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09/20/2006 Agreementcleltdlle CircuftCoun Danny L. Holhage Phone: 305-295-3130 Fax: 305-295-3663 To: Office of Fire Rescue Attn.: Darice Hates From: Isabel C. DeSant' , Deputy Clerk Date: Friday, November 4, 2005 At the Board meeting of September 20, 2006, the following was approved: Affiliation Agreement between Emergency Medical Sciences Academy, Inc., (EMS Academy) and the Board of County Commissioners of Monroe County, Florida for Monroe County Fire Rescue (MCFR) to provide an EMS training environment from date of approval of Affiliation Agreement through December 31, 2007. Enclosed is a fully executed duplicate original of the subject document for your handling. Should you have any questions concerning this matter, please feel free to contact this office. Copies: Finance County Attorney File AFFILIATION AGREEMENT I. PARTICIPATING AGENCIES This AGREEMENT between EMERGENCY MEDICAL SCIENCES ACADEMY, INC., hereinafter referred to as the AGENCY, and the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, hereinafter referred to as the j~.i~~.:mRVICE is e:t~~~~nto this dfOtU-dayof II. PURPOSE OF AGREEMENT It is mutually agreed that the purpose of this AGREEMENT is to provide a comprehensive learning experience for participants from the AGENCY, within a clinical setting, in accordance with provisions of the guidelines set forth in this AGREEMENT. III. GENERAL PROVISIONS OF AGREEMENT A. Both parties agree that there will be no distinction in employment or placement because of race, sex, color, creed, age, national origin, religion, marital status, disability or handicap and adhere to the provisions of Federal and State laws regarding discrimination. B. The AMBULANCE SERVICE will provide, to the Participant, at the Participant's expense, emergency care for injuries or acute illness while on duty at the AMBULANCE SERVICE in accordance with the provisions of this agreement. C. The term ofthis AGREEMENT shall be from the date of the AGREEMENT, and shall remain in full force and effect until December 31,2007. Either party may elect annually to extend this AGREEMENT for an additional one (1) year period upon providing at least thirty (30) days prior written notice of intent to extend. Either party hereto may terminate this AGREEMENT by giving at least thirty (30) day written notice to the other party. NOTICE: Where notice is required under this AGREEMENT to be given to either party, the notice shall be mailed to: For AGENCY: Frank Galgano, Program Director EMS Academy, Inc. 600 N. Pine Island Rd., Suite 320 Plantation, FL 33324 For AMBULANCE SERVICE: Clark O. Martin, Jr., Fire Chief/Div. Director Monroe County Fire Rescue 490 63'd Street, Suite 140 Marathon, FL 33050 1 IV. SPECIFIC RESPONSIBILITIES OF THE AGENCY A. AGENCY shall designate a person or persons to coordinate and act as a liaison with the appropriate AMBULANCE SERVICE personnel. B. AGENCY shall provide the AMBULANCE SERVICE with a list of participants in the learning experience at least ten (10) days before each program is to start. C. AGENCY shall insure that participants have the necessary didactic prerequisites to maximize the learning experience at the AMBULANCE SERVICE. D. AGENCY shall insure that the participants comply with the provisions of Section VI. E. AGENCY does undertake and agree that it will indemnify and hold harmless the AMBULANCE SERVICE and its officers, directors, employees, and agents, and reasonable attorney's fees on account thereof, that may be sustained or incurred by reason of any and all claims, demands, suits, actions, judgments, and executions for damages of any and every kind and by whomever and whenever made or obtained, allegedly caused by, arising out of, or relating in any manner to the activity of any participant or participants supplied by the AGENCY pursuant to this AGREEMENT. F. AGENCY shall procure and maintain, during the term of this AGREEMENT and any renewal, liability insurance to cover any and all liability (including professional liability) for claims, damages, or injuries to persons or property of whatsoever kind of nature arising out of the activities ofthe participants carried out under this AGREEMENT. Such insurance shall be on an occurrence basis in amounts no less than $1,000,000/ $3,000,000 for personal injuries and $50,000 for property damage; and the AMBULANCE SERVICE shall be an additional named insured under such general and professional liability policy or policies. AGENCY shall submit certificates of insurance to the AMBULANCE SERVICE evidencing such insurance at the time of the execution of this AGREEMENT, and as requested by the AMBULANCE SERVICE. AGENCY agrees that the AMBULANCE SERVICE will receive no less than thirty (30) days written notice prior to cancellation, modification, or non-renewal of any of the insurance coverage's described herein. Participants who do not have patient contact (non-allied health participants) will not be required to be covered by professional liability msurance. 2 V. SPECIFIC RESPONSIBILITIES OF THE AMBULANCE SERVICE It shall be the responsibility of the AMBULANCE SERVICE to: A. Provide an appropriate orientation of participants in connection with its facilities and its policies and procedures. B. Provide opportunities for a learning experience with appropriate supervision. C. Retain ultimate responsibility for patient care even ifthat care is given by a participating student. D. Designate a preceptor (or coordinator) from its staff to act as the liaison with the AGENCY in this AGREEMENT, as appropriate to the learning objectives. VI. SPECIFIC RESPONSIBILITIES OF THE PARTICIPANT It shall be the responsibility of the Participant(s) assigned through this AGREEMENT to: A. Comply with the policies and procedures of the AMBULANCE SERVICE. B. Provide the necessary and appropriate uniform while on duty in the AMBULANCE SERVICE. C. Obtain prior written approval of both parties to this AGREEMENT before publishing any material related to the learning experience provided under the terms of the AGREEMENT. D. Sign a "Hold Harmless Agreement" with the AMBULANCE SERVICE prior to commencing hislher experience within the AMBULANCE SERVICE of which is attached to this AGREEMENT as Exhibit A. E. At all times, must wear the appropriate badge on every clinical rotation, and comply in all respects with the student requirements set forth in the requirement sheets. VII.. REQUEST FOR WITHDRAWAL OF PARTICIPANT The AMBULANCE SERVICE shall reserve the right to deny any Participant from access to its facilities whose conduct or work with patients or personnel is not in accordance with the policies and procedures of the AMBULANCE SERVICE or is detrimental to patients or others. 3 VIII. MODIFICATION OF AGREEMENT Modification of this AGREEMENT may be made by mutual consent of both parties, in writing, and attached to this AGREEMENT and shall include the date and the signatures of parties agreeing to the modification. IX. COPIES OF AGREEMENT Copies of this signed AGREEMENT shall be placed on file and be available at the corporate office ofthe AGENCY and in the offices of the AMBULANCE SERVICE. IN WITNESS WHEREOF the parties hereto have caused this AGREEMENT to be executectin their respective corporate names and their corporate seals to be affixed by q!l-lY'tnitfii,)~.officers, all on the day and year first set forth above. ;~;::. .-" . "'<,<~.., -:1 (SEAL) Attest: DannyL. Kolhage, Clerk Board of County Commissioners of Monroe County, Florida M,y'''; ~ By:~Q".k'LC.~ Deputy Clerk Emergency Medical Sciences Academy, Inc. m Director MONROE COUNTY ATTORNEY APPR 0 AS TO FORM: ,. Cl CD M '"J <J; c-: _J 0 N '...; u.. ,:'1"' U -I;~jC L~! x: Cl::" a... ,..,.;::.:: 0:: N :,...:::~::-) <=> .'Je, w... ....J '0 C~') I- ?:::5~ LL.l U ."C_<...> ...J 0 ;;,:;-e.: a::: 1:: ~ <J; :z <<=> a 0 <<=> :I: ..... SU N M. GRIMSL: Y ASSISTAN~90U1'!.~'roRNEV Dale ~ 4 EXHIBIT A EMERGENCY MEDICAL SCIENCES ACADEMY HOLD HARMLESS AGREEMENT AND RELEASE I, , am presently enrolled as an Emergency Medical Technician or Emergency Medical Technician Paramedic student at Emergency Medical Sciences (EMS) Academy. My course of instruction at this school requires me to train, study, and receive instruction at EMS Academy and/or Monroe County Fire Rescue (County). In consideration for the County providing me this opportunity to acquire training and instruction, I, the undersigned, agree to indemnify, protect, and hold harmless the County and its officers, directors, employees, agents and assignees from any liability judgments, claims, costs, damages or injury arising out of or in connection with any and all acts of negligent conduct on my part, however caused, during any instructional or training activity. I agree that I will defend at my own expense, any and all actions, lawsuits or proceedings which may be brought against the County in connection with the above and shall satisfy, pay and discharge any and all judgments that may be entered against the County in any such claims, lawsuits, or proceedings. I understand that, generally, while I am engaged in the activities of and related to this course of instruction and training, I am not considered an employee of the County and therefore, I am not eligible for any benefits available to County's employees, nor to Workers Compensation coverage pursuant to Florida Statute Chapter 440 (1989-90 or its successor amendments/statutes). I understand that there are inherent risks in training with County, including but not limited to, my own injury, exposure to blood-borne illnesses, and exposure to contagious diseases and contraction of such diseases. Participation in this training can result in severe injury and even death. I release County from any and all liability from any consequences arising out of my training with County. Date of Instructional Activities: Date to Date Signature: . Date: Witness: Date: C UNTY�MONROE KEY WEST FLORIDA 33040 (305)294-4641 HEADQUARTERS of FIRE RESCUE 490 63rd Street Marathon, FL 33050 (305) 289-6004 / (305) 289-6010 TO: FROM: Maria Slavik Risk Management Darice Hayes Fire Rescue MEM BOARD OF COUNTY COMMISSIONERS MAYOR Charles "Sonny" McCoy, District 3 Mayor Pro Tern Dixie Spehar, District 1 George Neugent, District 2 Mario Di Gennaro, District 4 Glenn Patton, District 5 SUBJECT: Insurance Certificates — Emergency Medical Sciences Academy, Inc. DATE: October 10, 2006 Maria: Please find attached the Insurance Certificates with the correct Certificate Holder Name of Monroe County BOCC. The original ones had Fire Rescue added into the title. Please process this agreement which had been approved at the Sept. 20, 2006 BOCC meeting as Item C11. Thanks, Attachments eAo6 61 czo eaAe i0 cA c Q 0-6 al k--a P�6 ACORD� CERTIFICATE OF LIABILITY OATE(M130D INSURANCE PRODUCER SEITLIN 1D/3o/aoo7 007 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6700 N. ANDREWS AVENUE, STE #300 FORT LAUDERDALE PL 33309 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (954) 938-8788 (954) 938-8566 ' INSURERS AFFORDING COVERAGE NAIC # IN$IIRED Emergency Medical Sciences Academy, Inc. INSURERA'. PHILADELPHIA INDEMNITY INS. CO 18058 INBURER B: GENERAL STAR INDElIIiITY CO. 37362 INSURERC: LIBERTY MUTUAL FIRE INS. CO. 23035 20DO WEST COMMERCIAL BLVD., STE 02DO INSURER D: PORT LAUDERDALE FL 33309 INBURER E: rnve0wn�e. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NUMBER PHPX266098 PEIMMMPOLICYABINPOLICY 10/7/2007 LIMITS LIABILITYEACH GENERAL LIABILITY 10/7/2008 OCCURRENCE $ 1,000,000MERCIAL r 5 100,000 NED EXP(Anyone person) $ 5,000 CLAIMS MACE OCCUR PERSONAL BADV INJURY S 11000,000 GENERALAGGREGATE S 2,000,000 GREGATE ICY LIMITAPPLIES PER: PRO- X LOGILE TA PRODUCTS-COMPfOP AGG $ 2,000,000 LIABILITYCOMBINED PHPK266098 10/7/2007 30/7/2008 SINGLE LIMNAUTO (Ea accden0 S11000,000 OWNED AUTOSEOULEDAUTOS BODILYINJURYS (Perperson)D AUTOS-OWNEDAUTOS BODILY INJURY $ PROPERTY DAMAGE (PMacctdent) $ GARAGE LIABILITY ANY AUTO 4 ------�_.. �"�) 'T/ AUTO ONLY -EA ACCIDENT S OTHER THAN EA ACC $ 3 T AUTOONLY. AGG tB EXCESSNMBRELL�A" 'L,IABILITY X OCCUR uCLAIMS MACE IV0395725C _ "- 10/7/2007 10/7/2008 EACHOCCURRZOTH. 000,000 AGGREGATE000,000 SIR10,000 DEDUCTIBLERETENTION KERCCOMPENSATION AND WC2151287473016 9/21/2007 9/21/2 BOB X WC STATm?LOYERWLIABILITYANY E.L. EACH ACC500,000 PROPRIETORIPARTNER ECUTIVE CFFICER/MEMBER EXCWDEOt E.L.DISEASE-500 000 Il yes, desulbs Vntler OTHERLROVSONS W. OTHER E1. DISEASE-500,00D DESCRIPTION OF OPERATIONSI LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS CERTIFICATE HOLDER AS DESIGNATED ORGANIZATION IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY SUBJECT TO THE TERMS, CONDITIONS AND EXCLUSIONS OF THE POLICY. CERTIFICATE Nnl ne0 MONROE COUNTY BOCC 490 63 STREET SUITE #140 Marathon FL 33050 SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIMI) REPRESENTATIVE IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 ACORD,. C E RT I F I CA I TY INSURANCE DATE (MM/DD/YYYY) 10/13/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SEITLIN OOMLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6700 N. ANDREWS AVENUE, STE #300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. FORT LAUDERDALE FL 33309 (954) 938-8788 (954) 938-dV0 S AFFORDING COVERAGE INSURERS NAIC # INSURED _RE INSURERA_ PHILADELPHIA INDEMNITY_ IN_S. CO 18058_ _ Emergency Medical Sciences Academy, Inc. INSURERB: GENERAL STAR INDEMNITY CO. 37362 2000 WEST COMMERCIAL BLVD., STE #200 INSURERC: TECHNOLOGY INSURANCE COMPANY 43276 _ __ FORT LAUDERDALE FL 33309 INSURERD: CHICAGO INSURANCE COMPANY- _ _ 02266 I INSURER E: (_(1VPRAf_PC THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T DD'L POLICY NUMBER POLICY EFFECTIVE T XP POLICY EIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE S 000, 000 A X_ COMMERCIAL GENERAL LIABILITY PHPK353270 10/7/2008 10/7/2009 DAMAGE TO RENTED PREMISESLEa occurence ______l, $ - 100,000 MED EXP (Any one person) _ $ 5,000 CLAIMS MADE I ^ 1 OCCUR PERSONAL & ADV INJURY - _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2, 000,000 POLICY PRO- X1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ A X ANY AUTO PHPK353270 10/7/2008 10/7/2009 (Ea accident) 11000,000 BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY X HIRED AUTOS X NON -OWNED AUTOS (Per accident) S PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ' AUTO ONLY _EA ACCIDENT --$ OTHER THAN EA ACC - $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 1010001000 B X OCCUR EICLAIMSMADEIUG395725D 10/7/2008 10/7/2009 $ DEDUCTIBLE $ $ X RETENTION $ 10,000 C WORKERS COMPENSATION AND TWC3180507 9/21/2008 9/21/2009 OTH- X WC STIMIT ER TORY L EMPLOYERS' LIABILITY — E.L. EACH ACCIDENT ------ ----- $ 500,000 ANY ANY PROPRIETOR/PARTNER/EXECUTIVE -------- - E.L. DISEASE - EA EMPLOYEE -------- $ 500 , 000 OFFICER/MEMBER EXCLUDED? If yes, describe under -_-- SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 D OTHER STUDENT MEDICAL PROF ARC-1219125 10/7/2008 10/7/2009 $1,000,000 EACH OCCURANCE $3,000,000 AGGREGATE DESCRIPTION OF OPERATIONS ! LOCATIONS / VEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 DAYS NOTICE OF CANCELLATION IN THE EVENT OF NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER AS DESIGNATED ORGANIZATION IS AN ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY SUBJECT TO THE TERMS, CONDITIONS AND EXCLUSIONS OF THE POLICY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MONROE COUNTY BOCC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 490 63 STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR SUITE #140 REPRESENTATIVES. Marathon FL 33050 AUTHORIZED REPRESENTATIVE ----- -- -„ ._ - i< ACORD 25 (2001/08) © ACORD CORPORATION 1988 Page 1 of 1. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AUUKU 25 (ZUUI/US) 10/13/2008 Page 2 of 1