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AMBULANCE SERVICE AGREEMENT
This AGREEMENT for AMBULANCE SERVICE is made and entered into by and
between the CITY OF OSHKOSH, a Wisconsin municipality with its principal offices
located at 215 Church Avenue, Oshkosh, Winnebago County, Wisconsin 54903-1130
("CITY"), and the TOWN OF ALGOMA, a political subdivision and body politic of the
State of Wisconsin, with its principal offices located at 15 N. Oakwood Road, Oshkosh,
Winnebago County, Wisconsin 54904, the TOWN OF BLACKWOLF, a political
subdivision and body politic of the State of Wisconsin, with its principal offices located at
380 E. Black Wolf Avenue, Oshkosh, Winnebago County, Wisconsin 54902, the TOWN
OF NEKIMI, a political subdivision and body politic of the State of Wisconsin, with its
principal offices located at 3790 Pickett Road, Van Dyne, Winnebago County,
Wisconsin 54979, the TOWN OF OMRO, a political subdivision and body politic of the
State of Wisconsin, with its principal offices located at 4205 Rivermoor Road, Omro,
Winnebago County, Wisconsin 54963, the CITY OF OMRO, a political subdivision and
body politic of the State of Wisconsin, with its principal offices located at 205 South
Webster, Omro, Winnebago County, Wisconsin 54963, the TOWN OF POYGAN, a
political subdivision and body politic of the State of Wisconsin, with its principal offices
located at 8693 Town Hall Road, Winneconne, Winnebago County, Wisconsin 54986,
the TOWN OF RUSHFORD, a political subdivision and body politic of the State of
Wisconsin, with its principal offices located at Eureka, Winnebago County, Wisconsin,
the TOWN OF UTICA, a political subdivision and body politic of the State of Wisconsin,
with its principal offices located at 1730 County Road FF, Oshkosh, Winnebago County,
Wisconsin 54904, the TOWN OF WINNECONNE, a political subdivision and body politic
of the State of Wisconsin, with its principal offices located at 6494 County Road M,
Winneconne, Winnebago County, Wisconsin 54986, and the VILLAGE OF
WINNECONNE, a political subdivision and body politic of the State of Wisconsin, with
its principal offices located at Winneconne Municipal Center, 30 S. First Street,
Winneconne, Winnebago County, Wisconsin 54986, (collectively referred to as
"SURROUNDING COMMUNITIES").
WHEREAS, SURROUNDING COMMUNITIES desire to provide emergency
medical services to their citizens, pursuant to Chapter 256, of the Wisconsin Statutes,
and Chapters DHS 110 of the Wisconsin Administrative Code, as amended from time to
time, as may be applicable herein, through contract with CITY; and
WHEREAS, CITY has indicated a desire and willingness to provide such services
to SURROUNDING COMMUNITIES.
NOW, THEREFORE, for and in consideration of the mutual agreements herein
contained and other good and valuable consideration, CITY and SURROUNDING
COMMUNITIES agree as follows:
RECEIVED
IAN232019
CITY �'
OFFICE 1
1. DESCRIPTION OF SERVICES: CITY shall provide emergency
ambulance service in SURROUNDING COMMUNITIES. For purposes of this
agreement, "emergency ambulance service" shall be defined as that ambulance service
which is necessary to respond to a condition that in the opinion of the person, his/her
family or whoever calls for and/or attends to the person, requires immediate medical
attention, but shall specifically exclude non-emergency transfer calls. All ambulances
shall be equipped to provide Advanced Life Support Services.
2. TERM: The term of this agreement shall commence at 12:00 a.m. on
January 1, 2019, and shall continue until 11:59 p.m. on December 31, 2021, unless
terminated as provided in this agreement.
3. EQUIPMENT AND STAFFING OF AMBULANCE: CITY shall be
responsible to obtain, house and maintain a sufficient number of fully equipped and
staffed ambulances to reasonably assure response for requests for emergency medical
services covered by this Agreement or to request mutual aid for response as required.
Responses to the SURROUNDING COMMUNITIES should occur within nineteen (19)
minutes not less than ninety percent (90%) of the time. For purposes of this
Agreement, a one-level system of emergency ambulance service, staffed by
paramedics as defined by Sec. 256.01 (14) Wis. Stats., shall apply.
4. PAYMENT AND BILLING: Ambulance Services. The CITY shall be solely
responsible for invoicing and collection of all fees for ambulance service pursuant to its
schedule of costs, including mileage.
Per Capita Fee Surrounding Communities: SURROUNDING COMMUNITIIES shall pay
the CITY, an annual per resident fee, based on populations indicated by the most recent
Wisconsin Department of Administration Municipality Population Estimate. The per
resident fee shall be calculated annually based on the net operating cost of ambulance
service, divided by the total population of the service area (City and Surrounding
Communities). Prior to each year of service, the CITY shall provide the
SURROUNDING COMMUNITIES with the estimated per resident fee to be charged for
the following year of service, based on the preliminary budget, by September 1st. This
fee shall be invoiced to the SURROUNDING COMMUNITIES by October 31st of each
service year and shall be paid on or before February 15th of the year following the year
of service. (e.g. Estimated per resident fee provided to surrounding communities by
September 1, 2018 for the 2019 year of service, invoice sent October 31, 2019, fee due
February 15, 2020.)
Upon reasonable request, or annually by September 1st of each year the CITY shall
submit incident response data to include but not limited to; response times, average
response times, and transport information to each of the SURROUNDING
COMMUNITIES.
5. LIABILITY AND HOLD HARMLESS: Subject to any limitations contained
in Secs. 893.80, 893.83, 345.05, and any similar statute, of the Wisconsin Statutes, the
City of Oshkosh agrees to hold each of the SURROUNDING COMMUNITIES, its
officers, officials, employees and agents harmless from any and all liability, including
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claims, demands, losses, costs, damages, and expenses of every kind and description
(including death), or damages to person or property arising out of the terms of this
Agreement where such liability is founded upon or grows out of the acts or omission of
any of the City's officers, employees or agents while acting within the scope of their
employment.
Subject to any limitations contained in Secs. 893.80, 893.83, 345.05, and any similar
statute, of the Wisconsin Statutes, each of the SURROUNDING COMMUNITIES agree
to hold the CITY OF OSHKOSH, its officers, officials, employees and agents harmless
from any and all liability, including claims, demands, losses, costs, damages, and
expenses of every kind and description (including death), or damages to person or
property arising out of the terms of this Agreement where such liability is founded upon
or grows out of the acts or omission of any of SURROUNDING COMMUNITIES'
officers, employees or agents while acting within the scope of their employment.
It is the intention of the parties to this Agreement that each party shall be solely
responsible for its own actions and activities and the actions and activities of its own
officers, employees and agents while acting within the scope of their employment.
Further, it is the intention of the parties to this Agreement that each party shall be
entitled to rely upon the municipal limitations and immunities available under Wisconsin
law, including but not limited to section 345.05, 893.80 and 893.83 of the Wisconsin
Statutes and that such damage limits, caps and immunities shall be used to govern all
disputes, contractual or otherwise, as they apply to the parties, their agents, officers and
employees.
6. SERVICES AND SUPPLIES: CITY shall provide services and supplies
for emergency use as hereinafter defined as necessary, and may establish a
reasonable charge to the ambulance user for providing such services and supplies. For
purposes of this agreement, supplies for emergency use shall be defined as those
medical supplies which are essential for the personnel who are staffing ambulances
used by Provider to provide adequate care for the critical emergency scene and during
transport to medical facilities, including, but not limited to the following: (a) Intravenous
infusions, (b) Drugs, (c) Heart Monitoring, (d) Oxygen, (e) Disposable blankets, (f)
Universal dressing, (g) Sterile gauze pads, (h) soft roller-type bandages, (f) adhesive
tape.
City shall replace those supplies used by first responders to treat patients. City shall
bill patients for such supplies.
7. RE-EVALUATION OF CONTRACT, TERMINATION: The parties
understand that this is a contract of definite term. It is understood that in the event of
non-renewal, the parties may need time to make alternative arrangements. The parties
shall evaluate the services provided under this Agreement during the month of
September of each year. Agreed-upon changes would commence on January 1 of the
following year. Any party (s) may terminate this agreement by written notice to all other
parties delivered by first class mail to the town and municipal clerks, postmarked no
later than October 1 of any year. Termination of this contract by any of the undersigned
parties, shall result in calculation of the per capita fee among the remaining parties in
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the agreement.
8. AMENDMENTS, FULL TEXT OF AGREEMENT: All agreements and
understandings have been embodied in this Agreement and no changes will be made
herein except in writing and duly signed by the authorized representatives of the
respective parties.
9. FIRST RESPONDER PROGRAM. The SURROUNDING COMMUNITIES
will maintain a first responder program to assist CITY response in the SURROUNDING
COMMUNITIES. The program will follow the State of Wisconsin emergency medical
service training guidelines, as may be amended from time to time, and shall include an
automatic defibrillator program.
10. NO THIRD PARTY BENEFICIARIES. This agreement is solely for the
benefit of the parties to this agreement, and it is not intended to benefit any third party.
11. ENTIRE AGREEMENT. This Agreement, constitutes the entire
agreement between the parties, and any other prior understandings or representations
made by any party shall not be binding on any other party unless incorporated within
this document or a written amendment thereto.
(Signature Pages to Follow)
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this day of I 0L,NIA,rtj , 2018(.
CITY OF OSHKOSH
Mark A. Rohloff, City Manager
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Pamela R. Ubrig, City CI rk
APPROVED AS TO FORM:
AAA • I A11-6/'\--
Ci torney
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IN WITNESS WHEREOF,the parties have executed this agreement as follows:
Dated this p Ilday of Kl.b ly ' , 2018.
TOWN OFALGOMA
�oel Rasmussen,Town Chairperson
1
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Deborah Stark,Town Clerk
APPROVED AS TO FORM:
Town Attorney
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this ly day of N(I>u1 , 2018.
TOWN OF BLACKWOLF
Er-aQ4.2,setto, To ' n Chai erson
san Snyder, o nXiffik___
APPROVED AS TO FORM:
tiednittri-
Town Attorney
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this day of , 2018.
TOWN OF BLACKWOLF
Frank Frass o, Town Chairperson
Kimberly /*ins, Town Clerk
APPROV P : ' • • =
Town Attorne\N
IN WITNESS WHEREOF, the parties have executed this agreement as follows:
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Dated this a I _day of NfDVenl , 2018.
TOWN OF NEKIMI
,}70,„
Glen Barthels, Town Chairperson
Julie Bartheks, Town Clerk
APPROVED AS TO FORM:
Town Attorney
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this 19 4h.day of a n , 2018.
TOWN OF OMRO
Brian Noe, Town Chairperson
�Bb&mot, Town Clerk
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APPROVED AS TO FORM:
T wn Aftbrney lea, , L . c_
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this 0U-day of , 2018.
CITY OF OMRO
Linda Kutchenriter, Administrator
le4e1--0—/
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City Clerk
APPROVED AS TO FORM:
City Attorney
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IN WITN588 WHER15,0r, the partios hove executed this ooreernent as folfa,,vs:
Dated this i(5.--day of ,/ 490-0-4 ,e4e-- .2018.
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TOWN OF MYOAN
e'7/44-71:4-1 4)-411
Math J. Jahr on, Town Chairperson
,(2•!..?,t.:. _Ii.;:: ,,,,' „,,,2---,
/4110 Romeo.Town Clerk
APPROVED AS TO FORM:
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TOVI1 Attorney
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this 714` day of /00,41 , 2018.
TOWN OF USHFORD
Thorn J, Egan, T Ch ' person
P ggy n ricks, Town Clerk
APPROVED AS TO FORM:
To n Attorney
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this 164 day of !Vy(,11/YWl 1r , 2018.
TOWN OF UTICA
Leonard Schmick, Town Chairperson
144,14/14ita-diA-e.A--
J ny Sonn eitner, Town Clerk
APPROVED AS TO FORM:
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To n Attorney
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IN WITNESS WHEREOF, the p dies have executed this agreement as follows:
5r1 Dated this � /day of o v<<M , , 2018,
TOWN OF WINNECONNE
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Thomas R Snider, Town Chairperson
/ /
onne Zabel,O' n Clerk
I
ARP ED AS TO •
Town Att
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IN WITNESS WHEREOF, the parties have executed this agreement as follows:
Dated this ►* day
of �vc.r1 G� , 2018.
VILLAGE 01= WINNECONNE
o Rogers, Village President
Jaiquiri •er, Village CI rk I
APPQV TO FORM:
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Village Att n y
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