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Home My WebLink AboutFD04-253 - Amendment - #1 - Seattle KC Dept of Public Health - Basic Life Support Services (EMS Levy) - 01/01/2004 %ecords Document M eme KE]VT W�ax�woron CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed, ff you have questions, please contact City Clerks Office. Vendor Name: , /-�`Z .LQ_- _ o ' Vendor Number: JD Edwards Number Contract Number ry oY- Zr3 This is assigned by Deputy City Clerk Owly Description: f Detail: Q 0 O 1 QoZ°S Project Name: Qn 1 Contract Effective Date: NO Y Termination Date: Contract Renewal Notice(Days): Number of days required notice for termination or renewal or amendment Contract Manager. Department: , Abstract: S:Pub6c\Recor&,Manogement\Forms\ContractCover\ADCL7832 07/02 r Public Health Seattle & King County HEALTHY PEOPLE. HEALTHY COMMUNITIES. Alonzo I.Plough,Ph.D.,MPH,Director and Health Officer August 31, 2004 Paul Wright Kent Fire Department 24611 116th Ave SE Kent, WA 98030 RE: D33049D— Basic Life Support Services (Amendment #1) Dear Paul Wright: Enclosed is your fully signed copy of the referenced amendment. We have retained a copy of the amendment for our records. If you have any questions about the program, budget or reporting requirements, please contact your Program Monitor, Felisa Azpitarte, at (206) 296-4693. If you have any other questions, please call me at (206) 296-4898. Sincerely, Jeffrey Brown Contract Specialist II Grant & Contract Services JB: er Enclosure: D33049D— Basic Life Support Services (Amendment #1) cc: Felisa Azpitarte Finance&AdministrativeServices Division 999 Third Avenue,Suite 600• Seattle,WA 98104 111011, City of Seattle King County T(206)205-1076 F(206)206-0947•www.metrokc govftaith Gregory i Nickels,Mayor iron Sims,cxecutrw r Public Health Seattle & King County HEALTHY PEOPLE. HEALTHY COMMUNITIES. Alonzo L. Plough, Ph.D., MPH,Director and Health Offiter May 25,2004 TO: Kin County Fire Chiefs FR: Tom Hearne, Manager RE: January 1 —December 31,2004 Basic Life Support Contract Please find enclosed a listing of the 2004 Basic Life Support funding amounts, a Basic Life Support Program Plan, and Operating Budget for January 1 —December 31, 2004. Please complete and return the enclosed 2004 Program Plan and Operating Budget to: King County Emergency Medical Services 999 3'd Avenue Suite 700 Seattle,WA 98104 Attn: Felisa Azpitarte -Orhus, you will nee to sum ree original signed applications and current insurance documents and return to EMS. Once the applications are signed by Dr. Plough of the Health Department, you will receive a signed copy for your files, and the process is complete. If you have any questions regarding the process, or require any additional forms, please contact Felisa Azptitarte at(206)296-4693 or myself at(206)296-4555. Enclosure Emergency Medical Services Division 999 3rd Avenue,Suite 7D0 •Seattle,WA 981 D4.4039 City of Seattle ®King County T(206)296-4693 F(206)296-4866 •www metrokc govlhealth Gregory J Nickels,Mayor Ron Sims,Executive Rinhd on Recy[kd Paper EMERGENCY MEDICAL SERVICES FUNDS 2004 PROPOSED BUDGET FORM - BASIC LIFE SUPPORT SERVICES Applicant Agency City of Kent / King County Fire Prot. Dist. #37 Agency Service Area(s) East Kent city limits. North border is SE 192nd, east border is 188th Ave SE and the City of Covington City limits. South border is SE 288th, Kent WA Contact Person Paul Wright Title Battalion Chief / EMS Officer Address 24611 116th Ave SE Kent, WA 98030 Phone 253.856.4300 Amount Requested Budget Category in 2004* A. Personnel 1. Salaries & Benefits ** $ 707, 908 2. Per Shift Payments (list rate per shift) 3. Per Call Payments (list rate per call) B. Supplies (itemized on separate sheet) 21,317 C. Equipment (itemized on separate sheet) 11,720 D. Support Service (itemized on separate sheet) E. Total EMS Funds Allocated by King County EMS in 2004 (Please refer to the attached funding $ 740,945 allocation) *Please list only total amount of requested funds by category on this page. Attach itemized list of proposed expenditures if you are requesting funds for supplies, equipment, or support services. **Attach explanation of how requested funds for salary and benefits were calculated and how they will be used in accordance with the expenditure guidelines. An agency may request BLSS funding for that portion of salaries and benefits that can be attributed to EMS (% aid calls out of total fire and aid calls) up to the BLSS allocation for that agency. Show %'s and total salary/benefit budget used to derive BLSS request. 3 EXHIBIT 1 2004 PRQGRAMI PLAN AND PROPOSED BUDGET I. Identification Information A. Name and number of Fire Protection District or Fire Department: City of Kent / King County Fire Prot. Dist. #37 B. Name of Chief: Jim Schneider Mailing Address: 24611 116th Ave SE Kent, WA 98030 C. Name of EMS Coordinator (and Training Coordinator if different): Paul Wright Telephone No. 253-856-4300 Kevin Garling Telephone No. 253-856-4331 D. Location: manned or unmanned status of all fire stations in your department of district; location of aid vehicles. Include the address of each station (use other side if necessary). Defib No. EMS'Response No. & Type Fire Address Unit Status Vehicles at Location Vehicles at Location 1. Station # 71 X Full Time X 1 In Service 1 Engine/Aid 504 W. Crow St. PartTime/ 1 In Service 1 Ambulance Vol Kent WA 98032 2. Station # 72 X Full Time X 1 In Service 1 Engine/Aid 25620 140th Ave SE Partolime/ 1 Tender Kent WA 98042 3. Station # 73 X Full Time X 1 In Service 1 Engine/Aid Part Time/ eserve) 26512 Military Rd So Vol 1 Engine/Aid (reserve) —I-M-obilE 'Command (reserve) Kent WA 99032 1 Ambulance (reserve) 4. Station # 74 X Full Time X 1 In Service 1 Engine/Aid 24611 116th Ave SE Part Time/ 1 In Service 1 Ambulance Vol 1 In Service 1 Ladder Kent WA 98030 1 In Service 1 Command Vehicle 1 Tn Rarvi-P 1 Air VQhirla *Include aid units as well as fire apparatus, command cars, rescue units, etc. STATIONS PLANNNED for construction in 2004 Address Status Vehicles _--- --- ADDRESS _ __DEFISUNiT STA17M _-AID VEHICLES.-- FIRE VEHICLES. Station#75 XX Full Time 1 In Service 1 Engine/Aid Vehicle 15635 SE 27e I Reserve 1 Engine/Aid Vehicle(reserve) Kent WA 98042 1 Aid(reserve) 1 MCI Vehicle 1 Air Vehicle Station#76 XX Full Time 1 In Service i Ladder(reserve) 20676 72i°Ave So. 1 Engine/Aid Vehicle Kent WA 98032 1 liaz Mat Unit 2 EnginelAid(reserve) Station#77 XX Full Time 1 In Service 1 Engine/Aid Vehicle 20717 13r Ave Se 1 Engine(reserve) Kent WA 98031 NOTE- All of our engine/aid vehicles,as well as one of our ladder units,are licensed as aid units by D.SILS. We have nine(9)licensed aid units and fair(4)licensed ambulances. a Exhibit 1 2004 Program Plan and Proposed Budget Page 2 E. Agency Response Information Number of fire suppression responses in 2003 799 Number of EMS aid responses in 2003 9,530 Total number of responses in 2003 13,335 Percent aid responses of total responses 71.4% II. Relationships With other EMS Agencies A. Specify location of transfer points with paramedic provider groups if applicable: Exhibit 1 2004 Program Plan and Proposed Budget Page 3 III. Personnel A. Number of full-time paid fire fighters 149 of which 130 are EMT's and 12 are First Responders.* B. Number of volunteer fire fighters -0- of which -0 are EMT's and -0- are First Responders.* C. Number of personnel currently trained in defibrillation 130 Automated External Defibrillator Certified 22 Manual Defibrillator Certified 108 * Certified as First Responders by State of Washington IV. EMT Defibrillation Program Medtronic Physio Copttob A. Number and type of defibrillator units 12-Life Pack 12's Manual B. Location of defibrillation equipment (address) All stations, training center and an AED located on the Shift Commander's vehicle. C. Unit numbers of aid vehicle(s) usually carrying defibrillation equipment (use number(s) recorded when completing EMS Medical Incident Reporting Form) . 57 - All first line apparatus carry a life pack V. Budget The EMS Division is seeking to collect information that documents total fire department expenditures for emergency medical services. We are also requesting each fire department to report its total operating budget for the year. In order that the information be consistent, please exclude from these totals major capital expenditures including vehicles and buildings, and monies earmarked for bond payments, etc. A. Estimated total EMS budget for 2004 S 1,661,786 of which S 740,945 is provided by EMS funds. B. Total fire department or fire district S 17,466,849 budget for 2004. ,« Exhibit 1 2004 Program Plan and proposed Budget Page 4 VI. Fees for Services A. Does your department charge for providing emergency services? Yes No % B. If yes, please provide a list of charges below. VII. Service Improvements/Changes Please describe how EMS funds will be used by your department in 2004 to improve services to the citizens of King County. To supplement total EMS budget to maintain quality and timely delivery of EMS in the face of increasing demand for services and budget reductions, with local funds we will cover the remaining costs of the total EMS budget. fit./�Irir� �I.f/� Q6- /(J• O�' BLS Provider Date Alonzo Plough, 'rect r and Health Officer Dat Department of Public Health I` ISUMED LIST OF PROPOSED EXENDIiURE?S FOR SUPPLIES AND EQUIPMENT 2003 BASIC LIFE SUPPORT SERVICES -EMERGENCY MEDICAL SERVICES FUNDS APPROX CATEGORY ITEM COST EQUIPMENT BACKBOARDS $2,500.00 EQUIPMENT BP CUFFS $500.00 EQUIPMENT CYLINDER REQULATOR GUAGES $ AD-00 EQUIPMENT DISP.BAG VALVE MASKS $800.00 EQUIPMENT KED'S $720.00 EQUIPMENT OXYGEN CYLINDERS $1,000.00 EQUIPMENT RING CUTTER $200.DO EQUIPMENT SCOOPSTRETCHER $1.500.00 EQUIPMENT STETHESCOPES $500.00 EQUIPMENT SUCTION UNITS $1,000.00 EQUIPMENT TRACTION SPLINTS $2,OD0.00 TOTAL EQUIPMENT $11,720.00 SUPPLY BANDAIDS $100.00 SUPPLY BB STRAPS $1,000.00 SUPPLY BLANKETS $1,000.00 SUPPLY BLS TRAUMA PACKS $500.00 SUPPLY BURN SHEETS $300.00 SUPPLY CANNtA.AS/TUBBING $1,500.00 SUPPLY COLDWARM PACKS $800.00 SUPPLY CPR MICRO SHIELDS $500.00 SUPPLY ECG PRINTER PAPER $1,000.00 SUPPLY ELECTRODES $1,500.00 SUPPLY _.EXTRACA'TICN c_QV ARS --- $2,20.0.00 SUPPLY GAUZE $700.00 SUPPLY GAUZE PADS $500.00 SUPPLY GLOVES $4,217.00 SUPPLY IPECAC $50.00 SUPPLY LIFE PAK BATTERIES $1,000.00 SUPPLY OB KITS $100.00 SUPPLY OXYGEN CYLINDERS $1,D00.00 SUPPLY PENLIGHTS $3DO.00 SUPPLY PILLOWS $200.00 SUPPLY SCISSORS $200.00 SUPPLY THERMOMTERS $150.00 SUPPLY TRAUMA DRESSINGS $500.00 SUPPLY TRIANGULAR BANDAGES $500.00 SUPPLY TYVEK JUMPSUITS $500.00 SUPPLY VENT KITS $500.00 SUPPLY WATERPROOF TAPE $500.00 TOTAL SUPPLIES $21,317.00 r Insurance Authority P o Box 1165 £UN r ,,P Renton, 1Vd4 98057 23-Jun-04 _ Cert#: 3682 P,horze 425-277-7237 King Count EMS Attn: Felisa Azpitarte Fax 4z5 277-72�? 999 Third Ave.,Suite 700 Seattle,WA 98104 RE: City of Kent EMS Levy Funds Evidence of Coverage The above captioned entity is a member of the Washington Cities Insurance Authority (WCIA),which is a self insured pool of over 108 municipal corporations in the State of Washington. WCIA has at least$1 million per occurrence combined single limit of liability coverage in its self insured layer that may be applicable in the event an incident occurs that is deemed to be attributed to the negligence of the member. WCIA is an Interlocal Agreement among municipalities and liability is completely self funded by the membership. As there is no insurance policy involved and WCIA is not an insurance company,your organization cannot be named as an"additional insured. SSincerely, Eric B. Larson Deputy Director cc: Christopher Hills p� gg Margaret Martin,Fire Admin. rIKENT E I 17 6dMerN 2 B 20H E DEPARTMENT Y 1 2004 BLS funding Allocation Aaency 2004 Amount 2003 Amount %Difference Auburn $341,283 $331,066 3.09% Bellevue $1,060,336 $1,009,470 5.04% Bothell $161,540 $148,542 8.75% Eastside Fire $949,850 $949,850 0.00% Enumclaw $230,549 $230,549 0.000/0 Kent $740,945 $728,557 1.70% Kirkland $454,874 $444,966 2.23% Mercer I. $208,813 $195,756 6.67% Pacific $29,491 $29,233 0.88% Redmond $463,839 $444,996 4.23% Renton $461,303 $449,081 2.72% Sea Tac $201,826 $196,918 2.49% Snoqualmie Fire $48,360 $46,055 5.00% Tukwila $218,430 $212,602 2.74% FD 2 $209,165 $202,682 3.20% FD 4 -Shoreline $364,283 $361,000 0.91% FD 11 $260,044 $258,693 0.52% FD 13-Vashon $129,619 $129,619 0.000/0 FD 16-Northshore $192,523 $186,848 3.04% FD 17-Black Diamond $46,359 $46,359 0.00% FD 20 $96,727 $92,096 5.03% FD 26 $151,670 $151,670 0.00% FD 27 $63,160 $63,160 0.00% FD 36-Woodinville $280,376 $271,885 3.12% FD 39- Federal Way $600,108 $600,108 0.00% FD 40 $210,667 $210,667 0.00% FD 43-Maple Valley $304,293 $304,293 0.00% FD 44 $252,271 $252,271 0.00% FD 45- Duvall $110,372 $110,372 0.00% FD 47 $17,780 $17,780 0.00% FD 49(61)-Snoqualmie Pass $17,166 $17,166 0.00% FD 50- Skykomish $30,749 $30,749 0.00% Sub-Total $8,908,773 $8,725,059 2.11% Milton $12,747 $12,931 -1.42% Pierce County $1,500 $1,500 0.00% Total Allocation $8,923,020 $8,739,490 2.10%