08/17/2011 Agreement DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: August 29, 2011
TO: Fire Chief James Callahan
Fire - Rescue Department
ATTN: Susan Hover . 0�
FROM: Isabel C. DeSantis, D.C.
At the August 17, 2011, Board of County Commissioner's/BOG meetings, the Boards
approved the following:
Items C4 & G3 to award of bid and enter into an Agreement with Professional
Emergency Services Inc. to provide medical direction for Monroe County Fire Rescue pursuant
to Chapter 401, F. S. and Chapter 64J -1, FAC.
Enclosed is a duplicate original of the above - mentioned for your handling. Should you
have any questions, please do not hesitate to contact this office.
cc: County Attorney
Finance
File
CONTRACT BETWEEN
THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
AND
THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1
AND
PROFESSIONAL EMERGENCY SERVICES, INC.
FOR MEDICAL DIRECTION FOR MONROE COUNTY FIRE RESCUE
THIS CONTRACT is made and entered into this 17th day of August, 2011, by and between the
Board of County Commissioners, The Board of Governors of Fire and Ambulance District 1 of
Monroe County, Florida, hereinafter collectively referred to as the "COUNTY," and
Professional Emergency Services, Inc ., hereinafter referred to as "MEDICAL DIRECTOR ".
WITNESSETH:
WHEREAS, COUNTY provides fire and /or emergency medical services pursuant to Chapter
401, F. S. and Chapter 64J -1, FAC; and
WHEREAS, COUNTY is required to employ or contract with a MEDICAL DIRECTOR who
shall be a Florida licensed physician, Board Certified in Emergency Medicine with added
qualification in Emergency Medical Services (EMS) and pre - hospital care experience, or a
business entity that employs or contracts with similarly qualified physicians; and
WHEREAS, COUNTY has determined it to be in the best interests of the residents of and
visitors to Monroe County to contract with MEDICAL DIRECTOR for the purpose of providing
direction to the Fire and Emergency Medical Services; and
WHEREAS, MEDICAL DIRECTOR desires to provide professional services according to the
terms and conditions stated herein.
NOW THEREFORE, in consideration of the mutual understandings and Contracts set forth
herein, COUNTY and MEDICAL DIRECTOR agree as follows:
1. Term
This Contract shall become effective on October 1, 2011, and shall run through September 30,
2013, and shall be renewable thereafter at the option of COUNTY for two additional two (2)-
year periods.
2. Compensation
2.1 Ground Ambulance
MEDICAL DIRECTOR shall be paid at a rate of $58,000.00 annually to provide ground
ambulance medical direction. Payments shall be made monthly in arrears by COUNTY pursuant
to the Florida Local Government Prompt Payment Act after receipt of proper invoice submitted
by MEDICAL DIRECTOR.
2.2 Air Ambulance
MEDICAL DIRECTOR shall be paid at a rate of $36,000.00 annually to provide air ambulance
medical direction. Payments shall be made monthly in arrears by COUNTY pursuant to the
Florida Local Government Prompt Payment Act after receipt of proper invoice by MEDICAL
DIRECTOR. Note: This payment is contingent upon COUNTY's decision to continue to operate
air ambulance services under its ALS license, and if, for any reason, COUNTY decides not to
continue to operate air ambulance EMS service under its ALS license, then MEDICAL
DIRECTOR shall have no responsibility to serve as MEDICAL DIRECTOR for the air
ambulance service and COUNTY shall have no liability for this portion of MEDICAL
DIRECTOR's compensation.
COUNTY will reimburse MEDICAL DIRECTOR for any direct expenses associated with
meetings required by COUNTY or Monroe County Sheriff's Office. For the purpose of this
paragraph, the term "direct expenses" means per diem or subsistence allowances, transportation
costs or mileage allowances, and miscellaneous travel expenses, as those terms are defined by
Section 112.061, Florida Statutes. All compensation shall be according to County Ordinance and
State law.
COUNTY will reimburse MEDICAL DIRECTOR for the yearly application fee required for
renewal of the County's Drug Enforcement Administration (DEA) certificate, if the MEDICAL
DIRECTOR has paid the application fee in advance on behalf of the COUNTY.
2.4
Invoices received from MEDICAL DIRECTOR shall be reviewed and approved by
COUNTY Fire Chief or his designee, indicating that services have been rendered in
conformity with the Contract, and then will be sent to the Finance Department for
payment.
2.5
In order for both parties to close their books and records, MEDICAL DIRECTOR must
clearly state "FINAL INVOICE" on MEDICAL DIRECTOR's final and last billing to
COUNTY. This certifies that all services have been properly performed and all charges
and costs have been invoiced to Monroe COUNTY. Since this account will thereupon be
closed, any and other future charges if not properly included in this final invoice are
waived by MEDICAL DIRECTOR.
2.6
Nothing in this Contract prohibits MEDICAL DIRECTOR from billing any third party
for medical services rendered outside the scope of this Contract that may arise during or
after the term of this Contract.
3. Purpose
The purpose of this Contract is to assure compliance of COUNTY in Medical Direction of
Monroe County Fire Rescue in accordance with the provisions of F.S., Chapter 401, and FAC
Chapter 64J- 1.004.
4. Duties and Responsibilities
4.1
MEDICAL DIRECTOR shall be responsible to Monroe County Fire Rescue and report
directly to the Fire Chief, and/or his/her designee.
4.2
MEDICAL DIRECTOR shall adhere to the responsibilities as set forth in Chapter 401,
F.S., and Rule 64J- 1.004, FAC; the applicable rules of any government agency
implementing said chapter; and any duties upon written notice from the Florida
Department of Health that such additional duties are required of MEDICAL DIRECTOR.
These include supervising and accepting responsibility for the medical performance of all
certified/license response personnel functioning within the scope of their official duties
while on duty with Monroe County Fire Rescue (MCFR), including, but not limited to,
members of volunteer fire department under contract with COUNTY and /or Monroe
County Fire and Ambulance District 1. While these duties will typically occur within the
geographical borders of unincorporated Monroe County and the City of Layton, they also include
duties performed at the Key West International Airport, during mutual
performed during mutual aid to requesting municipalities outside those geographical
borders and while transporting patient to out of county medical facilities. For the purpose of this
Contract, Dr. Sandra Schwemmer is the individual who meets the licensing and registration
requirements of Chapter 401, F.S. and FAC Chapter 64J- 1.004.
4.3
MEDICAL DIRECTOR shall be knowledgeable with the standards set by National Fire
Protection Association, and in particular, Standard 1582: Standard on Comprehensive
Occupational Medical Program for Fire Departments.
4.4 Standards of Care
MEDICAL DIRECTOR shall establish and maintain standards of care for EMS providers.
4.4.1
MEDICAL DIRECTOR shall gather agency input in the review and development of standards of
care on an annual basis, and establish and revise agency performance standards as necessary;
4.4.2
Develop pre - hospital practice parameters for Fire Rescue Personnel of all levels. The parameters
shall be developed with consideration to budgetary and staffing limitations and the fiscal impact
on MCFR and the citizens of Monroe County.
4.5 Patient Advocate
MEDICAL DIRECTOR shall be a patient advocate in the fire rescue system, and shall ensure
that all aspects of the EMS systems are developed to place the needs of the patient first.
4.6 Protocols and Standing Orders.
4.6.1
MEDICAL DIRECTOR shall develop, revise, implement, and maintain basic and advanced life
support protocols and standing orders under which MCFR personnel will function under medical
control.
4.6.2
MEDICAL DIRECTOR shall review and revise existing protocols and standing orders to ensure
that they meet nationally accepted standards of practice for use by all system providers, which
permit specified ALS and BLS procedures when communication cannot be established with a
supervising physician, or when any delay in patient care would threaten the life or health of the
patient. These standards include, but are not limited to, Advanced Cardiac Life Support (ACLS),
Basic Trauma Life Support (BTLS), and Pediatric Advanced Life Support (PALS). In addition
to medical treatment, protocols shall address determination of patient destination.
4.6.3
MCFR shall publish and distribute, at its own cost, all protocols and standing orders. The
protocols and standing orders shall be published in a form consistent with agency Standard
Operating Procedures. Copies of the protocols and standing orders will be maintained on all
MCFR ambulances (air and ground) and ALS engines, and will be distributed to
certified/licensed response personnel. Personnel copies may be provided electronically. MCFR
shall obtain and retain a receipt from each personnel member verifying receipt of the protocols
and any changes. These receipts may be electronic, and shall state clearly that each person is
individually accountable and obligated to follow all rules, regulations and protocols. All
protocols and standing orders shall become public domain upon implementation.
4.6.4
MEDICAL DIRECTOR shall develop, review, and revise, when necessary, Trauma Transport
Protocols (TTP) for submission to the Florida Department of Health, Bureau of Emergency
Medical Services for approval in accordance with Rule 64J -2, FAC.
4.6.5
MEDICAL DIRECTOR shall develop enhanced protocols for specialty procedures or services
including but not limited to aeromedical (Trauma Star) transport.
4.6.6
MEDICAL DIRECTOR shall conduct an on -going review of all protocols and standing orders as
may be necessary to ensure reliable service delivery, appropriate patient care, and the
maintenance of the current standard of care. This shall include, at a minimum, a comprehensive
annual review and written approval of all protocols and standing orders. While conducting the
annual review, MEDICAL DIRECTOR shall take into consideration the results of quality
assurance reviews, review of current medical literature, and input from MCFR response
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personnel. Changes shall be developed with consideration to budgetary limitations and the fiscal
impact on MCFR and the citizens of Monroe County. The annual review shall be completed and
all proposed changes forwarded to the Fire Chief prior to the end of each Fiscal Year.
4.6.7
MEDICAL DIRECTOR shall ensure that appropriate training for new protocols and standing
orders is conducted prior to implementation; shall ensure compliance with protocols and standing
orders by all MCFR personnel; and ensure that additional training is conducted for any identified
needs.
4.7 Availability.
MEDICAL DIRECTOR or his/her previously- approved designee shall be available twenty -four
(24) hours a day, seven (7) days a week for medical direction to MCFR personnel in order to
resolve problems, system conflicts, and provide services in an emergency as that term is defined
in Section 252.34(3), F.S.
4.8 Trauma Scorecard Methodologies.
MEDICAL DIRECTOR shall ensure that all certified /licensed response personnel are trained in
the use of the trauma scorecard methodologies, as provided in Chapter 64J- 2.004, FAC, for adult
trauma patients and 64J- 2.005, FAC, for pediatric trauma patients.
4.9 Aeromedical Operations
4.9.1
MEDICAL DIRECTOR shall participate in Trauma Star safety and quality assurance
committees, and shall attend quarterly meetings to review safety policies, procedures, unusual
occurrences, safety issues, and audit compliance with safety policies and procedures.
4.9.2
Be knowledgeable with aeromedical requirements of patients and evaluate each patient in
person, by telephone, or by delegated written protocol prior to each interfacility transfer
flight for the purpose of determining that the aircraft, flight and medical crew, and equipment
meet the patient's needs.
4.10 Oversight of Medical Qualifications And Proficiency of MCFR Personnel
4.10.1
MEDICAL DIRECTOR shall ensure initial and continued medical qualifications and proficiency
of MCFR personnel.
4.10.2
MEDICAL DIRECTOR shall establish and periodically update the minimum personnel training
standards and certification requirements for all MCFR personnel who provide emergency
medical care. Such standards shall include the requirements for orientation and initial training,
continuing medical education, standards for professional conduct and evaluation standards and
procedures.
4.10.3
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MEDICAL DIRECTOR shall ensure that all field personnel meet the initial requirements and
continuously comply with established standards to attain and maintain approval to operate within
the MCFR system.
4.10.4
MEDICAL DIRECTOR shall establish procedures for issuance, renewal, suspension, and
revocation of practice privileges for MCFR personnel in concert with the Fire Chief, to include a
process for remediation. The procedures shall contain due process provisions and all such
provisions shall be approved, in advance, by the Fire Chief.
4.10.5
MEDICAL DIRECTOR shall provide for direct observation of field level providers while
performing their duties that meets or exceeds Section 401.265, F.S., and Rule 64J- 1.004, FAC.
4.11 Quality Assurance
4.11.1
MEDICAL DIRECTOR, in coordination with MCFR, shall develop, implement, and maintain an
effective patient care Quality Assurance System to assess the medical performance of all
certified/licensed MCFR response personnel.
4.11.2
MEDICAL DIRECTOR shall develop, implement, and supervise a formal patient care Quality
Assurance System in accordance with Section 401.265(2), F.S. and Rule 64J - 1.004, FAC, to
include the formation and supervision of a quality assurance committee.
4.11.2.1
The purpose and tone of the quality assurance review process shall be positive and educational;
however, MEDICAL DIRECTOR may, at any time and without limitation, conduct a quality
assurance review investigation or audit to ensure that MCFR personnel comply with the
Protocols and Standard of Care.
4.11.2.2
The method and extent of the investigation employed during any given quality assurance review
shall be determined by MEDICAL DIRECTOR in consultation with the Fire Chief. As a result
of said investigation, MEDICAL DIRECTOR may require remedial training of MCFR personnel
and/or revocation of practice privileges. Remedial training may be conducted by MEDICAL
DIRECTOR, MCFR personnel, or other personnel at MEDICAL DIRECTOR's discretion.
4.11.3
MEDICAL DIRECTOR or designee may also conduct special audits in response to observations
or customer feedback provided by patients, family members, caregivers, bystanders, crew
members, physicians and hospital personnel.
4.11.4
MEDICAL DIRECTOR may also develop procedures for routine auditing of EMS system
performance and adherence to protocols on individual EMS incidents and overall EMS system
compliance.
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4.11.5
MEDICAL DIRECTOR or designee shall review, in conjunction with MCFR battalion chiefs or
their designees, patient care reports on an ongoing basis; review all protocol deviations and
initiate or recommend corrective action. MEDICAL DIRECTOR or designee shall review at
least 40 patient care reports per month. MCFR shall provide electronic copies of patient care
reports.
4.11.6
MEDICAL DIRECTOR shall periodically visit and communicate with the hospital emergency
departments to exchange information and review the quality of care provided by the MCFR
personnel.
4.11.7
MEDICAL DIRECTOR shall participate in field activity and system monitoring to include the
following:
4.11.7.1
Ride along and observe field activity. Ride along shall involve observation and evaluation of
field level providers, and participation as a crew member /observer on a rescue, for a minimum of
twelve (12) hours per quarter. Ride time will be divided into thirds, with one third of the time
(four hours minimum) allocated to each shift. Over the course of the year, ride time shall also be
distributed equally among the various stations.
4.11.7.2
System monitoring shall include visiting fire stations to discuss issues with MCFR personnel.
4.11.8
MEDICAL DIRECTOR shall document in a quarterly status report to the Fire Chief, evidence of
the following required activities:
4.11.8.1
Field observation of MCFR personnel; and
4.11.8.2
Visitations and interactions with MCFR personnel, hospital emergency department staff, and
other medical and public safety personnel for quality assurance and education activities.
4.12 Educational Programs
4.12.1
MEDICAL DIRECTOR shall participate in educational programs at all levels, to include all
certified/licensed response personnel.
4.12.2
MEDICAL DIRECTOR or designee shall present a minimum of ten (10) hours a year of
continuing medical education related to pre - hospital care or teaching or a combination of both.
4.12.3
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MEDICAL DIRECTOR shall actively participate in the development and presentation of EMS
continuing education programs by identifying educational topics, presenting lectures and
providing other educational opportunities for the enhancement of the fire rescue system. MCFR
shall pay the actual direct cost of any course materials, instructors, and certificates.
4.12.3.1
Education should be geared to reach the specific needs of the audience. As some providers are
volunteers, consideration shall be given to scheduling some training on nights or weekends.
4.12.3.2
Course content should include system- specific issues and items resulting from audit and review.
4.12.4
Where MEDICAL DIRECTOR is not the presenter, and training services are conducted by other
COUNTY personnel and/or are subcontracted to an outside provider, MEDICAL DIRECTOR
will ensure the quality of the Continuing Medical Education (CME) training provided to EMS
personnel by:
4.12.4.1
Reviewing and approving all curriculum and courses for continuing education units (CEU's)
prior to MCFR personnel being trained;
4.12.4.2
Monitoring and auditing at least one (1) class session of every CME course held in which
MEDICAL DIRECTOR is issuing CME; and
4.12.4.3
Evaluating the educational effectiveness of instruction, courses and programs in consultation
with the CME contractor.
4.12.5
MEDICAL DIRECTOR shall host an annual six -hour education seminar, conducted twice on
two different shift days, at a location to be determined jointly by MEDICAL DIRECTOR and
COUNTY. MCFR shall pay the actual direct cost of seminar, including course materials,
instructors, and certificate preparation.
4.12.6
MEDICAL DIRECTOR shall maintain necessary and appropriate instructor certifications and
participate as Medical Director for educational programs sponsored by MCFR such as ACLS,
PALS, BTLS, etc.
4.12.7
Upon proof of completion, MEDICAL DIRECTOR shall sign documents and approve CME to
those EMT's and EMT -P's that have completed a minimum of 30 hours of biannual
recertification training, as set forth in Section 401.2715, F.S.
4.13 Agency Liaison
4.13.1
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MEDICAL DIRECTOR shall participate in interagency discussions about specific issues or
problems as necessary.
4.13.2
MEDICAL DIRECTOR shall notify MCFR of any pertinent concerns regarding patient care
raised by other agencies and provide advice on a resolution. MEDICAL DIRECTOR shall also
notify other agencies of any concerns regarding patient care, raised either by MCFR or
MEDICAL DIRECTOR.
4.13.3
MEDICAL DIRECTOR shall develop and maintain liaisons with the local medical community:
hospitals, emergency departments, mental health agencies, physicians, providers, ambulance
services, and other agencies impacting MCFR.
4.13.4
MEDICAL DIRECTOR shall assist in resolution of problems involving the delivery of pre -
hospital care and other services in accordance with Rule 64J- 1.004, FAC.
4.13.5
MEDICAL DIRECTOR shall interact with and educate local government officials on an as
needed basis.
4.13.6
MEDICAL DIRECTOR shall participate in the Florida EMS Medical Director's Association or a
statewide physician's group involved in pre - hospital care,
4.13.7
MEDICAL DIRECTOR shall be an active member of at least one national emergency medicine
constituency group such as the National Association of EMS Physicians, the American College
of Emergency Physicians, etc.
4.13.8
MEDICAL DIRECTOR shall interact with county, regional, state and federal authorities,
regulators and legislators to ensure standards, needs, and requirements are met, and resource
utilization is optimized.
4.13.9
MEDICAL DIRECTOR shall participate in grant application process for system funding,
expansion, and research.
4.14 Stress Management Programs.
MEDICAL DIRECTOR shall participate in stress management programs for providers within
the system, as needed.
4.15 Community Access to Healthcare Initiatives.
MEDICAL DIRECTOR, in conjunction with MCFR, shall coordinate community access to
healthcare initiatives such as public access to automatic external defibrillators.
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4.16 EMT Oversight.
4.16.1
In accordance with Rules 64J -1.004 (g) and (h), FAC, Assume direct responsibility for: the use
of an automatic or semi - automatic defibrillator; the use of a glucometer; the administration of
aspirin; the use of any medicated auto injector; the performance of airway patency techniques
including airway adjuncts, not to include endotracheal intubation; and on routine interfacility
transports, the monitoring and maintenance of non - medicated I.V.s by an EMT.
4.16.2
MEDICAL DIRECTOR shall ensure that all EMTs are trained to perform these procedures;
shall establish and/or maintain written protocols for performance of these procedures; and
shall provide written evidence to the Florida Department of Health documenting compliance
with provisions of these administrative rules.
4.17 Disaster Assistance and Planning
4.17.1
MEDICAL DIRECTOR shall be available for consultation and/or response during a disaster
situation occurring in Monroe County.
4.17.2
MEDICAL DIRECTOR shall function as a liaison between field EMS operations, hospitals and
public health agencies during disaster situations.
4.17.3
MEDICAL DIRECTOR shall provide specific information to assist in the mitigation of the EMS
aspects during a disaster situation.
4.17.4
MEDICAL DIRECTOR shall cooperate in planning, updating, and following applicable sections
of the Monroe County Comprehensive Emergency Management Plan, including, but not limited
to, participation in disaster drill and emergency management drills.
4.18 Controlled Substances, Medical Equipment and Supplies.
4.18.1
In accordance with F.S., Chapter 401 and Rule 64J- 1.004(4)(c), FAC, MEDICAL DIRECTOR
shall possess proof of current registration as a medical director with the U.S. Department of
Justice, DEA, to provide controlled substances to an EMS provider. The DEA registration shall
include each address at which controlled substances are stored. Proof of such registration shall
be maintained on file with MCFR, which shall maintain the copies and make them readily
available for inspection. MCFR will forward all renewal documents as received from DEA to
MEDICAL DIRECTOR in order to ensure continuous registration and will reimburse
MEDICAL DIRECTOR for the cost of such registration. Copies of physician license and
registrations must be provided to MCFR.
4.18.2
H
MEDICAL DIRECTOR shall formulate and ensure adherence to detailed written procedures to
cover the purchase, storage, use, and accountability for medications, fluids, and controlled
substances used by MCFR personnel, in accordance with Chapters 499 and 893, F.S., and Rule
64J- 1.021, FAC.
4.18.3
MEDICAL DIRECTOR shall ensure and certify that security procedures of all MCFR providers
for medications, fluids and controlled substances are in accordance with Chapters 499 and 893,
F.S., and Rule 64J- 1.021„ FAC.
4.18.4
MEDICAL DIRECTOR shall establish a list of mandatory equipment, medications and medical
supplies that must be on board a Rescue or ALS Engine for it to respond to EMS incidents.
4.18.5
MEDICAL DIRECTOR shall advise MCFR on appropriate staffing, structural requirements,
equipment and supplies necessary to ensure that the air ambulance complies with Rule 64J-
1.005, FAC, and Section 401.251(4), F.S.
4.18.6
MEDICAL DIRECTOR shall conduct an on -going and comprehensive review of all EMS
medical equipment, medications and medical supplies as may be necessary to ensure reliable
service delivery in the fire rescue System and excellence in patient care.
4.18.6.1
In conducting the review, MEDICAL DIRECTOR shall take into consideration the results of
Quality Assurance Reviews, review of medical literature, input from interested physicians, and
MCFR personnel.
4.18.6.2
MEDICAL DIRECTOR, in conjunction with MCFR, shall complete the comprehensive review
of all EMS System medical supplies and equipment and present the proposed changes to the Fire
Chief for approval prior to the end of each Fiscal Year.
4.18.7
MEDICAL DIRECTOR shall ensure that the following criteria are met prior to activating new
medical equipment or supplies within the EMS System:
4.18.7.1
Proposed medical equipment or supplies have been thoroughly researched, supported by medical
literature, a field evaluation completed when applicable, and the analysis of available system
data;
4.18.7.2
All Protocols related to the medical equipment or supplies have been evaluated and updated as
appropriate, to ensure consistency and accuracy; and
4.18.7.3
IF
Protocols, supporting documents and implementation instructions are distributed to MCFR
personnel prior to training or implementation, and training has been completed, if necessary prior
to implementation.
4.19 Infectious Disease Control Policy
4.19.1
MEDICAL DIRECTOR shall formulate, monitor, evaluate and update as necessary, a policy
complying with all applicable laws and rules necessary to control exposure of MCFR personnel
to infectious diseases. This policy shall cover protective measures to be taken on incidents,
inoculation procedures and recommendations, record keeping, follow up care recommendations
as well as storage and disposal policies for contaminated materials.
4.19.2
MEDICAL DIRECTOR shall be available, in conjunction with the MCFR Infection Control
Officer, for consultation from field personnel to determine the significance of any body fluid
exposure and suggest appropriate action for such an exposure in accordance with Monroe
County Fire Rescue's existing Workers' Compensation policies and procedures.
4.20
This Contract is a personal services contract based on the qualifications of Dr. Sandra
Schwemmer and the services required hereunder shall be performed by Professional Emergency
Services Inc. or under his/her supervision. Any additional personnel necessary for the
fulfillment of the services required under this Contract shall be secured at MEDICAL
DIRECTOR's sole expense and such personnel shall be fully qualified and, if required,
authorized or permitted under State and local law to perform such services.
5. Insurance
COUNTY shall maintain in full force and effect for the term of this Contract, and any
subsequent renewals, professional and General Liability Insurance with minimum limits of
$1,000,000.00 per occurrence. The Professional and General Liability certificate will specify
coverage for "EMS oversight/medical direction ".
COUNTY will provide certificate or proof of such insurance to MEDICAL DIRECTOR on an
annual basis. Medical Director will be provided thirty (30) days notice of cancellation, change in
policy limits, and/or any restrictions placed on coverage of the insurance provided by COUNTY
during the term of this Contract. COUNTY will be responsible for the payment of any deductible
and/or self- insured retention in the event of a claim.
The Contractor shall be responsible for all necessary Workers' Compensation and Vehicle
Liability insurance coverage. Certificates of Insurance must be provided to Monroe County
within fifteen (15) days after award of contract, with Monroe County BOCC listed as additional
insured as indicated. Policies shall be written by insurers admitted and licensed to do business in
the State of Florida and having an agent for service of process in the State of Florida.
Companies shall have an A.M. Best rating of VI or better. The required insurance shall be
maintained at all times while Respondent is providing service to County.
Prior to commencement of work governed by this contract, the CONTRACTOR must obtain:
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Worker's Compensation Insurance with limits sufficient to respond to applicable state
statutes. In addition, the Respondent must obtain Employer's Liability insurance with limits of
not less than:
$500,000 Bodily Injury by accident,
$500,000 Bodily Injury by Disease policy limits,
and $500,000 Bodily Injury by Disease, each employee.
Coverage must be maintained throughout the entire term of the contract.
Prior to commencement of work governed by this contract, the CONTRACTOR must obtain:
Vehicle Liability Insurance which shall cover owned, non -owned and hired vehicles. The
minimum acceptable limits shall be $300,000 Combined Single Limit (CSL). If split limits are
provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$50,000 Property Damage
Monroe County Board of County Commissioners shall be named as an Additional insured
on Vehicle Liability policies.
6. Termination
6.1 Early termination may occur as follows:
A. This Contract may be terminated by MEDICAL DIRECTOR, with or without cause,
upon not less than ninety (90) days written notice delivered to COUNTY.
B. COUNTY may terminate this Contract in whole or in part and without cause, upon not
less than ninety (90) days written notice, delivered to MEDICAL DIRECTOR.
C. COUNTY may terminate this Contract immediately in the event that MEDICAL
DIRECTOR fails to fulfill any of the terms, understandings or covenants of this Contract.
6.2 At such time as this Contract is terminated, whether at the natural ending date or at an
earlier time, MEDICAL DIRECTOR shall:
A. Stop work on the date and to the extent specified.
B. Terminate and settle all orders and subcontracts relating to the performance of the work.
C. Transfer all work in process, completed work, and other materials related to the
terminated work to COUNTY.
D. Continue and complete all parts of that work which have not been terminated, if any.
7. Payments
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Payments shall be made by COUNTY pursuant to the Florida Local Government Prompt
Payment Act after the completion of the rendered services and proper invoicing by MEDICAL
DIRECTOR.
8. Contingency
COUNTY's performance and obligation to pay under this Contract is contingent upon an annual
appropriation by the Board of County Commissioners.
9. Section Headings
Section headings have been inserted in this Contract as a matter of convenience of reference
only, and it is agreed that such section headings are not a part of this Contract and will not be
used in the interpretation of any provision of this Contract.
10. Ownership of the Proiect Document
Any documents submitted by MEDICAL DIRECTOR for this RFP belong to COUNTY and
may be reproduced and copied without acknowledgement or permission of MEDICAL
DIRECTOR.
11. Successors and Assigns
MEDICAL DIRECTOR shall not assign its right hereunder, except its right to payment, nor shall
it delegate any of its duties hereunder without the written consent of COUNTY. Subject to the
provisions of the immediately preceding sentence, each party hereto binds itself, its successors,
assigns and legal representatives to the other and to the successors, assigns and legal
representatives of such other party.
12. No Third Party Beneficiaries
Nothing contained herein shall create any relationship, contractual or otherwise, with or any
rights in favor of, any third party.
13. Public Entities Crimes
13.1
A person or affiliate who has been placed on the convicted vendor list following a conviction for
public entity crime may not submit a bid on contracts to provide any goods or services to a
public entity, may not submit a bid on a contract with a public entity for the construction or
repair of a public building or public work, may not submit bids on leases of real property to
public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or
MEDICAL DIRECTOR under a contract with any public entity, and may not transact business
with any public entity in excess of the threshold amount provided in Section 287.017 of the F.S.,
for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted
vendor list.
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13.2
By signing this Contract, MEDICAL DIRECTOR represents that the execution of this Contract
will not violate the Public Entity Crimes Act (Section 287.133, F.S.). Violation of this section
shall result in termination of this Contract and recovery of all monies paid hereto, and may result
in debarment from COUNTY's competitive procurement activities.
13.3
In addition to the foregoing, MEDICAL DIRECTOR further represents that there has been no
determination, based on an audit, that it or any SUBCONTRACTOR has committed an act
defined by Section 287.133, F.S., as a "public entity crime" and that it has not been formally
charged with committing an act defined as a "public entity crime" regardless of the amount of
money involved or whether CONUSULTANT has been placed on the convicted vendor list.
13.4
MEDICAL DIRECTOR will promptly notify COUNTY if MEDICAL DIRECTOR or any
subcontractor is formally charged with an act defined as a "public entity crime" or has been
placed on the convicted vendor list.
14. Records
MEDICAL DIRECTOR shall maintain all books, records, and documents directly pertinent to
performance under this Contract in accordance with generally accepted accounting principles.
Upon ten (10) business days written notice to the other party, representatives of either party shall
have access, at all reasonable times, to all the other party's books, records, correspondence,
instructions, receipts, vouchers and memoranda (excluding computer software) pertaining to
work under this Contract for the purpose of conducting a complete independent fiscal audit.
MEDICAL DIRECTOR shall retain all records required to be kept under this Contract for a
minimum of five years, and for at least four years after the termination of this Contract. Storage
of medical records required by Federal or State statute in excess of the times stated herein and
subsequent to the termination of this Contract shall be revisited by the parties at such time as any
transition period is established to accommodate the termination of this Contract. MEDICAL
DIRECTOR shall keep such records as are necessary to document the provision of services
under this contract and expenses as incurred, and give access to these records at the request of
COUNTY, the State of Florida or authorized agents and representatives of said government
bodies. It is the responsibility of MEDICAL DIRECTOR to maintain appropriate records to
insure a proper accounting of all collections and remittances. MEDICAL DIRECTOR shall be
responsible for repayment of any and all audit exceptions which are identified by the Auditor
General for the State of Florida, the Clerk of Court for Monroe County, the Board of County
Commissioners for Monroe County, or their agents and representatives.
15. Governing Law, Venue, Interpretation, Costs, and Fees
This Contract shall be governed by and construed in accordance with the laws of the State of
Florida applicable to contracts made and to be performed entirely in the State.
E
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Contract, COUNTY and MEDICAL DIRECTOR agree that
venue shall lie in Monroe County, Florida, in the appropriate court or before the appropriate
administrative body. The Parties waive their rights to a trial by jury. This Contract is not subject
to arbitration.
16. Severability
If any term, covenant, condition or provision of this Contract (or the application thereof to any
circumstance or person) shall be declared invalid or unenforceable to any extent by a court of
competent jurisdiction, the remaining terms, covenants, conditions and provisions of this
Contract, shall not be affected thereby; and each remaining term, covenant, condition and
provision of this Contract shall be valid and shall be enforceable to the fullest extent permitted
by law unless the enforcement of the remaining terms, covenants, conditions and provisions of
this Contract would prevent the accomplishment of the original intent of this Contract.
COUNTY and MEDICAL DIRECTOR agree to reform the Contract to replace any stricken
provision with a valid provision that comes as close as possible to the intent of the stricken
provision.
17. Attorney's Fees and Costs
COUNTY and MEDICAL DIRECTOR agree that in the event any cause of action or
administrative proceeding is initiated or defended by any party relative to the enforcement or
interpretation of this Contract, the prevailing party shall be entitled to reasonable attorney's fees,
court costs, investigative, and out -of- pocket expenses, as an award against the non - prevailing
party, and shall include attorney's fees, courts costs, investigative, and out -of- pocket expenses in
appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Contract
shall be in accordance with the Florida Rules of Civil Procedure and usual and customary
procedures required by the circuit court of Monroe County.
18. Binding Effect
The terms, covenants, conditions, and provisions of this Contract shall bind and inure to the
benefit of COUNTY and MEDICAL DIRECTOR and their respective legal representatives,
successors, and assigns.
19. Authority
Each party represents and warrants to the other that the execution, delivery and performance of
this Contract have been duly authorized by all necessary County and corporate action, as
required by law.
20. Claims for Federal or State Aid
MEDICAL DIRECTOR and COUNTY agree that each shall be, and is, empowered to apply for,
seek, and obtain federal and state funds to further the purpose of this Contract; provided that all
V
applications, requests, grant proposals, and funding solicitations shall be approved by each party
prior to submission.
21. Adiudication of Disputes
COUNTY and MEDICAL DIRECTOR agree that all disputes shall be attempted to be resolved
by meet and confer sessions between representatives of each of the parties. If the issue or issues
are still not resolved to the satisfaction of the parties, then any party shall have the right to seek
such relief or remedy as may be provided by this Contract or by Florida law.
22. Cooperation
In the event any administrative or legal proceeding is instituted against either party relating to the
formation, execution, performance, or breach of this Contract, COUNTY and MEDICAL
DIRECTOR agree to participate, to the extent required by the other party, in all proceedings,
hearings, processes, meetings, and other activities related to the substance of this Contract or
provision of the services under this Contract. COUNTY and MEDICAL DIRECTOR
specifically agree that no party to this Contract shall be required to enter into any arbitration
proceedings related to this Contract.
23. Nondiscrimination
MEDICAL DIRECTOR and COUNTY agree that there will be no discrimination against any
person, and it is expressly understood that upon a determination by a court of competent
jurisdiction that discrimination has occurred, this Contract automatically terminates without any
further action on the part of any party, effective the date of the court order. MEDICAL
DIRECTOR and COUNTY agree to comply with all Federal and F.S., and all local ordinances,
as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of
the Civil Rights Act of 1964 (PL 88 -352), which prohibits discrimination on the basis of race,
color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC
§§ 1681 -1683, and 1685- 1686), which prohibits discrimination on the basis of sex; 3) Section
504 of the Rehabilitation Act of 1973, as amended (20 USC § 794), which prohibits
discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended
(42 USC §§ 6101 - 6107), which prohibits discrimination on the basis of age; 5) The Drug Abuse
Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on the
basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act
of 1912, §§ 523 and 527 (42 USC §§ 690dd -3 and 290ee -3), as amended, relating to
confidentiality of alcohol and drug abuse patent records; 8) Title VIII of the Civil Rights Act of
1968 (42 USC §§ 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or
financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC §§ 1201), as
amended from time to time, relating to nondiscrimination in employment on the basis of
disability; 10) Monroe County Code Chapter 13, Article VI, which prohibits discrimination on
the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity
17
or expression, familial status or age; and 11) any other nondiscrimination provisions in any
federal or state statutes which may apply to the parties to, or the subject matter of, this Contract.
24. Covenant of No Interest
MEDICAL DIRECTOR and COUNTY covenant that neither presently has any interest, and
shall not acquire any interest, which would conflict in any manner or degree with its performance
under this Contract, and that only interest of each is to perform and receive benefits as recited in
this Contract.
25. Code of Ethics
MEDICAL DIRECTOR agrees that officers and employees of COUNTY recognize and will be
required to comply with the standards of conduct for public officers and employees as delineated
in Section 112.313, F.S., regarding, but not limited to, solicitation or acceptance of gifts; doing
business with one's agency; unauthorized compensation; misuse of public position, conflicting
employment or contractual relationship; and disclosure or use of certain information.
26. No Solicitation/Payment
MEDICAL DIRECTOR and COUNTY warrant that, in respect to itself, it has neither employed
nor retained any company or person, other than a bona fide employee working solely for it, to
solicit or secure this Contract and that it has not paid or agreed to pay any person, company,
corporation, individual, or firm, other than a bona fide employee working solely for it, any fee,
commission, percentage, gift, or other consideration contingent upon or resulting from the award
or making of this Contract. For the breach or violation of the provision, MEDICAL DIRECTOR
agrees that COUNTY shall have the right to terminate this Contract without liability and, at its
discretion, to offset from monies owed, or otherwise recover, the full amount of such fee,
commission, percentage, gift, or consideration.
27. Public Access
MEDICAL DIRECTOR and COUNTY shall allow and permit reasonable access to, and
inspection of, all documents, papers, letters or other materials in its possession or under its
control subject to the provisions of Chapter 119, F.S., and made or received by MEDICAL
DIRECTOR and COUNTY in connection with this Contract; and COUNTY shall have the right
to unilaterally cancel this Contract upon violation of this provision by MEDICAL DIRECTOR.
28. Non - Waiver of Immunity
Notwithstanding the provisions of Section 768.28, F.S., the participation of MEDICAL
DIRECTOR and COUNTY in this Contract and the acquisition of any commercial liability
insurance coverage, self- insurance coverage, or local government liability insurance pool
coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall
any contract entered into by COUNTY be required to contain any provision for waiver.
18
29. Privileges and Immunities
All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules
and pensions and relief, disability, workers' compensation, and other benefits which apply to the
activity of officers, agents, or employees of any public agents or employees of COUNTY, when
performing their respective functions under this Contract within the territorial limits of
COUNTY shall apply to the same degree and extent to the performance of such functions and
duties of such officers, agents, volunteers, or employees outside the territorial limits of
COUNTY.
30. Legal Obligations and Responsibilities
This Contract is not intended to, nor shall it be construed as, relieving any participating entity
from any obligation or responsibility imposed upon the entity by law except to the extent of
actual and timely performance thereof by any participating entity, in which case the performance
may be offered in satisfaction of the obligation or responsibility. Further, this Contract is not
intended to, nor shall it be construed as, authorizing the delegation of the constitutional or
statutory duties of COUNTY, except to the extent permitted by the Florida constitution, state
statute, and case law.
31. Non - Reliance by Non - Parties
No person or entity shall be entitled to rely upon the terms, or any of them, of this Contract to
enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or
program contemplated hereunder, and MEDICAL DIRECTOR MEDICAL DIRECTOR and
COUNTY agree that neither MEDICAL DIRECTOR nor COUNTY or any agent, officer, or
employee of either shall have the authority to inform, counsel, or otherwise indicate that any
particular individual or group of individuals, entity or entities, have entitlements or benefits
under this Contract separate and apart, inferior to, or superior to the community in general or for
the purposes contemplated in this Contract.
32. Attestations and Truth in Negotiation
MEDICAL DIRECTOR agrees to execute such documents as COUNTY may reasonably require,
including a Public Entity Crime Statement, an Ethics Statement, and a Drug -Free Workplace
Statement. Signature of this Contract by MEDICAL DIRECTOR shall act as the execution of a
truth in negotiation certificate stating that wage rates and other factual unit costs supporting the
compensation pursuant to the Contract are accurate, complete, and current at the time of
contracting.
33. No Personal Liability
No covenant or Contract contained herein shall be deemed to be a covenant or Contract of any
member, officer, agent or employee of COUNTY in his or her individual capacity, and no
member, officer, agent or employee of COUNTY shall be liable personally on this Contract or be
subject to any personal liability or accountability by reason of the execution of this Contract.
19
34. Execution of Counterparts
This Contract may be executed in any number of counterparts, each of which shall be regarded
as an original, all of which taken together shall constitute one and the same instrument and any
of the parties hereto may execute this Contract by signing any such counterpart.
35. Amendments and Assignments.
No amendment or assignment of this Contract shall be valid without the prior written consent
from COUNTY.
36. Independent Contractor
At all times and for all purposes hereunder, MEDICAL DIRECTOR is an independent
contractor and not an employee of the Board of County Commissioners of Monroe County. No
statement contained in this Contract shall be construed as to find MEDICAL DIRECTOR or any
of its employees, contractors, servants or agents to the employees of the Board of County
Commissioners of Monroe County, and they shall be entitled to none of the rights, privileges or
benefits of employees of Monroe County.
37. Compliance with Law
In carrying out its obligations under this Contract, MEDICAL DIRECTOR shall abide by all
statutes, ordinances, rules and regulations pertaining to or regulating the provisions of this
Contract, including those now in effect and hereafter adopted. Any violation of said statutes,
ordinances, rules or regulations shall constitute a material breach of this Contract and shall
entitle COUNTY to terminate this Contract immediately upon delivery of written notice of
termination to MEDICAL DIRECTOR.
38. Licensing and Permits.
MEDICAL DIRECTOR shall have, prior to commencement of work under this Contract and at
all times during said work, all required licenses and permits whether federal, state, county or
municipal.
39. Signatures of Parties Required
THIS CONTRACT SHALL NOT BE EFFECTIVE UNTIL EXECUTED BY BOTH PARTIES
AND RECEIVED IN FINAL EXECUTED FORM BY AN AUTHORIZED
REPRESENTATIVE OF MEDICAL DIRECTOR AT ITS PRINCIPAL PLACE OF
BUSINESS.
40. County Authority
20
By execution hereof the signer below hereby certifies that signer is duly authorized to execute
this Contract on behalf of the COUNTY.
41. Federal and State Tax
COUNTY is exempt from payment of Florida State Use and Sales Taxes. COUNTY will sign an
exemption certificate submitted by MEDICAL DIRECTOR. MEDICAL DIRECTOR will not
be exempted from paying state sales tax to its suppliers for materials used to fulfill contractual
obligations with COUNTY, nor is MEDICAL DIRECTOR authorized to use COUNTY's Tax
Exemption Number in securing such materials.
IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly
RK
M ROE COUNTY ATTORNEY
PRO Q A T F M:
YNTHI L. AL'
ASSIS N,T� O$ 2 ;i TTORNEY
Date
B —
.�' h 3aswct1, J- U•..,c -F-
r.�'
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FL
By:
Mayor /C irm
BOARD OF GOVERNORS OF
FIRE AND AMBULANCE DISTRICT 1,
OF MONROE COUNTY, FLORIDA
Mayor /Chairman
Name and Address of Respondent:
Professional Emergency Services, Inc.
Dr. Sandra Schwemmer
10 High Point Road
PO Box 379
Tavernier, F1 3N
By: �r
Signature of kespondent
a Setlll "
Print Name and Title
Date: V b
Approved by MONROE COUNTY on o 7 , 2011, Item # C q a4d, G'3
rF7
authorized representative.
SECTION TWO:
FORMS
Attachment A
Attachment B
Attachment C
Attachment D
Attachment E
Attachment F
Attachment G
Attachment H
Submission Response Form from Request for Proposal.
Non - Collusion Affidavit
Public Entity Crime Statement
Drug Free Workplace Form
Lobbying & Conflict of Interest Clause Sworn Statement under Ordinance
No. 10 -1990 (Ethics Clause)
Indemnification and Hold Harmless
Insurance Documents
Local Preference Form
SUBMISSION PROPOSAL RESPONSE FORM
MEDICAL DIRECTOR for MONROE COUNTY FIRE RESCUE
Respondent's Name and Address: t'f,.�r -;,j� c
? i
Telephone Numbers: n
All amounts must be written AND in number format. In case of a conflict between
the amount in words and the amount in numbers, the amount in words shall
control.
Annual fee to provide medical direction for ground ambulance service:
Annual fee to provide medical direction for air ambulance service:
Misce llaneous charges (specify whether the charges arp per year, or one -time only):
� 6t c)t 61 liyLZJt <1 ul r j"E �. tt f iYCl }r Lt �t �, i �"L�'ii,�� L y ; +�Ic ��L li^i' •� - Pi G
� $ Y'L�It
1' Y1f A i l Yili � ` c. Y'. �� � l� t':: r l / �`�5t I ���Yr tr lax b �- 61 t ". [rim
I have included: / r, LC i f i r;.g fit uc`t /
fCc "
o Proposal
J ri ;rt �i d by Fit ,
C +-i;t E ,
o Submission Response Form
o Non Collusion Affidavit
o Public Entity Crime Statement
o Lobbying and Conflict of Interest Clause Form
o Drug Free Workplace Form
_ Indemnification and Hold Harmless
r✓
c Local Preference Form
4/
(Check mark items above, as a reminder that they are included).
I state that I am authorized to submit this proposal.
'
STATE OF
(Signature of Respondent)
COUNTY OF ��(� (C} �1 f .� 1
,. t r
Date
PERSONALLY APPEARED BEFORE ME, the undersigned
authority, D 1' !t -IGI Sl'Yly��(Yl(1�tE' -f' who, after first being sworn by me, (name of
individual signing) affixed his,fher signature in the space provided above on this
- -- ! -- day of ,,/�((,,�,,' 20� .
"`7...- - -- - - --
My commission expires:
NOTARY PUBLIC ' ` I LISA ALL�E
MY COWSSM 0 EE 067841
i, > f Attachment A eawedThm aarr utbewrs
NON- COLLUSION AFFIDAVIT
kiu -Fc'C l the
city of' 10'(16-01 .! L `7v according to law on my oath,
and under penalty of edury, depose and say that;
1) I am Dc , 'SCc ij CA �c lt"'Ou (uE.f the respondent
making the Proposal for the project described as follows:
lLf cu H b t rrG &'
2) The prices in this proposal have been arrived at independently without
collusion, consultation, communication or Contract for the purpose of restricting
competition, as to any matter relating to such prices with any other respondent or with
any competitor;
3) Unless otherwise required by law, the prices which have been quoted in this
proposal have not been knowingly disclosed by the respondent and will not knowingly be
disclosed by the respondent prior to proposal opening, directly or indirectly, to any other
respondent or to any competitor; and
4) No attempt has been made or will be made by the respondent to induce any
other person, partnership or corporation to submit, or not to submit, a proposal for the
purpose of restricting competition; and
5) The statements contained in this affidavit are true and correct, and made with
full knowledge that Monroe County relies upon the truth of the att me contained in
this affidavit in awarding contracts for said project. ,7/
STATE OF E L d &
of Respondent)
COUNTY OF &)fO&aL q 1 � I
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
0r. S0,4 -YVA &Cf1 btA7?1"YV — who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
day of MA 520
n ,
My commission expires: USA WtLOWFIE
/ `' "' " WCOIIYYtlS MEE06M1
NOTARY PUBLIC
" - BXPM Mamh 22, 2015
OMB - MCP FORM #1 r: `'►p • BarrdedThrUKdWyPrblclfidaMWs
Attachment B '
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a
conviction for public entity crime may not submit a proposal on a contract to provide any
goods or services to a public entity, may not submit a proposal on a contract with a public
entity for the construction or repair of a public building or public work, may not submit
proposals on leases of real property to public entity, may not be awarded or perform work
as a bidder, supplier, subbidder, or RESPONDENT under a contract with any public
entity, and may not transact business with any public entity in excess of the threshold
amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a
period of 36 months from the date of being placed on the convicted vendor list."
By executing this form, I acknowledge that I/my company is in compliance with the
above.
STATE OF ELI I d 4
COUNTY OF Pa ( VI't I ea
(Signa a of Respondent)
- /s'
Date
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Qr, SC�ndY�� SC E } 1it,�Ql`�1 ne t' who, after first being sworn by me, (name of
individual signing) affixed his/her signature in the space provided above on this
_ day of MAU , 20 /i
k,j . -
My commission expires: e)
NOTARY PUBLIC
ED
MY C
' grndedl
Attachment C
DRUG -FREE WORKPLACE FORM
The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies
that:
J_ CIC.
(Name of Business) () ` cc v c� rz
1. Publishes a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace
and specifying the actions that will be taken against employees for violations of such
prohibition.
2. Informs employees about the dangers of drug abuse in the workplace, the business's
policy of maintaining a drug -free workplace, any available drug counseling,
rehabilitation, and employee assistance programs, and the penalties that may be imposed
upon employees for drug abuse violations.
3. Gives each employee engaged in providing the commodities or contractual services
that are under proposal a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notifies the employees that, as a condition
of working on the commodities or contractual services that are under proposal, the
employee will abide by the terms of the statement and will notify the employer of any
conviction of, or plea of guilty or nolo contendre to, any violation of Chapter 893
(Florida Statutes) or of any controlled substance law of the United States or any state, for
a violation occurring in the workplace no later than five (5) days after such conviction.
5. hnposes a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's community, or
any employee who is so convicted.
6. Makes a good faith effort to continue to maintain a drug -free workplace through
implementation of this section.
As the person authorized to si $h 'statement, 1 certify that this firm complies fully with
the above requirements.
Respondents Signature
Date
OMB MCP FORM #5
Attachment D
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
L:)- C t o ✓ (—
� �G� C C �►LL �Ct� dam' V fCC' warrants that he /it has not employed,
retained or otherwise had ct on s /its behalf any former County officer or employee in
violation of Section 2 of Ordinance No. 10 -1990 or any County officer or employee in
violation of Section 3 of Ordinance No. 10 -1990. For breach or violation of this
provision the County may, in its discretion, terminate this contract without liability and
may also, in its discretion, deduct from the contract or purchase price, or otherwise
recover, the full t of y fee, commission, percentage, gift, or consideration paid to
the former Con. er employee.
( (Signature)
Date:
%/,7-/1%
STATE OF bod a
COUNTY OF VCd m kA Ch
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
D r. Sw Clra who, after first being sworn by me, affixed
his/her
Signature (name of individual signing) in the space provided above on this 1c2 141 day
of
Mau , 2011
My LISA S IM#EE
NOTARY PUBLIC 22,2015
8
My commission expires: p3�a al/
OMB - MCP FORM #4
Attachment E
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
Indemnification and Hold Harmless
for
Other Bidders and Subbidders
The Bidder covenants and agrees to indemnify and hold harmless Monroe Board of
County Commissioners, its servants, agents and employees from any and all claims for
bodily injury (including death), personal injury, and property damage (including property
owned by Monroe County) and any other losses, damages, and expenses (including
attorney's fees) which arise out of, in connection with, or by reason of services provided
by the Bidder or any of its Subbidder(s) in any tier, occasioned by the negligence, errors,
or other wrongful act or omission of The Bidder or its Subbidders in any tier, their
employees, or agents.
In the event the completion of the project (to include the work of others) is delayed or
suspended as a result of the Bidder's failure to purchase or maintain the required
insurance, the Respondent shall indemnify the County from any and all increased
expenses resulting from such delay.
The first ten dollars ($10.00) of remuneration paid to the Respondent is for the
indemnification provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance
requirements contained elsewhere within this Contract.
's Signature
Date
TCS
Attachment F
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT MEDICAL DIRECTOR
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract requires the use of vehicles, the
Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance.
Coverage shall be maintained throughout the life of the contract and include, as a
minimum, liability coverage for:
• Owned, Non - Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
VL2
Attachment G (1 of 2)
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT MEDICAL DIRECTOR
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to the applicable state
statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not
less than:
$500,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$500,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in
the state of Florida.
If the Contractor has been approved by the Florida's Department of Labor, as an
authorized self - insurer, the County shall recognize and honor the Contractor's status. The
Contractor may be required to submit a Letter of Authorization issued by the Department
of Labor and a Certificate of Insurance, providing details on the Contractor's Excess
Insurance Program.
If the Contractor participates in a self - insurance fund, a Certificate of Insurance will be
required. In addition, the Contractor may be required to submit updated financial
statements from the fund upon request from the County.
WC2
Attachment G (2 of 2)
PAY -16 -2011 16:54 From:
ALLSTATE 1=IRE AND CASUALTY
Home Office
Northbrook, Illinois
Insured: SANDRA SCHWEMMER
City: TAVERNIER
To:561 999 1273 P.1 -
INSURANCE COPtPoANcy NumberCa941938561te.495j16420i1
Address: 160 KEY HGHTS DR
St: FL Zip: 33070 Home: 305 - 652 - 9778
ADD ITEM INTERESTED PARTY
Item Interested Party on 2008 RX400H JTJHW31U982062563 Dir Code.
MCBOCC
1100 SIMONTON STREET
KEY WEST FL 33040
THIS REQUEST IS SUBJECT TO POLICY TERMS AND IS EFFECTIVE ONLY IF THE POLICY
NOTED ABOVE IS CURRENTLY IN FORCE
Effective 04 : 54 PM 05 / 16 / 2011
icy o er s ignat
�f 051833 070 305 -245 -8488
Agent's Signatur Agent # Location Agent's Phone #
SAR42 -
Page 1 of 1
PAY- 16-2011 16:54 From:
Print Key Output
5761SS1 V6R1M0 080215 A4000038
Display Device . . . . . : OPADEV012Z
User . . . . . . . . . . : S303393
To:561 999 1273 P.2/2
Page 1
05/16/11 17:09:42
Insured: SANDRA SCHWEMMER
Pol. No.: 941938561 09/14
Home: ( 00 ) 852 - 9778
** ITEM
COVERAGES
**
08 RX400H
AA Bodily Injury S
250/500
S
250/500
250/500
250/500
_%Z> BB Property Damage
ST Lim/Ulm Bodily Injur S
100
100/300
S
100
100/300
00
1 0/300
100
100/300
SV UM /UIM Non - Stacking
CC Medical Payments
DD Collision (Ded) S
500
S
500
500
500
HH Comprehensive (Ded)
250
250
250
250
HG Fire /Light /Trap /The
JJ Towing. Labor (Occ)
UU Rental Reimb. (Day) S
30
S
30
30
30
ZA Sound System (Occ)
VA PIP (Ded)
2
2 -
2 -
PIP Plan
2 -
-
Make All Physical Damage Limits Consistent: N
(ENTER) CONTINUE (F1) HELP (F3) QUIT
(F6) PEND
Add Other Misc. Coverages: N
WARS181
ya%inV o+a.+e.
SCOTT GORNAIA, INSURANC6 AG[NT
126 NE 601 STREET, /7
NUMESTE". n 3307o
[N1`.i = 245.9406 • FAX (365) 2454M
LOCAL PREFERENCE FORM
Vendors claiming a local preference according to Ordinance 023 -2009 mustsomplete this form.
Name of Bidder/Responder �i - c C 55t n ; , La - S Date: 1 f�
1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated
at least one year prior to the notice or request forbid or proposal? Q S (Please fumish copy. )
2. Does the vendor have a physical business address located within Monroe County from which the vendor
operates or performs business on a day to day basis that is a substantial component of the goods or services
being offered to Monroe County? ' `� _
(C) � ,�Q (_ 3 0-7
List Address:
Telephone Number: 4 !s- ( g c UP �-
B. Does the vendor /prime contractor intend to subcontract 50% or more of the goods, services or
construction to local businesses meeting the criteria above as to licensing and location? AO
if yes, please provide:
1. Copy of Receipt of the business tax paid to "the Monroe County Tax Collector by the subcontractor dated
at least one year prior to the notice or request for bid or proposal.
2. Subcontractor Address within Monroe County from which the subcontractor operates:
Tel. Number
Prins Name
Signatur and Title of Authorized Signatory for C r �t'�� - '!>6 1 �'`t
Bidder/Responder
STATE OF i" 1 ur ld (-
COUNTY OF P A I M (Wk
On this P`— day of )v W , 20 , before me, the undersigned notary public, personally appeared
Q r • S r , known to me to be the Person whose name is subscribed above or who
produced as identification, and acknowledged that he/she is the person who
executed the above Local Preference Form for the purposes therein contained. USAILLOM
Notary Public = MyCwuSM#EE0W
EOWE& Matdt 22, 2015
u sa M LO(- r i etow Two "d rPd*u
Print Name
My commission expires: Seal
Attachment H