Item #04 Approval of Renewal of EMT/Paramedic Student Affiliation Agreement c of Good L;,.
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AGENDA ITEM COVER SHEET
Meeting Date: November 2, 2010
Item # ?
Reviewed By:
Contact Name: Pete McNeil Department Director: Pete McN it
Contact Number: 407 - 905 -3127 City Manager: Robert Frank J -�,
Subject: Renewal of EMT /Paramedic Student Affiliation Agreement between City of Ocoee and
Valencia Community College
Background Summary:
The City Commission approved for the Ocoee Fire Department to enter into an agreement with Valencia
Community College to provide supervised learning experiences for the College's emergency medical services
students on August 5, 2008. That agreement is set to expire on December 31, 2010. The Ocoee Fire Department
would like to renew the agreement for another two year period from January 1, 2011 to December 31, 2013.
Issue:
The City of Ocoee Fire Department utilizes its facilities to provide clinical experiences for students enrolled in the
College's emergency medical services programs. This provides an excellent learning experience for both the
students and the personnel of the Ocoee Fire Department. The terms of the original agreement allow it to be
extended by agreement of both parties. Commission approval is requested for the new agreement.
Recommendations
It is the recommendation of the Ocoee Fire Department that the City of Ocoee adopt the January 1, 2011 to
December 31, 2013 agreement between the City of Ocoee and Valencia Community College.
Attachments:
October 8, 2010 letter from Valencia CC requesting renewal of agreement
Two sets of the agreement, to be signed and returned to Valencia Community College
Certificate of liability insurance provided by Valencia Community College
Financial Impact:
There is no financial impact to either party.
Type of Item: (please mark with an "x')
Public Hearing For Clerk's Dept Use:
Ordinance First Reading / Consent Agenda
Ordinance Second Reading Public Hearing
Resolution Regular Agenda
Commission Approval
Discussion & Direction
v Original Document/Contract Attached for Execution by City Clerk
Original Document/Contract Held by Department for Execution
Reviewed by City Attorney N/A
Reviewed by Finance Dept. N/A
Reviewed by Human Resource N/A
y Director
1
VALENCIA
A BETTER PLACE TO START"
October 8, 2010
Chief Pete McNeil
Ocoee Fire Department
563 S. Bluford Ave
Ocoee, FL 34761
RE: Renewal of Affiliation Agreement
Dear Chief McNeil:
The current Letter of Agreement between Ocoee Fire Department and Valencia
Community College's Emergency Medical Services (EMT /Paramedics) expires
December 31, 2010. We would like to continue our clinical partnership with you by
renewing the Agreement for another two years from January 1, 2011 until December 31,
2012.
Enclosed you will find two (2) original Affiliation Agreements for your review. These
agreements have recently been revised by Valencia's legal department. If you approve,
please sign both sets and return both sets to me. (A self addressed envelope has been
enclosed for your convenience.) An original executed copy will be forwarded to your
office upon completion of the final signatures. Also enclosed is a new Certificate of
Insurance has been ordered. .
If you have any questions or concerns, please contact me at 407/582 -5687. We are very
grateful for your support of our programs and look forward for a mutually beneficial
clinical partnership.
Sincerely,
Penny Conners
Dean of Allied Health
/dp
Enclosures
Punt Uffic 130 3028
l)rlando Florida 12807 ;1128
(407)'_`19 -5000 Stint mi 339 -01 I
Valencia Community College • an cyual oppurtunitN institution
AFFILIATION AGREEMENT
BETWEEN
THE DISTRICT BOARD OF TRUSTEES
OF
VALENCIA COMMUNITY COLLEGE, FLORIDA
AND
THE CITY OF OCOEE, FLORIDA
THIS AFFILIATION AGREEMENT, entered into and effective
, 20 , is between THE DISTRICT BOARD OF TRUSTEES
OF VALENCIA COMMUNITY COLLEGE, FLORIDA, (hereinafter the "College "), and,
The City of Ocoee, Florida (hereinafter the "Agency "), hereinafter collectively referred to as
the "Parties ".
WHEREAS, the Agency is located at 150 N. Lakeshore Drive, Ocoee, Florida, 34761,
and provides clinical and/or medical services;
WHEREAS, the College is a public higher educational institution with approved
programs of study as specified in Exhibit "A," (hereinafter the "Programs "), which require
clinical or observation experiences of students enrolled therein (hereinafter "Clinical or
Observation Experience Rotation" or "Rotation "), and desires its students in the Programs
(hereinafter the "Students" or "Program Students ") to obtain educational experiences by utilizing
appropriate facilities within the Agency (hereinafter the "Facilities ") and personnel of third
parties consistent with the purpose of the College as well as accreditation and /or professional
requirements and standards; and
WHEREAS, Agency is a municipal corporation which has the resources in equipment
and staff to provide the educational experiences required by the Programs, and has agreed to
make such resources available to College; and
WHEREAS, it is to the benefit of both the College and the Agency to cooperate in the
educational preparation of Students enrolled in the Programs so as to promote excellence in
patient care, to ensure professional competence, and to provide maximum utilization of
community resources;
NOW AND THEREFORE, in consideration of mutual promises herein and other good
and valuable consideration, College and Agency agree that any Rotation established and
implemented by Agency and College during the term of this Agreement shall be subject to the
following terms and conditions:
1. PURPOSE. The purpose of this Agreement is to establish procedures and guidelines for
the provision of educational experiences within the Facilities for Program Students.
2. RESPONSIBILITY OF AGENCY. Except for acts to be performed by College
pursuant to the provisions of this Agreement, Agency shall furnish the Facilities,
personnel, services and all other items necessary for the educational experience, and, in
connection with such Rotation, Agency also shall:
a). Employ medical/health care providers, administrative, and direct patient care staff
who are currently licensed to practice in their designated health profession in the
State and who are qualified either through experience and/or academically to uphold
and demonstrate standards of health care practice as established by Agency;
b). Cooperate with the College in a mutually agreeable manner in enforcing College
policies and procedures related to Student performance and Student conduct,
provided that such policies and procedures do not conflict with Agency's policies
and procedures. In the event of a conflict, Agency's policies and procedures will
control.
c). Endeavor to comply with all applicable requirements of any accreditation
authority over Agency and certify such compliance upon request by College.
d). Permit the authority responsible for accreditation of College's curriculum to
evaluate for consistency with institutional purpose, vision, values and mission the
Facilities, services and all other items provided by Agency upon reasonable
notice.
e). Designate a person(s) to serve for Agency as liaison(s) (hereinafter the "Agency
Liaison "), and provide College, in writing, the name and professional and
academic credentials of all persons proposed as Agency Liaison prior to the start
of the educational experience(s), who will:
(1) Assist the College's coordinating faculty members (hereinafter the
"Faculty ") with the planning of educational experiences and patient care
assignments; and
(2) Meet with the College's coordinating Faculty to discuss the quality of the
educational experiences and any problems which may have arisen in the
provision of those experiences.
f). Endeavor to include appropriate members of the Faculty in Agency meetings or
communications when policies to be discussed will affect or are related to the
Rotation and /or Students at the Agency's discretion.
g). Provide the Students and Faculty with an orientation of the Facilities, or
orientation packets about the Facilities /Agency, which will include training about
policies and procedures, including without limitation the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), as modified by the Health
Information and Technology for Economic and Clinical Health Act (HITECH
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Act), especially as it relates to the Agency's confidentiality requirements, and
instruction on OSHA regulations regarding blood -borne pathogens, infectious
disease plans, and hazardous chemical plan, and how, when and why to report
incidents.
h). Provide supervised educational experiences for Students that fulfill the curriculum
requirements of the Program and meet the objectives agreed upon by the College
and the Agency. Allow Faculty access to the Facilities for the purposes of
coordinating, observing and instruction of Students engaged in educational
experiences;
i). Plan, administer and retain total responsibility for all aspects of patient care and
provide for qualified supervision of all patient activities.
j). Provide Faculty and Students with, or seek emergency accident care for injuries,
or illnesses of an acute nature, incurred while on duty at the Facilities.
Emergency treatment of Students or Faculty for any injuries incurred during
educational activities must be covered through the individual's personal health
insurance plan, or through his/her own resources. Personal health insurance
coverage for the College's Faculty and/or Students will not be the responsibility
of the College and/or Agency.
k). Not guarantee it will place or maintain placement of any Student at Agency.
1). Notify College of any Student whose work or conduct with clients, patients or
personnel is not, in the opinion of Agency, in accordance with acceptable
procedures or standards of performance or otherwise could disrupt patient care or
Agency's operation. The notice shall be prompt and contain an appropriate
description of the work or conduct necessitating the notice or removal of the
Student from the Facilities. Agency may withdraw any Student or Faculty from its
facilities whose conduct or work with patients, personnel, or medical staff is not
in accordance with the policies and procedures of Agency or is detrimental to
patients or others and College agrees to immediately communicate and implement
as appropriate the Agency's determination to withdraw such student or instructor
from Agency's Facilities.
m). Provide Faculty with written policies, procedures, standards of care and protocols of
Agency, which College acknowledges shall govern Students and Faculty involved in
the Rotation. The Agency may at any time summarily relieve a Student from a
specific assignment, or request that a Student or Faculty member leave a patient care
area for causes related to the quality of patient care;
n). Maintain its operating license and appropriate accreditation.
o). Provide preceptors for any Rotation for which College requests preceptors.
Preceptors selected by Agency for a Rotation will meet such experience, licensure,
and skills requirements as are mutually agreed upon by the College and the
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Agency. Agency designee will work with Faculty in determining the assignment
of Agency preceptors within the Rotation(s). The Program(s) for which Rotation
preceptors are requested are listed on Exhibit "B ".
3. RESPONSIBILITIES OF COLLEGE. The College shall:
a). Require a physical examination of all Students prior to their participation in the
Rotation. This examination shall include general physical exam, utilizing history
(mobility, motor skills, hearing, visual and tactile abilities) and immunization
assessment (Rubella, Rubeloa, Varicella, Diphtheria, Hepatitis B) TB screening,
and Tetanus. Required immunizations and PPD must be current. All Students
and Faculty must have current immunizations including Hepatitis B, MMR,
Tetanus. College will maintain required immunization records and provide copies
to the Medical Center upon request. All Students and Faculty must have a current
PPD. College will notify Medical Center of positive PPD results.
b). Cause a criminal background check to be conducted on all Students over the age
of 18 years and all Faculty, prior to sending Students and Faculty to Agency's
facility to participate in a Rotation. The criminal background check must include
all cities, counties, and states in which the Student or Faculty has resided and in
which the Student or Faculty has worked at any time during the preceding ten (10)
years. Agency will provide College with a list of convictions and /or pending
charges that Agency has determined will disqualify a Student or Faculty from
Rotation participation ( "Student Disqualification Guidelines — Criminal
Background" attached hereto as Exhibit C). College will not send any Student or
Faculty who is disqualified to Agency's facility to participate in a Rotation. In the
event College is unable to determine whether a particular Student or Faculty is
disqualified pursuant to Agency's list, College will consult Agency for Agency's
evaluation and determination. College must certify to Agency that a criminal
background check has been conducted on each Student and Faculty in compliance
with this requirement and that no disqualified Student or Faculty has been sent to
Agency's facility to participate in a Rotation.
c). Provide Agency, in writing, the names of the Students assigned by College to
participate in the Rotation prior to the beginning of the Rotation.
d). Present Program Students for Rotations who have adequate preclinical instruction
and who, in the discretion of the Faculty, have adequately fulfilled the preclinical
requirements of the Program curriculum;
e). Agree to require Students and Faculty to obtain and maintain, as a condition of
their participation in the Rotation and during the term of their Rotation
participation at Agency, professional liability insurance. Such insurance shall be
on a per occurrence basis in amounts no less than one million dollars /three million
dollars ($1,000,000.00/$3,000,000.00) for personal injuries. Prior to any Student
commencing his or her training, and prior to any Faculty coming on site to
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participate in a Rotation, the College shall provide the Agency with a Certificate
of Insurance evidencing such coverage. Such professional liability insurance shall
cover any and all liability for claims, damages, or injuries to persons whatsoever
kind or nature arising out of the activities of such Student and Faculty carried out
under this Agreement. Agency shall be named as a loss payee insured under such
professional liability policy or policies. In the event Students or Faculty
participating at Agency will not have patient contact, those Students or Faculty
shall not be required to procure and maintain any such policy or policies of
liability insurance as described above.
f). Provide the services of a Faculty member, or other College liaison, who will:
(1) Plan, in conjunction with staff member(s) of the Agency, the educational
experiences and patient care assignments that will fulfill the educational
requirements of the Program curriculum; and
(2) Meet with staff member(s) of the Agency to discuss the quality of the
educational experiences and any problems which may have arisen in the
provision of those experiences.
g). Upon receipt of Agency's notice of a Student or other Rotation participant whose
work or conduct with clients, patients or personnel is not in accordance with
acceptable procedures or standards of performance or otherwise could disrupt
patient care or Agency's operation, evaluate such Student's or Rotation
participant's conduct and take appropriate action. It is understood that, if Agency
takes action under the provisions of Section 2.1., above, that the Student's or
Rotation participant's participation in the Rotation at Agency shall immediately
cease, subject to being resumed only with the mutual written agreement of
College and Agency.
h). Not guarantee it will place or maintain the placement of any Program Student at
Agency.
i). Agree to require participating Faculty, staff and Students to comply with the
applicable policies and procedures of the Agency during the course of their
participation, to the extent permitted by law. Solely for the purpose of defining
the Students' role in relation to the use and disclosure of the Agency's protected
health information, such Students are defined as members of the Agency's
workforce, as that term is defined by 45 CFR 160.103, when engaged in activities
pursuant to this Agreement. However, such Students are not and shall not be
considered to be employees of the Agency.
j). Agree to require Program Students, Faculty and other College- employed Program
participants, as a condition of their participation in the Program, to execute a
Confidentiality Statement [(Exhibit D) or in another form mutually accepted by
the Parties] with the Agency, acknowledging their responsibility under applicable
5
Federal law and regulations, including but not limited to regulations under the
Health Insurance Portability and Accountability Act ( "HIPAA "), to keep
confidential any information regarding Agency patients, as well as confidential
information of the Agency, as a condition of participation in the Rotation; and
provide Agency with copies of the executed Confidentiality Statements for each
Program Student, Faculty, and other College- employed Rotation Participant prior
to the start of the Rotation.
k). Maintain individual records of class and clinical instruction, evaluations of
Students, preceptor, and Faculty competency and health.
1). Establish and maintain for this educational Rotation, curriculum standards and
h meet College standards and applicable licensing
educational policies that g s pp e a nd
accreditation requirements;
m.) Administer, organize and operate the overall educational Program and retain
responsibility for the education of Students in and for the Program curriculum, its
design, delivery, and quality;
n). Provide course outlines to Agency that include objectives, goals and classes for each
course providing educational experience;
o). Provide Agency with a copy of the College's Student Code of Conduct Policy
and /or the Health Science Program's Student Handbook that sets forth the rules
governing student behavior.
4. RESPONSIBILITY TO INFORM STUDENTS. The College shall inform its Students
in the Program that as participants in the Rotation they are required to:
a). Comply with the policies and procedures of Agency, to the extent permitted by
law, including the Agency's policies on confidentiality and disclosure of
information;
b). Comply with state and federal laws and regulations;
c). Provide and wear the necessary and appropriate uniform while on duty at Agency;
d). Obtain prior written approval of both Parties before publishing any material
related to the learning experience provided under the terms of this Agreement.
e). Maintain the confidentiality of all records or information exchanged in the course
of the Rotation.
f). Acknowledge and agree that neither the College nor the Agency guarantees to
place or maintain placement of any Program Student under this Agreement.
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g). As required by Agency as a condition of participation in the Rotation, execute and
abide by the attached Confidentiality Statement (Exhibit D) pursuant to Section
2(i) and 30) above.
h). Procure and maintain, during the term of their Rotation participation at Agency,
professional liability insurance. Such professional liability insurance shall cover
any and all liability for claims, damages, or injuries to persons whatsoever kind or
nature arising out of the activities of such Student carried out under this
Agreement. Such professional liability insurance shall be on a per occurrence
basis in amounts no less than one million dollars/three million dollars
($1,000,000.00/$3,000,000.00) for personal injuries. Agency shall be named as a
loss payee under such professional liability policy or policies. College shall
submit to Agency certificates of insurance evidencing such insurance at the time
Student's Rotation participation at Agency is to begin. In the event Program
Students participating at Agency will not have patient contact, those Students
shall not be required to procure and maintain any such policy or policies of
liability insurance as described above.
5. RESPONSIBILITY OF THE COLLEGE AND THE AGENCY: ROTATION
COORDINATION.
a). College and Agency agree to work together to establish and maintain a quality
Rotation. Agency agrees to take an active role in suggesting or establishing
education policy, curriculum, and course content.
b). College and Agency agree to provide representatives to form an Advisory
Committee to meet periodically to fashion, discuss, evaluate, and make
recommendations to revise the Rotation experience at Agency. College agrees upon
request to provide representatives from the Faculty to serve on Agency committee(s)
relevant to the Rotation.
c). The parties acknowledge that many student education records are protected by the
Family Educational Rights and Privacy Act ( "FERPA "), [20 United States Code
sections 1232(g), 1232(h) and 1232(i)], and federal regulations issued pursuant to
such act, and by state law in s. 1002.22, F.S., and that generally, written student
consent must be obtained before releasing personally identifiable student education
records to anyone other than College. College agrees to provide guidance to Agency
with respect to complying with the provisions of FERPA and similar state law.
Agency agrees to treat all student education records that are specifically identified as
such by the parties confidentially and not to disclose such student education records
except to College and Agency officials who need the information to fulfill their
professional responsibilities, or as required or permitted by law. The parties
acknowledge that the fact that a Student is mentioned in a record or report generated
and/or maintained by Agency in the normal course and scope of its operations, and
not created or maintained by College, may not cause such record or report to be
considered a "student education record" for purposes of this paragraph.
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d). Neither party shall have the power to obligate the other party's resources, or commit
the other party to any particular action.
e). Both Parties and their employees shall conduct themselves in compliance with all
applicable federal, state, and local laws, rules, and regulations and in compliance
with the standards, rulings, and regulations of relevant accreditation and regulatory
bodies, as well as their own respective institutional rules and regulations.
f). A Party will cooperate fully with the other Party and its counsel in the defense of
any claims against a Party in any way arising out of or connected with this
Agreement. Such cooperation, including attendance at depositions, trials,
conferences, and the rendering of written reports, will be at no expense to the
Party subject to the claim.
6. REQUEST FOR WITHDRAWAL OF FACULTY OR STUDENT. College shall
have full responsibility for the conduct of any Student or Faculty disciplinary proceedings
and shall conduct the same, with input from Agency, in accordance with all applicable
statutes, rules, regulations and case law.
(a) No provision of this Agreement shall prevent Agency from refusing to accept or
continue any Student or Faculty in the Rotation at Agency's Facilities who has
previously been employed by Agency and who has been determined by Agency to
be ineligible for rehire for any reason. The Agency shall notify the College in
writing of its refusal to accept or continue a Student or Faculty in the Rotation on
this basis but shall be under no obligation to provide a reason any individual is
considered ineligible for rehire. Agency can impose temporary withdrawal of a
Student or Faculty from Agency's Facilities. The Agency shall provide to the
College prompt written notice of such a withdrawal, which shall state the
reason(s) for the temporary withdrawal.
(b) The Agency may also submit to College a notice documenting its decision to
require the permanent withdrawal of any Student or Faculty from Agency's
Facilities for a reasonable cause related to the need for maintaining a safe and
orderly environment, and the College shall immediately cause the Student or
Faculty to comply with Agency's decision as documented. The notice from the
Agency shall set forth the basis for withdrawal.
(c) In the event the College does not agree with the Agency's refusal to accept or
continue a Student or Faculty, Agency's temporary withdrawal of a Student or
Faculty from Agency's facilities, or Agency's request for permanent withdrawal
of a Student or Faculty from Agency's facilities, the College may request a
meeting with Pete McNeil or the Agency's designee to discuss the basis for any
such disagreement, which meeting will be scheduled within a reasonable time as
mutually agreed between the parties. The parties agree that if such a meeting is
requested, the Student or Faculty in question will not be permitted in Agency's
8
Facilities pending the outcome of the meeting. Agency's decision following such
meeting will be final.
(d) The College may at any time withdraw a Faculty member or Student whose
progress, conduct, or work does not meet the standards of the College for
continuation in the Program.
7. INDEPENDENT CONTRACTOR/STUDENT STATUS.
a). The relationship of the Parties hereunder shall be an independent contractor
relationship, and not an agency, employment, joint venture or partnership
relationship. Neither party shall have the power to bind the other party or contract
in the name of the other party. All persons employed by a party in connection
with this Agreement shall be considered employees of that party and shall in no
way, either directly or indirectly, be considered employees or agents of the other
party.
b). Students shall participate in the Rotation hereunder for the sole consideration of
obtaining an educational experience. Each party agrees that the Students will be
in a learning situation and that the primary purpose of the placement is for the
Students' learning and the benefit of the Students. It is further understood that the
Student shall not at any time replace or substitute for any Agency employee. Nor
shall Student perform any of the duties normally performed by an employee of the
Agency except such duties as are a part of their training and are performed by the
Student under the direct supervision of an Agency employee. Students are not
entitled to a job at the completion of the educational experience. Agency derives
no immediate advantage from the activities of the Students, and on occasion its
operations may actually be impeded. The Agency, College and the Students
understand that the Students are not entitled to wages for the time spent in
training. Each party agrees that no Student in the Rotation will be deemed to be an
employee, agent or volunteer of the Agency or the College by virtue of
participation in the Rotation, nor will the Agency or the College be liable for the
payment of any wage, salary, or compensation of any kind for service provided by
the Students while participating in the Rotation. Further, no Student will be
covered under the Agency's or the College's Worker's Compensation, social
security, or unemployment compensation programs while participating in the
Rotation.
8. INSURANCE.
a). INSURANCE OF COLLEGE. The Agency acknowledges that the College is a
political subdivision of the State of Florida and warrants, and represents that it
participates in the Florida Community College Risk Management Consortium,
with headquarters in Gainesville, Florida, for worker' s compensation, general
liability, and other coverage, with said protection being applicable to officers,
employees, servants, and agents while acting within the scope of their
9
employment by the College. Its .self insured fund and various policies are
authorized and stated in Florida Statutes, Section 1001.64(27) and Section 768.28.
The College agrees to maintain its participation in the Florida Community
College Risk Management Consortium for the duration of this Agreement.
Furthermore, nothing contained herein shall be construed or interpreted as: (i)
denying to either party any remedy or defense available to such party under the
laws of the State of Florida; (ii) the consent of the College to be sued; or (iii) a
waiver of sovereign immunity of the College beyond the waiver provided in
Section 768.28, Florida Statutes.
b). INSURANCE OF AGENCY. Agency shall maintain, at its own cost and
expense, through commercial insurance, a program of self - insurance, or a
combination thereof, general and professional liability insurance covering Agency
against professional liability (malpractice) claims, in the minimum amount of One
million dollars ($1,000,000) per occurrence and Three million dollars
($3,000,000) aggregate. Evidence of such insurance or self - insurance shall be
provided to College upon request.
9. ASSIGNMENTS. This Agreement may not be assigned to a third party without the
prior written consent of the non - assigning party.
10. THIRD PARTY OBLIGATIONS. This Agreement is made solely for the benefit of
the Parties named in this Agreement, and is not intended to create rights or any cause of
action in any third parties, including without limitation, Students.
11. PERFORMANCE. A delay in or failure of performance of either party that is caused
by occurrences beyond the control of either party shall not constitute a default hereunder,
or give rise to any claim for damages.
12. TERM AND TERMINATION. The term of this Agreement is January 1, 2011
through December 31, 2013 (the "Term "). This Agreement may be extended or renewed
upon advanced written agreement of the Parties hereto.
If either party to this Agreement wishes to terminate the Agreement, it is understood that
at least ninety (90) days prior written notice shall be given prior to the termination date of
the Agreement. And, if such notice is given, this Agreement shall terminate at the end of
the ninety (90) days' notice; EXCEPT THAT the Rotation and this Agreement shall
continue to be effective for the purpose of permitting Students actually participating in
the Rotation at the time of termination to finish the Rotation at Agency.
13. APPLICABLE LAW. The validity, interpretation and enforcement of this Agreement
shall be governed by the laws of the State of Florida.
14. NONDISCRIMINATION. During this Agreement, neither party shall discriminate
against any person on the basis of race, color, religion, gender, national or ethnic origin,
sexual orientation, disability or veteran or marital status.
10
15. ENTIRETY OF AGREEMENT. This Agreement contains the entire Agreement
between the Parties and supersedes all prior agreements and understandings, oral or
written, with respect to the subject matter contained herein.
16. AMENDMENTS AND MODIFICATIONS TO AGREEMENT. All amendments and
modifications to this Agreement shall be made by addenda and with the written mutual
consent of both Parties. The addenda shall be attached to the Agreement, and shall
include the date and signatures of Parties agreeing to the modification(s).
17. COPIES OF AGREEMENT. Copies of this Agreement shall be placed on file and be
available at the College and at the Agency.
18. NOTICES. All notices under this Agreement shall be in writing and delivered by
personal delivery or United States, certified, return receipt requested, mail. Such notices
shall be delivered to the following:
College Representative: Penny Conners, Dean
Valencia Community College
P.O. Box 3028
Mail Code 4 -44
Orlando, Florida 32802 -3028
Agency Representative: Pete McNeil, Fire Chief
Ocoee Fire Department
563 S. Buford Ave.
Ocoee, FL 34761
11
APPROVED:
COLLEGE
Keith Houck
Vice President, Administrative Services
Date:
AGENCY
ATTEST: CITY OF OCOEE, FLORIDA
By:
Beth Eikenberry, City Clerk S. Scott Vandergrift, Mayor
FOR USE AND RELIANCE ONLY BY APPROVED BY THE OCOEE
THE CITY OF OCOEE, FLORIDA: COMMISSION AT A MEETING
APPROVED AS TO FORM AND HELD ON , 2010
LEGALITY this day of UNDER AGENDA ITEM NO.
, 2010.
FOLEY & LARDNER, LLP
By:
City Attorney
12
EXHIBIT A
The Programs
Emergency Medical Services
13
EXHIBIT B
Programs for Which Preceptors are Requested
Emergency Medical Services
14
1
EXHIBIT C
Student Disqualification Guidelines — Criminal Background
A student will be disqualified from placement at any Agency facility if the student admits to, or a
criminal background check reveals, a conviction or any disposition other than a finding of "not
guilty" or a complete dismissal of the charges for one or more of the following generic crimes or
their equivalents:
Murder
Manslaughter
Carj acking
Use of a weapon in the commission of a crime
Robbery or theft (including, but not limited to, theft by falsification of financial records or
embezzlement)
Passing worthless checks
Credit card fraud /fraudulent use of a credit card
Forgery
Identity theft
Burglary
Arson
Kidnapping
False Imprisonment
Home invasion
Assault
Aggravated assault
Battery
Aggravated battery
Resisting arrest with violence
Domestic violence
Any stalking offense
Rape
Sexual battery
Trespass for sexual purposes (e.g., peeping)
Lewd and lascivious behavior
Lewd and lascivious act upon a child
Lewd act in the presence of a child
Child abuse
Child abandonment
Child neglect
Any other crime involving physical violence or a crime against a child
Possession of child pornography
Sale, delivery or trafficking in child pornography
Exploitation, neglect, or abuse of a disabled adult or elderly person
Sale, delivery or trafficking in narcotics (drugs)
Felony possession of a controlled substance
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Any other felony level offense involving violation of a drug abuse prevention and control law
(including but not limited to felony level possession, sale, purchase, manufacture, or use of
controlled substance in violation of applicable law)
Felony driving while intoxicated or under the influence of drugs or alcohol
Falsification of prescription records
Hate crimes
Terrorism
Escape or attempted escape from incarceration
A student who admits to, or whose criminal background check reveals, a criminal conviction or
any disposition other than a finding of "not guilty" or a complete dismissal of the charges
relating to crimes other than those listed above is not automatically disqualified and may be
considered for placement at an Agency facility based on a case -by -case evaluation, including ,
but not limited to, the following factors: nature of the offense(s); criminal history
(pattern/recidivism); remoteness in time of the offense; relevance of offense to position being
offered; age at time of offense; and evidence of rehabilitation.
16
(EXHIBIT D)
CONFIDENTIALITY STATEMENT
School:
Program:
Facility /Agency:
The undersigned hereby acknowledges his /her responsibility under applicable federal law and
regulations, including but not limited to regulations under the Health Insurance Portability and
Accountability Act ( "HIPAA "), to keep confidential any information regarding Facility /Agency
patients, as well as all confidential information of Facility /Agency. The undersigned agrees,
under penalty of law, not to reveal to any person or persons any specific information regarding
any patient, except to authorized clinical staff and associated personnel of the Facility /Agency
and, as necessary, to other Program Participants /Students at the Facility /Agency who are
supervising or assisting the undersigned in the provision of services at Facility /Agency. The
undersigned further agrees not to reveal to any third party any confidential information of
Facility/Agency, except as required by law or as authorized by Facility/Agency.
Dated this day of , 20
Program Participant /Student (Signature)
Program Participant/Student (Printed Name)
Witness (Signature)
Witness (Printed Name)
17
AC' Rrx CERTIFICATE OF LIABILITY INSURANCE UAIt(7 TTT)
07/27/201/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 1- 800 -524 -0191 CONTACT Johanne Daguillard
NAME:
Arthur J. Gallagher Risk Management Services, Inc. PHONE 407 - 563 -3535 FAX 407- 370 -3057
(A/C. N o. Ext): (A/C, No):
7380 W. Sand Lake Road
E-MAIL SS j ohanne_daguili ard@ajg.com
Suite 390 PRODUCER FCCRMC
Orlando, FL 32819 CUSTOMER ID #:
Gregory S. Butterfield INSURER(S) AFFORDING COVERAGE NAIC
INSURED INSURERA: AMERICAN CAS CO OF READING PA 20427
Students of the Allied Health Sciences Courses of the INSURERS:
Participating Colleges of the Florida College System Risk
Management Consortium INSURER C:
5700 SW 34th Street, Suite 1205
INSURER D:
Gainesville, FL 32608 - 5367
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: 16791864 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W MID LIMITS
LTR INS VD POLICY NUMBER (MD/YYYY) (MM/DD/YYYY)
GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $
CLAIMS -MADE OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $
POLICY JE T LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
HIRED AUTOS (Per accident)
NON -OWNED AUTOS $
UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ _
EXCESS LIAB CLAIMS -MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? ( N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
A Student Professional 0127291333 08/26/1C 08/26/11 Each Claim 2,000,000
Liability Aggregate 5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
Valencia Community College Student Clinical Experience for EMS Program(s). Coverage includes College Faculty Members
for instruction /supervision of students only.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ocoee Fire Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
563 S. Bluford Avenue
AUTHORIZED REPRESENTATIVE
Ocoee, FL 34761 /117
USA
simonorl ® 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
16791864