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CARE AMBULANCE SERVICES INC. (2012-196)
N ~ ~ ~~ '--' 2C ~ \C . If - .- ...... '-J INSURANCE ~QJ ON FILE WORK MAY f:1QI PROCEEb CLERK OF COUNCIL ~ DATE: '() -\(0 - \ L A-2012-196 AGREEMENT FOR EMS EMERGENCY TRANSPORTATION SERVICES This agreement ("Agreement") is made and entered into this 17th day of September, 2012, by and between the CITY OF SANTA ANA of Santa Ana, a municipal corporation located in the County of Orange ("CITY OF SANTA ANA" or "CITY") and CARE Ambulance Service, Inc., a California corporation, with principal offices at 1517 W. Braden Court, Orange, California ("CONTRACTOR"). RECITALS WHEREAS, CITY issued a Request for Proposals on February 22, 2012 (Phase 1) and on June 14,2012 (Phase 2) related to the provision of emergency transportation services in the CITY (the "RFP"). A copy of the RFP is attached hereto and incorporated herein by this reference as Exhibit "A"; and WHEREAS, in response to the RFP, CONTRACTOR submitted a Proposal dated July 9, 2012 (the "Proposal"), a copy of which is attached hereto and incorporated herein by this reference as Exhibit "B"; and WHEREAS, CONTRACTOR is an ambulance provider fully licensed and otherwise qualified to perform the work required by this Agreement, and was selected by CITY following evaluation of proposals submitted in response to the RFP; and WHEREAS, CITY desires to utilize the services of CONTRACTOR to provide primary ambulance transportation services and other related services in accordance with the terms of the RFP and applicable federal, state and local laws; and WHEREAS, at its meeting of September 17, 2012, the City Council of the CITY OF SANTA ANA accepted CONTRACTOR's Proposal and authorized CITY staffto negotiate an Agreement with CONTRACTOR to provide emergency transportation services described in the RFP and in the Proposal. NOW, THEREFORE, in consideration of the mutual promises, covenants and conditions herein contained, the parties hereby agree as follows: AGREEMENT 1. Contract Documents and Order of Precedence A. This Agreement shall consist of the following documents: (a) this Agreement; (b) the CITY's RFP, (c) and the CONTRACTOR's Proposal. This Agreement, the RFP, and the Proposal, shall be hereinafter collectively referred to as the "Contract Documents". The Contract Documents constitute the entire agreement between the parties. This Agreement contemplates that CONTRACTOR will do whatever is required to perform the work in accordance with the terms of the Contract Documents and in accordance with any applicable governmental laws and regulations, whether specifically identified in the Contract Documents or not. Should any inconsistency be found to exist between the aforesaid Contract Documents and this written Agreement, the provisions of this Agreement shall control. ETS91712 Page 1 B. All provisions of the Contract Documents shall be binding on CONTRACTOR. In the event there is any discrepancy between the terms and conditions of one or more of the aforementioned Contract Documents, the Order of Precedence shall be used to resolve the discrepancy unless both parties mutually agree in writing to an alternative decision. The Order of Precedence for these documents shall be as follows: 1) First, this Agreement (together with any Amendments thereto). 2) Second, the RFP 3) Third, the Proposal. 2. Scope of Work A. In exchange for the compensation to be provided by CITY to CONTRACTOR, CONTRACTOR will perform all of the services described in this Section for CITY. The details of the services to be provided by CONTRACTOR are described in detail in the Contract Documents. Those services shall include the provision of all 9-1-1 Emergency Transportation Services, including but not limited to the First Tier Service and the Mutual Aid Service (as defined below), together with the provision of any labor, material, supplies and equipment related to the provision of those services, and any other duties, obligation or services required of CONTRACTOR in the Contract Documents. (All of the services to be provided by CONTRACTOR under this Agreement shall be hereinafter collectively referred to as the "9-1-1 9-1-1 Emergency Transportation Services"). CONTRACTOR shall perform the 9-1-1 Emergency Transportation Services in accordance with the terms and conditions contained in this Agreement, and as described in Contract Documents. B. All emergency transportation personnel assigned by CONTRACTOR or by the Mutual Aid Provider to perform 9-1-1 Emergency Transportation Services under this Agreement shall be hereinafter referred to as the "Transportation Personnel". C. Without limiting CONTRACTOR's obligation to comply with all of its duties and obligations under the Contract Documents, the 9-1-1 Emergency Transportation Services to be provided by CONTRACTOR shall include, but shall not be limited to, each of the following: 1. First Tier Service. CONTRACTOR will provide with its own forces a sufficient number of fully equipped ambulances and Transportation Personnel, so as to provide, in accordance with industry standards and this RFP, all of the CITY's needs for 9-1-1 Emergency Transportation Service, being able to respond 24 hours a day 7 days a week to all 911 and other emergencies as required (the "First Tier Service" or "First Tier"). The First Tier Service will be designed by CONTRACTOR so as to ensure that there are enough of CONTRACTOR's own ambulances and Transportation Personnel available to meet 100% of the anticipated number of calls for 9-1-1 Emergency Transportation Service in the City of Santa Ana. The First Tier Service shall meet the response times and all other requirements of this RFP for the 9-1-1 Emergency Transportation Service. Each year thereafter, for the duration of the Term of the proposed Contract, CONTRACTOR will be required to re-evaluate the level of coverage being provided, so as to ensure it is providing the required level of coverage. 2. Mutual Aid Service. CONT ACTOR will also enter into a mutual aid agreement with a separate qualified ambulance service provider doing business in Orange County, to provide backup services in the event the First Tier Service is unable to respond to a call for Emergency ETS91712 Page 2 Services (hereinafter "Mutual Aid Contract," "Mutual Aid Service," "Mutual Aid Service" or "Mutual Aid"). The company providing the Mutual Aid Service will be hereinafter referred to as the "Mutual Aid Provider." In providing 9-1-1 Emergency Transportation Services the Mutual Aid Provider must meet the same RFP requirements, response times, and otherwise provide the same level of service, as CONTRACTOR is required to provide under the Contract. The Mutual Aid Contract and the Mutual Aid Provider must be approved by the CITY and the OCF A prior to provision of any service by Contractor, such approval not to be unreasonably withheld. The intent of this RFP is that CONTRACTOR will provide a sufficient level of coverage under the First Tier Service, such that services under the Mutual Aid Service will only be needed in rare circumstances, if at all. CONTRACTOR will be solely responsible for paying the Mutual Aid Provider for any services rendered under the Mutual Aid, which amount will be the Mutual Aid Provider's sole compensation for services rendered under the Mutual Aid. D. BLS and ALS Services. All Transportation Personnel assigned to perform 9-1-1 Emergency Transportation Services under this Contract, whether under the First Tier Service or Mutual Aid Service, will provide Basic Life Support ("BLS") services and transport patients to medical facilities when required. OCF A, in cooperation with the Transportation Personnel, will provide on-scene Advanced Life Support ("ALS") services. E. All Transportation Personnel assigned to perform 9-1-1 Emergency Transportation Service under this Contract, whether under the First Tier Service or Mutual Aid Service, must at all times meet the minimum qualifications as listed in Section 5 of the RFP. F. The Agreement is subject to annual review based on the criteria specified in the Contract and as outlined herein. The CITY's intent is to contract with and hold accountable those parties working with and on behalf of the CITY and OCF A in providing 9-1-1 Emergency Transportation Service to the citizens and visitors of Santa Ana. G. CONTRACTOR and the Mutual Aid Provider will provide type III emergency transport (ambulance) vehicles (including all costs related to maintenance, fuel, insurance, repair costs and communication equipment) for all 9-1-1 Emergency Transportation Services provided under the First Tier Service and the Mutual Aid Service. 3. Contract Price and Payment A. CITY shall pay CONTRACTOR for furnishing the material and doing the prescribed work at the unit prices or lump sum prices set forth in CONTRACTOR's Proposal ("Contract Price"). 1. CONTRACTOR's sole compensation for providing all 9-1-1 Emergency Transportation Services, specifically including but not limited to the First Tier Service and Mutual Aid Service will be the Contract Price. CONTRACTOR will not be entitled to bill CITY or any of its customers any additional amount for any services provided under this Contract, unless it is first approved in writing by CITY. 2. The payment of the Contract Price includes the provision of the Mutual Aid Service. CONTRACTOR will be solely responsible for compensating the Mutual Aid Provider for any 9- 1-1 Emergency Transportation Services it may provide in the City of Santa Ana under this Contract, which compensation will be at the rate set forth in the Mutual Aid Contract or as otherwise required by law. CONTRACTOR and the Mutual Aid Provider will not have any recourse against the CITY to recover for any 9-1-1 Emergency Transportation Services provided ETS91712 Page 3 under either the First Tier Service or the Mutual Aid Service, except as specifically authorized in the Contract. CONTRACTOR's sole compensation will be the Contract Price it receives from CITY. In the event of a dispute between the Mutual Aid Provider and CONTRACTOR, the Mutual Aid Provider's sole remedy will be against CONTRACTOR. This fact will be clearly stated in the Mutual Aid Contract, and CONTRACTOR must agree to indemnify and defend CITY OF SANTA ANA against any claims or demands arising out of, or which are in any way related to, any services provided under the Mutual Aid Service. The Mutual Aid Contract will include similar provisions requiring the Mutual Aid Provider to indemnify CITY OF SANTA ANA for any claims or demands made by CONTRACTOR or other parties related to the 9-1-1 Emergency Transportation Services it may provide. 4. Billing A. CITY will be solely responsible for the billing and collection of all amounts owed by customers/patients provided 9-1-1 Emergency Transportation Services in the City of Santa Ana, whether for services provided by CONTRACTOR, the Mutual Aid Provider, OCF A, CITY, or their respective employees, agents, volunteers, or subcontractors. CITY, in its discretion, will be free to bill for these services in whatever manner it may deem appropriate, and may combine billings for various services provided. CONTRACTOR and the Mutual Aid Provider will actively cooperate with CITY to provide whatever information or assistance CITY may reasonably require so that it can process customer/patient billings in a timely manner. This will include, but is not limited to, CONTRACTOR providing CITY with a detailed list of all the 9-1-1 Emergency Transportation Services provided by both the CONTRACTOR and the Mutual Aid Provider during the preceding month. The specific information to be provided by CONTRACTOR in the monthly reports will be determined by CITY, and may be modified by CITY from time to time to meet its reasonable needs. Failure to provide accurate information in a timely manner will constitute a material breach of this Agreement. B. The entire proceeds of all such billings and collection efforts will be the sole property of CITY OF SANTA ANA. Neither CONTRACTOR nor the Mutual Aid Provider will have any right to the proceeds of any billings or collections for services provided under the First Tier Service, the Mutual Aid Service or for any other services provided under this Agreement, unless specifically authorized in writing by CITY. CONTRACTOR must design its bid so that the amount bid as the Contract Price will be sufficient to provide the required level of services under both the First Tier Service and the Mutual Aid Service, without expecting any additional amounts in compensation. C. CITY OF SANTA ANA may amend this contract in the event the City of Santa Ana elects an optional bid proposal submitted by a contractor as part of the Phase II RFP process. 5. Term A. Effective Date. The effective date of this Agreement shall be 12 a.m. on September 20,2012, ("Effective Date"), at which time CONTRACTOR will assume full responsibility for the provision of 9- 1-1 Emergency Transportation Services within the CITY OF SANTA ANA. At the sole discretion of the OCF A on behalf of the City of Santa Ana, the Effective Date may be postponed in order to protect public health and safety, or in the event CONTRACTOR is for any reason unable to commence performance at that time. B. Initial Term. This Agreement is for an initial three (3) year term, beginning on the Effective Date and ending on 12 a.m. on September 20, 2015 (the "Initial Term"). The contract shall automatically expire at the end of the Initial Term unless extended as provided below. ETS91712 Page 4 C. Extension. Upon the mutual written agreement of the parties, the contract may be extended for up to two (2) additional one (1) year terms (for a possible total of 5 years), by a writing executed by the City Manager and the City Attorney. Successful past performance during the initial contract period will be a critical factor in the decision to grant an extension. The CITY's decision to either grant or deny a contract extension(s) shall be final. The decision to grant an extension shall be made with the concurrence of OCFA. At the end of the Initial Term, or at the end of contract extension term(s) if granted, this Agreement shall automatically terminate (the Initial Term together with any contract extension(s), if any, shall hereinafter be collectively referred to as the "Term"). 6. Termination This Agreement may be terminated by the parties as hereinafter provided: A. This Agreement may be terminated by either party, with or without cause, upon ninety (90) days prior written notice to the other party. B. The CITY OF SANTA ANA may terminate this Agreement for Cause by providing CONTRACTOR seven (7) days prior written notice of termination for Cause and the factors constituting Cause. C. OCFA on behalf of the CITY OF SANTA ANA may terminate this Agreement immediately if the OCF A Fire Chief or designee (in their reasonable discretion) determine that continued operations by CONTRACTOR following the breach would constitute a danger to the public health, safety or general welfare. 7. Breach of Agreement A. Factors Constituting Breach and Cause. Factors constituting a breach of this Agreement and also warranting Cause for termination include but are not limited to each ofthe following: 1. A failure by CONTRACTOR to perform the covenants and requirements set forth in the Contract Documents in the time and manner specified, and as required by this Agreement. 2. Failure of CONTRACTOR to perform the 9-1-1 Emergency Transportation Services in a manner which enables the CITY OF SANTA ANAlOCF A or CONTRACTOR to remain in compliance with the requirements of the County of Orange Emergency Medical Services ("OCEMS") ambulance ordinance and related rules and regulations. 3. Supplying the CITY /OCFA with materially false or misleading information during the RFP process or during the course of producing any required reports to the CITY or OCF A. 4. Willful falsification or unreasonable withholding of data supplied to the CITY OF SANTA ANA or OCF A or to OCEMS during the Term of this Agreement, including but not limited to: dispatch data, patient report data, response time data, financial data, or omission of other data required under this Agreement. 5. Failure to meet the minimum vehicle deployment plan for ambulance service as described in the RFP. ETS91712 Page 5 6. Failure of CONTRACTOR's employees to conduct themselves In a professional and courteous manner, and to present a professional appearance. 7. Failure of CONTRACTOR to maintain all required vehicle maintenance schedules and records as set forth as described in the RFP or as reasonably required by CITY or OCF A. 8. Failure of CONTRACTOR to maintain all training and continuing education as required in the RFP, and as required by OCF A and OCEMS policies and procedures and State regulations. 9. CONTRACTOR's failure or refusal to respond to any request by CITY or OCFA concerning the manner or means by which CONTRACTOR is providing the operation of 9-1-1 Emergency Transportation Services in the CITY OF SANTA ANA under this Agreement and pursuant to the Contract Documents. 10. Transfer or assignment of ownership or other interest in CONTRACTOR contrary to the terms of this Agreement, including but not limited to Section 11 of this Agreement [" Assignment"]. 11. Disruption of service due to failure to maintain ambulance maintenance schedule. 12. The lapse of any license, permit or approval issued CONTRACTOR by a federal, state or local government, which license, permit or approval is/are reasonably necessary for the provision of the 9-1-1 Emergency Transportation Services contemplated by the Contract Documents. 13. CONTRACTOR becomes insolvent or unable to pay its debts as they mature, or makes an assignment for the benefit of creditors, or suffers or fails to pay and discharge within ninety (90) days of entry any final judgment (after exhaustion of any period of appeals) by any court in an amount of fifty thousand dollars ($50,000.00) or more. 14. CONTRACTOR files, or there is filed against CONTRACTOR, a petItIon to have CONTRACTOR adjudicated in a bankruptcy, or a petition for a reorganization or arrangement under any law relating to bankruptcy or insolvency. 15. CONTRACTOR is enjoined or prohibited by any court of competent jurisdiction from performing services under this Agreement. 16. The assets of CONTRACTOR are assumed by a trustee or other person pursuant to a judicial proceeding. 17. CONTRACTOR breaches or defaults in the performance of any of CONTRACTOR's material duties or obligations arising under this Agreement involving the payment of money, and after receiving written notice thereof from CITY OF SANTA ANA fails within seven (7) days from receipt of such notice to have fully cured and corrected such breach or default. 18. Lapse of insurance required under this Agreement. 19. Failure to manage and resolve citizen complaints to the satisfaction of the CITY or OCF A. ETS91712 Page 6 20. Failure to meet the on-time performance criteria as required in the RFP, as amended by CONTRACTOR'S proposed 93% response time to Code 2 and Code 3 incidents. 21. The breach or default of, or a failure to comply with, any material provision of this Agreement, any material provision of the RFP, or of any covenant specifically contained herein or incorporated by reference. B. Right to Cure. In the event of any dispute arising under this Agreement, the injured Party shall notify the injuring Party in writing of its contentions by submitting a claim therefore. The injured Party shall continue performing its obligations hereunder so long as the injuring Party cures any default within thirty (30) days after service of the notice; provided, however, if a breach of this Agreement creates an immediate danger to the health and safety or general welfare to the CITY OF SANTA ANA, in the reasonable discretion of the Fire Chief or designee, may take immediate action to remedy the breach itself and/or terminate this Agreement. Notwithstanding the preceding, if the Fire Chief or designee finds that CONTRACTOR is diligently proceeding with all steps necessary to cure such default, the Fire Chief or designee in conjunction with the CITY OF SANTA ANA may, in his sole discretion, extend the time period by which CONTRACTOR must cure such deficiencies, including the effective date of such termination. C. Waiver. No waiver of any Event of Breach or Default shall be valid or effective unless in writing and signed by CITY OF SANTA ANA. Any waiver of anyone Event of Default or Breach shall not constitute, or be construed as creating, a waiver of any other Event of Default or Breach. D. Action Following Termination. Should this Agreement be terminated for breach, CONTRACTOR agrees that CITY and/or OCF A, in their discretion, may take immediate possession of any CITY or OCF A materials, equipment, and supplies CONTRACTOR may have used in the performance of the 9-1-1 Emergency Transportation Services. Notwithstanding the above, should this Agreement be terminated for breach, CITY OF SANTA ANA or OCF A shall have the option to take over the delivery of the 9-1-1 Emergency Transportation Services itself, using CITY personnel or contractors; contract on a temporary emergency basis with other providers of emergency transport ambulance services; seek new proposals for service; or such other option as may be deemed necessary and legally available to CITY. E. No Limitation on CITY's Rights. Nothing herein shall act as any limitation upon the remedies available to CITY whether at law, or otherwise, in the event of a breach or default of this Agreement. 8. Insurance A. Prior to beginning the provision of 9-1-1 Emergency Transportation Services under this Agreement, CONTRACTOR must provide to the satisfaction of the CITY and OCF A, certificates of insurance and endorsements evidencing the policy or policies of insurance in the types and amounts set forth below. CONTRACTOR shall at all times during the term of this Agreement carry, maintain, and keep in full force and effect, the following minimum scope of insurance coverage: 1) Commercial General Liability Insurance in an amount not less than $10,000,000 per occurrence, written on an occurrence form. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $10,000,000 per occurrence. ETS91712 Page 7 2) Ambulance Medical Malpractice Insurance in an amount not less than $3,000,000 per occurrence. If the policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. Such insurance coverage may be combined with either the general or automobile liability coverage required above; provided, however, if the insurance coverage is so structured, the combined coverage shall be in an amount not less than $5,000,000 per occurrence, with an annual aggregate of not less than $10,000,000. 3) Comprehensive Business Automobile Liability Insurance in an amount not less than $3,000,000 per occurrence, covering owned, non-owned and hired vehicles, written on an occurrence form. If policy carries an annual aggregate, such aggregate shall be in an amount not less than $6,000,000 per occurrence. CONTRACTOR understands that it must provide Business Automobile Liability coverage for all vehicles under both the First Tier Service and the Mutual Aid Service. This specifically includes, but is not limited to, CONTRACTOR's obligation to provide Business Automobile Liability coverage for any vehicles provided by CITY /OCF A for use by CONTRACTOR under the First Tier, as well as for any vehicles provided by CONTRACTOR directly. 4) Workers' Compensation and Employers' Liability Insurance in a statutory amount for workers' compensation and in an amount not less than $1,000,000 for employers' liability. Such insurance shall contain a waiver-of-subrogation clause in favor of the CITY OF SANTA ANA and OCF A, and their respective officers, officials, employees and agents. B. CONTRACTOR shall also comply with the following requirements: 1) If the above-required insurance coverage does not provide for an annual aggregate which is twice the per-occurrence limit, in the alternative the insurance policy (policies) shall be amended (by appropriate ISO endorsements) so that the policy limits apply solely to this Agreement. 2) The above-required liability insurance shall be in a form which supports coverage for the provisions of the indemnification clause required under this Agreement, including a claim brought against the CITY OF SANTA ANA and/or OCF A for the injury to, or death of an employee or agent of CONTRACTOR. 3) In the event of a claim (claims) against the above-referenced liability policies which reasonably may deplete one-half or more of the aggregate limits, CONTRACTOR shall immediately notify CITY and OCFA. In the event a claim (claims) against the above-referenced liability policies which are reasonably expected to deplete 90% of the aggregate limits, CONTRACTOR shall, at CONTRACTOR's expense, reinstate the aggregate limits at least to an amount equal to one-half of the face amount of the aggregate limits on the policies. 4) All insurance required pursuant to this section shall be issued by a company authorized by the Insurance Department of the State of California and rated A-VII or better by the latest edition of Best's Key Rating Guide. 5) No insurance required herein shall provide for a deductible in excess of $5,000 or a self-insured retention in any amount, without prior written consent of the CITY and OCF A; and, ETS91712 Page 8 the granting or denying of such consent shall be at the sole and absolute discretion of the CITY OF SANTA ANA and OCFA. C. Endorsements. 1) All insurance required herein shall be endorsed to state that "Coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior to written notice by certified mail, return receipt requested, has been given to the CITY OF SANTA ANA and OCFA." 2) The liability policies required herein, except for professional liability (if a stand-above coverage), workers compensation and employers' liability, shall, by endorsement, contain the following provisions: (a) "The CITY OF SANTA ANA and OCFA, and their respective officers officials, employees, representatives, and volunteers, are hereby declared to be additional insureds as respects the operations, activities, work, errors, or omissions of the named insured arising out of or in connection with any contract or agreement with the CITY OF SANTA ANA." (b) "This insurance is primary to, and shall not contribute with, any insurance or self-insurance maintained by the CITY OF SANTA ANA, by OCF A, or by any of the designated additional insureds." (c) "This insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability." 3) Worker's Compensation and Professional Liability policies shall be endorsed to state that the insurer waives all rights of subrogation against the CITY OF SANTA ANA and OCF A, and their respective officers, officials, agents, employees, and volunteers for losses arising from work performed by the CONTRACTOR under this Agreement. D. All insurance coverages shall be confirmed by execution of endorsements and certificates of insurance. CONTRACTOR is required to file the completed policy endorsements and certificates with CITY OF SANTA ANA and OCF A on or before the Effective Date of this Agreement, and to thereafter maintain current endorsements on file with CITY and OCF A. The completed endorsements and certificates of insurance are subject to the approval of CITY and OCFA. E. Nothing in this section shall be construed as limiting in any way; the Indemnification and Hold Harmless clause contained herein in this Agreement, or the extent to which CONSULTANT may be held responsible for payments of damages to persons or property. F. CITY OF SANTA ANA or OCFA shall have the right at any time to review the coverage, form, and limits of insurance required herein. If, in the sole and absolute discretion of the CITY and/or OCF A, the insurance provisions in this Agreement do not provide adequate protection for the CITY OF SANTA ANA and/or OCFA, the CITY and/or OCFA shall have the right to require CONTRACTOR to obtain insurance sufficient in coverage, form, and limits to provide adequate protection and CONTRACTOR shall promptly comply with such requirement. The CITY's and OCF A's requirements shall not be unreasonable, but shall be adequate in the sole opinion of the CITY and OCF A to protect against the kind and nature of risks which exists at the time a change of insurance is required, or thereafter. ETS91712 Page 9 G. Alternate forms of insurance, that meet the above requirements, must be approved by the CITY OF SANTA ANA's and OCFA's Risk Manager prior to awarding a contract and beginning any work under this Agreement. 9. Indemnification CONTRACTOR agrees to defend, indemnify, hold free and harmless the CITY OF SANTA ANA and OCF A, and their respective officers, officials, agents, employees and volunteers, at CONTRACTOR's sole expense, from and against any and all claims, actions, suits or other legal proceedings brought against the CITY OF SANTA ANA or OCF A, or their respective officers, officials, agents, employees or volunteers, arising out of the performance of the CONTRACTOR, its employees, agents and/or authorized subcontractors, of the work undertaken pursuant to the Agreement, specifically including but not limited to the 9-1-1 Emergency Transportation Services. The defense obligation provided for hereunder shall apply without any advance showing of negligence or wrongdoing by the CONTRACTOR, its employees, agents and/or authorized subcontractors, but shall be required whenever any claim, action, complaint, or suit asserts as its basis the negligence, errors, omissions or misconduct of the CONTRACTOR, its employees, agents and/or authorized subcontractors, and/or whenever any claim, action, complaint or suit asserts liability against the CITY OF SANTA ANA or OCF A, or their respective officers, officials, agents, employees or volunteers, based upon the work performed by the CONTRACTOR, its employees, agents and/or authorized subcontractors under this Agreement, whether or not the CONTRACTOR, its employees, agents and/or authorized subcontractors are specifically named or otherwise asserted to be liable. Notwithstanding the foregoing, the CONTRACTOR shall not be liable for the defense or indemnification of the CITY OF SANTA ANA or OCF A for claims, actions, complaints or suits arising out of the sole negligence or willful misconduct of the CITY OF SANTA ANA or OCFA. 10. Compliance with RFP Requirements for Operations, Personnel and Safety. Without limiting CONTRACTOR's duty to comply with other requirements of the RFP, Contractor understands that throughout the Term of this Agreement CONTRACTOR must remain in full compliance with the terms, conditions and requirements in each of the following sections of the RFP: A. Section 4 of the RFP, entitled "Operational Standards, Procedures and Performance Requirements." B. Section 5 of the RFP, entitled "Personnel Rules and Requirements." C. Section 6 of the RFP, entitled "Personal Safety Equipment." The failure of CONTRACTOR to abide by any of the requirements set forth in Sections listed above will be considered a breach of this Agreement, and will be grounds for termination. 11. Assignment. A. Except as provided herein, CONTRACTOR may not delegate, transfer or assign its rights or otherwise transfer its obligations, in whole or in part, under the proposed contract to any other person or entity without first obtaining the prior written consent of the CITY OF SANTA ANA and OCF A and not for 180 days after the formal contract award. Any such assignment or transfer without the prior written consent of the CITY and OCF A shall be void; the attempted assignment shall constitute a breach of the Contract. ETS91712 Page 10 B. For purposes of this section, the following will be considered to be a "transfer" or "assignment": 1. Any change in the business structure, including but not limited to, changes from or to: (a) a sole proprietorship; (b) a partnership, including any change in the partners; (c) a corporation, including any change in the shareholders, whether by operation of law or otherwise; 2. Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver; or 3. A transfer by any of the owners, shareholders or members (whichever is applicable) of CONTRACTOR of greater than ten percent (10%) of the ownership interest, stock or membership interest (whichever is applicable) in CONTRACTOR's business, issued as of the Effective Date by the CONTRACTOR, or the sale or transfer of over twenty-five percent (25%) of the assets of the CONTRACTOR. In the event a CONTRACTOR experiences regular stock exchanges in excess of the ten percent (10%) threshold, a separate agreement may be negotiated to set a threshold that still provides the OCF A with the protections intended. The stock sale of a publicly traded corporation that does not constitute a change in majority ownership will not be deemed a transfer of ownership for purposes of this Section. 12. Audits and Inspections. At any time during normal business hours, and as often as may reasonably be deemed necessary by the CITY and OCF A, the CITY may observe and inspect CONTRACTOR's business office, and CONTRACTOR must make promptly available to the CITY or OCF A for its examination all of CONTRACTOR's records that pertain to performance of the Agreement. The CITY or OCFA may audit, examine, and copy any and all CONTRACTOR records pertaining to their performance of the Agreement, including but not limited to, personnel records, daily logs, conditions of employment, and all other data. The CITY's or OCFA's right to inspect CONTRACTOR's business office and any and all records pertaining to their performance of the Agreement will be restricted to normal business hours and reasonable notice shall be given to CONTRACTOR in advance of such inspection. 13. Independent Contractor. A. In the performance of this Agreement, CONTRACTOR shall be acting in an independent capacity from the CITY OF SANTA ANA and OCF A, and not as an agent, employee, partner, or pursuant to any kind of joint venture or partnership with the CITY or OCF A. The parties understand and agree that CONTRACTOR, its officers, agents and employees (which term specifically includes, but is not limited to, the Transportation Personnel) are not employees of the CITY, the County, or OCF A, and are not entitled to any of the rights, benefits, or privileges of CITY, County, or OCF A employees including, but not limited to, medical, unemployment, or workers' compensation insurance. B. Neither the County, the CITY OF SANTA ANA or OCF A, or any of their respective officers, elected officials, agents, representatives, or employees, shall have any control over the conduct of CONTRACTOR's agent's and employees except as specifically set forth in the Contract Documents. Under no circumstances shall CONTRACTOR or any of its agents or employees represent that they are in any manner agents or employees of the CITY, County or OCFA, it being understood that CONTRACTOR its agents and employees are as to the CITY, County and OCF A, wholly independent contractors and that CONTRACTOR's obligations to the CITY and OCFA are solely those prescribed by the Contract Documents. ETS91712 Page 11 C. CITY, the County, and OCFA have no responsibility whatsoever for the payment of any wages, salary, health benefits, retirement benefits, taxes, or any other benefits that may be due to CONTRACTOR's employees and agents performing 9-1-1 Emergency Transportation Services under this Agreement, specifically including but not limited to the Transportation Personnel. CONTRACTOR further acknowledges and agrees that the CITY, the County, and OCF A have no responsibility whatsoever for the filing of any employer related documentation (tax forms, payroll, or otherwise) with the federal, state or local governmental authorities, concerning those persons CONTRACTOR assigns to perform 9-1-1 Emergency Transportation Services under this Agreement. The preparation and filing of all employee related documentation shall be the sole responsibility of CONTRACTOR. 14. Compliance with Laws All services provided by CONTRACTOR pursuant to the Contract Documents must be rendered in full compliance with all applicable federal, state, and local laws, rules, statutes, and regulations. It will be CONTRACTOR's sole responsibility to determine which federal, state, and local laws, rules, statutes, and regulations apply to the services to be performed pursuant to the Contract Documents, and to maintain compliance at all times throughout the Term of this Agreement. 15. Responsibility Except as may be specifically stated herein to the contrary, it shall be the responsibility of CONTRACTOR to provide all Transportation Personnel with whatever resources and equipment are necessary to perform the 9-1-1 Emergency Transportation Services, and to otherwise satisfy all of the terms and conditions set forth in the Contract Documents at all times during the Term of this Agreement. Except where it may be specifically permitted in the Agreement, CONTRACTOR may not use any outside ambulance service providers or other resources to satisfy its obligations to provide 9-1-1 Emergency Transportation Services to the CITY OF SANTA ANA, without first obtaining the prior written consent of the CITY. Notwithstanding the granting of any such approval by the CITY, nothing stated herein shall relieve CONTRACTOR of its duties and responsibilities under the Agreement, and any additional cost incurred shall not be charged to the County, CITY or OCF A. 16. Acts or Omissions of Representatives The acts and/or omissions of the owner(s), officers, operators, officials, employees, agents, and representatives of the CONTRACTOR in the performance of the services and obligations under the Contract Documents shall constitute the acts and/or omissions of the CONTRACTOR. 17. Insolvency CONTRACTOR shall not, without the prior written consent of the CITY and OCF A Fire Chief or designee, suffer either the appointment of a receiver to take possession of all, or substantially all of the assets of CONTRACTOR, or make a general assignment of such assets for the benefit of creditors. Any such action taken or suffered by CONTRACTOR under any insolvency or bankruptcy proceeding constitutes a material breach of this Agreement by CONTRACTOR, and all property, equipment or materials assigned by OCF A, the CITY OF SANTA ANA and/or the County to CONTRACTOR related to the provision of services under this contract shall be automatically "released" by CONTRACTOR and returned back to the possession and control of the CITY OF SANTA ANA and OCFA. Following the occurrence of any such event, the OCF A Fire Chief or designee may assign such property, equipment or materials to another 9-1-1 Emergency Transportation Services provider, in the CITY OF SANTA ANA's sole discretion. ETS91712 Page 12 18. Familiarity with Work By execution of this Agreement, CONTRACTOR warrants that: A. It has thoroughly investigated and considered the 9-1-1 Emergency Transportation Services to be performed; B. It possesses any and all licenses which are required under relevant local, State, or Federal law to perform the 9-1-1 Emergency Transportation Services contemplated by this Agreement, and shall maintain all appropriate licenses during the performance of this Agreement. C. It has expertise in the provision of 9-1-1 Emergency Transportation Services as that term is defined in this Agreement; D. It carefully considered how the 9-1-1 Emergency Transportation Services should be performed; and E. It fully understands the difficulties and restrictions attending the performance of the 9-1-1 Emergency Transportation Services under this Agreement. 19. Validity The invalidity in whole or in part of any provision of this Agreement shall not void or affect the validity of any of the other provisions of this Agreement. 20. Governing Law This Agreement shall be governed by and construed in accordance with the laws of the State of California. Any legal action relating to or arising out of this Agreement shall be subject to the jurisdiction of the County of Orange, California. 21. Entire Agreement This Agreement supersedes any and all other agreements whether oral or written, between the parties hereto with respect to the subject matter hereof, and contains all of the covenants and agreements between the parties with respect to said matter, and each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that any other agreement or modification of this Agreement shall be effective only if executed in writing and signed by both CITY OF SANTA ANA, OCF A, and CONTRACTOR. 22. Attorney's Fees In the event any legal proceeding is instituted to enforce any term or provision of this Agreement, the prevailing party in said legal proceeding shall be entitled to recover attorneys' fees and costs from the opposing party in an amount determined by the Court to be reasonable. 23. Representatives and Notices The City Manager or his designee shall be the representative of CITY. The OCF A Fire Chief or his designee shall be the representative ofOCFA. For purposes of this Agreement the City Manager may ETS91712 Page 13 issue all administrative consents, approvals, directives and agreements. The OCF A Fire Chief on behalf of the CITY OF SANTA ANA, may issue operational directives required by this Agreement, except as otherwise expressly provided in this Agreement. Rick Richardson shall be the representative of CONTRACTOR for purposes of this Agreement and may issue all consents, approvals, directives and agreements on behalf of CONTRACTOR, called for by this Agreement, except as otherwise expressly provided in this Agreement. All notices and written communications sent by one party to the other shall be personally delivered or sent by registered or certified u.s. Mail, postage prepaid, return receipt requested, to the following addresses indicated below: To City: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M30) P.O. Box 1988 Santa Ana, CA 92702 With Courtesy copy to OCFA: Attn: Clerk of the Authority 1 Fire Authority Road Irvine, CA 92602 If to CONTRACTOR: CARE Ambulance Service, Inc. Mr. Rick Richardson 1517 W. Braden Court Orange, CA 92868 The effective date of any notice or written communications sent by one party to the other shall be the date received if by personal service, or forty-eight (48) hours after deposit in the U.S. Mail as reflected by the official u.S. postmark. Either party may change its address by giving notice in writing to the other party. 24. Waiver No waiver of any provision of this Agreement shall be effective unless in writing and signed by a duly authorized representative of the party against whom enforcement of a waiver is sought, referring expressly to this Paragraph. The waiver of any right or remedy in respect to any occurrence or event shall not be deemed a waiver of any right or remedy in respect to any other occurrence or event, nor shall any waiver constitute a continuing waiver. 25. Rights and Remedies are Cumulative Except with respect to rights and remedies expressly declared to be exclusive in this Agreement, the rights and remedies of the Parties are cumulative and the exercise by either Party of one or more of such rights or remedies shall not preclude the exercise by it, at the same or different times, of any other rights or remedies for the same default or any other default by the other Party. 26. Cooperation CONTRACTOR must cooperate with the CITY OF SANTA ANA and take all actions necessary to ensure that all terms and conditions, and required performance levels, set forth in the Contract Documents are satisfied at all times throughout the Term of the Agreement. ETS91712 Page 14 27. Legal Action In addition to any other rights or remedies, either Party may take legal action, in law or in equity, to cure, correct, or remedy and default, to recover damages for any default, to compel specific performance of this Agreement, to obtain injunctive relief, or to obtain any other remedy consistent with the purposes of this Agreement. 28. Amendment This Agreement may be amended only by the written mutual consent of CITY OF SANTA ANA and CONTRACTOR. 29. Additional Services CONTRACTOR shall not receive compensation for any services provided outside the scope of the Contract Documents unless such additional services are approved in writing by CITY OF SANTA ANA prior to CONTRACTOR performing the additional services. It is specifically understood that oral requests or approvals of such additional services, change orders, or additional compensation, and any approvals from the CITY OF SANTA ANA, shall be barred and are unenforceable. 30. Counterparts This Agreement may be executed in one or more counterparts by the parties hereto. All counterparts shall be construed together and shall constitute one Agreement. 31. Corporate Authority The persons executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said Parties and that by doing so the Parties hereto are formally bound to the provisions of this Agreement. [SIGNATURES TO FOLLOW ON NEXT PAGE] ETS91712 Page 15 IN WITNESS WHEREOF, the parties hereto have caused these presents to be duly executed with all formalities required by law on the respective dates set forth opposite their signatures. "CONTRACTOR" CITY OF SANTA ANA CARE AMBULANCE SERVICE, INC. By: cA {,4 l2J- Name""K~ "" "\2.\c;..c.1ADJ))U oj Title ~ B~k City Manager ATTEST: By: 't2~z~ ffi~ Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho, City Attorney By: ETS91712 Page 16 City of Santa Ana Request for Proposals for E.mergency Ambulance Transportation;;;; and Related Services RFP # }RSB002 Care Ambulance Service, Inc 1517 ~ Braden Ct., Orange, CA 92868 Rick ~ Richardson, CE.O Signature of Authorized Contact/Representative (714) 288-3800 July 9,2012 Original City of Santa Ana Request for Proposals for Emergency Ambulance Transportationc and Related Services RFP # }RSB002 Care Ambulance Service, Inc 1517 ~ Braden Ct., Orange, CA 92868 Rick ~ Richardson, CEO Signature of Authorized Contact/Representative (714) 288-3800 July 9,2012 Copy Ello PROl>OSAl.. DEPOSIT Please attach bela", (either naple ar athe""ise trffix) the requ/~ '1,500.00 Bid Prapasal Depaslt "'ade PaYable ta the City af Sahta J1na. Please find attached below the required $2,500.00 Bid PtoPOsal Deposit. TABLE OF CONTENTS Cover Letter................................................................................... ........................................... Page I General Overall Description of Plan to Provide Service ............................................5 First Tier Service ................................................................................... .............................................. 5 Second Tier Service .......................................................................................................................... 7 Response Time Commitment ....................................................................................................7 Overall Operational System................................................................................... ...................... 8 Supervisory Plan .................................................................................................................................. 8 Total Number of Ambulance in Fleet ................................................................................... 9 Total N umber of Employees....................................................................................................... 9 CI inical Contacts ................................................................................................................................. 9 EMT -D ...................................................................................................................................................... 9 Electronic PCR and Document Scanning.......................................................................... 10 Road Safety On-Board Computer System ...................................................................... I 0 Care's Capabilities to Respond to Terrorist Threats................................................. 10 Driver Training .................................................................................................................................. I I Pre-Employment Screening ....................................................................................................... I I Driver Training Program ............................................................................................................. I I Classroom I nstruction ................................................................................................................... I I Road Safety Computer Systems............................................................................................. I 2 Additional Specific Submission Data.................................................................................... 12 Internal Medical Quality Control............................................................................................ 13 Description of Care's "CQI" Process.................................................................................. 13 Data Management and Time Frames.................................................................................. 15 Meeting and Exceeding RFP "CQI" Standards .............................................................. 15 table of contents - continued Mutual Aid Provider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., Page 16 Personnel and Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . .18 (A) - Assigned Personnel Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Management Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 EMT Field Personnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18, 19 Communications Personnel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Topics covered in the Emergency Telecommunicator Course . . . . . .20 (B) - Field Training Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 FTO Training and Job Functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Supervisory Training and Job Functions. . . . . . . . . . . . . . . . . . . . . . . . .21 Management / Field Supervisor Oversight Plan . . . . . . . . . . . . . . . . . .21 (C) - Primary Personnel ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 (D) - Employee Recruitment, Screening and Orientation. . . . . . . . . . . . . . .24 (E) - Continuing Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 (F) - HIPAA Training Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 HI P AA Compliance Plan.............................................................................................................30 Corporate Compliance Plan .....................................................................................................31 Plan for Takeover of Service / Start-Up............................................................................ 33 Transition and Implementation Management Team ..................................................33 Proposed Start -U p Schedule ....................................................................................................35 Proposed Initial Service Response Plan.............................................................................. 35 Dedicated Ambu lance Fleet .....................................................................................................36 EMS Resume ...................................................................................................................................... 37 Emergency Transport Experience ......................................................................................... 37 Care's Current 9-1-1 Emergency Ambulance Contracts ........................................ 38 Description of Care's EMS System for Ambulance Deployment....................... 39 table of contents - continued Phase I - Approval Notification.........................................................""."".........""""..........42 Price W orksheet.........................................................................................................."..................43 Optional Billing Component......."...............................""".................................""...........".....44 Conflict of Interest Certification ....."...................................................................................... 49 Statement of T ruth......................................................................................................................... 50 Non-Collusion Certification ............"....................................................""............. ................... 5 I Photographs........................................................................................................................................52 CJUlE@ . AMBULANCE SERVICE, INC. July 9, 20 I 2 Scott Brown, EMS Battalion Chief Orange County Fire Authority I Fire Authority Road Irvine, CA 92602 Eva Goods, Buyer City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 9270 I Dear Chief Brown, Eva Goods and Evaluation Committee Members: Care Ambulance Service is pleased to present our response to your Request for Proposal (RFP) for the provision of Fire / EMS Emergency Ambulance Transportation and Related Services to the City of Santa Ana. Care Ambulance has been serving Orange County with professional ambulance services since 1969 and is the largest provider of 9-1-1 emergency and non-emergency ambulance services in Orange County. This year we celebrate our 43rd year of providing quality, cost-effective ambulance services to the residents and visitors of Orange County. Our on-site leadership team has deep Orange County community ties and extensive experience working with local city and fire officials. Listed below is the specific information requested for this section: A. Care Ambulance Service, Inc. is the official name of the Bidder. B. Care Ambulance Service, Inc. is a for profit California corporation. C. Care Ambulance Service was incorporated in California on March 28, 1988. D. Care's corporate headquarters are located at 1517 W Braden Ct., Orange, CA 92868. Our business telephone number is (714) 288-3800 and our primary fax number is (714) 288-3899. E. Our Federal Tax Identification Number is 33-0285453. F. The authorized contact for the City of Santa Ana regarding the bid proposal, the RFP Process, the Contract Documents and the administration of the contract, if awarded, with authorization to make representations on behalf of and to bind Care Ambulance is: Rick W Richardson - CEO Care Ambulance Service 1517 W Braden Ct. , Orange, CA 92868 Telephone (714) 288-3800 Fax (714) 288-3899 Email -rickr@careambulance.net 1517 W. Braden Court, Orange, California 92868 Phone (714) 288-3800 I Fax (714) 288-3889 www.careambulance.net cover letter - continued G. Authorized signature documentation, pursuant to Care's organizational structure / bylaws, verifying the authority of Rick W. Richardson to sign Care's original bid proposal and to commit to the proposal on behalf of Care Ambulance Service is provided as an Attachment to this section of the proposal. H. Care Ambulance Service is in good standing in the State of California and has all necessary licenses, permits, certifications, approvals and authorizations necessary to perform all required obligations specified in the RFP. Care Ambulance is licensed by the California Highway Patrol and the County of Orange - EMS Agency to provide ambulance services in Orange County. Copies of all licenses or certifications are available upon request. I. Care Ambulance Service is in good standing with the MediCare and Medi-Cal programs and is not the subject of any pending actions, investigation or prosecutions, whether civil, criminal, or administrative related to billing or reimbursement practices. Care Ambulance has never been excluded from any state or federal healthcare program and does not employ any persons who have been excluded from any state or federal healthcare program. J. Care Ambulance Service agrees and accepts all terms, conditions, requirements and performance criteria contained in the Contract Documents. K. Care Ambulance is known for the following unique strengths, which we commit to provide the City of Santa Ana through this proposal: Temporary Emergency Ambulance Transport Provider Care Ambulance has served with distinction as the contracted temporary 9-1-1 emergency ambulance provider for the City of Santa Ana since April 20, 2012. Working with City and OCFA Officials, Care Ambulance has exceeded all contract requirements and provided the City of Santa Ana with outstanding ambulance transport services. Commitment to the Community Care Ambulance is based in Orange County and maintains a state-of-the-art dispatch center within the County. Many members of Care's leadership team were raised in Orange County and continue to raise their families here. Many of the men and women who make up Care Ambulance were also raised or live in Orange County. This is our community and Care Ambulance takes great pride in being part of Orange County. National Accreditation and California Council for Excellence Award In February 1993, Care Ambulance applied for and was the first ambulance service in California to receive a national accreditation from the Commission on Accreditation of Ambulance Services (CAAS). cover letter - continued This accreditation for meeting the "Gold Standard of Excellence" was awarded after an exhaustive application process, on-site review by nationally recognized experts in emergency medical services and a perfectly scored evaluation. In addition to CAAS, Care Ambulance recently received the "Prospector Award for Performance Excellence" from the California Council for Excellence. Care Ambulance is one of only four private ambulance providers in the Nation to receive an award of this level, which is based on the criteria from the Malcolm Baldrige National Quality Award. Experience Care Ambulance provides significant experience in the field of 9-1-1 emergency ambulance operations. Care Ambulance is the current contracted provider to the City of Santa Ana and also operates a similar ambulance transport program for the City of La Habra. In addition, we are also the contracted emergency ambulance provider for the Cities of Midway City, Stanton, Garden Grove, Fountain Valley, Costa Mesa, Buena Park, Anaheim, Fullerton, La Palma and the 22 cities and communities comprising South-Eastern Los Angeles County. Care Ambulance Service does not come to the City of Santa Ana looking for emergency ambulance experience, we bring experience. Management Expertise Care Ambulance Service has a demonstrated depth of management experience in all areas of ambulance operations, fiscal management and prehospital medical care. We have an on-site management team with proven leadership capabilities and cumulative EMS management experience of over two hundred (200) years. Qualifications and Training of Personnel Care Ambulance is a people-oriented company providing a people-oriented service. We are acutely aware that the ambulance industry is a service industry, and as such, our most important resource is our people. To that end, Care Ambulance recruits and screens employees to ensure we hire only the most qualified applicants. Employees then receive ongoing training to maintain and improve their expertise. Operational Standards Care Ambulance has proposed an operational system and a plan to provide emergency services to the City of Santa Ana that meets or exceeds the performance standards established in the RFP. We have proposed, at no cost to the City of Santa Ana or OCFA, Operational System Enhancements that include Patient Care Record scanning with timely data transmission to the City of Santa Ana's billing service. We also offer Automatic Extemal Defibrillators (AEDs) on every ambulance in Care's fleet, a Road Safety On-Board Computer, a Video System on each dedicated City ambulance, and a language translation service. cover letter - continued Capabilities to Respond to Terrorist Threats or Disasters Care Ambulance Service is recognized as an ambulance service leader in disaster preparedness. On a county-wide level, Care Ambulance has taken a leadership position in developing standardized training for an operational response to acts of terrorism or natural disasters. We have created a master mutual aid agreement with five (5) other Orange County ambulance providers and we were the first ambulance service in California to equip all of our ambulances with Nerve Agent Antidote Auto-Injectors and to ensure that all of our EMT personnel were trained in Chemical Agent Exposures. Vehicles and Vehicle Maintenance Care's established preventative and regular maintenance program exceeds manufacturer standards. Our maintenance program ensures the highest quality equipment is available twenty-four (24) hours a day, seven (7) days a week. Mutual Aid Providers Care Ambulance already has an extensive network of mutual aid providers. Care and our mutual aid providers have been working together for years to deliver effective emergency ambulance services. These are not new relationships but long-term commitments from well-established ambulance service providers. Interagency Partnership Care believes the provision of high-quality emergency and non-emergency transportation services begins with a strong agency partnership. We are committed to working with the City of Santa Ana and OCFA to partner on issues related to EMS and health care services. What is important to you is important to us. We believe that our Proposal meets or exceeds all the standards specified in the Request for Proposal. Care Ambulance has the equipment, personnel, management talent and most of all, the desire to provide quality emergency ambulance services to the City of Santa Ana. Sincerely, Rick W. Richardson. CEO GENERAL OVERALL DESCRIPTION OF PLAN TO PROVIDE EMERGENCY SERVICE IN CITY Care Ambulance Service has already implemented an operational system plan that exceeds the requirements of the Request for Proposal and provides quality ambulance services to the residents and visitors of Santa Ana. With Care Ambulance Service. the City of Santa Ana is not dealing with an unknown entity. Our management team and implementation techniques have been tested and proven. Our capabilities have been clearly demonstrated. In the description that follows, Care Ambulance Service will demonstrate our commitment to the City of Santa Ana with our plan to provide continuing emergency services. First Tier Service Care's First Tier Service is designed to ensure that there are enough of Care's own ambulances and transportation personnel available to meet 100% of the anticipated number of calls for Emergency Transportation in the City of Santa Ana. Currently, Care Ambulance Service provides EMT staffing and emergency ambulance transportation personnel for seven (7) dedicated and fully equipped ambulances in accordance with all industry standards and requirements of the City of Santa Ana and OCFA. Care Ambulance operates our seven (7) dedicated City of Santa Ana emergency ambulances from the following Santa Ana ambulance station locations: Santa Ana Station One - I 108 N. Harbor Boulevard, Santa Ana Santa Ana Station Two - 1209 N. Broadway Street, Santa Ana Santa Ana Station Three - 270 I Hotel Terrace Drive, Santa Ana Santa Ana Station Four - 29 I 3 Wamer Avenue, Santa Ana Care's EMT personnel are able to respond twenty-four (24) hours a day, seven (7) days a week to all 9-1-1 and other emergencies as directed by the City of Santa Ana and the OCFA. Care's EMT personnel assigned to this dedicated transport program may be approved by the City of Santa Ana and the OCFA. This is very similar to the way we currently operate in the Cities of La Habra, Anaheim and Fullerton. By using a joint testing process to interview prospective EMT personnel from Care's large pool of existing EMT employees, we will assure the City that only the most qualified and desirable candidates are selected for Santa Ana. Care's dedicated Santa Ana EMT Personnel are assigned the same shift schedules as OCFA firefighters. This staffing pattem allows for a coordinated team effort and provides necessary familiarity with OCFA staff. Care Ambulance provides a minimum of 14 EMTs per shift, for a minimum of 42 EMTs assigned to this program. Each EMT assigned to the City of Santa Ana is licensed and qualified as an emergency ambulance driver. 5 All of Care's dedicated and non-dedicated EMT personnel are sufficiently trained W1d capable of ensuringJhe safe and proper discharge of their seNice responsibilities. To ensure this, Care Ambulance will work directly with the City of Santa Ana and OCFA officials to determine a proper training program. Care proposes that all EMTs assigned to the dedicated transport program have a minimum of six (6) months prior emergency ambulance experience and have completed, at minimum, the following additional training classes: In addition to the seven (7) fully dedicated transport ambulances and EMT crews, Care Ambulance provides full and complete backup services for the City of Santa Ana, twenty-four (24) hours a day, seven (7) days a week to all 9- I-I and other emergencies in the City of Santa Ana as may be required. Care Ambulance provides fully equipped and staffed vehicles from our regular fleet of I 30 emergency ambulances, ready to provide backup emergency transportation seNices to the City of Santa Ana in the event the dedicated ambulances are unavailable or unable to respond to a call for seNice. As the City of Santa Ana's interim provider, Care Ambulance has responded to 100% of the requests for seNice and exceeded all response time requirements. This has been done without the use of mutual aid assistance. One of the challenges faced today by the City of Santa Ana EMS Transport Program is that there are only two acute care hospitals located in the city. In addition, there can often be delays at the receiving hospital due to emergency room overload. Care Ambulance recognized this challenge and devised a secondary system that exceeds the requirements of the RFP. Currently as a contracted ambulance provider for the City of Santa Ana and the OCFA, Care Ambulance maintains a data link from our Computer Aided Dispatch (CAD) to the OCFA CAD. This allows for a seamless electronic handshake and exchange of information. By . electronically sharing this information, Care has knowledge when dedicated Santa Ana ambulances are unavailable for a response and we deploy additional ambulance(s) into the city in advance of a request for seNice rather than waiting for a response to occur and not having an ambulance properly deployed for that response. In addition to a program of "advance warning" of a call for seNice, Care Ambulance maintains a significant ambulance presence in cities and hospitals that surround the City of Santa Ana. We are the contracted emergency ambulance seNice for the Cities of Garden Grove, Fountain Valley, Stanton, Buena Park, Costa Mesa, Anaheim, Fullerton, and La Palma. In addition, Care Ambulance is the contracted non-emergency ambulance service to area hospitals in and near the City of Santa Ana, including Coastal Communities Hospital, St. Joseph Hospital, Garden Grove Hospital, Orange Coast Memorial Medical Center, West Anaheim Medical Center, Huntington Beach Hospital and UCI Medical Center. 6 As the largest provider of emergency and non-emergency ambulance services in Orange COLJnty, Care can deliver back-up services to the City of Santa Ana unmatched by any other provider. In the event that dedicated ambulances are unavailable or assigned to calls, we will immediately deploy ambulance resources from our fleet to Santa Ana to ensure there is always an ambulance available for an emergency response in the City. Second Tier Service In the unlikely event that Care's dedicated ambulances and Care's fleet of I 30 other ambulances were unavailable for an emergency response in the City of Santa Ana, Care Ambulance has entered into several "Mutual Aid" agreements with separate qualified ambulance service providers doing business in Orange County to provide backup ambulance services. In addition, we maintain a "Master Mutual Aid" agreement with five (5) other licensed Orange County ambulance services, each capable of responding to a request for Second Tier Services. For further details about Care's mutual aid capabilities, please refer to Item 6: Mutual Aid Providers. Response Time Commitment The most critical measure of an emergency ambulance service's performance is its response times. While clinical performance is essential, it is not commonly understood by the public or as easily measured as response times. The key question for most patients and the public is: How long does it take to get an ambulance after making the call for help? It is for that reason Care agrees to be held to a higher standard. Care Ambulance Service commits to the following response time standards that exceed the requirements of the RFP: Code 3 - Care Ambulance agrees that all Code 3, red lights and siren, responses shall not exceed nine (9) minutes and fifty-nine (59) seconds, ninety-three (93%) of the time, reported on a quarterly basis. Code 2 - Care Ambulance agrees that all Code 2, expeditious response without red lights and siren, responses shall not exceed fourteen (14) minutes and fifty-nine (59) seconds, ninety-three (93%) of the time, reported on a quarterly basis. These response time standards are extremely stringent and concrete. These are not promises that cannot be fulfilled. Unlike other bidders, these are response time standards that Care Ambulance achieves today. We are not promising something that we haven't done before. We do it today in Santa Ana and we will continue do it in the future for the City of Santa Ana. To date, Care Ambulance Service has never failed to meet our 9-1-1 emergency contracted response time obligations, nor been penalized for any sub-standard system performance. Care Ambulance is very confident in our abilities to deliver timely ambulance services and readily agrees to the response time requirements and penalties specified in the RFP. 7 OVERALL 0 PERATIONAL SYSTEM The following pages provide a review of Care's overall operational system, including a summary of our operations system and supervisory plans. In addition, we have outlined our proposed operational system enhancements. Supervisory Plan CUlTently, Care Ambulance Service provides an on-duty Operations Manager on a twenty-four (24) hour basis, seven (7) days a week In addition, Care Ambulance has a dedicated full-time Administrative Manager specifically assigned to the City of Santa Ana, Monday through Friday, from 0800 to I 600 hours. Care's Operations Managers function in a manner similar to a fire department Battalion Chief and are only assigned to field supervision and administrative duties. Our Operations Managers are located at our corporate offices in Orange. The on-duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center or directly through their cellular telephone. The following individuals cUlTently work as Operations and Administrative Managers in Care's Orange County Division: Rob Viera - OC Division Manager, Employed with Care for 15 years Jeffry Talmage - SA Admin. Manager, Employed with Care for 3 months. Rick Mount - OC Operations Manager, Employed with Care for 31 years. Marc Jessner - OC Operations Manager, Employed with Care for 21 years. Jeremy Seib - OC Operations Manager, Employed with Care for 9 years. Sean Cox - OC Operations Manager, Employed with Care for 6 years. All Operations Managers employed by Care Ambulance have successfully completed training at the ICS 300 level and Ambulance Strike Team Leader training. All have completed the Ambulance Service Manager (ASM) training offered by the American Ambulance Association and most recently, all have completed the Ambulance Supervisors Course offered by Texas A&M University. All Operations Managers have completed the required FEMA training, including IS 700 NIMS, IS 703 NIMS Resource Management and IS 800 National Response Plan. In addition, all Operations Managers have completed the Orange County EMS Agency courses in Bio-TelTorism (CBRNE), First Responder Awareness (FAA) and First Responder Operations (FRO). On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 capable vehicle equipped with all necessary fire department radios and extra medical equipment, including back-boards, medical supplies and oxygen. Each Operations Manager vehicle is also equipped with a Mobile Data Computer (MDC) allowing our supervisory personnel to continually monitor the location and activities of all Care ambulances within Orange County. 8 overall operational system - continued Summary of Care's Southern California System Operations Total Number of Ambulances in Fleet Care Ambulance provides a response ready fleet of 130 ambulances licensed to provide ambulance services in Orange County. We are the largest provider of emergency and non-emergency ambulance services in Orange County. Each emergency ambulance in Care's dedicated fleet is complete with the latest technology, including 800 MHz mobile radios and satellite-based Automatic Vehicle Locator (AVL) tracking systems. All of Care's ambulances meet and exceed the safety and equipment requirements listed in the RFP. Total Number of Employees By selecting Care Ambulance as the EMS Emergency Transportation Services provider for the City of Santa Ana, the City will gain an experienced, dedicated workforce trained to the highest clinical standards. Care Ambulance employs 816 individuals. The following is a breakdown of employees according to job category: Field Training Officers 31 RNs / RCPs 33 Fleet Maintenance 9 Clinical Contacts Care Ambulance provides clinical support and training for all employees through our in-house Training Department. With our full-time clinical education staff, including our participatory Medical Director, Care offers the City of Santa Ana the highest possible clinical standards. Contacts for the Medical Director and Training Department are: Medical Director, Dr. Michael Martin, Telephone (562) 698-081 I, Ext 751 I Employee Development Manager, Kevin Chao, Telephone (714) 288-3818 Driver Training Manager, Sergio Montoya, Telephone (714) 288-3920 Resumes for the above individuals are provided as an Attachment to this section. Implemented Operational System Enhancements I. EM"T-D Immediate defibrillation is the most effective treatment for out-of-hospital cardiac arrest (ventricular fibrillation). Care Ambulance is proud to be the first ambulance service in Orange County to provide Automatic External Defibrillators (AEDs) on all ambulance vehicles. Medical research shows that the sooner defibrillation can be administered to a patient in ventricular fibrillation; the better the chances are that normal cardiac activity can be restored. With the degenerative nature of ventricular fibrillation, seconds can literally mean the difference between life and death. 9 overall operational system - continued Care Ambulance equips all ambulances with an AED and ensures that all EMT personnel are properly trained in the use of an AED. Care Ambulance provides this service in the City of Santa Ana at no additional cost to the City of Santa Ana or OCFA. 2. Electronic PCR and Document Scanning Each ambulance in Care's fleet is equipped with Electronic PCR capabilities and portable document scanning. While other companies in the nation have implemented an EPCR solution, Care Ambulance is the first to go completely paperless, allowing our EMTs to instantly scan the paramedic's report and electronically transmit that report to the City of Santa Ana billing agency. This scanning service is not available with any other Orange County ambulance provider. 3. Road Safety On-Board Computer System Sixteen (16) years ago, Road Safety brought the "Black Box" from the airplane cockpit to the highway. Today, every Care Ambulance vehicle is equipped with this state-of-the-art technology. The Road Safety On-Board Computer System records each second and each mile of operation of every vehicle in the Care Ambulance fleet. Active driver identification enables the system to evaluate driver performance based on the amount of miles they drive and how safely they operate their ambulance. Each ambulance operated by Care Ambulance in the City of Santa Ana is equipped with this technology. Care Ambulance is truly committed to safety and we give our ambulance drivers the tools and training necessary to become part of the safe driving solution. On a county-wide level. Care Ambulance has taken a leadership I ~ position in devefoping standardized training for an operational : ~~ response to Multi-Casualty Incidents (MCI) and creating a master mutual aid agreement with five (5) other ambulance providers. Care Ambulance leads the training of local ambulance supervisors in the Incident Command System (ICS) and developed our own training CD to ensure that all Care Ambulance EMTs are trained at the ICS-l 00 level. "w ~ S. Care's Capabilities to Respond to Terrorist Threats or Disasters Long before the events of September I I th, Care Ambulance began preparing for our response to disasters or terrorist threats. Today, Care Ambulance is recognized as an ambulance service leader in disaster preparedness. \1" I 'i!- ;, . Care Ambulance recognizes our important role in disaster preparation and pledges support for our continuing disaster preparedness. 10 DRIVER TRAINING Care's in-house comprehensive emergency vehicle driver program includes the "Ernergency Vehicle Operators Course National Standard Curriculum" and "Coaching the Emergency Vehicle Operators" CoUrses. These programs provide the necessary classroom instruction, competency field training, and testing for new and existing drivers. Our program verifies proficiency in the understanding of emergency vehicle driving, as well as the practical application of that knowledge. Care's driver training program exceeds the performance standards established for the ambulance industry by the National Highway Traffic Safety Administration (NHTSA), the Department of Transportation (NHTSA DOT); the National Commission on the Accreditation of Ambulance Services (CMS); the California State Department of Motor Vehicles; and the California Highway Patrol. Pre-Employment Screening Care's risk management approach to driving safety begins with the insistence on high-caliber personnel. Care Ambulance requires all ambulance personnel to possess a valid California Driver's License, with all required certifications, and to remain compliant with all provisions of the Califomia Vehicle Code. Care Ambulance performs an extensive background check of all ambulance applicants and ensures that no Care Ambulance drivers have been convicted of or have pled nolo contender to any crime involving a stolen vehicle, stolen property, violence, drugs or moral turpitude, fraud or misdemeanor, or felony driving under the influence of alcohol or drugs. Driver Training Program The Care Ambulance driver training program is a three-phased comprehensive instructional based program incorporating: classroom instruction (Phase I); with a closed cone-course practice (Phase 2); and supervised on-the-road practical experience (Phase 3). Students are required to complete a minimum of fifty-six (56) hours of driving instruction. This time may be extended if our trainer decides more experience or training is necessary before the trainee can operate an emergency ambulance on their own. Phase I - Classroom Instruction Phase I consists of eight (8) hours of classroom instruction and covers the basic components of driving and emergency vehicle operations. The driver trainee is taught low force driving techniques, vehicle dynamics, vehicle code law, due regard and Care's polices and procedures relative to ambulance operations. Specific topics covered in Phase I include: backing, lane changes, intersection and skid control. special awareness, following distances, fatigue recognition, on-scene vehicle placement, daily crew responsibilities and operator liabilities. The classroom session includes case-study reviews of actual emergency vehicle collisions and actions that could have been taken to avoid those collisions. The final component of the classroom experience is a fifty (50) question written final. Examinations are submitted to the National Safety Council for independent grading. II driver training - continued Phase 2 - Closed Cone Course Upon successful completion of Phase I, the driver trainee moves to Phase 2: the Closed Cone Course. The Closed Cone Course is conducted at Anaheim Stadium, under the watchful eyes of Care's certified driving instructors. The course consists of eight (8) hours of practice, where trainees hone their driving skills in a controlled environment. During the cone course, trainees are required to safely drive their ambulance through a series of obstacles, such as diminishing lanes, backing, evasive maneuvers, forward and reverse serpentines, controlled braking and turning movements. Trainees are scored on their control of the vehicle and must score one hundred percent (100%) before proceeding to the next phase. Phase 3 - Supervised Practical Road Experience Driver trainees must successfully complete both Phase I and Phase 2 of Care's driver training program, before being assigned to work with a Field Training Officer (FTO), in our behind-the-wheel driving experience. Phase 3 is forty (40) hours of supervised practical road experience in which the trainee is paired with a FTO who continues to coach the trainee on an as-needed basis. This behind-the-wheel experience allows trainees to practice their driving skills in Southern California's unique driving environment, enhancing their ability to understand local traffic patterns, road and weather conditions and the reaction of other drivers to emergency vehicles. Road Safety Computer Systems All Care ambulances and supervisor vehicles are equipped with a Road Safety Driving Computer System. The same technologies that monitor commercial airline performance dynamics are used to monitor our drivers' performance. The system works as a full-time, unbiased driving coach, providing an audible warning as our drivers approach an unsafe condition, allowing sufficient time for the driver to take corrective action before an incident occurs. In addition to monitoring driving habits, the Road Safety Computer System provides data that allows Care to monitor incidents such as unsafe backings and emergency light and siren activation. All data generated from the Road Safety Computer System becomes a key component of Care's QA/QI process, allowing Care to monitor and provide important feedback to our drivers regarding their vehicle operations. Additional Specific Submission Data: I. A detailed course syllabus and curriculum for Care's driver training program has been provided as an Attachment to this section of the proposal. 2. Care's driver training program consists of a minimum of fifty-six (56) hours of instructor-led education. The program may be extended for trainees that have difficulty mastering a section of the program. 3. Care's three (3) phased training program is described above. If a driver trainee is unsuccessful in completing the program, remedial training is provided. If still unsuccessful, the trainee is removed from driver trainee status and returned to Ambulance Operations as an Ambulance Attendant. 4. N/A. Care Ambulance conducts all drivers' training in-house. 12 INTERNAL MEDICAL QUALITY CONTROL Excellence in customer service requires a commitment and systems in place to allow continuous evaluation and improvement. Care's Continuous Quality Improvement (CQI) Program meets this need. Our CQI processes are pervasive throughout our organization, from the traditional clinical application, to our communications center and fleet maintenance facility, to our billing office and our relationships with extemal providers and oversight agencies. The Care Ambulance Service Quality Assurance/Quality Improvement Manager, Chris Wilson, is responsible for the overall management of Care's Quality Improvement Program. Continuous Quality Improvement is not only a formal program, but also a pervasive philosophy that is embedded in the fiber of every part of our organization. Quality is just a word until the people in an organization give it meaning. At Care Ambulance, quality is the responsibility and commitment of every employee. Description of Care's "CQI" Process An effective CQI program must provide the education, resources and support staff needed to provide quality service and outstanding patient care. This is best accomplished through observation, review, discussion and exchange of ideas when areas for improvement are identified. These components are found in Care's CQI process in the following distinct but connected phases: Prospective - This phase includes employee recruitment, employee screening and selection, written protocols, operational policies and employee orientation. Care Ambulance has a comprehensive set of policies that address clinical, safety and operational issues, as well as performance expectations for all personnel. Policies are updated and distributed to all employees as needed to stay current with new laws, industry standards and EMS Agency guidelines. Employee screening and selection is the first step of prospective quality assurance. It is critically important to be able to recognize and choose the right personnel when they apply. EMT candidates are required to pass several rigorous tests before employment is offered to them. These tests include a written EMT knowledge test, EMT skills testing, oral interview, strength and flexibility testing, medical examination and drug screening test and a complete background check conducted by a licensed private investigator. As part of the prospective phase new employees are assigned to New Employee Orientation. All employees receive extensive education and training to create their personal foundation for delivering exceptional service. Each orientation class has a presentation on Customer Service and Quality Improvement. These presentations ensure that all Care employees understand the importance, concepts, and the expectations in both of these areas. 13 internal medical quality controls - continued Concurrent - The concurrent phase of the quality process encornpassesthe delivery of service and patient care. It focuses on performance monitoring and application of procedures. The Operations Managers are the primary resource for this evaluation. The Care Ambulance Operations Managers actively engage field employees, public safety personnel, and facility staff. During this interaction, the Operations Managers are observing patient care and crew interpersonal skills with other members of the patient care team. The concurrent evaluation provides the environment for almost immediate feedback on job performance. The concurrent evaluation is where many exceptional performances are recognized. The real time aspect of concurrent evaluation allows issues or concerns to be identified and addressed immediately. Quality improvement is ongoing and does not need to wait for the end of month report Operational changes to improve system performance can be implemented quickly when organizations are committed to quality. Care Ambulance through a variety of mechanisms has the ability to notify employees of changes that are put into practice. These changes are approved by appropriate company officials prior to implementation. Retrospective - All phases of the quality process are important. The retrospective phase is the after-event evaluation of system performance. To ensure positive findings retrospectively, it is important to invest heavily in quality control that is prospective (hiring, training etc.) and concurrent (evaluation of the service / care at the time of delivery). Retrospective quality control is looking back on service or care that has already been delivered. Examples of areas of retrospective review are: Patient Care Reports Use of an Automated External Defibrillator Documentation of the need for patient restraints Emergency Vehicle Operations reports Unexpected clinical events The results of the retrospective review provide data to facilitate changes in operating procedures to improve performance. This data also allows the organization to identify trends. Data is wonderful, but improvement only occurs when the data is acted on. The QA/QI Manager works closely with the Training Department to identify areas for additional training or the need for a change in training curriculum. There may be times when the quality process identifies an individual or individual(s); who require refresher training. These situations are referred to the Training Department where the necessary training is provided. Upon completion of the training, the Training Manager will advise the QAlQI Manager that the required training has been completed. The individual(s) will be monitored to ensure compliance. This action of "closing the loop" is one of the fundamental concepts of continuous quality improvement. Many organizations say that they are driven by the CQI process, yet only invest in the retrospective component of the process. Care Ambulance truly embraces CQI and has the systems in place to facilitate continual improvement: Prospective, Concurrent, and Retrospective. It is with great pride that Care Ambulance employees provide exceptional service to each and every customer because of our commitment to quality. 14 internal medical quality controls - continued Data Management and Time Frames The Care Ambulance Quality Improvement Program is designed to be dynamic and improve as the company and customer needs change. Our ability to collect and manage data is a key to the succ;ess of OUr CQI program. Information that is collected is evaluated and maintained in a database for future reference. The QA/QI Manager generates monthly reports on identified quality indicators. These reports are shared with the Company Executives, Company Medical Director, Department Directors, and other appropriate managers. Quality indicators specific to patient care are shared with field employees. Field employees have open communication in the quality process. They can direct questions, comments, or suggestions directly to the QA/QI Manager. The employees performing the job many times have the best perspective. Meeting and Exceeding RFP CQI Standards Care Ambulance fully complies with all federal, state and local medical standards, protocols, rules and regulations applicable to the provision of emergency BLS ambulance transportation, including those established by the Orange County EMS Agency. In addition, Care's intemal CQI process is directed at, but not limited to, effective administration and management of clinical performance, response time performance, driver performance, dispatch performance and other BLS service levels. We believe that our CQI process exceeds the standards and requirements set forth in the RFP. Our CQI process clearly covers all topics related to BLS ambulance transportation. It not only exceeds the specified requirements of effective administration and management of clinical performance, response time performance, driver performance and dispatch performance but also includes records, reports and documentation, radio and telephone communications, compliance with preventative maintenance and repair of ambulances and on-board equipment, infection control and employee safe practices, medical supply management, human resource practices, and employee education and training. We propose to further expand our existing CQI process to include a commitment to meet monthly or quarterly with City of Santa Ana officials and representatives of OCFA to discuss areas of mutual concem or opportunities for improvement. We propose to work collaboratively with Santa Ana and OCFA to develop CQI processes that are essential to the safe, efficient operations of their emergency ambulance service. By understanding what is important to the City of Santa Ana and OCFA, Care Ambulance can fine tune our CQI process to ensure that Santa Ana EMS Transportation Services are fiscally and clinically accountable to the patients served. Copies of Care's CQI Program and sample monthly CQI reports are prOVided as an Attachment to this section of the RFP. 15 MUTUAL AID PROVIDER Care Ambulance is the largest provider of emergency and non-emergency ambulance services in Orange County. At any given time, Care Ambulance has enough ambulance resources deployed throughout Orange County to cover our individually contracted cities and to ensure timely ambulance responses for all contracted service areas. Care Ambulance rarely needs mutual aid assistance, but in fact, frequently provides requested assistance to areas adjacent to our contracted cities. While Care Ambulance does not routinely rely on the services of another provider as an alternative method to meet contracted response time requirements, Care does recognize that the mutual aid process is important to ensure structured responses to mass casualty incidents and during periods of unusually high demand. For those reasons, Care Ambulance maintains mutual aid relationships as an EMS partner, particularly in these uncertain times of terrorist threats and increasing natural d'lsasters. Care Ambulance understands and agrees that all Second Tier or mutual aid agreements must be approved by the City of Santa Ana and that all mutual aid providers must meet the operational requirements of OCFA. Care further understands and agrees that should a Second Tier or mutual aid provider provide back-up services in the City of Santa Ana, Care Ambulance and not the Second Tier provider will be responsible for ensuring compliance with all terms, conditions, standards and performance requirements set forth in the contract documents, including payment of all transport services. As a current OCFA emergency ambulance contractor, Care Ambulance is party to the existing Master Mutual Aid Agreements between OCFA contracted ambulance providers and members of the Ambulance Association of Orange County (AAOC). In addition, Care Ambulance has negotiated separate mutual aid agreements with local, experienced providers of emergency ambulance services. Following are brief descriptions of each Second Tier or mutual aid provider used by Care Ambulance in Orange County that meet the operational requirements of the City of Santa Ana and OCFA: Doctor's Ambulance Doctor's Ambulance is a current contracted OCFA BLS ambulance service that meets all OCFA operational requirements, providing emergency ambulance services in Tustin, Dana Point, Laguna Beach, Irvine, Laguna Hills, Aliso Viejo, San Juan Capistrano, Laguna Niguel, Rancho Santa Margarita, Lake Forest and Laguna Woods. Doctor's uses a crew staffing of two (2) EMTs and has twenty-seven (27) Orange County licensed ambulances. Doctor's Ambulance began se~ice in 1974 and is CAAS Accredited. Doctor's Ambulance headquarters are located at 23091 Terra Drive, Laguna Hills, Califomia 92653. Contact person is Mike Herren - Senior Vice President. Telephone number is (949) 951-8535. 16 mutual aid provider - continued Emergency Ambulance Emergency is a current contracted OCFA BLS ambulance service that meets aU OCFA operational requirements, providing emergency ambulance services to the communities of Brea, PlacentiaandYQrba Linda. Emergency Ambulance uses a crew staffing of two (2) EMT s and has fifteen (15) Orange County licensed ambulances. Emergency Ambulance began service in 1977 and is CAAS Accredited. Emergency Ambulance headquarters are located at 3200 E. Birch Street. Suite A. Brea. Califomia 92821. Contact person is Phil Davis - President. Telephone number is (714) 990-1331. Medix Ambulance Medix Ambulance is another current contracted OCFA BLS ambulance service that meets all OCFA operational requirements. Medix serves the city of Mission Viejo with emergency ambulance services and provides non-emergency ambulance services throughout Orange County. Medix Ambulance uses a crew staffing of two (2) EMTs and has twenty-six (26) Orange County licensed ambulances. Medix Ambulance began service in 1978 and is CMS Accredited. Medix Ambulance headquarters are located at 26021 Paula Drive, Mission Viejo. Califomia 92691. Contact person is Michael Dimas - President. Telephone number is (714) 634-2671. Copies of the master mutual aid agreement and separate individual mutual aid agreements are provided as an Attachment to this section of the proposal. All mutual aid agreements are current and automatically renew, unless terminated by either party. 17 PERSONNEL AND TRAINING (A) Assigned Personnel Profile A key to Care Ambulance Service's successful provIsion of emergency and non~emel"gency ambulance services has been the strength of our on~site management team. By selecting Care Ambulance as the contracted EMS Emergency Transportation Services provider for the City of Santa Ana, the city will gain an experienced and dedicated workforce. Management Team During Care's forty~three (43) years of providing ambulance services to the residents and visitors. of Orange County, we have developed an outstanding management team, which will oversee and manage our contract with the City of Santa Ana The following table outlines the individuals responsible for the City of Santa Ana operations. Name Position Years in Experience Years with Care Dr. Michael Martin Medical Director 26 Years 21 Years Mitch Felde Director of Human Resources 20 Years 4 Years Kevin Chao Training Manager 26 Years 12 Years Rick Mount Operations Manager 31 Years 31 Years Jeremy Seib Operations Manager 15 Years 10 Years Field EMT Personnel Throughout our history Care Ambulance has offered and will continue to offer, the highest clinical and staffing levels. These professional standards comply with all applicable State of Califomia laws and regulations, as well as Orange County EMS Agency statutes, rules and regulations. Minimum requirements for Care's field personnel include the following: Califomia recognized EMT Certification Califomia Driver's License Ambulance Driver's License Endorsement CPR / AED Certification Orange County EMT Accreditation Medical Examiner's Certification Care Ambulance Service has 603 Orange County certified Emergency Medical Technicians (EMTs) and 31 Field Training Officers (FTOs). The table on the next page shows the name, years of experience as a Care employee, languages spoken in addition to English and certification level of EMT personnel who are currently assigned to the City of Santa Ana EMS Program.. 18 personnel and training - continued Name Edward Barnum David White Chad Smart Joe Arambula Daniel Nunez Johnathan Cendejas Mark Moubarek Scott Smith Bryan Frey Heber Mendoza-Miguel Andrew Roach Benjamin Garcia Mark Saverino Mychal Stevens Tray Dobberpuhl Breanna Flemming Daniel Easly Michael Megee Conner Drake Eric Sheldon Bryan Janovick Dave Howard Ericson Trieu Wesley T umer Nicholas Dibiasi James Crowell Allison Smith Brian Nunn Raymond Denijs James Silva Chris Garcia Aaron Harkless Nicholas Hart Joey Healy Chris Bustos John Sanchez Christopher Swanson Edgar Rodriguez Spencer Gracia Languages Spoken English English English English English and Spanish English English and Spanish English and Spanish English English and Spanish English English English English English English English English and Spanish English English English English and Spanish English and Cantonese English English English English English English English English English English English English English and Spanish English English and Spanish English and Japanese Average Experience Years of Service EMT License # II II 8 7 6 5 5 5 4 4 4 4 3 3 3 3 2 2 2 2 2 2 2 2 2 2 1.5 1.5 1.5 I I I I I I I I I 0.5 3.08 E074262 E065493 E065814 E066844 P284 14 P30892 E065952 E065074 E066085 E065080 E076865 E044784 E074772 E067044 E074448 E081143 E077389 E077993 E081933 E079550 E066157 E074463 E0756 I 8 E076815 E051303 E078909 E079886 E079259 E079439 E081899 E084666 E083624 E081416 E081263 E081361 E080091 E080840 E084538 E083070 A complete listing of Care's EMT and FrO personnel is provided as an Attachment to this section of the proposal. 19 personnel and training - cOhtinued Communications Personnel Minimum requirements for our communications personnel include the following: National Emergency Telecommunicator Certification, from the National Academies of Emergency Dispatch CPR / AED Certification The forty (40) hour, Emergency Telecommunicator Course is a joint effort between the National Academy, The National Emergency Number Association (NENA), and Jones and Bartlett publishers. The course is designed to train new employees who are unfamiliar with communication centers and their" technology, legal guidelines, stress factors, and methods of communication. Topics covered in the Emergency Telecommunicator Course: Roles and Responsibilities-essential knowledge and skills Technologies Interpersonal Communication-the communication cycle, listening, language problems Communication and call processing---<:ustomer service, types of callers, high risk calls Call classification Radio broadcast procedures Legal aspects of emergency telecommunication-risk management and liability Stress management-pressures of the job and stress management techniques The following table shows the name, years of EMS experience and position of communication center personnel who are responsible for dispatching Care's emergency ambulance units: Name Yrs. of Service Position Pete Morales Erick Aguilar 12 Years 17 3 Years 5 Years Dispatcher 4 Years I Year Dispatcher Jason Garrett 6 Years Dispatcher 20 personnel and training - continued (8) Field Training Officers Care's Field Training Officers (FTOs) are responsible for all aspects of EMT training, including ongoing observation in the field. The ratio of FTOs to EMTs committed to the City of Santa Ana EMS Transportation Program is I to 6. FTO Training and Job Functions The FTO job training program is an extensive familiarization with preceptor training objectives, including but not limited to evaluation forms, rating factors, EMT standards, inter-personal communications, patient care documentation, FTO ethics and standards, teaching and support services. FTOs must have at least one (I ) year of experience and undergo an extensive selection process before being chosen. The Field Training Officers perform many functions, including: New employee selection process and field orientation of new employees Driver training Classroom, refresher training and EMT-B skills testing Provide outside training (CPR, First Aid etc.) Career Days and Ambulance Demonstrations Supervisory Training and Job Functions Care's Operations Managers are r'esponsible for overseeing all EMT personnel in the field. All Operations Managers employed by Care Ambulance have successfully completed training at the ICS 300 level and Ambulance Strike Team Leader training. All have completed the Ambulance Service Manager (ASM) training offered by the American Ambulance Association (AAA) and the Ambulance Supervisors Course offered by Texas A&M University. All Operations Managers have completed required FEMA training, including IS 700, IS 703 and IS 800. In addition, all Operations Mangers have completed the Orange County EMS Agency courses in Bio- Terrorism (CBRNE) and First Responder Awareness (FRA) and First Responder Operations (FRO). Management I Field Supervisor Oversight Plan Currently, Care provides an on-duty Operations Manager on a twenty-four (24) hour basis, seven (7) days a week. The Operations Manager functions in a manner similar to a fire department Battalion Chief and is only assigned to field supervision duties. Our Operations Manager is located at our corporate offices in Orange, The on-duty Operations Manager is available at all times and may be contacted immediately via radio through Care's communications center or directly through their cellular telephone. On a daily basis, Care's Operations Managers are in the field, supervising the activities of all assigned personnel. They are deployed in a Code 3 capable vehicle equipped with all necessary fire department radios and extra medical equipment, including back-boards, medical supplies and oxygen. 21 personnel and training - continued (C) Primary Personnel Care Ambulance proposes to assign the following individuals to the City of Santa Ana EMS Emergency Transportation Services program. A summary of each person's current position, job duties and responsibilities, and years of employment is provided below, with detailed resumes provided as an Attachment to this section of our proposal. Rick Richardson, Chief Executive Officer Rick Richardson, Chief Executive Officer, has been employed at Care Ambulance Service, Inc., since 1979. Rick directs all business and financial operations of Care Ambulance. Rick was bom and raised in Orange County. Rick has served as the President of the Ambulance Association of Orange County and has participated as a committee member on the Emergency Medical Services Agency's Emergency Medical Care Committee and Weapons of Mass Destruction Task Group. Rick's financial leadership at Care has led to the development of a comprehensive growth strategy that has seen the company through thoughtful expansion spanning more than a decade. He has implemented a business office management system that ensures a billing and collection process that helps our patients maximize their MediCare and other healthcare benefits and limit out-of-pocket EMS expenses. Rick has participated at all levels of Care Ambulance operations. His leadership ability has grown out of his exposure to all aspects of our business. He has worked as an EMT and dispatcher. Rick truly understands that this is a twenty-four (24) hour, seven (7) day per week business. Bill Weston, Director of Operations Bill Weston, Director of Operations, is responsible for the daily operations of Care Ambulance. Bill has worked for Care Ambulance Service for I 5 years. He began his EMS career as an EMT and has responsibilities for field operations, training, EMT hiring and risk management. Bill directs and coordinates all activities of Care's ambulance operations to optimize use of equipment. facilities and personnel. Bill frequently acts as Care's representative before govemment commissions or regulatory bodies as it relates to ambulance operations and is the current President of the Ambulance Association of Orange County. Bill has a Bachelor of Science Degree and a Masters Degree in Business Administration from the University of Phoenix. Bill also has a Designated Subjects Teaching Credential from Califomia State University, Long Beach and is a current EMT educator. 22 personnel and training - continued Ben Baker, Director of Communications Ben Baker, Director of Communications, provides ambulance Deployment Management and Communication Center supervision. Ben has been employed at. Care Ambulance for I I years. Ben is responsible for Care Ambulance's Deployment Planning and optimal crew staffing. Ben monitors contractual compliance for our service areas, including quality indicators for continued improvement. Ben is a currently credentialed EMT and a retired Police Officer. Ben plays a pivotal role in Care's day-to-day performance and is an industry leader in maximizing the capabilities of our EMS computer-aided dispatching system. He is accountable for call-volume monitoring and responsible for ensuring that our staffing is optimal to exceed our contract demands. Care's continuous response time reliability has been achieved largely because of Ben's commitment to performance and skills at matching resources to demand. Kevin Chao - Training Manager Kevin Chao has been an important member of the Care management team since 200 I. As Care's Employee Development Manager, Kevin administers employee recruitment and selection, and oversees all initial and ongoing training. With the oversight of Care's Medical Director, Kevin sets and monitors Care's guidelines for continuing education and protocol compliance. He attends and contributes to regularly scheduled manager meeting and assists in developing new company procedures. Kevin supervises the daily activities of FTOs and Care's Driver Training Program. Kevin is a paramedic, who brings over 24 years of advanced experience to Care Ambulance. Rob Viera - Orange County Operations Division Manager Rob Viera was promoted to the Orange County Division Manager position in 2005. He supervises all Orange County ambulance operations and is directly responsible for the oversight of EMS supplies and his Division's Daily Operations Managers. Rob is tasked with the establishment of agency relationships in the EMS system and acts as a liaison for Care Ambulance to area fire department partners. As part of his duties, Rob also coordinates and documents the local operating area and the Region I ambulance response for emergency incidents. Rob has completed industry specific courses established by the American Ambulance Association and incident command system training. Rob is currently working towards the completion of his Bachelor's Degree in Business Administration at Vanguard University. 23 personnel and training - continued (0) Employee Recruitment, Screening and Orientation Recruitment If there were only one function a manager could control to provide high quality ambulance service, it would be recruitment. By starting with only qualified and motivated candidates, the remainder of the management process is simplified, allowing management to focus on quality improvement. The majority of our job applicants are experienced EMT personnel, drawn to Care Ambulance Service because of our core values, working conditions and comprehensive wage and benefits package. It is the policy of Care Ambulance Service to be fair and impartial to all employees and applicants for employment, without regard to race, religion, age, gender, color, ethnic or national origin, marital status, genetic information, sexual orientation or ancestry. Care Ambulance Service conforms to all applicable federal, state, and local regulations and guidelines guaranteeing equal employment opportunity for all qualified disabled individuals, disabled veterans, and veterans of the Vietnam Era. In any service industry, people shape the personality of the product. At Care Ambulance Service we recognize and respect the power that can be hidden behind each new face. Care Ambulance Service realizes that having the best equipment is only 50% of providing the best service. The other 50% of the impact on the patient's emergency is made by the people who care for them. Consequently, we are painstakingly careful about recruiting the right people to provide outstanding clinical and customer service to our patients. Screening Just as it is critically important to attract top quality personnel, it is also essential to be able to recognize and select them for employment. Care Ambulance Service EMT candidates are required to complete the following candidate screening process. This process is very stringent and modeled after the same selection criteria used by local fire departments and law enforcement agencies. CREDENTIAL VERIFICATION - All EMT candidates are required to submit current proof of a valid EMT certification, an Orange County EMT Accreditation, valid California Driver's License and a valid California Ambulance Driver's Certificate with a Medical Examiner's Certificate. DRIVING HISTORY - All EMT candidates must provide a current Department of Motor Vehicles Report of Driving Record. If the EMT candidate is a non-California licensed driver, the candidate must submit a driving record from the state in which the applicant is currently licensed. Any candidate with a poor driving history is not considered for employment. CRIMINAL HISTORY AND BACKGROUND INVESTIGATION - Care Ambulance Service uses the services of a retired police officer and currently licensed private investigator to conduct a thorough background investigation for prospective EMT employees. This includes a complete criminal history check, DMV search, reference check with former employers, social security check and credit history check. A sample criminal history and background investigation has been provided as an Attachment to this section of our proposal. 24 personnel and training - continued ORAL INTERVIEW - Qualified candidates are invited to an oral interview conducted by our Operations Managers and Field Training Officers. The candidate's prior work history, goals and EMT knowledge are reviewed. STRENGTH AND FLEXIBILITY TESTING - Strength and flexibility testing is conducted by a licensed physical therapist. The test is done to simulate the physical strength necessary for the position, flexibility, and use of proper lifting techniques. PHYSICAL EXAMINATION AND DRUG SCREENING - The final step in the process is a pre- placement medical examination, including a personal health history, vision testing, hearing tests, musculoskeletal evaluation, spinal x-ray and urinalysis drug screening. Orientation Because a new employee's most important leaming takes place, and good work habits are developed, during the formal training process, Care Ambulance Service uses a minimum of one hundred and twenty-four (124) hours of an organized structure and rigid training format. Orientation begins on the first day of employment and ends when scheduled, without interruption. The orientation program is taught by our Field Training Officers who maintain written documentation throughout the process. The program begins with a 40-hour classroom - didactic program that includes a general overview, OSHA requirements and Policy Manual Review. During the next phase of the orientation process the new employee is assigned to a Field Training Officer and rides as a third person ride-along in an ambulance. Basic skills are reviewed and tested. Training is continued until the EMT is able to function as a primary partner. The final phase of Care's orientation program is our in-house comprehensive emergency vehicle driver training program. We present the "Emergency Vehicle Operators Course National Standard Curriculum" and "Coaching the Emergency Vehicle Operators" courses. These programs provide the necessary classroom instruction, competency field training, and testing for new and existing drivers. Our program verifies proficiency in the understanding of emergency vehicle driving, as well as the practical application of that knowledge. 25 personnel and training - continued (E) Continuing Education Programs Care Ambulance Service has always had a commitment to and a reputation for service excellence. This well deserved reputation can be attributed to the Care Ambulance philosophy that employees are our most important asset. We treat employees as valuable customers and give them the tools to be st..1ccessful. These tools include training and education, and equip the employee to provide exceptional service to external customers. The applicants that make it through the rigorous selection process are assigned to New Employee Orientation. New Employee Orientation provides a combination of education and training that begins in the classroom and finishes in the field with a Field Training Officer. This New Employee Orientation is the foundation for ongoing continuing education. Care Ambulance provides continuing education through a variety of venues, described in detail below. Care commits to provide these programs at all times throughout the contract term. Annual Mandatory Training On-Line Education In-House Training T ailboard Training Classes on Various Topics Field Training Officer Meetings Conference Attendance Management Development Annual Mandatory Training Annual Mandatory Training is a requirement for all field employees. Topics such as Blood and Airborne Pathogens, Emergency Vehicle Operations, Customer Service, Incident Command System, Hazardous Materials, and Patient Care Documentation are covered. Continuing Education credit is given for those subjects that meet the criteria for CE approval. On-Line Education Care Ambulance pays for every field employee to be enrolled in the Virtual Solutions Manager (The 9th Brain) on-line education program. The program is explained to employees in the New Employee Orientation. Each employee is given their personal password to access the program. In-House Training There are times when training and education is facilitated in-house by outside providers. Examples of this are Incident Command System 200 and 300, EMS Basic Supervisory Workshop (Texas A&M), Sexual Harassment Prevention and Investigation, Terrorism Awareness, and Emergency Medical Dispatch. 26 A,- ow '4 - lq4a Aim °® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 10/i%a20 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willie of New York, Inc. c/o 26 Centur Blvd PHONE 877-94 5-7378 FAX 886-467-2378 . y P. O. Box 305191 E-MAIL gertificates@willir..com TH 37236-5191 INSURER(S)AFFORDING COVERAGE NAICif INSURERA: Arch specialty insurance Company 21199-002 INSURED INSURERB:Liberty Mutual Fire Insurance Company 23035-001 Cars Ambulance Service, Inc. 1517 Braden Court INSURERC:IF Skadeforsakrings AS F9367-001 Orange, CA 92868 INSURER p: Liberty insurance corporation 42404-001 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18767380 REVISION NUMBER: THIS IS TO CERTIFY THAT 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. II TO TYPE OF INSURANCE D SUB POLICY NUMBER POLICY EFF puffian= POLICY EXP LIMITS A GENERAL LIABILITY Y FLPDO46376-01 10/1/2012 10/1/2013 EACH OCCURRENCE $ 5. 000, D00 COMMERCIAL GENERAL LIABILITY DPREA EI ER' uDence $ 300,D00 CWMS-MADEa OCCUR MEDEXP An one rson $ 51000 PERSONAL&ADV INJURY S 5,000,000 GENERALAGGREGATE S 51000,000 GENLAGGREGATE LIMIT APPLIES PER." PRODUCTS -COMPIOPAGG S 5,000,000 POLICY PRO- LOG $ B AUTOMOBILE LIABILITY Y AS2-631-510005-022 0/1/2012 10/1/2013 51)s?!N ,tsINGLELIMIT $ 5,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED AUTOS SCHEDJLED AUTOS BODILY INJJRY(Perecddent) $ HIRED AUTOS P NONOWNIED AUTOS AMAGE Per ec,.d. $ E C UMBRELLA LIAB X OCCUR LP0000025622-12 0/1/2012 10/1/2013 EACH OCCURRENCE S X EXCESS LIAR CUUMS-MADE AGGREGATE $ 10,000,000 DED RETENIION$ $ D WORKERS COMPENSATION Y WA7-63D-510005-012 0/1/2012 10/1/2013 Z AND EMPLOYERS' LIABILITY ANY PROPRIETORrPARTNERIEXECUTIVEYO NIA E.L. EACH ACCIDENT $ 1,000,000 ?O1FaFICEWMEMBE1REXCLUDED? d N ELOtSFASE-FA EMPLOYEE $ 1,000,000 0.yes eealbe ntler DESCRIPTIONOFOPERATIONSbelow E.LDISEASE -POLICYLtMT $ 1,000,000 A Professional Liab F 10/1/2012 10/1/2013 Each Medical Incident $5,000,000 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach Acord 101, Addko" Remarks Sctwduk, ff mm span Is r"Wmd) APPROVED AS TO FORM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTOO D ESENT City of Santa Ana and OCFA Coll:3901342 Tpl:1522613 Cert:18767380 ® 88-2010ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered mark of ACORD KR'C,"'O' r-or0610 X 5Z?1 AGENCY CUSTOMER ID: 33004270 LOCH Paged of `'` °R°? ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Care Ambulance Service, Inc. Willis of New York, Inc. 1517 Braden Court POLICY NUMBER Orange, CA 92868 See First Page CARRIER ;?E See First Page [ EFFECTNEDATE See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Excess Liability Policy# TH7-631-510005-042 Effective/Expiration: 10/01/2012-10/01/2013 Carrier: Libert Insurance Corporation Limits of Liability: $5,000,001) Per occurrence/$5,000,000 Aggregate The City of Santa Ana and OCFA, and their respective officers, officials, employees, representatives and volunteers are hereby declared to be additional insured, as respects operations, activities, works, errors or omissions of the named insured arising out of or connection with any contract or agreement with the City of Santa Ana. This insurance is primary to, and shall not contribute with, any insurance or self-insurance maintained by the CITY of SANTA Ana, by OCFA, or by any of the designated additional insureds. This insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. Waiver of subrogation applies in favor of certificate holder under the workers compensation and professional liability policies. ACORD101 (2008101) Coll:3901342 Tpl:1522613 Cert:18767380 ®2008ACORDCORPORATION. Allrights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL PROTECTED PERSONS ENDORSEMENT - SPECIFIED TERMS AND NOTICE GL (30 DAYS) This endorsement modifies insurance provided under the following: Healthcare General Liability Coverage Form The organizations named below are added to Section II - Who Is An Insured of your policy. Coverage is provided for them only for the work you performed or should have performed on their behalf. They will share in your limit of insurance for any covered "claim" or 'suit'. Damages paid on their behalf will reduce and may exhaust your limits of insurance under this policy. Further, this insurance is primary, but only to the extent required by written contract with the named insured to provide insurance that is primary and non-contributory, and the written contract so requiring is executed by the named insured before any 'claim" or suit". With regard to these contracts, the following changes are made to your Common Policy Conditions 2. Cancellation is deleted in its entirety and replaced with the following: Cancellation The first Named Insured shown in the Introduction may cancel this policy by mailing or delivering to us advance written notice of cancellation. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: 1. Thirty (30) days before the effective date of cancellation if we cancel for nonpayment of premium; or 2. Thirty (30) days before the effective date of cancellation if we cancel for any other reason. We will mail or deliver our notice to the first Named Insured's last mailing address (mown to us. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. If notice is mailed, proof of mailing will be sufficient proof of notice. Section 15. Transfer of Rights of Recovery Against Others To Us is deleted in its entirety and replaced with the following: Transfer of Rights of Recovery Against Others To Us 00 ML0207 00 11 03 Page 1 of 2 We waive the right of recovery we may have against the organizations named below because of payments we make for injury or damage arising out of your ongoing operations or 'your worm' done under a contract with the organizations and included in the "products-completed operations hazard This waiver applies only to the organizations named below. Named Additional Protected Person Orange County Orange County Fire Authority City of Costa Mesa and its elected and appointed boards, officers, agents, and employees; Los Angeles County Dept of Health Services EMS Agency; Black Rock Realty; Diamond Canyon Park, LLC; Shephard Commercial Real Estate, LLC City of Santa Ana and its officers, employees, agents, volunteers and representatives Orange Unified School District County of Orange / Health Care Agency All other terms of your policy remain unchanged. Issued By: Arch Specialty Insurance Company Endorsement Number: 15 Policy Number: FLP0046376-01 Named Insured: Falck USA, Inc. Endorsement Effective Date: October 01 , 2012 President 00 ML0207 00 11 03 Page 2 of 2 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Not applicable in New Jersey Schedule All persons or organizations that are parties to a contract that requires you to obtain this agreement, provided you executed the contract before the loss This endorsement is executed by the Liberty Insurance Corporation 21814 Premium $ Effective Date Expiration Date For attachment to Policy No. WA7-63D-510005-012 WC 00 03 13 ® 1983 National Council on Compensation Insurance. Page 1 of 1 Ed. 4/1 /1984 4 NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. Schedule Name of Other Person(s) ! Email Address or mailing address: Number Days Notice: Organization(s): City of Santa Ana 20 Civic Center Plaza (M-30) 30 PO Box 1988 Santa Ana, CA 92702-1988 All other terms and conditions of this policy remain unchanged. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA7-63D-510005-012 Effective Date Premium $ Issued to WM 90 18 06 11 © 2011, Liberty Mutual Group. All Rights Reserved. Page 1 of 1 Ed. 06/01/2011 POLICY NUMBER: AS2-631-510005-022 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE 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- fied by the endorsement. SCHEDULE Name(s) Of Person(s) Or Organization(s): Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 0 Insurance Services Office, Inc., 2009 Page 1 of 1 Policy Number AS2-631-510005-022 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modes insurance provided under the following: BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF-INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY - UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) / O anization s : Email Address or mailing address: Number Days Notice: City of Santa Ana 20 Civic Center Plaza (M-30) PO Box 1988 30 Santa Ana, CA 92702-1988 A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 01 05 11 ® 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ®®Named Insured: Care Ambulance Service, qg® CERTIFICATE OF LIABILIT INSURANCE DAFE(MMIDD/YYYY) I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE, OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A staterrlent on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER Aon Risk Services Northeast, Inc. New York NY Office CONTACT NAME: (IAION .Exile ($tiff) 2fi3 -7122 IBC. N ©.): (fii}' ©) 363-0 .I.pS; ° °._ E -MAIL ADDRESS: 199 Water Street New York NY 10038 -3551 USA INSURER(S) AFFORDING COVERAGE NAtC 7 $2,000,000 INSURED INSURER A: Lib? `ty M.,.ual Fire. Ins CO. 230335 Care Ambulance Service, Inc. ENSURER B; Liberty Insurance Corporation 151,7 W. Braden Court Orange CA 92868 USA INSURER G: Lloyd's Syndicate NO. 2623 AA1128b23 'INSURER D: Steadfast insurance Company 26387 DAMAG G,HN �PREiv1SE5 'Ea accurr�nceY INSURER E: INSURER F: MED L'xP (A.y on. person;) COVERAGES CERTIFICATE NUMBER: 570055353066 REVISION NUMBER: THIS IS TO CERTIFY THAT 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 DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITiONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE PNSO WVD POLICY NUMBER fMMfOD1YYYYI IMWDDIYYYY LIMITS O X COMMERCIAL GENERAL. LIABILITY w14.3R7140201 1.0/01/201.4 EACH OCCURRENCE $2,000,000 �-"" CLAIM F, -MADE I X I OCCUR �.�.7 DAMAG G,HN �PREiv1SE5 'Ea accurr�nceY �� 3100,000 X MED L'xP (A.y on. person;) S5,000 FsoduoCa - -cWms Made PERSONAL &ADV INJURY Incl.ude.d GENERAL AGGREGATE $2,000,0 GEN'L AGGREGATE LIMIT APPLIES PER.. X. POLICY E] PRO- F LtiC L......�.1 JECT PRODUc: s comproP I' +.GG $2,000,000 , OTHER. A : AUTOMOBILE LIABILITY '�, AS2 -6:31- 510005 -024 10/01/21)14.10/0112015 COM,IEINEDSINGLEUM IT ''.. Ea accident' 'S2,000,000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED "OS AUTOS AUl °- PROPERTY DAMAGE HIREDAUTOS NON-OWNED SPer accident) AUTOS D' x UMBRELLA LIAB ccc,DR U+B541477001 t/O1204 0101 2:015 EACH OCCURRENCE S10,005 _0 AGGREGATE sila,000,000... EXCESS I CLF1M5 M DED RETENTION B EFRSATD1o�A4JD WA7G 3r 510005(714 1U, "01/2014 10/01/2015 I "ER r EMPLOYERS' EMP OYERS' LIABILITY E EACH ACCIDENT ST., (70'O, L7 RTTNER f EXECUTIVF YtiN,, (Mandatary in NH) ...,NIA E, L. DISEASE -EA EMP_OYEE 51,000,000 Ir yes describe under DESCRIP°If)N OF OPERATIONS below i E.L. DISEkSE- Pry " "iLOr.;1' LI<ti11T 31 , 00-076 _00 c Misc Med Prof W143B7140201 ArJ /01 ZU14 10/01/2015 Ea. Medical lnciden 32,000 ,000 Aggregate Litnit 52,000,000 (space A 52,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 191,. Addttsonal Remarks Schedule, rnay be aYlached it more Is required) Tile City of Santa Ana an'.€I CCFA, and Their respective officers, officials, eriployees, represent,atl ve. and volunteers are included as as Additional insured per Conti-act ar- AgreerrI with the City of Santa Ana in accordance with the policy provisions of the General Liability and AUtmobile Liability poliO eS, The Policies evidenced herein are Primary and Non - Contributory to other inSNranoe available to an Additional Insured, but only in accordance the policy's pro0 S5 onS, D,vitl wa gati...on 1S granted in favor of The city o'f Santa Ana add OCFA, their respective of "flcers, Officials, eloployees. repYecentatives and volunteers in accordance torith the PoliiCy provislpn5 of the workers COIM1pensation policy'. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 6 c, 'C as ro 0 2 h 0 Z Y nS U QY U The City of Santa Ana and OCFA AUTHORIZED REPRESENTATIVE f=inance & Management Services Agency 20 Civic Center Plaza PO Box 1988 Sanata Ana CA 92702 USA CC1988 -21 14 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD M yVr�41 l i I JN ,rJUde, 0? . , Effective date nfthis Endorsement: 01+Oct-2014 This Endorsement is attached tv and forms a part uf Policy Number: Wi43B714U2D1 Syndicates 2623/623 at Lloyd's Referred to in this endorsement ms either the "Insurer" or the SCHEDULED ADDITIONAL INSURED ENDORSEMENT— GENERAL LIABILITY COVERAGE ONLY This endorsement modifies insurance provided under the following: Beazlwy Miscellaneous Healthcare In consideration of the premium charged for the FoUoy, it is hereby understood and agreed that solely in relation to coverage provided under INSURING AGREEMENTS, A. 2, General Liability, Clause ||. PERSONS INSURED is amended to include the Additional Insureds listed in Item 8. below for which the Insured has assumed such person's/entities liability in a written contract n/ agreement (an "Additional Insured") solely for services rendered by or on behalf ofthe Named Insured and that is also named in a Claim if all of the following conditions are met: 1. The Claim against the Additional Insured seeks damages for which the Insured has assumed liability; 2. This insurance applies to such liability assumed by the Insured; 3 The obligation to defend the Additional |nsurmd, has also been assumed by the Insured in the same contract oragreement; 4. The allegations in the Claim and the information known about the incident are such that no conflict appears to exist between the interests of the Insured and the interests of the Additional Insured-, 5. The Additional Insured and the Insured ask Underwriters to conduct and control the defense of that Additional Insured against such Claim and agree that Underwriters can assign the same counsel tu defend the Insured and the Additional Insured; G. The Additional Insured agrees im writing to: a. Cooperate with the Underwriters hl the investigation, settlement or defense of the Claim; b. Immediately send Underwriters copies of any d*mondm, nmtices, summonses or legal papers received in connection with the Claim; C. Notify any other insurer whose coverage is available to the AddiUonal Insured; and d. Cooperate with Underwriters with respect to coordinating other applicable insurance available to the Additional |nemnad� and , 7. The Additional Insured provides Underwriters with written authorization to: Obtain records and other information related bm the Claim; and Conduct and control the defense of the Additional Insured in such Claim. All other terms and conditions cf this Policy remain unchanged. City of Santa Ana County of Marin 2O North San Pedro Road San Rafael, CAS49Q3 E02474 O12811ed. � �" �� /5 � �c / RPPRDOVED / Page of `—��� ��� w0 X If we cancel this policy for any reason other than nonpayment of premimn, we will notify the persona or organizations shown in the Schedule below, We will send notice to the email or mailing address listed be�w at least 10 daym, or the number of days listed be|mm, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate canceUation of the Name of Other Person(s) Email Address or mailing address: Number Days Notica 3Q C�y�San�Ana 28C�oC��P����0 PD Box 1S8O Santa Ana, CA 92702-1988 All other terms and conditions of this policy remain unchanged. �sauedby Lberty Insurance Corporation 2l814 For attachment bu Policy No. WA7-63D-510005-014 Effective Date Premium$ Issued to FabKU8A. Inc. VVMS0i8&611 (92O11. Liberty Mutual Group, All Rights Reserved. Ed�O6/O1/2O11 IN "872 01 -ri 0013- 10007- Policy Number: A52- 631 - 5100075 -029 Issued y: Liberty Mutual Fire Insurance Co. This endorsement modifies insurance provided under the following: BUSINIESSAUTO COVERAGE MOTOR CARRIER COVERAGE PART GARAGE ... PART TRUCKERS wa. EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELPANSURED TRUCKER EXCESS LIABILITY PART COMMERCIAL GENERAL LIABILITY COVERAGE Y EXCESS COMMERCIAL r LIABILITY qN1. PART Will w' a w w !I@L�r-10§r,A-2,4 r City cf Santa Ana Email Address or mail