ORDER NO. 29960
INTERLOCAL AGREEMEENT BETWEEN KERB COUNTY AND CITY
OF KERRVILLE FOR EMERGENCY MEDICAL SERVICES
Came to be heard this the 25th day of September, 2006, with a motion made
by Commissioner Letz, seconded by Commissioner Williams. The Court
unanimously approved by vote of 3-1-0 to:
Approve Interlocal Agreement for Emergency Medical Services between the
City of Kerrville and Kerr County.
~`~9S"i-l~~ s~.z
1 I ~ COMMI5SIONERS' COURT AGENDA REQUEST ~ ~ ~ b ~ ^ ~~" S ~i
PLEASE FURNISH ONE ORIGINAL AND TEN COPIES OF THIS
REOUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT.
MADE BY: Pat Tinley OFFICE: County Judge
MEETING DATE: September 25, 2006 TIME PREFERRED:
SUBJECT: Consider, discuss and approve on Interlocal Agreements between Kerr
County and the City of Kerrville for Fire Fighting and Emergency Medical Services and
authorize the County Judge to execute same.
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT: County Judge
ESTIMATED LENGTH OF PRESENTATION:
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in
accordance with Title 5, Chapter 551 and 552, Government Code, is as follows:
Meeting scheduled for Mondays:
THIS REQUEST RECEIVED BY:
THIS REQUEST RECEIVED ON:
5:00 P.M. previous Tuesday.

All Agenda Requests will be screened by the County Judge's Office to determine if adequate
information has been prepared for the Court's formal consideration and action at time of Court
Meetings. Your cooperation will be appreciated and contribute towazds your request being
addressed at the eazliest opportunity. See Agenda Request Rules Adopted by Commissioners'
Court.
#29960
INTERLOCAL AGREEMENT
FOR EMERGENCY MEDICAL SERVICES
STATE OF TEXAS §
COUNTY OF I{ERR §
This Interlocal Agreement for Emergency Medical Services and Management of
the County First Responder Program ("Agreement") is made and entered into between
the City of Kerrville, Texas ("City") and Kerr County, Texas ("County") and shall be
effective as of October 1, 2006, for the term stated below.
WHEREAS, County desires to provide emergency medical services with First
Responders to the specified unincorporated areas of Kerr County ("Service Area") and
more particularly described and depicted in Exhibit A, in order to serve and protect its
citizens; and
WHEREAS, City is willing to furnish equipment, trained medical technicians and
services to the Service Area and to provide Management of the County First Responders
for the consideration as provided herein;
NOW THEREFORE, in consideration of the mutual covenants and agreements
herein expressed, it is agreed as follows:
I. TERM
The term of this Agreement shall be from October 1, 2006 through September 30, 2007
("Initial Term"). This Agreement shall remain in full force and effect through its Initial
Term, provided that either City or County may terminate this Agreement upon ninety
(90) days written notice to the other party. This Agreement maybe terminated by mutual
agreement at any time upon such terms and conditions as the parties agree. This
Agreement may also be terminated by either party for cause, provided that in the event of
the breach, the non-breaching party shall give written notice to the breaching party
specifically stating the provision of this Agreement alleged to have been breached and the
factual basis underlying the alleged breach. Within thirty (30) days after receipt of
notice, the breaching party shall: i) cure said breach; or ii) contest the alleged breach.
Failure to cure the breach or contest the alleged breach within this thirty (30) day period
shall be deemed a material breach of this Agreement and shall authorize the non-
breaching party to unilaterally terminate this Agreement, upon delivery of written notice
of termination via certified mail or personal delivery, to the breaching party. Termination
shall be effective upon receipt of said notice.
Page 1 of 6
The parties agree that this Agreement shall renew automatically for one-year periods
following the Initial Term subject to the payment adjustment provisions of Section III
below. All terms and covenants of this Agreement shall apply to the renewal period.
II. SERVICES TO BE PROVIDED
A. During the Initial Term, or any extension provided for herein, City agrees to
fixrnish emergency medical services ("EMS") to the Service Area and
Management of the County First Responder Program.
B. For purposes of this Agreement, "EMS" shall include both responding to calls for
emergency medical assistance and providing medical transportation services, as
well as rescue/extrication services for automobile accidents. The amount and type
of equipment and number of personnel actually furnished in response to any
emergency call shall be determined solely by City and its duly appointed agents,
officers, directors, employees or subcontractors. It is understood and agreed that
City will give priority to calls within its own jurisdictional boundaries; however,
City will use their best effort to make a timely response to each request for
services within the Service Area.
C. For the purposes of this Agreement, "Management of the County First Responder
Program" shall mean and include the following services: The City shall manage
the operations of the First Responder services, on a contract basis, by maintaining,
ordering, storing and restocking equipment and supplies; request and manage the
budget expenditures, in addition to grant writing and proposals to obtain
Automated External Defibrillators or other non-budgeted equipment; assist
personnel by managing and/or administering the medical continuing education
program, teaching and coordinating education classes; file and maintain patient
Gaze reports, ensuring performance improvement through periodic run review with
the Medical Director, and ensure the compliance with the EMS protocols and
Standard Operating Guidelines. The EMS Coordinator shall also be the Infection
Control Officer, HIPAA Privacy Officer and representative to the Medical
Director and Fire Department Personnel.
D. In the performance of this Agreement, City shall observe and comply with all
federal, state and local laws, rules, ordinances and regulations in any manner
affecting the provision of services under this Agreement.
E. It is expressly understood that in the performance of the obligations taken under
this Agreement, City is an independent contractor with the sole right to supervise,
manage, control and direct the provision of EMS. Further, County shall look to
the City for performance only and shall have no right at any time to direct or
supervise the City, its agents, officers, directors, employees or subcontractors.
Nothing in this Agreement shall constitute or be construed to create a partnership
or a joint venture by and among the parties.
Page 2 of 6
F. City shall make reasonable efforts to maintain emergency response times for the
Service Area at an average of ten (10) minutes for all calls within the Service
Area. The City shall make reasonable efforts to provide at least two (2)
ambulances manned 24 hours per day 365 days per yeaz capable of responding to
City and County calls for service. The ambulances shall be staffed with a
minimum of two certified medical personnel at all times. City shall continuously
monitor its compliance with this provision. However, such response times may
be waived in times of natural disasters or other catastrophic events which limits or
renders performance standazds substantially impossible.
G. City shall maintain its EMS vehicles at or above the Texas Department of State
Health Services EMS provider rules and regulations at all times, and shall provide
patient caze supplies, medical equipment, vehicle maintenance and regular
equipment and vehicle inspections, calibrations and checks as determined by City
to be appropriate.
H. The provision of EMS under this Agreement shall be directed, supported and
supervised by a licensed physician who shall be designated by City as its Medical
Director for EMS.
City shall maintain insurance for the EMS at the following levels:
1. General Liability
$1,000,000 each occurrence and $2,000,000 annual aggregate
2. Errors and Omissions
$1,000,000 each occurrence and $2,000,000 annual aggregate
3. Automobile Liability
$1,000,000 per occurrence; $25,000 medical per person
4. Property/Auto for physical, catastrophe, and mobile equipment
Agreed value
5. Combination crime
$50,000
6. Personal property
$1,000,000 per loss occurrence
City shall provide quarterly run reports to County regarding the number of EMS
responses made within Service Area. Such report shall be a summary of the
response codes obtained from "Emergency Response Report" provided as part of
the EMS softwaze used by the City. County may request additional reports as
needed as long as the information sought does not impinge on required patient
confidentiality, violate federal or state law and County pays the cost of producing
such additional reports.
K. In carrying out EMS, City shall provide vehicle extrication, additional manpower
and establishment of landing zones for helicopter services as needed as
determined by the incident commander. In fixrtherance of meeting its obligations
Page 3 of 6
under this Agreement, City may enter into such contracts and interlocal
agreements with local govenunental entities and/or private companies as they
deem necessary or appropriate to provide the services and coverage required.
L. If personnel and equipment are available, City shall provide one (1) non-
dedicated, stand-by ambulance at community events and activities within City or
its Extraterritorial Jurisdiction (ETJ) upon fourteen (14) days written notice of
such request by County at no additional cost. It is understood and agreed that an
ambulance providing such service will remain available to respond to calls for
services anywhere within City or the Service Area and will leave the assigned
event when required for such calls. No replacement ambulance shall be provided
for the event during the periods when the ambulance is being otherwise utilized.
M. Should County desire a dedicated ambulance for a community event or activity,
County must request such in writing with City a minimum of fourteen (14) days
prior to the event or activity and pay an additional hourly charge for such
dedicated service as is outlined in Exhibit B. If available, City shall locate an
ambulance at the event or activity for its duration unless or until a transport from
the event is needed. The hourly charge for this service begins from the time the
ambulance arrives at the designated standby until it is released from the event. It
is further understood should another ambulance not be available to transport a
patient from the event the assigned ambulance may be required to depart the
assigned area. Upon the departure of the assigned ambulance no replacement
ambulance shall be available until such time as the assigned unit returns.
III. PAYMENT BY COUNTY; PROVIDER CHARGES
A. In exchange and consideration for the City's provision of services under this
Agreement during the Initial Term, County agrees to pay City $231,883.00. Such
contribution represents, after applying the revenues otherwise generated from
billing patients for such EMS, the estimated costs to City of providing EMS to
County within the Service Area, and the City's management of County's First
Responder Program. Such costs include but are not limited to costs relating to
personnel, medical supplies, licenses, insurance, fuel, maintenance, fee collection,
medical director, facilities, capital equipment replacement, as well as other related
expenses. The total contribution, being $231,883.00 represents the "annual
contribution" referred to throughout this Agreement.
B. Should this Agreement be extended beyond the Initial Tenn as authorized by
Section I above, the annual contribution that the County shall pay the City under
this Agreement shall be adjusted annually according to the following fiscal year's
Projected Base Budget. The Projected Base Budget is reviewed and approved by
the City Manager, Fire Chief and EMS Coordinator on or about May of each year.
The Projected Base Budget will include but will not be limited to: the Beginning
Balance, Projected Operational Revenues and Projected Total Expenditures. Any
deficit shall be allocated between the City and County based upon population.
Page 4 of 6
Thereafter, County shall pay its allocated share of the deficit based upon the
Projected Base Budget. If the Projected Base Budget balance is zero or reflects a
surplus, the County would not be held responsible for an annual contribution for
the associated fiscal yeaz. City shall conduct such analysis and report its findings
in writing to County on or before June 15th of each year.
C. Payment for the Initial Term shall be due and payable on or before October 1,
2006 with any subsequent payments being due on October 1st of the applicable
yeaz in which a subsequent term begins.
D. City, including any and all of its agents and subcontractors operating hereunder,
shall be entitled, in their sole discretion, to separately charge the patient/customer
for their services based on the prices set by the City. Prices charged shall be
based upon a number of factors, including but not limited to location of the call,
level of service provided, type of caze rendered, supplies used, personnel used and
other mitigating or contributing factors to include cost of Medicaze disallowance,
cost of collection and other related costs. Any and all costs provided for herein
shall survive the expiration of this Agreement.
IV. MISCELLANEOUS
A. For purposes of this Agreement, all notices required hereunder shall be delivered
to the following addresses of the respective parties via hand delivery or first class,
prepaid mail:
For the City of Kerrville:
City of Kenville
c/o City Manager
800 Junction Highway
Kerrville, TX 78028
For the Countv:
Kerr County
c/o County Judge
Kerr County Courthouse
700 Main Street
Kerrville, TX 78028
with copy to: City of Kerrville
c/o Fire Chief
87 Coronado
Kerrville, TX 78028
B. This Agreement supersedes all written or oral representations of the parties as to
the content, obligations or performance of the provision of emergency medical
services by City to County. Any modification to this Agreement shall be of no
force or effect unless in writing and signed by both parties. Each party hereto
certifies that the covenants and obligations stated in this Agreement constitute the
duly authorized act and agreement of the respective entity and that the persons
Page 5 of 6
affixing their signatures below have obtained all requisite approvals for the
execution of this Agreement.
C. The validity of the Agreement and any of its terms or provisions as well as the
rights and duties of the parties, shall be governed by the laws of the State of
Texas. Exclusive venue for any action concerning this Agreement shall be in
Kerr County, Texas.
D. Neither party may assign any right under this Agreement, and any purported
assignment will be null and void and a breach of the Agreement.
E. Notwithstanding any provision to the contrary, it is agreed that none of the
obligations contained within this Agreement shall run to or be enforceable by any
party other than a party to this Agreement.
F. In the event either party pursues litigation in order to enforce the provisions of
this Agreement, the prevailing party shall be entitled to recover its reasonable
attorney's fees, in addition to any and all other remedies, costs and damages
permitted by law.
~~
Dated this ~~ day of ~ o / , 2006.
CITY OF KERRVILLE, TEXAS KERB COUNTY, TEXAS
Euge e C. Smith, Mayor ~____r ey,
ATTEST:
Brenda G. Crai City Clerk
APPROVED TO FORM:
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Michael C. Hayes, C' Attorney
ATTEST:
Pieper, County Cl \SgipNERg ~,
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Page 6 of 6
2006 APPROVED FEE SCHEDULE
FEE
ADMINISTRATION DEPARTMENT:
AMBULANCE LICENSE (per year) 250.00
COPIES OF PUBLIC INFORMATION
Standard size paper copy (per page)	0.10
Non-standard size copy:	
Computer diskettes (each)	1.00
Computer magnetic tape (each)	10.00
VHS video casette (each)	2.50
Audio casette (each)	1.00
Paper copy (per page)	0.50
Other	Actual Cost
Personnel charge (per hour)	15.00
Overhead charge	20% of Personnel Charge
Microfiche or microfilm charge:	
Paper copy (per page)	0.10
Fiche or film copy	Actual Cost
Remote document retrieval charge	Actual Cost
FAX TRANSMISSIONS:	
Local (per page)	0.10
Long distance, same area code (per page)	0.50
"' Long distance, different area code (per page)	1.00
Other costs	Actual Cost
JUNK YARD OPERATION LICENSE	5.00
NATURAL GAS TRANSPORTED THROUGH PIPELINE:
3% of purchase price of gas transported or delivered within the City during the
preceding month for consumption or use within the City.
PEDDLERS AND SOLICITORS FEE
Base Charge (per year) 600.00
For Each Additional Person-
Thirty days 10.00
One Year 100.00
Deposit 750.00
Exemptions
Temporary special events, sales and festivals sponsored by charitable
organizations recognized as such by the United States' Internal Revenue
Service.
Temporary special events, sales and festivals sponsored by governmental
subdivisions, including school districts, Chamber of Commerce and Junior
Chamber of Commerce.
Texas State Arts and Crafts Fair and other special events such as the Easter
~' Chili Cook-off or Jimmy Rodgers Jubilee, as approved by Council, provided
that the organizer/operator of said events provides the information required for
an open air market.
2006 APPROVED FEE SCHEDULE
Traveling salesman or solicitor calling only upon commercial businesses in
the City.
Garage sales.
A business with a separate business location in the City that furnished proof
of payment to the City of all ad valorem and personal property taxes then due.
Six or more businesses that are organized in a sales show, convention, or
similar sales by an indoor shopping mall, hotel, or similar sponsor.
Businesses conducted in an open air market in compliance with all laws and
zoning regulations applicable thereto.
Sale of fresh produce (fruit, nuts, and vegetables).
Sale of firewood.
SEXUALLY ORIENTED BUSINESSES
FEE
-~ Annual License Fee 500.00
Annual Fee per Employee 50.00
VEHICLE FOR HIRE PERMIT
TRAVELING SHOW AND EXHIBITION LICENSE (30 days)
25.00
100.00
Exceptions-
Camivals, circuses, travel-shows, tent shows, exhibits, menagerie which are actually operated by volunteers of a public
school located in Kerr County, or a bona fide charity located in Kert County, or a service organization located in Kerr
County.
Memorandum
Date:	August 31, 2006
To:	Chief Holloway
CC:	Assistant Chief Beavers
From: Eric W. Maloney, EMS Coordinator
Subject: Fee Schedule Analysis & Surrounding County General Contribution
Report
I reviewed an EMS fee schedule increase for all patients and compared Kendall
County's fee schedule as the recommended increase. This would increase the patient's
average bill approximately 109% from $393 to $822. If the fee schedule increase were
adopted for all patients, the Net revenue would increase approximately $100,000 per
year. There are some concerns about these figures. First, this figure increases the bad
"° debt by 13% from 22.3% currently to 35% overall, based on best estimation. The bad
debt estimation could be low considering that the fee schedule is increasing by 109%.
Second, we also transport approximately 77% CMS (Medicare) patients that pay the bill
according to CMS allowables and not the original billed amount. Therefore, the patient
is responsible for only 20% of the CMS allowable and not the actual billing amount e.g. it
we charge $855 for an ALS-emergency call and CMS allows $343; CMS pays (80%)
$274 and the patient is responsible for (20%) $68 and not the difference of $855 minus
$274.
I contacted the surrounding counties in regards to FY 05/06 and FY 06/07 general
contributions for EMS. These general contributions are necessary to maintain a zero
budget balance. Fredericksburg EMS was provided general contributions of $339,000
for FY 05/07 and requested $290,000 for FY 06/07. Fredericksburg splits the general
contribution 50/50 with the City and County. Bandera County EMS was provided
general contributions of $49,000 for FY 05/06 and requested $579,000 for FY 06/07.
Kendall County EMS was provided general contributions of $450,000 for FY 05/06 and
requested $455,000 for FY 06/07. Kendall County supports the general contribution
from the County's general fund. Per Jeff Finke, Kendall County EMS Director, Kendall
County does not charge County residents anything over what insurance does not cover.
If we say yes to a rate increase based on Kendall County, we can assume we will add
some revenue. Our rates are currently low, but so is the general contribution. This is a
good deal compared to what other area jurisdictions are contributing in the region.
Comparing our rates to a jurisdiction such as Kendall County is not meaningful, as
" Kendall County residents don't pay anything over and above what is covered by
insurance.
Confidential Page 1 9/22/2006
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PROf"i Citu of Kerrvill~_ ~tega.l Lept. PHONE ND. : 830 ?92 5804 Sep. 25 2006 08:29PM P1
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THE CITY Of -
KERRVILLE, TEXAS ~a
August 1 s, 2007
Judge Pat Tinley
Kerr County Commissioner's Court
700 E Main Street
Kerrville, Texas 78028
RE: Interlocal Agreement for Emergency Medical Services
Dear Judge Tinley;
As outlined in Section I of the current Interlocal Agreement for Emergency Medical
Services, executed September 12, 2006, the agreement shall renew automatically for one-
year periods following the initial Term subject to the payment adjustment provisions of
Section III. Pursuant to Section III B, the general contribution shall be adjusted annually
according to the Projected Base Budget. The County agrees to pay the City a total
contribution of $220,33s.00, based on the fiscal year 2008 projected base budget.
Sincerely, ~ ,~
Pau1~A. I~ofr~°i'ann
City Manager
800 JUNCTION HIGHWAY • KERRVILLE, TEXAS 78028-5069 • 830/257-8000