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Item C06BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: January 28, 2009 Division: Emergency Services Bulk Item: Yes X No Department: Fire Rescue Staff Contact Person/Phone ##: Darice Haves/6004 AGENDA ITEM WORDING: Approval of a Renewal Agreement by and between the Board of County Commissioners of Monroe County, Florida and Emergency Medical Sciences Academy, Inc. (EMS Academy) to provide an emergency medical services (EMS) training environment. ITEM BACKGROUND: In September of 2006 the Board of County Commissioners approved an Affiliation Agreement with EMS Academy which would provide a resource for a comprehensive learning experience for the EMS Academy students, within a clinical field setting, for completion of the students' program criteria (EMT -Basic and Paramedic). The Affiliation Agreement included an option to extend the Agreement for an additional one (1) year period on a yearly basis. Fire Rescue is requesting approval to exercise this option: PREVIOUS RELEVANT BOCC ACTION: On September 20, 2006 the Board approved the Affiliation Agreement with EMS Academy for the provision of an EMS training environment for the period September 20, 2006 through December 31, 2007. On December 19, 2007 the Board approved the Renewal Agreement with EMS Academy for the period January 1, 2008 through December 31, 2008. CONTRACUAGREEMENT CHANGES: The Renewal Agreement will be for the period January 1, 2009 through December 31, 2009. All other terms of the original Affiliation Agreement of September 20, 2006 remain in full force and effect. STAFF RECOMMENDATIONS: Staff recommends approval of the Renewal Agreement between EMS Academy and the Monroe County Board of County Commissioners so that Academy students can have the training environment they require to complete EMS courses. These EMS courses are also available for locals who are interested in pursuing further courses in the Emergency Medical Services field. TOTAL COST: NIA COST TO COUNTY:N/A REVENUE PRODUCING: Yes APPROVED BY: County Attyj DOCUMENTATION: Included X BUDGETED: Yes No SOURCE OF FUNDS:NIA No X AMOUNT PER MONTH Year. OMB/Purchasing Risk Management Not Required DISPOSITION: AGENDA ITEM # MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Emergency Medical Sciences Contract # Academy, Inc. (EMS Academy) Effective Date: January 1, 2009 Expiration Date: December 31, 2009 Contract Purpose/Description: To provide an EMS training environment for students of EMS Academy within a clinical field setting with Monroe County Fire Rescue. Contract Manager: Darice Hayes (Name) for BOCC meeting on January 28, 2009 Total Dollar Value of Contract: $ Budgeted? Yes❑ No ❑ Grant: S County Match: $ Estimated Ongoing Costs: $ /yr (Not included in dollar value abbovc 6004 Fire Rescue / Stop #14 (Ext.) (Department/Stop #) ;enda Deadline: January 13, 2009 CONTRACT COSTS NIA Current Year Portion: $ Account Codes: ADDITIONAL COSTS For: CONTRACT REVIEW iti Changes Date Out Division Director Date In !' 13 " 09 Needed Yes❑ NoY viewer r� A lj �/ Risk Manag men ' YesO No� O.Mt./Put'chIng itmloat Yes[:] Nod A County Attorney r Yes❑ No4 4a)��� Comments: OMB Form Revised 2127101 MCP 42 RENEWAL AGREEMENT This RENEWAL AGREEMENT dated the day of , 2009, by and between the Board of County Commissioners of Monroe County, Florida, hereinafter referred to as "AMBULANCE SERVICE" and EMERGENCY MEDICAL SCIENCES ACADEMY, INC., hereinafter referred to as the "AGENCY". WHEREAS, the parties hereto did enter into an agreement dated September 20, 2006 to provide a comprehensive learning experience for participants form the AGENCY, within a clinical setting; and WHEREAS, said agreement provided an option for an additional (1) year period extension if elected by both parties; and WHEREAS, both the AGENCY and the AMBULANCE SERVICE have elected to exercise said option; now therefore IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as follows: 1. The parties elect to renew the contract for an additional year pursuant to paragraph III.0 of the agreement entered September 20, 2006. 2. The effective date of this amendment is January 1, 2009 and shall extend through December 31, 2009, under the same terms and conditions of the contract dated September 20, 2006. 3. All other terms and conditions of the contract dated September 20, 2006 shall remain in full force and effect. (SEAL) Attest: DANNY L. KOLHAGE, CLERK Deputy Clerk (CORPO TE SEAL) Attest: By: Title: BOARD Lo Mayor/Chairman EMERGENCY MEDICAL SCIENCES ACADEMY, INC, By: Title: Og i &� MONROE COUNTY ATTORNEY APP OVE�D�AS TQ R . NTHIA L. HALL ASSISTANT COUNTY ATTORNEY Date 1 ` - G' r ACORDDATE(MMfDDlYYYY) TN TT 10/13/zoo6 PRODUCER ` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION g�� SEITLIN i.i LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6700 N. ANDREWS AVENUE, STE #300 FORT LAUDERDALE FL 33309 (954) 938-8788 (954) 938_`s HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE EXTEND OR POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIL # _ INSURED INSURERA: PHILADELPHIA INDEMNITY INS. CO 18058 Emergency medical Sciences Academy, Inc. INSURER&: GENERAL STAR INDEMNITY CO. 37362 INSURER C, TECHNOLOGY INSURANCE COMPANY 43276 _ 2000 WEST COMMERCIAL BLVD. , STE #200 INSURERD! CHICAGO INSURANCE COMPANY 02266 FORT LAUDERDALE FL 33309 INSURER E COVERAGES 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 ❑D'L POLICY NUMBER POLICY EFFECTIVE DATE fMMIDDIYYILIMITS POLICY EXPIRATION GENERAL LIABILITY EACH OCCURRENCE S 1 1 000 1 000 DA A ETORENT 0 PREMISES Eaoccurence) 5 100,000 A X COMMERCIAL GENERAL LIABILITY PHPK353270 10/7/2008 10/7/2009 MED EXP (Any one person) S 5,000 CLAIMS MADE Fx_1 OCCUR PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 2,000,000 POLICY n PRO 7XI LOG A AUTOMOBILE X LIABILITY ANY AUTO PHPX353270 10/7/2008 10/7/2009 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 BODILY INJURY (Per person) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) S X HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE ( Per accident) S GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO r _.... .... ........ �,,..�._ ...._._ ..__. S AUTO ONLY'. AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S 10, 000, 000 B X OCCUR CLAIMS MADE IUG395725D 10/7/2008 10/7/2009 AGGREGATE _ $ 10,000,000 5 DEDUCTIBLE �, X RETENTION 5 io,flofl C WORKERS COMPENSATION AND EMPLOYERS` LIABILITY TWC31BG507 9/21/2008 9/21/2009 X WCSTATU- OTH- E.L. EACH ACCIDENT S 500,000 ANY PROPMETORIPARTNERIEXECUTIVE E.L. DISEASE - EA EMPLOYE S 500,000 OFFICERIMEMBER EXCLUDED? If yes, describe under ELL, DISEASE - POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below D OTHER STUDENT MEDICAL PROF AHC-1219125 10/7/2008 10/7/2009 $1,000,000 EACH OCCURANCE $3,000,000 AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I 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, t-r-K I WIUA I L llVI_Ut:K CANCELLATION MONROE COUNTY BOCC 490 63 STREET SUITE #140 Marathon FL 33050 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE ACORD 25 (2001/08) p 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. lo/13/2008 ACORD 25 (2001108) Page 2 of 1 RENEWAL AGREEMENT This RENEWAL AGREEMENTT dated the e �� day o , , 2007, by - and between the Board of County Come- issioners of Monroe County, Florida, hereinafter rofe-ired to as "AMBULANCE SERVICE" -and EMERGENCE' MEDICAL SCIENCES ACADEMY, INC., hereinafter referred to as the "AGENCY". IITNESSETI l WHEREAS, the parties hereto did enter into an agreement dated September 20, 2006 to provide a comprehensive learning experience for participants from the AGENCY, within a clinical setting; and WHEREAS, said agreement provided an option for an additional (1) year period extension if elected by both parties; and WHEREAS, both the AGENCY and the AMBULANCE SERVICE have elected to exercise said option; now therefore IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as follows: I. The parties elect to renew the contract for an additional year pursuant to paragraph III.C, of the agreement entered September 20, 2006. 2. The effective date of this amendment is January 1, 2008 and shall extend through December 31, 2008, under the same terms and conditions of the contract dated September 20, 2006. $er terms and conditions of the contract dated September 20, 2006 shall remain in full L. KOLHAGE, CLERK BOARD OF COU iTY COMMISSIONERS OF MONROE C TY, FLORIDA r By. By: Deputy Clerlc Mayor/Chairmaii EMERGENCY MEDICAL SCIENCES (CORPORATE SEAL) ACADEMY, INC, Attest: , By: Title: r (.I � Sq- 1 i s Title: -Tn ---�- - _JA.c�-t IUit7i�MOE CC-)UHTY ATTORNEY >,„„S. �l.IZABETFi I�COSE�!-I %� P °,IE �'i��80 ��Notary fubtio - State of Florida Niy Comm!3sion Expires May 25,20'10- - - - :, Commission LrD 513509 V G'� N IT L. HALL fe✓'iA0'; LCi<'��n ASSISTANT f'+� jiT� �.;,tl S F �l i F •,�, Conded try National Notary Assn. -�S P , C Ot_ ; IT ,-, � i ,,R -7 �111'1-llli 0-1 rAlL LET r;� �•s%,WTI - (q5 } 93 f^=So € rW) •5)so--Sz6v �l'iu Li'gG£I C{80 &:„;,p" col-slErmd J, Br,VD. , swr 1'26G POPT :aUm tYJlmup Pig 33305 _--fr(€ TV,rf ie Rtq ` E al Et<F a P I Eu E �iI1 14 w rti s6d s i 6 € 5 c" Ei l 0 flt;"UL $}e}A e'!i AND COWFH-r, Ijo jq,ICjE-I ­ S € pot i C "�°E��i � s t MLDEe € E �; €� )[ i # [ m c AmL-#m�E,, €�l Tl-[�rLs; Erb A�'I'M THEC VERAG c.TB�� E�omF�. AFFOROED iE I"f off CijSU` ERG AFFO UNG COVERAGEn _ WAIH '! INSURERA: PR1T,,TLt)r p..3T3s aIiRr PdIS1my sirs. co loose 114SURBRB: GMM—li'hL S1ai; C �0. 97362 'EVEC'": 17TR„^ET'Z €< UU k rx; ' E'€�. G'L3< , 2.3Cs5 1NuURER D: THE ANY MAY POLICIES. I1dSN F'� PO[.ICIE$ REQUIREfA-EWT, PERTAIN, tiD'L OF IIS U3ANCE LISTED 13ELOVV TERM OR CONDNION THE INSURANCE AFFORDED AGGREGATE i.IM1TS SHOWN MAY fi€�II1SI1�xaraG:E - GENERA!. LIABII.€Tf HAVE BEEN ISSUEO TO THE INSURED OFANY CONTRACT OP•. OTHER SY Tl :E POLICIES IRGSCRIBED HAVE S1=EN REDUCECI OY PAID PRL(CYT€€€Plf3E — - - NAMED 1113OVE FOR THE POLICY DOCUMENT WITH RESPECT TO WI.11CH HEREIN I$ SUBJECT TO ALL Virzi TERMS, CLAIM$. P[.7LICYEF^i=ECeVc FiQLIP'YEt.PIRhT[LlN 7A"1= 9 D. G: kl to 5 fa p PERIOD INDICATED. NOTWITHSTANDING THIS CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF SUCH Li 91T5 Z �C CDP,3G4GRGIF1' CEIlEIIALLIABILI7Y CLAWS MADE F0OCCUR P%i!?YL2G6098 14/7/2Q07 EO/7/2,403 EACH OCCURRENCE 5 1 000,d0 1 - E. " cr. MED EXP (Ar Vgno person) 100,000 S 5,000 PERSONAL AADV INJURY S .11.1000.000 GENERAL AWREGATE 5 ,000,400 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PR X L00 PRODUCTS-COMPIOPAGO S 2<000,000 AU MOBILE LIABILITY - X ANY AUTO ALl OWNED AUTOS ]?EPE20609a 3.0/7/2007 20/7/2008 COMBINED SINGLELIMI'€' (Eanoddent) S 110G01000 SCHEDULEOAUTOS BONLYINJURY (Par pomn) S X HIREDAUTOS 7"s NON•OWNEDAUTOS BODILVINJUP.Y (Parggddant) c y a r PROPERTV DAMAGE (Perpcoidenk) S GARAGELIADILITY 3ANY AUTQ EXCESMAISRELLA LIABILITY q - .., �- _ ... AUTO ONLY LEA ACCIDENT 5 OTH2RTHAN F-AACC AUTO dNLY: AGO 9 5 T� R OCCUR CLAIMS MADE IU0395725C 10/7/2R07y -10/7/2006 EACHOCGURRENCE 5 10, 000, 000 AGGREGATE 5 10,600,000 SIR S 101000 DEDUCTIBLE s C RETENTION 5 VVORIMRS COMPENSATION AND tiMPLOYERW LIAGIUTY WC21512974730kG 9/21/2007 9/21/2009 7� V€rCSTA7,U- DTH- S E.L. EACH ACCIDENT ANY PROPRIETORJPARTNERIEXi:CUTIVE OFFICEPWSMSER EXCLUDED? E.L. DISEASE - EA EMPLOYE S 500<000 Ify4r.describeunder SPEVAL PROVISIONS Batow El, DISEASE -POLICY LIMIT s 540, 000 OTHER ims"PI-710P1 OP 4F'ERP,3'kOH51 LOO-71ON€3 J 1JENICLEs ftCLUSIONG ADZJED BY E;d©DR5.�G7GP3T 1 SPC--GIRL PROVISIOtiS Cii TT��G'r2€>J SOLI mp Jig i R83:c-m' S a=-:1 TO HE TERZIS, COPTDjTjOLi6 LL1 ORGII XZAT313I7 1E XT9 39oCL,CYS%O€7S Ml ADjD7Wj0£TAL 111SURE-D a7S AVSPBCTS or 'SEE POAXCit. E4C=ILL V 1tAB$LE'ii'' CERTIFICATE HOLDEN 1110=103 COUNTY BOW 4DO 63 STRPCT SIp'XTD (I144 8+fathom rL .33050 SHOULD ANY OF THEABOVEDESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL . 30 . SAYS WRITTEN NOTICE TO THE C5RTJrrCATE BOLDER NAPr1ED TO THE LEFT, BUY RAtLU€iE TO DO 30 SHALL I7 POSE HO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSUNER, ITS AGENTS OR AUTHORIZED REPRESEN `AT1VE ACOI D 2S (200-110a) R® ��� a v,� ._m n - - -.. a _ Q € CORI3'" If the cerdficvate holder iW an ADU T IONAL INSURED, the policy(Ies) rnust be endorsed. A staternent on thls cord icato does not can er rights to the ce€°IF ice e holder in lieu of such endorsernent(s). if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies €nay require an cndorsernerrt. A statemeni on this cert icc€te doffs not confer rights to the certificate €101der in lieu of such enclorsoment(s). 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 a rrmatively or negatively arnend, extend or alter the coverage afforded by the policies fisted thereon. 23 (20011 -3) '[f1i,lo�i This AGREEMENT biaween EMERGENCY MEDICAL SCIENCES ACADEM-17, INC., herehu:rfter referred to as the AGENCY, curd the BOARD OF COUNTY Y COMMISSIONERS OF MONROE COUNTY, FLORIDA hereinafter referfed to as the AMDI AffE SERVICE is entered ito tills ay of 2006. 11. PURPOSE OF AGP�EME, NT It is mutually agreed that the purpose of this AGREEMENT is to provide a comprehensive lea ing experience for participants morn the AGENCY, within a clinical Setting, in accordance witlr provisions of the guidelines set ford, in 'This AGREEMENT. Ao 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. lam The AMBULANCE SERVICE will provide, to the Participant, at tile, 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. Ca The term of this AGREEMENT shall be from the date of the AGREEMENT, and shall remain in fZill force and effect until December 31, 2007. Either party may elect annually to extend this AGREEMENT forall 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: For AMBULANCE SERVICE: Frank Galgano, Program Director Clary O. Martin, Jr., Fire; Chief/Div. Director EMS .Academy, Inc. Monroe County Fire Rescue 600 N. Pine Island Rd., Suite 320 490 63' Street, Suite 140 Plantation, FL 33324 Marathon, FL 33050 U t i !!t E 'Ir, I, c( }}1 �� I! Ir''t rlr q� AG�ED:-ICY shah des la e a Jrsoo! person s to coo$ednate and ac€ as ikdsc yl wid, tl e appropriate, AMBULANCE SEIRVYCE poFson ol. _ Ba AGE114CY shall provide the AM ULANCE SERVICE with a list of partici-imli€s In tile, leaf $gig eZ-PC- .e1-'ce at least ten (1€) clays before e,- cl1 pro,' am is to stagy L Co AGENCY small insure that paid"ticipants have the necessary didactic preFeq isites to maximize the leaniing eKporience at the AMBULANCE SERVICE. . 1Da AGENCY shall insure that the pallicipatlts comply with the provisions of Section VI. E. AGENCY sloes undertake and agree that it will indemnify and hold harmless tho 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 bind and by whomever and whenever made or obtained, allegedly caused by, arising oL t of, or relatil g ire an�r ���a��izer to tho activity of any Participant or participants supplied by the AGENCY pursuant to this AGREEMENT. F. AGENCY shall procure, and maintain, during the term or 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 of the 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 "On -renewal of any of the insurance coverage's described herein. Participants who do not have patient contact (non -allied health particiWgnts) will not be required to be covered by professional liability insurance. rp , ji�i'l(ift- 1k i i ti.' �j � �� �� - % lip` ,-5 i P_,_� -: ii a`,' , ___I,ircl,- I,'_ _,� 1�d.i�, It shell lie the 9 ,_p�crnsihihty of flht 4_D,03 ULI=1:T�'�w. SERvYcEi t�: A9 . "rovide an aippro riate of ientation of participants in cosfilection with its 1`acilities and its policies a�ad laroccdures. IS. w°o-tide opportunities for a learlifilg e2�periezjce with appropriate supez vi sion. C. Retain ultimate responsibility for patient care even if that 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. Vff- S1FJC'CRNC RE' SPONSYBILETHES OF THE PARTICIPANT It shall be the resp011sibility of the Participant(s) assigned thro-e.rgh this AGREEMENT to: A6 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 "Fold Harmless .Agreement" with the AMBULANCE SERVICE prior to commencing his/her experience within the AMBULANCE SERVICE of which is attached to this AGREEMENT as Exhibit A. 2, At all times, must wear the appropriate badge on every clinical rotation, and comply i s all respects with the student requirements set forth in the requitement sheets. V11. REQUEST FOR WITHDRAWAL OF PARTICIPANT The AMBULANCE SERVICE shall reserve the right to deny any Participant i7-om access to its facilities whose conduct or work with patients or personnel is not in accordance with the policies and procedures of the ULA-14CE SERVICE or is detrimental to patients or others. AeTrcv,Eh/iEITT lynv be `r e y mutmis Lctij pr� C;s, and :>i,` a at.t :,as o:f ardos agaaing to dhe --alo il'Ic tion. 7a COPIES G AR -1,71,1WENT Copies of fl is siped AGFEEME11 T sly ll be placed 01I file and be available at the c04301 ate office of 'die AGENCY and in the offices of the ATE/ BUL ANCE SERVICE. IN W1TI MESS WHEREOF, the parties hereto have caused this AGREEMENT to be oxecute'd in their aespeadve corporate 11ml .es and their col-Porate seals to be a b�. ed by duly authorized of'fcers, all on the day and year first set forth above. (SEAL) Attest: Danny L . Kolhage, Cleric Ss 3 Emergency Medical Sciences Academy, hie. Frank Galgano; Pr Director Board or Comity Colmnissioners of Momoe County, Florida Mayor /l aaa tMOWROE COUNTY ATTORNEY APPnOVED AS TO FORM. a SUS �, eRIMS �E- A 9 iA Q iY A �F MEY Date t III I, , allf' tAOSCAIVY 83UOfted as din Emergency Medic,-:si Technician or Emergency Medical Technician Parannedic student at Emergency Medical Sciences (EMS) Academy. My course of instruction at this school requires me to train, study, and raceive 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. 1, 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, danjages or injury arising out of or in connection with any arid all acts of negligent conduct oil my part, however caused, during any instructional or training activity. I agree that l 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, l 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: Witness: to Data Date LEI Date, (_ I u I 4 � U AGE❑❑ t�p3 F r IDC5 v177hlf-i ' IP7StiP'CLZ �I'�9�'sx�, Ft �, N,r--DEAL S m-I:f.-_ .., ; INSUf:ERA. "Crui i , Dp -iL t 16)aUpja"a1 v l.! Yn�IFr„1 t� ad. INSURER a: I R��S�;ITATIP��J, r�, 3� ;art 11-IE 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 CERTWICATE 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 SY PAID CLAIMS. n A— _.. r3Ei;1EFiA. i, d.IAE€LfTY k 17 COMMERCIAL GENERAL LIABILITY CLg d 94La 9 CLAIMS h,9ADE i OCCUF GEN'L AGGREGATE LIMITAPPLIES PER: D TOZIILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEOULED AUTOS HIRED AUTOS NON -OWNED AUTOS 9 UGC LIABILITY ANY AUTO - OCCUR CLAIMS MADE DEDUCTIBLE tlr )RNIRFZO COI IPENZATIOP AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECU T IVE OFFiCERIMEMBER EXCLUDED? 0411112086 OTHER 1EECP1PT101`1 OF OPEP ATIOAS 11`13 1011-s I VEHICLE :-I IVICLUSIONS ADDED BY ENDDMA.MENT 1 SPECIAL PROVISIONS- ;ERTIFICATE HOLDER IS LISTED AS A1301TIOIJAL RIS'UPEI) PERSONAL 0 Any mui ir-'.Y a^ 2,1i}fi(( Qflp — j PP.ODUGF9-COMPIOPAGG s EXCLUDED �.�-J, PEBIODILYINJUqRY SINGLE LIMIT t) +' URY � RY t) PROPERTY DAMAGE (Per accident) AUTO ONLY -EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: ___ mraav va. e.r�M 6 A�➢fV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA-rjoP� ONROE COUNTY BOCC DATE THEREOF, THE t5SUWG INSURER MLL ENDEAVOR TO MA€L �0 DAYE LJf?iT PEF! 06 STREET SUITE 140 NOTICE TO THE CERTIFICAATE HOLDER NAP420 TO THE LEFT, BUT FAILURE TO DO SO SHALL 'LlL iOSE t1a OBLIGATION OP; LIABILITY OF ARY 91ND UPON THE IN9UP;EP„ ITS AGEOTS OF MARATHON, FL 3305 REPIRESENTATIVES. 61CiTPiOPI13 REPP.ESENTd1TIVE v11� r,43PP0w\Tft— If the COAdficate holder is an A;DFDITJOHAL INSURED, the PficY(iez) Must be endorsed. A statorileni, on this certificate does jj0j confer rigilis c& ji-€ ceFjjfjc@jQ_ holder in lie, or, SUCI-I andorsemont(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ceii(ain policies t-jjay require an endorserfloilt. � st@jea1101't Oil this certificate does, not confor rights to the cer-tificate holder in lion of such endorsernenqq). D0,53CLA, MW ER The CGrtific@ts Of Insurance on the reverse side of this form does not constitute a contract betwasn the issuing insurer(:), aujjloj-1zcd FePresentative Or producer, and the carifficate holder, nor does it affirmatively or negatively amend, e),tGnd or after the coverage afforded by the policies listed thereon. 215 � r r L l € is :'�C DIpr,' j,III-' .., .,. Lu VNPI c F nt�L aft iiY. L> E� flCW FcUormw� tm� 1 I"i Ii ')� l 4%fepSY��etFE � R iFT? tiE-m- r''aw�')t`fm'� r're � — _ ��_ sr. NE PcIl CL11[mll /+�. �j® [ ✓p "yt�q- lio g Loci E--VASs1iiYON {)i1G'i C5 0.uFr- 320 INsUrr'GR R. PW17AC I N R 33,2924 INSURER C. I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED f0 THE INSURED NAMED ABOVE FOR T1-IE POLICY PERIOD INDICATED. NOTVIIITHSTANOING ANY REQUIREMENT, TERM OR COND] 11ON OF ANY CONTRACT OR OTHER DOCUMENT WiTFI RESPECT TO WI NCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY -R-IE 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, -- 9E[dEi"y!•1L LIACILrAl .. -- .. -- . COMMERCIAL CENERAL LIA21LITY SI�7931393 CLAWIS MADE ❑ OCCUR 7i PROFESSIONAL LOAD GEN'L AGGREGATE LIMITAPPLIES PER: POLICY I O- LOC AUTGOOMILE Llk ILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE. LIABILITY ANYAUTO rXCESEMOZI:ELLA LIAEOLfre OCCUR CLAIMS MADE .r DEDUCTIBLE 1n2d,1V L:.'- RETENTION VJDF-'Kr:RS COMPENSATION Ann EMPLOYERS' LIABILITY ANY PROPRIETOW OFFICERIMEM ER EXCLUDED?ECUTIVE ©THER I 3GSCRiI�Tl4[•19f Or rl #lTl i15l Li9C61TiC3f181 VGi1iCLt w 1 ERWLUSI-ONS ADDED BY ENDORSE114EN T I SPECIAL PROVISIONS MONROE COUNTY 80CC 499 63 STREET SMITE 140 MARATHON, FL 33050 COMBINED SINGLE LIi'AIT $ (Eo ticcldenf) BODILY hyJURY (Par perecn) BODILY1NJURY S (Per accident) PROPER iY DAPs1AGEF-� (Per taccldant) AUTO ONLY -EA ACCIDENT s OTHER THAN EAACC 5 AUTO ONLY: SHOULD APdY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEFOP,E THE EXPIRATION DATC THERE-GF, THE 19Q,U1NG INGURER VdLL ENDEAVOR TO WAIL 10DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER LAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMFZ0C NO LIGATIO[1 OR UAEILfTV OF Am KIND UPOPf Tma risuRER, ITS "iGEi'1TS Op, REPRESENTATIVES. GAJTHCIRRIZEDREPRCSENTATIlJE M-2,0RIT/s\'my If the cerifficate holder is an ADDITIONAL INSURED, the policy(jos) must be 011dorscd. A statement on 't"fl$certificate d083 110i confer Fight5to the cenificate holder in lieu O5 such endorse,,ijent(s). If SUBROGATIOM IS WAED IV, subject to require an A sta the terms and conditions of tile POIiCY, certain policies may tc-rnent On this csrHc@tG does not confer 1-Ighis to the certificate 1101ft- In lieu Of such endor8orliont(s), DUSCLAOMER, The Certificate of Insurance oil tile reverse side of this form does not constitute a contract between the issuing insurer(s), auftrized reprOssritatIM or Producer, and the certificate holder, nor does it affirmatively or negatively amend, &,jend or alter the coverage afforded by the policies listed thereon.