ORDER NO. 18138
APPROVAL OF PROPOSED AMBULANCE CONTRACT WITH AMCARE AMBULANCE
AND MEDICAL SERVICES OF SAN ANTONIO, SUBJECT TO INCLUSION OF
MALPRACTICE AND WORKERS' COMPENSATION INSURANCE
On this the 22nd day of September 1988, upon motion made
by Commissioner Baldwin, seconded by Commissioner Ray, the
Court unanimously approved the proposed Ambulance Contract
with AMCARE AMBULANCE AND MEDICAL SERVICES OF SAN ANTONIO,
subject to inclusion of AMCARE carrying malpractice and
workers' compensation insurance, and subject to concurrence
by the City of Kerrville, retroactive to July 20th, 1987.

rr~ cm of
KERRVILLE, TEXAS
December 5, 1988
Mr. H. A. Baldwin
Kerr County Commissioner
Kerr County Courthouse
700 Main Street
Kerrville, TX 78028
Dear Buster,
Enclosed is the County's signed copy of the City/County
Ambulance Contract. Thank you for your attention in this
matter, and please let me know if I can be of further
assistance.
Sincerely,
~____~~~
Randy Thomas
Performance Specialist/Insurance Manager
be
enc.
800 JUNCTION HIGHWAY • KERRVILLE, TEXAS 78028-5069 • 512/257-8000
AMBULANCE CONTRACT
I. DEFINITIONS.
A. "Contractor" - The person or firm accepting this
contract as contractor.
B. "City" - City of Kerrville, Texas.
C. "County" - County of Kerr, Texas.
D. "Ambulance" - Any vehicle used by Contractor for
carrying patients.
E. "Emergency Ambulance" - An ambulance to which ALS
permits have been issued by the State Board of Health.
F. "Public Safety Committee" - Committee consisting of
two members from the County Commissioners Court, two
members from the Kerrville City Council, and Ex
Officio Members: City Manager, Emergency Management
Coordinator, and City/County Health Officer.
G. "Emergency Medical Technician" - An individual who is
certified by the Texas Department of Health as
minimally proficient to perform emergency prehospital
care that is necessary for basic life support and that
includes the control of hemorrhaging and
cardiopulmonary resuscitation.
H. "Emergency Medical Technician-Special Skills
(Intermediate}" - An individual who is certified by the
Texas Department of Health as minimally proficient in
performing skills required to provide emergency
prehospital care by initiating under medical
supervision certain procedures including intravenous
therapy and endotracheal or esophageal intubation or
both.
I. "Emergency Medical Technician-Paramedic" - An
individual who is certified by the Texas Department of
Health as minimally proficient to provide emergency
prehospital care by providing Advanced Life Support
that includes initiation under medical supervision of
certain procedures including intravenous therapy,
endotracheal or esophageal intubation or both,
electrical cardiac defibrillation or cardioversion, and
drug therapy.
II. TERM:
The term of this Contract shall begin on July 20, 1987, at~
5:00 p.m. and be for a three (3) year period ending July 20,
1990, at 5:00 p.m. unless sooner terminated as provided
herein, or as extended under "Option" paragraph.
III. PAYMENTS TO CONTRACTOR.
During the term of this contract, City and County shall pay a
total monthly sum to Contractor of $6,250, said sum to be
divided equally between City and County. The first payment
shall be due and payable the 20th day of the month next
following the month in which this contract begins and
continuing thereafter during the term of the contract such
that Contractor is paid such monthly payment after rendering
each month of service hereunder. This payment provision is
retroactive to July 20, 1987.
IV. CONTRACTOR'S CHARGES.
Contractor shall be authorized to charge for the services and
supplies rendered by Contractor, but such charges shall not
exceed those listed on Attachments "A" and "B".
V. CONTRACTOR'S SERVICES.
The Contractor agrees to furnish a twenty-four (24) hours a
day emergency ambulance service to the people of the City and
County in compliance with the following requirements:
2
A. Contractor shall maintain a central office.
Contractor's telephone and radio dispatching
equipment shall be manned at such central office
twenty-four (24) hours a day by means of persons
other than ambulance personnel (first response or
back-up). It is the intent of this provision that
Contractor receive and dispatch calls at its
central office, even though all crews are out on
calls. It is not the intent to deny any EMT to
work dispatch while they are off duty.
B. The location, or change of location, of Contractor's
central office shall be subject to approval of City
and County. This contract is conditioned on
Contractor not paying more than $3,000 per month in
rental payments. Contractor designates the
following as its initial central office:
620 SIDNEY BAKER, KERRVILLE, TEXAS.
C. Contractor will be furnished the following
telephone number: 896-2111. Upon termination
hereof, Contractor will relinquish such number to
the City/County.
D. The first ambulance crew shall be on duty at the
Contractor's central office twenty-four (24) hours
a day unless out on call. The second ambulance
crew shall also be on standby 24 hours a day unless
out on call. In addition, there shall be a third
ambulance crew on standby (subject to call) to
respond to one additional call if the other crews
are out on calls. A call may be in County or a
transfer out of County .
E. If a fourth call is received while all three
ambulances are on other calls, Contractor shall
notify the mutual aid ambulance services, including
AMCARE San Antonio operations, in order of closest
to Kerrville, to respond to the call. Contractor
shall estimate time of arrival of the first
returning AMCARE ambulance and instruct the
returning crew to proceed to the location of the
fourth call without returning first to the AMCARE
base station.
F. Radio dispatching equipment shall have an emergency
electrical backup system so as to keep radios in
operation during electrical outages.
3
VI. STANDARDS FOR PERSONNEL, AMBULANCES AND EQUIPMENT.
Contractor shall comply with and furnish the following:
A. Not less than three (3) ambulances which shall be
equipped and permitted to meet Texas Department of
Health ALS standards.
1. Contractor shall continue a preventive
maintenance program designed to reduce
mechanical failures. Every emergency ambulance
shall receive such check list inspection at
least once each twenty-four (24) hours.
2. Contractor shall furnish an enclosed covered
garage for all ambulances (both transfer and
emergency). This is to be done in order to
protect the vehicles from the elements and from
vandalism.
B. Each ambulance shall be manned by a crew consisting
of a minimum of two (2) persons (one EMT Basic or
greater, and one EMT Special Skills or greater)
when placed in service. Both crew members must
have State Department of Health certification of
successful completion of their respective skills
level.
1. Contractor shall maintain a continuing
education program such that all personnel
shall be acquainted with the latest techniques
and be encouraged to seek further advances
in qualifications and certifications. A file
will be maintained on all continuing education
credits on employees as well as information on
all lectures, in service training and classes.
This file will be available for inspection or
presentation upon request of the Public Safety
Committee.
2. The Contractor shall furnish an adequately
trained Medical Director. The Contractor
identifies Dr. Leonard D. Marks as its Medical
Director. Contractor shall promptly notify
City of any change.
C. When transporting a patient, whether an emergency
or routine transfer, an EMT of Special Skills or
greater will always accompany the patient in the
patient compartment of the ambulance.
4
D. The ambulances must be licensed as emergency
vehicles in compliance with applicable State
Statutes and in compliance with the rules and
regulations of the Texas Department of Health, to
meet ALS requirements.
E. All ambulances and equipment shall be inspected
quarterly by person or persons to be designated by
the City Manager of the City of Kerrville. Such
inspections may be made without notice upon the
premises of Contractor, and Contractor consents to
the entry of City and County personnel for such
purpose.
1. Emergency ambulances shall be kept in a state
of good mechanical condition.
2. There shall be a prima facie presumption
that any deficiency or repair can be corrected
within five (5) working days, depending on
availability of replacement parts; thereafter,
Contractor shall pay $50.00 per day liquidated
damages.
3. In no event shall any emergency ambulance be
inoperable for more than twenty (20)
consecutive days, and Contractor shall obtain
a replacement emergency ambulance in the event
any emergency ambulance will be inoperable for
more than twenty (20) consecutive days.
4. Each emergency ambulance shall be equipped
with a two-way radio which shall transmit and
receive on the frequencies enabling
communication with the following: Peterson
Hospital; Sheriff's Department; Department of
Public Safety; and City Police. An intercom
system may be used to contact these agencies.
City and County are the present owners and will
maintain necessary insurance for weather damage
on the following:
a. Three (3) Mobile Transceivers (GE)
Serial Nos. 7051761, 7051762, and 7051763;
b. Cabinet at Tower;
c. Antenna on Tower;
d. Remote Station on EMS Office;
e. Remote Station at Hospital;
f. Base Station Transmitter at Tower;
g. 2 Desk Remotes;
h. 1 Motorola Radio;
I. 1 Repeater Station.
5
5. Tower rental shall be the responsibility of
the City and County who are the Lessee on the
Agreement with the Times-Mirror Cable
Television, Inc.
6. Contractor may have the use of this equipment
during the term of this Contract without
paying rent. Contractor shall, however,
maintain all of such equipment in first-class
operating condition and upon expiration of this
Contract return same to City and County in the
condition received, ordinary wear and tear
excepted.
7. Each emergency ambulance shall be issued a
radio call number by the Kerr County
Sheriff. The radios shall be operated under
the County of Kerr and Sid Peterson
Hospital FCC License. License for Hilltop
repeater will be under City of Kerrville's
license. Radios shall be maintained to meet
current FCC specifications.
8. Emergency calls or runs shall be answered only
by "Emergency Ambulances." Each ambulance
must be marked distinctively with the name of
the Contractor.
9. All ambulances must comply with all State and
Federal Regulations, laws, And ALS standards.
10. This contract is expressly conditioned on an
inspection being made by City personnel of the
equipment prior to this contract taking effect
and further that the equipment shall meet all
of the standards listed in this Section upon
such inspection.
11. Contractor shall, on emergency runs which may
involve the use of Advance Life Support
systems, establish communication with a
hospital for the purpose of obtaining medical
direction.
12. Contractor shall provide an inventory of, and
report on the condition of City/County owned
radio equipment on each annual anniversary
date. The Contractor shall keep said equipment
in good order and safekeeping.
6
F. Contractor shall have the use of two defibrillators
owned by the City and County. Such defibrillators
shall be maintained by Contractor in good repair.
VII. CONTRACTOR'S BOOKS AND RECORDS.
A. Contractor shall keep all of its financial
records in a manner consistent with generally
accepted accounting principles, practices,
procedures and standards. Contractor will
also provide City and County a monthly
statement of income and expenses, within
fifteen days after the preceding month; and
a yearly summary report of income and
expenses, signed by Contractor.
B. Contractor will submit, at each Regular
Quarterly Public Safety Committee meeting, the
most recent available data on the attached
form {Attachment "C").
C. In addition to the above and foregoing
paragraphs relating to Contractor's books, the
City and County shall have the right at all
reasonable times during business hours, to
inspect and/or audit all financial records and
books of Contractor.
D. Contractor will maintain on file and open to
inspection by the City and County, detailed
records of all maintenance performed on
each ambulance, including preventative
maintenance.
E. From time to time the City and County or
r Public Safety Committee may make request from
the Contractor, reasonable additional reports.
F. In the event, however, no subsidy is paid
Contractor, there shall be no obligation to
report income and expense as provided by
Paragraph VII, A and B.
VIII. COMPLIANCE WITH LAW AND ORDINANCE.
Contractor agrees to operate the ambulances in accordance with
the requirements of the State laws and applicable ordinances
of the City of Kerrville and County of Kerr.
7
IX. INSURANCE.
Contractor shall keep in full force and effect insurance in at
least the limits specified below:
Coverages	Limits of Liability
Workers Compensation	Statutory.	
General Liability	$500,000 per occurrence,	combined
	single limit for bodily	injury and
	property damage.	
Malpractice Insurance	$500,000 per occurrence,	combined
	single limit for bodily	injury and
	property damage.	
Auto Liability	$300,000 per occurrence,	combined
	single limit for bodily	injury and
	property damage.	
The City of Kerrville	and County of Kerr shall be	shown as
additional insured on such policies. Such policies and
certificates thereof shall contain a provision that the City
Manager shall be given at least 30 days written notice of
cancellation, non-renewal or material change of required
insurance coverage. At least five (5) days prior to
termination of a policy, Contractor shall deliver to the City
and County evidence of continuation of coverage and payment
thereof .
X. INDEPENDENT CONTRACTOR.
Contractor is an Independent Contractor in its relationship to
the City and County. Nothing herein contained shall ever be
construed to mean that there exists any agreement of
partnership of joint venture or that either party is the
8
employer or master of any other party or any party's agents,
servants or employees. City and County do not and shall not
ever have the right to control the details of any activities
of Contractor or Contractor's employees. The City and County
have not granted an exclusive franchise hereunder nor does the
City and County endorse ary business, activities, or
solicitations of any kind whatsoever by Contractor other than
the items specifically listed herein. Contractor shall not
make any representation, implied or otherwise, to the contrary.
XI. INDEMNIFICATION AND ASSUMPTION OF LIABILITY.
The Contractor, its listed owner and/or owners, covenant and
agree to indemnify, hold harmless and defend, the City of
Kerrville and County of Kerr, its agents, servants, or
employees (even should they be negligent or alleged to be
negligent), from and against any all claims for damages or
injuries to persons or property of whatsoever kind or
character, whether real or asserted, arising out of or
incident to the operation of any ambulance service and all
other operations arising under or otherwise incident to the
provisions of this Contract.
XII. TERMINATION.
Either party may terminate this Contract for breach of any
provision hereof. In such event, thirty (30) days written
notice of such termination shall be given to the breaching
party, and at the end of such thirty (30) day period, this
Contract shall terminate.
9
XIII. PERSONNEL LIST.
Contractor shall maintain on file a list of all employees and
their qualifications. This shall be furnished upon request of
the Public Safety Committee.
XIV. ESSENTIAL AMBULANCE EQUIPMENT.
A. Each emergency ambulance shall be equipped
according to Advanced Life Support standards
required by the Texas Department of Health.
B. In addition to such requirements, each emergency
ambulance must be equipped with a manually operated
hydraulic extraction tool for removing trapped
persons from vehicles.
C. During each calendar year of this Contract, the
City and County may require the Contractor to
obtain additional or other equipment, but such
requirement shall not necessitate the expenditure
by Contractor of more than an additional $1,000.00
during each year of operation hereunder.
XV. DELEGATION: COOPERATION OF CONTRACTOR.
City and County may delegate the supervision and administration
of this contract to the Public Safety Committee or its
successor, a medical doctor, or other organizations and
persons. Contractor shall, with City and County or their
designee, cooperate, consult and advise, attend hearings and
meetings, and produce records, upon reasonable request.
XVI. OPTION.
Prior to the end of the three (3) year term hereof, City and
County and Contractor shall, without a formal bid process,
negotiate for an extended term of this Contract of one to
10
three (1 to 3) years. The prices, terms and conditions of any
such extended term shall be those that are agreed upon by the
parties. The parties shall use their best efforts, if bath
parties are in agreement, to begin such negotiations one
hundred twenty (120) days before the end of the three (3) year
term, such that if an extended term is agreed upon, such
extended term shall begin promptly on the next day after the
end of the three (3) year term.
XVII. MANAGER.
Contractor shall designate a person responsible for the day to
day operation and management of the ambulance service.
Manager appointment may be subject to City/County approval.
Such manager shall reside in Kerr County, Texas.
XVIII. INSOLVENT.
In the event that Contractor becomes insolvent, or does not
pay substantial amounts of bills, ad valorem taxes, or other
taxes (including income taxes) on a timely basis, or becomes
subject to bankruptcy proceedings of any kind, then
City/County, upon written notice to Contractor, may terminate
this contract.
XIX. ASSIGNABILITY.
Contractor may not assign, mortgage, or otherwise alienate,
this contract without the written consent of City/County.
Change of ownership of a majority of Contractor's stock
constitutes an assignment.
13.
XX. TEMPORARY LOCATION.
For the first 90 days of this contract, Contractor may operate
from a temporary location.
r~
SIGNED as of the '- day of E ~~?"~ ,,1=_ i.~..~--:, 1988.
~~~~~
~ `~~
ATTEST: THE CITY OF KERRVILLE
/;~ /'
f~
Sheila L. Brand, City Clerk
~~eQ~ ~ c~.~~~
Edd R. Turner, Mayor
DATE : ~;.J1-~.°~ , ` ~~;3'
i
ATTEST:
Patricia Dye, Count Clerk
ROVED AS TO FORM:
~iGtS ~ L' u L~~ I!'~9~ ~~s%
Thomas S. Terrel},
City Attorney
T OUNTY OF RR
~ ~~~~_~-
Danny ward Judge
Date:
AS TO $Q1~M
~~ry xe ey
County ttorney
12
ATTACHMENT "A"
CONTRACTOR'S MAXIMUM CHARGES
1. Advanced Life Support
2. Mileage Rate {one way, from
patient's origination to
destination, minimum two miles)
3. Aid Only (non-transport)
4. Waiting time and standby (per hour)
5. Long Distance Mileage (out of
County transfers that originate
in Kerr County)
5. Extra Personnel
7. Oxygen Administration
8. Supplies (See Attachment "B")
9. Advanced Life Support Administration
$175.00
1.50 per mile
50.00
50.00
2.75 per mile
25.00 each person
10.00
30.00
10. At the beginning of each semi-annual period of this three
year contract, these charges will be reviewed and may be adjusted
upward or downward as economic circumstances in the immediate area
dictate. Any revisions in rates will require recommendation and/or
approval from the Public Safety Committee, the City Council, and
the County Commissioners
Failing an agreement of the above parties, the following
procedures shall be utilized:
The adjustment shall be computed according to the following
formula:
1000 (Texas CPI, October 1, present term year, less Texas
CPI, October 1, prior to beginning of present term year)
(present rate) = adjustment, such that the adjustment will
equal all of the change in the Consumer Price Index.
13
ITEM
Y6105:
Abdominal Pad
Adhesive Tape 1/2"
Adhesive Tape 1"
Alcohol Bottle
Alcohol Swab
Aluminum Foil
Ammonia Inhalants
Bags-Isolation
Bags-Paper
Bandage 2" Roller
Bandage 3" Roller
Bandage 4" Roller
Bandaid
Betadine Bottle
Betadine Swab
Bite Block
Blood Tube-Red Top
Blood Tube-Purple
Top Burn Sheet
Gauze 4x4
Gauze 2x2
Ice Packs
Infusion Set 21GA
Infusion Set 23GA
I.V. Cath 14GA
I.V. Cath 16GA
I.V. Cath 18GA
I.V. Cath 20GA
Kleenix
Lancets
O. B. Kit
Peroxide
Pillow Case/Disposable
Sheets/Disposable
Sterile Water
Suction Liner
Surgical Mask
Syringe 1CC
ATTACHMENT "B"
SUPPLIES CHARGES
14
CHARGE
$ 5.00
N /'C
N/C
N/C
N/C
10.00
N/C
10.00
N/C
5.00
5.00
5.00
N/C
N/C
N/C
2.50
N/C
N/C
10.00
N/C
N/C
5.00
10.00
10.00
7.50
~.5a
7.50
7.50
N/C
N/C
10.00
N/C
10.00
10.00
10.00
la.oo
N/C
lo.oa
Syringe 5CC	10.00
Syringe 30CC	10.00
Trauma Dressing	5.00
Triangular Bandage	5.00
Urinal	10.00
Yankauer Tip	10.00
Tourniquet	5.00
A0999:
Airway	#0	1p,00
Airway	#1	10.00
Airway	#2	10.00
Airway	#3	10.00
Airway	#4	10.00
Airway	#5	10.00
Airway	#6	10.00
Bed Pan
Disposable Blanket
Body Bag
Cervical Colalr-SM (use of)
Cervical Collar-MD (use of)
Cervical Collar-LG
Desrose Stix
Electrode Gel
Electrode 3 Count
Emesis Basin
10.00
10.00
10.00
35.00
35.00
35.00
N/C
Part of ALS ADM
Part of ALS ADM
10.00
Endotracheal	Tube	2.5	10.00
Endotracheal	Tube	3.0	10.00
Endotracheal	Tube	4.0	10.00
Endotracheal	Tube	5.0	10.00
Endotracheal	Tube	6.0	10.00
Endotracheal	Tube	6.5	10.00
Endotracheal	Tube	7.0	10.00
Endotracheal	Tube	7.5	10.00
Endotracheal	Tube	8.0	10.00
Endotracheal	Tube	8.5	10.00
Esophogeal Tube	35.00
E.T. Tubr Restraint	_. 5.00
Isolation Kit	N/C
K-Y Lubricating Get	N/C
Levine Tube	Part of ALS ADM
Esophageal Mask	35.00
Oxygen Tubing	Oxygen ADM
Y8060:	
Heart Monitor/Debib	ALS ADM
15
A4215:
Needle 18GA 2.50
Needle 20GA 2.50
Needle 25GA 2.50
Y8069:
Nasal Cannula 5.00
Oxygen Mask/Adult 5.00
Oxygen Mask/Child 5.00
Y5102:
Suction Catheter 10.00
Drugs not charged by Sid Peterson Hospital:
Charcoal	10.00
Ipecac	10.00
Nubain	10.00
Thiamine	10.00
Lasix	10.00
Oxygen	10.00
Valium	10.00
16
f
Month
~~
S_
60 60 - 90
"' 30
L ,r--,------~' ~ "total Cash ODaY50 Days Days
False Monthly
Alarms Billing Collections .
And Basic Routine Subsidy •
Treatment tJo Pay Tra~isfers
N0 Runs Emergency
Routine Transport _l f___------""`"
Basic Transfers
E~rgenci es
ATTACNMEtIT ~~C~~
MOi1THLY RESPOtiSES -SICCED
OUT OF COUNTY-----""-