AMR current contract

DocuSign Envelope ID B4B068B5-3 137-4ODF-9298-4E125E9O933B 
EMERGENCY MEDICAL TRANSPORTATION SERVICE AGREEMENT 
THIS AGREEMENT is entered into this /C/~day of £..fi<.mbu·, 2023 (the "commencement date"), 
by and between the CITY OF EL MIRAGE (hereinafter referred to as the "City"), and American Medical 
Response of Maricopa, LLC (hereinafter collectively referred to as the "Contractor"). 
RECITALS 
Whereas the City of El Mirage desires to enter an Agreement for Emergency Transportation 
Services, and 
Whereas the City desires to provide for the health, safety and general welfare of its citizens, 
residents, and inhabitants with respect to emergency transportation services, and 
Whereas the City must often request emergency transportation services for members of the 
public through the operation of its fire departments, and 
Whereas the City desires to have Contractor furnish such services and Contractor desires to 
provide such service, and 
Whereas the City and Contractor desire to enter into this Agreement on the terms and conditions 
hereinafter stated, and 
Whereas the Contractor is currently authorized by the Arizona Department of Health Services to 
provide emergency transportation service within the State of Arizona. 
AGREEMENT: 
NOW, THEREFORE, for and in consideration of the mutual promise, covenants and agreements 
contained herein, and other good and valuable consideration, the receipt and sufficiency of which are 
hereby acknowledged, the parties hereto agree as follows 
1. 
Definitions. 
a. 
The term "Advanced Life Support" or "ALS" as used in this Agreement shall mean those 
medical treatments, procedures (including assessment), and techniques which may be 
administered or performed by ALS personnel established pursuant to AR.S. 36-2205. 
b. 
The term "Ambulance" as used in this Agreement, shall mean vehicles used in the 
transport of those receiving EMS (emergency medical services). 
c. 
The term "Automatic Aid Contract Areas," as used in this Agreement shall mean all areas 
within and surrounding the City and included in the service area of CON 136, in which the 
City has agreed to, provide Emergency Medical Service pursuant to automatic aid 
agreements. 
d. 
The term "Code 3 Call," as used in this Agreement, shall mean 
(i) 
an emergency response call in which the use of red lights and sirens are 
requested at the time of the initial request and red lights and sirens are used up 
and until arrival on the scene of an incident. 
(ii) 
A call in which the initial request by the City's 9-1 -1 Emergency Dispatch Center 
was for a Code 2 Call but was upgraded by the City's 9-1-1 Emergency Dispatch 
Center or responding fire unit to a Code 3 Call prior to arrival on the scene of an 
incident. 
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2. 
e. 
The term "Code 2 Call," as used in this Agreement, shall mean: 
(i) 
An emergency response call in which the use of red lights and sirens are not 
requested by the City's 9-1-1 Emergency Dispatch Center for Ambulance response to the 
scene of an incident. 
(ii) 
A call in which the initial request by the City's 9-1-1 Emergency Dispatch Center 
as for a Code 3 Call but was downgraded by the City's 9-1-1 Emergency Dispatch Center 
or responding fire unit to a Code 2 Call prior to arrival on the scene of an incident. 
f. 
The term "Cumulative Response Time", as used in this Agreement shall mean the sum-
total elapsed time of turnout and response time for an emergency call. 
g. 
The term "Designated Ambulance", as used in this Agreement shall mean Ambulances 
used to perform the services required under this Agreement. 
h. 
The term "OHS," as used in this Agreement shall mean the State of Arizona Department 
of Health Services. 
i. 
The term "Emergency Paramedic" or "Paramedic" as used in this Agreement shall mean 
a person who has been trained in an emergency paramedic training program and who is 
certified by the Director of Department of Health Services Bureau of Emergency Medical 
Services to render ALS pursuant to A.RS. 36-2205 and Article 4 of Chapter 25 of Title 9 
of the Arizona Administrative Code. 
j. 
The term "EMS Service Area," as used in this Agreement, shall mean all areas within the 
boundaries of the City's emergency services areas, as shown in Attachment F. Any use 
of the phrase "EMS Service Area," or similar terms shall in all respects be limited to the 
geographical boundaries of the City of El Mirage and any automatic/mutual aid partners, 
special districts, state lands, and county islands contained therein. Both parties 
acknowledge that these boundaries may change by way of annexations, etc. 
k. 
The term "Exception" as used in this Agreement shall mean ambulance responses not 
meeting the minimum response requirements established herein. 
I. 
The term "City" as used in this Agreement shall mean the City of El Mirage 
m. 
The term "City's 9-1-1 Emergency Dispatch Center", as used in this Agreement shall 
mean the City of Phoenix Public Safety Dispatch Center or any future facility used to 
dispatch fire and emergency medical incidents. 
n. 
The term "Response Time", as used in this Agreement shall mean the elapsed time from 
"en route" (wheels turning) to "on-scene" arrival (wheels stopped) at the dispatched 
location. 
o. 
The term "Response Zone" shall mean the defined geographical areas within the City, as 
shown in Attachment F. 
p. 
The term "Turnout Time", as used in this Agreement shall mean the elapsed time from 
notification or dispatch by the City's Emergency 9-1-1 Dispatch Center until Contractor is 
en route (wheels turning) to incident. 
Term. Extension and Agreement Modification. 
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a. 
The term of this Agreement shall begin upon approval from the Department of Health 
Services and continue for an initial period of three (3) years, unless earlier terminated as 
provided herein. 
b. 
The Parties may, at their option, extend the term of this Agreement for up to three (3) 
additional one (1) year terms by entering a signed and written amendment on or before 
90 calendar days prior to the expiration of the original term (or then current term) of the 
Agreement. 
c. 
The City and Contractor will conduct an operational review of the Agreement six (6) 
months after commencement of services. The intent of the review is to identify any 
potential amendments to the Agreement that may be necessary to address minor 
operational modifications. 
d. 
Any extension or modification of this Agreement shall be subject to the approval of OHS 
pursuant to its authority as granted in ARS 36-2232. 
3. 
Ambulance Service Requests. The City's 9-1-1 Emergency Dispatch Center shall dispatch to 
Contractor requests for ambulance services. Initial requests for service shall be responded to by 
Contractor as advised by City's 9-1-1 Dispatch Center. Responses will be requested as Code 3 
or Code 2 as determined by dispatch priorities by the City. In the event Contractor notifies the 
City of a possible prolonged response time, the City reserves the right, in its sole discretion, to 
dispatch requests for transportation and medical services to other ambulance companies, or to 
otherwise obtain the necessary ambulance services as provided by law. 
4. 
Acceptance. 
a. 
Contractor shall accept and respond within response time requirements of Section 6 to all 
requests for Ambulance transportation dispatched by the City for incidents arising within 
the EMS Service Area. When the City requests multiple Ambulances on a single 
incident, the Contractor will be responsible for meeting the response time requirements of 
Section 6 for the first two arriving Ambulances. 
b. 
The City and Contractor acknowledge that certain requests for ambulance service within 
the EMS Service Area may require transportation of the patient beyond the boundaries of 
the EMS Service Area and Contractor agrees to provide such service as may be 
required. 
5. 
Area of Responsibility. Contractor shall be responsible for providing Ambulance transportation for 
all calls within the EMS Service Area requested by the City. Should the City request the 
Contractor to respond outside the EMS Service Area (i.e., mutual aid}, the Contractor will do so in 
accordance with the terms of all contractual agreements, if any, that the Contractor has in place 
with other governmental entities with jurisdiction over such responses. In the event there is no 
contractual agreement in place between the Contractor and the governmental entity having 
jurisdiction, the Contractor shall respond under the terms of the Certificate of Necessity ("CON"). 
6. 
Response Time: Notice of Prolonged Response Time. 
a. 
b. 
Response Time: Minimum compliance is achieved when 90% or more of responses for 
Code 3 and Code 2 calls combined meet the specified Cumulative Response Time 
requirement. For calls in which the response code changes during response, the 90% 
requirement applies, as defined in Section 6i. 
To be in compliance for Code 3 calls, the Contractor must be able to place an Ambulance 
on the scene of each presumptively life-threatening emergency within 8 minutes 59 
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seconds (Cumulative Response Time) for not less than 90% of the time. For clarity, 9 
minutes 00 seconds is late. 
c. 
To be in compliance for Code 2 calls, the Contractor must be able to place an Ambulance 
on the scene of each non-life-threatening emergency within 14 minutes 59 seconds 
(Cumulative Response Time) for not less than 90% of the time. For clarity, 15 minutes 00 
seconds is late. 
d. 
Any changes or exceptions to the contractual response times as stated herein will be 
mutually agreed upon in writing by the Parties and the new response times will be 
documented in writing via a memo and, following approval by OHS, shall be incorporated 
into this Agreement via a duly executed amendment 
e. 
Arrival "On-Scene": For all types of requests for ambulance service, the response time 
clock shall be stopped by Contractor's unit arrived "on-scene" transmission via MCT or 
radio to the City's 9-1-1 Emergency Dispatch Center. Such transmission shall not be 
made until the ambulance actually arrives and is stopped at the specific address or 
location. In the instance of apartment or business complexes, such transmission shall 
not be made until the ambulance actually arrives at the point closest to the specified 
apartment or business unit to which it can reasonably be driven. 
Arrival "on-scene" means the moment an ambulance crew notifies the City's 9-1-1 
Dispatch Center that it is fully stopped at the location where the ambulance shall be 
parked while the crew exits to approach the patient In situations where the ambulance 
has responded to a location other than the specified scene (e.g. staging areas for 
hazardous scenes), arrival "on-scene" shall be the time the ambulance arrives at the 
designated staging location. The City may also require the Contractor to log time "at 
patient" for medical research purposes. However, during the term of this Contract, at 
patient times shall not be considered part of the contractually stipulated response time. 
In instances where the ambulance fails to report "on-scene" as required in this section, 
the time of the next communication with the ambulance crew, after arrival "on-scene", will 
be used as the "on-scene" time. However, Contractor may appeal such instances by 
providing appropriate documentation of the actual "on-scene" arrival time. Such 
documentation may include Automatic Vehicle Locator position equipment or verification 
by City's fire department personnel. 
f. 
Use of Mobile Computer Terminal {"MCT"): Contractor shall use MCT for all status 
changes as required by the City's 9-1-1 Emergency Dispatch Center Contractor must 
meet a 95% minimum MCT usage for ''en route" and "on-scene" activations. To be in 
compliance with this requirement Contractor must use MCT for "en route" and "on-scene" 
status changes at least 95% of the time calculated on a monthly basis. Contractor MCT 
use will be evaluated on a monthly basis by the City and the Contractor by reviewing 
CAD data to assure that MCT is being utilized on incidents for "en route" and "on-scene" 
times, as well as other data that may be required. The formulas used to calculate 
monthly compliance will be as follows: 
MCT "en route" activation: 
Total# of MCT activations "en route"/ total dispatches:::: .95 
MCT "on-scene" activation: 
Total# of MCT activations "on-scene"/ total dispatches not cancelled prior to 
arrival:::: .95 
Data used to determine Contractor's compliance with this section shall be drawn from the 
City of Phoenix computer aided dispatch system. 
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g. 
Notice of Extended/Prolonged Cumulative Response Time - Code 3: Contractor shall 
notify City's 9-1-1 Emergency Dispatch Center, at time of dispatch or at the earliest 
indication, the possibility of an extended Code 3 Cumulative Response Time greater than 
ten (10) minutes. Upon notification of a possible extended response time, City's 9-1-1 
Emergency Dispatch Center may, in its discretion and considering the severity of the 
situation, obtain other transport means that are faster. Contractor shall notify City's 9-1-1 
Emergency Dispatch Center, at time of dispatch or at the earliest indication, the 
possibility of a prolonged Code 3 Cumulative Response Time greater than fifteen (15) 
minutes. Upon notification of a possible prolonged response time, City's 9-1-1 
Emergency Dispatch Center may, in its discretion, obtain a response time estimate from 
another ambulance company and if the Cumulative Response Time estimate is less than 
fifteen ( 15) minutes or the response time stated by Contractor, the City's 9-1-1 
Emergency Dispatch Center may request the dispatch of another ambulance company to 
transport. The City's 9-1-1 Emergency Dispatch Center shall notify the Contractor that 
such second dispatch has been made, and Contractor shall be advised to discontinue 
response to the scene. Incidents that exceed 19 minutes 59 seconds will be considered 
as not meeting response time requirements as stated in Section 6b. 
h. 
Notice of Extended/Prolonged Cumulative Response Time - Code 2: Contractor shall 
notify City's 9-1-1 Emergency Dispatch Center, at time of dispatch or at the earliest 
indication, the possibility of an extended Code 2 Cumulative Response Time greater than 
twenty (20) minutes. Upon notification of a possible extended response time, City's 9-1-1 
Emergency Dispatch Center may, in its discretion and considering the severity of the 
situation, obtain other transport means that are faster. Contractor shall notify City's 9-1-1 
Emergency Dispatch Center, at time of dispatch or at the earliest indication, the 
possibility of a prolonged Code 2 Cumulative Response Time greater than twenty (20) 
minutes. Upon notification of a possible prolonged response time, City's 9-1-1 
Emergency Dispatch Center may, in its discretion, obtain a Cumulative Response Time 
estimate from another ambulance company and if the Cumulative Response Time 
estimate is less than twenty (20) minutes or the response time stated by Contractor, the 
City's 9-1-1 Emergency Dispatch Center may request the dispatch of another ambulance 
company. The City's 9-1-1 Emergency Dispatch Center shall notify the Contractor that 
such second dispatch has been made, and Contractor shall be advised to discontinue 
response to the scene. Incidents that exceed 29 minutes and 59 seconds will be 
considered as not meeting response time requirements as stated in Section 6c. 
i. 
Switch in Response Type After Dispatch: If Contractor was originally requested to 
provide a Code 3 response but was later requested to provide a Code 2 response on a 
particular call, Contractor shall arrive on the scene where emergency care is required 
within 14 minutes 59 seconds from the time that Contractor was originally dispatched to 
provide a Code 3 response. If Contractor was originally requested to provide a Code 2 
response but was later requested to provide a Code 3 response on a particular call, 
Contractor shall arrive on the scene where emergency care is required within the shorter 
of the following: 
(i) 
8 minutes 59 seconds from the time that Contractor was requested to update to a 
Code 3 response: or 
(ii) 
14 minutes 59 seconds from the time that Contractor was originally dispatched to 
provide a Code 2 response. 
Response Time Evaluation. 
a. 
Cumulative Response Time Calculation: For purposes of response time calculations, 
cumulative response time shall be calculated from the point in time when the City's 9-1-1 
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Emergency Dispatch Center initially notifies Contractor of a request for service (noted as 
"dispatch" in CAD) to the time the Contractor's responding Ambulance notifies the City's 
9-1-1 Emergency Dispatch Center and Contractor of its ·'on-scene" arrival time (wheels 
stopped) at the specific location to which Contractor was dispatched. 
b. 
Monthly Evaluations: The City shall conduct a monthly evaluation of response times. The 
evaluation shall include all responses that occurred within the City's boundaries. The 
City shall provide a list of all responses within the City correlated to the incident numbers 
provided by the City's 9-1-1 Emergency Dispatch Center and or the City's record 
management system no later than 15 calendar days following the evaluation month. The 
monthly evaluation meeting shall be held as soon as possible after the end of the 
evaluation month and no longer than thirty (30) days following the evaluation month. 
c. 
Exception Reports: The contractor shall generate monthly exception reports reflecting 
possible non-compliant response times. These reports shall be provided to the City 
whereby the City shall research each incident at the discretion of the City and be 
prepared to provide a written response to Contractor at the following evaluation meeting. 
Contractor shall also identify cause of possible delay and immediately implement 
corrective actions, if applicable, prior to monthly evaluation meetings. 
The exceptions detailed below are a non-exhaustive list of what may be considered by 
the City. In all cases Contractor must document that the exemption being requested was 
the direct cause for the late response. The Contractor shall have access to all the City's 
information related to contractor activities and include audio and data information on 
EMS/911 responses. Exception requests that may be considered by the City during the 
Contract period include, but are not limited to: 
(i) Call was reduced from Code-3 (emergency response) to Code-2 (non-emergency 
response by on-scene responders or by the dispatcher. 
(ii) Multiple units responded to the same scene. 
(iii) "Move up and cover" or ·'mutual aid" consistent with EMS policy and procedure. 
(iv) "Weather", e.g., Haboob. 
(v) "Technology Failure" e.g., MCT terminal failure. 
(vi) Late responses due to circumstances not in Contractor control, e.g., railroads, as 
determined by both the Contractor and the City. 
(vii) Other factors beyond the reasonable control of the Contractor 
In some cases, late responses will be excused from financial penalties and from 
response time compliance reports. The burden of proof that there is good cause for an 
exemption shall rest with the Contractor, and the Contractor must have acted in good 
faith. The alleged good cause must have been the causative factor in producing the 
excessive response time. Exceptions shall be considered on a case-by-case basis. 
d. 
Evaluation Data: The evaluation of response time data shall include the total number of 
requests for services within the City's EMS Services Area and the total number of 
exceptions. Exceptions shall be determined at evaluation meetings. Contractor may 
request waiver of exceptions based upon extenuating circumstances. The Fire Chief or 
designee shall issue final determination of whether a call is excluded from the exceptions. 
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e. 
Written Explanations: Upon request by City, Contractor agrees to prepare a written 
explanation for any incident in which the Contractor has not met the response time 
requirements. The Contractor's explanation shall include a full discussion of the 
circumstances of the incident and any corrective action required to comply with the 
provisions of this Agreement during the remainder of the term of this Agreement. 
f. 
Dispatch Methodology: Modifications of dispatch methodology may require modification 
to the response time performance and evaluation standards. Any changes or 
adjustments to the Dispatch Methodology that impact the Contractor's ability to meet the 
required response time performance standards shall be agreed upon by both the 
Contractor and City and submitted to OHS for approval. 
8. 
Liquidated Damages for Failure to Meet Requirements. City will notify Contractor in writing of any 
liquidated damages being assessed not less than 30 calendar days after they first become known 
to City. Upon notification of any liquidated damage assessments, Contractor will have 15 
calendar days to dispute any assessment; any dispute must be submitted in writing. The City's 
Contract Administrator and the EMS Division Manager from the jurisdiction where the instance 
took place (if applicable) will meet with Contractor to review the assessment and Contractor's 
response and to determine the validity or invalidity of the assessment. Should the Contract 
Administrator, City's EMS Division Manager (as applicable) and Contractor fail to reach an 
agreement on the validity or invalidity of the assessment, the matter will be referred to the Fire 
Chief (or their designee) of the jurisdiction where the instance took place who will review the 
circumstances of the assessment with the Contractor and Contract Administrator. The 
determination of the Fire Chief shall be final. The Problem Resolution Procedure as defined in 
Attachment C shall not be applicable to the assessment of liquidated damages. Any non-
performance penalties, fines, or liquidated damages will not be included in establishing rates and 
charges as prescribed in A.A. C. R9-25-1106. All penalties or fines will be reported separately on 
the ambulance Revenue and Cost Report. 
a. 
Failure to Meet 90% Response Time Requirement: The following liquidated damages 
table will not apply if there are less than 10 combined Code 3 calls and Code 2 
responses in a given month. The following liquidated damages will be assessed when 
the Cumulative Response Time compliance for Code 3 calls and Code 2 calls combined 
fall below 90% for any given month. 
Compliance 
Liquidated Damages 
Liquidated Damages 20+ 
% 
10 to 19 combined 
combined 
Code 3 and Code 2 calls 
Code 3 and Code 2 calls 
89.9%-
$1,500 
$3,000 
89.0% 
88.9%-
$3,000 
$5,000 
88.0% 
87.9%-
$5,000 
$7,000 
87.0% 
86.9%-
$7,000 
$9,000 
86.0% 
85.9%-
$9,000 
$11,000 
85.0% 
84.9% and 
$10,000 plus $2,000 per 
$13,000 plus $3,000 per 
below 
percentage point 
percentage point thereafter 
thereafter 
b. 
Notwithstanding liquidated damages in Section 8a, each Code 3 Cumulative Response 
Time in excess of 19 minutes 59 seconds will be assessed liquidated damages of $1,000 
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c. 
Notwithstanding liquidated damages in Section 8a, each Code 2 Cumulative Response 
Time in excess of 29 minutes 59 seconds will be assessed liquidated damages of $1,000 
d. 
Failure to meet requirement for MCT use as defined in Section 6f for ''en route" activation 
will result liquidated damages of $1,000 per full percentage point under 95% 
e. 
Failure to meet requirement for MCT use as defined in Section 6f for "on-scene" 
activation will result liquidated damages of $1,000 per full percentage point under 95% 
f. 
Assessed Liquidated Damages will be payable to the City. 
9. 
Alternative Care and Transportation. As Arizona Statute and OHS regulations are revised to 
encompass the implementation of alternative care and transportation options and destinations for 
service originated within public safety dispatch, the Contractor will work cooperatively with the 
City to provide equipment, personnel, joint guidelines, and performance criteria. This process 
may include, but is not limited to, community paramedicine programs, stretcher vans, BLS 
transportation units, bariatric units, stand-by ambulances or other vehicles or personnel as 
necessary to meet future needs. Any amendments and/or related agreements developed to this 
end will come with the approval of the City, be in writing, signed by the Parties and are subject to 
OHS approval. For clarity and to avoid doubt, this cooperation Section 9 does not preclude 
Contractor from creating its own programs in accordance with applicable laws and regulations. 
10. 
Ambulance and Locations. 
a. 
Contractor shall operate a sufficient number of ALS Ambulances to meet the response 
time standards set forth in Section 6. Upon execution of this Agreement, Contractor shall 
provide the City with a list of Designated Ambulances and substation locations of such 
ambulance units. This list shall be updated periodically as request by the City or upon 
the change in any substation location throughout the term of this Agreement. 
b. 
On an ongoing basis, Contractor and City will review call volume, historical transport 
volume, historical response time performance and historical seasonal trends to evaluate 
the need for additional ambulance unit hours within the City. Contractor and City shall 
review actual data (time of day/day of week) to determine the appropriate times of 
operation for the additional unit hours. 
c. 
Contractor will operate enough sub-operation stations within the City's EMS Response 
Area to meet the defined response time requirements of this Agreement. Contractor 
agrees to work closely with the City in the determination of future station needs, which 
will ensure Contractor continues to meet the defined response time requirements of this 
Agreement. At the discretion of the Contractor, Contractor may lease space from the City 
at fair market value to quarter a twenty-four (24) hour ambulance crew and an 
ambulance. Contractor shall comply with sub-operation station requirements pursuant to 
the rules and regulations set forth by OHS 
d. 
The City serves as the first responder to the emergency needs of the City. The 
Contractor serves as a second-responder transport unit that provides assistance to the 
City's Fire Department paramedic staff on-scene of an incident and as well as 
transportation to a local hospital. The City and Contractor agree that there are a number 
of times when the immediate dispatch of an ambulance transport unit is not required due 
to the minor nature of an incident. The City's first responder Fire Department on many 
occasions arrives on the scene of an incident, provides an evaluation of the patient, and 
determines that ambulance transportation is not needed. The City agrees to work with 
Contractor in developing dispatch protocols that reduce the number of ambulance 
responses to incidents that are minor in nature and to establish protocols for the 
immediate cancellation of ambulance service in such cases, allowing for the immediate 
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return of the ambulance to an available status, available to respond to other emergency 
calls within the City's EMS Service Area. 
11. 
ALS/BLS Ambulance Staffing Requirements. 
a. 
BLS transportation units shall be equipped and staffed to provide medical treatments, 
procedures, and techniques which may be administered or performed by an Emergency 
Medical Care Technician (EMCT). 
b. 
ALS transportation units shall be equipped and staffed to provide medical treatments, 
procedures, and techniques which may be administered or performed by an Emergency 
Medical Care Technician - Paramedic ("EMCT-P"). ALS transportation units shall meet 
minimum staffing of at least one (1) EMCT-P. 
12. 
Ambulance Specifications and Maintenance. 
a. 
No later than the commencement date, or as approved by the City, of this Agreement, all 
ambulances shall be equipped, maintained, and operated in accordance with the laws of 
the State of Arizona and the rules and regulations of OHS. All Designated Ambulances 
shall be Type 111, or as approved by the City, and meet all federal, state and OHS 
regulations. Ambulances shall be subject to inspection by the City at reasonable times 
and at reasonable intervals. 
b. 
Substitute Ambulances in place of Designated Ambulances shall be similarly equipped as 
the Designated Ambulances. Use of Substitute Ambulances for periods greater than 
twelve (12) hours shall require notification by the Contractor to the City. 
c. 
Contractor shall be responsible for all ambulance maintenance and repair, including but 
not limited to, all repair, preventative maintenance, parts replacement, labor and other 
actions necessary to keep each ambulance in safe and efficient operation conditions. 
The City reserves the right to review and audit maintenance reports of vehicles used to 
comply with this Agreement at reasonable times and at reasonable intervals. 
d. 
All Ambulances shall be additionally equipped to include the following: 
(i) 
Designated Ambulances shall be of similar type that is agreed upon by the City 
and Contractor. 
(ii.) 
Equipped with adequate crew cab A/C and separate standalone RV style A/C, 
heating and ventilation as agreed upon by the City and the contractor. 
(iii) 
Provide a usable safety restraint system for personnel attending to patient, as 
agreed upon by the City and contractor. 
e. 
Each Designated Ambulance shall be identified as to its call sign (e.g. Ambulance 100 
will have the designation 100 in no less than 6" letters on all 4 sides and no less than 22" 
letters on the roof of the vehicle). 
f. 
Contractor shall provide a list of all Designated Ambulances used to provide service 
under this Agreement. This list shall include vehicle identification number, make, model, 
year of manufacture, current mileage, and complete maintenance history. This list shall 
be provided upon award of Contract and upon request of the City during the term of the 
Contract. 
13. 
Equipment and Supplies. Contractor shall be solely responsible for providing all of the 
emergency medical equipment and supplies necessary for the Contractor to perform under this 
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Agreement. The equipment and supplies shall be current in nature and maintained in accordance 
with standard medical practices, the laws of the State of Arizona, and regulations of OHS. 
Without limiting the foregoing, Contractor shall install and maintain in each ambulance serving the 
EMS Service Area the following equipment: 
a. 
Mobile computer, docking station, AVL equipment and portable radios compatible with 
the City system that will allow for the dispatch and coordination of Contractor's 
ambulances through City's dispatching authority. 
b. 
Cellular telephone and radio equipment with a noise canceling microphone and speaker, 
located in the patient compartment of the ambulance, capable of communicating with 
appropriate medical direction. 
c. 
Child-restraint seating immediately available in each dedicated ambulance, and available 
upon request for non-designated Ambulances. 
d. 
All equipment identified by OHS for either ALS or BLS Ambulances. 
e. 
As mutually agreed upon by the Parties, EMS disposable tools and products listed on 
Attachment B of this Agreement, which is incorporated herein by this reference: 
f. 
All equipment listed in Attachment B to this Agreement, which is incorporated herein by 
this reference. 
g. 
Pre-emption emitter approved for use within the City's traffic control systems. 
14. 
Additional Equipment. Upon 90 days prior written notice to Contractor, City may add equipment, 
goods, or products to the lists contained in Attachment B to this Agreement, if such equipment, 
goods, or products are reasonably necessary for patient care and/or to facilitate patient transfer in 
the EMS Service Area. City will provide Contractor with information showing that such items are 
reasonable and necessary. In the event that the cost of such items is economically prohibitive to 
Contractor, Contractor shall provide City with a letter of explanation regarding the same. The 
cost of such equipment or products shall not exceed $3000.00 per Designated Ambulance per 
year. The efficacy of any City proposed changes shall be reviewed by Contractor's National 
Equipment Team. Any additional equipment shall remain the property of Contractor. In the event 
of a dispute over the efficacy of the proposed City changes, the Parties shall negotiate in good 
faith a reasonable resolution. 
15. 
EMS System Disposable Supplies. 
a. 
El Mirage Fire Department's disposable supplies and pharmaceuticals shall be replaced 
by Contractor at fair market value at a flat rate per call that is calculated at the end of 
each month. This dollar amount will be set at the beginning of each calendar year. The 
dollar amount is currently six dollars ($6.00) per transport. Each month the El Mirage Fire 
Department will submit a CAD report showing all patient transports where the El Mirage 
Fire Department provided first response and Contractor transported the patient. The 
Contractor shall reimburse the El Mirage Fire Department using the per transport rate 
monthly in arrears. The replacement or reimbursement of materials is limited to calls 
resulting in ambulance transport. 
b. 
Contractor and City agree to review fixed reimbursement amount 90 days from the 
initiation of the agreement to determine if fair market value is set accordingly to the 
amount of supplies that the City used for patients that were transported for the first 
calendar year. Annual review will commence in December of the calendar year to be set 
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DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E125E9O933B 
16. 
for the following year Any adjustment to the fixed amount will take effect January of each 
calendar year. 
c. 
The provisions of this Section shall be implemented within ninety (90) days of execution 
of this Agreement 
Dispatch and Communications Fees. 
a. 
City shall pay the City of Phoenix for each 9-1-1 dispatch of an Ambulance pursuant to this 
Agreement The fee will be the actual cost for City of Phoenix to provide dispatch 
services. Cost for dispatch services upon the execution of this Agreement will begin at 
current rate charged to the City (without mark-up) by the City of Phoenix with an annual 
evaluation and adjustment of the costs. 
b. 
Contractor shall reimburse on a monthly basis the City's actual cost of dispatch services 
for ambulance requests only. 
c 
If required by the City of Phoenix the contractor shall execute an associate agreement and 
maintain good standing with the City of Phoenix Regional Dispatch Center. Contractor shall 
pay all fees set forth by the Phoenix agreement 
17. 
Radio Communications. When Contractor utilizes the City's radio frequencies, Contractor shall 
be required to adhere to Federal Communications Commission (FCC) rules and regulations 
regarding radio communications. Specific guidelines regarding direct communications on the 
City's communication system shall be by directive from the City. The City shall be the authority 
regarding the City's communication system utilization. Contractor acknowledges that the FCC 
license is held by the City and that any shared transmitter use under this Agreement and 
pursuant to Section 90.179 of the FCC's Rule shall be subject to the City's control. 
18. 
Management and Supervisors. Contractor shall hire and maintain properly educated, trained, 
and experienced personnel to serve in Contractor's managerial and supervisory positions. 
Contractor shall identify one of their own staff as contract administrator/manager. The contract 
administrator/manager will act as a single point of contact for the City and will have the authority 
to make decisions on behalf of the Contractor regarding Contractor's operations under this 
Agreement. City reserves the right to request a change of the Contractor's contract 
administrator/manager 
19. 
Attendants. 
a. 
Contractor shall hire, train, and supervise all medical attendants in accordance with the 
laws of the State of Arizona and regulations of OHS. Attendants shall be properly certified 
Emergency Medical Care Technician (EMCT) and/or Emergency Medical Care 
Technician - Paramedic (EMCT-P). 
b. 
Designated Ambulances responding to calls for service within the City's EMS Services 
Area shall be staffed with personnel on a 24-hour shift schedule (3 platoon system; A, B, 
& C shifts) or such other schedule as the system requires. Due to workload, the 
Contractor may staff these units with split shift multiple crews as long as the same crews 
are used on each shift The personnel may be replaced with any other Contractor 
personnel for the purpose of covering vacations, sick leave, or other temporary 
absences. 
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DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E 125E9D933B 
c. 
Each ALS Ambulance responding to calls for service within the City's EMS Services Area 
shall be staffed with at least one EMCT and one EMCT-P. Contractor agrees to provide 
continuity of personnel stationed in the City to promote a cooperative work atmosphere 
for optimum patient care. This section may be modified by separate staffing agreements 
between the Parties. 
20. 
Operators. Contractor shall hire, train, and supervise all operators of Ambulances in accordance 
with the laws of the State of Arizona and regulations of OHS. Operators shall be properly certified 
EMCT or EMCT-P and have completed a comprehensive emergency driver-training program and 
possess an appropriate driver's license. Contractor shall provide on a regular basis driver's 
training continued education and require all Contractor Ambulance personnel to attend. Records 
of attendance shall be maintained by Contractor and be made available on request. 
21 . 
Records. 
22. 
a. 
Contractor shall maintain complete and accurate records in accordance with applicable 
laws, rules and regulations. 
b. 
Contractor shall maintain records in accordance with the record retention requirements of 
the OHS, regarding the personnel dispatched on each responding Ambulance. 
Contractor shall make available to the City a complete and current record of all personnel 
employed to perform Contractor's obligations under this Agreement. 
c. 
Records described in this Section shall be provided from time-to-time upon commercially 
reasonable request to the City. 
Reporting Requirements. 
a. 
All accounting records shall be maintained and reported in accordance with 
standard accounting procedures. 
b. 
The reports, and associated deadlines, defined in this Agreement shall be submitted by 
the Contractor (provided that the City has supplied Contractor with the necessary 
information from its CAD) to the City and will be utilized in determining and measuring 
compliance with the terms of this Contract. City and Contractor, through mutual 
agreement, may choose to add to, or delete from, the list of required reports contained in 
this Agreement. 
c. 
Upon commencement of the Agreement, Contractor shall provide the City's Contract 
Administrator with a list of all management, supervisory, vehicle maintenance, and field 
and dispatch personnel. 
d. 
Contractor must submit service and deployment records to the City's Contractor 
Administrator on a monthly basis. 
e. 
Failure to meet the requirements of this Section may result in a per occurrence 
assessment of liquidated damages in the amount of $1,000. 
23. 
Problem Resolution. All problems and issues between the City and Contractor, with reference to 
Agreement requirements or operational concerns, shall be handled promptly utilizing the Problem 
Resolution Guideline, Attachment C. The Problem Resolution Guideline does not diminish or 
replace any requirements for evaluating Contractor performance and/or other remedies provided 
for in this Agreement. 
24. 
Cost of Service. 
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DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E 125E9O933B 
a. 
All patient charges by Contractor for services to the public under the terms of this 
Agreement shall be in accordance with such rates and charges as may be approved by 
OHS or any successor governmental entity regulating rates and charges for Ambulance 
services. Contractor shall notify the City of any changes in the charges for services 
provided under this Agreement within (5) days after approval. The City shall not be 
responsible for non-payment of bills tendered to the individual(s) involved with the 
services rendered. 
b. 
In the event a ground Ambulance is en route to or has arrived on the scene, where 
Contractor did not transport the patient, and circumstances deemed air transport 
necessary, Contractor shall not charge the City for such response. 
c. 
Contractor may bill patient for ALS services that are rendered by Contractor in 
accordance with OHS regulation when transport is not provided by ground ambulance. 
25. 
Provision of ALS Services. 
a. 
As part of City's provision of fire and rescue services and of Contractor's provision of 
ambulance transportation services, there are instances where, as determined by City's 
ALS medical authority at the scene and/or in conjunction with City's base station 
physician, a patient requires ALS services involving on-site emergency medical care and 
the administration of initial care and preliminary treatment procedures by City's certified 
Paramedics. As first responders on the scene, City reserves the right, at the discretion of 
the medical authority at the scene in keeping with the West Valley Off-Line Medical 
Direction Algorithms and/or in conjunction with City's base station physician, to provide 
ALS services to the patient utilizing City's own Paramedics until transfer of care to 
Contractor or the receiving hospital is complete. 
b. 
In those instances where Contractor provides transportation of a patient to whom City's 
Paramedics render ALS Services during transportation, Contractor shall bill the patient 
for the ALS Services provided to the patient by City's Paramedics. The billing shall be 
equal to the ALS base rate and other rates, fares, and charges permitted and authorized 
by law and/or the Arizona Department of Health Services. City Paramedic personnel in 
accordance with standards established by Contractor and required by third party payers, 
including Medicare, must appropriately document ALS Services. City shall cooperate 
with Contractor in providing appropriate reimbursement documentation training to City 
Paramedics. 
c. 
For each instance where Contractor provides an ALS transportation unit for a patient that 
requires the City's Paramedics to render ALS Services during transportation, Contractor 
agrees to pay City 50% of the difference between the BLS base billing rate and ALS base 
billing rate, regardless of call type. 
For each instance where Contractor provides a BLS transportation unit for a patient to 
whom requires the City's Paramedics to render ALS Services during transportation, 
Contractor agrees to pay City 100% of the difference between the BLS base billing rate 
and ALS base billing rate, regardless of call type. 
The Contractor and the City with Medical Direction participation have developed a 
comprehensive Paramedic Ride-In Procedure (Attachment H). For clarity, mileage 
reimbursement is excluded from the calculations above and remains a reimbursement 
solely to Contractor. 
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DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E 125E9D933B 
The City, on a monthly basis, will provide a listing of all transports where ALS Services by 
City's Paramedics were required for effective patient care and City Paramedic 
accompanied the patient to the health care facility. This list shall include the date of 
service, address of pick-up location, patient's first and last name and the destination 
point. Contractor and City shall review the completeness of required documentation and 
final determination shall be agreed upon by both Contractor and City as to the 
appropriateness of an ALS Service classification. 
d. 
Contractor shall provide payment to City within 45 days of receipt of invoice from the City. 
Payments shall be made to City regardless of whether Contractor has billed and received 
payment from the patient. Late payments will be subject to 1.5% monthly interest. 
e. 
Nothing herein shall be construed to govern, alter, or amend Contractor's rates, fares, or 
charges. All such rates, fares, or charges by Contractor shall be in accordance with and 
shall not be greater or lesser than or different from Contractor's rates, fares, or charges 
as may be approved, fixed, determined, established, and/or authorized by the OHS (or 
any successor governmental entity regulating such rates, fares, or charges) for the 
service provided. 
f. 
City's Paramedics shall at all times be properly certified in accordance with the laws of 
the State of Arizona and the Rules and Regulations of the Arizona Department of Health 
Services. At Contractor's request, the City shall supply Contractor with a list and 
certification of its personnel that provide services. 
26. 
Independent Contractor. No personnel of City providing ALS Service as described herein shall 
be considered an employee of Contractor. City shall have the total responsibility for all salaries, 
wages, bonuses, retirement, withholdings, workers' compensation and occupational diseases 
compensation insurance, unemployment compensation, other benefits and all taxes and 
premiums appurtenant thereto and all other appropriate insurance concerning City personnel 
providing ALS services described herein, and City shall indemnify and hold harmless with respect 
thereto. City shall retain complete control of its personnel and Contractor shall have no authority 
to direct the operations of City personnel, or to hire, fire, or make other decisions regarding the 
terms and conditions of their employment. 
27. 
Contract Administration. 
a. 
The City will identify a Contract Administrator for the City. At a minimum the Contract 
Administrator will have responsibility for the following: 
(i) 
Assure compliance with the Agreement within the City 
(ii) 
Develop, conduct and coordinate training for personnel, as outlined in Section 32 
of this Agreement. 
(iii) 
Participate in meetings with Contractor. 
(iv) 
Act as liaison with Contractor and medical facilities receiving patients. 
(v) 
Coordinate research and reporting on Ambulance services and transports. 
(vi) 
Perform field observations and report such observations to Contractor and the 
City. 
(vii) 
Monitor response times. 
(viii) 
Coordinate Ambulance coverage for special events and Fire Department training. 
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DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
28. 
29. 
(ix) 
Coordinate or conduct customer (including patient) surveys and such other 
similar duties as assigned. 
(x) 
Act as primary liaison between City and the Contractor in the problem resolution 
process. 
Electronic Patient Care Reporting. The City, reserve the right to implement a program for 
electronic patient care reporting (ePCR). Upon notification from City of their intent to implement 
such a system or systems, Contractor will work diligently with City, their vendors or contractors, to 
develop interoperability between the City and the Contractor's ePCR system. The goal of 
developing interoperability will be, at a minimum, to establish seamless transfer of data between 
the City and the Contractor's ePCR system. 
Solicitation of Patient Information. 
a. 
Contractor agrees to abide by all policies, standards, and security procedures established 
by City and OHS relating to the release of information concerning the injured party to the 
extent such policies are not inconsistent with other legal requirements imposed by law. 
30. 
Confidential Information. 
a. 
As part of Contractor's performance under this Agreement, Contractor, its employees and 
agents, may be exposed to certain confidential and/or proprietary information of City. As 
used in this Agreement, the term "Confidential Information" means any information, 
whether oral or in writing or in any other medium, relating to the management, 
operations, products, intentions, plans, goals, objectives, inventions, data, records, costs, 
employee information, technical information, and other propriety information whether 
developed by the City or furnished to the City by other third parties, and all information 
which arises out of or relates to the analysis and evaluation of the Confidential 
Information. 
Notwithstanding the foregoing, the term ''Confidential Information" does not include 
information that: 
(i) 
Was publicly available at the time it was disclosed to Contractor or which, 
through no act or omission of Contractor, becomes publicly available before 
Contractor discloses it to a third-party. 
(ii) 
The City regularly discloses to third parties without restriction on disclosure. 
(iii) 
Contractor already rightfully possessed, without obligation of confidentiality, 
before the City disclosed it to the Contractor. 
(iv) 
Contractor rightfully receives without obligation of confidentiality from any 
unrelated third-party. 
(v) 
Contractor develops independently without reliance upon or use of the 
Confidential Information; or 
(vi) 
Contractor is required to disclose pursuant to Arizona's public records law 
(A.RS. § 39-121 et. seq.) or other applicable law, subpoena, or court order. 
b. 
Contractor will make no disclosure of any Confidential Information to third parties except 
upon City's explicit written permission. If Contractor loses or makes unauthorized 
disclosure of City Confidential Information, it shall notify the City immediately and take all 
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DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E125E9D933B 
31. 
32. 
33. 
34. 
steps reasonable and necessary to retrieve the lost or improperly disclosed information. 
Contractor shall use the same care to prevent disclosure of City Confidential Information 
as Contractor uses with respect to its own confidential information of a similar nature. 
which shall not in any case be less than the care a reasonable business person would 
use under similar circumstances. 
c. 
The City shall retain all right, title and interest in and to their Confidential Information. 
HIPAA Reporting Requirements. To the extent required by law, Contractor agrees to comply with 
the provision of the Health Insurance Portability and Accountability Act of 1996, related 
regulations, as amended ("HIPAA"). In particular, to the extent required by law, the Contractor 
agrees to comply with the provisions set forth in Attachment E regarding such Protected Health 
Information Contractor's obligations under this sub-part shall survive the expiration or 
termination of this Contract regardless of the reason for such termination. 
Training. Contractor agrees to make available the personnel, equipment, and Ambulances 
necessary to participate in the following 
a. 
A minimum of one (1) City disaster training drill per calendar year. 
b. 
Contractor agrees to schedule and participate in a minimum of two (2) training sessions 
annually with City. These sessions shall cover the integration of Fire Department EMS 
procedures, command procedures, patient care management, and other subjects as 
deemed necessary by the City Fire Department. At a minimum, a City training session 
shall be attended by respective Designated Ambulance personnel. 
c. 
Orientation training with City in operational procedures and patient care management for 
all new employees dedicated to the contracted area. 
d. 
Continuing education training for Contractor's response personnel to meet OHS 
requirements for EMCT and EMCT-P personnel. 
e. 
Compliance with all current OSHA training requirements including infection control and 
blood borne pathogen management. 
Emergency Standby. Contractor agrees to provide an ambulance for emergency scene standby, 
at no charge to the city, when a fire or police incident commander or City representative has 
reason to believe the situation warrants an ambulance standby 
Notification of Services Not Requested by City. 
a. 
Contractor shall notify City of any standbys at special events within the City Contractor 
shall work with City to develop procedures for dealing with emergency incidents that may 
occur at such events. 
b. 
Contractor shall immediately upon receipt notify City's 9-1-1 Emergency Dispatch Center 
of any Code 3 responses (Code 3 at any point during response) within the City in which 
the request for response was not initiated from the City's 9-1-1 Emergency Dispatch 
Center. The City, at its discretion. may dispatch City's Fire Department emergency 
medical personnel to the incident. In such case, all provisions of this Agreement shall 
apply, excluding the requirements in Section 6. 
35. 
Control of lncidenVScene. Contractor agrees that the City's emergency medical personnel, when 
present at the scene of an emergency, shall be considered to be the initial authority until transfer 
of care to Contractor's personnel is complete. Further, Contractor's employees shall comply with 
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DocuSign Envelope ID: B4806885-3137-4DDF-9298-4E125E9D933B 
the operating procedures adopted by the City for ambulances and ambulance personnel to the 
extent such compliance will not cause a violation of a OHS requirement. 
36. 
Transfer Procedure. The City shall advise Contractor of the status of any injured or ill person at 
an emergency incident. To provide for the transfer of responsibility for the care of such person or 
persons, City and Contractor hereby establish and agree upon the Transfer Procedure attached 
hereto and incorporated herein as Attachment D specifically detailing such procedures. All 
transfer procedures may be amended by mutual written agreement between City and Contractor. 
Any amendment to the transfer procedures will be submitted to OHS for approval prior to their 
implementation. 
In situations that require Fire Department personnel to accompany a patient in the Contractor's 
vehicle, Contractor agrees to return those personnel to their respective fire stations or units upon 
the transfer of patient care unless subjected to emergency system demands. 
37. 
Base Hospital. The City has entered into an Emergency Base Hospital Agreement with a hospital 
(currently Banner Boswell) near the City's service area. The Agreement sets forth Hospital 
responsibilities and identifies Hospital personnel for providing medical direction to the City, 
including direction to the Fire Department and Contractor personnel engaged in carrying out the 
medical ground transportation services specified within this Agreement. Contractor must ensure 
that permanently assigned personnel utilize the services available pursuant to the Emergency 
Base Hospital Agreement at all times and, as a Contractor for medical services with the City; 
Contractor must fully comply with the terms and conditions of such Agreement. Specifically, 
Contractor agrees to require its permanently assigned personnel to utilize, in every indicated 
circumstance, medical advice and services pursuant to the Emergency Base Hospital 
Agreements. Should the City enter into an Emergency Base Hospital Agreement with any other 
hospital, the Contractor agrees to honor that Agreement in the same manner as the current 
Agreement. 
38. 
Emergency/Disaster Assistance. Contractor shall set forth its plans for responding to major 
emergency situations within the EMS Services Area and outside the EMS Services Area where 
Designated Ambulances may be involved. In addition, Contractor must set forth its plans for 
declared disaster situations and required assistance. All such plans must be in accordance with 
and comply with applicable law, regulation, rules, policies and protocols. 
39. 
Continuous Service Delivery. The City may terminate this Agreement in the event of any material 
default by Contractor as defined herein. As a condition precedent to termination by City, City shall 
provide Contractor with no less than thirty (30) days' advance written notice citing, with specificity, 
the basis for the material default (the "Breach Notice"). In the event Contractor shall have cured 
the material default within such thirty (30) days period, or such longer period as may be specified 
in the Breach Notice, this Agreement shall remain in full force and effect. In the event City 
reasonably deems Contractor to remain in material default as of the end of the notice period 
specified in the Breach Notice, City shall provide Contractor with a notice of termination 
("Termination Notice"), setting forth the specific reasons the City believes Contractor remains in 
Material Breach and the effective date of termination ("Termination Date"), which shall be no less 
than thirty (30) days from the date of the Termination Notice. In the event of termination by either 
party for any reason, or of expiration of this Agreement, Contractor shall cooperate with City and 
with the successor provider to help assure a smooth transition. 
City may terminate the Agreement if Contractor is deemed to be in material default four (4) or 
more times in any twelve (12) month period regardless of whether Contractor has cured the 
material default. 
40. 
Insurance. 
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DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E125E9O933B 
a 
Contractor shall carry all insurance with respect to the Ambulances and personnel 
engaged in the performance of Contractor's duties under this Agreement as may be 
required by all applicable federal, state, county, and city laws, ordinances, charters, rules, 
regulations and codes. 
b. 
Without limiting any of their obligations or liabilities, the Contractor, at its own expense, 
shall purchase and maintain the minimum insurance specified in Section 42 of this 
Agreement with companies duly licensed or otherwise approved by the State of Arizona, 
Department of Insurance, and with forms reasonably satisfactory to the City. 
c. 
Additional Insured: The insurance coverage, except Workers' Compensation and 
Professional Liability, required by this Agreement, shall name the City, its agents, 
representatives, board members, officials, employees, and officers, as Additional 
insured's, and shall specify that insurance afforded the Contractor shall be primary 
insurance, and that any insurance coverage carried by the City or its employees shall be 
excess coverage, and not contributory coverage to that provided by the Contractor. 
d. 
Coverage Term: All insurance required herein shall be maintained in full force and effect 
until all work or service required to be performed under the terms of the Agreement is 
satisfactorily completed and formally accepted; failure to do so may constitute a material 
breach of this Agreement, at the sole discretion of City 
e. 
Insurance Company Rating: Any insurance company issuing a policy under this 
Agreement shall have an AM Best's financial rating of A-7 or better in the then current 
edition of Best Rating Guide, or in the alternative, be approved by the City as an 
otherwise acceptable carrier. Contractor shall notify the City, in writing, of Contractor's 
default in payment of insurance premiums no less than ten (10) days prior to any 
cancellation of the insurance. If City so elects, City may make payment of the insurance 
premiums to maintain the Contractor's insurance coverage in full force and effect. In the 
event the City elects to pay the insurance premiums in arrears, it shall be entitled to 
recover any premium paid from the Contractor. This in no way shall imply the Contractor 
is covered by the City's insurance or self-insured retention. 
41. 
Minimum Insurance Coverage. Contractor shall procure and maintain the following minimum 
insurance coverage. It is specifically noted that the insurance coverage and limits of liability 
required by the Agreement may be provided by a combination of primary and excess liability 
policies and self-insurance retentions or deductibles as applicable It is also noted that the 
liability insurance policies purchased by the Contractor provide coverage for general Contractor 
operations and include but are not exclusively limited to this Agreement. 
a 
Automobile Liability: Commercial/Business Automobile Liability insurance with coverage 
limits of not less than $2,000,000 (combined single limit), with respect to the Contractor's 
owned, hired, and non-owned vehicles assigned to or used in performance of the 
Contractors work or services, and an annual aggregate limit of $10,000,000. 
b. 
Commercial General Liability Commercial General Liability insurance with coverage 
limits of not less than $2,000,000 for each occurrence asserted and a $10,000,000 
annual aggregate limit (which may be satisfied with inclusion of umbrella policy). The 
policy shall include coverage for bodily injury, property damage, personal injury, products 
and blanket contractual covering, but not limited to, the liability assumed under the 
indemnification provisions of this Contract. The following entities must be named as 
additional insured's and endorsed to contractor's policy(ies) for general liability City of El 
Mirage, officers, volunteers, officials, employees, agents and elected officials. 
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DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E 125E9D933B 
42. 
In the event the general liability insurance policy is written on a "claims made" basis, 
coverage shall extend for two years past completion and acceptance of work or services 
as evidenced by annual Certificates of Insurance and endorsements, as applicable. 
Such policy shall contain a "severability of interests" provision (a.k.a. "cross liability" and 
"separation of insured") and shall not contain a sunset provision or commutation clause, 
or any provision which would serve to eliminate third party action over claims. 
c. 
Professional Liability: The Contractor providing the services required by this Agreement 
will maintain Professional Liability Insurance covering errors and omissions arising out of 
the work or services performed by the Contractor or any person employed by the 
Contractor, with coverage limits of not less than $2,000,000 each occurrence asserted 
and $10,000,000 annual aggregate limit. 
In the event the insurance policy is written on a "claims made" basis, coverage shall 
extend for two years past completion of all work or services contemplated by this 
Agreement to be evidenced by annual Certificates of Insurance and endorsements, as 
applicable. 
d. 
Worker's Compensation: The Contractor shall carry Workers' Compensation insurance 
to cover obligations imposed by federal and state statutes having jurisdiction of 
Contractor's employees engaged in the performance of the work or services; and 
Employer's Liability insurance of not less than $1,000,000 for each accident, $100,000 
disease for each employee, and $500,000 disease policy limit. 
e. 
Evidence of Insurance: Contractor will provide City with certificates of insurance and 
additional insured certificates prior to implementation of this agreement. Thereafter, 
Contractor will provide evidence of renewal coverage within thirty (30) days after 
policy(ies) renew. In the event of cancellation of any policy(ies) referenced herein, 
Contractor must notify the City thirty (30) days prior to policy(ies) cancellation for non-
payment of premium. 
In case any work is subcontracted, the Contractor will require the Subcontractor to 
provide Workers' Compensation and Employer's Liability to at least the same extent as 
provided by the Contractor herein. 
Indemnity by Contractor. 
a. 
In any occurrence resulting in claims, lawsuits or assertions of liability caused in whole or 
in part by any act or omission of the Contractor or any of its employees or agents the 
Contractor agrees to indemnify, defend and hold harmless the City, its Mayors and 
Councils, appointed boards and Commissions, Administrative Medical Director, officials, 
officers, and employees, individually and collectively from and against all such claims, 
lawsuits or assertions of liability. 
b. 
Contractor's duty to defend, indemnify and hold harmless the City, its agents, 
representatives, officers, directors, officials and employees shall arise in connection with 
any claim, damage, loss or expense (including but not limited to attorney's fees, court 
costs, and the cost of appellate proceedings) to the extent attributable to personal or 
bodily injury, sickness, disease, death, injury to, impairment or destruction of property 
including loss of use resulting there from, caused in whole or in part by any act or 
omission of the Contractor, its Subcontractor, anyone directly or indirectly employed by 
them. 
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DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
43. 
c. 
Contractor agrees to indemnify, defend, and hold City harmless from and against any and 
all penalties and damages incurred by City as a result of Contractor's failure to obtain any 
permit or license required under, or to comply with any applicable laws, ordinances or 
regulations. 
d. 
The amount and types of insurance coverage requirements set forth in this Agreement 
will in no way be construed as limiting the scope of indemnity in this section. 
Indemnity by City. 
a. 
In any occurrence resulting in claims, lawsuits or assertions of liability caused solely by 
any negligent act or omission of the City or any of its employees or agents the City 
agrees to indemnify, defend and hold harmless the Contractor, its Board of Directors, 
officials, officers, and employees, individually and collectively from and against all liability. 
b. 
City's duty to defend, indemnify and hold harmless the Contractor, its agents, 
representatives, officers, directors, officials and employees shall arise in connection with 
any claim, damage, loss or expense (including but not limited to attorney's fees, court 
costs, and the cost of appellate proceedings) to the extent attributable to personal or 
bodily injury, sickness, disease, death, injury to, impairment or destruction of property 
including loss of use resulting there from, caused solely by any act or omission of the 
City, its contractor(s), its employees or anyone for whose acts the City may be liable. 
c. 
City agrees to indemnify, defend, and hold Contractor harmless from and against any and 
all penalties and damages incurred by Contractor as a result of City's failure to obtain any 
permit or license required under, or to comply with any applicable laws, ordinances, or 
regulations. 
d. 
The amount and types of insurance coverage requirements set forth in this Agreement 
will in no way be construed as limiting the scope of indemnity of the City. 
44. 
Compliance with Law. Contractor shall comply with all requirements of any applicable federal, 
state, county, or city laws, statutes, ordinances, charters, codes, rules, regulations, and other 
governmental requirements, including but not limited to Arizona Statute and regulations of OHS 
and the charter or ordinances of the City. No provisions of this Agreement shall be construed to 
require Contractor to violate any orders or decisions issued by the Director of OHS or any 
governing statute or administrative rules regarding the provision of Ambulance or Ambulance 
service to the public. Furthermore, Contractor is advised that this Agreement is subject to 
cancellation pursuant to ARS 38-511. City shall comply with all requirements of any applicable 
federal, state, county, or city laws, statutes, ordinances, charters, codes, rules, regulations, and 
other governmental requirements. Additionally, Contractor agrees to comply with the 
requirements of (and as defined in) the Health Insurance Portability and Accountability Act of 
1996, as codified as 42 U.S.C. § 1320d through d-8 ("HIPAA"), and the regulations promulgated 
there under, including without limitation the federal privacy regulations as contained in 45 CFR 
Part 164 (the "Federal Privacy Standards"), the federal security regulations as contained in 45 
CFR Part 142 (the "Federal Security Standards"), and state privacy laws, all as amended, 
regarding the confidentiality of all patient information and records applicable to the obligations of 
City and as set forth in Attachment E. 
45. 
Compliance with Federal and State Immigration Laws. The Contractor agrees to comply with the 
Immigration Reform and Control Act of 1986 (IRCA) in performance under this Agreement and to 
permit the City or its agents to inspect personnel records to verify such compliance. The 
Contractor shall ensure and keep appropriate records to demonstrate that all employees have a 
legal right to live and work in the United States. 
20

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
46. 
47. 
48. 
49. 
Under the provisions of A.RS. §41-4401, Contractor hereby warrants to the City that the 
Contractor and each of its subcontractors ("Subcontractors") will comply with, and are 
contractually obligated to comply with, all Federal Immigration laws and regulations that relate to 
their employees and A.RS. §23-214(A) (hereinafter "Contractor Immigration Warranty"). 
A breach of the Contractor Immigration Warranty shall constitute a material breach of this 
Contract and shall subject the Contractor to penalties up to and including termination of this 
Contract at the sole discretion of the City. 
The City retains the legal right to inspect the papers of any Contractor or Subcontractors 
employee who works on this Contract to ensure that the Contractor or Subcontractor is complying 
with the Contractor Immigration Warranty. Contractor agrees to assist the City in regard to any 
such inspections. 
The City may, at its sole discretion, conduct random verification of the employment records of the 
Contractor and any of subcontractors to ensure compliance with Contractor's Immigration 
Warranty. Contractor agrees to assist the City in regard to any random verification performed. 
Neither the Contractor nor any of Subcontractor shall be deemed to have materially breached the 
Contractor Immigration Warranty if the Contractor or Subcontractor establishes that it has 
complied with the employment verification provisions prescribed by sections 274A and 2748 of 
the Federal Immigration and Nationality Act and the E-Verify requirements prescribed by A.R.S. 
§23-214, Subsection A. 
Drug Free Workplace Program. Contractor shall maintain a drug free workplace in compliance 
with federal law. 
Affirmative Action in Employment. Any Contractor performing under this Agreement shall not 
discriminate against any worker, employee or applicant, or any member of the public because of 
race, creed, color, age, religion, sex or national origin, qualified individuals because of their 
disability status, nor otherwise commit an unfair employment practice. The Contractor will take 
affirmative action to ensure that applicants are employed, and that employees are dealt with 
during employment without regard to their race, creed, color, age, religion, sex or national origin. 
Such action shall include, but not be limited to the following: employment, upgrading, demotion, 
or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other 
forms of compensation; and selection for training, including apprenticeship. 
Independent Contractor Status. This Agreement is not intended to and shall not constitute, 
create, give rise to, or otherwise recognize a joint venture, partnership agreement or relationship, 
or any other formal business organization or association of any kind between the parties, and the 
rights and obligations of the parties shall be only those expressly stated in this Agreement. The 
parties hereby agree that no person supplied by Contractor in the performance of this Agreement 
shall be an employee of the City and further agree that no right of the City's' civil service, 
retirement, or personnel rules shall accrue to such persons. Contractor shall have the total 
responsibility for all salaries, wages, bonuses, retirement, withholdings, workers' compensation 
insurance, unemployment compensation, other benefits and all taxes and premiums appurtenant 
thereto concerning Contractor's employees in the performance of this Agreement, and Contractor 
shall indemnify and hold City harmless with respect thereto. City shall have the total 
responsibility for all salaries, wages, bonuses, retirement, withholdings, workers' compensation 
insurance, unemployment compensation, other benefits and all taxes and premiums appurtenant 
thereto concerning City's employees in the performance of this Agreement, and City shall 
indemnify and hold Contractor harmless with respect thereto. 
Interruption of Service. 
a. 
In the event the Contractor is unable to provide adequate personnel to properly operate 
the above determined number of Designated Ambulances as required by this Agreement, 
21

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
the Contractor shall immediately allow the City to staff and operate a sufficient number of 
Ambulances, as permitted by Arizona law, in order to meet the response time standards. 
Contractor agrees to reimburse the City for reasonable labor costs. Any alteration in the 
method or nature service delivery as described in this section shall be subject to the 
statutory authority and approval of OHS as provided in ARS 36-2242. 
b. 
If Contractor knows or suspects that there is a possibility that Contractor may suffer a 
shortage of personnel that will affect Contractor's ability to make available to the City the 
number of operational Dedicated Ambulances needed to meet the requirements of 
Section 6, Contractor shall notify City of such possibility at least 72 hours prior to the 
anticipated occurrence of the personnel shortage. If Contractor knows or suspects such 
possible personnel shortage after this 72-hour notification deadline, Contractor shall 
notify City of such possibility immediately. 
50. 
Performance Bond. Prior to execution of this Agreement contractor shall provide a performance 
bond in the amount of one million dollars ($1,000,000) for the faithful performance of services and 
conditions set forth herein. The following shall be the conditions precedent before the City may 
draw on the performance security: (i) the City declares Contractor in Material Default; (ii) the 
Contractor fails to cure the Material Default within thirty (30) days or exceed the number of 
Material Defaults permitted in a twelve (12) month period pursuant to section 40; and (iii) the City 
terminates the Agreement. 
a. 
The bond shall be issued by a surety company holding a Certificate of Authority to 
transact surety business in the state of Arizona, issued by the Director of the Arizona 
Department of Insurance. A copy of the Certificate of Authority shall accompany the 
bonds. The Certificate shall have been issued or updated within two years prior to the 
execution of this Agreement. 
b. 
The bonds shall be made payable and acceptable to the City of El Mirage. 
c. 
The bond shall be written or countersigned by an authorized representative of the surety 
who is either a resident of the state of Arizona or whose principal office is maintained in 
this state, as required by law, and the bonds shall have attached thereto a certified copy 
of Power of Attorney of the signing official. 
d. 
The bond submitted shall be provided by a company which has been rated "A- or better" 
by the AM. Best Company. 
e. 
Personal or individual bonds are not acceptable. 
Upon the request of any person or entity appearing to be a potential beneficiary of bonds 
covering payment of obligations arising under this Agreement, the Contractor shall promptly 
furnish a copy of the bond or shall permit a copy of the bond to be made. 
51. 
Material Default. 
a. 
In addition to the conditions pursuant to section 39, Contractor shall be in Material Default 
under this Agreement if any of the following occur: 
(i) 
The Contractor shall procure all permits and licenses and pay all charges and 
fees necessary and incidental to the lawful conduct of business. The Contractor 
must stay fully informed of existing and future Federal, State and Local laws, 
ordinances and regulations that in any manner affect the fulfillment of this 
contract and shall comply with the same. The Contractor's personnel, facilities 
and equipment shall be in full compliance with all applicable federal, state, and 
local health, environmental and safety laws, regulations, standards, ordinances, 
22

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E 125E9D933B 
and privilege license and permit requirements, whether or not they have been 
referenced by the City. Failure to comply shall be in default. 
(ii) 
Any of Contractor's insurance (including, without limitation, workers 
compensation and occupational disease insurance) required by law, required by 
this Agreement, or required by OHS is revoked, terminated or surrendered, or 
lapses. 
(iii) 
Contractor becomes insolvent or is a party to any voluntary or involuntary 
bankruptcy or receiving proceeding, or there is any similar action that affects 
Contractor's capability to perform under this Agreement. 
(iv) 
Contractor fails to chronically comply with the dispatch protocols of the City. 
For purposes of this Section chronically shall mean three (3) or more times in 
any thirty (30) day period. 
(v) 
Contractor repeatedly engages in inappropriate or unauthorized use of City radio 
communication system. City will engage in the problem resolution procedure 
prior to default. 
(vi) 
Contractor fails to meet the monthly response time requirements under Section 6 
of this Agreement three (3) times within any consecutive twelve (12) month 
period. 
(vii) 
Contractor fails to have any equipment required by Sections 12, 13, 14, 15 in 
dedicated Ambulance responding to a request for Ambulance transportation 
made by the City. City will engage in the problem resolution procedure prior to 
default. Any occurrence of equipment not being available through no fault of 
Contractor shall be excluded from the calculation. 
(viii) 
Contractor otherwise fails to perform or comply with the terms and conditions of 
this Agreement after reasonable notice from the City and opportunity to cure, 
subject to the limitations on the number of Material Defaults and permitted cure 
periods set forth in section 39. 
(ix) 
Contractor chronically fails to have a sufficient number of Designated 
Ambulances available to the City to meet response time standards. For 
purposes of this Section chronically shall mean three (3) times in any ninety (90) 
day period. Any occurrence of a Designated Ambulance not being available 
through no fault of Contractor shall be excluded from the calculation. 
(x) 
An Ambulance suffers a breakdown of any kind while transporting a patient, 
unless, however, such breakdown resulted from an unforeseeable cause and 
Contractor can show that Contractor was in compliance with its maintenance 
requirements set forth in Section 12 and has resolved any and all defects 
resulting from OHS' ambulance inspections. City will engage in the problem 
resolution procedure prior to default. 
b. 
All remedies at law, in equity, and under this Agreement shall be available in the event of 
default under this Agreement. 
52. 
Termination. 
a. 
Termination Upon Default: The City may terminate this Agreement if the Contractor has 
failed to cure a default within thirty (30) calendar days after receiving written notice 
23

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E 125E9D933B 
b. 
C. 
specially setting forth such default. Such termination shall be effective on the date set 
forth in the default notice or other date specified by the City. 
Termination Upon Notice: Either party may terminate this Agreement for any reason, at 
any time, upon 90 days written notice. Such termination shall be effective 90 days after 
the date of such notice. No termination upon notice shall constitute a waiver of any rights 
granted under this Agreement, or at law or in equity for any default under this Agreement. 
If Agreement is terminated by Contractor, Contractor agrees to abide by the "Lame Duck" 
provisions detailed in Section 53. 
Termination for Life Safety Issues: The City may immediately terminate the Agreement if 
City determines that Contractor's significant or persistent failure to meet the requirements 
of the Agreement may endanger public health or safety. 
53. 
"Lame Duck" Provisions. Should Contractor be unsuccessful in a subsequent Emergency 
Transportation and Medical Services Agreement award process with City, Contractor shall, as 
required by the City, continue to provide services required under the Agreement until a new 
contractor is selected and performing services. Under these circumstances, Contractor will 
provide services as a lame duck contractor for a period not longer than 180 days. 
54. 
Attorney's Fees. In the event either party brings any action for any relief, declaratory or 
otherwise, arising out of this Agreement or on account of any breach or default hereof, the 
prevailing party shall be entitled to recover their reasonable costs and attorneys' fees. Prior to 
bringing any action both parties agree to utilize the Problem Resolution Procedure provided in 
paragraph 23 Problem Resolution and Attachment C. 
55. 
Successors and Assigns. Contractor shall not subcontract, convey, transfer, assign, 
hypothecate, or otherwise encumber this Agreement, or any right, title or interest herein, whether 
voluntarily or by operation of the law without first obtaining the express written approval and 
permission of the City. 
56. 
Controlling Law. This Agreement shall be construed in accordance with and shall be controlled 
by the laws of the State of Arizona. 
57. 
Surviving Provisions. The obligations under Section 21 (Records), Section 42 (Indemnity by 
Contractor), Section 43 (Indemnity by City), Section 49 (Interruption of Service), and Section 56 
(Controlling Law) shall survive expiration or other termination of this agreement. 
58. 
Pilot Program. Contractor agrees to meet with the City upon request at reasonable times 
convenient to Contractor to discuss the development of pilot programs and studies that may 
enhance service delivery or improve responder safety. Any pilot program agreed upon may 
require submission to the Department and have Director approval pursuant to Arizona 
Administrative Code R9-25-503. 
59. 
Customer Satisfaction. 
a. 
City may survey patients and their families to determine the level of public satisfaction 
with Contractor's services. Contractor shall be allowed to respond to any unfavorable 
responses from users. 
b. 
City may survey professionals that interact with the Contractor during transports, i.e., City 
personnel, hospital staff, etc. 
c. 
City may require the Contractor too periodically (up to two times per calendar year) 
perform patient surveys and share the results with the City. Patient surveys may be 
conducted by Contractor or by an independent contractor. In either case, the survey tool 
24

DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E 125E9O933B 
and methodology will be reviewed and approved by the City, provided that such review 
and approval shall not be unreasonably withheld. 
d. 
The City will work with Contractor to develop and establish performance related 
benchmarks. 
60. 
Other Agreements. This Agreement shall not preclude the City from entering into other 
agreements with the Contractor provided that the provisions of such agreement are not included 
in or in conflict with this Agreement. Any such agreements that are subject to OHS jurisdiction 
shall be submitted to OHS for approval prior to implementation. 
61. 
Monthly Payments. The City and Contractor may meet the payment obligations of Section 15 
(EMS System Disposable Supplies), Section 16 (Dispatch and Communications Fees), and 
Section 25 (Provision of ALS Services) by determining a consistent monthly payment schedule 
based on historical data. A reconciliation period will occur annually during the month of July. 
During that period the Parties will meet to ensure the obligations of this Agreement have been 
met. Compensation required to resolve any overpayment or underpayment shall be made within 
30 days of final reconciliation. 
SIGNATURES BEGIN ON NEXT PAGE 
25

DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E125E9O933B 
IN WITNESS WHEREOF, the parties hereto have placed their signature on the day and year first above 
written . 
CITY 
CONTRACTOR 
City of El Mirage 
:~ 
Date 9- Jq -J.3 
ATTEST 
By ----,
/ ~~~~
~ ~-=--t-L'~~=-:=,----
Date :__:--,_:.7'4r+..::=-=~;z::.:=----;,£-
- --
26 
American Medical Response of Maricopa, 
LL~
DocuSigned by: 
~ 
bsrv1Jf 
By: 
G26EEPEBEESE4EE 
Its Glenn Kasprzyk, Regional President 
8/14/2023

DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E125E9O933B 
Attachment A 
(Current OHS authorization to provide ambulance services in Arizona) 
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27

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
Attachment B - Additional Equipment Requirements 
In addition to the Arizona Department of Health Services Equipment List for Ambulances 
(ALS/BLS), the City also requires the following equipment. This additional equipment requirement may 
be revised, subject to OHS approval, as specified under the Equipment and Supplies section (Section 13) 
of the Ambulance Transportation Service Agreement. 
1. 
Monitor/Defibrillator - Physic Control LP 15 12 lead with external cardiac pacing capability, 
pulse oxygen Monitor, NIBP, and Capnography 
2. 
Blood Glucose Monitor - Portable unit for evaluation of patient blood sugar levels. 
3. 
Backboards - Equipment available on response units available for direct field exchange. 
4. 
Electric powered gurney 
5. 
(2) Stryker Lucas 3 Chest Compression Systems 
28

DocuSign Envelope ID B4806885-3137-4DDF-9298-4E125E9O9338 
Attachment C - Problem Resolution Procedure 
OBJECTIVE 
A 
• 
To provide the City and Contractor with a means to identify and resolve issues as they arise. 
• 
To institute a workable procedure for resolving issues which are not resolved on an individual 
basis. 
Introduction 
The majority of issues arising from disagreements in patient management with the ambulance 
provider can and should be dealt with on an individual basis with those individuals directly 
involved in the issue. A philosophy of fairness to all parties and thoroughness of investigation of 
all facts must be applied in all cases. 
Some issues may not lend themselves to determination between the involved individuals and 
may require a progressive process involving management for ultimate resolution. The following 
paragraphs outline the steps for problem clearance. 
B. 
Step 1 
Upon identification of a situation requiring application of this problem clearance procedure, those 
individuals directly involved should attempt to resolve the issue immediately on a private one-on-
one basis. If a resolution is mutually agreed upon, this procedure need not be carried further. 
Should either party involved in the issue prefer not to attempt resolution, if repeated cases occur, 
or if at any time the discussion on the matter becomes unproductive, attempts for initial resolution 
should be halted and Step 2 of this procedure applied. 
Step 2 
If initial resolution via a one-on-one basis for whatever reason is not possible, parties involved in 
the issue should present their concerns in writing with available facts to their agency's designated 
representative who can work to resolve the issue. These representatives from each agency 
should then interview the individuals from their agency directly involved in the issue to determine 
all facts This should be done separately within 14 calendar days following written notification of 
the incident at issue. After the facts are gathered from the person being interviewed, the 
representatives from each agency should meet in a timely manner and discuss the issue. If the 
facts confirm that the situation requiring correction did occur, justifying the assembly of all parties 
to resolve the matter, then such a meeting shall be scheduled. If however, the matter can be 
resolved between the agency representatives, then the assembly of parties involved is not 
necessary. 
If a need to assemble the parties involved persists, this should be done as soon as possible 
following the actual incident The meeting shall involve only those parties directly involved in the 
incident and shall be held in private. 
The objective of meeting should be to resolve this issue so that it does not recur. Resolutions 
may address related areas of training, policy revision and/or policy development, etc. 
Step 3 
29

DocuSign Envelope ID: B4B068B5-3137--4DDF-9298-4E125E9D933B 
Those issues not resolved through Steps 1 or 2 of this procedure shall be submitted in writing to 
each agency representative. Issues of this magnitude may include, but are not limited to, 
problems with contracted service, failure to comply with contract, or timely corrective action of 
situations discussed in Steps 1 and 2. Situations of this significance will be forwarded to the 
CEO, fire chief, or other agency identified representative(s). 
The designated representative from each party may be permitted access to documentation and other 
investigative materials from previous attempts for resolution. Once adequate information and/or evidence 
on the matter is prepared, a meeting with those parties directly involved must be held in private. 
Following a thorough investigation and at the conclusion of the meeting, the parties shall attempt a 
mutually agreed upon resolution. If an agreement is not reached, the fire chief or his/her designee shall 
determine a resolution. The fire chief or his/her designee shall have the authority in determining such 
resolution to require any corrective action, up to and including termination of the Agreement. Such 
resolution shall be delivered to Contractor in writing and shall include the timelines under which any 
corrective action shall occur. 
30

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
Attachment D- Patient Transfer Procedures 
It is the policy of the City to provide quality and efficient medical services to all injured or ill 
patients. The objective of this procedure is intended as a guide to the fire officer, ALS provider, 
and/or firefighter to act with the patient's well-being in mind. 
In order to facilitate the most efficient transfer of patient care from Fire Department to Contractor 
for patient transportation and/or treatment, the following transfer procedures have been adopted. 
Upon Ambulance arrival at the scene of a medical emergency where patient care is being 
provided by Fire Department personnel, the Ambulance crew shall report to the supervisor in 
charge of the incident. When arrival on scene of a multi-patient incident, the Ambulance crew 
shall report to command officer for assignment to avoid duplicating any patient assessment or 
treatment already completed. They shall work under the officer they are assigned for 
transportation assignments. 
Fire department paramedic personnel shall remain in charge of patient care until it is specifically 
relinquished to ambulance personnel. 
The Fire Department paramedic in charge will determine the necessity for Fire Department 
personnel to accompany the patient to the hospital. When the Fire Department paramedic 
accompanies the patient(s) to the hospital, the Fire Department paramedic shall remain in charge 
of patient care. 
The base station hospital will maintain control of the patient and will be the final authority 
regarding patient care once contact with the base station physician has been made. 
When verbal and/or written reports are required, the following information will be conveyed on the 
patient condition: 
1. 
Verbal report on patient condition including: 
• 
Patient's chief complaint. 
• 
All pertinent negative/positive physical findings and patient's current condition. 
• 
All patient treatment done up to the time of transfer. 
• 
Name and location of base station physician consulted, and orders received (if applicable); 
and 
• 
Patient destination. 
2. 
Copy of written or electronic Fire Department EMS incident report signed by the Fire Department 
and Contractor's personnel. 
All loading of patients into the Ambulance will be the responsibility of Contractor's personnel. 
When requested by the Contractor, the Fire Department will provide additional personnel to assist 
during transport. 
When the Ambulance has arrived on the scene of an EMS incident, prior to the arrival of a Fire 
Department unit, the officer in charge of the subsequently arriving fire department unit will seek 
out the Ambulance attendant in charge for a report on patient care that has already been 
31

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9O933B 
provided. Following this report, the Fire Department officer may assume Command of the 
incident/patient. 
It shall be the responsibility of all agencies providing patient care to cooperate and assist in 
treatment and transportation requirements. 
32

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
Attachment E - PHI 
1. 
Definitions. Terms used, but not otherwise defined, in this Agreement shall have the same 
meaning as those terms in 45 CFR Sections 160.103 and 164.501. For purposes of this 
Attachment E, Business Associate shall mean City. 
2. 
Obligations and Activities of Business Associate. In conformity therewith, the Business 
Associate agrees that it will: 
(a) 
Not use or further disclose Protected Health Information (PHI) except as permitted under the 
Agreement or required by law. 
(b) 
Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by the 
Agreement. 
(c) 
To mitigate, to the extent practicable, any harmful effect that is known to Business 
Associate of a use or disclosure of PHI by Business Associate in violation of this 
Agreement. 
(d) 
Report to Contractor any use or disclosure of PHI not provided for by this Agreement of 
which Business Associate becomes aware. 
(e) 
Ensure that any agents or subcontractors to whom Business Associate provides PHI, or 
who have access to PHI, or who the Business Associate receives PHI from, agree to the 
same restrictions and conditions that apply to Business Associate with respect to such 
PHI. 
(f) 
Make PHI available to Contractor and to the individual who has a right of access as 
required under HIPAA within thirty (30) days of the request by Contractor regarding the 
individual. 
(g) 
Incorporate any amendments to PHI when directed by Contractor. 
(h) 
Provide an accounting of all uses or disclosures of PHI made by Business Associate as 
required under the HIPAA privacy rule within sixty (60) days; and 
(i) 
Make its internal practices, books and records relating to the use and disclosure of PHI 
available to the Contractor or Secretary of the Department of Health and Human Services 
for purposes of determining Business Associate's and Contractor's compliance with 
HIPAA. 
3. 
Permitted Uses and Disclosures by Business Associates. The specific uses and disclosures of 
PHI that may be made by Business Associate on behalf of Contractor include: 
(a) 
To perform functions, activities, or services for, or on behalf of, Contractor as specified in 
the Agreement and in compliance with HIPAA. 
(b) 
For the proper management and administration of the Business Associate or to carry out 
the legal responsibilities of the Business Associate. 
(c) 
As required by law. 
(d) 
Other uses or disclosures of PHI as permitted by HIPAA. 
33

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E 125E9O933B 
4. 
Effective Date and Termination. 
(a) 
Notwithstanding any other provisions of the Agreement, Contractor may terminate this 
Agreement, in its sole discretion, if Contractor determines that Business Associate has 
violated a term or provision of this Agreement, or if Business Associate engages in 
conduct which would, if committed by Contractor, result in a violation of HIPAA. 
(b) 
At the termination of this Agreement, Business Associate agrees to return or destroy all 
PHI received from, or created, or received by Business Associate on behalf of Contractor, 
and if return is infeasible, the protections of this agreement will extend to such PHI. 
34

DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E125E9D933B 
Attachment F - EMS Service Area 
(City of El Mirage boundaries to be attached) 
Greenway Rd 
15400N 
I 
I 
I 
I 
I 
I '· 
I; 
I 
~~· 
I 
,-----· 
I 
I 
I 
I 
I 
I 
I 
I 
I ·- .... --
., __________ , 
City of El Mirage 
Zoning Map 
I 
I 
FEDERA L LUKE AFB APZ II 
_____ , 
CSJ FEDERA L LUKE AFB CLEAR ZONE 
□PA D PLANNED AREA DEVELOPMENT 
~IR NATURAL RESERVE 
35 
RA RURAL AREA 
SN SUBURBAN l~EIGHBORHOOD 
MP MOBILE PA RK 
MU M IXED URBAN 
• uc URBAN CORRIDOR 
•
TD TRANSIT DEVELOPMENT 
•
CP COMM ERCE PARK 
El EMPLOYM ENT/l~IDUSTRY 
Mole: All properties within the Luke AFB Accident 
Potential Zone ond Moise Contour areas a re subject 
to ARS 28-8481 regula tions. 
• Zoning pursuan t lo Judgment recorded with Maricopa 
County Recorder's Office. 1,10. 20160775497. 
Source : City of El Mirage. Planning & Zoning 
Adopted: September 22. 20 11 
Revised: Sep I ember 18. 20 12 
Revised: Moy 6. 201 ,1 
Revised: May 19, 20 15 
Revised: February 16 20 16 
Revised: Hovember 3. 20 16 
Revised: Decemb er 5. ::o 1 7 
Revised: May 2 L 20 !9 
Revised: November 6. :20:20 
Revised: January 7 20'20 
Revised: June 2. 2020 
Revised: Oclober 6. ~020 
Revised: Mav 18. 2021 
Ptepors-d l"Jy 
Cilv of El M'rage 
Pt.i>.. ··JMIIJG?,. ."C ltlMG I C IS 
Communilv oe~elooment >.oar 1rr1::nt 
Ciryof 
EL MIRAGE 
(,'l«.'W /M'Hff,4{,'/,', /JRlf:HT Fl,Tf,'/U!I

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
Attachment G - Expectations 
The City expects the following from Contractor and its employees while carrying out the provisions of the 
Agreement. 
Appearance - The City expects that all Contract Ambulance personnel will present themselves in a 
professional uniformed manor. 
• 
A uniform that indicates the employee works for the contracted Ambulance provider 
• 
Shirts tucked in 
• 
If wearing a hat, hat should be provided by Contractor 
• 
Boots and shoes should be zipped or tied 
Responding - The City expects that every emergency response will be conducted in a safe and 
expeditious manner. This includes a prompt turnout time. 
Communications - The City expects that Ambulance personnel utilize the proper "order model" when 
conducting radio communications. 
Turn Around Time - The City expects contract Ambulance personnel will, as expeditiously as possible, 
return to available service within the City following transportation of patient to the hospital. 
36

DocuSign Envelope ID B4B068B5-3137-4DDF-9298-4E125E9D933B 
ATTACHMENT H 
Additional Personnel Ride-in/Follow-up Guideline 
It is recommended that an additional provider consider riding in to assist in the care of the patient if there 
is an increased likelihood of patient complications or deterioration, or concerns of patient/crew safety. 
Some criteria that should be considered include: 
• Abnormal vital signs 
• Altered mental status 
• Abnormal neurologic exam 
• Current, or risk of, unstable cardiac dysrhythmia 
• Use of medication to support blood pressure 
• 
Respiratory compromise or impending failure 
• 
Uncontrolled or difficult to control bleeding 
• Situations to consider additional personnel (which may be either ALS or BLS provider) include: 
• Suicide ideation** 
• 
Homicidal ideation** 
• Sexualassault** 
Excludes: 
• Agency/jurisdictional guidelines that supersede this CARE MSG document. 
• 
If situation dictates transport without additional personnel, documentation to support this 
decision should be included in the ePCR. 
EMT 
Paramedic 
• 
Required indications-
• 
STEMI Alert 
• 
Stroke Alert 
• Trauma Alert 
• 
Cardiac Arrest/ROSC 
• 
Respiratory Arrest or impending Respiratory Failure/Distress (including use of RSI or NIPPV) 
• Seizure 
• Adult - active seizure/status epilepticus 
• 
Pediatric - active seizure/status epilepticus, first time seizure, persistent febrile seizure 
• 
Unstable cardiac dysrhythmia 
• 
Cardioversion/Defibrillation/Transcutaneous pacing 
• 
Imminent delivery 
• 
Vaginal bleeding in pregnant patient > 20 weeks gestation (viable fetus) 
• 
Eclampsia/Preeclampsia 
• 
Drowning/near drowning 
• 
Restraints/combative/medication administered for pharmacologic management of agitation 
• 
Request of transporting ALS provider for additional assistance 
• Patient in handcuffs/police custody** 
TOC

DocuSign Envelope ID: B4B068B5-3137-4DDF-9298-4E125E9D933B 
ATTACHMENT H 
• If agency policy dictates: Controlled substance administered for pain management 
* * = second provider could be ALS or BLS personnel 
Approved by El Mirage Fire Dept's 
Medical Director 
Printed Name:~·w ,C-v Colt_) 
Medical Director 
Date: l.e I '5 / zcrL o 
Approved by AM R's 
Medical Director 
Danniel Stites, MD 
Printed Name: -------------
Medical Director 
D 
8/25/2023 
ate: _________ _

FINAL 
I. Dispatch Service Fee 
$21.93 • El Mirage · AMR 
II. General M aintenance Service Fee 
MCT Main! · El Mirage · AMR 
Ill. Network System Fees 
IV. CAD System Fees 
V. GIS & Data Analytics Fees 
Regional Dispatch Center Partners 
Computer Aided Dispatch Consortium 
Equipment Maintenance & Dispatch Cost Estimates 
Fiscal Year 2023/ 2024 
EXHIBIT A 
INTERGOVERNMENTAL AGREEM ENT 
150284 
City of El Mirage 
City of El Mirage - AMR Ambulance subset) 
$ I Dispatch 
$21.93 
Dispatch Count 
2,135 
Total Dispatch Service Fees: 
~ 
$4.100 
Total Specific Maintenance Service Fees: 
II Units 
Total Network System Fees: 
$ I Dispatch 
Dispatch Count 
Total CAD System Fees: 
$ I Dispatch 
Dispatch Count 
Total GIS & Data Analystics Fees: 
Total Schedule A: 
Fees based on dispatch counts are calculated from the number of dispatch es that have occurred from July 1, 2020 through June 30, 2021. 
Total 
$46,820.55 
$46,820.55 
Total 
$4,100.00 
$4,100.00 
$0.00 
$0.00 
Total 
$0.00 
$50,920.55

City of 
EL MIRAGE 
ArizonJ 
(;RAND HliRfTAGE. RRIGHT Fl/TURF! 
DA TE SUBMITTED: 
09/06/2023 
DA TE ACTION REQUESTED: 
09/19/2023 
AGENDA SECTION: Consent 
TO: Mayor and Council 
AGENDA ITEM 5. 5. 
REQUEST FOR COUNCIL ACTION 
TYPE OF ACTION: SUBJECT: Consideration and action to enter into an 
Agreement 
agreement between American Medical Response 
(AMR) and the City of El Mirage for Emergency 
Medical Transport Services. (Fire) 
FROM: Charlotte Confer, Senior Fiscal Services Specialist 
RECOMMENDATION: 
Approve a Service Agreement between American Medical Response (AMR) and the City of El Mirage for 
Emergency Medical Transport Services. 
PROPOSED MOTION: 
Approve an agreement with American Medical Response (AMR) as presented. 
BACKGROUND: 
This agenda item was previously presented and approved during both the February 15th, 2022 and October 18. 
2022 City of El Mirage Council meetings. This item is being re-presented as additional contract revisions have 
been made by request of the Arizona Department of Health Services and are reflected in the contract as presented. 
El Mirage Fire Department is responsible for public safety. fire suppression activities, emergency medical 
response, treatment and emergency management mitigation strategies. This renewal service agreement will provide 
the City of El Mirage with a contracted ambulance transport company to transport sick and injured emergency 
medical patients to local hospitals for treatment and evaluation. 
BUDGETED: 
Yes 
SUFFICIENT FUNDS: Yes 
CIP: 
No 
MULTI-YEAR: 
Yes 
Fiscal Impact 
AMOUNT REQUESTED: 
$50.920.55 
FISCAL YEAR: 
23/24 
ACCOUNT TO BE CHARGED: 111-52511-325 
AMR Service Agreement 
AMR Annual Billing 
Attachments