HomeMy WebLinkAboutSTATE Emergency Medical Services Authority-Central California Emergency Medical Services Agency_A-23-636.pdf coU Hall of Records,Room 301
County of Fresno 2281 Tulare Street
Fresno,California
Board of Supervisors 93721-2198
O 'ss o Telephone:(559)600-3529
F1ZE`' Minute Order Toll Free: 1-800-742-1011
www.co.fresno.ca.us
November 28, 2023
Present: 5- Supervisor Steve Brandau,Vice Chairman Nathan Magsig,Supervisor Buddy Mendes,
Supervisor Brian Pacheco,and Chairman Sal Quintero
Agenda No. 65. Public Health File ID:23-1106
Re: Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California
Emergency Medical Services Authority for multi-county emergency medical services coordination,
effective July 1,2023 through June 30,2024($959,945)
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero
Agreement No.23-636
County of Fresno Page 67
coU�
t Board Agenda Item 65
O 1856 O
DATE: November 28, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement with the California Emergency Medical Services
Authority
RECOMMENDED ACTION(S):
Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California
Emergency Medical Services Authority for multi-county emergency medical services coordination,
effective July 1, 2023 through June 30, 2024($959,945).
There is no Net County Cost associated with the recommended action. Approval of the recommended
action will provide State General Fund revenue for continued emergency medical services coordination of
the four-county region: Fresno, Kings, Madera, and Tulare, pursuant to Section 1797.108 of the California
Health and Safety(H&S)Code. The funding may only be used to maintain and improve the Emergency
Medical Services (EMS)system and continue essential minimum program activities. The recommended
Agreement provides State Funds and requires local program funding from the four counties mentioned
above. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended action, the
Department of Public Health (Department)would be unable to fund personnel and service costs associated
with the administration of the EMS system for the four-county region.
RETROACTIVE AGREEMENT:
The recommended Agreement was received from the California Emergency Medical Services Authority
(EMSA)on September 7, 2023 and is retroactive to July 1, 2023 and is being brought to your Board in
accordance with the agenda item processing timelines.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended
action will provide$959,945 in State General Funds, an increase of$45 from prior year's award for Central
California EMS Agency. The allocation allows for reimbursement of personnel ($443,534),fringe benefits
($164,108), communications ($31,635), and software/software maintenance ($233,402)costs, but limits
reimbursement of indirect costs up to 10% ($87,266). The County's indirect cost rate is 18.314%; the
remaining $72,555 will be covered with Health Realignment. Sufficient appropriations and estimated
revenues are included in the Department's Organization 5620 FY 2023-24 Adopted Budget. There are no
pending invoices related to this retroactive revenue agreement.
DISCUSSION:
County of Fresno Page 1 File Number;23-1106
File Number.-23-1106
As the designated Local EMS Agency (LEMSA) pursuant to H&S, section 1797.108,the Department's
Emergency Services Division, also referred to as the Central California EMS Agency(CCEMSA), has the
responsibility to provide complete oversight and administration of emergency medical services throughout
the four-county region: Fresno, Kings, Madera and Tulare. The County is responsible for all H&S Code,
Division 2.5 local EMS agency functions. The EMSA identifies the following as potential benefits derived
from a regional EMS Agency:
• reducing administrative and program costs;
• standardizing system coordination of emergency response and patient flow;
• focusing of regional EMS concerns;
• providing more effective impacts at the State level; and,
• matching administrative boundaries with natural systems.
The recommended agreement will support existing staffing and services to the entire EMS region and
recovers any Fresno County costs that may have been used to support the administration of services in the
other counties. The additional funding assists in providing dispatch and technology services in the rural
areas of the region.
The recommended agreement for multi-county emergency medical services coordination contains
non-standard termination language as it allows the State to terminate the agreement immediately for cause
and without cause upon giving the County at least 30-days advanced written notice. The County may
submit a written request to terminate the agreement only if the State should substantially fail to perform its
responsibilities in the agreement.
The recommended agreement deviates from the County's standard indemnification and insurance
language and requires the County to indemnify the State of California, EMSA, and/or any of their officers,
agents and/or employees regardless of the existence or degree of negligence or fault.
OTHER REVIEWING AGENCIES:
The Health Directors and Administrative Officers of Kings, Madera, and Tulare Counties support the
continuation of the Central California EMS Agency.
REFERENCE MATERIAL:
BAI #47, November 29, 2022
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Agreement with California Emergency Medical Services Authority
CAO ANALYST:
Ronald Alexander
County of Fresno Page 2 File Number.23-1106
SCOID: 4120-C23023 Agreement No. 23-636
STATE OF CALIFORNIA-DEPARTMENT OF GENERAL SERVICES
STANDARD AGREEMENT AGREEMENT NUMBER PURCHASING AUTHORITY NUMBER(If Applicable)
STD 213(Rev.03/2019) C23-023 EMSA-4120
1.This Agreement is entered into between the Contracting Agency and the Contractor named below:
CONTRACTING AGENCY NAME
Emergency Medical Services Authority(EMSA)
CONTRACTOR NAME
County of Fresno,Acting as the Central California Emergency Medical Services Agency
2.The term of this Agreement is:
START DATE
July 1,2023
THROUGH END DATE
June 30,2024
3.The maximum amount of this Agreement is:
$959,945.00(Nine Hundred Fifty-Nine Thousand Nine Hundred Fourty-Five Dollars and Zero Cents)
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.
Exhibits Title Pages
Exhibit A Scope of Work 8
Attachment Funding Application 15
1
Exhibit B Budget Detail and Payment Provisions 2
+ GTC
Exhibit C* General Terms and Conditions 04/2017
Exhibit D Special Terms and Conditions 4
Exhibit Invoice Template 3
Items s own with an asterisk(*),are hereby incorporated by reference and made part of this agreement as ifattached hereto.
These documents can be viewed athttps•//www.dgs.ca.gov/OLS/Resources
IN WITNESS WHEREOF,THIS AGREEMENT HAS BEEN EXECUTED BY THE PARTIES HERETO.
CONTRACTOR
CONTRACTOR NAME(if other than an individual,state whether a corporation,partnership,etc.)
County of Fresno,Acting as the Central California Emergency Medical Services Agency
CONTRACTOR BUSINESS ADDRESS CITY STATE ZIP
PO Box 11867 Fresno CA 93775
PRINTED NAME OF PERSON SIGNING TITLE
Sal Quintero Chairman,Board of Supervisors County of Fresno
CONTRACTOR AUTHO IZED SIGNATURE DATE SIGNED
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County of Fresno,State of California
By Deputy
Page 1 of 2
SCO ID: 4120-C23023
STATE OF CALIFORNIA-DEPARTMENT OF GENERAL SERVICES
STANDARD AGREEMENT AGREEMENT NUMBER PURCHASING AUTHORITY NUMBER(IfApplicable)
STD 213(Rev.03/2019) C23-023 EMSA-4120
STATE OF CALIFORNIA
CONTRACTING AGENCY NAME
Emergency Medical Services Authority(EMSA)
CONTRACTING AGENCY ADDRESS CITY STATE ZIP
11120 International Drive 2nd Floor Rancho Cordova CA 95670
PRINTED NAME OF PERSON SIGNING TITLE
Elizabeth Basnett Director
CONTRACTING AGENCY AUTHORIZED SIGNATURE DATE SIGNED
1/2/2024
CAL RNIA DEPARTMENT OF GENERAL SERVICES APPROVAL EXEMPTION(If Applicable)
Exempt per: SCM Vol 1,4.04(A)(4)
Page 2 of 2
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 1 of 8
EXHIBIT A
Scope of Work
1. The Contractor (Central California EMS Agency) shall operate and manage a regional
EMS system, and report on accomplished works and duties to Emergency Medical Services
Authority (EMSA), in accordance with Division 2.5 of the Health and Safety Code and Title
22, CCR, Division 9 as described herein.
2. The Contractor shall refer to the EMSA publication #104, "Funding Multicounty EMS
Agencies with State General Funds"to assist in the administration of this contract. The
EMSA#104 can be found at http://www.emsa.ca.gov/Guidelines.
3. The Contractor requesting funding shall have on file a current EMS Plan/Annual update
approved by EMSA.
4. The term of this agreement shall be July 1, 2023 through June 30, 2024.
5. Representatives
All inquiries related to and during the term of this Agreement shall be addressed to the
authorized representatives listed below:
Agency: Contractor:
Emergency Medical Services Authority Central California Emergency Medical Services
Agency
Name: Angela Wise Name: Daniel Lynch
Title: Assistant Chief, EMS Systems Title: Director
Phone: (916) 431-3708 Phone: (559) 600-3387
Fax: Fax: (559) 600-7691
E-Mail: angela.wise@emsa.ca.gov Email: dlynch@fresnocountyca.gov
Direct all administrative inquiries to this agreement to:
Agency: Contractor:
Emergency Medical Services Authority Central California Emergency Medical Services
Agency
Name: Daniel Campbell Name: Daniel Lynch
Title: Contract Analyst Title: Director
Phone: 916-591-2047 Phone: (559) 600-3387
Fax: Fax: (559) 600-7691
Email: Daniel.campbell@emsa.ca.gov Email: dlynch@fresnocountyca.gov
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 2 of 8
EXHIBIT A
Scope of Work
6. Plan/Data Submission
A. The Contractor shall complete and submit an EMS Plan/update annually to EMSA in
compliance with Sections 1797.250 and 1797.254 of the Health and Safety Code. The
annual update shall be determined by EMSA in the agency's last EMS Plan decision.
B. The Contractor that has implemented a specialty care system shall complete and
submit a trauma care system, STEMI/Stroke system, and EMS for Children program
plan and annual updates to EMSA in compliance with Sections 1797.257, 1797.258,
and 1799.205 of the Health and Safety Code, and Chapters 7, 7.1, 7.2, and 14 of
Title 22, CCR, Division 9.
C. The Contractor shall complete and submit a Quality Improvement program and annual
updates to EMSA in compliance with Chapter 12 of Title 22, CCR, Division 9.
D. The Contractor shall regularly provide to EMSA, data it receives consistent with Section
1797.227 of the Health and Safety Code that conforms to EMSA's California EMS
Information System Standards, National EMS Information System, and the California
State EMS Data Set.
7. Audit
A. The Contractor shall have an annual financial audit conducted by an independent or
county auditor covering the fiscal year in which funds were allocated. The copy of
the audit must be received by EMSA by December 31st. (See EMSA publication #104,
"Funding Multicounty EMS Agencies with State General Funds" Section 6.1 - Audit).
B. The final audit shall determine:
1. All costs incurred have been in accordance with the contract and See EMSA
publication #104, "Funding Multicounty EMS Agencies with State General Funds".
2. Proper accounting records have been maintained for the administration of the
multicounty EMS agency and source documents have been filed.
3. All reimbursements have been proper and reflect actual and allowable costs.
4. Physical inventory has been taken of all equipment/property purchased with
State General Fund money. (See EMSA publication #104, "Funding Multicounty
EMS Agencies with State General Funds" See Sections 3.4 and 5.3).
5. Provisions have been made to retain source documents supporting costs
incurred for at least three years after the applicant agency has received final
payment or until any audit exceptions are resolved.
8. Quarterly Reporting
A. First through Fourth Quarter Task Reporting
1. The Contractor shall provide Quarterly Reports to EMSA by the 15th calendar day of
the month following the end of each quarter. The fourth quarter report is due by
August 1 and must include a Supplemental Year-End Data Report.
2. Quarterly Reports must contain a detailed description of work performed, the duties
of all parties, and a summary of activities that have been accomplished during the
quarter to meet the following eight EMS system components.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 3 of 8
EXHIBIT A
Scope of Work
B. Component 1 —System Organization and Management
1. Objective - To develop and maintain an effective management system to meet the
emergency medical needs and expectations of the total population served.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. Staff development, training, and, management.
B. Allocating and maintaining office space, office equipment, and office supplies.
C. Executing and maintaining contracts with member counties, service
providers, consultants, and contractual staff.
D. 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 a 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).
C. Component 2—System Organization and Management
1. 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.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. Ongoing assessment of local training program needs.
B. Authorizing and approving training programs and curriculum for all certification
levels.
C. Providing training programs and classes as needed.
D. Providing ongoing certification/authorization/accreditation or personnel approval
of local scope of practice for all certification levels.
E. Developing and maintaining treatment protocols for all certification levels.
F. Maintaining communication link with Quality Improvement program to assess
performance of field personnel.
G. Conducting investigations and taking action against certification when indicated.
H. Authorizing, maintaining, and evaluating EMS continuing education programs.
D. Component 3—Communications
1. Objective -To develop and maintain an effective communications system that meets
the needs of the EMS system.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. On-going assessment of communications status and needs.
B. Assuring appropriate maintenance of EMS related communications systems.
C. Approving ambulance dispatch centers.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 4 of 8
EXHIBIT A
Scope of Work
D. Providing acceptable procedures and communications for the purpose of
dispatch and on-line medical control.
E. Approving emergency medical dispatch (EMD) training and/or operational
programs.
E. Component 4— Response and Transportation
1. Objective - To develop and maintain an effective EMS response and ambulance
transportation system that meets the needs of the population served.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. Designating EMS responders including first responders, Limited Advanced Life
Support (LALS)/Advanced Life Support (ALS) providers, ambulance providers,
and Prehospital EMS Aircraft providers.
B. Monitoring local ordinances related to EMS.
C. Establishing policies and procedures to the system for the transportation of
patients to trauma centers and/or specialty care hospitals as needed.
D. Implementing and maintaining contracts with providers.
E. Creating exclusive operating areas
F. Component 5— Facilities and Critical Care
1. Objective - To establish and/or identify appropriate facilities to provide for the
standards and care required by a dynamic EMS patient care delivery system.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. Designating base hospital(s) or alternate base stations for on-line medical control
and direction.
B. Identifying ambulance receiving centers including hospitals and alternative
receiving facilities in rural areas.
C. Identifying and designating, as needed, trauma centers and other specialty care
facilities.
D. Periodically assessing trauma system and plan as needed.
E. Coordinating trauma patients to appropriate trauma center(s) or approved
receiving hospitals.
F. Periodically assessing hospitals (e.g., pediatric critical care centers, emergency
departments approved for pediatrics, other specialty care centers).
G. Completing hospital closure impact reports.
G. Component 6— Data Collection and System Evaluation
1. Objective - To provide for appropriate system evaluation through the use of quality
data collection and other methods to improve system performance and evaluation.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. Reviewing reportable incidents.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 5 of 8
EXHIBIT A
Scope of Work
B. Reviewing prehospital care reports including Automated External Defibrillators
(AED) reports.
C. Processing and investigating quality assurance/improvement incident reports.
D. Monitoring and reporting on EMS System Core Measures by March 31 st each
year and acknowledging completion of the monitoring and reporting as of
March 31 st each year.
E. Providing data to CEMSIS monthly.
F. Implementing Health and Safety Code Section 1797.227, including providing
data using the current versions of NEMSIS and CEMSIS standards from
Electronic Health Records (EHR).
G. Engaging healthcare partners and Health Information Organizations in your
jurisdiction in discussions and planning efforts to integrate EMS into developing
health information exchange networks that promote interoperability and the use
of the Search, Alert, File, Reconcile Model.
H. Component 7— Public Information and Education
1. 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.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. Information and/or access to CPR and first-aid courses taught within the EMS
system.
B. Involvement in public service announcements involving prevention or EMS
related issues.
C. Availability of information to assist the population in catastrophic events, as
appropriate.
D. Participating in public speaking events and representing the EMS Agency during
news events and incidents.
E. Seeking opportunities to collaborate with key partners, including local public
health and other community organizations, to promote healthcare and injury
prevention activities
I. Component 8— Disaster Medical Response
1. Objective -To collaborate with the Office of Emergency Services, Public Health and
EMS responders in the preparedness and response of the region's EMS systems in
the event of a disaster or catastrophic event within the regions or a neighboring
jurisdiction.
2. Tasks: The responsibilities of the Contractor shall include, at a minimum:
A. Participating in disaster planning, training, and exercises as needed.
B. Identifying disaster preparedness, mitigation, response and recovery needs, as
requested.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 6 of 8
EXHIBIT A
Scope of Work
C. Coordinating the Medical Health Operational Area Coordination (MHOAC)
Program or coordinating with the MHOAC Program of the affected
county/counties, as appropriate.
D. Coordinating the Regional Disaster Medical Health Coordinator (RDMHC)
Program or coordinating with the RDMHC Program within the member
county/county's California Office of Emergency Services mutual aid region.
E. Developing policies and procedures for EMS personnel in response to a multi-
casualty or disaster incident.
F. Participating in the development of mutual aid agreements, as requested.
G. Collaborating with EMS providers on Incident Command Systems (ICS) and
Standardized Emergency Management System (SEMS) training as requested.
H. Providing opportunities/exercises for Ambulance Strike Team Leader Trainees to
complete their Position Task Books (PTB), as available.
9. Supplemental Year End Data Reporting
A. The Supplemental Year-End Data Report is due to EMSA by August 1, and must be
submitted with the 4th Quarter Task Report.
B. The Supplemental Year-End Data Report must include year-end data for the
individual workload indicators.
C. Component 1 —System Organization and Management
1. Objective -To develop and maintain an effective management system to meet the
emergency medical needs and expectations of the total population served.
2. Workload indicators shall include:
A. Total static population served (Determined by DOF estimates).
B. Total annual tourism population (Determined by identified sources).
C. Number of counties.
D. Geographic size of region (in square miles).
D. Component 2—Staffing and Training
1. 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.
2. Workload indicators shall include:
A. Total number of personnel certified/authorized/accredited by EMS agency.
B. Total number and type of training programs approved by EMS agency
C. Total number and type of training programs conducted by EMS agency.
D. Total number of continuing education providers authorized by EMS agency.
E. Component 3 — Communications
1. Objective -To develop and maintain an effective communications system that
meets the needs of the EMS system.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 7 of 8
EXHIBIT A
Scope of Work
2. Workload indicators shall include:
A. Total number of primary and secondary Public Safety Answering Points.
B. Total number of EMS responses.
C. Total number of EMD training programs approved by EMS agency.
D. Total number and type of EMD programs authorized by EMS agency.
F. Component 4— Response and Transportation
1. Objective -To develop and maintain an effective EMS response and ambulance
transportation system that meets the needs of the population served.
2. Workload indicators shall include:
A. Total ambulance response vehicles.
B. Total first responder agencies.
C. Total patients transported.
D. Total patients not transported (e.g., treated and released, total dry runs).
E. Total number of LALS/ALS providers authorized by EMS agency.
F. Total number of transport providers in region.
G. Component 5— Facilities and Critical Care
1. Objective -To establish and/or identify appropriate facilities to provide for the
standards and care required by a dynamic EMS patient care delivery system.
2. Workload indicators shall include:
A. Total patients received.
B. Total number of hospitals designated by EMS agency (e.g., base, receiving,
trauma, STEMI, stroke, PCCC, EDAP/(PedRC), and PICU).
H. Component 6— Data Collection and System Evaluation
1. Objective -To provide for appropriate system evaluation through the use of
quality data collection and other methods to improve system performance and
evaluation.
2. Workload indicators shall include:
A. Total patient care reports generated.
B. Total trauma patients.
C. Total cardiac patients
D. Total medical patients.
E. Total pediatric patients.
F. Total number of situational/unusual occurrence reports processed by EMS
agency.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 8 of 8
EXHIBIT A
Scope of Work
G. Component 7— Public Information and Education
1. 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.
2. Workload indicators shall include:
A. Total number of public information and education courses approved by EMS
agency.
B. Total number of public information and education courses conducted by EMS
agency.
C. Total number of public information and education events involving EMS
agency.
H. Component 8— Disaster Medical Response
1. Objective -To collaborate with the Office of Emergency Services, Public Health
and EMS responders in the preparedness and response of the region's EMS
systems in the event of a disaster or catastrophic event within the regions or a
neighboring jurisdiction.
2. Workload indicators shall include:
A. Total number of Disaster/Multiple Casualty Incident (MCI) Responses
(response with 5 or more victims).
B. Total number of disaster drills involving staff.
C. Total disaster-related meetings attended by staff.
ATTACHMENT 1
vFunding Application
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Application
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STATE GENERAL FUND ALLOCATION
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Daniel J Lvnch
EMS Director
James Andrews,1�1.D.
EMS Medical Director
Fresno County
Dept of Public Health
1221 Fulton St
P.O.Box 11867
Fresno CA 9377�
(559 j 600-3387
Fax(559)60U-7691
www.ccemsa.ore
EMS AGENCY MISSION STATEMENT
The EMS Agency is committed to the needs of the multicounty pre-hospital
environment. Our mission is to inspire, educate, evaluate, direct, provide
resources, and ensure that each citizen receives the highest level of care.
Our goals are to facilitate an environment of collaboration among all providers
and agencies in which there is innovation, purpose, standardized care, proactive
technologies, preparedness, coordination, and integration.
Our values are honesty, loyalty, equality, originality, integrity, and communication.
INTRODUCTION
AWO" ac,� The funding provided by the State of California EMS Authority greatly assists the
',,�° EMS Agency in maintaining a level of commitment to each of these counties and
provides a standard level of care that may not be possible without this assistance.
( Daniel J. Lynch
This application to the State of California reducing patient volume in local emergency
Emergency Medical Services Authority is for the departments. This includes furthering the use of
continuation of State General Fund assistance Basic Life Support ambulances to handle
for the planning, implementation, and prehospital requests and many non-emergency
maintenance of a multi-county EMS system.The requests for ambulance service that data has
Fresno County Department of Public Health is shown not to require the use of a
the designated local EMS Agency for the paramedic ambulance. In recent years, the EMS
Counties of Fresno, Kings, Madera and Tulare Agency reduced code 3 responses by nearly
Counties. Through specific agreements 40% by conducting an in-depth study of
between each County, this integrated EMS responses, which resulted in reducing many
system provides 100% paramedic coverage with lights and sirens responses to non-lights and
consolidated resources of both public and sirens responses. Today, only 51% of EMS calls
private provider agencies. The development of are dispatched with red lights and sirens,which
regional policies and procedures assures that is significantly below the industry averages.
out of hospital care and procedures are
consistent and that patients throughout the The EMS agency's continuing challenge is to
region are receiving quality patient care. assure that the integrity of the EMS System
remains intact.The EMS system continues to
Significant changes are occurring in healthcare move forward and plans are in place to further
and the Emergency Medical Services has an enhance the quality level of care provided
increasing role in the delivery of prehospital and throughout the EMS region. The funding
"out-of-hospital"care. The response to the provided by the State of California greatly
COVID19 pandemic has tested the strength and assists the EMS Agency in maintaining this level
flexibility of the EMS system and the region has of commitment to each of these counties and
responded very well. As we move past the provides a standard level of care that may not
pandemic and its impact on our healthcare be possible without this assistance.
systems, we are working hard to return to
"normal", which is a "new normal"since the The Central California EMS Agency is prepared
impact that the COVID pandemic has had on the to meet the challenges of the coming year. With
health care systems has created challenges to the challenges come opportunities and the
EMS systems that will mandate changes in how CCEMSA will be aggressively pursuing any
the delivery of emergency care is provided in the changes that will continue to protect the citizens,
future. EMS systems still continue to find continue the provision of excellent prehospital
themselves in an awkward position of care, and expand the development of out-of-
developing changes in the delivery model of hospital care.
prehospital care, while at the same time trying to
protect the EMS system from expansion of
traditional services and roles that are no longer
needed. EMS systems are looking towards
healthcare models that further decrease the Daniel J. Lynch
number of patients accessing emergency EMS Director
departments. The CCEMSA has implemented
several changes over the past few years with
the sole focus of trying to keep paramedic
ambulances available to the EMS system and
CCEMSA-2023/24 Regional Funding Application Page I
SCOPE OF WORK
SCOPE OF WORK
The multicounty EMS agency shall operate and manage a regional EMS system, and report on
accomplished work and duties to EMSA, in accordance with Division 2.5 of the Health and Safety Code
and Title 22, CCR, Division 9. Refer to EMSA#104 "Funding Assistance Manual: Multicounty EMS
Agencies Using State General Funds" for funding criteria and requirements. EMSA#104 can be
accessed at https://emsa.ca.gov/multicounty-info/.
PLAN/DATA SUBMISSION
The multicounty EMS agency must complete and submit an EMS Plan/update annually to EMSA in
compliance with Sections 1797.250 and 1797.254 of the Health and Safety Code. The annual update
is determined by EMSA in the agency's last EMS Plan decision.
A multicounty EMS agency that has implemented a specialty care system must complete and submit a
trauma care system, STEMI/Stroke system, and EMS for Children program plan and annual updates to
EMSA in compliance with Sections 1797.257, 1797.258, and 1799.205 of the Health and Safety Code,
and Chapters 7, 7.1, 7.2, and 14 of Title 22, CCR, Division 9.
The multicounty EMS agency must complete and submit a Quality Improvement program and annual
updates to EMSA in compliance with Chapter 12 of Title 22, CCR, Division 9.
The multicounty EMS agency shall regularly provide to EMSA, data it receives consistent with Section
1797.227 of the Health and Safety Code that conforms to EMSA's California EMS Information System
Standards, National EMS Information System, and the California State EMS Data Set.
AUDIT
The multicounty EMS agency shall have an annual financial audit conducted by an independent or
county auditor covering the fiscal year in which funds were allocated. The copy of the audit must be
received by EMSA by December 31st. (See Section 6.1 -Audit)
The final audit shall determine:
• All costs incurred have been in accordance with the contract and EMSA#104.
• Proper accounting records have been maintained for the administration of the multicounty
EMS agency and source documents have been filed.
• All reimbursements have been proper and reflect actual and allowable costs.
• Physical inventory has been taken of all equipment/property purchased with State General
Fund money. (See Sections 3.4 and 5.3)
• Provisions have been made to retain source documents supporting costs incurred for at least
three years after the applicant agency has received final payment or until any audit exceptions
are resolved.
2023/24 Regional Funding Application Page 2
QUARTERLY REPORTING - 1st THROUGH 4th QUARTER TASK REPORTS
Quarterly Reports are due to EMSA by the 15th calendar day of the month following the end of each
quarter. The fourth quarter report is due by August 1st, and must include a Supplemental Year-End
Data Report.
Quarterly Reports must contain a detailed description of work performed, the duties of all parties, and a
summary of activities that have been accomplished during the quarter to meet the following eight EMS
system components.
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.
Tasks: The responsibilities of the 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 a 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)
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.
Tasks: The responsibilities of the 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
Continued on Next Page
Component 3 - Communications
Objective - To develop and maintain an effective communications system that meets the needs of the
EMS system.
Tasks: The responsibilities of the 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.
Tasks: The responsibilities of the EMS agency, at a minimum, include:
• Designating EMS responders including first responders, Limited Advanced Life Support
(LALS)/Advanced Life Support (ALS) providers, ambulance providers, and Prehospital EMS
Aircraft 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 and enforcing 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.
Tasks: The responsibilities of the 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 in
rural areas
• Identifying and designating, as needed, trauma centers and other specialty care facilities
• Periodically assessing specialty care system and plan(s) as needed
• Coordinating specialty care patients to appropriate specialty care center(s) or approved
receiving hospitals
• Periodically assessing hospitals (e.g., trauma centers, STEMI centers, stroke centers, pediatric
critical care centers (PCCC), emergency departments approved for pediatrics (EDAP)/pediatric
receiving centers (PedRC), pediatric intensive care unit (PICU)
• Completing hospital closure impact reports
2023/24 Regional Funding Application Page 4
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.
Tasks: The responsibilities of the EMS agency, at a minimum, include:
• Reviewing reportable incidents
• Reviewing prehospital care reports including Automated External Defibrillator (AED) reports
• Processing and investigating quality assurance/improvement incident reports
• Monitoring and reporting on EMS System Core Measures by March 31 st each year, and
acknowledging completion of the monitoring and reporting as of March 31 st each year
• Providing near real time data to CEMSIS, or at no less than monthly intervals
• Implementing Health and Safety Code Section 1797.227, including providing data from
Electronic Health Records (EHR) using the current NEMSIS and CEMSIS version standards
• Engaging healthcare partners and Health Information Organizations in your jurisdiction in
discussions and planning efforts to integrate EMS into developing health information exchange
networks that promote interoperability and the use of the Search, Alert, File, Reconcile Model
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.
Tasks: The responsibilities of the 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 EMS agency during news events
and incidents
• Seeking opportunities to collaborate with key partners, including local public health and other
community organizations, to promote healthcare and injury prevention activities
Component 8 - Disaster Medical Response
Objective - To collaborate with the affected county/county's Office of Emergency Services, public health
department(s), and EMS responders in the preparedness and response of the region's EMS system in
the event of a disaster or catastrophic event within the affected operational area, region, or neighboring
jurisdictions.
Tasks: The responsibilities of the EMS agency, at a minimum, include:
• Participating in disaster planning, training, and exercises, as needed
• Identifying medical disaster preparedness, mitigation, response, and recovery needs, as
requested
• Coordinating the Medical Health Operational Area Coordination (MHOAC) Program or
coordinating with the MHOAC Program of the affected county/counties, as appropriate
• Coordinating the Regional Disaster Medical Health Coordination (RDMHC) Program or
coordinating with the RDMHC Program within the member county/county's California Office of
Emergency Services mutual aid region
• Developing policies and procedures for EMS personnel in response to multicasualty or disaster
incidents
• Participating in the development of mutual aid agreements, as requested
• Collaborating with EMS providers on Incident Command Systems (ICS) and Standardized
Emergency Management System (SEMS) training, as requested
• Providing opportunities/exercises for Ambulance Strike Team Leader Trainees to complete their
Position Task Books (PTB), as available
SUPPLEMENTAL YEAR-END DATA REPORT
The Supplemental Year-End Data Report is due to EMSA by August 1 st, and must be submitted with
the 4th Quarter Task Report. The Supplemental Year-End Data Report must include year-end data for
the individual workload indicators.
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.
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.
Workload Indicators:
• Total number of personnel certified/authorized/accredited by EMS agency
• Total number and type of training programs approved by EMS agency
• Total number and type of training programs conducted by EMS agency
• Total number of continuing education providers authorized by EMS agency
Continued on Next Page
2023/24 Regional Funding Application Page 6
Component 3 - Communications
Objective - To develop and maintain an effective communications system that meets the needs of the
EMS system.
Workload Indicators:
• Total number of primary and secondary Public Safety Answering Points
• Total number of EMS responses
• Total number of EMD training programs approved by EMS agency
• Total number and type of EMD programs authorized by 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.
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 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.
Workload Indicators:
• Total patients received
• Total number of hospitals designated by EMS agency (e.g., base, receiving, trauma, STEMI,
stroke, PCCC, EDAP/(PedRC), and PICU)
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.
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 EMS agency
2023/24 Regional Funding Application Page 7
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.
Workload Indicators:
• Total number of public information and education courses approved by EMS agency
• Total number of public information and education courses conducted by EMS agency
• Total number of public information and education events involving EMS agency
Component 8 - Disaster Medical Response
Objective - To collaborate with the affected county/county's Office of Emergency Services, public health
department(s), and EMS responders in the preparedness and response of the region's EMS system in
the event of a disaster or catastrophic event within the affected operational area, region, or neighboring
jurisdictions.
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
2023/24 Regional Funding Application Page 8
BUDGET
BUDGET
STATE GENERAL FUND
BUDGET CATEGORIES LOCAL FUNDS TOTAL
Base ENY 2022 BCP
Personnel $282,645 $160,889 $870,518 $1,314,052
*Fringe Benefits $104,579 $59,529 $751,065 $915,173
Professional Services $0 $0 $0 $0
Communications $0 $31,635 $528,224 $559,859
Materials & Supplies $0 $0 $0 $0
Space $0 $0 $0 $0
Software/Software Maintenance $0 $233,402 $318,278 $551,680
Total Direct Costs $387,224 $485,455 $2,468,085 $3,340,764
Administrative/Indirect 10% of Total Direct $38,721 $48,545 $0 $87,266
Costs
**Unreimbursed Indirect Cost(Local
funding includes $72,555 unreimbursable $0 $0 $72,555 $72,555
indirect cost for the portion of 8.314% over
the allowable
10%from State General Fund)
$0 $0 $452,005 $452,005
TOTAL COSTS $425,945 $534,000 $2,992,645 $3,952,590
*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 18.816%.
PROGRAM FUNDING
STATE GENERAL FUND
PROGRAM FUNDING LOCAL FUNDS TOTAL
Base ENY 2023 BCP
State General Fund $425,945 $534,000 $0 $959,945
Kings County $0 $0 $53,874 $53,874
Madera County $0 $0 $53,874 $53,874
Tulare County $0 $0 $53,874 $53,874
Fresno County $0 $0 $2,831,023 $2,831,023
TOTALS $425,945 $534,000 $2,992,645 $3,952,590
Budget Detail/Narrative
Personnel:
The following positions are funded under this agreement.
Dale Dotson, EMS Coordinator 1.0 FTE 2080 hours $38.8375 1 $80,782
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.
Mato Parker, EMS Coordinator 1.0 FTE 2080 Hours @$38.8375 $80,782
Responsible for overall management of continuous quality improvement in Fresno, Kings, Madera,
and Tulare Counties. Responsibilities include oversight of data collection and evaluation, quality
assurance reporting, and monitoring of s eci Ity care centers trauma, STEMI, stroke
Curtis Jack, EMS Coordinator 0.4015 FTE r832.811hours @ 38.8375 $32,344
Responsible for Disaster Medical Services for the EMS region,which includes coordination with
ambulance providers, hospitals and allied agencies in disaster response and preparedness.
Doug Loera, Staff Analyst 1.0 FTE 2080 hours @$34.6966 $72,169
Responsible for administrative functions of the EMS agency.
John Cardona, EMS Specialist 1.0 FTE 2080 hours @$35.35 $73,528
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.
Luis Barrera, EMS Specialist 1.0 FTE 2080 Hours @$35.35 $73,528
Responsible for Kings/Madera operations and oversight, which includes ambulance inspections,
performance reviews, contract compliance evaluations, performance and appeal investigation, EMCC
preparation, system performance reports, and attendance at EMS related meetings. 100% of his
salary is paid for with State GF.
Gina Alonso , Office Assistant III 0.75 FTE j 1560 hours @$19.4878 $30,401
Responsible for clerical support for the operations division, which includes miscellaneous
administrative support, meeting minutes, purchasing and inventory, requisition management, and
correspondence materials. 75% of this salary is paid for with State GF.
Note: Personnel listed above are funded through the funds listed in Program Funding
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Benefit Amount Percent
Unemployment Insurance $459 0.11%
Retirement $276,925 63.52%
OASDI contribution $37,030 7.650%
Workers Compensation $3,625 Flat Rate*
Health Insurance $81,027 Flat Rate**
Benefits Administration $932 Flat Rate ***
Total ****399,998
*Workers Compensation is estimated at a flat rate of$537 per FTE.
**Health Insurance is estimated at a flat rate of$10,409 per FTE.Employees with dependent coverage is$13,280 and is based on
annual open enrollment information.
***Benefit administration is$138 per FTE.
****The Actual cost of fringe benefits is$399,998.The State Agreement limits fringe benefit costs to 37%(or$164,108)of total
personnel costs.The remaining difference will be covered by local funds.
Budget Detail
We are very appreciative of the BCP funding from the State. It has given us great relief and allows us to maintain
service levels across the region. Funding this year continues to be allocated to the original justified areas. Priority
areas have been targeted with funding allocations that are not expected to change in the subsequent years.
Communications—This cost represents the current county cost for radio access charges for EMS
Communications. This amount accounts for approx. 25 radios used in the rural and partner counties at a rate of
$105.45 per radio/per month.
Software/Software Maintenance-This cost represents a portion of the ongoing computer aided dispatch
software and software annual maintenance costs for partner counties and rural communities.The budgeted cost
represents the EMS Communications Center annual software maintenance cost for the Central Square Dispatch
System and software, which provides the primary dispatch for the EMS Region.
Data Collection and Evaluation software is currently in the process of being purchased through one-time grant
funds.The pursuit of grant funds for this item was initiated once it was verified that the BCP funds would be
approved. The BCP funding will be used to provide support costs for the new data collection and evaluation
software.
Administrative/Indirect Cost:
Fresno County has chosen to claim the 10% overhead/indirect cost allowed by the State. The 18.314% of indirect
cost rates are currently applied in Fresno County, and the cost includes administrative support, departmental
support and county overhead. Since the agreement is limited to 10% indirect cost, Fresno County will assume
the responsibilities of the unreimburseable 8.314% indirect costs.
2023/24 Regional Funding Application Page 12
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Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 1 of 2
EXHIBIT B
Budget Details and Provisions
1. Invoicing and Payment
A. For services satisfactorily rendered and approved by the EMSA Contract Manager, and
upon receipt and approval of the invoices, EMSA agrees to compensate the Contractor
in accordance with the Funding Application, Attachment 1 and this Exhibit B.
Incomplete or disputed invoices shall be returned to the Contractor, unpaid, for
correction.
B. Invoices shall be itemized in accordance with the Funding Application, Attachment 1,
and shall be signed and submitted on company letterhead in triplicate not more
frequently than monthly in arrears of the service.
C. Each invoice shall include:
1) Agreement Number
2) Time Period Covered
3) Invoice Number
4) Bill to Address
5) Remit to Address
6) 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, and any required reports.
D. Invoices shall be submitted in triplicate to:
Emergency Medical Services Authority
Attn: Angela Wise
Agreement Number:C23-023
11120 International Drive 2"d Floor
Rancho Cordova, CA 95670
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 EMSA does not approve the
invoice in accordance with identified general tasks or deliverables in this contract, payment
of the invoice will be withheld by EMSA 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 EMSA that the Contractor has successfully completed the
scheduled work for each general task or deliverable before payment will be made.
2. Budget Contingency Clause
A. It is mutually understood between the parties that this Agreement may have been written
before ascertaining the availability of congressional or legislative appropriation of funds,
for the mutual benefit of both parties in order to avoid program and fiscal delays that
would occur if the Agreement were executed after that determination was made.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 2 of 2
EXHIBIT B
Budget Details and Provisions
B. This Agreement is valid and enforceable only if sufficient funds are made available to the
State of California by the United States Government or the California State Legislature
C. for the purpose of this program. In addition, this Agreement is subject to any additional
restrictions, limitations, conditions, or any statute enacted by the Congress or the State
Legislature that may affect the provisions, terms or funding of this Agreement in any
manner.
D. It is mutually agreed that if the Congress or the State Legislature does not appropriate
sufficient funds for the program, this Agreement shall be amended to reflect any
reduction in funds.
E. Pursuant to Government Code, Section 927.13, no late payment penalty shall accrue
during any time period for which there is no Budget Act in effect, nor on any payment or
refund that is the result of a federally mandated program or that is directly dependent
upon the receipt of federal funds by a state agency.
F. In accordance with Health and Safety Code Section 1797.110, the Emergency Medical
Services Authority may provide advance payment to the Contractor. An advance
payment shall not exceed 25 percent of the total annual contract amount.
3. 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.
4. Cost Limitation
Total amount of this Agreement shall not exceed $959,945.00
5. Rates
Rates for these services may be found on Funding Application, Attachment 1 of this
document.
6. 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. EMSA will pay for any applicable State or local sales
or use taxes on the services rendered or equipment or parts supplied pursuant to this
Agreement. EMSA may pay any applicable sales and use tax imposed by another state.
7. Cost Principles
A. The Contractor agrees that the Cost Principles and Procedures in 48 Code of Federal
Regulations (CFR), Part 31, and the Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards, in 2 CFR, Part 200, shall be
used to determine the allowable individual items of cost.
B. Any costs for which payment has been made to the Contractor that are determined by
subsequent audit to be unallowable under 48 CFR, Part 31 or 2 CFR, Part 200 are
subject to repayment by Contractor to EMSA.
C. Any subcontract entered into as a result of this Agreement shall contain all of the
provisions of this Section.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 1 of 4
EXHIBIT D
Special Terms and Conditions
1. Settlement of Disputes
A. Any dispute arising under this Agreement that is not disposed of by Agreement shall be
decided by the EMSA Contract Officer, who may consider any written or verbal evidence
submitted by the Contractor. The decision of the Contract Officer, issued in writing, shall
be EMSA'final decision on the dispute.
B. Neither the pendency of a dispute nor its consideration by the Contract Officer will
excuse the Contractor from full and timely performance in accordance with the terms of
the Agreement.
2. Termination
A. If, after award and execution of the Agreement, the Contractor's performance is
unsatisfactory, the Agreement may be terminated for default. Additionally, the Contractor
may be liable to EMSA for damages including the difference between the Contractor's
original bid price and the actual cost of performing the work by another Contractor.
Default is defined as the Contractor failing to perform services required by the
Agreement in a satisfactory manner.
B. EMSA reserves the right to terminate this Agreement for any or no cause upon 30 days
written notice to the Contractor or immediately in the event of default or material breach
by the Contractor.
C. The State may terminate this Agreement immediately for good cause. The term "good
cause" may be defined as "impossibility of performance" or"frustration of purpose," but
does not include material breach, default, or termination without cause. In this instance,
the Agreement termination shall be effective as of the date indicated on the State's
notification to the Contractor.
D. In the event that the total Agreement amount is expended prior to the expiration date,
EMSA may, at its discretion, terminate this Agreement with thirty (30) days' notice to
Contractor.
3. Subcontractors
The Contractor shall perform the work contemplated with resources available within its own
organization and no portion of the work shall be subcontracted.
4. Retention of Records/Audits
A. For the purpose of determining compliance with Government Code Section 8546.7, the
Contractor and Subcontractors shall maintain all books, documents, papers, accounting
records, and other evidence pertaining to the performance of the Agreement, including but
not limited to, the costs of administering the Agreement. All parties shall make such
materials available at their respective offices at all reasonable times during the Agreement
period and for three years from the date of final payment under the Agreement. The State,
the State Auditor, or any duly authorized representative of the Federal government having
jurisdiction under Federal laws or regulations (including the basis of Federal funding in
whole or in part)shall have access to any books, records, and documents of the Contractor
that are pertinent to the Agreement for audits, examinations, excerpts, and transactions,
and copies thereof shall be furnished if requested.
B. Any subcontract entered into as a result of this Agreement shall contain all the provisions of
this clause.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 2 of 4
EXHIBIT D
Special Terms and Conditions
5. Assumption of Risk and Indemnifications Regarding Exposure to Environmental
Health Hazards
In addition to and not a limitation of the Contractor's indemnification obligations contained
elsewhere in this Agreement, the Contractor hereby assumes all risks of the consequences
of exposure of Contractor's employees, agents, Subcontractors, Subcontractors'
employees, and any other person, firm, or corporation furnishing or supplying work
services, materials, or supplies in connection with the performance of this Agreement, to
any and all environmental health hazards, local and otherwise, in connection with the
performance of this Agreement. Such hazards include, but are not limited to, bodily injury
and/or death resulting in whole or in part from exposure to infectious agents and/or
pathogens of any type, kind, or origin. Contractor also agrees to take all appropriate safety
precautions to prevent any such exposure to Contractor's employees, agents,
Subcontractors, Subcontractors' employees, and any other person, firm, or corporation
furnishing or supplying work services, materials, or supplies in connection with the
performance of this Agreement. Contractor also agrees to indemnify and hold harmless
EMSA, the State of California, and each and all of their officers, agents, and employees,
from any and all claims and/or losses accruing or resulting from such exposure. Except as
provided by law, Contractor also agrees that the provisions of this paragraph shall apply
regardless of the existence or degree of negligence or fault on the part of EMSA, the State
of California, and/or any of their officers, agents and/or employees.
6. Mandatory Organic Waste Recycling
It is understood and agreed that pursuant to Public Resources Code 42649.8 et. seq., if
Contractor generates four (4) cubic yards or more of organic waste or commercial solid
waste per week, the Contractor shall arrange for organic waste or commercial waste
recycling services that separate/source organic waste for organic waste recycling.
Contractor shall provide proof of compliance, i.e. organic waste recycling services or
commercial waste recycling services that separate/source organic waste recycling, upon
request from the EMSA Contract Manager
7. Force Majeure
Except for defaults of Subcontractors, neither party shall be responsible for delays or
failures in performance resulting from acts beyond the control of the offending party. Such
acts shall include but shall not be limited to acts of God, fire, flood, earthquake, other natural
disaster, nuclear accident, strike, lockout, riot, freight embargo, public regulated utility, or
governmental statutes or regulations superimposed after the fact. If a delay or failure in
performance by the Contractor arises out of a default of its Subcontractor, and if such
default of its Subcontractor, arises out of causes beyond the control of both the Contractor
and Subcontractor, and without the fault or negligence of either of them, the Contractor shall
not be liable for damages of such delay or failure, unless the supplies or services to be
furnished by the Subcontractor were obtainable from other sources in sufficient time to
permit the Contractor to meet the required performance schedule.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 3 of 4
EXHIBIT D
Special Terms and Conditions
8. Employment of Undocumented Workers
By signing this contract, the Contractor swears or affirms that it has not, in the preceding five
years, been convicted of violating a State or Federal law relative to the employment of
undocumented workers
9. General Provisions Required in all Insurance Polices
A. Deductible: Contractor is responsible for any deductible or self-insured retention
contained within the insurance program.
B. Coverage Term: Coverage must be in force for the complete term of this Agreement. If
insurance expires during the term of this Agreement, a new certificate must be received
by the EMSA Contract Manager at least ten (10) days prior to the expiration of the
insurance. Any new insurance must continue to comply with the original terms of this
Agreement.
C. Policy Cancellation or Termination and Notice of Non-Renewal: Contractor shall provide,
to the EMSA Contract Manager within five (5) business days, following receipt by
Contactor, a copy of any cancellation or non-renewal of insurance required by this
Agreement. In the event Contractor fails to keep, in effect at all times, the specified
insurance coverage, the State may, in addition to any other remedies it may have,
terminate this Agreement upon the occurrence of such event, subject to the provisions of
this Agreement.
D. Primary Clause: Any required insurance contained in this Agreement shall be primary,
and not excess or contributory, to any other insurance carried by the State.
E. Inadequate Insurance: Inadequate or lack of insurance does not negate the Contractor's
obligations under this Agreement.
F. Endorsements: Any required endorsements requested by the State must be physically
attached to all requested certificates of insurance and not substituted by referring to
such coverage on the certificate of insurance.
G. Insurance Carrier Required Rating: All insurance companies must carry a rating
acceptable to the DGS, Office of Risk and Insurance Management (GRIM). If the
Contractor is self-insured for a portion or all of its insurance, review of financial
information including a letter of credit may be required. DGS, ORIM Website:
https://www.dgs.ca.gov/ORIM.
H. Contractor shall include all of its subcontractors as insureds under Contractor's
insurance or supply evidence of insurance to the State equal to the policies, coverages
and limits required of Contractor.
I. The State will not be responsible for any premiums or assessments on the policy.
10. Insurance Requirements
A. Commercial General Liability
1) Contractor shall maintain general liability on an occurrence form with limits not less
than $1,000,000 per occurrence and $2,000,000 aggregate for bodily injury and
property damage liability. The policy shall include coverage for liabilities arising out of
premises, operations, independent contractors, products, completed operations,
personal and advertising injury, and liability assumed under an insured Agreement.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 4 of 4
EXHIBIT D
Special Terms and Conditions
This insurance shall apply separately to each insured against whom claim is made or
suit is brought subject to the Contractor's limit of liability. The policy must include:
EMSA , State of California, its officers, agents, employees and servants are
included as additional insured but only with respect to work performed under this
Agreement.
2) This endorsement must be supplied under form acceptable to DGS, ORIM.
11. Licenses and Permits
A. The Contractor shall be an individual or firm qualified to do business in California and
shall obtain at its expense all license(s) and permit(s) required by law for any work under
this Agreement.
B. If Contractor is a California or foreign corporation, Contractor must be registered and
active/in good standing with the California Secretary of State.
C. If the Contractor is any other business entity, Contractor must be registered and active/in
good standing with the California Secretary of State, to the extent applicable.
D. In the event any license(s) and/or permit(s) expire at any time during the term of this
Agreement, Contractor agrees to provide EMSA Contract Manager a copy of the
renewed license(s) and/or permit(s)within thirty (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
Agreement upon occurrence of such event.
12. Prohibition of Delinquent Taxpayers
Public Contract Code Section 10295.4 prohibits the State from entering into an Agreement
for goods or services with any taxpayer, whose name appears on either list maintained by
the State Board of Equalization or the Franchise Tax Board pursuant to Revenue and
Taxation Code sections 7063 and 19195, respectively, of the 500 largest tax delinquencies.
Public Contract Code Section 10295.4 provides no exceptions to these prohibitions.
Central California Emergency Medical Services Agency
Agreement Number: C23-023
Page 1 of 3
EXHIBIT E
Template Invoice
STA T E OF C ALI FORN IA
EMERGENC Y WZ01 CAL SERV ICES AUTHORIT-Y
FAR 5�)13 I-Kev.7.2U23)
0--
STATE OF CALIFORNIAEMERGENCY MEDICAL SERVICES AUTHORITY REIMBURSEMENT INVOICE
To: Emergency Medical Services Authority Invoice Date
11120 Internationa[ Dri,✓e;2nd Floor Contract Number
Rancho Cordova; CA 95670 Invoice Number
Attention: Angela Wise Invoice Period
Invoiced Amouni $Q
From Agency Name
Person
Address
Phone
Email
Purpose of this invoice is to reimburse the Contractor for actual expenditures associated with the Contract
above.Supporting documentation of requested reimbursement.reeds to be kept by the contractor.which
includes subcontractors documentation and made available to E',ASA upon request.Invoices wRh stuffing
expenditures must include supporting documentation,
1 ce&Fy that l am the duly appointed and acting officer of the herein named agency and the costs being
claimed herein are in a1i respects op-le, correct, and in accordance with the contract provisions,,that funds
were expended or obligated during the contract period,and the amount claimed above has not
previously presented to or reimbursed by the Emergency Medicaf Services authority(EMSA).
Request niust be sinned by the Contractor;Person with Signature A.utf-jority listed in the approved contract.
Sianature: Title:
PFIn Ted
Nance: Fia7e:
For EMSA Use Qnty
Reinibursc•ment Request has been reviewed and 1 recommend payment of the requested amount.
Sianature: Title:
Printed
Nance. Gave:
California EMS Authority
(Rev. 7/23)
SATE OF CAUFORNIA
EA;ERGEYCY AIMICAL SERVICES AUTHORITY
FArr5DIB 4_v.V2rr23j
invoice L7etaiis
Agency game :fate General Fund
Ba;e LCP Local Funds Total Invoiced
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General Expense
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Communications
Postage
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Travel Out-of-State
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California EMS Authority
(Rev. 7/23)
STATE OF CALIFORNIA.
EV,ERGENCY I,IDI CAL SERV It:ES AUTHORITY
FAIT&Di9
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Total Bud et $0 I 50 I {p I S0
Base I BCP I Local Funds I Total invoiced
California EMS Authority
(Rev. 7/23)
Agreement between the County of Fresno, Acting as the Central
California EMS Agency, and the California Emergency Medical Services
Authority (EMSA)
Name/No.: Central California EMS Agency Grant (State Agreement No. C23-023)
Fund/Subclass: 0001/10000
Organization #: 56201692
Revenue Account #: 3503