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HomeMy WebLinkAboutC20030483 Interlocal Agreement 1111111111111111111111111111111111 2 0 0 3 1 1 2 5 0 1 Skagit County Auditor 11/25/2003 Page 1 of 47 12:40PM INTERLOCAL COOPERATIVE AGREEMENT BETWEEN CITY OF ANACORTES AND SKAGIT COUNTY THIS AGREEMENT is made and entered into by and between City of Anacortes ("Anacortes") and Skagit County, Washington ("County") pursuant to the authority granted by Chapter 39.34 RCW and RCW 36.01.095. 1. PURPOSE: Skagit County has established an Emergency Medical Services Commission which is to coordinate, operate as appropriate, provide and maintain those services necessary for a countywide emergency medical services program within Skagit County, pursuant to Ordinance #20030003. Pursuant to that ordinance, the County is to enter into contracts with Contractors for the provision of Advanced Life Support Ambulance Services. City of Anacortes has been • providing such services for the Western region of Skagit County for 20 years. The County and Anacortes desire to enter into a contract for the provision of Advanced Life Support ambulance services within the Western region, designated as Sections AFD 14 and AFD 16 on the map attached hereto as Exhibit A. 2. RESPONSIBILITIES: City of Anacortes shall provide Advanced Life Support (ALS) Ambulance Services within Skagit County as set forth below. Anacortes shall not be held to higher standards or more stringent rules than those that apply to the EMS Commission's operation of the Central Valley Service. a. Ambulance Units: Anacortes shall provide two (2) ALS capable pre-Hospital Emergency Medical Services Response Teams (ALS Response Teams) on a 24 hours per day, 7 days per week basis with appropriate ALS vehicle and SKAGIT COUNTY INTERLOCAL AGREEMENT Contract # C20030483 Page 1 Page 1 of 1 equipment (Med 14 and Med 16). One of the ALS Response Teams (Med 14) shall be available to respond primarily to East Fidalgo Island and Guemes Island. The other ALS Response Team (Med 16) shall be available to respond primarily to West Fidalgo Island. Subject to maintaining required response times and Anacortes covering the response zones within the Western Region as identified on the map in Exhibit A, Anacortes may modify the general response zones to enhance response times and balance workload. All ambulances supplied for the purposes of this Agreement shall comply with all applicable State rules and regulations and shall be licensed by the Department of Health of State of Washington. b. Ambulance Use Restrictions: Both parties agree that the purpose of the ALS ambulance services under this Agreement is primarily to respond to emergency medical services/9-1- 1 situations within Skagit County. Anacortes shall reserve Med 14 and Med 16 predominately for 9-1-1 emergency response within the Western region, except for providing critical inter-facility transfers from Island Hospital. Nothing herein, however, shall prohibit Anacortes from providing non-critical inter-facility transports to its patients where medically indicated as long as Med 14 and Med 16 are not utilized regularly and as long as staffing is consistent with Section 2(e) below. c. Ambulance Response Times: Anacortes shall use its best efforts to comply with Patient Care Procedure #5 of the Operational Guidelines, which are attached hereto in Exhibit B. Response times shall be from the time the medic unit is notified until the ambulance unit arrives. This includes turnout and travel time. Response times to Guemes Island via ferry transport shall be modified to add the wait period, loading, travel and off-loading time of the Guemes Ferry. Response times shall be reported to the EMS Commission on a monthly basis on the Medical Incident Report form approved by the EMS Commission as set forth in Section 8 of this Agreement. Ambulance base stations shall be located in order to maximize coverage of the population within the service area. Compliance with this requirement hall be monitored by the EMS Commission and may be waived in the event of a natural disaster or other catastrophe which renders performance of this requirement substantially impossible. The current location of Anacortes' base stations are in the City of Anacortes at the Main Fire Station and the Norman Brown Station. INTERLOCAL AGREEMENT Page 2 Anacortes shall notify the Skagit County Consolidated Communications Center ("911 Center") upon all of the following: (i) receipt and response to the call; (ii) arrival at the scene; (iii) transport to closest trauma facility or other destination designated by the Skagit County EMS Medical Program Director (MPD); (iv) arrival at closest trauma facility or other destination designated by the MPD; (v) in service, ready for next call; and (vi) back in quarters. Anacortes shall also notify the dispatch agency immediately of any reason the ALS ambulance is out of service and unavailable for response pursuant to the terms of this agreement. d. Back-up Ambulance Service: Anacortes shall provide back-up ambulance service on a 24 hours per day, 7 days per week basis when both Med 14 and Med 16 are responding to a call. Anacortes may provide this back-up service through arrangements with Med 18 and/or through agreements with other ALS ambulance service providers within Skagit County, together with additional coverage pursuant to call back arrangements with ambulance crew members. Copies of any such agreements Anacortes enters into shall be filed with the EMS Commission no later than 30 days after the effective date of this Agreement. Any amendments thereto shall be filed with the EMS Commission no later than 7 days after the effective date of the amendment. e. Personnel and Training: Anacortes shall employ, during the term of this Agreement and any renewal thereof, an adequate number of ALS personnel and Emergency Medical Technician ("EMT") personnel so as to be able to provide the services required herein. ALS personnel shall mean EMT Paramedic qualified personnel. All ALS and EMT personnel shall be certified to the standards of the Washington State Department of Health and any and all other laws applicable to such personnel, as the same are now in effect or as may be hereafter amended. All ALS and EMT personnel shall be under the direct medical control and supervision of the Skagit County EMS Medical Program Director or his/or her designee. INTERLOCAL AGREEMENT Page 3 Each ALS Ambulance shall be staffed with a minimum of one ALS and one EMT personnel as required by WAC Chapter 246-976. In the event Anacortes is unable to secure a sufficient number of qualified personnel to staff the ambulances, it will notify the EMS Commission and the County immediately upon making this determination. If the MPD determines that Anacortes cannot provide the required certified personnel set forth in this Agreement, the County, Anacortes and the MPD shall meet and confer on possible solutions. After such meeting, the MPD shall determine which solution shall be used to address the problem. Without limiting the County's ability to determine whether a breach of the Agreement has occurred, the County and Anacortes will then meet to discuss the effect of such circumstance on this Agreement. f. Dispatch of Ambulances: The dispatch of ALS Ambulance Services for Anacortes shall be in accord with the terms and conditions of the contract entered into between the EMS Commission and the dispatch agency. A copy of that contract is attached as Exhibit E. Anacortes shall respond to all calls to which they are dispatched by the dispatch agency. 3. INDEPENDENT CONTRACTOR: The parties intend that an independent contractor relationship be created by this Agreement. Nothing herein shall be construed to create an employer-employee or master-servant relationship. All services performed pursuant to this agreement shall be performed by Anacortes as an independent contractor. Anacortes acknowledges that the entire compensation for this Agreement is contained in Section 5 and that Anacortes and its employees are not entitled to any County benefits afforded to Skagit County employees. Anacortes shall defend, indemnify and hold harmless the County, its officers, agents and employees from any loss or expense, including but not limited to settlements, judgments, setoffs, attorneys' fees or costs incurred by reason of claims or demands because of breach of the provisions of this paragraph. 4. TERM OF AGREEMENT: The term of this Agreement shall be from April 1, 2003 through December 31, 2003. 5. MANNER OF FINANCING: This Agreement shall be funded with EMS levy funds and no other County funds. County agrees to pay Anacortes a total of INTERLOCAL AGREEMENT Page 4 $334,319.56 for the services provided herein. Payment shall occur in monthly installments upon submission of an invoice by Anacortes. 6. ADMINISTRATION:The EMS Commission, on behalf of the County and in accord with Ordinance #20030003, shall monitor this contract for compliance with its terms and conditions. Any and all notices required to be given to the County under this Agreement must also be given to the EMS Commission. The following individuals are designated as representatives of the respective parties. The representatives shall be responsible for administration of this Agreement. In the event such representatives are changed, the party making the change shall notify the other party. 6.1 The County's representative shall be the County Administrator. 6.2 Anacortes' representative shall be the Mayor. 7. TREATMENT OF ASSETS AND PROPERTY: No real property will be jointly or cooperatively, acquired, held, used, or disposed of pursuant to this Agreement. Ambulances used as part of this Agreement are or have been paid for with Medic I levy funds. Title to the ambulances shall be in the name of Anacortes during the term of this Agreement. Title to other equipment acquired with Medic I levy funds shall be transferred to the EMS Commission. A list of the County-funded assets is set forth in Exhibit C attached hereto. Upon termination of the Agreement, title to those assets that were purchased with County funding (either directly from the County or indirectly through the EMS Commission) shall be transferred by Anacortes to the County or the EMS Commission. Those assets purchased with City funds shall remain the property of the City. 8. REPORTS: Anacortes shall complete a Medical Incident Report (MIR) form, approved by the EMS Commission, for the recording of pertinent ambulance response and patient care information for each call. Anacortes shall retain a file copy of this report, separate from any other patient care record, and provide one (1) copy of the report to the Skagit County EMS Medical Program Director, or his/or her designee, for review. A copy of the currently-approved form is attached hereto as Exhibit D. Anacortes shall submit the MIR information electronically to the EMS Commission, at the end of each month, but no later than the 5th of the ensuing month. Anacortes shall provide a data transfer application so that the information is received in the same format as the Skagit County EMS Commission data collection system. ALS Ambulance operational and financial information shall be INTERLOCAL AGREEMENT Page 5 provided to the EMS Commission, upon request, to assist in the cost efficiency review process. 9. RECORDS AND INSPECTION: This contract is subject to review by any Federal or State auditor. The County and the EMS Commission shall have the right to review and monitor the financial and service components of this program by whatever means are deemed expedient by the County, subject to any requirements of state or federal law otherwise. Such review may occur with or without notice, and may include, but is not limited to, on—site inspection by County or EMS Commission agents or employees, inspection of all records or other material 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. Anacortes shall preserve and maintain all financial records and records relating to the performance of work under this Agreement for 3 years after contract termination, Anacortes shall make such records available for review, upon request, unless state or federal law requires otherwise. Anacortes agrees that it shall be financially liable for the costs of any audit exceptions occurring as a result of its negligence or failure to comply with the terms of the Agreement. 10. INDEMNIFICATION AND INSURANCE: Each party agrees to be responsible and assume liability for its own wrongful and/or negligent acts or omissions or those of their officials, officers, agents, or employees to the fullest extent required by law, and further agrees to save, indemnify, defend, and hold the other party harmless from any such liability. It is further provided that no liability shall attach to the County by reason of entering into this contract except as expressly provided herein. It is understood that this agreement is solely for the benefit of the parties hereto and gives no right to any other party. The City of Anacortes shall provide evidence of insurance for the activities related to the Advanced Life Support Ambulance Service. The coverage provided shall include Medical Malpractice for the Medical Technicians associated with the service provided in the amount of$5 million dollars and Automobile Liability of$1 million dollars with, coverage for owned, non-owned, hired, and/or leased vehicles. Coverage must be provided by an insurance company authorized to write insurance in the State of Washington and has an A- or better rating in the AM Best Rating Guide. INTERLOCAL AGREEMENT Page 6 11. DISPUTE RESOLUTION: In the event that the EMS Commission and Anacortes believe that there is a contractual compliance issue they are unable to resolve, Anacortes shall bring that issue to the attention of the County Administrator. The County Administrator shall then meet with representatives of both the EMS Commission and Anacortes in an attempt to resolve the dispute. Nothing in this contract shall prohibit the EMS Commission from establishing a dispute resolution procedure to address any disputes with the ALS providers prior to those disputes being brought to the attention of the County Administrator. 12. TERMINATION: Any party hereto may terminate this Agreement upon ninety (90) days 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. If this Agreement is so terminated, the parties shall be liable only for performance rendered or costs incurred in accordance with the terms of this Agreement prior to the effective date of termination. 13. TERMINATION FOR BREACH: This Agreement may be terminated by either party for cause, provided that in the event of a breach, the non-breaching party shall give written notice to the breaching party stating specifically the provision of the Agreement alleged to have been breached and the factual basis underlying the alleged breach. Within 30 days after receipt of the notice, the breaching party shall: (a) cure said breach; or (b) contest the alleged breach. Failure to cure the breach or contest the alleged breach within thirty days shall be deemed a material breach of this contract and shall enable the non-breaching party to unilaterally terminate this Agreement, upon delivery of written notice of termination via certified mail, to the breaching party. Termination shall be effective upon receipt of said notice. In the event either party pursues litigation in order to enforce the provisions of this Agreement, the prevailing party shall be entitled to recover its reasonable attorney's fees, in addition to any and all other remedies, costs and damages permitted by law. 14. NOTICE: Any notice required to be given herein shall be in writing and shall be mailed via certified U.S. mail, return receipt requested, to the parties at the following addresses. INTERLOCAL AGREEMENT Page 7 County: Skagit County Commissioners' Office 700 South Second Street Mount Vernon, WA 98273 Anacortes: Anacortes Fire Department 1016 13th Street Anacortes, WA 98221 Any notice or submission required herein to be made to the EMS Commission shall be mailed to the EMS Commission, 2911 East College Way, Suite C, Mount Vernon, WA 98273, unless otherwise mutually agreed upon by Anacortes and the EMS Commission. 15. AMENDMENTS AND WAIVERS:This Agreement may be changed, modified, amended or waived only by written agreement executed by the parties hereto. Waiver of breach of any term or condition of this Agreement shall not be considered a waiver of any prior or subsequent breach. 16. 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. 17. ASSIGNMENT: This Agreement or any portion hereof shall not be assigned by either party without the prior written consent of the other party, which consent shall not be unreasonably withheld. 18. 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. INTERLOCAL AGREEMENT Page 8 I WITN SS WHEREOF, the parties have executed this Agreement this a� day �� , 2003. APPROVED: CITY OF ANACORTES: BOARD OF COUNTY COMMISSIONERS SKAGIT COUNTY, ASHINGTON 7/. i2/t/tmairi H. Dean Maxwell, Ma r en Dahlstedt, Chairman Mailing Address: Sixth Street & Q Avenue Ted W. Anderson, Commissioner P. O. Box 547 Anacortes, WA 98221 , .,.+ II i• Don Mun s, Commissioner Approved: A : By: IL 010 Ian S. Munce J• %n*- Giesbrec t, Clerk of the Board City Attorney Reco ended: By: De ead By: Bu t in Director Approved as to Indemnification: By: \--61,e,e-X-i, Risk Manager Approved as to Form: By: �.�--- e uty Prosecuting Attorney INTERLOCAL AGREEMENT Page 9 r j • fad -4 - " CYPRESS ISLAN❑ ' ISI APID ii''?:a' 'ji: .� ..._,,.�era:.! ,.r,.n;6�:, .: •:?',-,'rv' :': � .c;� • ..�'�.a : : v +.il • • .3Y.1 'y • • -1 n } .T is �,.,•..:,.err M, nt: hsy�• ; _ 'cz` .:. •.: :.. ..• . ..,....��v,.� .m.::. fn..4 5.,� .nor,.-.?;. .. : ._. - %�, • • • • . . 1..,.:..,iF....�:: .a.-.,i. .:_J..4r���..?i•n.�A'--r.+c�.v�.:{�•�_- N.' � ,.., n �.:y,�.i ,1lri.,,2::;1° iY`l!�r .. .. a �•�... .._ .:.is,:.. M :. .-,. k.rq��,�.�J. i ._b 1 ..���L ..-i.:u*e.�..')"tx.,:..u.. ,nr.eC :^a�-�I' jr ti:'a���i�:I,M'i��:<. .5• � '' - �::"�n. <4. Ea., . .. .. �,3 v,.......:�.. ,C ..- ...�',b. - ,n`3 qe Tdi`.i k - ',. 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Gam... - :'.. - • . 3 - :f,dr.,. .1?. '::6 xy3<�'l"gym:7tik"r'''`�d • -,•":.-,•::.•`i •.:�.. - i.,..r.:-..�., _ .4,K'.;•vtF., `F': .fib.'- • ,. . ,G.�:,1='two..}„ +,.ayyc �..;'h.;.a,:�,:,;o:', �. p,. ,.,.:,"'e� �:.. �,�. Via•� �.E 3..:x�_:.4..;���i'."•— •�i. 4 %�:� • •a"6�:-, • '' :� :LA�:' -•q • Emergency Medical Response Zones � � :r,. III Hospital • . N s ";4: -:' i-L(- .F''.A'. �J City Lints _ --'{ ;,.,:.,; `-j• �'.:. i • .. 3. ''' . ;: .. ' fir' • .. Boundary • between A�D1A and AF�16 • "� - --'� . • • d •%k ,`::-:Coun Bounda - `'v,x - ,, :;, ": !� - � 600 200 - , h'-rA April 21 2003 - � - •.� : � 'cif> - • .ti?Ska it County GIS ��;x.-:, ts� ' . 2 *c2db'..:1 ."2-",- v '. : . —.,v. ai.: :. - F .,. r.-�i� .,...: ♦. ... . Fee Exhibit B NORTH REGION EMS & TRAUMA CARE COUNCIL Operational Guidelines • PATIENT CARE PROCEDURE #5 Prehospital Response Times OBJECTIVES To define prehospital response times for major trauma to urban, suburban,rural and wilderness areas in the North Region. To define urban, suburban,rural and wilderness response areas. STANDARD 1 Response: When responding for major trauma to an urban area,initial response units will arrive at the scene within 5 minutes 80%of the time. Transport: When responding for major trauma to an urban area,ALS transport units will arrive within 8 minutes 80%of the time. STANDARD 2 Response: When responding forrnajor trauma to a suburban area,initial response units will arrive at the scene within 5 minutes 80%of the time. Transport: When responding for major trauma to a suburban area,ALS transport units will arrive within 10 minutes 80%of the time. STANDARD 3 Response: When responding for major trauma to a rural area,initial response units will arrive at the scene within 12 minutes 80%of the time. Transport: When responding for major trauma to a rural area,ALS transport units will arrive within 20 minutes 80%.of the time. ti J PATIENT CARE PROCEDURE # 5 Continued STANDARD 4 Response: When responding for major trauma to a wilderness area,initial response units will arrive at the scene within 40 minutes 80%of the time. Transport: When responding for major trauma to a wilderness area,ALS transport units will arrive within 60 minutes 80% of the time. STANDARD 5 When the initial response unit is also the transport unit and there is no other initial prehospital tiered response system in place, initial response time standards will apply to the dual purpose unit as follows: • To urban areas 5 minutes 80% of the time • To suburban 5 minutes 80% of the time • To rural areas 12 minutes 80% of the time • To wilderness areas 40 minutes 80% of the time Urban Area: An incorporated area over 30,000; or An incorporated or unincorporated area of at least 10,000 people and a population density over 2,000 people per square mile.. Suburban Area: An incorporated or unincorporated area with a population of 10,000 to 29,999 or any area with a population density of 1,000 to 2,000 people per square mile. Rural Area: An unincorporated or incorporated area with total population less than 10,000 people, or with population density of less than 1,000 people per square mile. Wilderness Area: Any rural area not readily accessible by public or private maintained road. 1 . bibit C City of Anacortes Ambulance MED1 8 VIN# IFDKE30MONHA74912 Ambulance MED 14 VIN# IHTMRAAM73H564784 Ambulance MED 16 VIN# IFDKE30FOSHB31025 LIFE PAK 12 Serial# 9442228 LIFE PAK 12 Serial# 9442230 LIFE PAK 12 Serial# 9442229 LIFE PAK 500 Serial# 12535947 • Exhibit D VLU Lv1L "VtY VAZ+ + +rL2J+/+Y YAILJV L.L,f..,1,A• - rage 1 OI I • • SKAGITCOUNTY s �.= - . • ° M' E © I C'='•, s Home 1 incident Information Patients 1 Uploads I Reports I I Exit Incident#: 'Location: Date: Incident Information Complete the incident information form below. Required fields are displayed in red. CAD Number: Grid Number: ❑ I I Date of Caller(Today) (Yesterday) Time of Call: ❑ Month Day Year Local Agency Response Tracking Number, If needed: 0 911 Response Zone - where the call originated: 0 Incident Address Status: 0 Incident Location: _:-I Address 1: Address 2: City: State: Zip: 1 1WAJ( I View Map Incident County Code: Po ulation T pe: ❑O 129 (Skagit) View Map Total m of Patients: 0 MCI Status: ❑ First Agency on Scene: ❑ `( SAVE/ NEXT» 1 • • :__ . :.. :� ... .. - - - -- 0 r..!'1v1.1 V V V 11 A. 1 1rl4LJ.JJ V11 L. V 1.1J.1-,11.. rage 1 71::: .7.......0"..........tzsagia'oss...... _'., -._L-t-,, ,..,,,:;-,:-:-..... , SKAGITCOUNTY ?.'M E D: 1 -Es'`.":313.1-- Home I Incident Information Patients I Uploads I Reports I . I Exit t Incident Patient I III Riling Trauma? [Cardiac I Vitals Airway E Narrative I I Pinched! i Info I I info i Arrest? I Other j M_'si ..Y'! PWIEIELI WftellIfa ftsiimmi =ter_,ram rgaaR+ WouitiM Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB: Not recorded Patient Information Part 1 Complete the patient information form below. Required fields are displayed In red. Response Times (hh/mmiss) Transporting Agency: 0 • Fill Times - 911 Call Recieved: Based Out of Station: I _1: I . A: I .J I LI Dispatched: Med Unit: I J: I .A: 1 .J I -- _ J Enroute: Location When Dispatched: ❑ I J: I A: I J I _ . il Arrived: Initial Lever of Care: ❑ I TJ: I Li: I J I Transport to Hospital: Trans or Level of Care: ❑ 1 A: I f: I A Action Taken: Hospital Time: I J: I J I L- Street Type: Back in Service: I , J f J: I J: I J In Quarters: ENTER FREQUENT PATIENT SSN . 10 1 1: I J: I Li Response Issues I- None 1-Adverse Road Conditions I- Adverse Weather P Crowd Control I- Hazardous Materials I- Language Barrier r Other ❑ Prolonged Extrication (>20 min) I- Unsafe Scene. (- Vehicle Problems Ambulance Information ❑ Ambulance Lead Tech: Additional Personnel: '� I J I LI JiS.A 111 C-.vUIN 1 I lvt:GlJI vINJG a 1.1.l.E..n. rage i CI 1 SKAGITCOUNTY - _ w 7:',.. . . / W . .�:._ M E Q' j.;L' =� i Home I IncidentInformation Patients I Uploads I Reports I 1 Exit Incident Patient Billing Trauma? Cardiac !Vitals Airway& :Narrative I Firishedf { I InTo Info I i Arrest? k 1 i Other Incident#: Location: , WA Patient*:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB: Not recorded Patient Information Part 2 Complete the patient information form below. Required fields-are displayed in red. Patient Number: Social Security Number: (Ex: 000-00-0000) Ii _ _ of 1 I . . First Name: 0 MI: Last Name: .. . . l l Date of E3irth:(mmldd/yy) Patient Age: I A/ I . Li/ I .. I I J P Estimated Age I— Click here to fill these values with the incident address information. Address 1: Gender: I I . 1 Address 2: Race: I I City: State: Zip: Ethnicity: 1 IWA LI I f.. _. A Telephone: (Ex: 000-000-0000) Advanced Directives: ❑ I A Chief Complaint: 0 POLST Status: 0 [ SAVE/NEXT>> I r .. .- _, .• , - ___-. __.._. .. 2 21 , • 1.,71LL ay 1i vv vat a a a.aa..✓av va Ia_ry •-I.a a.. a Mb/ J. V1 1 , SKAGITCOUNTY EDIC. ~-' M.44gI Home 1 Incident Information Patients 1 Uploads I Reports I I Exit Incident a Patient . I Biting Trauma? Cardiac j Vitah, Airway& i Narrative F•utahed! 1nfoy Info}q$. I ;Arrest? € ��±Olh+er� .c; .�y.:..'.:M''Y•iti "l �w'�'.IT Tx,� i "R'"['J"[.Y� _ _� 3-r.i ! ' fiatalgZi Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB:Not recorded Patient Information Part 3 Complete the patient information form below, Required fields are displayed in red. Severity: Transport Mode: ;Ground Ambulance Blunt or Penetrating Trauma: Original Location: 0 2-1 fool Incident Scene .211 Penetrated Chest/ Abdomen: Destination Hospital: ❑ ! l j Respiratory Effort: ( Reason for Destination Decision: J I J Consciousness: Response Code: I J 1 _. - . _ .. -- Suspected Alcohol / Drug Use: Transport Code: I___...--LI ——- — - — - Work Related: Patient Outcome: 'Unknown Patient was under police custody. Was the hospital contacted?: I SAVE / NEXT>> • "1 "0" • SKAG1TCOUNTY e ' T ` �.` Home 1 Incident Information Patients 1 Uploads I Reports I. 1 Exit Incident Patient .- Bang Trauma? . ;Cardiac Vitals Airway A J Narrative I Fin:shedl Info I Info Bi I I Arrest? .other 1 Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name:Not recorded Patients: 1 DOB:Not recorded Patient Information Part 4 Complete the patient Information form below. Required fields are displayed in red, Glasgow Coma Scale: Eye Verbal Motor Total �Y Mechanism Codes: C AC - Other Accident/Injury r GS - Firearms C AD - Adverse Drug Reaction r KN - Sharp Instrument ✓ AL - Alcohol Intoxication r MC - Motorcycle (inc. motorcycle/ car) C A• N - Animal-Caused Injury r MD - Medical (illness) C A• S - Beating / Fighting /Assault(w/o weapon) C ME - Machinery / Equipment C AX - Accidental Overdose/ Poison r MV - Motor Vehicle ✓ EI - Bicycle (inc. bicycle/car) r Oo - Obstetric ✓ EL - Blunt Instrument r OD - Drug C EU - Burn C PS - Psychiatric ✓ CH - Child Abuse r PV- Pedestrian / Vehicle ✓ DR - Drowning r SP - Sports or Play Injury ✓ l7T - Drug / Alcohol Withdrawal r ST- Strangulation of Suffocation ✓ ES - Electrical Shock or Explosion r SX - Sexual Assault C FA - Fall r xx - Other Alarm Illness Type: (select 1) Was the primary mechanism trauma or medical? r Trauma C Medical VJ.1i a.vaa .,+.....I a a a. av ....,.... L. raSG G V U. a • • Actions Performed: r 00 - None r 12 - Endotracheal Intubation IT 01 - Oxygen IT 13 - Multilumen Airway r-02 - Wound Care r 14 - IV, Central Line it 03 - Extrication / Rescue IT 15 - IV, Peripheral IT 04 - Splinting IT 16 -IV, Intraosseous r 05 - Cervical Collar, Backboard r 17 - Baseline Blood IT 06 - ECG Monitor r 18 - Blood Transfusion IT 07 - Airway/Bag Mask r 19 - Needle Thoracostomy r oa - CPR r 20 - Pericadiocentesis r 09 - Shock Trouser r 21 - Cricothyrotomy r 10 - Automatic DC Shock r 22 - Examination r 11 - Manual DC Shock • Medications Given to Patient lj ^:t^: t\w v.skagiter s.conl recording:patient_form-Li.asp -'21 20 . . `J15...Ats11 LtJUIN 1 T MZLJ11.._;VINE, 1.iJ.IJ.A. rage 1 01 2 • • SKAGITCOUNTY M-E 0 1 C`.. 'f� ' :4 Home Incident Information Patients Uploads Reports Exit ���.�� 1 I p l � l l IIncident Patient 9iling Trauma? Cardiac Vitals I Airway& 1 Narrative !Fin'sliedl Info Info I Arrest? 1 IOther 1 i I i tr; Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB:Not recorded Billing Information Complete the billing information form below. Required fields are displayed in red. Transport Mileage: Billing Conditions: . . P Patient is self-Insured. REMINDER: Has a signed released been collected or is one known to be on file? Primary Care Physician: ER MD: Primary Insurance Primary Insurance Company Name: Policy #: Group Primary Policy Holder Name: DOB: SSN: Secondary Insurance Secondary Insurance Company Name: Policy #: Group #: Secondary Policy Holder Name: DOB: SSN: 4 Check all that apply: I— Patient is unconscious. I— Patient required oxygen. I— Patient required restraints. I— Patient is bed confined. e-: .i ,. or y be rnc.ec C, - Patient has suspected fracture/ d�siocat�e-. I— Patient is suspected to be in shock. ._..�.. . �........,t .+a.+..+av ...:.�.....�.,..�..�.�.. F 4;16G L U 1 L � Y rl Acute episode or exacerbation. Seizing. E Other neurologic symptoms. rJ Potentially life threatening. O Suspected of cardiac or vascular etiology. C Threat to self or others. r Severe and Incapacitating. r.Iv meds required enroute, NSAVE!NE 17gM-=xl • Iorntasp 2 21 2( „,ate..�.. — --•— — --��...... f - SKAGITCOUi V 1 ..E' ©' I C'', : N ” r Home Incident Information Patients Uploads Reports I Exit Incident Patient 6i ing Trauma Cardiac.: Vila:s Airway d ? Narrative Fn's icdi : ., Info !�o I j �Info I 'Arrest? - � Other � �*- I t _. ;. itiNREg Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB: Not recorded Major Trauma Information Complete the trauma Information form below. Required fields are displayed In red. Extrication: ]Patient Flown from the Field: Ii Pe—Hospital Trauma System Activated: Protection Devices Used: Trauma Band Number: ✓ None r Airbag/ Belt r Trauma Band Not Placed on Patient r Airbag Only I— Helmet r Infant Child Seat ✓ Lap Belt IT Lap/ Shoulder Belt r Shoulder Belt r Other Safety ✓ Unknown Hospital Medical Record Number; Trauma Code Status: ❑ INotCalled Trauma Triage Criteria Used: (choose up to 3) Vital Signs Si Level of Consciousness High Energy Situation F 01 - BP <90 in an adult (Ped: BP <90 or Cap Refill r 15 - Rollover >2 secs) p 02 - HR> 120 adult (Ped: HR <60 or >120) n16 Motorcycle, AN, or Bicycle Accident ✓ 03 - RR <10 or >29 r 17 - Extrication Time >20 Minutes • 04 Altered Mental Status r 18 - Significant Intrusion Anatomy of an Injury Other Risks re-let-at, - In;.;•y c` }-,ea`'i, heck, T C . F - cx: e—es c' a_ ,`-- y C- >- ▪ G5 - Combination of burns =/>203/4 or cr,.c . -.; yrs; face or airway P 20 - Hostile environment (extremes of 0- - Amputation above the wrist or ankle heat or cold) 21 2,. Ultil 1V11 NJ V Viii A Fray„/yyAV VF iuv a.✓.4, • L. - a vr. �-- r 21 - Medical iuness (COPD,CHF, Renal Failure) 08 - Spinal Cord Injury r 22 - 2nd or 3rd trimester of pregnancy 09 - Flail Chest r 23 - Paramedic Gut Feeling 10 -Two or more obvious proximal long bone fractures Biomechanics of Injury 11 - Death of Same Car occupant iT 12 - Ejection of Patient from Enclosed Vehicle l 13 - Fall = or >20 feet fl 14 - Pedestrian hit at =/>20 mph or thrown =/>15 ft SAV N > I • • • er lr o a n p 2/2 21.F :- - �L-.\��-.s::aait,.�..�.com rzc���.�r_ tr�urn:. iorn..�s. �1 _ . L71v A-.1 A vv....el.A A AT11.LLv VAVA-•L.r+,A+.l.:.,rl. - ra ,c 101 1 4 :-...4401120.6._ SKAGITCOUNTY 1.- �r ,.... f . M E. 0. I 0 `„ .. ' '"'?3�M Home I Incident Information Patients I Uploads 'I Reports I I Exit lncidant awlPatient ; Biiing 7raun,a i Cardiac Vltii s Airway Narrative it hed! tnla -info ' info Arrest? other Incident#: Location: , WA Patient#:ID-1733 Date: 2/21/2003 Name:Not recorded Patients: 1 DOB: Not recorded Minor Trauma Information Complete the trauma information form below. Required fields are displayed in red. Extrica tion: Protection Devices Used: [— None r Airbag / Belt r Airbag Only ✓ Helmet ✓ Infant Child Seat r Lap Belt ✓ Lap/ Shoulder Belt ✓ Shoulder Belt r Other Safety ✓ Unknown Hospital Medical Record Number: Trauma Code Status: 0 'Not Called A SAVE/NEXT» I r ;`-- ,---,...co:-.1 ...20:-... .:i'.''_. " -,.. 2 21 20 T " SKAGITCOUNTY-=0"414a10141b1011`— � .r.r`_7d MEDIC: 03*'wA Home I Incident Information Patients I Uploads I Reports I I Exit Incident Patient BEng Cardiac Vitals Ainva & I Narrative rm icd. Adden dum I Info Info i Arrast Info Other I r �", �� � raaantgil Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB: Not recorded Cardiac Arrest Information Complete the cardiac arrest information form below, Required fields are displayed in red. Cardiac Arrest Witnessed: 0 Cardiac Arrest Post-EMS: 0 INo A CPR Initiated. By_.❑__-- - ...,.._ _ Presumed Arrest Cause: Defibs Used: ❑ ALE Defib E BLS AED Non-EMS AED E None Initial Shock Cardiac Treatment: 0 Spontaneous Circulation: (prior to arrival at ER)❑ INo J SAVE I NEXT» • 'fix`'•T.C': r • - n - - "-c r;t • s � • SKAGITCOUN n`� y: 44:E [] I (', {� - Home I Incident Information Patients I Uploads I Reports I F I Exit Irddcnt Patient .;:-. .,'1 6i3ing 1 Vitas Airway& Narrative `Finished! !Addendum Into Info a I M Othat �. t`F 2 1 3 I ;. i ?(;•'S ',s"q,r; n1 ..Sw Incident#: Location: , WA Patient#:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB: Not recorded Vital Information « BACK Complete the vitals information form below. Required fields are displayed in red. Vital Time: Performed By: IJ4 .. _` Bp Sys: 02 Device: r 1 IBp Dia: 02 Rate (liters per minute): 1 ] Bp Palp: Room Air: r r Capnography: Saturated 02 Percent: (IPulse Rate: Respiratory Rate: Pulse Description: ECG Rhythm r Irregular I r Regular [- strong r Weak Posture: Pupil Status: Nail Status: �Y(� J SAVE/ NEXT 5> • Y - 4 1Fn.- .+. LJ SKAGITCOUNTY - r _ Y -4. MEDIC { '1' Home 1 Incident Information Patients I Uploads I Reports I Exit k Incident Patient Ming Vitals Airw Finahed! Addendum Info Info i I Oth cay I IPl anrative Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name:Not recorded Patients: 1 DOB:Not recorded Other Information ;UPLOAD FILE __SAVE/NEXT». I Complete the form below, Press 'SAVE/ NEXT>>' if you wish to save this form. Thrombolitics Used: 0 Critical Patient: Choose a file from the list below to edit or delete. Title: Submitted: Sequence: Delete: • _..._. J _ ..• - �' Vtu........ �........r.♦t w =..+.+.+av ......�..�.a......a-.�.. - J.a.�v a vs A • • _` s ' • SKAGITCDUhITY ` � " "' � �' MEDIC '' ,ig:,-;,1 Home I Incident information Patients 1 Uploads I} Reports I I Exit Incident-W : Patient 1 Bi1in Vitals Airwa d Narrative Finished! Addendum Ink) :. 1n[o r; 9 I I o,hary I r r Incident#: Location: $WA Patient#:ID-1733 Date:2/21/2003 Name:Not recorded Patients: 1 DOB: Not recorded Narrative Information Complete the narrative below. For a printable version of the narrative, click here. • • • SPELLCHECK I SAVE / NEXT >> F4 *' • SKAGITCOUNTY ty 111719171111MIMEN Home 1 Incident Information Patients I Uploads I Reports I I Exit l Incident Patient.-;` , ... ' Biting V. I Airway& NarcaBvs I!meshed! !Addendum IInnto Into f I •IOther Incident#: Location: ,WA Patient#:ID-1733 Date: 2/21/2003 Name: Not recorded Patients: 1 DOB:Not recorded Incomplete Fields . The fields listed below need to be completed before the report can be finalized. NOTE! Make sure to push 'SAVE / NEXT »` to SAVE the form! Incident information CAD # Incident Location First Agency on Scene Population Type Patientinformation Part I - Med Unit Street Type Patient Information Part 2 Fist Name Las. Name Patient Age Zip Gender Race Ethnicity Patient Information Part 3 Severity Transport Mode Blunt/ Penetrating Respiratory Effort Reason for Destination Decision Consciousness Patient Information Part 4 Mechanism Codes Illness Type TY MEDIC ONES I.D.E.A. • i.`.} J _ . allIMBM Home 1 Incident information Patients 1 Uploads I Reports I J Exit • • BMnii I Vitals I Airwa d htarratrre Finished! Addendum ,ta t 1 C3'ttery Location; , WA Patient#: ID-1.733 343 Name: Not recorded DOB: Not recorded idum Information to the addendum below. SAVE I 7/51/200; Exhibit E SKAGIT COUNTY Contract# C 20030199 Page 35 of 47 04/08/2003 15:30 3604283235 SKAGIT EMS COUNCIL _ PAGE 02/12 • This Agreement is made and entered into this 30th day ojNavember,1998,between Skagit Emergency Medical Services Council, hereinafter referred to as Council,and Skagit 9111, an Interlocal Agency created by the Skagit County Emergency Management Council,hereinafter referred to es Skagit 911. WHEREAS the Council contracts with Skagit County.State of Washington,to coordinate and direct a comprehensive out-of-hospital emergency medical services system for Skagit County,and WHEREAS the Council receives funding through a contract from an emergency medical services excess levy(Medic 1 levy)for the purpose of coordinating and supporting the out-of-hospital emergency medical service system and WHEREAS the Council has determined that it is in the best interest of the Skagit County-wide Emergency Medical Service system1t�o contract with individuals and agencies to provide specific services,and WHEREAS,Skagit 911 has bee*selected to provide crespetch services in the out-of-hospital Skagit County-wide Emergency Medical Service system,now,therefore: W1TNESSET"H; • . 1. DisPata Service Arm; The dispatch service area shall include all of Skagit County. 2- Se 'vice Provided: Skagit 911 shall provide emergency access telephone answering,radio dispatching and communications to units and providers of the EMS system in Skagit County,24 hours a day,seven days . a week utilizing a coraleination-of Skagit 911 owned and Council owned and maintained equipment. Units dispatched shall include Paramedic Ambulance services,which are contracted by the Council and supporting fire department units.Primary Paramedic Ambulance service areas are outlined on the attached map. (Sector"A.") Communication support shall include emergency and non-emergency radio communications related to the operation of the emergency medical services system. 3. Personnel and training; Skagit 911 shall employ an adequate number of dispatchers to fulfill the service requirements of this Agreement. SKAGIT i'.r Y Contract# C20000u30199 skatsp,doc 11(30f98 Page 36 of 47 No- 04/08/2003 15:30 3604263235 SKAGIT EMS COUNCIL PAGE 03/12 Dispatchers shall complete a course of instruction in emergency medical services dispatching as may be required and provided by the Council.Provision for continuing education and training of dispatchers for EMS related dispatch will be provided jointly by Skagit 911 and the Council. 4. f'_�11rre_et,'Ln2' All emergency access telephone calls shall be answered at a central location;radio dispatching of emergency emits will be the same site. The dispatch service shall be utilized for the receipt of emergency medical services access calls. Calls for routine services shall be directed to the Paramedic Ambulance provider agencies. The following minimum information will be obtained from emergency access callers: • A. Time received 911 call at Skagit 911 B. Nature of emergency • C. ' Caller's telephone number • D. Name of caller . E. Address of medical emergency 5- Disp�hi : • The dispatched units shall be referenced utilizing a map or run card system.The basis for this system,caall be the Skagit County numbering system. The map or run card system shall be maintained by Skagit 911. Corrections or new entries shall be made with the approval of the affected agencies: The response routes of ambulances from maps or rtm cards shall be from their base stationer their location at the time of dispatching the unit.Copies of maps or run cards will be made available to ambulance service providers. . • The dispatch of specific Paramedic or BLS ambulance units shall be by written protocol established by the Skagit County Emergency Medical Program Director and approved by the Council. Fire department units shall be notified by radio or telephone when their response is required. The dispatch service shall maintain written records of each EMS dispatch including. A. Time of call received at Skagit 911 B. Initial information received C. Response times of ambulance and fire units D. Arrival at location times(of units) E, Unit scene departure and enroute time F. Unit arrival time at hospital or destination G. Unit in service time In addition, the dispatch service shall monitor location and availability of all Paramedic Ambulance service units. SKAGIT COUNTY skdIsp,dcc I I/10/99 Contract# C20030199 Page 37ot47 04/08/2003 15:30 3604283235 SKAGIT EMS COUNCIL PAGE 04/12 • • 6. Caninunicatiort support: Communication support during emergency responses may include: A. Directions to location B. Request for additional assistance • C. Traffic signal activation D. Other bone fide assistance request 7. Admini atioe: AU contractual issues shall be discussed and resolved by the Council's President or delegate and the Slcagit 911 Director orrepresentative. Skagit 911 agrees to save the Council harmless from all loss or damage occasioned it or to any third party or property by reason or any act or omission on the part its agents,employees or persons working directly or indirectly in the performance of this Agreement including joint acts or omissions of such agents,employees,or persons working in its'behalf, directly or indirectly is the performance of this Agreement,and shall,after reasonable notice thereof defend and pay the expense of defending any suit which may be commenced against the Council by any third person alleging injury by reason of such acts or omissions-and will pay any judgment which may be obtained against the Council in such suit. The parties intend that an independent contractor-Council relationship shall be created by this Agreement.The Council is interested solely in the results to be achieved,and the implementation Of services will lie is the discretion of Skagit 911.In the performance of the services herein contemplated, Skagit 911 shall be deemed to be an independent contractor with authority to control and direct the performance of the details of the work. However,the results of the work completed herein shall meet the approval of the Council and shall be subject to the Council's general rights of inspection or review to secure the satisfactory completion thereof as otherwise provided for in this Agreement. Skagit 911 agrees that it shall be financially liable for any audit exceptions occurring as the result of its negligence or failure to comply with the terms of this agreement Operational and procedural issues not covered by contract shall be determined with the input of the Directo?,Skagit 911 and the Skagit County EMS Medical Program Director or designated alternate. B. F.ec. prds and recta: Skagit 911 shall provide the Council with a monthly report within seven(7)days after the end of each month. Information shall include information stipulated in Paragraph S. The Council may require additional reports and records as it deems necessary for the execution of this contract and the management of the out-of-hospital emergency medical services system.The reports may include financial, statistical, and operational information. 9. Noncompliance.peulties: Noncompliance with the terms of this contract may result in the cancellation of this contract, withholding or forfeiture of scheduled payments or both. SKAGIT COUNTY Contract# C20030199 5kdllp,dcc 1 I/30/98 Page 38 of 47 04/08/2003 15:30 3604283235 SKAGIT EMS COUNCIL PAGE 05/M Notice of noncompliance will be made in writing, with the contract performance deficiency and period for correction duly noted.In the event the Skagit 911 wishes to contest the claimed non- compliance, the same procedure setforth herein to contest a claimed breach shall be followed. The minimum financial penalty imposed shall be 1%of the contracted amount accrued during any one month period. 10. Termination Breach: This Agreement may be terminated by either party for cause,subject to the following.In the event of a breach,the non-breaching party shall give written notice to the breaching party, advising said party of the claimed breach.Within thirty(30)days of receipt of said notice,the breaching party shall: A. Cure said breach or • B. Take all reasonable and necessary steps towards curing said breach,or C. •Contest the claimed breach. • In the event that the claimed breach is contested,the parties hereby agree to submit the dispute to binding arbitration by an arbitrator mutually agreed to by the parties.In the event the parties cannot ' • agree to the selection of an arbitrator,then,each party shall choose an arbitrator.The two arbitrators chosen shall choose a third arbitrator with the arbitration being conducted by the panel of three arbitrators.Cost of arbitration will be shared equally by both parties. Upon termination of this Agreement,the assets that are the property of the Council and supported or purchased by Council funding will revert to the Council.These assets will be used to continue the provision of services under this Agreement by the Council or a subsequent contractor. Any notice required herein or for any reason by either party shall be in writing and shall be mailed postage prepaid by registered mail,return receipt requested, to the parties at the following addresses: COUNCIL: Skagit Emergency Medical Services Council . 29I 1 East College Way,Suite C ' Mt Vernon,WA 98273 • SKAGIT 911: Skagit 911 2911 East College Way, Suite A Mt Vernon,WA 98273 11. er : The initial term of this Agreement shall be for three(3)months commencing October 1, 199$ through December 31, 1998. 'Thereafter,the term shall be January 1, 1999 through December 31, 1999, renewable each year unless otherwise amended or terminated by either party. SKAGIT COUNTY Contract# C20 D30199 Skdisp.dac I I/30148 Page 39 of 47 04/08/2883 15:30 3604283235 SKAGIT EMS COUNCIL_ PAGE 06/11 • • 12_ Amendments Amendments to this agreement shall be upon written request and mutual agreement of the parties. Any duties or obligations created herein are solely between the parties contracting herein and do not create any duties owed to any non-contracting or third parties.It is not the intention of the parties hereto to establish any additional standard of care to third parties that does not otherwise exist 13. batmei& Payment for services shall be in accordance with the pro-rata consolidated dispatch fee schedule adopted by the Skagit County Emergency Management Council on March 30, 1998 for the dispatch • period of October through December 1998 and January through December 1999. • The Council shall pay to Skagit 911 the sum of Forty One Thousand eight Hundred Eighty One Dollars and Twenty Five Cents($41,881.25)for the period of October 1,1998 through December 31,1998. The Council shall pay to Skagit 911 the sum of One Hundred Sixty Seven Thousand Five Hundred Twenty Five"J)oilars($167,525.00)for the period of January 1,1999 through December 31, 1999. , Payment may be requested by Skagit 911 by invoice to the Council at the beginning of each quarter(every three month)commencing October 1, 1998 and every three months thereafter. . • In Witness Whereof;the parties hereto have executed.this Agreement on this,P day of ,, ;' 1998. • • • Skagit 911 Skagit Emergency Medical Services Council Hank Cramer . Ervin D.Lindall Director President SKAGIT COUNTY 5kdisp.doc i ifani9s Contract# C200SO199 Page 40 of 47 04/08/2003 15:30 3604283235 SKAGIT EMS COUNCIL PAGE 07/1T Attachment to Agreement between Skagit EMS Council and Skagit 911,November 1998 Payment Schedule for Skagit 911 Dispatch Service (Invoiced at the beginning of each quarter) Wag Amount payable October 1 through December 31,1998 S41,881.25 Ja vt2ry 1 through March 31,1999 - S41,881.25 April l through June 30,-1999 S41,881.25 July 1 through August 31, 1999 • S41,881.25 September 1 through December 31, 1999 $41,881.25 • • • SKAGIT COUNTY Contract* C20030199 Skdisp.doc 11/30/98 Page 41 cf 47 T 04/08/2003 15:30 3604263235 SKAGIT EMS COI_RCIL PAGE 88/12-• 'lit Amendment to: Agreement Between Skagit EMS Council and Skagit 911 WHEREAS the Council contracts with Skagit 911 to provide emergency medical service dispatch in the out-of-hospital Skagit County-wide Emergency Medical Service,and; WHEREAS the Council agrees to pay the assessed amount for said services for the year 2000, as determined by Skagit 911, now, therefore: Paragraph 13, Payment: is amended to read: Payment for services shall be in accordance with the pro-rata consolidated dispatch fee schedule adopted by the Skagit County Emergency Management Council on November 29, 1999 for calendar year 2000, • The Council agrees to pay Skagit 911 the sum of ONE HUNDRED EIGHTY THREE THOUSAND, SIX HUNDRED FIFTEEN DOLLARS ($183,615.00) for the period of January 1, 2000 through December 31, 2000_ Payment may be requested by Skagit 911 by invoice to the Council at the beginning of each quarter(every three month) for$45,903.75, commencing January 1, 2000. we In ss Whereof,the parties hereto have executed this Amendment on this /17 day of ,. 2000. Skagit 911 Skagit E ency Medical S ces Council By Rick Smith an D.T or Director Secr tart' • SKAGIT COUNTY Contract# 020030199 Skdisp,doc ion) Page 42 of 47 7°lo 'r1 'I1/zflg` A Avg,co Vocoar 7i96 m co Cily d Calmly Agencies Fire P(3lice Medical Macy Total • lxi Tier$41.73 2nd Mier 324,61 31911ter$20.67 Ta16l lee N /natnrtes 334 4 20.685 $ 61.525 a 111,466 $ 193,578.00 co Burn¢ton . 10613 5 20.885 r 114.525 4 753.046 1 241 3.00 co Concrele 27 430 457 4 W.071 3 19.071.841 Hamilton 23 0 ! 28 5 - 1,163 - 5 1.1311.00 t-' LaCoriner 2ia 349 597 $ 206eS 5 2,3d7 �'� " En Lyman + 0 0 $ w Mount Vts non tam Milo 10775 $ 20,365 $ 31,523 '"1,..,001 " m S edro=Nooltey i 173 7405 6668 5 20,655 5 61.525 3 Slaaai 5 200.6atto Sub[ct:1 4545 asitaa 48493 S 124.564 241.487 S 733.319 5 1,111.37090 279,966.00 co S kalut Ct un y S.O. 12467.3 20.865 $ 81 525 $ „� 79.9©6 00 m Swinomiett 5a720,305 $ 2,141 $ tipper Skagit 1 41 3 1,711 1 1,717.00 N City 3CountySubtotal 4545 . 57033 a B1S76 d 159.00 S 312.163 $ 0316,395 5 t,416.653iA0 cus o Flrtr AQencias NI FPO Y1 20 5 835.00 to 02 Mdkan Rd 197 197 3 0,221 r' e3 Canway/'Cedardate 242 r 04 Clear Lake 120 15 Edisort/Alren/Samich 185 + i16 Burlington 271 4 ' " S7 Lk Cavanaugh 17 '' `` rid PrairialHickaonfPC + 350MI 14.603 + , 09 Big Lake A19 G,eesmow 411 hit.Erie r M7 2$ayvinw 013 Hope/Surnr0it 207 207 014 Alger 7,133.90 ($15 Lake McNlueray • , , 416 Oaf/Crook ""I 017 Guemex 816 Rockport/L1bbn t 101 IN •F . Subtotal 23 +0 =IIIMIMMIIIIIIIIIIIIMIMIIIIIM 1943 1943 $ 20,685 4 35,512 iiIIIIMM11111111111. $ 58.377.00 ' • Med a2 1921 1921 5 20.865 S 34.97iS 65.133-00 Med 24 394 3114 5 15,199 5 15 1120,00 Med 35 a a 5 ' ' 250 250.00 r Atoll03 36 345 5 1,532 ' `t . Med 07 344 344 5 _ 14,E ' Mad 010 17 17 3 705 IM1111 .11111111111EMMNIIIIIMINIMMa Med 0 13,14.15 12531 1253 20,565 $ 19,53t $ 34.396.00 Subtotal 5.01341 68e41$ _ $4,801 $ 89.0i4 $ 163.61 .00 • AGENCY 190811009 - 20110 SKAGIT COUNTY LawEnlareement ^S 1,344.416.90'$ 1,4I6,553.04 ^b Fire $ 01,231.00 .$ 95,43300 ` Contract# 020030199 . EMS 3 . 187.626.00 $ t83.b5san f9t1 Householdtalr $ 350,000.00 $ 38200.00 I Page 43 of 47 rota,$ 1.053.2a2.00 $ 2,057,1�_06 $ 134.404.00 s to M 1)31 w 04/08/2003 15:30 3604283235 SKAGIT EMS COUNCIL PAGE 10/12 Negotiating Prop. 539 -0 to 500; $23 -501 to 2.504; S19.50 -2501 to n a8t ieoli L i s I3 0 r Avg Cell Vol,-1 94195/96 ,. Agency Ag4ner'A MST SECOND THLRR TOTAL AVERAGE PERCET7 Fire Palace Medical 'Fetal Cad TIED. TIER TIER :FEE COST OF *CDT de Cavity Agencies __ _ ti'elorae $39.00 523.00 519SO 51,600,000 PER CALL BUDGET Artaeorele 207' 10736 _ 10943 15,49%,„ 304_ 2300 7943 3131,119 321.19 1.4,46% Bu ,1t tlon 511 9956 10537 14,92% 4004 7100 7537 5233,971 S21.36 13.97% Concrete 26 300 • 526 0,74% 500 26 530,09E 331,21 . 1?51.6 Hamilton 13 01 , S3 4.43%.,, 33, 0 51117I- Si900 0,01% • LaCanncr 240 533 713 1.11% 500 213 126,009 333.22 1.62% Lyman 0, 0 0 0,00;i 0_ 0 SO POIv101 (oustMt.Vernon I alr 17367_ 19351' 27,26% 500 2500 11333 3393.914 $20.46 _ 24,37% Scdro-Wool1e7 770 7664 1434 11.9.1% 500 3500_ 5434 3131963 521.69 11.e1% • • Subtotal_ 3 733 46756 545041 71,51% 3033 10309 31186 9100.131 $ 1.39 t 67,37% • Sk�iACounn'SO 11519� 11519 1661% 500, 2500 15191 3244.416 521.10 f5.25% Swinomith,, 16 ' 417. _ Si) 0.73% S00 13 319,799 331.59 1.23*A 1JppetSk,�[n 0 a . 01 0,00`.S 0" 0 SO ttbIV10i' • 0.00% 'Subtotal . 86 13116 12102 17.13% 1009 3513. 8589 5761,215, 521.54 16,41% Cltv&CountySubtotal 313b 51lf, 6261a_ 88.44% 40331 11812 457551 S1,.344.416 521.47 13.11% , o,. . - / Fire Aftaeies 1tPDt) 24 I 24 0,g3u 14 t 5936 539.00 0 06!4 - t2fMcleanRd) 195 195 0.21% 195_ 57,605_ _ 539.00 0,4744 43(Conway1Cedardelei _ 339 . 239 0.34% 239 59321` 539,00 , 0,58% 14law Lkd 125 125 _0,11'%F, 125 V, S4,175 539.00 0.30% 15(1;diso,V,ki3etr/Satrsish 141 141, 0.20% 141" S3,499 339.00 - 0-34% 06 u nboil 257 14A..257 0.34% 217 , S23, 539.00 0.63% s7(lkCa�'neug1) 21_ 21 0.03%, 21 5E19. 539.00 . 0.05a/e Et fPrauielHsekaonPPC 435 435 0,6116 435, 516,955 539,00 1.06% 1'9(EN L1Ice) •8d 16, 0.12%` '16a 33,254 539,00 0.21% pO_(Graesmare) 43 13 0,46sc 43 • _ St 677 539.00 0.10% . . -J11(Mt.Eric) 1754 • 175 0.25%� 17$ . _ • $6,125 - 539.00 0.43% 417,173.yvicv:) 45 _ 45 0.06% 15 51.755 539.00 0.11% 15 413(HcpeummII) 13 a , r _ 133 • 0.26% 111 37,137 339,00 0.453s 014(Apr) . 173 173, 0,24% 171~ . 56,747 r 539.00 0.42% rfll�CkMcMurrav) 23 - - 23 0.03% 23 - 3197 S19,00 0.06% Sid May Ott) 31 - 31 00S%. 31 51.412. S39,00 0.09% s17 Guomoa 33 _ 33 0.059(. ' 33. $1.217 334.00 0_01% Oa(8c1cFoo Mrblmt) 104 104 0.15% 104 _ 54.056 539.00 0.25% Strbtaeal 2340 - p 0 2340 3.3-1% 1340� - 311.261 r 539.00 6.69% Med 41 18111. 1111 2,66%' 500 1311 351363 527,25 3,20% Med e2 1197 1197 2 694&, 500 1397 • - 551431 527.21 _ 3.22% Med 64 367 367 0.52`4 367 S[1,313+ 539.00 0.19' • Merl Al 7 7 0,01% 7 S273 139,00 0.025 Med N3 - 39 39 0.06% 39 51,321 53g,00 009`r. ided12 _ 375 375 0.3114. 375 511,625 539.00 , 0.91% eel t10 13 13 0,02% 13 • 5507 539,00 0.03% Med k 13,14,15 1104 110e 556% 300 604 533392' 530,25 2.01% 5nbcetal 01 0 r 3513 54131 1,03' 2301 3312_ p- 5167,525 329.48 ltlas i. tGntadTote • ', 4178` SE777I5113 %EU 100,01/%1 E6741 1620_4 437551 31.603,3011 522,70J 100.00%1 4 of Grand Total 6.15%, 13.11% 5,45% 100.04y. 112.70:Aveptc Cost per call - 5310.640 Avenge Cost p¢r Console 5361.491 Fite&EMS Contn-btnien $1.234.511 -LawErdorcemam Comribulion . _ 1.16 No.of Fire t EMS Consoles US No.of Law EnroresmentConsoler . 3r30,91 • • SKAGIT COUNTY . Contract# C20030199 Page 44 of 47 04f08f2003 15:38 3604283235 SKAGIT EMS COUNCIL PAGE 11/1 26`i Amendment to: Agreement Between Skagit EMS Council And Skagit 911 WHEREAS the Council contracts with Skagit 911 to provide emergency medical services dispatch in the out-of-hospital Skagit County-wide Emergency Medical Service, and; WHEREAS the Council agrees to pay the assessed amount for said services for the year 2001, as determined by Skagit 911,now,therefore: Paragraph 13. Payment is amended to read: Payment for services shall be in accordance with the pro-rata consolidated dispatch fee schedule adopted by the Skagit County Emergency Management Council on November 29. 1999 for calendar year 2000. The Council agrees to pay Skagit 911 the sum of TWO HUNDRED SIX THOUSAND EIGHT HUNDRED TWENTY ONE DOLLARS ($206,821.00)for the period of January 1, 2001 through December 31, 2001, Payment may be requested by Skagit 911 by invoice to the Council at the beginning of each quarter(every three month)for$51,705,25,commencing January 1, 2001. In Witness Whereof,the parties hereto have executed this Amendment on this day of jv Pi ,2001. Skagit 911 Skagit Emergency Medical Services di • By42-74/4"-- 7t. Rick Smith J A. Paul$ Director sident SKAGIT COUNTY Contract# C20030199 Page 45 of 47 04/08/2003 15:30 3604283235 SKAGIT EMS COUNCIL PAGE 12/12' Amendment to: Agreement Between r`f.*1 . µ, �:>._ Skagit EMS Council and Skagit 911 WHEREAS the Council contracts with Skagit 911 to provide emergency medical services dispatch in the cut-of-hospital Skagit County wide Emergency Medical Service,and; WHEREAS the Council agrees to pay the assessed amount for said services for the year 2002, as determined by Skagit 911,now, therefore: Paragraph 13. Payment is amended to read: Payment for services shall be in accordance with the pro-rata consolidated dispatch fee schedule adopted by the Skagit County Emergency Management Council on November 29, 1999 for calendar year 2000. The Council agrees to pay Skagit 911 the sum of TWO HUNDRED TWENTY TWO THOUSAND FOUR HUNDRED THIRTY FIVE DOLLARS ($222,435.00) for the period of January 1, 2002 through December 31, 2002. Payment may be requested by Skagit 911 by invoice to the Council at the beginning of each quarter(every three months)for$55,608.75, commencing January 1, 2002. In itness Whereof, the parties hereto have executed this Amendment on this day of ; �, .�� . ,2002. 1 Skagit 911 Skagit Emergency Medical Services Council (// Pit" Rick mith ' arr!n O. a .r+ Director President SKAGIT COUNTY Contract# C20030 t 99 Page 46 of 47 11/19/2003 10:40 CITY/ANACORTES LEORL 3369307 NO.111 PO2 WA el cities Insurance Authority P.Q. Box 1165 November 18, 2003 R itoxn, WA 98057 Phone:42_5-27'-723? Skagit County Commissioners' Office Fax: 425_277- 241 700 South Second Street Mount Vernon, WA 98273 RE: City of Anacortes Interlocal Agreement for Anacortes to provide Advanced Life Support Ambulance Services for the County_�� Evidence of Coverage The above captioned entity is a member of the Washington Cities Insurance ,Authority (WCIA),which is a self-insured pool of 10S municipal corporations in.the State of Washington.. WCIA has $5 million per occurrence combined single limit of liability and$1 million automobile liability in its self insured layer that may be applicable in the event an incident occurs that is deemed to be attributed to the negligence of the member. WCIA is an Interlocal Agreement among municipalities and liability is self funded by the membership. As there is no insurance policy involved and WCIA.is not an insurance company, your organization cannot be named as an"additional insured". Sincer En B, Larson Assistant Director l ._ • Cc: .More .Cityof Anacort Carol Yates