Loading...
HomeMy WebLinkAbout09226 ORDINANCE NO. 9226 AN ORDINANCE APPROVING AN AMBULANCE SERVICE AGREEMENT BETWEEN THE CITY OF PUEBLO AND AMERICAN MEDICAL RESPONSE OF COLORADO, INC. WHEREAS, in order to assure that residents and visitors within the City limits receive the most efficient, cost effective and highest quality ground emergency ambulance service, the City is entering into this Ambulance Service Agreement for the protection of the health and safety of the residents and visitors and establishment of an efficacious and monitored ground emergency ambulance service provided by a competitively selected, qualified ambulance service provider. WHEREAS, Operator is experienced in the provision of ground emergency ambulance services and was the responsible bidder whose proposal was determined by City to be most advantageous to the City pursuant to the Request for Proposal for the procurement of the requested services. NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF PUEBLO, that: SECTION 1. The Ambulance Service Agreement by and between Pueblo, a Municipal Corporation, and American Medical Response of Colorado, Inc., a true copy of which is attached hereto and incorporated herein by reference (the “Agreement”) having been approved as to form by the City Attorney, is hereby approved. SECTION. 2. The City Council President is hereby authorized to execute said Agreement on behalf of Pueblo, A Municipal Corporation, and the City Clerk shall affix the seal of the City thereto and attest the same. SECTION 3. The officers of the City are directed and authorized to perform any and all acts consistent with the intent of this Ordinance and the attached Agreement to effectuate the policies and procedures described therein. SECTION 4. This Ordinance shall become effective immediately upon final passage. INTRODUCED January 8, 2018 BY: Ed Brown MEMBER OF CITY COUNCIL APPROVED: PRESIDENT OF CITY COUNCIL ATTESTED BY: ACTING CITY CLERK PASSED AND APPROVED: January 22, 2018 City Clerk’s Office Item # R-4 Background Paper for Proposed Ordinance COUNCIL MEETING DATE: January 8, 2018 TO: Members of City Council CC: Sam Azad, City Manager VIA: Brenda Armijo, Acting City Clerk FROM: Shawn Shelton, Fire Chief – Fire Department SUBJECT: AN ORDINANCE APPROVING AN AMBULANCE SERVICE AGREEMENT BETWEEN THE CITY OF PUEBLO AND AMERICAN MEDICAL RESPONSE OF COLORADO, INC. SUMMARY: The attached agreement authorizes the City to enter into this Ambulance Service Agreement for the protection of the health and safety of the residents, visitors, and establishment of the City of Pueblo. PREVIOUS COUNCIL ACTION: Approval of Addendum No. 1, Addendum No. 2, and Addendum No. 3, and Addendum No. 4. BACKGROUND: st This ground ambulance service agreement is to be entered into on the 1 day of February 2018 between the City of Pueblo and American Medical Response of Colorado and will be enforced for st a period of sixty months concluding on January 31 2023 unless further modified. American Medical Response shall provide Emergency Medical Transport Services twenty-four hours a day, seven days a week, three hundred and sixty-five days a year for all dispatched emergency medical calls without regard to the patient’s ability to pay. FINANCIAL IMPLICATIONS: This agreement calls for American Medical Response to reimburse the City of Pueblo $471,000 per year. City staff time to manage and monitor the contract will be required. BOARD/COMMISSION RECOMMENDATION: Not applicable. STAKEHOLDER PROCESS: Not applicable. ALTERNATIVES: If the agreement is not approved, the alternative is to extend the old contractual agreement through addendum. RECOMMENDATION: Approval of the Ordinance. Attachments: Ambulance Service Agreement AMBULANCE SERVICE AGREEMENT This Ambulance Service Agreement("Agreement") is entered into this 1st day of February 2018 by and between Pueblo, a municipal corporation ("City"), and American Medical Response of Colorado, Inc., a Colorado corporation("Operator"). RECITALS WHEREAS, in order to assure that residents and visitors within the City limits receive the most efficient,cost effective and highest quality ground emergency ambulance service,the City is entering into this Agreement for the protection of the health and safety of the residents and visitors and establishment of an efficacious and monitored ground emergency ambulance service provided by a competitively selected, qualified ambulance service provider. WHEREAS, Operator is experienced in the provision of ground emergency ambulance services and was the responsible bidder whose proposal was determined by City to be most advantageous to the City pursuant to the Request for Proposal for the procurement of the services herein described. NOW, THEREFORE, in consideration of the foregoing recitals and the mutual promises and covenants contained herein,and other good and valuable consideration,the receipt and sufficiency of which is hereby acknowledged,City and Operator agree as follows: TERMS AND CONDITIONS 1.0 DEFINITIONS. The following terms as used in this Agreement shall have the following meaning unless the context clearly indicates otherwise: (a) "ALS" means Advanced Life Support. (b) "EMS Services"means all ground emergency ambulance services and related services in the City limits to be provided by Operator under this Agreement for emergency medical dispatches through the PSAP. (c) "Fire Chief' means the Fire Chief of the Department of Fire of City. (d) "PFD" means the Department of Fire of City. (e) "PSAP"means the Public Safety Answering Point operated by and for the City. 2.0 TERM OF AGREEMENT. The term of this Agreement shall be for a period of sixty (60) months,commencing on February 1, 2018,at 12:00 a.m. and terminating on January 31,2023 at 11:59:59, unless earlier terminated under this Agreement, or otherwise modified by mutual written agreement of the parties. The City shall have the unilateral right,upon thirty(30)days written notice to Operator,to extend this Agreement for up to one hundred and twenty(120)days beyond the end of the Term. 3.0 OPERATOR'S PERFORMANCE OBLIGATIONS. 3.1 Operator shall provide EMS Services twenty-four hours a day, seven days a week, three hundred sixty-five days a year for all emergency medical calls dispatched through the PSAP and requested by City. Operator's response shall be without regard to the patient's ability to pay. 3.2 Operator shall provide EMS Services in a timely manner and shall comply with all response time requirements as set forth in Exhibit"A"which is attached hereto and made a part of this Agreement. 1 3.3 Operator's provision of EMS Services shall conform to the highest clinical and professional standards. Operator shall comply with all applicable City, county, state, and federal laws,regulations and standards regarding the provision of Services. All persons employed by Operator shall be competent in the performance of their duties,and hold and maintain applicable and valid certificates/licenses/accreditations in their respective roles or profession. Operator shall be held accountable for employee performance, licensing, and actions. Operator shall conduct,comply with, cooperate with, and submit to individual and corporate investigations requested by the City. 3.4 Operator will provide field medical supervision necessary for effective oversight of EMS Services. Such supervisors shall have current credentials and certifications, as well as clinical field experience as necessary to oversee or provide support to field personnel.Such supervisors shall serve as the liaisons with the PFD. 3.5 Operator shall staff ambulance crews to provide continuity of personnel. Operator shall staff each ambulance with at least one(1)EMT-Basic or above and one(1)EMT-Paramedic.Both must be emergency vehicle operator course(E.V.O.C.)qualified drivers.When ALS care is being rendered, at a minimum the EMT-Paramedic (an EMT-Intermediate may also attend an ALS patient at the direction of an EMT- Paramedic) must always be with the patient in the patient compartment. During the initial six (6) month period of the Agreement, Operator may utilize provisionally certified personnel on transporting ambulances. Following this phase-in period, no more than 20% of Operator's workforce shall be provisionally certified at any one time. Within six (6) months of the date of execution of the agreement, and thereafter within six(6)months of any new employee's hiring date, all ALS ambulance personnel shall obtain and maintain current status in the following: (a) Advanced Cardiac Life Support (ACLS), (b) Pediatric Advanced Life Support(PALS),(c)Incident Management System(IMS)training and certification for line personnel: ICS 100, 200 and N1MS 700, 800, (d) Additional IMS training and certification for supervisors: ICS 300, (e) PFD Rehabilitation training in accordance with NFPA 1584, (f) E.V.O.C. or equivalent,(g)CPR,(h)Colorado State EMT certification. Additionally, field supervisors shall be training to Hazmat operations level. 3.6 Operator must ensure that all employees have been properly oriented before being placed on dedicated 9-1-1 ambulances.The orientation shall include but not be limited to:overview of the City's EMS system applicable policies, procedures, orders, and guidelines; all communications; navigation, mapping, hospital routes;and ambulance equipment utilization and maintenance;and knowledge of relevant City and PFD policies and procedures. Orientation curriculums will be a joint venture between Operator and PFD. Operator must maintain documentation of compliance with these requirements 3.7 Operator's ambulance personnel shall at all times wear clean, professional uniforms. Name and level of training shall be identified as part of the uniform for all personnel. Operator acknowledges that EMS Services are often rendered under extremely stressful circumstances. Professional and courteous conduct and appearance is required at all times from Operator's personnel. 3.8 Operator shall assure that its EMTs, and Paramedics, who are assigned to the ambulances, are in compliance with all continuing permits, licenses, certifications and educational requirements. Such educational requirements shall include mandatory training required by the City,the City's Medical Director, or the State of Colorado.Operator shall provide to the City the name,title,reporting relationship and limits of authority for the senior executive who will serve as Operator's primary contact person with the City. 3.9 All 9-1-1 calls, including 10-digit emergency calls, within the City limits are routed through the City of Pueblo PSAP. If Operator receives a direct line call for emergency response, Operator will immediately process the call through the Pueblo Dispatch Center. The City currently uses an informal Priority Dispatch System to assign a response determinant and dispatch response units according to established guidelines. Operator will provide a dispatcher on an assigned channel for purposes of dispatching the dedicated 9-1-1 Operator ambulances.Operator shall provide continuous monitoring of the dedicated channel and shall institute internal dispatch and monitoring procedures as required to meet the response time requirements as set forth in this Agreement. The City at its sole discretion will assign the 2 response determinant of all requests for service processed through the City dispatch center. Operator shall begin to respond to the scene when requested by City dispatch, electronically, by radio, or by telephone. Operator shall respond as directed by the Pueblo Dispatch Communications Center. There may be prearranged protocols implemented,if both Operator and the PFD agree.At such time as the City requests, Operator will assign a unit number and designator to each ambulance unit which will allow them to interface with City's dispatch system. Operator ambulances shall remain on the assigned incident talk group and receive instructions from dispatch, the first due fire company officer or the incident commander. Ambulances are considered a resource assigned to the incident and are under the command and control of the PFD incident commander. Additionally, Operator agrees to provide at their expense an electronic link to the City's automated dispatch system currently provided by U.S. Digital Design (USDD) of Phoenix Arizona. This system will serve as the primary alerting system between the City's dispatch center and Operator's dispatch center. Prior to installation, the electronic link, including all network and security equipment and protocols necessary to implement the electronic link, must be approved by City. The electronic link shall be maintained and serviced solely by City,and Operator shall be obligated to reimburse City for all costs necessarily incurred by City in maintenance and service of the electronic link. Failure or disruption of the electronic link shall not otherwise relieve Operator from its performance obligations including response times when Operator is notified of the call and provided the address necessary to respond to the call. As an alternative to the aforementioned USDD communications link, Operator may negotiate with the City to embed Operator personnel in the City dispatch center. Accommodating the Operator staff in the City's dispatch center is at the sole discretion of the City. Operator crews shall announce on the PFD assigned radio channel when they are responding and the time they arrive at their assigned location. If the Operator responding unit has reason to believe there will be an extended response time, that information shall be broadcast as well. When transporting a 9-1-1 patient, Operator crews shall announce verbally on the PFD assigned radio channel when they leave the scene.They shall provide PFD dispatch with their unit number and destination. All radio communications with the Pueblo Dispatch Communications Center and PFD shall include the ambulance's unit number. 3.10 Operator's communications systems, including radios and other future communications system components, will fully interface with the radio and telephone systems within the City. For crew safety and continuity of patient care,Operator's ambulances shall have the following communications devices which interface with City dispatch: a minimum of two (2) Portable and one (1) mobile 800 mhz radios per ambulance,and at such time as requested by the City, AVL,CAD to CAD interface, and Status Heads. In the event of any future system enhancements, Operator agrees to maintain at Operator's expense, full interface with such future system as the City,at City's sole discretion, may institute. 3.11 Operator will actively participate with the City's dispatch center to improve service to the community.Participation will consist of assuring an Operator representative is available to attend meetings and provide data as requested for the purpose of continuing quality improvement. 3.12 Operator will provide at its expense AVL software and hardware on its ambulances that interfaces with the City's CAD system. The City is moving to an AVL system for their apparatus, once available the City and Operator shall work together to establish constant visibility of PFD and Operator resources to ensure that system resources are appropriately deployed to maximize efficiencies, decrease costs, and improve response times. The City and Operator shall share electronically (via interface) each other's computer aided dispatch data ("CAD"), automatic vehicle locator("AVL"), and vehicle status updates in real time for all system resources. For clarity, all Operator resources and all PFD engines are ALS while PFD trucks are BLS, unless indicated otherwise in the real-time shared CAD data. The City will continue to send real-time incident information to OPERATOR via the CAD to CAD link for all incidents where Operator is requested to respond.The parties will synchronize CAD clocks to atomic time at least on a daily basis. Until such time that the city resources are equipped with AVL, Operator shall share their AVL data with the City through the SunGuard CAD system. Both parties shall provide technological resource(s) to facilitate the foregoing CAD and/or AVL interface.In the event the technology is not ready due to the City's inability to comply with the foregoing CAD and/or AVL interface, the Operator will not be required to 3 meet the previous section until The technology is available and Operator has enough time as is customary in the industry to repair and implement such changes. 3.13 Operator shall provide sufficient 9-1-1 ambulance response vehicles to meet all EMS Services to be performed under this Agreement, including a reserve capacity to cover maintenance, break-downs or exceeding peak service demands. For purposes of the following requirements, the term "ambulance" shall apply to both ALS and Quick Response Vehicles(QRV)ambulances. (a) Ambulances must meet all applicable federal, state and local requirements and it shall be the responsibility of Operator to assure appropriate certifications from ambulance manufacturers and to assure that all ambulances are operated within federal (U.S. Department of Transportation), state and local laws,regulations and guidelines,including any Pueblo County local guidelines and/or requirements. (b) Guidelines shall include all applicable limitations on gross vehicle weight. (c) Each Operator ambulance must be an ambulance that meets or exceeds Colorado state and Pueblo County requirements for ambulances providing ALS services or, as applicable, the requirements and/or specifications for QRVs,as provided by applicable laws,regulations,and guidelines, and as mutually agreed upon between the City and Operator. QRV's shall, at a minimum,maintain the specifications and equipment set forth in Exhibit"E"to the Agreement. (d) Each ambulance of Operator must have a patient compartment for two(2)patients,and two(2) care givers. In the front seat area, all ambulances must be able to accommodate one(1) family member of a patient (in the front passenger seat) and an Operator employee, as driver. Additionally,each ambulance should be equipped for the transport of a small child with a child safety seat or other industry standard device.Except in the case of a legitimate health or safety concern a family member must be allowed to accompany the patient in the ambulance. (e) An ambulance unit's service shall not have more than 200,000 total miles in service. (f) Reserve or temporary replacement units shall not stay in front line regular 9-1-1 response service for any consecutive period longer than ninety(90)days unless otherwise permitted by the City due to an exceptional circumstance. (g) Operator shall monitor, through their established maintenance program, the condition, safety and reliability of all dedicated ambulances. Dedicated ambulances that accumulate 200,000 miles or reach sixty (60) months in total service time shall be replaced at Operator expense. Additionally, the City may approve for service an ambulance re-certified by Pueblo County if it is in good working order. The City shall not unreasonably withhold such approval; of any EMS Ambulance with mileage in excess of the mileage cap if Operator has replaced the engine, transmission,and performed overhauls of parts as necessary for the safe and effective operation of the ambulance. Operator will allow the City's mechanic to inspect any Ambulance that Operator wants re-certified. (h) Operator has one hundred twenty(120)days from the date of either mileage or age occurrence to replace the identified ambulance. (i) Operator shall provide a minimum of one bariatric ambulance. 3.14 While on or enroute to any scene, Operator's employees shall operate under the PFD's command and control structure and policies.The PFD company officer,or his/her designee,has ultimate authority for command and control; whenever there is a question as to medical treatment of a patient,the final decision shall be made by the first EMT-Paramedic to make patient contact or on-line medical control. PFD paramedics and EMTs shall ride in/attend to the hospital any patient,at any time,when medically necessary, to include but not limited to patient continuity of care and assistance in administering patient care.Clinical practices of Operator will be subject to the direction of the Medical Director. Medical training, beyond the minimum required by the Medical Director, will be at the sole discretion of Operator. The parties shall follow applicable laws, regulations and protocols regarding scene management. Personnel shall enter the scene upon arrival except when an immediate hazard is identified, or the law enforcement or ranking fire officer on-scene advises the scene is not safe for agency personnel. Patient care management shall be 4 defined by the Medical Director, through the county emergency medical guidelines or its successor document. 3.15 Operator shall develop and conduct a comprehensive quality assurance/quality improvement (QA/QI) program. Operator's QA/QI program shall interface, and work collaboratively with, the PFD's QA/QI program. The QA/QI program will be an organized,coordinated,multidisciplinary approach to the assessment of pre-hospital emergency medical response and patient care for the purpose of improving patient care services and outcomes. The QA/QI program should not be limited to clinical functions. Response times, customer satisfaction/complaints, system integration, performance measurement, identifying areas of improvement, and identifying methods to implement and evaluate changes should all be included. The Parties shall meet monthly to discuss clinical matters and shall have joint quarterly trainings. 3.16 Upon request by the City,Operator shall furnish courtesy stand by service at emergency incidents involving a potential danger to City personnel or the public at no charge to the City. Once dedicated to an incident, the Operator's ambulance shall not be removed from the incident until released by the incident commander. On prolonged incidents, the standby crew will also provide support for the on-scene rehab division. 3.17 The City and Operator recognize that differences of opinion may arise during the delivery of Services under this Agreement.The parties shall develop and maintain a written conflict resolution process. Such process shall include methods and means to address medical procedural issues, inappropriate and/or illegal conduct, and any other operational issues. In the event of an impasse the Fire Chief in his sole discretion shall settle all disputes. 3.18 The City and Operator each provide medical direction services applicable to their respective roles in the service model.The City and Operator shall reasonably cooperate to utilize the same Medical Director to provide unified medical supervision, to promote consistency in medical supervision and to achieve efficiencies and synergies in the provision of medical supervision. In the event of an impasse on this decision the Fire Chief in his sole discretion shall settle all disputes. 3.19 Request for lift assists by the Operator will only be accommodated by the City when (3) or more Operator's personnel are on scene and participating in the lift assist. 3.20 Operator will bring all necessary equipment to the patient,appropriate for the examination,based on the initial complaint reported. 4.0 PERFORMANCE SECURITY AND LIQUIDATED DAMAGES. 4.1 Operator shall provide to the City an automatically renewable,irrevocable Performance Bond or a Letter of Credit("Performance Security")in a form and substance acceptable to the City.Such Performance Security will expressly provide for the direct draw by the City and the restriction of rights of both Operator and the provider of the bond to object and/or to refuse to honor a demand for payment by the City. The Performance Security is attached hereto as Exhibit"C" and made a part of this Agreement. The amount of the Performance Security will be one million dollars ($1,000,000.00). The Performance Security shall be issued by a federally insured (FDIC) banking institution and/or surety, authorized to do business in Colorado,with a substantial presence in the United States,having a rating acceptable to the City.The City may accept a letter of credit, as a substitute for the surety bond herein required; provided, however, that such letter of credit shall be in a form acceptable to the City in its sole and absolute discretion. Operator shall maintain the Performance Security and the provider of the Performance Security will agree to renew the Performance Security throughout the term(s) of this Agreement and for a reasonable time thereafter. Operator shall ensure that written evidence of the Performance Security provided to the City is updated at least annually. 5 4.2 The parties agree that the failure to comply with performance requirements will result in damages to the City and that determining actual damages caused by some failures would be difficult or impractical. Therefore,the parties agree that the liquidated damages as set forth in the attached Exhibit"D" and made a part of this Agreement are not a penalty but are reasonable estimates of actual damages that will occur. Payment of liquidated damages will be due thirty (30) days from the date of invoice. If payment is not received within thirty(30)days from the date of the City's invoice,such invoice shall be considered a notice of default, and the City may thereafter withdraw such invoiced amount from the Performance Security. Assessment and collection of liquidated damages does not limit the City's rights or ability to exercise any other remedy provided in this Agreement or in law or equity. 4.3 The City and Operator agree that the unique nature of the EMS Services which are the subject of this Agreement require that in the event of Operator's material default leading to termination of this Agreement by the City, liquidated damages shall be awarded in the amount of the Performance Security. While costs and damages are not easily calculated,the work and expense to achieve another agreement and to conduct an RFP process is extensive. It may be difficult to distinguish the costs of restoration of the EMS Services on an interim or permanent basis and award a new contract. Costs to the City to implement the restoration of the EMS Services on an interim or permanent basis and award a new contract are estimated to equal the Performance Security. Upon declaration by the City of a termination of the Agreement, the City shall take immediate possession of the Performance Security and all of Operator's rights and interest in and to the Performance Security shall be waived as a liquidated damage to offset the City's expense in providing interim services.The City's draw of the Performance Security under this section shall not act as a bar or limitation on the City's ability to seek other remedies or to recover additional damages from Operator as a result of the material default and termination of the Agreement. 5.0 UTILIZATION. Provided Operator is in compliance with the terms and conditions of this Agreement and unless expressly authorized otherwise under the terms of this Agreement, City shall exclusively use Operator to provide EMS Services in the City limits. In events where the Operator has an extended response or is at level zero (no available units) the City may at its sole discretion request an ambulance from any other source available. 6.0 REIMBURSEMENTS TO CITY. The City will incur various costs related to Operator's rendition of EMS Services as identified in the Fee Schedule attached hereto as Exhibit"B"and made a part of this Agreement("City's Annual Costs"). Operator shall reimburse the City for City's Annual Costs. If, during the term of this Agreement, the City pays for additional costs associated with the rendition of the EMS Services by Operator, such costs may be added to Exhibit "B" by mutual written agreement of the parties. The reimbursements provided for hereunder shall not violate 42 U.S.C. Section 1320a-7b (the federal Anti-Kickback Statute. Moreover, the City represents that its actual costs incurred for its services provided hereunder will be greater than the reimbursements from Operator. Accordingly, the City shall review its incurred costs annually and shall provide adjustments, as necessary, to assure that the total amount of reimbursements by Operator does not exceed the City's actual costs for the services it provides. Operator shall pay one twelfth of the reimbursement of the City's Annual Costs each month. The monthly reimbursement payment shall be due on the first day of each month that this Agreement is in effect. Reimbursements not received by the City by such due date accrue interest at a rate of 8%per annum until paid. The City shall be entitled to annual increases in the total amount reimbursed for City incurred costs, as more particularly described in Exhibit"B." 7.0 OPERATOR PROVIDED EQUIPMENT,MATERIALS AND SUPPLIES. 7.1 The City will not provide any equipment, materials and/or supplies for use by Operator without reimbursement. 7.2 Operator is required to use the same or similar medical equipment with the same capabilities as used by the PFD. If the PFD anticipates an equipment change or addition, Operator will be provided a sufficient time frame to implement the change. Operator shall maintain detailed lists of equipment, 6 materials and supplies and shall provide for the management and replacement of its equipment, materials, and supplies. 7.3 Operator shall reimburse the City for equipment,materials and supplies used and consumed by the City in providing medical services related to Operator's rendition of EMS Services. 7.4 When possible Operator will resupply PFD expendable medical supplies as listed in Exhibit E on a one for one basis at the time of the call.When circumstances do not allow for immediate restocking,PFD shall be permitted to restock from a different Operator unit at a later time, or by such other means as mutually agreed. It is understood that it is difficult to regularly exchange certain expendable supplies and medications. Operator will provide direct access to a shared ordering system that will allow the PFD to order replacement supplies that are not replaced directly through on-scene exchange. All supplies will be shipped directly to a single address designated by the PFD. Ordering will take place on a twice monthly basis.Pricing will be based on Operator's actual cost and the total yearly requests shall not exceed$10,000. Operator and the City shall cooperate in controlling costs of supplies and the City agrees that all requests for supplies will be reasonable and justifiable. The provisions set forth in this Subsection can be modified upon mutual agreement by the parties. 7.5 Controlled medications will not be replaced or replenished due to laws that regulate their use. All other medications can be exchanged after use or between 90 and 120 days of their expiration date. 7.6 A system will be put in place for the exchange of medical oxygen cylinders. Operator agrees to exchange on a one for one basis expended cylinders for full cylinders. 7.7 Operator shall provide a mechanism to dispose of all bio waste generated by the PFD in providing medical services related to Operator's rendition of EMS Services. Operator and the City will work to develop a plan that is safe,reliable and easily accessible. 8.0 TRAINING. As a system enhancement and to improve patient care, Operator will permit PFD employees to participate in classes that Operator may offer to its own employees such as CPR, ACLS, PALS and Paramedic and EMT refresher courses, and PFD will permit Operator's employees to attend training of like kind that PFD may provide to PFD employees. With respect to any such training,Operator and PFD shall be responsible for the costs of any materials and/or certification materials for their own employees. 9.0 MATERIAL DEFAULT. Conditions and circumstances that constitute a material default by Operator pursuant to this Agreement include: (a) Failure to operate in a manner which enables the City and/or Operator to remain in compliance with federal,state and local laws, regulations and rules. (b) Falsification of information supplied subsequent to this Agreement. (c) Creating or otherwise falsifying ambulance responses or transports so as to inflate the volume or value of services. (d) Repeated failure to provide data to the City that is reasonably required to be generated in the course of operations,including by way of example,dispatch data,patient report data,complaint data, response time data, financial data, training data, billing and collection data, and other performance data and records. (e) Repeated failure to address and take corrective action with employees with documented professional or behavioral complaints. 7 (0 Repeated failure to maintain ambulances and equipment in accordance with manufacturer recommended maintenance procedures and as required by applicable laws,regulations and rules. (g) Failure to cooperate with and assist the City if a default warranting termination of this Agreement is asserted by the City. (h) Acceptance by Operator and/or Operator's employees, subcontractors or agents of any bribe, kickback or consideration of any kind that could be reasonably construed as a violation of federal, state or local law. (i) Payment by Operator and/or any of Operator's employees,agents or subcontractors of any bribe, kickback or consideration of any kind that could be reasonably construed as a violation of any federal, state or local law. (j) Failure to maintain insurance required by this Agreement. (k) Failure to meet response time requirements as set forth in the Agreement in an Emergency Priority 1 response time measurement for three (3) consecutive months or for four (4) months in any twelve(12)month consecutive period. (1) Failure to maintain the Performance Security required by this Agreement. (m) Repeated failure to submit reports and information. (n) Failure to cooperate fully with audits, investigations and inspections in accordance with this Agreement. (o) Making a general assignment for the benefit of creditors; filing a voluntary petition in bankruptcy or suffered the filing of an involuntary petition by creditors;having a receiver appointed to take possession of all or substantially all of its assets; obtaining the attachment or other judicial seizure of all,or substantially all,of its assets,or admitting in writing or electronically its inability to pay debts as they come due. (p) Failure to cure a minor breach after written notice from the City and reasonable opportunity to cure which shall be no less than thirty(30) days. (q) Any failure of performance required in the Agreement, which is determined by the City in its sole discretion to constitute a substantial and imminent threat to the public health and safety. The use of the term"repeated failure" in this section shall be determined by the City on a case-by-case basis and may include any instance of three or more failures to comply with the above requirements, as determined in the City's sole discretion. 10.0 REMEDIES IN THE EVENT OF MATERIAL DEFAULT. The City shall have all rights and remedies available at law or in equity. The City's remedies shall be cumulative and the exercise of any rights and remedies shall be in addition to the exercise of any other rights and remedies available to the City(including liquidated damages). 11.0 NOTICE OF MATERIAL DEFAULT AND TERMINATION. 11.1 In the event of a default under Section 9 which has been found by the City to be a substantial and imminent threat to the public health and safety, the City may provide Operator with a reasonable opportunity to cure,or the City may immediately terminate the Agreement to initiate an emergency takeover of the Operator's system in accordance with Section 12 of this Agreement. For all other defaults under 8 Section 9,the City will give Operator thirty (30)days written notice setting forth the nature of the default and an opportunity to cure. 11.2 Operator will be permitted to submit a written plan to cure such default;provided,however,the 30- day cure period will not be extended while Operator prepares a written plan. In the event Operator fails to timely cure,as determined in the City's sole discretion,the City may terminate this Agreement. 11.3 Upon termination,Operator will cooperate fully and immediately with the City to affect a prompt and orderly transfer of all responsibilities. The City shall determine the process by which the emergency takeover of the Operator's system will occur.Operator may dispute a default asserted by the City;however, such dispute will not delay, in any manner, the transfer of operations as required by the City. Moreover, such dispute by Operator as to whether a default has occurred will not delay or in any way limit the City's right to payment of the Performance Security if the City terminates the Agreement. Operator agrees that all rights and remedies(including drawing against the Performance Security)afforded to the City in the event of termination are reasonable and necessary for the protection of the public health and safety. 11.4 Operator's cooperation with and support of the City's termination of this Agreement,as well as the City's draw on the Performance Security, will not be construed as an admission or agreement by Operator as to the City's finding of a material default. 12.0 CONTINUOUS SERVICE DELIVERY UPON MATERIAL DEFAULT/TERMINATION. 12.1 In the event of material default by Operator,Operator will use its best efforts to assure continuous delivery of the Services required under this Agreement regardless of the underlying cause or consequence of such default. Operator agrees that there is a public health and safety obligation that requires that the City to provide uninterrupted service delivery in the event of default, even if Operator disagrees with the determination of default. 12.2 Assuring continuation of the Services may require the City to deliver the EMS Services. Operator agrees that if it is notified by the City of termination due to Operator's default, the City will have the right to execute an emergency takeover of Operator's operations within the City, including the portion of Operator's communications facility that serves this Agreement. Operator will be required to cooperate fully with such takeover and will challenge or appeal the matter only after such takeover has been completed. This cooperation will include allowing the City to directly operate Operator's systems for a period of up to twelve(12)months following the termination of Operator. 12.3 Upon termination of the Agreement by the City, Operator shall lease its ambulances, equipment, support vehicles and the City-dedicated portion of the communications facilities to the City for a period of up to twelve(12)months at fair market value to the City.The City shall maintain and repair such equipment and facilities using the same standards as required of Operator under this Agreement. Operator further agrees to make available to the City all means to contact Operator's employees who had been providing services under this Agreement so that they may be retained on an emergency basis by the City for operations. 12.4 The City will negotiate a fair market price for the use of all ambulances and equipment with Operator should the City retain the use of the equipment or facilities longer than twelve(12)months. 13.0 INSURANCE. 13.1 Operator shall provide insurance coverage during the term of this Agreement, including comprehensive general and automobile liability coverage with limits no less than one million dollars ($1,000,000)per occurrence and three million dollars($3,000,000)annual aggregate;medical professional liability coverage with limits no less than three million dollars($3,000,000)per occurrence and five million 9 dollars ($5,000,000) annual aggregate; and workers' compensation insurance in statutorily required amounts. To the extent the policies for liability or medical professional liability coverage are claims made policies, Operator shall provide continuing coverage after the expiration or termination of this Agreement for a period of three (3)years. Operator's insurance shall include waivers of subrogation against the City, and its officers and employees. All policies, except for workers' compensation and professional liability, shall name as additional insureds the City, the Pueblo City Council, and their employees, agents, representatives, and successors or assigns. All coverage furnished by Operator shall be primary, and any insurance held by the City shall be excess and non-contributory 13.2 Operator shall maintain umbrella/excess liability insurance on an occurrence basis in excess of the underlying general and automobile liability insurance which is as least as broad as the underlying policies. The policy shall have minimum limits of not less than Five Million Dollars ($5,000,000) per occurrence. The policy shall have as additional insureds the City,the Pueblo City Council,and their employees,agents, representatives,and successors or assigns, 13.3 Within ten days after execution of this Agreement by the last of the Parties to sign, Operator shall provide the City with a Certificate of Insurance and copies of insurance policies complying with the insurance and indemnification provisions in this Agreement. Operator shall provide additional or renewed copies of the Certificates of Insurance and policies upon thirty days written notice from the City. In the event that either of the insurance policies that Operator is required to maintain under this Agreement is cancelled or terminated, Operator shall immediately notify the City in writing and procure replacement policies forthwith, furnishing the City with copies of the same. 14.0 INDEMNIFICATION. 14.1 Operator shall indemnify,defend,and hold harmless the City,its Fire Department and their officers, agents, employees, and attorneys from and against any and all loss, damages, injuries, claims, cause or causes of action, or any liability of any kind whatsoever resulting from, or arising out of or in connection with the EMS Services, equipment, materials and supplies provided by Operator pursuant to this Agreement. 14.2 Operator will assume full responsibility for its own defense and the defense and indemnity of the City with respect to any claims for infringement of patents, copyrights or trademarks, or claims of unfair competition, that may arise from Operator's performance of this Agreement.The City may be represented by,and actively participate through, its own attorneys,with all such costs and reasonable attorneys'fees to be paid by Operator. 14.3 This indemnification obligation will survive the expiration or termination of this Agreement. 15.0 STANDARDS FOR EQUIPMENT,MATERIALS AND SUPPLIES. 15.1 Any specifications for equipment, materials and supplies set forth in this Agreement must be acceptable in accordance with standards established and/or adopted by the City.Equipment, materials and supplies provided by Operator shall meet or exceed Agreement requirements. The City may sample and test equipment,materials and supplies.An Equipment Schedule is contained in Exhibit"E." 15.2 Operator shall at a minimum carry all equipment and supplies listed in attached Exhibit"E". The City reserves the right to require Operator, at Operator's expense, to provide additional equipment to its ambulances during the term of this Agreement as determined by the City in its sole discretion; provided that such additional equipment does not interfere with important operations of ambulance units. The City will give Operator ninety(90)days'notice of its intent to require such additional equipment.Such request(s) shall not require expenditures of more than$3,000.00 per ambulance,per calendar year(excluding costs of routine maintenance and repairs). 10 16.0 BILLING, CUSTOMER FEE SCHEDULE AND PATIENT INFORMATION. 16.1 Operator shall be solely entitled to perform and be responsible for performing all billing of patients and third-party payers for EMS Services provided by Operator under this Agreement. Operator shall comply with all applicable laws governing billing and collection, including but not limited to laws and regulations applicable to patients covered by Medicare, Medicaid, Tricare and other public or private reimbursement programs. The City shall not bill for any EMS Services. All charges billed by Operator to patients or third-party payers for EMS Services provided by Operator under this Agreement shall be comparable with charges for similar services provided in Pueblo County and surrounding areas. Upon execution of this Agreement, Operator shall provide a list of the uniform charges used for EMS Services provided by operator under this Agreement and shall promptly notify City of any revision to the charges during the term of this Agreement. If City believes any such charges are not comparable with charges for similar services provided in Pueblo County and surrounding areas, City may give notice of same and the recommended changes to such charges. If such changes create an adverse and material financial impact upon Operator, Operator and the City agree to negotiate in good faith a revision to Operator's charges. In the event the parties are unable to reach agreement within thirty(30)days following a request from Operator for modification of the fee structure, the matter shall be submitted for private, non-binding mediation with the parties to bear equally the costs of the mediation. A retired Colorado,District Court Judge, as mutually agreed by the parties, shall serve as the mediator. The parties agree to participate in good faith in the mediation and negotiations related thereto for a period of thirty (30) calendar days. The substantive and procedural law of the State of Colorado shall apply to the proceedings. If the Parties are not successful in resolving the dispute through mediation, then the Parties shall be free to litigate the matter, and agree that in the event of such litigation, the exclusive venue for such litigation shall be the Pueblo County District Court,Pueblo,Colorado,and if necessary,for exclusive federal questions,the United States District Court for the District of Colorado.The mediation requirement provided herein shall apply only to disputes under this Section of the Agreement and not further or otherwise 16.2 In accordance with applicable laws (including but not limited to, HIPPA). Operator may request information about patients (including payor information). Notwithstanding the foregoing, no attempt will be made to solicit such information or to collect services or fees from a patient,the patient's representatives or any other payor until the patient has been accepted at a receiving medical facility for patients who are critical and in instances that would materially impact patient care. 16.3 In accordance with applicable laws (including but not limited to, HIPPA). Operator and the City may perform a customer service survey of patients transported pursuant to this Agreement.All such survey information shall be shared by the parties. 16.4 Nothing herein shall be construed to prohibit Operator from requesting authorization for transport, so long as the request of such authorization does not compromise or detrimentally affect patient care. Operator shall indemnify, defend, and hold harmless the City from any claim arising from or related to Operator's billing and maintenance of patient information under this Section of the Agreement. 17.0 CITY AUDITS AND INSPECTIONS. 17.1 In accordance with applicable laws (including but not limited to, HIPPA). Authorized City representatives will be permitted with reasonable advance notification, to observe Operator's operations, including the operators of its offices,communications center and related equipment,maintenance facilities, stations,ambulances and any other facility,location or activity utilized and/or conducted in the performance of this Agreement. 17.2 Operator's records (hard copy,as well as computer readable data), and any other material deemed necessary by the City to determine compliance with, and/or to establish performance of, this Agreement, will be open to inspection and subject to audit and/or reproduction by the City's authorized representatives upon reasonable advanced request. The City shall comply with the same privacy and security standards 11 imposed under state and federal law, applicable to Operator for purposes of maintaining and safeguarding such records. 17.3 All of Operator's records concerning this Agreement must be maintained for a period of five (5) years after expiration or termination of this Agreement. The City's authorized representatives shall be afforded access, at reasonable times and places, to all of Operator's personnel throughout the duration of this Agreement. 17.4 As permitted by applicable law, City representatives and/or medical direction representatives (including but not limited to the City's Medical Director)may ride as observers on any Operator ambulance at any time.The City and its medical direction representatives shall conduct themselves professionally and shall not interfere with the duties of Operator's employees,and shall at all times be respectful of Operator's employees and shall comply with Operator's policies and protocols. 17.5 In accordance with applicable laws (including but not limited to, HIPPA). The City's representatives and/or medical direction representatives shall have the right to audit medical,billing and all other reports and data that Operator is required to have,maintain and/or provide to any authority. 17.6 The City representatives may from time-to-time review Operator's System Status Plan,Patient Care Report form, and Complaint Policy and recommend changes to the same which changes shall be implemented by Operator. 17.7 Operator will require each subcontractor,insurer,material/equipment and supply provider to permit the City to audit and inspect their records in the same manner as the City may audit and inspect Operator and its records under this Agreement.The reasonable,actual costs of any City audit and inspection shall be reimbursed to the City by Operator as a part of the costs of contract administration paid by City,in addition to any amount set forth in Exhibit"B." 17.8 Except as otherwise provided, Operator will complete and submit all reports required to be submitted under this Agreement to the City by the 15th day of each month for the previous month. The information in the reports will be attained from the CAD program data and reported in a layout determined by the City.Additionally,the data will be provided to the City in a comma delineated format. 18.0 MODIFICATION OF THE RESPONSE ZONES. At least annually, and on an ongoing basis, the City, in coordination with Operator, will conduct a geographical analysis to monitor Operator's adherence to the response time standards and to determine whether changes are needed to the response zones. If, during the term of this Agreement, the City determines, in its sole discretion, that a specific community or area requires a modification in the Services from Operator due to changes in areas of growth, then Operator agrees to make adjustments to the response zones. Any such modification will be made on an annual basis,unless the City determines an immediate need for the modification exists. 19.0 NO MULTI-YEAR FISCAL OBLIGATION ON CITY. This Agreement is expressly made subject to the limitations of the Colorado Constitution. Nothing herein shall constitute, nor deemed to constitute,the creation of a debt or multi-year fiscal obligation or an obligation of future appropriations by the City Council of Pueblo, contrary to Article X, § 20 Colorado Constitution or any other constitutional, statutory or charter debt limitation.Notwithstanding any other provision of this Agreement,with respect to any financial obligation of the City which may arise under this Agreement in any fiscal year after the fiscal year in which this Agreement is executed,in the event the budget or other means of appropriations for any such year fails to provide funds in sufficient amounts to discharge such obligation, such failure shall not constitute a default or breach of this Agreement, including any sub-agreement, attachment, schedule, or exhibit thereto,by the City. 20.0 CONFIDENTIALITY OF RECORDS. Subject to federal and state confidentiality and privacy laws,Operator will establish and maintain procedures and controls that are acceptable to the City,including the City's designated HIPAA officer,for the purpose of assuring that no information contained in its records 12 or obtained from the City or from others used in carrying out its functions under this Agreement will be used by or disclosed by Operator,its agents,officers,or employees,except as required to perform its duties under this Agreement. Operator will ensure that the City's representatives are properly authorized and are in all respects in compliance with HIPAA laws and regulations or otherwise satisfy a permitted use and disclosure as set out in 45 C.F.R. §164.512 of HIPAA. 21.0 PROHIBITED INTEREST/REFERRALS. No official,employee or agent of the City shall have any financial interest or benefit,direct or indirect,arising from the negotiation,execution or implementation of this Agreement and any of its provisions, or any amendments thereto. No former official, former employee or former agent of the City who may become employed by the Operator shall have any involvement with the performance of this Agreement,nor shall such person,on behalf of the Operator,have any communication with any City participants or City participating agencies relating to the Agreement without the City's prior written consent. It is the intent of the parties that any remuneration, benefit, or privilege provided for in this Agreement shall not influence or in any way be based on the referral or recommended referral by either party or the purchasing, leasing, or ordering of any services other than the specific services described in this Agreement. Any payments specified in this Agreement are consistent with what the parties reasonably believe to be a fair market value for the services. 22.0 EQUAL EMPLOYMENT OPPORTUNITY. Operator shall follow applicable affirmative action guidelines,laws,regulations and rules in order to assure that employees and applicants applying for employment with Operator will not be discriminated against because of race, color, religion, sex, sexual orientation or national origin. Operator shall comply with the Americans with Disabilities Act(ADA) and similar state and local laws and will not discriminate against disabled persons in accordance with applicable laws,regulations and rules. 23.0 NON-DISCRIMINATION. Operator will not discriminate against any employee or applicant for employment because of race, color, sex, national origin, religion, age, handicap, veteran status, or genetic information. Operator will, where appropriate or required, take affirmative action to ensure that applicants and employees are treated without regard to their race,color, sex,or national origin. 24.0 DRUG FREE WORKPLACE. 24.1 OPERATOR shall,within 30 days after the Effective Date of this Agreement: (a) Publish a statement notifying its employees that the unlawful manufacture, distribution, dispensing,possession, or use of a controlled substance is prohibited in Operator's workplace and specifying the actions that will be taken against employees for violations of such prohibition. (b) Establish an ongoing drug-free awareness program to inform such employees about the following: (i) The dangers of drug abuse in the workplace, (ii) Operator's policy of maintaining a drug free workplace, (iii) Any available drug counseling,rehabilitation,and employee assistance programs, and (iv) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. (c) Provide all employees engaged in performance of this Agreement with a copy of the statement required by paragraph(a)of this Section. 13 (d) Notify such employees in writing in the statement required by paragraph(a)of this Section that, as a condition of continued employment on this Agreement,the employee will: (i) Abide by the terms of the statement and (ii) Notify the employer in writing of the employee's conviction under a criminal drug statute for a violation occurring in the workplace no later than 5 days after such conviction. (e) Notify the City in writing within 10 days after receiving notice under paragraph d (ii) of this Section, from an employee of otherwise receiving actual notice of such conviction.The notice shall include the position title of the employee. (0 Within 30 days after receiving notice under paragraph d(ii)of this Section of a conviction, take one of the following actions with respect to any employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination;or (ii) Require such employee to satisfactorily participate in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency; and (g) Make a good faith effort to maintain a drug-free workplace through implementation of paragraphs(a)through(b)of this Section. 24.2 Operator's drug free workplace policy shall also provide for pre-employment,reasonable suspicion and post-accident drug and alcohol testing in accordance with its established drug and alcohol testing policy. As allowed by applicable law, the data received from such testing (with confidential or private information redacted)shall be made available to a City representative for audit and compliance purposes. 24.3. In addition to other remedies available to the City, Operator's failure to comply with the requirements of this section will constitute a default under this Agreement. 25.0 RELATIONSHIP OF PARTIES. 25.1 Nothing in this Agreement is intended to, or shall be deemed to constitute, a partnership or joint venture between the Parties, or to create any agency or partner relationship between the Parties. Neither Party shall hold itself out as a partner, joint venture, agent, or representative of the other under this Agreement. 25.2 Operator understands and agrees that Operator and Operator's employees,agents,servants or other personnel are not employees of the City.Operator shall be solely responsible for payment of salaries,wages, payroll taxes,unemployment benefits and any other form of compensation or benefit to Operator or any of Operator's employees, agents, servants or other personnel performing the service or work or supplying equipment or materials specified herein, whether it be of a direct or indirect nature. It is expressly understood and agreed that for such purposes neither Operator nor Operator's employees,agents, servants, subcontractors or other personnel shall be entitled to any payroll, insurance, unemployment, worker's compensation,retirement or any other benefits whatsoever from the City. 26.0 ASSIGNMENT/AFFILIATED RELATIONSHIPS/SUBCONTRACTOR. 26.1 Operator shall not assign or transfer any portion of this Agreement without the prior written consent of the City. Any purported assignment or transfer without such consent will terminate this Agreement at the option of the City, as determined in the City's sole discretion, and will not convey any rights to the 14 assignee/transferee. A significant and material change in ownership of Operator will, for the purposes of this Agreement,be considered a form of assignment or transfer that is prohibited under this Agreement. 26.2 Except for ancillary services provided by Operator's affiliates or subcontractors for billing and collection, legal, etc.,Operator may not enter into any agreement or arrangement of any kind for the direct or indirect performance of this Agreement by an affiliate or subcontractor of Operator without the prior written consent of the City. The parties' intention is for Operator, and not an affiliated entity or subcontractor, to directly perform the EMS Services described in this Agreement. Upon request,Operator shall provide the City with a list of affiliates and subcontractors of Operator that provide ancillary services for this Agreement. 27.0 TAXES. Operator shall be responsible for complying with all federal, state and local tax laws, regulations and rules applicable to its performance of this Agreement. 28.0 NON-EXCLUSION. Each party represents and certifies that neither it nor any practitioner or employee who orders or provides services on its behalf hereunder has been convicted of any conduct that constitutes grounds for mandatory exclusion as identified in 42 U.S.C.§ 1320a-7(a). Each party further represents and certifies that it is eligible to participate in federal health care programs or in any other state or federal government payment program. Each party agrees that if DHHS/OIG excludes it, or any of its practitioners or employees who order or provide services, from participation in federal health care programs,the party must notify the other party within five(5)days of knowledge of such fact,and the other party may immediately terminate this Agreement, unless the excluded party is a practitioner or employee who immediately discontinues ordering or providing services hereunder. 29.0 END TERM PROVISION. Operator shall have ninety(90) days after termination or expiration of this Agreement in which to provide to the City all requested audited financial statements and all other documentation necessary to facilitate the close out of this Agreement. 30.0 COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAW, REGULATIONS AND LAWS. At all times during the performance of this Agreement, each party shall observe and conform to all applicable federal, state and local laws,rules,regulations,and orders that have been or may hereafter be established.Specifically,and without limitation,the parties shall comply with the Immigration Reform and Control Act of 1986 (IRCA), Medicare and Medicaid Regulations, the federal Anti-Kickback Statute, OSHA Regulations, including Title 29, Section 1910.1200 "Hazard Communication," and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Furthermore, Operator shall comply with and perform this Agreement in accordance with the provisions of all applicable rules, written guidelines, protocols and written policies established by the City. Operator will make available to the City a copy of its Code of Conduct, Anti-Kickback policies and other compliance policies, including any and all changes which may be made from time-to-time. Operator warrants that its personnel shall comply with Operator compliance policies, including training related to the Anti-Kickback Statute. 31.0 PERMITS, LICENSES AND CERTIFICATES. Operator shall obtain and hold any and all federal,state and local permits,licenses and certificates required to fully perform this Agreement.Operator shall make all necessary payments for such permits, licenses and certificates. Operator will assure that all necessary renewals of such permits, licenses and certificates are timely made.Operator shall assure that all of its personnel hold valid federal, state and local permits, licenses and certificates required in order for Operator to meet its responsibilities under this Agreement. City personnel engaged in providing reimbursable services will maintain or keep in effect any certifications required for the performance of their duties. 32.0 NOTICE OF LITIGATION AND CLAIMS/COMPLAINT PROCESS. Operator shall notify the City within five(5)calendar days of any material litigation or claims which arise out of, or are related in any way to, Operator's performance of this Agreement. To the extent permitted by law, Operator will disclose in writing or electronically to the City all litigation matters involving Operator's related organizations or affiliates, owners of Operator (having a 10% or greater interest in Operator) and key 15 personnel of Operator that may have a material impact on the Operator ability to continue performance of this Agreement. Operator shall maintain at all times and fully comply with its written complaint resolution policy, which shall be made available to the City upon request, related to Operator's performance under this Agreement. 33.0 FORCE MAJEURE. 33.1 Except as may be otherwise provided in this Agreement,neither party shall be liable in damages or have the right to terminate this Agreement for any delay or default in performance if such delay or default is proximately caused by conditions within the City beyond its reasonable control and occurs without the party's fault or negligence including, but not limited to, Acts of God, fire, storm, flood, war, rebellion, insurrection, riot, strike and/or any other cause beyond the reasonable control of the party whose performance is affected(each,a"Force Majeure Event"). 33.2 Neither party shall be liable for any failure or delay in performance under this Agreement (other than for delay in the payment of money due hereunder)to the extent such failures or delays are proximately caused by a Force Majeure Event, provided that, as a condition to the claim of nonliability, the party claiming nonliability due to a Force Majeure Event shall give the other prompt written notice, with full details,following the occurrence of the cause relied upon.Failure to give notice within seven(7)days from the occurrence of the Force Majeure Event shall act as a waiver of the party's right to claim nonliability due to the Force Majeure Event. 33.3 To the extent any dates by which performance obligations under this Agreement are scheduled to be met, such dates will be extended for a period equal to the time lost due to any delay caused by a Force Majeure Event for which timely notice is provided. 34.0 AGREEMENT MODIFICATION. 34.1 Any amendments or modifications of the terms of this Agreement shall be in writing and will be effective only after the approval and signing of the parties to this Agreement. 34.2 The City may, at any time,order changes within the scope of this Agreement without invalidating this Agreement. In such event, equitable adjustment of Agreement provisions may be authorized by the City. Such Agreement changes must be in writing in accordance with this Section. If such changes promulgated by the City create an adverse and material financial impact upon Operator, Operator and the City agree to negotiate in good faith a revision to the fee structure. In the event the parties are unable to reach agreement within thirty (30) days following a request from Operator for modification of the fee structure, the matter shall be submitted for private, non-binding mediation with the parties to bear equally the costs of the mediation.A retired Colorado,District Court Judge,as mutually agreed by the parties,shall serve as the mediator.The parties agree to participate in good faith in the mediation and negotiations related thereto for a period of thirty(30) calendar days.The substantive and procedural law of the State of Colorado shall apply to the proceedings. If the Parties are not successful in resolving the dispute through mediation,then the Parties shall be free to litigate the matter,and agree that in the event of such litigation, the exclusive venue for such litigation shall be the Pueblo County District Court, Pueblo, Colorado,and if necessary,for exclusive federal questions,the United States District Court for the District of Colorado.The mediation requirement provided herein shall apply only to disputes under this Section of the Agreement and not further or otherwise. 35.0 NOTICE.Any notice to the parties required under this Agreement shall be in writing delivered to the person designated below as Contract Coordinator at the indicated address unless otherwise designated in writing. Notices shall be personally delivered, sent by certified mail return receipt requested or sent for next day delivery by a nationally recognized next day courier service to: 16 FOR THE CITY FOR OPERATOR Contact: Fire Chief Contact: Regional Director American Medical Response of Colorado, Inc. Address: 1551 Bonforte Blvd Address: 922 S. Santa Fe Ave. City/State: Pueblo,CO City/State: Pueblo, CO Zip: 81001 Zip: 81006 WITH MANDATORY COPY TO: WITH MANDATORY COPY TO: r-- Contact: City Attorney Contact: Legal Department American Medical Response,Inc. Address: One City Hall Place Address: 6363 S. Fiddler's Green Circle Pueblo,CO 81003 14th Floor ....... ........... ........... Greenwood Village,CO 80111 36.0 STATE-IMPOSED MANDATES PROHIBITING ILLEGAL ALIENS FROM PERFORMING WORK. 36.1 At or prior to the time for execution of this Agreement(which may be referred to in this section as this "Contract"), Operator (which may be referred to in this section as "Contractor") shall submit to the Purchasing Agent of City its certification that it does not knowingly employ or contract with an illegal alien who will perform work under this Contract and that the Contractor will participate in either the "E-Verify Program"created in Public Law 208, 104th Congress, as amended and expanded in Public Law 156, 108th Congress, as amended, that is administered by the United States Department of Homeland Security or the "Department Program" established pursuant to §8-17.5-102(5)(c) C.R.S. that is administered by the Colorado Department of Labor and Employment in order to confirm the employment eligibility of all employees who are newly hired for employment to perform work under this Contract. 36.2 Contractor shall not knowingly employ or contract with an illegal alien to perform work under this contract; 36.3 The following state-imposed requirements apply to this contract: (a) The Contractor shall have confirmed the employment eligibility of all employees who are newly hired for employment to perform work under this Contract through participation in either the E-Verify Program or Department Program. (b) The Contractor is prohibited from using either the E-Verify Program or Department Program procedures to undertake pre-employment screening of job applicants while this Contract is being performed. (c) The Contractor is required to comply with any reasonable request by the Colorado Department of Labor and Employment(hereinafter referred to as "CDLE") made in the course of an investigation that CDLE is undertaking pursuant to its authority under§8-17.5-102(5),C.R.S. (d) Violation of this Section by the Contractor shall constitute a breach of contract and grounds for termination. 17 37. PERA LIABILITY. Operator shall reimburse the City for the full amount of any employer contribution required to be paid by the City of Pueblo to the Public Employees' Retirement Association ("PERA") for salary or other compensation paid to a PERA retiree performing contracted services for the City under this Agreement. Operator shall fill out the questionnaire attached as Attachment"F'and submit the completed form to City as part of the signed Agreement. 38.0 MISCELLANEOUS. 38.1 The captions of the Sections in this Agreement are set forth only for the convenience and reference of the Parties and are not intended in any way to define, limit or describe the scope or intent of this Agreement. 38.2 This Agreement shall be governed by the laws of the State of Colorado. Venue for any action arising under this Agreement or for the enforcement of this Agreement shall be in a state court with jurisdiction located in Pueblo County,Colorado. 38.3 The provisions of this Agreement pertaining to insurance, indemnification, payments to the City, and liability shall survive the expiration of the term of this Agreement and termination of this Agreement and continue in effect for a period of five years following the termination of this Agreement and for such further time as it may take to completely and finally negotiate,settle,or litigate any claim or suit concerning the same. 38.4 This Agreement represents the entire agreement between the Parties and supersedes all prior discussions and written agreements or understandings. If any provision of this Agreement is held invalid or unenforceable, no other provision shall be affected by such holding, and all of the remaining provisions of this Agreement shall continue in full force and effect. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original, and all of which together constitute one and the same agreement. 38.5 The Parties agree to execute any additional documents or take any additional action that may be necessary to carry out this Agreement. 38.6 Nothing in this Agreement is intended, nor should it be construed, to create any rights, claims, or benefits or assume any liability for or on behalf of any third party,or to waive any immunities or limitations conferred under federal or state law, including but not limited to the Colorado Governmental Immunity Act, § 24-10-101 et seq.,C.R.S. 38.7 Each person signing this Agreement on behalf of a party represents and warrants that he or she has the requisite power and authority to enter into,execute,and deliver this Agreement on behalf of such party and that this Agreement is a valid and legally binding obligation of such party enforceable against it in accordance with its terms. (Signature page follows) 18 Executed at Pueblo, Colorado,the day and year first above written. CITY OF PUE;LO,A MUNICIPAL CORPORATION AMERICAN MEDICAL RESPONSE OF COLORADO, INC. /r/By dyi.,a ��/ By: P .en ,:f the ity ouncil Attest: TLC( (l111i Pre 1're 5 t ka":C 4 CE O Acfiek9 City Clerk [SEAL] APPROVED AS TO FORM: City Attorney 19 EXHIBIT"A"RESPONSE TIME REQUIREMENTS I. RESPONSE TIMES For the purposes of calculating response times, the following definitions and measurements shall apply: 1. "Priority 1"responses shall be defined as an emergent response. Priority 2 calls require a less than emergent response. For clarity and to avoid doubt, only calls that originate through the City PSAP are part of this Agreement and only calls that originate through the PSAP are subject to response times. 2. The City currently utilizes two (2) 9-1-1 response priorities, emergent Priority 1, and less than emergent Priority 2.These response priorities are based on nature codes.Requests for service are assigned an applicable nature code by the City depending upon information obtained from those requesting service (e.g. chest pain, seizure, and structure fire).A current list of nature codes and their corresponding priority will be provided to operator.An updated list will be provided subsequent to changes in nature codes and or priority assignment. In situations where a call nature is not determined or assigned,a Priority 1 response will be initiated by the operator and the City 3. The City intends to transition to a recognized Medical Priority Dispatch System and the City, Operator and the City's medical director will work to establish a new baseline for Priority 1 and Priority 2 calls.The City at is sole discretion will determine the assigned priority of all calls for service. 4. The City is continually updating, refining, and altering dispatching protocols including priorities and codes. Any such update,refinement or change will become effective following a 30-day written notice to Operator. 5. In this performance-based contract, Operator has flexibility to choose the means and methods for providing EMS services.Performance that meets or exceeds the response time requirements is the result of Operator's expertise and choice of the means and methods, and therefore is solely their responsibility. An error or failure in one portion of Operator's operation does not excuse performance in other areas of operation. Further the City does not require the use of lights and siren for any call. 6. Response zone designations are depicted in Appendix "A" to this Exhibit"A." a. Twelve (12) response zones are defined per the City Response Zones Map (Appendix "A") and provided to operator by the City in the form of an electronic shape file.The parties shall agree in writing on any changes in the Response Zone Map before changes take effect. The response zones will be reviewed annually by the Fire Chief and Operator with changes implemented as deemed necessary by agreement of the parties. It is Operator's responsibility to be familiar with the geographic considerations and changes to response zones. b. In addition to the foregoing annual review of the Response Zone Map,Operator shall advise the Fire Chief of changes in the deployment of Operator assets relative to the most recent available PFD Statistical Abstract,to demonstrate how Operator's asset deployment is improving and contributing to the achievement of the 90th percentile compliance with the citywide 8 minute Priority 1 response standard, in the URBAN ZONES as defined in(Appendix"A").The City and Operator shall cooperate in compiling statistics to show the joint PFD/Operator annual total response time by response zone and Citywide measured according to the first ALS resource on scene. 7. For the purpose of measuring response times, the official clock will be the time displayed at the City of Pueblo Communication Center.Operator shall be required to synchronize its clocks with the City's Communications Center clock. Response times shall be determined in accordance with 10.a. below. 20 8. Fractile response time measurements for system response times are a key measurement of performance.This measurement is the determining factor, which drives the placement and redeployment of the system's resources throughout the entire system. Performance will be measured using a fractile distribution reported to the 90th percentile. a. For the purpose of calculating response times each incident will be counted as a single response regardless of the number of ambulance units that respond.The dispatch time of the 1st ambulance dispatched and the on scene time of the first arriving qualified resource will be used to compute the response time for the incident. Subsequent responding ambulances will be exempt from the response data. b. Operator shall use its best efforts to minimize variations or fluctuations in response time performance. c. Compliance with response times in this Agreement is measured by meeting the performance criteria Citywide. 9. Arrival time: a. For Priority 1 calls, arrival means the moment an ALS resource crew notifies the communications center that the unit is fully stopped at the location where the response vehicle will be parked while the City or Operator personnel attend the patient. b. For Priority 2 calls, arrival means the moment an Operator ALS or QRV resource notifies the communications center that the unit is fully stopped at the location where the response vehicle will be parked while City or Operator personnel attend the patient. c. In those situations,where the City or Operator have responded to a location other than the scene(e.g. staging),arrival shall be the time the qualified unit arrives in the designated staging area. d. In the event either Operator,PFD or other system resource fails to report non-scene, the time of the next communication will be used as the arrival time, unless Operator can verify the on-scene time through other verifiable means. 10. Response times shall be determined as follows: a. For Priority 1 calls, the response time for Operator's response shall commence when Operator's dispatch center is notified of the nature of the call and is provided with the address necessary to respond to the call and shall conclude upon the arrival of an Operator ALS resource, PFD ALS resource, or other ALS system resource. b. For Priority 2 calls, the response time for Operator's response shall commence when Operator's dispatch center is notified of the nature of the call and is provided with the address necessary to respond to the call and shall conclude upon the arrival of an Operator's ALS or QRV resource: 21 11. Minimum response time requirements: 90th Percentile time basis: Priority Citywide ALS 1"Response l 8:00/8:01 is late 2 13:00/13:01 is late First Operator unit on scene maximum response time Priority Urban Special Zone 1 13:00/13:01 is late 18:00/18:01 is late 2 18:00/ 18:01 is late 23:00/23:01 is late After January 1,2019,and if mutually agreed by the parties in a written amendment,alternate response times may apply to non-emergent Priority 3 calls. a. The foregoing response times shall not apply under conditions where police and fire personnel are operating under a modified response protocol or other disaster mode due to dangerous travel or other conditions that could impact the safety of responding personnel. b. Response Time Exemptions:Operator shall maintain mechanisms for reserve production capacity to increase production should temporary system overload persist. However, it is understood that unusual circumstances and conditions beyond Operator's reasonable control can produce response times that exceed the standards. If Operator believes that any run or group of runs should be excluded from the response time standards, a written request must be made to the Fire Chief.Any requests for exemption from response time standards shall be made with the Monthly Response Time Reports,as set forth in Section II.6(a)below.If no such request is received by the deadline required herein, no such request will be considered in compliance calculations.The Fire Chief has the sole discretion to exempt any call.Equipment failures,traffic congestion, ambulance failures, Operator dispatch errors, inability to staff units, and units deployed on inter facility transports will not be grounds for granting an exception to compliance with the response time requirements. c. Response times are critical to patient care. Operator is expected to meet the required response times to every call and failure to do so will result in liquidated damages as provided in Exhibit "D" to the Agreement.In addition,failure to meet the response time criteria citywide at least 90%of the time will result in additional liquidated damages as also provided in Exhibit"D." Additional liquidated damages will apply as provided in Exhibit"D."For purposes of determining citywide compliance, d. An improvement in response time minimums is the goal of the City in this Agreement.The City and Operator will work together to increase response time reliability to 92nd percentile by August 1,2018. e. Operator must commit to use its best efforts to minimize variations or fluctuations in response time performance and to provide equalized response time performance throughout the various communities inside the service area. 22 f. For the purpose of calculating the 90th percentile an individual call without an arrival time will be excluded from the data pool. Example: A call in which all responding units are cancelled en-route and none actually arrive on scene before the cancelation. 12. Response priority change: Special circumstances may result in a change in call priority or designation. Calculations to determine compliance with response time requirements shall be completed as follows: a. Upgrades: If an assignment is upgraded, prior to the arrival on scene of the first ambulance (e.g., Priority 2 to Priority 1),compliance with contract standards and liquidated damages will be calculated based on the shorter of: (i) The time elapsed from call receipt to the time of upgrade plus the highest priority response time standard,or (ii) The lower priority response time standard. b. Downgrades: If an assignment is downgraded, prior to the arrival on scene of the first ambulance (e.g., Priority 1 to Priority 2), compliance with Agreement standards and liquidated damages will be calculated based on: (i) The lower priority response time requirement,if the unit is downgraded before it would have been judged"late"under the higher priority response time requirement,or (ii) The higher priority response time requirement, if the unit is downgraded after it would have been judged"late"under the higher priority response time requirement. c. Cancellations: If an ambulance is cancelled by an authorized agent of the City, after an assignment has been made but prior to the arrival of the first ambulance, and no ambulance is required at the dispatch location.The response time clock will stop at the moment of cancellation.If the elapsed response time at the moment of cancellation exceeds the response time requirement for the assigned priority of the call, the unit will be judged"Late"for the purpose of Agreement compliance and calculation of liquidated damages.If the elapsed response time at the moment of cancellation is within the response time requirement for the assigned priority of the call. The unit will be determined "on time" for the purpose of Agreement compliance and calculation of liquidated damages. II. RESPONSE TIME AND DATA REPORTING REQUIREMENTS 1. The Pueblo Dispatch Communications Center is the central data source for all ambulance Agreement response time data. 2. Operator shall provide geographic location data on each ambulance using an Automatic Vehicle Locator (AVL)or Global Positioning System(GPS). 3. When technology permits the City must have the ability to access real time ambulance location and response time data of all ambulances involved in 9-1-1 responses under the Agreement. 4. The long term success of any EMS system is predicated upon the ability to measure, analyze, and report operational,clinical, and administrative data. Operator shall be responsible for data input and reporting in a manner which facilitates review by the City and any other entity authorized by law or contract to review data and reporting. All systems and reports must comply with City, state,and federal data collection and reporting requirements. 23 5. Operator will provide the City with a dedicated server,and replicate EMS call response data to that server in intervals the City desires. The server will house a Microsoft SQL server database engine where replicated data will be stored as table objects.There will be approximately five relational database tables to allow City analysts to write queries for information pertaining to all aspects of EMS ambulance requests for service in the City. The tables will store data listed below as well as any call edits performed. The raw data may then be queried directly from comma delineated files provided by Operator. a. Data fields Date and time of call received by Operator Date and time of call received by City Address of call Response Zone Responding Operator unit(s)number Latitude and Longitude of responding unit(s)at time of dispatch Operator call number City call number MPDS Code MPDS received time Operator unit dispatch time Operator unit responding time Operator on scene time Operator leave scene time(transport) First city ALS unit on scene time Additional data fields may need to be added for the purpose of determining compliance at the sole discretion of the Fire Chief. 6. All reports shall be electronically maintained and submitted in a format useful to the City a. Monthly Response Time Report Operator shall electronically submit to the City monthly response reports. Such reports must be transmitted no later than 5:00 p.m., five (5) business days following the receipt of the PFD's response data from the previous month. Operator may request up to an additional seven (7) business days when Operator's data analyst is unavailable due to emergency or is on paid time off.Failure by Operator to submit a report will be classified as an administrative failure and subject to liquidated damages, pursuant to Exhibit "D" to the 24 Agreement. For each incident for which a response is dispatched, the monthly response time compliance report shall include,but not be limited to: (i) A monthly summary of Operator's number of calls into the service area by volume,nature and by Response zone, (ii) The unique call number generated by City dispatch, (iii) Number of transports (iv) Address received time (v) address of incident (vi) The matching unique number generated by Operator's dispatch, (vii) Dispatch date, (viii) Time the call was received from Public Safety Answering Point(PSAP), (ix) MPDS code (x) MPDS received time, (xi) Dispatch time, (xii) Arrival time of the first Operator ambulance, (xiii) Arrival time of first ALS resource(PFD,Operator or other system resource), (xiv) Time transport from scene began, (xv) Time transport ended, (xvi) Identification number of the ambulance(s) that arrived on scene, (xvii) Response priority,linked to the dispatch and arrival times necessary to calculate the response time, (xviii) Response zone in which the call occurred, (xix) For calls canceled en-route,or up or downgraded,the aforementioned items shall be reported and any additional data necessary to calculate and verify response times (xx) For calls on which multiple ambulances arrive on scene,the responses of all ambulances that arrive on scene shall be reported, but only the first arriving ALS resource (PFD, Operator, or other system resource) shall be timed for compliance with performance requirements, (xxi) The Calculation to determine whether the performance standards for Priority 1 and Priority 2 responses have been met citywide. (xxii) Identification number of the ambulance(s) initially assigned to the incident if different than the ambulance(s)that ultimately arrived, and the reason for changed assignment. (xxiii) Latitude and longitude of responding ambulance(s)at time of dispatch. b. Non-Compliant Response Report. Operator shall submit a monthly non-compliant response report electronically to the City. Such reports must be transmitted no later than 5:00 p.m.,five(5)business days following the receipt of the PFD's response data from the previous month. Operator may request up to an additional seven(7)business days when Operator's data analyst is unavailable due to emergency or is on paid time off. This report shall include all information outlined in Section II(6)(a) in addition it should include the number of ambulances in-service at the time of the exception, for all calls in which the response time requirements were not achieved. Repeated failure to submit a report will be classified as an administrative failure and subject to liquidated damages,pursuant to Exhibit"D"to the Agreement. The existence of a repeated failure shall be determined according to Section 9.0 of the Agreement. 7. Incident Reports Operator will complete and submit to the City within 48 hours, or any shorter time if required by the Fire Chief, incident reports for actions considered non-conforming to policies and procedures and for any other incident if requested by the City. Non-conforming incidents include, but are not limited to, ambulance accidents or vehicle failures while on a call, equipment failures, patient injuries occurring after care is assumed from the City by ambulance personnel, and patient or facility complaints. A copy of all incident reports shall also be maintained on 25 file at Operator's administrative offices. Failure to submit a report will be classified as an administrative failure and subject to liquidated damages,pursuant to Exhibit"D"to the Agreement. Incident reports must include but not be limited to the following information: a. Date of incident, b. Incident number if applicable, c. Personnel involved,identified by employee number, d. Unit number if applicable, e. A detailed narrative of the event f. A summary of corrective action taken. To the extent permitted under the Colorado Open Records Act, such reports, and/or the content of the same, shall be excluded from production requests. 8. Performance Improvement&Clinical Reports Within fifteen(15)days following the end of each month,Operator shall provide a report electronically,summarizing quality improvement activities of the previous month. Repeated failure to submit a report will be classified as an administrative failure and subject to liquidated damages,pursuant to Exhibit"D"to the Agreement. Within fifteen (15) days following the end of each month, Operator shall also provide clinical data in the form and format required by the City for the purposes of ongoing measurement of clinical care.This data will include,but not be limited to,the following information: a. Changes in patient condition en-route to the hospital, b. Procedures performed, c. Number of patients with specific complaints or clinical signs/symptoms, and d. Patient outcome, to the extent Operator possesses such information, but not to include data maintained by destination hospitals. 9. Community&Public Information Report Operator shall provide a quarterly summary (based on the calendar year) of all community education and public information activities including a description of the activities, number of attendees, and number of staff hours provided,due within fifteen(15)days after the end of the quarter.Repeated failure to submit a report will be classified as an administrative failure and subject to liquidated damages,pursuant to Exhibit"D"to the Agreement. 10. Record Requests Operator shall complete, maintain, and if requested by the City,provide access to or copies of the following records and reports(including supporting data if requested) within fifteen(15) working days of the request: a. Equipment failure records, b. Vehicle maintenance records, c. Accounting and billing records sufficient to verify accurate billing in accordance with the Agreement, d. Deployment planning records,and e. Continuing education and training reports. 26 APPENDIX "A" TO EXHIBIT"A"-RESPONSE ZONES MAP Response Zones Map FY.81lIMtu 2118"661 Zair 1'ily L!7!b ■�, man zones ��+� D moospa• +'" '1 111111 ii 1 c1 � ; `til n1 - 7 a...7:: . 11=4,1 ,...1111111.1.1111' jti - , ' , ,,06.. � .b 0 ate.. 7 � � �*1.r - t- ... , . . , , r Rithi!..cr:m77, 1 ..,,,t ,, , ;or ,41(44,4111,11r17,!;;.:: :,, ;;(11, . .,. ,, i.t.... . , , b+ "44 "Hure .., 7 A . . 'iluing,, 0 t� -/C.�..b##b00"11 .311= Ei !!llk;•� 44. ilf 1 •.k.!� iii „, r 4,,-,..4,--4,,,ty A ww- ih„.011-..li ,..2;.K.4r. ,..: _iii.,..!--,..-17:::_ii..:-.::!..ii ,:. lI i::::F.. ;;t:''''''.:;'-'-t.-..— 0 .1.\j II 11.401 ii,,. ..,./11.ICI rAW.,... INip,t 1 .”. AV.;„tviti,.!-g.;;,' . 1n , 4!: ::::: i1: Aw1',.,- 0,140w- -1 11116tiiii-; -- ,■! .f +� ! 1i1p11111111�.� 4-141:1111 ::: I .�.1�_ _9(iiniic:n aun Alprta1r ,rr1 ,Ptr . �■ unwuunopu1u1u'IIS.#n�►1. Ii piT ________- •kiji1L4 +alas, ,°� elmf ��- +. 11ti11 -t oral 7. 77. MI /// '301 +', • • '#"�C 'N '$,S / i -!..(!f ,r*;•r.',,t,"4:11....,-,51.1- !Am ..- . N A �+ r �'t+Miw 'fir+ rC/I!�� Mir 2 27 EXHIBIT"B"FEE SCHEDULE PAYMENT FOR REIMBURSABLE ITEMS Operator shall pay to the City reimbursements in monthly installments for all amounts required to be furnished by the City related to Operator's delivery of the services. Operator shall reimburse the City in the amount of$471,000 per year, but not exceeding the amount of the City's actual costs,related to the City providing the following: (a) Communications/dispatch services (b) Contract administration and compliance (c) Hospital ride-ins (d) PFD ALS first response stopping the clock for Priority 1 responses Operator shall remit the reimbursement stated above to the City, without any billing or invoicing,. In the event of increases in the actual reimbursed costs,beginning with the budget cycle for 2019,the City may submit adjustments for reimbursed costs to Operator, which adjustments shall not exceed the amount allowed for inflation, being measured according to the Consumer Price Index for Denver-Boulder-Greely. Such adjustment shall be made not more frequently than once per year, and they shall only be made as a part of the City's annual budget process for 2019 and in years thereafter. 28 EXHIBIT"C"PERFORMANCE SECURITY Bond Number KNOW ALL MEN BY THESE PRESENTS : That we a (Name of Operator) (Corporation,Partnership,or Individual) hereinafter called "Principal" and (Surety) of , State of ,hereinafter called the"Surety",are held and firmly bound unto the City of Pueblo, a Municipal Corporation, hereinafter called "City", in the penal sum of Dollars ($ )in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors,jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that Whereas, the Principal entered into a certain contract captioned"Ambulance Service Agreement"with the City,dated the 1st day of February 2018,a copy of which is hereto attached and made a part hereof. NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties, all the undertakings, covenants, terms, conditions and agreements of said contract during the original term thereof, and any extensions thereof which may be approved by the City, with or without notice to the Surety, and if Principal shall satisfy all claims and demands incurred under such contract,and shall fully indemnify and save harmless the City from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the City all outlay and expense which the City may incur in making good any default,then this obligation shall be void;otherwise to remain in full force and effect. PROVIDED,FURTHER,pursuant to Section 4 of the contract,Principle and Surety expressly stipulate and agree to the City's right to payment of any direct draw by the City as provided in the contract and the restriction of rights of both Principle and Surety to object and/or to refuse to honor any such demand for payment by the City. PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the services and obligations to be performed thereunder or to the specifications accompanying the same shall in any way effect its obligation on this bond, and it does hereby waive notice of any such change, extension of time,alteration or addition to the terms of the contract or to the services or to the specifications. PROVIDED,FURTHER,no right of action shall accrue on this bond to or for the use of any person or corporation other than City. 29 IN WITNESS WHEREOF,this instrument is executed in four(4)counter-parts, each of which shall be deemed an original,this the day of ,20 Principal ATTEST: By By Principal Secretary (SEAL) (Address) By (Witness as to Principal) (Address) Surety ATTEST : By By (Surety) Attorney-In-Fact Attorney-In-Fact (SEAL) (Address) By (Witness as to Surety) (Address) NOTE: Date of Bond must not be prior to date of Ambulance Service Agreement. If Operator is a Partnership, all partners shall execute bond. 30 EXHIBIT"D"LIQUIDATED DAMAGES I. Start-up In the event Operator fails to achieve compliance with required response time standards by the end of the start-up period of the Agreement, which will expire 180 days following the implementation of this agreement, liquidated damages as provided in this Exhibit "D" will begin to accrue. For clarity and to avoid doubt, there shall be no liquidated damages assessed during the start-up period of the Agreement. II. Response Time Standards A. Operator Per Minute Liquidated Damages 1. Liquidated damages in the amount of$20 per minute,will accrue for each incident in which Operator fails to meet established response time requirement, not including exemptions granted as provided in Section I.11.b. of Exhibit"A" of this Agreement. These liquidated damages will accrue and be paid monthly.The per minute liquidated damages will apply for Operator after the maximum response time is exceeded according to the table set forth below Priority 1 Maximum response time: Urban Zones 13:00 Minutes(13:01 is late) Special Zones 18:00 Minutes(18:01 is late) Priority 2 Maximum response time: Urban Zones 18:00 Minutes(18:01 is late) Special Zones 23:00 Minutes(23:01 is late) 2. For the purposes of calculating per minute liquidated damages,any fraction of a minute will be rounded up for the first minute Operator is late. After the first minute, any fraction of a minute will be rounded up to the next minute.For example,a unit arriving on scene in seventeen(17)minutes and two (2) seconds for a priority 1 call in an urban zone would be five (5) minutes late and a liquidated damage of$100 would accrue. 3. The foregoing per minute liquidated damages shall be capped for each incident at$1,000.00. In the event that failure to respond results in monthly liquidated damages as provided below, such failure to respond liquidated damages shall be offset by any payment of$1,000.00 for the maximum per minute liquidated damages for a particular incident. B. Operator Failure to Respond Liquidated Damages 1. Escalating liquidated damages(per month) in the amount of$1,000.00, $3,000.00,$5,000.00,and$10,000.00,for the first,second,third,consecutive,fourth and continuing months, respectively, will be assessed for not responding to a request for service due to the shortage of Operator 9-1-1 ambulance(s).In addition to any liquidated damages,it is understood that the City may dispatch any non-Operator ambulance in the event of Operator not responding. 2. Not responding is defined as no ambulance being assigned to the call in ten (10) minutes from the time the call is transferred to Operator by the Pueblo Dispatch Communication Center. Or no ambulance arriving on scene within 30 minutes for a priority 1 call or 40 minutes for a priority 2 call in an urban zone. 31 3. In the event that Operator is subject to liquidated damages for failure to respond in an amount of$5,000.00 or more, the City reserves the right to terminate the Contract. C. Operator Release from the Scene Liquidated Damages 1. Except when otherwise acting according to the Command and Control requirements set forth Agreement and when medically necessary, liquidated damages in the amount of$1,000.00 will be assessed for leaving a scene without prior approval from PFD.Exceptions to this requirement may be granted by the Fire Chief in his sole discretion. D. Operator Citywide Liquidated Damages 1. In the event that Operator's response fails to meet citywide monthly response time requirements as set forth herein,additional liquidated damages will accrue as follows: Citywide compliance per month Priority 1 89.9%to 89.1% $8,000.00 89%to 88.1% $10,000.00 88%to 87.1% $12,000.00 87%to 86.1% $14,000.00 86%to 85.1% $16,000.00 85%to 84.1% $18,000.00 84%and below $32,000.00 Citywide compliance per month Priority 2 89.9%to 89.1% $2,000.00 89%to 88.1% $3,000.00 88%to 87.1% $4,000.00 87%to 86.1% $5,000.00 86%to 85.1% $6,000.00 85%to 84.1% $7,000.00 84%and below $8,000.00 For purposes of computing the foregoing citywide compliance, on Priority 1 responses, both PFD and Operator arrival times, whichever is earlier, shall be considered to stop the clock. Beginning August 1,2018,and there after the citywide compliance will be based upon a 92%requirement,and thereafter citywide liquidated damages shall be determined as follows: Citywide compliance per month Priority 1 91.9%to 91.1% $8,000.00 91%to 90.1°/0 $10,000.00 90%to 89.1% $12,000.00 89%to 88.1% $14,000.00 88%to 87.1% $16,000.00 87%to 86.1% $18,000.00 86%and below $32,000.00 32 Citywide compliance per month Priority 2 91.9% to 91.1% $2,000.00 91%to 90.1% $3,000.00 90%to 89.1% $4,000.00 89%to 88.1% $5,000.00 88%to 87.1% $6,000.00 87%to 86.1% $7,000.00 86%and below $8,000.00 E. Operator Citywide Incentives Operator incentives for exceeding the citywide goal for monthly response times will be awarded as liquidated damage reductions. These reductions are available monthly and are based on the citywide response. These reductions are applied to the total per minute liquidated damages assessed. These reductions are awarded monthly and cannot be accumulated or applied to other months.The response time goal will be the previous calendar year's PFD 90th percentile priority 1 citywide response time performance. This time standard will be changed each January 30th to reflect the PFD's previous year's performance. The allowable operator liquidated damage reductions shall be: Citywide response Incentive 99.0- 100% 100%off the per minute liquidated damages 97.0—98.9% 75%off the per minute liquidated damages 95.0—96.9% 50%off the per minute liquidated damages 93.0—94.9% 25%off the per minute liquidated damages III. Operator Equipment and Supplies If during any inspection by PFD, Operator's unit fails to have the minimum equipment and supplies required by the City,unless said equipment or supplies have been used on a recent call for service,liquidated damages in the amount of$500.00 will be incurred. IV. Operator Mechanical Failures In the event of any mechanical failure, the ambulance crew shall contact Pueblo Dispatch Communications Center via radio on FIRE One. Liquidated damages of $1,000.00 will be incurred for each preventable mechanical failure occurring while transporting patient(s)from any call.The City has the sole discretion to determine whether a failure was preventable, but a preventable incident typically would be defined when proper maintenance or repair procedures have not been performed by Operator. V. Operator Administrative Failures Failure to submit identified report(s) within the required time frame will result in liquidated damages of$200 plus $50 per day thereafter until the report is received by the City. VI. Weather Pueblo presents a multitude of weather events, for which Operator is expected to be aware and prepare. Weather does not necessarily exclude response time standards. Under circumstances where the Fire Chief, or his designee, directs Operator to prepare for a predicted, adverse weather event, Operator shall deploy two (2) additional ambulances during weekday days and one(1)additional ambulance during the night time and on weekend days.Such 33 additional deployment, as well as the safe operation of Operator vehicles, shall be considered by the Fire Chief in assessing response time exemption requests under Section I.11.b. of Exhibit "A" of this Agreement. In the event that that Operator fails to respond during predicted weather events, due to circumstances within Operator's control, as determined in the sole discretion of the Fire Chief, such failure may constitute a failure to respond subject to liquidated damages set forth in Section II.B,above. VII. Operator Ambulance Staffing Failure to staff any ambulance responding to any call per the requirements of the Agreement will result in liquidated damages of$1,000.00 per incident. VIII. Ambulance Deployment All ambulances will reflect accurate status in CAD with such status to be determined by Operator. Failure to reflect proper status will result in liquidated damages of$500 per incident. In the event the technology is not ready due to the City's inability to comply with the foregoing CAD and/or AVL interface, the Operator will not be required to meet the previous section,reference 3.12 of the agreement. VIV. Other Liquidated Damages Assessments of liquidated damages for willfully falsifying proper status shall be assessed at $500 if by Operator's field staff and $1,000 if by Operator's management staff, for each incident. For clarity and to avoid doubt a unit reporting on-scene before they arrive on scene is an example of falsifying proper status. Failure to timely respond to inquiries or goals assigned by the medical director will result in liquidated damages of $500 per incident. 34 EXHIBIT"E" AMBULANCE EQUIPMENT and SPECIFICATIONS PPE CABINET CARDIAC MONITOR Eye Protection—3 ECG Cables—1 set Surgical Masks—4 12 Lead Cables—1 set Personal Protection Kit—3 Electrodes—4 sets TB Mask,Large—2 LP Batt—1 TB Mask,Medium-2 LP Paper—1 TB Mask,Small—2 Razor—1 OB Kit—1 Combo Pads,adult—1 Peroxide- 1 Combo Pads,peds—1 Hand Cleaner-1 Waveform cap NC—1 MED CABINET Waveform cap ET-1 Adenocard—5 IV CABINET Albuterol—6 Shelf 1 Amiodarone—3 Macro Drip—8 50m1 NS—1 bag Normal Saline 500m1—8 ASA—1 bottle Shelf 2 Atropine—2 Normal Saline 1000m1-2 Atrovent-3 Micro Drip—1 Bicarb 8.4%—2 Pediatric arm board—1 Calcium Chloride—1 BANDAGING CABINET D50-2 Bandaids—1 box Diphenhydramine—2 Cold Pack—2 with micro&l8ga needle Hot Pack—2 Epi 1:10,000—5 Sterile Water-2 Epi 1:1000,lml—1 Burn Sheet-2 Glucagon—1 Trauma Dressing-2 Glutose—4 Kerlix—6 Lasix—2 Non-Sterile 4x4—1 package Lidocaine—1 Occlusive Dressing—2 Mag Sulfate—2 Sam Splint-2 Narcan—2 Sling—2 Nitrostat tabs—1 Sterile 4x4— 1 box Racemic Epi-1 Surgipads—6(3 ea) IV Zofran-2 Tourniquet- 1 Solumedrol 125mg—2 SUCTION CABINET PO Zofran-8 Suction Canisters with lids-2 Ring Cutter—1 Suction Tubing—2 Mucosal atomizer-2 Tonsil Tip—2 SPINAL CABINET French Suction Caths-1 set C-Collar,Adult—6 AMR C-Collar,Peds—2 Head blocks—1 2"tape—2 Spider Straps- 1 35 02 CABINET ACTION AREA Nasal Cannula—8 Spit sock - 2 Adult NRB-6 Syringe organizer—1 Adult Neb Kits—4 60cc-0 Peds NRB-2 30cc—1 Peds Cannula-2 10cc-4 OP Airways—1 set 5cc-4 NP Airways—1 set 3cc-4 Lubricating jelly-6 lcc-4 Emesis bags-6 Angio organizer—1 AIRWAY CABINET 14ga—6 Waveform cap ET—2 16ga—6 Waveform cap NC -2 18ga—10 BVM,Adult—2 20ga—10 BVM,Child—1 22ga—5 BVM Mask,Neonatal—1 24ga—5 Chest Kit x 1 Prefilled saline—4 Neb to ET Kit—1 Trauma shears—1 Nasal ETT(prep)kit Flat Organizer Tray-1 Cric Kit- 1 Iodine preps—4 Laryngascope handle Ammonia caps—4 C Batt—2 1Sga needle—2 ET Tubes Peds and Adult(3.0-9.0)—1 ea 22ga needle—2 Peds Stylet—2 25ga needle—2 Adult Stylet—2 Filter needle—4 Adult ETT holder—2 Small basket—1 Peds ETT holder—1 Extension sets-6 Bougie—1 Thermometer-1 CPAP assembly- 1 Suction supplies for canister CARDIAC CABINET Electrodes—10 sets LP Paper—1 Combo Pads,adult—2 KED—1 Combo Pads,peds- 1 Traction splint- 1 B/P Cuff,Neonate/Peds—1 CAPTAIN'S CHAIR DRAWER B/P Cuff,Child—1 Linen sheets(flats)—4 B/P Cuff,Large Adult—1 Blankets-2 Pillow cases-2 PORT 02 CABINET Port 02 bottles—1 02 wrench— 1 02 regulator—1 36 BENCH AREA BAG STOCK B/P Cuff,Adult—1 INTERIOR COMPARTMENT Disinfectant pads-6 MED BOXES LG&SM Electrodes—2 sets ASA—1 bottle Non-sterile 4x4s—1 package Amiodarone—3 Tape, 1"clear—4 Atropine—1 Tape,1"silk-2 Bicarb 8.4%—1 Tape,2"silk—4 D50- 1 Tourniquets—10 Epi 1:10,000—4 Tagaderm—10 Lasix e—1 Alcohol preps-20 Lasix—1 SPINAL AREA Lidocaine-1 Backboards- 1 Narcan—1 Scoop- 1 Atomizer- 1 CLEANING CABINET Nitrostat tabs—1 Disinfectant spray—1 Adenocard—3 Window spray— 1 Albuterol—2 Towels-2 Atrovent- 1 BAG CABINET Diphenhydramine—1 Red bags—10 Epi 1:1000,1 m—1 Clear trash can liners-10 Mag Sulfate—1 UNDER SQUAD BENCH Solumedrol 125mg— 1 Peds Car Seat—1 Zofran tabs—4 Zofran IV- 1 BVM,Adult—1 OP Airways,adult—1 set NP Airways,adult—1 set PEDS BAG STOCK Lubricating jelly—2 LEFT SIDE POCKET INTUBATION KIT Nasal Canula—1 10cc syringe—2 NRB—1 Blade,Mac 3 and 4— 1 ea FRONT POCKET Blade,Miller 3 and 4—1 ea Manual Child Cuff—1 C Batts-2 RIGHT SIDE POCKET Cric Kit—1 Stethoscope—1 Nasal Tube(prep)Kit—1 TOP FLAP INTERNAL POCKET ET waveform cap- 1 Broselow Tape-1 ET Tubes(5.5-9.0)—1 ea Silver S waddler or foil—1 Lubricating jelly-2 Stylet—1 Bougie- 1 ETT 3.0-5.0—1 ea Laryngascope handle—1 MAIN INTERNAL POCKET Laryngascope Bulb,Lg—2 OB Kit-1 Magills,Lg— 1 Quick Trach-1 Stylet,adult—2 BVM-1 Tube holder—1 adult BOTTOM ORANGE POCKET Biohazard(red)bag—1 Magill's-1 Laryngoscope Handle—1 Blades-1 ea Light bulb—1 Thomas Tube Tie—1 BOTTOM BLUE POCKET Neonate Mask—1 OPA's—1 set Arm Board—1 37 Bag Stock cont SMALL EXTERNAL POCKETS LONG EXTERNAL POCKET BANDAGING POCKET I.O.Kit Tourniquet—1 Driver—1 Kerlix—2 Lg.Adult needle- 1 Sterile 4x4s—8 Adult needle—1 5x9 Dressing—2 Peds needle-1 8x10 Dressing—2 IV Kit Occlusive Dressing—1 Normal Saline 500m1—1 Sling—1 Normal Saline 50m1-1 Tape, 1"silk—1 Macro Drip—2 Tape,2"silk—1 Blood Y Set—0 Emesis bags—2 Angio organizer—1 Sam splint—1 14ga—2 LID POCKET 16ga—2 Refusal form-1 18ga—2 Combitube-0 20ga—2 Or King Airways—0 22ga—2 Igel-3 24ga—2 Chest Kit x 1 Alcohol preps—6 Neb to ET Kit—1 Prefilled saline—1 02 POCKET Saline lock- 1 Nasal Cannula—1 Sharps shuttle—1 Adult NRB- 1 Sterile 4x4—6 Neb Kit—1 Tape,1"clear—1 Spit mask- 1 Tourniquets—2 CUFF POCKET 10cc-2 B/P Cuff,Adult—1 5cc-1 Adult stethoscope—1 3cc-1 GLUCOMETER POCKET lcc-1 Glucometer—1 18ga needle—2 Strips—1 bottle 22ga needle—1 Lancets—4 25ga needle—1 Bandaids—4 Filter needle—2 Alcohol preps—4 Lancets—6(loose in bottom) 38 PFD EXPENDABLE EQUIPMENT AND SUPPLIES Cardiac Electrodes(Diaphoretic,Not McKesson) Syringe LP 15 Paper 30cc Razor 10cc LP 15 Quik-Combo Pads,adult 5cc LP 15 Quik-Combo Pads,pediatric 3cc LP 15 Smart CapnoLine®Plus Waveform cap NC— lcc Adult&Pediatric Angio LP 15 Waveform cap ET 14 gauge(Braun) Macro Drip 16 gauge(Braun) Normal Saline(500m1 or 1000 ml) 18 gauge(Braun) Micro Drip IV Set 20 gauge(Braun) Blood Draw set(Parkview&St.Mary Corwin) 22 gauge(Braun) Pressure Infuser 24 gauge(Braun) Cold Pack Prefilled saline(10 ml Flush) Hot Pack Safety Needles(18 gauge,22,23 or 25 gauge) Sterile Water(1000 ml) Filter needle Burn Sheet-2 Extension sets Kerlix—4" Surgical Masks Occlusive Dressing OB Kit Sam Splint Adenocard(12 mg.) Sling(Triangular Bandage) Albuterol Sterile 4x4s Amiodarone Surgipads(5"x9") 50m1 bag NS CAT Tourniquet Atropine(pre-filled syringe) Suction Canisters with lids Atrovent Suction Tubing D50(pre-filled syringe) Tonsil Tip(S-SCORT®HI-D`BIG STICK') Diphenhydramine French Suction Caths 39 Nasal Cannulas Epi 1:10,000(pre-filled syringe) Adult NRB Epi 1:1000,lml Nebulizer Kits Oral Glucose Peds NRB Lasix(pre-filled syringe) Peds Cannula Lidocaine(pre-filled syringe) OP Airways Mag Sulfate(5 gram vials) NP Airways Narcan(pre-filled syringe) Emesis bags IV Zofran BVM,Adult Solumedrol 125mg BVM,Child PO Zofran BVM Mask,Neonatal Mucosal atomizer Chest Kit x 1 (ARS) C-Collar,Adult Neb to ET Kit C-Collar,Peds Nasal ETT(prep)kit Head blocks Cric Kit Spider Straps ET Tubes Pediatric and Adult(2.0-9.0) Tape,1"clear Pediatric Stylets Tape,1"silk Adult Stylets Tape,2"silk Adult ETT holder Tourniquets Pediatric ETT holder Transparent IV Dressing (i.e.Tagaderm, Kendall, etc.) Bougie Backboards CPAP- (CPAP-FLOW-SAFE® II EZ — Small & Large) Blood Glucose Safety Lancets Cold packs Neo-Synephrine Spit sock I-GEL Airways-#1,#1.5-,#2,#2.5,#3-#4-#5 40 LP15 Pediatric Disposable Pulse Ox Probes EZ-IO Needles(15mm,25mm,45mm) EZ-IO Stabilizers COBAN 3" 2"Roller Bandage Type D Oxygen Cylinders. Disposable Laryngoscope Blades (GREENLINE®Mac 1—4&Miller 0-4) Suction Tonsil Tips(S-SCORT®HI-D`BIG STICK') Replacement Video Laryngoscope Disposable exam gloves in small, medium, large and extra-large. Other items to be added per section 7.2 41 ATTACHMENT F COLORADO PUBLIC EMPLOYEES RETIREMENT ASSOCIATION SUPPLEMENTAL QUESTIONNAIRE TO BE ANSWERED BY ANY BUSINESS PERFORMING SERVICES FOR THE CITY OF PUEBLO Pursuant to section 24-51-1101(2),C.R.S., salary or other compensation from the employment, engagement, retention or other use of a person receiving retirement benefits (Retiree) through the Colorado Public Employees Retirement Association (PERA) in an individual capacity or of any entity owned or operated by a PERA Retiree or an affiliated party by the City of Pueblo to perform any service as an employee, contract employee, consultant, independent contractor,or through other arrangements, is subject to employer contributions to PERA by the City of Pueblo. Therefore, as a condition of contracting for services with the City of Pueblo, this document must be completed,signed and returned to the City of Pueblo: (a) Are you, or do you employ or engage in any capacity, including an independent contractor, a PERA Retiree who will perform any services for the City of Pueblo? Yes_, No_. (Must sign below whether you answer "yes"or"no".) (b) If you answered"yes"to(a)above,please answer the following question: Are you 1)an individual,2) sole proprietor or partnership, or 3) a business or company owned or operated by a PERA Retiree or an affiliated party? Yes No If you answered "yes" please state which of the above listed entities (1, 2, or 3) best describes your business: (c) If you answered"yes"to both(a)and(b),please provide the name,address and social security number of each such PERA Retiree. Name Name Address Address Social Security Number Social Security Number (If more than two,please attach a supplemental list) If you answered "yes" to both (a) and (b), you agree to reimburse the City of Pueblo for any employer contribution required to be paid by the City of Pueblo to PERA for salary or other compensation paid to you as a PERA Retiree or paid to any employee or independent contractor of yours who is a PERA Retiree performing services for the City of Pueblo. You further authorize the City of Pueblo to deduct and withhold all such contributions from any moneys due or payable to you by the City of Pueblo under any current or future contract or other arrangement for services between you and the City of Pueblo. Failure to accurately complete,sign and return this document to the City of Pueblo may result in your being denied the privilege of doing business with the City of Pueblo. Signed ,20 By: Name: Title: For purposes of responding to question(b)above,an"affiliated party"includes(1)any person who is the named beneficiary or cobeneficiary on the PERA account of the PERA Retiree;(2)any person who is a relative of the PERA Retiree by blood or adoption to and including parents,siblings,half-siblings,children,and grandchildren;(3)any person who is a relative of the PERA Retiree by marriage to and including spouse,spouse's parents,stepparents,stepchildren,stepsiblings,and spouse's siblings;and (4) any person or entity with whom the PERA Retiree has an agreement to share or otherwise profit from the performance of services for the City of Pueblo by the PERA Retiree other than the PERA Retiree's regular salary or compensation. 42