Dedicated Standby Contract

EVENT INFORMATION

Date Received:

 

Crew will be in place

15 minutes prior to start time.

 

Date of Event:

 

Start time:

 

End time:

 

Number of Ambulances:

 

 

[ ] Dedicated

 

[ ] ALS [ ] BLS

Rate Per Hour:

 

Mileage Fee (If outside of GJFD ASA)

N/a

Total Cost Estimate:

 

 

 

 

CONTACT INFORMATION

Event Name:

 

Event Location:

 

Contact Name:

 

Contact Phone Number:

 

Billing Address:

 

Contact email:

 

 

The Grand Junction Fire Department will provide:

 

[ ]  EMT staffed squad

 

[ ]  Paramedic staffed squad

 

[ ]  BLS - Basic Life Support ambulance (staffed at a minimum, with two EMT-B’s)

 

[ ]  ALS - Advance Life Support ambulance (staffed at a minimum, with one Paramedic and one EMT-B, preferred)

 

This coverage will be:

 

[X]  Dedicated (Assigned to the event)

 

The Grand Junction Fire Department will:

 Ensure compliance with all State, County, and local rules and regulations that govern ambulance services and/or coverage at special events. Ensure personnel follow the protocols of the Mesa County Medical Director. Apply the current fee schedule approved by the Grand Junction City Council. Invoices will be calculated using the actual time provided, not estimated times.

 

The event organizer agrees:

 

To pre-plan details of event coverage and encourage coordination between the on-site staff and the Grand Junction Fire Department:

 

[X]  With a communication plan

 

[X]  Identification of staging Areas

 

[X]  Identification of ingress and egress routes

 

[X]  Coordination of Medical Treatment protocols

 

[X]  Planning in the event additional resources are needed

 

In addition, the event organizer agrees that:

 

[X]  Payment for services provided is due within 30 days of the event.

 

[X]  In the event of inclement weather, this event may be cancelled with notification to the appropriate Grand Junction Fire Department (GJFD) Communications Center at least two (2) hours prior to the start time without cost. 242- HELP (4357)

[X]  Cancellations that occur within two hours of the event will be charged a minimum of two hours stand-by time at the agreed upon standby rate

 

 

 

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Signature, Special Event Representative     Date

 

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Title

 

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Signature, GJFD Representative        Date

 

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Title