HomeMy WebLinkAboutDunkerton Ambulance Service-2/24/2014Matt Schultz
Secretary of State
State of Iowa
28E
Agreement
FILED
M506896
3/3/2014 10:55:00 AM
PLEASE READ INSTRUCTIONS ON BACK BEFORE COMPLETING THIS FORM
Item 1. The full legal name, organization type and county of each participant to this agreement are:
*Enter "Other" if
not in Iowa
Item 2. The type of Public Service included in this agreement is: 210 Fire Response
(Enter only one Service Code and Description) Code Number Service Description
Item 3. The purpose of this agreement is: (please be specific)
Ambulance Response Agreement
Item 4. The duration of this agreement is: (check one) ❑Agreement Expires ®Indefinite Duration
[mm/dd/yyyy]
Item 5. Does this agreement amend or renew an existing agreement? (check one)
m NO
0 YES Filing # of the agreement:
(Use the filing number of the most recent version filed for this agreement)
The filing number of the agreement may be found by searching the 28E database at: www.sos.state.ia.us/28E.
Item 6. Attach two copies of the agreement to this form if not filing online.
Item 7. The primary contact for further information regarding this agreement is: (optional)
LAST Name Treloar FIRST Name Pat
Title Fire Chief Department Fire Chief
Email pat.treloarAwaterloo-ia.orq Phone 319-291-4460
Full Legal Name
Organization Type
*County
Party 1
Dunkerton, Iowa
City
Black Hawk
Party 2
Waterloo, Iowa
City
Black Hawk
Party 3
Party 4
Party 5
*Enter "Other" if
not in Iowa
Item 2. The type of Public Service included in this agreement is: 210 Fire Response
(Enter only one Service Code and Description) Code Number Service Description
Item 3. The purpose of this agreement is: (please be specific)
Ambulance Response Agreement
Item 4. The duration of this agreement is: (check one) ❑Agreement Expires ®Indefinite Duration
[mm/dd/yyyy]
Item 5. Does this agreement amend or renew an existing agreement? (check one)
m NO
0 YES Filing # of the agreement:
(Use the filing number of the most recent version filed for this agreement)
The filing number of the agreement may be found by searching the 28E database at: www.sos.state.ia.us/28E.
Item 6. Attach two copies of the agreement to this form if not filing online.
Item 7. The primary contact for further information regarding this agreement is: (optional)
LAST Name Treloar FIRST Name Pat
Title Fire Chief Department Fire Chief
Email pat.treloarAwaterloo-ia.orq Phone 319-291-4460
Mayor
BUCK
CLARK
COUNCIL
MEMBERS
DAVID
JONES
Ward 1
CAROLYN
COLE
Ward 2
HAROLD
GETTY
Ward 3
QUENTIN M.
HART
Ward 4
RON
WELPER
Ward 5
BOB
GREENWOOD
At -Large
STEVE
SCHMITT
At -Large
CITY OF WATERLOO, IOWA
WATERLOO FIRE RESCUE
425 East Third Street • Waterloo, IA 50703 • (319) 291-4459 Fax (319) 291-4279
Pat Treloar • Chief of Fire Services
AMBULANCE RESPONSE AGREEMENT
This Ambulance Response Agreement (the "Agreement") is entered into
fl
on 4�- ua , 2014, by and between Waterloo Fire Rescue, a
department of tie City of Waterloo, Iowa ("Responding Party") and Dunkerton
Ambulance Service, a department of the City of Dunkerton, Iowa ("Requesting
Party").
WHEREAS, Responding Party has the personnel, equipment, and
expertise in providing ambulance response for certain medical requests; and
WHEREAS, Requesting Party desires to use the ambulance services of
Responding Party since it does not have the personnel, equipment, or expertise of
Responding Party; and
WHEREAS, the parties are desirous of entering into an agreement for
Responding Party to provide ambulance response as requested and as Responding
Party is able depending on its own needs, among other factors.
NOW, THEREFORE, in consideration of the mutual covenants and
promises contained herein, and for other good and valuable consideration, the
receipt and sufficiency of which are acknowledged, the parties agree as follows:
Section 1. Authority to Request Assistance
The parties authorize their respective fire chiefs or, in the chiefs absence, any
authorized designee to request or provide ambulance aid from and to the other
party upon request. The parties do not create any separate legal or administrative
entity for purposes of this Agreement.
Section 2. Discretion to Respond; Failure to Reach the Place of Emergency
Notwithstanding anything to the contrary in this Agreement, Responding Party
retains sole discretion whether to respond to any request for assistance, based on
its own needs and other factors it considers relevant at the time, and Responding
Party will not be liable for any injury, death, damage or loss resulting from any
decision not to respond to a request for services. In the event of a response, there
shall be no liability whatsoever for Responding Party's failure to reach the place
of an emergency call whenever there are events beyond the control of the
Responding Party, which shall necessarily include but not be limited to weather
events or other emergency needs within the jurisdiction of the Responding Party
www.cedarnet.org/fire
CITY WEBSITE: www.cityofwaterlooiowa.com
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An Equal Opportunity/Affirmative Action Employer
which may impair or prevent a timely response. Responding Party shall not be liable to
Requesting Party for any damages or loss caused by or resulting from its inability or refusal to
provide a response, from the operation or failure to operate of its equipment, or from the acts or
omissions of its personnel.
Section 3. On -Scene Jurisdiction
The Responding Party's chief or his/her designee shall supervise its personnel, apparatus,
equipment, and material.
Section 4. Payment
The Requesting Party agrees to pay the Responding Party three hundred dollars ($300.00) for
each response. Requesting Party agrees to remit payment in full within 30 days of invoicing.
Response charges may be modified from time to time by written notice from Responding Party
to the Requesting Party given as set forth herein.
Section 5. Term of Agreement; Renewal
The term of this Agreement shall be for one (1) year from the date of the execution hereof, and it
may be renewed automatically for successive one-year terms with the same provisions, unless
either party notifies the other in writing at least sixty days (60) prior to the expiration of the
current term of its intention to modify, amend, or terminate this Agreement.
Section 6. Termination
Notwithstanding anything to the contrary in Section 5, either party may terminate this Agreement
at any time and for any reason by providing at least sixty (60) days' advance written notice to the
other party in care of the person to whom the notice must be given as set forth herein.
Section 7. Notices
All notices required by this Agreement shall be sent by U.S. certified mail, return receipt
requested, as follows:
Responding Party Requesting Party
Waterloo Fire Rescue
425 E. Third Street
Waterloo, IA 50703
Attn: Fire Chief
Dunkerton Ambulance Service
P.O. Box 100
Dunkerton, IA 50626
Attn: Ambulance Chief
Notice is deemed delivered two (2) business days after mailing. A party may change its address
for giving of notice in the manner prescribed by this section.
Section 8. General Terms
This Agreement is the entire agreement of the parties with respect to the subject matter hereof. It
may not be modified or amended except by a written instrument signed by both parties. This
Agreement may be executed in any number of counterparts, each of which shall be deemed an
original.
IN WITNESS WHEREOF, the parties have executed this Ambulance Response Agreement by
their duly authorized representatives.
Responding P • y: CITY OF WA 1BRLOO, IOWA
By:
Mayor
Requesting Party: CITY OF DLTNKERTON, IOWA
By:
Mayor
3
Date:
Date:
Date:
Date: �� I /