HomeMy WebLinkAboutAgreement A-16-392 with KWPH Enterprises (Laton).pdfAGREEMENT 1
2 THIS AGREEMENT is made and entered into this ___ day of ______ , 2016, by
3 and between the COUNTY OF FRESNO, a Political Subdivision ofthe State of California, hereinafter
4 referred to as "COUNTY," and K.W.P.H. ENTERPRISES, doing business as AMERICAN
5 AMBULANCE, a California Corporation, whose address is 2911 East Tulare Street, Fresno,
6 California 93721, hereinafter referred to as "CONTRACTOR."
7 W I T N E S S E T H:
8 WHEREAS, COUNTY's Emergency Medical Services ("EMS") Communications Center is
9 staffed and operated by CONTRACTOR through that certain Emergency Medical Services Provider
10 Agreement for Emergency Ambulance Service and Advanced Life Support (Paramedic) Ambulance
11 Service dated July 10, 2007 (COUNTY Agreement No. A-07-292, the "EMS PROVIDER
12 Agreement"), by and between COUNTY and PROVIDER; and
13 WHEREAS, Laton Community Service District ("DISTRICT") desires to receive dispatching
14 services for fire suppression calls, which may include dispatching of non-transport first responder
15 services, (collectively, "FIRE Dispatching Services") from COUNTY's EMS Communications
16 Center; and
17 WHEREAS, CONTRACTOR desires to provide dispatching services for DISTRICT; and
18 WHEREAS, it is to the mutual benefit and in the best interest of the DISTRICT and COUNTY,
19 and the parties hereto, to combine EMS dispatching services and FIRE Dispatching Services for the
2 0 purpose of providing improved services to the public; and
21 WHEREAS, CONTRACTOR and COUNTY developed an original Agreement on June 18,
22 2013 (COUNTY Agreement No. A-13-348) beginning July 1, 2013 through June 30, 2016; and
2 3 WHEREAS, it is a goal of COUNTY and DISTRICT to consolidate dispatching services in
2 4 Fresno County; and
2 5 WHEREAS, it has been determined by DISTRICT and COUNTY that there is a need to provide
2 6 EMS dispatching services and FIRE Dispatching Services through a centralized and combined effort by
2 7 COUNTY's EMS Communications Center; and
2 8 WHEREAS, DISTRICT and COUNTY intend to enter into an agreement which will continue
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1 the provision of FIRE Dispatching Services by COUNTY (the "DISTRICT-COUNTY Agreement");
2 and
3 WHEREAS, CONTRACTOR is willing to facilitate the DISTRICT-COUNTY Agreement by
4 entering into this Agreement.
5 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
6 hereto agree as follows:
1. SERVICES 7
8 A. Subject to DISTRICT timely paying COUNTY for FIRE Dispatching Services
9 (defined in Section 4.A. of the DISTRICT-COUNTY Agreement) under the DISTRICT-COUNTY
1 0 Agreement:
11 (1) COUNTY shall obtain and maintain dispatching equipment, hardware,
12 software (including software licenses), and other technologies, which will be utilized for the triage and
13 entry of information for FIRE Dispatching Services in COUNTY's EMS Communications Center
14 computer aided dispatch ("CAD") system, in connection with CONTRACTOR's performance of FIRE
15 Dispatching Services under this Agreement; and
16 (2) COUNTY shall be responsible for selection, configuration, installation,
17 and maintenance of all dispatching equipment, hardware, software and other technologies associated
18 with this Agreement. All dispatching equipment, hardware, software (including software licenses), and
19 other technologies purchased and/or obtained through this Agreement shall be the sole property of
20 COUNTY.
21 (3) CONTRACTOR shall provide FIRE Dispatching Services requiring
22 responses by DISTRICT apparatuses as follows:
23 (a) CONTRACTOR shall provide all FIRE Dispatching Services in
2 4 accordance with DISTRICT's Policies and Procedures ("DISTRICT's Policies and Procedures"),
2 5 which shall be approved by COUNTY's EMS Director, or his or her designee (the "COUNTY's
2 6 Representative").
27 (b) CONTRACTOR shall dispatch DISTRICT's apparatuses through
28 DISTRICT's radios and electronic communications, and in accordance with DISTRICT's Policies and
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1 Procedures approved by COUNTY's Representative.
2 (c) CONTRACTOR shall provide pre-arrival instructions to callers
3 requesting fire suppression service responses in accordance with DISTRICT's Policies and Procedures
4 approved by COUNTY's Representative.
5 (d) CONTRACTOR shall provide inter-agency coordination
6 regarding requests for fire suppression service, mutual aid and instant aid services, and order
7 specialized fire equipment from DISTRICT or other agencies (e.g., hazardous materials equipment, or
8 "jaws of life") which may be needed to handle an incident, and perform other related duties in
9 accordance with DISTRICT's Policies and Procedures approved by COUNTY's Representative.
10 (e) CONTRACTOR shall track all activity of DISTRICT's
11 apparatuses responses utilizing the COUNTY's EMS Communications Center CAD system.
12 (f) COUNTY shall provide one (1) radio operator for dispatching of
13 DISTRICT'S apparatuses twenty-four (24) hours a day, seven (7) days a week. DISTRICT
14 understands that the radio operator is not dedicated for the sole purpose of DISTRICT and that the
15 radio operator may be dispatching other fire and EMS providers.
16 (g) CONTRACTOR shall provide that a minimum of one (1) dispatch
17 supervisor shall be on duty at COUNTY's EMS Communications Center twenty-four (24) hours a day,
18 seven (7) days a week. The supervisor shall be available to DISTRICT's on-duty fire administration
1 9 as needed.
20 (h) CONTRACTOR shall maintain an up-to-date manual of
21 DISTRICT's Policies and Procedures (approved by COUNTY's Representative, as provided herein) for
2 2 all dispatch staff, and shall provide for training and continuing education of dispatch staff as needed.
23 (i) The goal for the immediate dispatch of a fire apparatus, in
2 4 accordance with DISTRICT approved dispatch protocols, and excluding multiple unit responses,
2 5 reassigned responses and other situations beyond the COUNTY's EMS Communications Center
2 6 control; shall be sixty (60) seconds. The dispatch time will be measured from the time the telephone is
2 7 answered by the call taker to the time the first fire apparatus is alerted to the incident either by radio,
2 8 telephone, pager, or station alerting device. A review shall occur for all cases in which dispatches are
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1 over ninety (90) seconds and results will be evaluated for improvement opportunities by the Fire
2 Dispatch Continuous Quality Improvement (CQI) Committee.
3 It is understood, because of the dynamic nature of emergency services, there are
4 situations when the sixty (60) second dispatch goal may not be achieved. Examples of these situations
5 include, but are not limited to:
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Calls not received through the 9-1-1 telephone system.
Calls that do not immediately geo-verify in the CAD.
Calls in which the public safety answering points (PSAP)
dispatcher does not immediately transfer the calling party.
Calls in which the reporting party is either unable or unwilling to
immediately provide all required information as part of the call
taking process (i.e., non-English speaking, hysterical, or
uncooperative).
Calls not meeting Priority I medical-aid criteria during initial
questioning.
It is understood by the parties hereto that (i) CONTRACTOR's provision of
17 FIRE Dispatching Services herein does not include any CONTRACTOR or COUNTY provision of
18 fire suppression services, (ii) all fire suppression services for all fire suppression calls to be dispatched
19 by CONTRACTOR are to be provided by DISTRICT pursuant to the DISTRICT-COUNTY
2 0 Agreement, (iii) CONTRACTOR is providing FIRE Dispatching Services herein on a non-exclusive
21 basis, (iv) COUNTY's compensation paid to CONTRACTOR for its performance of FIRE
22 Dispatching Services herein is for supplemental services that are in addition to any other services that
2 3 CONTRACTOR provides, and for which CONTRACTOR acknowledges that CONTRACTOR is paid
2 4 in accordance with the EMS PROVIDER Agreement, and (v) CONTRACTOR shall first obtain
25 COUNTY's written permission to provide any other dispatching services through the COUNTY's
2 6 EMS Communications Center. Notwithstanding anything stated to the contrary herein,
2 7 CONTRACTOR covenants, warrants, and represents to COUNTY that (i) Any funds that COUNTY
2 8 may pay to CONTRACTOR, or that CONTRACTOR otherwise may collect from performing service
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1 in connection with the EMS PROVIDER Agreement, including, but not limited to, COUNTY
2 compensation and CONTRACTOR's fees and charges for services rendered to patients, shall not be
3 diverted or otherwise used, either directly or indirectly, by CONTRACTOR to subsidize
4 CONTRACTOR's performance of this Agreement, and (ii) CONTRACTOR shall not directly or
5 indirectly charge any costs or expenses incurred in connection with the performance of this Agreement
6 to any of CONTRACTOR's other operations for or approved by COUNTY, including but not limited
7 to CONTRACTOR's operations in the COUNTY's EMS Communications Center for COUNTY under
8 the EMS PROVIDER Agreement and/or for other COUNTY -approved agencies (e.g., agencies that
9 may be outside of Fresno County such as the County of Kings or cities or special districts, if any,
10 within Fresno County).
11 C. CONTRACTOR's performance of FIRE Dispatching Services herein shall
12 enhance CONTRACTOR's peak load capacity, disaster readiness and overall efficiency in providing
13 dispatching services in COUNTY's EMS Communications Center, and shall not detract from
14 CONTRACTOR's performance of its obligations under the EMS PROVIDER Agreement, or any
15 other agreement, if any, entered into or authorized by COUNTY.
16 D. COUNTY shall perform the following functions:
17 (1) COUNTY shall provide COUNTY-approved DISTRICT Policies and
18 Procedures to CONTRACTOR.
19 (2) COUNTY shall assure that all calls to DISTRICT for EMS and fire
20 suppression services are immediately transferred to COUNTY's EMS Communications Center.
21 (3) COUNTY agrees to provide for an internal quality improvement
22 program, which includes the participation of CONTRACTOR and DISTRICT.
23 2. TERM
24 This Agreement shall become effective on the lst day of July, 2016 and terminate on the
25 31st day of December, 2017, unless sooner terminated as provided herein.
2 6 Notwithstanding anything stated to the contrary herein, this Agreement shall
27 automatically terminate on any earlier date that the DISTRICT-COUNTY Agreement terminates.
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1 3. TERMINATION
2 A. Non-Allocation of Funds -The terms of this Agreement, and the services to be
3 provided hereunder, are contingent on the approval of funds by the appropriating governmental agency,
4 provided however, should sufficient funds not be allocated, (i) the services provided may be modified
5 at any time upon the parties' mutual written agreement, or (ii) this Agreement may be terminated at any
6 time by the COUNTY giving at least sixty (60) days' advance written notice of an intention to
7 terminate to the CONTRACTOR.
8 B. Without Cause -Under circumstances other than those set forth above, this
9 Agreement may be terminated by CONTRACTOR or COUNTY upon the giving of at least sixty (60)
1 0 days' advance written notice of an intention to terminate to the other party.
11 c. Material Breach -Either party may terminate this Agreement at any time for
12 cause for the other party's material breach of its obligations herein if not less than seven (7) days'
13 advance, written notice has been given to the other party and such breach remains uncured within that
14 seven (7) day period. The party receiving such notice may respond to said notice and any charges
15 contained therein within that seven (7) day period. A "Material Breach" by CONTRACTOR, as that
16 term is defined by and used in the EMS PROVIDER Agreement, also shall be deemed to be a material
17 breach by CONTRACTOR under this Agreement. Any notice by COUNTY to CONTRACTOR of
18 CONTRACTOR's Material Breach under the EMS Provider Agreement shall satisfy the requirement of
19 COUNTY giving notice to CONTRACTOR of a material breach under this Agreement without the
2 0 necessity of such notice referring to CONTRACTROR's performance under this Agreement.
21 D. COUNTY shall compensate or provide funding to CONTRACTOR for any
2 2 services performed under this Agreement prior to any termination of this Agreement.
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4. COMPENSATION FOR SERVICES
A. For CONTRACTOR'S performance of FIRE Dispatching Services herein,
2 5 COUNTY agrees to pay CONTRACTOR and CONTRACTOR agrees to receive a quarterly lump-sum
2 6 payment of Five Hundred Sixty-Three and 501100 Dollars ($563.50) pursuant to Exhibit A, attached
2 7 hereto and incorporated herein by this reference. The quarterly lump-sum payment shall be paid for the
2 8 performance of services as stated in this contract only while the Agreement with American Ambulance
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(Agreement No. A-07-292) is still in effect. In no event shall compensation for CONTRACTOR'S
performance of FIRE Dispatching Services under this Agreement be in excess of Three Thousand
Three Hundred Eighty-One and N0/1 00 Dollars ($3,381.00).
B. COUNTY's obligation to compensate CONTRACTOR herein is subject to
COUNTY receiving sufficient and timely payments of funds from DISTRICT under the DISTRICT-
COUNTY Agreement. Subject to the foregoing sentence, COUNTY, promptly following COUNTY's
receipt of such DISTRICT funds, shall pay CONTRACTOR no later than the fifteenth (15th) day of the
month in which the services are provided by CONTRACTOR without the necessity of CONTRACTOR
submitting invoices to COUNTY. All payments shall be remitted to CONTRACTOR at the following
address: American Ambulance, 2911 East Tulare Street, Fresno, CA 93721.
5. INDEPENDENT CONTRACTOR
A. In performance of the work, duties, and obligations assumed by CONTRACTOR
under this Agreement, it is mutually understood and agreed that CONTRACTOR, including any and all
of CONTRACTOR's officers, agents, and employees will at all times be acting and performing as an
independent contractor, and shall act in an independent capacity and not as an officer, agent, servant,
employee, joint venture, partner, or associate of COUNTY. Furthermore, COUNTY shall have no right
to control or supervise or direct the manner or method by which CONTRACTOR shall perform its
work and function, except for CONTRACTOR's compliance with DISTRICT's Policies and
Procedures, herein. However, COUNTY shall retain the right to administer this Agreement so as to
verify that CONTRACTOR is performing its obligations in accordance with the terms and conditions
thereof. CONTRACTOR and COUNTY shall comply with all applicable provisions of law and the
rules and regulations, if any, of governmental authorities having jurisdiction over matters which are
directly or indirectly the subject of this Agreement.
B. Because of its status as an independent contractor, CONTRACTOR shall have
absolutely no right to employment rights and benefits available to COUNTY employees.
CONTRACTOR shall be solely liable and responsible for providing to, or on behalf of, its employees
all legally-required employee benefits. In addition, CONTRACTOR shall be solely responsible and
save COUNTY harmless from all matters relating to payment of CONTRACTOR's employees,
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1 including compliance with Social Security, withholding, and all other regulations governing such
2 matters. It is acknowledged that during the term of this Agreement, CONTRACTOR may be providing
3 services to others unrelated to COUNTY or to this Agreement.
4 6. MODIFICATION
5 Any matters of this Agreement may be modified from time to time by the written
6 consent of all the parties hereto without, in any way, affecting the remainder.
7 7. HOLD-HARMLESS
8 A. CONTRACTOR agrees to indemnify, save, hold harmless, and at COUNTY's
9 request, defend COUNTY and DISTRICT, including their respective officers, agents, and employees
10 from any and all costs and expenses (including attorneys' fees and costs), damages, liabilities, claims,
11 and losses occurring or resulting to COUNTY or DISTRICT (as applicable) in connection with the
12 performance, or failure to perform, by CONTRACTOR, including its officers, agents, or employees
13 under this Agreement, and from any and all costs and expenses (including attorneys' fees and costs),
14 damages, liabilities, claims, and losses occurring or resulting to any person, firm, or corporation who
15 may be injured or damaged by the performance, or failure to perform, of CONTRACTOR, including its
16 officers, agents, or employees under this Agreement.
17 B. COUNTY agrees to indemnify, save, hold harmless, and at CONTRACTOR's
18 request, defend CONTRACTOR, including its officers, agents, and employees from any and all costs
19 and expenses (including attorneys' fees and costs), damages, liabilities, claims, and losses occurring or
2 0 resulting to CONTRACTOR in connection with the performance, or failure to perform, by COUNTY
21 or DISTRICT, including their respective officers, agents, or employees under this Agreement or under
22 the DISTRICT-COUNTY Agreement (as applicable), and from any and all costs and expenses
2 3 (including attorneys' fees and costs), damages, liabilities, claims, and losses occurring or resulting to
2 4 any person, firm, or corporation who may be injured or damaged by the performance, or failure to
2 5 perform, of COUNTY or DISTRICT, including their respective officers, agents, or employees under
2 6 this Agreement or under the DISTRICT -COUNTY Agreement.
27 C. In the event of concurrent negligence on the part of CONTRACTOR or any of its
28 officers, agents or employees, and of COUNTY or DISTRICT or any of their respective officers,
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1 agents, or employees, the liability for any and all such claims, demands and actions in law or equity for
2 such costs and expenses (including attorneys' fees and costs), damages, and losses shall be apportioned
3 under the State of California's theory of comparative negligence as presently established or as may be
4 modified hereafter.
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D. This Section 7 shall survive termination or expiration of this Agreement.
8. INSURANCE
7 CONTRACTOR shall obtain and maintain, at all times, insurance coverages, with such
8 policies, and in such amounts, as are provided in the EMS Provider Agreement. The parties hereto
9 agree that the provisions of the EMS Provider Agreement (including any future amendments thereto)
1 0 shall and will be incorporated herein by this reference, as though each and every of such terms are set
11 forth herein below. CONTRACTOR's failure to maintain all such insurance coverages shall be
12 deemed to be a material breach of this Agreement.
13 9. CONFIDENTIALITY
14 All services performed by CONTRACTOR under this Agreement and any information
15 CONTRACTOR creates, receives, or maintains pertaining to protected health information shall be in
16 strict conformance with all applicable Federal, State of California and/or local laws and regulations
17 relating to confidentiality, including but not limited to all Health Insurance Portability and
18 Accountability Act (HIPAA) regulations.
19 10. NON-DISCRIMINATION
2 0 During the performance of this Agreement, CONTRACTOR shall not unlawfully
21 discriminate against any employee or applicant for employment, or recipient of services, because of
22 race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical
2 3 condition, genetic information, marital status, sex, gender, gender identity, gender expression, age,
2 4 sexual orientation, or military or veteran status pursuant to all applicable State of California and
2 5 Federal statutes and regulations.
26 ll. DISCLOSURE OF SELF-DEALING TRANSACTIONS
2 7 This provision is only applicable if the CONTRACTOR is operating as a corporation (a
28 for-profit or non-profit corporation) or if during the term of this agreement, the CONTRACTOR
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1 changes its status to operate as a corporation.
2 Members of the CONTRACTOR's Board of Directors shall disclose any self-dealing
3 transactions that they are a party to while CONTRACTOR is providing goods or performing services
4 under this agreement. A self-dealing transaction shall mean a transaction to which the CONTRACTOR
5 is a party and in which one or more of its directors has a material financial interest. Members of the
6 Board of Directors shall disclose any self-dealing transactions that they are a party to by completing
7 and signing a Self-Dealing Transaction Disclosure Form, attached hereto as Exhibit B and
8 incorporated herein by reference, and submitting it to the COUNTY prior to commencing with the self-
9 dealing transaction or immediately thereafter.
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12. RECORDS
A. Each party shall maintain its books, accounts and records in connection with the
12 respective services referred to under this Agreement. CONTRACTOR's books, accounts and records
13 of such services shall be kept separate and apart from CONTRACTOR's other books, accounts and
14 records of services kept in connection with the EMS PROVIDER Agreement, and any other agreement
15 entered into or approved by COUNTY. All of such CONTRACTOR's books, accounts, and records
16 shall be prepared and kept by CONTRACTOR in an organized manner that facilitates an efficient
17 review of the costs incurred and funds received in order to give COUNTY a complete and clear
18 understanding of the accounting thereof. All of such CONTRACTOR's books, accounts and records
19 shall be subject to public disclosure as provided in the EMS PROVIDER Agreement (including any
20 future amendments thereto), which shall and will be incorporated herein by this reference, as though
21 each and every of such terms are set forth herein below.
22 B. Each of the parties' books, accounts and records must be maintained for a
2 3 minimum of three (3) years. Such books, accounts and records must also be maintained a minimum of
24 three (3) years after the termination of this Agreement. The party generating the books, accounts and
2 5 records shall maintain ownership thereof upon termination of this Agreement.
26 13. AUDITS AND INSPECTIONS
27 A. Each party shall at any time during business hours, and as often as the other party
2 8 may deem necessary, make available to the other party for examination all of the former party's records
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1 and data with respect to the matters covered by this Agreement. Each party shall, upon request by the
2 other party, permit the other party to audit and inspect all such records and data necessary to ensure the
3 former party's compliance with the terms of this Agreement.
4 B. If this Agreement exceeds Ten Thousand and Noll 00 Dollars ($1 0,000.00),
5 CONTRACTOR shall be subject to the examination and audit of the State Auditor for a period ofthree
6 (3) years after final payment under contract (Government Code Section 8546. 7).
7 14. FORCE MAJEURE
8 A. If either party hereto is rendered unable, wholly or in part, by Force Majeure to
9 carry out its obligations under this Agreement, that party shall give to the other party hereto prompt
10 written notice of the Force Majeure with full particulars relating thereto. Thereupon, the obligations
11 of the party giving the notice, so far as they are affected by the Force Majeure, shall be suspended
12 during, but no longer than, the continuance of the Force Majeure, except for a reasonable time
13 thereafter required to resume performance.
14 B. During any period in which either party hereto is excused from performance by
15 reason ofthe occurrence of an event afForce Majeure, the party so excused shall promptly,
16 diligently, and in good faith take all reasonable action required in order for it to be able to promptly
17 commence or resume performance of its obligations under this Agreement. Without limiting the
18 generality of the foregoing, the party so excused from performance shall, during any such period of
19 Force Majeure, take all reasonable action necessary to terminate any temporary restraining order or
2 0 preliminary or permanent injunctions to enable it to so commence or resume performance of its
21 obligations under this Agreement.
22 C. The party whose performance is excused due to the occurrence of an event of
2 3 Force Majeure shall, during such period, keep the other party hereto notified of all such actions
2 4 required in order for it to be able to commence or resume performance of its obligations under this
2 5 Agreement.
26 D. "Force Majeure" is defined as an Act of God, act of public enemy, war, and other
2 7 extraordinary causes not reasonably within the control of either of the parties hereto.
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15. NOTICES
A. The persons having authority to give and receive notices under this Agreement
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COUNTY
Director, County of Fresno
Department of Public Health
P.O. Box 11867
Fresno, CA 93775
CONTRACTOR
American Ambulance
Attn: President
2911 East Tulare Street
Fresno, CA 93 721
B. Any and all notices between COUNTY and CONTRACTOR provided for or
11 permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
12 personally delivered to one of the parties hereto, or in lieu of such personal service, when deposited in
13 the United States Mail, postage prepaid, addressed to such party, except for notices of termination,
14 which are effective upon receipt. Notices under this Agreement are not modifications to this
1 5 Agreement.
16 16. GOVERNING LAW
17 A. The parties hereto agree, that for the purposes of venue, performance under this
18 Agreement is to be in Fresno County, California.
19 B. The rights and obligations of the parties hereto and all interpretation and
2 0 performance of this Agreement shall be governed in all respects by the laws of the State of California.
21 17. SEVERABILITY
2 2 The provisions of this Agreement are severable. The invalidity or unenforceability of
2 3 any one provision in the Agreement shall not affect the other provisions.
24 18. ENTIRE AGREEMENT
25 This Agreement constitutes the entire agreement between COUNTY and
2 6 CONTRACTOR with respect to the subject matter hereof and supersedes all previous agreement
27 negotiations, proposals, commitments, writings, advertisements, publications, and understandings of
2 8 any nature whatsoever unless expressly included in this Agreement. CONTRACTOR acknowledges
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1 that COUNTY detrimentally relies upon each and every of CONTRACTOR's covenants, warranties
2 and representations made herein to COUNTY. This Agreement may be executed in several counterparts
3 by the parties hereto, in which case, all of such executed duplicate counterpart originals thereof, taken
4 together, shall be deemed to be one and the same legal instrument.
5 19. NO THIRD PARTY BENEFICIARIES
6 Notwithstanding anything stated to the contrary in this Agreement, there shall not be any
7 intended third party beneficiaries to this Agreement.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day
2 and year first hereinabove written.
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4 K.W.P.H. ENTERPRISES, dba
5 AMERICAN AMBULANCE
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President, K.W.P.H. Enterprises
Print Name: \l;'&)\lo.\et"~
Date: CESJ\~1\([) By~ PrintNa~n
Title: c;,..~n.c:k., ~~~4c_;
Date: .Y/ l-/6
IS Chief Financial Officer or Corporate
l9 Secretary to K.W.P.H. Enterprises
20 d.b.a. American Ambulance,
21 a California Corporation
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23 Mailing Address:
24 2911 E. Tulare St.
25 Fresno, CA 93721
26 PLEASE SEE ADDITIONAL
27 SIGNATURE PAGE ATIACHED
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CO OFFRESNO
COUNTY OF FRESNO
Chairman, Board of Supervisors
Date: 'C lJ '\ \ \p
BERNICE E. SEIDEL, Clerk
Board of Supervisors
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APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
By
:::~Jd~& FOR APPROVAL:
Director
Department of Public Health
Fund/Subclass:
Organization:
Account#:
0001/10000
56201693
7295
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EXHIBIT A
Qtr Date Due Amount
1 10/01/2016 $563.50
2 01/01/2017 $563.50
3 04/01/2017 $563.50
4 07/01/2017 $563.50
5 10/01/2017 $563.50
6 01/01/2018 $563.50
Exhibit B
SELF-DEAUNG TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County"),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest."
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name, job title (if applicable), and date this disclosure is being made.
{2) Enter the board member's company/agency name and address.
{3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the Corporation has the transaction;
and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
{4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
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Exhibit B
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4} Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: -~ Date: I
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