PROVIDER AGREEMENT FOR RED CROSS TRAINING
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+ American Red Cross
Tampa Bay Chapter
P.O. Box 4236
Tampa, FL 33677
(813) 348-4820
May 4, 1999
City of Clearwater
Parks & Recreation
P.O. Box 4748
Clearwater, FL 33758
Dear Authorized Provider;
Enclosed is a copy of the signed Authorized Provider Agreement for
your files. When you prepare to teach a course, please contact your local
Service Representative listed on the front of the Agreement, to arrange for
needed equipment and supplies.
If you have any questions please contact either Susan A very at (813)
348-4820 x890 or me at x868.
Respectfull y;
Charles E. Curtice
Records & Reports Coordinator
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AUTHORIZED PROVIDER AGREEMENT (part II)
The course(s) the American Red Cross will support under A,1.a. are as follows:
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Basic Aid Training
Community First Aid & Safety
Responding to Emergencies
Automated External Defibrillator
Safety Training for Swim Coaches
Lifeguard Training
Head Lifeguard
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Standard First Aid
Oxygen Administration
Sports Safety Training
Emergency Response
Basic Water Rescue
Waterfront Lifeguarding
Babysitter's Training
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CPR for the Professional Rescuer
Preventing Disease Transmission
First Aid - When Help Is Delayed
Swimming
Small Craft Safety
Waterpark Lifeguarding
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The following equipment (and applicable rental fee) is available to the Authorized Provider from the American Red Cross under
A.1.b.:
Adult Actar Manikin Set of 10
Single Video
Rescue Tube
Paddleboard
$20.00 Per Use
$10.00 Per Viewing
$ 5.00 Per Use
$10.00 PerUse
Infant Actar Manikin Set of 10
Video Set of 2
Backboard
Diving Brick
The following price list is to be observed under A,1.c.:
Books & Materials - see attached.
Administrative Fee: $5.00 per student enrolled.
As stated in A,l.d. and B.1.d., the Authorized Provider will be invoiced and will pay the invoice as follows:
$20.00 Per Use
$20.00 Per Viewing
$10.00 Per Use
$ 5.00 Per Use
Fees for rental and resale items will be billed immediately. Administrative fees will be billed quarterly. Terms net 10 days.
As stated in A.1.i., the following individual is the primary contact for the American Red Cross:
Cathy Horn
813/251-0921
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Dan Ekstrom
727/446-2358
Carmen Ballew
813/898-3111
As stated in A,l.k., the American Red Cross will be compensated for instructor training according to the schedule listed below:
Instructor Candidate Training
Babysitter's Training Instructor
AED Instructor
Sports Safety Training Instructor
CPR Professional Rescuer Instructor
Basic Water Rescuer Instructor
Lifeguard Training Instructor
Head Lifeguard Instructor
Small Craft Safety Instructor
$29
$89
$69
$89
$89
$69
$89
$89
$89
Basic Aid Training Instructor
Preventing Disease Transmission Instructor
Standard First Aid Instructor
Community First Aid & Safety Instructor
Emergency Response Instructor
Water Safety Instructor
Waterfront Lifeguard Instructor
Safety Training Swim Coaches Instructor
HIV / AIDS Basic Fundamentals Instructor
$59
$69
$89
$89
$179
$89
$89
$89
$69
As stated in A,U., the American Red Cross will arrange for the delivery of certificates within 10 working days from receipt of the
Course Record to the individual instructor's home address.
As stated in B.1.b., the following individual is the primary contact for the Authorized Provider:
Name: ~~ la... ~yz..- Daytime Phone: (17-1) S b 2-- '-f go 8
As stated in B.1.b., for multiple facilities, the following individuals are the on-site contacts for ~~ individual facili!)' Ii\te,~: see
attached. Bo.r~ r'IlOQV) - Md("r'\'fj'slde PO~ l- ~SS lVortorV --:JP ~~~oH-
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Under B.1.g., the Authorized Provider agrees to notify the American Red Cross unit 10 days in advance of scheduled American Red
Cross training.
Prospective Provider Package 7/11 03/23/99
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AUTHORIZED PROVIDER AGREEMENT (pART III)
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(Name of corporation/organization herein referred to as the Authorized Provider)
and the Tampa Bay Regional Chapter of the American National Red Cross (herein referred to as the Red Cross)
This agreement consists of three parts and is effective for one year from the date indicated below unless renewed by
agreement of the parties for the period to be determined between them. It may be terminated by either party with 30
days' written notice to this effect. In the event of termination, the responsibility for any training courses scheduled
prior to the termination and/or expiration of this agreement shall survive for a period of 30 days after the date of
termination and/or expiration. All financial obligations shall continue until satisfied.
Geographic jurisdiction limited to this Red Cross unit:
Hillsborough County, Pinellas County, East Pasco County
Agreed to this lf1-/fJ day of /'1 tl ,V
E~ir~5 })eC. '3// /997
Authorized Provider Representative Printed Name and Title:
S-r~vt!F )1;Ll.6=1e. / S' fJ,e;eIN-rt:A.I/'}'EtV7
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Signature:
Address: dE~re.e ~ J-~aEA'H"rfl\
Primary Phone: L7:rJ ) S~ ;;J- 4 'if (J 1:;'
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Fax: ( 7"-7) .sb 2- - 9 ~ :J. ~
FL S3158
American Red Cross Service Delivery Unit Name: Tampa Bay Regional Chapter
Unit Representative Printed Name and Tide:
/ J)//,p('/Tol"'/ Jft?a/t-h+S~I'e,fyServ/~es
Signature:
FL. 33'
Fax: (fJ'3]:!,'i d - l/f?':3 tJ
Address:
Prospective Provider Package 8/11 03/23/99