HomeMy WebLinkAbout2011-189 Agrmt - PSR Physician Services t
Agreement for Provision of Services
of EMT Supervism Physician
This Amendment to the 26t6 26i+Agreement for Provision of Services of EMT
Supervising Physician is made on the date last written below by and between PSR Physician
Services, an Oregon limited liability company ('Physician") and Ashland Fire & Rescue
("Agency").
The following items are amended to read as follows:
2.0 Term
The term of this Agreement shall be one (1) year, commencing July 1, 2011 and ending
June 30, 2012. Either party may terminate this Agreement at any time for any reason upon
sixty (60) days advance written notice to the other.
5.0 Compensation
Agency shall pay Physician $7,030 per year as compensation for the services
performed under this Agreement. Payment shall be made no later than the 30th of September
of the term of this Agreement, unless other arrangements have been mutually agreed to.
Ashland Fire & QRescue
By Date 7 / 2-z/ / I
Title F%,,b U I C
PSR Physician Servic , an Oregon Limited Liability Company
By Date /— I
Paul WRostykus, MD - Member
i
2011-2012 Agreement for Provision of Services of EMT Supervising Physician
Agreement.for Provision of Services
of EMT Supervising Physician
This Agreement is made on the date last written below by and between PSR Physician
Services, an Oregon limited liability company ("Physician") and Ashland Fire & Rescue
("Agency").
Recitals
A. Physician employs Paul S. Rostykus, MD who is licensed to practice medicine in the
State of Oregon, and is qualified and approved as a Supervising Physician by the Board
of Medical Examiners ("Board") pursuant to OAR 847-035-0020. Physician represents
that Paul S. Rostykus, MD is (i) currently licensed to practice medicine under ORS
Chapter 677 and is actively registered and in good standing with the Board; (ii) is
currently engaged in the practice of medicine; (iii) is a resident of and is actively
practicing in the area in which the emergency service is located; (iv) possesses the
knowledge of skills assigned by standing order to Emergency Medical Technicians and
First Responders as defined at Oregon law; and (v) possesses thorough knowledge of
laws and rules of the State of Oregon pertaining to Emergency Medical Technicians and
First Responders as required by Oregon law.
B. Agency would like to employ Physician to perform services as the Supervising
Physician pursuant to OAR 847-035-0020.
C. All services hereunder shall be performed exclusively by Paul S. Rostykus, MD.
Agreement
1.0 Scope of Services
Physician shall perform the following services:
(i) The duties of Supervising Physician as described in OAR 847-035-0025,
including the ability to delegate responsibilities to the Agency as provided therein.
(ii) Coordinate Agency activities with other EMS agencies in Jackson County.
(iii) Evaluate and make recommendations concerning Agency's EMS training
programs, equipment, and apparatus.
(iv) Coordinate with Agency administration the implementation of disciplinary
measures that would limit or modify a First Responder or EMT's scope of
practice or duties.
Page 1 —2003-2004 Agreement for Provision of Services of EMT Supervising Physician
2.0 Term
The term of this Agreement shall be one (1) year, commencing July 1, 2003 and ending
June 30, 2004. Either party may terminate this Agreement at any time for any reason upon
sixty (60) days advance written notice to the other.
3.0 Physician Insurance
Physician shall maintain professional malpractice insurance with coverage limits of not
less than one million dollars ($1,000,000.00).
4.0 Agency Duties
Agency shall commit sufficient staff, resources, and other support to enable Physician to
carry out its duties as Supervising Physician pursuant to OAR 847-035-0025 and other
requirements of Oregon law, including, but not limited to:
(i) Provision of a designated Agency liaison to provide single-point communication
with the Agency and to help carry out the provisions of this Agreement.
(ii) Provide means and support for documentation and record keeping to enable
Physician to perform his duties hereunder.
(iii) Provide timely response to the recommendations of Physician.
(iv) Provide in-service training programs to help meet the recertification requirements
of Agency's First Responders and EMTs.
(v) Maintain an effective quality assurance program for Agency operations.
(vi) Maintain professional malpractice insurance for Agency's First Responders and
EMTs with coverage limits of not less than one million dollars ($1,000,000.00).
5.0 Compensation
Agency shall pay Physician $3,089.37 per year as compensation for the services
performed under this Agreement. Payment shall be made no later than the 30th of September
of the term of this Agreement, unless other arrangements have been mutually agreed to.
l
Page 2-2003-2004 Agreement for Provision of Services of EMT Supervising Physician
6.0 Miscellaneous
6.1 Independent Contractor. Physician is an independent contractor and not an
employee of Agency.
6.2 Assignment. This Agreement may not be assigned by either party.
6.3 Nonwaiver. Waiver by either party of strict performance of any provision of this
Agreement shall not be a waiver of or prejudice the party's right to require strict performance of
any other provision.
6.4 Attorney Fees. If suit or action or arbitration is instituted in connection with any
controversy arising out of this Agreement, the prevailing party shall be entitled to recover in
addition to costs such sums as the arbitrator or court may adjudge reasonable as attorney fees
at trial, on petition for review, and on appeal.
6.5 Applicable Law and Jurisdiction. This Agreement shall be governed by and
construed in accordance with the laws of the state of Oregon. Jurisdiction shall be in state or
federal court in Jackson County, Oregon.
Ashland Fire & Rescue
By �2/L rY� Date l ' / c' / 1 i.k)
Title
PSR Physician Services, an Or n Limited Liability Company
By Date l fl l l OJ
Paul S. Rostykus, Mb - Member
Page 3—2003-2004 Agreement for Provision of Services of EMT Supervising Physician
/JJ�� C I Tr Y O F I RECORDER Page 1 1
ASH LAND ,DATE s Csl r ^•1P.0 NUMBERI:'':c
20 E MAIN ST. 8/312011 10364
ASHLAND, OR 97520
(541)488-5300 -
VENDOR: 006381 SHIP TO: Ashland Fire Department
PSR PHYSICIAN SERVICES, LLC, DR. PAUL ROSI (541) 482-2770
436 GRANDVIEW DR 455 SISKIYOU BLVD
ASHLAND, OR 97520 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net 30 days Dept.:
Req.Del. Date: Contact: Greg Case
Special Inst: Confirming? No
,Quarih l-.lJnit ', Descri-tion -`"°- '` :Unit Pace,,..£ i,.. ,Ex€. PriceT,'..,,
._ .. :. ,.
EMT Supervising Physician Contract 7,030.00
Renewal for July 1, 2011 to June 30,
2012
Contract Amendment for 2011-2012
Original contract issued in 2003-2004
SUBTOTAL 703000
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 7,030.00
ASHLAND, OR 97520
.�.,
>Ac ount NumbeR , ;._ . P.rgect Number ° "' Amount: '�;'ccount Number 3r .#; PrgecfNUmber,� ,y� �+
E 110.07.13.00.60415 7030.00
�^ Au° t ����� VENDOR COPY
FORM CITY OF
ASHLAND
REQUISITION Date of request:
Required date for delivery:
El-
Vendor Name / QUI— Rt1S%M41S, P5-R 811 VS IP—MAI Si4 U ,G/G
Address,City,State,Zip �/3� �s/�jN/7y/6al ( /y6v /� .t//� 0/2 . 9752
Contact Name&Telephone Number l owle lganl U&5 SN! Go/ '- 7707
Fax Number
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding ❑ Emergency
Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
Date approved by Council: ❑ Quote or Proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5,000 ❑ Request for Proposal (Copies on f le) ❑ State of Oregon
Note:Total contract amount,including any Date approved by Council: Contract#
amendments may not exceed$6,000 ❑ State of Washington
Intermediate Procurement Sole Source Contract#
GOODS&SERVICES �eE,�,t Ilen finding s attached ❑ Other government agency contract
$5,000 to$900.000 i te r Agency
❑ (3)Written quotes attached 2 nce hdlM of � c1 4 -4d, Contract#
PERSONAL SERVICES ❑ Special Procurement ❑ Intergovernmental Agreement
$5,000 to$75,000 ❑ Written findings attached Agency
❑ Less than$35,000,by direct appointment ❑ Quote or Proposal attached Contract#
❑ (3)Written proposals attached Date approved by Council: Date approved by Council:
Description of SERVICES Total Cost
t</ ,+01-1v51e141/ 0o1✓11I/IC1 R6vewRz
0GlLy 1 20// i8 4UMF 30 r A0 1 z
Item# Quantity Unit Description of MATERIALS Unit Price Total Cost
❑ Per attached QUOTE TGTAL.COST
Project Number---------- Account Number/j0•Qz-/J-6?L2.0 L5-0 Account Number
___-__-_
Account Number------------------- Account Number___-__-_
'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed.
By signing this requisition form,l certify that the information provided above meets the City's public contracting requirements,and the do um� tat of can be provided
upon request.
Employee Signature: Department Head Signature:
Additional signatures(if applicable):
Funds appropriated for current fiscal year: / NO
Finance Director Date
Comments:
G:FinanceNrooedure'APTormsTorm#3-Requisition.doc updated on:10/27/2010