Alameda_County_EMS_Ambulance_Transport_Provider_Agreement_ 133044 Alameda County Ems Ambulance Transport Provider Agreement Optimiweb

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EmergencyMedicalServices
AmbulanceTransportProvider
Agreement
CountyofAlameda
and
ParamedicsPlus,LLC
June2010
EMSAmbulanceTransportProviderAgreement
i
TABLEOFCONTENTS
DEFINITIONSANDACRONYMS..........................................................................VII
RECITALSOFAUTHORITY................................................................................1
SCOPEOFWORK..........................................................................................2
1.SERVICES...................................................................................................................................2
2.SERVICEAREA/EMERGENCYRESPONSEZONES..................................................................................2
3.SERVICES/STANDARDS.................................................................................................................3
4.ASSISTANCETOOTHERCOUNTYEOAS/EXPANSIONOFTHEEOA.........................................................3
5.LOCATIONOFCONTRACTOR’SOFFICES............................................................................................4
6.TRANSITION...............................................................................................................................4
DISPATCH..................................................................................................4
7.ALAMEDACOUNTYREGIONALEMERGENCYCOMMUNICATIONSCENTER................................................4
8.ACRECCAGREEMENT.................................................................................................................4
9.DEPLOYMENTSUPERVISORATDISPATCHCENTER..............................................................................5
10.COUNTYCOMPUTERAIDEDDISPATCHSYSTEM.................................................................................5
11.CADDATA................................................................................................................................5
COMMUNICATIONS.......................................................................................5
12.RADIOEQUIPMENT......................................................................................................................5
RESPONSETIMEREQUIREMENTS.......................................................................6
13.RESPONSETIMEPERFORMANCEANDMEASUREMENT........................................................................6
14.RESPONSETIMEACCOUNTABILITY..................................................................................................6
15.RESPONSETIMEMEASUREMENTMETHODOLOGY.............................................................................7
16.CALCULATINGRESPONSETIMES.....................................................................................................8
17.CALCULATINGCHANGESINCALLPRIORITY.......................................................................................8
18.CANCELEDCALLS.........................................................................................................................9
19.EACHINCIDENTASEPARATERESPONSE...........................................................................................9
20.5150RESPONSE.........................................................................................................................10
21.RESPONSETIMEPERFORMANCEREPORT.........................................................................................10
22.RESPONSETIMELATERESPONSEEXEMPTIONS("EXEMPTION")...........................................................11
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STAFFINGREQUIREMENTS...............................................................................11
23.AMBULANCESTAFFINGREQUIREMENTS...........................................................................................11
24.WORKSCHEDULES......................................................................................................................11
25.PERSONNELLICENSURE/CERTIFICATION/TRAININGREQUIREMENTS......................................................12
TRANSPORTREQUIREMENT.............................................................................12
26.DESTINATION.............................................................................................................................12
27.INFLUENCEONDESTINATION.........................................................................................................13
28.AIRAMBULANCEAGREEMENTS......................................................................................................13
MULTI‐CASUALTYINCIDENT/DISASTERRESPONSE..................................................13
29.MULTI‐CASUALTYINCIDENT/DISASTERRESPONSE.............................................................................13
30.DISASTERRESPONSEVEHICLE/EQUIPMENT......................................................................................14
31.INCIDENTNOTIFICATION...............................................................................................................14
32.AMBULANCESTRIKETEAM............................................................................................................14
33.INTERAGENCYTRAININGFOREXERCISES/DRILLS................................................................................15
34.MUTUAL‐AIDREQUIREMENTS.......................................................................................................15
VEHICLESANDEQUIPMENT.............................................................................16
35.AMBULANCES.............................................................................................................................16
36.EQUIPMENT...............................................................................................................................17
37.VEHICLEANDEQUIPMENTMAINTENANCE........................................................................................17
ELECTRONICPATIENTCAREREPORTANDDATACOLLECTIONSYSTEM...........................18
38.PATIENTCAREREPORTS...............................................................................................................18
39.DATACOLLECTIONSYSTEMFORPATIENTCAREREPORTS....................................................................19
40.PCRDELIVERYTORECEIVINGHOSPITALSORPSYCHIATRICFACILITIES....................................................20
MEDICALOVERSIGHT....................................................................................21
41.MEDICALPROTOCOLS..................................................................................................................21
42.MEDICALREVIEW/AUDITS............................................................................................................21
PERSONNEL................................................................................................21
43.TREATMENTOFINCUMBENTWORKFORCE........................................................................................21
44.CHARACTER/COMPETENCE/PROFESSIONALISM.................................................................................22
45.INTERNALHEALTHANDSAFETYPROGRAMS......................................................................................22
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46.PERSONNELTRAINING..................................................................................................................23
47.CONTINUINGEDUCATIONPROGRAM..............................................................................................23
48.WORKFORCEENGAGEMENT..........................................................................................................23
49.KEYPERSONNELANDREQUIREDPOSITIONS......................................................................................24
QUALITYMANAGEMENTPLAN.........................................................................27
50.APPROVALOFQUALITYMANAGEMENTPLAN...................................................................................27
51.CALIFORNIAAWARDFORPERFORMANCEEXCELLENCE........................................................................28
REQUIREDREPORTS......................................................................................29
52.REPORTINGREQUIREMENTS..........................................................................................................29
53.RESPONSETIMEPERFORMANCE.....................................................................................................29
54.HIGH‐RISKPCRS........................................................................................................................30
55.COMPLIANCEWITHPROTOCOLS.....................................................................................................30
56.QUALITYIMPROVEMENT...............................................................................................................30
PENALTYPROVISIONS....................................................................................30
57.FAILURETORESPOND..................................................................................................................30
58.RESPONSELEVEL.........................................................................................................................31
59.MISSINGMANDATORYDATAFIELDS...............................................................................................31
60.MISSINGPCRATTHERECEIVINGHOSPITALORPSYCHIATRICFACILITY...................................................31
61.PCRGOODCAUSEEXEMPTION.....................................................................................................32
62.FAILURETOPROVIDETIMELYREPORTS............................................................................................32
63.FAILURETOMEETMINIMUMIN‐SERVICEEQUIPMENT/SUPPLYREQUIREMENTS......................................32
64.FAILURETOPROVIDEARRIVALATINCIDENTTIME..............................................................................32
65.RESPONSETIMEFINES.................................................................................................................32
66.FINESFOROUTLIERRESPONSETIMES..............................................................................................33
67.FINEDISPUTES............................................................................................................................33
68.INVOICINGANDPAYMENT.............................................................................................................33
COUNTY‐WIDECOOPERATION.........................................................................34
69.COLLABORATIONWITHFIRSTRESPONDERAGENCIES..........................................................................34
70.EMSSYSTEMPARTICIPATION........................................................................................................35
HEALTHSTATUSIMPROVEMENT/COMMUNITYEDUCATION.......................................35
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71.EMTTRAININGPROGRAMS,INTERNSHIPSANDRELATEDOPPORTUNITIES..............................................35
72.COMMUNITYPROGRAMS..............................................................................................................35
ENVIRONMENTALLYFRIENDLYBUSINESSPRACTICES................................................36
73.BUILDINGSANDVEHICLES.............................................................................................................36
74.EQUIPMENTANDSUPPLIES............................................................................................................37
75.MEDICALEQUIPMENTANDSUPPLIES..............................................................................................37
COMPLIANCEPROVISIONS...............................................................................37
76.MEDICARECOMPLIANCEPROGRAMREQUIREMENTS..........................................................................37
77.HIPAACOMPLIANCEPROGRAMREQUIREMENTS..............................................................................37
78.EMSPOLICIES............................................................................................................................38
79.MEDICALANDOTHERSTATEANDFEDERALPROGRAMS......................................................................38
CONTRACTORREVENUE..................................................................................38
80.CONTRACTORCOMPENSATION......................................................................................................38
81.PATIENTCHARGESANDFEES.........................................................................................................38
82.USERFEEADJUSTMENTS..............................................................................................................38
83.BILLING/COLLECTIONSERVICES......................................................................................................39
84.ACCOUNTINGPROCEDURE............................................................................................................40
85.CUSTOMERSERVICETELEPHONELINE.............................................................................................41
86.CONTRACTOR'SCOMPENSATIONTOTHECOUNTY..............................................................................42
ADMINISTRATIVEPROVISIONS..........................................................................42
87.ANNUALPERFORMANCEEVALUATION.............................................................................................42
88.ASSURANCEOFPERFORMANCE......................................................................................................43
89.MATERIALBREACH......................................................................................................................43
90.NOTICEANDCUREOFMATERIALBREACH........................................................................................44
91.COUNTYREMEDIES......................................................................................................................45
92.CONTINUOUSSERVICEDELIVERY....................................................................................................45
93.EMERGENCYTAKEOVER................................................................................................................45
94.TERMINATION............................................................................................................................46
FUTURECOMPETITIVEPROCUREMENTPROCESS/“LAMEDUCK”PROVISIONS................48
95.COMPETITIVEPROCUREMENTPROCESS...........................................................................................48
EMSAmbulanceTransportProviderAgreement
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96.“LAMEDUCK”PROVISIONS...........................................................................................................49
GENERALPROVISIONS...................................................................................49
97.PERMITSANDLICENSE..................................................................................................................49
98.PRIVATEWORK..........................................................................................................................50
99.PRODUCTENDORSEMENT/ADVERTISING..........................................................................................50
100.OBSERVATIONANDINSPECTIONS....................................................................................................50
101.NOCOSTTOCOUNTY..................................................................................................................51
102.COSTOFENFORCEMENT...............................................................................................................51
103.RELATIONSHIPOFTHEPARTIES.......................................................................................................51
104.INDEPENDENTCONTRACTOR..........................................................................................................51
105.INDEMNIFICATION.......................................................................................................................52
106.INSURANCEANDBOND.................................................................................................................53
107.WORKERS’COMPENSATION..........................................................................................................53
108.CONFORMITYWITHLAWANDSAFETY.............................................................................................53
109.DEBARMENTANDSUSPENSIONCERTIFICATION.................................................................................54
110.TAXES.......................................................................................................................................55
111.OWNERSHIPOFDOCUMENTS........................................................................................................55
112.DOCUMENTSANDMATERIALS.......................................................................................................56
113.CONFLICTOFINTEREST/CONFIDENTIALITY........................................................................................56
114.NOTICES....................................................................................................................................57
115.USEOFCOUNTYPROPERTY...........................................................................................................58
116.EQUALEMPLOYMENTOPPORTUNITYPRACTICESPROVISIONS..............................................................58
117.DRUGFREEWORKPLACE..............................................................................................................59
118.SMALL,LOCAL,ANDEMERGINGBUSINESS(SLEB)PARTICIPATION:......................................................59
119.FIRSTSOURCEPROGRAM..............................................................................................................60
120.WAIVER....................................................................................................................................60
121.ENTIREAGREEMENT....................................................................................................................60
122.HEADINGS.................................................................................................................................60
123.MODIFICATIONOFAGREEMENT.....................................................................................................60
124.SUBCONTRACTING/ASSIGNMENT/SALE...........................................................................................61
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125.SURVIVAL..................................................................................................................................61
126.SEVERABILITY.............................................................................................................................62
127.PATENTANDCOPYRIGHTINDEMNITY..............................................................................................62
128.CHOICEOFLAWANDVENUE.........................................................................................................63
SIGNATORY................................................................................................63
EXHIBITS....................................................................................................1
EXHIBITA‐DEPICTIONANDDEFINITIONOFCONTRACTOR’SEOAAND
EMERGENCYRESPONSEZONES.......................................................2
EXHIBITB‐DEPICTIONANDDEFINITIONOFSUB‐AREAS..........................................3
EXHIBITC‐MINIMUMINSURANCEREQUIREMENTS................................................6
EXHIBITD‐DEBARMENTANDSUSPENSIONCERTIFICATION......................................7
EXHIBITE‐COMMUNICATIONSEQUIPMENT.........................................................8
EXHIBITF‐RESPONSETIMESREQUIREMENTSANDFINES.........................................10
TABLEA‐PERSONNELANDRESPONSETIMEREQUIREMENTS...............................................................10
TABLEB‐RESPONSETIMEFINESBYCATEGORYANDCOMPLIANCE.......................................................10
TABLEC‐OUTLIERRESPONSETIMESBYCATEGORYANDSUBAREAINMINUTES&SECONDS.....................10
EXHIBITG‐PARAMEDICTRAININGREQUIREMENTS................................................11
EXHIBITH‐CONTRACTOR’SUSERFEES‐911SYSTEM............................................13
EXHIBITI‐MANDATORYDATAFIELDREQUIREMENTS.............................................14
EXHIBITJ‐FIRSTSOURCEAGREEMENT...............................................................15
EXHIBITK–TRANSITIONPLAN.........................................................................16
EXHIBITL‐COMMUNITYEDUCATIONPROGRAM...................................................22
EXHIBITM‐FIRSTRESPONDERSUPPORT............................................................24
EXHIBITN‐HIGHRISKPATIENTDESCRIPTION......................................................25
EXHIBITO‐PROPOSALOFPARAMEDICSPLUS......................................................26
EMSAmbulanceTransportProviderAgreement
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DEFINITIONSANDACRONYMS
ThefollowingdefinitionsandacronymsarecontainedinthisAgreement:
5150Call
Servicesinvolvingapatientwhohasbeen(orshallbe)placedonaholdfor
psychiatricevaluation,includingtransporttoapsychiatricfacilityin
accordancewiththeCaliforniaCodeofRegulationsWelfareandInstitutions
Code,Section5150andEMSPolicies.
Ambulance
AsdefinedpursuanttoTitle13oftheCaliforniaCodeofRegulations,section
1100.2.Avehiclespeciallyconstructed,modifiedorequipped,andusedforthe
purposeoftransportingsick,injured,convalescent,infirm,orotherwise
incapacitatedpersons,andcompliantwithstaterequirements.
AmbulanceStrike
Team(s)ReferencedescriptioninEMSAguideline#215
ACRECCAlamedaCountyRegionalEmergencyCommunicationsCenter
AlphaCallA911calldesignatedbyCountyDispatchCenterasanAlphaCallbasedonuse
oftheMedicalPriorityDispatchSystem.
ALSAdvancedLifeSupport‐paramediclevelofserviceasdefinedinCalifornia
HealthandSafetyCode,Division2.5,§1797.52
Arrivalat
Incident
ThemomenttheAmbulanceisfullystoppedattheIncidentLocationandField
PersonnelnotifiestheCountyDispatchCenterofthearrival.
AVLAutomaticVehicleLocator
BaseHospital
AsdefinedinCaliforniaHealthandSafetyCode,Division2.5,§1797.58.The
BaseHospitalforAlamedaCountyisAlamedaCountyMedicalCenter,Highland
Campus.
BLSBasicLifeSupport‐EMTlevelofservice,asdefinedinCaliforniaHealthand
SafetyCode,Division2.5,§1797.60
BoardAlamedaCountyBoardofSupervisors
BravoCallA911calldesignatedbyCountyDispatchCenterasaBravoCallbasedonuse
oftheMedicalPriorityDispatchSystem.
CADComputerAidedDispatch
CharlieCallA911calldesignatedbyCountyDispatchCenterasaCharlieCallbasedonuse
oftheMedicalPriorityDispatchSystem.
Continuing
Education(CE)AsdefinedintheCaliforniaCodeofRegulations,Title22,Chapter11
ContractorParamedicsPlus,LLC
EMSAmbulanceTransportProviderAgreement
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Contracting
City(ies)
AmunicipalityinZone1thathasacontractwithEMStoprovideitsown
Ambulanceservicesinthatcity'sexclusiveoperatingarea.
CountyTheCountyofAlameda
CountyDispatch
Center
ThemedicaldispatchcenterdesignatedbyEMStodispatchContractor’s
Ambulances,pursuanttothisAgreement.
DataCollection
System
Thesoftwareandhardwareusedtocollect,storeandreportoninformation
fromtheprovisionofServices,whichincludesthePatientCareReports.
DeltaCallA911calldesignatedbyCountyDispatchCenterasaDeltaCallbasedonuseof
theMedicalPriorityDispatchSystem.
DTMFDualToneMultiFrequency(Touch‐Tone).
EchoCall
A911calldesignatedbyCountyDispatchCenterasanEchoCall(non‐breathing
and/orineffectivebreathing)basedonuseoftheMedicalPriorityDispatch
System
EffectiveDateThedatetheAgreementissignedbythePresidentoftheAlamedaCounty
BoardofSupervisors
EMS
UsedinthisAgreementtorefertoAlamedaCountyEmergencyMedical
Services,aDivisionofthePublicHealthDepartment,aspartoftheHealthCare
ServicesAgency
EMSDirectorThedirectoroftheAlamedaCountyEmergencyMedicalServices,aDivisionof
thePublicHealthDepartment,aspartoftheHealthCareServicesAgency.
EMSMedical
Director
ThephysicianinthepositionofMedicalDirectorforAlamedaCounty
EmergencyMedicalServices,aDivisionofthePublicHealthDepartment,as
partoftheHealthCareServicesAgency..
EMSPolicies
PoliciesandproceduresissuedbytheAlamedaCountyEmergencyMedical
ServicesthatarecontainedintheAlamedaCountyEmergencyMedicalServices
FieldManualand/orAdministrationManual,whichmayberevisedfromtime
totime
EMSwebsiteacgov.org/ems
EMSAEmergencyMedicalServicesAuthorityoftheStateofCalifornia
EMTEmergencyMedicalTechnician
EOA
AsusedinthisAgreement,referstotheExclusiveOperatingAreafor"Services"
asdesignatedinAlamedaCounty’sapprovedEMSPlan,anddepictedinEXHIBIT
A‐DEPICTIONANDDEFINITIONOFCONTRACTOR'SEOAANDEMERGENCYRESPONSEZONES.
ERZEmergencyResponseZone,asdepictedinEXHIBITA‐DEPICTIONANDDEFINITIONOF
CONTRACTOR'SEOAANDEMERGENCYRESPONSEZONES.
EMSAmbulanceTransportProviderAgreement
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FederalReferstoUnitedStatesFederalGovernment,itsdepartmentsand/oragencies
FieldPersonnelContractor'sparamedicsandEMTsresponsibleforrespondingto911requests
foremergencymedicalgroundambulanceservicespursuanttothisAgreement
Fractile
Amethodofmeasuringdatainwhichallapplicabledataarestackedin
ascendingorderandthetotalnumberiscalculatedasapercentageofthetotal
numberofcalls.(e.g.:a90thpercentilestandardisonewhere90%ofthe
applicableAmbulancecallsareansweredwithintheresponsestandard,while
10%takelongerthanthestandard.)
FRALS
FirstResponseAdvancedLifeSupport–Afiredepartmentunitstaffedand
equippedwithaminimumofoneCaliforniaStatelicensedandAlamedaCounty
accreditedParamediccapableofprovidingALSatscenesofmedical
emergencies.TheseunitsaredesignatedbytheCountyandhaveanexecuted
agreementwiththeCountytoprovideservice
FirstResponder
Agency(ies)
ThefiredepartmentswithintheEOA,andthoseinZone1thatareunder
contractwiththeCounty,toprovidefirstresponsetothesceneofamedical
emergency
High‐RiskPCRAPatientCareRecordforaHigh‐Riskpatient.SeeEXHIBITN‐HIGHRISKPATIENT
DESCRIPTION
HIPAAHealthInsurancePortabilityandAccountabilityActof1996
IncidentLocationThedestinationaddressorlocationofthepatienttheAmbulanceisdispatched
tobytheCountyDispatchCenter
Incumbent
Personnel
ThoseemployeesworkingforAmericanMedicalResponseundercontractwith
CountyforemergencygroundambulanceservicestotheEOAontheEffective
Date
KeyPersonnelContractor’spersonnelprovidingServicesinthepositionsofa)Operations
Manager(ChiefOperationsOfficer),b)MedicalDirectorandc)QualityManager
LaborCodeCaliforniaLaborCode
LEMSALocalEmergencyMedicalServicesAgency,asdefinedinCaliforniaHealthand
SafetyCode,Division2.5,§1797.94
MandatoryData
Fields
Theminimumamountofinformationthatsatisfiestherequirementfora
completedPatientCareReportleftatthereceivinghospitalorpsychiatric
facility.
MedicalPriority
DispatchSystem
(“MPDS”)
Thesystemthatcategorizesemergencycallsusinganescalatingscaleof
severityassignedtomedicalconditions,relativetothelevelandtimelinessof
response.
Mutual‐Aid
Emergencyambulanceserviceperformedbyneighboringprovidersduring
periodsofsevereweather,multi‐casualtyincidents,orothereventsthat
overwhelmexistingresources
EMSAmbulanceTransportProviderAgreement
x
Multi‐Casualty
Incident(“MCI”)
AMulti‐CasualtyIncident(MCI)isanyincidentwherethenumberofinjured
personsexceedstheday‐to‐dayoperatingcapabilitiesandrequiresadditional
resourcesand/orthedistributionofpatientstomultiplehospitals,asdefinedin
EMSPolicies
OnboardMobile
Gateway
(“OMG”)
Themobilenetworkingtechnologythatconnectsandmanagesequipment,
informationandpeopleinthefield.Provideshighperformance,highsecurity,
wirelessbroadbandnetworkingformobileapplications
ParamedicAsdefinedinCaliforniaHealthandSafetyCode,Division2.5,§1797.84
PCRPatientCareRecord,ineitherprintorelectronicform
ResponseTime ThetimeelapsedfromthetimeacallisreceivedbyContractorfromtheCounty
DispatchCenter,untilArrivalattheIncidentLocationbytheAmbulance
Required
Positions
Thepositionsofa)Clinical/EducationStaff,b)ClinicalFieldSupervisors,c)
OperationalFieldSupervisors,andd)Analyst,forwhichContractorisrequired
tohaveindividualemployeeswhileprovidingServices
Quality
Improvement
AsdefinedintheCaliforniaCodeofRegulations,Title22,Chapter12andEMSA
#166:EMSSystemQualityImprovementGuidelines
StateTheStateofCalifornia,itsdepartmentsand/oragencies
ServiceStartDate12:00amonthedateContractorbeginsprovidingServices
Services
Contractor’sprovisionof911emergencymedicalgroundambulanceresponse
andtransportationatanAdvancedLifeSupport(ALS)levelofservice,and
wherespecifiedinthisAgreement,BasicLifeSupport(BLS);and,obligationsas
requiredbythisAgreementandinaccordancewithEMSPolicy
ServiceVehiclesContractor’svehiclesusedintheprovisionofServices,includingbutnotlimited
to,AmbulancesandSupervisorVehicles.
Subarea
DesignationswithinanEmergencyResponseZoneofMetro/Urban,
Suburban/RuralandWilderness,asdepictedinEXHIBITB‐DEPICTIONAND
DEFINITIONOFSUBAREAS.
Supervisor(s)ClinicalFieldSupervisorsandOperationalFieldSupervisors
Supervisor
Vehicles
Avehicle,otherthananambulance,drivenbyaSupervisorandequippedfor
emergencymedicalresponse
UserFeesChargestopatientsand/orinsuranceproviders,includingMedicareandMedi‐
CalforServicesprovidedbyContractor.
EMSAmbulanceTransportProviderAgreement
Page1of63
ThisAgreement("Agreement")isbyandbetweentheCountyofAlameda,hereinreferredtoas
County,andParamedicsPlus,LLC.,hereinreferredtoasContractor,andshallbeeffectivethedate
thisAgreementissignedbythepresidentoftheAlamedaCountyBoardofSupervisors("Effective
Date").
ThisAgreementisfortheprovisionof911emergencymedicalgroundambulanceresponseand
transportationatanAdvancedLifeSupport("ALS")levelofservice,andwherespecifiedinthis
Agreement,BasicLifeSupport("BLS")levelofservice("Services")forafiveyearperiod,
commencingNovember1,2011("ServiceStartDate")andcontinuingthroughOctober31,
2016,withanoptiontoextendforanadditionalfive(5)yearperiodatCounty'ssolediscretion.
TheCountyshallprovideContractorwithwrittennoticeofitsintenttoextendthisAgreementat
leasttwelve(12)monthspriortothescheduledendofthetermoftheAgreement.
RECITALSOFAUTHORITY
Whereas,Division2.5oftheHealthandSafetyCodeSections1797.224and1797.85allowsthe
LocalEmergencyMedicalServicesAgency("LEMSA")tocreateExclusiveOperatingAreas("EOA");
and,
Whereas,AlamedaCountyEmergencyMedicalServices("EMS")isthedesignatedLEMSA;and,
Whereas,EMShascreatedanEOA;and,
Whereas,pursuanttoDivision2.5oftheHealthandSafetyCode,Section1797.200,theCountyof
AlamedahasdesignatedtheLEMSAtodevelopawrittenagreementwithaqualifiedparamedic
serviceprovidertoprovideServices,andparticipateintheadvancedlifesupportprogramin
AlamedaCounty;and,
Whereas,Title22,CaliforniaCodeofRegulations,Section100168,Division9,Chapter4,Article6,
requiresawrittenagreementforServices;and,
EMSAmbulanceTransportProviderAgreement
Page2of63
Whereas,theCountyengagedinafaircompetitiveprocessinaccordancewithStatelawand
Countypolicy;and,
Whereas,onApril27,2010atitsregularmeeting,theAlamedaCountyBoardofSupervisors
determinedthatParamedicPlus,LLC.hadsubmittedtheproposalthatbestservestheoverall
interestsoftheCountyandattainedthehighestover‐allpointscore;and,
Whereas,CountyandContractordesiretoenterintoaperformance‐basedagreementfor
provisionofServicesinaccordancewiththisAgreement;
NOW,THEREFORE,thepartiesagreetothefollowingtermsandconditions:
SCOPEOFWORK
1. Services
1.1 ContractorshallprovideServices,asrequestedbytheCountyDispatchCenter,and
inaccordancewiththisAgreementandtheContractor’sproposal,whichisattached
heretoasExhibitO(Appendices1‐56incorporatedbyreference,butnotattached)
andincorporatedhereinbythisreference,exceptthatinthecaseofanyconflicting
provisionsthetermsofthisAgreementshallcontroloverthetermsoftheProposal.
1.2 ContractorshallprovideServicesinaccordancewiththerequirementsofCalifornia
StateHealthandSafetyCode,Division2.5,Sections1797etseq.,CaliforniaCodeof
Regulation,Title22,Division9,andanyamendmentsorrevisionsthereof.
1.3 ContractorshallemployallresourcesnecessarytoachievetheResponseTimesand
allotherrequiredperformance.
1.4 Contractoragreestoincreaseresourcesatitssoleexpensetomeetanyincreasein
needsordemandsforServices.
2. ServiceArea/EmergencyResponseZones
2.1 ContractorshallprovideServiceswithintheEOA,asdesignatedinCounty’s
EmergencyMedicalServicesPlanandapprovedbytheStateEmergencyMedical
ServicesAuthority("EMSA"),asdefinedinCaliforniaHealthandSafetyCode,
Division2.5,§1797.85.
EMSAmbulanceTransportProviderAgreement
Page3of63
2.2 ServicesshallbeprovidedtoallareaswithintheEOAandasotherwiserequiredby
thisAgreement.AmapoftheEOA,dividedintospecificEmergencyResponseZones
("ERZ")isattachedasEXHIBITA‐DEPICTIONANDDEFINITIONOFCONTRACTOR'SEOAAND
EMERGENCYRESPONSEZONES.
3. Services/Standards
3.1 ContractorshallprovideServices24hoursperday,7daysperweek,52weeksper
yearwithoutinterruption,forthefulltermoftheAgreement.Servicesshallbe
providedwithoutregardtothepatient'srace,color,nationalorigin,religion,sexual
orientation,age,sex,orabilitytopay
3.2 Contractorshallbetheexclusive911medicalgroundAmbulanceprovider
authorizedbytheCountyintheEOAandallcallsforServicesoriginatingintheEOA
shallbereferredtoContractor,withtheexceptionofMutual‐Aidanddisaster
response.
3.3 ContractorshallworkcooperativelywiththeEMSDirector,theEMSMedical
Director,andotherCountystaffandagenciestofulfillthetermsandconditionsof
thisAgreement.
3.4 ContractorshallattainaccreditationbytheCommissiononAccreditationof
AmbulanceServices(“CAAS”)withineighteen(18)monthsoftheServiceStartDate.
TheContractorshallthereaftermaintainaccreditationthroughoutthetermofthe
Agreement.
4. AssistancetoOtherCountyEOAs/ExpansionoftheEOA
4.1 Contractorshall,tothebestofitsability,assistinservicinganyotherexclusive
operatingareawithintheCounty,ifrequestedtodosobytheEMSDirector.
4.2 IftheEOAexpandstoincludeAlameda,BerkeleyorPiedmont,Contractorshall
extenditsserviceareaatnocosttothecityorCounty.Thenocostextensionshall
notapplytotheCityofAlbanyunlessitisaddedtotheEOAinconjunctionwith,or
following,theadditionoftheCityofBerkeley.
4.3 TheContractor,theEMSDirector,andcityrepresentativesshallcollaborateona
transitionplanfortheexpansionoftheEOA,consistentwiththisAgreement.
EMSAmbulanceTransportProviderAgreement
Page4of63
5. LocationofContractor’sOffices
ContractorshallmaintainoneormoreofficesforoperationswithinAlamedaCountyduring
thetermofthisAgreement.
6. Transition
6.1 At12:00AMonthedatefollowingthelastdayofservicesprovidedbythecurrent
serviceproviderContractorshallbeginprovidingServices("ServiceStartDate").
6.2 BeginningontheEffectiveDate,Contractorshalldevotetimeandresourcestobe
fullypreparedforbecomingtheAmbulancetransportproviderontheServiceStart
Date.ContractorshallmeetallmilestonesandrequirementsassetforthinEXHIBITK
‐TRANSITIONPLAN,whichmaybeamendedbymutualagreementoftheparties.
6.3 AllAmbulancesandSupervisorVehiclesshallbeinspectedbyEMSpriortothe
ServicesStartDate,andasdescribedinEXHIBITK‐TRANSITIONPLAN.
DISPATCH
7. AlamedaCountyRegionalEmergencyCommunicationsCenter
Contractor’sAmbulancesshallbedispatchedbytheCountyDispatchCenter,whichis
operatedbyAlamedaCountyRegionalEmergencyCommunicationsCenter("ACRECC").
8. ACRECCAgreement
8.1 ContractorshallmakeagoodfaithefforttoenterintoanagreementwithACRECC
fordispatchservicesforthesamelengthoftimeasthisAgreement,includingany
extensions.
8.2 IfContractorandACRECCareunabletoenterintoanagreementfordispatch
services,Contractorshallestablishitsowndispatchservicesorenterintoan
agreementwithanotherentitytoprovidedispatchservicesforthisAgreement
undertermsthataremutuallyacceptabletoCountyandContractor.IfContractor
andACRECCareunabletoreachagreementinsufficienttimeforthe
commencementofServices,thisAgreementshallbeamendedtoreflectmutually
agreeduponalternativedispatcharrangements.
8.3 Dispatchservicesshallinclude:a)EMScallintakefunctions,b)callprioritization
andc)pre‐arrivalinstructionsaccordingtoMedicalPriorityDispatchSystem
EMSAmbulanceTransportProviderAgreement
Page5of63
(“MPDS”)protocolsdevelopedincollaborationwiththeCountyEMSMedical
Director.
9. DeploymentSupervisoratDispatchCenter
9.1 ContractorshallstaffaDeploymentSupervisorattheCountyDispatchCenter24
hoursaday,seven(7)daysaweek.Thispositionshallberesponsiblefor
coordinatingSupervisorsandFieldPersonnel,andmonitoringthedeploymentof
AmbulancesandSupervisorVehiclesinthefieldforoptimalResponseTimes.
9.2 TheDeploymentSupervisorshallworkcollaborativelywithCountyDispatchCenter
to:a)assistwithtraining,b)identifyimprovementareas,andc)facilitateapositive
andproductiveworkingrelationshipbetweenCountyDispatchCenterpersonnel
andFieldPersonnel.
10. CountyComputerAidedDispatchSystem
10.1 ContractorshallpayforanymodificationstotheCountyDispatchCenterComputer
AidedDispatch("CAD")systemnecessarytoeffectivelymonitor,deploy,redeploy
itsAmbulances,andprovideServices.
10.2 Contractorshallprovideasneededadditionalcomputerservers,workstations,and
employeetrainingtoCountystaff.
11. CADData
ContractorshallensurethattheCountyhasimmediateaccesstoallEMSrelateddata
maintainedbytheCADsystematACRECC.
COMMUNICATIONS
12. RadioEquipment
12.1 ContractorshallworkwithCountyandtheFederalCommunicationsCommission
("FCC")toenableContractortoeffectivelyreceivecommunicationsasdirectedby
theCountyDispatchCenter.
12.2 ContractorshallworkwithCountyandtheFCCtoenableContractortoeffectively
utilizetheCounty’sradioinfrastructuretocommunicatewiththeCountyDispatch
CenterandFirstResponderAgencies.
EMSAmbulanceTransportProviderAgreement
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12.3 ContractorshallequipeachAmbulanceandSupervisorVehiclewithanOnboard
MobileGateway(“OMG”)whichshallprovidewirelessaccesstoCADandbilling
systemdata.
12.4 ContractorshallequipandmaintaineachAmbulanceandSupervisorVehiclewith
communicationsequipmentassetforthinEXHIBITE‐COMMUNICATIONSEQUIPMENT,
whichmaybechangedfromtimetotime.
RESPONSETIMEREQUIREMENTS
13. ResponseTimePerformanceandMeasurement
13.1 ContractorissolelyresponsibleforServiceStartDateperformance:
a. ResponseTimestandardsforCharlie,DeltaandEchoambulanceresponses
shallbeineffectontheServiceStartDate.
b. ResponseTimestandardsforAlphaandBravoresponsesshallbeineffecton
theServiceStartDate,however,finesshallnotbeassessedforsixmonths
aftertheServiceStartDate.
13.2 TheCountyDispatchCentershallclassifyandassigncallsasAlpha,Bravo,Charlie,
Delta,andEcho,byMedicalPriorityDispatchSystem("MPDS").
13.3 RespondingFieldPersonnelshallbenotifiedbytheCountyDispatchCenterofthe
MPDSdesignationviapager,cellularphoneorotherportablehandhelddevice
capableofreceivingemergencyresponsedatafromtheACRECCpagingsystem.
13.4 AnyMutual‐AidcalloriginatingoutsidetheEOAshallnotbecountedinthetotal
numberofcallsusedtodetermineResponseTimecompliance.
14. ResponseTimeAccountability
14.1Contractor'sResponseTimesshallbecalculatedonamonthlybasisforreporting
purposestodeterminecomplianceusingFractileResponseTimemeasurements.
14.2 Contractor'sResponseTimeforServicesintheEOAshallmeettherequirements
containedinEXHIBITF‐RESPONSETIMEREQUIREMENTSANDFINES(TableA,PERSONNEL
ANDRESPONSETIMEREQUIREMENTS)with100%compliance.
EMSAmbulanceTransportProviderAgreement
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14.3 ContractorshallbeassessedfinesifResponseTimecompliancefallsbelow90%,as
setforthinExhibitF‐RESPONSETIMEREQUIREMENTSANDFINES(TableB,RESPONSETIME
FINESBYCATEGORYANDCOMPLIANCE.)
15. ResponseTimeMeasurementMethodology
15.1 ResponseTimeshallbemeasuredinminutesandinteger(whole)secondsfromthe
timethecallisreceivedbyContractorfromtheCountyDispatchCenteruntilarrival
attheIncidentLocationbytheAmbulance,oruntilthecalliscancelledbyapublic
safetyagencyorCountyDispatchCenter.
15.2 DeterminationofResponseTimesdependsonthelocationoftheincidentwith
respecttotheEmergencyResponseZone(“ERZ”),depictedinEXHIBITA‐DEPICTION
ANDDEFINITIONOFCONTRACTOR'SEOAANDEMERGENCYRESPONSEZONES.
15.3 EachERZmaybecomprisedofoneormoreofthree(3)Sub‐areas,whichare
describedinEXHIBITB‐DEPICTIONANDDEFINITIONOFSUB‐AREAS.
15.4 InsituationswheretheAmbulancehasrespondedtoalocationotherthanthe
IncidentLocation(e.g.stagingareasforhazardousmaterials/violentcrime
incidents,non‐securedscenes,orwhereruggedterrainprecludesaccess),Arrivalat
IncidentshallbethetimetheAmbulancearrivesatthedesignatedstaginglocation
orthenearestpublicaccesspointtothepatient’slocation.
15.5 Allofthefollowingtimesshallbetracked:
a. TimecallreceivedattheCountyDispatchCenter(providedbyCounty
DispatchCenter)
b. TimecallansweredattheCountyDispatchCenter(providedbyCounty
DispatchCenter)
c. Timelocationverified(providedbyCountyDispatchCenter)
d. TimecallreceivedbytheContractorfromtheCountyDispatchCenter
e. Timeunitenroutetothecall
f. ArrivalatIncidenttime(vehiclestopped)
g. Timearrivalatpatient
EMSAmbulanceTransportProviderAgreement
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h. TimeAmbulancedepartsscene
i. TimeAmbulancearrivesatthereceivinghospitalorpsychiatricfacility
j. TimeFieldPersonneltransferscareofthepatienttoreceivinghospitalor
psychiatricfacilitypersonnel
k. TimeAmbulancedepartsthereceivinghospitalorpsychiatricfacility
15.6 TheContractormayberequiredtologadditionaltimesbytheEMSMedicalDirector
suchastimesofdefibrillation,administrationoftreatmentsandmedications,and
otherinstancesdeemedimportantforclinicalmonitoringandresearchactivities.
16. CalculatingResponseTimes
16.1 Contractormustsynchronizeitsmission‐criticalclocks(e.g.:PCRandcardiac
monitor),dailywiththeCountyDispatchCenter’sclock,soallreportsaccurately
reflectCountyDispatchCentertimes.
16.2 Contractor'sResponseTimesshallbecalculatedonamonthlybasisforreporting
purposesusingFractileResponseTimemeasurement.
16.3 ContractormustbeincompliancewithallResponseTimeswithinallEmergency
ResponseZonesandSubareasatalltimesforanyconsecutive30‐dayperiodor
Contractorshallbepenalized,assetforthinthisAgreement.TheCountyshall
periodicallyperformauditsofResponseTimesforarandomlyselectedconsecutive
30‐dayperiodinadditiontoanyotherreportingrequirementsunderthis
Agreement.
17. CalculatingChangesinCallPriority
17.1 Upgrades
IfanassignmentisupgradedpriortotheArrivalatIncidentoftheAmbulance(e.g.
fromaCharlietoDelta),Contractor’scomplianceandfinesshallbecalculatedbased
ontheshorterof:
TimeelapsedfromdispatchtotimeofupgradeplusthehigherpriorityResponse
Timestandard,or,
ThelowerpriorityResponseTimestandard.
EMSAmbulanceTransportProviderAgreement
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17.2 Downgrades
Ifacallisdowngraded,priortoarrivalonsceneoftheAmbulance(e.g.fromaDelta
toaCharlie),Contractor’scomplianceandfinesshallbedeterminedby:
a. Ifthetimeofthedowngradeoccursaftertheemergencyambulancehas
exceededthehigherpriorityResponseTimestandard,thehigherpriority
ResponseTimestandardshallapply;or,
b. Ifthetimeofthedowngradeoccursbeforetheemergencyambulancehas
exceededthehigherpriorityResponseTimestandard,thelowerpriority
ResponseTimestandardshallapply.
c. Inallsuchcases,documentationmustbepresentedforvalidationofthe
reasonwhytheprioritystatuswasdowngraded.Ifthedowngradewas
justified,inthesolediscretionoftheCounty,thelongerstandardshallapply.
17.3 ReassignmentEnroute
IfanAmbulanceisreassigneden‐routeorturnedaroundpriortoArrivalatIncident
Location(e.g.,torespondtoahigherpriorityrequest),complianceandfinesshallbe
calculatedbasedontheResponseTimeStandardapplicabletotheassignedpriority
oftheinitialresponse.TheResponseTimeclockshallnotstopuntilthearrivalofan
emergencyambulanceonthescenefromwhichtheambulancewasdiverted.
18. CanceledCalls
IfacalliscanceledpriortotheAmbulance’sArrivalatIncident,thecomplianceandfines
shallbecalculatedbasedontheelapsedtimefromdispatchtothetimethecallwas
canceled.
19. EachIncidentaSeparateResponse
19.1 Eachincidentshallbecountedasasingleresponseregardlessofthenumberof
unitsthatareutilized.TheResponseTimeoftheContractor'sfirstarriving
AmbulanceshallbeusedtocomputeContractorsResponseTimeforthatincident.
19.2 WhenContractorrequestsaMutual‐Aidresponsefromoneofthetransportingfire
departmentsinZone1,ContractorremainsresponsiblefortheResponseTimeto
theincident.
EMSAmbulanceTransportProviderAgreement
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20. 5150Response
20.1 5150ResponseswithintheEOA
a. ContractorshallrespondALSlevelpersonnelto5150Callsdispatchedasan
Echo,Delta,orCharlie.Ifthepatientdoesnotrequiremedicalclearanceatan
emergencydepartment,theALSAmbulancecanrequestthataBLS
Ambulancetransporttotheappropriatepsychiatricfacilityinaccordance
withEMSPoliciesregardingpsychiatricpatientcare.
b. ContractormayrespondBLSlevelpersonnelto5150callsdispatchedas
AlphaorBravo.
20.2 5150ResponsesintoZone1:
a. ContractormayrespondaBLStransportunitintoZone1for5150Callsifthe
callwasinitiallydispatchedasanAlphaorBravocallbytheCountyDispatch
Center.
b. ContractormayrespondaBLSunitintoZone1for5150callsinitially
dispatchedasEcho,Delta,orCharlie,followingmedicalclearancebyZone1
paramedics.TherequestmustbemadethroughtheCountyDispatchCenter
via911andinaccordancewithEMSPolicies.
c. ResponseTimesfor5150CallsinZone1aretobeincludedinthe
Contractor'sResponseTimeperformancecalculation.
21. ResponseTimePerformanceReport
21.1 ContractorshallsubmitamonthlyResponseTimePerformancereportin
accordancewithduedatesestablishedbyCounty.
21.2 EveryrequestfromtheCountyDispatchCenteroriginatingwithintheEOAand
those5150callsoriginatinginZone1shallbeincludedinContractor'smonthly
calculationofperformancetodeterminecompliancewithResponseTimestandards,
exceptasotherwiseprovidedinthisAgreement.
21.3 ContractorisrequiredtomeetthespecifiedResponseTimestandards;therefore,
Contractorshallmaintainmechanismsforexpansionofresponsecapacityshoulda
systemoverloadoccur.
EMSAmbulanceTransportProviderAgreement
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21.4 Themechanismsforexpansionofcapacityshallbeinawrittenplanandsubmitted
forapprovaltoEMS.
22. ResponseTimeLateResponseExemptions("Exemption")
22.1 Contractormayrequestthatalateresponsebeexcludedfromthecalculationof
ResponseTimestandards(“anExemption”),ifthatcallfallsintooneofthefollowing
categories:
a. AdeclaredMulti‐CasualtyIncident(“MCI”)ordisasterthattheEMSDirector
determineshashadamaterialimpactonContractor’sresources.
b. TherewasadelaybecauseinformationrelayedbytheCountyDispatch
Centerwassubstantiallyincorrectsoastoprohibittimelyarrivalatthecall.
22.2 ArequestforanExemptionmustbeinwriting,andreceivedbytheEMSDirector
withinten(10)calendardaysfollowingtheendofthemonthinwhichtheevent
occurred.Therequestmustincludeperformancereportsforthemonthinwhichthe
incidentoccurredandwrittendocumentationsupportingtherequest.
22.3 ResponseTimeExemptionsmaybegrantedbytheCountyonapercallbasis,
followingreviewandinvestigationbytheCounty.
22.4 CallsthatareapprovedasanExemptionshallnotbeincludedinthecalculationsfor
ResponseTimecompliance.
STAFFINGREQUIREMENTS
23. AmbulanceStaffingRequirements
23.1 Contractorshallstaff,ataminimum,one(1)Paramedicandone(1)EMTforall
AmbulancesrespondingtoCharlie,DeltaandEchocalls,andcallstheCounty
DispatchCenterdeterminesanALSresponseisappropriate
23.2 Contractorshallstaff,ataminimum,two(2)EMTsforallAmbulancesrespondingto
AlphaandBravocalls,ormulti‐unitresponses,orcallstheCountyDispatchCenter
determinesaBLSresponseisappropriate.
24. WorkSchedules
24.1 24‐hourShifts:
EMSAmbulanceTransportProviderAgreement
Page12of63
a. Contractor'semployeesassignedto24‐hourshiftsshallnotworkmorethan
24consecutivehourswithoutaminimumoftwelvehoursoff‐duty.
b. Anemployeemaycompleteacallthatwasinprogresspriortothe24‐hour
limit;however,thatemployeeshallnotbedispatchedtoanadditionalcall.
Thetotalhoursworkedshallnotexceedtwenty‐six(26)consecutivehours.
c. Contractorshallmonitortheworkloadforall24‐hourshiftsandsenda
reporttotheEMSDirectormonthly.IftheworkloadtrendshowsthatField
Personnelarenotaffordedatleasta4‐houruninterruptedbreakduringthe
24‐hourshift,onaconsistentbasisforgreaterthanthree(3)months,
ContractorshallworkwiththeCountytoidentifyalternatives,including
changestoshiftlengths.
24.2 Lessthan24‐hourShifts:
a. Contractor’semployeesassignedtolessthan24‐hourshiftsshallnotwork
morethan18consecutivehourswithoutaminimumoftwelvehoursoff‐
duty.
b. Anemployeemaycompleteacallthatwasinprogresspriortothe18‐hour
limit;however,thatemployeeshallnotbedispatchedtoanadditionalcall.
Thetotalhoursworkedshallnotexceedtwenty(20)consecutivehours.
25. PersonnelLicensure/Certification/TrainingRequirements
25.1 FieldPersonnelperformingServicesundertheAgreementshallatalltimesbe
appropriatelycertifiedand/orlicensedtopracticeintheStateofCaliforniaandin
thecaseofParamedics,accreditedinAlamedaCounty.
25.2 Contractorshall,atalltimes,retainelectroniccopiesofcurrentlicenses,
certifications,andtrainingdocumentationforFieldPersonnelperformingServices.
TRANSPORTREQUIREMENT
26. Destination
PatientsshallbetransportedinaccordancewithEMSPolicies,asmaybeamendedfrom
timetotime.
EMSAmbulanceTransportProviderAgreement
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27. InfluenceonDestination
FieldPersonnelshallnotattempttoinfluenceapatient’sdestinationselectionotherthanas
setforthintheEMSTransportGuidelinesPolicy.
28. AirAmbulanceAgreements
CountymayenterintoseparatetransportagreementswithAirAmbulanceproviders.
NotwithstandinganyotherprovisionofthisAgreement,Countymayprovideforair
transportofpatientswhensuchtransportationisdeemedtobemedicallyinthebest
interestofthepatient,asdefinedinEMSPolicies.
MULTI‐CASUALTYINCIDENT/DISASTERRESPONSE
29. Multi‐CasualtyIncident/DisasterResponse
29.1 ContractorshallcooperatewithCountyinrenderingemergencyassistanceduringa
declaredoranundeclareddisasterorMulti‐CasualtyIncident("MCI"),inaccordance
withtheEMSPolicies.
29.2 ContractorshallassignaFieldorDispatchManager/SupervisortotheOperational
AreaEmergencyOperationsCenter("EOC")‐MedicalHealthBranch(when
activated)asaliaisontoworkcloselywiththeMedicalHealthOperationalArea
Coordinator(“MHOAC”).
29.3 IfCountydirectsContractortorespondtoadisasterinaneighboringjurisdiction,
finesforResponseTimesmaybesuspended,butonlyifauthorizedbytheEMS
Director.Contractorshalluseitsbesteffortstomaintainprimaryemergency
servicesandmaysuspendnon‐emergencyservicesasrequired.
29.4 Withinone(1)yearfollowingtheEffectiveDateofthisAgreement,Contractorshall
submittotheEMSDirectorforreview,anEmergencyOperationPlan(“EOP”)forits
internalresponseandrecoveryintheeventofadisaster.Intheeventofadisaster,
ContractorshallfollowtheCounty'sdisasterplananditsEOP.
29.5 WhenContractorisnotifiedthatdisasterorMCIassistanceisnolongerrequired,
ContractorshallresumeResponseTimerequirementsinatimelymanner.
EMSAmbulanceTransportProviderAgreement
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30. DisasterResponseVehicle/Equipment
30.1 Contractorshallhouse,maintain,manageandstaffanyDisasterAmbulanceSupport
Unit(“DASU”)issuedtoCountybyEMSAfordisasterresponses.ADASUmaynotbe
usedbyContractorwithoutthespecificpermissionofandatthedirectionofCounty.
30.2 ContractorshallmaintaintheState‐issuedDASUingoodworkingorder,in
accordancewithEMSPoliciesandinaccordancewiththevehicleandequipment
maintenancerequirementssetforthinthisAgreement,forimmediatedisaster
deployment.
30.3 ContractorshallalsohouseandmaintaintheCounty’sEMSDisasterTrailersin
accordancewithEMSPoliciesandinaccordancewiththevehicleandequipment
maintenancerequirementssetforthinthisAgreement.Contractorshallnotusethe
EMSDisasterTrailers,unlessdirectedtodosobytheCountyDispatchCenter.
30.4 ContractorshallalsoprovideanadditionaltwotrailerstofurtheraugmentMCIand
disasterresponsewithinAlamedaCounty,whichshallbemaintainedinthesame
manner.
31. IncidentNotification
Contractorshallhaveamechanisminplacetocommunicatecurrentfieldinformationto
appropriateCountystaff,including,butnotlimitedtotheCountyDispatchCenterandthe
County’sEOCduringMCIs,disasterresponses,hazardousmaterialsincidentsandother
unusualoccurrences.
32. AmbulanceStrikeTeam
32.1 Contractor’sAmbulanceStrikeTeam("AST")shallatalltimesbestaffed,equipped,
andtrainedtorespondtoadisasterMutual‐AidrequestatCounty’sdirectionandin
accordancewiththeEMSAASTGuidelines.ContractorshallensurethatAST
membersandASTleadershavebeenappropriatelytrainedbyanEMSA‐approved
trainer.
32.2 TheContractorshallinsurethatanASTisavailabletorespondtodisasterrequests
fromEMSA.
32.3 ContractorshallnotifyEMSpriortodeploymentofanyAST.
EMSAmbulanceTransportProviderAgreement
Page15of63
33. InteragencyTrainingforExercises/Drills
ContractorshallparticipateinCounty‐sanctionedexercises,disasterdrills,andinteragency
training.
34. Mutual‐AidRequirements
34.1StateorFederalMutual‐Aidrequests
ContractorshallrespondtorequestsforMutual‐AidmadebyStateorFederal
agencies,ifdirectedtodosobytheEMSDirector.
34.2 In‐CountyMutual‐Aidrequests
a. ContractorshalluseitsbesteffortstoenterintoMutual‐Aidagreementswith
municipalitiesinZone1,orotherareaswhereMutual‐Aidisprovidedona
regularbasis.
b. AnyexecutedagreementsbetweenContractorandamunicipalityinZone1
forMutual‐AidshallbesenttotheEMSDirectorwithin45calendardaysof
execution.
c. IfContractorisunabletoenterintoanagreementforMutual‐Aidinany
municipality,ContractorshallnotifytheEMSDirector.
d. ContractorshallrespondtoMutual‐AidrequestsfromotherAlamedaCounty
agencieswithinAlamedaCountyaccordingtopriorwrittenagreementswith
thoseagencies.
e. ContractorshalldocumentthenumberandnatureofallMutual‐Aid
responsesitrequestsorprovides.
34.3Stand‐ByService
a. UponrequestbyapublicsafetyagencywithinAlamedaCounty,Contractor
shallprovide,atnochargetoCountyortotherequestingagency,stand‐by
servicesatthesceneofanemergencyincidentwithintheEOAwhendirected
bytheCountyDispatchCenter.
b. AnAmbulanceanditsFieldPersonnelplacedonstand‐byshallbededicated
totheincidentforwhichithasbeenplacedonstand‐by.
EMSAmbulanceTransportProviderAgreement
Page16of63
c. Stand‐byperiodsexceedingeight(8)hoursshallrequiretheapprovalofthe
EMSDirector.
VEHICLESANDEQUIPMENT
35. Ambulances
35.1 AllAmbulancesshallmeetthefollowingspecifications:
a. 2010EPAdieselandStateofCaliforniaemissionstandards
b. Title13,CaliforniaCodeofRegulations
c. CaliforniaVehicleCode.
35.2 Contractor,atitssoleexpense,shallacquireandmaintainServiceVehiclesandon‐
boardmedicalsuppliesandequipment,tobeusedtoperformServices.
35.3 VehicleMarkings
a. Emergencyvehicles,includingAmbulancesandSupervisor’sVehicles,shall
bemarkedasrequiredbytheNationalFireProtectionAgency(NFPA)
Standard1901(2009)thatincludesreflectivechevronmarkingsontherear
andareflectivestripeonthesidepanels.
b. ServicesVehiclesshalldisplaythefollowingsignage,onbothsides:
“AlamedaCountyEmergencyMedicalServices”inatleastfour(4)inch
letters,
Levelofservice(e.g.,"ParamedicUnit")
"911"emergencytelephonenumber
Contractor’sname
CAASlogoonceaccreditationhasbeenacquired
c. NoServiceVehicleshalldisplayanyotherwritingunlessapprovedbythe
County,otherthanvehicleidentification.
d. ContractorshallobtainEMSapprovaloftheoveralldesign,color,and
letteringusedforServiceVehicles.Contractorshall,withinten(10)calendar
daysofCounty'srequest,changeanynon‐approveddesign,colororlettering.
EMSAmbulanceTransportProviderAgreement
Page17of63
36. Equipment
36.1 Contractorshallhavesoleresponsibilityandbearallexpenseforallequipment
necessarytoprovideService.Allon‐boardequipment,medicalsuppliesand
personalcommunicationsequipmentusedbyContractorshallmeetorexceedthe
minimumrequirementsoftheEMSPoliciesandthisAgreement.
36.2 ContractorshallhaveandsubmittoCountynolaterthantheServiceStartDate,
policiesregardingtheacquisition,stockingandsecurityofcontrolledsubstances
carriedonServiceVehicles.
36.3 EquipmentandsupplyrequirementsmaybemodifiedwiththeapprovaloftheEMS
Director,includingmodificationsduetochangesintechnology.
36.4 TheCountymayinspectServiceVehiclesatanytimewithoutpriornotice.
36.5 Failuretomeetminimumin‐serviceequipment/supplyrequirements:
a. IfanyServiceVehiclefailstomeettherequirements,ascontainedinEMS
Polices,theCountymayfineContractor.
b. Inadditiontoanyfines,iftheEMSDirectordeterminesthatthefailureto
meetrequirementsiscritical,theServiceVehicleshallberemovedfrom
serviceuntilthenon‐complianceiscorrected.
37. VehicleandEquipmentMaintenance
37.1 ContractorshallmaintainallServiceVehiclesingoodworkingorderconsistentwith
themanufacturer'sspecifications.
37.2 ContractorshallmaintainandprovidetoCountyondemandalistingofallService
Vehicles,includingreservevehicles.Theinformationforeachvehicleshallinclude
thelicensenumber,andnameandaddressoflienholder,ifany.Changesinlien
holder,aswellasthetransfer,sale,orpurchaseofvehiclesusedtoprovideServices
shallbereportedtoCountywithinthirty(30)calendardaysofanychange,sale,
transferorpurchase.
37.3 ForeachServiceVehicle,detailedrecordsshallbemaintainedastoworkperformed,
costsrelatedtorepairs,andoperatingandrepaircostsanalyseswhereappropriate.
EMSAmbulanceTransportProviderAgreement
Page18of63
RecordsshallbemadeavailableforinspectionbyCountyuponrequestoftheEMS
Director.
37.4 Repairsshallbeaccomplishedandsystemsshallbemaintainedsoastoachieveat
leasttheindustrynormsinvehicleperformanceandreliability.
37.5 ContractorshallensureanAmbulancemaintenanceprogramthatisdesignedand
conductedtoachievethehigheststandardofreliabilityappropriatetoamodern
high‐performanceAmbulanceserviceby:a)utilizingappropriatelytrained
personnel,knowledgeableinthemaintenanceandrepairofAmbulances,b)
developingandimplementingstandardizedmaintenancepractices,andc)
incorporatinganautomatedormanualmaintenanceprogramrecordkeeping
system.
37.6 Contractorshallreplaceorremountambulancesonafive‐year,250,000‐mile
schedule,unlessotherwiseagreedtobyContractorandCounty.
37.7 AllServiceVehicles,andanyequipmentthathasadefect,includinginsignificantbut
visiblecosmeticdamage,shallberemovedfromserviceforrepairwithoutdelay,
andinnoeventinlessthantwelvehoursafterarequestfromtheEMSDirector.
37.8 Contractorshallcomplywithorexceedthemaintenancestandardsestablishedby
theCAAS,asmaybeamendedfromtime‐to‐time.
37.9 Contractorshallmaintainallbio‐medicalequipmentinaccordancewith
manufacture'srecommendations,aswellasapplicablestandardsestablishedbythe
JointCommissiononAccreditationofHealthCareOrganizations,whichmaybe
updatedannually.
37.10 ContractorshallinstallandmaintainAutomaticVehicleLocator(“AVL”)deviceson
allServiceVehicles.TheAVLsystemshallbecompatibleandinterfacewiththe
CountyDispatchCenter’ssoftware.
ELECTRONICPATIENTCAREREPORTANDDATACOLLECTIONSYSTEM
38. PatientCareReports
38.1 ContractorshallusePatientCareReports("PCR")forpatientdocumentationonall
calls,including:
EMSAmbulanceTransportProviderAgreement
Page19of63
a. patientcontacts;
b. canceledcalls;and,
c. non‐transports,withtheexceptionofrefusalofserviceanddisaster
response,pursuanttoEMSPolicies.
38.2 ThePCRshallclearlyidentifyanyinstancewheretwoormorepatientsare
transportedinthesameAmbulance.
39. DataCollectionSystemforPatientCareReports
39.1 ContractorshallworkwithEMStocreateanduseasingle,uniformPCRandData
CollectionSystemthatincludes,butisnotlimitedto:
a. Easeofuse
b. NEMSIS(NationalEMSInformationSystem)andCEMSIS(CaliforniaEMS
InformationSystem)compliant
c. EMSdataset,whichmaybeamendedfromtimetotime
d. Easeofmodifyingdataset
e. EaseofdescribingGraphicalUserInterfaceandinputmethods
f. Compatibleequipment/platforms
g. IntegrationwithCAD
h. Informationvalidation
i. Potentialforintegrationwithotherinformationsystemsincluding,butnot
limitedto,FireRMS(RecordsManagementSystem)
j. Regimeforversionupdates
k. Availabletechnicalsupport
l. Potentialforintegrationwithhospitalinformationsystems
m. Back‐enddataquerying,reportwriting,rawdataaccess
n. Aneffective,validatedprocesstoevaluateretentionofPCRs
39.2 ContractorandCountyshallupdate,asneeded,thePCRsystem,includingbutnot
limitedtoupdatestoallow:
EMSAmbulanceTransportProviderAgreement
Page20of63
a. AdditionaldatafieldsonthePCR
b. EMSsystemdatacollection,
c. Thepreparationofreports;and
d. Softwareversions.
39.3 Contractorshallprovide,atitssoleexpense,toEMSallhardwareandsoftware
necessaryforreviewingandmonitoringthePCR.Contractorshall,atitssole
expense,alsoprovideaPCRreaderorviewertoreceivinghospitals.
39.4 ContractorshallusesoftwareinthePCRandDataCollectionSystemtoallowreal‐
timeaccessintheformatspecifiedbyEMS.Thesoftwareshallalsoprovidedetailed
operations,clinical,andadministrativedatainamannerthatfacilitates
retrospectiveanalysis.
39.5 ContractorshallensureitsemployeesaretrainedontheDataCollectionSystem.
39.6 ContractorshallprovidePCRsoftware,training,andmobilecomputersforeach
FRALSunit,includingContractingCitiesinZone1,assetforthinEXHIBITM‐FIRST
RESPONDERSUPPORT.
39.7 Contractorshallprovideupgradestosoftwareandhardwareasneededtomaintain
compatibilitywithPCRusers,includingEMSandreceivinghospitals.
40. PCRDeliverytoReceivingHospitalsorPsychiatricFacilities
100%ofPCRsshallbeprovidedtoreceivinghospitalsandpsychiatricfacilitiespriorto
departureofFieldPersonnel.ContractorshallbefinedifPCRcompliancefallsbelow90%.
40.1 Foreverypatienttransported,especiallyHigh‐Riskpatients(EXHIBITN‐HIGH
RISKPATIENTDESCRIPTION),acomplete,print‐copyofthePCRistobeleftatthe
receivinghospitaland/orpsychiatricfacilitypriortoFieldPersonnelleaving.
AccesstoanelectroniccopyofthePCRbythehospitalorpsychiatricfacility
shallnotsubstituteforleavingaprintedcopy,unlessauthorizedinwriting
bytheEMSDirector.
40.2 IntheeventFieldPersonnelareunabletocompletethePCRpriortoleaving
thereceivinghospitalorpsychiatricfacilityhe/sheshall:
EMSAmbulanceTransportProviderAgreement
Page21of63
a. Leaveaprint‐copyofthePCRwithMandatoryDataFieldscompleted,
asdescribedinEXHIBITI‐MANDATORYDATAFIELDREQUIREMENTS);and,
b. DeliverafullycompletedPCRwithin24hoursofthetimeField
Personnelleftthehospital/facilityforthatpatient.
MEDICALOVERSIGHT
41. MedicalProtocols
41.1 Contractorshallcomplywithmedicalprotocols,onlinemedicalcontrol,andother
requirementsasestablishedbytheEMSMedicalDirector,and/orprovidedbythe
County(e.g.:BaseHospitalservices,authoritytoperformcertainmedical
interventions,etc.).
41.2 Contractorshalldocumentcompliancewithsystemmedicalprotocolsrequiredby
EMSPoliciesandtheStateofCalifornia.
42. MedicalReview/Audits
IfrequestedbytheEMSMedicalDirector,Contractor’semployeesshallattendmedical
reviewsand/oraudits.
PERSONNEL
43. TreatmentofIncumbentWorkforce
43.1 Contractorshallofferemploymentinsubstantiallysimilarpositionstoall911
IncumbentPersonnel,whoarequalified,insurable,andpassdrugtestingand
criminalbackgroundchecks.Thisprovisionshallbecomeinvalidsix(6)months
aftertheServiceStartDate.Thisprovisiondoesnotapplytodispatchers,billingstaff
orseniormanagementpositions.
43.2 ContractorshallalsooffertothoseemployeescurrentlyworkingintheAlameda
CountyBLSInterfacilityTransportDivisionofAmericanMedicalResponseonthe
EffectiveDate,preferentialhiringinavailablepositionstothosewhoarequalified,
insurable,andpassdrugtestingandcriminalbackgroundchecks(e.g.:wherethere
areequallyqualifiedapplicantsforanopenposition,currentAlamedaCountyAMR
employeesshallbegivenpreference.)Thisprovisionshallbecomeinvalidsix(6)
monthsaftertheServiceStartDate.
EMSAmbulanceTransportProviderAgreement
Page22of63
43.3 IncumbentPersonnelhiredbyContractorshallretaintheiroriginalhiringdatefor
senioritystatusforbiddingshifts,partners,orotherassignments,aspermittedby
anyapplicablelaboragreement.
43.4 Contractorshallprovideawageandbenefitprogramwhichis,ataminimum,
comparabletotheprogramprovidedtoIncumbentPersonnelontheEffectiveDate.
ContractorshallhonorlaboragreementsineffectasofJanuary1,2010regarding
wageincreases.
44. Character/Competence/Professionalism
44.1 Contractorshallensurethatallemployees,agentsandsubcontractorsconduct
themselvesinaprofessionalandcourteousmanner.Contractorshalladdressand
correctanydeparturefromthisstandardofconduct.
44.2 Contractor’semployees,agentsandsubcontractorsshall,atalltimeswhen
providingServices,becompetentandholdvalidlicenses,including,butnotlimited
to,aCaliforniadriver’slicenseand,certificates,accreditationsandpermits,asmay
berequiredforeachposition.
44.3 Contractorshallperformcriminalbackgroundchecks,pre‐employmentdrugtesting
andconfirmpossessionofarequiredlicense,certificates,accreditations,and
permitsforallemployees,includingIncumbentEmployees.
45. InternalHealthandSafetyPrograms
45.1 Contractorshallestablishandmaintainprogramstoenhancethesafetyandhealth
oftheworkforce.Theseshallincludebutarenotlimitedto:
a)drivertraining,b)safety,andc)riskmanagementtraining.
45.2 Contractorshallprovideadequatepersonalprotectiveequipment(“PPE”)to
employees,includinguniversalprecautionsforroutinecare,andpersonalprotective
geartoemployeesworkinginhazardousenvironments,rescueoperations,motor
vehicleaccidents,etc.
45.3 Contractorshallestablishacriticalincidentmanagementplan,whichincludesan
ongoingstressreductionprogramforitsemployees.Theplanshallalsoinclude
accesstotrained,experiencedprofessionalcounselors.Plansfortheseprograms
shallbesubmittedtotheEMSDirectorforreview.
EMSAmbulanceTransportProviderAgreement
Page23of63
45.4 Contractorshallmakehealthscreeningandallcurrentlyrecommended
immunizationsavailableatnocosttoitsFieldPersonnel,make‐readystaff
(individualpreparingambulancesfordeployment),andmechanicsproviding
Services.
46. PersonnelTraining
ContractorshallensurethatFieldPersonnelperformingServicesmeetalltraining
requirementsasrequiredinEMSPolicies,asmaybeamendedfromtimetotime.Currently
applicableparamedictrainingrequirementsaresetforthinEXHIBITG,PARAMEDICTRAINING
REQUIREMENTS.
47. ContinuingEducationProgram
47.1 ContractorshallapplyforandmaintainapprovalasanapprovedContinuing
Education(“CE”)providerinAlamedaCounty.Allin‐serviceprogramsofferedforCE
creditmustcomplywithTitle22‐Chapter11andEMSPolicies.
47.2 Contractorshalldevelopandprovidein‐houseCEtrainingprogramsdesignedto
meetStatelicensure/certificationrequirementsand/orCountyaccreditation
requirements,atnocosttoemployees.
47.3 ContractorshallprovideCEprogramswitheducationalcontenttoaddressAlameda
Countyneeds.TheEMSMedicalDirectormaymandatespecificCEprogramsand
contentrequirements.CountypersonnelmayreviewandauditanyCEprograms
offeredbytheContractor.
47.4 ContractorshallcoordinateandmakeavailableCEprogramstofiredepartment
personnelincontractingcities,asmaybearrangedwiththeindividualagencies.
ContractormayalsomakeCEprogramsavailabletootherentities.
48. WorkforceEngagement
48.1 ContractorshallprovidetoallFieldPersonnelanidentificationcardthatshallbe
wornandvisible;includingarecentpictureandthatincludes,ataminimum,the
employee’s:
a. Firstname,lastinitial
b. Title(EMTorParamedic)
EMSAmbulanceTransportProviderAgreement
Page24of63
c. Certificationorlicensenumber
d. Companyname
48.2 Contractorshalldevelopatwo‐waycommunicationprocessbetweenfront‐line
employeesandtheleadershipteam.
48.3 Contractorshallhaveamechanismfor:a)encouraging,b)gathering,
c)providingfeedbackonand,d)actingonemployeeimprovementsuggestions.
48.4 Contractorshalldevelopmethodsforprovidingsystemandindividualperformance
feedbacktoemployees.
48.5 Contractorshallhaveaprocessforinvolvingfront‐lineemployeesinqualityand
performanceimprovementprojects.
48.6 ContractorshalltrackcredentialingrequirementsforallEMTs,Paramedics,and
SupervisorsprovidingServices,includingContractor’semployeesworkinginthe
CountyDispatchCenter.
48.7 Contractorshalldevelopacareerladderandprofessionaldevelopmentprocessfor
employees,includingasuccessionplanforKeyPersonnel.
48.8 ContractorshallcollaboratewithfiredepartmentsintheCountytocreateacareer
ladderforParamedics,internshipsandfieldorientation.
48.9 Contractorshalluseexperiencedclinicianstotrain,mentor,monitor,andassistless
experiencedParamedicsandEMTsinthefield.
48.10 Contractorshallmakeeffortstohavediversityintheworkforce,includingthelevel
ofdiversityinalignmentwiththecommunity.Partofthiseffortshallincludea
targetedrecruitmentplanapprovedbytheEMSDirectornolaterthaneightmonths
priortoServiceStartDate.
48.11 Contractorshalldeveloppracticesandpoliciesdesignedtopromoteworkforce
harmonyandpreventdiscrimination,includingdiscriminationbasedonage,
nationalorigin,gender,race,sexualorientation,religion,andphysicalability.
49. KeyPersonnelandRequiredPositions
49.1 Contractorshallhaveanidentifiedpersonauthorizedandcapabletoactonbehalfof
theContractorinoperationalmattersavailableatalltimes.
EMSAmbulanceTransportProviderAgreement
Page25of63
49.2 Contractor'sKeyPersonnelareasfollows:
a.OperationsManager(ChiefOperationsOfficer):Contractorshallprovide
afull‐timeOperationsManagertooverseeandberesponsibleforthe
provisionofServices.Thispersonshallhavepriorexperiencemanaginga
large,high‐performanceemergencymedicalsystem.Thisindividualshallbe
responsibleforensuringthatallupper‐levelmanagementpositionsare
trainedandparticipateintheContractor'sQualityManagementPlan.
b.ProviderMedicalDirector:Contractorshallprovideahalf‐time(0.5FTE)
physician,experiencedinemergencymedicalservices,tooverseeclinical
areas.
c. QualityManager:Contractorshallprovideafull‐timephysician,Registered
Nurse,orhighlyqualifiedandexperiencedParamedictoimplementand
overseeContractor'squalitymanagementplan.Thisindividualshallbe
responsibleforthemedicalQualityImprovement/Assuranceevaluationof
allServices.
49.3 KeyPersonnelpositionsmustbedistinctandseparatefromeachother.Innoevent
shallanyonepersonperformanytwooftheKeyPersonnelpositions.Contractor
shallnotifytheEMSDirectorinwritingofanychangesinKeyPersonnel.
49.4 ContractorshallremoveKeyPersonnelifintheopinionoftheEMSDirectoran
individualhasnotperformedinamanneracceptabletotheCounty.
49.5 TheapprovalofCountytoarequestedchangeinKeyPersonnelshallnotrelease
ContractorfromanyofitsobligationsunderthisAgreement.
49.6 ContractoragreesthatitshallnottransferorreassigntheindividualsinKey
PersonnelpositionswithouttheexpresswrittenagreementofCounty,which
agreementshallnotbeunreasonablywithheld.Shouldsuchindividualor
individualsintheemployofContractornolongerbeemployedbyContractorduring
thetermofthisAgreement,Contractorshallmakeagoodfaithefforttopresentto
theCountyanindividualwithgreaterorequalqualificationsasareplacement,
subjecttotheCounty’sapproval,whichapprovalshallnotbeunreasonably
withheld.
EMSAmbulanceTransportProviderAgreement
Page26of63
49.7 Contractor’sKeyPersonnelshallparticipateinongoingtraininganddevelopment
programsforemergencymedicalservicemanagers.Theseprogramsshouldbe
offeredbyContractortothosepersonnelatnocost.
49.8 InadditiontotheKeyPersonnel,Contractorshallhireseparateindividualsforeach
RequiredPositions.
49.9 RequiredPositionsmustbestaffed,ataminimum,asfollows:
a. OperationalFieldSupervisors:thereshallbeatleastoneondutyatall
times.
b. ClinicalFieldSupervisors:thereshallbenofewerthanthree(3)Clinical
FieldSupervisorsondutyatalltimes.
Beexperienced,clinicallyandadministrativelycompetentParamedics
withpriorteaching/trainingexperience.
RespondtoallEchoLevelcallstoprovideoversightandassistanceas
required.RespondtoallDeltalevelcallswhenavailable.
RespondtoAlpha,Bravo,andCharliecallswhenavailabletoobserve
FieldPersonnelinthedeliveryofserviceandcare.
Providedirect,case‐by‐caseoversightofclinicalpersonnel
Notberesponsiblefordeliveryofsuppliesorequipment,withthe
exceptionofmulti‐casualtyincidentsanddisasterresponses.
Coordinatedatacollectionforongoingcomplianceincollectionand
reportingofcardiacarrest,airway,12‐leaddata
Directandassistwithresearchandcomplianceforresearchintrial
studies,focusedaudits,andState‐directeddemonstrationprojects
TeachandreinforceclinicalEMSPoliciesinthefieldandintrainings
IntroducenewtechniquesandproceduresasdirectedbytheEMSMedical
Director.
Facilitatetheuseofeducationalsoftware
CollaboratewithEMSLeadershipandPrehospitalCareCoordinators
EMSAmbulanceTransportProviderAgreement
Page27of63
http://www.quality.nist.gov/HealthCare_
Beavailabletorespondasaresourcefordifficultclinicalissues
CommunicatewithbasephysiciansandEMSon‐callstaff
Betatestclinicaltrials,pilotstudies,andnewequipment
Coordinatewithotherproviders'clinicalsupervisors
ParticipateintheCounty’sEMSQualityCouncilwiththeQualityManager
and/orotherperformanceimprovementcommittees,asrequested.
c) Analyst:thereshallbeatleastonefull‐timeanalystassignedtoevaluate
PatientCareReports.
d) Clinical/EducationStaff:thereshallbeatminimum,twofull‐timeclinical
andeducationalstaffpositionstoassisttheQualityManager.
e) Inaddition,Contractorshallprovideforeighty(80)compensatedhoursa
monthfordesignatedFieldPersonneltoparticipateinclinicalquality
improvementactivities.
49.10 Contractor’sKeyPersonnelandRequiredPositionsshallreceivetrainingfromor
comparabletotheAmericanAmbulanceAssociation'sAmbulanceServiceManager
CertificateProgram.Thistrainingshalloccurwithintwenty‐four(24)monthsofthe
EffectiveDateorhiredate.
QUALITYMANAGEMENTPLAN
50. ApprovalofQualityManagementPlan
50.1 ContractorshallworkwithEMStodevelopaQualityManagementPlan.
TheQualityManagementPlanshall:
a. BeconsistentwiththerequirementsoftheStateCaliforniaforemergency
medicalsystemqualityimprovement,includingthosecontainedinTitle22,
Chapter12.
b. BeconsistentwiththemostcurrenteditionoftheBaldrigeNationalQuality
Program,HealthCareCriteriaforPerformanceExcellence.
c. BeconsistentwithEMSPolicies.
EMSAmbulanceTransportProviderAgreement
Page28of63
d. BeintegratedwithFirstResponderAgencies,CountyDispatchCenter,and
EMSAgency.
e. Incorporatecomplianceassurance,processmeasurementandcontrol,and
processimprovements.
f. Measureclinicalindicatorsasdevelopedthroughcollaborativeeffortswith
theCounty.
h BebasedoncurrentEMSresearchandcalldemand.
i. Endeavortoensurethelong‐termeconomicviabilityoftheEMSsystem
whilemaximizingvaluetothecommunity.Contractorshallachievefinancial
andservicetargetsthroughprocessimprovement,standardization,and
evaluationofinternalprograms.
50.2 ThefinalQualityManagementPlanmustbesubmittedtotheEMSDirectorfor
approvalthree(3)monthspriortotheServiceStartDate.TheEMSDirectormay
revisetherequirementsoftheQualityManagementPlanfromtimetotime.
50.3 ContractorshallensurethatKeyPersonnelandRequiredPositionsactively
participateintheleadershipandoversightoftheQualityManagementPlan,
includingbutnotlimitedto:
a. ActivelyparticipatinginEMSgroupsand/orcommitteesdealingwithquality
management
b. DesignatingamanagertooverseeContractor’squalityprogram
c. SubmittingacomprehensiveQualityImprovementreportstotheCounty
d. Activelyparticipatinginprojectsdesignedtoimprovethequalityof
emergencymedicalservicesinAlamedaCounty.
51.CaliforniaAwardforPerformanceExcellence
ContractorshallapplyfortheCaliforniaAwardforPerformanceExcellenceinyearfiveof
thisagreement.
EMSAmbulanceTransportProviderAgreement
Page29of63
REQUIREDREPORTS
52. ReportingRequirements
52.1 Contractorshallprovide,withinthirty(30)calendardaysafterthefirstdayofeach
month,reportsaddressingitsperformanceduringtheprecedingmonthwith
respecttotheclinical,operational,andfinancialperformancerequirement,inthe
formandmannerrequiredbytheEMSDirector.
Reportsshallinclude,butarenotlimitedto:
a. ResponseTimeCompliancereports
b. Reportsoncustomercomplaints
c. ClinicalReports(e.g.:protocolcompliance,cardiacarrestsurvivalrate,
intubationsuccessrate,etc.)
d. WorkloadtrendsforFieldPersonnelassignedto24‐hourshifts
e. OtherreportsasrequestedbyCounty.
52.2 Otherreportsmayberequiredlessfrequentlythanmonthly,asdeterminedbythe
EMSDirector.
52.3. CountyshallprovidenoticetoContractoratleasttwo(2)monthsinadvanceofany
changetorequiredreports,frequency,orduedates.
53. ResponseTimePerformance
53.1 ResponseTimedata,includingreportsreceivedfromCountyDispatchCenter,shall
beusedbyContractorandCountytoevaluateContractor'sperformanceand
compliance.ContractorshallmakeeffortstocontinuallyimproveResponseTime.
53.2 IfResponseTimecomplianceisbelow90%,Contractorshallidentifythecausesand
shalldocumenteffortstoeliminateproblemsonanongoingbasis.
53.3 ForanymonthinwhichcompliancewithResponseTimeislessthan90%,
Contractorshallsubmitaperformanceimprovementplanwiththemonthly
ResponseTimeperformancereport.Theperformanceimprovementplanshall
identifyeachproblemthatcontributedtoafailuretomeetResponseTimesand
stepsbeingtakentocorrecttheproblem.
EMSAmbulanceTransportProviderAgreement
Page30of63
53.4 ResponseTimereportingandtimesshallbedocumentedassetforthinthis
Agreement.
54. High‐RiskPCRs
54.1 Contractorshallconductanauditbyrandomlyselectingandreviewingaminimum
oftenpercent(10%)oftheHigh‐RiskPCRs.Themonthlyauditshallreview
compliancewithEXHIBITI‐MANDATORYDATAFIELDREQUIREMENTS.
54.2 Eachnon‐compliantHigh‐RiskPCRfromthisauditshallbeevaluatedbyContractor
andtheEMSMedicalDirector.
54.3 ContractorshallprepareamonthlyreportdocumentingcompliancewithMandatory
DataFields(EXHIBITI‐MANDATORYDATAFIELDS)forHighRiskPCRs(EXHIBITN‐HIGH
RISKPATIENTDESCRIPTION).
55. CompliancewithProtocols
55.1 Contractorshallproducemonthlyreportsthatdescribetheoverallcompliancewith
EMSPoliciesandperformanceinallcalls.
55.2 Reportsforcomplianceshallbesubmittedinaggregateandstratifiedbycategories
identifiedintheQualityManagementPlanandapprovedbytheEMSDirector.
56. QualityImprovement
56.1 Contractorshalldevelopaclearandconcisesetofprocessesandpracticesdesigned
toidentifyandaddressopportunitiesforimprovement.Thedescriptionofthese
processesshallincludetheapproachforachievingandmaintainingmeasurable
outcomes.
56.2 Contractorshallprovidereportsthatupdateprogressonqualityimprovement
projectsasrequestedbytheEMSDirector.
56.3 Contractorshallprovidereportsonkeyperformanceindicatorsandkeyresultareas
asrequestedbytheEMSDirector.
PENALTYPROVISIONS
57. FailuretoRespond
EMSAmbulanceTransportProviderAgreement
Page31of63
ContractorshallpaytoCounty$25,000foreachfailurebytheContractortoprovidean
AmbulancetoalocationwithintheEOAwherearesponsehasbeenrequestedbythe
CountyDispatchCenter.PaymentofsuchfinesdoesnotreleaseContractorofanyother
liabilityfromtheirfailuretorespond.
58. ResponseLevel
ContractorshallpaytoCounty$500foreveryincidentinwhichaBLSAmbulanceresponds
toacalland/ortransportsapatientrequiringanALSAmbulance.
59. MissingMandatoryDataFields
ContractorshallpaytoCounty$500foreachHigh‐RiskPCRwhereoneormoreofthe
MandatoryDataFieldsarenotcomplete.
60. MissingPCRattheReceivingHospitalorPsychiatricFacility
60.1 AcompletePCRisonewhereallpatientcareinformationrequiredhasbeen
entered,asdefinedinEMSpolicies.
60.2 Acompleteprint‐copyPCRshallbeleftatthereceivinghospitalpriortodeparture
ofFieldPersonnel.
60.3 IfFieldPersonnelareunabletoleaveacompleteprint‐copyofthePCR,aPCRwith
atleasttheMandatoryDataFieldscompletedshallbeleftatthereceivinghospital
orpsychiatricfacilitypriortodepartureofFieldPersonnelfromthehospitalor
facility.IfneitheracompletePCR,noraPCRwithatleasttheMandatoryDataFields
completedisleft,Contractorshallbefined$50peroccurrence.ForHighRiskPCRs,
thisfineshallbe$500.
60.4 WhereapartialPCRwithonlyMandatoryDataFieldscompletedwasleftinsteadof
acompletePCR,theContractorshalldeliveracompleteprint‐copyofthePCRfor
thatpatientwithin24hoursofthedepartureofFieldPersonnelfromthereceiving
hospitalorfacility.
60.5 Ifacompleteprint‐copyofthePCRisnotdeliveredwithinthe24‐hourperiod
specifiedabove,thatPCRshallbeconsideredlateandincomplete,andsubjectto
additionalfinesof$50peroccurrence.
EMSAmbulanceTransportProviderAgreement
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60.6 Ifinanyconsecutive30‐dayperiodContractorfallsbelowninetypercent(90%)
compliancewiththePCRprintcopysubmittalrequirements,Contractorshallpayto
Countyanadditionalfineof$10,000.
61. PCRGoodCauseExemption
61.1 ContractormayapplyforanexemptionforfinesrelatedtoanyPCR.Anyapplication
foranexemptionmustbeinwritingandincludejustificationforeachexemption
requested.
61.2 ItiswithinthesolediscretionoftheCountytograntanexemptionbasedonthe
factsandcircumstancesofeachcase.
62. FailuretoProvideTimelyReports
ContractorshallpromptlydelivereachrequiredreporttotheCounty.Contractorshallpay
toCountyafineof$50perdayforeachdayareportislate.
63. FailuretoMeetMinimumIn‐ServiceEquipment/SupplyRequirements
ContractorshallpaytotheCountyafineofupto$1,000foranyServiceVehiclethatfailsto
complywithEMSPolicies.
64. FailuretoProvideArrivalatIncidentTime
64.1 ContractorshallpayCountya$500fineeachandeverytimeanAmbulanceis
dispatchedandContractorfailstodocumenttheArrivalatIncidenttime.
64.2 WhentheArrivalatIncidenttimeforacallisnotaccurate,theresponsetothatcall
shallbedeemedtohaveexceededResponseTime.
64.3 ContinuedfailuretomeetResponseTimestandardsmaybeconsideredaMajor
BreachoftheAgreement.
65. ResponseTimeFines
65.1 ContractorshallpaytoCountyafineanytimeResponseTimecompliancedrops
below90%foranyconsecutive30‐dayperiod,asshowninEXHIBITF‐RESPONSETIME
REQUIREMENTSANDPENALTIES(TABLEB,ResponseTimeFinesbyCategoryand
Compliance).ResponseTimecomplianceshallbebasedonthepercentageof
complianceforeach:
EMSAmbulanceTransportProviderAgreement
Page33of63
a. Category(Echo,Delta,Charlie,Bravo,Alpha)
b. ResponseZone,(Zone2,3,4,5),and
c. Subarea(metro/urban,suburban/rural,wilderness).
65.2 IfResponseTimecomplianceforEchocallsdropsbelow90%,aperformance
improvementplanmustbesubmittedtotheEMSDirectorwiththemonthly
compliancereport.Theperformanceimprovementplanmustidentifyeachproblem
thatledtothedelayedresponseandthestepsbeingtakentocorrecteachsuch
problem.
66. FinesforOutlierResponseTimes
66.1 AnOutlierResponseTimeisdefinedasgreaterthan150%ofthedesignated
ResponseTime(asdescribedinEXHIBITF–TABLEA)forthecategory.
66.2 FinesforOutlierResponseTimesshallbebasedontheindividualcallcategoryand
thesubarea.Inadditiontoanyotherfines,ContractorshallpaytoCountyfinesfor
OutlierResponseTimesasshownINEXHIBITF‐RESPONSETIMEREQUIREMENTSANDFINES
(TABLEC,OUTLIERRESPONSETIMESBYCATEGORYANDSUBAREAINMINUTES&SECONDS).
67. FineDisputes
67.1 IfContractorhasfailedtodocumentanArrivalatIncidentTime,anexemptionfrom
thefinemaybegrantedifContractordemonstrates,tothesatisfactionoftheEMS
Director,anaccurateArrivalatIncidenttime.
67.2 ContractormayappealafinetotheEMSDirectorinwritingwithinfourteen(14)
calendardaysofreceiptofnotificationoftheimpositionofapenaltyorfine
calculations.
67.3 TheEMSDirectorshallreviewallappealsandmakethedecisiontoeliminate,
modify,ormaintainthefine.TheEMSDirector’sdecisionshallbefinal.
68. InvoicingandPayment
68.1 CountyshallinvoiceContractorforanyfinesorpenaltiesunderthisAgreement
withinthirty(30)calendardaysfollowingCounty’sreceiptofContractor’smonthly
performancereports.ContractorshallpayCountywithinthirty(30)calendardays
followingreceiptoftheinvoice.Thepartiesshallmakeagoodfaithefforttoresolve
EMSAmbulanceTransportProviderAgreement
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anydisputesregardinganinvoicedamountwithinthis30‐dayperiod.Iftheparties
areunabletomutuallyresolvethedisputewithinthat30‐dayperiod,theinvoice
shallbepaidinfullandsubsequentinvoicesshallbeadjustedtoreflectthe
subsequentresolutionofthedispute.
68.2 FailurebytheCountytoassessorimposeanypenaltiesorfinesatanypoint,forany
reason,doesnotimpactCounty’srighttodosointhefuture;however,Countymay
notimposefinesretroactivelygreaterthanthree(3)months.
68.3 PaymentofanyfinedoesnotreleaseContractorfromanyotherliabilityrelatedto
thebreachthatresultedinfineimposition.
COUNTY‐WIDECOOPERATION
69. CollaborationwithFirstResponderAgencies
69.1 ContinuingEducation
AllALSandBLScontinuingeducationofferedbyContractortoitsemployeesunder
thisAgreementshallalsobeavailabletoFirstResponderAgencies.
69.2TrainingandInternships
a. Contractorshallenterintoagreementswithemergencymedicalservices
trainingprogramswithinAlamedaCountytoprovidefieldexperiencefor
EMTand/orParamedictrainingprograms.
b. Contractorshalldevelopacollaborativepartnershipwherebyfieldpersonnel
fromallFirstResponderAgencies,andContractingCitiesareprovidedfield
internshipsopportunities,includingworkingwithfieldtrainingofficersfor
initialsystemtraining.
c. AlltrainingconductedshallcomplywithEMSPolicies.
69.3 ContractorshalldesignateaParamedicasaliaisonwithFirstResponderAgencies.
69.4 FirstResponderEquipmentandSupplies
a. ContractorshallprovidetheequipmentdescribedinEXHIBITM‐FIRST
RESPONDERSUPPORTforusebyallFirstResponderAgenciesatnocost.
Contractorshallmaintainownershipoftheequipmentatalltimes,andshall
beresponsibleformaintenanceofallequipment.
EMSAmbulanceTransportProviderAgreement
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b. Contractorshallprovide,atnocosttoFirstResponderAgencies,required,
standardizedexpendablemedicalsupplies,excludingpharmaceuticals,as
definedinEMSPolicies.
c. Contractor,attherequestofanyFirstResponderAgency,shallmanagetheir
inventoryincludingon‐siteinventoryauditsandinventoryordersplacedon
behalfoftheagency.
d. FirstResponderAgenciesmayrequestContractortoprovideapricequote
andordersuppliesorequipmentthatareinadditiontothosedefinedas
expendablemedicalsuppliesinEMSPoliciesatthecostoftherequesting
FirstResponderAgency.
e. ContractorshalldevelopasupplyconsortiumincollaborationwithFirst
ResponderAgenciestobuysuppliesandequipmentthatContractorisnot
obligatedtoprovideusingContractor'ssuppliers.
70.EMSSystemParticipation
Contractorshallparticipateandassistinchangesrelatedtoemergencymedicalservicesin
AlamedaCounty.Contractorshallparticipateinlocalactivities,committeemeetings,and
workgroupsrelatedtoprovisionofServices.
HEALTHSTATUSIMPROVEMENT/COMMUNITYEDUCATION
71. EMTTrainingPrograms,InternshipsandRelatedOpportunities
71.1 Contractorshallimplementaplanned,multifacetedprocesstoattract,recruit,and
trainEMTsfromunderrepresentedpopulations.
71.2 Contractorshallestablishanin‐houseEMTtrainingprogramwherestudentsage18
orovercanparticipateinawork/studyprogram,earningfull‐timewages,while
progressingtowardtheNationalRegistryandCaliforniaEMTcertification.
72. CommunityPrograms
72.1 Contractorshallparticipateincommunityprogramsthatareofinteresttothe
County,withcommunityorganizationssuchasthosethatsupportyouth
developmentactivitiesandethnichealthinitiatives.
EMSAmbulanceTransportProviderAgreement
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72.2 Contractorshallplanandimplementanannualcommunityeducationprogramas
describedinEXHIBITL‐COMMUNITYEDUCATIONPROGRAM.
72.3 Inaddition,Contractorshallprovidethefollowingtothecommunityand/orto
benefitthecommunity:
a.Website‐Createandmaintainawebsiteshallbecreatedandmaintained
withlinkstocontinuouslyupdatedaudio/videofilesonvariousemergency
healthtopicssuchas“Calling911,”“WhattoExpectWhentheAmbulance
Arrives,”and“HowDoIBecomeaParamedic?”
b.Speakers'Bureau‐Organizeandmaintainaspeakers’bureautoprovide
speakersonhealthrelatedtopicstocommunityorganizations.
c.AutomaticExternalDefibrillator(AED)Distribution‐Contractorshall
purchaseandcausetobemaintained10AEDseachyearfordistribution
consistentwiththeEMSAEDprogram,atlocationsthroughoutAlameda
County.ContractorshallworkwithCountyEMStodeterminelocationsfor
AEDplacement.ThefinaldecisionregardinglocationsforAEDplacement
shallbeatthediscretionoftheEMSDirector.
d.CPRTraining–ContractorshallofferfreeCPRclassestothepublicatleast
onceamonthandencouragefamilymembersofheartattackpatients
transportedbyEMStoattendfreeclasses.Theseclassesaretoberotated
throughoutthenorth,south,centralandtri‐valleyareasofAlamedaCounty.
ContractormayworkwithEMStoassistinEMSCPRprograms.
e.EMSWeekandPublicEducation–ContractorshallusetheEMSWeek
platformtoconductpubliceducationactivitiesonavarietyoftopicswhich
mayincludestrokerecognitionandprevention,fallpreventionforelderly
citizens,heartattackwarningsigns,poolsafetyandchildplaygroundsafety.
ContractorshallcollaboratewiththeEMS,thePublicHealthDepartment,area
FireDepartments,andotherstakeholderstoidentifyandtargetthemost
appropriatetopics.
ENVIRONMENTALLYFRIENDLYBUSINESSPRACTICES
73. BuildingsandVehicles
EMSAmbulanceTransportProviderAgreement
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73.1 ContractorshallsearchforatleastonegreenbuildinginAlamedaCounty,consistent
withUSGreenBuildingCounsel,LEEDv3.0Silvercriteria.
73.2 AllServiceVehiclesshallbe2010modelyearorlater,lowemissionvehicles.
74.EquipmentandSupplies
74.1 Contractorshallreduce,reuse,andrecycle.
74.2 PurchasingshallbeconsistentwithguidelinesfromtheResponsiblePurchasing
Network.ConsiderationsinequipmentpurchasingshallincludeEPAEnergyStar
and/orElectronicProductEnvironmentalAssessmentTool(EPEAT)labeled.When
possible,productsshallberecycledcontentand/orbio‐based.
74.3 RecyclingshallbeimplementedtosupporttheAlamedaCountygoalofreducing
wastegoingtolandfillsby75percentandcoordinatedwithStopWaste.orgas
needed.
75.MedicalEquipmentandSupplies
ContractorshalliiimplementanEnvironmentallyPreferablePurchasingprogramwithan
emphasisonthePrecautionaryPrincipleforthepPurchase,handling,anddisposalof
medicalequipmentandsupplies.
COMPLIANCEPROVISIONS
76.MedicareComplianceProgramRequirements
76.1 ContractorshallimplementandmaintainacomprehensiveMedicarecompliance
programforallactivities,includingbutnotlimitedtodocumentation,claims
processing,billing,andcollection.
76.2 Contractor’sMedicarecomplianceprogramshallsubstantiallycomplywiththe
regulatoryapproachprogramoutlinedintheOfficeofInspectorGeneral(OIG)
ComplianceProgramGuidanceforAmbulanceSuppliersaspublishedintheFederal
RegisteronMarch24,2003(03FR14255),andanyamendmentthereto.
77.HIPAAComplianceProgramRequirements
77.1 ContractorshallimplementacomprehensiveplantoabidewiththeHealth
InsurancePortabilityandAccountabilityActof1996(“HIPAA”)andthecurrent
rulesandregulationsenactedbytheDepartmentofHealthandHumanServices.
EMSAmbulanceTransportProviderAgreement
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77.2 Theplanshallbesentviaimmediateemailandafollowuplettersentthesameday
toEMSDirector.
77.3 Contractorshallberesponsibleforallaspectsofcomplyingwiththeserulesand
particularlythoseenactedtoprotecttheconfidentialityofpatientinformation.Any
violationsofHIPAArulesandregulationsshallbereportedimmediatelytothe
CountyalongwithContractor’sactionstomitigatetheeffectofsuchviolations.
78.EMSPolicies
ContractorshallcomplywithCountyEMSPolicies,asmaybeupdatedorrevisedfromtime
totime.
79.MedicalandOtherStateandFederalPrograms
Contractorisresponsibleforcomplyingwithallrulesandregulationsassociatedwith
providingservicesforrecipientsofandbeingreimbursedbyStateMedi‐Calandotherstate
andfederallyfundedprograms.
CONTRACTORREVENUE
80.ContractorCompensation
Contractor'scompensationunderthisAgreementisthroughfeeforservicereimbursement
ofpatientcharges(“UserFees.”)
81.PatientChargesandFees
UserFeesshallbeestablishedbytheCounty,byapprovalofamajorityvoteoftheBoard.
ContractorisprohibitedfromcharginginexcessoftheapprovedUserFeesassetforthin
EXHIBITH‐CONTRACTOR'SUSERFEES‐911SYSTEM.
82.UserFeeAdjustments
82.1 EMSDirectorshallapproveannualincreasestoUserFeesbasedonchangesinthe
ConsumerPriceIndexforAllUrbanConsumers,SanFrancisco‐Oakland(“CPI”).
Annualrateincreasesshallbethegreateroftwoandone‐halfpercent(2.5%)orthe
increaseintheCPIforthemostrecent12‐monthperiod,cappedatfivepercent
(5%).
EMSAmbulanceTransportProviderAgreement
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82.2 IntheeventthatchangesoccurwithinAlamedaCountythatsubstantiallyimpact
Contractor’scostsofprovidingservices,Contractormayrequestincreasesor
decreasesinUserFees.
83.Billing/CollectionServices
83.1 ContractorshallestablishadedicatedCustomerServiceTelephoneLine,assetforth
inthisAgreement,includingsection85.
83.2 Contractorshalldesignatealocalemployeetohandleserviceinquiresand
complaints.
83.3 Contractorshallprovideabillingandaccountsreceivablesystemthatiswell
documented,easytoaudit,anddesignedtominimizetheeffortrequiredofpatients
torecoverpaymentsfrominsurancecompaniesorotherthirdpartysources.
83.4 Contractorshallmakenoattemptstocollectitsfeesatthetimeofservice.
Contractorshallmaintainanduseabillingsystemthatelectronicallygeneratesand
submitsclaimsforpatientsreceivingMedicareorMedi‐Cal.
83.5 Contractorshallnotchargeorbillpatientscoveredby,orwhoprovideevidenceof
eligibilityfor,CountyMedicalServicesPlan(CMSP),norshallContractorchargeor
billCountyforservicestothesepatients.
83.6 ContractorshallnotchargetheCountyoranygovernmentalentityrequesting
Servicesforpatientstransportedintra‐countywhileincustodyoronapsychiatric
(5150)hold.Contractormaybillthepatient’sinsurance;however,Contractorshall
notbillthepatientdirectlyforServices.
83.7 ContractorshallnotbilltheindividualrequestingServicesforawork‐relatedinjury
atthetimeofinjury.Contractormaybilltheappropriateinsurer,unlessthe
employerisapublicentitythatisself‐insured.
83.8 Contractorshallincludeonallbillingstatementscontactinformationfortheperson
designatedtorespondtobillinginquiries.
83.9 Contractorshallconductallbillingandcollectionactivityinaprofessionaland
courteousmanner.
EMSAmbulanceTransportProviderAgreement
Page40of63
83.10 ContractorshallsubmititsbillingandcollectionpolicytotheEMSDirectorfor
review,priortoServiceStartDate.
84.AccountingProcedure
Contractorshallallocatenomorethan$500,000annuallytocorporateoverheadcosts.This
limitshallbeadjustedannuallybasedontheConsumerPriceIndexforAllUrban
Consumers,SanFrancisco‐Oakland.
84.1AuditsandInspections
a. ThroughoutthetermofthisAgreement,includinganyrenewalperiods,
Contractor,attheendofeachofitsfiscalyears,shallprovideastatementof
operationsrelatedtotheperformanceofdutiescontainedinthisAgreement.
Contractorshallreportearningsinthisstatementofoperationsusing
generallyacceptedaccountingprinciples(GAAP)withinninety(90)daysof
Contractor’sfiscalyearend.Suchstatementofoperationsshallbereviewed
byanindependentaccountingfirm,selectedandpaidforbyContractor.
b. Withreasonablenotificationandduringnormalbusinesshours,Countyshall
havetherighttoreviewanyandallbusinessrecordsincludingfinancial
recordsofContractorpertainingtotheAgreement.Allrecordsshallbemade
availabletoCountyattheEMSofficeorothermutuallyagreeablelocation.
c. TheCountymayaudit,copy,maketranscripts,orotherwisereproducesuch
records,includingbutnotlimitedtocontracts,payroll,inventory,personnel
andotherrecords,dailylogs,andemploymentagreements.
d. Additionally,Contractorshallprovidetheannualconsolidatedaudited
financialstatementsofEastTexasMedicalCenterRegionalHealthcare
SystemthroughoutthetermofthisAgreement,includinganyrenewal
periods.
84.2 ProfitCap
ContractorhasagreedtocapitsannualnetprofitforServicesat7%.Contractor
shallprovideanannualstatementofitnetprofitswithin120calendardaysofthe
endofContractor'sfiscalyear.Allprofitsinexcessof7%shallbedisbursedto
Countywithin30calendardays.
EMSAmbulanceTransportProviderAgreement
Page41of63
85.CustomerServiceTelephoneLine
85.1 ContractorshallestablishandpublishaCustomerServiceTelephoneLinegiving
internalandexternalcustomersandsystemparticipantstheabilitytocontacta
designatedliaisonoftheContractor’sleadershipteam.Thetelephonelineshallbe
accessiblewithoutchargetoallcallerswithinthecontinentalUnitedStates.
85.2 Thenumbermaybeansweredbyadesignatedmanagerorprovideanopportunity
forthecallertoleaveavoicemailmessage.Thenumbershallbepublishedinthe
localtelephonedirectory,ontheContractor’swebsite,andpublicizedatlocalhealth
carefacilities,firestations,andpublicsafetyagencies.
85.3 Ifthenumberisansweredbyanautomaticgreetingand/ormenuselection,and
shouldacallerinadvertentlycallthecustomerservicelinelookingforemergency
service,theinitialmessagemustimmediatelyconveythatthisisacustomerservice
line,ifcallerhasanemergencyhangupanddial911.
85.4. MembersoftheContractor’sLeadershipTeamaretobeautomaticallynotifiedvia
pagerofanyincomingcalls.Amanagementdesigneemustreturnthecalltothe
customerwithin30minutes,90%ofthetime.Incidentsthatrequirefollowuptothe
customershouldberesolvedbytheendofthenextbusinessdayfromwhenthecall
wasreceived,andifnotpossible,acallshouldbemadetothecustomerwiththe
statusoftherequest.
85.5 HandlingServiceInquiriesandComplaints:
a. Contractorshalllogthedateandtimeofeachinquiryandservicecomplaint.
Contractorshallprovideapromptresponseandfollow‐uptoeachinquiry
andcomplaint.Suchresponsesshallbesubjecttothelimitationsimposedby
patientconfidentialityrestrictions.
b. ContractorshallsubmittotheCountyalistofallcomplaintsreceivedandthe
disposition/resolutiononamonthlybasis.Copiesofanyinquiriesand
resolutionsofaclinicalnatureshallbereferredtotheEMSMedicalDirector
usingtheEMSUnusualOccurrenceprocedure,withintwenty‐four(24)hours
oftheinitialinquiry.
c. ContractorshallsubmittotheEMSDirectoradescriptionoftheContractor’s
EMSAmbulanceTransportProviderAgreement
Page42of63
processformanagingservicecomplaintspriortotheServiceStartDate.
86.Contractor'sCompensationtotheCounty
86.1 FirstResponderSupportFees
ContractorshallpaytotheCountyanannualfirstrespondersupportfeeoffour
millionsixhundredthousanddollars($4,600,000.00).Paymentshallbemadein
quarterlyinstallmentsof$1,150,000.00.Thefirstquarterlyinstallmentshallbe
madeonorbeforetheServiceStartDate.Thereafter,paymentshallbemadeupon
receiptofaninvoicefromCounty.
Theamountofthefirstrespondersupportfeesshallincrease3%peryearforthe
termoftheAgreement,beginningoneyearfromtheServiceStateDate.
86.2 DispatchSystemFees
ContractorshallpayDispatchfeesintheamountofonemillion,fivehundred
thousanddollars($1,500,000.00)annually.PaymentshallbemadetoACREEC,as
specifiedinContractor'sseparateagreementfordispatchservices,withverification
ofpaymentsentbyContractortotheEMSDirector.
ADMINISTRATIVEPROVISIONS
87.AnnualPerformanceEvaluation
TheCountymayevaluatetheperformanceoftheContractoronanannualbasis.Contractor
shallprovideareporttotheCountytoassistinthisevaluationwithin60calendardaysof
writtennoticebyCountyofitsintentiontoconductaperformanceevaluation.Thereportis
toincludethefollowinginformation:
a. ResponseTimeperformance
b. Clinicalperformance
c. Innovativeprogramsthathavebeeninitiatedtoimprovesystem
performance
d. Updateonitsworkforce,includingeffortstominimizeemployeeturnover
e. Updateoncommunityeducationprogramsandothercommunityinitiatives
f. OtherinformationasrequestedbyCounty
EMSAmbulanceTransportProviderAgreement
Page43of63
g. OtherinformationContractorwouldlikeconsideredbyCounty.
88.AssuranceofPerformance
88.1 Ifatanytime,theCountybelievesContractormaynotbeadequatelyperformingits
obligationsunderthisAgreementorthatContractorisnotperformingtheServices
asrequiredbythisAgreement,CountymayrequestfromContractorpromptwritten
assurancesofperformanceandawrittenplanacceptabletoCounty,tocorrectthe
deficienciesinContractor’sperformance.
88.2 Contractorshallprovidewrittenassurancesandawrittenplanwithinten(10)
calendardaysofitsreceiptofCounty’srequestandshallthereafterdiligently
commenceandfullyperformsuchwrittenplan.
88.3Contractor’sfailuretoprovidesuchwrittenassurancesandwrittenplanwithinthe
requiredtimeisamaterialbreachofthisAgreement.
89.MaterialBreach
89.1 WillfulfailureofContractortoprovideServicesunderthisAgreementinsubstantial
compliancewiththerequirementsoftheapplicableFederal,State,andCountyof
Alamedalaws,rules,andregulationsshallconstituteamaterialbreachby
Contractor.Minorinfractionsofsuchrequirementsshallnotconstituteamaterial
breachunlesssuchinfractionsarewillfulandrepeated.
89.2 ActsoromissionsthatshallconstituteamaterialbreachbyContractorincludebut
arenotlimitedtothefollowing:
a. WillfulfalsificationofdatasuppliedtoCountyduringthecourseof
operations,includingbutnotlimitedtodispatchdata,patientreportdata,
ResponseTimedata,financialdata,orfalsificationofanyotherdatarequired
underAgreement;
b. Willfulfailuretomaintainequipmentinaccordancewiththerequirementsof
thisAgreement;
c. Willfulattemptstointimidateorpunishemployeeswhoparticipatein
protectedconcertedactivities,orwhoformorjoinanyprofessional
associations;
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d. Chronicandpersistentfailuretorequireemployeestoconductthemselvesin
aprofessionalandcourteousmanner,andtopresentaprofessional
appearance;
e. WillfulfailureofContractortocomplywithapprovedratesetting,billing,and
collectionprocedures;
f. RepeatedfailuretomeetResponseTimerequirementsafterreceivingnotice
ofnon‐compliancefromtheEMSDirector;
g. Failuretomaintaintherequiredinsuranceortoprovideandmaintainthe
requiredperformancesecuritybond;
h. Willfulfailuretocomplywithvehicleleaseprovisions;
i. WillfulandrepeatedmaterialbreachesofContractor’sbackupprovisions.
j. WillfulfailuretocomplywithexecutedMutual‐Aidagreements;
k. Failuretotimelyobtainandmaintainthenecessarylicensingand/or
certificationrequiredbylawtoprovideServices;
89.3 FollowingCounty’sannouncementofinitiationofanewprocurementprocess,and
priortoterminationofServicesunderthisAgreement,thefollowingshallbe
consideredamaterialbreachbyContractor:
a. Deliberate,excessive,andunauthorizedscaling‐downofoperations.
b. Attemptstointimidateorotherwisepunishemployeeswhodesiretosign
contingentemploymentcontractswithcompetingproviders.
90.NoticeandCureofMaterialBreach
90.1 CountyshallgiveContractorwrittennotice,returnreceiptrequested,settingforth
withreasonablespecificitythenatureofamaterialbreach.
90.2 Contractorshallhavetherighttocurethematerialbreachwithinten(10)calendar
daysofreceiptofnotice.Withintwenty‐four(24)hoursofreceiptofamaterial
breachnotice,ContractorshalldelivertoCounty,inwriting,aplanofactiontocure
thematerialbreach.
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90.3 Ifthematerialbreach,byitsnature,cannotreasonablybecuredwithinten(10)
calendardays,Contractormayrequestadditionaltimetocompletecureofthe
breach.
91.CountyRemedies
91.1 CountyshallhavetherighttoterminatethisAgreementinadditiontoanyother
legalremedyintheeventofamaterialbreachthatisnotcuredwithinthetime
specified.
91.2 County'sremediesforanybreacharenon‐cumulativeandinadditiontoanyother
remedyavailabletotheCounty.
91.3 IftheCountydeterminesanybreachhasoccurred,CountymayrequireContractor
tosubmitacorrectiveactionplan.Failuretosubmitandimplementanyrequested
correctiveactionplanmaybeconsideredamaterialbreach.
92.ContinuousServiceDelivery
ContractoragreesthatthereisapublichealthandsafetyobligationtoassistCountyin
everyefforttoensureuninterruptedandcontinuousservicedeliveryintheeventofa
materialbreach,evenifContractordisagreeswiththedeterminationofmaterialbreach.
93.EmergencyTakeover
93.1 IftheBoardbymajorityvotedeterminesthatthehealthandsafetyofAlameda
CountyresidentswouldbeendangeredbyallowingContractortocontinue
providingServices,CountymaytakeovertheprovisionofServicesonanemergency
basis(“EmergencyTakeover”).TheBoardshallgivenoticetoContractorofthedate
andtimetheEmergencyTakeovershallbeeffective.
93.2 UponnoticeofanEmergencyTakeover,Contractorshallpromptlyandcontinually
cooperatewithCountytoeffectuateanorderlytransition.Thisshallinclude,butnot
belimitedto:
a. ImmediatedeliverytoCounty,oritsdesignee,ofallServiceVehicles,and
equipmentusedtoprovideServices(“EmergencyTakeoverEquipment”).
EachAmbulanceshallbeequipped,ataminimum,withtheequipmentand
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suppliesnecessaryfortheoperationofALSAmbulances,inaccordancewith
EMSPolicies.
b. ImmediateaccesstoanduseofalllocationsusedtoprovideServices,
including,butnotlimitedto,thoselocationswhereContractorplacesits
Ambulances(“crewstations”)duringtheEmergencyTakeover.
93.3 FailureofContractortocooperatefullywiththeCountyintheeventofan
EmergencyTakeovershallconstituteamaterialbreach.
93.4 AsofthedatetheEmergencyTakeoveriseffective,allofContractor’sService
Vehicles,fullyequippedforprovisionofServices,shallbedeemedleasedtothe
County,duringtheEmergencyTakeover,attherateof$1.00(OneDollar)permonth
pervehicle.
93.5 CountymayrecoverfromContractorcostsassociatedwithanEmergencyTakeover
includingongoingrentpaymentsandotherliabilities.
93.6 Contractorshallinformandprovideacopyoftakeoverprovisionscontainedherein
toallvehicleandrealpropertylienholder(s)withinfive(5)calendardaysof
EmergencyTakeover
93.7 County,byamajorityvoteoftheBoard,maydiscontinuetheEmergencyTakeover
atanytime,andreturntheEmergencyTakeoverEquipmenttoContractor,who
shallresumeprovidingServicespursuanttothefulltermsandconditionsofthe
Agreement.
93.8 CountyshallreturnEmergencyTakeoverEquipmenttoContractoringoodworking
order,normalwearandtearexcepted,attheendoftheEmergencyTakeover.
Otherwise,CountyshallpayContractorthefairmarketvalueoftheEmergency
TakeoverEquipmentasofthecommencementoftheEmergencyTakeover,orshall
payContractorthereasonablecostsofrepair,orshallpromptlyrepairandreturn
suchEmergencyTakeoverEquipment.
94.Termination
94.1 MutualTermination
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ThisAgreementmaybeterminatedearlybymutualconsentoftheContractorand
theCounty.
94.2 WalkAwaybyContractor
IfContractorstopsprovidingServicespriortotheterminationofthisAgreement
(“WalkAway”),thefollowingprovisionsshallapply;howeverinnoeventshall
ContractorgivenoticetoCountylessthan90dayspriortostoppingServices:.
a. CountymayleaseanyandallServiceVehicles,including,butnotlimitedto,
fully‐equippedAmbulancesandSupervisorVehicles,foronedollar($1.00)
permonthpervehicle.Countyshallhavefulluseofvehiclesandequipment
andmay,atCounty'ssoleoption,hireamanagementcompanytomanage
ambulanceoperationsuntilareplacementproviderfortheEOAisselected
throughaCountyprocurementprocess.Theleaseagreementshallbenon‐
transferrabletoanewambulanceprovider,andshallterminateonthe
servicesstartdateofthenewprovider.
b. ContractorshallfullycooperateifCountyelectstoleaseanyorallService
Vehiclespursuanttothisprovision.Countyshallberesponsibleforinsuring
allvehiclesitleasespursuanttothisprovision.Alternatively,Countymay
electtopurchasethevehiclesattheirdepreciatedvalueasofthedateofsuch
election.Countyshallhavesolediscretionastowhichvehiclesitleasesor
purchasespursuanttothisprovision.
ContractorandCountyshallnegotiateacontingentleaseagreementpriortoService
StartDate.
94.3 TerminationforCause
  a. IfContractorfailstocureanymaterialbreach,followingnoticeand
opportunitytocure,County,uponwrittennoticetoContractor,may
terminatethisAgreementforcause.Theterminationshallbeeffectiveonthe
datespecifiedinthewrittennotice.
b. ContractorshallberesponsibleforallcostsincurredbyCountydueto
terminationforcause.
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c. Intheeventofterminationforcause,CountymaypurchaseanyandService
Vehiclesatthecurrentdepreciatedvalueasoftheeffectivedateofthe
termination.Alternatively,CountymayelecttorenttheServiceVehiclesfor
fairmarketrentalprice,asoftheeffectivedateofthetermination,as
determinedbyaneutralappraiser.Countyshallhavesolediscretionasto
whichvehiclesitpurchasesorrentspursuanttothisprovision.
94.4 End‐of‐TermProvisions
a. Contractorshallmakenochangesinmethodsofoperationforpurposesof
reducingServiceorContractor’soperatingcostspriortoterminationofthe
Agreement,withoutthewrittenconsentofCounty.
b. ContractorshallmakenochangespriortoterminationoftheAgreementthat
couldincreasecoststoanewprovider.
c. Contractorshallhaveninety(90)calendardaysafterterminationofthe
AgreementinwhichtosupplytherequiredauditedfinancialStatementsand
othersuchdocumentationnecessarytofacilitatethecloseoutofthe
Agreementattheendoftheterm.
FUTURECOMPETITIVEPROCUREMENTPROCESS/“LAMEDUCK”PROVISIONS
95.CompetitiveProcurementProcess
95.1 Countyhastherighttoconductacompetitiveprocurementprocessforthe
provisionofmedicalAmbulanceservicewithinitsEOA,andarequirementtodoso
atcertaintimeintervals.
95.2 CountymayselectadifferentAmbulanceserviceprovidertoprovideexclusive
medicalAmbulanceserviceswithintheEOAfollowingacompetitiveprocurement
process.
95.3 ContractorshallcontinuetoprovideallServicesafternotificationbyCountyofits
intenttoinitiateacompetitiveprocurementprocess.Contractorshallbeinmaterial
breachifitdoesnotcontinueServicesatthesamelevelofeffortandperformanceas
wereineffectpriortoanoticeofintenttoinitiateacompetitiveprocurement
process.
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95.3 Contractorshallnotpenalizeorbringpersonalhardshiptobearuponanyofits
employeeswhoapplyforworkonacontingentbasiswithcompetingproposers,and
shallallow,withoutpenalty,itsemployeestosigncontingentemployment
agreementswithcompetingproposers.Contractormayprohibititsemployeesfrom
revealingtradesecretsorotherinformationaboutContractor’sbusinesspractices
orfieldoperations.
96.“LameDuck”Provisions
96.1 IfandwhenCountyannouncesitsintenttochangeproviders,Contractoragreesto
continuetoprovideallServicesuntiltheCountyoranewproviderassumes
responsibilitiesforprovisionofServices.Thisshallincludeanytimeperiodafter
notificationbyCountyofitsintenttoinitiateacompetitiveprocurementprocess.
96.2 Contractorshallbeinmaterialbreachifitdoesnotcontinuealloperationsand
Servicesatthesamelevelofeffortandperformanceaswereineffectpriortonotice
ofintenttochangeproviders.
96.3 Contractorshallmakenochangesinmethodsofoperationforpurposesofreducing
ServiceorContractor’soperatingcostspriortoterminationoftheAgreement,
withoutthewrittenconsentofCounty.
96.4 ContractorshallmakenochangespriortoterminationoftheAgreementthatcould
increasecoststoanewprovider.Contractorshallallowitsemployeesproviding
Servicesreasonableopportunitiestodiscussissuesrelatedtoemploymentwitha
newproviderwithoutadverseconsequences.
GENERALPROVISIONS
97.PermitsandLicense
97.1 ContractorshallberesponsibleforandshallholdanyandallrequiredFederal,State
orlocalpermitsorlicensesrequiredtoperformitsobligationsunderthe
Agreement.
97.2 Contractorshallmakeallnecessarypaymentsforlicensesandpermitsforall
Ambulancevehiclesused.
97.3 ItshallbeentirelytheresponsibilityofContractortoscheduleandcoordinateall
applicationsandapplicationrenewalsasnecessarytoensurethatContractoris
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meetingitsobligationundertheAgreementandisincompletecompliancewith
Federal,Stateandlocalrequirementsforpermitsandlicensesasnecessaryto
providetheservices.
97.4 Contractorshallberesponsibleforensuringthatitsemployee’sStateandlocal
certificationsasnecessarytoprovidetheservices,ifapplicable,arevalidand
currentatalltimes.
98.PrivateWork
Contractorshallnotbepreventedfromconductingprivateworkthatdoesnotinterfere
withtherequirementsoftheAgreementorallocationofoverhead.IntheeventContractor
doesprivateworkoutsideoftheAgreement,andifanyoverheadcostsaresharedbetween
thetwobusinesses,financialinformationprovidedregardingtheAgreementshallclearly
identifytherelationandpercentageshared.
99.ProductEndorsement/Advertising
ContractorshallnotusethenameofAlamedaCountyorAlamedaCountyEMSforthe
endorsementofanycommercialproductsorserviceswithouttheexpressedwritten
permissionoftheEMSDirector.
100.ObservationandInspections
100.1 Countyrepresentativesmay,atanytime,andwithoutnotification,directlyobserve
Contractor'soperationsattheCountyDispatchCenter,maintenancefacility,orany
Ambulancepostlocation.ACountyrepresentativemayrideas“thirdperson”onany
ofContractor'sAmbulanceunitsatanytime,providedthatinexercisingthisrightto
inspectionandobservation,Countyrepresentativesshallconductthemselvesina
professionalandcourteousmanner,shallnotinterferewithContractoremployee's
duties,andshallatalltimesberespectfulofContractor'semployer/employee
relationships.
100.2 Atanytimeduringnormalbusinesshoursandasoftenasmaybereasonably
deemednecessarybytheCounty,CountyrepresentativesmayobserveContractor's
officeoperations,andContractorshallmakeavailabletoCountyforitsexamination
anyandallbusinessrecords,includingincidentreports,patientrecords,financial
recordsofContractorpertainingtotheAgreement.Countymayaudit,copy,make
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transcripts,orotherwisereproducesuchrecordsincludingbutnotlimitedto
contracts,payroll,inventory,personnelandotherrecords,dailylogs,employment
agreements,andotherdocumentationforCountytofulfillitsoversightrole.
101.NoCosttoCounty
ContractoragreesthattheprovisionofServicestobeperformedbyContractorunderthis
AgreementshallbecompletedwithoutcompensationfromtheCounty.
102.CostofEnforcement
IfCountyorContractorinstituteslitigationagainsttheotherpartytoenforceitsrights
pursuanttoperformingtheworkcontemplatedherein,theactualandreasonablecostof
litigationincurredbytheprevailingparty,includingbutnotlimitedto:a)attorney'sfees,
b)consultantandexpertfees,orc)othersuchcosts,shallbepaidorreimbursedwithin
ninety(90)calendardaysafterreceivingnoticebythepartywhichprevails.
103.RelationshipoftheParties
NothinginthisAgreementshallbeconstruedtocreatearelationshipofemployerand
employeeorprincipalandagent,partnership,jointventure,oranyotherrelationshipother
thanthatofindependentpartiescontractingwitheachothersolelyforthepurposeof
carryingouttheprovisionsoftheAgreement.NothingintheAgreementshallcreateany
rightorremediesinanythirdparty,itbeingsolelyforthebenefitoftheCountyand
Contractor.
104.IndependentContractor
104.1 NorelationshipofemployerandemployeeiscreatedbythisAgreement;itbeing
understoodandagreedthatContractorisanindependentcontractor.Contractoris
nottheagentoremployeeoftheCountyinanycapacitywhatsoever,andCounty
shallnotbeliableforanyactsoromissionsbyContractornorforanyobligationsor
liabilitiesincurredbyContractor.
104.2 Contractor,itsemployees,subcontractorsandagentsshallhavenoclaimunderthis
Agreementorotherwise,forseniority,vacationtime,vacationpay,sickleave,
personaltimeoff,overtime,healthinsurancemedicalcare,hospitalcare,retirement
benefits,socialsecurity,disability,Workers’Compensation,orunemployment
insurancebenefits,civilserviceprotection,oremployeebenefitsofanykind.
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104.3 Contractorshallbesolelyliableforandobligatedtopaydirectlyallapplicable
payrolltaxes(includingFederalandStateincometaxes)orcontributionsfor
unemploymentinsuranceoroldagepensionsorannuitieswhichareimposedby
anygovernmentalentityinconnectionwiththelaborusedorwhicharemeasured
bywages,salariesorotherremunerationpaidtoitsofficers,agentsoremployees
andagreestoindemnifyandholdCountyharmlessfromanyandallliabilitywhich
CountymayincurbecauseofContractor’sfailuretopaysuchamounts.
104.4 ContractorshallcomplywithallapplicableFederalandStateworkers’
compensationandliabilitylawsandregulationswithrespecttotheofficers,agents
and/oremployeesconductingandparticipatinginthework;andagreesthatsuch
officers,agents,and/oremployeesshallbeconsideredasindependentContractors
andshallnotbetreatedorconsideredinanywayasofficers,agentsand/or
employeesofCounty.
105.Indemnification
105.1 Tothefullestextentpermittedbylaw,Contractorshallholdharmless,defendand
indemnifytheCountyofAlameda,itsBoardofSupervisors,employeesandagents
fromandagainstanyandallclaims,losses,damages,liabilitiesandexpenses,
includingbutnotlimitedtoattorneys’fees,arisingoutoforresultingfromthe
performanceofServicesunderthisAgreement,providedthatanysuchclaim,loss,
damage,liabilityorexpenseisattributabletobodilyinjury,sickness,disease,death
ortoinjurytoordestructionofproperty,includingthelosstherefrom,ortoany
violationofFederal,Stateormunicipallaworregulation,whicharisesoutoforis
anywayconnectedwiththeperformanceofthisAgreement(collectively
“Liabilities”),exceptwheresuchLiabilitiesarecausedsolelybythenegligenceor
willfulmisconductofanyindemnitee.TheCountymayparticipateinthedefenseof
anysuchclaimwithoutrelievingContractorofanyobligationhereunder.
105.2 IntheeventthatContractororanyemployeeoragentofContractorproviding
servicesunderthisAgreementisdeterminedbyacourtofcompetentjurisdictionor
theAlamedaCountyEmployees’RetirementAssociation(ACERA)orCalifornia
PublicEmployees’RetirementSystem(PERS)tobeeligibleforenrollmentinACERA
andPERSasanemployeeofCounty,Contractorshallindemnify,defend,andhold
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harmlessCountyforthepaymentofanyemployeeand/oremployercontributions
forACERAandPERSbenefitsonbehalfofContractororitsemployeesoragentsas
wellasforthepaymentofanypenaltiesandinterestonsuchcontributions,which
wouldotherwisebetheresponsibilityofCounty.
106.InsuranceandBond
106.1 PerformanceSecurityBond:UpontheEffectiveDateofthisAgreement,Contractor
shallfurnishaperformancebondpayabletoCountyissuedbyalicensedsurety,
acceptabletoCounty,intheamountofsixmilliondollars($6,000,000.00).The
PerformanceBondshallremainineffectatalltimesduringthetermofthis
Agreement,includinganyrenewalterm.
106.2. ContractorshallatalltimesduringthetermoftheAgreementwiththeCounty
maintaininforcetheinsurancecoveragespecifiedinEXHIBITC‐MINIMUMINSURANCE
REQUIREMENTS,andshallcomplywithallthoserequirementsasStatedtherein.
107.Workers’Compensation
ContractorshallprovideWorkers'Compensationinsurance,atContactor’sowncostand
expenseandfurther,neithertheContractornoritsinsurershallbeentitledtorecoverfrom
Countyanycosts,settlements,orexpensesofWorkers'Compensationclaimsarisingoutof
thisAgreement.
108.ConformitywithLawandSafety
108.1 InperformingServicesunderthisAgreement,Contractorshall,atalltimes,observe
andcomplywithallapplicablelaws,ordinances,codesandregulationsof
governmentalagencies,includingFederal,State,municipal,andlocalgoverning
bodies,havingjurisdictionovertheServices,including,butnotlimitedto,all
applicableprovisionsoftheCaliforniaOccupationalSafetyandHealthAct.Itshallbe
Contractor’ssoleresponsibilitytobefullyfamiliarwithallsuchapplicablelaws,
ordinances,andregulations.
108.2 ContractorshallindemnifyandholdCountyharmlessfromanyandallliability,
fines,penaltiesandconsequencesfromanyfailurebyContractortocomplywith
suchlaws,ordinances,codesandregulations.
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108.3 Accidents:Ifadeath,seriouspersonalinjury,orsubstantialpropertydamage
occursinconnectionwithContractor’sperformanceofthisAgreementandwarrants
submissionofanAlamedaCountyEMSUnusualOccurrenceReport(asperEMS
Policy).ContractorshallimmediatelynotifyCountybycontactingtheEMSDispatch
CenterandaskingtospeaktotheEMSpersononcall.TheEMSpersononcallshall
immediatelynotifytheAlamedaCountyRiskManager’sOfficebytelephone.Ifafter
businesshours,thismessagemaybeleftasavoicemail.Contractorshallpromptly
submittoCountyawrittenreport,insuchformasmayberequiredbyCountyofall
accidents,whichoccurinconnectionwiththisAgreement.Thisreportmustinclude
thefollowinginformation:a)nameandaddressoftheinjuredordeceased
person(s);b)nameandaddressofContractor'ssub‐Contractor,ifany;c)nameand
addressofContractor'sliabilityinsurancecarrier;andd)adetaileddescriptionof
theaccidentandwhetheranyofCounty'sequipment,tools,material,orstaffwere
involved.
108.4 Contractorshalltakeallreasonablestepstopreserveallphysicalevidenceand
informationwhichmayberelevanttoanaccidentinvolvingpersonalinjury,death,
orpropertydamage,whilemaintainingpublicsafety,inordertoaffordCountythe
opportunitytoreviewandinspectsuchevidence,includingthesceneoftheaccident
109.DebarmentandSuspensionCertification
109.1 ContractorshallcomplywithapplicableFederalsuspensionanddebarment
regulations,includingbutnotlimitedto7CodeofFederalRegulations("CFR")
3016.35,28CFR66.35,29CFR97.35,34CFR80.35,45CFR92.35andExecutive
Order12549.
109.2 Contractorcertifiestothebestofitsknowledgeandbelief,thatitanditsprincipals:
a. Arenotpresentlydebarred,suspended,proposedfordebarment,declared
ineligible,orvoluntaryexcludedbyanyFederaldepartmentoragency;and,
b. Shallnotknowinglyenterintoanycoveredtransactionwithapersonwhois
proposedfordebarmentunderFederalregulations,debarred,suspended,
declaredineligible,orvoluntarilyexcludedfromparticipationinsuch
transaction.
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110.Taxes
Paymentofallapplicablefederal,state,andlocaltaxesshallbethesoleresponsibilityofthe
Contractor.
111.OwnershipofDocuments
111.1 ContractorassignstoCountyallcopyrightandotheruserightsinanyandall
proposals,plans,specifications,reportsandrelateddocuments(including
computerizedorelectroniccopiesrelatingtoServices,whetherpreparedby
County,Contractor,orthirdpartiesatContractor’srequest(collectively,
“DocumentsandMaterials”).
111.2 Contractorshallbepermittedtoretaincopies,includingreproduciblecopiesand
computerizedcopies,ofanyDocumentsandMaterials.Contractoragreestotake
suchfurtherstepsasmaybereasonablyrequestedbyCountytoeffectuate
assignmentofrightsintheDocumentsandMaterialstoCounty.Ifforanyreason
thisassignmentisnoteffective,ContractorherebygrantsCountyandanyassignee
ofCountylicensetoretainandusesuchDocumentsandMaterialsatnocostto
County.TheCounty’srightsunderthisparagraphshallapplyregardlessofthe
degreeofcompletionoftheDocumentsandMaterials.
111.3 InContractorcontractswiththirdpartiestoprovideServices,Contractorshall
expresslyobligateitssubcontractorstograntCountytheassignmentandlicense
rightsregardingtheDocumentsandMaterialsassetforthabove.Contractoragrees
todefend,indemnifyandholdCountyharmlessfromanydamagecaused
Contractor’sfailuretosecuresuchrightsfromitssubcontractors.
111.4 Contractorshallpayallroyaltiesandlicensefeeswhichmaybedueforanypatented
orcopyrightedmaterials,methodsorusedbyContractorfortheServices,andshall
defend,indemnifyandholdCountyharmlessfromanyclaimsforinfringementof
patentorcopyrightarisingoutofsuchuse.TheCounty’srightsunderthisParagraph
shallnotextendtoanycomputersoftwareusedtocreatesuchDocumentsand
Materials.
EMSAmbulanceTransportProviderAgreement
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112.DocumentsandMaterials
112.1 ContractorshallmaintainandmakeavailabletoCountyforitsinspectionanduse
duringthetermofthisAgreementallDocumentsandMaterials,asdefinedabove.
Thisdutyshallcontinueforthree(3)yearsfollowingterminationorexpirationof
thisAgreement.Contractorshallnotdisposeof,destroy,alter,ormutilatesuch
DocumentsandMaterials,forthree(3)yearsfollowingterminationorexpirationof
thisAgreement.
112.2 RetentionofRecords‐Contractorshallretainalldocumentspertainingtothe
AgreementasrequiredbyFederalandStatelawsandregulations,andnolessthan
seven(7)yearsfromtheendofthefiscalyearfollowingterminationorexpirationof
thisAgreement.Uponrequest,andexceptasotherwiserestrictedbylaw,
Contractorshallmaketheserecordsavailabletoauthorizedrepresentativesofthe
County,theStateofCalifornia,andtheFederalgovernment.
112.3 TimeofEssence‐Timeisoftheessenceinrespecttoallprovisionsofthis
Agreementthatspecifyatimeforperformance.Thisrequirementshallnotbe
construedtolimitordepriveapartyofthebenefitsofanygraceoruseperiod
allowedbythisAgreement.
113.ConflictofInterest/Confidentiality
113.1 Contractorcovenantsthatitpresentlyhasnointerest,andshallnothaveany
interest,directorindirect,whichwouldconflictinanymannerwiththe
performanceofServicesrequiredunderthisAgreement.Withoutlimitation,
ContractorrepresentstoandagreeswithCountythatContractorhasnopresent,
andshallhavenofuture,conflictofinterestbetweenprovidingServicestoCounty
andtoanyotherpersonorentity(includingbutnotlimitedtoanygovernmental
agency)whichhasanyinterestadverseorpotentiallyadversetotheCounty,as
determinedinthereasonablejudgmentoftheBoardofSupervisorsoftheCounty.
113.2 Contractoragreesthatanyconfidentialinformation,whetherproprietaryornot,
madeknowntoordiscoveredbyitduringtheperformanceoforinconnectionwith
thisAgreementfortheCountyshallbekeptconfidentialandshallnotbedisclosed
toanyotherperson.ContractoragreestoimmediatelynotifyCountyinaccordance
withthisAgreement,ifitisrequestedtodiscloseanyconfidentialinformationmade
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knowntoordiscoveredbyitduringtheperformanceoforinconnectionwiththis
Agreement.
113.3 Theseconflictofinterestandconfidentialityprovisionsshallremainfullyeffective
five(5)yearsafterterminationofthisAgreement.
114.Notices
Allnotices,requests,demands,orothercommunicationsunderthisAgreementshallbein
writing.Noticesshallbegivenforallpurposesasfollows:
114.1PersonalDelivery:Whenpersonallydeliveredtotherecipient,noticesare
effectiveondelivery.
114.2 FirstClassMail:Whenmailedfirstclasstothelastaddressoftherecipientknown
tothepartygivingnotice,noticeiseffectivethree(3)maildeliverydaysafter
depositinaUnitedStatesPostalServiceofficeormailbox.
114.3 CertifiedMail:Whenmailedcertifiedmail,returnreceiptrequested,noticeis
effectiveonreceipt,ifdeliveryisconfirmedbyareturnreceipt.
114.4 OvernightDelivery:Whendeliveredbyovernightdelivery(e.g.,Federal
Express/Airborne/UnitedParcelService/DHLWorldwideExpress)withcharges
prepaidorchargedtothesender’saccount,noticeiseffectiveondelivery,ifdelivery
isconfirmedbythedeliveryservice.
114.5 TelexorFacsimileTransmission:Whensentbytelexorfacsimiletothelasttelex
orfacsimilenumberoftherecipientknowntothepartygivingnotice,noticeis
effectiveonreceipt,providedthat:a)aduplicatecopyofthenoticeispromptly
givenbyfirst‐classorcertifiedmailorbyovernightdelivery,orb)thereceiving
partydeliversawrittenconfirmationofreceipt.Anynoticegivenbytelexor
facsimileshallbedeemedreceivedonthenextbusinessdayifitisreceivedafter
5:00p.m.(recipient’stime)oronanon‐businessday.
114.6 Addressesforpurposeofgivingnoticeareasfollows:
ToCounty:   CountyofAlameda
AlamedaCountyEMS
1000SanLeandroBlvd
SanLeandro,Ca
Attn:EMSDirector
EMSAmbulanceTransportProviderAgreement
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ToContractor:  PARAMEDICSPLUS,LLC
352S.GlenwoodDrive
Tyler,TX75702
Attn:AnthonyJ.Myers,President
114.7 Anycorrectlyaddressednoticethatisrefused,unclaimed,orundeliverablebecause
ofanactoromissionofthepartytobenotifiedshallbedeemedeffectiveasofthe
firstdatethatnoticewasrefused,unclaimed,ordeemedundeliverablebythepostal
authorities,messenger,orovernightdeliveryservice.
114.8 Anypartymaychangeitsaddressortelexorfacsimilenumberbygivingtheother
partynoticeofthechangeinanymannerpermittedbythisAgreement.
115.UseofCountyProperty
ContractorshallnotuseCountyproperty(includingequipment,instrumentsandsupplies)
orpersonnelforanypurposeotherthanintheperformanceofitsobligationsunderthis
Agreement.
116.EqualEmploymentOpportunityPracticesProvisions
116.1 ContractorshallcomplywithTitleVIIoftheCivilRightsActof1964andContractor
agreesthatnopersonshall,onthegroundsofrace,creed,color,disability,sex,
sexualorientation,nationalorigin,age,religion,VietnameraVeteran’sstatus,
politicalaffiliation,oranyothernon‐meritfactor,beexcludedfromparticipationin,
bedeniedthebenefitsof,orbeotherwisesubjectedtodiscriminationunderthis
Agreement.
116.2 Contractorshall,inallsolicitationsoradvertisementsforapplicantsforemployment
placedasaresultofthisAgreement,Statethatitisan“EqualOpportunity
Employer”orthatallqualifiedapplicantsshallreceiveconsiderationfor
employmentwithoutregardtotheirrace,creed,color,disability,sex,sexual
orientation,nationalorigin,age,religion,VietnameraVeteran’sstatus,political
affiliation,oranyothernon‐meritfactor.
116.3 UponrequestbyCounty,Contractorshallcertifythatithasnot,intheperformance
ofthisAgreement,discriminatedagainstapplicantsoremployeesbecauseoftheir
race,creed,color,disability,sex,sexualorientation,nationalorigin,age,religion,
VietnameraVeteran’sstatus,politicalaffiliation,oranyothernon‐meritfactor.
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116.4 UponrequestbyCounty,ContractorshallprovideCountywithaccesstocopiesofall
ofitsrecordspertainingorrelatingtoitsemploymentpractices,excepttotheextent
suchrecordsorportionsofsuchrecordsareconfidentialorprivilegedunderState
orFederallaw.
116.5 Contractorshallactivelyrecruitandencourageminorityandwomen‐owned
businessestobiditssubcontracts.
116.6 NothingcontainedinthisAgreementshallbeconstruedinanymannersoastorequire
orpermitanyactthatisprohibitedbylaw.
116.7 TheContractorshallincludetheprovisionssetforthinthissectionineachofits
subcontracts.
117.DrugFreeWorkplace
ContractoranditsemployeesshallcomplywiththeCounty’spolicyofmaintainingadrug
freeworkplace.NeitherContractornoritsemployeesshallunlawfullymanufacture,
distribute,dispense,possessorusecontrolledsubstances,asdefinedin21U.S.Code§812,
including,butnotlimitedto,marijuana,heroin,cocaine,andamphetamines,atanyCounty
facilityorworksite.IfContractororanyemployeeofContractorisconvictedorpleads
nolocontenderetoacriminaldrugstatuteviolationoccurringataCountyfacilityorwork
site,Contractorshall,withinfive(5)calendardaysthereafter,notifytheEMSDirector.
ViolationofthisprovisionshallconstituteamaterialbreachofthisAgreement.
118.Small,Local,andEmergingBusiness(SLEB)Participation:
118.1 TheCountyhaswaiveditsSmall,LocalandEmergingBusiness(“SLEB”)
requirementsforthisAgreement.Therefore,Contractorisnotrequiredto
subcontractwithanotherbusinessinordertosatisfytheCounty’sSLEB
requirements.
118.2 Ifcircumstanceschange,ContractormayberequestedtocomplywiththeCounty’s
SmallandEmergingLocalBusinessprovisions.
EMSAmbulanceTransportProviderAgreement
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119.FirstSourceProgram
ThisAgreementissubjecttotherequirementsoftheCounty’sFirstSourceProgram.A
copyoftheFirstSourceAgreementexecutedbyContractorisattachedasEXHIBITJ‐FIRST
SOURCEAGREEMENTtothisAgreementandincorporatedherein.
120.Waiver
Nowaiverofabreach,failureofanycondition,oranyrightorremedycontainedinor
grantedbytheprovisionsofthisAgreementshallbeeffectiveunlessitisinwritingand
signedbythepartywaivingthebreach,failure,rightorremedy.Nowaiverofanybreach,
failure,rightorremedyshallbedeemedawaiverofanyotherbreach,failure,rightor
remedy,whetherornotsimilar,norshallanywaiverconstituteacontinuingwaiverunless
thewritingsospecifies.
121.EntireAgreement
ThisAgreement,includingallattachments,exhibits,andanyotherdocumentsspecifically
incorporatedintothisAgreement,shallconstitutetheentireagreementbetweenthe
partiesrelatingtothesubjectmatterofthisAgreement.
ThisAgreementsupersedesandmergesallpreviousunderstandings,andallother
agreements,writtenororal,betweenthepartiesandsetsforththeentireunderstandingof
thepartiesregardingthesubjectmatterthereof.
122.Headings
Headingshereinareforconvenienceofreferenceonlyandshallinnowayaffectthe
interpretationoftheAgreement.
123.ModificationofAgreement
123.1 ThisAgreementmaybesupplemented,amendedormodifiedonlybythemutual
agreementoftheparties.Nosupplement,amendment,ormodificationofthis
Agreementshallbebindingunlessitisinwritingandsignedbyauthorized
representativesofbothparties.
123.2 WherethereismutualagreementbyContactorandtheEMSDirector,thefollowing
exhibitsmaybemodified,byawrittenamendmentsignedbyContractorandthe
DirectorofHealthCareServicesAgency:
EMSAmbulanceTransportProviderAgreement
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EXHIBITA DEPICTIONANDDEFINITIONOFCONTRACTOR'SEOAAND
EMERGENCYRESPONSEZONES
EXHIBITB DEPICTIONANDDEFINITIONOFSUB‐AREAS
EXHIBITE COMMUNICATIONSEQUIPMENT
EXHIBITG PARAMEDICTRAININGREQUIREMENTS
EXHIBITK TRANSITIONPLAN
EXHIBITL COMMUNITYEDUCATIONPROGRAM
EXHIBITM FIRSTRESPONDERSUPPORT
EXHIBITN HIGHRISKPATIENTDESCRIPTION
124. Subcontracting/Assignment/Sale
124.1 Contractorshallnotsubcontract,assignordelegateanyportionofthisAgreement
oranydutiesorobligationshereunderwithoutCounty’spriorwrittenapproval,
whichshallnotbeunreasonablywithheldordelayed.Countymayterminatethis
AgreementifParamedicsPlus,LLC.issoldoracquiredorotherwisechanges
ownershipwithoutCounty’spriorwrittenconsenttocontinuationofthis
Agreementunderchangedownership.
124.2 Neitherpartyshall,onthebasisofthisAgreement,contractonorinthenameofthe
otherparty.AnyagreementthatviolatesthisSectionshallconfernorightsonany
partyandshallbenullandvoid.
124.3 Contractorshallberesponsibleforcompliancebyitssubcontractorswithall
applicablethetermsofthisAgreement.
125. Survival
TheobligationsofthisAgreement,whichbytheirnaturewouldcontinuebeyondthe
terminationorexpirationoftheAgreement,includingwithoutlimitation,theobligations
regardingIndemnification,OwnershipofDocuments,andConflictofInterest,shallsurvive
terminationorexpiration.
EMSAmbulanceTransportProviderAgreement
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126. Severability
IfacourtofcompetentjurisdictionholdsthatanyprovisionofthisAgreementisillegal,
unenforceable,orinvalidinwholeorinpart,foranyreason,thevalidityandenforceability
oftheremainingprovisions,orportionsofthem,shallnotbeaffected,unlessanessential
purposeofthisAgreementwouldbedefeatedbythelossoftheillegal,unenforceable,or
invalidprovision.
127. PatentandCopyrightIndemnity
127.1 Contractorrepresentsthatitknowsofnoallegations,claims,orthreatenedclaims
thatthematerials,services,hardwareorsoftware(“ContractorProducts”)provided
toCountyunderthisAgreementinfringeanypatent,copyright,orotherproprietary
right.Contractorshalldefend,indemnifyandholdharmlessCounty,fromand
againstalllosses,claims,damages,liabilities,costsexpensesandamounts
(collectively,“Losses”)arisingoutoforinconnectionwithanyclaimthatany
ContractorProductsortheusethereof,infringeanypatent,copyrightorother
proprietaryrightofanythirdparty.Countyshall:1)notifyContractorpromptlyof
suchclaimorsuit;2)permitContractortodefend,compromise,orsettletheclaim;
and,3)provide,onareasonablebasis,informationtoenableContractortodoso.
ContractorshallnotagreewithoutCounty’spriorwrittenconsent,toany
settlement,whichwouldrequireCountytopaymoneyorperformsomeaffirmative
actinordertocontinueusingtheContractorProducts.
127.2 IfContractorisobligatedtodefendCountypursuanttothisSectionandfailstodoso
afterreasonablenoticefromCounty,Countymaydefenditselfand/orsettlesuch
claimorsuit,andContractorshallpaytoCountyanyandalllosses,damagesand
expenses(includingattorney’sfeesandcosts)incurredinrelationshipwith
County’sdefenseand/orsettlementofsuchclaimorsuit.
127.3 Inthecaseofanysuchclaimofinfringement,Contractorshalleither,atitsoption,
a)procureforCountytherighttocontinueusingtheContractorProducts;or
b)replaceormodifytheContractorProductssothatthattheybecomenon‐
infringing,butequivalentinfunctionalityandperformance.
EMSAmbulanceTransportProviderAgreement
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127.4 NotwithstandingthisSection,Countyretainstherightandabilitytodefenditself,at
itsownexpense,againstanyclaimsthatContractorProductsinfringeanypatent,
copyright,orotherintellectualpropertyright.
128.ChoiceofLawandVenue
ThisAgreementshallbegovernedbythelawsoftheStateofCalifornia.Venueforactions
andproceedingsbetweenthepartiesrelatedtothisAgreementshallbeAlamedaCounty
SuperiorCourtforstateactionsandtheNorthernDistrictofCaliforniaforanyfederal
action.
SIGNATORY
Bysigningthisagreement,signatorywarrantsandrepresentsthathe/sheexecutedthis
Agreementinhis/herauthorizedcapacityandthatbyhis/hersignatureonthisAgreement,
he/sheortheentityuponbehalfofwhichhe/sheacted,executedthisAgreement.
INWITNESSWHEREOF,thepartiesexecutethisAgreement:
CountyofAlamedaContractor
By:_______________________________________________
Signature
By:_____________________________________________
Signature
Name:AliceLai‐Bitker
Title:PresidentoftheBoardofSupervisors
Date:____________________________________________
Name:AnthonyJ.Myers
Title:President,ParamedicsPlus,LLC
Date:___________________________________________
ApprovedastoForm:
By:______________________________________________
CountyCounselSignature
EMSAmbulanceTransportProviderAgreement
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Thispageintentionallyleftblank
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EXHIBITS
EXHIBITA‐DEPICTIONANDDEFINITIONOFCONTRACTOR’SEOAAND
EMERGENCYRESPONSEZONES.........................................................2
EXHIBITB‐DEPICTIONANDDEFINITIONOFSUB‐AREAS..........................................3
EXHIBITC‐MINIMUMINSURANCEREQUIREMENTS................................................6
EXHIBITD‐DEBARMENTANDSUSPENSIONCERTIFICATION......................................7
EXHIBITE‐COMMUNICATIONSEQUIPMENT.........................................................8
EXHIBITF‐RESPONSETIMESREQUIREMENTSANDFINES.........................................10
TABLEA‐PERSONNELANDRESPONSETIMEREQUIREMENTS.....................................................................10
TABLEB‐RESPONSETIMEFINESBYCATEGORYANDCOMPLIANCE.............................................................10
TABLEC‐OUTLIERRESPONSETIMESBYCATEGORYANDSUBAREAINMINUTES&SECONDS...........................10
EXHIBITG‐PARAMEDICTRAININGREQUIREMENTS................................................11
EXHIBITH‐CONTRACTOR’SUSERFEES‐911SYSTEM............................................13
EXHIBITI‐MANDATORYDATAFIELDREQUIREMENTS.............................................14
EXHIBITJ‐FIRSTSOURCEAGREEMENT...............................................................15
EXHIBITK–TRANSITIONPLAN.........................................................................16
EXHIBITL‐COMMUNITYEDUCATIONPROGRAM...................................................22
EXHIBITM‐FIRSTRESPONDERSUPPORT............................................................24
EXHIBITN‐HIGHRISKPATIENTDESCRIPTION......................................................25
EXHIBITO‐PROPOSALOFPARAMEDICSPLUS......................................................26
EMSAmbulanceTransportProviderAgreement
PageE‐2of26
EXHIBITA‐DEPICTIONANDDEFINITIONOFCONTRACTOR’SEOAAND
EMERGENCYRESPONSEZONES
1. Therearefive(5)ERZsinAlamedaCounty,whichincludethecitiesandallunincorporated
areas.ThefollowingarecitiescontainedineachERZ:
a. Zone1–Alameda,Albany,Berkeley,Piedmont
 (thiszoneisnotincludedintheEOA)
b. Zone2–Oakland,Emeryville
c. Zone3–SanLeandro,CastroValley,Hayward
d. Zone4–Fremont,Newark,UnionCity
e. Zone5–Dublin,Pleasanton,Livermore‐exceptLawrenceLivermoreNational
Laboratory(ThisareaisnotincludedintheEOA).
2. ThefollowingisadepictionoftheeachEmergencyResponseZone(ERZ)withinAlameda
County
Zone1Zone2Zone3Zone4Zone5
21
1
3
2
4
5
6
7
10
11
13
14
15
16
17
20
19
8
912 18 21
1‐Alban
y
2‐Berkeley
3‐Emeryville
4‐Piedmont
5‐Oakland
6‐Alameda
7‐SanLeandro
8‐Ashland
9‐Cherryland
10‐SanLorenzo
11‐CastroValley
12‐Fairview
13‐Hayward
14‐UnionCity
15‐Newark
16‐Fremont
17‐Dublin
18‐Pleasanton
19‐Livermore
20‐Sunol
21‐LLNL
EMSAmbulanceTransportProviderAgreement
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EXHIBITB‐DEPICTIONANDDEFINITIONOFSUB‐AREAS
DensityAreaDesignation:Designationsofcalldensityareaswereaccomplishedbyreviewing
thecalldensityforeverysquarekilometergridintheCounty.Thegridswerenormalizedby
examiningtheunderlyingroadstructurewiththegoalofcreatingzoneswithRural/Suburban
contiguouswithMetro/Urban,eliminatinganomalouspocketsofhighorlowdensityinthemidst
ofoneofthedensityareas,andcreatingamapthatcanbeincorporatedintothecomputeraided
dispatchsystem.
Sub‐areadefinitionsareforgeneraldescriptivepurposesonly;theactualsub‐areasareidentified
onthemapsinthisExhibit.Themapdefinesthesubarea,nottheactualnumberofcallsreceived
duringanyperiod.TheidentifiedSub‐areasaresubjecttochangeatthediscretionoftheCounty.
Sub‐Areas:Thereare3possibleSub‐areascontainedwithineachERZ.
Metro/Urbancalldensitiesaredeterminedbyidentifyingthesquarekilometersthat
average2ormorecallspermonthandatleasthalfofthesurroundingsquarekilometers
alsoaverage2ormorecallspermonth.
Rural/Suburbanareasarethoseinwhichtheaveragecallspersquarekilometerare
between0.25andlessthan2.0callspermonthonaverage.
Wilderness/LowCallDensityisdeterminedbyidentifyingthesquarekilometersthat
averagelessthan0.25callspermonth(oronecallevery4months,onaverage).
AlamedaCounty:
EMSAmbulanceTransportProviderAgreement
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Zone2:
Zone3:
EMSAmbulanceTransportProviderAgreement
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Zone4:
Zone5:
EMSAmbulanceTransportProviderAgreement
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EXHIBITC‐MINIMUMINSURANCEREQUIREMENTS
WithoutlimitinganyotherobligationorliabilityunderthisAgreement,theContractor,atitssolecostandexpense,shallsecureandkeepinforce
duringtheentiretermoftheAgreementorlonger,asmaybespecifiedbelow,thefollowinginsurancecoverage,limitsandendorsements: 
TYPEOFINSURANCECOVERAGESMINIMUMLIMITS
A. CommercialGeneralLiability
PremisesLiability;ProductsandCompletedOperations;ContractualLiability;
PersonalInjuryandAdvertisingLiability;Abuse,Molestation,SexualActions,
andAssaultandBattery
$5,000,000.00peroccurrence(CSL)
BodilyInjuryandPropertyDamage
B. CommercialorBusinessAutomobileLiability
Allownedvehicles,hiredorleasedvehicles,non‐owned,borrowedand
permissiveuses.PersonalAutomobileLiabilityisacceptableforindividual
Contractorswithnotransportationorhaulingrelatedactivities
$5,000,000.00peroccurrence(CSL)
AnyAuto
BodilyInjuryandPropertyDamage
C. Workers’Compensation(WC)andEmployersLiability(EL)
RequiredforallContractorswithemployees
WC:StatutoryLimits
EL:$1,000,000.00peraccidentfor
bodilyinjuryordisease
D. ProfessionalLiability/Errors&Omissions
Includesendorsementsofcontractualliabilityanddefenseand
indemnificationoftheCounty
$5,000,000.00peroccurrence
$10,000,000.00projectaggregate
E. EndorsementsandConditions:
ADDITIONALINSURED:AllinsurancerequiredabovewiththeexceptionofProfessionalLiability,PersonalAutomobile
Liability,Workers’CompensationandEmployersLiability,shallbeendorsedtonameasadditionalinsured:Countyof
Alameda,itsBoardofSupervisors,theindividualmembersthereof,andallCountyofficers,agents,employeesand
representatives.
1. DURATIONOFCOVERAGE:AllrequiredinsuranceshallbemaintainedduringtheentiretermoftheAgreementwith
thefollowingexception:Insurancepoliciesandcoverage(s)writtenonaclaims‐madebasisshallbemaintained
duringtheentiretermoftheAgreementanduntil3yearsfollowingterminationandacceptanceofallworkprovided
undertheAgreement,withtheretroactivedateofsaidinsurance(asmaybeapplicable)concurrentwiththe
commencementofactivitiespursuanttothisAgreement.
2. REDUCTIONORLIMITOFOBLIGATION:Allinsurancepoliciesshallbeprimaryinsurancetoanyinsurance
availabletotheIndemnifiedPartiesandAdditionalInsured(s).PursuanttotheprovisionsofthisAgreement,
insuranceaffectedorprocuredbytheContractorshallnotreduceorlimitContractor’scontractualobligationto
indemnifyanddefendtheIndemnifiedParties.
3. INSURERFINANCIALRATING:InsuranceshallbemaintainedthroughaninsurerwithaminimumA.M.BestRating
ofA‐orbetter,withdeductibleamountsacceptabletotheCounty.AcceptanceofContractor’sinsurancebyCounty
shallnotrelieveordecreasetheliabilityofContractorhereunder.Anydeductibleorself‐insuredretentionamount
orothersimilarobligationunderthepoliciesshallbethesoleresponsibilityoftheContractor.Anydeductibleorself‐
insuredretentionamountorothersimilarobligationunderthepoliciesshallbethesoleresponsibilityofthe
Contractor.
4. SUBCONTRACTORS:Contractorshallincludeallsubcontractorsasaninsured(coveredparty)underitspoliciesor
shallfurnishseparatecertificatesandendorsementsforeachsubcontractor.Allcoveragesforsubcontractorsshall
besubjecttoalloftherequirementsstatedherein.
5. JOINTVENTURES:IfContractorisanassociation,partnershiporotherjointbusinessventure,requiredinsurance
shallbeprovidedbyanyoneofthefollowingmethods:
– Separateinsurancepoliciesissuedforeachindividualentity,witheachentityincludedasa“NamedInsured
(coveredparty),oratminimumnamedasan“AdditionalInsured”ontheother’spolicies.
– Jointinsuranceprogramwiththeassociation,partnershiporotherjointbusinessventureincludedasa“Named
Insured.
6. CANCELLATIONOFINSURANCE:Allrequiredinsuranceshallbeendorsedtoprovidethirty(30)daysadvance
writtennoticetotheCountyofcancellation.
7. CERTIFICATEOFINSURANCE:BeforecommencingoperationsunderthisAgreement,Contractorshallprovide
Certificate(s)ofInsuranceandapplicableinsuranceendorsements,informandsatisfactorytoCounty,evidencing
thatallrequiredinsurancecoverageisineffect.TheCountyreservestherightstorequiretheContractortoprovide
complete,certifiedcopiesofallrequiredinsurancepolicies.Therequirecertificate(s)andendorsementsmustbe
sentto:
– Department/Agencyissuingthecontract
–
WithacopytoRiskManagementUnit(125–12thStreet,3rdFloor,Oakland,CA94607)
EMSAmbulanceTransportProviderAgreement
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EXHIBITD‐DEBARMENTANDSUSPENSIONCERTIFICATION
1. ParamedicsPlus,LLC,underpenaltyofperjury,certifiesthat,exceptasnotedbelow,the
company,itsprincipal,andanynamedsubcontractor:
2. Isnotcurrentlyundersuspension,debarment,voluntaryexclusion,ordeterminationof
ineligibilitybyanyFederalagency;
3. Hasnotbeensuspended,debarred,voluntarilyexcludedordeterminedineligiblebyany
Federalagencywithinthepastthreeyears;
4. Doesnothaveaproposeddebarmentpending;and,
5. Hasnotbeenindicted,convicted,orhadaciviljudgmentrenderedagainstitbyacourtof
competentjurisdictioninanymatterinvolvingfraudorofficialmisconductwithinthepast
threeyears.
6. Ifthereareanyexceptionstothiscertification,inserttheexceptionsinthefollowingspace.

7. Exceptionsshallnotnecessaryresultindenialofaward,butshallbeconsideredin
determiningProposerresponsibility.Foranyexceptionnotedabove,indicatebelowto
whomitapplies,initiatingagency,anddatesofaction.
8. Providingfalseinformationmayresultincriminalprosecutionoradministrativesanctions.
TheabovecertificationispartoftheAgreement.SigningtheAgreementonthesignature
portionthereofshallalsoconstitutesignatureofthisCertification.
Name:
Signature:
Title:
Date://
EMSAmbulanceTransportProviderAgreement
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EXHIBITE‐COMMUNICATIONSEQUIPMENT
1.RadioEquipment:
1.1 ContractorshallpermanentlymountintoeachAmbulanceandoneachSupervisor
Vehicle,analoganddigitalcapable,700/800MHztrunkedmobileradiowithdual
controlheadsandatelephonestylemicrophoneinthepatientcompartmentwithan
externalantennamountedontheAmbulanceboxroof.Theseradiosshallhave
DUALTONE‐MULTIFREQUENCYcapabilitytoalerthospitalemergency
departmentradiosofincomingradiotraffic.Allmobileradiosshallbecompatible
withtheCounty’strunkedradiosystem(equivalenttoMotorolaAPX7500
(3600/9600)orbetter).
1.2 Contractor’sFieldPersonnelshallcarryanaloganddigitallycapable,700/800MHz
trunkedportableradiowithremotepublicsafetyspeakermicrophone.Allportable
radiosshallbecompatiblewithAlamedaCounty’strunkedradiosystem(equivalent
toMotorolaAPX7000(3600/9600)orbetter).
1.3 ContractorFieldPersonnelshallcarryCounty‐approvedradios,rebanding‐capable,
digitallyformattedandfullycompliantwithP‐25PhaseIandPhaseII(once
released)interoperabilitystandards.
1.4 Contractorshalloperatesubscriberradiosincompliancewithallrulesand
regulationsoftheFederalCommunicationsCommissionandAlamedaCounty.
1.5 ContractorshallequipallClinicalandOperationsFieldSupervisorVehicleswith
analog/digitalcapablemobileradioprogrammedforoperationontheCALCORD
(equivalenttoMotorolaAPX7500VHForbetter).
1.6 ContractorshallequipallAmbulancesandeachClinicalandOperationsField
SupervisorVehiclesusedinprovidingServicestotheCountywithradiosfor
communicationswithhospitalreceivingfacilitiesandforAmbulance‐to‐hospital
communications.
2. CellularPhones
Contractor'sSupervisorVehiclesshallbeequippedwithawirelesscellphonefordirect
landlinecommunicationswiththeBaseHospital,receivinghospitals,CountyDispatch
Centerandothernecessarypersonneloragencies.Cellularphoneorotherportable
EMSAmbulanceTransportProviderAgreement
PageE‐9of26
handhelddevicemustbecapableofreceivingemergencyresponsedatafromtheACRECC
pagingsystem.
3. 12LeadECGTransmission
Contractorshallinstall12‐Leadelectrocardiogram(“ECG”)monitorsincludingamodem
fortransmissioninallAmbulanceunits,ClinicalFieldSupervisorvehicles,andFRALS
apparatus(inaccordancewithEXHIBITM‐FIRSTRESPONDERSUPPORT),toallowtransmission
of12‐LeadECGstoreceivingfacilities..
EMSAmbulanceTransportProviderAgreement
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EXHIBITF‐RESPONSETIMESREQUIREMENTSANDFINES
ResponseTimefinesforCharlie,DeltaandEchoambulanceresponsesshallbeineffectonthe
ServicesStartDate.ResponseTimefinesforAlphaandBravoresponsesshallbeineffectsix
monthsaftertheServicesStartDate.
TableB‐ResponseTimeFinesbyCategoryandCompliance
Compliance:
CATEGORY:
89.5–<90%89‐<89.5%<89%
Echo$25,000.00 $35,000.00 $50,000.00
Delta/Charlie$15,000.00 $25,000.00 $35,000.00
Bravo/Alpha$5,000.00 $10,000.00 $15,000.00
TableC‐OutlierResponseTimesbyCategoryandSubareainMinutes&Seconds
Subarea:
CATEGORY:
Metro/UrbanSuburban/Rural Wilderness
Fine:
Echo12:45 21:00 27:00 $5,000.00
Delta15.45 24:00 33:00 $2,500.00
Charlie33:00 37:30 42:00 $2,500.00
Bravo33:00 37:30 42:00 $1,000.00
Alpha45:00 60:00 60:00 $1,000.00
TableA‐PersonnelandResponseTimeRequirements
MPDSDispatch
Category
SubArea:
Personnel
Configuration:
Metro/UrbanSuburban/RuralWilderness
Echo2Paramedics 08:30min. 14:00min. 18:00min.
Delta1Paramedic
1EMT 10:30min. 16:00min. 22:00min.
Charlie1Paramedic
1EMT 15:00min. 25:00min. 28:00min.
Bravo
2EMTs 15:00min. 25:00min. 28:00min.
Alpha2EMTs 30:00min. 40:00min. 40:00min.
EMSAmbulanceTransportProviderAgreement
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EXHIBITG‐PARAMEDICTRAININGREQUIREMENTS
1.AdvancedCardiacLifeSupport(ACLS)Certification‐AmericanHeartAssociationoran
approvedequivalent.
2.ECGTraining‐interpreting12‐LeadECGsforSTelevation
3.TraumaTraining‐PrehospitalTraumaLifeSupport(PHTLS)orInternationalTraumaLife
Support(ITLS)
4.PediatricEducation‐PediatricEducationforPrehospitalPersonnel(PEPP),Pediatric
AdvancedLifeSupport(PALS),orEmergencyPediatricCare(EPC).Contractorshallensure
thatallParamedicscompletethistrainingwithinsix(6)monthsofhirebyContractor.
5.CompanyOrientation‐Inadditiontoallotherrequirements,Contractorshallproperly
orientallFieldPersonnelbeforeassigningthemtorespondtoemergencymedicalrequests.
Suchorientationshallincludeataminimum,Contractor'spoliciesandprocedures;radio
communicationswithandbetweentheprovideragency,BaseHospital,receivinghospitals,
andCountycommunicationscenters;andAmbulanceandequipmentutilizationand
maintenance.
6.EMSOrientation‐ContractorshallensurethatallFieldPersonnelattendEMSorientation
sponsoredbyEMSonamonthlybasis.Thisorientationshallprovideanoverviewofthe
AlamedaCountyEMSsystem,reviewofEMSPolicies,documentationrequirements,and
CPRreview.
7.MCIResponse‐ContractorshalltrainallAmbulancepersonnelandsupervisorystaffin
theirrespectiverolesandresponsibilitiesundertheCountyMulti‐CasualtyIncidentPlanas
definedinEMSPolicies,andpreparethemtofunctioninthemedicalbranchoftheIncident
CommandSystem.ThespecificrolesoftheContractorandotherPublicSafetypersonnel
shallbedefinedbytherelevantplansandcommandstructure.
8.HomelandSecurity‐ContractorandContractor’semployeesshallparticipateinand
receivetraininginHomelandSecurityissues,includingparticipatinginexistingprograms
availablewithintheCountyfordealingwithterroristevents,weaponsofmassdestruction,
andotherHomelandSecurityissues.
9.AssaultiveBehaviorManagementTraining‐ContractorshallprovideAmbulance
personnelwiththetraining,knowledge,understanding,andskillstoeffectivelymanage
EMSAmbulanceTransportProviderAgreement
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patientswithpsychiatric,drug/alcoholorotherbehavioralorstressrelatedproblemson
anon‐goingbasis,aswellasdifficultscenes.Emphasisshallbeontechniquesfor
establishingaclimateconducivetoeffectivefieldmanagement,andforpreventingthe
escalationofpotentiallyvolatilesituations.
10.DriverTraining‐Contractorshallmaintainanon‐goingdrivertrainingprogramfor
Ambulancepersonnel.Theprogram,thenumberofinstructionhours,andthesystemfor
integrationintotheContractor'soperations(e.g.,accidentreviewboards,impactof
accidentsonemployeeperformancereviewsandcompensation,etc.)shallbereviewedand
issubjecttoapprovalbytheCountyinitiallyandonanannualbasisthereafter.Training
andskillproficiencyisrequiredatinitialemploymentwithannualtrainingrefresher
coursesandskillconfirmation.
11.InfectionControl‐Contractorshalldevelopaninfectioncontrolprogram,consistentwith
EMSPolicies,thatemphasizesaggressivehygienepracticesandproactivepersonal
protectiveequipmentdonning(e.g.eyeprotection,gloves,etc).TheContractorshall
developandstrictlyenforcepoliciesforinfectioncontrol,crosscontamination,andsoiled
materialsdisposaltodecreasethechanceofcommunicablediseaseexposureand
transmission.
12.ICSTraining‐AllfieldpersonnelmustcompletethefollowingIncidentCommandSystem
training:ICS100,200,700,and800.Coursesmaybecompletedthroughindependent
online‐learning;suchhasfreecoursesavailableontheFEMAwebsite.Additionally,ICS
300and400arerecommendedforSupervisorsandpersonnelwhoshallrespondtothe
CountyEmergencyOperationsCenter.
EMSAmbulanceTransportProviderAgreement
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EXHIBITH‐CONTRACTOR’SUSERFEES‐911SYSTEM
Effective11/1/2011
BundledBaseRate$1,560.17
Mileagepermile$35.90
Oxygen$117.63
*Treat,Non‐transportRate$433.39
*Treat,NonTransportFee‐shallbelimitedtopatientswhoreceiveamedicalintervention,such
asintravenousmedicationadministration,andsubsequentlyrefusetransport.Patient
assessment,includingECGmonitoring,doesnotconstitutetreatment.
EMSAmbulanceTransportProviderAgreement
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EXHIBITI‐MANDATORYDATAFIELDREQUIREMENTS
A. Locationofincident
B. Approximatetimeofpatientcontact
C. Patientname
D. Residence
E. Age
F. Weight
G. Generalassessment
H. Pastmedicalhistory
I. Historyofpresentillness/injury
J. Mechanismofinjury
K. Medications
L. Allergies
M. Physicalassessment
N. Vitalsigns(BP,Pulse,Respirations,Skinsigns,SpO2)
O. Treatmentadministered
P. Responsetotreatment
Q. Narrative
R. GlasgowComaScale
S. Signature/nameofpersoncompletingPCR
EMSAmbulanceTransportProviderAgreement
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http://www.co.alameda.ca.u
EXHIBITJ‐FIRSTSOURCEAGREEMENT
ContractoragreestoprovideAlamedaCounty(throughEastBayWorksandSocialServices
Agency),ten(10)workingdaystorefertoContractor,potentialcandidatestobeconsideredby
Contractortofillanyneworvacantpositionsthatarenecessarytofulfilltheircontractual
obligationstotheCounty,thatContractorhasavailableduringthelifeofthecontractbefore
advertisingtothegeneralpublic.ContractorshallalsoprovidetheCountywithspecificjob
requirementsforneworvacantpositions.Contractoragreestouseitsbesteffortstofillits
employmentvacancieswithcandidatesreferredbyCounty,butfinaldecisionofwhetherornotto
offeremployment,andthetermsandconditionsthereof,tothecandidate(s)restsolelywithinthe
discretionoftheContractor.
AlamedaCounty(throughEastBayWorksandSocialServicesAgency)agreestoonlyrefer
pre‐screenedqualifiedapplicants,basedonContractorspecifications,toContractorforinterviews
forprospectiveemploymentbyContractor(seeIncentivesforContractorParticipationunder
Contractor/FirstSourceProgramlocatedontheSmallLocalEmergingBusiness(SLEB)Website.
IfcompliancewiththeFirstSourceProgramshallinterferewithContractor’spre‐existinglabor
agreements,recruitingpractices,orshallotherwiseobstructContractor’sabilitytocarryoutthe
termsofthecontract,ContractorshallprovidetotheCountyawrittenjustificationofnon‐
complianceinthespaceprovidedbelow.
CompanyName:
ContractorsSignature:______________________________________________________________________________________
Title:
Date: / /
__________________________________________________________  Date://
(EastBayWorks/One‐StopRepresentativeSignature)
EMSAmbulanceTransportProviderAgreement
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EXHIBITK–TRANSITIONPLAN
April2010
AlamedaCountyBoardofSupervisorsawardsAgreement
BeginnegotiationswithACRECCforCommunicationsandDispatchservices
May2010
IdentifyParamedicsPlusOperationsFacilityinAlamedaCountyandbeginnegotiating
lease
MeetwiththeAlamedaCountyEMStodiscusstransitionandtonegotiatethefinalcontract
June2010
MeetwithNEMSAtodevelopanagreementtogetformonthlyupdateon#ofduespaying
members
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
July2010
CompletenegotiationswithAlamedaCountyFDforCommunicationsandDispatchservices
SchedulemeetingswiththecurrentAlamedaemployees.Theseinformalmeetingsare
designedtoquellanyrumorsandprovideemployeeswithusefulandfactualinformation
aboutthetransitionandensureasmoothchangeover.
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
August2010
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ScheduleameetingwiththeEMSMedicalDirectorandParamedicsPlussenior
managementteamtoensurethatourtransitionplancoversallclinicalissuesandconcerns.
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
September2010
RelocationofChiefOperatingOfficerbeginningSeptember1,2010
ExecuteagreementwithACRECCforCommunicationsandDispatchservices.Thisshould
includethefollowingitems.
o ACRECCtohiredispatchers4‐6monthsinadvancefortraining
o ParamedicsPlustoparticipateonACRECCTechnical/Operationssubcommittee
o ParamedicsPlustosecurevotingmembershiponAdvisoryCommittee
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
Formemployeeworkgroupsfor
o Equipmentlayoutinambulances
o OperationsFacilityprocessmanagement
o EMSWarehouselayoutandprocessmanagement
o Satellitestationlocations,layoutandprocessmanagement
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
FinalizeandexecuteParamedicsPlusOperationsFacilityleaseandbeginlease‐hold
improvements.
October2010
Establishane‐mailbasedmethodofcommunicationwiththeincumbentworkforceand
othersystemstakeholders.Thepurposeofthesecommunicationswillbetomanage
rumorsandprovideinterestedpartieswithinformationaboutthenewsystemandthe
transition.
EMSAmbulanceTransportProviderAgreement
PageE‐17of26
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
November2010
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
December2010
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
January2011
ObtainappropriateCityBusinessLicense
Placeorderswithvendorsforcapitalequipmentincludingambulancesandothersupport
vehicles
Setmeetingdates,timesandlocationstobeginmeetingwithincumbentleadership
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
February2011
Conductmeetingswithincumbentleadershiptohaveopendialogueregardingconcerns
fromworkforce,discussionaboutParamedicsplusphilosophyandculture,andsetoneon
onemeetingdatestodiscussindividualtransitionstoParamedicsplus
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
March2011
OngoingmeetingswiththeAlamedaCountyEMS,ParamedicsPlusseniorleadership
includinghumanresourcesandrepresentativesfromtheuniontoadjustandfinalizethe
activitiesandtimelineforstartuportakeoverofoperation
BeginmeetingwithallFireAgenciestodevelopMutual‐AidAgreements
Monthlymeetingwithincumbentleadershiptodeveloptransitionplans
Schedulemeetingwiththeincumbentprovider’smanagementteamtofinalizethe
transitionplan.
FollowupmeetingwiththeSystemMedicalDirectorandParamedicsPlussenior
managementteamtoensurethatourtransitionplancoversallclinicalissuesandconcerns.
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
MonitorReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
April2011
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
Initialdeliveryofcapitalequipmentandvehicles
BegininstallationofePCRsystem
o WorkingbothwithEMSITandACRECCIT
Obtainthefollowinginsurances:
o AutomobileLiability
EMSAmbulanceTransportProviderAgreement
PageE‐18of26
o ListofvehiclesbyVIN,modelandyear
o Originalcostofvehicle
o Listofalldrivers
Begintesting,installationandcheck‐offofallequipment
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
May2011
CompleteoutfittingofallEMSvehiclesandprepareforAlamedaEMSandCHPinspection
Beginestablishingmethodsandprocessesofthedaytodaybusinessandoperation
includingthefollowing:
Obtainthefollowinginsurances:
o ProfessionalLiabilityandCommercialGeneralLiability
o CommercialUmbrellaLiability
o AutomobileLiability
o ListofvehiclesbyVIN,modelandyear
o Originalcostofvehicle
o Listofalldrivers
Workers’Compensation
o Numberofemployeesbyjobclassification
o Addressofeachlocationandnumberofemployeesateachlocationbyjob
classification
AllNewEmployeesfromIncumbentProvider‐Totalwagesbyclassification
EmployeeInsurance
o Clarifycoveragedetailsformedical,dental,visions,ShortandLongTermDisability,
AD&D,LifeandEAP
o Numberofemployeesbygender
Totalwages
o Establishemployee401(k)program
o Establishpayrollsystem
Establishaccountspayablesystembyvendor
o Completecreditapplicationprocess
o GeneralLedgeraccountsforfinancials
Focusonemployeeneeds.Scheduleemployeemeetingsoverthreeconsecutivedaysto
allowallemployeestheopportunitytoattend.Duringthismeetingwewill:
o HaveallemployeescompleteaParamedicsPlusapplication
o Haveallemployeescompletedrugscreenapplication
o Haveallemployeescompletedrugscreenon‐sitebyutilizingamobiledrug
screeningunitorotherapprovedmobilecollectionpersonneloragency.
o Obtaincopiesofallemployeecertifications
o Obtaincopiesofalldriverslicensesandsocialsecuritycards
o CompleteI‐9andEEOdocumentation
o CompleteW‐4forms
o Completeinsurancecoverageforms
o Distributepolicyandproceduremanualswithsignedacknowledgmentofreceipt.
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
BegindevelopmentofanEmergencyOperationsPlan
EMSAmbulanceTransportProviderAgreement
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BegindevelopmentofQualityManagementPlan
BegindevelopmentofCISMPlan
June2011
FinalizeallFireAgencyMutualAidAgreements
MeetwithCaliforniaHighwayPatrolandAlamedaEMStolicenseallvehicles
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
July2011
Employeeorientationsbegin
o PoliciesandProcedures
o ePCRsystem
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
August2011
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
MeetwithNEMSAformonthlyupdateon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
SubmitanEmergencyOperationsPlan
SubmitQualityManagementPlan
SubmitCISMPlan
Submitcontrolledsubstancespolicy
September2011
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
October2011
MonthlyParamedicsPlus/AlamedaEMSPlanningandTransitionMeeting
Finalcheck‐offofentireProjectPlanforcompletion
ReviewmonthlyupdatefromNEMSAon#ofduespayingmembers
ReceivemonthlyEMSdatadumpstomonitorresponsevolumesthroughoutCounty
November1,2011Start‐up
ParamedicsPlusbeginsoperations

EMSAmbulanceTransportProviderAgreement
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EXHIBITL‐COMMUNITYEDUCATIONPROGRAM
1. Contractorshallprovideacommunityeducationprogram,basedontheneedsofthe
communityasdefinedbytheCountyandEMS.Thecommunityeducationprogramshall
containsomeorallofthefollowing,whichmaychangefromtime‐to‐timeascommunity
needschange:
2. Contractorshallannuallyundertakeatleastoneprojectthatshalldemonstrablyimprove
thehealthstatusinthecommunity.
3. Healthstatusimprovementprogramstargetedto“atriskpopulations”mayincludebutare
notlimitedto:
a. Seatbeltuse
b. Bikesafetyprogram
c. ParticipationinNTHSAsafecommunitiesprogram
d. CPRtraining
e. 911awareness
f.Gunsafety
g.Huntingsafety
h. Drowningprevention
i. Equestrianaccidentprevention
j. Seniorsafetyprogram
k. Homehazardinspectionprogram.
l. ChildPassengerSafetyProgram:
Contractorshallimplementachildpassengersafetyprogram(CPS)inAlameda
County.Theprogramshallincludethepurchaseanddistributionofcarseatsto
targetedpopulations,asdefinedbyEMS.
Within18monthsofEffectiveDateaminimumof:
– onememberoftheContractorstaffshallearninstructorstatusinthe
NationalChildPassengerCertificationProgramandshallbeginofferinga
EMSAmbulanceTransportProviderAgreement
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two‐hourintroductoryCPScourseaspartoftheorientationprocessforall
FieldPersonnel.
– twomembersoftheeducationstaffshallearnNationalChildPassenger
CertificationthroughtheNationalHighwaySafetyAdministration’s
curriculum.
ContractorshallofferCPSclassestothecommunityatnocost.Contractorshall
provideatleastoneprogramayearineachcityintheEOAincluding
unincorporatedareas.
Contractorshallmeasuretheeffectivenessofthechildpassengersafetyprogram
bymonitoringtheincreasedincidenceofchildrestraintuse.StateorCounty
observationstudiesshallbeutilizedtoprovideunbiaseddocumentation.
Contractorshallsetagoalofcontributingtoa1%increaseeachyearinchild
passengerrestraintusagefortheCounty.
m. GunSafetyProgram:
ContractorshallbringEddieEaglegunsafetyprogramtoAlamedaCounty
childrenfrompre‐Kthroughthirdgrade.Thisprogramshallfocusonteaching
youngchildrenwhattodowhenconfrontedwithafoundgun.
ContractorshallpartnerwithAlamedaCountyelementaryschoolsandday‐care
centerstoprovidethisprogramatnocosttothefacility.
Contractorshallcompilecomparativestatisticsregardingfirearmtraumato
childrenages10andyoungertotracktheeffectivenessofthisprogram.
EMSAmbulanceTransportProviderAgreement
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EXHIBITM‐FIRSTRESPONDERSUPPORT
1. Inadditiontothemonetaryprovisionforfirstrespondersupport,Contractorshallprovide
thefollowingequipment(orsimilarequipmentsubjecttomutualagreementwiththeFirst
ResponderAgencies)foreachFirstResponderapparatusoperatingwithinCounty,
includingContractingCitiesinZone1,aswellasforContractor’sClinicalFieldSupervisor
andOperationalFieldSupervisorVehicles:
1.1 RuggedmobilepersonalcomputersandsoftwareforthePCRsystemforeachFirst
Responderunitapparatus,includingupdateswhenrequiredformaintenanceof
compatibilitythroughouttheEMSsystem.
1.2 ITsupportforFirstRespondercomputersin#1above.
1.3 Ninety90LIFEPAK15monitor‐defibrillatorsincludingamodem(byVelocitor)for
transmissionof12‐leadECG’sforeachunit;aswellasasufficientdataplanthatcan
accommodateandsupportthisprocess.Contractorshallholdinreserve10
additionalmonitor‐defibrillatorstobedistributedasneededatContractor’s
discretion.
1.4 Ninety90Physio‐ControlChestCompressionSystemLUCASdevices.Contractor
shallholdinreserve10additionaldevicestobedistributedasneededat
Contractor’sdiscretion.
2. Contractorshallretainownershipofandberesponsibleformaintenanceoftheabove‐
listedequipment.
3. ContractorshallalsoprovideEMScontinuingeducationforallAlamedaCountyFirst
Responseagencies,regardlessofinclusionintheEOA.Recognizingtheinherentdifficulties
insendingFirstResponseagencypersonneltoContractor’slocation,continuingeducation
shallbemadeavailableatFirstResponseagenciesthroughContractorsfourclinical
educationcoordinators.Fornewfireemployees,collaborationwithFirstResponder
Agenciesshallalsoincludefieldinternships,ridingonAmbulancesandworkingwith
Contractor’sfieldtrainingofficersforinitialsystemtraining.
EMSAmbulanceTransportProviderAgreement
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EXHIBITN‐HIGHRISKPATIENTDESCRIPTION
“AHigh‐RiskPCR”isapatientcarereportforaHigh‐RiskPatient.AHigh‐RiskPatientis
definedasfollows:
1. STEMI(ST‐ElevationMyocardialInfarction)patienttransportedtoanyhospital,includinga
CardiacReceivingCenter,perEMSPolicies
2. CVA(Cardio‐VascularAccident)patienttransportedtoanyhospital,includingaStroke
Center,perEMSPolicies
3. CriticalTraumaPatientwithatraumaactivation,perEMSPolicies
4. Anypatientnotbreathingorbreathingineffectively(Echocall)
5. Anyemergent(lightsandsiren)returntothehospital
6. Anypatient(otherthana5150patientwhohasbeenmedicallycleared)whoisunable,for
anyreason,toprovideahistory
7. Anypatientaged10orless
EMSAmbulanceTransportProviderAgreement
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EXHIBITO‐ProposalofParamedicsPlus
(Appendices1‐56incorporatedbyreference,butnotattached)

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