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Home My WebLink AboutFD04-253 - Amendment - #3 - Seattle KC Dept of Public Health - Basic Life Support Services (EMS Levy) - 01/01/2006 Records Mania- gemul KEN T m n W,g„,„�,o„ Docu e t Akli 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, if you have questions, please contact City Clerks Office. Vendor Name: V/l r 1.a Hz / --laKi,'. Vendor Number: JD Edwards Number -Contract Number--, �- as'3 =_ r• - _-- -_-- -- This is assigned by Deputy City Clerk 67 Descriptiond�,� /L ` Detail: Project Name: L Contract Effective Date: Y/ /O Termination Date: Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Department: Abstract: 5 Pubhc\RecordsManagemen f\Forms\ConfrOdC0Ver\ADCL7832 07/02 D3304a6 EMERGENCY MEDICAL SERVICES FUNDS 2006 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 192, east border is 188 Ave SE and the City of Covington City Limits. South border is SE 288, Kent WA Contact Person Paul Wright Title Battalion Chief/EMS Officer Address 24611 116 Ave SE Kent WA 98030 Phone 253.856.4300 Amount Requested Budget Category in 2006-- A. Personnel 1. Salaries & Benefits ** 717,894.00 2. Per Shift Payments (list rate per shift) 3. Per Call Payments (list rate per call) B. Supplies (itemized on separate sheet) 15,958.00 C. Equipment (itemized on separate sheet) 25,488.00 D. Support Service (itemized on separate sheet) E. Total EMS Funds Allocated by King County EMS in 2006 (Please refer to the attached funding 759,340.00 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 BLS 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 BLS allocation for that agency. Show %'s and total salary/benefit budget used to derive BLS request. ITEMIZED LIST OF PROPOSED EXPENDITURES FOR SUPPLIES AND EQUIPMENT 2006 BASIC LIFE SUPPORT LEVY CATEGORY ITEM COST EQUIPMENT BACKBOARDS $2,655 00 EQUIPMENT BP CUFFS $53 00 EQUIPMENT CYLINDER REGULATOR GAUGES $1,062 00 EQUIPMENT DISP BAG VALVE MASKS $850 00 EQUIPMENT KED'S $765 00 EQUIPMENT OXYGEN CYLINDERS $1,062 00 EQUIPMENT SCOOP STRETCHER $1,593 00 EQUIPMENT STETHOSCOPES $531 00 EQUIPMENT PULSE OXIMETERS $1,593 00 EQUIPMENT GLUCOMETERS $2,608 00 EQUIPMENT SUCTION UNITS $1,062 00 EQUIPMENT TRACTION SPLINTS $2,124 00 TOTAL EQUIPMENT $15,958 00 SUPPLY BAND-AIDS $106 00 SUPPLY BB STRAPS $1,062 00 SUPPLY BLANKETS $1,062 00 SUPPLY BLS TRAUMA PACKS $531 00 SUPPLY BURN SHEETS $320 00 SUPPLY CANNULAS/TUBING $1,593 00 SUPPLY COLD/WARM PACKS $850 00 SUPPLY CPR MICRO SHIELDS $531 00 SUPPLY ECG PRINTER PAPER $1,062 00 SUPPLY ELECTRODES $1,593 00 SUPPLY EXTRICATION COLLARS $2,330 00 SUPPLY GAUZE $745 00 SUPPLY GAUZE PADS $531 00 SUPPLY GLOVES $7,330 00 SUPPLY IPECAC $53 00 SUPPLY LIFE PAK BATTERIES $1,062 00 SUPPLY OB KITS $106 00 SUPPLY OXYGEN CYLINDERS $1,062 00 SUPPLY PENLIGHTS $320 00 SUPPLY PILLOWS $212 00 SUPPLY SCISSORS $212 00 SUPPLY THERMOMETERS $160 00 SUPPLY TRAUMA DRESSINGS $531.00 SUPPLY TRIANGULAR BANDAGES $531 00 SUPPLY TYVEK JUMPSUITS $531 00 SUPPLY VENT KITS $531 00 SUPPLY WATERPROOF TAPE $531 00 TOTAL SUPPLIES $25,488 00 r EXHIBIT 1 2006 PROGRAM 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 116 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 Ambulance 1 Engine/Aid 504 W Crow St Part Time/ Vol Kent WA 98032 2. Station # 72 X Full Time_X_ 1 Engine/Aid Part Time/ 25620 140 Ave SE Vol 1 Tender Kent WA 98042 3. Station # 73 X Full Time X 1 Ambulance 1 Engine/Aid Part Time/ 26512 Military Rd. So. Vol 1 Mobile Command (reserve) Kent WA 98032 4. Station # 74 X Full Time X 1 Ambulance 1 Engine/Aid Part Time/ I Ladder 24611 116 Ave SE Vol 1 Command Vehicle Kent WA 98030 1 Air Vehicle *Include aid units as well as fire apparatus, command cars, rescue units, etc. STATIONS PLANNNED for construction in 2006 Address Status Vehicles #*' SEE REVERSE SIDE ADDRESS DEFIB UNIT STATUS AID VEHICLES FIRE VEHICLES Station#75 XX Full Time 1 Engine/Aid Vehicle 15635 SE 272nd 1 MCI Vehicle Kent WA 98042 1 Air Vehicle Station#76 XX Full Time 1 Engine/Aid Vehicle 20676 72"d Ave So 1 Haz Mat Unit Kent WA 98032 Engine/Aid(reserve) Station#77 XX Full Time 1 Engine/Aid Vehicle 20717 132"d Ave Se 1 Ladder(reserve) Kent WA 98031 1 Engine/Aid(reserve) NOTE All of our engine/aid vehicles,as well as one of our ladder units, are licensed as aid units by D S H S. Exhibit 1 2006 Program Plan and Proposed Budget Page 2 E. Agency Response Information Number of fire suppression responses in 2005 570 Number of EMS aid responses in 2005 11,067 - Total number of responses in 2005 14,034 - Percent aid responses of total responses 78.8% - II. Relationships With other EMS Agencies A. Specify location of transfer points with paramedic provider groups if applicable: Exhibit 1 2006 Program Plan and Proposed Budget Page 3 III. Personnel A. Number of full-time paid fire fighters 147 of which 133 are EMT's and 8 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 133 Automated External Defibrillator Certified 29 Manual Defibrillator Certified 104 * Certified as First Responders by State of Washington IV. EMT Defibrillation Program 1.3-Medtronic Physio Control LIfe Pak 12 A.E.D A. Number and type of defibrillator units Manual T 1 Heartstart FR2 B. Location of defibrillation equipment (address) All firstline apparatus carry a life pack, including the Shift Commanders Vehicle C. Unit numbers of aid vehicle(s) usually carrying defibrillation equipment (use number(s) recorded when completing EMS Medical Incident Reporting Form) . 57 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 2006 $ 1,725,131 of which $ 759,894.00 is provided by EMS funds. B. Total fire department or fire district S 19,699,215 budget for 2006. Exhibit 1 2006 Program Plan and proposed Budget Page 4 VI. Fees for Services A. Does your department charge for providing emergency services? Yes No XX 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 2006 to improve services to the citizens of King County. To supplement total EMS budget to amintain quality and timely delivery of ems in the face of increasing demand for services and budget reduction, with local funds we will cover the remaining costs of the total EMS budget. Pj��Aj a , '' 7- 19-OS BLS Provider Date 3 Dir r nd Health Officer Date 1Z Department of Public Health