HomeMy WebLinkAbout2011/06/21 Item 10CITY COUNCIL
AGENDA STATEMENT
~V/~ CITY OF
'~`CHULAVISTA
June 21, 2011 Item~~
ITEM TITLE: RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CHULA VISTA APPROVING A REVISED AND RESTATED
AGREEMENT FOR BASIC AND ADVANCED LIFE
SUPPORT SERVICE AND AN ADDITIONAL SIDE LETTER
AGREEMENT TO RECOVER EXISTING PROGRAM
EXPENSES WITH LAIDLAW MEDICAL
TRANSPORTATION INC, DBA AMERICAN MEDICAL
SUBMITTED BY:
REVIEWED BY:
RESPONSE, AND AUTHORIZING
EXECUTE THE AGREEMENT.
FIRE CHIEF
CITY MANAGER
THE MAYOR TO
4/STHS VOTE:
SUMMARY
YES ~ NO ~X
On December 11, 2007 the City Council approved the Revised and Restated Agreement
with American Medical Response (AMR) for Basic and Advanced Life Support Ambulance
Service (2007 Ageement). The 2007 Ageement became effective for the period of
December 11, 2007 through May 31, 2011. The 2007 Ageement contained a provision for
two additional three-yeaz extensions for AMR to continue providing ambulance services
subject to the City's discretion. The 2007 Agreement also contained a provision for AMR to
request rate adjustments for ambulance services. The current Ageement was temporarily
extended for a period of thirty days and will expire on June 30, 2011. This resolufion will
extend the ageement with AMR for a period of three additional yeazs and provide an option
to extend the ageement another three yeazs. The Agreement also contains a "termination for
convenience" clause in favor of the City. This agreement will increase the ambulance
service rate by 7% each year. The side letter agreement with AMR wil] provide a pass
through fee to the City for Emergency Medical Services related expenses to be recovered.
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
10-1
June 21, 2011, Item ~_
Page 2 of 5
to Section 15060 (c) (3) of the State CEQA Guidelines the activity is not subject to
CEQA. Thus, no environmental review is necessary.
RECOMMENDATION
That Council approves the resolution.
BOARDS/COMMISSION RECOMMENDATION
Not Applicable.
DISCUSSION
The City is authorized by Government Codes Section 38794 and Municipal Code
sections 5.10.310 - 5.10.340 to contract for ambulance services. The City has contracted
with Laidlaw Medical Transportation, Inc. dba American Medical Response (AMR) for
the provision of Basic and Advanced Life Support Ambulance services since 1989. The
current agreement permits AMR to provide services to an Exclusive Operating Area
(EOA) that was adopted by the County of San Diego. This EOA consists of the City of
Chula Vista, Bonita/Sunnyside Fire Protections District, and the City of Imperial Beach.
On December 11, 2007, the City Council adopted a revised and restated agreement (2007
Agreement) with AMR that clarified and reinforced the following key stipulations:
• Defmition of service requirements and performance standazds to optimize service
delivery
• Minimum resource requirements for the number of ambulances, staffing and
equipment to be deployed for the provision of service
• Provisions for termination that would provide the City with adequate notice in order
to avoid service interruptions
• Insurance requirements for motor vehicles operated by AMR in order to protect the
City from liability
• Hold harmless provisions that indemnified the City from liability arising from
negligence acts or omissions resulting from AMR's performance
• Renewal provisions that provided the flexibility to extend the agreement at their own
discretion
This agreement will continue to clarify and reinforce the key provisions stated above. The
side letter agreement also adds a method of recovering existing City expenses related to the
City's service of delivering Emergency Medical caze. Specifically, the City is currently
spending $54,000 annually on Basic Life Support equipment and training and an additional
$368,000 annually for the EMS related dispatching contract with the City of San Diego.
Increasing the ambulance rates that AMR collects an additional $264.32 per transport will
yield the City $422,000 in additional revenue to recover current expenses.
The City is working on enhancing our emergency medical services capabilities to our
citizens and throughout the EOA system. In that effort, the City has been working with
AMR to develop a plan to move Fire Department first response to the advanced life
support ("ALS") level. The City believes that changing to an ALS first response system
10-2
June 21, 201 I, Item
Page 3 of 5
will dramatically improve patient care and outcomes. It will also benefit AMR directly
with increased operational efficiencies and costs savings as the transport agency.
Working with AMR, the City moved a Battalion Chief position to a special project
assigtunent last year to work on the ALS plan. Funding for this position was provided by
AMR with the agreement that an increase in ambulance rate fees would be used to
reimburse AMR for the funding. The previous contract, at the request of the other
contracting parties, contained side-letter agreements establishing different rates for each
entity. Chula Vista's side letter provides AMR the ability to collect an additional $33.10
in ambulance service rate per year for the next three years. The recovered expense of this
ALS Plan is $167,000, which reflects the cost of the special assignment.
The ALS plan has been developed and the City and bargaining group (Local 2180)
continue to negotiate on labor issues related to the program. Once completed, an
amendment will be necessary to the side letter between the City and AMR providing for
Paramedic First Response from the City and a change in the ambulance service rates
collected by AMR to fund the ALS program. Staff will return to Council with a full
report detailing the service rate increase and implementation plan for ALS.
Request for Increase in the Basic and Advanced Life Support Ambulance Transport
Rates
Pursuant to Section 5.7 of the revised and restated agreement, AMR has the reserved
right to request a fee increase in the event of extraordinary cost increases occurring in any
of the contract yeazs. Extraordinary costs are defined as an increase of 20% or more from
the previous contract year in any of the following categories:
• Vehicle physical damage insurance
• Professional liability insurance
• Worker's compensation insurance
• General Liability Insurance
• Gasoline, diesel, propane, oil and petroleum products
• Pharmaceuticals or medical supplies
Accordingly, the City Council reserves the right to approve or disapprove such a request.
As part of this revised and restated agreement, AMR is seeking a 911 rate adjustment.
This adjustment would bring the ALS Emergency Base Rate to $860.90. This rate
remains in the lower 30% of rates found in Southern California and is substantially below
the Average Base Rate experienced in San Diego County, which is approximately
$1,591.00.
The justification for increasing the ALS emergency ambulance transport fee to $860.90
and allowing this rate to increase by 7% each year throughout the contract extension
period ending May 31, 2014 is attached and contained in an issue paper prepared by
AMR titled:
"American Medical Response, Ambulance Rate Increase Justification, June 2011"
10-3
June 21, 2011, Item rr
Page 4 of 5
City of Chula Vista AMR Proposed ALS Rate Schedule:
Contract Year Base Rate Requested
Rate Year 1 Rate Increase Annual
Ad'ustment
Current $ 804.58 $ 860.90 $ 56.32 7%
Jul 2011/12 $ 860.90 $ 60.26 7%
July 2012/13 $ 921.16 $ 64.48 7%
July 2013/14 $ 985.65 $ 69.00 7%
City of Chula Vista AMR Proposed Rate Schedule (with Chula Vista Pass Through
Fees):
Contract Base Defibrillators ALS Study 80% of BLS Total
Year Rate * Repayment Dispatch Equipment
(3 yes) Contract and
materials
Current $804.58
July $860.90 33.10 232.32 32.00 $1,276.90
2011/12
July $921.16 33.10 232.32 32.00 $1,337.16
2012/13
July $985.65 n 33.10 232.32 32.00 $1,401.65
2013/14
*The defibrillator replacement is already part of the 2007 agreement. The new agreement
simply continues it.
DECISION MAKER CONFLICT
Not Applicable
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.
CURRENT YEAR FISCAL IMPACT
There is no current year fiscal impact associated with this request.
ONGOING FISCAL IMPACT
A positive impact to the general fund is anticipated as a result of reimbursements from
the transport fees of approximately $422,000. It is the recommendation of the Fire
Department that these funds be set aside in the Fire Equipment Replacement Fund to fund
future equipment needs including the replacement of Fire Appazatus. Once the fee has
been in place and the actual funds available are identified, the Fire Department will return
for Council authorization to transfer the funds to the Fire Equipment Replacement Fund.
10-4
June 21, 2011, Item ~(~
Page 5 of 5
At the same time a recommended policy discussing the authorized use of the Fire
Equipment Replacement Fund will be brought forward for Council consideration.
ATTACHMENTS
1) American Medical Response, Ambulance Rate Increase Justification, June 2011
2) Revised and Restated Agreement for Basic and Advanced Life Support
Ambulance Services and Amendment to Agreement
3) Amendment to Ambulance Service Original Agreement between American
Medical Response Ambulance Service, Inc. and the City of Chula Vista
Prepared by: Dave Hanneman, Fire Chief, Fire Department
10-5
.,shibit °A°
Hquigmeat List
4x4 Non Sterile
4xd Steve
ABD Pads
Ace W raps 3' •
band Aids
Chux •
Cold Packs
Defib Pads
Eye Pads °
Flashlight °
Hot Packs
Keriix •
Occlusive Dressing •
Sam Splints
Stethoscope
Tape -1 ° Transpore
• Tape -1° Waterproof
Tape -2" Bron
Trauma Dressing
Trauma Shears
Triangu(arBandage -
Toumlquet -
Bulb Syr(nge
02 Wrench, small
KY Jelly Packets-
. Nasal Airway 12-36 fr •
. Oral Airway, 0-5
Nasal Cannuta, Adult
Nasal Cannuia, Ped
02 Mask, NRB, Adult
02 Mask NRB, Pad
02 Mask, Ped
Collar each size
NS, 500cc, Stenle
Water, 50'dcc, Sterile
Sharps Container
Splini Arm & Leg each
"
izers
Sta-8loks, Head Immobil
Ambu-Bag, Adult set
• Ambu-Bag, Ped. Set
+ Amhu-Bag, Infant set
• Mask, Resuscitator, pad
Qxygen
02 Rings
02 Wrench
02 Humidifier
02 Nebulizer Set
02. Nebulizer Adult
02 Nebulizer Ped
NaCI Bullet, 3cc .
Suction Cannister, 800cc w/Iid
Suction Cannister, 12QOcc w/ Ild
Suction Cath. Rigid Tip
Suction Cath, Flexible, 6-18 fr, Each
.Suction ConneGion Tubing
Suction, Portable
B/P Cuffs (Adult, Thigh, Ped, Infant)
Gloves, Exam, Box each small, rned,.large
Gbves, Stenle, pr Each 7,8
Hydrogen Peroxide
Mask, Surgigl
Mask, Hepa
OB KR
Plastic Bags, Clear Large
Plastic, Bags, Clear, small
Plastic, Bags, Red
Plastic, Bags, Yellow, Large
Mask, Resuscitator, Infant
10-6
EXHIBIT B
Imperial Beach/ Bonita
Paramedic Response Compliance Report
Reporting Period
through
Imperial Beachl Bonita
Contractual Compliance
Responses Transports Exceptions
0 0 0
Compliance
00.00%
Subzone Operational Performance
Area Responses Transports
Bonita 0 0
Imperial Beach 0 0
Exceptions
0
0
Granted
Exemptions
0
Granted
Exemptions Compliance %
0 OO.DO%
0 00.00%
ConPidenrial and Prop rie~ary Info rmalion, Not for Public Distnbu[ion.
Form and Format, ,c) 2007, Amorican Medical Response, Inc.
10-7
PARAMEDIC UNIT RESPONSE TIME SUMMARY
District: Bonita
PERIOD: Through
Final Report
Response Times (Received Total Runs Adjusted
to On Scene) Exempt Runs Percent Accumulative%
00:00-01:00 MIN 0 0 0.00% 0.00%
01:01-02:00 MIN 0 0 0.00% 0.00%
02;01-03:00 MIN 0 0 D.00% 0.00%
03:01-04:00 MIN 0 0 0.00% 0.00%
04:01-05:00 MIN 0 0 0.00% 0.00%
05:01-06:00 MIN 0 0 0.00% 0.00%
06:01 - 07:00 MIN 0 0 0.00 % 0.00
07:01-08:00 MIN 0 0 0.00% 0.00%
08:01-69:00 MIN 0 0 0.00% 0.00%
09:01 - 10:00 MIN 0 0 0.00% 0.00%
10:01 - 11:00 MIN 0 0 0.00% 0.00
11:01-12:00 MIN 0 0 0.00% 0.00%
Total Exemptions Requested: 0 Adjusted Compliance With
Total Exemptions Granted: 0 Granted Exemptions: 00.00
12:01-13:00 MIN 0 0 0 0.00% 00.00%
13:01-14:00 MIN 0 0 0 0.00% 00.00%
14:01-15:00 MIN 0 0 0 0.00% 00.00%
15:01 - 16:00 MIN 0 0 0 0.00% 00.00%
16:01 - 17:00 MIN 0 0 0 0.00°/ 00.00
17101 - 18:00 MIN 0 0 0 0.00% 00,00%
18:01 - 19:00 MIN 0 0 0 0.00 % 00.00%
19'.01-20:00 MIN 0 0 0 0.00% 00.00%
20:00 MIN OR GREATER 0 0 0 0.00 % 00.00%
TOTALS 0 0 0 00.0 % 00.00
Total Transports 0
Average Paramedic Response Time: 0.00
Prepared by William Meixner, AMR -San Diego, Utilizallon Analyst
10-8
PARAMEDIC UNIT RESPONSE TIME SUMMARY
District: Imperial Beach
PERIOD: Through
Final Report
Response Times (Received Total Runs Adjusted
to On Scene) Exempt Runs Percent Accumulative
00:00 - 01:00 MIN 0 0 0.00 % 0.00
01:01 - 02:00 MIN 0 0 0.00% 0.00%
02:01-03:00 MIN 0 0 0.00% 0.00%
03:01-04:00 MIN 0 0 0.00% 0.00%
04:01-05:00 MIN 0 0 0.00% 0.00%
05:01-06:00 MIN 0 0 0.00% 0.00%
06:01 -07:00 MIN 0 0 0.00% 0.00%
07101-06:00 MIN 0 0 0.00% 0.00%
08:01 -09:00 MIN 0 0 0.00% 0.00%
09:01-10:00 MIN 0 0 0.00% 0.00%
10:01-11:00 MIN 0 0 0.00% 0.00%
11'01 - 12:00 MIN 0 0 0.00% 0.00%
Total Exemptions Requested: 0 AdJusted Co mpliance With
To[al Exemptions Granted: 0 Granted Exemptions: 00.00
12:01-13:00 MIN 0 0 0 0.00% 0000%
13:01 - 14:00 MIN 0 0 0 0.00% 00.00
14:01 - 15:00 MIN 0 0 0 0.00% 00.00
15:01-16:00 MIN 0 0 0 0.00% 00.00%
16:01 - 17:00 MIN 0 0 0 0.00% 00.00%
17:01 - 18:00 MIN 0 0 0 0.00% 00.00
18101 - 19:00 MIN 0 0 0 0.00% 00.00%
19:01-20:00 MIN 0 0 0 0.00% 00.00%
20:00 MIN OR GREATER 0 0 0 0.00 % 00.00%
TOTALS 0 0 D 00.0% 00.00
Total Transports 0
Average Paramedic Response Time: 0.00
Prepared by William Meitner, AMR -San Diego, Utilization Analys[
10-9
PARAME171C UPVIT RESPONSE 71ME SUMMARY
district. Chula Vista
PERIOD: Through
Final Report
Response Times (Rereivetl Total Runs
to On Scene) Exempt
00:00 - 01:00 P41N 0
O i:01-02'AO MIN 0
02,01-03:00 MIN 0
03.01 -04.00 MIN 0
04'.01 - OS.OC MIN 0
05:01-06:00 MIN 0
06'.01 -07'.00 MIN 0
U7',01 - 08:00 MIN 0
0801 - 09.00 MIN 0
09:01-10:00 MIN 0
Total Exemptions Requested: 0
Total Exemptions Granted : 0
10'.CI - 11:00 MIN 0 0
11:01-12:00 MIN 0 0
1201 - 13:00 MIN 0 U
13101-14:00 MIN 0 0
14'.01 - 15'.00 MIN 0 0
15:01-16:00 MIN 0 0
1601-17.00 MIN 0 0
17:01-18:00 MIN 0 0
18'.01 - 19:00 MIN 0 0
1901-20:00 MtN 0 0
20'.00 MIN OR GREATER 0 0
TOTALS 0 0
Total Transports D
Average Paramedic Response Time', 0.00
Prepared by William Meixner, AMR -San Dicgc, Utilization Analyst
Adjusted
Runs Percent Accumulative
0 0.00 % 0.00
D ooo% o.oo%
0 0.00 % 0.00
0 0.00% 0.00
0 O.CO% 0,00%
0 0.00% 0.00%
0 0.00 % 0.00%
0 0.00°% 0.00%
0 0.00 % 0.00
0 0.00 % 0.00%
Adju sted Compliance With
Granted Exemptions: 00.00
0 0.00% 00.00%
0 0.00 % 00.00%
0 0.00 % 00.00
0 0.00% 00.00°
0 0,00% 00.00%
0 0.00% 00.00%
0 000% 00.00%
0 0.00% 00.00%
0 0.00% 00.00%
0 0.00 % OO.OC%
0 0.00% 00.00%
00 00.0% 00.00%
10-10
~tP`e~ir~tF , Exhibit C
fiY ~ q
~ O
~ _ _ ~
saN ~tw.vo ~ w
Paramedic Excepfiion Report
Response Exemption Request Form
Unit: Incident #:
Location:
M Received: Dispatched:
Crew Members:
Responded From:
I Dispatcher'.
Dispatcher
Notes:
Exception
Notes:
Date: Compliance Zone: I
Enroute: Onscene: Dispatch Time: Response Time:
Aire Departmen4 Review
Reviewer's Comments:
Request Approved (or Exemption ~ Request Denied '.
I
Reviewed by (print).
Reviewer's Signature=
_. _ _
_-
~~-~~
Exhibit D
SOUTH BAY FEE SCHEDULE
CHARGE BONITA CHULA VISTA IMPERIAL BEACH
ALS Base Rate $ $ - $ -
ALS 2 Base Rate $ - $ - $ -
8L5 Emergency Base Rate $ - $ - $ -
Mlleage $ - $ - $ -
Oxygen $ - $ $ "
Night Charge $ - $ $ -
Treatment only $ - $ - $
"*additional supplies as used
~~-12
EXHIBIT E
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 CG0001 or equivalent)
2. Insurance Services Offce 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
projecUlocation 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
damage.
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:
$2,000,000.00 each occurrence
1
10-13
Deductibles and Self-Insured Retentions
Any deductibles or self-insured retentions must be declared to the City.
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:
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 in 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 fhe 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.
10-14
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 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. All coverage for sub-consultants are
subject to all of the requirements included in these specifications.
10-15
_.. ' _ p p '' iI g ','z ~p ~r S a ,
rs ~~P:; ~..s1~A"5. F) N~~Ila+.~ ~~ A' ~~C` , G~k'a ~~~F N IIJ~k~ N.o-'. ~'~~h`5;~i 11~R3~B.., 9.s ll.nl
fie. C ~'e. } _
Y1~IS t~~H'fl~fi( Pfd 15,c5UELl r,,6,'l f5}l7fFh~G'G If41 ~~*hlRTlt7id OSSL'/ R1QE? CP9!;EEr3a GCZ RsQI['$S' tTG~d TH>_ ~t[SIrF4G`8kl" H~llggE•H TFtl3
c,rkd tl PUfsiL U(7r5 SdOf ns F7E1 tf1ATISE6 t OCi 9JGC.k79VEiR RonCNTJx ~:CTEfIb Ori P8L%'t`El THS C~sjltrWG~rrE ~[FFd li f7EU H'f 7lit F'(7l.ICJE's
81=LOifV, TFiiS CEF"fIFtCAT OF IRdSUWPx3dr~ rJrJES- i7+?T CgtJSSiTtsTP A c;9iJlh'A[:'l ur, I1VEk'N 'tHL- I°i33;gggyY3. [7~I.,.UHC-Fd{S),. J11P3,g6ftl,rEi_1
h~i^r~ESEPJ3R91Y/>_ c>li Fnd~IJ'LLR, REiCJ i"fJ€'t k?R7IFICATL IS,r:P60Cfi _
IPdr(JNE tSAC If the r_aril leak nraltP:-rr ua a.6)7Jk~f[CJll rf IIJ"Lr{AfU tCle ~{rufloy~rL Jl luek iSL am3ovsRU. tfbYi9'Fikd~A.IJi•l Ci `AtRIIr~Li, cutbJacl 1.+.r
Ehe tornxa artd. ctrhril6'llya,-. vY} Pha rnGUnJ :ny qu€fl FlioRaar_ ~ n+,o„ f+giWrs ..tr Lri+'lr~•eerrletdL k1 afl.l7am.en4 vn Cpfs cerGlicule dorio neY e:~nfsr rtplrt~ to Ftra
~artlPlsisC hnl }ar Na mars a+araolt orsdal ^IPRAfr.,-. ~..._...... .. ...........s.~.,..~ ..•,,,>.......~.,;. _._„m.,,_ .~.,,..•..,.,-
IRGt1llLF Na.PL .. ._._.~.. ._ ._ .._..
lS V 1 w'10> All V PPiotre 7111[ PA+~"_
91 I 111 f [111111 ir1 ~~~ ~~~~ ~~ ~ I ;;tnPP _ __
P mai,il Y IA
I I;`~,I,1, ~>a ~ ' Exhibit E ~~':11
rrr„an :~r~ ... .... ..
L`NLIFSO
F'Ik {' h!;fi;f l91" I AI dq,}Tl!CL W ulxBrpCfl
E':w ~AIJI"I 15}G:A~q{x4i4JSY,"pIC f'iCE}
Ir7 GN':iv =Lli l'ILLi;lSk, Ct] lxti tt•It77
1
7~tL
fyl Ic C~,I FDTIFYTIi~'rl lac n4Hat
2tJY EE(
C yr R
`a 11M` +ziera
CCa166N ru~s se "~ ~..,~..
Y 7EI7P1 I:1H P7C+F117171C"51S l7F 1d11 _ _
t Ci^LT$T:QIT
4f gTPIQ1 U
Gf'6kfL'h11" 4VLTd! •3LGU'PF:L
B W41 1 !'s '
to f
aY. 4TEP7 M1!I vl lCl d°~TI i R
~ I~ uLir rrH binw v
+ rAla lnl
-r rn Ir ";u,aurac~ nrFr~z~om sr r rl~ ~a~El~l~s 17~~uu1~~~ ~I~1+€.Ir! r.~ ,u~ IECt ers n~.t, ![I, r rtes,
~y u
~,v ~
~t~ii ~a F L
'
:
h
N
~
LIC ,
S L
I
11111s, SF'~41N ht YH~1511: 13F„Ttd R
18'34JrEP 4Y P
+i64ltlIA1
_ .
._ _
Insw a
-
1
.
1= VNI7 CCSl lOI lt7h r~[
-_. _' (7
]7`a5[
$$ c
'ZiI21T-
P
r xu vil~lMlt~ r~ )11'VFf 1'~Yi iR,\j ~•f -
IIF1I4'
--
1rn~ t>I> uF 10°awnNt r , ._.~,.
NI t'A[LI~~IIIW ~- 7t~k3u.2
I 1L:1R
~
1JAU4J[rOFIfiU.4. _
h ~Y'7 p[fEF'Ff
[lAA ;.7 M'I fii
..
_
..
V}
UQ ry
~
~~I 5
, w ;E1
rW 3 5l P'8difmjiq' ,
a ~~ (Zy~q LC~dL-~CiL ~
-
,
~
A 1 1Ltlr J1:AL. L^JLk14LF15'iI ITf `
•••' _
I r ~
h gg ktGT E'%1~ na [na n I
-
7run
,; ct nui ,tOt. ~ ~ p ~
FLllf Llpt „Iri 141 LIiY 2. 115sa;~.
Y \ : $ ~ f, t I
_
J _ 1{ ~
T
SrCYF.lAI PiY311C 1\fY
FIW31 FA 1+--a "uattY7NM _-
S
.. AI a~]~!
IJ
.,,,~. y.,
v l!_'i~ln ,asFLlri6.~Itl fv, `. + Y
I q,l 5 ITi]i_ I,\
L I C,
AIITGY-WLti EIFPILITY
~
7
f ~ .rte.-..-f....
``~`f(
. .....,.,....
I~j(31
i~13 .. ....,,.
L"U~11T :~ c
_ _..
'^[]JA h~`P,IIYwJ ("1141
+R~i.Nltidl __..
i fi,Gi l7lci,'
_
q ~ 1 ~
tIU. iVllll.~:~ (
~ ~I.gL11Lr{rG~-1~4{ I'LL[tNF f ~
vuL r inuYOU I
, @ ~ Jrw ILYINNr[91(' t/<sad} $ _.. .___
SaifLl lfLS gk}'r\w
i k qq
q
i f nUf EftFi FIPJl1M1 F
LLw elmkxnP
~
_
_
,
5 ..-. --
rllrlrrihurlsa 0 .
-_
__,_
' Pil~:•V U'YGLa su'rCa
uLfa al .nunR
J'Sl'il~
,,..„.
._....F
......,.rte .................
i ~_-
..p.._..n ........,...
r.>wu7Lx~~uh. t{~p _...__ S
.......
Z _....... __:
iA "sa..Qrri _ G ._~_
tun auo,F L1 f\YdS kWrfr ,
~~ '~
I =UI L IIL
('...1431 r r a~~
••••••..••.•~..•.
lR[YSnT
<
co .
..~.• . ,..,.. __._
11c1*`{F47 J1 tiJ3 rs}
Yr3 !"x.71 v 1
'tiJE '17? r9T.4TUT`~rj151-
% If.Y3S:I.L4A'...I...~L L.12
-...,_...... ..
q .
.
wvtl!tit s
P
ArM .a[rl u\frr, LSll3I43'ly Y7r1
- : I5o 70J3'Url ,gr,Jt,pyit `U.r1,4'371; ~I [~hI0., iCIQFHT 5, 1~~J.Y1P
"
t ravrlaur+ilert reutrllr-.:rLtu lut
eFFlI:Eh>,f'baLxE ~LP~uIT y ulA r¢F''d131 H+:S,\Z tN, 61A r']i'~74 1. ~M1}31+ (•I ',Y4f~,bgr {A nr l?MUF_
- ~ W:7 Ci ql
_-~~
~
y Plunua t-[fln NH
n a y n ~,.I c , ;fec
1m
'r1
711
" W J.. ,„tiTv. i f t WLtYYlV.>}"
...,.,
T..r- ,L3U,.iCt»1 +l„ 7AJ J1i: n [u eAee x_...a ~ ttaJi s i IXKJ.CFY"
`
1Y
LtL-Will IJIdLY?47FM1
~....._,.....
[,
CL
i
~.... ...,.,
. .•....................._
"'...`w` „tR,['i1y;;g7 AG s. J,.Gf Ua1
7
H MISFII ~Ir 'ti+fP ^nN+'•l.
•
Ip71Y
Ik ~F
14'3Ct271~
L;IR
3,irf;•,[)~1
L U LdLTS tt LP,E.,~ SF da=] g l;7:i~
r . --..~z
...-....am.wnF,e+--m.~....-..xmm
.+u.~.n..x`.-+~e++~~
6.ku'lilf`1h~Pdi T 41PFJih11 C,IbY~ :rJrd.%EGtd3P VLNICLC~ ¢1511%ICR MS"2PB0 1Gg.hllR1114P11 flC~CRt E=Sh rnm a .xllm eTMahS raypi(+I(I
NY;trl4rtra nl:.:r<:orgn irCn:nl'S Ira tlcedJ[,
E kR I H IC:.~ I C l-01FL111-I{ _._.._~... .....,. »,,.~....,..........._. ......~------~.
~...__e~ ~_ _, __. ~F}a~MANY`dF'6HE kQpME'~7E'~C:CilE1M P4L1CIIcS %13 CFrC4ELW~fk B~'1't57 {I';
TNa ~fPlgfil4CIOD! l3ATf^ T1d~fiC^O~, MOTlOG S.'iL.1. @6 UsUfFGL3Gd7 'IDi
,RSlttnl h: ~,vl i g3';G:[x.a ,nC~nIC6,ardCL ~VITri '1t1F 1optlC'Y NH2lyditllq'It4F.
ilt?69 FIR~wrr ma'mLl
Ih)fi Hit{•~. tS\ 'Xi'4d7 rptlICNEL61iITRlSiCde+x"ISY9E
ul a+.ri;l IJ$a bm.
.Jvhlll it. liannrtlirt !'^ic-.s.n. L' st4-..,-., .-,.,. i".
..r»~,. ,,.. ... .,.. .,.. .-....-~_.._-..- --_.. _.-_-
. .,.,~,._ ? .~.•..._..- -~- -- .-°`"-., ~r49y~e FnV;f1 I1f;P711d-t t.~t!rPC7ir rtTlt7:7. Y.II r,C,1l L:. t~7ears'*scf.
d1i.,fJ'3u S~riCf+!'-09) `iilszAi rilt6)nan~n wr i.,uca a.eA matina':~*,d ax.zllstt aP 61CV3CiU
~~-~6
-yy pp--pp77- _(~ I ~q~Tq
~~>~~~~~?
~
~
~~~ ~~~
~~
~ ~~~
~~
~~~~
Se.4110'1715319C5
SATE (MMIODfIV)
~
8
1
?
4a
tl
/
6 o3~z~rm11
-_-- -
reuoucea
mIARSR usa IFIC.
1 zaa n: ~ I smEET, su iTE 2mo
DENVEP., CO 80202-.v'34
8 50 5 3 9-1 2yl5-,AWUP-11/12 INSURERS AFFORmING CUVGRAGE NAIC#
ussulxe° nasuRER G:
FJ.-RGBJCY M..[`f AL SER`/CF9 GORPORATOW -- --- --- -'
INSURER H
- - _-
6200 SOUiH SYRAC,ICE WAV,SUITE 200
GREENWOOD NIl1~.GE, CU W111-0797 INSURER I:
INSUNER J-. j
~GXT
`$1,On0,OC0 JIR APPLIES TO GBCESG WC POLICY N0. NlCUC4GA70927
INSURER A -ACE APAERICAN INSURANCE CCMPANV
POLICY F: ISA H0867;f1Ui
f,OVERAliE- AUTOMOBILE IJABIU i Y (NYC
POLICY TERM'. 07;01111 1001/01/12
LIMIT. $50,000 COMBINED SINGLE LIPAIf
C F_ RT I P I C A~ T 13 I-101_ D F_ R
Amencan Netlic~l ResNronse
n803 Balbuz Av nue
Style 150
Sen Jmyo CA. 17123
a'a l'y+13
10-17
:h ~Sii In<~~~~ ~~ ~ ~ ~~
A.h<'lfllmef ~'~°Yii..ti-.. ~-~ ~~-v.rir%cJ
13xhibit °8'
DePinitiaae
The definitions included in California Code of Regalations, Title 22, Division 9,
Chapters) - 9; California Code of Regulations, Title 13, Division Z, Chapter 5,
Article 1; and Division 2.5, Chaptets2 - I 1 of the California Health and Safety Code,
shall apply to this Agreement Mess the Agreement indicates otherwise. By way of
example such definitions shall include, bui not be limited to EMT, EMT-lA, EMT•
Paramedic, Paramedic, Emergency Medical Services Agency and/or Medical
.Director.
1) Ambulance is defined as any motor vehicle which meets current specifications and is
licensed as an ambulance by the State of Califoornia and is permitted. in the County of
Saa Diego.
2) Arrival at lncideat Location is defined as the moment the EMS personnel notify an
appropriate Cammuaications Center that an emergency response unit is at its parking
position at the scene of an incident (e.g., the entrance to a speeific apartment buiIdiag,
not meroly the entrance to the aparment cootplex is general; or an actual collision
scene -not merely as approach location within sight of the collision). For purposes of
this paragraph, arrival at locked gates of a ocarpsacy shall constitute arrival ae shag
amva] at an appropriate ordesigaated staging area or "stand-back" location.
3) Beek-w is defined as assistance from another a null not naimally azsigned to tlu
EOA from outside the. EOA by responding into the Exclusive Operating Area at the
request of AMR.
4) CaII{s) far 5avice shall mean requests for emergency medical ambulance service
received by Heartland Fire Communications Center or other Public Safety Answering
Point serving rho Service Area.
5) CM5 means Craters £or Medicare and Medicaid Services. This agency of the United
States Department of health and Human Services was formally knmva as rho Aealtlt
Care Financing Administration (HCFA).
6) Computer-aided Dispatch (heceinatter referred to as "CAD's is a system of computer
hardware and software that facilitates call taking, resource dispatch and deployment,
dispatch and unit times documentation, creation and real lima maintenance of
incidents, data base and management iaformatioa system.
'i7 Codc 2 is a response to an emergency which has been designated in strict accordance
with approved protocols as non-life threatening at call reception by appropriate AMR
Commuaicaions personnel or other appropriate Public Safety Answering Point
(hereinafter referred to as "FSAP'~ personnel. Vehicles responding Code 2 shall obey
all traffic signs and respond without the use of the siren
10-18
S) Coda 3 is a response to an emergency which has been designated in strict accordance
with approved grotocols as fife-tbreatenutg by appropriate AMR Cotnmunieatioas
personnel or other appropriate PSAP personnel Vehicles responding Code 3 s1ra11
respond as quickly as possible using lights and sires and may move through traffic
against directional signs if ii can be done safely.
9) AMR Communications Ceattt is the central medical emergency dispatch center from
which all emergency ambulances operating in the ESA are dispatched sad controlled.
10) Emer&ancY is defined as a perceived Leed for immediate medical attention ar as
incident in which the potential for such need for immediate medical attention is
perceived by emergency medical Personnel or public safety personnel, and ~in which a
delay is providing such services may aggravate the medical condition or cause the loss
of life.
11) Emeracncv Medical Dispatch (hereafter refetzod to as °EbtD'~ is a pmotocol drives
system of caller interrogation that allows eomm„ni~tiona personnel trained a9
Emergency Medical Dispatchers to provide medical care instructiops, including
bleeding cgntrol, airway management, and CPR
12) Exception is a lafE response as determined by response time criteria.
a) Exclusive Operating Area (hereinafter referred to as "EOA"} is defined as
the EMS area or sub-area dethted in the EMS plan within which only the
designated emergency medical taro and transport service may provide pre-
hospital emergency medical care and iratrspart services in response to calls
received through the 9-I-1 system for a defined period of time_ For purposes
of this Agreement, the BC+A refers to the geographical boundaries of the City
of Chula Vista, Imperial Beach sad BonitalSutrnyside Fire Prntectioa
District
13) Exemntian is a determination to exclude an EM5 event ttnm the predetermined
response time criteria due to factors outside AMR's control.
14) First Responder Agency, for purposes of this Agreement, is defined as any pub&c
agency that has a current agreement with AMR, approved by the County, to respond to
medical emergencies when dispatched in order to assess the scene, initiate emergency
medical treatment sad document care prior to the arrival of the ALS Transport Team.
15) Medical Direction is direction given to EMS personnel, in accordance with EMS
agency policy, either by AMR Medical Director or by the Cormty EMS Medical
Director, through standing orders, ar through direct voice contact with a Base Station
Physician or with an approved mobile intensive care muse (hereinafter' referred to as
"MICN') with or without vital sign telemetry.
10-19
1 ~ Response Data is the measurement of time lapsed on a continuum of response to a 9-1-
l call. The components of time measured for a response to a 9-1-] call are defined as
Follows:
a) D--9i. coverv -time ofincideat until dispatcher receives 9-1-1 call;
b) Dispatch -time from 9-1-] call to dispatch of first responder and transport
ambulance;
c) First Response -time of unit notification until arrival of first response unit at I
incident location;
d) Response Time -time of unit notification until arrival of Transport Unit at incident
iacatioa;
e) Scene Time -time of arrival of First Response emit or Transport Unit at incident
location until they leave the scene. Scene time is calculated separately for First
Responders and Transport team;
f) Transport tithe -time Transport Unit leaves the scene aatiI amval at hospital; and
gJ Back in Seavice -Time Transport unit at hospital is clean sad ready for smother
call.
17) Service Area -Each PARTICIPATING AGENCY (City of Chula Vista, City of
Imperial Beach and the )3oaitalSurmyside Fim Protection District) is a separate and
distinct Service Area The thrt:e Service Areas compose the EOA.
18} Stead-by Service is defined as the dispatch of an ambtilaace unit by AMR
Commrmications Center at the epeafic request of a public safety agency to a position
of inmmediate availability. This does not include apre-arranged stand tsy request for
activity of any duration, such as concerts, sporting events, ere.
14) SYStem Status Manattement Plan is an algorithm and written opcratiag procedures for
on-line, real time management of system resources through system deployment,
posting patterns and redeployment of units and u~t hours w meet the ongoing demand
of the system and to optimize system coverage consistent with real time needs of the
system. .
10-20
CONTINUATION CERTIFICATE
The RLI Insurance Company (hereinafter called the Surety) hereby continues in force its Bond
No. CMS250681 in the sum of Three Hundred Thousand and NO/100 Dollars ($300,000.00)
dollars, on behalf of Laidlaw Medical Transportation, Inc. dba American Medical Response in
favor of the City of Chula Vista, Imperial Beach Fire Department and Bonita/Sunnyside Fire
Protection District for the (extended) term beginning on the 1st day of June 2011, and ending on
the 1st day of June 2012, subject to all the covenants and conditions of said Bond.
This Continuation is executed upon the express condition that the Company's liability shall not
be cumulative and shall be limited at all times by the amount of the penalty stated in the bond.
IN WITNESS WHEREOF, the Company has caused this instrument to be signed by its duly
authorized Attorney-in-fact and its corporate seal to be hereto affixed this 2" day of May, 2011.
Laidlaw Medical Transportation, Inc.
dba American Medical Response
Principal
By:
RLIlnsurance Company
Surety
By: '
Kristin Tennien, Attorney-in-fact
10-21
RL ~ ® RLI Surety
P.O. Box 3967 ~ Peoria, II. 61612-3967
Phone: (800)645-2402 ~ Fax: (309)689-2036
www.rlicorp.com
Know AU Men by These Presents:
POWER OF ATTORNEY
RLI Insurance Company
That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the
approving officer if desired.
That RLI Insurance Company, an Illinois corporation, does hereby make, constitute and appoint:
Douglas Bawler James Bel] Joan Armstrong I{ristin Tennien jointly or severally
in the City of Denver State of Colorado its true and lawful Agent and Attomey in Fact, with full
power and authority hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety, the following described
bond.
Any and all bonds, undertakings, and recognizances in an amount not to exceed Ten Million Dollars ($10,000,000) for
any single obligation.
The acknowledgment and execution of such bond by the said Attomey in Fact shall be as binding upon this Company as if such bond had been
executed and acknowledged by the regularly elected officers of this Company.
The RLI Insurance Company further certifies that the following is a true and exact copy of the Resolution adopted by the Boazd of Directors
of RLI Insurance Company, and now in force to-wit:
"All bonds, policies, undertakings, Powers of Attomey or other obligations of the corporation shall be executed in the corporate name of
the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the
Boazd of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint
Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Company. The
corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attomey or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile."
IN WITNESS WHEREOF, the RLI Insurance Company has caused these presents to be executed by its Vice President with its
corporate seal affixed this 7th day of October 2009
NCE •"
"~y~~:...,,oo~~,, RLI Insurance Company
State of Illinois ` ' S Fi A L.: BY '"`
1( SS Roy C. Di Vice President
County of Peoria J "o~<LiN0~5+ ``
CERTIFICATE
On this 7th day of October 2009 before me, a Notary
Public, personally appeazed Rov C Die ,who being by me duly sworn,
acknowledged that he signed the above Power of Attorney as the aforesaid
officer of the RLI Insurance Company and acknowledged said instrument to be
the voluntary act and deed of said corporation.
.~'
Jac eline M. Bocl~ r Notary Public
aui "OFFICIAL SEAL"
i ~ere~: JACQUELINE M. aOCKLER
~~++~ COMMISSION EXPIRES OJ/01/10
I, the undersigned officer of RLI Insurance Company, a stock
corporation of the State of Illinois, do hereby certify that the attached
Power of Attomey is in full force and effect and is irrevocable; and
furthermore, that Lhe Resolution of the Company as set forth in the
Power of Attorney, is now in force. In testimony whereof, I have
here~~n~[¢ set my hand nd the seal of the RLI Insurance Company
[hisa=day of ~~ , ~_
RLI Insurance Company
By:
Roy C. Di Vice President
a~~~,o A0059207
Attachment 1
AMERICAN MEDICAL RESPONSE
AMBULANCE RATE INCREASE JUSTIFICATION
JUNE 2011
As part of this contract amendment, American Medical Response (AMR) is seeking a 911 Rate
adjustment. This adjustment would bring the ALS Emergency Base Rate to $860.90. This rate remains in
the lower 30% of rates found in Southern California and is substantially below the Average Base Rate
experienced in San Diego County, which is approximately $1,591.
The scale of the needed rate increase occurs because of the unique economics of utilizing health
insurance (or health care reimbursement) as a vehicle for revenue generation. Unlike most fee-for-
service rates with which most municipal organizations are familiar -where one-dollar of rate increase
closely approximates one-dollar of additional revenue, rates reliant primarily on health insurance are
much less responsive. For example, in the case of this rate request, each additional dollar attached to a
new rate increase will generate only about 16-cents in new revenue.
Impact of Insurance payments on ability to collect revenue
The fundamental difference between traditional fee-for-service charges and charges reliant on
reimbursement of health insurance or government payers (i.e. Medicare) is the concept of "marginal
collection rate." Because of this impact, less than 16-cents of every additional dollar billed will
ultimately be collected within the Southbay system.
The reason for this is related to the realities of Medicare and the health insurance
industry. Revenue of any health care system is divided into various methods of payment
represented by the various forms of payment for healthcare services. Typically these categories include
the following:
1. Medicare
2. Medicaid {Medical)
3. Third Party Payers (Insurance Companies)
4. Private Pay
Each of these payers has a given "elasticity" of rate increases that they will recognize. Medicare
and Medicaid, for example, each set a given rate that they will pay for a service and will not pay above
that amount regardless of the amount charged. If 20% of the payer mix is paid by Medicare, then any
rate increase above the Medicare "profile" amount will go uncollected. The same is true for Medicaid
{Medical), except that the allowable rates for Medicaid are even lower
{in mostinstances)than Medicare.
The ability to recognize net revenue for each dollar of rate increase becomes more difficult as
the patient charge increases. Therefore, it can be seen that many rate increases may seem large, but the
actual ability of the health care provider to see any net revenue can be as low as 5% on each additional
dollar added to a charge. This phenomenon partly explains the shocking reality of seemingly
unreasonable hospital bills received 6y patients.
10-23
When applied to the rate request at hand, the following can provide a brief summary of the issues and
impacts.
SUMMARY AND STATEMENT OF FACT
AMR has submitted a request for a base rate adjustment of 7% to $860.90
The $860.90rate proposed is still below the average ALS ease Rates found in the current market and is,
in fact, in the lower 354'° of rates in the County.
Based upon current marginal collection rates, the proposed rate increase represents an increase of
$56.32 per transport
Of this, AMR will net only $9.01 per transport. This represents a realized rate of increase of only 1% of
base rates charged.
AMRs expenses are extra-ordinary in that Medical and Transportation CPI rates have averaged
4.2~° and 4.7~ respectively over the past 3-years while consumer CPI has averaged 2.6%. AMR is
particularly susceptible to increases in fuel which has brought the annualized transportation inflation
factor to close to 124'o during several of the past 8 quarters. The annualized rate of realized revenue to
AMR on an annual basis is 1.1%.
Additional expenses to be incurred by AMR in the new Southbay Contract include; requirements to paint
ambulance fleet Red, purchase Navy blue uniforms and the administration of Fire Department
Vaccination Program.
The table below illustrates that a 7~° annual rate increase will yield no more that 1.1% increase per year
over the term of the agreement. This results in between $9.01 and $11.06 of additional revenue realized
per transport.
Year
Rate 7%COIA
Increase
Rate Delta Marginal Collection
Rate [det Realized Effect per
Transport %
Realized
2011 $ 504.58 $ S6o.90 $ 56.32 16.0% $ 9.01 1.1%
2012 $ 860.90 $ 921.16 $ 60.26 16.0% $ 9.64 1.1%
2013 $ 921.16 $ 985.65 $ 64.48 16.0% $ 10.32 1.1°/a
2014 $ 485.65 $ 1,054.64 $ fi9.00 15.0% $ 10.35 1.1%
2015 $ 1,054.64 $ 1,128.47 $ 73.82 15.0% $ 11.07 1.1%
2016 $ 1,128.47 $ 1,2D7.46 $ 78.99 14.0% $ 11.06 1.0%
10-24
Attachment 2
THE ATTACHED AGREEMENT HAS BEEN REVIEWED
AND APPROVED AS TO FORM BY THE CITY
ATTORNEY'S OFFICE AND WILL BE
FORMALLY SIGNED UPON APPROVAL BY
THE CITY COUNCIL
~1~ ,
~~
Glen R. Googins r>~~:~ 7
City Attorney
Dated: ~ ~" ~ ~ - ~
AMENDED AND RESTATED AGREEMENT FOR
BASIC AND ADVANCED LIFE SUPPORT AMBULANCE SERVICE
BETWEEN
THE CITY OF CHULA VISTA AND
AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.
10-25
REVISED AND RESTATED AGREEMENT FOR BASIC AND
ADVANCED LRE SUPPORT AMBULANCE SERVICES
This REVISED AND RESTATED AGREEMENT FOR BASIC AND ADVANCED
LIFE SUPPORT AMBULANCE SERVICE ("Agreement') is entered into effective as of July 1,
201 l ("Effective Date"), by and between the CITY OF CHULA VISTA ("CITY"), a municipal
corporation, together with Imperial Beach Fire Department and Bonita/Sunnyside Fire Protection
Disu~ict (collectively °PARTICIPATING AGENCIES") and AMERICAN MEDICAL
RESPONSE AMBULANCE SERVICE, INC. F/K/A LAIDLAW MEDICAL
TRANSPORTATION, INC., a Delaware corporation, dba AMERICAN MEDICAL RESPONSE,
('`AMR").
WITNESSETH
A. WHEREAS, within the City of Chula Vista, there is a public health and safety need
for effective and efficient basic and advanced life support emergency and non-
emergency ambulance services; uid
B. WHEREAS, various shidies and actual practical experience have clearly
demonstrated that conumulities of the approximate size and population of Chula
Vista are best assured of receiving the highest level of emergency and non-
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; and
C. WHEREAS, the C[TY is authorized by Government Code Section 38794 and
Municipal Code Sections 5.10.310-5.10.340 to contract for ambulance services as
public convenience requires; and
D. WHEREAS, pursuant to California Health and Safety Code Section 1797.224, 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 Cormty
generally known as the City of Chula Vista, Bonita/Sunnyside Fire Protection
District, and the City of Lnperial Beach, for which EOA the CITY is empowered to
contract and
E. WHEREAS, the City of Chula Vista Fire Department participates in the EOA's first
responder system responding to all emergencies originated in the 911 system; and
F. WHEREAS, o^ May 9, 1989, City and Med-Trans, dba Hartson Medical Services,
which has since been acquired by AMR, entered into an agreement for the provision
of basic and advanced life support and emergency and non-emergency service; such
agreement was amended on November 26, 1996 (as amended, the "Original
Agreement"); and
1
10-26
G. WHEREAS, on June 1, ?002, CITY, AMR, and PARTICIPATING AGENCIES
entered into an Amended and Restated Agreement for Basic and Advanced Life Support
Ambulance Services with an option to extend the Agreement;
H. WHEREAS, on December 3l, ?007, CITY, AMR, anti PARTICIPATING AGENCIES
entered into a Revised and Restated Agreement for Basic and Advanced Life Support
Ambulance Services with an option to extend the Agreement;
I. WHEREAS, on May 31, 2011, CITY, AMR and PARTICIPATING AGENCIES
entered into an Amendment to the Agreement extending the Revised and Restated
Agreement for thirty (30) days; and
J. WHEREAS, the parties' desire to extend the Agreement, with revised and restated terms
and conditions, as set forth in this REVISED AND RESTATED AGREEMENT FOR
BASIC AND ADVANCED L[FE SUPPORT AMBULANCE SERVICE.
NOW, THEREFORE, in consideration of the muhral promises herein contained and for
other good and valuable consideration, receipt of which is hereby adaiowledged, the parties agree
as follows:
SERVICES
AMR shall, without cost to PARTICIPATING AGENCIES, perform the following services to fl1e
satisfaction of PARTICIAPATING 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 9l 1 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 inteiTUption, without regard to the patient's financial status.
1.2 AMR shall meet a maximum response time often (10) minutes for 90 percent of all
ALS emergency calls dispatched for each Service Area on a monthly basis.
13 AMR shall respond to all calls downgraded to BLS calls within twenty (20) minutes
for 90 percent of the calls dispatched for each Service Area on a monthly basis.
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.
If an ALS call is downgraded, the above maximum response time shall not apply;
however, AMR shall be responsible for responding to such a downgraded call as is
required for a BLS response.
10-27
I.5 At a minimum AMR shall provide four (4), Type III ALS capable ambulances,
operating twenty-four (24) hours per day; and an additional Type [II, ALS
ambulance operating rivelve (I2) how's per day, normally posted within the EOA.
1.6 Only ALS responses shall be rendered in direct response to calls for medical
emergencies originating from the 911 system or requests from public safety dispatch
and/or communications centers.
L7 Participate in disaster preparedness [raining with EOA personnel. This training shall
be in accordance with San Diego County and EOA disaster plans and consist of two
(2) training sessions and participation in two (2) exercises per year in order Co ensure
effective coordinatio^ between AMR and EOA employees during disaster
operations. AMR wilt provide a representative in Chula Vista's Emergency
Operations Center when reasonably required by local emergency.
1.8 Provide and maintain a minimum of one (1) 800 MHz mobile radio per ALS unit
with compatible with first responder fire agency radio frequencies within the EOA,
`'Central Zone" and "Metro Zone".
Provide and maintain a minimum of one (1) 800 MHz portable radio per ALS unit
compatible with first responder fire agency radio frequencies within the EOA,
"Central Zone" and "Metro Zone."
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 RC[P project which includes AVL capabilities.
AMR writs assigned to incidents will comply with the Incident Command System,
and report to the Incident Conunander (IC) for assigmnent on the assigned
Command and Tactical radio frequencies.
AI I AMR dispatch data shall be captured electronically on a "real-time" basis with a
computer system capable of providing information to CITY with respect to address,
times of dispatch, response times, arrival times and unit identifier.
AMR will work with EOA members in developing area specific radio identifiers and
designators.
1.9 Participate iu emergency medical services ("EMS") system activities including
development and operation of automatic and muhial aid agreements, disaster drills,
paramedic ride-atongs, paramedic intern training, and continuing education
programs. AMR also agrees to attend and participate in meetings called at
reasonable frequencies by the CITY for the purpose of Alarming and coordinating
EMS service.
3
10-28
AMR Feld supervisory staff shall be trained at ICS 300 level within six (6) months
of implementation of this agreement. AMR ambulance crews shall be trained at ICS
100 & 200 within six (6) months of implementation of this agreement. AMR will
provide proofot this training.
Joint Training:
AMR and CITY shall establish joint training efforts for the salve of better patient
care and teamwod< between both agencies.
AMR and CITY will establish a mutually agreed upon joint training curriculum and
corresponding training calendar for both BLS and ALS. Such training will take
place within the C1TY, and can be attended by both AMR and CITY crews. This
training will be open to other participating agencies.
Examples may include:
CPR Provider Course
EMT Defib / ETAD / AutoPulse Audi[ (3 times annually)
hlfection Control practices & procedures (4 hours)
Protocol Updates
Skills Day (Spinal Immobilization, Helmet removal, Traction Splint, FAST Splint,
KED device, Splinting, OB, SOF T tourniquet, etc.)
MC1 (START Triage, Triage Tags, Position roles and responsibilities, Treatment
areas, Co. MCA Trailers, etc.)
Documentation / CQI Issues
Using aero-medical resources
AMR and CITY will ensure adequate qualified instructors. AMR will provide
Instructor Training for CPR and First Aid for the department instructors of the other
partner agencies.
tf staffing levels decrease due to training needs AMR agrees to staff a Medic Unit
for the duration of the training.
EOA Paramedic Knowled«e/Skills/Proficiency Retention:
AMR shall accommodate to the best of their ability and provide interested EOA Fire
paramedics part-time employment subject to AMR's collective bargaining
agreements and their standards related to hiring and retention of employees. Such
accommodation is intended for retention of ALS lmowledge and skills.
AMR and City will enter an agreement suitable to both agencies a paramedic
mentorship program. Such program is designed to allow current EOA paramedics
the opportunity to practice and function as paramedics while on-duty for the CITY,
but under the direcC supervision of an AMR paramedic. Such program will also
have to receive approval from the County Medical Director.
4
10-29
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 Fonm shall
be completed. The field supervisor shall conduct the initial investigation with
emphasis placed on identification of potential system failures and defciencies,
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.
All documentation on complaints and a-iticisms shall be maintained for at least three
(3) years and a copy forwarded to appropriate PARTICIPATING AGENCY within
thirty (30) days of resolution or, in a case where no resolution is reached, the CITY
Manager of the PARTICIPATING AGENCY or his or her designee shall be notified
within two (2) business days of determining that the matter is not resolvable.
I.I 1 AMR shall resupply the Eire Departments of PARTICIPATING AGENCIES with
medical supplies and related emergency medical equipment, including Personal
Protective Equipment and disposable semi-automatic defibrillator supplies contained
within the lisC of equipment and supplies described in Exhibit "A," up to a maximum
cost ("Maximum Resupply Obligation") per fiscal year (July tlm~ough Jrme).
a. For equipment and supplies not exchanged one-for-one at the scene, beginning
July 1, 2011, the Maximum Resupply Obligation shall be $16,500. AMR's
Maximum Resupply Obligation shall be increased each fiscal year thereafter by
10 percent per year, not to exceed $20,000 for any fiscal year during the term of
this Agreeiilent or subsequent extensions. PARTICIPATING AGENCY will
document for AMR the equipment and supplies used but not exchanged at the
scene.
b. The ratio of Che resupply amount shall correspond, on a pro rata basis, to the
percentage of calls For service for each PARTICIPATING AGENCY.
c. The cost of the items supplied by AMR shall be deternlined by the actual invoice
cost to AMR. CITY shall be provided with an appropriate statement on a
monthly basis fiom AMR detailing supplies PARTICIPATING AGENCIES
have received through this process and the cost assigned to the same. In uo event
shall AMR's obligation hereunder exceed the actual cost of PARTICIPATING
AGENCLES~ resupply needs.
d. AMR shall clearly label all items delivered to the PARTICIPATING
AGENCIES and to provide, with the initial order, "Material Safety Data Sheets"
for any new items added to the PARTICIPATLNG AGENCIES' use or
inventory.
5
10-30
e. hi the event that changes in federal, state or local regulations require additional
Personal Protective EquipmenC or other medical equipment or supplies in
support of EMS operations, and/or if AMR and CITY, 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 iu 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 within the contract area and incorporate it into
their regular weekly rounds and may be changed subject to mutual consent of the
Parties.
g. Provide to CITY on a monthly basis a re-supply balance sheet. Information shall
identify all itemized transactions taken from the re-supply obligation in L11 (a)
of the Agreement.
h. Disposable medical supplies identified itr the revised "Exhibit A" (1/l 6/09) 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 supply balance provisions of the contract.
L l2 Properly transport and dispose of all biologicaVmedical waste generated by CITY
within the EOA while rendering services pursuant to this agreement. hlcludes
biological/medical waste storage sheds at Fire Station #52 and Fire Station #57 (new
location).
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 PARTICIPATING
AGENCIES at major emergencies as deternlined appropriate and necessary by
PARTICIPATING AGENCY'S incident commander. Exemptions shall be granted to
AMR for cabs 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
<~ranted exempt status from response time compliance.
1.15 Participate in disaster preparedness plamling and training activities carried out by
the AGENCIES within the EOA and the County of San Diego. A.N[R is not
responsible for providing medical supplies or equipment for such activities.
Ci
10-31
1.16 Comply with all training requirements established by the State of California, and all
applicable policies and provisions established by the San Diego County Emergency
Medical Services Division ("SDCEMSD").
1.17 AMR will submit Grooming/Tattoo policies to all participating jurisdictions for
review and input within 30 days of the effective date of this Agreement.
L13 AN[R will administer a program to male available influenza vaccine (seasonal and
pandemic) on an annual basis to all EOA suppression personnel during the Tenn of
this Agreement the cost of the vaccines shall be the responsibility of the City.
1.19 AMR will administer a program to make available Tetanus, Diphtheria, and
Acellular Pertusis (Tdap) booster vaccine available to all EOA suppression
personnel as recommended by the California Department of Public Health during
the Tenn of this agreement. The cost of the vaccines or serums shall be the
responsibility of the City.
1.20 AMR Uniforms: Shoulder Patch: A shoulder patch will be developed in
coojunetion with EOA members and worn by all AMR persomlel scheduled to work
the South Bay EOA to be agreed to by the EOA members and AMR. Work
Uniforms: 1) Ranl< /File 911 Paramedics: Uniform shirts and pants will be navy
blue in color, with black buttons; and 2) Administration: Uniform shirts and pants
will navy blue in color with black buttons. AMR will phase in the uew uniforms
within the firsC year of this Agreement.
1.21 Ambulance Graphics: AMR shall modify the exterior graphics on a minimum of
five (5), Type III ALS ambulances, operating twenty-four (24) hor~rs per day; and
two (2) Type III ALS ambulance operatnig twelve (12) hours per day within the
EOA.
All ambulances /vehicles serving the EOA will comply with NFPA Standard 1901
graphics; be red in color (color match to EOA Fire Departments as close as
possible); roof-top (from drip line) to be white. The ambulances will also contain:
1) diagonal red /lime green striping o^ the rear-side of the vehicle per NFPA
standards; 2) striping on inside of rear doors when open to oncoming traffic; and 3)
"i-4" white reflective striping will nm along each side of the vehicle (height at cab
mid-door), with AMR logo centered / in line with striping on each cab door.
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 prtrsuant
7
10-32
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 rmits as well as
units that respond into the Southbay EOA fi~om another area, will not be held to the mileage
or year requirements.
CITY shall have the ability to designate a reserve or replacement unit as in need of
evaluation 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 Chat has failed to respond because of a mechanical reason more than once in a
calendar year; and
• Excepting that this deftnition does not include units ouC of service for regular scheduled
maintenance. Once a unit is repaired and placed back into service it shall be moiritored
for a six (6) month period.
Under extreme circumstances, including but not limited to, a disaster, local emergency or
excessive fire activity, AMR shall 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 9ll system and/or public safety
dispatch and communication centers for calls within the Service 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 t(us
requirement:
a. AMR shall guarantee minimum staffing levels on all units assigned to the EOA twenty-
four (24) hours per day, 36~ days a year.
b. Such staffing levels shall be mandatory and employees needed for such staffing shall not
be released until such time as minimum stafFiug 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.
8
10-33
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 PARTICIPATING AGENCIES immediately whenever any condition
exists which adversely affects delivery of satisfactory emergency medical services Co 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 pre-
hospital emergency medical care and transport only in accordance with County policy and
with approval of AMR.
2G. When it becomes necessary to use other providers to assist in responding to 911 calls,
AMR shall include such incidents in the monthly report.
2J 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
die development the system.
2.9 CfTY ada~owledges AMR's responsibility to inform each Agency it contracts with of the
requirements contained in the Health Insurance & Portability Act of 1996 regarding
confidentiality ofpatient records. The PARTICIPATING AGENCIES agree to uphold
the law with regard to the confidentiality ofpatient records and bear the costs of any
violation ofpatient confidentiality by their respective employees.
2.10 A minimum ofsemi-annual operations meetings for this EOA shall take place. Those
presem shall include representatives from AMR and representatives from each
PARTICIPATING AGENCY. These meetings will take place to review monthly
response time reports, and to discuss any other issues involving this contract or
operations.
3. RESPONSE TIME PERFORMANCE
System response times are a key measurement of performance. This measurement is the
detenmining 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? AMR shall use its best efforts to minimize variations or fluctuations in response time
performance.
10-34
33 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 ^umber 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. For the City of Chula Vista, reports of response time compliance shall be submitted
on a monthly basis.
b. For the City of Imperial Beach and the Bonita/Sunnyside Fire Protection District, a
report combining the City of Lnperial Beach's and the Bonita/Sumryside Fire
Protection Districts response times shall be submitted on a monthly basis.
c. The form and format of such reporting shall approximate the form attached hereto as
Exhibit "B", which fi~oro time to time may be amended with agreement of the
parties, and shall be filed within ten (10) days of the end of the previous month.
d. Monthly Compliance Reporting: AMR shall submit a monthly report of response
time compliance. The format of this report will be developed by AMR, and
approved by the CITY within thirty (30) days of signing the amended contract
agreement This report shall include:
i. Total number of responses
ii. Incident response times
iii. Raw compliance (without exceptions) percentage
iv. Number of responses receiving exceptions
v. Adjusted compliance total with exceptions (percentage)
vi. Number of 91 1 calls handled by other transport provider agencies.
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 Mutti-Hazard Disaster Plan.
Equipment failure, traffic collisions not involving the responding ambulance, or Laclc of
a nearby ambulance shall not ftunish grounds for release from general response tune
standards. If AMR feels that any nm or group of runs should be exempt from response
time standards due to unusual circumstances beyond ANIR's reasonable control, AMR
may request that these runs be excluded from response time performance calculations.
Each PARTICIPATING AGENCY shall determine the granting of exemptions within
its service area. If the PARTICIPATING AGENCY concurs that flee circumstances do
10
10-35
fit the contract's exemption criteria, it shall allow such exemptions in calculating
overall response time performance.
a. Each request for exemption will be accompanied by a completed "Exception Inquiry
Form" attached hereto as Exhibit "C," which from time-to-time may be amended
wi[h the agreement of die parties, and shall be filed within ten (10) days of the end
of the previous month.
b. The PARTICIPATNG AGENC[ES 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 Gn 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.
h. AMR is expected to meet the applicable response times for the calls, even when
diverted.
3.7 Notwithstanding any other provision widlin 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.
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, but will be
noted in the monthly report
a. PENALTIES FOR RESPONSE TIME NON-COMPLIANCE
4.1 In the event AMR fails to meet the response time requirements in any service area,
AMR shall be accessed penalties as follows:
a. [f 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 Che event that AMR has nine (9) or mare ALS
calls for service in one (1) calendar month with response times of twenty (20)
11
10-36
minutes or longer, the following penalty shalt apply: AMR shall add an additional
eight (S) ALS Type TII unit-hours per day to the EOA for two (2) months.
d. These additional unit-hows described in paragraphs 4.1 and 43 shall be
implemented within seven (7) days of the 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 C[TY.
5.1 AUIR is authorized to bill patients transported on calls originating as medical calls for
service through 91 1 and/or public safety dispatch and communication centers
according to AMR's tee structure attached as Exhibit "D;' which may be modified fi'om
time to time as described in Subparagraphs below.
5.2 Rates charged for Base Rate, Oxygen, Mileage, Night Charges and Treaunent only (No
Transport) (`Primary Rate Components") shall not be increased above those set forth on
Exhibit "D" for the period .Iuly 1, 2011 tmtil June 30, 2012.
53 For each of the three (3) contract years July 1, 2011 to June 30,2012 (year 1) and July 1,
2012 to June 30, 2013 (Year 2); and July 1, 20 L3 to June 30, 2014 (Year 3), the
Primary Rate Components may be increased at AMR's discretion by an amounC not to
Exceed seven (7) percent per year. A justiftcation of this rate increase is also contained
in Exhibit "D."
5.4 If the C[TY exercises its option to extend the Agreement for an additional tear of three
(3) years, AMR agrees to meet and confer with the CITY for the purpose of negotiating
limitations on maximum rate increases in those years.
5.5 The meet and confer process shall begin six (6) months prior to the expiration of Year 3
of the initial term.
5.6 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 ALS/BLS service providers within the County of San Diego.
5.7 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
12
10-37
• 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.
5.3 Notwithstanding the move, 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.
5.9 The CITY 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.
5.10 In the event that either Bonita/Sunnyside FPD or the City of Imperial Beach withdraws
fiom this Agreement, the minimum ambulance requirements of the above
subparagraph shall be waived, and new minimum ambulance requirements established
upon mutual Agreement between the parties. The withdrawing AGENCY must provide
no less tban 180 days notice to all parties of its withdrawal.
6. INSURANCE
AMR shall obtain and maintain at all times a policy of insurance by an insruance carrier acceptable
to CITY 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 "E" [nsurance 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 the CITY and PARTICIPATING
AGENCIES, its 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 the CITY and PARTICIPATING AGENCIES, any subcontractor of the PARTICIPATING
AGENCIES, or anyone directly or indirectly employed by the PARTICIPATING AGENCIES or
its subcontractors.
13
10-38
Costs of Defense and Award. Included in the obligations in the Paragraph above, is the 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 CITY and PARTICIPATING AGENCIES,
its directors, officials, officers, employees, agents and/or volunteers, subject to the limitations
contained in the Paragraph above. AMR shall pay and satisfy any jud~nent, award or decree that
may be rendered against CITY and PARTICIPATING AGENCIES or its 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
CITY and PARTICIPATING AGENCIES, its directors, officials, officers, employees, agents,
and/or volunteers. AMR agrees to pay any and all costs CITY AND PARTICIPATING
AGENCIES incur in enforcing the indemnity and defense provisions set forth above.
AM R's obligations under the above provisions shall survive the termination of this Agreement
S. INDEPENDENT CONTRACTOR STATUS
8.1 Both parties hereto in the performance of this Agreement will be acting in an
independent capacity and not as agents, employees, partners orjoint ventures with one
another. AMR is noC an employee of CITY and is not entitled to any of the rights,
benefits, or privileges of CITY employees, including, but not limited to medical,
unemployment, or workers' compensation insurance.
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 CITY for entering into this Agreement was, and is, the professional reputation and
competence of AMR.
8.3 Neither C[TY nor its 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 C[TY, it being understood that AMR, its agents, servants,
employees and independent contractors are as to CITY wholly independent contractors
and that AMR's obligations to CITY 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 fi om CITY, which will not be unreasonably withheld.
10. PERMISSION TO SUBCONTRACT SERVICES
14
10-39
AMR may subcontract for ALS First Responder services with each PARTICIPATING AGENCY
within the service area. Each agency may enter into an agreement with AMR for the provision of
those services.
10.1 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 CITY at any time to require performance by AMR of any provisions hereof, shall in
no way effect the right of CITY thereafter Co enforce same. Nor shall waiver by CITY 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. SEVERAB[UTY
If any provision of this Agreement shall be declared to be illegal, void or unenforceable by a court
of competentjurisdiction, such provisions shall be deemed severable, and the other provisions shall
not be affected but shall remain in full Force and effect.
I ;. AUDiT AND REPORTING PROCEDURES
AMR agrees to allow C[TY officials complete access to all operational and financial records and
data (including computer generated reports) pertaining to the services 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 CITY the
following repots:
13.1 San Diego County (pre-hospital patient records) EMS Report Forms (ALS and BLS)
on request.
132 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:
C[TY reserves the right to conduct spot ched<s 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 perfonmance 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 PARTICIPATING AGENCIES. (Note:
time in the system is counted in seconds, not in whole minutes.)
1~
10-40
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.
8808 Balboa Avenue
San Diego, California 92123
and
Legal Department
American Medical Response, Inc.
6200 South Syracuse Way, Suite 200
Greenwood Village, CO 801 l I
All notices to PARTICPATING AGENCIES shall be mailed to:
Fire Chief
City oCChula Vista
27G Fourth Avenue
Chula Vista, California 9L910
and
City Manager
City of Chula Vista
276 Fourth Avem~e
Chula Vista, California 91910
and
Fire Chief
City of Imperial Beach
865 Imperial Beach Boulevard
hnperial Beach, California 91932
Fire Chief
BonitaSunnyside F.P.D.
4900 Bonita Road
Bonita, CA 91902
IC
10-41
L~. CONSIDERATION
Consideration provided to AMR for the comprehensive services to be provided by AMR is that
CITY shall ;rant 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.
lb. CONTRACT ADMINiSTRAT[ON
The CITY 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 behalf of
the CITY. 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 REVISED AND RESTATED AGREEMENT shall commence on July 1, 2011. The
Agreement shall tem~inate at midnight, June 30, 2014, unless extended as provided for herein.
This Agreement may be extended for one (1) additional period of three (3) years at CITY"s option,
in its sole discretion. CITY shall exercise its option to extend by sending written notice to AMR of
its intent by no later than six (6) months prior to the expiration of the then current term. If CITY
fails to notify AMR of its intent as provided above, then AMR shall notify CITY in writing of its
desire to extend or not to extend the term, and CITY shall have an additional thirty (30) days from
its receipt of such notice to make its election. Factors that will be considered by the CITY include
AMR's response time performance, compliance with the terms and provisions of this Agreement,
AMR's responsiveness and cooperation in relationships with the CITY, County Emergency
Medical Services and the Base Hospitals, and any other factors considered of importance to the
C[TY in its sale discretion.
I8. RIGHT OF AMR TO TERMINATE AT BEGINNING OF YEAR 4.
18.1 Notwithstanding any other provisions of this Agreement, should the parties fail to
come to agreement on base rate charges at the begimiing of the extension periods
AMR may terminate this Agreement by written notification to the
CITY providing notice of the effective date of such termination which shall not be less
than 365 days from the receipt of the notice. Service shall continue under the terms of
this Agreement for the time specified in the notice from AMR.
182 [f after due diligence by the CITY, the CITY has not procured alternative ALS/BLS
services, the C[TY shall be entitled to order an extension of service for an additional
period oCup to 180 days after the ternination by AMR. The CITY shall notify AMR in
writing at least sixty (60) days prior to the expiration of die one-year notice. Service
shall continue under the terms of this Agreement for the time specified in the notice
from CITY.
17
10-42
19. TERMINATION FOR CAUSE, L1QU[DATED DAMAGES
19.1 CITY may immediately terminate this Agreement ifAMR'slicense to operate
ambulances by the state is revoked or suspended.
19.2 CITY may terminate this Agreement for material breach, if the material breach is not
cured within thirty (30) clays after a written notice specifying the cause is delivered to
Michael Murphy, General Manager, American Medical Response Ambulance Service,
Inc., 8808 Balboa Avenue, San Diego, CA 92123 and Legal Department, American
Medical Response, [ne., 6200 South Syracuse Way, Suite 200, Greenwood Village, CO
80111 .
a. Material breach shall include, but not limited to:
(I) 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 Co operate in compliance with the requirements of the applicable federal,
state and local laws, rules anti regulations relating to the provision of ALS
paramedic and BLS ambulance service.
19.3 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 C[TY's representative, then CITY 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 CITY determines that the public health and safety would be
endangered by the continued provision of service by AMR, in consultation with the
Comity EMS Medical Director or designee, CITY may nevertheless, immediately
suspend further performance and give written notice of immediate termination of this
Agreement.
19.4 IC, after tenmination of this Agreement for cause by CITY pursuant to 19.1 and 19.2, it
is ultimately determined by an arbitrator that CITY's termination was noC justified (that
AMR had not committed a material breach of this Agreement), CITY and AMR agree
that the injury AMR may suffer as the result of such conduct by CITY is, impossible to
ascertain or estimate and that the sum of $50,000, shall be paid by CITY 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.
19.5 Any waiver, acceptance of services, or failure to require compliance as it relates to the
Agreement shalt not be deemed to be a waiver of any other breach of or change to the
terms of; or operate to stop CITY from enforcing the provisions of this Agreement. A
consent to one assignment by CITY shall not be deemed to waive the right to consent
l8
10-43
to any future assignments.
20. TEL2MINATION FOR CONVENIENCE
Notwithstanding any provisions to the foregoing, CITY may terminate this Agreement at any tune
and for any reason, by giving speciFc 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 CITY 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.
21. 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 Che City of Imperial Beach, the provisions of paragraph 3
(response time commitments) and Exhibit "D" (base rates) shall be superseded by the provisions, if
any, in any agreement in effect between AMR and the City of Imperial Beach.
If AMR and the City of Imperial Beach do not have an agreement in effect at any time during the
tenor of this Agreement, then response times and the Fee Schedule £or the Lmperial Beach portion of
the EOA shall be as provided herein.
22. AGREEMENT TO REOPEN NEGOTIATIONS
At any time during the Cerm 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.
23. SIDE-LETTER AGREEMENTS
Under the authority of this Agreement, the CITY and PARTICIPATING AGENCIES are permitted
to enter into side-letter agreements with AMR specifying different levels of services, response time
commitments and rates provided to each of them. These side-letters 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 aside-letter agreement.
24. PERFO[ZMANCE BOND
This Agreement also requires that AMR deposit with the CITY a performance bond in the amount
of $;00,000.00 in favor of C[TY and PARTICIPATNG AGENCIES. A copy of said bond and
miscellaneous definitions are attached hereto as "Exhibit F." CITY shall only call Che bond after the
following conditions precedent have been saCisfied: (i) AMR materially breaches the Agreement;
19
10-44
(ii) CITY issues a written declaratio^ of material breach; (iii) AMR fails to cure the material
breach; and (iv) the CITY terminates the Agreement.
25. 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 funding seC forth in this Agreement
(and/or any "side letter") shall be used only for the City services or system Enhancements set forth
herein. The CITY and each PARTICIPATING AGENCY warrants and represents that the
payments made by AMR shall be less than or equal to the CITY's or PARTICIPATING
AGENCY'S actual costs to provide those services or system Enhancements. No fiords shall be used
by the City or a PARTICIPATING AGENCY in a manner that may violate 42 U.S.C. Section
1320a-76, the federal Anti-Kid<back Statute.
26. 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 ad<nowledges receipt of such documents. AMR warrants that its
personae] shall comply with AMR's compliance policies, inchiding training related to the Anti-
kid<back Statute.
27. 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 constihttes 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 airy of
its practitioners or employees who order or provide Services, from participation in Federal health
care programs, the party must notify Che other party within five (5) days of knowledge of such fact,
and the other party may inul~ediately Ceiminate the Agreement, unless the excluded party is a
practitioner or employee who immediately discontinues ordering or providing Services hereunder.
28. REFERRALS.
[t is not the intent of either party that any remuneration, benefit or privilege provided for render 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 speciFed herein are consistent with what the parties reasonably believe to be a fair
maii<et value for the services provided.
~p
10-45
SIGNATURE PAGE TO AMENDED
AND RESTATED AGREEMENT FOR BASIC
AND ADVANCED LIFE SUPPORT AMBULANCE
SERVICE
THE CITY OF CHULA VISTA
Cheryl Cox
Mayor of the City of Chula Vista
AMERICAN MEDICAL RESPONSE
AMBULANCE SERVICE, INC.
a Delawaze Corporation, dba
AMERICAN MEDICAL RESPONSE
1 ~ c~s~
Name: Title:
ATTEST:
Approved as to form by:
Glen Googins
City Attorney
CITY OF IMPERIAL BEACH
BONITA/SUNNYSIDE FIRE
PROTECTION DISTRICT
Gary Brown
City Manager
Scott Walker
Fire Chief
i o?a's
Attachment 3
THE ATTACHED AGREEMENT HAS BEEN REVIEWED
AND APPROVED AS TO FORM BY THE CITY
ATTORNEY'S OFFICE AND WILL BE
FORMALLY SIGNED UPON APPROVAL BY
THE CITY COUNCIL
Glen R. Googins C r' = 7 `'
City Attorney
Dated: ~ '_ / ~~, .._ ( /
AMENDMENT TO AMBULANCE SERVICE
ORIGINAL AGREEMENT
FOR
BASIC AND ADVANCED LIFE SUPPORT AMBULANCE SERVICE
BETWEEN
THE CITY OF CHULA VISTA AND
AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.
10-47
AMENDMENT TO
AMBULANCE SERVICE ORIGINAL AGREEMENT
by and between
AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.
and
THE CITY OF CHULA VISTA
THIS AMENDMENT ("Amendment") to the Revised and Restated Agreement
For Basic and Advanced Life Support Ambulance Services between American Medical
Response Ambulance Service, Inc., formerly known as Laidlaw Medical Transportation,
Inc., d/b/a American Medical Response (hereinafter "AMR") and the CITY OF CHULA
VISTA (hereinafter "City") is made and becomes effective as of July 1, 2011.
WHEREAS, the parties hereto have previously entered into an Amended and
Restated Original Agreement for Basic and Advanced Life Support Ambulance
Services on July 1, 2011 (the "Original Agreement"), whereby AMR agreed to
provide ambulance services for the City and other Participating Agencies being the
City of Imperial Beach and the Bonita/Sunnyside Fire Protection District; and
WHEREAS, said Original Agreement allows the rates to be chazged in the various
agencies to vary by political jurisdiction; and
WHEREAS, the parties hereto wish to amend the Original Agreement by this
document to formally confirm the modification of the Original Agreement tenns with
respect to approved fees for enhancement(s) to the EMS system consistent with Sections 22
and 23 of said Original Agreement;
WHEREAS, the City is desirous of obtaining funding for certain
enhancement(s) to the EMS delivery system and herein identify those enhancements as
being consistent with the desired level of service for the community (hereinafter
"Enhancements"). These Enhancements are more particulazly described as providing one
(1) Zoll Defibrillator/Monitors as standard equipment on each of the first responder engines
within the City and the study of Advanced Life Support ("ALS") first response with
extended transport response times ("Enhancements"). These Enhancements improve patient
caze and outcomes;
WHEREAS, the City, working with AMR, moved a Battalion Chief position to a
special project assignment last year to work on the ALS plan. Funding for this position was
provided by AMR with the agreement that an increase in ambulance rate fees would be used
to reimburse AMR for the funding. The previous contract, at the request of the other
contracting parties, contained side-letter agreements establishing different rates for each
entity. The recovered expense of this ALS Plan is $167,000, which reflects the cost of the
10-48
special assignment. This Amendment would grant AMR the ability to collect an additional
$33.10 in ambulance service rate per yeaz for the next three yeazs to reimburse the City's
costs; and
WHEREAS, the City desires to recover specific costs for Basic Life Support "BLS"
services involving emergency medical caze including dispatch costs, equipment, training
and overhead costs.
NOW, THEREFORE, in consideration of the foregoing premises the parties agree as
follows:
1. Exhibit "D" of the Original Agreement is modified and amended to read as
follows specifically with respect to the City. The parties acknowledge that Exhibit "D" may
be modified by "side-letter" specifically for the City of Imperial Beach and/or the
Bonita/Sunnyside but those "side letters" shall have no effect on this Amendment.
DESCRIPTION RATES
$1,274.90
ALS Transport Base Rate
($860.90 AMR Transport)
($118.58 Monitor/Defibrillator equipment City recovery)
($232.32 dispatch services City recovery)
($32.00 supplies and equipment City recovery)
($33.10 ALS study City recovery)
BLS Trans ort Base Rate $651.87
Treatment Only (no $202.60
trans ort
Mileage Rate per loaded $26.24
mile or fraction thereof
Ox en Chaz e $94.83
Ni ht Char e $93.94
AMR shall not exceed the rates set forth in the table above for services provided within the
City of Chula Vista, except in accordance with the terms and conditions of the Agreement,.
10-49
2. Fundine Mechanism For Enhanced Services Inclusive of Service Costs.
The parties acknowledge their understanding that that funding and resulting
charges which are now by this Amendment included in Exhibit "D" above was
determined by City and AMR based on a mechanism developed after a careful review
and analysis of the actual and potential costs of providing service(s) at level(s)
determined by the City as appropriate and proposed system Enhancements.
3. Certification of Costs.
a. During the term of this Original Agreement, on or before March IS`h of
each year, City shall certify to AMR that the funding received for services or
Enhancements in the prior calendar year did not exceed the costs to the City.
b. During the term of this Original Agreement, on or before March 15`h 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 in order for
City staff to verify that any rate adjustments predicated upon changes related to the
Enhancements desired pursuant to the Original Agreement are reasonable ,and
necessary. Any statutory or case law exemptions to the California Public Records Act
will apply to any documentation provided to the City under the Original Agreement and
this Amendment.
4. 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 funding set forth in this Amendment and the Original Agreement shall be used
only for the City services or system Eenhancements set forth herein. The City warrants
and represents that the payments made by AMR to City shall be less than or equal to the
City's actual costs to provide those services or system Enhancements. 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.
5. Comnliance 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.
3
10-50
6. 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.§ 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 Original
Agreement, unless the excluded party is a practitioner or employee who immediately
discontinues ordering or providing Services hereunder.
7. Referrals. It is not the intent of either party that any remuneration,
benefit or privilege provided for under the Original 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 Original Agreement. Any
payments specified herein aze consistent with what the parties reasonably believe to be a
Fair market value for the services provided.
8. All other terms and conditions of Original Agreement not specified herein
shall remain in full force and effect.
[Signature Page Follows]
4
10-51
IN WITNESS THEREOF, the parties have caused this Amendment to be
executed and effective as of July 1, 2011.
CITY OF CHULA VISTA
Name:
Title:
AMERICAN MEDIC~L IjrESPONSE AMBULANCE SERVICE, INC.
Name:
Michael
'" ~` ~~- ~vn `n5 ~ .~ ~ PS~GQeI~'
10-52
RESOLUTION NO. 2011-
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CHULA VISTA APPROVING A REVISED AND
RESTATED AGREEMENT FOR BASIC AND ADVANCED
LIFE SUPPORT SERVICE AND AN ADDITIONAL SIDE
LETTER AGREEMENT TO RECOVER EXISTING
PROGRAM EXPENSES WITH LAIDLAW MEDICAL
TRANSPORTATION INC., DBA AMERICAN MEDICAL
RESPONSE, AND AUTHORIZING THE MAYOR
TO EXECUTE THE AGREEMENT
WHEREAS, the City is authorized by California Government Code Section 38794 and
Municipal Code Sections 5.10.310-5.10.340 to contract for ambulance services within its
jurisdiction; and
WHEREAS, the City has had on ongoing relationship with Laidlaw Medical Transport
Inc., dba American Medical Response (AMR) and formerly known as Hartson Medical Services
since 1989 to provide basic and advanced life support ambulance services; and
WHEREAS, an agreement entered into with AMR on November 1, 1998 granted AMR
the authority to provide basic and advanced life support ambulance services to the Exclusive
Operating Area (EOA) that was adopted by the County of San Diego. This EOA consists of the
City of Chula Vista, Bonita/Sunnyside Fire Protection District, and the City of Imperial Beach;
and
WHEREAS, this agreement was amended and was re-titled the Amended and Restated
Agreement and approved by Council on May 14, 2002; and
WHEREAS, the Amended and Restated Agreement commenced on June 1, 2002 and was
in effect for the three-year period ending May 31, 2005; and
WHEREAS, the Amended and Restated Agreement was extended by mutual option to
December ll, 2007; and
WHEREAS, additional updates to the Amended and Restated Agreement were submitted
to Council for approval on December 11, 2007; and
WHEREAS, Council approved the new Amended and Restated Agreement on December
11, 2007, set to expire on May 31, 2011; and
WHEREAS, the parties entered into a thirty (30) day extension on May, 31, 2011; and
WHEREAS, the City wishes to continue the contractual relationship with AMR on the
terms and conditions set forth in a Revised and Restated Agreement for a period of three (3)
10-53
years; and
WHEREAS, the Amended and Restated Agreement clarified and reinforced key
stipulations ensuring AMR's performance and service delivery throughout the EOA and thus
benefiting the members of the EOA;-and
WHEREAS, pursuant to Section 17 of the Amended and Restated Agreement, the City
has the option to extend the Amended and Restated Agreement for one (1) additional three-year
period at the City's option; and
WHEREAS, pursuant to Section 20 of the Amended and Restated Agreement, the City
has the option to terminate the Amended and Restated Agreement for convenience by providing
180 days written notice; and
WHEREAS, the authorized Primary Rate Components that AMR is permitted to charge
for services rendered in the EOA are stipulated and are stated in the Side-Letter Agreement; and
WHEREAS, pursuant to Section 5 of the Revised and Restated Agreement, AMR
reserves the right to submit a requesC for increases to the Primary Rate Components; and
WHEREAS, pursuant to Section 5 of the Revised and Restated Agreement, the City
Council has sole discretion to approve or disapprove increases to the Primary Rate Components
during the lifetime of the Agreement; and
WHEREAS, pursuant to Municipal Code 2.56.070, the City Council may waive any
competitive bidding requirements where there is a commodity or service available from only one
known source as the result of unique performance capabilities, compatibility requirements or
market conditions, or the competitive bidding requirements as applied to the contract are
impractical, impossible, or the City interests would be materially better served by applying a
different purchasing process; and
WHEREAS, AMR has demonstrated through its past performance the ability to fulfill
previous contract requirements, provide competitive pricing for its services, sustain its
interoperability with the Chula Vista Fire Department and deliver longstanding quality services
to the community; and
WHEREAS, the City's interests would be materially better served by continuing its long-
term contractual relationship with AMR because of its performance capabilities, compatibility
requirements, and market conditions, including cost and existing service relationship with all
members of the EOA; and
WHEREAS, it is the intent and desire of the City Council to waive any competition
bidding requirements and enter into the Revised and Restated Agreement with AMR for the
reasons set forth herein.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Chula
10-54
Vista waives any competitive bidding requirements and exercises its option to extend its
contractual relationship with AMR for the provision of basic and advanced life support
ambulance services.
BE IT FURTHER RESOLVED that the City Council of the City of Chula Vista does
hereby approve the Revised and Restated Agreement with AMR to be effective July 1, 2011,
through June 30, 2014, with an option to extend for one (1) additional three-year term thereafter.
BE IT FURTHER RESOLVED that the City Council of the City of Chula Vista does
hereby approve the increases to the Primary Rate Components effective July 1, 2011, as set forth
in the Side-Letter Agreement and as justified in Exhibit D to the Revised and Restated
Agreement.
BE IT FURTHER RESOLVED that the City Council of the City of Chula Vista does
hereby authorize the Mayor to execute the Revised and Restated Agreement in substantially the
form presented with such minor modifications or clarifications as maybe authorized or required
by the City Attorney.
Pre ted by:
~,~,.~ l~
D
Fire Chief
Approy_eA as to form byl
Glen Googins
City Attorney
10-55