HomeMy WebLinkAboutContract 24507 CITY SECRETARY,
CONTRACT NO.
RESTATED EMS WTERLOCAL COOPERATIVE AGREEMENT
WHEREAS,the State of Texas, in the Interlocal Cooperation Act, has provided in Chapter
791,Texas Government Code, et seq.,that this City(hereinafter called"this Jurisdiction)' may jointly
.exercise with other local governments the power to provide governmental services for the public
health and welfare, and such services include ambulance services; and
WHEREAS, it is in the best interests of the public health and welfare of the people of this
Jurisdiction to have available to them a state-of-the-art, high performance, high quality, pre-hospital
emergency medical system, with stringent medical controls and accountability, and adequate response
times; and
WHEREAS, due to the relatively low population and low population density of some portions
of the geographic area in Tarrant County, Texas, and the extremely high, start-up and fixed operating
costs of a state-of-the-art emergency medical system, it is necessary to award a single provider the
right to engage in ambulance operations within this Jurisdiction, in order to maximize economies of
scale for providing such emergency medical services.
THEREFORE, be it resolved that this Jurisdiction, which has joined with all other
jurisdictions which have adopted this Restated Interlocal Cooperative Agreement (the" Agreement"),
agrees as follows:
1. In 1988, an administrative agency was created, pursuant to Sec. 791.013 of the
Interlocal Cooperation Act, called the Area Metropolitan Ambulance Authority, (hereinafter
called the"Authority"). The Authority has all of the powers and duties set'forth and described
in Paragraph 8, below. This Jurisdiction has elected to become a member of the Authority,
by the adoption of this Restated Agreement, and by the adoption concurrently of the Uniform
EMS Ordinance(Exhibit A), and by the selection of a price/subsidy option from the Uniform
Schedules of Price/Subsidy Options. (Exhibits B and Q.
2. The Authority's term of existence and provisions for withdrawal from membership in
the Authority shall be as follows:
(a) The existence of the Authority is perpetual. This Jurisdiction may not
withdraw until July 31, 2004. Thereafter, this Jurisdiction may withdraw on the
termination date of the competitively awarded contracts for ambulance services with
the contractor, and the expiration dates of all options for extension thereof. This
Jurisdiction's right to withdraws occur on the last day of each contract, or the last
date of any option for extension thereof Notice of such intention to withdraw shall
be given in writing to the Authority, and to each member jurisdiction thereof not less
than twelve(12) months before the proposed effective date of withdrawal.
804249,v2
r
'k F,
(Interlocal Cooperative Agreement,cont.
3. The Authority's Board of Directors shall be composed of no more than nine members,
constituted when possible as follows:
(a) Members who are knowledgeable or have experience in one or more of the
following areas: health care, finance or accounting,business administration or law and
who have resided for at least three years in a jurisdiction which is a member of the
Authority.
(b) The Medical Director of the Emergency Physicians Advisory Board, who shall
serve ex officio, but with voting rights.
(c) The terms of office of all members of the Board of Directors shall be for a
period of three years. No member of the Board shall be appointed for more than two
consecutive terms in office.
(d) No member of the Board of Directors shall have any interest, financial or
otherwise, either directly or indirectly in any firm or organization which is a bidder for
the competitively awarded contract, or in any firm or organization which contracts to
provide ambulance service or other goods and service to the Authority;
(e) The membership of the Board shall be chosen as forth below in Paragraph 13._
(f) Any member of the Board who fails to attend any three (3) consecutive,,
regularly scheduled Board meetings or who fails to attend at least six (6) regularly
scheduled meetings in any twelve (12) month period, without a reasonable and valid
reason for such absence may be removed from the Board, and his position filled as
provided in Paragraph 11, below. Removal of a member pursuant to this provision
must be approved by a majority of the members of the board, excluding the member
in question.
4. Requirements for membership in the Authority shall be as follows:
(a) Membership shall be open, on an annual basis, to any city which is in Tarrant
County, Texas or to•any jurisdiction which is contiguous to the geographic area
served by the Authority, if such city is not located in Tarrant County, Texas, subject
to approval by the Authority. Rural Fire Prevention District Number One of Tarrant
County ("Tarrant County Fire District") may become a member by adopting and
executing this Agreement and selecting a price/subsidy option from the Uniform
Schedules of Price/Subsidy Options.
604249.Y2 2
antedoed Cooperative Agreement,cont...
(b) Any jurisdiction which becomes a member after June 15, 1999 shall be
required to pay a one-time initial capital assessment which is equal to that
jurisdiction's per-capita share of the net worth of the Authority, as calculated in
Paragraph 10(b),below. Such payment of the pro-rata share of the net worth may be
paid:
(1) By a one-time payment at time of joining; or
(2) In monthly payments over a two-year period which payments shall
also carry interest at the statutory rate for judgments, pursuant to
Texas law.
5. This Jurisdiction accepts no financial responsibility or commitment for its membership
in the Authority except for costs of furnishing a mechanism for transferring 911 callers
requesting medical assistance from the Jurisdiction's 911 center to Authority's designated
EMS control center, and that referred to in Paragraph 11 (b), below. The sole requirements
for membership in the Authority are:
(a) Except for the Tarrant County Fire District, this Jurisdiction agrees to adopt
and enforce the Uniform EMS ordinance, which is attached hereto, and incorporated
by reference herein(Exhibit A);
(b) This Jurisdiction agrees to establish and participate in the Authority's first
responder program, as provided for by the Uniform Ordinance which program shall
be regulated by EPAB, and to fund first responder operations within this Jurisdiction;
provided, however, that the Authority's ambulance service contractor shall provide
initial and continuing first responder training without charge to this Jurisdiction.
However, the contractor will not be required to provide initial EMT and paramedic
certification or training. Provided further that, at this Jurisdiction's option, required
first responder medical and communications equipment may be financed and
purchased by the Authority and paid for by way of an increase in the subsidy or price
level applicable in this Jurisdiction.
(c) Approval and adoption of one of the Uniform Schedules of Price/Subsidy
Options. Provided that if the Emergency Physicians Advisory Board certifies a
jurisdiction as advanced life support first responder such jurisdiction may choose
either Exluibit B or C; however, those jurisdictions certified as basic life support first
responder shall use Exhibit C (Exhibits B and C),
(d) Selection by this Jurisdiction of one option from the Uniform Schedules of
Price/Subsidy Options(Exhibits B and C);
$04249.vZ 3
(Intalocal Cooperative Agreement,cont....)
(e) Thereafter, this Jurisdiction agrees that, no later than July 31 of each year, it
will annually select, approve and adopt from the Authority's annually revised Uniform
Schedules of Price/Subsidy Options a price/subsidy formula to be effective in this
Jurisdiction. Prices selected on July 31 shall then become effective on the following
January 1, and the selected subsidy level shall become effective on the following
August 1.
(f) Until such time as the Authority has accumulated a prudent net worth as
defined in Paragraph, 10(b),below,the annual level of subsidy shall not be decreased
by more than 10%during any single year. Such subsidy contributions shall be made,
quarterly, in advance, to the Authority beginning with the quarter starting August 1,
1999. For purposes of this provision, subsidies paid for first responder services shall
not be counted as subsidy.
(g) If the subsidy/price structure effective in any member jurisdiction during fiscal
year 1997- 1998 was in excess of an applicable combination shown on the Uniform
Schedules ofPrice/Subsidy Options, that jurisdiction may upon becoming a member
of the Authority reduce its initial subsidy/price balance to any levels shown on the
Uniform Schedules. Thereafter, the restriction on rate of subsidy reduction specified
in Paragraph(f), immediately above, shall apply.
(h) Should any member jurisdiction fail to maintain substantial compliance with
any membership requirement specified herein, the Authority's Board of Directors
may, at its option and after written notice to that jurisdiction and reasonable
opportunity to correct the deficiency, disqualify that jurisdiction, from membership
in the Authority and revoke its membership status. In such event, the removed
jurisdiction shall not be eligible for distribution of any share of the Authority's then-
current net worth.
6. The Authority shall have all of the powers allowed or provided by Chapter 791 of the
Texas Government Code, the"Interlocal Cooperation Act."
7. The Authority shall not itself operate the ambulance service, except in the event of
default by the Authority's competitively selected provider("Contractor"). In the event of such
a default by the Contractor,the Authority may operate the ambulance system for a period not
to exceed 18 months, during which time the Authority shall again conduct a competitive
Request for Proposal process for the award of a contract to another provider.
8. The business structure of the emergency medical system to be created by this
Agreement, shall be what is known as the"Public Utility Model," although it is recognized
c .
4
(Interlocal Cooperative Agreement,cont....
that, at some point in time, a modification of this system to a"Fail Safe Franchise Model" may
occur.
9. The Authority shall have the following additional duties and powers:
(a) To set response time standards for all areas of each member jurisdiction, and
to enforce compliance therewith through contractually imposed financial penalties.
(b) To provide each member jurisdiction with advanced life support ambulance
service, such service to comply with all applicable state laws and rules, as well as all
rules, regulations, and clinical standards as the Emergency Physicians Advisory Board
may from time to time promulgate.
(c) To provide such ambulance service by the competitive award of a contract by
way of a Request for Proposal process. Such competitive Request for Proposals shall
be conducted for the selection of a Contractor no less frequently than every 11 years.
The contract awarded to the contractor shall require the contractor to provide all
A'ambulance services in each member jurisdiction, except for those exempted in Section
6F of the Uniform EMS Ordinance(Exhibit A) adopted concurrently herewith.
(d) To prepare and distribute, not later than June 30 of each year to each member
jurisdiction a schedule of pricetsubsidy options, called the Uniform Schedules of
Price/Subsidy Options which shall range from zero-level subsidy with full cost user-
fees to zero-level user fees with full-cost annual per capita subsidies, and shall also
include a first responder system with either a basic fife support first responder option
or advanced fife support first responder option, as determined by each local
jurisdiction. Future Price/Subsidy Option Schedules shall be prepared in the same
general format as Exhibit B and C to this Agreement. Each member jurisdiction shall,
no later than July 31 of each year notify the Authority of that member's selection of
a price/subsidy formula from the Uniform Schedules of Price/Subsidy Options
received by the jurisdiction from the Authority. The Authority shall set the rate
schedule for each member jurisdiction according to that member's decision effective
the following October 1, and the newly selected level of subsidy shall be effective the
following October V- (These effective dates are offset by three months to allow
adequate time to compensate for the substantial fee-for-service collection lag which
prevails in the pr hospital care industry.)
(e) To bill patients,third-party payors or other responsible parties, and collect the
revenue from such bills, for all ambulance services provided,
$04249.V2
(Interlocal Cooperative Agreement,cont
(f) The Authority shall implement an ambulance service subscription program
unless otherwise prohibited by law. That program shall be a contract which allows a
resident, and members of the resident's household of any member jurisdiction to
annually purchase and prepay all uninsured portions of medically necessary ambulance
service.
(g) To engage in related services such as nurse or physician staffed critical
transports, wheel chair or ambulatory non-emergency transports, or a Demand
Management System, either directly or through the contractor, or through other sub-
contractors.
(h) To purchase, lease, acquire, accept, own or hold real or personal property, to
operate or maintain the same,to borrow or incur debt in its own name, to accept gifts,
grants or bequests, to insure itself and its members for any liabilities which might be
incurred through performance of this Agreement, to contract in its own name and to
sue or be sued in its own name.
10. To fund the Authority's required operations, and to insure use of sound business
controls and financial management practices in the Authority's day-to-day operations, the
following financial requirements shall be met and maintained.
(a) The Authority shall adopt sound business practices and accounting methods}
appropriate to a governmental Enterprise Fund operation.
(b) The Authority shall establish and maintain a prudent net worth, which shall
mean an amount of money not less than$5,000,000, or 50%of the Authority's annual
budget, whichever is greater. Net worth shall be defined as the fund equity of the
Authority. Each member jurisdiction's pro-rata share of the Net Worth shall be
calculated at least once every fiscal year. Each members' pro-rata share of the Net
Worth shall be based upon the population of each member city as reporter by the
United States Census Bureau, compared to the total population of all member
jurisdictions, as reported by the United States Census Bureau.
(c) - The Authority shall operate on a fiscal year, which, shall begin on October I
and end on September 30 of each year.
(d) The Authority shall use to be developed and implemented a long range
financial management plan designed to ensure long-range financial stability.
(e) Until such time as the Authority has established a prudent net worth, the
Authority's Uniform Schedules of PricelSubsidy Options shall automatically be
804249.v2 6
(Interloced Cooperative Agreement,cont
adjusted in conformance with the Medical Consumer Price Index for the most recent
twelve month period for which such data are then available, not to exceed a 12
percent increase in any single year. After that prudent net worth level has been
achieved, all future Uniform Schedules of Price/Subsidy Options shall be revised as
necessary to maintain, but not exceed, a prudent net worth as defined herein, not to
exceed a 12 percent increase in ambulance service fees in any single year.
(f) At such time as the Authority's prudent net worth level has been achieved,
member jurisdictions may apply population-based discounts as may then be available
as described in Exhibit D, "Memorandum of Understanding" hereof, in any of the
following ways:
(1) To reduce rates or subsidies in that jurisdiction; or,
(2) To reduce the subscription program fee charged in that jurisdiction,
or
(3) A combination of(1), or(2) above.
(g) The Authority shall make provision for an annual audit of the Authority by an
independent certified public accounting firm.
(h) Any decision by the Authority affecting the financial obligations, contingent
or other, of a member jurisdiction shall be subject to prior approval by the affected
member jurisdiction.
11. Subject to the provisions of Paragraph 2 above, this Jurisdiction may withdraw from
membership in the Authority. Should this Jurisdiction withdraw as a member, for any reason
except that listed below in, Subparagraph(c) of this Section, this Jurisdiction:
(a) Forfeits all rights,title, interest or claim to any asset, or combination of assets
of the Net Worth of the Authority;
(b) - Commits itself-to pay to the Authority any unamortized infrastructure costs
attributable to this Jurisdiction or unpaid costs of first responder equipment financed
by the Authority which are carried on the books of the Authority, and which were
originally approved by this Jurisdiction.
(c) In the event any member jurisdiction experiences repeated and chronic failure
of the Authority, or the Authority's Contractor, to comply with the response time
standards established for that member jurisdiction, and after written notice to the
804249.v2 7
(Interlocal Cooperative Agreement,coat
Authority and reasonable opportunity to correct such deficiencies, that member
jurisdiction may withdraw subject to the following terms:
(1) The member jurisdiction must give written notice to the Authority that
the member intends to invoke this section of this Agreement;
(2) Upon a continued failure for the following three full months after
receipt by the Authority of the written notice described in(c) (1) above the
member jurisdiction may withdraw as a member, by giving written notice to
the Authority, to be effective ten(10) days after receipt of such notice by the
Authority.
(3) Upon the effective date of the withdrawal, the Authority shall cease
ambulance service to the former member jurisdiction and within one hundred
eighty (180) days, the Authority shall remit in full to the former member its
per capita share of the Authority's Net Worth, as defined in Paragraph 10(b)
above, as of the last fiscal year, less any unamortized capital costs and unpaid
first responder equipment owed by the former member jurisdiction, as defined
in Paragraph 11(b) above.
12. Until such time as the total population of all member jurisdictions of the Authority
exceeds 880,000 persons, the membership of the Board of Directors shall be appointed in the
following manner:
(a) The Medical Director of the Emergency Physicians Advisory Board shall be
a member of the Board of Directors, ex officio, but with full voting rights.
(b) The City of Fort Worth shall appoint four(4) directors.
(c) Should the City of Arlington choose to join, Arlington may appoint two (2)
members qualified to be directors.
(d) All other member jurisdictions of the Authority combined shall be entitled to
one(1) seat on the Board of Directors for each 110,000 persons residing within all
other member jurisdictions combined, but no less than one(1) member in any event.
All members of the Board selected by jurisdictions other than Fort Worth and
Arlington shall be chosen as follows-
(1) Each member jurisdiction shall be entitled to appoint one(1)member
to a selection Committee. Voting on the Selection Committee shall be on a
one vote per jurisdiction basis.
804249.v2 8
(Interlocal Cooperative Agreement,cont.
(2) No later than July 21, 1999, the Selection Committee shall, for each
position for which an appointment shall be made, compile a list of not more
than three(3)persons. Each fist of nominees for each available position shall
be called the "Candidates List," and all nominees on each such Candidates
List.
(3) The Candidates' List shall be submitted no later than July 22, 1999 to
the City Council of each member of the Authority, with the exception of Fort
Worth (and Arlington). If Rural Fire Protection District Number One of
Tarrant County is also a member of the Authority, the Candidates Lists shall
also be presented to the Board of that District.
(4) Each member jurisdiction shall cast all of its votes for one(1) of the
eligible candidates on the Candidates' List. Each member jurisdiction shall be
entitled to the number of votes which corresponds to the number of residents
residing in that member jurisdiction, as announced by the most recent United
States Census Bureau Statistics.
(5) The candidate for each available position receiving the most votes shall
be certified as the winner of the election to that seat. The Selection Committee
shall forward the certified results of the first election to the existing Board
Members appointed by Fort Worth (and Arlington and Tarrant County Fire-
District, if members). Those Board members shall receive and certify the
results causing the elected persons to become members of the Board.
Thereafter, the Selection Comn-dttee shall forward the results of all elections
of the Board to the other Board members of the Authority. Those Board
members shall receive and certify the results causing the elected persons to
become members of the Board.
13. At such time as the total population of all member jurisdictions exceeds 880,000
residents as reporter by the U.S. Census Bureau, the following methods shall apply to select
members of the Board:
(a) The total population of all member jurisdiction shall be divided by eight (8),
the number of appointed seats on the Board:
(b) Fort Worth and Arlington may each appoint one (1) member for each 118th
of the total population which the respective population of those two cities represents,
provided such appointees meet the eligibility requirements for residency and type of
expertise as set forth in Paragraph 12, above, and provided that no more than two
members possessing the same expertise may sit on the Board simultaneously. There
804249,,v2 9
(Interlocal Cooperative Agreement,cont....}
shall be no representation for fractional population; that is, for a Board membership
a full 118 of the total population is required.
(c) All other member jurisdictions shall elect Board members in the manner
described in Paragraph 12(c), above, except that instead of one Board member for
each 110,000 population, the other member jurisdictions may appoint one Board
member for each 118 of the then-current population of all member jurisdictions, and
provided that no more than two members possessing the same expertise may sit on
the Board simultaneously.
14. The Authority is expressly prohibited from furnishing service to any area which is not
a member of the Authority, except for service pursuant to a mutual aid agreement approved
by the Authority, or emergency coverage of non-member jurisdictions not to exceed sixty(60)
days in duration.
LIST OF EXHIBITS
Exhibit A. Uniform EMS Ordinance
Exhibit B. Uniform Schedule ofPrice/Subsidy Options for ALS First Responder
Exhibit C. Uniform Schedule ofPrice/Subsidy Options for BLS First Responder
Exhibit D Memorandum of Understanding(Population-based Discounts)
APPROVAL
Approved by the City Council of I L- Texas,
this kLA day of Ler 19_�Ly I I C11 I
Authorized Official
Atts by:
A C'ontract Authorization
Date
I-PPROVP AS NOya
A
804249.v2 10
Exhibit A
ORDINANCE NO. 1
AN ORDINANCE AMENDING CHAPTER 5 OF THE CODE OF THE
CITY OF FORT WORTH, "AMBULANCES/EMERGENCY MEDICAL
SERVICES" BY ENACTING A NEW CHAPTER ESTABLISHING A
REGULATED SOLE-PROVIDER AMBULANCE SERVICE SYSTEM
ADM[INISTERED BY THE AREA METROPOLITAN AMBULANCE
AUTHORITY, AN AGENCY CREATED BY INTERLOCAL
AGREEMENT, AND SUBJECT TO MEDICAL AND CLINICAL
REGULATION BY THE EMERGENCY PHYSICIANS ADVISORY
BOARD; PROVIDING FOR REPEAL OF CONFLICTING
ORDINANCES; PROVIDING A SEVERABILITY CLAUSE; PROVIDING
FOR PUBLICATION IN ACCORDANCE WITH STATE LAW; AND
PROVIDING AN EFFECTIVE DATE.
I.
Ordinance Enacted. That Chapter 5 of the Code of the City of Fort Worth (1986), as
amended, is hereby repealed and there is hereby enacted in lieu thereof a new Chapter, entitled
"AmbulancelEmergency Medical Services", the text of which shall read as set forth in Exhibit
"A", attached hereto and incorporated herein.
II.
Repealer. Ordinances and any resolutions in conflict herewith are hereby repealed
effective August 1, 1999.
IH.
Severability. It is the intention of this Jurisdiction that the separate provisions of this
Ordinance and applicable Rules and Regulations shall be deemed independent of all other
provisions contained herein and it is further intended that if any of the provisions of this
Ordinance and/or Rules be declared invalid, all other provisions hereof and thereof shall remain
valid and enforceable.
IV.
bli atictn. That the City Secretary of Fort Worth, Texas is hereby directed to publish
the caption summarizing the purpose of this Ordinance and the penalty clause prescribing the
penalties for violation of this Ordinance in the manner provided by applicable state law.
V.
Effective Date. This Ordinance shall be effective August 1, 1999.
Exhibit A
ORDINANCE NO. /
AN ORDINANCE AMENDING CHAPTER 5 OF THE CODE OF THE
CITY OF FORT WORTH, "AMBULANCES/EMERGENCY MEDICAL
SERVICES" BY ENACTING A NEW CHAPTER ESTABLISHING A
REGULATED SOLE-PROVIDER AMBULANCE SERVICE SYSTEM
ADMINISTERED BY THE AREA METROPOLITAN AMBULANCE
AUTHORITY, AN AGENCY CREATED BY INTERLOCAL
AGREEMENT, AND SUBJECT TO MEDICAL AND CLINICAL
REGULATION BY THE EMERGENCY PHYSICIANS ADVISORY
BOARD; PROVIDING FOR REPEAL OF CONFLICTING
ORDINANCES; PROVIDING A SEVERABILITY CLAUSE; PROVIDING
FOR PUBLICATION IN ACCORDANCE WITH STATE LAW; AND
PROVIDING AN EFFECTIVE DATE.
I.
Ordinance Enacted. That Chapter 5 of the Code of the City of Fart Worth (1986), as
amended, is hereby repealed and there is hereby enacted in lieu thereof a new Chapter, entitled
"Ambulance/Emergency Medical Services", the text of which shall read as set forth in Exhibit
"A", attached hereto and incorporated herein.
.,.II.
Repealer. Ordinances and any resolutions in conflict herewith are hereby repealed
effective August 1, 1999.
Severability. It is the intention of this Jurisdiction that the separate provisions of this
Ordinance and applicable Rules and Regulations shall be deemed independent of all other
provisions contained herein and it is further intended that if any of the provisions of this
Ordinance and/or Rules be declared invalid, all other provisions hereof and thereof shall remain
valid and enforceable.
IV.
" blicatiqn, That the City Secretary of Fart Worth, Texas is hereby directed to publish
the caption summarizing the purpose of this Ordinance and the penalty clause pre-scribing the
penalties for violation of this Ordinance in the manner provided by applicable state law.
V.
'ff . flv Date. This Ordinance shall be effective August 1, 1999.
Secs. 5-7-5-15. Reserved.
ARTICLE If. EMERGENCY PHYSICIANS ADVISORY BOARD
Sec. 5-16. Created.
There is hereby created an emergency physicians advisory board (EPAB) which
shall oversee and regulate on behalf of this city all medical aspects of the
ambulance system which affect patient care.
Sec. 5-17. Membership.
The EPAB shall consist of a board whose membership shall be composed of
licensed physicians as follows:
(1) The medical director, or his designee, of each hospital emergency
department which is located within the service area and which maintains an
emergency medical services department staffed twenty-four(24) hours per day,
seven (7) days per week by in-house physicians; all EPAB members shall be
licensed physicians.
(2) Five (5) additional licensed physicians with active specialties or sub-
specialties of benefit in developing standards for emergency prehospital care,
and who are appointed by and serve at the pleasure of the Tarrant County
Medical Society.
The EPAB may, at its option, elect from among its members an executive board
consisting of not less than seven (7) nor more than nine (9) physicians, which
executive board shall exercise such powers and duties of EPAB as are set forth
in written by-laws approved by a two-thirds majority vote of the entire EPAB
membership.
See. 5-18. Medical director.
The EPAB shall appoint a medical director who shall be responsible for the day-
to-day affairs of the EPAB in carrying out its duties under this chapter. The
medical director shall be a licensed physician who is board-certified in
emergency medicine. The medical director shall serve at the pleasure of EPAB.
Sec. 5-19. Powers and duties.
The EPAB shall have the following powers and duties:
(1) To recommend to the ambulance authority medically appropriate
response time standards for this jurisdiction;
(2) To establish standards for patient care, including standards for ambulance
and first responder vehicles and on-board equipment;
(3) To develop medical protocols for ambulance and first responder services
and periodically revise same;
(4) To develop communications center protocols and periodically revise
same;
(5) To conduct medical audits and develop standards and procedures for the
conduct of such audits;
(6) To develop and periodically revise and administer both written and
practical tests for the certification and licensing of emergency medical services
personnel, including ambulance personnel, first responders, and EMS
communications center personnel;
(7) To develop and periodically revise and administer educational material,
programs and/or tests to ensure that base station physicians are knowledgeable
of the local ambulance system, its medical protocols, radio procedures, and
transport protocols; and to certify qualified physicians as base station physicians;
(8) To conduct inspections of vehicles, equipment and supplies on both an
announced and unannounced basis;
(9) To monitor response time performance; in this regard, the ambulance
authority shall furnish such statistical information regarding response time
performance as may be requested by EPAB;
('1 Q) To develop standards and procedures for the resolution of disputes
regarding the application of exemptions from late run penalties assessed against
the ambulance service contractor for failure to meet response time standards;
(1'1) To periodically conduct intensive reviews of the system's performance
relative to specific clinical types and to revise medical protocols and such other
standards of the system as may be appropriate in light of the findings;
(12) To conduct medical audits of individual cases as requested by the
ambulance authority, by any elected official of a member jurisdiction, by any
licensed physician regarding a patient of such physician, or by any paramedic
involved in the case which is the subject of the audit request;
(13) To annually present a written and oral report to the ambulance authority
concerning the state of clinical performance of the ambulance systemi each
member jurisdiction shall be informed of the time and place of such oral report at
least thirty (30) days in advance of that meeting and shall be invited to send
representatives, and shall be famished a copy of the written report;
(14) To establish such committees as may be necessary to aid in the
performance of its powers and duties;
(15) To approve standards governing the operation of specialized mobile
intensive care units, including standards limiting the types of patients which may
be transported thereby, and to issue, suspend, revoke and renew permits for the
operation of such units as required by this chapter;
(16) To approve standards governing the operation of aeromedical
transportation units, including standards defining the circumstances under which
such units may be deployed to emergency scenes, and to issue, suspend,
revoke, and renew permits for the operation of such units as required by this
chapter, and
(17) To approve standards governing the operation of point-to-point wheelchair
transport units, stretcher vans and other types of patient transportation, including
standards limiting the types of patients which may be transported thereby, and to
issue, suspend, revoke and renew permits for the operation of such units as
required by this chapter.
Sec. 5-20. Fee payments; use of funds.
For each patient transported by the ambulance authority or its contractor, and for
each patient transported by ambulance by any other provider issued permits
pursuant to this chapter, the transporting provider shall pay to EPAB a fee of five
dollars and 10 cents ($5.10), which sum shall be used to defray the costs of
medical regulation of the EMS system. Such payments shall be made monthly by
the fifteenth day of each month for services rendered during the previous
calendar month.
Such funds shall be maintained in a separate account administered by the
ambulance authority on EPAB's behalf, and shall be expended solely for the
purposes set forth in this article as approved by EPA B or its executive board.
This per-transport fee may be periodically increased at the discretion of EPAB,
but not more often than annually, and no single increase may exceed five
percent (5%).
See. 5-21. Indemnification.
This jurisdiction shall indemnify and hold harmless EPAB, its members, its
medical director, and EPAB staff members from liability for actual damage,
including costs and attomeys fees, arising.from any claim, lawsuit, or judgment
resulting from an act or omission of said EPAB member, the medical director, or
EPAB staff member while acting in the scope and course of his office, provided
that such liability arises out of or in connection with the provision of ambulance
services or first responder services originating within the corporate limits of this
jurisdiction.
Secs. 5-22-5-30. Reserved.
ARTICLE 111. AREA METROPOLITAN AMBULANCE AUTHORITY
Sec. 5-31. General provisions.
By adopting this chapter, and concurrently therewith executing and approving
the restated interlocal cooperative agreement, there is hereby established an
area metropolitan ambulance authority i"' 'A"is herein called the "ambulance
A"
authority"; and in regard to that ambulance authority the following shall apply:
(1) The ambulance authority is hereby designated as the sole provider of all
ambulance services within this jurisdiction pursuant to the terms, conditions and
provisions of the restated interlocal cooperative agreement, except for those
services exempted by section 5-4(6).
(2) The ambulance authority shall comply with all terms of the restated
interlocal cooperative agreement, and have all of the duties, powers and
responsibilities enumerated therein.
(3) The ambulance authority is required to provide this jurisdiction with
advanced life support ambulance service. Such service shall comply with all
applicable state laws and rules, as well es all rules, regulations, standards and
response times as the ambulance authority or the EPAB may from time to time
promulgate.
EXHIBIT A
Chapter 5 AMBULANCESIEMERGENCY MEDICAL SERVICES
ARTICLE 1. IN GENERAL
Sec. 5-1. Statutory Authority.
This chapter is enacted by the City Council of Fort Worth, Texas, pursuant to
Sec. 773.051 of the Texas Health & Safety Code, which provides that
municipalities may establish standards for ambulances, and to See. 791.001 of
the Texas Government Code which provides that combinations of local
governmental units may contract for the provision of governmental services.
Sec. 5-2. General purposes and intent of chapter.
It is the purpose of this chapter:
(1) To establish a regulated ambulance service system which can provide
state-of-the-art clinical quality of care, with reasonable, reliable response time
standards, and with the goal of furnishing the best possible chance of survival,
without disability or preventable complication, to each ambulance patient.
(2) To establish a sole-provider ambulance system, because it is
unreasonable to have unnecessarily high rates and/or public subsidy to make
needed improvements to ambulance service in the service area, when a more
efficiently designed system can achieve the same results at lower cost. The most
efficient design to achieve the goals of high-quality service, at the lowest cost,
consistent with the quality of rare required, is the implementation of the system
described herein.
(3) To provide more effective system performance through the provision of
services by a competitively selected qualified private operator, rather than direct
governmental operation of ambulance services.
(4) To provide more effective medical control by establishing a multi-
jurisdictional emergency physicians advisory board (EPAB) and by empowering
that board to oversee and regulate all clinical aspects of the emergency medical
system which affect patient care.
See. 5-3. Definitions.
For the purposes of this chapter, the following words and phrases shall have the
meanings respectively ascribed to them by this section:
Advanced life support ambulance. Any vehicle which is equipped to provide
treatment of life-threatening emergencies through the use of advanced airway
management, intravenous therapy, and other advanced prehospital care
procedures, and which is equipped to transport sick or injured persons to or from
health care facilities.
Approved rate schedule. Those fees for ambulance services rendered which
have been established for this jurisdiction by the ambulance authority from the
uniform schedule of price/subsidy options.
Area Metropolitan Ambulance Authority ("ambulance authority"). That public
administrative agency established to oversee the operation of the ambulance
system established by this chapter.
Base station physician. A physician licensed to practice medicine in the State
of Texas, knowledgeable in the prehospital emergency medical protocols, EMS
radio procedure and the general operating policies of the ambulance system,
and a person from whom ambulance personnel may take medical direction by
radio or other remote communications device.
Contractor. That person selected by the ambulance authority, pursuant to the
request for proposal process, which is awarded the right to provide all
ambulance services in this jurisdiction, except those specifically exempted by
this chapter.
Emergency medical technician ("EMT"}. 'A person certified as an "emergency
medical technician" as defined by Sec. , ,73.047, Texas Health and Safety Code.
EMS Communications Center. The single facility designated by the ambulance
authority as the central communications center from which all ambulances
operating in the service area shall be dispatched and controlled.
Emergency physicians advisory board ("EPAB"'), The medical board created
by this chapter and empowered to promulgate the various standards, rules and
regulations related to clinical aspects of ambulance service and first responder
and other services within the service area, and to perform medical audits and
otherwise monitor system performance.
First responder. Any person, fire department vehicle, police vehicle, or other
vehicle not normally used for purposes of patient transport, but which vehicle and
on-board personnel are capable of providing first responder services in medical
emergencies.
Aeromedical transportation unit. Any rotary wing aircraft providing basic or
advanced life support services and patient transportation originating from the
scene of emergency incidents which occur within the service area.
Medical audit. An official inquiry into the circumstances involving an ambulance
run or request for ambulance service, conducted by the medical director or a
licensed physician designated by the medical director.
Medical control. Direction given ambulance personnel by a base station
physician through direct voice contact, with or without vital sign telemetry, as
required by applicable medical protocols promulgated by the EPAB, and by
Sec.773.003(18), Texas Health and Safety Code.
Medical director. The licensed physician appointed by the EPAB serving as
administrative officer in carrying out the duties and powers of the EPAB.
Medical protocol. Any diagnosis-specific or problem-oriented written statement
of standard procedure, or algorithm, promulgated by the EPAB as the normal
standard of prehospital care for a given clinical condition.
Mutual aid agreement. A written agreement between the ambulance authority
and one or more entities whereby the signing parties agree to provide backup
ambulance service to one another under conditions and pursuant to terms
specified in the agreement as approved by the ambulance authority.
Paramedic. A person qualified as a c'erfifi;e"d"'p.a.ramedic" as defined by Sec.
773.049, Texas Health and Safety Code.
Patient. An individual who is ill, sick, injured, wounded or otherwise
incapacitated and is in need of or is at risk of needing medical care during
transport to or from a health care facility.
Person. Any individual, firm, association, partnership, corporation, governmental
entity, or other group or combination acting as a unit.
Response time. The actual elapsed time between receipt of notification at the
EMS communication center that an ambulance is needed at a location within the
service area and the actual arrival of an ambulance at that location.
Restated Interlocal Cooperative Agreement ("Agreement"). That contract
adopted by this jurisdiction concurrently with the passage of this chapter, which
contract is entered into by this jurisdiction pursuant to Chapter 791 of the Texas
Government Code, more commonly known as the "Interiocal Cooperation Act."
Senior paramedic in charge. That person among the certified personnel
assigned to an ambulance, not the driver, who is a certified paramedic
designated as the individual in command of the ambulance.
Service area. That geographical area which is contained within the boundaries
of all of the.jurisdictions which adopt this uniform EMS ordinance, and which
adopt and execute the restated interlocal cooperation agreement implementing
the ordinance, thereby becoming members of the ambulance authority.
Special event. Any public event located within the service area, for which
standby ambulance service is arranged in advance, and for which an ambulance
(or ambulances) is hired by the sponsoro' f the event or other interested party.
Specialized mobile intensive care unit. A vehicle which is specially
constructed, equipped, staffed, and employed in the interfacility transport of
patients whose requirements for enroute medical support are likely to exceed the
clinical capabilities of an advance life support ambulance.
Wheelchair transport service. The transportation of a person (not a "patient" as
defined herein)who is situated in a wheelchair and is capable of sifting in said
wheelchair for at least one hour, where,no treatment is required or expected in
route, and where the person and transporting vehicle have no medical
equipment that requires adjustment or monitoring.
Sec. 5-4. Violations.
It shall be unlawful:
(1) To perform duties as an ambulance driver, attendant (EMT or paramedic),
or EMS dispatcher without a current certification issued by the EPAB;
(2) To permit a person to work as an ambulance driver, attendant or EMS
dispatcher without a current license issued by the EPAB;
(3) To use, or cause to be used, any ambulance service other than that of the
contractor authorized to operate in this jurisdiction by virtue of its contract with
the ambulance authority, except those services described in subsection (6) of
this section 5-4;
t4} For any person, firm or organization to provide ambulance service within
VT
this jurisdiction, other than the contractor which contracts with the ambulance
authority; or to provide point-to-point wheelchair transport, or stretcher van or
other patient transportation services to or from health care facilities, aeromedical
transportation unit services, or specialized mobile intensive care services except
in accordance with EPAB regulations governing the delivery of such services,
and then only pursuant to a permit issued by EPAB for the operation of such
units; or to provide first responder services without a first responder permit
issued by EPAB. All such special permits when issued by EPAB shall be valid for
a period of two years, and then shall be subject to provisions governing renewal,
such provisions to be developed by EPAB. Holders of such permits shall comply
with requirements for payment of permit fees as set forth in this chapter; or
(5) To knowingly give false information to induce the dispatch of an
ambulance or aeromediGal transportation unit;
(6) It shall be a defense to any alleged violation of this section 5-4 that the
vehicle is being used solely in any of the following manners:
a. A privately owned vehicle not ordinarily used in the business of
transporting persons who are sick, injured, wounded, incapacitated or helpless.
b. A vehicle rendering service as an ambulance in the event of a major
catastrophe or extreme system ovedo.1d,when such condition is declared by the
medical director, the executive director of the ambulance authority, or by an
authorized representative of the ambu(66c'e'adthoritys contracted ambulance
service provider, and such assistance has been requested by the communication
center.
C. Any ambulance owned or operated by the federal or state government.
d. Any transport to a location within the service area, which transport
originated from a point outside the service area.
e. Mutual aid calls when rendered pursuant to a mutual aid agreement
approved by the ambulance authority.
f. Special events coverage, so long as such service is provided without
charge by an emergency medical services volunteer provider, as defined in
section 773.003(13) of the Texas Health e(M Safety Code.
9. Wheelchair transport services which are not provided on a point-to-point
basis, but which provide pickup and delivery by way of regularly scheduled
routes.
h. Medical transports by aeromedical where such transports originate
outside the service area or at a hospital location within the service area.
Sec. 5-5. Penalties.
The following provisions for application of penalties for violation of this chapter
shall apply:
(1) Any person convicted of violating the provisions of this chapter shall be
fined no more than five hundred dollars ($500.00). This does not serve to limit
any other remedies available to this jurisdiction in law or equity.
(2) Each violation of this chapter that is committed shall constitute a separate
offense.
Sec. 5-6. Traffic laws; exemption.
When the ambulance vehicle operator has reasonable grounds to believe that an
emergency exists, as determined by the EMS Communication Center, the
ambulance vehicle operator may:
(1) Park or stand, irrespective of the! otherwise applicable provisions of law,
ordinance or regulations;
(2) Proceed past a red or stop signal or stop sign, but only after slowing down
as may be necessary for safe operation;
(3) Exceed the maximum speed limits permitted by law, ordinance or
regulation; provided, however, that life and property are not endangered thereby;
(4) Disregard laws, ordinances and regulations governing directions or
movements or turning in specified directions;
(5) Provided, however, that any exemption herein granted shall apply only
when such ambulance is operating with siren and emergency lights in operation,
and when such audible and visual signals meet the requirements of law,
ordinance or regulation; and provided further, that the foregoing provisions shall
not operate to relieve the ambulance vehicle operator from the duty to drive with
due regard for the safety of all persons, nor shall such provisions protect the
driver from the consequences of his reckless disregard for the safety of others.
APPROVED AS TO FORM AND LEGALITY:
} t t
Assistant City Attorney
ADOPTED:
Exhibit B
Uniform Schedule of Price/Subsidy Options for ALS First Responder
This exhibit does not exist since no city has registered recognition as an BLS First Responder.
r
Exhibit
Uniform Schedule of Price/Subsidy Captious for BLS First Responder
This exhibit is the current years Price/Subsidy Options,
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Area Metropolitan Ambulance Authority
Price/Subsidy Options
FY 1998-99
Patient Patient Net
Fee Per Fees Fees Subsidy Total Per Capita Collection
TransR2rt Billed llected Roquired Revenue Subsigy Rate
41 2,083,292 1,600,171 10,026,237 11,826,408 16.12 86.41%
42 2,134,104 1,829,317 9,997,091 11,826,408 16,07 85.72%
43 2,184,916 1,858,221 9,968,187 11,826,408 16.03 85.06%
44 2,235,728 1,886,916 9,939,492 11,826,408 15.98 84-40%
45 2,286,540 1,915,431 9,910,977 11,826,408 15-93 83.77%
46 2,3 7,362 1,943,797 9,882,611 11,826,408 15.89 83.16%
47 2,388.164 1,971,804 9,854,604 11,826,408 15.84 82.67%
48 2,438,976 1,999,712 9,826,696 11,826,40 15.80 81-99%
49 2,489,788 2,027,553 9,798,855 11,826,408 15.75 81.43%
50 2.540,600 2,055,101 9.771,307 11,826,408 15.71 80-89%
51 2,591,412 2,082,371 9,744,037 11,826,408 15.67 80-36%
52 2,642,224 2,109,644 9,716.764 11,826,408 15.62 79,840
53 2.693,036 2,136,680 9,689,728 11,826,408 15.58 79,34%
54 2,743,848 2,163,495 9,662,913 11.826,408 16.64 78.85%
55 2,794,660 2,190,102 9,636,306 11,826,408 15.49 78.37%
56 2,645,472 2,216,519 9,609,889 11,826,408 15.45 77.90%
57 2,896,284 2,242,759 9,583,649 11,826,408 16.41 77.44%
58 2,947,096 2,268,838 9,657,570 11,826,408 15.37 76.99%
59 2,967,908 2,294,771 9,531,637 11,826,408 15.32 76.5$%
60 3,048,720 2,320,574 9,505,834 11,826,408 15.28 76.12%
61 3,069,532 2,346,262 9,480,146 11,826,408 15.24 75.7070
62 3,1 50,344 2,371,850 9,454,558 11,826,408 15.20 7529%
63 3,201,156 2,397,353 9,429,055 11,826,408 15.16 74.89%
64 3,251,968 2,422,787 9,403,621 11,826,408 15.12 74.50%
65 3,302,780 2448,167 9,378,241 11,826,408 15.08 74.12%
66 3,353,592 2,473,170 9,353,238 11,826,408 15,04 73.75%
67 3,464,404 2,498,140 9,328,268 11,826,408 15.00 73.38%
68 3,465,216 2,523,091 9,303,317 11,826,408 14.96 73.020
69 3,566,028 2,547,686 9,278,722 11,826,408 14.92 72.67%
70 3,556,840 2,572,283 9,254125 11,826,408 14,88 72.32%
71 3,667,652 2,596,897 9,229,511 11,826,408 14.84 71,98%
72 3,668,464 2,621,175 9,205,233 11,826,408 14.80 71.65%
73 3,709,276 2,646,491 9,180,917 11,826,408 14.76 71.32%
74 3,760,088 2,669,482 9,156,926 11,826,408 14.72 71.00%
75 3,810,900 2,693,530 9,132,878 11,826,408 14.68 70,68%
76 3,861,712 2,717,651 9,108,757 11,826,408 14.64 70.37%
77 3,912.524 2,741,467 9,084,941 11,826,408 14,61 70.07%
78 3,963,336 2,766,376 9,061,032 11,826,408 14.57 69.77%
79 4,014,148 2,788,991 9,037,417 11,826,408 14Z3 69.48%
60 4,0$4,960 2,812,719 9,013,589 11,826,408 14.49 69.199
81 4,115,772 2,036,162 8,990,246 11,826,408 14,45 %910/0
82 4,166,584 2,859,321 8,967,087 11,826,408 14,42 68,63%
83 4,217,396 2,882,619 8,943,789 11,826,408 14.38 68-35%
84 4268,208 2,906,642 8,920,766 11,826,408 14.34 W08%
as 4,30,020 2,928,825 8,897,583 11,826,408 14.31 67151%
86 4,369,832 2,951,743 8,874.665 11,826,408 14.27 67.55%
87 4,420,644 2,974,841 8,851,567 11,826,408 14.23 67.29%
88 4,471,466 2,997,685 8,828,723 11,826,408 14.19 67.04%
89 4,524268 3,020.275 8,806,133 11,826,408 14,16 66,79%
90 4,57-3,080 3,043,069 8,783,339 11,826,408 14,12 -66,54%
91 4,623,892 3,065,620 8,760,788 11,826,408 14,09 66,301
92 4,674,704 3,087,427 8,738,481 11,826,408 14.05 016,06%
93 4,725.516 3,110,464 8,715,944 11,826,406 14k1 65,82010
94 4,776,328 3,132,768 8,693,640 11,826,408 1198 65.59%
95 4,827,140 3,154,837 8,671,571 11,826,408 1194 65.3610
96 4,877,952 3,177,163 8,649,245 11,826.408 1191 65.13%
07 4,928,764 3,199,265 8,627,143 11,826,408 13.87 64.91%
98 4,979,576 3221,143 8,605,265 11,826,408 13.84 64.69%
99 51030,388 3,243,302 8,583,106 11,826,408 13.80 64,47%
100 5,081,200 3,265,248 8,561,160 11,826,408 1316 64.26%
101 5,132,012 3,286,981 8,539,427 11,826.408 13,73 64.05%
102 5,162,824 3,308,500 8,517,908 11,826,408 13.69 63.84%
103 6,233,636 3,330,331 8,496,077 11,826,408 13.66 63.63%
104 5,284,448 3,351,959 8,474,449 11,826,408 13.62 63,43%
105 5,335,260 3,373,383 8.453,025 11,826,408 13.59 63,23%
106 5,366,072 3,394,604 8,431,804 11,826,408 13.56 6343%
107 5,436,884 3,416,168 8,410,240 11,826,408 13.52 62-83%
108 5,487,696 3,437,538 8,388,870 11,826,408 13,49 62.64%
109 5,538,508 3,458,715 8,367,693 11,826,408 13.45 62,45%
110 6,689,320 3,479,699 8,346,709 11,826,408 13.42 62.26%
111 5,640,132 3,601,055 8.325,353 11,826,408 13.39 62,07%
112 5,660,944 3,522,229 8,304,179 11,626,408 13.36 61.8 %
113 5,741,756 3,543,220 8,283,188 11,826,408 13.32 61,71%
114 5,792,568 3,564,028 8,262,380 11,826,408 13.28 61,53%
115 5,843,380 3,584,653 8,241,756 11,826,408 13,25 61.35%
116 5,89.4,192 3,605,686 8,220,722 11,826,408 13-22 81,17%
117 5,946,004 3,626,546 8,199,862 11,826,408 13.18 61,00%
118 5,995,816 3,647,233 8,179,175 11,826,408 13.15 010.83010
119 6,046,628 3,667,748 8,158,660 11,826,408 13.12 60.66%
120 6,047,440 3,688,090 8,138,318 11,826,408 13.08 60.49%
121 6,148,252 3,706,876 8,117,532 11,826,408 13.05 60,32%
122 6,199,064 3,729,499 8,096,909 11,826,408 13.02 60,16%
123 6,249,876 3,749,960 8,076,448 11,$26,408 12.98 60,00%
124 6,300,688 3,770,258 8,056,150 11,826,408 12,95 59.84%
125 6,351,500 3,790,393 8,036,015 11,826,408 12.92 59,68%
126 6,402,312 3,810,366 8,016,042 11,826,408 12.89 59,62%
127 6,453,124 3,830,823 7,995,586 11,826,408 12.85 59.36%
128 6503,936 3,851,128 7,975,280 11,826,4W 12.82 59.21%
129 6:554,748 3,871,280 7,955,128 11,826,408 12.79 59.06%
130 6,605,560 3,891,280 7,935,128 11,826,408 12.76 58,91%
131 6,666,372 3,911,127 7,915,281 11,826,408 12.73 58.76%
132 6,70'7,184 3,930,822 7,895,586 11,826,408 12.69 58.61%
133 6,767,996 3,951,042 7,875,366 11,826,408 12,66 58,46%
134 6,806,808 3,971,120 7,855,288 11,826,408 12.63 58.32%
136 6,856,620 3,991,056 7,836,352 11,826,408 12.60 58.18%
136 6,916,432 4,010,849 7,815,559 11,826,408 12.57 68.04%
137 6,961,244 4,030,600 7,795,908 11,826,408 12.53 57,90%
138 7,01 2,0501 4,050,008 7,776,400 11,826,408 12.50 57.76%
139 7,062,868 4,069,375 7,757,033 11,826,408 12.47 57,62%
140 7,11 3,680 4,088,599 7,737,809 11,826,408 12.44 57.48%
141 7,1654,492 4,108,399 7,718,009 11,826,408 12.41 57.34%
142 7,215,304 4,128,067 7,698,341 11,828,408 12.38 57.21%
143 7,266,116 4147,602 7,678,806 11,826,408 12,35 67.08%
144 7,316,428 4167,006 7,659,402 11,826,408 12,31 56.95%
145 7,367,740 4.186,278 7,640,130 11,826,408 1228 56.82%
146 7,418,552 4,205,417 7,620,991 11,826,408 110.25 M69%
147 7,469,364 4.224,424 7,601,984 11,826,408 1222 56,56%
148 7,526,176 4,243,20 7,583,109 11,826,408 12,19 56.43%
149 7,570,988 4,262,801 7,563,607 11,826,408 12,16 56.30%
150 7,621,800 4,282,181 7,544,227 11,826,408 12.13 56-18%
161 7,672,612 4,301,439 7,524,969 11,826.408 12.10 56.06%
152 7,723,424 4,320,575 7,5176,833 11,826,408 12.07 65.94%
153 7,774,236 4,339,689 7.486,819 11,826,408
12,174 55.82
154 7,825,048 4,358,481 7°467,927 11,826,408 12-01 55570%
155 7;875,860 4,377251 7,449,157 11,826.408 11,98 65-58%
166 7,926,672 4,395,900 7,430,508 11,826,408 11,95 5546%
167 7,0977,484 4,414,426 7,411,982 11,826,408 1112 55,34%
158 8,028,296 4,432,830 7,393,578 11,826,408 11,89 55.22%
159 8,079,108 4,451,922 7,374,486 11,826,409 11.86 55.100/.
160 8,129,920 4,470,902 7,355,506 11,826,408 11.83 54.99%
161 8,160,732 4,489,771 7,336,637 11,826,408 11.80 64.88%
162 8,231,544 4,608,527 7,317,881 11,826,408 11.77 64.776A
163 8,282,356 4,527,172 7,299,236 11,826,408 11.74 54.66%
164 8,333,168 4,545,705 7,280,703 11,826,408 1171 54.55%
165 8,383,980 4,564,126 7,262,282 11.826.408 11.68 54.44%
166 8,434,792 4,582,436 7,243,972 11,826,408 11.65 64.33%
167 8,485,604 4,600,633 7,225,775 11,826,408 11,62 54,22%
168 8,536,416 4,618,719 7,207,689 11,826,408 11.59 54,11%
169 8,597,228 4,636,693 7,189,715 11,626,408 11.56 54.00%
170 8,638,040 4,655,421 7,170,987 11,826,408 11.53 53,89%
171 808,852 4,674,047 7,152,361 11,826,408 11.50 63.79%
172 8,739,664 4,692,572 7,133,836 11,826,408 11.47 53.89%
173 8,750,476 4,710,995 7,115,413 11,826,408 11,44 53.59%
174 81841,288 4,729,316 7,097,092 11,826,408 11.41 63.49%
175 8,842,100 4,747,536 7,078,872 11,826,408 11.38 53.39%
176 8,94,2,912 4,765,654 7,060,754 11,826,408 11,36 53.29%
177 8,993,724 4,783,670 7,042,738 11,826,408 11-32 53.19%
176 9,044,536 4,801,585 7,024,823 11,826,408 11.29 53.09%
179 9,09 1 5,348 4,819,398 7,007,010 11,826,408 11.27 52.99%
180 9,146,160 4,837,110 6,989,298 11,826,408 11.24 52.89%
181 9,196,972 4,854,720 6,971,688 11,626,408 11.21 52.79%
182 9,2417,784 4,872,228 6,954,180 11.826,408 11.18 62.69%
183 9,298,696 4,890,666 6,935,842 11,826,408 11.15 52.59%
164 9,349,408 4,908,813 6,917,595 11,826,408 11.12 52,50%
185 9,4ob,220 4,926,968 6,899,440 11,826,408 11.09 52.41%
186 9,451,032 4,945,032 6,881,376 11,826,408 11.06 52.32%
187 9,501,844 4,963,004 6,863,404 11,826,408 11.03 52.23%
188 91662,656 4,980,885 6,845,523 11,826,408 11.01 52.14410
189 9,603468 4,998,675 6,827,733 11,826,408 10.98 52,05%
190 9,654,280 5,016,373 6,810,035 11,826,408 10.95 51.96%
191 9,705,092 5,033,979 6,792,429 11,826,408 10.92 51.87%
9,756,904 5,051,494 6,774,914 11,826,408 10.89 51.78%
193 9,808,716 5.068,918 6,757,490 11,826,408 10-86 51.69%
194 9,857.528 5,086,250 6,740,158 11,826,408 10.84 51.60%
195 9,90040 5,103,491 6,722,917 11,826,408 10.81 51.61%
196 9,959,152 5,120,640 6,705,768 11,826,408 10.78 51.42%
197 10,009,964 5,137,697 6,688,711 11,826,408 10.76 51-33%
198 10,060,776 5,154,664 6,671,744 11,826,408 10.73 51.24%
199 10,111,588 5,172,551 6,653,857 11,826,408 10.70 51.15%
200 10,16,400 5,190,358 6,636,050 11,826,408 10.67 51.07%
201 10,213,212 5,208,083 6,618,325 11,826,408 10.64 50.99%
202 10,264,024 5,225,727 6,600,681 11,826,408 10.61 50.91%
203 10,314,836 5,243,289 6,583,119 11,826,408 10.58 50.83%
204 10,365,648 5,260,770 8,565,63B 11,826,408 10.56 5075616
205 10,416,460 5,278,170 6,548,238 11,826,408 10.53 50,67%
206 10,467,272 5,296,09 6,630,919 11,826.408 10.50 504996
207 10.518,084 5*312,726 6,513,682 11,826,408 1047 50.519'6
208 10,568A96 5,329,882 6,496,526 11,826,408 1044 50,43%
209 10,619,708 6,346,956 6,479,452 11,826,408 10.42 50,35%
210 10.670,520 5,363,950 6,462,458 11,826,408 10,39 50.27%
211 10,721,332 5,380,862 6445,546 11,826,408 10,36 50.19%
212 10,772,144 5.397,693 6,4213,716 11,826,408 10,34 50.11%
213 10,822,956 5,414,442 6,411,966 11,826,408 14.31 50.03%
214 10,873,768 5,431,110 6,395,298 11,826,408 10.28 49.95%
216 10,924,580 5,447,697 6,378,711 11,826,408 10-26 49.87%
216 10,975,392 6,464,203 6,362,205 11,826,408 10.23 49.79%
217 11,026,204 5,480,627 6,345,781 11,626,408 10-20 49,71%
218 11,W,016 5,49&970 6,32-9,438 11,826,408 10,18 49M%
219 1 112i,828 5,514,'346 6,314062 11,826,408 10A6 49.55%
220 11,178,640 5,631,651 6,294,757 11,826,408 10-12 49.486/o
221 11,229,452 5,W06 6,277,623 11,826,408 10D9 49,41 66
222 11,280,264 5,566,048 6,260,360 11,826,408 10.07 49,34%
223 11,331,076 5,583,139 6,243,269 11,826,408 1o.04 40-2701,
224 11,381,888 5,600,160 6,226,248 11,826,408 10.01 49.20%
226 11,432,700 5,617,109 6,209,299 11,826,408 9.98 49.13%
226 11,483.512 5,633,987 6,102,421 11,826,408 9.96 49.06%
227 11,534,324 5,650,794 6,175,614 11,826,408 9.93 48,99%
228 11.555.136 5,667,530 6,158,878 11,826,408 9.90 48.92%
229 11,635,948 5,684,196 6,142,213 11,826,408 9.88 48.85%
230 11,686,760 5,700,788 6,125,620 11,826,408 9.85 48.78%
231 11,737,672 5,717,311 6,1019,097 11,826,408 9.82 48,71%
232 11,788,384 5,733,762 6,092,646 11,826,408 9180 48,64%
233 11,839,196 5,750,143 6,076,265 11,826,408 9.77 48,57%
234 11,860,008 5,766,452 6,059,956 11,826,408 9.74 48.50%
235 11,940,820 5,782,690 6,043,718 11,826,408 9.72 48.43%
236 11.99 1,632 6,798,856 6,027,662 11,826,408 9.69 48.36%
237 12,042,444 5,814,952 6,011,456 11,826,408 9.66 48.29%
236 12,09�3,256 5,630,977 5,995,431 11,826,408 9.64 48.22%
239 12,144,068 5,846,930 5,979,478 11,826,408 9.61 48.15%
240 12,194,880 6,862,812 5,963,596 11,826,408 9.59 48.08%
241 12,245.692 5,878,623 5,947,785 11,826,408 9.56 48.01%
242 12,2916,504 5,894,363 5,932,045 11,826,408 9.54 47,94%
243 12,34.316 5,911,269 5,916,139 11,826,408 951 47.87%
244 12,398,128 5,928,113 5,898,295 11,826,408 9.48 47,81%
245 12,440,940 5,944,896 5,881,512 11,826,408 9.46 47,75%
246 12,499,752 5,961,618 5,864,790 11,826,408 9.43 47.69%
247 12,550,564 5,978,280 5,848,128 11,826,408 9.40 47,63%
248 12,601,376 5,994,880 5,831,528 11,826,408 9.38 47.57%
249 12,652,188 6,011,420 5,814,988 11,826,408 9.35 47,51%
250 12,703,000 6,027,898 5,798,510 11,826.408 9.32 47.45%
251 12,753,812 6,044,315 5,782,093 11,826,408 9,30 47.39%
252 12,804,624 6,060,672 5,765,736 11,826,408 9,27 47,33%
253 12,855,436 6,476,987 5,749.441 11,826,408 9.24 47,27%
254 12,906,248 6,093,202 6,733,206 11,826,408 9.22 47.21%
255 12,967,060 6,109,376 5J17.032 11,826,408 9.19 47.15%
256 13,007,872 6,125,488 5,700,920 11,826,408 917 47,09%
257 13,058,684 6,141,540 5,684,868 11,826,408 9,14 47,03%
258 13,106,496 6,157,530 5,668,878 11,826,408 9.11 46.97%
259 13,160,308 6,173,460 6,662,948 11,826,408 9.09 46.01%
2150 13,211,120 6,189,329 5,637,079 11,826,408 9.06 46.85%
261 13,261,932 6,205,136 6,621,272 11,826,408 9.04 46.79%
262 13,312,744 6,220,883 5,605,525 11,826,408 9.01 4613%
263 13.363,556 6,236,569 5,689,839 11,826,408 8.99 46,87%
264 13,414,368 6,252,194 5,574,214 11,826,408 8.96 46.61%
265 13,465180 6,267,758 5,558,650 11,826,408 8.94 46.55%
206 13,516,992 6,283,260 5,543,148 11,826,408 8.91 46.4901
267 13,566,804 6,298,702 5,527,706 11,826,408 8.89 46.43%
268 13,617516 6,314,083 5,512,325 11,826,408 8.86 46.37%
269 13,666,428 6,329,403 5,497,005 11,826,408 8.84 46.31%
270 13,719,240 6,344,662 5,481,746 11,826,408 8.81 46.25%
271 13,770,052 6,350,860 5,466,548 11,826,408 8,79 4619%
272 13,820,864 6,374,997 5,451,411 11,826,408 8.76 46,13%
273 13,871,676 6,390,073 5.436,336 11,826,408 814 46.07%
274 13,522,488 6,406,088 5,421,320 11,826,408 1'3.72 46.0111/o
275 13,973,300 6,420,042 5,406,366 11,826,408 8.69 45.95%
276 14.024,112 6,436,339 5,3901069 11,826408 8,67 45.89%
277 14,074,924 6,452,586 5,373,822 11 A26.408 8.64 45x84%
278 14,126,736 6,468,781 5,357,627 11,826,408 8.61 4519%
279 14,176,548 6,484,926 5,341,482 11.826,408 8.59 45,7401
280 14,227360 6,601,020 5,325,388 11,826,405 8,56 45,69%
281 14,276,172 6,517,063 5,309,345 11,826,4013 8e54 45.64%
282 14,328,984 6,533,055 5,293,353 11,826,408 8,51 45.590
283 14,379,796 6,548,997 5,277,411 11,826,438 13A8 45.649`
284 14,430,608 6,564,888 5,261,520 11,826,408 8.46 45.49%
285 14,481,420 6,580,728 5,245,680 11,826,408 8.43 45.44%
286 14,532,232 6,596,517 5,229,891 11,826,408 8.41 45.39%
287 14,583,0" 6,612,255 5,214163 11,826,408 8.38 46,2401.
288 14,633,856 6,627,942 5,198,466 11,826,408 8.36 46,29%
289 14,684,668 6,643,579 5,182,829 11,826,408 8.33 45.24%
290 14,735.480 6,659,165 5,167,243 11,826,4061 8.34 46.19%
291 14,786,292 6,674,700 5,151,708 11,826,408 8.25 45.14%
292 14,837,104 6,690,164 5,136,224 11,826,408 8.26 45.09%
293 14,887,916 6,705,617 5,120,791 11,826,408 8.23 45.04%
294 14,938,728 6,721,000 5,105,408 11,826,408 8.21 44.99%
295 14,989,640 5,736,332 5,090,076 11,826,408 8.18 44,94%
296 15,040,352 6,751,613 5,074,795 11,826,408 8.16 44.89%
297 15,00,164 6,766,843 6,069,565 11,826,408 8.13 44.84%
298 15,144,976 6,782,022 5,044,386 11,826,408 8.11 44,79%
299 15,192,788 6,797,151 5,029,257 11,826,408 8.09 44,74%
300 15,243,600 6,812,228 5,014,180 11,826,408 8.06 44.69%
301 16,294,412 6,827,255 4,999,153 11,826,408 8,04 44.64%
302 15,345,224 6,842,231 4,984,177 11,826,406 8.01 44.59%
303 15,396,036 6,857,156 4,90,252 11,826,408 7.99 44.64%
304 15,446,848 6,872,031 4,954,377 11,826,408 7.97 44.499'
305 16,40,660 6,886,455 4,939,553 11,826,408 7.94 44.44%
306 15,64$,472 6,901,627 4,924,781 11,826,408 7.92 44.39%
307 15,599,284 6,916,349 4,910,059 11,826,408 7-89 44.34%
308 15,6513,096 6,931,021 4,895,387 11,826,408 7.87 44.29%
309 15,700,908 6,946,641 4,880,767 11,826,408 7.85 44.24%
310 15,751,720 6,960,211 4,866,197 11,826,408 7,82 44.19%
311 15,802,532 6,974,729 4,851,679 11,826,408 7.80 44.14%
312 15,853,344 6,989,197 4,837,211 11,826,408 718 44M%
313 15,904,166 7,003,614 4,822,794 11,826,408 7.75 44.04%
314 16,954,968 7,017,981 4,808,427 11,826,408 7.73 43.99%
315 16,005,780 7,032,296 4,794,112 11,826,408 7.71 43.144%
316 16,056,592 7,046,561 4,779,847 11,826,408 7.68 43.89%
317 16,107,404 7,060,775 4,765,633 11,826,408 7.66 43.84%
318 16,158,216 7,074,938 4,751,470 11,826,408 7,64 43.79%
319 16,206,028 7,089,050 4,737,358 11,826.408 7.62 43.746Ib
320 16,256,840 7,103,112 4,723,296 11,826,408 7.59 43.69%
321 16,316,652 7,118,755 4,707,653 11,826,408 7.57 43.64%
322 16,361,464 7,134,358 4,692,050 11,826,408 7.54 43.60%
323 16,412,276 7,149,920 4,676,488 11,826,408 7.52 43.56%
324 16,463,088 7,165,441 4,660,967 11,826,408 7,49 43.52%
325 16,513,900 7,180,922 4,645,486 11,826,408 7.47 43.48%
326 16,564,712 7,196,362 4,630,046 11,826,408 7.44 43.44%
327 16,615,624 7,211,762 4,614,646 11,826,408 7.42 43.40%
328 16,666,336 7,227,121 4,599,287 11,826,408 7.39 43.36%
329 18,717,148 7,242,439 4,683,969 11,626,408 7.37 43-32%
330 16,767,960 7,257,716 4,568,692 11,826,408 7.35 43.28%
331 16,818,772 7,272,953 4,553,456 11,826,408 7.32 43.24%
332 16,866,584 7,288,150 4,538,258 11,826,408 7.30 43.20%
333 16,920,396 7,303,305 4,523,103 11,826,408 7.27 43.16%
334 16,971,208 7,318,420 4,507,9$8 11,826,408 7.25 4312%
335 17,022,020 7,333,494 4,492,914 11,826,408 7.22 43.080
336 17,072,832 7,348,528 4,477,880 11,826,408 7,20 43.04%
337 17,123,6" 7,363,521 4,462,8437 11,8,26,408 7-18 43.000,E
338 17,174,466 7,378,473 4,447,936 11,826,408 7.15 42.96%
339 17,225,268 7,393,385 4,433,023 1'1.826.408 7.13 42V0
340 17,276,080 7,408,256 4,418,152 11,826,408 7,10 42,88%
341 17,326,892 7,423,086 4,403,322 11,826,408 TOS 42Z4%
342 17,377,704 7,437,876 4,388,532 11,826,408 7.06 42,80%
343 111,428,516 7,452,625 4,373,783 11,826,408 7.03 4216010
344 17,479,328 7,467,334 4,359.074 11,826,408 7-01 4212160
345 17,530,140 7,482,002 4,344.406 11,826,408 6,98 42.680
346 17,580.952 7,496,629 4,329.779 11,826,408 6,96 42.64%
347 17,631,764 7,511,215 4.315,193 11,826,408 6,94 4160%
348 17,682,576 7,625,761 4,300,64-7 11,826,408 6,91 42,56%
349 17,733,388 7,540,266 4,286,142 11,826,408 6,89 42.52%
350 17,784,200 7,554,731 4,271,677 11,826,408 6.87 42.48%
351 17,835,012 7,569,155 4,257,253 11,826,408 6.84 42.440/c,
352 17,885,824 7,583,538 4,242,870 11,826,405 6.62 42.40%
353 17,936,636 7,597,881 4,228,527 11,826,408 6.80 42,36%
354 17,987,448 7,612,183 4,214,225 11,826,408 6.78 42.32%
355 18,038,260 7,626,444 4,199,964 11,826,408 6.75 42.28%
356 18,066,072 7,640,664 4,185,744 11,826,408 6.73 42.24%
357 18,139,884 7,654,844 4,171,564 11,826,408 6.71 42.20%
358 18,190,696 7,668,984 4,157,424 11,826.408 6168 42.160
359 18,241,508 7,683,083 4,143,326 11,826,408 5.86 42.12%
360 18,292,320 7,697,141 4,129,267 11,826,408 6.64 42,08%
361 18,34132 7,711,156 4,115,250 11,826,408 6.62 42.04010
362 18,353,944 7,726,135 4,101,273 11,826,408 6.59 42.00%
363 18,444,756 7,739,071 4,087,337 11,826,408 6.57 41,96%
364 18,495,568 7,752,966 4,073,442 11,826,408 6.55 41.92%
365 18,546,380 7,766,821 4,059,587 11,826,408 6.53 41.88%
366 18,567,192 7,780,636 4,045,773 11,826,408 6.50 41.84%
367 18,648,004 7,794,409 4,031,999 11,826,408 6.48 41.80%
368 18,668,816 7,808,142 4,018,266 11,826,408 6,46 41.76%
369 18,749,628 7,821,834 4,004,574 11,826,408 6.44 41.72%
370 18,860,440 7,836,485 3,990,923 11,826,408 6.42 41 AS%
371 18,861,252 7,649,096 3,977,312 11,826,408 6.39 41.64%
372 16,902,064 7,862,667 3,963,741 11,826,408 6.37 41.60%
373 18,952,876 7,876,196 3,960,212 11,826,408 6.35 41.56%
374 19,063,688 7,889,685 3,936,723 11,826,408 6.33 41.52%
375 19,064,500 7,903,133 3,923,276 11,826,408 6.31 41,48%
376 19,165,312 7,916,541 3,909,867 11,826,408 6.29 41.44%
377 19,156,124 7,929,908 3,896,500 11,826,408 6.26 41.40%
378 19,206,936 7,943,234 3,883,174 11,526,408 6.24 41.36%
379 19,257,748 7,956,520 3,869,888 11,826,408 6.22 41.32%
380 19,308,560 7,969,766 3,856,643 11,826,408 6.20 41.28%
381 19,359,372 7,982,970 3,843,438 11,826,408 618 41.24%
382 19,410,184 7,996,133 3,830,276 11,826,408 6.16 41,20%
383 19,460,998 8,009,257 3,817,151 11,826,408 6.14 41,16%
384 19,511,808 8,022,339 3,804,069 11,826,408 6.12 41.12%
385 19,562,620 8,035,381 3,791,027 11,826,408 6.10 41.08%
386 19,613,432 8,048,382 3,778,026 11,826,408 6.07 41.04%
387 19,664,244 8,063,311 3,763,097 11,826,408 6.05 41.00%
388 19,715,056 8,078,209 3,748,199 11,826,408 6.03 40X010
389 19,765,868 8,093,076 3,733,332 11,826,408 6,00 40.94%
390 19,8115,680 8,107,914 3,718,494 11,826,408 5.98 40.91%
391 19,867,492 8,122,720 3,703,688 11,826,408 5.95 40.88%
392 19,68,304 8,137,406 3,688,912 11,826,408 5.93 40.86%
393 19,969,116 8,152,242 3,674,166 11,826,408 5.91 40.82%
394 20,01,9,928 8,166,957 3,659,451 11,826.408 5.88 40.79%
395 20,070,740 8,181,642 3,644,766 11,826,408 5.86 40.76%
396 20,111,652 81196,296 3,630,112 11,826,408 5.84 40.73%
397 20,172,364 8,210,920 3,615,488 11,826,408 5.81 40.70%
398 20,223,176 8,225,513 3,600,896 11,826,408 5.79 40,67%
399 20:273,988 8,240,076 3,586,332 11,826,408 517 40,64%
400 20,324,800 8,254,608 3,571,800 11,826,408 5.74 40,61010
401 20,375I612 8,269,110 3,557,298 11,826,408 5,72 40.58%
402 20,426,424 8,283,581 3,542x827 11,826,408 5.70 40.55%
403 20,477,236 8,2998,0722 3,528,386 11,826,408 5,67 40M010
404 20,52048 8,312,433 3,513,975 11,826,4076 5.66 40A9%
405 20,578,860 8,326,812 3,490,596 11,826,408 5,63 40.46IY6
406 20,629,672 8,341,162 3,485,246 11,826,408 5.60 40A3010
407 20,686,04 8,355,481 3,470,927 11,0326,408 5.58 40.40%
408 201,73,1,296 8,369,769 3,456,639 11,826,408 5.56 40.37%
409 20,702,108 8,364,027 3,442.3e1 11,026,408 5,63 40.34%
410 20,832,920 8,398,264 3,428,154 11,826,408 5.51 40,31%
411 20,883,732 8,412,451 3,413,957 11,826A08 5.49 40.28%
412 20,934,544 8,426,618 3,399,790 11,826,408 5.47 40.25%
413 20,985,356 8,440,754 3,3866654 11,826,408 5A4 40.22%
1
414 21,036,168 8,454,859 3,371,549 11,826,408 5.42 40.19%
415 21,086,980 8,468,934 3,357,474 11,826,408 5-40 40.1601,
416 21,137,792 8,482,979 3,343,429 11,826,408 538 40.13%
417 21,188,604 8,496,993 3.329,415 11,826,408 5.35 40.10%
418 21,239,416 8,510,976 3,315,432 11,826,408 6.33 40.070
419 21.290,228 8,624.929 3,301,479 11,826,408 5.31 40,04%
420 21,341,040 8,638,852 3,287,666 11,826,408 5.29 40.01%
421 21,391,852 8,552,744 3,273,664 11,826,408 5.26 39.98%
422 21,442,664 8566,605 3,269,803 11,826,408 5.24 39,95%
423 21,493,476 8,580,436 3,245,972 11,826,408 5.22 39.92%
424 21,544,288 8,694,237 3,232,171 11,826.408 5.20 39.89%
426 21,595.100 8,608,007 3,218,401 11,826,408 5.17 39.86%
426 21,645,912 8,621,747 3,204,661 11,826,408 5.15 39-83%
427 21,696,724 8,636,456 3,190,952 11,826,408 5.13 39,80%
428 21,747,536 8,6549,134 3,177,274 11,826,408 6.11 39.77%
429 21,799,349 8,662,783 3,163,625 11,826,408 5.09 39,74%
430 21,849,160 8,676,400 3,150,008 11,826,408 5.06 39.71%
431 21,89$,972 8,689,987 3,136,421 11,826,408 5.04 39.68%
432 21,956,784 8,703,544 3,122,864 11,826,408 5.02 39,65%
433 22,001,696 8,717,070 3.109,338 11,826,408 5.00 39.62%
434 22,052,408 8,730,666 3,095,842 11,826,408 4.98 39.59%
435 22,103.220 8,744,031 3.082,377 11.826,408 4.96 39.56%
436 22,154,032 8,757,466 3,068,942 11,826,408 4,93 39.53%
437 22,204,844 8,770,870 3,055,538 11,826,408 4.91 39.50%
438 22,255,656 8,784,244 3,042,164 11,826,408 4.89 39.47%
439 22,306,468 8,797,587 3,028,821 11.826,408 4,87 39.44%
440 22,357,280 8,810,900 3,015,508 11,826,408 4.85 39.41%
441 22,408,092 8,824,182 3,002,226 11,826,408 4.83 39.38%
442 22,458,904 8,837,434 2,988,974 11,826.408 4.81 39.35%
443 22,509,716 8,850,656 2,975,752 11.826,408 4.78 39.32%
444 22,560,528 8,863.846 2,962,562 11,626,408 4.76 39.29%
445 22,611,340 8,877,007 2,949,401 11,826,408 4.74 39.26%
446 22,662,152 8,890,137 2,936,271 11,826,408 4.72 39.23%
447 22,712,964 8,903,236 2,923,172 11,826,408 4.70 39,20%
448 22,763,776 8,916,305 2,910,103 11,826,408 4.68 39.17%
449 22,814,588 8,929,343 2,897,065 11,826,408 4.66 39.14%
450 22,865,400 8,942,351 2,884,057 11,826,408 4.64 39.11%
451 22,916,212 8,955,329 2,871.079 11,826,408 4.62 30.08%
452 22,967,024 8,988,276 2,858,132 11,828,408 4.60 39.06%
453 23,017.$36 8,981,192 2,845,216 11,826,408 4,57 39.02%
454 23,066,648 8,994,078 2,832,330 11,826.408 4.55 38.99%
455 23,119,460 9,008,934 2,819,474 11,826,408 4.53 38.96%
456 23,170,272 9,019,759 2,806,649 11,826,408 4.51 38.93%
457 23,221,084 9,032,553 2,793,355 11,826,408 4.49 38-90%
466 23,271,896 9,045,317 2,781,091 11,826,408 4.47 38.87010
469 23,322.708 9,058,051 2.768,357 11,826,408 4.45 38.84%
460 23,373,520 9,070,754 2,755,654 11,826,408 4.43 38.81%
461 23,424,332 9,063,426 2,742,982 11,826,408 4.41 3878%
462 23,475,144 9,096,068 2.73(}.340 11,826,408 4.39 38.750,E
463 23,525.956 91108,680 2,717,728 11,826,408 4.37 3812%
464 23,576,768 9,121,261 2,705,147 1"1,82(1,408 4.35 38.69%
465 23,627,580 9,133,812 2,692,596 118826A08 433 38.66%
466 23,678,392 9,146,332 2,680,076 11,826,408 4.31 38.63%
467 23,724,204 9,158,421 2,667,587 11,826,408 429 38-60%
468 23,7801,016 9,171,281 2,656,127 11,826,408 4.27 38.57%
460 23,830,828 9,183,709 2,64209 111826,408 426 38.540
470 23,881,640 9,196,107 2,630,301 11,826.408 4,23 38.51%
471 23,932,452 9,208,475 2,617,933 11,826,408 4,21 38.48%
472 23,983,264 9,220,812 46W596 11,826,408 4.19 38.45%
473 24,034,075 9,233,119 2,593,289 11,326,408 417 38.42%
474 24,084,888 9,245,395 2,581,013 11,826,408 415 3839%
475 24.136,700 9,257.641 2,5 ,767 11,826-408 4.13 38360
476 24,186,512 9269,856 2,666,552 11.826,408 4.11 38.33%
477 24,237,324 9282,041 2,544,367 11,826,408 4.09 38,30,,/o
478 24288,136 9,294,195 2,532,213 11,826,408 4.07 38.27%
479 24,338,948 9,306,319 2,520,089 11,826,408 4.05 38.24%
480 24,389,760 9,318,412 2,507,996 11,826.408 4.03 38.2114
481 24,440,572 9,330,475 2,496,933 11,826,408 4.01 38,184/4
482 24,461,384 9,342,508 2,483,900 11,826.408 3.99 38.15%
483 24,542,196 9.364,509 2.471,899 11,826,408 3.97 38-12414
484 24,563,008 9,366,481 2,459,927 11,826,408 3.95 38.09%
485 24,643,820 9,378,422 2,447,986 11,826,408 3.94 38.06%
486 24,664,632 9,390,332 2,436,076 11,826,408 3.92 38.03%
487 24,745,444 9,402,212 2,424,196 11,826,408 3.90 38.00%
488 24,796,266 9,414,061 2,412,347 11,826,408 3.88 37.97%
489 24,847,068 9,425,880 2,400,528 11,826,408 3.86 37.94%
490 24,867,880 9,437,669 2,380,739 11,826,408 3.84 37.91%
491 24,948,692 9,449,427 2,376,981 11,826,408 3.82 37.88%
492 24,969,504 9,461,154 2,365,254 11,826.408 3.80 37.85%
493 26,00,316 9,472,851 2,353,557 11,826,408 3.78 37,82%
454 25,161,128 9,484,518 2,341,890 11,826,408 3.77 37.79%
495 25,151,940 9,06,164 2,330,254 11,826,408 3.75 37.76%
496 25,262,1162 9,507,755 2,318,649 11,626,408 3.73 37.73%
497 25,2 3.664 9,519,334 2,307,074 11,826,408 3.71 37.70%
498 26,364.376 9,533,411 2,292,997 11,826,408 3.69 37.67014
499 25,365"188 9,547,467 2,278,941 11,826,408 3.66 37.65%
500 25,466,000 9,561,503 2,264,905 11,826,408 3,64 37.63%
501 25,456,812 9,675,519 2,260,889 11,826,408 3.62 37.61%
502 26,567,624 9,588,316 2,238,092 11,826,408 3.60 37.59%
503 25,558,436 9,601,100 2,225,308 11,826,408 3.68 37.57%
504 25,669,248 9,615,082 2,211,326 11,826,408 3.66 37.56%
505 25,660,060 9,629,044 2,197,364 11,826,408 3.53 37.53%
506 25,718,872 9,642,985 2,183,423 11,826,408 3.51 37.51%
507 25,761,684 9,666,906 2,169,602 11,826,408 3.49 37.49%
508 25,812,496 9,670,806 2,166,602 11,826,408 3.47 37.47414
509 26,863,308 9,684,686 2,141,722 11,826,408 3.44 37.45%
510 25,914,120 9,698,546 2,127,862 11,826,408 3.42 37.43%
511 25,964,932 9,712,385 2,114,023 11,826,408 3.40 37.41%
512 26,015,744 9,726,205 2,100,203 11,826,408 3.38 37.39%
513 26,066,556 9,740,004 2,086,404 11,826,408 3.35 37.37%
514 26,1 i 7,368 9,753,782 2,072,626 11,826,408 3.33 3735414
515 26,168,180 9,767,540 2,058,868 11,826,408 3.31 37.33%
516 26,218,992 9,781,278 2,045,130 11,826.408 3.29 37.31%
517 26,269,804 9,794,996 2,031,412 11,826,408 3.27 37.29%
518 26,320,616 9,808,693 2,017,715 11,826,408 3.24 37.27%
619 26,371,428 9,822,370 2,004,038 11,826,408 322 37.25%
520 26,422,240 9,836,026 1,990,382 11,826,408 3.20 37.23%
521 26,473,052 9,849,663 1,976,745 11,826,408 3.18 37.21%
522 26,523,864 9,863.278 11963,130 11,826,408 3.16 3719%
523 26,574,676 9,876,874 1,949,534 11,826,408 3.13 37.17%
524 26,625,488 9,890,449 1,935,959 11,826,408 3,11 37.15%
525 26,676,300 9,989,004 1,922,404 11,826,408 3.09 37.13%
526 26,727,112 9,917,539 1,908,869 11,826,408 3,07 37,11%
527 26,777,924 9,931,053 1,895,355 11,826,408 105 37M410
528 26,828,736 9,944,547 1,881,861 11,826,408 103 37,07%
629 26,879,548 9,956,821 1,868,387 11,826,408 3.00 37.05%
530 26,930,360 9,971,474 1,854.934 11,826,408 2.98 3T03%
531 26.981,172 9,584,907 1,841,501 11,826,408 2.96 37Z1414
532 27,01,9f9 9,991,320 1,828,088 11,826,408 2.94 383,99%
533 27,082,7196 10,011,712 1,814,06 11,826,408 2.92 36.97414
534 27,133,608 10,025,084 1,801,324 11,826,408 2.90 38.95014
535 27,164,420 10,038,436 1,787,972 11,626,408 2.87 36.93414
536 27,235,232 10,051,767 1,774,641 11,826,408 2.85 36,91%
537 27,2 10,065,076 1,761,330 11,626,406 2,83 38.894
538 27,336,856 10,078,369 1,748,039 11,826,408 2681 36,87%
539 27,367,668 10,091,639 1J34,769 '1,826x408 2.79 36,85%
540 27,438,480 10,104,889 1,721,614 11,826,408 2.77 W83416
541 27,489,202 10,118,119 1,708,289 11,826,408 2.75 36.8"1%
542 27,540,104 10,131,329 1,695,079 11,826,408 2.73 36.79%
543 27,590,916 10,144,518 1,681,890 11,826,408 230 a6.7701.
544 27,641,728 10,157,685 1,668,722 11,826.408 2.68 36,75%
545 27,692,540 10,170,835 1,655,573 11,826A08 2.66 36.73%
546 27.743,352 10,183,963 1,642,445 11,826,408 2,64 36.71%
547 27,794,164 11},197,071 1,629,337 11,826,408 2.62 36.89%
w 27,844,976 10,210156 1,616,250 11,826,408 2.60 36.67%
549 27,895,788 10,223,225 1,603,183 11,826,408 2.58 36.65%
550 27,946,600 10,236,272 1,590,136 11,826.408 2.56 36.63%
551 27,997,412 10,20,299 1,577,109 11,826,408 2.54 36,61%
562 28,048,224 10.262.305 1,664,103 11,826,408 2.51 36.59%
553 28,099,036 10,275,291 1,551117 11,826,408 2.49 36.57%
554 28,149,848 10,288,256 1,538,152 11,826,408 2.47 36.55%
555 23200,1360 10,301,201 1,525,2011 11,826AG8 2.45 36.53%
556 28,251,472 10,314,126 1,612,282 11,826,408 2.43 36.61%
657 28,302,284 10327,031 1.09,377 11,826,408 2.41 36.49%
558 28,353,096 10,339,915 1,486,493 11,826,408 2.39 36.47%
559 28,403,908 10,352,779 1,473,629 11 M6,408 2.37 36.45%
560 28,454,720 10,365,623 1,460,785 11,826.408 2.35 36.43%
661 28,505,532 10,378,446 1,447,962 11 M6,408 2.33 36.41%
562 28,556,344 10,391,249 1,435,159 11,826,408 2.31 36.39%
563 28,607,156 10,404,031 1,422,377 11,926,409 2.29 36.37%
564 29,657.968 10,416,794 1,409,614 11,826,408 2.27 36.35%
565 28,708,780 10,429,536 1.396.872 11,826,408 2.25 36.33%
566 28.750,592 10,442,267 1,364,151 11,826,408 2.23 36.31%
567 28,810,404 10,454,958 1,371,450 11 M6,408 2.20 36.2951
564 28,861,216 10,467,839 1,358,769 11,826,408 2.18 36.27%
569 28,912,026 10,480,300 1,346,108 11,826,408 2.16 36.26%
570 28,962,840 10,492,940 1,333,468 11,826,408 2.14 36-23%
571 29.013552 10.605,560 1,320,848 11,826,408 2.12 36.21%
572 29,064,464 10,518,160 1,308.249 11,826,408 2.10 36-19%
573 29115,276 10,530,739 1,295,669 11,826,408 2.08 36.17%
574 29A86,088 10,543,298 1,283,110 11,826,408 2.06 36,15%
575 29216,900 10,555,837 1,270,571 11,826,408 2.04 36.13%
576 29,267,712 10,568,356 1,258,052 11,826,408 2.02 36.11%
577 29,318,524 10,580,854 1,245,554 11,826,408 2.00 36,09%
578 29,369,336 10,593,331 1,233,077 11,826,408 1198 36.07%
579 29,420,148 10,605,789 1,220,619 11,826,408 1.96 36.05%
580 29,470,960 10,618,226 1208.182 11,826,408 1.94 36-03%
581 29,521,772 10,630,643 1,195,765 11,826,408 1.92 36.01%
682 29,572,684 10,643,039 1,183369 11,826,408 1.90 35.99%
583 29,623,396 10,655,415 1,170,993 11,826,408 1.88 35.97%
584 29,674,206 10,667,771 1,158,637 11,826,408 1.86 35.95%
585 29,725,020 10,680,106 1,146,302 11,826,408 1-84 36.93%
586 29,775,832 10,692,421 1,133,987 11,826,408 1.82 35.91%
587 29,826,644 10,704,716 1,121,692 11,826,408 1.80 35.89%
588 29,877,456 10,716,991 1,109,417 11,826,408 1.78 3&870/a
589 29,928,268 10,729,245 1,097163 11,826,406 1,76 35-e5%
590 29,979,080 10,741,479 1,084,929 11,826,408 1.74 35.830,E
591 30,029,892 10.753,692 1,072316 11,826,408 1,72 35AI%
592 30,080,704 10,765,885 1.060,523 11,826,408 1,71 35.79%
593 30,131,516 10778,058 1,046,350 11,826,408 1.69 35.77%
594 30,182,328 10,790,211 1,036197 11,826,408 1,57 35.76%
595 30233,140 10,802,343 1,024,065 11.826,408 1,65 3513515
596 30,283,952 10,814,456 1,011,853 11,826.408 1.63 35.71%
597 30,334,764 10,826,545 999,862 11,826,408 1.61 35.69%
598 30,385,576 10,838,618 987,750 11,826,408 1.59 35.67%
599 30,436,388 10,850,668 975,740 11,826,408 1.57 35.65%
6m 30,487200 10.862.699 963,709 11,826,408 tss 35.63%
601 30,538,012 10,874,709 951,699 11,826,408 1,53 35,6110
6032 30,588,824 110,886,699 939,709 11, 6,408 i.51 35,59%
603 30,639,636 110,898,669 927,739 11,826,408 1.49 35.575
604 30,690,448 10,91*0,618 915,790 11,826,406 1.47 3&56%
605 30,741,260 10,922,547 903.861 11,826,408 1.46 35.53%
606 30,792,072 10,934,456 891.952 11,526,408 1.43 35.51%
607 30,842.884 10,946,344 880,064 11,826,408 IM MAN,,
608 30,893,696 10,958,212 868,196 11,826,408 1.40 35,47%
6309 30,944,508 101970,060 866,345 11,826,408 1.38 35.45%
slo 30,99 ,320 10,981,887 844,521 11,826,408 1.36 35.43%
Bil 31,046,132 10,993,694 832,714 11,826,408 1.34 35.41%
612 31,096,944 11,005,481 820,927 11,826,408 1.32 35.39%
613 31,147,756 11,017,247 809,161 11,826,408 1.30 36.37%
614 31,198,668 11,028,993 797,415 11,826,408 1.28 36.35%
615 31,249,380 11,040,719 785,689 11,826,408 1.26 36-33%
616 31,300.192 11,052,424 773,984 11,826,408 1.24 35.31%
617 31,351.004 11.064,109 762,299 11,$26,408 1.23 35,29%
618 31,401.816 11,075,774 750,634 11,826,408 1.21 35.27%
619 31,452,628 11,087,418 738,990 11,826,408 1.19 35.25%
620 31,603,440 11,099,042 727,366 11,826,408 117 35.23%
621 31,551252 11,110,646 715,762 11,626,408 1.15 35.21%
622 31,605,064 11,122,230 704,178 11,826,408 1.13 35.19%
623 31,656,876 11,133,793 692,615 11,826,408 1.11 35.17%
$24 31,706,688 11,145,335 681,073 11,826,408 1.09 35.15%
625 31,757,500 11,156,858 669,550 11,826,408 1.08 35.13%
626 31,806,312 11,168,360 658,048 11,826,408 1.08 35.11%
627 31,859,124 11,179,842 646,666 11,826,408 1.04 35.09%
628 31,909,936 11,191,303 636,105 11,826,408 1.02 35.07010
629 31,966,748 11,202,744 623,664 11,826,408 1.00 36.06%
630 32,011,560 11,214,165 612,243 11,826,408 0.98 35.03%
631 32,062,372 11,225,566 600,842 11,826,408 0.97 35.01%
632 32,113,184 11,236,946 589,462 11,826,408 0.95 34.99%
633 32,163,996 11,248,306 578,102 11,826,408 0.93 34.97%
634 32,214,808 11,269,645 566,763 11,826,408 0.91 34.95%
635 32.265,620 11,270,965 555,443 11,826,408 0.89 34,93%
636 32,316,432 11,282,263 544,145 11,826,408 0.87 34.91%
637 32,367,244 11,293,542 532,866 11.826,408 0.86 34.89%
638 32,416,056 11,304,800 521,608 11,826,408 0.84 34.87%
639 32,468,868 11,316.03$ 510,370 11,826,408 0.82 34.85610
640 32,519,680 11,327,256 499.152 11,826,408 0.80 34.83%
641 32,576,492 11,338,453 487,955 11,826,408 078 34.81%
642 32,621,304 11,349,630 476,778 11,826,408 017 34.79%
643 32,672,116 11,360,786 465,622 11,826,408 0.75 34,77%
644 32,722,928 11,371,923 454,486 11,826,408 0.73 34,75%
645 32,773,740 11.383,039 443,369 11,826,408 0.71 34.73%
646 32,824,552 11,394,134 432,274 11,826,408 0.69 34.71%
647 32,876,364 11,405,210 421,198 11,826,408 0.68 34.69%
648 32,926,176 11,416,265 410,143 11,826,408 0.66 34,67%
649 32,976,988 11.427,299 399,109 11,826,408 0.64 34,65%
650 33,027.800 11,438,314 38$,094 11,826,408 0.62 34A3610
651 33,076,612 11,449,308 377,100 11,826,408 0.61 34.61%
652 33,124,424 11,460,281 366,127 11,826,408 0.59 34.59%
653 33,186,236 11,471,235 355,173 11,826,408 0.57 34.57%
664 33,231,048 11,482,168 344,240 11,826,408 0,55 34.55%
666 33.281,860 11,493,080 333,328 11,826,408 0.54 34.53%
656 33,332,672 11 M3,973 322,435 11,826,408 0.52 34.51610
657 33,383,484 11,514,846 311,563 11,826,408 0,50 34.49%
658 33,434,296 11,526,697 300,711 1 I,B26,408 0.48 34,47%
669 33,485,108 11,536,528 289,880 11„$26,4003 OA7 34,45%
660 33,535.920 11,547,339 279,069 11,826,4178 0A5 3443610
661 33,586,732 11,558,130 268,27fj 11,826,408 0.43 34.41%
662 33,637,5" 11,568," 257,508 11,826,408 0.41 34.39%
w 33,686,356 11,579,650 246,758 11,826,408 OAO 34,37610
664 33,739,168 11,590,380 236,028 11,826,408 0,38 34,36%
$65 33.70,980 11 V1,090 225.318 11,826,408 0<36 34,3367
666 33,840,792 11,611,779 214,629 11,8126,408 0.35 3431%
667 33,891,604 11,622,448 203,960 11,826,408 0.33 3419%
668 33,942,416 11,633,096 193,312 11,826,408 0.31 34,27%
669 33,993,228 11,643,724 182,664 11,826,408 029 3425%
670 34,044,040 11,654,332 172,076 11,826,408 0.28 34.23010
671 34,094,852 11,664,020 161,488 11,826,408 0.26 34.21 O16
672 34,145,664 11,676,487 160,921 11,826,408 0.24 34.19%
673 34,196,476 11,686,034 140,374 11,826,408 0.23 34.179'o
674 34,247,288 11,696,560 129,848 11,826,408 0.21 34.16%
675 34,298,100 11,707,066 119,342 11,826,408 0.19 34.13%
676 34,348,912 11,717,652 108,866 11.826,408 0.18 34.11%
677 34,399,724 11,728,018 98,390 11,826,408 0.16 34.090/6
678 34,450,536 11,738,463 87,945 11,826,408 0.14 34.070/a
6579 34,501,348 11,748,888 77.520 11,826,408 0.12 34.05%
680 34,662,160 11,759,293 67,115 11,826,408 0.11 34.030
681 34,602,972 11,769,677 56,731 11,826,408 0.09 34.01%
682 34,663,784 11,780,041 46,367 11,826,408 0.07 33,99%
683 34,704,596 11,790,384 36,024 11,826,408 0.06 33,97%
684 34,755,408 11,800,708 25,700 11,826,408 0.04 33.95%
685 34,806,220 11,811,011 15,397 11,826,408 0.02 33.93%
686 34,867,032 11,821,293 5,115 11,826,408 0.01 33.91%
687 34,907,844 11,831,556 (6,148) 11,826,408 (0.01) 33.89%
688 34,958,656 11,841,798 (15,390) 11,826,408 (0,02) 33,87%
689 35.009,468 11,852,019 (25,611) 11,826,408 (0.04) 33.86%
690 35,060,280 11,862,221 (35,813) 11,826,408 (0,06) 33.83%
691 35,111,092 11,872,402 (45,994) 11,626,408 (0.07) 33.81%
692 35,161,904 11,882,562 (56,154) 11,826,408 (0,09) 33.79%
693 35,212,716 11,892,703 (66,295) 11,826,408 (0.11) 33.77%
694 35,263,528 11,902,823 (76,415) 11,826,408 (0.12) 33.75%
695 35,314,340 11,912,922 (86,514) 11,826,408 (0.14) 33.73%
696 35,365,152 11,923,002 (96,694) 11,826,408 (0.16) 33.71%
697 35,41.5,964 11.933,061 (106,653) 11,826,408 (0.17) 33.69%
698 35,466,776 11,943,100 (116,692) 11,826,408 (0.19) 33.67%
699 35,61:7,588 11,963,118 (126,710) 11,826,408 (0,20) 33.65%
700 36,668,400 11,963,116 (136,708) 11,826,408 (0,22) 33.63%
701 35,6119,212 11,973,094 (146,686) 11,826,408 (0.24) 33.51%
702 35,670,024 11,983,051 (156,643) 11,826,408 (0.25) 33.59%
703 35,720,836 11,992,988 (166,680) 11,826,408 (0.27) 33.57%
704 35,7711,648 12,002,905 (176,497) 11,826,408 (0.28) 33.55%
705 35,822,460 12,012,802 (186,394) 11,826,408 (0.30) 33.53%
706 35,873,272 12,022,678 (196,270) 11,826,408 (0.32) 33.51%
707 35,92'4,084 12,032,534 (206,126) 11,826,408 (0.33) 33,49%
708 35,974,896 12,042,369 (215,961) 11,826,408 (0.35) 33.47%
700 36,025,708 12,052,184 (225,776) 11,826,408 (0.36) 33.45%
710 36.076,520 12,061,979 (235,571) 11,826,408 (0.38) 33,43%
711 36,127,332 12,071,764 (245,346) 11,826,408 (0.39) 33.41%
712 36,17 8,144 12,081.508 (265,100) 11,826,408 (0.41) 33.39%
713 36,22'8,956 12,091,242 (264,834) 11,826,408 (0,43) 33.37D/.
714 36,279,768 12,100,955 (274,547) 11,826,408 (0.44) 33.360
715 36,33b,580 12,110,648 (284,240) 11,826,408 (0A6) 3133%
716 36,381,392 12,120,321 (293,913) 11,826,408 (0,47) 33.31%
717 36,432204 12,129,974 (303,566) 11,826,408 (0.49) 33,29%
718 36.483,016 12,139,606 (313,108) 11,826,408 (0.60) 31271/o
719 36,533t828 12,149,218 (322,810) 11,826,408 (0.52) 33,25%
720 36,584,640 12,158,810 (332,402) 11,826.408 (0-53) 33,23%
721 36,635452 12,168,381 (341,973) 11,826,408 (0,55) 312110
722 36,686,264 12,177,932 (351,524) 11,826,408 33.19%
723 36,737,076 12,18-;,463 (361,055) 11,826,408 (0m) 33.17%
724 36,78'7,888 12,196,973 (370,565) 11,826,408 (0.60) 33.15%
725 36,838,700 12,206463 (380,055) 11,826,408 (0.61) 3113%
726 36,885,512 12,215,932 (389.524) 11,526,408 (0.63) 33.11%
727 36,946,324 12,225,382 (398,974) 11,826,408 (044) 33.09%
728 36.991,136 12,234,811 (408,403) 11,826408 (0.66) 3107010
729 37,041,948 14244,219 (417,811) 11,826,408 (0.67) 3106%
730 37,09 ,-760 12,2576315 (430,907) 11,826,408 (0-69) 423.05%
731 311,14�,572 12,270,401 (441993) 11,826408
(0.71) 33,04%
732 337,1",384 12,283,477 (457,069) 11,826,408 (0.73) 3103%
733 37,245,196 12,296,542 (470,134) 11,826,408 (0.76) 33.02%
734 37,296,006 12,309,598 (483,190) 11,826,408 (0.78) 33.01%
735 37,346.820 12,322,643 (496,235) 11,826,408 (0.80) 33.00%
736 37,397,632 12,336,678 (509,270) 11,826,408 (0.82) 32.99%
737 311.44-8,444 12,348,702 (522,294) 11,826,408 (0.84) 32.98%
738 37,499,256 12,361,717 (535,309) 11.826,408 (0.86) 32,97%
739 37,660,068 12,374,722 (548,314)
11,826,408 (0.88) 32.96%
740 37,6(70,$80 12,387,716 (661,308) 11,826,408 (0,90) 32.95%
741 37,661:692 12,400,700 (574,292) 11,826,408 (0.92) 32.944
742 37,702,504 12,413,674 (587,266) 11,826,408 (0,94) 32.93%
743 37,753,316 12,426,638 (600,230) 11,826,408 (0.97) 32.92%
744 37,804,128 12,439,591 (613,183) 11,826,408 32-91%
Change the population#in cell M11 and copy all the way
down the spreadsheet
Popu,lation of Authority 621,988
Traniports 50,812
Base Collection Rate 8X59
Charige in
Collections 0.33
Totali Revenue Required 11,826,408
Average Bill 502
Emergency Rate Premium Percentage 0.57
Percentage of Emergency
Ulls to Total Calls 0.43
Non-Emergency Rate 403
Emergency Rate 633
Exhibit D
MEMORANDUM OF UNDERSTANDJNG
This Memorandum of Understanding is to confirm the discussion of the tentative
agreements reached with respect to some of the issues involved in the conversion of the
paramedic service arrangement to a countywide "Enterprise Fund Model." This
understanding is based on previous discussions between representatives of Texas Lifeline
Corporation (herein "TLC"), Richard Neuhaus, members of the Fort Worth Ambulance
Authority, its consultant, Jack Stout, and the November 1987 report to the Fort Worth
Ambulance Authority from the Fourth Party, Inc. by Jack Stout entitled "Expanding the
MedStar System: Issues, Options, and Recommendations". The parties acknowledge that
this Memorandum of Understanding does not constitute a contract but will be attached to
and incorporate in the Interlocal Cooperative Agreement and serve as a guide for the new
contract to be executed between TLC and the Multi-Jurisdictional Ambulance Authority.
These understandings are summarized as follows:
1. Ambulance Authority
The Fort Worth Ambulance Authority would be converted to a multi jurisdictional
agency (herein the "Multi-Jurisdictional Ambulance Authority") pursuant to the
Interlocal Cooperative Agreement. The Multi-Jurisdictional Ambulance Authority
would be a legal entity separate from its city members and would own, control,
manage, and administer the accounts receivable and the billing system. Title to
infrastructure property and equipment would be transferred to the Multi-
Jurisdictional Ambulance Authority by the City of Fort Worth on some basis to be
negotiated between the two on them.
The contract between the City of Fort Worth and TLC would be renegotiated and
replaced with a new contract between TLC and the Multi-Jurisdictional
Ambulance Authority on the basis of terms and conditions set forth in this
Memorandum of Understanding and as negotiated to the extent not agreed to
herein. The term of the contract would be extended by thirty-nine (39) months
with 'the same provisions for earned renewals as are included in the cur-rent
contract.
2, Per Capita Management Fee
The contract between TLC and Multi-Jurisdictional Ambulance Authority will
provide for compensation to the contractor on the basis of a per capita rate
multiplied by the population in the service area under agreement with the Multi-
Jurisdictional Ambulance Authority each time a city is added. The per capita fee
will be arrived at using the following methodology:
1.) Using Fort Worth historical demand, determine the annual gross
volume of intro jurisdictional transports and multiply times $230.00 per
emergency transport and$153.33 per non-emergency ftwisport to arrive
at a projected gross revenue figure;
2.) Multiply the projected gross revenue figure by 63% to arrive at a
projected net revenue(under the Failsafe Franchise Model) figure;
3.) Subtract the actual cost of billing and collection;
4.) Subtract $3.00 per transport, for payment of the EPAB fee which will
no longer be the responsibility of the contractor;
5) Add the annual amount of first year subsidy from Fort Worth,
$875,000,ft-
6) Divide the total amount by the population covered (using COG offi cial
figures), to arri've at a per capita figure;
7.) Adjust the per capita figure by the CPI;
8,) Adjust the per capita figure to account for the changes in the definition
of the expanded Service Area. Both parties agree that an adjustment
needs to be negotiated to reflect the differences in the extended Service
Area; and then
9.) Multiply the per capita fee, thus calculated, times the population in the
newly contracted Service Area (again using the COG figures), and
dividing by 12 to determine a Base Monthly Fee for intro jurisdictional
work(excluding"extra-work" items).
In no event will the total monthly payment be reduced (because of reduction in
Service Area size or population) without at least 365 days prior notice unless a
member city withdraws for due cause, based on contractor's default as defined in
the Interlocal Cooperative Agreement. In addition, the contractor will be paid for
"extra work", for long distance transfers, special events coverage,DRO transports,
and transports in excess of the current per capita transport rate in the City of Fort
Worth. The fees for various categories of "extra work" have not yet been
negotiated but would be similar to such terms as they appear in the Pinellas
Court.ty RFP. The per Capita rate would be discounted by two percent (2%) after
total population in the service area exceeds 700,000 and by one percent (1%)
additional for each incremental population increase of 42,000 up to a maximum
discount of fourteen percent(14%).
3. Existink,Accounts Receivable
The parties have agreed to conduct an independent appraisal of the net value of
outstanding accounts receivable based on current collection practices less the
reasonable costs of collection and will not be reduced by a present cash value
discount. All outstanding accounts receivable would then be assigned by TLC to
the new Multi-Jurisdictional Ambulance Authority. The Multi-Jurisdictional
Ambulance Authority would give TLC a negotiable promissory note for the
agreed upon net value of transferred accounts receivable. The note would bear no
interest for the first year, interest at the rate of nine (9%) thereafter or the rate
charged by Texas American Bank on the existing operating capital loans,
whichever is less, and will be payable in twenty-four(24)months after the date on
which the accounts receivable are transferred, That note and/or the accounts
receivable would continue to collateralize the existing operating capital loans form
Texas American Bank. TLC would continue to be responsible for interest on the
operating capital loan for twelve (12) months after the date the accounts
receivable are transferred. This arrangement will be subject to the approval of
Texas American Bank.
4. Billie g System Hardware, Software and Management
ConsultingfMaintenance
TLC proposes to lease its billing system hardware, software and software support
(including upgrades) to the new Multi-Jurisdictional Ambulance Authority for a
monthly fee equal to its actual cost, beginning August 1, 1988. In addition, TLC
will provide management consulting and system maintenance services for $2,500
per month. Both arrangements will be for an initial term of six (6) months,
Thereafter the Multi-Jurisdictional Ambulance Authority will have the option to
continue all or a portion of the arrangement to purchase either the computer
hardware (for its fair market value, but for not less than the amount of any
unamortized debt on said hardware) or the software package or to terminate the
use of the hardware and software 'without penalty. In the event it is the Multi-
Jurisdictional Ambulance Authority's decision to terminate said use, TLC shall
cooperate fully in effecting the conversion of the data to the Authority's new
system.
5. Three-Way Lease Augement
The ,existing three-way lease agreement covering ambulances and medical
equipment between TLC and Fort Worth Ambulance Authority would be assigned
by the Fort Worth Ambulance Authority to the Multi-Jurisdictional Ambulance
Authority, The Fort Worth Ambulance Authority would not be released under the
current lease without the prior consent of Texas American Bank, however, under
no circumstances would the dollar amount if its liability be increased above the
then current level. All new equipment purchased by TLC to be used under the
contract would be ]eased directly to the Multi-Jurisdictional Ambulance Authority
and subleased to TLC. The Fort Worth Ambulance Authority would not be
involved as a master lessee and there would be no actual or implied guaranty of
the lease arrangement by the City of Fort Worth or the Fort Worth Ambulance
Autho'nity, All ambulance and medical equipment currently owned by Meissner-
Brown which would be used under the contract would be leased by Meissner-
Brown to the Multi-Jurisdictional Ambulance Authority which would sublease to
TLC The lease payments to Meissner-Brown will be set at a monthly rate
necessary. to amortize the current value of the leased equipment over its remaining
useful life, but not more than the amount of the sub-lease payments related to the
same'equipment paid to the Multi-Jurisdictional Ambulance Authority by TLC.
1
6. Subscription Pro am
TLC will send a letter to all current subscribers soliciting renewals for a sixteen
(16) month term beginning April 1, 1988, TLC's direct costs will be reimbursed
from the renewal proceeds and the balance shall be divided pro rata as of the
conversion date the Multi-Ruisdictional Ambulance Authority assumes control
over the system. As consideration for transfer of the subscription rights, the
Multi-'Jurisdictional Ambulance Authority 8411 pay$58,500.
7. Meissner=Brown
The parties acknowledge that TLC has purchased the assets and goodwill of
Meissner-Brown on an installment contract amortized over seven (7) years. The
parties further acknowledge that the contemplated system conversion will result in
a partial or total merger of the Meissner-Brown operation into the Medstar
operation. In the event the TLC contract should be terminated prior to full
amortization of the purchase price of Meissner-Brown, the Multi-Jurisdictional
Ambulance Authority will continue to make payments to Meissner-Brown for the
amortized cost of the goodwill portion of the Meissner-Brown purchase. In
return,TLC and Meissner-Brown will waive any and all claim they may otherwise
have :to the assets and goodwill value in the Meissner-Brown operations being
contributed to the converted ambulance system,
8. Service to Non-Conti ggous JUTIm Areas and Suburban Areas
The parties acknowledge that service to non-contiguous urban areas and to
suburban areas is more expensive for the same level of service because of greater
distances and time between revenue producing transports. Additionally, on a per
capita contract, the population base is too small to justify the same level of
response time commitment. Therefore, it is understood that the contract between
TLC and the Multi-Jurisdictional Ambulance Authority will provide for a higher
per capita fee in such areas or, in the alternative, a lower level of response time
commitment commensurate with the greater expense attributable in those areas;
provided however, that in no event shall the City Of Fort Worth receive a lower
level of service or a higher price/ subsidy combination than that already
established under its current contract with TLC (except for ordinary inflation of
the Uniform Schedule of Price/Subsidy Options as approved by the Multi-
Jurisdictional Ambulance Authority), Attached is a proposed table of response
time commitments for the per capita fee described in paragraph#2 above.
9. Termination of Interim Agreement
Although no formal, written interim agreement was executed in the spring of
1987, the major elements of the recommendations included in the Fourth Party's
"Twelve Thousand Mile Tune-Up" report have been implemented. It is agreed
that the new contract contemplated in this Memorandum of Understanding would
supersede and terminate such interim understandings, that the increase in subsidy
payments will terminate with the March 10, 1988 payment and that the increased
fee for service will remain in effect until the new contract becomes effective
August 1, 1988.
This letter sets forth all the issues the resolution of which the parties considered critical to
a determination to move forward with the contemplated EMS system conversion and
expansion to a multi jurisdictional service. However, the parties acknowledge that there
are many other issues which have been discussed and will be addressed in greater detail
during negotiation of the new contract. Those additional issues include but are not
necessarily limited to assignment of existing Meissner-Brown contracts to the Multi-
Jurisdictional Ambulance Authority, drafting and executing an Interlocal Cooperative
Agreement which includes provisions for first responders and agreement to appoint
EPAB as the medical control authority, upgrading and/or replacing the dispatch center,
establishing facilities for a training center, refinancing and remodeling the existing
building, drafting and adopting a model ordinance including provisions regarding
wheelchair service, and financing the acquisition of'
ETAK.
ContiLruous Non-ContiLyuous
Priori Time Reliability Priori Time Reliability
10 8 min 90% 10 10 min SOO/o
20 10 min 900/0 20 12 min 80%
3¢ 40 0 60 min 90% 3o ,4o ,5o 90 min 80%
Priori Time Reliability Priority Time Reliability
10 10 min 90% 10 12 min 80%
20 12 min 90% 20 14 min 80%
3- j- ,50 60 min. 90% 30 ,40 ,5- 90 in 80%
Priori Time Reliabilily
3
jo
15 min 70%
20 15 min 70%
30 ,40 ,50 90 min 70%
ORDINANCE NO.
AN ORDINANCE REPEALING CHAPTER 5 OF THE CODE OF THE CI'T'Y
OF FORT WORTH (1986) , AS AMENDED, AND ENACTING A NEW
CHAPTER 5 IN LIEU THEREOF, ENTITLED "AMBULANCES/EMERGENCY
MEDICAL SERVICES, " AND PROVIDING FOR THE ESTABLISHMENT OF
AN AMBULANCE SERVICE SYSTEM TO SERVE THE CITY AND OTHER
JURISDICTIONS UNDER APPLICABLE LAW AND THE OPERATIONAL AND
MEDICAL REGULATION THEREOF; PROVIDING A PENALTY CLAUSE;
PROVIDING A SEVERABILITY CLAUSE; PROVIDING FOR PUBLICATION
AS REQUIRED BY LAW; PROVIDING FOR ENGROSSMENT AND ENROLL-
MENT OF THIS ORDINANCE BY THE CITY SECRETARY; AND PROVID-
ING AN EFFECTIVE DATE.
NOW THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY
OF FORT WORTH, TEXAS:
SECTION 1.
That Chapter 5 of the Code of the City of Fort Worth (1986) , as
amended, is hereby repealed and there is hereby enacted in lieu
thereof a new Chapter 5, entitled "Ambulance/Emergency Medical
Services, " the text of which shall read as set forth in Exhibit "A" ,
attached hereto and incorporated herein.
SECTION 2 .
Repealer. Ordinances and any resolutions in conflict herewith
are hereby repealed effective August 1, 1988.
SECTION 3 .
Sever ability. It is the intention of this Jurisdiction that
the separate provisions of this Ordinance and applicable Rules and
Regulations shall be deemed independent of all ether provisions
contained herein and it is further intended that if any of the
provisions of this Ordinance anal/or Rules be declared invalid, all
Other provisions hereof and thereof shall remain vapid and en-force-
able.
SECTION 4.
Publication. That the City Secretary of the City of Fort
Worth, Texas is hereby directed to publish the caption summarizing
the purpose of this Ordinance and the penalty clause prescribing the
penalties for violation of this Ordinance in the manner provided by
applicable state law.
SECTION 5.
The City Secretary of the City of Fort Worth, Texas is hereby
directed to engross and enroll this Ordinance by copying the caption
and penalty clause in the minutes of the City Council and by filing
the Ordinance in the Ordinance records of the City.
SECTION 6.
Effective Date. This Ordinance shall be effective August
1988.
APPROVED AS TO FORM AND LEGALITY:
City Attorney
Date: "7
ADOPTED:
_P
IV
EFFECTIVE DATE:
-2-
EXHIBIT A. UNIFORM EMS ORDINANCE
Be it ordained by the City Council of EqR—t vqqg-r�
Texas:
SEC. 1 STATUTORY AUTHORITY.
This Ordinance is enacted by the City Council of FoRroopalk ,
Texas, pursuant to Sec. 3.10, Art. 44470 Texas Civil Statutes, which
provides that local governmental units may establish standards for
ambulances, and to Sec. 4(a), Art. 4413(32c) Texas Civil Statutes
which provides that combinations of local governmental units may
contract for the provision of governmental services.
SEC. 2 GENERAL PURPOSES AND INTENT OF ORDINANCE.
It is the purpose of this Ordinance:
A. To establish a regulated ambulance service system which
can provide state-of-the-art clinical quality of care, with
reasonable, reliable response time standards, and with the goal
of furnishing the best possible chance of survival, without
disability or preventable complication, to each ambulance
patient.
B. To establish a sole-provider ambulance system, because it is
unreasonable to have unnecessarily high rates and/or public
subsidy to make needed improvements to ambulance service in
the Service Area, when a more efficiently designed system can
achieve the same results at lower cost. The most efficient
design to achieve the goals of high-quality service, at the
lowest cost, consistent with the quality of care required, is the
implementation of the system described herein.
(Exhibit A. Uniform EMS Ordinance,cant....} 2
C. To provide more effective system performance through the
provision of services by a competitively selected qualified
private operator, rather than direct governmental operation of
ambulance services.
D. To provide more effective medical control by establishing a
multi-jurisdictional Emergency Physicians Advisory Board
(EPAB) and by empowering that Board to oversee and regulate
all clinical aspects of the emergency medical system which
affect patient care.
SEC. 3 DEFINITIONS.
For the purposes of this chapter, the following words and
phrases shall have the meanings respectively ascribed to them by this
section:
A. Advanced Life Support Ambulance. Any vehicle which is
equipped to provide treatment of life-threatening emergencies
through the use of advanced airway management, intravenous
therapy, and other advanced prehospital care procedures, and
which is equipped to transport sick or injured persons to or
from health care facilities.
B. Approved Rate Schedule. Those fees for ambulance
services rendered which have been established for this
Jurisdiction by the Ambulance Authority from the Uniform
Schedule of Price/Subsidy Options.
C. Area Metropolitan Ambulance Authority ("Ambulance
Authority"). That public adn-dnistrative agency established to
oversee the operation, of the ambulance system established by
this Ordinance.
D. Base Station Physician. A physician licensed to practice
medicine in the State of Texas, knowledgeable in the
(Exhibit A. Uniform EMS Ordinance,cont....) 3
prehospital emergency medical protocols, EM$ radio
procedure and the general operating policies of the ambulance
system, and a person from whom ambulance personnel may
take medical direction by radio or other remote com-
munications device.
E. Contractor. That person selected by the Ambulance
Authority, pursuant to the Request for Proposal process, which
is awarded the right to provide all ambulance services in this
Jurisdiction, except those specifically exempted by Section 6F of
this Ordinance.
F. Emergency Medical Technician (EMT). An individual who
is a "specially skilled emergency medical technician" under Sec.
1.03 (10) of Art. 4447o, Texas Civil Statutes.
G. EMS Control Center or Control Center. The single
facility designated by the Ambulance Authority as the central
communications center from which all ambulances operating in
the Service Area shall be dispatched and controlled.
H. Emergency Physicians Advisory Board ("EPAB"). The
medical board created by this Ordinance and empowered to
promulgate the various standards, rules and regulations
related to clinical aspects of ambulance service and first
responder services within the Service Area, and to perform
medical audits and otherwise monitor system performance.
1. First Responder. Any person, fire department vehicle,
police vehicle, or other vehicle not normally used for purposes
of patient transport, but which vehicle and on-board personnel
are capable of providing first responder services in medical
emergencies.
J. Helicopter Rescue Unit. Any rotary wing aircraft
providing basic or advanced life support services and patient
(Exhibit A. Uniform EMS Ordinance,cunt....} 4
transportation originating from the scene of emergency
incidents which occur within the Service Area,
K. Interlocal Cooperative Agreement ("Agreement"). That
contract adopted by this jurisdiction concurrently with the
passage of this Ordinance, which contract is entered into by
this Jurisdiction pursuant to Art. 4413(32c) Texas Civil Statutes
more commonly known as the "Interlocal Cooperation Act."
L. Medical Audit. An official inquiry into the circumstances
involving an ambulance run or request for ambulance service,
conducted by the Medical Director or a licensed physician
designated by the Medical Director.
M. Medical Control. Direction given ambulance personnel by
a base station physician through direct voice contact, with or
without vital sign telemetry, as required by applicable medical
protocols promulgated by the EPAB, and by Sec. 10.3(19), Art.
4447o, Texas Civil Statutes.
N. Medical Director. The licensed physician appointed by the
EPAB serving as administrative officer in carrying out the
duties and powers of the EPAB.
0. Medical Protocol. Any diagnosis-specific or problem-
oriented written statement of standard procedure, or
algorithm, promulgated by the EPAB as the normal standard of
prehospital care for a given clinical condition.
P. Mutual Aid Agreement. A -,written agreement between the
Ambulance Authority and one or more entities whereby the
signing parties agree to provide backup ambulance service to
one another under conditions and pursuant to terms specified
in the agreement as approved by the Ambulance Authority.
(Exhibit A. Uniform EMS Ordinance, cont....) 5
Q. Paramedic. A person qualified as a certified "paramedic
emergency medical technician" as defined by Sec. 1-0301) of
Art. 44470, Texas Civil Statutes.
R. Patient. An individual who is ill, sick, injured, wounded or
otherwise incapacitated and is in need of or is at risk of needing
medical care during transport to or from a health care facility.
S. Person. Any individual, firm, association, partnership,
corporation, governmental entity, or other group or
combination acting as a unit.
T. Response Time. The actual elapsed time between receipt
of notification at the EMS Control Center that an ambulance is
needed at a location within the Service Area and the actual
arrival of an ambulance at that location.
U. Senior Paramedic in Charge. That person among the
certified personnel assigned to an ambulance, not the driver,
who is a certified paramedic designated as the individual in
command of the ambulance.
V. Service Area. That geographic area which is contained
within the boundaries of all of the jurisdictions which adopt
this Uniform EMS Ordinance, and which adopt and execute
the Interlocal Cooperation Agreement implementing the
Ordinance, thereby becoming members of the Ambulance
Authority.
W. Special Event. Any public event located within the Service
Area, for which standby ambulance service is arranged in
advance, and for which an ambulance or ambulances) are
hired by the sponsor of the event or other interested party.
X. Specialized Mobile Intensive Care Unit. A vehicle which is
specially constructed, equipped, staffed, and employed in the
(Exhibit A. Uniform EMS Ordinance,cant....} 6
interfacility transport of patients whose requirements for
enroute medical support are likely to exceed the clinical
capabilities of an advanced life support ambulance.
SEC. 4 EMERGENCY PHYSICIANS ADVISORY BOARD (EPAB).
There is hereby created an Emergency Physicians Advisory Board
which shall oversee and regulate on behalf of this city all medical
aspects of the ambulance system which affect patient care.
A. The EPAB shall consist of a board whose membership shall
be composed as follows:
(1) The medical director, or his designee, of each
hospital emergency department which is located within
the Service Area and which maintains an emergency
medical services department staffed twenty-four (24)
hours per day, seven (7) days per week by in-house
physicians; all EPAB members shall be licensed
physicians, preferably engaged in the full-time practice of
emergency medicine; and,
(2) Five (5) additional licensed physicians with active
specialties or sub-specialties of benefit in developing
standards for emergency prehospital care, and who are
appointed by and serve at the pleasure of the Tarrant
County Medical Society.
(3) The EPAB may, at its option, elect from among its
members an Executive Board consisting of not less than
seven nor more than nine physicians, which Executive
Board shall exercise such powers and duties of EPAB as
are set forth in written by-laws approved by a two-thirds
majority vote of the entire EPAB membership.
(Exhibit A. Uniform EMS Ordinance,coast....}
B. The EPAB shall appoint a Medical Director who shall be
responsible for the day-to-day affairs of the EPAB in carrying
out its duties under this Ordinance. The Medical Director shall
be a licensed physician who is board-certified in emergency
medicine. The Medical Director shall serve at the pleasure of
EPAB.
C. The EPAB shall have the following powers and duties:
(1) To recommend to the Ambulance Authority medically
appropriate response time standards for this Jurisdiction;
(2) To establish standards for patient care, including
standards for ambulance and first responder vehicles and
on-board equipment;
(3) To develop medical protocols for ambulance and first
responder services and periodically revise same;
(4) To develop control center protocols and periodically
revise same;
(5) To conduct medical audits and develop standards
and procedures for the conduct of such audits;
(6) To develop and periodically revise and administer
both written and practical tests for the certification and
licensing of emergency medical services personnel,
including ambulance personnel, first responders, and
EMS control center personnel,;
(7) To develop and periodically revise and administer
educational material, programs and/or tests to insure
that base station physicians are knowledgeable of the
local ambulance system, its medical protocols, radio
(Exhibit A. Uniform EMS Ordinance,cunt....} 8
procedures, and transport protocols; and to certify
qualified physicians as base station physicians;
(8) To conduct inspections of vehicles, equipment and
supplies on both an announced and unannounced basis;
(9) To monitor response time performance; in this
regard, the Ambulance Authority shall furnish such
statistical information regarding response time
performance as may be requested by EPAB;
(10) To develop standards and procedures for the
resolution of disputes regarding the application of
exemptions from late run penalties assessed against the
ambulance service contractor for failure to meet response
time standards;
(11) To periodically conduct intensive reviews of the
system's performance relative to specific clinical types
and to revise medical protocols and such other standards
of the system as may be appropriate in light of the
findings;
(12) To conduct medical audits of individual cases as
requested by the Ambulance Authority, by any elected
official of a member jurisdiction, by any licensed
physician regarding a patient of such physician, or by any
paramedic involved in the case which is the subject of the
audit request;
(13) To annually present a written and oral report to the
Ambulance Authority concerning the state of clinical
performance of the ambulance system; each member
jurisdiction shall be informed of the time and place of
such oral report at least 30 days in advance of that
(Exhibit A. Uniform EMS Ordinance,cont....) 9
meeting and shall be invited to send representatives, and
shall be furnished a copy of the written report;
(14) To establish such committees as may be necessary
to aid in the performance of its powers and duties;
(15) To approve standards governing the operation of
specialized mobile intensive care units, including
standards limiting the types of patients which may be
transported thereby, and to issue, suspend, revoke, and
renew permits for the operation of such units as required
by this Ordinance;
(16) To approve standards governing the operation of
helicopter rescue units, including standards defining the
circumstances under which such units may be deployed to
emergency scenes, and to issue, suspend, revoke, and
renew permits for the operation of such units as required
by this Ordinance; and,
(17) To approve standards governing the operation of
point-to-point wheelchair transport units, including
standards limiting the types of patients which may be
transported thereby, and to issue, suspend, revoke, and
renew permits for the operation of such units as required
by this Ordinance.
D. For each patient transported by the Ambulance Authority or
its contractor, and for each patient transported by other
providers issued permits pursuant to this Ordinance, the
transporting provider shall pay to EPAB a fee of three dollars
($3.00), which sum shall be used to defray the costs of medical
regulation of the EMS system. Such payments shall be made
monthly by the fifteenth (15th) day of each month for services
rendered during the previous calendar month. Such funds
shall be maintained in a separate account administered by the
(Exhibit A. Uniform EMS Ordinance,cunt....} 10
Ambulance Authority on EPAB's behalf, and shall be expended
solely for the purposes set forth in this Sec. 4 as approved by
EPAB or its Executive Board. Effective August 1, 1990, this
per-transport fee shall be automatically increased to four
dollars ($4.00) per patient transported, and may thereafter be
periodically increased at the discretion of EPAB, subject to
approval by the Ambulance Authority, but not more often than
annually, and no single increase may exceed five percent (5%).
E. Effective August 1, 1988, funds then remaining in the
account of the Emergency Physicians Advisory Board of the
City of Fort Worth shall be automatically transferred to the
EPAB account established and maintained by the Ambulance
Authority.
F. This Jurisdiction shall indemnify and hold harmless EPAB,
its members, its Medical Director, and EPAB staff members
from liability for actual damage, including costs and attorney's
fees, arising from any claim, lawsuit, or judgement resulting
from an act or omission of said EPAB member, the Medical
Director, or EPAB staff member while acting in the scope and
course of his office, provided that such liability arises out of or
in connection with the provision of ambulance services or first
responder services originating within the corporate limits of
this Jurisdiction.
SEC. 5 AREA METROPOLITAN AMBULANCE AUTHORITY.
By adopting this Ordinance, and concurrently therewith
executing and approving the Interlocal Cooperative Agreement,
there is hereby established an Area Metropolitan Ambulance
Authority, which is herein called the "Ambulance Authority;" and in
regard to that Ambulance Authority the following shall apply:
_k The Ambulance Authority is hereby designated as the sole
provider of all ambulance services within this jurisdiction,
(Exhibit A. Uniform EMS Ordinance,cant....} 11
pursuant to the terms, conditions and provisions of the
Interlocal Cooperative Agreement, except for those services
exempted by Sec. 417, below.
B. The Ambulance Authority shall comply with all terms of the
Interlocal Cooperative Agreement, and have all of the duties,
powers and responsibilities enumerated therein.
C. The Ambulance Authority is require4 to provide this
jurisdiction with advanced life support ambulance service.
Such service shall comply with all applicable state laws and
rules, as well as all rules, regulations, standards and response
times as the Ambulance Authority or EPAB may from time to
time promulgate.
D. After termination of the current competitively-awarded
contract between the City of Fort Worth and Texas Lifeline
Corporation, which amended contract shall be assigned to the
Ambulance Authority effective August 1, 1988, and any
extensions thereof, the Ambulance Authority shall provide such
ambulance service by the award of a contract to a qualified
provider after a competitive bid process. However,
compliance with response time and quality of care standards
are the non-delegable duty of the Ambulance Authority.
SEC. 6 VIOLATIONS.
It shall be unlawful:
A. To perform duties as an ambulance driver, attendant
(EMT or paramedic), or EMS dispatcher without a current
certification issued by the EPAB;
B. To permit a person to work as an ambulance driver,
attendant or EMS dispatcher without a current license issued
by the EPAB;
(Exhibit A. Uniform EMS Ordinance,cont....) 12
C- To use, or cause to be used any ambulance service other
than that of the contractor authorized to operate in this
Jurisdiction by virtue of its contract with the Ambulance
Authority, except those services described in Paragraph F of
this Section 6.
D. For any person, firm or organization to provide ambulance
service within this jurisdiction, other than the contractor which
contracts with the Ambulance Authority; or to provide point-
to-point wheelchair transport services to or from health care
facilities, helicopter rescue services, or specialized mobile
intensive care services except in accordance with EPAB
regulations governing the delivery of such services, and then
only pursuant to a permit issued by EPAB for the operation of
such units; or after August 1, 1989 to provide first responder
services without a first responder permit issued by EPAB. All
such special permits when issued by EPAB shall be valid for a
period of two (2) years, and then shall be subject to provisions
governing renewal, such provisions to be developed by EPAB.
Holders of such permits shall comply with requirements for
payment of permit fees as set forth in Section 4D, hereof.
E. To knowingly give false information to induce the dispatch
of an ambulance or helicopter rescue unit.
F. It shall be a defense to any alleged violation of this Section 6
that the vehicle is being used solely in any of the following
manners:
(1) A privately owned vehicle not ordinarily used in the
business of transporting persons who are sick, injured,
wounded, incapacitated or helpless.
(2) A vehicle rendering service as an ambulance in the
event of a major catastrophe or extreme system overload
(Exhibit A. Uniform EMS Ordinance,cont....) 13
when such condition is declared by the Medical Director,
the Executive Director of the Ambulance Authority, or by
an authorized representative of the Ambulance
Authority's contracted ambulance service provider, and
such assistance has been requested by the Control Center.
(3) Any ambulance owned or operated by the federal or
state government.
(4) Any transport to a location within the Service Area,
which transport originated from a point outside the
Service Area.
(5) Mutual aid calls when rendered pursuant to a
mutual aid agreement approved by the Ambulance
Authority.
(6) Special events coverage, so long as such service is
provided without charge by an emergency medical
services volunteer provider, as defined in Sec. 1.03(18),
Art. 44470, Texas Civil Statutes.
(7) Wheelchair transport services which are not
provided on a point-to-point basis, but which provide
pickup and delivery by way of regularly scheduled routes.
(8) Medical transports by helicopter where such
transports originate outside the Service Area or at a
hospital location within the Service Area.
(9) Point-to-point wheelchair transport services
rendered by not-for-profit organizations.
{Exhibit A. Uniform EMS Ordinance, cant....} 14
SEC. 7 PENALTIES.
The following provisions for application of penalties for
violation of this Ordinance shall apply:
A Any person convicted of violating the provisions of this
Ordinance shall be fined no more than five hundred dollars
($500.00). This does not serve to limit any other remedies
available to this Jurisdiction in law or equity.
B. Each day that any violation of this article is committed or
permitted to continue shall constitute a separate offense.
SEC. 8 TRAFFIC LAWS; EXEMPTION.
When the driver of an ambulance has reasonable grounds to
believe that an emergency exists, as determined by the EMS control
center, the driver of the ambulance may:
A Park or stand, irrespective of the otherwise applicable
provisions of law, ordinance or regulations;
B. Proceed past a red or stop signal or stop sign, but only
after slowing down as may be necessary for safe operation;
C. Exceed the maximum speed limits permitted by law,
ordinance or regulation; provided, however, that life and
property are not endangered thereby;
D. Disregard laws, ordinances and regulations governing
directions or movements or turning in specified directions.
E. Provided, however, that any exemption herein granted
shall apply only when such ambulance is operating with siren
and emergency lights in operation, and when such audible and
visual signals meet the requirements of law, ordinance or
regulation; and provided further, that the foregoing provisions
(Exhibit A. Uniform EMS Ordinance,cont....) 15
shall not operate to relieve the driver of any ambulance from
the duty to drive with due regard for the safety of all persons,
nor shall such provisions protect the driver from the
-consequences of his reckless-disregard for the safety of others.
City of Fort Worth, Texas
"affor and ouncit Communication
DATE REFERENCE NUMBER LOG NAME PAGE
12MEDS I of 2
12/15/98 C-17191
suBjEar AUTHORIZE REVISED EMERGENCY MEDICAL SERVICES INTEffLOCAL
cboPERATIVE . AGREEMENT AND ADOPT REVISED UNIFORM EMERGENCY
MEDICAL SERVICES ORDINANCE
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the City Manager to execute an Emergency Medical Services Interlocal Cooperative
Agreement as described below; and
2. Adopt the attached ordinance which amends Chapter 5 of the City Code, "Ambulances/Emergency
Medical Services", and contains uniform provisions for the regulation of emergency medical
services in each member jurisdiction of the Area Metropolitan Ambulance Authority.
DISCUSSION:
The Area Metropolitan Ambulance Authority (the Authority) is an interlocal cooperative of thirteen
jurisdictions (Fort Worth, Burleson, Forest Hills, Haltom City, Haslet, Lakeside, Lake Worth, River Oaks,
Saginaw, Sansom Park, Westover Hills, White Settlement, and Westworth Village) formed for the
purpose of providing ambulance services in the region. The Authority was created in 1988 as a
successor to the Fort Worth Ambulance Authority and operates under the "MedStarO trade name.
The Authority's business structure is based on the Public Utility Model, wherein billing and collection is
perforrned by Authority staff and ambulance service is provided by a contractor under a performance-
based contract. Placing the financial risk of collection of patient fees on the Authority allows the
contractor to focus on provision of the medical and clinical services uninfluenced by fluctuations in the
collection rate. In addition, the ambulance contract is competitively awarded to a single provider which
is given, with certain exceptions, the exclusive right to furnish ambulance services in the Authority's
service area. The single provider system assures that ambulance patients receive a uniform level of
patient care and reduces the need for taxpayer subsidies created when other ambulance firms are
allowed to serve only the lucrative segments of the market. Medical regulation and quality control for
the system is provided by a medical director who is hired on a contract basis, and by the Emergency
Physicians Advisory Board (EPAB), composed of emergency room physicians representing each major
hospital, and other physicians appointed by the Tarrant County Medical Society. The EPAB serves
without compensation.
The Authority is currently conducting a Request for Proposal (RFP) process for awarding a new
ambulance contract to a qualified operator to furnish and manage dispatch and field operations
services. The RFP process also is reflective of changes in the industry, and based on the proposals
received, may provide an opportunity to operate non-exclusive "demand management" services and
wheelchair and other medical transportation services. As part of the process, the Authority is
requesting that its member jurisdictions, including Fort Worth, adopt a revised intedocal cooperative
agreement and revised uniform ambulance services ordinance. Copies of the revised agreement and
the ordinance are attached.
City of Fort Worth, Texas
U
"affor and cou"61 Comm nication
W
DATE REFERENCE NUMBER I I NAME
AGE
12/15/98 C-17191 12MEDS 2 of 2
SUBJECT AUTHORIZE REVISED EMERGENCY MEDICAL SERVICES INTERLOCAL
COOPERATIVE AGREEMENT AND ADOPT REVISED UNIFORM EMERGENCY
MEDICAL SERVICES ORDINANCE
As with the current Intedocal Agreement, the revised Interlocal Agreement provides that, until.such time
as the total population of the member jurisdictions exceeds 880,000 persons, the Authority's affairs
shall be governed by a board composed of directors appointed by Fort Worth (4 members), other
member jurisdictions (1 member for each 110,000 population) and the Medical Director (who serves ex
officio, but with voting rights). Annually, each member jurisdiction has the ability to select the
price/subsidy option to be applied to the member jurisdiction for the year, provided that no jurisdiction
can reduce its subsidy by more than 10% per year until the Authority establishes a prudent net worth
equal to 50% of its annual budget. Each member jurisdiction is required to establish and fund a first
responder operation and to adopt the Uniform EMS Ordinance.
The Uniform EMS Ordinance establishes the Authority as the provider of ambulance services in the
adopting jurisdiction, establishes the EPAB to oversee medical regulation of the system, and
establishes a single provider system with certain exceptions. The ordinance also provides for EPAB
regulation of wheelchair transport units, stretcher vans and other patient transportation services.
FISCAL INFORMATION/CERTIFICATION:
The Finance Director certifies that adoption of the revised contract and ordinance will have no material
effect on City funds.
CB:k
Submitted for City Manager's —EE—NTER AM 0 CITY SECRETARY
Office br. ct APPROVED
Mike Groomer 6140 CITY COUNCIL
Originating Department Read: DEC 15 im
Wade Adkins 7623 (from) V
setTetary of the
Cil Fort Worth,T--xA-;
Additional Information Contact: city
David Yett 7619
30*