Ambulance/EMT Event Request

Agreement Terms

THIS AGREEMENT, electronically signed and submitted on the above date and time, by and between the Concordville Fire & Protective Association (“Concordville”) and the Organization Name as stated above (“Service User”).

WHEREAS, Service User is requesting dedicated EMS Event Services; and WHEREAS, Concordville is willing to provide such services under the terms set forth herein.

NOW, THEREFORE, it is agreed as follows:

• Concordville agrees to provide dedicated EMS event service(s) to the Service User named above. Standby service, meaning an emergency vehicle staffed with personnel as agreed upon, will locate themselves at a function or event and will remain dedicated for the duration of the event. Such vehicle will be equipped to provide care at the capacity agreed upon as required by the service user.
• Concordville agrees to provide dedicated EMS event services to the Service User named above for the dates, times, and locations specified in the EMS Standby Information form attached to this agreement.
• In addition, if Service User agrees to the conditions of dedicated EMS event services, certain extreme, catastrophic, or immediate life-threatening emergencies may still require Concordville to utilize the vehicle assigned to the dedicated standby event. If this occurs during the EMS event (with this Agreement in place), and a lapse of on-site EMS coverage occurs, Concordville will be responsible for satisfying the agreed upon resource to minimize impact on the event.
• Dedicated EMS event crews will arrive at the location of the event no less than fifteen (15) minutes prior to the start of the event. Hourly charges for service begin at the time documented on the EMS Standby information form and terminates at the time of event conclusion, with a 2 hour minimum charge as outlined in this agreement. Concordville Fire & Protective Association reserves the right to waive fees for EMS event services if appropriate.
• EMS Event Services fees are as follows: (2 Hour Minimum for Each Type)

  a. Basic Life Support Ambulance (BLS Transport-Capable: $125/hour)
  b. Emergency Medical Technician (BLS Non-Transport-Capable: $75/hour)

• Upon completion of EMS Event Services, Concordville will bill Service User for costs associated with the Agreement and Service User agrees to pay all fees within 30 days of invoice receipt.
• Concordville reserves the right to refuse any EMS Event request submitted by the Service User less than thirty (30) days prior to event request.
• This agreement may be canceled by either party with twenty-four (24) hours of advanced notice without penalty.
• The Service User may cancel this agreement with four (4) hours of advanced notice for extraordinary circumstances, including, but not limited to: a weather event, natural disaster, etc. without penalty.
• Nothing herein shall be construed to create a higher standard of care on the part of EMS than generally recognized under the rules and regulations set forth by the Pennsylvania Department of Health Bureau of Emergency Medical Services. Concordville crews may only operate under the published and accepted protocols and procedures specifically approved by the Pennsylvania Department of Health Bureau of Emergency Medical Services and the Concordville EMS Medical Director.
• The charges associated with this agreement are reflective only of those associated with EMS Event Services. Any additional charges for care and transportation of patients will be the responsibility of the patient or responsible party.