Ambulance USA LLC d/b/a Air Medical Transport (“AMT“) is a Patient Transportation Managed Organization that provides medical transportation arrangement services. AMT participates in identifying, organizing, and coordinating air medical transportation as per the requirements and stipulations of the respective Client.
For value received, AMT hereby agrees to arrange transportation for the Client. You (“the Client,”) here undersigned, upon signature, are activating this “Trip,” accepting the terms & conditions of this contract, accepting financial responsibility for all monies due and owed under this contract including all services provided, and agree to be held fully responsible for all payments of monies due.
You authorize AMT to charge your credit card or bank draft for the total price stated above. You agree not to dispute those charges with AMT or your financial institutions. If the total monies due or owed are not received by AMT via the method and due dates described above, AMT reserves the right to convert the credit card authorizations listed above to charges for the collection of the balance due, in addition, any cancellation fees or other costs incurred.
Transport Arrangement Authorization & Disclosure of Protective Health Information: By signing this transport Contract, you authorize AMT to arrange your transport and consent AMT to the use and disclose disclosure of the patient’s Protected Health Information for treatment, payment, and Health Care Operations set out in HIPAA Regulations.
Quotes, discounts, and fees: All prices reflect a discount for pre-payment and a 4% discount for Wire or ACH. If paying by other methods such as credit card or debit card, a 4% fee will apply. The price is based on the programmed itinerary and anticipated charges. Some fees are based on the day and time of flight. Additional flight time charges and fuel surcharges may be incurred in the event of weather avoidance, holding, and Air Traffic Control routing changes. Unless the booking was approved on the same business day as the quote, AMT will make commercially reasonable attempts to adhere to the same quoted items, but AMT cannot commit to the original terms on different dates. The price does not include after-hours airport operation fees, parking fees, aircraft de-icing, special client requests, catering, hangar-related expense delays, or deviations/diversions from the stated itinerary, due to inclement weather or unforeseen circumstances outside of AMT’s control. Should any part of the programmed itinerary changes, the trip may be re-quoted. The Client is responsible for payment of these possible additional charges within 48 hours of the costs incurred.
Availability of Solutions Provided: All solutions are provided globally as per the availability at the time of booking; The Trip is subject to the availability of aircraft, flight team, overflight clearances, confirmation that the patient is fit to fly, and weather safety clearances. The locations, type of transport, service, and air ambulance are according to the stipulations and the information specifically requested by the Client at the time of quote and booking request (the “Trip”). You certify that all information you have provided is correct and current. In case of any change to the Trip, additional charges may apply. All current medical records are required upon reservation. In case of a change to the patient’s medical condition, a charge for additional items may apply. AMT maintains the right to change, outsource, or subcontract the type of air and ground ambulance used depending on availability. Therefore, we are not responsible for their actions.
Term: This Agreement shall be for a term of [ENTER PERIOD], commencing on the date you sign this Agreement. This Agreement may be renewed by the parties for a period of [ENTER PERIOD] upon written Agreement by both parties. Either party shall provide written notice of an intention to renew this Agreement prior to the expiration of this Agreement.
Travel Risks: The patient, purchaser, client, patient’s legal guardian, patient’s next of kin and any person(s) accompanying the patient hereby acknowledge and assume the travel risks inherent in air transportation and agree to hold harmless AMT and its agents, medical personnel, medical director, independent contractors, operators and employees, from any loss or claimed loss caused by delay, flight diversion, or failure of aircraft to depart from or arrive at any point according to any schedule or otherwise for whatever reason including, but not limited to, mechanical or technical problems with the aircraft, weather delays, air traffic control delays, or for any damage or injury to persons or personal property caused by weather conditions, acts of God or any other similar or dissimilar causes beyond the control of AMT while boarding, riding or alighting all aircraft, vehicles and conveyances, used during the course of transportation from the point of origin to the final destination. AMT makes no guarantee or warranty as to the results of air medical service.
Limitation of Liability. AMT, its partners, or affiliates will not be liable for any special, indirect, incidental, consequential or punitive damages as a result of or in connection with: the Client’s use of AMT’s services and any defect or fault resulting from the Client having breached the terms of this agreement. To the maximum extent permitted by applicable law, in no event shall AMT, its partners, or affiliates be liable for any special, incidental, indirect, or consequential damages whatsoever arising out of or in any way related to the use of or inability to use AMT’s services, or otherwise in connection with any provision of this terms, even if AMT, its partners. Or affiliates have been advised of the possibility of such damages.
Flight Itinerary times & stops: Flight time & stops are estimated and are not guaranteed as they may change based on the Trip’s logistics. Some trips may require stops for crew changes due to duty times. In case of emergency during flight, the medical team may land and transfer the patient’s care to the closest ER physician. The client will be liable for any incurred fees. AMT is NOT responsible for factors out of its reasonable control as any delays due to weather conditions, flight interruptions, and unexpected mechanical failures. If a Trip is delayed, you are obligated to wait for such a situation to be resolved and continue the travel later. If you decide to cancel, it will be at your cost, and AMT shall apply all cancelation fees accordingly to this Contract.
Passengers, weights & luggage: One passenger and one patient at no more than 250 lbs. per person are allowed on board. Each passenger may carry (1) 20 lb. carry-on-size luggage. Any excess luggage can be shipped to you at an extra cost. Any modification to these terms needs to be pre-approved and noted in this Contract.
Bed-to-bed transportation: The ground transportation is included up to $500 per leg. If such price exceeds $500, the Client is responsible for the balance. AMT will attempt to bill for reimbursement of the ground ambulance from your insurance provider. Any claims paid for ground transportation are non-refundable.
Cancellation: If the flight booking is cancelled for any reason by anyone other than AMT a partial refund may be given within the sole discretion of AMT as follows; (1) Upon signature, a full refund less $3,500 or 10% of the flight cost, whichever is higher, and any fees incurred to the point of cancelation associated with your booking. (2) If transportation is canceled less than 36 hours for domestic flights or less than 72 hours for international flights from the originally scheduled departure time, the Client will be charged 50% of the flight cost plus, and any fees incurred to the point of cancelation. (Refunds exclude credit card & bank fees) (3) Canceling the transport after departure or failure to provide oral & written notice of cancellation will result in NO REFUND.
Unpaid invoices or balances: The prices on this Contract have been negotiated and discounted as long as your account is in good standing. Further, Should any amount remain unpaid over thirty (30) days, AMT reserves the right to bill this Contract at the usual and customary rate of $30,000 base rate plus $180 per mile and any attorney fees, collection fees, and interest to the maximum permissible set by law at the expense of the undersigned.
Events of Default: Each of the following shall be an “Event of Default” under this Agreement entitling the non-defaulting party to declare this Agreement void and of no further force and effect without additional prior notice: (i) If the Client fails to pay AMT for the AMT’s Services; (ii) If either party fails to maintain its required licenses, permits or certifications, where applicable; (iii) If either party fails to keep in force relevant insurance policies required to be maintained under this Agreement; or (v) If any of the representations of either party as set forth in this Agreement are false or misleading in any material respect.
Confidentiality. The Client acknowledges that if it may get access to trade secrets or confidential and proprietary information in the course of this Agreement. Accordingly, the Client will therefore not disclose any confidential information to any other person, organization or entity. This provision shall survive termination of this Agreement.
ADDITIONAL TERMS
Binding Effect: All rights, obligations, and liabilities arising under this Contract shall be binding on the respective agents, heirs, executors, administrators, and successors of the parties hereto.
Entire Contract: This is the entire Contract between the two parties. Any prior and/or contemporaneous statements, whether oral or written, are merged into this Contract, and superseded hereby.
Litigation: In the event of any dispute or litigation arising out of or relating to this Contract, each party shall pay its own costs and attorneys’ fees.
Modification: Any modification or amendment to this Contract must be written and signed by all parties hereto. Any special requirement or special medical condition must should be specified in this Contract before each Trip. Failure to do so will release AMT from any liability.
Severability: If any provision of this Contract should be declared by a court of competent jurisdiction to be in violation of any applicable law or any law enacted subsequent to the date hereof, then the provision shall be severed from this Contract and shall not be deemed to invalidate any other part hereof.
Applicable Law, Jurisdiction and Venue: Before initiating any legal action or dispute against AMT, the Client agrees to contact AMT and allow AMT an opportunity to resolve a dispute. Should AMT take steps to resolve such dispute or action, the Client agrees to engage in good faith towards a resolution. Any action arising out of this Contract shall be governed, interpreted, and construed under the laws of the State of Texas without regard to principles of conflict of laws. Any action arising out of or related to this Contract must be mediated first in Fort Bend County, Texas, USA. Any unresolved disputes must be submitted to binding arbitration in Fort Bend County, Texas, USA, following the American Arbitration Association commercial rules, with the parties equally sharing the cost of any mediator or arbitrator, and all the parties hereto consent to jurisdiction and venue in said forum.
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