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HomeMy WebLinkAboutCityMgrForm.1491.09-19-1979 CITY MANAGER FORM ORDINANCE N0. 1 ��11 AN ORDINANCE APPROVING THE FORM OF A CONTRACT BETWEEN THE CITY OF CAPE GIRARDEAU AND THE COUNTY OF CAPE GIRARDEAU, FOR EMERGENCY AMBULANCE SERVICE, AUTHORIZING THE PAYMENT OF A SUM OF MONEY, AND AUTHORIZING THE MAYOR TO EXECUTE WHEREAS, The City and County of Cape Girardeau, Missouri have been contracting with the Cape County Private Ambulance Service, Inc. , for emergency ambulance service in the City and County of Cape Girardeau; and WHEREAS, it has become more feasible for one party to contract for ambulance service; and WHEREAS, there is a need to provide ambulance service throughout the County of Cape Girardeau; and WHEREAS, it is part of governmental responsibility of the City and County to assist in providing for emergency ambulance service to the citizens of Cape Girardeau County; and WHEREAS, the City and County desire to enter into an agreement for the providing of said ambulance service; NOW, THEREFORE, BE IT ORDAINED BY THE COUNCIL OF THE CITY OF CAPE GIRARDEAU, MISSOURI, AS FOLLOWS : SECTION 1. The "Contract" between the City of Cape Girardeau, Missouri and the County of Cape Girardeau, Missouri, copy of which is attached hereto marked Exhibit "A" , providing for emergency ambulance service, is approved as to form. SECTION 2. The Mayor is hereby authorized and directed to execute said "Contract" , copy attached hereto marked Exhibit "A" , for and on behalf of the City of Cape Girardeau, Missouri. SECTION 3. Payment of a sum of money by the City of Cape Girardeau, Missouri to the County of Cape Girardeau, Missouri, is hereby authorized to be made for the providing of emergency ambulance service, in accordance with the terms and provisions of said Contract. i ���i � SECTION 4. This ordinance shall be in full force and effect ten days after its passage and approval. PASSED AND APPROVED THIS /y� DAY OF �2 ' � �e Y�, 1979. ,� � Pa 1 W. Stehr, Mayor ATTEST: -, \ ` �{���� Verna L. Lan is, City Clerk CONTRACT _�L THIS AGREEMENT, made and entered into this � day of , 1979, by and between the CITY OF CAPE GIRARDEAU, a Municipal Corporation of the State of Missouri, hereinafter referred to as "The City" , and the COUNTY OF CAPE GIRARDEAU, a political subdivision of the State of Missouri, hereinafter referred to as "The County" ; WITNESSETH: City and County have been contracting with the Cape County Private Ambulance Service, Inc. , for emergency ambulance service in the City of Cape Girardeau and Cape Girardeau County; and WHEREAS, it has become more feasible for one party to contract for � ambulance service; and WHEREAS, there is a need to provide ambulance service throughout the County of Cape Girardeau; and WHEREAS, it is part of governmental responsibility of the City and County to assist in providing for emergency ambulance service to the citizens of Cape Girardeau County. NOW, THEREFORE, in consideration of payment by the City to the County of the sum of money set out more particularly in the agreement and in consideration of the mutual promises and agreement contained herein and for other good and valuable considerations, the County agrees that it will furnish to the City, ambulance service under the terms and conditions of this contract for a period of two (2) years starting January 1, 1979, to terminate December 31, 1980. The parties hereto agree as follows: 1. The County agrees to provide and furnish emergency ambulance service as herein set forth to the citizens of the City of Cape Girardeau, Missouri, for Twenty-Five Thousand Dollars ($25, 000. 00) per year, to be paid in equal monthly installments by the first day of each month. 2. The County agrees to enter into an agreement with the Cape County Private Ambulance Service, Inc. , which agreement will �XH I B.t"� �A• . contain the provisions set forth in Exhibit A, which is attached hereto and incorporated by reference as part of this document. This Agreement shall be binding upon and shall inure to the benefit of the respective parties hereto and their successors and assigns. IN WITNESS WHEREOF, the parties have executed this instrument in duplicate as of the day and year first herein written. CITY OF CAPE GIRARDEAU, MISSOURI � Pau W. Stehr, Mayor ATTEST: � ` Verna L. Landis, City Clerk , COUNTY OF CAPE GIRARDEAU, MISSOURI Presiding Judge County Court ATTEST: County Clerk 2. � . AGREEMENT THIS AGREEMENT, made and entered into this 21st �gy of December , 1978 � by� and between CAPE GIRARDEAU COUNTY� a political subdivision of the State of ?iissouri, acting by and through the duly authorized members of its governing body , the County Court , hereinafter referred to as "County", and CAPE COUNTY PRIVATE AMBULANCE SERVICE, INC. , a Missouri corporation, whose principal place of business is � 1458 North Kin�shighway� Cape Gi,rardeau� itissouri� herein- after referred to as "Ambulance Corporation" , WITNESSETH: WHEREAS , Ar.ibulance Corporation has been furnishing general ambulance service for sick and injured persons in need of emergency and non-emergency care within and .from and around Cape Girardeau County, Missouri, as a business for profit, and regularly responds to calls for ambulance services throughout Cape Girardeau County and the City of Cape Girardeau, ttissouri; and� WHEREAS , le�islation passed by the �eneral assembly of the State of tiissouri and codified as §§190 . 005-190. 195 , RSMo. Supp . 1975� hereinafter referred to as "Ambulance Licensin� Law", requires ambulance vehicles and operating personnel to be qualified and licensed by the Missouri Division of Health� and further provides for the approval of rates charged for such services ; and, . WHEREAS , Ambulance Corporation ia the only ambulance service operating in the County duly licensed� qualified and thereby meetin� all of the specifications of §§190.005- 190. 195, RSPio. Supp. 1975 , and the rules and regulations promul�ated pursuant thereto by the P4issouri State Board of Health, and the rules and regulations of the Public Service Commission of the State of tZissouri ; and� WHEREAS , to provide and maintain quality emergency . medical care in the form o� state licensed ambulance service throughout said County, it is necessary for the County to provide Ambulance Corporation subsidization to meet the public need for the aforesaid ambulance service ; and, WHEREAS, there is a substantial need for the furnishing of qualified and licensed emergency ambulance service to the residents of the County of Cape Girardeau; and WHEREAS, County acknowledges it is a governmental responsibility of the County to assist in providing for such emer�ency medical service ; and, WHEREAS , it is deemed by the County Court to be econom- �ically feasible, expedient, and practical for the County to contract to provide emergency ambulance service to the citizens and residents of Cape Girardeau County � t4issouri� NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the sufficiency of which is � acknowledged by the signatures of the parties in authority attached hereto. it is hereby mutually covenanted and agreed as followa: 1. Definitions : As used in this A�reement� the follow- ing words shall have the meaning specified unless the con- text clearly warrants otherwise : (a) "Ambulance service" Medical service provided by Ambulance Corporation with a state licensed ambulance vehicle manned by at least one state licensed ambulance attendant and one attendant-drive�, This aervice shall includ� the removal of dead persons at the request of proper . authorities . (b) "Ambulance" - A motor vehicle specifically designed to comply with the requirementa of and licensed � under the Ambulance Licensing Law. (c) "�mergency ambulance run" - The dispatching of properly equipped and manned ambulance vehicle in response to a request for emergency ambulance service. (d) "Incurred char�es" - The fees charged by . Ambulance Corporation to a user of its ambulance aervice in accordance with the rate schedule. , -2- (e) "Life support vehicle" - An ambulance equipped with telemetry equipment and/or other items specified in §190. 140(4) , RSMo. Supp. 1975, manned by one Mobile Emergency Medical Technician and one attendant-driver licensed by the State of Missouri. (f) "Rate schedule" - The list of regular fees charged to use�ra of the ambulance service provided by Ambulance Corporation as filed with and approved by the Missouri Divi- sion of Health and appended to this A�reement. 2. Ambulance Corporation agrees to provide and furnish� or have Provided and furnished, emergency ambulance aervice as herein set out and in the manner provided� throughout Cape Cirardeau County and the City of Cape Girardeau for a period of two years beginning January 1� 1979, and extending through December 31, 1980. � 3. In addition, Ambulance Corporation shall provide emergency ambulance service to the Cape Girardeau Municipal Airport located in Scott County, 24issouri� in response only to notification to Ambulance Corporation by any one of the following: Cape Girardesu Police Department ; Cape Girardeau Fire Department; or Cape Girardeau Municipal Airport Manager' s OffiCe. Service to the Cape Girardeau Municipal Airpozt sllall be made available provided a license from the Depart- ment of Health is issued allowing such service by Ambulance Corporation in Scott County. County agrees to cooperate with Ambulance Corporation to asaist it in obtaining such license. if necessary, together with a certificate of convenience and neceasity iseued pursuant to §190. 125 , RSMo. Supp. 1975. . (a) Subsequent to any emergency ambulance run to the Cape Girardeau Municipal Airport as provided for hereitt� Ambulance Corporation shall make every effort for one hundred twenty (120) days thereafter to collect the charge incurred from the recipient of such service or other pereon who has agreed to be responsible for payment of the Bervice provided. Such effort rnay include referral to an attorney for collec-' . tion, but shall not require suit to be brought by said -3- attorney if in the attorney ' s opinion suit is not warranted. (b) In the event collection of incurred charges � ie not effected as provided in parap,raph 2(a) above , County agreea to pay Ambulance Corporation the incurred charges within twenty (20) days from the date it receives a etatement for same from AmbuYance Corporation. 4. Ambulance Corporation agrees to provide and have available no less than two fully e�uipped ambulance vehicles . one fully equipped Life Support vehicle , and sufficient licensed personnel to operate the� in compliance With the Ambulance Licensing Law and Regulations promulgated by the• Missouri Board of Health. 5 . Ambu].ance Corporation a�rees to resnond to all calls for e�ergency ambulance service required of it within �the boundaries of Cape Girardeau County . Ambulance Corpora- tion shall retain sole authority to dispatch ambulances . Ambulance Corporation agrees to respond to any requeat by a commissioned law enforcement officer for emergency ambulance service . 6. Ambulance Corporation agrees that all ambulance vehicles and personnel which it shall place in service will be iri compliance with all current and applicable federal and state laws and regulations , and Ambulance Corporation agrees to operate its emexgency ambulance service in compliance with all current and applicable state and federal laws , and law�ul requests from any regulatory a�,ency having juriadiction over Ambulance Corporation. 7 . Ambulance Corporation agrees to make available emergency ambulance service twenty-four (24) hours per day � seven dayg per week , during the life of thie Agreement . Response to all calls shall be made within a rea8onable time from notification of request for emergency ambulance service. Ambulance Corporation shall at all times provide means whereby it can be notified of � request for emergency ambu- lance aervice . The County shall make available to Ambulance _ Corporation a roster of all law enEorcement officers � together -G- with badge numbers , on at least an annual basis , or more frequently if requested by Ambulance ,Corporation. The County shall encourage all political subdivisions within its boundaries to require law enforcement officers under their jurisdiction to cooperate fully with Ambulance Corporation to effect coordinated communications and services so as to provide to those in need all necessary emergency ambulance service. The County a�rees to encourage such cooperation, where possible , from all other law enforcement a�encies existing and operating from and within the County. 8 . The County agrees to pay to Ambulance Corporation• the amount of EIGHT THOUSAND SEVEN HUiJDRED FIFTY DOLLARS ($8, 750 . 00) per month , in twenty-four (24) e�ual monthly in- stallmenta , be�inning on January l , 1979 , and payable there- after on the first day of each month as long as Ambulance Corporation continues , during the life of this A�reement � to have available three ambulance vehicles in com�liance with the requirements of this A�,reement . County agrees to pay Ambulance Corporation in addition to the amounts specified in paragraph 8 the full incurred charge for service pro- vided by Ambulance Corporation at the request of a county offi�ial or official of any political subdivision in the County for transportation and care of any person then in the custody of a law enforcement agency or official of the County or respective political subdivisions of the County. 9. Ambulance Corporation agrees to bill for ambulance service provided to the requesting,. nerson, authority , ap,ency , place of business or concern from whom or from which the request is made based �pon its then current Rate Schedule . Ambulance Corporation agrees to notify the County immediately of any changes by Ambulance Corporation in the Rate Schedule during the term of this Agreement . Such Rate Schedule changes thereafter shall become a part of this Agreement. 10. Ambulance Corporation agrees to keep and maintain complete and accurate records of all ambulance service provided in Cape Girardeau County or otherwise contemplat'ed by this Agreement , including, but not limited to , those -5- items required in §190 . 175 , RSMo. Supp . 1975 , and related regulations . Such records shall be available to the County at all times during normal business hours upon reasonable notice to Ambulance Corporation through its desiRnated or duly authorized agent. Such records shall be maintained £or a period of one year after expiration of this Agreement. Ambulance Corpora'tion further a�rees to make these records available upon written request to the Cape Girardeau County Auditor for an annual audit . 11. The parties to this A�reement aRree that Ambulance Corporation has and shall continue to operate its business • solely as an independent contractor , and shall do so at such time or place and in a manner as it may desire� subject to the provisions of this Agreement . (a) The parties to this Agreement agree that " Ambulance Corporation may finance its business in any way it desires � and it may impose such charges as it may desire for any service outside the scope of this contract, suh�ect to any restrictions respecting rates as provided for herein, and sub�ect to the authority of the Missouri Division of Health. Ambulance Corporation ap,rees to keep and post its � current Rate Schedule in a public and consnicuous place at its place of business during the entire term of this Apreement. (b) The parties to this Agreement understand and agree that the County assumes no risk whatsoever for the actions of Ambulance Corporation, and that this Agreement shall not operate to effect any agency on behalf of Ambulance Corporation to or for County , nor shall it operate to estab-` lish a joint venture, joint enterprise or partnership between i the parties hereto , it being the express intention of the parties hereto only to provide for remuneration to be paid by the County to Ambulance Corporation in order to assure that the citizens of Cape Girardeau County be afforded adequate and quality emergency ambulance service. -6- 12 . Ambulance Corporation agrees to keep and maintain during the life of this Agreement public liability insurance . on all of its vehicles in an amount of not less than One Hundred Thousand Dollars ($100 ,000 . 00) per individual , per accident , and Three Hundred Thousand Dollars ($300 ,000 . 00) per accident as now required by §190 . 120 , RSMo . Supp . 1975 , and the Rules and Regulatione promulgated thereunder or such additional amounts if required by the aforesaid atatute and regulationa , and to provide and furnish to the County a copy of the declaration page of its current certificate of insurance providing such coveraRe � and showin� the same to� be in full force and effect throu�hout the period of this Agreement. 13. Ambulance Corporation agrees to keep , furnish and supply all vehicles , moving equipment , other equipment and personnel necessary to comoly with its obligations under this Agreement � and agrees that it shall be solely responsible for the maintenance and upkeep of same . Except as otherwise provided in this Agreement , Ambulance Cornoration shall be solely responsible for any indebtedness owed or incurred by it . � �14. Ambulance Corporation agrees to hold and save County harmless from any and all liability arising out of the operation of its business and the providing of services as contemplated by this Agreement. Included in the responsi- bilities of Ambulance Corporation as contemplated by this Agreement are the obligations normally attendant the employ- ment of individuals within a business such as withholding of Federal Income Tax, pr�viding for state and federal con[ribu- tions to unemployment where required, providing for any and all fringe benefits established by the Ambulance Corporation, and complying with the Federal Wage and Hour Law. 15 . No party to this Agreement shall assign or sublet any portion of the obligations and responsibilities provided for herein , without first obtaining the written consent of the other party. � - -7- ____ �____._____ �,—,-,,,,�,,., _ _-__. 16. (a) When a request ia made of Ambulance Corpor- ation to provide emerpency or non-emergency ambulance service , after Ambulance Corporation arrivea with the patient at any .medical facility within Cape Girardeau County, this initial request shall be considered as honored and ehall be termin- ated at this point in time and that location. Any request for ambulance service after termination of such initigl request shall be considered a request for additional ambu- � lance aervice, and additional char�es for such service may . � be made by Ambulance Corporation. (b) A specific request for out-of-county services to be provided by Ambulance Corporation shall be made directly to Ambulance Corporation prior to its beinp obligated to � comply with such request . County a�rees that the party requesting such out-of-county aervice shall accept responsi- bility in writing for paying, for such service , or shall make payment in full at the point of departure or point of destina- � tion at the sole option of Ambulance Corporation. 17. No later than July 1, 1980 , the parties shall commence negotiations for a new Agreement. Should the parties then desire to contract with one another for the purpose of providing emergency ambulance service � or in the event either of the parties intends not to renegotiate � such intention shall be made in writing, by one party to the other on or before August 1, 1980 . 18. This Agreement r�ay be modified only by written addendum to this Agreement executed in the same manner as the original Agreement . Such addendun shall then be attached to and made a part of Chfs Agreement . 19. This Agreement shall be binding upon the parties hereto� their successors and assigns . -8- ' . IN WITNESS WHEREOF, the parties hereto have hereunto set their hands the day and year first above written. COUNTY OF CAPE GIRARDEAU • • • " , � By : L . ,�..._ rvin o s � res ng u ge � f i:/� .�/� �� ATTEST: • By . 'C- %� � ' �j`� --�i'-� -'t;Cz� ' �F3� ssoc ate udge Leonard F. Sander / r .� � ,� , ( � . `y/ �� o n y Cler . R. Fisc er � Associate Ju ge CAPE COUNTY PRIVATE AMBULANCE ATTEST: SERVICES , INC. � p�, �— By r.�. � .« ecretary eor ouse , re ent r J _g_ RATE SCHEDULE Effective January 1, 1979 , the following rates will be charged for the designated classes of ambulance service pro- vided persons by Cape County Private Ambulance Service , Inc. ' Class • • Service I. Transfer within the city limits of Cape Girardeau or the city limits of Jackson, 24issouri : Routine transfer (non-emerge�cy) . $ �►0. 00 per person Emergency . . . . . $ 45. 00 per person II . All requests for transfer outside the city limits of Cape Girardeau or Jackson, Missouri , but within Cape Girardeau County , t4issouri� shall be � charged as follows : � Routine transfer (non-emergency) . $ 45 . 00, per person �mergency . . . . . $ 50. 00 per person III. Rates for out-of-county service (routine transfer only) will be as follows : St . Louis , Missouri . . . $170. 00 per patient riemphis , Tennessee . . . . $215. 00 per patient ' t1t. Vernon� Missouri . . . S 35. 00 per patient plus $1. 00 per mile Columbia, Missouri . . . . $ 35 . 00 per patient plus $1. 00 per mile IV. Transportation to any area not listed above shall be $35. 00 loading fee , plus $1. 00 per mile from . point of origin to point of destination. All emergency calls (not scheduled) shall be charged $5 . 00 extra per person in addition to the above rates. ' ADVANCED LIFE SUPPORT �, Any Ambulance call requesting or requiring Advanced Life Support Paramedics will be charged a $25 . 00 fee in addition to the transportation fee when such services are rendered. PRE-NOSPITAL ELECTROCARDIOGRAM (E. C.G . ) VI. Any patient being transported who requires an E.C.G upon Physician or Hospital request , will be charged � a $15.04 fee in addition to the transportation fee. Use of telemetry equipment in connection with an , :� E. C. G, will be charged at a rate of $25 . 00. ----,,� VII . The specified charp,es for the following specialized emer�ency equipr►ent needed for ill or in,jured persons , will be imposed in addition to the transport char�es : 1. Oxygen (minimum) . . . . . $ 7. 50 2, Portable Oxy�en . . . . . . 10. 00 3. Full "E" tank . . . . . 15.00 4. Scoop-fracture removal stretcher . . 5 . 00 5. Full Spineboar� . . . . . 5 . 00 6. Half Spineboard . . . . . 5 . 00 7 , Aspirator . . . . . . 7.•50 8. C. Collar-fracture . . . . 5 . 00 9. Splints-fracture � inc. Hare & Timmons . 10. 00 10. Burn sheets . . . . . . 5.00 11. Trauma pack . . . . . . 5. 00 . 12. Airway . . . . . . . � 2 . 00 - 13. Kling and A. B. D. dressing . . . 1. 00 14. 4 x 4 dressings . . . . . 1. 00 VIII. OTHER SPECIAL RATES AND PROVISIONS : 1. A minimum of $30. 00 per hour will be charged for waiting time, ' 2 . Any patient requiring service from second floor or above , where no elevator is available , will be charged $5. 00 per flight in addition to the regular charge . ALL CHARGES ARE DUE AND PAYABLE AT THE TIME SERVICE IS REQU�STED� UNLESS PREVIOUS ARRANGEMENTS HAVE BEEN MADE AND APPROVED BY THE AMBULANCE CORPORATI�ON. PARTIES REQUESTING SERVICE SHALL BE REQUIRED TO SIGN A WRITTEN REQUEST FORM WHICH SHALL INCLUDE A PROMISE TO PAY. � � ----. Emergency Telephonea Busintss Telephons 335-3305 335-2191 335-3306 Air Conditioned - Oxygen Equipped CAPE COUNTY Privaf-e ,C�Bn�a�la,i�c Serv��e, In�. 371[ZXlbE0��67�d(d'�dE�E 1458 N. KingshighWay CAPE GIRARDEAU, MISSOURI 63701 ,Tuly 30, 1979 FROM: George F. Rouse, President REFs Increase in Cape County Private Ambulance � 1�ansportation Service, Inc. Rates T0: Mr. Gene Huckstep Presiding Judge, Cape Girardeau County Court Courthouse ,Tackson, Mo. 63755 Dear Sir: 1. As a result of the spiriling cost of Gasoline, 011� Tires and " Medical Supplies that are used in our business, xe find it necessary as detailed in our contract xith the Court� to re- quest authority to increase our rates as presented to and charged to the user of the service. 2. The proposed rate increase for transportation charges are en- closed. 3. Please be advised that the request for increase in rates xill not, in anyxay, change or alter our existing contract. The in- crease requested xill be psid by the user of the service. 4. Your consideration in thia matter will be greatly appreciated. Sincerely yours, CAPE COUNTY PRZVATE AMBULANCE SERVICE. INC. ,�R�-s— G. eor F. ouse Encl. GFR�tr 3 ' 1 � � . � .. ..�� �mergency Telephones Business Telephone 335-3305 335-2191 335-3306 Air Conditioned - Oxygen Equipped CAPE COUNTY lPi•ivatc A���I'ul�»_�.�c Servi�e, In�. 3304 Independence CAPE GIRARDEAU, MISSOURI 63701 RA7'E SC}�IEDLTI,E I. TRANSFER: Within city li�nits of Jackson or Cape Girardeau $45.00 EMERGENCY: Within city limits of Jackson or Cape Girardeau 50.00 II. TRANSFER: Outside city limi�s of Jackson or Cape Girardeau 50.00 EMERGENCYs Outside city limits of Jackson or Cape Girardeau SS•� III. TRANSFER OUT OF COUNTYs St. Louis� Missouri ---------------------------------------- $200.00 Memphis� Tenn. --------------------------------------------- $250.00 IV. Transportation to any area not listed above shall be $40.00 loading fee, plus $1.50 per loa.ded mile. bnergency transportation xill be $5.00 additional. V. ADVAI4�ID LIFE SUPPORTi ZYansportation requesting or requiring Paramedical Skills xill be $35.00 in addition to transportation charges. VI. PRE-HOSPITAL EIECTROCARDIGRAM (E.K.C. ) 20.� VII. SPECIALIZED EN�RGENCY UIPMENT: 1. Oxygen minimum ---------------------------------------- $10.00 2. Portable Oxygen ----------------------------------------- 10.00 3. Full ��E„ tank o�cygen ------------------------------------ 15.00 4. Scoop Stretcher ----------------------------------------- 5.00 5. Full-Spineboard ----------------------------------------- $.00 6. Half-Spineboard ----------------------------------------- 5.00 7. Aspirator ----------------------------------------------- 7.50 8. Cervical Collar ----------------------------------------- 5•00 9. Traction Splints ---------------------------------------- 10.00 10. All other splints --------------------------------------- S•� 11. Burn sheets --------------------------------------------- 10.00 12. T�auma Pack --------------------------------------------- 5.00 z3. air,�y -------------------------------------------------- 2.00 14. Kling and A.B.D. dressings ------------------------------ 1.00 15. 4 x 4's ------------------------------------------------- 1.00 VIII. OTHER SPDCIAL RATES: 1. Waiting Time per hour) --------------------------------- $40.00 2. Service f�om second floor or above. xhere no elevator is available xill be charged $5.00 per flight. y � « . � . MEMBERS COURT: JUDY BEUSSINK, Deputy GENE E. HUCKSTEP, RODN EY M I LLER BETTY L. HAHS, Deputy Presiding Judpe NELL JONES, Oeputy LEONARD F. SANDER, RUTH DICKERSON, Deputy tst. District Judge J.R. "Ronnie" FISCHER. CLERK OF THE COUNTY COURT 2nd Dislrict Judge CAPE GIRARDEAU COUNTY Jackson, Missouri 63755 Telephone 243,-3547 AUgus t 6, 19 79 ; Mr. George Rouse Private Ambulance Serv. , Inc. 1458 N. Kingshighway Cape Girardesu, Missouri 63701 Dear Mr. �touse: • Having received your letter as of August 2, 1979, the Cape Girardeau County Court does hereby approve your request for Rate Increase in the Ambulance Contract. We hope this increase will suffice for the balance of contract, for the benifit of the consumer. Sincerely, --. / �y� � Clerk County Court RM/nj y ! I I���Mn�iti�+��� M��I