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EMERGENCY MEDICAL SERVICES CONTINUING MEDICAL EDUCATION AGREEMENT EMERGENCY MEDICAL SERVICES CONTINUING MEDICAL EDUCATION AGREEMENT OCTOBER 1, 2015 PINELLAS COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY 12490 Ulmerton Road Largo, FL 33774 Emergency Medical Services Continuing Medical Education Agreement Page 2 EMERGENCY MEDICAL SERVICES CONTINUING MEDICAL EDUCATION AGREEMENT AGREEMENT made this 2O—day of , 2016, between the Cities of I Clearwater, Dunedin, Gulfport, Largo, Madeira Beach, Oldsmar, Pinellas Park, Safety Harbor, Seminole, St. Pete Beach, St. Petersburg, South Pasadena, Tarpon Springs and Treasure Island, Florida municipal corporations; the East Lake Tarpon Special Fire Control District, Lealman Special Fire Control District, Palm Harbor Special Fire Control District and Pinellas Suncoast Fire & Rescue District, Florida political subdivisions ("Contractors") and the PINELLAS COUNTY EMERGENCY MEDICAL SERVICES AUTHORITY, a special district ("Authority") known as ("Parties"). RECITALS 1. The Authority is a special district created for the purpose of providing Emergency Medical Services ("EMS") throughout Pinellas County ("County"), pursuant to Chapter 80-585, Laws of Florida and Chapter 54,Article III, Pinellas County Code, as amended ("The Acts"). 2. Pursuant to The Acts, the Authority has contracted with various municipalities, independent special fire districts, and corporations to provide first responder services, ambulance services and Medical Director services. 3. Pursuant to Chapter 401, Florida Statutes, Chapter 64J-1, Florida Administrative Code and Pinellas County EMS Rules and Regulations, Paramedics and Emergency Medical Technicians ("EMTs") must meet certain Continuing Medical Education ("CME") requirements in order to be certified to provide emergency medical services in Pinellas County. 4. The Authority is responsible for providing and making available to Contractors a CME training program at multiple, regionally located training sites. 5. The Authority has determined that it is in the best interest of the Pinellas County EMS System that the CME training program be conducted Under the joint Emergency Medical Services Continuing Medical Education Agreement Page 3 auspices of the Authority and the Contractors for first responder services and ambulance services. 6. The Authority and Contractors desire to partner and cooperate to implement and maintain a CME training program. 7. The intent is to utilize classroom training for scenario and competency based skills assessment coupled with online training to meet CME requirements. 8. Classroom based training will include making a sufficient number of classes available at regional training sites on days, times and shifts necessary to maximize the availability of first responder units and ambulances. NOW THEREFORE, in consideration of the premises and mutual promises set forth herein, the Parties hereby agree as follows: ARTICLE I THE AGREEMENT SECTION 101. RECITALS AND PURPOSE The foregoing recitals are hereby incorporated and made part of this Agreement. The purpose of this Agreement is to define the obligations and responsibilities of the Parties hereto to enable the cooperative provision of a comprehensive CME training program. SECTION 102. COOPERATION The Parties shall cooperate and use all reasonable efforts, pursuant to the terms of this Agreement, to facilitate the terms of this Agreement. SECTION 103. CONTRACT DOCUMENTS The following Appendix is attached to and made part of this Agreement: Appendix A. List of Contractors Appendix B. Reimbursement Form Emergency Medical Services Continuing Medical Education Agreement Page 4 ARTICLE II DEFINITIONS SECTION 201. WORDS AND TERMS Terms used but not defined in this Agreement shall have the same meaning as those terms in the Emergency Medical Services ALS First Responder Agreement between the Authority and Contractors. Unless the context otherwise requires, capitalized terms used herein shall have the following meanings ascribed to them: "Continuing Medical Education Training Program" or "CME Training Program" means the medical education training program, through distance learning or classroom based courses, provided in accordance with the EMS Rules & Regulations. "CME Instructor" means a County Certified Paramedic or County Certified registered nurse, employed and approved by a Provider Agency, who meets the qualifications set forth in the EMS Rules and Regulations and is approved by the Medical Director. CME Instructors may be utilized to teach regular CME classes, specialized Courses, EMS System orientation or serve as a subject matter expert, curriculum developer or to complete a specific task assignment. "Course" means any individual CME offering available online or through a sufficient number of classroom based training classes. Regular CME Courses, whether online or classroom based, will be two (2) hours in duration. "EMS Director" means the Authority's Director of the EMS System or his/her designee. "Learning Management System" means the integrated fire and EMS software system utilized by Provider Agencies for online training, classroom based training attendance tracking, in-service education; dissemination of administrative and medical control directives, tracking receipt of protocols and directives, skill assessment and testing results. Authority's staff and Medical Director shall have administrative rights to upload Emergency Medical Services Continuing Medical Education Agreement Page 5 and post CME curriculum, in-service training modules, administrative and medical control directives, run attendance and grade reports for all students, and reports for CME Instructor activity. All Contractors will utilize the common software platform, Target Solutions, or a successor software product as determined by the Authority upon agreement with the CME steering committee as defined in the EMS Rules and Regulations. ARTICLE III OBLIGATIONS, COMPENSATION AND OTHER FINANCIAL PROVISIONS SECTION 301. PROVISION OF CME. Contractors will use their best efforts to provide a sufficient number of CME Instructors to conduct courses. The Authority will use its best efforts to provide a sufficient number of classes available at regional training sites on days, times and shifts necessary to maximize the availability of First Responder units and ambulances up to one hundred eighty (180) classes per regular CME Course or ninety (90) classes for paramedic only CME Courses. Contractors understand the Authority is responsible for the provision of CME instruction and if the pool of CME Instructors made available by the Contractors is deemed inadequate or insufficient by the Authority, the Authority may elect to provide the CME program directly or through another means. SECTION 302. REIMBURSEMENT FOR CME INSTRUCTORS. The Authority shall reimburse each Contractor for the actual cost of salary and benefits up to $60.00 per hour for overtime or backfill costs for the Contractor's CME Instructor hours that are actually performed and preapproved in writing, through the published master EMS training calendar, by the Authority. Contractor may establish a rate of pay for CME Instructor which shall be subject to the $60.00 per hour cap. The Authority shall not reimburse Contractor for the personnel costs for students to attend Courses or CME Instructor hours that are not preapproved in writing. Contractor shall submit invoices to Authority utilizing Exhibit B within twenty (20) days following the last day of each month. Contractor shall be reimbursed monthly in arrears. Emergency Medical Services Continuing Medical Education Agreement Page 6 SECTION 303. FISCAL NON-FUNDING. In the event sufficient budgeted funds are not available for a new Fiscal Year, the Authority shall timely notify Contractor of such occurrence prior to the end of the current Fiscal Year and this Agreement shall terminate on the last day of the current Fiscal Year. SECTION 304. NOT TO EXCEED CAP. The cumulative, not-to-exceed budgeted amount for all CME Instructor reimbursement for all Contractors for the Fiscal Year 2015-2016 under this Agreement, and the analogous provisions of the corresponding Ambulance Services Agreement, as amended, is Five Hundred Thousand Dollars ($500,000.00). The Authority shall reimburse annually, in the first payment in each Fiscal Year, the Contractor's cost for the use of the Learning Management System for its students. Such reimbursement shall be fifty percent (50%) of the costs of use of the Learning Management System up to $50 per student per Fiscal Year (does not include payment for student training time). For each year during the term of this Agreement, the total compensation amounts shall be established through the Authority's budget process, but in no event, shall the cumulative compensation to all Contractors for all payments under this Agreement, and payment for the analogous training provisions of the Ambulance Services Agreement, as amended,for any Fiscal Year exceed Six Hundred and Fifty Thousand Dollars ($650,000). It is recognized by the Parties that no payment may be compelled or made without a budget amendment approved by the Authority for any compensation that exceeds the total compensation authorized through the Authority approved budget for CME training. It is further agreed and understood among the Parties that the Authority may not compel the Contractors to incur expenses beyond the Authority's approved budget amount until such time as a budget amendment raising such budget is approved. Emergency Medical Services Continuing Medical Education Agreement Page 7 ARTICLE IV INSURANCE AND INDEMNIFICATION SECTION 1. INSURANCE REQUIREMENTS. Contractors and Authority adopt and incorporate herein the Minimum Insurance Requirements and Additional Insurance Requirements of the Emergency Medical Services ALS First Responder Agreement. SECTION 402. LIABILITY. Contractors and Authority agree to be fully responsible for their own acts of negligence or their respective agents' acts of negligence when acting within the scope of their employment, and agree to be liable for any damages resulting from said negligence. Nothing herein is intended to serve as a waiver of sovereign immunity or the limits of liability contained in Section 758.28, Florida Statutes, by the Contractor, County or Authority. Nothing herein shall be construed as consent by Contractor or Authority to be sued by third parties in any manner rising out of this Agreement. Contractor is not liable for the causes of action arising out of the negligence of the Authority, its employees or agents, or arising out of the negligence of any persons or entities contracted by, appointed by, or approved by the Authority to provide services related to this Agreement (including but not limited to other Contractors, the Ambulance Contractor, Medical Control Board and Medical Director.) This Section 402 shall survive expiration or earlier termination of this Agreement. ARTICLE V TERM AND TERMINATION SECTION 501. TERM OF AGREEMENT. This Agreement shall be for a term of two (2) years beginning on October 1, 2015, and shall expire on September 30, 2017. This Agreement may be renewed for two (2) additional one (1) year terms at the end of the initial term through written agreement of the Parties. SECTION 502. TERMINATION WITHOUT CAUSE. This Agreement may be terminated without cause by any Party at any time, upon giving ninety (90) days written notice to all Parties in accordance with Section 604. Emergency Medical Services Continuing Medical Education Agreement Page 8 SECTION 503. EFFECTIVE DATE. The effective date of this Agreement shall be retroactive to October 1, 2015 for reimbursement purposes. ARTICLE VI MISCELLANEOUS SECTION 601. CONTRACTOR IS INDEPENDENT CONTRACTOR. The Parties agree that throughout the term of this Agreement, and during the performance of any obligations hereunder, Contractor is an independent contractor in all respects and shall not be the agent, servant, officer or employee of the Authority or the County. SECTION 602. APPLICABLE LAWS. Florida Law shall govern the validity, interpretation, construction and performance of this Agreement. SECTION 603. COUNTERPARTS. This Agreement may be executed in more than one counterpart, each of which shall be deemed an original_ SECTION 604. NOTICES. All notices, consents, and agreements required or permitted by this Agreement shall be in writing, and, as applicable, shall be transmitted by registered or certified mail, return receipt requested, with notice deemed to be given upon receipt, and shall be addressed as follows: If to Authority: Executive Director, Pinellas County EMS Authority Pinellas Country EMS & Fire Administration 12490 Ulmerton Road ® Suite 134 Largo, Florida 33774 If to Contractor: See Appendix A. Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this ' day of J.1 tj,,ej 1 , 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners Deputy, t l Clerk"""I irman APPROVED AS TO FORM o, By. ...._ Office of the County Attorney ti. Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by: by:,. Deputy Clerk Chairman Countersigned: CITY OF CLEARWATER, FLORIDA Mayor City Manager Approved as to form: Attest: II 1 III m ""'l1Jl' 'Y � �I 1&,m rr"�M,�� ,rd" by. i i t r , y by City Clerk1' 11 11A Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on 'this........................................................................day of 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by: .............................................................................................................................................................. ................................................................................................................................................................................................ Deputy Clerk Chairman Countersigned: CITY OF DUNEDIN, FLORIDA r\ by: ........... Mayor an, 1 eir % tI t Approved as to Form: 'Ile 110 .............................................. .............................................................................................. Aul .............................. ........................................................................ ...................................................... 41 .... ..411. by: I C Ierk ity Atto I'VI(..:,�`y i Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by:.............................................................................................--_.......... ................. Deputy Clerk Chairman Countersigned: East Lake Tarpon Special Fire Control District by:__.. ....... ........ by�--------- Ak .................... --- Chai T, n Secretary --------------------------- Attest: N ....... . ..... .............. by: A b Treasurer Vice ali an Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this of , 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners lb y;........................................... by:............................................................................................ Deputy Clerk Chairman Countersigned: CITY OF GULFPORT, FLORIDA by' Clit.y Manager APPROVED AS TO IM: Attest: by: Ike Attorney ity Oieirl . 4 � Po n NS'1 pp Emevywicy Medioul Services C-Onfinuing lllftdicad lE..,'kJucafibn Agrew- nent F*fe!g INWITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on ttiis , .day Of 2016. ATTEST: PINELLAS COUNW EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners III Deputy Clefk Countersigned: CITY 0 LARGO, FLORIDA by, by Maym City Manager Reviewed and Approved: Attest: OF 1,4 oop .. .................. 0 1. by., II D P�y Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this of , 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners b .................................................._.................... by:, , Deputy Clerk Chairman LEALMAN SPECIAL FIRE CONTROL DISTRICT it i i by. Secretary easurer APPROVED AST by: m for Fire District Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners Y=v by Deputy Clerk Chairman Countersigned: CITY OF MADEIRA BEACH, FLORIDA M M I , ,." ".�.....: .......� ..��"r.":p,P..............................................................,.,W.M,,,,,,. by. ; ; ." I s yor City Manager APPROVED AS TO FORM: Attest: "10 'I IN by: City Attorney City Clerk Emergency Medical Services Continuing Medical Education Agreement Page 9 IN the t , by and through their undersigned authorized offloers have this nt to be executed nti 2016 PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by b . Deputy Clerk Chairman Countersigned: CITY OF OLDSMAR, FLORIDA l APPROVED AS TO FORM Attest: I y: by. =CftyAerne' C, �;iirk y � � �y Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this .............................. day of ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by:............................................................................................................................................................................ by: Deputy Clerk Chairman PALM HARBOR SPECIAL FIRE CONTROL AND RESCUE DISTRICT by:4,Chairm ' Board o'. Commissioners APPROVED A T ORM: by. for Fire District i Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of , 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by: by:............................. Deputy Clerk Chairman Countersigned: CITY OF PINELLAS PARK, FLORIDA 0v ...�. BNu - ,�� dal i � �� mii.n.......°.... m........n�......�:...n y° y: Mayor ' ty Manager APPROVED T FORM &CORRECTNESS: Attest: h n by: �f . by . City Attorney City C erlk Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on -this_ day Of 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by:,__,.. by;, Deputy Clerk Chairman Countersigned: Pinellas Suncoast Fire & Rescue District Attest: 1 71 by: mmU /00/ it n, Board of Commissioners Se(,,:-.re'tary/ilFreasurer Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on thus........... day of 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by:...... .........................................................................................................................................................._...................................................................... by:..............................................................................................................................................................................._............................................... Deputy Clerk Chairman Countersigned: CITY OF SAFETY HARBOR, FLORIDA p b „ Ihy. 7Mayor y„ ,,,,,, tiity IMainager APPROVED,�S TO FOR Attest: b .. by „w„_ N y............................................................................. C ty orney qty Clerk:, Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by: : Deputy Clerk Chairman Countersigned: CITY OF SEMINOLE, FLORIDA by: City Manage w' APP - Attest: y: Iby:...., i A r° City Clerk Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of 92016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by: : Deputy Clerk Chairman Countersigned: CITY OF SOUTH PASADENA, FLORIDA by; it vu „ Mayor APPRO E AS TO FORM: Attest: by: C orney C° Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners Icy: by: Deputy Clerk Chairman Countersigned: CITY OF ST., PETE BEACH, FLORIDA �m r APPROVED AS TO FORM: Attest: r ® b 4 •�I is .� .-qv Y City Attorney Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this day of 12016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners e by: Deputy Clerk it Countersigned: CITY OF ST., PETERSBURG, FLORIDA Print: Title: APPROVED AS TO T AND FORM Attest: FOR CITY OF ST. PE R BURG ONLY: City Attorney s ui a ii :, City (,,,Ir)ii* III. u VII" m Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this_ ...............................day of , ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by:_. by Deputy Clerk Chairman Countersigned: CITY OF TARPON SPRINGS, FLORIDA by:'........� _ } b y:......., .........May�r City Manager APPROVE S TO FORM: Attest: by: y. . ,,, .............. city .t e y Ci .,,. uil k Emergency Medical Services Continuing Medical Education Agreement Page 9 IN WITNESS WHEREOF the parties hereto, by and through their undersigned authorized officers have caused this Agreement to be executed on this-,., ........... day Of 2016. ATTEST: PINELLAS COUNTY EMERGENCY KENNETH BURKE, CLERK MEDICAL SERVICES AUTHORITY By and through its Board of County Commissioners by:. by-. Deputy Clerk Chairman Countersigned: CITY OF TREASURE ISLAND, FLORIDA bY. by. M )r ayor City Manager APPR D AS T, 0 Attest: by- ................ by:�.................................. f., fforney City Clerk Emergency Medical Services Continuing Medical Education Agreement Page 10 Appendix A List of Contractors City Manager City Manager CITY OF CLEARWATER CITY OF PINELLAS PARK 112 S. Osceola Avenue P 0 Box 1100 Clearwater, FL 33756 Pinellas Park, FL 33780-1100 City Manager Chairman, Board of Fire Commissioners CITY OF DUNEDIN PINELLAS SUNCOAST FIRE S RESCUE P 0 Box 1348 DISTRICT Dunedin, FL 34697 304 First Street Indian Rocks Beach, FL 33785 Chairman, Board of Commissioners City Manager EAST LAKE TARPON SPECIAL FIRE CONTROL CITY OF SAFETY HARBOR DISTRICT 750 Main Street 3375 Tarpon Lake Boulevard Safety Harbor, FL 34695-3597 Palm Harbor, FL 34685 City Manager City Manager CITY OF GULFPORT CITY OF ST.PETE BEACH 2401 53rd Street South 155 Corey Avenue Gulfport, FL 33707 St. Pete Beach, FL 33706-1701 City Manager Mayor CITY OF LARGO CITY OF ST. PETERSBURG P 0 Box 296 175 Fifth Street North Largo, FL 33779-0296 St. Petersburg, FL 33701 Chairman, Board of Commissioners City Manager LEALMAN SPECIAL FIRE CONTROL DISTRICT CITY OF SEMINOLE 4360 55th Avenue North 9199 113th Street North St. Petersburg, FL 33714 Seminole, FL 33772-2806 City Manager City Clerk CITY OF MADEIRA BEACH CITY OF SOUTH PASADENA 300 Municipal Drive 7047 Sunset Drive South Madeira Beach, FL 33708 South Pasadena, FL 33707-2895 City Manager City Manager CITY OF OLDSMAR CITY OF TARPON SPRINGS 100 State Street West 324 Pine Street East Oldsmar, FL 34677-3655 Tarpon Springs, FL 34689 Chairman, Board of Commissioners City Manager PALM HARBOR SPECIAL FIRE CONTROL DISTRICT CITY OF TREASURE ISLAND 250 W. Lake Road 1201 08th Avenue Palm Harbor, FL 34684 Treasure Island, FL 33706-4794 e Ap n m B CME Instructor Appendix Form . � ^ � � w _ae___e#ems■_ _ _ ■ � \ � � § � gig ��~ k w § : e d .411 n LU : e Ui , k � : , . 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