Beverly Hills City Council
March 1, 2022

AGENDA REPORT
Meeting Date: March 1, 2022
Item Number:

To:

D-12
Honorable Mayor & City Council
From: Mark Stainbrook, Chief of Police
Subject: APPROVAL OF A CHANGE PURCHASE ORDER TO VITAL MEDICAL SERVICES, LLC IN THE AMOUNT OF $205,491.00 FOR A TOTAL
NOT TO EXCEED AMOUNT OF $305,491.00
Attachments: 1. Vital Medical Services, LLC Original Agreement 528-19

2. Vital Medical Services, LLC Amendment No. 1. 377-20

3. Vital Medical Services, LLC Amendment No. 2. 294-21

4. Vital Medical Services, LLC Amendment No. 3. 135-22

RECOMMENDATION
Staff seeks City Council approval of a Fiscal Year 2021/2022 change purchase order in the amount of $205,491.00 for a total not to exceed amount of $305,491.00 for Vital Medical Services, LLC to provide medical services in the City’s jail, medical oversight and Narcan administration.

INTRODUCTION
On July 1, 2019, the City of Beverly Hills entered into an agreement with Vital Medical Services, LLC to provide medical services in the City’s jail and to provide medical directive oversight and a Nasal Naloxone “Narcan” program, which includes oversight, education, a standing order for medication administration, and reporting to EMS. Vital Medical Services, LLC also provides communicable disease exposure testing and counseling for police department personnel. During the outbreak of the Covid-19 pandemic, Vital Medical Services, LLC introduced Covid-19 Nasopharyngeal Swab testing and Covid-19 Rapid Antigen Testing for arrestees and employees. In subsequent years, agreement amendments were approved by City Council along with purchase orders. For the fiscal year 2021-22 amendment, the City Council approved the amendment; however, the purchase order request was not included at the time. Under the City Manager’s authority, a purchase order has been issued for $100,000 and a change order is required for $205,491 to equal the authority of the agreement amendment.

Meeting Date: March 1, 2022

DISCUSSION
Vital Medical Services, LLC provides continuous and reliable medical services, medical directive oversight, and Narcan program services as requested by the City. Vital Medical Services, LLC has provided services for over four years and consistently meets the police department’s customer service needs, cost, and time saving expectations.

The medical services provided have proven to be extremely valuable for the jail operations by eliminating the need to have officers waiting at local hospitals for “medical clearances to book” and blood draws; thus, saving hours of staff time. The “Narcan” program is also very effective, resulting in numerous lives being saved, wherein officers administer Naloxone nasal spray to individuals, temporarily counteracting the effects of their opioid overdose.

As the Covid-19 pandemic has evolved and the cases continue to increase, testing has become a priority and a necessity to help police department staff remain safe, protected and available for critical services. Vital Medical Services, LLC has a relationship and partnership with local hospitals and laboratory services that allows them to provide this service to the police department, even though testing supplies are limited and resources are stretched. The increased necessity for testing and safety has resulted in a need to encumber additional funds in the current purchase order. The additional funding will also be utilized for expanded training for field personnel including traffic control officers.

FISCAL IMPACT
Funds for this change purchase order have been identified in the Department’s operational budget for Jail Operations (Org/Object 00102403-731220) for Fiscal Year 2021/2022 in the amount of $205,491.00 for a total not to exceed amount of $305,491.00.

Mark Stainbrook,
Chief of Police
Approved By
Attachment 1
AGREEMENT NO.

AGREEMENT BETWEEN THE CITY OF BEVERLY HILLS AND VITAL

MEDICAL SERVICES, LLC TO PROVIDE MEDICAL SERVICES IN THE CITY’S JAIL, MEDICAL DIRECTIVE OVERSIGHT AND NARCAN

ADMINISTRATION
NAME OF CONSULTANT: VITAL MEDICAL SERVICES, LLC
RESPONSIBLE PRINCIPAL OF Alex G. Ghazalpour, Chief Operating Officer CONSULTANT:

CONSULTANT’S ADDRESS: 550 North Brand Boulevard, Suite 1850 Glendale, CA 91203
Attention: Alex G. Ghazalpour, Chief Operating Officer
CONSULTANT’S E.I.N/TAX ID. NO.: 46-1055770
City of Beverly Hills
455 N. Rexford Drive
CITY’S ADDRESS: Beverly Hills, CA 90210
Attention: Sandra Spagnoli, Chief of Police
COMMENCEMENT DATE: July 1, 2019
TERMINATION DATE: June 30, 2020
Medical Services Fee Not to Exceed $1 85,940 per
year ($15,495 per month)
CONSIDERATION: Contingency for additional work not to exceed $13,822 per year
Medical Director Oversight and Narcan
Administration Annual Fees $27,438 per year
Total not to exceed $227,200.00 per year
B0785-000 I ‘2304$30v I doe

AGREEMENT BETWEEN THE CITY OF BEVERLY HILLS AND VITAL

MEDICAL SERVICES, LLC TO PROVIDE MEDICAL SERVICES IN THE CITY’S JAIL, MEDICAL DIRECTIVE OVERSIGHT AND NARCAN

ADMIN ISTRATION
THIS AGREEMENT is made by and between the City of Beverly Hills (hereinafter called “CITY”), and VITAL MEDICAL SERVICES, LLC (herein after called “CONSULTANT”).

RECITALS
A. CITY desires to have certain services and/or goods provided as set forth in Exhibit A (the “Scope of Work”), attached hereto and incorporated herein.

B. CONSULTANT represents that it is qualified and able to perform the Scope of Work.

NOW, THEREFORE, the patties agree as follows:

Section 1. CONSULTANT’s Scope of Work.

CONSULTANT shall perform the Scope of Work described in Exhibit A in a manner satisfactory to CITY and consistent with that level of care and skill ordinarily exercised by members of the profession currently practicing in the same locality under similar conditions. CITY shall have the tight to order, in writing, changes in the Scope of Work. Any changes in the Scope of Work by CONSULTANT must be made in writing and approved by both parties. The cost of any change in the Scope of Work must be agreed to by both patties in writing.

Section 2. Time of Performance.

CONSULTANT shall commence its services under this Agreement upon the Commencement Date or upon a receipt of a written notice to proceed from CITY. CONSULTANT shall complete the performance of services by the Termination Date set forth above.

The City Manager or his designee may extend the time of performance in writing for two additional one-year terms or such other term not to exceed two years from the date of termination pursuant to the same terms and conditions of this Agreement, which includes a month to month option.

Section 3. Compensation.
(a) Compensation
CONSULTANT shall commence its services under this Agreement upon the Commencement Date or upon a receipt of a written notice to proceed from CITY. CONSULTANT shall complete the performance of services by the Termination Date set forth above. -2-
B07$5-000 \2304830v I doc
(b) Expenses
The amount set forth in paragraph (a) shall include reimbursement for all actual and necessary expenditures reasonably incurred in the performance of this Agreement (including, but not limited to, all labor, materials, delivery, tax, assembly, and installation, as applicable). There shall be no claims for additional compensation for reimbursable expenses. (c) Additional Services. CITY may from time to time require CONSULTANT to perform additional services not included in the Scope of Services. Such requests for additional services shall be made by CITY in writing and agreed upon by both parties in writing.

Section 4. Method of Payment. CITY shall pay CONSULTANT said Consideration in accordance with the method and schedule of payment set forth in Exhibit B.

Section 5. Independent Contractor. CONSULTANT is and shall at all times remain, as to CITY, a wholly independent contractor. Neither CITY nor any of its agents shall have control over the conduct of CONSULTANT or any of CONSULTANTs employees, except as herein set forth. CONSULTANT shall not, at any time, or in any manner, represent that it or any of its agents or employees are in any manner agents or employees of CITY.

Section 6. Assignment. This Agreement shall not be assigned in whole or in part, by CONSULTANT without the prior written approval of CITY. Any attempt by CONSULTANT to so assign this Agreement or any rights, duties or obligations arising hereunder shall be void and of no effect.

Section 7. Responsible Principal(s)
(a) CONSULTANTs Responsible Principal set forth above shall be principally responsible for CONSULTANT’s obligations under this Agreement and shall serve as principal liaison between CITY and CONSULTANT. Designation of another Responsible Principal by CONSULTANT shall not be made without prior written consent of CITY. (b) CITY’s Responsible Principal shall be the City Manager or his designee set forth above who shall administer the terms of the Agreement on behalf of CITY.

Section 8. Personnel. CONSULTANT represents that it has, or shall secure at its own expense, all personnel required to perform CONSULTANT’s Scope of Work under this Agreement. All personnel engaged in the work shall be qualified to perform such Scope of Work.

Section 9. Permits and Licenses. CONSULTANT shall obtain and maintain during the Agreement term all necessary licenses, permits and certificates required by law for the provision of services under this Agreement, including a business license.

Section 10. Interests of CONSULTANT. CONSULTANT affirms that it presently has no interest and shall not have any interest, direct or indirect, which would conflict in any manner with the performance of the Scope of Work contemplated by this Agreement. No person having any such interest shall be employed by or be associated with CONSULTANT. 1 -j -
80785-000! \2304830v I .doc
Section 11. Insurance.
(a) CONSULTANT shall at all times during the term of this Agreement carry, maintain, and keep in full force and effect, insurance as follows:
(1) A policy or policies of Comprehensive General Liability Insurance, with minimum limits of Two Million Dollars ($2,000,000) for each occurrence, combined single limit, against any personal injury, death, loss or damage resulting from the wrongful or negligent acts by CONSULTANT.
(2) A policy or policies of Comprehensive Vehicle Liability Insurance covering personal injury and property damage, with minimum limits of One Million Dollars ($1 000,000) per occurrence combined single limit, covering any vehicle utilized by CONSULTANT in performing the Scope of Work required by this Agreement.
(3) Workers’ compensation insurance as required by the State of California. (4) A policy or policies of Professional Liability Insurance with minimum limits of One Million Dollars ($1 000,000) per occurrence for any and all medical and diagnostic services provided by CONSULTANT in performing the Scope of Work required by this Agreement. (b) CONSULTANT shall require each of its subcontractors to maintain insurance coverage which meets all of the requirements of this Agreement. (c) The policy or polices required by this Agreement shall be issued by an insurer admitted in the State of California and with a rating of at least a A+;Vll in the latest edition of Best’s Insurance Guide.
(d) CONSULTANT agrees that if it does not keep the aforesaid insurance in full force and effect CITY may either immediately terminate this Agreement or, if insurance is available at a reasonable cost, CITY may take out the necessary insurance and pay, at CONSULTANT’s expense, the premium thereon.
(e) At all times during the term of this Agreement, CONSULTANT shall maintain on file with the City Clerk a certificate or certificates of insurance on the form set forth in Exhibit C, attached hereto and incorporated herein, showing that the aforesaid policies are in effect in the required amounts. CONSULTANT shall, prior to commencement of work under this Agreement, file with the City Clerk such certificate or certificates. The general liability insurance shall contain an endorsement naming the CITY as an additional insured. (f) CONSULTANT shall provide CITY with thirty (30) days prior written notice if the policies required under this Agreement will be canceled or reduced. All of the policies required under this Agreement shall state that the coverage contained in the policies affords insurance pursuant to the terms and conditions as set forth in this Agreement. (g) The insurance provided by CONSULTANT shall be primary to any coverage available to CITY. The policies of insurance required by this Agreement shall include provisions for waiver of subrogation.

B0785.000 I \2304830v I .doc
(h) Any deductibles or self-insured retentions must be declared to and approved by CITY. At the option of CITY, CONSULTANT shall either reduce or eliminate the deductibles or self-insured retentions with respect to CITY, or CONSULTANT shall procure a bond guaranteeing payment of losses and expenses.
(i) The insurance coverage amounts required under the Agreement do not limit CITY’s right to recover against CONSULTANT and its insurance carriers.

Section 12. Indemnification.
(a) CONSULTANT agrees to indemnify, hold harmless and defend CITY, City Council and each member thereof, and every officer, employee and agent of CITY, from any claim, liability or financial loss (including, without limitation, attorney’s fees and costs) arising from any intentional, reckless, negligent, or otherwise wrongful acts, errors or omissions of CONSULTANT or any person employed by CONSULTANT in the performance of this Agreement. (b) All duties of CONSULTANT shall survive termination or expiration of the Agreement.

Section 13. Termination.
(a) CITY shall have the right to terminate this Agreement for any reason or for no reason upon thirty calendar days’ written notice to CONSULTANT. CONSULTANT agrees to cease all work under this Agreement on or before the effective date of such notice. (b) In the event of termination or cancellation of this Agreement by CITY, due to no fault or failure of performance by CONSULTANT, CONSULTANT shall be paid based on the percentage of work satisfactorily performed at the time of termination. In no event shall CONSULTANT be entitled to receive more than the amount that would be paid to CONSULTANT for the full performance of the services required by this Agreement. CONSULTANT shall have no other claim against CITY by reason of such termination, including any claim for compensation.

Section 14. Compliance With Laws. CONSULTANT shall comply with all applicable federal, state and local laws, rules and regulations in performing the services contemplated in this Agreement. CONSULTANT has engaged the services of duly licensed professionals, as applicable, who shall provide the services to be provided under this Agreement. Any services that constitute the practice of medicine under California law shall be provided by physician(s) or physicians’ assistants licensed to practice medicine in the State of California (and with respect to physicians’ assistants, under the supervision of a medical doctor) engaged by CONSULTANT to provide such services in their capacities as licensed healthcare professionals and in accordance with applicable laws, rules and regulations regarding the practice of medicine. In accordance with applicable law, all decisions, procedures, diagnoses and treatments that constitute the practice of medicine shall be provided by duly licensed physicians who shall have sole and absolute discretion regarding all such matters. Notwithstanding the above, the patient may refuse such medical care, and/or deny further medical attention which shall be documented by CONSULTANT’s medical staff.

Section 15. Business Associate Agreement. CONSULTANT shall enter into a Business Associate Agreement in compliance with HIPAA on a form provided by CITY. -5-
BO785OOO I \2304830v I doc
Section 16. CITY’s Responsibility. CITY shall provide CONSULTANT with all pertinent data, documents, and other requested information as is available for the proper performance of CONSULTANT’s Scope of Work.

Section 17. Information and Documents. All data, information, documents and drawings prepared for CITY and required to be furnished to CITY in connection with this Agreement shall become the property of CITY, and CITY may use all or any portion of the work submitted by CONSULTANT and compensated by CITY pursuant to this Agreement as CITY deems appropriate.

Section 18. Records Retention and Examination. CONSULTANT shall retain, protect, and maintain in an accessible location all records and documents, including paper, electronic, and computer records, with respect to all matters covered under this Agreement for five (5) years after receipt of final payment by CITY under the Agreement. CONSULTANT shall make all such records and documents available for inspection, copying, or other reproductions, and auditing by authorized representatives of CITY, including the City Manager or designee, free of charge. CONSULTANT shall make available all requested data and records at reasonable locations within the County of Los Angeles at any time during normal business hours, and as often as CITY deems necessary. If records are not made available within the County of Los Angeles, CONSULTANT shall pay CITY’s travel, hotel and meal costs to the location where the records are maintained. CONSULTANT must include this provision in all subcontracts made in connection with this Agreement. This provision shall survive the termination of the Agreement.” Section 19. Notice. Any notices, bills, invoices, etc. required by this Agreement shall be deemed received on (a) the day of delivery if delivered by hand during the receiving party’s regular business hours or by facsimile before or during the receiving party’s regular business hours; or (b) on the second business day following deposit in the United States mail, postage prepaid to the addresses set forth above, or to such other addresses as the parties may, from time to time, designate in writing pursuant to this section.

Section 20. Attorney’s Fees. In the event that either party commences any legal action or proceeding to enforce or interpret the provisions of this Agreement, the prevailing party in such action shall be entitled to reasonable attorney’s fees, costs and necessary disbursements, in addition to such other relief as may be sought and awarded.

Section 21. Entire Agreement. This Agreement represents the entire integrated agreement between CITY and CONSULTANT, and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by a written instrument signed by both CITY and CONSULTANT.

Section 22. Exhibits; Precedence. All documents referenced as exhibits in this Agreement are hereby incorporated in this Agreement. In the event of any material discrepancy between the express provisions of this Agreement and the provisions of any document incorporated herein by reference, the provisions of this Agreement shall prevail.

Section 23. Governing Law. The interpretation and implementation of this Agreement shall be governed by the domestic law of the State of California.

Section 24. CITY Not Obligated to Third Parties. CITY shall not be obligated or liable under this Agreement to any party other than CONSULTANT. -6-
B0785-000 I \2304$30v I doc
________
City Clerk
CONSULTANT: VITAL MEDICAL

SERVICES, LLC
ALEX G. GHAZALPOUR
Chief perating Officer
6i

ARMEN VARTANIAN
Managing Director
APPROVED AS TO FORM: APPROVED AS TO CONTENT:

LAURENCE S. WIENER GEORGF-IVEZ
City Attorney
Canae,,

SANDRA SPAGN()
ChieLPoIice- -‘
SRRON C’[URtJX DRESSEL
Risk Manager
-7-
Section 25. Severability. Invalidation of any provision contained herein or the application thereof to any person or entity by judgment or court order shall in no way affect any of the other covenants, conditions, restrictions, or provisions hereof, or the application thereof to any other person or entity, and the same shall remain in full force and effect.

EXECUTED the 17th day September of 20 19 at Beverly Hills, California.

ATTEST:

CITY
AM’
Hills, California
B07$5-000 I ‘2304$30v I .doc

EXHIBIT A

SCOPE OF WORK
CONSULTANT shall perform the following services:

Medical Services:

1. Legal specimen collection Driving Under the Influence (‘DUI”) blood draws. The booking of the blood will be handled by CITY Police Department (‘BHPD”) officers in accordance with LA County standards and provisions and BHPD Policy. If an outside laboratory is used, CONSULTANT shall take responsibility for transporting and booking of blood for forensic analysis in accordance with all legal requirements.

2. Pre-booking and medical screening examinations, including with respect to mental health and any communicable diseases. If imaging services or comprehensive lab tests are determined necessary, CONSULTANT shall make appropriate recommendations to CITY with respect thereto and CITY shall transport the arrestee or inmate to a local hospital emergency department or other facility, as determined by CITY.

Forced blood draws shall be done in accordance with BHPD policies. Any forced blood draws will require a McNeely Warrant that must be obtained by CITY.

3. Title 15 pregnancy testing. Anytime an arrestee requests pre-natal care per Title 15 requirements the jail is required to provide it. CONSULTANT will conduct a pregnancy test using urine to determine the validity of the arrestee’s claim of being pregnant.

4. Treatment of minor injuries and conditions, as appropriate.

CONSULTANT shall use CITY’s existing video cameras in the room where the Covered Services will be provided to arrestees and inmates in CITY’s jail.

CONSULTANT shall be responsible for providing all necessary medical and other equipment and supplies in order for it to provide the Covered Services contemplated in this Agreement.

In addition, CONSULTANT staff will be available to assist CITY with medical screening exams and blood draws at all DUI checkpoints (“DUI Assignments”) established by CITY.

CONSULTANT shall make an attempt to respond to field evidence collection requests within 45 minutes upon receiving notification for services, whether it be at a hospital and/or at the scene of a fatal or pedestrian involved accident. Due to unforeseen circumstances beyond CONSULTANT’s control, there may be a slight delay in response, however all call details shall be communicated with CITY upon receiving a call for service.

CONSULTANT staff also must be available for depositions, courtroom testimony and responding to subpoenas (“Legal Testimony”) at an additional fee to be agreed upon between the parties in writing.
-8-
B0785-000 \2304830v .doc
Medical Director Oversight
CONSULTANT shall perform the following services:

Dispatch Center Medical Director Oversight: CONSULTANT shall provide a physician licensed in California, and board certified in emergency medicine, who possesses knowledge of emergency medical services (EMS) systems in California and the local jurisdiction and who is familiar with dispatching systems and methodologies and has ample experience in medical directorship. Said oversight shall be consistent with Los Angeles County Emergency Medical Services Agency (EMSA) Pre-hospital Policy, Reference No. 227.

As the Dispatch Center Medical Director, CONSULTANT shall provide:

1. Medical direction and oversight of the Emergency Medical Dispatch Center’s operations and governance, by way of, providing consultation, review and or assistance in the following:

2. Medical direction and oversight of the emergency medical dispatch centers daily operations through review of:

3. Policies and procedures related to Emergency Medical Dispatch and patient care

4. Standards for qualifying initial education and continuing education.

5. Create, implement and or review pre-arrival instructions, such that, said instructions reflect LA County EMSA Pre hospital Care Policies, Treatment Protocols and the community standard, as set forth by the LA County EMSA

6. Create, implement and review the EMD’s Quality Improvement (QI) Plan, its indicators therein and action or education applied thereafter, as applicable. a. Said QI Plan shall be consistent with LA County EMSA Pre hospital Policy Reference No. 620

7. Review of EMD call records and assist in the collation and interpretation of correlating data for the purposes of quality improvement and quality assurance

8. Participate in EMD risk management and compliance activities

9. Participate in Dispatch Center Advisory meetings and group work, as set forth by the LA County EMSA

10. Dispatch guidelines including pre-arrival instructions.

11. Quality improvement (QI) and compliance standards

12. Ongoing periodic review of dispatch records for identification of potential patient care issues

13. Participate in dispatch quality improvement, risk management and compliance activities

14. Attend participate by phone conference call, and send a representative to the Dispatch Center Advisory meetings scheduled by the Los Angeles County EMS Agency

15. Provide Emergency Medical Center monthly activity report -9-
B0785-000 l\2304830v .doc
CONSULTANT shall establish a QI Program, at the minimum, consistent with LA County EMSA Pte hospital Policy Ref. No. 620. Said Program shall evaluate indicators and other select data sets specific to the dispatch of emergency medical services.

CONSULTANT shall have a written Ql Program plan that includes all components defined in LA County EMS Pre hospital Policy Ref. No. 620. Additionally, the following components shall be included in the QI Program:

CONSULTANT shall help establish a QI Program that shall evaluate indicators specific to the dispatch of emergency medical services in order to foster continuous improvement in performance and quality patient care.

CONSULTANT shall have a written QI Program plan that includes, at minimum, the following components:

1. Mission statement, objectives, and goals for process improvement of the communication center

2. Organizational chart or narrative description of how the QI program is integrated within the dispatch center, process(s) for data collection and reporting. Include templates utilized in standardize reports

3. Key performance measures or indicators related to delivery of emergency medical dispatching. Methods or activities designed to address deficiencies and measure compliance to protocol standards as established by the EMD Medical Director through ongoing random case review for each emergency medical dispatcher

4. Activities designed to acknowledge excellence in the delivery of emergency medical dispatch performance
The QI process shall:

1. Monitor the quality of medical instruction given to callers, including ongoing random case review for each emergency medical dispatcher and observing telephone care rendered by emergency medical dispatchers for compliance with defined standards.

2. Conduct random or incident specific case reviews to identify calls/practices that demonstrate excellence in dispatch performance and/or identify practices that do not conform to defined policy or procedures so that appropriate training can be initiated.

3. Review EMD reports, and/or other records of patient care to compare performance against medical standards of practice.

4. Recommend training, policies and procedures for quality improvement.

5. Annually, and as requested prepare and submit a written QI Plan, to the specitications of the LA County EMSA, consistent with Ref. No. 620.

Nasal Narcan

NASAL NALOXONE (NARCAN) PROGRAM
CONSULTANT shall perform the following services in connection with the Nasal Naloxone (Narcan) Program:

Items 1-6 are further detailed in the VITAL-A004 Policy in Attachment 1 to this Exhibit. -10-
B07$5-000 I \2304830v I doe

1. Medical Director oversight for Nasal Naloxone (Narcan) administration

2. Executed Standing Order for Medication Administration

3. Nasal Naloxone (Narcan) Education

4. Nasal Naloxone (Narcan) Training -The use of Naloxone via a nasal injector is relatively simple and generally not dangerous or difficult. CONSULTANT shall create a comprehensive curriculum in accordance with the manufacturer’s suggested training recommendation, for a 1-2-hour training course to be required for all officers who will deploy with Naloxone kits. The course will include the following:

Course of instruction
Demonstrations
Brief competency skills and demonstrative examination

5. Nasal Naloxone (Narcan) Program Oversight and Implementation.

6. Nasal Naloxone (Narcan) Customized Policy Implementation

7. Mandatory reporting of usage to EMS Agency

8. QA-QI reporting quarterly to EMS Agency

STAFFING
CONSULTANT shall serve as CITY’s Program Coordinator, as referenced in VITAL-A004 Policy.

The Program Coordinator will designate and be responsible for reporting requirements. The Program Coordinator will be available to all CITY agents on an on-call basis (24) hours per day, seven (7) days per week.
-11-
80785-0001 \2304830v .doc
ATTACHMENT 1 TO EXHIBIT A
vtI
J’ ViTAL Beverly Hills Police Department
Vital Medical Services
Joint Policy
Subject: Nasal Narcan (Naloxone) Administration
Effective Date: Upon Deployment Category: Naloxone Administration Supersedes: New Number: VMS-A004

PURPOSE
Law enforcement personnel are occasionally the first responders to a person who is experiencing or suspected of experiencing an opioid-related overdose. The purpose of this policy is to establish procedures to govern an “Nasal Naloxone Program” through the deployment of Naloxone by Law enforcement personnel. The objective is to reduce injuries and fatalities resulting from opioid overdoses, in the instances where emergency medical personnel have not yet arrived. In response to dramatic increases in opioid related overdose deaths in recent years, the United States Attorney General strongly encouraged federal, state, and local law enforcement agencies to consider using drugs such as Naloxone (pronounced na-LOX-own) as first responders to treat subjects who have overdosed on these types of drugs. Many states, including California, have passed legislation to authorize licensed health care providers to prescribe and provide opioid antagonists (such as Naloxone) to family members, friends, or other persons who are in positions to assist people at risk of opioid-related overdoses. As a result, law enforcement agencies in at least 37 states across the nation are deploying Naloxone with field patrol personnel (Source: North Carolina Harm Reduction Coalition). Drug overdoses have continued to be the leading cause of injury death in the United States; and among people 25 to 64 yeats old, drug overdoses cause more deaths than motor vehicle traffic crashes. In the United States since 2001, overdose deaths from heroin have increased 594% while overdose deaths from prescription opioids have increased 342%

BACKGROUND
According to the United States Department of Justice and the Center for Disease Control and Prevention, a recent study indicated an average of 120 Americans die from drug overdoses every day in the United States, outnumbering even deaths from gunshot wounds or motor vehicle crashes. More than half of these drug overdose deaths involve opioids such as heroin and prescription pain relievers. These studies have indicated that between 2001 and 2014, heroin overdose deaths dramatically increased by 594%.

As a result of these shocking statistics, in March 2014 the United States Attorney General strongly encouraged federal, state, and local law enforcement agencies to review their policies and procedures to determine whether personnel in these agencies should be equipped and trained to recognize and respond to opioid overdoses by various methods, including the use of Naloxone. At that time, the United States Department of Justice reported that nineteen states and the District of Columbia had amended their laws to increase access to Naloxone, resulting in over 10,000 overdose reversals since 2001. Since that time, however, current research has indicated law enforcement officers in at least 37 states are deploying Naloxone with their field officers (Source: North Carolina Harm Reduction Coalition).

Fentanyl is a powerful synthetic drug that is similar to morphine and heroin but is 50 to 100 times more potent. Fentanyl and its analogs are members of the class of drugs known as rapid-acting synthetic opioids that alleviate pain. Other drugs in this class include fentanyl analogs, such as acetyl fentanyl, -12-
50785-0001 \2304830v doc
butyrfentanyl, Carfentanil, alfentanil, sufentanil and remifentanil. Fentanyl acts quickly to depress central nervous system and respiratory function. Exposure to fentanyl can and may be fatal.

The U.S. Drug Enforcement Administration (DEA) classifies fentanyl and some of its analogs as schedule II prescription drugs, which are typically used to treat patients with severe pain or to manage pain after surgery. They are sometimes used to treat patients with chronic pain who are physically tolerant to other opioids: however, per the CDC Guideline for Prescribing Opioids for Chronic Pain, only clinicians who are familiar with the dosing and absorption properties of fentanyl and are prepared to educate their patients about its use and risks should consider prescribing it for chronic pain. Carfentanil is used in veterinary medicine as a sedative or anesthetic agent for large animals. Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs, along with other fentanyl analogs which are not approved for medical purposes, are extremely dangerous when used illicitly.

Naloxone is a safe and effective antidote to all oploid-related overdoses, including fentanyl. It is a critical tool in preventing fatal opioid overdoses. Multiple doses of naloxone may be needed to treat a fentanyl overdose because of its high potency. Depending on state and local laws, naloxone can potentially be administered effectively by emergency responders, law enforcement, and others trained in its use. (Source: NIDSH and CDC 2017).

Abuse of opioid related drugs is at epidemic levels:
• Heroin overdose deaths have increased 594% since 2001 (U.S.) • Overdose deaths from prescription opioids have increased 342% since 2001 (U.S.) Facts:
• There were 28,647 opioid related drug overdose deaths in the United States in 2014 • California ranked #1 in the nation in oploid related overdose deaths with 4,521 (16% of the nation’s total)
• More than 60% of the nation’s drug
In summary, this legislation:
• Allows Vital Medical Services to approve and execute a standing order, and establish training and reporting protocol
• Provides protection from professional review and civil and criminal liability to those participating in the trial study
• Permits peace officer to participate
Naloxone Hydrochloride (Narcan®) is an opioid antagonist and works to reverse depressed breathing and improve alertness.
• Been in use for decades
• Very high safety profile
• Short acting with no permanent side effects
• Mild side effects, if any
• Can be administered to someone not experiencing an overdose with no adverse effects Naloxone is now being used by law enforcement field personnel in at least 39 states throughout the nation. Each agency has their own policies. VMS has standardized the Naloxone Program to adhere to State of California and Los Angeles County EMS agency requirements. This will allow agencies that have multiple officers representing them to have one standardized policy to follow. -13-
B0785.000 I \2304$30v I doe

LIABILITY PROTECTION
California legislation Assembly Bill 635 (Civil Code §1714.22) established complete protection from professional review (doctors) and civil and criminal liability for person(s) who are trained and act with reasonable care in administering opioid to antagonists to those experiencing or suspected of experiencing an overdose. In October 2013 California Governor Jerry Brown approved Assembly Sill No. 635 (Civil Code §1714 .22) that allowed licensed health care providers to establish and issue standing orders for the administration of opioid antagonists (Naloxone, for example) by family members, friends, or other persons “in a position to assist a person experiencing or suspected of experiencing an opioid overdose.” Additionally, AS 635 authorized licensed health care providers to prescribe and provide opioid antagonists to family members, friends, or other persons to assist people at risk of an opioid-related overdose. Importantly, AB 635 established legal protection from professional review and civil and criminal liability for licensed health care providers (who issue prescriptions or standing orders) and for persons who are trained and act with reasonable care in administering an opioid antagonist to those experiencing or suspected of experiencing an overdose.

The California Legislature approved and the Governor signed SB 1438 to amend in part Health & Safety Code §1797.197 effective January 1, 2015. SB 1438 requires the Emergency Medical Services Authority, a state agency, to develop and adopt training and standards for all pre-hospital emergency medical care personnel regarding the use and administration of Naloxone hydrochloride and other opioid antagonists.

It is important to note that Health & Safety Code §1797.789 specifically includes peace officers within the definition of pre-hospital emergency medical care personnel (see Health & Safety Code §1797.183 and California Penal Code §735 78). There is no timeframe in the statute for the Emergency Medical Services Authority to develop the training and standards, which then must be approved by the State Commission on Emergency Medical Services.

The amendments to Health & Safety Code §1797.197 allows for Law enforcement Agencies and its personnel with the appropriate training and oversight to participate in this program.

The training component is of critical importance to this program because the training requirement is what establishes the immunity provisions of Civil Code §1774.22 (see Health & Safety Code §7 797. 797(b)(3) (the training for the trial study “shall satisfy the requirements of paragraph (1) of subdivision (d) of Civil Code §7714.22 . ‘). According to Civil Code §1774.22(f): “Notwithstanding any other law, a person not otherwise licensed to administer an opioid antagonist, but trained as required under paragraph (7) of subdivision (U) (which requires that a person who is prescribed or possesses an opioid antagonist pursuant to standing order must be trained),who acts with reasonable care in administering an opiold antagonist, in good faith and not for compensation, to a person who is experiencing or is suspected of experiencing an overdose shall not be subject to professional review, be liable in a civil action, or be subject to criminal prosecution for this administration.” According to the Centers for Disease Control and Prevention, the rate of deaths by drug overdoses has risen dramatically in recent years; an average of 120 people die each day from drug overdoses.

TRAINING
Vital Medical Services (VMS) has agreed to assist law enforcement agencies with the acquisition of Nasal Naloxone through ADAPT PHARMA. VMS has partnered with law enforcement for a Naloxone Administration Program to help with the growing Fentanyl and Opioid epidemic in the United States.

The administration of Naloxone is relatively simple and VMS along with manufacturers (ADAPT PHARMA) recommendations has developed a 1 to 2-hour training course that includes:
• Course of instruction
• Demonstration
• Brief competency skills and visual examination
-14-
B0785-000 I \2304830v I .doc
The training will be conducted by VMS as a train the trainer course and each participating law enforcement agency will be required to send representative(s) to the course to train other agency personnel in the deployment and administration of Naloxone.

NALOXONE KITS
VMS along with protocol standards set forth has recommended Naloxone Kits for law enforcement deployment to contain the following:
• (2) Nitrile Gloves
• AMBU-CPR One Way Valve Mask with 02 Port
• Clear Eye Protection
• (2) 4Mg Nasal Naloxone Sprays
• Orange Pelican Cases with Customized Foam and Clearly Printed Nasal Naloxone Kit on the cover
IMPORTANT:

Naloxone is a perishable prescription medication that cannot be exposed to extreme temperatures for prolonged periods of time. Therefore, each participating agency must develop protocol for providing kits to officers- the Naloxone kits cannot be kept in patrol cars for days/weeks/months on end.

TRAINING PROTOCOL
The use of Naloxone via a Nasal Spray is relatively simple and generally not dangerous or difficult. Vital Medical Services will follow the instructions and training protocols set forth by Adapt Pharma Pharmaceuticals. The training course will include the following:
• Course of instruction
• Demonstration
• Brief competency skills and written examination
The training component coupled with the initial time for education is critical to establish the liability protection provided by legislation.

POLICY
VMS has:
• Executed a standing order for Nasal Naloxone
• Established training and reporting protocol pursuant to local, state and federal guidelines • Established initial and continuing training guidelines • Accepted responsibility for program evaluation and monitoring It is the policy of Vital Medical Services that officers shall be trained to administer Naloxone in accordance with mandated training guidelines as determined and established pursuant to Health & Safety Code 1797.1 97 and California Civil Code 1714.22. (a) Officers who are trained in accordance with mandated training guidelines shall deploy with Naloxone kits in the field. However, the Officer will retain the discretion to administer or not administer Naloxone to persons experiencing or suspected of experiencing opioid related overdoses. There is no -15-
BO785OOO \2304830v I .doc
legal obligation to administer Naloxone.
(b) Officers who administer Naloxone, are protected from civil and criminal liability if they act with reasonable care and “in good faith. This is accomplished by administering Naloxone according to established training protocol.

PROGRAM COORDINATOR
Vital Medical Services will serve as the police agencies Program Coordinator and will work in collaboration with the each respective local, state and federal law enforcement agency. The Program Coordinator will designate Program Managers at each participating location to provide support to the Program Coordinator. Each Law Enforcement agency designee will be responsible for tracking, storage, maintenance, replacement of Naloxone kits, and reporting to the Program Coordinator.

PROCEDURE/GENERAL INSTRUCTIONS

INITIALTRAINING
Officers may not administer Naloxone without the completion of mandated training by VMS. All Officers at participating agencies will receive initial training that will include, at a minimum, an overview of California Civil Code 1714.22, patient assessment (signs/symptomology of overdose), universal precautions, rescue breathing. seeking medical attention, and the use of intra-nasal Naloxone. Upon completion of training, Officers will have their training recorded with the Program Coordinator.

CONTINUING TRAINING
Officers will receive refresher training as deemed appropriate by VMS.

NALOXONE DEPLOYMENT
Law Enforcement Agencies will deploy Naloxone kits in patrol locations and other areas as deemed appropriate.

NALOXONE STORAGE
Naloxone kits mustbereturned tothe local equipmentcage or administratoratthe end ofshift and will not be kept in patrol vehicles for extended periods of time.

NALOXONE USE
Officers who have completed mandated Naloxone training by VMS are authorized to administer Naloxone when they reasonably believe someone is experiencing an oploid-related overdose.

Personnel will treat the incident as a medical emergency and shall follow these steps when performing this intervention:
(a) Confirm emergency personnel are responding;
(b) Maintain universal precautions;
(c) Perform patient assessment;
(d) Determine unresponsiveness;
(e) Update dispatch of potential overdose state;
-16-
B07$5-000 I \2304$30v .doc
(f) Follow Naloxone use protocol;
(g) Immediately notify responding emergency medical personnel that Naloxone has been administered; and
(h) Notify their immediate supervisor.

DOCUMENTATION/NALOXONE REPORTS
Upon completion of the incident, Officers will submit a report detailing the nature of the incident, the care the patient received, and the fact Naloxone was deployed.

REPORTING RESPONSIBILITY
The area patrol sergeant and or watch commander will contact Vital Medical Services upon being notified that Naloxone was used. VMS will deploy their administrative staff to complete all necessary reporting requirements set forth by Title 22.

MAINTENANCE AND REPLACEMENT
The daily inspection of Naloxone kits will be the responsibihty of officers who are assigned the kit for field deployment. The maintenance and replacement of Naloxone kits will be the responsibility of the Program Manager (or their designee) assigned to each patrol location where the kits are used. Used, lost, or damaged Naloxone kits will be reported to the immediate supervisor and returned to the local Program Manager for replacement.

RESOURCE(S):

North Carolina Harm Reduction Coalition
Adapt-Pharma Pharmaceuticals
National Institute of Occupational Safety and Health (NIOSH) United States Center for Disease Control (CDC)
Law enforcement Agencies with Current Naloxone Implementation Assembly Bill 635 (Civil Code §1714.22)
California Legislature
U.S. Drug Enforcement Administration
California Code of Regulations, Title 22, Division 9, Chapter 1.5, Article 3 -17-
B0785-000 I 23O483Ov I doe

EXHIBIT B

SCHEDULE OF PAYMENT AND RATES
CITY shall pay CONSULTANT an amount not to exceed One Hundred Eighty-Five Thousand Nine Hundred Forty Dollars ($185,940) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Thirteen Thousand Eight Hundred Twenty-Two Dollars ($13,822.00) per year at the following rates:

Flat Monthly Medical Services Fee - $15,495, which shall include:
• Up to 28 Medical Clearances per month with no toll-over • Up to 10 Blood Draws per month with no toll-over
• Per 2018 policy, forced or warrant blood draws count as one blood draw and one medical clearance as the patient must be cleated for this procedure Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 511.00
Blood Draw $ 174.00
DUI Check Point (OTS Reimbursement per detail) $ 400.00 Post Exposure Hazard $ 1,028.00
Reasonable Suspicion Drug and Alcohol Testing $ 408.00
Testimony Maximum Hourly Rate $ 124.00
Stand-by Time Maximum Hourly Rate $ 124.00
Cancellations $ 240.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
• $20,000 per year which includes Medical Director Oversight for Police/Fire Communications
• Annual Narcan Administration Fee $7,438.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Acreement Extensions -Consumer Price Index (‘CPI”):

If the term of the Agreement is extended by CITY, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the OP I-U is not published or available, less food and energy, to the neatest one dollar. The current CPI amount is 3.3 percent.
-18-
B0785-000 I \2304830v I doc
Cancellations:

A $240.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Twenty-Seven Thousand Two Hundred Dollars ($227,200)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY’s accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same. -19-
B07$5-000 \2304830v I .doc

EXHIBIT C

CERTIFICATE OF INSURANCE
This is to certify that the following endorsement is part of the police(iert described below

NAMED INSURED COMPANIES AFFORDING COVERAGE
A.

ADDRESS B.

C.

COMPANY COVERAGE NUMBER
EXPIRATION RI LIMITS p a AGGREGATE
i/i AUTOMOBILE LIABILITY

L GENERAL LIABILITY

PRODUCTS/COMPLETED

OPERATIONS
E. BLANKET CONTRACTUAL

F CONSULTANTS PROTECTIVE
/ PERSONAL INJURY

EXCESS LIABILITY
// WORKERS COMPENSATION
It is hereby understood and agreed that the Cut of Beverly Hills, its Cit Council and each member thereof and es sty officer and employee of the City shall be named as joint and several assureds with respect to claims arising out of the following project or agreement It is further agreed that the following indemnity agreement between the City of Beverly Hills and the named insured is covered under the policy Contractor agrees to indemnify, hold harmless and defend City, its City Council and each member thereof and every officer and employee of City from any and all liability or financial loss resulting from an suits, claims, losses or actions brought against and from all costs and expenses of litigation broLight against City, its City Council and each member thereof and any officer or employee of City which results directly or indirectly from the wrongful or negligent actions of contractor’s officers, employees, agents or others enuployed by Contractor while engaged by Contractor in the (performance of this agreement) construction of this project.

It is further agreed that the inclusion of more than one assured shall not operate to increase the limit of the company’s liability and that insurer waives any rigltt of contribution with insurance which may be available to the City of Beverly Hills.

In the event of cancellation or material change in the above coverage, the company wilt give 30 days written notice of cancellation or material change to the certificate holder
Except to certify that the policy(ies) described above have the above endorsement attached, this certificate or verification of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein Notwithstanding any requirement. term, or condition of any contract or other document with respect to which this certificate or verification of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all tlte terms, exclusions and conditions of such policies DATE: BY
Authorized Insurance Representative
TITLE
AGENCY Address
-20-
B07$5-000 I \2304830v I .doc
Attachment 2
DocuSign Envelope ID: 6C3DECBA-59C7.427B-8EFO-69DD0061 3B4A AMENDMENT NO. 1 TO AN AGREEMENT BETWEEN THE CITY OF

BEVERLY HILLS AND VITAL MEDICAL SERVICES, LLC TO PROVIDE MEDICAL SERVICES IN THE CITY’S JAIL, MEDICAL DIRECTIVE

OVERSIGHT AND NARCAN ADMINISTRATION
NAME OF CONSULTANT: VITAL MEDICAL SERVICES, LLC
RESPONSIBLE Alex G. Ghazalpour, Chief Operating Officer

PRINCIPAL OF
CONSULTANT:

CONSULTANT’S 700 North Brand Boulevard, Suite 220
ADDRESS: Glendale, CA 91203
Attention: Alex G. Ghazalpour, Chief Operating Officer
CONSULTANT’S 46-1055770
E.I.NJTAX l.D. NO.:

CITY’S ADDRESS: City of Beverly Hills
455 N. Rexford Drive
Beverly Hills, CA 90210
Attention: Dominick Rivetti, Interim Chief of Police
COMMENCEMENT DATE: July 1,2019
TERMINATION DATE: June 30, 2021, unless extended pursuant to Section 2 of the Agreement
CONSIDERATION: Original Agreement:

Medical Services Fee Not to Exceed $185,940 per year ($15,495 per month)
Contingency for additional work not to exceed $13,822 per year Medical Director Oversight and Narcan
Administration Annual Fees $27,438 per year
Total not to exceed $227,200.00 per year
Amendment No. 1: Additional $6,818.00 for fiscal year 2020- 2021, Medical Services Fee Notto Exceed $191,520 peryear ($15,960 per month) including a contingency for additional work not to exceed $14,237 per year
Medical Director Oversight and Narcan Administration Annual Fees $28,261 per year
B07$5-000l\24234$2v3 doc
377-20
Docusign Envelope ID: 6C3DECBA-59C7-4276-8EFO-69DD0061 384A Total Not to exceed amount of $234,018.00 for fiscal year 2020- 2021, as more particularly described in Exhibit B

CHANGE ORDER AGREEMENT
Pursuant to Beverly Hills Municipal Code Section 3-3-1 11, the Contracting Officer may approve a change order that does not exceed his/her purchasing authority
-2-
30785-0001\24234$2v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A AMENDMENT NO. 1 TO AN AGREEMENT BETWEEN THE CITY OF

BEVERLY HILLS AND VITAL MEDICAL SERVICES, LLC TO PROVIDE MEDICAL SERVICES IN THE CITY’S JAIL, MEDICAL DIRECTIVE

OVERSIGHT AND NARCAN ADMINISTRATION
This Amendment No. I is to that certain Agreement between the City of Beverly Hills (hereinafter called “CITY”), and Vital Medical Services, LLC (hereinafter called “CONSULTANT”) dated September 17, 2019 and identified as Contract No. 528-19 (“Agreement”).

NOW, THEREFORE, the parties agree as follows:

RECITALS
A. CITY entered into a written agreement with CONSULTANT to provide medical services in the city’s jail, medical directive oversight and narcan administration.

B. CITY and CONSULTANT desire to amend the Agreement to extend the termination date, amend the scope of services to include communicable disease exposure testing and counseling (Including Covid-1 9), and increase the consideration by 3% for fiscal year 2020-2021 for a cost of living increase.

C. International, national, state, and local health and governmental authorities are responding to an outbreak of respiratory disease caused by a novel coronavirus named “SARS CoV-2,” and the disease it causes has been named “coronavirus disease 2019,” abbreviated COVID-19, (“COVID-19”); and B. On March 4, 2020, the Los Angeles County Board of Supervisors and Department of Public Health declared a local emergency and local public health emergency to aid the regional healthcare and governmental community in responding to COVID 19; and
D. On March 4, 2020, the Governor of the State of California declared a state of emergency to make additional resources available, formalize emergency actions already underway across multiple state agencies and departments, and help the state prepare for broader spread of COVID-19; and
E. On March 13, 2020, the President of the United States of America declared a national emergency and announced that the federal government would make emergency funding available to assist state and local governments in preventing the spread of and addressing the effects of COVID-1 9; and
F. On March 15, 2020, the City Manager, in his role as the Director of Emergency Services, proclaimed the existence of a local emergency pursuant to Section 2-4-107 of the Beverly Hills -j -
B0785-000 l2423482v3 doe
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A Municipal Code to ensure the availability of mutual aid and an effective CITY response to the novel coronavirus (“COVID-1 9”); and
G. On March 16, 2020, the City Council adopted a Resolution ratifying the Director of Emergency Services’ proclamation of the existence of a local emergency; and H. The Centers for Disease Control and Prevention, the California Department of Public Health, and the Los Angeles County Department of Public Health have all issued order including but not limited to stay at home orders, social distancing, staying home if sick, canceling or postponing large group events, working from home, and other precautions to protect public health and prevent transmission of this communicable virus.

I. In light of these extraordinary emergency circumstances, it is recommended that the public and police officers avoid going to hospitals unless absolutely necessary. Pursuant to the Beverly Hills Municipal Code, CITY determined that it is in the best interest of CITY to waive further bidding of these services which are specialized and professional in nature, and CITY and CONSULTANT have an existing agreement for medical services for CITY’s Jail, Medical Directive Oversight, and Narcan Administration CONSULTANT is prepared to continue to provide the medical services to CITY at competitive and discounted rate.

J. CITY desires to amend the Agreement regarding services and/or goods that are needed due to the COVID-19 pandemic.

Section 1. The TERMINATION DATE shall be amended as set forth on the cover page.

Section 2. The CONSIDERATION shall be amended as set forth on the cover page.

Section 3. Section 13 of the Agreement entitled, ‘Termination”, shall be replaced in its entirety to read as follows:
“Section 13 Termination for Cause and Convenience; Remedies. (1) Termination for Convenience: CITY may terminate this Agreement, in whole or in part, at any time by written notice to CONSULTANT when it is in CITY’s best interest.

CONSULTANT shall be paid its costs, including Agreement close-out costs, up to the time of termination. CONSULTANT shall promptly submit its termination claim to CITY to be paid to CONSULTANT. If CONSULTANT has any property in its possession belonging to CITY, CONSULTANT will account for the same, and dispose of it in the manner CITY directs. (2) Termination for Cause: If CONSULTANT does not deliver supplies in accordance with the Agreement’s delivery schedule, or, if the Agreement is for services, the CONSULTANT fails to perform in the manner called for in the Agreement, or if CONSULTANT fails to comply with any other provisions of this Agreement, CITY may terminate this Agreement for cause. Termination shall be effected by serving a notice of termination on the CONSULTANT setting forth the manner in which the Agreement is in default. CONSULTANT will only be paid the -4-
30785-000] \2423482v3 doe
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A price for supplies delivered and accepted, or services performed in accordance with the manner of performance, as set forth in this Agreement.

If it is later determined by CITY that CONSULTANT had an excusable reason for not performing, such as a strike, fire, or flood, events which are not the fault of or are beyond the control of CONSULTANT, CITY, after setting up a new delivery of performance schedule, may allow the CONSULTANT to continue work, or treat the termination as a termination for convenience.
(3) Opportunity to Cure: CITY in its sole discretion may, in the case of a termination for breach or default, allow CONSULTANT three (3) days in which to cure the defect. In such case, the notice of termination will state the time period in which cure is permitted and other appropriate conditions.

If CONSULTANT fails to remedy to CITY’s satisfaction the breach or default of any of the terms, covenants, or conditions of the Agreement within three (3) days after receipt by CONSULTANT of written notice from CITY setting forth the nature of said breach or default, CITY shall have the right to terminate the Agreement without any further obligation to CONSULTANT.

Any such termination for default shall not in any way operate to preclude CITY from also pursuing all available remedies against CONSULTANT and its sureties for said breach or default. (4) Waiver of Remedies: In the event that CITY elects to waive its remedies for any breach by CONSULTANT of any covenant, term or condition of this Agreement, such waiver by CITY shall not limit CITY’s remedies for any succeeding breach of that or of any other term, covenant, or condition of this Agreement.”
Section 4. The following Section 26 shall be added to the Agreement as set forth below:
“Section 26. Federal Government Provisions:
(a) EQUAL EMPLOYMENT OPPORTUNITY.
[Applicable to “federally assisted construction contract” and “construction work” as defined in 41 C.F.R. § 60-1.3]
During the performance of this Agreement, CONSULTANT agrees as follows:
(1) CONSULTANT will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. CONSULTANT will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following:

Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. CONSULTANT agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause.
--
80785-000 I ‘2423482v3 doe
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO69DDOO61 3B4A (2) CONSULTANT will, in all solicitations or advertisements for employees placed by or on behalf of CONSULTANT, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
(3) CONSULTANT will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee’s essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with CONSULTANT’s legal duty to furnish information. (4) CONSULTANT will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers’ representatives of CONSULTANT’s commitments under this paragraph of this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. (5) CONSULTANT will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. (6) CONSULTANT will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders.
(7) In the event of CONSULTANT’s noncompliance with the nondiscrimination clauses of this Agreement or with any of the said rules, regulations, or orders, this Agreement may be canceled, terminated, or suspended in whole or in part and CONSULTANT may be declared ineligible for further federal government contracts or federally assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law.
(8) CONSULTANT will include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (8) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. CONSULTANT will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance:

B0785-000l 2423482v3 doe
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A Provided, however, that in the event CONSULTANT becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency, CONSULTANT may request the United States to enter into such litigation to protect the interests of the United States.

CITY further agrees that it will be bound by the above equal opportunity clause with respect to its own employment practices when it participates in federally assisted construction work: Provided, That if the applicant so participating is a State or local government, the above equal opportunity clause is not applicable to any agency, instrumentality or subdivision of such government which does not participate in work on or under the Agreement.

The applicant agrees that it will assist and cooperate actively with the administering agency and the Secretary of Labor in obtaining the compliance of contractors and subcontractors with the equal opportunity clause and the rules, regulations, and relevant orders of the Secretary of Labor, that it will furnish the administering agency and the Secretary of Labor such information as they may require for the supervision of such compliance, and that it will otherwise assist the administering agency in the discharge of the agencys primary responsibility for securing compliance.

CITY further agrees that it will refrain from entering into any contract or contract modification subject to Executive Order 11246 of September 24, 1965, with a contractor debarred from, or who has not demonstrated eligibility for federal government contracts and federally assisted construction contracts pursuant to the Executive Order and will carry out such sanctions and penalties for violation of the equal opportunity clause as may be imposed upon contractors and subcontractors by the administering agency or the Secretary of Labor pursuant to Part II, Subpart D of the Executive Order. In addition, CITY agrees that if it fails or refuses to comply with these undertakings, the administering agency may take any or all of the following actions: Cancel, terminate, or suspend in whole or in part this Agreement (grant, loan, insurance guarantee); refrain from extending any further assistance to CITY under the program with respect to which the failure or refund occurred until satisfactory assurance of future compliance has been received from CITY; and refer the case to the Department of Justice for appropriate legal proceedings. fb) DAVIS BACON ACT.
[Applicable to prime construction contracts in excess of $2,000 awarded by CITY. Applies only to the Emergency Management Preparedness Grant Program, Homeland Security Grant Program, Nonprofit Security Grant Program, Tribal Homeland Security Grant Program, Port Security Grant Program, and Transit Security Grant Program]
(1) All transactions regarding this Agreement shall be done in compliance with the Davis-Bacon Act (40 U.S.C. 31413144, and 3146-3148) and the requirements of 29 C.F.R. pt. 5 as may be applicable. CONSULTANT shall comply with 40 U.S.C. 3141-3144, and 3146- 3148 and the requirements of 29 C.F.R. pt. 5 as applicable. (2) CONSULTANT shall be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. Additionally, CONSULTANT shall be required to pay wages not less than once a week.
-7-
30785-000 I\24234$2v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EEO-69DD0061 3B4A fc) COPELAND ANTI-KICKBACK ACT.
[Applicable to all contracts for construction or repair work above $2,000 in situations where the Davis-Bacon Act also applies. It does not apply to the FEMA Public Assistance Program]
(1) CONSULTANT. CONSULTANT shall comply with 18 U.S.C. § 874, 40 U.S.C. § 3145, and the requirements of 29 C.F.R. pt. 3 as may be applicable, which are incorporated by reference into this Agreement.
(2) Subcontracts. CONSULTANT or subcontractor shall insert in any subcontracts the clause above and such other clauses as FEMA may by appropriate instructions require, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts.

The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all of these Agreement clauses.
(3) Breach. A breach of the Agreement clauses above may be grounds for termination of the Agreement, and for debarment as a contractor and subcontractor as provided in 29 C.F.R. § 5.12.
(d) CONTRACT WORK HOURS AND SAFETY STANDARDS ACT.
[Applicable to FEMA contracts awarded by CITY in excess of $100,000 under grant and cooperative agreement programs that involve the employment of mechanic or laborers]
(1) Overtime requirements. No contractor or subcontractor contracting for any part of the Agreement work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. (2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (b)(1) of this section CONSULTANT and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, CONSULTANT and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (b)(1) of this section, in the sum of $26 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (b)(1) of this section.
(3) Withholding for unpaid wages and liquidated damages. CITY shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by CONSULTANT or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally-assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of CONSULTANT or subcontractor for -8-
B07$5-000I 2423482v3 doc
DocuSign Envelope ID: 6C3DECBA59C7-427B-8EFO-69DDOO61 3B4A unpaid wages and liquidated damages as provided in the clause set forth in paragraph (b)(2) of this section.
(4) Subcontracts. CONSULTANT or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (d)(1)through (4) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (d)(l) through (4) of this section. (e) RIGHTS TO INVENTIONS MADE UNDER A CONTRACT OR AGREEMENT. [Applicable to “funding agreements” as defined under 37 C.F.R. 401.2(a) and any contractor for the performance of experimental, developmental, or research work funded in whole or in part by the Federal government, which does not include the Public Assistance, Hazard Mitigation Grant Program, Fire Management Assistance Grant Program, Crisis Counseling Assistance and Training Grant Program, Disaster Case Management Grant Program, and Federal Assistance to Individuals and Households — Other Needs Assistance Grant Program]
When applicable, CITY shall comply with the requirements of 37 C.F.R. Part 401 (Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements) and any implementing regulations issued by FEMA.
ff) CLEAN AIR ACT AND THE FEDERAL WATER POLLUTION CONTROL ACT. [Applicable awarded by CITY in excess of $150,000 under a federal grant] Clean Air Act

1. CONSULTANT agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. § 7401 et seq.

2. 6TCONSULTANT agrees to report each violation to CITY and understands and agrees that CITY will, in turn, report each violation as required to the Federal Emergency Management Agency (“FEMA”), and the appropriate Environmental Protection Agency Regional Office.

3. CONSULTANT agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA.

Federal Water Pollution Control Act

1. CONSULTANT agrees to comply with all applicable standards, orders, or regulations issued pursuant to the Federal Water Pollution Control Act, as amended, 33 U.S.C. 1251 et seq.

2. CONSULTANT agrees to report each violation to CITY and understands and agrees that CITY will, in turn, report each violation as required to assure notification to the Federal Emergency Management Agency, and the appropriate Environmental Protection Agency Regional Office. -9-
B07$5-000 1 ‘24234 $2v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A

3. CONSULTANT agrees to include these requirements in each subcontract exceeding $150,000 financed in whole or in part with Federal assistance provided by FEMA. (g) DEBARMENT AND SUSPENSION.

CONSULTANT and all subcontractors shall not be debarred or suspended throughout the duration of this Agreement pursuant to 2 CFR 180,2 CFR 200.213, and Executive Orders 12549 and 12689. If CONSULTANT or any subcontractor becomes debarred or suspended throughout the duration of the Work, CONSULTANT shall immediately notify CITY. (h) BYRD ANTI-LOBBYING AMENDMENT.

Pursuant to the Byrd Anti-Lobbying Amendment, 31 U.S.C. 1352, as amended by the Lobbying Disclosure Act of 1995, 2 U.S.C. § 1601 et seq., contractors who apply or bid for an award of $100,000 or more shall file the certification required by 49 CFR Part 20, “New Restrictions on Lobbying.” Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or any employee of a member of Congress in connection with obtaining any Federal Contract, grant or any other award covered by 31 U.S.C. 1352. Each tier shall also disclose the name of any registrant under the Lobbying Disclosure Act of 1995 who has made lobbying contacts on its behalf with non-Federal funds with respect to that Federal Contract, grant, or award covered by 31 U.S.C. 1352. Such disclosures are forwarded from tier to tier up to CITY. This requirement shall pass through to any and all subcontractors engaged to perform services under this Agreement.
(i) PROCUREMENT OF RECOVERED MATERIALS.
[Applicable to FEMA grant and cooperative agreement programs]

1. In the performance of this Agreement, CONSULTANT shall make maximum use of products containing recovered materials that are Environmental Protection Agency (“EPA”) designated items unless the product cannot be acquired — • Competitively within a timeframe providing for compliance with the Agreement performance schedule;
• Meeting Agreement performance requirements; or
• At a reasonable price.

2. Information about this requirement, along with the list of EPA-designated items, is available at EPA’s Comprehensive Procurement Guidelines web site, https://www.epa.qov/smm/comprehensive-procurement-Quideline-cpg-proqram.

3. CONSULTANT also agrees to comply with all other applicable requirements of Section 6002 of the Solid Waste Disposal Act.
- 0-
80785-00012423482; 3 doc
DocuSgn Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A (j) ACCESS TO RECORDS.

The following access to records requirements apply to this Agreement:

1. CONSULTANT agrees to provide CITY, the FEMA Administrator, the Comptroller General of the United States, or any of their authorized representatives access to any books, documents, papers, and records of CONSULTANT which are directly pertinent to this Agreement for the purposes of making audits, examinations, excerpts, and transcriptions.

2. CONSULTANT agrees to permit any of the foregoing parties to reproduce by any means whatsoever or to copy excerpts and transcriptions as reasonably needed.

3. CONSULTANT agrees to provide the FEMA Administrator or his authorized representatives access to construction or other work sites pertaining to the work being completed under the Agreement.

4. In compliance with the Disaster Recovery Act of 2018, CITY and CONSULTANT acknowledge and agree that no language in this Agreement is intended to prohibit audits or internal reviews by the FEMA Administrator or the Comptroller General of the United States. (k) NON-USE OF DHS SEAL, LOGO, AND FLAGS.

CONSULTANT shall not use the Department of Homeland Security (“DHS”) seal(s), logos, crests, or reproductions of flags or likenesses of DHS agency officials without specific FEMA pre-approval.
(I) COMPLIANCE WITH FEDERAL LAW, REGULATIONS, AND EXECUTIVE ORDER.

This is an acknowledgement that FEMA financial assistance will be used to fund all or a portion of the Agreement. CONSULTANT will comply with all applicable Federal law, regulations, executive orders, FEMA policies, procedures, and directives. (m) NO OBLIGATION BY THE FEDERAL GOVERNMENT.

The Federal Government is not a party to this Agreement and is not subject to any obligations or liabilities to CITY, CONSULTANT, or any other party pertaining to any matter resulting from the Agreement.
(n) PROGRAM FRAUD AND FALSEIFRAUDULENT STATEMENTS OR RELATED ACTS.

CONSULTANT acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to CONSULTANT’s actions pertaining to this Agreement.” —11—
80785-000I\2423482v3 doc
Docusign Envelope ID; 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A Section 5. Exhibit A “Scope of Work’ shall be amended as attached hereto and incorporated herein.

Section 6. Exhibit B “Schedule of Payment and Rates” shall be amended as attached hereto and incorporated herein.

Section 7, Except as specifically amended by this Amendment No. 1, the remaining provisions of the Agreement shall remain in full force and effect.

EXECUTED this
day of
____________________,
,
at Beverly Hills, California.

CITY OF BEVERLY HILLS
A Municipal Corporation

JEFF MUIR
Director of Finance
CONSULTANT: VITAL MEDICAL

SERVICES, LLC
4,4E/ VU)I’4)IJ

ARMEN VARTANIAN
Managing Director
c&-_
ALEX G. GHAZALPOUR
Chief Operating Officer
APPROVED AS TO FORM: APPROVED AS TO CONTENT:

Vuud. tfti LAURENCE S. WIENER DOMINICK RIVETTI
City Attorney Interim Chief of Police
S(woi t,’tw’ug Prt-sst±
SHARON L’HEUREUX DRESSEL
Risk Manager
-12-
B07$5-000 I ;2423482v3 doc
21st July
DocuSign Envelope ID: 6C3DECBA-59C7427B-8EFO-69DDOO613B4A

EXHIBIT A

SCOPE OF WORK
CONSULTANT shall perform the following services:

Medical Services:

1. Legal specimen collection Driving Under the Influence (“DUI”) blood draws. The booking of the blood will be handled by CITY Police Department (“BHPD”) officers in accordance with LA County standards and provisions and BHPD Policy. If an outside laboratory is used, CONSULTANT shall take responsibility for transporting and booking of blood for forensic analysis in accordance with all legal requirements.

2. Prebooking and medical screening examinations, including with respect to mental health and any communicable diseases. If imaging services or comprehensive lab tests are determined necessary, CONSULTANT shall make appropriate recommendations to CITY with respect thereto and CITY shall transport the arrestee or inmate to a local hospital emergency department or other facility, as determined by CITY.

Forced blood draws shall be done in accordance with BHPD policies. Any forced blood draws will require a McNeely Warrant that must be obtained by CITY.

3. Title 15 pregnancy testing. Anytime an arrestee requests pre-natal care per Title 15 requirements the jail is required to provide it, CONSULTANT will conduct a pregnancy test using urine to determine the validity of the arrestee’s claim of being pregnant.

4. Treatment of minor injuries and conditions, as appropriate.

5. Communicable Disease Exposure Testing and Counseling (including COVID-19).

CONSULTANT shall use CITY’s existing video cameras in the room where the Covered Services will be provided to arrestees and inmates in CITY’s jail.

CONSULTANT shall be responsible for providing all necessary medical and other equipment and supplies in order for it to provide the Covered Services contemplated in this Agreement.

In addition, CONSULTANT staff will be available to assist CITY with medical screening exams and blood draws at all DUI checkpoints (“DUI Assignments”) established by CITY.

CONSULTANT shall make an attempt to respond to field evidence collection requests within 45 minutes upon receiving notification for services, whether it be at a hospital and/or at the scene of a fatal or pedestrian involved accident. Due to unforeseen circumstances beyond CONSULTANT’s control, there may be a slight delay in response, however all call details shall be communicated with CITY upon receiving a call for service.

CONSULTANT staff also must be available for depositions, courtroom testimony and responding to subpoenas (“Legal Testimony”) at an additional fee to be agreed upon between the parties in writing.
-13-
B07$5-00012423482v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A Medical Director Oversight
CONSULTANT shall perform the following services:

Dispatch Center Medical Director Oversight: CONSULTANT shall provide a physician licensed in California, and board certified in emergency medicine, who possesses knowledge of emergency medical services (EMS) systems in California and the local jurisdiction and who is familiar with dispatching systems and methodologies and has ample experience in medical directorship. Said oversight shall be consistent with Los Angeles County Emergency Medical Services Agency (EMSA) Pre-hospital Policy, Reference No. 227.

As the Dispatch Center Medical Director, CONSULTANT shall provide:

1. Medical direction and oversight of the Emergency Medical Dispatch Center’s operations and governance, by way of, providing consultation, review and or assistance in the following:

2. Medical direction and oversight of the emergency medical dispatch centers daily operations through review of:

3. Policies and procedures related to Emergency Medical Dispatch and patient care

4. Standards for qualifying initial education and continuing education.

5. Create, implement and or review pre-arrival instructions, such that, said instructions reflect LA County EMSA Pre hospital Care Policies, Treatment Protocols and the community standard, as set forth by the LA County EMSA

6. Create, implement and review the EMD’s Quality Improvement (Ql) Plan, its indicators therein and action or education applied thereafter, as applicable. a. Said QI Plan shall be consistent with LA County EMSA Pre hospital Policy Reference No. 620

7. Review of EMD call records and assist in the collation and interpretation of correlating data for the purposes of quality improvement and quality assurance

8. Participate in EMD risk management and compliance activities

9. Participate in Dispatch Center Advisory meetings and group work, as set forth by the LA County EMSA

10. Dispatch guidelines including pre-arrival instructions.

11. Quality improvement (QI) and compliance standards

12. Ongoing periodic review of dispatch records for identification of potential patient care issues

13. Participate in dispatch quality improvement, risk management and compliance activities

14. Affend participate by phone conference call, and send a representative to the Dispatch Center Advisory meetings scheduled by the Los Angeles County EMS Agency

15. Provide Emergency Medical Center monthly activity report -14-
B0785-000I 2423482v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A CONSULTANT shall establish a Ql Program, at the minimum, consistent with LA County EMSA Pre hospital Policy Ref. No. 620. Said Program shall evaluate indicators and other select data sets specific to the dispatch of emergency medical services.

CONSULTANT shall have a written QI Program plan that includes all components defined in LA County EMS Pre hospital Policy Ref. No. 620. Additionally, the following components shall be included in the QI Program:

CONSULTANT shall help establish a QI Program that shall evaluate indicators specific to the dispatch of emergency medical services in order to foster continuous improvement in performance and quality patient care.

CONSULTANT shall have a written QI Program plan that includes, at minimum, the following components:

1. Mission statement, objectives, and goals for process improvement of the communication center

2. Organizational chart or narrative description of how the QI program is integrated within the dispatch center, process(s) for data collection and reporting. Include templates utilized in standardize reports

3. Key performance measures or indicators related to delivery of emergency medical dispatching. Methods or activities designed to address deficiencies and measure compliance to protocol standards as established by the EMD Medical Director through ongoing random case review for each emergency medical dispatcher

4. Activities designed to acknowledge excellence in the delivery of emergency medical dispatch performance
The QI process shall:

1. Monitor the quality of medical instruction given to callers, including ongoing random case review for each emergency medical dispatcher and observing telephone care rendered by emergency medical dispatchers for compliance with defined standards.

2. Conduct random or incident specific case reviews to identify calls/practices that demonstrate excellence in dispatch performance and/or identify practices that do not conform to defined policy or procedures so that appropriate training can be initiated.

3. Review EMD reports, and/or other records of patient care to compare performance against medical standards of practice.

4. Recommend training, policies and procedures for quality improvement.

5. Annually, and as requested prepare and submit a written QI Plan, to the specifications of the LA County EMSA, consistent with Ref. No. 620.

Nasal Narcan

NASAL NALOXONE (NARCAN) PROGRAM
CONSULTANT shall perform the following services in connection with the Nasal Naloxone (Narcan) Program:

Items 1-6 are further detailed in the VITAL-A004 Policy in Attachment 1 to this Exhibit. -15-
80785-0001 2423482’ 3 doc
Docusign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A

1. Medical Director oversight for Nasal Naloxone (Narcan) administration

2. Executed Standing Order for Medication Administration

3. Nasal Naloxone (Narcan) Education

4. Nasal Naloxone (Narcan) Training -The use of Naloxone via a nasal injector is relatively simple and generally not dangerous or difficult. CONSULTANT shall create a comprehensive curriculum in accordance with the manufacturer’s suggested training recommendation, for a 1-2-hour training course to be required for all officers who will deploy with Naloxone kits. The course will include the following:

Course of instruction
Demonstrations
Brief competency skills and demonstrative examination

5. Nasal Naloxone (Narcan) Program Oversight and Implementation.

6. Nasal Naloxone (Narcan) Customized Policy Implementation

7. Mandatory reporting of usage to EMS Agency

8. QA-QI reporting quarterly to EMS Agency

STAFFING
CONSULTANT shall serve as CITY’s Program Coordinator, as referenced in VITAL-A004 Policy.

The Program Coordinator will designate and be responsible for reporting requirements. The Program Coordinator will be available to all CITY agents on an on-call basis (24) hours per day, seven (7) days per week.
-16-
B0785-0001\24234$2v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A

EXHIBIT B

SCHEDULE OF PAYMENT AND RATES
ORIGINAL AGREEMENT:

CITY shall pay CONSULTANT an amount not to exceed One Hundred Eighty-Five Thousand Nine Hundred Forty Dollars ($185,940) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Thirteen Thousand Eight Hundred Twenty-Two Dollars ($13,822.00) per year at the following rates:

Flat Monthly Medical Services Fee - $15,495, which shall include:
• Up to 28 Medical Clearances per month with no roll-over • Up to 10 Blood Draws per month with no toll-over
• Per 2018 policy, forced or warrant blood draws count as one blood draw and one medical clearance as the patient must be cleared for this procedure Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 51 1.00
Blood Draw $ 174.00
DUI Check Point (OTS Reimbursement per detail) $ 400.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,028.00
Reasonable Suspicion Drug and Alcohol Testing $ 408.00
Testimony Maximum Hourly Rate $ 124.00
Stand-by Time Maximum Hourly Rate $ 124.00
Cancellations $ 240.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
• $20,000 per year which includes Medical Director Oversight for Police/Fire Communications
• Annual Narcan Administration Fee $7,438.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Agreement Extensions -Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of -17-
30785-000 02423482v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar. The current CPI amount is 3.3 percent.

Cancellations:

A $240.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Twenty-Seven Thousand Two Hundred Dollars ($227,200)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY’s accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt ofthe same.

AMENDMENT NO. 1:

All rates are increased by 3% from the 19/20 rates (including the medical services fee, contingency, and medical director oversight and Narcan administration fees) to cover cost of living increases.

CITY shall pay CONSULTANT an amount not to exceed One Hundred Ninety-One Thousand Five Hundred Twenty Dollars ($191,520.00) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Fourteen Thousand Two Hundred Thirty-Seven Dollars ($14,237.00) per year at the following rates:

Flat Monthly Medical Services Fee - $15,960, which shall include:
• Up to 28 Medical Clearances per month with no roll-over • Up to 10 Blood Draws per month with no roll-over
Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 526.00
Blood Draw $ 179.00
DUI Check Point (OTS Reimbursement per detail) $ 412.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,059.00
In-field, forced or warrant blood withdrawal (without
Medical Clearance) $ 590.00
In-field, forced or warrant blood withdrawal (with
Medical Clearance) $ 705.00
Medical Transportation Service (5150) $ 995.00
Reasonable Suspicion Drug and Alcohol Testing $ 420.00
B07$5-000l\2423482v3 doc
-1$-
Docusign Envelope ID: 6C3DECBA-59C7427B-8EFO-69DDOO613B4A Testimony Maximum Hourly Rate $ 128.00
Stand-by Time Maximum Hourly Rate $ 128.00
Cancellations $ 247.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
• $20,600.00 per year which includes Medical Director Oversight for Police/Fire Communications
• Annual Narcan Administration Fee $7,661.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Medication:

CITY will reimburse CONSULTANT for prescription and over-the-counter medications purchased to have on hand at the Jail Facility.

Medical Transportation Services:

If requested by CITY’s Chief of Police or his designee, CONSULTANT shall provide medical transport services (‘Medical Transport Services”) in connection with persons who are taken into custody pursuant to Welfare and Institution Code section 5150, mental health evaluation (“Medical Transport Service(s)”). The fee for each medical transport to a local medical facility where the distance to such facility is ten (10) miles or less is Nine Hundred Ninety-Five and 00/1 00 Dollars ($995.00). Medical Transport Service to a local medical facility where the distance is greater than ten (10) miles will be billed at Ten and 00/1 00 Dollars ($10.00) each mile past the first ten (10) miles travelled (“Medical Transport Services Additional Miles”). Upon arrival at the medical facility, the first thirty (30) minutes at the facility is included in the standard fee. If the wait time exceeds thirty (30) minutes, it will be billed at Seventy-Five Dollars and 00/100 Dollars ($75.00) per each fifteen (15) minutes (“Medical Transport Services Wait Time”).

Forced I Warrant I “McNeely Warrant Blood Draw” I In-field Blood Draw:

A forced blood draw, a warrant blood draw, a “McNeely Warrant Blood Draw” (“Evidentiary Warrant Blood Collection)”, or in-field blood draw (“Evidentiary In-Field Blood Collection)”, without a medical clearance, will be billed at a fee of Five Hundred Ninety and 00/1 00 Dollars ($590.00).

In-field blood draws denote when blood is drawn in the field (e.g. scene of an accident, at an address outside of the police department, etc.). If a medical clearance is requited (“Evidentiary Warrant Blood Collection with Medical Clearance” or “Evidentiary In-Field Blood Collection with Medical Clearance”), the procedure will be billed at a fee of Seven Hundred Five and 00/1 00 Dollars ($705.00).

Agreement Extensions -Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor -19-
D0785-000l\24234$2v3 doc
DocuSign Envelope ID: 6C3DECBA-59C7-427B-8EFO-69DD0061 3B4A Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar. The current CPI amount is 3.3 percent.

Cancellations:

A $247.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Thirty-Four Thousand and Eighteen Dollars ($234,018)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY’s accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same. -20-
50785-000 I\2423482v3 doc
Docu.’i
Certificate Of Comp’etion
Envelope Id: 6C3DECBA59C7427B8EF069DD0061 3B4A Status: Completed Subject: Please DocuSign: CLEAN Amendment No. 1 - Vital Medical Services LLC (2020) (Ready for Docusign)pdf Source Envelope:

Document Pages: 20 Signatures: 6 Envelope Originator:

Certificate Pages: 2 Initials: 0 Maria Lara
AutoNav: Enabled 455 N. Rexford Drive
Envelopeld Stamping: Enabled Beverly Hills, CA 90210
Time Zone: (UTC-08:00) Pacific Time (US & Canada) [email protected] P Address: 198,245.188.143
Record Tracking
Status: Original Holder: Maria Lara Location: DocuSign
719/2020 9:00:54 AM mlarabeverlyhilIs.org
Signer Events Signature Timestamp
Alex G. Ghazalpour Sent: 7/9/2020 9:11:59 AM
[email protected] ‘‘- Viewed: 7/9/2020 9:19:54 AM Security Level: Email, Account Authentication Signed: 7/9/2020 9:25:35 AM (None)
Signature Adoption: Drawn on Device
Using IP Address: 76.170.182.208
Signed using mobile
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
ARMEN VARTANIAN Sent: 7/9/2020 9:11:59AM
[email protected] Viewed: 7/9/2020 10:36:27 AM Security Level: Email, Account Authentication Signed: 7/9/2020 11:12:03 AM (None) Signature Adoption: Pre-selected Style
Using IP Address: 174.81.12.191
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Dominick Rivetti Sent: 7/9/202 0 11:12:04 AM
[email protected] Resent: 7/13/2020 10:03:32 AM Security Level: Email, Account Authentication Resent: 7/14/2020 3:56:54 PM (None) Viewed: 7/14/2020 4:19:47 PM Signature Adoption: Pre-selected Style Signed: 7/14/2020 4:20:03 PM Using IP Address: 198.245.188.143 Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Deborah Hakman Sent: 7/14/2020 4:20:05 PM
[email protected] Viewed: 7/14/2020 9:05:27 PM
Security Level: Email, Account Authentication Signed: 7/14/2020 9:05:48 PM (None) Signature Adoption: Pre-selected Style
Using IP Address: 47.154.20.98
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Signer Events Signature Timestamp
Jeff Muir Sent’ 7/14/2020 4:20:05 PM
[email protected] Viewed: 7/14/2020 5:11:06 PM
Director of Finance Signed: 7/14/2020 5:13:00 PM
City of Beverly Hills
Signature Adoption: Pre-selected Style Security Level: Email, Account Authentication (None) Using IP Address: 198245.188139
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Sharon L’Heureux Dressel Sent: 7/14/2020 4:20:05 PM
[email protected] L Resent: 7/15/2020 11:15:19 AM Sharon Dressel Resent: 7/16(2020 11:23:04 AM
Security Level: Email, Account Authentication Viewed: 7/16/2020 11:41:15 AM (None) Signature Adoption: Pre-selected Style Signed: 7/16/2020 11:42:04AM Using P Address: 198.245.188.139 Electronic Record and Signature Disclosure:

Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 7/16/2020 11:23:04 AM
Certified Delivered Security Checked 7/16/2020 11:41:15 AM Signing Complete Security Checked 7/16/2020 11:42:04 AM Completed Security Checked 7/16/2020 11:42:04 AM
Payment Events Status Timestamps
Attachment 3
-1-
B0785-0001\2535366v5.doc
AMENDMENT NO. 2 TO AN AGREEMENT BETWEEN THE CITY OF

BEVERLY HILLS AND VITAL MEDICAL SERVICES, LLC TO PROVIDE

MEDICAL SERVICES IN THE CITY'S JAIL, MEDICAL DIRECTIVE

OVERSIGHT AND NARCAN ADMINISTRATION
NAME OF CONSULTANT: Vital Medical Services, LLC

RESPONSIBLE

PRINCIPAL OF
CONSULTANT:

Alex G. Ghazalpour, Chief Operating Officer

CONSULTANT'S
ADDRESS:
700 North Brand Boulevard, Suite 220
Glendale, CA 91203
Attention: Alex G. Ghazalpour, Chief Operating Officer
CONSULTANT’S
E.I.N/TAX I.D. NO.:

CITY'S ADDRESS:
46-1055770
City of Beverly Hills
455 N. Rexford Drive
Beverly Hills, CA 90210
Attention: Dominick Rivetti, Chief of Police

COMMENCEMENT
DATE:

July 1, 2019
TERMINATION DATE: June 30, 2020, unless extended pursuant to Section 2 of the Agreement (original termination date)
June 30, 2021, unless extended pursuant to Section 2 of the Agreement (as extended pursuant to Amendment No. 1)
June 30, 2022 (as extended pursuant to Section 2 by letter dated April 19, 2021)
CONSIDERATION: Original Agreement:

Medical Services Fee Not to Exceed $185,940 per year ($15,495 per month)
Contingency for additional work not to exceed $13,822 per year Medical Director Oversight and Narcan
Administration Annual Fees $27,438 per year
Total not to exceed $227,200.00 per year
DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F 294-21
-2-
B0785-0001\2535366v5.doc
Amendment No. 1: Additional $6,818.00 for fiscal year 2020- 2021, Medical Services Fee Not to Exceed $191,520 per year ($15,960 per month) including a contingency for additional work not to exceed $14,237 per year
Medical Director Oversight and Narcan Administration Annual Fees $28,261 per year
Total Not to exceed amount of $234,018.00 for fiscal year 2020- 2021, as more particularly described in Exhibit B
Amendment No. 2: Additional $11,473.00 for fiscal year 2021- 2022, Medical Services Fee Not to Exceed $197,268 per year ($16,439.00 per month) including a contingency for additional work not to exceed $14,664.00 per year
Medical Director Oversight and Narcan Administration Annual Fees $29,109.00 per year
Annual Detention Medical Supply Fees $4,450.00
Total Not to exceed amount of $245,491.00 for fiscal year 2021- 2022, as more particularly described in Exhibit B

CHANGE ORDER AGREEMENT
Pursuant to Beverly Hills Municipal Code Section 3-3-110B, the Contracting Officer may approve a change order that does not exceed his/her purchasing authority
DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F -3-
B0785-0001\2535366v5.doc
AMENDMENT NO. 2 TO AN AGREEMENT BETWEEN THE CITY OF

BEVERLY HILLS AND VITAL MEDICAL SERVICES, LLC TO PROVIDE

MEDICAL SERVICES IN THE CITY'S JAIL, MEDICAL DIRECTIVE

OVERSIGHT AND NARCAN ADMINISTRATION
This Amendment No. 2 is to that certain Agreement between the City of Beverly Hills (hereinafter called "CITY"), and Vital Medical Services, LLC (hereinafter called "CONSULTANT”) dated September 17, 2019 and identified as Contract No. 528-19, as amended by Amendment No. 1 dated July 21, 2020 and identified as Contract No. 377-20 (collectively, the “Agreement”).

RECITALS
A. CITY entered into a written agreement with CONSULTANT to provide medical services in the CITY's jail, medical directive oversight and Narcan administration, which was previously amended.

B. CITY extended the Termination Date to June 30, 2022 pursuant to Section 2 of the Agreement by letter dated April 19, 2021.

C. CITY and CONSULTANT desire to further amend the Agreement to increase the Consideration for fiscal year 2021-22 for a cost of living increase.

NOW, THEREFORE, the parties agree as follows:

Section 1. The CONSIDERATION shall be amended as set forth on the cover page.

Section 2. Exhibit B “Schedule of Payment and Rates” shall be amended as attached hereto and incorporated herein.

Section 3, Except as specifically amended by the Recitals, and sections 1, 3 and 4 of Amendment No. 1 and this Amendment No. 2, the remaining provisions of the Agreement shall remain in full force and effect.

DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F -4-
B0785-0001\2535366v5.doc
EXECUTED this _____ day of ___________________, 2021, at Beverly Hills, California.

CITY OF BEVERLY HILLS
A Municipal Corporation

JEFF MUIR
Director of Finance
CONSULTANT: VITAL MEDICAL

SERVICES, LLC

ARMEN VARTANIAN
President
ALEX G. GHAZALPOUR
Chief Operating Officer
APPROVED AS TO FORM: APPROVED AS TO CONTENT:

LAURENCE S. WIENER DOMINICK RIVETTI
City Attorney Chief of Police
SHARON L’HEUREUX DRESSEL
Risk Manager
DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F 21st July
-5-
B0785-0001\2535366v5.doc

EXHIBIT B

SCHEDULE OF PAYMENT AND RATES
ORIGINAL AGREEMENT:

July 1, 2019-June 30, 2020
CITY shall pay CONSULTANT an amount not to exceed One Hundred Eighty-Five Thousand Nine Hundred Forty Dollars ($185,940) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Thirteen Thousand Eight Hundred Twenty-Two Dollars ($13,822.00) per year at the following rates:

Flat Monthly Medical Services Fee - $15,495, which shall include:
 Up to 28 Medical Clearances per month with no roll-over  Up to 10 Blood Draws per month with no roll-over
 Per 2018 policy, forced or warrant blood draws count as one blood draw and one medical clearance as the patient must be cleared for this procedure Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 511.00
Blood Draw $ 174.00
DUI Check Point (OTS Reimbursement per detail) $ 400.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,028.00
Reasonable Suspicion Drug and Alcohol Testing $ 408.00
Testimony Maximum Hourly Rate $ 124.00
Stand-by Time Maximum Hourly Rate $.................124.00 Cancellations $ 240.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
 $20,000 per year which includes Medical Director Oversight for Police/Fire Communications
 Annual Narcan Administration Fee $7,438.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Agreement Extensions - Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F -6-
B0785-0001\2535366v5.doc
for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar. The current CPI amount is 3.3 percent.

Cancellations:

A $240.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Twenty-Seven Thousand Two Hundred Dollars ($227,200)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY's accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same.

AMENDMENT NO. 1:

July 1, 2020-June 30, 2021
All rates are increased by 3% from the 2019/20 rates (including the medical services fee, contingency, and medical director oversight and Narcan administration fees) to cover cost of living increases.

CITY shall pay CONSULTANT an amount not to exceed One Hundred Ninety-One Thousand Five Hundred Twenty Dollars ($191,520.00) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Fourteen Thousand Two Hundred Thirty-Seven Dollars ($14,237.00) per year at the following rates:

Flat Monthly Medical Services Fee - $15,960, which shall include:
 Up to 28 Medical Clearances per month with no roll-over  Up to 10 Blood Draws per month with no roll-over
Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 526.00
Blood Draw $ 179.00
DUI Check Point (OTS Reimbursement per detail) $ 412.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,059.00
In-field, forced or warrant blood withdrawal (without
Medical Clearance) $ 590.00
In-field, forced or warrant blood withdrawal (with
Medical Clearance) $ 705.00
DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F -7-
B0785-0001\2535366v5.doc
Medical Transportation Service (5150) $ 995.00
Reasonable Suspicion Drug and Alcohol Testing $ 420.00
Testimony Maximum Hourly Rate $ 128.00
Stand-by Time Maximum Hourly Rate $ 128.00
Cancellations $ 247.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
 $20,600.00 per year which includes Medical Director Oversight for Police/Fire Communications
 Annual Narcan Administration Fee $7,661.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Medication:

CITY will reimburse CONSULTANT for prescription and over-the-counter medications purchased to have on hand at the Jail Facility.

Medical Transportation Services:

If requested by CITY’s Chief of Police or his designee, CONSULTANT shall provide medical transport services (“Medical Transport Services”) in connection with persons who are taken into custody pursuant to Welfare and Institution Code section 5150, mental health evaluation (“Medical Transport Service(s)”). The fee for each medical transport to a local medical facility where the distance to such facility is ten (10) miles or less is Nine Hundred Ninety-Five and 00/100 Dollars ($995.00). Medical Transport Service to a local medical facility where the distance is greater than ten (10) miles will be billed at Ten and 00/100 Dollars ($10.00) each mile past the first ten (10) miles travelled (“Medical Transport Services Additional Miles”). Upon arrival at the medical facility, the first thirty (30) minutes at the facility is included in the standard fee. If the wait time exceeds thirty (30) minutes, it will be billed at Seventy-Five Dollars and 00/100 Dollars ($75.00) per each fifteen (15) minutes (“Medical Transport Services Wait Time”).

Forced / Warrant / “McNeely Warrant Blood Draw” / In-field Blood Draw:

A forced blood draw, a warrant blood draw, a “McNeely Warrant Blood Draw” (“Evidentiary Warrant Blood Collection)”, or in-field blood draw (“Evidentiary In-Field Blood Collection)”, without a medical clearance, will be billed at a fee of Five Hundred Ninety and 00/100 Dollars ($590.00).

In-field blood draws denote when blood is drawn in the field (e.g. scene of an accident, at an address outside of the police department, etc.). If a medical clearance is required (“Evidentiary Warrant Blood Collection with Medical Clearance” or “Evidentiary In-Field Blood Collection with Medical Clearance”), the procedure will be billed at a fee of Seven Hundred Five and 00/100 Dollars ($705.00).

Agreement Extensions - Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F -8-
B0785-0001\2535366v5.doc
previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar. The current CPI amount is 3.3 percent.

Cancellations:

A $247.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Thirty-Four Thousand and Eighteen Dollars ($234,018)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY's accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same.

AMENDMENT NO. 2:

July 1, 2021-June 30, 2022
All rates are increased by 3% from the 2020/21 rates (including the medical services fee, contingency, and medical director oversight and Narcan administration fees) to cover cost of living increases.

CITY shall pay CONSULTANT an amount not to exceed Two Hundred Thirty Thousand Eight Hundred Twenty-Seven Dollars ($230,827.00) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Fourteen Thousand Six Hundred Sixty-Four Dollars ($14,664.00) per year at the following rates:

Flat Monthly Medical Services Fee - $16,439, which shall include:
 Up to 28 Medical Clearances per month with no roll-over  Up to 10 Blood Draws per month with no roll-over
Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 542.00
Blood Draw $ 184.00
DUI Check Point (OTS Reimbursement per detail) $ 424.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,091.00
In-field, forced or warrant blood withdrawal (without
Medical Clearance) $ 608.00
In-field, forced or warrant blood withdrawal (with
Medical Clearance) $ 726.00
DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F -9-
B0785-0001\2535366v5.doc
Medical Transportation Service (5150) $ 495.00
Reasonable Suspicion Drug and Alcohol Testing $ 433.00
Testimony Maximum Hourly Rate $ 132.00
Stand-by Time Maximum Hourly Rate $ 132.00
Cancellations $ 254.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
 $21,218.00 per year which includes Medical Director Oversight for Police/Fire Communications
 Annual Narcan Administration Fee $7,891.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Medication:

CITY will reimburse CONSULTANT for prescription and over-the-counter medications purchased to have on hand at the Jail Facility.

Annual Detention Medical Supplies Fee of $4,450.00 related to the oversight of suicide prevention kits, first aid supplies, over-the-counter medications and airway management supplies at the jail.

Medical Transportation Services:

If requested by CITY’s Chief of Police or his designee, CONSULTANT shall provide medical transport services (“Medical Transport Services”) in connection with persons who are taken into custody pursuant to Welfare and Institution Code section 5150, mental health evaluation (“Medical Transport Service(s)”). The fee for each medical transport to a local medical facility where the distance to such facility is ten (10) miles or less is Four Hundred Ninety-Five and 00/100 Dollars ($495.00). Medical Transport Service to a local medical facility where the distance is greater than ten (10) miles will be billed at Ten and 00/100 Dollars ($10.00) each mile past the first ten (10) miles travelled (“Medical Transport Services Additional Miles”). Upon arrival at the medical facility, the first thirty (30) minutes at the facility is included in the standard fee. If the wait time exceeds thirty (30) minutes, it will be billed at Seventy-Five Dollars and 00/100 Dollars ($75.00) per each fifteen (15) minutes (“Medical Transport Services Wait Time”).

Forced / Warrant / “McNeely Warrant Blood Draw” / In-field Blood Draw:

A forced blood draw, a warrant blood draw, a “McNeely Warrant Blood Draw” (“Evidentiary Warrant Blood Collection)”, or in-field blood draw (“Evidentiary In-Field Blood Collection)”, without a medical clearance, will be billed at a fee of Six Hundred Eight and 00/100 Dollars ($608.00). Infield blood draws denote when blood is drawn in the field (e.g. scene of an accident, at an address outside of the police department, etc.). If a medical clearance is required (“Evidentiary Warrant Blood Collection with Medical Clearance” or “Evidentiary In-Field Blood Collection with Medical Clearance”), the procedure will be billed at a fee of Seven Hundred Twenty-Six and 00/100 Dollars ($726.00).

DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F -10-
B0785-0001\2535366v5.doc
Agreement Extensions - Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY beyond Fiscal Year 2021-22, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar.

The current CPI amount is 3.3 percent.

Cancellations:

A $254.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Forty-Five Thousand Four Hundred Ninety-One Dollars ($245,491)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY's accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same.

DocuSign Envelope ID: E759801A-C950-4FA8-A092-59A6BD44AF9F Certificate Of Completion
Envelope Id: E759801AC9504FA8A09259A6BD44AF9F Status: Completed Subject: Please DocuSign: FINAL Amendment No. 2 - Vital Medical Services LLC.pdf Source Envelope:

Document Pages: 10 Signatures: 6 Envelope Originator:

Certificate Pages: 2 Initials: 0 Maria Lara
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
455 N. Rexford Drive
Beverly Hills, CA 90210
[email protected]
IP Address: 198.245.189.168
Record Tracking
Status: Original
7/16/2021 2:30:08 PM
Holder: Maria Lara
[email protected]
Location: DocuSign
Signer Events Signature Timestamp

ARMEN VARTANIAN
[email protected]
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 96.40.156.146
Signed using mobile
Sent: 7/16/2021 2:46:01 PM
Viewed: 7/16/2021 6:03:43 PM
Signed: 7/16/2021 6:06:25 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Alex G. Ghazalpour
[email protected]
Security Level: Email, Account Authentication
(None)
Signature Adoption: Drawn on Device
Using IP Address: 107.77.230.112
Signed using mobile
Sent: 7/16/2021 6:06:26 PM
Viewed: 7/16/2021 6:20:02 PM
Signed: 7/16/2021 6:20:27 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Dominick Rivetti
[email protected]
Chief of Police
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre-selected Style
Using IP Address: 108.185.236.143
Sent: 7/16/2021 6:20:28 PM
Viewed: 7/18/2021 6:29:20 AM
Signed: 7/18/2021 6:30:27 AM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Sharon L'Heureux Dressel
[email protected]
Risk Manager
Sharon Dressel
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 98.184.236.251
Signed using mobile
Sent: 7/18/2021 6:30:28 AM
Viewed: 7/18/2021 9:31:08 AM
Signed: 7/18/2021 9:35:12 AM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Signer Events Signature Timestamp
Deborah Hakman for
[email protected]
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 47.154.19.233
Signed using mobile
Sent: 7/18/2021 9:35:14 AM
Viewed: 7/18/2021 10:31:00 AM
Signed: 7/18/2021 10:31:17 AM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Jeff Muir
[email protected]
Director of Finance
City of Beverly Hills
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 47.6.122.53
Signed using mobile
Sent: 7/18/2021 10:31:18 AM
Viewed: 7/18/2021 8:34:53 PM
Signed: 7/18/2021 8:35:07 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 7/16/2021 2:46:01 PM
Certified Delivered Security Checked 7/18/2021 8:34:53 PM Signing Complete Security Checked 7/18/2021 8:35:07 PM
Completed Security Checked 7/18/2021 8:35:07 PM
Payment Events Status Timestamps
Attachment 4
-1-
B0785-0001\2614353v4.doc
AMENDMENT NO. 3 TO AN AGREEMENT BETWEEN THE CITY OF

BEVERLY HILLS AND VITAL MEDICAL SERVICES, LLC TO PROVIDE

MEDICAL SERVICES IN THE CITY'S JAIL, MEDICAL DIRECTIVE

OVERSIGHT AND NARCAN ADMINISTRATION
NAME OF CONSULTANT: Vital Medical Services, LLC

RESPONSIBLE

PRINCIPAL OF
CONSULTANT:

Alex G. Ghazalpour, Chief Operating Officer

CONSULTANT'S
ADDRESS:
700 North Brand Boulevard, Suite 220
Glendale, CA 91203
Attention: Alex G. Ghazalpour, Chief Operating Officer
CONSULTANT’S
E.I.N/TAX I.D. NO.:

CITY'S ADDRESS:
46-1055770
City of Beverly Hills
455 N. Rexford Drive
Beverly Hills, CA 90210
Attention: Mark Stainbrook, Chief of Police

COMMENCEMENT
DATE:

July 1, 2019
TERMINATION DATE: June 30, 2020, unless extended pursuant to Section 2 of the Agreement (original termination date)
June 30, 2021, unless extended pursuant to Section 2 of the Agreement (as extended pursuant to Amendment No. 1)
June 30, 2022 (as extended pursuant to Section 2 by letter dated April 19, 2021)
CONSIDERATION: Original Agreement:

Medical Services Fee Not to Exceed $185,940 per year ($15,495 per month)
Contingency for additional work not to exceed $13,822 per year Medical Director Oversight and Narcan
Administration Annual Fees $27,438 per year
Total not to exceed $227,200.00 per year
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 135-22
-2-
B0785-0001\2614353v4.doc
Amendment No. 1: Additional $6,818.00 for fiscal year 2020- 2021, Medical Services Fee Not to Exceed $191,520 per year ($15,960 per month) including a contingency for additional work not to exceed $14,237 per year
Medical Director Oversight and Narcan Administration Annual Fees $28,261 per year
Total Not to exceed amount of $234,018.00 for fiscal year 2020- 2021, as more particularly described in Exhibit B
Amendment No. 2: Additional $11,473.00 for fiscal year 2021- 2022, Medical Services Fee Not to Exceed $197,268 per year ($16,439.00 per month) including a contingency for additional work not to exceed $14,664.00 per year
Medical Director Oversight and Narcan Administration Annual Fees $29,109.00 per year
Annual Detention Medical Supply Fees $4,450.00
Total Not to exceed amount of $245,491.00 for fiscal year 2021- 2022, as more particularly described in Exhibit B
Amendment No. 3: Additional $60,000.00 for fiscal year 2021- 2022, Medical Services Fee Not to Exceed $197,268 per year ($16,439.00 per month) including a contingency for additional work not to exceed $74,664.00 per year
Medical Director Oversight and Narcan Administration Annual Fees $29,109.00 per year
Annual Detention Medical Supply Fees $4,450.00
Total Not to exceed amount of $305,491.00 for fiscal year 2021- 2022, as more particularly described in Exhibit B

CHANGE ORDER AGREEMENT
Pursuant to Beverly Hills Municipal Code Section 3-3-110B, the Contracting Officer may approve a change order that does not exceed his/her purchasing authority
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -3-
B0785-0001\2614353v4.doc
AMENDMENT NO. 3 TO AN AGREEMENT BETWEEN THE CITY OF

BEVERLY HILLS AND VITAL MEDICAL SERVICES, LLC TO PROVIDE

MEDICAL SERVICES IN THE CITY'S JAIL, MEDICAL DIRECTIVE

OVERSIGHT AND NARCAN ADMINISTRATION
This Amendment No. 3 is to that certain Agreement between the City of Beverly Hills (hereinafter called "CITY"), and Vital Medical Services, LLC (hereinafter called "CONSULTANT”) dated September 17, 2019 and identified as Contract No. 528-19, as amended by Amendment No. 1 dated July 21, 2020 and identified as Contract No. 377-20, as amended by Amendment No. 2 dated July 21, 2021 and identified as Contract No. 294-21 (collectively, the “Agreement”).

RECITALS
A. CITY entered into a written agreement with CONSULTANT to provide medical services in CITY's jail, medical directive oversight and Narcan administration, which was previously amended.

B. CITY extended the Termination Date to June 30, 2022 pursuant to Section 2 of the Agreement by letter dated April 19, 2021.

C. CITY and CONSULTANT desire to further amend the Agreement to increase the Consideration for Fiscal Year 2021-22 due to a greater than anticipated need for services due to the COVID-19 pandemic and Narcan training, add an infectious disease provision and include COVID-19 vaccination or testing, and record keeping requirements.

NOW, THEREFORE, the parties agree as follows:

Section 1. The CONSIDERATION shall be amended as set forth on the cover page.

Section 2. Section 27 of the Agreement, “CITY COVID-19 Vaccination Requirement” shall be added as set forth below:

DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -4-
B0785-0001\2614353v4.doc
“Section 27. CITY COVID-19 Vaccination or Testing, and Record Keeping Requirements.

CONSULTANT and its employees, personnel, agents, subconsultants, volunteers and subcontractors or any other individual under the control of CONSULTANT who work with and among CITY employees or the public at CITY worksites and facilities in the performance of their duties under the Agreement (collectively “Covered Employees” ) shall comply with CITY’s COVID19 vaccination or testing, and record keeping requirements in connection with the services provided to CITY under the Agreement and as more particularly described in the attached “Acknowledgement of CITY’s Vaccination Requirements Against The COVID-19 Virus”, Attachment 2 to Exhibit A. CONSULTANT shall execute Attachment 2 to Exhibit A attesting that only Covered Employees who are fully vaccinated or with proof of weekly negative COVID-19 PCR or antigen tests will be assigned to work at CITY worksites and/or facilities at all times during the term of the Agreement.”
Section 3. CONSULTANT shall execute the “ACKNOWLEDGEMENT OF CITY VACCINATION AND RECORD KEEPING REQUIREMENTS AGAINST THE COVID-19 VIRUS”, attached hereto and incorporated herein as Attachment 2 to Exhibit A, “Scope of Work” Section 4. The following provisions entitled, “Infectious Disease” and “COVID-19 Vaccination And Record Keeping Requirements” shall be added to Exhibit A, “Scope of Work” as set forth below and incorporated herein.
“EXHIBIT A

SCOPE OF WORK
. . .

INFECTIOUS DISEASE
A. The federal government and State of California, the County of Los Angeles, and CITY have declared an emergency due to a global pandemic caused by an infectious coronavirus which causes a disease referred to as COVID-19. In an effort to support and maintain a safe and healthy workplace for CITY employees and the community, CITY is requiring all contractors and CONSULTANT to immediately monitor and track the signs and symptoms of COVID-19, the common cold and influenza for all of its employees and subcontractors (collectively “CONSULTANT employees”) assigned to CITY projects that come onsite to any CITY facility to perform services under the Agreement.

B. CONSULTANT shall notify CITY immediately in writing if CONSULTANT or CONSULTANT employees have come in contact with anyone with an infectious disease or has contracted an infectious disease. Such CONSULTANT employees shall immediately cease performing services under the Agreement.

DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -5-
B0785-0001\2614353v4.doc
C. CONSULTANT shall monitor CONSULTANT employees’ signs and symptoms with written logs. CONSULTANT shall maintain a daily recording of the following:

1. Require CONSULTANT employees to take their temperature each time they enter and exit CITY facilities (both before and after work is performed at CITY facilities).

2. If CONSULTANT employees have a fever (100°F or higher), are coughing, have trouble breathing or other symptoms of COVID-19, the common cold, or influenza:
(a) Do not have CONSULTANT employees report to work.
(b) Contact your CITY Responsible Principal.
(c) Direct CONSULTANT employees to:
i. Not go out in public.
ii. Avoid contact with others.
iii. Not travel while sick.
iv. Cover mouth and nose with a tissue or sleeve (not hands), while coughing or sneezing.
v. Wash hands often with soap and water for at least 20 seconds to avoid spreading illnesses such as the common cold, influenza or COVID-19 to others. vi. If soap and water are not readily available, use an alcohol-based hand sanitizer, which contains 60%-95% alcohol or solutions available for use at the facility. vii. Wear face coverings at all times unless alone in a vehicle, personal office or cubical,

3. CONSULTANT shall disinfect all areas that CONSULTANT’s employees come in contact with while performing services under the Agreement before and after usage.

4. CONSULTANT employees shall not return to any CITY facility until they meet the guidance* of the Los Angeles County Department of Public Health. * CONSULTANT acknowledges it has reviewed, understands and will follow the Los Angeles County Department of Public Health guidance for managers.

D. CONSULTANT shall also maintain daily monitoring and record keeping in connection with CITY projects where CONSULTANT employees come on site for the following information:

1. Projects are adhering to Social Distancing and Industry Safety Standards for employees and the public. Please review Los Angeles County Department of Public Health guidelines for social distancing.

2. CONSULTANT employees are not working while sick.

3. CONSULTANT shall notify their CITY Project Manager or CITY Responsible Principal prior to reporting on site daily.

4. CONSULTANT shall contact their CITY Project Manager or CITY Responsible Principal to reschedule non-essential services.

E. CONSULTANT shall provide employees with handwashing and sanitizing equipment.

DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -6-
B0785-0001\2614353v4.doc
These requirements apply to all vendors and their employees regardless of whether they are fully vaccinated or not.

CONSULTANT shall be required to know and adhere to Los Angeles County Public Health Order http://publichealth.lacounty.gov/media/Coronavirus/reopening-la.htm#orders.

For the latest CITY updates and COVID-19 related FAQs please visit http://www.beverlyhills.org/novelcoronavirus
CITY reserves the right to review CONSULTANT’s daily logs to ensure compliance with this Agreement. CITY has the right to send CONSULTANT employees home who do not comply with these requirements. CONSULTANT shall maintain the recordings and logs in accordance with the Agreement.

For questions, please contact CITY’s Responsible Principal or Risk Management at 310- 285-1073.

COVID-19 VACCINATION AND RECORD KEEPING REQUIREMENTS
CONSULTANT shall execute the attached “ACKNOWLEDGEMENT OF CITY VACCINATION AND RECORD KEEPING REQUIREMENTS AGAINST THE COVID-19 VIRUS”, Attachment 2 to this Exhibit A.”
Section 5. Exhibit B, “Schedule of Payment and Rates” shall be amended as attached hereto and incorporated herein.

Section 6, Except as specifically amended by the Recitals, sections 1, 3 and 4 of Amendment No. 1, Amendment No. 2 and this Amendment nt No. 3, the remaining provisions of the Agreement shall remain in full force and effect.

EXECUTED this _____ day of ___________________, 2022, at Beverly Hills, California.

CITY OF BEVERLY HILLS
A Municipal Corporation

JEFF MUIR
Director of Finance
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 14th February
-7-
B0785-0001\2614353v4.doc
CONSULTANT: VITAL MEDICAL

SERVICES, LLC

ARMEN VARTANIAN
President
ALEX G. GHAZALPOUR
Chief Operating Officer
APPROVED AS TO FORM: APPROVED AS TO CONTENT:

LAURENCE S. WIENER MARK STAINBROOK
City Attorney Chief of Police
SHARON L’HEUREUX DRESSEL
Risk Manager
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -8-
B0785-0001\2614353v4.doc
ATTACHMENT 2 TO EXHIBIT A

ACKNOWLEDGEMENT OF CITY VACCINATION AND RECORD KEEPING
REQUIREMENTS AGAINST THE COVID-19 VIRUS

I, THE UNDERSIGNED, HEREBY ATTEST THAT I AM AN AUTHORIZED REPRESENTATIVE OF CONSULTANT.

I hereby acknowledge and agree to comply with any federal, state and/or local laws, regulations and orders including the CITY’s requirement that CONSULTANT and its employees, personnel, agents, subconsultants, volunteers, and subcontractors, or any other individuals under the control of the CONSULTANT, who work with and among CITY employees or the public at CITY worksites and facilities in the performance of their duties under the Agreement (collectively “Covered Employees”) shall be either fully vaccinated against the COVID-19 virus as defined in this Attachment or be administered weekly COVID-19 tests (PCR or antigen) as required in this Attachment.. Covered Employees shall include those with and without CITY badge access. Fully vaccinated shall be defined as two (2) weeks after the second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccine is administered to the Covered Employee or two weeks after the single dose of the Johnson and Johnson Janssen COVID-19 vaccine is administered to the Covered Employee, or as further defined by the Center for Disease Control and Prevention (“CDC”), State of California, County of Los Angeles, or City of Beverly Hills. Each Covered Employee shall provide proof (vaccine card, image of vaccine card showing vaccination status) to CONSULTANT that such Covered Employee is fully vaccinated as defined in this Attachment or, the Covered Employee shall provide proof of a negative COVID-19 test (PCR or antigen) to CONSULTANT as further described in this Attachment.

I, the undersigned hereby attest that only vaccinated individuals, or individuals with weekly negative COVID-19 tests (PCR or antigen), will be assigned to work at CITY worksites and/or facilities under the Agreement. Covered Employees may be required to show proof of their vaccination status or a weekly negative COVID-19 test (PCR or antigen) to a CITY representative prior to performing work under the Agreement or at any time while performing work under the Agreement. CONSULTANT shall be responsible for ensuring that all of its assigned Covered Employees are fully vaccinated, or, have a negative COVID-19 test (PCR or antigen) prior to performing work under the Agreement.

CONSULTANT shall maintain a log, certified by CONSULTANT, of vaccinated and tested Covered Employees for the term of the Agreement and shall provide such log to CITY upon request at any time.

I understand and acknowledge that CITY may, at a future time, determine that it cannot accommodate unvaccinated Covered Employees, and that it may not permit certain or all unvaccinated Covered Employees to perform work under the Agreement.

Failure to comply with these requirements shall be a default under the Agreement.

CONSULTANT is responsible for all costs associated with compliance with this Attachment.

I ALSO ACKNOWLEDGE THAT THESE REQUIREMENTS MAY CHANGE FROM TIME TO

TIME PURSUANT TO FUTURE FEDERAL, CALIFORNIA AND LOS ANGELES COUNTY

REQUIREMENTS AND AGREE TO COMPLY WITH ALL APPLICABLE STATUTES,

REGULATIONS, ORDERS, ORDINANCES AND POLICIES RELATING TO MITIGATING THE TRANSMISSION OF COVID-19.

DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -9-
B0785-0001\2614353v4.doc

I, THE UNDERSIGNED, HEREBY ACKNOWLEDGE THAT THE FOREGOING IS TRUE AND CORRECT UNDER PENALTY OF PERJURY.

VITAL MEDICAL SERVICES, LLC
By:____________________________________________________________ Name: Alex G. Ghazalpour
Title: Chief Operating Officer
Contract Nos. 528-19, 377-20, 294-21
Vendor # 7898
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -10-
B0785-0001\2614353v4.doc

EXHIBIT B

SCHEDULE OF PAYMENT AND RATES
ORIGINAL AGREEMENT:

July 1, 2019-June 30, 2020
CITY shall pay CONSULTANT an amount not to exceed One Hundred Eighty-Five Thousand Nine Hundred Forty Dollars ($185,940) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Thirteen Thousand Eight Hundred Twenty-Two Dollars ($13,822.00) per year at the following rates:

Flat Monthly Medical Services Fee - $15,495, which shall include:
 Up to 28 Medical Clearances per month with no roll-over  Up to 10 Blood Draws per month with no roll-over
 Per 2018 policy, forced or warrant blood draws count as one blood draw and one medical clearance as the patient must be cleared for this procedure Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 511.00
Blood Draw $ 174.00
DUI Check Point (OTS Reimbursement per detail) $ 400.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,028.00
Reasonable Suspicion Drug and Alcohol Testing $ 408.00
Testimony Maximum Hourly Rate $ 124.00
Stand-by Time Maximum Hourly Rate $.................124.00 Cancellations $ 240.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
 $20,000 per year which includes Medical Director Oversight for Police/Fire Communications
 Annual Narcan Administration Fee $7,438.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Agreement Extensions - Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -11-
B0785-0001\2614353v4.doc
for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar. The current CPI amount is 3.3 percent.

Cancellations:

A $240.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Twenty-Seven Thousand Two Hundred Dollars ($227,200)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY's accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same.

AMENDMENT NO. 1:

July 1, 2020-June 30, 2021
All rates are increased by 3% from the 2019/20 rates (including the medical services fee, contingency, and medical director oversight and Narcan administration fees) to cover cost of living increases.

CITY shall pay CONSULTANT an amount not to exceed One Hundred Ninety-One Thousand Five Hundred Twenty Dollars ($191,520.00) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Fourteen Thousand Two Hundred Thirty-Seven Dollars ($14,237.00) per year at the following rates:

Flat Monthly Medical Services Fee - $15,960, which shall include:
 Up to 28 Medical Clearances per month with no roll-over  Up to 10 Blood Draws per month with no roll-over
Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 526.00
Blood Draw $ 179.00
DUI Check Point (OTS Reimbursement per detail) $ 412.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,059.00
In-field, forced or warrant blood withdrawal (without
Medical Clearance) $ 590.00
In-field, forced or warrant blood withdrawal (with
Medical Clearance) $ 705.00
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -12-
B0785-0001\2614353v4.doc
Medical Transportation Service (5150) $ 995.00
Reasonable Suspicion Drug and Alcohol Testing $ 420.00
Testimony Maximum Hourly Rate $ 128.00
Stand-by Time Maximum Hourly Rate $ 128.00
Cancellations $ 247.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
 $20,600.00 per year which includes Medical Director Oversight for Police/Fire Communications
 Annual Narcan Administration Fee $7,661.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Medication:

CITY will reimburse CONSULTANT for prescription and over-the-counter medications purchased to have on hand at the Jail Facility.

Medical Transportation Services:

If requested by CITY’s Chief of Police or his designee, CONSULTANT shall provide medical transport services (“Medical Transport Services”) in connection with persons who are taken into custody pursuant to Welfare and Institution Code section 5150, mental health evaluation (“Medical Transport Service(s)”). The fee for each medical transport to a local medical facility where the distance to such facility is ten (10) miles or less is Nine Hundred Ninety-Five and 00/100 Dollars ($995.00). Medical Transport Service to a local medical facility where the distance is greater than ten (10) miles will be billed at Ten and 00/100 Dollars ($10.00) each mile past the first ten (10) miles travelled (“Medical Transport Services Additional Miles”). Upon arrival at the medical facility, the first thirty (30) minutes at the facility is included in the standard fee. If the wait time exceeds thirty (30) minutes, it will be billed at Seventy-Five Dollars and 00/100 Dollars ($75.00) per each fifteen (15) minutes (“Medical Transport Services Wait Time”).

Forced / Warrant / “McNeely Warrant Blood Draw” / In-field Blood Draw:

A forced blood draw, a warrant blood draw, a “McNeely Warrant Blood Draw” (“Evidentiary Warrant Blood Collection)”, or in-field blood draw (“Evidentiary In-Field Blood Collection)”, without a medical clearance, will be billed at a fee of Five Hundred Ninety and 00/100 Dollars ($590.00).

In-field blood draws denote when blood is drawn in the field (e.g. scene of an accident, at an address outside of the police department, etc.). If a medical clearance is required (“Evidentiary Warrant Blood Collection with Medical Clearance” or “Evidentiary In-Field Blood Collection with Medical Clearance”), the procedure will be billed at a fee of Seven Hundred Five and 00/100 Dollars ($705.00).

Agreement Extensions - Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -13-
B0785-0001\2614353v4.doc
previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar. The current CPI amount is 3.3 percent.

Cancellations:

A $247.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Thirty-Four Thousand and Eighteen Dollars ($234,018)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY's accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same.

AMENDMENT NO. 2:

July 1, 2021-June 30, 2022
All rates are increased by 3% from the 2020/21 rates (including the medical services fee, contingency, and medical director oversight and Narcan administration fees) to cover cost of living increases.

CITY shall pay CONSULTANT an amount not to exceed Two Hundred Thirty Thousand Eight Hundred Twenty-Seven Dollars ($230,827.00) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work set forth in Exhibit A not to exceed Fourteen Thousand Six Hundred Sixty-Four Dollars ($14,664.00) per year at the following rates:

Flat Monthly Medical Services Fee - $16,439, which shall include:
 Up to 28 Medical Clearances per month with no roll-over  Up to 10 Blood Draws per month with no roll-over
Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 542.00
Blood Draw $ 184.00
DUI Check Point (OTS Reimbursement per detail) $ 424.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,091.00
In-field, forced or warrant blood withdrawal (without
Medical Clearance) $ 608.00
In-field, forced or warrant blood withdrawal (with
Medical Clearance) $ 726.00
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -14-
B0785-0001\2614353v4.doc
Medical Transportation Service (5150) $ 495.00
Reasonable Suspicion Drug and Alcohol Testing $ 433.00
Testimony Maximum Hourly Rate $ 132.00
Stand-by Time Maximum Hourly Rate $ 132.00
Cancellations $ 254.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
 $21,218.00 per year which includes Medical Director Oversight for Police/Fire Communications
 Annual Narcan Administration Fee $7,891.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Medication:

CITY will reimburse CONSULTANT for prescription and over-the-counter medications purchased to have on hand at the Jail Facility.

Annual Detention Medical Supplies Fee of $4,450.00 related to the oversight of suicide prevention kits, first aid supplies, over-the-counter medications and airway management supplies at the jail.

Medical Transportation Services:

If requested by CITY’s Chief of Police or his designee, CONSULTANT shall provide medical transport services (“Medical Transport Services”) in connection with persons who are taken into custody pursuant to Welfare and Institution Code section 5150, mental health evaluation (“Medical Transport Service(s)”). The fee for each medical transport to a local medical facility where the distance to such facility is ten (10) miles or less is Four Hundred Ninety-Five and 00/100 Dollars ($495.00). Medical Transport Service to a local medical facility where the distance is greater than ten (10) miles will be billed at Ten and 00/100 Dollars ($10.00) each mile past the first ten (10) miles travelled (“Medical Transport Services Additional Miles”). Upon arrival at the medical facility, the first thirty (30) minutes at the facility is included in the standard fee. If the wait time exceeds thirty (30) minutes, it will be billed at Seventy-Five Dollars and 00/100 Dollars ($75.00) per each fifteen (15) minutes (“Medical Transport Services Wait Time”).

Forced / Warrant / “McNeely Warrant Blood Draw” / In-field Blood Draw:

A forced blood draw, a warrant blood draw, a “McNeely Warrant Blood Draw” (“Evidentiary Warrant Blood Collection)”, or in-field blood draw (“Evidentiary In-Field Blood Collection)”, without a medical clearance, will be billed at a fee of Six Hundred Eight and 00/100 Dollars ($608.00). Infield blood draws denote when blood is drawn in the field (e.g. scene of an accident, at an address outside of the police department, etc.). If a medical clearance is required (“Evidentiary Warrant Blood Collection with Medical Clearance” or “Evidentiary In-Field Blood Collection with Medical Clearance”), the procedure will be billed at a fee of Seven Hundred Twenty-Six and 00/100 Dollars ($726.00).

DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -15-
B0785-0001\2614353v4.doc
Agreement Extensions - Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY beyond Fiscal Year 2021-22, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar.

The current CPI amount is 3.3 percent.

Cancellations:

A $254.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled.

Total Not to Exceed Amount: Two Hundred Forty-Five Thousand Four Hundred Ninety-One Dollars ($245,491)
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY's accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same.

AMENDMENT NO. 3:

July 1, 2021-June 30, 2022
All rates are increased by 3% from the 2020/21 rates (including the medical services fee, contingency, and medical director oversight and Narcan administration fees) to cover cost of living increases.

CITY shall pay CONSULTANT an amount not to exceed Two Hundred Thirty Thousand Eight Hundred Twenty-Seven Dollars ($230,827.00) per year for the work described in Exhibit A and a contingency for unanticipated additional work outside the Scope of Work including Narcan Training and Narcan Kits set forth in Exhibit A not to exceed Seventy-Four Thousand Six Hundred Sixty-Four Dollars ($74,664.00) per year at the following rates:

Flat Monthly Medical Services Fee - $16,439, which shall include:
 Up to 28 Medical Clearances per month with no roll-over  Up to 10 Blood Draws per month with no roll-over
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -16-
B0785-0001\2614353v4.doc
Overage charge per procedure is charged as follows:

Service Overage Rates
Medical Clearances $ 542.00
Blood Draw $ 184.00
DUI Check Point (OTS Reimbursement per detail) $ 424.00 Communicable Disease Exposure Testing and
Counseling (including COVID-19) $ 1,091.00
In-field, forced or warrant blood withdrawal (without
Medical Clearance) $ 608.00
In-field, forced or warrant blood withdrawal (with
Medical Clearance) $ 726.00
Medical Transportation Service (5150) $ 495.00
Reasonable Suspicion Drug and Alcohol Testing $ 433.00
Testimony Maximum Hourly Rate $ 132.00
Stand-by Time Maximum Hourly Rate $ 132.00
Cancellations $ 254.00
In addition, the following annual fees apply:

Annual Fees (paid when services commence):
 $21,218.00 per year which includes Medical Director Oversight for Police/Fire Communications
 Annual Narcan Administration Fee $7,891.00 per year. Note this does not include the medication, which must be purchased directly by CITY at $75 per kit.

Medication:

CITY will reimburse CONSULTANT for prescription and over-the-counter medications purchased to have on hand at the Jail Facility.

Annual Detention Medical Supplies Fee of $4,450.00 related to the oversight of suicide prevention kits, first aid supplies, over-the-counter medications and airway management supplies at the jail.

Medical Transportation Services:

If requested by CITY’s Chief of Police or his designee, CONSULTANT shall provide medical transport services (“Medical Transport Services”) in connection with persons who are taken into custody pursuant to Welfare and Institution Code section 5150, mental health evaluation (“Medical Transport Service(s)”). The fee for each medical transport to a local medical facility where the distance to such facility is ten (10) miles or less is Four Hundred Ninety-Five and 00/100 Dollars ($495.00). Medical Transport Service to a local medical facility where the distance is greater than ten (10) miles will be billed at Ten and 00/100 Dollars ($10.00) each mile past the first ten (10) miles travelled (“Medical Transport Services Additional Miles”). Upon arrival at the medical facility, the first thirty (30) minutes at the facility is included in the standard fee. If the wait time exceeds thirty (30) minutes, it will be billed at Seventy-Five Dollars and 00/100 Dollars ($75.00) per each fifteen (15) minutes (“Medical Transport Services Wait Time”).

DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -17-
B0785-0001\2614353v4.doc
Forced / Warrant / “McNeely Warrant Blood Draw” / In-field Blood Draw:

A forced blood draw, a warrant blood draw, a “McNeely Warrant Blood Draw” (“Evidentiary Warrant Blood Collection)”, or in-field blood draw (“Evidentiary In-Field Blood Collection)”, without a medical clearance, will be billed at a fee of Six Hundred Eight and 00/100 Dollars ($608.00). Infield blood draws denote when blood is drawn in the field (e.g. scene of an accident, at an address outside of the police department, etc.). If a medical clearance is required (“Evidentiary Warrant Blood Collection with Medical Clearance” or “Evidentiary In-Field Blood Collection with Medical Clearance”), the procedure will be billed at a fee of Seven Hundred Twenty-Six and 00/100 Dollars ($726.00).

Agreement Extensions - Consumer Price Index (“CPI”):

If the term of the Agreement is extended by CITY beyond Fiscal Year 2021-22, the monthly medical service fees, overage charges and annual fees, will be increased once per year as of July 1st to reflect cost-of-living adjustments. Any such increase shall be based on the same percentage increase during the previous twelve (12) months, in the Consumer Price Index for All Urban Consumers (“CPI-U”) for the Los Angeles-Orange County-Riverside Metropolitan Area (published by the Bureau of Labor Statistics, U.S. Department of Labor), or applying a similar index if the CPI-U is not published or available, less food and energy, to the nearest one dollar.

The current CPI amount is 3.3 percent.

Cancellations:

A $254.00 cancellation service fee applies if services are requested by CITY but cancelled. This includes procedures requested by CITY and subsequently cancelled. isputed amounts of such billing within thirty (30) days of receipt of the same.

Narcan Training and Narcan Kits:

CONSULTANT shall provide Narcan Training and Narcan Kits to CITY as requested in writing.

The training shall be held in the Police Department Roll-Call sessions or scheduled training as deemed necessary. Training shall include, but not be limited to instruction of proper administration of Narcan Immediate and After Care for the patient.

ITEM QUANTITY COST TOTAL
Narcan Kit 30 (Veh’s) $210.00 $6,300.00
Training 39 (TCO’s) $ 0.00 $ 0.00
Total $6,300.00
Additional $60,000.00 for fiscal year 2021-2022, Medical Services Fee Not to Exceed $197,268 per year ($16,439.00 per month) including a contingency for additional work not to exceed $74,664.00 per year
Medical Director Oversight and Narcan Administration Annual Fees $29,109.00 per year Annual Detention Medical Supply Fees $4,450.00
Total Not to exceed amount of $305,491.00 for fiscal year 2021-2022, as more particularly described in Exhibit B
DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 -18-
B0785-0001\2614353v4.doc
CONSULTANT shall provide CITY with monthly written reports on a form approved by CITY which detail all encounters in the immediately preceding month, including any excess encounters.

CONSULTANT shall also include associated report numbers for all medical clearances and blood draws for CITY's accounting purposes. The reports shall detail the total amounts due to CONSULTANT for covered services rendered in the preceding month. CITY shall pay CONSULTANT all undisputed amounts of such billing within thirty (30) days of receipt of the same.

DocuSign Envelope ID: DB675E23-FA49-4CA4-811F-7297CD1C40A7 Certificate Of Completion
Envelope Id: DB675E23FA494CA4811F7297CD1C40A7 Status: Completed Subject: Please DocuSign: Amendment No. 3 - Vital Medical Services LLC (ready for DocuSign).pdf Source Envelope:

Document Pages: 18 Signatures: 7 Envelope Originator:

Certificate Pages: 2 Initials: 0 Maria Lara
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
455 N. Rexford Drive
Beverly Hills, CA 90210
[email protected]
IP Address: 198.245.189.168
Record Tracking
Status: Original
2/7/2022 12:34:36 PM
Holder: Maria Lara
[email protected]
Location: DocuSign
Signer Events Signature Timestamp

ARMEN VARTANIAN
[email protected]
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 35.129.94.7
Sent: 2/7/2022 12:43:49 PM
Viewed: 2/7/2022 5:37:07 PM
Signed: 2/8/2022 4:25:42 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Alex G. Ghazalpour
[email protected]
Security Level: Email, Account Authentication
(None)
Signature Adoption: Drawn on Device
Using IP Address: 76.170.182.208
Signed using mobile
Sent: 2/8/2022 4:25:43 PM
Viewed: 2/10/2022 8:47:17 AM
Signed: 2/10/2022 8:47:41 AM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Sharon L'Heureux Dressel
[email protected]
Risk Manager
Sharon Dressel
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.245.189.166
Sent: 2/10/2022 8:47:42 AM
Viewed: 2/10/2022 3:40:18 PM
Signed: 2/10/2022 3:42:43 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Mark Stainbrook
[email protected]
Chief
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre-selected Style
Using IP Address: 198.245.189.168
Sent: 2/10/2022 3:42:44 PM
Viewed: 2/10/2022 4:04:16 PM
Signed: 2/10/2022 4:04:26 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Signer Events Signature Timestamp
Deborah Hakman for
[email protected]
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 208.87.234.201
Sent: 2/10/2022 4:04:27 PM
Viewed: 2/10/2022 4:11:05 PM
Signed: 2/10/2022 4:11:20 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
Jeff Muir
[email protected]
Director of Finance
City of Beverly Hills
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 172.56.44.95
Signed using mobile
Sent: 2/10/2022 4:11:21 PM
Viewed: 2/10/2022 5:18:50 PM
Signed: 2/10/2022 5:18:57 PM
Electronic Record and Signature Disclosure:

Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 2/7/2022 12:43:49 PM
Certified Delivered Security Checked 2/10/2022 5:18:50 PM Signing Complete Security Checked 2/10/2022 5:18:57 PM
Completed Security Checked 2/10/2022 5:18:57 PM
Payment Events Status Timestamps