Fountain Valley City Council
January 20, 2026

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Section 2782.8, Consultant agrees to indemnify and hold harmless (but not defend) the City, its officers, directors and employees from and against damages and costs that City is legally obligated to pay, to the extent caused by the negligent act, error or omission of the Consultant or anyone for whom the Consultant is legally responsible, subject to any limitations of liability contained in this Agreement. Consultant shall have liability for reasonable and necessary defense costs incurred by persons indemnified to the extent caused by Consultant’s negligence herein and recoverable under applicable law on account of negligence.

For all Consultant performances under this Agreement that are not for design services as defined under California Civil Code Section 2782.8 the following shall apply:

Consultant agrees to defend, indemnify, protect and hold harmless City, its officers, officials, employees, agents, attorneys, and volunteers from and against any and all claims, demands, losses, attorney fees, defense costs or expenses, or liability of any kind or nature which City, its officers, officials, employees, agents, attorneys and volunteers may sustain or incur or which may be imposed upon them for injury to or death of persons, or damage to property arising out of Consultant's negligent or wrongful acts or omissions in performing or failing to perform under the terms of this Agreement, excepting only liability arising out of the negligence or wrongful conduct of City, its officers, officials, consultants, employees, agents, attorneys and volunteers. (b) Indemnification for Other Than Professional Liability. Other than in the performance of professional services and to the full extent permitted by law, CONSULTANT shall indemnify, defend, protect and hold harmless CITY, and any and all of its employees, officials, officers, agents, and volunteers from and against any liability (including liability for claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, losses, expenses, or costs of any kind, whether actual, alleged, or threatened, including attorneys fees and costs, court costs, interest, defense costs, and expert witness fees), where the same arise out of, are a consequence of, or are in any way attributable to, in whole or in part, the performance of this AGREEMENT by CONSULTANT or by any individual or entity for which CONSULTANT is legally liable, including but not limited to officers, agents, employees, or subconsultants of CONSULTANT.
(c) General Indemnification Provisions. CONSULTANT agrees to obtain executed indemnity agreements with provisions identical to those set forth here in this section from each and every subconsultant or any other person or entity involved by, for, with or on behalf of CONSULTANT in the performance of this AGREEMENT.

In the event CONSULTANT fails to obtain such indemnity obligations from others as required here, CONSULTANT agrees to be fully responsible according to the terms of this section.

Failure of CITY to monitor compliance with these requirements imposes no additional obligations on CITY and will in no way act as a waiver of any rights hereunder. This obligation to indemnify and defend CITY as set forth here is binding on the successors, assigns, or heirs of CONSULTANT and shall survive the termination of this AGREEMENT or this section.

Nothing in this indemnity shall be construed as authorizing any award of attorney’s fees in any action on or to enforce the terms of this Indemnity or AGREEMENT. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable.

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(d) Indemnity Provisions for Contracts Related to Construction. This paragraph applies only when this AGREEMENT is related to construction. Without affecting the rights of CITY under any provision of this AGREEMENT, CONSULTANT shall not be required to indemnify and hold harmless CITY for liability attributable to the active negligence of CITY, provided such active negligence is determined by agreement between the parties or by the findings of a court of competent jurisdiction. In instances where CITY is shown to have been actively negligent and where CITY’s active negligence accounts for only a percentage of the liability involved, the obligation of CONSULTANT will be for that entire portion or percentage of liability not attributable to the active negligence of CITY.

This section shall survive the lapse, termination, or completion of this AGREEMENT.

12. INSURANCE
Prior to performing any work or receiving any compensation under this AGREEMENT, CONSULTANT shall obtain, and thereafter maintain for the duration of this AGREEMENT, insurance coverage as specified in Exhibit B, attached hereto and incorporated herein as though set forth in full. This duty or obligation shall survive the lapse, termination, or completion of this AGREEMENT.

13. WARRANTY FOR GOODS
(a) If this AGREEMENT includes the purchase of equipment, supplies, or chattel (hereafter “GOODS”), CONSULTANT shall provide the following warranty of said GOODS, or obtain a warranty from the manufacturer and/or retailer with provisions equal to or exceeding those specified in this Section. In the event the manufacturer’s warranty or retailer’s warranty do not equal or exceed the protections specified in this Section, CONSUTLANT agrees to provide said warranty protections.

The warranty described hereunder extends to the original purchaser of the GOODS warranted under the warranty, and to each transferee owner of the GOODS. The term of this warranty begins on the date the GOODS are delivered to CITY, and continues therefrom. CONSULTANT warrants that:
(1) The GOODS will function properly under normal use, will be of good workmanship, free from defect, of merchantable quality, and fit for CITY’s intended use;
(2) The GOODS will fully comply with any specifications provided by CITY and any samples or documentation provided by CONSULTANT; (3) The GOODS will be free of any security interests, liens, or encumbrances and CONSULTANT has title to the GOODS;
(4) The GOODS will not violate any intellectual property rights of any third party;
(5) The GOODS will be delivered free of the rightful claim of a third person by way of infringement; and

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(6) The GOODS are merchantable in accordance with Commercial Code Section 2314.
(b) The warranty listed above is in addition to any other warranties made by CONSULTANT, the manufacturer, retailer, or imposed by law. All warranties will survive inspection and payment by CITY and are assignable to CITY’s successors and assigns. If any GOODS do not meet the warranty, CITY may, at CITY’s option, and without additional cost to CITY:
(1) Require CONSULTANT to repair or replace the GOODS until the GOODS meet the warranty. If CONSULTANT cannot replace the GOODS and repair either is not commercially practicable or cannot be made within three (3) days, CONSULTANT will refund the purchase price;
(2) Return any of the GOODS to CONSULTANT at CONSULTANT’s expense for a full refund;
(3) Correct the nonconformance and charge CONSULTANT for the costs to make the correction; or
(4) Engage a third party to provide substitute GOODS and charge CONSULTANT for the costs of obtaining the substitute GOODS from the third party.

14. INDEPENDENT CONTRACTOR
(a) CONSULTANT is and shall at all times remain as to the CITY a wholly independent contractor having only the contractual duties and obligations agreed upon as memorialized in this AGREEMENT. The personnel performing the services under this AGREEMENT on behalf of CONSULTANT shall at all times be under CONSULTANT's exclusive direction and control. Neither CITY nor any of its officers, officials, employees, agents, or volunteers shall have control over the conduct of CONSULTANT or any of CONSULTANT's officers, employees, or agents, except as set forth in this AGREEMENT. CONSULTANT shall not at any time or in any manner represent that it or any of its officers, employees, or agents are in any manner officers, employees, or agents of the CITY. CONSULTANT shall not incur or have the power to incur any debt, obligation, or liability whatsoever against CITY, or bind CITY in any manner, whether in law or equity.
(b) No employee benefits shall be available to CONSULTANT in connection with the performance of this AGREEMENT. Except for the fees paid to CONSULTANT as provided in this AGREEMENT, CITY shall not pay, nor be deemed to have paid or delivered, salaries, wages, or other compensation to CONSULTANT for performing services hereunder for CITY. CITY shall not be liable for compensation or indemnification to CONSULTANT for injury or sickness arising out of performing services hereunder. In addition to the indemnification provisions of Section 11, CONSULTANT shall indemnify, defend, and hold CITY harmless from claims or liability arising from CONSULTANT’s employees for CITY benefits including, but not limited to,

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pension, health benefits, holiday, vacations, etc.

15. LEGAL RESPONSIBILITIES
CONSULTANT shall keep itself informed of State and Federal laws and regulations which in any manner affect i t s r e q u i r e m e n t s u n d e r t h i s A g r e e m e n t , a n d those employed by it or in any way affect the performance of its service, duties, and obligations pursuant to this AGREEMENT. CONSULTANT shall at all times observe and comply with all such laws and regulations. CITY, and its officers, officials, employees, agents, and volunteers shall not be liable at law or in equity occasioned by failure of CONSULTANT to comply with this Section. This section shall survive, without limitation, the termination, lapse or completion of this Agreement.

16. POLITICAL REFORM ACT
If the Political Reform Act requires CONSULTANT to file a Form 700, then CONSULTANT must file a Form 700 with full disclosure within 30 days of assuming office and thereafter must file an annual statement for each calendar year of this AGREEMENT.

17. UNDUE INFLUENCE
CONSULTANT declares and warrants that no undue influence or pressure is used against or in concert with any officer or employee of CITY in connection with the award, terms, or implementation of this AGREEMENT, including any method of coercion, confidential financial arrangement, or financial inducement. No officer or employee of the CITY will receive compensation, directly or indirectly, from CONSULTANT, or from any officer, employee, or agent of CONSULTANT, in connection with the award of this AGREEMENT or any work to be conducted as a result of this AGREEMENT. Violation of this section shall be a material breach of this AGREEMENT entitling CITY to any and all remedies at law or in equity.

18. NO BENEFIT TO ARISE TO LOCAL EMPLOYEES
No member, officer, or employee of CITY, or their designees or agents, and no public official who exercises authority over or responsibilities with respect to the project during their tenure or for one year thereafter, shall have any interest, direct or indirect, in any agreement or sub-agreement, or the proceeds thereof, for work to be performed in connection with this AGREEMENT.

19. RELEASE OF INFORMATION / CONFLICTS OF INTEREST
(a) All information gained by CONSULTANT in performance of this AGREEMENT shall be considered confidential and shall not be released by CONSULTANT without CITY’s prior written authorization. CONSULTANT, its officers, employees, agents, or subconsultants, shall not without written authorization from the City Manager or unless requested by the Attorney for the City, voluntarily provide declarations, letters of support, testimony at depositions, response to interrogatories, or other information

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concerning the work performed under this AGREEMENT or relating to any project or property located within the CITY. Response to a subpoena or court order shall not be considered “voluntary” provided CONSULTANT gives CITY notice of such court order or subpoena.
(b) CONSULTANT shall promptly notify CITY should CONSULTANT, its officers, employees, agents, or subconsultants be served with any summons, complaint, subpoena, notice of deposition, request for documents, interrogatories, requests for admissions, or other discovery request, court order, or subpoena from any person or party regarding this AGREEMENT and the work performed thereunder or with respect to any project or property located within the CITY. CITY retains the right, but has no obligation, to represent CONSULTANT and/or be present at any deposition, hearing, or similar proceeding. CONSULTANT agrees to cooperate fully with CITY and to provide the opportunity to review any response to discovery requests provided by CONSULTANT. However, CITY's right to review any such response does not imply or mean the right by CITY to control, direct, or rewrite said response.

20. SECURITY OF INFORMATION
CONSULTANT shall identify reasonably foreseeable internal and external risks to the privacy and security of personal information acquired during performance of this AGREEMENT that could result in the unauthorized disclosure, misuse, alteration, destruction, or other compromise of the information. CONSULTANT shall regularly assess the sufficiency of any safeguards and information security awareness training in place to control reasonably foreseeable internal and external risks, and evaluate and adjust those safeguards in light of the assessment.

21. NOTICES
Any notices which either party may desire to give to the other party under this AGREEMENT must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but not limited to, Federal Express, which provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by notice:

CITY CONSULTANT
City of Fountain Valley Hoag Executive Health
10200 Slater Avenue 500 Superior Ave, Suite 200
Fountain Valley, CA 92708 Newport Beach, CA 92663
Attn: City Clerk Attn: Justin Davis, VP Buss. Devl

22. ASSIGNMENT
CONSULTANT shall not assign the performance of this AGREEMENT, nor any part thereof, nor any monies due hereunder, without the prior written consent of

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CITY, which the CITY may grant or withhold in its sole and absolute discretion, with no obligation to disclose the basis for its decision to any person, firm, entity, or Party. ☐ [Check if Applicable] CONSULTANT shall provide CITY fourteen (14) days’ notice prior to the departure of any key personnel from CONSULTANT’s employ.

Should key personnel leave CONSULTANT’s employ, CITY shall have the option to immediately terminate this AGREEMENT, within three (3) days of the close of said notice period. Upon termination of this AGREEMENT, CONSULTANT’s sole compensation shall be payment for actual services performed up to, and including, the date of termination or as may be otherwise agreed to in writing between the City Council and CONSULTANT.
☐ [Check if Applicable] Because of the personal nature of the services to be rendered pursuant to this AGREEMENT, only Click or tap here to enter text. (“PRINCIPAL”) shall perform the services described in this AGREEMENT. PRINCIPAL may use assistants, under their direct supervision, to perform some of the services under this AGREEMENT. CONSULTANT shall provide CITY fourteen (14) day's notice prior to the departure of PRINCIPLE from CONSULTANT's employ. Should they leave CONSULTANT's employ, CITY shall have the option to immediately terminate this AGREEMENT, within three (3) days of the close of said notice period.

Upon termination of this AGREEMENT, CONSULTANT's sole compensation shall be payment for actual services performed up to, and including, the date of termination or as may be otherwise agreed to in writing between CITY and CONSULTANT.

23. LICENSES
At all times during the term of this AGREEMENT and prior to commencement of any work under this AGREEMENT, CONSULTANT shall have in full force and effect, all licenses required of it by law for the performance of the services described in this AGREEMENT including, but not limited to, a Fountain Valley business license.

24. GOVERNING LAW
CITY and CONSULTANT understand and agree that the laws of the State of California, or, as necessary, the laws of the United States Federal government, shall govern the rights, obligations, duties, and liabilities of the parties to this AGREEMENT and also govern the interpretation of this AGREEMENT. Any litigation concerning this AGREEMENT shall take place in Orange County Superior Court or Central District of California Federal District Court.

25. ENTIRE AGREEMENT
This AGREEMENT contains the entire understanding between the parties relating to the obligations of the parties described in this AGREEMENT. All prior or contemporaneous agreements, understandings, representations, and statements, oral or written, direct or implied, are merged into this AGREEMENT and shall be of no further force or effect. Each party is entering into this AGREEMENT based solely upon the representations set forth herein and upon each party's own independent investigation

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of any and all facts such party deems material. Each Party has had the opportunity to have this Agreement reviewed by independent legal counsel of its own selection and is not relying on any representations, opinions, or advice of the other Party.

26. CONTENTS OF REQUEST FOR PROPOSAL AND PROPOSAL
CONSULTANT is bound by the contents of CITY’s Request for Proposals and the contents of the Proposal submitted by CONSULTANT. In the event of conflict, this AGREEMENT shall take precedence over CITY’s Request for Proposals and CONSULTANT’s Proposal; and CITY’s Request for Proposals shall take precedence over CONSULTANT’s Proposal. No limitation of CONSULTANT’s liability, waiver of rights of CITY, or release of rights or remedies held by CITY, contained in CONSULTANT’s Proposal shall be of any force or effect.

27. INTERPRETATION
In the event of conflict or inconsistency between this AGREEMENT and any other document, including any proposal or Exhibit hereto, this AGREEMENT shall control unless a contrary intent is clearly stated. This AGREEMENT shall be interpreted as though drafted by all parties hereto.

28. MODIFICATION
No modification to this AGREEMENT shall be effective unless it is in writing and signed by authorized representatives of the parties hereto. The written modification requirement cannot be waived.

29. ATTORNEY FEES
In any action or proceeding brought by either party against the other party arising out of or in any way connected to this AGREEMENT, or where any provision hereof is validly asserted as a defense, the parties shall bear their own attorney’s fees, costs, and expenses. Nothing in this provision shall excuse CONSULTANT’s duty to provide CITY with a defense at CONSULTANT’s cost when CITY receives a complaint, petition, or other pleading from a third party requiring CITY to defend itself.

30. AUTHORITY TO EXECUTE THIS AGREEMENT
The person or persons executing this AGREEMENT on behalf of CONSULTANT warrants and represents that they have the authority to execute this AGREEMENT on behalf of CONSULTANT and have the authority to bind CONSULTANT to the performance of its obligations hereunder. CONSULTANT agrees that the person executing this AGREEMENT is an authorized agent of the CONSULTANT with the power to bind CONSULTANT to this AGREEMENT. ///
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IN WITNESS WHEREOF, the parties hereto have caused this AGREEMENT to be executed the day and year first above written.

CITY OF FOUNTAIN VALLEY CONSULTANT
Jim Cunneen, Mayor Signature
Andrew Guarni

ATTEST: Typed Name

CFO

Title
Rick Miller, City Clerk
Approved as to Form:

Corporate seal (or attach Notary
HARPER & BURNS LLP acknowledgment)

Attorneys for the City
Approved as to Content:
________________________________
Tania Knauerhaze, Director of Human Resources

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Exhibit “A”
Scope of Services
And Payment Terms

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Exhibit “B”
Insurance Specifications

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EXHIBIT “B”

INSURANCE SPECIFICATIONS
Without limiting CONSULTANT’s indemnification of CITY, and prior to performing any work under this AGREEMENT or receiving any compensation, CONSULTANT shall obtain, provide and maintain at its own expense during the term of this AGREEMENT, policies of insurance of the type and amounts described below and in a form that is satisfactory to CITY.

General liability insurance. CONSULTANT shall maintain commercial general liability insurance with coverage at least as broad as Insurance Services Office form CG 00 01, in an amount not less than $2,000,000 per occurrence, $2,000,000 general aggregate, for bodily injury, personal injury, and property damage. The policy must include contractual liability that has not been amended. Any endorsement restricting standard ISO “insured contract” language will not be accepted. The policy shall name the City of Fountain Valley, and its officers, officials, employees, agents, and volunteers as additional insureds.

Umbrella or excess liability insurance. [If required to meet higher limits].

Umbrella liability insurance requirements. CONSULTANT shall obtain and maintain an umbrella liability insurance policy that offers comprehensive coverage. This policy must include coverage for bodily injury, personal injury, and property damage, and it should extend to encompass commercial general liability, automobile liability, and employer’s liability. The policy must incorporate the following terms and conditions:
• Drop-down feature. This feature activates if any primary insurance becomes partially or wholly uncollectible for any reason, excluding the bankruptcy or insolvency of the primary insurer.
• Claims handling. Coverage must be administered on a “pay on behalf of” basis, as opposed to reimbursement model, to ensure direct payment of claims by the insurer.
• Concurrency of coverage. The policy effective dates must align with those of the underlying primary insurance policies to ensure continuous coverage.

Excess liability insurance requirements. The CONSULTANT shall obtain and maintain an excess liability insurance policy. This policy must be structured to provide additional coverage over the CONSULTANT’s existing commercial general liability, automobile liability, and employer’s liability policies. The requirements for the policy are as follows:
 Follow-form coverage. The policy adheres strictly to the terms and conditions of the underlying policies, ensuring seamless integration of coverage.
 Drop-down provision. This provision states that the excess policy will respond as primary coverage in the event that the underlying insurer is unable to pay a claim due to insolvency, unless an insolvency exclusion specifically applies.
 Claims handling. Coverage must be administered on a “pay on behalf of”

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basis, as opposed to a reimbursement model, to ensure direct payment of claims by the insurer.
 Concurrency of coverage. The policy effective dates must align with those of the underlying policies to prevent any gaps in coverage.

Automobile liability insurance. CONSULTANT shall maintain automobile insurance at least as broad as Insurance Services Office form CA 00 01 covering bodily injury and property damage for all activities of CONSULTANT arising out of or in connection with the work to be performed under this AGREEMENT, including coverage for any owned, hired, non-owned, or rented vehicles, in an amount not less than $1,000,000.00 combined single limit for each accident.

Workers’ compensation insurance. CONSULTANT shall maintain Workers’ Compensation Insurance (Statutory Limits) and Employer’s Liability Insurance (with limits of at least $1,000,000 dollars). CONSULTANT shall submit to CITY, along with the certificate of insurance, a Waiver of Subrogation endorsement in favor of CITY, its officers, agents, employees, and volunteers.

Professional liability (errors & omissions) insurance. CONSULTANT shall maintain professional liability insurance that covers the services to be performed in connection with this AGREEMENT, in the minimum amount of $2,000,000 per claim and in the aggregate. Any policy inception date, continuity date, or retroactive date must be before the effective date of this AGREEMENT and CONSULTANT agrees to maintain continuous coverage through a period of no less than three years after completion of the services required by this AGREEMENT.

Other provisions or requirements
Proof of insurance. CONSULTANT shall provide certificates of insurance and required endorsements to CITY as evidence of the insurance coverage required herein. Insurance certificates and endorsements must be approved by CITY prior to commencement of performance. Current certification of insurance shall be kept on file with CITY for the contract period and any additional length of time required thereafter. CITY reserves the right to require complete, certified copies of all required insurance policies, at any time.

Duration of coverage. CONSULTANT shall procure and maintain for the contract period and any additional length of time required thereafter, insurance against claims for injuries to persons or damages to property, or financial loss, which may arise from or in connection with the performance of the work hereunder by CONSULTANT, their agents, representatives, employees, or subconsultants/ subcontractors. If this AGREEMENT involves construction, CONSULTANT must maintain general liability and umbrella or excess liability insurance for as long as there is a statutory exposure to completed operations claims. CITY and its officers, officials, employees, and agents shall continue as additional insureds under such policies.

Primary/noncontributing. Coverage provided by CONSULTANT shall be primary and any insurance or self-insurance procured or maintained by CITY shall not be required to

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contribute with it. The limits of insurance required herein may be satisfied by a combination of primary and umbrella or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of CITY before the CITY’s own insurance or self-insurance shall be called upon to protect it as a named insured.

CITY’s rights of enforcement. In the event any policy of insurance required under this AGREEMENT does not comply with these specifications or is canceled and not replaced, CITY has the right but not the duty to obtain the insurance it deems necessary and any premium paid by CITY will be promptly reimbursed by CONSULTANT or CITY will withhold amounts sufficient to pay premium from CONSULTANT’s payments. In the alternative, CITY may cancel this AGREEMENT.

Acceptable insurers. All insurance policies shall be issued by an insurance company currently authorized by the Insurance Commissioner to transact business of insurance in the State of California, with an assigned policyholders’ Rating of A- (or higher) and Financial Size Category Class VII (or larger) in accordance with the latest edition of Best’s Key Rating Guide, unless otherwise approved by CITY.

Waiver of subrogation. With the exception of Professional Liability, all insurance coverage maintained or procured pursuant to this AGREEMENT shall be endorsed to waive subrogation against CITY, its elected or appointed officers, agents, officials, employees, and volunteers or shall specifically allow CONSULTANT or others providing insurance evidence in compliance with these specifications to waive their right of recovery prior to a loss. CONSULTANT hereby waives its own right of recovery against CITY and shall require similar written express waivers and insurance clauses from each of its subconsultants/subcontractors.

Enforcement of contract provisions (non estoppel). CONSULTANT acknowledges and agrees that any actual or alleged failure on the part of CITY to inform CONSULTANT of noncompliance with any requirement imposes no additional obligations on the CITY nor does it waive any rights hereunder.

Requirements not limiting. Requirements of specific coverage features or limits contained in this Section are not intended as a limitation on coverage, limits on other requirements, or a waiver of any coverage normally provided by any insurance. Specific reference to a given coverage feature is for purposes of clarification only as it pertains to a given issue and is not intended by any party or insured to be all inclusive, or to the exclusion of other coverage, or a waiver of any type. If the CONSULTANT maintains higher limits than the minimums shown above, the CITY requires and shall be entitled to coverage for the higher limits maintained by the CONSULTANT. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the CITY.

Notice of cancellation. CONSULTANT agrees to oblige its insurance agent or broker and insurers to provide to CITY with a thirty (30) day notice of cancellation (except for nonpayment for which a ten (10) day notice is required) or nonrenewal of coverage for

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each required coverage. If any of the CONSULTANT’s insurers are unwilling to provide such notice, then Consultant shall have the responsibility of notifying the CITY immediately in the event of CONSULTANT’s failure to renew any of the required insurance coverages, or insurer’s cancellation or non-renewal.

Additional insured status. General liability, automobile liability, and umbrella/excess liability insurance policies shall provide or be endorsed to provide that CITY and its officers, officials, employees, agents, and volunteers shall be additional insureds under such policies.

Prohibition of undisclosed coverage limitations. None of the coverages required herein will be in compliance with these requirements if they include any limiting endorsement of any kind that has not been first submitted to CITY and approved of in writing.

Separation of insureds. A severability of interests provision must apply for all additional insureds ensuring that Consultant’s insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the insurer’s limits of liability. The policy(ies) shall not contain any cross-liability exclusions.

Pass through clause. CONSULTANT agrees to ensure that its subconsultants, subcontractors, and any other party who is brought onto or involved in the project/service by CONSULTANT (hereinafter collectively “subcontractor”), provide the same minimum insurance coverage and endorsements required of CONSULTANT. CONSULTANT agrees to monitor and review all such coverage and assumes all responsibility for ensuring that such coverage is provided in conformity with the requirements of this section. However, in the event CONSULTANT’s subcontractor cannot comply with this requirement, which proof must be submitted to the CITY, CONSULTANT shall be required to ensure that its subcontractor provide and maintain insurance coverage and endorsements sufficient to the specific risk of exposure involved with subcontractor’s scope of work and services, with limits less than required of the CONSULTANT, but in all other terms consistent with the CONSULTANT’s requirements under this agreement. This provision does not relieve the CONSULTANT of its contractual obligations under the agreement and/or limit its liability to the amount of insurance coverage provided by its subcontractors. This provision is intended solely to provide CONSULTANT with the ability to utilize a subcontractor who may be otherwise qualified to perform the work or services but may not carry the same insurance limits as required of the CONSULTANT under this agreement given the limited scope of work or services provided by the subcontractor.

CONSULTANT agrees that upon request, all agreements with subcontractors, and others engaged in the project, will be submitted to CITY for review.

City’s right to revise specifications. CITY reserves the right at any time during the term of the AGREEMENT to change the amounts and types of insurance required by giving CONSULTANT ninety (90) days advance written notice of such change. If such change results in substantial additional cost to CONSULTANT, CITY and CONSULTANT may renegotiate CONSULTANT’s compensation.

Self-insured retentions. Any self-insured retentions must be declared to and approved

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by CITY. CITY reserves the right to require that self-insured retentions be eliminated, lowered, or replaced by a deductible, or require proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention through confirmation from the underwriter. Self-insurance will not be considered to comply with these specifications unless approved by CITY.

Timely notice of claims. CONSULTANT shall give CITY prompt and timely notice of claims made or suits instituted that arise out of or result from CONSULTANT’s performance under this AGREEMENT, and that involve or may involve coverage under any of the required liability policies.

Additional insurance. CONSULTANT shall also procure and maintain, at its own cost and expense, any additional kinds of insurance, which in its own judgment may be necessary for its proper protection and prosecution of the work.

Program Approach
Cardiovascular Health and Wellness Exams
Hoag Corporate Health is confident in our ability to seamlessly implement our proven, world-class annual approach to clinical screening in order to fully meet and exceed the Scope of Services for the Fountain Valley Fire Department program. We are uniquely positioned to provide participants with access to our renowned clinical staff, while providing an unparalleled health, wellness and educational experience for all eligible participants.

Our approach to addressing the components of this program will be as follows:

1. State-of-the-Art Data Collection

2. Thorough and Complete Analysis & Reporting

3. Personalized Data Review
Data Collection
A key component to the Cardiovascular Health and Wellness program is based on what diseases, disorders and early detection tests will be performed. Hoag Corporate Health will assess eight distinct categories or systems, to identify and assess participants’ disease risk and performance as well as opportunities for improvement in each of the categories as follows:

Heart & Circulatory
- Lipid Profile
- EKG
- Blood Oxygen
Kidney & Urogenital
- Urinalysis
- Cancer Screen PSA (men 50+)
- BUN, Creatinine Panel
Brain & Nervous
- Reflexes & Sensations
- Hearing
- Vision
- Strength & Balance
- Symmetry
Hormonal & Glandular
- Pre-Diabetes Markers
- Metabolic Panel
- Metabolic Rate
Lungs & Breathing
- Pulmonary Function
- Exercise Heart Rate Ranges
Blood & Immunity
- Blood Composition
- Immunity
- Anemia
- Leukemia
Muscular & Bone
- Musculoskeletal Assessment
- Strength Assessment
- Postural Screen
- Body Composition
Stomach & Gastrointestinal
- Liver Function Panel
- Gall Bladder Markers
- Micronutrients
- Protein
In addition to the categories by which Hoag Corporate Health will assess each FVFD participant, below we have outlined the individual components included in each exam.

Questionnaires
Medical History & Health Risk
Fitness and Nutritional Assessment
Blood Work
CBC
MMR, Varicella, Hep B/C Titers
Chem Panel (CMP)
hs-CRP
Lipids
PSA (over 50)
QuantiFERON TB Test
Tetanus/Diphtheria (TDAP) Vaccine (10yr booster)
Heavy Metal Panel
Clinical Evaluation
Audiogram
Vision Testing
Vitals
PFT (Spirometry)
EKG
Comprehensive Physical Exam
Neurological Exam
Musculoskeletal Assessment
Hernia Exam
Skin Cancer Screen
Clinical Breast Exam optional
Prostate Exam optional
DRE optional
Fountain Valley Fire Department Wellness Exam Program
Fitness & Nutritional Evaluation
Digital Movement Screen
Digital Postural Analysis
Body Composition Analysis
Hand Grip Strength
Fitness & Nutrition Consultation & Plan
Optional Exam Evaluations
CA DMV/DOT Exam if needed or requested
Report
Contents
- Bloodwork
- Clinical Data
- Physical Exam Report
- Recommendations & Actional Plan
- Report provided to participant at
conclusion of exam

Data Analysis & Presentation
Hoag Corporate Health sees the interpretation of the complex data and assessments gathered during the Comprehensive Firefighter Wellness program exam as one of the key aspects of affecting positive change in the participants. Ensuring that the results and more importantly, the actionable plan is easy for participants to understand and follow will only increase the effectiveness of the data and information that is gathered. Hoag Corporate Health physicians have over 50 years of combined risk assessment exam experience amongst them – coupling this with the knowledge of our exercise physiologists, translates into invaluable expertise in creating and presenting realistic health goals, exercise, fitness and nutritional plans for City of Fountain Valley personnel.

Our proposed approach to the exam will utilize a proprietary set of risk calculations that will enable participants to have a clear, tangible understanding of their current health state when compared to a mean of people in their age and activity group. When coupled with our personalized assessments participants will be able to immediately begin implementing positive changes aimed at addressing their specific health and wellness goals.

Data Review
The experience that Hoag Corporate Health has, delivering this exact program for many years, allows us to glean from our experiences and best practices developed through delivering thousands of specialty physicals.

Additionally, it is important to understand that our physicians specialize in this type of clinical delivery and our exercise physiologists solely focus on assessing exercise and fitness capabilities and creating easily implementable plans and programs to achieve stated fitness goals…this is what we do.

Each FVFD participant will have dedicated in-person time set aside immediately following the completion of their assessment to review the entirety of their physical report. During this 15-20-minute follow-up, participants will personally review their physical report, lab work and other assessments. The results and recommendations entailed in each personalized physical report are created in such a way that they are actionable and easy to implement. Our exercise physiologist will answer questions, give further suggestions and provide real-world examples of how to implement the fully customized health plan that was created for the participant. In addition, we will make it easy to share the report and data with each participant’s primary care physician by providing a hardcopy of all reports, labs and diagnostics for personal review. Our clinical and lifestyle recommendations focus on behavioral changes and when necessary therapeutic interventions which can be easily enacted by the participants’ primary physician. Hoag Corporate Health understands that participation in the Cardiovascular Health and Wellness program voluntary and is only the start to positively impacting the health and well-being of participants – it is with this in mind that we have created our reporting and follow-up procedures aimed at ensuring positive change is simple to implement.

Lab Process
As it relates to the lab services process for Cardiovascular Health and Wellness exam participants, Hoag Corporate Health is proposing that we utilize a long-standing 3rd party lab partner, LabCorp, to perform the lab panel blood draws. Understanding that there will be significant eligible personnel and that these participants may not all live in Orange County boundaries, we feel as though the most convenient and reliable solution will be to utilize LabCorp and their significant network of draw locations throughout Southern California. The process will be initiated once a participant is scheduled for his/her exam 30 days in advance, at that time they will be entered into the Hoag Corporate Health EMR system and an electronic lab requisition will be created and sent to LabCorp.

The participant will then simply need to log onto the LabCorp website from a computer, phone or iPad and locate the closest and most convenient LabCorp location to either his/her worksite or home. In addition, Hoag

Corporate Health will email each participant with a copy of the lab requisition (just in case) as well as a website link that lists all SoCal LabCorp draw sites and instructions for the fasting blood draw. Participants will be asked to ensure they have completed their blood draw within 2-weeks of their scheduled exam to ensure results are obtained prior to their physical. Results are then electronically sent to Hoag Executive Health typically within 3-5 business days from the blood draw. Below is the link and an image of the LabCorp “Find a Location” website along with the contact information for our LabCorp representative – Hoag Corporate Health has used LabCorp since our inception 8 years ago and they continue to provide excellent service and reliability :
https://www.labcorp.com/labs-and-appointments

Sample Schedule for Fountain Valley Fire Department Personnel Hoag Corporate Health propose to offer two schedule blocks for the Fountain Valley Exam program, a morning and afternoon block. Each block consists of up to 4 appointment “slots”, those are as follows:

Morning Afternoon
9:00am – 12:00pm 1:00pm – 4:00pm
Hoag Corporate Health will offer both AM slots and PM slots in our Newport Beach facility – below is a sample exam schedule.

Cardiovascular Health & Wellness Exam
Document & Questionnaire Review

Cardiovascular Health & Wellness Exam Workflow
Below is a step-by-step overview of the testing process for firefighters:

1. Hoag Program Manager works with FVFD designee to establish an exam calendar – days of the week and dates that work best for that agency and personnel.
a. Hoag Program Manager will create a SharePoint calendar with designated exam dates/times and slots

2. Each agency will provide an eligible participant list with names, DOB, email address and phone number of eligible exam participants.

3. Participants will begin the “exam prep” process 4 weeks prior to their assigned exam date

4. Hoag Program Manager will register each participant into Hoag Corporate Health’s electronic medical record system
a. An email will be sent to the participant containing:

1. Medical history and fitness assessment questionnaires

2. Hard copy of the LabCorp lab requisition, lab draw instructions and a link to all LabCorp locations

5. Participant will complete their lab draw and applicable pre-exam questionnaires no less than 1-week prior to his/her annual exam.

6. 3-5 days prior to the scheduled exam date, participants will receive a confirmation email and phone call from the Hoag Program Manager confirming attendance on the scheduled exam date

7. Upon arrival in the office – participants will be checked in and a Hoag support staff member will walk participants to the participant lounge

8. The participant will first meet with our clinical support staff to capture all biometric/vital sign data

9. Diagnostic ultrasounds will be performed next, this portion of the exam will take approx..15 minutes

10. Next, the participant will meet with the physician to review all pre-exam questionnaires and conduct a thorough medical health history.

11. Following the physicians consultation, the complete physical examination will be performed

12. Following the completion of the physical exam, participants will transition to a private exercise lab with our exercise physiologist for the fitness and nutritional evaluation – this portion of the exam will take approximately 30 minutes

13. Following the fitness assessment, the exercise physiologist will excuse him/herself to retrieve the completed physical exam report in-hand to be reviewed with the participant

14. If there were any medically necessary referrals, our physician would coordinate these with the participant following the report review and prior to their departure.

Cost Proposal
Description of Services Unit Cost
Annual Firefighter Wellness & Fitness Exam Standard $1,250 Annual Firefighter Wellness & Fitness Exam HazMat $1,450 Add-On Services
Post Deployment Medical Exam $595
California DMV Exam $400
Cancellation Fees*
No-Show/Late Cancel (Unexcused) 50%
No-Show/Emergency Activities (Excused) No Charge
No-Show/Other (Excused) No Charge
**Additional Cost for HazMat is a pass through cost for Heavy Metals panel Additional Lab Test Options & Costs Unit Cost
Advanced Lipid Profile w/ insulin resistance markers $65 Lipoprotein(a) – Lp(a) $30
Lipoprotein-Associated Phospholipase A2 Activity (Lp-PLA2) $45 Multi-Cancer Blood Test Screening $825
*Cancellations are handled as follows:

No-Show - Late Cancel (Unexcused)
• Cancellation with less than 48-hours’ notice. This slot will not be counted as a “No- Show/Late Cancel” if the slot can be filled by the coordinator, with another FVFD firefighter • When a participant arrives for their scheduled appointment too late to allow for the exam to occur No-Show - Emergency Activities (Excused)
• If weather, fire conditions, or a major emergency (e.g., flood watch, red flag warnings, regional fires, major equipment or apparatus failure, earthquakes or similar hazard) occurs, then cancellation of all unnecessary activities may be required as Fountain Valley FD’s primary mission is to provide optimum emergency services • FVFD will inform Provider of these emergencies as soon as possible No-Show - Other (Excused) • Individuals, who have gone on Worker's Compensation leave between the time that the exam appointment is scheduled and the actual appointment, will be identified. FVFD (via the supervisor, Coordinator or fire captain) will inform Provider of these Worker's Compensation cases, and FVFD will not be charged for these appointments •Similarly, if an individual misses an appointment due to sick leave, then OCFA will verify the sick leave during the verification process. OCFA will inform Provider of this sick leave and will not be charged for these appointments.

At the conclusion of each scheduled WEFIT exam day, the Provider will notify the FVFD Coordinator of names of “No-Show / Late Cancel”. The Provider will provide the FVFD Coordinator documentation that will assist and support the evaluation of the “No-Show / Late Cancel” rates.

Submitted by:

Company Name: Hoag Corporate Health
Contact Name: Justin Davis
Title: Vice President – Business Development
Signature :

Email: [email protected]
Phone: 949.566.8419
Date: February 26, 2024

&LW\RI+XQWLQJWRQ%HDFK
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Invitation Number: 2024-1029
City of Huntington Beach
Attention: Purchasing Department
2000 Main Street
Huntington Beach, CA

Cover Letter & Project Summary
Hoag Executive Health
500 Superior Ave, Suite 200
Newport Beach, CA 92663
949.999.9300
November 4th, 2024
To Whom It May Concern:

Hoag Executive Health is excited at the opportunity to bid and ultimately participate in the Huntington Beach Medical & Wellness Examination Program – providing services to a range of departments within the city, including: Huntington Beach Fire, Huntington Beach Police Department, Marine Safety Division of HBFD, as well as executive management. In the following proposal, Hoag Executive Health will illustrate just how uniquely qualified our expert program staff is to accomplish every aspect of the Scope of Services outlined in the RFP, as well as our willingness to work hand in hand with the City of Huntington Beach to continue the growth and evolution of the program to ensure city employees, Huntington Beach firefighters, paramedics, police and lifeguard personnel are able to maintain the highest level of health and wellness, and in turn, succeed in their duties as highly trained first responder personnel.

At present Hoag operates two of the largest and most successful specialty clinical exam programs in the western United States. The first being the “Hoag First Responder Program” which has been in operation for 9 years, this program conducts roughly 3,000 specialty physicals annually, providing exclusive health and wellness programs for such clients as the Orange County Fire Authority, LA City Fire, Anaheim Fire & Rescue, City of Irvine Police Department, Huntington Beach Fire, Anaheim Police Department, Costa Mesa Police Department and Cathedral City Fire Department, to name a few. In addition to the annual NFPA exams listed above, the Hoag First Responder Program also conducts pre-employment exams for Newport Beach Fire & Police, Anaheim Fire & Rescue, Cathedral City Fire Department and has even delivered preemployment physical examinations for Huntington Beach Fire in the past. The Hoag First Responder Program is not simply familiar with the unique stressors, realities and requirements of fire, law enforcement and marine safety personnel, our physicians, physiologists and nurses specialize in providing pre-hire, ongoing and specialty care for this unique population.

The second specialty program that would be directly involved in this RFP is the Hoag Executive Health program. Started in 2012, Hoag’s Executive Health program conducts over 1,000 advanced annual screenings for clients such as the NFL and NFL Players Association, Fortune 500 organizations like Chipotle, Capital Group, Boston Consulting Group and over 100 other private and public employers.

Designed for the executive, the Hoag Executive physical is a streamlined, personalized and efficient experience delivered in our luxurious and private environment. The goal of the physical is to uncover medical, nutritional and/or physical imbalances that can lead to disease and/or injury. The half-day executive physical lasts approximately 4 hours and consists of state-of-the-art medical, fitness & nutrition evaluations along with breakfast, lunch and breaks.

Yet another differentiator for the Hoag First Responder Program is our superb clinical and fitness staff all of whom have decades of experience delivering our proprietary set of assessments to populations identical to Huntington Beach Fire, Police and Marie Safety personnel. Their understanding of the unique stressors and challenges associated to tactical athletes and emergency responders translates to our ability to provide meaningful, applicable health recommendations and fitness programming that can be immediately implemented, leading to effective and lasting health and lifestyle changes.

In addition to our experience with these populations and outstanding dedicated First Responder team, the Hoag Executive Health program is lucky enough to have state-of-the-art facilities and equipment.

Hoag Executive Health is proposing to deliver the Medical & Wellness Exam Program in our newest dedicated medical offices located in Newport Beach. This facility is equipped to deliver every component of the medical and fitness evaluations in our 10,000sq ft special programs suite that includes fully equipped exercise labs, technology integrated exam rooms, private lounges for participants and the newest clinical and fitness diagnostic tools. In addition, we have imaging capabilities located our medical office building which allows for a simple and smooth logistical process for participants.

Hoag Executive Health is confident that we can establish a world class program aimed at enhancing the health, fitness and performance of Huntington Beach Fire, Police and Marine Safety personnel through our comprehensive approach to health and overall wellness. Hoag Executive Health appreciates the City of Huntington Beach’s consideration of the following proposal and we welcome the opportunity to work together. Please note that proposal pricing will be valid for 180 days.

Regards,
Justin Davis
Vice President – Business Development
Hoag Executive Health

Proposed Delivery Location:

Hoag Executive Health
500 Superior Ave, Suite 200
Newport Beach CA 92663
949.629.2600

Methodology

1. Hoag Executive Health intends to detail our approach to facilitating the Medical & Wellness Examination Services. First and foremost we propose to offer 3 unique services – the first being recurring “Annual Evaluations” for existing City of Huntington Beach Firefighters, Police and Safety personnel, the second being “Pre-Employment Examinations” for Firefighters, Ambulance Operators, Police Officers and Ocean Lifeguard candidates and Firefighter candidates and the last being annual Executive/Management Exams.

The Hoag First Responder annual medical evaluation incorporates all aspects of the “wellness” assessment into each annual exam, thereby streamlining the current process that the City of Huntington Beach currently employs.

1. Annual Medical Evaluations – Firefighter, Ambulance Operator, Police Officer & Lifeguard Exams Hoag Executive Health currently manages, operates and delivers one of the most successful comprehensive Executive and First Responder clinical and fitness screening programs in the country on behalf of Hoag Hospital and has done so for 9 years. In fact, Hoag Executive Health currently administers these medical evaluations for Huntington Beach Fire Department and SWAT. The Hoag First Responder Program is recognized by the NFPA and the IAFF as a “Gold Standard” first responder wellness facility with our Chief Medical Officer regularly consulting with fire and police agencies across the United States on ways to replicate and model after the Hoag program.

In addition to services for Law Enforcement and First Responder agencies, the Hoag program currently offers a number of health and wellness services aimed at serving the specialized healthcare needs of corporations, professional sports leagues, city and local governments and other tactical personnel. The core services that Hoag Executive Health will look to glean from for Huntington Beach’s Medical & Wellness Exam Program are the customized clinical and fitness exam programs Hoag Executive Health has created for the Orange County Fire Authority, LA City Fire, Anaheim Fire & Rescue, the NFL Players Association, the City of Irvine Police, Anaheim Police Department and Costa Mesa PD. Each of these healthcare solutions offer unique parallels as well as logistical and operational learning that will ensure a state-of-the-art experience for Huntington Beach personnel.

We propose to create a custom solution for Huntington Beach by drawing on the best of the Hoag Executive physicals, while incorporating our unique expertise in research, education and lifestyle change, to create a best-in-class health and wellness experience aimed at assessing program participants’ potential risk, providing meaningful and actionable solutions to mitigate or eliminate said risk – all while utilizing our skilled staff to motivate, challenge and educate personnel. We are confident in our methods and clinicians as well as our outcomes and feel as though we are uniquely qualified to provide this service for the City of Huntington Beach with the highest levels of quality, convenience and participant satisfaction.

Hoag Executive Health is uniquely positioned to fulfill the entirety of the Scope of Services for the for Huntington Beach Medical & Wellness Exam Program, as each of the required service components fall within the standard set of services and expertise for our business. Specifically, as it relates to personnel, Hoag Executive Health may be the only proposed service provider that can state categorically that we currently have on staff all necessary clinicians, medical support staff, fitness and exercise specialists as well as administrative and management personnel to fully service the program as it is constructed today

as well as if the program were to expand. Hoag Executive Health currently has 7 primary care physicians (Internal Medicine/Family Practice/Sports Medicine) whom we are able to devote to this program. In addition, each of our physicians has their own devoted Medical Assistant who are specially trained to work with Hoag Executive Health participants. Other key members of the Hoag Executive Health team are our 7 Exercise Physiologists who provide fitness and nutritional training and consultation to participants in our programs. Our exercise physiologists will be tasked with conducting the IAFF WFI fitness and nutritional components of each annual and pre-employment exam in accordance with the NFPA

2. Pre-Employment Examinations for Firefighters, Ocean Lifeguards, Police and Ambulance Operators Given the types of services Hoag Executive Health provides to employers and public agencies – comprehensive clinical examinations – our team was approached about 5 years and asked if we could provide pre-employment assessments. At that time we engaged our internal Employee Health Services department in order to develop a world-class pre-employment exam program. Hoag Hospital currently employs ~11,000 staff, as such our EHS team onboards 150-250 new hires each month. Hoag Executive Health utilized this wealth of knowledge to establish chain of custody, documentation and department notification processes that ensure simple and quick response – we will most certainly be able to accommodate candidates within 7-days notice, accurate reporting and documentation – Hoag will provide all results in a fully encrypted email and has the ability to access an online portal should the City of Huntington Beach have one that we can utilize – and lastly unparalleled clinical and exercise physiology expertise which leads to confidence in the fit-to-hire determinations.

Currently Hoag Executive Health provide pre-hire screenings for the City of Newport Beach (Police, Fire & Paramedics), Cathedral City Fire Department and have also provided these services for Huntington Beach Fire in the past.

3. Executive/Management Physicals
The genesis of the Hoag First Responder program was built upon the over 65-years of physician experience and 15-years of operational experience providing the highest reviewed and rated Executive Physical program in the Western United States. Hoag Executive Health was developed to provide participants with an unparalleled assessment of their current health state, assessing every major system in the body and identifying current and future risk. Our program, unlike many others, is built upon a desire to not simply identify risk or disease, but rather provide actionable results, recommendations and lifestyle changes to directly address, improve and/or overcome the disease risk and improve overall health state. To gauge our service level, we provide every participant with a survey following their physical exam. We include a question regarding their likelihood of recommending our service to a coworker, friend or family member – this is commonly referred to as a Net Promoter Score (many Fortune 500 organizations utilize the NPS score as a barometer of their success at exceeding the expectations of patrons). Hoag Executive Health has maintained an NPS score of .90 or above for the last 5 years. To put this in perspective, American Express has a Net Promoter Score of .52, Costco has a NPS of .72, and Trader Joes received a NPS of .62 in 2022. Clearly, participants enjoy their experience, see value in the Hoag Executive Health process and feel strongly that their friends, family and co-workers should have the same experience.

Scope of Services
Hoag Executive Health is confident in our ability to seamlessly implement our proven, world-class physical exam programs in order to fully meet and exceed the Scope of Services for each of the three Medical & Wellness Exam Programs. We are uniquely positioned to provide participants with access to our renowned clinical staff, while providing an unparalleled health, wellness and educational experience for all participants.

Our approach to addressing the components of this program will be as follows:

1. State-of-the-Art Data Collection

2. Thorough and Complete Analysis & Reporting

3. Personalized Data Review and Actionable Plans for Health Improvement Data Collection
A key component to the Medical & Wellness Exam Programs is based on what diseases, disorders and early detection tests will be performed. Hoag Executive Health will assess a wide range of distinct categories or systems, to identify and assess participants’ disease risk, ability to effectively and safely perform a specific job role and/or to enhance performance and improve health in a number of categories – see below for a detailed list:

Annual Firefighter, Police Officer, Safety and Lifeguard Recurring Exam Heart & Circulatory
- Lipid Profile
- EKG / Treadmill Test
- Blood Oxygen
- CIMT Ultrasound
Kidney & Urogenital
- Urinalysis
- Cancer Screen PSA (men 50+)
- BUN, Creatinine Panel
Brain & Nervous
- Reflexes & Sensations
- Hearing
- Vision
- Strength & Balance
- Symmetry
Hormonal & Glandular
- Pre-Diabetes Markers
- Metabolic Panel
- Metabolic Rate
- Heavy Metals
Lungs & Breathing
- Pulmonary Function
- Maximal Oxygen Uptake
- Exercise Heart Rate Ranges
- X-Ray
Blood & Immunity
- Blood Composition
- Immunity
- Anemia
- Leukemia
Muscular & Bone
- Musculoskeletal Assessment
- Strength Assessment
- Postural Screen
- Body Composition
- Functional Mobility
Fitness & Exercise
- WFI Assessment
- Fitness Goals
- Assessment of Limitations
- Exercise Prescription/Programming
Stomach & Gastrointestinal
- Liver Function Panel
- Gall Bladder Markers
- Micronutrients
- Protein
Diet and Nutrition
- Assess of Current Nutrition (food log)
- Identifying Health Eating Barriers
- Resting Metabolic Rate
- Meal Planning
- Nutritional Education

In addition to the categories by which Hoag Executive Health will assess each Huntington Beach Medical & Wellness Exam participant, below we have outlined the individual components included in each exam.

Questionnaires
Medical History & Health Risk
Behavioral Health (PHQ-9)
Fitness and Nutritional Assessment
Blood Work
CBC
MMR, Varicella, Hep B/C Titers
CMP
hs-CRP
Lipids
PSA (over 50)
Heavy Metal Panel
- Urine Heavy Metals
o Lead
o Mercury
o Arsenic
- Blood Heavy Metals
o Lead
o RBC Cholinesterase
TB QuantiFERON
Tetanus Vaccine 10-yrs
Clinical Evaluation
Audiogram
Vision Testing
Vitals
PFT (Spirometry)
EKG
Comprehensive Physical Exam
Neurological Exam
Musculoskeletal Assessment
Hernia Exam
Skin Cancer Screen
Clinical Breast Exam optional
Prostate Exam optional
DRE optional
Chest x-ray (PA/Lat))
Ultrasound Exam
Fitness & Nutritional Evaluation
Functional Movement Screen
Body Composition Analysis
Skin Fold Assessment
VO2 Max (gas exchange)
Hand Grip Strength
Pushup Test
Posture Assessment
Abdominal Strength
Nutritional Assessment & Plan
Fitness Assessment & Plan
Optional Exam Evaluations
CA DMV/DOT Exam if needed or requested
Report
Contents
- Bloodwork
- Clinical Data
- Physical Exam Report
- Recommendations & Actional Plan
- Report provided to participant at
conclusion of exam
- Physicians’ clearance statement
Annual Recurring Huntington Beach Medical & Wellness Exam Program

Annual Executive/Management Exam
Personalized Physical Components
Heart & Circulation Brain & Nerves Blood & Immunity
Advanced Lipid Panel Memory Testing Blood Composition
Inflammation Markers Reflex & Sensations Omega 3-6-9 Distribution Blood Pressure Hearing Screen CBC Complete Blood Count
Biometrics Vision Testing White Blood Cells and Differential Carotid Artery Assessment Strength & Balance Red Blood Cell Count and Characteristics
Electrocardiogram Cranial Nerve Assessment Blood Composition Stress EKG Cognitive/Memory Testing Anemia Screen, Platelets, Globulin Levels
Resting and Stress Echocardiogram Comprehensive Vision Testing Abdominal Aneurysm Screening
Lungs & Breathing Hormones & Gland Muscle & Bone
Pulmonary Function Thyroid Hormone Testing Movement & Pain Allergies Insulin Resistance Strength Testing
Exercise Heart Rate Ranges Metabolic Panel Posture Screen Pulse Oximetry Metabolic Rate Body Composition
Maximum Oxygen Consumption (VO2 Max) Testosterone Testing Flexibility Assessment PA/Lat X-Ray
Stomach & Gastrointestinal Kidney & Urogenital Joint Biometrics Liver Panel Urinalysis
Gallbladder Cancer Screen Pap Smear (Women)
Micronutrients Cancer Screen PSA (Men)
Protein Panel Kidney Function Markers
Iron stores Pelvic Exam (optional)
Vitamin B9, B12, D
Essential Fatty Acids with Omega 3-6-9 distribution

Annual Lifeguard Skin Cancer Screening
Hoag Executive Health developed a one-of-a-kind annual skin cancer screening solution that is actively in place for the Huntington Beach Lifeguard personnel. Below is an outline of the 2 specific solutions for screening and clinical escalation aimed at providing HB Lifeguards with a comprehensive skin cancer screening program.

Screening
Annual screenings are delivered in the Hoag Corporate Health suite, located at 500 Superior Ave, Suite 200, Newport Beach CA. Hoag Corporate Health provides HBFD with a schedule of 15-min screening slots for each skin cancer screening. Screening details:
- Each skin cancer screening will be performed by a board-certified physician - Physicians will utilize a hand-held magnification tool called a dermatoscope to assess any skin lesions - Participants will be asked to remove all makeup, bandages and jewelry Physician Oversight & Review
In the event a mole or lesion appears to be cancerous or pre-cancerous, Hoag Executive Health has the ability to send digital images immediately to our program dermatologist Dr. Steven Wang for review. This process eliminates the need to schedule a follow-up dermatology appointment as Dr. Wang is able to review the potential cancer and provide direction as to whether it is benign or if additional inoffice follow-up or biopsy is recommended. The use of the Hoag Derm-On-Demand capability allows for the most efficient and cost-effective initial specialist referral solution.

Pre-Employment Examinations
Hoag Executive Health provides a number of clinical and fitness related pre-employment services to local first responder agencies throughout Orange County. Additionally, our group has recently provided pre-employment examinations for Newport Beach Fire & PD, Cathedral City Fire as well as Huntington Beach Fire and PD, this familiarity with the process and preferences of the agency as it relates to these exams only bolsters the confidence in our ability to meet and exceed the criteria for pre-employment exams. Additionally, our group has utilized the NFPA 1582 and POST guidelines as the framework for the development of every firefighter and lawenforcement personnel exam we have completed – over 10,000 exams to date – which hopefully further illustrates our confidence in effectively assessing the clinical and fitness capabilities of Firefighters, Ocean Lifeguards and Law-Enforcement personnel and their ability to effectively and safely perform the duties required for the job.

As with any occupational medical evaluation, Hoag Executive Health will maintain the utmost confidentiality of records, reporting and outcome determination related to all Huntington Beach Pre-Employment examinations.

The standards and scope of the Pre-Employment Examinations will be as follows:

To identify conditions that may interfere with a candidates physical or mental ability to safely perform essential job tasks without undue risk of harm to self or others.

Hoag Executive Health views the Pre-Employment Examination clinical process for Ambulance Operator Candidates and Firefighter Candidates as being extremely similar to that of the Annual Medical Wellness Exam program in the following capacities:
- Data Collection & Analysis
- Lab Draw Process
- Exam Logistics
Given this fact, we would employ the same systems and process as listed above for those components of the exam. In addition to the categories by which Hoag Executive Health will assess each Huntington Beach PreEmployment Exam participant, below we have outlined the individual components included in each exam.

Ocean Lifeguard Pre-Placement Exam
Questionnaires
Medical History & Health Risk
Clinical Evaluation
Audiogram
Urinalysis
Vision Testing
Vitals
PFT (Spirometry) & Interpretation
Comprehensive Physical Exam
Musculoskeletal Assessment
Hernia Exam
PPD TB Skin Test
Chain of Custody Screenings
4-Panel Non-DOT Rapid Urine Drug Screen
Marijuana THC Oral Fluid Drug Screen
Securely emailed or uploaded to secure Portal

Sample Clearance Report
Ocean Lifeguard Pre-Placement Exam

Police POST Pre-Placement Exam
Questionnaires
POST Medical History
Respirator C Questionnaire
Clinical Evaluation
Audiogram
Urinalysis
Vision Testing
Vitals
PFT (Spirometry) & Interpretation
Comprehensive Physical Exam
Musculoskeletal Assessment
PPD TB Skin Test
Chest X-Ray (PA)
Lumbar/Sacral if needed
Blood Work
CBC
CMP
Hep B Vaccine Series
Chain of Custody Screenings
4-Panel Non-DOT Rapid Urine Drug Screen
Marijuana THC Oral Fluid Drug Screen
Securely emailed or uploaded to secure Portal

Fitness Screening
Treadmill Stress Test – Bruce Protocol
Report
- Physicians’ clearance statement &
comments
Sample Clearance Report
Sample Respirator Clearance Form
Police POST Pre-Placement Exam

Ambulance Operator Pre-Placement Exam
Questionnaires
Medical History & Health Risk
Respirator C Questionnaire
Clinical Evaluation
Audiogram
Urinalysis
Vision Testing
Vitals
PFT (Spirometry) & Interpretation
Comprehensive Physical Exam
Musculoskeletal Assessment
PPD TB Skin Test
Lumbar/Sacral X-Ray
Blood Work
CBC
CMP
MMR, Varicella, Hep B/C Titers
Chain of Custody Screenings
4-Panel DOT Rapid Urine Drug Screen
Securely emailed or uploaded to secure Portal

Optional Exam Evaluations
CA DMV/DOT Exam if needed or requested
Report
- Physicians’ clearance statement &
comments
Sample Clearance Report
Ambulance Operator Pre-Placement Exam

Firefighter Pre-Employment Exam
Questionnaires
Medical History & Health Risk
Respirator C Questionnaire
Clinical Evaluation
Audiogram
Urinalysis
Vision Testing
Vitals
PFT (Spirometry) & Interpretation
Comprehensive Physical Exam
Musculoskeletal Assessment
PPD TB Skin Test
Chest X-Ray (PA/LAT)
Lumbar/Sacral X-Ray if needed per NFPA 1582
C-Spine 2V X-Ray if needed
Blood Work
CBC
CMP
MMR, Varicella, Hep B/C Titers
Tetanus Vaccine
Chain of Custody Screenings
4-Panel DOT Rapid Urine Drug Screen
Securely emailed or uploaded to secure Portal

Optional Exam Evaluations
CA DMV/DOT Exam if needed or requested
Report
- Physicians’ clearance statement &
comments
Sample Clearance Report
Firefighter Pre-Placement Exam

Data Analysis & Presentation
Hoag Executive Health sees the interpretation of the complex data and assessments gathered during the Annual Medical & Wellness Exams and Pre-placement exams as one of the key aspects effectively conducting these specialty exams. Ensuring that the results and more importantly, any actionable recommendations is easy for participants to understand and follow will only increase the effectiveness of the data and information that is gathered. Hoag Executive Health physicians have over 65 years of combined executive physical experience amongst them – coupling this with the knowledge of our coaches and exercise physiologists translates into invaluable expertise in creating and presenting realistic health goals, exercise, fitness and nutritional plans for Huntington Beach personnel.

Our proposed approach to the Annual Medical & Wellness Exams and Pre-placement exams will utilize a proprietary set of risk calculations that will enable participants and the City to have a clear, tangible understanding of their current health state when compared to a mean of people in their age and activity group and to identify any potential limitations to completing the tasks required for success in the stated roles.

Data Review
The experience that Hoag Executive Health has, delivering these exact Scope of Services to almost a dozen different agencies throughout Southern California for almost 10 years, allows us to glean from our experiences and best practices developed through delivering thousands of specialty exams. Additionally, it is important to understand that our physicians specialize in this type of clinical delivery – solely practicing preventative, risk identification and Occupational health services…this is what we do.

For all of the Wellness exams, each Huntington Beach participant will have dedicated in-person time set aside immediately following the completion of their fitness assessment to review the entirety of their physical report – this will be done with the same exercise physiologist who performed their fitness and nutritional assessment. During this 20-minute follow-up, participants will personally review their physical report, lab work and other assessments. The results and recommendations entailed in each personalized physical report are created in such a way that they are actionable and easy to implement. Our physiologists will answer questions, give further suggestions and provide real-world examples of how to implement the fully customized health plan that was created for the participant. In addition, we will make it easy to share the report and data with each participant’s primary care physician by providing a hardcopy of all reports, labs and diagnostics for personal review. Our clinical and lifestyle recommendations focus on behavioral changes and when necessary therapeutic interventions which can be easily enacted by the participants’ primary physician. Hoag Executive Health understands that participation in the Annual Medical & Wellness Exam program is only the start to positively impacting the health and well-being of participating firefighters – it is with this in mind that we have created our reporting and follow-up procedures aimed at ensuring positive change is simple to implement.

Pre-Placement Drug Testing
Pre-Placement exams will be conducted as a 2-part assessment where all clinical screenings are performed at the Hoag Executive Health First Responder facility, candidates will then be scheduled immediately following their clinical screening at the Hoag Employee Health Services office for any chain of custody drug screenings. Given the specific facility requirements (restrooms with auto-shutoff water faucets and no exposed ventilation registeres, etc.), our EHS facility meets and exceeds all drug screening requirements.

Lab Process
As it relates to the lab services process for Annual Medical & Wellness Exam participants, Hoag Executive Health is proposing that we utilize a long-standing 3rd party lab partner, LabCorp, to perform the lab panel blood draws. Understanding that there will be significant eligible personnel and that these participants may not all live in Orange County boundaries, we feel as though the most convenient and reliable solution will be to utilize LabCorp and their significant network of draw locations throughout Southern California.

The process will be initiated once a participant is scheduled for his/her exam 30 days in advance, at that time they will be entered into the Hoag Executive Health EMR system and an electronic lab requisition will be created and sent to LabCorp. The participant will then simply need to log onto the LabCorp website from a computer, phone or iPad and locate the closest and most convenient LabCorp location to either his/her worksite or home. In addition, Hoag Executive Health will email each participant with a copy of the lab requisition (just in case) as well as a website link that lists all Orange County LabCorp draw sites and instructions for the fasting blood draw. Participants will be asked to ensure they have completed their blood draw within 2-weeks of their scheduled exam to ensure results are obtained prior to their physical.

Results are then electronically sent to Hoag Executive Health typically within 3-5 business days from the blood draw. Below is the link and an image of the LabCorp “Find a Location” website along with the contact information for our LabCorp representative – Hoag Executive Health has used LabCorp since our inception 8 years ago and they continue to provide excellent service and reliability :
https://www.labcorp.com/labs-and-appointments

Sample Exam Schedule for Huntington Beach Medical & Wellness Exams Hoag Executive Health has proposed two schedule blocks for the Huntington Beach Medical & Wellness Exam Program, a morning and afternoon block. Each block consists of 4 exam “slots” those are as follows:

Morning Afternoon
9:00am – 12:30pm 1:00pm – 4:30pm
Hoag Executive Health will offer both AM slots and PM slots in our Newport Beach facility – below is a sample exam schedule.

Huntington Beach Medical & Wellness Exam Experience
Below is a step by step overview of the exam process for Huntington Beach First Responder Personnel

1. Hoag Program Manager works with FD / PD / Marine Safety designee to establish an exam calendar – days of the week and dates that work best for that agency and personnel. a. Hoag Program Manager will create a SharePoint calendar with designated exam dates/times and slots
b. FD / PD / Marine Safety designee will populate the exam calendar with participants in either 2, 3 or 4 personnel “crews”

2. Each agency will provide a participant list with names, DOB, email address and phone number of eligible exam participants.

3. Participant’s will begin the “exam prep” process 4 weeks prior to their assigned exam date

4. Hoag Program Manager will register each participant into Hoag Executive Health’s electronic medical record system
a. An email will be sent to the participant containing:

1. Medical history and fitness assessment questionnaires

2. Hard copy of the LabCorp lab requisition, lab draw instructions and a link to all LabCorp locations

5. Participant will complete their lab draw and applicable pre-exam questionnaires no less than 1-week prior to his/her annual exam.

6. 3-5 days prior to the scheduled exam date, participants will receive a confirmation email and phone call from the Hoag Program Manager confirming attendance on the scheduled exam date

7. Upon arrival in the office – participants will be checked in and a Hoag support staff member will walk participants to the imaging center to receive their baseline chest x-ray

8. Following completion of the chest x-ray, our staff member will walk the participant back to our office to begin the physical exam

9. The participant will first meet with our clinical support staff to capture all biometric/vital sign data

10. Diagnostic ultrasounds will be performed next, this portion of the exam will take approx..15 minutes

11. Next, the participant will meet with the physician to review all pre-exam questionnaires and conduct a thorough medical health history. Additionally, at this time the fitness for duty evaluation and occupational medicine consultation will be performed

12. Following the physicians consultation, the complete physical examination will be performed

13. Following the completion of the physical exam, participants will transition to a private exercise lab with our exercise physiologist for the fitness and nutritional evaluation – this portion of the exam will take approximately 45 minutes

14. Following the fitness and nutritional assessment, the exercise physiologist will excuse him/herself to retrieve the completed physical exam report in-hand to be reviewed with the participant

15. If there were any medically necessary referrals, our physician would coordinate these with the participant following the report review and prior to their departure.

In total, the entire exam process should take no more than 3-3.5 hours for a “crew” of 4 participants or 1.5hrs for an individual participant.

Exam Scheduling
Hoag Executive Health proposes working with the City of Huntington Beach to establish a mutually agreed upon schedule for Annual Medical & Wellness Exams. Once established we have the ability to flex exam delivery to accommodate a wide range of participants, with the understanding that we can administer as many as 24 exams per week while providing both AM and PM exam slots. Our delivery schedule would for an entire 4-member crew to be done and back "on-duty" in approximately 3 hours. Furthermore, no participant will have any more than 30- minutes of down time during the entire exam process. During down time, participants will have a private lounge to wait in that is equipped with a computer, WiFi, television and comfortable amenities. This is an almost identical schedule format to what we put together for the Orange County Fire Authority WEFIT program and we are confident that the logistical plan we've outlined will be time efficient while also allowing more than sufficient time to conduct a meaningful and thorough exam.

Hoag Executive Health is proposing that all initial scheduling of Annual Medical & Wellness Exams be done utilizing our secure online SharePoint scheduling system. Hoag Executive Health will create a shared online calendar where the FD/PD/Marine Safety “designee/coordinator” will be able to schedule exams as far as 1 year out and can schedule participants into designated AM or PM time slots at our Newport Beach Hoag Executive Health delivery location. When scheduling a crew or individual participants, each participants name, DOB, email address and phone number will need to be provided in order to secure the slot(s). Once the appointment has been scheduled, an email notification will be sent to the Hoag Executive Health Program Manager to complete the scheduling process, create the applicable lab requisitions and send a hard copy lab req and LabCorp location information to the individual unit participants. Once the participant is scheduled, he/she will receive an email confirming the appointment, as well as a confirmation phone call 3-5 days prior to the exam date.

With regards to timing of blood results, our hope would be that all Annual Medical & Wellness Exam participants have their blood draw completed 2-weeks prior to their exam date, this will allow for 3-5 business days for blood processing and we will then review and report results at the conclusion of the physical exam. Ideally, we would like to have crews scheduled no later than 30-45 days prior to an exam date.

Based on Hoag Executive Health’s experience working with firefighters, police and other emergency responders, we understand that on some occasion’s emergency situations will prevent participants from attending a scheduled exam. Likewise, these same circumstances may lead to the need for participants to reschedule their exam on some occasions – we are fully prepared to accommodate these situations and propose the following straight forward protocols.

No-Show / Late Cancel (Unexcused)
In these instances, we will allow the participant to reschedule his/her Medical & Wellness physical exam preferably within 60-days of the original exam date and we will bill the City of HB for 50% the cost of that designated exam.

Late cancel would be considered as any cancelation with less than a 48-hour notice.

No-Show / Emergency Activities (Excused)
In these instances, we will allow the participant to reschedule his/her Medical & Wellness physical exam preferably within 60-days of the original exam date and we WILL NOT BILL for the cost of the exam.

No-Show / Other (Excused)
In these instances, we will allow the participant to reschedule his/her Medical & Wellness physical exam preferably within 60-days of the original exam date and we WILL NOT BILL for the cost of the exam.

Sample Exam Schedule for Huntington Beach Pre-Employment Exams Hoag Executive Health propose to offer two schedule blocks when pre-employment candidates may be scheduled for exams. Each block could accommodate up to 4 exam “slots” those are as follows:

Morning Afternoon
9:00am – 12:00pm 1:00pm – 4:00pm
Hoag Executive Health will offer both AM slots and PM slots in our Newport Beach facility – below is a sample exam schedule.

City of Huntington Beach Pre-Employment Exam

Huntington Beach Pre-Employment Exam Experience
Below is a step-by-step overview of the exam process for Huntington Beach Ambulance Operator & Firefighter candidates.

1. Hoag Program Manager works with the City of Huntington Beach coordinator designee to establish an exam calendar – days of the week and dates that work best for that agency. a. Hoag Program Manager will create a SharePoint calendar with designated exam dates/times and slots
b. City of Huntington Beach coordinator will populate the exam calendar with up to 4 participants in a given AM or PM exam slot

2. The City of Huntington Beach will provide a participant list with names, DOB, email address and phone number of eligible exam participants.

3. Hoag Program Manager will register each participant into Hoag Executive Health’s electronic medical record system
a. An email will be sent to the participant containing:

1. Medical history questionnaire, POST and Respirator questionnaires if applicable

2. Hard copy of the LabCorp lab requisition, lab draw instructions as well as a link to LabCorp locations

3. Drug screen instructions will also be provided along with the address of Hoag EHS where the specimens will be securely collected.

4. Participants will complete their lab draw and applicable pre-exam questionnaire no less than 3-days prior to his/her Pre-Employment exam.

5. Drug screen specimens will be collected on the day of the pre-employment exam.

6. 3-5 days prior to the scheduled exam date, participants will receive a confirmation email and phone call from the Hoag Program Manager confirming attendance on the scheduled exam date

7. Upon arrival in the office – participants will be checked in and a Hoag support staff member will walk participants to the imaging center to receive their baseline x-ray(s)

8. Following completion of the x-ray, our staff member will walk the participant back to our office to begin the physical exam

9. The participant will first meet with our clinical support staff to capture all vital sign data

10. Next, the participant will meet with the physician to review all pre-exam questionnaires and conduct a thorough medical health history.

11. Following the physician’s consultation, the complete physical examination will be performed

12. Following the completion of the physical exam, candidates will transition to a private exercise lab with our exercise physiologist for any required physical performance test – this portion of the exam will take approximately 15-30 minutes
i. For Ambulance Operator and Lifeguard Candidates this is the conclusion of their exam

13. Following the physical performance test, Firefighter and Police Officer candidates will have completed their exam.

Post Exam Process and Reporting
Following the conclusion of the Pre-Employment exam, the Hoag Executive Health physician will review all clinical results and determine whether there are any Category A or Category B medical conditions that would preclude a person from performing the duties of the job. Our team will then complete a full and complete report of findings, any required vaccinations and indicate whether the participant has any defined restrictions. To further clarify, Hoag Executive Health will not provide a determination on hireabiltiy of candidates, rather we will work with the City of Huntington Beach to define a process for data and information sharing so that a determination of employment can be made by the city.

Logistics & Operations
At this point Hoag Executive Health is very familiar with the unique requirements and demands associated with day-to-day operations for Fire, Police and Marine Safety entities seeing as we currently conduct ~4,000 first responder exams annually across 4 delivery site locations in Orange County. As such, our goal is to alleviate as much of the direct oversight and participant interaction as possible so that once scheduled, our team handles almost the entirety of operational and logistical tasks associated with the delivery of exams. As indicated previously, Hoag Executive Health would look to identify a “coordinator designee” from each department (if there is a single point of contact that can provide the necessary information and details that would be ideal) to assist with:
a. Gathering necessary participant demographics (Legal name, DOB, email, phone number) for scheduling b. Scheduling Crews/Individual participants via secure SharePoint calendar c. Confirming excused/un-excused cancelations, reschedules or no-shows d. Ability to receive “Employer Exam Report” which indicates work status e. Attendance at quarterly/bi-annual program update meetings to review systems, processes and data We would hope and expect that should additional interactions or items be uncovered after the award of this contract that the City of Huntington Beach coordinator/designee would be willing to assist with these tasks.

Qualifications
Without sounding repetitive, Hoag Executive Health is truly uniquely qualified to deliver the city of Huntington Beach’s Annual Medical & Wellness and Pre-Employment Exam program. We are the preeminent provider of customized and personalized healthcare on the West Coast of the U.S., as illustrated by the partnerships and clients we serve. Our organization was founded Dr. James Lindberg who has been a luminary in the preventative and risk screening health space for almost 2 ½ decades. Dr.

Lindberg founded the Hoag Executive Health program after Hoag Hospital determined that a best-in-class executive health screening program was lacking in the Southern California market. Every aspect of a patient’s experience with Hoag Executive Health is framed by our desire to provide the highest level of clinical care and customer service to a very demanding clientele. Every member of our staff from our physicians to our medical assistants, practice managers, trainers and exercise physiologists…even our receptionists strive to exceed the highest expectation for clinical and customer service. We strive to turn what can be a stressful and worrisome event into an enjoyable experience through our friendly staff, comfortable facilities, and proactive approach to health. To gauge our service level, we provide every participant with a survey following their physical exam. We include a question regarding their likelihood of recommending our service to a co-worker, friend or family member – this is commonly referred to as a Net Promoter Score (many Fortune 500 organizations utilize the NPS score as a barometer of their success at exceeding the expectations of patrons). Hoag Executive Health has maintained an NPS score of .90 or above for the last 5 years. To put this in perspective, American Express has a Net Promoter Score of .52, Costco has a NPS of .72, and Trader Joes received a NPS of .62 in 2015. Clearly, participants enjoy their experience at Hoag Executive Health and feel strongly that their friends, family and co-workers should have the same experience.

There are a number of features that the Hoag Executive Health program possesses that distinguish our clinical approach and equate to measurable success in effecting lasting, meaningful and positive changes in the health and wellbeing of our participants. We would state that these differentiators fall under the following 3 areas:

Clinical Structure
Our physicians are able to specialize specifically in screening and preventative medicine. As such, they’re familiar with the logistical process and protocols of First Responder Exams and are able to spend significant time – much more than a typical “checkup” – with each first responder participant to ensure questions are answered and concerns are addressed.

Empowered Subject Matter Experts
Hoag Executive health believes that in order to provide a truly personalized healthcare experience, we must have access to individuals who have expertise in as many clinical and fitness realms as possible. In addition to hiring the very best, we also have the ability to access clinicians and subject matter experts from each and every Hoag Hospital specialty institute (Cancer Institute, Heart and Valve Institute, Women’s Health Institute, Hoag Orthopedic Institute, Neurosciences Institute). This means that whether it is for an educational talk, second opinion or creation of a new service or program, we are able to immediately access some of the best healthcare minds in the country at a moment’s notice.

Tools and Modalities
Our Chief of Service Dr. James Lindberg has always believed that in order to provide a world-class program, we must be able to provide our patients access to the very best tools and modalities for the job.

We incorporate a level of technology into our exams that other primary care providers simply do not have access to, and in turn this means that our patients are able to receive diagnostic tests and assessments that traditionally are not offered with most other providers.

Just some of the value-added benefits we are incorporating into the Medical & Wellness program are listed below:
- Cutting edge equipment and facilities
- Online scheduling process
- Advanced skin cancer screening
- Digital Postural analysis
- Full Gas exchange VO2 Max and Resting Metabolic Rate analysis - Employee Health and Occupational Health expertise
- Direct access to exercise physiologists and performance experts via email and phone o Customized meal planning
o Custom workout program prescription
Proposed Implementation & Launch
Given our current delivery of the majority of this program for the City of Huntington Beach, Hoag Executive Health foresees requiring no more than 2-weeks for a full implementation of the Huntington Beach Medical & Wellness Exam program. Below is our proposed outline for the program launch:

Award and Kickoff Meeting (ideally within 1 week of bid being awarded) - Introduction of all key Hoag Executive Health personnel (Program Director, Day to Day Manager, Medical Director, Exercise Physiologists, etc.), along with any other pertinent City of Huntington Beach personnel directly involved in the Annual Medical & Wellness Exam program. o We will cover a detailed overview of the exam process from initial scheduling to completion of exam, handling reschedules and no-shows, how to handle urgent medical referral situations, etc.
o Determine best practices for day-to-day communication o Set a preliminary schedule and desired content for quarterly in-person meetings o Review invoicing/billing systems and processes
Follow-up/Pre-Launch Meeting (ideally 1 week prior to launch of program) - The goal of this meeting will be to have final signoff/agreement on all exam scheduling and delivery systems and processes.
o Solidify any recommended changes to the exam process as proposed by FD/PD/Marine Safety designee/coordinator
o Solidify initial communication message and content to be distributed to all eligible personnel, announcing Hoag Executive Health as the new Annual Medical & Wellness Exam provider Program Launch - TBD

Support & Delivery Team
Project Manager – Justin Davis, Vice President of Client Services Justin currently oversees all operational and business development components of the Hoag Executive Health Program. Justin has a significant amount educational and work background that uniquely positions him for success in overseeing the Annual Medical & Wellness Exam program. Justin received his undergraduate degree from Cal-State Fullerton where he completed his Bachelor of Science degree in Kinesiology with an emphasis in Athletic Training. Upon completing his undergraduate degree, Justin began what would become a decade long role with Velocity Sports Performance, at the time, one of the country’s largest strength and conditioning organizations. Justin continued his education, receiving an advanced degree from Long Beach State University in Sports Management – his experience working in clinical, athletic and business environments will provide an ease of understanding and an ability to directly interact in every component of the Annual Medical & Wellness Exam program. In addition to overseeing the Orange County Fire Authority’s WEFIT program, Justin currently acts as the program director for the NFL Players Trust Brain and Body and Milestone Wellness Assessment programs. These are clinical joint venture programs with the Cleveland Clinic and Hoag Hospital wherein Hoag Executive Health oversees the management, delivery and administration for one of the most robust retired NFL player physical exam programs in the country.

Day-to-Day Account Manager – Ted Schaper, Coordinator – First Responder Programs Ted currently is responsible for the day to day operational functions and management oversight of 3 First Responder programs delivered in Newport Beach, Irvine and Aliso Viejo. Ted has been with Hoag Executive Health for 5 years. As the First Responder Program Coordinator, Ted oversees the world-class service delivery in each of our practice locations. Ted is responsible for every component of First Responder Programs, from personnel to clinical and service delivery, Ted is involved in all aspects of program oversight. Ted graduated with a Bachelors Degree in Physical Education and has a number of sports medicine and fitness certifications from the NSCA and ACSM. Ted works out of our Newport Beach medical office.

Chief of Service – Dr. Jim Lindberg
Dr. Lindberg is Board Certified in Internal Medicine. Since 2011, Dr. Lindberg has managed the medical delivery of the Hoag Executive Health Program and since 2016 the Hoag First Responder program as its Chief Medical Officer. In this role, Dr. Lindberg works with the Hoag Executive Health Physician Faculty to develop quality standards for the program, develop the medical protocols and the delivery model for each of our specialized physical exams and screening programs, as well as overseeing the Hoag Executive Health Certification Program that prepares qualifying physicians to deliver physicals.

HEH Physician Faculty
There will be 6 Hoag Executive Health physicians who will administer the clinical portion of the Annual Medical & Wellness Exam Program (additional physicians may be added later as needed to meet demand). Only Hoag Executive Health Certified Physicians will conduct the annual exams being delivered at our medical facility in Newport Beach, CA. Below is a list of the physicians who will be administering the program:

James Lindberg, M.D. – Board Certified Internal Medicine Steven Nemirov M.D. – Board Certified Family Medicine
Kory Tuominen M.D. – Board Certified Family Medicine
Glen Barbee – Board Certified Family Medicine
Pam Tabrizi, MD – Board Certified Family Medicine
Meenakshi Verma, MD – Board Certified Internal Medicine Program Cardiologist – Dr. Stephen A. Cohen
Dr. Cohen, a Board Certified Cardiologist, will oversee the cardiovascular components of the Annual Medical & Wellness Exam program. Dr. Cohen is a Fellow of the American College of Cardiology and was the Chief of Medical Staff at Irvine Regional Hospital and Medical Center from 2005-2007. Dr. Cohen is at the forefront of his specialty and widely regarded as one of the top cardiologists in Southern California. In this role, Dr. Cohen will review all cardiovascular tests, assessments, and labs in conjunction with the attending Hoag Executive Health Physician who performs the annual exams.

Exercise Physiologists
The primary function of the Exercise Physiologist is to assist the physician in providing fitness and nutrition testing/assessments to participants of the Annual Medical & Wellness Exam program. He or she will assess the participant’s current fitness and performance levels through a series of tests. From these test results, the Exercise Physiologists then create an individualized exercise program for the participant.

He or she will also assess the client’s current diet and make nutritional recommendations accordingly.

Dan Sparks – Exercise Physiology / Strength Coach
Darien Pyka – Exercise Physiology / Strength Coach
Aubrie Jaime – Exercise Physiologist / Athletic Trainer Shane Harris – Exercise Physiologist / Athletic Trainer Wray Watkins – Exercise Physiologist / Health Coach / Strength Coach Haley Lantiegne – Exercise Physiologist / Athletic Trainer Sean Higgs – Exercise Physiologist / Athletic Trainer / Strength Coach

References
Company Name – Hoag Executive Health

Offer Cost Proposal

Term of Offer
It is understood and agreed that this offer may not be withdrawn for a period of one hundred eighty days (180) from the Proposal Submittal Deadline, and at no time in case of successful Offeror. _______________________ ___11-4-2024___
Justin Davis Date
Vice President – Business Development
Hoag Executive Health

Insurance Documentation

Hoag Management Physical Collateral

Communication and Report Samples

Aggregate Data Reports
Below is a sample of some of the aggregate data metrics Hoag Executive Health plans on capturing and reporting.

We will look to add to this list as we begin to conduct exams and identify additional pertinent biometric markers that we deem valuable to the overall success of the program.

Sample Graphical Reporting of Aggregate Fitness Data

Sample Exam Reports and Questionnaires

Sample Pre-Employment Reports & Forms

Medical History and Individual Health Risk Assessment (Questionnaire) PERSONAL INFORMATION Date of Birth ____/ ____/ ________ First Name__________________ MI ____ Last Name _________________________________ Street Address _________________________________________________________________ City ______________________________ State ______ Zip Code ________________________ Married Single Separated Widowed Divorced (Circle One)

CONTACT INFORMATION
Home Phone ___________________________ Home Fax___________________________ Work Phone____________________________ Work Fax____________________________ Mobile Phone___________________________ email_______________________________ Preferred Contact Method Mail Phone (H W M) email (Circle one) Emergency Contact____________________________________Phone_____________________ Is there an individual able to receive medical information in case we are unable to contact you? Yes No (Circle One) Name_______________________ Phone____________________

SUPPORT PROVIDERS
Primary Care MD______________________________________ Phone____________________ Preferred Hospital_____________________________________ Preferred Pharmacy___________________________________ Phone_____________________

INSURANCE
Group Name______________________________ Group Number ________________________ Insurance Company _____________________________________________________________ Guarantor________________________________ Relation Self Spouse Other (Circle One)

INFORMATION
First Name__________________ MI ____ Last Name _________________________________

MEDICATION
Medication Prescription Dosage MD / Reason / How Long?

MEDICAL PROBLEM LIST
Medical Issue/ Problem Medical Problem/ Issue

ALLERGIES
Medication / Allergen Reaction

SURGICAL HISTORY
Date Surgery Doctor/ Hospital

HOSPITALIZATIONS
Date Reason Doctor/ Hospital

FAMILY HISTORY
Relation Alive Age Illnesses
Grand Parents
Father
Mother
Brothers
Sisters
Other
NOTES

SOCIAL HISTORY
SMOKING: Never [ ] Quit [ ] Years since ____ Ave; Cig/Day Still [ ] Ave Cig/ Day ___ HOME: Home Smoke Detectors (Y or N) Fire Extinguishers (Y or N) Non-skid surfaces on tubs/showers (Y or N) Use Proper Lifting Techniques (Y or N) HYGIENE: Number of times you brush teeth daily? ____ Floss Teeth Regularly? (Y or N) ALCOHOL: Consume in TYPIC AL WEEK ___Cans Beer ___Glass Wine ___ Ounces Liquor ___

STRESS ASSESSMENT
How do you feel you are CURRENTLY coping with life in general? [ ] I am seldom stressed and feel I am coping well
[ ] I get stressed sometimes, but seem to be coping fairly well [ ] I am always stressed and sometimes have trouble dealing with it all [ ] I am under a lot of stress that is pretty heavy and I often have trouble coping with it [ ] I am under tremendous stress and I feel I am unable to cope with it Have you felt tired, worn out, or exhausted during the past few months? [ ] The majority of the time
[ ] Less than 50% of the time
[ ] I only feel that way occasionally
[ ] I seldom, if ever, feel this way
How supportive do you feel your family, close friends and associates are? [ ] Very supportive [ ] Somewhat supportive [ ] I don’t feel they are very supportive Check all the stress management techniques you use to manage stress [ ] I have a hobby I enjoy and participate in it regularly [ ] I belong to a social group that I enjoy and attend regularly [ ] I practice deep relaxation at least 3 times each week [ ] I try and practice time management skills and use a system that works for me

HEALTH BEHAVIORS
Do you feel you could be at risk for HIV infection? Y N Do you know how HIV is prevented? Do you have a fair complexion? Y N Do you use sunscreen? Y N
Rate Your Health: poor fair good excellent
Number of days you missed work last year due to illness: ________

PREVENTIVE HEALTH PLANNING
Health Activity Never <30 Days <1 Yr < 2Yr < 3 Yr <5Yr
Physical Exam
Dental Exam
Eye Exam
Skin Exam
Prostate Exam
Self-Skin Exam
Stress EKG
Colonoscopy
BP Check
PSA Lab Test
Cholesterol
Heart Scan
Bone Density
Mammogram
PAP Smear
Pelvic Exam

WOMEN’S HEALTH QUESTIONS
At what age did you have your first menstrual period? _______ If you have children, how old were you when you when your first child was born? _______ How many women in your natural family have had breast cancer? _______ Have you had a hysterectomy? Y N
Do you or have you taken hormone replacement therapy? Y N Have you ever had an ABNORMAL PAP smear? Y N

REVIEW OF SYSTEMS
In each area, if you are not having any difficulties, please check “No Problems.” If you are experiencing any of the symptoms listed, PLEASE CIRCLE THE ONES THAT APPLY, or explain any that may not be listed (Health in General) ٱ No Problems Lack of energy, unexplained weight gain or weight loss, loss of appetite, fever, night sweats, pain in jaws when eating, scalp tenderness, prior diagnosis of cancer. Other:
_______________________________________________________________ Ears, Nose, Mouth & Throat ٱ No Problems Difficulty with hearing, sinus problems, runny nose, post-nasal drip, ringing in ears, mouth sores, loose teeth, ear pain, nosebleeds, sore throat, facial pain or numbness.

Other:______________________________________________
C-V (Heart & Blood Vessels) ٱ No Problems Irregular heartbeat, racing heart, chest pains, swelling of feet or legs, pain in legs with walking. Other: __________________________ Resp. (Lungs & Breathing) ٱ No Problems Shortness of breath, night sweats, prolonged cough, wheezing, sputum production, prior tuberculosis, pleurisy, oxygen at home, coughing up blood, abnormal chest x-ray.

Other: _____________________________________________________ GI (Stomach & Intestines) ٱ No Problems Heartburn, constipation, intolerance to certain foods, diarrhea, abdominal pain, difficulty swallowing, nausea, vomiting, blood in stools, unexplained change in bowel habits, incontinence. Other: ______________________________
GU (Kidney & Bladder) ٱ No Problems Painful urination, frequent urination, urgency, prostate problems, bladder problems, impotence. Other: ______________________________________ MS (Muscles, Bones, Joints) ٱ No Problems Joint pain, aching muscles, shoulder pain, swelling of joints, joint deformities, back pain. Other: ________________________________________ (Skin, Hair & Breast) ٱ No Problems Persistent rash, itching, new skin lesion, change in existing skin lesion, hair loss or increase, breast changes. Other: ______________________________ Neurologic (Brain & Nerves) ٱ No Problems Frequent headaches, double vision, weakness, change in sensation, problems with walking or balance, dizziness, tremor, loss of consciousness, uncontrolled motions, episodes of visual loss. Other: __________________________________
Psychiatric (Mood & Thinking) ٱ No Problems Insomnia, irritability, depression, anxiety, recurrent bad thoughts, mood swings, hallucinations, compulsions. Other: ________________ Endocrinologic (Glands) ٱ No Problems Intolerance to heat or cold, menstrual irregularities, frequent hunger/urination/thirst, changes in sex drive. Other: _______________________ Hematologic (Blood/Lymph) ٱ No Problems Easy bleeding, easy bruising, anemia, abnormal blood tests, leukemia, unexplained swollen areas. Other: ______________________________ Allergic/Immunologic ٱ No Problems Seasonal allergies, hay fever symptoms, itching, frequent infections, exposure to HIV. Other: _______________________________________________

HEALTH AGE
Sex M F
Race White Black Hispanic Asian American Indian Other
Longevity
Parents past 80 [ ] Parents past 70 [ ] Parents past 60 [ ] Few past 60 [ ] Few past 50 [ ] Education
Grade school [ ] high school [ ] Some college [ ] College graduate [ ] Sleep < 6 hours [ ] 6-7 hours [ ] 7-8 hours [ ] 8-9 hours [ ] >9 hours [ ] Cholesterol / HDL Ratio INTERNAL USE
Blood Pressure INTERNAL USE
Smoking Never [ ] Quit > 10 Yr [ ] Quit > 10 Yr [ ] Around smokers [ ] 1 pack daily [ ] Heart disease Heredity (Close Relatives)
No family Hx [ ] 1 > 60 years old [ ] 2 > 60 years old [ ] 1 < 60 years old [ ] 2< 60 Years old [ ] Waist/Hip Ratio INTERNAL USE
Stress Unhurried [ ] Ambitious [ ] Sometimes competitive [ ] Competitive [ ] Type A [ ] Physical Activity (intensity & frequency /week)
Sedentary [ ] 20m light, 1-2days [ ] 30m moderate 3-4 days [ ] 30m moderate 5 days [ ] 60m high most days [ ]
Medical Exams and Tests
Regular Exams [ ] Periodic Exams [ ] Sometimes get tests [ ] No Tests or Exams Exams [ ]

Heart History (Self or Family)
No History [ ] Some History [ ] Rheumatic Fever with murmur [ ] no murmur [ ] EKG Abnormality or Angina [ ]
Lung History including TB or pneumonia
No problems [ ] Some past problems [ ] Mild asthma [ ] Severe asthma or emphysema [ ] Severe Lung Problems [ ]
Digestive Health History
No problems [ ] Occasional Diarrhea [ ] Frequent Diarrhea [ ] Severe GI disorder [ ] Ulcers, Colitis, Gall bladder, Liver problems [ ]
Diabetes Personal or Family History
No problems [ ] Family History [ ] Hypoglycemia [ ] Hypoglycemia and family history [ ] Mild Diabetes, diet and exercise [ ] Diabetes with insulin [ ] Medication (OTC and prescription)
Seldom use [ ] Minimal OTC use [ ] Regular OTC use [ ] Regular Rx Use [ ] Heavy Rx Use [ ] Breakfast (frequency and nutrition)
Daily [ ] Sometimes [ ] None [ ] Coffee [ ] Coffee and doughnut [ ] Regular Meals per day
3 or more [ ] <3 meals [ ] Not regular [ ] Starve and stuff [ ] Fruits and Vegetables per day
5 or more full servings [ ] 2-4 servings [ ] 1 or fewer servings [ ] don’t eat them [ ] Monounsaturated Fats (Avocados, Olives, Olive oil, Almonds) Daily [ ] 2-4 times each week [ ] Occasional [ ] Rarely [ ] Omega 3 Fatty Acids (Fish, flax seeds, grass fed meats) Daily [ ] 2-4 times each week [ ] Occasional [ ] Rarely [ ] Refined Oil (Omega 6, fried foods, salad dressings, cooking oils, packaged foods) None [ ] Occasional [ ] 2-4 times each week [ ] Daily [ ] Regular hydrogenated oils and deep fried foods [ ]
Refined, Processed Foods
None [ ] Some [ ] Regular bread, rice, cereals [ ] Regular sugar, sodas, sweets and snacks [ ]

Alcohol
None [ ] 1 daily [ ] 2 daily [ ] 3+ periodically [ ] 3-6 drinks daily [ ] >6 drinks daily [ ] Driving <7000mi/Yr [ ] 7-15,000 mi/Yr [ ] 15-20,000 mi/Yr [ ] >20, 000 Mi / Yr [ ] Seat Bel Usage Always [ ] 75% of time [ ] On highway only [ ] Sometimes [ ] Never [ ] Risk Taking Never [ ] Some with care preparation [ ] Occasional [ ] Often [ ] Always [ ] Happiness
Generally happy [ ] Satisfied [ ] Unsure about life [ ] Often unhappy [ ] Usually unhappy [ ] Depression
No family History [ ] Family History, I’m OK [ ] Family History, I am mildly depressed [ ] Sometimes I feel life is not worth living [ ] Thoughts of Suicide [ ] Anxiety
Seldom Anxious [ ] Occasionally [ ] Often [ ] Always [ ] Panic Attacks [ ] Relaxation
Relax Daily [ ] Often [ ] Seldom [ ] Usually tense [] Always Tense [ ] Love and Marriage
Happily Married [ ] Married [ ] Unmarried [ ] Separated, divorced, widowed [ ] Extramarital [ ] Job Satisfaction
Enjoy Job [ ] Job OK [ ] Dislike job [ ] Hate job [ ]
Friends and Social
Have close friends [ ] Have friends [ ] Have no good friends [ ] Stuck with people I don’t enjoy [ ] No friends [ ]

OFFICE USE ONLY

Behavioral Health Questionnaire (PHQ-9)

Fitness Assessment
Huntington Beach Fire & PD Fitness & Nutrition Assessment Participant Information
Name: ____________________________ Gender:________________ Date: _________________ Date of Birth: ___________________ Age: __________ Physician: ___________________________ Body Composition (to be filled out by trainer)
Weight____________ Body Fat Percentage__________ Body Fat Mass_________ Muscle Mass __________ Goals

1. Rank your top 5 health and fitness goals in order of importance (1 being the most important) ____ Weight Loss ____ Improve Posture
____ Weight/Muscle Gain ____ Stress Relief
____ Improve Flexibility ____ Improve Cardiovascular Fitness Level ____ Improve Physical Appearance ____ Improve Overall Health ____ Improve Eating Habits ____ Reduce Pain in
____________________________________
____ Sports Performance: ________________________ ____ Other:
______________________________________________

2. Do you have a specific timeline for achieving a specific goal? If so, please specify:

3. Which type of progress is more important to you? Please explain.

Immediate progress that’s less easily maintained
Maintainable progress that may not be as rapid
__________________________________________________________________________________________ _____________________________
__________________________________________________________________________________________ _____________________________

Lifestyle & Exercise History

4. What is your occupational activity level?

Inactive (Sitting Only)

Light (Sitting & Standing)

Moderate (Mostly Standing & Moving)

Heavy (Manual Labor, Physically Demanding)

5. Including work, driving, eating, and lifestyle activities, how many hours a day do you spend sitting?

0-4hrs
4-8hrs
8-12hrs
12+hrs

6. How often do you travel?

Rarely
A few times a year
A few times a month
Weekly

7. Do you have a health club membership?
YES
NO Where?
_____________________________________

8. Are you currently exercising regularly (at least 3x per week)? YES
NO
If you answered YES, continue on to number 9& 10. If you answered NO, skip ahead to number 11 &

12. 9. How long have you been consistently exercising without a break? ______________________________________

10. In the chart below, fill in which type of exercise you normally perform each day.

Resistance Training (RT); Interval Cardio (IC); Low Intensity Cardio; Sport Specific Work (SSW).

Day Mon Tue Wed Thu Fri Sat Sun
Type of
Exercise
Duration

11. If you are not currently exercising regularly, have you ever been on a consistent exercise plan?

YES
NO
If yes, how long ago and how long did it last?
______________________________________________________________________________

12. What days & times do you have available each week for exercise? Please circle & indicate the amount of time you have available each day. (Only if you are not currently exercising) Day Mon Tue Wed Thu Fri Sat Sun
AM or
PM
Duration

13. Do you engage in recreational or leisure physical activities on a regular basis? YES
NO
If so, what type?
______________________________________________________________________________ _________________
Diet History

14. Are you currently following a nutrition plan? Yes / No If so, how long?

15. Which do you eat regularly?

Breakfast

Mid-afternoon
snack

Mid-morning snack

Dinner

Lunch

After-dinner snack

16. How often do you eat out each week? And
for which meals?
Meal Times per week
Breakfast
Lunch
Dinner
The places you usually eat at are:
a)_________________________________
b)_________________________________
c)__________________________________

17. How would you rate your current nutrition practices?

Test Patient Annual Medical & Wellness Exam Program

I don’t think nutrition is important and/or relevant to my goals

I don’t know where to start and/or I have tried before and failed, &/or nothing seems to work for me

Ok, I feel like I make ok choices occasionally, but not frequently

I make good choice most of the time

I always make good choices

18. Which food do you gravitate towards?

Appetizers/Bread/Chips

Fried foods

Sodas, teas, juices etc.

Caffeine

Dessert

Alcohol

19. Please list all supplements and medications you are currently taking:

20. How many times per week do you shop for groceries?
0 ___ 1 ___ 2 ___ 3 ___ 4+ ____

21. What do you consider your “Vice” to be? Example: Eating late at night; sugars; alcohol, etc.

22. My current diet could be best characterized as (check all that apply):

Low Fat
Low-carb
High-Protein
Vegetarian/Vegan
No special diet

23. Do you have any food allergies or dislikes or anything that causes you discomfort?

24. Let’s talk about your food log:

How accurate would you say your food log is?
___________________________________________________________ If it isn’t accurate, why not?
________________________________________________________________________________ If it is accurate, how long have you been eating this way? _______________________________________________

Test Patient Annual Medical & Wellness Exam Program
Surgeries & Injuries

25. Please list all surgeries & past injuries. Include sprains, strains, everything you can think of.

Injury/Surgery Date Does it still bother you?

26. Are you currently experiencing any joint or muscle pain? YES
NO
If yes, please explain:
____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

Test Patient Annual Medical & Wellness Exam Program
Individualized Health Risk Appraisal (Physical Report)
Test Patient
123 Main St.

Irvine, CA 92614
Dear Test Patient,
Thank you again for spending time with my team and allowing us to work with you in providing a comprehensive review of your current state of health. We thoroughly enjoyed having the opportunity to meet and get to know you. It is our belief that your health is your most important asset and we commend you on making it a priority.

The enclosed information is a summary of the findings and recommendations from your Annual Medical & WellnessPhyscial exam that we performed on May 25, 2019. This information is designed to be reviewed with your primary care physician. It is also designed as a reference for you to review periodically while working towards your Health and Fitness Goals.

It is important that you continue to have a comprehensive health assessment and physical examination on a yearly basis.

Having a Health Partner, such as a primary care physician, review this report and follow you appropriately throughout the year will help you achieve optimal health. It is much better to have a physician who is familiar with your unique health history care for you when the unexpected illness or accident occurs instead of seeking a new physician in times of crisis.

Also, having a health partner periodically review your fitness level will help motivate you to achieve your health and fitness goals through accountability and familiarity.

Lastly, included with this report is a USB Flash Drive. It should be kept with you at all times as it contains the medical information in this report (including a medication list), copies of your electrocardiogram, laboratory test results, and other information that may be important to the emergency department physicians in the event of a medical emergency.

Professionally yours,
Physician Name, M.D.

Test Patient Annual Medical & Wellness Exam Program
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Examination Date

May 26, 2019

Test Patient Annual Medical & Wellness Exam Program
Longevity
Biological Age and Life Expectancy
The reason we ask you some of the same questions each year is that life changes. The answers you give to questions about your lifestyle, including your habits, behavior and the environment you live in provide important clues to estimating your longevity.

The calculation of your “health age” also considers several important clinical results we collect during your exam.

While the estimate is just that, it does allow us to compare how your lifestyle and clinical results interact to preserve your good health. The “longevity” calculation projects what this information means relative to the estimated length of your life. Soft data, but interesting and meaningful directionally over time.

The following factors are known to maximize your longevity:

What you eat – A diet rich in vegetables, reduced in calories based on your weight and that avoids sugar with adequate, but not excessive protein can help lengthen your life. Be sure your diet is rich in Omega-3 Fatty Acids found in seafood or supplement with fish oil
What you weigh – Maintaining a healthy body weight with a body fat somewhere between 15-25% Move – Getting 40 minutes of exercise daily can help lengthen your life Don’t Smoke at all
Get at least 7 hours of sleep each night
Where your seat belt 100% of the time
Recognize, reduce and manage stress in your life
45 80
0 10
20 30
40 50
60 70
80 90
100
110
120
Biological Age Longevity
2017

Test Patient Annual Medical & Wellness Exam Program
Cardiovascular Exam and Risk Factors
Resting Electrocardiogram (ECG)
It is the contraction of your heart muscle that powers life. About the size of your closed fist, it takes deoxygenated blood from the veins in your body, pushes it into the lungs where it becomes oxygenated and then out through the arteries supplying oxygen to support your body’s life and function.

Result
Normal
The heart has a miraculous internal electrical system that keeps it pumping in a predictable way to perform its critical function. Small as this current is, it can be recorded from the surface of the body as an electrocardiogram which records how the current passes through the heart muscle itself.

The EKG is a valuable tool used to evaluate the electrical conduction through the heart muscle, the origin of abnormal heart rhythms, and the presence of heart muscle damage (past or present). It is also used to detect a lack of oxygen, abnormal heart muscle size or inflammation, the effect of cardiac drugs or even disturbances in some electrolytes (salts) in the blood.

While the EKG is helpful in evaluating many important heart related issues, it DOES NOT detect atherosclerosis in the arteries that supply blood to the heart muscle nor help us predict your future risk of developing heart disease.

An EKG can result can either be NORMAL, ABNORMAL or NON-SPECIFIC. Abnormal results typically need to be evaluated further by a cardiologist. Non-specific results may need to be evaluated by a cardiologist depending on the clinical context. It is always helpful to compare one year’s EKG with a previous EKG to help determine its clinical significance.

Test Patient Annual Medical & Wellness Exam Program
Blood Pressure : Too High
In populations, blood pressures follow a normal distribution, but the risk of heart disease and stroke increase with increasing blood pressure. Blood pressure is defined as the force blood exerts against the artery walls. Systolic pressure is the force exerted as the heart is contracting and diastolic pressure is the measured force between heartbeats. The separation of normal from elevated blood pressure is arbitrary and has been determined in the United States by panels of experts based on the health risk data. Based on the most recent group, The Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the following categories of risk have been determined:

BP Classification SBP (Top Number) DBP (Bottom Number)
Normal <120 And <80
Prehypertension 120-139 Or 80-89
Stage I Hypertension 140-159 Or 90-99
Stage II Hypertension >160 Or >100
Starting as low as 115/75 mmHg the risk of death due to heart disease doubles for every increase by 20 mmHg SBP or 10 mmHg DBP. Achieving and maintaining a healthy blood pressure can have a significant impact on your health and longevity. The good news is there is a lot you can do to lower your blood pressure. During your consultation you will learn that diet, exercise, weight loss, a reduced salt diet, moderate alcohol, smoking cessation, and stress management all contribute to achieving a healthy blood pressure.2
143
87 0
50 100
150
200
2017
systolic diastolic

Test Patient Annual Medical & Wellness Exam Program
Framingham Heart Disease Risk Scoreї10 Year Cardiovascular Score There are a number of different tools available to calculate the risk of heart disease in the future. The differences are related to the variables used for the calculation and the outcomes being considered. For instance, one calculation may reflect the risk of heart attack or death due to heart disease (Framingham ATP-III) another the risk of heart attack, death, angina, ischemic or hemorrhagic stroke, TIA, peripheral artery disease or heart failure over a 10-year period (Framingham NHLBI).

Though there are many factors we consider, in general we would consider a calculated risk below 10% as being LWO RISK; a calculated risk between 10-20% MODERATE RISK and above 20% as HIGH RISK. 1%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
22%
24%
26%
28%
30%
Framingham Heart Disease Risk Score
2017

Test Patient Annual Medical & Wellness Exam Program
Lipid Profile
Lipids are fats that circulate in the blood which when elevated are associated with cardiovascular risk. The most commonly recognized blood fats are cholesterol and its components LDL (bad) and HDL (good). Each of these, we now know, can be further sub-divided to create a more granular pattern of risk with differ therapeutic targets. Each of these is actually a particle that contains different levels of protein and cholesterol. We determine the amount of cholesterol as well as the number and sizes of the particles to get a better risk picture.

The lipid laboratory included provides a detailed profile of your cholesterol related risks so we can best advise you regarding reducing the previously calculated risk. We trend these over time to monitor treatment and/or risk progress.

We now know that inflammation plays a critical role in the development of atherosclerosis and impacts your risk and the character of the disease by destabilizing any plaque that may be present in the artery wall. There are three markers we now measure to help evaluate your cardiovascular risk.

Hs-CRP
Inflammation
hs-CRP is a very sensitive, non-specific marker of inflammation that can be elevated due to any inflammatory process including atherosclerosis. 217
0 200
Total Cholesterol 2017
95 0
25 50
75 100
125
150
175
200
Triglycerides
2017
125
0 25
50 75
100
125
150
175
200
LDL
2017
73 0
10 20
30 40
50 60
70 80
HDL 2017

2.20 0.00

2.00 4.00

6.00 8.00

10.00 hs-CRP
2017

Test Patient Annual Medical & Wellness Exam Program
Cancer Screening
Physical Exam No SignificantFindings related tocancer risk Laboratory Tests No Significant Findings related to cancer risk Diagnostic Testing No Significant Findings related to cancer risk Laboratory Tests
Complete Blood Count No significant abnormalities
Liver Panel No significant abnormalities
Urine and Kidneys No significant abnormalities
Electrolytes No significant abnormalities
Proteins No significant abnormalities
Diagnostic Test
Colonoscopy N/A
Consultant
N/A
PSA
The PSA blood test (prostate specific antigen) is one of the screening tests for prostate cancer, although conditions other than cancer can also cause the PSA to be elevated. Less than 4.0 is generally considered normal, though we monitor change over time and an accelerated increase in this level from year to year may prompt further testing.

2.0 0
1 2
3 4
5 6
7 8
9 10
PSA
2017

Test Patient Annual Medical & Wellness Exam Program
Metabolic and Hormonal Health
Diabetes
Fasting Blood Sugar (Glucose)
This is a test of the major sugar used for fuel by most of the cells in your body, glucose. The carbohydrates you eat daily found in fruit, bread, pasta, and cereals are rapidly broken down and converted to glucose which is a simple sugar that energizes your cells. As you eat carbohydrates your pancreas releases insulin to allow your cells to utilize the glucose produces in the process.

When your cells do not normally respond to insulin the glucose cannot enter the cells to produce energy. In this case both the glucose and insulin levels increase in your blood in a “pre-diabetic” condition known as insulin resistance increasing the ability to predict the risk of diabetes10. This is important to recognize as it can be reversed and diabetes with all its complications avoided.

Fasting Glucose Level Interpretation
<100 mg% NORMAL
101-125 mg% PRE-DIABETES
>125 mg% DIABETES
105
0 10
20 30
40 50
60 70
80 90
100
110
120
130
140
Fasting Blood Glucose
2017

Test Patient Annual Medical & Wellness Exam Program
Additional Biometric Testing
Results
Spirometry/Pulmonary Function Test
Spirometry is a sensitive measure of lung function. Pulmonary (Lung) function testing measures the total volume of air contained in the lungs as well as in various segments of exhalation. It also determines the flow of air during exhalation at various points in the effort. If screening reveals significant deviations from predicted norms which are based on sex, height and weight, it may indicate the need for more advanced testing.

Vision Testing
Your vision screening evaluates a number of important parameters of normal vision. It evaluates your far-point vision which is what an eye chart determines. Beyond this your screening examines near point vision, color vision and peripheral vision. Combined with your physicians screening evaluation of your retinal during your physical exam, a thorough screening of your eyesight is conducted.

Normal
Annual
Exam

Hearing Testing
Your hearing is tested for any loss of perception across a series of frequencies delivered at various intensities. We screen from 250 Hertz (a very low pitched sound) to 8000 Hz (a very high pitched sound). Each of these frequencies is presented initially at a very low dB intensity which is gradually increased until it is perceived. Normal hearing is the ability to perceive each of these frequencies at intensity below 40 dB. The inability to detect this intensity level may be a sign of aging at high frequencies or may require a more extensive exam by an audiologist if it presents in certain patterns which are atypical.

Normal

Test Patient Annual Medical & Wellness Exam Program
Medical Recommendations
Assessment & Plan
Annual physical exam
1) Awareness and Action
2) Purposeful and Directional MEDS: Mindfulness, Exercise, Diet, Sleep 3) Annual exams: Physical, ophthalmology, dentist
4) Immunizations
5) No distracted driving (seatbelt)
Primary snoring
1) Recommend strongly to rule out sleep disordered breathing with a home sleep study 2) Could be cause of non-restorative sleep.
3) If normal could consider Oral appliance
Urinary frequency
1) Recommend cutting out aspartame and other artificial sweeteners (can use small amount of stevia) 2) If persists then consider treatment with medication
Muscle cramps
1) hydration (avoidance of alcohol and caffeine)
2) Consider magnesium (reacted) nightly
Epistaxis, recurrent
Post chemical cautery
1) monitor and use a saline type gel
2) re-cauterize if needed.

Knee pain
1) Consider HokaOne shoes with increased cushion (change running shoes every 300 miles) 2) semi-custom orthotics
Elevated high sensitivity C-reactive protein
3/6/2017: 2.2 , Myeloperoxidase 823 (normal <470)
Lp(a) 89
These two being elevated are concerning for elevated risk of CAD as well as elevation of Lp(a). There is family history with PGF CAD in 60s.
1) Would favor more aggressive treatment of Lipids with behavioral modification and potentially medications. 2) Daily MEDS
3) Purified fish oil or Vascepa
4) Consideration of low dose statin (lipitor/crestor) or Red yeast rice 5) Aronia from eclectic institute 450 mg 2 tabs twice daily to help bring down the Lp(a) which can increase risk of cardiac event by 2-6 times.

Test Patient Annual Medical & Wellness Exam Program
Hyperlipidemia
3/2017: Total 217, LDL 1087, LDL 125, HDL 73, TG 95, Lp(a) 89, omega check 5.0 1) With the elevation of Lp(a) and inflammatory markers recommend more aggressive measures to decrease risk 2) Improve daily MEDS
3) Fish oil (Vascepa), and increased healthy fats
4) Consider low dose statins
Vitamin D insufficiency
Level 36
1) recommend 2000 iu daily
Elevated AST
Unknown etiology
1) Consider quitting alcohol and rechecking
2) follow up in 1-2 months
Renal insufficiency, mild
1) Possible related to dehydration
2) Recommend cutting back on alcohol and caffeine (and artificial sweeteners) 3) Increase water intake to 64-100 oz daily
4) Recheck in 1 month
Elevated fasting blood sugar
Story: 105
HgbA1 C : 5.4%
1) Daily MEDS and avoid refined sugars
2) Recheck at next blood draw.

Elevated blood pressure reading
Story: 143/87
1) Need to monitor and if continues to be elevated despite the behavior changes above then would consider treating. 2) Sleep study is important to rule out disordered breathing at night.

Thank you for choosing Hoag to complete your Comprehensive Executive Health Physical & Fitness Assessment for 2017. True wellness can involve many areas in our lives. I know that through the evaluation and recommendations of our team you are now well on your way to achieving optimal health! I hope to see you again next year so we can continue to track your health and see the changes that can occur with the implementation of our recommendations.

Kindest regards in good health,
Physician, MD
Hoag Executive Health Faculty

Test Patient Annual Medical & Wellness Exam Program
Patient Health History
Problem List/Past Medical
Elevated PSA, less than 10 ng/ml. Went from 1 to 4 in 2018 and was biopsied at that time (negative) Colon, diverticulosis
Hemorrhoid prolapse, not bothering at this time
Low back strain 2-3 times over the past 7 years.

History of bronchitis, Usually yearly
Hives of unknown origin, intermittent for 5 years.

Allergies
No Known Drug Allergies
Immunization History
Not up to date unknown when last Td was.

Family History
Mother Age 67 with DJD of the knees, otherwise healthy.

Father Age 69 with prostate CA, DJD, overweight.

Maternal Grandmother Died age 78 hit by a car.

Maternal Grandfather Died age 93, had colon polyps and macular degeneration (as well as her sister).

Paternal Grandmother Age 92, CVA x 2 now wheelchair bound.

Paternal Grandfather Age 93. CAD with stenting in 60's, kyphosis.

Brother 1 age 43 alive and well
Brother 2 Age 40 with MS
Brother 3 Age 38 alive and well
Brother 4 Age 32 alive and well
Social History
Current tobacco use Never smoker.

Light alcohol use (< 2 drinks/day)
Caffeine Use 2-3 coffees and 2-3 sodas (diet coke) daily No Drug Use
Exercise History 25-30 miles a week running, plays hockey (ball and ice). like golf Nutrition Up and down but currently not great
Activities Golf.

Sleep 4-6 hours "light sleeper" does snore.

Marital status Married
Number of Child (age 0-17) Dependents 3
Number of Adult (age 18 or over) Children 2
Seat Belt Use Always uses seat belts.

Test Patient Annual Medical & Wellness Exam Program
Medication History
ZyrTEC (10MG Tablet, Oral daily) Active.

Saw Palmetto Complex (2 tabs Oral daily) Specific dose unknown - Active.

Past Surgical History
Tonsillectomy and adenoids age 14 without complication.

Health Maintenance History
Patient received annual dental check-up
Annual Eye Exam
Flu Vaccine

Test Patient Annual Medical & Wellness Exam Program
Overall Nutrition Assessment
Lifestyle & Diet Summary:

Weekly work week: 80 hours
Travel: 80% of the year national & international
Meal frequency: irregular
Primary cook: restaurant client chooses 2 times per day, 5 days per week Macronutrients: high in Omega-6 and saturated fats, high in refined foods, likely high sodium Hunger/Food awareness: High
Food allergies/intolerances: A lot of sugar causes indigestion Major challenges: Time
Other: Loves to golf and hang with his kids
Nutrition Behavior Goals
In collaboration with our medical team, we have prioritized the following habits as being the most important for improving your health:

1. Fruit and Veggie intake is lower than desired. You are not getting adequate nutrition for your body. Aim to get 3-4 every day. By 6 months, work your way up tp 5-7/ day. Adding in more fruits and veggies into your day to day would be beneficial for you to get proper vitamins and minerals, fiber, hydration and help give you added natural energy. See attached handout.

2. Eating regimen is high in processed foods, bad fats, fried foods, and high sugar. Eating this way long term will have detrimental effects on your health. It is recommended that you work on increasing the amount of fiber you take in on a daily basis. Fiber helps fill you up, helps improve bad cholesterol, helps aid in weight loss, and helps regulate your gastrointestinal tract. Aim to get 20-30 grams per day. If increasing fiber it is recommended that you also increase your water otherwise bloating and discomfort may occur.

See attached handout.

3. Water intake is lower than desired. Aim to get at least 64 ounces of every day, especially if you are working out. A goal is to increase your water to 92 ounces per day. This will help keep you hydrated, help with energy levels, flush out toxins, and help aid in weight loss. See attached handout.

4. Breakfast choices could use some modifications. Aim to get some protein, fiber and healthy fats in the morning. See attached handout for fast and easy breakfast ideas that you can plan ahead.

5. Dining out 60% of the week. This can add a lot of extra unwanted calories, sodium, unhealthy fats, sugar, and even empty calories. See attached guide to make healthier choices when eating out. A goal is to eat well 80% of the week and having 20% of your meals whatever you would like.

Test Patient Annual Medical & Wellness Exam Program
Fruit & Vegetables
Eating more fruits and vegetables is a common prescription because they are low in calories, high in fiber, and nutrient dense. Research shows that eating a diet high in fruits and vegetables significantly reduces risk for chronic health conditions. How much is enough is still undecided, but
preliminary studies suggest 6-7 daily servings reap optimal health benefits24.

Water
Roughly 60% of our body weight is water. Water is necessary for all chemical reactions that happen in our bodies. During dehydration, these reactions happen at a slower rate25.

Sufficient water is especially important as we age since organs shrink. The average human consumes 1L of water from food.

The rest must be supplemented. The USDA has developed
Recommended Daily Intake based on age and gender, but
calculating water needs from BMR or bodyweight can be more accurate25.

Water Needs (ml) = (BMR(kcal)/100)*80(ml) to 110(ml)
Water Needs (ml) = Bodyweight(kg) * 30(ml) to 40(ml)
Alcohol
If within moderation, alcohol can be incorporated into a healthy diet. Serving sizes are listed below. Factors that exaggerate the effects of alcohol include medication, mental health,
dehydration, and age26.

Moderation Population
1-2 drinks / day
0-1 drink / day
0-1 drink / day
MEN
WOMEN
>65 years old
1 serving of alcohol:
12 oz beer = 5 oz wine = 3 oz fortified wine = 1.5 oz 40% liquor 1 0
2 4
6 8
10 Fist-Size Servings
2017
16 0
15 30
45 60
75 90
105
120
135
150
Ounces
2017
2 0
2 4
6 8
10 Daily Serving
2017

Test Patient Fitness Assessment
Overall Fitness Assessment
After analyzing the results of your fitness assessment the following conclusions were made:

1. Functional Movement Screen (FMS) shows that you are at a heightened risk for developing future injury. The areas that need the most improvement are: HIP/HAMSTRING MOBILITY and STABILITY.

2. Posture Screen indicates that due to postural deviations that your head weighs 43.6 lbs instead of

14.4lbs, which can be adding more stress to your neck, shoulders, and low back.

3. Cardiovascular fitness levels are SUPERIOR for your age group of 40-49.

4. Lower body strength is EXCELLENT and upper body strength is GOOD.

Fitness Action Plan
Based on these conclusions and your overall health evaluation, I have created this plan for you.

1. Complete the mobility routine 5-7x/ week to gain flexibility and mobility where it is needed most.

2. Complete the core stability exercises 3-4x/ week to gain strength and stability in your core. 185
-
50 100
150
200
Weight in Pounds
2017

26.46 16.00

20.00 24.00

28.00 32.00

36.00 40.00
BMI
2017
37 25
30 35
40 45
50 Waist Circumference
2017
88%
75%
85%
95%
105%
Waist to Hip Ratio
2017

Test Patient Fitness Assessment
Waist Circumference
A waist circumference of more than 40 in (102cm) in men or 35 in (88cm) in women is considered high and puts you at an increased risk for diseases such as type 2 diabetes, hypertension and coronary heart disease.20
Body Mass Index (BMI)
This is an important estimate of your body composition. While it can at times be misleading, it is a commonly used measure in the medical literature and so is included in your report.

The Ideal BMI lies between 18.5 and 24.9.19
Waist-to-Hip Ratio
People with more weight around their waist are at greater risk of lifestyle related diseases such as heart disease and diabetes than those with weight around their hips. It is a simple and useful measure of fat distribution. A ratio of 0.95 or below is desirable for men and 0.80 or below for women.19

Test Patient Fitness Assessment
Fitness Testing

Total Muscle Mass
The Percentage Body Fat analysis is a measure of the composition of fat in our body in relation to lean muscle. It is normal to lose muscle mass with age, but accelerated loss can be problematic for daily functioning. The method used in your analysis is through bioelectrical impedance testing.

CardiovascularFitness
Cardiorespiratory fitness is one of the best indicators of how well the heart, lungs and muscles are functioning. It is the most important fitness component for promoting good health & reducing the risk of heart disease. Cardiorespiratory fitness is the ability to perform aerobic exercises (walking, jogging, swimming & cycling) at moderate to high levels of intensity for prolonged periods of time.

Aerobic means “using oxygen for energy.” The maximum amount of oxygen used for energy is referred to as VO2max. The VO2max test is considered the best measure of an individual’s cardiorespiratory fitness level. Low fitness levels an increase your risk of dying prematurely, especially from cardiovascular disease.21 Increasing your cardiovascular fitness can improve your VO2max score. A workout program has been designed to meet your individual needs, so you can achieve real results in less time with greater ease.

Posture
Your posture is a great picture of the patterns that have developed in your body throughout your life. Much like the rings on a tree that can tell the story of what a tree has survived, more often than not, your posture tells your story. These patterns can be formed through acute trauma such as a car accident or sports injury; or through a series of repetitive motions like sitting at a computer for long periods of time or playing golf for many years without crosstraining. Examining your posture can help us determine the root cause of any current issue you may be having, while also working to find any issues that may arise later if these patterns continue.

43.60 -

10.00 20.00

30.00 40.00

50.00 60.00

70.00 80.00

90.00 Head Weight in Pounds
2017

52.10 -

10.00 20.00

30.00 40.00

50.00 60.00

70.00 Peak VO2
2017
85 10
30 50
70 90
110
Pounds
2017

Test Patient Fitness Assessment
Functional MovementScreen
The FMS is a full body screening that identifies muscular imbalances, weaknesses, mobility issues, and pain. It is essential to address these issues prior to starting any type of exercise program. Muscular imbalances are the number one cause of injuries. Any imbalances from one side of the body to the other, or a cumulative score of <14, indicates that an individual is at a high risk of injury.23 Areas of improvement are in bold:
- Thoracic/Shoulder Mobility: The thoracic spine is a mobile joint. If it becomes immobile, it usually forces the lumbar spine, which is designed to stabilize, to do more rotation. In return, you may experience LBP.
- Hip/ Hamstring Mobility: Without proper range of motion through the hip, which is designed to be a mobile joint, it forces either the lumbar spine or knee into more rotation, leading to knee or low back pain. It can result from tight hamstrings, hip flexors &/or glutes. - Core Stability: If the core doesn’t have adequate stability, it will lead to poor functional performance as well as an increased potential for injury.

Muscular Endurance
Muscular strength and endurance can lead to improvements in injury prevention, body composition, self-image, lifetime muscle, bone health, and metabolic health. Most important, greater muscular strength and endurance reduce the risk of premature death. Stronger people—particularly men— have a lower death rate due to all causes, including cardiovascular disease and cancer.23 20 0
10 20
30 40
50 Push Ups
2017
12 0
2 4
6 8
10 12
14 2017

Clinical Data

Nutritional Education Materials – Below are just a few samples of the nutritional education materials Hoag Executive Health would share with participants during the nutritional portion of the fitness assessment.

EASY BREAKFAST IDEAS:

1. Pumpkin and Granola Parfait: This one’s perfect to try out as fall sets in. In your favorite small Tupperware container (with a reliable lid!), top plain Greek yogurt with canned pumpkin puree and a handful of granola, then sprinkle with cinnamon.

2. Peanut Butter Banana Smoothie: Smoothies are a perfect on-the-go snack any time of day. Blend 1 frozen banana, 2 tablespoons natural peanut butter, 1 cup soy or almond milk, and a few ice cubes. (Add a scoop of your favorite chocolate or vanilla protein for an extra protein boost.)

3. Zapped Scrambled Eggs with Veggies: Yes, it’s possible to make really good scrambled eggs in the microwave.

And it’s easy! Beat 2 eggs, throw in a microwave-safe container, add 1 handful of your favorite veggies (cherry tomatoes and spinach leaves work well), and a sprinkle of cheese. Zap the mixture for 30 seconds, stir, and cook another 30 seconds, or until eggs are solid.

4. Breakfast Burrito: Breakfast burritos are a great, easy snack to keep on hand. Scramble 2 egg whites, ¼ cup black beans, 2 tablespoons salsa, and 2 tablespoons shredded cheese, and wrap in 1 small whole-wheat tortilla. Make a bunch, wrap in foil, and keep in the freezer for whenever the craving hits. Protein from the eggs and black beans keep you fuller longer.

5. Fruit and Yogurt Parfait: One of the easiest, healthiest, and tastiest snacks (or breakfasts) out there is a classic fruit and Greek yogurt parfait. It can really be made with any toppings you like.

6. Breakfast Quinoa Bites: Here’s a new way to enjoy quinoa — make mini quinoa breakfast quiches! In a medium bowl, combine 2 cups cooked quinoa, 2 eggs, 1 cup your favorite veggies (spinach or zucchini work well), 1 cup shredded cheese, and a sprinkle of salt and pepper. Portion into a lightly-greased mini muffin tin, and bake at 350 degrees for 15-20 minutes. These are easy to bring along and delicious to enjoy warm or cold.

7. Fruit and Yogurt Smoothie: Here’s a simple and delicious smoothie recipe for the morning rush. Blend 1 cup plain Greek yogurt with 1 cup frozen fruit (banana and berries work very well) with ½ cup liquid (milk, juice, coconut water — whatever you like). Freeze overnight and thaw throughout the day to enjoy in the afternoon, or blend up in the morning.

8. Egg Muffins: Finally, a muffin without all the carbs. Plus, these guys are simple to make. Beat 10 eggs, ¼ cup chopped onion, 3 handfuls of spinach, 1 shredded zucchini, ½ a bell pepper (chopped), 4 slices cooked bacon or ham, chopped, and a sprinkle of salt and pepper. Divide egg mixture evenly in a lightly-greased muffin tin, and bake for 20-25 minutes at 350 degrees. Zap it for a few seconds in the microwave before serving.

9. Fruity Breakfast Quinoa: Cooking quinoa in milk (cow, soy, or almond) and adding some sweet spices and fruit makes for a great substitute for classic hot breakfast cereals. Plus, it’s high in protein and essential amino acids like lysine, which is essential for tissue growth and repair. Simply cook quinoa according to package instructions, but substitute milk for water, and add some cinnamon of salt and pepper. Top with fresh berries and chopped nuts.

10. Waffle PBJ-Wich: Try this sweet take on a classic breakfast sandwich the next time eating on the go. Prepare 1 whole-grain toaster waffle and slice in half. Spread with 2 tablespoons nut butter and layer 2-3 sliced strawberries on top in place of the traditional jelly (to cut down on sugar).

11. Zucchini Bread Oatmeal: Take a classic baked loaf and make it into oatmeal with this recipe! Adding shredded zucchini to oatmeal is a great way to fit in an extra serving of veggies. Throw on a handful of toasted walnuts or pecans for some added crunch.

12. Oatmeal Squares: Oatmeal is a great option for a hearty snack or breakfast, but what’s the best way to make it into a more convenient and portable snack? Bake it into squares!

13. Ricotta and Tomato Breakfast Sandwich: Here’s a healthier take on the classic breakfast sandwich: Take 2 slices of a hearty whole-grain bread. Spread each slice with 1 tablespoon ricotta cheese and sprinkle with kosher salt and fresh cracked pepper to taste. Add 1-2 hearty slices of fresh beefsteak tomato (blotted with paper towel to remove excess liquid) and enjoy.

14. Egg and Cheese Cups: Fried eggs are great, but what about baking a whole egg with veggies and cheese and skipping the added oil? Try making a pan of these egg and cheese cups at the beginning of the week and bringing one along each day.

15. Homemade Instant Oatmeal: For anyone with a microwave or hot water at their disposal, these customized instant oatmeal packets are fantastic to have on hand. Instead of purchasing pre-made oatmeal packets, assemble your own in ziplock baggies using whole rolled oats, cinnamon, and mix-ins like raisins and nuts.

16. Overnight Oats: The night before, combine ½ cup milk, 1/3 cup rolled oats, ½ a banana (mashed), ¼ cup chopped nuts, and a sprinkle of cinnamon in sealed Tupperware container. By morning, you’ll have delicious cold overnight oats! These can also be heated in the microwave for 1-2 minutes if in the mood for something warm.

17. Frozen Nutty Banana: Cut 1 firm (but ripe) banana in half and un-peal. Arrange on a small baking sheet or freezer-safe plate, and spread each half with 1 tablespoon almond butter evenly (on the sides not touching the plate). Here’s the fun part: Stick whatever toppings you like on top of the almond butter — our favorites are granola, chia seeds, or flax seeds and cinnamon. Insert a popsicle stick or skewer into the cut end of each half, and freeze until solid (at least 2-3 hours).

18. Egg White Sandwich: Who doesn’t love a classic egg sandwich? Try giving it an extra healthy twist. Microwave 2 egg whites along with 1 handful spinach and a sprinkle of salt for 30-45 seconds. Place in a whole wheat English muffin or sandwich thin with 1 slice of cheddar cheese (optional). Wrap in foil so the cheese melts evenly, and enjoy whenever the craving hits!

THE EATING OUT SURVIVAL GUIDE
PLAN AHEAD. Take a look at the menu online and get a plan for what you want to order.

LEARN TO CHOOSE. If you decided to have an appetizer, choose a healthier option, and choose to opt out of dessert. If you know you want to have a drink with dinner, opt out of the appetizer & dessert.

REMEMBER THAT DRINKS HAVE CALORIES TOO. Of course the best option is no alcohol. But if you must drink, try having a full glass of water in between each alcoholic drink.

MENU ORDERING TIPS:
x Look for the “MAGIC 3”:

1. Vegetables & Fruits

2. Lean Protein

3. High Fiber Slow Digesting Carbs
x Skip anything that has the words “fried”, “cheesy”, "crispy", "glazed", or “secret blend”. “UNDRESS” YOUR FOOD. When choosing items, be aware of calorie- and fat-packed salad dressings, spreads, cheese, sour cream, etc. For example, ask for a grilled chicken sandwich without the mayonnaise SPECIAL ORDER. Many menu items would be healthy if it weren't for the way they were prepared. Ask for your vegetables to be steamed and main dishes to be served without the sauces. Ask for olive oil and vinegar for your salads or order the dressing "on the side" and spoon only a small amount on at a time. If your food is fried or cooked in oil or butter, ask to have it broiled or steamed.

END YOUR MEAL. Stop eating when you are no longer hungry -you should not be FULL! Ask the waiter/waitress to bring you a box or to take your plate away. Try chewing a piece of gum or a mint to keep your mouth busy if others are still eating at your table. Remind yourself that your health is your priority!

BURGER CHAINS
Figuring out healthier options at your favorite fast food burger chain can be tricky. A typical meal at a burger joint consists of a "sandwich", some fries and a drink, which can quickly come in at over 1700 calories for something like Burger King's Triple Whopper with a large fries and a 16 oz. soda. A better option would be a regular single patty burger, small fries, and water, which is about 500 calories. Alternatively you may enjoy a veggie burger smothered in grilled onion and mushrooms. Or if you want a large beef burger, then skip the fries and soda and have a side salad and water instead.

LESS HEALTHY CHOICES

1. Double-patty hamburger with cheese, mayo, special
sauce, and bacon

2. Fried chicken sandwich

3. Fried fish sandwich

4. Salad with toppings such as bacon, cheese, and ranch dressing

HEALTHIER CHOICES

1. Regular, single-patty hamburger without mayo or
cheese

2. Grilled chicken sandwich

3. Veggie burger

4. Garden salad with grilled chicken and low-fat
dressing

5. Breakfast burrito with steak

6. French fries

7. Milkshake

8. Chicken “nuggets” or tenders

9. Adding cheese, extra mayo, and special sauces

5. Egg on a muffin

6. Baked potato or a side salad

7. Yogurt parfait

8. Grilled chicken strips

9. Limiting cheese, mayo, and special sauces

FRIED CHICKEN CHAINS
Although certain chains have been advertising “no trans fats” in their food, the fact is that fried chicken can pack quite a fattening punch.

According to the restaurant’s nutrition info, just a single Extra Crispy Chicken breast at KFC has a whopping 440 calories, 27 grams of fat, and 970 mg of sodium. A healthier choice is the drumstick, which has 160 calories, 10 grams of fat, and 370 mg of sodium. Alternatively, if you like the breast meat, take off the skin and it becomes a healthy choice at 140 calories, 2 grams of fat, and 520 mg of sodium.

LESS HEALTHY CHOICES

1. Fried chicken, original or extra-crispy.

2. Teriyaki wings or popcorn chicken

3. Caesar salad

4. Chicken and biscuit “bowl”

5. Adding extra gravy and sauces

HEALTHIER CHOICES

1. Skinless chicken breast without breading

2. Honey BBQ chicken sandwich

3. Garden salad

4. Mashed potatoes

5. Limiting gravy and sauces

MEXICAN FOOD CHAINS
Fast food chains that specialize in tacos or burritos can be caloric minefields or they can be a good option for finding healthy fast food. Rice, beans, salsa and a few slices of fresh avocado can make a very healthy meal. But adding cheese, sour cream and tortilla chips can turn even a good meal unhealthy. Be sure to also remember portion control since these types of restaurants can have enormous menu items (eat half and take the rest for another meal). Several chains, like Taco Bell and Baja Fresh, have “healthy” menu options that feature less fat and fresher ingredients.

LESS HEALTHY CHOICES

1. Crispy shell chicken taco

2. Refried beans

3. Steak chalupa

4. Crunch wraps or gordita-type burritos

5. Nachos with refried beans

6. Adding sour cream or cheese

HEALTHIER CHOICES

1. Grilled chicken soft taco

2. Black beans

3. Shrimp ensalada

4. Grilled “fresco” style steak burrito

5. Veggie and bean burrito

6. Limiting sour cream or cheese

SUB SANDWICH CHAINS
Americans love all types of sandwiches: hot, cold, wrapped, foot long. The ads promote the health benefits of sandwich shops.

Easier said than done... studies have found that many people tend to eat more calories per meal at a sub shop than at McDonalds. This may be because people feel so virtuous eating “healthy” like the ads promise, that they reward themselves with chips, sodas, or extra condiments. You can make healthier choices at a deli or sub shop but you need to use some common sense.

LESS HEALTHY CHOICES

1. Foot-long sub

2. High-fat meat such as ham, tuna salad, bacon,
meatballs, or steak

HEALTHIER CHOICES

1. Six-inch sub

2. Lean meat (roast beef, chicken breast, lean ham) or
veggies

3. The “normal” amount of higher-fat (cheddar,
American) cheese

4. Adding mayo and special sauces

5. Keeping the sub “as is” with all toppings

6. Choosing white bread or “wraps” which are often
higher in fat than normal bread

3. One or two slices of lower-fat cheese (Swiss or
mozzarella) Or none at all!

4. Adding low-fat dressing or mustard instead of mayo

5. Adding extra veggie toppings

6. Choosing whole-grain bread or taking the top slice off your sub and eating it open-faced

ASIAN FOOD CHAINS
Asian cultures tend to eat very healthy, with an emphasis on veggies, and with meat used as a “condiment” rather than being the focus of the meal. Unfortunately, Americanized versions of these ethnic foods tend to be much higher in fat and calories – so caution is needed. But here’s a great tip for all Asian restaurants – use the chopsticks! You’ll eat more slowly, since you can’t grasp as much food with them at one time as you can with your normal fork and knife.

ITALIAN FOOD
The anti-carbohydrate revolution has given Italian food a bad rap, but Italian is actually one of the easiest types of cuisine to make healthy. Stay away from fried, oily or overly buttery, as well as thick crust menu items, and you can keep your diet goals intact. Watch out for the following terms, which are common culprits of high fat and calories: alfredo, carbonara, saltimbocca, parmigiana, lasagna, manicotti, stuffed (all have heavy amounts of cream and cheese). Generally Italian places have lots of veggies in their kitchen so it’s easy to ask to have extra veggies added to your meal. Be very aware of portion sizes and plan to share or take extra’s home.

LESS HEALTHY CHOICES

1. Thick-crust or butter-crust pizza with extra cheese and meat toppings

2. Garlic bread

3. Antipasto with meat

4. Pasta with cream or butter-based sauce

5. Entrée with side of pasta

6. Fried (“frito”) dishes

HEALTHIER CHOICES

1. Thin-crust pizza with half the cheese and extra veggies

2. Plain rolls or breadsticks

3. Antipasto with vegetables

4. Pasta with tomato sauce and veggies

5. Entrée with side of veggies

6. Grilled (“griglia”) dishes

THAI FOOD
Like most other Asian cuisine, Thai food is based around noodles and/or rice so as with Italian foods, portion size and additions are the best ways to watch your calories with this food choice. General rule of thumb is to stick with meals that are lightly sautéed with lemongrass and/or basil, or made with a broth base over a coconut milk base. Remember your portion sizes here as most servings are enough for 2-3 people.

LESS HEALTHY CHOICES

1. Dumplings or Fried Spring Rolls

2. Pad Thai (Noodle based dish that incorporates eggs,
shrimp, tofu, and
peanuts)

3. Any curry dish

HEALTHIER CHOICES

1. Tom Yum Koong (Shrimp and mushroom simmered in a
hot broth)

2. Sauteed shrimp and beef with basil, onion and chilies

3. Sauteed scallops and shrimp with mushroom, zucchini
and chili paste

4. Sauteed beef, chicken, or pork made with ginger and
black bean sauce

5. Thai fried Rice with vegetables and eggs

6. Deep fried whole fish or chicken with sweet and sour sauce

4. Sauteed beef, chicken, or pork with shrimp paste and green beans

5. Sauteed mixed veggies

6. Steamed mussels with Thai herbs

STEAKHOUSES
Steakhouses are prime places for diet disaster if you aren’t careful. Why? Because many steakhouses boast “healthier” options on the menu: big salads, veggies, baked potatoes, etc. The problem is not in the “healthier” options. The problem is that even healthier options are often cooked in oils and butter and many of these restaurants also come with never ending bread. When choosing here, opt out of the bread basket or ask not to have the first round refilled. When ordering, be careful how quickly your additions add up. Ask for dressings, butters, and sauces on the side. Use your napkin to dab off extra oils from veggies, and steaks.

LESS HEALTHY CHOICES

1. Rib-Eye Steak

2. Porterhouse (Usually come in
LARGE potions)

3. Strip Steak (Again- usually very large portions)

4. Prime Rib

5. Babyback Ribs

6. Loaded baked potato

7. Any “creamed sides” (creamy soups, creamed spinach,
sour cream)

8. Salads with several “Major Players” (several high
calorie items even if they are good for you- i.e.:

Chicken, plus nuts, plus cheese, plus eggs,etc)

HEALTHIER CHOICES

1. Petite filet mignon

2. Grilled tuna steak

3. Lean steak of approx. 6oz

4. Plain baked potato with a little butter on the side. Mix with vinegar to thin out butter

5. Garden salad with grilled chicken and low-fat dressing

6. Add a side salad instead of fries

7. Grilled Chicken with steamed or sautéed veggies and
rice (watch rice portions)

8. Limiting cheese, mayo, butter, and special sauces

To: Honorable Mayor and
Members of the City Council

CITY OF FOUNTAIN VALLEY

CITY COUNCIL

COUNCIL ACTION REQUEST
Agenda Date: January 20, 2026
SUBJECT: Amendment #2 to extend Contract# 21-50 from July 1, 2024 through June 30, 2026, with Airwave Communications, Ent. in the amount of $541,083.35.

Three-Year Strategic Goals
☒ Enhance the culture and environment of “A Nice Place to Live” ☐ Attract and retain revenue producing businesses
☐ Achieve fiscal stability in accordance with the 20-Year Financial Plan ☒ Attract and retain quality staff
☐ Not applicable

EXECUTIVE SUMMARY
The City budgets to replace four (4) Police Patrol vehicles annually to ensure that the fleet continues to meet the City's public safety needs. The FY 2025/26 Fleet Capital Replacement fund provided the replacement of four (4) Police Patrol vehicles in accordance with the fouryear life cycle established by the City. Staff regularly evaluate Police Patrol vehicles in the fleet to determine which vehicles are of the highest priority for replacement. All of the vehicles proposed for replacement in FY 2025/26 meet the City's criteria for replacement of Police Patrol vehicles. The Police Department is currently in possession of these four (4) vehicles. An additional five (5) vehicles were purchased in FY 2024/25. The Police Department is also in possession of these vehicles.

The nine (9) Police Patrol vehicles need to be outfitted with Police equipment. On July 1, 2021, the City entered into a contract agreement with Airwave Communications, Ent., for the outfitting of our Police vehicles. The original contract expired on June 30, 2022. On March 28, 2023, the City extended the contract with Airwave Communications, Ent. This extension (Amendment No. 1) expired on June 30, 2024. The City desires to extend the contract once again through June 30, 2026.
• FY 2025/2026 the cost of the equipment and labor for the next nine (9) vehicle builds shall be an amount not to exceed $238,963.11, prices attached hereto as Attachment "B" and shall remain in effect until June 30, 2026.

Airwave Communications Amendment No. 2
January 20, 2026

• The total cost of this agreement for the entire term shall not exceed $541,083.35. All other terms and conditions of the agreement (RFP 21-015), attached as Attachment "A," shall remain in effect.

DISCUSSION
Police Patrol vehicles have a four-year life cycle, and the City budgets to replace four (4) Police Patrol vehicles annually to ensure that the fleet continues to meet the City's public safety needs. This replacement cycle includes necessary emergency equipment for the vehicles. Staff has determined through decades of experience with the operation and maintenance of these vehicles that a four-year life cycle maximizes cost efficiency while providing a vehicle that is well-suited for the purpose intended. Staff regularly evaluate Police Patrol vehicles in the fleet to determine which vehicles are of the highest priority for replacement. All vehicles proposed for outfitting in FY 2025/26 meet the City's criteria for replacement of Police Patrol vehicles and related equipment.

Replacing the Police Patrol vehicles and associated emergency equipment as scheduled will support the City's strategic goals of enhancing the culture and environment of "A Nice Place to Live" and attracting and retaining quality staff. Outfitting vehicles with modern equipment improves officer safety by ensuring reliable communications, lighting, and vehicle systems during emergency responses. Updated equipment also enhances public safety by reducing equipment failures that can delay response times or limit coordination during critical incidents. Providing officers with the tools they need allows them to continue to effectively and efficiently serve and protect the community.

Staff has been satisfied with the service provided by Airwave Communications, Ent., and is recommending that the City Council approve Amendment No. 2 extending the term of their agreement to June 30, 2026. Staff plan to initiate a request for proposal this year.

FISCAL REVIEW
The current FY 2025-26 adopted budget includes sufficient funding for this agreement. The purchase will be expensed through the Fleet Capital Replacement fund in the Police Department, ISF - Fleet Capital - PD Passenger Cars accounts 112.70.70052.55545 and 112.70.70052.55544.

PUBLIC NOTIFICATION
Not applicable.

ENVIRONMENTAL IMPACT REVIEW
Not applicable.

ATTORNEY REVIEW
This action has been approved by the Attorney for the City.

Airwave Communications Amendment No. 2
January 20, 2026

ALTERNATIVES
Alternative No. 1: Approve Amendment No. 2 to extend Contract# 21-50 with Airwave Communications, Ent., to perform outfitting on nine Police vehicles through June 30, 2026.

Alternative No. 2: Do not approve Amendment No. 2 to extend Contract# 21-50 with Airwave Communications, Ent., to perform outfitting on nine Police vehicles through June 30, 2026.

RECOMMENDATION
Staff is requesting City Council approval of Alternative No. 1: Approve Amendment No. 2 to extend Contract# 21-50 through July 30, 2026, with Airwave Communications Ent., for Police vehicle upfitting.

Prepared by:

Reviewed by:

Attorney Review by:

Fiscal review by:

Approved by:

Bill Hughes, Police Sergeant
Anthony Luce, Acting Chief of Police
Vanessa Lassooy, Attorney for the City
Ryan Smith, Finance Director
Maggie Le, City Manager
Attachments:

A. Amendment No. 2
B. Original Contract 2021-2022 / Amendment No.1/ Airwave RFP Bid Results C. Outfitting Quotes

CITY OF FOUNTAIN VALLEY

CITY COUNCIL

COUNCIL ACTION REQUEST
To: Honorable Mayor and Agenda Date: January 20, 2026
Members of the City Council
SUBJECT: Charter City: Provide Direction to Staff on Language of Proposed Charter; Designate a Newspaper for Publication of Notice; Approve Communications Plan and Outreach Materials; and Authorize City Manager to Engage Survey Consultant and Outreach Consultant
Three-Year Strategic Goals
☒ Enhance the culture and environment of “A Nice Place to Live” ☐ Attract and retain revenue producing businesses
☐ Achieve fiscal stability in accordance with the 20-Year Financial Plan ☐ Attract and retain quality staff
☐ Not applicable

EXECUTIVE SUMMARY
On November 4, 2025, the City Council voted to move forward with placing a simple, Councildrafted charter on the November 2026 ballot. The City Council is now asked to: (1) provide directions to staff on the language of a proposed charter; (2) designate a newspaper for publication of notice; (3) approve a communications plan and outreach materials; and (4) authorize the City Manager to engage a survey consultant and an outreach consultant.

DISCUSSION
California cities operate under one of two forms of government: “general law” or “charter.” 121 of California’s 482 cities are charter cities. A general law city is subject to general laws of the state. A charter city operates pursuant to an adopted municipal charter, authorized by the California Constitution.

Charter Cities vs General Law Cities
The difference between a charter city and a general law city is that a charter city can adopt its own laws and regulations regarding “municipal affairs.” Charter cities are still subject to state laws relating to “matters of statewide concern.” General law cities, on the other hand, are subject to all state laws, even those pertaining to “municipal affairs.”

Charter City
January 20, 2026

Municipal Affairs vs. Matters of Statewide Concern
The California Constitution specifically designates four (4) areas as core “municipal affairs”:
(1) city police force; (2) subgovernment of the city; (3) city elections; and (4) the manner and method of appointment, compensation, removal, qualifications, tenure, etc., for municipal officers and employees. Other areas not specifically listed as core municipal affairs can also constitute municipal affairs, as determined by the Courts on a case-by-case basis. Some examples of areas found to constitute municipal affairs include: how a city spends its tax dollars, municipal contracting, competitive bidding, prevailing wages, and land use and zoning (excluding housing shortages and affordable housing, which have been deemed matters of statewide concern).

Matters of statewide concern, on the other hand, generally include matters with broad geographic impacts that require uniform rules. Examples include the Vehicle Code, environmental laws, the Penal Code, state income taxes, public agency ethics, and open government laws.

Charter Cities and Land Use
Operating as a charter city should not be seen as a way to avoid state housing mandates.

While land use is traditionally a local affair, and historic California Supreme Court precedent has spoken broadly of the ability of charter cities over self-government, more recent appellate court precedent has eroded charter authority, particularly in the area of housing. Further, the state legislature has consistently declared housing to be a “matter of statewide concern.” Further, while the city of Redondo Beach did obtain a recent victory against California’s fourplex mandate (SB 9), the Court’s decision specifically left open the possibility for the legislature to revise SB 9 to tailor it toward matters of statewide concern. Therefore, there should not be an expectation that adopting a charter will allow the city to avoid state housing mandates.

Charter Cities and Other Matters
Adopting a charter will provide the City with other options, however. For example, charter cities have the power to pass legislation, which provides that city contractors are not required to pay prevailing wages. State Building and Construction Trades Council vs. City of Vista.

Notwithstanding that power, the state legislature has determined that “a charter city shall not receive or use State funding or financial assistance for a construction project if the city has a charter provision or ordinance that authorizes a contractor to not comply with the provisions of [the Prevailing Wages] article on any public works contract.” (Labor Code 1782.) “State funding or financial assistance includes direct state funding, state loans and loan guarantees, state tax credits, and any other type of state financial support for a construction project. State funding or financial assistance does not include revenues that charter cities are entitled to receive without conditions under the California Constitution.” (Labor Code 1782.) Fountain Valley receives annual state funding from AQMD in the amount of $75,000 and from CalRecycle in the amount of $30,000. City also receives Gas Tax of $1,667,757 and SB1 funds of $1,534,883; however, it is believed City would continue to receive those Gas Tax and SB1

Charter City
January 20, 2026

funds because those funds are considered “constitutional revenue” and, therefore, do not qualify as “state funding” under LC 1782. Nonetheless, anecdotally, staff at other cities have informed that, due to the potential loss of state funding, they have determined to pay prevailing wages.

The City of Bellflower, for example, has determined to pay prevailing wages on traditional “public works contracts” to avoid the loss of public funding. Thus, for the construction of a city road, bridge, building, etc., prevailing wages would be required. However, Bellflower uses its charter authority to avoid payment of prevailing wages on non-traditional public works projects, such as where the city provides a grant to a private entity to perform community beautification.

In such cases, payment of public funds could convert a private project into a public project, making public support a hinderance, rather than an assistance. However, by using charter authority to avoid payment of prevailing wages in such cases, Bellflower can provide financial assistance to private parties for economic development.

Further, charter authority can be used to avoid state statutes governing public contracting, which tend to be pro-contractor. Charter authority can also be used to convert to alternative elections systems, such as cumulative voting.

Charter Litigation
There has been much coverage of Huntington Beach’s charter litigation against the state.

Huntington Beach has received some adverse decisions and, even when Huntington Beach has prevailed, the state legislature has responded to legislate around court rulings in favor of Huntington Beach.

For example, in July of 2015, Huntington Beach prevailed against a lawsuit brought by the Kennedy Commission, obtaining a ruling that, as a charter city, it was exempt from state provisions requiring it to restore affordable housing units to its housing element. However, in August of 2018, the state Legislature responded by passing Senate Bill 1333, which requires charter cities to comply with all state planning and zoning laws, including the provision involved in the Kennedy Commission case. Huntington Beach brought lawsuits against the state, arguing SB 1333 is invalid, but was unsuccessful
In October 2021, an Orange County Superior Court judge rejected Huntington Beach’s claim that charter cities aren’t subject to the Housing Accountability Act, which limits a city’s ability to deny housing projects that comply with zoning and other standards.

More recently, the state secured a decision requiring Huntington Beach to, among other things, adopt a housing element within 120 days. The city was required to fast track the review and approval of Builder's Remedy projects and projects that would have been entitled to byright approval if the City adopted its draft housing element in 2023; not deny projects that would have been entitled to by-right treatment; and the City's permitting, rezoning, and subdivision authority was suspended for sites identified in its draft housing element.

The order also noted Huntington Beach is out of compliance with the Housing Element Law, triggering penalty provisions of Gov. Code section 65585(l), which provides for escalating

Charter City
January 20, 2026

penalties after one year of non-compliance. Penalties under 65585(l) include fines of between $10,000-$100,000 per month to begin and, thereafter, those same fines multiplied by a factor of three for continued non-compliance and then by a factor of six ($60,000-$600,000 per month) for further non-compliance. In addition to fines, Huntington Beach spent millions of dollars on legal battles.

While Huntington Beach is at the forefront of state vs charter city housing challenges, the majority of California’s 121 charter cities have not taken the same course. In Orange County, for example, Newport Beach, Anaheim, Irvine, and Santa Ana are all charter cities that have not engaged in similar litigation.

Further, while charter cities have received adverse results in the areas of state housing mandates, there have been litigation successes in other areas. For example, and as shown on the attached summary document, charter cities can establish their own procedures for enacting local ordinances and resolutions Brougher v. Bd. of Public Works, 205 Cal. 426 (1928); bidding public projects R & A Vending Services, Inc. v. City of Los Angeles, 172 Cal. App. 3d 1188 (1985); setting penalties for violations of ordinances County of Los Angeles v. City of Los Angeles, 219 Cal. App. 2d 838, 844 (1963)); and, as in Bellflower, avoid prevailing wages on non-traditional public works contracts.

Procedure for Adopting a Charter
The City Council decided to move forward with the Council-drafted charter method. Under this method, the City Council drafts the charter directly. The Council must hold at least two public hearings, at least 30 days apart, on the matter of the proposal of a charter and the content of the charter. (Gov. Code 34458.) The City must then submit the measure to the Registrar of Voters no later than 88 days before the election. The proposed charter is placed on the ballot.

To become a Charter City, a majority of voters must ratify the Charter at an election.

Designation of Newspaper for Notice of Public Hearings
Prior to holding the two public hearings, City must provide notice of those hearings via posting and via publication in a newspaper. Regarding newspaper publication, “[n]otice of the public hearings shall be given … in a newspaper designated by the governing body and circulated throughout the city”[.] (Gov. Code 34458(b).) The Orange County Register is a newspaper circulated throughout the City. Council is asked to determine whether to “designate” the Orange County Register as the newspaper for publication of public hearing notices.

Proposed Charter Language
Council determined to move forward with a “simple” charter. Regarding the powers of a charter city, the California Constitution provides:

It shall be competent in any city charter to provide that the city governed thereunder may make and enforce all ordinances and regulations in respect to municipal affairs, subject only to restrictions and limitations provided in their several charters and in respect to other matters they shall be subject to general laws. City

Charter City
January 20, 2026

charters adopted pursuant to this Constitution shall supersede any existing charter, and with respect to municipal affairs shall supersede all laws inconsistent therewith.

Cal Const. Art XI sec. 5(a)
Tracking that constitutional language, the language proposed at prior presentations for a “simple charter” was as follows:
[T]he [C]ity [of Fountain Valley, governed under this charter,] … may make and enforce all ordinances and regulations in respect to municipal affairs, subject only to restrictions and limitations provided in [this] charter[,] and in respect to other matters [the City of Fountain Valley] shall be subject to general laws.

The City of Fountain Valley hereby avails itself of the full charter power provided by the California Constitution. Any city ordinance or regulation regarding a municipal affair will govern over the general law of the state.

The proposed language for the simple charter allows the City to determine how to specifically exercise its charter authority through the City Council’s passage of ordinances and resolutions.

More recently, questions have been raised about whether additional language should be included in the charter. Care should be taken when adding language as a charter can only be modified in an election. Therefore, if language is added that thereafter proves undesirable, it is very difficult to remove.

Proposed charter language prepared by Council Member Bui is submitted herewith as an attachment.

Bellflower Example
As shown in the Bellflower Charter, which is also attached, the Bellflower City Council’s also utilized a simple charter, with some additional language that proposed above. The Charter is four (4) pages long and consists of eight Articles summarized here:
• Preamble and Municipal Affairs (I–II): Establishes voter intent for local control and declares City responsibilities as municipal affairs, strengthening home‑rule authority. • General Laws and Council Authority (III): Confirms Charter supremacy in conflicts with general law and defines limited areas, such as land use, where general law city standards apply absent ordinance to the contrary.
• Governance and Elections (IV): Defines Council composition, officer appointments, compensation limits, district election change thresholds, and emergency preparedness review.
• Revenue (V): Grants broad revenue tools, enterprise authority, franchise powers, and imposes a 20% reserve policy with emergency modification by four‑fifths vote . • Intergovernmental Immunity (VI): Protects City revenues and guards against unfunded mandates.

Charter City
January 20, 2026

• Public Works (VII): Authorizes comprehensive local procurement rules, best‑value selection, and tailored wage policies with a prevailing‑wage floor for specified public projects.
• Interpretation and Continuity (VIII): Directs broad construction, provides a four‑fifths interpretive mechanism, preserves existing codes, and sets amendment and severability rules.

The structure of Bellflower’s Charter resulted in government efficiencies during 2025:
• Restructuring the procedures for soliciting bids and awarding public works projects (best value rather than lowest responsible bidder).
• Clarifying that prevailing wage must be paid for public works projects but not maintenance services, general services, or economic development opportunities. • Confirming that the Charter eliminated the office of city treasurer and transferred those functions to the finance director.
• Allowing cancellation of elections for uncontested city council seats when a proposition is placed on the ballot notwithstanding Elections Code § 10229.

Additional considerations that may occur in 2026 include (1) changing the voting requirements for adopting ordinances and resolutions (a simple majority rather than three (3) affirmative votes); and (2) whether to change noticing requirements to allow legal noticing in media other than a newspaper of general circulation.

Recent Attempts to Adopt Charter

Charter City
January 20, 2026

Community Surveys
The City conducted two (2) community surveys. The first survey was for the time period September 15 – October 7, 2025. Regarding the question, “Do you support the idea of the City of Fountain Valley becoming a charter city?” Responses were as follows:

Answer Choices Responses
Yes 32.72% 53
No 45.06% 73
Not sure / Need more information 22.22% 36
TOTAL 162
The second survey covered the time period October 1 – October 29, 2025. Regarding the same question, “Do you support the idea of the City of Fountain Valley becoming a charter city?” Responses were as follows:

Answer Choices Responses
Yes 48.24% 41
No 35.29% 30
Not sure / Need more information 16.47% 14
TOTAL 85
Outreach
City of Fountain Valley’s Charter Discussions / Presentations to date

1. At the May 23, 2024, Strategic Planning Session, the possibility of becoming a charter city was presented as a potential six-month objective. At that time, there was no support for adding a charter city as an objective.

2. At the March 27, 2025, Strategic Planning Session, the possibility of adding charter city as a six-month objective was against raised. This time, it was determined that a study of charter cities should be an objective.

3. At the May 6, 2025, Council Meeting, the Attorney for the City presented a Study Session on charter cities. Council asked staff to gather additional information.

4. At the August 19, 2025, Council Meeting, the Attorney for the City presented a further Study Session. Council then decided to hold two Town Hall meetings to obtain public opinion.

5. The first Town Hall was held on September 30, 2025, at Council Chambers.

6. The second Town Hall was held on October 18, 2025 (a Saturday), at the Recreation Center.

7. On November 4, 2025, a presentation was provided during “Administrative Items” regarding whether to place a charter measure on the November 2026 ballot. The

Charter City
January 20, 2026

Council majority determined to move forward with placing a Council-drafted simple charter measure on the ballot.

8. Tonight, January 20, 2026 is a presentation to discuss materials, matters, scheduling, etc. regarding the Charter measure.

City of Bellflower’s Charter Discussions and Outreach
Regarding the City of Bellflower’s outreach, initial actions began in early 2019, when the City Council created a Charter ad hoc subcommittee comprised of two Council Members. That ad hoc subcommittee recommended that the City Council form a nine‑member charter committee that held four meetings between July and September 2019 to review potential charter language and develop recommendations for Council consideration. The committee’s work culminated in October 2019, when the recommended charter language was presented to the City Council at a special meeting. City Charter discussions were postponed in June 2020 and resumed in 2022.

In 2022, the Charter and FM3 citywide survey results were presented at a May 3 special meeting, followed by a May 23 Council request for FM3 to conduct a voter survey specific to a potential charter ballot measure. Results of that focused survey were reported at the July 11 regular meeting. In mid‑July 2022, the Council determined there was insufficient time to meet public hearing and noticing requirements for the November 2022 ballot.

In 2024, the Charter discussion resumed. Two required public hearings were held (April 8 and May 13). At those times, the City Council received updated survey findings – showing increased community support for the Charter – and the Council directed to staff to prepare ballot materials. A unanimous July 8, 2024, Council vote placed the measure on the November 5, 2024 ballot.

Outreach efforts leading up to the election consisted of Council Member and City Manager presentations to various service clubs, including the Chamber of Commerce; informational mailers educating the public regarding the 2024 election that included excerpts from the City Attorney’s Impartial Analysis to ensure objectivity; and a website that included additional information. These combined efforts ultimately resulted in voter approval of the Bellflower City Charter by 77.7 percent on November 5, 2024.

Proposed Future Outreach-Communications Plan and Outreach Materials Staff proposes that the City of Fountain Valley engage in the following outreach activities:
• Mailers: InfoSend citywide or utility billing
• Media: Fountain Valley Living Magazine & OC Register
• Events: 5 city events, senior apartments, nonprofits, parks • Staff reports and presentations on the City website
• Languages: Spanish & Vietnamese interpreters available

Charter City
January 20, 2026

Timeline for Placing Charter Measure on the Ballot
• January 20, 2026 –Administrative Item seeking for Council direction on:
o Charter language
o Designating newspaper for notice
o Communications plan and outreach materials
• January 21, 2026 – Send communications plan and outreach materials to FPPC for review
• March 17, 2026 – Post notice of first public hearing
• March 23 – March 6, 2026 Public newspaper notice of first public hearing • April 7, 2026 –First public hearing
• April 25, 2026 – Post notice of second public hearing • May 2 – May 15, 2026 – Public notice of second public hearing • May 16, 2026 [Saturday] - Second public hearing
• June 16, 2026 – Adopt resolutions calling election and adopting resolution placing charter measure on the ballot (Second Meeting in June)
Costs
To Date
• Attorney for the City $11,114
• Translation $2,011
• Staff Time $1,860
$14,985
Future
• Mailers (InfoSend or Utility Bills) $16,431
• Magazines and Publications $19,688
• Outreach and Staff (5 Events) $21,669
• Election – Ballot Administration $8,500 - $17,000
$66,288-$74,788
Additional costs will also be incurred for outside legal and financial consulting. Additional costs may also be incurred if Council desires to engage a consultant to perform an additional survey and/or engagement of a community outreach consultant.

Cost of Operating as a General Law City versus Charter City Excluding the costs of analyzing and bringing forward the ballot measure and outreach, the main additional cost of becoming a charter city would be incurred if the City determined, on a case-by-case basis, to initiate charter litigation.

Charter City
January 20, 2026

Aside from litigation costs, in discussions with various cities, and Drew Corbett of DKG consultant, staff has been informed that there is negligible change to general operating costs between charter cities and general law cities.

FISCAL REVIEW
Costs will depend on the type of charter selected (simple, simple+, or complex) as well as the amount of consulting assistance desired. As shown above, costs incurred to date plus future costs for a simple charter, excluding additional consulting services, are estimated at $81,273- $89,773.

The current adopted budget does not include sufficient funding for these expenditures. Budgets amendments to the FY 2025-26 and FY 2026-27 Adopted Biennial Budget are required. The Budget Amendment would result in increased expenditure appropriations in the FY 2025-26 budget in the City Attorney Professional Services account within the General Fund.

Additionally, a further Budget Amendment in increased expenditure appropriations in the FY 2026-27 budget in the Elections Professional Services account within the General Fund. The exact amount of the additional appropriations will be determined at a later date and included with the FY 2025-26 Mid-Year Budget update and the FY 2026-27 Budget update.

PUBLIC NOTIFICATION
This item has been noticed in compliance with the Ralph M. Brown Act. Additionally, the City has provided notice via the following methods:
 Social media post (Facebook, Instagram, Nextdoor)
 City webpage
 City website ‘Newsflash’ post
 City November newsletter (digital)
 Mass email to various distribution list
 Air on channel 3
 Flyer distribution to the following locations/groups:
 City Hall
 Fountain Valley Library
 Senior Center Building
 Senior Living Communities
 Senior Living Buildings
 Senior Groups and Clubs
 Rec Center Buildings
 Churches
 Youth Sports Leagues
 Schools/PTA’s that we have contacts for
 Non-Profit Community Groups

ENVIRONMENTAL IMPACT REVIEW
This item will not have a reasonably foreseeable effect on the environment.

Charter City
January 20, 2026

ATTORNEY REVIEW
The Attorney for the City prepared this item.

ALTERNATIVES
Alternative No. 1:

Alternative No. 2:
(1) Provide Direction to Staff on Language of Proposed Charter; (2) Designate a Newspaper for Publication of Notice; (3) Approve Communications Plan and Outreach Materials; and (4) Authorize City Manager to Engage Survey Consultant and Outreach
Consultant.

Do not take the above actions and, instead, direct staff to take no further action or return with additional information / revised materials.

Prepared by: Colin Burns, Attorney for the City
Fiscal review by: Ryan Smith, Finance Director-City Treasurer Approved by: Maggie Le, City Manager
Attachments:

1. Outreach Meeting Notice

2. Outreach FAQ

3. Outreach Slide Deck

4. Bellflower Charter

5. Council Member Bui’s Sample Charter

Charter City
Frequently Asked Questions
A proposed City Charter has been placed on the November ____, 2026 ballot as Measure ____.

What is a Charter City?
Cities in California operate under one of two forms of government: “general law” or “charter.” A charter city operates pursuant to an adopted municipal charter while a general law city operates pursuant to state law.

The difference between a charter city and a general law city is that a charter city can adopt its own laws and regulations regarding “municipal affairs.” Charter cities are still subject to state laws regarding “matters of statewide concern.” General law cities, on the other hand, are subject to all laws of the state, even those pertaining to “municipal affairs.”
What are Municipal Affairs?
Municipal affairs include the city’s police force, elections, how a city spends its tax dollars, municipal contracting, competitive bidding, prevailing wages, and some land use and zoning matters.

What are Matters of Statewide Concern?
Matters of statewide concern generally include matters with broad geographic impacts that require uniform rules.

Examples include the Vehicle Code, public utility rights of way, environmental laws, the Penal Code, state income taxes, public agency ethics and open government laws.

What are the Advantages of Becoming a Charter City?
A charter would allow decisions over local concerns to be made locally. For example, charters provide greater flexibility to tailor public contracting and prevailing wage rules in the manner that works best for Fountain Valley.

Will a Charter Allow the City to Avoid State Housing Mandates? Probably not. The courts have consistently ruled that housing and affordable housing are matters of statewide concern and that charter cities, like general law cities, must follow state housing mandates. However, several charter cities recently prevailed in a lawsuit that determined that SB 9 (four-plex law) did not apply to charter cities.

How Can I Obtain More Information
Additional information on charter cities, including numerous reports and presentations, can be found on the City’s website: https://www.fountainvalley.gov/1627/Charter-City Page 506 The choice of whether to become a charter city is made by the voters. The election is on November _____, 2026. Stay informed, vote, and make your voice heard!

Measure ___
The Fountain Valley
Charter City Proposal

What is a Charter City?
• A document that defines a city's powers, functions, and procedures • Comparable to the U.S. Constitution at the municipal level • Derived from California Constitution Article XI, Section 5(a) • Gives cities authority over "municipal affairs"
• Charter law supersedes state law on municipal affairs

Two Types of California Cities
General Law Cities
Bound by all state general laws; Limited to powers granted by state constitution and statutes; Subject to all California regulations
Charter Cities
Adopt local charter; plenary authority over municipal affairs; Charter law trumps conflicting state law

California Charter Cities Today
• 121 of 482 California cities are charter cities (~25%) • Local examples: Irvine, Newport Beach, Huntington Beach, Buena Park, Cypress, Irvine, Newport Beach, Placentia, Santa Ana, and Seal Beach

Core Municipal Affairs
Charter cities have exclusive authority over four core areas:
• City police force and organization
• Sub-government of the city (structure, departments)
• City elections and voting methods
• Compensation and qualifications of city officials

Additional Municipal Affairs
• How the city spends its tax dollars and fiscal control • Municipal contracts and vendor selection
• Land use and zoning decisions (with exceptions)
• Public works contracts and bidding procedures
• Prevailing wage requirements (with limits)

Matters of Statewide Concern
Charter cities cannot override state law on these issues:
• School systems and education
• Traffic regulation and vehicle licensing
• Ralph M. Brown Act (open meetings)
• Meyers-Milias-Brown Act (labor)
• California Environmental Quality Act (CEQA)
• Eminent domain procedures

Key Litigation: Planning and Housing
City of Redondo Beach, et al., v. Rob Bonta (2024):
• Five charter cities successfully challenged SB 9 (4-plex law) • Ruling: Charter cities exempt from SB 9's application • General law cities still must comply with SB 9
• Demonstrates charter power over land use decisions

Huntington Beach: Housing Battles
2015-2019 Timeline
• 2015: HB prevails: exempt as charter city from affordable housing requirements • 2018: Legislature responds with SB 1333 requiring charter cities comply with housing laws • 2019: Governor sues HB; HB files three lawsuits against state; state prevails

Huntington Beach: Recent Outcomes
• Voter ID Case: HB lost; electoral integrity is statewide concern • Library Materials: HB lost; book access not a municipal affair • September 2025: Court of Appeal ruled against HB on housing • HB must adopt Housing Element within 120 days
• Charter city authority over housing significantly limited

Prevailing Wages and State Funding
Labor Code Section 1782:
• Charter cities cannot restrict prevailing wages if receiving state funding • State funding includes grants, loans, tax credits, assistance • Excludes constitutional revenue (gas tax, SB1, etc.)
• Impacts city infrastructure and development projects

Benefits of Charter Status
• Greater Local Control: Determine municipal affairs independently • Vendor Selection: Choose best-qualified vendors rather than lowest bidder • Fiscal Flexibility: Control how tax dollars are spent • Land Use Authority: Set zoning and planning policies locally

Challenges and Concerns
• Charter Inflexibility: Requires voter approval to amend • Legislative Changes: Legislature can restrict charter powers • Litigation Risk: Courts decide what qualifies as municipal affairs • Complexity: Charter must be carefully drafted to preserve authority

Charter Language

Interpretation & Amendments
• Charter broadly construed to facilitate municipal powers • Council implements via ordinances or resolutions
• Continuity with existing laws maintained
• Amendments require voter approval

Fountain Valley - Public Engagement & Decision
• May 6, 2025: Council Meeting – City Attorney presented Study Session on charter cities; Council requested additional information
• August 19, 2025: Council Meeting – City Attorney presented further Study Session; Council decided to hold two public Town Halls

Fountain Valley - Public Engagement & Decision
• September 30, 2025: First Town Hall – Held at Council Chambers to gather public input • October 18, 2025: Second Town Hall – Held at Recreation Center (Saturday) to reach broader audience
• November 4, 2025: Council Meeting – Presented decision on placing charter measure on ballot; Council majority voted to move forward with Council-drafted charter measure for November 2026 ballot
• January 20, 2026: Presentation on charter measure materials, scheduling, and next steps

Where to Get Additional Information

Election Information

City of Fountain Valley Charter – Proposed Foundational Articles (FINAL BALLOT VERSION)
ARTICLE I — INCORPORATION AND CONTINUITY
Section 100. Name and Incorporation
The municipal corporation now existing and known as the City of Fountain Valley shall continue its corporate existence under this Charter and the same name.

Section 101. Succession and Rights
The City shall continue to own, control, and administer all property, rights, and obligations vested in it at the effective date of this Charter, subject to all valid contracts and legally enforceable liabilities.

Section 102. Continuity of Laws and Officers
All ordinances, resolutions, rules, regulations, and appointments in effect at the time this Charter takes effect, not inconsistent herewith, shall remain in force until altered or repealed pursuant to the authority herein granted.

ARTICLE II — POWERS OF THE CITY
Section 200. General Powers
The City of Fountain Valley shall have all powers granted to charter cities under Article XI, Section 5 of the California Constitution with respect to municipal affairs.

Nothing in this Charter shall be construed to exempt the City from compliance with State or Federal law in matters of statewide or national concern.

ARTICLE III — FORM OF GOVERNMENT
Section 300. Council–Manager Government
(a) The City shall operate under the Council–Manager form of government. (b) All powers of the City shall be vested in the City Council, which shall establish policy. (c) The City Manager shall administer the affairs of the City consistent with policy and law.

ARTICLE IV — CITY COUNCIL AND ELECTIONS
Section 400. Composition and Terms
(a) The City Council shall consist of five (5) members elected at large from residency districts, with candidates residing in individually designated districts established by ordinance. All qualified voters of the city may vote for candidates for each Council seat. (b) Each Councilmember shall serve a four-year term and may not serve more than three consecutive full terms. After a lapse of at least two (2) years, the individual may again seek election. (c) Terms served prior to Charter adoption shall not count toward term limits.

Section 401. Council Operations and Leadership
(a) The mayor shall preside at meetings of the City Council and represent the City in ceremonial functions.
(b) The Vice Mayor shall act in the absence of the mayor and shall be selected annually by the Council.
(c) The Council shall adopt rules consistent with the Ralph M. Brown Act.

Commented [CB1]: Forever unless an
election?
Commented [CB2]: We do not elect from
districts.

Commented [CB3]: This would be a switch
to “by district” voting.

Section 402. Mayoral Selection
(a) The mayor shall not be separately elected.
(b) The mayor shall be selected by majority vote of the City Council annually. (c) The Mayor’s term shall be one (1) year.

Section 403. Initiative, Referendum, and Recall
The people of Fountain Valley reserve the powers of initiative, referendum, and recall as provided by the California Constitution and general law.

ARTICLE V — OPEN GOVERNMENT AND VOTER RIGHTS
Section 500. Transparency and Public Access
All City actions shall comply with the Ralph M. Brown Act, the Public Records Act, and the Political Reform Act.

Nothing in this Charter diminishes the rights of the people to participate in City governance.

ARTICLE VI — CHARTER AMENDMENT AND REVIEW
Section 600. Amendments
This Charter may be amended only by majority vote of the electors voting thereon, or by initiative, in accordance with the California Constitution.

Section 601. Periodic Review
The City Council shall provide for periodic review of this Charter at intervals not exceeding five (5) years.

ARTICLE VII — INTERPRETATION AND SEVERABILITY
Section 700. Interpretation
In matters not expressly addressed by this Charter, the Constitution and general laws of the State of California shall apply.

Section 701. Severability
If any provision of this Charter is held invalid, such invalidity shall not affect the remaining provisions.

Commented [CB4]: No ability to pass laws
and ordinances per Charter Power - except
reference to XI sec 5 may be enough.

Charter City

CHARTER CITIES IN CALIFORNIA
Presented by Karl H. Berger
Local Control and Home Rule Authority
Constitutional Framework and Practical Considerations

What is a Charter City?
• A document that defines a city's powers, functions, and procedures • Comparable to the U.S. Constitution at the municipal level • Derived from California Constitution Article XI, Section 5(a) • Gives cities authority over "municipal affairs"
• Charter law supersedes state law on municipal affairs

Two Types of California Cities
General Law Cities
Bound by all state general laws; Limited to powers granted by state constitution and statutes; Subject to all California regulations
Charter Cities
Adopt local charter; plenary authority over municipal affairs; Charter law trumps conflicting state law

California Charter Cities Today
• 121 of 482 California cities are charter cities (~25%) • Examples: Los Angeles, Long Beach, San Francisco, Oakland, Berkeley • Local examples: Downey, Cerritos, Whittier, Signal Hill, Los Alamitos, Anaheim, Irvine, Newport Beach, Huntington Beach, Buena Park, Cypress, Irvine, Newport Beach, Placentia, Santa Ana, and Seal Beach
• Bellflower became charter city in 2024 (Measure B: 77.7% approval)

Core Municipal Affairs
Charter cities have exclusive authority over four core areas:
• City police force and organization
• Sub-government of the city (structure, departments)
• City elections and voting methods
• Compensation and qualifications of city officials

Additional Municipal Affairs
• How the city spends its tax dollars and fiscal control • Municipal contracts and vendor selection
• Land use and zoning decisions (with exceptions)
• Public works contracts and bidding procedures
• Prevailing wage requirements (with limits)

Matters of Statewide Concern
Charter cities cannot override state law on these issues:
• School systems and education
• Traffic regulation and vehicle licensing
• Ralph M. Brown Act (open meetings)
• Meyers-Milias-Brown Act (labor)
• California Environmental Quality Act (CEQA)
• Eminent domain procedures

Key Litigation: Planning and Housing
City of Redondo Beach, et al., v. Rob Bonta (2024):
• Five charter cities successfully challenged SB 9 (4-plex law) • Ruling: Charter cities exempt from SB 9's application • General law cities still must comply with SB 9
• Demonstrates charter power over land use decisions

Huntington Beach: Housing Battles
2015-2019 Timeline
• 2015: HB prevails: exempt as charter city from affordable housing requirements • 2018: Legislature responds with SB 1333 requiring charter cities comply with housing laws • 2019: Governor sues HB; HB files three lawsuits against state; state prevails

Huntington Beach: Recent Outcomes
• Voter ID Case: HB lost; electoral integrity is statewide concern • Library Materials: HB lost; book access not a municipal affair • September 2025: Court of Appeal ruled against HB on housing • HB must adopt Housing Element within 120 days
• Charter city authority over housing significantly limited

Prevailing Wages and State Funding
Labor Code Section 1782:
• Charter cities cannot restrict prevailing wages if receiving state funding • State funding includes grants, loans, tax credits, assistance • Excludes constitutional revenue (gas tax, SB1, etc.)
• Impacts city infrastructure and development projects

Benefits of Charter Status
• Greater Local Control: Determine municipal affairs independently • Vendor Selection: Choose best-qualified vendors rather than lowest bidder • Fiscal Flexibility: Control how tax dollars are spent • Land Use Authority: Set zoning and planning policies locally

Challenges and Concerns
• Charter Inflexibility: Requires voter approval to amend • Legislative Changes: Legislature can restrict charter powers • Litigation Risk: Courts decide what qualifies as municipal affairs • Complexity: Charter must be carefully drafted to preserve authority

Charter Election Results (2008-2024)
Success Rate: ~56% (12 of 23 measures passed)
• Passed: Palmdale (82%), Lancaster (71%), Oceanside (54%) • Passed: Bellflower 2024 (77.7%)
• Failed: Hawthorne 2022 (39.8%), Saint Helena 2024 (43.8%) • Success depends on public education and voter support

Two Methods to Adopt a Charter
Charter Commission
Formal, time-intensive: Voter election of 15 commissioners; Several months of meetings; Brown Act compliance required
City Council Drafted
Faster, streamlined: Council drafts charter directly; Fewer formal steps; Quicker approval timeline

Typical Charter Language
Simple Charter Approach:
"The City may make and enforce all ordinances and regulations in respect to municipal affairs, subject only to restrictions in this charter. On other matters, the City shall be subject to general laws. City ordinances regarding municipal affairs govern over conflicting state law."

Charter Adoption Timeline (City Council Method)
• Phase 1: Council discussion and draft preparation (3-4 months) • Phase 2: Two public hearings, 30+ days apart (2-3 months) • Phase 3: Public outreach and voter education (6-8 months) • Phase 4: Submit to Registrar 88 days before election
• Phase 5: Election vote and Secretary of State filing

Costs of Charter Adoption
• Election Costs: $8,500-$17,000 (ballot measure administration) • Legal: City Attorney preparation and analysis
• Outreach Materials: Mailers, advertising, town halls (~$21,500+) • Staff Time: City Manager, Clerk, Management Analyst involvement

Public Outreach and Education
• Community events (5+ venues)
• Senior apartments and non-profit presentations
• Park location community meetings
• Utility billing inserts (efficient, low-cost)
• Social media and digital communications
• FAQ documents and clear explanations

Critical Discussion Points
• Housing Mandates: Charter authority limited by state housing laws • State Funding Impact: Prevailing wage restrictions lose state dollars • Bidding Authority: Vendor selection flexibility vs. competition • Council Compensation: Charter determines salary structure

Bellflower - Development (2018–2019)
• February 2019: Council forms Charter Ad Hoc Subcommittee • Members: 2 Council Members + 7 residents
• July–September 2019: Four subcommittee meetings
• October 2019: Recommendations presented to Council

Bellflower - Voter Engagement (2022)
• May 2022: Council considers ballot measure
• July 2022: FM3 survey shows voter support (67%)
• Timing constraints prevent 2022 ballot placement
• Council decides to proceed with 2024 timeline

• April 8, 2024: First required public hearing
• May 13, 2024: Second required public hearing
• May 2024: Updated survey shows 73% support
• Community outreach by City Manager and City Council Members • Postcards, surveys, and other informational materials Bellflower - Public Hearings (2024)

November 5, 2024: Election Day

77.7% Approval
Bellflower Charter Successfully Adopted

Bellflower - Preamble
Emphasizes the sovereignty of the people of Bellflower and their right to govern. Establishes that authority is delegated to local officials to act in the public interest.

Article I: Municipal Affairs
The City of Bellflower has the authority to make and enforce laws concerning its municipal affairs, as outlined in the Charter and the California Constitution.

Article II: General Laws & Council Authority
• Power to adopt and enforce legislation
• Charter provisions take precedence over conflicting state laws • Anti-discrimination requirement
• Protect economic opportunities and housing

Article III: Governance & Elections
• City Council: 5 elected members
• Restrictions on holding multiple city offices
• Compensation determined by California law
• Council appoints key city officers
• District boundaries subject to census review

Article IV: Revenue
• Authority to establish revenue regulations
• Management of public financing and franchises
• Fiscal responsibility with reserve requirements
• Flexibility for fiscal emergencies

Article V: Intergovernmental Immunity
City revenues cannot be taken by other governmental entities. State and federal mandates must provide compensation to the City.

Article VI: Public Works Projects
• City Council regulates public works contracts
• Emphasis on competitive bidding and best value
• Authority to set wage criteria
• Project labor agreements with prevailing wages

Article VII: Interpretation & Amendments
• Charter broadly construed to facilitate municipal powers • Council implements via ordinances or resolutions
• Continuity with existing laws maintained
• Amendments require voter approval

Fountain Valley - Initial Discussion & Study
• May 23, 2024: Strategic Planning Session – Charter possibility presented as potential six-month objective; no support
• March 27, 2025: Strategic Planning Session – Charter study approved as six-month objective; City Attorney directed to present to Council
• May 6, 2025: Council Meeting – City Attorney presented Study Session on charter cities; Council requested additional information
• August 19, 2025: Council Meeting – City Attorney presented further Study Session; Council decided to hold two public Town Halls

Fountain Valley - Public Engagement & Decision
• September 30, 2025: First Town Hall – Held at Council Chambers to gather public input • October 18, 2025: Second Town Hall – Held at Recreation Center (Saturday) to reach broader audience
• November 4, 2025: Council Meeting – Presented decision on placing charter measure on ballot; Council majority voted to move forward with Council-drafted charter measure for November 2026 ballot
• January 20, 2026: Presentation tonight to discuss charter measure materials, scheduling, and next steps

Key Legal Requirements
• 21-day posting period before public hearings
• Publication in newspaper for two successive weeks (GC §6066) • At least 30 days between first and second public hearings • 21-day wait period after second hearing before council vote • FPPC approval of outreach materials and communication plan

Item Amount
Attorney to the City $11,114.70
Translation Services $2,011.69
Staff Time (Clerk, Manager, Analyst) $1,860.12
Total Expended $14,985.51
Costs to Date

2026 Outreach Strategy
• Mailers: InfoSend citywide or utility billing
• Media: Fountain Valley Living Magazine & OC Register
• Events: 5 city events, senior apartments, nonprofits, parks • Languages: Spanish & Vietnamese interpreters available

Category Amount
Mailers (InfoSend or Utility Bill) $16,431
Magazine & Publications $19,688
Outreach & Staff (5 events) $21,569
Subtotal Hard & Soft Costs $57,688
Projected 2026 Costs

Next Steps: January – February
Jan 20 Admin Item to discuss charter, communications plan, and outreach materials
Jan 21 Send Outreach Materials and Communication Plan to FPPC for Approval
Mar 17 Notice of First Public Hearing by Posting (21 calendar days prior)
Mar 23–Apr 6 Notice of First Public Hearing by Publication (14 days, per GC §6066)

Next Steps: March – April
Apr 7 First Public Hearing on charter proposal and content Apr 25 Notice of Second Public Hearing by Posting (21 calendar days prior) May 2–15 Notice of Second Public Hearing by Publication (14 days, per GC §6066)

Next Steps: May – June
May 16 Second Public Hearing on charter proposal (30+ days after first hearing) Jun 11 Brown Act Agenda: Notice Resolutions Calling Election and adopting Resolution placing charter measure on November 2026 ballot (21-day wait after second hearing) Jun 16 Resolutions Calling Election and adopting resolution placing charter measure on ballot (Second June meeting)

Charter Cities: A Path to Local Control
Balanced against state regulatory requirements and litigation risks Success requires informed voters, careful drafting, and realistic expectations

Operational Costs
General Law vs. Charter City

Direction / Action

1. Language of the Proposed Charter

2. Designate OC Register for Publication of
Notices

3. Approve Communications Plan and
Outreach Materials

4. Authorize City Manager to Engage Survey
Consultant and Outreach Consultant

Language of the
Proposed Charter
Simple Charter
[T]he [C]ity [of Fountain Valley, governed under this charter,] … may make and enforce all ordinances and regulations in respect to municipal affairs, subject only to restrictions and limitations provided in [this] charter[,] and in respect to other matters [the City of Fountain Valley] shall be subject to general laws.

The City of Fountain Valley hereby avails itself of the full charter power provided by the California Constitution. Any city ordinance or regulation regarding a municipal affair will govern over the general law of the state.

Language of the
Proposed Charter
Simple+ Charter (Bellflower Example
See also Council Member Bui Example)
• Charter Authority
• Governance and Elections
• Revenue
• Intergovernmental Immunity
• Public Works

Language of the
Proposed Charter
Complex Charter
• Lengthy Charter
• Covers Many Areas of Governance Structure
• Risky Because Once Approved, Revisions Require Voter
Approval

Designate Newspaper for
Notice Publication
• “Notice of the public hearings shall be given by publication … in a newspaper designated by the governing body and
circulated throughout the city”[.] (Gov. Code 34458(b).) • The Orange County Register is a newspaper circulated
throughout the City.
• Staff Recommends Council “designate” the Orange County Register as the newspaper for publication of public hearing notices.

Communications Plan
Proposed Future Outreach-Communications Plan and
Outreach Materials
• Mailers: InfoSend citywide or utility billing
• Media: Fountain Valley Living Magazine & OC Register
• Events: 5 city events, senior apartments, nonprofits, parks • Languages: Spanish & Vietnamese interpreters available

Outreach Materials

Outreach Materials

CITY COUNCIL APPOINTMENTS 2026
Committee/Board Del. Alt. Contact Phone Address E-mail
Advisory Committee for
Persons with Disabilities
Kim Constantine Jim Cunneen Jenni Worsham Ext. 447 Fountain Valley Community Services
[email protected]
Public Cable Television
Authority (PCTA)
Patrick Harper /
Ted Bui
Jim Cunneen Danny Hitt 951-961-0633
Santa Ana River Flood
Protection Agency
Jim Cunneen Kim
Constantine
James Wahner
Chairman
(714) 834-5142 P.O. Box 4048
Santa Ana, CA 92702-4048
League of California
Cities/City Selection
Ted Bui Jim Cunneen Connor Medina (949) 421-9898 P.O. Box 28927 Anaheim Hills, CA 92809-
0164
[email protected]
Legislative Committee Jim Cunneen /
Kim Constantine
Glenn
Grandis
Maggie Le Ext 412 Fountain Valley City Hall [email protected] OC Sanitation District
(OCSD)
Ted Bui Glenn
Grandis
Kelly Lore
Clerk of the Board
(714) 593-7433 P.O. Box 8127
10844 Ellis Avenue
Fountain Valley, CA 92708
[email protected]
OC Library Advisory Board Jim Cunneen Kim
Constantine
Alejandra “Alex”
Martinez
(Exec. Secretary)
(714) 566-3011 1501 E. St. Andrew Place
Santa Ana, CA 92705
[email protected]
OCTA I-405 Policy Working
Group (PWG)
(Closed) (Closed) Christina Byrne (714) 560-5334 550 S. Main Street Orange, CA 92863
[email protected]
F.V. Community
Foundation
Kim Constantine Ted Bui Rob Frizzelle
Community
Services Manager
(714) 593-4449 Community Services [email protected] Vector Control Kim Constantine
(two Year Term
–Expires 1/1/28)
Jim Cunneen Tawnia Pett
Clerk of the Board
(714) 971-2421
Ext. 112
13001 Garden Grove Blvd.

Garden Grove, CA 92843
[email protected]
SCAG So. Cal. Association
of Government/OCCOG
Patrick Harper Jim Cunneen Maggie Aguilar
Clerk of the Board
Deputy Clerk Cecilia
Pulido
(213) 630-1420 600 So. Main St., Suite 906
Orange, CA 92868
[email protected]
[email protected]
California Joint Powers
Authority
Jim Cunneen Kim
Constantine
Rick Miller, City
Clerk
(562) 467-8700 8081 Moody Street
La Palma, CA 90623
[email protected]
Measure HH Ad-Hoc
Committee
Kim Constantine
/ Jim Cunneen
Glenn
Grandis
Ryan Smith,
Finance Director
Orange County Power
Authority
Glenn Grandis Ted Bui Joe Mosca (949) 263-2612 15642 San Canyon Ave Irvine, CA 92619