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AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of Wednesday, October 8, 2008
Please see directions for completing this document on the next page.
DATE: October 1, 2008
FROM: Sharon L. Smith Administrative Assistant 541-539-8622
TITLE OF AGENDA ITEM:
Consideration of Board Signature of Document No. 2008-546, an Intergovernmental Agreement wi th
the City of Springfield for EMS Account (ambulance billing) services.
PUBLIC HEARING ON THIS DATE? NO
BACKGROUND AND POLICY IMPLICATIONS:
This agreement was originally a one-year agreement that would be changed to a two-year agreement.
FISCAL IMPLICATIONS:
None; it is already budgeted.
RECOMMENDATION & ACTION REQUESTED:
Approve Document No. 2008-546, an Intergovernmental Agreement with the City of Springfield.
ATTENDANCE: Jim Coe / Sharon L. Smith
DISTRIBUTION OF DOCUMENTS:
Sharon L. Smith, Administrative Assistant, Sunriver Service District and Jim Coe, Chairman, Sunri\ er
Service District.
SUNRIVER SERVICE DISTRICT
Managing Board
Resolution to Approve EMS Account Services Intergovernmental
Agreement with the City of Springfield
R2008-009
Whereas the Sunriver Service .District was created on June 12, 2002 by Order No.
2002-085 of the Deschutes County Commissioners, and.
Whereas the Deschutes County Commissioners, acting as the Governing Board of
the Sunriver Service District on June 26, 2002 in Agreement No. 2002-147 did
specify that the Sunriver Service District (hereafter "District") provide law
enforcement, fire prevention and protection services, emergency medical services
including ambulance, security services by contract, and
Whereas the Deschutes County Commissioners, acting as the Governing Body of
the District on June 26, 2002 in the Memorandum of Understanding Contract No.
2002-201 and Agreement No. 2002-147 did delegate managing authority for the
District to the District Managing Board (hereafter "Board" created within these
documents, and;
Whereas the District Managing Board wishes to enter into an Intergovernmental
Agreement with the City of Springfield to provide EMS Account Service to the
Sunriver Service District.
Now, Therefore it is resolved by the District Managing Board that the attached
EMS Account Service Intergovernmental Agreement with the City of Springfield
is approved and requests the Governing Body to also approve the
Inter overnmental Agreement
Dated this 25th of Se tember, 2008
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41 WA
Bob WWghtson, Director
Steve Hamilton, Director
Page 1 of 1
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D ris Brannan, Director
September 25, 2008 R2008-009
1 EMS ACCOUNT SERVICES INTERGOVERNMENTAL AGREEMENT
2 This Agreement is entered into by and between the City of Springfield, an Oregon municipal corporation,
3 acting by and through its Department of Fire and Life Safety, hereinafter referred to as "Springfield" and
4 the Sunriver Service District Fire Department, an Oregon municipal corporation, on behalf of its
5 ambulance service, hereinafter referred to as "Sunriver."
6 RECITALS
7 A. ORS 190.010 provides that units of local government may enter into agreements for the
8 performance of any and all functions and activities that any party to the agreement, its officers, or
9 agents have authority to perform.
10 B. Provision of services for the remuneration specified in this Agreement will mutually benefit the
11 parties to it.
12 C. Timely and accurate billing, collection, and patient account services for ambulance services are
13 high priorities for both Sunriver and Springfield.
14 D. Sunriver desires to enter into an Agreement with Springfield whereby Springfield will provide
15 billing, collection, and patient account services on behalf of Sunriver for all billable patients
16 serviced by the Sunriver Emergency Medical Services system.
17 E. Springfield is willing to furnish ambulance billing, collection, and patient account services to
18 Sunriver according to the terms and conditions set forth herein.
19 AGREEMENT
20 NOW, THEREFORE, in consideration of the above recitals and the covenants contained herein, the
21 parties hereby agree as follows:
22 1. Springfield Services to be Provided. Springfield agrees to provide the services described in
23 EXHIBIT A, which is attached hereto and made a part hereof.
24 2. Sunriver Responsibilities. Sunriver agrees to perform the obligations and pay for the services
25 performed by Springfield in the manner and at the rate described in EXHIBIT B, which is attached
26 hereto and made a part hereof.
27 3. Contract Duration. This Agreement shall commence on July 1, 2008 and shall continue until
28 June 30, 2010 unless extended, modified, or terminated as provided herein.
29 4. Extension. This Agreement may be extended for additional one-year periods upon compliance
30 with the provisions of paragraph 12 and with the following procedure:
31 4.1. The parties shall confer not later than 30 days before the expiration of this Agreement
32 regarding the desirability of extending the Agreement. The Springfield Contract
33 Representative and the Sunriver Contract Representative shall confer regarding the
34 proposed fee for services and any other proposed Agreement revisions proposed by
35 either party.
36 4.2. If the parties, after negotiation, agree, an Agreement Modification that stipulates any and
37 all Agreement modifications shall be executed. The Agreement Modification shall be
38 attached to this Agreement.
39 5. Representatives. Each party shall appoint a Contract Representative to represent the party for
40 the purpose of extending this Agreement and giving or receiving any notices provided for in this
41 Agreement and to perform such other functions as are set forth in this Agreement and the
42 Exhibits hereto. The initial Contract Representatives are named in EXHIBIT D, which is attached
43 hereto and made a part hereof. A party may change its Contract Representative by notifying the
44 other party in conformance with the provisions of paragraph 9. Sunriver shall appoint an
45 Ambulance Service Representative to perform the Ambulance Service functions stated on
46 EXHIBIT B. The initial Ambulance Service Representative named on EXHIBIT D may be
EMS Account Services Intergovernmental Agreement—Sunriver Service District Fire Department Expires: June 30, 2010
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47 changed in the same way that Contract Representatives are changed. One person may serve in
48 both representative capacities, if that person meets the qualifications to perform both functions.
49 6. Status. In providing services specified in this Agreement (and any associated services), both
50 parties are public bodies and maintain the public body status as specified in ORS 30.260. Both
51 parties understand and acknowledge that each retains all immunities and privileges granted them
52 by the Oregon Tort Claims Act (ORS 30.260 through 30.295) and any and all other statutory
53 rights granted as a result of their status as local public bodies.
54 7. Indemnification. To the extent allowed by the Oregon Constitution and the Oregon Revised
55 Statutes, each of the parties hereto agrees to defend, indemnify, and save the other harmless
56 from any claims, liability or damages including attorney fees arising out of any error, omission or
57 act of negligence on the part of the indemnifying party, its officers, agents, or employees in the
58 performance of this agreement.
59 8. Assignment. Neither party shall assign this contract in whole or in part, or any right or obligation
60 hereunder, without the other party's written approval.
61 9. Notices. Any notices permitted or required by this contract shall be deemed given when
62 personally delivered or upon deposit in the United State mail, postage fully prepaid, certified,
63 retum receipt requested, addressed to the representative designated in EXHIBIT D. Either party
64 may change its address by notice given to the other in accordance with this paragraph.
65 10. Integration. This Agreement embodies the entire agreement of the parties. There are no
66 promises, terms, conditions, or obligations other than those contained herein. This contract shall
67 supersede all prior communications, representations, or agreements, either oral or written,
68 between the parties. This contract shall not be amended except in writing, signed by both parties.
69 11. Interpretation. This Agreement shall be governed by and interpreted in accordance with the
70 laws of the state of Oregon
71 12. Modification. This Agreement or any of its Exhibits may be modified at any time by mutual
72 consent of parties. No change or modification of this Agreement or any of its Exhibits shall be
73 valid or binding upon the parties hereto unless such a change or modification is in writing signed
74 by all the parties hereto.
75 13. Termination. Upon 180 days prior written notice delivered to the persons designated in EXHIBIT
76 D, either party, without cause, may terminate its participation in this Agreement.
77 14. Obligations upon Termination. Except for Default pursuant to paragraph 15, upon termination,
78 Springfield shall continue to perform all services set forth in EXHIBIT A for all ambulance
79 incidents occurring prior to the termination date except that instead of turning problem accounts
80 over to a collection agency or small claims court, these accounts shall be returned to Sunriver for
81 further processing. Upon completion of all services at termination, Springfield shall return all
82 books, accounts, and records to Sunriver that relate solely to billing accounts received from
83 Sunriver. After termination, Springfield shall have no obligation to render further services for
84 Sunriver except that Springfield shall continue to forward payments received on Sunriver
85 accounts to Sunriver.
86 15. Default. In the event that Sunriver shall fail to comply with any term or condition or fulfill any
87 obligation of this Agreement, Springfield may terminate the Agreement upon 14 days written
88 notice to Sunriver's Contract Representative. Springfield shall turn over to Sunriver all receipts,
89 books, accounts, and records in the possession of Springfield that relate solely to billing accounts
90 received from Sunriver. In such event, Springfield shall have no obligation to render further
91 services to Sunriver except that Springfield shall continue to forward payments received on
92 Sunriver's accounts to Sunriver. The provisions of paragraph 14 shall apply in connection with an
93 Agreement termination made under this provision.
94 16. Waiver and Breach. The waiver by either party of any breach or violation of any provision of this
95 Agreement shall not be deemed a waiver of such term or condition in the future.
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96 17. Attorney Fees. In the event of any action to enforce or interpret this Agreement, the prevailing
97 party shall be entitled to recover from the losing party such additional sums as the court may
98 adjudge for reasonable attorney fees plus all costs and disbursements at trial, on any appeal, or
99 upon review.
100 18. Notice of Adverse Action. Each party shall notify the other in writing, within five days of
101 receiving any written, or oral notice of any adverse action naming or otherwise involving the other.
102 19. Severability. Invalidation of any term or provision herein by judgment or court order shall not
103 affect any other provision, which shall remain in full force and effect.
104 20. Force Majeur. Neither party to this Agreement shall be held responsible for delay or default
105 caused by fire, riot, acts of God, and/or war that are beyond that party's reasonable control.
106 Sunriver may terminate this Agreement upon written notice after determining such delay or
107 default will reasonably prevent successful performance of the Agreement.
108 21. Exhibits. Each Exhibit, if any, to this Agreement is made a part of this Agreement as though set
109 forth fully herein. Any provision of any Exhibit that is in conflict with any provision of this
110 Agreement shall take precedence and supersede the conflicting provision of this Agreement.
111 22. Paragraph Headings. The paragraph headings appearing in this Agreement are not to be
112 construed as interpretations of the text, but are inserted for convenience and reference of the
113 reader only.
114 BY THE SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE BELOW, EACH PARTY
115 ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES
116 TO BE BOUND BY ITS TERMS AND CONDITIONS.
117 IN WITNESS WHEREOF, THE PARTIES HERETO HAVE EXECUTED THIS AGREEMENT.
118
SUNRIVER SERVICE DISTRICT FIRE
DEPAR ENT, OREGON: CITY OF SPRINGFIELD, OREGON:
A horized Represent'ive
Authorized Representative
Art Hatch Brian Evanoff
Print Name Print Name
Fire Chief
Administrative Services Bureau Manager
Title Title
S 171"
Date Date
(-, I1464t-ct-, tit&
Reviewed by City Contract Officer
EMS Account Services Intergovernmental Agreement—Sunriver Service District Fire Department Expires: June 30, 2010
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119 EMS Account Services Intergovernmental Agreement
120 EXHIBIT A
121 Springfield Services. Springfield agrees to perform the following services:
122 1. Perform billing and collection services under this Agreement on behalf of and in the best interests
123 of Sunriver according to the policies, rates, schedules, and instructions established by Sunriver.
124 2. Bill customers and/or insurance companies in a timely manner after receipt of completed patient
125 billing information from Sunriver. Assist customers in the preparation of forms that are required
126 by their insurance companies.
127 3. Appeal denials based upon medical necessity when documentation supports the need for
128 services rendered by Sunriver.
129 4. Refer delinquent patient accounts to a collection agency, as appropriate.
130 5. Accept patient payments made with a VISA, MasterCard, Discover, or American Express credit
131 cards.
132 6. Allow patients to pay their bills in installments when the patient meets criteria for the installment
133 plan option.
134 7. Transfer all funds collected on Sunriver accounts, whether received within the Agreement period
135 or thereafter, to Sunriver after the month-end posting has been completed, according to the
136 payment disposition instructions established by Sunriver. The transfer of funds shall consist of all
137 monies received by Springfield on account of ambulance services provided by Sunriver,
138 excluding any sums overpaid by the customer or third party payer that Springfield shall refund.
139 8. Springfield shall put Sunriver's billing data on the same computer as its own billing data and shall
140 take all reasonable precautions to protect said data. Springfield shall not be responsible for loss
141 of Sunriver data, or any damages or loss to Sunriver resulting from said loss of data, if that loss of
142 data results from circumstances beyond Springfield's control.
143 9. Provide the following data on a monthly basis:
144 9.1. Amount billed (categorized by non-member and member)
145 9.2. Number of patients billed (categorized by non-member and member)
146 9.3. Amount collected (categorized by non-member, member, and collection recovery)
147 9.4. Amount of write-downs and write-offs
148 9.5. Refunds made for overpayments
149 9.6. Other adjustments
150 9.7. Accounts receivable balance
151 10. Cooperate in the development or alteration of mutually acceptable billing and collection policies,
152 procedures, practices, or forms.
153 11. Assist Sunriver in the formulation of ambulance rate structures and fees.
154 12. Assist Sunriver in the analysis and development of managed healthcare agreements.
155 13. Minimize Sunriver's reporting requirements to as great an extent as is reasonably possible.
156 14. Meet with Sunriver's designated representatives to discuss problems and performance as
157 needed.
158 15. Provide reasonably necessary mutually agreed upon training to appropriate Sunriver field and
159 administrative staff regarding the gathering of necessary information and' proper completion of run
160 reports.
161 16. Provide mutually agreed upon additional services for special purposes, or for work outside the
162 normal scope of this Agreement.
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163 EMS Account Services Intergovernmental Agreement
164 EXHIBIT B
165 Sunriver Payment and Obligations. Sunriver agrees to make payment and perform as follows:
166 1. Establish the policies, rates, schedules, and instructions for the billing of Sunriver's patients and
167 the disposition of payments received for Springfield to use when providing services to Sunriver.
168 Sunriver may modify or revoke its policies, rates, schedules, and instructions, at its discretion.
169
170
171
1.1.
Sunriver agrees that the policies, instructions, rates, schedules, and payment disposition
for Springfield to use when providing services to Sunriver shall be made in good faith and
shall comply with all applicable laws, rules, and regulations.
172 1.2. Sunriver shall negotiate in good faith any impact that modifications or revocations may
173 have on Springfield's ability to provide the services listed in EXHIBIT A or upon the price
174 per patient billed as listed in EXHIBIT B, paragraph 13.
175 2. Provide Springfield, in a mutually acceptable format, the necessary information and proper
176 documentation required to prepare and reach final adjudication of patient claims, to include:
177 2.1. Ensuring that all ambulance service incident reports use mutually agreed upon report
178 forms and are completed according to the mutually agreed upon instructions of
179 Springfield.
180 2.2. Obtaining appropriate patient encounter, demographic, financial, and insurance
181 information as required to process patient account.
182 2.3. Obtaining an appropriate patient or patient representative signature for all billable
183 patients in a mutually acceptable form or format. Springfield shall not be held responsible
184 for billing or collections on accounts without aforementioned signature.
185 2.4. Obtaining a signed Physician Certification Statement (PCS) of Medical Necessity for non -
186 emergency services as required. Springfield shall not be held responsible for billing or
187 collections on accounts without aforementioned PCS.
188 2.5. Providing indication of the ambulance membership status of billable patients to ensure
189 that member patients are billed according to their membership terms of agreement.
190 2.6. Forwarding reports and other billing information forms to Springfield in a timely manner.
191 2.7. Both parties agree that Springfield will make reasonable efforts to verify and/or obtain
192 information needed to process patient accounts, however, Springfield is not responsible
193 for errors or omissions when relying on information provided by Sunriver.
194 3. Designate a single person in an administrative position to receive and evaluate all complaints by
195 Sunriver officials and employees regarding Springfield's performance under this Agreement, and
196 share the information with the appropriate Springfield Representative in a timely manner.
197 4. Refer all citizen inquiries regarding their accounts to Springfield.
198 5. Cooperate to the greatest extent possible with Springfield in its efforts to perform the services
199 described in EXHIBIT A.
200 6. Provide the following to Springfield at time of Agreement execution:
201 6.1. Medicare, Medicaid, and any other insurance provider numbers assigned to Sunriver.
202 6.2. Copy of most recent Ambulance Service License issued by the Oregon Health Division.
203 6.3. Copy of letter 147C from the Internal Revenue Service showing the legal name and tax
204 identification number or employer identification number for Sunriver Service District Fire
205 Department.
206 6.4. Power of Attorney to endorse payments received on behalf of, and payable to Sunriver.
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207 7. Minimize Springfield's reporting requirements to as great an extent as is reasonably possible.
208 8. Meet with Springfield's designated representatives to discuss problems and performance as
209 needed.
210 9. Cooperate in the development or alteration of mutually acceptable billing and collection policies,
211 procedures, practices, or forms.
212 10. Permit Springfield to review and comment on any contract or agreement that Sunriver may enter
213 into that could affect ambulance fees, charges, or billing and collection practices. Negotiate in
214 good faith any impact that the above-mentioned contracts or agreements may have on
215 Springfield's ability to provide the services listed in EXHIBIT A or upon the price per patient billed
216 as listed in EXHIBIT B, paragraph 13.
217 11. Provide a liaison in or with Sunriver's communication and dispatch center to assist with the
218 approval/denial process for non -emergency ambulance transfers.
219. 12. If desired, provide, at Sunriver's expense, a local Sunriver seven -digit telephone number or toll -
220 free long distance number that will automatically forward calls to the Springfield Account Services
221 office.
222 13. Pay Springfield for services rendered according to the following schedule:
223 13.1. For monthly services provided to Sunriver, the amount of $37.75 per patient billed on
224 behalf of Sunriver. Amount due for services rendered by Springfield will be invoiced
225 monthly. Invoices will be sent to Sunriver as soon as possible after month-end patient
226 statistics have been computed and will list the number of patients billed and the amount
227 due to Springfield.
228 13.2. Pay Springfield additional billing and collection costs incurred by Springfield for special
229 purposes, or for work outside the normal scope of this Agreement, if Sunriver approved
230 such additional costs before being incurred.
231 13.3. Other than the fees and charges for services rendered as described in this Agreement,
232 Springfield shall have no financial interest in, nor is its compensation related to, the
233 amounts billed and/or collected on behalf of Sunriver, regardless of whether amounts
234 were actually collected.
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235 EMS Account Services Intergovernmental Agreement
236 EXHIBIT C
237 Health Insurance Portability and Accountability Act Requirements. Springfield agrees that it will
238 carry out its obligations to Sunriver under this agreement in compliance with the privacy and security
239 regulations pursuant to Public Law 104-191 of August 21, 1996, known as the Health Insurance
240 Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections 261, et seq.,
241 as amended ("HIPAA").
242 Springfield agrees it will protect the confidentiality, integrity, and security of any personally identifiable
243 protected health information ("PHI") that is collected, processed or leamed as a result of the services
244 provided to Sunriver by Springfield, including any such information stored and transmitted electronically,
245 referred to as electronic protected health information ("e -PHI").
246 1. Springfield agrees that it will:
247
248
1.1.
Not use or further disclose PHI except as permitted under this Agreement or required by
law;
249 1.2. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by
250 this Agreement;
251 1.3. To mitigate, to the extent practicable, any harmful effect that is known to Springfield of a
252 use or disclosure of PHI by Springfield in violation of this Agreement.
253 1.4. Report to Sunriver any use or disclosure of PHI not provided for by this Agreement of
254 which Springfield becomes aware;
255 1.5. Ensure that any agents or subcontractors to whom Springfield provides PHI, or who have
256 access to PHI, agree to the same restrictions and conditions that apply to Springfield with
257 respect to such PHI;
258 1.6. Make PHI available to Sunriver and to the individual who has a right of access as
259 required under HIPAA within 30 days of the request by Sunriver to the individual;
260 1.7. Incorporate any amendments to PHI when notified to do so by Sunriver;
261 1.8. Provide an accounting of all uses or disclosures of PHI made by Springfield as required
262 under the HIPAA privacy rule within 60 days;
263 1.9. Make its internal practices, books and records relating to the use and disclosure of PHI
264 available to the Secretary of the Department of Health and Human Services for purposes
265 of determining Springfield's and Sunriver's compliance with HIPAA;
266 1.10. At the termination of this Agreement, return or destroy all PHI received from, or created
267 or received by Springfield on behalf of Sunriver, and if return is infeasible, the protections
268 of this agreement will extend to such PHI.
269 2. The specific uses and disclosures of PHI that may be made by Springfield on behalf of Sunriver
270 include:
271 2.1. The preparation of invoices to patients, carriers, insurers and others responsible for
272 payment or reimbursement of the services provided by Sunriver to its patients;
273 2.2. Preparation of reminder notices and documents pertaining to collections of overdue
274 accounts;
275 2.3. The submission of supporting documentation to carriers, insurers and other payers to
276 substantiate the health care services provided by Sunriver to its patients or to appeal
277 denials of payment for same.
278 2.4. Uses required for the proper management of the Springfield as a business associate.
279 2.5. Other uses or disclosures of PHI as permitted by HIPAA Privacy Rule.
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280 3. Springfield agrees to assume the following obligations regarding electronic Protected Health
281 Information (e -PHI):
282 3.1. Springfield agrees to implement administrative, physical and technical safeguards that
283 reasonably and appropriately protect the confidentiality, integrity and availability of the e-
284 PHI that it creates, receives, maintains or transmits on behalf of Sunriver.
285 3.2. Springfield will ensure that any agent, including a subcontractor, to whom it provides e-
286 PHI that was created, received, maintained or transmitted on behalf of Sunriver agrees to
287 implement reasonable and appropriate safeguards to protect the confidentiality, security,
288 and integrity of a -PHI.
289 3.3. Springfield agrees to alert Sunriver of any security incident (as defined by the HIPAA
290 Security Rule) which it becomes aware, and the steps it has taken to mitigate any
291 potential security compromise that may have occurred, and provide a report to Sunriver
292 of any loss of data or other information system compromise as a result of the incident.
293 4. Notwithstanding any other provisions of this Agreement, this Agreement may be terminated by
294 Sunriver, in its sole discretion, if Sunriver determines that Springfield has violated a term or
295 provision of this Agreement pertaining to Sunriver's obligations under the HIPAA privacy or
296 security rules, or if Springfield engages in conduct which would, if committed by Sunriver, would
297 result in a violation of the HIPAA privacy or security rules by Sunriver.
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298 EMS Account Services Intergovernmental Agreement
299 EXHIBIT D
300 Representatives. As provided in paragraph 5, the following individuals are the designated
301 representatives to perform the functions set forth in this Agreement.
302 1. Springfield Contract Representative
303 Brian Evanoff
304 Springfield Fire and Life Safety
305 225 North Fifth Street
306 Springfield OR 97477
307 Phone: 541-736-1019 FAX: 541-726-2297
308 e-mail: bevanoff@ci.springfield.or.us
309
310 2. Sunriver Contract Representative
311 Art Hatch Fire Chief
312 Contact Title
313 Sunriver Fire Department
314 Agency
315 PO Box 2108
316 Address
317 Sunriver OR 97707
318 City State Zip
319 541-593-8622 541-593-2768
320 Phone FAX
321 ahatchCa�sunriversd.org
322 E-mail
323 3. Sunriver Ambulance Service Representative
324 Jared Jeffcott EMS Captain
325 Contact Title
326 Sunriver Fire Department
327 Agency
328 PO Box 2108
329 Address
330 Sunriver OR 97707
331 City State Zip
332 541-593-8622 541-593-2768
333 Phone FAX
334 jaredjCa.sunriversd.org
335
E-mail
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