Signed Contract_Nicholas J. Edwards, MDCity of Dubuque
City Council Meeting
Consent Items # 14.
Copyrighted
July 6, 2021
ITEM TITLE: Signed Contract(s)
SUMMARY: Boys and Girls Club Facility Use Agreement; Drew Cook & Sons
Excavating Co. I nc. for the Dillon Street Drain Tile Project 2021;
Agreement with Nicholas J. Edwards, MD to act as the Medical Director
for the City's Fire Department Emergency Medical Services Division;
Tschiggfrie Excavating Co. for the 2021 Asphalt Overlay Ramp Project
Four;
SUGGESTED Suggested Disposition: Receive and File
DISPOSITION:
ATTACHMENTS:
Description Type
Boys and Girls Club Facility Use Agreement Supporting Documentation
Dillon Street Drain Tile Project 2021 Supporting Documentation
Agreement with Nicholas J. Edwards, MD Supporting Documentation
Medical Director Contract Memo Staff Memo
2021 Asphalt Overlay Ramp Project Four Supporting Documentation
AGREEMENT BETWEEN
THE CITY OF DUBUQUE, IOWA
AND
NICHOLAS J. EDWARDS, MD
This Agreement is made and entered into on this -516" day of June 2021,
between the City of Dubuque, Iowa (hereinafter, "City") and Nicholas J.
Edwards, MD (hereinafter, "Edwards"), whereby Edwards agrees to act as the
Medical Director for the City's Fire Department Emergency Medical Services
Division subject to the following terms and conditions:
NOW THEREFORE BE IT AGREED:
Duties. Edwards shall be retained to provide medical oversight of the City's Fire
Department Emergency Medical Services as outlined in the 2021 "Dubuque Fire
& EMS Medical Director Duties and Statement of Affirmation" (hereinafter, "MD
Duties and Affirmation") which is incorporated into and becomes a part of this
Agreement, and consistent with the requirements of Chapter 147A of the Iowa
Code.
2. Qualifications. Edwards agrees that -Edwards shall at all times provide the
services under this Agreement. Edwards certifies he is qualified to act as a
physician in the State of Iowa and is licensed pursuant to Chapter 148 of the
Iowa Code.
3. Consideration. In consideration of Edwards providing his expertise to the City,
the City shall pay Edwards at a rate of $40,000 per year to be paid in twelve (12)
installments on a schedule as established by the City's Budget and Finance
Department.
4. Term. This Agreement shall be effective as of July 1, 2021 and shall terminate
June 30, 2024. By mutual agreement of the parties, this Agreement may be
renewed for one (1) additional term of up to three (3) years.
5. Termination. Either party may terminate this Agreement for any reason prior to
its expiration date by giving written notice to the other party at least one hundred -
twenty (120) days prior to the date of termination.
6. Notice. Notices required by this Agreement shall be deemed given when either
party delivers in writing via regular mail to the parties at the following addresses:
City: Fire Chief, Dubuque Fire Department, 11 W. 9th ST, Dubuque,
Iowa 52001
Medical Director: Nicholas J. Edwards, MD, Emergency Department,
250 Mercy DR, Dubuque, Iowa 52001. In the event Edwards ends his
affiliation with Mercy Hospital, Edwards will inform the City of a new
address within three (3) days.
7. Independent Contractor. Edwards is an independent contractor performing
professional services for the City and is not an agent, officer, or employee of the
City of Dubuque, Iowa.
a. Edwards shall have no claim against the City for employee rights or
benefits including, but not limited to seniority, vacation, sick leave,
retirement benefits, unemployment insurance benefits, civil service
protection, disability retirement benefits, health, or dental insurance.
b. Edwards shall not be subject to the direction and control of the City except
as to the performance of this Agreement.
c. Edwards shall be obligated to pay applicable taxes, deduction and other
obligations including, but not limited to federal and state income taxes,
withholding, deductions for social security, unemployment, disability
insurance, worker's compensation, or Medicare payments.
8. Insurance. Edwards agrees to comply with the requirements contained in City
Insurance Schedule J, attached as Exhibit A Edwards will furnish the City with a
certificate or certificates of insurance by an insurance company licensed to do
business in the State of Iowa, in compliance with Exhibit A by no later than July
1, 2021, or July 1 of any renewal year.
9. Hold Harmless and Indemnification. Edwards shall indemnify, hold harmless
and defend City, its officers, employees, and agents harmless and free from any
and all liability arising out of or relating to any injury to any person or damage to
or loss of any property caused by or arising out of the negligence or willful
misconduct on the part of Edwards in the performance of this Agreement.
10.Assignment. Neither party may assignor transfer any of its rights or obligations
under this Agreement without obtaining the prior written consent of the other
party.
11. Subcontracting. Edwards shall not subcontract any portion of the services to be
performed under this Agreement without the prior written permission of the City.
City shall be reasonable in its approval of short-term subcontracts, where short-
term is defined as two (2) weeks or less in length, including, but not limited to
Edwards' vacation or medical absence.
12.Incapacity. If, during the term of this Agreement Edwards becomes
incapacitated due to illness, injury, or other incapacity, and is unable to render
the services contemplated hereunder the City, may appoint an interim director
and at its option, may terminate the Agreement hereunder by providing seven (7)
days' notice to Edwards and any personal representative on Edwards behalf.
13. Confidentiality. Any confidential information provided to or developed by
Edwards in the performance of this Agreement shall be kept confidential and
shall not be made available to any individual or organization by Edwards without
the prior written approval of the City.
14. Governing Law and Venue. This Agreement shall be governed by the laws of
the State of Iowa and the venue for any disputes shall be in the Iowa District
Court in and for Dubuque County.
15. Disputes. In the event of any dispute between the parties arising from this
Agreement or the Services provided hereunder, each party shall, prior to seeking
judicial resolution of such dispute, escalate the dispute as follows, each party
shall appoint a representative to meet for dispute resolution. The designated
representative shall be as follows:
a. City: A representative appointed by the City Manager
b. Edwards: By himself or a representative of his choosing.
c. The representatives of each party shall use good faith efforts to resolve
the dispute between them. If such senior representatives are unable to
resolve the dispute, such dispute shall then be decided by arbitration
pursuant to procedures jointly agreed upon by the parties. The parties
shall make good faith efforts to resolve any and all disputes as quickly
as possible.
16. Conflict of Interest. Edwards warrants that he presently has no interest and
shall not acquire any interest, direct or indirect, which would conflict in any
manner or degree with the performance of services required under this
Agreement.
17.Amendment. This Agreement shall not be altered, changed or amended except
in writing, and approved by both parties.
18. Headings. The headings included in this Agreement are for convenience or
reference only and shall not be considered in the construction hereof. The
singular number shall include the plural and vice versa. All uses of the word
"including" herein shall, unless otherwise indicated, be interpreted to mean
"including, but not limited to."
19. Severability of Provisions. If any part of this Agreement is found by a court of
competent jurisdiction or other competent authority to be invalid, unlawful, or
unenforceable, then such part shall be severed from the remainder of this
Agreement, which shall continue to be valid and enforceable to the fullest extent
permitted by law.
20. Waiver. No failure on the part of either party to exercise, and no delay in
exercising, any right, power or privilege hereunder operates as a waiver thereof;
nor does any single or partial exercise of any right, power or privilege hereunder
preclude any other or further exercise thereof, or the exercise of any other right,
power or privilege.
21. Counterparts. This Agreement may be executed in counterparts, each of which
taken together shall constitute one single agreement between the parties.
22. Entire Agreement. This Agreement sets forth the entire agreement between the
parties, and fully supersedes and replaces any prior agreement or
understandings between the parties, whether written or oral, regarding the
matters stated herein.
Nicholas J. Edwards, MD
Michael C. Van Milligen
City Manager
L 13 ®1Z'0
Date
June 23, 2021
Date
EXHIBIT A
INSURANCE SCHEDULE J
rdwe, rdS shall furnish a signed certificate of insurance to the City of Dubuque, Iowa for
the coverage required in Exhibit I prior to commencing work and at the end of the project if the
term of work is longer than 60 days. Contractors presenting annual certificates shall present a
certificate at the end of each project with the final billing. Each certificate shall be prepared on
the most current ACORD form approved by the Iowa Department of Insurance or an equivalent
approved by the Director of Finance and Budget. Each certificate shall include a statement under
Description of Operations as to why the certificate was issued. Eg: Project # or Project
Location at or construction of >% Fire ilMeallco 1 Dil'er-61,
2. All policies of insurance required hereunder shall be with an insurer authorized to do business in
Iowa and all insurers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each certificate shall be furnished to the Finance Department of the City of Dubuque.
4. Failure to provide coverage required by this Insurance Schedule shall not be deemed a waiver of
these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance
shall be considered a material breach of this agreement.
5. Contractors shall require all subconsultants and sub-subconsultants to obtain and maintain during
the performance of work insurance for the coverages described in this Insurance Schedule and
shall obtain certificates of insurances from all such subconsultants and sub-subconsultants.
Contractors agree that they shall be liable for the failure of a subconsultant and sub-
subconsultant to obtain and maintain such coverages. The City may request a copy of such
certificates from the Contractor.
6. All required endorsements shall be attached to certificate of insurance.
7. Whenever a specific ISO form is listed, required the current edition of the form must be used, or
an equivalent form may be substituted if approved by the Director of Finance and Budget and
subject to the contractor identifying and listing in writing all deviations and exclusions from the
ISO form.
8. Contractors shall be required to carry the minimum coverage/limits, or greater if required by law
or other legal agreement, in Exhibit I. If the contractor's limits of liability are higher than the
required minimum limits then the provider's limits shall be this agreement's required limits.
9. Contractor shall be responsible for deductibles and self -insured retention for payment of all policy
premiums and other cost associated with the insurance policies required below.
10. All certificates of insurance must include agents name, phone number, and email address.
11. The City of Dubuque reserves the right to require complete, certified copies of all required
insurance policies, including endorsements, required by this Schedule at any time.
12. The City of Dubuque reserves the right to modify these requirements, including limits, based on
changes in the risk or other special circumstances during the term of the agreement, subject to
mutual agreement of the parties.
Page 1 of 4 Schedule J Professional Services April 2021
INSURANCE SCHEDULE J (continued)
Exhibit I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products -Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit (any one occurrence) $50,000
Medical Payments $5,000
1) Coverage shall be written on an occurrence, not claims made, form. The general
liability coverage shall be written in accord with ISO form CG 00 01 or business
owners form BP 00 02. All deviations from the standard ISO commercial general
liability form_ CG 00 01, or business owners form BP 00 02, shall be clearly
identified.
2) Include endorsement indicating that coverage is primary and non-contributory.
3) Include Preservation of Governmental Immunities Endorsement. (Sample
attached).
4) Include additional insured endorsement for:
The City of Dubuque, including all its elected and appointed officials, all its
employees and volunteers, all its boards, commissions and/or authorities and
their board members, employees and volunteers. Use ISO form CG 20 26.
5) Policy shall include Waiver of Right to Recover from Others endorsement.
B) AUTOMOBILE LIABILITY
Combined Single Limit
$1,000,000
Coverage shall include all owned, non -owned, and hired vehicles. If the Contractor's business
does not own any vehicles, coverage is required on non -owned and hired vehicles.
1) Policy shall include Waiver of Right to Recover from Others endorsement.
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory Benefits covering all employees injured on the job by accident or disease as prescribed
by Iowa Code Chapter 85.
Coverage A Statutory —State of Iowa
Coverage B Employers Liability
Each Accident $100,000
Each Employee -Disease $100,000
Policy Limit -Disease $500,000
Policy shall include Waiver of Right to Recover from Others endorsement.
Coverage B limits shall be greater if required by the umbrella/excess insurer.
OR
Page 2 of 4 Schedule J Professional Services April 2021
INSURANCE SCHEDULE J (continued)
If, by Iowa Code Section 85.1A, the Contractor is not required to purchase Workers'
Compensation Insurance, the Contractor shall have a copy of the State's Nonelection of
Workers' Compensation or Employers' Liability Coverage form on file with the Iowa
Workers' Compensation Insurance Commissioner, as required by Iowa Code Section
87.22. Completed form must be attached.
D) UMBRELLA/EXCESS LIABILITY $1,000,000
The General Liability, Automobile Liability and Workers Compensation Insurance
requirements may be satisfied with a combination of primary and Umbrella or Excess
Liability Insurance. If the Umbrella or Excess Insurance policy does not follow the form of
the primary policies, it shall include the same endorsements as required of the primary
policies including Waiver of Subrogation and Primary and Non-contributory in favor of the
City.
E) PROFESSIONAL LIABILITY $1,000,000
If the required policy provides claims -made coverage:
1) The Retroactive Date must be shown and must be before the date of the
agreement.
2) Insurance must be maintained and evidence of insurance must be provided for at
least five (5) years after completion of the work or services.
3) If coverage is canceled or non -renewed and not replaced with another claims -
made policy form with a Retroactive Date prior to the date of the agreement, the
contractor must provide "extended reporting" coverage for a minimum of five (5)
years after completion of the work or services.
F) CYBER LIABILITY/BREACH $1,000,000
Yes X No
Coverage for First and Third Party liability including but not limited to lost data and restoration,
loss of income and cyber breach of information.
Page 3 of 4 Schedule J Professional Services April 2021
Please be aware that naming the City of Dubuque as an additional insured as is required by this
Insurance Schedule may result in the waiver of the City's governmental immunities provided in Iowa Code
sec. 670.4. If you would like to preserve those immunities, please use this endorsement or an equivalent
form.
PRESERVATION OF GOVERNMENTAL IMMUNITIES ENDORSEMENT
1. Nonwaiver of Governmental Immunity. The insurer expressly agrees and states that the purchase
of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any
of the defenses of governmental immunity available to the City of Dubuque, Iowa under Code of Iowa
Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coverage. The insurer further agrees that this policy of insurance shall cover only those
claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it
now exists and as it may be amended from time to time. Those claims not subject to Code of Iowa
Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting
any defense of governmental immunity, and may do so at any time and shall do so upon the timely written
request of the insurer.
4. Non -Denial of Coverage. The insurer shall not deny coverage under this policy and the insurer
shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa under this policy for
reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of
the defense(s) of governmental immunity asserted by the City of Dubuque, Iowa.
No Other Change in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
SPECIMEN
(DEPARTMENT MANAGER: FILL IN ALL BLANKS AND CHECK BOXES)
Page 4 of 4 Schedule J Professional Services April 2021
DUBUQUE FIRE & EMS MEDICAL DIRECTOR DUTIES
AND STATEMENT OF AFFIRMATION
.. N1S PI Y ►1 II ►N M D AL, L RE TOR DUTIES
Physicians that choose to serve as medical director for Dubuque Fire & EMS are obligated to comply
with 1 47A--Chapter 132: Emergency Medical Services --Service Program Authorization. The rules
can be accessed at https:Hidph.iowa.gov/bets/ems >> Administrative Rules.
Physicians that choose to function as the service pharmacy are obligated to comply with 657
Chapter 11: Drugs in Emergency Medical Service Programs. The rules can be accessed at
https://idph.iowa.gov/bets/ems >> Administrative Ruler.
"Medical director" means any physician licensed under Iowa Code chapter 148 who shall be
responsible for overall medical direction of the service program and who has completed a medical
director workshop, sponsored by the Iowa Bureau of Emergency and Trauma Services, within one
year of assuming duties.
The medical director's duties in Chapter 132 are included on the following list. Many of these
responsibilities and duties may be assigned to a designee. Designations must be done in writing and
need to be monitored by the medical director.
JOB DESCRIPTION/LIAISON
A medical director shall:
132.3(2) b. (1) Be accessible for medical direction 24 hours per day, seven days per week or ensure
accessibility to alternate medical direction.
132.3(2) b. (2) Ensure that all duties and responsibilities of the medical director are not relinquished
before a new or temporary replacement is functioning in that capacity.
132.3(2) b. (3) Complete a department -sponsored medical director training within one year of
assuming duties as a medical director and at a minimum once every three years thereafter.
132.3(2) b. (6) Be available for individual evaluation and consultation with service program personnel.
132.3(2) b. (7) Have authority to restrict a service program's authorized functional EMS service level.
132.3(2) b. (8) Have the authority to permanently or temporarily restrict a service program member to
function within a lower -level scope of practice or prohibit a service program member from
providing patient care.
In addition to the above -mentioned duties detailed in Chapter 132, the medical director will:
Act as a liaison with various local, regional, state, and national medical communities regarding
emergency medical service system by reviewing and responding to community needs.
When available, the medical director is encouraged to attend the following meetings:
Departmental Quarterly EMS Meetings, County EMS Association meetings, County Drug Box
Committee meetings, Departmental EMS Focus Group meetings, CQI Committee meetings.)
Page 1 of 4 June 2021
PROTOCOLS
"Protocols" means written directions and orders approved by a service program's medical director
utilizing the EMS clinical guidelines.
A medical director shall:
132.3(2) b. (4) Develop, approve, and update service program protocols that meet or exceed the
minimum EMS clinical guidelines approved by the department.
132.3(2) b. (5) Ensure that the emergency medical care providers rostered with the service program
are credentialed in the emergency medical skills to be provided and the duties of the
emergency medical care provider do not exceed the provider's scope of practice as referenced
in 641—subrule 131.5(2) and the service program's EMS service level of authorization.
A medical director may:
132.3(2) c. (1) Make additions to the department -approved EMS clinical guidelines when developing
service protocols provided the additions are within the service program's level of authorization,
the EMS provider's scope of practice, and acceptable medical practice.
132.3(2) c. (2) Request that service program providers provide additional emergency medical care
skills on a limited pilot project basis. The pilot project applications are available on the BETS
website (www.idph.iowa.gov/BETS). The department will issue written notice of an approved
or rejected pilot project.
CONTINUOUS QUALITY IMPROVEMENT (CQI)
"Continuous quality improvement" or "CQI" means a program that is an ongoing process to
monitor standards at all EMS operational levels.
A medical director shall:
132.3(2) b. (9) Approve the service program's CQI program.
132.3(2) b. (10) Perform or complete, or appoint a designee to perform or complete, the medical
audits in the service program's established CQI policy.
PATIENT CARE REPORT (PCR) AUDITS
"Patient care report" or "PCR" means a report that documents the assessment and management of
the patient by the emergency care provider.
A medical director shall:
132.3(2) b. (11) Randomly audit (on at least a quarterly basis) documentation of calls where
emergency medical care was provided.
132.3(2) b. (12) Randomly review audits performed by the qualified appointee.
Page 2 of 4 June 2021
In addition to the above -mentioned duties detailed in Chapter 132, the medical director will:
Work with the department's EMS Supervisor and CQI team to evaluate the department's
current level of service by its members. This will include reviewing Patient Care Reports,
monitoring training, and periodically riding with crews in the field.
Work with the department's EMS Supervisor to evaluate the continuing education and training
needs of the service based on findings from the CQI process.
EMERGENCY MEDICAL DISPATCH EVALUATIONS
The medical director will:
Work with the Dubuque 911 Center Manager to evaluate the department's current level of
service by its members. This will include listening to and evaluating recorded patient calls,
monitoring training, and periodically siting with dispatchers in the Communications Center.
Work with the Center Manager to arrange continuing education opportunities for dispatchers to
complete both field and ED observational rotations.
Page 3 of June 2021
I hereby affirm and declare I have read Iowa Code Chapter 147A and Iowa Administrative Code 641--
Chapter 132. The below named Iowa authorized service program(s) will comply with all applicable
requirements set forth.
I understand I am responsible for providing appropriate medical direction and overall supervision of
the medical aspects of the service program and shall ensure that those duties and responsibilities are
not relinquished before a new or temporary replacement is functioning in that capacity.
I understand that, unless previously attended, I must attend an Iowa EMS Physician Medical Director
Workshop sponsored by the department within one year of assuming duties.
I understand that failure to comply may result in denial, citation and warning, suspension, revocation
or probation of the service program's authorization.
PRINT OR TYPE SERVICE/SYSTEM NAME(S):
Print First Name
Print Last Name
Signature
License #
!a
Mailing Address
City
State
Zip Code
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Phone
Fax
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Have you attended an Iowa EMS Medical Director Workshop? Yes: No:
If yes, city: I)u"6 %_ -r—A Year (approximately): 20 20
Physician retains a copy of 1-3 (duties). Submit a signed copy of page 4 (affirmation)
electronically or mail to your Regional EMS Coordinator.
Page 4 of 4 June 2021
Physicians that choose to serve as medical director for a service program are obligated to comply with Iowa
Code 147A--Chapter 132: Emergency Medical Services —Service Program Authorization. The rules can be
accessed at www.idph.state.ia.us/ems >> Bureau >> Iowa Code and Administrative Rules.
Physicians that choose to function as the service pharmacy are obligated to comply with Iowa Board of
Pharmacy Administrative Rules 657—Chapter 11: Drugs in Emergency Medical Service Programs and 657--
Chapter 10 Controlled Substances. The rules can be accessed at www.idph.state.ia.us/ems >> Bureau >> Iowa
Code and Administrative Rules.
"Medical director" means a physician designated by the service program and responsible for providing
medical direction and overall supervision of the medical aspects of the service program and has completed a
department -sponsored medical director training within one year of assuming duties as a medical director and at
a minimum once every three years thereafter.
The medical director's duties in Chapter 132.3(2) are included on the following list. Many of these
responsibilities and duties may be assigned to an appointee. Designations must be done in writing and need to
be monitored by the medical director.
JOB DESCRIPTION/LIAISON
132.3(2) b. Medical director:
(1) Be accessible for medical direction 24 hours per day, seven days per week or ensure accessibility to
alternate medical direction.
(2) ensure that all duties and responsibilities of the medical director are not relinquished before a new or
temporary replacement is functioning in that capacity.
(3) Complete a department -sponsored medical director training within one year of assuming duties as a medical
director and at a minimum once every three years thereafter.
(4) Develop, approve, and update service program protocols that meet or exceed the minimum EMS clinical
guidelines approved by the department.
(5) Ensure that the emergency medical care providers rostered with the service program are credentialed in the
emergency medical skills to be provided and the duties of the emergency medical care provider do not exceed
the provider' s scope of practice as referenced in 641—subrule 131.5(2) and the service program' s EMS
service level of authorization.
(6) Be available for individual evaluation and consultation with service program personnel.
(7) Have authority to restrict a service program' s authorized functional EMS service level.
(8) Have the authority to permanently or temporarily restrict a service program member to function within a
lower level scope of practice or prohibit a service program member from providing patient care.
(9) Approve the service program' s CQI program.
(10) Perform or complete, or appoint a designee to perform or complete, the medical audits in the service
program' s established CQI policy.
(11) Randomly audit (on at least a quarterly basis) documentation of calls where emergency medical care was
provided.
Page 11 Sept. 2020
(12) Randomly review audits performed by the qualified appointee.
132.3(2) c. A medical director may:
(1) Make additions to the department -approved EMS clinical guidelines when developing service protocols
provided the additions are within the service program' s level of authorization, the EMS provider' s scope of
practice, and acceptable medical practice.
(2) Request that service program providers provide additional emergency medical care skills on a limited pilot
project basis. The pilot project applications are available on the BETS website (www.idph.iowa.gov/BETS).
The department will issue written notice of an approved or rejected pilot project.
(3) Approve the PA and RN exception form identifying the level of EMS provider equivalency not to exceed
the service program' s EMS service level authorization for each PA and RN who will be providing emergency
medical care as part of the service program.
d. A medical director who receives no compensation for the performance of the director' s volunteer duties
under this chapter shall be considered a state volunteer as provided in Iowa Code section 669.24 while
perforining volunteer duties as an emergency medical services medical director.
Compensation does not include payments for reimbursement of expenses.
e. A medical director, supervising physician, PA, or ARNP who gives orders to an emergency medical care
provider is not subject to criminal liability by reason of having issued the orders and is not liable for civil
damages for acts or omissions relating to the issuance of the orders unless the acts or omissions constitute
recklessness.
f. Nothing in these rules requires or obligates a medical director, supervising physician, PA, or
ARNP to approve requests for orders received from an emergency medical care provider.
g. A service program medical director who fails to comply with Iowa Code chapter 147A or these rules may be
referred to the Iowa board of medicine.
132.3(7) Continuous quality improvement (CQI)
a. A service program shall develop, maintain, and follow a CQI program that follows a written
CQI policy.
b. The CQI program shall include medical audits that review patient care provided.
c. The CQI program shall be utilized to identify deficiencies or potential deficiencies regarding medical
knowledge or skill or procedure performance.
d. The CQI program shall review at a minimum 911 response and scene times.
e. The CQI program shall develop a written plan that monitors, identifies and documents at a minimum
continuing education, credentialing of skills and procedures, and personnel performance for the service
program's emergency medical care providers, drivers, PA and RN exceptions.
f. The CQI program shall establish measurable outcomes that reflect the goals and standards of the service
program.
g. The CQI program shall ensure completion of loop closure/resolution of identified areas of concern.
PRINT OR TYPE SERVICE PROGRAM /SYSTEM NAME(S):
F' a sz c 12 Sept. 2020
Print First Name
Print Last Name
Signature
Iowa License Number
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Mailing Address
city
State
Zip Code
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Phone
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Fax
563-5�`9— 8-�oS
Email
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Date
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Have you attended an Iowa EMS Medical Director Workshop? es: No:
If yes, city: -PA �� ' Year (approximatel
132.3(4) Service program requirements.
(3) Select a new or temporary medical director if the current medical director cannot or no longer wishes to
serve in that capacity. Selection shall be made before the current medical director relinquishes the duties and
responsibilities of that position.
(4) Notify the department in writing within seven days prior to any change in medical director or any reduction
or discontinuance of operations.
P a g e 13 Sept. 2020
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if an
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a v
another not the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
V
N
El Other (see instructions) ►
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
e 3 K
6 City, state, and ZIP code
a�t�.ba grt�, X7 S 2-00 1
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
5
- M17 - (�
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and L Employer identification number
Number To Give the Requester for guidelines on whose number to enter. �� I I I I I
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
01911 Signature of
Here U.S. person ► Date ► (0/3o 12-4
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/F6rmW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is.backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 11-2017)
Form W-9 (Rev. 11-2017) Paget
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting, is correct. See What is
FATCA reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other
than Form W-9 to request your TIN, you must use the requester's form if
it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 on any foreign partners' share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 withholding tax. Therefore, if you are a U.S. person
that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a "saving clause." Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 28% of such
payments. This is called "backup withholding." Payments that may be
subject to backup withholding include interest, tax-exempt interest,
dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, payments made in settlement of payment card and
third party network transactions, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for
Part II for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding —
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
City of Dubuque
Vendor Set -Up Sheet
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Business Name: N',' 6A D (1:L .S UW A.X X S;, AA--b
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same as on the W-9)
Contact Name: �� � Qom$' Ee-O- w AA--W S
Telephone Number: PJ (a 3 S `� !9 Z 8. 3 2_
Fax Number:
Email: wdGkb@AS' e_dwAY'A9.1 t2_ 7�
(include 4-digit zip code)
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Related Party* [?[No Yes - Relationship:
Employee Name:
* A related party refers to a City employee or officer, or the spouse or unemancipated minor children of a
City employee or officer that have greater than a 5% interest in the business
No ❑Yes Employee Number:
I VINo ❑Yes
Financial Name Transit/ABA# Account # and Type
Institution on account (9 digits) of Account (checking/savings)
Lts 5dL_k_1r__ I N,'e_l�e iaS W S 07 3 0&0 615' 1 '1 W-172, 90 K 2- 3 $' Ck _e
Email address for ACH payment confirmation: 10,3 ea(u®aLX--Z1 .? / 2 %- ? @ R Kgu j . e 0 VA't-
Contact Name and Title: #1 GkD t q'9 FI Uj &.t/v-r Y1ALwe `e_Aj . ke_c e.,N-
I authorize the City of Dubuque to initiate credit entries (deposits) to the account at the financial institution indicated above:
Signature: ���� 5Date: (®13 ®zg�
Printed Name: O jce-k p I at -3 S
Title: 44 e- et l 'G 4.t bi ce 6*vy- - tic b 3 a ;: r e bp-,P Y, .
For more information on ACH payments from the City of Dubuque please contact
the Finance Department-56-3-5894135.
STANDARD OPERATING GUIDELINES
DATE FOR REVIEW: SOG #: 102.4 DATE CREATED:
January 2022 January 2020
SUBJECT: Quality Assurance of EMS
CREATED BY: LAST REVIEWED:
Esser PAGES: 2 February 2021
PURPOSE-.
To improve the quality of EMS provided by ensuring all applicable protocols, policies, SOG's, and best
practices are followed for all EMS calls.
GUIDELINE -
It shall be the responsibility of the company officer to ensure completion of all Patient Care Reports
(PCRs) before the end of their work shift.
All responses that required a PCR will go through the EMS review process. The EMS Supervisor shall
assign completed PCRs to members of the quality assurance (QA) team for review. All assigned PCRs
will be reviewed as soon as possible.
PCR's shall be reviewed to determine:
• Does the care provided meet the expected standard of care based on findings from the
PCR?
• Did a protocol deviation take place, and if so why, and is the reason documented?
• Did an equipment failure, or a lack of proper equipment, affect the outcome?
• Does the incident have the proper documentation?
The member reviewing 'the PCR for QA will use the guidelines developed to help with consistency
among all reports. If the reviewer finds an issue requiring changes, the reviewer will send a message to
the author of the report through ESO advising the author of the recommended changes. All PCRs are to
have gone through the QA process within seven days of being written. Changes are to be completed the
next work day the author of the PCR is on duty.
The EMS Supervisor will perform a documentation review of PCRs prior to being submitted to the
billing company. This is to ensure the PCR has the appropriate codes required for billing.
The EMS Supervisor will also work with the fire department's medical director on quality assurance
reviews. The medical director will advise on the type of incidents, medication administration,
procedures, and/or adverse outcomes he/she would like to review on a quarterly basis. Results of the
medical director's review will be discussed with the department at the EMS meetings.
Performance measures evaluated shall be a comparison of the department vs ESO Index measures for
Stroke assessment, End Tidal use with advanced airways, 12 lead acquisition for chest pain, and ASA
use in chest pain. Conformity with Mission Lifeline guidelines for performance and recognition is an
annual goal. Other performance measures examined are the BETS Compass quarterly reports,
department quarterly reports and ESO ad hoc reports.
AARs shall be held after responses that involve a cardiac arrest. An AAR may be held after responses
that involve a serious medical, major trauma (fall from heights, entanglement, penetrating injuries), or
following any response the incident commander feels it is necessary. For guidance on leading an AAR,
refer to SOG 300.11" After Action Review"
DEFINITIONS-
AAR- After action report
PCRs- Patient care reports
QA- Quality assurance
SOG's- Standard operating guidelines
REFERENCES-
SOG 300.11
Nicholas J. Edwards, MD
SOG Manual Page 2 of 2
013012
Date
THE CU�gkE
DUB
Masterpiece on the Mississippi
TO: Michael C. Van Milligen, City Manager
FROM: Rick Steines, Fire Chief
DATE: June 22, 2021
RE: Contract for Fire Department Medical Director
INTRODUCTION
Dubuque
All -America City
M11(YW,(M: I I ARA
2007-2012-2013
2017*2019
This memo is to notify you of the need to sign a contract for Medical Director for
the fire department.
BACKGROUND
Previous memos from May 7 and June 2 outlined a plan to begin contracting for
a paid service with Dr. Nicholas Edwards to provide medical direction. This plan was
approved and the funding for FY22 was determined through these memos.
DISCUSSION
EMS Supervisor Sam Janecke has worked with Dr. Edwards and City Attorney
Crenna Brumwell to finalize a contract. The deadline for this is June 30, as we need to
have the medical director in place and functioning July 1. At this time, the contract is
ready for your signature.
RECOMMENDATION
I recommend entering this contract for medical direction. I believe this will not
only solve a time -sensitive problem but will also be a catalyst for improvement of EMS
service in the future.
ACTION REQUESTED
I respectfully request your approval and signature on this contract. I am sending
a hard copy to your office for signature.
Cc: Crenna Brumwell, City Attorney
Juanita Hilkin, CMO
AGREEMENT BETWEEN
THE CITY OF DUBUQUE, IOWA
AND
NICHOLAS J. EDWARDS, MD
This Agreement is made and entered into on this day of June 2021,
between the City of Dubuque, Iowa (hereinafter, "City") and Nicholas J.
Edwards, MD (hereinafter, "Edwards"), whereby Edwards agrees to act as the
Medical Director for the City's Fire Department Emergency Medical Services
Division subject to the following terms and conditions:
NOW THEREFORE BE IT AGREED:
1. Duties. Edwards shall be retained to provide medical oversight of the City's Fire
Department Emergency Medical Services as outlined in the 2021 "Dubuque Fire
& EMS Medical Director Duties and Statement of Affirmation" (hereinafter, "MD
Duties and Affirmation") which is incorporated into and becomes a part of this
Agreement, and consistent with the requirements of Chapter 147A of the Iowa
Code.
2. Qualifications. Edwards agrees that Edwards shall at all times provide the
services under this Agreement. Edwards certifies he is qualified to act as a
physician in the State of Iowa and is licensed pursuant to Chapter 148 of the
Iowa Code.
3. Consideration. In consideration of Edwards providing his expertise to the City,
the City shall pay Edwards at a rate of $40,000 per year to be paid in twelve (12)
installments on a schedule as established by the City's Budget and Finance
Department.
4. Term. This Agreement shall be effective as of July 1, 2021 and shall terminate
June 30, 2024. By mutual agreement of the parties, this Agreement may be
renewed for one (1) additional term of up to three (3) years.
5. Termination. Either party may terminate this Agreement for any reason prior to
its expiration date by giving written notice to the other party at least one hundred -
twenty (120) days prior to the date of termination.
6. Notice. Notices required by this Agreement shall be deemed given when either
party delivers in writing via regular mail to the parties at the following addresses:
City: Fire Chief, Dubuque Fire Department, 11 W. 9th ST, Dubuque,
Iowa 52001
Medical Director: Nicholas J. Edwards, MD, Emergency Department,
250 Mercy DR, Dubuque, Iowa 52001. In the event Edwards ends his
affiliation with Mercy Hospital, Edwards will inform the City of a new
2
address within three (3) days.
7. Independent Contractor. Edwards is an independent contractor performing
professional services for the City and is not an agent, officer, or employee of the
City of Dubuque, Iowa.
a. Edwards shall have no claim against the City for employee rights or
benefits including, but not limited to seniority, vacation, sick leave,
retirement benefits, unemployment insurance benefits, civil service
protection, disability retirement benefits, health, or dental insurance.
b. Edwards shall not be subject to the direction and control of the City except
as to the performance of this Agreement.
c. Edwards shall be obligated to pay applicable taxes, deduction and other
obligations including, but not limited to federal and state income taxes,
withholding, deductions for social security, unemployment, disability
insurance, worker's compensation, or Medicare payments.
B. Insurance. Edwards agrees to comply with the requirements contained in City
Insurance Schedule J, attached as Exhibit A Edwards will furnish the City with a
certificate or certificates of insurance by an insurance company licensed to do
business in the State of Iowa, in compliance with Exhibit A by no later than July
1, 2021, or July 1 of any renewal year.
9. Hold Harmless and Indemnification. Edwards shall indemnify, hold harmless
and defend City, its officers, employees, and agents harmless and free from any
and all liability arising out of or relating to any injury to any person or damage to
or loss of any property caused by or arising out of the negligence or willful
misconduct on the part of Edwards in the performance of this Agreement.
10.Assignment. Neither party may assign or transfer any of its rights or obligations
under this Agreement without obtaining the prior written consent of the other
party.
11. Subcontracting. Edwards shall not subcontract any portion of the services to be
performed under this Agreement without the prior written permission of the City.
City shall be reasonable in its approval of short-term subcontracts, where short-
term is defined as two (2) weeks or less in length, including, but not limited to
Edwards' vacation or medical absence.
12. Incapacity. If, during the term of this Agreement Edwards becomes
incapacitated due to illness, injury, or other incapacity, and is unable to render
the services contemplated hereunder the City, may appoint an interim director
and at its option, may terminate the Agreement hereunder by providing seven (7)
3
days' notice to Edwards and any personal representative on Edwards behalf.
13.Confidentiality. Any confidential information provided to or developed by
Edwards in the performance of this Agreement shall be kept confidential and
shall not be made available to any individual or organization by Edwards without
the prior written approval of the City.
14. Governing Law and Venue. This Agreement shall be governed by the laws of
the State of Iowa and the venue for any disputes shall be in the Iowa District
Court in and for Dubuque County.
15.Disputes. In the event of any dispute between the parties arising from this
Agreement or the Services provided hereunder, each party shall, prior to seeking
judicial resolution of such dispute, escalate the dispute as follows, each party
shall appoint a representative to meet for dispute resolution. The designated
representative shall be as follows:
a. City: A representative appointed by the City Manager
b. Edwards: By himself or a representative of his choosing.
c. The representatives of each party shall use good faith efforts to resolve
the dispute between them. If such senior representatives are unable to
resolve the dispute, such dispute shall then be decided by arbitration
pursuant to procedures jointly agreed upon by the parties. The parties
shall make good faith efforts to resolve any and all disputes as quickly
as possible.
16.Conflict of Interest. Edwards warrants that he presently has no interest and
shall not acquire any interest, direct or indirect, which would conflict in any
manner or degree with the performance of services required under this
Agreement.
17.Amendment. This Agreement shall not be altered, changed or amended except
in writing, and approved by both parties.
18. Headings. The headings included in this Agreement are for convenience or
reference only and shall not be considered in the construction hereof. The
singular number shall include the plural and vice versa. All uses of the word
"including" herein shall, unless otherwise indicated, be interpreted to mean
"including, but not limited to."
19.Severability of Provisions. If any part of this Agreement is found by a court of
competent jurisdiction or other competent authority to be invalid, unlawful, or
unenforceable, then such part shall be severed from the remainder of this
Agreement, which shall continue to be valid and enforceable to the fullest extent
permitted by law.
12
20. Waiver. No failure on the part of either party to exercise, and no delay in
exercising, any right, power or privilege hereunder operates as a waiver thereof;
nor does any single or partial exercise of any right, power or privilege hereunder
preclude any other or further exercise thereof, or the exercise of any other right,
power or privilege.
21.Counterparts. This Agreement may be executed in counterparts, each of which
taken together shall constitute one single agreement between the parties.
22. Entire Agreement. This Agreement sets forth the entire agreement between the
parties, and fully supersedes and replaces any prior agreement or
understandings between the parties, whether written or oral, regarding the
matters stated herein.
Nicholas J. Edwards, MD Date
Michael C. Van Milligen Date
City Manager
5