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Home My WebLink AboutAgreement A-15-450 with State Emergency Medical Svcs.pdf Agreement No. 15-450 STATE OF CALIFORNIA STANDARD AGREEMENT STD 213(Rev 06103) AGREEMENT NUMBER C 15-003 REGISTRATION NUMBER 1. This Agreement is entered into between the State Agency and the Contractor named below: STATE AGENCYS NAME Emergency Medical Services Authority CONTRACTOR'S NAME County of Fresno acting as Central California EMS Agency 2. The term of this July 1, 2015 through June 30, 2016 Agreement is: 3_ The maximum amount $404.369,00 of this Agreement is: Four Hundred Four Thousand Three-Hundred Sixty-Nine Dollars and 001100 4. The parties agree to comply with the terms and conditions of the following exhibits which are by this reference made a part of the Agreement. ® Exhibit A-Scope of Work 10 pages ® Exhibit B- Contract and Payment Provisions 2 pages Exhibit B-1 -Budget Detail and Narrative 4 pages Exhibit C'- General Terms and Conditions GTC 610 Exhibit- D Special Terms and Conditions(Attached hereto as part of this agreement) 3 pages Exhibit E -Sample Invoice 1 page )lams shown with an Astorisk('), ere hereby incorporated by reference and mado part of this agreement as it otlached herelo. These documents can be viowed at www documents dos p9,.ygOvtolstGTC-610 riot IN WITNESS WHEREOF,this Agreement has been executed by the partles hereto. CONTRACTOR California Department of General Services Use Only CONTRACTOR'S NAMC(i/other than an Wwjividual,s/A(e whether n corporation,parrneahip,etc.) County of Fresno acting as C ral California EMS Agency BY(Ault 6rof signature) n DATE SIONED(bo mf pa) APPROVED PRINTED NAME AND TITLE OF PERSON SIGNING OPT 1 6 r.'01') Deborah A. Poochigian -Chairman, B d of Supervisors ADDRESS P.O. Box 11867 Fresno, CA 93775 STATE OF CALIFORNIA AGENCY NAME I Emergency edical Se SJA01 rity OV(Aut S natural DATE SI ED(D not rypa) .� wrA,UtDt,t � S �� FRIvfFo E AND TITLE OF PERSON SIGNING Cl Exempt per. Howard Backer, MD, MPH, FACER Director ADDRESS 10901 Gold Center Dr., Ste 400 Rancho Cordova, CA 95670-6073 ATTEST, BERNICE E.SEIDEL,Clerk Board of Supervisors By�•�—_ �� ` De Ury C15-003 County of Fresno acting as Centrai California EMS Agency EXHIBIT A SCOPE OF WORK Contractor agrees: To complete and submit an EMS Plan update annually per Health and Safety Code section 1797.254 with a deadline determined by the EMS Authority. To submit quarterly reports, that are, due on the 15th calendar day of the month following the end of each quarter. The fourth quarter report will be due August 31st, and include year-end data reports. The quarterly reports should contain a description of work performed, the duties of all parties, and a summary of activities the Contractor has accomplished to meet the following eight (8) components of a regional EMS Agency. I. Detailed description of work to be performed and duties of all parties. The Contractor shall operate and manage a regional EMS system that will be responsible for the work and duties, and report on accomplished work and duties to the State EMS Authority, as described herein: Multi-county EMS Agency Objectives V' THROUGH P QUARTER REPORTING Component 1 -System Organization and Management Objective:To develop and maintain an effective management system to meet the emergency medical needs and expectations of the total population served. Task-. The system organization and management responsibilities of the regional EMS agency, at a minimum, include: • Staff development, training, and, management • Allocating and maintaining office space, office equipment, and office supplies • Executing and maintaining contracts with member counties, service providers, consultants, and contractual staff • Attending or participating in a minimum of 3 EMSA/LEMSA meetings annually (following advance notice and reasonable justification provided by the LEMSA, EMSA will make a determination on the flexibility of the attendance requirement on case-by-case basis, and in the event the quarterly EMSA/LEMSA meeting is canceled, attendance at the meeting will not be counted for/against the LEMSA) 9 of 10 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A Component 2 - Staffing and Training Objective: To ensure LEMSA authorized personnel functioning within the EMS system are properly trained, licensed/certified/authorized and/or accredited to safely provide medical care to the public. Task: The staffing and training responsibilities of the regional EMS agency, at a minimum, include: • Ongoing assessment of local training program needs • Authorizing and approving training programs and curriculum for all certification levels • Providing training programs and classes (as needed) • Providing ongoing certification/authorization/accreditation or personnel approval of local scope of practice for all certification levels • Developing and maintaining treatment protocols for all certification levels • Maintaining communication link with Quality Improvement program to assess performance of field personnel • Conducting investigations and taking action against certification when indicated • Authorizing, maintaining, and evaluating EMS continuing education programs Component 3 - Communications Objective To develop and maintain an effective communications system that meets the needs of the EMS system. Task: The communications responsibilities of the regional EMS agency, at a minimum, include: • On-going assessment of communications status and needs • Assuring appropriate maintenance of EMS related communications systems • Approving ambulance dispatch centers • Providing acceptable procedures and communications for the purpose of dispatch and on-line medical control • Approving emergency medical dispatch (EMD) training and/or operational programs Component 4 - Response and Transportation Objective: To develop and maintain an effective EMS response and ambulance transportation system that meets the needs of the population served. Task: The response and transportation responsibilities of the regional EMS agency, at a minimum, include: 2of10 C 15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A • Designating EMS responders including first responders, Limited Advanced Life Support (LALS)/Advanced Life Support (ALS) providers, ambulance providers, and EMS helicopter providers • Monitoring local ordinances related to EMS • Establishing policies and procedures to the system for the transportation of patients to trauma centers and/or specialty care hospitals as needed • Implementing and maintaining contracts with providers Creating exclusive operating areas • Inspecting ambulance or LALS/ALS providers • Developing performance standards as needed Component 5 - Facilities and Critical Care Objective: To establish and/or identify appropriate facilities to provide for the standards and care required by a dynamic EMS patient care delivery system. Task: The facilities and critical care responsibilities of the regional EMS agency, at a minimum, include: • Designating base hospital(s) or alternate base stations for on-line medical control and direction • Identifying ambulance receiving centers including hospitals and alternative receiving facilities • Identifying and designating, as needed, trauma centers and other specialty care facilities • Periodically assessing trauma system and plan as needed • Coordinating trauma patients to appropriate trauma center(s) or approved receiving hospitals • Periodically assessing hospitals (e.g., pediatric critical care centers, emergency departments approved for pediatrics, other specialty care centers) • Completing hospital closure impact reports Component 6 - Data Collection and System Evaluation Objective: To provide for appropriate system evaluation through the use of quality data collection and other methods to improve system performance and evaluation. Task: The data collection and system evaluation responsibilities of the regional EMS agency, at a minimum, include: • Reviewing reportable incidents • Reviewing prehospital care reports including Automated External Defibrillators (AED) reports 3of10 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A • Processing and investigating quality assurance/improvement incident reports • Monitoring and reporting on EMS System Core Measures by March 31st each year • Providing data to CEMSIS monthly • Making progress towards implementing a system that will provide data to CEMSIS in the NEMSIS Version 3 data format no later than January 1, 2017 Component 7 - Public Information and Education Objective: To provide programs to establish an awareness of the EMS system, how to access and use the system and provide programs to train members of the public in first-aid and CPR. Task: The public information and education responsibilities of the regional EMS agency, at a minimum, include: • Information and/or access to CPR and first-aid courses taught within the EMS system • Involvement in public service announcements involving prevention or EMS related issues • Availability of information to assist the population in catastrophic events, as appropriate • Participating in public speaking events and representing the regional EMS agency during news events and incidents Component 8 - Disaster Medical Response Objective: To collaborate with the Office of Emergency Services, Public Health and EMS responders in the preparedness and response of the regions EMS systems in the event of a disaster or catastrophic event within the regions or a neighboring jurisdiction. Task: The disaster medical response system responsibilities of the regional EMS agency, at a minimum, include: • Participating in disaster planning and drills as needed • Identifying disaster preparedness needs • Coordinating the operational area disaster medical/health coordinator • Coordinating the regional disaster medical/health coordinator system • Developing policies and procedures for EMS personnel in response to a multi-casualty or disaster incident • Facilitating mutual aid agreements • Collaborating with all EMS personnel on training of incident command and Standardized Emergency Management System (SEMS) 4of10 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A 4" QUARTER REPORTING Component 1 - System Organization and Management Objective: To develop and maintain an effective management system to meet the emergency medical needs and expectations of the total population served. Task: The system organization and management responsibilities of the regional EMS agency, at a minimum, include: • Staff development, training, and management • Allocating and maintaining office space, office equipment, and office supplies • Executing and maintaining contracts with member counties, service providers, consultants, and contractual staff • Attending or participating in a minimum of 3 EMSA/LEMSA meetings annually (following advance notice and reasonable justification provided by the LEMSA, EMSA will make a determination on the flexibility of the attendance requirement on case-by-case basis, and in the event the quarterly EMSA/LEMSA meeting is canceled, attendance at the meeting will not be counted for/against the LEMSA) Workload Indicators: • Total static population served (Determined by DOF estimates) • Total annual tourism population (Determined by identified sources) • Number of counties • Geographic size of region (in square miles) Component 2 - Staffing and Training Objective: To ensure LEMSA authorized personnel functioning within the EMS system are properly trained, licensed/certified/authorized and/or accredited to safely provide medical care to the public, Task: The staffing and training responsibilities of the regional EMS agency, at a minimum, include: • Ongoing assessment of local training program needs • Authorizing and approving training programs and curriculum for all certification levels • Providing training programs and classes (as needed) • Providing ongoing certification/authorization/accreditation or personnel approval of local scope of practice for all certification levels • Developing and maintaining treatment protocols for all certification levels • Maintaining communication link with Quality Improvement program to assess performance of field personnel 5 of 10 C 15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A • Conducting investigations and taking action against certification when indicated • Authorizing, maintaining, and evaluating EMS continuing education programs Workload Indicators: • Total number of personnel certified/authorized/accredited by regional EMS agency • Total number and type of training programs approved by regional EMS agency • Total number and type of training programs conducted by regional EMS agency • Total number of continuing education providers authorized by regional EMS agency Component 3 - Communications Objective: To develop and maintain an effective communications system that meets the needs of the EMS system. Task: The communications responsibilities of the regional EMS agency, at a minimum, include: • On-going assessment of communications status and needs • Assuring appropriate maintenance of EMS related communications systems • Approving ambulance dispatch centers • Providing acceptable procedures and communications for the purpose of dispatch and on-line medical control • Approving emergency medical dispatch (EMD) training and/or operational programs Workload Indicators: • Total number of primary and secondary Public Safety Answering Points (PSAP) • Total number of EMS responses • Total number of EMD training programs approved by regional EMS agency • Total number and type of EMD programs authorized by regional EMS agency Component 4 - Response and Transportation Objective: To develop and maintain an effective EMS response and ambulance transportation system that meets the needs of the population served. Task: The response and transportation responsibilities of the regional EMS agency, at a minimum, include: 6of10 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A • Designating EMS responders including first responders, Limited Advanced Life Support (LALS)/Advanced Life Support (ALS) providers, ambulance providers, and EMS helicopter providers • Monitoring local ordinances related to EMS Establishing policies and procedures to the system for the transportation of patients to trauma centers and/or specialty care hospitals as needed • Implementing and maintaining contracts with providers • Creating exclusive operating areas • Inspecting ambulance or LALS/ALS providers • Developing performance standards as needed Workload Indicators. • Total ambulance response vehicles • Total first responder agencies • Total patients transported • Total patients not transported (e.g., treated and released, total dry runs) • Total number of LALS/ALS providers authorized by regional EMS agency • Total number of transport providers in region Component 5 - Facilities and Critical Care Objective: To establish and/or identify appropriate facilities to provide for the standards and care required by a dynamic EMS patient care delivery system. Task: The facilities and critical care responsibilities of the regional EMS agency, at a minimum, include: • Designating base hospital(s) or alternate base stations for on-line medical control and direction • Identifying ambulance receiving centers including hospitals and alternative receiving facilities • Identifying and designating, as needed, trauma centers and other specialty care facilities • Periodically assessing trauma system and plan as needed • Coordinating trauma patients to appropriate trauma center(s) or approved receiving hospitals • Periodically assessing hospitals (e.g., pediatric critical care centers, emergency departments approved for pediatrics, other specialty care centers) • Completing hospital closure impact reports Workload Indicators: 7of10 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A • Total patients received • Total number of hospitals designated by regional EMS agency (e.g., base, receiving, trauma, specialty centers, etc) Component 6 - Data Collection and System Evaluation Objective: To provide for appropriate system evaluation through the use of quality data collection and other methods to improve system performance and evaluation. Task: The data collection and system evaluation responsibilities of the regional EMS agency, at a minimum, include: • Reviewing reportable incidents • Reviewing prehospital care reports including Automated External Defibrillators (AED) reports • Processing and investigating quality assurance/improvement incident reports • Acknowledging completion of the monitoring and reporting on EMS System Core Measures as of March 31st each year • Providing data to CEMSIS monthly • Making progress towards implementing a system that will provide data to CEMSIS in the NEMSIS Version 3 data format no later than January 1, 2017 Workload Indicators: • Total patient care reports generated • Total trauma patients • Total cardiac patients • Total medical patients • Total pediatric patients Total number of situational/unusual occurrence reports processed by regional EMS agency Component 7 - Public Information and Education Objective: To provide programs to establish an awareness of the EMS system, how to access and use the system and provide programs to train members of the public in first-aid and CPR. Task: The public information and education responsibilities of the regional EMS agency, at a minimum, include: • Information and/or access to CPR and first-aid courses taught within the EMS system • Involvement in public service announcements involving prevention or EMS related issues 8of10 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A • Availability of information to assist the population in catastrophic events, as appropriate • Participating in public speaking events and.representing the regional EMS agency during news events and incidents Workload Indicators: • Total number of public information and education courses approved by regional EMS agency • Total number of public information and education courses conducted by regional EMS agency • Total number of public information and education events involving regional EMS agency Component 8 - Disaster Medical Response Objective: To collaborate with the Office of Emergency Services, Public Health and EMS responders in the preparedness and response of the regions EMS systems in the event of a disaster or catastrophic event within the regions or a neighboring jurisdiction, Task: The disaster medical response system responsibilities of the regional EMS agency, at a minimum, include: • Participating in disaster planning and drills as needed • Identifying disaster preparedness needs • Coordinating the operational area disaster medical/health coordinator • Coordinating the regional disaster medical/health coordinator system • Developing policies and procedures for EMS personnel in response to a multi-casualty or disaster incident • Facilitating mutual aid agreements • Collaborating with all EMS personnel on training of incident command and Standardized Emergency Management System (SEMS) Workload Indicators: • Total number of Disaster/Multiple Casualty Incident (MCI) Responses (response with 5 or more victims) • Total number of disaster drills involving staff • Total disaster-related meetings attended by staff Performance Evaluation There will be periodic assessments of Regional EMS Agency's performance by the State EMS Authority. 9of10 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT A The Project representatives during the term of this agreement will be: Agency: Emergency Medical Services Contractor: Central California EMS Authority Agency Name: Jeff Schultz Name: Dan Lynch, EMS Director Phone: (916) 431-3688 Phone: (559) 600-3387 Fax: (916) 324-2875 Fax: Email: ieff.schultz(a�emsa.ca.gov Email: dlynch(a)co.fresno.ca.us Direct all contractual/administrative inquiries to: Agency: Emergency Medical Services Contractor: Central California EMS Authority Agency Section/Unit: Administrative Unit Section/Unit: Attention: Lisa Vigil Attention: Dan Lynch, EMS Director Contract Analyst Address: 10901 Gold Center Dr, Ste 400 Address: P.O. Box 11867 Rancho Cordova, CA 95670 Fresno, CA 93775 Phone: (916) 431-3694 Phone: (559) 600-3387 Fax: (916) 322-1441 Fax: Email: lisa.vigil(-)emsa_ca.gov Email: d1ynch(a7co.fresno.ca.us 10of10 C 1 b-003 County of Fresno acting as Central California EMS Agency EXHIBIT B CONTRACT AND PAYMENT PROVISIONS Refer to the EMS Authority publication #104 "EMSA Policy for Funding Regional EMS Agencies with State General Funds" to assist you in the administration of this contract. The EMS Authority #104 can be found at http://www.emsa.ca.gov/Guidelines- Invoicing and Payment For services satisfactorily rendered, and upon receipt and approval of the invoices, the State agrees to compensate the Contractor for actual expenditures incurred in accordance with the rates listed in Exhibit B-1, titled Budget Detail/Narrative, which is attached hereto and made a part of this Agreement. Invoices shall be submitted in accordance with this agreement and Exhibit E-Sample Invoice, which is attached hereto and made a part of this Agreement. Invoices shall include the Agreement Number, company name and remittance address, sufficient scope and detail to define the actual work performed and specific milestones completed, including a description of the activities of the Contractor and Subcontractor, the hours allocated to those activities, the locations where work was performed, the expenses claimed, any required reports, and shall be submitted in duplicate not more frequently than monthly in arrears to: EMS Authority 10901 Gold Center Drive Rancho Cordova, CA 95670-6073 Attn: Lisa Vigil, Contracts Analyst If any of this information is not on the invoice, it may cause delays in payment processing. Final Invoices must be submitted no later than sixty (60) days after the end date of this agreement. Payment will be for actual services provided or actual costs. If the EMS Authority does not approve the invoice in accordance with identified general tasks or deliverables in this contract, payment of the invoice will be withheld by the EMS Authority and the Contractor will be notified. The Contractor must take timely and appropriate measures to correct or remedy the reason(s) for non-acceptance and demonstrate to the EMS Authority that the Contractor has successfully completed the scheduled work for each general task or deliverable before payment will be made. 4 of 2 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT B Budget Contingency Clause It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Agreement does not appropriate sufficient funds for the program, this Agreement shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Agreement and Contractor shall not be obligated to perform any provisions of this Agreement. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Agreement with no liability occurring to the State, or offer an agreement amendment to Contractor to reflect the reduced amount. Prompt Payment Clause Payment will be made in accordance with, and within the time specified in, Government Code Chapter 4.5, commencing with Section 927. 2 of 2 C15-004 County of Fresno acting as Central California EMS Agency EXHIBIT B-1 BUDGET DETAIL AND NARRATIVE Program Funding Program Funding State General Local Funds Total Fund State General Fund $ 404,369 { $ 404,369 Kings County $ 41,442 $ 41,442 Madera County $ 41,442 $ 41,442 Tulare County $ 41,442 $ 41,442 Fresno County $ 2,198,184 $ 2,198,184 Totals $ 404,369 $ 2,322,510 $ 2,726,879 Budget Detail Budget Categories State General Locall Fund Total Fund Personnel $ 229,701 $ 920,513 $ 1,150,214 *Fringe Benefits $ 84,989 $ 798,685 $ 883,674 Materials and Supplies $ 8,761 $ 10,250 $ 19,011 Professional Services $ 42,000 $ 279,000 $ 321,000 In-State Travel $ 2,157 $ 1,843 $ 4,000 Administrative/indirect 10% $ 36,761 $ 36,761 of Total Direct Costs **Unreimbursed Indirect Cost (Local funding includes $ 17,189 $ 17,189 $17,189 unreimbursable $ 295,030 $ 295,030 indirect cost for the portion of 4.676% over the allowable 10% from State General Fund TOTALS $ 404,369 $ 2,322,510 $ 2,726,879 Fringe benefits are reimbursable at maximum of 37%on personnel costs from State,and the exceeded costs are funded by local fund. -Currently, Indirect cost applied in Fresno County is 14 676%. 1 of 4 C15-004 County of Fresno acting as Central California EMS Agency EXHIBIT B-1 Personnel Detail The following positions are funded under this agreement. Dale Dotson, EMS Coordinator 1 .0 2080 hours @ $ 68,038 FTE $32.7106 Responsible for overall supervision of Operations in Fresno, Kings, Madera and Tulare Counties. Responsibilities include implementation and enforcement of policy and procedures, investigation of incidents, coordination between agencies and the EMS agency, first responder liaison, hospital and base hospital coordination, and attendance at EMS related meetings. 100% of his salary is paid for with State GF. Daniel Brown, EMS Specialist 1.0 2080 hours @ $ 63,388 FTE $30.4750 Responsible for Kings County operations and oversight, which includes ambulance inspections, performance reviews, contract compliance evaluations, performance and appeal investigation, Kings County Ambulance Commission preparation, system performance reports, and attendance at EMS related meetings. 100% of his salary is aid for with State GF. John Cardona, EMS Specialist 1-0 2080 hours @ $ 63,388 FTE $30.4750 Responsible for Tulare operations and oversight, which includes ambulance inspections, performance reviews, contract compliance evaluations, performance and appeal investigation, Tulare County Ambulance Commission preparation, system performance reports, and attendance at EMS related meetings. 100% of his salary is paid for with State GF. Veronica Zamora, Office Assistant Ill 1.0 2080 hours @ $ 34,887 FTE $16,7726 Responsible for clerical support for the operations division, which includes miscellaneous administrative support, meeting minutes, purchasing and inventory, requisition management, and correspondence materials. Note: Personnel listed above are funded through the funds listed in Program Funding 2of4 C 15-0 04 County of Fresno acting as Central California EMS Agency EXHIBIT B-1 Personnel Classification O T M r (D •d d O 01 cV o U7 d r C7 O 0 0 o rn o 0 0 0 01 m o ti o m o o cu 01 CO CNry3 LD M m Q� V h o N CO M M 00 on (D LO t-7 M r- M ti to r• CV V M O m (D co LD LD (1- (D t0 "0 � M N 'Q J Lfl LA 01) 69 69 69 ti3 LA 1A LA U) 66 69 (9 L09 69 (A O C> (D O O O b r CO CO OO {� r ("i O CO 00 O j O M enen LD LJ LD LO N N {fl b9 b9 b9 6N w _ O D O� O O O O O O O O O O O O o O r.•) O O O O O ja jp O O O O CDO O O O o O O O O O O O O H U w r r r r r r r O O H J O (D M O O O c} O U--, O 1-- UO LD _ m O M 6O (n OD ir) If) — d (-- Cl N N (D S� r m Q) OO r-- if) N CO 0.l = C N in CO O (7) Ln N `1 M ulY M h- r7 01 I` �. U a ti (V (V r N in O O O) O I-- M G O LD L7 Cf (-) M m m L`> M rn N Cn N N N N U C CO � N L.t_ a V'� (fi LA LA (f) L1) Ln bA LA Ul to b9 b9 V) 69 6A c W d U o 0 0 •� o 0 0 0 0 0 0 0 -o C14 L J F o O O CO ",D O o o O o O M o O O •- O O O O O O O O O O O � � O O M -L � U C 5 (D r-> O L� O Ul CV O . r � ti ti D_ (V O O (D y M M M �- b9 69 b9 UO p) LL m 0 3�• o o _. N E O O O O O O O O ? cc 12 v v c [O1 mY p v O O O > vN EE p>` U no u O p En 05 ro dm O o' aV-C U N C C) n d E U) m (h U) (/1 ` Ln N N (n N U� (n u, LG (O (Y (Y LO (Q fd Ld y j N U ry ID M U U U U U U U U �. (n Ln Q m CL n. a Q a v m v v w a) v v n N m o_ d u� cn cn 0 U) a n_ a a a a a a r � q Q) ro O O O O O v Cn U) Cn (/) (n (n (n to U) U U m Cn (n m m U) U) Q Li lU w lL LLJ W W L1J W U) O O (n 3 of 4 C15-004 County of Fresno acting as Central California EMS Agency EXHIBIT B-1 Fringe Benefits Benefit Amount Percent Unemployment Insurance $ 282 0.123% Retirement $ 143,449 62.45% OASDI contribution $ 17,572 7.65% Health Insurance $ 27,780 Flat Rater Benefits Administration $ 576 Flat Rate" Total rrr$ 189,659 Actualst` Health Insurance is estimated at a flat rate of$6,945 per FTE.One FTE have opted out of the plan.Employees with dependent coverage($2,489)is based on annual open enrollment information. "Benefit administration is$144 per FTE. "'The Actual cost of fringe benefits is$189,659.The Stale Agreement limits fringe benefit costs to 37%of total personnel costs.The remaining difference will be covered by local funds. Materials and Office Supplies The cost allocation of$8,761 is the estimated cost of materials and office supplies for this program. The local cost of$10,250 provides the necessary funding for materials and office supplies for the remaining programs in the EMS Agency. Professional Services (Consultants) The cost allocation of$42,000 represents a portion of the cost for the EMS Medical Director agreement for Dr. Jim Andrews and one assistant medical director. The local funding of $279,000 provides for the remainder of costs for the EMS Medical Director and a portion of reimbursement of ambulance costs for uncompensated transports. Travel in-State The Estimated cost of travel under this application is $2,157 Destination Number of Purpose Estimated People Cost EMSAAC Meetings 1 EMSAAC Meeting $ 1800 EMSA/LEMSA meetings 1 Quarterly Meeting with $ 357 EMS Authority The local funding of$1,843 provides for travel activities not associated with this agreement_ Administrative/Indirect Cost Fresno County has chosen to claim the 10% overhead/indirect cost allowed by the State. The 14.676% of indirect cost rates are currently applied in Fresno County, and the cost includes administrative support, departmental support and county overhead. Fresno County will assume the responsibilities of the unreimburseable 4.676% indirect costs. The local cost of$295,030 provides for the administrative and overhead costs that are not associated with this agreement. 4 of 4 GTC 610 EXHIBIT C GENERAL TERMS AND CONDITIONS 1. APPROVAL: This Agreement is of no force or effect until signed by both par6cs and approved by the Department of General Services, if required. Contractor may not commence performance until such approval has been obtained, 2. AMENDMENT: No amendment or variation of the terms of this Agreement shall be valid unless made in writing, signed by the parties and approved as required. No oral understanding or Agreement not incorporated in the Agreement is binding on any of the parties. 3. ASSIGNMENT: This Agreement is not assignable by the Contractor, either in whole or in part, without the consent of the State in the form of a formal written amendment. 4. AUDIT: Contractor agrees that the awarding department, the Department of General Services, the Bureau of State Audits, or their designated representative shall have the right to review and to copy any records and supporting documentation pertaining to the performance of this Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three (3) years after final payment, unless a longer period of records retention is stipulated. Contractor agrees to allow the auditor(s) access to such records during normal business hours and to allow interviews of any employees who might reasonably have information related to such records. Further, Contractor agrees to include a similar right of the State to audit records and interview staff in any subcontract related to performance of this Agreement. (Gov. Code §8546.7, Pub. Contract Code §10115 et seq., CCR Title 2, Section 1896). 5. INDEMNIFICATION: Contractor agrees to indemnify, defend and save harmlcss the State, its officers, agents and employees from any and all claims and losses accruing or resulting to any and all contractors, subcontractors, suppliers, laborers, and any other person, firm or corporation famishing or supplying work services, materials, or supplies in connection with the performance of this Agreement, and from any and all claims and losses accruing or resulting to any person, firm or corporation who may be injured or damaged by Contractor in the performance of this Agreement. 6. DISPUTES: Contractor shall continue with the responsibilities under this Agreement during any dispute. 7. TERMINATION FOR CAUSE. The State may terminate this Agreement and be relieved of any payments should the Contractor fail to perform the requirements of this Agreement at the time and in the manner herein provided. In the event of such termination the State may proceed with the work in any manner deemed proper by the State. All costs to the State shall be deducted from any sum due the Contractor under this Agreement and the balance, if any, shall be paid to the Contractor upon demand. 8. INDEPENDENT CONTRACTOR: Contractor, and the agents and employees of Contractor, in the performance of this Agreement, shall act in an independent capacity and not as officers or employees or agents of the State. 9. RECYCLING CERTIFICATION: The Contractor shall certify in writing under penalty of perjury, the minimum, if not exact, percentage of post consumer material as defined in the Public Contract Code Section 12200, in products, materials, goods, or supplies offered or sold to the State regardless of whether the product meets the requirements of Public Contract Code Section 12209. With respect to printer or duplication cartridges that comply with the requirements of Section 12156(e), the certification required by this subdivision shall specify that the cartridges so comply (Pub. Contract Code §12205). 10.NON-DISCRIMINATION CLAUSE: During the performance of this Agreement, Contractor and its subcontractors shall not unlawfully discriminate, harass, or allow harassment against any employee or applicant for employment because of sex,race, color, ancestry, religious creed, national origin, physical disability (including HIV and AIDS), mental disability, medical condition (e.g., cancer), age (over 40), marital status, and denial of family care leave. Contractor and subcontractors shall insure that the evaluation and treatment of their employees and applicants for employment are free from such discrimination and harassment. Contractor and subcontractors shall comply with the provisions of the Fair Employment and Housing Act (Gov. Code §12990 (a-f) et seq.) and the applicable regulations promulgated thereunder(California Code of Regulations, Title 2, Section 7285 et seq.). The applicable regulations of the Fair Employment and Housing Commission implementing Government Code Section 12990 (a-f), set forth in Chapter 5 of Division 4 of Title 2 of the California Code of Regulations, are incorporated into this Agreement by reference and made a part hereof as if set forth in full. Contractor and its subcontractors shall give written notice of their obligations under this clause to labor organizations with which they have a collective bargaining or other Agreement. Contractor shall include the nondiscrimination and compliance provisions of this clause in all subcontracts to perform work under the Agreement. 11. CERTIFICATION CLAUSES: The CONTRACTOR CERTIFICATION CLAUSES contained in the document CCC 307 are hereby incorporated by reference and made a part of this Agreement by this reference as if attached hereto. 12. TIMELINESS: Time is of the essence in this Agreement. 13. COMPENSATION: The consideration to be paid Contractor, as provided herein, shall be in compensation for all of Contractor's expenses incurred in the performance hereof, including travel, per diem, and taxes, unless otherwise expressly so provided. 14_ GOVERNING LAW: This contract is governed by and shall be interpreted in accordance with the laws of the State of California. 15. ANTITRUST CLAIMS: The Contractor by signing this agreement hereby certifies that if these services or goods are obtained by means of a competitive bid, the Contractor shall comply with the requirements of the Government Codes Sections set out below. a. The Government Code Chapter on Antitrust claims contains the following definitions: 1) "Public purchase" means a purchase by means of competitive bids of goods, services, or materials by the State or any of its political subdivisions or public agencies on whose behalf the Attorney General may bring an action pursuant to subdivision (c) of Section 16750 of the Business and Professions Code. 2) "Public purchasing body" means the State or the subdivision or agency making a public purchase. Government Code Section 4550. b. In submitting a bid to a public purchasing body, the bidder offers and agrees that if the bid is accepted, it will assign to the purchasing body all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Sec. 15) or under the Cartwright Act (Chapter 2 (commencing with Section 16700) of Part 2 of Division 7 of the Business and Professions Code), arising from purchases of goods, materials, or services by the bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and become effective at the time the purchasing body tenders final payment to the bidder. Government Code Section 4552. c. If an awarding body or public purchasing body receives, either through judgment or settlement, a monetary recovery for a cause of action assigned under this chapter, the assignor shall be entitled to receive reimbursement for actual legal costs incurred and may, upon demand, recover from the public body any portion of the recovery, including treble damages, attributable to overcharges that were paid by the assignor but were not paid by the public body as part of the bid price, less the expenses incurred in obtaining that portion of the recovery. Government Code Section 4553. d. Upon demand in writing by the assignor, the assignee shall, within one year from such demand, reassign the cause of action assigned under this part if the assignor has been or may have been injured by the violation of law for which the cause of action arose and(a) the assignee has not been injured thereby, or(b) the assignee declines to file a court action for the cause of action. See Government Code Section 4554. 16. CHILD SUPPORT COMPLIANCE ACT; For any Agreement in excess of$100,000, the contractor acknowledges in accordance with Public Contract Code 7110, that: a. The contractor recognizes the importance of child and family support obligations and shall fully comply with all applicable state and federal laws relating to child and family support enforcement, including, but not limited to, disclosure of information and compliance with earnings assignment orders, as provided in Chapter 8 (commencing with section 5200) of Part 5 of Division 9 of the Family Code; and b. The contractor, to the best of its knowledge is fully complying with the earnings assignment orders of all employees and is providing the names of all new employees to the New Hire Registry maintained by the California Employment Development Department. 17. UNENFORCEABLE PROVISION: In the event that any provision of this Agreement is unenforceable or held to be unenforceable, then the parties agree that all other provisions of this Agreement have force and effect and shall not be affected thereby. 18. PRIORITY HIRING CONSIDERATIONS: If this Contract includes services in excess of $200,000, the Contractor shall give priority consideration in filling vacancies in positions funded by the Contract to qualified recipients of aid under Welfare and Institutions Code Section 11200 in accordance with Pub. Contract Code §10353. 19. SMALL BUSINESS PARTICIPATION AND DVBE PARTICIPATION REPORTING RE UIREMENTS: a. If for this Contract Contractor made a commitment to achieve small business participation, then Contractor must within 60 days of receiving final payment under this Contract(or within such other time period as may be specified elsewhere in this Contract) report to the awarding department the actual percentage of small business participation that was achieved. (Govt. Code § 14841.) b. If for this Contract Contractor made a commitment to achieve disabled veteran business enterprise (DVBE)participation, then Contractor must within 60 days of receiving final payment under this Contract(or within such other time period as may be specified elsewhere in this Contract) certify in a report to the awarding department: (1) the total amount the prime Contractor received under the Contract; (2) the name and address of the DVBE(s) that participated in the performance of the Contract; (3) the amount each DVBE received from the prime Contractor; (4) that all payments under the Contract have been made to the DVBE; and (5) the actual percentage of DVBE participation that was achieved. A person or entity that knowingly provides false information shall be subject to a civil penalty for each violation. (Mil. & Vets. Code § 999.5(d); Govt. Code § 14841.) 20, LOSS LEADER: If this contract involves the furnishing of equipment, materials, or supplies then the following statement is incorporated. It is unlawful for any person engaged in business within this state to sell or use any article or product as a "loss leader" as defined in Section 17030 of the Business and Professions Code. (PCC 10344(e).) C:WsersWscham hors MppllataU.oeaWicrosoH\WindowsU mporary Internet Files\Contenc0udook\N17VILFRGTC-610.doe C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT D SPECIAL TERMS AND CONDITIONS 1. Amendments This agreement allows for amendments to add time for completion of specified deliverables and/or to increase funding. Should either party, during the term of this agreement, desire a change or amendment to the terms of this Agreement, such changes or amendments shall be proposed in writing to the other party, who will respond in writing as to whether the proposed changes/amendments are accepted or rejected. If accepted and after negotiations are concluded, the agreed upon changes shall be made through the State's official agreement amendment process. No amendment will be considered binding on either party until it is formally approved by both parties and the Department of General Services, if such approval is required. 2. Excise Tax The State of California is exempt from federal excise taxes, and no payment will be made for any taxes levied on employees' wages. The State will pay for any applicable State of California or local sales or use taxes on the services rendered or equipment or parts supplied pursuant to this Agreement. California may pay any applicable sales and use tax imposed by another state. 3. Force Majeure Neither party shall be liable to the other for any delay in or failure of performance, nor shall any such delay in or failures of performance constitute default, if such delay or failure is caused by "Force Majeure." As used in this section, "Force Majeure" is defined as follows: unforeseen circumstances that make performance of the agreement impossible such as acts of war, civil unrest, acts of governments (such as changes in law) and acts of God such as earthquakes, floods, and other natural disasters such that performance is impossible. 4. License and Permits The Contractor shall be an individual or firm licensed to do business in California and shall obtain at his/her expense all license(s) and permit(s) required by law for accomplishing any work required in connection with this contract. A. If you are a Contractor located within the State of California, a business license from the city/county in which you are headquartered is necessary,- however, if you are a corporation, a copy of your incorporation documents/letter from the Secretary of State's Office can be submitted. If you are a Contractor outside the State of California, you will need to submit to the EMS Authority a copy of your business license or incorporation 1 of 3 C15-003 County of Fresno acting as Central California EMS Agency EXHIBIT D papers for your respective State showing that your company is in good standing in that state. B. In the event, any license(s) and/or permit(s) expire at any time during the term of this contract; Contractor agrees to provide the EMS Authority with a copy of the renewed license(s) and/or permit(s) within 30 days following the expiration date. In the event the Contractor fails to keep in effect at all times all required license(s) and permit(s), the State may, in addition to any other remedies it may have, terminate this contract upon occurrence of such event. 5. Inspection of Services Services performed by Contractor under this Agreement shall be subject to inspection by the EMS Authority at any and all times during the performance thereof. If the EMS Authority official conducting the inspection determines that the services performed by Contractor (and/or materials furnished in connection therewith) are not in accordance with the specification, the EMS Authority may, at its option, have the work performed by an alternate provider, charging the Contractor with any excess cost occasioned thereby. 6. Liability for Loss and Damages Any damages by the contractor to the State's facility including equipment, furniture, materials or other State property will be repaired or replaced by the contractor to the satisfaction of the State at no cost to the State. The State may, at its option, repair any such damage and deduct the cost thereof from any sum due contractor under this Agreement. 7. Cancellation /Termination (SCM 7.85) A. This agreement may be cancelled or terminated without cause by the State by giving thirty (30) calendar days advance written notice to the Contractor. Such notification shall state the effective date of termination or cancellation and include any final performance and/or payment/invoicing instructions/requirements. Contractor may submit a written request to terminate this Agreement only if the State should substantially fail to perform its responsibilities as provided herein. B. Upon receipt of a notice of termination or cancellation from the State, Contractor shall take immediate steps to stop performance and to cancel or reduce subsequent contract costs. 2of3 C 15-003 County of Fresno acting as Central California EMS Agency EXHIBIT D C. Contractor shall be entitled to payment for all allowable costs authorized under this agreement, including authorized non-cancelable obligations incurred up to the date of termination or cancellation, provided such expenses do not exceed the stated maximum amounts payable. D. However, the agreement may be immediately terminated without advance notice for cause. The term "for cause" shall mean that the Contractor has committed a material breach of the provisions of the contract. In this instance, the contract termination shall be effective as of the date indicated on the State's notification to the Contractor. (Refer to GC, Exhibit C, Item 7_ Termination for cause.) E. This agreement may be suspended or cancelled without notice, at the option of the Contractor, if the Contractor or State's premises or equipment are destroyed by fire or other catastrophe, or so substantially damaged that it is impractical to continue service, or in the event the Contractor is unable to render service as a result of any action by any governmental authority. 8. Disputes Any dispute concerning a question of fact arising under this contract that is not disposed of by agreement shall be decided by the Director of the EMS Authority, who may consider written or verbal evidence submitted by the Contractor. The decision of the Director of the EMS Authority, issued in writing, shall be conclusive and binding on both parties to the contract on all questions of fact considered and determined by the Director of the EMS Authority. 9. Intellectual Property Rights All work products, intellectual property or otherwise, developed under this contract shall become the property of the EMS Authority. Products shall not be disclosed without the written permission of the Director of the EMS Authority and the Administration if necessary. Each report developed for this contract shall also become the property of the EMS Authority and shall not be disclosed except in such manner and such time as the Director of the EMS Authority may direct. No written product(s) shall be used for lobbying purposes. No products, processes, or materials developed using grant funds may be patented or copyrighted to the contractor. 3of3 C15-003 Central California Emergency Medical Services Agency EXHIBIT E SAMPLE INVOICE STATE GENERAL FUND Multi-county EMS Agency Address City, State, Zip Contract Number: C15-003 For the Period Covering: Total Budget Expenditures This Expenditures To Budget Balance Period Date State Local State Local State Local State Local Personnel Fringe Benefits Accounting Advertising Budgeting Communications Equipment Legal Expense Maintenance & Repairs Materials& Supplies Memberships, Subscriptions Motor Pools Printing & Reproduction Professional Srvs. Consultants Space Training Travel Total Direct Costs Admin./Indirect 10 % Total Direct Total Less Advance: $ (state) Net Balance: (state) $ Amount Requested: $ Total Requested to Date. $ 1 certify that this claim is in all respects true, correct, supportable by available documentation, and in compliance with all terms, conditions, laws, and regulations governing its payment. Executive Director/ Multi-county EMS Agency 1 of 1 ATTEST: BERNICE E.SEIOEL,Clerk Board of Supervisors CCC-307 By CERTIFICATION p ty I, the official named below,CERTIFY UNDER PENALTY OF PERJURY that I am duly authorized to legally bind the prospective Contractor to the clause(s)listed below.This certification is made under the laws of the State of California. Contractor/Bidder Firm Name (Printed) Federal ID Number County of Fresno 4-6000-512 By(A thorized Signal re) Printed Narne and Title oJPerson Se ing Deborah A. Poochigian, Chairman, Board of Supervisors Date Executed Executed in the County of Fresno CONTRACTOR CERTIFICATION CLAUSES 1.STATEMENT OF COMPLIANCE: Contractor has, unless exempted,complied with the nondiscrimination program requirements; (Gov.Code§12990(a-f)and CCR,Title 2, Section 8103) (Not applicable to public entities.) 2.DRUG-FREE WORKPLACE RE UIREMENIS: Contractor will comply with the requirements of the Drug-Free Workplace Act of 1990 and will provide a drug-free workplace by taking the following actions: a.Publish a statement notifying employees that unlawful manufacture,distribution, dispensation,possession or use of a controlled substance is prohibited and specifying actions to be taken against employees for violations. b.Establish a Drug-Free Awareness Program to inform employees about: 1)the dangers of drug abuse in the workplace; 2) the person's or organization's policy of maintaining a drug-free workplace; 3)any available counseling,rehabilitation and employee assistance programs;and, 4)penalties that may be imposed upon employees for drug abuse violations. c.Every employee who works on the proposed Agreement will: 1)receive a copy of the company's drug-free workplace policy statement; and, 2)agree to abide by the terms of the company's statement as a condition of employment on the Agreement. Failure to comply with these requirements may result in suspension of payments under the Agreement or termination of the Agreement or both and Contractor may be ineligible for award of any future State agreements if the department determines that any of the following has occurred: the Contractor has made false certification, or violated the certification by failing to carry out the requirements as noted above. (Gov. Code §8350 et seq.) 3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: Contractor certifies that no more than one (1) final unappealable finding of contempt of court by a Federal court has been issued against Contractor within the immediately preceding two-year period because of Contractor's failure to comply with an order of a Federal court, which orders Contractor to comply with an order of the National Labor Relations Board. (Pub. Contract Code §10296) (Not applicable to public entities.) 4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO REOUIREMENT: Contractor hereby certifies that contractor will comply with the requirements of Section 6072 of the Business and Professions Code, effective January 1, 2003. Contractor agrees to make a good faith effort to provide a minimum number of hours of pro Bono legal services during each year of the contract equal to the lessor of 30 multiplied by the number of full time attorneys in the firm's offices in the State, with the number of hours prorated on an actual day basis for any contract period of less than a full year or 10% of its contract with the State. Failure to make a good faith effort may be cause for non-renewal of a state contract for legal services, and may be taken into account when determining the award of future contracts with the State for legal services. 5. EXPATRIATE CORPORATIONS: Contractor hereby declares that it is not an expatriate corporation or subsidiary of an expatriate corporation within the meaning of Public Contract Code Section 10296 and 10286.1, and is eligible to contract with the State of California. 6. SWEATFREE CODE OF CONDUCT: a_ All Contractors contracting for the procurement or laundering of apparel, garments or corresponding accessories, or the procurement of equipment, materials, or supplies, other than procurement related to a public works contract, declare under penalty of perjury that no apparel, garments or corresponding accessories, equipment, materials, or supplies furnished to the state pursuant to the contract have been laundered or produced in whole or in part by sweatshop labor, forced labor,convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor, or with the benefit of sweatshop labor, forced labor, convict labor, indentured labor under penal sanction, abusive forms of child labor or exploitation of children in sweatshop labor. The contractor further declares under penalty of perjury that they adhere to the Sweatfree Code of Conduct as set forth on the California Department of Industrial Relations website located at www,dir.ca.g.ov, and Public Contract Code Section 6108. b. The contractor agrees to cooperate fully in providing reasonable access to the contractor's records,documents, agents or employees, or premises if reasonably required by authorized officials of the contracting agency, the Department of Industrial Relations, or the Department of Justice to determine the contractor's compliance with the requirements under paragraph (a). 7. DOMESTIC PARTNERS: For contracts over S 100,000 executed or amended after January 1, 2007, the contractor certifies that contractor is in compliance with Public Contract Code section 1029S.3. DOING BUSINESS WITH THE STATE OF CALIFORNIA The following laws apply to persons or entities doing business with the State of California. 1. CONFLICT OF INTEREST: Contractor needs to be aware of the following provisions regarding current or former state employees. If Contractor has any questions on the status of any person rendering services or involved with the Agreement, the awarding agency must be contacted immediately for clarification. Current State Employees (Pub. Contract Code §10410): 1). No officer or employee shall engage in any employment, activity or enterprise from which the officer or employee receives compensation or has a financial interest and which is sponsored or funded by any state agency, unless the employment, activity or enterprise is required as a condition of regular state employment. 2). No officer or employee shall contract on his or her own behalf as an independent contractor with any state agency to provide goods or services. Former State Employees (Pub. Contract Code §10411): 1). For the two-year period from the date he or she left state employment, no former state officer or employee may enter into a contract in which he or she engaged in any of the negotiations, transactions, planning, arrangements or any part of the decision-making process relevant to the contract while employed in any capacity by any state agency. 2). For the twelve-month period from the date he or she left state employment, no former state officer or employee may enter into a contract with any state agency if he or she was employed by that state agency in a policy-making position in the same general subject area as the proposed contract within the 12-month period prior to his or her leaving state service. If Contractor violates any provisions of above paragraphs, such action by Contractor shall render this Agreement void. (Pub_ Contract Code §10420) Members of boards and commissions are exempt from this section if they do not receive payment other than payment of each meeting of the board or commission,payment for preparatory time and payment for per diem. (Pub. Contract Code §10430 (e)) 2. LABOR CODE/WORKERS' COMPENSATION: Contractor needs to be aware of the provisions which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions, and Contractor affirms to comply with such provisions before commencing the performance of the work of this Agreement. (Labor Code Section 3700) 3. AMERICANS WITH DISABILITIES ACT: Contractor assures the State that it complies with the Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination on the basis of disability, as well as all applicable regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.) 4. CONTRACTOR NAME CHANGE: An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment. 5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA: a. When agreements are to be performed in the state by corporations, the contracting agencies will be verifying that the contractor is currently qualified to do business in California in order to ensure that all obligations due to the state are fulfilled. b. "Doing business" is defined in R&TC Section 23101 as actively engaging in any transaction for the purpose of financial or pecuniary gain or profit. Although there are some statutory exceptions to taxation, rarely will a corporate contractor performing within the state not be subject to the franchise tax. c. Both domestic and foreign corporations (those incorporated outside of California)must be in good standing in order to be qualified to do business in California. Agencies will determine whether a corporation is in good standing by calling the Office of the Secretary of State. 6. RESOLUTION. A county, city, district, or other local public body must provide the State with a copy of a resolution, order, motion, or ordinance of the local governing body which by law has authority to enter into an agreement, authorizing execution of the agreement_ 7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the Contractor shall not be: (1) in violation of any order or resolution not subject to review promulgated by the State Air Resources Board or an air pollution control district, (2) subject to cease and desist order not subject to review issued pursuant to Section 13301 of the Water Code for violation of waste discharge requirements or discharge prohibitions, or(3) finally determined to be in violation of provisions of federal law relating to air or water pollution. 8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all contractors that are not another state agency or other governmental entity. AGREEMENT BETWEEN THE COUNTY OF FRESNO AND THE STATE OF CALIFORNIA COUNTY OF FRESNO ACTING AS CENTERAL CA-LIFORNIA EMS AGENCY No.: State of California,HHS Ap_ency Term. July 1, 2015 — June 30, 2016 Emergency Medical Services Authority (EMSA) Regional EMS Administration (#C15-003) APPROVED AS TO LEGAL FORM: DANIEL C. CEDERBORG, COUNTY COUNSEL By APPROVED AS TO ACCOUNTING FORM: VICKI CROW, C.P.A., AUDITOR-CONTROLLER/ TREASURER -TAX COLLECTOR By 6PA REVIEWED AND RECOMMENDED FOR APPROVAL: Byzm P014-/ David Pomaville Director Department of Public Health Fund/Subclass: 0001/10000 Organization #: S6201692 Revenue: 3503 ks