COMPLETED BOARD ORDER�")6�16
Before the Board of Supervisors in and for the
County of Monterey, State of California
Agreement No: A-11496
a. Approve and authorize the Director of Health to sign Emergency
Medical Services EMS), Budget Unit 436, Agreement with San
Luis Ambulance to provide ambulance coverage in peripheral areas
of Monterey County for the period of January 1, 2009 through
December 31, 2009; and
b. Authorize the modification of the County standard insurance
requirements pertaining to General Liability insurance.
Upon motion of Supervisor Parker, seconded by Supervisor Salinas, and carried by those
members present, the Board hereby:
a. Approved and authorized the Director of Health to sign Emergency Medical Services EMS),
Budget Unit 436, Agreement with San Luis Ambulance to provide ambulance coverage in
peripheral areas of Monterey County for the period of January 1, 2009 through December 31,
2009; and
b. Authorized the modification of the County standard insurance requirements pertaining to
General Liability insurance.
PASSED AND ADOPTED this 21s' day of July, 2009, by the following vote, to wit:
AYES: Supervisors Armenta, Salinas, Calcagno, Parker
NOES: None
ABSENT: Supervisor Potter
I, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby
certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in
the minutes thereof of Minute Book 75 for the meeting on July 21, 2009.
Dated: July 22, 2009 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
Bye
Deputy
BIB]
40017-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82243-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
7/22/2009-U04
MUNOZP-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
SIGNED BOARD REPORTX��")8�MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: July 21, 2009 AGENDA NO.: 16
SUBJECT: a. Approve and authorize the Director of Health to sign Emergency Medical
Services EMS), Budget Unit 436, Agreement with San Luis Ambulance to
provide ambulance coverage in peripheral areas of Monterey County for the
period of January 01, 2009 through December 31, 2009; and
b. Authorize the modification of the County standard insurance requirements
pertaining to General Liability insurance.
DEPARTMENT: Health EMS Agency
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve and authorize the Director of Health to sign Emergency Medical Services EMS),
Budget Unit 436, Agreement with San Luis Ambulance to provide ambulance coverage in
peripheral areas of Monterey County for the period of January 01, 2009 through December
31, 2009.
b. Authorize the modification of the County standard insurance requirements pertaining to
General Liability insurance.
DISCUSSION/SUMMARY:
San Luis Ambulance is currently providing peripheral coverage in South Monterey County for
the areas south of Alvarado Road and the Community of Parkfield. The agreements with the
ambulance service providers in the peripheral areas were historically maintained by the EMS
Agency until the County entered into an agreement with Westmed Ambulance. When Westmed
Ambulance no longer provided ambulance service to the County, the agreements were
transitioned back to the EMS Agency. The proposed Agreement with San Luis Ambulance
would allow for the current coverage to continue and allow the closest ambulance provider to
respond to emergency transportation needs. The EMS Agency is currently developing a Request
for Proposal to contract with a new service provider. As part of the current Request for Proposal
process, the awarded ambulance provider will assume the responsibility for peripheral area
coverage within ninety days from the contract commencement date.
The EMS Agency and San Luis Ambulance have spent approximately six months in efforts to
meet County insurance requirements. In the interest of public health and safety, the EMS
Director has requested that the provider continue transport as necessary until such time as all
required documentation is submitted and approval of the contract is received from the Board of
Supervisors. The EMS Agency is requesting a waiver of the County standard insurance
requirements pertaining to General Liability primary and non-contributory language for San Luis
Ambulance Service, Inc. The insurance carrier will list the County of Monterey as the
additionally insured but will not agree to the primary and non-contributory clause. The
insurance does meet all other County requirements.
OTHER AGENCY INVOLVEMENT:
County Counsel has approved the Agreements as to legal form.
BIB]
40017-U01
SIGNED-U02
BOARD-U02
REPORT-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82244-U03
C10-U03
BOARD-U03
REPORTS-U03
7/22/2009-U04
MUNOZP-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
SIGNED BOARD REPORTX��")8�FINANCING:
The estimated $40,000 cost for services for January 01, 2009 through the end of the current fiscal
year was included in the Fiscal Year 2008-09 Adopted budget and Fiscal Year 2009-10
Recommended Budget. Funding comes directly from the County Service Area 74 and
consequently there is no effect on Net County Cost.
Prepared by:
h1t'/
Deanna Gunn
Finance Manager
755-5013 e t
v 5
Director of Health
Date Date
cc: Charles J. McKee, County Counsel
Michael Miller, Auditor-Controller
BIB]
40017-U01
SIGNED-U02
BOARD-U02
REPORT-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82244-U03
C10-U03
BOARD-U03
REPORTS-U03
7/22/2009-U04
MUNOZP-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��COUNTY OF MONTEREY AGREEMENT FOR PROFESSIONAL SERVICES
NOT TO EXCEED $100,000)A-11496
This Professional Services Agreement Agreement") is made by and between the County of Monterey, a
political subdivision of the State of California hereinafter County") and San Luis Ambulance
Service, Inc.
hereinafter CONTRACTOR").
In consideration of the mutual covenants and conditions set forth in this Agreement, the parties agree as
follows:
1. SERVICES TO BE PROVIDED. The County hereby engages CONTRACTOR to perform, and
CONTRACTOR hereby agrees to perform, the services described in Exhibit A in conformity with the terms of
this Agreement. The services are generally described as follows: Provide Advanced Life Support ALS)
and Basic Life Support BLS) responses to all requests_in_the exclusive operating zone entitled
South Valley Zone as defined in Exhibit A under PrimaryCoverage Area
2. PAYMENTS BY COUNTY. County shall pay the CONTRACTOR in accordance with the payment
provisions set forth in Exhibit A, subject to the limitations set forth in this Agreement. The total amount
payable by County to CONTRACTOR under this Agreement shall not exceed the sum of $ 40,000.00
3. TERM OF AGREEMENT. The term of this Agreement is from Janaury 01, 2009 to
December 31, 2009 unless sooner terminated pursuant to the terms of this Agreement. This
Agreement is of no force or effect until signed by both CONTRACTOR and County and with County signing
last, and CONTRACTOR may not commence work before County signs this Agreement.
4. ADDITIONAL PROVISIONS/EXHIBITS. The following attached exhibits are incorporated herein by
reference and constitute a part of this Agreement:
Exhibit A Scope of Services/Payment Provisions
Exhibit B Data Collection and Reporting Requirements
5. PERFORMANCE STANDARDS.
5.01. CONTRACTOR warrants that CONTRACTOR and CONTRACTOR's agents, employees, and
subcontractors performing services under this Agreement are specially trained, experienced, competent, and
appropriately licensed to perform the work and deliver the services required under this Agreement and are not
employees of the County, or immediate family of an employee of the County.
5.02. CONTRACTOR, its agents, employees, and subcontractors shall perform all work in a safe and
skillful manner and in compliance with all applicable laws and regulations. All work performed under this
Agreement that is required by law to be performed or supervised by licensed personnel shall be performed in
accordance with such licensing requirements.
Revised PSA Form $100,000 or Less I of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��5.03. CONTRACTOR shall furnish, at its own expense, all materials, equipment, and personnel necessary
to carry out the terms of this Agreement, except as otherwise specified in this Agreement. CONTRACTOR
shall not use County premises, property including equipment, instruments, or supplies) or personnel for any
purpose other than in the performance of its obligations under this Agreement.
6. PAYMENT CONDITIONS.
6.01. CONTRACTOR shall submit to the Contract Administrator an invoice on a form acceptable to
County. If not otherwise specified, the CONTRACTOR may submit such invoice periodically or at the
completion of services, but in any event, not later than 30 days after completion of services. The invoice shall
set forth the amounts claimed by CONTRACTOR for the previous period, together with an itemized basis for
the amounts claimed, and such other information pertinent to the invoice as the County may require. The
Contract Administrator or his or her designee shall certify the invoice, either in the requested amount or in such
other amount as the County approves in conformity with this Agreement, and shall promptly submit such
invoice to the County Auditor-Controller for payment. The County Auditor-Controller shall pay the amount
certified within 30 days of receiving the certified invoice.
6.02. CONTRACTOR shall not receive reimbursement for travel expenses unless set forth in this
Agreement.
7. TERMINATION.
7.01. During the term of this Agreement, the County may terminate the Agreement for any reason by
giving written notice of termination to the CONTRACTOR at least thirty 30) days prior to the effective date of
termination. Such notice shall set forth the effective date of termination. In the event of such termination, the
amount payable under this Agreement shall be reduced in proportion to the services provided prior to the date of
termination.
7.02. The County may cancel and terminate this Agreement for good cause effective immediately upon
written notice to CONTRACTOR. Good cause" includes the failure of CONTRACTOR to perform the
required services at the time and in the manner provided under this Agreement. If County terminates this
Agreement for good cause, the County may be relieved of the payment of any consideration to
CONTRACTOR, and the County may proceed with the work in any manner which County deems proper. The
cost to the County shall be deducted from any sum due the CONTRACTOR under this Agreement.
8. INDEMNIFICATION. Contractor shall indemnify, defend, and hold harmless the County of Monterey
hereinafter County"), its officers, agents and employees from any claim, liability, loss, injury or damage
arising out of, or in connection with, performance of this Agreement by Contractor and/or its agents, employees
or sub-contractors, excepting only loss, injury or damage caused by the negligence or willful misconduct of
personnel employed by the County. It is the intent of the parties to this Agreement to provide the broadest
possible coverage for the County. The Contractor shall reimburse the County for all costs, attorneys' fees,
expenses and liabilities incurred with respect to any litigation in which the Contractor is obligated to indemnify,
defend and hold harmless the County under this Agreement.
9. INSURANCE.
9.01. Evidence of Coverage:
Prior to commencement of this Agreement, the Contractor shall provide a Certificate of
Insurance" certifying that coverage as required herein has been obtained. Individual endorsements
executed by the insurance carrier shall accompany the certificate. In addition, the Contractor upon
request shall provide a certified copy of the policy or policies.
Revised PSA Form $100,000 or Less 2 of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��This verification of coverage shall be sent to the County's Contracts/Purchasing Department,
unless otherwise directed. The Contractor shall not receive a Notice to Proceed" with the work
under this Agreement until it has obtained all insurance required and the County has approved
such insurance. This approval of insurance shall neither relieve nor decrease the liability of the
Contractor.
9.02 Qualifying Insurers:
All coverage's, except surety, shall be issued by companies which hold a current policy holder's
alphabetic and financial size category rating of not less than A- VII, according to the current
Best's Key Rating Guide or a company of equal financial stability that is approved by the
County's Purchasing Manager.
9.03 Insurance Coverage Requirements: Without limiting CONTRACTOR's duty to indemnify,
CONTRACTOR shall maintain in effect throughout the term of this Agreement a policy or
policies of insurance with the following minimum limits of liability:
Commercial general liability insurance, including but not limited to premises and operations,
including coverage for Bodily Injury and Property Damage, Personal Injury, Contractual Liability,
Broad form Property Damage, Independent Contractors, Products and Completed Operations, with
a combined single limit for Bodily Injury and Property Damage of not less than $1,000,000 per
occurrence.
Exemption/Modification Justification attached; subject to approval).
Business automobile liability insurance, covering all motor vehicles, including owned, leased,
non-owned, and hired vehicles, used in providing services under this Agreement, with a combined
single limit for Bodily Injury and Property Damage of not less than $500,000 per occurrence.
Exemption/Modification Justification attached; subject to approval).
Workers' Compensation Insurance, if CONTRACTOR employs others in the performance of this
Agreement, in accordance with California Labor Code section 3700 and with Employer's Liability
limits not less than $1,000,000 each person, $1,000,000 each accident and $1,000,000 each
disease.
Exemption/Modification Justification attached; subject to approval).
Professional liability insurance, if required for the professional services being provided, e.g.,
those persons authorized by a license to engage in a business or profession regulated by the
California Business and Professions Code), in the amount of not less than $1,000,000 per claim
and $2,000,000 in the aggregate, to cover liability for malpractice or errors or omissions made in
the course of rendering professional services. If professional liability insurance is written on a
claims-made" basis rather than an occurrence basis, the CONTRACTOR shall, upon the
expiration or earlier termination of this Agreement, obtain extended reporting coverage tail
coverage") with the same liability limits. Any such tail coverage shall continue for at least three
years following the expiration or earlier termination of this Agreement.
Exemption/Modification Justification attached; subject to approval).
Revised PSA Form $100,000 or Less 3 of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��9.04. Other Insurance Requirements:
All insurance required by this Agreement shall be with a company acceptable to the County and issued and
executed by an admitted insurer authorized to transact Insurance business in the State of California. Unless
otherwise specified by this Agreement, all such insurance shall be written on an occurrence basis, or, if the
policy is not written on an occurrence basis, such policy with the coverage required herein shall continue in
effect for a period of three years following the date CONTRACTOR completes its performance of services
under this Agreement.
Each liability policy shall provide that the County shall be given notice in writing at least thirty days in
advance of any endorsed reduction in coverage or limit, cancellation, or intended non-renewal thereof.
Each policy shall provide coverage for Contractor and additional insureds with respect to claims arising
from each subcontractor, if any, performing work under this Agreement, or be accompanied by a certificate
of insurance from each subcontractor showing each subcontractor has identical insurance coverage to the
above requirements.
Commercial general liability and automobile liability policies shall provide an endorsement naming the
County of Monterey, its officers, agents, and employees as Additional Insureds with respect to liability
arising out of the CONTRACTOR'S work, including ongoing and completed operations, and shall further
provide that such insurance is primary insurance to any insurance or self-insurance maintained by the
County and that the insurance of the Additional Insureds shall not be called upon to contribute to a loss
covered by the CONTRACTOR'S insurance. The required endorsement form for Commercial General
Liability Additional Insured is ISO Form CG 20 10 11-85 or CG 20 10 10 01 in tandem with CG 20 3710
01 2000). The required endorsement form for Automobile Additional Insured endorsement is ISO Form
CA 20 48 02 99.
Prior to the execution of this Agreement by the County, CONTRACTOR shall file certificates of insurance
with the County's contract administrator and County's Contracts/Purchasing Division, showing that the
CONTRACTOR has in effect the insurance required by this Agreement. The CONTRACTOR shall file a
new or amended certificate of insurance within five calendar days after any change is made in any
insurance policy, which would alter the information on,the certificate then on file. Acceptance or approval
of insurance shall in no way modify or change the indemnification clause in this Agreement, which shall
continue in full force and effect.
CONTRACTOR shall at all times during the term of this Agreement maintain in force the insurance
coverage required under this Agreement and shall send, without demand by County, annual certificates to
County's Contract Administrator and County's Contracts/Purchasing Division. If the certificate is not
received by the expiration date, County shall notify CONTRACTOR and CONTRACTOR shall have five
calendar days to send in the certificate, evidencing no lapse in coverage during the interim. Failure by
CONTRACTOR to maintain such insurance is a default of this Agreement, which entitles County, at its
sole discretion, to terminate this Agreement immediately:
10. RECORDS AND CONFIDENTIALITY.
10.01. Confidentiality. CONTRACTOR and its officers, employees, agents, and subcontractors shall
comply with any and all federal, state, and local laws, which provide for the confidentiality of records and
other information. CONTRACTOR shall not disclose any confidential records or other confidential
information received from the County or prepared in connection with the performance of this Agreement,
unless County specifically permits CONTRACTOR to disclose such records or information.
CONTRACTOR shall promptly transmit to County any and all requests for disclosure of any such
Revised PSA Form $100,000 or Less 4 of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��confidential records or information. CONTRACTOR shall not use any confidential information gained by
CONTRACTOR in the performance of this Agreement except for the sole purpose of carrying out
CONTRACTOR's obligations under this Agreement.
10.02. County Records. When this Agreement expires' or terminates, CONTRACTOR shall return to
County any County records which CONTRACTOR used or received from County to perform services
under this Agreement.
10.03. Maintenance of Records. CONTRACTOR shall prepare, maintain, and preserve all reports and
records that may be required by federal, state, and County rules and regulations related to services
performed under this Agreement. CONTRACTOR shall maintain such records for a period of at least three
years after receipt of final payment under this Agreement. If any litigation, claim, negotiation, audit
exception, or other action relating to this Agreement is pending at the end of the three year period, then
CONTRACTOR shall retain said records until such action is resolved.
10.04. Access to and Audit of Records. The County shall have the right to examine, monitor and audit
all records, documents, conditions, and activities of the CONTRACTOR and its subcontractors related to
services provided under this Agreement. Pursuant to Government Code section 8546.7, if this Agreement
involves the expenditure of public funds in excess of $10,000, the parties to this Agreement may be subject,
at the request of the County or as part of any audit of the County, to the examination and audit of the State
Auditor pertaining to matters connected with the performance of this Agreement for a period of three years
after final payment under the Agreement.
10.05. Royalties and Inventions. County shall have a royalty-free, exclusive and irrevocable license to
reproduce, publish, and use, and authorize others to do so, all original computer programs, writings, sound
recordings, pictorial reproductions, drawings, and other works of similar nature produced in the course of
or under this Agreement. CONTRACTOR shall not publish any such material without the prior written
approval of County.
11. NON-DISCRIMINATION. During the performance of this Agreement, CONTRACTOR, and its
subcontractors, shall not unlawfully discriminate against any person because of race, religious creed, color,
sex, national origin, ancestry, physical disability, mental disability, medical condition, marital status, age
over 40), or sexual orientation, either in CONTRACTOR's employment practices or in the furnishing of
services to recipients. CONTRACTOR shall ensure that the evaluation and treatment of its employees and
applicants for employment and all persons receiving and requesting services are free of such discrimination.
CONTRACTOR and any subcontractor shall, in the performance of this Agreement, fully comply with all
federal, state, and local laws and regulations which prohibit discrimination. The provision of services
primarily or exclusively to such target population as may be designated in this Agreement shall not be
deemed to be prohibited discrimination.
12. COMPLIANCE WITH TERMS OF STATE OR FEDERAL GRANT. If this Agreement has been or
will be funded with monies received by the County pursuant to a contract with the state or federal
government in which the County is the grantee, CONTRACTOR will comply with all the provisions of said
contract, to the extent applicable to CONTRACTOR as a subgrantee under said contract, and said
provisions shall be deemed a part of this Agreement, as though fully set forth herein. Upon request, County
will deliver a copy of said contract to CONTRACTOR, at no cost to CONTRACTOR.
13. INDEPENDENT CONTRACTOR. In the performance of work, duties, and obligations under this
Agreement, CONTRACTOR is at all times acting and performing as an independent contractor and not as
an employee of the County. No offer or obligation of permanent employment with the County or particular
County department or agency is intended in any manner, and CONTRACTOR shall not become entitled by
Revised PSA Form $100,000 or Less 5 of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��virtue of this Agreement to receive from County any form of employee benefits including but not limited to
sick leave, vacation, retirement benefits, workers' compensation coverage, insurance or disability benefits.
CONTRACTOR shall be solely liable for and obligated to pay directly all applicable taxes, including
federal and state income taxes and social security, arising out of CONTRACTOR's performance of this
Agreement. In connection therewith, CONTRACTOR shall defend, indemnify, and hold County harmless
from any and all liability which County may incur because of CONTRACTOR's failure to pay such taxes.
14. NOTICES. Notices required under this Agreement shall be delivered personally or by first-class, postage
pre-paid mail to the County and CONTRACTOR'S contract administrators at the addresses listed below:
FOR COUNTY:
Tom Lynch, Emergency Medical Services
Director
FOR CONTRACTOR:
Betsey Kelton
Controller
Name and Title
19065 Portola Drive, Suite I
Salinas, Ca 93908
Address
831-755-5013 ext 27
Name and Title
P 0 Box 954
San Luis Obispo, Ca 93406
Address
Phone Phone
15. MISCELLANEOUS PROVISIONS.
15.01 Conflict of Interest. CONTRACTOR represents that it presently has no interest and agrees not to
acquire any interest during the term of this Agreement, which would directly, or indirectly conflict in
any manner or to any degree with the full and complete performance of the professional services
required to be rendered under this Agreement.
15.02 Amendment. This Agreement may be amended or modified only by an instrument in writing signed
by the County and the CONTRACTOR.
15.03 Waiver. Any waiver of any terms and conditions of this Agreement must be in writing and signed
by the County and the CONTRACTOR. A waiver of any of the terms and conditions of this
Agreement shall not be construed as a waiver of any other terms or conditions in this Agreement.
15.04 Contractor. The term CONTRACTOR" as used in this Agreement includes CONTRACTOR's
officers, agents, and employees acting on CONTRACTOR's behalf in the performance of this
Agreement.
15.05 Disputes. CONTRACTOR shall continue to perform under this Agreement during any dispute.
15.06 Assignment and Subcontracting. The CONTRACTOR shall not assign, sell, or otherwise transfer its
interest or obligations in this Agreement without the prior written consent of the County. None of the
services covered by this Agreement shall be subcontracted without the prior written approval of the
County. Notwithstanding any such subcontract, CONTRACTOR shall continue to be liable for the
performance of all requirements of this Agreement.
Revised PSA Form $100,000 or Less 6 of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��15.07 Successors and Assigns. This Agreement and the rights, privileges, duties, and obligations of the
County and CONTRACTOR under this Agreement, to the extent assignable or delegable, shall be
binding upon and inure to the benefit of the parties and their respective successors, permitted
assigns, and heirs.
15.08 Compliance with Applicable Law. The parties shall comply with all applicable federal, state, and
local laws and regulations in performing this Agreement.
15.09 Headings. The headings are for convenience only and shall not be used to interpret the terms of this
Agreement.
15.10 Time is of the Essence. Time is of the essence in each and all of the provisions of this Agreement.
15.11 Governing Law. This Agreement shall be governed by and interpreted under the laws of the State of
California.
15.12 Non-exclusive Agreement. This Agreement is non-exclusive and both County and CONTRACTOR
expressly reserve the right to contract with other entities for the same or similar services.
15.13 Construction of Agreement. The County and CONTRACTOR agree that each party has fully
participated in the review and revision of this Agreement and that any rule of construction to the
effect that ambiguities are to be resolved against the drafting party shall not apply in the
interpretation of this Agreement or any amendment to this Agreement.
15.14 Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be
deemed an original, but all of which together shall constitute one and the same Agreement.
15.15 Authority. Any individual executing this Agreement on behalf of the County or the
CONTRACTOR represents and warrants hereby that he or she has the requisite authority to enter
into this Agreement on behalf of such party and bind the party to the terms and conditions of this
Agreement.
15.16 Integration. This Agreement, including the exhibits, represent the entire Agreement between the
County and the CONTRACTOR with respect to the subject matter of this Agreement and shall
supersede all prior negotiations, representations, or agreements, either written or oral, between the
County and the CONTRACTOR as of the effective date of this Agreement, which is the date that the
County signs the Agreement.
15.17 Interpretation of Conflicting Provisions. In the event of any conflict or inconsistency between the
provisions of this Agreement and the Provisions of any exhibit or other attachment to this
Agreement, the provisions of this Agreement shall prevail and control.
This space is left blank, intentionally.
Revised PSA Form $100,000 or Less 7 of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��IN WITNESS WHEREOF, County and CONTRACTOR have executed this Agreement as of the day and
year written below.
By:
Date:
By:
Date:
COUNTY OF MONTEREY
Contracts/Purchasing Manager
ment He if
6e i4~9
CONTRACTOR
Contractor's Business Name*
Vice-President)*
Approved as to Form
By:
Date:
Co my Counsel
Approved as to Fiscal Provisionsi
By:
Auditor/Controller
Date:
L4 A it l COrL P
Name and Title
Signature of Secretary, Asst. Secretary, CFO, or
Asst. Treasurer)*
Name and Title
Approved as to Liability Provisions2
By:
Risk Management
Date:
By:
Date:
*INSTRUCTIONS: If CONTRACTOR is a corporation, including limited liability and non-profit corporations, the full legal naive of
the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a partnership, the
name of the partnership shall be set forth above together with the signature of a partner who has authority to execute this Agreement
on behalf of the partnership. If CONTRACTOR is contracting in an individual capacity, the individual shall set forth the name of the
business, if any, and shall personally sign the Agreement.
Approval by Auditor/Controller is necessary only if changes are made in paragraph 6 or if changes are made in paragraph 2 by
amendment.
AApproval by Risk Management is necessary only if changes are made in paragraph 8 or 9
Revised PSA Form $100,000 or Less 8 of 8 Project ID
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+� �EXHIBIT A
DEFINITIONS
SCOPE OF WORK
PAYMENT PROVISIONS
Purpose: To set forth the definition of Ambulance provider services to be provided by
Contractor under this Agreement, as well as the financial obligations of the County.
1. Definitions:
a) Advanced life support" ALS) means special services designed to provide definitive
pre-hospital emergency medical care, including, but not limited to, cardiopulmonary
resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management,
intravenous therapy, administration of specified drugs and other medicinal preparations,
and other specified techniques and procedures administered by authorized personnel
under the direct supervision of a base hospital as part of a local EMS system at the scene
of an emergency, during transport to an acute care hospital, during interfacility transfer,
and while in the emergency department of an acute care hospital until responsibility is
assumed by the emergency or other medical staff of that hospital.
b) Basic life support"(BLS) means emergency first aid and cardiopulmonary resuscitation
procedures which, as a minimum, include recognizing respiratory and cardiac arrest and
starting the proper application of cardiopulmonary resuscitation to maintain life without
invasive techniques until the victim may be transported or until advanced life support is
available.
c) Certificate" means a specific document issued to an individual denoting competence in
the name area of pre-hospital service.
d) Dry run" means a call responded to by Contractor which is canceled while Contractor is
enroute, or a call responded to by Contractor which results in the refusal or failure of the
patient to use the ambulance service.
e) Emergency" means a condition or situation in which an individual has a need for
immediate medical attention, or where the potential for such need is perceived by
emergency medical personnel or a public safety agency.
f) Emergency Ambulance patient" means all persons, who, by reason of accident,
misfortune, injury, illness, or mental disorder, require the services of an ambulance for
transportation to the emergency room of an acute care hospital.
g) Emergency Medical Technician l" or EMT-l" means an individual trained in all
facets of basic life support according to standards and who has a valid certificate.
h) Emergency Medical Technician-Paramedic" or EMT-P" or paramedic" means an
individual who is a mobile intensive care paramedic and whose scope of practice to
provide advanced life support is according to standards, and who has a valid certificate.
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+�
�i) Local EMS agency" means the designated agency, department, or office having primary
responsibility for administration of emergency medical services in a county.
1)
Response time" means the actual elapsed time between receipt of notification from the
Communication Center that a response unit is needed at a location and the arrival of the
response unit at that location.
2. Scope of Services
Primary Coverage Area:
Contractor is hereby assigned and does hereby accept responsibility for responding to all
requests in the boundaries defined as follows:
One mile north of Alvarado Road as it crosses Highway 101 east to the County line, going
west to Jolon Road, connecting to New Pleyto, crossing Lake San Antonio at midpoint,
connecting to the border of Fort Hunter Liggett, and turning south extending to the County
line, including Parkfield.
All of Bryson Hesperia Road.
The Monterey County ambulance provider is responsible for covering the area West of New
Pleyto Road
Mutual Aid:
Contractor may respond to mutual aid requests by Monterey County Communications in the
event of a multiple casualty incident beyond the primary coverage area when the Contractor
has resources available.
Procedure:
Requests for responses must be received from Monterey County Communications. All
requests from any other source other than Monterey County Communications must be
confirmed with Monterey County Communications; to avoid duplicate responses, to assure
that appropriate Monterey County resources are requested and dispatched, and incident
documentation occurs. Calls not received from Monterey County Communications must
have sufficient documentation, e.g. Sheriff's Department Dispatch Logs in order to be
invoiced to the County of Monterey.
Emergency Performance Standards:
The Contractor shall provide clinical performance and patient destination consistent with
approved medical standards and protocol as established by State of California regulations,
San Luis Obispo County EMS Agency policies and procedures and San Luis Obispo County
Base Hospital policies and procedures. Conduct of personnel must be professional and
courteous at all times. Clinical and response time performance must be reliable, with
equipment failure and human error held to an absolute minimum through constant attention to
procedures and prompt and definitive corrective action.
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+�
�The emergency ambulance(s) shall not respond to any non-emergency request when doing so
requires the use of the last or only ambulance unit available to serve the specified response
area.
Resolution of Disputes:
a) Patient care:
Upon a finding by the Monterey County EMS Director EMS Director) that the Contractor in
default with respect to any matter relating to patient care, and that the nature of the default is
such that termination of this Agreement is necessary to protect the public health and safety,
the specific deficiency shall be presented to the Contractor in writing, and the Contractor will
be allowed a reasonable opportunity to correct such deficiency. If the deficiency thereafter
remains, then the findings shall be presented to the Monterey County EMS Medical Director,
who will review questions involving patient care. If the EMS Director determines that the
Contractor's performance is both deficient and dangerous to public health and safety, then the
County may terminate this Agreement. The EMS Director may convene and consult any
advisory panel in making his/her determination.
b) Operations:
Upon a finding by the EMS Director that the Contractor is in default with respect to any
matter relating to operations, and that the nature of the default is such that termination of this
Agreement is necessary to protect the public health and safety, the specific deficiency shall be
presented to the Contractor in writing, and the Contractor will be allowed a reasonable
opportunity to correct such deficiency. If the deficiency remains, the County may terminate
this Agreement.
Medical Control:
Contractor's medical control will be provided by the San Luis Obispo County EMS Agency.
Contractor shall comply with all policies and procedures of the San Luis Obispo County EMS
Agency.
Traininp./Personnel
a) An advanced life support ambulance attendant and driver utilized by a Contractor shall be
at least eighteen 18) years of age, shall be trained and competent in the proper use of all
emergency ambulance equipment, and shall demonstrate compliance with all applicable
State and County laws and regulations. The attendant shall hold as a minimum
qualification a current California State certification as an EMT-P with local accreditation
in San Luis Obispo County. The driver shall hold as a minimum a current certification as
a California State EMT-1 and will have in his/her possession a valid California Driver's
License and a valid Ambulance Driver's Certificate.
b) Contractor shall participate with hospitals and the San Luis Obispo EMS Agency in
periodic reviews of emergency run cases and ensure that ambulance personnel in
contractual service do likewise in accordance with the policies and procedures of the
EMS Agency and Base Hospital.
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+�
�Communication:
a) Contractor shall provide 24 hour a day telephone answering and liaison and notify
County Communications when unable to respond.
b) Contractor shall notify County Communications of all emergency responses requested
from other sources.
c) All vehicles used in the performance of this Agreement shall be equipped with radios
capable of communicating on Monterey County Med Channel 5 and CALCORD.
d) Contractor shall operate communications equipment and use radio procedures in
accordance with instructions from the San Luis Obispo EMS Agency.
Access to Records and Reporting Requirements
The Contractor shall comply with the following recordkeeping and reporting requirements
throughout the term of this Agreement:
a) Patient Report Forms. Contractor shall complete a San Luis Obispo EMS Agency
approved form for every patient served by Contractor's personnel, and furnish a copy of
that form to the Monterey County EMS Agency for statistical analysis and medical audit
purposes see Exhibit B, attached).
b) Financial Records. The Monterey County EMS Agency shall have the right to inspect
Contractor's financial records related to this Agreement under this Agreement as follows:
upon reasonable notice and during normal business hours the Contract Officer shall have
access to Contractor's billing and accounts receivable records for purposes of
determining Contractor's compliance with approved charge schedules.
Approval of the Fee Schedule:
The Contractor's rate schedule shall not exceed the currently approved charge
schedule of San Luis Obispo County for all ambulance services. In addition, if
overcharging occurs, the payer will be immediately reimbursed for any excess taking.
Payment Provisions:
For services rendered under this Agreement during the term of this Agreement,
County shall pay to Contractor the sum of $1,000.00 per request of service per the
standard payment provisions stated in 6.01 of the Professional Services Agreement.
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+�
�Special Prohibitions:
During the term of this Agreement, and in regard to every 911 call as defined herein,
Contractor shall not engage in the following practices: telephone call screening,
refusal to transport a 911 patient to the nearest medically appropriate facility as
defined by San Luis Obispo EMS Agency transport protocols, and on-scene, enroute,
or at hospital collection of bills owed by 911 patients.
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��EXHIBIT
DATA COLLECTIOIL AND REPORTING REQUIREMENTS
The following, requirements apply only to Contractor's responses into Monterey Count,,.
A. For each patient contacted, Contractor's ambulance personnel shall complete a Sari Luis Obispo
County-approved patient care record. PCR"). Copies of the completed. PCRs shall be provided to
the Monterey County EMS Agency Agency") on a monthly basis.
B. Contractor shall furnish reports showing frequency and type of medical incidents as requested by
the Agency.
C. Contractor shall supply to the Agency, on a monthly basis, response-time data in a format
prescribed by the Agency for the Contractor`s service area, by response-zone type Urban. Rural,
Wilderness), by political jurisdiction., and any other breakdown as required by the Agency. The
following table provides a summary of the proposed reporting forrliat:
Response
I`irne
Code-3 Calls
e~~~ C urn %
Code-2 Calls
re dl Cum %
p
f
0-1 min
1-2 min
2-3 mill
3 4 ruin
4-5 min
Data on any individual ambulance call shall promptly be made available to the Agency upon
request.
E. The following irnfbrmation regarding Contractor's Monterey County responses only) shall be made
available to the Agency upon request on a month-to-month and year-to-year basis unless a different
schedule is indicated:
Sales by pay source.
2. Services provided by category e.g., A.LS. BLS, mileage) by financial classes and in total by
the last day of each month for the preceding nmonth.
3. Sales by date of service billing number per
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��4, Accounts receivable aging report by payer source.
Payment and adjustment iournal.
6. Billings schedules.
7. Collections by payer source.
8. Credit addius;mcnt by payer source write-offs).
9. Summary of billings and collections quarterly and annually).
10. Cash receipts, journal el any payments received at Contractor's location.
l 1, Quarterly statements, within 45 days of the close of each quarter, of revenues, expenses, and
cash 11m v.
12, Any other special reports within the capabilities ofComractor's computer system, as may be
requested by the Mency.
in
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID SG DATE(IAMVDIYYYY)
SANLU-3 04/16/09
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Der Manuel Ins & Fin Svcs Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Der Manuel Insurance Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 28906 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Fresno CA 93729-8906
Phone: 559-447-4600 INSURERS AFFORDING COVERAGE NAIL #
INSURED INSURERA ARCH Insurance Co
INSURERS; Tower Select Insurance
San Luis Ambulance
Service
Inc INSURER C:
P O Box 954
San L
i
Obi
CA 93406� INSURER D:
u
s
spo
INSURER E.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUIdENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERJS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
LTR TYPE OF INSURANCE POLICY NUMBER DATE MM~1DD DPOLI
ATE MID EXPIRATIONDNY)
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY MAPK06184903 09/30/08 09/30/09 PREEMMISES Eaocwrence $100000
CLAIMS MADE OCCUR MED EXP Arty one person) $ 5000
PERSONAL& ADV INJURY $1000000
GENERAL AGGREGATE $ 3000000
GEN7.AGGREGATE LIMIT APPLIES PER PRODUCTS COMPIOP AGO $ 3000000
17 POLICY LISM F1 LOC E Ben. 2000000
AU TOMOBILE LIABILITY
COMBINED SINGLE LIMIT
A ANYAUTO MAPK06184903 09/30/08 09/30/09
Ea accident) $ 1000000
ALL OWNED AUTOS
BODILY INJURY
X
SCHEDULED AUTOS
ta f
Per person) $
r
X HIRED AUTOS 9 BODILY INJURY
X NON-OWNED AUTOS c L
Per eccident) $
C) C PROPERTY DAMAGE
eag
n
PeraccIdent) $
GARAGE LIABI LITY tg 1 e.' j AUTO ONLY EA ACCIDENT $
R ANY AUTO MONTEREY COUNT) A. OTHERTHAN EAACC $
EMS AGENCY AUTO ONLY, AGG $
EXCESSNMBRELLALIABILITY A\
EACH OCCURRENCE $ 1000000
A X OCCUR j CLAIMSMADE
MAUM063772,03K�" I 09/30/08 09/30/09 AGGREGATE $1000000
$
0 DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND TORY LIMITS OETR
B EMPLOYERS'LLRBILITY
ANY PROPRIETOWPARTNERIEXECUTIVE WCC7008117 01/01/09 01/01/10 EL EACH ACCIDENT $ 1000000
OFFICERIMEMBER EXCLUDED? EL DISEASE- EA EMPLOYE $1000000
B s, describe under
SPECIAL PROVISIONS below
EL DISEASE- POLICY LIMIT
$ 1000000
OTHER
DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
*10 DAY NOTICE OF CANCELLATION WILL APPLY IN THE EVENT OF A NON-PAY
CANCELLATION. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED
CERTIFICATE HOLDER
CANCELLATION
MONTE- 5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
County of Monterey
19065 Porto la Drive #
IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPOt{.THE INSURER, ITS AGENTS OR
Salinas CA
93908 REPRESENTATIVES.
At1T O ZE
REP S
D
AA
7
ACORD 25 2001108)
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��INSURED: San Luis Ambulance Service,
POLICY NUMBER: MAPK06184903
COMMERCIAL GENERAL LIABILITY
POLICY FORMS & ENDORSEMENTS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: COUNTY OF MONTEREY
EMS
19065 Portola Drive, 91
SALINAS CA 93906
If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED Section 11) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or
rented to you.
CG.20 26 11 85 Copyright, Insurance Services, Inc., 1984
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012
FULLY EXECUTED AGREEMENT A-11+��POLICY NUMBER: MAP K06184903 COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fled by this endorsement.
This endorsement identifies person(s) or organization(s) who are insureds" under the Who Is An Insured Provi-
sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Endorsement Effective: 09/30/0$ Countersigned By:
o
Named Insured: SAN LUIS AMBULANCE w
1~aa_
Ct; t
SERVICE, INC.
honzec Representative)
Au
SCHEDULE
Name of Person(s) or Organization(s): COUNTY OF MONTEREY
I� no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to the endorsement.)
Each person or organization shown in the Schedule is an insured" for Liability Coverage, but only to the extent
that person or organization qualities as an insured" under the Who Is An Insured Provision contained
in Section ll'of the Coverage Form.
rn 9fl AO fl9 00 lnnicrnnnn Cnnrinna+ r%f6nn Inn 4 000 Dnnn 4 of 4 1
BIB]
40019-U01
FULLY-U02
EXECUTED-U02
AGREEMENT-U02
A-11496-U02
W/SAN-U02
LUIS-U02
AMBULANCE-U02
SERVICE,-U02
INC.-U02
LI21329-U03
FO21330-U03
FO74555-U03
FO75266-U03
MG75341-U03
AS75367-U03
AS75369-U03
AI81816-U03
DO82297-U03
C5-U03
AGREEMENTS-U03
7/24/2009-U04
BOYDA-U04
13708-U05
1-U06
A.-U07
APPROVE-U07
AUTHORIZE-U07
DIRECTOR-U07
OF-U07
HEALTH-U07
TO-U07
SIGN-U07
EMERGENCY-U07
MEDICAL-U07
SERVICES-U07
EMS),-U07
BUDGET-U07
UNIT-U07
436,-U07
411-HEALTH-U08
MCKEE-U09
SUSIE-U09
MCKEES-U10
7/9/2009-U011
AGREEMENT-U012
SAN-U012
LUIS-U012
AMBULANCE-U012
TO-U012
PROVIDE-U012
AMBULANCE-U012
COVERAGE-U012
IN-U012
PERIPHERAL-U012
AREAS-U012
OF-U012
MONTEREY-U012
COUNTY-U012
PERIOD-U012
OF-U012
JANUARY-U012
1,-U012
2009-U012
THROUGH-U012
DECEMBER-U012
31,-U012
2009;-U012
B.-U012
AUTHORIZE-U012
MODIFICATION-U012
OF-U012
COUNTY-U012
STANDARD-U012
INSURANCE-U012
REQUIREMENTS-U012
PERTAINING-U012
TO-U012
GENERAL-U012
LIABILITY-U012
INSURANCE.-U012