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HomeMy WebLinkAboutDocumentation_Regular_Tab 03_11/10/2022Agenda Item #3. Regular Council STAFF MEMO -D Meeting: Regular Council -Nov 10 2022 Staff Contact: Jeremy Allen, Village Manager Department: Manager TITLE Approval of Contracts Signed by Manager Under $25,000 (Per Village Ordinance we are presenting the following agreements, proposals, commitments and memorandum of understanding to Council.) A. Florida Department of Health Emergency Medical Services Program, Ground Ambulance Service Provider License 2 Year Renewal -Fire Department, $1,450.00. B. Florida Coast Equipment Account Credit Application -Water Distribution/Stormwater, $N/A C. Palm Beach County Certificate of Public Convenience &Necessity (COPCN) Renewal -Fire Department, $500.00 Application Fee. Approval of Contracts Signed by Manager Under $25,000 (Per Village Ordinance we are presenting the following agreements, proposals, commitments and memorandum of understanding to Council.) A. Florida Department of Health Emergency Medical Services Program, Ground Ambulance Service Provider License 2 Year Renewal -Fire Department, $1,450-00. B. Florida Coast Equipment Account Credit Application -Water Distribution/Stormwater, $N/A C. Palm Beach County Certificate of Public Convenience &Necessity (COPCN) Renewal -Fire Department, $500.00 Application Fee. This document and any attachments may be reproduced upon request in an alternative format by completing our Accessibility Feedback Form, sending an e-mail to the Village Clerk or calling 561-768- 0443. PROJECT NAME: Proposed: 3 Items, each with individual costs BUDGET: N/A ENCUMBERED: N/A Projected Remaining: N/A These agenda items are respectfully submitted for your review and approval. item is respectfully submitted for your review and approval. FL DOH EMS ALS License Renewal - Fire Dept Florida Coast Equipment Credit Account Application-Wtr Distr. & Stormwtr Page 30 of 475 Agenda Item #3. PBC Certificate of Public Convenience & Necessity Renewal - Fire Dept Page 31 of 475 Agenda Item #3. Village of Tequesta Department of Fire -Rescue Services 357 Tequesta Drive Tequesta, FL 33469 RES James Trube, Fire Chief To: Jeremy Allen, Village Manager From Fire Chief James Trube, Date: October 20, 2022 561-768-0500 www.tequesta.org Re State of Florida, Department of Health, Emergency Medical Services Program — Ground Ambulance Service Provider License Renewal — effective January 1, 2023 Please find the attached Ground Ambulance Service Provider License Renewal application that will go into effect January 1, 2023. The License is required by the State of Florida Department of Health which allows the Village of Tequesta Fire Rescue to operate as an Advance Life Support Transport Service. The license term is two {2) years. Vice -Mayor Kyle Stone Mayor Molly Young Council Member Frank D'Ambra III Council Member Laurie Brandon Council Member Aaron Johnson Village Manager Jeremy Allen Page 32 of 475 Agenda Item #3. Village of Tequesta Department of Fire -Rescue Services 357 Tequesta Drive Tequesta, FL 33469 James Trube, Fire Chief October 21, 2022 Alyshla Dark, EMS Li ensure Representative Florida Department of Health Bureau of Emergency Medical Services 4052 Bald Cypress Way, A-22 Tallahassee, FL 32399-1722 RE: Tequesta Fire Rescue - Advanced Life Support License -95021 Dear Ms. Dark: 561-768-0500 wvvw.tequesta.org Enclosed please find our Advanced/Basic Life Support Service License Application, along with the following documents: • Certificate of Public Convenience and Necessity COP 'I' • Permit Application Form DH Form 1510 • Insurance Policy • Trauma Transport Protocol Letter • Medical Director Agreement • Medical Director License • Drug Enforcement Administration Certificate The application for our COPCN renewal with Palm Beach County has been submitted for the 0 January 1, 2023 renewal. Enclosed is check # in the amount of $ 1,4 0.00 for the license & permit fees. We hope you find our application and attachments in order. If You have any questions or concerns, please do not hesitate to contact me at (561) 768-0559. Sincerely.. Lids J e I Ic ec at7o-er CC: Fire Chief James Trube Captain Raymond Giblin, EMS Coordinator Vice -Mayor Kyle Stone Mayor Molly Young Council Member Laurie Brandon Council Member Frank D'Arnbra III Council Member Aaron Johnson Village Manager Jeremy Allen Page 33 of 475 Agenda Item #3. ADVANCED/BASIC LIFE SUPPORT SERVICE LICENSE APPLICATION INSTRUCTIONS The items listed below are required for a complete application. Please use this list of instructions to ensure the application is complete before mailing. A complete application will greatly reduce the processing time. Your application must be received in this office 30 days before you wish to start a new service or renew your current license. Type of Application: Mark all the appropriate lines. Number One: The name of the service that is placed on line 1 must be identical to the name listed on your Certificate of Public Convenience and Necessity (COPCN). All the rest of the lines need to be filled out appropriately. Include your internet e-mail address if you have one. The manager's name should be the person who would receive all correspondence from this office. Under the Type of ownership, check ALL of the items that apply to your service. Number Two: All the blanks need to be filled in. If you have more than one medical director include the same information for each one on a separate sheet of paper. Number Three: Fill in as requested or if it does not apply put NIA. Number Four: List the address of your base station (headquarters) and all substations, including the substation identifier (e.g. station 2). Number Five: List all counties in which you have a COPCN, or mutual aid agreement. Number Six: List the type of communication between your vehicle and the hospital. Med 8 is required pursuant to the EMS communications plan established in Chapter 401 part 1, Florida Statutes. Number Seven: V Attachment 1: A COPCN is required for each county in which you operate. If you change a county throughout the year, the changes must be submitted to the department pursuant to Chapter 401.25, F.S. V Attachment 2: The permit application, DH Form 1510, needs to be filled out and signed. If you have a computer generated list of vehicles, you may just put "see attached" on Form 1510, sign the form and attach your list. Permit applications must be received by the department 30 days prior to change, as required on DH Form 1510, which is incorporated in Chapter 64J-1.002(1), Florida Administrative Code. Attachment 3: Insurance verification: A copy of an insurance policy, a self insurance policy or certificate of insurance is acceptable. Documentation must include a schedule of vehicles covered, if the policy is not blanket coverage or self-insurance. Limits of vehicle liability and property damage coverage and expiration date must be shown. Minimum limits -- Bodily injury $100,0001$300,000 and property damage $50,000 for non -government owned services. Bodily injury and property damage for government services is $200,000 total. V Attachment 4: Trauma Transport Protocols expire at the same time as your license. If there have been no changes, a signed statement from your medical director to that effect is acceptable. If they are uniform for the entire county a signed statement from your medical DH 631 04109 Incorporated by reference 64J-1.002, F.A.C. Page 34 of 475 Agenda Item #3. director to that effect is acceptable. otherwise there are directions and forms included in this package. 600" Attachment 5: A co of a full executed contract between a Florida licensed physician PY Y p Y and the applicant or a letter of agreement signed by the physician and the other party must be included, ✓ Attachment 6: The medical director must be a Florida license A co of physician. pY his/her current license from the department must be included. Attachment 7: ALS providers must also include a co of the U.S. Department of P copy p Justice, Drug Enforcement Administration Certificate issued to the physician or hospital pharmacy (if hospital based) listing the address at which the applicant stores controlled substances. If you are permitting aircraft under an ALS license application, please attach the following information: Attachment 8: A separate air permit application, ❑H Form 1576 must be filled out for each aircraft you wish to permit. Each application must be signed and include a FAA Part 135 Certificate and complete parts A & D of the operations specifications listing for each of the aircraft you wish permitted. If the 135 certificate holder is not the applicant, or the company which owns the aircraft, include a letter of agreement or contract between all involved parties. • Attachment 9: Medical malpractice/professional liability insurance for each air medical crew member and medical director. Form must show limits of liability and list the applicant as the insured. Minimum limits - $100,000/$300,000 for privately owned services. Minimum limit for government owned services is $200,000 for all coverage combined. Attachment 10: Aircraft liability insurance coverage. Policy must include the name of the licensed service, limits of coverage, expiration date, and FAA tail number of each aircraft or include all aircraft owned and operated by the insurer. Attachment 11: Provide a copy of each pilot's commercial license and current medical certificate. only legible copies will be accepted. Attachment 12: A copy of the air worthiness certificate for each aircraft permit you are applying for. Number Nine: A company or county check or money order made payable to Emergency Medical Services, 4052 Bald cypress way, Bin A22, Tallahassee, Florida, 32399-1738 must be included in the package. only volunteer providers identified as such by the EMS office are exempt from licensure fees. ALL FEES ARE NONREFUNDABLE. (401-34, F.S.) Advanced Life Support Service License $1375.00 Basic Life Support Service License $660.00 Vehicle or Aircraft Permit $25.00 each Applicants wishing to provide both ALS and BLS services must pay only the ALS and permit fees. Number Ten: check the box that applies to your service according to the COPCN issued to you by the county. DH 631 04/09 2 Incorporated by reference 64J-1.002, F.A.C. Page 35 of 475 Agenda Item #3. Number Eleven: Sign the application and have it notarized. IF YOU ARE NOT CURRENTLY LICENSED IN THIS STATE, A LICENSE MUST BE ISSUED BEFORE YOU MAY OPERATE IN THIS STATE. SECTION 401.25, F.S. YOUR APPLICATION MUST BE IN THIS OFFICE 30 DAYS BEFORE YOU WISH TO START A NEW SERVICE OR RENEW YOUR CURRENT LICENSE. All licensed agencies are subject to random inspections to assure compliance with all requirements. COMMUNICATION INFORMATION Chapter 401, Florida Statutes, Part 1, is administered by the State Technology Office which requires the following related to communications: Obtain copies of the Emergency Medical Services Communications Plan --Volume 1 for administration and Volume II for each Vehicle and dispatch center. Obtain final approval from the State Technology office to purchase your communication system (vehicular and dispatch) - an up to 30 day,_ process. Federal radio system_ requirements are as follows: Obtain a Federal Communication Commission (FCC) license authorizing your radio communication system operation - an up to 60 day process. Please direct all questions related to communications to: EMS Communications Engineer DMS Division of Telecommunication 4030 Esplanade Way Tallahassee, Florida 32399-0950 Phone: (850) 922-7435 Fax: (850) 922-5313 DH 631 04/09 Incorporated by reference 64J- I.002, F.A.C. Page 36 of 475 Agenda Item #3. STATE OF FLORIDA DEPARTMENT OF HEALTH EMERGENCY MEDICAL SERVICES PROGRAM GROUND AMBULANCE SERVICE PROVIDER LICENSE APPLICATION Type of application (Check all that apply): New Renewal ALS BLS Transport Change of Name ❑ Change of Address ❑ 1. Name of Service Villaqe of Tequesta Fire Rescue Provider ID# 5021 Mailing address 357 Tequesta Drive City Tequesta State FL Physical address of records 357 Tequesta Drive City Tequesta State FL County Palm Beach Zip Code 33469 Phone Number 561-768-0550 Fax Number 561-768-0693 24 Hour Number 561-768-0553 Internet E-mail address r iblin to uesta.or "on es(cb-teg uesta.or Manager's Name Jeremy Allen Type of Ownership (check all that applyl: Private City r Volunteer County Fire Department Hospital Based Corporation For Profit _ 2. Medical Director Dr. Don T. Tanabe Title Villaqe Manaqer Not for Profit Special Tax District Other (Describe) Mailing Address 357 Tequesta Drive City Tequesta State FL Zip Code 33469 Phone Number. 561-827-6940 Fax Number 561-768-0693 Florida License Number ME 61426 Exp. Date 1 /31 /2024 D.E.A. Certificate Number BT0488127 Exp. Date 11 /30/2024 (Attach separate sheet if more than one Medical Director. Also attach copy of Florida medical license and D.E.A. certificate for each) 3. Provide name of owner(s) or list all officers, directors and share holders (if a corporation) (attach separate sheet if necessary) Name Address Position N/A 4. List the address and/or describe the location of your base station and all substations (attach separate sheet if necessary). 357 Tequesta Drive, Tequesta, FL 33469 5. Identify the counties to be served by your service. Palm Beach County & Martin County DH 631 04/09 4 Incorporated by reference 64J-1.002, F.A.C. Page 37 of 475 Agenda Item #3. 6. You must have communication capability between your ambulance and hospital. List means of communication: Tequesta Fire Rescue operates on PBC's 800 MHz system under dispatch agreement. We utilize 800 MHz channels for hospital communication and maintain Med 8 radios in units. 7. Attach the following: Attachment # 1 Certificate of Public Convenience and Necessity (for each county in which you operate). Attachment #2 Application for ambulance permit(s) DH Form 1510 (multiple vehicle permit application). Attachment #3 Insurance verification - copy of insurance policy, certificate of insurance or certificate of self-insurance showing limits of auto liability coverage and expiration date. Must also list schedule of vehicles covered if not blanket coverage or self insured. Attachment #4 Trauma Transport Protocols signed by the current Medical Director. Attachment #5 Verification of Medical Director employment, (i.e. fully executed contract, letter of agreement, etc.) Attachment #6 Copy of the Medical Director's Florida medical license. Attachment #7 Copy of the Medical Director's D.E.A. certificate if ALS 8. If you are permitting aircraft under an ALS license application, please attach the following information: Attachment #S Application(s) for air ambulance permit(s) - for each aircraft requested. Must be completed and signed. Attachment #9 Medical Malpractice/professional liability insurance for all air medical crew members and medical director. Attachment # 10 Insurance verification - copy of insurance policy, certificate of insurance or certificate of self-insurance showing limits of coverage, policy expiration date and FAA number of each aircraft Attachment # 11 Pilot licensure - Copy of each pilot's commercial license and current medical certificate. Attachment # 12 Airworthiness certificate- Copy of the air worthiness certificate for each aircraft permit you are applying for. 9. Fees are established by §401.34, Florida Statutes. Check or money order should be made payable to Emergency Medical Services. All fees are nonrefundable. DH 631 04/09 5 Incorporated by reference 64J-1.002, F.A.C. Page 38 of 475 Agenda Item #3. 10. Check the box that applies �✓ I hereby certify that this service will provide continuous service on a 24-hour day, 7-day week basis. I hereby certify that this service will provide interfacility transport only and may not be available 24 hours a day 7 days a week. 11. 1, the undersigned, a representative of the above service do hereby attest that this licensee meets all requirements for operation of an ambulance service in the state as provided in Chapters 395 and 401, Florida Statutes, and Chapter 64J-1, Florida Administrative Code. I further acknowledge any violations or discrepancies discovered will subject this service and it's authorized representatives to actions and penalties provided by law. To the best of my knowledge, all statements on this application are true and correct. NOTARY SEA. Aotary Public M MT k KA.NNON M ate h. Expires July 30, 2025 BmW Tin Imy F* Wince 8&3�7019 Si ature remy Allen Name (Please Print) Village Manager Position Date FALSE OFFICIAL STATEMENTS: Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the perforiiiance of his official duty shall be guilty of a misdemeanor of the second degree. § 837-06, Florida Statutes. DH 631 04/09 Incorporated by reference 64J- 1.002, F.A.C. Page 39 of 475 Ariz%ndaJtem, ��=c r.►.e•a xr. 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LOLL 4-�+ N r- L N CO •Q N X w r 0 4y U C7 r'" CD V) CO rn r +-' CD r r N M 0 0 0 0 N N N N O 0 r CO CO :3 N N 0 CD 73 4-0 ML L L L � CD 0 0 0 0 -0 C U U U U C Qy C� • U_ J C C 0 r r N a) > Q] C7 0 C7 0 N N N Cal 0 • Q Cy r 0 U o Q? x U LLJ 00) N r C LEI} p a) r 0 D U LLI— T U U O J -- D a- CQ ua w z z z z w ��_�° C7 �7 0 - wcnw= LL U) 0 0 a) U ml U cl� CL a3 M E-- �-- F- E m 3 C O y..r C� E U] U a) {p C ❑ U < © c� 0� o C) C) w co 0 (D rn M C) �—1 'L W W N r-- N qCT C'7 00 N CY7 j r r N N D L) \ �► Ei C� Page 41 of 475 Agenda Item #3. CD 0 2 r, V N CO wP Co U) ncr W 4- 0 0 CD cz rd a 03 a 0 c - 0 cr UD M M co qt co M 0 u LL -� ca � C13 cr Vcon 0 • c ' M u �� � LO CY) n T- � ® zapCd T-C) ui LO U- �o - C� U W t� W LL C,) ' Q o � Fu o �4-j W V- b z p E 03 LL v N Z _Z W J [] "s y ' 0 _ CO WEll CY) 0 r-- w C] C7 0 N RI {V o -Sz w LL 03 con � o °o o 0cz 0 C: a) 4-04 ��� y El V) W .. x x n a o �(flo)rn 405 "' 4 o� a, E� SE w °� � C1 cs � • � ,..� ra 4� LZ, v ` ' 0 ' r 9.1 U ° o o M W-) �c r-- an 01) � M tn W�- Page 42 of 475 Agenda Item #3. 69 CERTIFICATE OF COVERAGE Certificate Holder '- PALM BEACH COUNTY Administrator Issue Date 10/3/22 Florida League of Cities, Inc. 301 N OLIVE AVE Department of Insurance Services WEST PALM BEACH, FL 33401 P.O. Box 538135 Orlando, Florida 32853-8135 COVERAGES THIS IS TO CERTIFY THAT THE AGREEMENT BELOW HAS BEEN ISSUED To THE DESIGNATED MEMBER FOR THE COVERAGE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TI:Rir1 OR CONDITION CONTRACT OR OTHER OOCLUMENT WRIT RESPECT To WHICH THIS CERTIFICATE MAY BE ISSUED OR I`1AY PERTAIN, THE COVERAGE AFFORDED BY THE AGREEMENT DESCRIBED EMEN I5 SUB]ECT EXCLUSIONS AND CONDITIONS OF SUCH AGREEMENT DfTlOH T ANY TO ALL THE TERMS, COVERAGE PROVIDED BY: FLORIDA MUNICIPAL INSURANCE TRUST AGREEMENT NUMBER: FMIT 0595J I COVERAGE PERIOD: FROM 10/1/22 COVERAGE PERIOD: TO 10 1 23 12:01 1 / AM STANDARD TIME TYPE OF COVERAGE - UABILiTy General Liability ® Comprehensive General Liability, Bodily Injury, Property Damage, Personal Injury and Adver#sing Injury ® Errors and Omissions Liability Q Employment Practices liability ® Employee Benefits Program Administration Liability Q Medical Attendants`/Medical Directors' Malpractice Liability Q Broad Form Property Damage ® Law Enforcement Liability ® Underground, Explosion & Collapse Hazard Limits of Liability _ * Combined Single Limit r Deductible $2,500 Automobile liability ® All owned Autos (Private Passenger) All owned Autos (Other than Private Passenger) © Hired Autos ® Non -Dunned Autos Limits of Liability * Combined Single Limit Deductible N/A Automobile/Equipment - Deductible TYPE OF COVERAGE - PROPERTY Q Buildings © Basic Form ❑ Special Form © Personal Property ❑( Basic Form El Special Form ❑ Agreed Amount Q Deductible $100,000 © Coinsurance 100°Io ❑ Blanket © Specific Q Replacement Cost ❑ Actual Cash Value Miscellaneous Inland Marine Electronic Data Processing ❑ Bond Limits of Liability on File with Administrator TYPE OF COVERAGE - WORKERS' COMPENSATION ® Statutory Workers' Compensation ® Employers Liability $11000,000 Each Accident $1,000,000 By Disease $I,000,000 Aggregate By Disease ❑ Deductible N/A ❑ SIR Deductible. N/A Q Physical Damage Per Schedule - Comprehensive - Auto Per Schedule - Collision - Auto Per Schedule -Miscellaneous Equipment Other * The limit of liability is $200,000 Bodily Injury and/or Property Damage per person or $300,000 Bodily Injury and/or Property Damage specific limits of liability are increased to $2,000,000 (combined single limit P �' 9 Per occurrence. These Section 768.28 (5) Florida Statutes or liability/settlement for whichn o claims bill s been iiledlor j abit ty or imposed Pursuant resulting F entry of a claims bill pursuant to State of Florida. P to Federal Law a actions Outside the Description of Operations/Locations/Vehicles/Special Items RE: Fire Department vehicles THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORhIATION ONLY AND CONFERS pro RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DpES NOT AMEND, E]CTEN0 DR ALTER THE COVERS THE AGREEMENT ABOVE GE AFFORDED BY Designated Member Cancellations Village of TequeSta SHOULDANY PART OF THE ABOVE DESCRI8ED AGREE •IENT BE CANCELED BEFORE THE EXPI 345 Tequesta Drive 'DATE THEREOI:, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 45 DAY RAT[°pr CERTIFICATE HOLDER NAMED ABOVE, BUT FAIWRE TO MAIL SUCH NOTICE SFWIALL N NOTOSE ICE TO THE TequeSta FL 33469-3062 OBLIGATION OR LLABIL17Y OF ANY IOND UPON THE PROGRAM, ITS AGENT S OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Page 43 of 475 Agenda Item #3. 9-1 Village of Teq ue Department of Fire -Rescue Services 357 Tequesta Drive or 561-768-0500 Tequesta, FL 33469 * t, ,i�* www.tequesta.org IRt I S James Trube, Fire Chief November 1, 2022 Ms. Alyshia Dark Florida Department of Health Bureau of Emergency Medical Services 4052 Bald Cypress Way, A22 Tallahassee, FL 32399-1738 Dear Ms. Dark. - This letter is to comply with the requirements of our license renewal for ground ambulance service regarding Trauma Transport Protocols. We are currently operating under the approved Palm Beach County Trauma Systems 2020 Uniform Treatment and Transport Protocols dated November 4, 2020. Should you have any questions or require additional information, do not hesitate to contact Captain Raymond Giblin 111, EMS Coordinator or me at 561-768-0550 Respectfully, Don Tanabe, MD Medical Director Vice -Mayor Kyle Stone Mayor Molly Young Council Member Frank D'Ambra III Council Member Laurie Brandon Council Member Aaron Ink Village Manager Jeremy Allen P;Y!ye 44 of 475 Agenda Item #3. Mission: Ron DeSantis To protect, promote & improve the health Governor of all people in Florida through integrated Flo ica Joseph A. Ladapo, MD, PhD. state, county & community efforts. HEALTH State Surgeon General Vision: To be the Healthiest State in the Nation BUREAU OF EMERGENCY MEDICAL OVERSIGHT TTP ATTESTATION STATEMENT As the medical director for vkk�a ��L&STZ1 Ftrco-Re-cue,* �J tea` (Servid6 Name) (License #) I developed, directed, and/or approved the development of the Trauma Transport Protocols presented in this document. Tar on T TQ.ee— o (r] DIP V P, -- Name of Medical Director SIrignature o0Medical 'Director Approval Date k E cat 444� G M.D./D.O. LICENSE NUMBER Florida Department of Health Division of Emergency Preparedness and Community Support Bureau of Emergency Medical Oversight 4052 Bald Cypress Way, Bin A-22 - Tallahassee, FL 32399-1722 PHONE: 850/245-4440 - FAX: 850/921-0377 FloridaHealth.gov Accredited Health Department PUblic Health Accreditation Board Page 45 of 475 Agenda Item #3. G MEDICAL DIRECTOR AGREEbMNT THIS AGREEMENT, made and entered into this 6th day of October, 2003, by and between the VILLAGE OF TEQUESTA a municipal corporation under the laws of the State of Florida (hereinafter referred to as "'Village"), and DON TANABE, M.D., a Florida licensed physician (hereinafter referred to as "Medical Director"), W I THE S SETH: WHEREAS, emergency medical services are provided by the Village of Tequesta by and through its Department of Fire -Rescue Services which employs paramedics to perform advanced life support; and WHEREAS. Section 401.265, Florida Statutes, requires that any emergency medical services system which utilizes paramedics to perform advanced life support procedures must employ or contract with a medical director; and WHEREAS,, the aforementioned statute and Chapter 64E-2 of the Florida Administrative Code set out certain criteria and requirements for said medical director; and WHEREAS, the Village desires to employ physician to serve as medical director and medical direction to the employees of the Tequesta Department of Fire -Rescue Services appropriate patient care and consistency. M:\Adm1nlstat1on Documents\Proposals & ContraLU a licensed to provide Village of to insure 1 Page 46 of 475 Agenda Item #3. - NOW, THEREFORE, in consideration of the mutual promises and covenants set forth herein, the parties agree as follows: Z. RESIGNATION OF MEDICAL DIRECTOR The Village does hereby engage Don Tanabe, M.D., a licensed physician in the State of Florida, as Medical Director for the Village's Emergency Medical Service System. II. DUTIES AND RESPONSIBILITIES The Medical Director shall: A.Be the Medical Director for the village of Tequesta Emergency Medical Service System. For the purposes of this agreement, the village of Tequesta Emergency Medical Service System shall include emergency medical technicians, paramedics, captains, lieutenants, firefighters and volunteer firefighters working for or providing services for the village of Tequesta Department of Fire -Rescue Services; B.Supervise and accept responsibility for the medical performance of the emergency medical technicians, paramedics, captains, lieutenants, firefighters and volunteer firefighters working for or providing services to the village of Tequesta Department of Fire -Rescue Services; C. Develop and authorize, or review and authorize for use, medically correct standing orders and/or protocols that permit specified ALS procedures M AAft nistration Documents) & co nb acts Page 47 of 475 Agenda Item #3. when communication cannot be established with a supervising physician or when any delay in patient care would have potential life or limb threatening consequences. Standing orders and protocol shall insure that patients are transported to facilities that offer a type and level of care appropriate to the patient's medical condition. The Medical Director or his appointee shall provide continuous twenty-four (24) hour per day availability of Medical Director Voff-line" service for potential problems, system conflicts and disaster events; D. Audit the performance of the Village's Department of Fire --Rescue Services personnel by use of a quality assurance program to include,, but not be limited to, a prompt review of run reports, direct observation, and comparison of performance standards for drugs, equipment,. and established protocols and procedures E , De responsible for participating in quality assurance programs developed by the Department of Health and Rehabilitation Services; F,Ensure and certify that security procedures for medications, fluids and controlled substances are in compliance with Chapter 499, Florida Statutes, and Chapter 893, Florida Statutes; G.Specify medication substitutions in writing; H . Submit to the Department of Health and Rehabilitation Services, within thirty (30) days of any deviation from the approved trauma transport protocols, a copy of the run report and a written explanation regarding the deviation; M AAdministr anon D xument skPropwals & Conks 3 Page 48 of 475 Agenda Item #3. I. Conduct one (1) meeting per month of not less than two (2) hours for the purpose of training and educating the Village's personnel in the Department of Fire -Rescue Services; J. Assist in identifying the specific medical skills and knowledge which the Village's personnel within the Department of Fire -Rescue Services must possess to achieve the desired level and standard of care; K. Assist in providing the necessary training in the special medical skills and knowledge which the Tillage's personnel within the Department of Fire --Rescue Services must possess to achieve the desired level and standard of care; L. Provide a minimum of eight (8) hours per month attendance at the Fire -Rescue headquarters to participate in monthly quality assurance planning meetings, to deliver monthly in-service training with department personnel, perform physician level call review on random medical reports and participate as a crew member on the response unit; M. Be responsible for complying with Florida Statutes Section 401.265 (2003) , as amended from time to time, all laws and admini s trat ive regulations promulgated in accordance with Chapter 401, Florida Statutes (2003) , as amended from time to time, and all rules of the Department of Health and Rehabilitation Services and shall perform all duties enumerated in Section 64E-2.004, Florida Administrative Code (2003), as amended from time to time. M:Wrninistiatn D=majs\ftpmajs & Cw ads 4 Page 49 of 475 Agenda Item #3. III. DUTIES OF THE VILLAGE A. In consideration for the services provided by Medical Director, the Village hereby agrees to pay Medical Director Nine Hundred and. Twenty -Five Dollars ($ 9 2 5 . a 0 ) per month, payable monthly, during the term of the agreement. . If the contract is extended in accordance with Section V (CONTRACT TERM), the Nine Hundred and Twenty -Five Dollars ($925, 40) per month compensation shall be considered the Base Amount. ii. Each year thereafter, the Base Amount shall be adjusted up or down from the compensation rate from the previous contract year by annual indices from the Bureau of Labor Statistics Southeastern Regional offices for May, utilizing the Consumer Price Index (CPI) for all Urban Consumer --South to arrive at the new compensation rate for the next fiscal year. In the event that during the term of this Agreement the above -referenced indices are no longer published, then the parties hereto agree to substitute therefore a mutually agreeable new index. B. The Village shall provide the Medical Director insurance coverage for medical malpractice with M:Wrninisbr on \Proposals & Conb-dM 5 Page 50 of 475 Agenda Item #3. liability limits of $1,000,000.00 for claims arising out of the scope and performance of activities specified in this agreement, and specifically as Medical Director for the Village of Tequesta. C . The Village will provide Medical Director with a pager and/or cell phone to assure communications with personnel i f needed, to perform his duties as Medical Director for the Village of Tequesta. IV. INDEPENDENT CONTRACTOR RELATIONSHIP A,The Medical Director is an independent contractor who will be responsible for payment of federal withholding tax and social security contributions. Furthermore, the Medical Director shall not be entitled to any fringe benefits normally provided to Village Employees such as worker's compensation, unemployment compensation, retirement, disability leave and any leave with pay. B, To the extent that some of the services provided by the Medical Director may cause the Medical Director to be defined as a Business Associate under 45 CFR Parts 164 and 164 issued under the Health Insurance Portability and Accountability Act of 1996 ( the "Privacy Rule") and the Village of Tequesta Fire --Rescue Department in its capacity as a Covered Entity, as defined in the Privacy Rule, is required to comply with Sections 164.504 (2) ( i j ) of the Privacy Rule. the Medical Director shall: WAAdministratiion aocumwts\P sWs & Contracts 5 Page 51 of 475 Agenda Item #3. a - Not use or further disclose Protected Health Information ("PHI"}■ other than as permitted or required by this Agreement or as required by law; b. Use appropriate safeguards to prevent use or disclosure of PHI other than as provided for in this Agreement c. Report to the village any use or disclosure of PHI by Medical Director, employees or agents other than as permitted by this agreement of which Medical Director becomes aware; d.Ensure that any agents of Medical Director, including a subcontractor, to whom Medical Director provides PHI received from, or created or received by Medical Director on behalf of village, agrees to the same restrictions and conditions that apply to Medical Director with respect to such Protected Health Information. e.To the extent applicable to Medical Directorr make available PHI in accordance with section 164.524 of the Privacy Rule; f- To the extent applicable to Medical Director, make available PHI for amendment and incorporate such amendments to PHI in accordance with Section 164.526 of the Privacy Rule; g. To the extent applicable to Medical Director, make available information required to provide an accounting of WAftdStaon Doaxnents& ConbxU Page 52 of 475 Agenda Item #3. disclosures in accordance with Section 164.52E of the Privacy Rule; h.Make Medical Director's internal practices, books, and records related to use and disclosure of PHI received f rom, or created or received by Medical Director on behalf of Village available to the secretary of Health and Human Services for purposes of determining Customer,'s compliance with this Section 29. i. At termination of this Agreement, if feasible, return or destroy all PHI received from, or created or received by Medical Director on behalf of the Village that the Medical Director still maintains in any form and retain no copies of such information, or, if such return or destruction is not feasible, extend the protections of this Agreement of the information and limit further uses and disclosure to those purposes that make the return or destruction of the PHI infeasible. j.Medical Director agrees to comply with Security Provisions as outlined within. the HIPAA Privacy and security Rules for the electronic storage and use of PHI. k. In the event that the Medical Director breaches any of the foregoing conditions regarding the Health Insurance Portability and Accountability Act, the Village may terminate this Agreement. M;WONs rNon is\ems & Cwnm 8 Page 53 of 475 Agenda Item #3. SST. CONTRACT TERM The Village agrees to retain the Medical. Director and the Medical Director agrees to be so retained in an independent contractor relationship for a period of one (1) year beginning October lr 2003. This agreement shall automatically renew each year unless written notice of intent to terminate is given by either party sixty (6o) days prior to the expiration date. VI. TERMINATION This agreement is subject to cancellation with or without cause by either party to this agreement at any time during the contract period,, including renewals thereof, by providing sixty (60) days prior written notice to the party. Such notice shall be forwarded by registered mail to the last mown address of the other party. YII. AUTHORITY A. The Medical Director is not authorized to obligate the expenditure of Tillage funds. B.The Medical Director shall retain the ultimate authority to permit and/or prohibit any paramedic or EMT working for the Village's Department of Fire -Rescue Services to utilize advance life support and/or basic life support techniques and shall immediately notify the Village Manager or his designee of the change of eligibility of any paramedic or EMT to perform emergency medical care. M:yWminisMon Dr=MWts\PmPM1s & Convwts 9 Page 54 of 475 Agenda Item #3. c.The operation and administrative control of the Village's Emergency Medical Services will be vested in the Village Manager or his designee and the Medical Director shall be responsible to the Village Manager or his designee. VIII. INTERPRETATION AND BINDING EFFECT Except as herein otherwise provided, this agreement shall inure to the benefit of and shall be binding upon on the parties hereto, their personal representatives, successors heirs and assigns. IX. INVALIDITY OR UNENFORCEABILITY Invalidity or unenforceability of any provision hereof shall in no way affect the validity or enforceability of any other provisions. X. GOVERNING LAW This agreement shall be governed and construed in accordance with the laws of the State of Florida. XI. ENTIRE AGREEMENT This agreement contains the entire understanding between the parties and may not be changed or modified except b an Y agreement in writing signed by all the parties. Page 55 of 475 ---- genda Item #3. ------ IN WITNESS 'THEREOF, the parties have signed this agreement, The date of this agreement shall be the date first written above. Signed, sealed and delivered In the presence of: VILLAGE OF TEQUESTA: By: Edward D. Resnik, Mayor MEDICAL DIRECTOR: ------- vf or 111B Don T. Tanabe, M.D. ATTEST: r - r /.. Mary Miles` Village Clerk K\Administration Dcuments\Proposals & Contracts n, r Witness r i t-. Witness Witness Page 56 of 475 Agenda Item #3. F I. C"UST A DI)E N D � TO MEDICAL DUKE -, TOR. AGREEMENT '11his First Addendum to 4Tedical Director A� r t~ er exit is nwaide and d�� �} -► critc.re�I trztt thr.� _ - (� ,�ctobcr .r020, by and 1)1 €t ecn i# �' i #3ixe t i+ :L.i.tt 7, ``� a t T , t ���. ►T•tiiy a 1. 3 SC.�a• Li ��� L�4�3Gi i • _ c )0T,1fio1i. I�erc:}r?�iter called �zc� :. � �o � �' zlta e . and =� I anabc�. M.D. a Florida kcinsed � a• � �� - fz� tiici � ���t called I' ed#cal r c t�. ht�rL `iftLr ...31, c :tc [ tTt}E!� tyi �: �Gi,lrrs and rs�tc'!n r , 0�A.t3�I k cxcuxed a .1te • a tre°�n]ell off rt[bLZ.��� e#tctt�t October 6. 21 io Provide rraC-diGa-] d3zccior �s�c�rr�-'iLe{csfor t}lo Villa'Oe's iirt zestte departl2leliL ;.q :.ecraired by S4c. 40I. 16antl �_ �~����•ic�ca .�� w- WHEREAS. ti C 200"' Medical Director Agrce-meilt provides for autoinatic aw-jua! Cllekvais, -uid the ParL'-s have allowed suel7 cjIjiltjal i'cI�C'wals to occur and di~sircto c();jtt.juc jo ►-rxLrcl�e win ual ren,--- als can a going forward basis with tine w)?e)2 y . • t ,. dr�_cn fi A<1de.-tdim-, to Medical Director A.recilicn t. Cart tl3�t��.f� rt-� this �- z t'ti t NOANV, in consideration o.T fl3c n1licu.,11 c0%.'�I�ai��S ht'."taal� [.'i]T����[3i`d, ����'. �� iila;.:�} �uid 'lie h��odieal I)i.rc:etor a�•�e tcz eoz3ti��ut �� er��tiz3=� �, wider tfie *� 0-% Mediea f N reel or Agreement t as c'. ??L' 3dt t hY tip.'s Firs- Alendzr3 1,0 Medreaf irc-�� t� • :., SECTION I.. RATI IC.-WrION Of 700�.-; 41,E f.�ICA L DfREnOCTOR : ; I ; . lFhe Nf edici'd Director AC"Yeement dated October , ?��� .s 3 liereb f' rzatifiebV ifie Village and the N/ledieaI Dirc.•i or. tail rights rCSp0 , i [ RN: � � w � L; ���•�r�:em�rzt ;►I��.I -- . �. � �ts. ,�-tti� �er�s ��� �l£e ���[� � :�feda�caI �]sr�`ctc�r � I r'er�aarrt in � �3f f I't�rce ��zzd el�f�;et cxce t a.� e:� t:Lstil �• �lddendurn tO Medical DirCCLO • �� Trees � P � � a��zt.nd�.d �; tf��s F�rs.r S" � ct31. A. The th'rd W HER ,.i\S c'1c111se is amended to refer to ■,(`h apter 64,1.. 1 of the Florida MalinistrCzti ve Code" and rel�refzcv to 110n,jer' ..�:liat7ter ������.. ,t 1-; r�C�� c'��� rcl 3� i� ti R 3 �' e � , � 1, ' - Is i���.etL�.. .. r :.rI C I .s amended to refer t�) thc, ",*DC ,-111'11C1,t o f` Health" t�'ft'ret�cc.• to #I1c' Ic�z`�i�Lr G.�} � .. Isz�d c..�t��i��z�z�t tit Healtll ar?d Reliabxfilatior) ��•r�'ice.�" is de[eted.■ `- Para,vr�.l)lt M oC p II is Dui-ten(led to rellei- ita all tF r�ale:� t�l` r -iatio1 - .tip' ,a S r } ��` g I� G )eP, ri�'71c111 o � �cal(V ti��z IlxtirC'Ct'�} LL� f��}i �J.��:• �.�LCri�;i�i �3 11��i�:l �� 3 �a7 '•r*' F•.} ri S r c es}r ■ deleted. "rbis paj'krapi� is also az��errled to refer t�� duties -� ]1�'}y •'j��-j �}}�•� 1'�'y •• •(-.j.+• r� a��rV�'.� R r•dd r � • ' � , ���LLi�7�iTLi�1,.L L11 ��vTVLio�� �l`�- ■.• to I • din Snistral ti' i► y�J� t��• �L�W w�'i aj y. 1 4 i� r S T ■ '1 rr ..Sc�:ti�ft� 64�:-?.C]04" is deleted. � o� =cs �n�t.z=e:'a.t��d ��� fr3rr:�c�r D. Para,(graph A ii W' i 's a:`lit t '? ■ k=�`Z �.��ttsr�.�enr to iize �}It'dicaf Nrec:Ior s eom 7ejjs�.:i it)z % ')ased or1 C.' P I. 1,11 is pani r ilp], is also imiended to cap ��,i- a.itor:zu;c �,� , � � :.., �K - ed ice.-11 D"r ecto r s Compensc1110n 'based oil (~1'i [o four percent (4%). :. dart Xis amended to pro �� ide that venue <�ia• any dxs��ote �•�,LL, o!ot l I s} C a)p, �• CIL-11Y.1pe-w-11."U isdiclion :11 N1,111-Be ac-h C`t3�z:7t�'. F0 lol't���i. Page 57-of 475 Agenda Item #3. F. An entirely new fart XIi is added as follows: XII. INSPEC O R GENERAL Pursuant to Article XIi of the Palni Beach County Charter, the Office of the Inspector (leneral leas ,jurisdiction to inNtesti ate munic i review � ,. � pal natters,c.ti r�e�r and audit rY�un�c.tpal c ontraus and other transactions, and niake reports and recommendations to nmunici al go erring bodies based on such audits, revici s r ins i r � . '. ' r •} o =est�gat�ons. �111 parties doing business with the VillaO::�c sball fully cooperatc with the inspector genertal in the exercise of the inspector generals Cunctions, authority, and pow=er. The inspector general has the power to take sworn stateineitts re p require re the production of records, and to audit, monitor. invCstigatc aI1d inspect the activitics cat' the villElge, as %yell as contractors and lobbyists of the Village in order to detect, deter, prevent. acid eradicate fraud, waslG. a�-�f Jsmankc;ement, misconduct, and abuses. IN WITNESS WHEREOF, the Tillage o[' Tequesta has caused this First Addendun3 to Medieal Director Agreement to be signed' and executed on its behalf by the: Mayor of 'I � uesta � q and duty attested by its Village Clerk, and Doi) Tanabe, M.D. has signed and executed this First Addendum to Medical Director Ac)reement in the; presence of a witness. the da and year first above written. Y 'pillage ue •filt Don TXonTan.. . i BY: bra;• it l3r � aii, It=Iitrnr ce, M. D. WITIN CSS: 13v:)Px- '` 1 eWil r TIC; �.�rl �� � c"�rl��. Village Clerk,.r��'''►i�ut►tu�fuisr�rrr'l�nr�r�������i w � SEALf ~ ' r oRAYE� =• INGoR�' •; %4�j C taF F�-�•��a ����►1i�Itl+lurl! t1ttlW►p►►� 1 Page 58 of 475 Agenda Item #3. Regular Council ti }^ STAFF MEMO f� - -------------- Meeting: Regular Council - Aug 11 2022 Staff Contact: Jeremy Allen, Village Manager Department: Manager Approval of contracts Signed by Manager Under $25,000 (Per Village ordinance we are presenting the following agreements, proposals, commitments and memorandum of understanding to Council.) A. Only Trees Estimate 1121-Public Works, $1,350.00. B. only Trees Estimate 11351-Public Works, $725.00. C. Medical Director Agreement, First Addendum Increase - Fire Dept., $1,395.31 Monthly Fee -MMARY, Approval of contracts Signed by Manager Under $25,000 (Per Village ordinance we are presentin 9 the follo wing agreements, proposals, commitments and memorandum of understanding to council.) A. only Trees Estimate 1121-Public Works, $1,350.00. B. only Trees Estimate 11361-Public Works, $725.00. C. Medical Director Agreement, First Addendum Increase - Fire Dept., $1,395.31 Monthly Fee This document and any attachments may be reproduced upon request in an alternative format by completing our Accessibility Feedback Form sending an e-mail to the Villacie Clerk or calling 557-758-0443. PROJECT NAME: BUDGET: NIA ENCUMBERED: NIA Proposed: Projected Remaining: 3 Items, each with individual costs Nla ILL, lwgl� -1 P This agenda item is respectfully submitted for your review and approval. '_ATTACHM Only Trees Estimate. 1.1221-Public Works Only Trees Estimate 11361-Public Works Medical Director A reement First Addedum Increase 22-23- Fire De t Page 59 of 475 Agenda Item #3. Village of Tequesta Department of Fire -Rescue Services °r rso 357 Tequesta Drive 561-768-0500 Tequesta, FL 33469 www.tequesta.org James Trube, Fire Chief To: Jeremy Allen, Village Manager From: James Trube, Fire Chief Date: July 22, 2022 Re: Increase for FY 22/23 Medical Director Fees based on CPI May 2022 This Medical Director Agreement between the Village of Tequesta and Don Tanabe, M.D. authorizes Dr. Don Tanabe to take on the duties and responsibilities of the Medical Director for the Village of Tequesta Emergency Medical Service System. Pursuant to the First Addendum to the Medical Director Agreement Section 2 D,The original Agreement Paragraph A Il OF Part III was amended to eliminate any automatic downward adjustment to the medical director's compensation based CPI. This paragraph was also amended to cap any automatic upward adjustment to the medical director's compensation based on CPI to four percent (4%). Attached is a copy of the First Addendum to the Medical Director Agreement and the May 2022 Bureau of Labor Statistics Consumer Price Index, South Region. The increase to the FY 22/23 Medical Director Fee is capped at 4% based on the CPI; Increasing the monthly fee from $1,341.64 to $1,395.31 beginning October 2022. Vice -Mayor Kyle Stone Mayor Molly Young Council Member Frank D'Arnbra III Council Member Laurie Brandon Council Member Aaron Johnson Village Manager Jeremy Allen Page 60 of 475 Agenda Item #3. 7/20/22, 11.12 AM Consumer Prioe Index, South Region -- June 2022 : Southeast Information office : U.S. Bureau of Labor Statistics Month 1-month 2 18i2-month '[-month '19tZ-month 11-month 202012-month 'Month 202112-month 1-month 202212-fnonth i January _ 1-mont!Q-51 12-montH.3> '1-montle.2j - 12-rnontli.21 1-mom .3' t!Q "12 3= �montl�- 1-mont lQ.5 12 -�montig.0 1-�rnontlQ.91 12-mnth7.$ i1 February 0.8 2.11 0.51 1.11 0.2 1.9 0.51 2.0 1.1 8.4 March 0.2 2.3 0.7 1.0 = -0.1= 1.1 ~ 0.8 2.9 1 A € 9.1 April 0.4' 2.4 4.5 1.8f -0.8 -0.2 0.7 4.4 0.5= 8.8 { may 0.3?" 2.711 -0.1 1.4� -0.2i.. -4.4` 0.8 5.6 � 1.21 9.21 June 0.2 2.7 -0.1 i 1.1 0.6 0.3 ° 0.9= 5.8 i • i j 'August -0.1; 2.4i -0.1 � 14; 0.4 p 1.1 i 0.3 5.6 YSeptember 0.01 1.7-' 0.01 1.3 0.2 1.3 0.3 5.81 - j October 0.2 2.1; 0.21 = 1.31 0.1; 1.3` 1.0` 6.8i November -0.3€ 1.9€ _-- 0.4 1.0 -0.1' 1.2 GA 7.2 December _ �_ -0.51 1.5 ..« 0.0 -.�.n._.ti�+ 2.1' 0.2 1.4= 0.31 7.4 The Consumer Vdce Index for Nly 2022 is scheduled to be released on Wednesday, August 10, 2022, at 8:30 a.m. (LT). Technical Tote The Consumer Price Index (CPI) is a measure of the average change in prices over time in a fixed market basket of goods and services. The Bureau of labor Statistics publishes CPIs for two population groups: (1) a CPI for All Urban Consumers (CPI-U) which covers approximately 93 percent of the total U.S. population and (2) a CP1 for Urban Wage Earners and Cierical Workers (CPI W) which covers approximately 29 percent of the total U.S. population. The CPI-U includes, in addition to wage earners and clerical workers, groups such as professional.. managerial, and technical workers, the self-employed, short-term workers, the unemployed, and retirees and others not in the labor force. The CP1 is based on prices of food, clothing, shelter, and fuels, transportation fares, charges for doctors' and dentists` services, drugs, and the other goods and services that people buy for day-to-day living, Each month, prizes are collected in 75 urban areas across the country from about 5,000 housing units and approximately 22,OW retail establishrnents-department stores, supermarkets, hospitals, filling stations, and other types of stores and service establishments. All taxes directly associated with the purchase and use of items are included in the index. The index measures price changes from a designated reference date; for most of the CPI-U the reference base is 1982-84 equals 100. An increase of 7 percent from the reference base, for example, is shown as 107.000, Alternatively, that relationship can also be expressed as the price of a base period market basket of goods and services rising from $100 to $107 For further details see the CP1 home page on the Internet at www. l ov&p and the CPI section of the SLS Handbook of Methods available on the interact at 3yww.b1s.gqyNRub/horn&W. In calculating the index, price changes for the various items in each location are averaged together with weights that represent their importance in the spending of the appropriate population group. Local data are then combined to obtain a U.S. city average. Because the sample size of a local area is smaller, the local area index is subject to substantially more sampling and other measurement error than the national index. In addition, local indexes are not adjusted for seasonal Influences. As a result, local area indexes show greater volatility than the national index, although their long-term trends are quite similar. NOTE: Area indexes do not measure differences in the level of prices between cities; they only measure the average change in prices for each area since the base period. The South region is comprised of Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. Information in this release will be made available to sensory impaired individuals upon request. Voice phone: (202) 591-5200; Telecommunications Relay Service: 7-1-1. Table 1. Consumer Price Index for All Urban Consumers (CPI-V): Indexes and percent changes for selected periods South (198244=100 unless otherwise noted) Indexes Percent change from. Item and Group ..�..._ AprsMay_ _•-_..._i• -- - -Jun._._._.._ _ Jun, ~_rApt'. �.. May 2022 2022 2022 2021 2022 2022 Expenditure category All [terns_29.879; - - -^- 283.307 . - 287,427 9.8-2.7� Footnotes (1) Indexes on a December 1982=100 base. (2) indexes on a December 1997=100 base. (3) Special index based on a substantially smaller sample. (4) Indexes on a December 1993=100 base. (5) Indexes on a December 1977=100 base. i - Data not available. Regions defined as the four Census regions. South includes Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and Test Virginia. f NOTE: index applies to a month as a whole, not to any specific date. Data not seasonally adjusted. fi< hops:J/www.bls.goviregions/southeast/news-release/oonsumerpriceindex south.htm Page 61 ot/475 Agenda Item #3. 7120/22, 11:12 AM Consumer Price Index, South Region - June 2022 : Southeast Information Office : U.S. Bureau of Labor Statistics Indexes Percent change from - Item and Group Apr, _ . - May [.. .tun.._.._! ..�.Jun. Apr. May 2022 2022 { 2022 2021 2022 2022 ' All Items (December'1977=10fl) 454.002 459.563s 466.247 Food and beverages 291.755 294.391 i 297.3751 9.81.9 1 A' _ Food _ - ; 294.609 297.4751 300. 550 _`-_.�..._.._..-___._.. 10.32.01 1.0 Food at home 278.880 282.376i 285.549€ 11.9= 2.41 1.1' Cereal and bakery - -- ry p 323.203 326.610 t 336.070' 14.0 4.0 2.9' Meats, poultry, fish, and eggs 302.814 305.3381� 306.944 10.8 1.41 Dal Dairyand related P products = 260.215 258.374E 262.159 ......... 14.7' 4.81 1.5 ! F Fruits and vegetables i 319.719 322.997 321.255 6.7' 0.51 -0.5 Nonalcoholic beverages and beverage materials 192.198 194.077 196.9991112.5 Other food at home i ... 243.811 246.995 E 250.863; 2.51, 14.0! 2.9 1.5 1.6 Food await from hams -` ____..___....._.._.�____.____..�..__..__-__....._____.__..._,,...__._.;_ __....-• 319.932 321 619 �_. -324.482 �_���.� 1 ~ � - -_�.. 7.8= 1 4'u _.........�.._..-._...� Q 9: Alcoholic beverages Housing Shelter Rent of primary residence Owners" equiv. rent of residencesw Qwnars' equiv. rent of primary residence uy W Fuels and utilities.....___w.. _.�__-_.__..w...._._....._._.......�._.__ .-____..�..___._._ s Household energy Energy services r Electricity '.w....__._._.. Utility (piped) gas service Household furnishings and operations Apparel Transportation Private transportation New and used motor vehiciesq} r New vehicles New cars and trucksU(1 ��..�._...._...___......._...______.�_._. 252.096 251.5401 253.2591 3.3! 0.5 0.7i 272.278 274-741 277.887 8.1 2.1 1.1 s 312.81 3315.381 318.204 ":. _ 7.01 1.7 4 0.94 329.443 �r 332.5741 336.108 - - -7.91 2.0 1.1 313,676 315.9811 319.065 6.6! - 1.7 1.0 i 313.672 315.9791 319.060' 6.5 ..w......_. 271-5511 277.092; 287.245"--- 14.6 220.979 226.873 237.629 18.4 220.033 225.7701 236.794 18.0 213.188 218.352; 227.8421 15.7 = 247-3821 256.4071 276.584 32.8 141.850 --__ 142.272 142.514 8.61; 136.131 136.625j 135.275 5.01 269.144, 277.639" 287.73W 21.1= 270.803 278.511: 289.154' 21 Al 1.7e 1.a _..._5.8 3.7 7.51 4.7 7.61 4.9; 6.91 4.3 11.8 7.9 0.51 0.2€ a -0.61 .0.3 3.6 6.81 3.8 130.594 131.942E 133.980 10.2; 2.53 1.5 177.369 �....-- 1 79.19.1 180.641 ^..�M..12.6 1 8� .�.�.�. 0.8 _ 1 i Now cars ] 176.819 .._.....�. Used carp and trucks�"-----^208.048 Motor fuel 344.680 Gasvllne (all types} 341.836 w Unleaded regularW 335.176 Unleaded tnidgradeC3j(0 Y i 375.678 ._..�..w�..�.�--- Unleaded premium{---..__.._..___-_._�...._....___._..._.._..__-••_._----_-.�__._.-- -� mow_ 360.554 178.6261 180.3131 14.0 z 2.0 0.9 209.507s 214.3265 7.1.3.0 2.3 374.0691 409.815i63.1 18.9 9.6 370.9111 03' 62.71 19.1 9.7; 364,5151 400.378' 64.0 19.5 9.8 402.1831 439.9361 57.6' 17.11 9.4= 384.3321 418.341 53.2 11611 8.8 Medical care 513.192i 515.023' 519.243 4.7' 12� 0.8 Wdiral cam commodities 362.212 { 363.141 363.694 4.31. 0.41 0.2 Footnotes (1) Indexes on a December 1982=100 base. (2) Indexes on a December 1997=100 base. (3) Special index based on a substantially smaller sample. (4) Indexes on a December 1993=100 base. (5) Indexes on a December 1977=100 base. Data not available. Regions defined as the four Census regions_ South includes Alabama, Arkansas, Oelaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, 1 Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and Vilest Virginia. i NOTE: Index applies to a month as a whole, not to any specific date. Data not seasonally adjusted. httpsJlwww.bis.gov/regionslsmtheast/news-release/consumerpdcreindex south.htrn ^` � gage -62 o 75 Agenda Item #3. 7/20/22, 11:12 AM Consumer Price Index, South Region June 2022 ; Southeast Information office : U.S. Bureau of Labor Statistics Indexes Percent change from - Item and Group Apr, May Jun. Jun. 1 Apr. May 2022 s 2022 2022 2021 1 2022 2022 i ' Medical care services 564.288 566.4311 571.931 4.81 1 A 1.0 Professional services 387.911 388.455-1 393.152 2.4 1.4 1.2; Recreations 129.972 131.1691 131.375 5,7 1.1 0.2` I Education and communicativntay , 138.682 138.577i 138.753 1.f 0.1 0.1 Tuition, other school fees, and child care ' 1 4a2.439 7 403 1,407.J 1,41fi.9B3; I 1 3.31 1.0 . 0.7' Other goods and services 479.1481 482.67T, 483.8301 6.9= 1.0 0.2 Commodity and service group All Hems 279.879 283.307l 287A27Y 9.8 2.7 1.5 2-22.5421 227.101 14.1: 3.7 2.4 I Commodities 218.958 Commodities less food and beverages 183.461 187.161', 191.987 16.41 4.61 2.6 T �. ._._.-....W- ~ '. ' 249,3'l4i 259.597 25.1. 7.91 4.1 Nondurables less food and beverages S 240.485 g Nondurables less food, beverages, and apparel 302.518 316.367 332.379 30.3 9.91 5.1 Durables 131-578 132.1621 133.567 8.8 1.51 1.1 Services 340.604i 343.8211 _ 347.424i 7.1= 2.0 1.D;' Rent of shelters 321.843 324.5281 327.399" T.1 1.7 0.9' Transportation services 392.5651 401.388! 407.280' 9.7= 3.7 1.5 Other services µ - _ 371.9301 373.615: 373.837 3.91 0.5 0.1 Special aggregate indexes All Items less medical care 267.032 270.5261 274.626 10.4' 2.81 1.5 All items less food 277.339 280.8401 285.101 9.$' 2.8 '! .5 Alt items leas shelter 268.224 272.0081 276.6601 11.2' 3.1 1.7€ Commodities less food 185.776 189.4011 194.1831 I 16.D� 4.5 2.5 Nondurables Nondurables lass food --------_�� 2134.8fl3 240.799 270.748� 277.6321, 17.01 4.8 2.5= 3.9 1.2€ 249-096 258.890; 23.7 7.5 309.2581y 324,001 28.11 9.2�. 378.941 S: 383.686 7.1' 2.3 Nondurables less food and apparel` 296.675 Services less rent of shetterW 374.M Services less medical care services e 320,450 323.7261 327.152 7.4 2.11 1.1; Energy 273.1181 289.645! s 311.bzu s 41.8 U. 7.$ All items less energy 282.1741 284.307 t 286.659 7.21 1.G, 0.8 = All items teas food and energy Commodities less food and energy commodities 280.540! 167.418 282-5591 168.132; 379.519! 284.799 169.463 415.098 6.71 7.5 62.5 1.5 1.2 18.63 ^ _ 0.8 4.8 9.4' 0.8 Energy commodities 349.922 Services less energy services 363.395�r_..- _ 356.350 359.177 6.4` 1.6i Footnotes (1) Indexes on a December 1982=100 base. (2) Indexes on a December 1997=100 base. (3) Special index based on a substantially smaller sample. (4) Indexes on a December 1993=100 base. (5) Indexes on a December 1977=100 base. Data not available. Regions defined as the four Census regions. South includes Alabama, Arkansas, Delaware, Distdct of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. NOTE: Index applies to a month as a whole, not to any specific date. Data not seasonally adjusted. Last Modf lied Date: Wednesday, July 13, 2022 https:lMww.bis.govlregionslsoutheast!news-releaselconsumerpriceindex south.htm Page 63 of 44675 Agenda Item #3. 7120/22, 11:12 AM Consumer Price Index, South Region —June 2022 : Southeast Information Office: : U.S. Bureau of tabor Statistics U.S. BUREAU OF LABOR STATISTICS Southeast Information Office Suite 7T50 51 Forsyth St., S.W. Atlanta, GA 30303 Telephone:l-�404-893-4222_ w.�g rre9iC�S4.u. east $ion https:ltwww.bis.gov/regionslsoutheastlnews-releaselaansumerpdceindox south.htm Page 64 of 475 Agenda Item #3. -ofu-4 roier --Y af/ 7120/22, 11:12 AM Consumer Price Index, South Region -- June 2022 : Southeast Information Office: U.S. Bureau of Labor Statistics w U.S. BUREAU OF LABOR5TAT 1 r t Bureau of tabor Statistics ) Geographic information > Southeast > News Release Search Southeast-Regio, Southeast Information Office---- ------- d'A 4U-f.%r 'i-1. .. Consumer Price Index, South Region June 202 News Release information Prices in the South up 1.6 percent over the month and 9.8 percent over the past year 22-1501 ATE The Consumer Price Index for All Urban Consumers (CPI-U) for the South increased 1.5 percent in June, the U.S. Bureau of labor Wednesday, DIY 13` 2022 Statistics reported today. The energy index advanced 7.6 percent over the month, while the all items less food and energy index rose 0.8 pereent. The food index increased 1.0 percent in June. (Data in this report are not seasonally adjusted. Accordingly, Contacts month-w-month changes reflect the impact of seasonal influences.) Technical informatfon: (404) 893-4222 The ail items CPI-U for the South advanced 9.8 percent for the 12 months ending in June, after increasing 9.2-percent over the BL- lnfnAtlan1&@bls.Qo-V 12-month period ending in May. The index for all items less food and energy rose 5.7 percent over the past year, while the energy www.b(s. 09 V/fegiptis Southr&st index advanced 41.8 percent. The food index also increased over the past 12 months, up 10.3 percent, (See ghart 1 and tail.} Akdia Contact' (404) 893-4?20 Chart t. 0"r-fir pmamd change 1n CP1-U, south re0on, .Tuna 21DI9rJune .... w ....._..-_...__.._-- _-....._.._..._.......__.... ---. . 202 Related Links All tems CPchart Parka9e Peresnt change Al Jems less food and energy 11.E _,_ .___---._.._....._.-__ ee n TO 1 3.0 �.Q -__-�� -.sue M•_.�.,, .,,,,, �.._._..._ . __.- - .----... _..w.W ;,; _.__... , 8_0 Jun Sep Dec MW ,tun sop Dec Mar Jun Sep Dec Mor .tun 2019 20" 2021 2822 Scums: U.S. Bureau of LAw 5teiisfim- View Chart Data Fond The food index rose 1.0 percent in June, fed by a 1.1 percent increase in the food at home index. The food away from home index also increased in dune, up 0.9 percent. The food index jumped 10.3 percent for the 12 months ending in June, reflecting increases in the food at home (+11.9 percent) and food away from home (+7.8 percent) indexes. Enemy The energy index rose 7.6 percent in June, primarily reflecting a 9.7-percent increase in the gasoline index. The electricity index and the utility (piped) gas service index also increased in June, up 4.3 percent and 7.9 percent, respectively. The energy index advanced 41.8 percent for the 12 months ending in June, led by a 62.7-percent jump in the gasoline index. The electricity index rose 15.7 percent over the past year, while the utility (piped) gas service index increased 32.8 percent. All items less food and energy The index for all items toss food and energy rose 0.8 percent in June, reflecting increases across several indexes, most notable, shelter (+0.9 percent). The index for all Items less food and energy advanced 6.7 percent for the 12 months ending in June, led by a 7.0-percent increase in the shelter index. The new and used motor vehicles index rose 10.2 percent over the past 12 months, reflecting increases in the new vehicles (+12.6 percent) and used cars and trucks (+7.1 percent) indexes. Geographic divisions Additional price indexes are now available for the three divisions of the South. The all items CPI-U advanced 1.6 percent in the East South Central in June. The all items index in the South Atlantic and West South Central divisions increased 1A percent each over the past month. Over the year, the all items index advanced 10.6 percent in the West South Central division and 9.8 percent in the South Atlantic division. The all items index rose 8.4 percent in the East South Central division over the past 12 months. Table A. South region CPI-U 1-month and 12--month percent changes, all items index, not seasonally adjusted Month � 2018 2019 2020 2021 2022 - https://www.bls.gov/regions/southeasVnews-release/consumerpriceindex south.htrn 11 Page 65 of 4�5 Agenda Item #3. PUBLIC RECORDS. In accordance with Sec. 119.0701. Florida Statutes, CONTRACTOR must keep and maintain this Agreement and any other records associated therewith and that are associated with the performance of the work described in the Proposal or Bid. Upon request from the Village's custodian of public records, CONTRACTOR must provide the Village with copies of requested records, or allow such records to be inspected or copied, within a reasonable time in accordance with access and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR who fails to provide the public records to the Village, or fails to make them available for inspection or copying, within a reasonable time may be subject to attorney's fees and costs pursuant to Sec. 119.0701, Florida Statutes, and other penalties under Sec. 119.10, Florida Statutes. Further, CONTRACTOR shall ensure that any exempt or confidential records associated with this Agreement or associated with the performance of the work described in the Proposal or Bid are not disclosed except as authorized by law for the duration of the Agreement term, and following completion of the Agreement if the CONTRACTOR does not transfer the records to the Village. Finally, upon completion of the Agreement, CONTRACTOR shall transfer, at no cost to the Village, all public records in possession of the CONTRACTOR, or keep and maintain public records required by the Village. If the CONTRACTOR transfers all public records to the Village g upon completion of the Agreement, the CONTRACTOR shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. if the CONTRACTOR keeps and maintains public records upon completion of the Agreement, the CONTRACTOR shall meet all applicable requirements for retaining public records. Records that are stored electronically must be provided to the VILLAGE, upon request from the Village's custodian of public records, in a format that is compatible with the Village's information technology systems. IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, PLEASE CONTACT THE VILLAGE CLERK, RECORDS CUSTODIAN FOR THE VILLAGE, AT (561) 768-044018 OR AT Imcwilllams@tegu,esta.org, OR AT 345 TEQUIESTA DRIVE TE UESTA FLORID 334690 Pursuant to Article X11 of the Palm Beach County Charter, the office of the Inspector General has jurisdiction to investigate municipal matters, review and audit municipal contracts and other transactions, and make reports and recommendations to municipal governing bodies based on such audits, reviews, or investigations. All parties doing business with the Village shall fully cooperate with the inspector general in the exercise of the inspector general's functions, authority, and power. The inspector general has the power to take sworn statements, require q . the production of records, and to audit, monitor, investigate and inspect the activities of the Village, as well as contractors and lobbyists of the Village in order to detect, deter, prevent, and eradicate fraud, waste, mismanagement, misconduct, and abuses. Page 66 of 475 Agenda Item #3. "The Village of Tequesta strives to be an inclusive environment. As such, it is the Village's policy Y to comply with the requirements of Title 11 of the American with Disabilities Act of 1990 ("ADA"") by ensuring that the Contractor's [ agreement /bid documents and specifications ] are accessible to individuals With disabilities. To comply with the ADA, the Contractor shall provide a written statement indicating that all [ agreement /bid documents and specifications], from Contractor, including files, images, graphics, text, audio, video, and multimedia, shall be provided in a format that ultimately conforms to the Level AA Success Criteria and Conformance Requirements of the Web Content Accessibility Guidelines 2.0 (Dec. 11, 2008) ("WCAG 2.0 Level AN'), published by the World Wide Web Consortium ("W3U), Web Accessibility Initiative ("WAI"), available at www.w3.org/TRZWCAG/.."P Page 67 of 475 �J 0 _..ART,,KNT eALTH DlVISiON:::C]FAEDICAL QUAUTY ASSURANCE DATE 'LICENSE N.7 = CONTROL NO. 01/11/202 786441 THE -MEDICAL DOCTOR- ": QUALIFICATIONS): Dispensing Practitioner NAMEDBELOV HAS;MET ALL RE U° f.f ,.MT$;aF - _ •_ • AN.THE THE LAW • •D RULE$F S �X1E OF: FLORID Expiration Date: JANUARY 31`1 p24-.. DON TAT$UMI TAIVABF :.. -s.- 7 G97 W IN61ANTOWN RQ JUPITER, FL - 33458 Ron..DeSantls GOVERNOR Joseph A. Ladapo, MD, PhD State Surgeon Genera! DISPLAY l-F REQ-UIRED BY LAW EXPIRATION DATE: JANUARY 31, 2024 z :ob W 10 - „µ: vs: o -��..� LL `_-jzz LU Cy r aU Z. W. i u. 1 0 Z LL LUp 4 Your license number is ME 61426. Please use it in all correspondence with your board/council. Each licensee is solely responsible for noti in fY g the Department in writing of the licensee's current mailing address and practice location address. if you have not received your renewal notice 90 days prior to the expiration date shown on this license, please visit www. FLHealthSource.gov and click "Renew A License" to renew online. The Medical Quality Assurance online Services Portal gives you the ability to manage your license to perform address updates, name changes, request duplicate licenses and much more. Ifs simple. Log onto your MQA online Services account today at http://flhealthsource.gov/. Select the "Account Login" button to access your account. For changes to your name, address or to request duplicate licenses, choose your selection from the dropdown list under "Manage My License". Your profession will open for renewal 90 days prior to your expiration date. When the renewal cycle opens for your profession, the "Renew My License" header will automatically display on your license Dashboard. IMPQRTANT ANNOUNCEMENTS ARE YOU RENEWAL READY? The Department of Health will now review your continuing education records at the time of license renewal. To learn more, please. visit www.FLHeafthSource.gov/AYRR GROUNDS FOR DISCIPLINE You should be familiar with the Grounds for Discipline found in Section 456.072(1), Florida Statutes, and in the practice act for the profession in which you are licensed. Florida Statutes can be accessed at www. leg -state.fl.us/Statutes W Q co W W C0 6 Page 68 of 475 Agenda Item #3. DEA REGISTRATION NUMBER THIS REGISTRATION EXPIRES FEE PAID BT0488127 11-30-2024 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, 3N,4,5 PRACTITIONER 11-01-2021 TANABE, DON T MD 357 TEQUESTA DR TEQUESTA, FL 334693088 CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHI NGTON D.C. 20537 Sections 304 and 1008 (21 USC 824 and 958) of the Controlled Substances Act of 1970, as amended, provide that the Attorney General may revoke or suspend a registration to manufacture, distribute, dispense, import or export a controlled substance. THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID BT0488127 11-30-2024 $888 SCHEDULES BUSINESS ACTIVITY ISSUE DATE 2,2N,3, PRACTITIONER 11-01-2021 3N,4,5 r 0 TANABE, DON T MD CF)357 TEQUESTA DR %-.-, Sections 304 and 1008 (21 USC 824 and 958) of the co TEQUESTA, FL 334693088 Controlled Substances Act of 1970, as amended, provide that the Attorney General may revoke or suspend a registration to manufacture, distribute, ❑ dispense, import or export a controlled substance. E L I0 THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. Page 69 of 475 Agenda Item #3. Village 345 Tequesta Drive Tequesta, FL 33469 To: Jeremy Allen, Village Manager of T 561-768-0700 www.tequesta.org From: David Tinoco, Water Distribution and Stormwater Superintendent Date: October 27, 2022 Subject: Florida Coast Equipment Account Application The following Agenda Item references an Account Credit Application from Florida Coast Equipment. Florida Coast Equipment is an equipment dealer that provides equipment service and parts. Florida Coast Equipment is conveniently located in West Palm Beach and qualified to service the utilities department's New Holland Bush Hog and Kubota Mini Excavator. Florida Coast Equipment is located at 357 Pike Rd, West Palm Beach, FL 33411. Funding for Equipment Repair and Maintenance is budgeted and available in account 401-243-546.310 and 403-250-546.310 David Tinoco Superintendent Vice -Mayor Kyle Stone Mayor Molly Young Council Member Frank D'Ambra III Council Member Laurie Brandon Council Member Aaron Johnson Village Manager Jeremy Allen Page 70 of 475 � : � CREDIT ACCOUNT APPLICATION EQUIPMENT Page 1 of 3 Today's Date- 10/27/2022 Date Business Began: 1957 Company Name: Village of Tecluesta Bi I I ifl a Address: 136 Bridge Road City: Tecluesta State and Zip Code: FL733469 Shionin Address: 136 Bridge Road City: Tecluesta State and Zip Code: FL,33469 Phone: 561-768-0482 Email Address: jmccorkle@tequesta.org�.... FIN or S.S #: 59-6044081 Type: 9 Corp El Individual El Partnership OFFICERS AND CONTACT PERSONS Officer: Jeremy Allen Officer: Title: Village Manager Me: Address: 345 Tecluesta Drive Address- City/State/Zip: Tecluesta, FL 33469 City/State/Zip: Phone #: Phone #-. Social Secuft #: Social Security #: Name: Email: Tax Exempt #: ACCOUNTS PAYABLE INFORMATION Telephone: 561-768-0482 jmccorkle@tequesta.org Are Purchase Orders Required: 85-8015833079C-7 (Certificate Required) Janet McCorkle WEST PALM REACH NAPLES FT. PIERCE Mims 7 K- �k -561-209-2705 239-435-1667 772-461-1003 321-267-2023 Tcr q 357 PIKE ROAD 694 COMMERCIAL BLVD 6000 Orange Ave 3030 Cuyler St West Palm Beach, FL 33411 Naples, FL 34104 Ft. Pierce, FL 34947 Mims, FL 32754 Page 71 of 475 Agem TRADE REFERENCES Please complete all six references. For faster service, please provide an email address. Company Name: TD Bank Company Name: Advantage Bundling Address: 2130 Centre Park West Dr Address: 2228 Page Road Ste 103 City/State/Zip: West Palm Beach, FL 33409 Phone 561-838-2245 Email Address: Qom Name: Nozzle Nolen Address: 341 Old Dixie Hwy City/State/Zip. Tecluesta, FL 33469 Phone #. 561-746-3928 Email Address: Company Name: Publix Super Market Inc Address: P.O. Box 32009 City/State/Zip: Lakeland, FL 33802 Phone 877-333-7585 Email Address: Citylstate/Zip: --Durham, NC 27703 Phone #: 866-286-3546 Email Address: Company Name: Terracon Services, Inc. Address- P.O. Box 2766 City/State/Zip: Jupiter, FL 33468 Phone #: 561-743-1079 Email Address - Company Name: Address: City/State/Zip: Phone #: Email Address: I agree to payment terms of Net 30 Days from the invoice date. I understand that my account is subject to a 2% per month or annualized (24%) service fee for all invoices over 30 days. Accounts that reach 60 days will automaficalN by pkiwd on C.O.D. status. Submitted By Signature Phone # title Date J WEST PALM BEACH MAPLES Fr. PIERCE 561-2Dg-2705 239-435-1667 772-461-1003 321-267-2023 3030 Cuyler St SiAfICE'357 PIKE RCA D 694 COMMERCIAL BLVD 6000 Orange Ave West Palm Beach, FL 33411 Naples, FL 34104 Ft. Pierce, FL 34947 Mims, FL32754 .may [RT171Ea I I F�� ? Page 72 of 475 Ageni TERMS AND CONDITIONS 1. Authorization- The Applicant hereby authorizes Florida Coast Equipment (FCE) to obtain any information from any source, including any references provided by applicant. In the event the GTP allows the Applicant to make pur- chases on credit, the Applicant hereby agrees to pay all amounts billed on this account, including any delinquency fees that may apply in accordance with the Terms and Conditions of this agreement, If the Applicant falls to pay in accordance with the Terms and Conditions, the Applicant and any guarantors shall be liable for all applicable costs and fees, including any legal fees necessitated by collections or legal action to recover any past due or unpaid obligations. 2. Payment Terms- Credit accounts are due and payable thirty (30) days from purchase. Delinquency charges, which are your obligation, are assessed on all unpaid balances every (30) days, at the rate of 2% per month, annualized (24% APR). No discounts are allowed. 3. Credit Limits- Charge accounts are approved with credit limited in accordance with the n*sk of profile and pur- chase history of the customer. Credit limits may not be exceeded. In the event a purchase would cause a cus- tomer to exceed its credit limit, the customer will be required to make payment on the account or purchase the additional product by cash, credit card, or check. No further charges will be allowed until the balance is reduced accordingly. 4. Delinquency- FACE reserves the right to revoke credit terms at any tune and place any account on C.O.D. status. Delinquent accounts will be subject to collection and/or litigation, as applicable. At the discretion of PE, an ac- count may be restored upon full payment of amounts due, including applicable fees or late charges. Invoices for late charges are not sent separately. Late charges will appear on the monthly statement only. J­- NAPLES FT, PIERCE 239-435-1667 772-461-1003 694 COMMERCIAL BLVD 6000 Orange Ave Naples, FL 34104 R. Pierce, FL 34947 WEST PALM BEACH 561-209-2705 357 PIKE ROAD West Palm Beach, FL 33411 Mims 321-267-2023 3030 Guyler St Mims, FL 32754 Ell Page 73 of 475 Agenda Item #3. PUBLIC RECORDS. In accordance with Sec. 119.07011 Florida Statutes, CONTRACTOR must keep and maintain this Agreement and any other records associated therewith and that are associated with the performance of the work described in the Proposal or Bid. Upon request from the Village's custodian of public records,. CONTRACTOR must provide the Village with copies of requested records, or allow such records to be inspected or copied, within a reasonable time in accordance with access and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR who fails to provide the public records to the Village, or fails to make them available for inspection or copying, within a reasonable time may be subject to attorney's fees and costs pursuant to Sec. 119.0701, Florida Statutes, and other penalties under Sec. 119.10, Florida Statutes. Further, CONTRACTOR shall ensure that any exempt or confidential records associated with this Agreement or associated with the performance of the work described in the Proposal or Bid are not disclosed except as authorized by law for the duration of the Agreement term, and following completion of the Agreement if the CONTRACTOR does not transfer the records to the Village. Finally, upon completion of the Agreement, CONTRACTOR shall transfer, at no cost to the Village, all public records in possession of the CONTRACTOR, or keep and maintain public records required by the Village. If the CONTRACTOR transfers all public records to the Village upon completion of the Agreement, the CONTRACTOR shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the CONTRACTOR keeps and maintains public records upon completion of the Agreement, the CONTRACTOR shall meet all applicable requirements for retaining public records. Records that are stored electronically must be provided to the VILLAGE, upon request from the Village's custodian of public records, in a format that is compatible with the Village's information technology systems. IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, PLEASE CONTACT THE VILLAGE CLERK, RECORDS CUSTODIAN FOR THE VILLAGE, AT (561) 768-0440, OR AT Imcwilliams@tequesta.OR AT 345 TEQUESTA DRIVE, TEQUESTA, FLORIDA 33469. Pursuant to Article XII of the Palm Beach County Charter, the Office of the Inspector General has jurisdiction to investigate municipal matters, review and audit municipal contracts and other transactions, and make reports and recommendations to municipal governing bodies based on such audits, reviews, or investigations. All parties doing business with the Village shall fully cooperate with the inspector general in the exercise of the inspector general's functions, authority, and power. The inspector general has the power to take sworn statements, require the production of records, and to audit, monitor, investigate and inspect the activities of the Village, as well as contractors and lobbyists of the Village in order to detect, deter, prevent, and eradicate fraud, waste, mismanagement, misconduct, and abuses. Page 74 of 475 Agenda Item #3. "The Village of Tequesta strives to be an inclusive environment. As such, it is the Village's policy to comply with the requirements of Title II of the American with Disabilities Act of 1990 ("'ADA") by ensuring that the Contractor's [ agreement /bid documents and specifications ] are accessible to individuals with disabilities. To comply with the ADA, the Contractor shall provide a written statement indicating that all [ agreement /bid documents and specifications], from Contractor, including files, images, graphics, text, audio, video, and multimedia, shall be provided in a format that ultimately conforms to the Level AA Success Criteria and Conformance Requirements of the Web Content Accessibility Guidelines 2.0 (Dec. 11, 2008) ("WCAG 2.0 Level AA"), published by the World Wide Web Consortium ("WK"), Web Accessibility Initiative UWAI"), available at www.w3.org/TR/WCAG/." Page 75 of 475 Agenda Item #3. Village c>f Tequesta Department of Fire -Rescue Services �� or reQo 357 Tequesta Drive � � +561-768-0500 Tequesta, FL 33469 * t,;� * www.tequesta.org �r�8 ABSG4 James Trube, Fire Chief To: Jeremy Allen, Village Manager z From: James Trube, Fire Chief r Date: October 12, 2022 Re: Palm Beach County Certificate of Public Convenience &Necessity (COPCN) Renewal Please find the attached COPCN renewal application that will go into effect January 1, 2023. The certificate of Public convenience and Necessity (COPCN) is a License through the Pala Beach County, Department of Public Safety, Office of Emergency Management which allows the Village of Tequesta Fire Rescue to operate as an Advance Life support Transport Service. COPCN's are issued a term of six years. Vice -Mayor Kyle Stone Mayor Molly Young council Member Frank D'Ambra III Council Member Laurie Brandon council Member Aaron Johnson Village Manager Jeremy Allen Page 76 of 475 Agenda Item #3. PALM BEACH COUNTY � DEPARTMENT OF PUBLIC SAFETY ' o�OFFICE OF EMERGENCY MEDICAL SERVICES At t,� APPLICATION FOR PRIMARY ADVANCED LIFE SUPPORT (ALS) PROVIDER CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY COPCN COPCN's for Primary Providers are issued every six years for a six year term. Applications for COPCN's are accepted only during the time specified in the public notice. Section 1: (Check one) DK Application for renewal Primary Provider Certificate of Public Convenience and Necessity (COPCN) _Application f'or new Primary Provider Certificate of Public Convenience and Necessity (COPCN) The below named Agency is hereby applying for a Primary Provider Certificate of Public Convenience and Necessity for a term from 1/1/2023 to _12/31/2028_, with an ALS Endorsement and the following additional Endorsements (check all that apply): Advanced Life Support Transport Service Routinely Transports Basic Life Support Air Ambulance Services Section 2: AGENCY INFORMATION Name of Agency Village of Tequesta Fire Rescue Mailing address 357 Tequesta Drive, Tequesta, F1, 33469 Base station address 357 Tequesta Drive, Tequesta, FL 33469_ Phone # 561-768-0550 Agency is public sector _private sector Note: The name of the service that is placed on the "Name of Agency" line will be identical to the name listed on your COPCN. Chief s / Manager's / Owner's name James Trube, Fire Chief Medical Director's name Dr. Don Tanabe Medical Director's business address 357 Tequesta Drive, Tequesta, F1, 33469 Page 77 of 475 Agenda Item #3. Medical Director's Medical License# ME 61426 Section 3: ATTACHMENTS REQUIRED Exp. Date 1/31/2024 Applicants shall submit the application for COPCN as set forth in Chapter 13 I of the P p , Article II, Division Palm Beach County Code (EMS ordinance), and satisfyall requirements t re uq herezn.In addition, applicants shall also provide satisfactory completion of the following rng requirements. Please be sure to include with the application, as separately numbered att achments in a three (3) ring binder, the fallowing: I. Describe the need and area(s) for the proposed service to be covered by your agency. You must submit copies of any municipal resolutions contractual agreements, . � �} g ements, allowing y xyour agency to provide medical response services to an municipality or community. 2. Copy of current State Emergency Medical Services (EMS) license(s) and/or current COPCN, if any. 3. Copy of profile sheet(s) relating to current Florida State license(s), if any, or the equivalent information sheet listing all of the agency's vehicles. In order to maintain an acceptable level of service response time, all applicants must have a sufficient number of ALS vehicles available for response. This number will vary based on the area of assignment. In no event shall any COPCN holder have less than one ALS unit and one ALS vehicle fully staffed, operationally available, and in service at all times ready for simultaneous response to calls. The COPCN holder must also have one ALS spare unit fully equipped in the event that their primary ALS unit is not in service. It is the intent of this provision that each COPCN holder is responsible to have sufficient ALS units available as necessary to demonstrate ability to ensure continuity of operations and to provide mutual assistance as reasonably required upon request. 4. Provide a current personnel roster. Personnel must meet all requirements of certification and training referred to in 64J-1.020, Florida Administrative Code ("F.A.C.") and Section 401.2701, Florida Statutes.. The applicant must have at least one (1) supervisory or higher level employee who possesses a minimum of three (3) years of experience in pre -hospital ALS Services. 5. Liability Insurance: Insurance coverage is required for claims arising out of injury or death of persons and damage to the property of others resulting from any cause for which applicant's business or service would be liable. Non -government operated g p service vehicles shall be insured for the sum of at least $200,000.00 for injuries to or � death of any one person arising out of any one accident; the sum of at least $300 000.00 for injuries to or death of more than one person in any one accident; and for the sure of at least $50,000.00 for damage to property arising from an one accident. . Y Government operated service vehicles shall be insured for at least the limitation amounts set forth in Florida Statutes 768.28, as may be amended, for an and all claims or Y judgments. Compliance with these insurance requirements is required at all times while q operating under the COPCN. Evidence of compliance is required at the time of application pp flan and thereafter as requested by the Department of Public Safety,office of Emergency Medical Services. 2 1 75 Agenda Item #3. 6. Insurance verification. A copy of an insurance policy, a self-insurance or a policy, Certificate of Insurance is acceptable. Documentation must be current and include a schedule of vehicles covered, if the policy is not blanket coverage or self-insurance. Limits of liability, effective, and expiration date must be indicated on the proof of coverage. 7. The Medical Director must be a Florida licensed physician. Provide a co of full copy a y executed contract or agreement. Include copies of current DEA and Florida Physician's License. Must meet requirements of 64J--1.004, F.A.C. and Section 401.265 Florida Statutes. 8. A letter from your Medical Director stating your agency has adopted minimum standard, , pre -hospital treatment/transport protocols that, at a minimum, meet the requirements of all applicable laws and regulations. 9. A letter from your Medical Director stating your agency has adopted the countywide p yw approved Trauma Transport Protocols or more stringent standards as approved b the applicant's Medical Director. pp Y 10. Copy of proposed rate structure. 11. The financial information of the applicant to ensure financial ability to provide and continue to provide service to the area. Such financial information shall include copies of the applicant's past two (2) Medicare audits, if any. Government entities must provide the past three (3) years Comprehensive Annual Financial Reports via hard copy, or electronically. 12. Exceht pt for current COPCN Holders a summary history of applicant's emergency pp g Y services performance record, which provides roof that at p p the time of application, the applicant has demonstrated experience providing ALS or BLS services. Experience providing ALS or BLS services must include experience proving the full continuum of patient care from call initiation, during patient transport and through to final patient g transfer to hospital or other final destination. This is not a personal reference for the agency but how the agency had provided ALS or BLS services in the past. 13. Disclosure of litigation involving patient care, for the past six ears which resulted (6) Y in a Judgement, award, or finding in favor of a patient or the complaining art p g party, including case number, nature of the claim and allegations, and a copyjudgmentof final or award. The administrator may request additional information regarding e thlitigation. g 14. Proof of satisfactory completion of all federal, state, and/or local agency vehicle and g Y staff inspections for the last six (6) years including copies of all deficiency reports. p Current COPCN Holders need not provide vehicle and staff er ons ins ectiformed b p p Y the Palm Beach County office of EMS (except deficiencies ) re orts . p 15. Records substantiating the implementation of a formal quality assurancesystem consistent with Florida Statute Section 401.265 and Rule 64J-1.004(3)(b , Florida Administrative Code, as may be amended. 3 Agenda Item #3. 16. Records substantiating that applicant has an Emergency Medical Dis atchp (EMD) program or an agreement for appropriate EMI] service consistent with Section 768.13351, Florida Statutes, titled "The Emergency Medical Services Dispatch Act" as may be amended. 17. A memorandum of understanding for radio communications that is executed between the applicant and Palm Beach County. (Facilities Development and Operations Dept.) 18. The applicant must provide a certified letter from the CQPCN holder's Chief Executive Operating Office or Fire Chief that the applicant has met all applicable federal state and local requirements pertaining to the delivery of EMS. 19. A non-refundable application fee in the amount of five -hundred dollars ($500.00) GG made payable to: Palm Beach County Board of County Commissioners." 11 aae 75 Agenda Item #3. SECTION 4: AUTHORIZED SIGNATURE 1, the undersigned Agency Representative of the applicant Agency, do hereby at that said Agency meets all the requirements of the EMS Ordinance, as codified in Chapter 13, Article 11, Division 1, of the Palm Beach County Code, and any accompanying Rules and Regulations, as well as all the requirements for the operation of an emergency service as provided for in Chapter 401, Part 111, Florida Statutes, and Chapter 64J, Florida Administrative Code. I the undersigned Agency Representative of the applicant Agency, further attest that tl is Agency is in compliance with the State of Florida EMS Communications Plan. 1, the undersigned Agency Representative of the applicant Agency, acknowledge that any discrepancies discovered by the Palm Beach County Emergency Medical Services staff during the annual mandatory inspections may subject my Agency and its representatives to corrective action and possible penalty as provided for by Florida law and applicable Rule. Further, I understand that an annual vehicle inspection permit -fee of fifty dollars ($50.00) per -vehicle shall be paid for any EMS vehicle or ambulance utilized in Palm Beach County. 1, the undersigned Agency Representative of the applicant Agency, hereby submit this application on behalf of the applicant Agency, and hereby affirm that I am authorized to submit this application on behalf of the applicant Agency and that, to the best of my knowledge, all statements on this application and the included attachments in SLIPPOrt of the application are true and correct. J r ana �r Printed TypedName of Agency Reppre tative ILA Signature �.�lHla Date 5 Page&"o 475 Agenda Item #3. PUBLIC RECORDS. In accordance with Sec. 119.07011 Florida Statutes, CONTRACTOR must keep and maintain this Agreement and any other records associated therewith and that are associated with the performance of the work described in the Proposal or Bid. Upon request from the Village's custodian of public records,. CONTRACTOR must provide the Village with copies of requested records, or allow such records to be inspected or copied, within a reasonable time in accordance with access and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR who fails to provide the public records to the Village, or fails to make them available for inspection or copying, within a reasonable time may be subject to attorney's fees and costs pursuant to Sec. 119.0701, Florida Statutes, and other penalties under Sec. 119.10, Florida Statutes. Further, CONTRACTOR shall ensure that any exempt or confidential records associated with this Agreement or associated with the performance of the work described in the Proposal or Bid are not disclosed except as authorized by law for the duration of the Agreement term, and following completion of the Agreement if the CONTRACTOR does not transfer the records to the Village. Finally, upon completion of the Agreement, CONTRACTOR shall transfer, at no cost to the Village, all public records in possession of the CONTRACTOR, or keep and maintain public records required by the Village. If the CONTRACTOR transfers all public records to the Village upon completion of the Agreement, the CONTRACTOR shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the CONTRACTOR keeps and maintains public records upon completion of the Agreement, the CONTRACTOR shall meet all applicable requirements for retaining public records. Records that are stored electronically must be provided to the VILLAGE, upon request from the Village's custodian of public records, in a format that is compatible with the Village's information technology systems. IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, PLEASE CONTACT THE VILLAGE CLERK, RECORDS CUSTODIAN FOR THE VILLAGE, AT (561) 768-0440, OR AT Imcwilliams@tequesta.OR AT 345 TEQUESTA DRIVE, TEQUESTA, FLORIDA 33469. Pursuant to Article XII of the Palm Beach County Charter, the Office of the Inspector General has jurisdiction to investigate municipal matters, review and audit municipal contracts and other transactions, and make reports and recommendations to municipal governing bodies based on such audits, reviews, or investigations. All parties doing business with the Village shall fully cooperate with the inspector general in the exercise of the inspector general's functions, authority, and power. The inspector general has the power to take sworn statements, require the production of records, and to audit, monitor, investigate and inspect the activities of the Village, as well as contractors and lobbyists of the Village in order to detect, deter, prevent, and eradicate fraud, waste, mismanagement, misconduct, and abuses. Page 82 of 475 Agenda Item #3. "The Village of Tequesta strives to be an inclusive environment. As such, it is the Village's policy to comply with the requirements of Title II of the American with Disabilities Act of 1990 ("'ADA") by ensuring that the Contractor's [ agreement /bid documents and specifications ] are accessible to individuals with disabilities. To comply with the ADA, the Contractor shall provide a written statement indicating that all [ agreement /bid documents and specifications], from Contractor, including files, images, graphics, text, audio, video, and multimedia, shall be provided in a format that ultimately conforms to the Level AA Success Criteria and Conformance Requirements of the Web Content Accessibility Guidelines 2.0 (Dec. 11, 2008) ("WCAG 2.0 Level AA"), published by the World Wide Web Consortium ("WK"), Web Accessibility Initiative UWAI"), available at www.w3.org/TR/WCAG/." Page 83 of 475