement modified in conformance with these new standards.
11. RIGHT TO REQUIRE PERFORMANCE
The failure of any EOA Agency at any time to require performance by AMR of any provisions
hereof, shall in no way effect the right of such EOA Agency thereafter to enforce same.Nor shall
waiver by any EOA Agency of any breach of any of the provisions hereof be taken or held to be a
waiver of any succeeding breach of such provision or as a waiver of any provision itself.
12. SEVERABILITY
If any provision of this Agreement shall be declared to be illegal, void or unenforceable by a court
of competent jurisdiction, such provisions shall be deemed severable, and the other provisions
shall not be affected but shall remain in full force and effect.
13. AUDIT AND REPORTING PROCEDURES
AMR agrees to allow officials from each EOA Agency complete access to all operational and
financial records and data (including computer generated reports) pertaining to the services
13
provided pursuant to this Agreement. All records and documents regarding this service shall be
available in the County of San Diego for a period of not. less than three (3) years. AMR further
agrees to submit to Chula Vista the following reports:
13.1 San Diego County (pre-hospital patient records) EMS Report Forms (ALS and
BLS) on request.
13.2 Annual Financial Report that shows revenues billed and collected by payment
source for calls originating within the EOA which includes a list of all transports.
(Note: Chula Vista reserves the right to conduct spot checks of patient billings.)
13.3 Monthly Response Time Analysis Report that shows percentage of calls arrived
within minute parameters and shows all late responses for all classifications.
13.4 Monthly Exception Report that lists all response performance exceptions requested.
AMR shall make every responsible effort to identify the cause of such extended
response time and shall document efforts to eliminate repetitions of that cause of
poor response time performance if requested by the EOA Agencies. (Note: time in
the system is counted in seconds, not in whole minutes.)
13.5 Annual Collection Percentage Report, which shows a breakdown of collection
performance.
14. NOTICES
All notices to AMR shall be mailed to:
General Manager
American Medical Response Ambulance Service, Inc.
3465 Camino Del Rio South Suite 410
San Diego, California 92108
and
Legal Department
American Medical Response, Inc.
6200 South Syracuse Way, Suite 200
Greenwood Village, CO 80111
All notices to the EOA Agencies shall be mailed to:
Fire Chief
City of Chula Vista
276 Fourth Avenue
Chula Vista, California 91910
14
J
and
City Manager and City Attorney
City of Chula Vista
276 Fourth Avenue
Chula Vista, California 91910
And
City Manager, Fire Chief and City Attorney
City of Imperial Beach
865 Imperial Beach Boulevard
Imperial Beach, California 91932
Fire Chief
Bonita Sunnyside FD.P..
4900 Bonita Road
Bonita, CA 91902-
15.
190215. CONSIDERATION
Consideration provided to AMR for the comprehensive services to be provided by AMR is that
the EOA Agencies shall grant to AMR the exclusive rights to provide emergency and non-
emergency basic and advanced life support service within the EOA originated through the 911
system.
16. CONTRACT ADMINISTRATION
The EOA Agencies designates the City Manager, City of Chula Vista, 276 Fourth Avenue, Chula
Vista,California 91910,or his/her designated representative,to administer this Agreement on their
behalf. AMR designates Michael Murphy, General Manager, 8808 Balboa Avenue, Suite 150, San
Diego, California 92123, 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.
17. TERM OF AGREEMENT AND RENEWAL PROVISIONS
This Agreement shall commence on October 1, 2018 and shall terminate at midnight, September
30, 2021 unless earlier terminated by either party as expressly provided herein.
18. TERMINATION FOR CAUSE, LIQUIDATED DAMAGES
18.1 Chula Vista, on behalf of the EOA Agencies, may immediately terminate this
Agreement if AMR's license to operate ambulances by the state is revoked or
suspended.
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18.2 Chula Vista, on behalf of the EOA Agencies, may terminate this Agreement for
material breach, if the material breach is not cured within thirty (30) days after a
written notice specifying the cause is delivered to Michael Murphy, General
Manager,American Medical Response Ambulance Service, Inc.,3465 Camino Del
Rio South, Suite 410, San Diego, CA 92108 and Legal Department, American
Medical Response, Inc., 6200 South Syracuse Way, Suite 200,Greenwood Village,
CO 80111.
a. Material breach shall include, but not limited to:
1) Failure to comply with the material terms and conditions of this Agreement,
after notice of the failure has been given to AMR;
2) Gross misinterpretation or fraud;
3) Failure to 'operate in compliance with the requirements of the applicable
federal, state and local laws, rules and regulations relating to the provision
of ALS paramedic and BLS ambulance service.
18.3 If, within the thirty(30) days after delivery of the written notice of termination for
Material breach, the material breach has not been cured to the reasonable
satisfaction of Chula Vista's representative, then Chula Vista may terminate this
Agreement effective as of a date specified in a written notice of termination
delivered thereafter. During the thirty (30) day cure period, if Chula Vista
determines that the public health and safety-would be endangered by the continued
provision of service by AMR, in consultation with the County EMS Medical
Director or designee, Chula Vista may nevertheless, immediately suspend further
performance and give written notice of immediate termination of this Agreement.
18.4 If, after termination of this Agreement for cause by Chula Vista pursuant to. 19.1
and 19.2, it is ultimately determined by an arbitrator that Chula Vista's termination
was not justified (that AMR had not committed a material breach of this
Agreement), Chula Vista and AMR agree that the injury AMR may suffer as the
result of such conduct by Chula Vista is, impossible to ascertain or estimate and
that the sum of$50,000, shall be paid by Chula Vista to AMR and is a reasonable
estimate of the potential injuries suffered. Said amount is agreed upon as liquidated
damages and not as a penalty.
18.5 Any waiver, acceptance of services, or failure to require compliance as it relates to
the Agreement shall not be deemed to be a waiver of any other breach of or change
to the terms of, or operate to stop Chula Vista from enforcing the provisions of this
Agreement. A consent to one assignment by Chula Vista shall not be deemed to
waive the right to consent to any future assignments.
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19. TERMINATION FOR CONVENIENCE
Notwithstanding any provisions to the foregoing; Chula Vista may terminate this Agreement at
any time and for any reason, by giving specific written notice to AMR of such termination and
specifying the effective date thereof,at least 180 days before the effective date of such termination.
In the event the Agreement is terminated by Chula Vista as provided in this paragraph,AMR shall
be entitled to receive compensation for services rendered prior to the effective date of such
termination.AMR hereby expressly waives any and all claims for damage or compensation arising
from termination as provided for herein.
20. APPLICABILITY IN IMPERIAL BEACH
This Agreement shall apply throughout the EOA; provided, however, with regard to the provision
of services within the corporate limits of Imperial Beach, the provisions of paragraph 3 (response
time commitments) and Exhibit "B"(base rates) shall be superseded by the provisions, if any, in
any agreement in effect between AMR and Imperial Beach. If AMR and Imperial Beach do not
have an agreement in effect at any time during the term of this Agreement, then response times
and the Fee Schedule for the Imperial Beach portion of the EOA shall be as provided herein.
21. AGREEMENT TO REOPEN NEGOTIATIONS
At any time during the term of the Agreement, either party reserves the right to propose system
enhancement changes which will better meet the needs of the service area. The parties agree to
meet and confer and determine the appropriateness of any such change to the system and any
necessary or appropriate corresponding increase in AMR's rates. Any such change shall be by
mutual agreement with each party acting in its sole discretion.
22. ADMINISTRATIVE AGREEMENTS
Under the authority of this Agreement,each EOA Agency is permitted to enter into Administrative
agreements with AMR specifying different levels of services; response time commitments and
rates provided to each of them.These administrative agreements will only be binding upon AMR
and the parties entering into them and the benefits therein will not accrue to any party not entering
into a administrative agreement.
23. PERFORMANCE BOND
Prior to the commencement of the term, AMR shall deposit with Chula Vista a performance bond
in the amount of$300,000 in favor of Chula Vista and the EOA Agencies from a surety and in a
form reasonably approved by City. Such form should be attached hereto as "Exhibit D". City
shall only call the bond after the following conditions precedent have been satisfied:
i) AMR materially breaches the Agreement;
ii) City issues a written declaration of material breach;
iii) AMR fails to cure the material breach; and
iv) City terminates the Agreement.
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24. COMPLIANCE
Each EOA Agency on its own behalf agrees that it will comply in all material respects with all
applicable federal and state laws and regulations including,the Federal Anti-kickback statute. The
funding set forth in this Agreement (and/or any "side letter") shall be used only for EOA Agency
services or system enhancements set forth herein. Each EOA Agency warrants and represents on
its own behalf that the payments made by AMR shall be less than or equal to such EOA Agency
actual costs to provide those services or system enhancements.No funds shall be used by any EOA
Agency in a manner that may violate 42 UC.S. Section 1320a-7b, the federal Anti-Kickback
Statute. .
25. COMPLIANCE PROGRAM AND CODE OF CONDUCT
AMR has made available to each party a copy of its Code of Conduct, Anti-kickback policies and
other compliance policies, as may be changed from time to time, at AMRs' web site, located at:
ww-vv.amr.com and each party acknowledges receipt of such documents. AMR warrants that its
personnel shall comply with AMR's compliance policies, including training related to the
Antikickback Statute.
26. NON-EXCLUSION.
Each party represents and certifies that neither it nor any practitioner who orders or provide
services on its behalf hereunder has been convicted of any conduct that constitutes grounds for
mandatory exclusion as identified in 42 U.S.C.S 1320a-7(a). Each party further represents and.
certifies that it is not ineligible to participate in Federal health care programs or in any other state
or federal government payment program. Each party agrees that if DHHS/OIG excludes it,or any
of its practitioners or employees who order or provide Services, from participation in Federal
health care programs, the party must notify the other party within five (5) days of knowledge of
such fact, and the other party may immediately terminate the Agreement, unless the excluded
party is a practitioner or employee who immediately discontinues ordering or providing services
hereunder.
27. REFERRALS
It is not the intent of either party that any remuneration, benefit or privilege provided for under the
Agreement shall influence or in any way be based 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 the specific services described in this Agreement. Any
payments specified herein are consistent with what the parties reasonably believe to be a fair
market value for the services provided.
[SIGNATURES APPEAR ON NEXT PAGE]
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SIGNATURE PAGE TO AMENDED
AND RESTATED AGREEMENT FOR BASIC
AND ADVANCED LIFE SUPPORT
AMBULANCE SERVICE
IN WITNESS THEREOF; the parties hereto have caused this Agreement to be executed, so as to
be effective and binding as of the Effective Date.
THE CITY OF CHULA VISTA "AMR"
AMERICAN MEDICAL RESPONSE
AMBULANCE SERVICE; INC.
a Delaware Corporation
Gary Halbert Edward B. Van Horne
City Manager President and CEO
ATTEST:
Approved as to form by:
Glen R. Googins
City Attorney
CITY OF IMPERIAL BEACH BONITA/SUNNYSIDE FIRE
PROTECTION DISTRICT
Andy Hall Tim Isbell
City Manager Fire Chief
ATTEST:
Approved as to form by:
Jennifer Lyon
City Attorney
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EXHIBIT "A"
DISPOSSABLE MEDICAL SUPPLIES TO BE RE-SUPPLIED BY AMR
[TO BE PROVIDED]
1 1"Tape White 43 Gown 85 Oxygen Key-Small
2 1"Transpore Tape 44 Hand Gel,Waterless,4 oz 86 Penlight
3 2"Tape 45 Heat Packs 87 Procedure Mask
4 5x9 Dressing 46 HyFin Chest Seal 88 Ring Cutter
5 8x10 Dressing 47 Isolation Kit Unisize 89 Saline 250cc
6 All-Risk Triage Tags 48 Kerlix 90 SAM Splint
7 ARS Needle Decompression 49 Mask N95,Gateway Trifold 91 Sanidex Wipes (Blue Top)
8 Backboard Strap 50 Mask P100, 92 Sharp Shuttle
9 Band-Aids(box) 51 Mega Mover 93 Sharp,1 Qt.
10 Biohazard Bags-Red 52 Multi Trauma Dressing 94 Sharps,Mailbox
11 Blanket,Disposable Yellow 53 Nasal Cannula Adult 95 Shoe Covers(Booties)
12 BP Cuff Adult 54 Nasal Cannula Pedi 96 Soft Restraints
13 BP Cuff Infant 55 Nasal Clamp 97 SOFT Tourniquet
14 BP Cuff Pediatric 56 Non Rebreather Adult 98 Spit Sock
15 BP Cuff Thigh 57 Non Rebreather Pedi 99 Sta-Block Head Immobilizer
16 Burn Sheets 58 Non-Sterile 4x4(pack) 100 Sterile 4x4's
17 BVM Adult 59 NPA 12fr 101 Sterile Water 250cc
18 BVM Infant 60 NPA 14fr 102 Stethoscope
19 BVM Pedi 61 NPA 16fr 103 Suction Canister-Large
20 C-Collar Adult Adjustable 62 NPA 18fr 104 Suction Catheter,10f
21 C-Collar Ped-Infant Adj 63 NPA 20fr 105 Suction Catheter,12f
22 Cold Packs 64 NPA 22fr 106 Suction Catheter,14f
23 Combat Guaze 65 NPA 24fr 107 Suction Catheter,16f
24 Contamination Bag,Yellow 66 NPA 26fr 108 Suction Catheter,18f
25 Disposable Prep Razors 67 NPA 28fr 109 Suction Catheter,6f
26 Duct Tape 68 NPA 30fr 110 Suction Catheter,8f
27 Elastic Bandage(Ace Wrap) 69 NPA 32fr 111 Suction Tubing
28 Electric Hair Trimmer 70 NPA 34fr 112 Trash Bags/small
29 ETAD,37 fr(Combitube) 71 NPA 36fr 113 Trauma Shears
30 Eye Pads 72 OB Baby Blizzard Wrap 114 Triage Ribbon,Black/White
31 FAST SPLINT,Large 73 OB Baby Cap/Beanie 115 Triage Ribbon,Green
32 FAST SPLINT,Medium 74 OB Kit 116 Triage Ribbon,Red
33 FAST SPLINT,Small 75 OB Towels 117 Triage Ribbon,Yellow
34 Gloves Latex Free(L) 76 OLAES Bandage 118 Triangular Bandages
35 Gloves Latex Free(M) 77 OPA 100mm 119 Tympanic Covers Container
36 Gloves Latex Free(S) 78 OPA 120mm 120 Tympanic Thermometer
37 Gloves Latex Free(XL) 79 OPA 40mm 121 Virex Wipes(White Top)
38 Gloves Sterile 7.0 80 OPA 50mm 122 Virex,24oz Spray
EXHIBIT A
39 Gloves Sterile 7.5 81 OPA 60mm 123 Water Soluable Lubricant
40 Gloves Sterile 8.0 82 OPA 70mm 124 Yankauer Rigid Suction
41 Gloves Sterile 8.5 83 OPA 80mm
42 Goggles 84 OPA 90mm
1 Activated Charcoal 45 EZ 10 Pedi Needle(Red) 89 Neb Mask Adult
2 Adenosine 6mg 46 EZ 10 Stabilizer 90 Neb Mask Pedi
3 Adensoine 12mg 47 Glucagon 91 Neb Stinger
4 Albuterol 48 Glucometer 92 Nebulizer,Bag Assist
5 Alcohol Prep Pads 49 Glucose Paste 93 Needle 18ga
6 Aspirin 81mg 50 IV Armboard 18" 94 Needle 21ga
7 Atropine Multi Dose 51 IV Armboard 9" 95 Needle 25ga
8 Atropine,1mg PLS 52 IV Armboard Infant 96 Needle Filter
9 Atrovent 53 IV Catheter 14ga 97 Nexterone Pre-Mix
10 AutoPulse Shoulder Harness 54 IV Catheter 16ga 98 NG Tube,10f
11 AutoPulse Zip Ties 55 IV Catheter 18ga 99 NG Tube,12f
12 Benadryl,50mg 56 IV Catheter 20ga 100 NG Tube,14f
13 Benzoin Swabsticks 57 IV Catheter 22ga 101 NG Tube,16f
14 Bougie 58 IV Catheter 24ga 102 NG Tube,18f
15 Calcium Chloride PLS 59 IV NACL 1000ml 103 Nitro Ointment(Single Dose)
16 Chloraprep Swab/Applicator 60 IV Tubing 10gtts 104 Nitro Papers
17 Control Solution,LVL1 61 IV Tubing 60gtts 105 Nitroglycerin Spray
18 CPAP,Large 62 King Video Blade 106 Povidine Prep Pads
19 CPAP,Small 63 Lancets 107 Pressure Infuser
20 CPR Stat Padz,Adult 64 Laryngo Handle Lg 108 Saline Bullett
21 CPR Stat Padz,Ped 65 Laryngo Handle Sm 109 Sodium Bicarb, Adult
22 Dextrose 10%250cc 66 Tapeth Based Resuscitation 110 Sodium Bicarb, Pedi
23 Dextrose 50%Adult 67 Lever Lock Cannula 111 SPO2 Probe,Neonate(X
Series)
24 Dopamine Pre-Mix 68 Lidocaine,100mg PLS 112 SPO2 Probe,Ped(X Series)
25 Electrode Adult 69 Lifeband,Zoll AutoPulse 113 Syringe 10cc Twinpack
26 Epi 1:10,000 PLS 70 Luer Lock-to-Luer Lock 114 Syringe 1cc Luer Block
27 Epi 1:1000 1ml Ampule 71 Mac Blade#0,Disp 115 Syringe 20cc
28 Epinephrine 1:1 Multi-Dose 72 Mac Blade#1,Disp 116 Syringe 3cc Twinpack
29 ET Tube 2.5 73 Mac Blade#2,Disp 117 Syringe 5cc Twinpack
30 ET Tube 3.0 74 Mac Blade#3,Disp 118 Syringe 60cc
31 ET Tube 3.5 75 Mac Blade#4,Disp 119 Syringe,Toomey
32 ET Tube 4.0 76 Magill Forceps,Adult 120 Test Strips(Container)
33 ET Tube 4.5 77 Magill Forceps,Pedi 121 Tourniquet,IV
34 ET Tube 5.0 78 Microstream CO2 Cannula,Adult 122 Tube Tamer Adult
35 ET Tube 5.5 79 Microstream CO2 Cannula,Ped 123 Tube Tamer Pedi
36 ET Tube 6.0 80 Microstream ETCO2,Adult/Ped 124 Veniguards
EXHIBIT A
37 ET Tube 6.5 81 Miller Blade#0,Disp 125 .Zofran 4mg
38 ET Tube 7.0 82 Miller Blade#1,Disp 126 Zofrari,Tablet(ODT)
39 ET Tube 7.5 83 Miller Blade#2,Disp 127 Zoll BP Cuff,Adult(Blue)
40 ET Tube 8.0 84 Miller Blade#3,Disp 128 Zoll BP Cuff,Child(Green)
41 ET Tube Stylet,Adult 85 Miller Blade#4,Disp 129 Zoll BP Cuff,Large Adult(Red)
42 ET Tube Stylet,Pedi 86 Mucosal Atomization Device 130 Zoll X Series EKG Paper(Roll)
43 EZ 10 Adult Needle(Blue) 87 NACL 10cc Flush
44 EZ 1O Large Adult Needle 88 Narcan PLS
EXHIBIT A
EXHIBIT "B"
PRIMARY COMPONENT RATES
Exhibit B
Primary Rate Components
Current
Chula Imperial
Bonita Vista Beach
ALS Base Rate $ 1,694.72 $ 2,665.65 $ 2,250.85
ALS2 Base Rate 1,874.80 2,845.74 2,430.93
BLS Emergency Base Rate 978.28 978.28 978.28
Mileage 39.39 39.39 39.39
Oxygen 142.31 142.31 142.31
Night Charge 140.99 140.99 140.99
Treatment Only 150.00 150.00 150.00
Other Non-Primary Rate Component Charges per current rate schedule
10/1/18 -9/30/19
Chula Imperial
Bonita Vista Beach
ALS Base Rate $ 1,834.78 $ 2,967.48 $ 2,392.33
ALS2 Base Rate 2,032.87 3,147.57 2,590.42
BLS Emergency Base Rate 1,076.11 1,076.11 1,076.11
Mileage 43.33 43.33 43.33
Oxygen 156.54 156.54 156.54
Night Charge 155.09 155.09 155.09
Treatment Only 165.00 165.00 165.00
Other Non-Primary Rate Component Charges increase no more than 10% per year
10/1/19 -9/30/20
Chula Imperial
Bonita Vista Beach
ALS Base Rate $ 1,988.85 $ 3,434.44 $ 2,547.96
ALS2 Base Rate 2,206.75 3,614.53 2,765.85
BLS Emergency Base Rate 1,183.72 1,183.72 1,183.72
Mileage 47.66 47.66 47.66
Oxygen 172.20 172.20 172.20
Night Charge 170.60 170.60 170.60
EXHIBIT B
Treatment Only 181.50 181.50 181.50
Other Non-Primary Rate Component Charges increase no more than 10% per year
10/1/20 -9/30/21
Chula - Imperial
Bonita Vista Beach
ALS Base Rate $ 2,158.33 $ 3,881.56 $ 2,719.15
ALS2 Base Rate 2,398.01 4,061.65 2,958.84
BLS Emergency Base Rate 1,302.09 1,302.09 1,302.09
Mileage 52.43 52.43 52.43
Oxygen 189.41 189.41 189.41
Night Charge 187.66 187.66 187.66
Treatment Only 199.65 199.65 199.65
Other Non-Primary Rate Component Charges increase no more than 10% per year
EXHIBIT B
EXHIBIT "C"
INSURANCE REQUIREMENTS FOR AMR("CONSULTANT")
Consultant must procure insurance against claims for injuries to persons or damages to property
that may arise from or in connection with the performance of the work under the contract and the
results of that work by the consultant; his agents; representatives,.employees or subcontractors and
provide documentation of same prior to commencement of work. The insurance must be
maintained for the duration of the contract.
Minimum Scope of Insurance
Coverage must be at least as broad as:
1. Insurance Services Office Commercial General Liability coverage (occurrence
Form CGOOOI or equivalent)
2. Insurance Sen./ices Office Form Number CA 0001 covering Automobile Liability,
Code 1 (any auto).
3. Workers' Compensation insurance as required by the State of California and
Employer's Liability Insurance.
4. Professional Liability or Errors&Omissions Liability insurance appropriate to the
consultant's profession. Architects' and Engineers' coverage is to be endorsed to
include contractual liability.
Minimum Limits of Insurance
Contractor must maintain limits no less than:
1. General Liability:. $5,000,000 per occurrence for bodily injury, personal injury
(Including operations, and property damage. If Commercial General Liability
products and completed insurance with a general aggregate limit is used, either the
operations, as applicable.) general aggregate limit must apply separately to this
project/location or the general aggregate limit must be twice
the required occurrence limit.
2. Automobile Liability: $2,000,000 per accident for bodily injury and property
3. Workers' Compensation Statutory
Employer's Liability: $1,000,000 each accident
$1,000,000 disease-policy limit
$1,000,000 disease-each employee
4. Professional Liability: $2,000,000 each occurrence
Deductibles and Self-Insured Retentions
Any deductibles or self-insured retentions must be declared to the City.
EXHIBIT C
Other Insurance Provisions
The general liability, automobile- liability, and where appropriate, the worker's compensation
policies are to contain, or be endorsed to contain, the following provisions:
1. The City of-Chula Vista, its officers,- officials, employees, agents, and volunteers are to
be named as additional insureds with, respect to liability arising out of automobiles
owned, leased, hired or borrowed by or on behalf of the consultant, where applicable,
and, with respect to liability arising out of work or operations performed by or on behalf
of the consultant's including providing materials, parts or equipment furnished in
connection with such work or operations. The general liability additional insured
coverage must be, provided the form of an endorsement to the contractor's insurance
using ISO CG 2010 (11/85) or its equivalent. Specifically, the endorsement must not
exclude Products/Completed Operations coverage.
2. The consultant's General Liability insurance coverage must be primary insurance
as it pertains to the City, its officers, officials, employees, agents, and volunteers. Any
insurance or self-insurance maintained by the City, its officers, officials, employees, or
volunteers is wholly separate from the insurance of-the contractor and in no way relieves
the contractor from its responsibility to provide insurance.
3. Consultant shall endeavor to provide thirty (30) days' prior written notice to the
City by certified mail, return receipt requested of any cancellation of coverage.
4. Coverage shall not extend to any indemnity coverage for the active negligence of
the additional insured in any case where an agreement to indemnify the additional
insured would be invalid under Subdivision (b) of Section 2782 of the Civil Code.
5. Consultant's insurer will provide a Waiver of Subrogation -in favor of the City for
each required policy providing coverage during the life of this contract.
If General Liability, Pollution and/or Asbestos Pollution Liability and/or Errors & Omissions
coverage are written on a claims-made form:
1 The "Retro Date" must be shown, and must be before the date of the contract
or the beginning of the contract work.
2 Insurance must be maintained and evidence of insurance must be provided
for at. least five (5) years after completion of the contract work.
3 If coverage is canceled or non-renewed,and not replaced with another claims-
made policy form with a"Retro Date"prior to the contract effective date, the
Consultant must purchase "extended reporting" coverage for a minimum of
five (5) years after completion of contract work.
4 A copy of the claims reporting requirements must be submitted to the City for
review.
Acceptability of Insurers
Insurance is to be placed with licensed insurers admitted to transact business in the State of
California with a current A.M. Best's rating of no less than A V. If insurance is placed with a
surplus lines insurer, insurer must be listed on the State of California List of Eligible Surplus
EXHIBIT C
Lines Insurers (LESLI) with a current A.M. Best's rating of no less than A X. Exception may be
made for the State Compensation Fund when not specifically rated.
Verification of Coverage
Consultant shall furnish the City with original certificates and amendatory endorsements effecting
coverage required by this clause.
Subcontractors
Consultants must include all sub-consultants as insureds under its policies or furnish separate
certificates for each sub-consultant.. Ali coverage for sub-consultants are subject to ail of the
requirements included in these specifications.
EXHIBIT C
EXHIBIT"D"
PERFORMANCE BOND
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EXHIBIT D
POWER OF ATTORNEY
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RLI Iusitrance Company
Contractors Bonding and insurance Company
9025\_LindherghDr. FleAa,1L61615
PLcate:8110-4454402
!list;AEM. r fiv These YreAY:•R&
That this Power or Attorney U ncd vsEd ar in cfthz nr,1cR3 attacked to l5a bond which it suthorizm exceatcd,but may be dctache2 by the
tr-ArvioL oilicer if dmiracL
i net RLI lnla-altee Company enc.+or Contractors Bonding and Inearance Comperty,encb an Dhoois carpetacion,{sgaratcly mud r
Ioge(ber,the"C:am iltany")do botchy raauY,cm.,ntuta rind appcint
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of nim0cra miry ltttth.PTLwC• The Provided nay Vice Provident, SemeLzry,any Assistpnt 5o,-rehty, to Lho Trensxtrw city appoint
Attorneys ir.Fact or Apnis who ohs][kA'c authority W into bands,policies w tmdcrta),irrgs in.hc name-of the Corrpgrry.The cvtpmate
aoel is not treaty for Iba validity of Lily baits,policies,undaulzikps.Powers of Atfcracy or other obEgaticns of:he corpom;ioo. The �
aigmture ofarty welt offeer and the mtporwe seal may,baprintcd byffscmnvto.°
IN WITNESS WTEREOP,tbaa RLI Emurance Company anc'or Cooirnctors Bonding and Imarance Company, no appUcabic,have
caused(loose presents to by"ecuted by its respe five Vice llg itl.0t wHi hs corpwraw seal affixed tluis ECth da;of I
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EXHIBIT D
AMENDED AND RESTATED
ADMINISTRATIVE AGREEMENT
FOR THE PROVISION OF
EMERGENCY MEDICAL RESPONSE SUPPORT SERVICES
[CHULA VISTA]
This ADMINISTRATIVE AGREEMENT FOR THE PROVISION OF
EMERGENCY MEDICAL RESPONSE SUPPORT SERVICES [CHULA VISTA]
("Agreement") is entered into effective as of October 1, 2018 ("Effective Date") by
and between AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.,
formerly known as Laidlaw Medical Transportation, Inc., d/b/a American Medical
Response ("AMR") and the CITY OF CHULA VISTA, a chartered municipal
corporation ("City"), with reference to the following facts:
A. Concurrently herewith, City, AMR, the City of Imperial Beach ("Imperial
Beach"), and the Bonita/Sunnyside Fire Protection District ("District') are entering into
that certain Amended and Restated Agreement for Basic and Advanced Life Support
Ambulance Services (the "EOA Agreement"), whereby AMR agreed to provide
emergency ambulance services for the City, Imperial Beach and the District
(collectively, the "Participating Agencies") within their defined "exclusive operating
area" ("EOA"). City, AMR and/or its predecessor companies have been providing
ambulance transport in the same manner and scope within the EOA since prior to
1980.
B. Sections 10 and 22 of the EOA Agreement provide each
participating agency with the authority to enter into agreements with AMR that
modify EOA Agreement requirements and standards within their respective
jurisdictions and/or allow for AMR to subcontract for ALS First Responder
Services therein.
C. In accordance with this authority, City and AMR desire to enter into this
Agreement in order to provide for specific terms and standards for the administration of
emergency medical response and transport services within the City.
NOW, THEREFORE, in consideration of the foregoing premises, and for good
and valuable consideration, the receipt and sufficiency of which the parties hereby
acknowledge, the parties agree as follows:
1. Contract for Services.
1.1. City Services.
1.1.1 In General. In order to facilitate performance by AMR of its
obligations within the City under the EOA Agreement, and to improve the
availability of advanced life support services provided within the City, AMR
4821-0799-9762.2 1
agrees to contract with City for City to provide to AMR certain emergency
medical response and transportation support services ("Support Services:"). City
supplied Support Services shall include the following: (1) emergency medical
dispatch services which are purchased by. City from the City of San Diego
("Dispatch"); (2) on-scene advanced life support equipment, and supplies ("ALS
Equipment and.Supplies"); (3) Zoll Defibrillator/Monitors as standard equipment
on each of the first responder engines within the City ("Defibrillators"); (4) EOA
contract oversight and administration ("Contract Oversight and Administration");
and (5) first responder advanced life support services delivered using fire engines
and trucks ("FRALS Services").
1.1.2 Service Standards. City shall provide AMR with Support Services
in accordance with mutually agreed specifications and protocols. At a minimum,
all Support Services shall be provided in accordance with (a) all applicable
federal, state and local laws and regulations, including, without limitation the
Emergency Medical Services System and Pre hospital Emergency Medical Care
Personnel Act set forth in California Health and Safety Code Sections 1797, et
seq; and regulations thereunder, and (b) any and all applicable standards and
requirements set forth in City's agreement with the County of San Diego entered
into effective June 1, 1991 regarding the provision of"EMT-Paramedic Services"
within the EOA (the"County/City EMS Agreement").
1.2 Coordination and Adjustments in AMR Services.
1.2.1 Response Time Requirements.
a. AMR shall respond to ALS emergency calls and reported structure fires,
in accordance with the response standards set forth in Sections 1.2 and 1.3 of the EOA
Agreement within the City's response zone.
b. At reported structure fires, AMR transport vehicles so dispatched shall
remain on site until released by the City's incident commander.
C. AMR shall utilize third party mutual aid support as necessary to meet
response time requirements.
1.2.2 Paramedic Coordination, Transport and Staffing. Whenever City's
paramedic is the actual "first responder" that initiates care, City's paramedic shall
make clinical decisions until such time as an AMR paramedic arrives at the scene.
Upon arrival, and after consultation with the City's paramedic, AMR's paramedic
may assume medical control to make decisions regarding treatment, transport
destination, and whether the City paramedic needs to accompany the patient to the
hospital. The paramedics from the City and AMR shall work together to provide
patient care on scene and en route to the hospital. In the event of a dispute
between City's paramedic and AMR's paramedic, such dispute shall be resolved
through base hospital medical direction. AMR shall be responsible for arranging
and paying all costs to transport City's paramedic(s) back to the station to which
4821-0799-9762.2 2
such paramedic(s) are assigned, as soon as possible following arrival of the
ambulance at the hospital; provided, however, City agrees that if a patient is
transported to Scripps Chula Vista or Sharp Chula Vista hospitals, City shall pick
up City's paramedic(s) at such facility at no cost to AMR.
1.2.3. Additional Requirements and Implementing Agreements. Any
additional system specifications or protocols, or agreements that modify or
implement the specifications and protocols already set forth in this Section 1 shall
be agreed upon by the parties, memorialized in writing and attached hereto as
Appendix 1.
2. Payments to City for EMR Support Services.
2.1 . In General. In consideration of City's agreement to provide Support
Services, AMR agrees to make payments to the City in quarterly installments (the
"Quarterly Support Services Payment") in the initial amount of $652,226 per
quarter. The amount for the Quarterly Support Services Payments to the City is
based on City's annual costs for Support Services. Quarterly Support Services
payments shall be increased in each year of the term to account for increased city
service costs. City costs for Support Services, including the projected annual
increases, are more particularly set forth on Exhibit A attached hereto.
2.2 Payment Schedule. The first Quarterly Support Services Payment shall be
due and payable in arrears January 1, 2019, for the period October 1, 2018
through December 31, 2018. Thereafter, each subsequent Quarterly Support
Services Payment shall be due and payable, in arrears, on each April 1St, July 1St,
October 1St and January 1St thereafter, throughout the remaining term of this
Agreement.
2.3 Authority. The parties acknowledge and agree that the City's rights to,
and the amount of, the Quarterly Support Services Payment was negotiated and
agreed to based upon each party's consideration of the following facts: (a) City's
lawful authority with respect to the delivery of emergency medical services within
the EOA and the City; (b) the City projected its Quarterly cost for the Support
Services it is providing AMR hereunder to be in excess of the Quarterly Support
Services Payment to be paid by AMR in consideration for such services; (c)
AMR's determination that the Quarterly Support Services provide value to the
services that it delivers within the City under the EOA Agreement that is equal to
or greater than the value of the Quarterly Support Services Payments; and (d) the
parties have determined that the Quarterly Support Payments are consistent with
the types of payments approved in advisory opinions issued by the Office of
Inspector General of the Department of Health and Human Services and with the
OIG's Compliance Program Guidance for Ambulance Suppliers.
2.4 Potential for Additional Cost Recovery and/or System Enhancements.
4821-0799-9762.2
3
2.4.1 In addition to the Support Services for which City is compensated
hereunder, City provides additional EMR support services, and incurs additional
costs in connection therewith, for which, currently, City receives no compensation
hereunder. The parties agree to meet and confer in order to evaluate such
additional costs and to determine what, if any, additional compensation should be
provided to City on a prospective basis as consideration therefor, consistent with
all applicable laws, generally accepted accounting principles, and the parties
mutual desire to maintain superior clinical care, meet changes in technology and
clinical advancements, and maintain competitive and reasonably priced medical
transport rates within City boundaries. Any changes under this Section shall be set
forth in a written agreement between the parties.
2.4.2 In the event that City requests additional services or system
enhancements from AMR above and beyond that required by prevailing industry
standards or applicable laws and regulations, AMR may request additional
compensation to offset additional costs related thereto and City agrees to meet and
confer with AMR to negotiate same.
3. Maximum Authorized Base Rate. AMR's maximum "Base Rates" per transport
as set forth in the EOA Agreement may be increased so that the maximum
adjusted Base Rates within the City ("Maximum City Base Rates") shall be as
follows:
October 1,2018 October 1,2019 October 1,2020
ALS1 $2,967.48 $3,434.44 $3,881.56
ALS2 $3,147.57 $3,614.53 $4,061.65
BLS
Svcs $1,076.11 $1,183.72 $1,302.09
Ancillary rates may be adjusted from time-to-time by AMR in accordance with
the EOA Agreement.
4. Material Change. In the event of a material change or potential material change
that will effect a Party, the affected Party shall send written notice to the other
Party to meet and confer on the impact of the material change. Material changes
may include, but are not limited to, changes in laws, rules, regulations, payer mix,
healthcare transportation delivery and utilization, clinical standards, payer
reimbursement practices, the costs to provide services and/or a 3% point change
to the annual marginal collection rate (from the current 11.4% marginal collection
rate, e.g., 8.4% or 14.4%).
5. Term. Unless earlier terminated as provided herein, the term of this Agreement
shall run concurrent with the term of the existing EOA Agreement and any
extension thereof.
6. Relationship to EOA Agreement and Previous Administrative Agreements. This
Agreement.shall amend the EOA Agreement as it relates the City and AMR's
4821-0799-9762.2 4
operations within City boundaries,but shall not amend the EOA as it relates to the
other Participating Agencies. In the event of any inconsistency between this
Agreement and the EOA Agreement, the terms of this Agreement shall govern.
All previous Administrative Agreements have no further force nor effect.
7. Certification of Costs.
7.1 During the term hereof, on or before November Is' each year, City shall
certify to AMR that the funding received for Support Services in the prior fiscal
year did not exceed the costs to the City of providing such services. In the event
that funding received from AMR for Support Services exceeds City's costs
incurred in connection therewith for the prior fiscal year by three percent (3%) or
more, up or down (a "Material Variation"), the parties shall meet and confer in
accordance with Section 4.
7.2 During the term of this Agreement, on or before November Is` of each
year, AMR will make available to City financial data showing for the 12-
month period, the payer mix, number of transports, current collection rate and
estimated Marginal Collection Rate for any adjustment to fees. The parties
agree that this information will remain proprietary and confidential and shall
be utilized by City solely to verify AMR's compliance with the terms of the
EOA Agreement and this Agreement, and to determine if amounts being
charged are reasonable and necessary. City agrees to assert applicable
statutory or case law exemptions to the California Public Records Act in
response to third party requests for any proprietary and confidential
documentation provided to the City hereunder. AMR shall be required to fund
any legal defense resulting from such requests.
8. Compliance. The parties will comply in all material respects with all
applicable federal and state laws and regulations including, the federal Anti-
kickback statute. The payments set forth in this agreement and the EOA
Agreement shall be used only for City emergency medical response services or
system enhancements. The City warrants and represents that the payments
made by AMR to City shall be less .than or equal to the City's calculations of
its actual costs to provide those Support Services. No funds shall be used by
the City in a manner that may violate 42 U.S.C. Section 1320a-7b, the federal
Anti-Kickback Statute.
9. Compliance Program and Code of Conduct. AMR has made available to
each party a copy of its Code of Conduct, Anti-kickback policies and .other
compliance policies, as may be changed from time-to-time, at AMR's web site,
located at: www.amr.net, and each party acknowledges receipt of such
documents. AMR warrants that its personnel shall comply with AMR's
compliance policies, including training related to the Anti-Kickback Statute.
10. Non-Exclusion. Each party represents and certifies that neither it nor any
4821-0799-9762.2 5
practitioner who orders or provide services on its behalf hereunder has been
convicted of any conduct that constitutes grounds for mandatory exclusion
as identified in 42 U.S.C.§ 1320a-7(a). Each party further represents and
certifies that it is not ineligible to participate in Federal health care programs
or in any other state or federal government payment program. Each party
agrees that if DHHS/OIG excludes it, or any of its practitioners or
employees who order or provide Services, from participation'in Federal
health care programs, the party must notify the other party within five (5) days of
knowledge of such fact, and the other party may immediately terminate this
Agreement, unless the excluded party is a practitioner or employee who
immediately discontinues ordering or providing services hereunder.
11. Referrals. It is not the intent of either party that any remuneration, benefit
or privilege provided for under this agreement shall influence or in any way
be based 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 the specific services described herein or in the
EOA Agreement. Any payments specified herein are consistent with what the
parties reasonably believe to be a fair market value for the services provided.
12. General Provisions.
12.1 Authority. Each party represents that it has the full right, power and
authority to execute this Agreement and to perform is obligations hereunder,
without the need for any further action under its governing instruments, and that
the parties executing this Agreement on behalf of such party are duly authorized
agents with authority to do so.
12.2 Counterparts. This Agreement may be executed in multiple copies, each
of which shall be deemed an original, but all of which shall constitute one
Agreement after each party has signed such a counterpart.
12.3 Entire Agreement. This Agreement, together with all other agreements
expressly referred to herein, constitutes the entire agreement between the parties
with respect to the subject matter contained herein. All prior or contemporaneous
agreements, understandings, representations, warranties and statements, oral or
written, are superseded.
12.4 Governing Law. This Agreement shall be governed, interpreted,
construed and enforced in accordance with federal law, as applicable, and the
laws of the State of California.
12.5 - No other inducement. The making, execution and delivery of this
Agreement by the parties hereto has been induced by no representations,
statements, warranties or agreement s other than those expressed herein.
12.6 Severability. If any term, provision, covenant or condition of this
Agreement is held to be invalid, void or otherwise unenforceable, to any extent,
4821-0799-9762.2 6
by a court of competent jurisdiction, the remainder of this Agreement shall not be
affected thereby and each term, provision, covenant or conditions of this
Agreement shall be valid and enforceable to the fullest extent permitted by law.
12.7 Remedies; Arbitration. Each party shall have any and all remedies
available at law or in equity to enforce the terms of this Agreement or to resolve
any dispute hereunder. Notwithstanding the foregoing, prior to initiating any such
remedy, the parties may 'agree to attempt to resolve their dispute through
arbitration. The arbitration shall occur within San Diego County on mutually
agreeable terms. Each party shall bear its own costs. The arbitration shall be non-
binding unless the parties otherwise agree.
[Signature Page Follows]
4821-0799-9762.2 7
SIGNATURE PAGE
TO ADMINISTRATIVE AGREEMENT
FOR THE PROVISION OF
EMERGENCY MEDICAL RESPONSE SUPPORT SERVICES
[CHULA VISTA]
IN WITNESS THEREOF, the parties have caused this Agreement to be
executed and effective as of the Effective Date.
"CITY"
CITY OF CHULA VISTA
Mary Casillas Salas,
Mayor
Attested By
Kerry Bigelow,
City Clerk
Approved as to form By
Glen R. Googins,
City Attorney
"AMR"
AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.
a Delaware Corporation
Edward B. Van Horne
President and CEO
1
4821-0799-9762.2 8
EXHIBIT A
EMS Program Summary October
2018 to September 2021
Oct 2018 to Sept 2019 Oct 2019 to Sept 2020 Oct 2020 to Sept 2021
Salaries
EMS Staff $ 545,015 $ 584,880 $ 595,702
EMT Differential Pay $ 203,766 $ 219,271 $ 224.971
Paramedic Differential Pay $ 946,172 $ 1,184,577 $ 1,344.257
Salary&Benefit Total 1,694,954 $ 1,988,728 $ 2,164;930
Training& Education
FTO $ 3,000 $ 3,000 $ 3,000
Cont.Education/Recert Fees $ 66,255 $ 62,309 $ 71;848
Training&Education Total $ 69,255 $ 65,309 $ 74;848
Materials,Supplies,& Services
ALS Equipment $ 110,415 $ 120,556 $ 123,700
Professional Services $ 35 $ 35 $ 35
Dispatch $ 391,000 $ 391,000 $ 391,000
Materials,Supplies,& Services
1 $ 501,450 $ 511,591 $ 514;735
Capital Equipment
Uniforms $ 1,000 $ 1,000 $ 1,000
Cardiac Monitors $ 214,000 $ 214,000 $ 214,000
Fleet Maintenance/Fuel $ 42,000 $ 42,000 $ 42,000
Capital Equipment Total $ 257,000 $ 257,000 $ 257;000
7.5%Salary Contingency $ 86,246 $ 105,289 $ 117,693
$ 343,246 $ 362,289 $ 374.693
GRAND TOTAL: $ 2,608,904 $ 2,927,916 $ 3,129,205
Qtrly
Pmt $ 652,226 $ 731,979 $ 782,301
4821-0799-9762.2 9
Exhibit A
Chula Vista Attachment 3
Administrative Agreement
Base Rate Schedule
FY19 FY20 FY21
10/1/18- 10/1/19- 10/1/20-
Current
0/1/20-
Current 9/30/19 9/30/20 ' 9/30/21
Rate Increase Required -ALS
AMR Annual Rate Increase 129.20 142.12 156.33
Chula Vista First Responder Fee 172.63 324.84 290.79
Total Increase to Base Rate-Chula Vista 301.83 466.96 447.12
Resulting Base Rate
ALS 2,665.65 2,967.48 3,434.44 3,881.56
ALS2 2,845.74 3,147.57 3,614.53 4,061.65
BLS 978.28 1,076.11 1,183.72 1,302.09