Backup Documents 12/13/2016 Item #16E6 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 E
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. the completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office
`i-k\to
4. BCC Office Board of CountyF�
Commissioner \/- A/
5. Minutes and Records Clerk of Court's Office ,
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Phone Number 252-3622
Contact/ Department Kathy Heinrichsberg]/
Agenda Date Item was December 13,2016 Agenda Item Number \
Approved by the BCC Item#2389
Type of Document Number of Original 4
Attached MOU Documents Attached
PO number or account
number if document is r
to be recorded l
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? C.� O� •444-
2. Does the document need to be sent to another agency for additional signator s? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. e_
3. Original document has been signed/initialed for legal sufficiency. (All documents to be KH
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the NA
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's KH
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip 441-
should be provided to the County Attorney Office at the time the item is input into \r-0
ACCELA Some documents are time sensitive and require forwarding to Tallahassee
within a certain time frame or the BCC's actions are nullified. Be aware of your
deadlines!
8. The document was approved by the BCC on December 13,2016 and all changes made KH
during the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by th- 1t--
BCC,all changes directed by the BCC have been made,and the document is ready fo the`
Chairman's signature. �,
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revi s 15•Rev. 1/30/12
Please send all four originals back to Kathy Heinrichsberg in Emergency
Management.
Thank you,
Kathy 1 6E 6
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
r
a 6
MEMORANDUM
Date: December 14, 2016
To: Kathy Heinrichsberg, Executive Secretary
Bureau of Emergency Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: MOU w/Concierge Medical Transport, LLC
Attached are three (3) Original Agreements as referenced above, (Item #16E6)
approved by the Board of County Commissioners on Tuesday, December 13, 2016.
If you have any questions, please contact me at 252-8411.
Thank you.
Attachments
16E6
MEMORANDUM OF UNDERSTANDING
BETWEEN CONCIERGE MEDICAL TRANSPORT,LLC, AND
COLLIER COUNTY
(Mass Casualty or Serious Emergency Event)
THIS MEMORANDUM OF UNDERSTANDING ("MOU") is made and entered into
this 13 h day of IDecenber, 2016, by and between COLLIER COUNTY, a political subdivision of
the State of Florida, 3299 East Tamiami Trail, Naples, Florida 34112, and CONCIERGE
MEDICAL TRANSPORT, LLC, 3200 Bailey Lane, Suite 117, Naples, Florida 34105, hereafter
referred to as "Parties."
WITNESSETH:
WHEREAS, the Parties are state licensed EMS providers and believe it is mutually
advantageous and in the interest of the public health, safety and welfare of its citizens to enter
into a Memorandum of Understanding (MOU) in instances where mass casualty events occur or
a local, state, or federal state of emergency and additional equipment and/or manpower is
needed; and
WHEREAS, the Parties desire to enter into this MOU to define their respective
responsibilities and liabilities in the event of a request for mutual aid from one of the parties
hereto.
NOW THEREFORE, in consideration of the mutual terms, conditions and promises
hereafter set forth, Collier County and Concierge Medical Transport, agree as follows:
MUTUAL AID REQUESTS
1. In the event that a mass casualty event, serious emergency or local, state, or federal state
of emergency exists within the territorial boundaries of Collier County and a party to this MOU
requests additional equipment and/or manpower to be provided by the other party to this MOU in
order to meet the needs of the system, the following provisions shall apply.
a. The Chief Operating Officer of Concierge Medical Transport, LLC and the Chief
of Collier County EMS, Director of Emergency Management or their designees, shall determine
among themselves the operational procedures to be employed by their respective agencies in the
implementation of a Mutual Aid response and shall instruct their respective Dispatch Operators
on the operational procedures for the routing of Mutual Aid responses to the requesting party.
b. All requests for Mutual Aid pursuant to this MOU shall include a statement of the
amount and type of equipment needed and/or the number of personnel needed and shall specify
the location and type of condition or situation to which the equipment and personnel shall be
dispatched. The decision as to the amount and type of equipment and the number of personnel
actually sent shall rest in the sole discretion of the responding party.
2. In addition to the above, the following provisions shall apply to Mutual Aid Requests:
16E (,
a. The terms "requesting party" as used in this MOU shall mean the party requesting
Mutual Aid in accordance with the terms of this MOU, or the party within whose jurisdiction an
inter-facility transfer occurs. The terms "responding party" shall mean the party responding to a
request for Mutual Aid located in the other party's jurisdiction in accordance with the terms of
this MOU.
b. If the responding party is unable to provide Mutual Aid to the requesting party due
to an emergency or other extenuating circumstance, then it shall not be deemed to be a violation
of this MOU. The determination of what constitutes an emergency or extenuating circumstances
shall be determined solely by Concierge Medical Transport - Chief Operating Officer or Collier
County's EMS Chief, Emergency Management Director or his/her designee. If the responding
party is unable to render Mutual Aid, it shall promptly notify the requesting party that it will be
unable to aid in or respond to the request for assistance.
c. A responding party under this MOU shall be compensated at its usual and
customary rates for its services during the Mass Casualty Incident or Serious Emergency Event.
d. Each party shall be solely responsible for the compensation of its own employees
at all times during this MOU, including any amounts paid or due for compensation for personal
injury or death which occurs while said employees are rendering aid pursuant to this MOU, to the
extent permitted by law.
e. Each party will charge the patient serviced by said party directly for any treatment
or transport provided to the patient under the terms of this MOU. However, should a local state
of emergency exist, and the County deems in the best interest of life-safety to make emergency
re- location of stretcher bound patients or citizens; the County's Emergency Management
Director shall authorize such emergency re-location cost to be borne by the Emergency
Management Department's Emergency Operations Center operational cost.
f. Neither party nor its employees shall have a claim against the other party arising
from any aid provided pursuant to this MOU. The parties agree that in the event of any litigation
arising out of any alleged breach or non-performance of this MOU, the venue for such litigation
shall be in Collier County.
g. Collier County and Concierge Medical Transport representatives agree to
establish mutually acceptable guidelines to conduct quality improvement review of clinical and
operational procedures and further agree to provide mutually acceptable training procedures for
their respective employees to assure dispatching procedures are followed and to provide for the
safety of any employees.
h. In the event either party hereunder desires or is required to provide any notice to the
other party, the party desiring or required to provide such notice shall provide it in writing, send
it by certified mail, return receipt requested, postage prepaid, to the other party at the address
listed below:
If to Collier County: Dan Summers, Director
Collier County Bureau of Emergency Services
2
1 6E' 6
8075 Lely Cultural Parkway, Suite 445
Naples, FL 34113
If to Concierge Medical Transport: Chuck Bacon, Chief Operating Officer
Concierge Medical Transport, LLC
3200 Bailey Lane, Suite 117
Naples, FL 34105
i. This MOU incorporates and includes all prior negotiations, correspondence,
agreements or understandings between the parties, and the parties agree that there are no
commitments, agreements or understandings concerning the subject matter of this MOU that are
not contained in this document.
j. No modification, amendment or alteration in the terms or conditions contained
herein shall be effective unless contained in a written document executed with the same formality
and of equal dignity herewith.
k. In the event any provision of this MOU shall be held invalid and unenforceable,
the remaining provisions shall be valid and binding upon the parties. One or more waivers by
either party of any breach of any provision, term, condition or covenant shall not be construed as
a waiver of a subsequent breach by the other party.
1. The term of this MOU shall begin after the last party has approved and signed this
MOU and it has been filed with the Clerk of the Circuit Court of Collier County and shall
automatically renew every year. This MOU may be terminated, without cause and without
penalty,by either party upon thirty(30) days'written notice to the other party.
IN WITNESS WHEREOF, the Parties hereto have executed this Memorandum of
Understanding as of the date and year first above written.
CONCIERGE MED A L TRANSPORT, LLC
,,
(---,,
By:
Chuck Bacon, Chief Operating Officer
chi„
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHIT E. BROCK LERK COLLIE OUNTY, LORIDA
illii •- c• By:
,,t, st ,s to chimuipTlerk DONNA FIALA, CHAIRMAN
signar re in
./�1 li Item# (.
Approv-;I • I �. . .nd legality:
1 Agenda to 13/4
,I Date / ,
Jeffrey A.1 1 1 t kow, County Attorney Date
3
Recd 'a1 i�t(�
Deputy Clerk