HomeMy WebLinkAbout01- Emergency Transportat Services The following is an overview of the proposed San Bernardino City Fire
Department Emergency Transport System. We have attempted to provide a
very simplistic view of our system. Our staffing configuration, applicable
costs, and revenue streams are accounted in this overview. The goal of the
San Bernardino City Fire Department is to provide the best service to our
citizens in medical aid, rescue, and fire service delivery.
The proposed system adds to the high quality service we currently
provide and has a positive effect on the general fund. Our service is
enhanced in all areas by increasing staffing levels with multifunction
Paramedic Firefighters. The vital responsibility we have to our citizens and
their safety is something we must remain in control of. As emergency
transport providers we are in complete control of the emergency medical
system. That system must be service driven, dictated by response time, and
multifaceted in order to meet the changing service needs of our city.
In order to increase profits, private business must concentrate on cost
cutting measures. These measures are matched against acceptable loss,
analyzed, and decisions made to insure profit for the company. In the
ambulance business that means fewer available units covering a larger area
( systems status management ), inexperienced, under paid, minimum staffed,
units ( one paramedic and one EMT), and charging the absolute maximum
in all areas of billing ( night charge, weekend charge, code three charge,
etc.).
It is not possible a private ambulance business can provide the same
level of service our emergency transport system can. We will provide a
minimum of two Paramedic Firefighters on our six transport units. At five of
the six Paramedic Stations, Paramedic Assessment Engines, staffed with one
Captain, one Engineer, ( both EMTs ) and one Paramedic Firefighter, will
backup those ambulances in their "first in districts". When a Fire Department
Paramedic Ambulance is on a call in its "first in district", and another call for
service is initiated, the Paramedic Assessment Engine will be able to initiate
paramedic level treatment prior to the arrival of the next closest Paramedic
Ambulance. Eleven paramedic service delivery units will be available, six
transport ambulances and five assessment engines. The expansion of service
we currently provide, to include emergency transport, is a sound approach to
meeting the growing needs of our community and a first class service we can
all be proud of.
Revenue / Expense Accounting Table
First Year, Second Year
Gross Revenue: $591459156. $593179745.
These revenue figures have been
accounted from actual run reports
for a three month period, 1/1/96
to 3/31/96, by Stat Physicians'
services.
Adjusted Gross Revenue: $390879094. $391909647.
Projected on a 60% collection
rate of"Gross Revenue".
Contract collection fee: ( 7%) $2169097. $2239346.
( Stat Physicians' Services )
Total Adjusted Gross Revenue: $298709997. $299679302.
Total Personnel Cost: - $194449550. -$194729954.
Includes Paramedic Firefighters
and all program support
personnel.
Total Equipment Cost: - $ 6079447. - $ 375,466.
Includes vehicles, paramedic
equipment, uniforms and
safety equipment.
Advertising budget: - $ 42,232. - $ 439921.
Total Net Revenue: $ 776,768. $ 1,074,660.
Current Equipment Stal'j"ing
11 Engine Companies 2 Truck Companies
5 Paramedic Engine Companies
( I Captain, I Engineer, 2 PM/Firefighters)
6 EMT Engine Companies
( f Captain, 1. Engineer, I Firefighter)
2 EMT Ladder Companies
Captain, I Engineer, I Firefighter)
Capt
Capt Eng
In, FF
FF Capt
Eng
FF
ENG 5 ENG 8
ENG 7
Capt
Eng
Capt Capt PM/F
Eng Eng I Capt I PM/F
PM/F PM/F Eng
PM/F PM/F FF Capt
PM ENG 6
Eng
FF apt
I
n
PM Capt g
PM ENG 1
F
ENG 3 Eng 4
PM/F
TRK 4
PM/F ENG 1
TRK I i
Capt PM ENG 2 Capt Capt
Eng Eng
FF Ing
FF PM/F
PM/F
ENG 11
ENG 9 PM ENG 10
Proposed i E u m en t Staffing�1 p
11 Engine Companies 2 Truck Companies
6 Paramedic Ambulances
5 Paramedic Assessment Engine Companies
(1 Captain, 1 Engineer, 1 PM/ Firefighter)
6 EMT Engine Companies
(1 Captain, 1 Engineer, 1 Firefighter)
2 EMT Ladder Companies
( l Captain, 1 Engineer, 1 Firefighter)
6 Paramedic/ Firefighter Ambulances
( 2 PM/ Firefighters )
!
Capt Capt Capt
Eng En g
FF I FFg I FF
- Eng 7
Eng 5 --, Eng 8
I � l
-- PM/F I Capt — Capt PM/F
PM/F j Eng Ca iEng PM/F
Capt PM I PM/F Eng IFF
Eng PM/F MA 4 l_� FFg �__) MA 6
PM/FI Eng 4 -J Eng 6
i MA 3 Trk 4
Eng 3
Cati
j Capt PM/F Enp -_
PM F Eng PM/F PM/Fi apt
PMM MA 1 I FF EFg
MA 2 -- En 1
Eng 2 g JI
Trk 1
i
�Capt I PM/F Engt 1 Capt
Eng PM/F PM/F I Eng
FF i ` i FF
MA 10 Eng 10 Eng 11
Eng 9
STAT2 5/23G6 PARAMEDIC RESCUE AMBULANCE BUDGET PROJECTIOI
REVENUE All figures as per Physican STAT 1996 1997
TOTAL EMS CALL VOLUME 15,182 2%inc./yr. 15,486
56% is Tx%of total calls tot.Trans. 8,350 8,517
ALS Transports
%ALS Transports of total transports 47% 47%
Total ALS Transports 3,925 4,003
ALS All-Inclusive Base Rate-City $612.10 $622.10
$2,441,461 $2,490,290
Mileage-projected revenue
Total ALS Transports 3925 4003
Mileage(scene to hasp.avg.) 5.0 5.0
Total ALS mileage 19,623 20,015
SB Co.mileage rates $11.80 $11.80
Total projected ALS mileage revenue $231,548 $236,179
Projected Gross Revenue-ALS $2,673,009 $2,726,469
BLS Transports&NON-Transports
? %BLS Transports of total transports 42%
42%
Total BLS Transports 3,507 3,577
BLS All-Inclusive Base Rate-City $822.10 $622.10
$2,181,731 $2,225,365
Mileage-projected revenue
Total BLS Transports 3507 3577
Mileage(scene to hosp.avg.) 5.0 5.0
Total BLS Mileage 17,535 17,886
SB Co.mileage revenue $11.80 $11.80
Total projected BLS mileage revenue $206,915 $211,064
? %Basic Life Support(BLS)NON-Transports 10% 10%
Total BLS NON-Transports 835 1,549
BLS NON-Transport Fee $100.00 $10000
$83,501 $154,856
Projected Gross Revenue-All BLS $2,472,147 $2,691,276
? 75% of total transports use Oxygen 5,010 5,110
? 02 fee-Total 02 Revenue $69.64 $6964
$348,901 $355,879
Projected GROSS Revenue-ALS+BLS+02 $5,145,156 $5,317,745
Projected Collection Rate(STAT Physician Services) 60% 60%
TOTAL Projected Adj.Gross Revenue(AGR) $3,087,094 $3,190,647
Billing Contract Fee(STAT Physician Services) 7.0% 7.0%
Billing Contract Fee Amount $216,097 $223,345
Projected NET Revenue-ALS+BLS+02 $2,870,997 $2,967,302
Total Projected NET Revenue $2,870,997 $2,967,302
EXPENSES
Personnel: 6-2 man PMFF AMBULANCES,7- EMT ENGINES,4-PM ASSESSMENT ENGINES
Salary+Benefits for additional positions
Medical Director 1 $0 1 $0
Paramedic Firefighters(P2)B-step 18 18
annual salary $46,5p3 $47,433
$837,054 $853,795
benefits $477,121 $486.663
Total P2 personnel expense $1,314,175 $1,340,468
EMS/Amb.CoordJ Captain 1 1
annual salary $58,735 $59,910
$58,735 $59,910
benefits $22,971 $23,431
Total P4 personnel expense $81,706 $83,340
Training i4 PM/CE.Expense 50 $0
Administrative Assistance 1 1
annual salary $34,986 $35,336
$34,986 $35,336
benefits $13,683 $13,820
Total(admin.)personnel expense $48,669 $49,156
Vehicle Mechanic 0 0
annual salary $32,748 $33,403
2 funded unfilled positions to hire $0 $0
benefits $0 $0
Total(shop)personnel expense s0 $0
TOTAL PERSONNEL EXPENSE $1,444,550 $1.472,954
NON-PERSONNEL EXPENSES
Ambulance lease purchase(4 yr.lease)
No.of Ambulances 8 8
Lease cost/amb./year $20,000 $20,000
Total Amb.lease cost/year $160,000 $160,000
cost/Amb. cosU Amb.
Amb.Maint.(tires,brakes,etc.) $8,882 $6L9,2% $8.008 $72,068
Amb.lubricants/fuel $4,320 $34,560 54.493 $3$,942
Radio(HT) $3.000 $24,000
Radio(mobile) $3.000 $24,000
Radio(MDT) $5,000 $40,000
Initial Amb.equip.(gumey,02 resp.) $5.400 $43,200
Consumable Medical Supplies so $50,947 so $0
Consumable Med.Sup.replacement $3.184 $25,472 $3.311 $26,491
Medical equip.maintJ repair $1.360 $10,880 $1.414 $11,315
Total Amb.Expense $482,355 $305,816
Additional equip.(per amb.>6 frontline) 1 2
mono Wm $9,695 $10.053 $20,166
ACORE radio $7.700 $7,700 $8,006 $16,016
intubation/suction lot $550 $550 $572 $1,144
SCBA,Turnouts,uniforms 15 0
$3.954 $59,310 $4,112 $0
Computers,deprec.,software,etc. 55,000
Infection control $37,837 $27,624
Overhead-misc.office expenses 55,000 $5.000
Total additional equip. $126,092 $69,850
FireMed Expense
Direct Mail $19,372 $20,147
Marketing $15,360 $15,974
Analysis $1,500 $1,560
Travel!meetings $6,000 $6,240
Total FireMed expense $42,232 $43,921
Total NON-Personnel Expenses $649,679 $419,687
Total Projected AGR $2,870,997 $2,967,302
Total Personnel Expense $1,444,550 $1,472,954
Total NOW Personnel Expense $649,679 $418687
Total Projected Expenses $2,094,229 $1.892,642
TOTAL NET REVENUE 5776168 ;1,0740-60
ORIGINAI
Jim - 8/26/96
I received the material from Fred:
Subsection (b)(5) of Section 6 of Section 4 of the The Right
To Vote on Taxes Act would provide as follows:
"No fee or charge may be imposed for general
governmental services including, but not limited to, police,
fire, ambulance or library services where the service is
available to the public at large in substantially the same
manner as it is to property owners."
Since "fee" and "charge" are defined to mean property-related
fees and charges, the way I read this provision is that the City may not
impose a fee or charge on property for a service that is generally
available to the public without such charge. For instance, we could not
impose a City-wide (or area) property assessment, fee or charge related
to property ownership for ambulance service, when we send
ambulances in the same way to property owners and nonproperty
owners alike. In our situation we do not impose a property related fee
or charge. Instead, the private provider, or if we change, the City
provider, charges everyone the same -- the cost established for the
service. I really don't think that the new initiative would prohibit such
a cost.
Of course, like a lot of things having to do with this initiative, we
may have to wait for judicial determinations to be sure.
DAB cntpled into Record at
�r w
City Clerk/CDC Secy
City of San Bernardino
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COPY
1 AGREEMENT
2 This agreement, made and entered into this
3 day of 1127&&� , 1996 by and between the CITY OF SAN
4 BERNARDINO ("City") and EMERGENCY CARE INFORMATION CENTER
5 ("CONSULTANT")
6
WITNESSETH
7 NOW THEREFORE, The parties hereto agree as follows:
8 1. City hereby engages Consultant to perform the following
9 services:
10 A. Analyze the feasibility of the San Bernardino Fire
11 Department providing emergency medical transportation
12 services.
13 The consultant's operational and organizational
14 feasibility analysis will include:
15 1. Response-time performance
16 2 . Service demand
17 3 . Impact on fire suppression capability
18 4. Apparatus, equipment, and facilities
19 5. Dispatch and communications
20 6. Education and training Entered into Record at J
600 o ;14'1i1V0evCms Mtg:
21 7. Quality management
22 S. Staffing and supervisiono�
re Rye�ycja iterrl �
23 9. Deployment
24 10. Work force issues
11. Equal opportunity
City Clerk/CDC Secy
25 City of San Bernardino
26 12. Turnover and burnout
27 13. Public information, education, relations
28
1
2 B. Project the long-term impact that in-house emergency
medical transport will have on the City's general fund.
3
Consultant's financial projections will include but not
4
be limited to:
5
1. Projected runs by type
6
(To be based on local data or data from a city
7
with similar demographics, population and other
8
variables that affect emergency medical
9
transport)
10
2. Project allowable rates by type of run
11
3 . Deductions from revenue by type (e.g. Medicaid
12 allowance, bad debt, etc. )
13 4. Projected salaries and benefits based on market
14 trends
15 5. Medical supplies expense
16 6. Administrative expenses
17 7. Depreciation expense/equipment replacement
18 costs
19 S. Liability expense
20 9. Avoidable costs under City service delivery
21
22 C. Identify short-term and long-term obstacles in the
23 transition from private service delivery to City service
24 delivery, including but not limited to:
25 short term:
26 1. Legislative issues
27 2
28
1 2. Personnel training
2 3. Posting strategy/deployment plan evolution and
3 response time compliance
4 4. Labor issues
5 5. Degree of office automation/information
6 management
7 6. Implementation -of systems for clinical and
8 operational accountability
9 7. Medicare/Medicaid provider eligibility
10
11 Long term:
12 1. Managed care impact/health care reform
13 2• Continued organizational commitment to EMS
14 delivery
15 3 . Compliance with performance requirements
16 4 . Career path
17 5. Responsiveness to customers
18 6. Cost recovery/financial efficiency
19
20 D. Project tasks
21 1. Project logistics
22 a. Identify a project manager
23 b. Review and finalize project tasks an timetable
24 C. Identify relevant system stakeholders
25 d. Identify sources for local data
26 e. Identify and request documents and electronic
27 3
28
1 information
2 f. Finalize report format and presentation
3
4 2 . Data accumulation and detailed Analysis
5 a. Develop data collection instrument
6 b. Conduct on-site visits with involved agencies
7 C. Review operational and administrative data
8 d. Identify, obtain and analyze pertinent economic
9 and demographic data
10 e. Review data, and information sources to
11 present local and national trends
12 f. Review data, and information sources to present
13 local and national trends
14 g. Conduct interviews with major stakeholders
15
16 2. Consultant shall provide draft report within 45 days of
17 receipt of all necessary data from the City. Final
18 report shall be provided within 60 days of receipt of all
19 data from the City. If consultant does not provide
20 reports in accordance with this schedule, a penalty of
21 $200 per additional calendar day will be deducted by the
22 City from the payment due to consultant.
23 Project report will contain:
24 A. An executive summary which will exhibit a
25 complete accounting of the methodologies used
26 by consultant in the review, the consultant's
27 4
28
A.
1 findings, an overview of key points, and an opinion
2 as to whether the city should maintain the current
3 arrangement for services or pursue providing
4 emergency medical transport services.
5 B. A detailed report which outlines all processes,
6 procedures and standards utilized to complete the
7 comprehensive review. The final report will focus
8 on the scope of work and place emphasis on critical
9 areas such as: financial analysis, reimbursement
10 capacity, quality-of-care, and Fire Department
11 resources, planning documents and capability to
12 expand services.
13
14 3 . Consultant's fee shall not exceed $24, 000. Consultant
15 shall submit detailed expenditure reports to the City of
16 San Bernardino on a regular basis, outlining all actual
17 hours worked. Professional fees will only be billed
18 for actual work performed by consultant, and will be
19 billed at a rate of $125 per hour. This hourly rate will
20 include all costs associated with the performance of the
21 services supplied, including labor, materials and
22 transportation. Travel expenses and printing costs are
23 additional and will be billed for their actual costs.
24 Maximum budget for this project is as follows:
25 A. Project logistics phase $1,000
26 B. Conduct on-site visits of involved $1,000
27 5
28
1 agencies
2 C. Review operational and administrative $2,000
3 data
4 D. Identify, obtain and analyze pertinent $15,000
5 economic and operational data
6 E. Review data and information sources to $1,000
7 present local and national trends
8 F. Preparation of draft report $2,000
9 G. Preparation of final report $2,000
10
11 4 . The City Administrator or her designee shall provide
12 general supervision and direction to the consultant. Consultant
13 shall submit a claim for payment to the City on a monthly basis in
14 the manner and form as prescribed by the City Administrator.
15 5. This agreement shall commence upon execution of this
16 contract by both parties. This agreement may be terminated by
17 either party upon thirty (30) days written notice to the other.
18 Upon termination, consultant shall be entitled only to payment for
19 actual work completed.
20 6. For all purposes, Consultant shall be considered as an
21 independent contractor and not as an employee of the City.
22 7. Except as specifically provided herein, Consultant shall
23 not be entitled to any employee benefits, such as, but not limited
24 to vacation leave or accrual, sick leave, retirement benefits, paid
25 vacation, seniority, etc. City shall not deduct from Consultant's
26 compensation any withholding except as is required for such
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A.
1 independent contractors. Consultant shall be responsible for all
2 taxes on said compensation. Consultant agrees to provide Worker's
3 Compensation insurance for his/her employees in accordance with
4 applicable California laws.
5 8. Consultant agrees to defend, indemnify, save and hold
6 City, its officers, agents and employees harmless from any claim or
7 suits that may be brought by third persons on account of personal
8 injury, death, or damage to property, or a property or business or
9 personal injury, arising from any negligent or intentional act or
10 omission by Consultant while performing services under this
11 Agreement.
12 9• Any notices to be sent pursuant to this Agreement from
13 one party to the other shall be deposited with the United States
14 Postal Services postage prepaid and addressed as follows:
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17 TO THE CITY: City Administrator
City of San Bernardino
18 300 North "D" Street
San Bernardino, CA 92418
19 TO THE CONSULTANT: Emergency Care Information Center
20 P. 0. Box 2789
Carlsbad, CA 92018
21 Nothing in the section shall be construed to prevent the giving of
22 notice by personal service.
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A....
AGREEMENT WIT ;MERGENCY CARE INFORMATIO. ;ENTER
1
2 IN WITNESS WHEREOF, the parties hereto have executed this
3 Agreement on the day and date first above shown.
4
5 CITY OF SAN BERNARDINO
6 By:'
/SHAUNA CLARK
City Administrator
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9
Approved as to form
10 and legal content:
11 JAMES F. PENMAN
City Attorney
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13 BY:
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15 CONSULTANT
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17 JAM O. P GE
D' ector
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