Item R2BOARD OF COUNTY CohnItSSIONERS
AGENDA ITEM SUMMARY
Meeting Date: September 21. 2012
Bulls Item: Yes No X
Public Hearing: Time Certain 10: 00am
Division:_ Emergency Services
Department: Fire Rescue
Staff Contact Person: Holly Pfiester ext. 6088
AGENDA ITEM WORDING: Public Hearing regarding amendment of Certificate of public
Convenience and Necessity (COPCN) for American Ambulance Service, Inc. to change name of
certificate holder to "Falck Southeast II Corp. d/b/a American Ambulance Service".
vn Marcn 21, 2U12, American Ambulance Service, Inc. submitted an
application for a new COPCN. The COPCN became effective on April 21, 2012. The new COPCN
was required under Section 11-174(a) of the Monroe County Code, because, at the time, American
Ambulance believed that 100% of the shares of American Ambulance were being sold to Faick
Southeast II Corp. Subsequent to issuance of the COPCN, American Ambulance and Falck revised
their transaction to be an asset purchase rather than a stock purchase. The parties are now requesting
that the COPCN be amended to reflect the corrected name of the ambulance service, which is "Falck
Southeast II Corp. d/b/a American Ambulance." As required by Monroe County Code section 11-
173(d)(2), the applicant and all other certificate holders have been notified of the public hearing.
PREVIOUS RELEVANT BOCC ACTION: Issuance of COPCN on March 21, 2012
` "" +�'� l��"=�rr•ty r �:t1Alr(�ES: Name change of certificate holder only.
STAFF RECOMMENDATIONS: Approval.
TOTAL COST: $0.00 INDIRECT COST: N/A BUDGETED: Yes No
INDIRECT COST: BUDGETED: Yes X No
COST TO COUNTY: $0.00 SOURCE OF FUNDS:
REVENUE PRODUCING: Yes No � AMOUNT PER MONTH Year
APPROVED BY: County A ttY r
OMB/Purchasing Risk Management (�
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM #
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MONROE COUNTY,FLORIDA
APPLICATION1 OF PUBLIC CONVENIENCE1 1'
EMERGENCYCLASS A 1,
1. NAME OF SERVICE Falck Southeast II, Corp. d/b/a American Ambulance Service
BUSINESS1 r ADDRESS 6605 NW 74 1h Ave Miami, FL 33166
BUSINESS PHONE NUMBER 305-307-8002 EMERGENCY PHONE NUMBER 305-307-801
2. TYPE OF OWNERS (i.e., Sole Proprietor, Partnership, Corporation, etc.)
Corporation
111111 1 1 1 1 1`
OFFICERS,3. LIST ALL DIRECTORS, 1 SHAREHOLDERS (Use separate
NAME
AGE
ADDRESS
TELEPHONE #
POSITION/TITLE
Robert Heffner
47
6605 NW 74 Ave Miami 33166
305-925-2000
President
Charles Ma mon
57
6605 NW 74 Ave Miami 33166
305-925-2000
Asst. Secretary
Morton Pedersen
44
6605 NW 74 Ave Miami 33166
305-925-2000
Officer
Shauna Vernal
43
6605 NW 74 Ave Miami 33166
305-925-2000
Secretary
4. LEVEL OF CARE TO BE PROVIDED: ❑ BLS or ® ALS
IF ALS: @ TRANSPORT or ❑ NON TRANSPORT
5. DESCRIBE THE ZONES(S) THAT YOUR SERVICE DESIRES TO SERVE (Use separate sheet if necessary):
Monroe County for inter -facility services
ADDRESS6. LIST THE AND/OR DESCRIBE 1 1 1 YOUR BASE STATION1 ALL SUB-
STATIONS
STATIONBASE 3710 North Roosvelt Blvd, 14
M11-In- 4 6[1AI
11 DR14 9 IB-Affillf X91- 11''! 1111
Statewide B
Veriza-0.4/ireless
=-,Fr*r,111`oR1mFT#1o,1MMF1 - , M-�M
8. LIST THE NAMES AND ADDRESSES OF THREE (3) U.S. CITIZENS WHO WILL ACT AS REFERENCES FOR
YOUR SERVICE:
0 0 0 71 UNA, M
Randy Walter
---- ----------1113
I Diamond Drive, Key West, FL 33040
725 Ashe St, Key West, FL 33040
10. PROVIDE VERIFICATION OF ADEQUATE INSURANCE COVERAGE DURING THE COPCN PERIOD.
11. ATTACH A COPY OF YOUR SERVICE'S CONTRACT WITH A MEDICAL DIRECTOR.
[Flolw4N* M4-
Iwo 11 It I �I III` �I iiawriiiii I III 1 11715 1 117i
SIGNATURE OF APPLICANT / AUTHORIZED REPRESENTATIVE
NOTARY PUB' IC -STATE OF FLORIDA
Michael Arguelles
S'
NOTARY SEAL :Commission # DD833601
...- Expires: DEC. 10, 2012
ONDED THRU ATL&NTIC BONDING CO., INQ
NOTARY
DATE
PI✓ — PARAMEDICS
Past 3 of G
PA zin, ry� F-- 91 C--
Burgos, David
MEDIC/KEYS
PMD9491
12/1/2012
Camargo, Miguel
MEDIC/KEYS
PMD518411
12/1/2012
Cruz, Jorge
MEDIC/KEYS
PMD517904
12/1/2012
Dunkelberger, Jeffrey
MEDIC/KEYS
PMD517051
12/1/2012
Gallegos, Jorge
MEDIC/KEYS
PMDS17597
12/1/2012
Gato, Carlos, Fro
MEDIC/KEYS
PMD516317
12/1/2012
Llanes, Eduardo
MEDIC/KEYS
PMD516112
12/1/2012
Lopes, Joel
MEDIC/KEYS
PMD517284
12/1/2012
Mendoza, Yasmany
MEDIC/KEYS
PMD517735
12/1/2012
Perez, Harold
MEDIC/KEYS
PMD521523
12/1/2012
Ramirez, Rey
MEDIC/KEYS
PMD517117
12/1/2012
Rosende, Nick
MEDIC/KEYS
PMD515736
12/1/2012
Sine, David
MEDIC/KEYS
PMD518372
12/1/2012
Vargas, Joseph
MEDIC/KEYS
PMD517365
12/1/2012
PERSONNEL - EMERGENCY MEDICAL TECHNICIANS
wn�
Boyce, Dominick
EMT/D
EMT528850
12/1/2012
Calzadilla, Arnaldo
EMT/D
EMT525515
12/1/2012
Cortes De Lavalle, Jose
EMT/D
EMT533143
12/1/2012
Cuomo, Kevin
EMT/D/KEYS
ET88151
12/1/2012
Escobar, Daniel
EMT/D
EMT522679
12/1/2012
Espinosa, David
EMT/D
EMT530197
12/1/2012
Gallegos, Jorge
EMT/D
EMT524858
12/1/2012
Gonzalez, Randy
EMT/D
EMT523809
12/1/2012
Hannert, David
EMT/D/KEYS
EMT537532
12/1/2012
agarino, Andrew
EMT/D
EMT527742
12/1/2012
Miranda, Victor
EMT/D
EMT516132
12/1/2012
Monteagudo, Nelson
EMT/D
EMT528148
12/1/2012
Ramirez, Rey
EMT/D/KEYS
EMT520975
12/1/2012
Resendiz, Miguel
EMT/D
EMT518806
12/1/2012
Reyes, Jorge
EMT/D
EMT531792
12/1/2012
Sine, David
EMT/D
EMT524921
12/1/2012
I
Rate Schedule
IT
Basic Life
Advanced Life
SCT
Support
Support
Base Rate Per Trip
$256.00
$380.00
$693.00
Mileage (Per Transport Mile)
C,
$7.50
$7.50
$7.50
Oxygen
$30.00
$130.00
$130.00
Waiting Time (Per Half Hour)
$80.00
$120.00
$120.00
DATE (MMIDDIWYY)
CERTIFICATE OF LIABILITY 2/1612013F 2/15/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER Lockton Companies, LLC-A DCCONTACT
1801 K Street NW, Suite 200 H No EXt : A/C No
FAX
Washinggton DC 20006 E-MaL
(202) 414-2400
INSURED Falck Southeast II, Corp., d/b/a
1076273 American Ambulance
6605 NW 74th Avenue
Miami FL 33166
-IRE AND MARINE INS. CO.
lerican Insurance Company
Guarantee and Liab. Ins. Co.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOC
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
A GENERAL LIABILITY N N CL318084 2/16/2012 2116/2013 EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY FR AGE TO R oNTED rice 100,000
CLAIMS -MADE OCCUR MED EXP An one person)5,000
X INCL PROF. LIABILITY PERSONAL & ADV INJURY s 1,000,000
X PROF. DEDUCTIBLE:$0 GENERAL AGGREGATE s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS -COMP/OP AGG $ 2,000,000
_1�llOY�_ I JECT LOC Is
B
AUTOMOBILE
LIABILITY
ANY AUTO
X
HH
AUTOS OWNED AU7OSULED
X
HIRED AUTOS X AUTOSWNED
X
$1,000 Comp K)(dl $1,000 Coll
C
UMBRELLA LIAR 1 X OCCUR
EXCESS LIAR CLAIMS-Mi
DED RETENTION $
N i N I PRA9474993-01
N I N I AUC 4755474-01
AMU CMrLV TCK0 LW1011-11 T Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE NOT APPLICABLE
OFFICERIMEMBER EXCLUDED? N / A
IMandatory in NHI
It yes, describe under
DESCRIPTION OF OPERATIONS below
2/ 16/2012 1 2/ 16/2013
2/ 16/2012 1 2/ 16/2013
Y INJURY (Per person) $
Y INJURY (Per accident $
ERN DAMAGE $
acident
$
OCCURRENCE $
ELATE $
Is
EACH ACCIDENT Is
DISEASE - EA EMPLOYEE I S XXXXXXX
DISFASF - POLICY LIMrr 1. XX
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /(Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Please note: The above named insured will be effective August 22, 2012 or at time of closing.
10450052
Monroe County
490 - 63rd St
Marathon FL 33050
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
H
Q t t ACORD CORP01M,The ACORD name . logo are registered marks of ACORD
American
. Ambulance
•
L. Scott Win Emergency Medical Services, Inc.
This agreement is made this 1st day of May 2011 by and between American
Ambulance Service (hereafter called American Ambulance Service) and L. Scott
Ulin (hereafter called Medical Director) for providing EMS Medical Director
services.
1. Serve as a patient advocate within American Ambulance Service.
2. Set and ensure compliance with patient care standards including Medical
• •
3. Develop and implement protocols and standing orders under which the EMT's
•, Paramedics
4. Ensure the appropriateness of initial qualifications of pre -hospital personnel
involved in patient care.
5. Ensure that the qualifications of pre -hospital personnel involved in patient
care are maintained on and ongoing basis through education, testing, and
accreditation.
6. Develop and implement and effective quality assurance program for
continuous system- - improvement.--
t with the quality
assurance -- on a monthly basis to review
and provide appropriate feedback to personnel as required. A mechanism
shall be set in place to insure the prompt review of run reports direct
observation and comparison of performance standards for drugs, equipme
system protocols and procedures. I
7. Maintain a liaison with the medical community including hospitals, emergency
departments, pre -hospital providers and nurses.
9,. Maintain knowledge levels appropriate for and EMS Medical Director
required in section 64J Florida Administrative Code governing EMS.
9. The Medical Director shall develop medically correct standing orders or
protocols which permit specified ALS and BLS procedures when
communication cannot be established with a supervising physician or when
any delay in patient care would potentially threaten the life or health of the
patient. The Medical Director shall issue standing orders and protocols to
American Ambulance Service to ensure that American Ambulance Service
transports each of its patients to facilities that offer a type and level of care
appropriate to the patient's medical condition if available within a reasonable
distance. Because American Ambulance Service performs inter -facility ALS,
the Medical Director shall provide continuous 24 hour per day, 7 day per
week medical direction which shall include, direction to personnel of American
Ambulance Service to the availability of the Medical Director "off line" service
to resolve problems, or conflicts which may arise and provide services in and
emergency as defined by section 252.349(2), FSS governing EMS.
10. Create authorize and ensure adherence to, detailed written operating
procedures regarding all aspects of the handling of medications, fluids and
controlled substances should American Ambulance Service utilize, such
substances.
11. Develop and revise when necessary, TTP's for submission to the State of
Florida for approval.
12.The Medical Director shall provide 24 hours per year (two hours per month) of
continuing education for American Ambulance Service personnel on agreed
upon subjects. The Medical Director shall be actively involved in the
education process; however the class time may be delivered through the
Medical Director's designee.
13.The Medical Director will upon Attending State Meetings (EMS Council
Meetings) provide for the interests of American Ambulance Service.
American Ambulance Service agrees to:
1. This agreement shall be effective on May 1, 2011 and terminate on April 30,
2015, unless otherwise terminated pursuant to the terms of this agreement.
The agreement may be renewed for Two (2) additional Two (2) year periods
at the option of American. Either party may terminate this agreement at any
time by giving thirty (30) written notice of intent to terminate to the other party.
2. American Ambulance Service agrees to pay the Medical Director $35,000.00
annually or $2,916.66 per month, beginning May 2011.
Insurance
It is understood between the parties that the Medical Director shall maintain
malpractice insurance to adequately cover the Medical Director and his
designees for the term of this agreement and shall provide proof of such to
American Ambulance Service.
American Ambulance Service agrees to maintain malpractice and general liability
insurance in such amounts to cover its agents, officers, and employees.
American Ambulance Service warrants that that such insurance is now in effect
and shall remain in effect for the term of this agreement.
The Medical Director shall indemnify, defend, and hold harmless, American
Ambulance Service and all of its officers, agents and employees from all suits,
actions, claims, demands, liabilities, of any nature whatsoever, arising out of,
because of or due to breach of this agreement by the Medical Director, its agents
or employees or due to any negligent or wrongful act or occurrence or
commission of the Medical Director its agent or employees, while engaged in any
work relating directly or indirectly to the performance of this agreement.
American Ambulance Service agrees to indemnify and hold harmless the Medical
Director from any and all liabilities and obligations arising out of the relationship
set forth in this agreement, if such liability shall be a result of any acts of
omissions on the part of American Ambulance Service or its officers, agents, or
employees.
It is acknowledged by both parties that the EMT's and Paramedics are
performing there duties under the license of the Medical Director, and that the
Medical Director shall therefore be granted the final determination regarding the
adequacy of skills demonstrated by each Paramedic and EMT. Should the
Medical Director or his designee determine that and individual EMT or Paramedic
is not proficient in a specific skill, American Ambulance Service agrees to remove
the EMT or Paramedic from active duty until such time as the EMT or Paramedic
may be provided further training. Should further training fail to resolve the skill
problem American Ambulance Service agrees to permanently remove the EMT
or Paramedic from its rooster at the direction of the Medical Director.
The Medical Director and American Ambulance Service shall comply with all
applicable laws, statutes, ordinances, rules, and lawful orders of the State of
Florida and Dade and Broward Counties, Florida and any other authority which
may be applicable to this agreement.
Lr1r. =- 8 a - 0 1-1416�
The Medical Director his employees or designees shall be and remain
independent contractors and not agents of American Ambulance Service, with
respect to all of the acts and services performed under the terms of this
agreement. This agreement shall not in any way be construed to create a
partnership, association or any other kind of joint undertaking or venture between
the •
ZZ=
Should any part of this agreement be found by a court of competent jurisdiction
to be illegal or in conflict with any law of the State of Florida, the validity of the
remaining portions shall not affected by this decision.
Any claim objection or dispute arising out of the term of this agreement shall b�-!
gated in Broward County, Florida.
This agreement represents the entire agreement between the Medical Director
and American Ambulance Service. This agreement may only be amended in
writing with the consent of both parties.
American Ambulance Service
Charles Maymon
Agreed on the 1 st day of May, 2011
L. Scott Ulin M.D.
By:
Title:
February 27, 2012
Dear Committee and Members of the Conunission,
The owners of American Ambulance Service, Inc. ("American") have reached a decision to sell
our organization to Falck, subject to the involved parties reaching legally binding agreements thereon.
Falck is a one hundred and six year old organization whose roots lie in the delivery of emergency medical
services. Twenty-four months ago Falck entered the US market and will become a dominant player in
delivery of emergency services over the next several years.
We feel fortunate to be one of the early United States acquisitions that Falck has decided to
undertake. Falck has a distinguished history of providing high quality EMS services on an international
scale. Tlae ownership and management staff of American is excited about the opportunity to join the Falck
organization. We feel strongly that Falck will help American provide the same outstanding services we
have become known for, and also work with American to provide new and innovative healthcare services.
It is important to note that the name "American Ambulance Service, Inc," will remain in place, and there
are no plans to change the name as it now exists.
A majority of the management team at American will remain in place, however, the President of
American Ambulance Service, Inc., Raul Medina, has decided to retire and leave his position.
Nevertheless, Mr. Medina will remain involved with American in an outside advisory capacity.
Additionally, Charles Maymon's current position as Vice President at American will transition into a
leadership role with the Falck organization. In this new position Mr. Maymon will provide leadership for
the operations in the State of Florida. The balance of the existing management team shall remain in place.
We invite you to visit Falck.com to learn more about the Falck organization and the services they
provide on a worldwide basis.
Please do not hesitate to contact us with any questions you may have concerning this change in
our organization.
Sincerely,
Raul Medina,
President
American Ambulance Service
Charles Maymo ,
Vice President
American Ambulance Service
Robert `Boo" Hefner
President
Falck Southeast Il Corp.
6605 Nor' 74 Avenue Miami, FL 33166 a Tel., (305) 925-2000 o Fax 305 888-3229
February 27, 2012
Ms. Cynthia Hall, Esq.
Assistant County Attorney
Monroe County Attorney's Office
1111 121h Street Suite 408
Key West, Florida 33040
Dear Ms. Hall,
As per our phone conversation, American Ambulance Service, Inc. has decided to sell
our business to Falck Southeast Il Corporation ("Falck"). Falck is a provider of emergency
medical services on a worldwide basis steeped in history. Falck has been in the business of
delivering emergency services for one hundred and six years.
American Ambulance is submitting a request for a new COPCN because Falck is
acquiring one hundred per -cent of the stock of American Ambulance Service. The name of the
company will remain "American Ambulance Service, Inc." There will be no name changes. I am
supplying the information to you because on the Monroe County COPCN application it does not
ask who the owner of the applicant is. This serves as a new application as required by Monroe
County when there is a change in ownership greater than twenty-five per -cent.
I am available to answer any questions that pertain to the change in our organization.
Please contact me directly at 954-868-6668.
Sincerely,
Charles Maymon
Vice President
P.O. Box 221178 Hollywood, FL 33022 a 954 or 305 925-2000 0Fax: 954-894-7676