HomeMy WebLinkAboutC20180481 Interlocal Agreement SKAGIT COUNTY
Contract # C20180481
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SKAGIT COUNTY
EMERGENCY MEDICAL SERVICES SYSTEM DELIVERY AGREEMENT
This Emergency Medical Services System Delivery Agreement is by and between Skagit
County ("County"); and "Provider(s)"which includes the City of Sedro-Woolley; the City of
Anacortes; the City of Mount Vernon; the City of Burlington; and Aero Skagit, a not for profit
Corporation, hereafter referred to collectively as the"Parties," for the provision of emergency
medical services throughout Skagit County.
RECITALS
1. The County, with approval from the voters of Skagit County and as authorized by RCW
84.52.069, collects a countywide Emergency Medical Services(EMS) levy, which is
independently accounted for in the "EMS Fund".
2. The Board of Skagit County Commissioners (BOCC) is responsible for disbursing EMS
levy funds and fulfilling oversight requirements of the EMS system.
3. The existing EMS levy expires.on December 31, 2018, and the voters of Skagit County
have just approved a new EMS levy that begins on January 1, 2019 and expires on
December 31, 2024.
4. The Cities each operate municipal fire departments through which they either currently
provide or will provide by January 1, 2019, both basic life support(BLS) and advanced
life support (ALS) responses and transports.
5. On July 25, 2018, the Skagit County Board of County Commissioners enacted
Ordinance No. 020180008, which created a fire-based emergency medical services
delivery model.
6. Aero Skagit operates as a nonprofit corporation for the provision of both basic life
support(BLS) and advanced life support(ALS) responses and transports in their
designated area.
7. The Parties to this Agreement are willing to work cooperatively to deliver seamless,
countywide EMS services with funding from the EMS levy as outlined in this Agreement.
EMS revenues are not intended to supplant current fire department funding; however
this model creates an economy of scale.
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AGREEMENT
1. PURPOSE: The purpose of this Agreement is to establish a unified system of delivery of
both ALS and BLS emergency medical services throughout Skagit County to be performed
by Providers pursuant to Exhibit A, "Scope of Work" and as otherwise specified in this
Agreement.
2. TERM OF AGREEMENT: The term of this Agreement shall commence January 1, 2019 and
shall continue until December 31, 2024.
3. MANNER OF FINANCING: Providers shall be compensated as detailed in Exhibit B,
"Compensation".
4. DEFENSE&INDEMNITY AGREEMENT:
To the extent of its comparative liability, each Party agrees to indemnify, defend and
hold the other party, its elected and appointed officials, employees, agents and
volunteers, harmless from and against any and all claims, damages, losses and
expenses, including but not limited to court costs, attorney's fees and alternative dispute
resolution costs, for any personal injury, for any bodily injury, sickness, disease or death
and for any damage to or destruction of any property (including the loss of use resulting
therefrom)which are alleged or proven to be caused by an act or omission, negligent or
otherwise, of its elected and appointed officials, employees, agents or volunteers.
In the event of any concurrent act or omission of the Parties, each Party shall pay its
proportionate share of any damages awarded. The Parties agree to maintain a
consolidated defense to claims made against them and reserve all indemnity claims
against each other until after liability to the claimant and damages, if any, are
adjudicated. If any claim is resolved by voluntary settlement and the Parties cannot
agree upon the apportionment of damages and defense costs, they shall submit
apportionment to binding arbitration.
Parties to this Agreement are fully responsible for any liability related to subcontracting
the work in this Agreement. Any indemnification agreed to between a primary party to
this Agreement and their subcontractor does not supersede nor negate the
indemnification in this Agreement.
The Parties agree all indemnity obligations shall survive the completion, expiration or
termination of this Agreement.
5. TERMINATION:
This Agreement may be terminated prior to the expiration of the Agreement Term for the
following listed reasons. Termination of a Provider shall not invalidate this Agreement in
regard to the other non-terminating Providers.
5.1. Termination for Public Convenience: Any Party may terminate this Agreement for
public convenience by giving 18 months' notice in writing either personally delivered
or mailed postage-prepaid by certified mail, return receipt requested, to the party's
last known address for the purposes of giving notice under this paragraph.
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5.2. Termination for Default. Subject to paragraphs 6, 7 & 8 of this Agreement, County
may terminate this Agreement if Provider fails to perform or adhere to the
requirements detailed in this Agreement. Providers may terminate this Agreement
due to default of the County.
5.3. Immediate Termination: The County may immediately terminate this Agreement in
regard to any Provider that is unable to perform the required services for any of the
below listed reasons. If the County elects to invoke immediate termination the
Agreement shall be deemed terminated upon notice of such to Provider.
5.3.1. Provider not having a valid state license to provide services
5.3.2. Inability to bill Medicare
5.3.3. Inability to perform services starting January 1, 2019.
6. QUALITY IMPROVEMENT ACTION PLAN FOR SERVICES (QIP) -RESPONSE
TIMES/FREQUENT UNAVAILABILITY:
In the event Provider fails to meet the listed response times as set forth in Section D 1 of
the Scope of Work, by the date noted in the Scope of Work, or fails to make good faith
work toward meeting the listed response times, or if Providers' Units are frequently
unavailable to respond to dispatched calls, County may require Provider to submit a
Quality Improvement plan. The QIP shall be prepared to: i) identify the cause(s) of
failure to meet such times and propose improvements and/or ii) determine whether the
response times need to be altered. Provider must prepare and submit the requested DIP
within fifteen working days of the request. If Provider fails to submit the QIP, County
may terminate the Agreement for default.
Provider and County shall meet within fifteen working days of Provider's submission of
the QIP to County. County may at the meeting to discuss the submitted QIP and may
either accept the QIP as submitted, agree to amendments/request modffications or
reject the QIP. If an acceptable QIP is not agreed upon by the Parties by the end of a
20-working day period starting from the first meeting to discuss the QIP either party may
submit the QIP to be resolved pursuant Section 7. The outcome of dispute resolution
shall constitute a final decision for the purposes of the creation and implementation of
the QIP. Failure to follow an agreed QIP or one in which dispute resolution set forth in
Section 7 has been completed shall constitute default.
7. DISPUTE RESOLUTION PROCEDURE FOR OPERATIONAL DISPUTES:
In the event of any dispute, claim or controversy between a Provider and the County
concerning the creation or implementation of a QIP or the creation or implementation of
the county-wide EMS Delivery Standard Operating Guidelines manual set forth in
Section C 4 of the Scope of Work, the Parties shall comply with the following process to
resolve all such disputes.
The Parties shall certify what issue(s) are in dispute to be decided by an arbitrator. In
the event the Parties cannot reach agreement each Party shall certify their own lists of
disputed issue(s).
Selection of an Arbitrator-Qualifications. The Arbitrator shall be selected based on his
or her knowledge of the subject matter of the dispute and ability to serve in a non-neutral
capacity. Provider and the County shall designate one person who is neither an
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employee nor former employee and with a minimum of five years management
experience with and knowledge of the delivery of emergency medical services. The
person selected by the Provider and the person selected by County shall, within 10 days
of their appointment, select a third neutral arbitrator with the same minimum qualification
or greater. In the event that they are unable to do so, the Parties or their attorneys may
request the American Arbitration Association to appoint the third neutral arbitrator. The
Parties shall follow the AAA rules. Decisions from the Arbiter shall be final and binding
upon the Parties. The Parties shall divide arbitration costs evenly.
8. VENUE AND DISPUTE RESOLUTION:
This paragraph establishes the sole and exclusive remedy for disputes arising under this
Agreement, except as otherwise set forth in paragraphs 6& 7. Both in the event of any
dispute arising under this Agreement and prior to any termination for cause, except
immediate termination as set forth in paragraph 5.3, the Parties shall, as a material
condition precedent to any suit or termination for cause under this Agreement, provide
formal written notice of the dispute to the other party, and engage in formal mediation
using a mutually agreed upon mediator. If the Parties are unable to agree on a
mediator within fifteen (15) days of written notice, any party may bring suit in Snohomish
County Superior Court for the sole purpose of seeking appointment of a mediator. If the
Parties are unable to resolve their differences within thirty (30) days after mediation: (1)
venue and jurisdiction for any action arising under this Agreement shall lie in the Courts
of Snohomish County, Washington, and (2) a termination for cause may be imposed. In
the event of any dispute arising under this Agreement, each Party shall be responsible
for its own attorney fees, costs, expert witness fees, and all other costs related to the
dispute. The Parties shall divide mediation costs evenly. This Agreement shall be
governed by the laws of the State of Washington
9. SUBCONTRACTING:
Provider may subcontract all or a portion of the services. Provider must give County 60
days advance written notice of its intent to subcontract which shall include the name(s)
of such subcontractor(s). Provider shall require that their subcontractors be bound by
same terms and conditions contained in this Agreement including insurance and
indemnification requirements. Provider subcontractors must be part of the County
dispatch system have all required licenses and training required under state and MPD
protocols, operate pursuant to the Standard Operating Guidelines and must be and
under MPD authority. If Provider subcontracts all or a portion of the services pursuant to
this Agreement to a non-public entity, Providers subcontractors must name the County
as an additional insured on all required polices (unless specifically waived in writing by
Skagit County's Risk Manager) and must be bound by the applicable Exhibit Cl
Insurance(Public Agencies that are full members of a governmental risk pool or
Exhibit C2 Insurance (Nonpublic agencies or providers that are not full members
of a governmental risk pool). The mutual aid agreements and automatic aid
agreements between and among the Parties in effect prior to January 1, 2019, are not
subject to this paragraph and shall not constitute default of this Agreement.
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10. CONSENT TO ALLOW PARTIES TO OPERATE AMBULANCE SERVICES IN
PROVIDERS BOUNDARIES: By signing this Agreement, Parties agree to allow the
other Parties (and their subcontractors)to operate ambulance services in their
boundaries.
11. INSURANCE: Providers agree to be bound by the insurance requirements set forth in
the applicable Exhibit Cl Insurance (Public Agencies that are full members of a
governmental risk pool) or Exhibit C2 Insurance(Nonpublic agencies or providers
that are not full members of a governmental risk pool).
12. REGIONAL TRAUMA COUNCIL: Parties are encouraged, but not mandated, to
participate in the establishment and operation of a regional trauma council.
13. INDEPENDENT CONTRACTOR: The Provider's services shall be furnished by the
Provider as an independent Provider and nothing herein contained shall be construed to
create a relationship of employer-employee or master-servant, but all payments made
hereunder, and all services performed shall be made and performed pursuant to this
Agreement by the Provider as an independent contractor.
14. NO GUARANTEE OF EMPLOYMENT: The performance of all or part of this contract by
the Provider shall not operate to vest any employment rights whatsoever and shall not
be deemed to guarantee any employment of the Provider or any employee of the
Provider or any subcontractor or any employee of any subcontractor by the County at
the present time or in the future.
15. PROVIDER ACKNOWLEDGMENT: The Provider acknowledges that the entire
compensation for this Agreement is specified in Exhibit"B" and the Provider is not
entitled to any county benefits including, but not limited to: vacation pay, holiday pay,
sick leave pay, medical, dental, or other insurance benefits, or any other rights or
privileges afforded to Skagit County employees.
16. RIGHT TO REVIEW: The County or its designee shall have the right to review and
monitor the financial and service components of this Agreement. Such review shall
occur with three days' notice; (absent cause) and may include, but is not limited to, on-
site inspection by County agents or employees during Provider's normal business hours,
inspection of all records or other materials which the County deems pertinent to the
Agreement and its performance, and any and all communications with or evaluation by
service recipients under this Agreement. County will conduct such review or execute
necessary agreements as needed in order for such review to be HIPAA-compliant.
Provider shall preserve and maintain all financial records and records relating to the
performance of work under this Agreement pursuant to the Washington State record
retention schedule, and shall make them available for such review, within Skagit County,
State of Washington, upon request.
17. CHANGES, MODIFICATIONS, AMENDMENTS AND WAIVERS: The Agreement may
be changed, modified, amended or waived only by written agreement executed by the
Parties. Waiver or breach of any term or condition of this Agreement shall not be
considered a waiver of any prior or subsequent breach.
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18. SEVERABILITY: In the event any term or condition of this Agreement or application
thereof to any person or circumstances is held invalid, such invalidity shall not affect other
terms, conditions or applications of this Agreement which can be given effect without the
invalid term, condition, or application. To this end, the terms and conditions of this
Agreement are declared severable.
19. ENTIRE AGREEMENT: This Agreement contains all the terms and conditions agreed
upon by the Parties. All items incorporated herein by reference are attached. No other
understandings, oral or otherwise, regarding the subject matter of this Agreement shall be
deemed to exist or to bind any of the Parties hereto.
20. NO PARTNERSHIP OR JOINT VENTURE: No partnership and/or joint venture exists
between the Parties, and no partnership and/or joint venture is created by and between the
Parties by virtue of this Agreement. No agent, employee, contractor, subcontractor,
consultant, volunteer, or other representative of the Parties shall be deemed an agent,
employee, contractor, subcontractor, consultant, volunteer, or other representative of the
other party.
21. NO THIRD-PARTY BENEFICIARIES: This Agreement is not intended to nor does it create
any third-party beneficiary or other rights in any third person or party, including, but not limited
to, property owners and/or residents located at or in the vicinity of the services provided, or
any agent, provider, subcontractor, consultant, volunteer, or other representative of either
party. Response times set forth in this Agreement or later agreed among the Parties are
targets and do not constitute an admission or representation that any response time
constitutes an ordinary standard of care for the community. Response times set forth in this
Agreement or later agreed shall not constitute nor is intended to create a special relationship
or duty to any persons or class of persons under the public duty doctrine.
22. NEUTRAL AUTHORSHIP: Each of the terms of and provisions of this Agreement have been
reviewed and negotiated and represents the combined work product of the Parties hereto.
No presumption or other rules of construction which would interpret the provisions of the
Agreement in favor of or against the Party preparing the same shall be applicable in
connection with the construction of interpretation of any of the provisions of this Agreement.
The Parties represent that they have had a full and fair opportunity to seek legal advice with
respect to the terms of this Agreement and have either done so or have voluntarily chosen
not to do so.The Parties represent and warrant that they have fully read this Agreement,that
they understand its meaning and effect, and that they enter into this Agreement with full
knowledge of its terms. The Parties have entered into this Agreement without duress or
undue influence.
23. SURVIVAL: The provisions of paragraphs 3, 4, 13, 16, 20, and 21 shall survive,
notwithstanding the termination or invalidity of this Agreement for any reason.
24. COUNTERPARTS: This Agreement may be executed in counterparts by the Parties.
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DATED this�_ day of OdObrjY , 2018.
BOARD OF COUNTY COMMISSIONERS
SKAGIT COUNTY,WASHINGTON
OPPOSED
Kenneth A. Dahlstedt, Chair
Lisa Janicki, Ce, missioner
1 #P41
Attest: Ron Wesen, Commissioner
1414 +1 %✓
Clerk of the Board
For contracts un er$5,000:
Authorization r Resolution R20030146
Recommes.;.: County ministrator
4
De1 ead
Approved as to form:
I.
Civil Deputy Prosecuting Attorney
Approved as to indemnification:
).4" anager
Approved as to budget:
1(444_
Budget& Finance Dire •r
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DATED this 2c1 day of_O(' FDI0e,r _, 2018.
MAYOR
CITY OF ANACORTES, WASHINGTON
Laurie ere, Mayor
Approved as to form:
Darcy wet am, City Attorney
Approved as to budget and Attest:
//A
,j
Finance Director
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CONTa RACTOR 2( Skagit Emergency Services)
- ,
1 ‘. /01
! h/ i 1) -i J 3daolrel
I 444 4 A i h( ' ( 'Le), /
Signature&Title o Signatory
(Date 02 October 2018)
Richard Frank Board Prçsident
Print Name of Signatory
Marnng Address:
P.O.Box 705
Cojee WA 98237
Telephone No.36O1853431
Fed.Tax ID#9112OO257
Contractor Lic.#.600 087 833
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Page 76 of 32
DATED this A day of October 2018
CITY OF MOUNT VERNON
By
Jill reau,Mayor
Attest:
/7) ./
Doug Voles ,Finance Dir for
Recommended:
ryan ice,Department Director
Approved as to form:
Kevin Rogerson,City Attorney
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Page 7C of 32
LTEO this 4"day 3fOctQbSr 2018
CITY O SEOWOcLLEV
Julia . Son
Mast;
CI‘AI a'' SIL-Cglr .
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Oln5l'ne Salseria.Deputy CIk
Apptoved as to foim:
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Fran B .City ,ttoney
NTELOCAt AGRE(M(?41
ooze 70
City of Burlington
t i
Stev: on,
Levon Yengoyan, Fire Chief
ATTEST:
' Renee Sindair, Budget and Aaounang Director
APPROVED AS TO FORM:
Leif Johnson,City Attorney
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EXHIBIT A: SCOPE OF WORK
Providers shall provide trauma verified ambulance services on a twenty-four (24) hours per day,
seven (7) days per week basis, with appropriate ambulances and equipment in accordance with
WAC Chapter 24&976, North Region EMS & Trauma Care Council, and other applicable laws,
regulations, ordinances and established policies of the Skagit County Medical Program Director
when authorized by state law.
A. Definitions:
a. "Call" is defined as a unique call ID assigned by Skagit 911. If the Provider
responds with more than one unit, it will be counted as only one call.
b. "In-service unit" is defined as a unit that is appropriately staffed per Washington
State standards, is appropriately equipped per Washington State and Skagit County
Medical Program Director standards and is available for immediate dispatch and
response.
c. "Time on task" is defined as the time from when a unit is assigned to call until
that unit is available for another response. If the unit remains out of service for any
reason other than patient care or call related (reasons like mechanical issues or crew
change), the time on task will be calculated to the point when the unit went out of service
for the other reason.
d. "Primary Service Area" is defined as the City in the Provider's Response Zone as
shown in Exhibit Al.
e. "Secondary Service Area" is defined as the remainder in the Provider's
Response Zone as shown in Exhibit Al.
f. "QI" is Quality Improvement.
g. "QA" is Quality Assurance.
i. "Unavailable in the CAD system" is when a Provider's unit is not able to respond
to an ALS or BLS call due to any unforeseeable reason, such as, mechanical failure of
the unit, the unit being involved in a vehicle accident, or otherwise unable to respond
due to an act of god.
j. "Criteria Based Dispatch" is an emergency medical dispatch triage program that
is based on patient signs and symptoms collected by 911 dispatchers or other dispatch
protocols established by the MPD.
k. "Closest Unit Dispatch" is sending the unit that fits the call type based on Criteria
Based Dispatch that is the closest unit to respond to the incident.
I. "Medical Program Director" or"MPD" is a physician recognized to be
knowledgeable in the county's administration and management of pre-hospital
emergency medical care and services and functions under RCW 18.71.212 and WAC
246-976-920, as appointed by the Washington State Department of Health.
M. "EMS" is Emergency Medical Services
N. "ALS" is Advanced Life Support
O. "BLS" is Basic Life Support
B. Response and Coverage Plan:
1. Unless all of Provider's units are Unavailable in the CAD System or assigned to
an emergency response incident Provider shall respond to ALS and BLS calls
they are dispatched to in their portion of Skagit County designated as response
areas on the Service Provider map attached as (EXHIBIT Al). and other areas of
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Skagit County. County can request for a QIP to address nonperformance,
frequent unavailability, responding with inadequate resources and if not
sufficiently resolved in a timely manner could be grounds for default. Any
Provider may request that the County initiate a QIP if another provider is
unavailable or responding with inadequate resources. Response times outside
Provider's designated zones shall be evaluated separately from primary and
secondary zones.
2. Provider shall participate in the creation and implementation of a county wide
response and coverage plan, to include all trauma verified providers and other
available transportation resources. Annually on the second Tuesday of
December at 13:00 or as soon thereafter as practical, the plan will be evaluated
and modified as necessary. Either Party may call for a plan modification at any
time and within 30 days of such call, the County will convene all trauma verified
Providers and other available transportation resources to evaluate and consider
modifications to the plan. All Parties will work in good faith to implement Closest
Unit dispatch and Criteria Based dispatch protocols.
C. Operations:
1. Provider agrees that they are responsible to meet all state, local and federal
requirements for records retention and that the County possessing copies of any
records does not release the Provider from that responsibility.
2. Provider, on reasonable request, will make available proof that the Provider is in
compliance with any or all State, local or federal rules and regulations of laws
pertaining to operation of their agency, as it pertains to this contract.
3. Provider shall notify the County's EMS Director within 3 business days in writing
when a certified individual is disciplined for circumstances that would be
unprofessional conduct under RCW 18.130.180 of the Uniform Disciplinary Act.
4. Provider and County shall participate in the creation and implementation of a
county wide EMS Delivery Standard Operating Guidelines manual. In the event
Providers of EMS services in Skagit County (i.e. the cities of Sedro-W000ey,
Anacortes, Burlington, Mount Vernon, and Aero Skagit Emergency Services)
reach agreement with the County in the creation of a county-wide EMS Delivery
Standard Operating Guidelines manual, then the Provider shall operate under the
EMS Delivery Standard Operating Guidelines. Provider agree to work with the
county and other Providers in good faith to reach agreement on a county-wide
EMS Delivery Standard Operating Guideline. Provider objections to guidelines
shall be limited to specific guidelines on the grounds that the guideline results in
unreasonable increased legal risk, unreasonable increased financial risk or
unduly interferes with Provider's right to control means and methods of the
contracted work. In the event that Provider objects to a specific guideline
pursuant to this paragraph, Provider shall be obligated to operate and perform in
compliance with all other Guidelines which are not objected to contained in the
Standard Operating Guidelines and shall be obligates to negotiate with the
County and other Providers to resolve the objection.
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The EMS Delivery Standard Operating Guidelines may contain but are not limited
to:
o System specific definitions
o Standardized supply minimums
o System specific recertification procedures
o System specific record keeping procedures
o System specific response requirements
Failure of Provider to participate in the creation of the EMS Delivery Standard
Operating Guidelines manual does not eliminate the Provider's responsibility to
function under all or part of the manual in the event all providers reach
agreement.
D. Reporting and Audits:
1. For each month, the Provider shall provide the County with a report detailing its
call volume, response fractals by individual Primary and Secondary Service
Areas and combined service areas, transport number and financial performance
for each month, as well as year-to-date. Additionally, Provider on a monthly basis
shall report response times to all calls dispatched. Upon commencement of
services pursuant to this Agreement, Providers shall in good faith work toward
meeting the response time and targeted percentages listed below. By April 1,
2020, Providers must meet the below listed response time targeted percentages.
In the event, Provider does not make sufficient efforts to work toward meeting the
below listed targeted response time percentage, or if by April 1, 2020, Provider
does not meet the targeted response time percentages then County can request
a quality improvement plan to address nonperformance. For the purpose of
response time calculations, aid non-priority citizen assist and welfare checks will
not be included, unless otherwise required under the Standard Operations
Guidelines.
a. Primary Service Area Response Times and Targeted Percentage.
Percentage of time first transport capable unit arrives in under 8 minutes,
or as otherwise required under the Standard Operations Guidelines, from
toned time in primary service area, target is 90 percent, evaluated on a
monthly basis.
b. Response Times and Targeted Percentages including the Secondary
Service. Percentage of time first transport capable unit arrives in under 12
minutes, or as otherwise required under the Standard Operations
Guidelines, from toned time in the service area, target is 90 percent,
evaluated on a monthly basis.
c. Aero Skagit Response Times: Aero Skagit response times will match
Washington State Department of Health response times unless mutually
agreed upon by Aero Skagit and the County.
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d. Closest and Criteria- Based Dispatch. Upon implementation of closest
unit and criteria-based dispatch, the Parties shall meet and may by
agreement adjust the primary and secondary response area response
times and targeted percentages.
2. Yearly, Providers will provide an annual report summarizing their activities from
the last year and describing innovations and efficiencies to the EMS delivery in
the upcoming year.
3. Weekly, Providers shall provide the County and the MPD with completed
Advanced Airway Audit Forms (Exhibit A2), for all calls on which advanced
airway procedures were performed including the video information from the video
laryngoscope.
4. Providers shall complete by Skagit County MPD standards electronic Patient
Care Reports ("ePCR") documenting all incidents where patient contact happens,
on all calls received by Provider from Skagit 911 to create a single uniform
county-wide ePCR and Data Collection System and close the record prior to the
end of the provider's shift.
5. Providers will work towards a QA and improvement process within the first 24
months of the contract. This will include:
a. Monthly reporting with templated reviews for:
• All Patients requiring Advanced Airway Management(Supraglottic
airway, CPAP, Intubation, and/or Surgical Airway attempts)
• All STEMI patients (ST-Elevation Myocardial Infarction)
• All Trauma Activation Patients as defined by Washington State
Department of Health DOH 689-164 July 2016
• All Cardiac Arrests
• NOTE: All Cardiac Arrests involving a shockable rhythm
should require a Zoll Data Code Review
• All Code Stroke Activation Patients
• All Sentinel Events as defined by Version 1.22 Skagit County EMS
Sentinel Events Implementation Date: 4/13/17
• Identified QA/QI and/or Unusual Event Calls
• ADDITIONAL NOTE: In the setting of an MPD requested
review of a specific call or incident, Provider will provide
the initial review within (4) weeks of the official request.
b. At least quarterly reporting of reviews for the following:
• A random selection of charts for documentation review(NOTE: no
less than 15% of patient transports per month should be reviewed.
This 15%total can include the special patient categories reviewed
above)
• Special Topic Reviews (Once a quarter a special topic shall be
identified for review(e.g., diabetic emergencies, seizures, etc.)
• New Project Rollout or Issue Identification Reviews (When a new
project is developed, or an issue of concern developed, a period
of initial intense reviews followed by periodic follow up reviews will
be developed and approved by the MPD)
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c. When a Provider begins transporting with BLS, Provider will review (and
will include as part of the monthly reporting) 25% of BLS transports for the
first six months of providing BLS transports.
d. QA/QI personnel will be expected to participate in case and educational
presentations. (OTEP credit will be awarded.)
e. County reserves the right at the MPD's discretion to require additional
provider quality assurance checks.
E. Medical Protocols:
1. Provider shall follow the Skagit County EMS Sentinel Events Protocol and
provide information as described in Exhibit A3 for all incidents meeting any
portion of this protocol.
2. All Provider field personnel shall be under the direct medical control and
supervision of the Skagit County Medical Program Director(MPD) or its
designee, and shall comply with medical protocols, online medical control, and
other requirements as established by the MPD, the county and the state.
F. Licensing and Accreditation:
1. At all times Provider personnel performing medical services under this
Agreement shall be certified to practice in the State of Washington and Skagit
County when required or allowed by law.
2. In the current levy cycle, the Provider shall pursue CARS accreditation or
approved similar option.
G. Equipment and Supplies:
1. Provider is responsible to purchase all equipment, vehicles, and supplies needed
to provide services to fulfill the contract.
2. Provider is responsible for maintenance and replacement of their equipment and
vehicles.
3. Provider will make available, upon reasonable request, service and maintenance
records for equipment and vehicles used for fulfilling this contract.
H. Federal Funding and HIPAA:
1. Provider is responsible for complying with all current rules and regulations
associated with providing services for recipients of and being reimbursed by
Medicare, Medicaid and other state and federally funded programs, and any
amendment thereto.
2. The County and Provider will comply with all applicable rules and regulations.
The County and Provider agrees to adhere to any specific HIPAA protocols,
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including any required training related to transmitting, storing, and using HIPAA
information pursuant to this Agreement.
3. Any suspected or actual violations of HI PAA rules and regulations, including a
breach of PHI confidentiality, shall be reported within three business days to the
other party's designated official, along with their actions to mitigate the effect of
such violations.
I. Billing:
1. Provider agrees to use the approved User Fees Schedule as set forth in EXHIBIT
A4 at all times.
2. It is Provider's obligation to expend reasonable efforts to maximize allowable
reimbursement to offset their EMS expenses.
3. Provider shall participate in an annual meeting to be scheduled in the month of
May by the EMS Department to discuss ambulance rate setting, billing and
collection services for the following calendar year. Provider shall bring rate
recommendations and all supporting documentation to the meeting. Provider
shall present rate recommendations and their financial impacts. The County will
review all presented information and issue rates for the next calendar year no
later than August 1. To the extent applicable, rates and charges shall be set in
compliance with RCW 35.21.766(3).
INTERLOCAL AGREEMENT
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EXHIBIT Al Service Provider Map
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INTERLOCAL AGREEMENT
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EXHIBIT A2
Version 1.2 QA REVIEW Implementation Date: 74-16
Last Reviewed 7-1 6-16 TrialApproval by Dr.Russell
ALS Template for Structured Chart Review - ADVANCED AIRWAY MANAGEMENT
Call# Reviewer (circle one) BLS/ALS/County
El EMS Online Airway Report Attached El Zoll data fileattached Video data file attached
Yes No ' q
Are Complete vital signs charted?
Are 2 sets of vitals documented it transport>5 minutes?
Is preairway intervention 02 saturation documented'
Is incubation procedure documented properly in ESO flow?
is the provider performing the procedure documented properly? 111111
Does procedure in FLOW match narrative description? 111111
Was incubation procedure ultimately successful?
Was 1st pass attempt successful?
How many attempts were required? (Document S under N/A) .111
Were any adjunctive medications used documented properly? !Tube confirmation documented appropriately?
Tube depth documented appropriately? 1111
It used, was rescue device/proceitire successful?
If used,was rescue device/procedure documented appropriately? 11111
Is post procedure quantitative ETCO2 documented?
Are complete past procedure vitals documented?
Does FLOW description match narrative?
Does EMS Online Airway description match ESO? 11111
host procedure care and monitoring appropriate?
Is overall carefdocumentatlon appropriate?
This chart should be reviewed by Agency Supervisor
This chart should be reviewed by the MPD 1.111
INTERLOCAL AGREEMENT
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Version 1.2 QA REVIEW Implementation Date: 71-16
Last Reviewed 7-1 616 Trial Approval by Dr. Russell
Any Additional Reviewer Feedback/Comments:
GENERAL DOCUMENTATION NOTE
Are allergies documented appropriately?
Is pertinent medical history (PMH) documented appropriately?
Are patient medications documented appropriately? -
If performed,are procedures documented correctly?
Are administered medications documented appropriately?
Is an appropriate physical exam documented?
Is the narrative adequate/appropriate? .1111
Are only approved abbreviations used? -
Are Primary and Secondary Impressions appropriate? I -
ADDITIONAL EMS QUQA OFFICE REVIEW OF OUTCOMES
Prehospital Care Appropriate or without concerns? ! -
Quality Improvement-ConfidTha1
This doctirnert(and any anacYunent to it)is protected by coordinated quality improvement/peer review Cpnfipvy,tiali^, nder RCN
7041 200/4 24 250/4370510
INTERLOCAL AGREEMENT
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EXHIBIT A3
Version 1.07 Skagit County EMS Sentinel Events Implementation Date:4/13/17
Date Last Reviewed:4-12-17 Approved for use by Dr.Russell
The following are event indicators that require Quality Assurance/Quality Improvement(QA/QI)reporting to both the EMS
Agency and the County QA/QI representatives.
Sentinel Events Notes
Unanticipated Patient Death I Notify MPD and County QA/QI ASAP
Unanticipated Potential Patient Includes dropped patient, adverse medication reaction,
Harm,Injury, or Adverse Event etc...
Failed Airway ALS i Any patient for which intubation was attempted and not ultimately suc-
cessful.(Includes patients for which an alternate airway such as a King
Airway or Surgical Airway ultimately established).Also includes pa-
tients for whom an alternate airway was attempted(King/Surgical)and
not successful.
Surgical Airway ALS Any time a surgical airway is performed
Failed Airway BLS I Unsuccessful attempt at placement or ventilation using a
Super-glottic Airway(e.g. King Airway)
Delayed Recognition of Esophageal !Notify MPD and County QA/QI ASAP
Intubation
Critical Diagnostic or Therapeutic Any case for which an individual has concern for a critical
Error error in problem identification or treatment
Medication Dosing Error
EMS Personnel Injury Any time an EMS Responder is injured. In setting of severe injury,noti-
fy MPD and County QA/QI ASAP.Include exposure incidents.
EMS Motor Vehicle Crash With Injuries->Notify MPD and County QA/QI ASAP
EMS Severe Safety ConcernfEvent Any issue for which a safety event or concern not identified in the above
categories and for which expedited County level review is warranted.
Examples:Concern for EMS responder intoxication or controlled sub-
stance diversion
Major Equipment Failure Any major equipment failure(e.g,monitor,vehicle,etc...)
Suspected or Potential Controlled Notify MPD and County QA/QI ASAP
Substance Diversion
Assault on EMS Personnel With or without injuries. All incidents should be reported.
Mass Casualty Incidents Incidents with>3 patients should be a)reported and b)initial review for
potential of MCI status and formal review.All declared and
retrospecitively identified MCPs should be formally reviewed.
Notes:
1. It is important to follow the designated QA/QI process. Reporting a Sentinel Event is NOT part of the patient medical record/ePCR but is a
separate,legally protected process and each component of the process should be clearly marked as a QA/QI component.An event can al-
ways be reported at http://wwwskagitcounty.neUDepartments/EmergencyMedicalServices/commentsform.htm
2. When MPD and County QA/QI ASAP notification is required,it should occur by a combination of phone call to(360)416-1837 and emal_
skagitmpd@icloud.com as soon as practically possible.
3. If the MPD is not available,notify the MPD Physician Delegate Supervisor Dr.Curran:Phone(248)568-9972 and CurranEMS@outlook.-
cQrn)
4. The Skagit County EMS QA/QI Contact is Kevin Chao at(360)416-1835 and kchaoco.skagit.wa.us
INTERLOCAL AGREEMENT
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EXHIBIT A4
SKAGIT COUNTY
Resolution # R20170145
RESOLUTION NO Page 1 of 2
RESOLUTION AMENDING SKAGIT COUNTY RESOLUTION NO. R20150181
REGARDING REVISION OF SKAGIT COUNTY
AMBULANCE FEE SCHEDULE
WHEREAS, Skagit County Ordinance No. 020030003 was passed by the Skagit Board of
Commissioners effective December 30, 2002, to provide efficient and effective emergency medical
and related services throughout Skagit County in compliance with state laws and
WHEREAS, pursuant to the Ordinance referenced above. the Skagit County Board of
Commissioners has the responsibility to establish ambulance user fee rates; and
WHEREAS, a public hearing was held on June 27, 2017, considering the revision of
ambulance fees to residents and non-residents of Skagit County; and
WHEREAS, the proposed rate schedule incorporates a higher rate for Skagit County
residents and non-residents who utilize the service.
NOW, THEREFORE, BE IT RESOLVED AND IT IS HEREBY ORDERED, that the
following Ambulance Rate Schedule be established effective July 1 2017, for all contracted
ambulance service providers pursuant to the above-referenced Ordinance:
CMS# Level of Service Codes ; Resident Fee Non-Resident Fegk
A0428 BLS -- Non Emergency Transport S 610.00 $ 850.00
A0429 BLS -- Emergent Transport 5 685.00 $ 900.00
A0426 } ALS -- Non Emergency Transport, Level 1 S 820.00 $ 1,163.00
A0427 I ALS-- Emergency Level 1----- $ 875.00 $ 1,168.00
A0433 ALS-- Emergency Transport, Level 2 $ 985.00 $ 1,230.00
A0434 Specialty CareTransport $ 1,150.00 $ 1,330.00
A0425 Mileage S 16.00 S 18.00
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PASSED this day, pfj492O17.
BOARD OF COUNTY COMMISSIONERS
SKAGIT COUNTY,WASHINGTON
GNI Cpuovlij&)A..
(00 C).44xssiePt\l'A.
R. Wesen, Chair N
SEAL j
I 0- Its,' Ar,
cwt./ Kenneth a Dahlstedt, Commissioner
Wie
Lisa Janicla, missioner
Attest:
Clerk or the Board
Approved as to form: Approved as to Content:
-2)5 /2,I--I)
Civil Deputy Proseci)tlng Attorney Department Head
INTERLOCAL AGREEMENT
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Exhibit B - Compensation For 2019- 2024 Levy Cycle
Compensation for the 2019- 2024 EMS Levy Cycle shall be as follows:
1. Skagit County has forecast a total of$40,035,518 will be available, assuming the Board of
County Commissioners approves a 1% property tax increase annually for the provision of
services detailed in this Agreement. Skagit County shall pay Providers the following
amounts which shall be inclusive of all supplies, equipment, labor and any other costs and
expenditures for the provision of services pursuant to this Agreement.
A. Aero Skagit-Annual amount, to be billed in equal monthly installments, at the end
of each month, as follows:
T
Year Amount
2019 $ 964,000
2020 $ 992,920
2021 $ 1,022,708
2022 $ 1,053,389
2023 $ 1,084,990
2024 $ 1,117,540
B. City of Anacortes - $208,000 for one-time startup expenses to be billed at the end of
the first month of service. Annual amount, to be billed in equal monthly installments,
at the end of each month, as follows:
Year Amount
2019 $ 1,310,00Q
2020 $ 1,349,300
2021 $ 1,389,779
2022 $ 1,431,472
2023 $ 1,474,417
2024 $ 1,518,649
C. City of Burlington - $184,800 for one-time startup expenses to be billed at the end of
the first month of service. Annual amount, to be billed in equal monthly installments,
at the end of each month, as follows:
Year Amount
2019 $ 1,138,000
.. 2020 $ 1,172,140
2021 $ 1,207,304
2022 $ 1,243,523
2023 $ 1,280,829
2024 $ 1,319,254
INTERLOCAL AGREEMENT
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D. City of Mount Vernon - $222,400 for one-time startup expenses to be billed at the
end of the first month of service. Annual amount, to be billed in equal monthly
installments, at the end of each month, as follows:
Year Amount
_2019 $ 1,446,000
_ 2020 $ 1,489,380
2021 $ 1,534,061
2022 $ 1,580,083
2023 $ 1627486
2024 $ 1,676,310
E. City of Sedro-Woolley- $184,800 for one-time startup expenses to be billed at the
end of the first month of service. Annual amount, to be billed in equal monthly
installments, at the end of each month, as follows:
- -
Year Amount
2019 $ 1,137,000
2020 _ $ 1,171,110
2021 $ 1,206,243
2022 $ 1,242,431
2023 $ 1,279,704
2024 $ 1,318,095
2. Capital equalization funding for the depreciated value equipment
A. In July 2019, City of Anacortes, upon presentation of an invoice, will receive
$153,231 of capital equalization funding for the depreciated value of the following
equipment: (1HTMRAAM44H674211).
B. In October 2019, City of Mount Vernon, upon presentation of an invoice, will receive
$145,312 of capital equalization funding for the depreciated value of the following
equipment: (3C7VVRLCL2EG224IO8).
C. In February 2021, City of Mount Vernon upon presentation of an invoice, will receive
$103,564, of capital equalization funding for the depreciated value of the following
equipment: (3C7VVRLCLOEG224I 07).
D. In September 2022, City of Sedro-Woolley, upon presentation of an invoice, will
receive $55,294 of capital equalization funding for the depreciated value of the
following equipment: (3C7WRLCL6GG325610).
3. If and when the Parties agree to renegotiate the payment for services after the
implementation of Closest Unit Dispatch, all Parties agree that Skagit County will not
INTERLOCAL AGREEMENT
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contribute any funds other than what is defined above as the total payment amount
currently projected as $40,035,518. A redistribution of allocated funds may be acceptable
upon agreement of the Providers.
4. If at any time during the term of this Agreement, there is a reduction in assessed value
such that an increase of 1% of the levy above the previous year is not possible, all Parties
agree to a proportionate reduction of funding in the payment amounts listed above.
5. In the event there are excess funds from CVAA after the dissolution and winding up of
CVAA's affairs, the County will add the excess funds to the Closest Unit and Priority
Dispatch implementation line item of the budget.
6. In the event the Agreement is terminated pursuant to paragraph 5 of the
Agreement, other than termination for convenience invoked by the County, the
one-time startup expenses and the value of the capital received will be reimbursed
to the County based on the schedule set forth below. Payments shall be calculated
at the time Provider actually ceases to provide services under this Agreement. In
the event this Agreement is terminated in regards to one or more Provider(s), if the
Provider or other EMS servicer agreeing to assume the terminating Providers
remaining response area agrees to take ownership of any surplus unit or monitor
belonging to the terminated Provider(s), the County may agree to an offset for the
value of some or all of the unit/monitor from the return of capital amounts listed
below. Additionally, Provider is not required to make the below listed payments to
County for return of Start Up Costs or unit/monitor costs if this Agreement is
terminated pursuant to paragraph 5.3 "immediate termination" before January 31,
2019, due to the Provider not obtaining the necessary ambulance licenses from the
state or inability to employ sufficient labor to perform the services conditioned upon
the terminated provider returning the unit/monitor pursuant to County direction and
that County has not made payment of start-up costs to the terminated Provider.
No Provider will be required to pay startup or unit and monitor costs if they have
not yet received payment for those items from the County at the time of termination
of services.
. I no% _ 100% 90% 80% 60% 0°r6
Start Up 2019 2020 2021 2022 2023 2024
AFD $208,ocx) $208,000 $187,200 $166,4(x)1 $124,800 $0
MVFD $222,4x) $222,400 $200,160 $177,920 $133,440 $01
BFD $184,800 $184,800 $166,320. $147,MO• $110,8801 $01
SWFD $184,8(X) $184,800 $166,320 $147,840 $110,880 $0
100% 100% 90% 80% 60% 0%
Capital 2019 2020 2021 2022 2023 2024
AFD $200,000 $200,000 $180,000 $160,000__$120,000 $0
MVFD $400,000 $400,000 $360,000 $320,000 $240,000 $0
BFD $200,000 $200,0xo $180,000 $160,000 $120,000 $0
SWFD $200,000 $2Cx),0x1 $180,(XX) $16O,(X)0, $120,000 $0
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7. In the event the Agreement is terminated for public convenience by one of the Providers
pursuant to paragraph 5.1 of the Agreement and the terminating Provider agrees to be
bound by the same requirements of any other EMS providers, including any required
insurance,
A. and the Provider provides no transport services, they will receive levy funds similar
to any other non-transporting fire provider.
B. and the Provider provides BLS transport services throughout the EMS system, they
will receive levy funds similar to any other BLS transport services provider.
C. and the Provider provides BLS transport services only in their municipal boundaries,
they will receive 50% of the levy funds similar of any other BLS transport services
provider.
D. and the Provider provides ALS transport services only in their municipal boundaries,
they will receive 30% of the levy funds listed in the paragraph above.
Pursuant to Skagit County Ordinance# 020090004 paragraph 9, the Board of Skagit County
Commissioners provides the transfer of these assets of the Central Valley Ambulance Authority
to these qualified entities, which will fulfill the purposes for which Central Valley Ambulance
Authority was created.
Ambulances and Equipment-Mileage as of 9-11-18
Med 1-SWFD Med 2-MVFD Med 3-MVFD Med 4-BFD
Ambulance-
Mileage Ambulance- Ambulance-
Ambulance-Mileage 51,870 90,466 Mileage 124,046 Mileage 9,767
AED Pro 1 AED Pro 2 AED Pro 5 AED Pro 3
Airway Kit 1 Airway Kit 2 Airway Kit 3 Airway Kit 4
Bone Gun 1 Bone Gun 2 Bone Gun 3 Bone Gun 4
Clam Shell 1 Clam Shell 2 Clam Shell 3 Clam Shell 4
CPAP Kit 1 CPAP Kit 2 CPAP Kit 3 CPAP Kit 4
Fetal Doppler 1 Fetal Doppler 2 Fetal Doppler 3 Fetal Doppler 4
Med Kit 1 Med Kit 2 Med Kit 3 Med Kit 4
Spare Med Kit 4
Zoll Monitor 5 Zoll Monitor 2 Zoll Monitor 4 Zoll Monitor 1
Stretcher 2 Stretcher 1 Stretcher 3 Stretcher 4
Suction Unit Suction Unit Suction Unit
Suction Unit w/Mounting w/Mounting w/Mounting w/Mounting
Thermometer 1 Thermometer2 Thermometer 3 Thermometer 4
VLS 6630 Edge VLS 6630 Edge Plus VLS 6630 Edge Plus
VLS 6630 Edge Plus 1 Plus 2 3 4
Stair Chair 1 Stair Chair 2 Stair Chair 3 Stair Chair 4
Toughbookl Toughbook2 Toughbook3 Toughbook4
Radio 1 Radio 1 Radio 1 Radio 1
Radio 2 Radio 2 Radio 2 Radio 2
Backup Radio Backup Radio Backup Radio Backup Radio
Reserve Radio
SPO2
SPO2 Monitor 1 Monitor 2 SPO2 Monitor 3 SPO2 Monitor 4
Tablet Med 1 Tablet Med 2 Tablet Med 3 Tablet Med 4
*For first round of purchases for each
Frontline Med Units (Med 1-4), pro-rated
funds will be dispersed to purchase new
ambulances at 150,000 miles.
Backup Ambulances and Equipment
CV-20-
CV-3 -SWFD CV-1 - BFD Anacortes CV-21- MVFD
Ambulance-
Mileage Ambulance- Ambulance-
Ambulance- Mileage 147,219 127,826 99,601 99,643
1 , Thermometer Thermometer
Suction Unit
Stretcher w/Monitoring
Stair Chair
Stair Chair CV3 CV1 Stair Chair CV2O
Wi-Fl CV3 Wi-Fl 1 WiFi20
MSO Rigs
CV19 - CV19 Equipment
CV6 -S-WFD MVFD - BFD
Sprint Flex-
Mileage
Truck- Mileage 17,268 127,106
AED Pro 4
Airway Kit Airway Kit
Bone Gun Bone Gun
CPAP Kit CPAP Kit
Fetal Doppler
Med Kit Med Kit
Zoll Monitor Zoll Monitor
•
Suction Unit
VLS 6630 Edge Plus
•
Toughbook MSO Toughbook Flex
•
Rechargeable Battery 1 Jet Pack
Rechargeable Battery 2 •
Radio Radio
Radio Charger
Tablet MSO Tablet Flex Med
Furniture, Storage and Misc.
. . ...... . ...
Med 1 Med 2 Med 3 Med 4
InterM Amplifier Mattress I Desk 1 Lounge 1
Printer/Fax Mattress 2 Desk 2 a Lounge 2
Network Booster a Mini Fridge Glass Table Reclining Couch
MiFi Twin Bed 1 Couch
Monitor 1 Twin Bed 2 Coffee Table
Monitor 2 Night Table 1 Twin Bed
Printer/Fax Night Table 2 Desk
Power Cot
Battery
Charger Mattress 1 Crew Desk 1
Mattress 2 Crew Desk 2
File Cabinet Crew Desk 3
Bathroom Cabinet Crew Desk 4
Vacuum Twin Bed 1
Shop Vacuum Twin Bed 2
Printer/Fax Twin Spare Bed
Paper Shredder Mattress 1
Mattress 2
Mattress 3
Vacuum
Monitor 1
Monitor 2
Printer/Copy/Fax
, .
Document
Scanner 1
Document
Scanner 2
Radio Charger
Reserve
Gigabit Switch
Microphone Spare
Paper Shredder
*All things listed in each Fire Station will be
kept at each Fire Station
INTERLOCAL AGREEMENT
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Exhibit Cl —Insurance
(Public Agencies who are full members of a governmental risk pool)
1. As0ement to provide coverage per specifications:
Prior to the beginning of and throughout the duration of the Work, Providers agree to maintain full
membership in a governmental risk pool in order to be compliant with the provisions of this
attachment. Full membership in a governmental Risk Pool in Washington State is sufficient
coverage to meet the insurance requirements of this agreement notwithstanding any other
provision in this Agreement. Provided that the insurance coverage of the Pool does not exclude
the providing of medical services unless such exclusion provides an exemption for emergency
medical services.
2. Evidence of insurance:
Provider agrees to provide evidence of their membership in a governmental risk pool
3. Priority of interpretation:
The requirements in this Section supersede all other sections and provisions of this Agreement to
the extent that any other section or provision conflicts with or impairs the provisions of this Section.
4. Notice of cancellation/change:
Provider agrees to provide notice to County 30 days prior to cancellation of membership in a
governmental risk pool or of any material alteration to their insurance coverages.
5. Primary and non-contributinqj
Per the provisions of the indemnification language of this agreement Provider's insurance coverage
shall be primary for claims filed against the provider only. In such cases, any insurance or coverage
available to the County, its officers, officials, employees or volunteers shall be excess of Provider's
insurance and shall not contribute to it.
6. Insurance "flowdown":
Provider agrees to require all subcontractors or other parties hired for this project,who are not public
agencies who are full members of a governmental risk pool, to provide the insurance as outlined in
Exhibit C2, unless otherwise agreed to in writing by the County. The subcontractor's general liability
insurance shall add as additional insureds all parties to this Agreement using Insurance Services
Office form CG 20 10 with an edition date prior to 2004. Provider agrees to obtain certificates
evidencing such coverage as required in Exhibit C2.
7. Party's right to revise requirements:
Should any party to this agreement believe that a change in types or levels of insurance coverages
may be necessary the parties agree to meet and discuss the proposed changes and discuss
appropriate increased compensation to offset increased Provider cost.
8. County's rights
of enforcement:
In the event any party to this agreement who is a full member of a governmental risk pool ceases
to be a member during the duration of this agreement they shall be immediately held to the
provisions in Exhibit C2.
INTERLOCAL AGREEMENT
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9.___Enforcement of contract provisi ons (non-estoapel): Provider acknowledges and
agrees that any actual or alleged failure on the part of the County to inform Provider of non-
compliance with any requirement imposes no additional obligations on the County nor does it
waive any rights hereunder.
10. Risk pool membershia is a Condition of Payment:
Payments due to Provider under this Agreement are expressly conditioned upon the Provider's
full membership in a governmental risk pool. Payment to the Provider shall be suspended in the
event of loss of membership, unless the provider is compliant with Exhibit C2. Upon receipt of
evidence of full compliance with Exhibit C2, payments not otherwise subject to withholding or set-
off will be released to Provider.
11. Claim notice requirement:
Provider agrees to provide notice to the County of any claim or loss against the Provider arising out
of the work performed under this agreement, no more than 30 days from the time that the Provider
becomes aware that claimed damages may exceed their insurance coverage limits, only for those
claims in which they are solely named. County assumes no obligation or liability by such notice.
12. Additional insurance:
Provider shall also procure and maintain, at its own cost and expense, any additional kinds of
insurance, which in its own judgment may be necessary for its proper protection and prosecution
of the Work.
INTERLOCAL AGREEMENT
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Exhibit C2-Insurance
(Non-Public Agencies or Providers who are not full members of a governmental risk pool)
This Exhibit, "C2- Insurance" sets forth the Insurance requirements for Providers and
subcontractors that are non-public agencies that are do not participate as full members of a
governmental risk pool.
1. Agreement to arovide coverage aer specifications:
Prior to the beginning of and throughout the duration of the Work, Providers agrees to provide and
maintain insurance in accordance with requirements set forth here. Providers acknowledges that the
insurance coverage and policy limits set forth in this section constitute the minimum amount of
coverage required. Any insurance proceeds in excess of the limits and coverage required in this
Agreement and which is applicable to a given loss,will be available to the County.
2. Additional insured requirements:
Provider agrees to obtain endorsements for third party general liability coverage required here to
include as Certificate Holder and additional insureds "Skagit County, its officials, employees and
agents." Provider also agrees to require this same provision of all providers, subcontractors, agents
or other Parties engaged by or on behalf of Provider in relation to this Agreement. This provision
shall also apply to any excess liability policies. Public Agencies are not required to name the
County as an additional insured on required polices. All non-public agency subcontractors must
comply with the additional insured requirements.
3. Evidence of insurance:
Provider agrees to provide evidence of the insurance required herein, satisfactory to County,
consisting of:
a) certfficate(s) of insurance evidencing all of the coverages required and,
b) an additional insured endorsement to Providers generally liability policy using Insurance
Services Office(ISO)form CG 20 10 with an edition date prior to 2004.
If the Providers insurer provides additional insured coverage through either the ISO "Automatic
Additional Insured" endorsement or through direct incorporation in policy language, Provider must
provide a copy of the automatic endorsement or a copy of the section of the policy granting such
status.
Providers agrees, upon request by County, to provide complete, certified copies of any policies
and/or endorsements required within 10 days of such request. Any actual or alleged failure on the
part of County or any other additional insured under these requirements to obtain proof of insurance
required under this Agreement in no way waives any right or remedy of County or any additional
insured, in this or in any other regard.
4. Prohibition of undisclosed covers! - limitations:
None of the policies required herein shall be in compliance with these requirements if they include
any limiting endorsement that has not been first submitted to County and approved of in writing.
5. Priority of interpretation:
The requirements in this Section supersede all other sections and provisions of this Agreement to
the extent that any other section or provision conflicts with or impairs the provisions of this Section.
INTERLOCAL AGREEMENT
28 of 32
6. Acceptable insurers.
All insurance policies shall be issued by an insurance company currently authorized by the Insurance
Commissioner to transact business of insurance in the State of Washington, with an assigned
policyholders'Rating of A-(or higher)and Financial Size Category Class VII(or larger)in accordance
with the latest edition of Best's Key Rating Guide, unless otherwise approved by the County's Risk
Manager.
7. Notice of canceIIationIchanq
Provider agrees to require insurers to provide notice to County 30 days prior to cancellation of any
coverage required herein or of any material alteration or non-renewal of any such coverage, other
than for non-payment of premium. Provider shall assure that this provision also applies to any
subcontractors, joint ventures or any other party engaged by or on behalf of Provider in relation to
this Agreement. Certificate(s) are to reflect that the issuer will provide 30 days' notice to County of
any cancellation of coverage.
8. Primary and noncontributing:
Provider's insurance coverage shall be primary. Any insurance or coverage available to the County,
its officers, officials, employees or volunteers shall be excess of Provider's insurance and shall not
contribute to it.
9. Prohibition against self-insurance:
Self-insurance will not be considered to comply with these insurance specifications, unless otherwise
agreed to in writing by the County. Any"self-insured retention"must also be declared and approved
by the County. County reserves the right to require the self-insured retention to be eliminated or
replaced by a deductible. Self-funding, policy fronting or other mechanisms to avoid risk transfer are
not acceptable. If Provider has such a program, Provider must fully disclose such program to the
County.
10. No change in scope or limits:
All coverage types and limits required are subject to approval, modification and additional
requirements by the County, as the need arises. Provider shall not make any reductions in scope of
coverage (e.g. elimination of contractual liability or reduction of discovery period) that may affect
County's protection without County's prior written consent.
11. Provider's waiver of subrogation:
All insurance coverage maintained or procured pursuant to this Agreement shall be endorsed to
waive subrogation against the County, its elected or appointed officers, agents, officials,
employees and volunteers or shall specifically allow Provider or others providing insurance
evidence in compliance with these specifications to waive their right of recovery prior to a loss.
Provider hereby waives its own right of recovery against the County and shall require similar
written express waivers and insurance clauses from each of its subcontractors.
12. Insurance "flowdown":
Provider agrees to require all subcontractors or other Parties hired for this project to provide the
same insurance as required of Provider unless otherwise agreed to in writing by the County. The
subcontractor's general liability insurance shall add as additional insureds all Parties to this
Agreement using Insurance Services Office form CG 20 10 with an edition date prior to 2004.
Provider agrees to obtain certificates evidencing such coverage as required here.
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13. County's right to revise requirements:
The County reserves the right at any time during the term of the contract to change the amounts and
types of insurance required by giving Provider ninety (90) days advance written notice of such
change. If such change results in substantial financial impact to Provider, the Parties agree to meet
and discuss appropriate increased compensation to offset increased Provider cost.
14. County's rights of enforcement:
In the event any policy of insurance required under this Agreement does not comply with the
specifications in this Exhibit or is canceled and not replaced, the County has the right but not the
duty to exercise one of the following options: 1) obtain the insurance it deems necessary and any
premium paid by the County will be promptly reimbursed by Provider or the County will withhold
amounts sufficient to pay premium from Provider payments, 2) the County may cancel this
Agreement. If the County exercises option 1 above, upon receipt of evidence of full compliance,
payments not otherwise subject to withholding or set-off will be released to the Provider.
15. Enforcement of contract arovisions (non-estoppel): Provider acknowledges and
agrees that any actual or alleged failure on the part of the County to inform Provider of non-
compliance with any requirement imposes no additional obligations on the County nor does it
waive any rights hereunder.
16. Insurance is a Condition of Payment:
Payments due to Provider under this Agreement are expressly conditioned upon the Provider's
strict compliance with all insurance requirements under this Agreement. Payment to the Provider
shall be suspended in the event of non-compliance, unless other resolution is agreed to by the
County. Upon receipt of evidence of full compliance, payments not otherwise subject to
withholding or set-off will be released to Provider.
17. Non-limitation of contract language:
Requirements of specific coverage features are not intended as limitation on other requirements or
as waiver of any coverage normally provided by any given policy. Specific reference to a coverage
feature is for purposes of clarification only as it pertains to a given issue and is not intended by any
party or insured to be all-inclusive.
18. Annual renewal requirement:
Provider will renew the coverage required here annually as long as Provider continues to provide
any services under this or any other contract or agreement with the County. Provider shall provide
proof that policies of insurance required herein expiring during the term of this Agreement have been
renewed or replaced with other policies providing at least the same coverage. Proof that such
coverage has been ordered shall be submitted prior to expiration. A coverage binder or letter from
Provider's insurance agent to this effect is acceptable. A certificate of insurance and/or additional
insured endorsement as required in these specifications applicable to the renewing or new coverage
must be provided to County no less than five days prior to the expiration of the coverages. Failure
to provide such evidence may result in a stop of payment to Provider, or other resolution agreed to
by the County.
19. Claim notice requirement:
Provider agrees to provide immediate notice to County of any claim or loss against Provider in excess
of$20,000 arising out of the work performed under this Agreement. County assumes no obligation
or liability by such notice but has the right(but not the duty)to monitor the handling of any such claim
or claims if they are likely to involve County.
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20. Additional insurance:
Provider shall also procure and maintain, at its own cost and expense, any additional kinds of
insurance, which in its own judgment may be necessary for its proper protection and prosecution
of the Work.
Provider shalpovide the following tvaes and amounts of insurance:
2:1 Commercial General Liability Insurance using ISO "Commercial General Liability" policy
form CG 00 01,with an edition date prior to 2004, or the exact equivalent. Coverage for additional
insured may not be limited to is vicarious liability. Defense costs must be paid in addition to limits.
Limits shall be no less than $10,000,000 per occurrence and $10,000,000 annual aggregate for
all covered loses.
Z Workers Compensation Insurance on a stateapproved policy form providing statutory
benefits as require by law with employer's liability limits no less than $1,000,000 per accident for
all covered losses. Enrollment in the state worker's comp program provides this coverage.
2] Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including owned,
non-owned, and hired autos, or the exact equivalent. Limits shall be no less than $5,000,000 per
accident and combined single limit. If Provider or Provider's employees will use personal autos in
any way on this project, Provider shall obtain evidence of personal auto liability coverage for each
person.
If Excess or Umbrella Liability Insurance is used to meet limit requirements over the primary
insurance as per this contract, such insurance shall provide coverage at least as broad as
specified for the underlying coverages. Such policy or policies shall include as insured those
covered by the underlying policies, including additional insureds. Coverage shall be "pay on
behalf', with defense costs payable in addition to policy limits. There shall be no cross-liability
exclusion precluding coverage for claims or suits by one insured against another. Coverage shall
be applicable to County for injury to employees of Provider, subcontractors or others involved in
the Work. The scope of coverage provided is subject to approval of County following receipt of
proof of insurance as required herein.
PROFESSIONAL LIABILITY INSURANCE REQUIREMENTS:
In addition to the insurance requirements outlined in Exhibit C, Provider shall maintain
professional liability insurance that covers the Emergency Medical Services performed in
connection with this Agreement, in the minimum amount of $10,000,000 per claim and
$10,000,000 in the aggregate.
Any policy inception date, continuity date, or retroactive date for professional liability coverage
must be before the effective date of this Agreement and Provider agrees to maintain continuous
coverage through a period no less than three years after completion of the services required by
this Agreement.
If Excess or Umbrella Liability Insurance is used to meet limit requirements over the primary
insurance, such insurance shall provide coverage at least as broad as specified for the underlying
coverages. Such policy or policies shall include as insured those covered by the underlying
policies, including additional insureds. Coverage shall be "pay on behalf', with defense costs
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payable in addition to policy limits. There shall be no cross-liability exclusion precluding coverage
for claims or suits by one insured against another. The scope of coverage provided is subject to
approval of County following receipt of proof of insurance as required herein.
If the Provider's General Liability policy includes coverage for professional liability, then the
General Liability policy shall meet the above professional liability requirements. In such a case,
the per occurrence and per claims limits must meet the minimum set forth above for each
coverage type and the annual program aggregate limit must be at a minimum of $20,000,000.
The County's Risk Management department will need to review the full policy document prior to
final approval.
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