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HomeMy WebLinkAboutPublic Health Seattle King Countyft 3.1 (0 .'K Contract,; Procurement and Real Estate Services (CPRES) public "Health- 401 Fifth Avenue Suite 1300 -' Seattle, wA 98104 1818.- . - -. - Seattle & King County 206- 263 =8747 Fax 206 296 0629: TTY Relay:,711:, _ - www Idngcounry gov /health - -- City of Auburn 25 W Main St Seattle, WA 98001 February 5, 2015 Enclosed is a copy of your agreement with King County Health Department. We have retained a copy for our records. Please contact Allen Cantara at (206) 263 -8744 if you have questions. 0 Public Health PHSKC Agreement # _ LQ COMMUNITY SERVICES Seattle K King County AGREEMENT EMS3746 This Agreement is between King County and the Recipient identified below. The County department overseeing the work to be performed in this Agreement is the Department of Public Health (PHSKC). RECIPIENT NAME RECIPIENT FEDERAL TAX ID # City of Auburn RECIPIENT ADDRESS RECIPIENT CONTACT & EMAIL ADDRESS 25 W Main St., Auburn, Washington, UNITED STATES, 98001- Sarah Miller, skmiller(Waubumwa.gov, 253 - 876 -1909 4998 PHSKC DIVISION PROJECT TITLE Emergency Medical Services Project RAMPART AGREEMENT START DATE AGREEMENT END DATE AGREEMENT MAXIMUM AMOUNT 1/1/2015 12/31 /2015 $4,940.43 FUNDING DETAILS Funding Source Amount King County Emergency Medical Services $4,940.43 Levy FUNDING SUMMARY FEDERAL: COUNTY:$4,940.43 STATE: OTHER: IS THE RECIPIENT A SUBRECIPIENT FOR PURPOSES OF THIS AGREEMENT? ❑ YES ® NO EXHIBITS. The following Exhibits are attached and are incorporated into this Agreement by reference: Exhibit A — Scope of Work Exhibit B — Budget Exhibit C — Invoice Exhibit D — CPR Reporting Forms In consideration of payments, covenants, and agreements hereinafter mentioned, to be made and performed by the parties hereto, the parties mutually agree that the Recipient shall provide services and comply with the requirements set forth in this Agreement. The parties signing below represent that they have read and understand this Agreement, and have the authority to execute this Agreement. Furthermore, in addition to agreeing to the terms and conditions provided herein, by signing this Agreement, the Recipient certifies that it has read and understands the Agreement requirements on the PHSKC website (http: / /www.kingcounty.gov /health /Agreements), and agrees to comply with all of the Agreement terms and conditions detailed on that site, including EEO /Nondiscrimination, HIPAA, Insurance, and Credentialing, as applicable. RECIPIENT SIGNATURE PRINTED NAME AND TITLE DATE SIGNED PHSKC SIGNATURE PR�_IJJTED NAME DATE SIGNED --TITLE ,,AND Jil't's Fi 11 / /ZG //S �•v+sron QreWora, El1n 5 Ap oved as to Form: OFFICE OF THE KING COUNTY PROSECUTING ATTORNEY (This form is available in alternate formats for people with disabilities upon request.) i • KING COUNTY TERMS AND CONDITIONS Agreement Term and Termination A. This Agreement shall commence on the Agreement Start Date and shall terminate on the Agreement End Date as specified on page 1 of this Agreement, unless extended or terminated earlier, pursuant to the terms and conditions of the Agreement. B. This Agreement may be terminated by the County or the Recipient without cause, in whole or in part, prior to the Agreement End Date, by providing the other party thirty (30) days advance written notice of the termination. The Agreement may be suspended by the County without cause, in whole or in part, prior to the date specified in Subsection I.A. above, by providing the Recipient thirty (30) days advance written notice of the suspension. C. The County may terminate or suspend this Agreement, in whole or in part, upon seven (7) days advance written notice in the event: (1) the Recipient materially breaches any duty, obligation, or service required pursuant to this Agreement, or (2) the duties, obligations, or services required herein become impossible, illegal, or not feasible. If the Agreement is terminated by the County pursuant to this Subsection 1.C. (1), the Recipient shall be liable for damages, including any additional costs of procurement of similar services from another source. If the termination results from acts or omissions of the Recipient, including but not limited to misappropriation, nonperformance of required services, or fiscal mismanagement, the Recipient shall return to the County immediately any funds, misappropriated or unexpended, which have been paid to the Recipient by the County. D. If County or other expected or actual funding is withdrawn, reduced, or limited in any way prior to the termination date set forth above in Subsection 1.A., the County may, upon written notification to the Recipient, terminate or suspend this Agreement in whole or in part. If the Agreement is terminated or suspended as provided in this Section: (1) the County will be liable only for payment in accordance with the terms of this Agreement for services rendered prior to the effective date of termination or suspension; and (2) in the case of termination the Recipient shall be released from any obligation to provide such further services pursuant to the Agreement ; and (3) in the case of suspension the Recipient shall be released from any obligation to provide services during the period of suspension and until such time as the County provides written authorization to resume services.. Funding or obligation under this Agreement beyond the current appropriation year is conditional upon appropriation by the County Council of sufficient funds to support the activities described in the Agreement. Should such appropriation not be approved, this Agreement will terminate at the close of the current appropriation year. E. Nothing herein shall limit, waive, or extinguish any right or remedy provided by this Agreement or law that either party may have in the event that the obligations, terms, and conditions set forth in this Agreement are breached by the other party. 2. Compensation and Method of Payment A. The County shall reimburse the Recipient for satisfactory completion of the services and requirements specified in this Agreement, payable upon receipt and approval by the County of a signed invoice that complies with the attached Budget Exhibit. B. The Recipient shall submit an invoice and all accompanying reports as specified in the attached exhibits not more than 60 working days after the close of each indicated reporting period. The County shall make payment to the Recipient not more than 30 days after a complete and accurate invoice is received. 0 0 C. The Recipient shall submit its final invoice and all outstanding reports within 90 days of the date this Agreement terminates. If the Recipient's final invoice and reports are not submitted by the day specified in this subsection, the County will be relieved of all liability for payment to the Recipient of the amounts set forth in said invoice or any subsequent invoice. D. When a budget is attached hereto as an exhibit, the Recipient shall apply the funds received from the County under this Agreement in accordance with said budget. The Agreement may contain separate budgets for separate program components. The Recipient shall request prior approval from the County for an amendment to this Agreement when the cumulative amount of transfers among the budget categories is expected to exceed 10% of the Agreement amount in any Agreement budget. Supporting documents necessary to explain fully the nature and purpose of the amendment must accompany each request for an amendment. Cumulative transfers between budget categories of 10% or less need not be incorporated by written amendment, however, the County must be informed immediately in writing of each such change. E. Should, in the sole discretion of the County, the Recipient not timely expend funds allocated under this Agreement, the County may recapture and reprogram any such under - expenditures unilaterally and without the need for further amendment of this Agreement. The County may unilaterally make changes to the funding source without the need for an amendment. The Recipient shall be notified in writing of any changes in the fund source or the recapturing or reprograming of under expenditures. F. If travel costs are contained in the attached budget, reimbursement of Recipient travel, lodging, and meal expenses are limited to the eligible costs based on the following rates and criteria. The mileage rate allowed by King County shall not exceed the current Internal Revenue Service (IRS) rates per mile as allowed for business related travel. The IRS mileage rate shall be paid for the operation, maintenance and depreciation of individually owned vehicles for that time which the vehicle is used during work hours. Parking shall be the actual cost. When rental vehicles are authorized, government rates shall be requested. If the Recipient does not request government rates, the Recipient shall be personally responsible for the difference. Please reference the federal web site for current rates. http: / /www.gsa.gov. Reimbursement for meals shall be limited to the per diem rates established by federal travel requisitions for the host city in the Code of Federal Regulations, 41 CFR § 301, App.A. Please reference htto: / /www.gsa.gov for the current host city per diem rates. 3. Accommodation rates shall not exceed the federal lodging limit plus host city taxes. The Recipient shall always request government rates. Air travel shall be by coach class at the lowest possible price available at the time the County requests a particular trip. In general, a trip is associated with a particular work activity of limited duration and only one round -trip ticket, per person, shall be billed per trip. Any air travel occurring as part of a federal grant must be in accordance with the Fly America Act. 3. Internal Control and Accounting System The Recipient shall establish and maintain a system of accounting and internal controls which complies with applicable generally accepted government accounting standards (GAGAS). 4. Debarment and Suspension Certification Entities that are debarred, suspended, or proposed for debarment by the U.S. Government are excluded from receiving federal funds and contracting with the County. The Recipient, by signature to this Agreement, certifies that the Recipient is not presently debarred, suspended, or proposed for debarment by any Federal department or agency. The Recipient also agrees that it will not enter • • into a sub - agreement with a Recipient that is debarred, suspended, or proposed for debarment. The Recipient agrees to notify King County in the event it, or a sub- awardee, is debarred, suspended, or proposed for debarment by any Federal department or agency. 5. Maintenance of Records /Evaluations and Inspections A. The Recipient shall maintain accounts and records, including personnel, property, financial, and programmatic records and other such records as may be deemed necessary by the County to ensure proper accounting for all Agreement funds and compliance with this Agreement. B. In accordance with the nondiscrimination and equal employment opportunity requirements set forth in Section 13. below, the Recipient shall maintain the following: 1. Records of employment, employment advertisements, application forms, and other pertinent data, records and information related to employment, applications for employment or the administration or delivery of services or any other benefits under this Agreement; and 2. Records, including written quotes, bids, estimates or proposals submitted to the Recipient by all businesses seeking to participate on this Agreement, and any other information necessary to document the actual use of and payments to sub - awardees and suppliers in this Agreement, including employment records. The County may visit the site of the work and the Recipient's office to review the foregoing records. The Recipient shall provide every assistance requested by the County during such visits. In all other respects, the Recipient shall make the foregoing records available to the County for inspection and copying upon request. If this Agreement involves federal funds, the Recipient shall comply with all record keeping requirements set forth in any federal rules, regulations or statutes included or referenced in the Agreement documents. C. Except as provided in Section 6 of this Agreement, the records listed in A and B above shall be maintained for a period of six (6) years after termination hereof unless permission to destroy them is granted by the Office of the Archivist in accordance with Revised Code of Washington (RCW) Chapter 40.14. D. Medical records shall be maintained and preserved by the Recipient in accordance with state and federal medical records statutes, including but not limited to RCW 70.41.190, 70.02.160, and standard medical records practice. If the Recipient ceases operations under this Agreement, the Recipient shall be responsible for the disposition and maintenance of such medical records. E. The Recipient agrees to cooperate with the County or its agent in the evaluation of the Recipient's performance under this Agreement and to make available all information reasonably required by any such evaluation process. The results and records of said evaluations shall be maintained and disclosed in accordance with RCW Chapter 42.56. F. The Recipient agrees that all information, records, and data collected in connection with this Agreement shall be protected from unauthorized disclosure in accordance with applicable state and federal law. 6. Compliance with the Health Insurance Portability and Accountability Act of 1996 ( HIPAA) The Recipient shall not use protected health information created or shared under this Agreement in any manner that would constitute a violation of HIPAA and any regulations enacted pursuant to its provisions. Recipient shall read and certify compliance with all HIPAA requirements at http: / /www. kingcou nty.gov /hea lthservices /health /partnerships /contracts Audits 0 0 A. If the Recipient is a municipal entity or other government institution or jurisdiction, it shall notify the County in writing within 30 days of when its annual report of examination /audit, conducted by the Washington State Auditor, has been completed. B. Additional audit or review requirements which may be imposed on the County will be passed on to the Recipient and the Recipient will be required to comply with any such requirements. 8. Corrective Action If the County determines that a breach of Agreement has occurred, that is, the Recipient has failed to comply with any terms or conditions of this Agreement or the Recipient has failed to provide in any manner the work or services agreed to herein, and if the County deems said breach to warrant corrective action, the following sequential procedure will apply: A. The County will notify the Recipient in writing of the nature of the breach; The Recipient shall respond in writing within three (3) working days of its receipt of such notification, which response shall indicate the steps being taken to correct the specified deficiencies. The corrective action plan shall specify the proposed completion date for bringing the Agreement into compliance, which date shall not be more than ten (10) days from the date of the Recipient's response, unless the County, at its sole discretion, specifies in writing an extension in the number of days to complete the corrective actions, B. The County will notify the Recipient in writing of the County's determination as to the sufficiency of the Recipient's corrective action plan. The determination of sufficiency of the Recipient's corrective action plan shall be at the sole discretion of the County, C. In the event that the Recipient does not respond within the appropriate time with a corrective action plan, or the Recipient's corrective action plan is determined by the County to be insufficient, the County may commence termination or suspension of this Agreement in whole or in part pursuant to Section 1.C.; D. In addition, the County may withhold any payment owed the Recipient or prohibit the Recipient from incurring additional obligations of funds until the County is satisfied that corrective action has been taken or completed; and E. Nothing herein shall be deemed to affect or waive any rights the parties may have pursuant to Section 1., Subsections B, C, D, and E. 9. Dispute Resolution The parties shall use their best, good -faith efforts to cooperatively resolve disputes and problems that arise in connection with this Agreement. Both parties will make a good faith effort to continue without delay to carry out their respective responsibilities under this Agreement while attempting to resolve the dispute under this section. 10. Hold Harmless and Indemnification A. In providing services under this Agreement, the Recipient is an independent contractor, and neither it nor its officers, agents, employees, or subcontractors are employees of the County for any purpose. The Recipient shall be responsible for all federal and /or state tax, industrial insurance, and Social Security liability that may result from the performance of and compensation for these services and shall make no claim of career service or civil service rights which may accrue to a County employee under state or local law. The County assumes no responsibility for the payment of any compensation, wages, benefits, or taxes, by, or on behalf of the Recipient, its employees, subcontractors and /or others by reason of this Agreement. The Recipient shall protect, indemnify, and save harmless the County, its officers, agents, and employees from and against any and all claims, costs, and /or losses whatsoever occurring or resulting from (1) the Recipient's failure to pay any such compensation, wages, benefits, or taxes, and /or (2) the supplying to the Recipient of work, 0 0 services, materials, or supplies by Recipient employees or other suppliers in connection with or support of the performance of this Agreement. B. The Recipient further agrees that it is financially responsible for and will repay the County all indicated amounts following an audit exception which occurs due to the negligence, intentional act, and /or failure, for any reason, to comply with the terms of this Agreement by the Recipient, its officers, employees, agents, or subcontractors. This duty to repay the County shall not be diminished or extinguished by the prior termination of the Agreement pursuant to the Term and Termination section. C. The Recipient shall defend, indemnify, and hold harmless the County, its officers, employees, and agents from any and all costs, claims, judgments, and /or awards of damages, arising out of, or in any way resulting from, the negligent acts or omissions of the Recipient, its officers, employees, sub - awardees and /or agents in its performance or non - performance of its obligations under this Agreement. In the event the County incurs any judgment, award, and /or cost arising therefrom including attorneys' fees to enforce the provisions of this article, all such fees, expenses, and costs shall be recoverable from the Recipient. D. The County shall defend, indemnify, and hold harmless the Recipient, its officers, employees, and agents from any and all costs, claims, judgments, and /or awards of damages, arising out of, or in any way resulting from, the negligent acts or omissions of the County, its officers, employees, or agents in its performance or non - performance of its obligations under this Agreement. In the event the Recipient incurs any judgment, award, and /or cost arising therefrom including attorneys' fees to enforce the provisions of this article, all such fees, expenses, and costs shall be recoverable from the County. E. Claims shall include, but not be limited to, assertions that use or transfer of software, book, document, report, film, tape, or sound reproduction or material of any kind, delivered hereunder, constitutes an infringement of any copyright, patent, trademark, trade name, and /or otherwise results in unfair trade practice. F. Nothing contained within this provision shall affect and /or alter the application of any other provision contained within this Agreement. G. The indemnification, protection, defense and save harmless obligations contained herein shall survive the expiration, abandonment or termination of this Agreement. 11. Insurance Requirements By the date of execution of this Agreement, the Recipient shall procure and maintain for the duration of this Agreement, insurance against claims for injuries to persons or damages to property which may arise from, or in connection with, the performance of work hereunder by the Recipient, its agents, representatives, employees, and /or sub - awardees. The costs of such insurance shall be paid by the Recipient or sub - awardee. The Recipient may furnish separate certificates of insurance and policy endorsements for each sub - awardee as evidence of compliance with the insurance requirements of this Agreement. The Recipient is responsible for ensuring compliance with all of the insurance requirements stated herein. Failure by the Recipient, its agents, employees, officers, sub - awardee, providers, and /or provider sub - awardees to comply with the insurance requirements stated herein shall constitute a material breach of this Agreement. Specific coverages and requirements are at http: / /www.kingcounty.gov /healthservices /health /partnerships /contracts; Recipients shall read and provide required insurance documentation prior to the signing of this Agreement. 12. Assignment/Sub- agreements A. The Recipient shall not assign or sub -award any portion of this Agreement or transfer or assign any claim arising pursuant to this Agreement without the written consent of the County. Said consent must be sought in writing by the Recipient not less than fifteen (15) days prior to the date of any proposed assignment. 0 0 B. "Sub- agreement" shall mean any agreement between the Recipient and a sub - awardee or between sub - awardees that is based on this Agreement, provided that the term "sub - awardee" does not include the purchase of (1) support services not related to the subject matter of this Agreement, or (2) supplies. C. The Recipient shall include Sections 2.D., 2.E., 3, 4, 5, 6, 10.A., 10.6., 10.G., 12, 13, 14, 15, 16, 17, 23, 24, 25, and the Funder's Special Terms and Conditions, if attached, in every sub - agreement that relates to the subject matter of this Agreement. D. The Recipient agrees to include the following language verbatim in every sub - agreement for services which relate to the subject matter of this Agreement: "Sub - awardee shall protect, defend, indemnify, and hold harmless King County, its officers, employees and agents from any and all costs, claims, judgments, and /or awards of damages arising out of, or in any way resulting from the negligent act or omissions of sub - awardee, its officers, employees, and /or agents in connection with or in support of this Agreement. Sub - awardee expressly agrees and understands that King County is a third party beneficiary to this Agreement and shall have the right to bring an action against sub - awardee to enforce the provisions of this paragraph." 13. Nondiscrimination and Equal Employment Opportunity The Recipient shall comply with all applicable federal, state and local laws regarding discrimination, including those set forth in this Section. During performance of the Agreement, the Recipient agrees that it will not discriminate against any employee or applicant for employment because of the employee or applicant's sex, race, color, marital status, national origin, religious affiliation, disability, sexual orientation, gender identity or expression or age except by minimum age and retirement provisions, unless based upon a bona fide occupational qualification. The Recipient will make equal employment opportunity efforts to ensure that applicants and employees are treated, without regard to their sex, race, color, marital status, national origin, religious affiliation, disability, sexual orientation, gender identity or expression or age. Additional requirements are at http: / /www.kingcounty.gov /healthservices /health /partnerships /contracts, Recipients shall read and certify compliance. 14. Conflict of Interest A. The Recipient agrees to comply with applicable provisions of K.C.C. 3.04. Failure to comply with such requirements shall be a material breach of this Agreement, and may result in termination of this Agreement pursuant to Section II and subject the Recipient to the remedies stated therein, or otherwise available to the County at law or in equity. B. The Recipient agrees, pursuant to KCC 3.04.060, that it will not willfully attempt to secure preferential treatment in its dealings with the County by offering any valuable consideration, thing of value or gift, whether in the form of services, loan, thing or promise, in any form to any county official or employee. The Recipient acknowledges that if it is found to have violated the prohibition found in this paragraph, its current Agreements with the county will be cancelled and it shall not be able to bid on any county Agreement for a period of two years. C. The Recipient acknowledges that for one year after leaving County employment, a former County employee may not have a financial or beneficial interest in an agreement or grant that was planned, authorized, or funded by a County action in which the former County employee participated during County employment. Recipient shall identify at the time of offer current or former County employees involved in the preparation of proposals or the anticipated performance of Work if awarded the Agreement. Failure to identify current or former County employees involved in this transaction may result in the County's denying or terminating this Agreement. After Agreement award, the Recipient is responsible for notifying the County's 0 0 Project Manager of current or former County employees who may become involved in the Agreement any time during the term of the Agreement. 15. Equipment Purchase, Maintenance, and Ownership A. The Recipient agrees that any equipment purchased, in whole or in part, with Agreement funds at a cost of $5,000 per item or more, when the purchase of such equipment is reimbursable as an Agreement budget item, is upon its purchase or receipt the property of the County and /or federal /state government. The Recipient shall be responsible for all such property, including the proper care and maintenance of the equipment. B. The Recipient shall ensure that all such equipment will be returned to the County or federal /state government upon termination of this Agreement unless otherwise agreed upon by the parties. 16. Proprietary Rights The parties to this Agreement hereby mutually agree that if any patentable or copyrightable material or article should result from the work described herein, all rights accruing from such material or article shall be the sole property of the party that produces such material or article. If any patentable or copyrightable material or article should result from the work described herein and is jointly produced by both parties, all rights accruing from such material or article shall be owned in accordance with US Patent Law. Each party agrees to and does hereby grant to the other party, irrevocable, nonexclusive, and royalty -free license to use, according to law, any material or article and use any method that may be developed as part of the work under this Agreement. The foregoing products license shall not apply to existing training materials, consulting aids, checklists, and other materials and documents of the Recipient which are modified for use in the performance of this Agreement. The foregoing provisions of this section shall not apply to existing training materials, consulting aids, checklists, and other materials and documents of the Recipient that are not modified for use in the performance of this Agreement. 17. Political Activity Prohibited None of the funds, materials, property, or services provided directly or indirectly under this Agreement shall be used for any partisan political activity or to further the election or defeat of any candidate for public office. 18. King County Recycled Product Procurement Policy In accordance with King County Code 18.20, the Recipient shall use recycled paper, and both sides of sheets of paper whenever practicable, when submitting proposals, reports, and invoices, if paper copies are required. 19. Future Support The County makes no commitment to support the services awarded for herein and assumes no obligation for future support of the activity awarded herein except as expressly set forth in this Agreement. 20. Entire Agreement/Waiver of Default The parties agree that this Agreement is the complete expression of the terms hereto and any oral or written representations or understandings not incorporated herein are excluded. Both parties recognize that time is of the essence in the performance of the provisions of this Agreement. Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or breach of any provision of the Agreement shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of the Agreement unless stated to be such through written approval by the County, which shall be attached to the original Agreement. 0 21. Amendments 0 Either party may request changes to this Agreement. Proposed changes which are mutually agreed upon shall be incorporated by written amendments to this Agreement. Changes to the County's Agreement numbering system or fund source may be made unilaterally by the County and without the need for amendment of this Agreement. The Recipient shall be notified in writing of any changes in the Agreement number or fund source assigned by the County; provided, however, that the total compensation allocated by the County through this Agreement does not change. 22. Notices Whenever this Agreement provides for notice to be provided by one party to another, such notice shall be in writing and directed to the chief executive office of the Recipient and the project representative of the County department specified on page one of this Agreement. Any time within which a party must take some action shall be computed from the date that the notice is received by said party. 23. Services Provided in Accordance with Law and Rule and Regulation The Recipient and any sub - awardee agree to abide by the laws of the state of Washington, rules and regulations promulgated thereunder, and regulations of the state and federal governments, as applicable, which control disposition of funds granted under this Agreement, all of which are incorporated herein by reference. In the event that there is a conflict between any of the language contained in any exhibit or attachment to this Agreement, the language in the Agreement shall have control over the language contained in the exhibit or the attachment, unless the parties affirmatively agree in writing to the contrary. 24. Applicable Law This Agreement shall be construed and interpreted in accordance with the laws of the State of Washington. The venue for any action hereunder shall be in the Superior Court for King County, Washington. 25. Electronic Processing and Signatures The parties agree that this Agreement may be processed and signed electronically, which if done so, will be subject to additional terms and conditions found at httlps://www.docusign.com/company/terms-cf-use. The parties acknowledge that they have consulted with their respective attorneys and have had the opportunity to review this Agreement. Therefore, the parties expressly agree that this Agreement shall be given full force and effect according to each and all of its express terms and provisions and the rule of construction that any ambiguities are to be resolved against the drafting party shall not be employed in the interpretation of this Agreement. The parties executing this Agreement electronically have authority to sign and bind its represented party to this Agreement. 26. No Third Party Beneficiaries Except for the parties to whom this Agreement is assigned in compliance with the terms of this Agreement, there are no third party beneficiaries to this Agreement, and this Agreement shall not impart any rights enforceable by any person or entity that is not a party hereto. END OF COUNTY TERMS AND CONDITIONS 0 0 Exhibit A — Scope of Work Public Health — Seattle and King County Emergency Medical Services Division Project RAMPART — City of Auburn Regional Approach to Municipal Public AED Registry and Training PURPOSE OF RAMPART: To fund a regional approach to Municipal Public Access Defibrillation Programs. Funding can support Automated External Defibrillator (AED) purchases and city employee training and encourages registration of AEDs in the King County PAD (Public Access Defibrillation) Registry. TIME PERIOD FOR GRANT: Funds must be used by Dec 31, 2015. Contracts may be amended with additional funding available in 2015. Funds are provided via a reimbursement contract. Purchases /expenditures are reimbursed quarterly. Funding may be used for the purchase of AEDs for public facilities and municipal employee training. A project plan /budget has been approved by King County. Any changes must be approved by the AED /CPR Program Manager, Anne Curtis. Project Mission: To provide incentives for King County and select municipalities to promote the placement and registration of Public Access Defibrillators in public facilities and other settings at high risk for cardiac arrest events, and to promote training of your city workforce. Specific Objectives of the Project: 1) Provide an incentive and guidelines for purchase and most efficient placement of AEDs in higher incident/higher risk locations. 2) Promote better inclusion of AEDs in the PAD Registry used by EMS and dispatch agencies (911 call centers), as required by state law (RCW 70.54.310). 3) Promote training of city employees in the use of AEDs. 4) Encourage municipalities to partner with King County EMS on the Shockingly Simple Campaign to promote PAD awareness in your communities Deliverables: 1) Provide a Project Rampart liaison to coordinate with King County EMS. 2) Provide training in CPR /AED to 156 city employees. This training can be reimbursed by Project Rampart as follows: A maximum of $47.00 per hour and no more than 1 instructor per class (exceptions must be approved by the CPR /AED Program Manager): • 3 hour maximum for Basic CPR Training, • 2 hour maximum for Refresher Training (every 2 years): 3) Additional cost for training above these caps must be paid for by The Agency and are not reimbursable under this Contract. 4) Coordinate your city Public Access Defibrillation efforts. 5) Ensure that all newly placed AEDs within your city government facilities are registered with King County PAD Registry. 6) Provide AED site coordination activities related to proper placement, training and maintenance of the AEDs for all the AEDs in public facilities. 7) Coordinate any private foundation, sponsorship, donation, and /or volunteer activities related to the purchase and placement of AEDs and AED training in private residences or private facilities within your city. 8) Coordinate contract activities with EMS to receive RAMPART funding. Submit quarterly invoices for reimbursement, including original Invoices using Exhibit C for all purchases and workforce training reports. 0 0 Public Health — Seattle & King County, Emergency Medical Services Division, will: 1) Provide a Project Rampart Program Manager liaison to coordinate with each Municipality. 2) Provide training to King County employees. 3) Coordinate the KC Public Access Defibrillation Program. Conduct PAD Public Awareness Campaign as directed in the EMS 2008 — 2013 Strategic Plan. 4) Maintain King County PAD Registry. Ensure that all AEDS in King County government facilities are registered with the King County PAD Registry. 5) Provide AED site guidance activities related to proper placement, training and maintenance of the AEDS for all KC government AEDS in public facilities. 6) Provide incentive funding to Municipalities via contract. Funding allocation to be based on city public employee count and number of public AEDs registered. 7) Pay quarterly invoices. 8) Send Quarterly PAD Registry Reports to City Fire Departments. Provide cardiac arrest data for trending and identification of high risk locations. Contract Reporting Requirements: The agency shall comply with the following reporting requirements during the contract period: A. Invoices shall be submitted for reimbursement of Project RAMPART expenses quarterly, and no later than July 15 "', Sept. 15" and December 15`". B. Documentation of Instructor Fees 1) A course roster (Exhibit D) for each CPR/AED course taught to city employees must be submitted with the RAMPART invoice. The course roster must include a) instructor name, b) date of class, c) type of class taught, d) number of class participants, and e) the number of hours of instruction taught.\ 2) This training can be reimbursed at a maximum of $46 per hour for one instructor. If course size is over 15 students, one additional instructor may be brought in for the 2 n or 3r° hour of the class for practical work on manikins. If payment of instructors must exceed $46 per hour, the agency must pay the extra cost. Documentation of instructor payment must be attached to the invoice. C. AED Purchases 1) You must purchase AEDs using pricing from the WA State contract #01710. More information and price lists are available on www.des.wa.gov. Just put the contract # on your Purchase Order for the vendor of your choice and you should get reduced pricing. After delivery, include the original vendor invoice with your RAMPART invoice for reimbursement. At minimum, we recommend purchase of 1 wall mount, 1 carrying case and 1 extra set of pads for each AED purchased. We do not recommend buying an extra battery at the time of AED purchase, because they have a life of about 4 years. You may buy batteries for Project RAMPART for AEDs purchased in previous years. D. Miscellaneous Equipment/Supplies and CPR /AED Training Supplies 1) Provide an itemized list of all equipment and supplies purchased and list the price of each item. Include an original vendor invoice attached to the RAMPART invoice. The Project RAMPART contract is a reimbursable contract and all purchases and services must be completed prior to invoicing King County. Invoices must be mailed to Anne Curtis, CPR /AED Program Manager, King County EMS, 401 Fifth Ave. Suite 1200, Seattle, WA 98104. All required reports described above must accompany the invoice. Invoices are due no later than 15 calendar days following the end of 2 n and 3rd calendar quarter and due on December 1 5`" for the 4" calendar quarter. 0 0 King County EMS Division Exhibit B Project RAMPART 2015 Program Plan and Budget —City of Auburn 2015 Annual RAMPART Funding Allowance: 4940 A) Purchase Manufacturer Number Cost per AED, include wall Total Cost AEDs and Model* of AEDs mounts, cases & extra For AED(s) pads ** Phillips On -site 3 $987.77 2963.32 (H51) w /case and extra pads Tax 281.52 Shipping 54 Total (Approximate) AED Cost (A) Total Cost, including Tax 3298.84 3298.84 and Shipping *Must purchase using WA State Contract #01710 (approx.. 30% discount): Philips, Cardiac Science, Physio - Control, Zoll). * *We do not recommend buying an extra battery at time of purchase because batteries last 2 - 4+ years. B) Training Estimated # of Estimated Estimated number of total Hourly Total Employees to # of class hours instructor wage Training be trained CPR /AED (# Basic classes X 3 hrs) + (max = $46.00 Cost classes to (# Refresher classes X 2) hour) (Hours X be held Wage) (B) Maximum allowable 156 Basic = 6 32 $35 $1120.00 CPR /AED class hours Basic Class = 3 hours Refresher Refresher Class = 2 hours = 7 C) Training Type of Supply Number Cost Total Cost of Supplies of Items Training Supplies Includes: • Mannequin 2 boxes $19.95 $39.90 • AHA cards; lungs • AED Trainers; • Batteries; • Gloves 4 boxes $12.00 $48.00 • Pads; • CPR Training • Pediatric 6 sets $56.52 $339.12 supplies, etc. AED Pads Tax $40.57 Shipping $20 Total (Approximate) Supply Cost (C) Total Cost, including Tax $487.59 $487.59 and Shipping Contingency $33.57 Grand Total $4940.43 Budget(A +B +C) Revised 11 -4 -14 For EMS, PHSKC Office Use Only: KCAP Information: PURCHASE ORDER k: Supplier Name: Invoice Date: Note to AP: Print on Remittance: _ PH /Prog Name /Number: Site# 1033/0,I1, 01,A Amt to be Paid: CPA: Req: _ Receipt: Public Health — Seattle & King County Emergency Medical Services Division (EMS, PHSKC) Project RAMPART EXHIBIT C — INVOICE AND BUDGET SUMMARY 2015 AGENCY: DATE: REMIT ADDRESS': PHONE: CITY STATE ZIP Must match address on contract "PLEASE COMPLETE BOTH SECTIONS" BUDGET CATEGORIES CONTRACT ITEM/ FUNDS EXPENDEDTHIS TOTALFUNDS EXPENDED TO DATE TOTAL FUNDS BUDGET DESCRIPTION REPORT (include current report) REMAINING Instructor Fees Number of new AEDs placed in your city and AED Purchases egistered in KC PAD Registry Misc. Equipment (pads, batteries, Access Defibrillation in your community all mounts, cabinets, etc. ) Attach list CPR /AED Training Supplies Includes AHA cards Attach list Other describe TOTAL Accomplishment Report TYPE OF ACTIVITY GOAL CURRENT REPORT TOTAL TO DATE (include current report) Number of city employees trained Number of AEDs purchased with RAMPART funds Kin County Contract funds Number of new AEDs placed in your city and egistered in KC PAD Registry Dollar amount of fundraising efforts for Public Access Defibrillation in your community CERTIFICATION FOR PAYMENT: I, the undersigned, do hereby certify that the materials have been furnished, the services rendered or the labor performed as described herein, and that the claim is a just, due and unpaid obligation against King County, and that I am authorized to authenticate and certify to said claim. Submit to: Emergency Medical Services, PHSKC 401 Fifth Ave. Suite 1200 Agency Representative Signature Date Seattle, WA 98104 ATTN: Anne Curtis Print Name Title FOR EMS, SEATTLE -KING COUNTY DEPARTMENT OF PUBLIC HEALTH USE ONLY APPROVED: Program Manager Date Revised 3125113 I • 0 AGENCY: Public Health — Seattle & King County Emergency Medical Services Division Project RAMPART EXHIBIT D — CPR INSTRUCTOR REPORTING FORM Contract Period: Jan 1, 2015 — December 31, 2015 CALENDAR QUARTER ENDING: (March. June, SeDt.. Dec.) DATE OF LAST CPR INSTRUCTOR'S NAME: INSTRUCTOR CERTIFICATION: PLEASE NOTE: Each CPR class must be listed separately. Please do not send in class rosters with this form: however, rosters must be kept as program records pursuant to the contract between King County and the agency.